To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria.
Design
A secondary data analysis using a cross-sectional design.
Setting
Referral-level hospitals (48 public and six private facilities).
Population
Women admitted for birth between 1 September 2019 and 31 August 2020.
Methods
Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model.
Main outcome measures
Prevalence of PPH and maternal and neonatal outcomes.
Results
Of 68 754 women, 2169 (3.2%, 95% CI 3.07%–3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%–2.85%) and 4.0% (95% CI 3.75%–4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8–2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1–3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4–14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5–2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4–4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8–4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions.
Conclusions
A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.
{"title":"Burden and outcomes of postpartum haemorrhage in Nigerian referral-level hospitals","authors":"Tajudeen Adebayo, Ayodeji Adefemi, Idowu Adewumi, Opeyemi Akinajo, Bola Akinkunmi, David Awonuga, Olufemi Aworinde, Ekundayo Ayegbusi, Iyabode Dedeke, Iretiola Fajolu, Zainab Imam, Olusoji Jagun, Olumide Kuku, Ezra Ogundare, Timothy Oluwasola, Lawal Oyeneyin, Damilola Adebanjo-Aina, Emmanuel Adenuga, Alaruru Adeyanju, Olufemi Akinsanya, Ibijoke Campbell, Bankole Kuti, Babatunde Olofinbiyi, Qasim Salau, Olukemi Tongo, Bosede Ezekwe, Tina Lavin, Olufemi T. Oladapo, Jamilu Tukur, Olubukola Adesina","doi":"10.1111/1471-0528.17822","DOIUrl":"10.1111/1471-0528.17822","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A secondary data analysis using a cross-sectional design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Referral-level hospitals (48 public and six private facilities).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women admitted for birth between 1 September 2019 and 31 August 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Prevalence of PPH and maternal and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 68 754 women, 2169 (3.2%, 95% CI 3.07%–3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%–2.85%) and 4.0% (95% CI 3.75%–4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8–2.6, <i>P</i> < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1–3.5, <i>P</i> < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4–14.7, <i>P</i> < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5–2.0, <i>P</i> < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4–4.0, <i>P</i> = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8–4.7, <i>P</i> < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17822","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140814928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this issue of BJOG, I like to highlight the issues relating to the definition of unexplained infertility and the perception of medical students on a career choice of obstetrics and gynaecology.
The concept of unexplained infertility is relatively simple. It is the diagnosis of infertility when all the other known causes such as lack of ovulation, fallopian tubal damage, inadequate sperm count and function, abnormalities of the uterine cavity as well as gynaecological conditions such as endometriosis and adenomyosis have been excluded. Despite the knowledge of the above extensive list of causes of infertility, Raperport and colleagues reported there is still a wide variation in the criteria used to diagnose this condition (pages 880–897). As usual, the devil lies in the details in the definitions employed in the various published guidelines. In their systematic review, they found that not all guidelines recommend the use of recognised diagnostic tests to diagnose the causes of infertility and different diagnostic criteria were also employed for each of these tests. For example, not all definitions require the use of formal day 21 serum progesterone or mid-cycle luteinising hormone surge to diagnose the presence of ovulation as long as there is a history of a regular menstrual cycle. Nearly 30% of the published articles did not specify any criteria on an adequate semen analysis. There is also disagreement on whether the presence unilateral alone or bilateral tubal patency is required to be present in order to exclude the diagnosis of tubal damage as a cause of infertility.
The heterogeneity in the infertility cases labelled as unexplained results in bias when comparing treatment effects reported from different randomised controlled trials as well as when the data from these trials are pooled in a systematic review. It may also result in the patient being prescribed an inappropriate treatment in some cases such as when the diagnosis of endometriosis was not detected during any empirical ovulation induction or assisted reproductive technology treatment.
The authors from this review have therefore called for a harmonisation of the definition of unexplained infertility in order to improve the quality of future research and management for this condition. This call is also echoed by Tarek El-Toukhy, one of our scientific editors, on page 898. A universally adopted definition will reduce the risk of recruitment bias into clinical trials and hence allow meaningful comparison of treatment strategies. This is akin to the call for the establishment of core outcome sets in order to minimise the risk of ascertainment bias.
