Bjog-An International Journal of Obstetrics and Gynaecology最新文献

{"title":"The impact of hormone therapy on cardiovascular risk in postmenopausal women: Insights and recommendations.","authors":"Luyang Su, Zeqing Du, Cuiqiao Meng","doi":"10.1111/1471-0528.17932","DOIUrl":"https://doi.org/10.1111/1471-0528.17932","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of models to estimate gestational age in the second and third trimester using ultrasound: A prospective multicentre observational study","authors":"Alice Self, Michael Schlussel, Gary S. Collins, Ferdinand Dhombres, Nicolas Fries, Georges Haddad, Laurent J. Salomon, Mona Massoud, Aris T. Papageorghiou","doi":"10.1111/1471-0528.17922","DOIUrl":"10.1111/1471-0528.17922","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Accurate assessment of gestational age (GA) is important at both individual and population levels. The most accurate way to estimate GA in women who book late in pregnancy is unknown. The aim of this study was to externally validate the accuracy of equations for GA estimation in late pregnancy and to identify the best equation for estimating GA in women who do not receive an ultrasound scan until the second or third trimester.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This was a prospective, observational cross-sectional study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>57 prenatal care centres, France.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Women with a singleton pregnancy and a previous 11–14-week dating scan that gave the observed GA were recruited over an 8-week period. They underwent a standardised ultrasound examination at one time point during the pregnancy (15–43 weeks), measuring 12 foetal biometric parameters that have previously been identified as useful for GA estimation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>A total of 189 equations that estimate GA based on foetal biometry were examined and compared with GA estimation based on foetal CRL. Comparisons between the observed GA and the estimated GA were made using <i>R</i><sup>2</sup>, calibration slope and intercept. RMSE, mean difference and 95% range of error were also calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2741 pregnant women were examined. After exclusions, 2339 participants were included. In the 20 best performing equations, the intercept ranged from −0.22 to 0.30, the calibration slope from 0.96 to 1.03 and the RSME from 0.67 to 0.87. Overall, multiparameter models outperformed single-parameter models. Both the 95% range of error and mean difference increased with gestation. Commonly used models based on measurement of the head circumference alone were not amongst the best performing models and were associated with higher 95% error and mean difference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We provide strong evidence that GA-specific equations based on multiparameter models should be used to estimate GA in late pregnancy. However, as all methods of GA assessment ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1862-1873"},"PeriodicalIF":4.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17922","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delivering in or out of water, the OASI rates in the POOL cohort study are disturbingly high.","authors":"Jan Willem de Leeuw, Katariina Laine, Margareta Manresa, Sari Raisanen, Vladimir Kalis, Zdenĕk Rušavý, Renaud de Tayrac","doi":"10.1111/1471-0528.17933","DOIUrl":"https://doi.org/10.1111/1471-0528.17933","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel use of the rectus abdominus muscle flap for vaginal reconstruction in complex obstetric fistula repair: A case series","authors":"Tulsi Patel,&nbsp;Rodger Brown,&nbsp;Ennet Chipungu,&nbsp;Michael Breen,&nbsp;Jennifer Draganchuk,&nbsp;Patrick Nampandeni,&nbsp;Awol Legesse,&nbsp;Jeffrey Wilkinson","doi":"10.1111/1471-0528.17926","DOIUrl":"10.1111/1471-0528.17926","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Globally, obstetric fistula is a tragic outcome following obstructed labour. Failure of complex repair and post-operative incontinence are common. We describe an innovative surgical technique incorporating the rectus abdominus flap at the time of fistula repair.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective case series.