Lise Qvirin Krogh, Tine Brink Henriksen, Katja Albert Taastrøm, Sidsel Boie, Anne Cathrine Maqving Kjeldsen, Jim Thornton, Jens Fuglsang, Julie Glavind
Introduction
Induction of labor (IOL) is a common intervention in industrialized countries. Failed induction is frequently reported, yet there is no consensus on its definition. Since the primary goal of IOL is to initiate labor, progress to the active phase is a more relevant measure of success than the surrogate of caesarean birth. Previous studies on the influence of body mass index (BMI) on the risk of failed IOL are limited. Most rely on data from the United States and define failed IOL primarily by caesarean delivery. This study aims to explore the association between maternal BMI and failed IOL, defined as failure to progress to the active phase of labor.
Material and Methods
We studied 22 114 term, singleton women undergoing IOL in the Central Denmark Region from 2013 to 2022. Women with spontaneous prelabor rupture of membranes, uterine scar, or fetal demise were excluded. The main outcome measure was failed IOL, defined as not reaching cervical dilation of 6 cm or more. BMI, our exposure, was modeled as a continuous variable using restricted cubic splines and as a categorical variable stratified according to the World Health Organization BMI groups. Adjusted logistic regression was used in both models to assess the association between BMI and failed IOL.
Results
Proportions of nulliparous women with failed IOL ranged between 4% for normal weight and 10% for obesity class III. Adjusted odds ratios for nulliparous women for failed IOL were 1.5 (95% confidence intervals [CI] 1.3, 1.7) for overweight, 1.8 (95% CI 1.4, 2.3) for obesity class I, 2.7 (95% CI 2.2, 3.3) for obesity class II, and 2.9 (95% CI 1.4, 6.0) for obesity class III compared to women with normal weight. In parous women, there was a similar but less pronounced association between BMI and failed IOL with a <2% absolute risk of failed IOL. A similar pattern was found when BMI and failed IOL were modeled using restricted cubic splines.
Conclusions
In singleton women with induced labor at term, increasing BMI was associated with higher odds of failed IOL; this association was more pronounced in nulliparous women.
导言：人工引产（IOL）是工业化国家常见的干预措施。归纳失败的报道屡见不鲜，但对其定义尚无共识。由于人工晶状体的主要目标是启动分娩，进展到活跃期是比代孕或剖腹产更相关的成功衡量标准。以往关于身体质量指数（BMI）对人工晶状体失败风险影响的研究较少。大多数依赖于美国的数据，并主要通过剖腹产来定义失败的人工晶状体。本研究旨在探讨母体BMI与IOL失败的关系，IOL失败定义为未能进入产程主动期。材料和方法：我们研究了2013年至2022年在丹麦中部地区接受人工晶状体植入术的22 114例妊娠期单胎妇女。排除了自发性产前胎膜破裂、子宫瘢痕或胎儿死亡的妇女。主要观察指标为人工晶状体植入失败，定义为宫颈扩张未达到或大于6cm。BMI，我们的暴露，被建模为使用受限三次样条的连续变量，并作为分类变量根据世界卫生组织BMI组分层。两个模型均采用调整后的逻辑回归来评估BMI与人工晶状体失败之间的关系。结果：未生育女性人工晶状体失败的比例在正常体重的4%和肥胖III级的10%之间。与体重正常的女性相比，未生育女性人工晶界失败的校正优势比为：超重1.5(95%可信区间[CI] 1.3, 1.7)，肥胖I级1.8(95%可信区间[CI] 1.4, 2.3)，肥胖II级2.7 (95% CI 2.2, 3.3)，肥胖III级2.9 （95% CI 1.4, 6.0）。在已产妇女中，BMI与人工晶状体植入失败之间存在类似但不太明显的关联。结论：在足月引产的单胎妇女中，BMI升高与人工晶状体植入失败的几率较高相关；这种关联在未生育妇女中更为明显。
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Elisabeth R. Knorren, Joke M. Schutte, Judith A. F. Huirne, Martijn F. Boomsma
<p>With great interest, we read the original article by Otonkoski et al.<span><sup>1</sup></span> This prominent Finnish research group on magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) showed remarkable improvement in clinical outcomes for patients with symptomatic uterine fibroids. Significant symptom relief was reported from 3 months post-treatment, persisting up to 12 months. Additionally, they reported an impressively low reintervention rate of 2% after 12 months.</p><p>Several predictive factors for MR-HIFU treatment success are already known, but a universally accepted, well-designed prediction tool is not yet available. This makes the authors' reported outcomes after what they describe as “meticulous screening” especially noteworthy. Nevertheless, only a rather brief and freely interpretable screening protocol is provided by the authors, corresponding to other available screening protocols.<span><sup>2-4</sup></span> This makes it impossible to exactly understand what “meticulous screening” entails, which is needed to replicate their results.</p><p>We believe that determining eligibility for MR-HIFU treatment largely depends on the hands-on experience and intuition of physicians. Therefore, we call upon all MR-HIFU communities to report their screening considerations in greater detail, including considerations regarding patient- and fibroid-specific characteristics on both ultrasound and MRI. More transparent documentation of inclusion and exclusion decisions would add nuance to reported clinical outcomes and guidance for the community to move forward.</p><p>Emphasizing that every patient case is unique and must be assessed individually, a shared understanding of screening criteria is nevertheless essential for developing an optimal protocol. By pooling insights from different centers, we can work toward a minimum standard of care, ensuring consistent treatment quality and better global outcomes for fibroid patients.</p><p>In this context, some nuance is also required in interpreting “meticulous screening.” We agree with the authors that screening is vital in reaching favorable clinical outcomes. However, we believe there is a delicate balance. Too restrictive screening limits clinical adoption, while too liberal inclusion results in poor clinical outcomes. Therefore, the real challenge, in our opinion, lies in defining this balance, optimizing both effectiveness and clinical adoption.</p><p>In conclusion, Otonkonski et al. have done excellent work for the MR-HIFU community, but more can be learned from their results by gaining insight into their considerations regarding screening during the study period. This knowledge is key to refining protocols, ensuring high-quality outcomes, and advancing MR-HIFU as a reliable treatment option for symptomatic fibroids worldwide.</p><p><b>Elisabeth R. Knorren:</b> Writing – original draft, <b>Joke M. Schutte:</b> Writing – review and editing, <b>Judith A. F. Huirne:</b> Writing
