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。
{"title":"Carbon monoxide levels, smoking and adverse pregnancy outcomes","authors":"Katarzyna Galka, Michael Shea, Christina Y. L. Aye, Lawrence Impey","doi":"10.1111/aogs.70068","DOIUrl":"10.1111/aogs.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2237-2243"},"PeriodicalIF":3.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290657","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}
<div> <section> <h3> Introduction</h3> <p>Umbilical venous blood flow (UV-Q) reflects fetoplacental circulation and contributes to an understanding of fetal physiology. It may also serve as a basis for developing new diagnostic tools to assess fetal wellbeing. This study aimed to investigate UV-Q patterns in pregnancies complicated by gestational diabetes mellitus (GDM) and to examine the associations between absolute and fetal weight-normalized UV-Q and placental size and histologic features.</p> </section> <section> <h3> Material and Methods</h3> <p>This prospective study was conducted at a university hospital in Bangkok, Thailand, between December 2021 and May 2024. A total of 200 singleton pregnancies complicated by GDM underwent ultrasound assessment between 35 and 36 weeks of gestation. Measurements included estimated fetal weight, umbilical vein diameter, and Doppler-derived flow velocity. Absolute and normalized UV-Q values were calculated and categorized into three groups: <10th, 10th–90th (reference), and >90th percentiles. After delivery, placental morphometry (weight, diameter, circumference, and volume) and histologic features—including maternal and fetal vascular malperfusion, delayed villous maturation (DVM), and chorangiosis—were evaluated. Associations between UV-Q and placental size were assessed using one-way analysis of covariance, adjusting for parity, insulin use, gestational age at delivery, birthweight, and infant sex. These covariates were also included in the multivariable logistic regression models to examine associations between UV-Q and histologic findings.</p> </section> <section> <h3> Results</h3> <p>Higher absolute UV-Q was significantly associated with greater placental weight, diameter, circumference, and volume (<i>p</i> = 0.018–0.049). Additionally, in multivariable analysis, pregnancies with absolute UV-Q >90th percentile had a significantly increased risk of DVM (adjusted odds ratio 2.75, 95% confidence interval 1.02–7.86). In contrast, normalized UV-Q showed no significant associations with placental morphometric features or DVM. Furthermore, neither absolute nor normalized UV-Q was significantly associated with other histologic placental abnormalities, including maternal or fetal vascular malperfusion or chorangiosis.</p> </section> <section> <h3> Conclusions</h3> <p>In pregnancies complicated by GDM, elevated absolute UV-Q was associated with increased placental size and a higher risk of DVM. These findings suggest that absolute UV-Q may serve as a noninvasive indicator of placental structural adapt
{"title":"Umbilical venous blood flow and its association with placental pathology in pregnancies complicated by gestational diabetes mellitus","authors":"Chadakarn Phaloprakarn, Petcharat Jenkumwong, Sasiwan Suthasmalee, Chutima Chavanisakun, Siriwan Tangjitgamol","doi":"10.1111/aogs.70073","DOIUrl":"10.1111/aogs.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Umbilical venous blood flow (UV-Q) reflects fetoplacental circulation and contributes to an understanding of fetal physiology. It may also serve as a basis for developing new diagnostic tools to assess fetal wellbeing. This study aimed to investigate UV-Q patterns in pregnancies complicated by gestational diabetes mellitus (GDM) and to examine the associations between absolute and fetal weight-normalized UV-Q and placental size and histologic features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This prospective study was conducted at a university hospital in Bangkok, Thailand, between December 2021 and May 2024. A total of 200 singleton pregnancies complicated by GDM underwent ultrasound assessment between 35 and 36 weeks of gestation. Measurements included estimated fetal weight, umbilical vein diameter, and Doppler-derived flow velocity. Absolute and normalized UV-Q values were calculated and categorized into three groups: <10th, 10th–90th (reference), and >90th percentiles. After delivery, placental morphometry (weight, diameter, circumference, and volume) and histologic features—including maternal and fetal vascular malperfusion, delayed villous maturation (DVM), and chorangiosis—were evaluated. Associations between UV-Q and placental size were assessed using one-way analysis of covariance, adjusting for parity, insulin use, gestational age at delivery, birthweight, and infant sex. These covariates were also included in the