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

{"title":"Optimising Aspirin Use for Pre-Eclampsia Prevention: The Critical Role of Dose, Timing and Adherence","authors":"Bethany Atkins, Dimitrios Siassakos","doi":"10.1111/1471-0528.18095","DOIUrl":"10.1111/1471-0528.18095","url":null,"abstract":"<p>There is abundant evidence that aspirin, commenced at 12 weeks gestation, can be very effective in preventing pre-eclampsia, including preterm pre-eclampsia, preterm delivery and severe pre-eclampsia variants such as HELLP syndrome. However, some clinicians may consider it only modestly effective and neglect its use. Thus, attempts to reduce the morbidity and mortality associated with pre-eclampsia may focus instead on managing its complications, and developing new diagnostics and drugs. Aspirin is hypothesised to improve placental development, either preventing entirely or delaying onset of pre-eclampsia.</p><p>The Cochrane review by Duley et al. [<span>1</span>] describes a ‘small-to-moderate’ benefit of aspirin in preventing pre-eclampsia, preterm birth, small-for-gestational age and perinatal death. However, of 34 514 women with individual patient data available, only 9272 were randomised before 16 weeks gestation, and only 5070 received > 75 mg per day. Does the amalgamation of low- and high-doses, with early and late commencement of aspirin give the appearance of lower efficacy, and dissuade clinicians from prioritising aspirin?</p><p>In resource-limited contexts, where the likelihood of healthy survival to adulthood is significantly lower for preterm infants [<span>2</span>], the importance of a safe, low-cost intervention such as aspirin is even more important. Underestimation of low-cost, effective interventions such as aspirin may cause considerable harm [<span>2</span>].</p><p>This editorial seeks to review the impact of dosage, timing and adherence to aspirin on its efficacy in pre-eclampsia prevention, and explore special considerations for utilisation.</p><p>The Cochrane review [<span>1</span>] examined aspirin dosage. Examining studies with individual patient data available, there appeared to be a greater reduction in risk of pre-eclampsia in the minority of women allocated ≥ 75 mg aspirin than those allocated < 75 mg aspirin (9107 women, 16 trials; RR 0.78, 95% CI 0.66–0.92 vs. 22 618 women, 11 trials; RR 0.92, 95% CI 0.85–1.00). The review found no evidence of a difference by aspirin dose in foetal or neonatal death, preterm delivery or small-for-gestational age birth weight, but of the large studies [<span>3</span>] (ASPRE [<span>3</span>], BLASP 1998 [<span>4</span>], ERASME 2003 [<span>5</span>]) examining aspirin ≥ 75 mg, 61% of participants had poor adherence, and 40% commenced aspirin after 20 weeks.</p><p>Two systematic reviews investigated aspirin for prevention of pre-eclampsia and foetal growth restriction [<span>6</span>] (Roberge et al. 2016), and pre-term pre-eclampsia [<span>7</span>] (Roberge et al. 2018) respectively. The first [<span>6</span>] clearly demonstrated that aspirin commenced before 16 weeks reduced risk of pre-eclampsia (RR 0.57, 95% CI 0.43–0.75), severe pre-eclampsia (RR 0.47, 95% CI 0.26–0.83) and foetal growth restriction (RR 0.56, 95% CI 0.44–0.70). This was strongly dose-dependent. When","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"547-551"},"PeriodicalIF":4.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385811","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":"Maternal and Fetal Outcomes in Pregnant Women With Lung Cancer: A Population-Based Study on 9 Million Pregnancies and 40 Cases of Lung Cancer","authors":"Samantha Jacobson, Ahmad Badeghiesh, Haitham Baghlaf, Noah Margolese, Michael H. Dahan","doi":"10.1111/1471-0528.18090","DOIUrl":"10.1111/1471-0528.18090","url":null,"abstract":"<p>Lung cancer during pregnancy is exceedingly rare, with only 93 cases reported in the literature from 1953 to 2024 [<span>1</span>]. It carries the highest mortality rate of cancers in pregnancy (64.3%) [<span>2</span>] and increases risks of placental abnomalities, preterm delivery and low birth weight, with delayed diagnosis often due to nonspecific symptoms [<span>1, 2</span>]. Using a 9-million patient database, we identified 40 additional cases, analysed independently in this study, bringing the total to 133. The objective is to evaluate maternal and fetal outcomes using this dataset, comparing pregnancies with and without lung cancer.</p><p>We conducted a retrospective population-based study using data from the Health Care Cost and Utilisation Project-Nationwide Inpatient Sample (HCUP-NIS) database (2004–2014). Lung cancer cases were identified using the ICD-9 code 162.x. The study group included pregnant woman with lung cancer, while all other deliveries were controls. Categorical variables were compared using chi-squared tests, except when any cell frequency was less than 5, in which case Fisher's exact test was applied to ensure validity. Logistic regression analysed associations between lung cancer and maternal and fetal outcomes, estimating odds ratios (ORs) and 95% confidence intervals (CIs) adjusting for potential confounders, including maternal age, race, income, insurance type, smoking history, obesity, preexisting hypertension and diabetes.