INTRODUCTION:Thelarche is often the first sign of puberty initiation in girls. Although Tanner staging is widely used, it remains subjective. This study aimed to investigate the relationship between Tanner breast staging and anthropometric, breast ultrasound, and pelvic ultrasound parameters in healthy premenarcheal girls. MATERIAL AND METHODS:A cross-sectional study was conducted at Vilnius University Hospital Santaros Clinics (September 2023-July 2025), including 251 premenarcheal girls aged 7-13 years. Breast development was staged using Tanner criteria. Anthropometric and ultrasound parameters were recorded, including body circumferences, skinfolds, uterine and ovarian dimensions, and breast tissue thickness. Logistic regression identified predictors of pubertal stage, and model performance was evaluated using ROC analysis. RESULTS:A total of 251 girls (mean age 10.5 ± 1.8 years) were included. Thelarche (Tanner B2) occurred at a mean age of 10.7 years. Anthropometric parameters varied significantly across Tanner stages, with body circumferences demonstrating very large effect sizes, whereas skinfold thickness showed only medium effects. Pelvic ultrasound parameters exhibited even stronger associations with Tanner staging. In multivariable analysis, uterine body length (OR = 1.12 per mm, p = 0.004), uterine thickness (OR = 1.23 per mm, p = 0.003), left ovarian follicle count (OR = 1.39, p = 0.035), and right ovarian length (OR = 1.11, p = 0.013) independently predicted Tanner B2-B3 status, while a higher number of right ovarian follicles was inversely associated (OR = 0.72, p = 0.036). The logistic model accurately distinguished Tanner B2-B3 from B1, demonstrating excellent discriminatory ability (AUC = 0.924, 95% CI 0.889-0.959). CONCLUSIONS:Anthropometric and particularly pelvic ultrasound parameters are strong indicators of thelarche and early pubertal maturation. Our findings support the use of pelvic ultrasound as an objective, non-invasive adjunct to Tanner staging, especially in situations where visual breast assessment may be uncertain.
INTRODUCTION:Magnesium sulfate (MgSO4) administered before very preterm birth reduces the risk of cerebral palsy in surviving infants and is recommended in international guidelines. In April 2020, a national guideline for MgSO4 for fetal neuroprotection was introduced in Denmark. We evaluated clinical uptake and adherence following guideline implementation. MATERIAL AND METHODS:This retrospective medical chart review study included women who delivered at gestational age 24 + 0 to 31 + 6 weeks of gestation at nine different Danish hospitals between April 2020 and December 2023. These departments handled around 50% of all deliveries in Denmark in this period. Data were obtained from electronic medical records. The primary outcome was administration of MgSO4 for fetal neuroprotection among eligible women. Secondary outcomes included temporal trends in uptake, differences by gestational age and hospital size, and documented reasons for non-administration. Descriptive statistics were used to summarize uptake rates and patient characteristics, and comparisons were performed using appropriate statistical tests. RESULTS:A total of 583 eligible women were included. Overall, 481 women (83%) received MgSO4 for fetal neuroprotection; of these, 340 women (71%) received MgSO4 within 24 h of birth. Uptake was highest among women delivering before 28 weeks of gestation, where MgSO4 was administered in nearly all eligible cases. Among women delivering between 28 + 0 and 31 + 6 weeks, approximately one in five did not receive treatment. Uptake did not increase over the study period, suggesting early adoption followed by stable implementation. Large-volume hospitals demonstrated higher treatment rates compared with smaller hospitals. The most frequent reasons for non-administration were lack of guideline awareness/oversight at later gestational ages and rapid delivery or maternal/fetal instability at earlier gestations. CONCLUSIONS:Following the implementation of the national guideline, uptake of MgSO4 for fetal neuroprotection in Denmark was high but incomplete. Persistent gaps in treatment, particularly among women delivering after 28 weeks of gestation, indicate a need for targeted implementation strategies to improve adherence and ensure equitable neuroprotective care.
