Francis G. Muriithi, Charles A. Ameh, Ruth W. Gakuo, Caitlin R. Williams, Adam Devall, Arri Coomarasamy, Sue Fawcus
Objective
To examine the variability in causes of maternal deaths in African countries using the World Health Organization (WHO) International Classification of Diseases Maternal Mortality (ICD-MM) framework and the contributing factors using the three delays framework.
Design
Secondary data analysis.
Setting
African countries.
Sample
National maternal death review reports.
Methods
A framework analysis of data extracted from maternal death review reports utilising the ICD-MM and three delays analytical frameworks.
Main Outcome Measures
Proportions of the causes of maternal death and contributing factors.
Results
Twenty-two reports published between 2009 and 2022 were included, comprising 18,321 maternal deaths. The mean proportions were: 73% direct, 20% indirect, 8% unspecified, and 1% coincidental. The causes of death consisted of: 6% abortion-related; 16% hypertensive disorders; 33% obstetric haemorrhage; 9% infection; 10% other direct complications; 3% complications of management; 20% non-obstetric complications; 8% unknown; and 1% coincidental. All three delays contributed to maternal deaths. The third delay: receiving adequate care, was the most common in all countries except Ethiopia, where the first delay: deciding to seek care, dominated. On average, the first, second, and third delays contributed to 26%, 15%, and 61% of deaths, respectively.
Conclusion
A renewed focus on the quality of care within health facilities, alongside addressing pre-facility contributing factors, could re-ignite progress in reducing the burden of preventable maternal deaths.
{"title":"Variability in the Causes and Delay Factors Contributing to Maternal Mortality: Evidence From Maternal Death Surveillance Reports of 22 African Countries","authors":"Francis G. Muriithi, Charles A. Ameh, Ruth W. Gakuo, Caitlin R. Williams, Adam Devall, Arri Coomarasamy, Sue Fawcus","doi":"10.1111/1471-0528.18342","DOIUrl":"10.1111/1471-0528.18342","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the variability in causes of maternal deaths in African countries using the World Health Organization (WHO) International Classification of Diseases Maternal Mortality (ICD-MM) framework and the contributing factors using the three delays framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Secondary data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>African countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>National maternal death review reports.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A framework analysis of data extracted from maternal death review reports utilising the ICD-MM and three delays analytical frameworks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Proportions of the causes of maternal death and contributing factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two reports published between 2009 and 2022 were included, comprising 18,321 maternal deaths. The mean proportions were: 73% direct, 20% indirect, 8% unspecified, and 1% coincidental. The causes of death consisted of: 6% abortion-related; 16% hypertensive disorders; 33% obstetric haemorrhage; 9% infection; 10% other direct complications; 3% complications of management; 20% non-obstetric complications; 8% unknown; and 1% coincidental. All three delays contributed to maternal deaths. The third delay: receiving adequate care, was the most common in all countries except Ethiopia, where the first delay: deciding to seek care, dominated. On average, the first, second, and third delays contributed to 26%, 15%, and 61% of deaths, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A renewed focus on the quality of care within health facilities, alongside addressing pre-facility contributing factors, could re-ignite progress in reducing the burden of preventable maternal deaths.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"106-115"},"PeriodicalIF":4.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18342","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915498","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}
Paolo Mannella, Chiara Benedetto, Emilie Canuto, Brigida Carducci, Ilma Floriana Carbone, Elena Cesari, Irene Cetin, Andrea Ciavattini, Nicola Colacurci, Antonella Cromi, Lorenza Driul, Nicoletta Di Simone, Sergio Ferrazzani, Tiziana Frusca, Serafina Garofalo, Tullio Ghi, Valentina Giardini, Pantaleo Greco, Annalisa Inversetti, Antonio Lanzone, Luca Marozio, Carmelinda Martino, Federico Mecacci, Maddalena Morlando, Caterina Neri, Gianluigi Pilu, Federico Prefumo, Giuseppe Rizzo, Giovanni Scambia, Tommaso Simoncini, Emanuela Taricco, Patrizia Vergani, Barbara Zaina, Rossella Nappi
Objective
To develop standardised Objective Structured Assessment of Technical Skills (OSATS) forms for major obstetric emergencies, thereby improving the quality and consistency of obstetric simulation training.
Design and Setting
A panel of national experts with extensive experience in teaching Gynaecology and Obstetrics, simulation training, and the clinical management of labour complications and peripartum emergencies.
Population and Methods
A Delphi process with four iterative rounds was conducted to create, evaluate, revise, and finalise OSATS checklists for 11 obstetric emergencies. Each OSATS form was rated using a Likert scale (0–9), refined according to expert feedback, and validated through structured discussions.
Main Outcome Measures
The creation and approval of OSATS forms for shoulder dystocia, vacuum delivery, assisted breech delivery, third- and fourth-degree laceration repair, external cephalic version, abnormal CTG management, postpartum haemorrhage, non-cephalic second twin delivery, reverse breech extraction at caesarean section, maternal collapse and forceps application.
Results
Consensus was achieved for all emergencies with good to excellent ratings: shoulder dystocia (82%), external cephalic version (94%), vacuum delivery (75%), abnormal CTG management (42%), postpartum haemorrhage (96%), reverse breech extraction (72%), maternal collapse (94%), forceps application (76%), non-cephalic second twin delivery (96%), assisted breech delivery (94%) and third- and fourth-degree laceration repair (82%).
Conclusion
The Delphi study successfully developed consensus-based OSATS forms, addressing the need for standardised assessments in obstetric simulation training. These tools enhance training quality, identify skill gaps and improve clinical preparedness. This study was supported by AGUI (Associazione Ginecologi Universitari Italiani).
