Background: Approximately 50% women who give birth after obstetric anal sphincter injury (OASI) develop anal incontinence (AI) over their lifetime.
Objective: To evaluate current evidence for a protective benefit of planned caesarean section (CS) to prevent AI after OASI.
Search strategy: MEDLINE/PubMed, Embase 1974-2024, CINAHL and Cochrane to 7 February 2024 (PROSPERO CRD42022372442).
Selection criteria: All studies reporting outcomes after OASI and a subsequent birth, by any mode.
Data collection and analysis: Eighty-six of 2646 screened studies met inclusion criteria, with nine studies suitable to meta-analyse the primary outcome of 'adjusted AI' after OASI and subsequent birth. Subgroups: short-term AI, long-term AI, AI in asymptomatic women.
Secondary outcomes: total AI, quality of life, satisfaction/regret, solid/liquid/flatal incontinence, faecal urgency, AI in women with and without subsequent birth, change in AI pre- to post- subsequent birth.
Main results: There was no evidence of a difference in adjusted AI after subsequent vaginal birth compared with CS after OASI across all time periods (OR = 0.92, 95% CI 0.72-1.20; 9 studies, 2104 participants, I2 = 0% p = 0.58), for subgroup analyses or secondary outcomes. There was no evidence of a difference in AI in women with or without subsequent birth (OR = 1.00 95% CI 0.65-1.54; 10 studies, 970 participants, I2 = 35% p = 0.99), or pre- to post- subsequent birth (OR = 0.79 95% CI 0.51-1.25; 13 studies, 5496 participants, I2 = 73% p = 0.31).
Conclusions: Due to low evidence quality, we are unable to determine whether planned caesarean is protective against AI after OASI. Higher quality evidence is required to guide personalised decision-making for asymptomatic women and to determine the effect of subsequent birth mode on long-term AI outcomes.
背景：产科肛门括约肌损伤（OASI）后分娩的妇女中约有50%终生发展为肛门失禁（AI）：目的：评估计划剖腹产（CS）对预防肛门括约肌损伤后肛门失禁有保护作用的现有证据：检索策略：MEDLINE/PubMed、Embase 1974-2024、CINAHL 和 Cochrane，检索期至 2024 年 2 月 7 日（PROSPERO CRD42022372442）：数据收集与分析：在筛选出的 2646 项研究中，有 86 项符合纳入标准，其中有 9 项研究适合对 OASI 和后续生育后的 "调整后 AI "这一主要结果进行元分析。次要结果：总AI、生活质量、满意度/遗憾、固体/液体/肛门失禁、粪便急迫性、有和没有随后生育的妇女的AI、AI在生育前和生育后的变化：在亚组分析或次要结果方面，没有证据表明在所有时间段内，阴道分娩后的调整后AI与OASI后的CS相比存在差异（OR = 0.92，95% CI 0.72-1.20；9项研究，2104名参与者，I2 = 0% p = 0.58）。没有证据表明有无后继生育的妇女的人工指数存在差异（OR = 1.00 95% CI 0.65-1.54；10 项研究，970 名参与者，I2 = 35% p = 0.99），或后继生育前与后继生育后的妇女的人工指数存在差异（OR = 0.79 95% CI 0.51-1.25；13 项研究，5496 名参与者，I2 = 73% p = 0.31）：由于证据质量较低，我们无法确定计划剖腹产是否可预防 OASI 后的人工流产。需要更高质量的证据来指导无症状妇女的个性化决策，并确定后续分娩方式对长期人工流产结局的影响。
{"title":"Caesarean section and anal incontinence in women after obstetric anal sphincter injury: A systematic review and meta-analysis.","authors":"Emily Carter, Rebecca Hall, Kelechi Ajoku, Jenny Myers, Rohna Kearney","doi":"10.1111/1471-0528.17899","DOIUrl":"https://doi.org/10.1111/1471-0528.17899","url":null,"abstract":"<p><strong>Background: </strong>Approximately 50% women who give birth after obstetric anal sphincter injury (OASI) develop anal incontinence (AI) over their lifetime.</p><p><strong>Objective: </strong>To evaluate current evidence for a protective benefit of planned caesarean section (CS) to prevent AI after OASI.</p><p><strong>Search strategy: </strong>MEDLINE/PubMed, Embase 1974-2024, CINAHL and Cochrane to 7 February 2024 (PROSPERO CRD42022372442).</p><p><strong>Selection criteria: </strong>All studies reporting outcomes after OASI and a subsequent birth, by any mode.</p><p><strong>Data collection and analysis: </strong>Eighty-six of 2646 screened studies met inclusion criteria, with nine studies suitable to meta-analyse the primary outcome of 'adjusted AI' after OASI and subsequent birth. Subgroups: short-term AI, long-term AI, AI in asymptomatic women.</p><p><strong>Secondary outcomes: </strong>total AI, quality of life, satisfaction/regret, solid/liquid/flatal incontinence, faecal urgency, AI in women with and without subsequent birth, change in AI pre- to post- subsequent birth.