{"title":"Paracetamol in Pregnancy: Reassurance Amidst Uncertainty","authors":"Athina Samara, Asma Khalil","doi":"10.1111/1471-0528.70129","DOIUrl":"https://doi.org/10.1111/1471-0528.70129","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897421","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}
Run Miao, Ning Zhang, Yuzhou Gao, Haoyu He, Dongmei Ji
{"title":"Infertility Burden Attributable to Maternal Sepsis and Other Infections With Projections to 2050","authors":"Run Miao, Ning Zhang, Yuzhou Gao, Haoyu He, Dongmei Ji","doi":"10.1111/1471-0528.70140","DOIUrl":"https://doi.org/10.1111/1471-0528.70140","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897424","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":"Clarifying Time‐to‐Event Methods for Delivery Timing After PPROM","authors":"Arash Mohazzab, Safdar Masoumi","doi":"10.1111/1471-0528.70134","DOIUrl":"https://doi.org/10.1111/1471-0528.70134","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897426","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":"Periviable Breech Delivery: Decision‐Making Under Evidence Uncertainty","authors":"Sharon Perlman","doi":"10.1111/1471-0528.70142","DOIUrl":"https://doi.org/10.1111/1471-0528.70142","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897423","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}
Background Numerous risk assessment tools for severe maternal outcomes (SMOs) exist, but systematic evaluations of prediction models for non‐ICU settings are lacking, where the majority of antenatal and intrapartum care is provided. Objective To systematically review and critically appraise prognostic models for predicting SMOs in non‐ICU settings. Search Strategy PubMed, Embase, Cochrane Library, Web of Science and CINAHL were searched from June 1, 2009, to November 22, 2024. Selection Criteria Studies developing, validating or updating multivariable prognostic models for SMOs in non‐ICU settings were included. Eligible populations were pregnant women and those within 42 days postpartum. Data Collection and Analysis Two reviewers independently conducted screening, data extraction and quality assessment using CHARMS and PROBAST AI. A narrative synthesis was performed due to study heterogeneity. Main Results Thirteen studies reporting 15 evaluations of 13 distinct prognostic models were included. Study populations encompassed pregnant or postpartum women in non‐ICU settings, including general obstetric admissions and specific high‐risk cohorts (acute fatty liver of pregnancy, liver dysfunction, pulmonary hypertension and cardiac arrest). Models demonstrated moderate to good discrimination (C‐statistics 0.74–0.95), yet all 15 evaluations were assessed as high risk of bias due to inadequate sample sizes, inappropriate variable selection, poor missing data management, arbitrary categorisation of continuous predictors, temporal misalignments between predictor measurement and intended use, and insufficient internal validation. Only five models underwent external validation, and none reported calibration performance. Conclusions Findings underscore the need for enhanced methodological rigour, models tailored to specific gestational stages, comprehensive outcome definitions and dynamic risk assessment, thereby facilitating their feasible integration into clinical practice.
背景：目前存在许多严重孕产妇结局（SMOs）的风险评估工具，但缺乏对非ICU环境预测模型的系统评估，而非ICU环境是提供大多数产前和产时护理的地方。目的系统回顾和批判性评价非ICU环境下SMOs的预后模型。检索策略PubMed、Embase、Cochrane Library、Web of Science和CINAHL的检索时间为2009年6月1日至2024年11月22日。选择标准纳入了发展、验证或更新非ICU环境下SMOs多变量预后模型的研究。符合条件的人群是孕妇和产后42天内的妇女。两名审稿人使用CHARMS和PROBAST人工智能独立进行筛选、数据提取和质量评估。由于研究的异质性，我们进行了叙事综合。主要结果纳入13项研究，对13种不同的预后模型进行了15项评估。研究人群包括非ICU环境下的孕妇或产后妇女，包括一般产科住院和特定高风险队列（妊娠急性脂肪肝、肝功能障碍、肺动脉高压和心脏骤停）。模型显示出中等到良好的判别（C - statistics 0.74-0.95），但由于样本量不足、变量选择不当、缺失数据管理不善、连续预测因子的任意分类、预测因子测量与预期用途之间的时间偏差以及内部验证不足，所有15项评估都被评估为高风险偏倚。只有五个模型进行了外部验证，没有一个报告校准性能。研究结果强调需要加强方法的严谨性，针对特定妊娠阶段量身定制的模型，全面的结果定义和动态风险评估，从而促进其与临床实践的可行结合。
