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

{"title":"Impact of the COVID-19 Pandemic on Cervical Cancer Screening: An International Comparative Study by INTRePID","authors":"Maria Carla Lapadula, Dorsa Mohammadrezaei, Angela Ortigoza, Amanda Freitas, Javier Silva-Valencia, the INTRePID Consortium","doi":"10.1111/1471-0528.18077","DOIUrl":"10.1111/1471-0528.18077","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"676-677"},"PeriodicalIF":4.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Pregnancies of Unknown Location With the M4 Prediction Model or the NICE Algorithm: A Randomised Controlled Trial With Cross-Sectional Diagnostic Accuracy Data","authors":"Johan Fistouris,&nbsp;Helen Garbergs,&nbsp;Katja Bergman,&nbsp;Christina Bergh,&nbsp;Annika Strandell","doi":"10.1111/1471-0528.18079","DOIUrl":"10.1111/1471-0528.18079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the diagnostic performance and clinical utility of the M4 prediction model and the NICE algorithm managing women with pregnancy of unknown location (PUL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The study has a superiority design regarding specificity for non-ectopic pregnancy for M4, given that the primary outcome of sensitivity for ectopic pregnancy (EP) is non-inferior in comparison with the NICE algorithm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Emergency gynaecology units in Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>595 women with PUL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were randomised (1:1) to M4 or the NICE algorithm after two serum human chorionic (hCG) levels and were categorised as high or low risk of having an EP. The diagnostic performance was evaluated on cross-sectional data and utility by parallel groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The proportion of EP categorised as high risk (sensitivity) and non-ectopic pregnancies categorised as low risk (specificity). Clinical outcomes were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sensitivity for EP was 79% (115 of 146) for M4 versus 85% (124 of 146) for the NICE algorithm, <i>p</i> = 0.1496 and the specificity for non-ectopic pregnancies was 67% (300 of 449) for M4 and 74% (334 of 449) for the NICE algorithm, <i>p</i> = 0.0003. Clinical outcomes were similar between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The sensitivity for EP by M4 was non-inferior to NICE, but specificity was better for the NICE algorithm. No between group differences were observed for clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>NCT 03461835, https://www.clinicaltrials.gov\u0000 </p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"742-751"},"PeriodicalIF":4.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Cost-Effectiveness of Antenatal Screening for Major Structural Anomalies During the First Trimester of Pregnancy: A Decision Model","authors":"Helen E. Campbell,&nbsp;Jehan N. Karim,&nbsp;Aris T. Papageorghiou,&nbsp;Edward C. F. Wilson,&nbsp;Oliver Rivero-Arias,&nbsp;the ACCEPTS Study","doi":"10.1111/1471-0528.18053","DOIUrl":"10.1111/1471-0528.18053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the cost-effectiveness of modifying current antenatal screening by adding first trimester structural anomaly screening to standard of care second trimester anomaly screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Health economic decision model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>National Health Service (NHS) in England and Wales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Pregnant women attending for first trimester antenatal screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The decision model estimated pregnancy outcomes (maternal and foetal) and 20-year costs for current screening practice and for a policy adding a protocol screening for eight major structural anomalies to the current first trimester ultrasound scan. Event probabilities, costs, and outcomes for the model were informed by meta-analyses, published literature, and expert opinion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes Measures</h3>\u0000 \u0000 <p>Expected numbers of pregnancy outcomes, healthcare costs, and maternal quality-adjusted life years (QALYs). Estimation of the incremental cost-effectiveness ratio (ICER), likelihood of cost-effectiveness, and a value of information (VoI) analysis assessing