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

{"title":"Is There a Diminishing Benefit With Increasing Operative Time of Minimally Invasive Sacrocolpopexy? A Retrospective Analysis","authors":"Maura A. Schlussel,&nbsp;Stephen P. Rhodes,&nbsp;Susan D. Wherley,&nbsp;C. Emi Bretschneider,&nbsp;Ankita Gupta,&nbsp;David Sheyn","doi":"10.1111/1471-0528.18069","DOIUrl":"10.1111/1471-0528.18069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine whether there is an operative time threshold beyond which minimally invasive sacrocolpopexy (MI-SCP) is less beneficial than abdominal sacrocolpopexy (ASCP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The National Surgical Quality Improvement Program (NSQIP) database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Patients undergoing MI-SCP or ASCP from 2011 to 2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Preoperative characteristics, operative variables and 30-day postoperative data were collected for each case. Groups were compared using the chi-squared or Kruskal–Wallis tests. Multivariable regression to identify risks of complications and prolonged hospital stay was performed using logistic and negative binomial models. Generalised additive models were applied to account for non-linear relationships between dependent and independent variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Occurrence of any major surgical complications and the length of stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>13 678 sacrocolpopexies were performed, with the majority (78.6%) being MI-SCP. Although the groups were similar in age and BMI, those undergoing ASCP were more likely to have medical comorbidities. After adjusting for confounders, ASCP was not significantly associated with an increase in the probability of major complications compared to MI-SCP (aOR = 1.59, 95% CI: 0.99–2.54) and there was no significant interaction between procedure and operative time (aOR = 1.06, 95% CI: 0.94–1.20). ASCP was still associated with a prolonged LOS (aIRR = 2.19, 95% CI: 2.00–2.38). The interaction between procedure and operative time was significant (aIRR = 0.958, 95% CI: 0.93–0.98), but the LOS for MI-SCP never exceeded that of ASCP for operative times less than 6 h.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>For surgeries lasting less than 6 h, MI-SCP is associated with similar morbidity and a shorter LOS when compared with ASCP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"663-671"},"PeriodicalIF":4.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937701","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":"Digital Foetal Scalp Stimulation Versus Foetal Blood Sampling to Assess Foetal Well-Being in Labour: A Multicentre Randomised Controlled Trial","authors":"Sahr Yambasu,&nbsp;Fiona Boland,&nbsp;Keelin O'Donoghue,&nbsp;Colleen Curran,&nbsp;Yulia Shahabuddin,&nbsp;Amanda Cotter,&nbsp;Geraldine Gaffney,&nbsp;Declan Devane,&nbsp;Eleanor J. Molloy,&nbsp;Deirdre J. Murphy","doi":"10.1111/1471-0528.18068","DOIUrl":"10.1111/1471-0528.18068","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 establish whether digital foetal scalp stimulation (dFSS) performs better than foetal blood sampling (FBS) in terms of reducing the rate of caesarean section (CS) in labour, without adversely affecting perinatal 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;A multicentre parallel-group 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;Maternity centres in Ireland.&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;The study aimed to randomise 2500 nulliparous women who required a second-line test of foetal well-being in labour due to abnormal cardiotocography (CTG).&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 were randomly allocated to dFSS or FBS in a 1:1 ratio. Analysis was according to the published protocol and included a meta-analysis of the pilot study data and trial data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main Outcome Measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The primary outcome was CS.&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;Due to lower-than-expected randomisations, the trial concluded early. Of 534 consented participants, 124 had a second-line test of foetal well-being in labour and 43 (34.7%) were randomised; 20 to dFSS and 23 to FBS. The rate of CS was 40.0% (8/20) in the dFSS group and 47.8% (11/23) in the FBS group (absolute difference 7.8%; OR 0.73, 95% CI 0.22–2.44). The rate of CS was lower in the dFSS group when the trial data were included in a meta-analysis with the pilot data (&lt;i&gt;n&lt;/i&gt; = 50), although the confidence limits were wide (OR 0.41, 95% CI 0.17–0.96). There was no significant difference in rates of adverse perinatal and maternal outcomes. Of the nonrandomised participants who received a second-line test, 65% (53/81) received dFSS.