AJOG global reports最新文献

{"title":"Evaluation of diagnostic and therapeutic hysteroscopy outcomes at a tertiary hospital in Rwanda","authors":"Vincent Dusingizimana MD, MMed ,&nbsp;Martin Nyundo MD, PhD ,&nbsp;Augustin Limgba MD, MMed ,&nbsp;Jacques Landenne MD, MMed ,&nbsp;Victor Mivumbi Ndicunguye MD, MMed ,&nbsp;Emmanuel Edwar Siddig PhD ,&nbsp;Uwimana Muhuza Marie Parfaite MD, MMed","doi":"10.1016/j.xagr.2025.100599","DOIUrl":"10.1016/j.xagr.2025.100599","url":null,"abstract":"<div><h3>Background</h3><div>Hysteroscopy is a minimally invasive technique for diagnosing and managing intrauterine pathologies, critical in addressing reproductive health issues. In Rwanda, limited data exist regarding the practice and outcomes of hysteroscopic procedures. Therefore, the objective of this study is to evaluate the practice, diagnostic and therapeutic outcomes, and patient-reported results of hysteroscopy performed at the University Teaching Hospital of Kigali (CHUK) from March 2022 to February 2025.</div></div><div><h3>Methods</h3><div>This retrospective and prospective study included 62 women who underwent hysteroscopy at CHUK. Data collected encompassed demographic details, indications, procedural characteristics, outcomes, and follow-up outcomes. Descriptive statistics and bivariate analyses assessed clinical findings, complication rates, efficacy of treatments, and factors associated with symptom improvement.</div></div><div><h3>Results</h3><div>A total of 62 women underwent hysteroscopic procedures within the study period. The mean age was 42 years (±6.4 years), with 74% aged between 30 and 50 years. Most participants were premenopausal (74%) and had attained at least secondary education (50%). The predominant indications for hysteroscopy were abnormal uterine bleeding (59.68%) and infertility (25.8%). Diagnostic hysteroscopy accounted for 52.2% of cases, while therapeutic procedures comprised 46.8%. The most common hysteroscopic findings included endometrial polyps (33.9%), intrauterine adhesions (16.1%), and fibroids (16.1%), with 25.8% showing a normal cavity. The majority of procedures (77.4%) lasted less than an hour, and the complication rate was 4.8%. Most patients (72.6%) had their intrauterine pathology successfully treated during the procedure.</div></div><div><h3>Conclusions</h3><div>Hysteroscopy in Rwanda demonstrates favorable diagnostic yield and therapeutic outcomes, with minimal complications. The increasing adoption of office-based procedures and targeted management of intrauterine lesions can enhance patient care. These findings support the expansion of hysteroscopic services and capacity building in the region.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100599"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of antenatal and pregnancy-related factors on recovery after childbirth: a systematic review","authors":"Zayël Z. Frijmersum MD ,&nbsp;Eva Van der Meij MD, PhD ,&nbsp;Ralph De Vries MSc ,&nbsp;Johannes R. Anema MD, PhD ,&nbsp;Judith A.F. Huirne MD, PhD ,&nbsp;Petra C.A.M. Bakker MD, PhD","doi":"10.1016/j.xagr.2026.100610","DOIUrl":"10.1016/j.xagr.2026.100610","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This study aimed to identify antenatal and pregnancy-related factors that affect recovery after childbirth, with the purpose of improving maternal health, return to work, and social participation.</div></div><div><h3>DATA SOURCES</h3><div>We searched PubMed, Embase, and Web of Science up to October 2024 using predefined search terms. The review is registered in PROSPERO (#CRD42022361262).</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>We included cohort studies, randomized controlled trials, and cross-sectional studies published in English or Dutch that evaluated antenatal and pregnancy-related factors associated with maternal morbidity beyond 6 weeks postpartum among women aged ≥18 years who delivered live-born singletons. A minimum follow-up of 6 weeks postpartum was required.</div></div><div><h3>METHODS</h3><div>Two reviewers independently screened and assessed studies for quality. Data were synthesized narratively, organized by recovery domain.