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

{"title":"CDK4/6 Inhibitor Can Improve Niraparib Sensitivity and Reverse Acquired Drug Resistance Through Endonuclease G Nuclear Translocation in BRCA Wild-Type Ovarian Cancer: A Vitro Study","authors":"Tianyu Zhou,&nbsp;Yahui Jiang,&nbsp;Xiaoxia Che,&nbsp;Fangfang Jian,&nbsp;Yiwei Wang,&nbsp;Weiwei Feng","doi":"10.1111/1471-0528.18177","DOIUrl":"10.1111/1471-0528.18177","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate whether the CDK4/6 inhibitor TQB-3616 has synergistic effects with niraparib ZL-2306 in suppressing BRCA wild-type ovarian cancer and to explore the mechanisms of combined therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>In vitro study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Laboratory of a tertiary hospital and Experimental Animal Centre of Shanghai Jiaotong University School of Medicine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>SKOV3 (human ovarian cancer cell line).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The BRCA wild-type ovarian cancer cell line, SKOV3, was used, and the niraparib-resistant cell line (SKOV3-NR) was generated using a concentration-increasing method. The effects of combined therapy with TQB-3616 and ZL-2306 on cell viability, long-term survival, apoptosis and cell cycle were studied in vitro and in vivo, and DNA damage was detected. Proteomic mass spectrometry was performed to determine the mechanism of action underlying combined therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure</h3>\u0000 \u0000 <p>CDK4/6 and niraparib efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A niraparib-resistant strain of the wild-type BRCA ovarian cancer cell line SKOV3 was generated, and the CDK4/6 inhibitor TQB-3616 was combined with niraparib ZL-2306 to inhibit the growth of ovarian cancer cells and reverse drug resistance. The feasibility and effectiveness of ZL-2306 in combination with TQB-3616 were demonstrated in a tumour-bearing nude mouse model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Combined therapy with the CDK4/6 inhibitor TQB-3616 and niraparib ZL-2306 showed synergistic antitumour effects against BRCA wild-type ovarian cancer without increasing the toxicity of each drug. The antitumour effect may be related to mitochondrial apoptosis, where EndoG nuclear translocation plays a critical role. This study proposes combined therapy of CDK4/6 and PARP inhibitors as a novel approach for the treatment of refractory ovarian cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S4","pages":"20-28"},"PeriodicalIF":4.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853093","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":"Progesterone Luteal Support in Natural Cycles for Unexplained Infertility: A Randomised Controlled Trial (The PiNC Trial)","authors":"Claudia Raperport,&nbsp;Elpiniki Chronopoulou,&nbsp;Aviva Petrie,&nbsp;Roy Homburg,&nbsp;Elizabeth Timlick,&nbsp;Sheetal Barhate,&nbsp;Kristina Sackett,&nbsp;Priya Bhide","doi":"10.1111/1471-0528.18171","DOIUrl":"10.1111/1471-0528.18171","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 effect of luteal-phase progesterone supplementation in natural cycles to expectant management on live birth rates in women with unexplained infertility (UI).&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;An open-label, parallel-arm, single-centre 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;One tertiary NHS-funded fertility unit.&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;Couples with UI for at least 1 year.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Method&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A comparison of luteal phase micronised vaginal progesterone treatment (400 mg bd) with timed intercourse and timed intercourse alone for 3 cycles.&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;Primary outcome: Livebirth rate. Secondary Outcomes: Biochemical pregnancy, clinical pregnancy, mid-luteal serum progesterone and pregnancy loss.