{"title":"Author Reply.","authors":"Giovanna Esposito, Matteo Di Maso","doi":"10.1111/1471-0528.70079","DOIUrl":"https://doi.org/10.1111/1471-0528.70079","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490863","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}
{"title":"Selective Serotonin Reuptake Inhibitors in Pregnancy: Perspectives on the Recent FDA Panel Discussion","authors":"Per Damkier, Matitiahu Berkovitch","doi":"10.1111/1471-0528.70087","DOIUrl":"10.1111/1471-0528.70087","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 4","pages":"553-555"},"PeriodicalIF":4.3,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145485753","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}
Rebecca Scott, Amy Downes, Ladina Weitnauer, Rebecca Dobra, Natasha Singh, Rachel Robinson, Emily Diable, Saraha Collins, Elaine Bowman, Thomas Tobin, Andrew Jones, Nicholas Simmonds, Imogen Felton
Objective
A comprehensive review of maternal, obstetric and neonatal outcomes in pregnancies in females with cystic fibrosis (fwCF) following the introduction of Elexacaftor/Tezacaftor/Ivacaftor (ETI) therapy in a novel, dedicated CF-Maternal Health service.
Design
Retrospective data review from a CF-Maternal Health service between September 2020 and February 2025.
Setting
A large adult-CF service in London, UK.
Population or Sample
Pregnant fwCF attending the Royal Brompton Hospital CF Service.
Methods
Review of CF-Maternal Health service data.
Main Outcome Measures
Maternal, obstetric and neonatal outcomes.
Results
Fifty-three fwCF completed 67 pregnancies, with 69 infants born. There were no stillbirths, neonatal or maternal deaths. ETI-therapy was reported in 81% of pregnancies. In fwCF without CF-Diabetes, 57% developed gestational diabetes. Hospital admission to treat an infective pulmonary exacerbation was required in 31% of pregnancies. Forty-five percent of pregnancies delivered vaginally; 78% of babies were born at term. A major congenital abnormality was diagnosed in 4% of infants. Baseline lung-function correlated positively with birth-weight and gestation at birth.
Conclusions
FwCF have improved maternal, obstetric and neonatal outcomes since the introduction of ETI-therapy, within a dedicated CF-Maternal Health service.
{"title":"Obstetric and Neonatal Outcomes in Pregnancies From a Dedicated Cystic Fibrosis-Maternal Health Service: A Retrospective Study","authors":"Rebecca Scott, Amy Downes, Ladina Weitnauer, Rebecca Dobra, Natasha Singh, Rachel Robinson, Emily Diable, Saraha Collins, Elaine Bowman, Thomas Tobin, Andrew Jones, Nicholas Simmonds, Imogen Felton","doi":"10.1111/1471-0528.70075","DOIUrl":"10.1111/1471-0528.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>A comprehensive review of maternal, obstetric and neonatal outcomes in pregnancies in females with cystic fibrosis (fwCF) following the introduction of Elexacaftor/Tezacaftor/Ivacaftor (ETI) therapy in a novel, dedicated CF-Maternal Health service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective data review from a CF-Maternal Health service between September 2020 and February 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A large adult-CF service in London, UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>Pregnant fwCF attending the Royal Brompton Hospital CF Service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Review of CF-Maternal Health service data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Maternal, obstetric and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-three fwCF completed 67 pregnancies, with 69 infants born. There were no stillbirths, neonatal or maternal deaths. ETI-therapy was reported in 81% of pregnancies. In fwCF without CF-Diabetes, 57% developed gestational diabetes. Hospital admission to treat an infective pulmonary exacerbation was required in 31% of pregnancies. Forty-five percent of pregnancies delivered vaginally; 78% of babies were born at term. A major congenital abnormality was diagnosed in 4% of infants. Baseline lung-function correlated positively with birth-weight and gestation at birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FwCF have improved maternal, obstetric and neonatal outcomes since the introduction of ETI-therapy, within a dedicated CF-Maternal Health service.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 4","pages":"690-697"},"PeriodicalIF":4.3,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477746","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}
