Allan J Kember, Jane Warland, Sebastian R Hobson, Kuan Liu, Jerry Coleman
{"title":"Position Modification Devices to Prevent Supine Sleep During Pregnancy.","authors":"Allan J Kember, Jane Warland, Sebastian R Hobson, Kuan Liu, Jerry Coleman","doi":"10.1111/1471-0528.18019","DOIUrl":"https://doi.org/10.1111/1471-0528.18019","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649652","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}
Hitomi Okubo, Shoji F. Nakayama, Asako Mito, Naoko Arata, Yukihiro Ohya, the Japan Environment and Children's Study Group
Objective
To quantify the association between a combination of modifiable prepregnancy lifestyle factors and the risk of adverse pregnancy outcomes (APOs).
Design
Prospective cohort study.
Setting
The Japan Environment and Children's Study.
Population
A total of 79 703 pregnant Japanese women without chronic disease.
Methods
Maternal lifestyle before pregnancy was assessed using a self-administered questionnaire. A healthy lifestyle score (HLS, 0–5 points) was calculated based on adherence to five prepregnancy healthy lifestyle factors: healthy weight, high-quality diet, regular physical activity, not smoking, and not drinking alcohol. Relative risks (RRs) and 95% credible intervals (CrIs) were estimated using a Bayesian log-binomial regression model.
Main Outcome Measures
Composite APOs, defined as the development of any APO, including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, low birth weight, and small-for-gestational-age, transcribed from medical records.
Results
A total of 13 894 women (17.4%) experienced one or more APOs. HLS was inversely associated with the risk of APOs in a dose–response manner. Women with an HLS of 5 points had a 33% (RR 0.67; 95% CrI, 0.61–0.74) lower risk of APOs than those with the lowest HLS (0–1 points). The population attributable fraction of five healthy lifestyle factors was 10.3%. A 1-point increase of HLS could have reduced APO cases by 6.6%.
Conclusions
A higher HLS was associated with a lower risk of APOs, suggesting that adopting a healthy lifestyle before pregnancy may reduce the risk of APOs, which can increase the risk of future chronic diseases in both mother and child.
摘要量化可改变的孕前生活方式因素组合与不良妊娠结局（APOs）风险之间的关联：前瞻性队列研究：环境：日本环境与儿童研究：方法：通过对孕前生活方式进行评估，确定孕前生活方式与不良妊娠结局（APOs）之间的关系：方法：采用自填式问卷对孕产妇怀孕前的生活方式进行评估。根据孕前五项健康生活方式因素（健康体重、优质饮食、规律运动、不吸烟、不饮酒）的坚持情况计算出健康生活方式得分（HLS，0-5 分）。采用贝叶斯对数二叉回归模型估算相对风险（RRs）和 95% 可信区间（CrIs）：主要结果测量指标：根据医疗记录转录的复合 APOs，定义为任何 APO 的发生，包括妊娠糖尿病、妊娠高血压疾病、早产、低出生体重和小于胎龄：共有 13 894 名妇女（17.4%）经历过一次或多次妊娠高血压。HLS与发生APO的风险呈剂量反应式的反比关系。健康生活方式指数为 5 分的妇女比健康生活方式指数最低（0-1 分）的妇女发生 APO 的风险低 33% (RR 0.67; 95% CrI, 0.61-0.74)。五项健康生活方式因素的人群可归因比例为 10.3%。结论：健康生活方式指数每增加1分，APO病例就会减少6.6%：结论：较高的健康生活方式指数与较低的 APO 风险相关，这表明在怀孕前采取健康的生活方式可降低 APO 风险，而 APO 可增加母婴未来罹患慢性疾病的风险。
{"title":"Adherence to Healthy Prepregnancy Lifestyle and Risk of Adverse Pregnancy Outcomes: A Prospective Cohort Study","authors":"Hitomi Okubo, Shoji F. Nakayama, Asako Mito, Naoko Arata, Yukihiro Ohya, the Japan Environment and Children's Study Group","doi":"10.1111/1471-0528.17994","DOIUrl":"10.1111/1471-0528.17994","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To quantify the association between a combination of modifiable prepregnancy lifestyle factors and the risk of adverse pregnancy outcomes (APOs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The Japan Environment and Children's Study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>A total of 79 703 pregnant Japanese women without chronic disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Maternal lifestyle before pregnancy was assessed using a self-administered questionnaire. A healthy lifestyle score (HLS, 0–5 points) was calculated based on adherence to five prepregnancy healthy lifestyle factors: healthy weight, high-quality diet, regular physical activity, not smoking, and not drinking alcohol. Relative risks (RRs) and 95% credible intervals (CrIs) were estimated using a Bayesian log-binomial regression