AJOG global reports最新文献

{"title":"Agreement of intraoperative clinical grading by the FIGO criteria with antenatal ultrasound diagnosis of placenta accreta spectrum and correlation with clinical outcomes","authors":"Warittha Limsirisawat MD ,&nbsp;Yuthasak Suphasynth MD ,&nbsp;Thiti Ajimakul MD ,&nbsp;Atitthan Ratanaburi MD ,&nbsp;Aroontorn Pichatechaiyoot MD ,&nbsp;Ingporn Jiamset MD ,&nbsp;Kulisara Nantamongkolkul MD ,&nbsp;Ekasak Thiangphak MD ,&nbsp;Kanet Kanjanapradit MD ,&nbsp;Savitree Pranpanus MD","doi":"10.1016/j.xagr.2025.100590","DOIUrl":"10.1016/j.xagr.2025.100590","url":null,"abstract":"<div><h3>Background</h3><div>Placenta accreta spectrum (PAS) is a serious obstetric condition characterized by abnormal invasion of placental tissue into the uterine wall, leading to severe maternal complications. Early and accurate diagnosis, both antenatally and intraoperatively, is crucial for effective management and for reducing associated morbidity and mortality.</div></div><div><h3>Objective</h3><div>The primary objective is to evaluate agreement between intraoperative clinical grading using the FIGO 2018 criteria of PAS and antenatal ultrasound diagnoses, and the secondary objective to assess the correlation between clinical outcomes and postpartum histopathological findings.</div></div><div><h3>Study Design</h3><div>In this prospective study, we enrolled 70 pregnant women with placenta previa suspected of having PAS, who were managed at an accredited PAS Center from September 2022 to July 2023. Antenatal ultrasound evaluations were performed in the third trimester, and patients underwent surgery between 34 and 36+6 weeks. The experienced surgeons assessed the intraoperative PAS grading using the FIGO 2018 criteria. Postoperatively, antenatal and intraoperative PAS grading were compared with histopathological findings. The agreement between antepartum and intraoperative grading, along with their correlations with clinical outcomes, was analyzed using kappa statistics.</div></div><div><h3>Results</h3><div>Twenty-eight patients (40%) had isolated placenta previa. Forty-two (60%) had PAS, including six with accreta (8.6%), 15 with increta (21.4%), and 21 with percreta (30%). Cesarean hysterectomy was performed in 39 (92.9%) of PAS and had confirmed with histopathological examination. The kappa agreement between ultrasound diagnosis and intraoperative grading was substantial (kappa=0.88; 95% confidence interval [CI]: 0.64–0.94). The agreement between intraoperative grading and histopathology was moderate (kappa=0.68; 95% CI: 0.40–0.91).</div></div><div><h3>Conclusion</h3><div>Antenatal ultrasound diagnoses and intraoperative clinical grading of PAS demonstrated a high level of concordance. Although antenatal ultrasound enables early preparation and correlation well with histopathology and clinical outcomes, intraoperative assessment remains crucial for accurately determining PAS severity and guiding surgery.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100590"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799048","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":"Fertility-sparing management of atypical polypoid adenomyoma in a premenopausal woman: a two-case report and literature review","authors":"Ivo Vukasović MD ,&nbsp;Dinka Pavičić Baldani MD, PhD ,&nbsp;Lana Škrgatić MD, PhD ,&nbsp;Magdalena Karadža MD, PhD","doi":"10.1016/j.xagr.2025.100589","DOIUrl":"10.1016/j.xagr.2025.100589","url":null,"abstract":"<div><h3>Objective</h3><div>To describe fertility-sparing management of atypical polypoid adenomyoma (APA) in two premenopausal women and to review the relevant literature on treatment strategies aimed at preserving fertility.</div></div><div><h3>Case Report</h3><div>A 39-year-old nulliparous woman presented with heavy menstrual bleeding and was diagnosed with APA via hysteroscopy and histopathology. Rapid recurrence prompted a second-look hysteroscopy and complete lesion resection. The second case involved a 30-year-old nulliparous woman with prolonged bleeding and a suspected submucosal fibroid; hysteroscopic resection confirmed APA. She received a levonorgestrel-releasing intrauterine device and regular follow-up. Both cases highlight diagnostic and therapeutic challenges in managing APA while preserving fertility.