Fati Kirakoya-Samadoulougou, Joyeuse Ukwishaka, Calypse Ngwasiri, Seema Subedi, Elizabeth A. Hazel, Daniel J. Erchick, Lee Shu Fune Wu, Carlos Grandi, Carl Lachat, Laéticia Céline Toe, Dominique Roberfroid, Lieven Huybregts, Alain B. Labrique, Mabhubur Rashid, Saijuddin Shaikh, Rezwanul Haque, Abdullah H. Baqui, Samir K. Saha, Rasheda Khanam, Sayedur Rahman, Md Mariângela F. Silveira, Romina Buffarini, Roger L. Shapiro, Rebecca Zash, Zhonghai Zhu, Lingxia Zeng, Xiu Qiu, Jianrong He, Seifu H. Gebreyesus, Kokeb Tesfamariam, Grace Chan, Delayehu Bekele, Seth Adu-Afarwuah, Kathryn G. Dewey, Stephaney Gyaase, Blair J. Wylie, Sunita Taneja, Ranadip Chowdhury, Giridhara R. Babu, R. Deepa, Mohamed Rishard, Marzia Lazzerini, Maria J. Rodriguez-Sibaja, Sandra Acevedo-Gallegos, Per Ashorn, Kenneth Maleta, Luke C. Mullany, Fyezah Jehan, Muhammad Ilyas, Stephen J. Rogerson, Holger W. Unger, Rakesh Ghosh, Sabine Musange, Aroonsri Mongkolchati, Paniya Keentupthai, Wafaie Fawzi, Dongqing Wang, Christentze Schmiegelow, Daniel Minja, Line Hjort, John P. A. Lusingu, Emily R. Smith, Honorati Masanja, Fathma Mohamed Kabole, Salim Nassir Slim, Abel Kakuru, Richard Kajubi, Dilys Walker, Peter Waiswa, Vundli Ramokolo, Wanga Zembe-Mkabile, Katherine Semrau, Davidson H. Hamer, R. Matthew Chico, Enesia Banda Chaponda, Albert Manasyan, Jake M. Pry, Kebby Musokotwane, Bowen Banda, Andrew Prendergast, Bernard Chasekwa, Joanne Katz, Anne C. C. Lee, Robert E. Black, Subnational Collaborative Group for Vulnerable Newborn Prevalence
<div> <section> <h3> Objective</h3> <p>To examine the prevalence of large-for-gestational age (LGA) and macrosomia in 23 countries between 2000 and 2021.</p> </section> <section> <h3> Design</h3> <p>Descriptive multi-country secondary data analysis.</p> </section> <section> <h3> Setting</h3> <p>Subnational, population-based cohort studies (<i>k</i> = 45 for LGA, <i>k</i> = 25 for macrosomia) in 23 low- and middle-income countries (LMICs).</p> </section> <section> <h3> Population</h3> <p>Liveborn infants.</p> </section> <section> <h3> Methods</h3> <p>We conducted a secondary analysis of individual-level data from the Vulnerable Newborn Measurement Collaboration, using INTERGROWTH-21st standards to define LGA (> 90th centile for gestational age and sex) and macrosomia (≥ 4000 g, regardless of gestational age). We included LMIC population-based datasets with reliable gestational age and birthweight data, excluding studies with small sample sizes, high missing data, or implausible measurements. Prevalence estimates were stratified by region, study period and gestational age, and results were summarised as medians and interquartile ranges (IQR).</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Prevalence of LGA and macrosomia.</p> </section> <section> <h3> Results</h3> <p>Among 476 939 live births, the median prevalence of LGA was 5.1% (IQR: 2.9%–9.6%) and was highest in Latin America and the Caribbean at 9.6% (4 studies, IQR: 2.7%–16.1%) and lowest in South Asia at 2.7% (13 studies, IQR: 2.3%–3.7%). Over time, the median LGA prevalence increased from 4.9% (12 studies; IQR: 4.1%–7.9%) during the period from 2000 to 2010 to 5.9% (33 studies, IQR: 2.7%–11.2%) from 2011 to 2021. Term LGA was more common at 3.2% (0.9–5.1) than preterm or post-term LGA. Among 313 064 live births, the median prevalence of macrosomia was 1.3% (<i>n</i> = 313 064, IQR: 0.2%–2.4%), which was highest in Latin America and the Caribbean (4 studies, 3.1%, IQR: 0.7%–6.8%) and lowest in South Asia (8 studies, 0.1%, IQR: 0.0%–0.7%). The median prevalence remained stable over time: 1.1% (8 studies, IQR: 0.2%–3.1%) in older studies (2000–2010) and 1.3% (17 studies, IQR: 0.5%–2.4%) in more recent studies (2011–2021). Term macrosomia was more common at 1.2% (0.2–2.0) than pre
研究2000年至2021年期间23个国家大胎龄儿（LGA）和巨大儿的患病率。
{"title":"Prevalence of Large-for-Gestational Age and Macrosomia Among Livebirths in 23 Low- and Middle-Income Countries Between 2000 and 2021: An Individual Participant Data Analysis","authors":"Fati Kirakoya-Samadoulougou, Joyeuse Ukwishaka, Calypse Ngwasiri, Seema Subedi, Elizabeth A. Hazel, Daniel J. Erchick, Lee Shu Fune Wu, Carlos Grandi, Carl Lachat, Laéticia Céline Toe, Dominique Roberfroid, Lieven Huybregts, Alain B. Labrique, Mabhubur Rashid, Saijuddin Shaikh, Rezwanul Haque, Abdullah H. Baqui, Samir K. Saha, Rasheda Khanam, Sayedur Rahman, Md Mariângela F. Silveira, Romina Buffarini, Roger L. Shapiro, Rebecca Zash, Zhonghai Zhu, Lingxia Zeng, Xiu Qiu, Jianrong He, Seifu H. Gebreyesus, Kokeb Tesfamariam, Grace Chan, Delayehu Bekele, Seth Adu-Afarwuah, Kathryn G. Dewey, Stephaney Gyaase, Blair J. Wylie, Sunita Taneja, Ranadip Chowdhury, Giridhara R. Babu, R. Deepa, Mohamed Rishard, Marzia Lazzerini, Maria J. Rodriguez-Sibaja, Sandra Acevedo-Gallegos, Per Ashorn, Kenneth Maleta, Luke C. Mullany, Fyezah Jehan, Muhammad Ilyas, Stephen J. Rogerson, Holger W. Unger, Rakesh Ghosh, Sabine Musange, Aroonsri Mongkolchati, Paniya Keentupthai, Wafaie Fawzi, Dongqing Wang, Christentze Schmiegelow, Daniel Minja, Line Hjort, John P. A. Lusingu, Emily R. Smith, Honorati Masanja, Fathma Mohamed Kabole, Salim Nassir Slim, Abel Kakuru, Richard Kajubi, Dilys Walker, Peter Waiswa, Vundli Ramokolo, Wanga Zembe-Mkabile, Katherine Semrau, Davidson H. Hamer, R. Matthew Chico, Enesia Banda Chaponda, Albert Manasyan, Jake M. Pry, Kebby Musokotwane, Bowen Banda, Andrew Prendergast, Bernard Chasekwa, Joanne Katz, Anne C. C. Lee, Robert E. Black, Subnational Collaborative Group for Vulnerable Newborn Prevalence","doi":"10.1111/1471-0528.70044","DOIUrl":"10.1111/1471-0528.