AJOG global reports最新文献

{"title":"In-theatre demonstration of laparoscopic retroperitoneal anatomy as an educational tool for final-year MBBS students: a novel quasi randomized experiment","authors":"Rumi Bhattacharjee MD ,&nbsp;Sangita Pandey MD ,&nbsp;Manisha Jana MBBS ,&nbsp;Jaishree Ganjiwale MSc ,&nbsp;Nitin Raithatha MD ,&nbsp;Somashekhar Nimbalkar MD","doi":"10.1016/j.xagr.2025.100572","DOIUrl":"10.1016/j.xagr.2025.100572","url":null,"abstract":"<div><h3>Introduction</h3><div>Traditional methods of teaching anatomical landmarks and their clinical and surgical significance often exhibit low retention rates. Medical educators have consistently sought to integrate innovative pedagogical approaches in response to evolving educational needs. The advent of multimedia technologies has significantly enhanced engagement and retention in learning, thus promoting a deeper contextual understanding in various clinical settings.</div></div><div><h3>Aims</h3><div>To compare the effectiveness of laparoscopic interactive demonstration of retroperitoneal vascular anatomy against traditional classroom teaching among medical students concerning knowledge acquisition, memory consolidation, and their perception of the teaching method.</div></div><div><h3>Design</h3><div>A prospective single-center, two-arm, Quasi-randomized Educational Intervention Trial (allocation ratio 1:1) assigned 152 final-year undergraduate medical students to either the intervention (live interactive schooling) or the control group (conventional classroom teaching). The primary outcome measured was an enhancement in fundamental pelvic retroperitoneal anatomy, which was assessed by administering pre- and post-test questionnaires of equal difficulty. Feedback forms were used to compare the acceptability and perception of the novel and traditional methods. Statistical analysis was performed using STRATA 14.4, paired t-tests for pre- and post-test comparisons, and Likert scale responses for feedback analysis.</div></div><div><h3>Results</h3><div>Both groups had comparable mean pretest scores. Post-test, the novel-method group demonstrated a significantly greater improvement (8.67±2.81) than the conventional group (5.74±3.18), with a mean difference of 2.93 (95% CI: 1.96–3.90; <em>P</em>&lt;.001) and a large effect size (Cohen’s d=0.98), which reflected the principal outcome measure. At six-month follow-up, performance declined in both groups (<em>P</em>=.064). Student feedback indicated greater enthusiasm and acceptability for the novel approach.</div></div><div><h3>Conclusion</h3><div>Live interactive educational techniques were found to be effective, acceptable, and more student-oriented than traditional teaching-learning methods.</div></div><div><h3>Trial Registration</h3><div>Clinical Trials Registry-India, CTRI/2024/02/062476</div><div>URL: <span><span>https://ctri.nic.in/</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100572"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466165","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":"Exacerbation of Evans syndrome in vaccinated pregnant woman with mild COVID-19 infection","authors":"Vesna Elveđi-Gašparović MD, PhD ,&nbsp;Dražen Pulanić MD, PhD ,&nbsp;Petrana Beljan Džubur MD, PhD ,&nbsp;Iva Miličić Pašalić MD ,&nbsp;Ivo Vukasović MD","doi":"10.1016/j.xagr.2025.100574","DOIUrl":"10.1016/j.xagr.2025.100574","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100574"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466166","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":"Incidence and predictors of mortality among cervical cancer patients in Sub-Saharan Africa: a systematic review and meta-analysis","authors":"Endale Tamiru Burayu MSc ,&nbsp;Bekem Dibaba Degefa MSc ,&nbsp;Zelalem Banjaw Zegeye MSc ,&nbsp;Gemechu Gelan Bekele MSc","doi":"10.1016/j.xagr.2025.100570","DOIUrl":"10.1016/j.xagr.2025.100570","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate the pooled incidence of mortality and identify key predictors of survival outcomes among cervical cancer patients in Sub-Saharan Africa by systematically reviewing and meta-analyzing observational studies and clinical trials published between 2000 and 2024, thereby providing evidence to guide targeted interventions and health policy improvements in the region.</div></div><div><h3>Data sources</h3><div>PubMed, Embase, Cochrane Library, Web of Science, AJOL, CINAHL, and Google Scholar for studies published between 2000 and 2024.</div></div><div><h3>Study eligibility criteria</h3><div>P: Patients with cervical cancer, I: Groups of variables that have a positive correlation with cervical cancer mortality, C: Types of variables that are notably linked to cervical cancer, O: individuals with cervical cancer and death rates. We included observational studies and clinical trials reporting mortality incidence and predictors among cervical cancer patients in SSA.