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Objective: To examine whether the Social Life Impact for Mother (SLIM) scale in the first trimester predicts postpartum suicide risk., Methods: We used part of the hospital-based prospective study conducted in obstetric clinics and hospitals in four populous prefectures in Japan (N = 7,462). Participants completed the SLIM scale, including nine risk factors in the first trimester, and postpartum suicide risk was assessed as item-10 in the Edinburgh Postnatal Depression Scale, self-harm ideation, at one month after delivery (N = 5,697)., Results: The weighted total score of the SLIM scale which was calculated using the results of odds ratio predicted postpartum suicide risk with moderate accuracy. Pregnant women with 6+ scores of the new SLIM score were 4.26 (95%CI = 3.12-5.01) times more likely to have postpartum suicide risk. The original SLIM score also predicted postpartum suicide risk. The new SLIM score showed higher accuracy than the original score., Conclusion: The SLIM scale at the first trimester of prenatal checkups may be useful for obstetricians to predict postpartum suicide risk and start to provide support for the expecting mothers. Both weighted total scores could be utilized according to the purpose of implementing the SLIM scale at obstetric institutions., (© 2025 American Association of Suicidology.)

Introduction: The ethical obligation to reduce the environmental impact of healthcare systems prompts an exploration of if and when environmental concerns should be integrated into clinical decision-making. In this study, we aimed to elucidate patients' attitudes regarding the provision of environmental information in healthcare decision-making and to identify preferred approaches for integrating these considerations into patient-provider consultations., Methods: This interview study served as an in-depth follow-up of a survey study on gynaecological patients' perspectives on environmental sustainability within healthcare settings. We conducted semistructured interviews with 14 patients from two Dutch outpatient clinics between February and May 2024. We employed reflexive thematic analysis to analyse the data., Results: Five main themes were developed from the data: (1) Patients are an integral part of the transition to sustainable healthcare, (2) Patients are open to information on environmental impact of healthcare, (3) Information on environmental impact should be tailored to the individual patient and context, (4) Patients vary in preferences for involvement in decision-making related to environmental sustainability and (5) Patients prioritize individual health over environmental concerns in healthcare decision-making., Conclusion: The findings of our study underscore the importance of integrating sustainability into clinical decision-making, aligning with bioethical principles and the expectations and goals of patients. By ensuring that environmental considerations are introduced in a personalized and context-appropriate manner within patient-provider interactions, healthcare can foster greater support for sustainable practices., Patient or Public Contribution: Patients were involved in developing the pre-interview questionnaire. The preliminary results of the study were presented to healthcare professionals from various backgrounds during a meeting of the Dutch Green Care Alliance, after which the input was incorporated into the interpretation of the study results. Finally, the complete manuscript was presented to representatives from the Dutch Patient Federation to obtain their input on the interpretation and implications of our research. The interpretation of our results aligned with the findings from their recent national inquiries, which included data from over 9300 patients within their network. Consequently, no changes were made to the manuscript's discussion., (© 2025 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Introduction: The objective of this study was to assess the publication status of RCTs studying hysteroscopy registered on clinical trial registries, and the trustworthiness of these studies., Material and Methods: We systematically searched 23 clinical trial registries and MEDLine for studies on hysteroscopy registered between March 2012 and 25 March 2022. Published RCTs were assessed for trustworthiness using the Trustworthiness in RAndomised Controlled Trials (TRACT) checklist. Authors of studies with an unknown outcome were contacted., Results: In total, 576 registered and/or published RCTs were identified. We excluded 13 studies not reported in English, 100 studies which were not RCTs, 118 that did not investigate hysteroscopy, 8 studies that were terminated or withdrawn, 2 that were retracted, 64 studies that were ongoing, 5 conference abstracts and 96 studies with an unknown outcome. We therefore assessed 170 published articles for trustworthiness. The most prolific countries were China (n = 26), Egypt (n = 24), Turkey (n = 14) and Iran (n = 13), which were responsible for 45 % of studies. The average trustworthiness score across all 170 papers was 1.9 out of 7 with a range of 0-5 (higher values indicating more concerns regarding trustworthiness). Areas with highest concern for trustworthiness were zero dropout (n = 90, 53 %) and having exactly the same number of participants in each group (n = 75, 44 %). Other significant areas of concern were studies having absent (n = 42, 25 %) or retrospective registration (n = 24, 14 %) and authors or institutions with retracted papers or large numbers of RCTs in a short period (n = 28, 16 %). There were 46 studies (27 %) with concerns regarding trustworthiness across three different domains, 12 studies (7 %) with concerns across four domains and 3 studies (1.7 %) with concerns across five domains., Conclusions: In research on hysteroscopy, many registered trials do not get published, in most cases for an unknown reason. A small number of countries are responsible for the majority of published hysteroscopy RCTs and registered trials with an unknown outcome. There is concern about the trustworthiness of RCTs published on hysteroscopy, with domains such as drop-out of participants, reporting participant characteristics and retrospective registration being areas for future methodological research., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: BWM is supported by a NHMRC Investigator grant (GNT1176437). BWM reports consultancy for ObsEva and Merck and travel support from Merck. The other authors do not report a conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Tumour type, treatment and patient related factors contribute to cancer associated venous thromboembolism (VTE), however, the role of each factor and the mechanisms involved are not understood., Aim: To assess the role of the tumour, and of chemotherapy, in mediating the procoagulant response associated with VTE in gynaecological cancer patients., Methods: Gynaecological cancer patients who developed VTE during follow-up (n = 59) (VTE+) were matched with treatment naïve(treatment (-)(VTE-)(n = 120) and chemotherapy treated patients(treatment (+)(VTE-) (n = 57)). Thrombin generation, Factor V(FV), VIIIc(FVIIIc), Tissue Factor Pathway Inhibitor(TFPI), soluble Thrombomodulin(sTM), Protein S(PS), C(PC) endothelial protein C receptor(EPCR) and fibrinogen were compared in each group. EPCR and TM expression was assessed in EA.hy926 cells in vitro following addition of chemotherapy agents. mRNA expression of coagulation genes was measured in tumour biopsies., Results: Thrombin