Journal Cover BJOG : An International Journal of Obstetrics and Gynaecology
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   Partially Free Journal Partially Free Journal
   ISSN (Print) 1470-0328 - ISSN (Online) 1471-0528
   Published by John Wiley and Sons Homepage  [1592 journals]
  • Many of the causes of preterm birth and poor fetal growth are genetic and
    • Authors: P J Steer
      Abstract: The study by Lane-Cordova et al reports that “women with preterm birth (PTB)/small for gestational age (SGA) babies had lower fitness” but then conclude that “Neither fitness nor hemodynamic responses to exercise, a median of 5 years preceding pregnancy, were associated with PTB/SGA”. This apparent contradiction came about because they adjusted for ‘a number of demographic variables independently associated with PTB/SGA - age, race, education, study center, BMI, current and former smoking, diabetes, and hypertension’. Is such adjustment appropriate and are these demographic variables truly independent'This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-23T02:45:59.230371-05:
      DOI: 10.1111/1471-0528.15183
  • Postpartum venous thromboembolism prophylaxis: harm versus benefit
    • Authors: Roopen Arya
      Abstract: Pregnancy-related venous thromboembolism (VTE) remains a leading cause of maternal morbidity and mortality. While the absolute risk is low, it is problematic considering the population comprises young women undergoing a common physiological process, and the risk is greatest postpartum. The evident benefits of targeted postpartum thromboprophylaxis ensure that expert guidance worldwide recommends risk assessment antenatally and at delivery and administration of thromboprophylaxis to those at high risk of VTE.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-23T02:41:44.050074-05:
      DOI: 10.1111/1471-0528.15182
  • Estimating gestational age at birth from fundal height and additional
           anthropometrics: a prospective cohort study
    • Authors: Sarah J. Pugh; Ana M. Ortega-Villa, William Grobman, Roger B. Newman, John Owen, Deborah A. Wing, Paul S. Albert, Katherine L. Grantz
      Abstract: ObjectiveAccurate assessment of gestational age is critical to pediatric care, yet is limited in developing countries without access to ultrasound. Our objectives were to assess the accuracy of gestational age at birth (GA) prediction and preterm birth (PTB) classification using routinely collected anthropometry measures.DesignProspective cohort study.SettingUnited States.Population or Sample2334 non-obese and 468 obese pregnant women.MethodsEnrollment GA was determined based on last menstrual period, confirmed by first-trimester ultrasound. Maternal anthropometry and fundal height (FH) were measured by a standardized protocol at study visits; FH alone was additionally abstracted from medical charts. Neonatal anthropometry measurements were obtained at birth. To estimate GA at delivery, we developed three predictor models using longitudinal FH alone and with maternal and neonatal anthropometry. For all predictors, we repeatedly sampled observations to construct training (60%) and test (40%) sets. Linear mixed models incorporated longitudinal maternal anthropometry and a shared parameter model incorporated neonatal anthropometry. We assessed models’ accuracy under varied scenarios.Main Outcome MeasuresEstimated GA at delivery.ResultsPrediction error for various combinations of anthropometric measures ranged between 13.9 to 14.9 days. Longitudinal FH alone predicted GA within 14.9 days weeks with relatively stable prediction errors across individual race/ethnicities [whites (13.9 days), blacks (15.1), Hispanics (15.5) and Asians (13.1)], and correctly identified 75% of PTB's. The model was robust to additional scenarios.ConclusionsIn low-risk, non-obese women, longitudinal FH measures alone can provide a reasonably accurate assessment of GA when ultrasound measures are not available.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-23T02:36:28.387436-05:
      DOI: 10.1111/1471-0528.15179
  • Angiogenic factors in preeclampsia: implications for clinical practice
    • Authors: S.Ananth Karumanchi
      Abstract: More than a decade ago, circulating anti-angiogenic factors of placental origin were implicated in the pathogenesis of preeclampsia (Karumanchi SA. Hypertension. 2016 Jun;67(6):1072-9). In particular, circulating soluble fms-like tyrosine kinase 1 (sFlt-1), an anti-angiogenic factor that inhibits vascular endothelial growth factor (VEGF) signaling has been extensively studied in humans and in animal models of preeclampsia. Epidemiological, experimental and genetic studies point to a causal role for sFlt1 in the etiology of the disease.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-23T02:35:25.056918-05:
      DOI: 10.1111/1471-0528.15180
  • Domperidone for increasing breast milk volume in mothers expressing breast
           milk for their preterm infants: a systematic review and meta-analysis
    • Authors: Luke E Grzeskowiak; Lisa G Smithers, Lisa H Amir, Rosalie M Grivell
      Abstract: BackgroundMothers of preterm infants often struggle to produce enough breast milk to meet the nutritional needs of their infant. Galactagogues such as domperidone are often prescribed to increase breast milk supply, but evidence supporting their role in clinical practice is uncertain.ObjectiveTo evaluate the efficacy and safety of domperidone for increasing breast milk volume in mothers expressing breast milk for their preterm infants.Search strategyMedline, Embase, and Web of Science were searched without language restrictions, from first publication until January 2017. Bibliographies of articles and reviews were hand searched for additional reports.Selection CriteriaRandomised controlled trials that compared domperidone with placebo in mothers of preterm infants (
      PubDate: 2018-02-22T09:41:31.813955-05:
      DOI: 10.1111/1471-0528.15177
  • Extravillous trophoblast invasion in placenta accreta is associated with
           differential local expression of angiogenic and growth factors: a cross
           sectional study
    • Authors: Christina M. Duzyj; Irina A. Buhimschi, Christine A. Laky, Genevieve Cozzini, Guomao Zhao, Mark Wehrum, Catalin S. Buhimschi
      Abstract: ObjectivePlacenta accreta is clinically associated with maternal uterine scar. Our objective was to investigate the biochemical contribution of maternal scarring to hyperinvasive trophoblast. We hypothesized that trophoblast over-invasion in placenta accreta is associated with aberrant invasion-site signaling of growth and angiogenic factors known to be involved in wound healing and promotion of cell invasion through the epithelial to mesenchymal cellular program.DesignCross-sectional series.SettingYale New Haven Hospital.PopulationWomen with histologically confirmed normal and abnormal placentation.MethodsPlacental invasion site tissue sections were immunostained for endoglin, and other angiogenic regulators, and transforming growth factor β (TGFβ) proteins. Maternal serum endoglin, and the vascular endothelial growth factor (VEGF) mediators hypoxia inducible factor-1α (HIF1α) and endostatin, were assessed using immunoassay.Main Outcome MeasuresDifferences in median H-score by immunostain, and in mean serum level by immunoassay.ResultsBy immunostaining, placenta accreta samples demonstrated intervillous endoglin shedding and increased trophoblast expression of its cleavage protein matrix metalloproteinase-14. Absent decidual HIF1α and endostatin were observed in areas of VEGF upregulation. TGFβ1 was present in myocytes, but not in collagen bundles into which accreta trophoblast invaded. Maternal serum endoglin decreased in previa and accreta when corrected for gestational age.ConclusionAngiogenic and growth factors at the placental invasion site are altered in accreta, both by decidual absence and within myometrial scar. We postulate this promotes the invasive phenotype of placenta accreta by activating hyperinvasive trophoblast, and by dysregulating placental vascular remodeling.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-22T09:35:35.660978-05:
      DOI: 10.1111/1471-0528.15176
  • Reproductive outcome of patients undergoing in vitro fertilization
           treatment and diagnosed with bacterial vaginosis or abnormal vaginal
           microbiota: a systematic PRISMA review and meta-analysis
    • Authors: Thor Haahr; Jane Zacho, Merethe Bräuner, K. Shathmigha, Jørgen Skov Jensen, Peter Humaidan
      Abstract: BackgroundDespite recent efforts, the risks associated with bacterial vaginosis (BV) or abnormal vaginal microbiota in IVF patients are not well-established.ObjectivesWe aimed to evaluate the risks associated with BV in IVF patients using meta-analysis.Search StrategyFollowing preliminary searches in order to find relevant key words and MeSH terms, a systematic search was performed in Pubmed (Medline) September 2017.Selection CriteriaThe population was infertile women attending IVF treatment. The exposure was BV or abnormal vaginal microbiota. Outcomes included live birth rate, early spontaneous abortion rate and clinical pregnancy rate.Data Collection and AnalysisData were collected for each study and for each outcome using a summary of findings table. If appropriate, data was quantitatively assessed using meta-analysis. Sensitivity analysis, Funnel plots and GRADE evidence assessment were performed for the abovementioned outcomes.Main ResultsA total of 12 studies were eligible comprising a total of 2980 patients. The prevalence of BV was 16% (95% CI 15-18%) in the general study population and tubal factor infertility was highly prevalent in patients diagnosed with BV compared to normal vaginal microbiota patients, P=0.001. Despite a significant association with early spontaneous abortion (RR 1.68; 95% CI 1.24, 2.27), BV did not significantly impact the live birth rate (RR 1.47; 95% CI 0.96, 1.57) or the clinical pregnancy rate (RR 0.93; 95% CI 0.75, 1.15).ConclusionsBV is associated with tubal factor infertility and early spontaneous abortion. However, the quality of evidence was very low and the equivocal results justify the need for further research.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-22T09:12:20.554414-05:
      DOI: 10.1111/1471-0528.15178
  • How would you help a colleague dealing with the stress of an adverse
           outcome' A report from #BlueJC
    • Authors: BD Einerson
      PubDate: 2018-02-22T02:21:06.174719-05:
      DOI: 10.1111/1471-0528.15120
  • Re: Stillbirth: balancing patient preferences with clinical evidence
    • Authors: Dimitrios Siassakos; Sue Jackson, Claire Storey
      PubDate: 2018-02-22T02:15:24.003061-05:
      DOI: 10.1111/1471-0528.15139
  • Re: Subsequent reproductive outcome among women with peripartum
           cardiomyopathy: a nationwide study
    • Authors: M Cauldwell; C Nelson-Piercy
      PubDate: 2018-02-22T02:15:23.113135-05:
      DOI: 10.1111/1471-0528.15141
  • Population based testing of non-mucinous epithelial ovarian cancer in
    • Authors: D.G Evans; R Edmondson, E.J Crosbie
      Abstract: Rust and colleagues provide strong support for the extension of BRCA1/2 germline testing to all high grade serous ovarian cancer (HGSOC) cases regardless of family history (Rust et al, BJOG 2018). The reflex testing of all consenting cases uncovered the deficiencies of the previous system whereby many women with a family history in the prevalent population of previous ovarian cancer were not tested despite having a Manchester score of ≥15, equivalent to a 10% detection rate or greater of a BRCA1/2 pathogenic variant (Evans et al, J Med Genet 2017;54:674-681). Although all HGSOC
      PubDate: 2018-02-20T03:30:48.412209-05:
      DOI: 10.1111/1471-0528.15174
  • Obstetric Providers Willing to Accept Women's Preferences for Mode of
    • Authors: Adeline A Boatin
      Abstract: Access to a safe caesarean delivery is a corner stone of comprehensive and quality reproductive health care. And yet, when performed for non-medically indicated reasons, caesarean delivery has been associated with higher rates of infection, haemorrhage, surgical injury and death (Vogel et al, BJOG, 2014, 121, 76-88). As outlined by Rivo et al, Latin American and Caribbean countries have the highest caesarean delivery rates globally, with over 40% of women delivering by caesarean.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-20T03:30:26.289202-05:
      DOI: 10.1111/1471-0528.15175
  • The role of NFĸB in the three stages of pregnancy: implantation,
           maintenance and labour; a review article
    • Authors: Agata Sakowicz
      Abstract: The transcription factor kappa B (NFĸB) controls the expression of over 400 genes, some of which are associated with reproductive events. During implantation, immune cells accumulate in the maternal-fetal interface; they secrete inflammatory mediators under the control of NFĸB, whose level also rises. NFĸB is then downregulated to maintain gestation, but its level rises again before birth to manage prostaglandin, cytokine and chemokine synthesis and stimulate uterine contraction. This review summarises the current state of knowledge about NFĸB and its role in the molecular regulation of processes related to pregnancy development.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-20T03:00:41.696216-05:
      DOI: 10.1111/1471-0528.15172
  • Clinical guidelines for prevention and management of preterm birth: a
           systematic review
    • Authors: Nancy Medley; Borna Poljak, Silvia Mammarella, Zarko Alfirevic
      Abstract: BackgroundClinical practice guidelines (CPG) endorse multiple strategies to prevent or manage preterm birth (PTB).ObjectivesTo summarise CPG recommendations for PTB and identify areas of international consensus.Search strategyIn June 2017 we searched for all CPG relavant to PTB without language restrictions.Selection criteriaCPG were eligible if the following criteria were met.i.The guideline was published or current from June 2013.ii.The guideline recommended practices for the prevention or management of PTB relevant to our pre-specified clinical questions for screening, medications or surgery and other interventions.iii.Publications on methods of guideline development for eligible CPG were included to enable quality assessment.Data collection and AnalysisTwo authors classified CPG recommendations relevant to pre-specified clinical questions. When more than 70% of CPGs reporting on a topic recommended or rejected an intervention we regarded this as consensus. We summarised recommendations in tables.Main resultsWe identified 49 guidelines from 16 guideline developers. We found consensus for several clinical practices including cervical length screening for high risk women; short-term tocolysis; steroids for fetal lung maturation; and magnesium sulphate for fetal neuroprotection. We found discrepant recommendations for progesterone and fibronectin. No guideline identified an effective strategy for women with multiple pregnancy.ConclusionsWe identified interventions for which there is an international consensus of benefit for PTB. Systematic reviews of CPG using standardized methodology will help avoid duplication and target scarce resources for guideline developers globally.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-20T03:00:39.264911-05:
      DOI: 10.1111/1471-0528.15173
  • Routine germline BRCA1 and BRCA2 testing in ovarian carcinoma patients:
           analysis of the Scottish real life experience
    • Authors: Kelly Rust; Pavlina Spiliopoulou, Chee Yuan Tang, Christine Bell, Diane Stirling, Tze hui Fifi Phang, Rosemarie Davidson, Melanie Mackean, Fiona Nussey, Ros Glasspool, Nick Reed, Azmat Sadozye, Mary Porteous, Trevor McGoldrick, Michelle Ferguson, Zofia Miedzybrodzka, Iain A. McNeish, Charlie Gourley