if further research is needed before making a decision about screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>First trimester anomaly screening increased mean per woman costs by £11 (95% CI £1–£29) and maternal QALYs by 0.002065 (95% CI 0.00056–0.00358). The ICER was £5270 per QALY and the probability of cost-effectiveness at a willingness to pay value for a QALY of £20 000, exceeded 95%. VoI analysis showed further research would be unlikely to represent value for money. The protocol would likely lead to a reduction in infant healthcare costs and QALYs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A protocol to screen for eight major structural anomalies during the first trimester appears to represent value for money for the NHS. The opposing implications for mothers and infants, however, raise complex, challenging, and sensitive issues.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"638-647"},"PeriodicalIF":4.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991563","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":"INTERGROWTH-21st Birthweight Charts Offer Excellent Concordance With UK-WHO Birthweight Charts Used by Neonatologists","authors":"Sophie Alexandra Relph,&nbsp;Julien Josseph Stirnemann,&nbsp;Raffaele Napolitano","doi":"10.1111/1471-0528.18048","DOIUrl":"10.1111/1471-0528.18048","url":null,"abstract":"&lt;p&gt;There is a wide range of charts available for the assessment of estimated foetal weight (EFW) and measured neonatal weight centiles at a given gestational age. Charts vary in methodology, with descriptive and prescriptive, population and customised versions available, many designed with a high risk of bias [&lt;span&gt;1, 2&lt;/span&gt;]. In many countries, including the UK, operators use varied charts for prenatal and neonatal care, leading to disagreement on diagnosis of abnormal growth. In determining which chart to apply in our tertiary centre and potentially nationwide, we aimed to identify a chart package that is applicable to our population, offers charts for assessment of EFW, actual birthweight and fundal height and is concordant with the UK-WHO birthweight charts recommended nationally by the Royal College of Paediatrics and Child Health (RCPCH—rcpch.ac.uk) which are based on British growth reference centiles derived by Cole in 1990 [&lt;span&gt;3&lt;/span&gt;]. Such concordance should facilitate agreement on small or large sizes, including the presence of growth restriction, between obstetricians and neonatologists, improving continuity of care with regard to the risk of perinatal morbidity and mortality. The INTERGROWTH-21st package offers both foetal and neonatal charts and has previously shown good continuity of growth between prenatal and neonatal centiles at late pre-term and term gestations in these populations when EFW in grams was calculated using both their formula including head and abdominal circumference only, or the Hadlock's formula, using three parameters (head, abdominal circumference and femur length) [&lt;span&gt;4, 5&lt;/span&gt;]. INTERGROWTH-21st prenatal chart centiles have also been shown to adequately fit the distribution of a large French prospective sample of ultrasound-derived foetal measurements [&lt;span&gt;6&lt;/span&gt;]. Here, we describe work to evaluate whether the INTERGROWTH-21st birthweight centiles are concordant with those of the UK-WHO birthweight charts for pre-term and term births [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We used 10th, 50th and 90th centile thresholds published by the INTERGROWTH-21st group for neonatal birthweight charts at each gestational day between 24 and 42 weeks to produce centile charts for male and female babies. UK-WHO birthweight centiles have only been published in chart format, from which it is difficult to derive the exact birthweight for the 10th, 50th and 90th centiles during each gestational day. We therefore produced a simulation data set, including male and female neonates with birthweights of 10-g increments between 400 and 5500 g, for each gestational day between 24 and 42 weeks. We calculated the UK-WHO birthweight centiles using the Stata ‘zanthro’ command (StataCorp LLC, Texas, USA). &lt;i&gt;Zanthro&lt;/i&gt; is a user-written command that calculates z-scores for anthropometric measures according to reference growth charts, with a specific option to apply the Cole UK-WHO charts. We then converted z-scores into birthweight cent","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"674-675"},"PeriodicalIF":4.