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

{"title":"Women's Childbirth Experiences in the WILL Randomised Trial (When to Induce Labour to Limit Risk in Pregnancy Hypertension): A Mixed Methods Analysis","authors":"Sue Tohill, Katie Kirkham, Eleni Gkini, Catherine A. Moakes, Sergio A. Silverio, Gillian Horgan, Ben Wills, Jennifer A. Hutcheon, Joel Singer, Clive Stubbs, Jim G. Thornton, Peter von Dadelszen, Laura A. Magee, the WILL Trial Study Group","doi":"10.1111/1471-0528.18257","DOIUrl":"10.1111/1471-0528.18257","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare childbirth satisfaction in women with chronic or gestational hypertension, randomised to ‘planned early term birth at 38<sup>+0–3</sup> weeks' gestation’ (intervention) or ‘usual care at term’ (control).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Randomised trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Forty-two consultant-led maternity units, United Kingdom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>357/403 women randomised completed the Childbirth Experience Questionnaire (CEQ).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Mixed-methods analysis of the 22-item CEQ, assessing: ‘Own capacity’, ‘Professional support’, ‘Perceived safety’ and ‘Participation’. Directed content analysis sorted free-text comments into themes covered by the CEQ and two additional themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>CEQ scores overall and by domain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In intervention (vs. control) groups, the CEQ was completed by 177/202, 88.1% (vs. 180/202, 89.1%) participants, and 378 free-text comments were made by 93/177, 52.5% (vs. 98/180, 54.4%) participants. There was no significant difference in CEQ scores overall (3.1 ± 0.4 vs. 3.1 ± 0.4, respectively) or by domain (‘Own capacity’ [2.8 ± 0.5 vs. 2.7 ± 0.5, respectively]; ‘Professional support’ [3.7 ± 0.5 vs. 3.7 ± 0.6, respectively]; ‘Perceived safety’ [3.2 ± 0.6 vs. 3.1 ± 0.6, respectively]; and ‘Participation’ [2.6 ± 0.7 vs. 2.7 ± 0.6]). Most comments were positive (222/378, 58.7%), and about ‘Relational care and care interactions’ (CEQ ‘Professional support’). Neither the number nor positivity of comments appeared to differ between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For women with chronic or gestational hypertension who remain well at term, we found no difference in childbirth experience between women randomised to planned early term birth versus usual care at term. Shared decisions about timing of birth may be more influenced by differences in clinical outcomes and costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 10","pages":"1426-1437"},"PeriodicalIF":4.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18257","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478638","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":"Annual Academic Meeting 2025 Abstracts","authors":"","doi":"10.1111/1471-0528.18140","DOIUrl":"10.1111/1471-0528.18140","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S3","pages":"3-16"},"PeriodicalIF":4.3,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367585","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":"Top Scoring Abstracts of the RCOG World Congress 2025","authors":"","doi":"10.1111/1471-0528.18215","DOIUrl":"10.1111/1471-0528.18215","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S5","pages":"3-199"},"PeriodicalIF":4.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18215","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339504","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":"Correction to ‘The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-Top Guideline No. 69)’","authors":"","doi":"10.1111/1471-0528.18258","DOIUrl":"10.1111/1471-0528.18258","url":null,"abstract":"<p>We apologise for these errors.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 10","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18258","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Surgery on Endometriomas on Fertility (2025 Second Edition)","authors":"P. R. Supramaniam,&nbsp;M. Mittal,&nbsp;C. Becker,&nbsp;K. Jayaprakasan,&nbsp;the Royal College of Obstetricians and Gynaecologists","doi":"10.1111/1471-0528.18221","DOIUrl":"10.1111/1471-0528.18221","url":null,"abstract":"<p>Endometriosis is a condition where the lining of the uterus (womb) is found in other locations in the body such as, but not limited to, the ovaries, bowel and bladder. It is a common condition that can affect up to one in 10 women and can be found in between three to five in 10 women who have been diagnosed with subfertility.</p><p>Women with endometriosis often present with painful periods, heavy periods, pain while opening their bowels or passing urine, pain during sexual intercourse and difficulty in conceiving. A proportion of those with endometriosis remain asymptomatic of the disease. Care should be tailored to each individual.</p><p>The significant improvement in diagnostic technology has increased the detection rate of endometriosis. People with ovarian endometriosis, also known as an ovarian endometrioma, can be diagnosed using a transvaginal (internal) or transabdominal (via the tummy) ultrasound scan. Detection rates of up to 90% have been reported for routine ultrasound scans.</p><p>Ovarian endometriomas can impact fertility outcomes, and for these people a multidisciplinary approach to care is required. The presence of an ovarian endometrioma and endometriosis is known to have a negative impact on the ovarian reserve (egg count and quality) and overall, chance of successful conception. Women with known endometriosis should therefore be counselled about the various options available for fertility preservation.