Ggenga Kayode, Baskaran Thilaganathan, Christy Burden, Amy Howell, Vincent Cheng, Jane Sandall, Maria Viner, Lia Brigante, Dilly Anumba, Cathy Winter, Birte Harlev-Lam, Timothy Draycott, Andrew Judge, Erik Lenguerrand, Tommy's National Centre for Maternity Improvement
{"title":"Disparities in Stillbirths in England: Analysis of A Population-Based Study of 1.3 Million Births","authors":"Ggenga Kayode, Baskaran Thilaganathan, Christy Burden, Amy Howell, Vincent Cheng, Jane Sandall, Maria Viner, Lia Brigante, Dilly Anumba, Cathy Winter, Birte Harlev-Lam, Timothy Draycott, Andrew Judge, Erik Lenguerrand, Tommy's National Centre for Maternity Improvement","doi":"10.1111/1471-0528.18147","DOIUrl":"10.1111/1471-0528.18147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the variation in stillbirth rates between different ethnic and socioeconomic groups within each organisational hospital group (health trust).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>National registry study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>All health trusts (HT) in National Health Service England.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>All mothers and babies born between April 2015 and March 2017.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational study examined ethnic and socioeconomic disparities in stillbirth rates for 1 268 367 births in 133 HTs compared to the national average.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcome</h3>\u0000 \u0000 <p>Stillbirth at or after 24 gestational weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The average stillbirth rates ranged from 3.4/1000 births for White women up to 7.1/1000 births for Black women. The rates ranged from 2.9/1000 births for women living in the least deprived areas to 4.7/1000 births for those in the most deprived. The proportions of HTs with stillbirth rates well above the national average (more than 2 standard deviations) for White, Asian and Black women were 0.8%, 21.8% and 38.6%, respectively. When HTs were ranked by stillbirth rate, there were notable variations, with some trusts demonstrating lower than average stillbirth rates for White women while concurrently having higher than average stillbirth rates for Asian and/or Black women. There were no units exhibiting lower than national average stillbirth rates for Asian/Black women while concurrently having higher than average stillbirth rates for White women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings suggest that access to and delivery of maternity care vary depending on the mother's ethnicity and level of socioeconomic deprivation. Social factors are likely determinants of inequality in stillbirth rather than maternity care alone.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 8","pages":"1130-1138"},"PeriodicalIF":4.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065636","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}
Briar Hunter, Vanessa Jordan, Jordon Wimsett, Liza Edmonds, Tina Allen-Mokaraka, Lisa Dawes, Katie Groom
{"title":"Impact of Implementation Tools for Spontaneous Preterm Birth Guidelines: A Systematic Review and Meta-Analysis","authors":"Briar Hunter, Vanessa Jordan, Jordon Wimsett, Liza Edmonds, Tina Allen-Mokaraka, Lisa Dawes, Katie Groom","doi":"10.1111/1471-0528.18219","DOIUrl":"10.1111/1471-0528.18219","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Preterm birth is a priority area for practice improvement internationally. Clinical practice guidelines improve the efficiency of clinical decision-making and, when implemented effectively, may advance the quality and consistency of care. Guideline implementation tools may help to further optimise the use of guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine if guideline implementation tools improve adherence to preterm birth guideline recommendations and have an impact on differences seen by ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>Systematic search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and Scopus on 11 December 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Eligibility criteria included randomised and non-randomised studies that used an implementation tool and measured adherence to a guideline on preterm birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Data were extracted including study details and ethnicity as an equity consideration. Meta-analyses were performed on adherence to preterm birth guideline recommendations with planned subgroup analysis by ethnicity/Indigeneity and topic of guideline.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Twenty studies were included; two cluster randomised controlled trials and 18 before–after studies. Nineteen studies comparing guideline implementation tool to no tool reported improved adherence to guideline recommendations with the use of a tool (data for meta-analysis from 14 studies, 20 961 people, OR 13.8, 95% CI 6.02–31.71, adherence in 3871/11 195 [34.6%] before compared with 6607/9766 [67.6%] after). Only one study performed analysis by ethnicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Effective implementation tools have the potential to increase adherence to evidence-based preterm birth guidelines, improving quality and consistency of preterm birth care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 11","pages":"1543-1561"},"PeriodicalIF":4.