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

{"title":"Neglected for Too Long: Perinatal Mental Health Impacts of Stillbirth in Low- and Middle-Income Countries","authors":"Hannah Blencowe, Oona Campbell, Toma Kerac, Renae Stafford, Vandana Tripathi, Veronique Filippi","doi":"10.1111/1471-0528.18051","DOIUrl":"10.1111/1471-0528.18051","url":null,"abstract":"<p>Stillbirths are one of the world's most neglected tragedies. The estimated 1.9 million babies that are stillborn after 28 completed weeks of pregnancy in 2021 underestimates the overall burden of all fetal deaths from 22 weeks onward [<span>1</span>]. Each death has an important impact on affected women, families and healthcare workers [<span>2</span>]. Yet, despite this, until very recently, national governments, UN organisations and civil society institutions (including non-governmental organisations and professional associations) worldwide have given little attention to stillbirths. This has resulted in lack of prioritisation of stillbirths in data strengthening efforts, limiting visibility of underlying biomedical causes [<span>3</span>]. This coupled with the failure to include stillbirths in maternal and child health dialogues exacerbates stigma towards affected women, and frequently leaves bereaved parents to deal with their grief in silence.</p><p>Perinatal mental health disorders, occurring during pregnancy and in the first year after childbirth, affect almost one in five women giving birth and have only recently been brought out of the shadows [<span>4</span>]. Many organisations are now accelerating their focus on the issue and global guidance on the integration of perinatal mental health into routine healthcare provision is now available [<span>5</span>]. However, despite a strong body of evidence describing increased risks of adverse perinatal mental health outcomes associated with stillbirth in high-income countries [<span>2</span>], and newer evidence reporting similar effects across a wide range of low- and middle- income countries (LMICs) [<span>6-9</span>], stillbirths have been to-date largely left out of perinatal mental health guidance.</p><p>We conducted a rapid review of evidence on the perinatal mental health consequences of stillbirth as part of the MOMENTUM Safe Surgery in Family Planning and Obstetrics (MOMENTUM Safe Surgery) project's work to improve postnatal services [<span>10, 11</span>]. Collating available data across 20 studies from 12 low- and middle-income countries, a median of 41% of women reported evidence of depression in the year following a perinatal loss (stillbirth or early neonatal death) [<span>9</span>]. This is at least double the risk compared to after a live birth, translating to around 1.2 million women annually with depression in the year following a stillbirth or early neonatal death in sub-Saharan Africa and South Asia alone. Increases in anxiety and stress were also observed, presenting a substantial burden on women, families and communities in these regions.</p><p>Adverse perinatal mental health consequences following stillbirth can be partly mitigated through timely, person-centred supportive bereavement care. The past decade has seen large advances in understanding the experiences and care needs for affected women, partners and families, including the introduction of national care berea","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"554-556"},"PeriodicalIF":4.7,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825048","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 After Metabolic Bariatric Surgery: Risks and Rewards for Mother and Child","authors":"Dries Ceulemans,&nbsp;Ellen Deleus,&nbsp;Katrien Benhalima,&nbsp;Bart van der Schueren,&nbsp;Matthias Lannoo,&nbsp;Roland Devlieger","doi":"10.1111/1471-0528.18032","DOIUrl":"10.1111/1471-0528.18032","url":null,"abstract":"<div>\u0000 \u0000 <p>As the prevalence of obesity increases worldwide, and lifestyle modification or pharmaceutical treatment yields insufficient results for patients with severe obesity, an increasing number of patients opt for metabolic bariatric surgery as an effective and durable treatment of this disease. Seeing as 80% of these patients are women, many of whom are of reproductive age, pregnancies after metabolic bariatric surgery become increasingly common. Metabolic bariatric surgery has many benefits for overall health and pregnancy outcomes, but certain risks are also reported. This leads to the rise of a new population of patients with their own specific needs regarding follow-up. This review discusses the various benefits and risks of these types of surgery for pregnancy. We provide an overview of the current state of the evidence and look into future research goals.</p>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"401-413"},"PeriodicalIF":4.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142810160","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":"A Care Bundle Aiming to Reduce the Risk of Obstetric Anal Sphincter Injury: A Survey of Women's Experiences","authors":"Magdalena Jurczuk,&nbsp;Lizzie Phillips,&nbsp;Posy Bidwell,&nbsp;Dorian Martinez,&nbsp;Louise Silverton,&nbsp;Nick Sevdalis,&nbsp;Jan van der Meulen,&nbsp;Ipek Gurol-Urganci,&nbsp;Ranee Thakar","doi":"10.1111/1471-0528.18029","DOIUrl":"10.1111/1471-0528.18029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To study experiences of women who gave birth in maternity units that have implemented a ‘care bundle’ quality improvement initiative to reduce obstetric anal sphincter injury (OASI) and associated morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Postnatal electronic questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Twenty-nine maternity units across England, Scotland and Wales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women with live vaginal births.