Tara Tancred, Andrew D. Weeks, Vincent Mubangizi, Emmanuel Nene Dei, Sylvia Natukunda, Chloe Cobb, Imelda Bates, Lucy Asamoah-Akuoko, Bernard Natukunda
Objective
To determine structural and process readiness for postpartum haemorrhage (PPH) care at referral-level facilities in Ghana and Uganda to identify opportunities for strengthening.
Design
Mixed-methods cross-sectional study.
Setting
Three districts in Ghana and two in Uganda.
Population or Sample
Nine hospitals in Ghana and seven in Uganda; all hospitals had theoretical capacity for caesarean section and blood transfusion.
Methods
We deployed a modular quantitative health facility assessment to explore structural readiness (drugs, equipment, staff) complemented by in-depth interviews with maternity health service providers to understand process readiness (knowledge, attitudes, and practices as related to World Health Organization [WHO] guidance on PPH care).
Main Outcome Measures
Availability of essential structural components needed to support key PPH processes of care.
Results
In both countries, there was generally good structural readiness for PPH care. However, key common gaps included inadequate staffing (especially specialist physicians), and unavailability of blood for transfusion. Interviews highlighted particularly good process readiness in the provision of uterotonics, recognising and responding to retained placenta, and repairing tears. However, there were clear gaps in the utilisation of tranexamic acid and uterine balloon tamponade.
Conclusions
We have identified good structural and process readiness across both Ghanaian and Ugandan health facilities to support PPH responses. However, some key missed opportunities—to align with current WHO guidance on providing bundles of interventions for PPH care—could be strengthened with minimal investment but promising impact.
确定加纳和乌干达转诊机构产后出血（PPH）护理的结构和流程准备情况，以确定加强的机会。
{"title":"Assessment of Structural and Process Readiness for Postpartum Haemorrhage Care in Uganda and Ghana: A Mixed Methods Study","authors":"Tara Tancred, Andrew D. Weeks, Vincent Mubangizi, Emmanuel Nene Dei, Sylvia Natukunda, Chloe Cobb, Imelda Bates, Lucy Asamoah-Akuoko, Bernard Natukunda","doi":"10.1111/1471-0528.17953","DOIUrl":"10.1111/1471-0528.17953","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine structural and process readiness for postpartum haemorrhage (PPH) care at referral-level facilities in Ghana and Uganda to identify opportunities for strengthening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Mixed-methods cross-sectional study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Three districts in Ghana and two in Uganda.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>Nine hospitals in Ghana and seven in Uganda; all hospitals had theoretical capacity for caesarean section and blood transfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We deployed a modular quantitative health facility assessment to explore structural readiness (drugs, equipment, staff) complemented by in-depth interviews with maternity health service providers to understand process readiness (knowledge, attitudes, and practices as related to World Health Organization [WHO] guidance on PPH care).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Availability of essential structural components needed to support key PPH processes of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In both countries, there was generally good structural readiness for PPH care. However, key common gaps included inadequate staffing (especially specialist physicians), and unavailability of blood for transfusion. Interviews highlighted particularly good process readiness in the provision of uterotonics, recognising and responding to retained placenta, and repairing tears. However, there were clear gaps in the utilisation of tranexamic acid and uterine balloon tamponade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We have identified good structural and process readiness across both Ghanaian and Ugandan health facilities to support PPH responses. However, some key missed opportunities—to align with current WHO guidance on providing bundles of interventions for PPH care—could be strengthened with minimal investment but promising impact.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"433-443"},"PeriodicalIF":4.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17953","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247139","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}
Ruth V. Pritchett, Gavin Rudge, Beck Taylor, Carole Cummins, Sara Kenyon, Ellie Jones, Sharon Morad, Christine MacArthur, Kate Jolly
Objective
To determine the change in English emergency postnatal maternal readmissions 2007–2017 (pre-COVID-19) and the association with maternal demographics, obstetric risk factors and postnatal length of stay (LOS).
Design
National cohort study.
Setting
All English National Health Service hospitals.
Population
A total of 6 192 140 women who gave birth in English NHS hospitals from April 2007 to March 2017.