It is well-known that undergraduate clinical attachments to the different specialities in medicine may have a profound effect on the subsequent career choice for some medical students. This is certainly the case for me after I have completed my undergraduate obstetrics and gynaecology attachment. For others, this
过去几十年来，随着《欧洲工作时间指令》的出台，英国的工作条件有了显著改善，在打击工作欺凌和骚扰方面也取得了进展，但其他地方的情况可能并非如此。在第 969 页，魏斯曼用 "顾客最了解顾客 "这一基本营销原则做了一个很好的比喻，说明我们需要倾听和重视 "顾客 "的关切和愿望，在这种情况下，"顾客 "就是决定从事医学专业的医学生。我们应该应用 Sein 及其同事的研究结果，实施能够满足所报告的关切的措施。
{"title":"Definition of unexplained infertility and career choice of obstetrics and gynaecology for medical students","authors":"Patrick Chien","doi":"10.1111/1471-0528.17827","DOIUrl":"https://doi.org/10.1111/1471-0528.17827","url":null,"abstract":"<p>In this issue of BJOG, I like to highlight the issues relating to the definition of unexplained infertility and the perception of medical students on a career choice of obstetrics and gynaecology.</p><p>The concept of unexplained infertility is relatively simple. It is the diagnosis of infertility when all the other known causes such as lack of ovulation, fallopian tubal damage, inadequate sperm count and function, abnormalities of the uterine cavity as well as gynaecological conditions such as endometriosis and adenomyosis have been excluded. Despite the knowledge of the above extensive list of causes of infertility, Raperport and colleagues reported there is still a wide variation in the criteria used to diagnose this condition (pages 880–897). As usual, the devil lies in the details in the definitions employed in the various published guidelines. In their systematic review, they found that not all guidelines recommend the use of recognised diagnostic tests to diagnose the causes of infertility and different diagnostic criteria were also employed for each of these tests. For example, not all definitions require the use of formal day 21 serum progesterone or mid-cycle luteinising hormone surge to diagnose the presence of ovulation as long as there is a history of a regular menstrual cycle. Nearly 30% of the published articles did not specify any criteria on an adequate semen analysis. There is also disagreement on whether the presence unilateral alone or bilateral tubal patency is required to be present in order to exclude the diagnosis of tubal damage as a cause of infertility.</p><p>The heterogeneity in the infertility cases labelled as unexplained results in bias when comparing treatment effects reported from different randomised controlled trials as well as when the data from these trials are pooled in a systematic review. It may also result in the patient being prescribed an inappropriate treatment in some cases such as when the diagnosis of endometriosis was not detected during any empirical ovulation induction or assisted reproductive technology treatment.</p><p>The authors from this review have therefore called for a harmonisation of the definition of unexplained infertility in order to improve the quality of future research and management for this condition. This call is also echoed by Tarek El-Toukhy, one of our scientific editors, on page 898. A universally adopted definition will reduce the risk of recruitment bias into clinical trials and hence allow meaningful comparison of treatment strategies. This is akin to the call for the establishment of core outcome sets in order to minimise the risk of ascertainment bias.</p><p>It is well-known that undergraduate clinical attachments to the different specialities in medicine may have a profound effect on the subsequent career choice for some medical students. This is certainly the case for me after I have completed my undergraduate obstetrics and gynaecology attachment. For others, this","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17827","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140648222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jennifer C. Davies, Alexandra Sargent, Elisabeth Pinggera, Suzanne Carter, Clare Gilham, Peter Sasieni, Emma J. Crosbie
<div> <section> <h3> Objective</h3> <p>To evaluate the sensitivity of human papillomavirus (HPV) tested urine to detect high-grade cervical precancer (cervical intraepithelial neoplasia grade 2+ [CIN2+]) using two urine collection devices.</p> </section> <section> <h3> Design</h3> <p>Randomised controlled trial.</p> </section> <section> <h3> Setting</h3> <p>St Mary's Hospital, Manchester, UK.</p> </section> <section> <h3> Population</h3> <p>Colposcopy attendees with abnormal cervical screening; a total of 480 participants were randomised. Matched urine and cervical samples were available for 235 and 230 participants using a first-void urine (FVU)-collection device and standard pot, respectively.</p> </section> <section> <h3> Methods</h3> <p>Urine was self-collected and mixed with preservative – randomised 1:1 to FVU-collection device (Novosanis Colli-pee® 10 mL with urine conservation medium [UCM]) or standard pot. Matched clinician-collected cervical samples were taken before colposcopy. HPV testing used Roche cobas® 8800. A questionnaire evaluated urine self-sampling acceptability.</p> </section> <section> <h3> Main outcome measures</h3> <p>The primary outcome measured sensitivity of HPV-tested urine (FVU-collection device and standard pot) for CIN2+ detection. Secondary outcomes compared HPV-tested cervical and urine samples for CIN2+ and evaluated the acceptability of urine self-sampling.