Obstetrics and Gynaecology

Consensus Statements on the Definition of Surgical Success Following Obstetric Urinary Pelvic Floor Fistula Repair: An IUGA-ICS Proposal (2026)

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Type of publication:

Journal article

Author(s):

Maljaars LP; Corcos J; Ghoniem G; Goh JTW; Greenwell TJ; Kupualor D; Pope R; *Rachaneni S; Regmi MC

Citation:

International Urogynecology Journal. 2026 Mar 18.

Abstract:

INTRODUCTION: Standardized definitions for surgical success after obstetric urinary pelvic floor fistula (UPF) repair are lacking. This study aimed to establish a consensus among fistula surgeons on defining surgical success for UPF repair caused by obstetric (childbirth-related) injuries.

MATERIALS AND METHODS: A working group was initiated by the International Urogynecology Association (IUGA) in collaboration with the International Continence Society (ICS). Following a systematic literature review, statements were developed, and a Delphi method was applied to reach a consensus on each statement.

RESULTS: Consensus was reached on 34/44 statements (77.3%). These were grouped into five categories: (1) definition of outcome, (2) treatment and outcome assessment, (3) post-fistula repair urinary incontinence, (4) incurable fistula, and (5) quality of life.

DISCUSSION: The consensus group recommends defining surgical success as anatomical closure of the fistula without residual urinary incontinence, as closure alone is insufficient. Women with residual urinary incontinence should not be classified as cured and require further diagnostic and therapeutic intervention. A postoperative dye test at catheter removal is advised as an objective measure of surgical success. The group also underscores the importance of basic urodynamic evaluation to assess residual incontinence following fistula closure. A diagnosis of "incurable" fistula should only be considered after three failed repairs and requires independent assessments by two expert surgeons. Finally, clinical success should include improvements in patient quality of life, and a specialized, validated quality-of-life questionnaire is essential to evaluate the physical, social, and emotional impact of UPF on patients and to assess treatment effectiveness from the patient's perspective.

CONCLUSION: The consensus statements aim to standardize the definition of successful outcomes in obstetric UPF repair, guiding future research and patient counseling. The group encourages further investigation into existing knowledge gaps in obstetric urinary pelvic floor fistula.

DOI: 10.1007/s00192-025-06413-6

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Unscheduled PMB and HRT-An analysis of urgent unscheduled bleeding referrals in accordance with BMS 2024 guidelines (2026)

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Type of publication:

Conference abstract

Author(s):

Chopra S.; Kaur H.; *Chai A.; *Sahu B.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BGCS 2026 Book of Abstracts. Bristol United Kingdom. 133(Supplement 2) (pp S25), 2026. Date of Publication: 01 Jun 2026.

Abstract:

Background: Management of unscheduled bleeding on HRT is an integral part of investigating endometrial cancer, due to the increasing referrals to the Urgent Suspicion of Cancer Pathway (USCP). Objective(s): We aimed to retrospectively assess the impact that this pathway will have on our clinical practice. Method(s): Patients referred to the gynaecology cancer services at Shrewsbury and Telford Hospitals (SaTH) between March and October 2024 were retrospectively included. Under the BMS 2024 guidelines, data was extracted, including but not limited to demographics, time since menopause, HRT duration, parity, cancer risk factors, and amendment status during primary care. The recorded biopsy results served as the outcome. Result(s): Of the 1308 referrals identified, 627 (47.9%) were referred while actively using HRT. The rate of endometrial cancer diagnosis was significantly lower in the HRT cohort (0.15% (1/627)) when compared to the non-HRT cohort (4.55% (31/681)). Age was not included as a major risk factor, despite higher predictive value for uterine cancer in women over 55. The BMS pathway, although designed primarily for use in primary care, was complex and difficult to apply within a standard 10-min GP consultation when identifying patients requiring secondary care referral. Conclusion(s): We developed a simplified modified pathway to support our GP colleagues. We incorporated age as an additional risk factor and tailored the pathway to reflect best practice and the needs of our local population. The success of this initiative may support the development and adoption of similar pathways in other services.

