To estimate the pooled incidence of mortality and identify key predictors of survival outcomes among cervical cancer patients in Sub-Saharan Africa by systematically reviewing and meta-analyzing observational studies and clinical trials published between 2000 and 2024, thereby providing evidence to guide targeted interventions and health policy improvements in the region.
Data sources
PubMed, Embase, Cochrane Library, Web of Science, AJOL, CINAHL, and Google Scholar for studies published between 2000 and 2024.
Study eligibility criteria
P: Patients with cervical cancer, I: Groups of variables that have a positive correlation with cervical cancer mortality, C: Types of variables that are notably linked to cervical cancer, O: individuals with cervical cancer and death rates. We included observational studies and clinical trials reporting mortality incidence and predictors among cervical cancer patients in SSA.
Study appraisal and synthesis methods
Following PRISMA guidelines and registered with PROSPERO, all identified records were imported into reference Rayyan software to remove duplicates. Meta-analysis was conducted utilizing Stata 17 version statistical software.
Results
From 57 studies, predominantly from South Africa, Kenya, and Nigeria. The pooled mortality incidence was 32.06% (95% CI: 29.71–34.41). Significant predictors of mortality included advanced stage at diagnosis (HR=2.6, 95% CI: 2.1–3.2), age over 65 years (HR=2.0, 95% CI: 1.5–2.6), HIV-positive status (HR=1.52, 95% CI: 1.06–2.19), treatment with radiotherapy alone (HR=1.41, 95% CI: 1.22–1.63), and anemia (HR=2.0, 95% CI: 1.5–2.5). High heterogeneity (I²=95.72%) was observed across studies.
Conclusion
Approximately one-third of cervical cancer patients in SSA die from the disease, driven by identifiable predictors that highlight the need for enhanced screening, early diagnosis, and improved treatment access. Targeted interventions for high-risk groups, such as HIV-positive women and the elderly, are critical to reducing mortality in this region.
{"title":"Incidence and predictors of mortality among cervical cancer patients in Sub-Saharan Africa: a systematic review and meta-analysis","authors":"Endale Tamiru Burayu MSc , Bekem Dibaba Degefa MSc , Zelalem Banjaw Zegeye MSc , Gemechu Gelan Bekele MSc","doi":"10.1016/j.xagr.2025.100570","DOIUrl":"10.1016/j.xagr.2025.100570","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate the pooled incidence of mortality and identify key predictors of survival outcomes among cervical cancer patients in Sub-Saharan Africa by systematically reviewing and meta-analyzing observational studies and clinical trials published between 2000 and 2024, thereby providing evidence to guide targeted interventions and health policy improvements in the region.</div></div><div><h3>Data sources</h3><div>PubMed, Embase, Cochrane Library, Web of Science, AJOL, CINAHL, and Google Scholar for studies published between 2000 and 2024.</div></div><div><h3>Study eligibility criteria</h3><div>P: Patients with cervical cancer, I: Groups of variables that have a positive correlation with cervical cancer mortality, C: Types of variables that are notably linked to cervical cancer, O: individuals with cervical cancer and death rates. We included observational studies and clinical trials reporting mortality incidence and predictors among cervical cancer patients in SSA.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>Following PRISMA guidelines and registered with PROSPERO, all identified records were imported into reference Rayyan software to remove duplicates. Meta-analysis was conducted utilizing Stata 17 version statistical software.</div></div><div><h3>Results</h3><div>From 57 studies, predominantly from South Africa, Kenya, and Nigeria. <em>The pooled mortality incidence was 32.06% (95% CI: 29.71–34.41).</em> Significant predictors of mortality included advanced stage at diagnosis (HR=2.6, 95% CI: 2.1–3.2), age over 65 years (HR=2.0, 95% CI: 1.5–2.6), HIV-positive status (HR=1.52, 95% CI: 1.06–2.19), treatment with radiotherapy alone (HR=1.41, 95% CI: 1.22–1.63), and anemia (HR=2.0, 95% CI: 1.5–2.5). High heterogeneity (I²=95.72%) was observed across studies.</div></div><div><h3>Conclusion</h3><div>Approximately one-third of cervical cancer patients in SSA die from the disease, driven by identifiable predictors that highlight the need for enhanced screening, early diagnosis, and improved treatment access. Targeted interventions for high-risk groups, such as HIV-positive women and the elderly, are critical to reducing mortality in this region.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100570"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-12DOI: 10.1016/j.xagr.2025.100567
Alice Mukansanga BSc , Mary Bernadette Hadley PhD , Jean Baptiste Ukwizangira MSc
BACKGROUND
The most efficient way to increase the prevalence of contraceptive use is to provide family planning to women after delivery, particularly in countries with high health facility delivery rates.
OBJECTIVE
This study aimed to increase the uptake of postpartum family planning in hospitals in Rwanda.
STUDY DESIGN
This mixed-methods cohort study was conducted at a teaching hospital in Rwanda from June 2022 to July 2022, with uptake of postpartum family planning recorded until March 2025. This study was part of a broader research aimed at improving maternal and neonatal outcomes in the hospital. The postpartum family planning rates were extracted from the Health Management Information System before the study was conducted and up to March 2025 to demonstrate the sustainability of the interventions introduced based on the recommendations derived from the study. The two components of the study were as follows: (1) telephone interviews with key staff in district hospitals and (2) interviews with a sample of mothers who delivered at the hospital. Analysis of the responses to open-ended questions was performed using inductive reasoning, whereas quantitative data were analyzed using Microsoft Excel (Microsoft, Redmond, WA). Ethical approval was obtained in May 2022.
RESULTS
Higher family planning uptake rates were observed after cesarean delivery (90%; P=.04), in women aged 39 to 43 years (100%), and in women who had discussed family planning during pregnancy (80%; P=.00). The reasons for refusing family planning were associated with cultural/religious beliefs and values. Some women were not offered family planning, particularly on weekends. Teamwork and engagement in or emphasis on postpartum family planning within the maternity unit of district hospitals were responsible for increased postpartum family planning uptake. The implementation of the recommendations at the hospital increased postpartum family planning uptake from 26% (April 2022) to 89% (March 2025).
CONCLUSION
The findings highlight the importance of family planning counseling during pregnancy. Within the hospital, an increased awareness of the importance of family planning among staff, teamwork, and involvement of all midwives in the provision of family planning were the key factors to improve uptake.