</p> </section> <section> <h3> Results</h3> <p>Urine HPV test sensitivity for CIN2+ was higher with the FVU-collection device (90.3%, 95% CI 83.7%–94.9%, 112/124) than the standard pot (73.4%, 95% CI 64.7%–80.9%, 91/124, <i>p</i> = 0.0005). The relative sensitivity of FVU-device-collected urine was 0.92 (95% CI 0.87–0.97, <i>p</i><sub>McN</sub> = 0.004) compared with cervical, considering that all women were referred after a positive cervical HPV test. Urine-based sampling was acceptable to colposcopy attendees.</p> </section> <section> <h3> Conclusions</h3> <p>Testing of FVU-device-collected urine for HPV was superior to standard-pot-collected urine in colposcopy attendees and has promising sensitivity for CIN2+ detection. General population HPV testing of FVU
{"title":"Urine high-risk human papillomavirus testing as an alternative to routine cervical screening: A comparative diagnostic accuracy study of two urine collection devices using a randomised study design trial","authors":"Jennifer C. Davies, Alexandra Sargent, Elisabeth Pinggera, Suzanne Carter, Clare Gilham, Peter Sasieni, Emma J. Crosbie","doi":"10.1111/1471-0528.17831","DOIUrl":"10.1111/1471-0528.17831","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the sensitivity of human papillomavirus (HPV) tested urine to detect high-grade cervical precancer (cervical intraepithelial neoplasia grade 2+ [CIN2+]) using two urine collection devices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Randomised controlled trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>St Mary's Hospital, Manchester, UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Colposcopy attendees with abnormal cervical screening; a total of 480 participants were randomised. Matched urine and cervical samples were available for 235 and 230 participants using a first-void urine (FVU)-collection device and standard pot, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Urine was self-collected and mixed with preservative – randomised 1:1 to FVU-collection device (Novosanis Colli-pee® 10 mL with urine conservation medium [UCM]) or standard pot. Matched clinician-collected cervical samples were taken before colposcopy. HPV testing used Roche cobas® 8800. A questionnaire evaluated urine self-sampling acceptability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>The primary outcome measured sensitivity of HPV-tested urine (FVU-collection device and standard pot) for CIN2+ detection. Secondary outcomes compared HPV-tested cervical and urine samples for CIN2+ and evaluated the acceptability of urine self-sampling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Urine HPV test sensitivity for CIN2+ was higher with the FVU-collection device (90.3%, 95% CI 83.7%–94.9%, 112/124) than the standard pot (73.4%, 95% CI 64.7%–80.9%, 91/124, <i>p</i> = 0.0005). The relative sensitivity of FVU-device-collected urine was 0.92 (95% CI 0.87–0.97, <i>p</i><sub>McN</sub> = 0.004) compared with cervical, considering that all women were referred after a positive cervical HPV test. Urine-based sampling was acceptable to colposcopy attendees.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Testing of FVU-device-collected urine for HPV was superior to standard-pot-collected urine in colposcopy attendees and has promising sensitivity for CIN2+ detection. General population HPV testing of FVU","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17831","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140642959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michela Tinelli, Antonios Athanasiou, Areti Angeliki Veroniki, Orestis Efthimiou, Ilkka Kalliala, Sarah Bowden, Maria Paraskevaidi, Deirdre Lyons, Pierre Martin-Hirsch, Phillip Bennett, Evangelos Paraskevaidis, Georgia Salanti, Maria Kyrgiou, Huseyin Naci
Objective
To compare the cost-effectiveness of different treatments for cervical intraepithelial neoplasia (CIN).
Design
A cost-effectiveness analysis based on data available in the literature and expert opinion.
Setting
England.
Population
Women treated for CIN.
Methods
We developed a decision-analytic model to simulate the clinical course of 1000 women who received local treatment for CIN and were followed up for 10 years after treatment. In the model we considered surgical complications as well as oncological and reproductive outcomes over the 10-year period. The costs calculated were those incurred by the National Health Service (NHS) of England.
Main outcome measures
Cost per one CIN2+ recurrence averted (oncological outcome); cost per one preterm birth averted (reproductive outcome); overall cost per one adverse oncological or reproductive outcome averted.
Results
For young women of reproductive age, large loop excision of the transformation zone (LLETZ) was the most cost-effective treatment overall at all willingness-to-pay thresholds. For postmenopausal women, LLETZ remained the most cost-effective treatment up to a threshold of £31,500, but laser conisation became the most cost-effective treatment above that threshold.
Conclusions
LLETZ is the most cost-effective treatment for both younger and older women. However, for older women, more radical excision with laser conisation could also be considered if the NHS is willing to spend more than £31,500 to avert one CIN2+ recurrence.
