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

{"title":"Experiences of vaginal lengthening treatment and sexual well-being in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: An interview study.","authors":"Amalie Hahn Jensen, Morten Krogh Herlin, Birgitta Trolle, Ida Vogel, Stina Lou","doi":"10.1111/1471-0528.17916","DOIUrl":"https://doi.org/10.1111/1471-0528.17916","url":null,"abstract":"<p><strong>Objective: </strong>To explore how women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome experience dilation or surgical vaginal lengthening treatment, and their current sexual well-being.</p><p><strong>Design: </strong>A qualitative interview study.</p><p><strong>Setting: </strong>Denmark.</p><p><strong>Population: </strong>Women aged ≥25 years diagnosed with MRKH syndrome.</p><p><strong>Methods: </strong>Semi-structured video interviews were conducted with 18 women. Interviews lasted a median of 92 min and were digitally recorded, transcribed and anonymised. Data were analysed using thematic analysis.</p><p><strong>Main outcome measures: </strong>A qualitative analysis of women's experiences.</p><p><strong>Results: </strong>The analysis identified three themes. Firstly, Experiences with dilation treatment revealed dilation as an awkward routine, especially for adolescents living with parents and yet to sexually debut. While some experienced successful vaginal lengthening, others faced treatment failure leading to frustration and self-blame. Secondly, Experiences with neovaginal surgery described the procedure as extremely painful but resulting in a 'normal size' vagina. Some women felt that the procedure had negatively impacted their self-confidence, and all underscored the importance of maturity before opting for surgery. Lastly, Current sex life and sexual well-being indicated a well-functioning sex life for many women, but with reported low sexual confidence and genital self-image due to the perceived 'deviance' of their genitalia.</p><p><strong>Conclusions: </strong>For women with MRKH syndrome, vaginal lengthening treatment, whether through dilation or surgery, may result in a 'normal size' vagina. However, according to the women's experiences, vaginal lengthening treatment does not adequately foster positive sexual esteem and genital self-image.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749573","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":"Same-day discharge after laparoscopic hysterectomy for benign/premalignant disease: A multicentre randomised controlled trial.","authors":"Suzanne J Dedden, Jacques W M Maas, Nicol A C Smeets, Dennis van Hamont, Freek A Groenman, Arianne C Lim, Huib A A M van Vliet, Jan Willem van der Steeg, Jaklien C Leemans, Patrick Meijer, Sander M J van Kuijk, Judith A F Huirne, Marlies Y Bongers, Peggy M A J Geomini","doi":"10.1111/1471-0528.17911","DOIUrl":"https://doi.org/10.1111/1471-0528.17911","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether physical function and quality of life was influenced by discharge on the same-day after a total laparoscopic hysterectomy.</p><p><strong>Design: </strong>Multicentre non-inferiority randomised controlled trial.</p><p><strong>Setting: </strong>Five teaching hospitals and two university hospitals in the Netherlands.</p><p><strong>Population: </strong>Patients undergoing laparoscopic hysterectomy for benign or premalignant disease.</p><p><strong>Methods: </strong>Following informed consent, participants were allocated 1:1 either to same-day discharge (SDD) or next-day discharge (NDD).</p><p><strong>Main outcome measures: </strong>The primary outcome was physical function at 7 days after surgery measured by the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function short Form 10A. Secondary outcomes were physical function and quality of life at 1 and 3 days and 6 weeks after surgery measured with PROMIS short Form 10A and the EuroQol questionnaire (EQ-5D-5L).</p><p><strong>Results: </strong>Two hundred and five patients were included of whom 105 were allocated to SDD and 100 to NDD. Physical function 7 days after surgery was 35.95 in the SDD group and 35.63 in the control group (mean difference 0.32; 95% CI [0.07-0.57]). As the upper limit of the 95% CI does not exceed the non-inferiority margin of 4 points, non-inferiority of SDD could be demonstrated. No difference in physical function nor quality of life on Days 1 and 3 and 6 weeks could be found.