Alma Larsdotter Zweygberg, Stamatia Tsampa, Rosaria Galanti, Cecilia Magnusson, Viktor H Ahlqvist
{"title":"Nicotine Use Among Young Women Before Pregnancy: National Register-Based Time Trend Analysis.","authors":"Alma Larsdotter Zweygberg, Stamatia Tsampa, Rosaria Galanti, Cecilia Magnusson, Viktor H Ahlqvist","doi":"10.1111/1471-0528.70153","DOIUrl":"https://doi.org/10.1111/1471-0528.70153","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919083","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":"Amniotic Fluid Index Versus Maximum Vertical Pocket Versus Both for Polyhydramnios.","authors":"Alessandro Petrecca, Suneet P Chauhan, Chiara Tersigni, Tullio Ghi, Vincenzo Berghella","doi":"10.1111/1471-0528.70139","DOIUrl":"https://doi.org/10.1111/1471-0528.70139","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919075","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}
Rupsa C Boelig, Avinash Kavi, Janet L Moore, Denise C Babineau, Mrityunjay C Metgud, Manjunath S Somannavar, Shivaprasad S Goudar, Richard J Derman, Shiyam Sunder Tikmani, Sarah Saleem, Robert L Goldenberg, Adrien L Lokangaka, Antoinette K Tshefu, Melissa S Bauserman, Musaku Mwenechanya, Elwyn Chomba, Manolo Mazariegos, Lester Figueroa, Nancy F Krebs, Paul Nyongesa, Fabian Esamai, Sherri Bucher, Archana B Patel, Patricia L Hibberd, William A Petri, Sk Masum Billah, Rashidul Haque, Marion Koso-Thomas, Elizabeth M McClure, Waldemar A Carlo, Alan T N Tita
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.
{"title":"Timing of Prophylactic Intrapartum Azithromycin Administration and Efficacy in Prevention of Maternal and Infant Infections: A Secondary Analysis of a Randomized Controlled Trial.","authors":"Rupsa C Boelig, Avinash Kavi, Janet L Moore, Denise C Babineau, Mrityunjay C Metgud, Manjunath S Somannavar, Shivaprasad S Goudar, Richard J Derman, Shiyam Sunder Tikmani, Sarah Saleem, Robert L Goldenberg, Adrien L Lokangaka, Antoinette K Tshefu, Melissa S Bauserman, Musaku Mwenechanya, Elwyn Chomba, Manolo Mazariegos, Lester Figueroa, Nancy F Krebs, Paul Nyongesa, Fabian Esamai, Sherri Bucher, Archana B Patel, Patricia L Hibberd, William A Petri, Sk Masum Billah, Rashidul Haque, Marion Koso-Thomas, Elizabeth M McClure, Waldemar A Carlo, Alan T N Tita","doi":"10.1111/1471-0528.70121","DOIUrl":"https://doi.org/10.1111/1471-0528.70121","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>This is a secondary analysis of a randomized controlled trial.</p><p><strong>Setting: </strong>Multi-centre international randomized controlled trial.</p><p><strong>Population: </strong>Pregnant patients ≥ 28 weeks gestation (singleton or multiple gestation) presenting in labour for planned vaginal delivery.</p><p><strong>Outcomes: </strong>The primary outcome for this secondary analysis was maternal infection and the secondary outcome was any neonatal infection.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890464","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":"Author Reply.","authors":"Basky Thilaganathan, Monica Minopoli","doi":"10.1111/1471-0528.70132","DOIUrl":"10.1111/1471-0528.70132","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844310","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}
Mario Rüdiger, Christy Burden, Charles Christoph Roehr
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.
