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

{"title":"RETRACTION: Evaluation of Postpartum Blood Loss After Misoprostol-Induced Labour","authors":"","doi":"10.1111/1471-0528.18318","DOIUrl":"10.1111/1471-0528.18318","url":null,"abstract":"<div>\u0000 \u0000 <p>\u0000 RETRACTION: <span>M. El-Sedeek</span>, <span>E.E. Awad</span>, <span>S.M. Elsebaey</span>, “ <span>Evaluation of Postpartum Blood Loss After Misoprostol-Induced Labour</span>,” <i>BJOG: An International Journal of Obstetrics and Gynaecology</i>, <span>116</span>, <span>3</span> (<span>2009</span>): <span>431</span>–<span>435</span>, https://doi.org/10.1111/j.1471-0528.2008.02054.x.\u0000 </p>\u0000 <p>The above article, published online on 21 January 2009 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Aris Papageorghiou; and John Wiley &amp; Sons Ltd. UK. Concerns were raised by a third party regarding the statistical data reported in the article. The third party noted the p-values reported in Table 1 were not compatible with the article's summary data, and the distribution data featured in the scatterplots of Figures 3 and 4 was unusual. An independent expert evaluated the summary data reported in the article and confirmed that many of the statistical results were not reproducible using reported methods. The expert noted that there were several instances of data anomalies within the article, including the distribution of postpartum bleeding within Group 1, where the scores reported feature a pattern that is unusual. The authors did not respond when asked for their original data and clarification. As a result, the data and conclusions are considered unreliable, and the article must be retracted.</p>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 11","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677639","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":"Clinical Grade of Obstetric Anal Sphincter Injuries and Prediction of Mode of Birth Recommendations: A 20-Year Retrospective Analysis","authors":"Nicola Adanna Okeahialam,&nbsp;Ranee Thakar,&nbsp;Abdul H. Sultan","doi":"10.1111/1471-0528.18303","DOIUrl":"10.1111/1471-0528.18303","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine whether assessment of symptoms and clinical grade of obstetric anal sphincter injuries (OASIs) is predictive of subsequent endoanal ultrasound (EAUS) and anal manometry (AM) findings to guide mode of birth recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Twenty-year retrospective analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Tertiary urogynaecology unit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>Women (<i>n</i> = 607) with a history of OASI in the second half of a subsequent pregnancy, 2002–2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A St Mark's Incontinence Score (SMIS), AM and EAUS were completed. An elective caesarean section (ELCS) was recommended if there was an external anal sphincter (EAS) defect and an incremental maximum squeeze pressure (IMSP) &lt; 20 mmHg.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Accuracy, sensitivity, specificity, negative and positive predictive values (NPV and PPV) with 95% CI were calculated for the assessment of anorectal symptoms and clinical grade of tear relative to EAUS and AM findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Accuracy of symptom assessment and clinical grade of tear in determining those with an EAS defect and IMSP &lt; 20 was 75.4% (95% CI 69.3%), 69.6% (95% CI 63.8%–75.0%), 62.7% (95% CI 50.0–74.2) and 43.6% (95% CI 27.8%–60.4%) with 3a, 3b, 3c and fourth degree tears, respectively. 3a tears had the highest NPV for EAS defect and IMSP &lt; 20 (100.0% [95% CI 97.9–100.0]), EAS defect alone (97.1% [95% CI 94.7%–98.4%]) and IMSP &lt; 20 alone (93.5% [95% CI 90.1–82.1]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Symptom assessment and clinical grade of OASI cannot be used solely to guide mode of delivery recommendations in a subsequent birth. Absence of symptoms in women with 3a tears has a high NPV, meaning these women can be recommended a vaginal birth.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 12","pages":"1802-1809"},"PeriodicalIF":4.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677662","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":"RETRACTION: Plasma Orexin-A Levels in Postmenopausal Women: Possible Interaction With Estrogen And Correlation With Cardiovascular Risk Status","authors":"","doi":"10.1111/1471-0528.18317","DOIUrl":"10.1111/1471-0528.18317","url":null,"abstract":"<p>\u0000 <b>RETRACTION</b>: <span>M. El-Sedeek</span>, <span>A.A. Korish</span>, and <span>M.M. Deef</span>, “ <span>Plasma Orexin-A Levels in Postmenopausal Women: Possible Interaction With Estrogen And Correlation With Cardiovascular Risk Status</span>,” <i>BJOG: An International Journal of Obstetrics and Gynaecology</i> <span>117</span>, no. <span>4</span> (<span>2010</span>): <span>488</span>–<span>492</span>, https://doi.org/10.1111/j.1471-0528.2009.02474.x.