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

{"title":"Pregnancy‐Related Venous Thromboembolism Risk Perception and Prevention in Risk‐Averse Times—Significant Change Required: a Commentary","authors":"Laura A. Magee, Roopen Arya, Clare Boag, Luci Buxton, Matthew A. Coleman, Fizzah Jivraj, Rebecca Scott, Kayleigh Sheen, Sergio A. Silverio, Peter von Dadelszen","doi":"10.1111/1471-0528.18229","DOIUrl":"https://doi.org/10.1111/1471-0528.18229","url":null,"abstract":"Between 2020 and 2022 in the United Kingdom (UK), there were 45 maternal deaths from venous thromboembolism (VTE), out of more than 2 million maternities. This occurred despite extensive risk assessment and prescribing of low molecular weight heparin (LMWH) thromboprophylaxis, alongside clinicians' overestimate of risk and commitment to the cause. Whilst every maternal death is a tragedy, the challenge ahead is immense—to identify, in an efficient and consistent way, those few women at risk of life‐threatening thrombosis, and then minimise that risk with a cost‐effective therapy that is acceptable to pregnant and postpartum women, and does not do more harm than good. We propose a way forward.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113671","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":"Foetal Cardiac Function in Early Labour and Intrapartum Outcomes: A Prospective Observational Study","authors":"Andrea Dall'Asta, Chiara Melito, Beatrice Valentini, Mariagrazia Capurso, Maria Teresa Baffa, Olga Patey, Basky Thilaganathan, Tullio Ghi","doi":"10.1111/1471-0528.18224","DOIUrl":"https://doi.org/10.1111/1471-0528.18224","url":null,"abstract":"ObjectiveTo assess foetal myocardial deformation in normo‐oxygenated foetuses in early labour and its relationship with intrapartum outcomes.DesignSingle centre prospective study.SettingReferral tertiary maternity unit.PopulationUncomplicated singleton term pregnancies in early labour.MethodsTwo‐dimensional (2D) ultrasound clips of the 4‐chamber view of the foetal heart were collected in labour and sent to TomTec software for the offline speckle tracking echocardiography analysis. The left (LV) and right ventricular (RV) myocardial (MyoGLS) and endocardial longitudinal (EndoGLS) strain were evaluated.Main Outcome MeasuresOperative delivery including caesarean or assisted vaginal birth due to suspected intrapartum foetal compromise (IFC) as defined by standard CTG criteria.ResultsIn total, 208 cases were included. Operative delivery due to suspected IFC was recorded in 20 (9.6%) cases and was associated with higher LV ejection fraction (EF) (47.4 + 8.2 vs. 40.9 + 12.9%, <jats:italic>p</jats:italic> = 0.03) and increased RV MyoGLS (−15.9 + 4.0 vs. −12.5 + 4.3%, <jats:italic>p</jats:italic> &lt; 0.01) and RV EndoGLS (−17.7 + 4.4 vs. −14.3 + 4.7%, <jats:italic>p</jats:italic> &lt; 0.01) compared to cases not having operative delivery due to suspected IFC. Maternal age (OR 1.138, 95% CI [1.010–1.281], <jats:italic>p</jats:italic> = 0.03), baseline foetal heart rate at acquisition (OR 1.068, 95% CI [1.007–1.134], <jats:italic>p</jats:italic> = 0.03) and RV MyoGLS (OR 0.575, 95% CI [0.366–0.903], <jats:italic>p</jats:italic> = 0.02) were independently associated with the primary outcome.ConclusionsIncreased right ventricular myocardial deformation is associated with operative delivery due to suspected IFC, suggesting an early cardiac response to labour‐related hypoxia.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113672","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":"Virtual Reality for Pain Management and Patient Satisfaction During Outpatient Hysteroscopy: A Randomised Controlled Trial","authors":"Alejandro Olloqui, Alvaro Tejerizo‐Garcia, Carmen Guillen, Concha Perez‐Sagaseta, Cristina Gonzalez‐Macho, Ana Belen Bolívar‐Miguel, Ana Villalba‐Gutierrez, Blanca Gil‐Ibañez","doi":"10.1111/1471-0528.18228","DOIUrl":"https://doi.org/10.1111/1471-0528.18228","url":null,"abstract":"ObjectiveTo evaluate virtual reality (VR) as a distraction technique to diminish pain perception and improve satisfaction in patients who underwent an outpatient hysteroscopy (OH).DesignA prospective, parallel group, 1:1 randomised controlled trial.SettingSpanish University Hospital.SampleA total of 120 patients between 18 and 70 years old underwent an OH.MethodA total of 120 patients were randomly allocated to undergo an OH either with standard treatment with vocal‐local support (<jats:italic>n</jats:italic> = 60) or with the use of a VR device (<jats:italic>n</jats:italic> = 60) between January and June 2022.Main Outcome MeasuresThe primary outcome was worst and average patient‐reported pain score (0–10) during the procedure. The secondary outcome was patient satisfaction (1–5) with the OH and with the use of VR.ResultsMean duration of the procedure (4.57 vs. 5.63 min, <jats:italic>p</jats:italic> = 0.11) and procedure performed did not differ among groups. There were no statistically significant differences in worst pain perception (VAS score 4.83 vs. 4.84, <jats:italic>p</jats:italic> = 0.95) or average pain perception (VAS score 2.91 vs. 3.21, <jats:italic>p</jats:italic> = 0.41) between the standard care and the VR group. There were no statistically significant differences in patient satisfaction between both groups.ConclusionsThe use of VR was as effective as the standard care with vocal‐local support to improve pain perception and patient satisfaction in