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

{"title":"Twelve-Year Follow-Up of a Randomised Controlled Trial Comparing the Effectiveness of Pelvic Floor Muscle Training Versus Mid-Urethral Sling Surgery for Female Moderate to Severe Urinary Incontinence","authors":"Hélène F. C. van Oorschot, Deodata Tijsseling, Julien Labrie, Carl H. van der Vaart","doi":"10.1111/1471-0528.18092","DOIUrl":"10.1111/1471-0528.18092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the 12-year effectiveness of pelvic floor muscle training versus midurethral sling surgery for moderate to severe female stress urinary incontinence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Observational follow-up study of a randomised controlled trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Conducted at the Division of Gynaecology, University Medical Centre Utrecht, The Netherlands.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women from the PORTRET study experiencing moderate to severe stress urinary incontinence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A validated questionnaire was sent to participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The primary outcome was subjective improvement in urinary incontinence symptoms. Secondary outcomes included subjective cure, severity of incontinence, impact of incontinence as urogenital symptom and cross-over and re-operation rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this long-term study, 184 of 386 (47.7%) women responded to the questionnaire. Cross-over (86.9%) from the initial physiotherapy group to surgery was very high. No statistically significant differences were found in the intention to treat analysis. However, the post hoc analysis showed that women who underwent physiotherapy only reported a statistically significant lower improvement compared to those who underwent initial surgery (50.6% absolute difference; 95% CI 28.2–73.1) or surgery after physiotherapy (49.7% absolute difference; 95% CI 25.8–73.7). Subjective cure, decrease in perceived severity and impact of urinary incontinence also statistically significantly favoured women who underwent (initial) surgery Re-operation was reported by 4.6% of women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This 12-year follow-up study showed a very high cross-over rate to surgical treatment, considering a substantial proportion of non-responders. Midurethral sling surgery, either initial or after physiotherapy, statistically significantly improved subjective outcomes for moderate to severe stress urinary incontinence as compared to pelvic fl","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"826-833"},"PeriodicalIF":4.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385813","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 Aspirin Use for Pre-Eclampsia Prevention: The Critical Role of Dose, Timing and Adherence","authors":"Bethany Atkins, Dimitrios Siassakos","doi":"10.1111/1471-0528.18095","DOIUrl":"10.1111/1471-0528.18095","url":null,"abstract":"<p>There is abundant evidence that aspirin, commenced at 12 weeks gestation, can be very effective in preventing pre-eclampsia, including preterm pre-eclampsia, preterm delivery and severe pre-eclampsia variants such as HELLP syndrome. However, some clinicians may consider it only modestly effective and neglect its use. Thus, attempts to reduce the morbidity and mortality associated with pre-eclampsia may focus instead on managing its complications, and developing new diagnostics and drugs. Aspirin is hypothesised to improve placental development, either preventing entirely or delaying onset of pre-eclampsia.</p><p>The Cochrane review by Duley et al. [<span>1</span>] describes a ‘small-to-moderate’ benefit of aspirin in preventing pre-eclampsia, preterm birth, small-for-gestational age and perinatal death. However, of 34 514 women with individual patient data available, only 9272 were randomised before 16 weeks gestation, and only 5070 received > 75 mg per day. Does the amalgamation of low- and high-doses, with early and late commencement of aspirin give the appearance of lower efficacy, and dissuade clinicians from prioritising aspirin?</p><p>In resource-limited contexts, where the likelihood of healthy survival to adulthood is significantly lower for preterm infants [<span>2</span>], the importance of a safe, low-cost intervention such as aspirin is even more important. Underestimation of low-cost, effective interventions such as aspirin may cause considerable harm [<span>2</span>].</p><p>This editorial seeks to review the impact of dosage, timing and adherence to aspirin on its efficacy in pre-eclampsia prevention, and explore special considerations for utilisation.</p><p>The Cochrane review [<span>1</span>] examined aspirin dosage. Examining studies with individual patient data available, there appeared to be a greater reduction in risk of pre-eclampsia in the minority of women allocated ≥ 75 mg aspirin than those allocated < 75 mg aspirin (9107 women, 16 trials; RR 0.78, 95% CI 0.66–0.92 vs. 22 618 women, 11 trials; RR 0.92, 95% CI 0.85–1.00). The review found no evidence of a difference by aspirin dose in foetal or neonatal death, preterm delivery or small-for-gestational age birth weight, but of the large studies [<span>3</span>] (ASPRE [<span>3</span>], BLASP 1998 [<span>4</span>], ERASME 2003 [<span>5</span>]) examining aspirin ≥ 75 mg, 61% of participants had poor adherence, and 40% commenced aspirin after 20 weeks.