\u0000 </p><p>The above article, published online on 08 February 2010 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Aris Papageorghiou; and John Wiley &amp; Sons Ltd. UK. Concerns were raised by a third party regarding the reported calculations and statistical results. The third party was unable to recalculate the mean BMI using the reported weight and height metrics and also noted that the <i>F</i> values in Tables 1 and 2 were unusually large and the p-values reported in these tables do not appear compatible with the reported summary data. An independent expert evaluated the summary data reported in the article and confirmed the incompatibility of the statistical results and found that both the reported and recalculated <i>F</i> values are implausibly large. The authors did not respond when asked for their original data and clarification. As a result, the data and conclusions are considered unreliable, and the article must be retracted.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 11","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18317","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677642","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 Introduction of the vNOTES Hysterectomy in The Netherlands: A Nationwide Cohort Study","authors":"Hilde M. M. Sluijter,&nbsp;Ilse P. W. Bekkers,&nbsp;Rebecca Henschen,&nbsp;Marcel van Alphen,&nbsp;Inge Ebisch,&nbsp;Helen S. Kok,&nbsp;Julien Labrie,&nbsp;Sanne A. L. van Leijsen,&nbsp;Angéle L. M. Oei,&nbsp;Louisette W. Peters,&nbsp;Brenda M. Pijlman,&nbsp;J. Marko Sikkema,&nbsp;Matthieu Y. van der Vlist,&nbsp;Kevin G. J. A. Voogdt,&nbsp;Nikki Vos,&nbsp;Jorien M. Woolderink,&nbsp;Nicol A. C. Smeets,&nbsp;Anne Damoiseaux,&nbsp;Aleida G. Huppelschoten,&nbsp;Martine L. H. Wassen,&nbsp;Huib A. A. M. van Vliet","doi":"10.1111/1471-0528.18307","DOIUrl":"10.1111/1471-0528.18307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to assess the peri- and postoperative outcomes of the vNOTES hysterectomy in the Netherlands during implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Nationwide cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>vNOTES hysterectomies performed in the Netherlands by 15 hospitals since the implementation of the technique, from August 2019 to September 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>673 patients undergoing vNOTES hysterectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Descriptive data are presented as frequencies with percentage or mean with range. Logistic regression was used to assess the risk of conversions/complications per BMI group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Peri- and postoperative outcomes such as operating time, conversions, and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean operating time was 67.4 min (range 24–210). There were 37 (5.5%) conversions and 94 (15.5%) complications. Nineteen (2.8%) complications were perioperative, and 75 (12.7%) postoperative. Ten (1.5%) of the perioperative complications were classified as Clavien-Dindo (CD) 1, and nine (1.3%) as CD3. Postoperatively, 18 patients (3.1%) had a reintervention (<i>N</i> = 17 CD3, <i>N</i> = 1 CD4), and two (0.3%) patients were admitted to the intensive care unit (CD4). The mean blood loss was 127 mL (range 50–2000), and 220 (37%) of patients were discharged the same day.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This large nationwide cohort study during implementation of the vNOTES hysterectomy demonstrates the safety and feasibility of this upcoming technique, reporting on a short surgery duration and a similar complication percentage compared to other methods of hysterectomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 12","pages":"1810-1816"},"PeriodicalIF":4.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652815","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":"Adherence to a Cholesterol-Lowering Diet and the Risk of Female Hormone-Related Cancers: An Analysis From a Case–Control Study Network","authors":"Giovanna Esposito,&nbsp;Livia S. A. Augustin,&nbsp;David J. A. Jenkins,&nbsp;Monica Ferraroni,&nbsp;Fabio Parazzini,&nbsp;Anna Crispo,&nbsp;Luigino Dal Maso,&nbsp;Eva Negri,&nbsp;Carlo La Vecchia,&nbsp;Jerry Polesel,&nbsp;Matteo Di Maso","doi":"10.1111/1471-0528.18302","DOIUrl":"10.1111/1471-0528.18302","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We investigated the association between a cholesterol-lowering diet score and the risk of female hormone-related cancers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>We used data on 2108 breast, 367 endometrial, 869 ovarian cancer cases and corresponding controls from an Italian network of case–control studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Hospital-based.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Breast, endometrial, and ovarian cancer cases and controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We assessed the adherence to a cholesterol-lowering diet using a score based on seven dietary components: high intake of non-cellulosic polysaccharides, monounsaturated fatty acids, legumes, seeds/corn oil; low intake of saturated fatty acids, dietary cholesterol, and glycaemic index. We assigned one point for each component if the requirement was met; otherwise, we assigned zero. The overall score was calculated by summing up points over the seven components, ranging from 0 (null) to 7 (complete adherence).