multivariable logistic regression models to examine associations between UV-Q and histologic findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher absolute UV-Q was significantly associated with greater placental weight, diameter, circumference, and volume (<i>p</i> = 0.018–0.049). Additionally, in multivariable analysis, pregnancies with absolute UV-Q >90th percentile had a significantly increased risk of DVM (adjusted odds ratio 2.75, 95% confidence interval 1.02–7.86). In contrast, normalized UV-Q showed no significant associations with placental morphometric features or DVM. Furthermore, neither absolute nor normalized UV-Q was significantly associated with other histologic placental abnormalities, including maternal or fetal vascular malperfusion or chorangiosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In pregnancies complicated by GDM, elevated absolute UV-Q was associated with increased placental size and a higher risk of DVM. These findings suggest that absolute UV-Q may serve as a noninvasive indicator of placental structural adapt","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2244-2253"},"PeriodicalIF":3.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290628","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}
Áine Fox, Emma Doyle, Adam Reynolds, Maria Farren, Rocco Cuzzilla, Michael Geary, Breda Hayes, Claire M. McCarthy
Introduction
Specific fetal heart rate (FHR) patterns are associated with fetal compromise. Several placental histopathological findings are associated with neonatal morbidity and adverse neurodevelopment. The relationships between intrapartum FHR patterns and placental histopathology in infants with hypoxic–ischemic encephalopathy (HIE) remain uncertain. This study hypothesized that in infants with HIE, placental histopathology findings are related to abnormal FHR patterns.
Material and Methods
This was an observational study performed on a historical cohort from a single tertiary neonatal intensive care unit. Infants were born at ≥36 weeks' gestation with moderate or severe HIE between September 2006 and December 2021. Placental histopathology was assessed by a perinatal pathologist using the Amsterdam Working Group Criteria. FHR, recorded from intrapartum cardiotocography (CTG) was assessed by an obstetrician using a structured proforma. Assessors were blinded to clinical course and outcomes. Duration and type of FHR abnormality were compared across categories of placental histopathology findings.
Results
Fifty infants with moderate or severe HIE (with complete data relating to intrapartum CTG and placental histopathology) were included. Increased duration of FHR abnormality was associated with the presence of histological chorioamnionitis (HCA) (p = 0.013) but not with other placental histopathological lesions. There was no evidence of associations between placental histopathology findings and specific FHR features on intrapartum CTG.
Conclusions
This study demonstrates an association between HCA and increased duration of CTG abnormality in infants with moderate or severe HIE. Intrapartum CTG alone is limited in its ability to identify the presence or absence of placental histopathology. Multimodal intrapartum assessment, such as CTG with placental NIRs or Doppler assessment, may improve the maternal–placental–fetal triad assessment. This could lead to improved intrapartum risk stratification and infant outcomes. Future research should investigate the utility of multimodal assessment to improve risk stratification in labor.
{"title":"Placental pathology and its association with duration of abnormal fetal heart tracing in near-term and term infants with hypoxic–ischemic encephalopathy: A retrospective study","authors":"Áine Fox, Emma Doyle, Adam Reynolds, Maria Farren, Rocco Cuzzilla, Michael Geary, Breda Hayes, Claire M. McCarthy","doi":"10.1111/aogs.70064","DOIUrl":"10.1111/aogs.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Specific fetal heart rate (FHR) patterns are associated with fetal compromise. Several placental histopathological findings are associated with neonatal morbidity and adverse neurodevelopment. The relationships between intrapartum FHR patterns and placental histopathology in infants with hypoxic–ischemic encephalopathy (HIE) remain uncertain. This study hypothesized that in infants with HIE, placental histopathology findings are related to abnormal FHR patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was an observational study performed on a historical cohort from a single tertiary neonatal intensive care unit. Infants were born at ≥36 weeks' gestation with moderate or severe HIE between September 2006 and December 2021. Placental histopathology was assessed by a perinatal pathologist using the Amsterdam Working Group Criteria. FHR, recorded from intrapartum cardiotocography (CTG) was assessed by an obstetrician using a structured proforma. Assessors were blinded to clinical course and outcomes. Duration and type of FHR abnormality were compared across categories of placental histopathology findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty infants with moderate or severe HIE (with complete data relating to intrapartum CTG and placental histopathology) were included. Increased duration of FHR abnormality was associated with the presence of histological chorioamnionitis (HCA) (<i>p</i> = 0.013) but not with other placental histopathological lesions. There was no evidence of associations between placental histopathology findings and specific FHR features on intrapartum CTG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrates an association between HCA and increased duration of CTG abnormality in infants with moderate or severe HIE. Intrapartum CTG alone is limited in its ability to identify the presence or absence of placental histopathology. Multimodal intrapartum assessment, such as CTG with placental NIRs or Doppler assessment, may improve the maternal–placental–fetal triad assessment. This could lead to improved intrapartum risk stratification and infant outcomes. Future research should investigate the utility of multimodal assessment to improve risk stratification in labor.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2254-2262"},"PeriodicalIF":3.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290664","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}
<p>Fetal neuroimaging has become one of the most dynamic and demanding areas within maternal–fetal medicine. Advances in ultrasound resolution, the widespread availability of fetal MRI, and the integration of genomic testing have transformed the way anomalies of the developing brain are detected, interpreted, and communicated to families. These advances raise a fundamental question: how can clinicians gain comprehensive expertise in the diagnosis, prognostication, and management of fetal neurological conditions?</p><p>The first challenge lies in imaging itself. At the foundation of fetal neuroimaging is neurosonography, defined by ISUOG as a dedicated, multiplanar diagnostic examination of the fetal brain and spine in pregnancies at high risk for neurological malformations.<span><sup>1</sup></span> This requires technical mastery in both transabdominal and transvaginal approaches, as well as growing competence in three-dimensional imaging. Yet even with the most skilled hands, ultrasound has limitations, and fetal MRI is increasingly used to complement sonography. Interpreting prenatal MRI, however, is a specialized skill in its own right. Few maternal–fetal medicine specialists or radiologists receive structured and formal training in acquisition protocols or in the nuanced interpretation of congenital and acquired brain abnormalities. The result is highly variable expertise, dependent largely on local mentorship or exposure.</p><p>Interpretation of findings constitutes the next major hurdle. Imaging phenotypes are often complex, subtle, and overlapping across different etiologies. A finding that suggests a vascular pathology may mimic infection or genetic disease, while subtle and focal cortical malformations may escape recognition altogether without careful review. Furthermore, even after a diagnosis is reached, terminology in the literature remains inconsistent, with definitions used inaccurately and interchangeably (i.e. anomalies in the spectrum of Dandy–Walker, or those involving the corpus callosum<span><sup>2</sup></span>). This lack of standardization hampers meaningful data comparison and undermines the reliability of prognostic assessments.</p><p>These challenges are compounded by the timing of assessment. Gestational age influences the spectrum of findings that can be visualized, as many anomalies, particularly those associated with cortical development, evolve over time and require follow-up to clarify their progression and clinical significance. Early fetal MRI can provide valuable complementary information to ultrasound, but is often limited by motion artifacts that obscure subtle abnormalities. Later sonographic and MRI assessments may yield more definitive insights; however, these options may not be available in settings where termination of pregnancy is legally restricted beyond certain gestational age thresholds.</p><p>Postmortem imaging is an emerging technique that adds further dimensions<span><sup>3</sup></span> clinicians