generation was increased in treatment(-)VTE(+) compared with treatment(-)VTE(-) controls but not in the treatment(+)VTE(+) patients. Using the TM modified assay, thrombin generation was increased in the treatment (+)VTE(-) group compared with treatment(-)(VTE-) with a further increase in the treatment (+) VTE(+) group. Reduced levels of sTM in treatment (+) VTE(+) patients correlated with thrombin generation. TM expression was reduced in vitro by carboplatin and paclitaxel. FVIIIc was increased in both VTE groups and was predictive of VTE. F5 mRNA levels were lower in tumours from VTE(+) patients compared with controls., Conclusion: Chemotherapy alters sTM and confers an acquired activated Protein C(aPC) resistance which may be implicated in cancer associated VTE in gynaecological cancer patients. FVIIIc may be a useful predictive marker for VTE in cancer patients in this setting., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Lucy Norris reports financial support was provided by LEO Pharma. Feras Abu Saadeh reports a relationship with LEO Pharma that includes: funding grants, speaking and lecture fees, and travel reimbursement. Lucy Norris reports a relationship with LEO Pharma that includes: funding grants, speaking and lecture fees, and travel reimbursement. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Patients with advanced ovarian cancer often require radical cytoreductive surgery and chemotherapy, with or without targeted therapy. Return to intended oncological therapy after surgery is a crucial metric, as delay can worsen survival. The concept of return to intended oncological therapy is important because it highlights the need for not just successful surgical outcomes, but also the ability to continue with the comprehensive cancer treatment plan., Methods: A comprehensive review of the literature was conducted to identify relevant English language studies published from January 2010 to September 2024., Results: Delayed return to intended oncological therapy after surgery was associated with poor survival outcomes in ovarian cancer. This narrative review investigates how pre-operative counselling and education; optimisation of the patient's medical condition; meticulous surgical planning and execution; early recognition of complications; and comprehensive postoperative care influence return to intended therapy in gynaecological surgery. Effective multidisciplinary care involving anaesthetists; nurses; physiotherapists; dietitians; psychologists; and the patient's relatives or friends, can prevent complications and ensure timely return to intended oncological therapy., Discussion: Awareness and management of factors affecting return to intended oncological therapy are essential for improving outcomes in patients with advanced ovarian cancer. We highlight the importance of multidisciplinary care (including enhanced recovery after surgery programmes) and the factors affecting these including age; nutrition; and occurrence of postoperative complications., (© 2025 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)

Background: HPV-related vulvar cancer is increasing in prevalence, especially in women living with HIV. Treatment of vulva cancer is based on evidence from HPV-independent cancers, which affect older women. The impact of HIV on vulvar cancer characteristics and treatment outcomes needs to be elucidated., Patients and Methods: A retrospective observational study compared the clinical characteristics, treatment, and outcomes of 92 HIV-positive and 131 HIV-negative women with vulvar cancer at our institution. Using descriptive statistics, HIV-positive and negative patients were compared and Cox regression models were tested for differences in mortality and recurrence., Results: HIV-positive patients were 20 years younger than HIV-negative patients ( p < 0.001). More than 50% of patients presented with advanced stage cancer, however this was independent of HIV-status. Although HIV infection was associated with poorer survival ( p = 0.022); rates of cure ( p = 0.933) and recurrence rates ( p = 0.8) were similar in HIV-positive and negative women., Conclusions: Vulvar cancer occurs at a much younger age in women living with HIV. Awareness among HIV-positive women and health care providers would lead to diagnosis of vulvar cancer at an earlier stage. Treatment protocols for HPV-related vulvar cancer should not be altered due to HIV status and should take into consideration the young age of the patients., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Caesarean scar ectopic pregnancy (CSEP) is associated with significant maternal and foetal morbidity. However, the optimal treatment remains unknown., Objectives: The aim of this study was to review outcomes reported in studies on CSEP treatment and outcome reporting quality., Search Strategy: We reviewed 1270 articles identified through searching PubMed, MEDLINE and Google Scholar from 2014 to 2024 using the search terms 'caesarean scar ectopic pregnancy and caesarean scar pregnancy'., Selection Criteria: We included all study types evaluating any form of CSEP treatment, with a sample size of ≥ 50, where diagnosis was described, and the article was in English., Data Collection and Analysis: Two authors independently reviewed studies and assessed outcome reporting and methodological quality. The relationship between outcome reporting quality and publication year and journal type was assessed with univariate and bivariate models., Main Results: A total of 108 studies, including 17 941 women, were included. 83% of all studies originated from China. Studies reported on 326 outcomes; blood loss (86%), need for additional intervention (77%) and time for serum hCG to normalise post treatment (69%) were the most common outcomes. A primary outcome was clearly defined in 11 (10%) studies. The median quality of outcome reporting was 3 (IQR 3-4). No relationship was demonstrated between outcome reporting quality and publication year (p = 0.116) or journal type (p = 0.503)., Conclusions: This review demonstrates that there is a wide variation in outcomes reported in studies on CSEP treatment. Development and implementation of a core outcome set by international stakeholders which includes patients is urgently needed to enable high-quality research that is both useful and relevant to patients., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Purpose of Review: The global incidence of breast cancer continues to increase and increasing efficacy of treatments has improved overall prognosis and survival with a resulting requisite focus on improving quality of life after cancer. Treatment inevitably results in symptoms of menopause and these symptoms may be more severe after cancer treatment compared to natural menopause and may pose a potential risk of early treatment discontinuation. Consequently, the global burden of successfully managing these symptoms is significant., Recent Findings: There is a discordance between randomized and observational data regarding the risk of systemic menopausal hormone therapy and breast cancer recurrence; hormone receptor status is significant to recurrence risk in this setting. The systemic absorption of local oestrogen is not a consistent surrogate marker for cancer recurrence and clinical data has not demonstrated a consistent increase in the risk of cancer recurrence with local therapy., Summary: Nonhormonal treatments remain first-line management of menopause symptoms in breast cancer survivors to minimize the risk of cancer recurrence. However, severe symptoms not responding