Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular condition that causes obstruction of venous blood flow or cerebrospinal fluid circulation, leading to intracranial hypertension symptoms such as syncope and vomiting. Transurethral Resection of the Prostate (TURP) syndrome, a complication of hysteroscopic surgery, can also present with cerebral edema and symptoms similar to CVST, making differentiation challenging. Cases of unexplained recurrent syncope posthysteroscopy diagnosed as CVST have not been previously reported. We present a case of a 33-year-old woman who underwent hysteroscopy for abnormal uterine bleeding. Five hours postoperation, she experienced syncope, which resolved spontaneously. Ten hours later, she had recurrent syncope, nausea, and vomiting. Head computed tomography suggested cerebral edema, potentially indicating TURP syndrome. However, the brief surgery and minimal fluid imbalance (200 mL) made TURP syndrome unlikely. Further investigation with cranial magnetic resonance venography revealed multiple venous sinus thromboses, explaining the recurrent syncope linked to minimal fluid volume expansion postsurgery. Subsequent screening identified hyperhomocysteinemia as a contributing factor. Treatment with anticoagulants, folic acid, and vitamin B6 led to a favorable outcome. This case involves recurrent syncope after hysteroscopy secondary to CVST. If symptoms such as recurrent syncope, nausea, and vomiting, indicating increased intracranial pressure, arise posthysteroscopy and cannot be attributed to typical TURP syndrome, primary intracranial vascular conditions like CVST should be considered, as even a minor increase in blood volume can exacerbate these intracranial pressure symptoms.
{"title":"Recurrent syncope after hysteroscopy finally diagnosed as cerebral venous sinus thrombosis: a case report","authors":"Yongqing Zhang MD , Hongxing Ye MD , Danqing Chen MD, PhD , Guohui Yan MD , Zhanfu Li MD , Qianhui Xie MD , Guodong Shan MD , Zhaoxia Liang MD, PhD","doi":"10.1016/j.xagr.2025.100446","DOIUrl":"10.1016/j.xagr.2025.100446","url":null,"abstract":"<div><div>Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular condition that causes obstruction of venous blood flow or cerebrospinal fluid circulation, leading to intracranial hypertension symptoms such as syncope and vomiting. Transurethral Resection of the Prostate (TURP) syndrome, a complication of hysteroscopic surgery, can also present with cerebral edema and symptoms similar to CVST, making differentiation challenging. Cases of unexplained recurrent syncope posthysteroscopy diagnosed as CVST have not been previously reported. We present a case of a 33-year-old woman who underwent hysteroscopy for abnormal uterine bleeding. Five hours postoperation, she experienced syncope, which resolved spontaneously. Ten hours later, she had recurrent syncope, nausea, and vomiting. Head computed tomography suggested cerebral edema, potentially indicating TURP syndrome. However, the brief surgery and minimal fluid imbalance (200 mL) made TURP syndrome unlikely. Further investigation with cranial magnetic resonance venography revealed multiple venous sinus thromboses, explaining the recurrent syncope linked to minimal fluid volume expansion postsurgery. Subsequent screening identified hyperhomocysteinemia as a contributing factor. Treatment with anticoagulants, folic acid, and vitamin B6 led to a favorable outcome. This case involves recurrent syncope after hysteroscopy secondary to CVST. If symptoms such as recurrent syncope, nausea, and vomiting, indicating increased intracranial pressure, arise posthysteroscopy and cannot be attributed to typical TURP syndrome, primary intracranial vascular conditions like CVST should be considered, as even a minor increase in blood volume can exacerbate these intracranial pressure symptoms.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100446"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143104011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xagr.2024.100434
Md. Nawal Sarwer MPH , Effat Ara Jahan MSc , Akibul Islam Chowdhury MSc
BACKGROUND
Women empowerment is a crucial issue that is less studied as a factor of contraceptive use among married women that helps to achieve sustainable development goals.
OBJECTIVE
This study aimed to assess the relationship between women empowerment and contraceptive use.
STUDY DESIGN
This cross-sectional study used 2017–2018 Bangladesh Demographic and Health Survey data, which included 12,006 women (weighted) aged 15 to 49 years. Hierarchical logistic regression and structural equation models were used to show the relationship between women empowerment and contraceptive use.
RESULTS
Overall, increased use of contraception was associated with increased age, urban residence, increased wealth index, and education level of both the husband and wife. After controlling individual and locality factors, the findings from the regression model showed that women empowerment in terms of women decision-making, attitude toward violence, and social independence significantly influences contraceptive use (P<.05). However, the structural equation model analysis revealed a negative but nonsignificant relationship between overall women empowerment and contraceptive use (β=−0.138; P>.05).
CONCLUSION
This study implies that greater women empowerment may not always act as a stronger determinant of contraceptive use, and therefore, other contributing factors, such as age, education, religion, husband's participation, joined decision-making, economic status, and couple relationship, should be considered.
{"title":"Does women empowerment alone influence contraception utilization in Bangladesh perspective? Findings from the 2017–2018 Demographic Health Survey using a structural equation model analysis","authors":"Md. Nawal Sarwer MPH , Effat Ara Jahan MSc , Akibul Islam Chowdhury MSc","doi":"10.1016/j.xagr.2024.100434","DOIUrl":"10.1016/j.xagr.2024.100434","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Women empowerment is a crucial issue that is less studied as a factor of contraceptive use among married women that helps to achieve sustainable development goals.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to assess the relationship between women empowerment and contraceptive use.</div></div><div><h3>STUDY DESIGN</h3><div>This cross-sectional study used 2017–2018 Bangladesh Demographic and Health Survey data, which included 12,006 women (weighted) aged 15 to 49 years. Hierarchical logistic regression and structural equation models were used to show the relationship between women empowerment and contraceptive use.</div></div><div><h3>RESULTS</h3><div>Overall, increased use of contraception was associated with increased age, urban residence, increased wealth index, and education level of both the husband and wife. After controlling individual and locality factors, the findings from the regression model showed that women empowerment in terms of women decision-making, attitude toward violence, and social independence significantly influences contraceptive use (<em>P</em><.05). However, the structural equation model analysis revealed a negative but nonsignificant relationship between overall women empowerment and contraceptive use (β=−0.138; <em>P</em>>.05).</div></div><div><h3>CONCLUSION</h3><div>This study implies that greater women empowerment may not always act as a stronger determinant of contraceptive use, and therefore, other contributing factors, such as age, education, religion, husband's participation, joined decision-making, economic status, and couple relationship, should be considered.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100434"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xagr.2024.100436
Kadek A. Kurniawan MD , Sri Winarsih Apt., MKes , Nurdiana Nurdiana MD, MKes , Sri Andarini MD, MKes , Wiwit Nurwidyaningtyas MBiomed
Background
Immunoglobulin A (IgA) plays a crucial role in the maturation the neonatal mucosal barrier. The accumulation of IgA antibody-secreting cells (ASCs) in the lactating mammary gland facilitates the secretion of IgA antibodies into milk, which are then passively to the suckling newborn, providing transient immune protection against gastrointestinal pathogens. Physiologically, full-term infants are unable to produce IgA, required for mucosal barrier maturation for at least 10 days after birth. Prior studies declare that interleukin 5 (IL-5) responsible to encourage of IgA-producing B cells maturation during lactating periods.