      Abstract: ObjectiveTo determine the rate of germline BRCA1 and BRCA2 mutations in Scottish ovarian cancer patients before and after a change in testing policy.DesignRetrospective cohort study.SettingFour cancer/genetics centres in Scotland.PopulationOvarian cancer patients undergoing germline BRCA1 and BRCA2 (gBRCA1/2) gene sequencing before 2013 (‘old criteria’; selection based solely on family history), after 2013 (‘new criteria’; sequencing offered to newly presenting non-mucinous ovarian cancer patients) and the ‘prevalent population’ (who presented before 2013, were not eligible for sequencing under the old criteria but were sequenced under the new criteria).MethodsClinicopathological and sequence data were collected before and for 18 months after this change in selection criteria.Main Outcome MeasuresFrequency of germline BRCA1, BRCA2, RAD51C and RAD51D mutations.ResultsOf 599 patients sequenced, 205, 236 and 158 were in the ‘old criteria’, ‘new criteria’ and ‘prevalent’ populations respectively. The frequency of gBRCA1/2 mutations was 30.7%, 13.1% and 12.7% respectively. The annual rate of gBRCA1/2 mutation detection was 4.2 before and 20.7 after the policy change. 48% (15/31) ‘new criteria’ patients with gBRCA1/2 mutations had a Manchester score 70 years was 8.2%.ConclusionsSequencing all non-mucinous ovarian cancer patients produces much higher annual gBRCA1/2 mutation detection with the frequency of positive tests still exceeding the 10% threshold upon which many family history based models operate.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-20T02:51:08.486483-05:
      DOI: 10.1111/1471-0528.15171
  • Is cidofovir a better treatment than imiquimod for high-grade vulval
           intraepithelial neoplasia'
    • Authors: C William Helm
      Abstract: High grade vulvar intraepithelial neoplasia (HGVIN), also called usual type VIN, is an important but irksome condition for patient and physician alike: important because it is precancerous, its incidence has been increasing and it affects younger women and irksome because debilitating symptoms can be difficult to treat and are complicated by the possibility of an underlying invasive carcinoma.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-17T08:55:24.368228-05:
      DOI: 10.1111/1471-0528.15170
  • Cost Effective Innovations in Low Resource Settings
    • Authors: Olivia H. Chang; Jeffrey P. Wilkinson
      Abstract: As health technologies are slowly adapted in low resource settings, the support modalities, equipment and supplies that allow these advances to be implemented are often not fully considered. It is not uncommon to install a new computed tomography scan machine in a hospital in sub-Saharan Africa only to suffer extensive downtime from unreliable electricity supply or unavailability of contrast agents (Essential Health Technologies WHO 2011). Countless expensive high-tech devices sit idle in low resource settings for lack of proper disposables and properly trained health care professionals.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-17T08:25:22.95867-05:0
      DOI: 10.1111/1471-0528.15169
  • Issue Information
    • PubDate: 2018-02-14T20:40:26.194285-05:
      DOI: 10.1111/1471-0528.14870
  • Cumulative live birth rates and perinatal outcomes with the use of time
           lapse imaging incubators for embryo culture: a retrospective cohort study
           of 1882 ART cycles
    • Authors: Mariano Mascarenhas; Sarah J Fox, Karen Thompson, Adam H Balen
      Abstract: ObjectiveComparison of live birth rates and the perinatal outcomes after fresh and frozen embryo transfer between time lapse imaging (TLI) and standard culture (SC) incubators.DesignRetrospective cohort study.SettingA single tertiary level IVF unit.PopulationWomen undergoing IVF between January 2014 and October 2015.MethodsComparison was done between 1064 IVF cycles using TLI (TLI cycles) and 818 IVF cycles using SC (SC cycles).Main outcome measuresCumulative live birth rate per oocyte retrieval and perinatal outcomes including birth weight, gestational age, preterm birth (PTB) (
      PubDate: 2018-02-14T11:50:42.523614-05:
      DOI: 10.1111/1471-0528.15161
  • The evolving contribution of non-communicable diseases (NCDs) to maternal
           mortality in Jamaica, 1998-2015: a population based study
    • Authors: Affette M McCaw-Binns; Leroy V Campbell, Simone S Spence
      Abstract: ObjectiveDescribe trends in indirect cause-specific pregnancy-related mortality from 1998-2015.DesignSecondary analysis of annual, national cross-sectional database of maternal and late maternal deaths, identified through active surveillance of deaths among women 10-50 years.SettingJamaica, a middle-income Caribbean country.PopulationMaternal and late maternal deaths.MethodsDescriptive trend analyses of demographic and cause-specific maternal and pregnancy-related mortality ratios undertaken comparing the periods 1998-2003, 2004-9 and 2010-15. Multivariate logistic regression was used to confirm changes in risk of indirect death.Main Outcome MeasuresMaternal, pregnancy-related, direct, indirect and cause specific mortality ratios (deaths/100,000 livebirths).ResultsMaternal deaths from indirect conditions increased between the first two periods (p=0.004) and stabilized in the third (p=0.085). Associated with upward movement in cardiovascular deaths (p[trend]=0.003), women under 25 years were at elevated risk (OR: 1.44, 1.00-2.08; p=0.052). Hematological/immunological conditions (69% sickle cell disease) ranked second but did not vary with time. Health service utilisation was similar across age, parity, health region and major cause categories (NCDs, non-obstetric infections, direct), however women with indirect conditions spent more time in hospital (median 5 versus 3 days) and more often died after the puerperium.ConclusionsMedical conditions, especially cardiovascular disease, are increasingly associated with maternal and late maternal mortality than previously. Middle-income countries need to simultaneously improve management of indirect conditions, while redoubling efforts to reduce direct deaths. Post-puerperal medical services should be integrated into routine infant health services to improve continuity of care during this high risk period.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-08T10:51:17.964767-05:
      DOI: 10.1111/1471-0528.15154
  • High-throughput, non-invasive prenatal testing for fetal RHD genotype to
           guide antenatal prophylaxis with anti-D immunoglobulin: a
           cost-effectiveness analysis
    • Authors: Pedro Saramago; Huiqin Yang, Alexis Llewellyn, Stephen Palmer, Mark Simmonds, Susan Griffin
      Abstract: ObjectiveTo evaluate the cost-effectiveness of high-throughput, non-invasive prenatal testing (HT-NIPT) for fetal RhD genotype to guide antenatal prophylaxis with anti-D immunoglobulin compared to routine antenatal anti-D immunoglobulin prophylaxis (RAADP).DesignCost-effectiveness decision-analytic modelling.SettingPrimary care.ParticipantsA simulated population of 100,000 RhD negative women not known to be sensitised to the RhD antigen.MethodsA decision tree model was used to characterise the antenatal care pathway in England and the long-term consequences of sensitisation events. The diagnostic accuracy of HT-NIPT was derived from a systematic review and bivariate meta-analysis; estimates of other inputs were derived from relevant literature sources and databases. Women in whom the HT-NIPT was positive or inconclusive continued to receive RAADP, while women with a negative result received none. Five alternative strategies in which the use of HT-NIPT may affect the existing post-partum care pathway were considered.Main outcome measuresCosts expressed in 2015GBP and impact on health outcomes expressed in terms of quality adjusted life years (QALYs) over a lifetime.ResultsThe results suggested that HT-NIPT appears cost saving but also less effective than current practice, irrespective of the post-partum strategy evaluated. A post-partum strategy in which inconclusive test results are distinguished from positive results performed best. HT-NIPT is only cost-effective when the overall test cost is £26.60 or less.ConclusionsHT-NIPT would reduce unnecessary treatment with routine anti-D immunoglobulin and is cost saving when compared to current practice. The extent of any savings and cost-effectiveness is sensitive to the overall test cost.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-07T15:25:34.032422-05:
      DOI: 10.1111/1471-0528.15152
  • The role of metformin and statins in the incidence of epithelial ovarian
           cancer in type 2 diabetes: a cohort and nested case-control study
    • Authors: Elina Urpilainen; Mikko Marttila, Ari Hautakoski, Martti Arffman, Reijo Sund, Pirjo Ilanne-Parikka, Reetta Arima, Jenni Kangaskokko, Ulla Puistola, Esa Läärä, Marianne Hinkula
      Abstract: ObjectiveTo obtain evidence of the effects of metformin and statins on the incidence of ovarian cancer in women with type 2 diabetes (T2D).DesignA retrospective cohort study and nested case-control study.SettingThe data were obtained from a diabetes database (FinDM) combining information from several nationwide registers.PopulationA cohort of 137 643 women over 40 years old and diagnosed with T2D during 1996 through 2011 in Finland.MethodsIn full cohort analysis Poisson regression was utilized to estimate the hazard ratios (HR) in relation to ever use of metformin, insulin, other oral antidiabetic medication or statins. In the nested case-control analysis 20 controls were matched to each case of ovarian cancer. Conditional logistic regression was used to estimate HRs in relation to medication use and cumulative use of different medications. The estimates were adjusted for age and duration of T2D.Main outcome measure. Incidence of ovarian cancerResults303 women were diagnosed with ovarian cancer during the follow-up. Compared with other forms of oral antidiabetic medication, metformin (HR 1.02, 95% CI 0.72–1.45) was not found to be associated with the incidence of ovarian cancer. Neither was there evidence for statins to affect the incidence (HR 0.99, 95% CI 0.78–1.25). In nested case-control analysis the results were essentially similar.ConclusionsNo evidence of an association between the use of metformin or statins and the incidence of ovarian cancer in patients with T2D was found.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-07T08:40:25.654694-05:
      DOI: 10.1111/1471-0528.15151
  • Authors’ reply re: Safety and effectiveness of female tubal
           sterilisation by hysteroscopy, laparoscopy or laparotomy: a register-based
    • Authors: Ewa Jokinen; Anna Heino, Tuula Karipohja, Mika Gissler, Ritva Hurskainen
      PubDate: 2018-02-06T23:30:22.159038-05:
      DOI: 10.1111/1471-0528.15117
  • Re: Pregnancy outcomes in patients with uterine fibroids treated with
           ultrasound-guided high-intensity focused ultrasound Is the noninvasive
           nature of HIFU ablation for uterine fibroids and adenomyosis setting
           patients up for future operative delivery'
    • Authors: Kae-Yng Ou; Cherng-Jye Jeng, Cheng-Yu Long, Linus Chuang
      PubDate: 2018-02-06T01:41:53.659533-05:
      DOI: 10.1111/1471-0528.15114
  • Re: Safety and effectiveness of female tubal sterilisation by
           hysteroscopy, laparoscopy or laparotomy: a register-based study
    • Authors: Emily Wright; Vivian Leung, Abhinav Bhansali, Muhammad Chaudhry, Montasser Mahran
      PubDate: 2018-02-06T01:35:54.267722-05:
      DOI: 10.1111/1471-0528.15116
  • Re: A comparison of the cost–utility of ultrasound-guided high-intensity
           focused ultrasound and hysterectomy for adenomyosis: a retrospective study
           Is the cost-effectiveness of HIFU for adenomyosis and fibroids
    • Authors: Kae-Yng Ou; Cherng-Jye Jeng, Cheng-Yu Long, Linus Chuang
      PubDate: 2018-02-06T01:35:18.823002-05:
      DOI: 10.1111/1471-0528.15115
  • Multiple Pregnancies Following Assisted Conception
    • PubDate: 2018-02-02T00:06:00.944688-05:
      DOI: 10.1111/1471-0528.14974
  • Foundation for an Evidence Informed Algorithm for Treating Pelvic Floor
           Mesh Complications: A Review
    • Authors: Geoffrey W. Cundiff; David J. Quinlan, Jacobus A van Rensburg, Mark Slack
      Abstract: To address evidence gaps on the management of complications related to mesh in pelvic floor surgery, we created an evidence-based algorithm, including defining evidence gaps. We utilized the Delphi Method within a panel of surgeons treating mesh complications to define a treatment strategy. The first round provided a list of clinically based postulates that informed a review, which expanded postulates to recommendations, including grading of the quality of evidence. A second round informed the final algorithm. While the quality of evidence is low, the available evidence provides a framework for planning diagnosis and management of mesh related complications.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-31T11:58:22.391855-05:
      DOI: 10.1111/1471-0528.15148
  • PPROM is a collateral effect of improvement in perinatal outcomes
           following fetoscopic coagulation of chorionic vessels for TTTS: a
           retrospective observational study of 1092 cases
    • Authors: J. Stirnemann; F. Djaafri, A. Kim, I. Mediouni, L. Bussieres, E. Spaggiari, C. Veluppillai, A. Lapillonne, E. Kermorvant, J.-F. Magny, C. Colmant, Y. Ville
      Abstract: ObjectivePreterm premature rupture of membranes (PPROM) is a leading complication following fetoscopic laser coagulation (FLC) for twin-twin transfusion syndrome (TTTS). Our primary objective was to describe the impact of improvements in surgical technique on survival and rate of PPROM over time. The secondary objective was to assess potential risk factors for PPROM.Design and SettingSingle center retrospective observational study.Population1092 consecutive cases of TTTS operated by FLC, between 2000 and 2016, with a 6.8% rate of loss to follow-up.MethodsThe incidence of PPROM and potential risk factors were analyzed using competing risks models.OutcomesPPROM, neonatal survival and neurological damage at 28 days.ResultsPPROM
      PubDate: 2018-01-30T03:15:39.941411-05:
      DOI: 10.1111/1471-0528.15147
  • Cardiorespiratory Fitness, Exercise Hemodynamics and Birth Outcomes: The
           Coronary Artery Risk Development in Young Adults (CARDIA) Study
    • Authors: Abbi D Lane-Cordova; Mercedes R Carnethon, Janet M Catov, Samantha Montag, Cora E Lewis, Pamela J Schreiner, Annie Dude, Barbara Sternfeld, Sylvia E Badon, Philip Greenland, Erica P Gunderson
      Abstract: ObjectiveDetermine associations of cardiorespiratory fitness, exercise systolic blood pressure (SBP), and heart rate recovery (HRR) following a maximal exercise test performed years preceding pregnancy with odds of preterm birth (PTB;
      PubDate: 2018-01-29T10:41:33.381548-05:
      DOI: 10.1111/1471-0528.15146
  • Re: Vaginal seeding following caesarean delivery: a commentary regarding
           clinical management Vaginal seeding: implications, trends and expectations
           of the pregnant women
    • Authors: Jeevan Prasanga Marasinghe; Nisha Khot
      PubDate: 2018-01-28T23:50:17.762439-05:
      DOI: 10.1111/1471-0528.15049
  • Authors’ reply re: Vaginal seeding or vaginal microbial transfer from
           the mother to the caesarean-born neonate: a commentary regarding clinical
    • Authors: Thor Haahr; Tine D Clausen
      PubDate: 2018-01-28T23:45:21.601917-05:
      DOI: 10.1111/1471-0528.15050
  • To reduce maternal mortality, we must know and respond to women's personal
    • Authors: Matthews Mathai
      Abstract: Targets for maternal mortality reduction have been set under the Sustainable Development Goals (h t t p: / / w w w. un. org / sustainabledevelopment/health/). However, obtaining reliable information on the levels and causes of maternal mortality, and thus measuring progress towards elimination of preventable maternal deaths, remains a challenge.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-27T02:15:20.721421-05:
      DOI: 10.1111/1471-0528.15145
  • Authors’ reply re: Peripartum hysterectomy: an economic analysis of
           direct healthcare costs using routinely collected data
    • Authors: Felix Achana; Kate Fleming, Laila J Tata, Alyshah Abdul Sultan, Stavros Petrou
      PubDate: 2018-01-23T01:41:13.350543-05:
      DOI: 10.1111/1471-0528.15104