{"title":"Prediction Models for Severe Maternal Outcomes in Non‐ ICU Settings: Systematic Review","authors":"Zhongchen Luo, Jiangyan Li, Xiaofang Liu, Xianhuan Lu, Jiao Tang, Huan Zhang, Qing Wang, Xiaotong Ding, Hongli Chen, Zheng Li","doi":"10.1111/1471-0528.70124","DOIUrl":"https://doi.org/10.1111/1471-0528.70124","url":null,"abstract":"Background Numerous risk assessment tools for severe maternal outcomes (SMOs) exist, but systematic evaluations of prediction models for non‐ICU settings are lacking, where the majority of antenatal and intrapartum care is provided. Objective To systematically review and critically appraise prognostic models for predicting SMOs in non‐ICU settings. Search Strategy PubMed, Embase, Cochrane Library, Web of Science and CINAHL were searched from June 1, 2009, to November 22, 2024. Selection Criteria Studies developing, validating or updating multivariable prognostic models for SMOs in non‐ICU settings were included. Eligible populations were pregnant women and those within 42 days postpartum. Data Collection and Analysis Two reviewers independently conducted screening, data extraction and quality assessment using CHARMS and PROBAST AI. A narrative synthesis was performed due to study heterogeneity. Main Results Thirteen studies reporting 15 evaluations of 13 distinct prognostic models were included. Study populations encompassed pregnant or postpartum women in non‐ICU settings, including general obstetric admissions and specific high‐risk cohorts (acute fatty liver of pregnancy, liver dysfunction, pulmonary hypertension and cardiac arrest). Models demonstrated moderate to good discrimination (C‐statistics 0.74–0.95), yet all 15 evaluations were assessed as high risk of bias due to inadequate sample sizes, inappropriate variable selection, poor missing data management, arbitrary categorisation of continuous predictors, temporal misalignments between predictor measurement and intended use, and insufficient internal validation. Only five models underwent external validation, and none reported calibration performance. Conclusions Findings underscore the need for enhanced methodological rigour, models tailored to specific gestational stages, comprehensive outcome definitions and dynamic risk assessment, thereby facilitating their feasible integration into clinical practice.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"115 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897422","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}
Zoe Byrne, Sonja Brennan, David Watson, Donna Rudd, Yoga Kandasamy
Background Distinguishing pathological fetal growth restriction (FGR) from constitutionally small‐for‐gestational‐age (SGA) fetuses remains clinically challenging. The maternal soluble fms‐like tyrosine kinase‐1/placental growth factor (sFlt‐1/PlGF) ratio reflects placental angiogenic imbalance and may assist recognition of placental insufficiency. Objectives To assess the performance of the maternal sFlt‐1/PlGF ratio for differentiating FGR from SGA and appropriate‐for‐gestational‐age (AGA) pregnancies. Search Strategy PubMed, Scopus, Web of Science, Embase, Cochrane CENTRAL and Google Scholar were searched from inception to 14 January 2025 using MeSH and text terms for “sFlt‐1”, “PlGF”, “fetal growth restriction”, and “small‐for‐gestational‐age”. Selection Criteria Peer‐reviewed human studies reporting maternal sFlt‐1/PlGF ratios in pregnancies classified as FGR, SGA or AGA. Data Collection and Analysis Two reviewers independently screened records; one reviewer extracted data and assessed quality with second‐reviewer verification (> 30%). Owing to heterogeneity, findings were synthesised narratively, with a meta‐analysis restricted to studies directly comparing FGR and SGA. Main Results Forty observational studies (> 25 000 pregnancies) were included. Across gestation, FGR consistently showed higher sFlt‐1/PlGF ratios than AGA. SGA exhibited modest or no elevation. Four studies ( n = 614) enabled pooling: log‐transformed ratios were significantly higher in FGR than SGA (SMD 0.58, 95% CI 0.35–0.81) with low heterogeneity. Ratios were most discriminatory in early‐onset placental FGR. Conclusions The sFlt‐1/PlGF ratio is best considered an adjunctive indicator of placental insufficiency. Normal results can support expectant management in SGA when ultrasound and Doppler are reassuring, whereas elevated values warrant closer surveillance.
