BJOG: An International Journal of Obstetrics and Gynaecology
1470-0328
Cơ quản chủ quản: WILEY , Wiley-Blackwell Publishing Ltd
Lĩnh vực:
Obstetrics and Gynecology
Các bài báo tiêu biểu
The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery Objectives
To define the prevalence of pelvic floor disorders in a non‐institutionalised community and to determine the relationship to gender, age, parity and mode of delivery.Design
A representative population survey using the 1998 South Australian Health Omnibus Survey.Sample
Random selection of 4400 households; 3010 interviews were conducted in the respondents'homes by trained female interviewers. This cross sectional survey included men and women aged 15–97 years.Results
The prevalence of all types of self‐reported urinary incontinence in men was 4.4% and in women was 35.3% (P < 0.001P < 0.03Conclusion
Pelvic floor disorders are very common and are strongly associated with female gender, ageing, pregnancy, parity and instrumental delivery. Caesarean delivery is not associated with a significant reduction in long term pelvic floor morbidity compared with spontaneous vaginal delivery.
Tập 107 Số 12 - Trang 1460-1470 - 2000
Randomised controlled trials – the gold standard for effectiveness research
Tập 125 Số 13 - Trang 1716-1716 - 2018
Pregnancy and childbirth outcomes among adolescent mothers: a <scp>W</scp>orld <scp>H</scp>ealth <scp>O</scp>rganization multicountry study Objective To investigate the risk of adverse pregnancy outcomes among adolescents in 29 countries. Design Secondary analysis using facility‐based cross‐sectional data of the W orld H ealth O rganization Multicountry S urvey on M aternal and N ewborn H ealth. Setting Twenty‐nine countries in A frica, L atin A merica, A sia and the M iddle E ast. Population Women admitted for delivery in 359 health facilities during 2–4 months between 2010 and 2011. Methods Multilevel logistic regression models were used to estimate the association between young maternal age and adverse pregnancy outcomes. Main outcome measures Risk of adverse pregnancy outcomes among adolescent mothers. Results A total of 124 446 mothers aged ≤24 years and their infants were analysed. Compared with mothers aged 20– 24 years, adolescent mothers aged 10–19 years had higher risks of eclampsia, puerperal endometritis, systemic infections, low birthweight, preterm delivery and severe neonatal conditions. The increased risk of intra‐hospital early neonatal death among infants born to adolescent mothers was reduced and statistically insignificant after adjustment for gestational age and birthweight, in addition to maternal characteristics, mode of delivery and congenital malformation. The coverage of prophylactic uterotonics, prophylactic antibiotics for caesarean section and antenatal corticosteroids for preterm delivery at 26– 34 weeks was significantly lower among adolescent mothers. Conclusions Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low‐ and middle‐income countries.
Tập 121 Số s1 - Trang 40-48 - 2014
Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study Objective Dysbiosis of the infant gut microbiota may have long‐term health consequences. This study aimed to determine the impact of maternal intrapartum antibiotic prophylaxis (IAP ) on infant gut microbiota, and to explore whether breastfeeding modifies these effects. Design Prospective pregnancy cohort of Canadian infants born in 2010–2012: the Canadian Healthy Infant Longitudinal Development (CHILD ) Study. Setting General community. Sample Representative sub‐sample of 198 healthy term infants from the CHILD Study. Methods Maternal IAP exposures and birth method were documented from hospital records and breastfeeding was reported by mothers. Infant gut microbiota was characterised by Illumina 16S rRNA sequencing of faecal samples at 3 and 12 months. Main outcome measures Infant gut microbiota profiles. Results In this cohort, 21% of mothers received IAP for Group B Streptococcus prophylaxis or pre‐labour rupture of membranes; another 23% received IAP for elective or emergency caesarean section (CS ). Infant gut microbiota community structures at 3 months differed significantly with all IAP exposures, and differences persisted to 12 months for infants delivered by emergency CS . Taxon‐specific composition also differed, with the genera Bacteroides and Parabacteroides under‐represented, and Enterococcus and Clostridium over‐represented at 3 months following maternal IAP . Microbiota differences were especially evident following IAP with emergency CS , with some changes (increased Clostridiales and decreased Bacteroidaceae) persisting to 12 months, particularly among non‐breastfed infants. Conclusions Intrapartum antibiotics in caesarean and vaginal delivery are associated with infant gut microbiota dysbiosis, and breastfeeding modifies some of these effects. Further research is warranted to explore the health consequences of these associations. Tweetable abstract Maternal #antibiotics during childbirth alter the infant gut #microbiome.
Tập 123 Số 6 - Trang 983-993 - 2016
Dose–response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA)—a systematic review and meta‐analyses Please cite this paper as: Patra J, Bakker R, Irving H, Jaddoe V, Malini S, Rehm J. Dose–response relationship between alcohol consumption before and during pregnancy and the risks of low birthweight, preterm birth and small for gestational age (SGA)—a systematic review and meta‐analyses. BJOG2011;118:1411–1421.Background Descriptions of the effects of moderate alcohol consumption during pregnancy on adverse pregnancy outcomes have been inconsistent.Objective To review systematically and perform meta‐analyses on the effect of maternal alcohol exposure on the risk of low birthweight, preterm birth and small for gestational age (SGA).Search strategy Using Medical Subject Headings, a literature search of MEDLINE, EMBASE, CINAHL, CABS, WHOlist, SIGLE, ETOH, and Web of Science between 1 January 1980 and 1 August 2009 was performed followed by manual searches.Selection criteria Case–control or cohort studies were assessed for quality (STROBE), 36 available studies were included.Data collection and analysis Two reviewers independently extracted the information on low birthweight, preterm birth and SGA using a standardised protocol. Meta‐analyses on dose–response relationships were performed using linear as well as first‐order and second‐order fractional polynomial regressions to estimate best fitting curves to the data.Main results Compared with abstainers, the overall dose–response relationships for low birthweight and SGA showed no effect up to 10 g pure alcohol/day (an average of about 1 drink/day) and preterm birth showed no effect up to 18 g pure alcohol/day (an average of 1.5 drinks/day); thereafter, the relationship showed a monotonically increasing risk for increasing maternal alcohol consumption. Moderate consumption during pre‐pregnancy was associated with reduced risks for all outcomes.Conclusions Dose–response relationship indicates that heavy alcohol consumption during pregnancy increases the risks of all three outcomes whereas light to moderate alcohol consumption shows no effect. Preventive measures during antenatal consultations should be initiated.
