International Journal of Gynecology & Obstetrics最新文献

{"title":"Clinical performance of sFlt-1/PlGF ratio triage in suspected pre-eclampsia: A prospective, observational multicenter diagnostic-triage study in South Africa (TsHEPPO study).","authors":"Ismail Bhorat, Priya Soma-Pillay, Lawrence Chauke, Mushi Matjila, Tshidi Sebitloane, Nitalia Naidoo, Manu Vatish","doi":"10.1002/ijgo.71428","DOIUrl":"https://doi.org/10.1002/ijgo.71428","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic and short-term predictive performance of the soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF ratio) in South African women with suspected pre-eclampsia (PE), comparing thresholds of ≥ 33 and ≥ 38 in a predominantly African population.</p><p><strong>Methods: </strong>This was a prospective, observational diagnostic-triage multicenter study across four tertiary hospitals in South Africa. A total of 555 women with suspected PE with complete outcome data were enrolled from four study sites. The sFlt-1/PlGF ratio (Elecsys, Roche Diagnostics) was measured at presentation and comprehensive clinical and delivery outcome data were collected. Diagnostic and short-term predictive performance for sFlt-1/PlGF thresholds (≥ 33 and ≥ 38) were assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristics (ROC) and associated area under the curve (AUC).</p><p><strong>Results: </strong>PE was diagnosed in 349/555 women (62.9%). The sFlt-1/PlGF ratio showed moderate discrimination for PE (area under the receiver operating characteristic curve [AUROC] 0.78, 95% confidence interval [CI]: 0.7-0.8) overall. Continuous-data ROC analysis in 418 women from Durban, Johannesburg and Pretoria yielded an AUROC of 0.8465 (95% CI: 0.8090-0.8841). In the all-site analysis, sensitivity, specificity, PPV, NPV and accuracy were 67.05%, 89.32%, 91.41%, 61.54% and 75.32% at ≥ 33, and 62.46%, 90.29%, 91.60%, 58.68% and 72.79% at ≥ 38, respectively. In short-term prediction, both thresholds showed high sensitivity (86.5%) for PE within 7 days while specificity/PPV were 77.3%/81.8% at ≥ 33 and 81.8%/84.9% at ≥ 38, with NPVs of 82.9% and 83.7%, respectively. By 28 days, NPVs declined to 62% and 64%.</p><p><strong>Conclusion: </strong>The sFlt-1/PlGF ratio is a clinically useful biomarker primarily as a rule-in triage tool for suspected PE in South Africa. The ratio showed high specificity and PPV in this predominantly African cohort. The exploratory ≥ 33 threshold increased sensitivity relative to ≥ 38, with a small reduction in specificity in the all-site estimates. The findings support its evaluation as an adjunct to clinical assessment in women with suspected PE. Both thresholds showed limited rule-out performance beyond short follow-up supporting the need for reassessment and repeat testing where clinically indicated. These findings support consideration of region-adapted thresholds and highlight the value of biomarker-guided triage in African settings.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149286801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An immune-inflammatory and thyroid function machine learning model for predicting adverse pregnancy outcomes: Development in a retrospective cohort and external validation in a prospective cohort.","authors":"Yumao Huang, Haihui Chen, Xiaolei Xie, Yu Jin, Jin Huang","doi":"10.1002/ijgo.71412","DOIUrl":"https://doi.org/10.1002/ijgo.71412","url":null,"abstract":"<p><strong>Objective: </strong>Maternal thyroid dysfunction is associated with adverse pregnancy outcomes, yet thyroid status alone stratifies individual risk poorly and the immune-inflammatory contribution is rarely incorporated into prospectively validated prediction tools. We aimed to develop and externally validate a model predicting a composite adverse pregnancy outcome from antenatal thyroid and cytokine markers.</p><p><strong>Methods: </strong>The model was developed in a retrospective cohort (n = 650; 131 events, 20.2%) and externally validated in an independent prospective cohort (n = 150; 26 events, 17.3%). Fifteen antenatal candidate predictors common to both cohorts were considered. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection; LASSO-logistic regression, random forest, extreme gradient boosting, and a support-vector machine were compared by repeated stratified cross-validation. Discrimination was quantified using the area under the receiver operating characteristic curve (AUC); calibration and clinical utility were also assessed, with internal-external cross-validation (IECV) as a sensitivity analysis.