AJOG global reports最新文献

英文中文

Association of Professors of Gynecology and Obstetrics Preparation for Residency Knowledge Assessment scores are more closely associated with first postgraduate year Council on Resident Education in Obstetrics and Gynecology scores than United States Medical Licensing Examination Steps 1 and 2 妇产科教授协会住院医师准备知识评估分数与第一个研究生年妇产科住院医师教育委员会分数的关系比美国医学执业资格考试第 1 和第 2 步更密切。

AJOG global reports

Pub Date : 2024-05-01 DOI: 10.1016/j.xagr.2024.100354

Amanda Morgan MD, Myanna Cook BA, Megan Christman DO, Nicole Scott MD, Anthony Shanks MD, MS, MEd

引用次数: 0

The iPREFACE score is useful for predicting fetal acidemia: A retrospective cohort study of 113 patients who underwent emergency cesarean section for non-reassuring fetal status during labor iPREFACE 评分有助于预测胎儿酸血症：一项对 113 名在分娩过程中因胎儿状态不稳定而接受紧急剖宫产术的患者进行的回顾性队列研究

AJOG global reports

Pub Date : 2024-04-04 DOI: 10.1016/j.xagr.2024.100343

Ayumu Ito MD, PhD , Eijiro Hayata MD, PhD , Hikari Kotaki MD , Makiko Shimabukuro MD , Mayumi Takano MD, PhD , Sumito Nagasaki MD, PhD , Masahiko Nakata MD, PhD

BACKGROUND

The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision in the future.

OBJECTIVE

This study aimed to assess the score use of the iPREFACE as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor.

STUDY DESIGN

This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean delivery owing to a nonreassuring fetal status. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery score, calculated from a 30-minute cardiotocography waveform before the decision to perform emergency cesarean delivery, and the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer score, calculated from a 30-minute cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography score.

RESULTS

The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery and integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer scores demonstrated the capability to predict an umbilical artery blood pH of <7.2. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery and −removal of cardiotocography transducer score, with cutoff values of 37 and 46 points, respectively, exhibited an area under the receiver operating characteristic curve of 0.82 and 0.87, respectively. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer group with ≥46 points had higher incidence rates of an umbilical cord artery blood pH of <7.2, <7.1, and <7.0 and neonatal intensive care unit admissions for neonatal asphyxia.

CONCLUSION

The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring, derived from cardiotocography during an emergency cesarean delivery, may enable clinicians to predict fetal acidemia in cases of nonreassuring fetal status. Improved prediction of fetal acidemia

背景 iPREFACE 评分可帮助预测紧急剖宫产和阴道分娩中的胎儿酸血症和新生儿窒息，这可能会提高未来产程管理的精确性。目的本研究旨在评估 iPREFACE 评分的使用情况，作为在产程中反复出现异常波形且无同时需要立即医疗干预指征的情况下是否需要快速分娩的客观指标。研究设计这项回顾性队列研究的对象是足月（37+0 天至 41+6 天）单胎孕妇，她们因胎儿状态不稳定而接受了紧急剖宫产。该研究采用了产前胎心率监测预测胎儿酸血症综合评分指数--决定紧急剖宫产评分（根据决定紧急剖宫产前 30 分钟的心动图波形计算），以及产前胎心率监测预测胎儿酸血症综合评分指数--移除心动图换能器评分（根据移除心动图换能器前 30 分钟的心动图波形计算）。主要结果是评估这些评分对胎儿酸血症的预测能力，次要结果是两组间脐动脉血气结果和产后结果的差异，除以通过产前胎心率监测-移除心动图评分预测胎儿酸血症的综合评分指数的临界值。结果通过产前胎心率监测-决定紧急剖宫产预测胎儿酸血症的综合评分指数和通过产前胎心率监测-移除心脏排畸换能器预测胎儿酸血症的综合评分指数证明了预测脐动脉血pH值为<7.2的能力。通过产前胎儿心率监测-决定紧急剖宫产和移除心动图换能器评分预测胎儿酸血症的综合评分指数的临界值分别为 37 分和 46 分，其接收器操作特征曲线下面积分别为 0.82 和 0.87。通过产前胎心率监测-移除心动图换能器预测胎儿酸血症的综合评分指数≥46分组的脐动脉血pH值为<7.2、<7.1和<7.0以及因新生儿窒息入住新生儿重症监护室的发生率较高。结论通过产前胎心率监测预测胎儿酸血症的综合评分指数，可使临床医生在胎儿状态不稳定的情况下预测胎儿酸血症。改进对胎儿酸血症的预测并促进及时干预，有望改善分娩过程中母亲和新生儿的预后。需要进行前瞻性研究，以确定精确的临界值，并验证这些评分的临床应用。

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引用次数: 0

Aspirin for preeclampsia prevention in low- and middle-income countries: mind the gaps 阿司匹林在中低收入国家用于预防子痫前期：注意差距

AJOG global reports

Pub Date : 2024-04-03 DOI: 10.1016/j.xagr.2024.100352

Ellen Kupka MD, James M. Roberts MD, Zaleha A. Mahdy MD, FRCOG, Carlos Escudero MD, PhD, Lina Bergman MD, PhD, Leandro De Oliveira MD, PhD, Global Pregnancy Collaboration