&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;One hundred and forty-three couples were randomised. Livebirth rates were 11/72 (15.3%) in the treatment group versus 5/71 (7.0%) in the control group (RR 2.17, 95% CI 0.79–5.93). Biochemical pregnancy rates were 15/72 (20.8%) versus 10/71 (14.1%), (RR 1.48, 95% CI 0.72–3.07) and clinical pregnancy rates were 14/72 (19.4%) versus 9/71 (12.7%), (RR 1.53, 95% CI 0.71–3.31) in the treatment and control groups respectively. Pregnancy losses: 4/15 treatment group versus 5/10 control group (RR 0.53, 95% CI 0.19–1.51). One biochemical pregnancy loss in each group and 2/15 miscarriages in the treatment group versus 3/10 in the control group. Total miscarriage rates including biochemical losses were 3/15 (20%) versus 4/10 (40%) (RR 0.5, 95% CI 0.14–1.77).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The results did not reach statistical significance. However, the difference in livebirth rates warrants further investigation as this simple, noninvasive, inexpensive treatment would be a very attractive option for affected couples. A larger trial using the effect size from this study to guide sample size is planned.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Trial Registr","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 9","pages":"1220-1227"},"PeriodicalIF":4.7,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857626","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":"Management of Thyroid Disorders in Pregnancy","authors":"Shiao-Yng Chan,&nbsp;Michael S. Marsh,&nbsp;Jackie Gilbert,&nbsp;Kristien Boelaert,&nbsp;Carol Evans,&nbsp;Rima Dhillon-Smith,&nbsp;the Royal College of Obstetricians and Gynaecologists","doi":"10.1111/1471-0528.18088","DOIUrl":"10.1111/1471-0528.18088","url":null,"abstract":"&lt;p&gt;Thyroid disease is a common endocrine disorder in women of childbearing age. There is variation in clinical practice and approach to thyroid diseases globally, in part influenced by differences in population iodine status. There remains controversy regarding testing for and management of thyroid disorders before conception, during pregnancy and postpartum. This guideline presents the available evidence for best practice and, where evidence is lacking, consensus opinion by a multidisciplinary, cross-specialty team of authors is presented.&lt;/p&gt;&lt;p&gt;Preconception testing for thyroid dysfunction in the subfertile and recurrent miscarriage populations is not within the scope of this guideline and is addressed in a separate RCOG Scientific Impact Paper [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;This guideline is for healthcare professionals who care for women, non-binary and trans people with thyroid disorders in pregnancy.&lt;/p&gt;&lt;p&gt;Within this document we use the terms woman and women's health. However, it is important to acknowledge that it is not only women for whom it is necessary to access women's health and reproductive services in order to maintain their gynaecological health and reproductive wellbeing. Gynaecological and obstetric services and delivery of care must therefore be appropriate, inclusive and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth.&lt;/p&gt;&lt;p&gt;Dynamic changes occur in thyroid function through the course of pregnancy, to provide adequate concentrations of thyroid hormone to the woman and fetus [&lt;span&gt;2-4&lt;/span&gt;]. Overall, demands on maternal thyroid hormone production increase by approximately 50% during pregnancy; this requires both an adequate supply of iodine for the biosynthesis of thyroid hormones and the absence of significant thyroid disease.&lt;/p&gt;&lt;p&gt;Increased oestrogen in pregnancy raises thyroxine-binding globulin concentrations, starting very early in pregnancy, and plateauing by approximately 18–20 weeks of gestation. To maintain adequate free thyroid hormone concentrations, thyroxine (T4) and tri-iodothyronine (T3) production by the thyroid gland increases during the first half of pregnancy, a new steady-state is reached by mid-gestation and the synthesis of thyroid hormones returns to pre-pregnancy rates. First trimester increases in human chorionic gonadotrophin (hCG), which has weak thyroid-stimulating activity, transiently increases free thyroxine (fT4) and free tri-iodothyronine (fT3) and decrease thyroid stimulating hormone (TSH) [&lt;span&gt;5&lt;/span&gt;]. From mid-gestation, as hCG declines, serum fT4 and fT3 concentrations decline gradually, while serum TSH concentrations rise slightly.