Caesarean section (CS) results in the occurrence of the phenomenon ‘niche’. A ‘niche’ describes the presence of a hypoechoic area within the myometrium of the lower uterine segment, reflecting a ...discontinuation of the myometrium at the site of a previous CS. Using gel or saline instillation sonohysterography, a niche is identified in the scar in more than half of the women who had had a CS, most with the uterus closed in one single layer, without closure of the peritoneum. An incompletely healed scar is a long-term complication of the CS and is associated with more gynaecological symptoms than is commonly acknowledged. Approximately 30% of women with a niche report spotting at 6–12 months after their CS. Other reported symptoms in women with a niche are dysmenorrhoea, chronic pelvic pain and dyspareunia. Given the association between a niche and gynaecological symptoms, obstetric complications and potentially with subfertility, it is important to elucidate the aetiology of niche development after CS in order to develop preventive strategies. Based on current published data and our observations during sonographic, hysteroscopic and laparoscopic evaluations of niches we postulate some hypotheses on niche development. Possible factors that could play a role in niche development include a very low incision through cervical tissue, inadequate suturing technique during closure of the uterine scar, surgical interventions that increase adhesion formation or patient-related factors that impair wound healing or increase inflammation or adhesion formation.
Objective
To assess the current prevalence of and risk factors for infertility among couples of reproductive age in China.
Design
Population‐based cross‐sectional study.
Setting
We approached 25 270 ...couples in eight provinces/municipalities, of whom 18 571 (response rate 74%) were interviewed.
Population
Couples living together and married for more than 1 year, of whom the female spouse was 20–49 years old.
Methods
Women were approached via telephone and face‐to‐face conversation to complete the standardised and structured questionnaire by trained interviewers.
Main outcome measures
Prevalence of and risk factors for infertility.
Results
Among women ‘at risk’ of pregnancy, the prevalence of infertility was 15.5% (2680/17 275). Among 10 742 women attempting to become pregnant, the prevalence of infertility was 25.0% (2680/10 742), which increased with age in the second population. Among women who failed to achieve pregnancy in the last 12 months, 3470 finished our questionnaire about fertility care, and 55.2% (1915/3470) of them had sought medical help. Sociodemographic risk factors for infertility included lower educational level adjusted odds ratio (aOR) 3.4, 95% CI 2.0–5.5 and employment (aOR 2.3, 95% CI 1.9–2.9). Clinical risk factors were irregular menstrual cycle (aOR 1.8, 95% CI 1.2–2.5), light menstrual blood volume (aOR 1.6, 95% CI 1.2–2.0), history of cervicitis (aOR 1.5, 95% CI 1.2–2.0) and endometriosis (aOR 3.1, 95% CI 1.1–9.3), previous stillbirth (aOR 2.1, 95% CI 1.3–3.3) and miscarriage (aOR 2.7, 95% CI 2.1–3.5). In addition, history of operation was a significant risk factor of infertility.
Conclusions
Among couples of reproductive age in China, the prevalence of infertility was 25%, and almost half of the couples experiencing infertility had not sought medical help.
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In China, 25% of couples actively attempting to become pregnant suffered infertility.
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In China, 25% of couples actively attempting to become pregnant suffered infertility.
Background
Preterm birth may leave the brain vulnerable to dysfunction. Knowledge of future neurodevelopmental delay in children born with various degrees of prematurity is needed to inform practice ...and policy.
Objective
To quantify the long‐term cognitive, motor, behavioural and academic performance of children born with different degrees of prematurity compared with term‐born children.
Search strategy
PubMed and Embase were searched from January 1980 to December 2016 without language restrictions.
Selection criteria
Observational studies that reported neurodevelopmental outcomes from 2 years of age in children born preterm compared with a term‐born cohort.
Data collection and analysis
We pooled individual estimates of standardised mean differences (SMD) and odds ratios (OR) with 95% confidence intervals using a random effects model.
Main results
We included 74 studies (64 061 children). Preterm children had lower cognitive scores for FSIQ (SMD: −0.70; 95% CI: −0.73 to −0.66), PIQ (SMD: −0.67; 95% CI: −0.73 to −0.60) and VIQ (SMD: −0.53; 95% CI: −0.60 to −0.47). Lower scores for preterm children in motor skills, behaviour, reading, mathematics and spelling were observed at primary school age, and this persisted to secondary school age, except for mathematics. Gestational age at birth accounted for 38–48% of the observed IQ variance. ADHD was diagnosed twice as often in preterm children (OR: 1.6; 95% CI: 1.3–1.8), with a differential effect observed according to the severity of prematurity (I2 = 49.4%, P = 0.03).
Conclusions
Prematurity of any degree affects the cognitive performance of children born preterm. The poor neurodevelopment persists at various ages of follow up. Parents, educators, healthcare professionals and policy makers need to take into account the additional academic, emotional and behavioural needs of these children.
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Adverse effect of preterm birth on a child's neurodevelopment persists up to adulthood.
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Adverse effect of preterm birth on a child's neurodevelopment persists up to adulthood.
Objective
To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births.
Design
A nationwide cohort study.
Setting
The Netherlands.
Population
Low‐risk ...women in midwife‐led care at the onset of labour.
Methods
Analysis of national registration data.
Main outcome measures
Intrapartum and neonatal death, Apgar scores, and admission to a neonatal intensive care unit (NICU) within 28 days of birth.