Preeclampsia is a syndrome that continues to be a major contributor to maternal and neonatal mortality, especially in low-income countries. Low-dose aspirin reduces the risk of preeclampsia, but the mechanism is still unknown. Risk factors to identify women at risk of preeclampsia are based on clinical characteristics. Women identified as high-risk would benefit from aspirin treatment initiated, preferably at the end of the first trimester. Current efforts have largely focused on developing screening algorithms that incorporate clinical risk factors, maternal biomarkers, and uterine artery Doppler evaluated in the first trimester. However, most studies on preeclampsia are conducted in high-income settings, raising uncertainties about whether the information gained can be totally applied in low-resource settings. In low- and middle-income countries, lack of adequate antenatal care and late commencement of antenatal care visits pose significant challenges for both screening for preeclampsia and initiating aspirin treatment. Furthermore, the preventive effect of first-trimester screening based on algorithms and subsequent aspirin treatment is primarily seen for preterm preeclampsia, and reviews indicate minimal or no impact on reducing the risk of term preeclampsia. The lack of evidence regarding the effectiveness of aspirin in preventing term preeclampsia is a crucial concern, as 75% of women will develop this subtype of the syndrome. Regarding adverse outcomes, low-dose aspirin has been linked to a possible higher risk of postpartum hemorrhage, a condition as deadly as preeclampsia in many low- and middle-income countries. The increased risk of postpartum hemorrhage among women in low-income settings should be taken into consideration when discussing which pregnant women would benefit from the use of aspirin and the ideal aspirin dosage for preventing preeclampsia. In addition, women's adherence to aspirin during pregnancy is crucial for determining its effectiveness and complications, an aspect often overlooked in trials. In this review, we analyze the knowledge gaps that must be addressed to safely increase low-dose aspirin use in low- and middle-income countries, and we propose directions for future research.

先兆子痫是一种综合征，仍然是造成孕产妇和新生儿死亡的主要原因，尤其是在低收入国家。小剂量阿司匹林可降低先兆子痫的风险，但其机制尚不清楚。识别子痫前期高危妇女的风险因素基于临床特征。被确定为高风险的妇女最好在妊娠头三个月结束时开始接受阿司匹林治疗。目前的工作主要集中在开发筛查算法，将临床风险因素、母体生物标志物和妊娠头三个月的子宫动脉多普勒评估结合起来。然而，大多数有关子痫前期的研究都是在高收入环境中进行的，因此无法确定所获得的信息能否完全应用于低资源环境。在中低收入国家，缺乏足够的产前保健和产前保健就诊开始较晚，给子痫前期筛查和开始阿司匹林治疗带来了巨大挑战。此外，基于算法的首胎筛查和随后的阿司匹林治疗的预防效果主要体现在早产子痫前期，而综述显示，其对降低足月子痫前期风险的影响极小或没有影响。阿司匹林在预防足月子痫前期方面的有效性缺乏证据，这是一个值得关注的重要问题，因为 75% 的妇女会患上这种亚型子痫综合征。关于不良后果，低剂量阿司匹林可能与产后出血的风险升高有关，在许多中低收入国家，产后出血与子痫前期一样是一种致命疾病。在讨论哪些孕妇可从使用阿司匹林中获益以及预防先兆子痫的理想阿司匹林剂量时，应考虑到低收入环境中妇女产后出血风险的增加。此外，妇女在怀孕期间坚持服用阿司匹林对于确定阿司匹林的有效性和并发症至关重要，这也是试验中经常忽略的一个方面。在这篇综述中，我们分析了在中低收入国家安全地增加低剂量阿司匹林的使用所必须解决的知识缺口，并提出了未来的研究方向。

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引用次数: 0

Implementation challenges in preeclampsia care: perspectives from health care professionals in urban Uganda 子痫前期护理的实施挑战：乌干达城市医护人员的观点

AJOG global reports

Pub Date : 2024-04-02 DOI: 10.1016/j.xagr.2024.100348

Imelda Namagembe MD , Babu Karavadra BSc Hons, MBBS, PhD , Lawrence Kazibwe MBChB, MMed , Joseph Rujumba PhD , Noah Kiwanuka MBChB, MPH, PhD , Brandon Smith BSc Hons, PhD , Josaphat Byamugisha PhD , Ashley Moffett MB/BChir, PhD , Tom Bashford MBBS, MBiochem, PhD, MRCP, FRCA , Annettee Nakimuli MD, PhD , Catherine E. Aiken MB/BChir, MA, PhD, MRCOG, MRCP

BACKGROUND

Sub-Saharan Africa bears the burden of 70% of maternal deaths worldwide, of which ∼10% are attributable to hypertensive disorders of pregnancy, primarily complications of preeclampsia. In other global settings, outcomes of pregnancies affected by preeclampsia are improved with timely and effective medical care.

OBJECTIVE

This study aimed to explore the perspectives of local health care professionals on how preeclampsia care is currently delivered in the study setting and what challenges they experience in providing prompt and safe care. We identified specific objectives of exploring stakeholder perceptions of (1) recognizing preeclampsia and (2) timely intervention when preeclampsia is diagnosed. We also explored the wider system factors (eg, cultural, financial, and logistic challenges) that health care professionals perceived as affecting their ability to deliver optimal preeclampsia care.

STUDY DESIGN

Individual semistructured interviews were conducted with health care professionals and stakeholders. The findings were analyzed using thematic analysis.

RESULTS

Thirty-three participants contributed to the study, including doctors and midwives with varying degrees of clinical experience and external stakeholders. The following 5 key themes emerged: delayed patient presentation, recognizing the unwell patient with preeclampsia, the challenges of the existing triage system, stakeholder disconnect, and ways of learning from each other. Health care professionals referenced an important psychosocial perspective associated with preeclampsia in the study setting, which may influence the likelihood of seeking care through traditional healers rather than hospital-based routes.

CONCLUSION

We identify the key barriers to improving maternal and neonatal outcomes of preeclampsia, described at both the institutional level and within the wider setting. The study provides invaluable contextual information that suggests that a systems-based approach to health care quality improvement may be effective in reducing rates of maternal and neonatal morbidity and mortality.