</div></div><div><h3>Conclusion</h3><div>These cases illustrate the diagnostic and therapeutic challenges of APA while preserving fertility. Based on our cases and a review of the literature, complete hysteroscopic resection, combined with hormonal therapy when appropriate, may be effective. Close follow-up is essential due to the risk of recurrence and potential malignant transformation, and individualized management is recommended to optimize fertility outcomes.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100589"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841272","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 impact of neighborhood socioeconomic status and racial composition on semen quality","authors":"Georgia Pridgen MD,&nbsp;Alexander Marion MD,&nbsp;Kristina C. Hawkins MD,&nbsp;Abdelmoneim Younis DVM, MS, PhD, HCLD","doi":"10.1016/j.xagr.2026.100611","DOIUrl":"10.1016/j.xagr.2026.100611","url":null,"abstract":"<div><h3>Background</h3><div>Socioeconomic and racial disparities are well-established determinants of health outcomes, yet their influence on male reproductive health remains underexplored. Semen quality, particularly total motile sperm count (TMSC), is increasingly recognized not only as a marker of fertility but also as a proxy for overall health. This study investigates the relationship between neighborhood-level socioeconomic deprivation and racial composition with semen quality among men undergoing fertility evaluation.</div></div><div><h3>Objective</h3><div>To assess the association between neighborhood deprivation, measured by the Area Deprivation Index (ADI), and TMSC, and to evaluate racial disparities in these associations.</div></div><div><h3>Study Design</h3><div>A retrospective cohort study was conducted involving 2198 men evaluated at a single academic fertility clinic in Georgia between 2015 and 2024. ADI scores were calculated using geocoded residential addresses and matched to census block data. Participants were stratified into quartiles based on ADI scores. Semen samples were analyzed for TMSC and other parameters. Regression analyses were performed to assess associations between ADI, race, and semen quality.</div></div><div><h3>Results</h3><div>The mean ADI score was 67.1±19.9, and the mean TMSC was 71.3 million. A statistically significant inverse relationship was found between ADI and TMSC (<em>B</em>=–0.403, <em>P</em>&lt;.001), indicating a decrease of approximately 4 million motile sperm per 10-point increase in ADI. Black men had the highest ADI scores and were disproportionately represented in the most deprived quartile, which was associated with the lowest TMSC. In contrast, White and Asian/Hispanic men were more likely to reside in less deprived neighborhoods and exhibited higher sperm counts.</div></div><div><h3>Conclusion</h3><div>Neighborhood socioeconomic deprivation is significantly associated with reduced semen quality, with Black men disproportionately affected. These findings underscore the impact of structural inequality on male reproductive health and suggest that socioeconomic context should be considered in fertility assessments. Addressing neighborhood-level disparities may improve reproductive outcomes and reduce health inequities.</div></div><div><h3>Clinical Implications</h3><div>Clinicians should incorporate socioeconomic factors into infertility evaluations and consider targeted interventions for men from disadvantaged neighborhoods. Public health policies aimed at improving environmental conditions, healthcare access, and lifestyle resources in deprived areas may mitigate adverse effects on male fertility.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100611"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379777","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":"Prevalence and factors associated with early antenatal care visit in Ghana: recent evidence from the 2022 Ghana Demographic and Health Survey","authors":"Befkad Derese Tilahun MSc ,&nbsp;Mulat Ayele MSc ,&nbsp;Eyob Shitie Lake MSc ,&nbsp;Bogale Molla MSc ,&nbsp;Gizachew Yilak MSc ,&nbsp;Molla Azmeraw MSc ,&nbsp;Tegene Atamenta Kitaw MSc","doi":"10.1016/j.xagr.2026.100605","DOIUrl":"10.1016/j.xagr.2026.100605","url":null,"abstract":"<div><h3>Introduction</h3><div>Antenatal care (ANC) is a critical component of the maternal and child health continuum, and early initiation is essential to achieving optimal outcomes for both mothers and infants. Although the World Health Organization recommends initiating ANC within the first 12 weeks of gestation, many women in developing countries, including Ghana, do not meet this guideline.