</p><p>Two systematic reviews investigated aspirin for prevention of pre-eclampsia and foetal growth restriction [<span>6</span>] (Roberge et al. 2016), and pre-term pre-eclampsia [<span>7</span>] (Roberge et al. 2018) respectively. The first [<span>6</span>] clearly demonstrated that aspirin commenced before 16 weeks reduced risk of pre-eclampsia (RR 0.57, 95% CI 0.43–0.75), severe pre-eclampsia (RR 0.47, 95% CI 0.26–0.83) and foetal growth restriction (RR 0.56, 95% CI 0.44–0.70). This was strongly dose-dependent. When","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"547-551"},"PeriodicalIF":4.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385811","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":"Maternal and Fetal Outcomes in Pregnant Women With Lung Cancer: A Population-Based Study on 9 Million Pregnancies and 40 Cases of Lung Cancer","authors":"Samantha Jacobson, Ahmad Badeghiesh, Haitham Baghlaf, Noah Margolese, Michael H. Dahan","doi":"10.1111/1471-0528.18090","DOIUrl":"10.1111/1471-0528.18090","url":null,"abstract":"<p>Lung cancer during pregnancy is exceedingly rare, with only 93 cases reported in the literature from 1953 to 2024 [<span>1</span>]. It carries the highest mortality rate of cancers in pregnancy (64.3%) [<span>2</span>] and increases risks of placental abnomalities, preterm delivery and low birth weight, with delayed diagnosis often due to nonspecific symptoms [<span>1, 2</span>]. Using a 9-million patient database, we identified 40 additional cases, analysed independently in this study, bringing the total to 133. The objective is to evaluate maternal and fetal outcomes using this dataset, comparing pregnancies with and without lung cancer.</p><p>We conducted a retrospective population-based study using data from the Health Care Cost and Utilisation Project-Nationwide Inpatient Sample (HCUP-NIS) database (2004–2014). Lung cancer cases were identified using the ICD-9 code 162.x. The study group included pregnant woman with lung cancer, while all other deliveries were controls. Categorical variables were compared using chi-squared tests, except when any cell frequency was less than 5, in which case Fisher's exact test was applied to ensure validity. Logistic regression analysed associations between lung cancer and maternal and fetal outcomes, estimating odds ratios (ORs) and 95% confidence intervals (CIs) adjusting for potential confounders, including maternal age, race, income, insurance type, smoking history, obesity, preexisting hypertension and diabetes.</p><p>Maternal characteristics are summarised in Table 1. Women with lung cancer were older, with significantly higher smoking rates (<i>p</i> = 0.01), chronic hypertension and pregestational diabetes (<i>p</i> < 0.0001). There were no significant differences in racial distribution, income quartiles, obesity, previous caesarean sections, thyroid disease or illicit drug. Medicaid and private insurance plans were more prevalent in the lung cancer group (<i>p</i> < 0.0001). Table 2 presents pregnancy, delivery and neonatal outcomes. Women with lung cancer had higher risks of placenta previa (OR: 5.67, 95% CI: 1.36–23.65, <i>p</i> = 0.017), abruptio placenta (OR: 4.99, 95% CI: 1.49–16.74, <i>p</i> = 0.009), operative vaginal delivery (OR: 4.88, 95% CI: 2.14–11.11, <i>p</i> < 0.001), transfusion (OR: 8.92, 95% CI: 3.28–24.28, <i>p</i> < 0.001), venous thromboembolism (VTE) (OR:21.83, 95% CI: 2.92–163.47, <i>p</i> < 0.001), disseminated intravascular coagulation (DIC) (OR: 8.45, 95% CI: 1.14–62.42, <i>p</i> = 0.04) and maternal death (OR: 195.02, 95% CI: 40.61–936.55, <i>p</i> < 0.001), though differences in spontaneous vaginal delivery became non-significant after adjustment (OR: 0.58, 95% CI: 0.30–1.14, <i>p</i> = 0.112). Neonatal outcomes were similar between groups.</p><p>These findings align with existing literature indicating that pregnant women with lung cancer are older and present with comorbidities like chronic hypertension and pregestational diabetes [<span>1</span>], w","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"834-837"},"PeriodicalIF":4.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385814","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":"Effect of Comprehensive Individualised Interventions on the Clinical Outcomes of Patients With Recurrent Implantation Failure: A Single-Centre Retrospective Cohort Study","authors":"Yuan Li, Qi Zhao, Xiangxiu Fan, Shujuan Ma, Ge Lin, Fei Gong","doi":"10.1111/1471-0528.18093","DOIUrl":"10.1111/1471-0528.18093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to evaluate the impact of comprehensive individualised interventions on the clinical outcomes of patients with recurrent implantation failure (RIF), as few studies have evaluated their effectiveness.