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National implementation of vaginal Natural Orifice Transluminal Endoscopic Surgery for benign hysterectomies: A historical cohort study of Swedish data 2021-2023. 良性子宫切除术在全国实施阴道自然口腔内内镜手术:2021-2023年瑞典数据的历史队列研究
IF 3.1 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-14 DOI: 10.1111/aogs.70142
Johanna Wagenius, Sophia Ehrström, Karin Källén, Jan Baekelandt, Andrea Stuart

Introduction: Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a technique combining vaginal entrance to the abdomen with endoscopic overview. Previous studies have shown that vNOTES decreases operating time, hospitalization, postoperative complications, and pain. We aimed to present patient demographics, costs, and surgical outcomes following the implementation of vNOTES for benign hysterectomies in Sweden.

Material and methods: We conducted a historical cohort study with the first vNOTES hysterectomies in Sweden 2021-2023 involving 8 hospitals. Data was extracted from the Swedish National Quality Register for Gynecological Surgery (GynOp). Our main outcomes were intraoperative and postoperative complications, costs, and patient satisfaction. As a secondary objective, the odds ratios (OR) for any intraoperative or postoperative complication, respectively, were computed for BMI ≥30 versus <30, and for uterus weight ≥500 g versus <500 g.

Results: A total of 545 patients were included in the study. The mean age of the patients was 49.9 ± 10.7 years. Of the included patients, 8.1% (n = 44) were nullipara, 19.3% (n = 105) had a BMI ≥30, 17.4% (n = 95) had a previous cesarean section, and 16.7% (n = 91) had other previous abdominal surgery. The median uterus weight was 148 g (interquartile range, IQR 86-299). The median surgical time was 65 minutes (IQR 48-91), and the median blood loss was 40 mL (IQR 25-90). Conversions to laparotomy occurred in 2% (n = 11), and reoperations occurred in 0.6% (n = 3) of the cases. The total intraoperative complication rate was 2.2% and the total postoperative complication rate was 8.4%. No significant differences in intraoperative and postoperative complications were found between BMI ≥30 and <30 and between uterus weight ≥500 and <500 g. Most of the patients (57.1%, n = 311) left the hospital the same day as the surgery. The 1-year follow-up after surgery showed that 90% of the patients were satisfied or very satisfied with the result.

Conclusions: The implementation of vNOTES hysterectomies in Sweden has been safe showing similar complication rates compared to studies of other minimally invasive hysterectomy techniques. Surgical time, intraoperative bleeding, and conversions were in analogy with previous observational vNOTES studies. The 1-year follow-up after surgery showed high patient satisfaction.

阴道自然孔腔内窥镜手术(vNOTES)是一种结合阴道进入腹部和内窥镜检查的技术。先前的研究表明,vNOTES减少了手术时间、住院时间、术后并发症和疼痛。我们的目的是介绍瑞典良性子宫切除术实施vNOTES后的患者人口统计、费用和手术结果。材料和方法:我们对瑞典2021-2023年第一例vNOTES子宫切除术进行了历史队列研究,涉及8家医院。数据来自瑞典国家妇科手术质量登记(GynOp)。我们的主要结果是术中和术后并发症、费用和患者满意度。作为次要目标,分别计算BMI≥30时术中或术后并发症的比值比(OR)。结果:共有545例患者纳入研究。患者平均年龄49.9±10.7岁。在纳入的患者中,8.1% (n = 44)为产妇,19.3% (n = 105) BMI≥30,17.4% (n = 95)有剖宫产史,16.7% (n = 91)有其他腹部手术史。子宫中位重量为148 g(四分位数差,IQR 86-299)。手术时间中位数为65分钟(IQR 48-91),出血量中位数为40 mL (IQR 25-90)。2% (n = 11)的病例转为开腹手术,0.6% (n = 3)的病例再次手术。术中总并发症发生率为2.2%,术后总并发症发生率为8.4%。结论:与其他微创子宫切除术技术相比,瑞典实施vNOTES子宫切除术是安全的,并发症发生率相似。手术时间、术中出血和转归与先前的观察性vNOTES研究相似。术后1年随访患者满意度高。
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引用次数: 0
Laparoscopic cervical cerclage and pregnancy outcomes in consecutive pregnancies: An observational study. 连续妊娠的腹腔镜宫颈环切术与妊娠结局:一项观察性研究。
IF 3.1 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-12 DOI: 10.1111/aogs.70125
Lise Qvirin Krogh, Lea Kirstine Hansen, Rikke Bek Helmig, Iben Sundtoft, Aiste Kloster, Axel Forman, Niels Ulbjerg, Julie Glavind

Introduction: Laparoscopic cervical cerclage is an intervention for the prevention of preterm birth, for example, in women with a weak cervix due to prior cervical surgery or prior failed vaginal cerclage. Little is known about pregnancy outcomes when a cerclage is left in situ across consecutive pregnancies; this study aims to investigate neonatal outcomes following laparoscopic cervical cerclage placement in first and subsequent pregnancies and to compare pre- and postconception placement of the laparoscopic cervical cerclage on neonatal survival.

Material and methods: We performed an observational study in women who had a laparoscopic cervical cerclage at Aarhus University Hospital, Denmark, between 2011 and 2021. Data on the timing of the procedure (pre- vs post-conception), surgical complications, obstetric, and neonatal outcomes were collected from electronic patient records and analyzed descriptively. The primary outcome was neonatal survival. Secondary outcomes were neonatal survival without major morbidity, preterm birth, and gestational age at birth.

Results: A total of 170 women had a laparoscopic cervical cerclage during the study period. Uterine wall perforation occurred in 10/170 procedures (6%), postoperative infection in 4/170 (2%), and 125/170 (74%) were discharged on the same day as the procedure. There were 145 women with at least one subsequent pregnancy and 229 registered pregnancies in total. In the 185 pregnancies that progressed beyond 20 weeks, 166/181 (92%) delivered ≥34 weeks of gestation. Neonatal survival was 183/186 (98%), and survival without major morbidity was 181/186 (97%). Neonatal outcomes were similar between women with a cerclage placed pre- or postconception. Fifty of 145 women (34%) with a cerclage left in situ had more than one pregnancy beyond 20 weeks of gestation. These repeated pregnancies showed consistently favorable outcomes, with neonatal survival rates of 100% in second pregnancies (44/44) and 100% in third pregnancies (4/4).