Results
Of the total of 814 979 women, 466 112 had a planned home birth and 276 958 had a planned hospital birth. For 71 909 women, their planned place of birth was unknown. The combined intrapartum and neonatal death rates up to 28 days after birth, including cases with discrepancies in the registration of the moment of death, were: for nulliparous women, 1.02‰ for planned home births versus 1.09‰ for planned hospital births, adjusted odds ratio (aOR) 0.99, 95% confidence interval (95% CI) 0.79–1.24; and for parous women, 0.59‰ versus 0.58‰, aOR 1.16, 95% CI 0.87–1.55. The rates of NICU admissions and low Apgar scores did not significantly differ among nulliparous women (NICU admissions up to 28 days, 3.41‰ versus 3.61‰, aOR 1.05, 95% CI 0.92–1.18). Among parous women the rates of Apgar scores below seven and NICU admissions were significantly lower among planned home births (NICU admissions up to 28 days, 1.36 versus 1.95‰, aOR 0.79, 95% CI 0.66–0.93).
Conclusions
We found no increased risk of adverse perinatal outcomes for planned home births among low‐risk women. Our results may only apply to regions where home births are well integrated into the maternity care system.
Summary Preterm birth is the most important cause of neonatal mortality and morbidity worldwide. In this review, we review potential risk factors associated with preterm birth and the subsequent ...management to prevent preterm birth in low and high risk women with a singleton or multiple pregnancy. A history of preterm birth is considered the most important risk factor for preterm birth in subsequent pregnancy. General risk factors with a much lower impact include ethnicity, low socio-economic status, maternal weight, smoking, and periodontal status. Pregnancy-related characteristics, including bacterial vaginosis and asymptomatic bacteriuria, appear to be of limited value in the prediction of preterm birth. By contrast, a mid-pregnancy cervical length measurement is independently associated with preterm birth and could be used to identify women at risk of a premature delivery. A fetal fibronectin test may be of additional value in the prediction of preterm birth. The most effective methods to prevent preterm birth depend on the obstetric history, which makes the identification of women at risk of preterm birth an important task for clinical care providers.
Objective
To assess whether vaginal secretions and breast milk of women with coronavirus disease 2019 (COVID‐19) contain severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).
Design
Single ...centre cohort study.
Setting
Renmin Hospital of Wuhan University, Wuhan, Hubei province, China.
Population
We studied 13 SARS‐CoV‐2‐infected pregnant women diagnosed between 31 January and 9 March 2020.
Methods
We collected clinical data, vaginal secretions, stool specimens and breast milk from SARS‐CoV‐2‐infected women during different stages of pregnancy and collected neonatal throat and anal swabs.
Main outcomes and measures
We assessed viral presence in different biosamples.
Results
Of the 13 women with COVID‐19, five were in their first trimester, three in their second trimester and five in their third trimester. Of the five women in their third trimester who gave birth, all delivered live newborns. Among these five deliveries, the primary adverse perinatal outcomes included premature delivery (n = 2) and neonatal pneumonia (n = 2). One of nine stool samples was positive; all 13 vaginal secretion samples, and five throat swabs and four anal swabs collected from neonates, were negative for the novel coronavirus. However, one of three samples of breast milk was positive by viral nucleic acid testing.
Conclusions
In this case series of 13 pregnant women with COVID‐19, we observed negative viral test results in vaginal secretion specimens, suggesting that a vaginal delivery may be a safe delivery option. However, additional research is urgently needed to examine breast milk and the potential risk for viral contamination.
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New evidence for the safety of vaginal delivery and breastfeeding in pregnant women infected with SARS‐CoV‐2, positive viral result in a breast‐milk sample.
New evidence for the safety of vaginal delivery and breastfeeding in pregnant women infected with SARS‐CoV‐2, positive viral result in a breast‐milk sample.
Objective To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low‐risk women who started their labour in primary care.
Design A ...nationwide cohort study.
Setting The entire Netherlands.
Population A total of 529 688 low‐risk women who were in primary midwife‐led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.
Methods Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics.
Main outcome measures Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.
Results No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).
Conclusions This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low‐risk women, provided the maternity care system facilitates this choice through the availability of well‐trained midwives and through a good transportation and referral system.
Anti-Mullerian hormone (AMH) is a marker of ovarian reserve status and represents a good predictor of ovarian response to ovarian hyperstimulation. The aim of this study was to assess the accuracy of ...AMH and antral follicle count (AFC) as predictors of an excessive response in IVF/ICSI treatment.
A systematic review and meta-analysis of the existing literature was performed. Studies were included if 2 × 2 tables for the outcome excessive response in IVF patients in relation to AMH/AFC could be constructed. Using a bivariate meta-analytic model, both summary point estimates for sensitivity and specificity were calculated, as well as summary ROC curves. Clinical value was analysed by calculating post-test probabilities of excessive response at optimal cut-off levels, as well as the corresponding abnormal test rates.
Nine studies reporting on AMH and five reporting on AFC were found. Summary estimates of sensitivity and specificity for AMH were 82 and 76%, respectively, and 82 and 80%, respectively, for AFC. Comparison of the summary estimates and ROC curves for AMH and AFC showed no statistical difference. Abnormal test rates for AMH and AFC amounted to ∼14 and 16%, respectively, at cut-off levels where test performance is optimal likelihood ratio for a positive result (LR + ) > 8, with a post-test probability of ± 70%.
Both AMH and AFC are accurate predictors of excessive response to ovarian hyperstimulation. Moreover, both tests appear to have clinical value. This opens ways to explore the potential of individualized FSH dose regimens based on ovarian reserve testing.
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