AJOG global reports最新文献

{"title":"Bone mineral density changes during use of progestin-only contraceptives: a rapid review of recent evidence","authors":"Blake Erhardt-Ohren MPH ,&nbsp;Ndola Prata MD, MSc ,&nbsp;Scott Rosenblum MS","doi":"10.1016/j.xagr.2025.100509","DOIUrl":"10.1016/j.xagr.2025.100509","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this paper is to consolidate existing evidence and identify knowledge and research gaps on the bone health effects of progestin-only oral contraception, injectables, hormonal intrauterine devices, and implants. implementation.</div></div><div><h3>Data sources</h3><div>We searched PubMed, CINAHL, Web of Science, and The Cochrane Library for conference abstracts, original research articles, systematic reviews, and meta-analyses published between 05 May 2012 and 31 August 2023.</div></div><div><h3>Study eligibility criteria</h3><div>We limited results to any study design published as a conference abstract, original research study, meta-analysis, or systematic review in English-language peer-reviewed journals.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>Two independent reviewers screened item titles. One reviewer read all abstracts and full papers, and a second reviewer confirmed alignment with a 5% sample of each. One reviewer extracted relevant information into Excel with a 5% sample review by another research team member. We reviewed the references for all included items and screened potentially relevant items in the same manner as described above. Subject matter experts contributed additional items. We assessed items using the Mixed Methods Appraisal tool.</div></div><div><h3>Results</h3><div>The search strategy yielded 32 items, most of which explored the use of intra-muscular depot medroxyprogesterone acetate 150mg. We found a clear association between any use of depot medroxyprogesterone acetate and bone mineral density loss. This negative effect seems to be more common among younger women and women on antiretrovirals. There is, however, evidence to suggest that bone loss can be restored after depot medroxyprogesterone acetate discontinuation. Hormonal intrauterine device and implant users do not seem to experience bone mineral density loss.</div></div><div><h3>Conclusions</h3><div>While there is a clear association between bone mineral density loss and depot medroxyprogesterone acetate injectable use, treatment during contraceptive use and bone health restoration following discontinuation are not adequately researched. In this review, we provide evidence that bone health can be partially or completely restored after depot medroxyprogesterone acetate discontinuation, identify opportunities to learn more about depot medroxyprogesterone acetate injectables and bone health during and after use, and find gaps in knowledge on potential associations between bone health and other progestin-only contraceptives.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100509"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297794","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":"Perceived, objective, and applied numeracy among pregnant women engaged in home blood pressure monitoring in Ghana","authors":"Emma R. Lawrence MD ,&nbsp;Sanaya Irani BS ,&nbsp;Betty Nartey MPH ,&nbsp;Brittney Collins BS ,&nbsp;Elorm Segbedzi-Rich MD ,&nbsp;Andrea Pangori MS ,&nbsp;Titus K. Beyuo MD ,&nbsp;Cheryl A. Moyer PhD ,&nbsp;Jody R. Lori PhD ,&nbsp;Samuel A. Oppong MD","doi":"10.1016/j.xagr.2025.100468","DOIUrl":"10.1016/j.xagr.2025.100468","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive disorders of pregnancy are associated with poor maternal and neonatal outcomes. Since elevated blood pressure is often a first presenting sign, a major function of antenatal care is frequent blood pressure monitoring. A newer approach to this—patient-performed home monitoring—has not been widely implemented in low- and middle-income countries, including Ghana. Patient numeracy levels that are sufficient to understand and interpret home blood pressure values are a critical component of a successful home monitoring intervention.</div></div><div><h3>Objective</h3><div>To evaluate perceived, objective, and applied numeracy to identify elevated blood pressure values among pregnant women engaged in home blood pressure monitoring in Ghana.