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>Following PRISMA guidelines and registered with PROSPERO, all identified records were imported into reference Rayyan software to remove duplicates. Meta-analysis was conducted utilizing Stata 17 version statistical software.</div></div><div><h3>Results</h3><div>From 57 studies, predominantly from South Africa, Kenya, and Nigeria. <em>The pooled mortality incidence was 32.06% (95% CI: 29.71–34.41).</em> Significant predictors of mortality included advanced stage at diagnosis (HR=2.6, 95% CI: 2.1–3.2), age over 65 years (HR=2.0, 95% CI: 1.5–2.6), HIV-positive status (HR=1.52, 95% CI: 1.06–2.19), treatment with radiotherapy alone (HR=1.41, 95% CI: 1.22–1.63), and anemia (HR=2.0, 95% CI: 1.5–2.5). High heterogeneity (I²=95.72%) was observed across studies.</div></div><div><h3>Conclusion</h3><div>Approximately one-third of cervical cancer patients in SSA die from the disease, driven by identifiable predictors that highlight the need for enhanced screening, early diagnosis, and improved treatment access. Targeted interventions for high-risk groups, such as HIV-positive women and the elderly, are critical to reducing mortality in this region.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100570"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324495","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":"Bone mineral density with elagolix plus add-back therapy in women with heavy menstrual bleeding and uterine fibroids: open-label and post-treatment results of a 60-month phase 3 trial","authors":"Vicki L. Schnell MD ,&nbsp;Liesl K. Bredeson MD ,&nbsp;Eric Brown MD ,&nbsp;Anna Chan PharmD ,&nbsp;James Thomas MS ,&nbsp;James Simon MD ,&nbsp;Michael C. Snabes MD, PhD","doi":"10.1016/j.xagr.2025.100578","DOIUrl":"10.1016/j.xagr.2025.100578","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The gonadotropin-releasing hormone antagonist elagolix (ELA) plus hormonal add-back (+AB) therapy reduces menstrual blood loss in women with heavy menstrual bleeding (HMB) associated and uterine fibroids. Prescribed ELA+AB therapy is limited to 24 months due to concerns about the hypoestrogenic effects of potential decreased bone mineral density (BMD).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;To evaluate 48-month safety and BMD effects of ELA+AB therapy in premenopausal women with HMB associated with uterine fibroids.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;This phase 3b, multicenter study (NCT03271489) was conducted September 13, 2017–June 28, 2024. Three study periods included a 12-month randomized, double-blind treatment period (months 1–12), a 36-month open-label extension (OLE) period (months 13–48), and a 12-month post-treatment follow-up period (months 49–60). Premenopausal women aged 18–50 years with HMB associated with uterine fibroids were randomized 2:1 to receive ELA+AB therapy (ELA 300 mg twice daily plus estradiol 1.0 mg/norethindrone acetate 0.5 mg once daily) or placebo during double-blind treatment. All patients entering the OLE received ELA+AB therapy for 36 months, including those switching from placebo (placebo/ELA+AB group) and those remaining on ELA+AB therapy (ELA+AB/ELA+AB group). BMD was assessed every 6 months at the lumbar spine, total hip, and femoral neck using dual-energy X-ray absorptiometry. Data were analyzed using an analysis of covariance model with treatment as the main effect and baseline values as covariates. Safety assessments included incidence of treatment-emergent adverse events (TEAEs).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Overall, 277 patients entered the OLE period, with 103 completing treatment. In the ELA+AB/ELA+AB group, the mean percent decrease in BMD from baseline was &lt;2% in the lumbar spine, total hip, and femoral neck at all scheduled visits through 48 months of treatment. Categorical analysis of percent BMD recovery showed that the majority of patients in the ELA+AB/ELA+AB group who had decreased BMD at month 48 achieved partial or full BMD recovery 12 months after treatment at each anatomic site. In the OLE, TEAEs were reported in 59 (70.2%) patients in the placebo/ELA+AB group and 124 (64.2%) patients in the ELA+AB/ELA+AB group. Most TEAEs were mild or moderate and nonserious, with no severe TEAEs occurring in &gt;1 patient in either treatment group. The most frequent TEAE (excluding COVID-19) was decreased BMD (placebo/ELA+AB, 8 [9.5%] patients; ELA+AB/ELA+AB, 27 [14.0%] patients). BMD-related TEAEs (including osteopenia and bone fractures) in the OLE occurred in 12 (14.3%) patients in the placebo/ELA+AB group and 31 (16.1%) patients in the ELA+AB/ELA+AB group. Decreased BMD was the most common TEAE leading to treatment discontinuation (placebo/ELA+AB, 7 [8.3%] patients; ELA+AB/ELA+AB, 24 [12.4%] patients).