AJOG global reports最新文献

{"title":"Association of Professors of Gynecology and Obstetrics Preparation for Residency Knowledge Assessment scores are more closely associated with first postgraduate year Council on Resident Education in Obstetrics and Gynecology scores than United States Medical Licensing Examination Steps 1 and 2","authors":"Amanda Morgan MD, Myanna Cook BA, Megan Christman DO, Nicole Scott MD, Anthony Shanks MD, MS, MEd","doi":"10.1016/j.xagr.2024.100354","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100354","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100354"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000480/pdfft?md5=4afd7aff3bfca71ccfd714a9ab69b2c0&pid=1-s2.0-S2666577824000480-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The iPREFACE score is useful for predicting fetal acidemia: A retrospective cohort study of 113 patients who underwent emergency cesarean section for non-reassuring fetal status during labor","authors":"Ayumu Ito MD, PhD ,&nbsp;Eijiro Hayata MD, PhD ,&nbsp;Hikari Kotaki MD ,&nbsp;Makiko Shimabukuro MD ,&nbsp;Mayumi Takano MD, PhD ,&nbsp;Sumito Nagasaki MD, PhD ,&nbsp;Masahiko Nakata MD, PhD","doi":"10.1016/j.xagr.2024.100343","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100343","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision in the future.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess the score use of the iPREFACE as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor.</p></div><div><h3>STUDY DESIGN</h3><p>This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean delivery owing to a nonreassuring fetal status. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery score, calculated from a 30-minute cardiotocography waveform before the decision to perform emergency cesarean delivery, and the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer score, calculated from a 30-minute cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography score.</p></div><div><h3>RESULTS</h3><p>The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery and integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer scores demonstrated the capability to predict an umbilical artery blood pH of &lt;7.2. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery and −removal of cardiotocography transducer score, with cutoff values of 37 and 46 points, respectively, exhibited an area under the receiver operating characteristic curve of 0.82 and 0.87, respectively. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer group with ≥46 points had higher incidence rates of an umbilical cord artery blood pH of &lt;7.2, &lt;7.1, and &lt;7.0 and neonatal intensive care unit admissions for neonatal asphyxia.</p></div><div><h3>CONCLUSION</h3><p>The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring, derived from cardiotocography during an emergency cesarean delivery, may enable clinicians to predict fetal acidemia in cases of nonreassuring fetal status. Improved prediction of fetal acidemia ","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100343"},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000376/pdfft?md5=72893d346015d23ba308693a0e360317&pid=1-s2.0-S2666577824000376-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140638344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspirin for preeclampsia prevention in low- and middle-income countries: mind the gaps","authors":"Ellen Kupka MD,&nbsp;James M. Roberts MD,&nbsp;Zaleha A. Mahdy MD, FRCOG,&nbsp;Carlos Escudero MD, PhD,&nbsp;Lina Bergman MD, PhD,&nbsp;Leandro De Oliveira MD, PhD,&nbsp;Global Pregnancy Collaboration","doi":"10.1016/j.xagr.2024.100352","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100352","url":null,"abstract":"<div><p>Preeclampsia is a syndrome that continues to be a major contributor to maternal and neonatal mortality, especially in low-income countries. Low-dose aspirin reduces the risk of preeclampsia, but the mechanism is still unknown. Risk factors to identify women at risk of preeclampsia are based on clinical characteristics. Women identified as high-risk would benefit from aspirin treatment initiated, preferably at the end of the first trimester. Current efforts have largely focused on developing screening algorithms that incorporate clinical risk factors, maternal biomarkers, and uterine artery Doppler evaluated in the first trimester. However, most studies on preeclampsia are conducted in high-income settings, raising uncertainties about whether the information gained can be totally applied in low-resource settings. In low- and middle-income countries, lack of adequate antenatal care and late commencement of antenatal care visits pose significant challenges for both screening for preeclampsia and initiating aspirin treatment. Furthermore, the preventive effect of first-trimester screening based on algorithms and subsequent aspirin treatment is primarily seen for preterm preeclampsia, and reviews indicate minimal or no impact on reducing the risk of term preeclampsia. The