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

{"title":"Low‐Dose Aspirin in the Prevention of Recurrent Spontaneous Preterm Birth Stratified by Placental Maternal Vascular Malperfusion: Secondary Analysis of a Randomized Trial","authors":"James A. L. Meliëzer, Anadeijda J. E. M. C. Landman, Adelia A. Gieskes, Marianna Bugiani, Laura Visser, Mireille N. Bekker, Judith O. E. H. van Laar, Marieke Sueters, Sanne J. Gordijn, Joris van Drongelen, J. Marko Sikkema, Wietske Hermes, Anjoke J. M. Huisjes, Dimitri N. M. Papatsonis, Janine Boon, Joost J. Zwart, Christianne J. M. de Groot, Martijn A. Oudijk, Marjon A. de Boer","doi":"10.1111/1471-0528.70350","DOIUrl":"https://doi.org/10.1111/1471-0528.70350","url":null,"abstract":"Objective To evaluate the effectiveness of low‐dose aspirin in the prevention of recurrent preterm birth (PTB) in women with signs of maternal vascular malperfusion (MVM) in the placenta of the previous spontaneous PTB. Design Secondary analysis of the APRIL study. Setting The APRIL study, conducted in 34 centres in the Netherlands, evaluated low‐dose aspirin versus placebo in the prevention of recurrent PTB after spontaneous PTB. Population Women with a history of spontaneous PTB participating in the APRIL study, with available placenta histology reports from the previous spontaneous PTB. Methods Placental histology reports were retrieved from participating centres and categorized for presence of MVM as defined by the Amsterdam criteria. Main Outcome Measures Recurrent PTB. Results Placental histology reports of the previous spontaneous PTB were available for 41.3% (160/387) of participants, and MVM was present in 27.5% (44/160). In participants with MVM, recurrent PTB occurred in 4.2% (1/24) of the aspirin group, versus in 45.0% (9/20) in the placebo group (Relative Risk (RR) 0.09; 95% Confidence Interval (CI) 0.01–0.43; <jats:italic>p</jats:italic> = 0.02). In participants without MVM, PTB occurred in 29.3% (17/58) in the aspirin group compared to 17.2% (10/58) in the placebo group (RR 1.70; 95% CI 0.87–3.56; <jats:italic>p</jats:italic> = 0.13). Conclusion In women with a history of spontaneous PTB and signs of MVM in the placenta, a vascular‐mediated subgroup, the use of low‐dose aspirin in a subsequent pregnancy was associated with a lower rate of recurrent PTB.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149235687","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":"Twin‐Twin Transfusion Syndrome: “It's Not Over Until It's Over”","authors":"Mariano Lanna","doi":"10.1111/1471-0528.70353","DOIUrl":"https://doi.org/10.1111/1471-0528.70353","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221342","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":"Cytology and hrHPV Testing in HPV ‐Vaccinated Women Entering Cervical Screening: A Prospective Observational Study","authors":"Margaret E. Cruickshank, Jiafeng Pan, Kate Cuschieri, Sarah Liptrot, Seonaidh C. Cotton, Supriti Ghosh, Kimberley Kavanagh, Heather Cubie, Chris Robertson","doi":"10.1111/1471-0528.70348","DOIUrl":"https://doi.org/10.1111/1471-0528.70348","url":null,"abstract":"Objective To compare the predictive performance of cytology and high‐risk HPV (hrHPV) testing in young HPV‐vaccinated women participating in the cervical screening programme in Scotland. Design Prospective observational study. Setting Routine cervical screening services in three Scottish Health Boards between 2011 and 2015. Population Women born between 1991 and 1995 attending routine cervical screening who were eligible for HPV immunisation, including catch‐up vaccination cohorts. Methods Residual liquid‐based cytology samples were tested for hrHPV using Hybrid Capture 2. Women with high‐grade cytology, hrHPV‐positive and BNA/mild dyskaryosis, and a subset of hrHPV‐positive women with negative cytology from one participating region were invited for colposcopy. Colposcopy and histology outcomes were obtained from the National Colposcopy Clinical Information Audit System (NCCIAS). Positive and negative predictive values (PPV, NPV) for CIN2+ were estimated within the study referral framework, and hrHPV persistence across repeat testing was examined. Main Outcome Measures PPV and NPV for CIN2+ within the colposcopy referral pathway and patterns of hrHPV persistence in a selected group who attended for colposcopy. Results From 10 000 co‐tested residual samples, hrHPV positivity was 86% in borderline/mild cytology and 27% in cytology‐negative samples. Among 1352 women who attended for