</p><p><strong>Conclusion: </strong>This research demonstrates same-day discharge after laparoscopic hysterectomy is non-inferior to next day discharge in physical function 7 days after surgery.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635618","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":"Comparing the treatment of endometriosis-related pain by excision of endometriosis or hysterectomy: A multicentre prospective cohort study.","authors":"Jonathan Lewin, Arvind Vashisht, Martin Hirsch, Bassel H Al-Wattar, Ertan Saridogan","doi":"10.1111/1471-0528.17910","DOIUrl":"https://doi.org/10.1111/1471-0528.17910","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness of endometriosis excision alone to excision plus hysterectomy, with and without bilateral oophorectomy, for endometriosis-related symptoms.</p><p><strong>Design: </strong>Multicentre prospective cohort.</p><p><strong>Setting: </strong>Eighty-six specialist endometriosis centres.</p><p><strong>Population: </strong>Women undergoing rectovaginal endometriosis surgery between 2009 and 2021.</p><p><strong>Methods: </strong>We performed multivariable regression with random effects for patient and centre, controlling for age, BMI, smoking, laparoscopic versus open approach and type of bowel surgery performed, with sensitivity analysis for loss to follow-up.</p><p><strong>Main outcome measures: </strong>Pain scores, bowel symptoms and quality-of-life measures.</p><p><strong>Results: </strong>Compared to endometriosis excision alone, women undergoing hysterectomy with conservation of ovaries had greater improvement in non-cyclical pain (MD: 1.41/10, 95% CI: 1.03-1.78, p < 0.001), dyspareunia (MD: 1.12/10, 95% CI: 0.71-1.53, p < 0.001), back pain (MD: 1.29/10, 95% CI: 0.92-1.67, p < 0.001) and quality-of-life scores (MD: 8.77/100, 95% CI: 5.79-11.75, p < 0.001) at 24 months post-operatively. Women undergoing hysterectomy with bilateral oophorectomy also had greater improvement in non-cyclical pelvic pain (MD: 2.22/10, 95% CI: 1.80-2.63, p < 0.001), dyspareunia (MD: 1.05/10, 95% CI: 0.59-1.52, p < 0.001), back pain (MD: 1.18/10, 95% CI: 0.77-1.59, p < 0.001) and quality of life (MD: 12.41/100, 95% CI: 9.07-15.74, p < 0.001) at 24 months compared to endometriosis excision alone. Compared to hysterectomy with ovarian conservation, hysterectomy with bilateral oophorectomy was associated with greater improvement in non-cyclical pelvic pain (MD: 0.81/10, 95% CI: 0.32-1.30, p = 0.001) at 24 months and quality of life (MD: 3.74/100, 95% CI: 0.56-6.92, p = 0.021) at 12 months, although this result was sensitive to loss to follow-up.</p><p><strong>Conclusions: </strong>Patients who undergo endometriosis excision plus hysterectomy experience greater improvement in pain and quality of life compared to those who have endometriosis excision alone. There are additional benefits of bilateral oophorectomy with hysterectomy, although its value is less clear due to loss of follow-up.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621714","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":"Menopausal stages and overactive bladder symptoms in middle-aged women: A cross-sectional study.","authors":"Jungeun Park, Yoosoo Chang, Jae Heon Kim, Hye Rin Choi, Ria Kwon, Ga-Young Lim, Jiin Ahn, Kye-Hyun Kim, Hoon Kim, Yun Soo Hong, Di Zhao, Juhee Cho, Eliseo Guallar, Hyun-Young Park, Seungho Ryu","doi":"10.1111/1471-0528.17912","DOIUrl":"https://doi.org/10.1111/1471-0528.17912","url":null,"abstract":"<p><strong>Objective: </strong>To examine the prevalence of overactive bladder (OAB) according to menopausal stages in middle-aged women.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Total Healthcare Center in South Korea.</p><p><strong>Population: </strong>Middle-aged Korean women (n=3469, mean age, 49.5 ± 2.9 years).</p><p><strong>Methods: </strong>Menopausal stages were defined according to the Stages of Reproductive Aging Workshop +10 criteria, and menopausal symptoms were assessed using the Korean version of Menopause-Specific Quality of Life (MENQOL). Logistic regression models were used to estimate prevalence ratios with 95% confidence intervals for OAB according to menopausal stage and to assess the associations with menopausal symptoms.