Johnson, K., Elvander, C., Johansson, K., Saltvedt, S. and Edqvist, M. (2025), Medical Interventions and Women's Perceptions of Respectful Intrapartum Care: A National Survey-Based Cohort Study. BJOG, 132: 1844–1855. https://doi.org/10.1111/1471-0528.18329.
In the Ethics statement, the reference number for the amendment concerning this specific study was incorrect. This should have read: The study was approved by the Swedish Ethical Review Authority at Karolinska no 2020-02500 on 10 October 2020, and amendment 2021-06055-02 on 4 January 2021.
{"title":"Correction to ‘Medical Interventions and Women's Perceptions of Respectful Intrapartum Care: A National Survey-Based Cohort Study’","authors":"","doi":"10.1111/1471-0528.70082","DOIUrl":"10.1111/1471-0528.70082","url":null,"abstract":"<p>Johnson, K., Elvander, C., Johansson, K., Saltvedt, S. and Edqvist, M. (2025), Medical Interventions and Women's Perceptions of Respectful Intrapartum Care: A National Survey-Based Cohort Study. <i>BJOG</i>, 132: 1844–1855. https://doi.org/10.1111/1471-0528.18329.</p><p>In the Ethics statement, the reference number for the amendment concerning this specific study was incorrect. This should have read: The study was approved by the Swedish Ethical Review Authority at Karolinska no 2020-02500 on 10 October 2020, and <b>amendment 2021-06055-02</b> on 4 January 2021.</p><p>We apologize for this error.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145455106","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}
<div> <section> <h3> Objective</h3> <p>To investigate the association between prenatal maternal perceived stress, salivary cortisol, and the odds of recurrent preterm birth (rPTB).</p> </section> <section> <h3> Design</h3> <p>Prospective cohort study.</p> </section> <section> <h3> Setting</h3> <p>Soroka University Medical Center and Clalit Health Maintenance Organization clinics in Israel.</p> </section> <section> <h3> Population</h3> <p>A total of 245 pregnant women with a history of spontaneous singleton PTB, all carrying singleton pregnancies in the current pregnancy. Data source were on-line self-completed computerised REDCap questionnaires and summary of computerised medical records including data on medications and laboratory results and cortisol in the saliva.</p> </section> <section> <h3> Methods</h3> <p>Participants provided saliva samples and completed stress questionnaires twice during pregnancy, with two assessments separated by 4–8 weeks. Recurrent PTB incidence was compared between women with high vs. low cortisol and perceived stress (> 75th percentile). Multivariable logistic regression models were used to analyse the odds of rPTB.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Recurrent PTB incidence, defined as delivery < 37 weeks in the current pregnancy, identified from hospital records.</p> </section> <section> <h3> Results</h3> <p>Among 245 women, 22.4% experienced rPTB. High perceived stress levels later in pregnancy were associated with a higher incidence of rPTB (38.9% vs. 19.2%; <i>p</i> = 0.011, adj. OR = 2.44, 95% CI: 1.053–5.639; <i>p</i> = 0.038), while adjusting for maternal age, number of prior PTBs and parity. Women with consistently high stress levels had the highest incidence of rPTB (40%), followed by women with increased stress later in pregnancy (37.5%). The multivariable regression analyses identified consistently high stress (adj. OR = 3.82, 95% CI: 1.37–10.64; <i>p</i> = 0.010) and high stress only in later pregnancy (adj. OR = 3.18, 95% CI: 1.04–9.73; <i>p</i> = 0.042) as significant risk factors of rPTB. No association was observed between cortisol levels, high perceived stress in the first trimester and rPTB. No differences were observed between women with versus without rPTB in terms o
目的探讨产前产妇感知应激、唾液皮质醇与复发性早产（rPTB）的关系。前瞻性队列研究。以色列索罗卡大学医学中心和克拉利特健康维护组织诊所。共有245例有自发性单胎性肺结核病史的孕妇，均为单胎妊娠。数据来源为在线自行完成的计算机化REDCap问卷和计算机化医疗记录摘要，包括药物数据、实验室结果和唾液中的皮质醇。方法孕妇在怀孕期间两次提供唾液样本并填写压力问卷，两次评估间隔4-8周。比较高皮质醇组与低皮质醇组和感知压力组的PTB复发发生率（bbb75百分位数）。采用多变量logistic回归模型分析rPTB的发病几率。主要观察指标PTB复发发生率，定义为从医院记录中确定的当前妊娠分娩< 37周。结果245名妇女中，22.4%的人经历过肺结核。妊娠后期的高感知压力水平与rPTB的高发病率相关（38.9% vs. 19.2%; p = 0.011, OR = 2.44, 95% CI: 1.053-5.639; p = 0.038），同时调整了母亲年龄、既往ptb数量和胎次。持续高压力水平的妇女患rPTB的发病率最高（40%），其次是怀孕后期压力增加的妇女（37.5%）。多变量回归分析发现，高压力（OR = 3.82, 95% CI: 1.37-10.64; p = 0.010）和仅在妊娠后期高压力（OR = 3.18, 95% CI: 1.04-9.73; p = 0.042）是妊娠期结核的重要危险因素。未观察到皮质醇水平、妊娠早期高感知压力和rPTB之间的关联。在人口统计学、健康或生活方式特征方面，没有观察到有rPTB的妇女与没有rPTB的妇女之间的差异。未观察到皮质醇水平、妊娠早期高感知压力和rPTB之间的关联。在人口统计学、健康或生活方式特征方面，没有观察到有rPTB的妇女与没有rPTB的妇女之间的差异。结论孕期持续和妊娠后期的高感知压力是诱发rPTB的重要危险因素。