背景区分病理性胎儿生长受限（FGR）和构成性小胎龄（SGA）胎儿仍然具有临床挑战性。母体可溶性fms样酪氨酸激酶- 1/胎盘生长因子（sFlt - 1/PlGF）比值反映胎盘血管生成失衡，可能有助于胎盘功能不全的识别。目的评估母体sFlt - 1/PlGF比值在区分FGR、SGA和适孕龄（AGA）妊娠中的表现。检索策略PubMed， Scopus, Web of Science, Embase， Cochrane CENTRAL和谷歌Scholar从成立到2025年1月14日，使用MeSH和文本术语“sFlt‐1”，“PlGF”，“胎儿生长限制”和“小胎龄”进行检索。选择标准同行评审的人类研究报告了归类为FGR、SGA或AGA的孕妇sFlt - 1/PlGF比率。数据收集和分析两名审稿人独立筛选记录；一名审稿人提取数据并通过第二审稿人验证评估质量（> 30%）。由于异质性，研究结果是叙述性的，荟萃分析仅限于直接比较FGR和SGA的研究。主要结果纳入40项观察性研究（约25 000例妊娠）。在整个妊娠期间，FGR的sFlt‐1/PlGF比率始终高于AGA。SGA表现出中度或无升高。四项研究（n = 614）采用了合并：FGR的对数转换比显著高于SGA (SMD 0.58, 95% CI 0.35-0.81)，异质性较低。在早发性胎盘FGR中，这一比率最具歧视性。结论sFlt‐1/PlGF比值被认为是胎盘功能不全的辅助指标。当超声和多普勒检查结果令人放心时，正常的结果可以支持SGA的预期治疗，而升高的结果则需要更密切的监测。
{"title":"Maternal sFlt ‐1/ PlGF Ratio to Distinguish Pathological Fetal Growth Restriction From Constitutional Smallness: Systematic Review","authors":"Zoe Byrne, Sonja Brennan, David Watson, Donna Rudd, Yoga Kandasamy","doi":"10.1111/1471-0528.70128","DOIUrl":"https://doi.org/10.1111/1471-0528.70128","url":null,"abstract":"Background Distinguishing pathological fetal growth restriction (FGR) from constitutionally small‐for‐gestational‐age (SGA) fetuses remains clinically challenging. The maternal soluble fms‐like tyrosine kinase‐1/placental growth factor (sFlt‐1/PlGF) ratio reflects placental angiogenic imbalance and may assist recognition of placental insufficiency. Objectives To assess the performance of the maternal sFlt‐1/PlGF ratio for differentiating FGR from SGA and appropriate‐for‐gestational‐age (AGA) pregnancies. Search Strategy PubMed, Scopus, Web of Science, Embase, Cochrane CENTRAL and Google Scholar were searched from inception to 14 January 2025 using MeSH and text terms for “sFlt‐1”, “PlGF”, “fetal growth restriction”, and “small‐for‐gestational‐age”. Selection Criteria Peer‐reviewed human studies reporting maternal sFlt‐1/PlGF ratios in pregnancies classified as FGR, SGA or AGA. Data Collection and Analysis Two reviewers independently screened records; one reviewer extracted data and assessed quality with second‐reviewer verification (> 30%). Owing to heterogeneity, findings were synthesised narratively, with a meta‐analysis restricted to studies directly comparing FGR and SGA. Main Results Forty observational studies (> 25 000 pregnancies) were included. Across gestation, FGR consistently showed higher sFlt‐1/PlGF ratios than AGA. SGA exhibited modest or no elevation. Four studies ( <jats:italic>n</jats:italic> = 614) enabled pooling: log‐transformed ratios were significantly higher in FGR than SGA (SMD 0.58, 95% CI 0.35–0.81) with low heterogeneity. Ratios were most discriminatory in early‐onset placental FGR. Conclusions The sFlt‐1/PlGF ratio is best considered an adjunctive indicator of placental insufficiency. Normal results can support expectant management in SGA when ultrasound and Doppler are reassuring, whereas elevated values warrant closer surveillance.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897425","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":"Temporal Bias in Predicting Adverse Perinatal Outcomes in Dichorionic Twins","authors":"David Wright, Alan Wright, Kypros H. Nicolaides","doi":"10.1111/1471-0528.70102","DOIUrl":"https://doi.org/10.1111/1471-0528.70102","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"126 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145836001","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}
Simrit Nijjar, Lucrezia V. De Braud, Ewelina Rogozińska, Cecilia Bottomley, Davor Jurkovic, Eric Jauniaux
Background Caesarean scar ectopic pregnancy (CSEP) is defined by the implantation and development of a gestational sac inside a caesarean scar defect, but variations in classification systems and diagnostic criteria exist. Objectives This study aimed to systematically review the different criteria used in the medical literature to diagnose CSEP in the first trimester of pregnancy. Search Strategy Systematic search of PubMed, MEDLINE and Google Scholar from September 1990 to January 2024. Selection Criteria We included prospective and retrospective observational studies published in English reporting on imaging criteria used to diagnose CSEP. Data Collection and Analysis Two reviewers independently reviewed retrieved articles and performed data extraction using a priori‐developed data collection form. Findings were tabulated and synthesised in a narrative format. Main Results A total of 22 studies, involving 1749 CSEP cases, met the inclusion criteria. Diagnostic modalities varied, with eight different classification systems