patients undergoing OH.Trial Registration<jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" xlink:href=\"http://clinicaltrials.gov\">ClinicalTrials.gov</jats:ext-link>: NCT06463210","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"135 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113670","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":"Stakeholder Perspectives on the Design of First-In-Human Trials for Artificial Amnion and Placenta Technology.","authors":"Philip J Steer","doi":"10.1111/1471-0528.18230","DOIUrl":"https://doi.org/10.1111/1471-0528.18230","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103636","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":"Measures of Structural Racism and Black-White Disparity in Stillbirth Rates in New York City, 2009-2018: A Population-Based Cross-Sectional Study.","authors":"Susannah Hopkins Leisher,Pam Factor-Litvak,Mary Huynh,Jennie Kline,Robert M Silver,Shuang Wang,Lisa M Bates","doi":"10.1111/1471-0528.18217","DOIUrl":"https://doi.org/10.1111/1471-0528.18217","url":null,"abstract":"OBJECTIVETo explore associations between measures of structural racism and stillbirth.DESIGNPopulation-based cross-sectional.SETTINGNew York City (NYC), USA.POPULATIONAll non-Hispanic Black and White singleton births 2009-2018.METHODSWe modelled associations between measures of structural racism (Indices of Dissimilarity, Isolation and Concentration at the Extremes [ICE] and an Educational Inequity Ratio) and stillbirth. For indicators with evidence of interaction with race, we estimated odds ratios for stillbirth separately in 221 925 Black and 325 058 White births.OUTCOME MEASUREStillbirth (fetal death at 20+ completed gestational weeks).RESULTSThe stillbirth rate (per 1000 total births) was 13.8 in Black and 4.7 in White births. For Black mothers, residence in privileged versus disadvantaged PUMAs (Public Use Microdata Areas) (ICE Quintile 5 vs. 1) was associated with 54% greater odds of stillbirth (95% confidence interval, CI, 1.11, 2.14), and residence in more versus less isolated PUMAs (Isolation Tertile 3 vs. 1) was associated with 36% lower odds of stillbirth (95% CI 0.51, 0.82). There were no associations between measures of structural racism and stillbirth in White births.CONCLUSIONSICE and Isolation were associated with stillbirth in Black but not White births, but associations were not in the expected direction, raising questions about whether and how these measures represent structural racism. NYC stillbirths comprise about 4% of the USA's stillbirths but 15% of all Black stillbirths. Hence, reductions in racial disparities in stillbirth rates in NYC will also contribute to national public health.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"211 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144097754","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":"Is This Letter Truly Human-Written?","authors":"Shigeki Matsubara","doi":"10.1111/1471-0528.18227","DOIUrl":"https://doi.org/10.1111/1471-0528.18227","url":null,"abstract":"<h2> Disclosure</h2>\u0000<p>AI Detectors Used: GPTZero: https://gptzero.me; Quillbot: https://quillbot.com; Scribbr: https://www.scribbr.com/ai-detector; Surfer: https://surferseo.com/ai-content-detector (Accessed 2 April 2025).</p>","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"209 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144088041","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":"Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996-2023: An Observational Study of the Welsh Population.","authors":"Robin Andrews,Arron Lacey,Kate Bache,Emma J Kidd","doi":"10.1111/1471-0528.18220","DOIUrl":"https://doi.org/10.1111/1471-0528.18220","url":null,"abstract":"OBJECTIVETo analyse prescribing trends for oral and transdermal hormone replacement therapy (HRT) in Wales from 1996 to 2023, including predictors of discontinuation within one year of initiation.DESIGNObservational study using the Secure Anonymised Information Linkage (SAIL) databank.SETTINGPrimary and secondary care data from Wales, encompassing 86% of the population.POPULATIONAnnual HRT prescription rates from 1996 to 2023 were assessed for all women in Wales. Predictors of HRT discontinuation within one year were assessed in women aged 40-65 (n = 103 114), excluding those with oophorectomy, hysterectomy, or premature menopause.METHODSHRT prescription rates were calculated per 1000 women per year and stratified by HRT type, age groups and deprivation quintiles. Predictors of discontinuation were assessed using a zero-inflated negative binomial regression.MAIN OUTCOME MEASURESAnnual HRT prescription rates and predictors of discontinuation, including age, deprivation, time period and HRT type.RESULTSFrom 1996 to 2023, 292 707 women were prescribed oral or transdermal HRT in Wales. Transdermal prescriptions rose exponentially post-2021, whereas oral prescriptions declined post-2002. Discontinuation rates followed a curvilinear trend: increasing at ages 40-43 and mid-50s onwards and decreasing in mid-40s to early 50s. Oral formats were linked to decreased discontinuation, whereas transdermals showed increased discontinuation. Deprivation reduced HRT prescriptions overall. Prescriptions post-2000 predicted increased discontinuation, with highest rates seen post-2021.CONCLUSIONSDisparities in HRT prescribing patterns reflect GP and patient perceptions of safety. Women in their mid-40s to early 50s, often at a natural menopause stage, adhered better, particularly to oral tablets, suggesting that administration route and symptom relief influence adherence. Socio-economic deprivation remains a barrier to HRT access. Time trends highlight the influence of widely publicised studies and media on uptake, albeit adherence has continually declined since 2001. Additional research is needed to tackle socio-economic inequalities and assess strategies for achieving cost-effective and efficient HRT prescribing practices.