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142990547","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":"Salpingectomy With Delayed Oophorectomy Versus Salpingo-Oophorectomy in BRCA1/2 Carriers: Three-Year Outcomes of a Prospective Preference Trial","authors":"Majke H. D. Van Bommel,&nbsp;Miranda P. Steenbeek,&nbsp;Joanna Inthout,&nbsp;Tessa Van Garderen,&nbsp;Marline G. Harmsen,&nbsp;Marieke Arts-De Jong,&nbsp;Angela H. E. M. Maas,&nbsp;Judith B. Prins,&nbsp;Johan Bulten,&nbsp;Helena C. Van Doorn,&nbsp;Marian J. E. Mourits,&nbsp;Rachel Tros,&nbsp;Ronald P. Zweemer,&nbsp;Katja N. Gaarenstroom,&nbsp;Brigitte F. M. Slangen,&nbsp;Monique M. A. Brood-Van Zanten,&nbsp;M. Caroline Vos,&nbsp;Jurgen M. J. Piek,&nbsp;Luc R. C. W. van Lonkhuijzen,&nbsp;Mirjam J. A. Apperloo,&nbsp;Sjors F. P. J. Coppus,&nbsp;Nicoline Hoogerbrugge,&nbsp;Rosella P. M. G. Hermens,&nbsp;Joanne A. De Hullu","doi":"10.1111/1471-0528.18075","DOIUrl":"10.1111/1471-0528.18075","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 menopause-related quality of life (QoL) after risk-reducing salpingectomy (RRS) versus risk-reducing salpingo-oophorectomy (RRSO) until 3 years of post-surgery.&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;A prospective study (TUBA study) with treatment allocation based on patients' preference. Data were collected pre-surgery and at 3 months, 1 and 3 years of post-surgery.&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;Multicentre prospective preference trial in thirteen hospitals in 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;\u0000 &lt;i&gt;BRCA1/2&lt;/i&gt; pathogenic variant (PV) carriers aged 25–40 (&lt;i&gt;BRCA1&lt;/i&gt;) or 25–45 (&lt;i&gt;BRCA2&lt;/i&gt;), who were premenopausal, without a future child wish and without current (treatment for) malignancy.&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;Treatment allocation was based on patients' preference: either RRS from the age of 25 years with delayed oophorectomy at the maximum age of 45 (&lt;i&gt;BRCA1&lt;/i&gt;) or 50 (&lt;i&gt;BRCA2&lt;/i&gt;), or RRSO between the ages of 35–40 (&lt;i&gt;BRCA1&lt;/i&gt;) or 40–45 (&lt;i&gt;BRCA2&lt;/i&gt;). After RRSO, hormone replacement therapy (HRT) was recommended, if not contraindicated. Primarily, menopause-related QoL as measured with the Greene Climacteric Scale (GCS) was compared between the RRS and RRSO without HRT group. Secondarily, GSC-scores of the RRS group were compared with the scores of the RRSO with HRT after surgery group. A higher GSC-score reflects more climacteric symptoms.&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;Until April 2023, 410 participants had undergone RRS and 160 RRSO. The &lt;i&gt;BRCA1/BRCA2&lt;/i&gt; proportions were 51.4%/48.6%. The mean age at surgery (SD) was 37.9 (3.5) years. Participants 3 years after RRSO without HRT had a 4.3 (95% CI 2.1–6.5; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) point higher increase in GCS-score from baseline compared to those after RRS, while the difference was 7.9 (95% CI 5.9–9.8) and 8.5 (95% CI 6.5–10.5) points at 3 and 12 months, respectively. Among participants with HRT after surgery, the RRSO group had a 2.4 (95% CI 0.8–3.9; &lt;i&gt;p =&lt;/i&gt; 0.002) point higher increase in GCS-score from baseline compared to the RRS group.&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;In this multicentre preference trial, me","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"782-794"},"PeriodicalIF":4.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987604","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":"Intrauterine Contraction Monitoring in Chorioamnionitis: A Secondary, Blinded Analysis of a Randomised Controlled Trial Cohort","authors":"Milla Juhantalo,&nbsp;Tuija Hautakangas,&nbsp;Outi Palomäki,&nbsp;Jukka Uotila","doi":"10.1111/1471-0528.18076","DOIUrl":"10.1111/1471-0528.18076","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 study the effects of chorioamnionitis on uterine activity and to investigate associations between external and intrauterine monitoring methods and neonatal outcomes.&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;Secondary analysis of a randomised controlled trial cohort.