  • Is this primip a nullip' The daily abuse of language in obstetrics
    • Authors: Geoffrey Hughes
      Abstract: A decade ago Opara and Zaidi1 detailed the poor understanding of the word parity in this journal, detailing different definitions, but preferring “the number of pregnancies at or above 24 weeks gestation, regardless of outcome”. The reader is therefore left to wonder if an undelivered woman at 30 weeks in her first ever pregnancy (therefore having attained viability) has a parity of zero or one. They also describe the confusion regarding surrounding a twin birth; 79% of the surveyed obstetricians and midwives incorrectly assigned that single parous event to a parity of two.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-19T09:50:23.999766-05:
      DOI: 10.1111/1471-0528.15138
  • Re: Peripartum hysterectomy: an economic analysis of direct healthcare
           costs using routinely collected data
    • Authors: Shigeki Matsubara; Hironori Takahashi, Daisuke Matsubara, Akihide Ohkuchi
      PubDate: 2018-01-19T02:11:10.782552-05:
      DOI: 10.1111/1471-0528.15103
  • Best practice perioperative strategies and surgical techniques for
           preventing caesarean section surgical site infections: a systematic review
           of reviews and meta-analyses
    • Authors: Elizabeth K Martin; Michael M Beckmann, Louise N Barnsbee, Kate A Halton, Katharina M D Merollini, Nicholas Graves
      Abstract: BackgroundSurgical site infection (SSI) following caesarean section is a problem for women and health services. Caesarean section is a high volume procedure and the estimated incidence of SSI may be as high as 9%.ObjectivesThe objective of this study was to identify a suite of perioperative strategies and surgical techniques that reduce the risk of SSI following caesarean section.Search strategySix electronic databases were searched to systematically review literature reviews, systematic reviews and meta-analyses published from 2006 to 2016. Search terms included: endometritis, SSI, caesarean section, meta-analysis, review, systematic.Selection criteriaStudies were sought in which competing perioperative strategies and surgical techniques relevant for caesarean section were identified and quantifiable infection outcomes were reported. General surgical infection control techniques were excluded.Data collection and analysisData on study characteristics and clinical effectiveness were extracted. Quality, including bias within individual studies, was examined using a modified A Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist. Recommendations for SSI risk reducing strategies were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Main resultsOf 466 records retrieved, 44 studies were selected for the evidence synthesis. Recommended strategies were: administer pre-incision antibiotic prophylaxis, prepare the vagina with iodine-povidone solution and spontaneous placenta removal.ConclusionsWe recommend clinicians implement pre-incision antibiotic prophylaxis, vaginal preparation and spontaneous placenta removal as an infection control bundle for caesarean section.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-16T04:10:28.79815-05:0
      DOI: 10.1111/1471-0528.15125
  • Recurrence of vulval intraepithelial neoplasia following treatment with
           cidofovir or imiquimod: results from a multi-centre, randomised, phase II
           trial (RT3VIN)
    • Authors: Christopher N. Hurt; Sadie E.F. Jones, Tracie-Ann Madden, Alison Fiander, Andrew J. Nordin, Raj Naik, Ned Powell, Margherita Carucci, Amanda Tristram
      Abstract: ObjectiveTo compare the recurrence rates after complete response to topical treatment with either cidofovir or imiquimod for vulval intraepithelial neoplasia (VIN) 3.DesignA prospective, open, randomised multicentre trial.Setting32 general hospitals located in Wales and England.Population or Sample180 patients were randomised consecutively between Oct 21, 2009, and Jan 11, 2013, 89 to cidofoovir (of whom 41 completely responded to treatment) and 91 to imiquimod (of whom 42 completely responded to treatment).MethodsAfter 24 weeks of treatment, complete responders were followed up at 6 monthly intervals for 24 months. At each visit, the Common Terminology Criteria for Adverse Events (CTCAE) v3.0 was assessed and any new lesions were biopsied for histology.Main Outcome MeasuresTime to histologically confirmed disease recurrence (any grade of VIN).ResultsThe median length of follow up was 18.4 months. At 18 months, more participants were VIN-free in the cidofovir arm: 94% (95% CI: 78.2-98.5) vs 71.6% (95% CI: 52.0-84.3) (univariable HR: 3.46, 95% CI: 0.95-12.60, p=0.059; multivariable HR: 3.53, 95% CI: 0.96-12.98, p=0.057). The number of grade 2+ events was similar between treatment arms (imiquimod: 24/42 (57%) vs. cidofovir: 27/41 (66%), χ2=0.665, p=0.415), with no grade 4+.ConclusionsLong term data indicates a trend towards response being maintained for longer following treatment with cidofovir compared to imiquimod, with similar low rates of adverse events for each drug. Adverse event rates indicated acceptable safety of both drugs.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-16T02:35:50.004745-05:
      DOI: 10.1111/1471-0528.15124
  • Cassava Flour Slurry as a Low-cost Alternative to Commercially Available
           Gel for Obstetrical Ultrasound: a blinded non-inferiority trial comparison
           of image quality
    • Authors: Aleha Aziz; Pe'er Dar, Francine Hughes, Clemencia Solorzano, Mundenga Mutendi Muller, Christian Salmon, Margaret Salmon, Nerys Benfield
      Abstract: ObjectiveTo evaluate the quality of ultrasound images obtained with cassava flour slurry (CFS) compared to conventional gel in order to determine objectively whether CFS could be a true low-cost alternative.DesignBlinded non-inferiority trial.SettingObstetrical ultrasound unit in an academic medical center.Population or SampleWomen with a singleton pregnancy, undergoing anatomy ultrasounds.MethodsThirty pregnant women had standard biometry measures obtained with CFS and conventional gel. Images were compared side-by-side in random order by two blinded sonologists and rated for image resolution, detail, and total image quality using 10cm VAS. Ratings were compared using paired t-tests. Participant and sonographer experience was measured using 5-point Likert scales.Main Outcome MeasuresImage resolution, detail, and total image quality. Participant experience of gel regarding irritation, messiness, and ease of removal.ResultsWe found no significant difference between perceived image quality obtained with CFS [mean=6.2 SD=1.2] and commercial gel [mean= 6.4 SD=1.2] t (28) = - 1.1 (p = 0.3). Images were not rated significantly differently for either reviewer in any measure, any standardized image, or any view of a specific anatomic structure. All five sonographers rated CFS as easy to obtain clear images and easy for patient and machine cleanup. Only 1 participant reported itching with CFS.ConclusionsCFS produces comparable image quality to commercial ultrasound gel. The dissemination of these results and the simple CFS recipe could significantly increase access to ultrasound for screening, monitoring and diagnostic purposes in resource-limited settings.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-12T09:35:28.02074-05:0
      DOI: 10.1111/1471-0528.15123
  • Obstetrical providers’ preferred mode of delivery and attitude towards
           non-medically indicated caesarean sections: a cross-sectional study
    • Authors: Julie C. Rivo; Melissa Amyx, Verónica Pingray, Roberto A. Casale, Angél E. Fiorillo, Hugo B. Krupitzki, Julio D. Malamud, Maria Mendilaharzu, María Lucía Medina, Gerardo Murga Tartalo, Alicia B. del Pino, Lucio Ribola, Javier A. Schvartzman, Monica Trasmonte, Silvana Varela, Fernando Althabe, José M. Belizán,
      Abstract: ObjectiveTo describe obstetrical providers’ delivery preferences and attitudes toward caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes.DesignCross-sectional study.SettingTwo public and two private hospitals in Argentina.PopulationObstetrician-gynecologists and midwives who provide prenatal care and/or labor/delivery services.MethodsProviders in hospitals with at least 1,000 births per year completed a self-administered, anonymous survey.Main Outcome MeasuresProvider delivery preference for low-risk women, perception of women's preferred delivery method, support for a woman's right to choose her delivery method and willingness to perform caesarean section on maternal request.ResultsOne hundred and sixty-eight providers participated (89.8% coverage rate). Providers (93.2%) preferred a VD for their patients in the absence of a medical indication for caesarean section. While 74.4% of providers supported their patient's right to choose a delivery method in the absence of a medical indication for caesarean section and 66.7% would perform a caesarean section upon maternal request, only 30.4% would consider a non-medically indicated caesarean section for their own personal delivery or that of their partner. In multivariate adjusted analysis, providers in the private sector (OR 4.70, 95% CI 1.19-18.62) and obstetrician-gynecologists (OR 4.37, 95% CI 1.58-12.09) were more willing than providers working in the public/both settings and midwives, respectively to perform a caesarean section on maternal request.ConclusionsDespite the ethical debate surrounding non-medically indicated caesarean sections, we observe very high levels of support, especially by providers in the private sector and obstetrician-gynecologists, consistent with the high caesarean section rates in Argentina.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-11T19:05:50.591397-05:
      DOI: 10.1111/1471-0528.15122
  • The safety of quinolones and fluoroquinolones in pregnancy – A
    • Authors: Enav Yefet; Naama Schwartz, Bibiana Chazan, Raed Salim, Shabtai Romano, Zohar Nachum
      Abstract: BackgroundQuinolones were contraindicated during pregnancy due to concerns regarding fetal malformations and carcinogenesis in animals. The literature is conflicted regarding their safety in humans.ObjectivesTo conducted a meta-analysis evaluating the risk for fetal malformations and pregnancy complications following exposure to quinolones during pregnancy.Search strategyWe searched Embase, PubMed, Medline, the Cochrane database, clinicaltrials. gov and Dart Databases. We added articles found through the references of included articles.Selection criteriaRelevant English citations using the terms quinolone/s, fluoroquinolone/s and pregnancy in humans. Exclusion criteria were case reports, reviews, and articles without data regarding the study outcomes.Data Collection and AnalysisTwo authors performed the database search, assessment of eligibility, and abstraction of data from included studies. Disagreement was settled by consensus among all authors. The pooled odds ratios (with 95%CI) were estimated. The Cochrane's Q test of heterogeneity and I² were used for the measurement of heterogeneity. A total of 256 papers was retrieved of which 13 met inclusion criteria and were analyzed.Main ResultsNo association was found between quinolones and fetal malformations (pooled OR 1.08 95%CI [0.96-1.21]), preterm delivery (pooled OR 0.97 95%CI [0.75-1.24]), stillbirth (pooled OR 1.11 95%CI [0.34-3.6]) or miscarriage (pooled OR 1.78 95%CI [0.93-3.38]).Conclusion(s)Quinolones are not associated with unfavorable pregnancy outcomes. However, larger studies are needed before safety is established. Until then, it is suggested that quinolones should not be used as a first line therapy during the first trimester.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-10T08:25:55.356416-05:
      DOI: 10.1111/1471-0528.15119
  • Authors’ reply re: Advanced maternal age increases the risk of very
           preterm birth irrespective of parity – a population based register study
    • Authors: Mikael Norman; Sven Cnattingius, Linda Vixner, Ulla Waldenström
      PubDate: 2018-01-10T00:11:05.375015-05:
      DOI: 10.1111/1471-0528.15053
  • Tidying Up
    • Authors: William C Dodson
      Abstract: The practice of medicine can be messy: inconsistent diagnostic criteria, imprecise laboratory results, and uncertain exposure effects, all of which convey enormous implications for public health. At times the clinician seems to be directing care based on faith rather than evidence. The natural consequence is polarization into groups of skeptics and devotees instead of consensus. One only has to review the history of gestational diabetes mellitus (GDM) to understand just how untidy medical practice can be.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-09T03:20:44.126435-05:
      DOI: 10.1111/1471-0528.15121
  • Antidepressant use during pregnancy and ADHD risk in children: current
    • Authors: Takoua Boukhris
      Abstract: Antidepressants (ADs) are among the most frequently used medications in pregnancy. ADs can cross the placental barrier (Rampono et al. Pharmacopsychiatry 2009;42(3):95-100, Loughhead et al. Biol Psychiatry 2006;59(3):287-90), resulting in a dysfunction of the serotonergic and norepinephrine systems, which could cause inattention or hyperactivity-impulsivity behaviors as exhibited in ADHD. Several epidemiological studies have investigated the potential link between AD exposure during pregnancy and the risk of attention deficit disorder with/without hyperactivity (ADHD) in children. However, findings have been conflicting.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-09T02:51:07.024835-05:
      DOI: 10.1111/1471-0528.15118
  • Is it time to move towards non-invasive prenatal screening for Down
           syndrome and screening for pre-eclampsia'
    • Authors: Rui Wang; Patrick Chien, Tak Yeung Leung
      Pages: 397 - 398
      Abstract: Trainee Scientific Editor, Rui Wang, discusses his top articles from this issue in an audio podcast available at:
      PubDate: 2018-02-14T20:40:32.393343-05:
      DOI: 10.1111/1471-0528.15126
  • Insights from outside BJOG
    • Authors: Athol Kent; Shona Kirtley
      Pages: 399 - 403
      PubDate: 2018-02-14T20:40:27.539666-05:
      DOI: 10.1111/1471-0528.15127
  • Authors' reply re: Medical therapy for preventing recurrent endometriosis
           after conservative surgery: a cost-effectiveness analysis
    • Authors: Bin Wu; Yu Wang
      Pages: 504 - 504
      PubDate: 2018-02-14T20:40:25.842759-05:
      DOI: 10.1111/1471-0528.14818
  • Every Woman, Every Child's ‘Progress in Partnership’ for stillbirths:
           a commentary by the stillbirth advocacy working group
    • Authors: Elena Ateva; Hannah Blencowe, Theresa Castillo, Alka Dev, Mychelle Farmer, Mary Kinney, Surendra Kumar Mishra, Susannah Hopkins Leisher, Shannon Maloney, Victoria Ponce Hardy, Paula Quigley, Jessica Ruidiaz, Dimitrios Siassakos, Julie E Stoner Brock, Claire Storey, Maria Luisa Tejada de Rivero Sawers
      Abstract: Globally, an estimated 2.6 million third trimester stillbirths occurred in 2015 (2, 3) – a number which has not seen meaningful decline over the past decade and which has improved at a considerably slower rate than levels of child and maternal mortality.(1, 4) Half of all stillbirths occur during labour and birth, and almost all take place in low and middle income countries.(4) Until recently, this huge burden remained largely invisible.(2, 5)This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-29T02:20:40.051892-05:
      DOI: 10.1111/1471-0528.15113
  • Gestational Age and Stillbirths-Questions left unanswered
    • Authors: A M Siega-Riz; D Dudley
      Abstract: In this issue of the journal, Johansson and colleagues provide evidence of the lack of an association between gestational weight gain (GWG) and stillbirths in normal weight women using a large perinatal data set from two specific regions in Sweden. (Johansson K., et al., BJOG, 2018 xx) The advantages of having such data are noteworthy, allowing for the examination of a rare outcome—stillbirths–stratified by maternal body mass index, with the exposure being gestational weight gain early on and through out pregnancy.