DOI: 10.1111/1471-0528.70281

Obstetric Bleeding Study UK (OBS UK): protocol for a stepped wedge cluster randomised trial investigating the clinical and cost-effectiveness of a maternity quality improvement programme to reduce excess bleeding and need for transfusion after childbirth (2026)

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Type of publication:

Journal article

Author(s):

Kotecha S.J.; Potter C.; Hope-Bell J.; Riddell N.S.; Munnery K.; Onyimadu O.; Liberty C.; Taylor H.; Dop C.; De Lloyd L.; *Parry-Smith W.; Townson J.; Pallmann P.; Moody G.; Moriarty Y.; Deere R.; Barlow C.; Dhadda A.; *Elsmore A.; Willson S.; *Millward H.; *Siddall K.; Sanders J.; Stanworth S.J.; Black M.; Petrou S.; Rai T.; Slade P.; Hinton L.; Fye H.; Gur Geden A.; Collis R.E.; Collins P.; Bell S.

Citation:

BMJ open. 16(8) (pp e118723), 2026. Date of Publication: 20 Aug 2026.

Abstract:

INTRODUCTION: Bleeding during and after childbirth (postpartum haemorrhage, PPH) is the leading cause of severe maternal morbidity in the UK. Between 2017 and 2018, a PPH care bundle termed the Obstetric Bleeding Strategy (OBS) was implemented as a quality improvement project across all Welsh maternity units and improvements in maternal outcomes were observed. The OBS PPH care bundle incorporates assessment of bleeding risk, real-time cumulative quantification of blood loss, escalation of multiprofessional care including more senior staff at defined volumes of blood loss and point-of-care testing of coagulation at 1 L blood loss (or earlier if clinical concern) with targeted blood product transfusion in cases of haemostatic impairment. The Obstetric Bleeding Study UK (OBS UK) will evaluate this intervention in a larger number of maternity units across the UK. METHODS AND ANALYSIS: OBS UK is a stepped wedge cluster randomised trial designed to test the effectiveness of the OBS intervention compared with usual care on clinical and psychological PPH outcomes after childbirth, evaluate its cost-effectiveness and perform a process evaluation. The study will be capturing data from over 270 000 women and birthing people giving birth in the care of 36 participating maternity units during the 30-month study period. All maternity units will undertake a control period (lasting 3-18 months) during which usual PPH care will be provided, followed by a 9-month implementation period during which the OBS PPH care bundle will be introduced using quality improvement methods and then an OBS UK intervention period (lasting 3-18 months) during which OBS PPH care will be delivered.The primary outcome is the number of women receiving allogeneic red blood cell transfusion for PPH per 1000 maternities. Secondary outcomes are informed by the core PPH outcome set, psychological and cost-effectiveness measures for women and their partners and a mixed methods process evaluation exploring how the intervention was deployed and possible improvements to inform wider implementation. ETHICS AND DISSEMINATION: OBS UK will establish whether (and how) the OBS UK PPH care bundle improves outcomes and experiences of women and their partners. Published results will provide evidence to inform PPH maternity care across the UK and internationally. Dissemination of the findings will be made available to members of the public and participants. TRIAL REGISTRATION NUMBER: ISRCTN17679951

DOI: 10.1136/bmjopen-2026-118723

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A systematic review of clinical outcome reporting in randomised controlled trials evaluating remote obstetric antenatal monitoring (2026)

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Type of publication:

Conference abstract

Author(s):

Le Vance J.; Man R.; *Adeoye A.; Amaranathan S.; Massey S.; Gurney L.; Morton V.H.; Morris R.K.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BMFMS Abstracts 2026. Leeds United Kingdom. 133(Supplement 1) (pp S29), 2026. Date of Publication: 01 Aug 2026.

