During pregnancy, the prescription of beta-blockers to the mother may be necessary for pre-existing chronic conditions. Their use raises concerns due to potential effects on the fetus.
Objectives
This study aimed to investigate the impact of beta-blockers on mean fetal heart rate in pregnant women treated with these medications compared to an untreated patient group.
Study Design
This was a retrospective case-control study involving 90 patients, divided into two groups: 45 patients on beta-blockers and 45 untreated patients. Included patients delivered singleton pregnancies after 24 weeks of gestational age at two university hospitals in Île-de-France between 2009 and 2021. They were matched based on age, parity, and gestational age at delivery. Fetal heart rate and maternal heart rate were recorded on the day of delivery. Pregnancy outcomes were studied secondarily.
Results
There was no significant difference in mean fetal heart rate between the two groups: 87% of fetuses from mothers treated with beta-blockers had a heart rate between 110 and 150 bpm, compared to 93% of fetuses in the second group (P=.71). Among patients taking beta-blockers, the most commonly used treatment was bisoprolol.
Conclusion
The study did not reveal a significant effect of beta-blockers on fetal heart rate. However, close monitoring and appropriate clinical management are still necessary for pregnant patients on beta-blocker treatment due to other potential implications like intra-uterine growth restriction for both the mother and the fetus.
{"title":"Effect of maternal beta-blocker treatment on mean fetal heart rate","authors":"Sarah Hautier MD , Thi Minh Thu Nguyen MD , Arane Kim MD , Tiphaine Barral MD , Dominique Luton PhD","doi":"10.1016/j.xagr.2024.100423","DOIUrl":"10.1016/j.xagr.2024.100423","url":null,"abstract":"<div><h3>Background</h3><div>During pregnancy, the prescription of beta-blockers to the mother may be necessary for pre-existing chronic conditions. Their use raises concerns due to potential effects on the fetus.</div></div><div><h3>Objectives</h3><div>This study aimed to investigate the impact of beta-blockers on mean fetal heart rate in pregnant women treated with these medications compared to an untreated patient group.</div></div><div><h3>Study Design</h3><div>This was a retrospective case-control study involving 90 patients, divided into two groups: 45 patients on beta-blockers and 45 untreated patients. Included patients delivered singleton pregnancies after 24 weeks of gestational age at two university hospitals in Île-de-France between 2009 and 2021. They were matched based on age, parity, and gestational age at delivery. Fetal heart rate and maternal heart rate were recorded on the day of delivery. Pregnancy outcomes were studied secondarily.</div></div><div><h3>Results</h3><div>There was no significant difference in mean fetal heart rate between the two groups: 87% of fetuses from mothers treated with beta-blockers had a heart rate between 110 and 150 bpm, compared to 93% of fetuses in the second group (<em>P</em>=.71). Among patients taking beta-blockers, the most commonly used treatment was bisoprolol.</div></div><div><h3>Conclusion</h3><div>The study did not reveal a significant effect of beta-blockers on fetal heart rate. However, close monitoring and appropriate clinical management are still necessary for pregnant patients on beta-blocker treatment due to other potential implications like intra-uterine growth restriction for both the mother and the fetus.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100423"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933828","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.2024.100421
Emily Leubner MD, Brooke A. Levandowski PhD, MPA, Sage Mikami MD , Theresa Green PhD, MBA, Sarah Betstadt MD, MPH
BACKGROUND
Postpartum contraception is typically provided during postpartum visits. When desired and accessible, the immediate postpartum period provides an additional opportunity to increase the use of more effective contraceptive methods to potentially reduce subsequent unintended pregnancies and improve pregnancy outcomes. In New York State, recent policy changes expanded Medicaid coverage to include immediate postplacental intrauterine device insertion.
OBJECTIVE
This study aimed to investigate clinically documented intrauterine device expulsion within 12 months of placement in patients who depend on state-funded health insurance.
STUDY DESIGN
This retrospective cohort study included Medicaid patients with an immediate postplacental intrauterine device placed after third-trimester delivery, who delivered between March 2, 2017 and September 2, 2019. Current Procedural Terminology code billing data were used to identify 238 patients who underwent intrauterine device placement during their delivery admission. Electronic medical record data were analyzed using chi-squared tests, t tests, and multivariable logistic regression.
RESULTS
There were 17.6% (42/238) documented intrauterine device expulsions within the first year after placement. Among patients with vaginal deliveries, 22.1% (29/131) of intrauterine devices placed had a documented expulsion, whereas the expulsion rate was 12.2% (13/107) among patients who had cesarean deliveries (P=.04). After controlling for body mass index, parity, intrauterine device type, and gestational age, patients who delivered vaginally were more likely to experience intrauterine device expulsion within 1 year compared with those who had cesarean delivery (adjusted odds ratio, 2.71; 95% confidence interval, 1.27–5.80). Patients with a documented intrauterine device expulsion within 1 year were more likely to have a subsequent pregnancy before October 2020 (35.7% [15/42] vs 15.3% [30/196] in the no-expulsion group; P=.002).
CONCLUSION
The overall percentage of documented intrauterine device expulsion within 1 year following immediate postplacental placement was 17.6%, with a greater percentage of expulsion in patients who underwent vaginal delivery. Patients with a documented intrauterine device expulsion within 1 year of placement were significantly more likely to experience a subsequent pregnancy.