{"title":"50 Years and Counting—Re-Examining the APGAR Score for Preterm Babies","authors":"Mario Rüdiger, Christy Burden, Charles Christoph Roehr","doi":"10.1111/1471-0528.70118","DOIUrl":"10.1111/1471-0528.70118","url":null,"abstract":"<p>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.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 4","pages":"660-661"},"PeriodicalIF":4.3,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812934","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}
Shiri Shinar, Dilkash Kajal, Sarah Johnson, Anna Otvodenko, Seungwoo Lee, Priscilla P. L. Chiu, Johannes Keunen, Tim Van Mieghem, Greg Ryan, Prakesh S. Shah, Nimrah Abbasi
<div> <section> <h3> Objective</h3> <p>To evaluate the reliability of qualitative foetal lung size assessments on ultrasound (US) and MRI in left congenital diaphragmatic hernia (CDH) and their correlation with quantitative metrics and neonatal mortality.</p> </section> <section> <h3> Design</h3> <p>Retrospective cohort study.</p> </section> <section> <h3> Setting</h3> <p>Single tertiary center, 2008–2020.</p> </section> <section> <h3> Population</h3> <p>A total of 103 cases of prenatally diagnosed isolated left CDH underwent postnatal active care.</p> </section> <section> <h3> Methods</h3> <p>Two independent reviewers performed qualitative foetal lung size assessments on US and MRI. Interrater agreement was assessed, and correlations were determined between qualitative assessments, quantitative metrics (observed-to-expected lung-to-head ratio [o/e LHR] and observed-to-expected total Foetal lung volume [o/e TFLV]), and neonatal mortality.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Interrater agreement and correlation between qualitative and quantitative assessments of lung size and neonatal mortality.</p> </section> <section> <h3> Results</h3> <p>A total of 74 cases with both US and MRI imaging were included. Interrater agreement for qualitative lung size assessment was strong for US (weighted kappa: 0.80, 95% CI 0.68–0.93) and moderate for MRI (Cohen's kappa: 0.48, 95% CI 0.30–0.66). Both modalities showed a strong correlation between qualitative and quantitative lung size assessments. On US, qualitative and quantitative assessments had similar associations with neonatal mortality (Spearman's correlation: 0.44 for each reviewer vs. 0.49). On MRI, quantitative metrics correlated more strongly with neonatal mortality than qualitative assessment (Cramér's V: 0.44 vs. 0.34–0.35).</p> </section> <section> <h3> Conclusions</h3> <p>Qualitative foetal lung size assessment, by US more so than MRI, is a reliable and reproducible tool that correlates with established quantitative metrics and neonatal mortality. These findings support its role as a complementary method for prenatal risk stratification in left CDH.</p> </section
目的评价超声（US）和MRI对左先天性膈疝（CDH）胎儿肺大小定性评估的可靠性及其与定量指标和新生儿死亡率的相关性。设计回顾性队列研究。2008-2020年单一三级中心。共有103例产前诊断为孤立性左CDH的患者接受了产后积极护理。方法两名独立审稿人通过超声和MRI对胎儿肺大小进行定性评估。评估了评估者间的一致性，并确定了定性评估、定量指标（观察到的与预期的肺头比[0 /e LHR]和观察到的与预期的总胎儿肺容量[0 /e TFLV]）与新生儿死亡率之间的相关性。主要结果测量肺大小与新生儿死亡率定性和定量评估之间的一致性和相关性。结果本组共74例合并超声和MRI检查的病例。定性肺大小评估在US（加权kappa: 0.80, 95% CI 0.68-0.93）和MRI （Cohen’s kappa: 0.48, 95% CI 0.30-0.66）中具有较强的一致性。两种方法均显示定性和定量肺大小评估之间有很强的相关性。在美国，定性和定量评估与新生儿死亡率有相似的关联（Spearman相关性：每位评论者0.44比0.49）。在MRI上，定量指标与新生儿死亡率的相关性比定性评估更强（cramamer’s V: 0.44 vs. 0.34-0.35）。结论定性胎儿肺大小评估，通过US比MRI更可靠，是一个可重复的工具，与已建立的定量指标和新生儿死亡率相关。这些发现支持其作为左侧CDH产前风险分层的补充方法的作用。
{"title":"Qualitative Assessment of Foetal Lung Size in Left Congenital Diaphragmatic Hernia Using Ultrasound and MRI: A Retrospective Cohort Study","authors":"Shiri Shinar, Dilkash Kajal, Sarah Johnson, Anna Otvodenko, Seungwoo Lee, Priscilla P. L. Chiu, Johannes Keunen, Tim Van Mieghem, Greg Ryan, Prakesh S. Shah, Nimrah Abbasi","doi":"10.1111/1471-0528.70120","DOIUrl":"10.1111/1471-0528.