{"title":"Breaking the Cycle of Preterm Birth: A Prospective Cohort Study on Maternal Stress and Recurrent Preterm Birth","authors":"Maayan Hagbi Bal, Shimrit Yaniv Salem, Eyal Sheiner, Iris Shoham, Israel Yoles, Noa Dina Israel-Tov, Noam Tomasis Damri, Doron Bergman, Ron Rosenbaum, Ayal Haimov, Ifat Baram Goldberg, Ilana Shoham-Vardi, Tamar Wainstock","doi":"10.1111/1471-0528.70064","DOIUrl":"10.1111/1471-0528.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the association between prenatal maternal perceived stress, salivary cortisol, and the odds of recurrent preterm birth (rPTB).</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>Soroka University Medical Center and Clalit Health Maintenance Organization clinics in Israel.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>A total of 245 pregnant women with a history of spontaneous singleton PTB, all carrying singleton pregnancies in the current pregnancy. Data source were on-line self-completed computerised REDCap questionnaires and summary of computerised medical records including data on medications and laboratory results and cortisol in the saliva.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants provided saliva samples and completed stress questionnaires twice during pregnancy, with two assessments separated by 4–8 weeks. Recurrent PTB incidence was compared between women with high vs. low cortisol and perceived stress (> 75th percentile). Multivariable logistic regression models were used to analyse the odds of rPTB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Recurrent PTB incidence, defined as delivery < 37 weeks in the current pregnancy, identified from hospital records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 245 women, 22.4% experienced rPTB. High perceived stress levels later in pregnancy were associated with a higher incidence of rPTB (38.9% vs. 19.2%; <i>p</i> = 0.011, adj. OR = 2.44, 95% CI: 1.053–5.639; <i>p</i> = 0.038), while adjusting for maternal age, number of prior PTBs and parity. Women with consistently high stress levels had the highest incidence of rPTB (40%), followed by women with increased stress later in pregnancy (37.5%). The multivariable regression analyses identified consistently high stress (adj. OR = 3.82, 95% CI: 1.37–10.64; <i>p</i> = 0.010) and high stress only in later pregnancy (adj. OR = 3.18, 95% CI: 1.04–9.73; <i>p</i> = 0.042) as significant risk factors of rPTB. No association was observed between cortisol levels, high perceived stress in the first trimester and rPTB. No differences were observed between women with versus without rPTB in terms o","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 3","pages":"495-503"},"PeriodicalIF":4.3,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381212","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}
Jill M. Krapf, Rachel Pope, Rachel S. Rubin, Chailee F. Moss, Melissa M. Mauskar
Objective
The objective of this study is to develop accepted definitions and grading scales for clitoral phimosis and clitoral adhesions. Design: Using a Delphi model of international vulvar experts, we attempt to reach consensus on definitions and factors included in grading scales.
Setting
This was done through electronic surveys to accommodate the global reach.
Population
Physicians with significant clinical and/or research experience in vulvar dermatoses. Content experts were included from the fields of Dermatology, Gynaecology, and Urology.
Methods
International content experts were invited to respond to two surveys on clitoral phimosis and clitoral adhesions. Individuals were deemed experts due to publications, international and national speaking engagements, and teaching on the topic of vulvar dermatoses. They were asked whether there is a need for definitions, the wording of definitions, and the variables that should constitute a future classification.
Main Outcome Measures
A priori, we decided that a mean score of 7 out of 10 (70%) would constitute a consensus.
Results
The following statements gained consensus: (1) there is a need for a definition of clitoral phimosis and clitoral adhesions, (2) clitoral phimosis is defined as the inability to retract the clitoral prepuce to expose the entire glans, (3) clitoral adhesion is defined as the tethering of the clitoral prepuce (clitoral hood) to the glans clitoris, (4) the prepuce (90%) and the size of the glans (70%) should be considered in a classification, and (5) the degree of phimosis should be described as mild, moderate, or severe and whether or not the prepuce is retractable.
Conclusion
Unifying communication on clitoral phimosis and adhesions could help improve research and clinical management.