</p><p>The treatment for ovarian endometrioma(s) in those wanting to conceive can be broadly divided into two categories, expectant (watch-and-wait approach), and surgical which most commonly involves-keyhole surgery.</p><p>Expectant management avoids the risks of surgery, along with no further surgically related reduction in ovarian reserve. It also reduces the delay from diagnosis to starting fertility treatment. The disadvantages of this approach, however, would be the persistence of pain symptoms, and ongoing difficulty with accessing the ovaries during assisted fertility treatment such as in vitro fertilisation.</p><p>Surgical treatment for ovarian endometrioma(s) in the context of women trying to conceive is often approached with caution. Surgery has been shown to reduce the ovarian reserve further, and clinicians would attempt to limit the degree of impact by reducing the amount of surgical stress to an ovary. The benefits of this approach, however, would be an improvement in symptoms and access to the ovaries for fertility treatment.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 11","pages":"e175-e184"},"PeriodicalIF":4.3,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18221","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320201","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":"Authors' Reply","authors":"Milla Juhantalo,&nbsp;Tuija Hautakangas,&nbsp;Outi Palomäki,&nbsp;Jukka Uotila","doi":"10.1111/1471-0528.18242","DOIUrl":"10.1111/1471-0528.18242","url":null,"abstract":"<p>We sincerely thank Drs. Qi and Yang [<span>1</span>] for their interest in our work [<span>2</span>]. The observations shared in their correspondence raised valuable points for further clarification.</p><p>We appreciate that the infection risk associated with the use of an intrauterine pressure catheter (IUPC) was highlighted in the comments. Evidence from two large RCTs (combined <i>n</i>≈3000 deliveries) comparing IUPC with external monitoring did not demonstrate an increased risk of infection in the IUPC group [<span>3, 4</span>]. However, most of the studies addressing this risk, including the one referenced in the comment letter [<span>1</span>], have been retrospective. As IUPC placement is typically recommended when external monitoring is inadequate or to guide oxytocin augmentation [<span>5</span>], the independent risk attributable to IUPC use remains difficult to determine in a retrospective setting. To minimise procedural risks, IUPC insertion should always avoid the caesarean scar site and the placenta, reducing the potential for uterine perforation or injury to fetal vessels.</p><p>The potential of alternative strategies for oxytocin administration, such as amniotomy in cases of reduced uterine activity associated with chorioamnionitis, was raised in the comments. While amniotomy is a prerequisite for IUPC placement, it did not demonstrate specific relevance to uterine activity in our study. Additionally, we wish to emphasise that although the absence of placental histology may be considered a limitation, it represents a retrospective diagnosis and therefore does not support clinical decision-making. A key objective of our clinical study was to support evidence-based decisions during labour, where real-time assessments are essential.</p><p>Drs Qi and Yang pointed out how prolonged labour itself poses risks to both maternal and neonatal outcomes. We agree that future research should highlight this. As our analysis of uterine activity was limited to the final 4 h preceding delivery, this could not be addressed within the scope of the current study.</p><p>M.J. Is the principal author of the manuscript. T.H., O.P. and J.U. contributed to the study planning and provided critical revisions to the manuscript.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 11","pages":"1699-1700"},"PeriodicalIF":4.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18242","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303425","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":"Current Pathways of Care Continue to Fail Those With a Diagnosis of Endometriosis","authors":"Katy Vincent,&nbsp;Andrew W. Horne","doi":"10.1111/1471-0528.18245","DOIUrl":"10.1111/1471-0528.18245","url":null,"abstract":"&lt;p&gt;Endometriosis is a chronic, oestrogen-dependent, inflammatory condition that is associated with disabling pelvic pain and infertility [&lt;span&gt;1&lt;/span&gt;]. It affects ~10% of those born female, and recent data show that within the NHS in England alone, almost 2500 women per month receive the diagnosis [&lt;span&gt;2&lt;/span&gt;]. Current UK clinical practice for the management of endometriosis-associated pain aligns with the recommendations of both NICE [&lt;span&gt;3&lt;/span&gt;] and ESHRE [&lt;span&gt;4&lt;/span&gt;], focusing on simple analgesia, hormonal therapies and surgical removal (excision or ablation) of lesions. There has been increasing awareness of endometriosis among both primary and secondary care clinicians, researchers and the public over recent years, including high-profile media coverage. Much of the dialogue focuses on diagnostic delay, which remains between 5–12 years from onset of symptoms throughout the developed world [&lt;span&gt;5&lt;/span&gt;]. These narratives frequently highlight the ongoing dismissal of women's pain and wider-reaching medical misogyny as key contributors. However, there have been two recent largescale UK reports which paint a stark picture of the challenges which also face those who &lt;b&gt;&lt;i&gt;have&lt;/i&gt;&lt;/b&gt; received a diagnosis and call into question our approach to the subsequent management of the condition.