Abdulbasit Seid, Miranda S Cumpston, Kedir Y Ahmed, Habtamu Mellie Bizuayehu, Subash Thapa, Teketo Kassaw Tegegne, Abel F Dadi, Daniel Bogale Odo, Desalegn Markos Shifti, Sewunet Admasu Belachew, Getiye Dejenu Kibret, Daniel Bekele Ketema, Zemenu Yohannes Kassa, Erkihun Amsalu, Meless G Bore, Tahir Ahmed Hassen
Background: Around half of preterm births lack identifiable causes, indicating the need for further investigation to understand preterm birth risk factors. Existing studies on the intergenerational association of preterm birth showed inconsistency in effect size and direction.
Objective: This systematic review and meta-analysis aimed to review existing studies and provide comprehensive evidence on the intergenerational association of preterm births.
Search strategy: We searched MEDLINE, Embase and Maternity and Infant Care databases, from the inception of each database to 04 April 2024.
Selection criteria: Eligibility criteria included studies that reported on women who had given birth and had recorded information about a family history of preterm birth in one or both of the child's biological parents.
Data collection and analysis: Data were extracted by two independent reviewers. A random-effects model was used to compute pooled estimates using odds ratios.
Main results: Sixteen eligible studies with a total of 2 271 612 mothers were included. The findings indicated a 1.44 (OR = 1.44, 95% CI: 1.34, 1.54) fold increase in odds of giving preterm births among women who were born preterm. Additionally, having a sibling born preterm (OR = 1.53, 95% CI: 1.24, 1.87) and having a partner born preterm (OR = 1.12, 95% CI: 1.01, 1.25) were associated with increased likelihood of giving preterm births among women.
Conclusion: The study revealed that women with a family history of preterm birth face an increased risk of giving preterm births. Screening pregnant women for a family history of preterm birth is essential, with those having a positive family history requiring closer follow-up.
{"title":"The intergenerational association of preterm birth: A systematic review and meta-analysis.","authors":"Abdulbasit Seid, Miranda S Cumpston, Kedir Y Ahmed, Habtamu Mellie Bizuayehu, Subash Thapa, Teketo Kassaw Tegegne, Abel F Dadi, Daniel Bogale Odo, Desalegn Markos Shifti, Sewunet Admasu Belachew, Getiye Dejenu Kibret, Daniel Bekele Ketema, Zemenu Yohannes Kassa, Erkihun Amsalu, Meless G Bore, Tahir Ahmed Hassen","doi":"10.1111/1471-0528.17924","DOIUrl":"https://doi.org/10.1111/1471-0528.17924","url":null,"abstract":"<p><strong>Background: </strong>Around half of preterm births lack identifiable causes, indicating the need for further investigation to understand preterm birth risk factors. Existing studies on the intergenerational association of preterm birth showed inconsistency in effect size and direction.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to review existing studies and provide comprehensive evidence on the intergenerational association of preterm births.</p><p><strong>Search strategy: </strong>We searched MEDLINE, Embase and Maternity and Infant Care databases, from the inception of each database to 04 April 2024.</p><p><strong>Selection criteria: </strong>Eligibility criteria included studies that reported on women who had given birth and had recorded information about a family history of preterm birth in one or both of the child's biological parents.</p><p><strong>Data collection and analysis: </strong>Data were extracted by two independent reviewers. A random-effects model was used to compute pooled estimates using odds ratios.</p><p><strong>Main results: </strong>Sixteen eligible studies with a total of 2 271 612 mothers were included. The findings indicated a 1.44 (OR = 1.44, 95% CI: 1.34, 1.54) fold increase in odds of giving preterm births among women who were born preterm. Additionally, having a sibling born preterm (OR = 1.53, 95% CI: 1.24, 1.87) and having a partner born preterm (OR = 1.12, 95% CI: 1.01, 1.25) were associated with increased likelihood of giving preterm births among women.</p><p><strong>Conclusion: </strong>The study revealed that women with a family history of preterm birth face an increased risk of giving preterm births. Screening pregnant women for a family history of preterm birth is essential, with those having a positive family history requiring closer follow-up.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903506","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}
Marcelo de França Moreira, Marco Aurelio Pinho Oliveira
{"title":"Endometriosis pain or its 'phantom' pain? The elephant in the room of research.","authors":"Marcelo de França Moreira, Marco Aurelio Pinho Oliveira","doi":"10.1111/1471-0528.17927","DOIUrl":"https://doi.org/10.1111/1471-0528.17927","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890813","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}
Objective: To analyse the global burden, trends and cross-country inequalities of female breast and gynaecologic cancers (FeBGCs).
Design: Population-Based Study.
Setting: Data sourced from the Global Burden of Disease Study 2019.
Population: Individuals diagnosed with FeBGCs.
