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

{"title":"Predicting Preterm Birth: An Evolving Landscape","authors":"Caroline Fox, Andrew Shennan","doi":"10.1111/1471-0528.18067","DOIUrl":"10.1111/1471-0528.18067","url":null,"abstract":"<p>Recently, the international company Hologic has withdrawn fetal fibronectin (fFN), a commonly used biomarker for preterm birth prediction. This is related to quality controls and sourcing consumables. However, fFN is currently recommended by the National Institute for Health and Care Excellence (NICE) and the National Health Service in England and had been implemented widely across Europe and the United Kingdom. Therefore, withdrawal of fFN is forcing countries to reconsider their clinical approaches.</p><p>It is estimated worldwide that 13.4 million or 1 in 10 babies annually are preterm, before 37 completed weeks of gestation (WHO 2023). The earlier the birth, the higher the mortality and lifelong morbidity (D'Onofrio et al. <i>JAMA Psychiatry</i>. 2013;70:1231). Preterm birth is also a leading health cause of lost human capital (WHO 2023). Preterm birth rates are currently static and therefore initiatives to reduce prematurity and its complications are a priority.</p><p>Unfortunately, predicting and therefore preventing preterm birth is difficult as symptoms of threatened preterm birth can be vague and most do not go on to have their babies early. This led to consideration of tests to refine prediction of preterm birth and these include transvaginal cervical length (TCVL), as well as several cervico-vaginal biomarker tests (fetal fibronectin [fFN], Actim Partus [phosphorylated insulin-like growth factor binding protein-1] and Partosure [placental alpha macroglobulin-1]). Novel tests, such as cervical microRNA expression, cell-free RNA, metabolomics and microbiome assessment, have yet to be widely evaluated.</p><p>NICE recommends transvaginal ultrasound measurement of cervical length and if unavailable or unacceptable fFN to define risk of preterm birth. A Cochrane systematic review (Berghella et al. 2019) reported that data are limited but knowledge of TVCL appears to prolong pregnancy by 4 days. This interval allows antenatal optimisation with corticosteroids and magnesium sulphate to improve survival and reduce morbidity. However, TVCL requires expertise and experience, and highly trained sonographers are not universally available at the point of care. fFN testing in contrast can be performed by speculum examination and was therefore the more widely adopted test. A low fFN, is reassuring that preterm birth within 7 or 14 days is unlikely with a negative predictive value of > 99% (Wing et al. <i>Obstet Gynaecol</i> 2017;130:1183). This allows women to be safely reassured and discharged. Cervical length alone has moderate prediction (area under curve to predict delivery < 30 weeks is 0.7), compared to fFN alone (0.89), but they can be used in combination for optimal prediction (Carter et al. <i>Ultrasound Obstet Gynecol</i>. 2019:55:357). Unfortunately, now fFN has been withdrawn, cervical scanning length is the only established alternative as other tests, such as Actim Partus, are not recommended by NICE. The Saving Babies Lives Care","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"672-673"},"PeriodicalIF":4.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974779","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":"L-Arginine and L-Citrulline for Prevention and Treatment of Pre-Eclampsia: A Systematic Review and Meta-Analysis","authors":"Maureen Makama,&nbsp;Annie R. A. McDougall,&nbsp;Jenny Cao,&nbsp;Kate Mills,&nbsp;Phi-Yen Nguyen,&nbsp;Roxanne Hastie,&nbsp;Anne Ammerdorffer,&nbsp;A. Metin Gülmezoglu,&nbsp;Joshua P. Vogel","doi":"10.1111/1471-0528.18070","DOIUrl":"10.1111/1471-0528.18070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Evidence suggests L-arginine may be effective at reducing pre-eclampsia and related outcomes. However, whether L-arginine can prevent or only treat pre-eclampsia, and thus the target population and timing of initiation, remains unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the effects of L-arginine and L-citrulline (precursor of L-arginine) on the prevention and treatment of pre-eclampsia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>MEDLINE, Embase, CINAHL, Global Index Medicus and the Cochrane Library were searched through 7 February 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Trials administering L-arginine or