比较宫颈上皮内瘤变（CIN）不同治疗方法的成本效益。
{"title":"Treatment methods for cervical intraepithelial neoplasia in England: A cost-effectiveness analysis","authors":"Michela Tinelli, Antonios Athanasiou, Areti Angeliki Veroniki, Orestis Efthimiou, Ilkka Kalliala, Sarah Bowden, Maria Paraskevaidi, Deirdre Lyons, Pierre Martin-Hirsch, Phillip Bennett, Evangelos Paraskevaidis, Georgia Salanti, Maria Kyrgiou, Huseyin Naci","doi":"10.1111/1471-0528.17829","DOIUrl":"10.1111/1471-0528.17829","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the cost-effectiveness of different treatments for cervical intraepithelial neoplasia (CIN).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A cost-effectiveness analysis based on data available in the literature and expert opinion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>England.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women treated for CIN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We developed a decision-analytic model to simulate the clinical course of 1000 women who received local treatment for CIN and were followed up for 10 years after treatment. In the model we considered surgical complications as well as oncological and reproductive outcomes over the 10-year period. The costs calculated were those incurred by the National Health Service (NHS) of England.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Cost per one CIN2+ recurrence averted (oncological outcome); cost per one preterm birth averted (reproductive outcome); overall cost per one adverse oncological or reproductive outcome averted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For young women of reproductive age, large loop excision of the transformation zone (LLETZ) was the most cost-effective treatment overall at all willingness-to-pay thresholds. For postmenopausal women, LLETZ remained the most cost-effective treatment up to a threshold of £31,500, but laser conisation became the most cost-effective treatment above that threshold.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LLETZ is the most cost-effective treatment for both younger and older women. However, for older women, more radical excision with laser conisation could also be considered if the NHS is willing to spend more than £31,500 to avert one CIN2+ recurrence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17829","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140643113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To examine long-term complications in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP), with and without surgical mesh implants.
Design
Longitudinal open cohort study from 1 April 2006 (or 1 April 2012) to 30 November 2018.
Setting
The Clinical Practice Research Datalink (CPRD) Gold database, which is linked to Hospital Episodes Statistics (HES) inpatient data, the HES Diagnostic Imaging Dataset (DID), Office for National Statistics mortality data and Index of Multiple Deprivation socio-economic status data.
Sample
Women aged ≥18 years with a diagnostic SUI/POP Read code.
Methods
Rates are estimated using negative binomial regression.
Main outcome measures
Rates of referrals for: psychological and pain services; urinalysis, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) testing; and pelvic ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) scans.
Results
A cohort of 220 544 women were eligible for inclusion; 74% (n = 162 687) had SUI, 37% (n = 82 123) had POP and 11% (n = 24 266) had both. Rates of psychological referrals and CT scans were lower in women with SUI mesh surgery, but this was offset by higher rates of CRP testing in women with SUI or POP mesh, MRI scans in women with SUI mesh, and urinalysis testing and referrals to pain clinics for women with POP mesh.
Conclusions
Our results suggest a higher burden of morbidity in women with SUI/POP mesh surgery, and that these women may require ongoing follow-up in the primary care setting.
目的研究患有压力性尿失禁（SUI）和盆腔器官脱垂（POP）的女性在植入和未植入手术网片的情况下的长期并发症.设计2006年4月1日（或2012年4月1日）至2018年11月30日的纵向开放队列研究.设置临床实践研究数据链（CPRD）黄金数据库，该数据库与医院发病统计（HES）住院病人数据、HES诊断成像数据集（DID）、国家统计局死亡率数据和多重贫困指数社会经济状况数据相连接。主要结果测量转诊率：心理和疼痛服务；尿液分析、C反应蛋白（CRP）和红细胞沉降率（ESR）检测；盆腔超声波、计算机断层扫描（CT）和磁共振成像（MRI）扫描。结果220 544名妇女符合纳入条件，其中74%（n = 162 687）患有SUI，37%（n = 82 123）患有POP，11%（n = 24 266）同时患有SUI和POP。接受 SUI 网片手术的妇女接受心理转诊和 CT 扫描的比例较低，但接受 SUI 或 POP 网片手术的妇女接受 CRP 检测的比例较高，接受 SUI 网片手术的妇女接受 MRI 扫描的比例较高，接受 POP 网片手术的妇女接受尿液分析检测和疼痛诊所转诊的比例较高，从而抵消了上述比例。
{"title":"The long-term impact of vaginal surgical mesh devices on pain clinic and psychological service referrals, anti-inflammatory testing and pelvic scans in UK primary care: A cohort study with the Clinical Practice Research Datalink","authors":"Emily McFadden, Carl Heneghan","doi":"10.1111/1471-0528.17828","DOIUrl":"10.1111/1471-0528.17828","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine long-term complications in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP), with and without surgical mesh implants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Longitudinal open cohort study from 1 April 2006 (or 1 April 2012) to 30 November 2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The Clinical Practice Research Datalink (CPRD) Gold database, which is linked to Hospital Episodes Statistics (HES) inpatient data, the HES Diagnostic Imaging Dataset (DID), Office for National Statistics mortality data and Index of Multiple Deprivation socio-economic status data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Women aged ≥18 years with a diagnostic SUI/POP Read code.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Rates are estimated using negative binomial regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Rates of referrals for: psychological and pain services; urinalysis, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) testing; and pelvic ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) scans.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A cohort of 220 544 women were eligible for inclusion; 74% (<i>n</i> = 162 687) had SUI, 37% (<i>n</i> = 82 123) had POP and 11% (<i>n</i> = 24 266) had both. Rates of psychological referrals and CT scans were lower in women with SUI mesh surgery, but this was offset by higher rates of CRP testing in women with SUI or POP mesh, MRI scans in women with SUI mesh, and urinalysis testing and referrals to pain clinics for women with POP mesh.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results suggest a higher burden of morbidity in women with SUI/POP mesh surgery, and that these women may require ongoing follow-up in the primary care setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17828","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140636132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laura Cattani, Dominique Van Schoubroeck, Christine De Bruyn, Sophie Ghesquière, Jan Deprest
Objective
To determine the prevalence of pelvic floor dysfunction (PFD) among pregnant women, their clustering and their association with body image disturbance (BID) up to 1 year postpartum.