</p><p>Maternal characteristics are summarised in Table 1. Women with lung cancer were older, with significantly higher smoking rates (<i>p</i> = 0.01), chronic hypertension and pregestational diabetes (<i>p</i> < 0.0001). There were no significant differences in racial distribution, income quartiles, obesity, previous caesarean sections, thyroid disease or illicit drug. Medicaid and private insurance plans were more prevalent in the lung cancer group (<i>p</i> < 0.0001). Table 2 presents pregnancy, delivery and neonatal outcomes. Women with lung cancer had higher risks of placenta previa (OR: 5.67, 95% CI: 1.36–23.65, <i>p</i> = 0.017), abruptio placenta (OR: 4.99, 95% CI: 1.49–16.74, <i>p</i> = 0.009), operative vaginal delivery (OR: 4.88, 95% CI: 2.14–11.11, <i>p</i> < 0.001), transfusion (OR: 8.92, 95% CI: 3.28–24.28, <i>p</i> < 0.001), venous thromboembolism (VTE) (OR:21.83, 95% CI: 2.92–163.47, <i>p</i> < 0.001), disseminated intravascular coagulation (DIC) (OR: 8.45, 95% CI: 1.14–62.42, <i>p</i> = 0.04) and maternal death (OR: 195.02, 95% CI: 40.61–936.55, <i>p</i> < 0.001), though differences in spontaneous vaginal delivery became non-significant after adjustment (OR: 0.58, 95% CI: 0.30–1.14, <i>p</i> = 0.112). Neonatal outcomes were similar between groups.</p><p>These findings align with existing literature indicating that pregnant women with lung cancer are older and present with comorbidities like chronic hypertension and pregestational diabetes [<span>1</span>], w","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"834-837"},"PeriodicalIF":4.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385814","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":"Reproductive Implications and Management of Congenital Uterine Anomalies (2024 Second Edition)","authors":"M. A. Akhtar,&nbsp;S. H. Saravelos,&nbsp;T. C. Li,&nbsp;K. Jayaprakasan,&nbsp;the Royal College of Obstetricians and Gynaecologists","doi":"10.1111/1471-0528.18054","DOIUrl":"10.1111/1471-0528.18054","url":null,"abstract":"<p>Congenital uterine anomalies (CUAs) are malformations of the uterus (womb) that develop during fetal life. When a female baby is in her mother's uterus, her uterus develops as two separate halves from two tubular structures called Müllerian ducts, which fuse together before she is born. Anomalies that occur during the baby's development can be variable, from complete absence of the uterus through to more subtle anomalies, which are classified into specific categories. While conventional ultrasound is good at detecting CUAs, 3D ultrasound is used to confirm a diagnosis. If a complex uterine anomaly is suspected, additional investigations may be used, including MRI scanning, laparoscopy (where a camera is inserted into the cavity of the abdomen) and/or hysteroscopy (where a camera is placed in the uterine cavity). As there can be a link between CUAs and anomalies of the kidney and bladder, scans of these organs are also usually requested.</p><p>Although CUAs are present at birth, adult women typically do not have any symptoms, although some may experience painful periods. Most cases of CUA do not cause difficulties in becoming pregnant, and the outcome of pregnancy, in most cases, is good. However, these uterine anomalies are often discovered during investigations for infertility or miscarriage. Moreover, depending upon the type and severity of CUA, there may be increased risk of first and second trimester miscarriages, preterm birth, fetal growth restriction (smaller and lighter babies for the stage of pregnancy), pre-eclampsia (development of high blood pressure and protein in urine after the 20th week of pregnancy) and fetal malpresentation (baby not facing head-first down the birth canal) at birth. Surgical treatment may be considered for those who have had recurrent miscarriages and have a septate uterus, i.e. the uterine cavity is divided by a partition. In this case, surgery may reduce the chances of miscarriage. However, women should be informed that there is inconclusive and conflicting evidence regarding the improved likelihood of live births in this context. Further evidence from large randomised controlled trials are required to provide conclusive evidence-based recommendations for surgical treatment for septate uterus. Surgical treatment for other types of CUAs is not usually recommended as the risks outweigh potential benefits, and evidence for any benefits is lacking. Women with CUAs may be at an increased risk of preterm birth even after surgical treatment for a septate uterus. These people, if suspected to be at an increased risk of preterm birth based on the severity of CUA, should be followed up using an appropriate protocol for preterm birth as outlined in UK Preterm Birth Clinical Network Guidance.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"e86-e97"},"PeriodicalIF":4.