{"title":"Immediate postplacental intrauterine device placement: retrospective cohort study of expulsion and associated risk factors","authors":"Emily Leubner MD, Brooke A. Levandowski PhD, MPA, Sage Mikami MD , Theresa Green PhD, MBA, Sarah Betstadt MD, MPH","doi":"10.1016/j.xagr.2024.100421","DOIUrl":"10.1016/j.xagr.2024.100421","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Postpartum contraception is typically provided during postpartum visits. When desired and accessible, the immediate postpartum period provides an additional opportunity to increase the use of more effective contraceptive methods to potentially reduce subsequent unintended pregnancies and improve pregnancy outcomes. In New York State, recent policy changes expanded Medicaid coverage to include immediate postplacental intrauterine device insertion.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to investigate clinically documented intrauterine device expulsion within 12 months of placement in patients who depend on state-funded health insurance.</div></div><div><h3>STUDY DESIGN</h3><div>This retrospective cohort study included Medicaid patients with an immediate postplacental intrauterine device placed after third-trimester delivery, who delivered between March 2, 2017 and September 2, 2019. Current Procedural Terminology code billing data were used to identify 238 patients who underwent intrauterine device placement during their delivery admission. Electronic medical record data were analyzed using chi-squared tests, <em>t</em> tests, and multivariable logistic regression.</div></div><div><h3>RESULTS</h3><div>There were 17.6% (42/238) documented intrauterine device expulsions within the first year after placement. Among patients with vaginal deliveries, 22.1% (29/131) of intrauterine devices placed had a documented expulsion, whereas the expulsion rate was 12.2% (13/107) among patients who had cesarean deliveries (<em>P</em>=.04). After controlling for body mass index, parity, intrauterine device type, and gestational age, patients who delivered vaginally were more likely to experience intrauterine device expulsion within 1 year compared with those who had cesarean delivery (adjusted odds ratio, 2.71; 95% confidence interval, 1.27–5.80). Patients with a documented intrauterine device expulsion within 1 year were more likely to have a subsequent pregnancy before October 2020 (35.7% [15/42] vs 15.3% [30/196] in the no-expulsion group; <em>P</em>=.002).</div></div><div><h3>CONCLUSION</h3><div>The overall percentage of documented intrauterine device expulsion within 1 year following immediate postplacental placement was 17.6%, with a greater percentage of expulsion in patients who underwent vaginal delivery. Patients with a documented intrauterine device expulsion within 1 year of placement were significantly more likely to experience a subsequent pregnancy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100421"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907743","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.2025.100444
Claire Masters MHP , Chuhan Wu MS , Dara Gleeson MPH , Michaela Serafica RN, MSN , Jordan L. Thomas PhD , Jeannette R. Ickovics PhD
Objective
To systematically review the literature on associations between climate drivers and health outcomes among pregnant people. This review fills a gap by synthesizing evidence for a clinician audience.
Data Sources
Systematic scoping review of articles published in PubMed and clinicaltrials.gov from January 2010 through December 2023.
Study Eligibility Criteria
Empirical studies published in English-language peer-reviewed journals, assessing associations between select climate drivers and adverse maternal and birth outcomes. The review included studies examining heat, storms, sea level rise, flooding, drought, wildfires, and other climate-related factors. Health outcomes included preterm birth, low birthweight, small for gestational age, gestational diabetes, pre-eclampsia/eclampsia, miscarriage/stillbirth and maternal mortality.
Study Appraisal and Synthesis Methods
The scoping review protocol was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202410004, January 3, 2024) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Data were extracted by 2 authors; quality and risk of bias was assessed independently.
Results
Total of 966 references were screened; 16.35% (k=158) met inclusion criteria. The majority of studies (146/158; 92.4%) documented statistically significant and clinically meaningful associations between climate drivers and adverse perinatal health outcomes, including risk of preterm birth, low birthweight, and stillbirth as well as preeclampsia, gestational diabetes, miscarriage, and maternal death. Among the most durable findings: extreme heat exposure in early and late pregnancy were associated with increased risk of preterm birth and stillbirth. Driven in part by large (often population-based) studies and objective outcomes from surveillance data or medical record reviews, studies in this scoping review were evaluated as high quality (scoring 7-9 on the Newcastle-Ottawa Scale). Risk of bias was generally low.
Conclusions
Climate drivers are consistently associated with adverse health outcomes for pregnant people. Continuing education for clinicians, and clinician-patient communications should be expanded to address risks of climate change and extreme weather exposure, especially risks of extreme heat in late-pregnancy. Results from this review should inform multilevel interventions to address adverse health effects of climate during pregnancy as well as practice advisories, protocols, checklists, and clinical guidelines in obstetrics.
