To evaluate publication patterns of Complex Benign Gynecology (CBG) scholarship in specialized and general Obstetrics and Gynecology (OB/GYN) journals and assess their association with indicators of subspecialty maturation within the OB/GYN publication ecosystem. Retrospective bibliometric analysis. Five major peer-reviewed gynecologic journals: Journal of Minimally Invasive Gynecology (JMIG), Fertility and Sterility (F&S), American Journal of Obstetrics and Gynecology (AJOG), BJOG, and Obstetrics & Gynecology (O&G). A total of 2,798 articles published between January 1, 2015, and December 31, 2025, identified through systematic searches for endometriosis, uterine fibroids, and chronic pelvic pain. Articles were stratified by Primary CBG Focus (disease as central objective) vs Secondary CBG Focus (disease as contextual variable). Publication volume, focus distribution, citation impact, and functional specialization were compared using chi-square tests, Kruskal-Wallis H tests, and multivariable regression models. The 5 journals demonstrated distinct publication patterns that were complementary in scope. Specialized journals (JMIG and Fertility and Sterility) had a higher proportion of primary CBG-focused (62-77%) articles, whereas general OB/GYN journals published a larger share of secondary CBG-focused content (62-83%). Across journals, primary CBG-focus was independently associated with approximately 28% higher citation counts after adjustment for journal and publication year. JMIG contributed the largest volume of CBG publications but had lower per-article citation rates compared with the general and reproductive journals, consistent with its narrower subspecialty scope and audience. OB/GYN journals together support a collaborative publication environment for CBG scholarship, with subspecialty journals emphasizing disease-focused content (reflected by a higher proportion of primary CBG-focus articles and greater overall CBG volume) and general journals disseminating CBG work to broader clinical audiences (reflected by higher field-weighted citation efficiency and annual citation rates). These patterns are consistent with an emerging, differentiated scholarly profile for CBG.
To co-produce a bespoke maternity care checklist for recently arrived migrant women in the UK. To use this to describe the maternity care received by recently arrived migrant women who died during or up to six weeks after pregnancy over the past decade in the UK, and generate hypotheses about areas for improvement. Confidential national review of medical records. Thirty-nine recently arrived pregnant or postnatal migrant women died in the UK between 2012 and 2021. Maternal deaths amongst recently arrived migrant women were identified using UK Confidential Enquiry into Maternal Deaths and Morbidity (MBRRACE-UK) data. A national case note review was conducted using a co-produced migrant maternity care checklist developed with input from service users. Assessment against the migrant maternity care checklist. Amongst those eligible for antenatal care, most (70%, n = 19/27) attended their first appointment after 13 weeks gestation. Amongst women needing an interpreter, 42% (n = 8/19) had professional interpreting services during antenatal care, 19% (n = 3/16) in intrapartum care, and 0% (n = 0/9) in postpartum care. Two fifths of women had documentation suggestive of discrimination or racism (41%, n = 16/39). Potential areas for improvement included access to formal interpreting services; access to first antenatal appointments before 13 weeks; and follow-up after non-attendance. Results should be interpreted with caution given the small number of women included and the descriptive and hypothesis generating nature of this paper. However, this study identifies areas of care that are important to women and professionals and could be prioritised for further research and improved practice.