背景撒哈拉以南非洲地区的孕产妇死亡人数占全球孕产妇死亡人数的70%，其中10%可归因于妊娠高血压疾病，主要是子痫前期的并发症。在全球其他地区，及时有效的医疗护理可改善受子痫前期影响的孕妇的预后。目标本研究旨在探讨当地医疗专业人员对目前如何在研究环境中提供子痫前期护理的看法，以及他们在提供及时、安全的护理时遇到的挑战。我们确定了具体的目标，即探讨利益相关者对（1）识别子痫前期和（2）确诊子痫前期后及时干预的看法。我们还探讨了医护人员认为影响其提供最佳子痫前期护理能力的更广泛的系统因素（如文化、财务和后勤挑战）。结果33名参与者参与了研究，其中包括具有不同临床经验的医生和助产士以及外部利益相关者。研究得出了以下 5 个关键主题：患者延迟就诊、识别子痫前期不适患者、现有分诊系统面临的挑战、利益相关者脱节以及相互学习的方法。医护人员在研究中提到了与子痫前期相关的重要社会心理观点，这可能会影响通过传统医治者而非医院途径寻求治疗的可能性。这项研究提供了宝贵的背景信息，表明以系统为基础的医疗质量改进方法可以有效降低孕产妇和新生儿的发病率和死亡率。

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引用次数: 0

Mainz II urinary diversion in low-resource settings: patient outcomes in women with irreparable fistula in Malawi 低资源环境下的美因茨 II 尿路转流术：马拉维瘘管无法修复的妇女患者的治疗效果

AJOG global reports

Pub Date : 2024-04-01 DOI: 10.1016/j.xagr.2024.100350

Tulsi D. Patel MD , Ennet B. Chipungu MBBS , Jennifer M. Draganchuk MD , Chisomo Chalamanda DCM , Jeffrey P. Wilkinson MD

BACKGROUND

Obstructed labor leading to a vesicovaginal fistula remains a devastating outcome of childbirth in low-resource countries. Women with an irreparable vesicovaginal fistula may be candidates for a urinary diversion, such as the Mainz II modified ureterosigmoidostomy procedure. Previous reviews state that the procedure should be considered in low-resource countries. However, given the limited duration of postoperative follow-up, these studies do not adequately represent the long-term morbidity and mortality that is likely associated with this procedure. We present data that strongly support avoiding the procedure in low-resource countries.

OBJECTIVE

This study aimed to evaluate the postoperative status of the patient (dead, alive, lost to follow-up) and time to death following the Mainz II procedure.

STUDY DESIGN

This is a case series including 21 patients who underwent a Mainz II urinary diversion from April 2013 to June 2015 for management of irreparable vesicovaginal fistula at the Fistula Care Centre in Lilongwe, Malawi. Patients were seen postoperatively at 3, 6, 9, and 12 months, followed by every 6 to 12 months thereafter. Descriptive statistics were performed to summarize the data.

RESULTS

During the postoperative period, 8 (38.1%; 8/21) patients died, 5 (23.8%; 5/21) were lost to follow-up, and 8 (38.1%; 8/21) are currently alive and followed up at the Fistula Care Centre. We strongly suspect that 7 of the 8 deaths were related to the procedure given that the patients had illnesses that exacerbated the metabolic consequences of the procedure. The eighth patient died after being attacked by robbers. Unfortunately, the exact cause of death could not be determined for these patients. Given that most of the suspected illnesses would be treatable in an otherwise healthy patient, even in this low-resource setting, we surmised that the metabolic compromise from the Mainz II procedure likely contributed to their untimely death. The average time from procedure to death was 58 months, with the earliest death at 10 months and the most recent at 7 years after the procedure.

CONCLUSION

The Mainz II procedure is an option for patients with irreparable fistula. However, it should likely not be performed in low-resource countries given the long-term complications that often cannot be adequately addressed in these settings, leading to significant morbidity and mortality.

背景在资源匮乏的国家，难产导致的膀胱阴道瘘仍然是分娩过程中的一种严重后果。患有无法修复的膀胱阴道瘘的妇女可能需要进行尿流改道手术，如美因茨 II 改良输尿管乙状结肠造口术。之前的评论指出，在资源匮乏的国家应考虑采用该手术。然而，由于术后随访时间有限，这些研究并不能充分反映该手术可能带来的长期发病率和死亡率。我们提供的数据强烈支持在低资源国家避免该手术。研究设计这是一个病例系列，包括2013年4月至2015年6月期间在马拉维利隆圭瘘管病护理中心接受Mainz II尿流改道手术治疗不可修复的膀胱阴道瘘的21名患者。患者在术后 3、6、9 和 12 个月接受了检查，之后每 6 至 12 个月接受一次检查。结果在术后期间，8（38.1%；8/21）名患者死亡，5（23.8%；5/21）名患者失去随访机会，8（38.1%；8/21）名患者目前还活着并在瘘管病护理中心接受随访。我们强烈怀疑 8 名死亡患者中的 7 人与手术有关，因为这些患者所患的疾病加剧了手术的代谢后果。第八名患者是在遭到劫匪袭击后死亡的。遗憾的是，这些病人的确切死因无法确定。鉴于即使在资源匮乏的环境中，大多数疑似疾病对健康患者来说都是可以治疗的，我们推测美因茨二期手术造成的代谢紊乱很可能是导致他们过早死亡的原因。从手术到死亡的平均时间为58个月，最早的死亡时间为术后10个月，最近的死亡时间为术后7年。结论：美因茨二期手术是不可修复瘘管患者的一种选择，但在资源匮乏的国家，这种手术很可能无法实施，因为长期并发症往往无法在这些国家得到充分解决，从而导致严重的发病率和死亡率。

