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

{"title":"Towards the Development of a Conceptual Framework of the Determinants of Pre-Eclampsia: A Hierarchical Systematic Review of Social Determinants.","authors":"Mai-Lei Woo Kinshella, Kelly Pickerill, Sarina Prasad, Olivia Campbell, Jalila Devji, Lívia Vieira Lopes, Rosa Balleny, Terteel Elawad, Rachel Craik, Marie-Laure Volvert, Hiten D Mistry, Hannah Blencowe, Véronique Filippi, Peter von Dadelszen, Laura A Magee, Marianne Vidler","doi":"10.1111/1471-0528.18082","DOIUrl":"https://doi.org/10.1111/1471-0528.18082","url":null,"abstract":"<p><strong>Background: </strong>Existing reviews of pre-eclampsia determinants have focused on clinical and genetic risk factors.</p><p><strong>Objective: </strong>To evaluate social determinants for pre-eclampsia prevention.</p><p><strong>Search strategy: </strong>Systematic searches were conducted from relevant electronic databases from inception of each database to 30th December 2024.</p><p><strong>Selection criteria: </strong>Reviews and large cohort studies (≥ 1000 participants), published between 2013 and 2024, reporting quantitative associations between social determinant exposures and pre-eclampsia outcomes.</p><p><strong>Data collection and analysis: </strong>Titles and abstracts, then relevant full-texts were reviewed by two reviewers, independently. Strength of association was evaluated as 'definite' (odds ratios [OR] or relative risk [RR] ≥ 3.00 or < 0.33), 'probable' (OR or RR 1.50-2.99 or 0.33-0.67), 'possible' (OR or RR 1.10-1.49 or 0.68-0.89), or 'unlikely' (OR or RR 0.90-1.09). Quality of the evidence was high, moderate, low, or very-low, using GRADE.</p><p><strong>Main results: </strong>Twenty-seven publications found 24 associations of pre-eclampsia with socioeconomic status, social support/exclusion, healthcare access, and occupational and physical environmental factors. One association (polygamy) was definite (low-quality evidence). Probable associations included: work stress, lack of antenatal care and heat exposure in early pregnancy (high-quality evidence); prolonged occupational exposure to whole body vibrations or bending, distance to health facility, and UV-B radiation exposure (protective factor), all based on moderate-quality evidence; and neighbourhood deprivation, rotating work shifts, and Asian/Oceanian origins (protective factor), all based on low-quality evidence. There were 13 possible associations, which did not include education.</p><p><strong>Conclusion: </strong>Our findings support recommendations to address climate change, strengthen occupational protection, and promote early antenatal attendance. Social determinants may be indicative of upstream factors (e.g., obesity) that increase likelihood of clinical risk factors for pre-eclampsia incidence and severity.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460468","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":"Management of Monochorionic Twin Pregnancy Green-Top Guideline No. 51 (2024 Partial Update)","authors":"Mark D. Kilby,&nbsp;Leanne Bricker,&nbsp;Royal College of Obstetricians and Gynaecologists","doi":"10.1111/1471-0528.18055","DOIUrl":"10.1111/1471-0528.18055","url":null,"abstract":"&lt;p&gt;This guideline provides evidence-based recommendations and advice on best practices for the clinical care of monochorionic twin (and much rarer higher order) pregnancies. The use of ultrasound to determine chorionicity and amnionicity is key to the management of multiple pregnancies and the interpretation of potential risks to the fetuses. This guideline will outline the best evidence to guide clinical care, including fetal surveillance, the screening for, and treatment of complications associated with monochorionic multiple pregnancy. It is important to emphasise that this guideline is focused on the management of monochorionic multiple pregnancies rather than all multiple pregnancies.&lt;/p&gt;&lt;p&gt;It is also recognised that women carrying a monochorionic pregnancy (most commonly twins) may have concerns and anxieties surrounding their pregnancy. This requires accurate and evidence-based information given in a sensitive manner by healthcare professionals and supported by a multidisciplinary team, ideally within a multiple-pregnancy clinic [&lt;span&gt;1, 2&lt;/span&gt;]. In the UK, support is also often given in conjunction with the Twins Trust (formally the Twins And Multiple Births Association [TAMBA]) and The Multiple Births Foundation.