{"title":"Standardising Simulation-Based Obstetric Emergency Training: A Delphi Consensus Study","authors":"Paolo Mannella, Chiara Benedetto, Emilie Canuto, Brigida Carducci, Ilma Floriana Carbone, Elena Cesari, Irene Cetin, Andrea Ciavattini, Nicola Colacurci, Antonella Cromi, Lorenza Driul, Nicoletta Di Simone, Sergio Ferrazzani, Tiziana Frusca, Serafina Garofalo, Tullio Ghi, Valentina Giardini, Pantaleo Greco, Annalisa Inversetti, Antonio Lanzone, Luca Marozio, Carmelinda Martino, Federico Mecacci, Maddalena Morlando, Caterina Neri, Gianluigi Pilu, Federico Prefumo, Giuseppe Rizzo, Giovanni Scambia, Tommaso Simoncini, Emanuela Taricco, Patrizia Vergani, Barbara Zaina, Rossella Nappi","doi":"10.1111/1471-0528.18332","DOIUrl":"10.1111/1471-0528.18332","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To develop standardised Objective Structured Assessment of Technical Skills (OSATS) forms for major obstetric emergencies, thereby improving the quality and consistency of obstetric simulation training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Setting</h3>\u0000 \u0000 <p>A panel of national experts with extensive experience in teaching Gynaecology and Obstetrics, simulation training, and the clinical management of labour complications and peripartum emergencies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population and Methods</h3>\u0000 \u0000 <p>A Delphi process with four iterative rounds was conducted to create, evaluate, revise, and finalise OSATS checklists for 11 obstetric emergencies. Each OSATS form was rated using a Likert scale (0–9), refined according to expert feedback, and validated through structured discussions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The creation and approval of OSATS forms for shoulder dystocia, vacuum delivery, assisted breech delivery, third- and fourth-degree laceration repair, external cephalic version, abnormal CTG management, postpartum haemorrhage, non-cephalic second twin delivery, reverse breech extraction at caesarean section, maternal collapse and forceps application.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Consensus was achieved for all emergencies with good to excellent ratings: shoulder dystocia (82%), external cephalic version (94%), vacuum delivery (75%), abnormal CTG management (42%), postpartum haemorrhage (96%), reverse breech extraction (72%), maternal collapse (94%), forceps application (76%), non-cephalic second twin delivery (96%), assisted breech delivery (94%) and third- and fourth-degree laceration repair (82%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The Delphi study successfully developed consensus-based OSATS forms, addressing the need for standardised assessments in obstetric simulation training. These tools enhance training quality, identify skill gaps and improve clinical preparedness. This study was supported by AGUI (Associazione Ginecologi Universitari Italiani).</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 12","pages":"1875-1883"},"PeriodicalIF":4.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910741","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}
Joel G. Ray, Sho Podolsky, Carla Sorbara, Therese A. Stukel
Objective
To assess whether infant emergency department (ED) use differs between a midwifery-based and obstetrics-based model of care.
Design
Retrospective population-based cohort study.
Setting
Province of Ontario, Canada.
Population
Infants born to low-risk primiparous women in a hospital, 2012–2021.
Methods
Modified Poisson regression compared ED use between women with midwifery and obstetrics-model care, weighting by propensity-based overlap weights.
Main Outcome Measures
Any unscheduled infant ED visit after the birth hospitalisation discharge date up to 27 days thereafter.
Results
Included were 36 949 livebirths to women receiving care by a midwife and 120 463 to women receiving care by an obstetrician. Median gestational age at birth was 39 weeks; 11.8% and 13.3% were admitted to the NICU, and the median newborn hospital length of stay was 1.3 and 1.8 days, respectively. Midwifery-care mother–child pairs received a median of 6.9 postpartum visits by a midwife. An infant ED visit ≤ 27 days occurred among 1789 (4.8%) midwife-led care patients versus 11 886 (9.9%) obstetrician-led care recipients (relative risk [RR] 0.51, 95% CI 0.49 to 0.54; absolute risk difference −4.6%, 95% CI −4.9 to −4.3). The corresponding RR was 0.42 (95% CI 0.39 to 0.46) for infant ED visit ≤ 7 days and 0.87 (95% CI 0.86 to 0.89) for infant ED visit ≤ 365 days.
Conclusions
Among infants born to low-risk primiparous women, midwifery-model care was associated with less ED use after birth than an obstetrics model of care. Among similar populations, enhanced access to midwifery care might reduce postnatal newborn resource use.