Methods
Statistical analysis using birth and readmission data from routinely collected National Hospital Episode Statistics (HES) database.
Main Outcome Measures
Rate of emergency postnatal maternal hospital readmissions related to pregnancy or giving birth within 42 days postpartum, readmission diagnoses and association with maternal demographic factors, obstetric risk factors and postnatal LOS.
Results
A significant increase in the rate of emergency postnatal maternal readmissions from 15 128 (2.5%) in 2008 to 20 734 (3.4%) in 2016 (aOR 1.32, 95% CI 1.28–1.37) was found. Risk factors for readmission included minoritised ethnicity (particularly Black or Black British ethnicity: aOR 1.35, 95% CI 1.31–1.39); age < 20 years (aOR 1.09, 95% CI 1.05–1.12); 40+ years (aOR 1.07, 95% CI 1.03–1.10); primiparity (multiparity: aOR 0.92, 95% CI 0.91–0.93); nonspontaneous vaginal birth modes (emergency caesarean: aOR 1.86, 95% CI 1.82–1.90); longer LOS (4+ vs. 0 days: aOR 1.58, 95% CI 1.53–1.64); and obstetric risk factors including urinary retention (aOR 2.34, 95% CI 2.06–2.53) and postnatal wound breakdown (aOR 2.01, 95% CI 1.83–2.21).
Conclusions
The concerning rise in emergency maternal readmissions should be addressed from a health inequalities perspective focusing on women from minoritised ethnic groups; those < 20 and ≥ 40 years old; primiparous women; and those with specified obstetric risk factors.
{"title":"Emergency Maternal Hospital Readmissions in the Postnatal Period: A Population-Based Cohort Study","authors":"Ruth V. Pritchett, Gavin Rudge, Beck Taylor, Carole Cummins, Sara Kenyon, Ellie Jones, Sharon Morad, Christine MacArthur, Kate Jolly","doi":"10.1111/1471-0528.17955","DOIUrl":"10.1111/1471-0528.17955","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the change in English emergency postnatal maternal readmissions 2007–2017 (pre-COVID-19) and the association with maternal demographics, obstetric risk factors and postnatal length of stay (LOS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>National cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>All English National Health Service hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>A total of 6 192 140 women who gave birth in English NHS hospitals from April 2007 to March 2017.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Statistical analysis using birth and readmission data from routinely collected National Hospital Episode Statistics (HES) database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Rate of emergency postnatal maternal hospital readmissions related to pregnancy or giving birth within 42 days postpartum, readmission diagnoses and association with maternal demographic factors, obstetric risk factors and postnatal LOS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A significant increase in the rate of emergency postnatal maternal readmissions from 15 128 (2.5%) in 2008 to 20 734 (3.4%) in 2016 (aOR 1.32, 95% CI 1.28–1.37) was found. Risk factors for readmission included minoritised ethnicity (particularly Black or Black British ethnicity: aOR 1.35, 95% CI 1.31–1.39); age < 20 years (aOR 1.09, 95% CI 1.05–1.12); 40+ years (aOR 1.07, 95% CI 1.03–1.10); primiparity (multiparity: aOR 0.92, 95% CI 0.91–0.93); nonspontaneous vaginal birth modes (emergency caesarean: aOR 1.86, 95% CI 1.82–1.90); longer LOS (4+ vs. 0 days: aOR 1.58, 95% CI 1.53–1.64); and obstetric risk factors including urinary retention (aOR 2.34, 95% CI 2.06–2.53) and postnatal wound breakdown (aOR 2.01, 95% CI 1.83–2.21).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The concerning rise in emergency maternal readmissions should be addressed from a health inequalities perspective focusing on women from minoritised ethnic groups; those < 20 and ≥ 40 years old; primiparous women; and those with specified obstetric risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 2","pages":"178-188"},"PeriodicalIF":4.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17955","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236962","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}