</p><p><strong>Main results: </strong>There was no evidence of a difference in adjusted AI after subsequent vaginal birth compared with CS after OASI across all time periods (OR = 0.92, 95% CI 0.72-1.20; 9 studies, 2104 participants, I<sup>2</sup> = 0% p = 0.58), for subgroup analyses or secondary outcomes. There was no evidence of a difference in AI in women with or without subsequent birth (OR = 1.00 95% CI 0.65-1.54; 10 studies, 970 participants, I<sup>2</sup> = 35% p = 0.99), or pre- to post- subsequent birth (OR = 0.79 95% CI 0.51-1.25; 13 studies, 5496 participants, I<sup>2</sup> = 73% p = 0.31).</p><p><strong>Conclusions: </strong>Due to low evidence quality, we are unable to determine whether planned caesarean is protective against AI after OASI. Higher quality evidence is required to guide personalised decision-making for asymptomatic women and to determine the effect of subsequent birth mode on long-term AI outcomes.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535818","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}
Cervical cerclage is an established intervention for the management of pregnancies at high risk of preterm birth. Although studies exist to support its use in certain situations, particularly in singleton pregnancies, many questions such as adjunct therapies and efficacy in specific subgroups of high-risk women have not been fully elucidated. This review will assess the current evidence as well as areas where there is currently a paucity of data and an urgent requirement for further research.
{"title":"Cervical cerclage: An evolving evidence base","authors":"Lisa Story, Andrew Shennan","doi":"10.1111/1471-0528.17905","DOIUrl":"10.1111/1471-0528.17905","url":null,"abstract":"<p>Cervical cerclage is an established intervention for the management of pregnancies at high risk of preterm birth. Although studies exist to support its use in certain situations, particularly in singleton pregnancies, many questions such as adjunct therapies and efficacy in specific subgroups of high-risk women have not been fully elucidated. This review will assess the current evidence as well as areas where there is currently a paucity of data and an urgent requirement for further research.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 12","pages":"1579-1586"},"PeriodicalIF":4.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17905","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499565","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}
Raanan Meyer, Kacey M. Hamilton, Rebecca J. Schneyer, Gabriel Levin, Mireille D. Truong, Matthew T. Siedhoff, Kelly N. Wright
<p>The rise in carbon dioxide (CO<sub>2</sub>) in the atmosphere has contributed significantly to climate change, which has been called the greatest threat to human health.<span><sup>1, 2</sup></span> The healthcare system accounts for 4.4% of all CO<sub>2</sub> emissions worldwide, more than global aviation, with the United States contributing 27% of this effect.<span><sup>3, 4</sup></span> Telemedicine has been adopted in various medical disciplines with the emergence of the SARS-CoV2 pandemic and has been shown to reduce costs.<span><sup>1, 5</sup></span> Currently, data regarding the sustainability effect of preoperative visits in gynaecology are limited. We aimed to evaluate the economic and carbon emission effects of preoperative visit types, virtual versus in-person in the office, in a minimally invasive gynaecologic surgery practice.</p><p>All women who underwent surgery with a Division of Minimally Invasive Gynecologic Surgery at a high-volume urban referral quaternary care centre from January 2016 to May 2023 were included. The Division of Minimally Invasive Gynecologic Surgery treats benign gynaecologic conditions only. Virtual consultations, preoperative and postoperative visits were implemented in March 2020, during the COVID-19 pandemic, and have continued to the present day. Prior to March 2020, all patients were seen in person, at our outpatient clinic. After March 2020, decision on the type of preoperative visit since the pandemic was according to clinic closures due to infection surges, patients' preferences and providers' permission, though most patients were recommended to be seen virtually for their initial consultation if an in-office procedure was not required. Patients who experienced both types of visits prior to surgery, virtual and in-person, were excluded. We analysed the costs associated with driving to office visits, driving times, distances and costs, CO<sub>2</sub> emissions, as well as patient characteristics, surgical characteristics and complications defined according to the Clavien–Dindo classification. Driving distances, times and CO<sub>2</sub> emissions were calculated based on patients' zip codes and their distance to the office (Data S1). Virtual and office visits were compared. The primary outcome was the quantification in driving costs, driving times and CO<sub>2</sub> emissions for each group.