colposcopy, 184 CIN2+ cases were identified. Within the selective referral framework, hrHPV testing demonstrated a PPV for CIN2+ of 14.3% (95% CI: 12.5–16.4) and an NPV of 98.9% (95% CI: 94.0–99.9), while high‐grade cytology demonstrated a PPV of 71.7% (95% CI: 59.2–81.5) and an NPV of 89.2% (95% CI: 87.4–90.8). Among 1007 women with repeat testing, hrHPV persistence declined with increasing inter‐test intervals, with greater clearance observed over longer follow‐up periods. Conclusions In this early HPV‐vaccinated cohort screened within the historical Scottish programme from age 20 years, hrHPV testing retained a high negative predictive value but a low positive predictive value for CIN2+, reflecting the low prevalence of disease in vaccinated populations. These estimates reflect outcomes within a selective colposcopy referral framework and should not be interpreted as population‐level screening accuracy measures. The findings support the role of cytology triage alongside hrHPV testing while highlighting the need for further evaluation of screening strategies in highly vaccinated populations.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221402","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":"Postpartum Blood Pressure After Hypertensive Disorders of Pregnancy and Subsequent Cardiovascular Disease: A Population‐Based Cohort Study","authors":"Diane Korb, Rema Ramakrishnan, Aden C. H. Kwok, Yangmei Li, Claire Carson, Marian Knight","doi":"10.1111/1471-0528.70341","DOIUrl":"https://doi.org/10.1111/1471-0528.70341","url":null,"abstract":"Objective To assess the association between blood pressure values at 6 weeks postpartum and subsequent cardiovascular disease (CVD) over a 20‐year period among women with hypertensive disorders of pregnancy (HDP). Design Population‐based cohort study. Setting English primary and secondary care data, linked to cause‐specific mortality records from 2000 to 2020. Population A cohort of 39 934 women between 15 and 49 years of age at birth who had HDP, were registered with a general practitioner (GP) contributing to the Clinical Practice Research Datalink (CPRD), and eligible for linkage to hospital episode statistics (HES) data were included. We excluded 22 100 (55.3%) women with no blood pressure values recorded at 6 weeks postpartum. Methods Primary analysis included multivariable Cox regression modelling (weighted by the inverse probability of having a severe HDP). Main Outcome Measure Validated composite outcome of 12 cardiovascular diseases. Results The rate for incident cardiovascular events was 109 per 10 000 person‐years; 794 (68%) of them occurred in women aged &lt; 40 years. Women with abnormal blood pressure at 6 weeks postpartum had a higher risk of subsequent CVD than women with normal blood pressure: 10.9% vs. 5.4% ‐ adjusted hazard ratio 1.96 (95% CI 1.51–2.54). Conclusions Less than half of women with HDP had a blood pressure record in their GP notes at 6 weeks postpartum. The absence of a record of normal blood pressure at this time point was associated with an increased risk for subsequent CVD The immediate postpartum period may be a crucial window in preventive care to improve women's health.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198972","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":"HPA ‐1a Alloimmunisation in Pregnancy: What Does Postpartum Positivity Reveal?","authors":"Yun Zhu, Junjun Xiong, Hao Zhang","doi":"10.1111/1471-0528.70351","DOIUrl":"https://doi.org/10.1111/1471-0528.70351","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172600","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":"Efficacy and Safety of Lidocaine Compared to Other Agents for Intrauterine Device Insertion Pain: A Systematic Review and Meta‐Analysis","authors":"Rachael G. Pirrami, Greeshma Pandya, Aminah Islam, Jalyn Shaw, Andrew Y. Hwang","doi":"10.1111/1471-0528.70345","DOIUrl":"https://doi.org/10.1111/1471-0528.70345","url":null,"abstract":"Background Pain during intrauterine device (IUD) insertion remains a common barrier to use, with limited guidance on preferred pharmacological agents. Objective Evaluate the efficacy and safety of lidocaine compared to other pharmacologic agents for reducing pain during IUD insertion. Search Strategy Electronic database searches were conducted in August 2025 and included randomized controlled trials (RCTs) published between January 1984 and August 2025. Selection Criteria RCTs involving women or adolescents that evaluated the efficacy and safety of