The increasing rate of cesarean section (C-section) deliveries has become a global concern, prompting intervention from governments and healthcare organizations, including the World Health Organization (WHO), which is actively working to reduce the number of unnecessary C-sections worldwide. This study examines the role of physicians, family, and societal factors on C-section decision-making among Lebanese women.
Methods
This cross-sectional study included 367 Lebanese women recruited between March and September 2024. The Attitude Toward Birth Selection Method was used to determine factors influencing birth method preference. The scale evaluates eight factors: beliefs and attitudes, sexual and physical attitudes, fear of childbirth, preference of convenience, health and support, sociocultural norms, confidence in the birth practitioners, personal and practical choice, and sources of motivation.
Results
Findings suggest that sources of motivation and confidence in birth practitioner were associated with a higher preference for C-section delivery. In contrast, beliefs and attitudes and personal and practical choices were more strongly associated with a preference for vaginal delivery.
Conclusion
This study highlights the significant role of physicians, family, and societal influences play in shaping C-section decision-making. These findings serve as a first step for developing awareness campaigns aimed at reducing unnecessary C-sections and supporting women to make informed and health-conscious decisions about childbirth.
{"title":"Impact of physician, family and society on the choice of Cesarean-section delivery mode among Lebanese females","authors":"Elie Ouainaty , Abdallah Chahine , Elie Chalhoub , Charly-Joe Layoun , Souheil Hallit , Habib Barakat","doi":"10.1016/j.eurox.2025.100378","DOIUrl":"10.1016/j.eurox.2025.100378","url":null,"abstract":"<div><h3>Background</h3><div>The increasing rate of cesarean section (C-section) deliveries has become a global concern, prompting intervention from governments and healthcare organizations, including the World Health Organization (WHO), which is actively working to reduce the number of unnecessary C-sections worldwide. This study examines the role of physicians, family, and societal factors on C-section decision-making among Lebanese women.</div></div><div><h3>Methods</h3><div>This cross-sectional study included 367 Lebanese women recruited between March and September 2024. The Attitude Toward Birth Selection Method was used to determine factors influencing birth method preference. The scale evaluates eight factors: beliefs and attitudes, sexual and physical attitudes, fear of childbirth, preference of convenience, health and support, sociocultural norms, confidence in the birth practitioners, personal and practical choice, and sources of motivation.</div></div><div><h3>Results</h3><div>Findings suggest that sources of motivation and confidence in birth practitioner were associated with a higher preference for C-section delivery. In contrast, beliefs and attitudes and personal and practical choices were more strongly associated with a preference for vaginal delivery.</div></div><div><h3>Conclusion</h3><div>This study highlights the significant role of physicians, family, and societal influences play in shaping C-section decision-making. These findings serve as a first step for developing awareness campaigns aimed at reducing unnecessary C-sections and supporting women to make informed and health-conscious decisions about childbirth.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"26 ","pages":"Article 100378"},"PeriodicalIF":1.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent research suggests that genetic factors linked to Caesarean delivery may influence variations in children's intelligence and anxiety traits. This review synthesizes findings from genome-wide association studies (GWAS) to examine these associations, clarifying that it does not establish causation.
Methods
This review systematically aggregated findings from GWAS studying the impact of Caesarean delivery on intelligence and anxiety traits. A thorough literature search was performed in key scientific databases like PubMed and Scopus, using various keywords related to delivery methods, cognitive traits, and psychological outcomes from 2005, when the first GWAS was published, through December 1, 2024. The inclusion criteria focused on original research articles published in English, excluding studies involving non-human subjects or without empirical data. The quality of the studies was assessed using a modified STROBE checklist adapted for GWAS.
Results
Five GWAS identified 36 significant genetic loci associated with intelligence and anxiety traits in offspring related to Caesarean delivery. In terms of verbal intelligence, four alleles were found to be significantly linked to decreased scores, with allele rs1276529-G associated with a mean reduction of −2.04 units (p = 1E-6). Conversely, allele rs705670-G correlated with an increase in performance intelligence scores, resulting in a mean elevation of 2.3 units (p = 3E-7). Several alleles exhibited a negative correlation with overall intelligence, particularly rs17800861-A, which was associated with a mean decrease of 3.32 units (p = 7E-7). Significant risk alleles for anxiety were also identified, including rs62389045-C, linked to a 117 % increase in the risk of anxiety symptoms (p = 4E-8). Furthermore, in the context of self-injury, 17 risk alleles were identified, with allele rs117077436-C demonstrating an odds ratio of 11.34 (p = 3E-9).
Conclusion
This study highlights multiple genetic loci associated with verbal performance, overall intelligence, and susceptibility to anxiety, revealing significant variations in offspring delivered via Caesarean section. While certain alleles are linked to increased risks of anxiety and self-injurious behavior, the results underscore the presence of genetic predispositions influencing cognitive and psychological outcomes. It is essential to emphasize that GWAS findings indicate associations rather than causal relationships. Further exploration into the biological mechanisms and environmental interactions that underlie these complex traits is warranted.