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引用次数: 0

Clinical application of amino-terminal pro-brain natriuretic peptide concentration in amniotic fluid for the prediction of preterm birth in symptomatic women 羊水中氨基末端前脑钠尿肽（NT-proBNP）浓度在预测无症状妇女早产中的临床应用

AJOG global reports

Pub Date : 2024-03-30 DOI: 10.1016/j.xagr.2024.100345

Fernando A. Ferrer-Marquez MD, Rocío P. Astudillo MD, Jorge A. Carvajal MD, PhD

BACKGROUND

Preterm birth accounts for 60% to 80% of neonatal mortality. Approximately one-third of preterm births are caused by the spontaneous onset of preterm labor. Nevertheless, 70% to 90% of women diagnosed with preterm labor will not deliver within 7 days. Thus, many women will be unnecessarily treated by preterm labor with risk medications. Better tools are needed to categorize women in preterm labor into high or low risk of preterm delivery.

OBJECTIVE

This study aimed to evaluate the amino-terminal pro-brain natriuretic peptide concentration in the amniotic fluid as a prognostic test to predict the risk of delivery within 48 hours or 7 days and before 34 0/7 or 37 0/7 weeks of gestation in women in preterm labor.

STUDY DESIGN

A total of 102 pregnant women presenting signs and symptoms of spontaneous preterm birth (22 0/7 to 34 0/7 weeks of gestation) were included. Amniotic fluid was obtained by amniocentesis, and amino-terminal pro-brain natriuretic peptide concentration was measured. Below normal concentration was defined as <0.5 multiples of the median of the standard curve according to gestational age. The risk of preterm delivery was estimated according to normal or lower-than-normal amino-terminal pro-brain natriuretic peptide concentrations. The predictive capacity of the test (below normal amino-terminal pro-brain natriuretic peptide concentration) was evaluated to identify spontaneous preterm birth at 48 hours or 7 days from amniocentesis and less than 34 0/7 or 37 0/7 weeks at delivery.

RESULTS

For the outcome delivery within 48 hours, lower-than-normal amino-terminal pro-brain natriuretic peptide concentration had 94.6% sensitivity, 73.8% specificity, 96.0% negative predictive value, 3.61 positive likelihood ratio, and 0.07 negative likelihood ratio. For the outcome delivery within 7 days, the test had 93.9% sensitivity, 88.7% specificity, 94.0% negative predictive value, 8.31 positive likelihood ratio, and 0.07 negative likelihood ratio. For the outcomes of spontaneous preterm birth before 34 0/7 and 37 0/7 weeks of gestation, below normal amino-terminal pro-brain natriuretic peptide concentrations had 80.0% sensitivity, 83.0% specificity, 78.0% negative predictive value, 4.70 positive likelihood ratio, and 0.24 negative likelihood ratio and 64.1% sensitivity, 91.7% specificity, 44.0% negative predictive value, 7.70 positive likelihood ratio, and 0.39 negative likelihood ratio, respectively.

CONCLUSION

Among patients in spontaneous preterm labor, the detection of lower-than-normal amino-terminal pro-brain natriuretic peptide concentrations (<0.5 multiples of the median) in amniotic fluid has an excellent predictive capacity to identify those patients at low risk of preterm delivery within 48 hours or 7 days.

背景早产占新生儿死亡率的 60% 至 80%。约有三分之一的早产是由于自然发生的早产造成的。然而，70% 到 90% 被诊断为早产的产妇不会在 7 天内分娩。因此，许多早产妇女将不必要地接受危险药物治疗。本研究旨在评估羊水中氨基末端前脑钠肽的浓度，作为预测早产妇女在妊娠 34 0/7 周或 37 0/7 周前 48 小时内或 7 天内分娩风险的预后测试。研究设计共纳入 102 名出现自然早产迹象和症状（妊娠 22 0/7 周至 34 0/7 周）的孕妇。通过羊膜穿刺术获得羊水，并测量氨基末端前脑钠肽的浓度。根据胎龄，低于正常浓度的定义为<标准曲线中位数的 0.5 倍。根据氨基末端前脑钠肽浓度正常或低于正常估算早产风险。评估了该测试（低于正常的氨基末端前脑钠肽浓度）的预测能力，以确定羊膜腔穿刺后 48 小时或 7 天、分娩时不足 34 0/7 周或 37 0/7 周的自然早产。结果对于 48 小时内的分娩结果，氨基末端前脑钠肽浓度低于正常的敏感性为 94.6%，特异性为 73.8%，阴性预测值为 96.0%，阳性似然比为 3.61，阴性似然比为 0.07。对于 7 天内分娩的结果，该检测的灵敏度为 93.9%，特异性为 88.7%，阴性预测值为 94.0%，阳性似然比为 8.31，阴性似然比为 0.07。对于妊娠 34 0/7 周和 37 0/7 周前的自然早产结果，低于正常的氨基末端脑钠肽浓度具有 80.0% 的灵敏度、83.0% 的特异性、78.0% 的阴性预测值、4.70 的阳性似然比和 0.24 的阴性似然比，以及 64.1% 的灵敏度、91.7% 的特异性、44.0% 的阴性预测值、7.结论在自然早产患者中，检测羊水中低于正常的氨基末端前脑钠肽浓度（<中位数的 0.5 倍）具有极佳的预测能力，可识别 48 小时或 7 天内早产的低风险患者。

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引用次数: 0

Migraine among women with endometriosis: a hospital-based case-control study in Bangladesh 患有子宫内膜异位症的妇女中的偏头痛：孟加拉国医院病例对照研究

AJOG global reports

Pub Date : 2024-03-30 DOI: 10.1016/j.xagr.2024.100344

Samina Sultana MS , Touhidul A. Chowdhury FRCS , Tanzeem S. Chowdhury MRCOG , Nusrat Mahmud MSc , Rebeka Sultana FCPS , Naushaba T. Mahtab FCPS , Yushuf Sharker PhD , Firoz Ahmed PhD

BACKGROUND

Endometriosis is a disease among women of reproductive age, which causes several health problems, such as dysmenorrhea, dyspareunia, and subfertility. In addition, it increases psychological stress and often results in marital disharmony. Similarly, migraine is more frequent among this group of women. Several studies have shown an association between endometriosis and migraine among groups of populations completely different from Bangladesh.

