Endometriosis (EMs) is a common gynaecological condition with high recurrence rates after fertility-preserving laparoscopic surgery, and optimal postoperative medical treatment remains unclear.
To evaluate the efficacy and safety of various postoperative medical treatments in reducing recurrence, pain and adverse events in EMs patients after fertility-preserving surgery.
PubMed, Web of Science, CENTRAL and Embase databases searched until August 1, 2024.
Randomised controlled trials (RCTs) involving women aged 20–45 years post-fertility-preserving laparoscopic surgery, comparing single postoperative medications with a minimum follow-up of 2 months.
Two reviewers independently extracted data and assessed quality using ROB 2.0 and CINeMA. Bayesian network meta-analysis calculated odds ratios (OR) and mean differences (MD) for recurrence rates, VAS pain reduction and adverse events.
Sixteen RCTs (n = 1605 participants) evaluated 10 drugs: danazol, desogestrel, dienogest, gestrinone, goserelin, leuprolide, LNG-IUS, medroxyprogesterone, oral contraceptives and triptorelin. Only LNG-IUS significantly reduced recurrence rates (OR 0.12, 95% CI 0.02–0.63) and showed the greatest reduction in VAS pain scores (MD −24.96, 95% CI −41.76 to −8.75). Danazol significantly increased weight gain, and goserelin increased hot flashes.
LNG-IUS combined with laparoscopic surgery appears most effective in reducing recurrence and pain in EMs patients. Danazol and goserelin should be used cautiously due to notable adverse effects.
To compare the trajectories of placental biomarkers throughout pregnancy after aspirin discontinuation at 24–28 weeks with those of a cohort treated until 36 weeks of gestation.
A longitudinal secondary analysis of the StopPRE trial, using repeated measures of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and their ratio.
Nine maternity hospitals across Spain.
The original StopPRE trial included 936 women at high risk for preterm preeclampsia based on first-trimester screening. All participants received aspirin 150 mg daily until randomisation at 24–28 weeks. At that point, 463 women were assigned to continue aspirin until 36 weeks, while 473 were assigned to discontinue it.
sFlt-1, PlGF, sFlt-1/PlGF were measured at baseline (24–28 weeks) and during follow-up visits at 28–32, 32–36, and after 36 weeks of gestation. Linear mixed-effects models (LMM) with treatment-by-gestational age interaction were used to analyze biomarker trajectories over time.
Differences in trajectories of raw values and multiples of the median for sFlt-1, PlGF, sFlt-1/PlGF between groups.
Among 463 participants in the aspirin continuation group and 473 in the discontinuation group, 3483 measurements of each biomarker were analysed. There were no significant differences in the trajectories of sFlt-1, PlGF, or sFlt-1/PlGF between groups (p-values for raw analysis: 0.662, 0.728 and 0.979, respectively).
In women at high risk of preterm preeclampsia, discontinuing aspirin at 24–28 weeks did not alter the trajectories of placental biomarkers. This may explain why stopping aspirin did not increase preterm PE risk in the StopPRE trial.
Linked article: This is a mini commentary on Kingdon et al., pp. 2024–2039 in this issue. To view this article, visit https://doi.org/10.1111/1471-0528.18269.
To evaluate school performance at 12 years of age in children prenatally exposed to maintenance tocolysis with nifedipine versus placebo.
12-year follow-up of the multicentre APOSTEL 2 trial, in which participants with threatened preterm birth between 26+0 and 32+2 weeks of gestation, who remained pregnant after initial 48-h tocolysis, were randomised to nifedipine maintenance tocolysis or placebo for up to 12 days.
The APOSTEL 2 trial was conducted in 11 Dutch hospitals from 2008 to 2010. School outcomes were assessed at age 12.
Children from singleton and multiple pregnancies born to APOSTEL 2 participants.
School performance data were received through linkage with a national registry (Statistics Netherlands).
A high track recommendation for secondary school, adjusted for maternal education level, socioeconomic status, and child's biological sex.
Of 492 eligible children, 357 were included (follow-up rate 73%). In the nifedipine group, significantly fewer children received a high track recommendation for secondary school, 67/189 (35.4%), compared to 74/168 (44.0%) in the placebo group (adjusted risk ratio (aRR) 0.76; 95% confidence interval (CI) 0.61–0.95). Outcomes were significantly poorer in children with the longest nifedipine exposure (9–14 days) compared to those not exposed (aRR 0.58; 95% CI 0.41–0.83).
Children prenatally exposed to maintenance tocolysis with nifedipine had significantly poorer school performance at 12 years of age compared to those exposed to placebo. These findings further discourage nifedipine's use for maintenance tocolysis, and more research is warranted regarding its long-term effects on child development.
Acute kidney injury (AKI) in pregnancy is associated with adverse maternal and foetal outcomes. However, there is limited evidence regarding cardiac and renal outcomes associated with AKI in pregnancy.
To quantify and perform a meta-analysis of the risk of adverse cardiovascular and renal outcomes following AKI in pregnancy.
A systematic search of MEDLINE, Cochrane Library and EMBASE from inception until 23 January 2024.
Studies investigating adverse cardiovascular and renal outcomes in pregnant patients with AKI.
Two reviewers independently performed screening, data extraction and quality assessment. A random-effects model was used to estimate risk.
A total of 17 studies were included with 50 285 836 pregnant women, of which 36 806 women were affected by AKI. Our evidence synthesis showed that AKI in pregnancy is associated with a 52-fold increase in the risk of composite adverse renal outcomes (OR 52.37; 95% CI 4.67–587.63), a 23-fold increase in the risk of heart failure (OR 22.55; 95% CI 4.39–115.71) and stroke (OR 22.92; 95% CI 2.32–226.65), as well as a 9.3-fold and 3.9-fold increased risk of maternal mortality (OR 9.26; 95% CI 2.53–33.96) and intensive care unit admission (OR 3.86; 95% CI 1.93–7.71), respectively.
The study shows that AKI in pregnancy is associated with adverse cardiovascular and renal outcomes. Careful monitoring and follow-up of patients with AKI in pregnancy may enable earlier detection and management of some adverse cardiovascular and renal outcomes.
This scoping review was undertaken as part of an NIHR-commissioned study, APPRAISE, to develop a patient-reported outcome measure (PROM) and experience measure (PREM) to assess outcomes relevant to surgery for pelvic organ prolapse (POP), stress urinary incontinence (SUI) and pelvic mesh complications surgery, with cross-cultural applicability.
To identify PROMs and PREMs used to assess POP, SUI and mesh complication surgery; to compare the length, recall periods, response options of these tools and the outcomes/experiences assessed.
Three databases searched from inception to September 2023 were screened by two independent reviewers.
Primary studies using subjective measures to assess POP, SUI and mesh complication surgery for women aged 16+ years were eligible for inclusion. Related systematic reviews were also reviewed.
Data were extracted into a piloted electronic form by one reviewer and checked by a second. A narrative synthesis of the data was performed.
Of the 2079 included primary studies, 1607 (77%) used a PROM with evidence of psychometric testing. Five hundred and twenty-two (25%) studies used one PROM; 1082 studies (52%) used two or more PROMs. One hundred and fifty-one measures were extracted; of these, condition-specific measures were the most highly cited. There was limited use of PROMs specific to surgery, mental health, body image and PREMs. Some outcomes (e.g., urinary symptoms, emotional wellbeing) are measured in a significantly higher proportion of PROMs than other outcomes.
Currently, no existing validated PROM evaluates all patient-reported outcomes relevant to surgery for POP, SUI or mesh complications.
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