Objective
This purpose of this study was determine IgA and IL-5 colostrum concentration based on maternal factors.
Study design
Ninety primiparous with full-term pregnancy and vaginal delivery were enrolled in a cross-sectional study. Colostrum samples were collected on the first day after delivery, followed by the measurement of IgA and IL-5 concentrations using ELISA. Sociodemographic and maternal factors were recorded based on participants’ self-reports using a questionnaire.
Result
The results showed that mean of colostrum IgA concentration in primiparous 24.9 ± 0.3 years old (95%CI: 24.3–25.6) was 1.51 ± 0.15µg/mL, while colostrum IL-5 concentration was 82.37 ± 20.2pg/mL. The results showed that IgA levels were not significantly correlated with age, education, occupation, weight, height, body mass index (BMI), fish consumption, or smoking habits but were significantly related to baby sex disappointment and weight gain during pregnancy (P<.05). Meanwhile, the IL-5 concentration was significantly correlated with smoking habits, baby's birth weight, and maternal age.
Conclusion
The composition of IgA and IL-5 in breast milk is strongly associated with several maternal factors including baby sex disappointment, weight gain during pregnancy, smoking habits, baby's birth weight, and maternal age. This maternal factor corroborate the recently evidence refer to inflammatory pathways involvement in colostrum IgA synthesis.
{"title":"The primiparous IgA and IL-5 colostrum concentration based on maternal factor: corroborate the inflammation pathways to IgA colostrum synthesis","authors":"Kadek A. Kurniawan MD , Sri Winarsih Apt., MKes , Nurdiana Nurdiana MD, MKes , Sri Andarini MD, MKes , Wiwit Nurwidyaningtyas MBiomed","doi":"10.1016/j.xagr.2024.100436","DOIUrl":"10.1016/j.xagr.2024.100436","url":null,"abstract":"<div><h3>Background</h3><div>Immunoglobulin A (IgA) plays a crucial role in the maturation the neonatal mucosal barrier. The accumulation of IgA antibody-secreting cells (ASCs) in the lactating mammary gland facilitates the secretion of IgA antibodies into milk, which are then passively to the suckling newborn, providing transient immune protection against gastrointestinal pathogens. Physiologically, full-term infants are unable to produce IgA, required for mucosal barrier maturation for at least 10 days after birth. Prior studies declare that interleukin 5 (IL-5) responsible to encourage of IgA-producing B cells maturation during lactating periods.</div></div><div><h3>Objective</h3><div>This purpose of this study was determine IgA and IL-5 colostrum concentration based on maternal factors.</div></div><div><h3>Study design</h3><div>Ninety primiparous with full-term pregnancy and vaginal delivery were enrolled in a cross-sectional study. Colostrum samples were collected on the first day after delivery, followed by the measurement of IgA and IL-5 concentrations using ELISA. Sociodemographic and maternal factors were recorded based on participants’ self-reports using a questionnaire.</div></div><div><h3>Result</h3><div>The results showed that mean of colostrum IgA concentration in primiparous 24.9 ± 0.3 years old (95%CI: 24.3–25.6) was 1.51 ± 0.15µg/mL, while colostrum IL-5 concentration was 82.37 ± 20.2pg/mL. The results showed that IgA levels were not significantly correlated with age, education, occupation, weight, height, body mass index (BMI), fish consumption, or smoking habits but were significantly related to baby sex disappointment and weight gain during pregnancy (<em>P</em><.05). Meanwhile, the IL-5 concentration was significantly correlated with smoking habits, baby's birth weight, and maternal age.</div></div><div><h3>Conclusion</h3><div>The composition of IgA and IL-5 in breast milk is strongly associated with several maternal factors including baby sex disappointment, weight gain during pregnancy, smoking habits, baby's birth weight, and maternal age. This maternal factor corroborate the recently evidence refer to inflammatory pathways involvement in colostrum IgA synthesis.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100436"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xagr.2024.100428
Marielle E. Meurice MD, MAS , Gennifer Kully Msc , Sarah Averbach MD, MAS , Antoinette Marengo MD , Jesse Nodora DrPH , Maricela Cervantes MPH , Sheila K. Mody MD, MPH
Background
Telemedicine contraception services have increased since the COVID-19 pandemic. There may be unique equity implications and language barriers for patients who speak Spanish.
Objective
To identify the barriers and facilitators of telemedicine for contraception care among patients who speak Spanish using a community-based participatory research approach.
Study Design
The study was designed and conducted in consultation with a community advisory board. We interviewed 20 patients after telemedicine and in-person contraception visits conducted in Spanish at Planned Parenthood of the Pacific Southwest in Southern California between April 2022 and May 2023. Telemedicine visits were conducted by audio only. Two coders analyzed the data using thematic analysis.