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the reliability of qualitative foetal lung size assessments on ultrasound (US) and MRI in left congenital diaphragmatic hernia (CDH) and their correlation with quantitative metrics and neonatal mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Single tertiary center, 2008–2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>A total of 103 cases of prenatally diagnosed isolated left CDH underwent postnatal active care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two independent reviewers performed qualitative foetal lung size assessments on US and MRI. Interrater agreement was assessed, and correlations were determined between qualitative assessments, quantitative metrics (observed-to-expected lung-to-head ratio [o/e LHR] and observed-to-expected total Foetal lung volume [o/e TFLV]), and neonatal mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Interrater agreement and correlation between qualitative and quantitative assessments of lung size and neonatal mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 74 cases with both US and MRI imaging were included. Interrater agreement for qualitative lung size assessment was strong for US (weighted kappa: 0.80, 95% CI 0.68–0.93) and moderate for MRI (Cohen's kappa: 0.48, 95% CI 0.30–0.66). Both modalities showed a strong correlation between qualitative and quantitative lung size assessments. On US, qualitative and quantitative assessments had similar associations with neonatal mortality (Spearman's correlation: 0.44 for each reviewer vs. 0.49). On MRI, quantitative metrics correlated more strongly with neonatal mortality than qualitative assessment (Cramér's V: 0.44 vs. 0.34–0.35).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Qualitative foetal lung size assessment, by US more so than MRI, is a reliable and reproducible tool that correlates with established quantitative metrics and neonatal mortality. These findings support its role as a complementary method for prenatal risk stratification in left CDH.</p>\u0000 </section","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 4","pages":"833-841"},"PeriodicalIF":4.3,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801128","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}
Elaine Cristina Fontes de Oliveira, Frederico Timm Rodrigues de Sousa, Felipe Augusto Oliveira Lemos, Ciro Peixoto Vasconcelos, Ana Luiza Lunardi Rocha
Background
The levonorgestrel-releasing intrauterine system (LNG-IUS) is a widely used long-term contraceptive with high continuation rates, but acne may lead to discontinuation.
Objectives
To evaluate the incidence of acne among LNG-IUS users.
Search Strategy
A systematic search was conducted in PubMed, Embase, and Cochrane Central from inception to September 2024.
Selection Criteria
Randomised clinical trials (RCTs) analysing patients of any age using LNG-IUS at 52 mg, 19.5 mg, or 13.5 mg, with acne reported as an outcome, were included.
Data Collection and Analysis
Statistical analyses were conducted using OpenMeta. Chi-square and Z-tests assessed differences between groups, and study quality was appraised using the ROB-2 tool.
Main Results
Of 587 studies identified, nine RCTs met inclusion criteria, comprising 6305 LNG-IUS users. The overall acne incidence was 15.0% (95% CI 9.8%–20.3%). Among 2295 users of LNG-IUS 52 mg, incidence reached 19.5% (95% CI 5.2%–33.7%), whereas in 2322 users of LNG-IUS 13.5 mg it was 13.1% (95% CI 8.3%–17.9%) (p < 0.001). Two trials evaluated the 19.5 mg device but data were insufficient for pooling. Studies enrolling younger women (mean age ~24 years) reported an incidence of 19.3% (95% CI 11.0%–27.5%). Excluding Suhonen et al. yielded pooled proportions of 11.9% (95% CI 1.1%–22.7%) for LNG-IUS 52 mg users, 10.8% (95% CI 6.1%–15.5%) when all dosages were combined, and 9.9% (95% CI 9.0%–10.9%) among young women. Heterogeneity remained substantial in the overall and dosage-specific analyses (I2≈95%–97%); it was eliminated in the young women subgroup (I2 = 0%).
Conclusions
LNG-IUS 52 mg users showed a higher incidence of acne compared with those using LNG-IUS 13.5 mg. Studies enrolling younger women also showed a higher incidence. These findings suggest that device dosage and age influence acne occurrence among LNG-IUS users.