</div></div><div><h3>Study Design</h3><div>Participants were 80 pregnant women at a tertiary hospital in Accra, Ghana. After training, participants engaged in home blood pressure monitoring for 2 to 4 weeks. A post-monitoring survey evaluated confidence and experience interpreting blood pressure values, a validated numeracy scale, and interpretation of blood pressure monitor outputs—half with numbers only and half with both numbers and colors. Mean correct responses on numbers only and numbers and colors outputs were compared. Linear regression evaluated predictors of correct interpretation of blood pressures.</div></div><div><h3>Results</h3><div>On a validated numeracy scale, mean score was 16.73 (SD: 6.01) out of 25, with 73.8% (n=59) having numeracy. Perceived ability was high, with 70.9% (n=56) definitely believing they could interpret blood pressures values. However, on objective evaluation, only 36.3% (n=29) correctly identified the cutoff for elevated systolic and 26.3% (n=21) for elevated diastolic blood pressure values. Out of eight displayed blood pressure monitor outputs, correct identification was significantly higher on outputs with both numbers and colors (μ=7.19, σ=0.81) compared to numbers only (μ=6.54, σ=1.35). On an adjusted linear regression, only scores on the numeracy scale had a significant yet small association with correctly identifying blood pressure monitor outputs (β 0.07, <em>P</em>=.025).</div></div><div><h3>Conclusion</h3><div>Home blood pressure monitoring would benefit from monitors with both numerical and color-coded output. Focused training, rather than education level or general numeracy, may best predict blood pressure interpretation.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100468"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886604","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":"Assessments of midwives’ knowledge and practice toward postpartum hemorrhage management and associated factors at selected public hospitals in Addis Ababa, Ethiopia, 2023","authors":"Ashenu Bidiru MSc ,&nbsp;Heyria Hussein MSc ,&nbsp;Tola Getachew Bekele MSc ,&nbsp;Tilahun Teshager MSc ,&nbsp;Fenta Wondimneh MSc ,&nbsp;Indeshaw Ketema MSc ,&nbsp;Beyene Feleke MSc ,&nbsp;Lema Daba MSc ,&nbsp;Merga Shelema MSc","doi":"10.1016/j.xagr.2025.100495","DOIUrl":"10.1016/j.xagr.2025.100495","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Postpartum hemorrhage as the primary cause was associated with 41% to 51% of all maternal deaths in Ethiopia between 2013 and 2018. The majority of postpartum hemorrhage–related deaths can be avoided by using efficient therapies and having midwives with good knowledge and skills.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed at determining the knowledge and practices of midwives related to postpartum hemorrhage management and associated factors at selected public hospitals in Addis Ababa, Ethiopia.</div></div><div><h3>STUDY DESIGN</h3><div>An institutional-based, cross-sectional study design was employed from March 15 to April 15, 2023. A simple random sampling technique was used to select the 207 sampled participants. Data were collected using a pretested, structured, self-administered questionnaire. Data coding and cleaning were done before data analysis. Variables with a <em>P</em> value &lt;.25 in the bivariate logistic regression analysis were entered and checked for association in a multivariable logistic regression model so as to not miss an important variable. The finding was expressed as the adjusted odd ratio with 95% confidence interval and a variable at a <em>P</em> value of &lt;.05 was declared as statistically significant.</div></div><div><h3>RESULTS</h3><div>In this study, 34.3% (95% confidence interval, 28–41) of the study participants had good knowledge, whereas 65.7% (95% confidence interval, 59–72) had poor knowledge. Participants who had received job training in the labor ward had 3 times better knowledge than those who did not receive it (adjusted odds ratio, 3.386; 95% confidence interval, 1.427–8.033). In total, 30.4% (95% confidence interval, 24.6–37.6) of the participants had good practice, whereas 69.6% (95% confidence interval, 62.4–75.4) had poor practice.</div></div><div><h3>CONCLUSION</h3><div>The participant responses showed that the majority of midwives lacked adequate knowledge of and practice related to postpartum hemorrhage management. All stakeholders should consider on-job training for participants, improving educational levels, and continuous screening and identification of institutional needs.