OBJECTIVETo develop a core outcome set (COS) to standardise measurement and reporting of race equality within the obstetrics and gynaecology workforce and training.DESIGNMulti-stakeholder Delphi survey.SETTINGObstetrics and gynaecology care in secondary and tertiary hospitals in the UK.POPULATIONClinicians, trainees, service managers, researchers, midwives, and service design representatives from healthcare organisations, professional bodies, and charities relevant to maternity services and medical education.METHODSRelevant outcomes from the literature were identified and grouped thematically. We undertook a two-round Delphi survey, prioritising outcomes by scoring on a nine-point Likert scale (1 = limited importance, 9 = critical). Consensus was predefined as a median score ≥ 8 and IQR ≤ 2. The final core outcome set was finalised by consensus and consultation.MAIN OUTCOME MEASURESA minimum set of core outcomes for assessing race equality within obstetrics and gynaecology workforce and training.RESULTSThe survey was completed by 45 stakeholders. Ninety-two outcomes were identified, condensed to 41 and grouped across 11 themes. Thirteen were chosen in the first round, five in the second, 10 additional were proposed, and after consensus, 18 were selected to be included as core outcomes. Fifteen participants attended the final consultation meeting. Outcome themes included workforce representation, pay, postgraduate training, disciplinary processes, career progression, and harassment and bullying.CONCLUSIONSThis is the first COS developed to measure race equality in the obstetrics and gynaecology workforce. Standardised reporting of these outcomes will enable benchmarking across organisations, inform targeted interventions, and support the development of a more equitable and inclusive workforce.
{"title":"Measuring Race Equality in the Obstetrics and Gynaecology Workforce and Training: A Delphi Core Outcome Set Study.","authors":"Nicola Adanna Okeahialam,Jameela Sheikh,John Allotey,Farah Siddiqui,Ranee Thakar,Shakila Thangaratinam","doi":"10.1111/1471-0528.70163","DOIUrl":"https://doi.org/10.1111/1471-0528.70163","url":null,"abstract":"OBJECTIVETo develop a core outcome set (COS) to standardise measurement and reporting of race equality within the obstetrics and gynaecology workforce and training.DESIGNMulti-stakeholder Delphi survey.SETTINGObstetrics and gynaecology care in secondary and tertiary hospitals in the UK.POPULATIONClinicians, trainees, service managers, researchers, midwives, and service design representatives from healthcare organisations, professional bodies, and charities relevant to maternity services and medical education.METHODSRelevant outcomes from the literature were identified and grouped thematically. We undertook a two-round Delphi survey, prioritising outcomes by scoring on a nine-point Likert scale (1 = limited importance, 9 = critical). Consensus was predefined as a median score ≥ 8 and IQR ≤ 2. The final core outcome set was finalised by consensus and consultation.MAIN OUTCOME MEASURESA minimum set of core outcomes for assessing race equality within obstetrics and gynaecology workforce and training.RESULTSThe survey was completed by 45 stakeholders. Ninety-two outcomes were identified, condensed to 41 and grouped across 11 themes. Thirteen were chosen in the first round, five in the second, 10 additional were proposed, and after consensus, 18 were selected to be included as core outcomes. Fifteen participants attended the final consultation meeting. Outcome themes included workforce representation, pay, postgraduate training, disciplinary processes, career progression, and harassment and bullying.CONCLUSIONSThis is the first COS developed to measure race equality in the obstetrics and gynaecology workforce. Standardised reporting of these outcomes will enable benchmarking across organisations, inform targeted interventions, and support the development of a more equitable and inclusive workforce.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021511","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}
Isabelle Malhamé,Robin Campen,Mara Bensson,Clarissa Andre,Sarah Dominguez,Sally Twin,Ambreen Syeda,Rizwana Ashraf,Angel Vasquez,Yoliana Guardo,Carlos Lopez,Byron Rosero-Britton,Hannah Spalding,Kristen Petagna,Grace DeCost,Benjamin A Bouvier,A Kinga Malinowski,James O'Brien,Valery A Danilack-Fekete,Christina A Raker,Rohan D'Souza,Jose Rojas-Suarez,Thomas van den Akker,Stephen E Lapinsky,Kenneth K Chen
OBJECTIVETo assess risk markers for short-term major adverse cardiovascular events (MACE) following postpartum haemorrhage (PPH).DESIGNA retrospective cohort study.SETTINGFive study sites across the US, Canada, the Netherlands and Colombia.POPULATIONIndividuals with PPH in 2012-2017.MAIN OUTCOME MEASURESMACE (including acute myocardial infarction, pulmonary oedema, cardiomyopathy, stroke, and cardiac death) observed during a hospitalisation for birth.METHODSWe compared characteristics and therapeutic interventions (as indicators of severe bleeding) among participants with and without MACE. We conducted an exploratory analysis using multivariable logistic regression to identify risk markers for MACE.RESULTSTwo thousand and sixty-nine participants had PPH (US: n = 1055, Canada: n = 613, the Netherlands: n = 302, Colombia: n = 99), of whom 40 (1.93%, 95% CI [1.38, 2.62]) experienced MACE. Pulmonary oedema was the most common type of event (n = 37, 1.79%, 95% CI [1.26-2.46]). Participants with MACE had more preeclampsia (30% vs. 9.91%) and heart disease (7.50% vs. 1.38%) than those without (p < 0.05). MACE occurred more frequently in the context of infections (adjusted odds ratio [aOR] 6.81, 95% CI [3.24-14.33]), aspirin use (aOR 4.49, 95% CI [1.07-18.85]), and markers of severe bleeding, such as the need for prostaglandin F2 alpha analogues (aOR 3.16, 95% CI [1.41-7.07]) and blood products (aOR 3.08, 95% CI [1.41-6.71]). A higher antenatal haemoglobin was associated with less MACE (aOR 0.96, 95% CI [0.94-0.98]).CONCLUSIONAbout 2 in 100 persons with PPH developed MACE, mostly pulmonary oedema. Risk markers identified individuals with PPH who may require increased monitoring. Whether treating anaemia can prevent cardiovascular morbidity following PPH must be evaluated.