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the prevalence of large-for-gestational age (LGA) and macrosomia in 23 countries between 2000 and 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Descriptive multi-country secondary data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Subnational, population-based cohort studies (<i>k</i> = 45 for LGA, <i>k</i> = 25 for macrosomia) in 23 low- and middle-income countries (LMICs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Liveborn infants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a secondary analysis of individual-level data from the Vulnerable Newborn Measurement Collaboration, using INTERGROWTH-21st standards to define LGA (> 90th centile for gestational age and sex) and macrosomia (≥ 4000 g, regardless of gestational age). We included LMIC population-based datasets with reliable gestational age and birthweight data, excluding studies with small sample sizes, high missing data, or implausible measurements. Prevalence estimates were stratified by region, study period and gestational age, and results were summarised as medians and interquartile ranges (IQR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Prevalence of LGA and macrosomia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 476 939 live births, the median prevalence of LGA was 5.1% (IQR: 2.9%–9.6%) and was highest in Latin America and the Caribbean at 9.6% (4 studies, IQR: 2.7%–16.1%) and lowest in South Asia at 2.7% (13 studies, IQR: 2.3%–3.7%). Over time, the median LGA prevalence increased from 4.9% (12 studies; IQR: 4.1%–7.9%) during the period from 2000 to 2010 to 5.9% (33 studies, IQR: 2.7%–11.2%) from 2011 to 2021. Term LGA was more common at 3.2% (0.9–5.1) than preterm or post-term LGA. Among 313 064 live births, the median prevalence of macrosomia was 1.3% (<i>n</i> = 313 064, IQR: 0.2%–2.4%), which was highest in Latin America and the Caribbean (4 studies, 3.1%, IQR: 0.7%–6.8%) and lowest in South Asia (8 studies, 0.1%, IQR: 0.0%–0.7%). The median prevalence remained stable over time: 1.1% (8 studies, IQR: 0.2%–3.1%) in older studies (2000–2010) and 1.3% (17 studies, IQR: 0.5%–2.4%) in more recent studies (2011–2021). Term macrosomia was more common at 1.2% (0.2–2.0) than pre","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 S8","pages":"S97-S108"},"PeriodicalIF":4.3,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145485722","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}
Felix Neis, Bernhard Kraemer, Armin Bauer, Tjeerd Dijkstra, Sabine Matovina, Annika Rohner, Sara Y. Brucker
<div> <section> <h3> Objective</h3> <p>To evaluate early recovery outcomes with transcervical fibroid ablation (TFA) compared to minimally invasive myomectomy (MIM) in women with symptomatic uterine fibroids.</p> </section> <section> <h3> Design</h3> <p>Randomised controlled trial.</p> </section> <section> <h3> Setting</h3> <p>Tübingen University Hospital (Tübingen, Germany).</p> </section> <section> <h3> Sample</h3> <p>Premenopausal women aged 18–50 years with symptomatic uterine fibroids.</p> </section> <section> <h3> Methods</h3> <p>Participants were randomised to undergo TFA or MIM. The MIM group underwent laparoscopic myomectomy with concurrent hysteroscopic myomectomy if submucosal fibroids were present.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>The primary endpoint was the time to return to normal activities. Secondary outcomes included procedure time, postprocedural pain, hospital discharge readiness, time to return to 10 additional activities of daily living, and adverse events. Clinical outcomes through 7 weeks of follow-up were reported. The primary endpoint was evaluated at <i>p</i> < 0.028 due to a pre-planned interim analysis; secondary outcomes were evaluated at <i>p</i> < 0.05.</p> </section> <section> <h3> Results</h3> <p>Among 144 randomised patients, 119 provided follow-up data (58 TFA; 61 MIM). The primary endpoint was met with the median time to return to normal activities favouring TFA (5.5 vs. 13 days; log-rank <i>p</i> < 0.001). Procedure time (51 ± 21 vs. 95 ± 37 min; <i>p</i> < 0.001), postprocedural pain through discharge (all <i>p</i> < 0.01), opioid utilisation (25.9% vs. 49.2%, <i>p</i> = 0.009), and time to discharge readiness (22.9 ± 13.2 vs. 58.9 ± 33.1 h; <i>p</i> < 0.001) favoured TFA. Nine of 10 treatment recovery metrics statistically favoured TFA with none favouring MIM. One serious adverse event occurred in a patient treated with MIM (diagnostic laparoscopy for postoperative bleeding).</p> </section> <section> <h3> Conclusions</h3> <p>TFA offers a faster recovery than MIM for the treatment of symptomatic uterine fibroids, with a comparable short-term safety profile.</p>