目的评估以助产学和产科为基础的护理模式对婴儿急诊科（ED）的使用是否有差异。设计：基于人群的回顾性队列研究。加拿大安大略省。2012-2021年医院低风险孕妇所生婴儿数。方法采用改进泊松回归比较助产和产科模式护理妇女的ED使用情况，采用基于倾向的重叠权重加权。主要观察指标出生后住院出院后27天内任何未安排的婴儿急诊科就诊。结果接受助产士护理的产妇中有36949例活产，接受产科医生护理的产妇中有120463例活产。出生时中位胎龄为39周；11.8%和13.3%的新生儿入住NICU，新生儿住院时间中位数分别为1.3天和1.8天。助产士-护理母婴对接受助产士产后随访的中位数为6.9次。1789（4.8%）名助产士领导的护理患者与11886（9.9%）名产科医生领导的护理患者中，婴儿ED就诊≤27天（相对危险度[RR] 0.51, 95% CI 0.49至0.54；绝对危险度差异为4.6%,95% CI - 4.9至- 4.3）。婴幼儿急诊科就诊≤7天的相应RR为0.42 (95% CI 0.39 ~ 0.46)，婴幼儿急诊科就诊≤365天的相应RR为0.87 （95% CI 0.86 ~ 0.89）。结论：在低风险初产妇所生的婴儿中，助产模式护理比产科模式护理与出生后较少使用ED相关。在类似人群中，增加获得助产护理的机会可能会减少产后新生儿资源的使用。
{"title":"Infant Emergency Department Use After Midwifery- Versus Obstetrician-Led Perinatal Care: A Population-Based Cohort Study","authors":"Joel G. Ray, Sho Podolsky, Carla Sorbara, Therese A. Stukel","doi":"10.1111/1471-0528.18346","DOIUrl":"10.1111/1471-0528.18346","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess whether infant emergency department (ED) use differs between a midwifery-based and obstetrics-based model of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective population-based cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Province of Ontario, Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Infants born to low-risk primiparous women in a hospital, 2012–2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Modified Poisson regression compared ED use between women with midwifery and obstetrics-model care, weighting by propensity-based overlap weights.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Any unscheduled infant ED visit after the birth hospitalisation discharge date up to 27 days thereafter.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Included were 36 949 livebirths to women receiving care by a midwife and 120 463 to women receiving care by an obstetrician. Median gestational age at birth was 39 weeks; 11.8% and 13.3% were admitted to the NICU, and the median newborn hospital length of stay was 1.3 and 1.8 days, respectively. Midwifery-care mother–child pairs received a median of 6.9 postpartum visits by a midwife. An infant ED visit ≤ 27 days occurred among 1789 (4.8%) midwife-led care patients versus 11 886 (9.9%) obstetrician-led care recipients (relative risk [RR] 0.51, 95% CI 0.49 to 0.54; absolute risk difference −4.6%, 95% CI −4.9 to −4.3). The corresponding RR was 0.42 (95% CI 0.39 to 0.46) for infant ED visit ≤ 7 days and 0.87 (95% CI 0.86 to 0.89) for infant ED visit ≤ 365 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among infants born to low-risk primiparous women, midwifery-model care was associated with less ED use after birth than an obstetrics model of care. Among similar populations, enhanced access to midwifery care might reduce postnatal newborn resource use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"132-141"},"PeriodicalIF":4.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910744","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}
Bo Verberckmoes, Steffi van Wessel, Tjalina Hamerlynck, Jan Bosteels, Marc Coppens, Steven Weyers
Objective
This study investigates whether total laparoscopic hysterectomy in trans men can be safely performed as an ambulatory procedure without negatively impacting patient satisfaction with length of stay compared to inpatient surgery.
Trans men scheduled for total laparoscopic hysterectomy.
Methods
Participants were randomly allocated to ambulatory surgery (intervention) or overnight stay (comparator).
Main Outcome Measures
The main outcome was satisfaction with the length of hospital stay, measured on Day 7 postoperatively. Secondary outcomes were pain scores, analgesics use, quality of recovery, hospital anxiety and depression, complications, and readmission.
Results
One hundred trans men gave informed consent. Ninety-four underwent surgery (50 allocated inpatient and 44 ambulatory). The non-inferiority margin for the primary outcome was −20 on a 100-point VAS. Total laparoscopic hysterectomy as an ambulatory procedure was non-inferior to the inpatient setting regarding satisfaction with length of hospital stay after 1 week (mean difference 1.45; 95% CI: −6.71 to 9.61). There were lower pain scores in the ambulatory group, along with significantly more use of moderate analgesics on Days 1, 2, and 3 (resp. risk difference 0.35 (95% CI: 0.17–0.53), 0.32 (95% CI: 0.10–0.54), 0.31 (95% CI: 0.10–0.52)). The quality of recovery and hospital anxiety and depression scores were comparable between both groups. The readmission and postoperative complication rates were higher in the inpatient group.
Conclusions
This study shows non-inferiority for patient satisfaction with length of hospital stay after hysterectomy in the ambulatory versus inpatient setting in a transgender population.
{"title":"Ambulatory Versus Inpatient Total Laparoscopic Hysterectomy in Trans Men: A Randomised Controlled Non-Inferiority Trial","authors":"Bo Verberckmoes, Steffi van Wessel, Tjalina Hamerlynck, Jan Bosteels, Marc Coppens, Steven Weyers","doi":"10.1111/1471-0528.18340","DOIUrl":"10.1111/1471-0528.18340","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study investigates whether total laparoscopic hysterectomy in trans men can be safely performed as an ambulatory procedure without negatively impacting patient satisfaction with length of stay compared to inpatient surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Single-centre non-inferiority randomised controlled trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Ghent University Hospital, Belgium.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Trans men scheduled for total laparoscopic hysterectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were randomly allocated to ambulatory surgery (intervention) or overnight stay (comparator).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The main outcome was satisfaction with the length of hospital stay, measured on Day 7 postoperatively. Secondary outcomes were pain scores, analgesics use, quality of recovery, hospital anxiety and depression, complications, and readmission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred trans men gave informed consent. Ninety-four underwent surgery (50 allocated inpatient and 44 ambulatory). The non-inferiority margin for the primary outcome was −20 on a 100-point VAS. Total laparoscopic hysterectomy as an ambulatory procedure was non-inferior to the inpatient setting regarding satisfaction with length of hospital stay after 1 week (mean difference 1.45; 95% CI: −6.71 to 9.61). There were lower pain scores in the ambulatory group, along with significantly more use of moderate analgesics on Days 1, 2, and 3 (resp. risk difference 0.35 (95% CI: 0.17–0.53), 0.32 (95% CI: 0.10–0.54), 0.31 (95% CI: 0.10–0.52)). The quality of recovery and hospital anxiety and depression scores were comparable between both groups. The readmission and postoperative complication rates were higher in the inpatient group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study shows non-inferiority for patient satisfaction with length of hospital stay after hysterectomy in the ambulatory versus inpatient setting in a transgender population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov: NCT05393583</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"52-60"},"PeriodicalIF":4.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144905870","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}