      PubDate: 2017-12-27T09:10:34.253983-05:
      DOI: 10.1111/1471-0528.15112
  • Obstetric Fistula: A paradigm shift is needed in research and
           prevention– A Commentary
    • Authors: P Letchworth; E MacLaren, S Duffy
      Abstract: The impact of an obstetric fistula on a woman's quality of life is catastrophic. It is a devastating condition that affects the most vulnerable women in society. In 2006 the World Health Organisation (WHO) estimated that two million women throughout the world live with an untreated fistula, with between 50,000 and 100,000 new cases occurring each year.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-27T09:00:56.239706-05:
      DOI: 10.1111/1471-0528.15110
  • Obstetricians Awareness Associated with Better Outcomes
    • Authors: David A Eschenbach
      Abstract: Doctors are charged to treat disease while causing no harm. An anaphylactic reaction is the furthest from our mind in dispensing medication. However, an anaphylactic reaction to medication can cause serious harm and even death as outlined by McCall et al. (1). This report is a well-conducted and important prospective study. First, their strict definition of anaphylaxis included only patients with a life threatening airway problem, a life threatening breathing problem or a significant circulation problem. Second, they also used a semi-active surveillance system to both identify and report anaphylaxis monthly at individual hospitals. This important monthly reminder probably led to an increased identification of anaphylaxis.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-27T04:15:43.570066-05:
      DOI: 10.1111/1471-0528.15111
  • Vitamin D: A possible intervention for preventing gestational
    • Authors: Christopher J. Robinson
      Abstract: Efforts to improve pregnancy outcomes through nutritional interventions in developed and low-resource settings remain challenging given lack of adequately power trials. Global rates of obesity and diabetes are increasing dramatically with impacts upon maternal-fetal health. Since vitamin D deficiency is common and often profound among women of childbearing age, investigations have focused on improving pregnancy outcome through vitamin D supplementation (Triunfo, S, J Endocrinol Invest. 2017 Oct;40(10):1049-1059).This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-22T09:55:23.788708-05:
      DOI: 10.1111/1471-0528.15109
  • Pregnancy leisure physical activity and children′s neurodevelopment:
           a narrative review
    • Authors: Celia Álvarez-Bueno; Iván Cavero-Redondo, Mairena Sánchez-López, Miriam Garrido-Miguel, Jose Alberto Martínez-Hortelano, Vicente Martínez-Vizcaíno
      Abstract: In recent years, interest in the relationship between maternal physical activity during pregnancy and children's neurocognitive development has been growing. Several observational studies and clinical trials have analysed this relationship and they differ in the findings, especially for children's language related skills and IQ. Physical activity assessment, amount of physical activity and the test used for measuring children's cognition could affect this relationship, as well as other factors that should be considered. This article will review the evidence on the effects of physical activity during pregnancy on children's different cognitive domains.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-20T05:10:31.042063-05:
      DOI: 10.1111/1471-0528.15108
  • The Clinical and Economic Impact of School-based Nonavalent Human
           Papillomavirus Vaccine on Females in Singapore: A Transmission Dynamic
           Mathematical Model Analysis
    • Authors: Tay Sun Kuie; Tun-Ying Hsu, Andrew Pavelyev, Anuj Walia, Amit S Kulkarni
      Abstract: ObjectivesTo examine the epidemiological and economic impact of a nine-valent (nonavalent) human papillomavirus (HPV)-(6/11/16/18/31/33/45/52/58) vaccine programme for young teenagers in Singapore.DesignMathematical modelling.SettingPharmaco-economic simulation projection.PopulationSingapore demography.MethodsClinical, epidemiological and financial data from Singapore were used in a validated HPV transmission dynamic mathematical model to analyse the impact of nonavalent HPV vaccination over quadrivalent and bivalent vaccines in a school-based 2-dose vaccination for 11-to-12-year-old girls in the country. The model assumed routine cytology screening in the current rate (50%) and vaccine coverage rate of 80%.Main Outcome MeasuresChanges over a 100-year time horizon in the incidence and mortality rates of cervical cancer, case load of genital warts, and incremental cost –effectiveness ratio (ICER).ResultsCompared to bivalent and quadrivalent HPV vaccination programme, nonavalent HPV universal vaccination resulted in an additional reduction of HPV31/33/45/52/58 related CIN1 by 40.5%, CIN 2/3 by 35.4%, cervical cancer by 23.5%, and cervical cancer mortality by 20.2%. Compared to bivalent HPV vaccination, there was an additional reduction in HPV-6/11 related CIN1 by 75.7%, and genital warts by 78.9% in women and 73.4% in men. Over the 100 years, after applying a discount of 3%, disease management cost will be reduced by 32.5% (vs bivalent) and 7.5% (vs quadrivalent). The incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year gained was SGD$929 compared to bivalent vaccination and SGD$9,864 compared to quadrivalent vaccination.ConclusionUniversal 2-dose nonavalent HPV vaccination for 11-to-12-year-old adolescent females is very cost-effective in Singapore.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-20T04:20:29.003189-05:
      DOI: 10.1111/1471-0528.15106
  • Do Stillbirth and Abortion Increase Risks of Attempted and Completed
    • Authors: Shu-Chuan Weng; Jung-Chen Chang, Ming-Kung Yeh, Shun-Mu Wang, Chua-Shoun Lee, Yi-Hua Chen
      Abstract: ObjectiveTo investigate the risks of attempted and completed suicide in women who experienced a stillbirth or abortion within 1 year postnatally and compared this risks with that in women who experienced a live birth.DesignA nested case-control study.SettingLinking three nationwide population-based datasets in Taiwan: National Health Insurance Research Database, National Birth Registry, and National Death Registry.Sample485 and 350 cases of attempted and completed, respectively, were identified during 2001–2011; for each case, 10 controls were randomly selected and matched to the cases according to the age and year of delivery.MethodsConditional logistic regression.Main outcome measuresAttempted and completed suicidal statuses were determined.ResultsThe rates of attempted suicide increased in the women who experienced foetal loss. The risk of completed suicide was higher in women who experienced a stillbirth (adjusted odds ratio (aOR)=5.2; 95% confidence interval (CI)=1.77–15.32), miscarriage (aOR=3.81; 95% CI=2.81–5.15), or termination of pregnancy (aOR=3.12; 95% CI=1.77–5.5) than in those who had a live birth. Furthermore, the risk of attempted suicide was significantly higher in women who experienced a miscarriage (aOR=2.1; 95% CI=1.66–2.65) or termination of pregnancy (aOR=2.5; 95% CI=1.63–3.82). In addition to marital and educational statuses, psychological illness increased the risk of suicidal behaviour.ConclusionsThe risk of suicide might increase in women who experienced foetal loss within 1 year postnatally. Healthcare professionals and family members should enhance their sensitivity to care for possible mental distress, particularly for women who have experienced a stillbirth.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-20T04:10:38.52519-05:0
      DOI: 10.1111/1471-0528.15105
  • The Impact of Isolated Maternal Hypothyroxinemia on the Incidence of
           Large-for-Gestational-Age Infants: the Ma'anshan Birth Cohort (MABC) Study
    • Authors: Yuan-duo Zhu; Yan Han, Kun Huang, Bei-bei Zhu, Shuang-qin Yan, Xing Ge, Shan-shan Zhou, Yuan-yuan Xu, Ling-ling Ren, Jie Sheng, Wei-jun Pan, Jia-hu Hao, Peng Zhu, Fang-biao Tao
      Abstract: ObjectiveThe purpose of this study was to investigate whether isolated maternal hypothyroxinemia (IMH) is associated with risks of small/large-for-gestational-age (SGA/LGA) infants.DesignPopulation-based prospective cohort study.SettingMa'anshan Maternal and Child Health (MCH) clinics, China.PopulationPregnant women with singleton births (n=3,178).MethodsDescriptive statistics were calculated for the demographic characteristics of the mothers and their newborns. Linear regression was applied to estimate the association between thyroid hormone levels and birth weight. Logistic regression was performed to calculate the association between IMH and SGA/LGA.Main Outcome Measure(s)Outcomes included SGA/ LGA.ResultsThe prevalence of IMH, defined as an FT4 value lower than the 2.5th percentile with normal TSH, was 2.5% (78/3080) and 2.5% (74/2999) in the first and second trimesters, respectively. Additionally, 306 (9.6%) and 524 (16.5%) infants were defined as SGA and LGA, respectively. No evidence supported the notion that IMH isassociated with an increased risk for SGA either in the first (OR: 1.762, 95% CI: 0.759 to 4.089) or the second (OR: 0.763, 95%CI: 0.231 to 2.516) trimester. However, an increased risk of LGA was observed among IMH women in the second trimester (OR: 2.088, 95%CI: 1.193 to 3.654). Maternal TPO-Ab positivity in the second trimester increased the risk of SGA (OR: 2.094, 95%CI: 1.333 to 3.290).ConclusionsThis study provides evidence that IMH is associated with LGA.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-19T13:05:43.077368-05:
      DOI: 10.1111/1471-0528.15107
  • Hypothesis: Does exposure to sperm lead to pregnancy'
    • Authors: David H Barad
      Abstract: This issue of BJOG includes a manuscript by G. Saccone et al (BJOG) examining if exposure to semen is associated with the clinical outcome of pregnancy, in IVF cycles. While it seems obvious that exposure to semen with sperm should increase the chance of pregnancy in a woman who has recently undergone induction of ovulation, some of these studies used only seminal plasma or were performed in cycles with ovulation suppression in preparation for transfer of cryopreserved embryos.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-16T01:28:01.68778-05:0
      DOI: 10.1111/1471-0528.15102
  • No-call NIPT gives important information
    • Authors: Niels Uldbjerg
      Abstract: Non-invasive prenatal testing (NIPT) based on cell free fetal DNA fragments in maternal serum samples (cffDNA) is a well-established method for Downs-screening in early pregnancy. The sensitivity is above 99%. However, when used for screening of younger women without risk factors, the positive predictive value is below 50%, i.e. a suspicion of Down's syndrome based on NIPT must be confirmed by an invasive diagnostic test such as via chorion villus sampling (CVS).This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-16T01:25:49.933422-05:
      DOI: 10.1111/1471-0528.15101
  • Vitamin D and Gestational Diabetes Mellitus: A Systematic Review Based on
           Data Free of Hawthorne Effect
    • Authors: Yanbo Zhang; Yunhui Gong, Hongmei Xue, Jingyuan Xiong, Guo Cheng
      Abstract: BackgroundGestational diabetes mellitus (GDM) is an increasingly prevalent disorder, associated with low blood vitamin D (VD) level.ObjectivesTo evaluate the relationship between VD and GDM.Search StrategyEMBASE, MEDLINE, Cochrane library and China Biology Medicine disc were searched till May 2017. The references of previous studies were screened.Selection CriteriaObservational studies on the relationship between VD and GDM free from Hawthorne effect and randomized controlled trials of VD supplementation during pregnancy for preventing or treating GDM were included.Data Collection and AnalysisData and information of included articles were extracted by duplicate using piloted tables. Newcastle-Ottawa Scale and Cochrane Handbook were used for quality assessment. Random-effects models were used for meta-analyses. Heterogeneity tests, sensitive analysis, and analysis of publication bias were conducted.Main ResultsEighty-seven observational studies and 25 randomized controlled trials involving 55859 and 2445 subjects respectively were included. Low blood VD level during pregnancy was associated with a higher risk of GDM (OR = 1.850, 95% CI: 1.471, 2.328). Blood VD level for subjects with GDM were lower than the controls. Blood VD level was associated with fasting plasma glucose (FPG) and HOMA-IR (r = -0.100 and -0.351), whereas the correlation between blood VD level and fasting insulin (FINS) might be concealed by publication bias. VD intervention during pregnancy could change blood level of VD, FINS, FPG, HOMA-IR, glutathione, C-reactive protein, and lipid.ConclusionsLow blood VD level could increase the risk of GDM, and VD supplementation during pregnancy could ameliorate the condition of GDM.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-15T09:46:09.859194-05:
      DOI: 10.1111/1471-0528.15060
  • Antidepressant use during pregnancy and the risk of
           attention-deficit/hyperactivity disorder in the children: a meta-analysis
           of cohort studies
    • Authors: Hai-yin Jiang; Chun-ting Peng, Xue Zhang, Bing Ruan
      Abstract: BackgroundEvidence for the relationship between antidepressant use during pregnancy and the risk of attention-deficit/hyperactivity disorder (ADHD) in the children is conflicting.ObjectiveTo assess the association between fetal exposure to antidepressant drugs and the subsequent development of ADHD.Search strategyA systematic literature search was conducted in PubMed, EMBASE, PsycINFO, and CINAHL databases to identify relevant cohort studies published from inception until October 2017.Selection criteriaCohort studies, identifying children with ADHD diagnosis and linking antidepressant use during pregnancy in their mothers.Data collectionTwo reviewers independently abstracted data and assessed study quality.Main resultsThe literature search identified six relevant cohort studies with association between antidepressant exposure during pregnancy and the risk of ADHD in children (HR = 1.34; 95% confidence interval [CI] 1.14–1.57). However, the association was not statistically significant when the reference group was mothers with psychiatric disorders not treated during pregnancy (HR = 0.96; 95% CI 0.76–1.2; n=2 studies). Moreover, preconception exposure to antidepressants was significantly associated with increased risk of ADHD (HR = 1.82; 95% CI 1.54–2.15; n=3 studies).ConclusionsThe significant association between antidepressant exposure during pregnancy and ADHD in the children can be partially explained by confounding by indication. Given the low number of included studies, further studies with prospective designs that use validated measurement and control for important confounders are needed to verify our findings.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-15T04:01:07.162864-05:
      DOI: 10.1111/1471-0528.15059
  • Re: Genetic variation in the progesterone receptor gene and susceptibility
           to recurrent pregnancy loss: a case–control study
    • Authors: Saumya Pandey; Kshitiz Murdia, Vipin Chandra, Ajay Murdia
      PubDate: 2017-12-15T03:07:03.376177-05:
      DOI: 10.1111/1471-0528.14994
  • Authors’ reply re: Partner smoking influences whether mothers quit
           smoking during pregnancy: a prospective cohort study
    • Authors: RM Román-Gálvez; C Amezcua-Prieto, R Olmedo-Requena, AM Lewis-Mikhael Saad, JM Martínez-Galiano, A. Bueno-Cavanillas
      PubDate: 2017-12-15T03:06:59.640497-05:
      DOI: 10.1111/1471-0528.15031
  • Authors’ reply re: Genetic variation in the progesterone receptor gene
           and susceptibility to recurrent pregnancy loss: a case–control study
    • Authors: Wassim Y Almawi; Wael Bahia, Touhami Mahjoub
      PubDate: 2017-12-14T05:20:21.401359-05:
      DOI: 10.1111/1471-0528.14995
  • Re: Partner smoking influences whether mothers quit smoking during
           pregnancy: a prospective cohort study
    • Authors: Saumya Pandey; Kshitiz Murdia, Ajay Murdia, Vipin Chandra, Nitiz Murdia
      PubDate: 2017-12-14T05:19:23.777782-05:
      DOI: 10.1111/1471-0528.15030
  • Author's reply re: Pre-eclampsia is primarily a placental disorder: FOR:
           Pre-eclampsia is primarily a placental disorder
    • Authors: Stefan Verlohren
      PubDate: 2017-12-14T05:19:03.020562-05:
      DOI: 10.1111/1471-0528.15010
  • Re: Pre-eclampsia is primarily a placental disorder
    • Authors: Xue Qing Wu; Xin Xin Xu, Zhi Yang Zhou, MJ Quinn
      PubDate: 2017-12-14T05:16:24.252378-05:
      DOI: 10.1111/1471-0528.15008
  • Author's reply re: Pre-eclampsia is primarily a placental disorder:
           AGAINST: Pre-eclampsia: the heart matters
    • Authors: Basky Thilaganathan
      PubDate: 2017-12-14T05:15:43.560067-05:
      DOI: 10.1111/1471-0528.15009
  • Authors’ reply re: Maternal prepregnancy obesity and the risk of
           shoulder dystocia: a meta-analysis
    • Authors: Caixia Zhang; Dongfeng Zhang
      PubDate: 2017-12-14T05:06:11.831567-05:
      DOI: 10.1111/1471-0528.15020
  • Smoking and Pregnancy: Getting dads “on the bus”
    • Authors: Robert M. Silver
      Abstract: In this issue of BJOG, Roman-Galvez and colleagues show that some women decrease their amount of smoking or stop smoking entirely during pregnancy (Roman-Galvez BJOG; in press). However, few partners decrease smoking during pregnancy. In addition to exposing the pregnancy to passive smoking, continued smoking by their partner decreases the odds of the woman quitting. Accordingly, public health measures should target partners as well as patients.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-13T02:00:54.711677-05:
      DOI: 10.1111/1471-0528.15056
  • Respectful maternity care needs to be the standard for all women worldwide
    • Authors: Elaine Denny
      Abstract: The principles of care and respect during childbirth, and of women's rights during childbirth, are universal (McConville, Midwifery, 2014:30(2):154-7). The relationship between women and the doctors, midwives and other birth attendants who care for them is crucial in upholding these principles. However, a WHO statement in 2014 points out that across the world many women experience treatment that is neglectful, abusive and disrespectful, which violates their human rights and their rights to care.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-12T02:41:24.983244-05:
      DOI: 10.1111/1471-0528.15055
  • Authors’ reply re: Inositol treatment of anovulation in women with
           polycystic ovary syndrome: a meta-analysis of randomised trials
    • Authors: Jyotsna Pundir; Dimitrios Psaroudakis, Prakash Savnur, Priya Bhide, Luca Sabatini, Helena Teede, Arri Coomarasamy, Shakila Thangaratinam
      PubDate: 2017-12-11T01:55:20.00487-05:0
      DOI: 10.1111/1471-0528.14996
  • Authors’ reply re: Starting a Uterus transplantation service: Notes
           from a small island
    • Authors: HK Tan; BK Tan, LK Tan, JI Olofsson, P Dahm-Kähler, M Brännström
      PubDate: 2017-12-11T01:22:21.842726-05:
      DOI: 10.1111/1471-0528.15019
  • Traditional and molecular chromosomal abnormality analysis of products of
           conception in spontaneous and recurrent miscarriage
    • Authors: Ting Zhang; Yun Sun, Zi-jiang Chen, T. C Li
      Abstract: Chromosome abnormalities account for half of miscarriages. Data from cytogenetic analysis of the products of conception (POC) in miscarriages are reviewed in the paper. Genetic analysis of POC allows patients to be given prognostic information. Molecular genetic techniques can overcome the pitfalls of conventional karyotyping such as culture failure and trace submicroscopic abnormalities. We compare the pros and cons when these technologies are applied to the analysis of POC of miscarriage. Guidance is also provided for future clinical applications. The objective of the review is to help clinicians understand the limitations and optimize the usefulness of genetic analysis of POC.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-08T09:46:12.587963-05:
      DOI: 10.1111/1471-0528.15052
  • Respectful care during childbirth in health facilities globally: a
           qualitative evidence synthesis
    • Authors: E Shakibazadeh; M Namadian, MA Bohren, JP Vogel, A Rashidian, V Nogueira Pileggi, S Madeira, S Leathersich, Ӧ Tunçalp, OT Oladapo, JP Souza, AM Gülmezoglu
      Abstract: BackgroundWhat constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable.ObjectivesTo develop a conceptualisation of RMC.Search strategyKey databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies.Selection criteriaPrimary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date.Data collection and analysisA combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings.Main resultsSixty-seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent.ConclusionsThis review presents an evidence-based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes.Tweetable abstractUnderstanding respectful maternity care – synthesis of evidence from 67 qualitative studies.
      PubDate: 2017-12-08T01:18:20.0713-05:00
      DOI: 10.1111/1471-0528.15015
  • Re Re Re: Perinatal and maternal morbidity and mortality among term
           singletons following midcavity operative vaginal delivery versus caesarean
    • Authors: Manoj Mohan; Jithesh Puthen, Rauf Ghani, Antonios Antoniou, Farina Kidwai, Stephen Lindow
      PubDate: 2017-12-08T01:11:30.247841-05:
      DOI: 10.1111/1471-0528.14978
  • Uterine Caesarean Closure Techniques Affect Ultrasound Findings and
           Maternal Outcomes: a Systematic Review and Meta-Analysis
    • Authors: S I Stegwee; I P M Jordans, L F van der Voet, P M van de Ven, J C F Ket, C B Lambalk, C J M de Groot, W J K Hehenkamp, J A F Huirne
      Abstract: BackgroundCaesarean section (CS) rates are rising globally. Long-term adverse outcomes after CS might be reduced when the optimal uterine closure technique becomes evident.ObjectiveTo determine the effect of uterine closure techniques after CS on maternal and ultrasound outcomes.Search strategyLiterature search in electronic databases.Selection criteriaRandomised controlled trials (RCTs) or prospective cohort studies that evaluated uterine closure techniques and reported on ultrasound findings, perioperative or long-term outcomes.Data collection and Analysis20 studies (15053 women) were included in our meta-analyses for various outcomes. We calculated pooled risk ratio's (RR) with 95% CI through random-effect analysis.Main ResultsResidual myometrium thickness (RMT), reported in eight studies (508 women), decreased with 1.26 mm after single- compared to double-layer closure (95% CI: -1.93 - -0.58), particularly when locked sutures were used. Healing ratio (RMT/adjacent myometrium thickness (AMT)) diminished after single-layer closure (WMD -7.74%, 95% CI: -13.31 - -2.17), particularly in case of locked sutures. Niche prevalence increased (RR 1.71, 95% CI: 1.11 - 2.62) when the decidua was excluded. Dysmenorrhea occurred more often in the single-layer group (RR 1.23, 95% CI: 1.01 - 1.48), whereas incidence of uterine rupture was similar (RR 1.91, 95% CI: 0.63 - 5.74).ConclusionDouble-layer unlocked sutures are favorable over single-layer locked sutures concerning RMT, healing ratio and dysmenorrhea. Excluding the decidua seems to result in higher niche prevalence. Since thin residual myometrium or niches may serve as intermediates for gynaecological and reproductive outcomes, future studies should focus on these outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-07T08:45:46.556839-05:
      DOI: 10.1111/1471-0528.15048
  • Non-invasive prenatal testing for fetal inheritance of maternal
           β-thalassaemia mutations using targeted sequencing and relative mutation
           dosage: a feasibility study
    • Authors: Li Xiong; Angela N Barrett, Rui Hua, Sherry S Y Ho, Li Jun, K C Allen Chan, Zhong Mei, Mahesh Choolani
      Abstract: ObjectiveTo evaluate whether targeted sequencing and relative mutation dosage can be used to correctly diagnose inheritance of maternal β-thalassaemia mutations in cell-free DNA.DesignFeasibility study using samples collected in a prenatal clinic.SettingSouth East Asia.PopulationCouples where both partners were known to be carriers of one of four common β-thalassaemia mutations or an HbE mutation, and therefore at risk of carrying a fetus affected with β-thalassaemia.Methods49 samples previously identified as having inherited a paternal β-thalassaemia mutation were amplified using nested PCR, and then sequencing. Relative mutation dosage was used to classify the fetus as having inherited the wild-type or mutant maternal allele.Main Outcome MeasuresClassification of the fetus as ‘unaffected’ (if the maternal wild-type allele was inherited) or ‘affected’ with β-thalassaemia (if the maternal mutant allele was inherited).ResultsA classification for inheritance of maternal allele was obtained in 48/49 samples (98.0%). A concordant call was made in 44/48 cases (91.7%); one false positive and three false negatives were obtained. Thus, we had an overall sensitivity of 87.5% (95% CI: 67.6-97.3%) and a specificity of 95.8% (95% CI: 78.9-99.9%) for inheritance of maternal genotype.ConclusionsRMD for detection of inheritance of maternal β-thalassaemia mutations has potential for clinical use. Our sequential approach could be applied to other single-gene disorders.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-06T11:36:04.758974-05:
      DOI: 10.1111/1471-0528.15045
  • Recent work supports the concept of an active sphincter in the uterine
    • Authors: Helen Feltovich; Joy-Sarah Vink
      Abstract: In this issue, Nott et al. qualitatively and quantitatively investigate the architecture of the cervix in ex vivo nonpregnant human samples. Using Diffusion Tensor MRI and a fiber tracking algorithm, they identify an outer circular and inner longitudinal layer of fibers throughout the cervix. Quantitative measurements of diffusion, tract orientation and volume confirm that the outer circumferential band of fibers is particularly dense and uniform in the proximal cervix, at the region of the internal os.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-06T11:21:39.904429-05:
      DOI: 10.1111/1471-0528.15043
  • Look, then Leap: Quality and Improving Maternity Care
    • Authors: Neel Shah
      Abstract: Obstetricians learned this lesson the hard way. A century ago, very little in obstetric practice was codified. Care was artisanal, variable, and sometimes dangerous. Based on a theory that childbirth is inherently “pathogenic,” prominent American obstetricians recommended sweeping reforms. (DeLee, JB, Principles and Practice of Obstetrics, 1913, first edition).This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-06T11:20:51.56369-05:0
      DOI: 10.1111/1471-0528.15044
  • Subsequent reproductive outcome among women with peripartum
           cardiomyopathy: a nationwide study
    • Authors: Maria Guldbrandt Hauge; Marianne Johansen, Niels Vejlstrup, Finn Gustafsson, Peter Damm, Anne S. Ersbøll
      Abstract: ObjectiveTo describe the subsequent reproductive outcome for a Danish nationwide cohort of women with peripartum cardiomyopathy (PPCM).DesignNationwide historic cohort study.SettingSecondary and tertiary centres across Denmark.SampleWomen with PPCM.MethodsSixty-one women with PPCM during 2005-2014 were identified in a nationwide, registry-based study and the diagnosis was validated through audit of patient records. A new search for subsequent reproductive outcome in this cohort from 2005-2016 was conducted in the Danish National Birth Registry and the Danish National Patient Registry. Detailed clinical data were obtained from patient records.Main outcome measuresSterilizations and subsequent reproductive outcomes after PPCM, including all pregnancies, miscarriages, terminations and deliveries.ResultsOut of 61 women with PPCM, 13 (21%) had a total of 16 subsequent pregnancies resulting in one miscarriage, seven early terminations, one ectopic pregnancy and seven live-born children. There were no maternal deaths or significant cardiac events during pregnancy, but one woman, who gave birth to a live-born child, had a relapse of PPCM seven weeks postpartum. None of the six women, who had a first trimester termination, experienced relapse of PPCM.Of the 13 women with a subsequent pregnancy, 62% had prior to this been advised against a new pregnancy due to the risk of recurrent PPCM. A total of four women (6.6%) were sterilized.ConclusionPPCM affects women's reproduction with few subsequent pregnancies resulting in a live-born child. The finding of a 1/7 relapse among women with recovered LVEF is in accordance with most previous studies.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-06T11:15:35.36599-05:0
      DOI: 10.1111/1471-0528.15046
  • Safety of the balloon catheter for cervical ripening in outpatient care:
           complications during the period from insertion to expulsion of a balloon
           catheter in the process of labour induction: a systematic review
    • Authors: M Diederen; J S M Gommers, C Wilkinson, D Turnbull, B W J Mol
      Abstract: BackgroundIt has been suggested that cervical ripening with a balloon catheter for labour induction can be done in an outpatient setting in low-risk pregnancies. Introduction of such an approach needs to be accompanied with monitoring of potential complications. Therefore the existence and frequency of any associated adverse event during cervical ripening needs to be established.ObjectiveTo assess the complication rate during cervical ripening with balloon induction.Search strategyWe searched Embase, Medline, Cochrane Collaboration and CINAHL using keywords ‘induction of labour’, ‘cervical ripening’, ‘balloon catheter’, ‘Foley balloon’, ‘transcervical balloon’.Selection criteriaWe included randomized controlled trials and cohort studies containing original data on fetal and maternal morbidity in pregnant women during cervical ripening with a balloon catheter. Only articles of which authors were able to give data for this exact time frame were included.Data collection and analysisTwo reviewers assessed independently the eligibility of included studies, extracted data and performed a quality assessment. A meta-analysis was performed to calculate the estimated prevalence of the adverse events.Main resultsIn total 26 studies were included reporting on 8,292 women. The estimated prevalence of the analysed adverse events in the random effects model was between 0.0% and 0.26% of which ‘pain/discomfort’ had the highest prevalence.ConclusionThis study suggest the risk of adverse events during the period between insertion and expulsion of a balloon catheter in cervical ripening to be low. These data facilitate further evaluation and implementation of this procedure in an outpatient setting for low risk pregnancies.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-06T11:02:16.841761-05:
      DOI: 10.1111/1471-0528.15047
  • Implications of failure to achieve a result from prenatal maternal serum
           cell-free DNA testing: a historical cohort study
    • Authors: N Chan; M-E Smet, R Sandow, F Silva Costa, A McLennan
      Abstract: ObjectiveTo investigate the pregnancy outcomes in a cohort of women who failed to obtain a result in non-invasive prenatal testing (NIPT).DesignHistorical cohort study.SettingA multicentre private practice in Sydney, Australia.PopulationWomen who failed to obtain a result from NIPT (n = 131).MethodsThe maternal characteristics, antenatal investigations and pregnancy outcomes for these women were compared with those who obtained a result at the same practice and to the general Australian obstetric population.Main outcome measuresAntenatal investigations: pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotrophin (β-hCG), placental growth factor (PlGF), uterine artery pulsatility index (PI), mean arterial pressure (MAP). Pregnancy outcomes: chromosomal abnormality, pre-eclampsia, gestational diabetes, small-for-gestational-age (SGA), preterm delivery.ResultsOnly 1.1% of NIPT samples failed to return a result. This cohort was significantly older and had significantly increased weight compared with the general Australian obstetric population. Pregnancy outcomes were available for 94% of the cohort. There were significantly higher rates of chromosomal aneuploidies (6.5% versus 0.2%, P < 0.0001), pre-eclampsia (11% versus 1.5%, P < 0.0001) and gestational diabetes (23% versus 7.5%, P < 0.0001) compared with the general obstetric population. Rates of preterm delivery and SGA were elevated but did not reach significance. Antenatal investigations demonstrated decreased PAPP-A MoM (0.75 versus 1.14, P < 0.0001), decreased free β-hCG (0.71 versus 1.01, P < 0.0001) and increased uterine artery PI (1.79 versus 1.65, P = 0.02).ConclusionWomen who fail to obtain a result from NIPT are at increased risk of adverse pregnancy outcomes, in particular chromosomal aneuploidy, gestational diabetes and pre-eclampsia.FundingNone received.Tweetable abstractWomen who fail to obtain a result from cell-free DNA NIPT are at increased risk of adverse pregnancy outcomes.
