Bjog-An International Journal of Obstetrics and Gynaecology最新文献

Background: Risk factors for the placental disorders of pregnancy (pre-eclampsia, fetal growth restriction, preterm birth, and stillbirth) are complex, frequently involving the interplay between clinical factors and wider social and environmental determinants of health. Biomarkers modulate the maternal and fetal responses to biological processes that underlie the development of placental disorders.

Objectives: To develop a standardised methodology to assess the importance of, and inter-relationships between, candidate risk factors for the various placental disorders.

Search strategy: Systematic searches were conducted using Medline, Embase, Health Technology Assessments, Database of Abstracts of Reviews of Effects, Cochrane Library databases, Google Scholar, and reference lists of retrieved papers.

Selection criteria: We deployed a hierarchy of reviews, systematic reviews, and cohort studies with at least 1000 participants (100 for biomarker studies), published in the prior decade.

Data collection and analysis: We assessed the strengths of association and quality of evidence linking risk factors with individual placental outcomes.

Conclusions: We have developed a standardised approach to assess the importance and inter-relatedness of putative risk factors for the placental disorders of pregnancy.

Background: Existing reviews of pre-eclampsia determinants have focused on clinical and genetic risk factors.

Objective: To evaluate social determinants for pre-eclampsia prevention.

Search strategy: Systematic searches were conducted from relevant electronic databases from inception of each database to 30th December 2024.

Selection criteria: Reviews and large cohort studies (≥ 1000 participants), published between 2013 and 2024, reporting quantitative associations between social determinant exposures and pre-eclampsia outcomes.

Data collection and analysis: Titles and abstracts, then relevant full-texts were reviewed by two reviewers, independently. Strength of association was evaluated as 'definite' (odds ratios [OR] or relative risk [RR] ≥ 3.00 or < 0.33), 'probable' (OR or RR 1.50-2.99 or 0.33-0.67), 'possible' (OR or RR 1.10-1.49 or 0.68-0.89), or 'unlikely' (OR or RR 0.90-1.09). Quality of the evidence was high, moderate, low, or very-low, using GRADE.

Main results: Twenty-seven publications found 24 associations of pre-eclampsia with socioeconomic status, social support/exclusion, healthcare access, and occupational and physical environmental factors. One association (polygamy) was definite (low-quality evidence). Probable associations included: work stress, lack of antenatal care and heat exposure in early pregnancy (high-quality evidence); prolonged occupational exposure to whole body vibrations or bending, distance to health facility, and UV-B radiation exposure (protective factor), all based on moderate-quality evidence; and neighbourhood deprivation, rotating work shifts, and Asian/Oceanian origins (protective factor), all based on low-quality evidence. There were 13 possible associations, which did not include education.

Conclusion: Our findings support recommendations to address climate change, strengthen occupational protection, and promote early antenatal attendance. Social determinants may be indicative of upstream factors (e.g., obesity) that increase likelihood of clinical risk factors for pre-eclampsia incidence and severity.

Objective: Evaluate the feasibility and quality of a national standardised mid-trimester ultrasound protocol using a consensus-based quality assessment (QA) scoring system.

Design: Multicenter prospective observational 'FLASH' study.

Setting: (i) Assessing the feasibility of a standardised protocol of 24 views at the mid-trimester scan, with 21 recommended and 3 additional views, in routine practice. (ii) Assessing the quality of these images by evaluating the presence of conformity criteria. (iii) Analysing the reliability between self-assessment and peer-assessment of the images.

Population: A total of 440 mid-trimester scans.

Methods: A consensus-based QA scoring system comprising 73 conformity criteria was established with 28 experts using a 3-round Delphi method. Secondly, we asked operators to record 5 consecutive routine mid-trimester scans. Images were analysed by the sonographer themselves and by a qualified expert according to the scoring system. The frequency of recorded images was calculated for each of the views. Factors associated with missing images per scan were evaluated. The robustness of conformity criteria was assessed by reliability between self-evaluation and peer-evaluation.

Main outcome measures: Based on 9849 images, we observed feasibility of the 21 recommended standardised views for mid-trimester scan ranging from 88.5% to 100%.