</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>Tertiary hospital, from June 2016 to December 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Overall, 1546 patients with RIF underwent endometrial biopsy during implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The comprehensive individualised interventions were conducted on the basis of the endometrial histological dating, endometrial CD138 count, endometrial immune-cell proportion and endometrial microbiota testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Cumulative ongoing pregnancy rate (cOPR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median number of failed transfer cycles was 3 (range, 2–12), and the cOPR was 58.0%. The rates of window of implantation (WOI) displacement, CD138 positivity, imbalanced endometrial immune-cell proportion, endometrial microbiota testing, multiple factors and unexplained RIF were 34.0%, 9.3%, 7.5%, 4.1%, 32.4% and 12.7%, respectively. The cOPRs of the individualised frozen embryo transfers in patients having RIF with WOI displacement, WOI CD138 positivity, imbalanced endometrial immune-cell proportion, endometrial microbiota testing, multiple factors and unexplained RIF were 64.1%, 57.6%, 55.1%, 38%, 64.2% and 34.5%, respectively. After adjusting for basic characteristics through logistic regression analysis, the cOPRs of the WOI displacement group, WOI CD138 positive group and immune-cell proportion imbalanced group remained higher than that of the unexplained RIF group. However, the cOPR was comparable between the endometrial microbiota testing and unexplained RIF groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Comprehensive individualised interventions may improve clinical outcomes for patients with RIF, warranting further investigation.</p>\u0000 </section>\u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S2","pages":"83-91"},"PeriodicalIF":4.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385812","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":"Perinatal and Neonatal Outcomes Following In Vitro Fertilisation in Poor Ovarian Responders: A Prospective Single-Centre Observational Study","authors":"Cuiping Hu,&nbsp;Tianxiang Ni,&nbsp;Zhangwei Jia,&nbsp;Jianye Deng,&nbsp;Jing Li,&nbsp;Qian Zhang,&nbsp;Mingdi Xia,&nbsp;Juanjuan Lu,&nbsp;Junhao Yan","doi":"10.1111/1471-0528.18046","DOIUrl":"10.1111/1471-0528.18046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the risk of adverse perinatal and neonatal outcomes between individuals with poor ovarian response (POR) and those with normal ovarian response (NOR) following in vitro fertilisation (IVF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A prospective single-centre observational study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>University hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Overall, 1663 patients who underwent embryo transfer cycles between June 2017 and August 2019 were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The patients were divided into the POR and NOR groups based on the Bologna diagnostic criteria. The risk of perinatal and neonatal complications was then compared between groups with adjustment made for confounding factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The risk of perinatal and neonatal complications between the POR and NOR groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared with the NOR group, the POR group had poor pregnancy outcomes but comparable overall risks of poor perinatal and neonatal outcomes. The overall incidence rate of complications was 25.42% and 25.30% in the POR and NOR groups respectively [risk ratio (RR): 1.01; 95% confidence interval (CI): 0.63–1.59]. In subgroup analysis of singleton live births, the overall risk of total complications was higher in the POR group than in the NOR group (24.07% vs. 15.21%; RR: 1.77; 95% CI: 1.04–3.00); however, the risks became comparable between them after logistic regression adjustment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The overall risk of perinatal and neonatal complications among singleton live births was higher in patients with POR than in those with NOR; however, the risks became similar after logistic regression adjustment. Our findings provide overall comforting evidence for POR patients with IVF treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S2","pages":"36-43"},"PeriodicalIF":4.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143258750","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":"Caesarean Scar Endometrial Defects Contribute to Post-Caesarean Abnormal Uterine Bleeding and Chronic Endometritis: A Retrospective Case–Control Study","authors":"Yanpeng Wang,&nbsp;Yongshu Han,&nbsp;Xiaoyan Guo,&nbsp;Qianqian Wei,&nbsp;Yan Xia,&nbsp;Leilei Gao,&nbsp;Huihua Wang,&nbsp;Xue Lu,&nbsp;Jing Shu","doi":"10.1111/1471-0528.18089","DOIUrl":"10.1111/1471-0528.18089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the role of endometrial defects in the pathogenesis of abnormal uterine bleeding (AUB).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective case–control study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Two tertiary centres.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>We included 155 patients with caesarean scar defects (CSDs) who underwent hysteroscopy (69 AUB, 86 non-AUB). Thirty patients with AUB were successfully matched with 30 patients without AUB after propensity score matching (PSM) based on CSD size and number of previous caesarean sections, which indicate myometrial defect severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Hysteroscopic features of CSD before and after PSM were compared between two groups. Pathological features of 13 patients in each group with biopsies of the CSD surface and uterine endometrium were compared, including endometrial thickness determined by haematoxylin–eosin staining, vascular density identified by CD31 staining and chronic endometritis assessed by plasma cells stained with CD138.