Design
Monocentric prospective cohort study.
Setting
University Hospitals Leuven.
Population
Pregnant women attending for pregnancy care, first assessed prior to 14 weeks of gestation and agreeing to follow-up until 1 year postpartum.
Methods
Standardised questionnaires reporting on PFD and BID at 12–14 and 28–32 weeks of gestation, and again at 6–8 weeks and 1 year postpartum. We calculated the prevalence of PFD, how the cases clustered and how the cases correlated with BID using a linear mixed-model analysis. A minimum of 174 women with complete follow-up were required.
Main Outcome Measures
The questionnaires used were the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF), St. Mark's Incontinence Score (SMIS), Patient Assessment of Constipation Symptoms (PAC-SYM), Pelvic Organ Prolapse Distress Inventory (POPDI), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA Revised (PISQ-IR) and the Body Image Disturbance Questionnaire (BIDQ).
Results
Out of 208 women, 92.8% reported one or multiple symptoms of PFD at 28–32 weeks of gestation, dropping to 73.6% by 1 year postpartum. The most common symptoms were constipation (65.3% at 28–32 weeks of gestation and 42.8% at 1 year postpartum) and urinary incontinence (56.8% at 28–32 weeks of gestation and 35.1% at 1 year postpartum). After correcting for body mass index, parity and mode of delivery, the severity of BID was associated with the ICIQ-UI SF score (β = 0.016, range 0.007–0.024), the PAC-SYM score (β = 0.006, range 0.002–0.011) and the POPDI score (β = 0.009, range 0.005–0.012), but not with the SMIS score (β = 0.015, range −0.001 to 0.031) or the PISQ-IR score, in sexually active women.
Conclusions
Urinary incontinence, constipation and symptoms of prolapse have a measurable impact on BID.
{"title":"Body image and pelvic floor dysfunction in pregnancy and postpartum: A prospective one-year follow-up cohort study","authors":"Laura Cattani, Dominique Van Schoubroeck, Christine De Bruyn, Sophie Ghesquière, Jan Deprest","doi":"10.1111/1471-0528.17820","DOIUrl":"10.1111/1471-0528.17820","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the prevalence of pelvic floor dysfunction (PFD) among pregnant women, their clustering and their association with body image disturbance (BID) up to 1 year postpartum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Monocentric prospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>University Hospitals Leuven.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Pregnant women attending for pregnancy care, first assessed prior to 14 weeks of gestation and agreeing to follow-up until 1 year postpartum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Standardised questionnaires reporting on PFD and BID at 12–14 and 28–32 weeks of gestation, and again at 6–8 weeks and 1 year postpartum. We calculated the prevalence of PFD, how the cases clustered and how the cases correlated with BID using a linear mixed-model analysis. A minimum of 174 women with complete follow-up were required.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The questionnaires used were the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF), St. Mark's Incontinence Score (SMIS), Patient Assessment of Constipation Symptoms (PAC-SYM), Pelvic Organ Prolapse Distress Inventory (POPDI), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA Revised (PISQ-IR) and the Body Image Disturbance Questionnaire (BIDQ).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 208 women, 92.8% reported one or multiple symptoms of PFD at 28–32 weeks of gestation, dropping to 73.6% by 1 year postpartum. The most common symptoms were constipation (65.3% at 28–32 weeks of gestation and 42.8% at 1 year postpartum) and urinary incontinence (56.8% at 28–32 weeks of gestation and 35.1% at 1 year postpartum). After correcting for body mass index, parity and mode of delivery, the severity of BID was associated with the ICIQ-UI SF score (<i>β</i> = 0.016, range 0.007–0.024), the PAC-SYM score (<i>β</i> = 0.006, range 0.002–0.011) and the POPDI score (<i>β</i> = 0.009, range 0.005–0.012), but not with the SMIS score (<i>β</i> = 0.015, range −0.001 to 0.031) or the PISQ-IR score, in sexually active women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Urinary incontinence, constipation and symptoms of prolapse have a measurable impact on BID.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140607458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Agnes Rygaard, Maria Jonsson, Anna-Karin Wikström, Sophia Brismar-Wendel, Susanne Hesselman
Objective
To investigate whether perineal wound complications in the first birth, alone or in conjunction with obstetric anal sphincter injury (OASI), is associated with an increased risk of OASI in the second birth.