Tập 118 Số 12 - Trang 1411-1421 - 2011
Outcome of pregnancy in a woman with an increased body mass index Objective To show the increased risk of adverse outcomes in labour and fetomaternal morbidity in obese women (BMI > 30).Design A population‐based observational study.Setting University Hospital of Wales. The study sample was drawn from the Cardiff Births Survey, a population‐based database comprising of a total of 60,167 deliveries in the South Glamorgan area between 1990 and 1999.Population Primigravid women with a singleton uncomplicated pregnancy with cephalic presentation of 37 or more weeks of gestation with accurate information regarding height and weight recorded at the booking visit (measured by the midwives) were included in the study.Methods Comparisons were made between women with a body mass index of 20–30 and those with more than 30. SPSS version 10 was used for statistical analysis. Student's t test, χ2 and Fisher's exact tests were used wherever appropriate.Main outcome measures Labour outcomes assessed were risk of postdates, induction of labour, mode of delivery, failed instrumental delivery, macrosomia and shoulder dystocia. Maternal adverse outcomes assessed were postpartum haemorrhage, blood transfusion, uterine and wound infection, urinary tract infection, evacuation of uterus, thromboembolism and third‐ or fourth‐degree perineal tears. Fetal wellbeing was assessed using Apgar <7 at 5 minutes, trauma and asphyxia, cord pH < 7.2, babies requiring neonatal ward admissions, tube feeding and incubator.Results We report an increased risk [quoted as odds ratio (OR) and confidence intervals CI)] of postdates, 1.4 (1.2–1.7); induction of labour, 1.6 (1.3–1.9); caesarean section, 1.6 (1.4–2); macrosomia, 2.1 (1.6–2.6); shoulder dystocia, 2.9 (1.4–5.8); failed instrumental delivery, 1.75 (1.1–2.9); increased maternal complications such as blood loss of more than 500 mL, 1.5 (1.2–1.8); urinary tract infections, 1.9 (1.1–3.4); and increased neonatal admissions with complications such as neonatal trauma, feeding difficulties and incubator requirement.Conclusion Obese women appear to be at risk of intrapartum and postpartum complications. Induction of labour appears to be the starting point in the cascade of events. They should be considered as high risk and counselled accordingly.
Tập 112 Số 6 - Trang 768-772 - 2005
Systematic review of effects of low–moderate prenatal alcohol exposure on pregnancy outcome Objective The aim of this study was to review systematically the available evidence on studies in humans on the effects of low–moderate levels of prenatal alcohol consumption (up to 10.4 UK units or 83 g/week) compared with consumption of no alcohol on pregnancy outcome.Design Systematic review.Population Pregnant women or women who are trying to become pregnant.Methods The search strategy included Medline, Embase, Cinahl and PsychInfo for the years 1970–2005. Titles and abstracts were read by two researchers and inclusion/exclusion being decided according to prespecified criteria. All the included articles were then obtained and read in full by the two researchers to decide on inclusion. The articles were assessed for quality using the Newcastle–Ottawa Quality Assessment Scales.Main outcome measures Outcomes considered were miscarriage, stillbirth, intrauterine growth restriction, prematurity, birthweight, small for gestational age at birth and birth defects including fetal alcohol syndrome.Results The search resulted in 3630 titles and abstracts, which were narrowed down to 46 relevant articles. At low–moderate levels of consumption, there were no consistently significant effects of alcohol on any of the outcomes considered. Many of the reported studies had methodological weaknesses.Conclusions This systematic review found no convincing evidence of adverse effects of prenatal alcohol exposure at low–moderate levels of exposure. However, weaknesses in the evidence preclude the conclusion that drinking at these levels during pregnancy is safe.
Tập 114 Số 3 - Trang 243-252 - 2007
Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia Summary. The paper describes the technique of ‘LLETZ’ (large loop excision of the transformation zone), a new method of management for women with an abnormal cervical smear which offers the advantages of conization with those of local destruction. A large loop of thin wire forms a diathermy electrode that allows deep excision of the transformation zone with minimal tissue damage. The tissue removed can be examined histologically. The technique was used to investigate and treat 111 women with abnormal smears referred to the Bristol Royal Infirmary during 1986. Microinvasive disease was revealed in one woman where it was not suspected by cytology or colposcopic examination. Of 102 women followed up for at least 1 year by cytology, colposcopy and, where appropriate, histology, two women were found to have residual/recurrent cervical intraepithelial neoplasia.
Tập 96 Số 9 - Trang 1054-1060 - 1989
Maternal health after childbirth: results of an Australian population based survey Objective
To describe the prevalence of maternal physical and emotional health problems six to seven months after birth.Design
Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth.Participants
All women who gave birth in a two‐week period in Victoria, Australia in September 1993 except those who had a stillbirth or known neonatal death.Results
The response rate was 62.5% (n = 1336Conclusion
Physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.
Tập 105 Số 2 - Trang 156-161 - 1998