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Yasser Sabr, Sarka Lisonkova, Amélie Boutin, Chantal Mayer, K S Joseph
{"title":"Author Reply.","authors":"Yasser Sabr, Sarka Lisonkova, Amélie Boutin, Chantal Mayer, K S Joseph","doi":"10.1111/1471-0528.70054","DOIUrl":"https://doi.org/10.1111/1471-0528.70054","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349754","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}
Mariam Ayyash MD, MSCR, Timothy Wen MD, MPH, Stephanie Purisch MD, Maria Andrikopoulou MD PhD, Alexander Friedman MD, MPH
<div> <section> <h3> Objective</h3> <p>To analyse the association between hypertensive diagnoses at delivery—both as a composite and individual diagnoses—and subsequent postpartum readmission for cardiovascular severe maternal morbidity (SMM).</p> </section> <section> <h3> Design</h3> <p>Retrospective cohort study.</p> </section> <section> <h3> Setting</h3> <p>2016–2022 Nationwide Readmissions Database.</p> </section> <section> <h3> Population or Sample</h3> <p>Delivery hospitalisations with subsequent 6-month postpartum readmissions with cardiovascular SMM.</p> </section> <section> <h3> Methods</h3> <p>Multivariable logistic regression models were performed for postpartum cardiovascular SMM with delivery hospitalisation hypertensive diagnoses as the exposure of interest. Adjusted odds ratios (aORs) accounting for demographic, clinical and hospital factors were estimated as measures of association. An ancillary analysis restricted to deliveries with hypertensive diagnoses, excluding preterm prelabour rupture of membranes and preterm labour was performed to analyse the effect of gestational age at delivery.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Composite cardiovascular SMM.</p> </section> <section> <h3> Results</h3> <p>Among 12.0 million delivery hospitalisations, 1.8 million (15.4%) had an associated hypertensive diagnosis at delivery. Overall, 14 297 individuals (1.19 per 1000) were readmitted within 6 months postpartum with cardiovascular SMM, of whom 5912 (41.4%) had a hypertensive diagnosis at delivery. Hypertensive diagnoses were associated with increased odds for 6 months postpartum cardiovascular SMM readmission (aOR 2.8 95% CI 2.7–3.0). Evaluating individual diagnoses, superimposed preeclampsia (aOR 4.3, 95% CI 3.8–4.8), chronic hypertension (aOR 3.2, 95% CI 2.9–3.5), preeclampsia without severe features (aOR 3.1, 95% CI 2.8–3.5), preeclampsia with severe features (aOR 3.0, 95% CI 2.7–3.3) and gestational hypertension (aOR 2.1, CI 1.9–2.3) were all associated with significantly higher odds for postpartum cardiovascular SMM readmission compared to the absence of hypertensive diagnoses. In ancillary analysis restricted to patients with hypertensive disorders, delivery < 34 weeks was associated with higher odds for 6-month cardiovascular SMM postpartum readmission (aOR 1.4, 95% CI 1.2–1.6).</p> </section> <section>
目的分析分娩时高血压诊断（无论是综合诊断还是单独诊断）与产后心血管严重孕产妇发病率（SMM）再入院的关系。设计回顾性队列研究。SETTING2016-2022全国再入院数据库。人群或样本：分娩时住院，产后6个月再入院，并发心血管SMM。方法采用多变量logistic回归模型对产后心血管SMM进行分析，并以分娩住院高血压诊断为研究对象。考虑人口统计学、临床和医院因素的调整优势比（aORs）被估计为相关性的度量。一项辅助分析仅限于高血压诊断的分娩，不包括早产、胎膜破裂和早产，以分析分娩时胎龄的影响。主要观察指标：复合心血管SMM。结果在1200万例分娩住院患者中，180万例（15.4%）分娩时伴有高血压诊断。总体而言，14297例（每1000人中有1.19例）在产后6个月内再次入院，其中5912例（41.4%）在分娩时诊断为高血压。高血压诊断与产后6个月心血管SMM再入院的几率增加相关（aOR为2.8,95% CI为2.7-3.0）。评估个体诊断，与没有高血压诊断相比，叠加子痫前期（aOR 4.3, 95% CI 3.8-4.8）、慢性高血压（aOR 3.2, 95% CI 2.9-3.5）、无严重特征的子痫前期（aOR 3.1, 95% CI 2.8-3.5）、有严重特征的子痫前期（aOR 3.0, 95% CI 2.7-3.3）和妊娠期高血压（aOR 2.1, CI 1.9-2.3）均与产后心血管SMM再住院的几率显著升高相关。在仅限于高血压疾病患者的辅助分析中，分娩< 34周与6个月后心血管SMM再入院的几率较高相关（aOR 1.4, 95% CI 1.2-1.6）。结论高血压诊断与产后6个月心血管SMM再入院的几率显著增加相关，个体诊断的几率有明显差异。在患有高血压疾病的患者中，分娩< 34周的患者患病几率增加尤为明显。高血压疾病是导致产后产科不良结局的重要危险因素，是识别患者风险和提高产后护理质量的重要因素。
{"title":"Hypertensive Disorders at Delivery and Postpartum Cardiovascular Morbidity: A Retrospective Cohort Study","authors":"Mariam Ayyash MD, MSCR, Timothy Wen MD, MPH, Stephanie Purisch MD, Maria Andrikopoulou MD PhD, Alexander Friedman MD, MPH","doi":"10.1111/1471-0528.70065","DOIUrl":"10.1111/1471-0528.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To analyse the association between hypertensive diagnoses at delivery—both as a composite and individual diagnoses—and subsequent postpartum readmission for cardiovascular severe maternal morbidity (SMM).</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>2016–2022 Nationwide Readmissions Database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>Delivery hospitalisations with subsequent 6-month postpartum readmissions with cardiovascular SMM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multivariable logistic regression models were performed for postpartum cardiovascular SMM with delivery hospitalisation hypertensive diagnoses as the exposure of interest. Adjusted odds ratios (aORs) accounting for demographic, clinical and hospital factors were estimated as measures of association. An ancillary analysis restricted to deliveries with hypertensive diagnoses, excluding preterm prelabour rupture of membranes and preterm labour was performed to analyse the effect of gestational age at delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Composite cardiovascular SMM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 12.0 million delivery hospitalisations, 1.8 million (15.4%) had an associated hypertensive diagnosis at delivery. Overall, 14 297 individuals (1.19 per 1000) were readmitted within 6 months postpartum with cardiovascular SMM, of whom 5912 (41.4%) had a hypertensive diagnosis at delivery. Hypertensive diagnoses were associated with increased odds for 6 months postpartum cardiovascular SMM readmission (aOR 2.8 95% CI 2.7–3.0). Evaluating individual diagnoses, superimposed preeclampsia (aOR 4.3, 95% CI 3.8–4.8), chronic hypertension (aOR 3.2, 95% CI 2.9–3.5), preeclampsia without severe features (aOR 3.1, 95% CI 2.8–3.5), preeclampsia with severe features (aOR 3.0, 95% CI 2.7–3.3) and gestational hypertension (aOR 2.1, CI 1.9–2.3) were all associated with significantly higher odds for postpartum cardiovascular SMM readmission compared to the absence of hypertensive diagnoses. In ancillary analysis restricted to patients with hypertensive disorders, delivery < 34 weeks was associated with higher odds for 6-month cardiovascular SMM postpartum readmission (aOR 1.4, 95% CI 1.2–1.6).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 3","pages":"504-513"},"PeriodicalIF":4.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338537","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}
To describe and classify mistreatment during maternity care as described by a diverse set of women across the United States.
Design
Interpretive description qualitative analysis.
Setting
Qualitative data were collected via a web-based survey (n = 1151) and in semi-structured interviews (n = 25).
Sample
Adult women with a history of caesarean who had a subsequent birth (of any mode) in the United States in the 5 years preceding study participation.
Methods
Deductive Content Analysis was employed using a priori codes based on Bohren et al.'s Typology of Mistreatment of Women during Childbirth framework.
Results
Participants described all eight types of mistreatment. Marginalised participants, who are most at risk for adverse maternal and infant birth outcomes, were also the most likely to describe experiences of mistreatment during their maternity care. Consequences of mistreatment in maternity care described by participants included healthcare system distrust, reduced postpartum healthcare utilisation and maternal mental health complications.
Conclusions
Participants experienced mistreatment in their interactions with their maternity care team. Oftentimes, these same situations may have been perceived as benign or routine from the clinicians' perspectives.
{"title":"Narratives of Mistreatment and Coercion in Maternity Care: An Interpretive Description Qualitative Analysis","authors":"Bridget Basile, Melissa Cheyney, Saraswathi Vedam, Holly Powell Kennedy","doi":"10.1111/1471-0528.70061","DOIUrl":"10.1111/1471-0528.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe and classify mistreatment during maternity care as described by a diverse set of women across the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Interpretive description qualitative analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Qualitative data were collected via a web-based survey (<i>n</i> = 1151) and in semi-structured interviews (<i>n</i> = 25).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Adult women with a history of caesarean who had a subsequent birth (of any mode) in the United States in the 5 years preceding study participation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Deductive Content Analysis was employed using a priori codes based on Bohren et al.'s Typology of Mistreatment of Women during Childbirth framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants described all eight types of mistreatment. Marginalised participants, who are most at risk for adverse maternal and infant birth outcomes, were also the most likely to describe experiences of mistreatment during their maternity care. Consequences of mistreatment in maternity care described by participants included healthcare system distrust, reduced postpartum healthcare utilisation and maternal mental health complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Participants experienced mistreatment in their interactions with their maternity care team. Oftentimes, these same situations may have been perceived as benign or routine from the clinicians' perspectives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2284-2298"},"PeriodicalIF":4.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331766","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}
To assess the prevalence of and trend in bothersome vaginal flatus from mid-pregnancy to 12 months postpartum, according to vaginal parity. The secondary objective was to assess differences in pelvic floor anatomy as risk factors for bothersome flatus at 12 months postpartum.
Design
Longitudinal cohort study.
Setting
Akershus University Hospital, Norway.
Sample
880 women with vaginal births.
Methods
Participants completed questionnaires in mid-pregnancy, at 3 and 12 months postpartum, and attended a gynaecological examination including ultrasound at 12 months postpartum. Parity was classified as primipara, secundipara, or multipara (no, one, or ≥ 2 previous vaginal births, respectively). A generalised linear mixed model and logistic regression models were used for analysis.
