BJOG: An International Journal of Obstetrics and Gynaecology

What is a mediation analysis? Simply put, it is a powerful statistical modelling approach to determine if a third factor helps explain the association between an exposure and an outcome. The approach to mediation analysis rests on a few key assumptions, but importantly provides estimates for a few interesting parameters (VanderWeele TJ. Explanation in Causal inference. Oxford University Press, 2015). This article is protected by copyright. All rights reserved.

With the modernization of laparoscopy and subsequent rapid uptake of the robotic platform, minimally invasive surgery (MIS) became the widely accepted standard of care for gynecologic cancer. Virtually all data supporting improved patient outcomes and oncologic safety for MIS in gynecologic cancer derive from retrospective studies. Nevertheless, the advantages of MIS rapidly became accepted, not only due to perceived benefits to patients. This article is protected by copyright. All rights reserved.

Are we witnessing the beginning of the end of the speculum? The speculum has been an essential tool for gynecological examinations for millennia and almost dreaded by women since the first time it was used. No device has proven to be better for evaluating the cervix-until now. Today, it appears feasible that HPV vaginal swabs may soon be an alternative to traditional cervical screening in some circumstances (Harvey LFB et al. Am J Obstet Gynecol. 2016 Apr;214(4):546-547). Smith and colleagues now provide "vast" evidence that most office hysteroscopies can be performed without a speculum, faster and with less pain in this remarkable randomized clinical trial (Smith et al...

OBJECTIVE: To explore the separate effects of being 'at risk' of gestational diabetes mellitus (GDM) and screening for GDM, and of raised fasting plasma glucose (FPG) and clinical diagnosis of GDM, on the risk of late stillbirth. DESIGN: Prospective case-control study. SETTING: Forty-one maternity units in the United Kingdom. POPULATION: Women who had a stillbirth ≥28 weeks of gestation (n = 291) and women with an ongoing pregnancy at the time of interview (n = 733)...

No abstract text is available yet for this article.

Against the background of a renewed global focus on improving women's health and well-being during and after pregnancy, Kopp et al have assessed 290 women at least one year after primary surgical repair for obstetric fistula in Malawi. Following surgery 19.3% of women reported urinary incontinence and 3.5% depressive symptoms. Women who had more severe types of fistula reported poorer quality of life after surgery. This article is protected by copyright. All rights reserved.

BACKGROUND: Telemedicine is increasingly used to access abortion services. OBJECTIVE: To assess the success rate, safety and acceptability for women and providers of medical abortion using telemedicine. SEARCH STRATEGY: We searched Pubmed, EMBASE, clinicalTrials.gov, and Web of Science up until November 10th 2017. STUDY CRITERIA: We selected studies where telemedicine was used for comprehensive medical abortion services i...

OBJECTIVE: To study maternal complications and pregnancy outcome in women with pulmonary hypertension, attending a tertiary centre in south India. STUDY DESIGN: Retrospective Observational study. SETTING: Tertiary centre in south India. POPULATION: Pregnant women with pulmonary hypertension. METHOD: Data regarding demographics, clinical course, medications received and echocardiographic diagnosis regarding pulmonary hypertension, and antenatal care received were collected from the records...

Sovio and Smith (BJOG 2019 xxxx) are to be congratulated for completing this important phase in the life of an outcome prediction/risk stratification model in attempting to convert the competing risks model (Akolekar et al. Fetal Diagn Ther 2013;33:8-15) used in the ASPRE trial (Rolnick et al. New Engl J Med 2017;377:613-622) into a risk score. The risk score was derived from the beta-co-efficients of the individual components of the competing risks model and tested in the Pregnancy Outcome Prediction (POP) study cohort and compared with the use of all competing risks variables as continuous variables, when relevant...

No abstract text is available yet for this article.

OBJECTIVE: To investigate the relation between vaginal microbiota composition and outcome of rescue cervical cerclage. DESIGN: Prospective observational study. SETTING: Queen Charlotte's and Chelsea Hospital, London. POPULATION: Twenty singleton pregnancies undergoing a rescue cervical cerclage. METHODS: Vaginal microbiota composition was analysed in women presenting with a dilated cervix and exposed fetal membranes before and 10 days following rescue cervical cerclage and was correlated with clinical outcomes...

