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}
<p>Misoprostol, a synthetic analogue of prostaglandin E1, was approved in 1988, for the prevention and treatment of peptic ulcers associated with the use of nonsteroidal anti-inflammatory drugs. It is hard to believe that a drug initially used by gastroenterologists could become a crucial medication in obstetric practice. Misoprostol's versatility in administration, affordability, efficacy, relative safety and easy storage have contributed to its popularity. In 1987, the first studies on the off-label use of misoprostol for pregnancy termination, medical evacuation of missed abortions and as a cervical-priming agent prior to vacuum aspiration of the uterus started being published. These were followed by studies on its use for mid-trimester termination of pregnancy, management of intra-uterine fetal death, third stage of labour, induction of labour and post-partum haemorrhage.<span><sup>1</sup></span> It wasn't until nearly 15 years later that the FDA finally approved a new label addressing the use of misoprostol during pregnancy. This was followed by a number of trials demonstrating that misoprostol is at least as safe and effective as dinoprostone, the previous most popular agent for labour induction.<span><sup>2</sup></span> In this issue of BJOG (pages 1167-1180) Patabendige et al. conducted an individual participants' data meta-analysis of randomised controlled trials comparing the use of vaginal misoprostol and dinoprostone for the induction of labour. They concluded that both methods of labour induction were comparable in terms of effectiveness and perinatal safety as well as mode of delivery including vaginal, instrumental or Caesarean birth performed for failure to progress or fetal distress, supporting the non-inferiority of vaginal misoprostol.</p><p>Approximately, 30% of women in the UK and US deliver by Caesarean section<span><sup>3, 4</sup></span> and at least 5% of these deliveries are performed in the second stage of labour. Full dilatation caesarean sections can be associated with significant maternal and neonatal complications, mainly due to extension of the uterine incision, resulting in haemorrhage, and birth injuries related to ‘impacted fetal head’; both of which are classified as obstetric emergencies. There is no consensus on the definition of ‘impacted head’ and consequently data on its incidence and guidance on the most effective and safest method of management, are lacking. Several management strategies including tocolysis, vaginal disimpaction (‘push’ method), breech extraction, Patwardhan method and use of the Fetal Pillow® have been employed. In 2022, a UKOSS prospective survey showed that the ‘push’ technique was the most commonly used technique to facilitate the delivery of the deeply engaged head, followed by the Fetal Pillow®.<span><sup>5</sup></span> The Fetal Pillow® was first introduced in 2014 and initial small studies suggested a reduction in maternal and fetal complications. However, subsequent studies faile
{"title":"The journey from induction to birth and beyond","authors":"Makrina Savvidou","doi":"10.1111/1471-0528.17883","DOIUrl":"10.1111/1471-0528.17883","url":null,"abstract":"<p>Misoprostol, a synthetic analogue of prostaglandin E1, was approved in 1988, for the prevention and treatment of peptic ulcers associated with the use of nonsteroidal anti-inflammatory drugs. It is hard to believe that a drug initially used by gastroenterologists could become a crucial medication in obstetric practice. Misoprostol's versatility in administration, affordability, efficacy, relative safety and easy storage have contributed to its popularity. In 1987, the first studies on the off-label use of misoprostol for pregnancy termination, medical evacuation of missed abortions and as a cervical-priming agent prior to vacuum aspiration of the uterus started being published. These were followed by studies on its use for mid-trimester termination of pregnancy, management of intra-uterine fetal death, third stage of labour, induction of labour and post-partum haemorrhage.<span><sup>1</sup></span> It wasn't until nearly 15 years later that the FDA finally approved a new label addressing the use of misoprostol during pregnancy. This was followed by a number of trials demonstrating that misoprostol is at least as safe and effective as dinoprostone, the previous most popular agent for labour induction.<span><sup>2</sup></span> In this issue of BJOG (pages 1167-1180) Patabendige et al. conducted an individual participants' data meta-analysis of randomised controlled trials comparing the use of vaginal misoprostol and dinoprostone for the induction of labour. They concluded that both methods of labour induction were comparable in terms of effectiveness and perinatal safety as well as mode of delivery including vaginal, instrumental or Caesarean birth performed for failure to progress or fetal distress, supporting the non-inferiority of vaginal misoprostol.</p><p>Approximately, 30% of women in the UK and US deliver by Caesarean section<span><sup>3, 4</sup></span> and at least 5% of these deliveries are performed in the second stage of labour. Full dilatation caesarean sections can be associated with significant maternal and neonatal complications, mainly due to extension of the uterine incision, resulting in haemorrhage, and birth injuries related to ‘impacted fetal head’; both of which are classified as obstetric emergencies. There is no consensus on the definition of ‘impacted head’ and consequently data on its incidence and guidance on the most effective and safest method of management, are lacking. Several management strategies including tocolysis, vaginal disimpaction (‘push’ method), breech extraction, Patwardhan method and use of the Fetal Pillow® have been employed. In 2022, a UKOSS prospective survey showed that the ‘push’ technique was the most commonly used technique to facilitate the delivery of the deeply engaged head, followed by the Fetal Pillow®.<span><sup>5</sup></span> The Fetal Pillow® was first introduced in 2014 and initial small studies suggested a reduction in maternal and fetal complications. However, subsequent studies faile","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 9","pages":"1165-1166"},"PeriodicalIF":4.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17883","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494152","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}
Su Mon Latt, Charles Opondo, Fiona Alderdice, Jennifer J. Kurinczuk, Rachel Rowe
Objective
To investigate the association between postpartum haemorrhage (PPH) and subsequent cardiovascular disease.