Adverse maternal and perinatal outcomes such as preeclampsia, small-for-gestational age (SGA) and preterm birth remain major global health concerns. Beyond known high-risk placental features, emerging evidence suggests lateral placenta to be associated with impaired uteroplacental blood flow resulting in placenta dysfunction and adverse outcomes. A better understanding of these associations requires synthesizing both crude and adjusted effect estimates from available evidence. To comprehensively review and synthesize available evidence on the association between lateral placenta and adverse maternal and perinatal outcomes. MEDLINE (PubMed), EMBASE, Scopus and Cochrane CENTRAL were searched on 25th August, 2025. Studies that assessed the association between lateral placentation and adverse maternal and perinatal outcomes in singleton pregnancies. Data were independently extracted by two reviewers. The random-effects model was used to pool estimates of both crude and adjusted odds ratios (ORs) with corresponding 95% confidence interval (CI). Statistical heterogeneity was assessed by the I2 statistic and Cochran's Q test. Twenty one eligible studies with a total of 162 727 singleton pregnancies were included in the meta-analyses. Lateral placenta was associated with preeclampsia (OR = 1.65, 95% CI: 1.25, 2.19, I2 = 41.0%), SGA (OR = 1.40, 95% CI: 1.17, 1.68, I2 = 69.0%), preterm birth < 34 weeks (OR = 2.10, 95% CI: 1.62, 2.72, I2 = 0.0%), preterm birth < 37 weeks (OR = 1.50, 95% CI: 1.26, 1.80, I2 = 60.5%), retained placenta (OR = 2.52, 95% CI: 1.60, 3.95, I2 = 87.7%), and non-vertex foetal presentation at birth (OR = 1.50, 95% CI: 1.19, 1.89, I2 = 28.6%). Two individual studies reported independent association between lateral placenta and preeclampsia; with adjusted odds ratio (aOR) of 2.04 (95% CI: 1.28, 3.25) and 1.32 (95% CI: 1.04, 1.67). Pooled adjusted OR (95% CI) demonstrated increased odds of SGA (aOR = 1.84, 95% CI: 1.33, 2.53, I2 = 0.0%), and retained placenta (aOR = 4.43, 95% CI: 1.70, 11.53, I2 = 76.1%). Marginal increase in odds was noted for preterm birth < 34 weeks (aOR = 2.14, 95% CI: 1.34, 3.41, I2 = 0.00%) and preterm birth < 37 weeks (aOR = 1.54, 95% CI: 1.11, 2.13, I2 = 38.8%). Lateral placenta is associated with increased odds of preeclampsia, SGA, preterm birth, non-vertex foetal presentation, and retained placenta. After controlling for confounders, lateral placenta remained independently associated with increased odds of SGA, preterm birth, and retained placenta. More studies that adjust for confounders are, however, needed to further clarify and strengthen the evidence base of this independent association.
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Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality, with risk factors reported across a vast literature base fragmented between social and clinical factors. To develop a comprehensive conceptual framework of the strongest risk factors and their relationships contributing to pre-eclampsia incidence. Medline, Embase, Health Technology Assessments and Database of Abstracts of Reviews of Effects, Cochrane Library were searched. Reviews, randomized controlled trials and cohort studies (> 1000 participants), reporting social and clinical factors associated with pre-eclampsia were included. The strongest factors, defined as those with at least moderate strength of association and quality of evidence using GRADE, were compiled from our previously published individual frameworks to create a combined conceptual framework. Indirect associations were searched and the strongest indirect factors were added. The conceptual framework integrated 35 social and clinical determinants of pre-eclampsia. Key modifiable factors included BMI, interlinked with chronic hypertension/elevated blood pressure in early pregnancy, type 2 diabetes mellitus, and obstructive sleep apnoea, as well as antenatal care attendance, interconnected with maternal/work stress and prenatal micronutrient supplementation. Other modifiable factors included smoking, antiphospholipid syndrome, infection, exposure to occupational hazards, distance to health facility, maternal heat exposure in early gestation, and UV-B exposure. There are strong social factors alongside clinical factors associated with pre-eclampsia incidence. Interwoven relationships between factors highlight the multifactorial aetiology of pre-eclampsia. Many determinants were potentially modifiable, which provides actionable intervention points for clinical care and public health strategies.