{"title":"Short-Term Major Adverse Cardiovascular Events Following Postpartum Haemorrhage: A Cohort Study (The MACEPH Study).","authors":"Isabelle Malhamé,Robin Campen,Mara Bensson,Clarissa Andre,Sarah Dominguez,Sally Twin,Ambreen Syeda,Rizwana Ashraf,Angel Vasquez,Yoliana Guardo,Carlos Lopez,Byron Rosero-Britton,Hannah Spalding,Kristen Petagna,Grace DeCost,Benjamin A Bouvier,A Kinga Malinowski,James O'Brien,Valery A Danilack-Fekete,Christina A Raker,Rohan D'Souza,Jose Rojas-Suarez,Thomas van den Akker,Stephen E Lapinsky,Kenneth K Chen","doi":"10.1111/1471-0528.70130","DOIUrl":"https://doi.org/10.1111/1471-0528.70130","url":null,"abstract":"OBJECTIVETo assess risk markers for short-term major adverse cardiovascular events (MACE) following postpartum haemorrhage (PPH).DESIGNA retrospective cohort study.SETTINGFive study sites across the US, Canada, the Netherlands and Colombia.POPULATIONIndividuals with PPH in 2012-2017.MAIN OUTCOME MEASURESMACE (including acute myocardial infarction, pulmonary oedema, cardiomyopathy, stroke, and cardiac death) observed during a hospitalisation for birth.METHODSWe compared characteristics and therapeutic interventions (as indicators of severe bleeding) among participants with and without MACE. We conducted an exploratory analysis using multivariable logistic regression to identify risk markers for MACE.RESULTSTwo thousand and sixty-nine participants had PPH (US: n = 1055, Canada: n = 613, the Netherlands: n = 302, Colombia: n = 99), of whom 40 (1.93%, 95% CI [1.38, 2.62]) experienced MACE. Pulmonary oedema was the most common type of event (n = 37, 1.79%, 95% CI [1.26-2.46]). Participants with MACE had more preeclampsia (30% vs. 9.91%) and heart disease (7.50% vs. 1.38%) than those without (p < 0.05). MACE occurred more frequently in the context of infections (adjusted odds ratio [aOR] 6.81, 95% CI [3.24-14.33]), aspirin use (aOR 4.49, 95% CI [1.07-18.85]), and markers of severe bleeding, such as the need for prostaglandin F2 alpha analogues (aOR 3.16, 95% CI [1.41-7.07]) and blood products (aOR 3.08, 95% CI [1.41-6.71]). A higher antenatal haemoglobin was associated with less MACE (aOR 0.96, 95% CI [0.94-0.98]).CONCLUSIONAbout 2 in 100 persons with PPH developed MACE, mostly pulmonary oedema. Risk markers identified individuals with PPH who may require increased monitoring. Whether treating anaemia can prevent cardiovascular morbidity following PPH must be evaluated.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"88 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021506","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}
Martha Hickey,Trevor Tejada-Berges,Susan M Domchek,Efrosinia O Krejany,Alison Brand,Peixuan Li,Sabine Braat,Sheryl Kingsberg
OBJECTIVETo determine the effect of surgical menopause (risk-reducing salpingo-oophorectomy, RRSO) on sexual function and the modifying effects of HRT.DESIGNProspective observational study of women undergoing RRSO and age-matched comparison group who retained their ovaries.SETTINGHigh-risk clinics and general population.METHODSSexual function was measured at baseline, 3, 6, 12 and 24 months.MAIN OUTCOME MEASURESPrimary outcome was sexual function at 24 months using the Female Sexual Function Index (FSFI). Secondary outcomes included the Fallowfield Sexual Activity Questionnaire (SAQ) and Female Sexual Distress Scale-Revised (FSDS-R).RESULTSBaseline sexual function was similar between groups. At 24 months, sexual dysfunction increased from 19% to 42% after RRSO versus 24% to 29% in comparisons (Odds Ratio (OR) 1.9, 95% CI 0.7-5.1; p = 0.21). Compared to comparisons, sexual desire (-0.4, p = 0.02), arousal (-0.7, p < 0.001), lubrication (-0.6, p = 0.01) and satisfaction (-0.6, p < 0.001) were significantly reduced in the RRSO group. Sexual pain (-0.5, p = 0.05) and discomfort (-1.0, p < 0.001) increased after RRSO; sexual habit was unchanged. Sexual distress nearly quadrupled in the RRSO group (OR 3.7, 95% CI 1.6-9.0; p = 0.003). After RRSO, 61% commenced HRT. HRT was not associated with sexual function, activity or distress.CONCLUSIONSSexual dysfunction and distress increased after RRSO. Use of HRT was not associated with better sexual function.
