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

{"title":"Trends in Severe Postpartum Haemorrhage Among Nulliparous Women","authors":"Grace Townsend, Danielle R. Zabala, Amir L. Butt, Kaitlyn J. Kulesus","doi":"10.1111/1471-0528.17957","DOIUrl":"10.1111/1471-0528.17957","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 3","pages":"396-397"},"PeriodicalIF":4.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236315","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":"COVID-19 Vaccine Safety in Pregnancy, A Nested Case–Control Study in Births From April 2021 to March 2022, England","authors":"Anna A. Mensah,&nbsp;Julia Stowe,&nbsp;Jennifer E. Jardine,&nbsp;Freja C. M. Kirsebom,&nbsp;Tom Clare,&nbsp;Meaghan Kall,&nbsp;Helen Campbell,&nbsp;Jamie Lopez-Bernal,&nbsp;Nick Andrews","doi":"10.1111/1471-0528.17949","DOIUrl":"10.1111/1471-0528.17949","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Assessment of COVID-19 vaccine safety in pregnancy using population-based data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Matched case–control study nested in a retrospective cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>April 2021–March 2022, England.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>All pregnant individuals aged between 18 and 50 years with valid health records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Individuals identified from the national Maternity Services Data Set (MSDS) had their records linked to hospital admission, national COVID-19 vaccine and COVID-19 testing databases. Matching included participant's age and estimated week of conception. We compared outcomes across multiple COVID-19 vaccine exposures using conditional multivariable logistic regression, adjusting for demographic and health characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Adverse pregnancy, maternal and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>514 013 individuals were included. We found lower odds of giving birth to a baby who was low birthweight (aOR = 0.86, 95% CI: 0.79–0.93), preterm (aOR = 0.89, 95% CI: 0.85–0.92) or who had an Apgar score &lt; 7 at 5 min of age (aOR = 0.89, 95% CI: 0.80–0.98) for individuals who received at least one dose of COVID-19 vaccine during pregnancy. The odds of admission to intensive care unit during pregnancy were lower in those vaccinated (aOR = 0.85, 95% CI: 0.76–0.95). There was no association between vaccination in pregnancy and stillbirth, neonatal death, perinatal death and maternal venous thromboembolism in pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>COVID-19 vaccines are safe to use in pregnancy. Our findings generated important information to communicate to pregnant individuals and health professionals to support COVID-19 maternal vaccination programmes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1882-1893"},"PeriodicalIF":4.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234107","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":"Fertility and Miscarriage Incidence After Cervical Intraepithelial Neoplasia Treatment by Thermal Ablation: A Cohort Study","authors":"Ania Wisniak,&nbsp;Virginie Yakam,&nbsp;Sophie Evina Bolo,&nbsp;Alida Moukam,&nbsp;Jessica Sormani,&nbsp;Pierre Vassilakos,&nbsp;Bruno Kenfack,&nbsp;Patrick Petignat","doi":"10.1111/1471-0528.17954","DOIUrl":"10.1111/1471-0528.17954","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the impact of thermal ablation (TA) for the treatment of cervical dysplasia on fertility and pregnancy outcomes among women screened for cervical cancer in Cameroon.</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>Dschang health district, Cameroon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Participants aged 30–45 years from two screening trials conducted between 2015 and 2020 in Dschang District Hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were primarily screened for human papillomavirus infection, triaged by visual inspection and treated by TA if needed. Between October 2021 and March 2022, interviews on subsequent fertility were conducted with participants treated by TA and a control group of untreated women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Pregnancy and miscarriage after screening/treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 760 participants (219 treated and 541 untreated) completed the survey, with a mean follow-up time of 1297 days. Sixty-two women (28.3%) treated by TA reported a pregnancy postscreening versus 165 (30.5%) in the control group (<i>p</i> = 0.550). Adjusted for potential confounders, the hazard ratio of pregnancy for treated compared with untreated women was 0.82 (0.54–1.24, <i>p</i> = 0.350). Among women reporting pregnancies with a known outcome and which were not voluntarily terminated, 18 (35.3%) treated participants had a miscarriage versus 31 (21.4%) in the control group (<i>p</i> = 0.048). In the adjusted model, no association remained between TA and miscarriage (1.04, 0.39–2.78, <i>p</i> = 0.935).