INTRODUCTION:Gestational diabetes mellitus (GDM) is associated with increased neonatal morbidity in singleton pregnancies, but evidence in multifetal pregnancies is limited. Current diagnostic thresholds are largely extrapolated from singleton data; It remains unclear whether plurality modifies GDM-associated neonatal and long-term offspring outcomes. We wanted to evaluate neonatal complications and long-term offspring healthcare utilization associated with GDM in multifetal versus singleton pregnancies, and to assess effect modification by plurality and the impact of gestational age at delivery. MATERIAL AND METHODS:This multicenter retrospective cohort study utilized electronic medical records across six university-affiliated medical centers in Israel (1/1/2010-6/30/2024). All live births at 22 weeks' gestation or later or with birthweight of >500 g were included. Four exposure groups were defined by plurality and GDM status (ICD-9 code 648.8x): singleton without GDM, singleton with GDM, multifetal without GDM, and multifetal with GDM. Short-term neonatal complications (neonatal hypoglycemia, neonatal ICU admission, respiratory distress, intraventricular hemorrhage, and growth abnormalities) and long-term offspring outcomes were assessed by hospital-based health-care utilization (e.g., neurology, ophthalmology, cardiology). Multivariable Firth logistic and ordinary least squares regression models were adjusted for maternal age, body mass index, parity, and fertility treatment. Additional models adjusted for gestational age were performed. False discovery rate correction and GDM-by-plurality interaction terms were applied. RESULTS:Of 134 517 pregnancies (136 579 live-born offspring) to 104 023 mothers, 10 605 singleton (7.9%) and 256 multifetal (0.2%) pregnancies were complicated by GDM. In multifetal pregnancies, GDM was not associated with increased short-term neonatal complications nor with lower adjusted odds of neonatal hypoglycemia (adjusted odds ratio [aOR], 0.30; 95% CI: 0.18-0.49), neurologic (aOR, 0.37; 95% CI: 0.24-0.59), or ophthalmologic (aOR, 0.49; 95% CI: 0.31-0.77) health-care utilization. Adjustment for gestational age attenuated associations for neonatal intensive care unit admission but did not fully explain interactions for hypoglycemia or selected long-term outcomes. Conversely, GDM in singleton pregnancies was associated with increased neonatal morbidity. CONCLUSIONS:Associations between GDM and neonatal and offspring outcomes differ by plurality. Risk stratification strategies derived from singleton pregnancies may not fully capture risk profiles in multifetal pregnancies.
INTRODUCTION:Cardiotocography (CTG) is used worldwide for fetal surveillance with the aim to detect fetal hypoxia and aid timely intervention. The method is associated with shortcomings; for example, low interobserver reliability and low specificity for fetal hypoxia. Fetal scalp blood sampling (FBS) is an adjunct method to improve the specificity for fetal acidemia. Given the updated Swedish CTG classification introduced in 2017, the aim of this study was to evaluate which fetal heart rate (FHR) patterns are most strongly associated with acidemia as determined by FBS. MATERIAL AND METHODS:An observational cohort study on all fetuses that during the year 2019 underwent indicated FBS during labor. The data were collected from the Stockholm-Gotland Perinatal cohort. CTG traces were retrospectively interpreted, focusing on the last hour prior to FBS. All analyses were made with the bedside meter Lactate Pro 2™, and a lactate concentration > 7.3 mmol/L was used as a proxy for fetal acidemia. RESULTS:During the study period, 1116 fetuses underwent FBS (8%-9% of the laboring population). Of the 1116, 148 (13%) had acidemia at the first FBS, and 38% had more than one FBS. The corresponding number of fetuses with acidemia at the last FBS was 239/1116 (21%). The FHR patterns with the strongest association with acidemia at FBS were fetal tachycardia and/or reduced variability with repetitive late decelerations (20% at 1st FBS, 34% at last FBS) or severe variable decelerations (22% at first FBS, 33% at last FBS). At the last FBS, 6/23 (26%) fetuses with a normal baseline frequency, normal variability, and non-repetitive decelerations since >60 min of the types severe variable or late had acidemia. These FHR patterns would be classified as normal with the current classification. CONCLUSIONS:Among high-risk fetuses with FHR patterns giving rise to FBS, the FHR patterns most often associated with fetal acidemia during labor are tachycardia and/or reduced variability combined with repetitive late or severe variable decelerations. All FHR patterns with the highest risk of acidemia are classified as abnormal in the current Swedish CTG classification system. However, longstanding milder FHR alterations warrant increased attention.
