{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T02:13:58Z","timestamp":1794449638668,"version":"4.9.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"CAMS Innovation Fund for Medical Sciences","award":["CAMS 2021-I2M-1-004"],"award-info":[{"award-number":["CAMS 2021-I2M-1-004"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Inappropriate management of high-grade squamous intraepithelial lesions (HSIL) may be the result of an inaccurate colposcopic diagnosis. The aim of this study was to assess colposcopic performance in identifying HSIL+\u2009cases and to analyze the associated clinical factors.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Records from 1130 patients admitted to Shenzhen Maternal and Child Healthcare Hospital from 12th January, 2018 up until 30th December, 2018 were retrospectively collected, and included demographics, cytological results, HPV status, transformation zone type, number of cervical biopsy sites, colposcopists\u2019 competencies, colposcopic impressions, as well as histopathological results. Colposcopy was carried out using 2011 colposcopic terminology from the International Federation of Cervical Pathology and Colposcopy. Logistic regression modelling was implemented for uni- and multivariate analyses. A forward stepwise approach was adopted in order to identify variables associated with colposcopic accuracy. Histopathologic results were taken as the comparative gold standard.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Data from 1130 patient records were collated and analyzed. Colposcopy was 69.7% accurate in identifying HSIL+\u2009cases. Positive predictive value, negative predictive value, sensitivity and specificity of detecting HSIL or more (HSIL+) were 35.53%, 64.47%, 42.35% and 77.60%, respectively. Multivariate analysis highlighted the number of biopsies, cytology, and transformation zone type as independent factors. Age and HPV subtype did not appear to statistically correlate with high-grade lesion\/carcinoma.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Evidence presented here suggests that colposcopy is only 69.7% accurate at diagnosing HSIL. Even though not all HSIL will progress into cancer it is considered pre-cancerous and therefore early identification will save lives. The number of biopsies, cytology and transformation zone type appear to be predictors of misdiagnosis and therefore should be considered during clinical consultations and by way of further research.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12905-022-01592-6","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T04:45:28Z","timestamp":1641876328000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Assessing colposcopic accuracy for high\u2010grade squamous intraepithelial lesion detection: a retrospective, cohort study"],"prefix":"10.1186","volume":"22","author":[{"given":"Anying","family":"Bai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Seery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"issue":"3","key":"1592_CR1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209\u201349.","journal-title":"CA Cancer J Clin"},{"issue":"5","key":"1592_CR2","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.currproblcancer.2018.06.003","volume":"42","author":"M Vu","year":"2018","unstructured":"Vu M, Yu J, Awolude OA, Chuang L. Cervical cancer worldwide. Curr Probl Cancer. 2018;42(5):457\u201365.","journal-title":"Curr Probl Cancer"},{"issue":"2","key":"1592_CR3","doi-asserted-by":"publisher","first-page":"115","DOI":"10.3322\/caac.21338","volume":"66","author":"W Chen","year":"2016","unstructured":"Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66(2):115\u201332.","journal-title":"CA Cancer J Clin"},{"issue":"25","key":"1592_CR4","doi-asserted-by":"publisher","first-page":"3977","DOI":"10.1038\/sj.onc.1206629","volume":"22","author":"C Ziegert","year":"2003","unstructured":"Ziegert C, Wentzensen N, Vinokurova S, Kisseljov F, Einenkel J, Hoeckel M, et al. A comprehensive analysis of HPV integration loci in anogenital lesions combining transcript and genome-based amplification techniques. Oncogene. 