</p><p><strong>Main outcome measures: </strong>OAB symptoms were evaluated using the Overactive Bladder Symptom Score (OABSS).</p><p><strong>Results: </strong>The prevalence of OAB increased with menopausal stage; however, the multivariable-adjusted prevalence ratios for women in menopausal transition and postmenopausal stage were insignificant (p_trend = 0.160) compared to those for premenopausal women. Among individual OAB symptoms, the multivariable-adjusted prevalence ratios for nocturia increased with menopausal stage in a dose-response manner (p_trend = 0.005 for 1 time/day; p_trend < 0.001 for ≥2 times/day). The association between menopausal stages and nocturia occurring ≥2 times/day was evident in women without OAB and with relatively high MENQOL scores, vasomotor symptoms and difficulty sleeping.</p><p><strong>Conclusions: </strong>The prevalence of OAB, particularly nocturia, increased with menopausal stage, and the association was obvious in women with other menopausal symptoms. This finding underscores the importance of addressing nocturia as a potential menopausal symptom in middle-aged women. Further studies are required to understand the mechanisms linking OAB with menopausal symptoms in middle-aged women.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592041","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":"Stillbirth risk by fetal size among 126.5 million births in 15 countries from 2000 to 2020: A fetuses-at-risk approach.","authors":"Yemisrach B Okwaraji, Lorena Suárez-Idueta, Eric O Ohuma, Ellen Bradley, Judith Yargawa, Veronica Pingray, Gabriela Cormick, Adrienne Gordon, Vicki Flenady, Erzsébet Horváth-Puhó, Henrik Toft Sørensen, Liili Abuladze, Mohammed Heidarzadeh, Narjes Khalili, Khalid A Yunis, Ayah Al Bizri, Arturo Barranco, Aimée E van Dijk, Lisa Broeders, Fawzya Alyafei, Tawa O Olukade, Neda Razaz, Jonas Söderling, Lucy K Smith, Ruth J Matthews, Rachael Wood, Kirsten Monteath, Isabel Pereyra, Gabriella Pravia, Sarka Lisonkova, Qi Wen, Joy E Lawn, Hannah Blencowe","doi":"10.1111/1471-0528.17890","DOIUrl":"https://doi.org/10.1111/1471-0528.17890","url":null,"abstract":"<p><strong>Objective: </strong>To compare stillbirth rates and risks for small for gestational age (SGA), large for gestational age (LGA) and appropriate for gestational age (AGA) pregnancies at 24-44 completed weeks of gestation using a birth-based and fetuses-at-risk approachs.</p><p><strong>Design: </strong>Population-based, multi-country study.</p><p><strong>Setting: </strong>National data systems in 15 high- and middle-income countries.</p><p><strong>Population: </strong>Live births and stillbirths.</p><p><strong>Methods: </strong>A total of 151 country-years of data, including 126 543 070 births across 15 countries from 2000 to 2020, were compiled. Births were categorised into SGA, AGA and LGA using INTERGROWTH-21st standards. Gestation-specific stillbirth rates, with total births as the denominator, and gestation-specific stillbirth risks, with fetuses still in utero as the denominator, were calculated from 24 to 44 weeks of gestation.</p><p><strong>Main outcome measures: </strong>Gestation-specific stillbirth rates and risks according to size at birth.</p><p><strong>Results: </strong>The overall stillbirth rate was 4.22 per 1000 total births (95% CI 4.22-4.23) across all gestations. Applying the birth-based approach, the stillbirth rates were highest at 24 weeks of gestation, with 621.6 per 1000 total births (95% CI 620.9-622.2) for SGA pregnancies, 298.4 per 1000 total births (95% CI 298.1-298.7) for AGA pregnancies and 338.5 per 1000 total births (95% CI 337.9-339.0) for LGA pregnancies. Applying the fetuses-at-risk approach, the gestation-specific stillbirth risk was highest for SGA pregnancies (1.3-1.4 per 1000 fetuses at risk) prior to 29 weeks of gestation. The risk remained stable between 30 and 34 weeks of gestation, and then increased gradually from 35 weeks of gestation to the highest rate of 8.4 per 1000 fetuses at risk (95% CI 8.3-8.4) at ≥42 weeks of gestation. The stillbirth risk ratio (RR) was consistently high for SGA compared with AGA pregnancies, with the highest RR observed at ≥42 weeks of gestation (RR 9.2, 95% CI 15.2-13.2), and with the lowest RR observed at 24 weeks of gestation (RR 3.1, 95% CI 1.9-4.3). The stillbirth RR was also consistently high for SGA compared with AGA pregnancies across all countries, with national variability ranging from RR 0.70 (95% CI 0.43-0.97) in Mexico to RR 8.6 (95% CI 8.1-9.1) in Uruguay. No increased risk for LGA pregnancies was observed.