INTRODUCTION:To compare prenatal imaging phenotypes, primary structural anomalies, fetal growth restriction, and perinatal outcomes of umbilical-portal-systemic venous shunts between singleton and twin pregnancies. MATERIAL AND METHODS:This single-center historical cohort included fetuses with a prenatal diagnosis of an umbilical-portal-systemic venous shunt at Shanghai First Maternity and Infant Hospital from November 2019 to August 2023. The primary outcome was shunt subtype distribution by pregnancy type. Secondary outcomes were fetal growth restriction, primary structural anomalies, genetic findings, twin-specific complications, and perinatal outcomes. Shunts were classified as Type I, II, or III according to their vessel of origin. A post hoc analysis repeated the overall growth-restriction comparison after excluding fetuses with primary structural anomalies or abnormal genetic results. RESULTS:Sixty-three pregnancies, each contributing one fetus with UPSVS, were included: 37 singleton and 26 twin pregnancies. Twins were diagnosed earlier than singletons (22.7 ± 4.2 vs. 27.1 ± 5.4 weeks; p < 0.001). Subtype distribution differed between the groups: Type III predominated in singletons and Type II in twins (p < 0.001). Primary structural anomalies were found in 6/26 twins (23.1%) and 11/37 singletons (29.7%; p = 0.774). Genetic testing was performed in 44 fetuses, with abnormal results in 5/44 (11.4%). Fetal growth restriction was more frequent in twins (20/26, 76.9% vs. 17/37, 45.9%; p = 0.019). Among monochorionic pregnancies, 14/15 Type II cases had selective fetal growth restriction. The overall difference remained after fetuses with primary structural anomalies or abnormal genetic results were excluded (85.0% vs. 50.0%; p = 0.027). CONCLUSIONS:Shunt subtype distribution differed between singleton and twin pregnancies, and fetal growth restriction was more frequent in twins; primary structural anomaly rates were similar. Pregnancy type and chorionicity should be considered when interpreting prenatal findings. Larger studies with standardized postnatal imaging are needed to clarify prognosis and spontaneous closure.
INTRODUCTION:In 2020-2022, the maternal mortality rate in the United Kingdom rose to its highest level in nearly 20 years. This period coincided with the COVID-19 pandemic, when pregnant women were at increased risk of severe infection and death. After excluding deaths directly attributed to COVID-19, maternal mortality rates remained high, suggesting that disruptions to maternity and wider health services may have adversely affected outcomes. This study describes the patterns, causes and characteristics of maternal deaths in the UK before and during the pandemic. MATERIAL AND METHODS:The MBRRACE-UK database was used to identify all maternal deaths in the UK during or up to 6 weeks after pregnancy from 2014 to 2022. The pre-pandemic period was defined as January 2014 to February 2020 and the pandemic as March 2020 to December 2022. Data were cleaned and aggregated to permit analysis of small numbers. Maternal mortality rates and 95% confidence intervals were calculated using national maternity data as denominators. Comparisons were made between periods using chi-square tests and mortality rate ratios (RR). Analyses were conducted in Stata 17 with statistical significance set at p < 0.05. RESULTS:Maternal mortality rates were significantly higher during the pandemic compared to the pre-pandemic period (RR 1.46, 95% CI 1.25-1.71). Rates of all direct causes of maternal deaths increased during the pandemic with statistically significant increases in deaths due to thromboembolism (RR 1.69, 95% CI 1.11-2.57) and early pregnancy-related causes (RR 2.39, 1.02-5.61). During the pandemic, a greater proportion of women who died had mental health problems or experienced domestic abuse; a smaller proportion had pre-existing medical problems. Persistent inequalities were observed in maternal mortality rates for women living in deprived areas or belonging to ethnic minority groups. CONCLUSIONS:These findings indicate that the effects of the COVID-19 pandemic, including changes to service provision, were associated with increased rates of direct maternal death, underscoring the importance of maintaining equitable access to essential maternity services during future crises. The greater prevalence of mental health and social complexities amongst the women who died during the pandemic further highlights the need to improve equity in access and strengthen integrated maternity services.