</div></div><div><h3>Methods</h3><div>This study examined the prevalence of early ANC initiation and its associated factors among Ghanaian women using a weighted sample of 5,075 respondents. Data were analyzed with STATA/SE version 17, applying descriptive statistics and binary logistic regression to identify predictors of early initiation, with variables significant at <em>p</em>≤0.05 retained in the final model.</div></div><div><h3>Results</h3><div>Overall, 65.1% of women initiated ANC within the recommended period. Urban residence (adjusted odds ratio [AOR], 1.87; 95% CI, 1.95–2.32), tertiary or higher maternal education (AOR, 2.53; 95% CI, 1.72–3.73), and higher socioeconomic status (AOR, 1.33; 95% CI, 1.07–1.66) were positively associated with early initiation, whereas higher parity (≥3 children) was negatively associated (AOR, 0.59; 95% CI, 0.46–0.76).</div></div><div><h3>Conclusion</h3><div>These findings highlight that socioeconomic and demographic factors significantly influence ANC timing, underscoring the need for interventions targeting rural women, those with limited education, and economically disadvantaged groups to promote timely initiation of ANC.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100605"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188800","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":"Prevalence of gestational diabetes mellitus in Sub-Saharan Africa: a systematic review and meta-analysis","authors":"Ingrid T. Sabbagh PhD ,&nbsp;Faheem Seedat DPhil ,&nbsp;Atsumi Hirose PhD ,&nbsp;Alisha N. Wade DPhil","doi":"10.1016/j.xagr.2026.100607","DOIUrl":"10.1016/j.xagr.2026.100607","url":null,"abstract":"<div><h3>Background</h3><div>Gestational diabetes mellitus (GDM) is a significant cause of adverse perinatal outcomes and major risk factor for type 2 diabetes in mother and child. Although global prevalence is estimated at 14%, the burden in sub-Saharan Africa remains unclear due to limited data and variable diagnostic protocols. This study aimed to generate a robust estimate of GDM prevalence in sub-Saharan Africa using methodologically comparable studies, and to assess subregional variation.</div></div><div><h3>Methods</h3><div>We systematically searched Embase, MEDLINE, CINAHL, Global Health, African Journals Online, and African Index Medicus from January 1990 to March 2025 for observational studies of pregnant women in sub-Saharan Africa screened for GDM at ≥24 weeks’ gestation using an oral glucose tolerance test and internationally recognized criteria. Studies using inconsistent, unclear or incomplete diagnostic protocols or self-reported data were excluded. Quality was assessed using the Joanna Briggs Institute checklist. Prevalence estimates were pooled using random-effects meta-analysis of Freeman–Tukey–transformed proportions. Subgroup analyses were conducted by subregion, and mixed-effects meta-regression examined study-level moderators.</div></div><div><h3>Findings</h3><div>Fifty-nine studies met the inclusion criteria, of which 49 were selected for meta-analysis based on use of comparable diagnostic criteria. Studies represented 16 countries and involved 27,540 participants. The pooled GDM prevalence was 14.0% (95% CI, 11.6 to 16.5; prediction interval 1.9 to 34.3) with substantial heterogeneity (I²=97.1%). Prevalence varied across subregions: Southern Africa 10.2%, Eastern Africa 13.9%, Western Africa 15.1%, and Central Africa 18.0%. Meta-regression showed that small studies (&lt;300 participants), studies using point-of-care testing, and studies conducted before 2016 reported higher prevalence. Subregional differences persisted after adjustment.</div></div><div><h3>Interpretation</h3><div>When comparable diagnostic protocols are applied, GDM prevalence in sub-Saharan Africa matches the global average, challenging perceptions of a lower regional burden. Subregional variability highlights the need for locally representative data. Standardized diagnostic criteria for epidemiological studies would improve comparability and inform targeted public health interventions.