Dara D. Méndez, Hyagriv N. Simhan, Sade A. Tukuru, Stacy Bartlett, Catherine L. Haggerty, Ashley Hill, Onome Oghifobibi, Cynthia Salter, Jada Shirriel, Ngozi Tibbs, Lovie J. J. Foster, Linda Adodoadji, Iris Ryn Olson, Mehret Birru Talabi
<div> <section> <h3> Objective</h3> <p>To describe the development of the EMBRACE Center, which seeks to advance Black maternal health in Allegheny County through research and capacity building.</p> </section> <section> <h3> Design</h3> <p>The EMBRACE Center is a multidisciplinary community-academic research partnership at the University of Pittsburgh. Researchers and community collaborators—many of them Black-led organisations—share power in ways that value diverse forms of knowledge.</p> </section> <section> <h3> Setting</h3> <p>Allegheny County, Pennsylvania.</p> </section> <section> <h3> Population or Sample</h3> <p>Birthing people in Allegheny County, Pennsylvania, and surrounding regions.</p> </section> <section> <h3> Methods</h3> <p>The EMBRACE Center's Research Project seeks to enhance postpartum (4th Trimester) and interconception care that improves pregnancy outcomes and reduces rates of severe maternal morbidity among Black individuals. EMBRACE's community and training components facilitate community partnerships throughout research, implementation, training, and capacity building for reproductive justice and equity. Working groups focus on shared decision-making, communication, and dissemination processes that enhance data collection and sharing with the community. A multi-disciplinary advisory board and a community advisory board provide feedback to the Center.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Research outcomes of interest include reducing maternal morbidity and mortality. Center outcome measures include development of a regional maternal health equity workforce.</p> </section> <section> <h3> Results</h3> <p>Center activities include education in maternal health and reproductive justice, data justice community trainings, development of measures for structural and social determinants of maternal health, and convening community advocates, researchers and practitioners for black maternal health and reproductive justice.</p> </section> <section> <h3> Conclusions</h3> <p>The work of EMBRACE will result in sustainable approaches to advance maternal and reproductive health equity and improve well-being for black bir
{"title":"Advancing Maternal Health Through the EMBRACE Research Center of Excellence: Foundations, Approach and Protocol","authors":"Dara D. Méndez, Hyagriv N. Simhan, Sade A. Tukuru, Stacy Bartlett, Catherine L. Haggerty, Ashley Hill, Onome Oghifobibi, Cynthia Salter, Jada Shirriel, Ngozi Tibbs, Lovie J. J. Foster, Linda Adodoadji, Iris Ryn Olson, Mehret Birru Talabi","doi":"10.1111/1471-0528.18335","DOIUrl":"10.1111/1471-0528.18335","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the development of the EMBRACE Center, which seeks to advance Black maternal health in Allegheny County through research and capacity building.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The EMBRACE Center is a multidisciplinary community-academic research partnership at the University of Pittsburgh. Researchers and community collaborators—many of them Black-led organisations—share power in ways that value diverse forms of knowledge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Allegheny County, Pennsylvania.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>Birthing people in Allegheny County, Pennsylvania, and surrounding regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The EMBRACE Center's Research Project seeks to enhance postpartum (4th Trimester) and interconception care that improves pregnancy outcomes and reduces rates of severe maternal morbidity among Black individuals. EMBRACE's community and training components facilitate community partnerships throughout research, implementation, training, and capacity building for reproductive justice and equity. Working groups focus on shared decision-making, communication, and dissemination processes that enhance data collection and sharing with the community. A multi-disciplinary advisory board and a community advisory board provide feedback to the Center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Research outcomes of interest include reducing maternal morbidity and mortality. Center outcome measures include development of a regional maternal health equity workforce.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Center activities include education in maternal health and reproductive justice, data justice community trainings, development of measures for structural and social determinants of maternal health, and convening community advocates, researchers and practitioners for black maternal health and reproductive justice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The work of EMBRACE will result in sustainable approaches to advance maternal and reproductive health equity and improve well-being for black bir","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2217-2225"},"PeriodicalIF":4.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18335","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144905851","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}
Natalie Holowko, Nathalie Roos, Björn Pasternak, Jonas Söderling, Martin Neovius, Soffia Gudbjörnsdottir, Anna Sandström, Jonas F. Ludvigsson, Olof Stephansson
