Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Lack of consensus in calculation of interval cancer rates for cervical cancer screening.","authors":"Patricia Fitzpatrick, Therese Mooney, Yvonne Williams, Caroline Mason Mohan, Jesper Bonde, Julia Gao, Andrzej Nowakowski, Annemie Haelens, Urska Ivanus, Maiju Pankakoski, Tina Karapetyan, Noirin E Russell","doi":"10.1111/aogs.15172","DOIUrl":"https://doi.org/10.1111/aogs.15172","url":null,"abstract":"<p><strong>Introduction: </strong>In 2018, nondisclosure of results of retrospective audits of cytology in interval cancers precipitated a crisis in the Irish national cervical screening programme. In response, an Expert Reference Group was convened which recommended a collaborative approach to the development of a new key performance indicator, the interval cancer rate. The Expert Reference Group also recommended that the Irish programme should collaborate with international colleagues to reach consensus on (i) the definition of an interval cervical cancer, (ii) the methodology to calculate the interval cancer rate, and (iii) benchmarking with other international programs. This study was undertaken to determine if a consensus regarding the definition of an interval cervical cancer and the calculation of an interval cancer rate exists.</p><p><strong>Material and methods: </strong>A web-based questionnaire was sent to 18 population-based cervical screening programs. Inclusion criteria involved (1) a national or regional population-based cervical screening prograe; (2) a country or region with a population ≥population of Ireland; (3) programs located in Europe, Australia, or Canada; (4) programs that had responded to a previously published international survey on the disclosure of retrospective cytology reviews in cervical cancer cases.</p><p><strong>Results: </strong>The response rate was nine out of 18. Of nine respondents, six had an agreed definition of interval cervical cancer, and four of these calculated an interval cancer rate. Three programs neither calculated interval cancer rates nor had any guidelines related to this. Of the six with an agreed definition, all respondents defined the numerator as invasive cancers in the screening age group, with four including microinvasive disease. Respondents included cancers diagnosed 3-5 years after the last screening test had been taken. Three respondents also included cancers diagnosed in women up to 3.5 years after they exited the screening program. Countries use different denominators, including (i) per women years, (ii) per number of screens, and (iii) per total cancers in screened population.</p><p><strong>Conclusions: </strong>There is variation in the parameters used in interval cancer rate calculation. To allow benchmarking of cervical screening program performance, there is a need for consensus on a standardized method of interval cancer definition and interval cancer rate calculation.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-sectional and longitudinal metabolomics-based profiles associated with oral contraceptive and progestin-only pill use: A Finnish population-based study.","authors":"Elena Toffol, Jari Haukka, Pekka Jousilahti, Lara Lehtoranta, Anni Joensuu, Timo Partonen, Iris Erlund, Oskari Heikinheimo","doi":"10.1111/aogs.15176","DOIUrl":"https://doi.org/10.1111/aogs.15176","url":null,"abstract":"<p><strong>Introduction: </strong>The use of combined oral contraceptives (COCs), but not of progestin-only pills (POPs) is associated with an increased risk of cardiovascular events. A detailed examination of how different oral contraceptives impact the metabolism in the short- and long-term has not been conducted. This study comparatively examines cross-sectional and longitudinal metabolomics-based profiles of different COCs and POPs, and explores how they perform relative to a metabolically safer contraceptive option.</p><p><strong>Material and methods: </strong>Data were obtained from a population-based survey (Health 2000) and its 11-year follow-up (Health 2011). Altogether, 212 metabolic measures in OC users (n = 299; COC, n = 245; POP, n = 33) were compared to those in non-users of hormonal contraception (HC; n = 1422), and in users of a levonorgestrel intrauterine device (LNG-IUD; n = 341) via multivariable general estimating equations models adjusted for age, body mass index, duration of use, study cohort, diseases, medication use, alcohol use, smoking, and physical activity. Participants with complete longitudinal information (n = 327) were divided into continuers, stoppers, starters, switchers, and never-user groups, and the 11-year changes in the levels of each metabolite were compared.