OBJECTIVE

This study aimed to identify the association between endometriosis and migraine among the Bangladeshi population.

STUDY DESIGN

This nonrandomized case-control study was conducted with cases of endometriosis and controls without endometriosis who were confirmed by laparoscopy or laparotomy. Among the study participants, cases of migraine in 1 group of respondents who were already diagnosed as patients of migraine were identified, and the others with complaints of headaches were further confirmed by a medicine specialist. Patients were recruited from the Department of Obstetrics and Gynecology at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College. The study was approved by the ethical review committee of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital. Multivariate logistic regression was used to identify the association between endometriosis and migraine using odds ratios and 95% confidence intervals.

RESULTS

Of 1496 patients who underwent laparoscopy or laparotomy during the study period, the frequency of endometriosis was found to be 12.7%. A total of 190 patients with confirmed endometriosis cases and an equal number of controls without endometriosis were enrolled, maintaining the age distribution of the controls similar to that of the cases. Compared with controls, the distribution of age, body mass index, education, and marital status of the patients with endometriosis were similar. The average ages of respondents were 30.6 years in both the case and control groups. Regarding occupation, cases included more students than controls (12% vs 0%, respectively). The odds of suffering from dysmenorrhea and dyspareunia among the cases were 3.3 (95% confidence interval, 2.66–4.15; P<.001) and 9.5 (95% confidence interval, 5.3–17.9; P<.001) times higher than that of controls, respectively. In addition, the odds of menstrual irregularity was 60% lower among the cases than among controls (odds ratio, 0.4; 95% confidence interval, 0.24–0.64; P<.001). No significant difference was observed in having primary subfertility and secondary subfertility among the 2 groups of respondents. Univariate regression analysis showed that patients with endometriosis have 6.13 times higher odds (95% confidence interval, 2.50

背景子宫内膜异位症是育龄妇女的一种疾病，会导致多种健康问题，如痛经、排卵障碍和不孕症。此外，子宫内膜异位症还会增加心理压力，常常导致婚姻不和谐。同样，偏头痛在这一妇女群体中也较为常见。多项研究表明，在与孟加拉国完全不同的人群中，子宫内膜异位症与偏头痛之间存在关联。研究设计这项非随机病例对照研究的对象是经腹腔镜或开腹手术确诊的子宫内膜异位症病例和无子宫内膜异位症的对照组。在研究参与者中，有一组受访者已被确诊为偏头痛患者，其他主诉头痛的受访者则由医学专家进一步确诊。患者来自孟加拉国糖尿病、内分泌和代谢紊乱综合医院和易卜拉欣医学院的妇产科。该研究获得了孟加拉国糖尿病、内分泌和代谢紊乱综合医院研究与康复研究所伦理审查委员会的批准。研究采用多变量逻辑回归法，利用几率比和 95% 的置信区间来确定子宫内膜异位症与偏头痛之间的关联。共有 190 名确诊子宫内膜异位症的患者和相同数量的无子宫内膜异位症的对照组被纳入研究，对照组的年龄分布与病例相似。与对照组相比，子宫内膜异位症患者的年龄、体重指数、教育程度和婚姻状况分布相似。病例组和对照组受访者的平均年龄均为 30.6 岁。在职业方面，病例组中的学生人数多于对照组（分别为 12% 和 0%）。病例中出现痛经和排便困难的几率分别是对照组的 3.3 倍（95% 置信区间，2.66-4.15；P<.001）和 9.5 倍（95% 置信区间，5.3-17.9；P<.001）。此外，病例中月经不调的几率比对照组低 60%（几率比，0.4；95% 置信区间，0.24-0.64；P<.001）。两组受访者在原发性不孕症和继发性不孕症方面无明显差异。单变量回归分析显示，与对照组相比，子宫内膜异位症患者患偏头痛的几率高出 6.13 倍（95% 置信区间，2.50-18.40；P<.001），患头痛的几率高出 2.00 倍（95% 置信区间，1.2-3.2；P=.01）。此外，经年龄和体重指数调整的多变量模型显示，子宫内膜异位症患者患偏头痛的几率是无子宫内膜异位症患者的 5.4 倍（95% 置信区间，2.11-16.4；P<.001）。此外，育龄妇女的年龄越大，患偏头痛的几率越高。我们的研究结果表明，在孟加拉国人口中，子宫内膜异位症与偏头痛之间存在关联，这与其他地区的相关研究结果相似。治疗子宫内膜异位症和偏头痛这两种疾病患者的医生群体应牢记这种相互关系，以确保提高患者的生活质量。