lack of evidence regarding the effectiveness of aspirin in preventing term preeclampsia is a crucial concern, as 75% of women will develop this subtype of the syndrome. Regarding adverse outcomes, low-dose aspirin has been linked to a possible higher risk of postpartum hemorrhage, a condition as deadly as preeclampsia in many low- and middle-income countries. The increased risk of postpartum hemorrhage among women in low-income settings should be taken into consideration when discussing which pregnant women would benefit from the use of aspirin and the ideal aspirin dosage for preventing preeclampsia. In addition, women's adherence to aspirin during pregnancy is crucial for determining its effectiveness and complications, an aspect often overlooked in trials. In this review, we analyze the knowledge gaps that must be addressed to safely increase low-dose aspirin use in low- and middle-income countries, and we propose directions for future research.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100352"},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000467/pdfft?md5=e89a27dae02e0d8f80abed3c8c59fce2&pid=1-s2.0-S2666577824000467-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140638345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation challenges in preeclampsia care: perspectives from health care professionals in urban Uganda","authors":"Imelda Namagembe MD ,&nbsp;Babu Karavadra BSc Hons, MBBS, PhD ,&nbsp;Lawrence Kazibwe MBChB, MMed ,&nbsp;Joseph Rujumba PhD ,&nbsp;Noah Kiwanuka MBChB, MPH, PhD ,&nbsp;Brandon Smith BSc Hons, PhD ,&nbsp;Josaphat Byamugisha PhD ,&nbsp;Ashley Moffett MB/BChir, PhD ,&nbsp;Tom Bashford MBBS, MBiochem, PhD, MRCP, FRCA ,&nbsp;Annettee Nakimuli MD, PhD ,&nbsp;Catherine E. Aiken MB/BChir, MA, PhD, MRCOG, MRCP","doi":"10.1016/j.xagr.2024.100348","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100348","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Sub-Saharan Africa bears the burden of 70% of maternal deaths worldwide, of which ∼10% are attributable to hypertensive disorders of pregnancy, primarily complications of preeclampsia. In other global settings, outcomes of pregnancies affected by preeclampsia are improved with timely and effective medical care.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to explore the perspectives of local health care professionals on how preeclampsia care is currently delivered in the study setting and what challenges they experience in providing prompt and safe care. We identified specific objectives of exploring stakeholder perceptions of (1) recognizing preeclampsia and (2) timely intervention when preeclampsia is diagnosed. We also explored the wider system factors (eg, cultural, financial, and logistic challenges) that health care professionals perceived as affecting their ability to deliver optimal preeclampsia care.</p></div><div><h3>STUDY DESIGN</h3><p>Individual semistructured interviews were conducted with health care professionals and stakeholders. The findings were analyzed using thematic analysis.</p></div><div><h3>RESULTS</h3><p>Thirty-three participants contributed to the study, including doctors and midwives with varying degrees of clinical experience and external stakeholders. The following 5 key themes emerged: delayed patient presentation, recognizing the unwell patient with preeclampsia, the challenges of the existing triage system, stakeholder disconnect, and ways of learning from each other. Health care professionals referenced an important psychosocial perspective associated with preeclampsia in the study setting, which may influence the likelihood of seeking care through traditional healers rather than hospital-based routes.</p></div><div><h3>CONCLUSION</h3><p>We identify the key barriers to improving maternal and neonatal outcomes of preeclampsia, described at both the institutional level and within the wider setting. The study provides invaluable contextual information that suggests that a systems-based approach to health care quality improvement may be effective in reducing rates of maternal and neonatal morbidity and mortality.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100348"},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266657782400042X/pdfft?md5=7b11cd7cad1c9931a15000c51a5b1c29&pid=1-s2.0-S266657782400042X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140631769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mainz II urinary diversion in low-resource settings: patient outcomes in women with irreparable fistula in Malawi","authors":"Tulsi D. Patel MD ,&nbsp;Ennet B. Chipungu MBBS ,&nbsp;Jennifer M. Draganchuk MD ,&nbsp;Chisomo Chalamanda DCM ,&nbsp;Jeffrey P. Wilkinson MD","doi":"10.1016/j.xagr.2024.100350","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100350","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Obstructed labor leading to a vesicovaginal fistula remains a devastating outcome of childbirth in low-resource countries. Women with an irreparable vesicovaginal fistula may be candidates for a urinary diversion, such as the Mainz II modified ureterosigmoidostomy procedure. Previous reviews state that the procedure should be considered in low-resource countries. However, given the limited duration of postoperative follow-up, these studies do not adequately represent the long-term morbidity and mortality that is likely associated with this procedure. We present data that strongly support avoiding the procedure in low-resource countries.