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143258754","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":"Bringing Endometriosis to the Road of Contemporary Pain Science","authors":"Marcelo de França Moreira,&nbsp;Marco Aurelio Pinho Oliveira","doi":"10.1111/1471-0528.18096","DOIUrl":"10.1111/1471-0528.18096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endometriosis pain is mainly understood based on peripheral lesion characteristics and an outdated perspective equating nociception with pain. This limited view may divert understanding of interventions beyond peripheral logic, leading clinicians to see approaches targeting other processes as supplementary, limiting the effective addressing of treatment failure. Integrating critical advancements in pain and endometriosis can promote more comprehensive knowledge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This article provides a conceptual framework focusing on overlooked or less clearly linked areas concerning the interplay between nociception and factors influencing endometriosis pain. It explores the complexity of nociceptive processing, the association between neuromerically connected structures, and the role of the brain in pain perception. Further, it emphasizes adopting mechanism-based understanding of pain that integrates neurobiological aspects of the nociceptive apparatus and related systems, shaped by psychosocial factors contributing to a possible negative spiral in those living with endometriosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Aware of such a broader perspective can incentivize a balanced effort to inquire into peripheral lesion-related mechanisms and other domains potentially impacting endometriosis pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"685-693"},"PeriodicalIF":4.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124450","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":"Prenatal Screening for CMV Primary Infection: A Cost-Utility Model","authors":"Gebrael El Hachem,&nbsp;Thomas G. Poder,&nbsp;Catherine Mc Carey,&nbsp;Soren Gantt,&nbsp;Fatima Kakkar,&nbsp;Marc Sab,&nbsp;Christian Renaud,&nbsp;Isabelle Boucoiran","doi":"10.1111/1471-0528.18080","DOIUrl":"10.1111/1471-0528.18080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Congenital cytomegalovirus (CMV) infection is a major cause of deafness and neurodevelopmental disability in children. Our objective was to assess the cost utility of first-trimester serological CMV screening, compared to screening of high-risk pregnancies and no serological screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A decision-analytic model was created to compare the cost utility of three strategies from a healthcare sector perspective: universal first-trimester serological screening, screening only of high-risk pregnant women (both including antiviral prophylaxis in cases of primary infection) and serological testing triggered by foetal morphological ultrasound (no CMV serological screening).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Hypothetical population of 80 000 pregnant women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Probability, expected values and cost estimates were derived from published literature and local hospital and national insurance data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure</h3>\u0000 \u0000 <p>Cost per maternal and infant quality-adjusted life year (QALY) lost.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Universal serological screening was superior to both screening of high-risk women and no screening (utility of −0.42, −0.63 and − 0.87 QALY lost, respectively). Sensitivity analysis demonstrated that universal screening was the most cost-effective strategy regardless of the incidence of primary infection, the acceptability of amniocentesis and the efficacy of antiviral prophylaxis. In the Monte Carlo analyses, universal serological screening was the most cost-effective option in 96.36% of simulations. Universal serological screening would allow detection of 152 cases of primary maternal CMV infection and would prevent 29 cases of congenital CMV infection annually.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings support the adoption of a population-based prenatal screening programme for the prevention of congenital CMV infection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"805-815"},"PeriodicalIF":4.