Antenatal Corticosteroids for Fetal Maturation: A Comprehensive Review of Major Guidelines.

Cervical cerclage (CC) represents one of the few effective measures currently available for the prevention of preterm delivery caused by cervical insufficiency, thus contributing in the reduction of neonatal morbidity and mortality rates. The aim of this study was to review and compare the most recently published major guidelines on the indications, contraindications, techniques, and timing of placing and removal of CC. A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the International Federation of Gynecology and Obstetrics (FIGO) on CC was carried out. There is a consensus among the reviewed guidelines regarding the recommended techniques, the indications for rescue CC, the contraindications, as well as the optimal timing of CC placement and removal. All medical societies also agree that ultrasound-indicated CC is justified in women with history of prior spontaneous PTD or mid-trimester miscarriage and a short cervical length detected on ultrasound. In addition, after CC, serial sonographic measurement of the cervical length, bed rest, and routine use of antibiotics, tocolysis, and progesterone are unanimously discouraged. In case of established preterm labor, CC should be removed, according to ACOG, RCOG, and SOGC. Furthermore, RCOG and SOGC agree on the prerequisites that should be met before attempting CC. These 2 guidelines along with FIGO recommend history-indicated CC for women with 3 or more previous preterm deliveries and/or second trimester pregnancy miscarriages, whereas the ACOG suggests the use of CC in singleton pregnancies with 1 or more previous second trimester miscarriages related to painless cervical dilation or prior CC due to painless cervical dilation in the second trimester. The role of amniocentesis in ruling out intra-amniotic infection before rescue CC remains a matter of debate. Cervical cerclage is an obstetric intervention used to prevent miscarriage and preterm delivery in women considered as high-risk for these common pregnancy complications. The development of universal international practice protocols for the placement of CC seems of paramount importance and will hopefully improve the outcomes of such pregnancies.

Study question How diverse is the board-level executive leadership of the leading fertility and reproductive health societies in Europe, Australia and North America? Summary answer There is good gender diversity among the reproductive health societies included in the study, with limited ethnic diversity. What is known already Reproductive health societies promote understanding and interest in reproductive biology and medicine. They are leading authorities, providing guidelines, opinions, and direction to practitioners, policy makers and the public. Membership on these societies’ board is a marker of influence and prestige. Many societies have clear Equality and Diversity Statement on their website, suggesting that they value representation of members from whom they obtain fees. This study presents a quantification of the executive leadership demographic diversity of major fertility and reproductive health societies in Europe, Australia and North America to evaluate diversity in governance. Study design, size, duration We conducted a review of the websites of ten leading fertility and reproductive health societies in the Europe, Australia and North America to quantity gender and ethnic diversity. Data analysis was conducted on the information obtained in January 2022. We included the executive leadership team /governing board members but excluded subgroup leaders or special interest group coordinators. Participants/materials, setting, methods Organisations reviewed include: American College of Obstetricians and Gynaecologists(ACOG), American Society for Reproductive Medicine(ASRM), British Fertility Society(BFS), Canadian Fertility and Andrology Society(CFAS), European Society of Human Reproduction and Embryology(ESHRE), The Fertility Society of Australia and New Zealand(FSA), International Federation of Obstetrics and Gynaecology(FIGO), The Royal Australian and New Zealand College of Obstetricians and Gynaecologists(RANZCOG), Royal College of Obstetricians and Gynaecologists (RCOG), and The Society of Obstetricians and Gynaecologists of Canada(SOGC). Main results and the role of chance Proportion for each demographic group at the time of the study are summarised below; where n = total number of board members; Gender: W= women, M= Men; ethnicity: Wh = White, B = Black and A = Asian. In total, the number of board level/executive leadership members, responsible for governance in the societies reviewed were 112. Gender diversity was 41% Men, 59% Women, while ethnic diversity was 82% White, 3% Black and 15% Asian. It is encouraging to see the gender parity in the executive leadership of the organisations review, there remains an important need to improve ethnic diversity in order to better represent the membership and wider community they serve. This has implications for role-modelling, equity, minimising the negative impact of groupthink and reaching/giving underrepresented group a voice. Limitations, reasons for caution Results presented are based on a snapshot at the time of review. Organisations periodically change leadership. Additionally, gender identification is based on self-identification in individual’s profile biography. Wider implications of the findings As reproductive health organisations continue make extensive contributions to the field, it is important for their leadership to represent the diversity of members and wider population they serve. There remains a need to move beyond diversity and equality statement to actively deploy policies and processes to improve and monitor representation. Trial registration number not applicable