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to evaluate the postoperative status of the patient (dead, alive, lost to follow-up) and time to death following the Mainz II procedure.</p></div><div><h3>STUDY DESIGN</h3><p>This is a case series including 21 patients who underwent a Mainz II urinary diversion from April 2013 to June 2015 for management of irreparable vesicovaginal fistula at the Fistula Care Centre in Lilongwe, Malawi. Patients were seen postoperatively at 3, 6, 9, and 12 months, followed by every 6 to 12 months thereafter. Descriptive statistics were performed to summarize the data.</p></div><div><h3>RESULTS</h3><p>During the postoperative period, 8 (38.1%; 8/21) patients died, 5 (23.8%; 5/21) were lost to follow-up, and 8 (38.1%; 8/21) are currently alive and followed up at the Fistula Care Centre. We strongly suspect that 7 of the 8 deaths were related to the procedure given that the patients had illnesses that exacerbated the metabolic consequences of the procedure. The eighth patient died after being attacked by robbers. Unfortunately, the exact cause of death could not be determined for these patients. Given that most of the suspected illnesses would be treatable in an otherwise healthy patient, even in this low-resource setting, we surmised that the metabolic compromise from the Mainz II procedure likely contributed to their untimely death. The average time from procedure to death was 58 months, with the earliest death at 10 months and the most recent at 7 years after the procedure.</p></div><div><h3>CONCLUSION</h3><p>The Mainz II procedure is an option for patients with irreparable fistula. However, it should likely not be performed in low-resource countries given the long-term complications that often cannot be adequately addressed in these settings, leading to significant morbidity and mortality.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100350"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000443/pdfft?md5=a73b794e4b7c2e7be3b463984bb4b156&pid=1-s2.0-S2666577824000443-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140551692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical application of amino-terminal pro-brain natriuretic peptide concentration in amniotic fluid for the prediction of preterm birth in symptomatic women","authors":"Fernando A. Ferrer-Marquez MD,&nbsp;Rocío P. Astudillo MD,&nbsp;Jorge A. Carvajal MD, PhD","doi":"10.1016/j.xagr.2024.100345","DOIUrl":"10.1016/j.xagr.2024.100345","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Preterm birth accounts for 60% to 80% of neonatal mortality. Approximately one-third of preterm births are caused by the spontaneous onset of preterm labor. Nevertheless, 70% to 90% of women diagnosed with preterm labor will not deliver within 7 days. Thus, many women will be unnecessarily treated by preterm labor with risk medications. Better tools are needed to categorize women in preterm labor into high or low risk of preterm delivery.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to evaluate the amino-terminal pro-brain natriuretic peptide concentration in the amniotic fluid as a prognostic test to predict the risk of delivery within 48 hours or 7 days and before 34 0/7 or 37 0/7 weeks of gestation in women in preterm labor.</p></div><div><h3>STUDY DESIGN</h3><p>A total of 102 pregnant women presenting signs and symptoms of spontaneous preterm birth (22 0/7 to 34 0/7 weeks of gestation) were included. Amniotic fluid was obtained by amniocentesis, and amino-terminal pro-brain natriuretic peptide concentration was measured. Below normal concentration was defined as &lt;0.5 multiples of the median of the standard curve according to gestational age. The risk of preterm delivery was estimated according to normal or lower-than-normal amino-terminal pro-brain natriuretic peptide concentrations. The predictive capacity of the test (below normal amino-terminal pro-brain natriuretic peptide concentration) was evaluated to identify spontaneous preterm birth at 48 hours or 7 days from amniocentesis and less than 34 0/7 or 37 0/7 weeks at delivery.