</p><p><strong>Results: </strong>LASSO retained three predictors: thyroid peroxidase antibody (TPOAb), interleukin-6 (IL-6), and interleukin-10 (IL-10). LASSO-logistic regression was selected (development cross-validated AUC 0.762, 95% confidence interval [CI] 0.692-0.846). On external validation, the model achieved an AUC of 0.750 (95% CI 0.647-0.848), exceeding a thyroid group-only reference model (AUC 0.625); the Brier score was 0.127, and the calibration slope was 1.77. Random 10-fold IECV gave a pooled AUC of 0.761 (95% CI 0.720-0.800). Higher IL-6 was associated with increased risk and higher IL-10 with decreased risk.</p><p><strong>Conclusion: </strong>A parsimonious three-marker model combining TPOAb, IL-6, and IL-10 showed moderate discrimination for adverse pregnancy outcomes and outperformed thyroid status alone. Calibration requires refinement, and validation in larger multicenter cohorts is warranted before clinical implementation.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-trimester sum-estimated fetal weight and gestational diabetes risk in twin pregnancies.","authors":"Naphtali Justman, Dana M Carny, Ron Beloosesky, Ido Solt, Nizar Khatib, Yuval Ginsberg, Yaniv Zipori","doi":"10.1002/ijgo.71440","DOIUrl":"https://doi.org/10.1002/ijgo.71440","url":null,"abstract":"<p><strong>Objective: </strong>Gestational diabetes mellitus (GDM) is more prevalent in twin pregnancies, yet screening strategies remain largely based on singleton data. In the present study, we aimed to evaluate whether the mid-trimester sum of estimated fetal weights (sum-EFW) at the anatomy scan is associated with subsequent GDM in twin pregnancies.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of twin pregnancies undergoing routine mid-trimester ultrasound (2010-2025) at a tertiary center. Sum-EFW was calculated as the combined estimated fetal weight of both fetuses. The primary outcome was GDM. Receiver operating characteristic (ROC) analysis assessed discriminative performance and multivariable logistic regression identified independent predictors.</p><p><strong>Results: </strong>Among 728 women, 70 (9.6%) developed GDM. Sum-EFW was higher in GDM pregnancies (1177 ± 187.9 vs. 1103 ± 178.8 g; P = 0.001). ROC analysis demonstrated modest discriminative ability (area under the curve [AUC] 0.62; 95% confidence interval [CI]: 0.55-0.69; P = 0.001). After adjustment for gestational age, discrimination was similar (AUC 0.586; 95% CI: 0.518-0.655; P = 0.013), with sensitivity 67.1%, specificity 47.6%, positive predictive value (PPV) 12.1%, and negative predictive value (NPV) 93.1% at the optimal threshold. A cutoff of 1130 g identified a higher-risk subgroup (14.3% vs. 6.3%; P = 0.001). In multivariable analysis, maternal age ≥ 30 years (adjusted odds ratio [aOR] 2.45; 95% CI: 1.10-5.45), body mass index (BMI) ≥30 (aOR 5.48; 95% CI: 2.33-12.85), and sum-EFW ≥1130 g (aOR 3.21; 95% CI: 1.41-7.34) were independently associated with GDM.</p><p><strong>Conclusion: </strong>In twin pregnancies, a higher mid-trimester sum-EFW is independently associated with subsequent GDM. These findings suggest that combined fetal growth may reflect early metabolic alterations in twin gestations. Discrimination remains modest, limiting use as a screening or risk-stratification tool.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric violence and associated factors among postpartum women in Turkey: A cross-sectional study.","authors":"Meserret Aslan, Hüsniye Dinç Kaya, Sevil Günaydın, Tülay Yılmaz","doi":"10.1002/ijgo.71432","DOIUrl":"https://doi.org/10.1002/ijgo.71432","url":null,"abstract":"<p><strong>Objective: </strong>The present study aimed to determine the level of reported obstetric violence among women who had given birth in Turkey and to identify the factors associated with reported obstetric violence.</p><p><strong>Methods: </strong>A cross-sectional, descriptive study was carried out between October 1 and December 30, 2024. The sample comprised 286 women aged 18 years or older, within their first postpartum year, who had given birth in Turkey. Data were collected using a Personal Information Form and the Obstetric Violence Scale (OVS) and were analyzed with SPSS.</p><p><strong>Results: </strong>In unadjusted analyses, higher OVS scores were associated with unplanned pregnancy, cesarean birth, postpartum complications, inadequate information, lack of consent, and several intervention-intensive childbirth practices (P < 0.05). In multivariable negative binomial regression, postpartum complications (aIRR = 1.42, 95% CI = 1.01-2.00), lack of information during labor (aIRR = 2.40, 95% CI = 1.43-4.03), prolonged fasting (aIRR = 1.60, 95% CI = 1.09-2.35), prolonged bed rest (aIRR = 3.07, 95% CI = 1.87-5.04), continuous non-stress test (NST) (aIRR = 1.56, 95% CI = 1.07-2.29), vacuum extraction (aIRR = 2.83, 95% CI = 1.18-6.80), and fundal pressure (aIRR = 2.29, 95% CI = 1.34-3.94) remained independently associated with higher total OVS scores.