</div></div><div><h3>RESULTS</h3><div>A total of 56 studies were included. Seven categories of influencing factors were identified: mental health in pregnancy (n=18), demographic and socioeconomic background (n=17), medical and psychological history (n=16), lifestyle in pregnancy (n=12), physical health in pregnancy (n=9), prepregnancy social and lifestyle factors (n=8), and psychosocial resources in pregnancy (n=5). Recovery outcomes included persistent pain, mental health problems, functional ability, and urinary incontinence. Although 47 studies focused on physical or mental health, only 9 studies assessed functional ability. No studies explicitly examined social participation. Previous pain, high body mass index, and antenatal mental health problems were consistently associated with poorer recovery outcomes. In contrast, physical activity, social support, and psychological resilience were generally protective factors.</div></div><div><h3>CONCLUSION</h3><div>Postpartum recovery is influenced by multiple antenatal and pregnancy-related factors. A personalized, biopsychosocial approach to care may improve maternal health outcomes and social participation.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100610"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ruptured uterus: a rare and catastrophic complication of molar pregnancy","authors":"Ayalkibet Alemayehu Debele MD ,&nbsp;Shimelis Fantu Gebresilasie MD ,&nbsp;Solomon Elias Kefeni MD ,&nbsp;Gelagay Zewudie Workineh MD ,&nbsp;Eyerusalem Fissehatsion Dejene MD ,&nbsp;Zekarias Dejene Adugna MD","doi":"10.1016/j.xagr.2025.100591","DOIUrl":"10.1016/j.xagr.2025.100591","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Gestational trophoblastic disease is the term used to describe the heterogeneous group of interrelated lesions that arise from abnormal proliferation of placental trophoblasts. The clinical presentations of the gestational trophoblastic tumor include vaginal bleeding, uterine enlargement greater than expected for gestational age, hyperemesis, and secondary clinical hyperthyroidism. Less common presentations include pregnancy-induced hypertension in the first or second trimester of pregnancy and theca lutea cyst torsion. It is a rare incident to find uterine rupture because of a molar pregnancy. Most uterine ruptures reported so far were all malignant histologic types of the spectrum. This study presents a case of a ruptured uterus as a complication of complete molar pregnancy presenting with shock and severe anemia.</div></div><div><h3>CASE PRESENTATION</h3><div>A 37-year-old gravida 6, para 5 patient with a 5-month amenorrhea presented to the hospital with vaginal bleeding, abdominal pain, and symptoms of anemia. The patient’s hemoglobin level was 2.8 g/dL. Further assessment revealed a honeycomb-appearing endometrial mass and free fluid in the general peritoneum. The patient underwent emergency laparotomy, where a hysterectomy was performed for cornual uterine rupture. The patient was tested for serial serum human chorionic gonadotropin and declared cured after 6 months of observation.</div></div><div><h3>CONCLUSION</h3><div>Although rupture of the uterus is rare, a ruptured uterus in a molar pregnancy can be a catastrophic complication, presenting with massive hemoperitoneum and hemorrhagic shock. Hysterectomy, along with vascular filling with crystalloid and transfusion of blood products, can save a patient’s life. Patients can be followed by serial serum human chorionic gonadotropin (HCG) safely for any transformation to gestational trophoblastic neoplasia (GTN).</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100591"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE INAPRES (Indonesia Preeclampsia Study): impact of eclampsia on maternal and perinatal outcomes among women with preeclampsia: findings from a National Multicenter Cohort","authors":"Muhammad Ilham Aldika Akbar MD, PhD, MME ,&nbsp;Ernawati MD, PhD ,&nbsp;Manggala Pasca Wardhana MD, PhD ,&nbsp;Ruth Widhiati Raharjo Putri MD ,&nbsp;Anak Agung Gede Putra Wiradnyana MD, PhD ,&nbsp;Dhanny Primantara Johari Santoso MD ,&nbsp;Wiku Andonotopo MD, PhD ,&nbsp;Gustaaf Dekker MD, PhD, FDCOG, FRANZCOG ,&nbsp;Rozi Aditya Aryananda ,&nbsp;HKFM Preeclampsia Research Group","doi":"10.1016/j.xagr.2025.100596","DOIUrl":"10.1016/j.xagr.2025.100596","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Hypertension during pregnancy, including preeclampsia (PE) and its severe complication, eclampsia, remains a primary cause of maternal mortality globally. Eclampsia is a critical complication of PE that severely impacts maternal and neonatal health. Evidence regarding outcomes in pregnancies complicated by eclampsia, especially in developing nations, is limited.