</p><p>A total of 1196 and 1751 women had preoperative virtual and office visits, respectively (Tables 1 and S1). Median age was lower in the group of virtual visits (37.0 vs. 40.0 years, <i>p</i> < 0.001). There was a higher proportion of stage IV endometriosis (16.4% vs. 7.8%, <i>p</i> < 0.001) and minimally invasive surgery (89.7% vs 77.7%, <i>p</i> < 0.001) in the virtual group compared to the office visit group. Complication proportions were similar in both groups (5.9% virtual vs. 6.3% office groups, <i>p</i> = 0.639, Table S2). Intraoperative complication proportion was significantly lower in the vi
7RM-构思、设计、获取数据、分析和解释数据、起草文章、批准最终版本；KH-获取数据、严格修改文章、批准最终版本；RS-获取数据、严格修改文章、批准最终版本；GL-构思和设计、分析和解释数据、对文章进行重要修改、批准最终版本；MT-获取数据、对文章进行重要修改、批准最终版本；MS-获取数据、对文章进行重要修改、批准最终版本；KW-构思、设计、获取数据、对文章进行重要修改、批准最终版本。MT- Ethicon、Medtronic、Heracure Medical 和 Cooper Surgical 的顾问；MS- Applied Medical 和 Intuitive Surgical 的顾问；KW- Aqua Therapeutics、Hologic、Ethicon 和 Karl Storz 的顾问；RM- Intuitive Surgical 的顾问。所有其他作者均未报告利益冲突。该研究获得了雪松西奈医疗中心机构审查委员会的批准（#00001714, 8/28/2023）。
{"title":"Costs and carbon emissions of virtual preoperative visits implementation","authors":"Raanan Meyer, Kacey M. Hamilton, Rebecca J. Schneyer, Gabriel Levin, Mireille D. Truong, Matthew T. Siedhoff, Kelly N. Wright","doi":"10.1111/1471-0528.17906","DOIUrl":"10.1111/1471-0528.17906","url":null,"abstract":"<p>The rise in carbon dioxide (CO<sub>2</sub>) in the atmosphere has contributed significantly to climate change, which has been called the greatest threat to human health.<span><sup>1, 2</sup></span> The healthcare system accounts for 4.4% of all CO<sub>2</sub> emissions worldwide, more than global aviation, with the United States contributing 27% of this effect.<span><sup>3, 4</sup></span> Telemedicine has been adopted in various medical disciplines with the emergence of the SARS-CoV2 pandemic and has been shown to reduce costs.<span><sup>1, 5</sup></span> Currently, data regarding the sustainability effect of preoperative visits in gynaecology are limited. We aimed to evaluate the economic and carbon emission effects of preoperative visit types, virtual versus in-person in the office, in a minimally invasive gynaecologic surgery practice.</p><p>All women who underwent surgery with a Division of Minimally Invasive Gynecologic Surgery at a high-volume urban referral quaternary care centre from January 2016 to May 2023 were included. The Division of Minimally Invasive Gynecologic Surgery treats benign gynaecologic conditions only. Virtual consultations, preoperative and postoperative visits were implemented in March 2020, during the COVID-19 pandemic, and have continued to the present day. Prior to March 2020, all patients were seen in person, at our outpatient clinic. After March 2020, decision on the type of preoperative visit since the pandemic was according to clinic closures due to infection surges, patients' preferences and providers' permission, though most patients were recommended to be seen virtually for their initial consultation if an in-office procedure was not required. Patients who experienced both types of visits prior to surgery, virtual and in-person, were excluded. We analysed the costs associated with driving to office visits, driving times, distances and costs, CO<sub>2</sub> emissions, as well as patient characteristics, surgical characteristics and complications defined according to the Clavien–Dindo classification. Driving distances, times and CO<sub>2</sub> emissions were calculated based on patients' zip codes and their distance to the office (Data S1). Virtual and office visits were compared. The primary outcome was the quantification in driving costs, driving times and CO<sub>2</sub> emissions for each group.