To compare the efficacy, safety and tolerability of elagolix with dienogest in women with moderate-to-severe endometriosis-associated pain. A multicentre, double-blind, double-dummy, randomised, parallel-group, active-controlled, non-inferiority phase III study. Nineteen clinical centres across India. Women (18-49 years) diagnosed with endometriosis and experiencing moderate-to-severe pain. Participants were randomised (1:1) to receive oral elagolix (150 mg once daily) or dienogest (2 mg once daily) for 24 weeks. The primary outcome was change in endometriosis-related pain (Numeric Rating Scale [NRS]) from baseline to Day 85. Secondary outcomes included changes in NRS (Day 169), dysmenorrhoea, non-menstrual pelvic pain (NMPP) scores (Days 85 and 169), rescue medication use, patient global impression of change (PGIC), adverse events and bone mineral density. Of 340 patients screened, 230 were randomised (115 per group). At Day 85, both arms showed similar reductions in NRS pain scores with a treatment difference of 0.04 (95% CI: -0.3, 0.37) [p = 0.9747] demonstrating non-inferiority as upper 95% CI was below pre-specified margin of 1.5. At Day 169, both arms showed comparable improvements in overall pain, dysmenorrhoea and NMPP from baseline (p = 0.9372, p = 0.8884, and p = 0.9616, respectively). Rescue medication use and PGIC were comparable between treatment arms. Adverse event incidence was similar (elagolix: 14.8%; dienogest: 19.1%), with no serious TEAEs or discontinuations. No significant bone mineral density changes were observed. Elagolix demonstrated non-inferiority to dienogest with an acceptable safety and tolerability profile, supporting its use in managing endometriosis-associated pain. ClinicalTrials.gov identifier: CTRI/2023/01/049292.
To examine the risks of maternal, neonatal and non-obstetrical medical complications in individuals with cerebral palsy (CP) compared to those without CP. Population-based cohort study. Ontario, Canada. Females aged 13-54 years with a livebirth or stillbirth, 2004-2023. Individuals with (N = 1400) and without CP (N = 2 276 561) were compared using modified Poisson regression, adjusted for socio-demographics, followed by clinical characteristics. Maternal (e.g., severe maternal morbidity or mortality), neonatal (e.g., severe neonatal morbidity or mortality) and non-obstetrical medical complications (e.g., seizure disorders) in the perinatal period. After adjusting for socio-demographics, individuals with CP had an elevated risk, compared to those without CP, of severe maternal morbidity or mortality (adjusted relative risk [aRR] 1.79, 95% confidence interval [CI] 1.36-2.34), caesarean section (1.38, 1.27-1.50) and maternal hospital readmission (1.86; 1.34-2.58). Their newborns were at elevated risk for preterm birth (1.67, 1.43-1.94), small for gestational age (1.34, 1.19-1.52), congenital anomalies (1.77, 1.40-2.24) and severe neonatal morbidity or mortality (1.48, 1.28-1.71). Individuals with CP were also at elevated risk of seizure disorders (13.06, 10.45-16.33) and urinary tract infections (1.50, 1.25-1.79) perinatally. aRRs were slightly attenuated, but remained statistically significant after further adjusting for clinical characteristics. Individuals with CP are at elevated risk of adverse pregnancy outcomes. Findings suggest the need for enhanced preconception counselling, perinatal monitoring and postpartum supports for individuals with CP, facilitated by multidisciplinary care teams.
Unintended pregnancy and repeat abortion remain significant challenges in the field of reproductive health. To summarize evidence from systematic reviews and meta-analyses (SRMAs) comparing immediate versus delayed long-acting reversible contraception (LARC) insertion in postpartum and postabortion populations. Five databases were systematically searched in April 2025 without restrictions. SRMAs were included if they assessed the possible health outcomes between immediate and delayed LARC insertions for postabortion or postpartum populations. Pooled results were extracted as reported, with most effect sizes presented as relative risks (RRs) with 95% confidence intervals (CIs). Eligible SRMAs were assessed utilizing AMSTAR-2 for methodological quality. Evidence certainty was assessed by GRADE tool or predefined criteria. From 1998 screened records, nine SRMAs were included, yielding 92 comparisons. Compared with the delayed group, postpartum women in the immediate group had higher LARC initiation, higher 6-month LARC utilization and lower 6-month pregnancy rates (RR, 0.16; 95% CI, 0.04-0.71; moderate-certainty evidence). Similar comparison results of such outcomes were discovered in postabortion populations. However, immediate intrauterine device insertion significantly increased the risk of expulsion, especially in the vaginal delivery subgroup for postpartum populations (RR, 5.09; 95% CI, 2.04-12.73; high-certainty evidence) and in the first trimester subgroup for medical abortion populations (RR, 2.02; 95% CI, 1.37-2.98; moderate-certainty evidence). Compared with delayed insertion, immediate LARC placement after delivery (moderate-certainty) or abortion (low-certainty) was more effective in preventing unintended pregnancies. Additionally, abortion methods should be considered in future guideline updates, though supporting evidence was of low-certainty. PROSPERO number: CRD420251031374.