reported across 11 studies, with the remaining 11 studies not specifying a classification system. Histology was used as a reference standard in 59% (13/22), intraoperative features in 18% (4/22) and a combination of both in 23% of studies (5/22). Seventy‐two percent of studies (13/18) that used histology as a reference standard did not provide specific histological criteria for diagnosing CSEP. Conclusions This review highlights the wide variability in diagnostic approaches, imaging criteria and classification systems used in the first‐trimester diagnosis of CSEP. The absence of a universally accepted reference standard for CSEP diagnosis poses a major challenge for prospective studies evaluating diagnostic accuracy.
{"title":"Caesarean Scar Ectopic Pregnancy in Early Gestation: A Scoping Review of Definitions and Diagnostic Approach","authors":"Simrit Nijjar, Lucrezia V. De Braud, Ewelina Rogozińska, Cecilia Bottomley, Davor Jurkovic, Eric Jauniaux","doi":"10.1111/1471-0528.70122","DOIUrl":"https://doi.org/10.1111/1471-0528.70122","url":null,"abstract":"Background Caesarean scar ectopic pregnancy (CSEP) is defined by the implantation and development of a gestational sac inside a caesarean scar defect, but variations in classification systems and diagnostic criteria exist. Objectives This study aimed to systematically review the different criteria used in the medical literature to diagnose CSEP in the first trimester of pregnancy. Search Strategy Systematic search of PubMed, MEDLINE and Google Scholar from September 1990 to January 2024. Selection Criteria We included prospective and retrospective observational studies published in English reporting on imaging criteria used to diagnose CSEP. Data Collection and Analysis Two reviewers independently reviewed retrieved articles and performed data extraction using a priori‐developed data collection form. Findings were tabulated and synthesised in a narrative format. Main Results A total of 22 studies, involving 1749 CSEP cases, met the inclusion criteria. Diagnostic modalities varied, with eight different classification systems reported across 11 studies, with the remaining 11 studies not specifying a classification system. Histology was used as a reference standard in 59% (13/22), intraoperative features in 18% (4/22) and a combination of both in 23% of studies (5/22). Seventy‐two percent of studies (13/18) that used histology as a reference standard did not provide specific histological criteria for diagnosing CSEP. Conclusions This review highlights the wide variability in diagnostic approaches, imaging criteria and classification systems used in the first‐trimester diagnosis of CSEP. The absence of a universally accepted reference standard for CSEP diagnosis poses a major challenge for prospective studies evaluating diagnostic accuracy.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145830293","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}
Objective To assess whether ultrasound‐guided ovulation monitoring, compared to home ovulation tests, increases stress levels or impairs sexual function in subfertile couples. Design A prospective cohort study. Setting Academic medical centre from November 2023 to October 2024. Population A total of 311 subfertile couples are trying to conceive. Methods Subfertile couples were allocated to two groups: the ultrasound‐guided ovulation monitoring group and the home ovulation tests group and were surveyed over four menstrual cycles. Stress, anxiety, depression, and sexual function of both partners were investigated through questionnaires. Main Outcome Measures Perceived stress scale. Results During the four menstrual cycles, neither significant between‐group differences nor group‐by‐cycle interaction effects were observed for stress, anxiety, or depression in either partner (all p > 0.05). However, a significant cycle effect was identified over the 4 cycles: anxiety levels increased in women ( p = 0.037), while both anxiety ( p < 0.020) and depression ( p < 0.001) rose significantly in men. Additionally, across the study period, women's Female Sexual Function Index scores ( p = 0.021) and men's erectile function ( p < 0.001) showed a significant decline. In terms of pregnancy outcomes, the ultrasound‐guided group achieved a pregnancy rate twice that of the test group (adjusted OR = 2.12, 95% CI 1.32–3.39, p = 0.002). Conclusion Ultrasound‐guided ovulation monitoring shortens time to conception, with no evidence of increased emotional distress or impaired sexual function.