Results
The average age of the participants was 32.5 years old (range 19–45). Most participants had some college education (13/20, 65.0%) and public insurance (18/20, 90.0%). Most chose a short-acting contraceptive method (11/20, 55.0%). Five key themes were identified. (1) Participants reported less comfort with video technology and a preference to not be seen during the appointment, therefore preferring audio-only for telemedicine visits. (2) Participants did not report difficulty with Spanish interpreters using telemedicine. (3) Telemedicine has conveniences related to time, work, childcare, and transportation but may have inconveniences related to method receipt. (4) Preference for physical exam and preventative care and familiarity with the in-clinic model motivated people who sought in-person care rather than technology barriers with telemedicine. (5) There is trust in the privacy and confidentiality of the visits, but privacy at home for the individual may impact choice for in-person care.
Conclusion
Among patients who speak Spanish, telemedicine contraception care was acceptable and had many conveniences. Many patients who speak Spanish preferred audio-only for telemedicine contraception visits. Use of interpreters and technology were not perceived barriers to care.
{"title":"Barriers and facilitators to telemedicine contraception among patients that speak Spanish: a qualitative study","authors":"Marielle E. Meurice MD, MAS , Gennifer Kully Msc , Sarah Averbach MD, MAS , Antoinette Marengo MD , Jesse Nodora DrPH , Maricela Cervantes MPH , Sheila K. Mody MD, MPH","doi":"10.1016/j.xagr.2024.100428","DOIUrl":"10.1016/j.xagr.2024.100428","url":null,"abstract":"<div><h3>Background</h3><div>Telemedicine contraception services have increased since the COVID-19 pandemic. There may be unique equity implications and language barriers for patients who speak Spanish.</div></div><div><h3>Objective</h3><div>To identify the barriers and facilitators of telemedicine for contraception care among patients who speak Spanish using a community-based participatory research approach.</div></div><div><h3>Study Design</h3><div>The study was designed and conducted in consultation with a community advisory board. We interviewed 20 patients after telemedicine and in-person contraception visits conducted in Spanish at Planned Parenthood of the Pacific Southwest in Southern California between April 2022 and May 2023. Telemedicine visits were conducted by audio only. Two coders analyzed the data using thematic analysis.</div></div><div><h3>Results</h3><div>The average age of the participants was 32.5 years old (range 19–45). Most participants had some college education (13/20, 65.0%) and public insurance (18/20, 90.0%). Most chose a short-acting contraceptive method (11/20, 55.0%). Five key themes were identified. (1) Participants reported less comfort with video technology and a preference to not be seen during the appointment, therefore preferring audio-only for telemedicine visits. (2) Participants did not report difficulty with Spanish interpreters using telemedicine. (3) Telemedicine has conveniences related to time, work, childcare, and transportation but may have inconveniences related to method receipt. (4) Preference for physical exam and preventative care and familiarity with the in-clinic model motivated people who sought in-person care rather than technology barriers with telemedicine. (5) There is trust in the privacy and confidentiality of the visits, but privacy at home for the individual may impact choice for in-person care.</div></div><div><h3>Conclusion</h3><div>Among patients who speak Spanish, telemedicine contraception care was acceptable and had many conveniences. Many patients who speak Spanish preferred audio-only for telemedicine contraception visits. Use of interpreters and technology were not perceived barriers to care.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100428"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xagr.2024.100435
Greg J. Marchand MD , Ahmed Massoud MD , Hollie Ulibarri BS , Amanda Arroyo BS , Daniela Gonzalez Herrera BS , Brooke Hamilton BS , Kate Ruffley BS , Mckenna Robinson BS , Marissa Dominick BS , Ali Azadi MD
OBJECTIVE
Ectopic pregnancy is an emergency frequently requiring laparoscopic intervention. This study aimed to determine whether single-incision laparoscopic surgery is a safe and effective treatment method compared with conventional laparoscopic surgery with multiple ports.
DATA SOURCES
This study searched 6 databases from their inception to May 15, 2024, for articles comparing the safety outcomes of single-incision laparoscopic surgery with conventional laparoscopic surgery in managing women with ectopic pregnancy.
STUDY ELIGIBILITY CRITERIA
This study included all studies that evaluated the safety outcomes of single-incision laparoscopic surgery compared with conventional laparoscopic surgery in patients with ectopic pregnancy and included at least 1 of our preselected outcomes. In addition, this study included both randomized controlled trials and observational studies.
METHODS
Review Manager (version 5.4.1) and OpenMetaAnalyst software were used to analyze the extracted data. In addition, this study used odds ratios for dichotomous outcomes, mean difference for continuous outcomes, a fixed effects model for homogeneous outcomes, and a random effects model for heterogeneous outcomes. Furthermore, heterogeneity was evaluated using the I2 and P values. After removing duplicates, this study identified 83 studies. Using a 2-step screening process, this study excluded non-English and animal studies and included randomized controlled trials and observational studies that included at least 1 of our preselected outcomes. Ultimately, 12 studies were included in the final synthesis.
RESULTS
Our analysis showed a significant favoring of the single-incision laparoscopic surgery group in the pain visual analog scale score (median difference=−0.57; P<.01). However, our study found no statistically significant difference between both procedures in the times of analgesic use (median difference=−0.08; P=.19), intraoperative complications (odds ratio=1.17; P=.8), postoperative complications (odds ratio=1.02; P=.96), conversion to laparotomy (odds ratio=1.40; P=.59), bowel injury (odds ratio=1.42; P=.8), and postoperative fever (odds ratio=0.52; P=.42).
CONCLUSION
The use of single-incision laparoscopic surgery for treating ectopic pregnancy may reduce postoperative pain with similar rates of analgesic use. The incidences of intraoperative and postoperative complications were comparable. Furthermore, the rates of conversion to laparotomy, bowel injury, and postoperative fever were similar between the 2 techniques. Our results seem to show that single-incision laparoscopic surgery is noninferior to conventional laparoscopic surgery for the safe treatment of ectopic pregnancy.