&lt;/p&gt;&lt;p&gt;A monochorionic pregnancy is a multiple pregnancy, most commonly a twin pregnancy (99% of cases), in which babies are dependent on a single, shared placenta and where there are placental anastomoses conjoining the fetal circulations. Approximately 20% of twin pregnancies in the UK are monochorionic. Monochorionic placentation can also occur in rarer, higher-order multiples, especially triplets (i.e., dichorionic or monochorionic triplets).&lt;/p&gt;&lt;p&gt;There has been an increase in all types of multiple pregnancies with the use of assisted reproductive technology and the choice of individuals to defer pregnancy to a later maternal age (especially pronounced in high/middle-income countries). Although the rates of twining and higher order pregnancies are increased in people of Nigerian ethnicity, the rate of monochorioncity is not significantly increased in this group. Assisted reproductive technology increases the prevalence of both dichorionic and monochorionic twinning. However, using day 5 blastocyst transfers seems to be associated with a significantly higher rate of monozygotic twinning compared with cleavage stage day 3 transfers (adjusted OR 2.04, 95% CI 1.29–4.48) [&lt;span&gt;3-5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;All multiple pregnancies have increased risks of preterm birth, fetal growth restriction (FGR), pre-eclampsia, postpartum haemorrhage, and additional postnatal potentially morbid complications, such as infant feeding difficulties and adverse puerperal mood change [&lt;span&gt;1, 2, 6, 7&lt;/span&gt;]. These complications are not addressed further in this guideline as they are not specific to monochorionic placentation.&lt;/p&gt;&lt;p&gt;The challenges of monochorionic pregnancies arise from the single, shared placenta and placental vascular anastomoses that ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"e98-e129"},"PeriodicalIF":4.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450780","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":"Feasibility of a Standardised Mid-Trimester Ultrasound Protocol: A National Multicenter Study.","authors":"Thierry Bultez, Laurent Julien Salomon, Houman Mahallati, Nicolas Fries","doi":"10.1111/1471-0528.18102","DOIUrl":"https://doi.org/10.1111/1471-0528.18102","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the feasibility and quality of a national standardised mid-trimester ultrasound protocol using a consensus-based quality assessment (QA) scoring system.</p><p><strong>Design: </strong>Multicenter prospective observational 'FLASH' study.</p><p><strong>Setting: </strong>(i) Assessing the feasibility of a standardised protocol of 24 views at the mid-trimester scan, with 21 recommended and 3 additional views, in routine practice. (ii) Assessing the quality of these images by evaluating the presence of conformity criteria. (iii) Analysing the reliability between self-assessment and peer-assessment of the images.</p><p><strong>Population: </strong>A total of 440 mid-trimester scans.</p><p><strong>Methods: </strong>A consensus-based QA scoring system comprising 73 conformity criteria was established with 28 experts using a 3-round Delphi method. Secondly, we asked operators to record 5 consecutive routine mid-trimester scans. Images were analysed by the sonographer themselves and by a qualified expert according to the scoring system. The frequency of recorded images was calculated for each of the views. Factors associated with missing images per scan were evaluated. The robustness of conformity criteria was assessed by reliability between self-evaluation and peer-evaluation.</p><p><strong>Main outcome measures: </strong>Based on 9849 images, we observed feasibility of the 21 recommended standardised views for mid-trimester scan ranging from 88.5% to 100%.</p><p><strong>Results: </strong>Most conformity criteria (64/73, 88%) were met in over 90% of cases. Gwet's AC1 correlation between expert evaluation (peer-evaluation) and participant evaluation (self-evaluation) was greater than 0.80 for 70/73 (96%) criteria.