{"title":"Ultrasound‐Guided Ovulation Monitoring Versus Home Ovulation Tests and Psychosocial Outcomes in Subfertile Couples: Prospective Cohort Study","authors":"Yueying Zhu, Qi Xi, Zhuo Li, Rulin Dai, Xin Lv, Yang Yu","doi":"10.1111/1471-0528.70127","DOIUrl":"https://doi.org/10.1111/1471-0528.70127","url":null,"abstract":"Objective To assess whether ultrasound‐guided ovulation monitoring, compared to home ovulation tests, increases stress levels or impairs sexual function in subfertile couples. Design A prospective cohort study. Setting Academic medical centre from November 2023 to October 2024. Population A total of 311 subfertile couples are trying to conceive. Methods Subfertile couples were allocated to two groups: the ultrasound‐guided ovulation monitoring group and the home ovulation tests group and were surveyed over four menstrual cycles. Stress, anxiety, depression, and sexual function of both partners were investigated through questionnaires. Main Outcome Measures Perceived stress scale. Results During the four menstrual cycles, neither significant between‐group differences nor group‐by‐cycle interaction effects were observed for stress, anxiety, or depression in either partner (all <jats:italic>p</jats:italic> > 0.05). However, a significant cycle effect was identified over the 4 cycles: anxiety levels increased in women ( <jats:italic>p</jats:italic> = 0.037), while both anxiety ( <jats:italic>p</jats:italic> < 0.020) and depression ( <jats:italic>p</jats:italic> < 0.001) rose significantly in men. Additionally, across the study period, women's Female Sexual Function Index scores ( <jats:italic>p</jats:italic> = 0.021) and men's erectile function ( <jats:italic>p</jats:italic> < 0.001) showed a significant decline. In terms of pregnancy outcomes, the ultrasound‐guided group achieved a pregnancy rate twice that of the test group (adjusted OR = 2.12, 95% CI 1.32–3.39, <jats:italic>p</jats:italic> = 0.002). Conclusion Ultrasound‐guided ovulation monitoring shortens time to conception, with no evidence of increased emotional distress or impaired sexual function.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812933","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}
Shiri Shinar, Dilkash Kajal, Sarah Johnson, Anna Otvodenko, Seungwoo Lee, Priscilla P. L. Chiu, Johannes Keunen, Tim Van Mieghem, Greg Ryan, Prakesh S. Shah, Nimrah Abbasi
Objective To evaluate the reliability of qualitative foetal lung size assessments on ultrasound (US) and MRI in left congenital diaphragmatic hernia (CDH) and their correlation with quantitative metrics and neonatal mortality. Design Retrospective cohort study. Setting Single tertiary center, 2008–2020. Population A total of 103 cases of prenatally diagnosed isolated left CDH underwent postnatal active care. Methods Two independent reviewers performed qualitative foetal lung size assessments on US and MRI. Interrater agreement was assessed, and correlations were determined between qualitative assessments, quantitative metrics (observed‐to‐expected lung‐to‐head ratio [o/e LHR] and observed‐to‐expected total Foetal lung volume [o/e TFLV]), and neonatal mortality. Main Outcome Measures Interrater agreement and correlation between qualitative and quantitative assessments of lung size and neonatal mortality. Results A total of 74 cases with both US and MRI imaging were included. Interrater agreement for qualitative lung size assessment was strong for US (weighted kappa: 0.80, 95% CI 0.68–0.93) and moderate for MRI (Cohen's kappa: 0.48, 95% CI 0.30–0.66). Both modalities showed a strong correlation between qualitative and quantitative lung size assessments. On US, qualitative and quantitative assessments had similar associations with neonatal mortality (Spearman's correlation: 0.44 for each reviewer vs. 0.49). On MRI, quantitative metrics correlated more strongly with neonatal mortality than qualitative assessment (Cramér's V: 0.44 vs. 0.34–0.35). Conclusions Qualitative foetal lung size assessment, by US more so than MRI, is a reliable and reproducible tool that correlates with established quantitative metrics and neonatal mortality. These findings support its role as a complementary method for prenatal risk stratification in left CDH.