{"title":"Understanding the interplay of Caesarean delivery and genetic influences on intelligence and anxiety traits in offspring findings from genome-wide association studies","authors":"Bita Fallahpour , Mahsa Danaei , Maryam Yeganegi , Fatemeh Jayervand , Sepideh Azizi , Heewa Rashnavadi , Seyed Alireza Dastgheib , Reza Bahrami , Amirhossein Shahbazi , Ali Masoudi , Kazem Aghili , Fatemeh Nematzadeh , Hossein Neamatzadeh","doi":"10.1016/j.eurox.2025.100377","DOIUrl":"10.1016/j.eurox.2025.100377","url":null,"abstract":"<div><h3>Background</h3><div>Recent research suggests that genetic factors linked to Caesarean delivery may influence variations in children's intelligence and anxiety traits. This review synthesizes findings from genome-wide association studies (GWAS) to examine these associations, clarifying that it does not establish causation.</div></div><div><h3>Methods</h3><div>This review systematically aggregated findings from GWAS studying the impact of Caesarean delivery on intelligence and anxiety traits. A thorough literature search was performed in key scientific databases like PubMed and Scopus, using various keywords related to delivery methods, cognitive traits, and psychological outcomes from 2005, when the first GWAS was published, through December 1, 2024. The inclusion criteria focused on original research articles published in English, excluding studies involving non-human subjects or without empirical data. The quality of the studies was assessed using a modified STROBE checklist adapted for GWAS.</div></div><div><h3>Results</h3><div>Five GWAS identified 36 significant genetic loci associated with intelligence and anxiety traits in offspring related to Caesarean delivery. In terms of verbal intelligence, four alleles were found to be significantly linked to decreased scores, with allele rs1276529-G associated with a mean reduction of −2.04 units (p = 1E-6). Conversely, allele rs705670-G correlated with an increase in performance intelligence scores, resulting in a mean elevation of 2.3 units (p = 3E-7). Several alleles exhibited a negative correlation with overall intelligence, particularly rs17800861-A, which was associated with a mean decrease of 3.32 units (p = 7E-7). Significant risk alleles for anxiety were also identified, including rs62389045-C, linked to a 117 % increase in the risk of anxiety symptoms (p = 4E-8). Furthermore, in the context of self-injury, 17 risk alleles were identified, with allele rs117077436-C demonstrating an odds ratio of 11.34 (p = 3E-9).</div></div><div><h3>Conclusion</h3><div>This study highlights multiple genetic loci associated with verbal performance, overall intelligence, and susceptibility to anxiety, revealing significant variations in offspring delivered via Caesarean section. While certain alleles are linked to increased risks of anxiety and self-injurious behavior, the results underscore the presence of genetic predispositions influencing cognitive and psychological outcomes. It is essential to emphasize that GWAS findings indicate associations rather than causal relationships. Further exploration into the biological mechanisms and environmental interactions that underlie these complex traits is warranted.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"25 ","pages":"Article 100377"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-12DOI: 10.1016/j.eurox.2025.100373
Etoroabasi Ekpe , Jason Collier , Benjamin H. Chi , Divya Mallampati
While antenatal recommendations regarding preterm birth are essential to preventing neonatal morbidity and mortality, implementation of these recommendations underscore how health system capacity and systemic factors, such as access and quality, greatly influence their utilization. To date, there is limited synthesis focused on the implementation of antenatal preterm birth interventions. Our objectives were to focus on implementation science studies intended to 1) increase referral mechanisms of pregnant people to higher levels of care where the management of preterm labor or delivery is possible and 2) map the implementation of preterm birth interventions, including the administration of antenatal corticosteroids, magnesium sulfate, and antibiotics. We conducted a scoping review using key terms in online databases to identify implementation science strategies focused on referral mechanisms and preterm birth interventions. Studies were selected based on the strength of existing literature. Quality assessment was conducted with the Mixed Methods Assessment Tool (MMAT). To evaluate study intervention strategies, we used the RE-AIM framework – a comprehensive evaluative framework composed of 5 dimensions: reach, effectiveness, adoption, implementation, and maintenance. Of the 1178 articles that were screened, 18 were evaluated, and 13 included in this review. The studies were conducted in 12 countries, the majority of which were lower to lower-middle income countries. Designs ranged from quantitative non-randomized studies to qualitative and mixed methods. By using the RE-AIM framework, we found that there was heterogeneity among the studies with regards to whether they addressed reach, effectiveness, adoption, implementation, or maintenance. Common interventions for referring pregnant women to higher levels of care included the use of skilled birth attendants, referral systems, financial incentives, quality of emergency obstetric care, and community health workers. Implementation studies on preterm birth interventions with corticosteroids or magnesium sulfate focused on increasing awareness and knowledge of evidence-based practices using care bundles, online or in person training sessions, focus groups, interviews, and surveys. Overall, we identified how implementation studies increased the use of antenatal corticosteroids and magnesium sulfate and also identified how community health workers, skilled birth attendants, and referral systems can reduce complications from preterm birth. With further review of implementation science research, implementation science can be used to further understand and integrate evidence based-knowledge into practice in a consistent and reproducible matter.