</p><p><strong>Conclusion: </strong>This large-scale 2-month 'flash' observational study demonstrates the feasibility and quality of a national standardised mid-trimester ultrasound protocol using a consensus-based QA scoring system.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415858","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":"Correction to “The Hayman Technique: A Simple Method to Treat Postpartum Haemorrhage”","authors":"","doi":"10.1111/1471-0528.18099","DOIUrl":"10.1111/1471-0528.18099","url":null,"abstract":"<p>F. Ghezzi, A. Cromi, S. Uccella, L. Raio, P. Bolis, and D. Surbek, “The Hayman Technique: A Simple Method to Treat Postpartum Haemorrhage,” <i>BJOG: An International Journal of Obstetrics &amp; Gynaecology</i> 114, no. 3 (2007): 362–365, https://doi.org/10.1111/j.1471-0528.2006.01204.x.</p><p>Concerns were raised by a third party regarding Figure 1B of the article [<span>1</span>]. Firstly, that the image was previously published by Habek et al. (2006) and was used without permission or appropriate attribution, and secondly, that it originally depicts a different operative method, the B-Lynch procedure.</p><p>The authors admitted to the unintentional reuse of the figure, which they erroneously believed was their own. The authors now provide an original image from their own cases that accurately represents the Hayman technique for correction.</p><p>The authors apologise for this oversight.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"850"},"PeriodicalIF":4.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415847","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":"Regarding the Association Between Polycystic Ovary Syndrome and Risk of Pre-Eclampsia.","authors":"Hong Li, Jue He, Yan Xu, Minhui Yi, Yan Qin","doi":"10.1111/1471-0528.18087","DOIUrl":"https://doi.org/10.1111/1471-0528.18087","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415868","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 of Zona Pellucida Gene Variants With Female Infertility: A Retrospective Genetic Analysis","authors":"Sha-wei Sa,&nbsp;Li-li Wang,&nbsp;Qian-hong Ma","doi":"10.1111/1471-0528.18094","DOIUrl":"10.1111/1471-0528.18094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We investigated the clinical characteristics and pregnancy outcomes of patients with zona pellucida (ZP) gene variants undergoing assisted reproductive technology (ART) treatment, to identify variants associated with female infertility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>University-based reproductive medicine centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Twelve patients in whom only empty follicles or degenerated oocytes were retrieved after controlled ovulation stimulation and for whom no successful pregnancies were achieved after ART treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Next-generation sequencing (NGS) and Sanger sequencing were performed on DNA obtained from peripheral blood of the patients. The VCF files generated by the Genome Analysis Toolkit were functionally annotated using SnpEff with reference to the refSeq, gnomAD, dbSNP, InhouseSNP, ClinVar and dbNSFP databases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>American College of Medical Genetics and Genomics (ACMG) annotation of the SnpEff results was performed using InterVar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 14 ZP variants, including eight novel variants. These included heterozygous variants in <i>ZP1</i>, <i>ZP2</i> and <i>ZP3</i>. These findings contribute to the understanding of ZP gene variants and their roles in the diagnosis of an abnormal ZP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ZP gene variants are associated with female infertility, which can potentially affect ART outcomes. Therefore, ZP gene variant screening should be performed in female patients experiencing ART failure with pertinent clinical and laboratory indicators to guide personalised treatment and enhance fertility outcomes. However, further research is required to confirm the functional impact of these variants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S2","pages":"75-82"},"PeriodicalIF":4.