{"title":"Scoping review of climate drivers on maternal health: current evidence and clinical implications","authors":"Claire Masters MHP , Chuhan Wu MS , Dara Gleeson MPH , Michaela Serafica RN, MSN , Jordan L. Thomas PhD , Jeannette R. Ickovics PhD","doi":"10.1016/j.xagr.2025.100444","DOIUrl":"10.1016/j.xagr.2025.100444","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically review the literature on associations between climate drivers and health outcomes among pregnant people. This review fills a gap by synthesizing evidence for a clinician audience.</div></div><div><h3>Data Sources</h3><div>Systematic scoping review of articles published in PubMed and clinicaltrials.gov from January 2010 through December 2023.</div></div><div><h3>Study Eligibility Criteria</h3><div>Empirical studies published in English-language peer-reviewed journals, assessing associations between select climate drivers and adverse maternal and birth outcomes. The review included studies examining heat, storms, sea level rise, flooding, drought, wildfires, and other climate-related factors. Health outcomes included preterm birth, low birthweight, small for gestational age, gestational diabetes, pre-eclampsia/eclampsia, miscarriage/stillbirth and maternal mortality.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>The scoping review protocol was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY202410004, January 3, 2024) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Data were extracted by 2 authors; quality and risk of bias was assessed independently.</div></div><div><h3>Results</h3><div>Total of 966 references were screened; 16.35% (<em>k</em>=158) met inclusion criteria. The majority of studies (146/158; 92.4%) documented statistically significant and clinically meaningful associations between climate drivers and adverse perinatal health outcomes, including risk of preterm birth, low birthweight, and stillbirth as well as preeclampsia, gestational diabetes, miscarriage, and maternal death. Among the most durable findings: extreme heat exposure in early and late pregnancy were associated with increased risk of preterm birth and stillbirth. Driven in part by large (often population-based) studies and objective outcomes from surveillance data or medical record reviews, studies in this scoping review were evaluated as high quality (scoring 7-9 on the Newcastle-Ottawa Scale). Risk of bias was generally low.</div></div><div><h3>Conclusions</h3><div>Climate drivers are consistently associated with adverse health outcomes for pregnant people. Continuing education for clinicians, and clinician-patient communications should be expanded to address risks of climate change and extreme weather exposure, especially risks of extreme heat in late-pregnancy. Results from this review should inform multilevel interventions to address adverse health effects of climate during pregnancy as well as practice advisories, protocols, checklists, and clinical guidelines in obstetrics.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100444"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378043","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.2024.100422
Md. Kamrul Hasan MS, MPH, PhD(s)
{"title":"Balancing screen time during pregnancy: implications for maternal and fetal health","authors":"Md. Kamrul Hasan MS, MPH, PhD(s)","doi":"10.1016/j.xagr.2024.100422","DOIUrl":"10.1016/j.xagr.2024.100422","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100422"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973553","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.2024.100405
Natalie D. Cohen MD, Milan Ho BS, Donald McIntire PhD, Katherine Smith MD, Kimberly A. Kho MD
Introduction
The use of generative artificial intelligence (AI) has begun to permeate most industries, including medicine, and patients will inevitably start using these large language model (LLM) chatbots as a modality for education. As healthcare information technology evolves, it is imperative to evaluate chatbots and the accuracy of the information they provide to patients and to determine if there is variability between them.
Objective
This study aimed to evaluate the accuracy and comprehensiveness of three chatbots in addressing questions related to endometriosis and determine the level of variability between them.
Study Design
Three LLMs, including Chat GPT-4 (Open AI), Claude (Anthropic), and Bard (Google) were asked to generate answers to 10 commonly asked questions about endometriosis. The responses were qualitatively compared to current guidelines and expert opinion on endometriosis and rated on a scale by nine gynecologists. The grading scale included the following: (1) Completely incorrect, (2) mostly incorrect and some correct, (3) mostly correct and some incorrect, (4) correct but inadequate, (5) correct and comprehensive. Final scores were averaged between the nine reviewers. Kendall's W and the related chi-square test were used to evaluate the reviewers’ strength of agreement in ranking the LLMs’ responses for each item.
Results
Average scores for the 10 answers amongst Bard, Chat GPT, and Claude were 3.69, 4.24, and 3.7, respectively. Two questions showed significant disagreement between the nine reviewers. There were no questions the models could answer comprehensively or correctly across the reviewers. The model most associated with comprehensive and correct responses was ChatGPT. Chatbots showed an improved ability to accurately answer questions about symptoms and pathophysiology over treatment and risk of recurrence.
Conclusion
The analysis of LLMs revealed that, on average, they mainly provided correct but inadequate responses to commonly asked patient questions about endometriosis. While chatbot responses can serve as valuable supplements to information provided by licensed medical professionals, it is crucial to maintain a thorough ongoing evaluation process for outputs to provide the most comprehensive and accurate information to patients. Further research into this technology and its role in patient education and treatment is crucial as generative AI becomes more embedded in the medical field.