{"title":"Noninferiority of single-incision laparoscopy vs conventional laparoscopy in salpingectomy or salpingotomy for ectopic pregnancy: a meta-analysis","authors":"Greg J. Marchand MD , Ahmed Massoud MD , Hollie Ulibarri BS , Amanda Arroyo BS , Daniela Gonzalez Herrera BS , Brooke Hamilton BS , Kate Ruffley BS , Mckenna Robinson BS , Marissa Dominick BS , Ali Azadi MD","doi":"10.1016/j.xagr.2024.100435","DOIUrl":"10.1016/j.xagr.2024.100435","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>Ectopic pregnancy is an emergency frequently requiring laparoscopic intervention. This study aimed to determine whether single-incision laparoscopic surgery is a safe and effective treatment method compared with conventional laparoscopic surgery with multiple ports.</div></div><div><h3>DATA SOURCES</h3><div>This study searched 6 databases from their inception to May 15, 2024, for articles comparing the safety outcomes of single-incision laparoscopic surgery with conventional laparoscopic surgery in managing women with ectopic pregnancy.</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>This study included all studies that evaluated the safety outcomes of single-incision laparoscopic surgery compared with conventional laparoscopic surgery in patients with ectopic pregnancy and included at least 1 of our preselected outcomes. In addition, this study included both randomized controlled trials and observational studies.</div></div><div><h3>METHODS</h3><div>Review Manager (version 5.4.1) and OpenMetaAnalyst software were used to analyze the extracted data. In addition, this study used odds ratios for dichotomous outcomes, mean difference for continuous outcomes, a fixed effects model for homogeneous outcomes, and a random effects model for heterogeneous outcomes. Furthermore, heterogeneity was evaluated using the <em>I<sup>2</sup></em> and <em>P</em> values. After removing duplicates, this study identified 83 studies. Using a 2-step screening process, this study excluded non-English and animal studies and included randomized controlled trials and observational studies that included at least 1 of our preselected outcomes. Ultimately, 12 studies were included in the final synthesis.</div></div><div><h3>RESULTS</h3><div>Our analysis showed a significant favoring of the single-incision laparoscopic surgery group in the pain visual analog scale score (median difference=−0.57; <em>P</em><.01). However, our study found no statistically significant difference between both procedures in the times of analgesic use (median difference=−0.08; <em>P</em>=.19), intraoperative complications (odds ratio=1.17; <em>P</em>=.8), postoperative complications (odds ratio=1.02; <em>P</em>=.96), conversion to laparotomy (odds ratio=1.40; <em>P</em>=.59), bowel injury (odds ratio=1.42; <em>P</em>=.8), and postoperative fever (odds ratio=0.52; <em>P</em>=.42).</div></div><div><h3>CONCLUSION</h3><div>The use of single-incision laparoscopic surgery for treating ectopic pregnancy may reduce postoperative pain with similar rates of analgesic use. The incidences of intraoperative and postoperative complications were comparable. Furthermore, the rates of conversion to laparotomy, bowel injury, and postoperative fever were similar between the 2 techniques. Our results seem to show that single-incision laparoscopic surgery is noninferior to conventional laparoscopic surgery for the safe treatment of ectopic pregnancy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100435"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xagr.2025.100445
Pearl A. McElfish PhD , Britni L. Ayers PhD , Nicola L. Hawley PhD , Aaron Caldwell PhD , Austin Porter DrPh , Michael D. Macechko MD , Donya Watson MD , Jennifer A. Callaghan-Koru PhD , James P. Selig PhD , Jennifer A. Andersen PhD , Nirvana Manning MD , Lanita White PharmD , Enrique Gomez-Pomar MD , Clare C. Brown PhD
BACKGROUND
Unnecessary cesarean delivery can have negative implications for both mothers and infants. In the United States, the proportion of women undergoing cesarean delivery exceeds the acceptable World Health Organization proportion. Reducing cesarean deliveries is a national goal of Centers for Disease Control and Prevention Healthy People 2030, the American College of Obstetricians and Gynecologists, and the Alliance for Innovation on Maternal Health.
OBJECTIVE
This study aimed to examine if excessive gestational weight gain is associated with increased risk of cesarean delivery across multiple body mass index categories.
STUDY DESIGN
Analysis was conducted using vital records data from the National Center for Health Statistics birth records. Only low-risk births were included (singleton, term-gestation [≥37 weeks], cephalic presentation, and first birth to exclude women who had a prior cesarean delivery). We used the rate of gestational weight gain (lb/wk) measured as both a categorical and continuous variable. These results were confirmed by a sensitivity analysis using total gestational weight gain (lb).
RESULTS
Regardless of prepregnancy body mass index category, women with excessive gestational weight gain had a higher risk of cesarean delivery. Among women with a healthy prepregnancy body mass index, the risk of cesarean delivery decreased with appropriate weight gain, suggesting a potential protective effect of moderate weight gain for individuals with a healthy prepregnancy body mass index. However, weight gain beyond the appropriate level increased the risk of cesarean delivery. For women with overweight or obese prepregnancy body mass index, any increase in gestational weight gain was associated with a higher cesarean delivery risk.
CONCLUSION
This study found a strong association between an excessive rate of gestational weight gain and the risk of cesarean delivery, regardless of prepregnancy body mass index, suggesting the need for continued efforts to reduce excessive gestational weight gain across populations.