Methods: Age-standardised mortality rates (ASMRs), age-standardised Disability-Adjusted Life Years (DALYs) rates (ASDRs) and their 95% uncertainty interval (UI) described the burden. Estimated annual percentage changes (EAPCs) and their confidence interval (CI) of age-standardised rates (ASRs) illustrated trends. Social inequalities were quantified using the Slope Index of Inequality (SII) and Concentration Index.
Main outcome measures: The main outcome measures were the burden of FeBGCs and the trends in its inequalities over time.
Results: In 2019, the ASDRs per 100 000 females were as follows: breast cancer: 473.83 (95% UI: 437.30-510.51), cervical cancer: 210.64 (95% UI: 177.67-234.85), ovarian cancer: 124.68 (95% UI: 109.13-138.67) and uterine cancer: 210.64 (95% UI: 177.67-234.85). The trends per year from 1990 to 2019 were expressed as EAPCs of ASDRs and these: for Breast cancer: -0.51 (95% CI: -0.57 to -0.45); Cervical cancer: -0.95 (95% CI: -0.99 to -0.89); Ovarian cancer: -0.08 (95% CI: -0.12 to -0.04); and Uterine cancer: -0.84 (95% CI: -0.93 to -0.75). In the Social Inequalities Analysis (1990-2019) the SII changed from 689.26 to 607.08 for Breast, from -226.66 to -239.92 for cervical, from 222.45 to 228.83 for ovarian and from 74.61 to 103.58 for uterine cancer. The concentration index values ranged from 0.2 to 0.4.
Conclusions: The burden of FeBGCs worldwide showed a downward trend from 1990 to 2019. Countries or regions with higher Socio-demographic Index (SDI) bear a higher DALYs burden of breast, ovarian and uterine cancers, while those with lower SDI bear a heavier burden of cervical cancer. These inequalities increased over time.
{"title":"The global burden, trends and cross-country inequalities of female breast and gynaecologic cancers: A population based study.","authors":"Liangxing Cheng, Zhihong Wang, Rufeng Li, Min Qiang, Chen Yang, Guoer Yang, Yingying Xie, Ruixia Yuan, Yungang Xu","doi":"10.1111/1471-0528.17925","DOIUrl":"https://doi.org/10.1111/1471-0528.17925","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the global burden, trends and cross-country inequalities of female breast and gynaecologic cancers (FeBGCs).</p><p><strong>Design: </strong>Population-Based Study.</p><p><strong>Setting: </strong>Data sourced from the Global Burden of Disease Study 2019.</p><p><strong>Population: </strong>Individuals diagnosed with FeBGCs.</p><p><strong>Methods: </strong>Age-standardised mortality rates (ASMRs), age-standardised Disability-Adjusted Life Years (DALYs) rates (ASDRs) and their 95% uncertainty interval (UI) described the burden. Estimated annual percentage changes (EAPCs) and their confidence interval (CI) of age-standardised rates (ASRs) illustrated trends. Social inequalities were quantified using the Slope Index of Inequality (SII) and Concentration Index.</p><p><strong>Main outcome measures: </strong>The main outcome measures were the burden of FeBGCs and the trends in its inequalities over time.</p><p><strong>Results: </strong>In 2019, the ASDRs per 100 000 females were as follows: breast cancer: 473.83 (95% UI: 437.30-510.51), cervical cancer: 210.64 (95% UI: 177.67-234.85), ovarian cancer: 124.68 (95% UI: 109.13-138.67) and uterine cancer: 210.64 (95% UI: 177.67-234.85). The trends per year from 1990 to 2019 were expressed as EAPCs of ASDRs and these: for Breast cancer: -0.51 (95% CI: -0.57 to -0.45); Cervical cancer: -0.95 (95% CI: -0.99 to -0.89); Ovarian cancer: -0.08 (95% CI: -0.12 to -0.04); and Uterine cancer: -0.84 (95% CI: -0.93 to -0.75). In the Social Inequalities Analysis (1990-2019) the SII changed from 689.26 to 607.08 for Breast, from -226.66 to -239.92 for cervical, from 222.45 to 228.83 for ovarian and from 74.61 to 103.58 for uterine cancer. The concentration index values ranged from 0.2 to 0.4.</p><p><strong>Conclusions: </strong>The burden of FeBGCs worldwide showed a downward trend from 1990 to 2019. Countries or regions with higher Socio-demographic Index (SDI) bear a higher DALYs burden of breast, ovarian and uterine cancers, while those with lower SDI bear a heavier burden of cervical cancer. These inequalities increased over time.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890843","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}
<p>One of the most concerning papers in this issue of BJOG is a study from the Netherlands noting an increased percentage of maternal deaths (through one year postpartum) are due to suicide (Lommerse et al, BJOG 2024). The percentage of maternal deaths in the Netherlands due to suicide increased from 18% between 1996 to 2005, to 28% between 20006 to 2020. Indeed, suicide is now the leading cause of maternal death in the Netherlands. Sadly, this problem is not unique to Holland. Suicide is also the most common cause of maternal death in the U.K., France, and the U.S. (Diguisto et al, BMJ. 2022;379:e070621; Knight et al., Oxford: National</p><p>Perinatal Epidemiology Unit, University of Oxford; 2021; Khalifeh et al, Lancet Psychiatry. 2016; 3:233–42; Trost et al, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2024). Further, mortality is merely the tip of the iceberg, accounting for only a small fraction of cases of severe maternal mental health and substance use disorders. Accordingly, improved screening for and treatment of mental health conditions and substance use disorder has the potential to greatly impact maternal morbidity and mortality.</p><p>A theme linking several articles in this issue of BJOG, are the “non-scientific” aspects of medicine. These include implementation science, patient experience, and cost-effectiveness. Moffat and coworkers report on postpartum contraception uptake in the Northeast and North Cumbrian Integrated Care System in England (Moffat et al; BJOG 2024). Data were obtained via online survey, and thus, prone to bias. Nonetheless, only 38.7% of respondents accessed any contraception postpartum, and only 15.5% accessed long-acting reversable contraception. 