{"title":"Increasing postpartum family planning using an evidence-based approach: the success of a university teaching hospital in Rwanda","authors":"Alice Mukansanga BSc , Mary Bernadette Hadley PhD , Jean Baptiste Ukwizangira MSc","doi":"10.1016/j.xagr.2025.100567","DOIUrl":"10.1016/j.xagr.2025.100567","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>The most efficient way to increase the prevalence of contraceptive use is to provide family planning to women after delivery, particularly in countries with high health facility delivery rates.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to increase the uptake of postpartum family planning in hospitals in Rwanda.</div></div><div><h3>STUDY DESIGN</h3><div>This mixed-methods cohort study was conducted at a teaching hospital in Rwanda from June 2022 to July 2022, with uptake of postpartum family planning recorded until March 2025. This study was part of a broader research aimed at improving maternal and neonatal outcomes in the hospital. The postpartum family planning rates were extracted from the Health Management Information System before the study was conducted and up to March 2025 to demonstrate the sustainability of the interventions introduced based on the recommendations derived from the study. The two components of the study were as follows: (1) telephone interviews with key staff in district hospitals and (2) interviews with a sample of mothers who delivered at the hospital. Analysis of the responses to open-ended questions was performed using inductive reasoning, whereas quantitative data were analyzed using Microsoft Excel (Microsoft, Redmond, WA). Ethical approval was obtained in May 2022.</div></div><div><h3>RESULTS</h3><div>Higher family planning uptake rates were observed after cesarean delivery (90%; <em>P</em>=.04), in women aged 39 to 43 years (100%), and in women who had discussed family planning during pregnancy (80%; <em>P</em>=.00). The reasons for refusing family planning were associated with cultural/religious beliefs and values. Some women were not offered family planning, particularly on weekends. Teamwork and engagement in or emphasis on postpartum family planning within the maternity unit of district hospitals were responsible for increased postpartum family planning uptake. The implementation of the recommendations at the hospital increased postpartum family planning uptake from 26% (April 2022) to 89% (March 2025).</div></div><div><h3>CONCLUSION</h3><div>The findings highlight the importance of family planning counseling during pregnancy. Within the hospital, an increased awareness of the importance of family planning among staff, teamwork, and involvement of all midwives in the provision of family planning were the key factors to improve uptake.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100567"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-05DOI: 10.1016/j.xagr.2025.100565
Jameaka L. Hamilton MD , Paula L. McGee MS , George R. Saade MD , Rebecca G. Clifton PhD , Michael W. Varner MD , Alan T.N. Tita MD, PhD , Monica Longo MD, PhD , Edward F. Bell MD , Barbara J. Stoll MD , Donna Allard RNC , Ashley Salazar DNP , John M. Thorp Jr. MD , Uma M. Reddy MD, MPH , Maged M. Costantine MD, MBA , Emily S. Miller MD, MPH , Dwight J. Rouse MD , Hyagriv N. Simhan MD , Jennifer L. Bailit MD, MPH , Lorraine Dugoff MD , George A. Macones MD, MSCE , Baha M. Sibai MD
<div><h3>Background</h3><div>Hospital-based obstetrical triage units frequently serve as an extension to outpatient care. Evaluation of the burden of preterm birth (PTB) typically focuses on the delivery and neonatal periods, while antepartum health care utilization related to risk of PTB is seldom reported.</div></div><div><h3>Objective</h3><div>To identify the characteristics and outcomes associated with multiple triage visits among patients with suspected preterm labor (PTL) or preterm premature rupture of membranes (pPROM).</div></div><div><h3>Study Design</h3><div>Secondary analysis of a retrospective cohort study of all triage visits from 20 0/7 through 34 6/7 weeks gestation on randomly selected dates in 2019 at 34 hospitals across the US. Those in whom the reason for the visit was suspected PTL or pPROM and who were subsequently discharged were eligible for this analysis. Patients with ≥3 triage visits were compared with those who had <3 visits in the index pregnancy visits. Data were abstracted by certified research personnel using predefined criteria. The primary outcome was a composite of severe neonatal morbidity or mortality before 120 days. Secondary outcomes included PTB (<37 weeks gestation), a composite of respiratory neonatal morbidities, and maternal outcomes. Multivariable logistic regression analyses were used for the maternal outcomes, and generalized linear and logistic models were used for the neonatal outcomes to account for the correlation among twins.</div></div><div><h3>Results</h3><div>A total of 1764 mother/newborn dyads were included. Patients with more frequent triage visits (≥3) were more likely to self-identify as Black, be younger, not married/living with a partner, unemployed, have government-assisted insurance, or have less than a college degree compared to those individuals with less frequent triage visits (<em>P</em><.05). Additionally, individuals in the more frequent triage visits group were more likely to be multiparous, have obesity, and pre-existing medical conditions, including kidney or liver disease requiring treatment (<em>P</em><.05). There were no significant differences between groups for the primary composite neonatal outcome (1.6% in the more frequent group vs 2.4% in the less frequent group, adjusted odds ratios [aOR] 0.69, 95% CI 0.35–1.39) or secondary neonatal outcomes including PTB less than 37 weeks gestation (25.2% vs 23.2%, aOR 0.94, 95% CI 0.68–1.30), composite of respiratory morbidity (11.8% vs 11.0%, aOR 1.01, 95% CI 0.71–1.43), SGA (10.5% vs 10.6%, aOR 0.92, 95% CI 0.66–1.29), or birthweight (3056±639 g vs 3048±678 g, LS mean 27, 95% CI –27, 82). Similarly, there were also no statistically significant differences between groups for the secondary maternal outcomes including composite of severe maternal morbidity (8.1% vs 8.7%, aOR 1.00, 95% CI 0.69–1.44), composite of maternal infection (5.8% vs 5.1%, aOR 1.11, 95% CI 0.72–1.73), or delivery via cesarean section (31.2% vs