Main Outcome Measures
Bothersome vaginal flatus, defined as responding “often” or “always” to the question “Are you bothered by sounds caused by air escaping from the vagina?”
Results
The prevalence of bothersome flatus in mid-pregnancy, at 3 and 12 months postpartum was: primiparas: 0.7%, 4.0%, and 2.5%; secundiparas: 2.3%, 4.4%, and 7.3%; multiparas: 5.4%, 3.0%, and 7.1%, respectively. Compared to primiparas, multiparas had higher odds in pregnancy (OR 14.0, 95% CI 1.8–108.1), and both secundi- and multiparas had higher odds at 12 months postpartum (OR 4.8, 95% CI 1.3–17.6, and OR 6.4, 95% CI 1.1–38.6, respectively). Independent risk factors for bothersome flatus included levator avulsion (aOR 3.6, 95% CI 1.5–8.7), a larger genital hiatus (aOR 2.0, 95% CI 1.2–3.3), and a shorter perineal body (aOR 0.8, 95% CI 0.6–1.0).
Conclusion
Parity and differences in pelvic floor anatomy affect the odds for bothersome vaginal flatus during the first postpartum year.
目的探讨妊娠中期至产后12个月阴道胀气的发生率及变化趋势。次要目的是评估盆底解剖差异作为产后12个月烦人的肠胃胀气的危险因素。设计纵向队列研究。背景：挪威Akershus大学医院。抽样880名阴道分娩的妇女。方法在妊娠中期、产后3个月和12个月分别完成问卷调查，并于产后12个月进行妇科超声检查。胎次分为初产、次产和多产（分别为没有、一次或≥2次阴道分娩）。采用广义线性混合模型和逻辑回归模型进行分析。恼人的阴道胀气，定义为“经常”或“总是”回答“你是否被阴道排出的空气引起的声音困扰？”结果妊娠中期、产后3个月、12个月恼人的肠胃胀气患病率分别为：初产妇：0.7%、4.0%、2.5%；第二段：2.3%、4.4%和7.3%；多段式：分别为5.4%、3.0%和7.1%。与初产产妇相比，多产产妇在妊娠中的几率更高（OR 14.0, 95% CI 1.8-108.1），产后12个月，二产和多产产妇的几率都更高（OR 4.8, 95% CI 1.3-17.6, OR 6.4, 95% CI 1.1-38.6）。恼人的胀气的独立危险因素包括提上睑肌撕脱（aOR 3.6, 95% CI 1.5-8.7）、生殖器裂孔较大（aOR 2.0, 95% CI 1.2-3.3）和会阴体较短（aOR 0.8, 95% CI 0.6-1.0）。结论产次和骨盆底解剖结构的差异影响产后第一年阴道胀气的发生率。
{"title":"Prevalence and Risk Factors for Vaginal Flatus From Mid-Pregnancy to 12 Months Postpartum: A Longitudinal Cohort Study","authors":"Marthe Dalevoll Macedo, Hanne Sether Lilleberg, Jeanette Risløkken, Jūratė Šaltytė Benth, Marie Ellström Engh, Franziska Siafarikas","doi":"10.1111/1471-0528.70063","DOIUrl":"https://doi.org/10.1111/1471-0528.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the prevalence of and trend in bothersome vaginal flatus from mid-pregnancy to 12 months postpartum, according to vaginal parity. The secondary objective was to assess differences in pelvic floor anatomy as risk factors for bothersome flatus at 12 months postpartum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Longitudinal cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Akershus University Hospital, Norway.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>880 women with vaginal births.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants completed questionnaires in mid-pregnancy, at 3 and 12 months postpartum, and attended a gynaecological examination including ultrasound at 12 months postpartum. Parity was classified as primipara, secundipara, or multipara (no, one, or ≥ 2 previous vaginal births, respectively). A generalised linear mixed model and logistic regression models were used for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Bothersome vaginal flatus, defined as responding “often” or “always” to the question “Are you bothered by sounds caused by air escaping from the vagina?<i>”</i></p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of bothersome flatus in mid-pregnancy, at 3 and 12 months postpartum was: <i>primiparas</i>: 0.7%, 4.0%, and 2.5%; <i>secundiparas</i>: 2.3%, 4.4%, and 7.3%; <i>multiparas</i>: 5.4%, 3.0%, and 7.1%, respectively. Compared to primiparas, multiparas had higher odds in pregnancy (OR 14.0, 95% CI 1.8–108.1), and both secundi- and multiparas had higher odds at 12 months postpartum (OR 4.8, 95% CI 1.3–17.6, and OR 6.4, 95% CI 1.1–38.6, respectively). Independent risk factors for bothersome flatus included levator avulsion (aOR 3.6, 95% CI 1.5–8.7), a larger genital hiatus (aOR 2.0, 95% CI 1.2–3.3), and a shorter perineal body (aOR 0.8, 95% CI 0.6–1.0).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Parity and differences in pelvic floor anatomy affect the odds for bothersome vaginal flatus during the first postpartum year.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 3","pages":"487-494"},"PeriodicalIF":4.3,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905004","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 Pettinger, Humfrey Legge, Olivia Smith, Narges Hopper, Sam Oddie
<div> <section> <h3> Objective</h3> <p>To describe current variations in antenatal steroid (AS) course durations in England, Wales, and Scotland according to gestational age, region, and drug. A secondary objective was to assess the availability of AS course duration data over time and by region.</p> </section> <section> <h3> Design</h3> <p>Population based observational study.</p> </section> <section> <h3> Setting</h3> <p>UK perinatal practice.</p> </section> <section> <h3> Sample</h3> <p>Routinely collected data from the National Neonatal Audit Programme (NNAP) relating to preterm infants (< 34 weeks) born between January 2024 and February 2025.