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100495"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167561","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":"Cost-effectiveness of the sFlt-1/PlGF ratio test in pregnant patients with suspected pre-eclampsia: a systematic review","authors":"Charlotte S. Goutallier MD ,&nbsp;Alayna Carrandi MPH ,&nbsp;Shaun P. Brennecke MBBS, DPhil ,&nbsp;Emily J. Callander PhD","doi":"10.1016/j.xagr.2025.100498","DOIUrl":"10.1016/j.xagr.2025.100498","url":null,"abstract":"<div><h3>Objectives</h3><div>Pre-eclampsia (PE) affects approximately 2%–4% of pregnancies. Diagnosis involves repeated assessment of pregnant patients with risk factors. The sFlt-1/PlGF ratio test is shown to have clinical utility in ruling in and out PE among at-risk patients. By excluding the probability of PE, the addition of the sFlt-1/PlGF ratio test to antenatal care may prevent unnecessary hospital admissions, intensive management, and premature delivery, thus reducing costs. The objective of this systematic review is to determine the cost-effectiveness of the sFlt-1/PlGF ratio test globally for pregnant patients at-risk of developing PE.</div></div><div><h3>Data sources</h3><div>PubMed, Medline (OVID), National Health Service Economic Evaluation Database, Web of Science, Econlit, and Cost Effectiveness Analysis Registry was systematically searched between 2013-April 2023.</div></div><div><h3>Study eligibility criteria</h3><div>Empirical studies quantifying costs of the sFlt-1/PlGF ratio test compared to other diagnostic options for pregnant patients with suspected PE.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>Eleven studies were included in the systematic review; all were cost analyses and modelled economic evaluations, and most used a health system perspective. Cost data were extracted into tables and indexed to 2022 United States Dollars (USD). An assessment of risk of bias for each study was performed using the Drummond critical appraisal checklist.</div></div><div><h3>Results</h3><div>All studies reported “cost-savings” of the test in antenatal care. Studies varied with costs and assumptions included, therefore a large range of incremental cost savings per patient was reported ($15–$1,881, 2022USD). No Incremental Cost-Effectiveness Ratios or health outcomes including Quality Adjusted Life Years were reported.</div></div><div><h3>Conclusions</h3><div>The included studies demonstrated “cost-savings” of the sFlt-1/PlGF ratio test in antenatal care for at-risk pregnant patients. However, this does not account for health outcome differences and long-term health care utilisation and expenditure.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100498"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124374","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":"Building a safe operative laparoscopy service in a resource-constrained setting: a case series","authors":"Xun Lian MD ,&nbsp;Emilia Selemane MD ,&nbsp;Sibone Mocumbi MD ,&nbsp;Naima Guterriez MD ,&nbsp;Sierra Washington MD, MSc","doi":"10.1016/j.xagr.2025.100510","DOIUrl":"10.1016/j.xagr.2025.100510","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Successful laparoscopic programs in low- and middle-income countries can be difficult to implement because of expensive equipment and limited skills. We describe the establishment of a gynecologic laparoscopic program through collaboration between two hospitals, namely one in New York (a high-income setting) and the other in Mozambique (a low-income setting).</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to evaluate the safety of a gynecologic laparoscopic program through a novel recycling program and collaboration between two hospitals.</div></div><div><h3>STUDY DESIGN</h3><div>This was a prospective cohort study.</div></div><div><h3>RESULTS</h3><div>The patient characteristics, length of stay, and postoperative complications were evaluated. A total of 29 patients were identified. All underwent an operative laparoscopy. The ages ranged from 23 to 52 years. The procedures included 8 ovarian cystectomies, 6 bilateral salpingectomies, 10 hysterectomies, and 4 myomectomies. The majority of patients were discharged on the same day of surgery (19 of 29). There were no conversions to laparotomy or intraoperative blood transfusions. Four patients were lost to follow-up. No postoperative complications were noted up to two months postoperatively.</div></div><div><h3>CONCLUSION</h3><div>This case series provides preliminary evidence that the re-use and recycling of needed instrumentation can be implemented in laparoscopy programs in low-income countries without compromising patient safety. However, larger cohorts are required to be certain.