目的探讨手术停经（降低风险的输卵管卵巢切除术，RRSO）对性功能的影响及HRT的调节作用。设计：前瞻性观察研究：接受RRSO手术的女性和保留卵巢的年龄匹配对照组。高危诊所和一般人群。方法分别于基线、3、6、12、24个月测定性功能。主要结局指标主要结局指标是24个月时的性功能，使用女性性功能指数（FSFI）。次要结果包括Fallowfield性活动问卷（SAQ）和女性性困扰量表（FSDS-R）。结果两组患者的基线性功能基本相同。在24个月时，RRSO后性功能障碍从19%增加到42%，而对照组从24%增加到29%(优势比（OR） 1.9, 95% CI 0.7-5.1；p = 0.21)。与对照组相比，RRSO组的性欲（-0.4,p = 0.02）、性唤起（-0.7,p < 0.001）、润滑（-0.6,p = 0.01）和满意度（-0.6,p < 0.001）显著降低。性疼痛（-0.5,p = 0.05）和不适感（-1.0,p < 0.001）增加；性习惯没有改变。性困扰在RRSO组中几乎翻了两番（OR 3.7, 95% CI 1.6-9.0; p = 0.003）。在RRSO后，61%的患者开始了HRT治疗。HRT与性功能、活动或痛苦无关。结论RRSO术后性功能障碍和焦虑加重。使用激素替代疗法与更好的性功能无关。
{"title":"Sexual Function, Activity and Distress 24 Months After Surgical Menopause: What Happens After Menopause (WHAM)-A Prospective Controlled Study.","authors":"Martha Hickey,Trevor Tejada-Berges,Susan M Domchek,Efrosinia O Krejany,Alison Brand,Peixuan Li,Sabine Braat,Sheryl Kingsberg","doi":"10.1111/1471-0528.70158","DOIUrl":"https://doi.org/10.1111/1471-0528.70158","url":null,"abstract":"OBJECTIVETo determine the effect of surgical menopause (risk-reducing salpingo-oophorectomy, RRSO) on sexual function and the modifying effects of HRT.DESIGNProspective observational study of women undergoing RRSO and age-matched comparison group who retained their ovaries.SETTINGHigh-risk clinics and general population.METHODSSexual function was measured at baseline, 3, 6, 12 and 24 months.MAIN OUTCOME MEASURESPrimary outcome was sexual function at 24 months using the Female Sexual Function Index (FSFI). Secondary outcomes included the Fallowfield Sexual Activity Questionnaire (SAQ) and Female Sexual Distress Scale-Revised (FSDS-R).RESULTSBaseline sexual function was similar between groups. At 24 months, sexual dysfunction increased from 19% to 42% after RRSO versus 24% to 29% in comparisons (Odds Ratio (OR) 1.9, 95% CI 0.7-5.1; p = 0.21). Compared to comparisons, sexual desire (-0.4, p = 0.02), arousal (-0.7, p < 0.001), lubrication (-0.6, p = 0.01) and satisfaction (-0.6, p < 0.001) were significantly reduced in the RRSO group. Sexual pain (-0.5, p = 0.05) and discomfort (-1.0, p < 0.001) increased after RRSO; sexual habit was unchanged. Sexual distress nearly quadrupled in the RRSO group (OR 3.7, 95% CI 1.6-9.0; p = 0.003). After RRSO, 61% commenced HRT. HRT was not associated with sexual function, activity or distress.CONCLUSIONSSexual dysfunction and distress increased after RRSO. Use of HRT was not associated with better sexual function.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021507","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}
{"title":"Anaemia in Women: A Historical Example of Intersectionality in Health Care.","authors":"Eric Jauniaux,Carolyn Paul","doi":"10.1111/1471-0528.70164","DOIUrl":"https://doi.org/10.1111/1471-0528.70164","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021456","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}
{"title":"Target Trial Emulation for Clarity of Causal Questions.","authors":"Jeffrey N Bone","doi":"10.1111/1471-0528.70141","DOIUrl":"https://doi.org/10.1111/1471-0528.70141","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015397","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}