Design
Population-based retrospective cohort study, using record linkage between Aberdeen Maternity and Neonatal Databank (AMND) and Scottish healthcare data sets.
Setting
Grampian region, Scotland.
Population
A cohort of 70 904 women who gave birth after 24 weeks of gestation in the period 1986–2016.
Methods
We used extended Cox regression models to investigate the association between having had one or more occurrences of PPH in any (first or subsequent) births (exposure) and subsequent cardiovascular disease, adjusted for sociodemographic, medical, and pregnancy and birth-related factors.
Main Outcome Measures
Cardiovascular disease identified from the prescription of selected cardiovascular medications, hospital discharge records or death from cardiovascular disease.
Results
In our cohort of 70 904 women (with 124 795 birth records), 25 177 women (36%) had at least one PPH. Compared with not having a PPH, having at least one PPH was associated with an increased risk of developing cardiovascular disease, as defined above, in the first year after birth (adjusted hazard ratio, aHR 1.96; 95% confidence interval, 95% CI 1.51–2.53; p < 0.001). The association was attenuated over time, but strong evidence of increased risk remained at 2–5 years (aHR 1.19, 95% CI 1.11–1.30, P < 0.001) and at 6–15 years after giving birth (aHR 1.17, 95% CI 1.05–1.30, p = 0.005).
Conclusions
Compared with women who have never had a PPH, women who have had at least one episode of PPH are twice as likely to develop cardiovascular disease in the first year after birth, and some increased risk persists for up to 15 years.
{"title":"Postpartum haemorrhage and risk of cardiovascular disease in later life: A population-based record linkage cohort study","authors":"Su Mon Latt, Charles Opondo, Fiona Alderdice, Jennifer J. Kurinczuk, Rachel Rowe","doi":"10.1111/1471-0528.17896","DOIUrl":"10.1111/1471-0528.17896","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the association between postpartum haemorrhage (PPH) and subsequent cardiovascular disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Population-based retrospective cohort study, using record linkage between Aberdeen Maternity and Neonatal Databank (AMND) and Scottish healthcare data sets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Grampian region, Scotland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>A cohort of 70 904 women who gave birth after 24 weeks of gestation in the period 1986–2016.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used extended Cox regression models to investigate the association between having had one or more occurrences of PPH in any (first or subsequent) births (exposure) and subsequent cardiovascular disease, adjusted for sociodemographic, medical, and pregnancy and birth-related factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Cardiovascular disease identified from the prescription of selected cardiovascular medications, hospital discharge records or death from cardiovascular disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In our cohort of 70 904 women (with 124 795 birth records), 25 177 women (36%) had at least one PPH. Compared with not having a PPH, having at least one PPH was associated with an increased risk of developing cardiovascular disease, as defined above, in the first year after birth (adjusted hazard ratio, aHR 1.96; 95% confidence interval, 95% CI 1.51–2.53; <i>p</i> < 0.001). The association was attenuated over time, but strong evidence of increased risk remained at 2–5 years (aHR 1.19, 95% CI 1.11–1.30, <i>P</i> < 0.001) and at 6–15 years after giving birth (aHR 1.17, 95% CI 1.05–1.30, <i>p</i> = 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Compared with women who have never had a PPH, women who have had at least one episode of PPH are twice as likely to develop cardiovascular disease in the first year after birth, and some increased risk persists for up to 15 years.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 12","pages":"1705-1714"},"PeriodicalIF":4.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17896","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472218","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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