{"title":"Toward structured fellowships in fetal neuroimaging","authors":"Shiri Shinar, Elka Miller","doi":"10.1111/aogs.70078","DOIUrl":"10.1111/aogs.70078","url":null,"abstract":"<p>Fetal neuroimaging has become one of the most dynamic and demanding areas within maternal–fetal medicine. Advances in ultrasound resolution, the widespread availability of fetal MRI, and the integration of genomic testing have transformed the way anomalies of the developing brain are detected, interpreted, and communicated to families. These advances raise a fundamental question: how can clinicians gain comprehensive expertise in the diagnosis, prognostication, and management of fetal neurological conditions?</p><p>The first challenge lies in imaging itself. At the foundation of fetal neuroimaging is neurosonography, defined by ISUOG as a dedicated, multiplanar diagnostic examination of the fetal brain and spine in pregnancies at high risk for neurological malformations.<span><sup>1</sup></span> This requires technical mastery in both transabdominal and transvaginal approaches, as well as growing competence in three-dimensional imaging. Yet even with the most skilled hands, ultrasound has limitations, and fetal MRI is increasingly used to complement sonography. Interpreting prenatal MRI, however, is a specialized skill in its own right. Few maternal–fetal medicine specialists or radiologists receive structured and formal training in acquisition protocols or in the nuanced interpretation of congenital and acquired brain abnormalities. The result is highly variable expertise, dependent largely on local mentorship or exposure.</p><p>Interpretation of findings constitutes the next major hurdle. Imaging phenotypes are often complex, subtle, and overlapping across different etiologies. A finding that suggests a vascular pathology may mimic infection or genetic disease, while subtle and focal cortical malformations may escape recognition altogether without careful review. Furthermore, even after a diagnosis is reached, terminology in the literature remains inconsistent, with definitions used inaccurately and interchangeably (i.e. anomalies in the spectrum of Dandy–Walker, or those involving the corpus callosum<span><sup>2</sup></span>). This lack of standardization hampers meaningful data comparison and undermines the reliability of prognostic assessments.</p><p>These challenges are compounded by the timing of assessment. Gestational age influences the spectrum of findings that can be visualized, as many anomalies, particularly those associated with cortical development, evolve over time and require follow-up to clarify their progression and clinical significance. Early fetal MRI can provide valuable complementary information to ultrasound, but is often limited by motion artifacts that obscure subtle abnormalities. Later sonographic and MRI assessments may yield more definitive insights; however, these options may not be available in settings where termination of pregnancy is legally restricted beyond certain gestational age thresholds.</p><p>Postmortem imaging is an emerging technique that adds further dimensions<span><sup>3</sup></span> clinicians ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 11","pages":"2024-2027"},"PeriodicalIF":3.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278714","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}
Joanna C. Y. Fung, Piya Chaemsaithong, Yunyu Chen, Nutnaree Yuenyongdechawat, Hillary H. Y. Leung, Patricia N. P. Ip, Caitlyn S. L. Lau, Liona C. Poon
Introduction
The aim of this study was to assess the effectiveness of fetal fibronectin (fFN) in combination with cervical length for predicting spontaneous preterm birth (sPTB) in women presenting with threatened preterm labor.
Material and Methods
This was a prospective study involving singleton pregnancies at 20–36 weeks of gestation with symptoms of threatened preterm labor. Upon admission, cervical length (CL) and fFN test in cervicovaginal secretions were measured. Logistic regression analysis was performed to develop the following models: CL alone, fFN at various thresholds, and their combined models for the prediction of sPTB. Area under the receiver operating characteristic curve (AUROC) was calculated.
Results
A total of 398 cases were analyzed. The median gestational age at recruitment was 30.1 weeks. Among these cases, 55 (13.8%) cases had sPTB at <37 weeks of gestation. A history of preterm birth (HxPTB), shorter CL, and increased fFN level were independently associated with an increased risk of sPTB. AUROC of the fFN test, at ≥50 ng/mL or ≥200 ng/mL, was significantly higher than that of ≥500 ng/mL for predicting sPTB. For the prediction of sPTB, the AUROCs were 0.78 for CL, 0.78 for fFN, and 0.84 for the combination of HxPTB, CL, and fFN ≥50 ng/mL. The ROC curves showed that, at a false-positive rate of 10%, the sensitivities were 53% for CL ≤2.44 cm, 33.9% for fFN ≥50 ng/mL, and 60% for the combination of HxPTB, CL, and fFN ≥50 ng/mL (p < 0.05).
Conclusions
In women symptomatic of threatened preterm labor, a combination of fFN and CL has improved the predictive performance of sPTB compared with either measure alone.