背景：以医院为基础的产科分诊单位经常作为门诊护理的延伸。对早产负担的评估通常侧重于分娩和新生儿期，而与早产风险相关的产前保健利用很少有报道。目的探讨疑似早产（PTL）或胎膜早破（pPROM）患者多次分诊的特点及预后。研究设计：对2019年在美国34家医院随机选择的日期进行的妊娠20 /7至34 /7周的所有分诊就诊的回顾性队列研究进行二次分析。那些就诊原因疑似为PTL或pPROM并随后出院的患者有资格进行此分析。将就诊次数≥3次的患者与妊娠指数就诊次数≥3次的患者进行比较。数据由经过认证的研究人员使用预定义的标准进行抽象。主要终点是120天前严重新生儿发病率或死亡率的综合指标。次要结局包括PTB（妊娠37周）、新生儿呼吸系统疾病的综合发病率和产妇结局。产妇结局采用多变量logistic回归分析，新生儿结局采用广义线性和logistic模型来解释双胞胎之间的相关性。结果共纳入母亲/新生儿对1764例。与分诊次数较少的患者相比，分诊次数较多（≥3次）的患者更有可能自我认同为黑人、更年轻、未婚/与伴侣同居、失业、有政府资助的保险或大学学历不足（P<.05）。此外，更频繁的分诊组的个体更有可能是多胞胎、肥胖和先前存在的疾病，包括需要治疗的肾脏或肝脏疾病（P< 0.05）。新生儿主要综合结局（多发组为1.6%，少发组为2.4%，校正优势比[aOR] 0.69, 95% CI 0.35-1.39）、新生儿次要结局包括妊娠37周以下PTB（25.2%对23.2%,aOR 0.94, 95% CI 0.68-1.30）、呼吸道综合发病率（11.8%对11.0%,aOR 1.01, 95% CI 0.71-1.43）、SGA（10.5%对10.6%,aOR 0.92, 95% CI 0.66-1.29）、或出生体重（3056±639 g vs 3048±678 g， LS平均值27,95% CI - 27,82）。同样，两组间产妇继发性结局也无统计学差异，包括严重产妇并发症（8.1% vs 8.7%, aOR 1.00, 95% CI 0.69-1.44）、产妇感染（5.8% vs 5.1%, aOR 1.11, 95% CI 0.72-1.73）或剖宫产（31.2% vs 35.2%, aOR 0.86, 95% CI 0.69-1.07）。结论：在这个经过严格确定和数据收集的多地点分类就诊记录中，多次就诊（≥3次）疑似PTL或pPROM与产妇或新生儿结局的差异无关。
{"title":"Characteristics and outcomes associated with multiple triage visits among patients with suspected preterm labor or preterm premature rupture of membranes","authors":"Jameaka L. Hamilton MD , Paula L. McGee MS , George R. Saade MD , Rebecca G. Clifton PhD , Michael W. Varner MD , Alan T.N. Tita MD, PhD , Monica Longo MD, PhD , Edward F. Bell MD , Barbara J. Stoll MD , Donna Allard RNC , Ashley Salazar DNP , John M. Thorp Jr. MD , Uma M. Reddy MD, MPH , Maged M. Costantine MD, MBA , Emily S. Miller MD, MPH , Dwight J. Rouse MD , Hyagriv N. Simhan MD , Jennifer L. Bailit MD, MPH , Lorraine Dugoff MD , George A. Macones MD, MSCE , Baha M. Sibai MD","doi":"10.1016/j.xagr.2025.100565","DOIUrl":"10.1016/j.xagr.2025.100565","url":null,"abstract":"<div><h3>Background</h3><div>Hospital-based obstetrical triage units frequently serve as an extension to outpatient care. Evaluation of the burden of preterm birth (PTB) typically focuses on the delivery and neonatal periods, while antepartum health care utilization related to risk of PTB is seldom reported.</div></div><div><h3>Objective</h3><div>To identify the characteristics and outcomes associated with multiple triage visits among patients with suspected preterm labor (PTL) or preterm premature rupture of membranes (pPROM).</div></div><div><h3>Study Design</h3><div>Secondary analysis of a retrospective cohort study of all triage visits from 20 0/7 through 34 6/7 weeks gestation on randomly selected dates in 2019 at 34 hospitals across the US. Those in whom the reason for the visit was suspected PTL or pPROM and who were subsequently discharged were eligible for this analysis. Patients with ≥3 triage visits were compared with those who had <3 visits in the index pregnancy visits. Data were abstracted by certified research personnel using predefined criteria. The primary outcome was a composite of severe neonatal morbidity or mortality before 120 days. Secondary outcomes included PTB (<37 weeks gestation), a composite of respiratory neonatal morbidities, and maternal outcomes. Multivariable logistic regression analyses were used for the maternal outcomes, and generalized linear and logistic models were used for the neonatal outcomes to account for the correlation among twins.</div></div><div><h3>Results</h3><div>A total of 1764 mother/newborn dyads were included. Patients with more frequent triage visits (≥3) were more likely to self-identify as Black, be younger, not married/living with a partner, unemployed, have government-assisted insurance, or have less than a college degree compared to those individuals with less frequent triage visits (<em>P</em><.05). Additionally, individuals in the more frequent triage visits group were more likely to be multiparous, have obesity, and pre-existing medical conditions, including kidney or liver disease requiring treatment (<em>P</em><.05). There were no significant differences between groups for the primary composite neonatal outcome (1.6% in the more frequent group vs 2.4% in the less frequent group, adjusted odds ratios [aOR] 0.69, 95% CI 0.35–1.39) or secondary neonatal outcomes including PTB less than 37 weeks gestation (25.2% vs 23.2%, aOR 0.94, 95% CI 0.68–1.30), composite of respiratory morbidity (11.8% vs 11.0%, aOR 1.01, 95% CI 0.71–1.43), SGA (10.5% vs 10.6%, aOR 0.92, 95% CI 0.66–1.29), or birthweight (3056±639 g vs 3048±678 g, LS mean 27, 95% CI –27, 82). Similarly, there were also no statistically significant differences between groups for the secondary maternal outcomes including composite of severe maternal morbidity (8.1% vs 8.7%, aOR 1.00, 95% CI 0.69–1.44), composite of maternal infection (5.8% vs 5.1%, aOR 1.11, 95% CI 0.72–1.73), or delivery via cesarean section (31.2% vs","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100565"},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-05DOI: 10.1016/j.xagr.2025.100569
Anna Axmon PhD , Can Liu PhD , Alessandra Grotta PhD , Kristina Edvardsson PhD , Magnus Sandberg PhD
Background
Women with intellectual disabilities face significant barriers to gynecological, reproductive, antenatal, and perinatal care, which may adversely impact maternal and fetal health. Previous research indicates increased risks for gestational diabetes, pre-eclampsia, caesarean birth, preterm birth, and other complications in pregnant women with intellectual disabilities. However, studies on the reproductive health in this group remain scant, and comprehensive research on maternal and fetal health from pregnancy to the postpartum period remain missing.