{"title":"Implementation of antepartum preterm birth interventions: A scoping review","authors":"Etoroabasi Ekpe , Jason Collier , Benjamin H. Chi , Divya Mallampati","doi":"10.1016/j.eurox.2025.100373","DOIUrl":"10.1016/j.eurox.2025.100373","url":null,"abstract":"<div><div>While antenatal recommendations regarding preterm birth are essential to preventing neonatal morbidity and mortality, implementation of these recommendations underscore how health system capacity and systemic factors, such as access and quality, greatly influence their utilization. To date, there is limited synthesis focused on the implementation of antenatal preterm birth interventions. Our objectives were to focus on implementation science studies intended to 1) increase referral mechanisms of pregnant people to higher levels of care where the management of preterm labor or delivery is possible and 2) map the implementation of preterm birth interventions, including the administration of antenatal corticosteroids, magnesium sulfate, and antibiotics. We conducted a scoping review using key terms in online databases to identify implementation science strategies focused on referral mechanisms and preterm birth interventions. Studies were selected based on the strength of existing literature. Quality assessment was conducted with the Mixed Methods Assessment Tool (MMAT). To evaluate study intervention strategies, we used the RE-AIM framework – a comprehensive evaluative framework composed of 5 dimensions: reach, effectiveness, adoption, implementation, and maintenance. Of the 1178 articles that were screened, 18 were evaluated, and 13 included in this review. The studies were conducted in 12 countries, the majority of which were lower to lower-middle income countries. Designs ranged from quantitative non-randomized studies to qualitative and mixed methods. By using the RE-AIM framework, we found that there was heterogeneity among the studies with regards to whether they addressed reach, effectiveness, adoption, implementation, or maintenance. Common interventions for referring pregnant women to higher levels of care included the use of skilled birth attendants, referral systems, financial incentives, quality of emergency obstetric care, and community health workers. Implementation studies on preterm birth interventions with corticosteroids or magnesium sulfate focused on increasing awareness and knowledge of evidence-based practices using care bundles, online or in person training sessions, focus groups, interviews, and surveys. Overall, we identified how implementation studies increased the use of antenatal corticosteroids and magnesium sulfate and also identified how community health workers, skilled birth attendants, and referral systems can reduce complications from preterm birth. With further review of implementation science research, implementation science can be used to further understand and integrate evidence based-knowledge into practice in a consistent and reproducible matter.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"25 ","pages":"Article 100373"},"PeriodicalIF":1.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143452998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-12DOI: 10.1016/j.eurox.2025.100374
Hiba J. Mustafa , Nikan Zargarzadeh , Kevin L. Moss , May Abiad , Brian Gray , Kjersti M. Aagaard , Terry L. Buchmiller , Erin E. Perrone , Alireza A. Shamshirsaz
Objectives
To investigate the prevalence trend of gastroschisis in the United States between 2014 and 2022.
Methods
A cross-sectional retrospective analysis of the Centers for the United States live births between 2014 and 2022. Pregnancies and neonatal singleton live births with documented isolated gastroschisis were included. Neonates with other major congenital anomalies and known chromosomal abnormalities were excluded. Prevalence per 10,000 live births along with 95 % confidence intervals was estimated.
Results
Among 32,088,301 singleton live births, 6804 cases of isolated gastroschisis were identified (Point prevalence: 2 in 10,000 live births). A significant decline in gastroschisis prevalence was observed, decreasing from 2.86 per 10,000 live births in 2014–1.55 per 10,000 live births in 2022 (P < 0.001). The risk of gastroschisis was significantly higher in teen and nulliparous gravidae, with prepregnancy tobacco use, and among socially vulnerable populations (underweight, < 12th-grade education, Medicaid, non-Hispanic Indigenous Americans). The drop in gastroschisis births from 2014 to 2022, compared to non-gastroschisis births, is more significant in maternal age < 20 years, nulliparous, BMI < 18.5, and in smokers prior to pregnancy than in the overall population (P = 0.02, 0.0008, <0.0001, <0.0001, and 0.01 respectively). All of the associated maternal factors had a significant decline in prevalence (P < 0.001), which may influence the decreasing trend of gastroschisis. There was no perceived considerable impact of the COVID-19 pandemic on gastroschisis trends.
Conclusions
The study highlights a notable decline in gastroschisis prevalence mostly attributable to a declining birth rate in the highest at-risk strata, suggesting recent increases in birth rates among these at-risk gravidae may reverse the trend of declining gastroschisis disease prevalence. These findings support the need for ongoing further research to understand effective means of sustaining this decreasing trend.
