BJOG : An International Journal of Obstetrics and Gynaecology

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OBJECTIVE: To investigate hair cortisol concentrations (HCC) monthly in pregnant women and to explore the effect of parity. DESIGN: Prospective cohort study from gestational week (GW) 26, at childbirth and postpartum. SETTING: An antenatal care clinic in southeast Sweden. SAMPLE: 390 pregnant women. METHODS: Cortisol was measured using radioimmunoassay in methanol extracts of ground hair samples...

BACKGROUND: Women with a history of hypertensive disorders of pregnancy (HDP) are at increased long-term risk of cardiovascular disease. However, there has been increasing evidence on the same risks in the months following birth. OBJECTIVES: This review aims to estimate the incidence of hypertension in the first two years after HDP. SEARCH STRATEGY: MEDLINE, EMBASE and Cochrane databases were systematically searched in October 2019. SELECTION CRITERIA: Observational studies comparing hypertension rate following HDP and normotensive pregnancies up to two years...

Preterm birth prevention is multifaceted and produces many nuanced questions. This review addresses six 'important clinical questions' about preterm birth prevention as voted for by members of the UK Preterm Clinical Network. The questions cover the areas of: preterm birth prevention in 'low-risk' populations; screening for asymptomatic genital tract infection in women at high-risk of preterm birth; cervical length screening with cerclage or vaginal pessary in situ; cervical shortening whilst using progesterone; use of vaginal progesterone in combination with cervical cerclage; and optimal advice about intercourse for women at high-risk of preterm birth...

Research evaluating the vaginal microbiome during pregnancy has largely focused on bacteria, although the most abundant component of the human microbiome are bacteriophages (phages). Phages, viruses that infect bacteria, have largely been neglected in vaginal microbiome research, largely due to limitations in isolating and characterizing phages from clinical samples.

OBJECTIVE: Studies have shown Prenatal Exome Sequencing (PES) improves diagnostic yield in cases of fetal structural malformation. We have retrospectively analysed PES cases from two of the largest fetal medicine centres in the UK to determine the impact of results on management of a pregnancy. DESIGN: A retrospective review of clinical case notes. SETTING: Two tertiary fetal medicine centres. POPULATION: Pregnancies with fetal structural abnormalities referred to clinical genetics via a multidisciplinary team...

As genetic technologies evolve, our understanding of the causes of fetal structural anomalies and related fetal genetic diseases will expand. This ability will no longer mean that with the discovery of a severe fetal anomaly the patient must decide to either terminate the pregnancy or risk having a child with potentially severe and lifelong difficulties, the extent of which can only be reliably elucidated postnatally. However, implementation of in-utero genomic testing now allows "precision fetal medicine" in which specific fetal diagnosis and prognosis are available...

The paper by Mulder et al. addresses the effect of pregnancy prolongation on maternal and fetal outcomes in women with early-onset pre-eclampsia diagnosed after 24 weeks of gestation (Mulder et al., BJOG 2020 xxxx). They report that pregnancy prolongation - from the time of pre-eclampsia diagnosis to delivery - is associated with improved offspring outcome and survival, without adverse consequences on short-term maternal cardiovascular and metabolic function.

OBJECTIVES: To identify predictors for intact motor function (MF) at birth and at 12 months of life in babies with prenatally versus postnatally repaired open spina bifida (OSB). DESIGN: Retrospective cohort study SETTING: Texas Children's Hospital, 2011 to 2018 POPULATION: Patients who underwent either prenatal or postnatal OSB repair METHODS: Prenatal MF of the lower extremities was evaluated by ultrasound following a metameric distribution at the time of diagnosis (US1), 6 weeks postoperatively (or 6 weeks after initial evaluation in postnatally repaired cases) (US2), and at the last US before delivery (US3)...

Fetal structural anomalies have an impact on fetal mortality and morbidity. Next Generation Sequencing (NGS) may be incorporated into clinical pathways for investigation of paediatric morbidity but also be used to delineate the prognosis of fetal anomalies. This paper reviews the role of NGS in the investigation of fetal malformations, the literature defining the clinical utility, the technique most commonly used and potential promise and challenges for implementation into clinical practice. Prospective case selection with informative pre-test counselling by multidisciplinary teams is imperative...