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100607"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188914","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":"Transabdominal ultrasound sliding sign for predicting intra-abdominal adhesions in repeat cesarean delivery: a prospective observational study from Vietnam","authors":"Hoang Lam Vo MD, MSc ,&nbsp;Lam Huong Le MD, PhD ,&nbsp;Minh Phuong Nguyen MD, MSc ,&nbsp;Tran Thao Nguyen Nguyen MD, PhD ,&nbsp;Minh Tam Le MD, PhD ,&nbsp;Vu Quoc Huy Nguyen MD, PhD","doi":"10.1016/j.xagr.2025.100598","DOIUrl":"10.1016/j.xagr.2025.100598","url":null,"abstract":"<div><h3>Background</h3><div>Intra-abdominal adhesions are a common complication in repeat cesarean sections and can increase surgical risks and operative time. The ultrasound sliding sign is a non-invasive technique that may help predict adhesions by assessing the movement of the uterus relative to surrounding structures, offering a safer alternative to traditional diagnostic methods.</div></div><div><h3>Objective</h3><div>To evaluate the diagnostic accuracy of the transabdominal ultrasound sliding sign in predicting intra-abdominal adhesions and its association with maternal and neonatal outcomes in women undergoing repeat cesarean delivery in Vietnam.</div></div><div><h3>Methods</h3><div>This prospective observational study was conducted at the Obstetrics and Gynecology Center of Hue Central Hospital from April 2022 to December 2024. The study included 400 pregnant women with a previous cesarean section scar who underwent elective repeat cesarean delivery at or beyond 28 weeks of gestation. The sliding sign was assessed using transabdominal ultrasound during the third trimester. Intra-abdominal adhesions were classified intraoperatively by blinded surgeons according to Nair’s criteria as no (70.25%, 281/400), mild/moderate (13.25%,53/400), or severe (16.50%, 66/400) adhesions. A <em>p</em>-value of &lt;.05 was considered statistically significant for all tests.</div></div><div><h3>Results</h3><div>The sliding sign showed strong diagnostic performance in predicting intra-abdominal adhesions. For adhesion, the area under the curve (AUC) was 79.29% (95% confidence interval [CI]: 73.91%–84.68%), sensitivity 68.91% (95% CI: 60.11–76.52), and specificity 89.68% (96% CI: 85.57–92.72). For severe adhesions, AUC was 83.48% (95% CI: 77.21–89.76), specificity was 89.68% (95% CI: 85.57–92.72) and the negative predictive value was 94.38% (95% CI: 91.96–96.80). The absence of the sliding sign was significantly more frequent in women with severe adhesions (51/66, 77.23%) compared to mild/moderate (31/53, 58.49%) and no adhesions (26/281, 10.32%) (<em>p</em>&lt;.001). Operative time increasing with adhesion severity (<em>p</em>&lt;.001). Intraoperative complications were infrequent but higher in adhesion group. Neonatal outcomes (birth weight, Apgar scores) showed no significant differences across groups (<em>p</em>=.605).</div></div><div><h3>Conclusion</h3><div>Transabdominal ultrasound assessment of the sliding sign provides a reliable, non-invasive method of predicting intra-abdominal adhesions prior to repeat cesarean delivery and is particularly useful for excluding severe adhesions. Its use can improve preoperative risk stratification, reduce maternal surgical risks, and maintain positive neonatal outcomes.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100598"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926986","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":"Nationwide trends in physician consultation and surgical management for pelvic organ prolapse in Japan, 2014 to 2024: a health insurance claims database analysis","authors":"Maika Nariai MD ,&nbsp;Osamu Wada-Hiraike MD, PhD ,&nbsp;Yusuke Sasabuchi MD, PhD ,&nbsp;Hideo Yasunaga MD, PhD ,&nbsp;Miyuki Harada MD, PhD ,&nbsp;Yasushi Hirota MD, PhD","doi":"10.1016/j.xagr.2026.100613","DOIUrl":"10.1016/j.xagr.2026.100613","url":null,"abstract":"<div><h3>Background</h3><div>Pelvic organ prolapse (POP) is a common disease that substantially impairs women’s quality of life. Nationwide data on the proportions of physician consultations and surgical management of POP in Japan are not available. Furthermore, surgical approaches, including minimally invasive surgeries, have diversified in recent years; however, the extent of their application and potential regional disparities in each procedure have not been evaluated at the national level.</div></div><div><h3>Objective</h3><div>To visualize the 10-year trends in the diagnosis and surgical procedure selection for POP in Japan from 2014 to 2024 and examine the regional variations in the selection of surgical procedures.</div></div><div><h3>Study Design</h3><div>This nationwide descriptive study used data extracted from the DeSC database, which is a repository of Japanese health insurance claims data.