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;BMD was st","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100578"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519615","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":"Mobile telephone provider to provider helpline: A pilot study in Cameroon","authors":"Comfort Enah PhD ,&nbsp;Victoria Jauk MPH ,&nbsp;Mary Glory Ngong ,&nbsp;Christyenne Lily Bond MPH ,&nbsp;Lionel Neba Ambe MD ,&nbsp;Rahel Mbah Kyeng MPH ,&nbsp;Roland Mbole MSc ,&nbsp;Waldemar A. Carlo MD ,&nbsp;Gregory Halle-Ekane MD ,&nbsp;Pius Muffih Tih PhD, MPH ,&nbsp;Jeff Szychowski PhD ,&nbsp;Henna Budhwani PhD, MPH ,&nbsp;Alan Thevenet N. Tita MD, PhD","doi":"10.1016/j.xagr.2025.100581","DOIUrl":"10.1016/j.xagr.2025.100581","url":null,"abstract":"<div><h3>Background</h3><div>Despite the availability of effective strategies, countries in Sub-Saharan Africa continue to be disproportionately affected by maternal and perinatal morbidity and mortality. Mobile health interventions are recognized for their potential usefulness in addressing gaps to quality maternal and neonatal care in low-income countries, including those for health care providers.</div></div><div><h3>Objectives</h3><div>To measure feasibility and acceptability of an adapted 24/7 mobile phone-based medical information service via telephone (mMIST) provider-to-provider intervention in one district of Cameroon.</div></div><div><h3>Study Design</h3><div>We implemented a multimethods pilot study of mMIST in Ndop Health District in the Northwest region of Cameroon from March 2022 to February 2023. We projected on average one call every 2 days as an acceptable demand level, and at least 70% of providers rated the mMIST intervention as satisfactory for acceptability. We evaluated the feasibility of collecting administrative data on maternal and neonatal morbidity and mortality for the assessment of mMIST on clinical outcomes.</div></div><div><h3>Results</h3><div>Thirty front line and on-call expert maternal healthcare workers who staffed the mMIST answering line and 76 peripheral maternity providers in the Ndop Health District were trained to use the system. A total of 3991 births were reported during the mMIST pilot year. Monthly calls ranged from 2 in the first month to a high of 28 calls by the 6th month, with an average call volume of 14 per month. Forty-six out of 48 providers (96%; 95% confidence interval [78,95]) were satisfied with mMIST. Providers reported that intermittent electricity and internet connectivity issues were the main barriers to usage. We found that it was feasible to obtain administrative data on relevant neonatal and maternal outcomes in the district but inconsistencies in local reporting prevented reliable comparisons.</div></div><div><h3>Conclusion</h3><div>Overall, the mMIST intervention was feasible to implement and was acceptable to maternal healthcare providers who staffed or used the intervention. Adaptation to local context, engagement of, and buy-in from multiple stakeholders in our formative work contributed to feasibility and promising findings to inform larger scale evaluation of the intervention.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100581"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519613","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":"Transradial uterine artery embolization for the treatment of symptomatic fibroids: A ten year experience","authors":"Carlos Jiménez-Rámila MD, PhD ,&nbsp;Ana Redondo-Villatoro MD ,&nbsp;Rafael J. Ruiz-Salmerón MD, PhD ,&nbsp;Sergio Rodríguez de Leiras-Otero MD ,&nbsp;Antonio Jiménez-Caraballo MD, PhD","doi":"10.1016/j.xagr.2025.100582","DOIUrl":"10.1016/j.xagr.2025.100582","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Uterine fibroids are the most common tumors in women. They are generally asymptomatic but can cause bleeding problems and/or compression of neighboring structures and infertility. Embolization is an effective treatment for fibroids. However, transradial access is underused for various reasons.