OBJECTIVES: Little is known about the experiences of women who travel within Europe for abortion care from countries with relatively liberal laws. This paper aims to assess the primary reasons for travel among a sample of women who travelled from European countries with relatively liberal abortion laws to obtain abortion care mainly in the UK and the Netherlands. DESIGN: Multi-country, 5-year mixed methods study on barriers to legal abortion and travel for abortion...

The American obstetrician, Joseph DeLee, 'father of modern obstetrics', founded the Chicago Lying-in Hospital in 1931 with his vision for womens' health captured in a set of five stone plaques at the top of the cloister of the hospital's building. Four of the five stone plaques are engraved with the names of pioneering clinicians whose contributions to the field of obstetrics and gynaecology have been seminal: Jan Palfyn (1650-1730), for introducing the obstetric forceps in the 1720s.

The early and adequate recognition of associated or presumed non-associated/incidental imaging findings have a significant impact on decision making of intrauterine corrective surgical procedures. The association between a spinal dysraphia and the occurrence of a Chiari 2 malformation (C2M) are linked to the mechanical consequences of a venting/leakage of cerebro-spinal fluid (CSF) from the developing caudal embryonic rhombencepalic and metencephalic vesicles during early fetal life. This unified theory does not explain the entire spectrum of anatomical abnormalities that may be observed on imaging...

No abstract text is available yet for this article.

As obesity rates increase throughout the world, the effect on pregnancy, delivery, and neonatal outcomes have been a significant concern (Bloomberg M. Obstet Gynecol. 2013 Jul; 122(1): 50-5). Dr. Tzadikevitch-Geffen and colleagues conducted a retrospective cohort study to determine neonatal outcomes of women with a BMI ≥35 kg/m2 who underwent a trial of labour compared to an elective cesarean delivery (BJOG 2020 xxxx).

OBJECTIVE: Determine the presence and identity of extracellular bacteriophage (phage) families, genera and species in the vagina of pregnant women DESIGN: Descriptive, observational cohort study SETTING: São Paulo, Brazil POPULATION: Pregnant women at 21-24 weeks gestation METHODS: Vaginal samples from 107 women whose vaginal microbiome and pregnancy outcomes were previously determined were analyzed for phages by metagenomic sequencing, Main outcome measures Identification of phage families, genera and species RESULTS: Phages were detected in 96 (89...

The use of culture-independent assays to determine the composition of the vaginal microbiota in pregnant women has greatly improved our knowledge of the diversity and relative abundance of bacteria present. However, despite advances in bacterial gene amplification technology and computer-assisted determination of microbial composition down to the strain level (even more specific than species), gaps remain in our knowledge of how racial, genetic and clinical factors affect vaginal microbiome composition and its sequelae...

Stillbirth is a major global public health problem, but in the absence of a robust method to predict a woman's individualized risk of stillbirth, identifying women at increased risk remains a challenge. Awareness of factors that increase risk is a necessary step in improving care through better communication and shared decision-making, with the goal of reducing stillbirths. Despite a high proportion of unexplained stillbirths, many women have one or more risk factors that are often unrecognized (Flenady, V...

BACKGROUND: The significant number of qualitative and quantitative ultrasound markers described for first-trimester screening of open spina bifida (OSB) and other posterior brain defects (oPBD) have resulted in their complex implementation and interpretation for a widespread screening and in a lack of consensus regarding diagnostic accuracy. OBJECTIVES: To assess and compare the accuracy of qualitative and quantitative cranial sonographic markers at 11-14 weeks for the detection of OSB and oPBD...

BACKGROUND: Little is known about the oestrogen exposure measurement and mutual effect of age at menarche and age at menopause in the risk of cardiovascular disease (CVD) events. OBJECTIVES: To evaluate oestrogen exposure measurement and describe mutual effect of age at menarche and age at menopause in the risk of CVD events. Search strategy Systematic review of literature in PubMed, Embase and Web of Science for studies published up to June 28, 2020. Selection criteria Observational studies related to oestrogen exposure measurement, including mutual effect of age at menarche and age at menopause and risk of CVD events...