Trial Registration
PROSPERO registration number: CRD42024588771
背景左炔诺孕酮释放宫内系统（LNG - IUS）是一种广泛使用的长期避孕药，具有较高的延续率，但痤疮可能导致停药。目的评估LNG - IUS服用者痤疮的发生率。系统检索PubMed， Embase， Cochrane Central从成立到2024年9月。纳入随机临床试验（rct），分析使用LNG - IUS剂量为52 mg、19.5 mg或13.5 mg的任何年龄患者，结果报告为痤疮。数据收集与分析使用OpenMeta进行统计分析。卡方检验和Z检验评估组间差异，并使用ROB‐2工具评估研究质量。在587项研究中，9项随机对照试验符合纳入标准，包括6305名LNG - IUS使用者。痤疮总发生率为15.0% （95% CI 9.8%-20.3%）。在2295名LNG - IUS 52 mg服用者中，发病率达到19.5% (95% CI 5.2%-33.7%)，而在2322名LNG - IUS 13.5 mg服用者中，发病率为13.1% (95% CI 8.3%-17.9%) （p < 0.001）。两项试验评估了19.5 mg的装置，但数据不足以汇总。纳入年轻女性（平均年龄~24岁）的研究报告发病率为19.3% （95% CI 11.0%-27.5%）。排除Suhonen等人的结果，LNG - IUS 52 mg服用者的总比例为11.9% (95% CI 1.1%-22.7%)，所有剂量联合使用时的总比例为10.8% (95% CI 6.1%-15.5%)，年轻女性的总比例为9.9% （95% CI 9.0%-10.9%）。在总体和剂量特异性分析中，异质性仍然很大（I 2≈95%-97%）；在年轻女性亚组中被排除（i2 = 0%）。结论：与使用LNG - IUS 13.5 mg的患者相比，使用LNG - IUS 52 mg的患者痤疮发生率更高。招募年轻女性的研究也显示出更高的发病率。这些发现表明，设备剂量和年龄影响LNG - IUS使用者痤疮的发生。普洛斯彼罗注册号：CRD42024588771
{"title":"Incidence of Acne in Women Using the Levonorgestrel-Releasing Intrauterine Device: A Systematic Review and Meta-Analysis","authors":"Elaine Cristina Fontes de Oliveira, Frederico Timm Rodrigues de Sousa, Felipe Augusto Oliveira Lemos, Ciro Peixoto Vasconcelos, Ana Luiza Lunardi Rocha","doi":"10.1111/1471-0528.70108","DOIUrl":"10.1111/1471-0528.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The levonorgestrel-releasing intrauterine system (LNG-IUS) is a widely used long-term contraceptive with high continuation rates, but acne may lead to discontinuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the incidence of acne among LNG-IUS users.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>A systematic search was conducted in PubMed, Embase, and Cochrane Central from inception to September 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Randomised clinical trials (RCTs) analysing patients of any age using LNG-IUS at 52 mg, 19.5 mg, or 13.5 mg, with acne reported as an outcome, were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Statistical analyses were conducted using OpenMeta. Chi-square and Z-tests assessed differences between groups, and study quality was appraised using the ROB-2 tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Of 587 studies identified, nine RCTs met inclusion criteria, comprising 6305 LNG-IUS users. The overall acne incidence was 15.0% (95% CI 9.8%–20.3%). Among 2295 users of LNG-IUS 52 mg, incidence reached 19.5% (95% CI 5.2%–33.7%), whereas in 2322 users of LNG-IUS 13.5 mg it was 13.1% (95% CI 8.3%–17.9%) (<i>p</i> < 0.001). Two trials evaluated the 19.5 mg device but data were insufficient for pooling. Studies enrolling younger women (mean age ~24 years) reported an incidence of 19.3% (95% CI 11.0%–27.5%). Excluding Suhonen et al. yielded pooled proportions of 11.9% (95% CI 1.1%–22.7%) for LNG-IUS 52 mg users, 10.8% (95% CI 6.1%–15.5%) when all dosages were combined, and 9.9% (95% CI 9.0%–10.9%) among young women. Heterogeneity remained substantial in the overall and dosage-specific analyses (<i>I</i><sup>2</sup>≈95%–97%); it was eliminated in the young women subgroup (<i>I</i><sup>2</sup> = 0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LNG-IUS 52 mg users showed a higher incidence of acne compared with those using LNG-IUS 13.5 mg. Studies enrolling younger women also showed a higher incidence. These findings suggest that device dosage and age influence acne occurrence among LNG-IUS users.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO registration number: CRD42024588771</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 4","pages":"590-597"},"PeriodicalIF":4.3,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801129","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}
Linked article: This is a mini commentary on Moradi et al., pp. 577–588 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.70015.
