Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Changes in physical violence and injury during sexual assaults over time among females 16-29 years.","authors":"Frida M Larsson, Anna Nielsen, Zangin Zeebari, Mariano Salazar, Anna Mia Ekström, Anna Möller","doi":"10.1111/aogs.70012","DOIUrl":"https://doi.org/10.1111/aogs.70012","url":null,"abstract":"<p><strong>Introduction: </strong>Despite movements like \"Me Too\" and refined laws, many young people in Sweden still experience sexual violence. The changing nature and severity of these assaults are of significant interest, especially due to common long-term effects like post-traumatic stress disorder (PTSD). Understanding these trends can help healthcare providers support victims and develop effective prevention strategies. This study aimed to examine changes in the severity of physical violence and injury during sexual assaults over the past decade among women aged 16-29 in Stockholm, Sweden, with a particular focus on trends in non-fatal strangulation and its associated factors.</p><p><strong>Material and methods: </strong>This retrospective study analyzed data from the Emergency Clinic for Rape Victims at South General Hospital, which centralizes care for sexual assault victims in Region Stockholm, Sweden. A final sample of 1074 records of women aged 16-29 was included in the analysis (299 in 2012, 391 in 2017, and 384 in 2022). Data were analyzed using descriptive and regression analysis to assess adjusted odds ratios (AORs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Most victims experienced physical violence during sexual assault (65.3% in 2012, 68.1% in 2017 and 67.6% in 2022). In 2022, there was an increase in hitting (13.7% to 21.7%, p = 0.008), multiple physical violence (28.4% to 37.7%, p = 0.012), and severe physical violence (15.1% to 28.9% p < 0.001) compared to 2012. Non-fatal strangulation rose significantly from 8.2% in 2012 to 24.5% in 2022 (p < 0.001), with adjusted AORs of 2.2 (95% CI: 1.2, 3.9) in 2017 and 3.3 (95% CI: 1.9, 5.8) in 2022 compared to 2012. Factors linked to non-fatal strangulation included assaults in a home environment (AOR = 1.8, 95% CI: 1.2, 2.8), vaginal penetration along with another sexual act (AOR = 2.9, 95% CI: 1.6, 5.1), and blunt force (AOR = 5.9, 95% CI: 4.0, 8.5). Genital injuries also increased significantly from 25.2% in 2012 to 37.6% in 2022.</p><p><strong>Conclusions: </strong>This study highlights a rise in severe physical violence in sexual assaults, involving non-fatal strangulation and an increased presence of genital injuries. Findings underscore the need for thorough medical follow-up and nationally representative research to inform prevention and understand associated violence dynamics.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635906","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":"Insomnia and sleepiness during pregnancy: Associations with gestational diabetes mellitus.","authors":"Otto Forsbom, Laura Perasto, Linda Aukia, E Juulia Paavonen, Inka Mattila, Sanni Reinilä, Hasse Karlsson, Linnea Karlsson, Päivi Polo-Kantola","doi":"10.1111/aogs.70013","DOIUrl":"https://doi.org/10.1111/aogs.70013","url":null,"abstract":"<p><strong>Introduction: </strong>Sleep quality typically deteriorates during pregnancy, and poor sleep is a risk factor for pregnancy complications, including gestational diabetes mellitus (GDM). The present study is the first longitudinal study addressing associations between sleep quality and GDM at separate time-points throughout the pregnancy.</p><p><strong>Material and methods: </strong>This study was a part of the FinnBrain cohort, including 3808 pregnant women. Sleep quality was assessed using the Basic Nordic Sleep Questionnaire four times during pregnancy, and GDM was diagnosed by glucose tolerance testing. Four groups were formed: non-GDM, GDM, and two subgroups of GDM (medical nutritional therapy and GDM with pharmacotherapy). Paired comparisons within the groups between different time-points were conducted, and cross-sectional logistic regression analyses were carried out. The results were adjusted by maternal age, body mass index, parity, education, smoking, mood symptoms, and pre-eclampsia.</p><p><strong>Results: </strong>In paired comparisons between time-points, the insomnia score increased during pregnancy, albeit similarly in the GDM and non-GDM groups. However, the pattern of changes in sleepiness score differed between the groups during pregnancy. In the non-GDM group, mean scores showed a U-shape, decreasing in mid-pregnancy. This decrease was not observed in the GDM group, with scores remaining similar between early and mid-pregnancy and higher compared with the non-GDM group. These differences were more pronounced in the pharmacotherapy subgroup. In the cross-sectional analysis, only a few differences emerged between the groups. Women in the GDM group were more likely to report poor general sleep quality in mid-pregnancy compared with women in the non-GDM group (aOR 1.4, 95% CI 1.0-1.9, p = 0.037), but no differences in distinct insomnia symptoms emerged. Sleepiness symptoms were more common in the GDM group in early pregnancy (aOR 1.1, 95% CI 1.0-1.1, p = 0.028) and in mid-pregnancy (aOR 1.1, 95% CI 1.0-1.1, p = 0.030). Women in the GDM pharmacotherapy subgroup reported daytime napping more often in mid-pregnancy (aOR 1.8, 95% CI 1.0-3.3, p = 0.049).