</div></div><div><h3>Results</h3><div>The proportion of patients with POP among all women aged 40 years or above in the database was 1.47% (112,775/7660,925; 95% confidence interval [CI]: 1.46%–1.48%). A total of 16,752 patients underwent surgery at least once, and the prevalence of surgery was 14.85% (16,752/112,775; 95% CI: 14.65%–15.06%). The rate of surgery was 53.3 per 1000 person-years. Among women diagnosed with POP, the proportion of hysterectomy with vaginal wall repair and transvaginal mesh surgery decreased after the introduction of insurance coverage for laparoscopic sacrocolpopexy (LSC) in 2016. Robot-assisted sacrocolpopexy (RSC) partially replaced LSC since gaining insurance coverage in 2020. Urethral sling surgery was the most frequently performed second surgery. Regional differences were observed in the proportions of consultations and surgical rates. The proportion of procedures chosen as initial surgery differed across regions; the implementation rates of vaginal vault suspension and RSC exhibited particularly large regional disparities.</div></div><div><h3>Conclusion</h3><div>This study offers valuable evidence to enhance patient education on POP in Japan and help mitigate regional inequalities in insured healthcare services.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100613"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379840","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":"Corrigendum to ‘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 Terefe 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.2026.100608","DOIUrl":"10.1016/j.xagr.2026.100608","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100608"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188801","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":"Global, regional, and national burdens of liver disease due to hepatitis B in women of childbearing age, 1990 to 2021: an analysis of the Global Burden of Disease Study","authors":"Guiying Cao PhD ,&nbsp;Jue Liu PhD ,&nbsp;Min Liu PhD","doi":"10.1016/j.xagr.2026.100614","DOIUrl":"10.1016/j.xagr.2026.100614","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Women of childbearing age with hepatitis B are at risk for progression to life-threatening liver disease and vertical and horizontal transmission and have an increased risk for poor fetal health outcomes during pregnancy. Estimates of the burden of liver disease due to hepatitis B are scarce for women of childbearing age.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This study aimed to use data from the Global Burden of Disease (GBD) Study to quantify the burden of liver disease due to hepatitis B in women of childbearing age at the global, regional, and national levels.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Annual counts of incident cases, prevalent cases, and deaths, and rates of incidence, prevalence, and mortality of liver disease due to hepatitis B in women of childbearing age (15–49 years) between 1990 and 2021 were collected from the GBD 2021. Percentage changes in counts of incident cases, prevalent cases, and deaths, and estimated annual percentage changes (EAPCs) in rates of incidence, prevalence, and mortality were calculated to quantify their temporal trends.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Globally, the absolute counts of liver disease due to hepatitis B in women of childbearing age decreased 3.45% from 18.45 million in 1990 to 17.82 million in 2021 for incident cases, by 1.08% from 74.50 million in 1990 to 73.35 million in 2021 for prevalent cases, and by 3.74% from 36.38 thousand in 1990 to 35.02 thousand in 2021 for deaths, respectively. The global rates of incidence, prevalence, and mortality of liver disease due to hepatitis B in women of childbearing age decreased by an average of 1.26% (95% confidence interval [CI]: 1.16%, 1.35%), 1.21% (95% CI: 1.12%, 1.31%), and 1.49% (95% CI: 1.42%, 1.55%) per year between 1990 and 2021, respectively. At the regional level, an increasing trend in the mortality of liver disease due to hepatitis B in women of childbearing age between 1990 and 2021 was observed in Australasia (EAPC=0.46; 95% CI: 0.23, 0.68), Eastern Europe (EAPC=3.39; 95% CI: 2.34, 4.45), and High-income North America (EAPC=0.77; 95% CI: 0.57, 0.97). At the national level, a significant increasing trend in the incidence rate, prevalence rate, and/or mortality rate of liver disease due to hepatitis B in women of childbearing age between 1990 and 2021 was observed in several countries, such as Denmark, the United Kingdom, and Ukraine. As of 2023, there were still 53 countries worldwide that have not yet introduced the hepatitis B birth dose vaccination in the national immunization program. These countries are mainly located in Sub-Saharan Africa, with a high incidence of liver disease due to hepatitis B in women of childbearing age and a high total fertility rate.