&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 small sample size limits the ability to conclude whether dFSS performs better as a second-line test of foetal well-being in labour than FBS. A clinician preference for dFSS was apparent, even though robust evidence is lacking.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;&lt;b&gt;Trial Registration:&lt;/b&gt; This trial was prospectively registered on ClinicalTrials.gov on the 31st of March 2","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"557-564"},"PeriodicalIF":4.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937735","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 Impact of Dating Twin Pregnancy by the Larger, Smaller or Mean Twin Crown-Rump Length: A Retrospective Cohort Study","authors":"Gillian V. Blayney,&nbsp;Veronica Giorgione,&nbsp;Amar Bhide,&nbsp;Basky Thilaganathan","doi":"10.1111/1471-0528.18065","DOIUrl":"10.1111/1471-0528.18065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the impact of twin dating by ultrasound-measured crown-rump length (CRL) of the larger (CRL-L), smaller (CRL-S) or mean twin measurement (CRL-M) on the rates of preterm birth (PTB) and detection of small for gestational age (SGA) births.</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>A tertiary fetal medicine centre (London, UK).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>All twin pregnancies between 1998 and 2023 who underwent first trimester CRL ultrasound assessment and fetal growth assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data collection included CRL measurement, estimated fetal weight (EFW), pregnancy outcome and birthweight (BW) for each twin. Pregnancies were retrospectively re-dated by CRL-S, CRL-L and CRL-M.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>SGA &lt; 10th centile and extreme PTB rates (&lt; 28 weeks).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the 1129 twin pregnancies, median CRL-S was 61 mm (interquartile range [IQR]: 56.0–66.0) and CRL-L was 63 mm (IQR: 58.4–68.9) with a mean discordance of 4.0%. Prenatal SGA diagnosis occurred in 19.8% and 23.1% of smaller twins when dated by CRL-S and CRL-L, respectively. When pregnancies were dated by CRL-M versus CRL-S or CRL-L, there was no difference in prenatal SGA diagnosis (<i>p</i> = 0.275 and <i>p</i> = 0.419); SGA at birth (<i>p</i> = 0.132 and <i>p</i> = 0.325); or extreme PTB (<i>p</i> = &gt; 0.999 and <i>p</i> = 0.765 respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Dating by the smaller, larger or mean twin CRL does not significantly alter rates of extreme preterm birth, SGA detection or SGA birth. Dating by the mean twin CRL reduces stigmatisation of the smaller twin and retains the utility of accurate gestational age assessment without impacting clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"648-655"},"PeriodicalIF":4.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142937699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising Luteinising Hormone Levels on Trigger Day for Improved Ovarian Response and Pregnancy Outcomes in Gonadotropin-Releasing Hormone Antagonist Protocols: A Retrospective Cohort Study","authors":"Zijin Xu,&nbsp;Qiwang Lin,&nbsp;Zhu Liang,&nbsp;Sichen Li,&nbsp;Yixuan Wu,&nbsp;Yang Fu,&nbsp;Jianqiao Liu,&nbsp;Haiying Liu","doi":"10.1111/1471-0528.18064","DOIUrl":"10.1111/1471-0528.18064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the optimal luteinising hormone (LH) level on the trigger day and its impact on pregnancy outcomes in gonadotropin-releasing hormone (GnRH) antagonist protocols using a data-driven approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Third Affiliated Hospital of Guangzhou Medical University.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Overall, 6107 in vitro fertilisation/intra-cytoplasmic sperm injection fresh embryo transfer cycles with GnRH-antagonist protocols were performed between January 1, 2018 and February 1, 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Restricted cubic spline analysis and segmented regression identified the optimal LH threshold. Patients were categorised into low (≤ 1.6 IU/L) and high (&gt; 1.6 IU/L) LH groups. Propensity score matching (PSM) and multivariable logistic regression were applied to adjust for confounding factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Live birth rate per embryo transfer cycle.