Conclusions: Laparoscopic cervical cerclage supports favorable neonatal outcomes in first and subsequent pregnancies. Neonatal outcomes did not appear to differ based on whether the cerclage was placed pre- or postconception. Pregnancies in which the cerclage was left in situ demonstrated high neonatal survival rates and favorable obstetric outcomes in both second and third pregnancies.

引言:腹腔镜宫颈环切术是一种预防早产的干预措施,例如,由于既往宫颈手术或阴道环切失败而导致宫颈薄弱的妇女。在连续妊娠中,结扎处留在原位对妊娠结局知之甚少;本研究旨在调查首次妊娠和随后妊娠中腹腔镜宫颈环扎术放置后的新生儿结局,并比较孕前和孕后放置腹腔镜宫颈环扎术对新生儿存活率的影响。材料和方法:我们对2011年至2021年间在丹麦奥胡斯大学医院行腹腔镜宫颈环切术的妇女进行了一项观察性研究。从电子病历中收集有关手术时间(受孕前后)、手术并发症、产科和新生儿结局的数据,并进行描述性分析。主要终点是新生儿存活率。次要结局是无重大发病率的新生儿生存、早产和出生时胎龄。结果:在研究期间,共有170名妇女接受了腹腔镜宫颈环切术。10/170例术后发生子宫壁穿孔(6%),4/170例术后感染(2%),125/170例(74%)当日出院。145名妇女至少有一次怀孕,总共有229名妇女登记怀孕。在超过20周的185例妊娠中,166/181(92%)分娩≥34周。新生儿生存率为183/186(98%),无重大发病生存率为181/186(97%)。在怀孕前或怀孕后接受环扎术的妇女的新生儿结局相似。145名原地留下环扎的妇女中,有50名(34%)在妊娠20周后不止一次怀孕。这些重复妊娠的结果一致良好,第二次妊娠的新生儿存活率为100%(44/44),第三次妊娠的新生儿存活率为100%(4/4)。结论:腹腔镜宫颈环扎术在首次妊娠和后续妊娠中支持良好的新生儿结局。新生儿的结局似乎并没有因为环扎术是在怀孕前还是怀孕后而有所不同。在妊娠中,环扎环留在原位显示出高的新生儿存活率和良好的产科结局在第二次和第三次妊娠。
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引用次数: 0
Beyond evidence hierarchies: Leveraging randomized controlled trials and real-world data to advance the value of maternity care. 超越证据层次:利用随机对照试验和现实世界的数据,以提高产妇护理的价值。
IF 3.1 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-09 DOI: 10.1111/aogs.70094
Yanan Hu, Valerie Slavin, Joanne Enticott, Emily Callander

While existing literature has compared the methodological strengths and limitations of randomized controlled trials (RCTs) and real-world data (RWD) in general medical research, two critical gaps remain unaddressed: (1) no prior communication papers have specifically examined this comparison in the context of maternity care where unique ethical and practical considerations exist, and (2) no studies have systematically compared cost-effectiveness analyses derived from RCTs versus RWD approaches-a crucial dimension for value-based maternity care decisions. This article examines how both approaches can strengthen the evidence base and support the delivery of value-based maternity care. We argue that neither RCTs nor RWD should be regarded as inherently superior in guiding decision-making. Each study design offers valuable insights, and their findings must be critically appraised in light of methodological rigor, context, and relevance, particularly when their results diverge.

虽然现有文献比较了一般医学研究中随机对照试验(rct)和真实世界数据(RWD)的方法学优势和局限性,但仍有两个关键差距未得到解决:(1)没有先前的交流论文专门在存在独特伦理和实践考虑的产科护理背景下研究这种比较,(2)没有研究系统地比较来自rct和RWD方法的成本效益分析-这是基于价值的产科护理决策的关键维度。本文探讨了这两种方法如何加强证据基础,并支持提供基于价值的产妇护理。我们认为rct和RWD都不应该被认为在指导决策方面具有天生的优势。每个研究设计都提供了有价值的见解,他们的发现必须根据方法的严谨性、背景和相关性进行批判性评估,特别是当他们的结果出现分歧时。
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引用次数: 0
Early versus late termination for fetal anomalies: Women's perspectives and psychological impact in a mixed methods study. 胎儿畸形的早期与晚期终止妊娠:一项混合方法研究中妇女的观点和心理影响。
IF 3.1 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-09 DOI: 10.1111/aogs.70122
Eline E R Lust, Kim Bronsgeest, Lidewij Henneman, Neeltje M T H Crombag, Caterina M Bilardo, Robert-Jan H Galjaard, Esther Sikkel, Audrey B C Coumans, Ayten Elvan-Taşpınar, Sander Galjaard, Attie T J I Go, Gwendolyn T R Manten, Eva Pajkrt, Elisabeth van Leeuwen, Monique C Haak, Mireille N Bekker

Introduction: A frequently cited benefit of the first-trimester anomaly scan (FTAS) is that it reduces psychological impact by enabling earlier termination of pregnancy (TOP). However, the impact of early versus late TOP due to fetal anomalies remains unclear. This study evaluates the psychological impact and perspectives associated with early versus late TOP.

Material and methods: A prospective mixed methods study was conducted. The early group (TOP <18 weeks) included women with an abnormal FTAS; the late group (TOP 20-24 weeks) included women with an abnormal second-trimester scan (SAS), abnormal FTAS, or normal FTAS followed by abnormal SAS. Women completed questionnaires 2 (T1) and 6 months (T2) postpartum addressing psychological impact using validated scales (State-Trait Anxiety Inventory, Edinburgh Depression Scale, Impact of Event Scale, Perinatal Grief Scale) and study-specific questions. Semi-structured interviews were conducted with women and their partners 3-6 months after termination.