The timing of repeat caesarean section after previous multiple caesarean sections has long been a balance ('the art of obstetrics') between the notion of maternal morbidity from anecdotal instances of antenatal scar rupture, maternal haemorrhage related to abnormal placentation, the onset of preterm labour requiring emergency caesarean section with its associated increased morbidity from maternal haemorrhage and infection and neonatal morbidity, which may be immediate and predominantly respiratory in nature, or possibly later with neurodevelopmental morbidity associated with late preterm and early term delivery of the neonate, as reported by Blencowe et al (Blencowe et al 2013 Ped Res...

Endometrial cancer is the most common gynaecological malignancy amongst the developed world. The incidence of its precursor, endometrial hyperplasia, is estimated to be more than three times greater, and if left untreated, can progress to cancer (Reed et al. Am J Obstet Gynecol 2009;200:678). Successful treatment for endometrial hyperplasia has been found in the form of progestogens which modify the proliferative effects of unopposed oestrogen action on the endometrium, thus achieving disease regression. This article is protected by copyright...

Much has been discussed about the effects of the obesity epidemic in the countries involved in the multi-national study by Grieger et al (BJOG, 2019 xxxx). Although obesity has been associated with impaired fertility, the impact of metabolic syndrome (MetS), a more specifically pointed measure, has rarely been assessed. From this very large multi-national study, it is apparent that MetS is associated with a longer time to pregnancy and infertility regardless of whether obesity is also present. This article is protected by copyright...

OBJECTIVE: Pregnancies in women with Loeys Dietz Syndrome (LDS) are rare, and typically documented in case reports only. Early reports suggested high rates of maternal complications during pregnancy and the puerperium, including aortic dissection and uterine rupture, but information on fetal outcomes was very limited. DESIGN: A retrospective cohort study. SETTING: 8 specialist UK centres. SAMPLE: Pregnant women with LDS...

In this cluster randomised trial, Romijn and colleagues sought to evaluate the impact of team training on adverse obstetric outcomes (Romijn et al. BJOG 2019). The intervention relied on crew resource management (CRM) principles and focused on strengthening communication during referrals. CRM, a training modality utilized in military and aviation settings, is well-suited to obstetrics, a high-volume, high-acuity field where effective teamwork is essential. Over 400 providers from five hospitals and their catchment areas underwent classroom-based trainings, organized by locale in a stepwise fashion...

OBJECTIVE: Mitochondrial disease is a disorder of energy metabolism that affects 1 in 4300 adults in the UK. Pregnancy is associated with physiological demands that have implications for energy metabolism. We were interested to know how pregnancy was affected in women with mitochondrial disease, particularly those with the most common pathogenic mutation m.3243A>G. DESIGN: Retrospective case-comparison study. POPULATION/SETTING: 67 women with genetically-confirmed mitochondrial disease from the UK Mitochondrial Diseases Cohort and 69 unaffected women participated...

OBJECTIVE: To investigate the association between IVF and severe maternal morbidity (SMM) and to explore the role of multiple pregnancy as an intermediate factor. DESIGN: Population-based cohort-nested case-control study. SETTING: 6 French regions in 2012-2013. POPULATION: Cases were 2540 women with SMM according to the EPIMOMS definition; controls were 3651 randomly selected women who gave birth without SMM. METHODS: Analysis of the associations between IVF and SMM with multivariable logistic regression models, differentiating IVF with autologous oocytes(IVF-AO) from IVF with oocyte donation(IVF-OD)...

OBJECTIVES: (1) To derive a simple risk score for preterm preeclampsia based on the model used in the ASPRE trial, and (2) to compare it (i) with the original ASPRE algorithm, (ii) with the NICE Guideline score, and (iii) with and without biochemical and ultrasonic predictors. DESIGN: Prospective cohort study. SETTING: Cambridge, UK. POPULATION OR SAMPLE: 4,184 nulliparous women from the Pregnancy Outcome Prediction study...

OBJECTIVE: To evaluate whether vaginoscopy or standard hysteroscopy was more successful in the outpatient setting. DESIGN: Randomised controlled multicentre trial. SETTING: Outpatient hysteroscopy clinics at two UK hospitals. POPULATION: 1597 women aged 16 or older undergoing an outpatient hysteroscopy. METHODS: Women were allocated to vaginoscopy or standard hysteroscopy using third party randomisation stratified by menopausal status with no blinding of participants or clinicians...