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Incidence of hysteroscopic and pathological features of CSD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Before PSM, the AUB group exhibited larger diverticulum sizes and more severe myometrial CSD defects than the non-AUB group. After PSM, five features of endometrial defects demonstrated statistically significant differences: in situ haemorrhage, bloody mucus, epithelial deficiency, exposed blood vessels and hyperplastic vessels. Pathological assessments also revealed significant differences in endometrial thickness of CSD, local vascularization and plasma cell count at CSD between the AUB and non-AUB groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Endometrial defects at caesarean scars contribute more to AUB than myometrial defects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S2","pages":"132-139"},"PeriodicalIF":4.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143258637","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":"Reproductive Implications and Management of Congenital Uterine Anomalies (2024 Second Edition)","authors":"M. A. Akhtar,&nbsp;S. H. Saravelos,&nbsp;T. C. Li,&nbsp;K. Jayaprakasan,&nbsp;the Royal College of Obstetricians and Gynaecologists","doi":"10.1111/1471-0528.18054","DOIUrl":"10.1111/1471-0528.18054","url":null,"abstract":"<p>Congenital uterine anomalies (CUAs) are malformations of the uterus (womb) that develop during fetal life. When a female baby is in her mother's uterus, her uterus develops as two separate halves from two tubular structures called Müllerian ducts, which fuse together before she is born. Anomalies that occur during the baby's development can be variable, from complete absence of the uterus through to more subtle anomalies, which are classified into specific categories. While conventional ultrasound is good at detecting CUAs, 3D ultrasound is used to confirm a diagnosis. If a complex uterine anomaly is suspected, additional investigations may be used, including MRI scanning, laparoscopy (where a camera is inserted into the cavity of the abdomen) and/or hysteroscopy (where a camera is placed in the uterine cavity). As there can be a link between CUAs and anomalies of the kidney and bladder, scans of these organs are also usually requested.</p><p>Although CUAs are present at birth, adult women typically do not have any symptoms, although some may experience painful periods. Most cases of CUA do not cause difficulties in becoming pregnant, and the outcome of pregnancy, in most cases, is good. However, these uterine anomalies are often discovered during investigations for infertility or miscarriage. Moreover, depending upon the type and severity of CUA, there may be increased risk of first and second trimester miscarriages, preterm birth, fetal growth restriction (smaller and lighter babies for the stage of pregnancy), pre-eclampsia (development of high blood pressure and protein in urine after the 20th week of pregnancy) and fetal malpresentation (baby not facing head-first down the birth canal) at birth. Surgical treatment may be considered for those who have had recurrent miscarriages and have a septate uterus, i.e. the uterine cavity is divided by a partition. In this case, surgery may reduce the chances of miscarriage. However, women should be informed that there is inconclusive and conflicting evidence regarding the improved likelihood of live births in this context. Further evidence from large randomised controlled trials are required to provide conclusive evidence-based recommendations for surgical treatment for septate uterus. Surgical treatment for other types of CUAs is not usually recommended as the risks outweigh potential benefits, and evidence for any benefits is lacking. Women with CUAs may be at an increased risk of preterm birth even after surgical treatment for a septate uterus. These people, if suspected to be at an increased risk of preterm birth based on the severity of CUA, should be followed up using an appropriate protocol for preterm birth as outlined in UK Preterm Birth Clinical Network Guidance.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 5","pages":"e86-e97"},"PeriodicalIF":4.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143258754","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":"Bringing Endometriosis to the Road of Contemporary Pain Science","authors":"Marcelo de França Moreira,&nbsp;Marco Aurelio Pinho Oliveira","doi":"10.1111/1471-0528.18096","DOIUrl":"10.1111/1471-0528.18096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endometriosis pain is mainly understood based on peripheral lesion characteristics and an outdated perspective equating nociception with pain. This limited view may divert understanding of interventions beyond peripheral logic, leading clinicians to see approaches targeting other processes as supplementary, limiting the effective addressing of treatment failure. Integrating critical advancements in pain and endometriosis can promote more comprehensive knowledge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This article provides a conceptual framework focusing on overlooked or less clearly linked areas concerning the interplay between nociception and factors influencing endometriosis pain. It explores the complexity of nociceptive processing, the association between neuromerically connected structures, and the role of the brain in pain perception. Further, it emphasizes adopting mechanism-based understanding of pain that integrates neurobiological aspects of the nociceptive apparatus and related systems, shaped by psychosocial factors contributing to a possible negative spiral in those living with endometriosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Aware of such a broader perspective can incentivize a balanced effort to inquire into peripheral lesion-related mechanisms and other domains potentially impacting endometriosis pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"685-693"},"PeriodicalIF":4.