Linked article: This is a mini commentary on Kapp et al., pp. 553–561 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.18344.
Linked article: This is a mini commentary on Kapp et al., pp. 553–561 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.18344.
To identify the factors contributing to tacker dislodgement and associated complications during sacrospinous ligament fixation (SSF) procedures.
Retrospective study.
Tertiary medical center.
Six hundred and seventy-six patients with stage ≥ 3 pelvic organ prolapse (POP) who underwent SSF with anchor-based devices (tackers) between April 2018 and November 2023.
Of these, 657 underwent SSF with transvaginal mesh (Surelift: 463; Calistar-S: 194), and 19 underwent SSF with Anchorsure alone. Patients were grouped into secure (n = 649) and dislodged tacker (n = 27) groups. Standardised institutional protocols, included pre-operative assessments, validated Chinese questionnaires at baseline and follow-up at 6 and 12 months postoperatively.
Determine the occurrence of a tacker dislodge during application and the injury caused to the patient and the operator.
Tacker dislodgement occurred in 2.2% of the cases. The dislodged group had a significantly higher BMI (p < 0.001) and prevalence of hypertension (p = 0.004). Complications in this group included two bladder injuries and four operator injuries, including glove tears and finger cuts (p < 0.001). The secure group demonstrated significantly less blood loss than the non-secure group (p < 0.001). Objective and subjective cure rates were high and comparable between the groups: 95.5% and 94.4% for the secure group and 90% for the dislodged group. The quality of life and sexual function outcomes were similarly favourable.
SSF using a tacker-based device was safe and effective. Recognising the risks associated with tacker dislodgement can enhance preparedness and minimise complications for both patients and operators.
To describe menstrual pain and pain management, and the associations of pain relief with school absenteeism and educational performance, among Ugandan adolescents.
Cross-sectional mixed-methods study, nested within a school-based cluster randomised controlled trial.
Adolescent girls in 60 secondary schools in Uganda.
Quantitative surveys, focus group discussions and in-depth interviews were conducted. Data were analysed using thematic framework analysis for qualitative data, and random-effects regression analysis for quantitative data.
Self-reported pain during the last menstrual period (LMP), school absenteeism and educational performance.
Among 2683 participants, the majority (n = 2227; 83.0%) reported pain during their LMP and were more likely to miss school than those without pain (mean days missed per month 2.1 vs. 1.4; adjusted incidence rate ratio [aIRR] = 1.46, 95% CI 1.30–1.65). Participants reported that menstrual pain hindered their ability to engage at school, leading to reduced class attendance and participation. Pain management strategies (painkillers, warm water bottles, stretching, or exercise) were reported by 1587 (71.3%) participants with pain at LMP, and were less commonly reported among participants with mental health problems and poorer menstrual self-efficacy. Participants who did not report pain relief missed more school days than those who did report pain relief (aIRR = 1.39, 95% CI 1.11–1.74).
Menstrual pain without effective relief was associated with increased school absenteeism. There is a need to improve the uptake of effective pain relief strategies in Ugandan schools and similar settings.
Although large language models are increasingly used in clinical and research settings, the validity of the information they provide remains uncertain. This study aimed to evaluate the accuracy, consistency, and reliability of three large language models—ChatGPT 4.0, DeepSeek R1, and Gemini 2.0—in answering cervical cancer-related questions based on the ESGO/ESTRO/ESP guidelines.
Prospective, comparative in silico benchmarking study.
Fondazione Policlinico Universitario A. Gemelli, Rome, Italy. Population or Sample: Fifty questions derived from the ESGO/ESTRO/ESP (European Society of Gynaecologic Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology) Guidelines for Cervical Cancer.
Each question was submitted simultaneously to ChatGPT 4.0, DeepSeek R1, and Gemini 2.0, and re-entered twice to assess response repeatability. Answers were evaluated for accuracy using a Global Quality Score (GQS) from 1 (poor) to 5 (completely accurate). Consistency (intra-model response stability) and reliability (alignment with guidelines) were assessed using binary classification. Main Outcome Measures: Median GQS, percentage of GQS 5 responses, consistency between repeated answers, and reliability.
ChatGPT 4.0 achieved the highest performance, with 42% of responses rated GQS 5, followed by Gemini 2.0 (30%) and DeepSeek R1 (28%). DeepSeek R1 and Gemini 2.0 scored lower in median GQS (3.50) compared to ChatGPT 4.0 (4.00). Response consistency varied significantly, with ChatGPT 4.0 and DeepSeek R1 showing differences from Gemini 2.0 (p = 0.034 and p = 0.044, respectively). No significant difference was observed in reliability (p = 0.602).
All models demonstrated suboptimal accuracy in aligning with clinical guidelines. ChatGPT 4.0 was the most accurate and consistent whereas DeepSeek R1 underperformed. Despite similar reliability across models, expert oversight remains essential to ensure safe clinical application and prevent misinformation.
Spontaneous vaginal births are often the presumed choice, representing 45% of UK births. However, information about benefits and risks is inconsistently given, impacting decision-making and experience. A Core Information Set (CIS) is an agreed set of information points discussed prior to a decision. We aimed to develop a CIS for vaginal birth.
A Delphi study was used to create the CIS. Information points were identified from a literature search, patient leaflets, interviews, and a survey. These informed a two-round Delphi survey, where stakeholders rated item importance. Items rated critically important by ≥ 80% of parents or professionals, and of limited importance by < 15%, progressed to consensus meetings, where 20 parents and professionals discussed retained items. The final CIS was populated with an engagement group ensuring accessibility.