Objective(s)
Using high-quality data from Swedish registers, the present study aims to examine a full range of maternal and fetal outcomes among birthing women with intellectual disabilities and to compare them to those of birthing women in the general population. Such knowledge is important in understanding and preventing adverse health outcomes.
Study Design
This was a register study based on all women living in Skåne, Sweden on January 1st, 2104, with at least 1 singleton birth in 2014–2021. By linking regional and national registers, we were able to compare maternal and fetal outcomes in a cohort of women with intellectual disabilities (n=378), including a subgroup of women with diagnosis of mild intellectual disability (n=177), to outcomes among women from the general population (n=65 925). Diagnoses (i.e., outcomes) were collected from the Skåne Healthcare Register, which comprises all healthcare contacts in the Skåne region in Sweden. Poisson regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) to quantify the association between intellectual disability and each outcome. The fully adjusted model included maternal year of birth and age at birthing, sociodemographic indicators, and obstetric comorbidities.
Results
In the fully adjusted models, women with intellectual disabilities had increased risk of pre-eclampsia (RR 1.67, 95% CI 1.15–2.42), infections of the genitourinary tract (2.30, 1.67–3.16), premature rupture of membranes (2.42, 1.24–4.69 for women with mild intellectual disability), and false labor (1.27, 1.05–1.53). In crude (i.e., unadjusted) models, increased risks were also found for maternal care for known or suspected fetal abnormality and damage, maternal care for other known or suspected fetal problems, other disorders of amniotic fluid and membranes, antepartum hemorrhage, not elsewhere classified, and failed induction of labor.
Conclusion(s)
Pregnant women with intellectual disabilities have increased risk of several adverse maternal outcomes, with the risk for some likely driven-at least in part-by lower sociodemographic status and worse obstetric health.
{"title":"Maternal outcomes among women with intellectual disabilities in comparison with the general population (IDcare)","authors":"Anna Axmon PhD , Can Liu PhD , Alessandra Grotta PhD , Kristina Edvardsson PhD , Magnus Sandberg PhD","doi":"10.1016/j.xagr.2025.100569","DOIUrl":"10.1016/j.xagr.2025.100569","url":null,"abstract":"<div><h3>Background</h3><div>Women with intellectual disabilities face significant barriers to gynecological, reproductive, antenatal, and perinatal care, which may adversely impact maternal and fetal health. Previous research indicates increased risks for gestational diabetes, pre-eclampsia, caesarean birth, preterm birth, and other complications in pregnant women with intellectual disabilities. However, studies on the reproductive health in this group remain scant, and comprehensive research on maternal and fetal health from pregnancy to the postpartum period remain missing.</div></div><div><h3>Objective(s)</h3><div>Using high-quality data from Swedish registers, the present study aims to examine a full range of maternal and fetal outcomes among birthing women with intellectual disabilities and to compare them to those of birthing women in the general population. Such knowledge is important in understanding and preventing adverse health outcomes.</div></div><div><h3>Study Design</h3><div>This was a register study based on all women living in Skåne, Sweden on January 1<sup>st</sup>, 2104, with at least 1 singleton birth in 2014–2021. By linking regional and national registers, we were able to compare maternal and fetal outcomes in a cohort of women with intellectual disabilities (n=378), including a subgroup of women with diagnosis of mild intellectual disability (n=177), to outcomes among women from the general population (n=65 925). Diagnoses (i.e., outcomes) were collected from the Skåne Healthcare Register, which comprises all healthcare contacts in the Skåne region in Sweden. Poisson regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) to quantify the association between intellectual disability and each outcome. The fully adjusted model included maternal year of birth and age at birthing, sociodemographic indicators, and obstetric comorbidities.</div></div><div><h3>Results</h3><div>In the fully adjusted models, women with intellectual disabilities had increased risk of pre-eclampsia (RR 1.67, 95% CI 1.15–2.42), infections of the genitourinary tract (2.30, 1.67–3.16), premature rupture of membranes (2.42, 1.24–4.69 for women with mild intellectual disability), and false labor (1.27, 1.05–1.53). In crude (i.e., unadjusted) models, increased risks were also found for maternal care for known or suspected fetal abnormality and damage, maternal care for other known or suspected fetal problems, other disorders of amniotic fluid and membranes, antepartum hemorrhage, not elsewhere classified, and failed induction of labor.</div></div><div><h3>Conclusion(s)</h3><div>Pregnant women with intellectual disabilities have increased risk of several adverse maternal outcomes, with the risk for some likely driven-at least in part-by lower sociodemographic status and worse obstetric health.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100569"},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.xagr.2025.100564
Jasmine X. Kiley BS , Annabelle Corlett BA , Emma Mitchell-Sparke MPhil , Brittany Jasper MD , Tabitha Wishlade MSc , Catriona Bhagra MD , Sara Wetzler MD , Catherine E. Aiken MBBChir, PhD
Objective
The leading cause of maternal mortality in high-income countries is cardiovascular conditions. The highest risk period for women with cardiac conditions is usually the early postnatal phase; however, postnatal care is often under-resourced. We aim to inform supportive care pathways that address the medical and emotional needs of women with cardiac disease during the postnatal period.
Data Sources
To identify studies, Medline via Ovid, Embase via Ovid, CINAHL via EBSCO, PsycINFO via EBSCO, Scopus, Web of Science Core Collection, and ASSIA via ProQuest were searched (database inception—June 2025).
Study Eligibility Criteria
Studies reporting qualitative data about the postnatal experiences of women with any cardiac condition globally were included. The postnatal period was defined as the events occurring between delivery and 1 year postpartum.
Study Appraisal and Synthesis Methods
The Critical Appraisal Skills Programme checklist for qualitative research was used to perform quality assessment and reduce risk of bias. Inductive coding and thematic analysis were performed using NVivo v.15.
Results
Eleven qualitative studies were included in the meta-synthesis. We identified a chronological framework to describe the postnatal experiences of women with cardiac conditions. We identified key themes of (1) initial fragmentation of attention, (2) physical and psychosocial transitions, and (3) planning for the future. Women described a fragmentation of attention after delivery of their infant, as their own mindset frequently shifted toward motherhood, while their care team focused more on the infant and maternal cardiac recovery. Their experience of motherhood often differed from their expectations, adding to feelings of stress around their postnatal experience. Emotional recovery from complex pregnancies was influenced by desire for future pregnancies and by the degree of support available from family and wider community.