To determine the anatomical effect of pessaries in the upright position in women with pelvic organ prolapse (POP). Prospective observational cohort study. Outpatient clinic of our gynaecology department. Fifteen POP patients with successful ring-shaped pessary use. Upright magnetic resonance (MR) images of the pelvis were acquired before, immediately after insertion of their pessaries, and 1 week later. Distances from the lowest points of the bladder, cervix, and pessary to the pelvic inclination correction system (PICS) line were measured, as well as the angles of the uterus and pessary relative to the PICS in the midsagittal plane. Pessary insertion lifted the bladder's lowest point from 0.1 cm below to 0.6 cm above the PICS (p = 0.015), but it descended to 0.2 cm above the PICS 1 week later (p = 0.334). The cervix was lifted from 0.0 to 2.5 cm above the PICS (p < 0.001), which persisted after 1 week (p = 0.470). The angle between uterus and PICS increased after insertion from 97o to 115o (p = 0.008) and remained stable (113°, p = 0.198). Pessary position changed from 0.7 to 0.3 cm below the PICS in 1 week (p = 0.020); the angle did not change (56° to 54°, p = 0.820). Pessary insertion changes the pelvic organ position and angulation. After an initial lift, the effect on the bladder diminished after 1 week, while for the uterus it remained. This may suggest a role for uterus lift in relieving POP symptoms.
To evaluate if the effect of low-dose aspirin (LDA) commenced between 6 and 13 weeks of gestational age (GA) on preterm delivery (PTD) is modified by total exposure. Post hoc analysis of a randomized controlled trial. Hospitals in low-resource settings in Africa, Asia and Latin America. Outcomes were obtained for 11 908/11943 women at 6 0/7 to 13 6/7 weeks' GA randomized. Women received prepackaged two-week medication allotments. Adherence was assessed by pill counts every 2 weeks. Estimated relative risk and 95% confidence interval data for each outcome at each GA of treatment initiation weeks were obtained by fitting a Poisson model to each outcome, adjusting for site, treatment arm and GA at treatment initiation. The primary outcome was PTD. Secondary outcomes included PTD < 34 weeks and perinatal mortality including analysis by region. The median gestational age at treatment initiation was 10.1 weeks (IQR 8.6, 12.0). 85.5% of the mothers had over 90% adherence to treatment. For each 1 week increase of GA at treatment initiation, the treatment risk ratio did not change for PTD [RR 0.97 (95% CI, 0.93, 1.02)], PTD < 34 weeks [< 0.98 (0.89, 1.07)] or perinatal mortality [1.04 (0.96, 1.12)], with no evidence of effect modification. For each 5% increase in adherence, the treatment risk ratio did not change for PTD [1.01 (0.99, 1.04)], PTD < 34 weeks [< 0.99 (0.95, 1.03)] or perinatal mortality [1.02 (0.98, 1.06)], indicating no meaningful interaction with adherence. There was no effect modification by region. This analysis shows that the results of PTD, PTD < 34 weeks and perinatal mortality were not dependent on the timing of the initiation or adherence to treatment. ClinicalTrials.gov identifier: NCT02409680.