L-citrulline to pregnant women, with the comparison group receiving placebo or standard care, were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Meta-analyses were conducted separately for prevention or treatment trials, using random-effects models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Twenty randomised controlled trials (RCTs) (2028 women) and three non-randomised trials (189 women) were included. The risk of bias was ‘high’ in eight RCTs and showed ‘some concerns’ in 12. In prevention trials, L-arginine was associated with a reduced risk of pre-eclampsia (relative risk [RR] 0.52; 95% confidence interval [CI], 0.35, 0.78; low-certainty evidence, four trials) and severe pre-eclampsia (RR 0.23; 95% CI, 0.09, 0.55; low-certainty evidence, three trials). In treatment trials, L-arginine may reduce mean systolic blood pressure (MD −5.64 mmHg; 95% CI, −10.66, −0.62; very low-certainty evidence, three trials) and fetal growth restriction (RR 0.46; 95% CI, 0.26, 0.81; low-certainty evidence, two trials). Only one study (36 women) examined L-citrulline and reported no effect on pre-eclampsia or blood pressure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>L-arginine may be promising for pre-eclampsia prevention and treatment, but findings should be interpreted cautiously. More trials are needed to determine the optimal dose and time to commence supplementation and support clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"698-708"},"PeriodicalIF":4.7,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967907","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":"Prolonged Ovarian Stimulation Does Not Worsen Neonatal Outcomes After Fresh Embryo Transfers","authors":"Jing Wu,&nbsp;Ying Ju,&nbsp;Jie Dong,&nbsp;Hengde Zhang,&nbsp;Xifeng Xiao,&nbsp;Xiaohong Wang","doi":"10.1111/1471-0528.18062","DOIUrl":"10.1111/1471-0528.18062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the relationship between prolonged ovarian stimulation and neonatal outcomes after autologous fresh embryo transfer (fET).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>University-affiliated centres.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>3529 patients underwent autologous in vitro fertilisation (IVF) cycles between August 1, 2016 and December 31, 2022, with a live singleton birth after fET.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Univariate and multivariate regression analyses were used to determine the relationship between prolonged ovarian stimulation and neonatal outcomes. Propensity score matching (PSM) was applied to evaluate independent effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Multivariate regression showed no significant association between simulation duration and birthweight (adjusted <i>β</i>: 4.19, 95% confidence interval [CI]: −13.86 to 22.23; <i>p</i> = 0.6494) or gestational age (GA) (adjusted <i>β</i>: −0.01, 95% [CI]: −0.09 to 0.06; <i>p</i> = 0.7403) Categorical analysis of neonatal outcomes, including low birthweight (LBW) (adjusted Odds Ratio [OR]: 0.94, 95% [CI]: 0.70 to 1.25; <i>p</i> = 0.6501), macrosomia (adjusted OR: 0.95, 95% [CI]: 0.78 to 1.16; <i>p</i> = 0.6294), small for gestational age (SGA) (adjusted OR: 0.95, 95% [CI]: 0.75 to 1.19; <i>p</i> = 0.6465), large for gestational age (LGA) (adjusted OR: 1.02, 95% [CI]: 0.85 to 1.21; <i>p</i> = 0.8542) and preterm (adjusted OR: 0.93, 95% [CI]: 0.77 to 1.11; <i>p</i> = 0.4191), revealed no associations with stimulation duration. PSM analysis confirmed these findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prolonged ovarian stimulation does not appear to increase adverse neonatal outcomes in singleton newborns after autologous fET.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S2","pages":"26-35"},"PeriodicalIF":4.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940075","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":"Improving Maternal and Infant Health Outcomes: Strengthening Research and Interventions for Cannabis Use Disorder During Pregnancy","authors":"Jiahua Peng,&nbsp;Yi Shi,&nbsp;Mei Yang","doi":"10.1111/1471-0528.18072","DOIUrl":"10.1111/1471-0528.18072","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 8","pages":"1178-1179"},"PeriodicalIF":4.