2003;22(25):3977\u201384.","journal-title":"Oncogene"},{"issue":"Suppl 2","key":"1592_CR5","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1016\/j.ijgo.2005.01.009","volume":"89","author":"R Sankaranarayanan","year":"2005","unstructured":"Sankaranarayanan R, Gaffikin L, Jacob M, Sellors J, Robles S. A critical assessment of screening methods for cervical neoplasia. Int J Gynaecol Obstet. 2005;89(Suppl 2):S4-s12.","journal-title":"Int J Gynaecol Obstet"},{"issue":"10","key":"1592_CR6","doi-asserted-by":"publisher","first-page":"9166","DOI":"10.18632\/oncotarget.24074","volume":"9","author":"A Fan","year":"2018","unstructured":"Fan A, Wang C, Zhang L, Yan Y, Han C, Xue F. Diagnostic value of the 2011 International Federation for Cervical Pathology and Colposcopy Terminology in predicting cervical lesions. Oncotarget. 2018;9(10):9166\u201376.","journal-title":"Oncotarget"},{"issue":"3","key":"1592_CR7","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1016\/S0090-8258(03)00082-9","volume":"89","author":"LS Massad","year":"2003","unstructured":"Massad LS, Collins YC. Strength of correlations between colposcopic impression and biopsy histology. Gynecol Oncol. 2003;89(3):424\u20138.","journal-title":"Gynecol Oncol"},{"issue":"1","key":"1592_CR8","first-page":"123","volume":"48","author":"A Stafl","year":"1976","unstructured":"Stafl A. New nomenclature for colposcopy. Report of the committee on terminology. Obstet Gynecol. 1976;48(1):123\u20134.","journal-title":"Obstet Gynecol"},{"issue":"2","key":"1592_CR9","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1097\/00006250-199102000-00032","volume":"77","author":"A Stafl","year":"1991","unstructured":"Stafl A, Wilbanks GD. An international terminology of colposcopy: report of the Nomenclature Committee of the International Federation of Cervical Pathology and Colposcopy. Obstet Gynecol. 1991;77(2):313\u20134.","journal-title":"Obstet Gynecol"},{"issue":"1","key":"1592_CR10","first-page":"175","volume":"101","author":"P Walker","year":"2003","unstructured":"Walker P, Dexeus S, De Palo G, Barrasso R, Campion M, Girardi F, et al. International terminology of colposcopy: an updated report from the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol. 2003;101(1):175\u20137.","journal-title":"Obstet Gynecol"},{"issue":"6","key":"1592_CR11","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1007\/s00404-020-05740-x","volume":"302","author":"Y Ruan","year":"2020","unstructured":"Ruan Y, Liu M, Guo J, Zhao J, Niu S, Li F. Evaluation of the accuracy of colposcopy in detecting high-grade squamous intraepithelial lesion and cervical cancer. Arch Gynecol Obstet. 2020;302(6):1529\u201338.","journal-title":"Arch Gynecol Obstet"},{"issue":"16","key":"1592_CR12","doi-asserted-by":"publisher","first-page":"2114","DOI":"10.1001\/jama.287.16.2114","volume":"287","author":"D Solomon","year":"2002","unstructured":"Solomon D, Davey D, Kurman R, Moriarty A, O\u2019Connor D, Prey M, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287(16):2114\u20139.","journal-title":"JAMA"},{"issue":"9","key":"1592_CR13","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1055\/s-0033-1350824","volume":"73","author":"J Quaas","year":"2013","unstructured":"Quaas J, Reich O, Frey Tirri B, K\u00fcppers V. Explanation and Use of the Colposcopy Terminology of the IFCPC (International Federation for Cervical Pathology and Colposcopy) Rio 2011. Geburtshilfe Frauenheilkd. 