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18219","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945301","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":"Women's Pregnancy Experiences With a Transvaginal Cervical Cerclage: A Qualitative Study","authors":"Stina Lou, Lotte Groth Jensen, Lea Kirstine Hansen, Niels Uldbjerg, Pernille Tine Jensen, Ingeborg Rytter Stenstrup, Puk Sandager, Rikke Bek Helmig, Julie Glavind","doi":"10.1111/1471-0528.18218","DOIUrl":"10.1111/1471-0528.18218","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate women's experiences of being pregnant with cervical cerclage and managing the risk of preterm birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Qualitative interview study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Denmark.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women who had undergone transvaginal cervical cerclage (elective or emergency) in at least one pregnancy, regardless of outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured, in-depth interviews with 21 women. The interviews lasted 42–90 min and were analysed using reflexive thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>A qualitative analysis of women's experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three themes were identified. <i>Navigating uncertain and conflicting information</i> describes the women's experience of fear of pregnancy loss and their requests for information and professional guidance. Faced with contradictory advice regarding activity restriction, many adopted the most restrictive regimen in a ‘better safe than sorry’ approach. <i>My baby, my body, my responsibility</i> describes the women's sense of personal responsibility towards prolonging pregnancy (e.g., by bed rest) and their ‘hyper-alertness’ to any signs of impending birth. Though restricted activity weakened their bodies, it was described as a ‘necessary price to pay’. <i>Enduring bed rest</i> describes the emotional and bodily burden of restricted activity, and the strategies developed to cope—such as establishing daily routines, setting short- and long-term goals, and drawing on support from partners and networks. Continuity of care with trusted healthcare professionals was described as essential to feeling safe and hopeful.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cervical cerclage offers some reassurance, but women still carry a heavy sense of responsibility for preventing preterm birth through restricted activity. Clear and consistent information from healthcare professionals may help reduce some of this burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 10","pages":"1481-1488"},"PeriodicalIF":4.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18218","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945305","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}
Ioannis Papastefanou, Yunyu Chen, Long Nguyen-Hoang, Duy-Anh Nguyen, Linh Thuy Dinh, Ritsuko K. Pooh, Arihiro Shiozaki, Mingming Zheng, Yali Hu, Yunping Wu, Aditya Kusuma, Piengbulan Yapan, Mahesh A. Choolani, Mayumi Kaneko, Suchaya Luewan, Tung-Yao Chang, Noppadol Chaiyasit, Tongta Nanthakomon, Yanmin Jiang, Steven W. Shaw, Wing Cheong Leung, Ainaa Syazana Mohamad, Angela Aguilar, So Ling Lau, Nikki M. W. Lee, Esther Wai Chi Tang, Daljit S. Sahota, Marc K. C. Chong, Liona C. Poon
{"title":"Impact of Aspirin on Timing of Birth in Pregnancies With Clinical Manifestations of Placental Dysfunction: Evidence From a Multicentre Randomised Clinical Trial","authors":"Ioannis Papastefanou, Yunyu Chen, Long Nguyen-Hoang, Duy-Anh Nguyen, Linh Thuy Dinh, Ritsuko K. Pooh, Arihiro Shiozaki, Mingming Zheng, Yali Hu, Yunping Wu, Aditya Kusuma, Piengbulan Yapan, Mahesh A. Choolani, Mayumi Kaneko, Suchaya Luewan, Tung-Yao Chang, Noppadol Chaiyasit, Tongta Nanthakomon, Yanmin Jiang, Steven W. Shaw, Wing Cheong Leung, Ainaa Syazana Mohamad, Angela Aguilar, So Ling Lau, Nikki M. W. Lee, Esther Wai Chi Tang, Daljit S. Sahota, Marc K. C. Chong, Liona C. Poon","doi":"10.1111/1471-0528.18211","DOIUrl":"10.1111/1471-0528.18211","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine whether aspirin delays gestational age at delivery (GAD) in pregnancies with placental dysfunction (PD) phenotypes (preeclampsia [PE], small-for-gestational-age [SGA], placental abruption and/or stillbirth).