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100510"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271994","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":"Erratum to ‘Prevalence, determinants, and complications of adolescent pregnancy: an umbrella review of systematic reviews and meta-analyses’ [AJOG Global Reports Volume 5, Issue 1, February 2025, 100441]","authors":"Biruk Beletew Abate ,&nbsp;Ashenafi Kibret Sendekie MSc ,&nbsp;Addis Wondimagegn Alamaw MSc ,&nbsp;Kindie Mekuria Tegegne MSc ,&nbsp;Tegene Atamenta Kitaw MSc ,&nbsp;Molla Azmeraw Bizuayehu MSc ,&nbsp;Amare Kassaw MSc ,&nbsp;Gizachew Yilak MSc ,&nbsp;Alemu Birara Zemariam MSc ,&nbsp;Befkad Derese Tilahun MSc","doi":"10.1016/j.xagr.2025.100517","DOIUrl":"10.1016/j.xagr.2025.100517","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100517"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239857","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":"What delivery-related factors affect postpartum recovery? A systematic review","authors":"Zayël Z. Frijmersum MD ,&nbsp;Eva Van der Meij PhD ,&nbsp;Petra C.A.M. Bakker PhD ,&nbsp;Ralph De Vries MSc ,&nbsp;Johannes R. Anema PhD ,&nbsp;Judith A.F. Huirne PhD","doi":"10.1016/j.xagr.2025.100496","DOIUrl":"10.1016/j.xagr.2025.100496","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This study aimed to identify the delivery-related factors that affect postpartum recovery.</div></div><div><h3>DATA SOURCES</h3><div>The PubMed, Embase, and Web of Science databases were searched until April 2024 using the following terms: “Childbirth,” “Caesarean section,” “Complications,” “Recovery,” and “Time Factors.” Studies in English or Dutch were considered for inclusion.</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>All studies that included participants aged ≥18 years who delivered a live-born singleton and that evaluated the effect of delivery-related factors on recovery of health, ability, and activity in the postpartum period with a minimum follow-up period of 6 weeks were included.</div></div><div><h3>METHODS</h3><div>Data from the included studies were extracted, and quality assessment was performed using the Newcastle-Ottawa Scale.</div></div><div><h3>RESULTS</h3><div>A total of 38 articles were included. Of note, 5 different factors related to delivery that could affect recovery were identified as follows: mode of delivery, perineal lacerations, birth experience, parity, and neonatal factors. Articles could evaluate multiple affecting factors. Outcome measures were related to (genitopelvic or surgical site) pain, incontinence, mental health, and functional ability. Of note, 8 articles reported a negative effect on at least one of the outcome measures after cesarean delivery, 4 articles reported no significant difference between the delivery modes, and 2 articles found a negative effect on one of the outcome measures after vaginal delivery compared with cesarean delivery. Most articles (14/17) on perineal trauma reported a negative effect on recovery regarding incontinence and perineal pain. A negative birth experience was significantly associated with postpartum depression up to 6 weeks after childbirth. Parity of &gt;2 was associated with more dyspareunia, and a high neonatal birthweight was associated with more pelvic pain.</div></div><div><h3>CONCLUSION</h3><div>Our study findings indicate that mode of delivery, particularly cesarean delivery, is most frequently reported as having an effect on postpartum recovery. Recovery took longer (and was more painful) after cesarean delivery than after vaginal delivery. Extensive (third- and fourth-degree) perineal lacerations are frequently reported as an affecting factor. A small number of articles used functional ability as an outcome measure and attention for social participation.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100496"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907505","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":"Advanced abdominal pregnancy at a tertiary hospital in South Africa: a case series","authors":"Shannon Harries ,&nbsp;Lloyd Tooke ,&nbsp;Jean-Christophe Imbeault ,&nbsp;Mushi Matjila ,&nbsp;Shakti Pillay","doi":"10.1016/j.xagr.2025.100500","DOIUrl":"10.1016/j.xagr.2025.100500","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Advanced abdominal pregnancy occurs when the products of conception implant within the peritoneal cavity, external to the fallopian tubes and myometrium, beyond 20 weeks gestation. This is a rare condition that typically carries high maternal and neonatal mortality and morbidity especially in low middle income countries.