Chivon Winsloe, James Elhindi, Matias C. Vieira, Sophie Relph, Charles G. Arcus, Alessandro Alagna, Annette Briley, Mark Johnson, Louise M. Page, Andrew Shennan, Baskaran Thilaganathan, Neil Marlow, Christoph Lees, Deborah A. Lawlor, Asma Khalil, Jane Sandall, Andrew Copas, Dharmintra Pasupathy, the DESiGN Trial team
<div> <section> <h3> Objective</h3> <p>To identify whether maternal and pregnancy characteristics associated with stillbirth differ between preterm and term stillbirth.</p> </section> <section> <h3> Design</h3> <p>Secondary cohort analysis of the DESiGN RCT.</p> </section> <section> <h3> Setting</h3> <p>Thirteen UK maternity units.</p> </section> <section> <h3> Population</h3> <p>Singleton pregnant women and their babies.</p> </section> <section> <h3> Methods</h3> <p>Multiple logistic regression was used to assess whether the 12 factors explored were associated with stillbirth. Interaction tests assessed for a difference in these associations between the preterm and term periods.</p> </section> <section> <h3> Main Outcome Measure</h3> <p>Stillbirth stratified by preterm (<37<sup>+0</sup> weeks') and term (37<sup>+0</sup>–42<sup>+6</sup> weeks') births.</p> </section> <section> <h3> Results</h3> <p>A total of 195 344 pregnancies were included. Six hundred and sixty-seven were stillborn (3.4 per 1000 births), of which 431 (65%) were preterm. Significant interactions were observed for maternal age, ethnicity, IMD, BMI, parity, smoking, PAPP-A, gestational hypertension, pre-eclampsia and gestational diabetes but not for chronic hypertension and pre-existing diabetes. Stronger associations with term stillbirth were observed in women with obesity compared to BMI 18.5–24.9 kg/m<sup>2</sup> (BMI 30.0–34.9 kg/m<sup>2</sup> term adjusted OR 2.1 [95% CI 1.4–3.0] vs. preterm aOR 1.1 [0.8–1.7]; BMI ≥ 35.0 kg/m<sup>2</sup> term aOR 2.2 [1.4–3.4] vs. preterm aOR 1.5 [1.2–1.8]; <i>p</i>-interaction < 0.01), nulliparity compared to parity 1 (term aOR 1.7 [1.1–2.7] vs. preterm aOR 1.2 [0.9–1.6]; <i>p</i>-interaction < 0.01) and Asian ethnicity compared with White (<i>p</i>-interaction < 0.01). A weaker or lack of association with term, compared to preterm, stillbirth was observed for older maternal age, smoking and pre-eclampsia.</p> </section> <section> <h3> Conclusion</h3> <p>Differences in association exist between mothers experiencing preterm and term stillbirth. These differences could contribute to design of timely surveillance and interventions to
目的确定与死胎相关的孕产妇和妊娠特征在早产和足月死胎之间是否存在差异.设计DESiGN RCT的二次队列分析.设置英国13家产科医院.人群足月孕妇及其婴儿.方法使用多重逻辑回归评估所探讨的12个因素是否与死胎相关。结果共纳入 195 344 名孕妇。有 667 例死胎（每 1000 例分娩中有 3.4 例），其中 431 例（65%）为早产儿。观察到产妇年龄、种族、IMD、体重指数、胎次、吸烟、PAPP-A、妊娠高血压、子痫前期和妊娠糖尿病之间存在显著的交互作用，但慢性高血压和原有糖尿病之间不存在交互作用。与 BMI 18.5-24.9 kg/m2 相比，肥胖妇女与足月死胎的关系更密切（BMI 30.0-34.9 kg/m2 足月调整 OR 2.1 [95% CI 1.4-3.0] vs. 早产 aOR 1.1 [0.8-1.7]；BMI ≥ 35.0 kg/m2 足月 aOR 2.2 [1.4-3.4] vs. 早产 aOR 1.5 [1.2-1.8]; p-交互作用 < 0.01)，无产褥期 vs. 产褥期 1（足月 aOR 1.7 [1.1-2.7] vs. 早产 aOR 1.2 [0.9-1.6]; p-交互作用 < 0.01），亚裔 vs. 白人（p-交互作用 < 0.01）。与早产相比，高龄产妇、吸烟和先兆子痫与足月死胎的关联较弱或缺乏关联。这些差异有助于设计及时的监测和干预措施，以进一步降低死胎风险。