18.8 % indicated that they could not obtain their preferred method of contraception. These data underscore the need for better implementation strategies. Although we know that contraception is effective, it only works if people can obtain it. Further work should identify barriers (educational, logistical, financial, cultural, etc.) and potential solutions to enhance utilization of contraception and other effective interventions.</p><p>The emotional impact of medical interventions is critically important, but often neglected in research studies. In work by Kwong et al, 2596 people evaluated for ovarian cancer were evaluated for anxiety using the State-trait anxiety inventory (STAI-6) and distress using the Impact of Event Scale – revised (Kwong et al, BJOG 2024). 52.1% of participants reported moderate-severe anxiety and 68.6% had moderate-severe distress. Category of anxiety or distress remained unchanged or worse after 12 months in 76%, despite finding out that they did not have cancer. This study underscores the need to provide mental health support for people being evaluated for cancer, and to consider the duress associated with false positive screening tests. In another study assessing emotional health, Cattani and cow
{"title":"Neglected aspects of Obstetrics and Gynecology: Mental health, patient experience, implementation, and cost-effectiveness","authors":"Robert M. Silver","doi":"10.1111/1471-0528.17920","DOIUrl":"10.1111/1471-0528.17920","url":null,"abstract":"<p>One of the most concerning papers in this issue of BJOG is a study from the Netherlands noting an increased percentage of maternal deaths (through one year postpartum) are due to suicide (Lommerse et al, BJOG 2024). The percentage of maternal deaths in the Netherlands due to suicide increased from 18% between 1996 to 2005, to 28% between 20006 to 2020. Indeed, suicide is now the leading cause of maternal death in the Netherlands. Sadly, this problem is not unique to Holland. Suicide is also the most common cause of maternal death in the U.K., France, and the U.S. (Diguisto et al, BMJ. 2022;379:e070621; Knight et al., Oxford: National</p><p>Perinatal Epidemiology Unit, University of Oxford; 2021; Khalifeh et al, Lancet Psychiatry. 2016; 3:233–42; Trost et al, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2024). Further, mortality is merely the tip of the iceberg, accounting for only a small fraction of cases of severe maternal mental health and substance use disorders. Accordingly, improved screening for and treatment of mental health conditions and substance use disorder has the potential to greatly impact maternal morbidity and mortality.</p><p>A theme linking several articles in this issue of BJOG, are the “non-scientific” aspects of medicine. These include implementation science, patient experience, and cost-effectiveness. Moffat and coworkers report on postpartum contraception uptake in the Northeast and North Cumbrian Integrated Care System in England (Moffat et al; BJOG 2024). Data were obtained via online survey, and thus, prone to bias. Nonetheless, only 38.7% of respondents accessed any contraception postpartum, and only 15.5% accessed long-acting reversable contraception. 18.8 % indicated that they could not obtain their preferred method of contraception. These data underscore the need for better implementation strategies. Although we know that contraception is effective, it only works if people can obtain it. Further work should identify barriers (educational, logistical, financial, cultural, etc.) and potential solutions to enhance utilization of contraception and other effective interventions.</p><p>The emotional impact of medical interventions is critically important, but often neglected in research studies. In work by Kwong et al, 2596 people evaluated for ovarian cancer were evaluated for anxiety using the State-trait anxiety inventory (STAI-6) and distress using the Impact of Event Scale – revised (Kwong et al, BJOG 2024). 52.1% of participants reported moderate-severe anxiety and 68.6% had moderate-severe distress. Category of anxiety or distress remained unchanged or worse after 12 months in 76%, despite finding out that they did not have cancer. This study underscores the need to provide mental health support for people being evaluated for cancer, and to consider the duress associated with false positive screening tests. In another study assessing emotional health, Cattani and cow","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 10","pages":"1329-1330"},"PeriodicalIF":4.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17920","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876634","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}
James Castleman, Stephanie Curtis, Caroline Fox, Lucy Hudsmith, Lynn Nolan, James Geoghegan, Yavor Metodiev, Eleri Roberts, Lucy Morse, Ashley Nisbet, Paul Foley, Ian Wright, Honey Thomas, Katie Morris, Dawn Adamson, Joseph De Bono, the United Kingdom Maternal Cardiology Society, British Heart Rhythm Society and British Maternal and Fetal Medicine Society
The aim of this document is to provide guidance for the management of women and birthing people with a permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD). Cardiac devices are becoming more common in obstetric practice and a reference document for contemporary evidence-based practice is required. Where evidence is limited, expert consensus has established recommendations. The purpose is to improve safety and reduce the risk of adverse events relating to implanted cardiac devices during pregnancy, birth and the postnatal period.