{"title":"A comparative analysis of generative artificial intelligence responses from leading chatbots to questions about endometriosis","authors":"Natalie D. Cohen MD, Milan Ho BS, Donald McIntire PhD, Katherine Smith MD, Kimberly A. Kho MD","doi":"10.1016/j.xagr.2024.100405","DOIUrl":"10.1016/j.xagr.2024.100405","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of generative artificial intelligence (AI) has begun to permeate most industries, including medicine, and patients will inevitably start using these large language model (LLM) chatbots as a modality for education. As healthcare information technology evolves, it is imperative to evaluate chatbots and the accuracy of the information they provide to patients and to determine if there is variability between them.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the accuracy and comprehensiveness of three chatbots in addressing questions related to endometriosis and determine the level of variability between them.</div></div><div><h3>Study Design</h3><div>Three LLMs, including Chat GPT-4 (Open AI), Claude (Anthropic), and Bard (Google) were asked to generate answers to 10 commonly asked questions about endometriosis. The responses were qualitatively compared to current guidelines and expert opinion on endometriosis and rated on a scale by nine gynecologists. The grading scale included the following: (1) Completely incorrect, (2) mostly incorrect and some correct, (3) mostly correct and some incorrect, (4) correct but inadequate, (5) correct and comprehensive. Final scores were averaged between the nine reviewers. Kendall's <em>W</em> and the related chi-square test were used to evaluate the reviewers’ strength of agreement in ranking the LLMs’ responses for each item.</div></div><div><h3>Results</h3><div>Average scores for the 10 answers amongst Bard, Chat GPT, and Claude were 3.69, 4.24, and 3.7, respectively. Two questions showed significant disagreement between the nine reviewers. There were no questions the models could answer comprehensively or correctly across the reviewers. The model most associated with comprehensive and correct responses was ChatGPT. Chatbots showed an improved ability to accurately answer questions about symptoms and pathophysiology over treatment and risk of recurrence.</div></div><div><h3>Conclusion</h3><div>The analysis of LLMs revealed that, on average, they mainly provided correct but inadequate responses to commonly asked patient questions about endometriosis. While chatbot responses can serve as valuable supplements to information provided by licensed medical professionals, it is crucial to maintain a thorough ongoing evaluation process for outputs to provide the most comprehensive and accurate information to patients. Further research into this technology and its role in patient education and treatment is crucial as generative AI becomes more embedded in the medical field.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100405"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985299","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}
Obstetric fistulas are one of the most severe injuries resulting from prolonged, obstructed labor, particularly when timely medical care is unavailable. In Ethiopia, numerous women and girls continue to endure the consequences of obstetric fistula due to contributing factors like early marriage and limited access to skilled healthcare during childbirth. The development of prevention strategies remains challenging, as reports on the knowledge surrounding obstetric fistulas and their causes are inconsistent across the country. To assess the overall, knowledge of reproductive-aged women regarding obstetric fistulas and the contributing factors to its occurrence.
Methods
Studies were systematically searched from May 30 2024 to July 1, 2024, using Web of Science, Scopus, PubMed/Medline, Science Direct, African Journal Online, and the Wiley Online Library. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects meta-analysis was performed with STATA version 11 software to estimate the knowledge, and the results are reported in a forest plot. Simple charts and tables were used to summarize the evidence for the pooled level of knowledge and its determinants.
Results
The pooled knowledge of fistula complications among reproductive-aged women in Ethiopia was 43.3% (95% CI: 35.2, 51.4). Above secondary education level (OR=3.73[2.40, 5.86]), urban residence (OR=3.77 [2.45, 5.80], access to media (OR=2, 82[1.26, 6.33]), and women attended pregnancy conference (OR=3.75[2.35, 5.99]) were determinants of good knowledge of obstetric fistula.
Conclusions
In Ethiopia, only 43.3% of reproductive-age women had good knowledge about obstetric fistulas. Factors that contribute to a higher knowledge include having a secondary education, living in urban areas, access to media, and attending pregnancy-related conferences. To improve knowledge, it is recommended to increase specific education on obstetric fistulas and prevention strategies, particularly for women living in rural areas. Promoting institutional deliveries and providing better health education on how to prevent obstetric fistulas, including pregnancy conferences is essential. Additionally, policymakers and stakeholders should focus on empowering women of reproductive age and addressing the overlooked yet significant public health issue of obstetric fistulas.
产科瘘是长时间难产造成的最严重的伤害之一，特别是在没有及时医疗护理的情况下。在埃塞俄比亚，由于早婚和分娩期间获得熟练保健的机会有限等因素，许多妇女和女孩继续忍受产科瘘管病的后果。预防策略的制定仍然具有挑战性，因为关于产科瘘及其原因的知识报告在全国范围内不一致。评估育龄妇女对产科瘘的总体认识及其发生的影响因素。方法：系统检索Web of Science、Scopus、PubMed/Medline、Science Direct、African Journal Online和Wiley Online Library，检索时间为2024年5月30日至2024年7月1日。本综述按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。使用STATA version 11软件进行随机效应荟萃分析来估计知识，结果在森林样地中报告。使用简单的图表和表格来总结知识汇集水平及其决定因素的证据。结果：埃塞俄比亚育龄妇女对瘘管并发症的总知晓率为43.3% （95% CI: 35.2, 51.4）。中等以上文化程度（OR=3.73[2.40, 5.86]）、城市居住（OR=3.77[2.45, 5.80]）、媒体接触（OR= 2,82[1.26, 6.33]）、参加妊娠会议（OR=3.75[2.35, 5.99]）是产科瘘知识良好的决定因素。结论：在埃塞俄比亚，只有43.3%的育龄妇女对产科瘘有良好的了解。有助于获得更高知识的因素包括受过中等教育、生活在城市地区、接触媒体和参加与怀孕有关的会议。为了提高知识，建议加强关于产科瘘和预防战略的专门教育，特别是对生活在农村地区的妇女。促进机构分娩和提供关于如何预防产科瘘的更好的健康教育，包括妊娠会议是至关重要的。此外，决策者和利益攸关方应侧重于增强育龄妇女的权能，并解决被忽视但重要的产科瘘公共卫生问题。
