European Journal of Obstetrics and Gynecology and Reproductive Biology: X最新文献

{"title":"Pentaerithrityl tetranitrate (PETN) for prevention of fetal growth restriction in pregnancy: A systematic review and meta-analysis","authors":"","doi":"10.1016/j.eurox.2024.100350","DOIUrl":"10.1016/j.eurox.2024.100350","url":null,"abstract":"<div><h3>Background</h3><div>Fetal Growth Restriction (FGR), often due to placental insufficiency, poses significant risks to perinatal outcomes. This review evaluates the efficacy of pentaerythritol tetranitrate (PETN), a nitric oxide donor, in preventing FGR.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was conducted by searching PubMed, Embase, and CENTRAL up to July 2024. The inclusion criteria focused on randomized controlled trials comparing PETN to placebo in FGR prevention. Key outcomes were incidences of FGR, perinatal mortality, neonatal mortality, and intrauterine fetal demise (IUFD). Other outcomes were classified as maternal, fetal, neonatal and safety outcomes. We used Cochrane RoB 2.0 tool to assess risk of bias, and GRADE criteria for evidence quality.</div></div><div><h3>Results</h3><div>Two eligible studies encompassing 417 pregnant women at risk of FGR were included. PETN did not significantly reduce incidence of FGR (RR 0.83, 95 % CI 0.66–1.04, 2 trials, 417 participants, low certainty) or perinatal mortality (RR 0.64, 95 % CI 0.26–1.58, 2 trials, 417 participants, very low certainty) compared to placebo. None of the studies reported neonatal mortality or IUFD. However, PETN treatment was associated with a reduction in preterm birth (RR 0.74, 95 % CI 0.58–0.93, 2 trials, 417 participants, moderate certainty). Other outcomes were similar between the groups.</div></div><div><h3>Conclusion</h3><div>While PETN does not significantly impact FGR rates or perinatal mortality, it is associated with a reduction in preterm birth, suggesting potential benefits in high-risk pregnancies. Larger trials are necessary to substantiate these findings and clarify the role of PETN in FGR prevention.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent pain after laparoscopic surgery for ovarian endometrioma: Clinical features and long-term follow up","authors":"","doi":"10.1016/j.eurox.2024.100349","DOIUrl":"10.1016/j.eurox.2024.100349","url":null,"abstract":"<div><h3>Purpose</h3><div>We aimed to examine the clinical characteristics of patients with ovarian endometriosis (OMA) who were diagnosed with recurrent pain after laparoscopic surgery in an 8- to 12- year postoperative follow-up.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data of 45 OMA patients with recurrent pain, including a minimum 8 years of post-laparoscopic follow-up reports. All laparoscopic cystectomy procedures were performed by the same surgeon at Peking Union Medical College Hospital between January 2009 and April 2013. Clinical data were retrieved to analyze patients' preoperative characteristics, relevant surgical findings, and postoperative outcomes at follow-up.</div></div><div><h3>Results</h3><div>A total of 45 patients with OMA were included, with a mean age of 31.8 ± 4.92 years. The mean recurrence period was 45.78 ± 24.89 months. Before surgery, 60 % (27/45) of patients had severe dysmenorrhea. During surgery, 93.3 % (42/45) of patients were in stage III/IV, 51.1 % (23/45) had coexisting adenomyosis, and 66.7 % (30/45) had deep infiltrating endometriosis (DIE). For the whole study group, mean follow-up time was 121.96 ± 15.55 months. All patients underwent postoperative medical treatment. The mean recurrence period was 45.78 ± 24.89 months. Cyst recurrence was presented in 24.4 % (11/45) of patients, while 75.6 % (34/45) only complained of pain recurrence. At the end of follow-up, spontaneous pregnancy was seen in 24.4 % (11/45) of patients and 6.7 % (3/45) received in vitro fertilization and embryo transfer (IVF-ET).</div></div><div><h3>Conclusions</h3><div>Patients with symptomatic recurrence after surgery had more severe dysmenorrhea, larger proportion of coexisting adenomyosis and DIE, and a higher revised American Fertility Society (rAFS) stage. Recurrence of endometrial cysts was not related to pain recurrence. Long-term postoperative pharmacological therapy is recommended to reduce recurrence.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association and diagnostic value between Maternal Serum Placental Markers and Placenta Previa","authors":"","doi":"10.1016/j.eurox.2024.100346","DOIUrl":"10.1016/j.eurox.2024.100346","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to evaluate the correlation and diagnostic value of maternal serum placental markers: pregnancy-associated plasma protein-A (PAPP-A), free beta human chorionic gonadotropin (free β-hCG), and alpha fetoprotein (AFP) in relation to placenta previa.