OBJECTIVEAddressing inequalities in maternal and newborn health is a UK public health priority. Evidence on effective multi-interventional strategies is urgently needed. This study evaluated the impact of community-based midwife continuity of care (CBMCOC) models for women and babies in ethnically diverse and socially disadvantaged areas of South London.DESIGNWe conducted a prospective cohort study using the eLIXIR, Born in South London, maternity-child data linkage.SETTINGUnited Kingdom.POPULATIONPregnant women exposed to CBMCOC and standard care between 2018 and 2020.METHODSPropensity score matching (1:4) was used to account for differences between CBMCOC and standard care cohorts and control for confounding bias. Conditional logistic regression estimated risk ratios. Subgroup analysis included women of Black, Asian and other ethnic minority groups, and those living in highly deprived areas.OUTCOMESThe primary outcome was preterm birth (< 37 weeks' gestation). Secondary outcomes included other relevant maternal, perinatal, process and clinical variables.RESULTSBefore matching, 12 386 women were exposed to standard care and 1338 to CBMCOC; after matching, 5352 and 1338 were included, respectively. The risk of preterm birth was lower among women exposed to CBMCOC (unmatched: 4.6% vs. 10.3%, RR = 0.50, 95% CI: 0.38-0.64; matched: 4.6% vs. 8.4%, RR = 0.54, 95% CI: 0.40-0.70). Subgroup analyses showed reduced preterm birth rates among ethnic minority women and those in deprived areas when exposed to CBMCOC.CONCLUSIONSIn this diverse population with a range of risk factors, locality-based interventions integrating community-based care and midwife continuity may reduce maternal and newborn health inequalities. Further trials of such models should be conducted.
目的解决孕产妇和新生儿健康方面的不平等问题是联合王国公共卫生的优先事项。迫切需要关于有效的多干预战略的证据。本研究评估了基于社区的助产士护理连续性（cbcoc）模式对伦敦南部种族多样化和社会弱势地区妇女和婴儿的影响。设计：我们使用eLIXIR，出生在伦敦南部，母婴数据链接进行了一项前瞻性队列研究。SETTINGUnited王国。人群：2018年至2020年期间暴露于cbcoc和标准护理的孕妇。方法采用倾向评分匹配（1:4）来解释CBMCOC与标准护理队列之间的差异，并以混杂偏倚为对照。条件逻辑回归估计风险比。亚组分析包括黑人、亚洲和其他少数民族的妇女，以及生活在高度贫困地区的妇女。主要结局为早产（< 37周妊娠）。次要结局包括其他相关的产妇、围产期、过程和临床变量。结果配对前，12386名妇女接受标准护理，1338名妇女接受cbcoc；匹配后分别得到5352和1338。暴露于CBMCOC的妇女早产风险较低（未匹配组：4.6% vs. 10.3%, RR = 0.50, 95% CI: 0.38-0.64；匹配组：4.6% vs. 8.4%, RR = 0.54, 95% CI: 0.40-0.70）。亚组分析显示，少数民族妇女和贫困地区妇女在接触cbcoc时早产率降低。结论在具有一系列危险因素的多样化人群中，结合社区护理和助产士连续性的基于地方的干预措施可能会减少孕产妇和新生儿健康不平等。应该对这些模型进行进一步的试验。
{"title":"The Impact of Community-Based Midwife Continuity of Care Models for Women Living in Areas of Social Disadvantage and Ethnic Diversity in the United Kingdom: A Prospective Cohort Study.","authors":"Cristina Fernandez Turienzo,Sam Burton,Zahra Khan,Hannah Rayment-Jones,Mary Newburn,Paul T Seed,Zoe Vowles,Jane Sandall,Abigail Easter, ","doi":"10.1111/1471-0528.70101","DOIUrl":"https://doi.org/10.1111/1471-0528.70101","url":null,"abstract":"OBJECTIVEAddressing inequalities in maternal and newborn health is a UK public health priority. Evidence on effective multi-interventional strategies is urgently needed. This study evaluated the impact of community-based midwife continuity of care (CBMCOC) models for women and babies in ethnically diverse and socially disadvantaged areas of South London.DESIGNWe conducted a prospective cohort study using the eLIXIR, Born in South London, maternity-child data linkage.SETTINGUnited Kingdom.POPULATIONPregnant women exposed to CBMCOC and standard care between 2018 and 2020.METHODSPropensity score matching (1:4) was used to account for differences between CBMCOC and standard care cohorts and control for confounding bias. Conditional logistic regression estimated risk ratios. Subgroup analysis included women of Black, Asian and other ethnic minority groups, and those living in highly deprived areas.OUTCOMESThe primary outcome was preterm birth (< 37 weeks' gestation). Secondary outcomes included other relevant maternal, perinatal, process and clinical variables.RESULTSBefore matching, 12 386 women