{"title":"Knowledge of obstetric fistula and contributing factors among reproductive-age women in Ethiopia: a systematic review and meta-analysis","authors":"Agerie Mengistie Zeleke , Worku Chekol Tassew , Getnet Azanaw Takele , Yosef Aragaw Gonete , Yeshiwas Ayale Ferede","doi":"10.1016/j.xagr.2024.100426","DOIUrl":"10.1016/j.xagr.2024.100426","url":null,"abstract":"<div><h3>Introduction</h3><div>Obstetric fistulas are one of the most severe injuries resulting from prolonged, obstructed labor, particularly when timely medical care is unavailable. In Ethiopia, numerous women and girls continue to endure the consequences of obstetric fistula due to contributing factors like early marriage and limited access to skilled healthcare during childbirth. The development of prevention strategies remains challenging, as reports on the knowledge surrounding obstetric fistulas and their causes are inconsistent across the country. To assess the overall, knowledge of reproductive-aged women regarding obstetric fistulas and the contributing factors to its occurrence.</div></div><div><h3>Methods</h3><div>Studies were systematically searched from May 30 2024 to July 1, 2024, using Web of Science, Scopus, PubMed/Medline, Science Direct, African Journal Online, and the Wiley Online Library. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects meta-analysis was performed with STATA version 11 software to estimate the knowledge, and the results are reported in a forest plot. Simple charts and tables were used to summarize the evidence for the pooled level of knowledge and its determinants.</div></div><div><h3>Results</h3><div>The pooled knowledge of fistula complications among reproductive-aged women in Ethiopia was 43.3% (95% CI: 35.2, 51.4). Above secondary education level (OR=3.73[2.40, 5.86]), urban residence (OR=3.77 [2.45, 5.80], access to media (OR=2, 82[1.26, 6.33]), and women attended pregnancy conference (OR=3.75[2.35, 5.99]) were determinants of good knowledge of obstetric fistula.</div></div><div><h3>Conclusions</h3><div>In Ethiopia, only 43.3% of reproductive-age women had good knowledge about obstetric fistulas. Factors that contribute to a higher knowledge include having a secondary education, living in urban areas, access to media, and attending pregnancy-related conferences. To improve knowledge, it is recommended to increase specific education on obstetric fistulas and prevention strategies, particularly for women living in rural areas. Promoting institutional deliveries and providing better health education on how to prevent obstetric fistulas, including pregnancy conferences is essential. Additionally, policymakers and stakeholders should focus on empowering women of reproductive age and addressing the overlooked yet significant public health issue of obstetric fistulas.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100426"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985311","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.2024.100438
Biraj Sharma MBBS, MPH , Roger Smith MBBS, PhD , Binod Bindu Sharma PhD , Craig Pennell MBBS, PhD
<div><h3>BACKGROUND</h3><div>Maternal mortality is most prevalent in low- and middle-income countries, especially those from sub-Saharan Africa and South Asia. The Sustainable Development Goal 3.1 aims to reduce global maternal mortality by 2030 to <70 per 100,000 live births globally and <140 per 100,000 live births at the national level. For maternal mortality ratio estimations, the World Health Organization recommends a census in low- and middle-income countries that lack civil registration and vital statistics; however, other methods have also been used.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to compare maternal mortality ratio estimating methods and maternal mortality ratio trends over time. Associations between sociodemographic variables in low- and middle-income countries and maternal mortality ratios are described and compared between countries projected to meet or fall short of Sustainable Development Goal 3.1.</div></div><div><h3>STUDY DESIGN</h3><div>Publications from the World Health Organization and the Maternal Mortality Estimation Inter-Agency Group were used to identify countries that reported maternal mortality ratio estimates at least twice since 2004 using census, noncensus, or both approaches. Maternal mortality ratios were extracted from the Maternal Mortality Estimation Inter-Agency Group, and covariates associated with maternal mortality ratios were obtained from the Our World in Data and the Fragile States Index web pages. Group comparisons were performed using paired <em>t</em> tests, and correlations between variations among maternal mortality ratio estimates and population demographic covariates were analyzed using linear mixed-effect models. Projected maternal mortality ratio estimates for 2030 were calculated using the exponential growth/decay method used by the World Health Organization.</div></div><div><h3>RESULTS</h3><div>Data were available for 45 countries for comparison; 21 countries had data from different maternal mortality ratio estimation methods, and 42 countries reported maternal mortality ratios using the same estimation method over time. Census maternal mortality ratio estimates were 83.2 per 100,000 live births higher than the estimates from noncensus methods, although this difference was statistically nonsignificant (<em>P</em>=.19). Of the 45 countries assessed, 30.1% were projected to meet the Sustainable Development Goal 3.1 maternal mortality ratio target of <140 per 100,000 births by 2030. National maternal mortality ratio estimates were significantly influenced by total fertility rate, skilled birth attendance rate, gross domestic product per capita, female and male literacy rates, female rate of access to modern contraceptives, and the Fragile States Index.</div></div><div><h3>CONCLUSION</h3><div>Maternal mortality ratio estimates are reproducible using different estimation methods in low- and middle-income countries. Only 30% of the low- and middle-income countries for