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385810","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 Calcium Intake at 36 Weeks' Gestation and Pre-Eclampsia Risk—A Cohort Study","authors":"Anastasija Arechvo,&nbsp;Argyro Syngelaki,&nbsp;Laura A. Magee,&nbsp;Sophie E. Moore,&nbsp;Andrew Doel,&nbsp;Alan Wright,&nbsp;Kypros H. Nicolaides,&nbsp;Peter von Dadelszen","doi":"10.1111/1471-0528.18091","DOIUrl":"10.1111/1471-0528.18091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to examine the association between dietary calcium intake (Ca) and pre-eclampsia (PE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Inner-city hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>A total of 2838 women with singleton pregnancies at 35⁺⁰–36⁺⁶ weeks' gestation, including 96 (3.4%) who subsequently developed PE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Online 24-h dietary recall questionnaire was used to measure Ca intake. In the low (&lt; 700 mg/d) vs. adequate (≥ 700 mg/d) Ca intake groups, we compared the prevalence of PE-associated maternal risk factors and the incidence of PE. In multivariate regression, we examined the low Ca intake and PE relationship, adjusted for established PE risk factors (including blood pressure and angiogenic biomarkers) and any additional factors associated with low Ca intake specifically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure</h3>\u0000 \u0000 <p>PE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 405 (14.3%) women had low Ca intake. Low (vs. adequate) Ca intake was associated with a higher incidence of PE (6.2% vs. 2.9%; odds ratio 2.2, 95% confidence interval 1.3–3.7), as well as more prevalent risk factors for PE, including Black ethnicity (34.1% vs. 11.8%), South Asian ethnicity (10.1% vs. 7.2%), high body mass index (29.8 vs. 28.3 kg/m²) and more deprived index of multiple deprivation (54.3% vs. 35.5%). In multivariate regression adjusting for other PE risk factors, low Ca intake was no longer associated with PE (OR 1.7, 95% CI 0.9–3.2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although some contribution from low Ca to the development of PE cannot be ruled out, after accounting for maternal characteristics, medical history and deprivation, low Ca intake did not make an independent contribution to the development of PE in this population of mixed-ethnicity women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"816-825"},"PeriodicalIF":4.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385816","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":"Twelve-Year Follow-Up of a Randomised Controlled Trial Comparing the Effectiveness of Pelvic Floor Muscle Training Versus Mid-Urethral Sling Surgery for Female Moderate to Severe Urinary Incontinence","authors":"Hélène F. C. van Oorschot,&nbsp;Deodata Tijsseling,&nbsp;Julien Labrie,&nbsp;Carl H. van der Vaart","doi":"10.1111/1471-0528.18092","DOIUrl":"10.1111/1471-0528.18092","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 compare the 12-year effectiveness of pelvic floor muscle training versus midurethral sling surgery for moderate to severe female stress urinary incontinence.&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;Observational follow-up study of a 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;Conducted at the Division of Gynaecology, University Medical Centre Utrecht, The Netherlands.&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;Women from the PORTRET study experiencing moderate to severe stress urinary incontinence.&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;A validated questionnaire was sent to participants.&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 subjective improvement in urinary incontinence symptoms. Secondary outcomes included subjective cure, severity of incontinence, impact of incontinence as urogenital symptom and cross-over and re-operation rates.&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;In this long-term study, 184 of 386 (47.7%) women responded to the questionnaire. Cross-over (86.9%) from the initial physiotherapy group to surgery was very high. No statistically significant differences were found in the intention to treat analysis. However, the post hoc analysis showed that women who underwent physiotherapy only reported a statistically significant lower improvement compared to those who underwent initial surgery (50.6% absolute difference; 95% CI 28.2–73.1) or surgery after physiotherapy (49.7% absolute difference; 95% CI 25.8–73.7). Subjective cure, decrease in perceived severity and impact of urinary incontinence also statistically significantly favoured women who underwent (initial) surgery Re-operation was reported by 4.6% of women.