</p><p>A total of 1196 and 1751 women had preoperative virtual and office visits, respectively (Tables 1 and S1). Median age was lower in the group of virtual visits (37.0 vs. 40.0 years, <i>p</i> < 0.001). There was a higher proportion of stage IV endometriosis (16.4% vs. 7.8%, <i>p</i> < 0.001) and minimally invasive surgery (89.7% vs 77.7%, <i>p</i> < 0.001) in the virtual group compared to the office visit group. Complication proportions were similar in both groups (5.9% virtual vs. 6.3% office groups, <i>p</i> = 0.639, Table S2). Intraoperative complication proportion was significantly lower in the vi","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1894-1897"},"PeriodicalIF":4.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499566","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}
Aisha Abdurrahman, Aisha Nana Adamu, Adewale Ashimi, Oguntayo O. Adekunle, Stephen B. Bature, Labaran D. Aliyu, Owodunni Akeem, Hauwa Abdullahi, Tina Lavin, Sulaiman Daneji, Basiru Musa, Zulkiflu Muazu, Jamilu Tukur, Hadiza Shehu Galadanci
<div> <section> <h3> Objective</h3> <p>Determine prevalence, risk factors and outcomes of hypertensive disorders in pregnancy (HDP).</p> </section> <section> <h3> Design</h3> <p>Cross-sectional analysis of data captured in the Maternal and Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) between September 2019 and August 2020.</p> </section> <section> <h3> Setting</h3> <p>Fifty-four referral level facilities in Nigeria.</p> </section> <section> <h3> Population</h3> <p>Women whose pregnancy ended (irrespective of the location or duration of pregnancy) or who were admitted within 42 days of delivery.</p> </section> <section> <h3> Methods</h3> <p>Descriptive statistics and multilevel mixed-effects logistic regression models.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Prevalence of HDP, sociodemographic and clinical factors associated with HDP and perinatal outcomes.</p> </section> <section> <h3> Results</h3> <p>Among the 71 758 women 6.4% had HDP and gestational hypertension accounted for 49.8%. Preeclampsia and eclampsia were observed in 9.5% and 7.0% of all pregnancies, respectively. The predictors of HDP were age over 35 years (OR1.96, 95% CI 1.82–2.12; <i>p</i> < 0.001), lack of formal educational (OR 1.18, 95% CI 1.06–1.32; <i>p</i> = 0.002), primary level of education (OR 1.20, 95% CI 1.03–1.4; <i>p</i> < 0.002), nulliparity (OR 1.21, 95% CI 1.12–1.31; <i>p</i> < 0.001), grand-multiparity (OR 1.36, 95%CI 1.21–1.52; <i>p</i> < 0.001), previous caesarean section (OR 1.26, 95%CI 1.15–1.38; <i>p</i> < 0.001) and previous miscarriage (OR 1.22, 95% CI 1.13–1.31; <i>p</i> < 0.001). Overall 3.7% of the patients with HDP died, with eclampsia having the highest case fatality rate of 27.9%. Stillbirth occurred in 11.9% of pregnancies with hypertensive disorders.</p> </section> <section> <h3> Conclusions</h3> <p>Hypertensive disorders in pregnancy are not uncommon in Nigeria. They are associated with adverse outcomes with over one-quarter of women with eclampsia dying. The main predictors include older age, poor education, extremes of parity and previous CS or miscarriage. Maternal and perinatal outcomes are
{"title":"Predictors, prevalence and outcome of hypertensive disorders in pregnancy in Nigerian tertiary health facilities","authors":"Aisha Abdurrahman, Aisha Nana Adamu, Adewale Ashimi, Oguntayo O. Adekunle, Stephen B. Bature, Labaran D. Aliyu, Owodunni Akeem, Hauwa Abdullahi, Tina Lavin, Sulaiman Daneji, Basiru Musa, Zulkiflu Muazu, Jamilu Tukur, Hadiza Shehu Galadanci","doi":"10.1111/1471-0528.17902","DOIUrl":"10.1111/1471-0528.17902","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Determine prevalence, risk factors and outcomes of hypertensive disorders in pregnancy (HDP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cross-sectional analysis of data captured in the Maternal and Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) between September 