{"title":"Decreasing trend of gastroschisis prevalence in the United States from 2014 through 2022: Is attributed to declining birth rates in young, high-risk gravidae","authors":"Hiba J. Mustafa , Nikan Zargarzadeh , Kevin L. Moss , May Abiad , Brian Gray , Kjersti M. Aagaard , Terry L. Buchmiller , Erin E. Perrone , Alireza A. Shamshirsaz","doi":"10.1016/j.eurox.2025.100374","DOIUrl":"10.1016/j.eurox.2025.100374","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the prevalence trend of gastroschisis in the United States between 2014 and 2022.</div></div><div><h3>Methods</h3><div>A cross-sectional retrospective analysis of the Centers for the United States live births between 2014 and 2022. Pregnancies and neonatal singleton live births with documented isolated gastroschisis were included. Neonates with other major congenital anomalies and known chromosomal abnormalities were excluded. Prevalence per 10,000 live births along with 95 % confidence intervals was estimated.</div></div><div><h3>Results</h3><div>Among 32,088,301 singleton live births, 6804 cases of isolated gastroschisis were identified (Point prevalence: 2 in 10,000 live births). A significant decline in gastroschisis prevalence was observed, decreasing from 2.86 per 10,000 live births in 2014–1.55 per 10,000 live births in 2022 (<em>P</em> < 0.001). The risk of gastroschisis was significantly higher in teen and nulliparous gravidae, with prepregnancy tobacco use, and among socially vulnerable populations (underweight, < 12th-grade education, Medicaid, non-Hispanic Indigenous Americans). The drop in gastroschisis births from 2014 to 2022, compared to non-gastroschisis births, is more significant in maternal age < 20 years, nulliparous, BMI < 18.5, and in smokers prior to pregnancy than in the overall population (P = 0.02, 0.0008, <0.0001, <0.0001, and 0.01 respectively). All of the associated maternal factors had a significant decline in prevalence (<em>P</em> < 0.001), which may influence the decreasing trend of gastroschisis. There was no perceived considerable impact of the COVID-19 pandemic on gastroschisis trends.</div></div><div><h3>Conclusions</h3><div>The study highlights a notable decline in gastroschisis prevalence mostly attributable to a declining birth rate in the highest at-risk strata, suggesting recent increases in birth rates among these at-risk gravidae may reverse the trend of declining gastroschisis disease prevalence. These findings support the need for ongoing further research to understand effective means of sustaining this decreasing trend.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"25 ","pages":"Article 100374"},"PeriodicalIF":1.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-11DOI: 10.1016/j.eurox.2025.100372
Bouchra Koullali , Charlotte E. van Dijk , Charlotte E. Kleinrouweler , Jacqueline C.E.J.M.P. Limpens , Ben W. Mol , Martijn A. Oudijk , Eva Pajkrt
The effect of an exam-indicated cerclage (EIC) remains uncertain due to limited evidence from reviews covering pregnancies beyond this timeframe. With the 24-week mark serving as an international threshold for neonatal care initiation, the aim of this systematic review was to evaluate the available literature on the effectiveness of an EIC before 24 weeks of gestation. MEDLINE, EMBASE, Web of Science, CENTRAL, clinicaltrials.gov and WHO-ICTRP were searched for randomized controlled trials, cohort and case-control studies comparing EIC with expectant management in singleton pregnancies with cervical dilation ≤ 5 cm between 14 and 24 weeks of gestation to prevent preterm birth (PTB) < 37 weeks of gestation. Secondary outcomes included obstetrical and neonatal outcomes. Quality assessment was preformed using Newcastle-Ottawa Scale. Analyses were conducted using R(studio) version 3.6.1. and outcomes stated as odds ratios (OR) with 95 % confidence intervals (CI). Prospero: #CRD42019137400. The search yielded 787 potential studies. Four studies non-randomized (retrospective) could be included. Quality assessment showed overall good quality. The main weaknesses were retrospective designs, small sample sizes and the poor comparability of the intervention and control groups. The study population resulted in 215 women, among whom 163 (76 %) underwent cerclage placement and 52 (24 %) were expectantly managed. EIC compared with expectant management was associated with significant lower rates of PTB before 37 weeks (71.2 % vs 94.2 %; OR 0.11; 95 % CI 0.03–0.35), 34 weeks (49.1 % vs 86.5 %; OR 0.10; 95 % CI 0.03–0.31), 32 weeks (43.0 % vs 80.0 %; OR 0.13; 95 % CI 0.04–0.43), 28 weeks (43.0 % vs 75.0 %; OR 0.19; 95 % CI 0.07–0.51) and 24 weeks (23.3 % vs 50 %; OR 0.29; 95 % CI 0.13–0.65) of gestation, significant prolongation of the pregnancy (mean difference 39.14 days; 95 %CI 30.58–47.71; p-value <0.0001) and a greater gestational age at delivery (mean difference 4.91 weeks; 95 % CI 2.32–7.49; p-value 0.0002) compared to expectant management. The current literature suggests that EIC before 24 weeks of gestation is associated with improved pregnancy outcomes compared to expectant management. The results are limited by the lack of randomised trials and studied neonatal outcomes plus the potential for bias in the included studies.