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In our study population, TA did not significantly impact fertility nor miscarriage risk. Our results support the widespread use of TA as a treatment of choice for precancerous cervical lesions in low-income settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 2","pages":"167-177"},"PeriodicalIF":4.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17954","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234120","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":"A Position Modification Device for the Prevention of Supine Sleep During Pregnancy: A Randomised Crossover Trial","authors":"Danielle L. Wilson,&nbsp;Carley Whenn,&nbsp;Maree Barnes,&nbsp;Susan P. Walker,&nbsp;Mark E. Howard","doi":"10.1111/1471-0528.17952","DOIUrl":"10.1111/1471-0528.17952","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 the effectiveness and acceptability of a pillow-like position modification device to reduce supine sleep during late pregnancy, and to determine the impacts on the severity of sleep-disordered breathing (SDB) and foetal well-being.&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;Randomised cross-over study.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting and Population&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Individuals in the third trimester of pregnancy receiving antenatal care at a tertiary maternity hospital in Australia.&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 used their own pillow for a control week and an intervention pillow for a week overnight, in randomised order. Sleep position and total sleep time for each night of both weeks were objectively monitored, with a sleep study and foetal heart rate monitoring performed on the last night of each week.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main Outcome Measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Primary outcome = percentage of sleep time in the supine position; secondary outcomes = apnoea–hypopnoea index, foetal heart rate decelerations and birthweight centile.&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;Forty-one individuals were randomised with data collected on 35 participants over 469 nights. There was no difference in percentage of total sleep time in the supine position overnight between the control or intervention pillow week (13.0% [6.1, 25.5] vs. 16.0% [5.6, 27.2], &lt;i&gt;p&lt;/i&gt; = 0.81 with a mean difference of 2.5% [95% CI] = −0.7, 5.6, &lt;i&gt;p&lt;/i&gt; = 0.12), and no difference in the severity of SDB or foetal heart rate decelerations across weeks. However, increased supine sleep was significantly related to a higher apnoea–hypopnoea index (&lt;i&gt;r&lt;/i&gt;&lt;sub&gt;s&lt;/sub&gt; = 0.37, &lt;i&gt;p&lt;/i&gt; = 0.003), lower birthweight (&lt;i&gt;r&lt;/i&gt;&lt;sub&gt;s&lt;/sub&gt; = −0.45, &lt;i&gt;p&lt;/i&gt; = 0.007) and lower birthweight centile (&lt;i&gt;r&lt;/i&gt;&lt;sub&gt;s&lt;/sub&gt; = −0.45, &lt;i&gt;p&lt;/i&gt; = 0.006). The proportion of supine sleep each night of the week varied widely both within and across participants, despite awareness of side-sleeping recommendations.&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;We found no evidence to suggest that the adoption of a pillow designed to discourage supine sleep was effective in late pregnancy, with women spending an average of 1 h per","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 2","pages":"145-154"},"PeriodicalIF":4.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17952","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235379","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":"Cardiovascular Adaptation in Fetal Growth Restriction: A Longitudinal Study From Fetuses at Term to the First Year of Life","authors":"Conrado Milani Coutinho,&nbsp;Veronica Giorgione,&nbsp;Basky Thilaganathan,&nbsp;Olga Patey","doi":"10.1111/1471-0528.17956","DOIUrl":"10.1111/1471-0528.17956","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate longitudinal trends in fetal and offspring cardiovascular adaptation in fetal growth restriction (FGR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective longitudinal study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Fetal Medicine Unit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Thirty-five FGR pregnancies and 37 healthy controls assessed as term fetuses (mean age 37 ± 1 weeks) and again in infancy (mean age 8 ± 2 months).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Conventional echocardiographic techniques, tissue Doppler imaging and speckle tracking echocardiography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Left ventricular (LV) and right ventricular (RV) geometry and function. Echocardiographic parameters were normalised by ventricular size adjusting for differences in body weight between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to healthy controls, late FGR fetuses showed significant alterations in cardiac geometry with more globular LV chamber (LV sphericity index, 0.56 vs. 0.52), increase in biventricular global longitudinal systolic contractility (MAPSE, 0.29 vs. 0.25 mm; TAPSE, 0.42 vs. 0.37 mm) and elevated cardiac output (combined CO: 592 vs. 497 mL/min/kg, <i>p</i> &lt; 0.01 for all). Indices of LV diastolic function in FGR fetuses were significantly impaired with myocardial diastolic velocities (LV A', 0.30 vs. 0.26 cm/s; IVS E', 0.19 vs. 0.16 cm/s) and LV torsion (1.2 vs. 3.5 deg./cm, <i>p</i> &lt; 0.01 for all). At postnatal assessment, FGR offspring revealed persistently increased SAPSE (0.27 vs. 0.24 mm), LV longitudinal strain (−19.0 vs. −16.0%), reduced LV torsion (1.6 vs. 2.1 deg./cm) and elevated CO (791 vs. 574 mL/min/kg, <i>p</i> &lt; 0.01 for all).