<div> <section> <h3> Objective</h3> <p>No large-scale studies exist investigating glycaemic control around conception and preeclampsia risk.</p> </section> <section> <h3> Design</h3> <p>Population-based nationwide cohort study using the National Diabetes Register and other health registers.</p> </section> <section> <h3> Setting</h3> <p>Sweden.</p> </section> <section> <h3> Population</h3> <p>Singleton pregnancies between 2003 and 2019 (<i>N</i> = 1 689 301); 4429 with type 1 diabetes (T1DM) and 1 684 872 without.</p> </section> <section> <h3> Methods</h3> <p>The main exposure was having a pre-gestational diagnosis of T1DM (first diagnosis anytime ≤ 91 days after conception and ≥ 1value of glycated haemoglobin (HbA1c) within ±90 days from conception). Peri-conceptional glycaemic control was categorised using the most recent HbA1c measurement (mmol/mol: < 48; 48–61; 62–75; ≥ 76). Unexposed were women without any diabetes diagnosis (≤ 91 days after conception).</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Preeclampsia was defined using ICD codes and further categorised according to completed gestational weeks at delivery with preeclampsia diagnosis: early preterm preeclampsia (< 34 + 0), late preterm preeclampsia (34 + 0 to 36 + 6), or term preeclampsia (≥ 37 + 0).</p> </section> <section> <h3> Results</h3> <p>16.8% of women with T1DM developed preeclampsia, compared to 2.9% of women without diabetes (adjusted RR [aRR] 4.7, 95% CI 4.4–5.0). Preeclampsia risk increased with peri-conceptional HbA1c, from 11.6% in women with HbA1c < 48 mmol/mol to 23.3% in women with HbA1c ≥ 76 mmol/mol. Compared to unexposed women, there was a dose–response relationship between HbA1c and preeclampsia in women with T1DM (HbA1c < 48 mmol/mol aRR 3.4 (2.9–4.0); HbA1c 48–61 mmol/mol aRR 4.6 (4.2–5.1); HbA1c 62–75 mmol/mol aRR 5.7 (5.0–6.5): HbA1c ≥ 76 mmol/mol aRR 6.3 (CI 5.3–7.7)). Compared to unexposed women, the aRR of term preeclampsia was 3.5 times higher (3.1–3.9) in women with T1DM, while the aRR was much higher for early preterm preeclampsia (aRR 7.2: 6.1–8.5) and late preterm preeclampsia (aRR 9.9: 8.8–11.1).</p> </section> <section> <h3> Conclusions</h3>
{"title":"Glycaemic Control in Women With Type 1 Diabetes and Preeclampsia Risk: A Nationwide Cohort Study","authors":"Natalie Holowko, Nathalie Roos, Björn Pasternak, Jonas Söderling, Martin Neovius, Soffia Gudbjörnsdottir, Anna Sandström, Jonas F. Ludvigsson, Olof Stephansson","doi":"10.1111/1471-0528.18339","DOIUrl":"10.1111/1471-0528.18339","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>No large-scale studies exist investigating glycaemic control around conception and preeclampsia risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Population-based nationwide cohort study using the National Diabetes Register and other health registers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Sweden.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Singleton pregnancies between 2003 and 2019 (<i>N</i> = 1 689 301); 4429 with type 1 diabetes (T1DM) and 1 684 872 without.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The main exposure was having a pre-gestational diagnosis of T1DM (first diagnosis anytime ≤ 91 days after conception and ≥ 1value of glycated haemoglobin (HbA1c) within ±90 days from conception). Peri-conceptional glycaemic control was categorised using the most recent HbA1c measurement (mmol/mol: < 48; 48–61; 62–75; ≥ 76). Unexposed were women without any diabetes diagnosis (≤ 91 days after conception).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Preeclampsia was defined using ICD codes and further categorised according to completed gestational weeks at delivery with preeclampsia diagnosis: early preterm preeclampsia (< 34 + 0), late preterm preeclampsia (34 + 0 to 36 + 6), or term preeclampsia (≥ 37 + 0).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>16.8% of women with T1DM developed preeclampsia, compared to 2.9% of women without diabetes (adjusted RR [aRR] 4.7, 95% CI 4.4–5.0). Preeclampsia risk increased with peri-conceptional HbA1c, from 11.6% in women with HbA1c < 48 mmol/mol to 23.3% in women with HbA1c ≥ 76 mmol/mol. Compared to unexposed women, there was a dose–response relationship between HbA1c and preeclampsia in women with T1DM (HbA1c < 48 mmol/mol aRR 3.4 (2.9–4.0); HbA1c 48–61 mmol/mol aRR 4.6 (4.2–5.1); HbA1c 62–75 mmol/mol aRR 5.7 (5.0–6.5): HbA1c ≥ 76 mmol/mol aRR 6.3 (CI 5.3–7.7)). Compared to unexposed women, the aRR of term preeclampsia was 3.5 times higher (3.1–3.9) in women with T1DM, while the aRR was much higher for early preterm preeclampsia (aRR 7.2: 6.1–8.5) and late preterm preeclampsia (aRR 9.9: 8.8–11.1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"95-105"},"PeriodicalIF":4.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18339","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144905869","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}
Ellen S. Mooren, Jeroen van Bavel, Anita C. J. Ravelli, Jan Willem de Leeuw
Background
Obstetric anal sphincter injuries (OASIS) are complications with a risk of maternal morbidity. To estimate the individual risk of OASIS, prediction models have been developed.
Objectives
Identifying studies on development and validation of prediction models for OASIS, with a critical assessment of methodology and clinical applicability.
Search Strategy
This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the CHecklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). PubMed, Embase, Cochrane Library and Scopus were searched up to 26 June 2024.
Selection Criteria
Studies with description of model performance used for the development of prediction models.
Data Collection and Analysis
Data extraction and assessment were performed by two independent researchers. The Prediction model Risk of Bias Assessment Tool (PROBAST) was used to assess risk of bias and applicability.
Main Results
Of the 855 retrieved papers, 16 papers with 25 prediction models for OASIS were included. In these models, 2 to 15 variables were used. Model discrimination ranged from 0.64 to 0.83. All studies had shortcomings, particularly because of small or non-generalisable cohorts and were at risk of bias. Nine studies were of concern regarding clinical applicability. There were no geographical external validation studies of the 25 pre-existing models.
Conclusions
The included prediction models for OASIS were of low or moderate quality and not applicable for use in clinical care yet. Future studies should focus on developing models based on larger generalisable multicentre cohorts, with clinically applicable predictors and with internal and external validation.