INTRODUCTION:To report the prevalence of chromosomal anomalies in fetuses with a nuchal translucency (NT) between 3.0 and 3.4 mm and to assess the incremental yield of invasive prenatal diagnosis over cell-free DNA (cfDNA) in these fetuses. MATERIAL AND METHODS:MEDLINE, EMBASE, and The Cochrane Library were searched. Inclusion criteria encompassed fetuses with an NT between 3.0 and 3.4 mm undergoing prenatal invasive testing or postnatal genetic assessment. The observed outcomes included common trisomies such as Trisomy 21, 18, and 13, sex chromosomal anomalies (SCAs), rare autosomal anomalies, copy number variants detected by chromosomal microarray (CMA), and single-gene disorders. We also reported the rate of anomalies potentially detectable by cfDNA. Finally, we planned to perform a subgroup analysis involving cases with isolated NT between 3.0 and 3.4 mm, including only cases undergoing detailed first-trimester ultrasound assessment. A random-effects meta-analysis of proportions was utilized to analyze the data. RESULTS:Seventeen studies (7007 fetuses) were included. In fetuses with NT measurements between 3.0 and 3.4 mm, chromosomal anomalies were identified in 13.1% (95% CI 9.3-17.3). Common trisomies included Trisomy 21 at 8.0% (95% CI 5.1-11.5), Trisomy 18 at 1.0% (95% CI 0.6-1.7), and Trisomy 13 at 0.52% (95% CI 0.2-1.0) of all chromosomal anomalies. SCAs occurred in 0.58% (95% CI 0.4-0.8), while rare autosomal trisomies and pathogenic or likely pathogenic copy number variants (CNVs) were found in 0.27% (95% CI 0.1-0.6) and 2.5% (95% CI 1.3-3.9), respectively. Additionally, single-gene disorders detected via NGS/WES were reported in 5.7% (95% CI 3.3-8) of cases with NT between 3.0 and 3.4 mm. When examining only fetuses with an isolated NT between 3.0 and 3.4 mm, all chromosomal anomalies were identified in 12.4% (95% CI 7.9-17.7). CONCLUSIONS:Fetuses with an NT between 3.0 and 3.4 mm showed a high rate of chromosomal anomalies and CNVs, most of which could potentially be detected through cfDNA.
INTRODUCTION:Evidence suggests that physical exercise may help prevent gestational diabetes mellitus, although available clinical trials are limited by small sample sizes and low adherence. Strength training may achieve higher adherence rates, but its preventive effect has not been sufficiently evaluated in randomized clinical trials. The objective of this trial is to evaluate the effect of a strength training program in pregnant women with overweight or obesity on the incidence of gestational diabetes mellitus and other outcomes (obstetric and quality of life). MATERIAL AND METHODS:A randomized clinical trial including 209 pregnant women (body mass index ≥25 kg/m2). The intervention group followed a strength training program from gestational weeks 12-14 until week 36 or delivery, combining supervised and home-based sessions. The primary outcome was gestational diabetes incidence; secondary outcomes included gestational weight gain, macrosomia, physical activity, quality of life, and pregnancy symptoms. Trial Registration ClinicalTrials.gov NCT05840497. RESULTS:Forty-eight per cent of participants in the intervention group achieved the adherence target. The intervention group showed lower incidences of gestational diabetes and hydramnios, with absolute risk differences of -5.3% (95% CI: -12.5 to 0.5; p = 0.07) and -4.5% (95% CI: -11.0 to 2.0; p = 0.05), respectively. No significant differences in fetal macrosomia were observed in the intention-to-treat analysis. In the per-protocol analysis, the incidence of GDM was 0% in the adherent intervention group and 7.3% in the control group (risk difference -7.3 [95% CI: -14.3, 3.0]; p = 0.09), and no cases of macrosomia were recorded in the adherent intervention group, compared with 6.3% in the control group (difference -6.3 [95% CI: -13.1 to 4.5]; p = 0.1). The intervention group showed significant improvements in quality of life (mean difference: 8.4; 95% CI: 4.9-11.9; p < 0.001) and reported lower frequency and impact of pregnancy symptoms. No differences were observed in adverse events, including preterm birth. CONCLUSIONS:Strength training during pregnancy improved maternal quality of life and reduced pregnancy-related symptom burden. Although the primary outcome did not reach statistical significance, consistent trends toward lower rates of gestational diabetes and related outcomes, particularly among adherent women, suggest a potential preventive effect that should be confirmed in larger trials.