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated through unconditional logistic regression models including terms for potential confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to a low adherence to a cholesterol-lowering diet (0–2 points), the ORs for a higher adherence (5–7 points) were 0.74 (95% CI: 0.60–0.92) for breast, 0.48 (95% CI: 0.30–0.77) for endometrial, and 0.77 (95% CI: 0.57–0.99) for ovarian cancer. The ORs for a 1-point increment in the score were 0.87 (95% CI: 0.97–0.80), 0.80 (95% CI: 0.72–0.90), and 0.90 (95% CI: 0.84–0.97) for breast, endometrial, and ovarian cancers, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A cholesterol-lowering diet may favourably affect the risk of female hormone-related cancers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 12","pages":"1791-1801"},"PeriodicalIF":4.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652807","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":"Hormonal Contraception and Endometrial Thickness in IVF/ICSI Cycles: A Multicentre Historical Cohort Study","authors":"Mette Peters Michaelsen,&nbsp;Laura Cæcilie Nielsen,&nbsp;Michelle Poulsen,&nbsp;Regitze Gyldenholm Skals,&nbsp;Bettina Troest,&nbsp;Janne Gasseholm Bentzen,&nbsp;Jimmi Elers,&nbsp;Anette Vestergaard Gabrielsen,&nbsp;Marie Louise Grøndahl,&nbsp;Betina Boel Povlsen,&nbsp;Mikael Tang-Pedersen,&nbsp;Ulrik Schiøler Kesmodel","doi":"10.1111/1471-0528.18295","DOIUrl":"10.1111/1471-0528.18295","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To study the association between previous use of levonorgestrel intrauterine system (LNG-IUS) and endometrial thickness (EMT) in women undergoing in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Multicentre historical cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Eight Danish public and private fertility clinics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>12786 women aged 18–46 years contributing with an EMT measurement from 22 464 different IVF/ICSI treatment cycles between 2000 and 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Exposure was previous use of LNG-IUS, combined oral contraceptive pills (OCPs), progeste-only pills (POPs), no/other contraception or combined, cumulated use of contraception when more contraceptives had been used during the inclusion period. Further, ever use of LNG-IUS was categorised into 0–3 years, &gt; 3–6 years, &gt; 6–9 years and &gt; 9 years. Mixed effect logistic regression adjusted for age, BMI, smoking, educational level, total FSH dose and fertility clinic was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure (s)</h3>\u0000 \u0000 <p>EMT (&lt; 7 mm ≥ 7 mm).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Statistically significantly higher odds of EMT ≥ 7 mm were found for OCPs [odds ratio (OR) 3.53 (95% confidence interval (95% CI) 1.29–9.65)], POPs [OR 6.43, (95% CI 1.45–28.63)] and no/other contraception [OR 6.67, (95% CI 2.37–18.74]) relative to LNG-IUS in IVF/ICSI cycles. Further, all duration categories of ever use of LNG-IUS were associated with statistically significantly lower odds of obtaining an EMT ≥ 7 mm compared to no/other contraception.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this study, previous use of LNG-IUS was associated with decreased endometrial growth in women undergoing IVF/ICSI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 11","pages":"1681-1688"},"PeriodicalIF":4.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640102","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":"Metformin for the Prevention of Hyperemesis Gravidarum: Cautious Enthusiasm","authors":"Cathy Nelson-Piercy,&nbsp;Melanie Nana,&nbsp;Catherine Williamson,&nbsp;Rebecca Painter","doi":"10.1111/1471-0528.18297","DOIUrl":"10.1111/1471-0528.18297","url":null,"abstract":"<p><b>Linked article:</b> This is a mini commentary on Sillis et al., pp. 1772–1778 in this issue. To view this article, visit https://doi.org/10.1111/1471-0528.18238.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 12","pages":"1779-1780"},"PeriodicalIF":4.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640105","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":"Author Reply.","authors":"Adam Brook, Georgia Baynes, Jonathan Scargill, Angelos Evangelinos, Charlotte Brennan-Richardson, Freya Dow, Yuval Ginsberg, Tal Weissbach, Jana Brodszki, Eva Hansson, Anke Diemert, Kurt Hecher, Katarzyna Maksym, Neil Marlow, Rebecca N Spencer, Anna L David, Stefan R Hansson, Paul Brownbill","doi":"10.1111/1471-0528.18268","DOIUrl":"https://doi.org/10.1111/1471-0528.18268","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644075","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":"What Is the Safest Population-Level Caesarean Delivery Rate? A National Cohort Study Using Natural Variation","authors":"Dag Moster,&nbsp;Allen J. Wilcox,&nbsp;Rolv Terje Lie","doi":"10.1111/1471-0528.18301","DOIUrl":"10.1111/1471-0528.18301","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Ten to fifteen per cent has been proposed for many decades as the optimal level of caesarean section, with little supporting data. Norway provides a natural experiment in which local variations in the use of caesarean section can be related to health outcomes in the context of free access to high-quality medical services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective national cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Norway.