Design
Nationwide population-based cohort study.
Setting
Sweden.
Population
Women (n = 411 317) with first and second singleton vaginal births in Sweden, 2001–2019.
Methods
Data on diagnostic codes and surgical procedures were retrieved from the Swedish Medical Birth Register and the Swedish Patient Register. A perineal wound complication was defined as wound infection, dehiscence or perineal haematoma within 2 months of childbirth.
Main outcome measures
Associations between wound complications in the first birth and OASI in the second birth were investigated with logistic regression and presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs).
Results
In total, 2619 (0.6%) women had a wound complication in the first birth, and 5318 (1.3%) had an OASI in the second birth. Women with a wound complication but no OASI in the first birth had more than doubled odds of OASI in the second birth (aOR 2.73, 95% CI 2.11–3.53). Women with OASI and a wound complication in the first birth had almost tenfold odds (aOR 9.97, 95% CI 6.53–15.24) of recurrent OASI.
Conclusions
Perineal wound complication in the first birth increases the likelihood of OASI in a subsequent birth.
{"title":"Obstetric anal sphincter injury in the second birth after perineal wound complication in the first birth: A nationwide register cohort study","authors":"Agnes Rygaard, Maria Jonsson, Anna-Karin Wikström, Sophia Brismar-Wendel, Susanne Hesselman","doi":"10.1111/1471-0528.17830","DOIUrl":"10.1111/1471-0528.17830","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate whether perineal wound complications in the first birth, alone or in conjunction with obstetric anal sphincter injury (OASI), is associated with an increased risk of OASI in the second birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Nationwide population-based cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women (<i>n</i> = 411 317) with first and second singleton vaginal births in Sweden, 2001–2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data on diagnostic codes and surgical procedures were retrieved from the Swedish Medical Birth Register and the Swedish Patient Register. A perineal wound complication was defined as wound infection, dehiscence or perineal haematoma within 2 months of childbirth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Associations between wound complications in the first birth and OASI in the second birth were investigated with logistic regression and presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 2619 (0.6%) women had a wound complication in the first birth, and 5318 (1.3%) had an OASI in the second birth. Women with a wound complication but no OASI in the first birth had more than doubled odds of OASI in the second birth (aOR 2.73, 95% CI 2.11–3.53). Women with OASI and a wound complication in the first birth had almost tenfold odds (aOR 9.97, 95% CI 6.53–15.24) of recurrent OASI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Perineal wound complication in the first birth increases the likelihood of OASI in a subsequent birth.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17830","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140607882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samuel Adelaiye, Ishaya Wanonyi, Abiodun Adanikin, Abdulkarim Mairiga, Abubakar Kadas, Joel Morrupa, Tina Lavin, Abubakar Lamara, Ibrahim Yahaya, Jamilu Tukur, Calvin Chama
Objective
To estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria.
Design
Retrospective observational study.
Setting
A total of 54 referral-level hospitals across the six geopolitical regions of Nigeria.
Population
Pregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020.
Methods
Secondary analysis of routine maternity care data sets. Random-effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour.
Main outcome measures
Risk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis.
Results
Obstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50–2.75), who lacked formal education (OR 1.88, 95% CI 1.55–2.30), were unemployed (OR 1.94, 95% CI 1.57–2.41), were nulliparous (OR 2.11, 95% CI 1.83–2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53–4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41–15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death.
Conclusions
Modifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions.
估计尼日利亚转诊医院网络中难产的发生率、相关风险因素和结果。
{"title":"Determinants of obstructed labour and associated outcomes in referral hospitals in Nigeria","authors":"Samuel Adelaiye, Ishaya Wanonyi, Abiodun Adanikin, Abdulkarim Mairiga, Abubakar Kadas, Joel Morrupa, Tina Lavin, Abubakar Lamara, Ibrahim Yahaya, Jamilu Tukur, Calvin Chama","doi":"10.1111/1471-0528.17826","DOIUrl":"10.1111/1471-0528.17826","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective observational study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A total of 54 referral-level hospitals across the six geopolitical regions of Nigeria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Pregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Secondary analysis of routine maternity care data sets. Random-effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Risk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Obstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50–2.75), who lacked formal education (OR 1.88, 95% CI 1.55–2.30), were unemployed (OR 1.94, 95% CI 1.57–2.41), were nulliparous (OR 2.11, 95% CI 1.83–2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53–4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41–15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Modifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17826","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140553699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahalakshmi Gurumurthy, Alice E. McGee, Lucky Saraswat
Background
There is a lack of robust evidence to recommend the use of perioperative ureteric catheterisation or stenting in complex gynaecological surgery.