{"title":"Cardiac implantable electronic devices in pregnancy: A position statement","authors":"James Castleman, Stephanie Curtis, Caroline Fox, Lucy Hudsmith, Lynn Nolan, James Geoghegan, Yavor Metodiev, Eleri Roberts, Lucy Morse, Ashley Nisbet, Paul Foley, Ian Wright, Honey Thomas, Katie Morris, Dawn Adamson, Joseph De Bono, the United Kingdom Maternal Cardiology Society, British Heart Rhythm Society and British Maternal and Fetal Medicine Society","doi":"10.1111/1471-0528.17918","DOIUrl":"10.1111/1471-0528.17918","url":null,"abstract":"<p>The aim of this document is to provide guidance for the management of women and birthing people with a permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD). Cardiac devices are becoming more common in obstetric practice and a reference document for contemporary evidence-based practice is required. Where evidence is limited, expert consensus has established recommendations. The purpose is to improve safety and reduce the risk of adverse events relating to implanted cardiac devices during pregnancy, birth and the postnatal period.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1739-1746"},"PeriodicalIF":4.7,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17918","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861499","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}
S. Hagen, C. Sellers, A. Elders, C. Glazener, C. MacArthur, P. Toozs-Hobson, C. Hemming, P. Herbison, D. Wilson
Objective
To investigate pelvic floor dysfunction (PFD; urinary incontinence (UI), faecal incontinence (FI) and prolapse) ≥20 years after childbirth and their association with delivery mode history and demographic characteristics.
Design
Cohort study with long-term follow-up.
Setting
Maternity units in Aberdeen and Birmingham (UK) and Dunedin (NZ).
Population
Women giving birth in 1993/1994.
Methods
Postal questionnaires at 20 (New Zealand) or 26 (United Kingdom) years after index birth (n = 6195). Regression analyses investigated associations between risk factors and UI, FI and prolapse symptoms.
Main Outcome Measures
Prevalence of self-reported UI, FI, ‘something coming down’ from or in the vagina (SCD), and the Pelvic Organ Prolapse-Symptom Score, and relationships with delivery method.
Results
Thirty-seven per cent (n = 2270) responded at 20/26 years, of whom 61% reported UI (59% of whom reported more severe UI), 22% FI and 17% prolapse symptoms. Having only caesarean section (CS) was associated with a significantly lower risk of UI (OR 0.63, 95% CI 0.46–0.85), FI (OR 0.63, 95% CI 0.42–0.96) and SCD (OR 0.44, 95% CI 0.27–0.74) compared to only spontaneous vaginal deliveries (SVDs). Having any forceps delivery was associated with reporting FI compared to only SVDs (OR 1.29, 95% CI 1.00–1.66), but there was no association for UI (OR 0.95, 95% CI 0.76–1.19) or SCD (OR 1.05, 95% CI 0.80–1.38). Higher current BMI was associated with all PFD outcomes.
Conclusions
Prevalence of PFD continues to increase up to 26 years following index birth, and differences were observed according to delivery mode history. Exclusive CS was associated with less risk of UI, FI and any prolapse symptoms.
