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

{"title":"Labour Dynamics After Induction in Nulliparous IVF/ICSI and Spontaneous Pregnancies: A Matched Cohort Study.","authors":"Anna Seidenari,Sara Doroldi,Maria Cecilia Rinaldi,Sofia Calisti,Chiara Sollevanti,Cristina Scollo,Giuseppe Scibilia,Danila Morano,Antonio Farina","doi":"10.1111/1471-0528.70300","DOIUrl":"https://doi.org/10.1111/1471-0528.70300","url":null,"abstract":"OBJECTIVETo compare labour dynamics between nulliparous women with IVF/ICSI and spontaneous conception, and to assess the effect of epidural analgesia on the timing and incidence of vaginal birth using time-to-event methods.DESIGNMatched retrospective cohort study.SETTINGTertiary referral centre, Bologna, Italy.POPULATIONA total of 124 IVF/ICSI and 248 maternal age-matched spontaneous conceptions undergoing induction of labour at ≥ 37 weeks between January 2019 and December 2023.METHODSTime-to-vaginal-delivery patterns were evaluated using smoothed instantaneous hazard (SIH) functions. Caesarean delivery was treated as a competing event, and subhazard ratios (sHR) were estimated using Fine-Grey regression. Analyses were stratified by epidural analgesia and adjusted for cervical dilation at induction, body mass index at term, and induction-related variables.MAIN OUTCOME MEASURESLabour dynamics and cumulative incidence of vaginal delivery over time.RESULTSAmong 372 inductions, spontaneous conceptions had higher vaginal delivery rates than IVF/ICSI pregnancies (85.1% vs. 72.6%, p = 0.005) and shorter active labour (167 vs. 272 min, p < 0.001). SIH curves showed earlier and more sustained peaks with late-labour rebound in spontaneous conceptions, whereas IVF/ICSI pregnancies exhibited flatter, persistently lower hazards. IVF/ICSI conception was associated with a significantly lower cumulative incidence of vaginal birth (sHR 0.67, p < 0.001). Epidural analgesia delayed the timing but did not reduce the overall likelihood of vaginal delivery in spontaneous conceptions, while no significant effect was observed in IVF/ICSI pregnancies.CONCLUSIONSLabour dynamics differ by mode of conception. IVF/ICSI pregnancies show reduced labour progression and earlier transition to caesarean delivery.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393730","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 Outcomes After Retropubic and Transobturator Sling Procedures: Reoperation for Recurrent Stress Urinary Incontinence","authors":"Ayssa Teles Abrao Trad, Sherif A. El Nashar, Brian J. Linder, Annetta M. Madsen, John A. Occhino, John B. Gebhart, Michaela E. McGree, Angela J. Fought, Emanuel C. Trabuco","doi":"10.1111/1471-0528.70295","DOIUrl":"https://doi.org/10.1111/1471-0528.70295","url":null,"abstract":"Objective To evaluate long‐term failure rates and complications after retropubic and transobturator midurethral sling procedures for primary stress urinary incontinence (SUI). Design Retrospective cohort study. Setting Academic medical centre. Population A previously described cohort of patients ( <jats:italic>n</jats:italic> = 1881) who underwent midurethral sling procedures (2002–2012) and a covariate‐matched cohort of patients with retropubic ( <jats:italic>n</jats:italic> = 570) or transobturator ( <jats:italic>n</jats:italic> = 317) slings. Methods Health record review with follow‐up extended by 9 years (through December 31, 2022). Main Outcome Measures Treatment failure (reoperation for recurrent SUI) and procedure‐associated complications. Results The duration of assessment was extended by 6.9 years for the retropubic group and by 6.4 years for the transobturator group. The median (IQR) follow‐up was 11.1 (5.1–14.5) years (retropubic, 11.4 [5.9–14.6]; transobturator, 9.6 [2.6–13.7]). Higher risk of reoperation was observed with transobturator (8.8%) than retropubic (4.4%) slings (unadjusted hazard ratio [HR], 2.29 [95% CI, 1.49–3.54]; <jats:italic>p</jats:italic> &lt; 0.001; covariate‐matched analysis HR, 1.91 [95% CI, 1.15–3.17]; <jats:italic>p</jats:italic> = 0.01). The increased risk of reoperation with a transobturator sling was higher when the procedure was combined with prolapse repair (unadjusted HR, 6.34 [95% CI, 3.09–13.02]; <jats:italic>p</jats:italic> &lt; 0.001; covariate‐matched analysis HR, 3.96 [95% CI, 1.35–11.58]; <jats:italic>p</jats:italic> = 0.01). Higher rates of reoperation for urinary retention were observed for the retropubic group than for the transobturator group (covariate‐matched analysis HR, 8.39 [95% CI, 1.11–63.22]; <jats:italic>p</jats:italic> = 0.04). Conclusion In this long‐term follow‐up study, midurethral slings had a low failure rate. Women with SUI undergoing transobturator sling placement plus prolapse repair had a greater risk of reoperation. However, women with retropubic slings had a greater risk of urinary retention requiring intervention.