</p> </section> <section> <h3> Methods</h3> <p>The numbers and proportions were calculated of: 1. women receiving a complete course of AS, 2. AS course duration availability, 3. length of AS course categorised as short (< 18 h), standard (18–36 h), or long (> 36 h). Descriptive statistics and Chi-squared tests assessed variation by region, drug, gestational age, and month for course duration, and by region and month for data availability.</p> </section> <section> <h3> Outcome Measures</h3> <p>Primary: proportion of complete AS courses classified as short. Secondary: proportion of complete AS courses with course duration data available.</p> </section> <section> <h3> Results</h3> <p>Among 13 489 preterm births (< 34 weeks), 8640 were exposed to a complete antenatal steroid (AS) course; course duration data was available for 4428 (51.3%). Among these, 2069 (46.7%) were short, 2202 (49.7%) standard, and 157 (3.5%) long. The proportion of mothers receiving short AS courses were consistent over time but varied widely by region (Northern 17/223: 7.62%, North–West 359/588 61.05% <i>p</i> < 0.001). Short courses were more commonly used with dexamethasone (1047/1928: 54.30%) than betamethasone (847/2081: 40.75%) (<i>p</i> < 0.001). The proportion of full courses with documented course duration data improved from 35.3% (223/631) in March 2024 to 61.5% (339/551) by February 2025 (<i>p</i> < 0.001), ranging regionally from 30.5% (156/512, London South) to 67.6% (223/330, Northern).</p> </section> <section> <h3> Conclusion</h3> <p>Despite national and international guidelines, shortened AS courses are common and vary by region. Variation in course duration undermi
{"title":"Shortened Courses of Antenatal Steroids in Preterm Births: An Observational Study","authors":"Katherine Pettinger, Humfrey Legge, Olivia Smith, Narges Hopper, Sam Oddie","doi":"10.1111/1471-0528.70059","DOIUrl":"https://doi.org/10.1111/1471-0528.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe current variations in antenatal steroid (AS) course durations in England, Wales, and Scotland according to gestational age, region, and drug. A secondary objective was to assess the availability of AS course duration data over time and by region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Population based observational study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>UK perinatal practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Routinely collected data from the National Neonatal Audit Programme (NNAP) relating to preterm infants (< 34 weeks) born between January 2024 and February 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The numbers and proportions were calculated of: 1. women receiving a complete course of AS, 2. AS course duration availability, 3. length of AS course categorised as short (< 18 h), standard (18–36 h), or long (> 36 h). Descriptive statistics and Chi-squared tests assessed variation by region, drug, gestational age, and month for course duration, and by region and month for data availability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcome Measures</h3>\u0000 \u0000 <p>Primary: proportion of complete AS courses classified as short. Secondary: proportion of complete AS courses with course duration data available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 13 489 preterm births (< 34 weeks), 8640 were exposed to a complete antenatal steroid (AS) course; course duration data was available for 4428 (51.3%). Among these, 2069 (46.7%) were short, 2202 (49.7%) standard, and 157 (3.5%) long. The proportion of mothers receiving short AS courses were consistent over time but varied widely by region (Northern 17/223: 7.62%, North–West 359/588 61.05% <i>p</i> < 0.001). Short courses were more commonly used with dexamethasone (1047/1928: 54.30%) than betamethasone (847/2081: 40.75%) (<i>p</i> < 0.001). The proportion of full courses with documented course duration data improved from 35.3% (223/631) in March 2024 to 61.5% (339/551) by February 2025 (<i>p</i> < 0.001), ranging regionally from 30.5% (156/512, London South) to 67.6% (223/330, Northern).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite national and international guidelines, shortened AS courses are common and vary by region. Variation in course duration undermi","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 3","pages":"480-486"},"PeriodicalIF":4.3,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905025","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}
Roberta Maria Arseni, Emanuele De Angelis, Ilaria Cuccu, Andrea Giannini, Giorgio Bogani, Francesco Plotti, Corrado Terranova, Roberto Angioli, Tommaso Simoncini, Giuseppe Vizzielli, Stefano Restaino, Jvan Casarin, Massimiliano Fambrini, Flavia Sorbi, Paolo Scollo, Fulvio Zullo, Eliona Demaliaj, Giorgia Perniola, Ludovico Muzii, Violante Di Donato