目的评价超声（US）和MRI对左先天性膈疝（CDH）胎儿肺大小定性评估的可靠性及其与定量指标和新生儿死亡率的相关性。设计回顾性队列研究。2008-2020年单一三级中心。共有103例产前诊断为孤立性左CDH的患者接受了产后积极护理。方法两名独立审稿人通过超声和MRI对胎儿肺大小进行定性评估。评估了评估者间的一致性，并确定了定性评估、定量指标（观察到的与预期的肺头比[0 /e LHR]和观察到的与预期的总胎儿肺容量[0 /e TFLV]）与新生儿死亡率之间的相关性。主要结果测量肺大小与新生儿死亡率定性和定量评估之间的一致性和相关性。结果本组共74例合并超声和MRI检查的病例。定性肺大小评估在US（加权kappa: 0.80, 95% CI 0.68-0.93）和MRI （Cohen’s kappa: 0.48, 95% CI 0.30-0.66）中具有较强的一致性。两种方法均显示定性和定量肺大小评估之间有很强的相关性。在美国，定性和定量评估与新生儿死亡率有相似的关联（Spearman相关性：每位评论者0.44比0.49）。在MRI上，定量指标与新生儿死亡率的相关性比定性评估更强（cramamer’s V: 0.44 vs. 0.34-0.35）。结论定性胎儿肺大小评估，通过US比MRI更可靠，是一个可重复的工具，与已建立的定量指标和新生儿死亡率相关。这些发现支持其作为左侧CDH产前风险分层的补充方法的作用。
{"title":"Qualitative Assessment of Foetal Lung Size in Left Congenital Diaphragmatic Hernia Using Ultrasound and MRI: A Retrospective Cohort Study","authors":"Shiri Shinar, Dilkash Kajal, Sarah Johnson, Anna Otvodenko, Seungwoo Lee, Priscilla P. L. Chiu, Johannes Keunen, Tim Van Mieghem, Greg Ryan, Prakesh S. Shah, Nimrah Abbasi","doi":"10.1111/1471-0528.70120","DOIUrl":"https://doi.org/10.1111/1471-0528.70120","url":null,"abstract":"Objective To evaluate the reliability of qualitative foetal lung size assessments on ultrasound (US) and MRI in left congenital diaphragmatic hernia (CDH) and their correlation with quantitative metrics and neonatal mortality. Design Retrospective cohort study. Setting Single tertiary center, 2008–2020. Population A total of 103 cases of prenatally diagnosed isolated left CDH underwent postnatal active care. Methods Two independent reviewers performed qualitative foetal lung size assessments on US and MRI. Interrater agreement was assessed, and correlations were determined between qualitative assessments, quantitative metrics (observed‐to‐expected lung‐to‐head ratio [o/e LHR] and observed‐to‐expected total Foetal lung volume [o/e TFLV]), and neonatal mortality. Main Outcome Measures Interrater agreement and correlation between qualitative and quantitative assessments of lung size and neonatal mortality. Results A total of 74 cases with both US and MRI imaging were included. Interrater agreement for qualitative lung size assessment was strong for US (weighted kappa: 0.80, 95% CI 0.68–0.93) and moderate for MRI (Cohen's kappa: 0.48, 95% CI 0.30–0.66). Both modalities showed a strong correlation between qualitative and quantitative lung size assessments. On US, qualitative and quantitative assessments had similar associations with neonatal mortality (Spearman's correlation: 0.44 for each reviewer vs. 0.49). On MRI, quantitative metrics correlated more strongly with neonatal mortality than qualitative assessment (Cramér's V: 0.44 vs. 0.34–0.35). Conclusions Qualitative foetal lung size assessment, by US more so than MRI, is a reliable and reproducible tool that correlates with established quantitative metrics and neonatal mortality. These findings support its role as a complementary method for prenatal risk stratification in left CDH.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801128","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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