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;This study aimed to demonstrate that transradial access is safe and effective for treating symptomatic uterine fibroids to avoid the need for conventional surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;A single-center retrospective observational study of medical records between 2012 and 2022, in which 189 procedures were planned in patients with symptomatic uterine fibroids with fulfilled gestational desire, was conducted. The feasibility and safety of the technique, the need for subsequent surgery because of the lack of effectiveness of the treatment in women who could complete it from the date of the procedure until 24 months later, changes in uterine volume and in the largest fibroid, and changes in hemoglobin levels, follicle-stimulating hormone, luteinizing hormone, and estradiol were analyzed before and 6 months after the procedure. Changes in the quality of life questionnaire (Uterine Fibroid Symptom and Health-Related Quality of Life questionnaire) were analyzed before embolization and at 2 and 6 months after embolization.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Of note, 184 of 189 procedures (97.35%) were performed with total or partial angiographic success. Surgical intervention was not necessary 24 months after the procedure in 85.4% of patients (158/180 patients with complete angiographic success) with a very low rate of complications, all of them mild (13/185 [7%]). Between the first visit and the visit at 6 months after the intervention, both the uterine volume decreased (n=176; previous volume, 458.11 mL; volume after 6 months, 311.87 mL; −146.24 mL [95% confidence interval, −115.41 to −177.06]; &lt;em&gt;P&lt;/em&gt;&lt;.001) and the largest fibroid (previous volume 132.31 mL; volume after 6 months, 78.33 mL; −53.98 mL [95% confidence interval, −42.79 to −65.17]; &lt;em&gt;P&lt;/em&gt;&lt;.001) and the scores in the quality of life questionnaires and the hemoglobin level improved (previous level, 11.4 g/dL; level after 6 months, 12.85 g/dL; −9.94 [95% confidence interval, −1.74 to −1.16]; &lt;em&gt;P&lt;/em&gt;&lt;.001). Follicle-stimulating hormone (previous level, 18.61; level after 6 months, 30.68; −4.18 [95% confidence interval, −6.35 to −17.77]; &lt;em&gt;P&lt;/em&gt;&lt;.001) and luteinizing hormone (previous level, 13.52; level after 6 months, 20.91; −3.60 [95% confidence interval, −3.31 to −11.45]; &lt;em&gt;P&lt;/em&gt;&lt;.001) levels were elevated, but estradiol levels (previous level, 97.98; level after 6 months, 99.01; 0.11 [95% confidence interval, −32.40 to 28.84]) levels were not affected.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;The transradial approach should be adopted as a safe and effective alternative for the tr","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100582"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571678","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":"Characteristics and outcomes associated with multiple triage visits among patients with suspected preterm labor or preterm premature rupture of membranes","authors":"Jameaka L. Hamilton MD ,&nbsp;Paula L. McGee MS ,&nbsp;George R. Saade MD ,&nbsp;Rebecca G. Clifton PhD ,&nbsp;Michael W. Varner MD ,&nbsp;Alan T.N. Tita MD, PhD ,&nbsp;Monica Longo MD, PhD ,&nbsp;Edward F. Bell MD ,&nbsp;Barbara J. Stoll MD ,&nbsp;Donna Allard RNC ,&nbsp;Ashley Salazar DNP ,&nbsp;John M. Thorp Jr. MD ,&nbsp;Uma M. Reddy MD, MPH ,&nbsp;Maged M. Costantine MD, MBA ,&nbsp;Emily S. Miller MD, MPH ,&nbsp;Dwight J. Rouse MD ,&nbsp;Hyagriv N. Simhan MD ,&nbsp;Jennifer L. Bailit MD, MPH ,&nbsp;Lorraine Dugoff MD ,&nbsp;George A. Macones MD, MSCE ,&nbsp;Baha M. Sibai MD","doi":"10.1016/j.xagr.2025.100565","DOIUrl":"10.1016/j.xagr.2025.100565","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Hospital-based obstetrical triage units frequently serve as an extension to outpatient care. Evaluation of the burden of preterm birth (PTB) typically focuses on the delivery and neonatal periods, while antepartum health care utilization related to risk of PTB is seldom reported.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To identify the characteristics and outcomes associated with multiple triage visits among patients with suspected preterm labor (PTL) or preterm premature rupture of membranes (pPROM).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Secondary analysis of a retrospective cohort study of all triage visits from 20 0/7 through 34 6/7 weeks gestation on randomly selected dates in 2019 at 34 hospitals across the US. Those in whom the reason for the visit was suspected PTL or pPROM and who were subsequently discharged were eligible for this analysis. Patients with ≥3 triage visits were compared with those who had &lt;3 visits in the index pregnancy visits. Data were abstracted by certified research personnel using predefined criteria. The primary outcome was a composite of severe neonatal morbidity or mortality before 120 days. Secondary outcomes included PTB (&lt;37 weeks gestation), a composite of respiratory neonatal morbidities, and maternal outcomes. Multivariable logistic regression analyses were used for the maternal outcomes, and generalized linear and logistic models were used for the neonatal outcomes to account for the correlation among twins.