</p><p><strong>Results: </strong>Use of COCs, but not of POPs, was associated with altered levels of several metabolic measures compared to HC non-use or to use of LNG-IUD: higher concentrations and ratios of monounsaturated fatty acids but lower ratios of polyunsaturated fatty acids, and higher concentrations and ratios of triglycerides in lipoproteins. Additionally, in comparison to HC non-use or to use of LNG-IUD, users of third generation or other COCs had higher levels of inflammation markers and of cholesterol, but a lower percentage of cholesterol and a higher percentage of triglycerides in lipoproteins. Continuation or starting of LNG-IUD was not related to changes in metabolic profiles, while women who changed or stopped using COCs had greater levels of unsaturation and lower levels of total and lipoprotein triglycerides and other lipids.</p><p><strong>Conclusions: </strong>The use of COCs, especially of third generation and other COCs, is related to various metabolic alterations suggestive of increased cardiovascular risk. Conversely, the use of POPs and LNG-IUD appeared metabolically safe. These associations were mostly reversible after interruption of use or switch to different preparations.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of laparoscopic lateral suspension with mesh for pelvic organ prolapse: A systematic review and meta-analysis.","authors":"Qi Wang, Stefano Manodoro, Xiaoxiang Jiang, Chaoqin Lin","doi":"10.1111/aogs.15170","DOIUrl":"https://doi.org/10.1111/aogs.15170","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic lateral suspension (LLS) with mesh is an alternative treatment for pelvic organ prolapse, offering enhanced apical vaginal suspension. This review aims to comprehensively evaluate the efficacy and safety of LLS for the treatment of pelvic organ prolapse through systematic review and meta-analysis.</p><p><strong>Material and methods: </strong>Original studies including randomized controlled trials, prospective, or retrospective studies reporting outcomes on the efficacy and safety of LLS with mesh for pelvic organ prolapse were retrieved from PubMed and Web of Science up to November 30, 2024. Case reports, reviews, and non-English literature were excluded. Primary outcomes included anatomical and subjective success rates. Secondary outcomes were recurrence rates, reoperation rates, and complications. Random-effects meta-analysis was performed where appropriate. This study has been registered in PROSPERO with the registration number CRD42024620632.</p><p><strong>Results: </strong>Eighteen studies (3 randomized controlled trials, 9 prospective studies, and 6 retrospective studies) involving 1430 LLS patients with a mean follow-up of 20.27 months were included. The pooled anatomical success rates for the apical and anterior compartments were 92.9% (95% confidence interval [CI]: 89.8-95.1) and 86.9% (95% CI: 81.4-90.9), respectively. The subjective success rate was 88.9% (95% CI: 85.3-91.7). The pooled recurrence rate was 9.6% (95% CI: 7.0-13.2), and the reoperation rate was 6.2% (95% CI: 4.3-8.9). Overall complication and mesh-related complication rates were 5.7% (95% CI: 3.4-9.4) and 1.9% (95% CI: 1.0-3.8), respectively. The incidence of Clavien-Dindo grade ≥3 complications was only 1.9% (16/848).</p><p><strong>Conclusions: </strong>LLS demonstrates favorable anatomical and subjective success rates, indicating its reliability and safety for pelvic organ prolapse treatment. However, longer follow-up is needed to validate its long-term efficacy.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing harm and benefit for induction of labor at 41 weeks: Slow acting is the problem.","authors":"Anita C J Ravelli, Joris A M van der Post, Christianne J M de Groot, Ameen Abu-Hanna, Martine Eskes","doi":"10.1111/aogs.15173","DOIUrl":"https://doi.org/10.1111/aogs.15173","url":null,"abstract":"","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Offspring exposure to Crohn's disease during pregnancy and association with milder psychiatric regulatory disturbances in childhood.","authors":"Elin Skott, Gustav Söderberg, MaiBritt Giacobini, Samson Nivins, Xinxia Chen, Daniel Lindqvist, Mika Gissler, Klas Sjöberg, Catharina Lavebratt","doi":"10.1111/aogs.15167","DOIUrl":"https://doi.org/10.1111/aogs.15167","url":null,"abstract":"<p><strong>Introduction: </strong>Prenatal exposure to inflammatory states has been suggested to influence offspring neurodevelopment. The aim was to investigate if offspring exposure to maternal Inflammatory bowel disorder (IBD), or specifically the IBD disorder Crohn's disease, during gestation is associated with neurodevelopmental or psychiatric disorders in childhood.