{"title":"Predicting spontaneous preterm birth with cervical length and fetal fibronectin for symptomatic women of threatened preterm labor: A prospective study","authors":"Joanna C. Y. Fung, Piya Chaemsaithong, Yunyu Chen, Nutnaree Yuenyongdechawat, Hillary H. Y. Leung, Patricia N. P. Ip, Caitlyn S. L. Lau, Liona C. Poon","doi":"10.1111/aogs.70062","DOIUrl":"10.1111/aogs.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The aim of this study was to assess the effectiveness of fetal fibronectin (fFN) in combination with cervical length for predicting spontaneous preterm birth (sPTB) in women presenting with threatened preterm labor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a prospective study involving singleton pregnancies at 20–36 weeks of gestation with symptoms of threatened preterm labor. Upon admission, cervical length (CL) and fFN test in cervicovaginal secretions were measured. Logistic regression analysis was performed to develop the following models: CL alone, fFN at various thresholds, and their combined models for the prediction of sPTB. Area under the receiver operating characteristic curve (AUROC) was calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 398 cases were analyzed. The median gestational age at recruitment was 30.1 weeks. Among these cases, 55 (13.8%) cases had sPTB at <37 weeks of gestation. A history of preterm birth (HxPTB), shorter CL, and increased fFN level were independently associated with an increased risk of sPTB. AUROC of the fFN test, at ≥50 ng/mL or ≥200 ng/mL, was significantly higher than that of ≥500 ng/mL for predicting sPTB. For the prediction of sPTB, the AUROCs were 0.78 for CL, 0.78 for fFN, and 0.84 for the combination of HxPTB, CL, and fFN ≥50 ng/mL. The ROC curves showed that, at a false-positive rate of 10%, the sensitivities were 53% for CL ≤2.44 cm, 33.9% for fFN ≥50 ng/mL, and 60% for the combination of HxPTB, CL, and fFN ≥50 ng/mL (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In women symptomatic of threatened preterm labor, a combination of fFN and CL has improved the predictive performance of sPTB compared with either measure alone.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2292-2299"},"PeriodicalIF":3.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278666","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}
Massimiliano Lia, Anne Dathan-Stumpf, Julia Franke, Beatrice Vogt, Noura Kabbani, Holger Stepan, Anne Tauscher
Introduction
Magnetic resonance (MR) pelvimetry is widely used in planning vaginal breech birth and may support women's informed decision-making regarding their preferred mode of birth. This feasibility study aimed to assess whether transperineal ultrasound (TPU) could measure the maternal pelvis as accurately as MR pelvimetry and thus predict the outcome of vaginal breech birth.
Material and Methods
In this prospective cohort study, nulliparous women with a singleton fetus in breech presentation received TPU for the measurement of the anteroposterior mid-pelvic diameter (AMD). These measurements were compared with those in MR pelvimetry to assess agreement and reliability. In women choosing to attempt vaginal breech birth, we additionally examined the association between the AMD (adjusted for possible confounders) and intrapartum cesarean section. The predictive performance of the AMD and traditional pelvic diameters (i.e., obstetric conjugate, interspinous, and intertuberous distance) was compared by means of the area under the receiver operating characteristic curve (AUC).
Results
Overall, 67 nulliparous women with breech presentation received both TPU and MR pelvimetry, of which 47 chose a vaginal breech birth (30 successful vaginal births and 17 intrapartum cesarean sections). The repeatability coefficients and intraclass correlation coefficient for the AMD were 0.38 cm and 0.97 (95% CI 0.96–0.98), respectively. Bland–Altman analysis between the AMD measured in TPU and MR pelvimetry yielded a mean difference of −0.0052 cm (95% CI −0.066 to 0.056 cm) with upper and lower limits of agreement of 0.48 cm (95% CI 0.38–0.59 cm) and −0.49 cm (95% CI −0.6 cm to −0.39 cm), respectively. In the subgroup of women who attempted vaginal breech birth, AMD was significantly associated with intrapartum cesarean section (adjusted odds ratio 0.25; 95% CI 0.06–0.81; AUC 0.77), while the obstetric conjugate, interspinous, and intertuberous distances were not.
Conclusions
TPU can accurately and reliably measure the AMD, a novel pelvic diameter in breech presentation. Importantly, a smaller AMD was associated with an increased risk of intrapartum cesarean section if vaginal breech birth was attempted. Consequently, TPU could represent an alternative to MR pelvimetry and support women in deciding their preferred mode of birth in breech presentation.