to nonhormonal interventions require a multidisciplinary, patient-centred approach to discuss the evidence base for hormonal treatments., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The objective of this study is to assess associations between pregnancy complications and pregnancy-associated maternal mortality (PAM) within 1 year after childbirth., Design: Population-based cohort study., Setting: Norway, 1967-2020., Population: 1 237 254 mothers with one or more singleton pregnancies registered in the Medical Birth Registry, 1967-2019 and followed in the Cause of Death Registry to 2020., Methods: Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for maternal education, age, year of first childbirth and chronic medical conditions., Main Outcome Measures: PAM by lifetime history of pregnancy complications: placental abruption, preeclampsia, preterm birth, perinatal death, small for gestational age (< 2.5 percentile), gestational diabetes and gestational hypertension., Results: Crude OR for PAM was 4.24 (95% CI 3.53-5.10), if complications occurred in the last pregnancy, whereas 2.52 (2.08-3.06) if complications occurred in the first pregnancy, compared to mothers without complications in any pregnancy. Adjusted ORs for PAM when complications occurred in the last pregnancy were, for placental abruption 3.75 (1.20-11.72), preeclampsia: 4.42 (3.17-6.15), preterm birth: 4.32 (3.25-5.75), perinatal death: 24.18 (16.66-35.08), small for gestational age: 2.90 (1.85-4.54), gestational diabetes: 1.43 (0.63-3.25) and pregnancy hypertension: 2.05 (1.12-3.74) compared to mothers without complications. The OR for PAM increased slightly by increasing the number of complicated pregnancies but the trend was stronger for increasing number of complications in the last pregnancy (e.g., during 1999-2019: one complication; 4.14 [2.79-6.13], two complications; 11.50 [6.81-19.43])., Conclusion: Complications in the last pregnancy were more strongly associated with PAM than those in the first pregnancy., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Endometriosis is a chronic inflammatory disease for which there is currently no accurate screening test to identify or predict the probability of the disease in individuals. This can often lead to delays in diagnosis. Several systemic immune-inflammation indices are currently used as predictive or supportive markers for several inflammation-associated diseases. In this study, we investigated whether these immune-inflammation indices, such as systemic immune inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and pan-immune inflammation value (PIV) could serve as predictive or supplementary markers for diagnosing endometriosis. A total of 434 women with confirmed endometriosis and 517 controls were included in this study. Data on peripheral blood tests, including total counts of white cells, neutrophils, monocytes, lymphocytes, and platelets, were collected, and systemic immune-inflammation indices were calculated. SII, SIRI, NLR, and PIV values were significantly higher in women diagnosed with endometriosis compared to controls. Using the cut-off values of 538 for SII, 0.814 for SIRI, 2.03 for NLR, and 210 for PIV, we achieved 76 % sensitivity and 70 % specificity. When the four indices were combined, the area under the ROC curve (AUC) was 0.796 (95 % CI: 0.766, 0.827), with 76 % sensitivity and 70 % specificity. In conclusion, while ultrasonography or MRI remains the gold standard for visualizing the lesions in diagnosing endometriosis, followed by laparoscopy and histologic verification, routine peripheral blood tests in combination with clinical symptoms, could provide additional clinical diagnostic value for endometriosis as a non-invasive and cost-effective test., Competing Interests: Declaration of Competing Interest None of the authors have a conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: A parallel has been drawn between first-trimester placental vascular maturation and maternal cardiovascular adaptations, including blood pressure. Although 140/90 mm Hg is well-accepted as the threshold for chronic hypertension in the general obstetric population in early pregnancy, a different threshold could apply to stratify the risk of adverse outcomes, such as preeclampsia. This could have implications for interventions, such as the threshold for initiation of antihypertensive therapy and the target blood pressure level., Objective: We evaluated the relationship between various blood pressure cutoffs at 11-13 weeks of gestation and the development of preeclampsia, overall and according to key maternal characteristics., Study Design: This secondary analysis was of data from a prospective nonintervention cohort study of singleton pregnancies delivering at ≥24 weeks, without major anomalies, at 2 United Kingdom maternity hospitals, 2006-2020. Blood pressure at 11-13 weeks of gestation was classified according to American College of Cardiology/American Heart Association categories (mm Hg) as (1) normal blood pressure (systolic <120 and diastolic <80), (2) elevated blood pressure (systolic ≥120 and diastolic <80), stage 1 hypertension (systolic ≥130 or diastolic 80-89), and stage 2 hypertension (systolic ≥140 or diastolic ≥90). For blood pressure category thresholds and the outcome of preeclampsia, the following were calculated overall and across maternal age, body mass index, ethnicity, method of conception, and previous pregnancy history: detection rate, screen-positive rate, and positive and negative likelihood ratios, with 95% confidence intervals. A P value of <.05 was considered significant., Results: There were 137,458 pregnancies screened at 11-13 weeks of gestation. The population was ethnically diverse, with 15.9% of Black ethnicity, 6.7% of South or East Asian ethnicity, and 2.7% of mixed ethnicity, with the remainder of White ethnicity. Compared with normal blood pressure, stage 2 hypertension was associated with both preterm preeclampsia (0.3% to 4.9%) and term preeclampsia (1.0% to 8.3%). A blood pressure threshold of 140/90 mm Hg was good at identifying women at increased risk of preeclampsia overall (positive likelihood ratio, 5.61 [95% confidence interval, 5.14-6.11]) and across maternal characteristics, compared with elevated blood pressure (positive likelihood ratio, 1.70 [95% confidence interval, 1.63-1.77]) and stage 1 hypertension (positive likelihood ratio, 2.68 [95% confidence interval, 2.58-2.77]). There were 2 exceptions: a blood pressure threshold of 130/80 mm Hg was better for the 2.1% of women with body mass index <18.5 kg/m 2 (positive likelihood ratio, 5.13 [95% confidence interval, 3.22-8.16]), and a threshold of 135/85 mm Hg better for the 50.4% of parous women without a history of preeclampsia (positive likelihood ratio, 5.24, [95% confidence interval, 4.77-5.77]). There was no blood pressure threshold below which reassurance could be provided against the development of preeclampsia (all-negative likelihood ratios ≥0.20)., Conclusion: The traditional blood pressure threshold of 140/90 mm Hg performs well to identify women at increased risk of preeclampsia. Women who are underweight or parous with no prior history of preeclampsia may be better identified by lower thresholds; however, a randomized trial would be necessary to determine any benefits of such an approach if antihypertensive therapy were also administered at this threshold. No blood pressure threshold is reassured against the development of preeclampsia, regardless of maternal characteristics., (Copyright © 2024. Published by Elsevier Inc.)

