BJOG: An International Journal of Obstetrics and Gynaecology

The use of synthetic mesh prostheses to treat pelvic organ prolapse (POP) remains highly controversial. Despite complete restriction on vaginally placed mesh in Australia and New Zealand (2017), the UK (2018), and the USA (2019), transvaginal mesh (TVM) prolapse repair remain widely in many countries, including China and most of East Asia. Sacrocolpopexy (SC) is widely considered as the gold-standard for surgical correction of vaginal vault prolapse. (Maher C et al,. Cochrane Database of Systematic Reviews 2016, Issue 11...

Correct clinical decision making that avoids unnecessary complications for the mother and the child, rests in differentiating when pre-eclampsia is present and when it is not. The first step is to always keep this condition in mind. There is no point in having the most up-to-date guidance if we do not recognize the palpebral edema of a pregnant woman that enters through our office door while looking at the computer screen. The second step is to achieve a diagnostic confirmation as soon as possible. The inaccuracy of the diagnostic criteria used - that are not based on the etiopathogenic knowledge - has been written about widely...

OBJECTIVE: We aim to compare the cost-effectiveness of the old cytology programme with the new high-risk human papillomavirus (hrHPV) screening programme, using performance indicators from the new Dutch hrHPV screening programme. DESIGN: Model-based cost-effectiveness analysis. SETTING: The Netherlands. POPULATION: Dutch 30-year-old unvaccinated females followed up lifelong. METHODS: We updated the microsimulation screening analysis (MISCAN) model using the most recent epidemiological and screening data from the Netherlands...

OBJECTIVE: To describe differences in outcomes between pregnant women with and without COVID-19 DESIGN: Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for SARS-CoV-2 using reverse transcriptase polymerase chain reaction (RT-PCR). All infants of mothers with COVID-19 underwent SARS-CoV-2 testing. SETTING: Three New York City hospitals POPULATION: Pregnant women > 20 weeks' gestation admitted for delivery METHODS: Data were stratified by SARS-CoV-2 result and symptomatic status, and summarized using parametric and nonparametric tests...

OBJECTIVE: To investigate the learning curve of robot-assisted laparoscopy in early stage cervical cancer and quantify impact on oncological outcomes. DESIGN: Observational cohort study. SETTING: Tertiary referral centre with one surgical team. POPULATION: All early stage cervical cancer patients treated consecutively with robot-assisted laparoscopy between 2007 and 2017. METHODS: With multivariate risk-adjusted cumulative sum analysis (RA-CUSUM), we assessed the learning curve of robot-assisted laparoscopy of a single surgical team based on cervical cancer recurrence...

Understanding patients' experiences of treatment and care is essential to effective service development, and is therefore a common topic of investigation for clinicians and health services researchers. For service development, different kinds of investigation may be useful for a different purpose. Closed measures of patient satisfaction (e.g. rating scales) are useful in providing reproducible measures in specified domains; however, they are often limited both by the scope of predefined questions, and the level of detail they provide on processes affecting reported outcomes...

Gestational diabetes mellitus (GDM) increases the risk for short-term adverse perinatal outcomes for mothers and their infants. In addition, women with GDM are at increased risk for type 2 diabetes, and their offspring also face long-term risk for diabetes and obesity. Women who develop GDM have a high rate of recurrence in subsequent pregnancies. However, prevention of GDM remains a significant challenge. Weight gain during pregnancy has not been consistently associated with development of GDM, and dietary and physical activity interventions have shown only modest benefit in reducing the risk for GDM...

Pelvic floor protection strategies have become are an important area of research. Our knowledge and understanding of such strategies continue to increase with the growing body of research in this area. Urinary incontinence is the most common pelvic floor disorder with prevalences up to 67% in parous women (Wesnes, S. L. et al.; Obstet Gynecol 2007;109;922-8). Risk factors for pelvic floor disorders such as age, body mass index and parity have been well established (Nygaard, I. et al.; JAMA 2008;300;1311-6)...

This paper briefly reviews the role of hypermethylation of host cell genes in cervical carcinogenesis and discusses potential clinical applications of methylation analysis in the management of high-risk HPV (hrHPV) positive women. We argue that methylation assays can be used: 1. for primary triage of hrHPV positive women to detect cervical cancer and advanced CIN; 2. as secondary triage for women with minor cytological abnormalities to identify those with the highest risk of CIN3 or worse; 3. as exit test for women leaving the screening programme to identify cervical cancer and advanced CIN; and 4...