{"title":"Recovery After Transcervical Fibroid Ablation Versus Minimally Invasive Myomectomy for Symptomatic Uterine Fibroids: A Randomised Controlled Trial","authors":"Felix Neis, Bernhard Kraemer, Armin Bauer, Tjeerd Dijkstra, Sabine Matovina, Annika Rohner, Sara Y. Brucker","doi":"10.1111/1471-0528.70081","DOIUrl":"10.1111/1471-0528.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate early recovery outcomes with transcervical fibroid ablation (TFA) compared to minimally invasive myomectomy (MIM) in women with symptomatic uterine fibroids.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Randomised controlled trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Tübingen University Hospital (Tübingen, Germany).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Premenopausal women aged 18–50 years with symptomatic uterine fibroids.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were randomised to undergo TFA or MIM. The MIM group underwent laparoscopic myomectomy with concurrent hysteroscopic myomectomy if submucosal fibroids were present.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The primary endpoint was the time to return to normal activities. Secondary outcomes included procedure time, postprocedural pain, hospital discharge readiness, time to return to 10 additional activities of daily living, and adverse events. Clinical outcomes through 7 weeks of follow-up were reported. The primary endpoint was evaluated at <i>p</i> < 0.028 due to a pre-planned interim analysis; secondary outcomes were evaluated at <i>p</i> < 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 144 randomised patients, 119 provided follow-up data (58 TFA; 61 MIM). The primary endpoint was met with the median time to return to normal activities favouring TFA (5.5 vs. 13 days; log-rank <i>p</i> < 0.001). Procedure time (51 ± 21 vs. 95 ± 37 min; <i>p</i> < 0.001), postprocedural pain through discharge (all <i>p</i> < 0.01), opioid utilisation (25.9% vs. 49.2%, <i>p</i> = 0.009), and time to discharge readiness (22.9 ± 13.2 vs. 58.9 ± 33.1 h; <i>p</i> < 0.001) favoured TFA. Nine of 10 treatment recovery metrics statistically favoured TFA with none favouring MIM. One serious adverse event occurred in a patient treated with MIM (diagnostic laparoscopy for postoperative bleeding).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TFA offers a faster recovery than MIM for the treatment of symptomatic uterine fibroids, with a comparable short-term safety profile.</p>\u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 4","pages":"618-625"},"PeriodicalIF":4.3,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477748","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}
Johnson, K., Elvander, C., Johansson, K., Saltvedt, S. and Edqvist, M. (2025), Medical Interventions and Women's Perceptions of Respectful Intrapartum Care: A National Survey-Based Cohort Study. BJOG, 132: 1844–1855. https://doi.org/10.1111/1471-0528.18329.
In the Ethics statement, the reference number for the amendment concerning this specific study was incorrect. This should have read: The study was approved by the Swedish Ethical Review Authority at Karolinska no 2020-02500 on 10 October 2020, and amendment 2021-06055-02 on 4 January 2021.
{"title":"Correction to ‘Medical Interventions and Women's Perceptions of Respectful Intrapartum Care: A National Survey-Based Cohort Study’","authors":"","doi":"10.1111/1471-0528.70082","DOIUrl":"10.1111/1471-0528.70082","url":null,"abstract":"<p>Johnson, K., Elvander, C., Johansson, K., Saltvedt, S. and Edqvist, M. (2025), Medical Interventions and Women's Perceptions of Respectful Intrapartum Care: A National Survey-Based Cohort Study. <i>BJOG</i>, 132: 1844–1855. https://doi.org/10.1111/1471-0528.18329.</p><p>In the Ethics statement, the reference number for the amendment concerning this specific study was incorrect. This should have read: The study was approved by the Swedish Ethical Review Authority at Karolinska no 2020-02500 on 10 October 2020, and <b>amendment 2021-06055-02</b> on 4 January 2021.</p><p>We apologize for this error.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145455106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Cornthwaite, R. Bahl, C. Winter, A. Wright, J. Kingdom, K. F. Walker, G. Tydeman, A. Briley, M. Schmidt-Hansen, J. W. van der Scheer, T. Draycott, the Royal College of Obstetricians and Gynaecologists
<p>Impacted fetal head (IFH) at caesarean birth (CB) is an unpredictable and challenging obstetric emergency [<span>2-4</span>]. There is no clear, consensus definition for IFH in the published literature. This can lead to variable recognition and documentation of IFH, with an associated risk of bias in research comparing techniques. Regarding definition, most obstetricians responding to two national surveys on IFH at CB would use ‘the need for additional manoeuvres’ as a diagnostic criterion [<span>5, 6</span>]. IFH can therefore be described as: ‘a caesarean birth where the obstetrician is unable to deliver the fetal head with their usual delivering hand, and additional manoeuvres and/or tocolysis are required to disimpact and deliver the head’.</p><p>This guidance is for healthcare professionals who care for women, non-binary and trans people. 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>IFH and related complications are being encountered more frequently by healthcare professionals [<span>2, 7, 8</span>]. Recent single-centre and national UK studies estimate that IFH may complicate as many as one in 10 unplanned caesarean births (1.5% of all births) [<span>2, 7</span>] and 16% to 32% of second-stage CS births [<span>2, 9</span>]. The apparent rise in cases of IFH may, in part, be explained by an increasing rate of caesarean births [<span>10</span>] and a rise in CB at full cervical dilatation [<span>11, 12</span>].