model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Composite APOs, defined as the development of any APO, including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, low birth weight, and small-for-gestational-age, transcribed from medical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 13 894 women (17.4%) experienced one or more APOs. HLS was inversely associated with the risk of APOs in a dose–response manner. Women with an HLS of 5 points had a 33% (RR 0.67; 95% CrI, 0.61–0.74) lower risk of APOs than those with the lowest HLS (0–1 points). The population attributable fraction of five healthy lifestyle factors was 10.3%. A 1-point increase of HLS could have reduced APO cases by 6.6%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A higher HLS was associated with a lower risk of APOs, suggesting that adopting a healthy lifestyle before pregnancy may reduce the risk of APOs, which can increase the risk of future chronic diseases in both mother and child.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 3","pages":"375-386"},"PeriodicalIF":4.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649644","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}
Andrea Stuart, Johanna Wagenius, Levon Badiglian-Filho, Jens Schnabel, Alvaro Montealegre, Sophia Ehrström, Michael Hartmann, Jona Vercammen, Daniela Huber, Anna Lingström, Jan Baekelandt
<div> <section> <h3> Objective</h3> <p>To present the rates of intra- and postoperative complications and conversions in a large cohort of unselected vNOTES hysterectomies, performed by surgeons with different levels of expertise.</p> </section> <section> <h3> Design</h3> <p>International register-based cohort study.</p> </section> <section> <h3> Setting</h3> <p>Hysterectomies in the iNOTESs registry, 2015 to January 2024, performed by 201 surgeons from multiple countries.</p> </section> <section> <h3> Population</h3> <p>4565 patients undergoing vNOTES hysterectomy.</p> </section> <section> <h3> Methods</h3> <p>Descriptive data are presented in frequencies (<i>n</i>) and percent (%).</p> </section> <section> <h3> Main Outcome Measure</h3> <p>Intra- and postoperative complications. Conversions.</p> </section> <section> <h3> Results</h3> <p>Intraoperative and postoperative complication rates were 3.2% (<i>n</i> = 144) and 2.5% (<i>n</i> = 115), respectively. Conversions occurred in 1.6% (<i>n</i> = 72), of which 10 (0.2%) to laparotomy, and 82% of the conversions occurred within the first 50 cases of the surgeon's learning curve. The most common intraoperative complication was cystotomy, occurring in 1.3%, and almost half were performed by inexperienced surgeons. Other intraoperative organ injuries occurred in 20 cases (0.44%). Postoperatively, the most common complications were haemorrhage (<i>n</i> = 28), vault complications (<i>n</i> = 26) including 11 infected vault hematomas, cystitis (<i>n</i> = 18) and non-specific infections (<i>n</i> = 14). The vNOTES hysterectomies were performed by 201 surgeons, of which 9.5% had performed more than 50 vNOTES cases, representing 70% of the registered cases in the registry. The remaining 30% of the hysterectomies mainly represent learning curve data from 90% of the included surgeons. The complication rate decreased with increasing surgical experience.</p> </section> <section> <h3> Conclusions</h3> <p>The largest study population of vNOTES hysterectomies is presented, including both learning curve data and data from experienced surgeons, with acceptable rates of intra- and postoperative complications. No imp
