Background: Abnormal uterine bleeding (AUB) affects one-third of reproductive age women globally. Point-of-care ultrasound (POCUS) can assist in diagnosing some causes of AUB. Objectives: To evaluate the diagnostic accuracy and clinical utility of POCUS for assessing AUB in non-pregnant women. Search strategy: MEDLINE, Embase, Emcare, Cochrane Library, CINAHL, WHO Global Index Medicus, and Web of Science were searched from January 2000 to July 11, 2025. Preprint servers, trial registries and AI-assisted tools were also searched. Selection criteria: Studies using portable, handheld or AI-guided POCUS for transabdominal ultrasound versus conventional ultrasound or other diagnostic procedures were included. Data collection and analysis: Findings were narratively synthesised following Synthesis Without Meta-analysis guidelines. Main results: Seven studies were eligible (three peer-reviewed articles, one pre-print, and three abstracts). One study (n=70, some concerns of bias) found POCUS had high sensitivity and specificity for identifying intrauterine device position versus transvaginal ultrasound. Another (n=162, some concerns of bias) reported high accuracy (>80%) for measuring uterine longitudinal diameter, measuring uterine volume >160cm 3 and detecting fibroids ≥20 mm; but poor sensitivity for small fibroids (23%) and polyps (9%). A third study (n=40 , low risk-of-bias) showed POCUS detected endometrial pathology and fibroids with high accuracy compared to transabdominal ultrasound. Another (n=50, low risk-of-bias) found POCUS comparable to transvaginal ultrasound for triage but missed 4% of ovarian cysts. Conclusions: Evidence on the diagnostic accuracy and clinical utility of POCUS for assessing AUB in non-pregnant women is limited. POCUS may aid in evaluating some causes like large fibroids, but further research is needed, particularly on its performance when used by less-experienced operators.

Background: The role of uterine gauze packing in treating refractory postpartum haemorrhage (PPH) is uncertain given limited evidence of benefit and possible harms. Objectives: To evaluate the safety and effectiveness of uterine packing using plain gauze or impregnated with haemostatic agent for treating refractory PPH. Search strategy: We searched MEDLINE, Embase, Emcare, Web of Science, CINAHL and CENTRAL through 18 March 2025. Selection Criteria: We included randomised controlled trials (RCTs) and non-randomised controlled studies of intervention (NRSIs) evaluating uterine packing using plain gauze or impregnated with haemostatic agent, compared with usual care or other interventions, for women with refractory PPH. Data collection and analysis: We included one RCT (204 women) and seven NRSIs (959 women). We reported the relative risks (RR) for the RCTs and conducted random-effects meta-analyses for NRSIs. Main results: We identified three comparisons: gauze with or without haemostatic agent versus balloon tamponade; gauze impregnated with haemostatic agent versus balloon tamponade; and plain gauze versus uterine artery ligation/embolisation. From the RCT, uterine packing with plain gauze may not reduce the need for additional surgical intervention (RR 1.29, 95% CI 0.50 - 3.32) or blood transfusion (RR 0.97, 95% CI 0.67 to 1.41; low certainty evidence). Moderate-certainty evidence indicates that for women with refractory PPH, uterine packing with plain gauze probably increases postpartum anaemia (<11g/dl) (RR 1.27, 95% CI 1.07 to 1.51) and maternal fever >38 oC (RR 2.40, 95%CI 1.21 to 4.76), compared to uterine balloon tamponade. From NRSIs, evidence is very uncertain about the effects of uterine packing with or without haemostatic agent on all outcomes ( very low certainty evidence). Conclusion: There are no clear benefits of uterine packing with or without haemostatic agent for treating refractory PPH, and the risk of postpartum anaemia and maternal fever is probably increased compared to standard care. Prospective well-controlled trials are needed to evaluate the effects of uterine packing and its role in treating PPH.

Background: Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are menstrual disorders that are often overlooked clinically and academically, despite their significant morbidity. Objective: To summarise the available evidence on prevalence, burden, treatment, and barriers to accessing treatment for PMS and PMDD in low-and middle-income countries (LMICs). Search Strategy: A systematic search of nine databases (Medline, Embase, Emcare, CINAHL, PsycInfo, Global Index Medicus, Web of Science, Global Health and Scopus) was conducted (January 2000-June 2024), along with grey literature searches (May 2023-June 2024). Women’s health organizations (412) were searched for clinical guidelines. Selection Criteria Studies from LMICs addressing prevalence, burden, and treatment barriers were included. Clinical guidelines and treatment studies were eligible irrespective of income level. All primary research studies were included. Data Collection and Analysis This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Two reviewers independently screened titles/abstracts/full texts and performed data extraction. Main Results: Overall, 23,435 records were identified, with 504 included. Prevalence rates ranged from 5.5% to 98.2% for PMS and 0.5% to 65.7% for PMDD. Included studies used twelve different diagnostic tools for PMS. Treatment studies were primarily conducted in high-income countries (HICs) with all three clinical guidelines being from HICs.Conclusion: Despite their prevalence, there is a lack of standardized diagnostic criteria for PMS and guidance on management for both conditions. Further studies are needed to address burden of PMS and PMDD and to identify effective treatment in LMICs. Funding This study did not receive any funding.