&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;Two labour wards, in a university tertiary hospital and a central hospital.&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;Parturients with singleton pregnancies, gestational age ≥ 37 weeks and fetus in cephalic position. Clinical chorioamnionitis developed in 8.6% of cases (&lt;i&gt;n&lt;/i&gt; = 130/1504).&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;Analyses of uterine activity (contractions/10 min or intrauterine pressure in Montevideo units) during the 4 h before birth adjusted for maternal characteristics and intrapartum factors.&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;Uterine activity with or without chorioamnionitis and the intervention of external versus intrauterine monitoring in relation to fetal distress (admission to neonatal intensive care with umbilical artery pH ≤ 7.10 or 5-min Apgar score &lt; 7), stratified by chorioamnionitis status.&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;Uterine contraction frequency/10 min decreased in labours with chorioamnionitis during the final hour preceding birth (4.2 [SD 1.1] vs. 3.9 [SD 1.2], adjusted regression coefficient −0.383, 95% CI −0.654 to −0.112, &lt;i&gt;p&lt;/i&gt; = 0.006) compared to non-infected labors. In chorioamnionitis cases, mean frequency/10 min during last 4 h was higher with external versus intrauterine monitoring (4.2 [SD 0.8] vs. 3.8 [SD 0.9], MD 0.39, 95% CI 0.02–0.76, &lt;i&gt;p&lt;/i&gt; = 0.038), and the intrauterine monitoring group had a lower incidence of fetal distress (6.7% vs. 23.1%, OR 0.24, 95% CI 0.07–0.79, &lt;i&gt;p&lt;/i&gt; = 0.013).&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;Chorioamnionitis impairs uterine activity. Intrauterine monitoring may provide more accurate contraction analysis than external tocodynamometry and help reduce fetal compromise during labours complicated by chorioamnionitis.&lt;/p&gt;\u0000 &lt;/sec","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"795-804"},"PeriodicalIF":4.7,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987148","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":"Consensus on Symptom Selection for Endometriosis Questionnaires: A Modified e-Delphi Study","authors":"Tong Zhu,&nbsp;Henrik Marschall,&nbsp;Karina E. Hansen,&nbsp;Andrew W. Horne,&nbsp;Lucky Saraswat,&nbsp;Krina T. Zondervan,&nbsp;Stacey A. Missmer,&nbsp;Lone Hummelshoj,&nbsp;Atilla Bokor,&nbsp;Camilla S. Østrup,&nbsp;Anna Melgaard,&nbsp;Dorte Rytter","doi":"10.1111/1471-0528.18066","DOIUrl":"10.1111/1471-0528.18066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To build consensus on most important symptoms and related consequences for use in questionnaires to characterise individuals with suspected and confirmed endometriosis in the general population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A questionnaire of 107 symptoms and related consequences of endometriosis was collaboratively developed by patients, medical doctors and researchers and further assessed in a two-round e-Delphi study. Participants assessed the relevance of the symptoms, and a priori it was decided that 70% was the threshold for inclusion of a symptom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Participants represented 7 countries, including Australia, Denmark, France, Hungary, the United Kingdom, the United States, and Turkey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Individuals with endometriosis, medical doctors and researchers with expertise in endometriosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A modified e-Delphi study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Consensus-based selection of symptoms for endometriosis questionnaires.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-six participants completed the first Delphi round and 65 completed the second round. Four symptoms met consensus in the first round (menstrual pain, pain during sexual intercourse, cyclic pain during defecation, and infertility), with two additional symptoms reaching consensus in the second round (cyclic pain and increased doctor/health care contacts for abdominal/pelvic pain).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlighted six symptoms relevant for inclusion in endometriosis research questionnaires: menstrual pain, pain during sexual intercourse, cyclic pain during defecation, cyclic pain, infertility, and a high number of doctor/health care visits due to abdominal/pelvic pain. Recognising a broad range of potential symptoms is essential for raising awareness and supporting early detection efforts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"656-662"},"PeriodicalIF":4.