{"title":"Differences in Factors Associated With Preterm and Term Stillbirth: A Secondary Cohort Analysis of the DESiGN Trial","authors":"Chivon Winsloe, James Elhindi, Matias C. Vieira, Sophie Relph, Charles G. Arcus, Alessandro Alagna, Annette Briley, Mark Johnson, Louise M. Page, Andrew Shennan, Baskaran Thilaganathan, Neil Marlow, Christoph Lees, Deborah A. Lawlor, Asma Khalil, Jane Sandall, Andrew Copas, Dharmintra Pasupathy, the DESiGN Trial team","doi":"10.1111/1471-0528.17951","DOIUrl":"10.1111/1471-0528.17951","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify whether maternal and pregnancy characteristics associated with stillbirth differ between preterm and term stillbirth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Secondary cohort analysis of the DESiGN RCT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Thirteen UK maternity units.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Singleton pregnant women and their babies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Multiple logistic regression was used to assess whether the 12 factors explored were associated with stillbirth. Interaction tests assessed for a difference in these associations between the preterm and term periods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure</h3>\u0000 \u0000 <p>Stillbirth stratified by preterm (<37<sup>+0</sup> weeks') and term (37<sup>+0</sup>–42<sup>+6</sup> weeks') births.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 195 344 pregnancies were included. Six hundred and sixty-seven were stillborn (3.4 per 1000 births), of which 431 (65%) were preterm. Significant interactions were observed for maternal age, ethnicity, IMD, BMI, parity, smoking, PAPP-A, gestational hypertension, pre-eclampsia and gestational diabetes but not for chronic hypertension and pre-existing diabetes. Stronger associations with term stillbirth were observed in women with obesity compared to BMI 18.5–24.9 kg/m<sup>2</sup> (BMI 30.0–34.9 kg/m<sup>2</sup> term adjusted OR 2.1 [95% CI 1.4–3.0] vs. preterm aOR 1.1 [0.8–1.7]; BMI ≥ 35.0 kg/m<sup>2</sup> term aOR 2.2 [1.4–3.4] vs. preterm aOR 1.5 [1.2–1.8]; <i>p</i>-interaction < 0.01), nulliparity compared to parity 1 (term aOR 1.7 [1.1–2.7] vs. preterm aOR 1.2 [0.9–1.6]; <i>p</i>-interaction < 0.01) and Asian ethnicity compared with White (<i>p</i>-interaction < 0.01). A weaker or lack of association with term, compared to preterm, stillbirth was observed for older maternal age, smoking and pre-eclampsia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Differences in association exist between mothers experiencing preterm and term stillbirth. These differences could contribute to design of timely surveillance and interventions to","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 1","pages":"89-98"},"PeriodicalIF":4.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17951","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245525","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":"Advocating for Change: Lifting Mesh Suspension in SUI Surgery Based on Established Literature and Long-Term TVT Study Results","authors":"Reut Rotem, Orfhlaith E. O'Sullivan","doi":"10.1111/1471-0528.17963","DOIUrl":"10.1111/1471-0528.17963","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 4","pages":"539-540"},"PeriodicalIF":4.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245526","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}
Grace Townsend, Danielle R. Zabala, Amir L. Butt, Kaitlyn J. Kulesus
{"title":"Trends in Severe Postpartum Haemorrhage Among Nulliparous Women","authors":"Grace Townsend, Danielle R. Zabala, Amir L. Butt, Kaitlyn J. Kulesus","doi":"10.1111/1471-0528.17957","DOIUrl":"10.1111/1471-0528.17957","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 3","pages":"396-397"},"PeriodicalIF":4.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236315","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}
Anna A. Mensah, Julia Stowe, Jennifer E. Jardine, Freja C. M. Kirsebom, Tom Clare, Meaghan Kall, Helen Campbell, Jamie Lopez-Bernal, Nick Andrews
Objective
Assessment of COVID-19 vaccine safety in pregnancy using population-based data.
Design
Matched case–control study nested in a retrospective cohort.
Setting
April 2021–March 2022, England.