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940074","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":"Is There a Diminishing Benefit With Increasing Operative Time of Minimally Invasive Sacrocolpopexy? A Retrospective Analysis","authors":"Maura A. Schlussel,&nbsp;Stephen P. Rhodes,&nbsp;Susan D. Wherley,&nbsp;C. Emi Bretschneider,&nbsp;Ankita Gupta,&nbsp;David Sheyn","doi":"10.1111/1471-0528.18069","DOIUrl":"10.1111/1471-0528.18069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine whether there is an operative time threshold beyond which minimally invasive sacrocolpopexy (MI-SCP) is less beneficial than abdominal sacrocolpopexy (ASCP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The National Surgical Quality Improvement Program (NSQIP) database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Patients undergoing MI-SCP or ASCP from 2011 to 2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Preoperative characteristics, operative variables and 30-day postoperative data were collected for each case. Groups were compared using the chi-squared or Kruskal–Wallis tests. Multivariable regression to identify risks of complications and prolonged hospital stay was performed using logistic and negative binomial models. Generalised additive models were applied to account for non-linear relationships between dependent and independent variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Occurrence of any major surgical complications and the length of stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>13 678 sacrocolpopexies were performed, with the majority (78.6%) being MI-SCP. Although the groups were similar in age and BMI, those undergoing ASCP were more likely to have medical comorbidities. After adjusting for confounders, ASCP was not significantly associated with an increase in the probability of major complications compared to MI-SCP (aOR = 1.59, 95% CI: 0.99–2.54) and there was no significant interaction between procedure and operative time (aOR = 1.06, 95% CI: 0.94–1.20). ASCP was still associated with a prolonged LOS (aIRR = 2.19, 95% CI: 2.00–2.38). The interaction between procedure and operative time was significant (aIRR = 0.958, 95% CI: 0.93–0.98), but the LOS for MI-SCP never exceeded that of ASCP for operative times less than 6 h.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>For surgeries lasting less than 6 h, MI-SCP is associated with similar morbidity and a shorter LOS when compared with ASCP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"663-671"},"PeriodicalIF":4.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937701","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":"Digital Foetal Scalp Stimulation Versus Foetal Blood Sampling to Assess Foetal Well-Being in Labour: A Multicentre Randomised Controlled Trial","authors":"Sahr Yambasu,&nbsp;Fiona Boland,&nbsp;Keelin O'Donoghue,&nbsp;Colleen Curran,&nbsp;Yulia Shahabuddin,&nbsp;Amanda Cotter,&nbsp;Geraldine Gaffney,&nbsp;Declan Devane,&nbsp;Eleanor J. Molloy,&nbsp;Deirdre J. Murphy","doi":"10.1111/1471-0528.18068","DOIUrl":"10.1111/1471-0528.18068","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To establish whether digital foetal scalp stimulation (dFSS) performs better than foetal blood sampling (FBS) in terms of reducing the rate of caesarean section (CS) in labour, without adversely affecting perinatal outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A multicentre parallel-group randomised controlled trial.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Maternity centres in Ireland.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Population&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The study aimed to randomise 2500 nulliparous women who required a second-line test of foetal well-being in labour due to abnormal cardiotocography (CTG).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Participants were randomly allocated to dFSS or FBS in a 1:1 ratio. Analysis was according to the published protocol and included a meta-analysis of the pilot study data and trial data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main Outcome Measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The primary outcome was CS.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Due to lower-than-expected randomisations, the trial concluded early. Of 534 consented participants, 124 had a second-line test of foetal well-being in labour and 43 (34.7%) were randomised; 20 to dFSS and 23 to FBS. The rate of CS was 40.0% (8/20) in the dFSS group and 47.8% (11/23) in the FBS group (absolute difference 7.8%; OR 0.73, 95% CI 0.22–2.44). The rate of CS was lower in the dFSS group when the trial data were included in a meta-analysis with the pilot data (&lt;i&gt;n&lt;/i&gt; = 50), although the confidence limits were wide (OR 0.41, 95% CI 0.17–0.96). There was no significant difference in rates of adverse perinatal and maternal outcomes. Of the nonrandomised participants who received a second-line test, 65% (53/81) received dFSS.