<div> <section> <h3> Background</h3> <p>Simple hysterectomy is one of the most common gynaecological surgical procedures worldwide; however, its association as a possible aetiological factor for urinary dysfunction remains controversial.</p> </section> <section> <h3> Objective</h3> <p>To evaluate the clinical impact of different types of non-radical hysterectomy on lower urinary tract symptoms (LUTS).</p> </section> <section> <h3> Search Strategy</h3> <p>A structured search was conducted across scientific sources through December 1989 to March 2025, using terms including: ‘urodynamics’, ‘urinary incontinence’, ‘stress incontinence’, ‘urge incontinence’, ‘urinary urgency’, ‘urinary frequency’, ‘urinary nocturia’ and ‘urinary retention’, ‘lower urinary tract symptoms’, ‘hysterectomy’.</p> </section> <section> <h3> Selection Criteria</h3> <p>Randomised controlled trials and prospective observational studies assessing patients undergoing simple hysterectomy with pre- and post-operative evaluation by validated questionnaires. Exclusion criteria included case reports, reviews, editorials, short communications, radical hysterectomy, post-operative assessment only, non-English publications and studies on pelvic organ prolapse surgery.</p> </section> <section> <h3> Data Collection and Analysis</h3> <p>Ten studies, encompassing 1769 patients, were included in the analysis. Five outcomes were selected: changes in urinary frequency; occurrence of stress urinary incontinence; occurrence of urge urinary incontinence; changes in nocturia; changes in incomplete bladder emptying.</p> </section> <section> <h3> Main Results</h3> <p>Changes from baseline to last follow-up available in urinary frequency (OR 0.48, 95% CI 0.36–0.66; <i>p</i> < 0.00001); stress urinary incontinence (OR = 0.54, 95% CI 0.44–0.68; <i>p</i> < 0.00001); urge urinary incontinence (OR = 0.76, 95% CI 0.72–0.94; <i>p</i> = 0.01); nocturia (OR 0.55, 95% CI 0.36–0.84; <i>p</i> = 0.005); incomplete bladder (OR = 0.95, 95% CI 0.66–1.36; <i>p</i> = 0.77).</p> </section> <section> <h3> Conclusion</h3> <p>The present meta-analysis suggests that simple hysterectomy is associated with a reduction in the prevalence of urinary symptoms postoperatively.</p> </section>
背景：单纯子宫切除术是世界范围内最常见的妇科手术之一；然而，其作为泌尿功能障碍可能的病因因素的关联仍然存在争议。目的评价不同类型非根治性子宫切除术对下尿路症状的临床影响。搜索策略：从1989年12月到2025年3月，对科学来源进行结构化搜索，使用的术语包括：“尿动力学”、“尿失禁”、“压力性尿失禁”、“急迫性尿失禁”、“尿频”、“尿夜症”和“尿潴留”、“下尿路症状”、“子宫切除术”。选择标准：随机对照试验和前瞻性观察研究，通过有效问卷评估单纯子宫切除术患者的术前和术后评价。排除标准包括病例报告、综述、社论、简短通讯、根治性子宫切除术、术后评估、非英文出版物和盆腔器官脱垂手术的研究。数据收集和分析包括1769例患者的连续研究被纳入分析。选择了五个结局：尿频变化；应激性尿失禁的发生；急迫性尿失禁的发生；夜尿变化；膀胱排空不完全的变化。主要结果：尿频从基线到最后一次随访的变化（OR 0.48, 95% CI 0.36-0.66; p < 0.00001）；应激性尿失禁（OR = 0.54, 95% CI 0.44-0.68; p < 0.00001）；急迫性尿失禁（OR = 0.76, 95% CI 0.72 ~ 0.94; p = 0.01）；夜尿症（OR 0.55, 95% CI 0.36-0.84; p = 0.005）；膀胱不全（OR = 0.95, 95% CI 0.66-1.36; p = 0.77）。结论：本荟萃分析提示单纯子宫切除术可降低术后泌尿系统症状的发生率。试用注册：crd42024575574。
{"title":"The Impact of Non-Radical Hysterectomy on Urinary Functions: Evaluation of Symptoms—A Systematic Review and Meta-Analysis","authors":"Roberta Maria Arseni, Emanuele De Angelis, Ilaria Cuccu, Andrea Giannini, Giorgio Bogani, Francesco Plotti, Corrado Terranova, Roberto Angioli, Tommaso Simoncini, Giuseppe Vizzielli, Stefano Restaino, Jvan Casarin, Massimiliano Fambrini, Flavia Sorbi, Paolo Scollo, Fulvio Zullo, Eliona Demaliaj, Giorgia Perniola, Ludovico Muzii, Violante Di Donato","doi":"10.1111/1471-0528.70056","DOIUrl":"10.1111/1471-0528.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Simple hysterectomy is one of the most common gynaecological surgical procedures worldwide; however, its association as a possible aetiological factor for urinary dysfunction remains controversial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the clinical impact of different types of non-radical hysterectomy on lower urinary tract symptoms (LUTS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>A structured search was conducted across scientific sources through December 1989 to March 2025, using terms including: ‘urodynamics’, ‘urinary incontinence’, ‘stress incontinence’, ‘urge incontinence’, ‘urinary urgency’, ‘urinary frequency’, ‘urinary nocturia’ and ‘urinary retention’, ‘lower urinary tract symptoms’, ‘hysterectomy’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Randomised controlled trials and prospective observational studies assessing patients undergoing simple hysterectomy with pre- and post-operative evaluation by validated questionnaires. Exclusion criteria included case reports, reviews, editorials, short communications, radical hysterectomy, post-operative assessment only, non-English publications and studies on pelvic organ prolapse surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Ten studies, encompassing 1769 patients, were included in the analysis. Five outcomes were selected: changes in urinary frequency; occurrence of stress urinary incontinence; occurrence of urge urinary incontinence; changes in nocturia; changes in incomplete bladder emptying.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Changes from baseline to last follow-up available in urinary frequency (OR 0.48, 95% CI 0.36–0.66; <i>p</i> < 0.00001); stress urinary incontinence (OR = 0.54, 95% CI 0.44–0.68; <i>p</i> < 0.00001); urge urinary incontinence (OR = 0.76, 95% CI 0.72–0.94; <i>p</i> = 0.01); nocturia (OR 0.55, 95% CI 0.36–0.84; <i>p</i> = 0.005); incomplete bladder (OR = 0.95, 95% CI 0.66–1.36; <i>p</i> = 0.77).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The present meta-analysis suggests that simple hysterectomy is associated with a reduction in the prevalence of urinary symptoms postoperatively.</p>\u0000 </section>\u0000 \u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 3","pages":"391-400"},"PeriodicalIF":4.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305403","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}