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Perinatal cardiac remodelling and myocardial dysfunction in late FGR fetuses is most likely due to chronic placental hypoxaemia. Persistent changes in cardiac geometry and function in FGR offspring may reflect fetal cardiovascular maladaptation that could predispose to long-term cardiovascular complications in later life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 2","pages":"189-196"},"PeriodicalIF":4.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236963","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":"Systematic Review of Clinical Prediction Models for the Risk of Emergency Caesarean Births","authors":"Alexandra Hunt,&nbsp;Laura Bonnett,&nbsp;Jon Heron,&nbsp;Michael Lawton,&nbsp;Gemma Clayton,&nbsp;Gordon Smith,&nbsp;Jane Norman,&nbsp;Louise Kenny,&nbsp;Deborah Lawlor,&nbsp;Abi Merriel,&nbsp;the Options Study Collaborative Group","doi":"10.1111/1471-0528.17948","DOIUrl":"10.1111/1471-0528.17948","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Globally, caesarean births (CB), including emergency caesareans births (EmCB), are rising. It is estimated that nearly a third of all births will be CB by 2030.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Identify and summarise the results from studies developing and validating prognostic multivariable models predicting the risk of EmCBs. Ultimately understanding the accuracy of their development, and whether they are operationalised for use in routine clinical practice.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Search Strategy&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Studies were identified using databases: MEDLINE, CINAHL, Cochrane Central and Scopus with a search strategy tailored to models predicting EmCBs.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Selection Criteria&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Prospective studies developing and validating clinical prediction models, with two or more covariates, to predict risk of EmCB.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Data Collection and Analysis&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Data were extracted onto a proforma using the Prediction model Risk Of Bias ASsessment Tool (PROBAST).&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;In total, 8083 studies resulted in 56 unique prediction modelling studies and seven validating studies, with a total of 121 different predictors. Frequently occurring predictors included maternal height, maternal age, parity, BMI and gestational age. PROBAST highlighted 33 studies with low overall bias, and these all internally validated their model. Thirteen studies externally validated; only eight of these were graded an overall low risk of bias. Six models offered applications that could be readily used, but only one provided enough time to offer a planned caesarean birth (pCB). These well-refined models have not been recalibrated since development. Only one model, developed in a relatively low-risk population, with data collected a decade ago, remains useful at 36 weeks for arranging a pCB.&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;To improve personalised clinical conversations, there is a pressing need for a model that accurately predicts the timely risk of an EmCB for women across diverse clinical backgrounds.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;&lt;b&gt;Trial Registration:&lt;/b&gt; PROSPERO registration number: CRD42023384439.&lt;/p&gt;\u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 3","pages":"231-240"},"PeriodicalIF":4.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17948","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142166633","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":"Role of Child Marriage and Adolescent Childbearing on Hysterectomy Among Married Women in India: A Cross-Sectional and Time-to-Event Analysis.","authors":"Biplab Kumar Datta, Ashwini Tiwari","doi":"10.1111/1471-0528.17950","DOIUrl":"https://doi.org/10.1111/1471-0528.17950","url":null,"abstract":"<p><strong>Objective: </strong>Child marriage forces a girl into adult roles before physical and psychological maturity, which can take a toll on women's health over the life course. This article aims to assess whether child marriage and adolescent childbearing are associated with elevated risk of gynaecologic disorders leading to hysterectomy.</p><p><strong>Design: </strong>Cross-sectional and time-to-event analysis.</p><p><strong>Setting: </strong>India.</p><p><strong>Population: </strong>528 816 ever-married women, aged 20-49 years.