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 1764 mother/newborn dyads were included. Patients with more frequent triage visits (≥3) were more likely to self-identify as Black, be younger, not married/living with a partner, unemployed, have government-assisted insurance, or have less than a college degree compared to those individuals with less frequent triage visits (&lt;em&gt;P&lt;/em&gt;&lt;.05). Additionally, individuals in the more frequent triage visits group were more likely to be multiparous, have obesity, and pre-existing medical conditions, including kidney or liver disease requiring treatment (&lt;em&gt;P&lt;/em&gt;&lt;.05). There were no significant differences between groups for the primary composite neonatal outcome (1.6% in the more frequent group vs 2.4% in the less frequent group, adjusted odds ratios [aOR] 0.69, 95% CI 0.35–1.39) or secondary neonatal outcomes including PTB less than 37 weeks gestation (25.2% vs 23.2%, aOR 0.94, 95% CI 0.68–1.30), composite of respiratory morbidity (11.8% vs 11.0%, aOR 1.01, 95% CI 0.71–1.43), SGA (10.5% vs 10.6%, aOR 0.92, 95% CI 0.66–1.29), or birthweight (3056±639 g vs 3048±678 g, LS mean 27, 95% CI –27, 82). Similarly, there were also no statistically significant differences between groups for the secondary maternal outcomes including composite of severe maternal morbidity (8.1% vs 8.7%, aOR 1.00, 95% CI 0.69–1.44), composite of maternal infection (5.8% vs 5.1%, aOR 1.11, 95% CI 0.72–1.73), or delivery via cesarean section (31.2% vs","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100565"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267968","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":"Increasing postpartum family planning using an evidence-based approach: the success of a university teaching hospital in Rwanda","authors":"Alice Mukansanga BSc ,&nbsp;Mary Bernadette Hadley PhD ,&nbsp;Jean Baptiste Ukwizangira MSc","doi":"10.1016/j.xagr.2025.100567","DOIUrl":"10.1016/j.xagr.2025.100567","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>The most efficient way to increase the prevalence of contraceptive use is to provide family planning to women after delivery, particularly in countries with high health facility delivery rates.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to increase the uptake of postpartum family planning in hospitals in Rwanda.</div></div><div><h3>STUDY DESIGN</h3><div>This mixed-methods cohort study was conducted at a teaching hospital in Rwanda from June 2022 to July 2022, with uptake of postpartum family planning recorded until March 2025. This study was part of a broader research aimed at improving maternal and neonatal outcomes in the hospital. The postpartum family planning rates were extracted from the Health Management Information System before the study was conducted and up to March 2025 to demonstrate the sustainability of the interventions introduced based on the recommendations derived from the study. The two components of the study were as follows: (1) telephone interviews with key staff in district hospitals and (2) interviews with a sample of mothers who delivered at the hospital. Analysis of the responses to open-ended questions was performed using inductive reasoning, whereas quantitative data were analyzed using Microsoft Excel (Microsoft, Redmond, WA). Ethical approval was obtained in May 2022.</div></div><div><h3>RESULTS</h3><div>Higher family planning uptake rates were observed after cesarean delivery (90%; <em>P</em>=.04), in women aged 39 to 43 years (100%), and in women who had discussed family planning during pregnancy (80%; <em>P</em>=.00). The reasons for refusing family planning were associated with cultural/religious beliefs and values. Some women were not offered family planning, particularly on weekends. Teamwork and engagement in or emphasis on postpartum family planning within the maternity unit of district hospitals were responsible for increased postpartum family planning uptake. The implementation of the recommendations at the hospital increased postpartum family planning uptake from 26% (April 2022) to 89% (March 2025).</div></div><div><h3>CONCLUSION</h3><div>The findings highlight the importance of family planning counseling during pregnancy. Within the hospital, an increased awareness of the importance of family planning among staff, teamwork, and involvement of all midwives in the provision of family planning were the key factors to improve uptake.