BJOG: An International Journal of Obstetrics & Gynaecology最新文献

{"title":"'The UK Maternity Crisis: Analysing the Underlying Causes to Find Solutions': The Timing of Prophylactic Caesarean Antibiotics.","authors":"G Justus Hofmeyr","doi":"10.1111/1471-0528.70254","DOIUrl":"https://doi.org/10.1111/1471-0528.70254","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754946","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":"Beyond the Seizure: Hidden Neurological Burden in Hypertensive Pregnancy.","authors":"Alexandra Ridout,Katy Kuhrt,Catherine Nelson-Piercy,Andrew Shennan","doi":"10.1111/1471-0528.70255","DOIUrl":"https://doi.org/10.1111/1471-0528.70255","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754591","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":"A Needle Lasso Method for Port Site Closure and Amniotic Membrane Plication in Fetoscopic Surgery","authors":"Farokh R. Demehri, Claudio V. Schenone, Weston T. Northam, Alireza A. Shamshirsaz, Eyal Krispin","doi":"10.1111/1471-0528.70252","DOIUrl":"https://doi.org/10.1111/1471-0528.70252","url":null,"abstract":"Introduction Amniotic membrane plication is associated with lower rates of preterm birth following fetoscopy. Methods We describe a novel needle lasso technique for amniotic membrane plication during port site closure in laparotomy‐ and mini‐laparotomy‐assisted fetoscopic spina bifida repair. Result This approach enables precise placement of full‐thickness sutures around the port tract, even when direct suturing is technically challenging. We achieved amniotic membrane plication in all the cases, and delivery beyond 34 weeks of gestation without membrane‐related complications. Conclusion These findings support the technique‘s feasibility. Larger studies are needed to corroborate the results and potentially broaden their application in fetoscopic surgery.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147752783","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":"Reduced Fetal Movements Green-Top Guideline No. 57.","authors":"Melissa Whitworth,Margaret Fisher,Alexander Heazell, ","doi":"10.1111/1471-0528.70198","DOIUrl":"https://doi.org/10.1111/1471-0528.70198","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753283","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":"Evaluation of the IOTA ADNEX Model, Two-Step Strategy and RMI in Routine Gyneacologic Care in Denmark and Implications for Implementation: A Prospective Multicenter Cohort Study.","authors":"Nikoline Schou Karlsen,Eva Dreisler,Claus Kim Høgdall,Estrid Solyom Høgdall,Mona Aarenstrup Karlsen,Thomas Alexander Gerds,Guðbjörg Andrésdóttir,Lea Langhoff-Thuesen,Malene Merete Forstholm,Abelone Elisabeth Sakse","doi":"10.1111/1471-0528.70253","DOIUrl":"https://doi.org/10.1111/1471-0528.70253","url":null,"abstract":"OBJECTIVETo evaluate whether the IOTA ADNEX model and the Two-Step Strategy improve triage and referral of adnexal masses in routine gyneacologic care compared with the RMI and to identify an appropriate malignancy-risk threshold.DESIGNProspective multicenter cohort study.SETTINGThirteen non-tertiary hospitals and clinics and one tertiary referral hospital in Denmark.SAMPLEA complete-case cohort of 966 patients with adnexal masses.METHODSMalignancy risk was estimated using prospectively collected clinical data, ultrasound findings, and CA125 levels. Reference standard was histopathology or ≥ 12 months of clinical follow-up. Performance was evaluated across predefined thresholds (1%-30% for ADNEX/Two-Step Strategy (modified benign descriptors + ADNEX); ≥ 200 for RMI), stratified by centre type.OUTCOME MEASURESNegative and positive predictive values (NPV, PPV), sensitivity, referral rates to assess correct and incorrect referrals.RESULTSIn non-tertiary centres, NPVs were ≥ 96% for IOTA models versus 95% for RMI; corresponding values in the tertiary centre were 82%-100% versus 78%. PPVs increased with higher thresholds and approached RMI at 20% threshold. In non-tertiary centres, where referral decisions are made, a 15% threshold provided the most favourable balance between sensitivity (~63%) and referral rate (~14%). At thresholds ≥ 25%, referral rates were similar to RMI (~8%), with only marginal gains in sensitivity (~50% vs. 39%). Most additionally detected tumours were stage I ovarian cancers or borderline tumours. For masses classified as benign by modified benign descriptors, ADNEX showed high NPVs but low PPVs and negligible net benefit, providing limited additional diagnostic value over the Two-Step Strategy.CONCLUSIONSIOTA-based models improve early detection but increase referral rates. A 15% risk threshold appears to offer a clinically reasonable balance between early detection of malignancy and referral burden, based on observed trade-offs between detection and referral rates.TRIAL REGISTRATIONClinicalTrials.gov identifier: NCT04188652.