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Nahshon C, Abramov Y, Kugelman N, Cohen N, Lavie O, Zilberlicht A. The effect of subsequent pregnancy and childbirth on stress urinary incontinence recurrence following midurethral sling procedure: a meta-analysis. Am J Obstet Gynecol 2024; 230:308-314.e5. [PMID: 38036163 DOI: 10.1016/j.ajog.2023.11.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE This study aimed to assess the risk of stress urinary incontinence recurrence and reoperation after a midurethral sling procedure in women with subsequent childbirth and to assess the effect of delivery mode on this risk. DATA SOURCES An electronic database search was performed using MEDLINE with the OvidSP interface and PubMed, Embase, Web of Science, and the Cochrane Library up to September 20, 2023. STUDY ELIGIBILITY CRITERIA This study included experimental and nonexperimental studies, composed of randomized controlled and observational (case-control, cohort, and cross-sectional) studies assessing the risk factors for stress urinary incontinence recurrence and reoperation after childbirth in women who had previously undergone a midurethral sling procedure for stress urinary incontinence. METHODS Analysis was performed using RevMan (version 5.3; Cochrane Collaboration, Oxford, United Kingdom). Quantitative synthesis was used if the included studies were sufficient in numbers and homogeneity. The overall certainty of the evidence was assessed using criteria recommended by the Grading of Recommendations Assessment, Development, and Evaluation Working Group. RESULTS A total of 2001 studies were identified, of which 6 were eligible for analysis, composed of 381 patients who had at least 1 childbirth after a midurethral sling procedure (study group) and 860 patients who underwent a midurethral sling without having a subsequent childbirth (control group). All included studies were observational, the patients' mean age at the time of the midurethral sling procedure ranged from 34 to 36 years, and the mean time from midurethral sling procedure to delivery ranged from 21 to 31 months. No difference in stress urinary incontinence recurrence (relative risk, 0.1.02; 95% confidence interval, 0.78-1.33) or reoperation (relative risk, 1.37; 95% confidence interval, 0.87-2.17) was found between the study and control groups. The average follow-up time among the included studies of this comparison was 9.8 years (range, 2-18). Furthermore, the mode of delivery (vaginal vs cesarean) did not seem to affect the risk of stress urinary incontinence recurrence. CONCLUSION Subsequent pregnancy and childbirth did not increase the risk of stress urinary incontinence recurrence or reoperation after a midurethral sling procedure.
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Affiliation(s)
- Chen Nahshon
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Yoram Abramov
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nir Kugelman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nadav Cohen
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Andebrhan SB, Caron AT, Szlachta-McGinn A, Parameshwar PS, Jackson NJ, Rosenman AE, Anger JT, Ackerman AL. Pelvic organ prolapse recurrence after pregnancy following uterine-sparing prolapse repair: a systematic review and meta-analysis. Int Urogynecol J 2023; 34:345-356. [PMID: 35920935 DOI: 10.1007/s00192-022-05306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/07/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION We sought to determine rates of pelvic organ prolapse (POP) recurrence following pregnancy and delivery in reproductive-age women with prior hysteropexy. METHODS Scopus, MEDLine, EMBASE, Cochrane Library, and ClinicalTrials.gov databases were searched from inception to May 2020 for combinations of any of the keywords: "pregnancy", "delivery", "fertility", or "cesarean" with a comprehensive list of uterine-sparing surgical procedures for POP repair. Using approach, 1,817 articles were identified describing surgical, uterine-sparing POP repair techniques and subsequent pregnancy and delivery outcomes in reproductive-age women. RESULTS: Twenty-seven studies describing 218 pregnancies, including 215 deliveries and 3 abortions, were summarized using narrative review and descriptive statistics. Successful pregnancies were reported following a diverse range of uterine-sparing prolapse repairs, both native tissue and mesh-augmented, that utilized vaginal, open abdominal, and laparoscopic approaches. We observed shifts from native tissue repairs to mesh-augmented laparoscopic repairs over time. POP recurrence occurred in 12% of subjects overall, 15% after vaginal and 10% after abdominal prolapse repairs. While meta-analysis identified higher recurrence rates after vaginal delivery (15%) than cesarean section (10%), due to small study numbers, multiple confounders, and heterogeneity between studies, no significant differences in recurrence rates could be identified between vaginal and abdominal surgical approaches, utilization of mesh augmentation, or mode of delivery. CONCLUSION Although literature on pregnancy following uterine-sparing POP repair is limited, available data suggest that prolapse recurrence after pregnancy and delivery remains similar to that after prolapse repair without subsequent pregnancies with few documented perinatal complications. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021247722.
