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

Objective: To compare reoperation rates for recurrent vaginal vault prolapse among six surgical suspension procedures and to assess compartment-specific reoperation rates.

Design: Nationwide cohort study with 3-14 years of follow-up.

Setting: The Danish Urogynecological Database (DugaBase) and medical records.

Population: Women with prior hysterectomy undergoing primary vaginal vault prolapse surgery between 1 January 2010 and 31 December 2020 using sacrocolpopexy (SCP), laparoscopic or ipsilateral uterosacral ligament suspension (LUSLS, IUSLS), vaginal extraperitoneal uterosacral ligament suspension (VEULS), sacrospinous ligament fixation (SSLF), or SSLF with graft.

Methods: Identification by NOMESCO codes and chart review. Reoperations only for recurrent prolapse recorded through December 31, 2023. Cox regression estimated adjusted hazard ratios (aHR), adjusting for demographics, comorbidities, prior anterior/posterior prolapse surgery, prolapse stage, concomitant surgery and surgeon experience.

Main outcome measures: Overall and compartment-specific reoperation rates by surgical technique.

Results: Among 1374 women, no procedure was superior across compartments. SSLF was associated with the highest overall reoperation rate (30.7%; aHR 2.14, 95% CI, 1.26-3.62). SCP had the lowest apical reoperation rate (1.3%), whereas SSLF had the highest (23.1%; aHR 42.7, 95% CI, 5.7-317.5 compared to SCP). Anterior reoperation risk was lower after IUSLS (aHR 0.46, 95% CI, 0.21-0.99) and VEULS (aHR 0.09, 95% CI, 0.01-0.71), while posterior risk was lower after IUSLS (aHR 0.30, 95% CI, 0.12-0.77), SSLF (aHR 0.30, 95% CI, 0.11-0.87) and SSLF with graft (aHR 0.09, 95% CI, 0.01-0.79).

Conclusion: Long-term reoperation risk varies by surgical technique, with SCP providing the most durable apical support and SSLF showing higher recurrence.

Objective: Indigenous pregnant and postpartum people are more likely to experience severe maternal morbidity (SMM) and mortality than non-Indigenous groups. We sought to explore how community and societal factors, culture, and resilience impact Native American individuals' pregnancy experiences and might offer insights to address inequities in SMM.

Design: Qualitative study.

Setting: Virtual community focus group discussions.

Population: Individuals who self-identify as Native or Indigenous and gave birth in Utah within 5 years prior.

Methods: We partnered with local Tribes and Tribal organisations to virtually conduct 3 focus groups of 3-5 participants and 1 individual interview. Open-ended questions elicited participants' perceptions of their community and health system resources for perinatal care. Interviews were coded and analyses conducted to identify themes.

Main outcome measures: Native individuals' perceptions of perinatal care focused on interactions with medical providers and the healthcare system.

Results: 12 participants enrolled. Participants reported harmful interactions that they believed were due to their Native American heritage. Four key themes emerged: participant experiences of discrimination, stereotyping, cultural dismissiveness, and explicit racism by their medical team. Participants suggested improving community support during and after pregnancy, holding cultural humility trainings for providers, and increasing representation of Native peoples in medicine.

Conclusions: Native respondents endorsed several types of negative interactions with their medical providers during and after pregnancy that could affect their perinatal care. Efforts to reduce provider stigma and bias and improve cultural humility and awareness could improve these outcomes.

Objective: To evaluate the spontaneous clearance of Mycoplasma genitalium (MG) and associated factors in women.

Design: Prospective cohort.

Setting: Pregnancy termination centre in Bordeaux, France.

Population: A cohort of 1496 women seeking pregnancy termination.

Methods: MG was detected using self-collected vaginal swabs obtained prior to abortion. Women with concurrent Chlamydia trachomatis infection or prior intake of antibiotics active against MG were excluded. Demographic, clinical, biological and behavioural data were collected. Follow-up visits were scheduled at 3 and 9 weeks after inclusion, during which self-collected vaginal swabs and sexual behaviour data were collected. MG-positive samples were analysed for bacterial load, mpgB gene typing, and mutations associated with macrolide and fluoroquinolone resistance.

Main outcome measures: MG negativity at follow-up visits.