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The global rates of incidence, prevalence, and mortality of liver disease due to hepatitis B in women of childbearing age decreased between 1990 and 2021. An unfavorably increasing trend in the inc","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100614"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396572","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":"Caesarean section Robson classification, complications, and lessons learned in a rural hospital in Walikale, North Kivu, Democratic Republic of Congo: a cross-sectional study","authors":"Geoges Lubuto Bushu MD ,&nbsp;Christophe Kambale ,&nbsp;Seraphin Kikwabantu ,&nbsp;Faida Boelongo Benedite ,&nbsp;Wolfgang Weber MD, MPH ,&nbsp;Benjamin O. Black MD ,&nbsp;Kim J.C. Verschueren MD, PhD","doi":"10.1016/j.xagr.2025.100586","DOIUrl":"10.1016/j.xagr.2025.100586","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Globally rising caesarean section (CS) rates have resulted in more women with a scarred uterus. In low-resource, high-fertility settings, this likely contributes to a growing number of high-risk pregnancies and births. Exploring and understanding this trend in low-resource settings is essential to reduce maternal and perinatal mortality globally.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;This study aimed to assess CS practices in Walikale, eastern Democratic Republic of Congo (DRC), using the Robson classification, clinical indications, maternal and perinatal complications, and quality of care, to improve CS decision-making and clinical outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A cross-sectional study was conducted at the General Referral Hospital of Walikale, North Kivu, DRC, from January 1 to March 31, 2024. Data from all births were reviewed, and clinical case reviews were performed systematically for each CS by a team of health care providers. Descriptive statistics were used for analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The CS rate was 15.7%, with 136 CS of 868 births. Women in Robson group 5 (previous CS, term, cephalic presentation), accounted for 50% of all CS (68/136). Among CS in Robson groups 6 to 10 (malpresentation, twins, preterm), 65.6% (21/32) were also performed in women with a previous CS. Vaginal birth after CS (VBAC) rates were high: 71.2% (79/111) after one and 50.0% (23/46) after two previous CS. Among women with a previous CS (191/868, 22.0% of the population), uterine rupture occurred in 5.8% (11/191) and abnormally invasive placenta in 3.7% (7/191). Surgical site infections occurred in 7.4% (10/136) of CS. Perinatal mortality was 60 per 1000 births (53/886 total births). Case reviews showed that 9.6% (13/136) of CS were performed “too late” and 24.3% (33/136) “too soon.” Positive findings included high antenatal care attendance and short decision-to-CS intervals. Recommendations following from case review included strengthening clinical supervision and training health workers, team decision-making for CS with relative indications, ensuring access to the hospital, medication, blood, and contraception, especially for women with prior CS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;In this conflict-affected, high-fertility, low-resource context, the CS rate is rising as well as the proportion of women with a scarred uterus. The majority of CS are performed in women with a previous CS. VBAC rates are notably high, though both VBAC and multiple repeat CS carry important safety considerations. Applying the Robson classification is challenging in low-resource settings, where gestational age is often unknown. To optimize CS care and reduce adverse outcomes, it is crucial to prevent the first unnecessary CS, ensure timely and appropriate indications through context-adapted guidelines, clinical supervision, and routine case reviews, and strengthen both basic and comprehensive antenatal and obste","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100586"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799050","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}