lidocaine versus other pharmacologic agents for reducing IUD insertion pain. Data Collection and Analysis Conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) methodology. Risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomized Trials (RoB‐2) and meta‐analysis was conducted on 5 of the 6 studies using Meta‐Analysis version 4.0.2. Main Results Six studies ( <jats:italic>N</jats:italic> = 658) compared lidocaine to non‐steroidal anti‐inflammatory drugs (NSAIDs) or misoprostol. Of these, two studies showed statistically significant pain reduction with lidocaine versus NSAIDs (study 1: 5.4 ± 2.8 vs. 7.3 ± 2.1, <jats:italic>p</jats:italic> &lt; 0.001; study 2: 2.6 ± 0.9 vs. 4.1 ± 1.1, <jats:italic>p</jats:italic> &lt; 0.001). The meta‐analysis showed no statistically significant pain reduction with lidocaine overall. Conclusions Lidocaine did not demonstrate a statistically significant reduction in pain. It remains unclear whether lidocaine, NSAIDs, and misoprostol are clinically comparable options. Secondary outcomes varied, and safety data were limited, highlighting the need for standardized endpoints. Further head‐to‐head trials are needed to guide optimal pain management for IUD insertion.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149173000","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 and Cardiomyopathy: A Prospective Cohort Study","authors":"Matthew Cauldwell, Mark Johnson, Catherine Nelson Piercy, Philip Steer","doi":"10.1111/1471-0528.70343","DOIUrl":"https://doi.org/10.1111/1471-0528.70343","url":null,"abstract":"Objective To establish in a national cohort whether the type of cardiomyopathy in women with a prepregnancy diagnosis affected pregnancy outcomes including mortality, gestational age at birth, and delivery type. Design Prospective Observational study using United Kingdom Obstetric Surveillance System (UKOSS). Population Women with pre‐pregnancy diagnosis of cardiomyopathy. Methods Cases included were defined as women with pre‐pregnancy diagnosis of cardiomyopathy (dilated cardiomyopathy, hypertrophic cardiomyopathy, arrhymogenic right ventricular cardiomyopathy, or Peripartum Cardiomyopathy (PPCM)). Details were notified monthly to UKOSS (1st June 2021 until the 31st May 2024). Main Outcome Measures Obstetric, neonatal, and cardiovascular outcomes. Results 210 pregnancies in 209 women were identified, 103/209 (49.3%) with dilated cardiomyopathy, 40/209 (19.1%) with hypertrophic cardiomyopathy, 24/209 (11.5%) with previous PPCM, 11/209 (5.3%) with arrhythmogenic right ventricular cardiomyopathy and 31/209 (14.8%) women with ‘other’ cardiomyopathies. Median gestation at delivery in 206 singleton pregnancies was 38.1 (IQR 259–273) weeks; 36/180 (20%) of babies with data recorded were admitted to the neonatal unit. There were no maternal deaths. 10% of women had a documented episode of heart failure and 8% a documented arrhythmia during pregnancy. Conclusions Pregnancies in women with cardiomyopathy managed in the UK typically have successful outcomes, consistent with published data. Maternal cardiac complications rate was small. There were no maternal deaths.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140449","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":"Bidirectional Mediation Effects of Body Mass Index and Inflammatory Markers on Assisted Reproductive Outcomes in Women With Polycystic Ovary Syndrome","authors":"Xin Li, Ting Luan, Xiufeng Ling, JuanJuan Zhang, Chun Zhao","doi":"10.1111/1471-0528.70344","DOIUrl":"https://doi.org/10.1111/1471-0528.70344","url":null,"abstract":"Objective To evaluate the bidirectional mediation effects of body mass index (BMI) and inflammatory markers (neutrophil‐to‐lymphocyte ratio [NLR], systemic immune‐inflammation index [SII], platelet‐to‐lymphocyte ratio [PLR]) on assisted reproductive technology (ART) outcomes in women with polycystic ovary syndrome (PCOS). Design A historical cohort study. This analysis is exploratory and hypothesis‐generating rather than confirmatory. Setting Department of Reproductive Medicine, Nanjing Women's Hospital of Nanjing Medical University, China. Population A total of 966 women with PCOS undergoing ART, categorized by BMI: underweight ( <jats:italic>n</jats:italic> = 38), normal weight ( <jats:italic>n</jats:italic> = 547), overweight ( <jats:italic>n</jats:italic> = 282), and obesity ( <jats:italic>n</jats:italic> = 99). Methods Multivariable regression, restricted cubic splines, and bidirectional causal mediation analysis using the