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751274","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":"Pregnancy Outcomes Among Individuals With Cerebral Palsy: A Population‐Based Cohort Study","authors":"Marina Vainder, Anne Berndl, Aditi Patrikar, Hilary K. Brown","doi":"10.1111/1471-0528.70249","DOIUrl":"https://doi.org/10.1111/1471-0528.70249","url":null,"abstract":"Objective To examine the risks of maternal, neonatal and non‐obstetrical medical complications in individuals with cerebral palsy (CP) compared to those without CP. Design Population‐based cohort study. Setting Ontario, Canada. Population Females aged 13–54 years with a livebirth or stillbirth, 2004–2023. Methods Individuals with ( <jats:italic>N</jats:italic> = 1400) and without CP ( <jats:italic>N</jats:italic> = 2 276 561) were compared using modified Poisson regression, adjusted for socio‐demographics, followed by clinical characteristics. Main Outcome Measures Maternal (e.g., severe maternal morbidity or mortality), neonatal (e.g., severe neonatal morbidity or mortality) and non‐obstetrical medical complications (e.g., seizure disorders) in the perinatal period. Results After adjusting for socio‐demographics, individuals with CP had an elevated risk, compared to those without CP, of severe maternal morbidity or mortality (adjusted relative risk [aRR] 1.79, 95% confidence interval [CI] 1.36–2.34), caesarean section (1.38, 1.27–1.50) and maternal hospital readmission (1.86; 1.34–2.58). Their newborns were at elevated risk for preterm birth (1.67, 1.43–1.94), small for gestational age (1.34, 1.19–1.52), congenital anomalies (1.77, 1.40–2.24) and severe neonatal morbidity or mortality (1.48, 1.28–1.71). Individuals with CP were also at elevated risk of seizure disorders (13.06, 10.45–16.33) and urinary tract infections (1.50, 1.25–1.79) perinatally. aRRs were slightly attenuated, but remained statistically significant after further adjusting for clinical characteristics. Conclusion Individuals with CP are at elevated risk of adverse pregnancy outcomes. Findings suggest the need for enhanced preconception counselling, perinatal monitoring and postpartum supports for individuals with CP, facilitated by multidisciplinary care teams.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147733284","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":"Antenatal Prediction of Shoulder Dystocia and Birth Trauma Using Routine Maternal and Ultrasound Variables: Retrospective Cohort Study","authors":"Anat Schwartz, Monica Minopoli, Chiara Di Ilio, Daniele Di Mascio, Amaranth Bhide, Basky Thilaganathan","doi":"10.1111/1471-0528.70250","DOIUrl":"https://doi.org/10.1111/1471-0528.70250","url":null,"abstract":"Objective To develop antenatal prediction models for shoulder dystocia and birth trauma using routinely collected maternal and sonographic variables. Design Retrospective cohort study. Setting Single tertiary referral centre in the UK. Population or Sample All singleton term liveborn pregnancies delivered between January 2016 and November 2024 with a third‐trimester ultrasound performed at or beyond 36 weeks' gestation. Methods Multivariable logistic regression was used to develop antenatal prediction models for shoulder dystocia and birth trauma, incorporating maternal characteristics and fetal biometry including abdominal circumference (AC; centile or mm) and estimated fetal weight (EFW; grams or centile). Model performance was assessed using tests for multicollinearity, discrimination (area under the ROC curve, AUC) and calibration. Main Outcome Measures Shoulder dystocia and birth trauma, the latter defined as a composite of shoulder dystocia, postpartum haemorrhage requiring blood transfusion, caesarean delivery at full dilatation, or hypoxic–ischaemic encephalopathy (HIE ≥ 1). Results A total of 24 334 singleton term pregnancies were included; 432 (1.8%) were complicated by shoulder dystocia and 1210 (5.0%) by birth trauma. The model including maternal characteristics and AC centile demonstrated the best discrimination. For shoulder dystocia, the apparent AUC was 0.706 (95% CI 0.682–0.730); the optimism‐corrected AUC after bootstrap validation was 0.699. For birth trauma, the apparent AUC was 0.669 (95% CI 0.654–0.685); the optimism‐corrected AUC was 0.665. At a 10% false‐positive rate, sensitivity was 31.5% for shoulder dystocia and 22.8% for birth trauma, compared with 20.4% and 14.0%, respectively, using EFW ≥ 90th centile. Conclusions Antenatal models combining fetal AC centile with maternal risk factors outperform EFW‐based thresholds currently used in clinical practice. Although discrimination was modest, the model may be useful for antenatal risk stratification and counselling, rather than as a stand‐alone clinical test. Such models may help identify pregnancies at increased risk of delivery‐related complications associated with fetal overgrowth and inform future studies evaluating targeted interventions.