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A secondary analysis of a multicentre stepped-wedge cluster randomised trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>18 maternity/diagnostic units in Asia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Singleton pregnancies examined at 11–13<sup>+6</sup> weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A model in which the effect of aspirin is to delay the GAD in pregnancies with PD was developed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>GAD in pregnancies with PD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Aspirin administration was associated with a significant reduction in PD < 32 weeks (adjusted relative risk 0.543, 95% CI: 0.330–0.864), with a trend for an increase of PD ≥ 32 weeks (test for trend, <i>p</i>-value = 0.0018). Similar findings were observed individually for PE, SGA and/or placental abruption. At 24 weeks, the aspirin-induced prolongation of pregnancies with PD was 2.85 weeks (95% CI: 0.44–5.40), and this effect was decreased by −0.19 weeks (95% CI: −0.33 to −0.05) for each week of gestation; therefore, at 28 and 32 weeks' gestation, the aspirin-induced prolongation was 2.09 and 1.33 weeks, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this secondary analysis of a cluster randomised trial, women at high risk of PE who are destined to develop a clinical spectrum of PD may benefit from longer pregnancy duration through aspirin administration in early pregnancy. Aspirin may delay the GAD due to PD, particularly benefiting those deliveries that would occur at earlier gestations without aspirin administration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 10","pages":"1460-1468"},"PeriodicalIF":4.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18211","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945302","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}
Joanna Beaumont, Debbie Smith, Emilie Bailey, Rebecca Barron, Emma Tomlinson, Alexander E. P. Heazell
{"title":"Psychological Distress, Post-Traumatic Stress and Emotional Suppression in a Pregnancy After a Perinatal Death: A Longitudinal Survey","authors":"Joanna Beaumont, Debbie Smith, Emilie Bailey, Rebecca Barron, Emma Tomlinson, Alexander E. P. Heazell","doi":"10.1111/1471-0528.18212","DOIUrl":"10.1111/1471-0528.18212","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate parents' psychological distress and emotional suppression in the antenatal and postnatal periods of a pregnancy following a perinatal death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Tertiary Maternity Unit in the UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Parents who were pregnant and attending a specialist antenatal clinic for pregnancy after loss.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Partners and mothers completed questionnaire measures which evaluated their levels of depression, anxiety, post-traumatic stress (PTS) and emotional suppression at 23 and 32 weeks' gestation, and 6 weeks postnatally. Repeated measures ANOVA or Friedman tests were used to identify significant changes in scores. Independent samples <i>t</i>-tests or Mann–Whitney <i>U</i> tests were used to determine significant differences in partners' and mothers' group scores. The proportion of partners and mothers scoring above threshold for each measure was identified, and a one-sample <i>t</i>-test examined partners' and mothers' within-couple scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Psychological distress and emotional suppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-one partners and 54 mothers completed the questionnaire. Partners', but not mothers', depression symptoms significantly decreased (<i>p</i> = 0.004; 95% CI 0.6–2.7) from 23 weeks' gestation (<i>M</i> = 11.32, SD = 5.35) to 32 weeks' gestation (<i>M</i> = 9.68, SD = 4.68). Mothers' depression symptoms significantly decreased (<i>z =</i> −3.91, <i>p</i> < 0.001) from 32 weeks gestation (median value of 13; IQR 8–17) to 6 weeks postnatal (median value of 10; IQR 5–13). Parents' anxiety levels did not change across the course of pregnancy. Mothers', but not partners', anxiety symptoms significantly decreased (<i>z =</i> −2.49, <i>p =</i> 0.013) from 32 weeks' gestation (median value of 7.5; IQR 4–14) to 6 weeks postnatal (median value of 6; IQR 2–13). PTS did not change across the course of a pregnancy, and mothers' symptoms continued into the postnatal period. Partners are more likely to hide their emotions during pregnancy than mothers (<i>z</i>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 10","pages":"1469-1480"},"PeriodicalIF":4.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945190","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}
Madeline Flanagan, Nicole Au, Malitha Patabendige, Arsheeya Rattan, Ritwik Samanta, Daljit Sahota, Enrique Teran, Vanita Jain, Abdulkarim O. Musa, Munir'deen A. Ijaiya, Daniel L. Rolnik, Wentao Li, Ben W. Mol