Quasi‐Bayesian approach with 1000 simulations were performed. Main Outcome Measures Number of oocytes retrieved, high‐quality embryos, available embryo rate, and clinical pregnancy outcomes. Results Oocytes retrieved decreased from 14.50 (IQR 12.00–20.75) in underweight to 12.00 (IQR 9.00–16.00) in obese women ( <jats:italic>p</jats:italic> &lt; 0.001). High‐quality embryos declined from 4.00 (IQR 0.25–6.00) to 1.00 (IQR 0.00–3.50) across BMI categories ( <jats:italic>p</jats:italic> &lt; 0.001). All inflammatory markers showed consistent negative dose–response relationships with available embryo rate (all <jats:italic>p</jats:italic> &lt; 0.001). NLR mediated 9.2% (95% CI: 2.3%–20.0%) of BMI's effect on high‐quality embryos. BMI mediated 26.6% (95% CI: 13.3%–62.3%) of NLR's effect on high‐quality embryos and 58.6% (95% CI: 5.6%–528.4%) on available embryos. SII and PLR showed minimal mediation effects (&lt; 5%). Conclusions These findings are exploratory and hypothesis‐generating. In this single‐centre cohort of women with PCOS, higher BMI and higher peripheral inflammatory indices were associated with fewer oocytes retrieved and fewer high‐quality embryos, and BMI and NLR appeared to lie on shared, bidirectionally related pathways, with the larger share attributable to BMI.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149130408","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":"Validity of Informed Consent and Care Outside Clinical Guidance in Maternity Care","authors":"Junaid Rafi","doi":"10.1111/1471-0528.70340","DOIUrl":"https://doi.org/10.1111/1471-0528.70340","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088278","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":"Glucagon‐Like Peptide‐1 Receptor Agonists in Pregnancy: Periconception Exposure and Perinatal Outcomes","authors":"Katherine G. Y. Lau, Anisha Chopra, Edward Mullins, Rochan Agha‐Jaffar, Tricia Tan, Lynne Sykes, Christina K. H. Yu","doi":"10.1111/1471-0528.70339","DOIUrl":"https://doi.org/10.1111/1471-0528.70339","url":null,"abstract":"Objective An increasing number of women of childbearing age worldwide are using glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) and are advised to use effective contraception during treatment. Nevertheless, maternity services are encountering increasing numbers of women exposed to GLP‐1 RAs shortly before conception or during pregnancy. The true extent of exposure is likely underestimated because routine enquiry is not universal. The effects of GLP‐1 RA exposure on pregnancy remain poorly understood, and there is currently limited guidance on counselling women with inadvertent periconceptional exposure. Design Narrative review. Population or Sample Original research articles, systematic reviews and meta‐analyses published in English from inception to 2026 were considered for inclusion. Methods A non‐systematic literature search of PubMed, Google Scholar, MEDLINE and Embase was undertaken. Evidence relating to GLP‐1 RA use from preconception through pregnancy and the postnatal period was reviewed. Main Outcome Measures Key findings relating to preclinical safety data, human pregnancy outcomes—including congenital anomalies, hypertensive disorders of pregnancy, gestational diabetes, preterm birth, fetal growth and stillbirth; pharmacokinetic and drug washout considerations. Results GLP‐1 RAs improve weight and metabolic parameters and may improve fertility outcomes in selected populations, including women with obesity and polycystic metabolic ovarian syndrome (PMOS). Available human observational data have not demonstrated a clear increase in adverse pregnancy outcomes following periconceptional exposure. However, the evidence base is limited by small numbers, observational study designs, potential confounding and incomplete ascertainment of exposure and outcomes. Conclusions Current observational data have not identified a clear safety signal associated with inadvertent periconceptional exposure to GLP‐1 RAs. However, robust pregnancy safety data remain limited and are insufficient to exclude clinically important risks. Further prospective data and consistent reporting of pregnancy exposures are needed. In the meantime, women with inadvertent exposure should receive individualised counselling based on the available evidence rather than assuming that exposure is either established to be harmful or proven to be safe.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086778","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}