Results: Most conformity criteria (64/73, 88%) were met in over 90% of cases. Gwet's AC1 correlation between expert evaluation (peer-evaluation) and participant evaluation (self-evaluation) was greater than 0.80 for 70/73 (96%) criteria.

Conclusion: This large-scale 2-month 'flash' observational study demonstrates the feasibility and quality of a national standardised mid-trimester ultrasound protocol using a consensus-based QA scoring system.

Congenital uterine anomalies (CUAs) are malformations of the uterus (womb) that develop during fetal life. When a female baby is in her mother's uterus, her uterus develops as two separate halves from two tubular structures called Müllerian ducts, which fuse together before she is born. Anomalies that occur during the baby's development can be variable, from complete absence of the uterus through to more subtle anomalies, which are classified into specific categories. While conventional ultrasound is good at detecting CUAs, 3D ultrasound is used to confirm a diagnosis. If a complex uterine anomaly is suspected, additional investigations may be used, including MRI scanning, laparoscopy (where a camera is inserted into the cavity of the abdomen) and/or hysteroscopy (where a camera is placed in the uterine cavity). As there can be a link between CUAs and anomalies of the kidney and bladder, scans of these organs are also usually requested.

Although CUAs are present at birth, adult women typically do not have any symptoms, although some may experience painful periods. Most cases of CUA do not cause difficulties in becoming pregnant, and the outcome of pregnancy, in most cases, is good. However, these uterine anomalies are often discovered during investigations for infertility or miscarriage. Moreover, depending upon the type and severity of CUA, there may be increased risk of first and second trimester miscarriages, preterm birth, fetal growth restriction (smaller and lighter babies for the stage of pregnancy), pre-eclampsia (development of high blood pressure and protein in urine after the 20th week of pregnancy) and fetal malpresentation (baby not facing head-first down the birth canal) at birth. Surgical treatment may be considered for those who have had recurrent miscarriages and have a septate uterus, i.e. the uterine cavity is divided by a partition. In this case, surgery may reduce the chances of miscarriage. However, women should be informed that there is inconclusive and conflicting evidence regarding the improved likelihood of live births in this context. Further evidence from large randomised controlled trials are required to provide conclusive evidence-based recommendations for surgical treatment for septate uterus. Surgical treatment for other types of CUAs is not usually recommended as the risks outweigh potential benefits, and evidence for any benefits is lacking. Women with CUAs may be at an increased risk of preterm birth even after surgical treatment for a septate uterus. These people, if suspected to be at an increased risk of preterm birth based on the severity of CUA, should be followed up using an appropriate protocol for preterm birth as outlined in UK Preterm Birth Clinical Network Guidance.

Background: Artificial oocyte activation (AOA) is used to improve fertilisation rates in intracytoplasmic sperm injection (ICSI) cycles.

Objectives: To assess the effectiveness of AOA on fertilisation, embryo development, and clinical outcomes, including live birth.

Search strategy: We searched PubMed, Cochrane, and Scopus from January 1990 to March 2024 using terms related to 'artificial oocyte activation' and 'ICSI.'

Selection criteria: Study designs included randomised trials (RCTs), quasi-experimental, cohort, and case-control studies that evaluated AOA's effects on ICSI outcomes, provided quantitative data and were published in English.

Data collection and analysis: Reviewers independently performed data extraction using a standardised form. Study quality was appraised using Joanna Briggs Institute (JBI) Checklists. Meta-analyses employed a random-effects model, and evidence was classified using a comprehensive numerical framework.

Main results: We included 45 studies covering 56 787 mature oocytes, 7463 women for clinical pregnancies, and 7063 women for live births. AOA showed potential in increasing fertilisation rates in patients with a history of low or absent fertilisation but did not enhance embryo development or clinical outcomes. This effect diminished when excluding low-quality studies or focusing solely on RCTs. In other patient groups, AOA showed limited or nonsignificant benefits.

Conclusions: Applying comprehensive evidence assessment, AOA showed potential in improving fertilisation rates in patients with fertilisation problems but no benefits for embryo development or live birth rates. This underscores the critical importance of rigorous evidence credibility in informing clinical practice in assisted conception.