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Malawi, Fistula Care Centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients were followed for 3 months after discharge to determine continence and healing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five of six patients were continent at 3 months and one was lost to follow-up by dry at a one month post-operative phone call. There were no major complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The rectus abdominus flap may be a useful adjunct to repair of complex obstetric fistula.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 1","pages":"6-11"},"PeriodicalIF":4.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The intergenerational association of preterm birth: A systematic review and meta-analysis","authors":"Abdulbasit Seid,&nbsp;Miranda S. Cumpston,&nbsp;Kedir Y. Ahmed,&nbsp;Habtamu Mellie Bizuayehu,&nbsp;Subash Thapa,&nbsp;Teketo Kassaw Tegegne,&nbsp;Abel F. Dadi,&nbsp;Daniel Bogale Odo,&nbsp;Desalegn Markos Shifti,&nbsp;Sewunet Admasu Belachew,&nbsp;Getiye Dejenu Kibret,&nbsp;Daniel Bekele Ketema,&nbsp;Zemenu Yohannes Kassa,&nbsp;Erkihun Amsalu,&nbsp;Meless G. Bore,&nbsp;Tahir Ahmed Hassen","doi":"10.1111/1471-0528.17924","DOIUrl":"10.1111/1471-0528.17924","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Around half of preterm births lack identifiable causes, indicating the need for further investigation to understand preterm birth risk factors. Existing studies on the intergenerational association of preterm birth showed inconsistency in effect size and direction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This systematic review and meta-analysis aimed to review existing studies and provide comprehensive evidence on the intergenerational association of preterm births.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>We searched MEDLINE, Embase and Maternity and Infant Care databases, from the inception of each database to 04 April 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Eligibility criteria included studies that reported on women who had given birth and had recorded information about a family history of preterm birth in one or both of the child's biological parents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Data were extracted by two independent reviewers. A random-effects model was used to compute pooled estimates using odds ratios.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Sixteen eligible studies with a total of 2 271 612 mothers were included. The findings indicated a 1.44 (OR = 1.44, 95% CI: 1.34, 1.54) fold increase in odds of giving preterm births among women who were born preterm. Additionally, having a sibling born preterm (OR = 1.53, 95% CI: 1.24, 1.87) and having a partner born preterm (OR = 1.12, 95% CI: 1.01, 1.25) were associated with increased likelihood of giving preterm births among women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study revealed that women with a family history of preterm birth face an increased risk of giving preterm births. Screening pregnant women for a family history of preterm birth is essential, with those having a positive family history requiring closer follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 1","pages":"18-26"},"PeriodicalIF":4.7,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17924","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometriosis pain or its ‘phantom’ pain? The elephant in the room of research","authors":"Marcelo de França Moreira,&nbsp;Marco Aurelio Pinho Oliveira","doi":"10.1111/1471-0528.17927","DOIUrl":"10.1111/1471-0528.17927","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 1","pages":"15-17"},"PeriodicalIF":4.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The global burden, trends and cross-country inequalities of female breast and gynaecologic cancers: A population based study","authors":"Liangxing Cheng,&nbsp;Zhihong Wang,&nbsp;Rufeng Li,&nbsp;Min Qiang,&nbsp;Chen Yang,&nbsp;Guoer Yang,&nbsp;Yingying Xie,&nbsp;Ruixia Yuan,&nbsp;Yungang Xu","doi":"10.1111/1471-0528.17925","DOIUrl":"10.1111/1471-0528.17925","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To analyse the global burden, trends and cross-country inequalities of female breast and gynaecologic cancers (FeBGCs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Population-Based Study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Data sourced from the Global Burden of Disease Study 2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Individuals diagnosed with FeBGCs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Age-standardised mortality rates (ASMRs), age-standardised Disability-Adjusted Life Years (DALYs) rates (ASDRs) and their 95% uncertainty interval (UI) described the burden. Estimated annual percentage changes (EAPCs) and their confidence interval (CI) of age-standardised rates (ASRs) illustrated trends. Social inequalities were quantified using the Slope Index of Inequality (SII) and Concentration Index.