{"title":"Migraine among women with endometriosis: a hospital-based case-control study in Bangladesh","authors":"Samina Sultana MS , Touhidul A. Chowdhury FRCS , Tanzeem S. Chowdhury MRCOG , Nusrat Mahmud MSc , Rebeka Sultana FCPS , Naushaba T. Mahtab FCPS , Yushuf Sharker PhD , Firoz Ahmed PhD","doi":"10.1016/j.xagr.2024.100344","DOIUrl":"10.1016/j.xagr.2024.100344","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Endometriosis is a disease among women of reproductive age, which causes several health problems, such as dysmenorrhea, dyspareunia, and subfertility. In addition, it increases psychological stress and often results in marital disharmony. Similarly, migraine is more frequent among this group of women. Several studies have shown an association between endometriosis and migraine among groups of populations completely different from Bangladesh.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to identify the association between endometriosis and migraine among the Bangladeshi population.</p></div><div><h3>STUDY DESIGN</h3><p>This nonrandomized case-control study was conducted with cases of endometriosis and controls without endometriosis who were confirmed by laparoscopy or laparotomy. Among the study participants, cases of migraine in 1 group of respondents who were already diagnosed as patients of migraine were identified, and the others with complaints of headaches were further confirmed by a medicine specialist. Patients were recruited from the Department of Obstetrics and Gynecology at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College. The study was approved by the ethical review committee of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital. Multivariate logistic regression was used to identify the association between endometriosis and migraine using odds ratios and 95% confidence intervals.</p></div><div><h3>RESULTS</h3><p>Of 1496 patients who underwent laparoscopy or laparotomy during the study period, the frequency of endometriosis was found to be 12.7%. A total of 190 patients with confirmed endometriosis cases and an equal number of controls without endometriosis were enrolled, maintaining the age distribution of the controls similar to that of the cases. Compared with controls, the distribution of age, body mass index, education, and marital status of the patients with endometriosis were similar. The average ages of respondents were 30.6 years in both the case and control groups. Regarding occupation, cases included more students than controls (12% vs 0%, respectively). The odds of suffering from dysmenorrhea and dyspareunia among the cases were 3.3 (95% confidence interval, 2.66–4.15; <em>P</em><.001) and 9.5 (95% confidence interval, 5.3–17.9; <em>P</em><.001) times higher than that of controls, respectively. In addition, the odds of menstrual irregularity was 60% lower among the cases than among controls (odds ratio, 0.4; 95% confidence interval, 0.24–0.64; <em>P</em><.001). No significant difference was observed in having primary subfertility and secondary subfertility among the 2 groups of respondents. Univariate regression analysis showed that patients with endometriosis have 6.13 times higher odds (95% confidence interval, 2.50","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 2","pages":"Article 100344"},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000388/pdfft?md5=b53761037099a265963cdc215a171a88&pid=1-s2.0-S2666577824000388-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405296","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}

引用次数: 0

The effect of cervical pessary on increasing gestational age at delivery in twin pregnancies with asymptomatic short cervix: a systematic review and meta-analysis of randomized controlled trials 宫颈栓塞对无症状短宫颈双胎妊娠增加分娩胎龄的影响：随机对照试验的系统回顾和元分析

AJOG global reports

Pub Date : 2024-03-30 DOI: 10.1016/j.xagr.2024.100347

Amir Hossein Norooznezhad MD , Nikan Zargarzadeh MD , Ali Javinani MD , Seyedeh Maedeh Nabavian MD , Shohra Qaderi MD , Shayan Mostafaei MD , Vincenzo Berghella MD , Yinka Oyelese MD , Alireza A. Shamshirsaz MD, FACOG

Objective

The incidence of preterm delivery is much higher in twin pregnancies than in singletons and even higher if a short cervical length is detected in the second trimester. Studies are contradictory regarding the efficacy of a cervical pessary to decrease preterm birth in twin pregnancies and short cervical length. To conduct a systematic review and meta-analysis investigating the efficacy of cervical pessary in prolonging gestation, preventing preterm birth, and reducing adverse neonatal outcomes in twin pregnancies with an asymptomatic short cervix.

Data sources

PubMed, Scopus, Web of Science, and ClinicalTrials.org were searched for randomized controlled trials from inception to June 2023.

Study eligibility criteria

In this study, randomized controlled trials comparing the cervical pessary to expectant management in the pregnant population with twin gestations and asymptomatic short cervix were included.

Methods

The Cochrane risk-of-bias-2 tool for randomized controlled trials was used for the evaluation of the risk of bias in included studies. A meta-analysis was performed by calculating risk ratio and mean difference with their 95% confidence interval using the random effects model or fixed effect model on the basis of heterogeneity and accounting for potential covariates among the included randomized controlled trials.

Results

A total of 6 randomized controlled trials were included in the analysis. Cervical pessary did not significantly increase the gestational age at delivery in twin pregnancies with asymptomatic patients (mean difference, 0.36 weeks [−0.27 to 0.99]; P=.270; I²=72.0%). Moreover, the cervical pessary use did not result in a reduction of spontaneous or all-preterm birth before 37 weeks of gestation (risk ratio, 0.88 [0.77–1.00]; P=.061; I²=0.0%). There was no statistically significant difference in the composite neonatal adverse outcomes (risk ratio, 1.001 [0.86–1.16]; P=.981; I²=20.9%), including early respiratory morbidity, intraventricular hemorrhage, necrotizing enterocolitis, and confirmed sepsis.

Conclusion

The use of cervical pessary in twin pregnancies with asymptomatic short cervix does not seem to be effective in increasing the gestational age at delivery, preventing preterm birth, or reducing adverse neonatal outcomes. This indicates that alternative interventions should be sought for the management of this patient population.