This case report describes episodic symptomatic hypotension following Implanon NXT insertion and symptom resolution after removal. We aim to alert clinicians of episodic hypotension as a possible adverse drug reaction to Implanon NXT, facilitating early intervention and improved patient outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Empty follicle syndrome (EFS) is a disorder characterised by the unsuccessful retrieval of oocytes from matured follicles following ovarian stimulation for in vitro fertilisation (IVF). Genetic factors significantly contribute to this pathology. To date, an increasing number of genetic mutations associated with GEFS have been documented, however, some cases still remain unexplained by these previously reported mutations. Here, we identified a novel homozygous missense ZP1 variant (c.1096 C > T, p.Arg366Trp) in a female patient with GEFS from a consanguineous family who failed to retrieve any oocytes during two cycles of IVF treatment. We conducted a molecular dynamics simulation analysis on the mutant ZP1 model, revealing that the mutant ZP1 protein has an altered 3D structure, lower fluctuation, higher compactness and higher instability than wild-type ZP1. Immunostaining, immunoblotting and co-immunoprecipitation results showed that the homozygous missense mutation in ZP1 impaired protein secretion and weakened interactions between ZP1 and other ZP proteins, which may affect the ZP assembly. This study contributes to a more comprehensive understanding of the genetic aetiopathogenesis of GEFS., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Cesarean scar pregnancy (CSP) occurs in 0.2%-0.5% of women with a previous cesarean section globally. Multiple factors influence the development of CSP; however, to date, the critical factors contributing to the development of CSP have not been fully explored due to its relatively low incidence. Moreover, CSP can be clinically categorized into type 1 and type 2 CSP. In this retrospective study with a large sample size, we investigated potential risk factors that could contribute to CSP development., Methods: Two hundred-one women diagnosed with CSP, either type 1 or type 2 CSP, and 1700 pregnant women with a history of cesarean section but without CSP diagnosis in subsequent pregnancy were included. Gravidity, previous live birth(s), consecutive cesarean section(s), surgical abortion(s), the interval between the pregnancies, and maternal age were compared between the 2 groups., Results: Gravidity, the number of previous live births, the number of previous consecutive cesarean sections, and the number of surgical abortions were significantly associated with CSP development in women with a past cesarean section. This association was regardless of the subtypes of CSP. Notably, the interval between 2 pregnancies was also significantly associated with CSP development, but this association was only seen in type 2 CSP. However, maternal age was not an independent risk factor for CSP development. Additionally, a higher incidence of CSP was observed in China compared to that reported in the literature., Conclusion: In addition to a previous cesarean section, our study highlights at the number of surgical abortions also contributes to the development of CSP., (© 2024 American Institute of Ultrasound in Medicine.)

Objective: This study aimed to increase understanding of the signs and symptoms that lead pregnant people to seek hospital care in the second trimester of pregnancy. In addition, we aimed to describe management and follow up, to record pregnancy outcomes, and to gather information about symptoms and signs related to second trimester pregnancy loss., Methods: This prospective audit in seven geographically dispersed sites across the UK collected data over two weeks (7th March-20th March 2022 inclusive) on all unscheduled secondary care attendances between 14 and 21 completed weeks' gestation. Data on the number of patients booked at each unit within this 8-week second trimester gestational age range were collected. Descriptive analyses identified common patterns and associations with second trimester pregnancy loss., Results: Of 8,585 patients in the second trimester of their pregnancy, 283 presented acutely at least once over the two-week period (3.3 %) Of these, 19 patients experienced a second trimester pregnancy loss (7 % of those presenting in the second trimester). There were a broad range of presentations and diagnoses and a lack of standardisation of investigation and management of patients. Logistic regression identified associations between previous first trimester miscarriage (OR 2.95 95 % CI 1.15, 7.60), previous first trimester termination of pregnancy (OR 7.00 95 % CI 2.45, 19.98), and presentation with increased vaginal discharge (OR 3.82 CI 1.24, 11.7) with second trimester pregnancy loss., Conclusions: This study has identified that a significant number of pregnant people attend hospital and reattend in the second trimester of pregnancy, with a worrying lack of standardisation of both investigation and management, and a broad range of presenting symptoms and diagnoses. Patients who present in the second trimester have a high rate of second trimester pregnancy loss and the preliminary associations identified would benefit from further research in a larger scale study., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Research to reduce maternal morbidity due to cardiovascular disease is vitally important in the United States, especially for the growing number of individuals with congenital heart disease (CHD) reaching childbearing age. Understanding patient experiences through patient engagement is critical to designing research that is aligned with the needs of adults with CHD undergoing pregnancy., Methods: This patient engagement project, grounded in human centered design, focuses on the discovering patient and healthcare provider priorities for reducing maternal morbidity in CHD through patient centered outcomes research (PCOR). In this first stage, a capacity building consortium of over 90 key partners, including patients, advocates, healthcare providers, and researchers, was assembled. Baseline education on patient engagement, PCOR, and survey instrument design was delivered virtually. Two questionnaires were designed to elicit tacit knowledge - 1 for patients and 1 for providers - regarding gaps and needs across 4 key pillars: access to clinical care, patient and provider education, mental health, and research opportunities. The pillars were determined through thematic summaries from consortium discussions., Results: The patient questionnaire received 828 responses (age range: 18-60 years) from 48 U.S. states. The provider questionnaire garnered 218 responses from professionals. Several common themes for areas of research were observed across all pillars including improved access to specialized cardio-obstetric care and improved education about the need for specialized care. Healthcare providers cited insufficient care coordination models and resources as a major barrier to providing effective clinical care. Both patients and providers expressed a need for improved access to mental health care. While only 28% of patient respondents who underwent a pregnancy reported a pre-existing mental health diagnosis, nearly 2/3 reported having significant anxiety symptoms related to their pregnancy. Of those with significant symptoms, 44% were unable to access mental health services. Additionally, only 55% of healthcare providers reported referral for assessment and treatment if mental health concerns arose during or after pregnancy., Conclusion: The results provide valuable insights into the unique challenges faced by patients with CHD and their providers during pregnancy. By addressing the identified gaps through PCOR, we can work towards a goal to improve maternal care for women with CHD., Competing Interests: Conflict of interest None reported., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Decision-making is important in user-involved maternity care and patient experience instruments Mothers Autonomy in Decision Making scale (MADM) and Mothers on Respect index (MORi) are used internationally to measure the user involvement quality and users' experiences of autonomy and respect. This