{"title":"Gestational weight gain and increased risk of cesarean delivery across body mass index categories","authors":"Pearl A. McElfish PhD , Britni L. Ayers PhD , Nicola L. Hawley PhD , Aaron Caldwell PhD , Austin Porter DrPh , Michael D. Macechko MD , Donya Watson MD , Jennifer A. Callaghan-Koru PhD , James P. Selig PhD , Jennifer A. Andersen PhD , Nirvana Manning MD , Lanita White PharmD , Enrique Gomez-Pomar MD , Clare C. Brown PhD","doi":"10.1016/j.xagr.2025.100445","DOIUrl":"10.1016/j.xagr.2025.100445","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Unnecessary cesarean delivery can have negative implications for both mothers and infants. In the United States, the proportion of women undergoing cesarean delivery exceeds the acceptable World Health Organization proportion. Reducing cesarean deliveries is a national goal of Centers for Disease Control and Prevention Healthy People 2030, the American College of Obstetricians and Gynecologists, and the Alliance for Innovation on Maternal Health.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to examine if excessive gestational weight gain is associated with increased risk of cesarean delivery across multiple body mass index categories.</div></div><div><h3>STUDY DESIGN</h3><div>Analysis was conducted using vital records data from the National Center for Health Statistics birth records. Only low-risk births were included (singleton, term-gestation [≥37 weeks], cephalic presentation, and first birth to exclude women who had a prior cesarean delivery). We used the rate of gestational weight gain (lb/wk) measured as both a categorical and continuous variable. These results were confirmed by a sensitivity analysis using total gestational weight gain (lb).</div></div><div><h3>RESULTS</h3><div>Regardless of prepregnancy body mass index category, women with excessive gestational weight gain had a higher risk of cesarean delivery. Among women with a healthy prepregnancy body mass index, the risk of cesarean delivery decreased with appropriate weight gain, suggesting a potential protective effect of moderate weight gain for individuals with a healthy prepregnancy body mass index. However, weight gain beyond the appropriate level increased the risk of cesarean delivery. For women with overweight or obese prepregnancy body mass index, any increase in gestational weight gain was associated with a higher cesarean delivery risk.</div></div><div><h3>CONCLUSION</h3><div>This study found a strong association between an excessive rate of gestational weight gain and the risk of cesarean delivery, regardless of prepregnancy body mass index, suggesting the need for continued efforts to reduce excessive gestational weight gain across populations.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100445"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xagr.2024.100424
Annettee Nakimuli MD, PhD , Jackline Akello MD , Musa Sekikubo MD, PhD , Sarah Nakubulwa MD, PhD , Moses Adroma MD , Rehema Nabuufu , Emmanuel Obuya , John Paul Bagala MD , Andrew Twinamatsiko MD , Hadijah Nakatudde , Patrica Pirio MD , Grace Latigi , Baifa Arwinyo MD , Kenneth Mugabe MD , Irene Chebet MD , Richard Mugahi MD , Isabella Aitchison BA , Charlotte Patient MD , Ashley Moffett MD , Catherine E Aiken MB/BChir, PhD
Background
Worldwide, 70% of maternal deaths occur in Sub-Saharan Africa. Approximately 10% are attributable to hypertensive disorders of pregnancy, primarily complications of pre-eclampsia. Timely and effective care improves outcomes, but this is not consistently available, particularly in low-resource settings such as Uganda.
Objectives
We conducted a national evaluation of the provision of prompt and safe care for women with severe pre-eclampsia across all regions of Uganda. We explored the wider health system-related factors, eg supply availability, facilities, and emergency training drills, that may affect the ability of healthcare facilities to deliver optimal pre-eclampsia care.
Study design
A multidisciplinary research team carried out in-person, unannounced visits to maternity facilities across Uganda to assess the quality of care provided. Evaluations of facilities, staff interviews, and case notes reviews were performed.
Results
75 maternity facilities were included from all regions of Uganda. Of these, 25% were unable to provide correct emergency care for severe pre-eclampsia, and 21% were unable to consistently provide delivery or referral for eclamptic seizure within 12 hours. Factors strongly associated with not providing optimal pre-eclampsia care were lack of staff training, lack of readily available clinical protocols, lack of antenatal education, lack of close postnatal monitoring and care that was not always woman-centered.
Conclusions
The key barriers associated with delayed or poor quality pre-eclampsia care across Uganda are potentially modifiable with strengthened clinical governance initiatives. Developing context-specific, standardized, national training and educational programmes could be effective in reducing rates of maternal and neonatal morbidity and mortality from pre-eclampsia.
{"title":"Variations in emergency care for severe pre-eclampsia in Uganda: a national evaluation study","authors":"Annettee Nakimuli MD, PhD , Jackline Akello MD , Musa Sekikubo MD, PhD , Sarah Nakubulwa MD, PhD , Moses Adroma MD , Rehema Nabuufu , Emmanuel Obuya , John Paul Bagala MD , Andrew Twinamatsiko MD , Hadijah Nakatudde , Patrica Pirio MD , Grace Latigi , Baifa Arwinyo MD , Kenneth Mugabe MD , Irene Chebet MD , Richard Mugahi MD , Isabella Aitchison BA , Charlotte Patient MD , Ashley Moffett MD , Catherine E Aiken MB/BChir, PhD","doi":"10.1016/j.xagr.2024.100424","DOIUrl":"10.1016/j.xagr.2024.100424","url":null,"abstract":"<div><h3>Background</h3><div>Worldwide, 70% of maternal deaths occur in Sub-Saharan Africa. Approximately 10% are attributable to hypertensive disorders of pregnancy, primarily complications of pre-eclampsia. Timely and effective care improves outcomes, but this is not consistently available, particularly in low-resource settings such as Uganda.</div></div><div><h3>Objectives</h3><div>We conducted a national evaluation of the provision of prompt and safe care for women with severe pre-eclampsia across all regions of Uganda. We explored the wider health system-related factors, eg supply availability, facilities, and emergency training drills, that may affect the ability of healthcare facilities to deliver optimal pre-eclampsia care.</div></div><div><h3>Study design</h3><div>A multidisciplinary research team carried out in-person, unannounced visits to maternity facilities across Uganda to assess the quality of care provided. Evaluations of facilities, staff interviews, and case notes reviews were performed.</div></div><div><h3>Results</h3><div>75 maternity facilities were included from all regions of Uganda. Of these, 25% were unable to provide correct emergency care for severe pre-eclampsia, and 21% were unable to consistently provide delivery or referral for eclamptic seizure within 12 hours. Factors strongly associated with not providing optimal pre-eclampsia care were lack of staff training, lack of readily available clinical protocols, lack of antenatal education, lack of close postnatal monitoring and care that was not always woman-centered.</div></div><div><h3>Conclusions</h3><div>The key barriers associated with delayed or poor quality pre-eclampsia care across Uganda are potentially modifiable with strengthened clinical governance initiatives. Developing context-specific, standardized, national training and educational programmes could be effective in reducing rates of maternal and neonatal morbidity and mortality from pre-eclampsia.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100424"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143104012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xagr.2025.100442
