We aimed to explore the conceptualization and perception of self-monitoring amongst women, partners, healthcare professionals (HCPs), and policymakers, with particular interest in those living with social/medical complexity.
Across the United Kingdom, 96 semi-structured in-depth qualitative interviews were conducted with 40 women, 15 partners, 21 HCPs, and 20 policymakers to discuss their lived experience of utilizing, delivering, or developing policy for self-monitoring during the COVID-19 pandemic. A thematic framework analysis was undertaken to develop themes, considered by participant type, ethnicity, geographical region, personal experience of self-monitoring, and social complexity, and a content analysis was used to explore how self-monitoring was conceptualized.
Two themes (and ten sub-themes) were derived from the Thematic Framework Analysis: “Organizational logistics” (reported by up to 10% participants; sub-themes: useful resources and infrastructure, lack of instructions and information provided, communication between HCPs and service users, logistical issues, legitimate concerns about clinical practice, and personalization of care) and “Agency and responsibility over care” (reported by up to 6% participants; sub-themes: anxiety and overwhelm, control over care, avoiding hospitals, and disengaged users). A post hoc Qualitative Content Analysis was conducted in a deviation from the protocol which showed women and partners conceptualized self-monitoring as a general awareness of one's body and monitoring for specific clinical signs, whereas HCPs and policymakers understood self-monitoring as the use of a device for self-measurement.
Marked differences exist in how self-monitoring is conceptualized by service users and service providers, which could influence how service users engage with the practice. Outstanding concerns about implementation include instructions for service users, communication between service users and service providers, HCP workload, safety and quality of care, and the management of disengaged users when self-monitoring is used to replace care delivered face to face.
Trustworthiness criteria for meta-analyses of randomized controlled studies: OBGYN Journal guidelines. Acta Obstet Gynaecol Scand. 2024; 103: 2118–2121. https://doi.org/10.1111/aogs.14942
In the list of participating members of the OBGYN Editors' Integrity Group (OGEIG), Dr. Luis Sanchez-Ramos' affiliation was incorrectly stated as Am J Obstet Gynecol MFM; it should have been given as Am J Obstet Gynecol.
The online version of the article has now been rectified.
We apologize for this error.
Gestational diabetes mellitus (GDM) affects approximately 14% of pregnancies globally, with rising incidence depending on the diagnostic criteria used. In the UK, screening relies on risk factors at booking, followed by a diagnosis via an oral glucose tolerance test in the second trimester. This approach may lack sensitivity and has poor tolerability. Emerging evidence suggests that GDM pathophysiology begins in the first trimester, with biomarkers showing potential for early prediction. Identifying these could enable earlier risk stratification, improved diagnostic pathways, and better maternal–fetal outcomes. This scoping review maps the existing literature on first-trimester biomarkers of GDM to evaluate their clinical utility and integration into predictive models. A literature search was conducted using Medline, Embase, and PubMed to identify studies on first-trimester biomarkers of GDM. Inclusion criteria included (1) studies investigating biomarkers at <15 weeks' gestation; (2) studies that diagnosed GDM using an OGTT with recognized diagnostic guidelines or clearly stated glucose thresholds. A total of 133 studies were included, reporting a wide range of biomarkers (145 in total). PAPP-A was generally lower in GDM, with mixed findings for β-hCG and PlGF. Metabolic markers, including lipid profiles, fasting glucose, and HbA1c, were often elevated. Inflammatory markers, such as WCC, neutrophils, and CRP, were higher in those later diagnosed with GDM. First-trimester biomarkers highlight GDM's complex pathophysiology. PAPP-A shows predictive potential, while metabolic and inflammatory biomarkers suggest early systemic dysfunction. Emerging tools like 3D ultrasonography indicate placental structural changes. Larger studies are needed to validate these biomarkers and integrate them into predictive models to improve maternal–fetal outcomes.
This systematic review examines the application of multiple deep learning algorithms in the analysis of intraoperative videos to enable feature extraction and pattern recognition of surgical phases, anatomical structures, and surgical instruments.
A comprehensive literature search was conducted across PubMed, Web of Science, and EBSCO, covering studies published until March 2024. This review includes studies that applied AI models in the operating room for surgical-phase recognition and/or anatomical structures and instruments. Only studies utilizing machine learning or deep learning for surgical video analysis were considered. The primary outcome measures were accuracy, precision, recall, and F1 score.
A total of 21 studies were included. Multilayer architecture of interconnected neural networks was predominantly used. The deep learning models demonstrated promising results, with accuracy ranging from 81% to 93.2% for surgical-phase recognition. Anatomical structure recognition models achieved accuracy between 71.4% and 98.1%.
Artificial intelligence has the potential to significantly improve surgical precision and workflow, with demonstrated success in phase recognition and anatomical structure identification. However, further research is needed to address dataset limitations, standardize annotation protocols, and minimize biases.
The aim of this study was to investigate the risk factors and timing of birth for different types of preterm birth, including iatrogenic preterm birth, spontaneous preterm birth, and preterm prelabor rupture of membranes across health services in New South Wales, Australia.