</p><p>Worldwide, it is estimated that 21% of women give birth by CB, with rates closer to 30% in more developed countries [<span>13</span>]. At least 5% of these caesarean births occur at full cervical dilatation [<span>2, 11, 12, 14</span>]. Reduced skill and confidence in the use of rotational and mid-cavity forceps births and a more general decline in assisted vaginal birth, have been proposed as contributory factors [<span>15-17</span>]. Increased use of regional analgesia and rising rates of maternal obesity may also exacerbate the problem [<span>18</span>]. However, IFH is not limited to CB at full cervical dilatation and there is emerging evidence that obstetricians may frequently encounter IFH at CB performed before full cervical dilatation [<span>2</span>].</p><p>IFH is a more heterogeneous condition than previously considered [<span>2, 7</span>]. Until recently, most research characterising the risk factors for IFH at CB, have used second-stage CB as a surrogate for IFH [<span>18-20</span>]. Approximately 1 in 3 CB at full cervical dilatation may be complicated
{"title":"Management of Impacted Fetal Head at Caesarean Birth (2025 Second Edition)","authors":"K. Cornthwaite, R. Bahl, C. Winter, A. Wright, J. Kingdom, K. F. Walker, G. Tydeman, A. Briley, M. Schmidt-Hansen, J. W. van der Scheer, T. Draycott, the Royal College of Obstetricians and Gynaecologists","doi":"10.1111/1471-0528.70008","DOIUrl":"10.1111/1471-0528.70008","url":null,"abstract":"<p>Impacted fetal head (IFH) at caesarean birth (CB) is an unpredictable and challenging obstetric emergency [<span>2-4</span>]. There is no clear, consensus definition for IFH in the published literature. This can lead to variable recognition and documentation of IFH, with an associated risk of bias in research comparing techniques. Regarding definition, most obstetricians responding to two national surveys on IFH at CB would use ‘the need for additional manoeuvres’ as a diagnostic criterion [<span>5, 6</span>]. IFH can therefore be described as: ‘a caesarean birth where the obstetrician is unable to deliver the fetal head with their usual delivering hand, and additional manoeuvres and/or tocolysis are required to disimpact and deliver the head’.</p><p>This guidance is for healthcare professionals who care for women, non-binary and trans people. 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>IFH and related complications are being encountered more frequently by healthcare professionals [<span>2, 7, 8</span>]. Recent single-centre and national UK studies estimate that IFH may complicate as many as one in 10 unplanned caesarean births (1.5% of all births) [<span>2, 7</span>] and 16% to 32% of second-stage CS births [<span>2, 9</span>]. The apparent rise in cases of IFH may, in part, be explained by an increasing rate of caesarean births [<span>10</span>] and a rise in CB at full cervical dilatation [<span>11, 12</span>].</p><p>Worldwide, it is estimated that 21% of women give birth by CB, with rates closer to 30% in more developed countries [<span>13</span>]. At least 5% of these caesarean births occur at full cervical dilatation [<span>2, 11, 12, 14</span>]. Reduced skill and confidence in the use of rotational and mid-cavity forceps births and a more general decline in assisted vaginal birth, have been proposed as contributory factors [<span>15-17</span>]. Increased use of regional analgesia and rising rates of maternal obesity may also exacerbate the problem [<span>18</span>]. However, IFH is not limited to CB at full cervical dilatation and there is emerging evidence that obstetricians may frequently encounter IFH at CB performed before full cervical dilatation [<span>2</span>].</p><p>IFH is a more heterogeneous condition than previously considered [<span>2, 7</span>]. Until recently, most research characterising the risk factors for IFH at CB, have used second-stage CB as a surrogate for IFH [<span>18-20</span>]. Approximately 1 in 3 CB at full cervical dilatation may be complicated","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 4","pages":"e18-e44"},"PeriodicalIF":4.3,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145448375","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}
Samuel J. Perry, Donal Griffin, Eleanor V. Williams, Tracy E. Roberts, Fong Lien Kwong, Sarah Williams, Jon Deeks, Katie Scandrett, Ridhi Agarwal, Sudha S. Sundar, Mark Monahan