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Affiliation(s)
- Sarah B Andebrhan
- Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, IL, USA
| | - Ashley T Caron
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Alec Szlachta-McGinn
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Nicholas J Jackson
- Department of Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USA
| | - Amy E Rosenman
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jennifer T Anger
- Department of Urology, University of California, San Diego, CA, USA
| | - A Lenore Ackerman
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Department of Urology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Box 951738, Los Angeles, CA, 90095-1738, USA.
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Youssef A, Montaguti E, Dodaro MG, Kamel R, Rizzo N, Pilu G. Levator ani muscle coactivation at term is associated with longer second stage of labor in nulliparous women. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:686-692. [PMID: 30353589 DOI: 10.1002/uog.20159] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/05/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the effect of levator ani muscle (LAM) coactivation at term on outcome of labor in nulliparous women. METHODS This was a prospective study of 284 low-risk nulliparous women with a singleton pregnancy at term recruited before the onset of labor. The anteroposterior diameter of the levator hiatus was measured in each woman on transperineal ultrasound at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver before and after visual feedback. LAM coactivation was defined as a reduction in the anteroposterior diameter of the levator hiatus on maximum Valsalva maneuver in comparison with that at rest. The association of pelvic hiatal diameter values and LAM coactivation with mode of delivery and duration of labor was assessed. RESULTS No significant difference was found between women who underwent Cesarean delivery and those who had a vaginal delivery with regard to the anteroposterior diameter of the levator hiatus at rest, on pelvic floor muscle contraction and on Valsalva maneuver. Longer second stage of labor was associated with shorter anteroposterior diameter of the levator hiatus on all assessments, but in particular at rest and on Valsalva both before and after visual feedback. LAM coactivation was found in 89 (31.3%) and 75 (26.4%) women before and after visual feedback, respectively. Post visual feedback, women with LAM coactivation had a significantly longer second stage of labor than did those without LAM coactivation (83 ± 63 vs 63 ± 42 min; P = 0.006). On Cox regression analysis, LAM coactivation post visual feedback was an independent predictor of longer second stage of labor (adjusted hazard ratio, 1.499 (95% CI, 1.076-2.087); P = 0.017). CONCLUSION LAM coactivation in nulliparous women at term is associated with a longer second stage of labor. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M G Dodaro
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - R Kamel
- Department of Obstetrics and Gynecology, Kasr Al-Ainy University Hospital, Cairo University, Egypt
| | - N Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Pandeva I, Mistry M, Fayyad A. Efficacy and pregnancy outcomes of laparoscopic single sheet mesh sacrohysteropexy. Neurourol Urodyn 2016; 36:787-793. [DOI: 10.1002/nau.23026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 04/08/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Ivilina Pandeva
- Urogynaecology Unit, Department of Obstetrics and Gynaecology; Luton and Dunstable University Hospital NHS Foundation Trust; Luton United Kingdom
| | - Minesh Mistry
- Urogynaecology Unit, Department of Obstetrics and Gynaecology; Luton and Dunstable University Hospital NHS Foundation Trust; Luton United Kingdom
| | - Abdalla Fayyad
- Urogynaecology Unit, Department of Obstetrics and Gynaecology; Luton and Dunstable University Hospital NHS Foundation Trust; Luton United Kingdom