study aimed to translate and qualitatively adapt the original MADM and MORi instruments to the Danish language and culture., Methods: A forward and backward translation using a standard guideline. Subsequently, qualitative interviews to refine the translation and cultural adaptation by pilot testing the scales., Results: The translation process showed cultural differences linked to linguistic variations between Danish and English. Cognitive interviews with 14 diverse pregnant women revealed challenges in women's understanding of decision-making in maternity care. Changes in wording and assisting descriptive texts were made. Further, the order of the MADM items was changed to improve the understanding of decision-making., Discussion: Primarily, the discussion concerns how decision-making can be understood in the context of maternity care and why women's understanding of decision-making in Danish maternity care in the MADM scale items was challenged., Conclusion: The qualitative pilot test using cognitive interviews after translation of the instruments was a valuable method for cultural adaptation providing important knowledge on women's understanding and perceptions of item contents. The cognitive interviews provided a comprehensive understanding of decision-making and contributed to a thoroughly worked Danish version of the MADM and MORi instruments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

The aim of this systemic review and meta-analysis was to examine the differences in caesarean section rates across European regions and at a country level by utilizing the Robson classification system. The study has compared caesarean rates across European regions using the Robson classification to identify the drivers of caesarean section use. This review shows significant variations in caesarean section rates across European regions, ranging from 16.9 % in Northern Europe to 43.6 % in Southern Europe. There was a higher contribution of previous CS (Robson Group 5), ranging from 51.2 to 95.0 % of CS in this group to overall rates, particularly in Southern Europe (95.0 %), raises concerns about the "domino effect" of primary caesareans. This finding emphasises the critical importance of strategies to reduce primary CS rates., Background: Caesarean section (CS) rates exhibit considerable global variation, reflecting diverse medical practices, cultural attitudes, and healthcare policies. While some regions maintain relatively low rates, others report significantly higher incidences of the procedure. Analysing these differences is crucial for understanding and developing targeted healthcare strategies and ensuring optimal maternal and neonatal outcomes. This review examines differences in CS rates in Europe according to the Robson 10 group classification., Methods: We identified articles between January 2000 to June 2023 using MEDLINE/PubMed, CINAHL, EMBASE, Global Index Medicus, Web of Science and Cochrane library. There was no restriction on patient population, except for birth in a country of the European region. We excluded all studies that were conference proceedings and studies reported in a language other than English and Swedish., Findings: The search generated a total of 1024 studies, out of which 44 were included, encompassing 6,641,615 births. The majority were from Northern (38 %) and Western Europe (33.5 %). CS rates varied markedly across Europe, ranging from 16.9 % in Northern region to 43.6 % in Southern Europe. The highest contribution to CS rates came from Robson Group 5 (previous CS), with contributions ranging from 51.2 % in Northern to 95.0 % in Southern Europe. The mode of birth for Robson Group 6 (nulliparous, breech) was predominately by CS (88.8 % in Northern to 92.5 % in Central-Eastern Europe)., Interpretation: CS rates continue to vary widely across Europe, with the highest rates in Southern and the lowest in Northern Europe. Previous CS and breech presentation were prominent drivers of CS rates. Region-specific strategies are needed to address these diverse factors to minimise accelerating CS rates across Europe., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Klippel-Trenaunay Syndrome (KTS) is a rare congenital vascular disorder characterized by extensive capillary and venous malformations that pose unique challenges during pregnancy. This case report discusses the successful management of a 34-year-old pregnant woman with KTS who had two caesarean sections, resulting in the birth of two healthy babies. Despite the lack of evidence-based guidelines for obstetrical management in KTS, a multidisciplinary team collaborated to devise a high-risk thrombosis management plan, involving the use of compression stocking and low molecular weight heparin prophylaxis. The patient's elevated risk of thrombosis, exacerbated during pregnancy, informed the decision of caesarean sections, aligning with finding that in most KTS pregnancies, this method of delivery based on obstetric indications and arteriovenous malformations is chosen. This case highlights the importance of systematic and patient-centered care, advocating for comprehensive obstetric management guidelines to address the unique challenges posed by KTS during pregnancy. Further research is warranted to enhance our understanding and refine guidelines for individuals with vascular abnormalities linked to KTS., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

There is limited evidence on heterogenous co-developmental trajectories of internalizing (INT) and externalizing (EXT) problems from childhood to adolescence and predictors of these joint trajectories. We utilized longitudinal data from Raine Study participants ( n = 2393) to identify these joint trajectories from 5 to 17 years using parallel-process latent class growth analysis and analyze childhood individual and family risk factors predicting these joint trajectories using multinomial logistic regression. Five trajectory classes were identified: Low-problems (Low-INT/Low-EXT, 29%), Moderate Externalizing (Moderate-EXT/Low-INT, 26.5%), Primary Internalizing (Moderate High-INT/Low-EXT, 17.5%), Co-occurring (High-INT/High-EXT, 17%), High Co-occurring (Very High-EXT/High-INT, 10%). Children classified in Co-occurring and High Co-occurring trajectories (27% of the sample) exhibited clinically meaningful co-occurring problem behaviors and experienced more adverse childhood risk-factors than other three trajectories. Compared with Low-problems : parental marital problems, low family income, and absent father predicted Co-occurring and High Co-occurring trajectories; maternal mental health problems commonly predicted Primary Internalizing, Co-occurring , and High Co-occurring trajectories; male sex and parental tobacco-smoking uniquely predicted High Co-occurring membership; other substance smoking uniquely predicted Co-occurring membership; speech difficulty uniquely predicted Primary Internalizing membership; child's temper-tantrums predicted all four trajectories, with increased odds ratios for High Co-occurring (OR = 8.95) and Co-occurring (OR = 6.07). Finding two co-occurring trajectories emphasizes the importance of early childhood interventions addressing comorbidity.

