BACKGROUND: In routine antenatal care, blood pressure is used as a screening tool for preeclampsia and its associated adverse outcomes. As such women with a blood pressure greater than 140/90 mm Hg undergo further investigation and closer follow-up, whereas those with lower blood pressures receive no additional care. In the nonpregnant setting, the American College of Cardiology now endorses lower hypertensive thresholds and it remains unclear whether these lower thresholds should also be considered in pregnancy. OBJECTIVE: (1) To examine the association between lower blood pressure thresholds (as per the American College of Cardiology guidelines) and pregnancy outcomes and (2) to determine whether there is a continuous relationship between blood pressure and pregnancy outcomes and identify the point of a change at which blood pressure is associated with an increased risk of such outcomes. STUDY DESIGN: This was a retrospective study of singleton pregnancies at Monash Health, Australia. Data were obtained with regards to maternal characteristics and blood pressure measurements at varying gestational ages. Blood pressures were then categorized as (1) mean arterial pressure and (2) normal, elevated, stage 1 and stage 2 hypertension, as per the American College of Cardiology guidelines.Multivariable regression analysis was performed to identify associations between blood pressure categories and pregnancy outcomes. RESULTS: This study included 18,243 singleton pregnancies. We demonstrated a positive doseeresponse relationship between mean arterial pressure and the development of preeclampsia in later pregnancy. Across all gestational ages, the risk of preeclampsia was greater in those with "elevated blood pressure" and "stage 1 hypertension" in comparison with the normotensive group (adjusted risk ratio; 2.45, 95% confidence interval, 1.74e3.44 and adjusted risk ratio, 6.60; 95% confidence interval, 4.98e8.73 respectively, at 34e36 weeks' gestation). There was also an association between stage 1 hypertension, preterm birth, and adverse perinatal outcomes. CONCLUSION: This study demonstrated that preeclampsia and the associated adverse outcomes are not exclusive to those with blood pressures greater than 140/90 mm Hg. As such, those with prehypertensive blood pressures may also benefit from closer monitoring. Further research is essential to determine whether lowering the blood pressure threshold in pregnancy would improve detection and outcomes.

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BackgroundWomen with a history of preeclampsia are at increased risk of cardiovascular morbidity and mortality. However, the underlying mechanisms of disease association, and the ideal method of monitoring this high‐risk group, remains unclear. This review aims to determine whether women with a history of preeclampsia show clinical or subclinical cardiac changes when evaluated with an echocardiogram.Methods and ResultsA systematic search of MEDLINE, EMBASE, and CINAHL databases was performed to identify studies that examined cardiac function in women with a history of preeclampsia, in comparison with those with normotensive pregnancies. In the 27 included studies, we found no significant differences between preeclampsia and nonpreeclampsia women with regard to left ventricular ejection fraction, isovolumetric relaxation time, or deceleration time. Women with a history of preeclampsia demonstrated a higher left ventricular mass index and relative wall thickness with a mean difference of 4.25 g/m2 (95% CI, 2.08, 6.42) and 0.03 (95% CI, 0.01, 0.05), respectively. In comparison with the nonpreeclampsia population, they also demonstrated a lower E/A and a higher E/e′ ratio with a mean difference of −0.08 (95% CI, −0.15, −0.01) and 0.84 (95% CI, 0.41, 1.27), respectively.ConclusionsIn comparison with women who had a normotensive pregnancy, women with a history of preeclampsia demonstrated a trend toward altered cardiac structure and function. Further studies with larger sample sizes and consistent echocardiogram reporting with the use of sensitive preclinical markers are required to assess the role of echocardiography in monitoring this high‐risk population group.