</p><p><strong>Conclusion: </strong>Reported obstetric violence was independently associated with several care-related factors, particularly lack of information during labor and selected intervention-intensive practices. These findings underscore the importance of respectful maternity care, effective communication, and careful evaluation of obstetric interventions.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal head station and head circumference at second-stage onset and likelihood of vaginal delivery in nulliparous women.","authors":"Itamar Gilboa, Keren-Or Wertheimer, Daniel Gabbai, Einat Tako, Anat Lavie, Yariv Yogev, Emmanuel Attali","doi":"10.1002/ijgo.71409","DOIUrl":"https://doi.org/10.1002/ijgo.71409","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to evaluate the combined association of fetal head station (FHS) at second-stage onset and fetal head circumference (HC) with the likelihood of spontaneous vaginal delivery (SVD) in nulliparous women.</p><p><strong>Methods: </strong>This retrospective cohort study included nulliparous women with singleton, vertex-presenting, term pregnancies (≥37 weeks) who reached the second stage of labor between 2013 and 2023 at a tertiary medical center. FHS was categorized as above, at, or below the ischial spines. HC, measured by ultrasound within 14 days before delivery, was dichotomized as <350 mm or ≥350 mm. Participants were classified into six FHS-HC groups. The primary outcome was SVD. Associations were assessed using multivariable logistic regression.</p><p><strong>Results: </strong>Among 4230 women, SVD rates ranged from 57.7% for FHS above the ischial spines with HC ≥350 mm to 88.7% for FHS below the ischial spines with HC ≥350 mm. Compared with the reference group (FHS below the ischial spines and HC <350 mm), the adjusted odds of SVD decreased with higher station: adjusted odds ratio (aOR) 0.73 (95% confidence interval [CI] 0.60-0.88) for station at the ischial spines and 0.59 (95% CI 0.44-0.80) for station above the ischial spines. Among women with HC ≥350 mm, those with FHS above the ischial spines had the lowest likelihood of SVD (aOR 0.35; 95% CI 0.14-0.82). Higher FHS and larger HC were associated with longer second-stage duration (P < 0.001).</p><p><strong>Conclusion: </strong>FHS at second-stage onset was more strongly associated with SVD than was HC. Combined FHS-HC assessment may help identify women at increased likelihood of operative delivery and support closer monitoring of labor progress.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Birth satisfaction and resilience in the association between prenatal anxiety and postpartum depressive symptoms: A mediational analysis.","authors":"Yanchi Wang, Wei Huang, Xujuan Xu, Jian Gu","doi":"10.1002/ijgo.71426","DOIUrl":"https://doi.org/10.1002/ijgo.71426","url":null,"abstract":"<p><strong>Objective: </strong>Postpartum depression (PPD) is a common mental health disorder among women after childbirth. This study aimed to examine whether birth satisfaction and resilience statistically mediated the association between prenatal anxiety and PPD.</p><p><strong>Methods: </strong>From February to August 2023, pregnant women in the third trimester were recruited using convenience sampling from three tertiary hospitals in Nantong, China. Prenatal anxiety was assessed using the anxiety subscale of the Depression Anxiety Stress Scale-21 (DASS-21), and resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) during pregnancy. Birth satisfaction and postpartum depressive symptoms were assessed using the Birth Satisfaction Scale-Revised Indicator (BSS-RI) and Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks postpartum. Parallel mediation analysis was performed using PROCESS macro with 5000 bootstrap samples, adjusting for maternal age and physical discomfort.</p><p><strong>Results: </strong>A total of 635 participants completed two rounds of questionnaire surveys. Birth satisfaction and resilience showed significant indirect associations between prenatal anxiety and PPD. The indirect association through birth satisfaction was 0.047 (95% confidence interval [CI]: 0.025-0.073), accounting for 17.34% of the total statistical association. Furthermore, the indirect association through resilience was 0.082 (95% CI: 0.054-0.116), accounting for 30.26% of the total statistical association.