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148372423","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 a Structured Caesarean Reduction Strategy on Perinatal Outcomes: A Retrospective Ecological Time‐Trend Study","authors":"Stefania Fieni, Giovanni Morganelli, Gabriella Maria Celora, Biancamaria Mastrandrea, Tullio Ghi","doi":"10.1111/1471-0528.70297","DOIUrl":"https://doi.org/10.1111/1471-0528.70297","url":null,"abstract":"Objective To evaluate the long‐term impact of a structured, multidisciplinary CS reduction strategy in a high‐complexity Italian hospital. Design Retrospective ecological time‐trend study. Setting Tertiary obstetric care Italian centre. Sample 28 577 deliveries, ≥ 22 weeks' gestation, from 2014 to 2024 were analysed. Methods In 2014, a multifaceted improvement program including standardised protocols, continuous staff training, Robson Ten‐Group Classification audits, and tailored intrapartum care (revised dystocia criteria, updated induction methods, intrapartum ultrasound, dedicated VBAC clinic, and physiology‐based CTG interpretation) was introduced. Main Outcome Measure Temporal trend in CS rate, maternal morbidity (postpartum haemorrhage &gt; 1000 mL, obstetric anal sphincter injuries, hysterectomy) and neonatal morbidity (cord pH &lt; 7.0, resuscitation, therapeutic hypothermia). Temporal trends were assessed using segmented regression. Results Segmented regression analysis of CS rates identified 2016 as a breakpoint. Prior to 2016, the annual change in CS rate was not significant (−0.24 percentage points per year; <jats:italic>p</jats:italic> = 0.75), whereas after 2016 a significant downward trend was observed (−1.64 percentage points per year; <jats:italic>p</jats:italic> &lt; 0.001). Conversely, VBAC rates showed a significant increasing trend over time, while uterine rupture rates remained consistently below 0.3% throughout the study period. Maternal outcomes were overall stable, although a modest increase in postpartum haemorrhage was observed. Neonatal outcomes did not show significant changes over time, including the rate of arterial cord pH &lt; 7.0 at birth. Conclusions The implementation of a structured, multifaceted strategy aimed at containing CS rates was associated with a significant change in their temporal trend, with a sustained post‐2016 decline identified by segmented regression analysis. This trend was not associated with clinically significant detrimental effects on maternal or neonatal outcomes.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148372003","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":"Large Language Models on European Guidelines for Cervical Cancer: Implications of Design and Clinical Applicability","authors":"Aya Mudrik","doi":"10.1111/1471-0528.70299","DOIUrl":"https://doi.org/10.1111/1471-0528.70299","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"270 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355616","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":"Internal Consistency of the Hadlock Estimated Fetal Weight Reference: Methodological Analysis","authors":"Theophilus K. Adu‐Bredu, Clement Twumasi, Sam Mathewlynn, Lawrence Impey, Christos Ioannou","doi":"10.1111/1471-0528.70296","DOIUrl":"https://doi.org/10.1111/1471-0528.70296","url":null,"abstract":"Objective To assess the internal consistency of the Hadlock normal range for estimated fetal weight (EFW) and its clinical implications. Design Methodological analysis and retrospective observational audit. Setting Tertiary maternity hospital in Oxford, UK. Population Women with a non‐anomalous singleton pregnancy. Methods Reanalysis of the original Hadlock reference EFW chart using functional data analysis (FDA) and penalised functional regression (PFFR‐GAM), and systematic bias assessment across gestation. Retrospective EFW centile analysis in a population of pregnancies undergoing a growth scan between 35 + 0 and 36 + 6 weeks, calculating the EFW centile using both the published reference chart (chart‐derived centile) and the reported regression equation (equation‐derived centile). Outcome Measures Agreement between chart‐derived and equation‐derived centiles and the corresponding differences in classification of fetuses below the 3rd and 10th centiles. Results There is a statistically significant disparity between the chart‐derived and equation‐derived centiles, most pronounced in the 3rd and 10th centiles where clinical implications are critical. The 3rd and 10th chart‐derived centiles approximately correspond to the 1st and 6th equation‐derived centiles. Conversely, the equation‐derived 10th centile corresponds to the chart‐derived 17th centile. In a population of 21 874 pregnancies undergoing a growth scan between 35 + 0 and 36 + 6 