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The small sample size limits the ability to conclude whether dFSS performs better as a second-line test of foetal well-being in labour than FBS. A clinician preference for dFSS was apparent, even though robust evidence is lacking.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;&lt;b&gt;Trial Registration:&lt;/b&gt; This trial was prospectively registered on ClinicalTrials.gov on the 31st of March 2","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"557-564"},"PeriodicalIF":4.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937735","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":"The Impact of Dating Twin Pregnancy by the Larger, Smaller or Mean Twin Crown-Rump Length: A Retrospective Cohort Study","authors":"Gillian V. Blayney,&nbsp;Veronica Giorgione,&nbsp;Amar Bhide,&nbsp;Basky Thilaganathan","doi":"10.1111/1471-0528.18065","DOIUrl":"10.1111/1471-0528.18065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the impact of twin dating by ultrasound-measured crown-rump length (CRL) of the larger (CRL-L), smaller (CRL-S) or mean twin measurement (CRL-M) on the rates of preterm birth (PTB) and detection of small for gestational age (SGA) births.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A tertiary fetal medicine centre (London, UK).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>All twin pregnancies between 1998 and 2023 who underwent first trimester CRL ultrasound assessment and fetal growth assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data collection included CRL measurement, estimated fetal weight (EFW), pregnancy outcome and birthweight (BW) for each twin. Pregnancies were retrospectively re-dated by CRL-S, CRL-L and CRL-M.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>SGA &lt; 10th centile and extreme PTB rates (&lt; 28 weeks).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the 1129 twin pregnancies, median CRL-S was 61 mm (interquartile range [IQR]: 56.0–66.0) and CRL-L was 63 mm (IQR: 58.4–68.9) with a mean discordance of 4.0%. Prenatal SGA diagnosis occurred in 19.8% and 23.1% of smaller twins when dated by CRL-S and CRL-L, respectively. When pregnancies were dated by CRL-M versus CRL-S or CRL-L, there was no difference in prenatal SGA diagnosis (<i>p</i> = 0.275 and <i>p</i> = 0.419); SGA at birth (<i>p</i> = 0.132 and <i>p</i> = 0.325); or extreme PTB (<i>p</i> = &gt; 0.999 and <i>p</i> = 0.765 respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Dating by the smaller, larger or mean twin CRL does not significantly alter rates of extreme preterm birth, SGA detection or SGA birth. Dating by the mean twin CRL reduces stigmatisation of the smaller twin and retains the utility of accurate gestational age assessment without impacting clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"648-655"},"PeriodicalIF":4.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937699","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":"Optimising Luteinising Hormone Levels on Trigger Day for Improved Ovarian Response and Pregnancy Outcomes in Gonadotropin-Releasing Hormone Antagonist Protocols: A Retrospective Cohort Study","authors":"Zijin Xu,&nbsp;Qiwang Lin,&nbsp;Zhu Liang,&nbsp;Sichen Li,&nbsp;Yixuan Wu,&nbsp;Yang Fu,&nbsp;Jianqiao Liu,&nbsp;Haiying Liu","doi":"10.1111/1471-0528.18064","DOIUrl":"10.1111/1471-0528.18064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the optimal luteinising hormone (LH) level on the trigger day and its impact on pregnancy outcomes in gonadotropin-releasing hormone (GnRH) antagonist protocols using a data-driven approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Third Affiliated Hospital of Guangzhou Medical University.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Overall, 6107 in vitro fertilisation/intra-cytoplasmic sperm injection fresh embryo transfer cycles with GnRH-antagonist protocols were performed between January 1, 2018 and February 1, 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Restricted cubic spline analysis and segmented regression identified the optimal LH threshold. Patients were categorised into low (≤ 1.6 IU/L) and high (&gt; 1.6 IU/L) LH groups. Propensity score matching (PSM) and multivariable logistic regression were applied to adjust for confounding factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Live birth rate per embryo transfer cycle.