&lt;/p&gt;&lt;p&gt;Iodine requirement increases considerably during pregnancy as there is increased consumption of iodine for thyroid hormone synthesis and increased renal iodine clearance [&lt;span&gt;6&lt;/span&gt;]. The placenta may also be an organ of storage for iodine [&lt;span&gt;7&lt;/span&gt;]. The fetal thyroid beg","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 8","pages":"e130-e161"},"PeriodicalIF":4.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841368","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":"Assisted Reproductive Technology in China: A Commentary","authors":"Fang Gu,&nbsp;Yao Lu,&nbsp;Yanwen Xu,&nbsp;Yun Sun","doi":"10.1111/1471-0528.18157","DOIUrl":"https://doi.org/10.1111/1471-0528.18157","url":null,"abstract":"&lt;p&gt;Over the past few decades, assisted reproductive technology (ART) has rapidly developed in mainland China. The number of ART centers increased dramatically from 85 in 2006 to 375 in 2018. In total, 1.08 million ART cycles were performed in 2018 [&lt;span&gt;1&lt;/span&gt;]. Based on the large volume of ART data in China, Chinese researchers have conducted studies on various aspects to improve clinical practice and seek innovations and breakthroughs in the field of ART.&lt;/p&gt;&lt;p&gt;However, the popularity of ART raises concerns regarding the safety of ART offspring [&lt;span&gt;2&lt;/span&gt;]. Wang et al. [&lt;span&gt;3&lt;/span&gt;] conducted a prospective cohort study to assess the comprehensive health status of school-age children conceived through ART compared to that of children conceived naturally. They found that ART- and naturally conceived children had a similar overall health status, but ART-conceived children had at an increased risk of latent exotropia. Liu et al. [&lt;span&gt;4&lt;/span&gt;] performed a matched cohort study to examine the effect of laser-assisted hatching (LAH) on the physical, metabolic, cognitive, and behavioural profiles of singletons conceived through frozen–thawed embryo transfer (FET) at preschool age. The results showed that at 4–6 years of age, the cognitive, metabolic, and physical developmental outcomes of pre-school children born after LAH treatment were comparable to those of pre-school children born without LAH treatment, indicating that LAH is possibly a safe assisted reproductive technology method. This study by Liu et al. is the first follow-up study to assess the health of offspring born after LAH up to the preschool age. Wu et al. [&lt;span&gt;5&lt;/span&gt;] investigated the relationship between prolonged ovarian stimulation and neonatal outcomes after autologous fresh embryo transfer (fET) and found that prolonged ovarian stimulation did not increase adverse neonatal outcomes in singleton newborns after autologous fET. This retrospective cohort study by Wu et al. is the first to investigate the effects of prolonged ovarian stimulation on neonatal outcomes after autologous fET. Hu et al. [&lt;span&gt;6&lt;/span&gt;] found that the overall risk of perinatal and neonatal complications in singleton live births was higher in patients with poor ovarian response (POR) than in those with normal ovarian response (NOR); however, the risks were similar after logistic regression adjustment. Taken together, these studies indicate that ART does not increase the risk of adverse events in offspring.&lt;/p&gt;&lt;p&gt;Robust evidence of effectiveness and safety is a prerequisite for the introduction of new technologies in reproductive medicine [&lt;span&gt;7&lt;/span&gt;]. Chinese researchers are making great efforts to investigate whether each ART intervention improves clinical outcomes. Xu et al. [&lt;span&gt;8&lt;/span&gt;] found that higher luteinizing hormone (LH) levels on trigger day were associated with improved pregnancy outcomes in gonadotropin-releasing hormone (GnRH) antagonist protocols. Maintaining an optimal","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S2","pages":"5-7"},"PeriodicalIF":4.7,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18157","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831437","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":"Advancing Ovarian Cancer Therapy in China: Insights From Research and Practices","authors":"Xiaohua Wu","doi":"10.1111/1471-0528.18170","DOIUrl":"10.1111/1471-0528.18170","url":null,"abstract":"&lt;p&gt;Ovarian cancer is a major health burden in China. Over the past three decades, the burden of ovarian cancer has significantly increased, and in the next decade, it is expected to keep increasing at a rate higher than the global average [&lt;span&gt;1&lt;/span&gt;]. The 5-year survival rate of patients with ovarian cancer in China has been approximately 40% with no improvement [&lt;span&gt;2&lt;/span&gt;]. With robust support from the Chinese government, several gynaecological oncology committees have recently made unprecedented efforts to improve the 5-year survival rate by promoting screening technologies, accelerating the construction of a gynaecological oncology specialist system, and enhancing awareness of standardised diagnosis and treatment, as well as the whole process management. In this special issue of &lt;i&gt;BJOG&lt;/i&gt;, we have selected seven manuscripts focusing on poly (ADP-ribose) polymerase (PARP) inhibitors, chemotherapy, and surgery for ovarian cancer in China, showing the significant progress China has made in the treatment of ovarian cancer.&lt;/p&gt;&lt;p&gt;The advent of PARP inhibitors has been a significant milestone in the pharmacological treatment of ovarian cancer. Since 2017, many clinical registration studies for Chinese patients with ovarian cancer have been conducted to investigate the efficacy and safety of PARP inhibitor maintenance therapy [&lt;span&gt;3-8&lt;/span&gt;]. The results of these studies have provided strong evidence to support the clinical application of PARP inhibitors. Xie and Shao et al. have, respectively, provided comprehensive summaries of data from clinical trials and real-world studies of PARP inhibitors for first-line and platinum-sensitive recurrent (PSR) maintenance in China. Moreover, Xie et al. analysed the differences in patient characteristics and safety data between Chinese and international studies in their review of first-line maintenance and proposed maintenance strategies for patients with different biomarker statuses based on the current status of first-line maintenance in China. In their review of PSR maintenance, Shao et al. elucidated the safety issues resulting from the long-term use of PARP inhibitors and discussed the differences in indications for PARP inhibitors between China and abroad.&lt;/p&gt;&lt;p&gt;As PARP inhibitors are widely used, drug resistance is inevitable. Chinese researchers and physicians are exploring ways to overcome this and evaluating the potential for PARP inhibitor rechallenge. Zhou et al. established a niraparib-resistant &lt;i&gt;BRCA&lt;/i&gt; wild-type ovarian cancer cell line and found that the combination of CDK4/6 inhibitor TQB-3616 and niraparib could effectively inhibit the growth of ovarian cancer cells and reverse resistance. EndoG nuclear translocation might be the key mechanism for synergy. Li et al. evaluated the efficacy of PARP inhibitor rechallenge as a maintenance therapy in a real-world setting and revealed that using a combination regimen and achieving complete remission might be associated with a good p","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S4","pages":"3-4"},"PeriodicalIF":4.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827317","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":"An In-Depth Analysis and Classification of Placental Causes of Stillbirth: A 10-Year Retrospective Study of a Regional Stillbirth Registry","authors":"Leila Caillault,&nbsp;Rémi Béranger,&nbsp;Philippe Loget,&nbsp;Pauline Blanc-Petitjean,&nbsp;Maela Le Lous,&nbsp;Gwenaelle Le Bouar,&nbsp;Alain Lescoat,&nbsp;Ronan Garlantézec,&nbsp;Nicolas Belhomme,&nbsp;the Ille et Vilaine stillbirth study group","doi":"10.1111/1471-0528.18158","DOIUrl":"10.1111/1471-0528.18158","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Abnormal placental lesions are commonly identified in stillbirth. Interpreting these lesions and their contribution to fetal demise presents significant challenges. Recommended CODAC classification does not include detailed placental examination results.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study reports abnormal placental patterns in relation to the distribution of stillbirth causes in order to refine the categories of causes.&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;Data from the Ille-Et-Vilaine Stillbirth cohort, an exhaustive register of stillbirth cases across the Ille-et-Vilaine French department, were implemented in 2010.&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;All seven maternity wards in the Ille-et-Vilaine department, France.