Conclusion
Cardiac conditions profoundly influence postnatal emotional and psychosocial well-being. During the early postnatal phase, care must balance the needs of mother, infant, and maternal cardiac condition. Postnatal cardio-obstetric care should include debriefing appointments with providers, with thorough, sensitive discussion of the risks of potential future pregnancies. Supporting women’s transition into motherhood is critical to help them process experiences and engage with care to improve their long-term cardiac prognosis.
目的高收入国家孕产妇死亡的主要原因是心血管疾病。患有心脏病的妇女风险最高的时期通常是产后早期；然而，产后护理往往资源不足。我们的目标是告知支持性护理途径，以解决产后心脏病妇女的医疗和情感需求。为了确定研究，检索了Medline通过Ovid， Embase通过Ovid， CINAHL通过EBSCO， PsycINFO通过EBSCO， Scopus， Web of Science Core Collection和ASSIA通过ProQuest（数据库创建至2025年6月）。研究资格标准纳入报告全球任何心脏疾病妇女产后经历定性数据的研究。产后期定义为分娩至产后1年之间发生的事件。研究评估和综合方法使用定性研究的关键评估技能程序检查表进行质量评估并降低偏倚风险。使用NVivo v.15进行归纳编码和专题分析。结果meta-synthesis纳入了6项均匀定性研究。我们确定了一个时间框架来描述患有心脏病的妇女的产后经历。我们确定了以下几个关键主题：(1)最初的注意力分散，(2)身体和心理社会的转变，(3)对未来的规划。妇女们描述了分娩后注意力的分散，因为她们自己的心态经常转向母亲，而她们的护理团队更多地关注婴儿和母亲的心脏恢复。她们做母亲的经历往往与她们的期望不同，这增加了她们产后经历的压力感。复杂怀孕后的情绪恢复受到对未来怀孕的渴望以及家庭和更广泛社区提供的支持程度的影响。结论心脏疾病对产后情绪和社会心理健康有深远影响。在产后早期，护理必须平衡母亲、婴儿和母亲心脏状况的需要。产后心脏-产科护理应包括与提供者的报告预约，并对未来潜在怀孕的风险进行彻底、敏感的讨论。支持妇女过渡到母亲是至关重要的，帮助她们处理经验和参与护理，以改善他们的长期心脏预后。
{"title":"Postnatal experiences of women with cardiac conditions: a systematic review and meta-synthesis","authors":"Jasmine X. Kiley BS , Annabelle Corlett BA , Emma Mitchell-Sparke MPhil , Brittany Jasper MD , Tabitha Wishlade MSc , Catriona Bhagra MD , Sara Wetzler MD , Catherine E. Aiken MBBChir, PhD","doi":"10.1016/j.xagr.2025.100564","DOIUrl":"10.1016/j.xagr.2025.100564","url":null,"abstract":"<div><h3>Objective</h3><div>The leading cause of maternal mortality in high-income countries is cardiovascular conditions. The highest risk period for women with cardiac conditions is usually the early postnatal phase; however, postnatal care is often under-resourced. We aim to inform supportive care pathways that address the medical and emotional needs of women with cardiac disease during the postnatal period.</div></div><div><h3>Data Sources</h3><div>To identify studies, Medline via Ovid, Embase via Ovid, CINAHL via EBSCO, PsycINFO via EBSCO, Scopus, Web of Science Core Collection, and ASSIA via ProQuest were searched (database inception—June 2025).</div></div><div><h3>Study Eligibility Criteria</h3><div>Studies reporting qualitative data about the postnatal experiences of women with any cardiac condition globally were included. The postnatal period was defined as the events occurring between delivery and 1 year postpartum.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>The Critical Appraisal Skills Programme checklist for qualitative research was used to perform quality assessment and reduce risk of bias. Inductive coding and thematic analysis were performed using NVivo v.15.</div></div><div><h3>Results</h3><div>Eleven qualitative studies were included in the meta-synthesis. We identified a chronological framework to describe the postnatal experiences of women with cardiac conditions. We identified key themes of (1) initial fragmentation of attention, (2) physical and psychosocial transitions, and (3) planning for the future. Women described a fragmentation of attention after delivery of their infant, as their own mindset frequently shifted toward motherhood, while their care team focused more on the infant and maternal cardiac recovery. Their experience of motherhood often differed from their expectations, adding to feelings of stress around their postnatal experience. Emotional recovery from complex pregnancies was influenced by desire for future pregnancies and by the degree of support available from family and wider community.</div></div><div><h3>Conclusion</h3><div>Cardiac conditions profoundly influence postnatal emotional and psychosocial well-being. During the early postnatal phase, care must balance the needs of mother, infant, and maternal cardiac condition. Postnatal cardio-obstetric care should include debriefing appointments with providers, with thorough, sensitive discussion of the risks of potential future pregnancies. Supporting women’s transition into motherhood is critical to help them process experiences and engage with care to improve their long-term cardiac prognosis.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100564"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Placenta accreta spectrum (PAS) is becoming increasingly common and is associated with significant morbidity and mortality. Prenatal diagnosis and timely referral to centers have been shown to improve outcomes. We present a case of maternal death at 28 weeks of gestation due to massive internal bleeding caused by the rupture of abnormal blood vessels from placenta accreta. The diagnosis of PAS was suspected by morphological ultrasound at 23 weeks of gestation. Expectant management was decided for this patient since she had no children. The patient was transported to the emergency room at 28 weeks of gestation after having a sudden loss of consciousness without other signs (no pelvic pain, no metrorrhagia). After preliminary assessment, maternal death was noted. Hemoperitoneum associated with a placental vascular rupture was found at the autopsy. In the absence of a therapeutic consensus, this case highlights the challenges in managing pregnant women with suspected PAS disorders in the second trimester.