2013;73(9):904\u20137.","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"1592_CR14","first-page":"8984516","volume":"2017","author":"Y Li","year":"2017","unstructured":"Li Y, Duan X, Sui L, Xu F, Xu S, Zhang H, et al. Closer to a uniform language in colposcopy: study on the potential application of 2011 international federation for cervical pathology and colposcopy terminology in clinical practice. Biomed Res Int. 2017;2017:8984516.","journal-title":"Biomed Res Int"},{"issue":"4","key":"1592_CR15","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1007\/s00404-021-06012-y","volume":"304","author":"J Li","year":"2021","unstructured":"Li J, Wang W, Yang P, Chen J, Dai Q, Hua P, et al. Analysis of the agreement between colposcopic impression and histopathological diagnosis of cervical biopsy in a single tertiary center of Chengdu. Arch Gynecol Obstet. 2021;304(4):1033\u201341.","journal-title":"Arch Gynecol Obstet"},{"issue":"3","key":"1592_CR16","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1159\/000497110","volume":"63","author":"N Karia","year":"2019","unstructured":"Karia N, Van Loon A, Simoens C, Benoy I, Bogers J. The positive predictive value of high-grade squamous intraepithelial lesion on cytology for the histological diagnosis of cervical intraepithelial neoplasia 2 or higher: a systematic review. Acta Cytol. 2019;63(3):206\u201314.","journal-title":"Acta Cytol"},{"issue":"9","key":"1592_CR17","first-page":"2451","volume":"12","author":"S Ouitrakul","year":"2011","unstructured":"Ouitrakul S, Udomthavornsuk B, Chumworathayi B, Luanratanakorn S, Supoken A. Accuracy of colposcopically directed biopsy in diagnosis of cervical pathology at Srinagarind Hospital. Asian Pac J Cancer Prev APJCP. 2011;12(9):2451\u20133.","journal-title":"Asian Pac J Cancer Prev APJCP"},{"issue":"1","key":"1592_CR18","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.ejogrb.2008.07.007","volume":"141","author":"RL Bekkers","year":"2008","unstructured":"Bekkers RL, van de Nieuwenhof HP, Neesham DE, Hendriks JH, Tan J, Quinn MA. Does experience in colposcopy improve identification of high grade abnormalities? Eur J Obstet Gynecol Reprod Biol. 2008;141(1):75\u20138.","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"4","key":"1592_CR19","first-page":"626","volume":"91","author":"MF Mitchell","year":"1998","unstructured":"Mitchell MF, Schottenfeld D, Tortolero-Luna G, Cantor SB, Richards-Kortum R. Colposcopy for the diagnosis of squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol. 1998;91(4):626\u201331.","journal-title":"Obstet Gynecol"},{"issue":"2","key":"1592_CR20","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1158\/0008-5472.CAN-05-3066","volume":"66","author":"PE Castle","year":"2006","unstructured":"Castle PE, Jeronimo J, Schiffman M, Herrero R, Rodr\u00edguez AC, Bratti MC, et al. Age-related changes of the cervix influence human papillomavirus type distribution. Can Res. 2006;66(2):1218\u201324.","journal-title":"Can Res"},{"issue":"2","key":"1592_CR21","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/0002-9378(95)90279-1","volume":"173","author":"CW Critchlow","year":"1995","unstructured":"Critchlow CW, W\u00f6lner-Hanssen P, Eschenbach DA, Kiviat NB, Koutsky LA, Stevens CE, et al. Determinants of cervical ectopia and of cervicitis: age, oral contraception, specific cervical infection, smoking, and douching. Am J Obstet Gynecol. 1995;173(2):534\u201343.","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"1592_CR22","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.3802\/jgo.2020.31.e13","volume":"31","author":"SI Kim","year":"2020","unstructured":"Kim SI, Kim SJ, Suh DH, Kim K, No JH, Kim YB. Pathologic discrepancies between colposcopy-directed biopsy and loop electrosurgical excision procedure of the uterine cervix in women with cytologic high-grade squamous intraepithelial lesions. J Gynecol Oncol. 