</p><p><strong>Methods: </strong>Women were grouped in four mutually exclusive categories: (i) married adult-not an adolescent mother (reference category), (ii) married adult-adolescent mother, (iii) married child-not an adolescent mother and (iv) married child-adolescent mother. Multivariable logistic regressions were fitted to assess the odds of hysterectomy for these groups. Nonparametric Kaplan-Meier survivor functions were estimated to evaluate survival rates across the groups.</p><p><strong>Main outcome measures: </strong>Whether had a hysterectomy and age when hysterectomy was performed.</p><p><strong>Results: </strong>Compared to women married as adults, not an adolescent mother, women married in childhood and gave birth in adolescence were 1.87 (95% CI: 1.78-1.96) times more likely to have a hysterectomy. The latter group also had the lowest survival probability for hysterectomy at all ages (e.g., 85.80% [95% CI: 85.41-86.18] at age 49 years as compared to 91.65% [95% CI: 91.37-91.89] for the former group). Women married as children but not adolescent mothers and married as an adult but gave birth in adolescence also had higher odds of hysterectomy-1.40 (95% CI: 1.31-1.50) and 1.53 (95% CI: 1.40-1.66) times of that of the reference group, respectively.</p><p><strong>Conclusions: </strong>Our results, showing a strong relationship between child marriage and hysterectomy, contribute to the literature on later-life health consequences of child marriage.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141684","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":"Preventing Postpartum Venous Thromboembolism With Low-Molecular-Weight Heparin: The PP-HEP Pilot Randomised Controlled Trial","authors":"Marc Blondon,&nbsp;Marine Claver,&nbsp;Emilienne Celetta,&nbsp;Marc Righini,&nbsp;Begoña Martinez de Tejada","doi":"10.1111/1471-0528.17943","DOIUrl":"10.1111/1471-0528.17943","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;Uncertainty surrounds the risk–benefit of low-molecular-weight heparin to prevent postpartum venous thromboembolism (VTE). Data from randomised clinical trials (RCT) are critically needed, but recent feasibility studies in North America yielded low participation rates, with &lt;1 enrolment per month per centre. Our aim was to assess the feasibility of a trial of postpartum short-term enoxaparin in Europe.&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;Pragmatic, open-label pilot randomised controlled trial (RCT).&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;Swiss tertiary 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;Postpartum women, within 48 h of delivery, deemed at intermediate risk of VTE with at least one major risk factor (morbid obesity, thrombophilia, emergency caesarean section, pre-eclampsia, preterm delivery, intrauterine growth restriction or systemic peripartum infection) and/or at least two minor risk factors.&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 randomised to enoxaparin 40–60 mg once daily for 10 days or no treatment, with a 90-day follow-up.&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;Participation rate and study acceptance (randomised participants among women in whom informed consent was sought).&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;Recruitment was open for 25 weeks in 2022. Among 1504 postpartum women, 480 were eligible and 77 were randomised. The recruitment rate was 3.1 per week (13.3 per month) and the study acceptance was 23.8%. At 3 months, there was no VTE event, but one major, one nonmajor obstetrical bleeding and one surgical site complication, all in the enoxaparin 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;This pilot RCT of postpartum thromboprophylaxis set in Switzerland yielded greater participation rate and acceptance than previous attempts in North America. It calls for a large, international, collaborative trial to guide this important clinical decision.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Trial Registration&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 1","pages":"35-43"},"PeriodicalIF":4.7,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17943","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141683","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":"A call to action to address the maternal health crisis in Nigeria","authors":"Charles Anawo Ameh,&nbsp;Olufemi T. Oladapo,&nbsp;Aris T. Papageorghiou","doi":"10.1111/1471-0528.17903","DOIUrl":"10.1111/1471-0528.17903","url":null,"abstract":"&lt;p&gt;In the tapestry of global health challenges, few issues evoke as much urgency as the crisis of maternal and newborn health in low-resource settings. Nowhere is this challenge more pronounced than in Nigeria, where the struggle for accessible, quality healthcare resonates across its diverse landscape. Against the backdrop of staggering population statistics, the need for concerted action and innovative solutions becomes ever more pressing.&lt;/p&gt;&lt;p&gt;Nigeria with a population of over 200 million, grapples with an ongoing maternal mortality crisis that stretches logic and conscience, despite being endowed with vast human and natural resources. The risk of perinatal death in Nigeria is also unacceptably high, with no significant change recorded in the last 20 years.