{"title":"Maternal death at 28 weeks gestation due to vascular rupture of placenta accreta","authors":"Khaoula Magdoud MD , Ons Hmandi MD , Sana Menjli MD , Ines Ben Hassen MD , Imen Labidi MD , Eya Azouz MD , Bilel Arfaoui MD , Hassine Saber Abouda MD","doi":"10.1016/j.xagr.2025.100562","DOIUrl":"10.1016/j.xagr.2025.100562","url":null,"abstract":"<div><div>Placenta accreta spectrum (PAS) is becoming increasingly common and is associated with significant morbidity and mortality. Prenatal diagnosis and timely referral to centers have been shown to improve outcomes. We present a case of maternal death at 28 weeks of gestation due to massive internal bleeding caused by the rupture of abnormal blood vessels from placenta accreta. The diagnosis of PAS was suspected by morphological ultrasound at 23 weeks of gestation. Expectant management was decided for this patient since she had no children. The patient was transported to the emergency room at 28 weeks of gestation after having a sudden loss of consciousness without other signs (no pelvic pain, no metrorrhagia). After preliminary assessment, maternal death was noted. Hemoperitoneum associated with a placental vascular rupture was found at the autopsy. In the absence of a therapeutic consensus, this case highlights the challenges in managing pregnant women with suspected PAS disorders in the second trimester.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100562"},"PeriodicalIF":0.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145097551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tarlov cysts commonly occur in women but are often thought to be asymptomatic findings. However, recent studies have suggested that Tarlov cysts can be a contributing factor to various pain and neurologic dysfunctions with a significant effect on health-related quality of life. Tarlov cysts and various intrapelvic pathologies can result in compression or impairment of peripheral and spinal nerve roots and can potentially affect women’s sexual function, particularly by causing persistent genital arousal disorder. Persistent genital arousal disorder is characterized by spontaneous and often unrelenting sensations of genital arousal in the absence of sexual desire or stimulation and, by definition, is intrusive, unwanted, and distressing. This review details the prevalence, characteristics, and treatments of persistent genital arousal disorder and Tarlov cysts and evaluates potential relationships between these conditions.
The prevalence of persistent genital arousal disorder ranges from 1.6% to 11.1% in community-based surveys, and 33% of women who are referred to a sexual health clinic report at least 1 persistent genital arousal disorder screening question. The prevalence of Tarlov cysts ranges from 1.5% to 13.2% and is higher among women referred to pain centers, ranging from 16% to 39%. Despite the already high prevalence, these numbers for both conditions are likely underestimated as sexual dysfunction. Therefore, persistent genital arousal disorder is not readily disclosed, and optimal sacral magnetic resonance imaging is infrequently performed to detect Tarlov cysts. Persistent genital arousal disorder is a symptom complex for which psychological, vascular, central, and peripheral neurologic factors have been proposed as possible causes.
When peripheral nerve entrapments are believed to be the cause of persistent genital arousal disorder, mechanical release of the nerve or nerve root is the generally accepted treatment. Several surgical and minimally invasive percutaneous procedures are effective treatments when Tarlov cysts are symptomatic, although evidence for their effectiveness for persistent genital arousal disorder is limited. For surgical/interventional failures to decompress nerves and decrease symptoms in patients with Tarlov cysts or persistent genital arousal disorder, neuromodulation is increasingly being performed as a rescue therapy.
Because of the weak evidence base, the relationship between Tarlov cysts and persistent genital arousal disorder remains uncertain, and healthcare professionals are encouraged to inquire more broadly about the symptoms related to these conditions, conduct neurologic examinations, and order relevant sacral imaging to clarify the relationship further.
{"title":"Sacral Tarlov cysts and spontaneous persistent genital arousal: 2 unrecognized and underappreciated health conditions with an uncertain relationship","authors":"Randa Yosef MD , Gaylene Pron PhD , Nucelio Lemos MD , Kieran Murphy MD","doi":"10.1016/j.xagr.2025.100563","DOIUrl":"10.1016/j.xagr.2025.100563","url":null,"abstract":"<div><div>Tarlov cysts commonly occur in women but are often thought to be asymptomatic findings. However, recent studies have suggested that Tarlov cysts can be a contributing factor to various pain and neurologic dysfunctions with a significant effect on health-related quality of life. Tarlov cysts and various intrapelvic pathologies can result in compression or impairment of peripheral and spinal nerve roots and can potentially affect women’s sexual function, particularly by causing persistent genital arousal disorder. Persistent genital arousal disorder is characterized by spontaneous and often unrelenting sensations of genital arousal in the absence of sexual desire or stimulation and, by definition, is intrusive, unwanted, and distressing. This review details the prevalence, characteristics, and treatments of persistent genital arousal disorder and Tarlov cysts and evaluates potential relationships between these conditions.</div><div>The prevalence of persistent genital arousal disorder ranges from 1.6% to 11.1% in community-based surveys, and 33% of women who are referred to a sexual health clinic report at least 1 persistent genital arousal disorder screening question. The prevalence of Tarlov cysts ranges from 1.5% to 13.2% and is higher among women referred to pain centers, ranging from 16% to 39%. Despite the already high prevalence, these numbers for both conditions are likely underestimated as sexual dysfunction. Therefore, persistent genital arousal disorder is not readily disclosed, and optimal sacral magnetic resonance imaging is infrequently performed to detect Tarlov cysts. Persistent genital arousal disorder is a symptom complex for which psychological, vascular, central, and peripheral neurologic factors have been proposed as possible causes.</div><div>When peripheral nerve entrapments are believed to be the cause of persistent genital arousal disorder, mechanical release of the nerve or nerve root is the generally accepted treatment. Several surgical and minimally invasive percutaneous procedures are effective treatments when Tarlov cysts are symptomatic, although evidence for their effectiveness for persistent genital arousal disorder is limited. For surgical/interventional failures to decompress nerves and decrease symptoms in patients with Tarlov cysts or persistent genital arousal disorder, neuromodulation is increasingly being performed as a rescue therapy.</div><div>Because of the weak evidence base, the relationship between Tarlov cysts and persistent genital arousal disorder remains uncertain, and healthcare professionals are encouraged to inquire more broadly about the symptoms related to these conditions, conduct neurologic examinations, and order relevant sacral imaging to clarify the relationship further.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100563"},"PeriodicalIF":0.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145097550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The prevalence of metabolic syndrome in menopause varies globally. There is a paucity of data regarding knowledge of metabolic syndrome in menopause in South Africa.
Objective(s)
The study was designed to describe the prevalence of metabolic syndrome in perimenopausal and postmenopausal and the lipid changes that occur during the menopause transition.