带着极大的兴趣，我们阅读了Otonkoski等人的原始文章1。这个芬兰著名的研究小组在磁共振引导下的高强度聚焦超声（MR-HIFU）方面的研究表明，有症状的子宫肌瘤患者的临床结果有显著改善。治疗后3个月症状明显缓解，持续12个月。此外，他们报告了12个月后2%的再干预率，令人印象深刻。MR-HIFU治疗成功的几个预测因素已经为人所知，但目前还没有一个普遍接受的、设计良好的预测工具。这使得作者在经过他们所谓的“细致筛选”后报告的结果特别值得注意。然而，作者只提供了一个相当简短和可自由解释的筛选方案，与其他可用的筛选方案相对应。2-4这使得我们不可能确切地理解“细致筛选”的含义，这是复制他们的结果所需要的。我们认为，确定MR-HIFU治疗的资格在很大程度上取决于医生的实践经验和直觉。因此，我们呼吁所有MR-HIFU社区更详细地报告他们的筛查考虑，包括超声和MRI对患者和子宫肌瘤特异性特征的考虑。更透明的纳入和排除决定文件将为报告的临床结果增加细微差别，并为社区前进提供指导。强调每个病例都是独特的，必须单独评估，但对筛查标准的共同理解对于制定最佳方案至关重要。通过汇集来自不同中心的见解，我们可以为纤维瘤患者制定最低标准的护理，确保一致的治疗质量和更好的全球结果。在这种情况下，在解释“细致筛选”时也需要一些细微的差别。我们同意作者的观点，筛查对于达到良好的临床结果至关重要。然而，我们相信存在一种微妙的平衡。过于严格的筛查限制了临床采用，而过于宽松的纳入导致临床结果不佳。因此，在我们看来，真正的挑战在于确定这种平衡，优化有效性和临床应用。总之，Otonkonski等人为MR-HIFU社区做了出色的工作，但通过深入了解他们在研究期间对筛查的考虑，可以从他们的结果中学到更多。这方面的知识是完善方案、确保高质量结果和推动MR-HIFU成为世界范围内症状性肌瘤可靠治疗选择的关键。Elisabeth R. Knorren：写作-原稿，Joke M. Schutte：写作-评论和编辑，Judith A. F. Huirne：写作-评论和编辑，Martijn F. Boomsma：写作-评论和编辑。数据共享不适用于本文，因为在当前研究期间没有生成或分析数据集。
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Giovanna Esposito, Anna Cantarutti, Matteo Franchi, Fedro Alessandro Peccatori, Giovanna Scarfone, Eva Negri, Giovanni Corrao, Fabio Parazzini, Carlo La Vecchia
<div> <section> <h3> Introduction</h3> <p>Fertility after cancer represents a growing clinical concern. This study assessed childbearing outcomes among women diagnosed with cancer during reproductive age between 2012 and 2017 in Lombardy, the largest region in Italy.</p> </section> <section> <h3> Material and Methods</h3> <p>Women aged 15–45 years with a primary diagnosis of cancer recorded in hospital discharge records from regional healthcare databases were selected. Each woman diagnosed with cancer was matched with up to five cancer-free women of the same age at diagnosis. The cumulative probability of childbirth up to December 31, 2022 was estimated using the Kalbfleisch–Prentice cumulative incidence function estimator. Cox regression models were used to estimate the cause-specific hazard ratios (HRs) and the 95% confidence intervals (CIs) of childbirth according to the cancer diagnosis. Furthermore, in the group of cancer survivors, exposure to antineoplastic treatment was considered and included in the model as a time-dependent covariate. Finally, a log-binomial regression model was used to assess the association between antineoplastic therapy and medically assisted reproduction.</p> </section> <section> <h3> Results</h3> <p>A total of 13,877 women were diagnosed with cancer at reproductive age during the study period (1.16 per 1000 person-years). The cumulative probability of childbirth was lower among women diagnosed with cancer compared to cancer-free women across all age groups: 31.4% vs 32.2% (<i>p</i> = 0.02) among those diagnosed under 30, 13.3% vs 22.7% (<i>p</i> < 0.01) among those aged 30–39, and 0.8% vs 1.6% (<i>p</i> < 0.01) among those aged 40 and over. The corresponding HRs were 0.93 (95% CI: 0.83–1.05), 0.58 (95% CI: 0.53–0.64), and 0.52 (95% CI: 0.40–0.68). When analyses were stratified by time since diagnosis, the reduced probability among cancer survivors was confirmed to be significant only within the first 5 years after diagnosis, also for younger individuals. Antineoplastic treatment was associated with a reduced probability of subsequent birth (HR = 0.46, 95% CI: 0.39–0.52). Moreover, the therapy was positively associated with medically assisted reproduction (RR = 1.71, 95% CI: 1.14–2.56).</p> </section> <section> <h3> Conclusions</h3> <p>The probability of childbearing was reduced within the first 5 years of diagnosis, regardless of the patient's age. A more pronounced reduction was observed in women diagnosed after the age of 30. Age and antineoplastic therapy were key factors in determining childbearing in women
{"title":"Childbearing in women diagnosed with cancer during reproductive age","authors":"Giovanna Esposito, Anna Cantarutti, Matteo Franchi, Fedro Alessandro Peccatori, Giovanna Scarfone, Eva Negri, Giovanni Corrao, Fabio Parazzini, Carlo La Vecchia","doi":"10.1111/aogs.70071","DOIUrl":"10.1111/aogs.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Fertility after cancer represents a growing clinical concern. This study assessed childbearing outcomes among women diagnosed with cancer during reproductive age between 2012 and 2017 in Lombardy, the largest region in Italy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Women aged 15–45 years with a primary diagnosis of cancer recorded in hospital discharge records from regional healthcare databases were selected. Each woman diagnosed with cancer was matched with up to five cancer-free women of the same age at diagnosis. The cumulative probability of childbirth up to December 31, 2022 was estimated using the Kalbfleisch–Prentice cumulative incidence function estimator. Cox regression models were used to estimate the cause-specific hazard ratios (HRs) and the 95% confidence intervals (CIs) of childbirth according to the cancer diagnosis. Furthermore, in the group of cancer survivors, exposure to antineoplastic treatment was considered and included in the model as a time-dependent covariate. Finally, a log-binomial regression model was used to assess the association between antineoplastic therapy and medically assisted reproduction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 13,877 women were diagnosed with cancer at reproductive age during the study period (1.16 per 1000 person-years). The cumulative probability of childbirth was lower among women diagnosed with cancer compared to cancer-free women across all age groups: 31.4% vs 32.2% (<i>p</i> = 0.02) among those diagnosed under 30, 13.3% vs 22.7% (<i>p</i> < 0.01) among those aged 30–39, and 0.8% vs 1.6% (<i>p</i> < 0.01) among those aged 40 and over. The corresponding HRs were 0.93 (95% CI: 0.83–1.05), 0.58 (95% CI: 0.53–0.64), and 0.52 (95% CI: 0.40–0.68). When analyses were stratified by time since diagnosis, the reduced probability among cancer survivors was confirmed to be significant only within the first 5 years after diagnosis, also for younger individuals. Antineoplastic treatment was associated with a reduced probability of subsequent birth (HR = 0.46, 95% CI: 0.39–0.52). Moreover, the therapy was positively associated with medically assisted reproduction (RR = 1.71, 95% CI: 1.14–2.56).