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This study aimed to compare the maternal and perinatal outcomes in patients with preeclampsia, both with and without eclampsia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;This was a national, multicenter, observational, retrospective cohort study conducted in Indonesia. Data were gathered from medical records of patients who delivered at 30 hospitals across five principal islands in Indonesia between January 2022 and December 2023. The study included 1,808 cases with complete data who met the inclusion criteria, consisting of all pregnancies impacted by PE that culminated in delivery at the research sites. The sample was classified into 2 groups: the eclampsia group (n=151) and the non-eclampsia group (n=1657). Primary outcomes examined included maternal outcomes (eg, severe morbidity, maternal mortality), intrapartum management, labor complications, and perinatal outcomes (eg, preterm birth, neonatal morbidity, neonatal death). Statistical analysis utilized SPSS version 29, employing independent t-tests or Mann-Whitney U tests for continuous data, and Chi-square or Fisher's exact tests for categorical variables, with results expressed as numerical percentages, mean ± SD, or median (minimum-maximum).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The overall incidence of PE during the study period was 5.3% (6763 out of 127,604 births). Among PE patients with complete data (n=1808), the incidence of eclampsia was 8.35% (151 cases). Pregnant women with eclampsia were significantly younger, more frequently nulliparous, and had elevated diastolic blood pressure compared to the noneclamptic cohort (&lt;em&gt;p&lt;/em&gt;&lt;.05). Eclampsia was associated with markedly greater maternal morbidity, including HELLP syndrome (27.8% vs 10.7%; RR: 2.85), hypertensive emergencies (35.1% vs 21.4%; RR: 1.80), CVA (2.0% vs 0.1%; RR: 18.01), and ICU admission (34.4% vs 13.2%; RR: 2.86) (&lt;em&gt;p&lt;/em&gt;&lt;.05). The eclampsia cohort also had a higher likelihood of cesarean section delivery (95.4% vs 83.7%) and a markedly elevated incidence of seizures during labor (31.3% vs 0.0%). Perinatal morbidity was also greater in the eclampsia cohort, with increased preterm birth rates (52.3% vs 42.5%; RR: 1.35), lower absolute and percentile birth weight, lower Apgar scores at 1 minute (&lt;7: 76.2% vs 46.3%; RR: 1.80) and 5 minutes (&lt;7: 38.4% vs 21.5%; RR: 1.96), increased NICU admissions (32.2% vs 22.8%; RR: 1.59), and a greater prevalence of respiratory distress syndrome (RDS) (32.2% vs 12.9%; RR: 2.80), necrotizing enterocolitis (NEC) (4.7% vs 0.8%; RR: 7.00), and neon","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100596"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of maternal transportation mode and travel time for timely emergency obstetric care in selected public hospitals, Addis Ababa, Ethiopia, 2025","authors":"Boyosa Yadessa Banti MPH ,&nbsp;Bacha Mirkena Dhabi MPH ,&nbsp;Damtew Workineh Regasa MPH","doi":"10.1016/j.xagr.2026.100612","DOIUrl":"10.1016/j.xagr.2026.100612","url":null,"abstract":"<div><h3>Background</h3><div>Inadequate transportation infrastructure and ineffective emergency transport services remain critical barriers to timely obstetric care in low- and middle-income countries, particularly in sub-Saharan Africa. In Ethiopia, despite efforts to expand ambulance coverage, many pregnant women still face delays in accessing emergency obstetric services, contributing to preventable maternal morbidity and mortality.</div></div><div><h3>Objective</h3><div>This study aimed to assess determinants of maternal transportation mode and travel time for emergency obstetric care (EmOC) among pregnant women attending selected public hospitals in Addis Ababa, Ethiopia.</div></div><div><h3>Study Design</h3><div>An institutional-based cross-sectional study was conducted from June to July 2025 across three public referral hospitals in Addis Ababa. Data were collected through a pretested structured questionnaire. Of the 319 mothers selected, 311 provided complete responses, yielding a response rate of 97.2%. Analysis was conducted exclusively on these respondents. Descriptive statistics summarized participant characteristics, and logistic regression was employed to identify associations between transportation mode and influencing factors. Statistical significance was set at <em>P</em>&lt;.05.