Study Design
A prospective cross-sectional study was conducted at Dr George Mukhari Academic Hospital, the gynaecological outpatient department, Pretoria, South Africa. Perimenopausal and postmenopausal women were included. Six hundred ninety menopausal women were enrolled in this study. The participants were evaluated by physical examination. Blood samples were also taken for biochemical assay. The researcher also took their blood pressure. Data compiled from the study were analyzed using the Statistical Package for Social Sciences version 21. Descriptive statistical analysis established the range, mean (including 95% confidence interval), and standard deviation for quantitative variables. Categorical variables were analysed using Fisher's exact test, and risk analysis of factors associated with Metabolic syndrome was performed by calculating the odds ratio (OR) and its 95% confidence interval for both perimenopausal and postmenopausal women. A 2-tailed statistical analysis yielding a p-value <.05 was taken as statistically significant.
Results
The study consisted of 690 women (n=690), including 338 perimenopausal women (n=338; 49.0%) and 352 postmenopausal women (n=352; 51.0%). The prevalence of metabolic syndrome was noted to be 47% and 61.4% in the perimenopausal and postmenopausal groups, respectively. The mean waist circumference was higher than the cut-off value of 88cm for perimenopausal and postmenopausal women. There were no statistically significant differences in lipid profiles between perimenopausal and postmenopausal women. The odds ratio for elevated triglycerides was 0.65 (95% CI: 0.32–1.01) and for low HDL levels was 0.83 (95% CI: 0.41–0.98). Perimenopausal women had significantly higher odds (OR 2.19, P<.0001) of experiencing hot flushes compared to postmenopausal women. Multivariate logistic regression analysis demonstrated that age (P=.3789) was not significantly associated with metabolic syndrome. However, the prevalence of metabolic syndrome was higher in postmenopausal women compared to perimenopausal women. Sleep disorders (P<.0001) and vasomotor symptoms (P=.0198) showed significant correlations with the presence of metabolic syndrome. When comparing women with and without metabolic syndrome, both perimenopausal (HDL; P<.0001, triglycerides; P<.0001) and postmenopausal groups (HDL; P<.0001, triglycerides; P<.0001) demonstrated significant associations between dyslipidae
{"title":"Metabolic syndrome in perimenopausal and postmenopausal women attending gynaecology outpatient department at a tertiary institution in South Africa","authors":"Lawrence Marapo MBChB, FCOG (SA) , Lineo Matsela PhD, Mmed, MD , ME Chabalala MBChB, FCOG(SA), Mmed , Olakunle Adewunmi Towobola PhD (Endocrinology & Contraception)","doi":"10.1016/j.xagr.2025.100560","DOIUrl":"10.1016/j.xagr.2025.100560","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of metabolic syndrome in menopause varies globally. There is a paucity of data regarding knowledge of metabolic syndrome in menopause in South Africa.</div></div><div><h3>Objective(s)</h3><div>The study was designed to describe the prevalence of metabolic syndrome in perimenopausal and postmenopausal and the lipid changes that occur during the menopause transition.</div></div><div><h3>Study Design</h3><div>A prospective cross-sectional study was conducted at Dr George Mukhari Academic Hospital, the gynaecological outpatient department, Pretoria, South Africa. Perimenopausal and postmenopausal women were included. Six hundred ninety menopausal women were enrolled in this study. The participants were evaluated by physical examination. Blood samples were also taken for biochemical assay. The researcher also took their blood pressure. Data compiled from the study were analyzed using the Statistical Package for Social Sciences version 21. Descriptive statistical analysis established the range, mean (including 95% confidence interval), and standard deviation for quantitative variables. Categorical variables were analysed using Fisher's exact test, and risk analysis of factors associated with Metabolic syndrome was performed by calculating the odds ratio (OR) and its 95% confidence interval for both perimenopausal and postmenopausal women. A 2-tailed statistical analysis yielding a p-value <.05 was taken as statistically significant.</div></div><div><h3>Results</h3><div>The study consisted of 690 women (n=690), including 338 perimenopausal women (n=338; 49.0%) and 352 postmenopausal women (n=352; 51.0%). The prevalence of metabolic syndrome was noted to be 47% and 61.4% in the perimenopausal and postmenopausal groups, respectively. The mean waist circumference was higher than the cut-off value of 88cm for perimenopausal and postmenopausal women. There were no statistically significant differences in lipid profiles between perimenopausal and postmenopausal women. The odds ratio for elevated triglycerides was 0.65 (95% CI: 0.32–1.01) and for low HDL levels was 0.83 (95% CI: 0.41–0.98). Perimenopausal women had significantly higher odds (OR 2.19, <em>P<.</em>0001) of experiencing hot flushes compared to postmenopausal women. Multivariate logistic regression analysis demonstrated that age (<em>P=.</em>3789) was not significantly associated with metabolic syndrome. However, the prevalence of metabolic syndrome was higher in postmenopausal women compared to perimenopausal women. Sleep disorders (<em>P<.</em>0001) and vasomotor symptoms (<em>P=.</em>0198) showed significant correlations with the presence of metabolic syndrome. When comparing women with and without metabolic syndrome, both perimenopausal (HDL; <em>P<.</em>0001, triglycerides; <em>P<.</em>0001) and postmenopausal groups (HDL; <em>P<.</em>0001, triglycerides; <em>P<.</em>0001) demonstrated significant associations between dyslipidae","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100560"},"PeriodicalIF":0.0,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-14DOI: 10.1016/j.xagr.2025.100558
Emily Malloy PhD, CNM , Jessica J.F. Kram MPH , James O. Adefisoye PhD , Marie Forgie DO , Diana Kleber RN , MaryAnne Scherer CNM , Anna Anklam CNM , Natasha Hernandez MD , Lisa Hanson PhD, CNM