{"title":"Maternal mortality ratios in low- and middle-income countries: a comparison of estimation methods and relationships with sociodemographic covariates","authors":"Biraj Sharma MBBS, MPH , Roger Smith MBBS, PhD , Binod Bindu Sharma PhD , Craig Pennell MBBS, PhD","doi":"10.1016/j.xagr.2024.100438","DOIUrl":"10.1016/j.xagr.2024.100438","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Maternal mortality is most prevalent in low- and middle-income countries, especially those from sub-Saharan Africa and South Asia. The Sustainable Development Goal 3.1 aims to reduce global maternal mortality by 2030 to <70 per 100,000 live births globally and <140 per 100,000 live births at the national level. For maternal mortality ratio estimations, the World Health Organization recommends a census in low- and middle-income countries that lack civil registration and vital statistics; however, other methods have also been used.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to compare maternal mortality ratio estimating methods and maternal mortality ratio trends over time. Associations between sociodemographic variables in low- and middle-income countries and maternal mortality ratios are described and compared between countries projected to meet or fall short of Sustainable Development Goal 3.1.</div></div><div><h3>STUDY DESIGN</h3><div>Publications from the World Health Organization and the Maternal Mortality Estimation Inter-Agency Group were used to identify countries that reported maternal mortality ratio estimates at least twice since 2004 using census, noncensus, or both approaches. Maternal mortality ratios were extracted from the Maternal Mortality Estimation Inter-Agency Group, and covariates associated with maternal mortality ratios were obtained from the Our World in Data and the Fragile States Index web pages. Group comparisons were performed using paired <em>t</em> tests, and correlations between variations among maternal mortality ratio estimates and population demographic covariates were analyzed using linear mixed-effect models. Projected maternal mortality ratio estimates for 2030 were calculated using the exponential growth/decay method used by the World Health Organization.</div></div><div><h3>RESULTS</h3><div>Data were available for 45 countries for comparison; 21 countries had data from different maternal mortality ratio estimation methods, and 42 countries reported maternal mortality ratios using the same estimation method over time. Census maternal mortality ratio estimates were 83.2 per 100,000 live births higher than the estimates from noncensus methods, although this difference was statistically nonsignificant (<em>P</em>=.19). Of the 45 countries assessed, 30.1% were projected to meet the Sustainable Development Goal 3.1 maternal mortality ratio target of <140 per 100,000 births by 2030. National maternal mortality ratio estimates were significantly influenced by total fertility rate, skilled birth attendance rate, gross domestic product per capita, female and male literacy rates, female rate of access to modern contraceptives, and the Fragile States Index.</div></div><div><h3>CONCLUSION</h3><div>Maternal mortality ratio estimates are reproducible using different estimation methods in low- and middle-income countries. Only 30% of the low- and middle-income countries for","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100438"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143104010","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.2024.100431
Pradip Dashraath MRCOG, Karin Nielsen-Saines MD, David A. Schwartz MD, Didier Musso MD, David Baud
{"title":"Vertical transmission potential of Oropouche virus infection in human pregnancies","authors":"Pradip Dashraath MRCOG, Karin Nielsen-Saines MD, David A. Schwartz MD, Didier Musso MD, David Baud","doi":"10.1016/j.xagr.2024.100431","DOIUrl":"10.1016/j.xagr.2024.100431","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100431"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985390","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.2024.100427
Jecca R. Steinberg MD, MSc , Julia D. Ditosto MS , Brandon E. Turner MD, MSc , Anna Marie Pacheco Young MD, MPH , Naixin Zhang MD , Danielle Strom MD , Sarah Andebrhan MD , Madeline F. Perry MD , Danika Barry MD, MPH , Kai Holder MD , Natalie A. Squires MD , Jill N. Anderson MD , Michael T. Richardson MD , Dario R. Roque MD , Lynn M. Yee MD, MPH
<div><h3>BACKGROUND</h3><div>In obstetrics and gynecology (OBGYN) research, gender disparities permeate through leadership, funding, promotion, mentorship, publishing, compensation, and publicity. Few studies have investigated OBGYN clinical trial leadership as it relates to investigator gender. Thus, we undertook an investigation of principal investigator (PI) gender and clinical trial success.</div></div><div><h3>OBJECTIVE</h3><div>To characterize United States (US) OBGYN clinical trials by PI gender and analyze the association between PI gender and features of trial success.</div></div><div><h3>STUDY DESIGN</h3><div>This is a cross-sectional study of all US-based obstetric and gynecologic clinical trials registered on ClinicalTrials.gov (2007–2020). We examined associations between PI gender (ie, led by women, men, or both) and four primary outcomes that capture clinical trial success: early discontinuation (ie, absence of early discontinuation is a feature of success), reporting of complete trials to ClinicalTrials.gov, publication in a peer-reviewed journal, and clinical trial participant diversity (reporting of racial and ethnic diversity data and representation of diverse cohorts). Multivariable analyses controlled for subspecialty, multiple PI status, source of funding, primary purpose, phase, number of arms, enrollment, year of trial registration, blinding, oversight by a Data Safety Monitoring Committee, and number of study sites. Sensitivity analysis accounted for individual PI who led multiple clinical trials. Univariable and multivariable logistic regression analysis models were applied. We conducted multiple imputation for missing covariable data. There were no missing exposure or outcome data in the final cohort.