Results: Among 1496 women tested, 94 (6.3%) were MG-positive. Of these, 70 met the inclusion criteria, and 75.7% (53 of 70) were asymptomatic. The prevalence of macrolide and fluoroquinolone resistance was 32.3% (11 of 34) and 6% (3 of 50), respectively. Forty-eight women attended follow-up. Spontaneous clearance occurred in 45.8% (22 of 48) of cases throughout the study period. Lower bacterial load at inclusion was the only factor associated with clearance.

Conclusion: The high rate of spontaneous clearance and the substantial prevalence of macrolide resistance support the recommendation against routine MG screening in women presenting for pregnancy termination.

Trial registration: ClinicalTrials.gov identifier: NCT04841408.

Objective: Assess the short-term surgical outcomes of bilateral salpingectomy performed as a standalone procedure, focusing on complication rates by surgical indication and age group.

Design: Retrospective population-based cohort.

Setting: British Columbia, Canada, from January 1st, 2008, to December 31st, 2022.

Population: 7102 people who received bilateral salpingectomies performed without concurrent surgical procedures.

Methods: International Disease Classification codes were used to identify the indication for bilateral salpingectomy. We compared outcomes for salpingectomy performed for prophylactic versus contraceptive indications, as well as across different age groups.

Main outcome measures: The primary outcome was a composite measure of complications assessed up from the index surgery to 6 weeks after discharge. We included admission to the intensive care unit, return to the operating room, in-hospital surgical complications, readmissions, and complications diagnosed during physician visits.

Results: There were 197 complications out of 7102 surgeries for bilateral salpingectomy corresponding to an overall complication rate of 2.8%. Complications occurred in 2.7% of procedures performed for contraception and 4.5% of those performed for prophylaxis, with no statistically significant difference between groups. There were also no significant differences in the adjusted risk ratios for same day discharge, postoperative complications, diagnostic imaging, or prescriptions for NSAIDs or opioids between indication groups. No significant differences in any of the measured outcomes were observed across age groups (< 35, 35-45, and > 45 years).

Conclusion: These results illustrate low complication rates in people undergoing bilateral salpingectomy as a standalone surgical procedure.

Objective: A multi-centre international trial (A-PLUS), demonstrated that a single dose of 2 g oral azithromycin in labour reduced the risk of maternal sepsis or death, but not neonatal mortality. We aimed to determine whether the efficacy of azithromycin in prevention of any maternal infection or neonatal infection varied by time interval from azithromycin administration to delivery.

Design: This is a secondary analysis of a randomized controlled trial.

Setting: Multi-centre international randomized controlled trial.

Population: Pregnant patients ≥ 28 weeks gestation (singleton or multiple gestation) presenting in labour for planned vaginal delivery.

Outcomes: The primary outcome for this secondary analysis was maternal infection and the secondary outcome was any neonatal infection.

Methods: The estimated relative risks (and 95% confidence interval) of any maternal or neonatal infection comparing azithromycin to placebo were obtained by fitting a Poisson model adjusting for site, treatment arm, hours between drug administration and delivery (as continuous measure, and ≤ 12 or > 12 h for maternal and ≤ 9 or > 9 h for neonatal), and the two-way interaction between treatment arm and hours between drug administration and delivery.

Results: Included in the analysis were n = 14 569 randomized to azithromycin and n = 14 667 to placebo. There was no evidence that the benefit of azithromycin on reducing the risk of any maternal infection varied by time from dose to delivery (RR 0.71 (0.64-0.79) and RR 0.71 (0.54-0.94) for ≤ 12 and > 12 h respectively, interaction p = 0.987), although there was an observed interaction in Sub-Saharan Africa subgroup with reduced risk observed with administration > 12 vs. ≤ 12 (RR 0.21 (0.08-0.54) vs. RR 0.52 (0.41-0.66), interaction p = 0.03). There was no benefit observed in prevention of infant infection regardless of time from dose to delivery (≤ 9 or > 9 h) (RR 1.00 (0.95-1.06) and RR 1.01 (0.88-1.15) interaction p = 0.997).

Conclusion: The benefit observed with a single intrapartum dose of azithromycin for prevention of any maternal infection in the setting of planned vaginal delivery was not observed to vary by time interval from azithromycin administration to delivery, although in some populations there may be greater benefit with delivery > 12 h from administration. Pregnant patients presenting for planned vaginal birth benefit from a single dose of 2 g azithromycin regardless of how soon delivery is anticipated.

Linked article: This is a mini commentary on Ehrhardt et al., pp. 564–574 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.18291.