INTRODUCTION:Fetal growth and birthweight are influenced by various endogenous and exogenous factors during pregnancy. Pregnant women with obesity face higher rates of complications, which can impact fetal growth. This study aims to explore how gestational weight gain and metabolic factors, such as HbA1C and adipokines, are associated with fetal growth in the second and third trimesters and with birthweight in Norwegian women with a pregestational BMI ≥35 kg/m2. MATERIAL AND METHODS:We conducted a prospective longitudinal cohort study at the Department of Gynecology and Obstetrics at Drammen Hospital from 2016 to 2019. We included 163 pregnant women (nulliparous 47.6%) with pregestational BMI ≥35 kg/m2 and singleton pregnancy, excluding type 1 and 2 diabetes. Gestational weight gain (GWG) was calculated as the difference between pregestational weight and the last weight before delivery. Fetal growth was monitored via ultrasonography at five time points, alongside fasting metabolic samples withdrawn around 18 and 36 weeks' gestation. Statistical analyses were conducted using linear regression in Stata Version 17.0. RESULTS:Mean birthweight was within normal ranges (mean z-score 0.117). However, the proportions of LGA (18.4%) and SGA (12.9%) were high. One in three women was diagnosed with GDM, of whom approximately one in three needed medical treatment. In the adjusted multivariate analyses, only HbA1C measured around gestational week 36 and the weekly weight gain remained positively associated with birthweight, biparietal diameter, and mean abdominal diameter. CONCLUSIONS:In this population of pregnant women with pBMI ≥35 kg/m2, weekly GWG calculated from weight measurement around 36 weeks' gestation was positively associated with birthweight (z-score), mean abdominal diameter (MAD), and biparietal diameter (BPD). HbA1C was positively associated with birthweight (z-score). Our results indicate that HbA1C and the modifiable GWG are exposures with the potential to influence fetal growth and birthweight. Nevertheless, current follow-up protocols do not routinely emphasize these factors. Their evaluation therefore warrants further investigation.
When the COVID-19 pandemic emerged, pregnant women were quickly identified as a high-risk group. It became a priority to clarify any risks associated with COVID-19 infection, and later vaccination, to pregnant women and their offspring. The Nordic registries constituted unique resources to quickly answer these questions. Our findings from the Nordic registries demonstrated that pregnant women with COVID-19 face a higher risk of hospitalization compared to non-pregnant women of reproductive age, and a higher risk of venous thromboembolism and stillbirth. However, the majority of studies proved no COVID-19 associated risks of adverse pregnancy outcomes. We also provided reassuring evidence indicating no increased risk of miscarriage, stillbirth, congenital malformations, preterm birth, or other adverse neonatal outcomes in children born to mothers vaccinated against COVID-19 during pregnancy. In this commentary, we highlight both opportunities and methodological challenges when using the Scandinavian health registries during an ongoing pandemic crisis.
INTRODUCTION:Globally, 1 in 5 maternal deaths are attributable to major postpartum hemorrhage (PPH), despite widespread uterotonic use. Intrauterine tamponade is recommended as second-line therapy for refractory atonic PPH. Uterine balloon tamponade (UBT) achieves hemostasis through intrauterine pressure. Conversely, the vacuum-assisted hemorrhage-control device (VHD) promotes uterine contraction through negative pressure. Limited data compare these modalities. We compared the clinical effectiveness of UBT and VHD in refractory atonic PPH. MATERIAL AND METHODS:This retrospective cohort study was conducted at the National University Hospital in Singapore and included all women treated for primary PPH with either the UBT or VHD between January 2020 and September 2025, during which ROTEM-guided transfusion and E-MOTIVE-aligned practices were implemented. The composite morbidity endpoint, comprising transfusion of ≥4 units of packed red blood cells (PRBC), plasma or cryoprecipitate administration, examination under anesthesia, high dependency or intensive care unit admission, or device failure was compared between groups with logistic regression adjusted for placenta previa major and cesarean delivery. RESULTS:Fifty-three women met inclusion criteria (33 UBT, 20 VHD). The composite morbidity outcome occurred less frequently with VHD than UBT (45.0% versus 75.8%; unadjusted OR 0.26, 95% CI 0.08-0.86, p = 0.03); after adjusting for placenta previa major and cesarean delivery, this difference was no longer statistically significant (adjusted OR 0.38, 95% CI 0.10-1.41, p = 0.15). Baseline characteristics were similar except for higher rates of placenta previa (45.5% versus 5.0%) and cesarean delivery (78.8% versus 50.0%) in the UBT group. Median estimated blood loss at device insertion was comparable (1500 mL). Among secondary outcomes, VHD was associated with lower median PRBC transfusion (1 vs. 2 units, p = 0.009), fewer women receiving ≥4 PRBC units (5.0% versus 36.4%, p = 0.02), fewer plasma transfusions (5.0% versus 36.4%, p = 0.02), shorter device indwelling duration (10.1 versus 24.3 h, p < 0.001), shorter hospital stay (54 versus 72 h, p = 0.007), and fewer high-dependency admissions (45.0% versus 72.7%, p = 0.04). CONCLUSIONS:The VHD demonstrated outcomes comparable to balloon tamponade in managing refractory atonic PPH, with lower transfusion requirements and shorter hospitalization. VHD may be a useful component of standardized PPH protocols incorporating the E-MOTIVE bundle and ROTEM-guided transfusion, warranting further evaluation in broader clinical settings.