<div> <section> <h3> Objective</h3> <p>To assess the costs and consequences of seven diagnostic strategies for ovarian cancer in pre- and post-menopausal women with symptoms in secondary care.</p> </section> <section> <h3> Design</h3> <p>Economic evaluation alongside a prospective single-arm diagnostic accuracy study.</p> </section> <section> <h3> Setting</h3> <p>NHS secondary care outpatients (2-week referrals, clinics, GP referrals, cross-specialty referrals) and inpatients (emergency presentations to secondary care).</p> </section> <section> <h3> Sample</h3> <p>Two cohorts of 857 pre-menopausal and 1242 post-menopausal women newly presenting to secondary care with symptoms of suspected ovarian cancer.</p> </section> <section> <h3> Methods</h3> <p>A model-based cost-consequence analysis (CCA) was conducted using a decision tree simulating patient pathways over 12 months. Diagnostic accuracy data were sourced from the ROCkeTS study and supplemented by literature.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Cancer deaths, correct diagnosis proportion, and diagnostic yield.</p> </section> <section> <h3> Results</h3> <p>No diagnostic strategy was optimal across all outcomes. Across both cohorts, the Risk of Malignancy Index (RMI) 200 was least expensive but had poor cancer death and diagnostic yield outcomes. The ADNEX 3% strategy had the highest diagnostic yield and lowest cancer mortality but was the most expensive. For pre-menopausal women, the IOTA ADNEX 10% strategy outperformed ORADS, ROMA, and CA125 in cost and outcomes. For post-menopausal women, the high cancer prevalence required a trade-off. In sensitivity analysis, a two-step IOTA ADNEX 10% strategy outperformed ORADS, ROMA, and CA125 across all three outcomes, making the strategy a more balanced choice in both cohorts.</p> </section> <section> <h3> Conclusion</h3> <p>At 12 months, no single diagnostic strategy was superior. Early diagnosis requires balancing cancer mortality, diagnostic yield, and cost. The IOTA ADNEX two-step strategy at a 10% threshold provided the best trade-off across these factors and is recommended for practice.</p> </section>
{"title":"A Cost Consequence Analysis of Seven Diagnostic Strategies for Ovarian Cancer: A Model-Based Economic Evaluation","authors":"Samuel J. Perry, Donal Griffin, Eleanor V. Williams, Tracy E. Roberts, Fong Lien Kwong, Sarah Williams, Jon Deeks, Katie Scandrett, Ridhi Agarwal, Sudha S. Sundar, Mark Monahan","doi":"10.1111/1471-0528.70074","DOIUrl":"10.1111/1471-0528.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the costs and consequences of seven diagnostic strategies for ovarian cancer in pre- and post-menopausal women with symptoms in secondary care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Economic evaluation alongside a prospective single-arm diagnostic accuracy study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>NHS secondary care outpatients (2-week referrals, clinics, GP referrals, cross-specialty referrals) and inpatients (emergency presentations to secondary care).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Two cohorts of 857 pre-menopausal and 1242 post-menopausal women newly presenting to secondary care with symptoms of suspected ovarian cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A model-based cost-consequence analysis (CCA) was conducted using a decision tree simulating patient pathways over 12 months. Diagnostic accuracy data were sourced from the ROCkeTS study and supplemented by literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Cancer deaths, correct diagnosis proportion, and diagnostic yield.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No diagnostic strategy was optimal across all outcomes. Across both cohorts, the Risk of Malignancy Index (RMI) 200 was least expensive but had poor cancer death and diagnostic yield outcomes. The ADNEX 3% strategy had the highest diagnostic yield and lowest cancer mortality but was the most expensive. For pre-menopausal women, the IOTA ADNEX 10% strategy outperformed ORADS, ROMA, and CA125 in cost and outcomes. For post-menopausal women, the high cancer prevalence required a trade-off. In sensitivity analysis, a two-step IOTA ADNEX 10% strategy outperformed ORADS, ROMA, and CA125 across all three outcomes, making the strategy a more balanced choice in both cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>At 12 months, no single diagnostic strategy was superior. Early diagnosis requires balancing cancer mortality, diagnostic yield, and cost. The IOTA ADNEX two-step strategy at a 10% threshold provided the best trade-off across these factors and is recommended for practice.</p>\u0000 </section>\u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 4","pages":"680-689"},"PeriodicalIF":4.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447171","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}
Genevieve M. Dietrich, Adrielle P. Souza Lira, Eman Ramadan, Adewumi Adanlawo, Ernesto A. Figueiro-Filho