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The probability of childbearing was reduced within the first 5 years of diagnosis, regardless of the patient's age. A more pronounced reduction was observed in women diagnosed after the age of 30. Age and antineoplastic therapy were key factors in determining childbearing in women","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2309-2319"},"PeriodicalIF":3.1,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375522","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}
Sofie Gellert, Sara Norrestam, Alexandra Tidstedt, Claes Ignell, Per-Erik Isberg, Nana Wiberg, Linda Iorizzo
<div> <section> <h3> Introduction</h3> <p>This multicenter, prospective observational study aimed to evaluate the performance of the StatStrip<sup>®</sup> Lactate 2 (Nova Biomedical, Waltham, US) point-of-care device for fetal blood lactate measurement and to determine the corresponding lactate value equivalent to the established intervention cutoff used with the outgoing StatStrip<sup>®</sup> Lactate device.</p> </section> <section> <h3> Material and Methods</h3> <p>The study was conducted from August 2024 to February 2025 at two maternity clinics in Sweden and one in Denmark. It included women with singleton pregnancies (≥35 + 0 weeks) undergoing fetal blood sampling due to non-reassuring intrapartal fetal heart rate patterns during labor. Fetal scalp blood sampling (FBS) lactate concentrations were measured using both StatStrip<sup>®</sup> Lactate and StatStrip<sup>®</sup> Lactate2. The first StatStrip<sup>®</sup> Lactate measurement guided clinical decisions, while subsequent StatStrip<sup>®</sup> Lactate2 measurements were recorded for validation and establishment of a conversion equation by linear regression. Additionally, arterial and venous umbilical cord blood samples were analyzed by both ABL 800 (Radiometer, Denmark) and StatStrip<sup>®</sup> Lactate2 for validation.</p> </section> <section> <h3> Results</h3> <p>Blood samples from 349 fetuses were included, with 549 parallel FBS lactate samples. StatStrip<sup>®</sup> Lactate2 concentrations correlated with StatStrip<sup>®</sup> Lactate (<i>r</i> = 0.94;<i>p</i> ≤ 0.001). A conversion equation was retrieved: StatStrip<sup>®</sup> Lactate2 = (1.4 × StatStrip<sup>®</sup> Lactate) − 0.28. From 37 paired umbilical cord blood samples, the correlation between lactate concentrations by StatStrip<sup>®</sup> Lactate2 and ABL800 was <i>r</i> = 0.99 (<i>p</i> ≤ 0.001) in arterial blood and r = 0.98 (<i>p</i> ≤ 0.001) in venous blood. Mean coefficients of variation for lactate concentrations >3.0 mmol/L were 8.2% in fetal scalp blood and 3.8% in umbilical cord blood.</p> </section> <section> <h3> Conclusions</h3> <p>A fetal blood lactate concentration ≥7.0 mmol/L measured by StatStrip<sup>®</sup>Lactate2 corresponds to the established intervention cutoff lactate value ≥5.2 mmol/L measured by StatStrip<sup>®</sup>Lactate. Precision was acceptable but may be improved by using the mean of two measurements, particularly when the first result falls between 6.0 and 8.0 mmol/L. We also recommend ensuring the correct sampling techniques to minimize preanalytical variation.</p> </section>
{"title":"Validation and proposal of a clinical intervention cutoff in fetal scalp blood for the point-of care-lactate meter StatStrip®2","authors":"Sofie Gellert, Sara Norrestam, Alexandra Tidstedt, Claes Ignell, Per-Erik Isberg, Nana Wiberg, Linda Iorizzo","doi":"10.1111/aogs.70080","DOIUrl":"10.1111/aogs.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This multicenter, prospective observational study aimed to evaluate the performance of the StatStrip<sup>®</sup> Lactate 2 (Nova Biomedical, Waltham, US) point-of-care device for fetal blood lactate measurement and to determine the corresponding lactate value equivalent to the established intervention cutoff used with the outgoing StatStrip<sup>®</sup> Lactate device.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>The study was conducted from August 2024 to February 2025 at two maternity clinics in Sweden and one in Denmark. It included women with singleton pregnancies (≥35 + 0 weeks) undergoing fetal blood sampling due to non-reassuring intrapartal fetal heart rate patterns during labor. Fetal scalp blood sampling (FBS) lactate concentrations were measured using both StatStrip<sup>®</sup> Lactate and StatStrip<sup>®</sup> Lactate2. The first StatStrip<sup>®</sup> Lactate measurement guided clinical decisions, while subsequent StatStrip<sup>®</sup> Lactate2 measurements were recorded for validation and establishment of a conversion equation by linear regression. Additionally, arterial and venous umbilical cord blood samples were analyzed by both ABL 800 (Radiometer, Denmark) and StatStrip<sup>®</sup> Lactate2 for validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Blood samples from 349 fetuses were included, with 549 parallel FBS lactate samples. StatStrip<sup>®</sup> Lactate2 concentrations correlated with StatStrip<sup>®</sup> Lactate (<i>r</i> = 0.94;<i>p</i> ≤ 0.001). A conversion equation was retrieved: StatStrip<sup>®</sup> Lactate2 = (1.4 × StatStrip<sup>®</sup> Lactate) − 0.28. From 37 paired umbilical cord blood samples, the correlation between lactate concentrations by StatStrip<sup>®</sup> Lactate2 and ABL800 was <i>r</i> = 0.99 (<i>p</i> ≤ 0.001) in arterial blood and r = 0.98 (<i>p</i> ≤ 0.001) in venous blood. Mean coefficients of variation for lactate concentrations >3.0 mmol/L were 8.2% in fetal scalp blood and 3.8% in umbilical cord blood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A fetal blood lactate concentration ≥7.0 mmol/L measured by StatStrip<sup>®</sup>Lactate2 corresponds to the established intervention cutoff lactate value ≥5.2 mmol/L measured by StatStrip<sup>®</sup>Lactate. Precision was acceptable but may be improved by using the mean of two measurements, particularly when the first result falls between 6.0 and 8.0 mmol/L. We also recommend ensuring the correct sampling techniques to minimize preanalytical variation.</p>\u0000 </section>\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2273-2281"},"PeriodicalIF":3.1,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371998","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}
Roman Chmel Jr., Nikoleta Chubanovova, Jan Balko, Roman Chmel, Zlatko Pastor
Approximately 25 million people worldwide do not identify with the sex assigned at birth. Treatment options for gender dysphoria are multidisciplinary and include gender-affirming hormone therapy and surgery. Uterus transplantation in women without a uterus is promising for treating absolute uterine factor infertility, and its efficacy has been demonstrated through successful transplant surgeries and subsequent births via cesarean section following single embryo transfer. Transgender men undergoing gender-affirming hysterectomy to alleviate gender dysphoria symptoms should be considered as potential uterus donors for transplantation. Although transgender men show positive attitudes toward uterus donation to women with infertility, who do not have a uterus, long-term gender-affirming testosterone therapy induces uterine changes that necessitate assessment before donation for transplantation should be considered. This commentary highlights the major challenges associated with uterus donation by transgender men for transplantation.
{"title":"Transgender men as uterus donors for transplantation: A theoretical perspective","authors":"Roman Chmel Jr., Nikoleta Chubanovova, Jan Balko, Roman Chmel, Zlatko Pastor","doi":"10.1111/aogs.70086","DOIUrl":"10.1111/aogs.70086","url":null,"abstract":"<p>Approximately 25 million people worldwide do not identify with the sex assigned at birth. Treatment options for gender dysphoria are multidisciplinary and include gender-affirming hormone therapy and surgery. Uterus transplantation in women without a uterus is promising for treating absolute uterine factor infertility, and its efficacy has been demonstrated through successful transplant surgeries and subsequent births via cesarean section following single embryo transfer. Transgender men undergoing gender-affirming hysterectomy to alleviate gender dysphoria symptoms should be considered as potential uterus donors for transplantation. Although transgender men show positive attitudes toward uterus donation to women with infertility, who do not have a uterus, long-term gender-affirming testosterone therapy induces uterine changes that necessitate assessment before donation for transplantation should be considered. This commentary highlights the major challenges associated with uterus donation by transgender men for transplantation.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2210-2214"},"PeriodicalIF":3.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342605","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}
Reut Rotem, Craven Simon, Misgav Rottenstreich, Barry A O'reilly, Adi Y Weintraub, Orfhlaith E O'Sullivan
Introduction: Large language models (LLMs) are increasingly used in healthcare, including urogynecology, where stigma may limit open discussion. LLM-based chat platforms may provide a less intimidating and more accessible way for patients to obtain information, but their reliability requires evaluation. This study compared the quality of ChatGPT-generated responses in urogynecology with those provided by a consultant urogynecologist, focusing on understandability, helpfulness, and reassurance.
Material and methods: A cross-sectional survey was conducted among urogynecology patients. After informed consent, participants reviewed responses to six common questions, each answered by ChatGPT and a single consultant. A blinded third-party consultant verified clinical accuracy. Patients rated responses using a 5-point Likert scale across three domains (maximum score 15 per response). Wilcoxon signed-rank tests were used for comparison.
Results: A total of 203 patients participated (median age 56 years, interquartile range 46-66). ChatGPT responses received higher total ratings than consultant responses (76 [67-85] vs. 72 [63-80], p < 0.01). Scores were higher for understandability, helpfulness, and reassurance (all p < 0.01). ChatGPT was preferred in four of six questions, one showed no difference, and one favored the consultant. Subgroup analyses showed no significant variation based on patient characteristics.
Conclusions: In this exploratory study, women rated ChatGPT's responses as clearer and more reassuring than consultant answers. These findings reflect patient perceptions in a limited setting and should be interpreted with caution. While LLMs may have a supportive role in patient education, their use must remain secondary to expert clinical care and subject to careful oversight.