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The high LH group showed significantly higher live birth rates (42.9% vs. 36.9%, adjusted odds ratio [aOR]: 1.468; 95% CI: 1.220–1.766, <i>p</i> &lt; 0.001), ongoing pregnancy rates (51.4% vs. 43.6%, aOR: 1.498; 95% CI: 1.338–1.678, <i>p</i> &lt; 0.001), clinical pregnancy rates (52.4% vs. 45.6%, aOR: 1.439; 95% CI: 1.285–1.611, <i>p</i> &lt; 0.001) and biochemical pregnancy rates compared with the low LH group, despite retrieving fewer oocytes (median 10 vs. 12, <i>p</i> &lt; 0.001). These results remained consistent after PSM and multivariable logistic regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher LH levels on the trigger day are associated with improved pregnancy outcomes in GnRH-antagonist protocols. Maintaining an optimal LH range is crucial for balancing oocyte yield and assisted reproductive technology success, highlighting the importance of individualised ovarian stimulation protocols.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S2","pages":"44-52"},"PeriodicalIF":4.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936456","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":"Comprehensive Health Assessment of School-Age Children Conceived by Assisted Reproductive Technology: A Prospective Cohort Follow-Up Study","authors":"Jing Wang,&nbsp;Lingling Chen,&nbsp;Yonghong Yong,&nbsp;Xiang Yu,&nbsp;Yin Chen,&nbsp;Jie Zhang,&nbsp;Xinru Xia,&nbsp;Yugui Cui,&nbsp;Feiyang Diao,&nbsp;Jiayin Liu,&nbsp;Yan Meng","doi":"10.1111/1471-0528.18044","DOIUrl":"10.1111/1471-0528.18044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the comprehensive health status of school-age children conceived through assisted reproductive technology (ART) compared to that of those conceived naturally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A prospective cohort study of children conceived through ART.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>First Affiliated Hospital of Nanjing Medical University, China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population Sample</h3>\u0000 \u0000 <p>One hundred school-age children were enrolled and followed up (51 conceived via ART and 49 naturally conceived (controls)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive health status assessment was performed in children aged 6–12 years, including anthropometric measurements, glucose-lipid metabolism, echocardiography, intelligence, behaviour, vision and hearing. Multivariate regression models were used to adjust for sociodemographic and perinatal covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Comprehensive health status of children conceived via ART.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Children conceived by ART had similar height, weight, blood pressure, blood glucose and lipid profiles compared to the controls. Echocardiography showed similar cardiac geometric morphology and left/right ventricular diastolic-systolic function between the two groups. ART children had lower carotid intima-media thickness than controls (0.52 ± 0.11 vs. 0.58 ± 0.11). Visual acuity, hearing and intellectual and behavioural assessments were similar. An alternating covering test for the eyes showed a higher incidence of abnormal eye movement in the ART group than in the control group (87.76% vs. 68.89%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The similar overall health status of ART- and naturally conceived children is reassuring for those receiving ART. However, our study shows a possible increase in the incidence of latent exotropia among ART children. Long-term follow-up is warranted to assess the overall health status associated with ART throughout the lifespan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S2","pages":"8-17"},"PeriodicalIF":4.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936454","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":"Addressing Limitations in Stillbirth Assessment Research: A Call for Broader Perspectives","authors":"Sijia Liu,&nbsp;Jialao Ma","doi":"10.1111/1471-0528.18061","DOIUrl":"10.1111/1471-0528.18061","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 7","pages":"1014-1015"},"PeriodicalIF":4.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936490","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}