Results: 149 women with early TOP (15 + 2 weeks, range 14 + 4-16 + 1) and 129 with late TOP (22 + 0, 21 + 0-23 + 1) completed T1. In both groups, the majority had clinically relevant anxiety at T1 and T2 and moderate/severe distress at T1. The late TOP group had higher median depression and mean grief scores at T1 (5.0, range 3.0-8.0 vs. 4.0, range 2.0-7.0, p = 0.004) (85.9 ± 21.0 vs. 76.5 ± 22.4, p < 0.001) and at T2 (4.0, 1.0-7.0 vs. 3.0, 1.0-6.0, p = 0.043) (81.3 ± 22.9 vs. 70.8 ± 22.6, p < 0.001), respectively, and higher mean distress scores at T1 (33.8 ± 13.3 vs. 30.2 ± 14.7, p = 0.034). Of 51 interviews with women and partners (22 early, 29 late TOP), four themes were identified: fetal attachment, time pressure, grief, and reflections on gestational age. Most late TOP participants expressed strong fetal attachment; for early TOP participants, the experiences were more variable. Half of the late TOP participants reported time pressure due to the legal limit. Perceived grief and impact were substantial in both groups.

Conclusions: Our findings suggest that early TOP is associated with lower psychological impact compared to late TOP, mainly in the first months postpartum. This may reflect less intense fetal attachment and more time for reproductive decision-making for some parents, supporting the presumed benefit of earlier intervention. Nevertheless, TOP causes a significant emotional impact at any gestational age.

引言:妊娠早期异常扫描(FTAS)的一个经常被引用的好处是,它可以通过早期终止妊娠(TOP)来减少心理影响。然而,由于胎儿异常,早期和晚期TOP的影响尚不清楚。本研究评估了早期与晚期TOP相关的心理影响和观点。材料与方法:采用前瞻性混合方法研究。结果:149例早期TOP患者(15 + 2周,范围14 + 4-16 + 1)和129例晚期TOP患者(22 + 0,21 + 0-23 + 1)完成T1。在两组中,大多数患者在T1和T2时有临床相关的焦虑,在T1时有中度/重度痛苦。晚期TOP组在T1时的中位抑郁和平均悲伤得分较高(5.0,范围3.0-8.0比4.0,范围2.0-7.0,p = 0.004)(85.9±21.0比76.5±22.4,p)。结论:我们的研究结果表明,早期TOP与晚期TOP相比,心理影响较低,主要在产后第一个月。这可能反映出对一些父母来说,不那么强烈的胎儿依恋和更多的生育决策时间,支持早期干预的假定益处。然而,在任何胎龄,TOP都会对情绪产生重大影响。
{"title":"Early versus late termination for fetal anomalies: Women's perspectives and psychological impact in a mixed methods study.","authors":"Eline E R Lust, Kim Bronsgeest, Lidewij Henneman, Neeltje M T H Crombag, Caterina M Bilardo, Robert-Jan H Galjaard, Esther Sikkel, Audrey B C Coumans, Ayten Elvan-Taşpınar, Sander Galjaard, Attie T J I Go, Gwendolyn T R Manten, Eva Pajkrt, Elisabeth van Leeuwen, Monique C Haak, Mireille N Bekker","doi":"10.1111/aogs.70122","DOIUrl":"https://doi.org/10.1111/aogs.70122","url":null,"abstract":"<p><strong>Introduction: </strong>A frequently cited benefit of the first-trimester anomaly scan (FTAS) is that it reduces psychological impact by enabling earlier termination of pregnancy (TOP). However, the impact of early versus late TOP due to fetal anomalies remains unclear. This study evaluates the psychological impact and perspectives associated with early versus late TOP.</p><p><strong>Material and methods: </strong>A prospective mixed methods study was conducted. The early group (TOP <18 weeks) included women with an abnormal FTAS; the late group (TOP 20-24 weeks) included women with an abnormal second-trimester scan (SAS), abnormal FTAS, or normal FTAS followed by abnormal SAS. Women completed questionnaires 2 (T1) and 6 months (T2) postpartum addressing psychological impact using validated scales (State-Trait Anxiety Inventory, Edinburgh Depression Scale, Impact of Event Scale, Perinatal Grief Scale) and study-specific questions. Semi-structured interviews were conducted with women and their partners 3-6 months after termination.</p><p><strong>Results: </strong>149 women with early TOP (15 + 2 weeks, range 14 + 4-16 + 1) and 129 with late TOP (22 + 0, 21 + 0-23 + 1) completed T1. In both groups, the majority had clinically relevant anxiety at T1 and T2 and moderate/severe distress at T1. The late TOP group had higher median depression and mean grief scores at T1 (5.0, range 3.0-8.0 vs. 4.0, range 2.0-7.0, p = 0.004) (85.9 ± 21.0 vs. 76.5 ± 22.4, p < 0.001) and at T2 (4.0, 1.0-7.0 vs. 3.0, 1.0-6.0, p = 0.043) (81.3 ± 22.9 vs. 70.8 ± 22.6, p < 0.001), respectively, and higher mean distress scores at T1 (33.8 ± 13.3 vs. 30.2 ± 14.7, p = 0.034). Of 51 interviews with women and partners (22 early, 29 late TOP), four themes were identified: fetal attachment, time pressure, grief, and reflections on gestational age. Most late TOP participants expressed strong fetal attachment; for early TOP participants, the experiences were more variable. Half of the late TOP participants reported time pressure due to the legal limit. Perceived grief and impact were substantial in both groups.</p><p><strong>Conclusions: </strong>Our findings suggest that early TOP is associated with lower psychological impact compared to late TOP, mainly in the first months postpartum. This may reflect less intense fetal attachment and more time for reproductive decision-making for some parents, supporting the presumed benefit of earlier intervention. Nevertheless, TOP causes a significant emotional impact at any gestational age.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Retropubic hemorrhage following Midurethral sling surgery: Diagnosis, clinical challenges, and management. 中尿道悬吊手术后耻骨后出血:诊断、临床挑战和处理。
IF 3.1 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-04 DOI: 10.1111/aogs.70129
Greta Lisa Carlin, Christina Tanja Grech, Wolfgang Umek, Engelbert Hanzal, Marianne Koch, Barbara Bodner-Adler

Mid-urethral slings (MUS) such as tension-free vaginal tape (TVT) are the established gold standard surgical approach for treating stress urinary incontinence (SUI). While generally effective, complications such as bladder injury, urinary retention, and bleeding can occur. This article focuses on a rare but significant complication: postoperative hemorrhage into the retropubic space (Cavum Retzii) following MUS/TVT placement. Key challenges, diagnostic options, and management strategies for this condition are assessed. Additionally, a structured clinical guideline to support a systematic approach to diagnosis and treatment of complications is provided.