{"title":"ChatGPT in urogynecology: Comparing large language model responses to human experts.","authors":"Reut Rotem, Craven Simon, Misgav Rottenstreich, Barry A O'reilly, Adi Y Weintraub, Orfhlaith E O'Sullivan","doi":"10.1111/aogs.70085","DOIUrl":"10.1111/aogs.70085","url":null,"abstract":"<p><strong>Introduction: </strong>Large language models (LLMs) are increasingly used in healthcare, including urogynecology, where stigma may limit open discussion. LLM-based chat platforms may provide a less intimidating and more accessible way for patients to obtain information, but their reliability requires evaluation. This study compared the quality of ChatGPT-generated responses in urogynecology with those provided by a consultant urogynecologist, focusing on understandability, helpfulness, and reassurance.</p><p><strong>Material and methods: </strong>A cross-sectional survey was conducted among urogynecology patients. After informed consent, participants reviewed responses to six common questions, each answered by ChatGPT and a single consultant. A blinded third-party consultant verified clinical accuracy. Patients rated responses using a 5-point Likert scale across three domains (maximum score 15 per response). Wilcoxon signed-rank tests were used for comparison.</p><p><strong>Results: </strong>A total of 203 patients participated (median age 56 years, interquartile range 46-66). ChatGPT responses received higher total ratings than consultant responses (76 [67-85] vs. 72 [63-80], p < 0.01). Scores were higher for understandability, helpfulness, and reassurance (all p < 0.01). ChatGPT was preferred in four of six questions, one showed no difference, and one favored the consultant. Subgroup analyses showed no significant variation based on patient characteristics.</p><p><strong>Conclusions: </strong>In this exploratory study, women rated ChatGPT's responses as clearer and more reassuring than consultant answers. These findings reflect patient perceptions in a limited setting and should be interpreted with caution. While LLMs may have a supportive role in patient education, their use must remain secondary to expert clinical care and subject to careful oversight.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342620","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}
Gustavo Yano Callado, Maria Celidonio Gutfreund, Catarina Monteiro Palumbo, Chloe Higgins, Edward Araujo Júnior, Eduardo Félix Martins Santana, Daniel L. Rolnik
Introduction
The optimal mode of delivery for twins has been debated for decades. The objective of this study is to compare maternal and perinatal outcomes between planned cesarean birth and planned vaginal delivery in twin pregnancies.
Material and Methods
We conducted searches across MedLine, CINAHL, Cochrane CENTRAL, Web of Science, Scopus, and Embase, from database inception to June 13, 2025, for studies that compared planned vaginal delivery with planned cesarean birth regarding maternal and/or neonatal outcomes in twin gestations. Random-effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was assessed using the I2 statistic. The Downs and Black scale was used to assess study quality and risk of bias.
Results
Among 11 207 publications, 33 studies met the inclusion criteria. Planned cesarean versus vaginal delivery showed no significant differences in neonatal death (OR 0.99, 95% CI: 0.58–1.67), Apgar score <7 at 5 min (OR 0.74, 95% CI: 0.51–1.08), low umbilical artery pH (OR 0.56, 95% CI: 0.30–1.06), or maternal death (OR 0.68, 95% CI: 0.11–4.31). The analysis of composite adverse outcomes (16 studies) showed a slight advantage for planned cesarean (OR 0.96, 95% CI: 0.94–0.99). Planned vaginal delivery showed lower rates of periventricular leukomalacia (OR 3.14, 95% CI: 1.45–6.83) and maternal wound complications (OR 1.86, 95% CI: 1.25–2.76).
Conclusions
Planned cesarean delivery in twin pregnancies shows a small trend toward improved neonatal outcomes but is associated with higher maternal wound complications. Mortality and most individual outcomes were similar between groups. Individualized decisions should guide the choice of delivery mode.
双胞胎的最佳分娩方式已经争论了几十年。本研究的目的是比较计划剖宫产和计划阴道分娩在双胎妊娠中的孕产妇和围产期结局。材料和方法：我们对MedLine、CINAHL、Cochrane CENTRAL、Web of Science、Scopus和Embase进行了检索，从数据库建立到2025年6月13日，对双胎妊娠中孕产妇和/或新生儿结局的计划阴道分娩和计划剖宫产进行了比较研究。随机效应模型用于估计95%置信区间（CI）的合并优势比（OR），并使用I2统计量评估异质性。Downs和Black量表用于评估研究质量和偏倚风险。结果：11 207篇文献中，33篇符合纳入标准。计划剖宫产与阴道分娩在新生儿死亡方面无显著差异（OR 0.99, 95% CI: 0.58-1.67）， Apgar评分。结论：双胎妊娠计划剖宫产在改善新生儿结局方面有小趋势，但与较高的产妇伤口并发症相关。两组之间的死亡率和大多数个体结果相似。个性化的决定应该指导交付模式的选择。
{"title":"Maternal and infant outcomes of planned mode of delivery in twin pregnancies: A systematic review and meta-analysis","authors":"Gustavo Yano Callado, Maria Celidonio Gutfreund, Catarina Monteiro Palumbo, Chloe Higgins, Edward Araujo Júnior, Eduardo Félix Martins Santana, Daniel L. Rolnik","doi":"10.1111/aogs.70074","DOIUrl":"10.1111/aogs.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The optimal mode of delivery for twins has been debated for decades. The objective of this study is to compare maternal and perinatal outcomes between planned cesarean birth and planned vaginal delivery in twin pregnancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted searches across MedLine, CINAHL, Cochrane CENTRAL, Web of Science, Scopus, and Embase, from database inception to June 13, 2025, for studies that compared planned vaginal delivery with planned cesarean birth regarding maternal and/or neonatal outcomes in twin gestations. Random-effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was assessed using the <i>I</i><sup>2</sup> statistic. The Downs and Black scale was used to assess study quality and risk of bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 11 207 publications, 33 studies met the inclusion criteria. Planned cesarean versus vaginal delivery showed no significant differences in neonatal death (OR 0.99, 95% CI: 0.58–1.67), Apgar score <7 at 5 min (OR 0.74, 95% CI: 0.51–1.08), low umbilical artery pH (OR 0.56, 95% CI: 0.30–1.06), or maternal death (OR 0.68, 95% CI: 0.11–4.31). The analysis of composite adverse outcomes (16 studies) showed a slight advantage for planned cesarean (OR 0.96, 95% CI: 0.94–0.99). Planned vaginal delivery showed lower rates of periventricular leukomalacia (OR 3.14, 95% CI: 1.45–6.83) and maternal wound complications (OR 1.86, 95% CI: 1.25–2.76).