Population or Sample
All pregnant individuals aged between 18 and 50 years with valid health records.
Methods
Individuals identified from the national Maternity Services Data Set (MSDS) had their records linked to hospital admission, national COVID-19 vaccine and COVID-19 testing databases. Matching included participant's age and estimated week of conception. We compared outcomes across multiple COVID-19 vaccine exposures using conditional multivariable logistic regression, adjusting for demographic and health characteristics.
Main Outcome Measures
Adverse pregnancy, maternal and neonatal outcomes.
Results
514 013 individuals were included. We found lower odds of giving birth to a baby who was low birthweight (aOR = 0.86, 95% CI: 0.79–0.93), preterm (aOR = 0.89, 95% CI: 0.85–0.92) or who had an Apgar score < 7 at 5 min of age (aOR = 0.89, 95% CI: 0.80–0.98) for individuals who received at least one dose of COVID-19 vaccine during pregnancy. The odds of admission to intensive care unit during pregnancy were lower in those vaccinated (aOR = 0.85, 95% CI: 0.76–0.95). There was no association between vaccination in pregnancy and stillbirth, neonatal death, perinatal death and maternal venous thromboembolism in pregnancy.
Conclusions
COVID-19 vaccines are safe to use in pregnancy. Our findings generated important information to communicate to pregnant individuals and health professionals to support COVID-19 maternal vaccination programmes.
利用人群数据评估 COVID-19 疫苗在孕期的安全性。
{"title":"COVID-19 Vaccine Safety in Pregnancy, A Nested Case–Control Study in Births From April 2021 to March 2022, England","authors":"Anna A. Mensah, Julia Stowe, Jennifer E. Jardine, Freja C. M. Kirsebom, Tom Clare, Meaghan Kall, Helen Campbell, Jamie Lopez-Bernal, Nick Andrews","doi":"10.1111/1471-0528.17949","DOIUrl":"10.1111/1471-0528.17949","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Assessment of COVID-19 vaccine safety in pregnancy using population-based data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Matched case–control study nested in a retrospective cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>April 2021–March 2022, England.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population or Sample</h3>\u0000 \u0000 <p>All pregnant individuals aged between 18 and 50 years with valid health records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Individuals identified from the national Maternity Services Data Set (MSDS) had their records linked to hospital admission, national COVID-19 vaccine and COVID-19 testing databases. Matching included participant's age and estimated week of conception. We compared outcomes across multiple COVID-19 vaccine exposures using conditional multivariable logistic regression, adjusting for demographic and health characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Adverse pregnancy, maternal and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>514 013 individuals were included. We found lower odds of giving birth to a baby who was low birthweight (aOR = 0.86, 95% CI: 0.79–0.93), preterm (aOR = 0.89, 95% CI: 0.85–0.92) or who had an Apgar score < 7 at 5 min of age (aOR = 0.89, 95% CI: 0.80–0.98) for individuals who received at least one dose of COVID-19 vaccine during pregnancy. The odds of admission to intensive care unit during pregnancy were lower in those vaccinated (aOR = 0.85, 95% CI: 0.76–0.95). There was no association between vaccination in pregnancy and stillbirth, neonatal death, perinatal death and maternal venous thromboembolism in pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>COVID-19 vaccines are safe to use in pregnancy. Our findings generated important information to communicate to pregnant individuals and health professionals to support COVID-19 maternal vaccination programmes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"131 13","pages":"1882-1893"},"PeriodicalIF":4.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234107","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}
Ania Wisniak, Virginie Yakam, Sophie Evina Bolo, Alida Moukam, Jessica Sormani, Pierre Vassilakos, Bruno Kenfack, Patrick Petignat
Objective
To assess the impact of thermal ablation (TA) for the treatment of cervical dysplasia on fertility and pregnancy outcomes among women screened for cervical cancer in Cameroon.
Design
Retrospective cohort study.
Setting
Dschang health district, Cameroon.
Population
Participants aged 30–45 years from two screening trials conducted between 2015 and 2020 in Dschang District Hospital.