</div></div><div><h3>Results</h3><div>A majority of the participants relied on private car or ride-hailing service (39.2%) during obstetric emergencies, with only 35.7% utilizing ambulances. Despite an average travel time of approximately 51 minutes, 27% experienced a second delay in reaching care. Ambulance use was significantly associated with urban residence, transportation preparedness, prior awareness of emergency transport phone numbers, and knowledge of available services, while 27.7% of participants experienced delivery complications—most commonly prolonged labor (8%), eclampsia (6.8%), and retained placenta (5.1%).</div></div><div><h3>Conclusion</h3><div>This study underscores that transportation barriers—especially reliance on private transport and underutilization of ambulances—remain a major contributor to delays in accessing EmOC in Addis Ababa. Key predictors of ambulance use, such as residence and awareness of emergency services, point to systemic gaps in public education and referral coordination. Strengthening transport systems and community awareness is essential to reducing second delays and improving maternal outcomes in urban Ethiopia.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100612"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The migration of placenta even after 30 gestational weeks is a risk factor for postpartum hemorrhage","authors":"Gaku Yamamoto MD ,&nbsp;Kosuke Hiramatsu MD, PhD ,&nbsp;Yoko Kawanishi MD, PhD ,&nbsp;Mamoru Kakuda MD, PhD ,&nbsp;Koji Nakamura MD, PhD ,&nbsp;Tatsuya Miyake MD, PhD ,&nbsp;Kazuya Mimura MD, PhD ,&nbsp;Toshihiro Kimura MD, PhD ,&nbsp;Masayuki Endo MD, PhD ,&nbsp;Tadashi Kimura MD, PhD ,&nbsp;Michiko Kodama MD, PhD","doi":"10.1016/j.xagr.2025.100593","DOIUrl":"10.1016/j.xagr.2025.100593","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Almost 10% of all pregnant women are diagnosed with placental location abnormalities (PLA), including placenta previa and low-lying placenta; however, most of PLA resolve as pregnancy process. Despite of placental migration, postpartum hemorrhage (PPH) is often experienced in those cases. The association between the timing of placental migration and the risk of PPH has remained unclear.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;The aim of this study is to investigate the relationship between the timing of placental migration and the PPH, and to establish a cutoff value to accurately predict the risk of PPH in cases who underwent the placental migration during course of pregnancy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;This was a retrospective cohort study using electronic medical records in Osaka University Hospital (Japan). Patients diagnosed with PLA after 22 gestational weeks using transvaginal ultrasonography were eligible for inclusion. All patients delivered at our hospital between 2009 and 2022. Focusing on the cases in which placental migration (more than 2 cm away from the internal cervical os) were observed, the association between the timing of placental migration and the PPH was investigated only in vaginal delivery using the multivariate analyses with collecting covariates that could affect the PPH. Based on the results, receiver operating characteristic curves were generated to determine the optimal cutoff for the number of weeks of placental migration to predict PPH.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;One hundred and forty-five patients were diagnosed with PLA after 22 gestational weeks and delivered at our hospital between 2009 and 2022. Seventy-six after-placental migration cases with successful vaginal delivery were analyzed. The median gestational age of placental migration was 32 weeks, and the median amount of hemorrhage during delivery was 777 mL. PPH (500–1000 mL) occurred in 34 cases (44.7%), &gt;1000 mL in 26 (34.2%). In the univariate analysis, a positive correlation was observed between the timing of placental migration and the amount of hemorrhage (&lt;em&gt;r&lt;/em&gt;=0.365, &lt;em&gt;P&lt;/em&gt;&lt;.01). Furthermore, multivariate analysis showed that the timing of placental migration is the most strongly influential covariate (standardized partial regression coefficient: 0.31, &lt;em&gt;P&lt;/em&gt;=.0036) for predicting the amount of hemorrhage. In addition, the timing of placental migration was a significant risk for PPH (more than 500 mL) (adjusted unit OR 1.26 [95% CI: 1.07–1.49]). The receiver operating characteristic curve indicated that the moderate cutoff of the timing of placental migration to predict the risk of PPH (more than 500 mL) was 29 gestational weeks. In comparison between the groups in which