{"title":"Intrapartum Antibiotic Prophylaxis and Child Health Outcomes","authors":"Tomi Kanninen","doi":"10.1111/1471-0528.70126","DOIUrl":"10.1111/1471-0528.70126","url":null,"abstract":"<p><b>Linked article:</b> This is a mini commentary on Moradi et al., pp. 577–588 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.70015.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 4","pages":"568-569"},"PeriodicalIF":4.3,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807514","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}
Zeenat Ladak, Jennifer A. Jairam, Sarah Swayze, Jennifer Shuldiner, Olesya Falenchuk, Richard Volpe, Noah M. Ivers, Joel G. Ray
<p>A mother or her infant may face life-threatening events during childbirth or shortly thereafter, which may be preventable [<span>1</span>]. Adequacy of prenatal care is one determinant of maternal and newborn outcomes [<span>2</span>]. This study assessed whether adequacy of prenatal care is associated with maternal and newborn morbidity and mortality after birth.</p><p>This population-based, retrospective cohort study was completed using deidentified healthcare datasets, linked using unique encoded identifiers at ICES (Table S1). Included were hospital-based singleton livebirths and stillbirths from 20 to 42 weeks' gestation, in Ontario, Canada, from April 1, 2012, to March 31, 2020 (Table S2).</p><p>Study variables were chosen a priori (Figure S1). The exposure was adequacy of prenatal care, determined using the Revised-Graduate Prenatal Care Utilisation Index (R-GINDEX), which includes the number of prenatal visits, newborn gestational age, and initiation of first-trimester care [<span>2</span>]. It reflects adequacy on a five-level scale: no care, inadequate, intermediate, adequate (reference), and intensive care. The primary maternal outcome was a validated composite of any severe <i>maternal</i> morbidity and mortality (SMM-M) from the mother's delivery hospitalisation date and up to 42 days thereafter [<span>3</span>]. The primary infant outcome was a validated composite of any severe <i>neonatal</i> morbidity and mortality (SNM-M) from the infant's birth and up to 27 days thereafter (Table 1) [<span>4</span>].</p><p>Mean values and proportions of baseline variables were contrasted using standardised differences. Modified Poisson regression with generalised estimating equations generated unadjusted and adjusted relative risks (aRR) for SMM-M and SNM-M, respectively, comparing the five-level exposure group of adequacy of prenatal care. The maternal assessment was among all livebirths and stillbirths, while the neonatal assessment was limited to livebirths. Additional analyses were conducted for the outcomes of non-fatal severe maternal morbidity (SMM) and severe neonatal morbidity (SNM), and also for maternal and neonatal mortality. Analyses were performed using SAS version 9.4 software.</p><p>Among 955 814 births, 950 757 (99.5%) were livebirths (Figure S2). A total of 924 773 (96.8%) pregnancies had sufficient prenatal care (mean age 30.9 years), while 31 041 (3.2%) did not (mean age 27.9 years) (Table S3 and Table S4).</p><p>SMM-M occurred among 27 757 (2.9%) women. Relative to receipt of adequate prenatal care, those with no care had an aRR of SMM-M of 1.42 (95% CI 1.13–1.77) (Table 1). Women with inadequate (aRR 1.08, 95% CI 1.01–1.15) and intensive (aRR 1.04, 95% CI 1.00–1.06) care also had a somewhat higher risk of SMM-M.</p><p>SNM-M occurred among 64 613 (6.8%) liveborn infants. Compared to newborns of women who received adequate care, those receiving no prenatal care had the greatest aRR of SNM-M (1.60, 95% CI 1.40–1.83) (Table