</p><p><strong>Conclusion: </strong>Prenatal anxiety was associated with postpartum depressive symptoms, with significant indirect associations through birth satisfaction and resilience. These findings highlight the potential relevance of psychological resources and childbirth experience in postpartum mental health and support further longitudinal and intervention research.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149266843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of pre-pregnancy underweight on the risk of perineal and anal sphincter injury in nulliparous women.","authors":"Daniel Gabbai, Omri Dominsky, Emmanuel Attali, Itamar Gilboa, Ronen Gold, Asnat Groutz, Yariv Yogev, Yoav Baruch","doi":"10.1002/ijgo.71399","DOIUrl":"https://doi.org/10.1002/ijgo.71399","url":null,"abstract":"<p><strong>Introduction: </strong>Perineal injury is a common complication of vaginal delivery with maternal consequences. Although the effects of obesity are established, the impact of underweight on perineal and obstetric anal sphincter injury (OASI), remains unclear.</p><p><strong>Objective: </strong>Our objective was to determine the association between pre-pregnancy underweight and the risk of non-severe perineal injury (NSPI) and OASI in nulliparous women.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a single, tertiary medical center including nulliparous women aged 18-45 years with singleton term vaginal deliveries (≥37 weeks) and pre-pregnancy body mass index (BMI) <25 kg/m² between 2012 and 2024. Women with diabetes were excluded. The cohort was divided into underweight (BMI <18.5 kg/m²) and normal BMI groups. The primary outcome was NSPI, and the secondary outcome was OASI. Multivariable logistic regression was performed to assess independent associations.</p><p><strong>Results: </strong>Overall, 32 112 women were included, 12.9% of whom were underweight. Underweight women had lower birthweights and lower rates of induction and occiput-posterior presentation (all P < 0.05). NSPI occurred slightly less frequently among underweight women than among women with normal BMI (81.5% vs 84.3%, P < 0.001), whereas OASI was more common (1.1% vs 0.8%, P = 0.033). In the fully adjusted model, underweight BMI was associated with slightly lower odds of NSPI (adjusted odds ratio [aOR] 0.905; 95% confidence interval [CI] 0.825-0.994) and higher odds of OASI (aOR 1.641; 95% CI 1.179-2.286). Additional factors associated with OASI in the fully adjusted model included higher birthweight per 100 g increment (aOR 1.132; 95% CI 1.096-1.169), occiput-posterior presentation (aOR 2.815; 95% CI 1.806-4.386), prolonged second stage (aOR 1.590; 95% CI 1.158-2.182), and vacuum-assisted delivery (aOR 2.304; 95% CI 1.666-3.187).</p><p><strong>Conclusion: </strong>Pre-pregnancy underweight was associated with slightly lower odds of NSPI but higher odds of OASI.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary incontinence burden and phenotype transitions after colpocleisis in older women with advanced pelvic organ prolapse.","authors":"Qi Wang, Xiaoxiang Jiang, Chaoqin Lin","doi":"10.1002/ijgo.71410","DOIUrl":"https://doi.org/10.1002/ijgo.71410","url":null,"abstract":"<p><strong>Objective: </strong>This study characterizes urinary incontinence (UI) burden and symptom-based UI phenotype transitions 1 year after colpocleisis in older women with advanced pelvic organ prolapse.</p><p><strong>Methods: </strong>This single-center retrospective cohort included women aged 60 years or older undergoing colpocleisis for advanced or recurrent pelvic organ prolapse between August 2019 and May 2025. Paired analyses included women with 1-year urinary follow-up. UI burden was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and symptom-based phenotypes were classified as stress UI (SUI), urgency UI (UUI), or mixed UI (MUI).</p><p><strong>Results: </strong>Of 505 women, 495 completed 1-year follow-up; 258 had preoperative UI. Any UI decreased from 52.1% to 39.8% (paired absolute risk difference -12.3 percentage points, 95% confidence interval [CI] -17.8 to -6.7; P < 0.001). The median ICIQ-SF total score declined from 4.0 (interquartile range [IQR] 0.0-7.0) to 0.0 (IQR 0.0-5.0), with a Hodges-Lehmann paired estimate of -0.5 (95% CI -1.5 to 0.0; P < 0.001). UUI and MUI decreased, whereas SUI increased modestly. Among 237 women without preoperative UI, 65 (27.4%) developed de novo UI, of which 55.4% was slight and none was very severe. Baseline UUI most often transitioned to no UI, whereas baseline MUI showed the broadest postoperative distribution.</p><p><strong>Conclusion: </strong>Colpocleisis was associated with reduced UI burden and distinct symptom-based phenotype transitions at 1 year. Descriptive transition patterns might inform preoperative counseling but should not be interpreted as an individual prediction tool.