      PubDate: 2017-12-06T02:30:29.126956-05:
      DOI: 10.1111/1471-0528.15006
  • Angiogenic factors: Potential to change clinical practice in
    • Authors: Ana Sofia Cerdeira; Swati Agrawal, Anne Cathrine Staff, Christopher W. Redman, Manu Vatish
      Abstract: Preeclampsia is a complex disease with significant maternal and fetal morbidity and mortality. Its syndromic nature makes diagnosis and management difficult. The field is rapidly evolving with the definition of preeclampsia being challenged by some organizations with proteinuria no longer being essential in the presence of other features. In the last decade angiogenic factors, in particular soluble fms-like tyrosine kinase 1 (sFlt-1), have emerged as important molecules in the pathogenesis of preeclampsia. Here we review the most recent evidence regarding the potential of these factors as biomarkers and therapeutic targets for preeclampsia.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-29T02:52:55.527942-05:
      DOI: 10.1111/1471-0528.15042
  • The incidence, characteristics, managements and outcomes of anaphylaxis in
           pregnancy: a population-based descriptive study
    • Authors: Stephen J McCall; Kathryn J Bunch, Peter Brocklehurst, Rhiannon D'Arcy, Kim Hinshaw, Jennifer J Kurinczuk, D Nuala Lucas, Benjamin Stenson, Derek Tuffnell, Marian Knight
      Abstract: ObjectiveThe aim of this study was to estimate the incidence of anaphylaxis in pregnancy and describe the management and outcomes in the UK.DesignA population based descriptive study using the UK Obstetric Surveillance System(UKOSS).SettingAll consultant-led maternity units in the UK.PopulationAll pregnant women who had anaphylaxis between 1st October 2012 and 30th September 2015. Anaphylaxis was defined as a severe, life-threatening generalised or systemic hypersensitivity reaction.MethodsProspective case notification using UKOSS.ResultsThere were 37 confirmed cases of anaphylaxis in pregnancy, giving an estimated incidence of 1.6(95%CI:1.1-2.2) per 100,000 maternities. Four cases of anaphylaxis were in women with known penicillin allergies: two received co-amoxiclav and two cephalosporins. Twelve women had anaphylaxis following prophylactic use of antibiotics at the time of a caesarean delivery. Prophylactic use of antibiotics for Group B Streptococcal infection accounted for anaphylaxis in one woman Two women died(5%), 14(38%) women were admitted to intensive care and seven women(19%) had one or more additional severe maternal morbidities, which included three haemorrhagic events, two cardiac arrests, one thrombotic event and one pneumonia. No infants died; however, in those infants whose mother had anaphylaxis before delivery(n=18) there were 7(41%) neonatal intensive care unit admissions, 3 preterm births and one baby was cooled for neonatal encephalopathy.ConclusionsAnaphylaxis is a rare severe complication of pregnancy and frequently the result of a reaction to antibiotic administration. This study highlights the seriousness of the outcomes of this condition for the mother. The low incidence is reassuring given the large proportion of the pregnant population that receive prophylactic antibiotics during delivery.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-29T02:05:39.829548-05:
      DOI: 10.1111/1471-0528.15041
  • Decisions about aneuploidy screening: why women's reasons are important
    • Authors: Dafina Petrova; Rocio Garcia-Retamero
      Abstract: Several tests exist that can help detect Down syndrome and other chromosomal disorders during the first weeks of pregnancy. Non-invasive prenatal testing (NIPT) is gaining popularity because of its improved accuracy over traditional screening methods and its improved safety compared to invasive tests that carry some risk of miscarriage. In a recent study conducted in Hong Kong, Cheng et al. recruited women at high or intermediate risk of Down syndrome according to their 1st or 2nd trimester screening.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-28T03:49:55.870556-05:
      DOI: 10.1111/1471-0528.15038
  • Preterm birth with placental evidence of malperfusion is associated with
           cardiovascular risk factors after pregnancy: a prospective cohort study
    • Authors: Janet m. Catov; matthew f. Muldoon, steven e. Reis, roberta b. Ness, lananh n. Nguyen, jose-miguel yamal, hyunsoo hwang, w. Tony parks
      Abstract: ObjectivePreterm birth (PTB) is associated with excess maternal cardiovascular disease risk. We considered that women with PTB and placental evidence of maternal malperfusion would be particularly affected.DesignPregnancy cohort study.SettingPittsburgh Pennsylvania, US.PopulationWomen with PTB (n=115) and term births (n=210) evaluated 4-12 years after pregnancy.MethodsCardiometabolic risk markers were compared in women with prior PTB vs. term births; preeclampsia and growth restriction cases were excluded. Placental evidence of maternal vascular malperfusion (vasculopathy, infarct, advanced villous maturation, perivillous fibrin, intervillous fibrin deposition), acute infection/inflammation (chorioamnionitis, funisitis, deciduitus), and villitis of unknown etiology (chronic inflammation) was used to classify PTBs.Main outcome measureCarotid artery intima-media thickness (IMT), fasting lipids, blood pressure (BP) and inflammatory markers measured after delivery.ResultsWomen with PTB and malperfusion lesions had higher total cholesterol (+13.5 mg/dl) and systolic BP (+4.0 mmHg) at follow up compared to women with term births, accounting for age, race, pre-pregnancy BMI, and smoking (p
      PubDate: 2017-11-28T03:02:22.751371-05:
      DOI: 10.1111/1471-0528.15040
  • Genetic linkage studies for the non-geneticist
    • Authors: Stephanie Romero
      Abstract: In this issue of BJOG, Bahia et al present the findings of a case control study evaluating progesterone receptor gene (PGR) alleles for a correlation with recurrent pregnancy loss (RPL). Genetic polymorphisms of the progesterone receptor have been studied with respect to influence on preterm birth rates, responsiveness to intramuscular progesterone injections, and non-obstetric outcomes such as migraines and breast cancer.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-28T02:56:00.656935-05:
      DOI: 10.1111/1471-0528.15039
  • Hospital variation in costs – a challenge to the value proposition
    • Authors: Aaron B. Caughey; Jonathan M Snowden
      Abstract: There is variation from clinician to clinician and institution to institution within the healthcare industry. This was identified by Wennberg in seminal work more than four decades ago.(Wennberg J. Science. 1973;182:1102-8) Since that time, variation in the provision of healthcare has been demonstrated in numerous settings and is thought to be related to the local and regional healthcare culture. Additionally, not only has a difference in health care utilization been demonstrated, but also health care costs.(Welch. N Engl J Med. 1993 Mar 4;328:621-7)This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-21T11:51:16.015273-05:
      DOI: 10.1111/1471-0528.15033
  • Pregnancy weight gain by gestational age and stillbirth: a
           population-based cohort study
    • Authors: Kari Johansson; Jennifer A Hutcheon, Lisa M Bodnar, Sven Cnattingius, Olof Stephansson
      Abstract: ObjectiveTo study the association between total and early pregnancy (
      PubDate: 2017-11-21T11:50:59.904592-05:
      DOI: 10.1111/1471-0528.15034
  • Coverage and Capacity: Addressing the ‘Night & Weekend
           Effect’ in Obstetrics
    • Authors: Brett D. Einerson
      Abstract: The Night & Weekend Effect, a phenomenon of higher morbidity in hospitals during off-hours, has been demonstrated across numerous medical specialties. Recently there has been an increased focus on whether such an effect exists in obstetrics. In this issue of BJOG, Reif and colleagues contribute data to this conversation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-21T02:05:28.853013-05:
      DOI: 10.1111/1471-0528.15032
  • Drug interactions between rifamycin antibiotics and hormonal
           contraception: A systematic review
    • Authors: Katharine B Simmons; Lisa B Haddad, Kavita Nanda, Kathryn M Curtis
      Abstract: BackgroundRifamycin antibiotics are commonly used for treatment of tuberculosis, but may reduce effectiveness of hormonal contraception (HC).ObjectivesTo determine whether interactions between rifamycins and HC result in decreased effectiveness or increased toxicity of either therapy.Search strategyWe searched MEDLINE, Embase, Cochrane and clinicaltrials. gov through May, 2017.Selection criteriaWe included trials, cohort, and case-control studies addressing pregnancy rates, pharmacodynamics, or pharmacokinetic (PK) outcomes when HC and rifamycins were administered together versus apart. Of 7291 original records identified, 11 met inclusion criteria after independent review by two authors.Data collection and analysisTwo authors independently abstracted study details and assessed study quality using the United States Preventive Services Task Force grading system. Findings are reported descriptively.Main resultsStudies only addressed combined oral contraceptives (COCs) and none reported pregnancy rates. Quality ranged from good to poor. Rifampin increased the frequency of ovulation in two of four studies, and reduced estrogen and/or progestin exposure in five studies. Rifabutin led to smaller PK changes than rifampin in two studies. Rifaximin and rifalazil did not alter hormone PK in one study each.ConclusionsNo studies evaluated pregnancy risk or non-oral HCs. PK and ovulation outcomes support a clinically concerning drug interaction between COCs and rifampin, and to a lesser extent rifabutin. Data are limited for other rifamycins.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-12T07:05:26.53599-05:0
      DOI: 10.1111/1471-0528.15027
  • Women's Preference For Non-Invasive Prenatal DNA Testing (NIPT) Versus
           Chromosomal Microarray After Screening For Down Syndrome: A Prospective
    • Authors: Yvonne Kwun Yue Cheng; Wing Cheong Leung, Tak Yeung Leung, Kwong Wai Choy, Rossa Wai Kwun Chiu, Tsz-kin LO, Ka Yin Kwok, Daljit Singh Sahota
      Abstract: ObjectiveTo examine preference for follow-up test in women screened high or intermediate risk in 1st or 2nd trimester Down syndrome screening.DesignProspective cohort study.SettingThree public hospitals in Hong Kong, China.SampleWomen with term high risk ≥ 1:250 (HR) or intermediate risk 1:251-1:1200 (IR).MethodsWomen screened high risk were asked to decide among 1) an invasive test plus chromosomal microarray (CMA) to obtain more detailed fetal genetic information, 2) a non-invasive cell free prenatal DNA screening (NIPT) to detect trisomies 13, 18 and 21 to avoid procedure related miscarriage, and 3) decline further testing. Women received standardized counselling, reporting times were identical, procedure miscarriage risk was 0.1-0.2% and that there was no charge. Women with risk between 1:251 -1:1200 (IR) were offered NIPT as a secondary screening test.Main Outcome MeasureNIPT uptake rate.ResultsThree hundred and forty-seven women were HR, 344(99.1%) opted for follow-up testing of which 216 (62.2%) chose NIPT. Five hundred and seven (82.6%) of 614 women with IR risk chose NIPT. Seven (21%) of 34 women with nuchal translucency ≥3.5mm opted for NIPT.ConclusionsIn a setting where reporting times are similar and there is no cost difference between options, approximately 60% of HR women would opt for NIPT offering simple but limited aneuploidy assessment over a diagnostic procedure with comprehensive and more detailed assessment.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-10T11:35:30.554695-05:
      DOI: 10.1111/1471-0528.15022
  • First trimester pre-eclampsia screening: why delay implementation'
    • Authors: Howard S Cuckle
      Abstract: In recent years, consensus has shifted on the efficacy of aspirin in pre-eclampsia prophylaxis. Meta-analysis of published trials has now shown unequivocally that, provided treatment begins
      PubDate: 2017-11-10T11:35:20.6017-05:00
      DOI: 10.1111/1471-0528.15021
  • Efficacy of antenatal corticosteroids in preterm twins: the EPIPAGE2
           cohort study
    • Authors: Déborah Palas; Virginie Ehlinger, Corinne I. Alberge, Patrick Truffert, Gilles Kayem, François Goffinet, Pierre-Yves Ancel, Catherine Arnaud, Christophe Vayssiere
      Abstract: ObjectivesTo investigate the efficacy of ACS therapy on short-term neonatal outcomes in preterm twins and further document the influence of the ACS-to-delivery interval.DesignEPIPAGE2 is a nationwide observational multicentre prospective cohort study of neonates born between 22 and 34 completed weeks of gestation.SettingAll French maternity units, except in a single administrative regions, between March and December 2011.Population750 twin neonates born between 24 and 31 weeks of gestation.MethodsExposure to antenatal corticosteroids was examined in 4 groups: single complete course with ACS administration-to-delivery interval ≤7 days, single complete course with ACS-to-delivery>7 days, repeated courses, or no ACS treatment.Main outcome measuresNeonatal outcomes analysed were severe bronchopulmonary dysplasia, periventricular leukomalacia or intraventricular haemorrhage grade III/IV, in-hospital mortality, and a composite indicator of severe outcomes.ResultsCompared with no ACS, in multivariable analysis, a single ACS course with administration-to-delivery ≤7 days was significantly associated with a reduced rate of periventricular leukomalacia or intraventricular haemorrhage grade III/IV (0.2; 0.1-0.5), in-hospital mortality (0.3; 0.1-0.6) and composite indicator (0.1; 0.1-0.3), whereas a single course of antenatal corticosteroids with administration-to-delivery>7 days did not significantly reduce the frequency of in-hospital mortality (0.7; 0.3-1.8). No significant differences in terms of benefit or risk were found when comparing repeated courses with a single complete course.ConclusionIn preterm twins, a single complete course of antenatal corticosteroids was associated with an improvement of severe neurological outcome, whereas reduced in-hospital mortality was seen only when the ACS-to-delivery interval was ≤7 days.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-08T20:00:25.264791-05:
      DOI: 10.1111/1471-0528.15014
  • A step-wise approach to developing indicators to compare the performance
           of maternity units using hospital administrative data
    • Authors: Rebecca S Geary; Hannah E Knight, Fran E Carroll, Ipek Gurol-Urganci, Edward Morris, David A Cromwell, Jan H der Meulen
      Abstract: Hospital administrative data are attractive for comparing performance of maternity units due to their often large sample sizes, lack of selection bias, and the relatively low costs of accessing these data compared to conducting primary data collection. However, using administrative data to develop indicators can also present challenges including varying data quality, the limited detail on clinical risk factors and a lack of structural and user experience measures. This review illustrates how to develop performance indicators for maternity units using hospital administrative data, including methods to address the challenges administrative data pose.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-06T04:55:04.223206-05:
      DOI: 10.1111/1471-0528.15013
  • A Prospective Cause of Death Classification System for Maternal Deaths in
           Low and Middle-Income Countries: Results from the Global Network Maternal
           Newborn Health Registry
    • Authors: Omrana Pasha; Elizabeth M McClure, Sarah Saleem, Shiyam Sunder, Adrien Lokangaka, Antoinette Tshefu, Carl L Bose, Melissa Bauserman, Musaku Mwenechanya, Elwyn Chomba, Waldemar A Carlo, Ana L Garces, Lester Figueroa, K Michael Hambidge, Nancy F Krebs, Shivaprasad Goudar, Bhalachandra S Kodkany, Sangappa Dhaded, Richard J Derman, Archana Patel, Patricia L Hibberd, Fabian Esamai, Constance Tenge, Edward A Liechty, Janet L Moore, Dennis D Wallace, Marion Koso-Thomas, Menachem Miodovnik, Robert L Goldenberg
      Abstract: ObjectiveTo describe the causes of maternal death in a population-based cohort in six low and middle-income countries using a standardized, hierarchical, algorithmic cause of death (COD) methodology.DesignA population-based, prospective observational study.SettingSeven sites in six low-middle income countries including the Democratic Republic of the Congo (DRC), Guatemala, India (2), Kenya, Pakistan and Zambia.PopulationAll deaths amongst pregnant women resident in the study sites from 2014 to December 2016.MethodsFor women who died, we used a standardized questionnaire to collect clinical data regarding maternal conditions present during pregnancy and delivery. These data were analyzed using a computer-based algorithm to assign cause of maternal death based on the International Classification of Disease - Maternal Mortality system (trauma, abortion-related, eclampsia, hemorrhage, pregnancy-related infection and medical conditions). We also compared the COD results to health care provider assigned maternal COD.Main Outcome MeasuresAssigned causes of maternal mortality.ResultsAmongst 158,205 women, there were 221 maternal deaths. The most common algorithm-assigned maternal COD were obstetric hemorrhage (38.6%), pregnancy-related infection (26.4%) and preeclampsia/eclampsia (18.2%). Agreement between algorithm-assigned COD and COD assigned by health care providers ranged from 75% for hemorrhage to 25% for medical causes coincident to pregnancy.ConclusionsThe major maternal COD in the Global Network sites were hemorrhage, pregnancy-related infection and preeclampsia/eclampsia. This system could allow public health programs in low and middle-income countries to generate transparent and comparable data for maternal COD across time or regions.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-01T21:26:20.671599-05:
      DOI: 10.1111/1471-0528.15011
  • Hospital Variation in Cost of Childbirth and Contributing Factors: A
           Cross-Sectional Study
    • Authors: Xiao Xu; Henry C Lee, Haiqun Lin, Lisbet S Lundsberg, Christian M Pettker, Heather S Lipkind, Jessica Illuzzi
      Abstract: ObjectiveTo examine hospital variation in cost of childbirth hospitalizations and identify factors that contribute to the variation.DesignCross-sectional analysis of linked birth certificate and hospital discharge data.Setting220 hospitals in California delivering ≥100 births per year.Population405,908 nulliparous term singleton vertex births during 2010-2012.MethodsCost of childbirth hospitalizations was compared across hospitals after accounting for differences in patient clinical risk factors. Relative contribution of patient sociodemographic, obstetric intervention, birth attendant, and institutional characteristics to variation in cost was assessed by further adjusting for these factors in hierarchical generalized linear models.Main Outcome MeasuresCost of childbirth hospitalization.ResultsMedian risk-standardized cost of childbirth was $7,149 among the hospitals (10th-90th percentile range: $4,760-$10,644). Maternal sociodemographic characteristics and type of birth attendant did not explain hospital variation in cost. Adjustment for obstetric interventions overall reduced within-hospital variance by 15.8% (P
      PubDate: 2017-11-01T03:45:42.710656-05:
      DOI: 10.1111/1471-0528.15007
  • Cervical Mucus Removal Prior To Intrauterine Insemination: a randomized
    • Authors: Mohammad Ahmed Maher; Tarek Mohammad Sayyed, Nabih Elkhouly
      Abstract: ObjectiveTo detect if removing the cervical mucus before performing intrauterine insemination (IUI) could improve pregnancy outcomes in patients with unexplained infertility.DesignProspective randomized study.SettingAn Egyptian University Hospital.PopulationSeven hundred fourteen couples with unexplained infertility who underwent intrauterine insemination (IUI) with or without cervical mucus removal.MethodsPatients were randomly allocated using computer-generated numbers into cervical mucus removal (removed from both internal and external os) or a non-mucus removal groups. Only participants were masked to group assignment.Main outcome measuresThe clinical pregnancy rate.ResultsDuring the period between November, 2014, and March, 2017, the mucus removal group included 361 patients and no-mucus removal group 353 patients. Difficult catheterization was encountered in 17 (4.1%) cases (12 among cervical mucus removal, and 5 among no mucus removal). 666 IUI cycles were completed while 48 cycles were either cancelled or lost in their follow-up. The clinical pregnancy rate was significantly higher in the mucus removal group (31.0% [n=112]) than in no-mucus removal group (21.8% [n=77]; P=0.005). Ovarian hyperstimulation developed in 33 (4.6%) cases; 18 among cervical mucus removal and 15 among no-mucus removal. All except one were of mild type that was managed as outpatient care.ConclusionsCervical mucus removal before IUI could improve pregnancy outcomes in women with unexplained infertility.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-27T15:15:47.848187-05:
      DOI: 10.1111/1471-0528.15003
  • Diffusion Tensor Imaging determines three-dimensional architecture of
           human cervix: a cross sectional study
    • Authors: James P. Nott; Eleftheria Pervolaraki, Al P. Benson, Elizabeth A. Bonney, James D. Pickering, Nafisa Wilkinson, Nigel A.B. Simpson
      Abstract: ObjectiveTo determine the microarchitecture of the cervix using high resolution diffusion-tensor (DT) magnetic resonance imaging (MRI).DesignCross-sectional study.SettingLeeds, United Kingdom.Population or SampleWomen undergoing hysterectomy for benign pathology.MethodsEx-vivo DT-MRI measurements were obtained using a 9.4T Bruker NMR on seven fixed human cervices obtained at hysterectomy. A deterministic fibre tracking algorithm was used to indirectly visualise underlying fibre organisation. Interregional differences in tissue structure were sought using quantitative measurements of diffusion.Main outcome measuresIdentification of an occlusive structure in the region corresponding to the internal cervical os.ResultsFibre tracking demonstrated two regions: an outer circular and inner longitudinal layer. The total circumferential tract volume (TV) was greatest in the proximal region of the cervix (TV: proximal= 271 ± 198 mm3, middle= 186 ± 119 mm3, distal= 38 ± 36 mm3). Fractional anisotropy (FA) and apparent diffusion coefficient(ADC) measurements were significantly different between regions in all samples (P < 0.0005), indicating greater tract density and organisation towards the internal os.ConclusionsFibre tracking infers a system of dense, well-defined, encircling fibres in the proximal region of the cervix, corresponding to the location of the internal os. These findings may provide evidence of specific anatomic microarchitecture within the cervix able to resist intrauterine forces associated with pregnancy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-26T11:31:41.772959-05:
      DOI: 10.1111/1471-0528.15002
  • First trimester screening for pre-eclampsia in Chinese pregnancies: Case
           control study
    • Authors: Yvonne Kwun Yue Cheng; Tak Yeung Leung, Lai Wa Law, Yuen Ha Ting, Kwok Ming Law, Daljit Singh Sahota
      Abstract: ObjectiveTo assess the potential of screening for pre-eclampsia (PE) in a Chinese population.DesignCase Control Study.SettingTeaching Hospital in Hong Kong.Population3,330 women having a viable singleton pregnancy attending 1st trimester Down syndrome screening.MethodsMean arterial pressure (MAP), bilateral uterine artery pulsatility index (UtA-PI), and placental growth factor (PlGF) were measured. Screening markers were transformed to multiple of the gestational median (MoM) and adjusted for maternal and pregnancy characteristics. MoM distributions in PE and non-PE pregnancies were compared published expected values. PE screening performance was assessed using area under receiver operating curves (AUROC).Main Outcome MeasuresPE detection rate.Results30 (0.9%) women developed either early (
      PubDate: 2017-10-15T04:20:39.235824-05:
      DOI: 10.1111/1471-0528.14970
  • Inadequate safety reporting in pre-eclampsia trials. A systematic
    • Authors: James M. N. Duffy; Martin Hirsch, Louise Pealing, Marian Showell, Khalid S. Khan, Sue Ziebland, Richard J. McManus,
      Abstract: BackgroundRandomised trials and their syntheses in meta-analyses offer a unique opportunity to assess the frequency and severity of adverse reactions.ObjectiveTo assess safety reporting in pre-eclampsia trials.Search strategySystematic search using bibliographic databases, including Cochrane Central Register of Controlled Trials, Embase, and MEDLINE, from inception to August 2017.Selection criteriaRandomised trials evaluating anticonvulsant or antihypertensive medication for pre-eclampsia.Data collection and analysisDescriptive statistics appraising the adequacy of adverse reaction and toxicity reporting.Main resultsWe included 60 randomised trials. Six trials (10%) were registered with the International Clinical Trials Registry Platform, two registry records referred to adverse reactions, stating “safety and toleration” and “possible side effects” would be collected. Twenty-six trials (43%) stated the frequency of withdrawals within each study arm and five (8%) trials adequately reported these withdrawals. Adverse reactions were inconsistently reported across eligible trials: 24 (40%) reported no serious adverse reactions and 36 (60%) reported no mild adverse reactions. The methods of definition or measurement of adverse reactions were infrequently reported within published trial reports.ConclusionsPre-eclampsia trials regularly omit critical information related to safety. Despite the paucity of reporting, randomised trials collect an enormous amount of safety data. Developing and implementing a minimum data set could help to improve safety reporting, permitting a more balanced assessment of interventions considering the trade-off between the benefits and harms.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-14T10:55:28.048506-05:
      DOI: 10.1111/1471-0528.14969
  • Epidemiology of infertility in China: a population-based study
    • Authors: Zehong Zhou; Danni Zheng, Hongping Wu, Rong Li, Suxin Xu, Yuefan Kang, Yunxia Cao, Xiujuan Chen, Yimin Zhu, Shuguang Xu, Zi-Jiang Chen, Ben Willem Mol, Jie Qiao
      Abstract: ObjectiveTo assess the current prevalence of and risk factors for infertility among couples of reproductive age in China.DesignPopulation-based cross-sectional study.SettingWe approached 25,270 couples in 8 provinces/municipalities, of whom 18,571 (response rate 74%, 18,571/25,270) were interviewed.PopulationCouples living together and married for more than 1 year, of whom the female spouse was 20-49 years old.MethodsWomen were approached via telephone and face-to-face conversation to complete the standardized and structured questionnaire by trained interviewers.Main outcome measuresPrevalence and risk factors of infertility.ResultsAmong women ‘at risk’ of pregnancy, the prevalence of infertility was 15.5% (2,680/17,275). Among 10,742 women attempting to become pregnant, the prevalence of infertility was 25.0% (2,680/10,742), which increased with age in the second population. Among women who failed to achieve pregnancy in the last 12 months, 3,470 finished our questionnaire about fertility care, and 55.2% (1,915/3,470) of them had sought medical help.Socio-demographic risk factors for infertility included lower educational level (aOR=3.4, 95%CI: 2.0-5.5) and employment (aOR=2.3, 95%CI: 1.9-2.9). Clinical risk factors were irregular menstrual cycle (aOR=1.8, 95%CI: 1.2 -2.5), light menstrual blood volume (aOR=1.6, 95%CI: 1.2-2.0), history of cervicitis (aOR=1.5, 95%CI: 1.2-2.0) and endometriosis (aOR=3.1, 95%CI: 1.1-9.3), previous stillbirth (aOR=2.1, 95%CI: 1.3-3.3) and miscarriage (aOR=2.7, 95%CI: 2.1-3.5). In addition, history of operation was a significantly risk factor of infertility.ConclusionsAmong couples of reproductive age in China, the prevalence of infertility was 25%, and almost half of the couples experiencing infertility had not sought medical help.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-14T02:50:42.183068-05:
      DOI: 10.1111/1471-0528.14966
  • Starting a uterus transplantation service: notes from a small island
    • Authors: H-K Tan; B-K Tan, L-K Tan, JI Olofsson, P Dahm-Kähler, M Brännström
      Pages: 404 - 406
      PubDate: 2017-11-17T01:51:07.878887-05:
      DOI: 10.1111/1471-0528.14968
  • Maternal prepregnancy obesity and the risk of shoulder dystocia: a
    • Authors: C Zhang; Y Wu, S Li, D Zhang
      Pages: 407 - 413
      Abstract: BackgroundResults from epidemiological studies about the association between maternal prepregnancy obesity and the risk of shoulder dystocia are inconsistent.ObjectiveTo evaluate the effect of maternal prepregnancy obesity on the risk of shoulder dystocia.Search strategyWe searched PubMed and the Web of Science database for all relevant studies up to 5 August 2016 and reviewed the reference lists of identified articles.Selection criteriaObservational studies that investigated the association between prepregnancy obesity and the risk of shoulder dystocia were included.Data collection and analysisA total of 20 articles involving 2 153 898 participants were included in this meta-analysis. A random-effects model was used to calculate the pooled relative risks (RRs) with 95% CIs.Main resultsFor obese versus nonobese, the pooled RR of shoulder dystocia was 1.63 (95% CI: 1.33–1.99). The findings remained significant in the cohort studies (RR = 1.57, 95% CI: 1.28–1.93) and case–control studies (RR = 2.70, 95% CI: 1.46–4.98). With regard to the subgroup ‘continents’, there was a significant association between obesity and the risk of shoulder dystocia in Europe (RR = 1.51, 95% CI: 1.18–1.92) and Asia (RR = 2.59, 95% CI: 1.15–5.83). The result from the sensitivity analysis for studies adjusted for gestational diabetes was significant (RR = 1.61, 95% CI: 1.05–2.47). The pooled RRs for obesity classes I, II and III versus nonobese were 1.29 (95% CI: 1.06–1.57), 1.94 (95% CI: 1.26–2.98) and 2.47 (95% CI: 1.56–3.93), respectively.ConclusionThis meta-analysis suggests that maternal prepregnancy obesity is associated with an increased risk of shoulder dystocia.Tweetable abstractA meta-analysis shows that maternal prepregnancy obesity increases the risk of shoulder dystocia.