母亲或她的婴儿在分娩期间或分娩后不久可能面临危及生命的事件，这些事件是可以预防的。产前护理的充分性是孕产妇和新生儿结局的一个决定因素[b]。本研究评估了产前护理是否与产妇和新生儿出生后的发病率和死亡率有关。这项基于人群的回顾性队列研究是使用未识别的医疗数据集完成的，在ICES中使用唯一编码标识符进行连接（表S1）。其中包括2012年4月1日至2020年3月31日在加拿大安大略省住院的单胎活产和妊娠20至42周的死产（表S2）。研究变量的选择是先验的（图S1）。暴露是产前护理的充足性，使用修订毕业生产前护理利用指数（R-GINDEX）来确定，其中包括产前就诊次数、新生儿胎龄和妊娠早期护理的开始bb0。它反映了五个级别的适当性：无护理、不充分、中等、适当（参考）和重症监护。主要产妇结局是一项经过验证的综合指标，包括从产妇分娩住院之日起至产后42天内的任何严重产妇发病率和死亡率（SMM-M）。婴儿的主要结局是婴儿出生后27天内任何严重新生儿发病率和死亡率（SNM-M）的经过验证的综合结果（表1）。使用标准化差异对比基线变量的平均值和比例。使用广义估计方程的修正泊松回归分别为SMM-M和SNM-M产生未调整和调整的相对风险（aRR），比较产前护理充足性的五个水平暴露组。产妇评估包括所有活产和死产，而新生儿评估仅限于活产。对非致死性严重孕产妇发病率（SMM）和严重新生儿发病率（SNM）以及孕产妇和新生儿死亡率的结果进行了进一步分析。采用SAS 9.4版软件进行分析。在955814例出生中，950757例（99.5%）为活产（图S2）。共有924773例（96.8%）孕妇得到充分的产前护理（平均年龄30.9岁），而31041例（3.2%）孕妇没有得到充分的产前护理（平均年龄27.9岁）（表S3和表S4）。SMM-M发生在27757例（2.9%）女性中。相对于接受足够的产前护理，未接受护理者的aRR为1.42 (95% CI 1.13-1.77)（表1）。护理不充分（aRR 1.08, 95% CI 1.01-1.15）和强化（aRR 1.04, 95% CI 1.00-1.06）的妇女发生SMM-M的风险也较高。SNM-M发生在64 613例（6.8%）活产婴儿中。与接受充分护理的妇女的新生儿相比，未接受产前护理的妇女的SNM-M的aRR最高（1.60,95% CI 1.40-1.83）（表1）。非致命性SMM和SNM的结果与SMM- m和SNM- m的结果相似（表S5）。产妇和新生儿死亡率的结果也类似，但更为明显（表S6）。在具有完整人口数据集的全民医疗保健系统中，没有产前护理的妇女及其婴儿有更高的严重发病率和死亡风险。加拿大马尼托巴省的一项研究发现，产前护理不足与死产、早产、胎龄小出生体重和新生儿重症监护病房住院的几率较高有关。目前的研究表明，接受强化产前护理的妇女的相关发病率略高，但她们的婴儿没有。前者可能是由于适应症的混淆，因为高危妊娠更有可能接受多次产前护理，但可能仍然容易发生产妇并发症。在确定的高危妇女中，例如那些有孕前合并症的妇女，产前护理强度与SMM-M、SNM-M和其他结果之间的关系可以使用倾向评分加权分析来评估。使用R-GINDEX的产前护理主要基于产前就诊的次数，而不考虑护理的质量。潜在的混杂因素，包括肥胖和吸烟状况，都无法获得。此外，我们排除了20周前结束的妊娠，这可能与产前护理不足有关。危及生命的孕产妇和新生儿发病率在很少或没有产前护理的人群中更为明显。今后的研究和公共卫生方案应侧重于改善获得产前护理的机会和这种护理的质量。J.G.R.和N.M.I.对作品的构思和设计做出了贡献。z.l和S.S.对数据的获取、分析和清理做出了贡献。z.l起草了手稿。所有作者都对原稿进行了修改，并批准了最终版本的出版。由安大略省研究生奖学金资助。 这项研究得到了多伦多大学数据科学研究所（DSI-DAGY3R1P07）和ICES的支持，ICES由安大略省卫生部（MOH）和长期护理部（MLTC）的年度拨款资助。本文所报道的观点、结果和结论均为作者的观点、结果和结论，与资助来源无关。没有得到ICES、卫生部或MLTC的认可，也不应该推断。nmi得到了加拿大循证实践实施研究主席、女子学院医院家庭和社区医学部以及多伦多大学的支持。作者声明无利益冲突。本研究的数据集以编码形式安全地保存在ICES中。虽然国际数据中心与数据提供者（例如医疗保健组织和政府）之间的法律数据共享协议禁止国际数据中心公开提供数据集，但可以向符合预先规定的保密访问标准的人员授予访问权，可通过www.ices.on.ca/DAS（电子邮件：[email protected]）获得。完整的数据集创建计划和底层分析代码可根据要求从作者处获得，理解计算机程序可能依赖于编码模板或宏，这些模板或宏是ICES独有的，因此，要么无法访问，要么可能需要修改。
{"title":"Adequacy of Prenatal Care and Ensuing Maternal and Neonatal Severe Morbidity and Mortality","authors":"Zeenat Ladak, Jennifer A. Jairam, Sarah Swayze, Jennifer Shuldiner, Olesya Falenchuk, Richard Volpe, Noah M. Ivers, Joel G. Ray","doi":"10.1111/1471-0528.70119","DOIUrl":"10.1111/1471-0528.70119","url":null,"abstract":"<p>A mother or her infant may face life-threatening events during childbirth or shortly thereafter, which may be preventable [<span>1</span>]. Adequacy of prenatal care is one determinant of maternal and newborn outcomes [<span>2</span>]. This study assessed whether adequacy of prenatal care is associated with maternal and newborn morbidity and mortality after birth.