The levonorgestrel-releasing intrauterine system (LNG-IUS) is a widely used long-term contraceptive with high continuation rates, but acne may lead to discontinuation.
To evaluate the incidence of acne among LNG-IUS users.
A systematic search was conducted in PubMed, Embase, and Cochrane Central from inception to September 2024.
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.
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.
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%).
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.
PROSPERO registration number: CRD42024588771
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.
To assess whether combining estimated fetal weight (EFW) and fetal Doppler ultrasound parameters would provide information to optimize the timing of birth in monochorionic twin pregnancies and prevent adverse perinatal outcomes.
Retrospective multicentre cohort study.
Three tertiary centres in the UK, Italy and Belgium.
624 monochorionic twin pregnancies managed between 2013 and 2023.
Univariable and multivariable analyses assessed the association between EFW and Doppler indices taken within 2 weeks of birth.
Stillbirth at any gestation or iatrogenic preterm birth before 34 weeks for suspected fetal compromise.
The primary outcome occurred in 143 (22.9%) pregnancies with 70 cases of early PTB for fetal reasons and 73 cases of at least one IUD. Significant associations between biometric and Doppler parameters and adverse perinatal outcomes were found. The best-performing prediction models incorporated EFW discordance and umbilical artery pulsatility index (UA PI) discordance, achieving an AUC of 0.85 (95% CI 0.78–0.91) and EFW discordance and absent or reverse end diastolic flow of UA PI with an AUC of 0.86 (95% CI 0.80–0.92). The model incorporating EFW and UA PI discordance could be applied to the largest proportion of pregnancies and outperformed the currently clinical sFGR classification in predicting adverse outcomes.
A model incorporating intertwin EFW discordance and UA PI discordance outperforms the current clinical classification for prediction of adverse perinatal outcomes in monochorionic pregnancies. If confirmed by further external validation studies, these findings could contribute to building a tailored risk assessment in these pregnancies.
Almost half the deaths from cervical cancer in the UK are among women aged over 65 who were already above the upper age of screening when primary HPV screening was introduced in the UK in 2019. Our aim is to test the feasibility of a national catch-up HPV testing programme.
This first phase of the Catch-Up Screen study involved randomizing over 3000 invited participants to receive a urine HPV test and a follow-up telephone call or text message.
GP practices in Hull and Manchester, UK.
Women aged 60–79 who have not undergone primary HPV screening.
Eligible women were selected from GP practice records, and 3074 were invited to provide an at-home first-void urine sample for HPV testing.
Uptake of at-home urine screening according to screening history, area-level index of deprivation, and randomised follow-up method.
Overall, 59% (1816) of invited women returned a urine sample for HPV testing. Response varied by screening history and index of area-level deprivation, but 39% of those who declined their last invited NHS screen responded favorably and took part in Catch-Up Screen. Telephone reminders yielded a 5% absolute increase in response compared to the text message arm (p = 0.007).
An at-home first-void urine sample is a viable method for a national catch-up HPV test and has the potential to address decreasing national coverage among older women being invited for their last screen.
To provide further evidence on the outcomes associated with fetal malformations of cortical development (MCD), currently informed by data from symptomatic paediatric cohorts, this study provides a new classification system.
Multicentre retrospective cohort study.
Fetal medicine units of three tertiary centres in the United Kingdom and Italy.
118 foetuses diagnosed with MCD by ultrasound and/or magnetic resonance imaging included.
The cases were classified according to their presumed aetiology (genetic, haemorrhage, dysgenesis, infection) and imaging findings (focal, diffuse, mantle, sulcation). Neurodevelopmental delay was classified as mild, moderate or severe. Cases with missing information on postnatal outcome were excluded.
Postnatal neurodevelopmental outcome ascertained from the infant's neurological assessments according to international performance scales, depending on the age.
There were 52/118 (44%) livebirths, 64/118 (54.2%) terminations of pregnancy (TOP) and 2/118 (1.6%) intrauterine demises. Twenty-five of 46 cases (54.3%, 95% CI 39–69.1) that survived the neonatal period had a normal or mildly delayed neurological development. The commonest aetiology was genetic, and the most frequent radiological finding was reduced sulcation. The best neurological outcome was found in children with focal lesions; those with diffuse hemispheric lesions had the worst one.
This is the largest cohort of foetuses diagnosed with MCDs systematically classified by aetiology and radiological findings. In this retrospective cohort of liveborn survivors, over half had normal or mildly abnormal neurodevelopmental outcomes. Prognosis varied according to lesion pattern and suspected aetiology. Fetal MCDs in this study had better neurodevelopmental outcomes than previously reported, though findings should be interpreted with caution given selection and follow-up limitations.
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