2019 and August 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Fifty-four referral level facilities in Nigeria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women whose pregnancy ended (irrespective of the location or duration of pregnancy) or who were admitted within 42 days of delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Descriptive statistics and multilevel mixed-effects logistic regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Prevalence of HDP, sociodemographic and clinical factors associated with HDP and perinatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 71 758 women 6.4% had HDP and gestational hypertension accounted for 49.8%. Preeclampsia and eclampsia were observed in 9.5% and 7.0% of all pregnancies, respectively. The predictors of HDP were age over 35 years (OR1.96, 95% CI 1.82–2.12; <i>p</i> < 0.001), lack of formal educational (OR 1.18, 95% CI 1.06–1.32; <i>p</i> = 0.002), primary level of education (OR 1.20, 95% CI 1.03–1.4; <i>p</i> < 0.002), nulliparity (OR 1.21, 95% CI 1.12–1.31; <i>p</i> < 0.001), grand-multiparity (OR 1.36, 95%CI 1.21–1.52; <i>p</i> < 0.001), previous caesarean section (OR 1.26, 95%CI 1.15–1.38; <i>p</i> < 0.001) and previous miscarriage (OR 1.22, 95% CI 1.13–1.31; <i>p</i> < 0.001). Overall 3.7% of the patients with HDP died, with eclampsia having the highest case fatality rate of 27.9%. Stillbirth occurred in 11.9% of pregnancies with hypertensive disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Hypertensive disorders in pregnancy are not uncommon in Nigeria. They are associated with adverse outcomes with over one-quarter of women with eclampsia dying. The main predictors include older age, poor education, extremes of parity and previous CS or miscarriage. Maternal and perinatal outcomes are ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 S3","pages":"42-54"},"PeriodicalIF":4.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17902","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Michael Crawford, Colin Evans, Alison Shaw, Chloe E. Barr, Emma J. Crosbie
{"title":"Measuring HE4 alongside CA125 for ovarian cancer diagnosis: A pilot clinical study","authors":"S. Michael Crawford, Colin Evans, Alison Shaw, Chloe E. Barr, Emma J. Crosbie","doi":"10.1111/1471-0528.17904","DOIUrl":"10.1111/1471-0528.17904","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 12","pages":"1725-1726"},"PeriodicalIF":4.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494150","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":"Oral and e-Poster Presentations","authors":"","doi":"10.1111/1471-0528.17881","DOIUrl":"10.1111/1471-0528.17881","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 S1","pages":"3-88"},"PeriodicalIF":4.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17881","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499592","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}
{"title":"Recognising acute lobar nephronia in pregnancy to improve outcomes.","authors":"Junaid Rafi","doi":"10.1111/1471-0528.17898","DOIUrl":"https://doi.org/10.1111/1471-0528.17898","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477924","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}
Smriti Prasad, Asma Khalil, Jamie J. Kirkham, Andrew Sharp, Kerry Woolfall, Tracy Karen Mitchell, Odai Yaghi, Tracey Ricketts, Mariana Popa, Zarko Alfirevic, Dilly Anumba, Richard Ashcroft, George Attilakos, Carolyn Bailie, Ahmet A. Baschat, Christine Cornforth, Fabricio Da Silva Costa, Mark Denbow, Jan Deprest, Natasha Fenwick, Monique C. Haak, Louise Hardman, Jane Harrold, Andy Healey, Kurt Hecher, Rajeswari Parasuraman, Lawrence Impey, Richard Jackson, Edward Johnstone, Shauna Leven, Liesbeth Lewi, Enrico Lopriore, Isabella Oconnor, Danielle Harding, Joel Marsden, Jessica Mendoza, Tommy Mousa, Surabhi Nanda, Aris T. Papageorghiou, Dharmintra Pasupathy, Jane Sandall, Shakila Thangaratinam, Baskaran Thilaganathan, Mark Turner, Brigitte Vollmer, Michelle Watson, Karen Wilding, Yoav Yinon, FERN Study Team