目的调查产后≥20 年的盆底功能障碍（PFD；尿失禁（UI）、大便失禁（FI）和脱垂）及其与分娩方式史和人口特征的关系：设计：长期跟踪的队列研究：地点：阿伯丁、伯明翰（英国）和达尼丁（新西兰）的产科医院：方法： 在 1993/1994 年的 20 个月内进行邮寄问卷调查：方法：在婴儿出生后 20 年（新西兰）或 26 年（英国）进行邮寄问卷调查（n = 6195）。回归分析调查了风险因素与尿失禁、排尿困难和脱肛症状之间的关系：主要结果测量：自我报告的UI、FI、阴道内 "有东西下来"（SCD）和盆腔器官脱垂症状评分的发生率，以及与分娩方式的关系：37%的受访者（n = 2270）在 20/26 岁时做出了回答，其中 61% 报告了尿频（其中 59% 报告了较严重的尿频），22% 报告了 FI，17% 报告了脱垂症状。只进行剖腹产（CS）与只进行阴道自然分娩（SVD）相比，发生 UI（OR 0.63，95% CI 0.46-0.85）、FI（OR 0.63，95% CI 0.42-0.96）和 SCD（OR 0.44，95% CI 0.27-0.74）的风险明显较低。与自然阴道分娩（SVDs）相比，使用产钳分娩与报告 FI 有关（OR 1.29，95% CI 1.00-1.66），但与 UI（OR 0.95，95% CI 0.76-1.19）或 SCD（OR 1.05，95% CI 0.80-1.38）无关。目前较高的体重指数与所有 PFD 结果都有关联：结论：PFD的患病率在指数分娩后26年内持续上升，分娩方式的不同会导致患病率的差异。纯CS与较低的UI、FI和任何脱垂症状风险相关。
{"title":"Urinary incontinence, faecal incontinence and pelvic organ prolapse symptoms 20–26 years after childbirth: A longitudinal cohort study","authors":"S. Hagen, C. Sellers, A. Elders, C. Glazener, C. MacArthur, P. Toozs-Hobson, C. Hemming, P. Herbison, D. Wilson","doi":"10.1111/1471-0528.17913","DOIUrl":"10.1111/1471-0528.17913","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate pelvic floor dysfunction (PFD; urinary incontinence (UI), faecal incontinence (FI) and prolapse) ≥20 years after childbirth and their association with delivery mode history and demographic characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cohort study with long-term follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Maternity units in Aberdeen and Birmingham (UK) and Dunedin (NZ).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women giving birth in 1993/1994.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Postal questionnaires at 20 (New Zealand) or 26 (United Kingdom) years after index birth (<i>n</i> = 6195). Regression analyses investigated associations between risk factors and UI, FI and prolapse symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Prevalence of self-reported UI, FI, ‘something coming down’ from or in the vagina (SCD), and the Pelvic Organ Prolapse-Symptom Score, and relationships with delivery method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-seven per cent (<i>n</i> = 2270) responded at 20/26 years, of whom 61% reported UI (59% of whom reported more severe UI), 22% FI and 17% prolapse symptoms. Having only caesarean section (CS) was associated with a significantly lower risk of UI (OR 0.63, 95% CI 0.46–0.85), FI (OR 0.63, 95% CI 0.42–0.96) and SCD (OR 0.44, 95% CI 0.27–0.74) compared to only spontaneous vaginal deliveries (SVDs). Having any forceps delivery was associated with reporting FI compared to only SVDs (OR 1.29, 95% CI 1.00–1.66), but there was no association for UI (OR 0.95, 95% CI 0.76–1.19) or SCD (OR 1.05, 95% CI 0.80–1.38). Higher current BMI was associated with all PFD outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prevalence of PFD continues to increase up to 26 years following index birth, and differences were observed according to delivery mode history. Exclusive CS was associated with less risk of UI, FI and any prolapse symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1815-1823"},"PeriodicalIF":4.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17913","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857043","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>Pregnancy complicated with type B aortic dissection is a rare but devastating condition. Guidelines for managing this condition are lacking. We present our observation and experiences in managing five pregnant women with complicated type B aortic dissection in the second or third trimesters, aiming to gain insights that can aid in proposing an appropriate management strategy.</p> </section> <section> <h3> Design</h3> <p>A retrospective study.</p> </section> <section> <h3> Setting</h3> <p>Zhongnan Hospital of Wuhan University.</p> </section> <section> <h3> Population</h3> <p>Pregnant women with complicated type B aortic dissection.</p> </section> <section> <h3> Methods</h3> <p>Clinical data of five pregnant women with complicated type B aortic dissection admitted to Zhongnan Hospital of Wuhan University from January 2022 to June 2023 were collected. The clinical characteristics, treatment strategies, and corresponding maternal and infant outcomes were retrospectively analysed.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Survival of mothers and foetuses.</p> </section> <section> <h3> Results</h3> <p>All five study participants were diagnosed with complicated type B aortic dissection by computed tomography angiography (CTA). The range of gestational weeks at admission was 27 weeks + 3 days to 36 weeks + 6 days. The first patient, planning a caesarean section (C-section) followed by thoracic endovascular aortic repair (TEVAR), died of aortic dissection rupture during C-section. Her neonate was successfully rescued. In contrast, the remaining four patients who underwent TEVAR first survived. Among them, three patients underwent single-stage aortic repair and delivery, while one patient received C-section 31 days after TEVAR. Three preterm live births were recorded among these surviving mothers. Neonatal death occurred in one case with a gestational age of 29 weeks + 5 days, who had foetal distress before surgery. During the follow-up period of up to 3 months, no maternal or infant death occurred. No device-related or systemic complications were observed in the surviving mothers after discharge. Routine physical examinations of the four live births showed no abnormalities.</p> </sectio