We conducted a historical cohort study between 2018 and 2023 using routinely collected electronic data across four local health districts in New South Wales. Maternal characteristics and outcomes were compared using summary statistics. Differences in the incidence of each preterm birth type were compared using multivariate logistic regression models. Cox regression was performed to assess the time-to-event for each preterm birth type and account for confounders.
A total of 113 244 singleton pregnancies were included, of which 7940 (7.0%) were born preterm. Of these, 3909 (49.2%) were iatrogenic preterm births, 2931 (36.9%) were spontaneous preterm births, and 1100 (13.9%) had preterm prelabor rupture of membranes. Iatrogenic late preterm (32–36 weeks' gestation) births accounted for 38.8% of all preterm births. All three categories of preterm birth were strongly associated with a history of previous preterm birth and model of antenatal care. Among higher capacity (level 4–6) maternity hospitals, there was significant variation in the gestational age of birth for those with preterm prelabor rupture of membranes and iatrogenic preterm birth affected by hypertensive disorders of pregnancy or pre-eclampsia.
There was a high rate of iatrogenic preterm birth, especially in the late preterm period. There is variation in the timing of birth in higher capacity maternity hospitals, suggesting different management approaches and/or unmeasured confounding factors.
A symptomatic uterine niche is a long-term complication after a cesarean section (CS). A group of international niche experts reached consensus on a standardized definition of a disorder caused by a symptomatic niche, named cesarean scar disorder (CSDi). However, the prevalence of this disorder is unclear. The aim of this study was to assess the prevalence of CSDi in patients 3 years after a first CS.
A secondary analysis was performed on the 3-year follow-up results of the 2Close study. The 2Close study was a multicenter randomized controlled trial that evaluated single- versus double-layer uterine closure at CS in 32 hospitals in the Netherlands and included 2292 patients (registered in Dutch trial register: [NTR5480]). Patients, aged ≥18 years, undergoing a first CS were included. Three months after their CS, transvaginal ultrasonography was performed to evaluate the uterine scar for the presence of a niche. Three years after their CS, a digital questionnaire was sent to evaluate the primary and secondary symptoms of CSDi. For this secondary analysis, patients were excluded if they were pregnant, breastfeeding, or using hormonal contraception. The primary outcome of the study was the prevalence of CSDi.
Of the 1648 participants who completed the 3-year questionnaire, patients were excluded due to pregnancy or breastfeeding (n = 305), use of hormonal contraception (n = 509), missing ultrasound evaluations (n = 76), and incomplete responses (n = 88). Of the 670 patients included in this analysis, 543 (81.0%) had a uterine niche visible on ultrasound and 127 (19.0%) were without a niche. The prevalence of CSDi at 3 years following a first CS was 42.5% (285/670). Most reported symptoms were chronic pelvic pain (35.0%), postmenstrual spotting (32.8%), and abnormal vaginal discharge (23.2%).
Our study found a high prevalence of CSDi 3 years following their first CS. Symptoms were self-reported and the exclusion criteria of pregnancy, breastfeeding, or hormonal contraception use could have introduced selection bias. Therefore, this percentage could be an overestimation of the actual prevalence. However, this high prevalence should be included in counseling patients with a scheduled CS.
Introduction: Although childbirth-related perineal trauma affects the majority of women after vaginal birth, very few healthcare resources are allocated to reducing morbidity from perineal trauma. Wound complications are frequent after perineal trauma has been sustained; however, we know little about which factors are predictive of developing a wound issue. To target possible interventions effectively, it is crucial that those at higher risk are identified. Here, we perform a systematic review and meta-analysis of prognostic factors for sustaining wound complications after childbirth-related perineal trauma.
Material and methods: Medline, Embase, Web of Science, and CINAHL were searched from inception to December 2024 using relevant search terms. There were no restrictions on language or year of publication. Observational studies that investigated two or more potential prognostic factors for wound complications after childbirth related-perineal trauma, where adjusted risks were calculated, were eligible for inclusion. We included all types of tears, sustained through spontaneous or assisted vaginal birth. Meta-analysis was performed where five or more studies investigated a particular prognostic factor for perineal wound complications. Odds ratios (ORs) were pooled using a random effects model. The review was prospectively registered in PROSPERO (CRD42023458738).
Results: Fifteen studies were eligible for inclusion, involving 71409 women. Studies included were published between 2006 and 2024 across six different countries. Assisted vaginal birth (10 studies, 65 375 women: OR 2.77, 95% confidence interval [CI] 1.89-4.06) was a significant risk factor for wound complication. Raised body mass index (six studies, 64 770 women: OR 1.33, 95% CI 0.56-3.18) was not a significant risk factor. Prolonged second stage of labor, smoking, and episiotomy were each investigated in three primary studies; therefore, data was insufficient for meta-analysis; however, individual studies indicated that there might be an association with perineal wound complication.
Conclusions: Assisted vaginal birth is a significant risk factor for perineal wound complication after childbirth-related perineal trauma. Overall, there are limited studies investigating prognostic factors for perineal wound complication after childbirth related-perineal trauma. Whilst we highlight potential prognostic factors, we recommend that a robust, well-powered primary research study with clearly defined wound complication outcomes and prognostic factors is needed.
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