</p><p><strong>Conclusions: </strong>Small for gestational age (SGA) was strongly associated with stillbirth risk in this study based on high-quality data from high- and middle-income countries. The highest RRs were seen in preterm gestations, with two-thirds of the stillbirths born as preterm births. To advance our understanding of stillbirth, further analyses should be conducted using high-quality data sets from low-income settings, particularly those with relatively high rates of SGA.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591962","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":"Clinical algorithms for the monitoring and management of spontaneous, uncomplicated labour and childbirth","authors":"Julia Pasquale,&nbsp;Celina Gialdini,&nbsp;Mónica Chamillard,&nbsp;Virginia Diaz,&nbsp;Marcus J. Rijken,&nbsp;Joyce L. Browne,&nbsp;Mimi Tin Yan Seto,&nbsp;Ka Wang Cheung,&nbsp;Mercedes Bonet,&nbsp;WHO Intrapartum Care Algorithms Working Group","doi":"10.1111/1471-0528.17895","DOIUrl":"10.1111/1471-0528.17895","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To develop evidence-based clinical algorithms for the assessment and management of spontaneous, uncomplicated labour and vaginal birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Pregnant women at any stage of labour, with singleton, term pregnancies considered to be at low risk of developing complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Health facilities in low- and middle-income countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>We searched for relevant published algorithms, guidelines, systematic reviews and primary research studies on Cochrane Library, PubMed, and Google on terms related to spontaneous, uncomplicated labour and childbirth up to 01 June 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case scenarios</h3>\u0000 \u0000 <p>Three case scenarios were developed to cover assessments and management for spontaneous, uncomplicated first, second and third stage of labour. The algorithms provide pathways for definition, assessments, diagnosis, and links to other algorithms in this series for management of complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We have developed three clinical algorithms to support evidence-based decision making during spontaneous, uncomplicated labour and vaginal birth. These algorithms may help guide health care staff to institute respectful care, appropriate interventions where needed, and potentially reduce the unnecessary use of interventions during labour and childbirth.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17895","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581368","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 vaginal birth after caesarean in limited resource settings.","authors":"Yinka Oyelese","doi":"10.1111/1471-0528.17909","DOIUrl":"https://doi.org/10.1111/1471-0528.17909","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565055","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":"Most donor-conceived people have good psychological health.","authors":"Tessa Copp, Karin Hammarberg","doi":"10.1111/1471-0528.17908","DOIUrl":"https://doi.org/10.1111/1471-0528.17908","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565054","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":"Maternal asthma during pregnancy and risks of allergy and asthma in progeny: A systematic review and meta-analysis.","authors":"Andrea J Roff, Joshua L Robinson, Sarah J Hammond, Jana Bednarz, Andrew Tai, Vicki L Clifton, Janna L Morrison, Kathryn L Gatford","doi":"10.1111/1471-0528.17900","DOIUrl":"https://doi.org/10.1111/1471-0528.17900","url":null,"abstract":"<p><strong>Background: </strong>Clinical and preclinical evidence indicate that in utero maternal asthma exposure increases progeny asthma risk. Whether maternal asthma also increases the risks of progeny allergy is unclear.