&lt;/p&gt;&lt;p&gt;In July 2024, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) published their review of the quality of healthcare provided to adults diagnosed with endometriosis [&lt;span&gt;6&lt;/span&gt;]. This enquiry combined data from multiple sources (623 clinician questionnaires, 167 organisational questionnaires, review of 309 sets of case notes, 941 responses to a patient survey and 137 responses to a clinician survey) to assess the pathway and quality of care provided by the NHS in England, Wales and Northern Ireland between 1 February 2018 and 31 July 2020 to those aged 18 and over with an endometriosis diagnosis. Aligned with NICE/ESHRE guidance, a large proportion (77.9%) of patients had been prescribed hormonal treatment in primary and/or secondary care. Appropriately, many of those who were not offered hormonal therapy were trying to conceive. However, 42.8% reported no improvement with hormonal medication. To be included in this study, patients had to have had a laparoscopy during their index admission and thus we cannot use these data to determine any information about rates of surgery in the UK. However, given the central role of surgery in the current management of endometriosis, one of the most striking findings of this report was that only 17.3% of patients were satisfied with the results of their primary surgery. It is also surprising, given that pain was the primary presenting symptom for the majority (77.7%), that only just over half (54.4%) of patients were prescribed pain medication. This may of course represent an assumption that simple analgesics could be bought over the counter. Despite good evidence that chronic p","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 10","pages":"1346-1349"},"PeriodicalIF":4.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310774","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":"Breaking the Cycle: Why Women of Reproductive Age Belong in All Areas of Health Research.","authors":"Rachel Hulme, Margherita Bielli, Kate Womersley, Edward Mullins","doi":"10.1111/1471-0528.18255","DOIUrl":"https://doi.org/10.1111/1471-0528.18255","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310772","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 ‘Identification and Management of Maternal Sepsis During and Following Pregnancy’","authors":"","doi":"10.1111/1471-0528.18259","DOIUrl":"10.1111/1471-0528.18259","url":null,"abstract":"<p>Lissauer, D., Morgan, M., Banerjee, A., Plaat, F., Pasupathy, D. and (2025), Identification and Management of Maternal Sepsis During and Following Pregnancy. BJOG, 132: e61–e85. https://doi.org/10.1111/1471-0528.18009.</p><p>In the recommendation table of Section 6.1, ‘Use of a sepsis bundle may improve compliance with urgent management in women at high risk of sepsis’ the rationale was incorrect. This should have read: ‘As per Surviving Sepsis Campaign Bundle [74]’.</p><p>We apologise for this error.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 10","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18259","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310773","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":"Antenatal Corticosteroid Administration and Childhood Respiratory Morbidity: A Regression Discontinuity Study.","authors":"Jennifer A Hutcheon, Sam Harper, M Claire Cordingley, Jessica Liauw, M Amanda Skoll, Peter M Socha, Myriam Srour, Joseph Y Ting, Erin C Strumpf","doi":"10.1111/1471-0528.18252","DOIUrl":"https://doi.org/10.1111/1471-0528.18252","url":null,"abstract":"<p><strong>Objective: </strong>To determine if routine administration of antenatal corticosteroids affects the risk of infant lower respiratory tract infection and/or childhood asthma.</p><p><strong>Design: </strong>Linked population-based cohort analysed using a regression discontinuity design, which better controls for confounding than standard observational studies.</p><p><strong>Setting: </strong>British Columbia, Canada.</p><p><strong>Population: </strong>Singleton pregnancies with a maternal admission for delivery between 31 + 0 and 36 + 6 weeks' gestation from 2000 to 2016, with follow-up to 2020.</p><p><strong>Methods: </strong>We estimated if risks of childhood respiratory outcomes differed between pregnancies admitted just before the Canadian recommended clinical cut-off for antenatal corticosteroid administration of 34 + 0 weeks gestation (i.e., with higher probability of exposure to antenatal corticosteroids; 'exposed') than those admitted just after this cut-off (i.e., with lower probability of exposure; 'unexposed') using log binomial regression (infant lower respiratory infection hospitalisation) and pooled log binomial regression (asthma).</p><p><strong>Main outcome measures: </strong>Infant lower respiratory tract infection hospitalisation, inpatient or outpatient asthma diagnosis at 1-18 years.</p><p><strong>Results: </strong>In our cohort of 21 965 children, 412 (1.9%) infants were hospitalised with a lower respiratory tract infection and 2287 (10.4%) were diagnosed with asthma. Routine administration of antenatal corticosteroids was not associated with infant lower respiratory tract infection (risk ratio = 0.95 [95% CI: 0.61, 1.37], risk difference = -0.15 excess cases per 100 [95% CI: -1.30, 0.99]) or childhood asthma (rate ratio = 1.08 [95% CI: 0.88, 1.24] 5.49 excess cases per 100 by age 13 years [95% CI: -1.78, 14.39]).</p><p><strong>Conclusions: </strong>We found no evidence that routine administration of antenatal corticosteroids affects the risk of later childhood respiratory illnesses.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287026","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}