{"title":"Misoprostol Versus Oxytocin for the Prevention of Postpartum Haemorrhage: A Systematic Review and Meta-Analysis Including Individual Participant Data","authors":"Madeline Flanagan, Nicole Au, Malitha Patabendige, Arsheeya Rattan, Ritwik Samanta, Daljit Sahota, Enrique Teran, Vanita Jain, Abdulkarim O. Musa, Munir'deen A. Ijaiya, Daniel L. Rolnik, Wentao Li, Ben W. Mol","doi":"10.1111/1471-0528.18197","DOIUrl":"10.1111/1471-0528.18197","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postpartum haemorrhage (PPH) is the leading cause of maternal mortality. Uterotonics are the mainstay of PPH prevention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare the efficacy of misoprostol and oxytocin for the prevention of PPH and to evaluate the trustworthiness of these randomised controlled trials (RCTs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy and Selection Criteria</h3>\u0000 \u0000 <p>Seven databases were searched for peer-reviewed literature meeting the inclusion criteria of RCTs comparing misoprostol and oxytocin for the prevention of PPH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Data were collected by two independent reviewers. Individual participant data (IPD) were meta-analysed for outcomes PPH ≥ 500 and ≥ 1000 mL. RCTs that did not share IPD were classified as trustworthy or not, and aggregate data were meta-analysed according to trustworthiness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Of 79 eligible RCTs, 10 (12.7%) provided IPD, of which 6 were included. Analysis of IPD showed PPH ≥ 500 mL to be significantly higher in the misoprostol than in the oxytocin group (2022 participants, aOR 1.84, 95% CI 1.43–2.34). For PPH ≥ 1000 mL, analysis of IPD showed that misoprostol and oxytocin were comparable (2022 participants, OR 1.14, 95% CI 0.68–1.91).</p>\u0000 \u0000 <p>Of the 69 studies that did not provide IPD, 23 (33.3%) were assessed as trustworthy. Analysis of trustworthy data (IPD and 23 aggregate data RCTs) showed no difference between misoprostol and oxytocin for PPH ≥ 500 mL (24 334 participants, OR 1.01, 95% CI 0.69–1.49), while misoprostol was associated with a significantly increased risk of PPH ≥ 1000 mL compared to oxytocin (25 249 participants, OR 1.36, 95% CI 1.16–1.59).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Of 79 RCTs comparing misoprostol and oxytocin for the prevention of PPH, 36.7% met trustworthiness criteria. Oxytocin is comparable to misoprostol for preventing PPH and may be superior for preventing severe PPH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 10","pages":"1364-1377"},"PeriodicalIF":4.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18197","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945191","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}
Daniel Gabbai, Itamar Gilboa, Anat Lavie, Yariv Yogev, Emmanuel Attali
{"title":"Neutrophil-To-Lymphocyte Ratio and Delivery Within 24 h in Preterm Premature Rupture of Membranes: A Retrospective Cohort Study","authors":"Daniel Gabbai, Itamar Gilboa, Anat Lavie, Yariv Yogev, Emmanuel Attali","doi":"10.1111/1471-0528.18208","DOIUrl":"10.1111/1471-0528.18208","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the association between maternal neutrophil-to-lymphocyte ratio (NLR) and delivery within 24 h in women with preterm premature rupture of membranes (PPROM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design and Setting</h3>\u0000 \u0000 <p>Retrospective cohort study in a single university-affiliated tertiary medical centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women with PPROM at ≤ 36 + 6 weeks' gestation planning vaginal delivery. Exclusions included women who lacked complete blood count (CBC) data within the first 24 h from PPROM caesarean delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Maternal demographic and clinical data, including age, gestational age, body mass index, parity and mode of conception, were collected. Women who delivered within 24 h of membrane rupture were compared to those who did not via univariate and multivariate Cox analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure</h3>\u0000 \u0000 <p>Women who delivered within 24 h from rupture of membrane.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 145 833 deliveries during the study period, 1498 women (0.9%) presented with PPROM. After exclusions, 371 women were included, with 173 (46.6%) delivering spontaneously within 24 h. Cox regression analysis identified NLR > 10 (HR = 1.60; 95% CI, 1.06–2.40; <i>p</i> = 0.025) as an independent risk factor for spontaneous delivery within 24 h.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Elevated maternal NLR is associated with delivery within 24 h in PPROM and may support clinical assessment for anticipating imminent preterm delivery, aiding in management decisions for this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 10","pages":"1454-1459"},"PeriodicalIF":4.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920650","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 Meta-Analysis: Anti-Inflammatory Medicinal Plants for Age-Related Menopause-Like Symptoms and Psychological Problems in Breast Cancer and Healthy Perimenopausal Women","authors":"Fan Zhang, Dianhui Yang","doi":"10.1111/1471-0528.18209","DOIUrl":"10.1111/1471-0528.18209","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medicinal plant supplements (MPS) have benefits in improving menopause-like symptoms (MLS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the effectiveness of MPS in reducing MLS in healthy women and those with breast cancer (BC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang database and Chinese Scientific Journals Database