were exposed to standard care and 1338 to CBMCOC; after matching, 5352 and 1338 were included, respectively. The risk of preterm birth was lower among women exposed to CBMCOC (unmatched: 4.6% vs. 10.3%, RR = 0.50, 95% CI: 0.38-0.64; matched: 4.6% vs. 8.4%, RR = 0.54, 95% CI: 0.40-0.70). Subgroup analyses showed reduced preterm birth rates among ethnic minority women and those in deprived areas when exposed to CBMCOC.CONCLUSIONSIn this diverse population with a range of risk factors, locality-based interventions integrating community-based care and midwife continuity may reduce maternal and newborn health inequalities. Further trials of such models should be conducted.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005466","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}
OBJECTIVETo compare risks of adverse birth outcomes between maternally vaccinated and unvaccinated twin pregnancies.DESIGNMulti-jurisdictional data linkage cohort study.SETTINGAll registered births in Queensland (Qld) and Northern Territory (NT), Australia between 1 January 2012 and 31 December 2017.POPULATIONTwin pregnancies with infants born ≥ 20 weeks gestation and weighing ≥ 400 g.METHODSWe used Cox proportional-hazard models to calculate risk, with maternal vaccination status as the time-varying exposure, and national birthweight percentile charts specific for Australian-born twins to accurately reflect risk among small for gestational age (SGA) infants.MAIN OUTCOME MEASURESAdverse birth outcomes including preterm birth, stillbirth and SGA infants.RESULTSAmong our cohort of n = 11 435 infants, there was no statistically significant increased risk of preterm births, stillbirths or SGA infants between women who received a maternal influenza or pertussis vaccination and unvaccinated women. We observed a non-significant lower risk of SGA infants among pertussis vaccinated Qld (aHR 0.85, 95% CI 0.70-1.03) and NT women (aHR 0.50, 95% CI 0.17-1.44), and a lower risk of preterm infants among influenza vaccinated Qld women (aHR 0.93, 95% CI 0.84-1.03) and pertussis vaccinated NT women (aHR 0.78, 95% CI 0.44-1.38).CONCLUSIONMaternal influenza and pertussis vaccinations did not increase the risk of preterm birth, stillbirth or SGA infants among twin pregnancies. These novel and important findings alleviate safety concerns for a cohort that carries a higher baseline risk of adverse birth outcomes compared to singleton pregnancies.
目的比较母亲接种疫苗和未接种疫苗的双胎妊娠不良出生结局的风险。设计多辖区数据联动队列研究。所有在2012年1月1日至2017年12月31日期间在澳大利亚昆士兰州（Qld）和北领地（NT）出生的注册婴儿。人群：双胎妊娠，婴儿出生≥20周，体重≥400g。方法我们使用Cox比例风险模型计算风险，以母亲疫苗接种状况作为时变暴露，并使用澳大利亚出生双胞胎的国家出生体重百分位数图准确反映小胎龄（SGA）婴儿的风险。主要结局指标不良出生结局包括早产、死产和SGA婴儿。结果在我们的队列n = 11435名婴儿中，接种流感或百日咳疫苗的妇女和未接种疫苗的妇女发生早产、死产或SGA婴儿的风险没有统计学意义上的显著增加。我们观察到接种百日咳疫苗的Qld妇女（aHR 0.85, 95% CI 0.70-1.03）和NT妇女（aHR 0.50, 95% CI 0.17-1.44）发生SGA婴儿的风险无显著性降低，接种流感疫苗的Qld妇女（aHR 0.93, 95% CI 0.84-1.03）和接种百日咳疫苗的NT妇女（aHR 0.78, 95% CI 0.44-1.38）发生早产婴儿的风险较低。结论母亲接种流感和百日咳疫苗不会增加双胎妊娠中早产、死产或SGA婴儿的风险。这些新颖和重要的发现减轻了对一个与单胎妊娠相比具有更高基线不良分娩结局风险的队列的安全性担忧。
{"title":"The Risk of Adverse Birth Outcomes Among Twin Pregnancies After Influenza and Pertussis Vaccinations During Pregnancy: A Data Linkage Study.","authors":"Kahlee Boyle,Sarah Graham,Michael Binks,Lisa McHugh","doi":"10.1111/1471-0528.70156","DOIUrl":"https://doi.org/10.1111/1471-0528.70156","url":null,"abstract":"OBJECTIVETo compare risks of adverse birth outcomes between maternally vaccinated and unvaccinated twin pregnancies.DESIGNMulti-jurisdictional data linkage cohort study.SETTINGAll registered births in Queensland (Qld) and Northern