weeks, the chart classified 4.2% as below the 10th centile, compared with 7.2% using the equation, with an absolute difference of 3.0% (95% CI 2.8%–3.3%; McNemar's test; <jats:italic>p</jats:italic> &lt; 0.001). Also, the chart classified 0.8% under the 3rd centile, compared with 2.3% using the equation, with an absolute difference of 1.5% (95% CI 1.3%–1.7%; McNemar's test; <jats:italic>p</jats:italic> &lt; 0.001). Conclusion Systematic disparity exists between the published chart‐ and equation‐derived centiles in the original Hadlock growth reference. The equation‐derived centiles are closer to the expected nominal proportions of our population, whereas the chart‐derived centiles significantly underestimate the incidence of small for gestational age.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355683","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":"Correction to “The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green‐Top Guideline No. 69)”","authors":"","doi":"10.1111/1471-0528.70298","DOIUrl":"https://doi.org/10.1111/1471-0528.70298","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355682","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":"Placenta Praevia and Placenta Accreta Spectrum: Diagnosis and Management: Green-Top Guideline No. 27a.","authors":"Eric Jauniaux,Amarnath Bhide,Ahmed M Hussein,Christoph Lees,Francesco D'Antonio,Steve C Robson,Andrea Kaelin Agten,Davor Jurkovic, ","doi":"10.1111/1471-0528.70239","DOIUrl":"https://doi.org/10.1111/1471-0528.70239","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148349287","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":"Correction to \"Identification and Management of Maternal Sepsis During and Following Pregnancy Green-top Guideline No. 64\".","authors":"","doi":"10.1111/1471-0528.70293","DOIUrl":"https://doi.org/10.1111/1471-0528.70293","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148342184","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":"Indications and Efficacy of Progestogen-Monotherapy as Menopause Hormone Therapy: A Narrative Review.","authors":"Chloe Thomas,Olivia Carere,Lauren Clarfield,Michelle Jacobson","doi":"10.1111/1471-0528.70292","DOIUrl":"https://doi.org/10.1111/1471-0528.70292","url":null,"abstract":"Menopausal hormone therapy (MHT) remains the most effective treatment for vasomotor symptoms (VMS) and other manifestations of menopause; however, its use is limited in women with contraindications to oestrogen. Progestogen monotherapy, though historically underutilized, represents a viable alternative in this population. This narrative review summarizes the indications, efficacy, and limitations of progestogen monotherapy as MHT. A structured literature search identified systematic reviews, guidelines, randomized controlled trials, and cohort studies evaluating progestogen monotherapy for menopausal symptom management, bone health, and oncologic safety. Evidence supports its use in patients with contraindications specific to oestrogen, including those with certain gynecologic malignancies (e.g., low-grade endometrial stromal sarcoma, select ovarian cancers), prior venous thromboembolism, coronary artery disease, compensated liver disease, and endometriosis. Contraindications to progestogen monotherapy are limited to unexplained abnormal vaginal bleeding and personal history of breast cancer, with caution utilised in patients with meningioma. Clinical data demonstrate that progestogens provide significant VMS relief, with efficacy observed across oral, intramuscular, and transdermal preparations. Micronized progesterone shows additional benefits for sleep quality, while synthetic progestins such as medroxyprogesterone acetate, megestrol acetate, and norethindrone acetate variably confer bone protection. Effects on mood appear neutral overall. Breast cancer risk associated with progestogen monotherapy remains uncertain due to limited and underpowered studies. Despite promising evidence, research is constrained by heterogeneous methodologies, small sample sizes, and lack of contemporary trials directly comparing progestogen monotherapy with standard MHT or nonhormonal alternatives. In conclusion, progestogen monotherapy is an effective, well-tolerated, and under-recognized therapeutic option for women with contraindications to oestrogen-containing MHT. Its optimal use may be tailored to clinical context: micronized progesterone for sleep disturbance, norethindrone acetate for bone health, or progestins with known antineoplastic properties in hormone-sensitive tumours. Larger, high-quality studies are needed to better define long-term safety and efficacy.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148313866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'The 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}