Purpose of Review: This review examines Turkey's cervical cancer screening programme, highlighting its evolution from a cytology-based approach to a more effective HPV-based strategy. The review is timely given the global push to reduce cervical cancer incidence through improved screening practices, and it positions Turkey's programme as a potential model for other countries facing similar public health challenges., Recent Findings: Recent advances in cervical cancer screening in Turkey include the nationwide introduction of HPV DNA testing, centralized laboratory systems and innovative management software. The programme has significantly improved screening coverage and early detection rates, particularly in underserved communities. However, challenges remain in areas such as training healthcare workers, raising awareness of HPV vaccination, and integrating self-sampling methods into the screening process., Summary: The Turkish experience demonstrates that a well organized HPV-based cervical cancer screening programme can overcome significant cultural and logistical barriers and lead to improved public health outcomes. Future efforts should focus on refining triage strategies, exploring new molecular tests, and expanding the use of self-sampling to further improve the effectiveness of cervical cancer prevention efforts worldwide., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: To characterize the gingival crevicular fluid (GCF) and plasma extracellular vesicles (EVs) and explore their proteomic cargo in healthy pregnant women compared to those with gestational diabetes mellitus (GDM) and periodontitis., Methods: One-hundred and four pregnant women were recruited at 24-30 gestation weeks. GDM was diagnosed by an oral glucose tolerance test. GCF and plasma samples were obtained to isolate EVs and characterized by nanoparticle tracking, immunoassays, electron microscopy and mass spectrometry., Results: Of the recruits,17.3% women were healthy, 50% had periodontitis and 32.7% had both GDM and periodontitis. Probing depth, clinical attachment loss and bleeding on probing were more severe in GDM and periodontitis pregnancies (p < 0.0001). Additionally, this group showed an increase concentration of total, small and large GCF-EVs (p = 0.0015, p = 0.0011 and p = 0.0008, respectively), with decreased expression of CD9, CD81 and CD81/CD63 ratio (p = 0.0461, p = 0.0164 and p = 0.0005, respectively). No differences were observed in plasmatic EVs concentration or markers expression. Proteomic analysis of GCF-EVs showed peptides of both host and bacterial origin. Gene ontology analysis revealed that proteins of GCF-EVs participate in immune inflammatory responses, glucose metabolism and insulin response mechanisms., Conclusion: GCF-EVs were increased in both GDM and periodontitis, and their proteomic cargo suggest their involvement in immune inflammatory response, glucose metabolism and insulin pathways during pregnancy., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: With increasing availability of brain magnetic resonance imaging (MRI) in high-income countries, cranial ultrasound (cUS) is used less frequently to evaluate infants with hypoxic-ischemic encephalopathy (HIE). This study aimed to correlate findings of brain injury on early postnatal cUS with brain injury on neonatal brain MRI performed as part of routine clinical care for near-term and term infants with moderate to severe HIE., Methods: This was a retrospective cohort study comparing early postnatal cUS and later neonatal brain MRI using scoring systems with prognostic validity to assess brain injury in near-term/term infants with moderate or severe HIE. Infants were born between 2010 and 2021 and were treated at a single tertiary neonatal intensive care unit., Results: A total of 94 infants were included in this study. cUS was performed in the first five days after birth and brain MRI at a median of 6.7 days (interquartile range 5.4, 7.9). Findings of white matter injury on cUS <24 hours and gray matter injury on cUS >48 hours correlated with similar nature and severity of brain injury on brain MRI. Subgroup analyses of cUS performed <24 and >48 hours and contemporaneous brain MRI performed on days 3 to 5 provided stronger evidence for correlations of brain injury between neuroimaging modalities., Conclusion: This study provides evidence for the correlation of findings of brain injury between cUS and brain MRI. Early postnatal cUS can provide information on potential findings on brain MRI and may help inform outcome of newborns in low-middle income countries and situations where MRI is not clinically possible., Competing Interests: Declaration of competing interest Conflicts of interest: The authors have no conflicts of interest to declare., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Objective: To explore the value of amide proton transfer (APT) imaging in assessing parametrial invasion (PMI) and lymph-vascular space invasion (LVSI) of cervical cancer., Materials and Methods: We retrospectively analyzed the clinical and imaging data of cervical cancer patients diagnosed pathologically at our hospital from January 2021 to June 2024. All patients underwent routine magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and APT imaging before treatment. Apparent diffusion coefficient (ADC) and APT values were measured. Based on the pathological results, patients were categorized into LVSI (+) and LVSI (-) groups, and PMI (+) and PMI (-) groups. Independent sample t-tests were used to compare the ADC and APT values between these groups. Receiver operating characteristic (ROC) curves were used to assess the sensitivity, specificity, and area under the curve (AUC) of ADC, APT, and ADC + APT in predicting PMI and LVSI. The Delong test was employed to compare the diagnostic performance among these measures., Results: A total of 83 patients were included, with 56 in the LVSI (-) group, 27 in the LVSI (+) group, 35 in the PMI (-) group, and 16 in the PMI (+) group. The ADC values for the LVSI (+) and PMI (+) groups were significantly lower than those for the LVSI (-) and PMI (-) groups (P < 0.01). The APT values for the LVSI (+) and PMI (+) groups were significantly higher than those for the LVSI (-) and PMI (-) groups (P < 0.01). The AUC values for ADC, APT, and the combination of ADC + APT in predicting LVSI were 0.839, 0.788, and 0.880, respectively, and in predicting PMI were 0.770, 0.764, and 0.796, respectively. There were no statistically significant differences in the diagnostic performance of ADC, APT, and ADC + APT in predicting PMI. However, the diagnostic performance of ADC + APT in predicting LVSI was significantly better than that of ADC and APT alone (P < 0.01)., Conclusion: APT imaging can predict LVSI and PMI status in cervical cancer before surgery. When combined with ADC, its diagnostic accuracy for predicting LVSI is higher than that of APT or ADC alone. This suggests a novel approach for assessing LVSI in cervical cancer., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Globally, caesarean births (CB), including emergency caesareans births (EmCB), are rising. It is estimated that nearly a third of all births will be CB by 2030., Objectives: Identify and summarise the results from studies developing and validating prognostic multivariable models predicting the risk of EmCBs. Ultimately understanding the accuracy of their development, and whether they are operationalised for use in routine clinical practice., Search Strategy: Studies were identified using databases: MEDLINE, CINAHL, Cochrane Central and Scopus with a search strategy tailored to models predicting EmCBs., Selection Criteria: Prospective studies developing and validating clinical prediction models, with two or more covariates, to predict risk of EmCB., Data Collection and Analysis: Data were extracted onto a proforma using the Prediction model Risk Of Bias ASsessment Tool (PROBAST)., Results: In total, 8083 studies resulted in 56 unique prediction modelling studies and seven validating studies, with a total of 121 different predictors. Frequently occurring predictors included maternal height, maternal age, parity, BMI and gestational age. PROBAST highlighted 33 studies with low overall bias, and these all internally validated their model. Thirteen studies externally validated; only eight of these were graded an overall low risk of bias. Six models offered applications that could be readily used, but only one provided enough time to offer a planned caesarean birth (pCB). These well-refined models have not been recalibrated since development. Only one model, developed in a relatively low-risk population, with data collected a decade ago, remains useful at 36 weeks for arranging a pCB., Conclusion: To improve personalised clinical conversations, there is a pressing need for a model that accurately predicts the timely risk of an EmCB for women across diverse clinical backgrounds., Trial Registration: PROSPERO registration number: CRD42023384439., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Objective: To assess if off-label oral solution of misoprostol compared with licensed oral tablet of misoprostol approved for induction of labour (IOL) is as efficient in resulting in vaginal delivery within 24 h, using a non-inferiority design., Design: Prospective, randomised, non-inferiority, open-label, blinded endpoint