There is a broad range in the rates of operative vaginal deliveries (OVD) worldwide, which reflects the variety of local practice patterns, the number of trained clinicians and the lack of international evidence-based guidelines. The aim of this study was to review and compare the recommendations from published guidelines on OVD. Thus, a descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the American College of Obstetricians and Gynecologists (ACOG) on instrumental vaginal birth was conducted. All the guidelines point out that the use of any instrument should be based on the clinical circumstances and the experience of the operator. The indications, the contraindications, the prerequisites and the classification for OVD are overall very similar in the reviewed guidelines. Further, they all agree that episiotomy should not be performed routinely. The RCOG, the RANZCOG and the SOGC describe some interventions which may promote spontaneous vaginal birth and therefore reduce the need for OVD. They also highlight the importance of adequate postnatal care and counseling. There is no consensus on the actual technique that should be used, including the type of forceps or vacuum cup, the force and duration of traction or the number of detachments allowed. Hence, there is need for international practice protocols, so as to encourage the clinicians to use OVD when indicated, minimize the complications and reduce rates of cesarean delivery.

Definition of bleeding events in studies evaluating prophylactic antithrombotic therapy in pregnant women: A systematic review and a proposal from the ISTH SSC

Delivery timing for preterm prelabor rupture of membranes (PPROM) was historically recommended at 34 weeks' gestation. Recent studies have shown expectant management of PPROM beyond 34 weeks is associated with increased antepartum or intrapartum hemorrhage and intrapartum fever and decreased risk of newborn respiratory distress, admission to neonatal intensive care unit, and cesarean delivery. Despite the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), and the Society of Obstetricians and Gynaecologists of Canada (SOGC) embracing expectant management as an option to consider for PPROM, widespread uptake and implementation of this management and the nuanced discussion remain mixed. With this clinical opinion, we highlight the outcomes associated with expectant management of PPROM beyond 34 weeks, summarize the current state of the controversy, review the nationally published guidelines, and discuss our opinion on the controversy as well as future directions for research endeavors. Given the data present at this time, we believe that providers should at least routinely offer, but not necessarily recommend, the option of expectant management for PPROM beyond 34 weeks in the absence of contraindications. Foregoing this discussion limits patients' ability to make informed decisions and, worse, if not universally offered in the absence of contraindications to expectant management, may be an area of inequitable or biased care. · Recent studies have characterized outcomes with expectant management of PPROM after 34 weeks.. · There remains controversy regarding delivery timing for pregnancies complicated by PPROM.. · Expectant management should be routinely offered for PPROM in the absence of contraindications..

Dorothy Shaw: promoting women's sexual and reproductive rights

Obstetricians and gynecologists are well positioned to influence population health through maternity and women's health services. Obesity is common in women of reproductive age and the prevalence is rising in both low-/middle-income and high-income countries 1 . Obesity affects requirements for assessment, monitoring, and intervention and can impact maternal and child outcomes. Obstetricians and gynecologists require guidance on the care of women of reproductive age with obesity at all time points related to pregnancy, including how to address modifiable risk factors such as diet and physical activity. Many guidelines have been developed to date, although they vary in scope, methodology, and individual recommendations. FIGO's Committee Guideline for the Management of Prepregnancy, Pregnancy, and Postpartum Obesity (Table It serves as a practical resource to support obstetricians and gynecologists in the management of

Neonatal outcomes by delivery indication after administration of antenatal late preterm corticosteroids