<div> <section> <h3> Objective</h3> <p>To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies.</p> </section> <section> <h3> Design</h3> <p>Cross-sectional survey.</p> </section> <section> <h3> Setting</h3> <p>International.</p> </section> <section> <h3> Population</h3> <p>Clinicians involved in the management of MCDA twin pregnancies with sFGR.</p> </section> <section> <h3> Methods</h3> <p>A structured, self-administered survey.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Clinical practices and attitudes to diagnostic criteria and management strategies.</p> </section> <section> <h3> Results</h3> <p>Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter-twin EFW discordance of >25% for the diagnosis of sFGR. For early-onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early-onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early-onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early-onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide.</p> </section> <section> <h3> Conclusions</h3> <p>There is significant variation in clinician practices and attitudes towards the management of early-onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high-level evidence to
目的确定目前处理单绒毛膜双胎妊娠选择性胎儿生长受限（sFGR）的方法：设计：横断面调查：调查对象方法：结构化自填式调查：主要结果测量：临床实践以及对诊断标准和管理策略的态度：总体而言，62.8%（113/180）的临床医生完成了调查；其中，66.4%（75/113）的受访者表示他们会使用估计胎儿体重（EFW）为 25% 的标准来诊断 sFGR。对于早发的 I 型 sFGR，79.8%（75/94）的受访者表示他们的常规做法是进行预期管理。另一方面，對於早期發病的 II 型及 III 型 sFGR，分別有 19.3%（17/88）及 35.7%（30/84）的受訪者會在懷孕期間進行處理，而 71.6%（63/88）及 57.1%（48/84）的受訪者會將這些妊娠轉介至胎兒介入中心，或為 II 型及 III 型個案提供胎兒介入服務。此外，39.0%（16/41）的受訪者會考慮為早期發病的 I 型 sFGR 進行胎兒內視鏡激光手術（FLS），而 41.5%（17/41）的受訪者會提供胎兒內視鏡激光手術或選擇性胎死腹中，12.2%（5/41）的受訪者只會提供選擇性胎死腹中。对于早发的Ⅱ型和Ⅲ型sFGR病例，分别有25.9%（21/81）和31.4%（22/70）的人只会提供FLS，而33.3%（27/81）和32.9%（23/70）的人只会提供选择性胎死宫内术：结论：临床医生对 MCDA 双胎妊娠中早发 sFGR 的处理方法和态度存在很大差异，尤其是对 II 型和 III 型病例，这突出表明需要高水平的证据来指导处理方法。
{"title":"Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey","authors":"Smriti Prasad, Asma Khalil, Jamie J. Kirkham, Andrew Sharp, Kerry Woolfall, Tracy Karen Mitchell, Odai Yaghi, Tracey Ricketts, Mariana Popa, Zarko Alfirevic, Dilly Anumba, Richard Ashcroft, George Attilakos, Carolyn Bailie, Ahmet A. Baschat, Christine Cornforth, Fabricio Da Silva Costa, Mark Denbow, Jan Deprest, Natasha Fenwick, Monique C. Haak, Louise Hardman, Jane Harrold, Andy Healey, Kurt Hecher, Rajeswari Parasuraman, Lawrence Impey, Richard Jackson, Edward Johnstone, Shauna Leven, Liesbeth Lewi, Enrico Lopriore, Isabella Oconnor, Danielle Harding, Joel Marsden, Jessica Mendoza, Tommy Mousa, Surabhi Nanda, Aris T. Papageorghiou, Dharmintra Pasupathy, Jane Sandall, Shakila Thangaratinam, Baskaran Thilaganathan, Mark Turner, Brigitte Vollmer, Michelle Watson, Karen Wilding, Yoav Yinon, FERN Study Team","doi":"10.1111/1471-0528.17891","DOIUrl":"10.1111/1471-0528.17891","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cross-sectional survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>International.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Clinicians involved in the management of MCDA twin pregnancies with sFGR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A structured, self-administered survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Clinical practices and attitudes to diagnostic criteria and management strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter-twin EFW discordance of >25% for the diagnosis of sFGR. For early-onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early-onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early-onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early-onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is significant variation in clinician practices and attitudes towards the management of early-onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high-level evidence to","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 12","pages":"1684-1693"},"PeriodicalIF":4.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17891","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the positive rate of late-onset gestational diabetes mellitus (GDM) by additional fasting blood glucose (FBG) screening at 32–34 gestational weeks (GW) and analyse the perinatal outcomes of late-onset GDM after standard treatment.