</p><p><strong>Material and methods: </strong>We conducted a population-based registry study in Finland. All live births from 1996 until 2014 in Finland were included and followed up until December 2018. Exposure was maternal IBD or Crohn's disease. Outcome was a broad range of neurodevelopmental and psychiatric disorders in offspring. Cox proportional hazards regression was applied to assess association. Sensitivity analyses included assessing, for example, exposure to severe episode of IBD or Crohn's disease, the outcome psychotropic medication for the children, and influence from perinatal risk factors.</p><p><strong>Results: </strong>Of the participants (N = 1 105 997), 0.55% (N = 6067) were exposed to maternal IBD 0.18% (N = 1959) to maternal Crohn's disease. Among the children exposed to IBD or the subgroup Crohn's disease, 6.3% or 7.3%, respectively, had received an outcome diagnosis during the follow-up. There were higher risks for Sleeping disorders HR = 1.77 (95% CI, 1.13-2.78), Other feeding disorders HR = 1.83 (95% CI, 1.19, 2.19), and Incontinence HR = 1.42 (95% CI, 1.02-1.97) in children exposed to maternal Crohn's disease compared to unexposed children. This was supported by even higher point risk estimates for Incontinence HR = 2.43 (95% CI, 1.34-4.38) and Other feeding disorders HR = 2.83 (95% CI, 1.35-5.91) in offspring where the mother was hospitalized for Crohn's disease during pregnancy. Furthermore, there was a higher risk of dispensed antipsychotic, anxiolytic, hypnotic, and/or sedative medications for children with maternal Crohn's disease HR = 1.38 (95% CI, 1.03-1.85). These associations were not explained by cesarean section, preterm birth, or small birth size.</p><p><strong>Conclusions: </strong>Offspring exposed to maternal Crohn's disease during pregnancy had modestly higher risks of early sleeping, continence, and feeding disturbances. The exposure had no detectable association with any of the other psychiatric disorders studied.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Miscarriage treatment-related adverse events: A nationwide registry study from Finland.","authors":"Nea Helle, Maarit Mentula, Tomi Seppälä, Mika Gissler, Maarit Niinimäki, Oskari Heikinheimo","doi":"10.1111/aogs.15174","DOIUrl":"https://doi.org/10.1111/aogs.15174","url":null,"abstract":"<p><strong>Introduction: </strong>The treatment of miscarriage has transformed substantially from surgical to non-surgical. The aim of this study was to evaluate the rates of adverse events related to the treatment of miscarriage and their risk factors.</p><p><strong>Material and methods: </strong>This nationwide retrospective cohort study included 69 593 fertile-aged (15-49 years) women who experienced their first miscarriage during 1998-2016 and received a diagnostic code of missed abortion or blighted ovum in a public hospital. We used data from the Finnish National Hospital Discharge Registry (NHDR). Miscarriage type, treatment modalities, and treatment-related adverse events (secondary surgery for any reason, infection and severe adverse events) were identified using diagnostic and surgical procedure codes.</p><p><strong>Results: </strong>Since 2004, non-surgical management has been the dominant treatment of miscarriage in Finland. Between 1998 and 2016, a total of 11 397 women (16.4%) experienced at least one miscarriage treatment-related adverse event. The need for secondary surgery was the most common adverse event and more common after primary non-surgical treatment (22.0% vs. 3.8%). However, the annual rate of secondary surgery after non-surgical treatment declined from 34.8% in 1998 to 15.9% in 2016. The total number of women undergoing surgical treatment (primary or secondary) declined from 3918 (84.6%) to 651 (23.1%). Age was associated with an increased risk of secondary surgery (age ≥ 25; Adjusted odds ratio [AdjOR] 1.15, 95% CI 1.07-1.24) and with a decreased overall risk of infection (age 40-49 years; AdjOR 0.51 [0.40-0.63]). Parity was associated with lower risk of secondary surgery (one delivery, AdjOR 0.82 [0.78-0.95], and ≥2 deliveries, AdjOR 0.75, [0.71-0.84]) and infection (one delivery, AdjOR 0.85, [0.77-0.95]; ≥2 deliveries, AdjOR 0.74 [0.66-0.84]). Severe adverse events were rare (0.2%-0.4%) and did not differ between the two treatment options for either type of miscarriage.