</div></div><div><h3>Methods</h3><div>A retrospective case-control study was conducted to gather data on 137 pregnant women who were hospitalized for delivery at Hangzhou Women’s Hospital. These women participated in the late stage of early and mid-term maternal serum prenatal screening between January 2018 and December 2020. Of the 137 women, 45 were diagnosed with placenta previa, while 92 were selected at random as the control group, in a ratio of 1: 2. Independent samples t-test or Mann-Whitney U test were utilized to compare the quantitative data of the two groups, and the Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic value of maternal serum placental marker levels for placenta previa.</div></div><div><h3>Results</h3><div>The levels of first trimester and second trimester free beta subunit of human chorionic gonadotropin (FT-Free β-hCG; ST-Free β-hCG) in the placenta previa group were higher than those in the normal group [1.38 (0.55–6.03) MoM vs.1.08 (0.32–4.00) MoM, 1.38 (0.39–4.10) MoM vs.1.01 (0.29–4.12) MoM], and the differences between the groups were statistically significant (<em>Z</em> = 2.830, <em>Z</em> = 2.846, both <em>P</em> &lt; 0.05). The AFP level was higher than the normal group [1.13 (0.65–2.15) MoM vs. 0.94 (0.51–2.02) MoM], and the difference was statistically significant (<em>Z</em> = 2.551, <em>P</em> &lt; 0.05). There was no significant difference in PAPP-A between the placenta previa group and the normal group (<em>Z</em> = 1.396, <em>P</em> &gt; 0.05). The ROC curve analysis results showed that the AUCs of FT-Free β-hCG and ST-Free β-hCG for placenta previa were 0.649 (95 % CI: 0.551–0.747, <em>P</em> = 0.005), 0.634 (95 % CI: 0.539–0.730, <em>P</em> = 0.011), and 0.650 (95 % CI: 0.554–0.746, P = 0.004). Using PPV, NPV, FPR, FNR, +LR, and -LR as evaluation indicators for the 5 models, the results showed that FT-Free β-hCG was the best performer in terms of PPV, FPR, and +LR, with values of 0.725, 0.600, and 2.632, respectively. The three-indicator combined detection model (AFP + ST-Free β-hCG + FT-Free β-hCG) had the best performance in terms of NPV and -LR, with values of 0.770 and 0.298, respectively.</div></div><div><h3>Conclusion</h3><div>The elevated maternal serum levels of Free β-hCG and AFP may be associated with placenta previa. The combined detection of maternal serum markers in the early and mid-trimesters has better diagnostic value for predicting placenta previa than individual detection.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical cerclage vs cervical pessary in women with cervical insufficiency: A multicentric, open-label, randomised, controlled pilot trial [the CEPEIC trial]","authors":"","doi":"10.1016/j.eurox.2024.100347","DOIUrl":"10.1016/j.eurox.2024.100347","url":null,"abstract":"<div><h3>Objective</h3><div>Cervical insufficiency accounts for 8 % of preterm births. Pessary and cerclage are considered preventive approaches for preterm birth. These interventions were compared in terms of reducing the prematurity rate in women with previous preterm birth, due to cervical insufficiency or due to having a short cervix in their current pregnancy.</div></div><div><h3>Methods</h3><div>This was a prospective, multicentric, open-label, randomised, pilot, controlled trial. Participants were women with singleton pregnancies who had previous preterm birth caused by cervical insufficiency or previous preterm birth and a short cervix [≤ 25 mm] in their current pregnancy. Women were randomised [1:1] to either cerclage or pessary. The primary outcome was to assess the feasibility of a trial on cervical pessary vs. cerclage to prevent preterm birth before 34 weeks in women with cervical insufficiency. As a secondary outcome, we studied the morbidity rate of the pessary versus the cerclage in women with cervical insufficiency and assessed the financial impact of using both devices in these women. The sample size was calculated based on the estimated population that we could potentially recruit: 60 women, 30 for each group, to ascertain whether the rate of preterm birth &lt; 34 weeks of gestation may be reduced from 34 % to at least 27 % in the pessary group, as in the results obtained with the cerclage.