Jezid Miranda PhD , Miguel A. Parra-Saavedra PhD , William O. Contreras-Lopez PhD , Cristóbal Abello MD , Guido Parra MD , Juan Hernandez MD , Amanda Barrero MD , Isabela Leones MD , Adriana Nieto-Sanjuanero MD , Gerardo Sepúlveda-Gonzalez MD , Magdalena Sanz-Cortes PhD
<div><h3>Background</h3><div>Spina bifida (SB) is a severe congenital malformation that affects approximately 150,000 infants annually, predominantly in low- and middle-income countries, leading to significant morbidity and lifelong disabilities. In Latin America, the birth prevalence of SB is notably high, often exacerbated by limited healthcare resources and poor access to advanced medical care. The implementation of laparotomy-assisted fetoscopic in-utero SB repair programs in Latin America targets reducing prematurity rates and enabling vaginal births while preserving the benefits of decreased need for hydrocephalus treatment and improved mobility in children.</div></div><div><h3>Objective</h3><div>This study evaluated the safety, efficacy, and outcomes of laparotomy-assisted fetoscopic in-utero SB repair in Latin America compared to traditional open-hysterotomy methods.</div></div><div><h3>Study design</h3><div>This retrospective cohort study included 39 cases of laparotomy-assisted fetoscopic in-utero SB repair, with 14 cases from Mexico (2017–2021) and 25 cases from Colombia (2019–2024). These cases were compared to 78 cases from the MOMs trial and 314 from other Latin American centers using traditional open-hysterotomy methods. Statistical analyses included the Student's t-test, Kruskal-Wallis test, and Pearson's chi-square test.</div></div><div><h3>Results</h3><div>The gestational age (GA) at the time of surgery was significantly higher in fetoscopic centers (26±1.27 weeks) compared to the MOMs trial (23.6±1.42 weeks) and traditional hysterotomy methods (25.4±1 weeks) (<em>P</em><.001). Mean GA at delivery was significantly earlier in the hysterotomy-based groups than in our fetoscopic group (MOMs: 34.1 [± 3.1] vs open-repair centers in LATAM: 34 [±3002] vs Fetoscopic: 35.3 [± 3.79] weeks; <em>P</em> values=.14 and 0004, respectively). Moreover, and the fetoscopic repair group exhibited a significantly lower rate of spontaneous preterm births (<34 weeks) at 15.8%, compared to 46.2% in the MOMs trial group and 49% in the other Latin American centers using traditional open-hysterotomy methods (<em>P</em>=.004 and .001, respectively). Additionally, the fetoscopic group had higher birthweights (2618±738g) and a lower cesarean delivery rate (65.8%) compared to the other groups (<em>P</em><.001). Hydrocephalus treatment requirements at 12 months were similar across all groups. No maternal deaths or other outcomes such as pulmonary edema or need for maternal transfusion were noted in the fetoscopic SB repair group.</div></div><div><h3>Conclusion</h3><div>The laparotomy-assisted fetoscopic SB repair offers a feasible and safer alternative to traditional hysterotomy-based techniques in Latin America. This approach significantly reduces the rates of prematurity and cesarean deliveries, facilitating vaginal births and minimizing maternal morbidity. These findings support the broader adoption of fetoscopic SB repair in regions with a high p
{"title":"Implementation of in utero laparotomy-assisted fetoscopic spina bifida repair in two centers in Latin America: rationale for this approach in this region","authors":"Jezid Miranda PhD , Miguel A. Parra-Saavedra PhD , William O. Contreras-Lopez PhD , Cristóbal Abello MD , Guido Parra MD , Juan Hernandez MD , Amanda Barrero MD , Isabela Leones MD , Adriana Nieto-Sanjuanero MD , Gerardo Sepúlveda-Gonzalez MD , Magdalena Sanz-Cortes PhD","doi":"10.1016/j.xagr.2025.100442","DOIUrl":"10.1016/j.xagr.2025.100442","url":null,"abstract":"<div><h3>Background</h3><div>Spina bifida (SB) is a severe congenital malformation that affects approximately 150,000 infants annually, predominantly in low- and middle-income countries, leading to significant morbidity and lifelong disabilities. In Latin America, the birth prevalence of SB is notably high, often exacerbated by limited healthcare resources and poor access to advanced medical care. The implementation of laparotomy-assisted fetoscopic in-utero SB repair programs in Latin America targets reducing prematurity rates and enabling vaginal births while preserving the benefits of decreased need for hydrocephalus treatment and improved mobility in children.</div></div><div><h3>Objective</h3><div>This study evaluated the safety, efficacy, and outcomes of laparotomy-assisted fetoscopic in-utero SB repair in Latin America compared to traditional open-hysterotomy methods.</div></div><div><h3>Study design</h3><div>This retrospective cohort study included 39 cases of laparotomy-assisted fetoscopic in-utero SB repair, with 14 cases from Mexico (2017–2021) and 25 cases from Colombia (2019–2024). These cases were compared to 78 cases from the MOMs trial and 314 from other Latin American centers using traditional open-hysterotomy methods. Statistical analyses included the Student's t-test, Kruskal-Wallis test, and Pearson's chi-square test.</div></div><div><h3>Results</h3><div>The gestational age (GA) at the time of surgery was significantly higher in fetoscopic centers (26±1.27 weeks) compared to the MOMs trial (23.6±1.42 weeks) and traditional hysterotomy methods (25.4±1 weeks) (<em>P</em><.001). Mean GA at delivery was significantly earlier in the hysterotomy-based groups than in our fetoscopic group (MOMs: 34.1 [± 3.1] vs open-repair centers in LATAM: 34 [±3002] vs Fetoscopic: 35.3 [± 3.79] weeks; <em>P</em> values=.14 and 0004, respectively). Moreover, and the fetoscopic repair group exhibited a significantly lower rate of spontaneous preterm births (<34 weeks) at 15.8%, compared to 46.2% in the MOMs trial group and 49% in the other Latin American centers using traditional open-hysterotomy methods (<em>P</em>=.004 and .001, respectively). Additionally, the fetoscopic group had higher birthweights (2618±738g) and a lower cesarean delivery rate (65.8%) compared to the other groups (<em>P</em><.001). Hydrocephalus treatment requirements at 12 months were similar across all groups. No maternal deaths or other outcomes such as pulmonary edema or need for maternal transfusion were noted in the fetoscopic SB repair group.</div></div><div><h3>Conclusion</h3><div>The laparotomy-assisted fetoscopic SB repair offers a feasible and safer alternative to traditional hysterotomy-based techniques in Latin America. This approach significantly reduces the rates of prematurity and cesarean deliveries, facilitating vaginal births and minimizing maternal morbidity. These findings support the broader adoption of fetoscopic SB repair in regions with a high p","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100442"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xagr.2024.100420
Mojdeh Banaei PhD, Nasibeh Roozbeh PhD, Fatemeh Darsareh PhD, Vahid Mehrnoush MD, Mohammad Sadegh Vahidi Farashah PhD, Farideh Montazeri BSc
Background
Episiotomy has specific indications that, if properly followed, can effectively prevent women from experiencing severe lacerations that may result in significant complications like anal incontinence. However, the risk factors related to episiotomy has been the center of much debate in the medical field in the past few years.