目的双胎妊娠的早产率比单胎妊娠高得多，如果在妊娠后三个月发现宫颈过短，早产率甚至更高。关于宫颈栓剂对减少双胎妊娠和宫颈长度过短早产的疗效，研究结果相互矛盾。数据来源检索了PubMed、Scopus、Web of Science和ClinicalTrials.org上从开始到2023年6月的随机对照试验。研究资格标准在本研究中，纳入了在双胎妊娠和无症状短宫颈的妊娠人群中比较宫颈息肉和预期管理的随机对照试验。方法采用 Cochrane risk-of-bias-2 随机对照试验工具来评估纳入研究的偏倚风险。根据随机对照试验的异质性并考虑潜在的协变量，采用随机效应模型或固定效应模型计算风险比和平均差及其 95% 的置信区间，从而进行荟萃分析。在无症状患者的双胎妊娠中，宫颈栓塞并没有显著增加分娩时的胎龄（平均差异为 0.36 周 [-0.27 至 0.99]；P=.270；I2=72.0%）。此外，使用宫颈栓并没有减少妊娠 37 周前的自然分娩或所有早产（风险比为 0.88 [0.77-1.00]；P=.061；I2=0.0%）。新生儿综合不良结局（包括早期呼吸系统发病率、脑室内出血、坏死性小肠结肠炎和确诊败血症）无统计学差异（风险比，1.001 [0.86-1.16]；P=.981；I2=20.9%）。结论在无症状宫颈过短的双胎妊娠中使用宫颈栓似乎不能有效提高分娩时的胎龄、预防早产或减少新生儿不良结局。这表明，在管理这一患者群体时，应寻求其他干预措施。

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引用次数: 0

Performance of the first-trimester Fetal Medicine Foundation competing risks model for preeclampsia prediction: an external validation study in Brazil 胎儿医学基金会用于子痫前期预测的首胎竞争风险模型的性能：巴西外部验证研究

AJOG global reports

Pub Date : 2024-03-29 DOI: 10.1016/j.xagr.2024.100346

Karina Bilda de Castro Rezende MD, PhD , Rita G. Bornia MD, PhD , Daniel L. Rolnik MD, PhD, MPH , Joffre Amim Jr. MD, PhD , Luiza P. Ladeira MD , Valentina M.G. Teixeira MS , Antonio Jose L.A. da Cunha MD, PhD, MPH

BACKGROUND

The current version of the Fetal Medicine Foundation competing risks model for preeclampsia prediction has not been previously validated in Brazil.

OBJECTIVE

This study aimed (1) to validate the Fetal Medicine Foundation combined algorithm for the prediction of preterm preeclampsia in the Brazilian population and (2) to describe the accuracy and calibration of the Fetal Medicine Foundation algorithm when considering the prophylactic use of aspirin by clinical criteria.

STUDY DESIGN

This was a cohort study, including consecutive singleton pregnancies undergoing preeclampsia screening at 11 to 14 weeks of gestation, examining maternal characteristics, medical history, and biophysical markers between October 2010 and December 2018 in a university hospital in Brazil. Risks were calculated using the 2018 version of the algorithm available on the Fetal Medicine Foundation website, and cases were classified as low or high risk using a cutoff of 1/100 to evaluate predictive performance. Expected and observed cases with preeclampsia according to the Fetal Medicine Foundation–estimated risk range (≥1 in 10; 1 in 11 to 1 in 50; 1 in 51 to 1 in 100; 1 in 101 to 1 in 150; and <1 in 150) were compared. After identifying high-risk pregnant women who used aspirin, the treatment effect of 62% reduction in preterm preeclampsia identified in the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention trial was used to evaluate the predictive performance adjusted for the effect of aspirin. The number of potentially unpreventable cases in the group without aspirin use was estimated.

RESULTS

Among 2749 pregnancies, preterm preeclampsia occurred in 84 (3.1%). With a risk cutoff of 1/100, the screen-positive rate was 25.8%. The detection rate was 71.4%, with a false positive rate of 24.4%. The area under the curve was 0.818 (95% confidence interval, 0.773–0.863). In the risk range ≥1/10, there is an agreement between the number of expected cases and the number of observed cases, and in the other ranges, the predicted risk was lower than the observed rates. Accounting for the effect of aspirin resulted in an increase in detection rate and positive predictive values and a slight decrease in the false positive rate. With 27 cases of preterm preeclampsia in the high-risk group without aspirin use, we estimated that 16 of these cases of preterm preeclampsia would have been avoided if this group had received prophylaxis.

CONCLUSION

In a high-prevalence setting, the Fetal Medicine Foundation algorithm can identify women who are more likely to develop preterm preeclampsia. Not accounting for the effect of aspirin underestimates the screening performance.

目的本研究旨在（1）验证胎儿医学基金会用于预测巴西人群先兆子痫的综合算法；（2）描述胎儿医学基金会算法在根据临床标准考虑预防性使用阿司匹林时的准确性和校准性。研究设计这是一项队列研究，包括2010年10月至2018年12月期间在巴西一所大学医院接受子痫前期筛查的连续单胎妊娠，检查孕产妇特征、病史和生物物理标记物。使用胎儿医学基金会网站上提供的2018年版算法计算风险，并以1/100为分界线将病例分为低风险和高风险，以评估预测性能。根据胎儿医学基金会估计的风险范围（≥1/10；1/11 至 1/50；1/51 至 1/100；1/101 至 1/150；<1/150），对预期和观察到的子痫前期病例进行比较。在确定使用阿司匹林的高危孕妇后，利用 "联合多标志物筛查和阿司匹林随机患者治疗用于循证子痫前期预防试验 "中确定的子痫前期减少 62% 的治疗效果来评估根据阿司匹林的效果进行调整后的预测性能。结果在 2749 例妊娠中，84 例（3.1%）发生了先兆子痫。风险临界值为 1/100，筛查阳性率为 25.8%。检出率为 71.4%，假阳性率为 24.4%。曲线下面积为 0.818（95% 置信区间，0.773-0.863）。在风险范围≥1/10 时，预期病例数与观察病例数一致，而在其他范围内，预测风险低于观察率。考虑到阿司匹林的影响，检出率和阳性预测值均有所提高，假阳性率略有下降。在未使用阿司匹林的高风险组中有 27 例先兆子痫病例，我们估计，如果该组接受了预防性治疗，其中 16 例先兆子痫病例就可以避免。如果不考虑阿司匹林的影响，则会低估筛查效果。