{"title":"Intra- and Postoperative Complications in 4565 vNOTES Hysterectomies: International Registry Cohort Study","authors":"Andrea Stuart, Johanna Wagenius, Levon Badiglian-Filho, Jens Schnabel, Alvaro Montealegre, Sophia Ehrström, Michael Hartmann, Jona Vercammen, Daniela Huber, Anna Lingström, Jan Baekelandt","doi":"10.1111/1471-0528.18000","DOIUrl":"10.1111/1471-0528.18000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To present the rates of intra- and postoperative complications and conversions in a large cohort of unselected vNOTES hysterectomies, performed by surgeons with different levels of expertise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>International register-based cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Hysterectomies in the iNOTESs registry, 2015 to January 2024, performed by 201 surgeons from multiple countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>4565 patients undergoing vNOTES hysterectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Descriptive data are presented in frequencies (<i>n</i>) and percent (%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure</h3>\u0000 \u0000 <p>Intra- and postoperative complications. Conversions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Intraoperative and postoperative complication rates were 3.2% (<i>n</i> = 144) and 2.5% (<i>n</i> = 115), respectively. Conversions occurred in 1.6% (<i>n</i> = 72), of which 10 (0.2%) to laparotomy, and 82% of the conversions occurred within the first 50 cases of the surgeon's learning curve. The most common intraoperative complication was cystotomy, occurring in 1.3%, and almost half were performed by inexperienced surgeons. Other intraoperative organ injuries occurred in 20 cases (0.44%). Postoperatively, the most common complications were haemorrhage (<i>n</i> = 28), vault complications (<i>n</i> = 26) including 11 infected vault hematomas, cystitis (<i>n</i> = 18) and non-specific infections (<i>n</i> = 14). The vNOTES hysterectomies were performed by 201 surgeons, of which 9.5% had performed more than 50 vNOTES cases, representing 70% of the registered cases in the registry. The remaining 30% of the hysterectomies mainly represent learning curve data from 90% of the included surgeons. The complication rate decreased with increasing surgical experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The largest study population of vNOTES hysterectomies is presented, including both learning curve data and data from experienced surgeons, with acceptable rates of intra- and postoperative complications. No imp","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"464-472"},"PeriodicalIF":4.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649649","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}
Melle A. Spruijt, Wenche M. Klerkx, Kim Notten, Hugo van Eijndhoven, Leonie Speksnijder, Manon H. Kerkhof, Kirsten B. Kluivers
Objective
To evaluate and compare the efficacy and safety of Botulinum Toxin A (BTA) injections versus placebo injections, combined with pelvic floor muscle therapy (PFMT), in women with chronic pelvic pain (CPP).
This multicentre study was conducted at four hospitals in the Netherlands.
Population and Sample
Ninety-four women with CPP and increased pelvic floor muscle tone despite previous PFMT, were enrolled.
Methods
Participants received either BTA injections (100 units) or placebo injections into the pelvic floor muscle, followed by four PFMT sessions.
Main Outcomes and Measures
Primary outcomes included the number of women with at least a 33% reduction in pain and those reporting (very) much improvement of their pain. Secondary outcomes covered quality of life and pelvic floor function. Follow-up visits were scheduled at 4, 8, 12, and 26 weeks post-treatment. Mixed models for repeated measurements were used for analysis.
Results
A 33% reduction or more in average pain score was reported by 15 participants (33%) after BTA treatment and 9 participants (20%) after placebo treatment (odd ratio placebo/BTA 1.88; 95% CI 0.72–4.90, p = 0.19). In both groups, 8 women (17%) reported their improvement as (very) much better (odd ratio placebo/BTA 0.947; 95% CI 0.32–2.80, p = 0.92). Pelvic floor resting activity decreased significantly after BTA treatment compared to placebo (p = 0.001).
Conclusion
The results from this study do not support the use of BTA injections in the management of CPP in women.