Abstract:

Objective: Technological innovations in remote antenatal care have expanded rapidly, aiming to shift aspects of care outside the hospital setting. However, current research objectively heralds variable outcome reporting, currently limiting meaningful comparison. This review systematically examined the heterogeneity of outcome reporting in remote obstetric monitoring trials and determined the need for a core outcome set (COS). Method(s): Five databases were searched from January 2015 to November 2025. Randomised controlled trials (RCTs), RCT protocols and randomised pilot studies evaluating any remote antenatal monitoring device with an appropriate comparator were included. Outcomes and their timing were extracted verbatim by two reviewers. Duplicate and similarly worded outcomes were removed, and outcome variability was assessed by the number of unique outcomes reported. Outcomes were categorised into domains. Result(s): Forty studies were included: 24 (60%) RCTs, 10 (25%) RCT protocols and 6 (15%) pilot RCTs. Blood pressure (17, 42.5%) and blood glucose monitoring (16, 40.0%) were the most frequently used technologies, with 19 studies (47.5%) employing multiple monitoring devices. Across all studies, 1,004 verbatim outcomes were reported, of which 11% (113) were primary outcomes. No single outcome was reported in all studies. After de-duplication, 361 unique outcomes remained, grouped into 73 domains. Glycaemic monitoring demonstrated the greatest definitional variation, with 29 distinct definitions. When stratified by measurement time-points, outcomes increased to 1,210, with fewer than 6% assessed beyond three months postpartum. Conclusion(s): This review demonstrated the current variability in consistent outcome reporting for remote antenatal monitoring trials. A COS is recommended for standardising outcome reporting.

DOI: 10.1111/1471-0528.70283

Robotic hysterectomy: an umbrella review and regional access in the Midlands, UK - Is there inequity? (2026)

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Type of publication:

Journal article

Author(s):

Saoudi, Tareq Al; Kanani, Trisha; McGill, Shaun; Isherwood, John; Fan, Frankie; Brown, Luke; Williams, Philippa; Sahare, Pankhuri; Sisodia, Shilpa; McVicar, Kathryn; Lacey, Patricia; Elleray, Rebecca; *Cheetham, Mark; Habiba, Marwan; Orrock, Emma; Wilson, Robert; Dennison, Ashley.

Citation:

European Journal of Obstetrics, Gynecology, & Reproductive Biology. 321:115041, 2026 Feb 28.

Abstract:

STUDY OBJECTIVE: To review current evidence on robotic-assisted hysterectomy (RAH) and assess hysterectomy practices across the Midlands, UK, with a focus on the availability of robotic procedures, geographical variations in the incidence of uterine cancer, and service provision.

DESIGN: An umbrella review conducted in accordance with the PRISMA guidelines combined with a descriptive regional data analysis.

SETTING: Midlands, UK.

PATIENTS: Women undergoing hysterectomy for uterine cancer between 2019 and 2023, based on national and regional datasets.

INTERVENTION: Comparison of RAH with open and laparoscopic approaches, and assessment of access to robotic surgery across integrated care boards (ICBs) in the Midlands.

MEASUREMENTS AND MAIN RESULTS: The final analysis included 12 systematic reviews. Compared with open hysterectomy, RAH was associated with reduced blood loss, lower transfusion rate, shorter hospital stay, and lower complication rates, while benefits over laparoscopic hysterectomy were less consistent. Descriptive regional analysis demonstrated substantial variation in uterine cancer incidence and hysterectomy rates across ICBs in the Midlands. Visual comparison suggested that areas with a higher
incidence of uterine cancer did not align consistently with higher rates of RAH, and access to robotic surgery varied across the region, with some ICBs having no local provision.

CONCLUSION: The continued expansion of RAH in the UK highlights the need for coordinated governance and service planning. Observed regional variation supports the development of clear referral pathways, standardized patient selection criteria, and regional oversight to guide equitable and effective integration of robotic surgery, particularly in areas with limited local provision.