</div></div><div><h3>Results</h3><div>No significant differences in preterm birth &lt; 34 weeks of gestation were observed in our study, although it was underpowered to detect these differences [the relative risk [RR] of PB &lt; 34 weeks of gestation was 0.8 [95 % CI: 0.31–2.09, p = 0.888]. The rates of obstetric and perinatal complications were similar for both devices [15 cases in both groups, 50 % of cases [RR; 0.6–1.68; p = 1]. Cervical pessary had fewer secondary effects than the cerclage [less bleeding at insertion in the pessary group compared with cerclage, 1 case vs 14 cases, p &lt; 0.001; less pain at removal in the pessary group compared with cerclage, 14 vs 22 cases. p = 0.042 and less bleeding, 2 cases vs. 10 cases, p = 0.027].</div></div><div><h3>Conclusions</h3><div>Pessary does not seem less effective than cerclage, although these findings need to be confirmed in a larger randomised controlled trial. Pessary had fewer secondary effects than cerclage both at insertion and removal.</div></div><div><h3>Sinopsis</h3><div>Cervical pessary does not seem to be less effective than cerclage. Cervical pessary had fewer secondary effects than cerclage.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vegetarian diet and pregnancy outcome","authors":"","doi":"10.1016/j.eurox.2024.100345","DOIUrl":"10.1016/j.eurox.2024.100345","url":null,"abstract":"<div><h3>Objective</h3><div>Vegetarian diets are becoming increasingly popular. Our aim was to evaluate the association of a vegetarian diet with pregnancy, labor, and newborn’s outcome.</div></div><div><h3>Study design</h3><div>This retrospective case-control study included 150 women on a vegetarian diet and 300 omnivores. The data were collected from Tampere University Hospital pregnancy database from January 2015 to April 2021. Diet was a self-reported variable. Outcomes of interest were compared between the groups. The frequency of small-for-gestational age (SGA) newborns and low birth weight were primary outcomes. Other parameters concerning pregnancy, labor, and newborn served as secondary outcomes.</div></div><div><h3>Results</h3><div>The rate of SGA at the 10 % cutoff was lower in the vegetarian group. Based on a definition of two standard deviations, SGA did not differ between the vegetarian diet group and the control group. The median birthweight was significantly higher in the vegetarian group. Gestational diabetes (GDM) was more common in the vegetarian group, however the numbers of large for gestational age (LGA) newborns were comparable between the study groups. Labor induction was more common, and the second stage of labor was longer in the vegetarian group. Preterm births (&lt; 32⁺⁰ and &lt; 37⁺⁰ gestational weeks) were more common in the control group. No differences were found in the mean umbilical artery pH value, 1- and 5- minutes Apgar scores or the number of newborns transferred to the neonatal intensive care unit and neonatal ward. The proportions of hypertensive disorders in pregnancy did not differ between the groups.</div></div><div><h3>Conclusion</h3><div>According to our results, a vegetarian diet may be considered safe during pregnancy. It was not associated with an increased risk of pregnancy- or neonatal complications.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rapid diagnostic technique based on metabolomics to differentiate between preeclampsia (PE) and chronic kidney disease (CKD) using maternal urine","authors":"","doi":"10.1016/j.eurox.2024.100348","DOIUrl":"10.1016/j.eurox.2024.100348","url":null,"abstract":"<div><div>Similar clinical manifestations between preeclampsia and chronic kidney diseases can lead to potential misdiagnosis. Therefore, it is crucial to investigate effective diagnostic approaches that can reduce misdiagnosis and ensure the well-being of pregnant women. In this study, urine samples collected from 44 individuals with preeclampsia, 37 individuals with chronic kidney disease, and 37 healthy pregnant women were analyzed using metabolomic and proteomic strategies to distinguish between these two diseases. A total of 15 small molecules were tentatively identified as biomarkers to differentiate these two diseases, including potential internally exposed drugs and their metabolites like labetalol and SN-38, metabolites of exogenous substances like 3-phenylpropyl glucosinolate, and endogenous substances related to metabolism such as isoglobotriaose and chitobiose. Metabolic differences between preeclampsia from healthy pregnant women, as well as the differences between chronic kidney disease and healthy pregnant women were also investigated. Major mechanistic pathways were investigated based on the combination of metabolomic and proteomic, amino acid metabolisms and folate metabolism play key roles in distinguishing preeclampsia and chronic kidney disease. Two patients who were initially diagnosed with chronic kidney disease were found to have a closer association with preeclampsia following metabolomic analysis. Subsequent clinical symptoms and manifestations further supported the diagnosis of preeclampsia, and one of patient's pregnancy was ultimately terminated due to severe preeclampsia. Results of this study contribute to a better understanding of the pathogenesis and clinical diagnosis of preeclampsia, offering insights that could potentially improve future diagnostic and management approaches.