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Norwegian deliveries 1995–2014.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We calculated annual rates of caesarean delivery and health outcomes for 435 municipalities. To avoid hospital referral bias, the mother's municipality of residence was the unit of analysis. Caesarean-delivery rates in each year were based on the 2 years before and after, avoiding indication bias. Analyses were adjusted for year, with additional adjustments in sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Maternal mortality, severe maternal haemorrhage and perineal tears; stillbirth and neonatal death, neonatal encephalopathy and cerebral palsy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 1 172 546 deliveries across 8647 municipality-year combinations over a 20-year period. Caesarean rates across municipalities ranged from about 10% to 20%, with quartile values of 13%, 16% (median) and 18%. Most adverse outcomes were least frequent in municipalities with caesarean rates above 15%. Lower rates of caesarean delivery were associated with more frequent occurrence of perineal tears (OR 1.41, 95% confidence interval 1.36–1.46), neonatal encephalopathy (OR 1.91, 1.71–2.13), cerebral palsy (1.48, 1.24–1.77) and stillbirths (OR 1.07, 0.99–1.17), but also with less frequent maternal haemorrhage (OR 0.81, 0.77–0.85). Further adjustments had minimal effect on estimates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In Norway, a country with free access to high-quality medical care, a local caesarean-delivery rate of 10% was associated with nearly a two-fold risk of neonatal encephalopathy and a 50% higher occurrence of cerebral palsy compared with areas with a caesarean-delivery rate of 20%.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 12","pages":"1781-1788"},"PeriodicalIF":4.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622012","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":"Association Between Post-Partum Anaemia and Depressive Symptoms at Two Months After Vaginal Delivery: A Secondary Analysis of the TRAAP Trial","authors":"Lola Loussert,&nbsp;Loïc Sentilhes,&nbsp;Alizée Froeliger,&nbsp;Aurélien Seco,&nbsp;Marie Pierre Bonnet,&nbsp;Sarah Tebeka,&nbsp;Catherine Deneux-Tharaux,&nbsp;the TRAAP study group","doi":"10.1111/1471-0528.18289","DOIUrl":"10.1111/1471-0528.18289","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the association between maternal haemoglobinaemia in the immediate post-partum period and PPD symptoms 2 months after vaginal delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Ancillary cohort study of the TRAAP trial, a multicentre trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>In France, 2015–2016.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women with a singleton pregnancy and vaginal delivery ≥ 35 weeks. We excluded women with known psychiatric conditions and those who were non-respondent to the Edinburgh Post-partum Depression Scale (EPDS) questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The exposure was immediate post-partum haemoglobinemia (systematically collected in TRAAP trial) as a continuous variable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome</h3>\u0000 \u0000 <p>PPD symptoms at 2 months post-partum, defined as an EPDS score ≥ 11. We also differentiated two levels of PPD symptom severity: moderate (11 ≤ EPDS &lt; 13) and severe (EPDS ≥ 13) depressive symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Amongst the 2672 women included, 1115 (43.6%) had post-partum anaemia (haemoglobin &lt; 11 g/dL) in the immediate post-partum and 369 (13.8%) had PPD symptoms at 2 months. The relation between haemoglobin and PPD symptoms was linear. In the multivariable analysis, each 1 g/dL increase in haemoglobin level was associated with a 9% decrease in the risk of post-partum depression symptoms (adjusted Relative Risk 0.91; 95% CI 0.82–0.997). Post-partum haemoglobin was specifically associated with moderate depressive symptoms (adjusted Relative Risk 0.84; 95% CI, 0.72–0.98) but not with severe depressive symptoms (aRR 0.95; 95% CI, 0.84–1.07).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In women with vaginal delivery, each 1 g/dL increase in haemoglobin level was associated with a 9% decrease in the risk of post-partum depression symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 11","pages":"1644-1654"},"PeriodicalIF":4.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621998","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}