Territory (NT), Australia between 1 January 2012 and 31 December 2017.POPULATIONTwin pregnancies with infants born ≥ 20 weeks gestation and weighing ≥ 400 g.METHODSWe used Cox proportional-hazard models to calculate risk, with maternal vaccination status as the time-varying exposure, and national birthweight percentile charts specific for Australian-born twins to accurately reflect risk among small for gestational age (SGA) infants.MAIN OUTCOME MEASURESAdverse birth outcomes including preterm birth, stillbirth and SGA infants.RESULTSAmong our cohort of n = 11 435 infants, there was no statistically significant increased risk of preterm births, stillbirths or SGA infants between women who received a maternal influenza or pertussis vaccination and unvaccinated women. We observed a non-significant lower risk of SGA infants among pertussis vaccinated Qld (aHR 0.85, 95% CI 0.70-1.03) and NT women (aHR 0.50, 95% CI 0.17-1.44), and a lower risk of preterm infants among influenza vaccinated Qld women (aHR 0.93, 95% CI 0.84-1.03) and pertussis vaccinated NT women (aHR 0.78, 95% CI 0.44-1.38).CONCLUSIONMaternal influenza and pertussis vaccinations did not increase the risk of preterm birth, stillbirth or SGA infants among twin pregnancies. These novel and important findings alleviate safety concerns for a cohort that carries a higher baseline risk of adverse birth outcomes compared to singleton pregnancies.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994948","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}
Claire Z Kalpakjian,Susan D Ernst,Heidi J Haapala,Melissa L Barber,Brittany R Orians,Lukonde Mulenga,Shannen M McIntosh,Julia Shah,Jodi M Kreschmer,Rebecca Parten,Sara Rosenblum,Gina M Jay
OBJECTIVEUnderstand the pregnancy informational needs and decision-making of women with physical disabilities.DESIGNCross-sectional.SETTINGCommunity.SAMPLE114 adult American women with physical disabilities who had experience making a decision about pregnancy while disabled.METHODSOnline survey.MAIN OUTCOME MEASURESPregnancy information needs and decision-making survey.RESULTSAmong the most important factors (very much-quite a bit) for decision-making were risks to the baby (72.8%) and themselves (58.7%), happiness of their partner (65.8%), and long-term effects of pregnancy on health (58.8%). Most had the least (not at all-a little bit) knowledge about equipment to care for an infant (57.9%), how to adapt as their body changed (54.4%), or ways to care for their infant (53.5%). Most had some to a lot of confidence (66.7%) in healthcare providers' recommendations but were highly variable about how much their individual concerns were understood. Important information (very much-quite a bit) included other health problems (92.5%), caring for an infant (94.2%), medications (88.4%), ambulation (78.5%), balance problems (82.6%), and spasticity (68.2%); this information was often difficult to find and unhelpful. Others were helpful when engaging in realistic discussions, being emotionally supportive, and providing financial and physical support. Healthcare providers were supportive when setting realistic expectations, providing non-biased information, discussing risks, providing reassurance, and collaborating with other specialists.CONCLUSIONSWhile pregnancy decision-making was challenging, participants had realistic concerns, often amplified by their disability and disability-related concerns. These results highlight areas where interventions can be developed to improve the experience of pregnancy decision-making.