2020;31(2):e13.","journal-title":"J Gynecol Oncol"},{"issue":"2","key":"1592_CR23","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1007\/s00404-018-4953-8","volume":"299","author":"FA Stuebs","year":"2019","unstructured":"Stuebs FA, Schulmeyer CE, Mehlhorn G, Gass P, Kehl S, Renner SK, et al. Accuracy of colposcopy-directed biopsy in detecting early cervical neoplasia: a retrospective study. Arch Gynecol Obstet. 2019;299(2):525\u201332.","journal-title":"Arch Gynecol Obstet"},{"issue":"2","key":"1592_CR24","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1097\/01.AOG.0000220505.18525.85","volume":"108","author":"JC Gage","year":"2006","unstructured":"Gage JC, Hanson VW, Abbey K, Dippery S, Gardner S, Kubota J, et al. Number of cervical biopsies and sensitivity of colposcopy. Obstet Gynecol. 2006;108(2):264\u201372.","journal-title":"Obstet Gynecol"},{"issue":"3","key":"1592_CR25","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1097\/LGT.0b013e3181fb4547","volume":"15","author":"RG Pretorius","year":"2011","unstructured":"Pretorius RG, Belinson JL, Burchette RJ, Hu S, Zhang X, Qiao YL. Regardless of skill, performing more biopsies increases the sensitivity of colposcopy. J Low Genit Tract Dis. 2011;15(3):180\u20138.","journal-title":"J Low Genit Tract Dis"},{"issue":"1","key":"1592_CR26","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1200\/JCO.2014.55.9948","volume":"33","author":"N Wentzensen","year":"2015","unstructured":"Wentzensen N, Walker JL, Gold MA, Smith KM, Zuna RE, Mathews C, et al. Multiple biopsies and detection of cervical cancer precursors at colposcopy. J Clin Oncol. 2015;33(1):83\u20139.","journal-title":"J Clin Oncol"},{"issue":"4","key":"1592_CR27","doi-asserted-by":"publisher","first-page":"321.e1","DOI":"10.1016\/j.ajog.2010.05.033","volume":"203","author":"C Zuchna","year":"2010","unstructured":"Zuchna C, Hager M, Tringler B, Georgoulopoulos A, Ciresa-Koenig A, Volgger B, et al. Diagnostic accuracy of guided cervical biopsies: a prospective multicenter study comparing the histopathology of simultaneous biopsy and cone specimen. Am J Obstet Gynecol. 2010;203(4):321.e1-6.","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"1592_CR28","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1097\/LGT.0000000000000334","volume":"21","author":"N Wentzensen","year":"2017","unstructured":"Wentzensen N, Schiffman M, Silver MI, Khan MJ, Perkins RB, Smith KM, et al. ASCCP colposcopy standards: risk-based colposcopy practice. J Low Genit Tract Dis. 2017;21(4):230\u20134.","journal-title":"J Low Genit Tract Dis"},{"issue":"1","key":"1592_CR29","doi-asserted-by":"publisher","first-page":"423","DOI":"10.7314\/APJCP.2014.15.1.423","volume":"15","author":"M Tatiyachonwiphut","year":"2014","unstructured":"Tatiyachonwiphut M, Jaishuen A, Sangkarat S, Laiwejpithaya S, Wongtiraporn W, Inthasorn P, et al. Agreement between colposcopic diagnosis and cervical pathology: Siriraj hospital experience. Asian Pac J Cancer Prev APJCP. 2014;15(1):423\u20136.","journal-title":"Asian Pac J Cancer Prev APJCP"},{"issue":"5","key":"1592_CR30","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1007\/s00404-017-4500-z","volume":"296","author":"A Fan","year":"2017","unstructured":"Fan A, Zhang L, Wang C, Wang Y, Han C, Xue F. Analysis of clinical factors correlated with the accuracy of colposcopically directed biopsy. Arch Gynecol Obstet. 2017;296(5):965\u201372.","journal-title":"Arch Gynecol Obstet"},{"issue":"6","key":"1592_CR31","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1111\/j.1471-0528.1991.tb10376.x","volume":"98","author":"DT Howe","year":"1991","unstructured":"Howe DT, Vincenti AC. Is large loop excision of the transformation zone (LLETZ) more accurate than colposcopically directed punch biopsy in the diagnosis of cervical intraepithelial neoplasia? Br J Obstet Gynaecol. 