</p><p><strong>Conclusions: </strong>Despite significant changes in miscarriage treatment practices, no substantial or alarming increase in treatment-associated adverse events was detected. Both treatment options proved safe for the two types of miscarriage studied. These findings are important regarding the provision of individualized counseling and for the allocation of healthcare resources.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of local symptoms on health-related quality of life in vulvar cancer survivors-A nationwide prospective study.","authors":"Diana Zach, Pernille T Jensen, Henrik Falconer, Zuzana Kolkova, Katja Stenström Bohlin, Preben Kjølhede, Ivette Raices Cruz, Elisabeth Åvall-Lundqvist, Angelique Flöter Rådestad","doi":"10.1111/aogs.15164","DOIUrl":"https://doi.org/10.1111/aogs.15164","url":null,"abstract":"<p><strong>Introduction: </strong>Vulvar cancer may cause serious local symptoms that may impact negatively on the woman's health-related quality of life (HRQOL). However, knowledge about the prevalence of vulvar and lymphedema symptoms at diagnosis and during follow-up is limited. The aim of this study was to evaluate the longitudinal development of vulvar and lymphedema symptoms as well as the trajectory of HRQOL in women with vulvar cancer. Furthermore, associations between vulvar symptoms and HRQOL were investigated.</p><p><strong>Material and methods: </strong>In this nationwide prospective cohort study, women completed validated patient-reported outcome measures; the EORTC-QLQ C30 and the EORTC-QLQ-VU34 at diagnosis, three, and 12 months post-treatment. Mean scores of symptom- and functioning scales were calculated over time. Heatmaps were used to visualize proportional changes in the prevalence of symptoms at baseline and 12 months after treatment. Linear mixed-effects models with patient-specific random intercepts were specified to estimate changes in mean scores of HRQOL over time. Additionally, adjusted linear mixed-effects models were applied to investigate the effect of the most prevalent vulvar symptom on HRQOL. The study has been registered at ClinicalTrials.gov (NCT04152512).</p><p><strong>Results: </strong>Between 2019 and 2021, 153 women consented to participate in the study, and 140 (92%) completed the patient-reported outcome measures at least once. In total, 105 (69%) completed the patient-reported outcome measures at all three time points. The most prevalent reported symptom was itchy, irritated skin in the vulva, which decreased from 82% at diagnosis to 56% 12 months after treatment. All vulvar symptoms, except narrowing of the vaginal entrance, improved over time but persisted in large proportions of the women. Women with severe vulvar symptoms reported a significant decline in HRQOL. A deterioration of leg swelling symptoms was reported by 33% of the women. Emotional-, role-, social-, and cognitive functioning, global and mental health improved significantly after treatment.</p><p><strong>Conclusion: </strong>Local vulvar symptoms were highly prevalent at diagnosis; however, as most aspects of HRQOL, they improved significantly during the first year of follow-up. Severe vulvar symptoms were associated with impaired HRQOL. Symptoms of leg lymphedema increased after treatment. © 2025 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of opportunistic salpingectomy for ovarian cancer prevention: Analyzing clinical practice and key characteristics.","authors":"Charlotte Fisch, Malou E Gelderblom, Brigitte Slangen, Angèle L M Oei, Alexandra A van Ginkel, Huy Ngo, Joanne de Hullu, Jurgen Piek, Rosella Hermens","doi":"10.1111/aogs.15128","DOIUrl":"https://doi.org/10.1111/aogs.15128","url":null,"abstract":"<p><strong>Introduction: </strong>Ovarian cancer (OC) is the most lethal gynecologic cancer, often diagnosed at an advanced stage due to nonspecific symptoms and lack of effective screening. Over 90% of all ovarian cancer cases are epithelial in origin, which is thought to originate from the fallopian tubes in approximately 70% of cases. Opportunistic salpingectomy (OS), the additional removal of fallopian tubes during abdominal surgery, has emerged as a preventive strategy. Despite growing evidence, the implementation of OS varies widely. This study examines OS counseling and performance trends in the Netherlands from 2019 to 2022 and identifies associated patient, surgical, physician, and institutional characteristics.