目的：妊娠并发 B 型主动脉夹层是一种罕见的破坏性疾病。目前尚缺乏处理这种情况的指南。我们介绍了对五名妊娠第二或第三季度并发 B 型主动脉夹层孕妇的观察和处理经验，旨在获得有助于提出适当处理策略的见解：设计：回顾性研究：人群：患有复杂 B 型主动脉夹层的孕妇：方法：5 名患有复杂 B 型主动脉夹层的孕妇的临床数据：收集武汉大学中南医院2022年1月至2023年6月收治的5例复杂B型主动脉夹层孕妇的临床资料。回顾性分析其临床特征、治疗策略以及相应的母婴结局：主要结局指标：母亲和胎儿的存活率：所有五名研究参与者均经计算机断层扫描血管造影术（CTA）确诊为复杂B型主动脉夹层。入院时孕周范围为27周+3天至36周+6天。第一例患者计划进行剖腹产，然后进行胸腔内血管主动脉修补术（TEVAR），但在剖腹产过程中因主动脉夹层破裂而死亡。她的新生儿抢救成功。相比之下，其余四名先接受 TEVAR 的患者都存活了下来。其中，三名患者接受了单阶段主动脉修复和分娩，一名患者在 TEVAR 术后 31 天接受了剖腹产。在这些幸存的母亲中，有三例早产活产。一名胎龄为29周+5天的产妇在手术前出现胎儿窘迫，导致新生儿死亡。在长达 3 个月的随访期间，没有产妇或婴儿死亡。出院后，幸存的产妇均未出现与设备相关的并发症或全身并发症。四名活产婴儿的常规身体检查未发现异常：结论：对于胸背部疼痛并高度怀疑主动脉夹层的孕妇，应及时进行CTA检查，以防止漏诊或延误诊断。一旦确诊，产妇的生存应优先于胎儿的结果。TEVAR 被证明对这类患者是安全可行的。对于妊娠晚期患有复杂B型主动脉夹层的妇女，TEVAR术后再进行剖腹产可能是一种很有前途的治疗策略。
{"title":"Management and outcomes of aortic dissection type B in late pregnancy: A retrospective case series","authors":"Zhen Wang, Xuechen Yu, Shuai Ding, Wei Zhang, Chuan Liang, Huijun Chen","doi":"10.1111/1471-0528.17923","DOIUrl":"10.1111/1471-0528.17923","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Pregnancy complicated with type B aortic dissection is a rare but devastating condition. Guidelines for managing this condition are lacking. We present our observation and experiences in managing five pregnant women with complicated type B aortic dissection in the second or third trimesters, aiming to gain insights that can aid in proposing an appropriate management strategy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Zhongnan Hospital of Wuhan University.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Pregnant women with complicated type B aortic dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Clinical data of five pregnant women with complicated type B aortic dissection admitted to Zhongnan Hospital of Wuhan University from January 2022 to June 2023 were collected. The clinical characteristics, treatment strategies, and corresponding maternal and infant outcomes were retrospectively analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Survival of mothers and foetuses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All five study participants were diagnosed with complicated type B aortic dissection by computed tomography angiography (CTA). The range of gestational weeks at admission was 27 weeks + 3 days to 36 weeks + 6 days. The first patient, planning a caesarean section (C-section) followed by thoracic endovascular aortic repair (TEVAR), died of aortic dissection rupture during C-section. Her neonate was successfully rescued. In contrast, the remaining four patients who underwent TEVAR first survived. Among them, three patients underwent single-stage aortic repair and delivery, while one patient received C-section 31 days after TEVAR. Three preterm live births were recorded among these surviving mothers. Neonatal death occurred in one case with a gestational age of 29 weeks + 5 days, who had foetal distress before surgery. During the follow-up period of up to 3 months, no maternal or infant death occurred. No device-related or systemic complications were observed in the surviving mothers after discharge. Routine physical examinations of the four live births showed no abnormalities.</p>\u0000 </sectio","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1874-1881"},"PeriodicalIF":4.7,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17923","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794043","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}
Serena Negri, Charlotte Fisch, Joanne A. de Hullu, Majke van Bommel, Michiel Simons, Joep Bogaerts, Consortium STIC focusgroup, Rosella P. M. G. Hermens, Miranda P. Steenbeek
<div> <section> <h3> Objective</h3> <p>A Serous Tubal Intraepithelial Carcinoma (STIC) without concomitant invasive carcinoma is occasionally identified and associated with a high risk of subsequent peritoneal carcinomatosis. Management needs optimisation. This study explores professionals' opinions and clinical practices regarding the diagnosis, counselling, treatment and follow-up of isolated STIC to facilitate clinical decision making and optimise the direction of future research. A secondary aim is to assess international clinical guidelines.</p> </section> <section> <h3> Design</h3> <p>Focus group study.</p> </section> <section> <h3> Setting</h3> <p>Four online sessions.</p> </section> <section> <h3> Population</h3> <p>International panel (<i>n</i> = 12 countries) of gynaecologists, gynaecologic oncologists, pathologists and medical oncologists (<i>n</i> = 49).</p> </section> <section> <h3> Methods</h3> <p>A semi-structured interview guide was used. Two independent researchers analysed transcripts by open and axial coding. Results were organised in domains. Relevant (inter)national guidelines were screened for recommendations regarding isolated STIC.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Professionals' opinions and clinical practices regarding isolated STIC management.</p> </section> <section> <h3> Results</h3> <p>Regarding pathology, most professionals identified the SEE-FIM protocol as standard of care for high-risk patients, whereas variation exists in the histopathological examination of fallopian tubes in the general population. Confirmation of STIC diagnosis by a specialised pathologist was recommended. Regarding work-up and follow-up after STIC diagnosis, there was variety and discordance. Data on outcomes is limited. As for treatment, chemotherapy and PARP inhibitors were not recommended by most. Eleven guidelines provided limited recommendations.</p> </section> <section> <h3> Conclusions</h3> <p>We identified recommendations and highlighted knowledge gaps in the diagnosis and management of isolated STIC. Moreover, recommendations in clinical guidelines are limited. There is an agreed need for international collab