{"title":"Prediction Models for Obstetric Anal Sphincter Injuries (OASIS): A Systematic Review and Critical Appraisal","authors":"Ellen S. Mooren, Jeroen van Bavel, Anita C. J. Ravelli, Jan Willem de Leeuw","doi":"10.1111/1471-0528.18334","DOIUrl":"10.1111/1471-0528.18334","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Obstetric anal sphincter injuries (OASIS) are complications with a risk of maternal morbidity. To estimate the individual risk of OASIS, prediction models have been developed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Identifying studies on development and validation of prediction models for OASIS, with a critical assessment of methodology and clinical applicability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the CHecklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). PubMed, Embase, Cochrane Library and Scopus were searched up to 26 June 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Studies with description of model performance used for the development of prediction models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Data extraction and assessment were performed by two independent researchers. The Prediction model Risk of Bias Assessment Tool (PROBAST) was used to assess risk of bias and applicability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Of the 855 retrieved papers, 16 papers with 25 prediction models for OASIS were included. In these models, 2 to 15 variables were used. Model discrimination ranged from 0.64 to 0.83. All studies had shortcomings, particularly because of small or non-generalisable cohorts and were at risk of bias. Nine studies were of concern regarding clinical applicability. There were no geographical external validation studies of the 25 pre-existing models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The included prediction models for OASIS were of low or moderate quality and not applicable for use in clinical care yet. Future studies should focus on developing models based on larger generalisable multicentre cohorts, with clinically applicable predictors and with internal and external validation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 12","pages":"1734-1741"},"PeriodicalIF":4.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910742","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}
Anne Armstrong, Ashu Gandhi, Suzanne Frank, David Williams, Samantha Nimalasena, the Royal College of Obstetricians and Gynaecologists
<p>The purpose of this guideline is to describe the diagnosis, management and treatment of breast cancer during and immediately after pregnancy. It also provides advice on future fertility considerations after a breast cancer diagnosis.</p><p>This guideline is for healthcare professionals who care for women, non-binary and trans people who experience pregnancy associated breast cancer (PABC). Within this document we use the terms woman and women's health. However, it is important to acknowledge that it is not only women for whom it is necessary to access women's health and reproductive services in order to maintain their gynaecological health and reproductive wellbeing. Gynaecological and obstetric services and delivery of care must therefore be appropriate, inclusive and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth.</p><p>Breast cancer is the most common cancer in the UK, accounting for 15% of all new cancer cases (2017–19) [<span>1</span>]. There are around 56 800 new breast cancer cases in the UK every year (2017–19) [<span>1</span>]. Of these, 9% occur in women at or under 44 years of age [<span>1</span>]. Survival rates have improved significantly in recent decades. In women diagnosed under the age of 39 years, 85% are alive more than 5 years after their diagnosis [<span>1</span>] leading many women to now consider pregnancy as an option after cancer.</p><p>A new breast cancer diagnosis complicates about 1 in 3000 pregnancies [<span>2</span>]. With advancing maternal age at pregnancy [<span>3</span>] it is likely that the incidence of breast cancer during pregnancy will increase.</p><p>Clinical care of people who are pregnant with breast cancer should follow the principles of care for all pregnant women with medical disorders: the clinician's duty of care is first towards the woman and then to the fetus. This principle was outlined in the 2021 MBRRACE report which states that clinicians should ‘Treat women who may become pregnant, are pregnant, or who have recently been pregnant the same as a non-pregnant person unless there is a very clear reason not to’ [<span>4</span>]. For pregnant women with breast cancer a care plan should first be established by surgeons and oncologists, as if the woman was not pregnant. This plan can then be adapted with a multidisciplinary team (MDT) that should also include obstetricians, fetal and neonatal specialists. This team should balance potential treatment for the woman and her fetus with potential compromise for pregnancy outcome. These treatment options must be discussed with the woman.</p><p>As breast cancer during pregnancy is relatively rare and heterogeneous in its presentation, recommendations for care are guided by international registries rather than clinical trials. Treatment decisions are therefore limited to the best available evidence, which is often not definitive. In the absence of evidence of harm or safety in pregn
{"title":"Pregnancy and Breast Cancer","authors":"Anne Armstrong, Ashu Gandhi, Suzanne Frank, David Williams, Samantha Nimalasena, the Royal College of Obstetricians and Gynaecologists","doi":"10.1111/1471-0528.18270","DOIUrl":"10.1111/1471-0528.18270","url":null,"abstract":"<p>The purpose of this guideline is to describe the diagnosis, management and treatment of breast cancer during and immediately after pregnancy. It also provides advice on future fertility considerations after a breast cancer diagnosis.</p><p>This guideline is for healthcare professionals who care for women, non-binary and trans people who experience pregnancy associated breast cancer (PABC). Within this document we use the terms woman and women's health. However, it is important to acknowledge that it is not only women for whom it is necessary to access women's health and reproductive services in order to maintain their gynaecological health and reproductive wellbeing. Gynaecological and obstetric services and delivery of care must therefore be appropriate, inclusive and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth.</p><p>Breast cancer is the most common cancer in the UK, accounting for 15% of all new cancer cases (2017–19) [<span>1</span>]. There are around 56 800 new breast cancer cases in the UK every year (2017–19) [<span>1</span>]. Of these, 9% occur in women at or under 44 years of age [<span>1</span>]. Survival rates have improved significantly in recent decades. In women diagnosed under the age of 39 years, 85% are alive more than 5 years after their diagnosis [<span>1</span>] leading many women to now consider pregnancy as an option after cancer.</p><p>A new breast cancer diagnosis complicates about 1 in 3000 pregnancies [<span>2</span>]. With advancing maternal age at pregnancy [<span>3</span>] it is likely that the incidence of breast cancer during pregnancy will increase.</p><p>Clinical care of people who are pregnant with breast cancer should follow the principles of care for all pregnant women with medical disorders: the clinician's duty of care is first towards the woman and then to the fetus. This principle was outlined in the 2021 MBRRACE report which states that clinicians should ‘Treat women who may become pregnant, are pregnant, or who have recently been pregnant the same as a non-pregnant person unless there is a very clear reason not to’ [<span>4</span>]. For pregnant women with breast cancer a care plan should first be established by surgeons and oncologists, as if the woman was not pregnant. This plan can then be adapted with a multidisciplinary team (MDT) that should also include obstetricians, fetal and neonatal specialists. This team should balance potential treatment for the woman and her fetus with potential compromise for pregnancy outcome. These treatment options must be discussed with the woman.</p><p>As breast cancer during pregnancy is relatively rare and heterogeneous in its presentation, recommendations for care are guided by international registries rather than clinical trials. Treatment decisions are therefore limited to the best available evidence, which is often not definitive. In the absence of evidence of harm or safety in pregn","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 12","pages":"e194-e228"},"PeriodicalIF":4.3,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18270","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977370","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}
Iona Hindes, Buthaina Ibrahim, Jennifer Jardine, Dominik Zenner, Stamatina Iliodromiti
Objective
To quantify the interplay between socioeconomic and ethnic inequalities in preterm birth rates in England from 2018 to 2021.