中尿道吊带(MUS)如无张力阴道带(TVT)是治疗压力性尿失禁(SUI)的金标准手术方法。虽然一般有效,但可能出现膀胱损伤、尿潴留和出血等并发症。这篇文章的重点是一个罕见但重要的并发症:MUS/TVT置入后耻骨后腔出血。评估了该疾病的主要挑战、诊断选择和管理策略。此外,提供了一个结构化的临床指南,以支持系统的方法来诊断和治疗并发症。
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引用次数: 0
HPV vaccination following cervical intraepithelial neoplasia grade 2 diagnosis and risk of progression 宫颈上皮内瘤变2级诊断和进展风险后的HPV疫苗接种。
IF 3.1 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-02 DOI: 10.1111/aogs.70128
Dina O. Eriksen, Louise Krog, Eva B. Ostenfeld, Pernille T. Jensen, Kathrine D. Lycke, Therese K. Grønborg, Nicolas Wentzensen, Megan A. Clarke, Anne Hammer

Introduction

Human papillomavirus (HPV) vaccination is associated with a significantly reduced risk of cervical cancer when administered before initial exposure to HPV. Women with high-grade cervical intraepithelial neoplasia (CIN) have an increased risk of subsequent HPV-related disease, including recurrent high-grade CIN, compared to women without CIN. Some clinicians have advised women with high-grade CIN to undergo HPV vaccination to reduce their subsequent risk, despite a lack of evidence for this practice. We aimed to evaluate whether HPV vaccination of women undergoing active surveillance for CIN grade 2 (CIN2) is associated with a decreased risk of progression to cervical intraepithelial neoplasia grade 3 or worse (CIN3+).

Material and Methods

We conducted a nationwide population-based historical cohort study in Denmark on women aged 18–40 years undergoing active surveillance for CIN2 from 2007 to 2020. We compared women receiving at least one HPV vaccine dose within 6 months after their CIN2 diagnosis to women not receiving the vaccine. Our primary outcome was progression to CIN3+. We stratified by age at CIN2 diagnosis (18–29, 30–40), calendar year (2007–2012, 2013–2020), and index cytology (high-grade, nonhigh-grade). We used Cox proportional hazards regression to estimate hazard ratios of the outcomes with unvaccinated women as the reference. Age at diagnosis, calendar year, index cytology, income, and educational level were adjusted for.

Results

We included 4585 women, of whom 583 (12.7%) were vaccinated within 6 months after CIN2 diagnosis. A total of 1391 (30.3%) progressed to CIN3+ during follow-up. The 5-year cumulative risk was 29.9% (28.5–31.3). Overall, no protective effect of vaccination after CIN2 diagnosis was found (aHR 1.45 [1.24–1.69]). Stratified analyses showed increased progression risk with vaccination among women <30 years, in the early calendar period (2007–2012), and across both non-high-grade and high-grade index cytology; no significant difference in risk was observed in women ≥30 years or in the latest calendar period (2013–2020).

Conclusions

HPV vaccination did not reduce the risk of progression in women undergoing active surveillance for CIN2. This finding indicates that HPV vaccination should not be recommended in this group of women.

导言:人乳头瘤病毒(HPV)疫苗接种与宫颈癌风险显著降低相关,如果在初次接触HPV之前接种。与没有宫颈上皮内瘤变(CIN)的妇女相比,宫颈高度上皮内瘤变(CIN)的妇女发生hpv相关疾病的风险增加,包括复发的高度宫颈上皮内瘤变。一些临床医生建议患有高度CIN的妇女接种HPV疫苗以降低其随后的风险,尽管缺乏证据支持这种做法。我们的目的是评估接受CIN2级(CIN2)主动监测的妇女接种HPV疫苗是否与进展为宫颈上皮内瘤变3级或更糟(CIN3+)的风险降低相关。材料和方法:我们在丹麦进行了一项以全国人口为基础的历史队列研究,研究对象为年龄在18-40岁之间的女性,2007年至2020年期间接受了CIN2的主动监测。我们比较了在CIN2诊断后6个月内接受至少一剂HPV疫苗的妇女和未接受疫苗的妇女。我们的主要结局是进展到CIN3+。我们根据CIN2诊断时的年龄(18-29岁、30-40岁)、日历年(2007-2012年、2013-2020年)和指标细胞学(高级别、非高级别)进行分层。我们使用Cox比例风险回归来估计未接种疫苗的妇女作为参考的结果的风险比。诊断年龄、日历年、细胞学指标、收入和教育水平进行了调整。结果:我们纳入了4585名女性,其中583名(12.7%)在CIN2诊断后6个月内接种了疫苗。随访期间,1391例(30.3%)进展为CIN3+。5年累积风险为29.9%(28.5-31.3)。总体而言,诊断为CIN2后未发现接种疫苗的保护作用(aHR 1.45[1.24-1.69])。分层分析显示接种HPV疫苗的女性进展风险增加。结论:HPV疫苗接种并没有降低接受CIN2主动监测的女性的进展风险。这一发现表明不应建议在这组妇女中接种HPV疫苗。
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引用次数: 0
Impact of episiotomy on anal incontinence following second- to fourth-degree perineal tears-A cohort study. 会阴切开对二至四度会阴撕裂后肛门失禁的影响——一项队列研究。
IF 3.1 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-01 DOI: 10.1111/aogs.70124
Mette L Josefsson, Eva Uustal, Sara Sohlberg, Cecilia Ekéus, Erik Lampa, Maria Jonsson

Introduction: Anal incontinence can have a significant negative impact on quality of life. The leading cause of anal incontinence among women of child-bearing age is obstetric-related perineal injury. The objective of this study was to examine the impact of episiotomy on the incidence of anal incontinence among primiparous women with second-, third-, or fourth-degree perineal tears at 8 weeks and 1 year postpartum and to assess change in incidence over time across varying degrees of perineal tears.