Design
An Prospective cohort study.
Setting
Single centre in China.
Population
1130 singleton pregnancies with negative GDM screening in their first and second trimester.
Methods
Additional FBG testing was performed at 32–34 GW. Pregnancies with FBG ≥5.1 mmol/L were diagnosed as GDM and received standardized treatment. Perinatal outcomes were collected and compared.
Main Outcome Measures
Diagnosis of late-onset GDM, obstetric and neonatal outcomes.
Results
6.3% (71/1130) of participants had FBG values ≥5.1 mmol/L and were diagnosed with late-onset GDM. Sixty-five (91.5%) were treated by dietary therapy and 6 (8.5%) by insulin therapy. The perinatal outcomes of full-term delivery were compared. The incidence of macrosomia (22.7% vs. 5.1%, adjusted odds ratio (aOR) 5.51, 95% confidence interval (CI) 1.83–16.61, p = 0.002) and NICU transferring (18.3% vs. 10.1%, aOR 1.94, 95% CI 1.01–3.74, p = 0.046) was significantly higher in late-onset GDM group than that in FBG <5.1 mmol/L group. Elevated FBG was associated with overweight or obesity during pregnancy (54.9% vs. 34.9%, OR 2.27, 95% CI 1.40–3.68, p = 0.001).
Conclusions
6.3% of singleton pregnancies with normal GDM screening results in the first and second trimester were found to have late-onset GDM by additional FBG screening at 32–34 GW, and their risk of macrosomia during a full-term pregnancy remains significantly higher after standard treatment.
{"title":"Fasting blood glucose as a screening measure for late-onset gestational diabetes in the third trimester","authors":"Xiaoxia Tang, Jin Wei, Shaohua Wu, Sufang Wu","doi":"10.1111/1471-0528.17897","DOIUrl":"10.1111/1471-0528.17897","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the positive rate of late-onset gestational diabetes mellitus (GDM) by additional fasting blood glucose (FBG) screening at 32–34 gestational weeks (GW) and analyse the perinatal outcomes of late-onset GDM after standard treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>An Prospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Single centre in China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>1130 singleton pregnancies with negative GDM screening in their first and second trimester.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Additional FBG testing was performed at 32–34 GW. Pregnancies with FBG ≥5.1 mmol/L were diagnosed as GDM and received standardized treatment. Perinatal outcomes were collected and compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Diagnosis of late-onset GDM, obstetric and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>6.3% (71/1130) of participants had FBG values ≥5.1 mmol/L and were diagnosed with late-onset GDM. Sixty-five (91.5%) were treated by dietary therapy and 6 (8.5%) by insulin therapy. The perinatal outcomes of full-term delivery were compared. The incidence of macrosomia (22.7% vs. 5.1%, adjusted odds ratio (aOR) 5.51, 95% confidence interval (CI) 1.83–16.61, <i>p</i> = 0.002) and NICU transferring (18.3% vs. 10.1%, aOR 1.94, 95% CI 1.01–3.74, <i>p</i> = 0.046) was significantly higher in late-onset GDM group than that in FBG <5.1 mmol/L group. Elevated FBG was associated with overweight or obesity during pregnancy (54.9% vs. 34.9%, OR 2.27, 95% CI 1.40–3.68, <i>p</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>6.3% of singleton pregnancies with normal GDM screening results in the first and second trimester were found to have late-onset GDM by additional FBG screening at 32–34 GW, and their risk of macrosomia during a full-term pregnancy remains significantly higher after standard treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 12","pages":"1715-1724"},"PeriodicalIF":4.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477923","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}
Megan Hall, Natalie Suff, Paddy Slator, Mary Rutherford, Andrew Shennan, Jana Hutter, Lisa Story