INTRODUCTION:Intravaginal products, including silicon dioxide-based gels, are marketed to support short-term high-risk human papillomavirus (hrHPV) clearance or loss of detectability, but independent randomized evidence testing these short-term claims against observation is limited. We evaluated whether daily intravaginal silicon dioxide-based gel treatment increases the proportion of women with no detectable cervical hrHPV DNA compared with observation alone. MATERIAL AND METHODS:This prospective, single-center, parallel-group, randomized, open-label controlled trial included women with PCR-confirmed cervical hrHPV infection and no indication for immediate treatment. Participants were randomized 1:1 to 3 months of self-administered daily intravaginal gel treatment or observation alone. The primary outcome was absence of detectable cervical hrHPV DNA by PCR at 3 months. Secondary outcomes during the randomized study period were patient-reported satisfaction and adverse events. TRIAL REGISTRATION:ClinicalTrials.gov, NCT05509413, https://clinicaltrials.gov/study/NCT05509413. RESULTS:Between November 2022 and January 2025, 242 women were randomized, with 121 allocated to each group. Primary-endpoint data were available for 208 women. At 3 months, hrHPV DNA was not detected in 18/99 women (18%) in the gel treatment group and 23/109 women (21%) in the observation group (absolute risk difference -2.9 percentage points, 95% CI -14 to 8; p = 0.60). A reduced post hoc adjusted sensitivity analysis did not materially change the interpretation of the primary comparison. Patient-reported adverse events were more frequent in the gel treatment group than in the observation group (32/99 [32%] vs. 2/106 [2%]; absolute risk difference 30 percentage points, 95% CI 21 to 40; p < 0.001). Satisfaction scores were high in both groups but lower with gel treatment. CONCLUSIONS:In this randomized trial, 3 months of daily intravaginal silicon dioxide-based gel treatment did not improve short-term loss of detectable cervical hrHPV DNA compared with observation alone. The trial did not reproduce the large short-term virologic benefit suggested by prior product-related studies. The findings do not support routine use of this intervention solely to promote short-term hrHPV non-detectability in women without an indication for immediate treatment, particularly given the higher frequency of local adverse events.
INTRODUCTION:A transabdominal cerclage is inserted to prevent recurrent midtrimester loss and spontaneous preterm birth. The transabdominal cerclage often remains as a permanent foreign body for years. Synthetic materials within the abdomen, cesarean birth, and prior adverse pregnancy outcomes have each been associated with long-term complications or poorer health-related quality-of-life. However, the long-term effects of a permanent transabdominal cerclage have not been investigated. We aimed to evaluate patient-reported late effects and health-related quality-of-life in Danish women who underwent transabdominal cerclage between 2004 and 2025. MATERIAL AND METHODS:In this nationwide cohort study, women with a transabdominal cerclage were matched in a 1:1:1 ratio to two comparison groups: (1)women without transabdominal cerclage who had a cesarean birth, and (2)women without transabdominal cerclage who had a non-instrumental vaginal birth and no prior cesarean birth. Participants completed validated questionnaires assessing quality-of-life, anxiety and depression, bladder discomfort, pelvic pain and sexual health. The primary outcome was the General Health scale in SF-36. Domain- and total scale scores were compared between the groups using multiple linear regression. The study was pre-registered on clinicaltrials.gov (NCT06875401). RESULTS:Two hundred three women with a transabdominal cerclage, 90 with a cesarean section, and 98 with a vaginal birth participated. The mean General Health score did not differ between groups by a predefined minimally important difference of 10 points. Adjusted mean differences were - 4.0 points (95% CI -9.5-1.4) for women with cesarean birth and -0.6 (95% -CI-6.2-4.9) for women with vaginal birth in comparison to the transabdominal cerclage group. Mental health, bladder discomfort, pelvic pain, and sexual health symptom burdens were similar between groups. Response rates were higher in the transabdominal cerclage group, which may have introduced selection bias. Cerclage-related complications leading to suture removal after completed pregnancies were rare (3/203 women, 1.5%). Quality-of-life scores tended to be higher with longer time since cerclage procedure. CONCLUSIONS:Permanent transabominal cerclage was not associated with poorer self-reported general health compared with women without transabominal cerclage, regardless of mode of birth. These findings support that a permanent transabominal cerclage does not appear to have long-term negative health effects.