Design
A retrospective cohort study using electronic health data.
Setting
English hospitals.
Population
1537 595 women aged 13–55 with a singleton livebirth (April 2018–March 2021) at 24–42 gestational weeks were included.
Methods
Multivariate Poisson regression was used to estimate the rate of preterm birth in each ethnic and deprivation group, adjusted rate ratios between groups, and associations. A post hoc calculation identified the rate of preterm birth for each ethnic group at each level of deprivation.
Main Outcome Measures
Preterm birth (birth at less than 37 gestational weeks).
Results
The rate of preterm birth was 6.30% (95% CI: 6.22–6.37) in women living in the most deprived areas, compared to a rate of 5.05% (95% CI: 4.96–5.14) among women in the least deprived areas. White women had a preterm birth rate of 5.74% (95% CI: 5.70–5.78), whereas South Asian and Black women had higher rates of preterm birth at 6.09% (95% CI: 5.98–6.21) and 5.89% (95% CI: 5.70–6.09), respectively. Deprivation interacted with ethnicity and attenuated the differences in the rate of preterm birth across all ethnicity groups (p < 0.001). In areas of high deprivation, preterm birth rates were similar across ethnicity groups, whereas in the least deprived areas, South Asian and Black women had higher rates.
Conclusion
Deprivation and ethnicity remain key drivers of inequalities in preterm birth. Prevention strategies need to address socioenvironmental and structural determinants of preterm birth in areas of high deprivation and minority ethnicity groups.
{"title":"Inequalities in Preterm Birth in England: A Retrospective National Cohort Study Focusing on Deprivation and Ethnicity, Using Routinely Collected Maternity Hospital Data","authors":"Iona Hindes, Buthaina Ibrahim, Jennifer Jardine, Dominik Zenner, Stamatina Iliodromiti","doi":"10.1111/1471-0528.18331","DOIUrl":"10.1111/1471-0528.18331","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To quantify the interplay between socioeconomic and ethnic inequalities in preterm birth rates in England from 2018 to 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective cohort study using electronic health data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>English hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>1537 595 women aged 13–55 with a singleton livebirth (April 2018–March 2021) at 24–42 gestational weeks were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multivariate Poisson regression was used to estimate the rate of preterm birth in each ethnic and deprivation group, adjusted rate ratios between groups, and associations. A post hoc calculation identified the rate of preterm birth for each ethnic group at each level of deprivation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Preterm birth (birth at less than 37 gestational weeks).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The rate of preterm birth was 6.30% (95% CI: 6.22–6.37) in women living in the most deprived areas, compared to a rate of 5.05% (95% CI: 4.96–5.14) among women in the least deprived areas. White women had a preterm birth rate of 5.74% (95% CI: 5.70–5.78), whereas South Asian and Black women had higher rates of preterm birth at 6.09% (95% CI: 5.98–6.21) and 5.89% (95% CI: 5.70–6.09), respectively. Deprivation interacted with ethnicity and attenuated the differences in the rate of preterm birth across all ethnicity groups (<i>p</i> < 0.001). In areas of high deprivation, preterm birth rates were similar across ethnicity groups, whereas in the least deprived areas, South Asian and Black women had higher rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Deprivation and ethnicity remain key drivers of inequalities in preterm birth. Prevention strategies need to address socioenvironmental and structural determinants of preterm birth in areas of high deprivation and minority ethnicity groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 12","pages":"1866-1874"},"PeriodicalIF":4.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899540","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}
Carol Bugge, Rohna Kearney, Catherine Best, Kirsteen Goodman, Sarkis Manoukian, Lynn Melone, Melanie Dembinsky, Helen Mason, Andrew Elders, Margaret Graham, Wael Agur, Suzanne Breeman, Jane Culverhouse, Lucy Dwyer, Mark Forrest, Karen Guerrero, Christine Hemming, Aethele Khunda, Angela Kucher, Doreen McClurg, John Norrie, Ranee Thakar, Suzanne Hagen