&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;All cases of stillbirth located in the Ille-et-Vilaine department between 2010 and 2019.&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;Descriptive statistics were used with the chi-squared test.&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;All placental examinations were reported following the Amsterdam consensus. Cause of death was ascertained according to the CODAC (Classification of Cause of Death and Associated Conditions) classification during multidisciplinary meetings.&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;A total of 566 stillbirths were documented. The most frequent stillbirth causes were placental cause (36%), followed by umbilical cord (11%) and infections (9%). Stillbirth remained unexplained in 17% of cases. Small placenta and maternal malperfusion emerged as the most frequent placental lesions within the placental stillbirth group (65%), but also within the maternal cause groups (65%).&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;Placental vascular anomalies were the most frequent cause of stillbirth in this study. Based on the combined use of international classification and observation of histological anomalies, our data suggest the existence of a vascular stil","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 8","pages":"1166-1177"},"PeriodicalIF":4.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775707","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":"Fetoscopic Robotic Open Spina Bifida Treatment (FROST): A Preclinical Feasibility and Learning Curve Study","authors":"Yada Kunpalin,&nbsp;Charlotte C. Kik,&nbsp;Francis Lebouthillier,&nbsp;Nimrah Abbasi,&nbsp;Greg Ryan,&nbsp;Jochem Spoor,&nbsp;Thomas Looi,&nbsp;Abhaya V. Kulkarni,&nbsp;Tim Van Mieghem","doi":"10.1111/1471-0528.18161","DOIUrl":"10.1111/1471-0528.18161","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The primary aim was to assess the feasibility of robotic OSB repair in a simulation training model, documenting the learning curve and ensuring quality control among surgeons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The learning curve was assessed using the cumulative summation test (LC-CUSUM). Following LC-CUSUM, six additional experiments were performed for competency-cumulative summation (C-CUSUM) analysis to ensure ongoing quality control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The simulator was created through 3D printing and hand sculpting, simulating a partially exteriorised uterus for laparotomy-assisted laparoscopic OSB surgery. It included a silicone uterus, placenta and foetal manikin with a simulated OSB lesion, replicating the lesion sac, paraspinal muscles and neural placode.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Four surgeons participated: an expert Maternal Fetal Medicine consultant, a neurosurgical consultant, a Maternal Fetal Medicine fellow and a neurosurgical resident.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The surgical procedure included eight steps: uterine access, working space creation, lesion exposition, junctional zone dissection, skin mobilisation, dural patch application, closure of myofascial flaps and closure of skin. Success was defined by precise restoration (suture interval &lt; 3 mm), foetal repair time ≤ 120 min and a GEARS score &gt; 21/30.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes</h3>\u0000 \u0000 <p>Learning curve and competency were documented via LC-CUSUM and C-CUSUM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Competence was achieved after 15–21 procedures, with novices reaching competency within this range. Participants maintained high performance in subsequent quality-controlled procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Robotic-assisted foetal OSB surgery in a high-fidelity simulation is feasible, showing promising outcomes for a large animal model and clinical translation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 9","pages":"1259-1268"},"PeriodicalIF":4.