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Descriptive statistics for quantitative results. Analysis of free-text responses informed by framework method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Experience with components of the care bundle: information provision, manual perineal protection (MPP) and post-birth rectal examination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this study, 1208 women completed the survey: 684 (56.6%) said they received antenatal information about perineal health, 377 (31.2%) recalled MPP, and 664 (55.0%) recalled rectal examination. Of the 684 women who said they received antenatal information, 595 (87.0%) agreed that the information was easy to understand, and 423 (61.8%) agreed that it helped them to make their own choices to reduce their OASI risk. One hundred and fifty-four (22.5%) agreed that the information made them fearful about giving birth vaginally. Of the 377 women who recalled MPP, 203 (53.9%) felt it provided them with support, and another 97 (25.7%) did not mind the sensation. Of the 664 women who recalled rectal examination, 281 (42.3%) did not mind the exam, and another 335 (50.5%) felt it was uncomfortable but understood its importance. Free-text responses aligned with quantitative results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Many women did not recall MPP or rectal examination. The reported experiences for those who recalled these components do not support concerns that the OASI care bundle has negative effects on women's experiences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"588-595"},"PeriodicalIF":4.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142810161","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":"Point-of-Care Tests for Preeclampsia: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies","authors":"Nouran Elbarbary,&nbsp;Filippa Pritsini,&nbsp;Ayisha Kazi,&nbsp;Chao Wang,&nbsp;Baskaran Thilaganathan,&nbsp;Amarnath Bhide","doi":"10.1111/1471-0528.18040","DOIUrl":"10.1111/1471-0528.18040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preeclampsia is a common condition associated with significant maternal and foetal complications. The diagnosis of preeclampsia is based on clinical criteria, with recent introduction of angiogenic markers as an aid to clinical triage. Several biomarkers are now available in a point-of-care test format, which provide swift results to support clinical decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine sensitivity and specificity of available point-of-care tests used for preeclampsia prediction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>Systematic searches of databases (PubMed/Medline, Ovid Embase) from inception till May 2024 were done to identify relevant studies. Selection criteria: we included studies reporting on the diagnostic test accuracy of any point-of-care test for short-term prediction of preeclampsia in the second or third trimester.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Data were extracted using pre-designed template, and statistical analysis was performed to pool sensitivity and specificity and a hierarchal summary receiver operating characteristic curve model was used. Quality of included studies and risk of bias were assessed following the QUADAS-2 tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>We identified 17 studies that met the inclusion criteria, six of which described the use of glycosylated fibronectin, five with Congo red, two with placental growth factor (PlGF) and one study each investigated nephrin, misfolded protein, CD44/FKBPL ratio and inositol phosphoglycan-P. Meta-analysis was possible only for glycosylated fibronectin with a pooled sensitivity of 0.80 (95% CI: 0.51–0.94) and a specificity of 0.84 (95% CI: 0.71–0.93). Five studies were included in meta-analysis, all of which had a low risk of bias on the QUADAS assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings suggest that the point-of-care glycosylated fibronectin testing might be beneficial in clinical triage for preeclampsia in an at-risk population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"414-425"},"PeriodicalIF":4.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142810158","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":"Factors Contributing to Uptake of Stillbirth Evaluations: A Qualitative Analysis","authors":"Naomi O. Riches,&nbsp;Tsegaselassie Workalemahu,&nbsp;Erin P. Johnson,&nbsp;Sarah Lopez,&nbsp;Nathan Blue,&nbsp;Jessica Page,&nbsp;Robert M. Silver,&nbsp;Erin Rothwell","doi":"10.1111/1471-0528.18038","DOIUrl":"10.1111/1471-0528.18038","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;The purpose of this study was to explore individuals' beliefs, values, and experiences surrounding stillbirth evaluation decisions.&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;Qualitative research.&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;University of Utah Health.&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;Parents who experienced a stillbirth in the past 5 years (&lt;i&gt;n&lt;/i&gt; = 19) were interviewed about their experiences and decision to consent to or decline stillbirth evaluations, such as autopsy, placental histopathology, or genetic testing.&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;Qualitative content analysis.&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;Barriers and facilitators to parentsstillbirth postmortem decision-making.&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;Participants communicated several facilitators and barriers that contributed to their stillbirth evaluation decision. Reasons for consenting to evaluations were belief in science, background in medicine, altruism, to inform future pregnancies, thinking about preventing another stillbirth, and how patients viewed the care of their stillborn by the medical team. Reasons for declining evaluations were receiving a diagnosis prior to being offered a postmortem evaluation, intent to avoid causing further harm to the baby, interest to spend more time with their baby, and cost of the evaluation.&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;Stillbirth is one of the most difficult experiences of a parent. Diagnostic and emotional barriers create further challenges to decision-making for stillbirth postmortem evaluations. Parents often rely on inadequate information and personal values and beliefs during this time-sensitive decision process. Decision support for stillbirth evaluations and training for medical providers could benefit parents, may increase stillbirth evaluation uptake, and potentially prevent decisional regret.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Funding&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Research reported in this publication was sup","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"606-613"},"PeriodicalIF":4.