<p>Pre-eclampsia and placental dysfunction are characterised by an imbalance of angiogenic factors: maternal placental growth factor (PlGF) concentrations decline early and the antiangiogenic soluble fms-like tyrosine kinase1 (sFlt1) rises later [<span>1, 2</span>]. In a case–control study, women who subsequently developed pre-eclampsia had significantly lower PlGF levels from as early as 13–16 weeks of gestation (mean 90 pg/mL vs. 142 pg/mL in controls, <i>p</i> = 0.01) [<span>2</span>]. Increased levels of sFlt1 preceded clinical disease by approximately 5 weeks [<span>2</span>]. Therefore, depressed PlGF occurs first, followed by a subsequent sFlt1 rise. Relying solely on the sFlt1/PlGF ratio may miss early placental dysfunction [<span>2</span>]. Large prospective cohorts have shown that PlGF measured at 14–16 and 18–20 weeks is about half that of controls in pregnancies destined to deliver < 34 weeks with pre-eclampsia or foetal growth restriction [<span>1</span>]. A recent review emphasised that PlGF and sFlt1 are ‘powerful new tools to guide obstetric and medical care’ [<span>3</span>]. Our group recently implemented PlGF testing across 12–36 weeks in a tertiary Western Canadian centre and reported high negative predictive values (> 90%) for pre-eclampsia and preterm birth [<span>4</span>]. However, there remains limited evidence focusing specifically on the early second trimester in high-risk populations such as those with a high prevalence of diabetes. We therefore aimed to evaluate maternal PlGF at 12 + 0–20 + 6 weeks' gestation in relation to pre-eclampsia, preterm birth and low birthweight, using gestational age adjusted centiles rather than fixed thresholds.</p><p>This retrospective cohort study was conducted at the Fetal Assessment Unit of the Regina General Hospital, Regina, Saskatchewan, Canada. Institutional ethics approval was obtained (REB #Bio3702). The cohort comprised all pregnant individuals who underwent PlGF testing between December 2021 and September 2025 at 12 + 0–20 + 6 weeks' gestation and subsequently delivered during the study period. PlGF measurements were converted to gestational age-specific centiles using published reference ranges [<span>5</span>]. Low PlGF was defined as < 10th centile and normal as ≥ 10th centile. Maternal characteristics (age, BMI, diabetes status), indications for testing, and outcomes were extracted from electronic records. BMI was categorised using WHO cutoffs: normal weight 18.5–24.9 kg/m<sup>2</sup>; overweight 25.0–29.9; obese I 30.0–34.9; obese II 35.0–39.9; obese III ≥ 40. Diabetes status (no diabetes, gestational diabetes [GDM], Type 1 DM or Type 2 DM) was recorded at the patient's first visit.</p><p>Outcomes were: (1) pre-eclampsia (diagnosis recorded in the medical record), (2) preterm birth (PTB) < 37 weeks, and (3) low birthweight < 2500 g. Birthweight was also analysed as a continuous variable. Odds ratios (OR) with 95% confidence intervals (CI) were computed comp
先兆子痫和胎盘功能障碍的特点是血管生成因子失衡：母体胎盘生长因子（PlGF）浓度早期下降，抗血管生成的可溶性膜样酪氨酸激酶（sFlt1）较晚升高[1,2]。在一项病例对照研究中，随后发生先兆子痫的妇女早在妊娠13-16周时PlGF水平就显著降低（平均90 pg/mL vs.对照组142 pg/mL， p = 0.01）。sFlt1水平升高在临床疾病发生前约5周。因此，PlGF首先下降，随后sFlt1升高。单纯依靠sFlt1/PlGF比值可能会错过早期胎盘功能障碍[2]。大型前瞻性队列研究表明，在14-16周和18-20周的妊娠中，伴有先兆子痫或胎儿生长受限的妊娠34周的PlGF约为对照组的一半。最近的一项审查强调，PlGF和sfl1是“指导产科和医疗保健的有力新工具”。我们的团队最近在加拿大西部的一个三级中心实施了12-36周的PlGF测试，并报告了对先兆子痫和早产婴儿的高阴性预测值（> 90%）。然而，针对高危人群（如糖尿病高发人群）妊娠中期早期的证据仍然有限。因此，我们的目的是评估母体PlGF在妊娠12 + 0-20 + 6周与先兆子痫、早产和低出生体重的关系，使用胎龄调整百分位数而不是固定阈值。这项回顾性队列研究是在加拿大萨斯喀彻温省里贾纳里贾纳总医院胎儿评估科进行的。已获得机构伦理批准（REB #Bio3702）。该队列包括2021年12月至2025年9月期间在妊娠12 + 0-20 + 6周期间接受PlGF检测并随后在研究期间分娩的所有孕妇。使用公布的参考范围[5]将PlGF测量值转换为妊娠年龄特异性百分位数。低PlGF定义为<； 10百分位，正常定义为≥10百分位。从电子记录中提取产妇特征（年龄、BMI、糖尿病状况）、检测适应症和结果。BMI采用WHO标准进行分类：正常体重18.5-24.9 kg/m2；超重25.0 - -29.9;肥胖I 30.0-34.9；肥胖型35.0 ~ 39.9；肥胖III≥40。患者首次就诊时记录糖尿病状况（无糖尿病、妊娠期糖尿病、1型糖尿病或2型糖尿病）。结果是：(1)先兆子痫（诊断记录在医疗记录中），(2)早产（PTB） 37周，(3)低出生体重（2500g）。出生体重也作为一个连续变量进行分析。使用二元结果的Fisher精确检验和连续变量的Student t检验，计算低PlGF与正常PlGF的比值比（OR）和95%置信区间（CI）。计算每个结果的诊断指标——敏感性(S)、特异性(E)、阳性预测值（PPV）、阴性预测值（NPV）和准确性。缺失的结果数据被视为负面事件。使用GraphPad Prism（10.6版）进行分析。在研究窗口12 + 0-20 + 6周的174例受试者中，10例因胎儿早亡或终止妊娠而被排除，6例因缺乏分娩信息而被排除，1例因其他数据缺失而被排除（图1）。共有157名参与者进行分析：46名PlGF低（第10百分位数），111名PlGF正常（≥第10百分位数）（图1）。平均胎龄17.2±2.5周。产妇年龄组间差异无统计学意义（31.8±5.2岁∶32.1±5.7岁，p = 0.78）。BMI指数为76/157，表1给出了基于世卫组织指南的分类。记录所有病例的糖尿病状况。低PlGF组包括24例无糖尿病患者，6例合并GDM， 14例合并2型糖尿病，2例合并1型糖尿病。正常PlGF组包括53例无糖尿病患者，29例合并GDM， 25例合并2型糖尿病，4例合并1型糖尿病。低PlGF妊娠发生先兆子痫的比例为14/46(30.4%)，正常PlGF妊娠发生先兆子痫的比例为15/111 (13.5%)（OR 2.80, 95% CI 1.21-6.38; p = 0.02）。低PlGF妊娠组早产率为23/46(50.0%)，而正常组为24/111 (21.6%)（OR 3.63, 95% CI 1.69-7.44; p = < 0.01）。低PlGF妊娠的9/41（22.0%）与正常组的10/87（11.5%）相比记录了低出生体重2500 g （OR 2.17, 95% CI 0.84-5.42; p = 0.18）。低PlGF组平均出生体重2977.4±743.1 g，正常PlGF组平均出生体重3200.8±690.3 g （p = 0.10）。表2总结了诊断性能。正常PlGF对子痫前期的阴性预测值为86.5%，对出生体重2500 g的阴性预测值为88.5%，对孕37周PTB的阴性预测值为78.4%。 本研究证实，妊娠12 + 0-20 + 6周的低PlGF与先兆子痫和早产有关。低PlGF妊娠组的先兆子痫发生率为30%，而正常组为14% （OR 2.80）。子痫前期正常PlGF的NPV为86.5%。低PlGF妊娠中早产（37周）的发生率为50%，而正常组为22% （OR 3.63）。正常PlGF早产儿NPV为78.4%。这些发现与显示早期PlGF[1]下降的机制研究相一致，并与来自大型前瞻性队列的证据相一致，其中14-20周的中位PlGF是早期子痫前期[1]的对照组的一半。正常的PlGF结果显示出较高的阴性预测值，表明妊娠中期早期PlGF检测可以使临床医生和患者对不良后果的可能性放心。虽然低PlGF与出生体重（2500 g）之间没有统计学上的显著关联，但低PlGF组的平均出生体重更低，可能反映了更高的早产率。本研究的优势包括使用胎龄特定百分位数和跨越四个日历年的大型队列。局限性包括缺乏BMI、糖尿病和出生体重的数据，以及缺乏种族信息。此外，用于分类PlGF水平的参考百分位数仅来自高加索人群，这可能限制了对不同群体的适用性[10]。作为一个回顾性的图表回顾，本研究也受到固有的设计限制。需要有不同参与者的前瞻性多中心研究来验证临界值并评估PlGF检测与临床护理途径的整合。在糖尿病高发人群中，在12 + 0至20 + 6周期间测量的低PlGF（胎龄第10百分位）与先兆子痫和早产的风险增加有关。早期PlGF检测可能有助于风险分层和指导监测，特别是在早期妊娠筛查不普遍的情况下。正常的PlGF结果具有较高的阴性预测值，可以使临床医生和患者放心。胎龄调整PlGF测量，而不是固定阈值或sFl-t1/PlGF比值，仍然是早期识别胎盘功能障碍的首选方法。Genevieve M. Dietrich：数据收集，数据分析和解释，手稿起草和最终版本的批准发送。Adrielle P. Souza Lira：研究的构思和设计，数据的分析和解释，手稿的起草和最终版本的批准。Eman Ramadan：对数据进行分析和解释，起草稿件，最终审定稿件。Adewumi Adanlawo：对数据进行分析和解读，撰写稿件并最终审定版本。Ernesto A. figuiro - filho：主要的PI，研究的概念和设计，数据的分析和解释，手稿的起草和最终版本的批准。作者声明无利益冲突。支持本研究结果的数据可向通讯作者索取。由于隐私或道德限制，这些数据不会公开。