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The high LH group showed significantly higher live birth rates (42.9% vs. 36.9%, adjusted odds ratio [aOR]: 1.468; 95% CI: 1.220–1.766, <i>p</i> &lt; 0.001), ongoing pregnancy rates (51.4% vs. 43.6%, aOR: 1.498; 95% CI: 1.338–1.678, <i>p</i> &lt; 0.001), clinical pregnancy rates (52.4% vs. 45.6%, aOR: 1.439; 95% CI: 1.285–1.611, <i>p</i> &lt; 0.001) and biochemical pregnancy rates compared with the low LH group, despite retrieving fewer oocytes (median 10 vs. 12, <i>p</i> &lt; 0.001). These results remained consistent after PSM and multivariable logistic regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher LH levels on the trigger day are associated with improved pregnancy outcomes in GnRH-antagonist protocols. Maintaining an optimal LH range is crucial for balancing oocyte yield and assisted reproductive technology success, highlighting the importance of individualised ovarian stimulation protocols.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S2","pages":"44-52"},"PeriodicalIF":4.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936456","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":"Comprehensive Health Assessment of School-Age Children Conceived by Assisted Reproductive Technology: A Prospective Cohort Follow-Up Study","authors":"Jing Wang,&nbsp;Lingling Chen,&nbsp;Yonghong Yong,&nbsp;Xiang Yu,&nbsp;Yin Chen,&nbsp;Jie Zhang,&nbsp;Xinru Xia,&nbsp;Yugui Cui,&nbsp;Feiyang Diao,&nbsp;Jiayin Liu,&nbsp;Yan Meng","doi":"10.1111/1471-0528.18044","DOIUrl":"10.1111/1471-0528.18044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the comprehensive health status of school-age children conceived through assisted reproductive technology (ART) compared to that of those conceived naturally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A prospective cohort study of children conceived through ART.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>First Affiliated Hospital of Nanjing Medical University, China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population Sample</h3>\u0000 \u0000 <p>One hundred school-age children were enrolled and followed up (51 conceived via ART and 49 naturally conceived (controls)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive health status assessment was performed in children aged 6–12 years, including anthropometric measurements, glucose-lipid metabolism, echocardiography, intelligence, behaviour, vision and hearing. Multivariate regression models were used to adjust for sociodemographic and perinatal covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Comprehensive health status of children conceived via ART.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Children conceived by ART had similar height, weight, blood pressure, blood glucose and lipid profiles compared to the controls. Echocardiography showed similar cardiac geometric morphology and left/right ventricular diastolic-systolic function between the two groups. ART children had lower carotid intima-media thickness than controls (0.52 ± 0.11 vs. 0.58 ± 0.11). Visual acuity, hearing and intellectual and behavioural assessments were similar. An alternating covering test for the eyes showed a higher incidence of abnormal eye movement in the ART group than in the control group (87.76% vs. 68.89%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The similar overall health status of ART- and naturally conceived children is reassuring for those receiving ART. However, our study shows a possible increase in the incidence of latent exotropia among ART children. Long-term follow-up is warranted to assess the overall health status associated with ART throughout the lifespan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S2","pages":"8-17"},"PeriodicalIF":4.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936454","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":"Addressing Limitations in Stillbirth Assessment Research: A Call for Broader Perspectives","authors":"Sijia Liu,&nbsp;Jialao Ma","doi":"10.1111/1471-0528.18061","DOIUrl":"10.1111/1471-0528.18061","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 7","pages":"1014-1015"},"PeriodicalIF":4.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936490","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":"Postpartum Pre-Eclampsia: Novel Insights Into a Complex Clinical Entity","authors":"Frances Conti-Ramsden,&nbsp;Antonio de Marvao,&nbsp;Lucy Chappell","doi":"10.1111/1471-0528.18056","DOIUrl":"10.1111/1471-0528.18056","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"760-761"},"PeriodicalIF":4.