placental migration was confirmed before 29 gestational weeks (&lt;em&gt;n&lt;/em&gt;=19) and after 30 gestational weeks (&lt;em&gt;n&lt;/em&gt;=57), the incidences of PPH (more than 500 mL) were significantly higher in the group in wh","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100593"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility, acceptability, and effectiveness of the E-MOTIVE bundle intervention for early detection and management of postpartum hemorrhage in a low-middle-income country: implementation research","authors":"Wondimu Gudu MD ,&nbsp;Felagot Taddese Tefera MD ,&nbsp;Aida Tilahun MD ,&nbsp;Abrham Getachew MPH ,&nbsp;Delayehu Bekele MD ,&nbsp;Malede Birara MD ,&nbsp;Mekitie Wondafrash MD ,&nbsp;Kidist Lemma MD ,&nbsp;Saron Teka MD ,&nbsp;Yemisrach Mulugeta MD ,&nbsp;Bethelhem Birhanu Tefera MD ,&nbsp;Lemi Belay Tolu MD ,&nbsp;Mebratu Abraha MPH ,&nbsp;Abraham Fessehaye Sium MD","doi":"10.1016/j.xagr.2025.100588","DOIUrl":"10.1016/j.xagr.2025.100588","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Postpartum hemorrhage continues to be a leading cause of maternal mortality globally. Although the E-MOTIVE bundle is an innovative approach for the early detection and management of postpartum hemorrhage that reduces maternal mortality by as high as 60%, its universal implementation in clinical practice in low-middle-income countries remains low.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This study aimed to determine the effectiveness and acceptability of the E-MOTIVE bundle intervention in Ethiopia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;This was an implementation research on the E-MOTIVE bundle intervention for the early detection and treatment of postpartum hemorrhage using a mixed-method study design (pre- and postintervention quantitative study and cross-sectional qualitative study) in Ethiopia for over 22 months (June 2023 to February 2025). The primary outcome of the study was the rate of severe postpartum hemorrhage. The secondary outcomes were the detection of postpartum hemorrhage complications (such as blood transfusion, maternal death, admission to a high-dependency unit, and estimated blood loss) and the acceptability of the E-MOTIVE bundle approach. The participants of the quantitative study included pregnant women who delivered vaginally at St. Paul’s Hospital during the study period. Participants of the qualitative data were postpartum women who had the E-MOTIVE bundle approach applied during delivery, obstetrical care providers, maternity care coordinators, and representatives of nongovernmental organizations who focused on maternal care delivery. Quantitative data (including the characteristics of the E-MOTIVE bundle approach, occurrence of postpartum hemorrhage, and postpartum hemorrhage complication) were collected using a structured questionnaire, and qualitative data were collected using key informant interviews and focus group discussions (in-depth interviews and focused discussions focusing on the E-MOTIVE experience, attitude, and practice were conducted). Quantitative data were analyzed using simple descriptive statistics on IBM SPSS Statistics (version 23; IBM Corporation, Armonk, NY), and qualitative data were analyzed using thematic analysis on Scientific Software (ATLAS.ti.9.Ink; ATLAS.ti Scientific Software Development GmbH, Berlin, Germany).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;There were a total of 2500 and 2225 vaginal deliveries during the preintervention and postintervention periods, respectively. Compared with the preintervention period, there was a significant reduction in severe postpartum hemorrhage (25.0% in the preintervention period vs 13.5% in the postintervention period) and complications of postpartum hemorrhage, including maternal death (laparotomy: 5.0% in the preintervention period vs 1.0% in the postintervention period; maternal death: one maternal death in the preintervention period vs no encounter of maternal death in the postintervention period) in the postinterven","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100588"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness and associated factors of pregnancy-induced hypertension among pregnant women in Africa: a systematic review and meta-analysis","authors":"Getanew Kegne Nigate MPH ,&nbsp;Yeshiwas Ayale Ferede MPH ,&nbsp;Berhanu Wale Yirdaw MSC ,&nbsp;Worku Chekol Tassew MSC","doi":"10.1016/j.xagr.2025.100601","DOIUrl":"10.1016/j.xagr.2025.100601","url":null,"abstract":"<div><h3>Introduction</h3><div>Pregnancy-Induced hypertension (PIH) remains a major contributor to maternal and fetal illness and death. Enhancing knowledge and implementing preventive measures for PIH among pregnant women is crucial for achieving positive health outcomes. This study explored the level of knowledge and the associated factors among pregnant women in Africa.