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077166","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":"Antenatal Physical Activity Interventions and Pregnancy Outcomes: A Systematic Review and Meta-Analysis With a Focus on Trial Quality","authors":"Amanda J. Poprzeczny,&nbsp;Andrea R. Deussen,&nbsp;Megan Mitchell,&nbsp;Laura Slade,&nbsp;Jennie Louise,&nbsp;Jodie M. Dodd","doi":"10.1111/1471-0528.18084","DOIUrl":"10.1111/1471-0528.18084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Guidelines recommending regular physical activity in pregnancy for improving pregnancy outcomes are informed by published meta-analyses. Inclusion of randomised trials of poor methodological quality may bias effect estimates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the validity of these recommendations by focusing on trial quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>Systematic search of PubMed, PubMed Central, Ovid Medline, Embase, Cochrane Central Register of Controlled Trials, and CINAHL from inception to 14 December 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Randomised trials evaluating an antenatal physical activity intervention alone, compared with no such intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Trial quality was assessed using the Cochrane Risk of Bias tool. Independent of this, studies were grouped based on degree of deviation from the intention to treat principle. Sequential meta-analysis was performed in which greater degrees of potential bias were allowed. Between intervention group comparisons used, relative risks or mean differences with 95% confidence intervals for dichotomous outcomes and continuous outcomes, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Overall, the quality of trial reporting was low. Only 5 trials (12.5%) were performed and analysed in keeping with the intention to treat principle. When considering only those trials performed rigorously, there was no evidence that antenatal physical activity improves pregnancy outcomes or limits gestational weight gain (WMD −0.60 kg; 95% CI −2.17, 0.98 WMD −0.60 kg; 95% CI −2.17, 0.98).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>When considering only trials at no/negligible risk of bias, antenatal physical activity interventions were not associated with improved pregnancy outcomes. Most trials were not methodologically rigorous. Incorporation of such meta-analyses into pregnancy care guidelines may result in inaccurate recommendations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"709-723"},"PeriodicalIF":4.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077167","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":"Evaluating the Effectiveness of Assisted Oocyte Activation in ICSI: Pairwise Meta-Analyses and Systematic Evidence Evaluation","authors":"Mohamed Fawzy,&nbsp;Mohamad AlaaEldein Elsuity,&nbsp;Yasmin Magdi,&nbsp;Mosab Mahmod Rashwan,&nbsp;Mostafa Ali Gad,&nbsp;Nehal Adel,&nbsp;Mai Emad,&nbsp;Dina Ibrahem,&nbsp;Sara El-Gezeiry,&nbsp;Ahmed Etman,&nbsp;Niveen Shaker Ahmed,&nbsp;Tamer Abdelhamed,&nbsp;Ahmed El-Damen,&nbsp;Ali Mahran,&nbsp;Gamal I. Serour,&nbsp;Mohamed Y. Soliman","doi":"10.1111/1471-0528.18085","DOIUrl":"10.1111/1471-0528.18085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Artificial oocyte activation (AOA) is used to improve fertilisation rates in intracytoplasmic sperm injection (ICSI) cycles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the effectiveness of AOA on fertilisation, embryo development, and clinical outcomes, including live birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>We searched PubMed, Cochrane, and Scopus from January 1990 to March 2024 using terms related to ‘artificial oocyte activation’ and ‘ICSI.’</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Study designs included randomised trials (RCTs), quasi-experimental, cohort, and case–control studies that evaluated AOA's effects on ICSI outcomes, provided quantitative data and were published in English.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Reviewers independently performed data extraction using a standardised form. Study quality was appraised using Joanna Briggs Institute (JBI) Checklists. Meta-analyses employed a random-effects model, and evidence was classified using a comprehensive numerical framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>We included 45 studies covering 56 787 mature oocytes, 7463 women for clinical pregnancies, and 7063 women for live births. AOA showed potential in increasing fertilisation rates in patients with a history of low or absent fertilisation but did not enhance embryo development or clinical outcomes. This effect diminished when excluding low-quality studies or focusing solely on RCTs. In other patient groups, AOA showed limited or nonsignificant benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Applying comprehensive evidence assessment, AOA showed potential in improving fertilisation rates in patients with fertilisation problems but no benefits for embryo development or live birth rates. This underscores the critical importance of rigorous evidence credibility in informing clinical practice in assisted conception.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"724-741"},"PeriodicalIF":4.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068882","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":"Factors Influencing Pregnant Women's Participation in Randomised Clinical Trials in India: A Qualitative Study","authors":"Mridula Shankar,&nbsp;Umesh Charantimath,&nbsp;Ashwini Dandappanavar,&nbsp;Alya Hazfiarini,&nbsp;Yeshita V. Pujar,&nbsp;Manjunath S. Somannavar,&nbsp;Sara Rushwan,&nbsp;Joshua P. Vogel,&nbsp;A. Metin Gülmezoglu,&nbsp;Shivaprasad S. Goudar,&nbsp;Meghan A. Bohren","doi":"10.1111/1471-0528.18074","DOIUrl":"10.1111/1471-0528.18074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore factors affecting participation of pregnant women in randomised clinical trials in Belagavi, Karnataka, India.