Objective
The present study used a machine learning model to predict the factors that put women at the risk of having episiotomy using intrapartum data.
Study design
This was a retrospective cohort study design. Factors such as age, educational level, residency place, medical insurance, nationality, attendance at prenatal education courses, parity, gestational age, onset of labor, presence of a doula during labor, maternal health conditions like anemia, diabetes, preeclampsia, prolonged rupture of membrane, placenta abruption, presence of meconium in amniotic fluid, intrauterine growth retardation, intrauterine fetal death, maternal body mass index, and fetal distress were extracted from the electronic health record system of a tertiary-care medical center in Iran, from January 2022 to January 2023. The criteria for inclusion were vaginal delivery of a single pregnancy. Deliveries done through scheduled/emergency cesarean section or at the mother's request were excluded. The participants were divided into two groups: those who had vaginal deliveries with episiotomy and those who had vaginal deliveries without episiotomy. The significant variables, as determined by their P-values, were selected as features for the eight machine-learning models. The evaluation of performance included area under the curve (AUC), accuracy, precision, recall, and F1-Score.
Results
During the study period, out of 1775 vaginal deliveries, 629 (35.4%) required an episiotomy. Each model had an AUC value assigned to it: linear regression (0.85), deep learning (0.82), support vector machine (0.79), light gradient-boosting (0.79), logistic regression (0.78), XGBoost classification (0.77), random forest classification (0.76), decision tree classification (0.75), and permutation classification—knn (0.70). Linear regression had a better diagnostic performance among all the models with the area under the ROC curve (AUC): 0.85, accuracy: 0.80, precision: 0.74, recall: 0.86, and F_1 score: 0.79). Parity, labor onset, gestational age, body mass index, and doula support were the leading clinical factors related to episiotomy, according to their importance rankings.
Conclusions
Utilizing a clinical dataset and various machine learning models to assess the risk factors of episiotomy resulted in promising results. Further research, focusing on intrapartum clinical data and perspectives of the birth attendant, is necessary to enhance the accuracy of predictions.
{"title":"Utilizing machine learning to predict the risk factors of episiotomy in parturient women","authors":"Mojdeh Banaei PhD, Nasibeh Roozbeh PhD, Fatemeh Darsareh PhD, Vahid Mehrnoush MD, Mohammad Sadegh Vahidi Farashah PhD, Farideh Montazeri BSc","doi":"10.1016/j.xagr.2024.100420","DOIUrl":"10.1016/j.xagr.2024.100420","url":null,"abstract":"<div><h3>Background</h3><div>Episiotomy has specific indications that, if properly followed, can effectively prevent women from experiencing severe lacerations that may result in significant complications like anal incontinence. However, the risk factors related to episiotomy has been the center of much debate in the medical field in the past few years.</div></div><div><h3>Objective</h3><div>The present study used a machine learning model to predict the factors that put women at the risk of having episiotomy using intrapartum data.</div></div><div><h3>Study design</h3><div>This was a retrospective cohort study design. Factors such as age, educational level, residency place, medical insurance, nationality, attendance at prenatal education courses, parity, gestational age, onset of labor, presence of a doula during labor, maternal health conditions like anemia, diabetes, preeclampsia, prolonged rupture of membrane, placenta abruption, presence of meconium in amniotic fluid, intrauterine growth retardation, intrauterine fetal death, maternal body mass index, and fetal distress were extracted from the electronic health record system of a tertiary-care medical center in Iran, from January 2022 to January 2023. The criteria for inclusion were vaginal delivery of a single pregnancy. Deliveries done through scheduled/emergency cesarean section or at the mother's request were excluded. The participants were divided into two groups: those who had vaginal deliveries with episiotomy and those who had vaginal deliveries without episiotomy. The significant variables, as determined by their <em>P</em>-values, were selected as features for the eight machine-learning models. The evaluation of performance included area under the curve (AUC), accuracy, precision, recall, and F1-Score.</div></div><div><h3>Results</h3><div>During the study period, out of 1775 vaginal deliveries, 629 (35.4%) required an episiotomy. Each model had an AUC value assigned to it: linear regression (0.85), deep learning (0.82), support vector machine (0.79), light gradient-boosting (0.79), logistic regression (0.78), XGBoost classification (0.77), random forest classification (0.76), decision tree classification (0.75), and permutation classification—knn (0.70). Linear regression had a better diagnostic performance among all the models with the area under the ROC curve (AUC): 0.85, accuracy: 0.80, precision: 0.74, recall: 0.86, and F_1 score: 0.79). Parity, labor onset, gestational age, body mass index, and doula support were the leading clinical factors related to episiotomy, according to their importance rankings.</div></div><div><h3>Conclusions</h3><div>Utilizing a clinical dataset and various machine learning models to assess the risk factors of episiotomy resulted in promising results. Further research, focusing on intrapartum clinical data and perspectives of the birth attendant, is necessary to enhance the accuracy of predictions.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100420"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.xagr.2025.100440
Laura J. O'Byrne BMBS, MSc, PhD , Gillian M. Maher PhD , Jill M. Mitchell MB, BCh, BAO , Ali S Khashan PhD , Richard M. Greene MB, BCh, BAO , John P. Browne PhD , Fergus P. McCarthy MB, BCh, BAO, PhD