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793209","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":"BMFMS Abstracts 2024","authors":"","doi":"10.1111/1471-0528.18006","DOIUrl":"10.1111/1471-0528.18006","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S1","pages":"3-105"},"PeriodicalIF":4.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793873","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":"Endometriosis-Related Genetic Factors and Their Role in Preterm Birth: A Two-Sample Mendelian Randomisation Study","authors":"Christopher Flatley,&nbsp;Dana Kristjansson,&nbsp;Karin Ytterberg,&nbsp;Julius Juodakis,&nbsp;Pol Sole-Navais,&nbsp;Bo Jacobsson","doi":"10.1111/1471-0528.18039","DOIUrl":"10.1111/1471-0528.18039","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;Endometriosis affects 10% of women worldwide and is linked to adverse pregnancy outcomes, including preterm birth. Recent epidemiological and genetic studies indicate that endometriosis may influence gestational duration and the likelihood of preterm birth. This study aimed to estimate the direct genetic causal effects of endometriosis on gestational duration and preterm birth using Mendelian randomisation (MR) analysis, leveraging genetic data from recent genome-wide association studies (GWASs).&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 two-sample MR study.&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;Summary statistics from published GWASs on European ancestry populations for endometriosis and gestational duration.&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;Instrumental variables for endometriosis were derived from a meta-analysis comprising 60 674 endometriosis cases and 701 926 controls.&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;Genetic correlations and heritability estimates were calculated using linkage disequilibrium score regression. Two-sample MR with multiplicative random-effects inverse variance weighting assessed the primary objectives, supplemented by sensitivity analyses to validate MR assumptions.&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 outcomes were gestational duration and preterm birth, sourced from the latest GWAS data.&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;LD score regression revealed no genetic correlation between endometriosis and either gestational duration or preterm birth. MR analysis showed no causal association between endometriosis and maternal effects on offspring gestational duration (&lt;i&gt;β&lt;/i&gt; = 0.40, 95% CI: −0.39 to 1.19, &lt;i&gt;p&lt;/i&gt; = 0.32) or preterm birth (OR = 0.94, 95% CI: 0.82–1.06, &lt;i&gt;p&lt;/i&gt; = 0.36). Sensitivity analyses indicated pleiotropy but no violations of MR assumptions. Of the four loci overlapping between the gestational duration and endometriosis GWASs, three (&lt;i&gt;EBF1&lt;/i&gt;, &lt;i&gt;WNT4&lt;/i&gt;, and &lt;i&gt;GDAP1&lt;/i&gt;) were identified as outliers using MR-Presso.&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;Contrary to observational studies, MR analyses found no direct causal link between endometriosis and gestational duration or preterm birth. Overlaps in genomic regions suggest ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"762-769"},"PeriodicalIF":4.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782711","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":"Author's Reply","authors":"Abdalla Fayyad","doi":"10.1111/1471-0528.18042","DOIUrl":"10.1111/1471-0528.18042","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"848-849"},"PeriodicalIF":4.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142777393","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":"Authors' Reply","authors":"Elisa Piovano,&nbsp;Giovannino Ciccone,&nbsp;Eva Pagano","doi":"10.1111/1471-0528.18037","DOIUrl":"10.1111/1471-0528.18037","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"844-845"},"PeriodicalIF":4.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142763302","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":"Levator Ani Deficiency and Pelvic Floor Dysfunction 1 Year Postpartum: A Prospective Nested Case–Control Study","authors":"Markus Harry Jansson,&nbsp;Sophia Brismar Wendel,&nbsp;Emilia Rotstein","doi":"10.1111/1471-0528.18036","DOIUrl":"10.1111/1471-0528.18036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>First, to assess whether levator ani deficiency (LAD) is associated with pelvic floor dysfunction 1 year postpartum, including urinary, vaginal and bowel symptoms; and second, to explore at what cut-off of LAD score such pelvic floor dysfunction arises.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Nested case–control study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Örebro University Hospital, Örebro, Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>Primiparous women 1 year after vaginal birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three-dimensional endovaginal ultrasound assessment of the levator ani muscle; LAD score based on this ultrasound, and validated questions about pelvic floor dysfunction. Logistic regression models were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Symptoms of pelvic floor dysfunction associated with LAD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 190 women were included, 103 of whom were symptomatic cases and 87 asymptomatic controls. 53% in the case group, and 58% in the control group had a LAD score of 0. A greater LAD score was significantly associated with urinary incontinence (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.00–1.22) and vaginal laxity (aOR 1.14, 95% CI 1.03–1.25). The risk of urinary incontinence was increased when the LAD cut-off score was set between ≥ 1 point and ≥ 4 points. The risk of vaginal laxity was increased when the cut-off was set between ≥ 8 and ≥ 14 points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LAD was associated with both urinary incontinence and vaginal laxity. The risk of urinary incontinence increased already with minor LAD and defects of the most medial levator ani muscle portions normally supporting the midurethra may explain this increase.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"596-605"},"PeriodicalIF":4.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142760491","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}