Material and methods: This Swedish cohort study included 12 658 primiparous women who sustained a second- (n = 5309), third- (n = 6771), or fourth-degree tear (n = 578), either spontaneously or in association with an episiotomy, between 2014 and 2019. Data were collected from national health and quality registers. The primary outcomes assessed were fecal and gas incontinence at 1 year postpartum. Secondary outcomes included lifestyle alteration and Wexner score. Logistic regression analyses were performed, and results were presented as odds ratios (ORs) with 95% confidence intervals (CIs), using spontaneous tear as the reference group. Models were adjusted for age, body mass index, prepregnancy diabetes, gestational age, mode of delivery, length of the second stage, fetal presentation, birth weight, and head circumference.

Results: The incidence of gas incontinence 1 year after second-, third-, or fourth-degree tears was 11.0%, 23.6%, and 37.8%, respectively. The incidence of fecal incontinence was 1.8%, 5.2%, and 14.5% for loose stool, and 0.8%, 2.1%, and 6.6% for solid stool, respectively. Women with a second-degree tear and episiotomy had an adjusted OR of 1.26 (95% CI 1.02-1.55) for gas incontinence and 1.38 (95% CI 0.90-2.10) for fecal incontinence at 1 year postpartum. Episiotomy did not increase the risk of anal incontinence among women with third-degree and fourth-degree tears. Anal incontinence, lifestyle changes, and Wexner score decreased over time across all types of tears.

Conclusions: Anal incontinence increases with the severity of perineal tears; however, the risk of incontinence is primarily determined by the grade of injury rather than the presence or absence of an episiotomy. Symptoms decline over time across all degrees of tears.

肛门失禁会对生活质量产生显著的负面影响。育龄妇女肛门失禁的主要原因是产科相关的会阴损伤。本研究的目的是研究会阴切开术对产后8周和1年伴有二度、三度或四度会阴撕裂的初产妇肛门失禁发生率的影响,并评估不同程度会阴撕裂的发生率随时间的变化。材料和方法:这项瑞典队列研究包括12658名初产妇女,她们在2014年至2019年期间自发或与会阴切开术相关地遭受了二度撕裂(n = 5309)、三度撕裂(n = 6771)或四度撕裂(n = 578)。数据是从国家卫生和质量登记处收集的。评估的主要结果是产后1年的大便和气体失禁。次要结局包括生活方式改变和Wexner评分。进行逻辑回归分析,以自发性撕裂为参照组,结果以95%置信区间(ci)的优势比(ORs)表示。模型根据年龄、体重指数、孕前糖尿病、胎龄、分娩方式、第二阶段长度、胎儿表现、出生体重和头围进行调整。结果:二度、三度、四度撕裂1年后气体失禁的发生率分别为11.0%、23.6%和37.8%。大便失禁的发生率,稀便组分别为1.8%、5.2%、14.5%,实便组分别为0.8%、2.1%、6.6%。二度撕裂和会阴切开的妇女产后1年气体失禁的调整OR为1.26 (95% CI 1.02-1.55),大便失禁的调整OR为1.38 (95% CI 0.90-2.10)。会阴切开术并没有增加三度和四度撕裂的女性发生肛门失禁的风险。随着时间的推移,肛门失禁、生活方式的改变和Wexner评分在所有类型的眼泪中都有所下降。结论:肛门失禁随会阴撕裂程度的加重而加重;然而,失禁的风险主要取决于损伤的程度,而不是是否进行会阴切开术。随着时间的推移,所有程度的眼泪症状都会减轻。
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引用次数: 0
Hemodynamic changes in pregnancies with impaired fetal growth: A systematic review and meta-analysis 胎儿生长受损妊娠的血流动力学改变:一项系统回顾和荟萃分析。
IF 3.1 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-12-31 DOI: 10.1111/aogs.70102
Britt M. J. G. Kempener, Laura M. Jorissen, Eva G. Mulder, Chahinda Ghossein-Doha, Joris van Drongelen, Ralph R. Scholten, Christoph C. Lees, Sander de Haas, Emma B. N. J. Janssen, Marc E. A. Spaanderman

Introduction

Abnormalities in central hemodynamic functions before and throughout pregnancy may antedate impaired fetal growth. We aimed to assess cardiac output (CO) and total peripheral vascular resistance (TPVR) trajectories throughout singleton pregnancies with and without impaired fetal growth by systematic review and meta-analysis.

Material and Methods

PubMed and Embase were systematically searched (inception – July 2023), and reference lists were screened. Studies reporting CO and TPVR during singleton pregnancies complicated by impaired fetal growth were included. Studies measuring hemodynamic parameters in women with prepregnancy hypertension and/or cardiac diseases were excluded. Absolute values of hemodynamic parameters were calculated over pregnancy using a random-effects model, and subgroup analyses differentiated more severe clinical phenotypes of impaired fetal growth. The systematic review was registered in the PROSPERO database (CRD42020172252).

Results

Thirty-three studies were included, comprising 7816 women. Hemodynamic function in non-pregnant women did not differ between those who subsequently gave birth to a growth-restricted neonate or an appropriately grown neonate. Pregnancies complicated by impaired fetal growth were accompanied by elevated second and third-trimester TPVR and concurrent reduced third-trimester CO. Second and third-trimester TPVR was consistently higher when fetal growth restriction was accompanied by abnormal perfusion indices instead of only low birthweight (centile), concurrent maternal hypertensive disorder of pregnancy, and when small for gestational age was accompanied by preterm birth.

Conclusions

Impaired fetal growth is associated with increased vascular resistance and reduced CO from the second trimester onwards. More severe phenotypes, particularly those with attenuated placental perfusion or lower gestational age at birth, exhibit the most vasoconstrictive hemodynamic profile. Future studies could focus on targeted preventive measures to restore hemodynamic function.