To quantify and compare the gestational age (GA)-specific risks of stillbirth across pre-pregnancy body mass index (BMI) categories, stratified by pre-pregnancy diabetes status: DESIGN: Retrospective population-based cohort study. United States from 2022 to 2023. Singleton live and stillbirths between 20 and 43 weeks' gestation. Data were obtained from the live birth and fetal death certificates available from the National Center for Health Statistics. We used Piecewise Additive Mixed Models to assess the GA-specific relationship between pre-pregnancy BMI and stillbirth in women with and without pre-pregnancy diabetes mellitus adjusted for confounders. Results were expressed as gestational age-specific adjusted hazard ratios (aHR), and weekly risk estimates from 37 to 40 weeks' gestation. Stillbirth. A total of 6 923 146 women were included of which 187 734 (2.7%) were underweight, 2 631 390 (38.0%) had normal BMI, 1 915 636 (27.7%) were overweight, and 1 169 109 (16.9%), 591 078 (8.5%), and 428 199 (6.1%) had obesity class I, II and III, respectively. Overall, stillbirth rates increased with increasing BMI and were higher in women with pre-pregnancy diabetes (16.6 per 1 000 total births) than those without these conditions (4.4 per 1 000 total births). The gestational age-specific associations between elevated BMI and stillbirth differed depending on the presence of pre-pregnancy diabetes across all gestational weeks. For example, at 31 weeks' gestation, the aHR for women with a BMI of 40 kg/m2 vs. 20 kg/m2 and diabetes was 0.68 (95% CI = 0.54 to 0.85), while the same aHR for a non-diabetic pregnancy was 1.22 (95% CI = 1.13, 1.33). Absolute risks were highest in diabetic women with class III obesity. Among obese women, the optimal gestational age for delivery depends on the presence of other risk factors such as pre-pregnancy diabetes.
To assess the internal consistency of the Hadlock normal range for estimated fetal weight (EFW) and its clinical implications. Methodological analysis and retrospective observational audit. Tertiary maternity hospital in Oxford, UK. Women with a non-anomalous singleton pregnancy. Reanalysis of the original Hadlock reference EFW chart using functional data analysis (FDA) and penalised functional regression (PFFR-GAM), and systematic bias assessment across gestation. Retrospective EFW centile analysis in a population of pregnancies undergoing a growth scan between 35 + 0 and 36 + 6 weeks, calculating the EFW centile using both the published reference chart (chart-derived centile) and the reported regression equation (equation-derived centile). Agreement between chart-derived and equation-derived centiles and the corresponding differences in classification of fetuses below the 3rd and 10th centiles. There is a statistically significant disparity between the chart-derived and equation-derived centiles, most pronounced in the 3rd and 10th centiles where clinical implications are critical. The 3rd and 10th chart-derived centiles approximately correspond to the 1st and 6th equation-derived centiles. Conversely, the equation-derived 10th centile corresponds to the chart-derived 17th centile. In a population of 21 874 pregnancies undergoing a growth scan between 35 + 0 and 36 + 6 weeks, the chart classified 4.2% as below the 10th centile, compared with 7.2% using the equation, with an absolute difference of 3.0% (95% CI 2.8%-3.3%; McNemar's test; p < 0.001). Also, the chart classified 0.8% under the 3rd centile, compared with 2.3% using the equation, with an absolute difference of 1.5% (95% CI 1.3%-1.7%; McNemar's test; p < 0.001). Systematic disparity exists between the published chart- and equation-derived centiles in the original Hadlock growth reference. The equation-derived centiles are closer to the expected nominal proportions of our population, whereas the chart-derived centiles significantly underestimate the incidence of small for gestational age.