were searched from the date of library construction until 30 January 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Randomised controlled trials were selected that involved healthy perimenopausal women, BC patients treated with herbal medicines, and the effects of plant-based compounds on MLS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>The review included 12 studies with 917 patients with BC and 15 studies with 2104 healthy perimenopausal women. The data were analysed using the Meta-mar tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>MPS improved Kupperman's Index (KMI) and menopause rating scale (MRS) scores compared with the comparator. Patients with BC experienced a greater reduction in KMI and MRS because of treatment than healthy perimenopausal women. Patients with BC had a more significant reduction in KMI than women who received hormone therapy. In both healthy perimenopausal women and women with BC, MPS treatment resulted in significantly higher response rates and fewer psychological problems. Women with BC experienced a decrease in anxiety and insomnia by MPS. Network analysis showed that the response rate was the factor most associated with MPS use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Anti-inflammatory MPS may assist women with BC or healthy perimenopausal women experience less MLS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 10","pages":"1399-1415"},"PeriodicalIF":4.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915090","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":"Propranolol may Increase the Effectiveness of Oxytocin In Vitro","authors":"Annie M. Dude","doi":"10.1111/1471-0528.18206","DOIUrl":"10.1111/1471-0528.18206","url":null,"abstract":"<p><b>Linked article:</b> This is a mini commentary on Balki et al., pp. 1228–1237 in this issue. To view this article, visit https://doi.org/10.1111/1471-0528.18146.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 9","pages":"1238-1239"},"PeriodicalIF":4.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143910852","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}
Sven Becker, Marie-Madeleine Dolmans, Francisco Carmona Herrera, Felice Petraglia, Stefan P. Renner, Raluca Ionescu-Ittu, Julien St-Pierre, Mitra Boolell, Elke Bestel, Satoshi Hori, Jacques Donnez
{"title":"Pain Reduction in Linzagolix-Treated Patients With Uterine Fibroids: A Secondary Mediation Analysis of the PRIMROSE 1 and 2 Phase 3 Trials","authors":"Sven Becker, Marie-Madeleine Dolmans, Francisco Carmona Herrera, Felice Petraglia, Stefan P. Renner, Raluca Ionescu-Ittu, Julien St-Pierre, Mitra Boolell, Elke Bestel, Satoshi Hori, Jacques Donnez","doi":"10.1111/1471-0528.18190","DOIUrl":"10.1111/1471-0528.18190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Among women with uterine fibroids (UFs), we assess the extent to which the linzagolix effect on pain alleviation is explained by its effect on reducing heavy menstrual bleeding (HMB) and fibroid volume (FV).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Post hoc analysis on the pooled data from two randomised double-blind placebo-controlled phase 3 trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>94 sites in the US (PRIMROSE 1 trial) and 95 sites in Europe/US (PRIMROSE 2 trial).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women aged ≥ 18 years with ultrasound-confirmed UFs and HMB (<i>n</i> = 1012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were randomised to linzagolix (100 mg and 200 mg, with and without hormonal add-back therapy) versus placebo. A post hoc mediation analysis was conducted on the pooled PRIMROSE 1 and PRIMROSE 2 data. The effect of linzagolix versus placebo on pain reduction was divided into three components (effect explained by HMB reduction associated with linzagolix, FV reduction associated with linzagolix, and remaining [not yet explained] treatment effect), with proportions of each component reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The mediation analysis outcome was clinically significant pain reduction, defined as a change of ≥ 2 pain categories from baseline to Week 24 using the Numeric Rating Scale (pain categories: no pain (0), and mild (1–3), moderate (4–6), severe pain (7–10)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the mediation analysis, 28%–51% (depending on treatment arm) of linzagolix effect on pain reduction was explained by its effect on HMB reduction, while 2%–8% was explained by its effect on FV reduction. The residual proportion ranged between 44% and 67%, depending on treatment arm, and was statistically significant only in the linzagolix 200 mg without add-back therapy arm (<i>p</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This analysis showed that reductions in pain were significantly mediated by reductions in HMB (all doses) and FV (200 mg alone) in linzagolix-treated women with UFs. ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 9","pages":"1297-1306"},"PeriodicalIF":4.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143910853","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}