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Al-Kadri HM, Al-Anazi SA, Tamim HM. Increased cesarean section rate in Central Saudi Arabia: a change in practice or different maternal characteristics. Int J Womens Health 2015. [PMID: 26203285 PMCID: PMC4506023 DOI: 10.2147/ijwh.s85215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Cesarean section (CS) rate has shown an alarming increase. We aimed in this work to identify factors contributing to the increasing rate of CS in central Saudi Arabia. Methods A retrospective cohort study was conducted at King Abdulaziz Medical City. Two groups of women were included (G1 and G2). G1 had delivered by CS during the year 2002 (CS rate 12%), and G2 had delivered by CS during the year 2009 (CS rate 20%). We compared the included women’s characteristics, neonates, CS indications, and complications. Data were analyzed using SPSS version 15 program. Odds ratios and confidence intervals were calculated to report precision of categorical data results. A P-value of ≤0.05 was considered significant. Results A total of 198 women were included in G1 and 200 in G2. Both groups had comparable maternal and fetal characteristics; however, absence of antenatal care has resulted in 70% increase in CS deliveries for G2, P=0.008, OR =0.30, CI 0.12–0.76. Previous vaginal surgeries have contributed to tenfold increase in CS deliveries for G2, P=0.006, OR =10.37, CI 1.32–81.78. G2 had eight times increased CS deliveries than G1 due to intrauterine growth restriction, P=0.02, OR =8.21, CI 1.02–66.25, and 80% increased risk of CS was based on maternal demand, P=0.02, OR =0.20, CI 0.02–1.71. Decision taken by less-experienced staff was associated with 2.5-fold increase in CS deliveries for G2, P=0.002, OR =2.62, CI 1.39–4.93. There was a significant increase in CS deliveries under regional analgesia and shorter duration of hospital stay for G2, P=0.0001 and P=0.001, respectively. G2 women had 2.75-fold increase in neonatal intensive care unit admission, P=0.03, OR =2.75, CI 1.06–7.15. Conclusion CS delivery rate significantly increased within the studied population. The increased rate of CS may be related to a change in physician’s practice rather than a change in maternal characteristics, and it appears to be reducible.
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Affiliation(s)
- Hanan M Al-Kadri
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sultana A Al-Anazi
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Hani M Tamim
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Purwar B, Ismail KM, Turner N, Farrell A, Verzune M, Annappa M, Smith I, El-Gizawy Z, Cooper JC. General or Spinal Anaesthetic for Vaginal Surgery in Pelvic Floor Disorders (GOSSIP): a feasibility randomised controlled trial. Int Urogynecol J 2015; 26:1171-8. [PMID: 25792351 DOI: 10.1007/s00192-015-2670-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 02/24/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Spinal anaesthesia (SA) and general anaesthesia (GA) are widely used techniques for vaginal surgery for pelvic floor disorders with inconclusive evidence of the superiority of either. We conducted a randomised controlled trial (RCT) to assess the feasibility of a full scale RCT aiming to examine the effect of anaesthetic mode for vaginal surgery on operative, patient reported and length of hospital stay (LOHS) outcomes. METHODS Patients undergoing vaginal surgery, recruited through a urogynaecology service in a University teaching hospital, were randomised to receive either GA or SA. Patients were followed up for 12 weeks postoperatively. Pain was measured on a visual analogue scale; nausea was assessed with a four-point verbal rating scale. Patient's subjective perception of treatment outcome, quality of life (QoL) and functional outcomes were assessed using the International Consultation on Incontinence Modular Questionnaire (ICIQ) on vaginal symptoms and the SF-36 questionnaire. RESULTS Sixty women were randomised, 29 to GA and 31 to SA. The groups were similar in terms of age and type of vaginal surgery performed. No statistically significant differences were noted between the groups with regard to pain, nausea, quality of life (QoL), functional outcomes as well as length of stay in the postoperative recovery room, use of analgesia postoperatively and LOHS. CONCLUSION This study has demonstrated that a full RCT is feasible and should focus on the length of hospital stay in a subgroup of patients undergoing vaginal surgery where SA may help to facilitate enhanced recovery or day surgery.