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935151","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":"Smoking, Genetic Susceptibility and Early Menopause: Unveiling Biological Mechanisms and Potential Therapy Targets","authors":"Yuhang Liang,&nbsp;Jie Ou,&nbsp;Jing Fu,&nbsp;Yijing Wang,&nbsp;Yanping Li,&nbsp;Jinchen Li,&nbsp;Yan Yi","doi":"10.1111/1471-0528.18052","DOIUrl":"10.1111/1471-0528.18052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the association between smoking, genetic susceptibility and early menopause (EM) and clarify the potential mechanisms underlying this relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>An observational and Transcriptome-wide association analysis (TWAS) study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>UK Biobank and public summary statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>139 869 women with full baseline and menopause data, and no gynaecological surgery history.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adjusted modified Poisson regression models were developed to determine the smoking and genetic risk effects on EM. TWAS was used to identify gene expression between smoking and EM, with Mendelian randomisation (MR) to infer causality. Enrichment analysis explored regulatory networks of transcription factors, microRNAs and potential therapeutic targets. Small molecule drugs were predicted using drug-gene interaction analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>EM prevalence and common gene expression patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Women with over 30 pack-years of smoking had about 1.5 times higher EM risk, with RRs of 1.39 (95%CI, 1.23–1.56), 1.45 (1.33–1.59) and 1.45 (1.36–1.55) in the low, intermediate and high genetic risk groups. TWAS identified hub genes such as IMMP2L, BMPR2 and HMGN1. MR confirmed daily cigarette consumption as a causal factor in early menopause. Several potential therapeutic targets (e.g., SP600125, INCB18424 and ruxolitinib) were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Smoking reduction significantly lowered the risk of EM. Hub genes and therapeutic targets identified provided new avenues for mitigating harmful effects of smoking.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"625-637"},"PeriodicalIF":4.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887328","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":"Safety of Fertility Treatments in Women With Systemic Lupus Erythematosus: Data From a Prospective Population-Based Study","authors":"Amandine Dernoncourt,&nbsp;Gaëlle Guettrot-Imbert,&nbsp;Loïc Sentilhes,&nbsp;Marie Charlotte Besse,&nbsp;Anna Molto,&nbsp;Viviane Queyrel-Moranne,&nbsp;Maelle Le Besnerais,&nbsp;Estibaliz Lazaro,&nbsp;Nathalie Tieulié,&nbsp;Christophe Richez,&nbsp;Eric Hachulla,&nbsp;Françoise Sarrot-Reynauld,&nbsp;Gaëlle Leroux,&nbsp;Pauline Orquevaux,&nbsp;Jonathan London,&nbsp;Laurent Sailler,&nbsp;Odile Souchaud-Debouverie,&nbsp;Perrine Smets,&nbsp;Bertrand Godeau,&nbsp;Emmanuelle Pannier,&nbsp;Anne Murarasu,&nbsp;Alice Berezne,&nbsp;Tiphaine Goulenok,&nbsp;Nathalie Morel,&nbsp;Luc Mouthon,&nbsp;Pierre Duhaut,&nbsp;Véronique Le Guern,&nbsp;Nathalie Costedoat-Chalumeau,&nbsp;The Gr2 Study Group","doi":"10.1111/1471-0528.18050","DOIUrl":"10.1111/1471-0528.18050","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 assess safety of fertility treatments in women with systemic lupus erythematosus (SLE).&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 multicentre French observational GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares) study (2014-ongoing).&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;Seventy-six centres in 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 pregnancies in women with SLE enrolled in the GR2 study, conceived before 1 August 2022, with available end-of-pregnancy data and known conception type, were included; that is, 577 spontaneous and 53 assisted pregnancies.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A comparative analysis of spontaneous and assisted pregnancies was conducted. Logistic regression was used to determine if fertility treatments were independently associated with live birth prognosis, adjusting for confounders (e.g., maternal age). Kaplan–Meier analysis compared cumulative incidences of disease flares and adverse pregnancy outcomes (APOs), with confounding factors adjusted using a Cox regression model.&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;Live birth, disease flares, and APOs.