</div></div><div><h3>RESULTS</h3><div>We reviewed 12,635 clinical trials focused on OBGYN. Of the 4342 trials with at least one site in the US, PI names were available for 3087 trials (71.1%). The majority of OBGYN trials were women-led (women 1696, 54.9%; men 1272, 41.2%, coled 119, 3.9%). A greater proportion of obstetrics trials (617, 60.0%) were women-led than gynecology trials (1079, 52.4%). Family planning had the greatest proportion of women-led trials (145, 74.7%), whereas reproductive endocrinology and infertility had the lowest (50, 30.9%). A greater proportion of industry-funded trials were led by men (123, 64.7%). In adjusted analysis, women-led trials had lower odds of early discontinuation (men-led reference; women-led adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.44, 0.77). Women-led trials reported results less frequently (men-led reference; women-led aOR 0.52, CI 0.40–0.62) but no significant difference was seen in publication (men-led reference; women-led aOR 1.02, CI 0.57, 1.81). Women-led trials had greater odds of reporting race and ethnicity participant data (men-led reference; aOR 1.87, CI 1.27–2.47) but there was no difference in cohort diversity by PI gender.</div></div><div><h3>CON
{"title":"Principal investigator gender and clinical trial success: analysis of over 3000 obstetrics and gynecology trials","authors":"Jecca R. Steinberg MD, MSc , Julia D. Ditosto MS , Brandon E. Turner MD, MSc , Anna Marie Pacheco Young MD, MPH , Naixin Zhang MD , Danielle Strom MD , Sarah Andebrhan MD , Madeline F. Perry MD , Danika Barry MD, MPH , Kai Holder MD , Natalie A. Squires MD , Jill N. Anderson MD , Michael T. Richardson MD , Dario R. Roque MD , Lynn M. Yee MD, MPH","doi":"10.1016/j.xagr.2024.100427","DOIUrl":"10.1016/j.xagr.2024.100427","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>In obstetrics and gynecology (OBGYN) research, gender disparities permeate through leadership, funding, promotion, mentorship, publishing, compensation, and publicity. Few studies have investigated OBGYN clinical trial leadership as it relates to investigator gender. Thus, we undertook an investigation of principal investigator (PI) gender and clinical trial success.</div></div><div><h3>OBJECTIVE</h3><div>To characterize United States (US) OBGYN clinical trials by PI gender and analyze the association between PI gender and features of trial success.</div></div><div><h3>STUDY DESIGN</h3><div>This is a cross-sectional study of all US-based obstetric and gynecologic clinical trials registered on ClinicalTrials.gov (2007–2020). We examined associations between PI gender (ie, led by women, men, or both) and four primary outcomes that capture clinical trial success: early discontinuation (ie, absence of early discontinuation is a feature of success), reporting of complete trials to ClinicalTrials.gov, publication in a peer-reviewed journal, and clinical trial participant diversity (reporting of racial and ethnic diversity data and representation of diverse cohorts). Multivariable analyses controlled for subspecialty, multiple PI status, source of funding, primary purpose, phase, number of arms, enrollment, year of trial registration, blinding, oversight by a Data Safety Monitoring Committee, and number of study sites. Sensitivity analysis accounted for individual PI who led multiple clinical trials. Univariable and multivariable logistic regression analysis models were applied. We conducted multiple imputation for missing covariable data. There were no missing exposure or outcome data in the final cohort.</div></div><div><h3>RESULTS</h3><div>We reviewed 12,635 clinical trials focused on OBGYN. Of the 4342 trials with at least one site in the US, PI names were available for 3087 trials (71.1%). The majority of OBGYN trials were women-led (women 1696, 54.9%; men 1272, 41.2%, coled 119, 3.9%). A greater proportion of obstetrics trials (617, 60.0%) were women-led than gynecology trials (1079, 52.4%). Family planning had the greatest proportion of women-led trials (145, 74.7%), whereas reproductive endocrinology and infertility had the lowest (50, 30.9%). A greater proportion of industry-funded trials were led by men (123, 64.7%). In adjusted analysis, women-led trials had lower odds of early discontinuation (men-led reference; women-led adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.44, 0.77). Women-led trials reported results less frequently (men-led reference; women-led aOR 0.52, CI 0.40–0.62) but no significant difference was seen in publication (men-led reference; women-led aOR 1.02, CI 0.57, 1.81). Women-led trials had greater odds of reporting race and ethnicity participant data (men-led reference; aOR 1.87, CI 1.27–2.47) but there was no difference in cohort diversity by PI gender.</div></div><div><h3>CON","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100427"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025859","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.2024.100437
Sarah Hansen BSc. Med , Monica Lauridsen Kujabi MD, PhD , Rikke Damkjær Maimburg PhD , Anna Macha MD , Luzango Maembe MD , Idrissa Kabanda MD , Manyanga Hudson MD , Rukia Juma Msumi MD , Mtingele Sangalala MD , Natasha Housseine MD, PhD , Brenda Sequeira D'mello MD, PhD , Kidanto Hussein MD, PhD , Thomas van den Akker MD, PhD , Dan Wolf Meyrowitsch PhD , Nanna Maaløe MD, PhD
Background
Globally, the cesarean section rate has increased dramatically with many cesarean sections being performed on questionable medical indications. Particularly in urban areas of sub-Saharan Africa, the cesarean section rate is currently increasing rapidly. This potentially undermines the positive momentum of increased facility births and may be a central contributor to a growing "urban disadvantage" in maternal and perinatal health, which is seen in some settings.