<div><h3>Background</h3><div>Waterbirth is the act of giving birth submerged in a tub of warm water, with the baby born underwater. Support for widespread adoption of waterbirth in the United States (US) has been limited by predominantly retrospective study designs, the underutilization of interdisciplinary citations, and disagreement between professional organizations. No randomized controlled trials of waterbirth have been conducted in the US.</div></div><div><h3>Objective</h3><div>The purpose of this randomized controlled trial was to compare pain management, maternal and neonatal outcomes, and maternal satisfaction between low-risk water and land group study participants.</div></div><div><h3>Study Design</h3><div>Low-risk pregnant adults were offered study participation between 25 to 34 weeks of gestation during routine prenatal care. Participants who met the inclusion criteria were consented, enrolled, and randomly assigned to waterbirth or land birth in a 2:1 unblinded fashion, to achieve a sample size of n=120 (80 waterbirth: 40 land birth). The sample size was adjusted for attrition and increased to n=186 (124 waterbirth: 62 land birth) based on an interim analysis. Participants in both arms were excluded if they developed intrapartum risk factors prior to delivery using a modified intention-to-treat model. Study participants received routine intrapartum care, including all available pain relief options. Only those assigned to the waterbirth group were given the option of giving birth in water. Prior to discharge, participants completed <em>The US Birth Satisfaction Scale Revised</em>. The primary study outcome was the use of any intravenous narcotics and/or epidural anesthesia. Secondary outcomes included predetermined composite maternal and neonatal outcomes and overall birth satisfaction. Using a modified intention-to-treat approach, outcomes were analyzed using Chi-square, Fisher’s Exact, or Wilcoxon-Mann-Whitney test as appropriate. Relative risks (RR) were computed where applicable.</div></div><div><h3>Results</h3><div>From January 2022 to December 2023, 186 participants were enrolled (n=124 waterbirth, n=62 land birth). Following enrollment, 106 participants (n=74 waterbirth, and n=32 land birth) remained eligible for the study. Attrition was 39%. Compared to the land birth group, waterbirth participants were significantly less likely to use intravenous narcotics [RR: 0.36 (95% confidence interval [CI], 0.17−0.75), <em>P<</em>.01] and epidural analgesia [RR: 0.38 (95% CI, 0.24−0.58), <em>P<</em>.01] and had shorter average first stage labor duration [median difference -2.00 hours (95% CI, -3.00 to 1.00), <em>P</em>=.43]. One cord avulsion occurred in the waterbirth group. Additional maternal and neonatal outcomes were not significantly different between groups. Waterbirth participants experienced higher overall birth satisfaction [median difference 3.50 (95% CI, 1.00-5.00), <em>P</em>=.01].</div></div><div><h3>Conclusion</h3>
{"title":"Hospital waterbirth for low-risk birthing people: findings of a randomized controlled trial","authors":"Emily Malloy PhD, CNM , Jessica J.F. Kram MPH , James O. Adefisoye PhD , Marie Forgie DO , Diana Kleber RN , MaryAnne Scherer CNM , Anna Anklam CNM , Natasha Hernandez MD , Lisa Hanson PhD, CNM","doi":"10.1016/j.xagr.2025.100558","DOIUrl":"10.1016/j.xagr.2025.100558","url":null,"abstract":"<div><h3>Background</h3><div>Waterbirth is the act of giving birth submerged in a tub of warm water, with the baby born underwater. Support for widespread adoption of waterbirth in the United States (US) has been limited by predominantly retrospective study designs, the underutilization of interdisciplinary citations, and disagreement between professional organizations. No randomized controlled trials of waterbirth have been conducted in the US.</div></div><div><h3>Objective</h3><div>The purpose of this randomized controlled trial was to compare pain management, maternal and neonatal outcomes, and maternal satisfaction between low-risk water and land group study participants.</div></div><div><h3>Study Design</h3><div>Low-risk pregnant adults were offered study participation between 25 to 34 weeks of gestation during routine prenatal care. Participants who met the inclusion criteria were consented, enrolled, and randomly assigned to waterbirth or land birth in a 2:1 unblinded fashion, to achieve a sample size of n=120 (80 waterbirth: 40 land birth). The sample size was adjusted for attrition and increased to n=186 (124 waterbirth: 62 land birth) based on an interim analysis. Participants in both arms were excluded if they developed intrapartum risk factors prior to delivery using a modified intention-to-treat model. Study participants received routine intrapartum care, including all available pain relief options. Only those assigned to the waterbirth group were given the option of giving birth in water. Prior to discharge, participants completed <em>The US Birth Satisfaction Scale Revised</em>. The primary study outcome was the use of any intravenous narcotics and/or epidural anesthesia. Secondary outcomes included predetermined composite maternal and neonatal outcomes and overall birth satisfaction. Using a modified intention-to-treat approach, outcomes were analyzed using Chi-square, Fisher’s Exact, or Wilcoxon-Mann-Whitney test as appropriate. Relative risks (RR) were computed where applicable.</div></div><div><h3>Results</h3><div>From January 2022 to December 2023, 186 participants were enrolled (n=124 waterbirth, n=62 land birth). Following enrollment, 106 participants (n=74 waterbirth, and n=32 land birth) remained eligible for the study. Attrition was 39%. Compared to the land birth group, waterbirth participants were significantly less likely to use intravenous narcotics [RR: 0.36 (95% confidence interval [CI], 0.17−0.75), <em>P<</em>.01] and epidural analgesia [RR: 0.38 (95% CI, 0.24−0.58), <em>P<</em>.01] and had shorter average first stage labor duration [median difference -2.00 hours (95% CI, -3.00 to 1.00), <em>P</em>=.43]. One cord avulsion occurred in the waterbirth group. Additional maternal and neonatal outcomes were not significantly different between groups. Waterbirth participants experienced higher overall birth satisfaction [median difference 3.50 (95% CI, 1.00-5.00), <em>P</em>=.01].</div></div><div><h3>Conclusion</h3>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100558"},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-14DOI: 10.1016/j.xagr.2025.100550
Wen-Shuang Li MSc , Rong-Jing Dong PhD , Shui-Tao Yi MSc , Ru-Qin Zhang BSc , Rui-Xia Chen MSc , Yan-Jie Ning MSc , Dian-Jiang Xiao BSc
We report one case in China of a couple simultaneously infected with the monkeypox. Both spouses developed genital skin lesions successively and the female partner had widespread skin lesions all over her body, while the male partner is HIV-positive, had a history of homosexual behavior before the onset of symptoms.
{"title":"Monkeypox virus infection in a 23-year-old woman with a genital rash and global skin lesions: evidence for spouse-to-spouse transmission","authors":"Wen-Shuang Li MSc , Rong-Jing Dong PhD , Shui-Tao Yi MSc , Ru-Qin Zhang BSc , Rui-Xia Chen MSc , Yan-Jie Ning MSc , Dian-Jiang Xiao BSc","doi":"10.1016/j.xagr.2025.100550","DOIUrl":"10.1016/j.xagr.2025.100550","url":null,"abstract":"<div><div>We report one case in China of a couple simultaneously infected with the monkeypox. Both spouses developed genital skin lesions successively and the female partner had widespread skin lesions all over her body, while the male partner is HIV-positive, had a history of homosexual behavior before the onset of symptoms.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 4","pages":"Article 100550"},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号