{"title":"Diagnosis and management of isolated serous tubal intraepithelial carcinoma: A qualitative focus group study","authors":"Serena Negri, Charlotte Fisch, Joanne A. de Hullu, Majke van Bommel, Michiel Simons, Joep Bogaerts, Consortium STIC focusgroup, Rosella P. M. G. Hermens, Miranda P. Steenbeek","doi":"10.1111/1471-0528.17919","DOIUrl":"10.1111/1471-0528.17919","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>A Serous Tubal Intraepithelial Carcinoma (STIC) without concomitant invasive carcinoma is occasionally identified and associated with a high risk of subsequent peritoneal carcinomatosis. Management needs optimisation. This study explores professionals' opinions and clinical practices regarding the diagnosis, counselling, treatment and follow-up of isolated STIC to facilitate clinical decision making and optimise the direction of future research. A secondary aim is to assess international clinical guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Focus group study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Four online sessions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>International panel (<i>n</i> = 12 countries) of gynaecologists, gynaecologic oncologists, pathologists and medical oncologists (<i>n</i> = 49).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A semi-structured interview guide was used. Two independent researchers analysed transcripts by open and axial coding. Results were organised in domains. Relevant (inter)national guidelines were screened for recommendations regarding isolated STIC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Professionals' opinions and clinical practices regarding isolated STIC management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Regarding pathology, most professionals identified the SEE-FIM protocol as standard of care for high-risk patients, whereas variation exists in the histopathological examination of fallopian tubes in the general population. Confirmation of STIC diagnosis by a specialised pathologist was recommended. Regarding work-up and follow-up after STIC diagnosis, there was variety and discordance. Data on outcomes is limited. As for treatment, chemotherapy and PARP inhibitors were not recommended by most. Eleven guidelines provided limited recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We identified recommendations and highlighted knowledge gaps in the diagnosis and management of isolated STIC. Moreover, recommendations in clinical guidelines are limited. There is an agreed need for international collab","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1851-1861"},"PeriodicalIF":4.7,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17919","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762318","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}
To explore how women with Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome experience dilation or surgical vaginal lengthening treatment, and their current sexual well-being.
Design
A qualitative interview study.
Setting
Denmark.
Population
Women aged ≥25 years diagnosed with MRKH syndrome.
Methods
Semi-structured video interviews were conducted with 18 women. Interviews lasted a median of 92 min and were digitally recorded, transcribed and anonymised. Data were analysed using thematic analysis.
Main Outcome Measures
A qualitative analysis of women's experiences.
Results
The analysis identified three themes. Firstly, Experiences with dilation treatment revealed dilation as an awkward routine, especially for adolescents living with parents and yet to sexually debut. While some experienced successful vaginal lengthening, others faced treatment failure leading to frustration and self-blame. Secondly, Experiences with neovaginal surgery described the procedure as extremely painful but resulting in a ‘normal size’ vagina. Some women felt that the procedure had negatively impacted their self-confidence, and all underscored the importance of maturity before opting for surgery. Lastly, Current sex life and sexual well-being indicated a well-functioning sex life for many women, but with reported low sexual confidence and genital self-image due to the perceived ‘deviance’ of their genitalia.
Conclusions
For women with MRKH syndrome, vaginal lengthening treatment, whether through dilation or surgery, may result in a ‘normal size’ vagina. However, according to the women's experiences, vaginal lengthening treatment does not adequately foster positive sexual esteem and genital self-image.