目的：评估和比较肉毒杆菌毒素 A (BTA) 注射与安慰剂注射以及盆底肌肉疗法 (PFMT) 在慢性盆腔痛 (CPP) 女性患者中的疗效和安全性。
{"title":"The Efficacy of Botulinum Toxin A Injection in Pelvic Floor Muscles in Chronic Pelvic Pain Patients: A Double-Blinded Randomised Controlled Trial","authors":"Melle A. Spruijt, Wenche M. Klerkx, Kim Notten, Hugo van Eijndhoven, Leonie Speksnijder, Manon H. Kerkhof, Kirsten B. Kluivers","doi":"10.1111/1471-0528.17991","DOIUrl":"10.1111/1471-0528.17991","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate and compare the efficacy and safety of Botulinum Toxin A (BTA) injections versus placebo injections, combined with pelvic floor muscle therapy (PFMT), in women with chronic pelvic pain (CPP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Randomised, double-blinded clinical trial (January 2020–April 2023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>This multicentre study was conducted at four hospitals in the Netherlands.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population and Sample</h3>\u0000 \u0000 <p>Ninety-four women with CPP and increased pelvic floor muscle tone despite previous PFMT, were enrolled.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants received either BTA injections (100 units) or placebo injections into the pelvic floor muscle, followed by four PFMT sessions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes and Measures</h3>\u0000 \u0000 <p>Primary outcomes included the number of women with at least a 33% reduction in pain and those reporting (very) much improvement of their pain. Secondary outcomes covered quality of life and pelvic floor function. Follow-up visits were scheduled at 4, 8, 12, and 26 weeks post-treatment. Mixed models for repeated measurements were used for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A 33% reduction or more in average pain score was reported by 15 participants (33%) after BTA treatment and 9 participants (20%) after placebo treatment (odd ratio placebo/BTA 1.88; 95% CI 0.72–4.90, <i>p</i> = 0.19). In both groups, 8 women (17%) reported their improvement as (very) much better (odd ratio placebo/BTA 0.947; 95% CI 0.32–2.80, <i>p</i> = 0.92). Pelvic floor resting activity decreased significantly after BTA treatment compared to placebo (<i>p</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results from this study do not support the use of BTA injections in the management of CPP in women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 3","pages":"297-305"},"PeriodicalIF":4.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17991","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610060","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}
Andrew Grey, Alison Avenell, Mark J. Bolland, Jim G. Thornton
{"title":"The Fetal Pillow Deflates—Lessons for All","authors":"Andrew Grey, Alison Avenell, Mark J. Bolland, Jim G. Thornton","doi":"10.1111/1471-0528.18004","DOIUrl":"10.1111/1471-0528.18004","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"429-432"},"PeriodicalIF":4.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610061","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}
{"title":"Mini Commentary on ‘Pregnancy and Birth Complications and Maternal Mental Health—The Case is Clear’","authors":"Nicole Votruba","doi":"10.1111/1471-0528.17990","DOIUrl":"10.1111/1471-0528.17990","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 2","pages":"143-144"},"PeriodicalIF":4.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601304","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}
{"title":"Insights on Stillbirths in Africa Using the Robson Classification System: Mini Commentary","authors":"Adeline A. Boatin","doi":"10.1111/1471-0528.17993","DOIUrl":"10.1111/1471-0528.17993","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 2","pages":"222-223"},"PeriodicalIF":4.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599917","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}
Julie Cormier, Lola Mirouse, Janine Barbot, François Goffinet, Camille Le Ray
Objective
To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10-year period and understand their reasons by interviewing obstetricians and midwives.
Design
Mixed-methods study.
Setting
A tertiary university public maternity hospital, Paris, France.
Population
All patients who delivered vaginally between January 2012 and December 2021 in the maternity hospital and 20 interviews with obstetrician-gynaecologists and midwives.
Methods
Quantitative data analysis using a multivariate logistic regression model, stratifying on the mode of delivery. Semi-structured interview with 20 obstetricians and midwives, with an interview guide.
Main Outcome Measures
Obstetric anal sphincter injuries.
Results
The quantitative study of 37 942 women (16.1% of whom had an episiotomy and 1.4% OASIS) shows that, the incidence of episiotomy decreased from 25% to 7.6% over this 10-year period. Allow on the known risk factors for OASIS, we demonstrate that its incidence rose (adjusted odds ratio 1.35, 95% confidence interval 1.09–1.67) for the years in which the episiotomy incidence fell below 10% for the overall population. The interviews showed professionals' apparent awareness that the decreased incidence in episiotomy (achieved by changes in departmental policy, redefining its benefit/risk balance and acquiring new skills to manage the expulsion phase) could lead to an increased incidence of OASIS.
Conclusions
Decreasing the episiotomy incidence appears to be associated with a rising incidence of OASIS. The optimal incidence of episiotomy remains controversial in the literature and among professionals.