To compare Vaginal Hysterectomy (VH) with Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) hysterectomy (VANH) as a day-care procedure. Single-blind, multicentre randomised controlled trial. Two Dutch non-academic teaching hospitals. Women aged ≥ 18 years undergoing hysterectomy for benign indications. Women were randomised 1:2 (VH or VANH). Primary outcome was SDD. Secondary outcomes included operative time, rate of elective salpingectomies, intraoperative blood loss, complications (Clavien-Dindo), pain scores (NRS) and analgesic use, post-operative recovery (RI-10), and quality of life (EQ-5D-5L). Analyses were performed on an intention-to-treat basis. A total of 113 patients were included in the analyses (n = 42 VH, and n = 71 VANH). SDD occurred significantly more frequently in the VANH group (87.3%) than VH group (71.4%; OR 2.76, 95% CI 1.04-7.25; p = 0.04). VANH was associated with a significantly shorter operative time (median 55 min versus 65 min; p = 0.005), less blood loss (median 50 mL vs. 150 mL; p < 0.001) and more often elective opportunistic salpingectomy compared to VH (100% vs. 77.4%; p = 0.008). NRS were significantly lower in the VANH group the first hour post-operative (3 vs. 1, p < 0.001). Post-operative complications (VH 9.5% vs. VANH 15.5%; p = 0.34), readmission (VH 4.8% vs. VANH 8.5%; p = 0.47), analgesic use, recovery, and quality of life were not statistically significant. VANH is a safe and effective alternative to VH, offering a higher likelihood of SDD, shorter operative time, reduced blood loss, and more often an elective salpingectomy, without increased complications or differences in pain, recovery, or quality of life.
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To assess the association between vasomotor symptoms of menopause and retirement in Australian women. Population-based cohort study. Secondary analysis of six surveys collected between 1996 and 2010. A total of 6928 Australian women, born between 1946 and 1951. Data were obtained from participants in the cohort born between 1946 and 1951 of the Australian Longitudinal Study on Women's Health. Between 1996 and 2010, self-reported longitudinal survey data were collected. Vasomotor symptoms, specifically hot flushes and night sweats, and retirement status were captured. Data were analysed by discrete time survival analyses using logistic regression. Odds of retirement. In fully adjusted analyses, women who experienced both hot flushes and night sweats reported higher odds of retirement compared to women with no vasomotor symptoms (Adjusted Odds Ratio (AOR) = 1.13, 95% CI: 1.03, 1.25). There was no significant association with retirement for women who experienced only hot flushes (AOR = 0.97, 95% CI: 0.85, 1.11) or only night sweats (AOR = 1.19, 95% CI: 0.94, 1.50), compared with those who experienced no symptoms. Combined menopausal vasomotor symptoms may contribute to women's retirement from the workforce. Improving access to effective symptom management, along with examining how workplace conditions shape women's experiences of menopause, may help guide strategies to support continued workforce participation in midlife.
To assess whether early antihypertensive treatment after Hypertensive Disorders of Pregnancy (HDP) influences subsequent development of cardiovascular complications. Population-based nationwide cohort of health data set in France. 108 906 women with HDP (excluding pre-existing Chronic Hypertension (CH)) who delivered between 2010 and 2014, with 35 878 (33%) receiving at least one antihypertensive treatment in the month after giving birth. Traditional Cox model, estimated 10-year cardiovascular risk. Extended Cox Step Function model and Restricted Mean Survival Time evaluated time trends. New-onset CH, heart failure, coronary, cerebrovascular, peripheral artery diseases and 2 composite events (one including CH, the other excluding it) over 10 years following giving birth. Women receiving early postnatal antihypertensive treatment had a higher long-term risk of complications over 10 years than non-treated women (CH: aHR = 3.067, 95% CI [2.996-3.139]; composite event including CH: aHR = 3.025 [2.956-3.096]; composite event excluding CH: aHR = 1.451 [1.305-1.614]). Treated women had events earlier than non-treated women, presenting a higher risk at the beginning of the postpartum period. The 10-year absolute risk for CH remained high in both groups: 44% for treated women and 18% for non-treated women. Our study shows that women receiving early postpartum antihypertensive treatment are at higher long-term cardiovascular risk, with 44% of them having CH within 10 years. Besides, approximately 1 in 5 women non-treated in the postpartum period subsequently developed CH, demonstrating that many high-risk women are not being identified in the peripartum period and may be missing opportunities for timely intervention.