The study took place in the UK, with participants recruited online.
Pregnant and postnatal women, birth partners, healthcare professionals, medicolegal professionals, and representatives from relevant organizations.
A CIS for vaginal birth.
77 information items were identified. In round 1 (631 participants) of the Delphi Survey, 84.5% were from the patient group and 15.5% from the professional group; in round 2 (228 participants), 74.3% were from the patient group and 25.7% from the professional group. 29 items met the criteria for consensus discussion. The final CIS includes 19 information points addressing: labour process, pain relief, labour complications, procedures or interventions during labour, experiences after birth, outcomes for the baby and labour environment.
This CIS can facilitate discussions and support informed decision-making about vaginal birth.
To investigate whether the risk of asthma, eczema and allergic rhinitis at 5 years in children born by caesarean section (CS) differs by the timing of antibiotic administration to the mother (pre-incision vs. post-cord clamping).
Natural experiment using birth cohort data.
UK single centre population-based birth cohort.
3013 liveborn children delivered by CS, from the Born in Bradford (BiB) cohort born 2007–2011 and BiB's Better Start (BiBBS) cohort born 2016–2019. Only the first-born of multiple births was included.
Risk of asthma, atopic eczema and allergic rhinitis at age 5 years.
Among 3013 children, 579 (19.2%) were exposed to pre-incision antibiotics. At 5 years, 272 (9.0%) children had asthma, 672 (22.3%) had eczema and 180 (6.0%) had allergic rhinitis. There was no evidence of an increased risk of asthma (adjusted risk ratio [aRR] 1.01, 95% CI 0.56, 1.83; adjusted risk difference [aRD] 0.08 per 100, 95% CI −5.28, 5.44), eczema (aRR 0.96, 95% CI 0.68, 1.35; aRD −1.01 per 100, 95% CI −8.65, 6.63) or allergic rhinitis (aRR 1.16, 95% CI 0.59, 2.28; aRD 0.88 per 100, 95% CI −3.17, 4.92) at 5 years in children exposed to pre-incision antibiotics versus post-cord clamping.
This study found no evidence of an association between pre-incision antibiotics for CS and increased risk of asthma, eczema or allergic rhinitis by age 5. These findings contribute to the evidence base informing the optimum timing of maternal antibiotic prophylaxis for CS, balancing risks and benefits to the mother and her child.
To investigate whether genetic predisposition to pre-eclampsia (PE), measured by a polygenic risk score (PRS), is associated with incident hypertension and cardiovascular disease (CVD) after delivery in Asian women.
Prospective population-based cohort study.
Data were utilised from the Korean Genome and Epidemiology Study and additional multicentre cohorts.
35 872 parous Korean women aged 40–80 years at last surveillance, with genotype data, no history of hypertension or CVD before delivery, and complete clinical information. For external validation, 559 parous Korean women were included.
The PE-PRS was calculated for Asian women, and the study population was divided into the high PE-PRS and low PE-PRS groups. The long-term risks of incident hypertension and CVD (ischaemic heart disease or stroke) after delivery were compared between the groups.
Incident hypertension and CVD after delivery.
Women in the high PE-PRS group had an increased risk of developing hypertension (adjusted hazard ratio [aHR] 1.25, 95% CI 1.17–1.34) and ischaemic heart disease (aHR 1.28, 95% CI 1.07–1.54) compared to the low PE-PRS group. The risk of hypertension was highest among women with both a history of PE and a high PE-PRS.
Genetic predisposition to PE, as measured by the PE-PRS, is associated with an elevated risk of incident hypertension and ischaemic heart disease in Asian women. These findings suggest the potential utility of the PE-PRS as a complementary tool in assessing individualised hypertension risk in parous women.
Monochorionic (MC) twins are at risk of acute exsanguination after single fetal demise (sFD) due to their shared placental circulation, which may result in sequelae for survivors.
To evaluate the prevalence of ante- and postnatal brain injury and long-term neurodevelopmental impairment (NDI) in co-twins after sFD. Secondary outcomes were the prevalence of termination of pregnancy (TOP), neonatal death (NND) and potential risk factors for brain injury.
PubMed, Embase, Scopus and Web of Science were searched to identify relevant studies in October 2024.
Studies reporting MC twin pregnancies with spontaneous sFD. Studies with selective feticide, twin reversed arterial perfusion sequence, twin anaemia–polycythaemia sequence, congenital anomalies, higher-order multiple pregnancies, fetoscopic laser surgery and double fetal demise were excluded.
Systematic review and meta-analysis were performed following the PRISMA and MOOSE guidelines.
Thirteen studies involving 311 survivors after sFD were included. The prevalence of TOP, NND, brain injury and NDI was 3% (95% CI: 0%–7%), 6% (95% CI: 0%–16%), 27% (95% CI: 18%–37%), 6% (95% CI: 3%–11%), respectively. The median GA at birth in survivors with brain injury was 29 weeks (IQR 27.7–34.1) compared to 36 weeks (IQR: 32.3–37.0) in the overall group of survivors.
Brain injury occurs in one in four survivors and is associated with lower GA at birth, suggesting a double-hit injury due to a combination of exsanguination and (severe) prematurity. NDI occurs in one in 20 survivors, compared to two-thirds of those with brain injury.
PROSPERO number: CRD42024608912
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