检查表明的环切（EIC）的影响仍然不确定，因为对超过这个时间框架的妊娠的评估证据有限。随着24周标志作为新生儿护理开始的国际门槛，本系统综述的目的是评估关于妊娠24周前EIC有效性的现有文献。我们检索了MEDLINE、EMBASE、Web of Science、CENTRAL、clinicaltrials.gov和WHO-ICTRP的随机对照试验、队列和病例对照研究，比较了妊娠14 - 24周宫颈扩张≤ 5 cm的单胎妊娠和妊娠37周妊娠中EIC与准用药预防早产（PTB）的效果。次要结局包括产科和新生儿结局。采用纽卡斯尔-渥太华量表进行质量评价。使用R(studio) 3.6.1版本进行分析。结果以95% %置信区间（CI）的比值比（OR）表示。普洛斯彼罗:# CRD42019137400。这项搜索产生了787项潜在研究。可纳入4项非随机（回顾性）研究。质量评价显示质量总体良好。主要缺点是回顾性设计，样本量小，干预组和对照组的可比性差。研究人群中有215名妇女，其中163名（76% %）接受了环扎术，52名（24% %）接受了预期治疗。与预期治疗相比，EIC与37周前PTB的发生率显著降低相关(71.2 % vs 94.2 %；或0.11;95 % CI 0.03-0.35)， 34周(49.1 % vs 86.5 %；或0.10;95 % CI 0.03-0.31)， 32周(43.0 % vs 80.0 %；或0.13;95 % CI 0.04-0.43)， 28周(43.0% % vs 75.0% %；或0.19;95 % CI 0.07-0.51)和24周(23.3 % vs 50 %；或0.29;95 % CI 0.13-0.65)，妊娠期明显延长(平均差39.14天；95年 %可信区间30.58 - -47.71;p值<；0.0001)和分娩时较大的胎龄(平均差4.91周；95 % ci 2.32-7.49；p值0.0002)。目前的文献表明，与妊娠管理相比，妊娠24周前的EIC与妊娠结局的改善有关。由于缺乏随机试验和新生儿结局研究，加上纳入的研究可能存在偏倚，结果受到限制。
{"title":"The effect of an exam-indicated cerclage before 24 weeks of gestation to prevent preterm birth: A systematic review and meta-analysis","authors":"Bouchra Koullali , Charlotte E. van Dijk , Charlotte E. Kleinrouweler , Jacqueline C.E.J.M.P. Limpens , Ben W. Mol , Martijn A. Oudijk , Eva Pajkrt","doi":"10.1016/j.eurox.2025.100372","DOIUrl":"10.1016/j.eurox.2025.100372","url":null,"abstract":"<div><div>The effect of an exam-indicated cerclage (EIC) remains uncertain due to limited evidence from reviews covering pregnancies beyond this timeframe. With the 24-week mark serving as an international threshold for neonatal care initiation, the aim of this systematic review was to evaluate the available literature on the effectiveness of an EIC before 24 weeks of gestation. MEDLINE, EMBASE, Web of Science, CENTRAL, clinicaltrials.gov and WHO-ICTRP were searched for randomized controlled trials, cohort and case-control studies comparing EIC with expectant management in singleton pregnancies with cervical dilation ≤ 5 cm between 14 and 24 weeks of gestation to prevent preterm birth (PTB) < 37 weeks of gestation. Secondary outcomes included obstetrical and neonatal outcomes. Quality assessment was preformed using Newcastle-Ottawa Scale. Analyses were conducted using R(studio) version 3.6.1. and outcomes stated as odds ratios (OR) with 95 % confidence intervals (CI). Prospero: #CRD42019137400. The search yielded 787 potential studies. Four studies non-randomized (retrospective) could be included. Quality assessment showed overall good quality. The main weaknesses were retrospective designs, small sample sizes and the poor comparability of the intervention and control groups. The study population resulted in 215 women, among whom 163 (76 %) underwent cerclage placement and 52 (24 %) were expectantly managed. EIC compared with expectant management was associated with significant lower rates of PTB before 37 weeks (71.2 % vs 94.2 %; OR 0.11; 95 % CI 0.03–0.35), 34 weeks (49.1 % vs 86.5 %; OR 0.10; 95 % CI 0.03–0.31), 32 weeks (43.0 % vs 80.0 %; OR 0.13; 95 % CI 0.04–0.43), 28 weeks (43.0 % vs 75.0 %; OR 0.19; 95 % CI 0.07–0.51) and 24 weeks (23.3 % vs 50 %; OR 0.29; 95 % CI 0.13–0.65) of gestation, significant prolongation of the pregnancy (mean difference 39.14 days; 95 %CI 30.58–47.71; p-value <0.0001) and a greater gestational age at delivery (mean difference 4.91 weeks; 95 % CI 2.32–7.49; p-value 0.0002) compared to expectant management. The current literature suggests that EIC before 24 weeks of gestation is associated with improved pregnancy outcomes compared to expectant management. The results are limited by the lack of randomised trials and studied neonatal outcomes plus the potential for bias in the included studies.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"25 ","pages":"Article 100372"},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-06DOI: 10.1016/j.eurox.2025.100371
Dorien Feyaerts , Maïgane Diop , Jose Galaz , Jakob F. Einhaus , Petra C. Arck , Anke Diemert , Virginia D. Winn , Mana Parast , Cynthia Gyamfi-Bannerman , Jelmer R. Prins , Nardhy Gomez-Lopez , Ina A. Stelzer
Precisely timed immune adaptations, observed in the maternal circulation, underpin the notion of an immune clock of human pregnancy that supports its successful progression and completion at delivery. This immune clock is divided into three immunological phases, with the first phase starting at the time of conception and implantation, shifting into the second phase that supports homeostasis and tolerance throughout pregnancy, and culminating in the last phase of labor and parturition. Disruptions of this immune clock are reported in pregnancy complications such as spontaneous preterm birth. However, our understanding of the immune clock preceding spontaneous preterm birth remains scattered. In this review, we describe the chronology of maternal immune cell adaptations during healthy pregnancies and highlight its disruption in spontaneous preterm birth. With a focus on single-cell cytometric, proteomic and transcriptomic approaches, we review recent studies of term and spontaneous preterm pregnancies and discuss the need for future prospective studies aimed at tracking pregnancies longitudinally on a multi-omic scale. Such studies will be critical in determining whether spontaneous preterm pregnancies progress at an accelerated pace or follow a preterm-intrinsic pattern when compared to those delivered at term.