</p></div><div><h3>RESULTS</h3><p>For the outcome delivery within 48 hours, lower-than-normal amino-terminal pro-brain natriuretic peptide concentration had 94.6% sensitivity, 73.8% specificity, 96.0% negative predictive value, 3.61 positive likelihood ratio, and 0.07 negative likelihood ratio. For the outcome delivery within 7 days, the test had 93.9% sensitivity, 88.7% specificity, 94.0% negative predictive value, 8.31 positive likelihood ratio, and 0.07 negative likelihood ratio. For the outcomes of spontaneous preterm birth before 34 0/7 and 37 0/7 weeks of gestation, below normal amino-terminal pro-brain natriuretic peptide concentrations had 80.0% sensitivity, 83.0% specificity, 78.0% negative predictive value, 4.70 positive likelihood ratio, and 0.24 negative likelihood ratio and 64.1% sensitivity, 91.7% specificity, 44.0% negative predictive value, 7.70 positive likelihood ratio, and 0.39 negative likelihood ratio, respectively.</p></div><div><h3>CONCLUSION</h3><p>Among patients in spontaneous preterm labor, the detection of lower-than-normal amino-terminal pro-brain natriuretic peptide concentrations (&lt;0.5 multiples of the median) in amniotic fluid has an excellent predictive capacity to identify those patients at low risk of preterm delivery within 48 hours or 7 days.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100345"},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266657782400039X/pdfft?md5=33a55557b8dfe548934c129b4137cb88&pid=1-s2.0-S266657782400039X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migraine among women with endometriosis: a hospital-based case-control study in Bangladesh","authors":"Samina Sultana MS ,&nbsp;Touhidul A. Chowdhury FRCS ,&nbsp;Tanzeem S. Chowdhury MRCOG ,&nbsp;Nusrat Mahmud MSc ,&nbsp;Rebeka Sultana FCPS ,&nbsp;Naushaba T. Mahtab FCPS ,&nbsp;Yushuf Sharker PhD ,&nbsp;Firoz Ahmed PhD","doi":"10.1016/j.xagr.2024.100344","DOIUrl":"10.1016/j.xagr.2024.100344","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Endometriosis is a disease among women of reproductive age, which causes several health problems, such as dysmenorrhea, dyspareunia, and subfertility. In addition, it increases psychological stress and often results in marital disharmony. Similarly, migraine is more frequent among this group of women. Several studies have shown an association between endometriosis and migraine among groups of populations completely different from Bangladesh.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to identify the association between endometriosis and migraine among the Bangladeshi population.</p></div><div><h3>STUDY DESIGN</h3><p>This nonrandomized case-control study was conducted with cases of endometriosis and controls without endometriosis who were confirmed by laparoscopy or laparotomy. Among the study participants, cases of migraine in 1 group of respondents who were already diagnosed as patients of migraine were identified, and the others with complaints of headaches were further confirmed by a medicine specialist. Patients were recruited from the Department of Obstetrics and Gynecology at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College. The study was approved by the ethical review committee of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital. Multivariate logistic regression was used to identify the association between endometriosis and migraine using odds ratios and 95% confidence intervals.</p></div><div><h3>RESULTS</h3><p>Of 1496 patients who underwent laparoscopy or laparotomy during the study period, the frequency of endometriosis was found to be 12.7%. A total of 190 patients with confirmed endometriosis cases and an equal number of controls without endometriosis were enrolled, maintaining the age distribution of the controls similar to that of the cases. Compared with controls, the distribution of age, body mass index, education, and marital status of the patients with endometriosis were similar. The average ages of respondents were 30.6 years in both the case and control groups. Regarding occupation, cases included more students than controls (12% vs 0%, respectively). The odds of suffering from dysmenorrhea and dyspareunia among the cases were 3.3 (95% confidence interval, 2.66–4.15; <em>P</em>&lt;.001) and 9.5 (95% confidence interval, 5.3–17.9; <em>P</em>&lt;.001) times higher than that of controls, respectively. In addition, the odds of menstrual irregularity was 60% lower among the cases than among controls (odds ratio, 0.4; 95% confidence interval, 0.24–0.64; <em>P</em>&lt;.001). No significant difference was observed in having primary subfertility and secondary subfertility among the 2 groups of respondents. Univariate regression analysis showed that patients with endometriosis have 6.13 times higher odds (95% confidence interval, 2.50","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100344"},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000388/pdfft?md5=b53761037099a265963cdc215a171a88&pid=1-s2.0-S2666577824000388-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of cervical pessary on increasing gestational age at delivery in twin pregnancies with asymptomatic short cervix: a systematic review and meta-analysis of randomized controlled trials","authors":"Amir Hossein Norooznezhad MD ,&nbsp;Nikan Zargarzadeh MD ,&nbsp;Ali Javinani MD ,&nbsp;Seyedeh Maedeh Nabavian MD ,&nbsp;Shohra Qaderi MD ,&nbsp;Shayan Mostafaei MD ,&nbsp;Vincenzo Berghella MD ,&nbsp;Yinka Oyelese MD ,&nbsp;Alireza A. Shamshirsaz MD, FACOG","doi":"10.1016/j.xagr.2024.100347","DOIUrl":"10.1016/j.xagr.2024.100347","url":null,"abstract":"<div><h3>Objective</h3><p>The incidence of preterm delivery is much higher in twin pregnancies than in singletons and even higher if a short cervical length is detected in the second trimester. Studies are contradictory regarding the efficacy of a cervical pessary to decrease preterm birth in twin pregnancies and short cervical length. To conduct a systematic review and meta-analysis investigating the efficacy of cervical pessary in prolonging gestation, preventing preterm birth, and reducing adverse neonatal outcomes in twin pregnancies with an asymptomatic short cervix.