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The main outcome measures were the burden of FeBGCs and the trends in its inequalities over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2019, the ASDRs per 100 000 females were as follows: breast cancer: 473.83 (95% UI: 437.30–510.51), cervical cancer: 210.64 (95% UI: 177.67–234.85), ovarian cancer: 124.68 (95% UI: 109.13–138.67) and uterine cancer: 210.64 (95% UI: 177.67–234.85). The trends per year from 1990 to 2019 were expressed as EAPCs of ASDRs and these: for Breast cancer: −0.51 (95% CI: −0.57 to −0.45); Cervical cancer: −0.95 (95% CI: −0.99 to −0.89); Ovarian cancer: −0.08 (95% CI: −0.12 to −0.04); and Uterine cancer: −0.84 (95% CI: −0.93 to −0.75). In the Social Inequalities Analysis (1990–2019) the SII changed from 689.26 to 607.08 for Breast, from −226.66 to −239.92 for cervical, from 222.45 to 228.83 for ovarian and from 74.61 to 103.58 for uterine cancer. The concentration index values ranged from 0.2 to 0.4.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The burden of FeBGCs worldwide showed a downward trend from 1990 to 2019. Countries or regions with higher Socio-demographic Index (SDI) bear a higher DALYs burden of breast, ovarian and uterine cancers, while those with lower SDI bear a heavier burden of cervical cancer. These inequalities increased over time.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 1","pages":"55-63"},"PeriodicalIF":4.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neglected aspects of Obstetrics and Gynecology: Mental health, patient experience, implementation, and cost-effectiveness","authors":"Robert M. Silver","doi":"10.1111/1471-0528.17920","DOIUrl":"10.1111/1471-0528.17920","url":null,"abstract":"&lt;p&gt;One of the most concerning papers in this issue of BJOG is a study from the Netherlands noting an increased percentage of maternal deaths (through one year postpartum) are due to suicide (Lommerse et al, BJOG 2024). The percentage of maternal deaths in the Netherlands due to suicide increased from 18% between 1996 to 2005, to 28% between 20006 to 2020. Indeed, suicide is now the leading cause of maternal death in the Netherlands. Sadly, this problem is not unique to Holland. Suicide is also the most common cause of maternal death in the U.K., France, and the U.S. (Diguisto et al, BMJ. 2022;379:e070621; Knight et al., Oxford: National&lt;/p&gt;&lt;p&gt;Perinatal Epidemiology Unit, University of Oxford; 2021; Khalifeh et al, Lancet Psychiatry. 2016; 3:233–42; Trost et al, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2024). Further, mortality is merely the tip of the iceberg, accounting for only a small fraction of cases of severe maternal mental health and substance use disorders. Accordingly, improved screening for and treatment of mental health conditions and substance use disorder has the potential to greatly impact maternal morbidity and mortality.&lt;/p&gt;&lt;p&gt;A theme linking several articles in this issue of BJOG, are the “non-scientific” aspects of medicine. These include implementation science, patient experience, and cost-effectiveness. Moffat and coworkers report on postpartum contraception uptake in the Northeast and North Cumbrian Integrated Care System in England (Moffat et al; BJOG 2024). Data were obtained via online survey, and thus, prone to bias. Nonetheless, only 38.7% of respondents accessed any contraception postpartum, and only 15.5% accessed long-acting reversable contraception. 18.8 % indicated that they could not obtain their preferred method of contraception. These data underscore the need for better implementation strategies. Although we know that contraception is effective, it only works if people can obtain it. Further work should identify barriers (educational, logistical, financial, cultural, etc.) and potential solutions to enhance utilization of contraception and other effective interventions.&lt;/p&gt;&lt;p&gt;The emotional impact of medical interventions is critically important, but often neglected in research studies. In work by Kwong et al, 2596 people evaluated for ovarian cancer were evaluated for anxiety using the State-trait anxiety inventory (STAI-6) and distress using the Impact of Event Scale – revised (Kwong et al, BJOG 2024). 