</div></div><div><h3>OBJECTIVE</h3><div>To describe the outcomes of advanced abdominal pregnancies over 14 years at a tertiary neonatal unit.</div></div><div><h3>STUDY DESIGN</h3><div>This case series retrospectively analyzed 17 extrauterine pregnancies at Groote Schuur Hospital in Cape Town, South Africa. Seventeen mothers and 18 babies were included in the analysis. Data analysis focused on maternal history, risk factors, delivery complications, intraoperative findings, and neonatal outcomes. Microsoft StatPlus was used for statistical calculations.</div></div><div><h3>RESULTS</h3><div>Of the 17 pregnancies, 16 were singleton births and one was a set of monochorionicmonoamniotic twins. In 14 cases (82.4%—14/17), the diagnosis was missed on the initial ultrasound scan. Sixteen (94.1%—16/17) deliveries were expedited within 48 hours of diagnosis. All deliveries were performed via open laparotomy under general anesthesia. There were 2 maternal deaths, and all cases involved at least 1 maternal complication. Thirteen (76.5%—13/17) placentae were implanted on multiple sites including the uterus, adnexa, omentum and bowel. Of the 18 babies, 12 (66.7%—12/18) were born alive, with 1 early and 1 late neonatal death. The median birth weight of live-born babies was 1313 grams (interquartile range: 970–2250 g). The median Apgar score was 5 (interquartile range: 3–6) at 1 minute and 7 (interquartile range: 4–8) at 5 minutes. Two (16.7%—2/12) babies had transient cranial asymmetry. The median length of hospital stay for the ten babies discharged home was 32 days (interquartile range: 19–41 days).</div></div><div><h3>CONCLUSION</h3><div>Advanced abdominal pregnancies, when detected early and managed at well-resourced tertiary hospitals, can result in favorable outcomes. This is the first case series from a low- and middle-income country demonstrating such positive neonatal outcomes.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100500"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189427","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":"Long-acting pre-exposure prophylaxis preferences among pregnant and postpartum women in Kenya: results from a discrete choice experiment","authors":"Tessa Concepcion PhD ,&nbsp;John Kinuthia MMed ,&nbsp;Felix A. Otieno BS ,&nbsp;Eunita Akim BSN ,&nbsp;Brian P. Flaherty PhD ,&nbsp;Laurén Gómez MPH ,&nbsp;Grace John-Stewart PhD ,&nbsp;Emmaculate M. Nzove MBA ,&nbsp;Nancy Ngumbau MPH ,&nbsp;Jerusha N. Mogaka PhD ,&nbsp;Ben Odhiambo MPH ,&nbsp;Anjuli D. Wagner PhD ,&nbsp;Salphine Watoyi MPH ,&nbsp;Jillian Pintye PhD","doi":"10.1016/j.xagr.2025.100494","DOIUrl":"10.1016/j.xagr.2025.100494","url":null,"abstract":"<div><h3>Background</h3><div>New long-acting HIV pre-exposure prophylaxis (LA-PrEP) methods may address adherence barriers during pregnant and postpartum periods, when HIV risk is elevated. Understanding their preferences for LA-PrEP is essential for person-centered HIV prevention in maternal and child health (MCH) systems, yet evidence on preferred attributes is limited.</div></div><div><h3>Objective</h3><div>To estimate pregnant and postpartum women’s preferred PrEP attributes using a discrete choice experiment (DCE) at important timepoints in the perinatal period</div></div><div><h3>Study design</h3><div>From February 2023 to July 2024, we conducted a DCE among 513 HIV-negative pregnant and postpartum women taking daily oral PrEP in Kisumu and Siaya, Kenya, enrolled between 24–32 weeks gestation and a high HIV risk score. Participants completed the DCE with 12 choice sets at their third antepartum (median gestational age: 37.0 weeks) and/or 6-month postpartum visits. Attributes included effectiveness, form and dosing, safety data, side effects, collection place, cost, and multipurpose prevention (postpartum only). We fit effects-coded choice data to a conditional logit model, latent class analysis (LCA) for preference heterogeneity, and univariate multinomial logistic regressions to predict class membership by individual characteristics.