</p></div><div><h3>Data sources</h3><p>PubMed, Scopus, Web of Science, and ClinicalTrials.org were searched for randomized controlled trials from inception to June 2023.</p></div><div><h3>Study eligibility criteria</h3><p>In this study, randomized controlled trials comparing the cervical pessary to expectant management in the pregnant population with twin gestations and asymptomatic short cervix were included.</p></div><div><h3>Methods</h3><p>The Cochrane risk-of-bias-2 tool for randomized controlled trials was used for the evaluation of the risk of bias in included studies. A meta-analysis was performed by calculating risk ratio and mean difference with their 95% confidence interval using the random effects model or fixed effect model on the basis of heterogeneity and accounting for potential covariates among the included randomized controlled trials.</p></div><div><h3>Results</h3><p>A total of 6 randomized controlled trials were included in the analysis. Cervical pessary did not significantly increase the gestational age at delivery in twin pregnancies with asymptomatic patients (mean difference, 0.36 weeks [−0.27 to 0.99]; <em>P</em>=.270; I²=72.0%). Moreover, the cervical pessary use did not result in a reduction of spontaneous or all-preterm birth before 37 weeks of gestation (risk ratio, 0.88 [0.77–1.00]; <em>P</em>=.061; I²=0.0%). There was no statistically significant difference in the composite neonatal adverse outcomes (risk ratio, 1.001 [0.86–1.16]; <em>P</em>=.981; I²=20.9%), including early respiratory morbidity, intraventricular hemorrhage, necrotizing enterocolitis, and confirmed sepsis.</p></div><div><h3>Conclusion</h3><p>The use of cervical pessary in twin pregnancies with asymptomatic short cervix does not seem to be effective in increasing the gestational age at delivery, preventing preterm birth, or reducing adverse neonatal outcomes. This indicates that alternative interventions should be sought for the management of this patient population.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100347"},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000418/pdfft?md5=a600b492d02c7c4494c97bebd791dd05&pid=1-s2.0-S2666577824000418-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140404011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of the first-trimester Fetal Medicine Foundation competing risks model for preeclampsia prediction: an external validation study in Brazil","authors":"Karina Bilda de Castro Rezende MD, PhD ,&nbsp;Rita G. Bornia MD, PhD ,&nbsp;Daniel L. Rolnik MD, PhD, MPH ,&nbsp;Joffre Amim Jr. MD, PhD ,&nbsp;Luiza P. Ladeira MD ,&nbsp;Valentina M.G. Teixeira MS ,&nbsp;Antonio Jose L.A. da Cunha MD, PhD, MPH","doi":"10.1016/j.xagr.2024.100346","DOIUrl":"10.1016/j.xagr.2024.100346","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>The current version of the Fetal Medicine Foundation competing risks model for preeclampsia prediction has not been previously validated in Brazil.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed (1) to validate the Fetal Medicine Foundation combined algorithm for the prediction of preterm preeclampsia in the Brazilian population and (2) to describe the accuracy and calibration of the Fetal Medicine Foundation algorithm when considering the prophylactic use of aspirin by clinical criteria.</p></div><div><h3>STUDY DESIGN</h3><p>This was a cohort study, including consecutive singleton pregnancies undergoing preeclampsia screening at 11 to 14 weeks of gestation, examining maternal characteristics, medical history, and biophysical markers between October 2010 and December 2018 in a university hospital in Brazil. Risks were calculated using the 2018 version of the algorithm available on the Fetal Medicine Foundation website, and cases were classified as low or high risk using a cutoff of 1/100 to evaluate predictive performance. Expected and observed cases with preeclampsia according to the Fetal Medicine Foundation–estimated risk range (≥1 in 10; 1 in 11 to 1 in 50; 1 in 51 to 1 in 100; 1 in 101 to 1 in 150; and &lt;1 in 150) were compared. After identifying high-risk pregnant women who used aspirin, the treatment effect of 62% reduction in preterm preeclampsia identified in the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention trial was used to evaluate the predictive performance adjusted for the effect of aspirin. The number of potentially unpreventable cases in the group without aspirin use was estimated.