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recombinant activated factor VIIa for severe postpartum hemorrhage in Africa: Evidence, appropriate use, and research priorities-A narrative review.","authors":"Johnny Mahlangu, Haroun Rhemtula, Jarrod Zamparini, Lawrence Chauke","doi":"10.1002/ijgo.71429","DOIUrl":"https://doi.org/10.1002/ijgo.71429","url":null,"abstract":"<p><p>Postpartum hemorrhage (PPH) accounts for 30%-50% of maternal mortality in Africa and occurs in the context of pre-existing anemia, limited blood product availability, delayed recognition, and constrained referral systems. Although bundle-based care (E-MOTIVE), early tranexamic acid (TXA), and uterotonics have substantially improved outcomes, a small proportion of women develop refractory hemorrhage despite optimal conventional management. This narrative review evaluates the role of recombinant activated factor VIIa (rFVIIa) in severe PPH within the African context. We conducted a structured search of PubMed/MEDLINE, Embase, Scopus, and Google Scholar, which was supplemented by manual review of international guidelines. We critically evaluated and synthesized data from clinical studies, systematic reviews, registries, consensus statements, and relevant African literature. The principal evidence derives from a French-Swiss randomized controlled trial demonstrating a 40% relative reduction in invasive procedures, supported by observational studies and expert consensus. In 2022, the European Medicines Agency approved rFVIIa for severe PPH after uterotonic failure, followed by South African approval in 2023. The indication remains unapproved by the U.S. Food and Drug Administration and is off-label in most other African countries. Efficacy depends on timely administration after definitive obstetric source control and correction of coagulopathy and physiological derangements. Current evidence supports rFVIIa as a protocolized rescue adjunct rather than routine therapy. In Africa, its use should be restricted to carefully selected women with refractory PPH managed in tertiary centers with multidisciplinary expertise. African registries, pragmatic implementation studies, and health-economic evaluations are needed to define its optimal role within resource-constrained healthcare systems.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal death and mode of delivery among term singleton breech births: A retrospective cohort study at a tertiary hospital in Ghana.","authors":"Sebastian Ken-Amoah, Joycelyn Ashong, Betty Anane-Fenin, Abena Konadu Yawson, Evans Kofi Agbeno, Godfred O Boateng","doi":"10.1002/ijgo.71423","DOIUrl":"https://doi.org/10.1002/ijgo.71423","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the burden of perinatal death and identify factors associated with perinatal death and with cesarean delivery among term singleton breech births at Cape Coast Teaching Hospital, Ghana.</p><p><strong>Methods: </strong>This retrospective cohort study included term singleton breech births with documented fetal cardiac activity at admission from 2015 to 2021; antepartum stillbirths were excluded. Multivariable logistic regression examined factors associated with perinatal death. Mixed-effects logistic regression, with a random intercept for delivery year, examined factors associated with cesarean delivery. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) are reported.</p><p><strong>Results: </strong>Among 695 eligible births, 542 (78.0%) were by cesarean delivery. There were 41 perinatal deaths (5.9%; 59.0 per 1000 births), comprising 25 intrapartum stillbirths and 16 early neonatal deaths. Perinatal death occurred in 32 of 153 vaginal breech births (20.9%) and in nine of 542 cesarean deliveries (1.7%). These figures describe outcomes according to actual rather than intended mode of delivery and should not be interpreted causally or as a comparison of planned delivery strategies. Higher parity was associated with increased odds of perinatal death (aOR = 1.32, 95% CI = 1.04-1.68). Older maternal age was associated with higher odds of cesarean delivery (aOR = 1.04, 95% CI = 1.005-1.09), whereas higher parity was associated with lower odds of cesarean delivery (aOR = 0.72, 95% CI = 0.63-0.83).</p><p><strong>Conclusion: </strong>The burden of perinatal death was substantial among term singleton breech births at this Ghanaian tertiary hospital. Most deaths were intrapartum stillbirths. Strengthening antenatal detection, timely referral, intrapartum care, operative readiness, neonatal care, and proficiency in emergency vaginal breech birth may improve outcomes.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}