OBJECTIVE: To evaluate the usefulness of a Doppler technology highly sensitive for low velocity flow in the antenatal imaging of the torcular herophili (TH) in the second trimester of pregnancy. DESIGN: Prospective study. SETTING: Referral Fetal Medicine Unit. POPULATION: Non-consecutive series of singleton pregnancies submitted to antenatal neurosonogram between 20 and 28 weeks of gestation. METHODS: A midsagittal section of the fetal brain was obtained by insonating through the anterior fontanelle, then the MV-FlowTM and LumiFlowTM presets were selected in order to visualize the TH as the posterior confluence of the superior sagittal sinus and the straight sinus...

BACKGROUND: Excessive blood loss is a significant risk of myomectomy with the potential need for hysterectomy. OBJECTIVE: To study the effectiveness of preoperative misoprostol compared to placebo at open myomectomy on intra- and postoperative outcomes. SEARCH STRATEGY: Pubmed, Cochrane, Scopus, Medline, and EMBASE. SELECTION CRITERIA: Randomised control studies of women undergoing open myomectomy for symptomatic fibroids who were given either misoprostol or placebo preoperatively...

We are all likely to need a blood test, a biopsy or wind up on the wrong end of an endoscope. We know that the experience is not going to be pleasant. Many of us will revert to techniques to divert attention away from painful stimuli, such as counting forwards or backwards in our heads, deep breathing, imagining tranquil places or listening to music. But the paper published in this issue of BJOG by (Neo D et al, BJOG 2020; xxxx) shows us how we can distract patients in a more sophisticated way, using virtual reality (VR) technology...

OBJECTIVE: Evaluate clinical effectiveness of the first trimester combined (FMF) pre-eclampsia screening programme when implemented in a public healthcare setting. DESIGN: Retrospective cohort study. SETTING: London tertiary hospital from January 2017 to March 2019. METHODS: 7720 women screened for pre-eclampsia according to National Institute for Health and Care Excellence (NICE) risk-based guidance and 4841 by the Fetal Medical Foundation (FMF) algorithm which combined maternal risk factors, blood pressure, PAPP-A and uterine artery Doppler indices in the first trimester...

Global estimates for 2017 indicated that there were 295,000 maternal deaths, 35 per cent lower than in 2000 with a decline in global maternal mortality ratio from 342 to 211 deaths per 100,000 live births (World Health Organization (WHO) 2019). Maternal hemorrhage is the leading direct cause of maternal death worldwide, representing 27% (20-36) of maternal deaths ( Say L, et al. Lancet 2014). Multiple large retrospective population cohorts have identified risk factors invariably associated with maternal hemorrhage including mode of delivery, prolonged labor, chorioamnionitis, and twins among others (Briley A, et al...

Effective Cervical screening involves a complex sequence of interactions between women, clinical staff and systems. Even in well organised screening programmes, achieving high population coverage is challenging. The transition to using Human Papilloma Virus (HPV) testing as the primary screening modality, rather than cytology, has introduced the possibility of using a self-collected sample for the primary HPV test. This has been shown to be a reliable method of detecting CIN2+ (Polman et al, Lancet Oncology 2019;20(2):229-38)...

No abstract text is available yet for this article.

OBJECTIVE: We hypothesized that a multi-compartment MRI technique that is sensitive to fetal blood oxygenation would identify changes in placental blood volume and fetal blood oxygenation in pregnancies complicated by early-onset Fetal Growth Restriction (FGR). DESIGN: Case-Control study. SETTING: London, UK. POPULATION: Women with uncomplicated pregnancies (estimated fetal weight, EFW>10th centile for gestational age, GA and normal maternal and fetal Doppler ultrasound, n=12) or early-onset FGR (EFW<3rd centile with or without abnormal Doppler US<32 weeks GA, n=12) were studied...

A Cochrane review of universal late pregnancy ultrasound has been highly influential in guiding UK practice, concluding that it does not improve outcome. However, the meta-analysis combines trials that used diverse definitions of screen positive, were designed in the absence of high quality data on diagnostic effectiveness, and did not couple screening to an effective intervention. Moreover, even if the trials had combined a highly effective screening test with a highly effective intervention, the sample size was 15% of that required to study perinatal death...

No abstract text is available yet for this article.

No abstract text is available yet for this article.