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Affiliation(s)
- B Purwar
- Department of Obstetrics and Gynaecology, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, Staffordshire, ST4 6QG, UK
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Prevalence of genital prolapse symptoms in primary care: a cross-sectional survey. Int Urogynecol J 2014; 26:505-10. [PMID: 25381004 DOI: 10.1007/s00192-014-2556-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of our study was to determine the prevalence of pelvic organ prolapse (POP) symptoms in a community-dwelling population in the United Kingdom. METHODS All women over the age of 18 from a community practice were sent the validated International Consultation on Incontinence Questionnaire for vaginal symptoms (ICIQ-VS), to determine their POP symptoms. Data were analysed as numbers (raw data) and percentages of responders. Statistical comparisons were made using Chi-squared and Kruskal-Wallis tests as appropriate. RESULTS Questionnaires were mailed to 3,412 women, 1,832 completed questionnaires were received (response 53.7 %). Symptoms strongly associated with prolapse; vaginal bulge/lump and bulge or lump outside of the vagina had a prevalence of 8.4 % and 4.9 % respectively. Vaginal symptoms, previous pelvic floor surgery, and age were statistically increased in those who had had a previous vaginal delivery. There were statistically worse scores (more symptoms) for the group with any vaginal delivery with regard to "feeling a loose or lax vagina", "a vaginal lump or bulge coming down in the vagina". There was a high prevalence of worry regarding sexual function, regardless of delivery status, with no statistically significant differences found between those who had had a vaginal delivery and those who had not. The group with no vaginal deliveries described a statistically significant increase in the reported sensation of "do you feel your vagina is too tight". CONCLUSIONS Symptoms of POP were increased in those women who had experienced a vaginal delivery, whilst the sensation of having a tight vagina was decreased in those who had had a previous vaginal birth.
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Edozien LC, Gurol-Urganci I, Cromwell DA, Adams EJ, Richmond DH, Mahmood TA, van der Meulen JH. Impact of third- and fourth-degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study. BJOG 2014; 121:1695-703. [DOI: 10.1111/1471-0528.12886] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Affiliation(s)
- LC Edozien
- Maternal and Fetal Health Research; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
| | - I Gurol-Urganci
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
| | - DA Cromwell
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| | - EJ Adams
- Department of Urogynaecology; Liverpool Women's NHS Foundation Trust; Liverpool UK
| | - DH Richmond
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
- Department of Urogynaecology; Liverpool Women's NHS Foundation Trust; Liverpool UK
| | - TA Mahmood
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
| | - JH van der Meulen
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
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Gurol-Urganci I, Cromwell DA, Mahmood TA, van der Meulen JH, Templeton A. A population-based cohort study of the effect of Caesarean section on subsequent fertility. Hum Reprod 2014; 29:1320-6. [DOI: 10.1093/humrep/deu057] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gurol-Urganci I, Cromwell DA, Edozien LC, Mahmood TA, Adams EJ, Richmond DH, Templeton A, van der Meulen JH. Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors. BJOG 2013; 120:1516-25. [PMID: 23834484 DOI: 10.1111/1471-0528.12363] [Citation(s) in RCA: 254] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- I Gurol-Urganci
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
| | - DA Cromwell
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
| | - LC Edozien
- Maternal and Fetal Health Research; Manchester Academic Health Sciences Centre; University of Manchester; Manchester UK
| | - TA Mahmood
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
| | - EJ Adams
- Department of Urogynaecology; Liverpool Women's NHS Foundation Trust; Liverpool UK
| | - DH Richmond
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
- Department of Urogynaecology; Liverpool Women's NHS Foundation Trust; Liverpool UK
| | - A Templeton
- Office for Research and Clinical Audit; Lindsay Stewart R&D Centre; Royal College of Obstetricians and Gynaecologists (RCOG); London UK
| | - JH van der Meulen
- Department of Health Services Research and Policy; London School of Hygiene and Tropical Medicine; London UK
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