导语:妊娠前和妊娠期间的中枢血流动力学功能异常可能早于胎儿生长受损。我们的目的是通过系统回顾和荟萃分析,评估心输出量(CO)和总外周血管阻力(TPVR)在单胎妊娠有无胎儿生长受损的轨迹。材料和方法:系统检索PubMed和Embase(创建至2023年7月),筛选参考文献列表。研究报告CO和TPVR在单胎妊娠合并胎儿生长受损。在妊娠前高血压和/或心脏病妇女中测量血流动力学参数的研究被排除在外。使用随机效应模型计算妊娠期间血流动力学参数的绝对值,并通过亚组分析区分胎儿生长受损的更严重的临床表型。该系统评价已在PROSPERO数据库注册(CRD42020172252)。结果:纳入33项研究,包括7816名女性。未怀孕妇女的血液动力学功能在随后生下生长受限的新生儿和正常生长的新生儿之间没有差异。妊娠合并胎儿生长受损时,妊娠中期和妊娠晚期TPVR升高,同时妊娠晚期CO降低。妊娠中期和妊娠晚期TPVR持续升高,当胎儿生长受限伴灌注指数异常,而不仅仅是低出生体重(百分数),同时伴有妊娠高血压疾病,以及胎龄小伴早产时。结论:胎儿生长受损与妊娠中期起血管阻力增加和CO降低有关。更严重的表型,特别是那些胎盘灌注减弱或出生时胎龄较低的,表现出最严重的血管收缩血流动力学特征。未来的研究可侧重于有针对性的预防措施,以恢复血流动力学功能。
{"title":"Hemodynamic changes in pregnancies with impaired fetal growth: A systematic review and meta-analysis","authors":"Britt M. J. G. Kempener,&nbsp;Laura M. Jorissen,&nbsp;Eva G. Mulder,&nbsp;Chahinda Ghossein-Doha,&nbsp;Joris van Drongelen,&nbsp;Ralph R. Scholten,&nbsp;Christoph C. Lees,&nbsp;Sander de Haas,&nbsp;Emma B. N. J. Janssen,&nbsp;Marc E. A. Spaanderman","doi":"10.1111/aogs.70102","DOIUrl":"10.1111/aogs.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Abnormalities in central hemodynamic functions before and throughout pregnancy may antedate impaired fetal growth. We aimed to assess cardiac output (CO) and total peripheral vascular resistance (TPVR) trajectories throughout singleton pregnancies with and without impaired fetal growth by systematic review and meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>PubMed and Embase were systematically searched (inception – July 2023), and reference lists were screened. Studies reporting CO and TPVR during singleton pregnancies complicated by impaired fetal growth were included. Studies measuring hemodynamic parameters in women with prepregnancy hypertension and/or cardiac diseases were excluded. Absolute values of hemodynamic parameters were calculated over pregnancy using a random-effects model, and subgroup analyses differentiated more severe clinical phenotypes of impaired fetal growth. The systematic review was registered in the PROSPERO database (CRD42020172252).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-three studies were included, comprising 7816 women. Hemodynamic function in non-pregnant women did not differ between those who subsequently gave birth to a growth-restricted neonate or an appropriately grown neonate. Pregnancies complicated by impaired fetal growth were accompanied by elevated second and third-trimester TPVR and concurrent reduced third-trimester CO. Second and third-trimester TPVR was consistently higher when fetal growth restriction was accompanied by abnormal perfusion indices instead of only low birthweight (centile), concurrent maternal hypertensive disorder of pregnancy, and when small for gestational age was accompanied by preterm birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Impaired fetal growth is associated with increased vascular resistance and reduced CO from the second trimester onwards. More severe phenotypes, particularly those with attenuated placental perfusion or lower gestational age at birth, exhibit the most vasoconstrictive hemodynamic profile. Future studies could focus on targeted preventive measures to restore hemodynamic function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"215-224"},"PeriodicalIF":3.1,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pelvic pain and lower urinary tract symptoms; long-term comparison between women with and without mid-urethral sling insertion. 盆腔疼痛和下尿路症状;有和没有中尿道吊带插入的妇女的长期比较。
IF 3.1 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-12-30 DOI: 10.1111/aogs.70079
Anna Lundmark Drca, Vasileios Alexandridis, Marie Westergren Söderberg, Pia Teleman, Marion Ek

Introduction: Stress urinary incontinence is the most prevalent type of incontinence among women, with mid-urethral sling (MUS) surgery considered the gold standard surgical treatment. Despite its widespread use, the role of mesh in this procedure has sparked controversy over the past decade. The primary objective of this study was to compare pelvic pain in women who have undergone MUS surgery with those who have not. The secondary objective was to evaluate lower urinary tract symptoms in both groups.

Material and methods: This prospective cohort study included Swedish women who underwent MUS surgery between 2006 and 2010 and were registered in the GynOp database, and a reference group of Swedish women without MUS, self-registered in Lifegene, a national cohort launched in 2009. The women completed the Urogenital Distress Inventory questionnaire-6 (UDI-6) assessing pelvic pain and lower urinary tract symptoms, administered ~10 years after MUS surgery or at matched ages.

Results: Pelvic pain was analyzed at least 10 years post-MUS surgery and in the reference group at matched ages. Significant differences in pelvic pain were observed among women aged ≥50 years. Logistic regression analysis, incorporating an interaction between MUS surgery and age, revealed adjusted odds ratios (aOR) for pelvic pain among women with MUS as follows: 0.82 (CI: 0.51-1.31) for women aged <50 years, 1.79 (CI: 1.13-2.42) for women aged 50-59 years, 1.85 (CI: 1.13-3.00) for women aged 60-69 years, and 2.08 (CI: 1.30-3.32) for women ≥70 years. Women with previous MUS surgery reported higher UDI-6 scores, indicating more bothersome lower urinary tract symptoms, except among those aged <50 years, compared with the reference group.

Conclusions: Women aged 50 years or older, who have undergone MUS surgery ≥10 years earlier, report more frequent pelvic pain and lower urinary tract symptoms than those who have not undergone MUS surgery. Whether this is related to the MUS surgery or an expression of a progressing pelvic floor dysfunction is unclear.