      PubDate: 2017-09-08T06:35:51.067611-05:
      DOI: 10.1111/1471-0528.14841
  • Diagnostic accuracy of haptoglobin within ovarian cyst fluid as a
           potential point-of-care test for epithelial ovarian cancer: an
           observational study
    • Authors: AP Mahyuddin; L Liu, C Zhao, N Kothandaraman, M Salto-Tellez, BNK Pang, DGS Lim, L Annalamai, JKY Chan, TYK Lim, A Biswas, G Rice, K Razvi, M Choolani
      Pages: 421 - 431
      Abstract: ObjectiveTo investigate haptoglobin within ovarian cyst fluid (OCF) as a diagnostic biomarker for epithelial ovarian cancer (EOC) and develop an in vitro diagnostic point-of-care device test (IVDPCT) for use in the operating theatre.DesignRetrospective and prospective cohort study.SettingSouth-East Asia.PopulationWomen with suspicious ovarian cysts.MethodsProteomic, immunohistochemical and ELISA methods measured haptoglobin in OCF to differentiate benign and EOCs. Diagnostic performance of haptoglobin was compared with CA125, risk malignancy indices (RMI) and frozen section. Blinded validation of the IVDPCT was performed.Main outcome measuresPrediction of malignancy.ResultsHaptoglobin concentration measured by ELISA was 0.70 ± 0.09 mg/ml in patients with benign cysts (n = 87), 6.22 ± 0.53 mg/ml in early stage-EOC (n = 17), and 6.57 ± 0.65 mg/ml in late stage-EOC (n = 20). Haptoglobin in EOCs was significantly higher than in benign cysts (P 
      PubDate: 2017-09-04T04:41:37.231858-05:
      DOI: 10.1111/1471-0528.14835
  • Medical therapy for preventing recurrent endometriosis after conservative
           surgery: a cost-effectiveness analysis
    • Authors: B Wu; Z Yang, RG Tobe, Y Wang
      Pages: 469 - 477
      Abstract: ObjectiveTo assess the cost-effectiveness of different strategies, including gonadotropin-releasing hormone agonist (GnRH-a) and oral contraceptive therapy, for the prevention of endometriosis recurrence after conservative surgery.DesignCost-effectiveness analysis from a health care perspective.SettingA health-resource-limited setting in China.PopulationPatients who underwent conservative laparoscopic or laparotomic surgery for endometriosis.MethodsA Markov model was developed for the endometriosis disease course. Clinical data were obtained from published studies. Direct medical costs and resource utilization in the Chinese health care setting were taken into account. The health and economic outcomes were evaluated over a period from treatment initiation to menopause onset. Sensitivity analyses were carried out to test the impact of various parameters and assumptions on the model output.Main outcome measuresQuality-adjusted life years (QALYs) gained and costs from a health care perspective.ResultsThe incremental cost-effectiveness ratio of 6-month GnRH-a therapy compared with no therapy ranged from $6,185 per QALY in deep endometriosis to $6,425 with peritoneal endometriosis. A one-way sensitivity analysis showed considerable influential factors, such as remission rates and utility values. Probabilistic sensitivity analysis indicated that 6-month GnRH-a therapy is cost-effective in most cases at a threshold of $7,400/QALY, regardless of the type of endometriosis.ConclusionSix months of therapy with GnRH-a can be a highly cost-effective option for the prevention of endometriosis recurrence.Tweetable abstractGonadotropin-releasing hormone agonist is cost effective for the prevention of endometriosis recurrence.
      PubDate: 2017-07-26T00:10:51.608704-05:
      DOI: 10.1111/1471-0528.14786
  • Peripartum type B aortic dissection in patients with Marfan syndrome who
           underwent aortic root replacement: a case series study
    • Authors: S Sayama; N Takeda, T Iriyama, R Inuzuka, S Maemura, D Fujita, H Yamauchi, K Nawata, M Bougaki, H Hyodo, R Shitara, T Nakayama, A Komatsu, T Nagamatsu, Y Osuga, T Fujii
      Pages: 487 - 493
      Abstract: ObjectiveTo investigate pregnancy outcomes, especially the risk of pregnancy-related aortic dissection (AD), in patients with Marfan syndrome (MFS) after prophylactic aortic root replacement (ARR).DesignRetrospective case series study.SettingTertiary perinatal care centre at a university hospital.PopulationPregnant women fulfilling the revised Ghent nosology (2010) criteria for MFS who were managed at our institute.MethodsThe pregnancy outcomes of all patients with MFS managed at our institute between 1982 and September 2016 were reviewed retrospectively based on medical records.Main outcome measuresObstetrical management and complication including the incidence of AD throughout the peripartum period.ResultsAmong 22 patients (28 pregnancies) who had been managed as potential MFS or related disorders, 14 (17 pregnancies) fulfilled the revised Ghent nosology (2010) criteria for MFS and were enrolled in this study. Five patients (five pregnancies) had received ARR before conception: three (60%) developed type B aortic dissection [AD(B)] during the peripartum period, compared with only one of 10 patients (12 pregnancies) without ARR (P 
      PubDate: 2017-05-02T10:20:07.073048-05:
      DOI: 10.1111/1471-0528.14635
  • Pregnancy, Marfan syndrome, and type-B aortic dissection
    • Authors: MR Johnson; JW Roos Hesselink
      Pages: 494 - 494
      PubDate: 2017-07-17T23:16:59.776289-05:
      DOI: 10.1111/1471-0528.14781
  • The impact of a novel transendometrial approach for caesarean myomectomy
    • Authors: SY Huang; SW Shaw, SY Su, WF Li, HH Peng, PJ Cheng
      Pages: 495 - 500
      Abstract: ObjectiveTo evaluate the obstetric and surgical outcomes of a novel transendometrial approach for myomectomy during caesarean section in subsequent pregnancies.DesignLongitudinal panel study.SettingChang Gung Memorial Hospital, Taiwan, with approximately 5000 births per annum.PopulationPregnant women complicated with uterine myoma.MethodSixty-three pregnant women who received transendometrial myomectomy during the first caesarean delivery reported a subsequent live pregnancy and planned an elective repeat caesarean delivery.Main outcome measuresObstetric outcomes consisted of gestational age at birth, newborn weight, Apgar score, birthweight adequacy, uterine rupture, placental abruption, placenta praevia, placenta accreta, spontaneous preterm birth and preterm premature rupture of membranes. Surgical outcomes consisted of surgical time, blood loss, blood transfusion, postoperative fever, length of hospital stay and mean adhesion score.ResultThe mean gestational age at birth and newborn weight at the subsequent caesarean section were superior to those at the first caesarean delivery. Spontaneous preterm birth, small-for-gestational-age infants and preterm premature rupture of membranes occurred more often in the first pregnancy than in the subsequent pregnancy. The mean surgical time was shorter for the subsequent caesarean delivery than for the first caesarean delivery combined with myomectomy. The other surgical composite outcomes of blood loss, blood transfusion, postoperative fever, length of hospital stay and mean adhesion score were similar across the two stages of caesarean deliveries.ConclusionThe novel transendometrial approach for caesarean myomectomy may improve the obstetric outcomes of subsequent pregnancy without causing any additional immediate and long-term adverse surgical outcomes.Tweetable abstractTransendometrial caesarean myomectomy may improve future obstetric outcomes.
      PubDate: 2017-08-28T23:07:05.968654-05:
      DOI: 10.1111/1471-0528.14798
  • Caesarean myomectomy: TE or not TE'
    • Authors: KSJ Oláh
      Pages: 501 - 501
      PubDate: 2017-08-30T06:50:20.46934-05:0
      DOI: 10.1111/1471-0528.14807
  • Authors' reply re: Peripartum type B aortic dissection in patients with
           Marfan syndrome who underwent aortic root replacement: a case series study
    • Authors: Seisuke Sayama; Norifumi Takeda, Takayuki Iriyama, Ryo Inuzuka, Sonoko Maemura, Daishi Fujita, Haruo Yamauchi, Kan Nawata, Masahiko Bougaki, Hironobu Hyodo, Rieko Shitara, Toshio Nakayama, Atushi Komatsu, Takeshi Nagamatsu, Yutaka Osuga, Tomoyuki Fujii
      Pages: 502 - 503
      PubDate: 2017-08-10T23:45:26.610293-05:
      DOI: 10.1111/1471-0528.14778
  • Re: Peripartum type B aortic dissection in patients with Marfan syndrome
           who underwent aortic root replacement: a case series study
    • Authors: Matthew Cauldwell; Philip J Steer
      Pages: 502 - 502
      PubDate: 2017-08-09T02:15:17.651503-05:
      DOI: 10.1111/1471-0528.14777
  • Re: Medical therapy for preventing recurrent endometriosis after
           conservative surgery: a cost-effectiveness analysis
    • Authors: Saumya Pandey; Rajul Tyagi
      Pages: 503 - 504
      PubDate: 2017-08-24T02:15:17.848861-05:
      DOI: 10.1111/1471-0528.14816
  • Re: The impact of a novel transendometrial approach for caesarean
           myomectomy on obstetric outcomes of subsequent pregnancy: a longitudinal
           panel study
    • Authors: Saumya Pandey
      Pages: 504 - 505
      PubDate: 2017-09-04T05:00:35.963774-05:
      DOI: 10.1111/1471-0528.14848
  • Authors’ reply re: The impact of a novel transendometrial approach for
           caesarean myomectomy on obstetric outcomes of subsequent pregnancy: a
           longitudinal panel study
    • Authors: Po-Jen Cheng; Shang-Yu Huang
      Pages: 505 - 506
      PubDate: 2017-10-10T06:00:33.157676-05:
      DOI: 10.1111/1471-0528.14849
  • Re: Antenatal corticosteroids: it's all about timing
    • Authors: A Ridout; H Watson, R Best, A Shennan
      Pages: 506 - 507
      PubDate: 2017-10-05T01:30:24.176476-05:
      DOI: 10.1111/1471-0528.14915
  • Re: Antidepressant use in late gestation and risk of postpartum
           haemorrhage: a retrospective cohort study
    • Authors: Shunji Suzuki
      Pages: 507 - 508
      PubDate: 2017-10-26T23:31:14.730396-05:
      DOI: 10.1111/1471-0528.14928
  • Author's reply re: Changes in anti-müllerian hormone levels as a
           biomarker for ovarian reserve after ultrasound-guided high-intensity
           focused ultrasound treatment of adenomyosis and uterine fibroid
    • Authors: Tae-Eung Kim
      Pages: 508 - 509
      PubDate: 2017-11-17T01:56:05.314529-05:
      DOI: 10.1111/1471-0528.14979
  • Re: Changes in anti-müllerian hormone levels as a biomarker for ovarian
           reserve after ultrasound-guided high-intensity focused ultrasound
           treatment of adenomyosis and uterine fibroid
    • Authors: Vincent YT Cheung
      Pages: 508 - 508
      PubDate: 2017-11-17T01:50:19.517418-05:
      DOI: 10.1111/1471-0528.14977
  • Re: Inositol treatment of anovulation in women with polycystic ovary
           syndrome: a meta-analysis of randomised trials
    • Authors: Rachel Hibberd; Nick Raine-Fenning, Jim Thornton
      Pages: 509 - 509
      PubDate: 2017-12-06T01:01:29.150805-05:
      DOI: 10.1111/1471-0528.14991
  • Re: Insights from Outside BJOG. Research Snippets
    • Authors: David Hutchon
      Pages: 510 - 511
      PubDate: 2017-12-06T01:06:10.860914-05:
      DOI: 10.1111/1471-0528.14993
  • Author's reply re: Insight from outside BJOG. Research Snippets
    • Authors: Athol Kent
      Pages: 511 - 511
      PubDate: 2017-12-06T01:10:43.842266-05:
      DOI: 10.1111/1471-0528.14998
  • Re: Maternal prepregnancy obesity and the risk of shoulder dystocia: a
    • Authors: Lauren Jade Ewington; Siobhan Quenby
      Pages: 514 - 514
      PubDate: 2017-12-06T01:00:48.570691-05:
      DOI: 10.1111/1471-0528.15017
  • Re: Starting a uterus transplantation service: notes from a small island
    • Authors: Iori Kisu; Yusuke Matoba, Kouji Banno, Daisuke Aoki
      Pages: 515 - 516
      PubDate: 2017-12-06T01:00:31.754266-05:
      DOI: 10.1111/1471-0528.15018
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