1991;98(6):588\u201391.","journal-title":"Br J Obstet Gynaecol"},{"issue":"5","key":"1592_CR32","doi-asserted-by":"publisher","first-page":"468","DOI":"10.3109\/00016349709047830","volume":"76","author":"JJ Baldauf","year":"1997","unstructured":"Baldauf JJ, Dreyfus M, Ritter J, Philippe E. An analysis of the factors involved in the diagnostic accuracy of colposcopically directed biopsy. Acta Obstet Gynecol Scand. 1997;76(5):468\u201373.","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"4","key":"1592_CR33","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1097\/00008469-199808000-00005","volume":"7","author":"L Loiudice","year":"1998","unstructured":"Loiudice L, Abbiati R, Boselli F, Cecchini G, Costa S, Grossi E, et al. Improvement of Pap smear sensitivity using a visual adjunctive procedure: a co-operative Italian study on speculoscopy (GISPE). Eur J Cancer Prev. 1998;7(4):295\u2013304.","journal-title":"Eur J Cancer Prev"},{"issue":"1","key":"1592_CR34","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1186\/s12916-020-01860-y","volume":"18","author":"P Xue","year":"2020","unstructured":"Xue P, Tang C, Li Q, Li Y, Shen Y, Zhao Y, et al. Development and validation of an artificial intelligence system for grading colposcopic impressions and guiding biopsies. BMC Med. 2020;18(1):406.","journal-title":"BMC Med"},{"issue":"1","key":"1592_CR35","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1186\/s12916-020-01613-x","volume":"18","author":"P Xue","year":"2020","unstructured":"Xue P, Ng MTA, Qiao Y. The challenges of colposcopy for cervical cancer screening in LMICs and solutions by artificial intelligence. BMC Med. 2020;18(1):169.","journal-title":"BMC Med"},{"issue":"1","key":"1592_CR36","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1186\/s12905-020-01121-3","volume":"20","author":"K Taghavi","year":"2020","unstructured":"Taghavi K, Rohner E, Basu P, Low N, Rutjes A, Bohlius J. Screening test accuracy of portable devices that can be used to perform colposcopy for detecting CIN2+ in low- and middle-income countries: a systematic review and meta-analysis. BMC Womens Health. 2020;20(1):253.","journal-title":"BMC Womens Health"},{"issue":"5","key":"1592_CR37","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1111\/j.1471-0528.2012.03280.x","volume":"119","author":"A Zaal","year":"2012","unstructured":"Zaal A, Louwers JA, Berkhof J, Kocken M, Ter Harmsel WA, Graziosi GC, et al. Agreement between colposcopic impression and histological diagnosis among human papillomavirus type 16-positive women: a clinical trial using dynamic spectral imaging colposcopy. BJOG Int J Obstet Gynaecol. 2012;119(5):537\u201344.","journal-title":"BJOG Int J Obstet Gynaecol"}],"container-title":["BMC Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-022-01592-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12905-022-01592-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-022-01592-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T04:46:01Z","timestamp":1641876361000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcwomenshealth.biomedcentral.com\/articles\/10.1186\/s12905-022-01592-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,11]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["1592"],"URL":"https:\/\/doi.org\/10.1186\/s12905-022-01592-6","relation":{},"ISSN":["1472-6874"],"issn-type":[{"value":"1472-6874","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,11]]},"assertion":[{"value":"31 October 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the institutional review board of Shenzhen maternal and Child Health Hospital (No. 164). All methods were performed in accordance with the Declaration of Helsinki.\u00a0The need for informed consent was waived by the IRB of SZMCHH due to the retrospective nature of archived datasets and fully anonymized personal information.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors consent to the publication of this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"9"}}