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引用次数: 0

Exploring the relationship between language, postoperative pain, and opioid use 探索语言、术后疼痛和阿片类药物使用之间的关系

AJOG global reports

Pub Date : 2024-03-28 DOI: 10.1016/j.xagr.2024.100342

Rachel A. Levy MD , Allison H. Kay MD , Nancy Hills PhD , Lee-may Chen MD , Jocelyn S. Chapman MD

BACKGROUND

Racial and ethnic disparities in pain management are well documented. Differences in pain assessment and management by language have not been studied in the postoperative setting in gynecologic surgery.

OBJECTIVE

This study aimed to investigate the association between language and immediate postoperative pain management by comparing pain assessments and perioperative opioid use in non-English speakers and English speakers.

STUDY DESIGN

This was a retrospective cohort study comparing perioperative outcomes between non–English-speaking patients and English-speaking patients who had undergone a gynecologic oncology open surgery between July 2012 and December 2020. The primary language was extracted from the electronic medical record. Opioid use is expressed in oral morphine equivalents. Proportions are compared using chi-square tests, and mean values are compared using 2-sample t tests. Although interpreter services are widely available in our institution, the use of interpreters for any given inpatient-provider interaction is not documented.

RESULTS

Between 2012 and 2020, 1203 gynecologic oncology patients underwent open surgery, of whom 181 (15.1%) were non-English speakers and 1018 (84.9%) were English speakers. There was no difference between the 2 cohorts concerning body mass index, surgical risk score, or preoperative opioid use. Compared with the English-speaking group, the non–English-speaking group was younger (57 vs 54 years old, respectively; P<.01) and had lower rates of depression (26% vs 14%, respectively; P<.01) and chronic pain (13% vs 6%, respectively; P<.01). Although non–English-speaking patients had higher rates of hysterectomy than English-speaking patients (80% vs 72%, respectively; P=.03), there was no difference in the rates of bowel resections, adnexal surgeries, lengths of surgery, intraoperative oral morphine equivalents administered, blood loss, use of opioid-sparing modalities, lengths of hospital stay, or intensive care unit admissions. In the postoperative period, compared with English-speaking patients, non–English-speaking patients received fewer oral morphine equivalents per day (31.7 vs 43.9 oral morphine equivalents, respectively; P<.01) and had their pain assessed less frequently (7.7 vs 8.8 checks per day, respectively; P<.01) postoperatively. English-speaking patients received a median of 19.5 more units of oral morphine equivalents daily in the hospital and 205.1 more units of oral morphine equivalents at the time of discharge (P=.02 and P=.04, respectively) than non–English-speaking patients. When controlling for differences between groups and several factors that may influence oral morphine equivalent use, English-speaking patients received a median of 15.9 more units of oral morphine equivalents daily in the hosp

背景种族和民族在疼痛管理方面的差异有据可查。本研究旨在通过比较非英语使用者和英语使用者的疼痛评估和围手术期阿片类药物使用情况，研究语言与术后即时疼痛管理之间的关联。研究设计这是一项回顾性队列研究，比较了2012年7月至2020年12月期间接受妇科肿瘤开放手术的非英语患者和英语患者的围手术期结果。主要语言从电子病历中提取。阿片类药物的使用以口服吗啡当量表示。使用卡方检验比较比例，使用双样本t检验比较平均值。结果2012年至2020年间，1203名妇科肿瘤患者接受了开放手术，其中181人（15.1%）不讲英语，1018人（84.9%）讲英语。两组患者在体重指数、手术风险评分或术前阿片类药物使用方面没有差异。与英语组相比，非英语组患者更年轻（分别为 57 岁对 54 岁；P<.01），抑郁率（分别为 26% 对 14%；P<.01）和慢性疼痛率（分别为 13% 对 6%；P<.01）更低。虽然非英语患者的子宫切除率高于英语患者（分别为 80% 对 72%；P=.03），但在肠道切除率、附件手术率、手术时间、术中口服吗啡当量、失血量、阿片类药物保留方式的使用、住院时间或重症监护室入院率方面没有差异。在术后期间，与讲英语的患者相比，不讲英语的患者每天接受的口服吗啡当量较少（分别为31.7对43.9口服吗啡当量；P<.01），术后疼痛评估的频率也较低（分别为每天7.7对8.8次检查；P<.01）。与不讲英语的患者相比，讲英语的患者每天在医院接受的口服吗啡当量中位数多 19.5 个单位，出院时接受的口服吗啡当量中位数多 205.1 个单位（P=.02 和 P=.04）。当控制了组间差异和可能影响口服吗啡当量使用的几个因素后，与不讲英语的患者相比，讲英语的患者在住院期间每天获得的口服吗啡当量中位数多出15.9个单位，出院时获得的口服吗啡当量也与不讲英语的患者相似。语言障碍、疼痛评估的频率和提供者的偏见可能会导致疼痛管理方面的差异长期存在。根据这项研究的结果，我们主张对所有术后患者定期进行口头疼痛评估，并由语言沟通能力强的工作人员或医疗翻译人员进行评估。

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