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Planned cesarean delivery in twin pregnancies shows a small trend toward improved neonatal outcomes but is associated with higher maternal wound complications. Mortality and most individual outcomes were similar between groups. Individualized decisions should guide the choice of delivery mode.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2226-2236"},"PeriodicalIF":3.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353500","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}
Pablo Garcia-Manau, Judit Platero, Noah Costa, Zoraida Garcia, Carmen Garrido-Giménez, Claudia Pellicer, Johana Ullmo, Madalina Nan, Josefina Mora, Alvaro Garcia-Osuna, Olga Sánchez-Garcia, Mariona Jordi, Marta Choliz, Mónica Cruz-Lemini, Cristina Trilla, Carla Dominguez-Gallardo, Elisa Llurba
<div> <section> <h3> Introduction</h3> <p>Preeclampsia and fetal growth restriction, which are clinical presentations of placental dysfunction, are frequently associated with angiogenic imbalance during pregnancy and increased long-term cardiovascular risk. Whether this risk is driven by the pre-pregnancy risk factors, clinical disease, or by an elevated sFlt-1/PlGF ratio remains unclear. This study aimed to assess the association between vascular assessments (ophthalmic artery Doppler and carotid intima-media thickness) 3–6 years postpartum and a history of preeclampsia and fetal growth restriction, and to evaluate if associations were impacted by an angiogenic imbalance during pregnancy.</p> </section> <section> <h3> Material and Methods</h3> <p>This was a cross-sectional study, which included individuals prospectively recruited during their index pregnancy between 2018 and 2021 and re-evaluated 3–6 years postpartum. Preeclampsia, fetal growth restriction, and sFlt-1/PlGF values were defined from pregnancy data. Postpartum assessment included ophthalmic artery Doppler and carotid intima-media thickness performed by a single operator. Multivariable linear regression models assessed associations between placental dysfunction, angiogenic imbalance, and vascular parameters, adjusting for maternal covariates.</p> </section> <section> <h3> Results</h3> <p>354 participants were included, 148 with and 206 without a history of preeclampsia or fetal growth restriction. Both placental dysfunction and angiogenic imbalance during pregnancy were independently associated with a significantly higher ophthalmic artery peak systolic velocity ratio 3–6 years postpartum. Participants with a history of placental dysfunction showed higher values compared to those without [0.75 (0.67–0.81) vs. 0.69 (0.63–0.78), <i>p</i> = 0.03], as did those with an elevated sFlt-1/PlGF ratio during pregnancy [0.76 (0.66–0.82) vs. 0.70 (0.64–0.78), <i>p</i> = 0.03]. The highest values were observed in women who had experienced both conditions. When preeclampsia and fetal growth restriction were analyzed separately, the association remained significant for preeclampsia, whereas in the fetal growth restriction group, a significant difference was observed only in the right eye. No statistically significant differences were observed in carotid intima-media thickness.</p> </section> <section> <h3> Conclusions</h3> <p>Both a history of angiogenic imbalance and a clinical placental dysfunction presentation (particularly preeclampsia) during pregnancy were associated with increased ophthalmic
{"title":"Ophthalmic artery Doppler and carotid intima-media thickness 3–6 years postpartum in women with and without a history of placental insufficiency","authors":"Pablo Garcia-Manau, Judit Platero, Noah Costa, Zoraida Garcia, Carmen Garrido-Giménez, Claudia Pellicer, Johana Ullmo, Madalina Nan, Josefina Mora, Alvaro Garcia-Osuna, Olga Sánchez-Garcia, Mariona Jordi, Marta Choliz, Mónica Cruz-Lemini, Cristina Trilla, Carla Dominguez-Gallardo, Elisa Llurba","doi":"10.1111/aogs.70059","DOIUrl":"10.1111/aogs.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Preeclampsia and fetal growth restriction, which are clinical presentations of placental dysfunction, are frequently associated with angiogenic imbalance during pregnancy and increased long-term cardiovascular risk. Whether this risk is driven by the pre-pregnancy risk factors, clinical disease, or by an elevated sFlt-1/PlGF ratio remains unclear. This study aimed to assess the association between vascular assessments (ophthalmic artery Doppler and carotid intima-media thickness) 3–6 years postpartum and a history of preeclampsia and fetal growth restriction, and to evaluate if associations were impacted by an angiogenic imbalance during pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a cross-sectional study, which included individuals prospectively recruited during their index pregnancy between 2018 and 2021 and re-evaluated 3–6 years postpartum. Preeclampsia, fetal growth restriction, and sFlt-1/PlGF values were defined from pregnancy data. Postpartum assessment