DOI: 10.1016/j.ejogrb.2026.115041

Development and design of a Delphi protocol to produce a consensus core information set for caesarean section (2025)

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Type of publication:

Conference abstract

Author(s):

Greenfield B.; *Elsmore A.; Frizelle J.; Bradley F.; Kingdon C.; Merriel A.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BMFMS Abstracts 2024. Liverpool United Kingdom. 132(Supplement 1) (pp 70), 2025. Date of Publication: 01 Jan 2025.

Abstract:

Objectives: Core information sets are a standardised way to guide discussions with patients to aid decision making for surgical procedures. 1-3 Informed decision making is foundational for ensuring women have agency and autonomy towards their pregnancy and reproductive choices.4 This work will produce a consensus expert opinion, via a Delphi method,5 of relevant information necessary for decision making regarding caesarean sections. Method(s): A scoping review of peer-reviewed publications was undertaken using electronic databases, alongside internet searches for patient information relating to caesarean section. Qualitative and mixed-method studies were reviewed to inform domains and questions. Think Aloud interviews with stakeholders (healthcare professionals and lay people) were conducted to ensure correct syntax and legibility, prior to Delphi distribution. Result(s): A total of 305 studies were identified, from which 345 information points were collected. Patient information leaflets, focus-group interviews, and surveys identified 60, 54 and 12 separate points, respectively. These were collated into 64 questions across 11 domains including indications, risks/benefits, and patient experience of elective/emergency caesarean sections. These questions were refined by 7 Think Aloud interviews until no further changes were identified. The resultant online Delphi (REDCap) is ready for distribution. There will be two rounds prior to a stakeholder consensus meeting in Q1 2024. Conclusion(s): The need for a core information set for caesarean section is evidenced by the disparate nature of current decision aids and proliferation of public information. This work has produced an information set ready for prioritisation by a Delphi panel to provide consistent information regarding caesarean sections.

DOI: 10.1111/1471-0528.18006

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Development of a core information set for caesarean section - A scoping review of patient information leaflets (2025)

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Type of publication:

Conference abstract

Author(s):

*Elsmore A.; Merriel A.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: BMFMS Abstracts 2024. Liverpool United Kingdom. 132(Supplement 1) (pp 56-57), 2025. Date of Publication: 01 Jan 2025

Abstract:

Objectives: Good clinical practice mandates that women have full choice and autonomy for their care in pregnancy and childbirth and are armed with key information points to facilitate informed decision making.1 Development of a core information set will allow women to access consistent, accurate information, containing facts that are important to them.2 As part of this work, a scoping review of patient information leaflets was performed to identify information points. Method(s): We performed an internet search for patient information leaflets, articles, and electronic information sources, such as national and international medical, midwifery, or nursing organisations, from health providers (e.g. NHS), and non-governmental organisations. The search terms were 'caesarean section', 'caesarean section UK', and 'caesarean section patient information leaflet'. Data points were extracted and entered into a database in Microsoft ExcelTM. Result(s): Information points were extracted from 50 sources with 60 separate information points collected. Data collection ceased at 50 sources as saturation was reached. Sources included national organisations, trust patient information leaflets, private care providers, and patient organisations. The number of information points per source ranged from 2 to 40. The type of anaesthetic was the most common information point found, in 78% of sources (39/50); the least common was increased risk of neonatal death in first 28 days in 2% of sources (1/50). Conclusion(s): A large degree of heterogeneity of information points within patient information leaflets was noted, reinforcing the need for the development of a core information set for caesarean section. Women must be provided with consistent information regarding different types of delivery

DOI: 10.1111/1471-0528.18006

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Remote home cardiotocography: A systematic review and meta-analysis (2026)

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Type of publication:

Systematic Review

Author(s):

Le Vance, Jack; *Adeoye, Adekunle; Man, Rebecca; Eltaweel, Nashwa; Gurney, Leo; Morris, R Katie; Hodgetts Morton, Victoria.

Citation:

PLOS Digital Health. 5(1):e0001184, 2026 Jan.