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accurate birth weight prediction from fetal biometry using the Gompertz model","authors":"","doi":"10.1016/j.eurox.2024.100344","DOIUrl":"10.1016/j.eurox.2024.100344","url":null,"abstract":"<div><h3>Objectives</h3><div>Monitoring of fetal growth and estimation of birth weight is of clinical importance. During pregnancy, ultrasound fetal biometry values including femur length, head circumference, abdominal circumference, biparietal diameter are measured and used to place fetuses on “growth charts”. There is no simple growth-model-based, predictive formula in use for fetal biometry. Estimation of fetal weight at birth currently depends on ultrasound data taken a short time before birth.</div></div><div><h3>Study design</h3><div>Our cohort (“Seethapathy cohort”) consists of ultrasound biometry measurements and other data for 774 pregnant women in Chennai, India, 2015–2017. We use the Gompertz model, a standard model for constrained growth, with just three intuitive parameters, to model the growth of fetal biometry, and a machine learning (ML) model trained on these parameters to predict birth weight (BW).</div></div><div><h3>Results</h3><div>The Gompertz model convincingly fits the growth of fetal biometry values. Two Gompertz parameters—<span><math><msub><mrow><mi>t</mi></mrow><mrow><mn>0</mn></mrow></msub></math></span> (inflection time) and <span><math><mi>c</mi></math></span> (rate of decrease of growth rate)—seem universal to all fetuses, while the third, <span><math><mi>A</mi></math></span>, is an overall scale specific to each fetus, capturing individual variation. On the Seethapathy cohort we can infer <span><math><mi>A</mi></math></span> for each fetus from ultrasound data available by the 24 or 35 weeks. Our ML model predicts birth weight with &lt; 8 % error, outperforming published methods that have access to late-term ultrasound data. The same model gives an 8.4 % error in BW prediction on an independent validation cohort of 365 women.</div></div><div><h3>Conclusions</h3><div>The Gompertz model fits fetal biometry growth and enables birth weight estimation without need of late-term ultrasounds. Aside from its clinical predictive value, we suggest its use for future growth standards, with almost all variation described by a single scale parameter <span><math><mi>A</mi></math></span>.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of patients with heterotopic pregnancy after laparoscopic surgery","authors":"","doi":"10.1016/j.eurox.2024.100342","DOIUrl":"10.1016/j.eurox.2024.100342","url":null,"abstract":"<div><h3>Objective</h3><div>This retrospective study aims to analyze laparoscopic surgical management and clinical consequences of patients with heterotopic pregnancy (HP) who underwent in vitro fertilization and embryo transfer (IVF-ET) and laparoscopic surgical management.</div></div><div><h3>Material and methods</h3><div>We conducted a retrospective analysis of clinical characteristics and pregnancy results of patients with HP who underwent IVF-ET at the Affiliated Maternity and Child Health Care Hospital of Nantong University between January 2013 and December 2022.</div></div><div><h3>Results</h3><div>21 patients were diagnosed with HP, with an average diagnostic period of 49.1 ± 11.1 days. 11 cases (52.4 %) exhibited clinical manifestations such as abdominal pain and vaginal hemorrhage before the surgery, while 10 cases (47.6 %) were asymptomatic prior to diagnosis. All patients underwent laparoscopic surgery, resulting in 8 cases of miscarriage postoperatively (6.15 %), and all 13 neonates showed no anomalies at birth.</div></div><div><h3>Conclusion</h3><div>Laparoscopic surgery is a safe and effective treatment, and most patients can achieve satisfactory pregnancy outcomes after surgery.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of nationwide adjustment of tocolysis protocol in the Netherlands on neonatal outcomes in women with threatened preterm birth and delivery at 30-32 weeks of gestation: A cohort study","authors":"","doi":"10.1016/j.eurox.2024.100343","DOIUrl":"10.1016/j.eurox.2024.100343","url":null,"abstract":"<div><h3>Objective</h3><div>In 2019 the Dutch national prevention of preterm birth (PTB) protocol was adjusted to withhold tocolysis for threatened PTB above 30 weeks of gestation due to insufficient evidence regarding its effectiveness on improving perinatal outcomes. The aim of this study is to evaluate neonatal outcomes of children born in the Netherlands between 30 and 32 weeks of gestation before and after the national protocol change.