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18161","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767132","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":"Vulval Flap Reconstruction in Women With Benign, Preneoplastic and Malignant Vulval Conditions: A Prospective Study","authors":"Fong Lien Kwong,&nbsp;Rachel Pounds,&nbsp;Yasmin Farah,&nbsp;Jason K. W. Yap","doi":"10.1111/1471-0528.18156","DOIUrl":"10.1111/1471-0528.18156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To (i) evaluate the surgical morbidity, (ii) identify correlates of these and, (iii) explore whether flap reconstruction following vulvectomy improves patient symptoms and quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Single arm prospective study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Single tertiary vulval centre, UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Consecutive cases of women undergoing radical vulvectomy and flap reconstructions for benign and (pre)invasive vulval conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective data collection from April 2020–February 2024. All women were given two validated questionnaires preoperatively and at 3-, 6- and 12-months to evaluate their satisfaction with the aesthetic, genitourinary and psychosexual outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Early and late complications within 30 days. Patient reported outcome measures preoperatively and post-reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>136 flaps in 69 women were analysed. 92.6% (126/136) and 83.1% (113/136) flaps developed none-to-mild complications at 7 days, and between days 8 to 30, respectively. Five necrotic flaps in two patients were surgically debrided. All flaps had healed/healing at 30 days. We did not identify any correlates of complications. At 12 months, women reported an improvement in genital symptoms (<i>p</i> &lt; 0.001). 80.4% (37/46) reported no urinary incontinence vs. 48.1% (26/54) preoperatively, <i>p</i> = 0.0038. 24.4% (11/45) were sexually active vs. 9.3% (5/54) preoperatively, <i>p</i> = 0.0410. More women felt attractive (<i>p</i> = 0.0498), were satisfied with their body (<i>p</i> = 0.0407) and comfortable in intimate situations (<i>p</i> = 0.0273). 88.9% (40/45) stated that reconstruction helped with acceptance of their cancer diagnosis and surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Locoregional flap reconstruction has low surgical morbidity, leads to a significant improvement in genitourinary and psychosexual functions. In women with cancer, reconstruction supports women to cope with their diagnosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 8","pages":"1156-1165"},"PeriodicalIF":4.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736880","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":"Human Papillomavirus (HPV) Screening With Universal Access to Vaginal Self-Testing: Outcomes of an Implementation Trial","authors":"Peter Sykes,&nbsp;Carrie Innes,&nbsp;Rebecca Bell,&nbsp;Janine Nip,&nbsp;John McMenamin,&nbsp;Lynn McBain,&nbsp;Ben Hudson,&nbsp;Melanie Gibson,&nbsp;Sarah Te Whaiti,&nbsp;Alexandria Tino,&nbsp;Jonathan Williman,&nbsp;Andrew Miller,&nbsp;Beverley Lawton","doi":"10.1111/1471-0528.18159","DOIUrl":"10.1111/1471-0528.18159","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;Determine the feasibility of high-risk human papillomavirus (HPV)-based cervical screening that included the option of a vaginal swab HPV test (&lt;i&gt;vaginal self-test&lt;/i&gt;).&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;Implementation 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;17 primary care practices.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Population or Sample&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;People due for a cervical screening test.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Participants could choose a clinician-taken &lt;i&gt;cervical test&lt;/i&gt; or a &lt;i&gt;vaginal self-test&lt;/i&gt; (undertaken in clinic or at home), unless a cervical co-test (HPV and cytology) was clinically indicated.&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;Proportion of participants who had (a) a &lt;i&gt;vaginal self-test&lt;/i&gt;, (b) an HPV-detected result and (c) HPV detected on a &lt;i&gt;vaginal self-test&lt;/i&gt; and returned for further investigation.&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;3121 people were enrolled. Participation rates were high for people of all recorded ethnicities. A &lt;i&gt;vaginal self-test&lt;/i&gt; was undertaken by 95% (2954/3121, 95% confidence interval [CI] [93.8, 95.4]) of people. HPV was detected in 12.9% (404/3121, 95% CI [11.8, 14.2]) of people. 95% (384/404, 95% CI [92.5, 97.0]) of people with HPV detected had follow-up cytology or colposcopy. 