&lt;span&gt;&lt;sup&gt;1-4&lt;/sup&gt;&lt;/span&gt; Nigeria makes the second highest contribution of 12% of global maternal deaths, stillbirths and neonatal deaths, and is amongst the top 10 countries with the highest perinatal mortality globally.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; These figures do not only pose a serious challenge to the attainment of the first target of the third sustainable development goal: behind these stark figures lie the untold stories of countless families, whose hopes and dreams are shattered by the cruel realities of inadequate healthcare access. Their struggles underscore the urgent need for increased political will, application of evidence-based interventions, and comprehensive healthcare reform to achieve universal health coverage.&lt;/p&gt;&lt;p&gt;To address the poor quality of care and high perinatal mortality in Nigeria, the Maternal and Perinatal Database for Quality, Equity, and Dignity Programme (MPD-4-QED) was established by the World Health Organization (WHO) and the Nigerian Federal Ministry of Health in 2019.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; The aim of the programme was to facilitate the largest, periodic analysis on the quality and outcomes of care provided to women and their newborns in Nigerian referral-level hospitals to inform policy and programmatic decisions at national, subnational and facility levels.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this &lt;i&gt;Special Issue&lt;/i&gt; of BJOG we turn our attention to this critical issue of maternity care in Nigeria. In a series of articles, many of which represent analyses of the MPD-4-QED Programme, the authors examine the multifaceted complexities of maternal healthcare delivery in this African nation. The articles address diverse challenges from early pregnancy loss and preterm birth, hypertensive disorders, obstructed labour, postpartum haemorrhage, birth asphyxia and caesarean section, to neonatal jaundice and sepsis. The mission is clear: to shed light on the challenges, explore potential interventions, and pave the way for meaningful change.&lt;/p&gt;&lt;p&gt;Through rigorous epidemiological research and insightful analyses, the contributors undertake a detailed analysis of Nigeria's maternal and perinatal health crisis. From the underutilization of primary health centres,","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 S3","pages":"3-4"},"PeriodicalIF":4.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17903","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037640","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":"Procedural abortion, provider-initiated preterm delivery and survival in pregnant people with cancer: A population-based cohort study","authors":"Amy Metcalfe,&nbsp;Zoe F. Cairncross,&nbsp;Joel G. Ray,&nbsp;Lorraine Shack,&nbsp;Gregg Nelson,&nbsp;Christine M. Friedenreich,&nbsp;Khokan Sikdar,&nbsp;Sarka Lisonkova,&nbsp;Carly A. McMorris,&nbsp;Parveen Bhatti,&nbsp;Deshayne B. Fell","doi":"10.1111/1471-0528.17937","DOIUrl":"10.1111/1471-0528.17937","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess whether procedural-induced abortion or provider-initiated preterm delivery are associated with improved survival in pregnant people with cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective population-based cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Provinces of Alberta and Ontario, Canada, 2003–2016.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Females aged 18–50 years diagnosed with cancer at &lt;20 weeks' (for the assessment of procedural-induced abortion) or &lt;37 weeks' gestation (for the assessment of provider-initiated delivery).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cox proportional hazard models assessed all-cause mortality in relation to procedural-induced abortion and provider-initiated preterm delivery, adjusting for cancer site, stage at diagnosis and age. Meta-analysis pooled the results across both provinces.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>All cause mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 512 pregnant people diagnosed with cancer at &lt;20 weeks' gestation and 782 diagnosed with cancer at &lt;37 weeks' gestation. Neither procedural-induced abortion (adjusted hazard ratio [aHR] = 1.39, 95% CI: 0.32–6.17) nor provider-initiated preterm delivery (aHR = 1.17, 95% CI: 0.76–1.81) were associated with improved survival following adjustment for age, stage at diagnosis and cancer site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Neither procedural-induced abortion nor provider-initiated preterm birth was associated with improved survival in pregnant people diagnosed with cancer; however, these obstetric interventions are highly personal decisions best decided by the pregnant person in consultation with their care providers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 1","pages":"81-88"},"PeriodicalIF":4.7,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17937","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019471","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}