Objectives
To evaluate the evidence on the benefits and risks of perioperative ureteric catheterisation or stenting in complex gynaecological surgery.
Search strategy
A literature search was performed in CINAHL, the Cochrane Library, Embase and MEDLINE, from 1946 to January 2024, using a combination of keywords and Medical Subject Headings (MeSH) terminology.
Selection criteria
Randomised controlled trials (RCTs) and observational studies were included.
Data collection and analysis
Meta-analysis of the RCTs and observational studies were performed separately. Cochrane RevMan 6.5.1 was used to undertake meta-analysis. Risk ratios with 95% CIs were calculated for the outcome measures.
Main results
Ten studies were included: three RCTs and seven observational studies, comprising 8661 patients. The three RCTs, comprising a total of 3277 patients, showed no difference in the risk of immediate complications in the form of ureteric injury between the ureteric stent and the control groups (RR 0.9, 95% CI 0.49–1.65). The observational studies included 5384 patients. Four studies that explored the ureteric injury as an outcome did not show any difference between the two groups (RR 0.76, 95% CI 0.27–2.16). One case–control study with 862 participants found that the rate of ureteric injury was higher in the non-stented group, although this was observed in only three patients. The risk of urinary tract infection (UTI) was increased in the stent group, although not with statistical significance (RR 1.84, 95% CI 0.47–7.17). There was no significant difference in the risk of ureteric fistulae (RR 1.91, 95% CI 0.62–5.83), although the number of studies was limited.
Conclusions
Prophylactic ureteric catheterisation or stenting for complex gynaecological surgery is not associated with a lower risk of ureteric injury.
在复杂的妇科手术中使用围手术期输尿管导管插入术或支架植入术的建议缺乏有力的证据。
{"title":"Prophylactic ureteric catheterisation during complex gynaecological surgery: A systematic review and meta-analysis","authors":"Mahalakshmi Gurumurthy, Alice E. McGee, Lucky Saraswat","doi":"10.1111/1471-0528.17823","DOIUrl":"10.1111/1471-0528.17823","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is a lack of robust evidence to recommend the use of perioperative ureteric catheterisation or stenting in complex gynaecological surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the evidence on the benefits and risks of perioperative ureteric catheterisation or stenting in complex gynaecological surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search strategy</h3>\u0000 \u0000 <p>A literature search was performed in CINAHL, the Cochrane Library, Embase and MEDLINE, from 1946 to January 2024, using a combination of keywords and Medical Subject Headings (MeSH) terminology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection criteria</h3>\u0000 \u0000 <p>Randomised controlled trials (RCTs) and observational studies were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data collection and analysis</h3>\u0000 \u0000 <p>Meta-analysis of the RCTs and observational studies were performed separately. Cochrane RevMan 6.5.1 was used to undertake meta-analysis. Risk ratios with 95% CIs were calculated for the outcome measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main results</h3>\u0000 \u0000 <p>Ten studies were included: three RCTs and seven observational studies, comprising 8661 patients. The three RCTs, comprising a total of 3277 patients, showed no difference in the risk of immediate complications in the form of ureteric injury between the ureteric stent and the control groups (RR 0.9, 95% CI 0.49–1.65). The observational studies included 5384 patients. Four studies that explored the ureteric injury as an outcome did not show any difference between the two groups (RR 0.76, 95% CI 0.27–2.16). One case–control study with 862 participants found that the rate of ureteric injury was higher in the non-stented group, although this was observed in only three patients. The risk of urinary tract infection (UTI) was increased in the stent group, although not with statistical significance (RR 1.84, 95% CI 0.47–7.17). There was no significant difference in the risk of ureteric fistulae (RR 1.91, 95% CI 0.62–5.83), although the number of studies was limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prophylactic ureteric catheterisation or stenting for complex gynaecological surgery is not associated with a lower risk of ureteric injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140545486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chinyere Ukamaka Onubogu, Uchenna Ekwochi, Ijeoma Obumneme-Anyim, Linda Nneka Nwokeji-Onwe, George Uchenna Eleje, Nnabuike Okechukwu Ojiegbe, Ifeanyichukwu Uzoma Ezebialu, Eziamaka Pauline Ezenkwele, Emily Akuabia Nzeribe, Uchenna Anthony Umeh, Innocent Anayochukwu Ugwu, Ogochukwu Chianakwana, Nkechi Theresa Ibekwe, Onyebuchi Ignatius Ezeaku, Gloria Nwuka Ekweagu, Abraham Bong Onwe, Tina Lavin, Bose Ezekwe, Eugenia Settecase, Jamilu Tukur, Joseph Ifeanyichukwu Ikechebelu
Objective
To examine the prevalence, perinatal outcomes and factors associated with neonatal sepsis in referral-level facilities across Nigeria.