</p><p><strong>Material and methods: </strong>A historical cohort study was performed, analyzing electronic medical records from six Dutch hospitals, including two academic, two teaching, and two nonteaching hospitals. Patients undergoing elective gynecologic surgery from January 2019 to December 2022 were considered eligible. Multilevel logistic regression analyses identified characteristics associated with counseling and performance of OS.</p><p><strong>Results: </strong>Out of 2716 eligible patients, 51% were counseled about OS, of whom 92% opted for the procedure. The counseling rate increased from 38% in 2019 to 57% in 2022, while the performance rate rose from 39% to 56%. OS was more common among patients undergoing hysterectomy, laparoscopic surgery, and treatment at teaching hospitals. OS was less common during vaginal surgery. Physician characteristics accounted for 18% of counseling and 12% of performance variations.</p><p><strong>Conclusions: </strong>Although OS implementation improved, substantial variability remains in counseling and performance, largely driven by surgical approach and type of surgery. Targeted interventions to enhance uptake among underutilized surgical types, including vaginal procedures, are necessary to standardize OS practice and ensure wider adoption across all eligible patients.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The advance grading of intracervical hypervascularity in transvaginal ultrasound indicates a significant risk in Placenta Accreta Spectrum.","authors":"Rozi Aditya Aryananda, Heleen J Van Beekhuizen, Arie Franx, Johannes J Duvekot","doi":"10.1111/aogs.15171","DOIUrl":"https://doi.org/10.1111/aogs.15171","url":null,"abstract":"","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of progesterone treatment to prevent preterm birth in pregnancies with a short cervix: A population-based historical cohort study.","authors":"Anders Einum, Roy Miodini Nilsen, Quaker E Harmon, Linn Marie Sørbye, Nils-Halvdan Morken","doi":"10.1111/aogs.15147","DOIUrl":"https://doi.org/10.1111/aogs.15147","url":null,"abstract":"<p><strong>Introduction: </strong>Randomized trials have shown that progesterone treatment in mothers with a short cervix may reduce the risk of preterm birth, but the optimal time window for treatment remains unknown. We aimed to investigate progesterone treatment for the prevention of preterm birth by gestational age at diagnosis and initiation of treatment.</p><p><strong>Material and methods: </strong>This was a population-based historical cohort study of 1162 mothers with singleton pregnancies diagnosed with a cervix <20 mm from 16 to 31 gestational weeks receiving progesterone treatment (n = 390) or no preventive treatment (n = 772). Data were collected from the Medical Birth Registry of Norway from 2014 to 2020 and linked to national health registries providing demographic, diagnostic, and prescription information. Risks of preterm birth <28, <34, and <37 gestational weeks were compared between mothers with and without progesterone treatment in the full study sample and in three periods of gestational age at diagnosis (16-21, 22-27, and 28-31 weeks) using log-binomial regression analyses.</p><p><strong>Results: </strong>The absolute risk of preterm birth <28 gestational weeks was 0.8% in mothers treated with progesterone and 3.4% in mothers who did not receive treatment (adjusted relative risk (aRR) 0.25, 95% confidence interval (CI) 0.08-0.81). The strongest protective association was observed in mothers diagnosed from 16 to 21 weeks (aRR 0.13, 95% CI 0.02-0.98). Preterm birth <34 weeks occurred in 8.7% of mothers in the progesterone group and 11.1% in the untreated group (aRR 0.80, 95% CI 0.54-1.17), and the relative risk reduction associated with treatment diminished with increasing gestational age at diagnosis: aRR 0.27 (95% CI 0.08-0.96) from 16 to 21 weeks; aRR 0.68 (95% CI 0.38-1.23) from 22 to 27 weeks; and aRR 1.30 (95% CI 0.71-2.39) from 28 to 31 weeks. There was no difference in the risk of birth <37 weeks in mothers treated with progesterone (23.1%) and untreated mothers (22.3%), and the risk estimates were similar in the three periods of gestational age at diagnosis.</p><p><strong>Conclusions: </strong>Compared to no treatment, progesterone treatment is associated with a reduced risk of preterm birth <28 gestational weeks in pregnancies with a short cervix. The preventive effect of treatment may extend to 34 weeks if treatment is initiated early in the second trimester.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}