&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;The mean age was older (35.8 vs. 32.3 years, &lt;i&gt;p&lt;/i&gt; &lt; 1 × 10&lt;sup&gt;−4&lt;/sup&gt;), and twins were more frequent in assisted pregnancies (5/50, 10.0% vs. 20/554, 3.6%; &lt;i&gt;p&lt;/i&gt; = 0.047). Lupus disease was clinically inactive at baseline in 51 (96.2%) assisted pregnancies (vs. &lt;i&gt;n&lt;/i&gt; = 511, 89.6%; &lt;i&gt;p&lt;/i&gt; = 0.15), with 35 of 45 (77.8%) having no chronic damage (vs. 448/513, 87.3%; &lt;i&gt;p&lt;/i&gt; = 0.07). The live birth rate was similar between assisted and spontaneous pregnancies (&lt;i&gt;n&lt;/i&gt; = 46, 86.8% vs. &lt;i&gt;n&lt;/i&gt; = 505, 87.5%; &lt;i&gt;p&lt;/i&gt; = 0.83), with no statistical difference in the incidence of lupus flares and APOs. These results remained consistent after adjusting for confounding factors.&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;Fertility treatments in women with mostly well-controlled SLE did not appear to increase risks of maternal and neonatal complications, supporting current recommendations.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;Trial Registration&lt;/p&gt;\u0000 \u0000 &lt;p&gt;ClinicalTrials.gov identifier: NCT02450396&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 &lt;/d","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"614-624"},"PeriodicalIF":4.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857535","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":"Identification and Management of Maternal Sepsis During and Following Pregnancy","authors":"David Lissauer,&nbsp;Marina Morgan,&nbsp;Anita Banerjee,&nbsp;Felicity Plaat,&nbsp;Dharmintra Pasupathy,&nbsp;the Royal College of Obstetrics and Gynaecology","doi":"10.1111/1471-0528.18009","DOIUrl":"10.1111/1471-0528.18009","url":null,"abstract":"&lt;p&gt;The need for such a guideline was originally identified by the 2007 Confidential Enquiry into Maternal Deaths [&lt;span&gt;1&lt;/span&gt;]. The scope of this guideline covers the recognition and management of sepsis in the antenatal, intrapartum and postpartum periods, including post-abortion sepsis. The scope includes bacterial infections arising in the genital tract or elsewhere and influenza and their management in secondary care. Sepsis arising due to primary viral (other than influenza and HSV) or parasitic infection is outside the scope of this guideline. There is separate specific guidance available on Coronavirus (COVID-19) infection in pregnancy [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;This guideline is for healthcare professionals who care for women, non-binary and trans people suspected of, or diagnosed with, sepsis in primary or secondary healthcare. This guideline excludes mild to moderate illness in primary care.&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;Sepsis during and following pregnancy remains an important cause of maternal death globally, accounting for 11% of all maternal deaths [&lt;span&gt;3&lt;/span&gt;]. Between 2019–21, 241 of 2 066 997 women giving birth in the UK died. Of these, 78 women died of sepsis, either direct or indirect. Despite a statistically non-significant increase in the overall maternal death rate due to sepsis in the UK between 2016–18 and 2019–21, most of this was accounted for by SARS-COV-2 viral infections in unvaccinated women.&lt;/p&gt;&lt;p&gt;In the UK and Ireland, during or up to six weeks after the end of pregnancy and defined “&lt;i&gt;in the broadest sense as death from a primary infective cause&lt;/i&gt;” the overall mortality rate for sepsis was 2.50 per 100 000 maternities (95% CI 1.89–3.25 per 100 000) [&lt;span&gt;1, 4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Between 2019–21, 10% of all maternal deaths were due to sepsis and 14% of deaths were due to COVID-19 infection [&lt;span&gt;4&lt;/span&gt;]. Overall, 47 of the 78 deaths (60%) were attributable to viral infections, 43 due to COVID-19, one varicella zoster virus, one viral myocarditis of unknown cause and two following influenza A [&lt;span&gt;4&lt;/span&gt;]. Deaths attributable to influenza A were significantly lower than in the years 2010–12 when 13 women died, reflecting the importance of vaccination. Only one of the 43 women who died from SARS-CoV-2 had been vaccinated, and had only had one dose of COVID-19 vaccine [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The number of bacterial sepsis related deaths was significantly higher than in the previous MBRRACE report (2015–2017), [&lt;span&gt;5&lt;/span&gt;","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"e61-e85"},"PeriodicalIF":4.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142849241","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}