<div> <section> <h3> Objective</h3> <p>To utilise combined diffusion-relaxation MRI techniques to interrogate antenatal changes in the placenta prior to extreme preterm birth among both women with PPROM and membranes intact, and compare this to a control group who subsequently delivered at term.</p> </section> <section> <h3> Design</h3> <p>Observational study.</p> </section> <section> <h3> Setting</h3> <p>Tertiary Obstetric Unit, London, UK.</p> </section> <section> <h3> Population</h3> <p>Cases: pregnant women who subsequently spontaneously delivered a singleton pregnancy prior to 32 weeks' gestation without any other obstetric complications. Controls: pregnant women who delivered an uncomplicated pregnancy at term.</p> </section> <section> <h3> Methods</h3> <p>All women consented to an MRI examination. A combined diffusion-relaxation MRI of the placenta was undertaken and analysed using fractional anisotropy, a combined T2*-apparent diffusion coefficient model and a combined T2*-intravoxel incoherent motion model, in order to provide a detailed placental phenotype associated with preterm birth. Subgroup analyses based on whether women in the case group had PPROM or intact membranes at time of scan, and on latency to delivery were performed.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Fractional anisotropy, apparent diffusion coefficients and T2* placental values, from two models including a combined T2*-IVIM model separating fast- and slow-flowing (perfusing and diffusing) compartments.</p> </section> <section> <h3> Results</h3> <p>This study included 23 women who delivered preterm and 52 women who delivered at term. Placental T2* was lower in the T2*-apparent diffusion coefficient model (<i>p</i> < 0.001) and in the fast- and slow-flowing compartments (<i>p</i> = 0.001 and <i>p</i> < 0.001) of the T2*-IVIM model. This reached a higher level of significance in the preterm prelabour rupture of the membranes group than in the membranes intact group. There was a reduced perfusion fraction among the cases with impending delivery.</p> </section> <section> <h3> Conclusions</h3> <p>Placental diffusion-relaxation reveals significant
{"title":"Placental multimodal MRI prior to spontaneous preterm birth <32 weeks' gestation: An observational study","authors":"Megan Hall, Natalie Suff, Paddy Slator, Mary Rutherford, Andrew Shennan, Jana Hutter, Lisa Story","doi":"10.1111/1471-0528.17901","DOIUrl":"10.1111/1471-0528.17901","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To utilise combined diffusion-relaxation MRI techniques to interrogate antenatal changes in the placenta prior to extreme preterm birth among both women with PPROM and membranes intact, and compare this to a control group who subsequently delivered at term.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Observational study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Tertiary Obstetric Unit, London, UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Cases: pregnant women who subsequently spontaneously delivered a singleton pregnancy prior to 32 weeks' gestation without any other obstetric complications. Controls: pregnant women who delivered an uncomplicated pregnancy at term.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All women consented to an MRI examination. A combined diffusion-relaxation MRI of the placenta was undertaken and analysed using fractional anisotropy, a combined T2*-apparent diffusion coefficient model and a combined T2*-intravoxel incoherent motion model, in order to provide a detailed placental phenotype associated with preterm birth. Subgroup analyses based on whether women in the case group had PPROM or intact membranes at time of scan, and on latency to delivery were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Fractional anisotropy, apparent diffusion coefficients and T2* placental values, from two models including a combined T2*-IVIM model separating fast- and slow-flowing (perfusing and diffusing) compartments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 23 women who delivered preterm and 52 women who delivered at term. Placental T2* was lower in the T2*-apparent diffusion coefficient model (<i>p</i> < 0.001) and in the fast- and slow-flowing compartments (<i>p</i> = 0.001 and <i>p</i> < 0.001) of the T2*-IVIM model. This reached a higher level of significance in the preterm prelabour rupture of the membranes group than in the membranes intact group. There was a reduced perfusion fraction among the cases with impending delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Placental diffusion-relaxation reveals significant","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1782-1792"},"PeriodicalIF":4.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17901","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494151","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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