</div></div><div><h3>Results</h3><div>A total of 513 women completed the DCE at least once (151 at third antepartum, 509 at 6-month postpartum). Every 2-month injections were strongly preferred, showing the highest positive preference weight (pregnant: 1.22, 95% CI: 1.12–1.33; postpartum: 1.24, 95% CI: 1.18–1.30). Four latent classes emerged: “Flexible PrEP Adopters” (37.2%), “Safe and Effective Injection Preference” (16.5%), “Strong Injection Preference” (37.7%), and “Oral PrEP Preference” (8.6%). Higher parity was associated with lower odds of membership in “Flexible PrEP Adopters” (OR=0.6, 95% CI: 0.4–0.8, <em>P=</em>.001), “Safe and Effective Injection Preference” (OR=0.6, 95% CI: 0.4–0.8, <em>P=</em>.003), and “Strong Injection Preference” (OR=0.7, 95% CI: 0.5–1, <em>P=</em>.027) compared to “Oral PrEP preference.”</div></div><div><h3>Conclusions</h3><div>Strong preferences for every 2-month injectables emphasize the need to prioritize LA-PrEP in this population. ANC settings can support diverse PrEP preference profiles with tailored counseling to account for individual preferences, PrEP experience, and obstetric history.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100494"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143927427","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":"Single- vs double-layer uterine closure of the cesarean scar in niche development: the Nicest Study","authors":"Ha Thi Thu Nguyen PhD,&nbsp;Giang Thi Tra Duong MD,&nbsp;Dat Tuan Do PhD,&nbsp;Thuong Thi Huyen Phan PhD,&nbsp;Duc Anh Tran MD,&nbsp;Toan Khac Nguyen MD,&nbsp;Anh Duy Nguyen PhD","doi":"10.1016/j.xagr.2025.100507","DOIUrl":"10.1016/j.xagr.2025.100507","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;There is an ongoing controversy regarding the optimal uterine closure technique for preventing niche development. Single- and double-layer closures have been considered comparable in terms of niche incidence after primary cesarean delivery. However, rather than simply the presence of a niche, its volume and residual myometrial thickness are the most potent factors in predicting gynecologic symptoms and subsequent pregnancy complications in women with cesarean scar defects. In addition, there is limited evidence on how uterine scars and niche sizes evolve over time.&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 residual myometrial thickness and niche characteristics between the single-layer and double-layer uterine closure techniques and to evaluate the change in uterine scar characteristics from 6 to 12 months after cesarean delivery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;This prospective randomized study was conducted from May 2022 to December 2024 at Hanoi Obstetrics and Gynecology Hospital. A total of 530 full-term pregnant women who underwent primary cesarean delivery were randomized into single- or double-layer, unlocked, continuous suture. The exclusion criteria included previous major uterine surgery and abnormal placenta (placenta previa or placenta accreta spectrum) in the current pregnancy. Women were invited for 2 consecutive follow-up visits within 10 days of menstruation at 6 months (n=429) and 12 months (n=381) after cesarean delivery. Transvaginal ultrasound was used to evaluate uterine ultrasound characteristics. If the niche was detected, 3-dimensional transvaginal ultrasound was applied to measure the niche volume via the Virtual Organ Computer-aided AnaLysis method. Complete-case analysis was performed to evaluate the change in uterine ultrasound characteristics between the 2 visits.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Of 429 women who participated in the 6-month visit, 216 had single-layer closure, and 213 had double-layer closure. The niche incidence at the first assessment was similar for both uterine closure techniques, at 35.6% in the single-layer group and 31.9% in the double-layer group, respectively (&lt;em&gt;P&lt;/em&gt;&gt;.05). At 6 months after delivery, the double-layer technique resulted in greater residual myometrial thickness (4.3 vs 4.0 mm; &lt;em&gt;P&lt;/em&gt;=.007), better healing ratio (69% vs 60%; &lt;em&gt;P&lt;/em&gt;=.048), and a lower proportion of large niches with residual myometrial thickness of &lt;3 mm (9.9% vs 19.4%; &lt;em&gt;P&lt;/em&gt;=.033). The median niche volume in the single-layer group (62 mm&lt;sup&gt;3&lt;/sup&gt;) at 6 months after delivery was significantly higher than that in the double-layer group (39 mm&lt;sup&gt;3&lt;/sup&gt;) (&lt;em&gt;P&lt;/em&gt;=.003). Of 381 women who completed both assessments, 194 had single-layer closure, and 187 had double-layer closure. The results between the single-layer and double-layer groups of the second visit at 12 months after delivery mirrored those at the first vi","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100507"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204314","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}