Design
Secondary analysis of data from the Maternal and Perinatal Database for Quality, Equity and Dignity Programme in 54 referral-level hospitals across Nigeria.
Setting
Records covering the period from 1 September 2019 to 31 August 2020.
Population
Mothers admitted for birth during the study period, and their live newborns.
Methods
Analysis of prevalence and sociodemographic and clinical factors associated with neonatal sepsis and perinatal outcomes. Multilevel logistic regression modelling identified factors associated with neonatal sepsis.
Main outcome measures
Neonatal sepsis and perinatal outcomes.
Results
The prevalence of neonatal sepsis was 16.3 (95% CI 15.3–17.2) per 1000 live births (1113/68 459) with a 10.3% (115/1113) case fatality rate. Limited education, unemployment or employment in sales/trading/manual jobs, nulliparity/grand multiparity, chronic medical disorder, lack of antenatal care (ANC) or ANC outside the birthing hospital and referral for birth increased the odds of neonatal sepsis. Birthweight of <2500 g, non-spontaneous vaginal birth, preterm birth, prolonged rupture of membranes, APGAR score of <7 at 5 min, birth asphyxia, birth trauma or jaundice were associated with neonatal sepsis. Neonates with sepsis were more frequently admitted to a neonatal intensive care unit (1037/1110, 93.4% vs 8237/67 346, 12.2%) and experienced a higher rate of death (115/1113, 10.3% vs 933/67 343, 1.4%).
Conclusions
Neonatal sepsis remains a critical challenge in neonatal care, underscored by its high prevalence and mortality rate. The identification of maternal and neonatal risk factors underscores the importance of improved access to education and employment for women and targeted interventions in ant
研究尼日利亚转诊机构中新生儿败血症的发病率、围产期结果和相关因素。
{"title":"Prevalence, perinatal outcomes and factors associated with neonatal sepsis in Nigeria","authors":"Chinyere Ukamaka Onubogu, Uchenna Ekwochi, Ijeoma Obumneme-Anyim, Linda Nneka Nwokeji-Onwe, George Uchenna Eleje, Nnabuike Okechukwu Ojiegbe, Ifeanyichukwu Uzoma Ezebialu, Eziamaka Pauline Ezenkwele, Emily Akuabia Nzeribe, Uchenna Anthony Umeh, Innocent Anayochukwu Ugwu, Ogochukwu Chianakwana, Nkechi Theresa Ibekwe, Onyebuchi Ignatius Ezeaku, Gloria Nwuka Ekweagu, Abraham Bong Onwe, Tina Lavin, Bose Ezekwe, Eugenia Settecase, Jamilu Tukur, Joseph Ifeanyichukwu Ikechebelu","doi":"10.1111/1471-0528.17824","DOIUrl":"10.1111/1471-0528.17824","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the prevalence, perinatal outcomes and factors associated with neonatal sepsis in referral-level facilities across Nigeria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Secondary analysis of data from the Maternal and Perinatal Database for Quality, Equity and Dignity Programme in 54 referral-level hospitals across Nigeria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Records covering the period from 1 September 2019 to 31 August 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Mothers admitted for birth during the study period, and their live newborns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Analysis of prevalence and sociodemographic and clinical factors associated with neonatal sepsis and perinatal outcomes. Multilevel logistic regression modelling identified factors associated with neonatal sepsis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Neonatal sepsis and perinatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of neonatal sepsis was 16.3 (95% CI 15.3–17.2) per 1000 live births (1113/68 459) with a 10.3% (115/1113) case fatality rate. Limited education, unemployment or employment in sales/trading/manual jobs, nulliparity/grand multiparity, chronic medical disorder, lack of antenatal care (ANC) or ANC outside the birthing hospital and referral for birth increased the odds of neonatal sepsis. Birthweight of <2500 g, non-spontaneous vaginal birth, preterm birth, prolonged rupture of membranes, APGAR score of <7 at 5 min, birth asphyxia, birth trauma or jaundice were associated with neonatal sepsis. Neonates with sepsis were more frequently admitted to a neonatal intensive care unit (1037/1110, 93.4% vs 8237/67 346, 12.2%) and experienced a higher rate of death (115/1113, 10.3% vs 933/67 343, 1.4%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Neonatal sepsis remains a critical challenge in neonatal care, underscored by its high prevalence and mortality rate. The identification of maternal and neonatal risk factors underscores the importance of improved access to education and employment for women and targeted interventions in ant","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17824","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140545465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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