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted on June, 2025, using international electronic databases including PubMed, Google Scholar, Hinari, Medline, and Open Google to assess the pooled awareness of pregnancy-induced hypertension and its associated factors among pregnant women. Two authors independently screened and extracted relevant data from the eligible studies. The collected data were compiled in Excel and subsequently analyzed using STATA version 11. Heterogeneity among the studies was assessed using the I² statistic, while potential small study effects were evaluated through graphical methods and Egger’s test, with a significance threshold set at 5%. Subgroup and sensitivity analyses were also performed.</div></div><div><h3>Result</h3><div>A total of eight studies met the inclusion criteria and were incorporated into the systematic review and meta-analysis. The meta-analysis revealed significant associations between PIH knowledge and several factors: educational status (AOR = 4.88, 95% CI: 1.73–13.79), history of previous births (OR = 2.04, 95% CI: 1.30–3.19), and employment status (OR = 2.85, 95% CI: 1.26–6.44). However, due to the limited number of studies addressing each specific variable, the evidence was insufficient to establish conclusive links between PIH knowledge and other factors such as primi gravida status, socioeconomic status, maternal age, sources of information, marital status, maternal nutrition, antenatal care attendance, place of residence, and other related variables.</div></div><div><h3>Conclusion</h3><div>Awareness of PIH is typically lower among women with a personal or family history of the condition, first-time mothers (primiparous women), and those with limited educational attainment, compared to their respective counterparts. To address this gap, increased investment in women's health is essential, with healthcare providers giving particular attention to those at higher risk due to limited PIH knowledge. Moreover, targeted interventions should aim to improve educational opportunities for women and raise awareness about the risk factors associated with PIH.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100601"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why low-dose aspirin persists in recurrent pregnancy loss without APS: cognitive bias and system design","authors":"Kentaro Iga MD ,&nbsp;Takeshi Murakoshi MD, PhD ,&nbsp;Hiroshi Adachi MD, PhD","doi":"10.1016/j.xagr.2025.100602","DOIUrl":"10.1016/j.xagr.2025.100602","url":null,"abstract":"<div><div>Low-dose aspirin (LDA) is widely prescribed for recurrent pregnancy loss (RPL) even when antiphospholipid syndrome (APS) is absent, despite high-level evidence showing no improvement in live-birth rate in such cases. In Japan and elsewhere, this empirical use persists across fertility and obstetric settings, suggesting a behavioral and systemic rather than purely evidentiary problem. This commentary interprets the persistence of LDA through the lens of cognitive bias and institutional design. At the cognitive level, action bias—the instinct to intervene when outcomes are uncertain—provides a sense of control for both patient and clinician after miscarriage. The availability heuristic further normalizes use because LDA is already familiar as prophylaxis for pre-eclampsia, and professional conformity (social proof) reinforces its legitimacy. Once started, status-quo bias and loss aversion make discontinuation difficult, as both clinician and patient fear regret if another loss occurs. Systemic structures amplify these biases. In Japan, time-intensive counseling is rarely reimbursed, whereas prescriptions are; ambiguous phrasing in domestic reports (“may consider aspirin”) subtly encourages action over restraint. Discontinuity between fertility and obstetric care promotes pharmacologic reassurance in place of relational continuity. Together, these conditions transform an evidence-neutral intervention into a psychologically and institutionally self-reinforcing default. Recognizing this pattern reframes empirical LDA as a system phenomenon rather than