</p><p>This population-based, retrospective cohort study was completed using deidentified healthcare datasets, linked using unique encoded identifiers at ICES (Table S1). Included were hospital-based singleton livebirths and stillbirths from 20 to 42 weeks' gestation, in Ontario, Canada, from April 1, 2012, to March 31, 2020 (Table S2).</p><p>Study variables were chosen a priori (Figure S1). The exposure was adequacy of prenatal care, determined using the Revised-Graduate Prenatal Care Utilisation Index (R-GINDEX), which includes the number of prenatal visits, newborn gestational age, and initiation of first-trimester care [<span>2</span>]. It reflects adequacy on a five-level scale: no care, inadequate, intermediate, adequate (reference), and intensive care. The primary maternal outcome was a validated composite of any severe <i>maternal</i> morbidity and mortality (SMM-M) from the mother's delivery hospitalisation date and up to 42 days thereafter [<span>3</span>]. The primary infant outcome was a validated composite of any severe <i>neonatal</i> morbidity and mortality (SNM-M) from the infant's birth and up to 27 days thereafter (Table 1) [<span>4</span>].</p><p>Mean values and proportions of baseline variables were contrasted using standardised differences. Modified Poisson regression with generalised estimating equations generated unadjusted and adjusted relative risks (aRR) for SMM-M and SNM-M, respectively, comparing the five-level exposure group of adequacy of prenatal care. The maternal assessment was among all livebirths and stillbirths, while the neonatal assessment was limited to livebirths. Additional analyses were conducted for the outcomes of non-fatal severe maternal morbidity (SMM) and severe neonatal morbidity (SNM), and also for maternal and neonatal mortality. Analyses were performed using SAS version 9.4 software.</p><p>Among 955 814 births, 950 757 (99.5%) were livebirths (Figure S2). A total of 924 773 (96.8%) pregnancies had sufficient prenatal care (mean age 30.9 years), while 31 041 (3.2%) did not (mean age 27.9 years) (Table S3 and Table S4).</p><p>SMM-M occurred among 27 757 (2.9%) women. Relative to receipt of adequate prenatal care, those with no care had an aRR of SMM-M of 1.42 (95% CI 1.13–1.77) (Table 1). Women with inadequate (aRR 1.08, 95% CI 1.01–1.15) and intensive (aRR 1.04, 95% CI 1.00–1.06) care also had a somewhat higher risk of SMM-M.</p><p>SNM-M occurred among 64 613 (6.8%) liveborn infants. Compared to newborns of women who received adequate care, those receiving no prenatal care had the greatest aRR of SNM-M (1.60, 95% CI 1.40–1.83) (Table ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 4","pages":"849-851"},"PeriodicalIF":4.3,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770802","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}
{"title":"Author Reply.","authors":"Katy Vincent, Andrew Wemyss Horne","doi":"10.1111/1471-0528.70113","DOIUrl":"https://doi.org/10.1111/1471-0528.70113","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764602","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}
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