{"title":"Pregnancy Decision-Making Among Women With Physical Disabilities: Cross-Sectional Survey Study.","authors":"Claire Z Kalpakjian,Susan D Ernst,Heidi J Haapala,Melissa L Barber,Brittany R Orians,Lukonde Mulenga,Shannen M McIntosh,Julia Shah,Jodi M Kreschmer,Rebecca Parten,Sara Rosenblum,Gina M Jay","doi":"10.1111/1471-0528.70135","DOIUrl":"https://doi.org/10.1111/1471-0528.70135","url":null,"abstract":"OBJECTIVEUnderstand the pregnancy informational needs and decision-making of women with physical disabilities.DESIGNCross-sectional.SETTINGCommunity.SAMPLE114 adult American women with physical disabilities who had experience making a decision about pregnancy while disabled.METHODSOnline survey.MAIN OUTCOME MEASURESPregnancy information needs and decision-making survey.RESULTSAmong the most important factors (very much-quite a bit) for decision-making were risks to the baby (72.8%) and themselves (58.7%), happiness of their partner (65.8%), and long-term effects of pregnancy on health (58.8%). Most had the least (not at all-a little bit) knowledge about equipment to care for an infant (57.9%), how to adapt as their body changed (54.4%), or ways to care for their infant (53.5%). Most had some to a lot of confidence (66.7%) in healthcare providers' recommendations but were highly variable about how much their individual concerns were understood. Important information (very much-quite a bit) included other health problems (92.5%), caring for an infant (94.2%), medications (88.4%), ambulation (78.5%), balance problems (82.6%), and spasticity (68.2%); this information was often difficult to find and unhelpful. Others were helpful when engaging in realistic discussions, being emotionally supportive, and providing financial and physical support. Healthcare providers were supportive when setting realistic expectations, providing non-biased information, discussing risks, providing reassurance, and collaborating with other specialists.CONCLUSIONSWhile pregnancy decision-making was challenging, participants had realistic concerns, often amplified by their disability and disability-related concerns. These results highlight areas where interventions can be developed to improve the experience of pregnancy decision-making.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"141 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971878","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}
{"title":"Managing Impacted Fetal Head: Insights From a Simulation Study of Applied Forces","authors":"Lawrence Devoe","doi":"10.1111/1471-0528.70150","DOIUrl":"https://doi.org/10.1111/1471-0528.70150","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145968363","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}
Muhammad Pradhiki Mahindra, Muhammad Pradhika Mapindra, Hadi Waheed, Owen Vaughan, John Ciaran Hutchinson, Sara L. Hillman, Dimitrios Siassakos
Background Delayed villous maturation (DVM) is a placental maturation disorder that mainly affects maternal‐to‐foetal oxygen transfer. Objectives We conducted a systematic review, meta‐analysis, and sensitivity analysis exploring study heterogeneities ( I2 ) of risk factors and outcomes associated with histopathological findings of DVM. Search Strategy Medline, EMBASE, Web of Science, and MIDIRS databases were searched from inception to December 2023. Selection Criteria Peer‐reviewed, observational studies including cohort, case–control, and cross‐sectional studies reported the histopathological findings of DVM after placenta delivery. All eligible studies were included and assessed for their risk of bias using the Newcastle‐Ottawa scale (NOS) for cohort and case–control studies. Data Collection and Analysis Two reviewers independently performed the systematic article screening, bias assessment, and data extraction. Senior authors resolved the disagreement between reviewers. The risk of bias was assessed by two reviewers using NOS criteria. The random‐effects model was used for meta‐analysis due to heterogeneity across studies. Sensitivity analyses were performed according to the NOS risk of bias assessment and the DVM definition per the Amsterdam criteria. Main Results Fifty‐two eligible studies reporting DVM and linked risk factors and outcomes were included. The risk factors associated with DVM were gestational diabetes (GDM) (OR = 4.90; 95% CI = 2.98, 8.06; I2 = 39%), pregestational diabetes (PGDM) (OR = 2.77; 95% CI = 1.56, 4.92; I2 = 0%), and maternal obesity (OR = 1.88; 95% CI = 1.20, 2.96; I2 = 0%). DVM was also associated with congenital foetal malformations (OR = 5.22; 95% CI =2.39, 11.39; I2 = 40), stillbirth (OR = 4.89; 95% CI = 3.55, 6.72; I2 = 0) and preterm birth (OR = 17.41; 95% CI = 10.14, 29.90; I2 = 0). The association between DVM and stillbirth (OR = 12.06; 95% CI =3.40, 42.78; I2 = 50; 2/5 studies) persisted in analyses limited to studies that used Amsterdam criteria exclusively for DVM. Conclusion DVM is a placental abnormality associated with congenital foetal malformations and maternal dysmetabolism, including GDM, PGDM, and maternal obesity; and with adverse outcomes including stillbirth and preterm birth. In studies using Amsterdam criteria, placenta with DVM was associated with stillbirth and congenital malformations. Optimising metabolism could prevent harm to the baby.