简介:压力性尿失禁是女性中最常见的尿失禁类型,尿道中悬吊(MUS)手术被认为是金标准的手术治疗。尽管其广泛使用,网状物在这个过程中的作用在过去的十年中引发了争议。本研究的主要目的是比较盆腔疼痛的妇女谁接受了MUS手术和那些没有。次要目的是评估两组患者的下尿路症状。材料和方法:这项前瞻性队列研究包括2006年至2010年间接受MUS手术并在GynOp数据库中注册的瑞典妇女,以及2009年启动的国家队列Lifegene中自行注册的瑞典无MUS妇女的参考组。这些女性完成了泌尿生殖窘迫问卷-6 (UDI-6),评估盆腔疼痛和下尿路症状,在MUS手术后约10年或在匹配的年龄。结果:盆腔疼痛分析了mus手术后至少10年和参照组在匹配年龄。年龄≥50岁的女性在盆腔疼痛方面存在显著差异。纳入MUS手术与年龄之间相互作用的Logistic回归分析显示,老年女性盆腔疼痛的调整优势比(aOR)如下:0.82 (CI: 0.51-1.31)。结论:50岁及以上、≥10年前接受过MUS手术的女性盆腔疼痛和下尿路症状比未接受过MUS手术的女性更频繁。这是否与MUS手术或进展的盆底功能障碍的表达有关尚不清楚。
{"title":"Pelvic pain and lower urinary tract symptoms; long-term comparison between women with and without mid-urethral sling insertion.","authors":"Anna Lundmark Drca, Vasileios Alexandridis, Marie Westergren Söderberg, Pia Teleman, Marion Ek","doi":"10.1111/aogs.70079","DOIUrl":"https://doi.org/10.1111/aogs.70079","url":null,"abstract":"<p><strong>Introduction: </strong>Stress urinary incontinence is the most prevalent type of incontinence among women, with mid-urethral sling (MUS) surgery considered the gold standard surgical treatment. Despite its widespread use, the role of mesh in this procedure has sparked controversy over the past decade. The primary objective of this study was to compare pelvic pain in women who have undergone MUS surgery with those who have not. The secondary objective was to evaluate lower urinary tract symptoms in both groups.</p><p><strong>Material and methods: </strong>This prospective cohort study included Swedish women who underwent MUS surgery between 2006 and 2010 and were registered in the GynOp database, and a reference group of Swedish women without MUS, self-registered in Lifegene, a national cohort launched in 2009. The women completed the Urogenital Distress Inventory questionnaire-6 (UDI-6) assessing pelvic pain and lower urinary tract symptoms, administered ~10 years after MUS surgery or at matched ages.</p><p><strong>Results: </strong>Pelvic pain was analyzed at least 10 years post-MUS surgery and in the reference group at matched ages. Significant differences in pelvic pain were observed among women aged ≥50 years. Logistic regression analysis, incorporating an interaction between MUS surgery and age, revealed adjusted odds ratios (aOR) for pelvic pain among women with MUS as follows: 0.82 (CI: 0.51-1.31) for women aged <50 years, 1.79 (CI: 1.13-2.42) for women aged 50-59 years, 1.85 (CI: 1.13-3.00) for women aged 60-69 years, and 2.08 (CI: 1.30-3.32) for women ≥70 years. Women with previous MUS surgery reported higher UDI-6 scores, indicating more bothersome lower urinary tract symptoms, except among those aged <50 years, compared with the reference group.</p><p><strong>Conclusions: </strong>Women aged 50 years or older, who have undergone MUS surgery ≥10 years earlier, report more frequent pelvic pain and lower urinary tract symptoms than those who have not undergone MUS surgery. Whether this is related to the MUS surgery or an expression of a progressing pelvic floor dysfunction is unclear.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessing signal loss, accuracy, and acceptability of an ambulatory fetal electrocardiography with cardiotocography in the antepartum and intrapartum phases 评估信号丢失,准确性和可接受的动态胎儿心电图与产前和产时阶段的心脏摄影。
IF 3.1 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2025-12-30 DOI: 10.1111/aogs.70113
Marie Min Tse Tan, Kirsten Jie Ying Ong, Michelle Mei Ying Tiong, Rehena Sultana, Chuyen Luong, Serene Thain, Devendra Kanagalingam, Jerry Kok Yen Chan, See Ling Loy, Chee Wai Ku
<div> <section> <h3> Introduction</h3> <p>Electronic fetal heart rate (FHR) monitoring is integral to antepartum and intrapartum care to detect fetal compromise, reducing neonatal morbidity and mortality. Conventional wired cardiotocography (CTG) limits mobility, birthing positions, and potentially increases instrumental births. Wireless non-invasive fetal electrocardiography (NIFECG) aims to address these challenges. However, NIFECG has limitations, including signal interference and limited accuracy data for FHR and uterine contraction (UC) monitoring. This study aimed to (i) quantify acceptable NIFECG traces based on signal loss in women ≥37 weeks' gestation; (ii) compare FHR and UC monitoring accuracy between NIFECG and CTG; (iii) and assess NIFECG acceptability.</p> </section> <section> <h3> Material and Methods</h3> <p>A prospective cohort involving women with singleton pregnancies ≥37 weeks’ gestation was conducted between August 2020 and April 2023 in KK Women's and Children's Hospital, Singapore. Women underwent 40 min of concurrent NIFECG and CTG monitoring during antepartum and intrapartum phases. Data were compared in 3.75-s epochs. Based on the International Federation of Gynecology and Obstetrics guidelines, NIFECG traces with signal loss ≤20% were accepted. FHR monitoring accuracy was assessed using Bland–Altman and Passing–Bablok regression analyses. UC monitoring accuracy was determined by a fourfold contingency table with CTG as a gold standard. Acceptability was assessed via post-monitoring feedback questionnaire.