Becky MacGregor, Samuel Madejowski, Helen Leach, Clare Macdonald, Jeremy Dale, Amy Grove, Alexander E. P. Heazell, Jo Parsons, Sophie Staniszewska, Sarah Hillman
Background
Stillbirth, second-trimester miscarriage and recurrent miscarriage carry significant consequences for women. We lack sufficient high-quality evidence of interventions to improve a woman's health and subsequent pregnancy outcomes after discharge to the community.
Objective
Assess the effectiveness of interventions to improve general health and subsequent pregnancy outcomes for non-pregnant women who have had a stillbirth, second trimester miscarriage, or recurrent miscarriage.
Search Strategy
Database searches were undertaken in August 2022 (updated March 2024) and limited to full-text documents published from 1995.
Selection Criteria
Interventions delivered after discharge for non-pregnant women following a pregnancy loss.
Data Collection and Analysis
Screening was performed independently by two reviewers; narrative synthesis was undertaken. Risk of bias was assessed by RoB-2, ROBINS-I or the Mixed Methods Appraisal Tool.
Main Results
A total of 18 603 abstracts screened; 196 full texts assessed and 15 papers included. The quality of evidence was low, and the primary aim of the review was not met due to limited evidence. All included studies aimed to improve mental health. No studies were identified that aimed to improve the physical health of women or subsequent pregnancy outcomes.
Conclusions
There is a significant evidence gap regarding how best to care for women who experience pregnancy loss after discharge to the community. There is an urgent need for research to determine which interventions are most effective to improve a woman's short- and long-term health and subsequent pregnancy outcomes following a stillbirth, second-trimester miscarriage or recurrent miscarriage.
{"title":"Interventions to Improve Outcomes After Pregnancy Loss: A Systematic Review","authors":"Becky MacGregor, Samuel Madejowski, Helen Leach, Clare Macdonald, Jeremy Dale, Amy Grove, Alexander E. P. Heazell, Jo Parsons, Sophie Staniszewska, Sarah Hillman","doi":"10.1111/1471-0528.70043","DOIUrl":"10.1111/1471-0528.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Stillbirth, second-trimester miscarriage and recurrent miscarriage carry significant consequences for women. We lack sufficient high-quality evidence of interventions to improve a woman's health and subsequent pregnancy outcomes after discharge to the community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Assess the effectiveness of interventions to improve general health and subsequent pregnancy outcomes for non-pregnant women who have had a stillbirth, second trimester miscarriage, or recurrent miscarriage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>Database searches were undertaken in August 2022 (updated March 2024) and limited to full-text documents published from 1995.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Interventions delivered after discharge for non-pregnant women following a pregnancy loss.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Screening was performed independently by two reviewers; narrative synthesis was undertaken. Risk of bias was assessed by RoB-2, ROBINS-I or the Mixed Methods Appraisal Tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>A total of 18 603 abstracts screened; 196 full texts assessed and 15 papers included. The quality of evidence was low, and the primary aim of the review was not met due to limited evidence. All included studies aimed to improve mental health. No studies were identified that aimed to improve the physical health of women or subsequent pregnancy outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is a significant evidence gap regarding how best to care for women who experience pregnancy loss after discharge to the community. There is an urgent need for research to determine which interventions are most effective to improve a woman's short- and long-term health and subsequent pregnancy outcomes following a stillbirth, second-trimester miscarriage or recurrent miscarriage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>PROSPERO Registration: CRD42022360264</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 3","pages":"365-374"},"PeriodicalIF":4.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305729","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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