BJOG: An International Journal of Obstetrics and Gynaecology

It has been known for many years that there are risks associated with pregnancy for women with a range of established connective tissue diseases (CTD), especially systemic lupus erythematosus (SLE). These risks can be to do with the disease itself, the autoantibodies found in association with the disease, or the medications used to treat symptoms. This recent large, epidemiological study from the UK looks closely at this issue from a different perspective (BJOG 2020 xxxx). Using a retrospective case-control design, the authors examine the risks for women who experienced an adverse pregnancy outcome (APO) of being diagnosed subsequently with a CTD or found to have the antibodies associated with the anti-phospholipid syndrome (APS)...

Ling and colleagues (BJOG 2020 xxxx) have contributed important information on cardiovascular (CV) assessment over the course of pregnancy, with and without aspirin treatment, associated with risk of pre-term pre-eclampsia, as assessed by the multivariable competing risks model at 11-13 weeks. There are a number of important messages in these data. First, women at low- (vs. high-) risk of preterm pre-eclampsia appear to have lower cardiac output (CO), stroke volume (SV), and blood pressure (BP) in early pregnancy, consistent with the hypothesis that maternal CV predisposition plays a major role in pre-eclampsia risk (Ridder A et al...

Although gestational trophoblastic neoplasia (GTN) is a rare event, particularly after a non-molar pregnancy, the true incidence of GTN is difficult to establish with certainty because data regarding the incidence of pregnancies and subsequent trophoblastic events are not available in most countries. This is not the case in the United Kingdom, where there is nearly a 50-year history of unified care of GTN at two major reference centres. The data generated from these centres has positioned them as world leaders in the care of women with GTN...

OBJECTIVE: To develop a core outcome set for endometriosis. DESIGN: Consensus development study. SETTING: International. POPULATION: One hundred and sixteen healthcare professionals, 31 researchers, and 206 patient representatives. METHODS: Modified Delphi method and modified nominal group technique. RESULTS: The final core outcome set includes three core outcomes for trials evaluating potential treatments for pain and other symptoms associated with endometriosis: overall pain; improvement in the most troublesome symptom; and quality of life...

No abstract text is available yet for this article.

Karmarkar et al. analysed a large retrospective cohort of women with mid-urethra slings (MUS), 1.2% (33/2823) complicated by vaginal exposure that required surgical revision to close the vagina.

A third of patients with gestational trophoblastic disease (GTD) scored as low risk (FIGO score 0-6) failed the initial methotrexate (MTX) treatment. These patients require second-line treatment, either with single-agent (dactinomycin) or with combination chemotherapy (EMA/CO).

Premature birth is not only the commonest cause of new-born babies dying, but also an important cause of long-term handicap. This is why the paper by van Winden et al. in this issue, reporting two-year outcomes for participants in their APOSTEL-3 trial, comparing atosiban with nifedipine tocolysis, is so important.

For years, practising gynaecologists adopted a sound and simple surgical principle when treating women with ovarian torsion (OT): necrotic ischemic tissue has to be excised and discarded. As such, the radical cure of oophorectomy was the standard option. But is it time to critically examine this practice?

Since December 2019, a new coronavirus (COVID-19) infection has rapidly become prevalent in central China1 . On the basis of knowledge obtained from a previous coronavirus outbreak2 , pregnant women are believed to be susceptible to this virus. Once a maternal infection of COVID-19 is suspected or confirmed, childbirth becomes complicated and challenging. Efficient obstetric treatment is required, and is key to optimizing the prognosis for both mother and child. Care should be taken in determination of the timing of delivery, assessment of the indications for caesarean section, preparation of the delivery room to prevent infection, choice of the type of anesthesia, and newborn management...

No abstract text is available yet for this article.

OBJECTIVE: To evaluate the superficial surgical site infection (SSI) rate to 28 days and patient satisfaction with wound coverage management when their transverse suprapubic Caesarean wound is left exposed compared to dressed after skin closure DESIGN: Randomised trial SETTING: University Hospital, Malaysia: April 2016-October 2016 POPULATION: 331 women delivered by Caesarean section METHOD: Participants were randomised to leaving their wound entirely exposed (n=165) or dressed (n=166) with a low adhesive dressing (next day removal) MAIN OUTCOME MEASURES: Primary outcomes were superficial SSI rate (assessed by provider inspection up to hospital discharge and telephone questionnaires on Day 14 and 28) and patient satisfaction with wound coverage management before hospital discharge RESULTS: The superficial SSI rates were 2/153(1...

The majority of women experience nausea and vomiting of pregnancy. Women falling at the severe end of the clinical spectrum may be diagnosed with Hyperemesis Gravidarum (HG), persistent nausea and vomiting accompanied by weight loss. HG can result in serious maternal sequelae such as abnormal electrocardiography parameters from electrolyte disturbances, and post-traumatic stress disorder from prolonged symptoms.

Coronary heart disease kills twice as many women as breast cancer in the UK and is the single biggest killer of women worldwide. Underlying risk factors include hypertension, diabetes, hyperlipidaemia, obesity and smoking. Mulder and colleagues have performed a systematic review and meta-analysis of the literature and demonstrated that women with infertility are significantly more likely to have certain cardiometabolic risk factors, namely increased BMI, cholesterol and triglycerides, when compared with fertile women...

OBJECTIVES: We assessed the incidence, risk factors and adverse birth outcomes associated with elevated liver enzymes and low platelets (HELLP) syndrome. DESIGN: A retrospective population-based cohort study. SETTING: Canada (excluding Quebec), 2012/13-2015/16. POPULATION: Mothers with a singleton hospital live birth or stillbirth at ≥24 weeks gestation (N=1,078,323). METHODS: HELLP syndrome was identified using ICD-10-CA diagnostic code from delivery hospitalization data...

No abstract text is available yet for this article.

Alphabet soup brings back memories of childhood and a warm belly on a cold day. Alphabet soup was one of mom's ways of trying to prevent illness. In the case of an article in this issue of the Journal (Giles, et al, BJOG 2020), the alphabet soup involves the study of HBV, GDM, an H and the 5 W's.

OBJECTIVE: To assess the impact of increasing obstetric intervention on birthweight centiles. DESIGN: Retrospective cohort study of births in five two-year epochs: 1983-84, 1993-94, 2003-04, 2013-14, and 2016-17. POPULATION: 665,205 singleton births at ≥32 weeks' gestation. SETTING: All maternity services in Victoria, Australia. METHODS: For each epoch, we calculated the birthweight cutoffs defining each birthweight centile at 34, 37 and 40 weeks' gestation...

OBJECTIVE: An estimated two billion people worldwide live with hepatitis B virus (HBV) infection. Many of these are women of reproductive age. Studies that have examined pregnancy outcomes in women living with HBV have reported conflicting results in relation to the incidence of gestational diabetes (GDM). The aim of this study is to examine if gestational diabetes is more common in women with chronic HBV residing in a non-Asian country DESIGN: Cross sectional study SETTING: Victoria, Australia POPULATION: All singleton births between 2009 and 2017 METHODS: Poisson regression was performed to determine if gestational diabetes is more common in women with HBV compared to women without HBV taking into account other risk factors such as maternal age, body mass index, parity, and country of birth...

OBJECTIVE: Data regarding low maternal hemoglobin concentration and severe maternal morbidity (SMM) are limited and potentially biased. This study evaluated the relation between early maternal hemoglobin concentration and SMM or maternal mortality. DESIGN: Population-based cohort study. SETTING: Ontario, Canada, in a public healthcare system. POPULATION: 737,393 births with a routine outpatient hemoglobin measured at a calculated gestational age of 2-16 weeks...