<div> <section> <h3> Objective</h3> <p>To compare long-term clinical and cost-effectiveness of pessary self-management (SM) with clinic-based care (CBC) for pelvic floor-specific quality of life (QoL).</p> </section> <section> <h3> Design</h3> <p>Four-year questionnaire follow-up of trial participants.</p> </section> <section> <h3> Setting</h3> <p>UK pessary clinics.</p> </section> <section> <h3> Sample</h3> <p>Responders at 4 years aged ≥ 18 years at recruitment, using a pessary (except Shelf, Gellhorn or Cube) which had been retained ≥ 2 weeks. Exclusions: limited manual dexterity; cognitive deficit; pregnancy; requiring non-English SM teaching.</p> </section> <section> <h3> Methods</h3> <p>SM group received a 30-min teaching session; information leaflet; 2-week follow-up call; and telephone support. CBC group received routine appointments. Allocation was by remote web-based application, minimised on age, user type (new/existing) and centre with no blinding. Participants were invited to opt into a 4-year follow-up. The primary analysis was intention to treat.</p> </section> <section> <h3> Outcome Measures</h3> <p>The primary outcomes were pelvic floor-specific QoL (PFIQ-7) and incremental net monetary benefit (INB) 4 years post-randomisation. Secondary outcomes included complications and prolapse symptoms.</p> </section> <section> <h3> Results</h3> <p>Of 340 women randomised, 186 (55%) responded at 4 years (86/169 [51%] SM, 100/171 [58%] CBC). There was no statistically significant group difference in PFIQ-7 at 4 years (mean SM 32.9 vs. CBC 31.4, adjusted mean difference [AMD] SM-CBC 4.86, 95% CI −6.41 to 16.12). There was a statistically non-significant lower percentage of pessary complications for SM (SM 17.7% vs. CBC 22.0%, AMD 3.01 CI −0.58 to 6.61). At 4-years, SM was cost-effective (INB £2240). There was one potentially related serious adverse event (SM group).</p> </section> <section> <h3> Conclusions</h3> <p>Pessary self-management is an effective and cost-effective long-term option for women with prolapse.</p> </section> <section> <h3> Trial Registration</h3>
目的：比较盆底自我管理（SM）与临床护理（CBC）对盆底特异性生活质量（QoL）的长期临床和成本效益。设计：对试验参与者进行为期四年的问卷随访。环境：英国必要的诊所。样本：招募时年龄≥18岁的4岁应答者，使用保留≥2周的托具（Shelf、Gellhorn或Cube除外）。排除：有限的手工灵巧性；认知赤字;怀孕;要求非英语SM教学。方法：SM组给予30 min的教学时间；信息传单;2周随访电话；还有电话支持。CBC组接受常规预约。分配是通过远程基于网络的应用程序，最小化年龄，用户类型（新/现有）和中心，没有盲法。参与者被邀请参加为期4年的随访。主要分析是治疗意向。结果测量：主要结果是随机分组后4年盆底特异性生活质量（PFIQ-7）和增量净货币效益（INB）。次要结局包括并发症和脱垂症状。结果：在340名随机分组的女性中，186名（55%）在4年时有反应（86/169 [51%]SM, 100/171 [58%] CBC）。4年PFIQ-7组间差异无统计学意义（SM均值32.9 vs CBC均值31.4，调整后平均差异[AMD] SM-CBC均值4.86,95% CI -6.41 ~ 16.12）。SM的必要并发症发生率较SM低（SM 17.7% vs CBC 22.0%, AMD 3.01 CI -0.58 ~ 6.61），统计学上无显著性差异。在4年的时间里，SM是划算的（2240英镑）。有一个潜在的相关严重不良事件（SM组）。结论：子宫内膜自我管理对脱垂妇女是一种有效且经济的长期选择。试验注册：ISRCTN号：62510577 （https://doi.org/10.1186/ISRCTN62510577）。
{"title":"Four Year Clinical and Cost Effectiveness of Vaginal Pessary Self-Management Versus Clinic-Based Care for Pelvic Organ Prolapse (TOPSY): Long Term Follow-Up of a Randomised Controlled Superiority Trial","authors":"Carol Bugge, Rohna Kearney, Catherine Best, Kirsteen Goodman, Sarkis Manoukian, Lynn Melone, Melanie Dembinsky, Helen Mason, Andrew Elders, Margaret Graham, Wael Agur, Suzanne Breeman, Jane Culverhouse, Lucy Dwyer, Mark Forrest, Karen Guerrero, Christine Hemming, Aethele Khunda, Angela Kucher, Doreen McClurg, John Norrie, Ranee Thakar, Suzanne Hagen","doi":"10.1111/1471-0528.18333","DOIUrl":"10.1111/1471-0528.18333","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare long-term clinical and cost-effectiveness of pessary self-management (SM) with clinic-based care (CBC) for pelvic floor-specific quality of life (QoL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Four-year questionnaire follow-up of trial participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>UK pessary clinics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Responders at 4 years aged ≥ 18 years at recruitment, using a pessary (except Shelf, Gellhorn or Cube) which had been retained ≥ 2 weeks. Exclusions: limited manual dexterity; cognitive deficit; pregnancy; requiring non-English SM teaching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>SM group received a 30-min teaching session; information leaflet; 2-week follow-up call; and telephone support. CBC group received routine appointments. Allocation was by remote web-based application, minimised on age, user type (new/existing) and centre with no blinding. Participants were invited to opt into a 4-year follow-up. The primary analysis was intention to treat.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcome Measures</h3>\u0000 \u0000 <p>The primary outcomes were pelvic floor-specific QoL (PFIQ-7) and incremental net monetary benefit (INB) 4 years post-randomisation. Secondary outcomes included complications and prolapse symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 340 women randomised, 186 (55%) responded at 4 years (86/169 [51%] SM, 100/171 [58%] CBC). There was no statistically significant group difference in PFIQ-7 at 4 years (mean SM 32.9 vs. CBC 31.4, adjusted mean difference [AMD] SM-CBC 4.86, 95% CI −6.41 to 16.12). There was a statistically non-significant lower percentage of pessary complications for SM (SM 17.7% vs. CBC 22.0%, AMD 3.01 CI −0.58 to 6.61). At 4-years, SM was cost-effective (INB £2240). There was one potentially related serious adverse event (SM group).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pessary self-management is an effective and cost-effective long-term option for women with prolapse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 12","pages":"1762-1771"},"PeriodicalIF":4.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884241","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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