Objectives To review the accuracy of different imaging modalities for the detection of rectosigmoid deep endometriosis (DE) in women with clinical suspicion of endometriosis, and to determine the optimal modality. Methods A search was conducted using PubMed, MEDLINE, Scopus, EMBASE and Google Scholar to identify studies using imaging to evaluate women with suspected DE, published from inception to May 2020. Studies were considered eligible if they were prospective and used any imaging modality to assess preoperatively for the presence of DE in the rectum/rectosigmoid, which was then correlated with the surgical diagnosis as the reference standard. Eligibility was restricted to studies including at least 10 affected and 10 unaffected women. The QUADAS‐2 tool was used to assess the quality of the included studies. Mixed‐effects diagnostic meta‐analysis was used to determine the overall pooled sensitivity and specificity of each imaging modality for rectal/rectosigmoid DE, which were used to calculate the likelihood ratio of a positive (LR+) and negative (LR–) test and diagnostic odds ratio (DOR). Results Of the 1979 records identified, 30 studies (3374 women) were included in the analysis. The overall pooled sensitivity and specificity, LR+, LR– and DOR for the detection of rectal/rectosigmoid DE using transvaginal sonography (TVS) were, respectively, 89% (95% CI, 83–92%), 97% (95% CI, 95–98%), 30.8 (95% CI, 17.6–54.1), 0.12 (95% CI, 0.08–0.17) and 264 (95% CI, 113–614). For magnetic resonance imaging (MRI), the respective values were 86% (95% CI, 79–91%), 96% (95% CI, 94–97%), 21.0 (95% CI, 13.4–33.1), 0.15 (95% CI, 0.09–0.23) and 144 (95% CI, 70–297). For computed tomography, the respective values were 93% (95% CI, 84–97%), 95% (95% CI, 81–99%), 20.3 (95% CI, 4.3–94.9), 0.07 (95% CI, 0.03–0.19) and 280 (95% CI, 28–2826). For rectal endoscopic sonography (RES), the respective values were 92% (95% CI, 87–95%), 98% (95% CI, 96–99%), 37.1 (95% CI, 21.1–65.4), 0.08 (95% CI, 0.05–0.14) and 455 (95% CI, 196–1054). There was significant heterogeneity and the studies were considered methodologically poor according to the QUADAS‐2 tool. Conclusions The sensitivity of TVS for the detection of rectal/rectosigmoid DE seems to be slightly better than that of MRI, although RES was superior to both. The specificity of both TVS and MRI was excellent. As TVS is simpler, faster and more readily available than the other methods, we believe that it should be the first‐line diagnostic tool for women with suspected DE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

Randomized controlled trials (RCTs) serve as the pillar of evidence-based medicine and guide medical practice. Compromised data integrity in RCTs undermines the authority of this valuable tool for science and puts patients at risk. Although a large number of retractions due to data issues in obstetrics and gynecology have occurred in the past few years, many problematic RCTs could still go uncovered because in general there is insufficient willingness to envisage and confront research misconduct. In this article, we discuss the necessity of assessing research misconduct, summarize methods that have been applied in detecting previous cases of misconduct, and propose potential solutions. There is no established mechanism to monitor feedback on published articles and the current system that handles potential research misconduct is unsatisfactory. Fortunately, there are methods to assess data integrity in RCTs both with and without individual participant data. Investigations into research misconduct can be facilitated by assessing all publications from a leading author or author group to identify duplication and patterns of ongoing misconduct. There is a pressing need to improve the mechanism that investigates data manipulation. The mechanism that handles misconduct should prioritize the interests of patients and readers rather than trial authors and their institutions. An equally urgent issue is to establish mechanisms that prevent compromised trials from polluting evidence synthesis or misguiding practice.

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To investigate the coupling relationship between ionospheric variations and great earthquakes in the seismic zone of southwest China, the total electron content (TEC) anomalies before Mw 6.0+ earthquakes in that area between 2001 and 2013 were analyzed to study the precursors of great earthquakes. To analyze the lithosphere-atmosphere-ionosphere effect, TEC estimated by the Center for Orbit Determination in Europe was used to determine anomalies prior to 18 moderate-to-great earthquakes with magnitudes of ≥ 6.0. Spatial and temporal TEC variations in the seismic zone were calculated and examined to study the relationship between the identified TEC anomalies and subsequent earthquakes. The results showed that ionospheric anomalies were observed before 72 % of earthquakes and among those anomalies, positive and negative anomalies accounted for approximately 58 % and 42 % of anomalies, respectively. Most of the ionospheric anomalies could be observed within 1 to 6 days prior to the earthquakes and approximately 82 % of ionospheric anomalies usually occurred between 13:00 and 18:00 in the region's local time. Furthermore, the anomaly amplitudes and occurrence time were proportional to the magnitude of the earthquake but the relationship was not linear. After eliminating the effect of solar activities and geomagnetic storms, some obvious and regular anomalous behavior in TEC could be detected on the 19th day before several earthquakes and the peak of anomaly enhancement coincided with the vertical projection of the epicenter. Our results indicate that these TEC anomalies may be the ionospheric precursors of forthcoming earthquakes in the seismic belt of southwest China.

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