Abstract:

Cardiotocography (CTG) is a common investigative modality in obstetrics to evaluate the fetal condition. Advancements in digital technology has enabled the innovation of CTG monitoring for usage in the home setting. This review aims to comprehensively examine the current evidence on the effectiveness and applicability of home antenatal CTG monitoring. MEDLINE, EMBASE, Cochrane, Web of Science, and PubMed databases were searched from inception to June 2025. Primary studies examining home antenatal CTG were included. For randomised controlled trials (RCTs), the joint primary outcomes were perinatal mortality and emergency caesarean section. For observational studies, the feasibility, diagnostic accuracy, qualitative and economic burden of home CTG were evaluated. RCTs were eligible for meta-analysis using risk ratio or mean difference, with 95% confidence intervals. Included observational studies were narratively described due to significant methodological heterogeneity. 39 studies (28 observational, seven RCTs and four qualitative studies), comprising of 7240 participants were included. Home antenatal CTG monitoring was non-inferior to conventional care across all meta-analysed maternal, perinatal and healthcare usage outcomes. GRADE assessments were low/very low quality of evidence. Home CTG monitoring was feasible in several settings and remote interpretation was graded as moderate to excellent. Transmission failures were frequently low but commonly occurred due to infrastructure and/or equipment errors. Remote CTG monitoring demonstrated comparative capabilities to conventional CTG with respect to coincidence and beat-to-beat variability. Overall acceptability ratings were high for patient and providers. Often implementation costs were high but accrued back by non-fixed savings when compared against routine care. High-quality studies were underrepresented, particularly when assessing service-led and safety outcomes. Home antenatal CTG monitoring demonstrates noninferiority to conventional care across several outcomes, representing a promising avenue for antenatal management However, current evidence is of low quality and additional high-quality evidence with sufficient methodological detail and standardised outcome assessment is required prior to making definitive recommendations.

DOI: 10.1371/journal. pdig.0001184

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An audit of testosterone referrals to the menopause clinic (2024)

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Type of publication:

Conference abstract

Author(s):

*Clark M.; *Magar C.P.; *Ritchie J.

Citation:

Post Reproductive Health. Conference: 33rd British Menopause Society Annual Scientific Conference, BMS 2024. Kenilworth United Kingdom. 30(1 Supplement) (pp 12S), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Objective: Referrals to the menopause clinic for testosterone and low libido have steadily increased. Locally, we have written prescribing information for primary care to follow, after testosterone initiation in the menopause clinic. This prescribing information adheres to British Menopause Society (BMS) guidelines but has only recently been introduced. The objective of this audit was to determine if the BMS guidelines are currently being followed. Method(s): Retrospective case note review of a selection referrals to the Menopause by two speciality registrars training in Menopause. The electronic patient records were reviewed using pre-determined criteria and recorded on the same secure spreadsheet. Result(s): A total of 245 patient notes were reviewed, of these patients 35 had been specifically referred to request testosterone. 33 of these 35 patients were able to fully discuss testosterone in the menopause clinic. All patients were already taking Hormone replacement therapy (HRT). 32 patients reported that their libido had changed around the time of the menopause. Only 15 patients were already taking vaginal estrogen. 6 patients did not have a baseline testosterone level prior to commencement of testosterone. 24 patients were subsequently started on testosterone. Only 10 patients had reported testosterone levels at 3 months. 4 were referred for psychosexual counselling. Conclusion(s): This audit demonstrated how locally we would benefit from keeping a specific log of patients on testosterone. This is to ensure that patients have their baseline testosterone levels and subsequent monitoring, to make sure testosterone levels are being kept in the physiological range. Our audit showed only a small proportion of patients were already using vaginal estrogen, Vaginal dryness can be a contributing factor to low libido. By increasing uptake in vaginal estrogen this may help some patients prior to their referral or potentially reduce the need for referral. In addition, psychosexual counselling was provided for some of these patients and identified further contributing factors towards low libido, highlighting the importance of a holistic approach to the management of low libido. In those where testosterone was not commenced, this was mostly due to low estrogen levels therefore HRT regimes were altered to optimise absorption prior to considering testosterone.

DOI: 10.1177/20533691241273937