included ophthalmic artery Doppler and carotid intima-media thickness performed by a single operator. Multivariable linear regression models assessed associations between placental dysfunction, angiogenic imbalance, and vascular parameters, adjusting for maternal covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>354 participants were included, 148 with and 206 without a history of preeclampsia or fetal growth restriction. Both placental dysfunction and angiogenic imbalance during pregnancy were independently associated with a significantly higher ophthalmic artery peak systolic velocity ratio 3–6 years postpartum. Participants with a history of placental dysfunction showed higher values compared to those without [0.75 (0.67–0.81) vs. 0.69 (0.63–0.78), <i>p</i> = 0.03], as did those with an elevated sFlt-1/PlGF ratio during pregnancy [0.76 (0.66–0.82) vs. 0.70 (0.64–0.78), <i>p</i> = 0.03]. The highest values were observed in women who had experienced both conditions. When preeclampsia and fetal growth restriction were analyzed separately, the association remained significant for preeclampsia, whereas in the fetal growth restriction group, a significant difference was observed only in the right eye. No statistically significant differences were observed in carotid intima-media thickness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both a history of angiogenic imbalance and a clinical placental dysfunction presentation (particularly preeclampsia) during pregnancy were associated with increased ophthalmic ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"94-104"},"PeriodicalIF":3.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336086","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}
Julia F. van der Meulen, Mohamed El Alili, Sjors F. P. J. Coppus, Helen S. Kok, Jaklien C. Leemans, Marlies Y. Bongers, Judith E. Bosmans
<div> <section> <h3> Introduction</h3> <p>Hysteroscopic myomectomy is the first-choice treatment for symptomatic type 0 and 1 fibroids and was traditionally performed under general anesthesia. Over the last decade, surgical procedures have increasingly been performed in an outpatient setting under procedural sedation and analgesia. However, studies evaluating the safety and cost-effectiveness of hysteroscopic myomectomy under procedural sedation and analgesia are lacking. This study aimed to assess the cost-effectiveness of procedural sedation and analgesia with propofol in an outpatient setting for hysteroscopic myomectomy compared to general anesthesia in an operating room.</p> </section> <section> <h3> Material and Methods</h3> <p>This was a cost-effectiveness analysis from a societal perspective alongside a multicenter randomized controlled non-inferiority trial. It was conducted in 14 Dutch university and teaching hospitals. Women aged ≥18 years with symptomatic type 0/1 fibroids (maximum number 3, maximum diameter 3.5 cm), sufficient knowledge of Dutch/English, and American Society of Anesthesiologists class 1/2 were included. A total of 209 women were randomized to hysteroscopic myomectomy with procedural sedation and analgesia in an outpatient setting (<i>n</i> = 106) or general anesthesia in an operating room (<i>n</i> = 103). The primary outcome of the clinical trial was the percentage of complete resections measured by transvaginal ultrasonography 6 weeks postoperatively (non-inferiority margin 7.5% of incomplete resections). Societal costs and quality-adjusted life years (QALYs) were assessed. Societal costs were related to the percentage of complete resections and QALYs. Incremental Cost-Effectiveness Ratios (ICERs) were calculated. Uncertainty surrounding these was estimated using bootstrapping. Follow-up period was 12 months. Dutch Trial Register NTR 5357.</p> </section> <section> <h3> Results</h3> <p>Hysteroscopic resection was complete in 86/98 women (87.8%) with procedural sedation and analgesia and 79/89 women (88.8%) with general anesthesia, mean difference −0.0052 (95% CI −0.097 to 0.086). Non-inferiority could not be demonstrated. There was a statistically significant difference in costs between procedural sedation and analgesia and general anesthesia (€−2577, 95% CI −3950 to −1157), but not in QALYs (0.011, 95% CI −0.019 to 0.040). The ICER per additional complete resection was €498 797 and for QALYs the ICER showed that procedural sedation and analgesia was dominant over general anesthesia.</p> </section> <section> <h3> Conclusions</h3>
宫腔镜子宫肌瘤切除术是有症状的0型和1型肌瘤的首选治疗方法，传统上在全身麻醉下进行。在过去的十年中，外科手术越来越多地在门诊环境下进行镇静和镇痛。然而，评估宫腔镜子宫肌瘤切除术在手术镇静和镇痛下的安全性和成本效益的研究缺乏。本研究旨在评估门诊宫腔镜子宫肌瘤切除术中异丙酚镇静镇痛与手术室全身麻醉的成本效益。材料和方法：这是一项从社会角度进行的成本-效果分析，同时进行多中心随机对照非劣效性试验。该研究在荷兰14所大学和教学医院进行。年龄≥18岁，有症状的0/1型肌瘤（最大数量3个，最大直径3.5 cm），足够的荷兰语/英语知识，美国麻醉医师学会1/2级。共有209名妇女被随机分为两组，一组在宫腔镜下进行子宫肌瘤切除术，在门诊进行镇静镇痛（106例），另一组在手术室进行全身麻醉（103例）。临床试验的主要终点是术后6周经阴道超声检查的完全切除率（非劣效性边缘为7.5%）。评估社会成本和质量调整生命年（QALYs）。社会成本与完全切除的百分比和qaly相关。计算增量成本-效果比（ICERs）。这些不确定性是用自举法估计的。随访期12个月。荷兰审判登记册NTR 5357。结果：手术镇静镇痛下宫腔镜切除成功率为86/98(87.8%)，全麻下为79/89(88.8%)，平均差异为-0.0052 （95% CI -0.097 ~ 0.086）。非劣等性无法证明。程序性镇静和镇痛与全身麻醉的成本差异有统计学意义（€-2577,95% CI -3950至-1157），但在QALYs中无统计学差异（0.011,95% CI -0.019至0.040）。每额外完全切除的ICER为498 797欧元，对于QALYs， ICER显示手术镇静和镇痛优于全身麻醉。结论：在本研究中，与手术室全身麻醉相比，门诊宫腔镜子宫肌瘤切除术的手术镇静和镇痛具有成本效益，尽管完全切除的非劣效性尚未得到证明。因此，我们建议门诊患者在宫腔镜子宫肌瘤切除术中使用程序性镇静和镇痛。