</p> </section> <section> <h3> Results</h3> <p>One hundred and three women contributed to 124 paired traces. Seventy-three traces (58.9%) were acceptable, comprising 52 antepartum (56.5%) and 21 intrapartum traces (65.6%). Bland–Altman (bias: −0.4 beats per minute, 95% limits of agreement: [−9.0, 8.1]) and Passing–Bablok (slope = 0.97, 95% confidence interval (CI) 0.97–0.98) analyses showed high agreement between NIFECG and CTG FHR measurements. NIFECG showed a specificity of 0.96 (95% CI 0.94–0.97) and sensitivity of 0.90 (95% CI 0.89–0.92) for UC monitoring. Additionally, 90.1% of women and 88.9% of nurses preferred NIFECG.</p> </section> <section> <h3> Conclusions</h3> <p>NIFECG has comparable accuracy to CTG for FHR and UC monitoring during the antepartum and intrapartum phases and is well-accepted by women and nurses. Given that 41.1% of NIFECG traces were rejected due to signal loss, further research on improving the technology to reduce signal loss, and re-evaluating the criteria for rejecting traces is vital to ac
电子胎心率(FHR)监测是不可或缺的产前和产时护理,以发现胎儿损害,降低新生儿发病率和死亡率。传统的有线心脏造影(CTG)限制了机动性,分娩姿势,并可能增加器械分娩。无线无创胎儿心电图(NIFECG)旨在解决这些挑战。然而,NIFECG有其局限性,包括信号干扰和监测FHR和子宫收缩(UC)数据的准确性有限。本研究旨在(i)量化妊娠≥37周妇女信号丢失的可接受NIFECG痕迹;(ii)比较NIFECG和CTG监测FHR和UC的准确性;(iii)评估NIFECG的可接受性。材料和方法:2020年8月至2021年6月,在新加坡KK妇女儿童医院对单胎妊娠≥37周的妇女进行了前瞻性队列研究。妇女在产前和产时同时进行40分钟的NIFECG和CTG监测。数据以3.75-s为周期进行比较。根据国际妇产科联合会指南,接受信号损失≤20%的NIFECG迹线。采用Bland-Altman和Passing-Bablok回归分析评估FHR监测准确性。以CTG为金标准,采用四重列联表确定UC监测精度。通过监测后反馈问卷评估可接受性。结果:103名女性贡献了124个配对痕迹。其中产前52例(56.5%),产时21例(65.6%),可接受73例(58.9%)。Bland-Altman(偏差:-0.4次/分钟,95%一致性限:[-9.0,8.1])和Passing-Bablok(斜率= 0.97,95%可信区间(CI) 0.97-0.98)分析显示NIFECG和CTG FHR测量结果高度一致。NIFECG监测UC的特异性为0.96 (95% CI 0.94-0.97),敏感性为0.90 (95% CI 0.89-0.92)。此外,90.1%的女性和88.9%的护士更倾向于使用NIFECG。结论:NIFECG在产前和产时监测FHR和UC的准确性与CTG相当,被妇女和护士广泛接受。鉴于41.1%的NIFECG导线因信号丢失而被拒绝,进一步研究改进技术以减少信号丢失,并重新评估拒绝导线的标准对于实现NIFECG更广泛的临床应用至关重要。
{"title":"Assessing signal loss, accuracy, and acceptability of an ambulatory fetal electrocardiography with cardiotocography in the antepartum and intrapartum phases","authors":"Marie Min Tse Tan,&nbsp;Kirsten Jie Ying Ong,&nbsp;Michelle Mei Ying Tiong,&nbsp;Rehena Sultana,&nbsp;Chuyen Luong,&nbsp;Serene Thain,&nbsp;Devendra Kanagalingam,&nbsp;Jerry Kok Yen Chan,&nbsp;See Ling Loy,&nbsp;Chee Wai Ku","doi":"10.1111/aogs.70113","DOIUrl":"10.1111/aogs.70113","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Electronic fetal heart rate (FHR) monitoring is integral to antepartum and intrapartum care to detect fetal compromise, reducing neonatal morbidity and mortality. Conventional wired cardiotocography (CTG) limits mobility, birthing positions, and potentially increases instrumental births. Wireless non-invasive fetal electrocardiography (NIFECG) aims to address these challenges. However, NIFECG has limitations, including signal interference and limited accuracy data for FHR and uterine contraction (UC) monitoring. This study aimed to (i) quantify acceptable NIFECG traces based on signal loss in women ≥37 weeks' gestation; (ii) compare FHR and UC monitoring accuracy between NIFECG and CTG; (iii) and assess NIFECG acceptability.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Material and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A prospective cohort involving women with singleton pregnancies ≥37 weeks’ gestation was conducted between August 2020 and April 2023 in KK Women's and Children's Hospital, Singapore. Women underwent 40 min of concurrent NIFECG and CTG monitoring during antepartum and intrapartum phases. Data were compared in 3.75-s epochs. Based on the International Federation of Gynecology and Obstetrics guidelines, NIFECG traces with signal loss ≤20% were accepted. FHR monitoring accuracy was assessed using Bland–Altman and Passing–Bablok regression analyses. UC monitoring accuracy was determined by a fourfold contingency table with CTG as a gold standard. Acceptability was assessed via post-monitoring feedback questionnaire.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;One hundred and three women contributed to 124 paired traces. Seventy-three traces (58.9%) were acceptable, comprising 52 antepartum (56.5%) and 21 intrapartum traces (65.6%). Bland–Altman (bias: −0.4 beats per minute, 95% limits of agreement: [−9.0, 8.1]) and Passing–Bablok (slope = 0.97, 95% confidence interval (CI) 0.97–0.98) analyses showed high agreement between NIFECG and CTG FHR measurements. NIFECG showed a specificity of 0.96 (95% CI 0.94–0.97) and sensitivity of 0.90 (95% CI 0.89–0.92) for UC monitoring. Additionally, 90.1% of women and 88.9% of nurses preferred NIFECG.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;NIFECG has comparable accuracy to CTG for FHR and UC monitoring during the antepartum and intrapartum phases and is well-accepted by women and nurses. Given that 41.1% of NIFECG traces were rejected due to signal loss, further research on improving the technology to reduce signal loss, and re-evaluating the criteria for rejecting traces is vital to ac","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"327-335"},"PeriodicalIF":3.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Acta Obstetricia et Gynecologica Scandinavica
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