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100567"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267969","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":"Maternal death at 28 weeks gestation due to vascular rupture of placenta accreta","authors":"Khaoula Magdoud MD ,&nbsp;Ons Hmandi MD ,&nbsp;Sana Menjli MD ,&nbsp;Ines Ben Hassen MD ,&nbsp;Imen Labidi MD ,&nbsp;Eya Azouz MD ,&nbsp;Bilel Arfaoui MD ,&nbsp;Hassine Saber Abouda MD","doi":"10.1016/j.xagr.2025.100562","DOIUrl":"10.1016/j.xagr.2025.100562","url":null,"abstract":"<div><div>Placenta accreta spectrum (PAS) is becoming increasingly common and is associated with significant morbidity and mortality. Prenatal diagnosis and timely referral to centers have been shown to improve outcomes. We present a case of maternal death at 28 weeks of gestation due to massive internal bleeding caused by the rupture of abnormal blood vessels from placenta accreta. The diagnosis of PAS was suspected by morphological ultrasound at 23 weeks of gestation. Expectant management was decided for this patient since she had no children. The patient was transported to the emergency room at 28 weeks of gestation after having a sudden loss of consciousness without other signs (no pelvic pain, no metrorrhagia). After preliminary assessment, maternal death was noted. Hemoperitoneum associated with a placental vascular rupture was found at the autopsy. In the absence of a therapeutic consensus, this case highlights the challenges in managing pregnant women with suspected PAS disorders in the second trimester.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100562"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145097551","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":"Maternal outcomes among women with intellectual disabilities in comparison with the general population (IDcare)","authors":"Anna Axmon PhD ,&nbsp;Can Liu PhD ,&nbsp;Alessandra Grotta PhD ,&nbsp;Kristina Edvardsson PhD ,&nbsp;Magnus Sandberg PhD","doi":"10.1016/j.xagr.2025.100569","DOIUrl":"10.1016/j.xagr.2025.100569","url":null,"abstract":"<div><h3>Background</h3><div>Women with intellectual disabilities face significant barriers to gynecological, reproductive, antenatal, and perinatal care, which may adversely impact maternal and fetal health. Previous research indicates increased risks for gestational diabetes, pre-eclampsia, caesarean birth, preterm birth, and other complications in pregnant women with intellectual disabilities. However, studies on the reproductive health in this group remain scant, and comprehensive research on maternal and fetal health from pregnancy to the postpartum period remain missing.</div></div><div><h3>Objective(s)</h3><div>Using high-quality data from Swedish registers, the present study aims to examine a full range of maternal and fetal outcomes among birthing women with intellectual disabilities and to compare them to those of birthing women in the general population. Such knowledge is important in understanding and preventing adverse health outcomes.</div></div><div><h3>Study Design</h3><div>This was a register study based on all women living in Skåne, Sweden on January 1^st, 2104, with at least 1 singleton birth in 2014–2021. By linking regional and national registers, we were able to compare maternal and fetal outcomes in a cohort of women with intellectual disabilities (n=378), including a subgroup of women with diagnosis of mild intellectual disability (n=177), to outcomes among women from the general population (n=65 925). Diagnoses (i.e., outcomes) were collected from the Skåne Healthcare Register, which comprises all healthcare contacts in the Skåne region in Sweden. Poisson regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) to quantify the association between intellectual disability and each outcome. The fully adjusted model included maternal year of birth and age at birthing, sociodemographic indicators, and obstetric comorbidities.</div></div><div><h3>Results</h3><div>In the fully adjusted models, women with intellectual disabilities had increased risk of pre-eclampsia (RR 1.67, 95% CI 1.15–2.42), infections of the genitourinary tract (2.30, 1.67–3.16), premature rupture of membranes (2.42, 1.24–4.69 for women with mild intellectual disability), and false labor (1.27, 1.05–1.53). In crude (i.e., unadjusted) models, increased risks were also found for maternal care for known or suspected fetal abnormality and damage, maternal care for other known or suspected fetal problems, other disorders of amniotic fluid and membranes, antepartum hemorrhage, not elsewhere classified, and failed induction of labor.</div></div><div><h3>Conclusion(s)</h3><div>Pregnant women with intellectual disabilities have increased risk of several adverse maternal outcomes, with the risk for some likely driven-at least in part-by lower sociodemographic status and worse obstetric health.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100569"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267970","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}