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967909","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":"Predicting Preterm Birth: An Evolving Landscape","authors":"Caroline Fox,&nbsp;Andrew Shennan","doi":"10.1111/1471-0528.18067","DOIUrl":"10.1111/1471-0528.18067","url":null,"abstract":"&lt;p&gt;Recently, the international company Hologic has withdrawn fetal fibronectin (fFN), a commonly used biomarker for preterm birth prediction. This is related to quality controls and sourcing consumables. However, fFN is currently recommended by the National Institute for Health and Care Excellence (NICE) and the National Health Service in England and had been implemented widely across Europe and the United Kingdom. Therefore, withdrawal of fFN is forcing countries to reconsider their clinical approaches.&lt;/p&gt;&lt;p&gt;It is estimated worldwide that 13.4 million or 1 in 10 babies annually are preterm, before 37 completed weeks of gestation (WHO 2023). The earlier the birth, the higher the mortality and lifelong morbidity (D'Onofrio et al. &lt;i&gt;JAMA Psychiatry&lt;/i&gt;. 2013;70:1231). Preterm birth is also a leading health cause of lost human capital (WHO 2023). Preterm birth rates are currently static and therefore initiatives to reduce prematurity and its complications are a priority.&lt;/p&gt;&lt;p&gt;Unfortunately, predicting and therefore preventing preterm birth is difficult as symptoms of threatened preterm birth can be vague and most do not go on to have their babies early. This led to consideration of tests to refine prediction of preterm birth and these include transvaginal cervical length (TCVL), as well as several cervico-vaginal biomarker tests (fetal fibronectin [fFN], Actim Partus [phosphorylated insulin-like growth factor binding protein-1] and Partosure [placental alpha macroglobulin-1]). Novel tests, such as cervical microRNA expression, cell-free RNA, metabolomics and microbiome assessment, have yet to be widely evaluated.&lt;/p&gt;&lt;p&gt;NICE recommends transvaginal ultrasound measurement of cervical length and if unavailable or unacceptable fFN to define risk of preterm birth. A Cochrane systematic review (Berghella et al. 2019) reported that data are limited but knowledge of TVCL appears to prolong pregnancy by 4 days. This interval allows antenatal optimisation with corticosteroids and magnesium sulphate to improve survival and reduce morbidity. However, TVCL requires expertise and experience, and highly trained sonographers are not universally available at the point of care. fFN testing in contrast can be performed by speculum examination and was therefore the more widely adopted test. A low fFN, is reassuring that preterm birth within 7 or 14 days is unlikely with a negative predictive value of &gt; 99% (Wing et al. &lt;i&gt;Obstet Gynaecol&lt;/i&gt; 2017;130:1183). This allows women to be safely reassured and discharged. Cervical length alone has moderate prediction (area under curve to predict delivery &lt; 30 weeks is 0.7), compared to fFN alone (0.89), but they can be used in combination for optimal prediction (Carter et al. &lt;i&gt;Ultrasound Obstet Gynecol&lt;/i&gt;. 2019:55:357). Unfortunately, now fFN has been withdrawn, cervical scanning length is the only established alternative as other tests, such as Actim Partus, are not recommended by NICE. The Saving Babies Lives Care","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"672-673"},"PeriodicalIF":4.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974779","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":"L-Arginine and L-Citrulline for Prevention and Treatment of Pre-Eclampsia: A Systematic Review and Meta-Analysis","authors":"Maureen Makama,&nbsp;Annie R. A. McDougall,&nbsp;Jenny Cao,&nbsp;Kate Mills,&nbsp;Phi-Yen Nguyen,&nbsp;Roxanne Hastie,&nbsp;Anne Ammerdorffer,&nbsp;A. Metin Gülmezoglu,&nbsp;Joshua P. Vogel","doi":"10.1111/1471-0528.18070","DOIUrl":"10.1111/1471-0528.18070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Evidence suggests L-arginine may be effective at reducing pre-eclampsia and related outcomes. However, whether L-arginine can prevent or only treat pre-eclampsia, and