<div><h3>Background</h3><div>Despite a focus on patient-reported outcome measures (PROM) in maternity care, a standardized tool is lacking. Current existing measures often focus on a single dimension of postpartum health.</div></div><div><h3>Objective</h3><div>This study evaluated the construct validity of using a suite of PROMs based on the top psychometrically validated tools available. They were combined to achieve coverage of all important aspects of postpartum well-being outlined by the International Consortium of Health Outcomes (ICHOM).</div></div><div><h3>Methods</h3><div>Recruitment took place in a tertiary university maternity hospital between April 3<sup>rd</sup> 2023, and October 28<sup>th</sup> 2023, with final responses collected in January 2024. Postnatal women were recruited before hospital discharge and consented to completing the PROM tool which consisted of the Postpartum Quality of Life (PQoL) tool, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and 2 additional questions on pelvic pain with sexual intercourse. The PROM was administered at T1=first week postpartum, T2=6 weeks and T3=12 weeks postpartum. We evaluated the construct validity of these tools through hypothesis testing, proposing that: (1) the instrument should differentiate between groups with and without morbidity, (2) the instrument should differentiate between groups based on delivery type, and (3) should detect change over the postpartum period. Statistical analyses, including chi-square tests, repeated measures ANOVA, and independent t-tests, were used for data analysis.</div></div><div><h3>Results</h3><div>534 women were recruited, with an average age of 32 years (±5.0), 90.6% (n=484) had term deliveries, 59% (n=316) were multiparous, 40% (n=216) had spontaneous vaginal deliveries (SVD), 12% (n=63) had operative vaginal deliveries and 47.7% (n= 255) had caesarean sections. Examining the tools’ ability to detect changes based on morbidity found no significant differences in PQoL, ICIQ-UI SF or pelvic pain scores between groups with and without maternal morbidity. There were also no differences found in the scores of mothers who had babies admitted to the Neonatal Unit (NNU). Examining score differences based on delivery type, found no variations in total PQoL scores across all timepoints. There were no score differences at other time points in the ICIQ-UI SF or pelvic pain question scores. The PQoL, ICIQ-UI SF and the pelvic pain with sexual intercourse questions had statistically significant difference in their overall scores over the 3 timepoints of the study. The PQoL scores were T1: 128 [<span><math><mo>±</mo></math></span>9.67], T2: 125 [<span><math><mo>±</mo></math></span>8.47], and T3: 126 [<span><math><mo>±</mo></math></span>8.51] <em>P=</em>.002. The ICIQ-UI SF had a median score and interquartile ranges of T1: 7.7 (IQR=6), T2: 9 (IQR=7), and T3: 9 (IQR=7), <em>P=<</em>.001. The pelvic pain
{"title":"Construct validation of a complete postpartum health and well-being patient reported outcome measure: prospective cohort study","authors":"Laura J. O'Byrne BMBS, MSc, PhD , Gillian M. Maher PhD , Jill M. Mitchell MB, BCh, BAO , Ali S Khashan PhD , Richard M. Greene MB, BCh, BAO , John P. Browne PhD , Fergus P. McCarthy MB, BCh, BAO, PhD","doi":"10.1016/j.xagr.2025.100440","DOIUrl":"10.1016/j.xagr.2025.100440","url":null,"abstract":"<div><h3>Background</h3><div>Despite a focus on patient-reported outcome measures (PROM) in maternity care, a standardized tool is lacking. Current existing measures often focus on a single dimension of postpartum health.</div></div><div><h3>Objective</h3><div>This study evaluated the construct validity of using a suite of PROMs based on the top psychometrically validated tools available. They were combined to achieve coverage of all important aspects of postpartum well-being outlined by the International Consortium of Health Outcomes (ICHOM).</div></div><div><h3>Methods</h3><div>Recruitment took place in a tertiary university maternity hospital between April 3<sup>rd</sup> 2023, and October 28<sup>th</sup> 2023, with final responses collected in January 2024. Postnatal women were recruited before hospital discharge and consented to completing the PROM tool which consisted of the Postpartum Quality of Life (PQoL) tool, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and 2 additional questions on pelvic pain with sexual intercourse. The PROM was administered at T1=first week postpartum, T2=6 weeks and T3=12 weeks postpartum. We evaluated the construct validity of these tools through hypothesis testing, proposing that: (1) the instrument should differentiate between groups with and without morbidity, (2) the instrument should differentiate between groups based on delivery type, and (3) should detect change over the postpartum period. Statistical analyses, including chi-square tests, repeated measures ANOVA, and independent t-tests, were used for data analysis.</div></div><div><h3>Results</h3><div>534 women were recruited, with an average age of 32 years (±5.0), 90.6% (n=484) had term deliveries, 59% (n=316) were multiparous, 40% (n=216) had spontaneous vaginal deliveries (SVD), 12% (n=63) had operative vaginal deliveries and 47.7% (n= 255) had caesarean sections. Examining the tools’ ability to detect changes based on morbidity found no significant differences in PQoL, ICIQ-UI SF or pelvic pain scores between groups with and without maternal morbidity. There were also no differences found in the scores of mothers who had babies admitted to the Neonatal Unit (NNU). Examining score differences based on delivery type, found no variations in total PQoL scores across all timepoints. There were no score differences at other time points in the ICIQ-UI SF or pelvic pain question scores. The PQoL, ICIQ-UI SF and the pelvic pain with sexual intercourse questions had statistically significant difference in their overall scores over the 3 timepoints of the study. The PQoL scores were T1: 128 [<span><math><mo>±</mo></math></span>9.67], T2: 125 [<span><math><mo>±</mo></math></span>8.47], and T3: 126 [<span><math><mo>±</mo></math></span>8.51] <em>P=</em>.002. The ICIQ-UI SF had a median score and interquartile ranges of T1: 7.7 (IQR=6), T2: 9 (IQR=7), and T3: 9 (IQR=7), <em>P=<</em>.001. The pelvic pain","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100440"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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