trial., Setting: Two tertiary level hospitals, Stockholm, Sweden, January 2022 to May 2023., Population: In all, 874 women, without previous caesarean section, with an unripe cervix and a singleton, cephalic foetus at 37 + 0 to 42 + 0 gestational weeks, with a normal cardiotocography, planned for IOL were included., Methods: Women were randomised 1:1 to intervention (25 μg oral solution of misoprostol) or control (25 μg oral tablet of misoprostol) two-hourly for a maximum of eight doses. Subsequent methods of induction followed clinical practice., Main Outcome Measures: The primary outcome was vaginal delivery within 24 h tested using non-inferiority testing procedures at a non-inferiority margin of 5 percentage points. Secondary efficacy outcomes were tested for superiority of either treatment. Analyses were by intention-to-treat., Results: There were 207 (47.4%) vaginal deliveries within 24 h for women receiving oral solution and 192 (43.9%) vaginal deliveries within 24 h for women receiving oral tablet, establishing non-inferiority with an absolute risk difference of 3.4% (95% CI -3.2% to 10.0%). Women receiving oral solution required fewer doses to reach active labour than women receiving oral tablet (5.7 vs. 6.1, p = 0.007). There were no significant differences for other secondary or safety outcomes., Conclusions: Off-label oral solution of misoprostol was non-inferior to the licensed oral tablet regarding efficacy of IOL defined as vaginal delivery within 24 h., Trial Registration: Clinicaltrials.gov identifier: NCT05424445., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Fundamental and translational research in ovarian cancer aims to enhance understanding of disease mechanisms and improve treatment and survival outcomes. To support this, we established the Dutch multicenter, interdisciplinary Archipelago of Ovarian Cancer Research (AOCR) infrastructure, which includes a nationwide biobank. In this study, we share our experiences in establishing the infrastructure, offer guidance for similar initiatives, and evaluate the AOCR patient cohort. Key challenges included obtaining Data Protection Impact Assessment (DPIA) clearance, drafting the consortium agreement, and securing ethical approval from all hospitals. Over three years, 1093 patients were enrolled across 17 hospitals, resulting in the collection of 1339 tissue samples and 2280 blood samples. Of the 523 patients with currently available clinical and pathological data, 74 % (n = 387) had primary ovarian cancer. Among these patients, 73.4 % was diagnosed with high-grade serous ovarian carcinoma, and 80.9 % presented with advanced-stage disease. Surgery was performed on 93 % of patients with primary ovarian cancer, and chemotherapy was administered to 90.4 % of these patients. In conclusion, the AOCR biobank has established a robust foundation for future fundamental and translational ovarian cancer research. This manuscript provides valuable insights and guidance for developing future research infrastructures and biobanks, and contains detailed information about the AOCR patient cohort to date., Competing Interests: Declaration of competing interest The authors have no competing interests to declare that are relevant to the content of this article., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Second victim syndrome (SVS) is described as when healthcare providers encounter significant moral distress after traumatic patient care events. Although broadly recognized in medicine, this remains underrecognized in surgery, and no systemic approaches exist to mitigate potential harms of SVS among surgeons. When SVS is left unaddressed, surgeons not only suffer personal psychological harm but their ability to care for future patients can also be compromised. The aim was to examine surgeons' perceptions and attitudes regarding mitigation of SVS., Study Design: This study was conducted at a tertiary-care university hospital using a mixed-methods approach coupling quantitative and qualitative assessments including a 13-item survey, follow-up focus group, and semistructured interviews, The Wilcoxon signed rank test was used for quantitative analysis and content analysis used to report qualitative findings., Results: Surgeons believe SVS is a universal experience among surgeons that healthcare institutions have a moral obligation to address. Surgeons further believe that any effective mitigation strategy must receive legal protection similar to morbidity and mortality conferences. The culture, tenor, and tone of review processes after surgical complications can either reduce or exacerbate the burden of SVS. Successful interventions must be easily accessible, voluntary, and culturally acceptable. Surgeons may suffer greater SVS compared with nonprocedural physicians as adverse events can be inevitable in operation and may potentially be a high-frequency outcome depending on patient population., Conclusions: Surgeons agreed that healthcare organizations have a moral imperative to assist surgeons in navigating the psychosocial impacts of SVS after adverse surgical outcomes. The success of mitigation strategies was viewed as ethically relevant to patients and surgeons and dependent on the culture, tenor, and tone of the process., (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Small for gestational age is defined as a birthweight below a birthweight percentile threshold, usually the 10th percentile, with the third or fifth percentile used to identify severe small for gestational age. Small for gestational age is used as a proxy for growth restriction in the newborn, but small-for-gestational-age newborns can be physiologically small and healthy. In addition, this definition excludes growth-restricted newborns who have weights more than the 10th percentile. To address these limits, a Delphi study developed a new consensus definition of growth restriction in newborns on the basis of neonatal anthropometric and clinical parameters, but it has not been evaluated., Objective: To assess the prevalence of growth restriction in the newborn according to the Delphi consensus definition and to investigate associated morbidity risks compared with definitions of Small for gestational age using birthweight percentile thresholds., Study Design: Data come from the 2016 and 2021 French National Perinatal Surveys, which include all births ≥22 weeks and/or with birthweights ≥500 g in all maternity units in France over 1 week. Data are collected from medical records and interviews with mothers after the delivery. The study population included 23,897 liveborn singleton births. The Delphi consensus definition of growth restriction was birthweight less than third percentile or at least 3 of the following criteria: birthweight, head circumference or length <10th percentile, antenatal diagnosis of growth restriction, or maternal hypertension. A composite of neonatal morbidity at birth, defined as 5-minute Apgar score <7, cord arterial pH <7.10, resuscitation and/or neonatal admission, was compared using the Delphi definition and usual birthweight percentile thresholds for defining small for gestational age using the following birthweight percentile groups: less than a third, third to fourth, and fifth to ninth percentiles. Relative risks were adjusted for maternal characteristics (age, parity, body mass index, smoking, educational level, preexisting hypertension and diabetes, and study year) and then for the consensus definition and birthweight percentile groups. Multiple imputation by chained equations was used to impute missing data. Analyses were carried out in the overall sample and among term and preterm newborns separately., Results: We identified that 4.9% (95% confidence intervals, 4.6-5.2) of newborns had growth restriction. Of these infants, 29.7% experienced morbidity, yielding an adjusted relative risk of 2.5 (95% confidence intervals, 2.2-2.7) compared with newborns without growth restriction. Compared with birthweight ≥10th percentile, morbidity risks were higher for low birthweight percentiles (less than third percentile: adjusted relative risk, 3.3 [95% confidence intervals, 3.0-3.7]; third to fourth percentile: relative risk, 1.4 [95% confidence intervals, 1.1-1.7]; fifth to ninth percentile: relative risk, 1.4 [95% confidence intervals, 