{"title":"Evolution of Episiotomy Incidence and Obstetric Anal Sphincter Injury Over 10 Years: A Mixed-Methods Study","authors":"Julie Cormier, Lola Mirouse, Janine Barbot, François Goffinet, Camille Le Ray","doi":"10.1111/1471-0528.17999","DOIUrl":"10.1111/1471-0528.17999","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10-year period and understand their reasons by interviewing obstetricians and midwives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Mixed-methods study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A tertiary university public maternity hospital, Paris, France.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>All patients who delivered vaginally between January 2012 and December 2021 in the maternity hospital and 20 interviews with obstetrician-gynaecologists and midwives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Quantitative data analysis using a multivariate logistic regression model, stratifying on the mode of delivery. Semi-structured interview with 20 obstetricians and midwives, with an interview guide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Obstetric anal sphincter injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The quantitative study of 37 942 women (16.1% of whom had an episiotomy and 1.4% OASIS) shows that, the incidence of episiotomy decreased from 25% to 7.6% over this 10-year period. Allow on the known risk factors for OASIS, we demonstrate that its incidence rose (adjusted odds ratio 1.35, 95% confidence interval 1.09–1.67) for the years in which the episiotomy incidence fell below 10% for the overall population. The interviews showed professionals' apparent awareness that the decreased incidence in episiotomy (achieved by changes in departmental policy, redefining its benefit/risk balance and acquiring new skills to manage the expulsion phase) could lead to an increased incidence of OASIS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Decreasing the episiotomy incidence appears to be associated with a rising incidence of OASIS. The optimal incidence of episiotomy remains controversial in the literature and among professionals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"454-463"},"PeriodicalIF":4.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17999","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142599918","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}
Katherine C. Whitehouse, Patricia A. Lohr, John Reynolds-Wright, Jonathan Lord, Stephen Robson, Tracey Masters, Yvonne Neubauer, Lydia Kingsley, Sharon Cameron
{"title":"Optimising Anti-D Use: Revisiting Guidelines for First Trimester Abortions","authors":"Katherine C. Whitehouse, Patricia A. Lohr, John Reynolds-Wright, Jonathan Lord, Stephen Robson, Tracey Masters, Yvonne Neubauer, Lydia Kingsley, Sharon Cameron","doi":"10.1111/1471-0528.17996","DOIUrl":"10.1111/1471-0528.17996","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"426-428"},"PeriodicalIF":4.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592021","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}
Carol Bedwell, Wendy Taylor, Caroline Cunningham, Andrew D. Weeks, Dame Tina Lavender
Objective
To understand the experiences of women, birth partners and health professionals of verbal followed by retrospective written consent in a prospective cohort study of a device to manage postpartum haemorrhage (PPH).
Design
Grounded Theory.
Setting
Tertiary facility in North-West England, UK.
Sample
We used purposive and theoretical sampling to recruit 51 participants; 12 women, 12 birth partners, 16 obstetricians and 11 midwives.
Methods
Semi-structured interviews were conducted, using a topic guide for focus, until data saturation was achieved. Data were analysed using framework analysis technique.
Results
Most women wanted sufficient information to make a decision at the time of the event, rather than in advance, and preferred not to be overwhelmed with detail. A key factor in making the decision to participate was a positive and trusting relationship with the attending obstetrician. Obtaining consent for research in emergencies was viewed by obstetricians as requiring a different approach and more challenging than consent for standard procedures in an emergency.
Conclusions
This is one of the first studies to explore verbal followed by retrospective written consent processes with women, clinicians and observers. This was acceptable to all, however information needs to be appropriate, and those discussing consent require adequate training (199/200).
{"title":"Emergency Verbal Consent for Intrapartum Research: A Grounded Theory Study","authors":"Carol Bedwell, Wendy Taylor, Caroline Cunningham, Andrew D. Weeks, Dame Tina Lavender","doi":"10.1111/1471-0528.17997","DOIUrl":"10.1111/1471-0528.17997","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To understand the experiences of women, birth partners and health professionals of verbal followed by retrospective written consent in a prospective cohort study of a device to manage postpartum haemorrhage (PPH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Grounded Theory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Tertiary facility in North-West England, UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>We used purposive and theoretical sampling to recruit 51 participants; 12 women, 12 birth partners, 16 obstetricians and 11 midwives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured interviews were conducted, using a topic guide for focus, until data saturation was achieved. Data were analysed using framework analysis technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most women wanted sufficient information to make a decision at the time of the event, rather than in advance, and preferred not to be overwhelmed with detail. A key factor in making the decision to participate was a positive and trusting relationship with the attending obstetrician. Obtaining consent for research in emergencies was viewed by obstetricians as requiring a different approach and more challenging than consent for standard procedures in an emergency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is one of the first studies to explore verbal followed by retrospective written consent processes with women, clinicians and observers. This was acceptable to all, however information needs to be appropriate, and those discussing consent require adequate training (199/200).</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"446-453"},"PeriodicalIF":4.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17997","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142596800","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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