individual error. Practical countermeasures include bias-awareness education, explicit “do-not-start” criteria limiting LDA to APS-confirmed cases, audit and feedback cycles, and shared decision aids that display live-birth data from randomized trials. Above all, continuity-based reassurance—scheduled follow-up and early-pregnancy access without unnecessary medication—can restore alignment between evidence and empathy. Understanding the cognitive architecture of empirical LDA use enables reproductive medicine to redesign its environment so that good science and good care no longer compete. Recognizing these dynamics can help clinicians and institutions redesign care environments that support evidence-based restraint without diminishing empathy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100602"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relation between epidural analgesia and perinatal outcomes on Robson class 2a","authors":"Serena Lecis MD ,&nbsp;Giulia Bonfiglioli MD ,&nbsp;Francesco Cannistrà MD ,&nbsp;Sara Verra MD ,&nbsp;Lucia Lisotti MD ,&nbsp;Letizia Ramovecchi MD ,&nbsp;Antonio Saddò MD ,&nbsp;Giuseppe Chiossi MD ,&nbsp;Riccardo Cuoghi Costantini MSc ,&nbsp;Roberto D’Amico PhD ,&nbsp;Sara Lazzarin MD ,&nbsp;Fabio Facchinetti PhD, MD ,&nbsp;Isabella Neri PhD, MD ,&nbsp;Lara Donno MD ,&nbsp;Massimo Girardis PhD, MD ,&nbsp;Antonio La Marca PhD, MD ,&nbsp;Francesca Monari MD","doi":"10.1016/j.xagr.2025.100554","DOIUrl":"10.1016/j.xagr.2025.100554","url":null,"abstract":"<div><h3>BACKGROUND</h3><div><strong>:</strong> The use of epidural analgesia represents the gold standard for pain management during labor, however, the influence of the use of epidural analgesia on delivery mode and neonatal outcomes is not fully understood. Moreover, the rate of induction of labor worldwide is increasing dramatically.</div></div><div><h3>OBJECTIVE</h3><div><strong>:</strong> This study aimed to analyze the impact of epidural analgesia on the mode of parturition and perinatal outcomes among individuals classified as Robson class 2a.</div></div><div><h3>STUDY DESIGN</h3><div>A retrospective cohort study was conducted on every Robson class 2a individual who delivered from January 1, 2022, to December 31, 2023, at the University Hospital of Modena in the north of Italy. The primary outcome was the delivery mode (cesarean delivery, vaginal delivery, and operative vaginal delivery rates), and the secondary outcomes were the effect of epidural analgesia on the duration of labor, duration of the second stage of labor, Apgar score, and neonatal intensive care unit admission.</div></div><div><h3>RESULTS</h3><div>Overall, 809 individuals were included in the final analysis, and 456 of them (56.4%) received epidural analgesia on request. Among individuals with and those without epidural analgesia, the cesarean delivery rate was 25% and 20.4% (<em>P</em>=.12), the vaginal delivery rate was 65.6% and 69.4% (<em>P</em>=.25), and the operative vaginal delivery rate was 9.4% and 10.2% (<em>P</em>=.72), respectively, without statistically significant differences. Furthermore, no significant difference was found in the neonatal outcomes between the 2 groups. Individuals with epidural analgesia had longer induction (<em>P</em>&lt;.001) and second stage (<em>P</em>=.004) times than those without. These findings were confirmed by multivariable logistic and multinomial regression analyses. In the multivariable logistic regression, the increased induction time was associated not only with epidural analgesia (<em>P</em>&lt;.001) but also with body mass index at delivery (<em>P</em>=.027), the gestational age at induction (<em>P</em>&lt;.001), post-term pregnancy (<em>P</em>&lt;.001), and induction indications of gestational diabetes or an estimated fetal weight &gt;95th percentile (<em>P</em>&lt;.001). Similarly, the increased duration of the second stage was associated not only with epidural analgesia (<em>P</em>=.026) but also with neonatal weight (<em>P</em>=.005) and induction indication for gestational diabetes or estimated fetal weight &gt;95th percentile (<em>P</em>=.034).</div></div><div><h3>CONCLUSION</h3><div>Epidural analgesia was among the factors that increased both the induction and second stage of delivery times. However, epidural analgesia did not impact the mode of delivery and perinatal outcomes in Robson class 2a individuals.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100554"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}