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Mette van de Meent, Ewoud Schuit, Wessel Ganzevoort, Salwan Al-Nasiry, Mireille N. Bekker, Jan B. Derks, Johannes J. Duvekot, Sanne J. Gordijn, Floris Groenendaal, Reint Jellema, H. Marieke Knol, Elisabeth M. W. Kooi, René F. Kornelisse, Gwendolyn T. R. Manten, Susanne M. Mulder-De Tollenaer, Wes Onland, Eline van der Wilk, Hans Wolf, A. Titia Lely, Judith Kooiman
Objective(s)
Timing of birth is complex in early-onset fetal growth restriction (FGR) and the literature is limited regarding the exact sequence of changes in antenatal parameters. This study aimed to examine this sequence in a large early-onset FGR cohort.
Design
Multicenter, retrospective cohort study.
Setting
Six tertiary care hospitals in the Netherlands.
Population
A post hoc analysis of the OPtimal TIming of antenatal COrticosteroids in early-onset fetal growth REstriction (OPTICORE) study was performed.
Methods
Repeated measures of antenatal parameters were assessed routinely from diagnosis to birth. Mixed-effects models were used to determine the probability of abnormality (binary) and the trend (Z-score, continuous) over time for each parameter (< 32 and ≥ 32 weeks).
Main Outcome Measures
The time sequence of changes in fetal and maternal health parameters from diagnosis to birth in early-onset FGR pregnancies.
Results
A total of 1453 patients were included, of whom 1025 patients gave birth < 32 weeks and 428 ≥ 32 weeks, with median gestational ages of 29 + 3 weeks (IQR 27 + 6, 30 + 5) and 34 + 4 weeks (IQR 33 + 0, 37 + 0), respectively. The most apparent changes in fetal parameters in the last days preceding birth comprised: absent/reversed end-diastolic velocity of the umbilical artery and cardiotocography abnormalities. Regarding maternal parameters, an increased probability of antihypertensive agent(s) use was seen shortly preceding birth < 32 weeks.
Conclusion(s)
This large cohort of early-onset FGR pregnancies provides a time sequence of fetal and maternal health parameters from diagnosis to birth, which could inform clinical management.
{"title":"Temporal Changes in Fetal and Maternal Parameters in Early-Onset Fetal Growth Restriction: A Multicenter, Retrospective Cohort Study","authors":"Mette van de Meent, Ewoud Schuit, Wessel Ganzevoort, Salwan Al-Nasiry, Mireille N. Bekker, Jan B. Derks, Johannes J. Duvekot, Sanne J. Gordijn, Floris Groenendaal, Reint Jellema, H. Marieke Knol, Elisabeth M. W. Kooi, René F. Kornelisse, Gwendolyn T. R. Manten, Susanne M. Mulder-De Tollenaer, Wes Onland, Eline van der Wilk, Hans Wolf, A. Titia Lely, Judith Kooiman","doi":"10.1111/1471-0528.70073","DOIUrl":"10.1111/1471-0528.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective(s)</h3>\u0000 \u0000 <p>Timing of birth is complex in early-onset fetal growth restriction (FGR) and the literature is limited regarding the exact sequence of changes in antenatal parameters. This study aimed to examine this sequence in a large early-onset FGR cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Multicenter, retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Six tertiary care hospitals in the Netherlands.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>A post hoc analysis of the OPtimal TIming of antenatal COrticosteroids in early-onset fetal growth REstriction (OPTICORE) study was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Repeated measures of antenatal parameters were assessed routinely from diagnosis to birth. Mixed-effects models were used to determine the probability of abnormality (binary) and the trend (Z-score, continuous) over time for each parameter (< 32 and ≥ 32 weeks).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>The time sequence of changes in fetal and maternal health parameters from diagnosis to birth in early-onset FGR pregnancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1453 patients were included, of whom 1025 patients gave birth < 32 weeks and 428 ≥ 32 weeks, with median gestational ages of 29 + 3 weeks (IQR 27 + 6, 30 + 5) and 34 + 4 weeks (IQR 33 + 0, 37 + 0), respectively. The most apparent changes in fetal parameters in the last days preceding birth comprised: absent/reversed end-diastolic velocity of the umbilical artery and cardiotocography abnormalities. Regarding maternal parameters, an increased probability of antihypertensive agent(s) use was seen shortly preceding birth < 32 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion(s)</h3>\u0000 \u0000 <p>This large cohort of early-onset FGR pregnancies provides a time sequence of fetal and maternal health parameters from diagnosis to birth, which could inform clinical management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 4","pages":"671-679"},"PeriodicalIF":4.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433745","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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