{"title":"The single-cell immune profile throughout gestation and its potential value for identifying women at risk for spontaneous preterm birth","authors":"Dorien Feyaerts , Maïgane Diop , Jose Galaz , Jakob F. Einhaus , Petra C. Arck , Anke Diemert , Virginia D. Winn , Mana Parast , Cynthia Gyamfi-Bannerman , Jelmer R. Prins , Nardhy Gomez-Lopez , Ina A. Stelzer","doi":"10.1016/j.eurox.2025.100371","DOIUrl":"10.1016/j.eurox.2025.100371","url":null,"abstract":"<div><div>Precisely timed immune adaptations, observed in the maternal circulation, underpin the notion of an immune clock of human pregnancy that supports its successful progression and completion at delivery. This immune clock is divided into three immunological phases, with the first phase starting at the time of conception and implantation, shifting into the second phase that supports homeostasis and tolerance throughout pregnancy, and culminating in the last phase of labor and parturition. Disruptions of this immune clock are reported in pregnancy complications such as spontaneous preterm birth. However, our understanding of the immune clock preceding spontaneous preterm birth remains scattered. In this review, we describe the chronology of maternal immune cell adaptations during healthy pregnancies and highlight its disruption in spontaneous preterm birth. With a focus on single-cell cytometric, proteomic and transcriptomic approaches, we review recent studies of term and spontaneous preterm pregnancies and discuss the need for future prospective studies aimed at tracking pregnancies longitudinally on a multi-omic scale. Such studies will be critical in determining whether spontaneous preterm pregnancies progress at an accelerated pace or follow a preterm-intrinsic pattern when compared to those delivered at term.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"25 ","pages":"Article 100371"},"PeriodicalIF":1.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-04DOI: 10.1016/j.eurox.2025.100370
Renata Bortolus , Francesca Filippini , Sonia Cipriani , Daniele Trevisanuto , Federico Marchetti , Pierpaolo Mastroiacovo , Fabio Parazzini , Francesco Cavallin , on behalf of the Italian Folic Acid Trial Study Group
Objective and study design
This 1-year follow-up study reports the results on the health status, visits to the paediatrician and hospitalizations of children born from the women recruited in the main randomized controlled trial (RCT) that investigated the effect of periconception folic acid (FA) supplementation of 4.0 mg/day on reducing adverse reproductive outcomes.
Methods
The health status of livebirths was evaluated by a trained health care provider (HCP) through a phone interview with the paediatrician (at 1–3–12 months of age) and with the parents (at 12 months of age), using a structured data collection form.
Results
Information at 1 year of life could be obtained for 347/376 (92.3 %) newborns included in the original RCT. No statistically significant differences were observed between the two groups regarding weight, health problems, hospitalizations from birth to 1 year of life and developmental milestones, as well as accesses to the emergency ward and parents’worries. Breastfeeding differed significantly at 1, 3 and 12 months of life, with higher proportion of exclusive breastfeeding in the 4.0 mg FA Group.
Conclusion
The findings suggest that the periconception FA supplementation of 4.0 mg/day versus 0.4 mg/day, does not affect the health status and hospitalizations from birth to 1 year of life, as well as normal child’s developmental milestones at 1 year of life. The increase in exclusive breastfeeding in the 4.0 mg FA group needs further investigation.
{"title":"Randomized controlled trial of 4.0 mg versus 0.4 mg folic acid supplementation: Follow-up of children at 1 year of age","authors":"Renata Bortolus , Francesca Filippini , Sonia Cipriani , Daniele Trevisanuto , Federico Marchetti , Pierpaolo Mastroiacovo , Fabio Parazzini , Francesco Cavallin , on behalf of the Italian Folic Acid Trial Study Group","doi":"10.1016/j.eurox.2025.100370","DOIUrl":"10.1016/j.eurox.2025.100370","url":null,"abstract":"<div><h3>Objective and study design</h3><div>This 1-year follow-up study reports the results on the health status, visits to the paediatrician and hospitalizations of children born from the women recruited in the main randomized controlled trial (RCT) that investigated the effect of periconception folic acid (FA) supplementation of 4.0 mg/day on reducing adverse reproductive outcomes.</div></div><div><h3>Methods</h3><div>The health status of livebirths was evaluated by a trained health care provider (HCP) through a phone interview with the paediatrician (at 1–3–12 months of age) and with the parents (at 12 months of age), using a structured data collection form.</div></div><div><h3>Results</h3><div>Information at 1 year of life could be obtained for 347/376 (92.3 %) newborns included in the original RCT. No statistically significant differences were observed between the two groups regarding weight, health problems, hospitalizations from birth to 1 year of life and developmental milestones, as well as accesses to the emergency ward and parents’worries. Breastfeeding differed significantly at 1, 3 and 12 months of life, with higher proportion of exclusive breastfeeding in the 4.0 mg FA Group.</div></div><div><h3>Conclusion</h3><div>The findings suggest that the periconception FA supplementation of 4.0 mg/day versus 0.4 mg/day, does not affect the health status and hospitalizations from birth to 1 year of life, as well as normal child’s developmental milestones at 1 year of life. The increase in exclusive breastfeeding in the 4.0 mg FA group needs further investigation.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"25 ","pages":"Article 100370"},"PeriodicalIF":1.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The efficacy of different uterotonic agents is yet to be determined.