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124450","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":"Prenatal Screening for CMV Primary Infection: A Cost-Utility Model","authors":"Gebrael El Hachem,&nbsp;Thomas G. Poder,&nbsp;Catherine Mc Carey,&nbsp;Soren Gantt,&nbsp;Fatima Kakkar,&nbsp;Marc Sab,&nbsp;Christian Renaud,&nbsp;Isabelle Boucoiran","doi":"10.1111/1471-0528.18080","DOIUrl":"10.1111/1471-0528.18080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Congenital cytomegalovirus (CMV) infection is a major cause of deafness and neurodevelopmental disability in children. Our objective was to assess the cost utility of first-trimester serological CMV screening, compared to screening of high-risk pregnancies and no serological screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A decision-analytic model was created to compare the cost utility of three strategies from a healthcare sector perspective: universal first-trimester serological screening, screening only of high-risk pregnant women (both including antiviral prophylaxis in cases of primary infection) and serological testing triggered by foetal morphological ultrasound (no CMV serological screening).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Hypothetical population of 80 000 pregnant women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Probability, expected values and cost estimates were derived from published literature and local hospital and national insurance data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure</h3>\u0000 \u0000 <p>Cost per maternal and infant quality-adjusted life year (QALY) lost.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Universal serological screening was superior to both screening of high-risk women and no screening (utility of −0.42, −0.63 and − 0.87 QALY lost, respectively). Sensitivity analysis demonstrated that universal screening was the most cost-effective strategy regardless of the incidence of primary infection, the acceptability of amniocentesis and the efficacy of antiviral prophylaxis. In the Monte Carlo analyses, universal serological screening was the most cost-effective option in 96.36% of simulations. Universal serological screening would allow detection of 152 cases of primary maternal CMV infection and would prevent 29 cases of congenital CMV infection annually.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings support the adoption of a population-based prenatal screening programme for the prevention of congenital CMV infection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"805-815"},"PeriodicalIF":4.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077166","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 Physical Activity Interventions and Pregnancy Outcomes: A Systematic Review and Meta-Analysis With a Focus on Trial Quality","authors":"Amanda J. Poprzeczny,&nbsp;Andrea R. Deussen,&nbsp;Megan Mitchell,&nbsp;Laura Slade,&nbsp;Jennie Louise,&nbsp;Jodie M. Dodd","doi":"10.1111/1471-0528.18084","DOIUrl":"10.1111/1471-0528.18084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Guidelines recommending regular physical activity in pregnancy for improving pregnancy outcomes are informed by published meta-analyses. Inclusion of randomised trials of poor methodological quality may bias effect estimates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the validity of these recommendations by focusing on trial quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>Systematic search of PubMed, PubMed Central, Ovid Medline, Embase, Cochrane Central Register of Controlled Trials, and CINAHL from inception to 14 December 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Randomised trials evaluating an antenatal physical activity intervention alone, compared with no such intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Trial quality was assessed using the Cochrane Risk of Bias tool. Independent of this, studies were grouped based on degree of deviation from the intention to treat principle. Sequential meta-analysis was performed in which greater degrees of potential bias were allowed. Between intervention group comparisons used, relative risks or mean differences with 95% confidence intervals for dichotomous outcomes and continuous outcomes, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Overall, the quality of trial reporting was low. Only 5 trials (12.5%) were performed and analysed in keeping with the intention to treat principle. When considering only those trials performed rigorously, there was no evidence that antenatal physical activity improves pregnancy outcomes or limits gestational weight gain (WMD −0.60 kg; 95% CI −2.17, 0.98 WMD −0.60 kg; 95% CI −2.17, 0.98).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>When considering only trials at no/negligible risk of bias, antenatal physical activity interventions were not associated with improved pregnancy outcomes. Most trials were not methodologically rigorous. Incorporation of such meta-analyses into pregnancy care guidelines may result in inaccurate recommendations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 6","pages":"709-723"},"PeriodicalIF":4.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077167","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}