Methods
Participants were primarily screened for human papillomavirus infection, triaged by visual inspection and treated by TA if needed. Between October 2021 and March 2022, interviews on subsequent fertility were conducted with participants treated by TA and a control group of untreated women.
Main Outcome Measures
Pregnancy and miscarriage after screening/treatment.
Results
A total of 760 participants (219 treated and 541 untreated) completed the survey, with a mean follow-up time of 1297 days. Sixty-two women (28.3%) treated by TA reported a pregnancy postscreening versus 165 (30.5%) in the control group (p = 0.550). Adjusted for potential confounders, the hazard ratio of pregnancy for treated compared with untreated women was 0.82 (0.54–1.24, p = 0.350). Among women reporting pregnancies with a known outcome and which were not voluntarily terminated, 18 (35.3%) treated participants had a miscarriage versus 31 (21.4%) in the control group (p = 0.048). In the adjusted model, no association remained between TA and miscarriage (1.04, 0.39–2.78, p = 0.935).
Conclusions
In our study population, TA did not significantly impact fertility nor miscarriage risk. Our results support the widespread use of TA as a treatment of choice for precancerous cervical lesions in low-income settings.
评估喀麦隆接受宫颈癌筛查的妇女在接受宫颈发育不良热消融（TA）治疗时对生育和妊娠结果的影响。
{"title":"Fertility and Miscarriage Incidence After Cervical Intraepithelial Neoplasia Treatment by Thermal Ablation: A Cohort Study","authors":"Ania Wisniak, Virginie Yakam, Sophie Evina Bolo, Alida Moukam, Jessica Sormani, Pierre Vassilakos, Bruno Kenfack, Patrick Petignat","doi":"10.1111/1471-0528.17954","DOIUrl":"10.1111/1471-0528.17954","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the impact of thermal ablation (TA) for the treatment of cervical dysplasia on fertility and pregnancy outcomes among women screened for cervical cancer in Cameroon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Dschang health district, Cameroon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Participants aged 30–45 years from two screening trials conducted between 2015 and 2020 in Dschang District Hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants were primarily screened for human papillomavirus infection, triaged by visual inspection and treated by TA if needed. Between October 2021 and March 2022, interviews on subsequent fertility were conducted with participants treated by TA and a control group of untreated women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Pregnancy and miscarriage after screening/treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 760 participants (219 treated and 541 untreated) completed the survey, with a mean follow-up time of 1297 days. Sixty-two women (28.3%) treated by TA reported a pregnancy postscreening versus 165 (30.5%) in the control group (<i>p</i> = 0.550). Adjusted for potential confounders, the hazard ratio of pregnancy for treated compared with untreated women was 0.82 (0.54–1.24, <i>p</i> = 0.350). Among women reporting pregnancies with a known outcome and which were not voluntarily terminated, 18 (35.3%) treated participants had a miscarriage versus 31 (21.4%) in the control group (<i>p</i> = 0.048). In the adjusted model, no association remained between TA and miscarriage (1.04, 0.39–2.78, <i>p</i> = 0.935).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In our study population, TA did not significantly impact fertility nor miscarriage risk. Our results support the widespread use of TA as a treatment of choice for precancerous cervical lesions in low-income settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 2","pages":"167-177"},"PeriodicalIF":4.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17954","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142234120","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}
Danielle L. Wilson, Carley Whenn, Maree Barnes, Susan P. Walker, Mark E. Howard
<div> <section> <h3> Objective</h3> <p>To assess the effectiveness and acceptability of a pillow-like position modification device to reduce supine sleep during late pregnancy, and to determine the impacts on the severity of sleep-disordered breathing (SDB) and foetal well-being.</p> </section> <section> <h3> Design</h3> <p>Randomised cross-over study.</p> </section> <section> <h3> Setting and Population</h3> <p>Individuals in the third trimester of pregnancy receiving antenatal care at a tertiary maternity hospital in Australia.</p> </section> <section> <h3> Methods</h3> <p>Participants used their own pillow for a control week and an intervention pillow for a week overnight, in randomised order. Sleep position and total sleep time for each night of both weeks were objectively monitored, with a sleep study and foetal heart rate monitoring performed on the last night of each week.