1.2-1.6]). In adjusted models including the definition of growth restriction and birthweight percentile groups and excluding birthweights less than third percentile, which are included in both definitions, morbidity risks remained higher for birthweights at the third to fourth percentile (adjusted relative risk, 1.4 [95% confidence intervals, 1.1-1.7]) and fifth to ninth percentile (adjusted relative risk, 1.4 [95% confidence intervals, 1.2-1.6]), but not for the Delphi definition of growth restriction (adjusted relative risk, 0.9 [95% confidence intervals, 0.7-1.2]). Similar patterns were found for term and preterm newborns., Conclusion: The Delphi consensus definition of growth restriction did not identify more newborns with morbidity than definitions of small for gestational age on the basis of birthweight percentiles. These findings illustrate the importance of evaluating the results of Delphi consensus studies before their adoption in clinical practice., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To evaluate and compare the efficacy and safety of Botulinum Toxin A (BTA) injections versus placebo injections, combined with pelvic floor muscle therapy (PFMT), in women with chronic pelvic pain (CPP)., Design: Randomised, double-blinded clinical trial (January 2020-April 2023)., Setting: This multicentre study was conducted at four hospitals in the Netherlands., Population and Sample: Ninety-four women with CPP and increased pelvic floor muscle tone despite previous PFMT, were enrolled., Methods: Participants received either BTA injections (100 units) or placebo injections into the pelvic floor muscle, followed by four PFMT sessions., Main Outcomes and Measures: Primary outcomes included the number of women with at least a 33% reduction in pain and those reporting (very) much improvement of their pain. Secondary outcomes covered quality of life and pelvic floor function. Follow-up visits were scheduled at 4, 8, 12, and 26 weeks post-treatment. Mixed models for repeated measurements were used for analysis., Results: A 33% reduction or more in average pain score was reported by 15 participants (33%) after BTA treatment and 9 participants (20%) after placebo treatment (odd ratio placebo/BTA 1.88; 95% CI 0.72-4.90, p = 0.19). In both groups, 8 women (17%) reported their improvement as (very) much better (odd ratio placebo/BTA 0.947; 95% CI 0.32-2.80, p = 0.92). Pelvic floor resting activity decreased significantly after BTA treatment compared to placebo (p = 0.001)., Conclusion: The results from this study do not support the use of BTA injections in the management of CPP in women., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Purpose: To compare the cost-effectiveness of a nurse-led sexual rehabilitation intervention with standard care in women treated with external beam radiotherapy, with or without brachytherapy, for gynaecological cancers., Methods: Eligible women were randomly assigned to the intervention (n = 112) or standard care (n = 117). Primary endpoint was sexual functioning at 12-months post-radiotherapy, assessed by the Female Sexual Function Index (FSFI). Nurses documented frequency and duration of intervention sessions, patients reported sexual healthcare and functioning at 1, 3, 6, and 12-months. Costs were related to quality-adjusted-life-years (QALYs) using the EuroQol-5 Dimensions and visual analogue scale, and to sexual functioning improvement at 12-months. T-tests compared mean QALYs and costs, with multiple imputation for missing data., Results: The nurse-led intervention added €172 per patient, including training costs and 4-5 sessions. Other sexual rehabilitation costs were higher in the standard care group (€107 versus €141, p = 0.02). Total costs were €478 for the intervention group and €357 for standard care (p = 0.03). Valued at €20.000 per QALY, the intervention was 60 %-70 % likely to be cost-effective and less than 50 % likely to be cost-effective in terms of improved sexual functioning., Conclusion: The nurse-led sexual rehabilitation intervention is not more cost-effective than standard care, however with low costs in both groups. Since costs for standard care were slightly lower, it is preferred from a health-economic perspective. It includes detailed patient education and a dedicated sexual rehabilitation session within the first three months post-radiotherapy, which is better provided at lower cost by a trained nurse., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: This study aimed to adapt the 6-Item Self-Efficacy Scale for Chronic Disease Management (SEMDC-6S) to women with endometriosis in the Turkish population and to evaluate its validity and reliability., Methods: This methodological study comprised of 200 women with endometriosis. The construct validity of the scale was tested using the confirmatory factor analysis methods. The reliability of the scale was tested using Cronbach's alpha coefficient, item-total score correlations and test-retest reliability analysis., Results: It was determined that the SEMDC-6S consisted of six items and one subscale. In the confirmatory factor analysis, the fit index values of the scale were found to be acceptable. The intraclass correlation coefficient of test-retest reliability was 0.95, and Cronbach's alpha coefficient was 0.76., Conclusion: The Turkish version of the SEMDC-6S is a valid and reliable tool for assessing the self-efficacy of women with endometriosis., (© 2024 John Wiley & Sons Ltd.)

Objective: Lack of accessibility to oral glucose tolerance tests (OGTTs) in South Africa means many pregnant women go without testing for gestational diabetes mellitus (GDM). This study evaluated point-of-care (POC) glucometers against the laboratory-based glucose method in pregnant women., Methods: This was a cross-sectional study on pregnant women attending the prenatal clinic in Johannesburg who were recommended for the OGTT. OGTTs were conducted as per International Association of Diabetes and Pregnancy Study Groups (IADPSG) guidelines. Women who consented to the study donated both venous and capillary blood for laboratory-based and POC glucose measurements using seven POC glucometers: I-STAT, Xpress, LDX, VivaChek-Ino, Accu-Chek Active, StatStrip, and Codefree. By assessing sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) and comparing Bland-Altman plots, the diagnostic accuracy of each glucose meter was compared with the reference method, the laboratory-based glucose method., Results: Data were analyzed for 1076 pregnant women. Based on OGTT testing, 83 women had GDM (7.7%). Overall, the POC glucometers performed poorly, with sensitivity ranging from 17.6% to 87.18% and specificity ranging between 62.7% and 99.8%. The AUC ranged from 0.59 to 0.79. All POC glucometers showed moderate to poor reliability. Laboratory-based fasting plasma glucose (FPG) surpassed the POC glucometers in sensitivity, specificity, and AUC, with values of 94.0%, 100%, and 0.98, respectively., Conclusion: We demonstrated that laboratory-based FPG has the potential to be used as a diagnostic test for GDM and that the POC glucometers cannot replace OGTT laboratory-based measurements., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

For surgeons and clinicians, nonobstetric surgery during pregnancy has certain difficulties and considerations. In order to aid in decision-making in these situations, this manuscript offers a thorough review of the guidelines currently in place from renowned obstetric and surgical societies, such as the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians & Gynecologists, and others. Using AGREE II-S methodology, a comprehensive analysis of guidelines reveals differences in recommendations for anesthetics, surgical procedures, imaging modalities, and thromboembolic prophylaxis. Furthermore, a thorough discussion of strategic surgical planning is provided, covering aspects such as patient positioning, trocar placement, pneumoperitoneum generation, and thromboembolic risk management. The publication highlights that in order to maximize the results for both the mother and the fetus after nonobstetric surgery performed during pregnancy, a multidisciplinary approach and evidence-based decision-making are essential., (© 2024 International Federation of Gynecology and Obstetrics.)