2.6% (82/3121, 95% CI [2.1, 3.2]) had HPV 16/18 detected, all of whom attended colposcopy. Cytology triage was completed for 92% (276/301, 95% CI [88.0, 94.3]) of people with non-16/18 HPV types (&lt;i&gt;HPV other&lt;/i&gt;) detected on a &lt;i&gt;vaginal self-test.&lt;/i&gt; This varied by ethnicity and screening history.&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 study confirms the feasibility of cervical screening with the universal option of a &lt;i&gt;vaginal self-test&lt;/i&gt; and demonstrated a clear preference for the &lt;i&gt;vaginal self-test&lt;/i&gt;. Challenges remain in relation to equitable provision of cytology triage. Ongoing programme monitoring is imperative.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Trial Registration&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Aust","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 9","pages":"1240-1249"},"PeriodicalIF":4.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18159","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736831","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":"Pregnancy Outcomes in Women With Primary Adrenal Insufficiency: Data From a Multicentre Cohort Study","authors":"Matthew Cauldwell,&nbsp;Philip J. Steer,&nbsp;Masato Ahsan,&nbsp;Amanda Ali,&nbsp;Shabana Ashiq,&nbsp;Rebecca Ashworth,&nbsp;Deena Basha,&nbsp;Hsu Chong,&nbsp;Gillian A. Corbett,&nbsp;Fidelma Dunne,&nbsp;Amanda Hill,&nbsp;Katarzyna Gajewska-Knapik,&nbsp;Adam Jakes,&nbsp;David McLaren,&nbsp;Therese Kinsella,&nbsp;Tara Lee,&nbsp;Miles Levy,&nbsp;Lucy MacKiliop,&nbsp;Fionnuala M. McAuliffe,&nbsp;Aarthi Mohan,&nbsp;Clare Mumby,&nbsp;Melanie Nana,&nbsp;Catherine Napier,&nbsp;Francesca Neuberger,&nbsp;Christine Newman,&nbsp;Tabitha Oosterhouse,&nbsp;Amelia Shard,&nbsp;Hassan Shehata,&nbsp;Linden Stocker,&nbsp;Jeremy W. Tomlinson,&nbsp;Adele Beck,&nbsp;Bijay Vaidya,&nbsp;Kate Wiles,&nbsp;Catherine Williamson,&nbsp;Julia Zollner,&nbsp;Emma Ward,&nbsp;Helen E. Turner","doi":"10.1111/1471-0528.18143","DOIUrl":"10.1111/1471-0528.18143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine characteristics and pregnancy outcomes in women with primary adrenal insufficiency (PAI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective multicentre cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Twenty-three maternity units in the UK and Ireland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Seventy-nine women with PAI who had 101 pregnancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Retrospective chart analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Adrenal crisis, pregnancy outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We obtained data on 101 pregnancies in 79 women with PAI. Most (51, 64.1%) had autoimmune disease, 8 (10.3%) had prior adrenal infarction/surgery/haemorrhage, 2 (2.6%) had congenital adrenal hyperplasia, and 18 (21.3%) were unclassified. 19 (24%) women experienced a crisis during pregnancy (18.8% of pregnancies). One woman died postpartum. Although all women had recorded endocrinology input during pregnancy, steroid emergency cards were only reportedly carried in 40 (39.6%) pregnancies and 9/19 (47.4%) of those with an adrenal crisis in pregnancy. Compared with the pre-pregnancy dose, only 41% of women received an increased hydrocortisone dose in pregnancy. The caesarean section rate was higher than the UK average: 62/97 (63.9%). The preterm birth rate was 21.2% (21/99) and 12.8% (12/94) of neonates had a birthweight &lt; 10th centile.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Whilst the obstetric outcome of pregnancy with PAI is generally favourable, there are high rates of caesarean birth and prematurity. A high number of women experienced adrenal crisis and further exploration is warranted. Recommendations regarding third trimester increases in hydrocortisone need consideration and potentially strengthening, in light of further evidence. Pregnant women with adrenal insufficiency should carry an NHS steroid warning card; this should be reinforced both by endocrine and obstetric teams because of the increased risk of life-threatening adrenal crisis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 8","pages":"1122-1129"},"PeriodicalIF":4.7,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737067","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}