INTRODUCTION:The objective of this study is to evaluate, in fetuses with early-onset fetal growth-restricted (FGR) requiring delivery before 30 weeks, the relationship between the longitudinal Doppler changes and severe morbidity and mortality. MATERIAL AND METHODS:A retrospective cohort was constructed of singleton pregnancies between January 2013 and December 2021 with antenatal suspicion of FGR, born before 30 weeks in a single tertiary center in Barcelona (Hospital Sant Joan de Déu and Hospital Clínic). A total of 103 cases of FGR fetuses were included. Accurate anatomical examination, fetal biometry, and prenatal Doppler ultrasound examination were performed by experienced operators. The association between the intervals from diagnosis to abnormal Doppler and severe adverse outcome was evaluated with Cox and logistic regression, adjusted for gestational age at onset and preeclampsia. The primary outcome was a composite of severe adverse outcomes defined as mortality or severe neurological morbidity. RESULTS:Among the 83 pregnancies with ductus venosus (DV) pulsatility index (PI) ≤95th centile at admission, the median time to a DV PI >95th centile was 16 days in pregnancies presenting severe adverse outcomes and 20 days in those without (p = 0.007). Among the 64 pregnancies with a positive umbilical artery (UA) end-diastolic velocity (EDV), the median time to be absent/reversed was 11 days in pregnancies presenting severe adverse outcome and 14 days in those without (p = 0.016). Among the 86 pregnancies with nonreversed UA EDV, the median time to reversed flow was 18 days in pregnancies destined to present severe outcomes and 26 days in those without (p = 0.001). CONCLUSIONS:The prediction of mortality or severe morbidity could be better achieved with longitudinal Doppler assessment in FGR fetuses born before 30 weeks.
INTRODUCTION:Cervical carcinoma can be prevented by treating precancerous lesions, which are classified as low-grade (LSIL) and high-grade (HSIL) squamous intraepithelial lesions. Follow-up of patients diagnosed with LSIL or treated HSIL is typically conducted in secondary care by a gynecologist. However, this may also be conducted in a primary care setting at the general practitioner. This latter approach offers potential benefits such as lower healthcare costs and care closer to home. However, the effectiveness of follow-up by general practitioners is unknown. MATERIAL AND METHODS:This retrospective cohort study included patients diagnosed with LSIL or treated HSIL by the gynecologist, with no prior history of SIL or cervical cancer, who either underwent cytological follow-up at the gynecologist or the general practitioner. The primary outcome was loss to follow-up at 12 months for LSIL and 24 months for treated HSIL. RESULTS:A total of 691 patients were followed up by the gynecologist, and 1172 by the general practitioner. In the LSIL group, 38.1% (333/874) of patients followed up by a general practitioner were lost to follow-up at 12 months, compared with 16.6% (92/554) of those followed up by a gynecologist (p < 0.001). For treated HSIL, 44.3% (132/298) were lost to follow-up at 24 months in the general practitioner group, versus 24.1% (33/137) in the gynecologist group (p < 0.001). CONCLUSIONS:Follow-up by a general practitioner after a diagnosis of LSIL or treated HSIL is associated with nearly twice the rate of loss to follow-up compared to follow-up by a gynecologist.