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087545","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":"Financial Hardship and Crowdfunding for Endometriosis Care: A Cross-Sectional Study.","authors":"Irene Masini,Natalie Cooley,Kelly N Wright,Matthew T Siedhoff,Raanan Meyer","doi":"10.1111/1471-0528.18210","DOIUrl":"https://doi.org/10.1111/1471-0528.18210","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945299","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":"Impact of Implementation Tools for Spontaneous Preterm Birth Guidelines: A Systematic Review and Meta-Analysis.","authors":"Briar Hunter,Vanessa Jordan,Jordon Wimsett,Liza Edmonds,Tina Allen-Mokaraka,Lisa Dawes,Katie Groom","doi":"10.1111/1471-0528.18219","DOIUrl":"https://doi.org/10.1111/1471-0528.18219","url":null,"abstract":"BACKGROUNDPreterm birth is a priority area for practice improvement internationally. Clinical practice guidelines improve the efficiency of clinical decision-making and, when implemented effectively, may advance the quality and consistency of care. Guideline implementation tools may help to further optimise the use of guidelines.OBJECTIVESTo determine if guideline implementation tools improve adherence to preterm birth guideline recommendations and have an impact on differences seen by ethnicity.SEARCH STRATEGYSystematic search of MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and Scopus on 11 December 2023.SELECTION CRITERIAEligibility criteria included randomised and non-randomised studies that used an implementation tool and measured adherence to a guideline on preterm birth.DATA COLLECTION AND ANALYSISData were extracted including study details and ethnicity as an equity consideration. Meta-analyses were performed on adherence to preterm birth guideline recommendations with planned subgroup analysis by ethnicity/Indigeneity and topic of guideline.MAIN RESULTSTwenty studies were included; two cluster randomised controlled trials and 18 before-after studies. Nineteen studies comparing guideline implementation tool to no tool reported improved adherence to guideline recommendations with the use of a tool (data for meta-analysis from 14 studies, 20 961 people, OR 13.8, 95% CI 6.02-31.71, adherence in 3871/11 195 [34.6%] before compared with 6607/9766 [67.6%] after). Only one study performed analysis by ethnicity.CONCLUSIONSEffective implementation tools have the potential to increase adherence to evidence-based preterm birth guidelines, improving quality and consistency of preterm birth care.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945301","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":"Women's Pregnancy Experiences With a Transvaginal Cervical Cerclage: A Qualitative Study.","authors":"Stina Lou,Lotte Groth Jensen,Lea Kirstine Hansen,Niels Uldbjerg,Pernille Tine Jensen,Ingeborg Rytter Stenstrup,Puk Sandager,Rikke Bek Helmig,Julie Glavind","doi":"10.1111/1471-0528.18218","DOIUrl":"https://doi.org/10.1111/1471-0528.18218","url":null,"abstract":"OBJECTIVETo investigate women's experiences of being pregnant with cervical cerclage and managing the risk of preterm birth.DESIGNQualitative interview study.SETTINGDenmark.POPULATIONWomen who had undergone transvaginal cervical cerclage (elective or emergency) in at least one pregnancy, regardless of outcome.METHODSSemi-structured, in-depth interviews with 21 women. The interviews lasted 42-90 min and were analysed using reflexive thematic analysis.MAIN OUTCOME MEASURESA qualitative analysis of women's experiences.RESULTSThree themes were identified. Navigating uncertain and conflicting information describes the women's experience of fear of pregnancy loss and their requests for information and professional guidance. Faced with contradictory advice regarding activity restriction, many adopted the most restrictive regimen in a 'better safe than sorry' approach. My baby, my body, my responsibility describes the women's sense of personal responsibility towards prolonging pregnancy (e.g., by bed rest) and their 'hyper-alertness' to any signs of impending birth. Though restricted activity weakened their bodies, it was described as a 'necessary price to pay'. Enduring bed rest describes the emotional and bodily burden of restricted activity, and the strategies developed to cope-such as establishing daily routines, setting short- and long-term goals, and drawing on support from partners and networks. Continuity of care with trusted healthcare professionals was described as essential to feeling safe and hopeful.CONCLUSIONSCervical cerclage offers some reassurance, but women still carry a heavy sense of responsibility for preventing preterm birth through restricted activity. Clear and consistent information from healthcare professionals may help reduce some of this burden.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945305","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}