{"title":"Procedural sedation and analgesia versus general anesthesia for hysteroscopic myomectomy: A cost-effectiveness analysis alongside a randomized controlled trial","authors":"Julia F. van der Meulen, Mohamed El Alili, Sjors F. P. J. Coppus, Helen S. Kok, Jaklien C. Leemans, Marlies Y. Bongers, Judith E. Bosmans","doi":"10.1111/aogs.70053","DOIUrl":"10.1111/aogs.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hysteroscopic myomectomy is the first-choice treatment for symptomatic type 0 and 1 fibroids and was traditionally performed under general anesthesia. Over the last decade, surgical procedures have increasingly been performed in an outpatient setting under procedural sedation and analgesia. However, studies evaluating the safety and cost-effectiveness of hysteroscopic myomectomy under procedural sedation and analgesia are lacking. This study aimed to assess the cost-effectiveness of procedural sedation and analgesia with propofol in an outpatient setting for hysteroscopic myomectomy compared to general anesthesia in an operating room.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a cost-effectiveness analysis from a societal perspective alongside a multicenter randomized controlled non-inferiority trial. It was conducted in 14 Dutch university and teaching hospitals. Women aged ≥18 years with symptomatic type 0/1 fibroids (maximum number 3, maximum diameter 3.5 cm), sufficient knowledge of Dutch/English, and American Society of Anesthesiologists class 1/2 were included. A total of 209 women were randomized to hysteroscopic myomectomy with procedural sedation and analgesia in an outpatient setting (<i>n</i> = 106) or general anesthesia in an operating room (<i>n</i> = 103). The primary outcome of the clinical trial was the percentage of complete resections measured by transvaginal ultrasonography 6 weeks postoperatively (non-inferiority margin 7.5% of incomplete resections). Societal costs and quality-adjusted life years (QALYs) were assessed. Societal costs were related to the percentage of complete resections and QALYs. Incremental Cost-Effectiveness Ratios (ICERs) were calculated. Uncertainty surrounding these was estimated using bootstrapping. Follow-up period was 12 months. Dutch Trial Register NTR 5357.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Hysteroscopic resection was complete in 86/98 women (87.8%) with procedural sedation and analgesia and 79/89 women (88.8%) with general anesthesia, mean difference −0.0052 (95% CI −0.097 to 0.086). Non-inferiority could not be demonstrated. There was a statistically significant difference in costs between procedural sedation and analgesia and general anesthesia (€−2577, 95% CI −3950 to −1157), but not in QALYs (0.011, 95% CI −0.019 to 0.040). The ICER per additional complete resection was €498 797 and for QALYs the ICER showed that procedural sedation and analgesia was dominant over general anesthesia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2320-2330"},"PeriodicalIF":3.1,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145317926","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}
Katarzyna Galka, Michael Shea, Christina Y. L. Aye, Lawrence Impey
Introduction
Identifying pregnant smokers is crucial for cessation support and increased fetal surveillance, but some patients may not disclose their smoking. Biochemical markers like breath carbon monoxide (CO) can improve detection, yet the optimal CO threshold for predicting smoking-related risks remains unknown. Our objective was to assess the relationship between smoking, CO levels, and adverse pregnancy outcomes.
Material and Methods
This retrospective cohort study analyzed 1 year of pregnancies (2023) in Oxford. Birthweight and adverse outcomes, small for gestational age (SGA), preterm birth (PTB), and extended perinatal mortality (EPM) were compared across CO categories and between self-reported smokers and nonsmokers with CO ≤2 and >2 ppm. Statistical analyses included changepoint analysis, one-way ANOVA, the Cochran–Armitage test for trend, binary logistic regression, and univariate linear regression.
Results
Of 6963 pregnancies, 5041 (72.4%) had recorded CO levels. The mean gestation at birth was 39 + 6 weeks, and the mean birthweight (BW) was 3439 g (560); the mean BW centile was 54.25 (28.00). The prevalence of SGA, PTB, and EPM was 6.7%, 5.0%, and 0.6%, respectively. CO levels were >2 ppm in 11.7% of the cohort, including 5.0% of self-reported non-smokers. Changepoint analysis identified 2 ppm as the threshold for mean birthweight. Above this level, each 1 ppm increase in CO was associated with a 69.35 g decrease in BW and a 3.15-point decrease in BW centile, indicating a dose–response relationship. Above 2 ppm, the odds of adverse outcomes were significantly increased: for SGA, OR 2.05–3.37; for PTB, OR 1.50–3.21; and for EPM, OR 2.52–4.22. Compared to non-smokers with low CO, smokers with high CO had the highest risk of all outcomes. Non-smokers with high CO had increased risks, but not significantly.
Conclusions
At a threshold of >2 ppm, CO was associated with lower mean birthweight and higher rates of SGA and PTB, with a dose–response relationship. Universal CO testing could help identify and quantify risk in pregnancy.
识别怀孕吸烟者对于戒烟支持和增加胎儿监测至关重要，但一些患者可能不会透露他们吸烟。呼吸一氧化碳（CO）等生化指标可以提高检测水平，但预测吸烟相关风险的最佳CO阈值仍不清楚。我们的目的是评估吸烟、一氧化碳水平和不良妊娠结局之间的关系。材料和方法：本回顾性队列研究分析了牛津大学1年的妊娠（2023年）。出生体重和不良结局、胎龄小（SGA）、早产（PTB）和延长围产期死亡率（EPM）在不同CO类别和自我报告的吸烟者和不吸烟者（CO≤2和bbb2ppm）之间进行比较。统计分析包括变点分析、单因素方差分析、Cochran-Armitage趋势检验、二元logistic回归和单变量线性回归。结果：6963例妊娠中，5041例（72.4%）有CO水平记录。平均出生妊娠期39 + 6周，平均出生体重（BW） 3439 g (560)；平均体重百分位数为54.25（28.00）。SGA、PTB和EPM的患病率分别为6.7%、5.0%和0.6%。11.7%的队列中，包括5.0%的自我报告的不吸烟者，二氧化碳水平为bb20 ppm。变化点分析确定2ppm为平均出生体重的阈值。在此水平以上，CO浓度每增加1 ppm，体重下降69.35 g，体重百分位数下降3.15个点，表明存在剂量-反应关系。高于2 ppm，不良结局的几率显著增加：对于SGA， OR 2.05-3.37；对于PTB， OR为1.50-3.21；EPM的OR为2.52-4.22。与低一氧化碳的非吸烟者相比，高一氧化碳的吸烟者在所有结果中的风险最高。高一氧化碳的非吸烟者的风险增加，但不明显。结论：在bbb2ppm的阈值下，CO与较低的平均出生体重和较高的SGA和PTB发生率相关，并存在剂量-反应关系。通用一氧化碳检测有助于确定和量化妊娠风险。
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