Sepsis is one of the leading causes of maternal morbidity and mortality worldwide and a major public health concern, often associated with delayed diagnosis, suboptimal management, and poor perinatal outcomes. The aim of this study was to review and compare the most recently published influential guidelines on the prevention, diagnosis, and management of this complication during antenatal, intrapartum, and postpartum periods. A descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG), the Society for Maternal-Fetal Medicine (SMFM), the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ), the World Health Organization (WHO), and the Society of Obstetricians and Gynecologists of Canada (SOGC) on maternal and puerperal sepsis was carried out. RCOG, SMFM, and SOMANZ provide guidance on the diagnosis and management of sepsis in pregnancy and the puerperium, whereas the WHO and the SOGC refer only to the prevention of peripartum infections. There is a consensus among the reviewed guidelines that a detailed personal history, along with physical examination, cultures, laboratory tests, and appropriate imaging, is the mainstay in sepsis diagnosis; however, there are several discrepancies regarding the diagnostic criteria. On management, the necessity of broad-spectrum antibiotics administration, within the first hour from recognition, and early source control are underlined by RCOG, SMFM, and SOMANZ. Furthermore, adequate fluid resuscitation with crystalloids is required, targeting for a mean arterial pressure (MAP) >65 mm Hg, whereas persistent hypotension or tissue hypoperfusion should be managed with vasopressors. In addition, RCOG, SMFM, and SOMANZ agree that increased fetal surveillance is warranted in case of maternal sepsis and point out that the decision regarding the optimal time of delivery should be guided according to maternal and fetal condition. In case of preterm labor, the use of corticosteroids should be considered. Moreover, SOMANZ and SMFM recommend thromboprophylaxis for septic women. With regards to prevention of peripartum infections, the WHO recommends prophylactic antibiotic administration in case of cesarean delivery, group B Streptococcus colonization, manual placenta removal, third/fourth-degree perineal tears, and preterm premature rupture of membranes, while discouraging antibiotics in case of preterm labor with intact membranes, prelabor rupture of membranes at term, meconium-stained amniotic fluid, uncomplicated vaginal birth, episiotomy, and operative vaginal delivery. Finally, SOGC, although supporting antibiotic prophylaxis for cesarean delivery and third/fourth-degree perineal injury, does not recommend this intervention in case of manual placenta removal, postpartum dilatation, and curettage for retained products of conception, operative vaginal delivery, and cervical cerclage. Sepsis remains a significant contributor of maternal morbidity and mortality with a constantly rising global incidence, despite the advances in diagnostic and therapeutic techniques. Thus, the development of consistent international practice protocols for the prevention, timely recognition, and effective management of this complication both in pregnancy and in the puerperium seems of paramount importance to safely guide clinical practice and subsequently improve perinatal outcomes.

Vasa previa (VP) is a serious pregnancy complication in which fetal vessels, unprotected by the umbilical cord, run across or within close proximity to the internal cervical os, which can potentially result in fetal exsanguination in the event of membrane rupture. There is global consensus that women with antenatally diagnosed VP should have caesarean delivery prior to onset of labour to prevent the catastrophic complications of VP. However, there is variability in the approach to management of these women antenatally, particularly regarding hospitalisation and timing of steroid administration and delivery. In this review, we aim to compare the VP guidelines of four prominent obstetric advisory bodies: The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), The Royal College of Obstetricians and Gynaecologists (RCOG), The Society for Maternal-Fetal Medicine (SMFM) and The Society of Obstetricians and Gynaecologists of Canada (SOGC) with a particular focus on antenatal hospitalisation, administration of steroids, and timing of birth in asymptomatic patients. We also aim to evaluate the evidence cited to support their recommendations. Current guidelines are based on low-quality evidence that often does not include insights from recent studies and are vague in their recommendations for antenatal hospitalisation and timing of delivery. More robust evidence for management of VP is needed to inform future guidelines.

Sonographic confirmation of fetal position before operative vaginal delivery should be recommended in clinical guidelines

Use of Uterine Artery Embolization for the Treatment of Uterine Fibroids: A Comparative Review of Major National Guidelines

ALARM and moreOB: Shaping the Present and Future of Labour and Delivery Training in Canada and Abroad.

Objective: To compare the accuracy of five different classification systems for interpreting electronic fetal monitoring (EFM) when predicting neonatal status at birth, as determined by the umbilical cord arterial pH. Methods: Ninety-seven cardiotocography traces were retrospectively interpreted according to five classification systems for EFM: Dublin Fetal Heart Rate Monitoring Trial (DFHRMT), Royal College of Obstetricians and Gynecologists (RCOG), Society of Obstetricians and Gynaecologists of Canada (SOGC), National Institute of Child Health and Human Development (NICHD) and Parer & Ikeda’s. For each classification system, sensitivity, specificity, positive and negative predictive values were calculated. The capacity of the classifications to predict neonatal pH was also evaluated by receiver-operating characteristic (ROC) curves. Agreement between the five systems was estimated using weighted kappa statistic. Results: Considering pH ≤7.15 as the cutoff for low pH, the sensitivity and specificity values were 100 and 18% (DFHRMT); 100 and 15% (RCOG); 88 and 37% (SOGC); 67 and 92% (NICHD); 55 and 67% (Parer & Ikeda). The ROC curves showed that all classifications analyzed had a low discriminative capacity when predicting umbilical artery pH ≤7.15. An excellent agreement was observed between DFHRMT and RCOG (weighted κ value: 0.860). Conclusions: Parer & Ikeda and NICHD classifications had the highest specificity in detecting umbilical cord arterial pH ≤7.15. The high specificity of the NICHD classification is hindered by a high percentage of “intermediate” traces (80%). Parer & Ikeda classification is the one that best classify as pathological only the traces of fetuses that are truly at risk of acidemia, thus avoiding unnecessary intervention. It also showed the best trade-off between sensitivity and specificity and the lowest rate of traces considered “intermediate.”

Ultrasound curricula in obstetrics and gynecology training programs.