thus the target population and timing of initiation, remains unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the effects of L-arginine and L-citrulline (precursor of L-arginine) on the prevention and treatment of pre-eclampsia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>MEDLINE, Embase, CINAHL, Global Index Medicus and the Cochrane Library were searched through 7 February 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Trials administering L-arginine or L-citrulline to pregnant women, with the comparison group receiving placebo or standard care, were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Meta-analyses were conducted separately for prevention or treatment trials, using random-effects models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Twenty randomised controlled trials (RCTs) (2028 women) and three non-randomised trials (189 women) were included. The risk of bias was ‘high’ in eight RCTs and showed ‘some concerns’ in 12. In prevention trials, L-arginine was associated with a reduced risk of pre-eclampsia (relative risk [RR] 0.52; 95% confidence interval [CI], 0.35, 0.78; low-certainty evidence, four trials) and severe pre-eclampsia (RR 0.23; 95% CI, 0.09, 0.55; low-certainty evidence, three trials). In treatment trials, L-arginine may reduce mean systolic blood pressure (MD −5.64 mmHg; 95% CI, −10.66, −0.62; very low-certainty evidence, three trials) and fetal growth restriction (RR 0.46; 95% CI, 0.26, 0.81; low-certainty evidence, two trials). Only one study (36 women) examined L-citrulline and reported no effect on pre-eclampsia or blood pressure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>L-arginine may be promising for pre-eclampsia prevention and treatment, but findings should be interpreted cautiously. More trials are needed to determine the optimal dose and time to commence supplementation and support clinical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"698-708"},"PeriodicalIF":4.7,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967907","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":"Prolonged Ovarian Stimulation Does Not Worsen Neonatal Outcomes After Fresh Embryo Transfers","authors":"Jing Wu,&nbsp;Ying Ju,&nbsp;Jie Dong,&nbsp;Hengde Zhang,&nbsp;Xifeng Xiao,&nbsp;Xiaohong Wang","doi":"10.1111/1471-0528.18062","DOIUrl":"10.1111/1471-0528.18062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the relationship between prolonged ovarian stimulation and neonatal outcomes after autologous fresh embryo transfer (fET).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>University-affiliated centres.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>3529 patients underwent autologous in vitro fertilisation (IVF) cycles between August 1, 2016 and December 31, 2022, with a live singleton birth after fET.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Univariate and multivariate regression analyses were used to determine the relationship between prolonged ovarian stimulation and neonatal outcomes. Propensity score matching (PSM) was applied to evaluate independent effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Multivariate regression showed no significant association between simulation duration and birthweight (adjusted <i>β</i>: 4.19, 95% confidence interval [CI]: −13.86 to 22.23; <i>p</i> = 0.6494) or gestational age (GA) (adjusted <i>β</i>: −0.01, 95% [CI]: −0.09 to 0.06; <i>p</i> = 0.7403) Categorical analysis of neonatal outcomes, including low birthweight (LBW) (adjusted Odds Ratio [OR]: 0.94, 95% [CI]: 0.70 to 1.25; <i>p</i> = 0.6501), macrosomia (adjusted OR: 0.95, 95% [CI]: 0.78 to 1.16; <i>p</i> = 0.6294), small for gestational age (SGA) (adjusted OR: 0.95, 95% [CI]: 0.75 to 1.19; <i>p</i> = 0.6465), large for gestational age (LGA) (adjusted OR: 1.02, 95% [CI]: 0.85 to 1.21; <i>p</i> = 0.8542) and preterm (adjusted OR: 0.93, 95% [CI]: 0.77 to 1.11; <i>p</i> = 0.4191), revealed no associations with stimulation duration. PSM analysis confirmed these findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prolonged ovarian stimulation does not appear to increase adverse neonatal outcomes in singleton newborns after autologous fET.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S2","pages":"26-35"},"PeriodicalIF":4.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940075","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}