</p></div><div><h3>RESULTS</h3><p>Among 2749 pregnancies, preterm preeclampsia occurred in 84 (3.1%). With a risk cutoff of 1/100, the screen-positive rate was 25.8%. The detection rate was 71.4%, with a false positive rate of 24.4%. The area under the curve was 0.818 (95% confidence interval, 0.773–0.863). In the risk range ≥1/10, there is an agreement between the number of expected cases and the number of observed cases, and in the other ranges, the predicted risk was lower than the observed rates. Accounting for the effect of aspirin resulted in an increase in detection rate and positive predictive values and a slight decrease in the false positive rate. With 27 cases of preterm preeclampsia in the high-risk group without aspirin use, we estimated that 16 of these cases of preterm preeclampsia would have been avoided if this group had received prophylaxis.</p></div><div><h3>CONCLUSION</h3><p>In a high-prevalence setting, the Fetal Medicine Foundation algorithm can identify women who are more likely to develop preterm preeclampsia. Not accounting for the effect of aspirin underestimates the screening performance.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100346"},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000406/pdfft?md5=689e0c8665c0e262200dee583da13c13&pid=1-s2.0-S2666577824000406-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the relationship between language, postoperative pain, and opioid use","authors":"Rachel A. Levy MD ,&nbsp;Allison H. Kay MD ,&nbsp;Nancy Hills PhD ,&nbsp;Lee-may Chen MD ,&nbsp;Jocelyn S. Chapman MD","doi":"10.1016/j.xagr.2024.100342","DOIUrl":"10.1016/j.xagr.2024.100342","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Racial and ethnic disparities in pain management are well documented. Differences in pain assessment and management by language have not been studied in the postoperative setting in gynecologic surgery.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to investigate the association between language and immediate postoperative pain management by comparing pain assessments and perioperative opioid use in non-English speakers and English speakers.</p></div><div><h3>STUDY DESIGN</h3><p>This was a retrospective cohort study comparing perioperative outcomes between non–English-speaking patients and English-speaking patients who had undergone a gynecologic oncology open surgery between July 2012 and December 2020. The primary language was extracted from the electronic medical record. Opioid use is expressed in oral morphine equivalents. Proportions are compared using chi-square tests, and mean values are compared using 2-sample <em>t</em> tests. Although interpreter services are widely available in our institution, the use of interpreters for any given inpatient-provider interaction is not documented.</p></div><div><h3>RESULTS</h3><p>Between 2012 and 2020, 1203 gynecologic oncology patients underwent open surgery, of whom 181 (15.1%) were non-English speakers and 1018 (84.9%) were English speakers. There was no difference between the 2 cohorts concerning body mass index, surgical risk score, or preoperative opioid use. Compared with the English-speaking group, the non–English-speaking group was younger (57 vs 54 years old, respectively; <em>P</em>&lt;.01) and had lower rates of depression (26% vs 14%, respectively; <em>P</em>&lt;.01) and chronic pain (13% vs 6%, respectively; <em>P</em>&lt;.01). Although non–English-speaking patients had higher rates of hysterectomy than English-speaking patients (80% vs 72%, respectively; <em>P</em>=.03), there was no difference in the rates of bowel resections, adnexal surgeries, lengths of surgery, intraoperative oral morphine equivalents administered, blood loss, use of opioid-sparing modalities, lengths of hospital stay, or intensive care unit admissions. In the postoperative period, compared with English-speaking patients, non–English-speaking patients received fewer oral morphine equivalents per day (31.7 vs 43.9 oral morphine equivalents, respectively; <em>P</em>&lt;.01) and had their pain assessed less frequently (7.7 vs 8.8 checks per day, respectively; <em>P</em>&lt;.01) postoperatively. English-speaking patients received a median of 19.5 more units of oral morphine equivalents daily in the hospital and 205.1 more units of oral morphine equivalents at the time of discharge (<em>P</em>=.02 and <em>P</em>=.04, respectively) than non–English-speaking patients. When controlling for differences between groups and several factors that may influence oral morphine equivalent use, English-speaking patients received a median of 15.9 more units of oral morphine equivalents daily in the hosp","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100342"},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000364/pdfft?md5=9d73e3d2d7b3f2a46f5c9a7881164edd&pid=1-s2.0-S2666577824000364-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}