{"title":"Experiences of vaginal lengthening treatment and sexual well-being in women with Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome: An interview study","authors":"Amalie Hahn Jensen, Morten Krogh Herlin, Birgitta Trolle, Ida Vogel, Stina Lou","doi":"10.1111/1471-0528.17916","DOIUrl":"10.1111/1471-0528.17916","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore how women with Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome experience dilation or surgical vaginal lengthening treatment, and their current sexual well-being.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A qualitative interview study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Denmark.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women aged ≥25 years diagnosed with MRKH syndrome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Semi-structured video interviews were conducted with 18 women. Interviews lasted a median of 92 min and were digitally recorded, transcribed and anonymised. Data were analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>A qualitative analysis of women's experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis identified three themes. Firstly, <i>Experiences with dilation treatment</i> revealed dilation as an awkward routine, especially for adolescents living with parents and yet to sexually debut. While some experienced successful vaginal lengthening, others faced treatment failure leading to frustration and self-blame. Secondly, <i>Experiences with neovaginal surgery</i> described the procedure as extremely painful but resulting in a ‘normal size’ vagina. Some women felt that the procedure had negatively impacted their self-confidence, and all underscored the importance of maturity before opting for surgery. Lastly, <i>Current sex life and sexual well-being</i> indicated a well-functioning sex life for many women, but with reported low sexual confidence and genital self-image due to the perceived ‘deviance’ of their genitalia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>For women with MRKH syndrome, vaginal lengthening treatment, whether through dilation or surgery, may result in a ‘normal size’ vagina. However, according to the women's experiences, vaginal lengthening treatment does not adequately foster positive sexual esteem and genital self-image.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1841-1850"},"PeriodicalIF":4.7,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17916","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749573","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}
To determine the prevalence and secular trends of obstetric anal sphincter injuries (OASIS) in vacuum and forceps deliveries in Norway, both with and without episiotomy.
Design
Population-based real-world data collected during 2001–2018.
Setting
Medical Birth Registry Norway.
Population or Sample
Nulliparous women with singleton foetuses in a cephalic presentation delivered by either vacuum or forceps (n = 70 783).
Methods
Logistic regression analyses were applied to the OASIS prevalence in six 3-year time periods. Both crude odds ratios and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were determined.
Main Outcome Measures
OASIS prevalence.
Results
The OASIS prevalence in vacuum and forceps deliveries decreased from 14.8% during 2001–2003 to 5.2% during 2016–2018. The overall reduction between the first and last 3-year time period was 61% (aOR = 0.39, 95% CIs = 0.35–0.43). The only exception to this decreasing trend in OASIS was found in forceps deliveries performed without an episiotomy. The OASIS prevalence was approximately twofold higher in forceps compared to vacuum deliveries (aOR = 1.92, 95% CIs = 1.79–2.05). Performing either a mediolateral or lateral episiotomy was associated with a 45% decrease in the prevalence of OASIS relative to no episiotomy (aOR = 0.55, 95% CIs = 0.52–0.58).
Conclusions
Opting for vacuum rather than forceps delivery in conjunction with a mediolateral or lateral episiotomy could significantly lower the OASIS prevalence in nulliparous women.
{"title":"Obstetric anal sphincter injuries during instrumental vaginal delivery: An observational study based on 18-years of real-world data","authors":"Kathrine Fodstad, Katariina Laine, Sari Räisänen","doi":"10.1111/1471-0528.17914","DOIUrl":"10.1111/1471-0528.17914","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the prevalence and secular trends of obstetric anal sphincter injuries (OASIS) in vacuum and forceps deliveries in Norway, both with and without episiotomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Population-based real-world data collected during 2001–2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Medical Birth Registry Norway.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>Nulliparous women with singleton foetuses in a cephalic presentation delivered by either vacuum or forceps (<i>n</i> = 70 783).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Logistic regression analyses were applied to the OASIS prevalence in six 3-year time periods. Both crude odds ratios and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were determined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>OASIS prevalence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The OASIS prevalence in vacuum and forceps deliveries decreased from 14.8% during 2001–2003 to 5.2% during 2016–2018. The overall reduction between the first and last 3-year time period was 61% (aOR = 0.39, 95% CIs = 0.35–0.43). The only exception to this decreasing trend in OASIS was found in forceps deliveries performed without an episiotomy. The OASIS prevalence was approximately twofold higher in forceps compared to vacuum deliveries (aOR = 1.92, 95% CIs = 1.79–2.05). Performing either a mediolateral or lateral episiotomy was associated with a 45% decrease in the prevalence of OASIS relative to no episiotomy (aOR = 0.55, 95% CIs = 0.52–0.58).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Opting for vacuum rather than forceps delivery in conjunction with a mediolateral or lateral episiotomy could significantly lower the OASIS prevalence in nulliparous women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1824-1831"},"PeriodicalIF":4.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17914","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141726305","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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