</p><p><strong>Objectives: </strong>To synthesise the available evidence on the relationship between in utero exposure to maternal asthma and postnatal asthma, wheezing and allergic diseases (Prospero: CRD42020201538).</p><p><strong>Search strategy: </strong>We systematically searched MEDLINE [PubMed], Embase [Ovid], Web of Science, Informit Health, the Cochrane Library, CINAHL [EBSCOhost], MedNar [Deep Web Technologies], ProQuest Theses and Dissertations, Scopus [Elsevier] and Trove, to the end of 2023.</p><p><strong>Selection criteria: </strong>Studies reporting asthma, wheeze and/or allergic disease in progeny of women with and without asthma or with asthma classified by control, exacerbation or severity.</p><p><strong>Data collection and analysis: </strong>Double screening, selection, data extraction and quality assessment were performed, using Joanna Briggs Institute (JBI) scoring.</p><p><strong>Main results: </strong>Of 134 non-overlapping studies, 127 were included in ≥1 meta-analysis. Maternal asthma ever was associated with greater risks of asthma (65 studies, risk ratio [95% confidence interval] 1.76 [1.57-1.96]), wheeze (35 studies, 1.59 [1.52-1.66]), food allergy (5 studies, 1.32 [1.23-1.40]), allergic rhinitis (7 studies, 1.18 [1.06-1.31]) and allergic dermatitis (14 studies, 1.17 [1.11-1.23]) ever in progeny. Asthma during the pregnancy, more severe, and uncontrolled maternal asthma were each associated with greater risks of progeny asthma.</p><p><strong>Conclusions: </strong>Children of mothers with asthma are at increased risk for the development of allergic diseases. Whether improved maternal asthma control reduces risks of child allergy as well as asthma requires further investigation.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555847","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":"Caesarean section and anal incontinence in women after obstetric anal sphincter injury: A systematic review and meta-analysis.","authors":"Emily Carter, Rebecca Hall, Kelechi Ajoku, Jenny Myers, Rohna Kearney","doi":"10.1111/1471-0528.17899","DOIUrl":"https://doi.org/10.1111/1471-0528.17899","url":null,"abstract":"<p><strong>Background: </strong>Approximately 50% women who give birth after obstetric anal sphincter injury (OASI) develop anal incontinence (AI) over their lifetime.</p><p><strong>Objective: </strong>To evaluate current evidence for a protective benefit of planned caesarean section (CS) to prevent AI after OASI.</p><p><strong>Search strategy: </strong>MEDLINE/PubMed, Embase 1974-2024, CINAHL and Cochrane to 7 February 2024 (PROSPERO CRD42022372442).</p><p><strong>Selection criteria: </strong>All studies reporting outcomes after OASI and a subsequent birth, by any mode.</p><p><strong>Data collection and analysis: </strong>Eighty-six of 2646 screened studies met inclusion criteria, with nine studies suitable to meta-analyse the primary outcome of 'adjusted AI' after OASI and subsequent birth. Subgroups: short-term AI, long-term AI, AI in asymptomatic women.</p><p><strong>Secondary outcomes: </strong>total AI, quality of life, satisfaction/regret, solid/liquid/flatal incontinence, faecal urgency, AI in women with and without subsequent birth, change in AI pre- to post- subsequent birth.</p><p><strong>Main results: </strong>There was no evidence of a difference in adjusted AI after subsequent vaginal birth compared with CS after OASI across all time periods (OR = 0.92, 95% CI 0.72-1.20; 9 studies, 2104 participants, I² = 0% p = 0.58), for subgroup analyses or secondary outcomes. There was no evidence of a difference in AI in women with or without subsequent birth (OR = 1.00 95% CI 0.65-1.54; 10 studies, 970 participants, I² = 35% p = 0.99), or pre- to post- subsequent birth (OR = 0.79 95% CI 0.51-1.25; 13 studies, 5496 participants, I² = 73% p = 0.31).</p><p><strong>Conclusions: </strong>Due to low evidence quality, we are unable to determine whether planned caesarean is protective against AI after OASI. Higher quality evidence is required to guide personalised decision-making for asymptomatic women and to determine the effect of subsequent birth mode on long-term AI outcomes.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535818","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}