Methods
This was a randomized clinical trial on 240 pregnant mothers with a history of cesarean section in three groups: A: sublingual misoprostol and oxytocin, B: intrauterine misoprostol and oxytocin, and C: a higher dose of oxytocin alone. The intrapartum blood loss and the estimated blood loss within 24 h after surgery were compared between the groups.
Results
The baseline characteristics showed no significant differences among the groups. The volume of blood loss during surgery and within 24 h postpartum did not differ significantly among the groups (A: 230.72 ± 97.30, B: 245.60 ± 88.50, C: 229.02 ± 109.78, p = 0.115, and A: 2023.84 ± 480.08, B: 2045.26 ± 598.99, C: 2025.61 ± 538.93, p = 0.819, respectively).
Conclusion
Intrauterine misoprostol plus oxytocin, sublingual misoprostol plus oxytocin and a higher dose of oxytocin did not show any significant difference in the amount of blood loss during surgery and within 24 h post-operation.
{"title":"The effect of oxytocin, sublingual, and intrauterine misoprostol on blood loss in cesarean delivery: A randomized clinical trial","authors":"Mahdieh Masoumzadeh , Vahideh Rahmani , Manizheh Sayyah-Melli , Anis Sani","doi":"10.1016/j.eurox.2025.100369","DOIUrl":"10.1016/j.eurox.2025.100369","url":null,"abstract":"<div><h3>Background</h3><div>The efficacy of different uterotonic agents is yet to be determined.</div></div><div><h3>Methods</h3><div>This was a randomized clinical trial on 240 pregnant mothers with a history of cesarean section in three groups: A: sublingual misoprostol and oxytocin, B: intrauterine misoprostol and oxytocin, and C: a higher dose of oxytocin alone. The intrapartum blood loss and the estimated blood loss within 24 h after surgery were compared between the groups.</div></div><div><h3>Results</h3><div>The baseline characteristics showed no significant differences among the groups. The volume of blood loss during surgery and within 24 h postpartum did not differ significantly among the groups (A: 230.72 ± 97.30, B: 245.60 ± 88.50, C: 229.02 ± 109.78, p = 0.115, and A: 2023.84 ± 480.08, B: 2045.26 ± 598.99, C: 2025.61 ± 538.93, p = 0.819, respectively).</div></div><div><h3>Conclusion</h3><div>Intrauterine misoprostol plus oxytocin, sublingual misoprostol plus oxytocin and a higher dose of oxytocin did not show any significant difference in the amount of blood loss during surgery and within 24 h post-operation.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"25 ","pages":"Article 100369"},"PeriodicalIF":1.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143327423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abnormal uterine bleeding (AUB) can be associated with underlying endometrial pathology. The current existing guidelines discuss the role of endometrial biopsy in women 40 years old and above, however, there are no clear recommendations for younger women. This study aims to identify the factors that increase the risk of endometrial pathology in women below 40 years of age presenting with AUB for consideration of endometrial biopsy.
Methods
We conducted a retrospective observational study reviewing the records of 464 women aged under 40 years old who underwent endometrial biopsy for AUB. The data analysis included demographics, investigations undertaken, ultrasound findings, biopsy results, and treatment. Multivariable analysis was performed using modified Poisson regression models to compare women with endometrial hyperplasia (EH) (with or without atypia) and endometrial cancer (EC), to those with benign pathology, to identify risk factors for endometrial pathology.
Results
In our study, 71.3 % of women had a benign histology, 22.8 % had EH with and without atypia and 2.2 % of women had a diagnosis of EC. A BMI ≥ 30 (RR 1.76, p = 0.002), nulliparity (RR 1.84, p = 0.001), ultrasound findings of thickened endometrium ≥ 15 mm (RR 1.39, p = 0.048) and cystic spaces in the endometrium (RR 1.83, p < 0.001) were identified as significant risk factors after a multivariate analysis. A combination of at least 3 of these risk factors had a cumulative increased risk of EH/EC (RR 3.80, p < 0.001).
Conclusion
Endometrial biopsy in younger women with AUB should be carefully considered on a case-by-case basis and reserved for those with risk factors for a serious endometrial pathology.