Objective
To assess to what extent cesarean section indications follow evidence-based, locally co-created audit criteria in five urban, high-volume maternity units in Dar es Salaam, Tanzania, and identify reasons contributing to nonmedically indicated cesarean sections.
Study Design
This was a retrospective cross-sectional study conducted, from October 1st, 2021 to August 31st, 2022. A criterion-based audit with pre-defined, localized audit criteria was used to examine the clinical case-files of all women who gave birth by cesarean section during 3-month periods at the 5 maternity units. Primary outcomes were the cesarean section rate, indications for cesarean section, and proportion of nonmedically indicated cesarean sections. The PartoMa study is registered in ClinicalTrials.gov (NCT04685668).
Results
Overall, the cesarean section rate was 31.5% (2949/9364), of which 2674/2949 (90.7%) cesarean sections had available data for analysis. Main indications were previous cesarean section (1133/2674; 42.4%), prolonged labor (746/2674; 27.9%), and fetal distress (554/2674; 20.7%). Overall, 1061/2674 (39.7%) did not comply with audit criteria at the time cesarean section was decided. Main reasons were one previous cesarean section with no trial of labor (526/1061; 49.6%); reported prolonged labor without actual slow progress (243/1061; 22.9%); and fetal distress with normal fetal heart rate at time of decision (211/1061; 19.9%).
Conclusion
Two in 5 cesarean sections were categorized as nonmedically indicated at time of decision. Particularly, fear of poor outcomes and delay in accessing emergency surgery may cause resource-consuming "defensive decision-making" for cesarean section. Investments in conducive urban maternity units are crucial to ensure safe vaginal births and to reach a population-based approach that provides best possible timely care for all with the limited resources available.
{"title":"Disclosing possible nonmedically indicated cesarean sections in 5 high-volume urban maternity units in Tanzania: a criterion-based clinical audit","authors":"Sarah Hansen BSc. Med , Monica Lauridsen Kujabi MD, PhD , Rikke Damkjær Maimburg PhD , Anna Macha MD , Luzango Maembe MD , Idrissa Kabanda MD , Manyanga Hudson MD , Rukia Juma Msumi MD , Mtingele Sangalala MD , Natasha Housseine MD, PhD , Brenda Sequeira D'mello MD, PhD , Kidanto Hussein MD, PhD , Thomas van den Akker MD, PhD , Dan Wolf Meyrowitsch PhD , Nanna Maaløe MD, PhD","doi":"10.1016/j.xagr.2024.100437","DOIUrl":"10.1016/j.xagr.2024.100437","url":null,"abstract":"<div><h3>Background</h3><div>Globally, the cesarean section rate has increased dramatically with many cesarean sections being performed on questionable medical indications. Particularly in urban areas of sub-Saharan Africa, the cesarean section rate is currently increasing rapidly. This potentially undermines the positive momentum of increased facility births and may be a central contributor to a growing \"urban disadvantage\" in maternal and perinatal health, which is seen in some settings.</div></div><div><h3>Objective</h3><div>To assess to what extent cesarean section indications follow evidence-based, locally co-created audit criteria in five urban, high-volume maternity units in Dar es Salaam, Tanzania, and identify reasons contributing to nonmedically indicated cesarean sections.</div></div><div><h3>Study Design</h3><div>This was a retrospective cross-sectional study conducted, from October 1st, 2021 to August 31st, 2022. A criterion-based audit with pre-defined, localized audit criteria was used to examine the clinical case-files of all women who gave birth by cesarean section during 3-month periods at the 5 maternity units. Primary outcomes were the cesarean section rate, indications for cesarean section, and proportion of nonmedically indicated cesarean sections. The PartoMa study is registered in ClinicalTrials.gov (NCT04685668).</div></div><div><h3>Results</h3><div>Overall, the cesarean section rate was 31.5% (2949/9364), of which 2674/2949 (90.7%) cesarean sections had available data for analysis. Main indications were previous cesarean section (1133/2674; 42.4%), prolonged labor (746/2674; 27.9%), and fetal distress (554/2674; 20.7%). Overall, 1061/2674 (39.7%) did not comply with audit criteria at the time cesarean section was decided. Main reasons were one previous cesarean section with no trial of labor (526/1061; 49.6%); reported prolonged labor without actual slow progress (243/1061; 22.9%); and fetal distress with normal fetal heart rate at time of decision (211/1061; 19.9%).</div></div><div><h3>Conclusion</h3><div>Two in 5 cesarean sections were categorized as nonmedically indicated at time of decision. Particularly, fear of poor outcomes and delay in accessing emergency surgery may cause resource-consuming \"defensive decision-making\" for cesarean section. Investments in conducive urban maternity units are crucial to ensure safe vaginal births and to reach a population-based approach that provides best possible timely care for all with the limited resources available.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 1","pages":"Article 100437"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082366","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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