背景：绒毛成熟延迟（DVM）是一种胎盘成熟障碍，主要影响母体对胎儿的氧转移。我们进行了一项系统综述、荟萃分析和敏感性分析，探讨与DVM组织病理学结果相关的危险因素和结果的研究异质性。检索策略Medline、EMBASE、Web of Science和MIDIRS数据库，检索时间从成立到2023年12月。同行评议的观察性研究，包括队列研究、病例对照研究和横断面研究报告了胎盘分娩后DVM的组织病理学结果。纳入所有符合条件的研究，并使用纽卡斯尔-渥太华量表（NOS）对队列研究和病例对照研究进行偏倚风险评估。两名审稿人独立进行系统的文章筛选、偏倚评估和数据提取。资深作者解决了审稿人之间的分歧。两名审稿人采用NOS标准评估偏倚风险。由于研究间存在异质性，我们采用随机效应模型进行meta分析。根据NOS偏倚风险评估和阿姆斯特丹标准的DVM定义进行敏感性分析。主要结果纳入了52项符合条件的研究，报告了DVM及其相关的危险因素和结果。与DVM相关的危险因素是妊娠期糖尿病（GDM） （OR = 4.90; 95% CI = 2.98, 8.06; I 2 = 39%）、妊娠期糖尿病（PGDM） （OR = 2.77; 95% CI = 1.56, 4.92; I 2 = 0%）和产妇肥胖（OR = 1.88; 95% CI = 1.20, 2.96; I 2 = 0%）。DVM还与先天性胎儿畸形（OR = 5.22; 95% CI =2.39, 11.39; i2 = 40）、死产（OR = 4.89; 95% CI = 3.55, 6.72; i2 = 0）和早产（OR = 17.41; 95% CI = 10.14, 29.90; i2 = 0）相关。DVM和死产之间的关联（OR = 12.06; 95% CI =3.40, 42.78; I 2 = 50； 2/5研究）在仅限于使用阿姆斯特丹标准的DVM研究的分析中仍然存在。结论DVM是一种与先天性胎儿畸形和母体代谢异常相关的胎盘异常，包括GDM、PGDM和母体肥胖；以及包括死胎和早产在内的不良后果。在使用阿姆斯特丹标准的研究中，胎盘与DVM与死产和先天性畸形有关。优化新陈代谢可以防止对婴儿造成伤害。
{"title":"Risk Factors and Outcomes Associated With Delayed Villous Maturation in Placenta: A Systematic Review and Meta‐Analysis","authors":"Muhammad Pradhiki Mahindra, Muhammad Pradhika Mapindra, Hadi Waheed, Owen Vaughan, John Ciaran Hutchinson, Sara L. Hillman, Dimitrios Siassakos","doi":"10.1111/1471-0528.70125","DOIUrl":"https://doi.org/10.1111/1471-0528.70125","url":null,"abstract":"Background Delayed villous maturation (DVM) is a placental maturation disorder that mainly affects maternal‐to‐foetal oxygen transfer. Objectives We conducted a systematic review, meta‐analysis, and sensitivity analysis exploring study heterogeneities ( <jats:italic>I</jats:italic> <jats:sup> <jats:italic>2</jats:italic> </jats:sup> ) of risk factors and outcomes associated with histopathological findings of DVM. Search Strategy Medline, EMBASE, Web of Science, and MIDIRS databases were searched from inception to December 2023. Selection Criteria Peer‐reviewed, observational studies including cohort, case–control, and cross‐sectional studies reported the histopathological findings of DVM after placenta delivery. All eligible studies were included and assessed for their risk of bias using the Newcastle‐Ottawa scale (NOS) for cohort and case–control studies. Data Collection and Analysis Two reviewers independently performed the systematic article screening, bias assessment, and data extraction. Senior authors resolved the disagreement between reviewers. The risk of bias was assessed by two reviewers using NOS criteria. The random‐effects model was used for meta‐analysis due to heterogeneity across studies. Sensitivity analyses were performed according to the NOS risk of bias assessment and the DVM definition per the Amsterdam criteria. Main Results Fifty‐two eligible studies reporting DVM and linked risk factors and outcomes were included. The risk factors associated with DVM were gestational diabetes (GDM) (OR = 4.90; 95% CI = 2.98, 8.06; <jats:italic>I</jats:italic> <jats:sup>2</jats:sup> = 39%), pregestational diabetes (PGDM) (OR = 2.77; 95% CI = 1.56, 4.92; <jats:italic>I</jats:italic> <jats:sup>2</jats:sup> = 0%), and maternal obesity (OR = 1.88; 95% CI = 1.20, 2.96; <jats:italic>I</jats:italic> <jats:sup>2</jats:sup> = 0%). DVM was also associated with congenital foetal malformations (OR = 5.22; 95% CI =2.39, 11.39; <jats:italic>I</jats:italic> <jats:sup> <jats:italic>2</jats:italic> </jats:sup> = 40), stillbirth (OR = 4.89; 95% CI = 3.55, 6.72; <jats:italic>I</jats:italic> <jats:sup> <jats:italic>2</jats:italic> </jats:sup> = 0) and preterm birth (OR = 17.41; 95% CI = 10.14, 29.90; <jats:italic>I</jats:italic> <jats:sup>2</jats:sup> = 0). The association between DVM and stillbirth (OR = 12.06; 95% CI =3.40, 42.78; <jats:italic>I</jats:italic> <jats:sup>2</jats:sup> = 50; 2/5 studies) persisted in analyses limited to studies that used Amsterdam criteria exclusively for DVM. Conclusion DVM is a placental abnormality associated with congenital foetal malformations and maternal dysmetabolism, including GDM, PGDM, and maternal obesity; and with adverse outcomes including stillbirth and preterm birth. In studies using Amsterdam criteria, placenta with DVM was associated with stillbirth and congenital malformations. Optimising metabolism could prevent harm to the baby.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954970","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}
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