目的子宫异常出血（AUB）可能与子宫内膜潜在病理有关。目前现有的指南讨论了子宫内膜活检在40岁及以上女性中的作用，然而，对于年轻女性没有明确的建议。本研究旨在确定增加40岁以下AUB女性子宫内膜病理风险的因素，以考虑子宫内膜活检。方法对464例40岁以下因AUB接受子宫内膜活检的女性进行回顾性观察性研究。数据分析包括人口统计、调查、超声检查结果、活检结果和治疗。采用改良泊松回归模型进行多变量分析，比较子宫内膜增生（EH）（伴或不伴异型）和子宫内膜癌（EC）与良性病理的妇女，以确定子宫内膜病理的危险因素。结果71.3% %的妇女为良性组织，22.8% %的妇女为EH伴或不伴异型，2.2% %的妇女诊断为EC。BMI≥ 30 (RR 1.76, p = 0.002),未产妇(RR 1.84, p = 0.001),超声发现增厚的子宫内膜≥ 15毫米(RR 1.39, p = 0.048)和子宫内膜囊性空腔(RR 1.83, p & lt; 0.001)后被确定为重大风险因素多变量分析。这些危险因素中至少3个的组合会增加EH/EC的累积风险（RR 3.80, p <； 0.001）。结论年轻AUB女性应根据具体情况仔细考虑子宫内膜活检，并保留给有严重子宫内膜病理危险因素的患者。
{"title":"To do or not to do? – Endometrial biopsy in younger women with abnormal uterine bleeding","authors":"Sandra Lynn Jaya-Bodestyne , Marlene Samantha Goh , Madeline Chan Hiu Gwan , Sonali Prashant Chonkar , Khurshid Merchant , Manisha Mathur","doi":"10.1016/j.eurox.2025.100368","DOIUrl":"10.1016/j.eurox.2025.100368","url":null,"abstract":"<div><h3>Objective</h3><div>Abnormal uterine bleeding (AUB) can be associated with underlying endometrial pathology. The current existing guidelines discuss the role of endometrial biopsy in women 40 years old and above, however, there are no clear recommendations for younger women. This study aims to identify the factors that increase the risk of endometrial pathology in women below 40 years of age presenting with AUB for consideration of endometrial biopsy.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study reviewing the records of 464 women aged under 40 years old who underwent endometrial biopsy for AUB. The data analysis included demographics, investigations undertaken, ultrasound findings, biopsy results, and treatment. Multivariable analysis was performed using modified Poisson regression models to compare women with endometrial hyperplasia (EH) (with or without atypia) and endometrial cancer (EC), to those with benign pathology, to identify risk factors for endometrial pathology.</div></div><div><h3>Results</h3><div>In our study, 71.3 % of women had a benign histology, 22.8 % had EH with and without atypia and 2.2 % of women had a diagnosis of EC. A BMI ≥ 30 (RR 1.76, p = 0.002), nulliparity (RR 1.84, p = 0.001), ultrasound findings of thickened endometrium ≥ 15 mm (RR 1.39, p = 0.048) and cystic spaces in the endometrium (RR 1.83, p < 0.001) were identified as significant risk factors after a multivariate analysis. A combination of at least 3 of these risk factors had a cumulative increased risk of EH/EC (RR 3.80, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Endometrial biopsy in younger women with AUB should be carefully considered on a case-by-case basis and reserved for those with risk factors for a serious endometrial pathology.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"25 ","pages":"Article 100368"},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-23DOI: 10.1016/j.eurox.2025.100366
M. Fasero , M. Sanchez , L. Baquedano , I. Gippini , D. Fuentes , C. Navarro , E. Beltrán , M. Lilue , I. Porcel , C. Pingarrón , M. Herrero , P. Romero , T. Ortega , E. Carretero , S. Palacios , N. Mendoza , P.J. Coronado
This project aims to develop recommendations for treating vasomotor symptoms (VMS) based on the Cervantes short-form scale score (menopausal domain) using the best available evidence. A total of 166 studies were selected: 108 randomized controlled trials, 23 systematic reviews, 3 reviews, 3 meta-analyses, 11 case-control studies, 9 observational studies, and 12 transversal studies. To achieve this objective, a series of PICO (Patient, Intervention, Comparison, and Outcome) questions have been established for the treatment of VMS. We evaluate the quality of the scientific evidence and, with the findings, create a decision framework to treat hot flashes based on the Cervantes short-form scale score.
{"title":"Management of menopausal hot flushes. Recommendations from the Spanish Menopause Society","authors":"M. Fasero , M. Sanchez , L. Baquedano , I. Gippini , D. Fuentes , C. Navarro , E. Beltrán , M. Lilue , I. Porcel , C. Pingarrón , M. Herrero , P. Romero , T. Ortega , E. Carretero , S. Palacios , N. Mendoza , P.J. Coronado","doi":"10.1016/j.eurox.2025.100366","DOIUrl":"10.1016/j.eurox.2025.100366","url":null,"abstract":"<div><div>This project aims to develop recommendations for treating vasomotor symptoms (VMS) based on the Cervantes short-form scale score (menopausal domain) using the best available evidence. A total of 166 studies were selected: 108 randomized controlled trials, 23 systematic reviews, 3 reviews, 3 meta-analyses, 11 case-control studies, 9 observational studies, and 12 transversal studies. To achieve this objective, a series of PICO (Patient, Intervention, Comparison, and Outcome) questions have been established for the treatment of VMS. We evaluate the quality of the scientific evidence and, with the findings, create a decision framework to treat hot flashes based on the Cervantes short-form scale score.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"25 ","pages":"Article 100366"},"PeriodicalIF":1.5,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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