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This 12-year follow-up study showed a very high cross-over rate to surgical treatment, considering a substantial proportion of non-responders. Midurethral sling surgery, either initial or after physiotherapy, statistically significantly improved subjective outcomes for moderate to severe stress urinary incontinence as compared to pelvic fl","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"826-833"},"PeriodicalIF":4.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385813","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 Aspirin Use for Pre-Eclampsia Prevention: The Critical Role of Dose, Timing and Adherence","authors":"Bethany Atkins,&nbsp;Dimitrios Siassakos","doi":"10.1111/1471-0528.18095","DOIUrl":"10.1111/1471-0528.18095","url":null,"abstract":"&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;The Cochrane review by Duley et al. [&lt;span&gt;1&lt;/span&gt;] 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 &gt; 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?&lt;/p&gt;&lt;p&gt;In resource-limited contexts, where the likelihood of healthy survival to adulthood is significantly lower for preterm infants [&lt;span&gt;2&lt;/span&gt;], 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 [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;The Cochrane review [&lt;span&gt;1&lt;/span&gt;] 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 &lt; 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 [&lt;span&gt;3&lt;/span&gt;] (ASPRE [&lt;span&gt;3&lt;/span&gt;], BLASP 1998 [&lt;span&gt;4&lt;/span&gt;], ERASME 2003 [&lt;span&gt;5&lt;/span&gt;]) examining aspirin ≥ 75 mg, 61% of participants had poor adherence, and 40% commenced aspirin after 20 weeks.&lt;/p&gt;&lt;p&gt;Two systematic reviews investigated aspirin for prevention of pre-eclampsia and foetal growth restriction [&lt;span&gt;6&lt;/span&gt;] (Roberge et al. 2016), and pre-term pre-eclampsia [&lt;span&gt;7&lt;/span&gt;] (Roberge et al. 2018) respectively. The first [&lt;span&gt;6&lt;/span&gt;] 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,&nbsp;Ahmad Badeghiesh,&nbsp;Haitham Baghlaf,&nbsp;Noah Margolese,&nbsp;Michael H. Dahan","doi":"10.1111/1471-0528.18090","DOIUrl":"10.1111/1471-0528.18090","url":null,"abstract":"&lt;p&gt;Lung cancer during pregnancy is exceedingly rare, with only 93 cases reported in the literature from 1953 to 2024 [&lt;span&gt;1&lt;/span&gt;]. It carries the highest mortality rate of cancers in pregnancy (64.3%) [&lt;span&gt;2&lt;/span&gt;] and increases risks of placental abnomalities, preterm delivery and low birth weight, with delayed diagnosis often due to nonspecific symptoms [&lt;span&gt;1, 2&lt;/span&gt;]. 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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;Maternal characteristics are summarised in Table 1. Women with lung cancer were older, with significantly higher smoking rates (&lt;i&gt;p&lt;/i&gt; = 0.01), chronic hypertension and pregestational diabetes (&lt;i&gt;p&lt;/i&gt; &lt; 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 (&lt;i&gt;p&lt;/i&gt; &lt; 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, &lt;i&gt;p&lt;/i&gt; = 0.017), abruptio placenta (OR: 4.99, 95% CI: 1.49–16.74, &lt;i&gt;p&lt;/i&gt; = 0.009), operative vaginal delivery (OR: 4.88, 95% CI: 2.14–11.11, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), transfusion (OR: 8.92, 95% CI: 3.28–24.28, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), venous thromboembolism (VTE) (OR:21.83, 95% CI: 2.92–163.47, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), disseminated intravascular coagulation (DIC) (OR: 8.45, 95% CI: 1.14–62.42, &lt;i&gt;p&lt;/i&gt; = 0.04) and maternal death (OR: 195.02, 95% CI: 40.61–936.55, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), though differences in spontaneous vaginal delivery became non-significant after adjustment (OR: 0.58, 95% CI: 0.30–1.14, &lt;i&gt;p&lt;/i&gt; = 0.112). Neonatal outcomes were similar between groups.&lt;/p&gt;&lt;p&gt;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 [&lt;span&gt;1&lt;/span&gt;], 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}