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147733283","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":"Pre‐Pregnancy Body Mass Index, Diabetes Status, and Gestational Age‐Specific Stillbirth Risk: A Nationwide Retrospective Cohort Study","authors":"Jeffrey N. Bone, K. S. Joseph, Laura Magee, Chantal Mayer, Sarka Lisonkova","doi":"10.1111/1471-0528.70247","DOIUrl":"https://doi.org/10.1111/1471-0528.70247","url":null,"abstract":"Objective To quantify and compare the gestational age (GA)‐specific risks of stillbirth across pre‐pregnancy body mass index (BMI) categories, stratified by pre‐pregnancy diabetes status: Design Retrospective population‐based cohort study. Setting United States from 2022 to 2023. Population or Sample Singleton live and stillbirths between 20 and 43 weeks' gestation. Methods Data were obtained from the live birth and fetal death certificates available from the National Center for Health Statistics. We used Piecewise Additive Mixed Models to assess the GA‐specific relationship between pre‐pregnancy BMI and stillbirth in women with and without pre‐pregnancy diabetes mellitus adjusted for confounders. Results were expressed as gestational age‐specific adjusted hazard ratios (aHR), and weekly risk estimates from 37 to 40 weeks' gestation. Main Outcome Measures Stillbirth. Results A total of 6 923 146 women were included of which 187 734 (2.7%) were underweight, 2 631 390 (38.0%) had normal BMI, 1 915 636 (27.7%) were overweight, and 1 169 109 (16.9%), 591 078 (8.5%), and 428 199 (6.1%) had obesity class I, II and III, respectively. Overall, stillbirth rates increased with increasing BMI and were higher in women with pre‐pregnancy diabetes (16.6 per 1 000 total births) than those without these conditions (4.4 per 1 000 total births). The gestational age‐specific associations between elevated BMI and stillbirth differed depending on the presence of pre‐pregnancy diabetes across all gestational weeks. For example, at 31 weeks' gestation, the aHR for women with a BMI of 40 kg/m <jats:sup>2</jats:sup> vs. 20 kg/m <jats:sup>2</jats:sup> and diabetes was 0.68 (95% CI = 0.54 to 0.85), while the same aHR for a non‐diabetic pregnancy was 1.22 (95% CI = 1.13, 1.33). Absolute risks were highest in diabetic women with class III obesity. Conclusions Among obese women, the optimal gestational age for delivery depends on the presence of other risk factors such as pre‐pregnancy diabetes.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147733282","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":"Coordinating Fertility Preservation in Children and Young Adults at Risk of Treatment-Induced Infertility: A Commentary.","authors":"Ursula Blyth,Pedro Melo,Rod T Mitchell,Suzannah A Williams,Ephia Yasmin,Phillipa Sangster,Kokila Lakhoo,Sheila Lane,Richard A Anderson,Christian M Becker","doi":"10.1111/1471-0528.70238","DOIUrl":"https://doi.org/10.1111/1471-0528.70238","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731540","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-Term Cardiovascular Impact of Postpartum Treatment After Hypertensive Disorders of Pregnancy: Population-Based Cohort Study.","authors":"Emmanuel Simon,Solène Tapia,Sonia Bechraoui-Quantin,Jonathan Cottenet,Basky Thilaganathan,Catherine Quantin","doi":"10.1111/1471-0528.70251","DOIUrl":"https://doi.org/10.1111/1471-0528.70251","url":null,"abstract":"OBJECTIVETo assess whether early antihypertensive treatment after Hypertensive Disorders of Pregnancy (HDP) influences subsequent development of cardiovascular complications.DESIGN AND SETTINGPopulation-based nationwide cohort of health data set in France.POPULATION108 906 women with HDP (excluding pre-existing Chronic Hypertension (CH)) who delivered between 2010 and 2014, with 35 878 (33%) receiving at least one antihypertensive treatment in the month after giving birth.METHODSTraditional Cox model, estimated 10-year cardiovascular risk. Extended Cox Step Function model and Restricted Mean Survival Time evaluated time trends.MAIN OUTCOME MEASURESNew-onset CH, heart failure, coronary, cerebrovascular, peripheral artery diseases and 2 composite events (one including CH, the other excluding it) over 10 years following giving birth.RESULTSWomen receiving early postnatal antihypertensive treatment had a higher long-term risk of complications over 10 years than non-treated women (CH: aHR = 3.067, 95% CI [2.996-3.139]; composite event including CH: aHR = 3.025 [2.956-3.096]; composite event excluding CH: aHR = 1.451 [1.305-1.614]). Treated women had events earlier than non-treated women, presenting a higher risk at the beginning of the postpartum period. The 10-year absolute risk for CH remained high in both groups: 44% for treated women and 18% for non-treated women.CONCLUSIONOur study shows that women receiving early postpartum antihypertensive treatment are at higher long-term cardiovascular risk, with 44% of them having CH within 10 years. Besides, approximately 1 in 5 women non-treated in the postpartum period subsequently developed CH, demonstrating that many high-risk women are not being identified in the peripartum period and may be missing opportunities for timely intervention.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731539","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}