52.1% of participants reported moderate-severe anxiety and 68.6% had moderate-severe distress. Category of anxiety or distress remained unchanged or worse after 12 months in 76%, despite finding out that they did not have cancer. This study underscores the need to provide mental health support for people being evaluated for cancer, and to consider the duress associated with false positive screening tests. In another study assessing emotional health, Cattani and cow","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 10","pages":"1329-1330"},"PeriodicalIF":4.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17920","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac implantable electronic devices in pregnancy: A position statement","authors":"James Castleman,&nbsp;Stephanie Curtis,&nbsp;Caroline Fox,&nbsp;Lucy Hudsmith,&nbsp;Lynn Nolan,&nbsp;James Geoghegan,&nbsp;Yavor Metodiev,&nbsp;Eleri Roberts,&nbsp;Lucy Morse,&nbsp;Ashley Nisbet,&nbsp;Paul Foley,&nbsp;Ian Wright,&nbsp;Honey Thomas,&nbsp;Katie Morris,&nbsp;Dawn Adamson,&nbsp;Joseph De Bono,&nbsp;the United Kingdom Maternal Cardiology Society, British Heart Rhythm Society and British Maternal and Fetal Medicine Society","doi":"10.1111/1471-0528.17918","DOIUrl":"10.1111/1471-0528.17918","url":null,"abstract":"<p>The aim of this document is to provide guidance for the management of women and birthing people with a permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD). Cardiac devices are becoming more common in obstetric practice and a reference document for contemporary evidence-based practice is required. Where evidence is limited, expert consensus has established recommendations. The purpose is to improve safety and reduce the risk of adverse events relating to implanted cardiac devices during pregnancy, birth and the postnatal period.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1739-1746"},"PeriodicalIF":4.7,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17918","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary incontinence, faecal incontinence and pelvic organ prolapse symptoms 20–26 years after childbirth: A longitudinal cohort study","authors":"S. Hagen,&nbsp;C. Sellers,&nbsp;A. Elders,&nbsp;C. Glazener,&nbsp;C. MacArthur,&nbsp;P. Toozs-Hobson,&nbsp;C. Hemming,&nbsp;P. Herbison,&nbsp;D. Wilson","doi":"10.1111/1471-0528.17913","DOIUrl":"10.1111/1471-0528.17913","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate pelvic floor dysfunction (PFD; urinary incontinence (UI), faecal incontinence (FI) and prolapse) ≥20 years after childbirth and their association with delivery mode history and demographic characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cohort study with long-term follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Maternity units in Aberdeen and Birmingham (UK) and Dunedin (NZ).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women giving birth in 1993/1994.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Postal questionnaires at 20 (New Zealand) or 26 (United Kingdom) years after index birth (<i>n</i> = 6195). Regression analyses investigated associations between risk factors and UI, FI and prolapse symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Prevalence of self-reported UI, FI, ‘something coming down’ from or in the vagina (SCD), and the Pelvic Organ Prolapse-Symptom Score, and relationships with delivery method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-seven per cent (<i>n</i> = 2270) responded at 20/26 years, of whom 61% reported UI (59% of whom reported more severe UI), 22% FI and 17% prolapse symptoms. Having only caesarean section (CS) was associated with a significantly lower risk of UI (OR 0.63, 95% CI 0.46–0.85), FI (OR 0.63, 95% CI 0.42–0.96) and SCD (OR 0.44, 95% CI 0.27–0.74) compared to only spontaneous vaginal deliveries (SVDs). Having any forceps delivery was associated with reporting FI compared to only SVDs (OR 1.29, 95% CI 1.00–1.66), but there was no association for UI (OR 0.95, 95% CI 0.76–1.19) or SCD (OR 1.05, 95% CI 0.80–1.38). Higher current BMI was associated with all PFD outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prevalence of PFD continues to increase up to 26 years following index birth, and differences were observed according to delivery mode history. Exclusive CS was associated with less risk of UI, FI and any prolapse symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1815-1823"},"PeriodicalIF":4.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17913","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}