</div></div><div><h3>Study design</h3><div>We performed a nationwide retrospective cohort study comparing outcomes of births in the years 2018 (tocolysis) and 2020 (no tocolysis). Tocolytic therapy consisted of either nifedipine or atosiban. Data were extracted from the national Perinatal Registry (PERINED). Women with a spontaneous PTB from 30 + 0 to 31 + 6 weeks of gestation were included. The primary outcome was a composite of mortality, severe intraventricular hemorrhage, severe necrotizing enterocolitis, cystic periventricular leukomalacia, and retinopathy of prematurity needing therapy. Secondary outcomes included additional neonatal outcomes. The odds ratio (OR) with corresponding 95 % confidence interval (CI) was calculated by logistic regression analysis for the year 2020 compared with 2018.</div></div><div><h3>Results</h3><div>Composite neonatal outcome did not differ between 2018 compared to 2020 (8.4 % (18/215) vs 8.2 % (25/306), OR 0.95; 95 % CI 0.51–1.77). No difference in composite neonatal outcome was found when analyzing groups as singletons (7.1 % vs 9.3 %, OR 1.35; 95 % CI 0.64–2.87), and multiples (13.3 % vs 5.9 %, OR 0.41; 95 % CI 0.13–1.26).</div></div><div><h3>Conclusion</h3><div>There was no significant difference in composite neonatal outcome in pregnancies resulting in spontaneous PTB between 30 and 32 weeks of gestation in 2018 (with tocolysis) compared to 2020 (no tocolysis). These results support the protocol adjustment to withhold tocolytic treatment in women with threatened PTB above 30 weeks of gestation.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foeto–Maternal outcomes of pregnancies beyond 41 weeks of gestation after induced or spontaneous labour","authors":"","doi":"10.1016/j.eurox.2024.100339","DOIUrl":"10.1016/j.eurox.2024.100339","url":null,"abstract":"<div><h3>Objective</h3><p>It has been suggested that induction of labour before 42 weeks of pregnancy prevents foetal complications. To evaluate the maternal and foetal outcomes of induced and spontaneous labour beyond gestational week 41 + 0.</p></div><div><h3>Study design</h3><p>We conducted a register-based nationwide cohort study that included pregnant women who were delivered in Sweden in 2016–2021. Women were classified into two groups: induction of labour (IOL) or spontaneous onset of labour (SOL). Maternal and foetal outcomes after IOL in gestational week 41 were compared with SOL in gestational week 41 and 42.</p></div><div><h3>Results</h3><p>Comparison between the IOL (n = 23,772) and SOL (n = 62,611) groups in gestational weeks 41 showed that various parameters were higher in the IOL group: caesarean deliveries (12.3 % and 4.6 %, <em>P</em> &lt; 0.001), vacuum extraction (8.7 % and 6.9 %, <em>P</em> &lt; 0.001), blood loss of &gt; 1000 ml during labour (11 % vs 8.3 %, <em>P</em> &lt; 0.001). The risks were remained significant even after adjusting for potential confounders (caesarean delivery: aOR 2.36; 95 % CI, 2.23–2.50, vacuum delivery: aOR 1.09; 95 % CI, 1.03–1.16, <em>P</em> = 0.002, and blood loss of &gt;1000 ml: aOR 1.25; 95 % CI 1.18–1.31). The proportions of stillbirths (0.07 % and 0.18, <em>P</em> &lt; 0.001), and newborns with apgar scores &lt; 4 at five minutes (0.4 % vs 0.3 %, <em>P</em> &lt; 0.001), were also higher in the IOL group. The risk of stillbirth after IOL in gestational week 41 was increased relative to SOL in the same week and remained high after adjusting for potential confounders (aOR 1.75; 95 % CI 1.07–2.80, <em>P</em> = 0.025).</p><p>The IOL group in gestational weeks 41 comprised a higher proportion of caesarean deliveries (12.3 % and 8.5 %, <em>P</em> &lt; 0.001), but a lower (8.7 % and 9.7 %, <em>P</em> = 0.006) proportion of deliveries by vacuum extraction than the SOL group (n = 4548) in week 42.</p></div><div><h3>Conclusions</h3><p>Inducing labour at gestational week 41 in women with prolonged pregnancies may have adverse effects on foetal and maternal outcomes compared to those who experience spontaneous labour onset at the same gestational age. The risk of negative foetal outcomes after induction at week 41 appears similar to that in women who give birth after spontaneous labour at week 42.</p></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590161324000590/pdfft?md5=fffdea7e9c6f11f6823fdcca11fcb483&pid=1-s2.0-S2590161324000590-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142148083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}