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Primary outcome = percentage of sleep time in the supine position; secondary outcomes = apnoea–hypopnoea index, foetal heart rate decelerations and birthweight centile.</p> </section> <section> <h3> Results</h3> <p>Forty-one individuals were randomised with data collected on 35 participants over 469 nights. There was no difference in percentage of total sleep time in the supine position overnight between the control or intervention pillow week (13.0% [6.1, 25.5] vs. 16.0% [5.6, 27.2], <i>p</i> = 0.81 with a mean difference of 2.5% [95% CI] = −0.7, 5.6, <i>p</i> = 0.12), and no difference in the severity of SDB or foetal heart rate decelerations across weeks. However, increased supine sleep was significantly related to a higher apnoea–hypopnoea index (<i>r</i><sub>s</sub> = 0.37, <i>p</i> = 0.003), lower birthweight (<i>r</i><sub>s</sub> = −0.45, <i>p</i> = 0.007) and lower birthweight centile (<i>r</i><sub>s</sub> = −0.45, <i>p</i> = 0.006). The proportion of supine sleep each night of the week varied widely both within and across participants, despite awareness of side-sleeping recommendations.</p> </section> <section> <h3> Conclusions</h3> <p>We found no evidence to suggest that the adoption of a pillow designed to discourage supine sleep was effective in late pregnancy, with women spending an average of 1 h per
{"title":"A Position Modification Device for the Prevention of Supine Sleep During Pregnancy: A Randomised Crossover Trial","authors":"Danielle L. Wilson, Carley Whenn, Maree Barnes, Susan P. Walker, Mark E. Howard","doi":"10.1111/1471-0528.17952","DOIUrl":"10.1111/1471-0528.17952","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the effectiveness and acceptability of a pillow-like position modification device to reduce supine sleep during late pregnancy, and to determine the impacts on the severity of sleep-disordered breathing (SDB) and foetal well-being.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Randomised cross-over study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting and Population</h3>\u0000 \u0000 <p>Individuals in the third trimester of pregnancy receiving antenatal care at a tertiary maternity hospital in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants used their own pillow for a control week and an intervention pillow for a week overnight, in randomised order. Sleep position and total sleep time for each night of both weeks were objectively monitored, with a sleep study and foetal heart rate monitoring performed on the last night of each week.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Primary outcome = percentage of sleep time in the supine position; secondary outcomes = apnoea–hypopnoea index, foetal heart rate decelerations and birthweight centile.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-one individuals were randomised with data collected on 35 participants over 469 nights. There was no difference in percentage of total sleep time in the supine position overnight between the control or intervention pillow week (13.0% [6.1, 25.5] vs. 16.0% [5.6, 27.2], <i>p</i> = 0.81 with a mean difference of 2.5% [95% CI] = −0.7, 5.6, <i>p</i> = 0.12), and no difference in the severity of SDB or foetal heart rate decelerations across weeks. However, increased supine sleep was significantly related to a higher apnoea–hypopnoea index (<i>r</i><sub>s</sub> = 0.37, <i>p</i> = 0.003), lower birthweight (<i>r</i><sub>s</sub> = −0.45, <i>p</i> = 0.007) and lower birthweight centile (<i>r</i><sub>s</sub> = −0.45, <i>p</i> = 0.006). The proportion of supine sleep each night of the week varied widely both within and across participants, despite awareness of side-sleeping recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found no evidence to suggest that the adoption of a pillow designed to discourage supine sleep was effective in late pregnancy, with women spending an average of 1 h per","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 2","pages":"145-154"},"PeriodicalIF":4.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.17952","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142235379","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}
Conrado Milani Coutinho, Veronica Giorgione, Basky Thilaganathan, Olga Patey
Objective
To investigate longitudinal trends in fetal and offspring cardiovascular adaptation in fetal growth restriction (FGR).
Design
Prospective longitudinal study.
Setting
Fetal Medicine Unit.
Sample
Thirty-five FGR pregnancies and 37 healthy controls assessed as term fetuses (mean age 37 ± 1 weeks) and again in infancy (mean age 8 ± 2 months).
Methods
Conventional echocardiographic techniques, tissue Doppler imaging and speckle tracking echocardiography.