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A qualitative study using semi-structured in-depth interviews and focus group discussions as data collection methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Primary, secondary and tertiary health facilities and their community catchment areas in Belagavi district.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Thirty-three in-depth interviews with health workers and previous participants of a pregnancy-focused trial, and 12 focus group discussions with currently pregnant women who had not previously participated in a clinical trial, family and community members, and accredited social health activists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Inductive thematic analysis with a team-based approach to interpretation in the study context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pregnant women were often unable to distinguish between maternal health programmes and trial interventions. Among previous trial participants, expectations of higher quality care were a key motivation for trial participation. Household gendered power relations and trust in the health workforce influenced decisional dynamics regarding participation. Health workers vouched for trial safety, once they assessed the intervention as acceptable. Trial Implementation by the health workforce required understanding and navigating pregnancy-related beliefs and practices in communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Anticipated health benefits, improved healthcare access, and trust in health workers are facilitators of trial participation. Engaging primary decision-makers is essential due to household gender dynamics. Trials must integrate strategies that clarify the distinct goals of research versus clinical care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"772-781"},"PeriodicalIF":4.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054291","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":"Impact of the COVID-19 Pandemic on Cervical Cancer Screening: An International Comparative Study by INTRePID","authors":"Maria Carla Lapadula,&nbsp;Dorsa Mohammadrezaei,&nbsp;Angela Ortigoza,&nbsp;Amanda Freitas,&nbsp;Javier Silva-Valencia,&nbsp;the INTRePID Consortium","doi":"10.1111/1471-0528.18077","DOIUrl":"10.1111/1471-0528.18077","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"676-677"},"PeriodicalIF":4.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992117","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":"Managing Pregnancies of Unknown Location With the M4 Prediction Model or the NICE Algorithm: A Randomised Controlled Trial With Cross-Sectional Diagnostic Accuracy Data","authors":"Johan Fistouris,&nbsp;Helen Garbergs,&nbsp;Katja Bergman,&nbsp;Christina Bergh,&nbsp;Annika Strandell","doi":"10.1111/1471-0528.18079","DOIUrl":"10.1111/1471-0528.18079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the diagnostic performance and clinical utility of the M4 prediction model and the NICE algorithm managing women with pregnancy of unknown location (PUL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The study has a superiority design regarding specificity for non-ectopic pregnancy for M4, given that the primary outcome of sensitivity for ectopic pregnancy (EP) is non-inferior in comparison with the NICE algorithm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Emergency gynaecology units in Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>595 women with PUL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were randomised (1:1) to M4 or the NICE algorithm after two serum human chorionic (hCG) levels and were categorised as high or low risk of having an EP. The diagnostic performance was evaluated on cross-sectional data and utility by parallel groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The proportion of EP categorised as high risk (sensitivity) and non-ectopic pregnancies categorised as low risk (specificity). Clinical outcomes were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sensitivity for EP was 79% (115 of 146) for M4 versus 85% (124 of 146) for the NICE algorithm, <i>p</i> = 0.1496 and the specificity for non-ectopic pregnancies was 67% (300 of 449) for M4 and 74% (334 of 449) for the NICE algorithm, <i>p</i> = 0.0003. Clinical outcomes were similar between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The sensitivity for EP by M4 was non-inferior to NICE, but specificity was better for the NICE algorithm. No between group differences were observed for clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>NCT 03461835, https://www.clinicaltrials.gov\u0000 </p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"742-751"},"PeriodicalIF":4.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992116","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}