导读：磁共振（MR）骨盆测量被广泛应用于阴道臀位分娩计划，并可能支持妇女对其首选分娩方式的知情决策。本可行性研究旨在评估经会阴超声（TPU）是否能像MR骨盆测量一样准确地测量产妇骨盆，从而预测阴道臀位分娩的结果。材料和方法：在这项前瞻性队列研究中，臀位单胎的无产妇女接受TPU测量骨盆前后正中直径（AMD）。将这些测量结果与MR骨盆测量结果进行比较，以评估一致性和可靠性。在选择阴道臀位分娩的女性中，我们进一步研究了AMD（排除可能的混杂因素）与产宫中剖宫产之间的关系。通过受者工作特征曲线下面积（AUC）比较AMD和传统骨盆直径（即产科共轭、棘间和结节间距离）的预测性能。结果：总的来说，67例有臀位表现的无产妇女同时接受了TPU和MR骨盆测量，其中47例选择阴道臀位分娩（30例阴道分娩成功，17例剖宫产）。AMD的重复性系数和类内相关系数分别为0.38 cm和0.97 （95% CI 0.96 ~ 0.98）。TPU测量的AMD与MR骨盆测量的AMD之间的Bland-Altman分析得出的平均差异为-0.0052 cm (95% CI -0.066至0.056 cm)，一致性的上限和下限分别为0.48 cm （95% CI 0.38-0.59 cm）和-0.49 cm （95% CI -0.6 cm至-0.39 cm）。在尝试阴道臀位分娩的妇女亚组中，AMD与产宫中剖宫产显著相关（校正优势比为0.25；95% CI为0.06-0.81；AUC为0.77），而产科共轭、棘间和结节间距离与之无关。结论：TPU可以准确可靠地测量AMD，这是一种新的骨盆直径。重要的是，如果尝试阴道臀位分娩，较小的AMD与产时剖宫产的风险增加有关。因此，TPU可以作为MR骨盆测量的一种替代方法，并支持女性决定她们在臀位分娩时的首选方式。
{"title":"Prediction of obstetric outcome in vaginal breech birth using ultrasound pelvimetry in nulliparous women—A feasibility study","authors":"Massimiliano Lia, Anne Dathan-Stumpf, Julia Franke, Beatrice Vogt, Noura Kabbani, Holger Stepan, Anne Tauscher","doi":"10.1111/aogs.70072","DOIUrl":"10.1111/aogs.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Magnetic resonance (MR) pelvimetry is widely used in planning vaginal breech birth and may support women's informed decision-making regarding their preferred mode of birth. This feasibility study aimed to assess whether transperineal ultrasound (TPU) could measure the maternal pelvis as accurately as MR pelvimetry and thus predict the outcome of vaginal breech birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In this prospective cohort study, nulliparous women with a singleton fetus in breech presentation received TPU for the measurement of the anteroposterior mid-pelvic diameter (AMD). These measurements were compared with those in MR pelvimetry to assess agreement and reliability. In women choosing to attempt vaginal breech birth, we additionally examined the association between the AMD (adjusted for possible confounders) and intrapartum cesarean section. The predictive performance of the AMD and traditional pelvic diameters (i.e., obstetric conjugate, interspinous, and intertuberous distance) was compared by means of the area under the receiver operating characteristic curve (AUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 67 nulliparous women with breech presentation received both TPU and MR pelvimetry, of which 47 chose a vaginal breech birth (30 successful vaginal births and 17 intrapartum cesarean sections). The repeatability coefficients and intraclass correlation coefficient for the AMD were 0.38 cm and 0.97 (95% CI 0.96–0.98), respectively. Bland–Altman analysis between the AMD measured in TPU and MR pelvimetry yielded a mean difference of −0.0052 cm (95% CI −0.066 to 0.056 cm) with upper and lower limits of agreement of 0.48 cm (95% CI 0.38–0.59 cm) and −0.49 cm (95% CI −0.6 cm to −0.39 cm), respectively. In the subgroup of women who attempted vaginal breech birth, AMD was significantly associated with intrapartum cesarean section (adjusted odds ratio 0.25; 95% CI 0.06–0.81; AUC 0.77), while the obstetric conjugate, interspinous, and intertuberous distances were not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TPU can accurately and reliably measure the AMD, a novel pelvic diameter in breech presentation. Importantly, a smaller AMD was associated with an increased risk of intrapartum cesarean section if vaginal breech birth was attempted. Consequently, TPU could represent an alternative to MR pelvimetry and support women in deciding their preferred mode of birth in breech presentation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2263-2272"},"PeriodicalIF":3.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278690","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号