Main Outcome Measures
Left ventricular (LV) and right ventricular (RV) geometry and function. Echocardiographic parameters were normalised by ventricular size adjusting for differences in body weight between groups.
Results
Compared to healthy controls, late FGR fetuses showed significant alterations in cardiac geometry with more globular LV chamber (LV sphericity index, 0.56 vs. 0.52), increase in biventricular global longitudinal systolic contractility (MAPSE, 0.29 vs. 0.25 mm; TAPSE, 0.42 vs. 0.37 mm) and elevated cardiac output (combined CO: 592 vs. 497 mL/min/kg, p < 0.01 for all). Indices of LV diastolic function in FGR fetuses were significantly impaired with myocardial diastolic velocities (LV A', 0.30 vs. 0.26 cm/s; IVS E', 0.19 vs. 0.16 cm/s) and LV torsion (1.2 vs. 3.5 deg./cm, p < 0.01 for all). At postnatal assessment, FGR offspring revealed persistently increased SAPSE (0.27 vs. 0.24 mm), LV longitudinal strain (−19.0 vs. −16.0%), reduced LV torsion (1.6 vs. 2.1 deg./cm) and elevated CO (791 vs. 574 mL/min/kg, p < 0.01 for all).
Conclusions
Perinatal cardiac remodelling and myocardial dysfunction in late FGR fetuses is most likely due to chronic placental hypoxaemia. Persistent changes in cardiac geometry and function in FGR offspring may reflect fetal cardiovascular maladaptation that could predispose to long-term cardiovascular complications in later life.
研究胎儿生长受限（FGR）的胎儿和后代心血管适应性的纵向趋势。
{"title":"Cardiovascular Adaptation in Fetal Growth Restriction: A Longitudinal Study From Fetuses at Term to the First Year of Life","authors":"Conrado Milani Coutinho, Veronica Giorgione, Basky Thilaganathan, Olga Patey","doi":"10.1111/1471-0528.17956","DOIUrl":"10.1111/1471-0528.17956","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate longitudinal trends in fetal and offspring cardiovascular adaptation in fetal growth restriction (FGR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective longitudinal study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Fetal Medicine Unit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Sample</h3>\u0000 \u0000 <p>Thirty-five FGR pregnancies and 37 healthy controls assessed as term fetuses (mean age 37 ± 1 weeks) and again in infancy (mean age 8 ± 2 months).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Conventional echocardiographic techniques, tissue Doppler imaging and speckle tracking echocardiography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Left ventricular (LV) and right ventricular (RV) geometry and function. Echocardiographic parameters were normalised by ventricular size adjusting for differences in body weight between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to healthy controls, late FGR fetuses showed significant alterations in cardiac geometry with more globular LV chamber (LV sphericity index, 0.56 vs. 0.52), increase in biventricular global longitudinal systolic contractility (MAPSE, 0.29 vs. 0.25 mm; TAPSE, 0.42 vs. 0.37 mm) and elevated cardiac output (combined CO: 592 vs. 497 mL/min/kg, <i>p</i> < 0.01 for all). Indices of LV diastolic function in FGR fetuses were significantly impaired with myocardial diastolic velocities (LV A', 0.30 vs. 0.26 cm/s; IVS E', 0.19 vs. 0.16 cm/s) and LV torsion (1.2 vs. 3.5 deg./cm, <i>p</i> < 0.01 for all). At postnatal assessment, FGR offspring revealed persistently increased SAPSE (0.27 vs. 0.24 mm), LV longitudinal strain (−19.0 vs. −16.0%), reduced LV torsion (1.6 vs. 2.1 deg./cm) and elevated CO (791 vs. 574 mL/min/kg, <i>p</i> < 0.01 for all).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Perinatal cardiac remodelling and myocardial dysfunction in late FGR fetuses is most likely due to chronic placental hypoxaemia. Persistent changes in cardiac geometry and function in FGR offspring may reflect fetal cardiovascular maladaptation that could predispose to long-term cardiovascular complications in later life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 2","pages":"189-196"},"PeriodicalIF":4.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142236963","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}
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