</p><p><strong>Conclusions: </strong>Insomnia was found to increase as pregnancy proceeds, independently of GDM. However, the decrease in sleepiness found in women without GDM in mid-pregnancy was not observed in women with GDM, possibly indicating that the effectiveness of sleep is compromised in GDM patients.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612056","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":"Preterm birth in Latvia: Two-decade national trends, structure, and risk factors.","authors":"Diana Andzane, Ludmila Volozonoka, Maksims Zolovs, Anna Kornete, Dace Rezeberga, Anna Miskova","doi":"10.1111/aogs.70015","DOIUrl":"https://doi.org/10.1111/aogs.70015","url":null,"abstract":"<p><strong>Introduction: </strong>Latvia, alongside other Baltic and Nordic countries, exhibits some of the world's lowest preterm birth (PTB) rates. We sought to identify the factors sustaining this stability and to examine how PTB structure, trends, and risk factors have evolved in Latvia over time, amid the nation's significant socioeconomic transformation in recent decades.</p><p><strong>Material and methods: </strong>This retrospective study analyzed all term and PTBs in Latvia from 2000 to 2023, using data from the Disease Prevention and Control Centre's Health Statistics database. We evaluated records at 5-year intervals, assessing temporal trends in PTB and term birth outcomes, including neonatal and perinatal mortality, labor onset (spontaneous or indicated), and prematurity subgroups, alongside known PTB risk factors (n = 16). Joinpoint regression identified significant trend shifts, with statistical significance set at p < 0.05.</p><p><strong>Results: </strong>Latvia's overall PTB rate remained stable at 5.5% from 2000 to 2023, with no significant trend, while the proportion of spontaneous versus indicated PTB changed over time. Spontaneous extremely PTB decreased by 0.7% every 5 years, from 8.5% in 2000 to 5.2% in 2023 (p = 0.005), and very to moderate PTB declined by 1.3% every 5 years, from 26.2% to 19.5% over the same period (p = 0.011). A significant upward trend was identified in the total indicated PTB rate, with an increase of 3.3% every 5 years, rising from 12.5% in 2000 to 29.2% in 2023 (p = 0.036), driven by the increase in late indicated PTBs. Perinatal mortality for PTB in Latvia declined significantly by 1.21% every 5 years, from 13.15% in 2000 to 7.09% in 2023 (p = 0.005). Primiparity, smoking, urinary tract infections, and lower education levels among PTB mothers decreased significantly, while maternal age, previous cesarean sections, and intrauterine growth restriction as PTB risk factors increased.</p><p><strong>Conclusions: </strong>Despite PTB structure and risk factor shifts, Latvia's 5.5% PTB rate remained stable over two decades, with indicated PTB rising due to expanded late preterm indications. Improved neonatal and perinatal mortality reflect effective guidelines, socioeconomic growth, and care investments, countering adverse trends.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607091","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 flat glucose response curve during oral glucose tolerance tests in Chinese pregnant women and its association with adverse outcomes.","authors":"Ya Xi, Qianqian Wu, Binbin Yin, Jinghua Zhang, Yongying Bai","doi":"10.1111/aogs.70016","DOIUrl":"https://doi.org/10.1111/aogs.70016","url":null,"abstract":"<p><strong>Introduction: </strong>Flat glucose response curves observed during the oral glucose tolerance test (OGTT) in pregnant women are relatively prevalent. This study aimed to investigate the characteristics and perinatal outcomes of Chinese women who presented with flat OGTT curves during pregnancy.</p><p><strong>Material and methods: </strong>A total of 23 576 pregnant women without gestational diabetes mellitus (GDM) were recruited into this study. They were classified into two groups according to the shape of their glucose response curves obtained from OGTTs performed at 24-28 weeks of gestation. The curves were categorized as either flat or normal. Specifically, a flat curve was defined as a less than 16.5% increase in plasma glucose levels during the OGTT, while all other curves were regarded as normal. Logistic regression analysis was employed to examine the associations between these curve types and the risk of perinatal outcomes. Additionally, these relationships were evaluated across different maternal age groups and preconception body mass index (BMI) categories.</p><p><strong>Results: </strong>Among the participants, 932 (3.95%) displayed a flat curve, while 22 644 (96.05%) showed a normal curve. Women with a flat curve were significantly younger (p < 0.001) and had a lower BMI (p < 0.001). Compared with those with a normal curve, women with a flat curve had lower incidences of gestational hypertension and preeclampsia. Additionally, neonates born to mothers with a flat curve had lower birth weights and lower occurrences of large for gestational age (LGA) and macrosomia. Logistic regression analyses, using the normal-curve group as the reference, demonstrated that, regardless of confounder adjustments, the flat-curve group was associated with a protective effect against gestational hypertension, preeclampsia, LGA, and macrosomia development (all p < 0.05). Moreover, these risks differed according to maternal age and preconception BMI. No significant differences were observed in other maternal or neonatal outcomes.</p><p><strong>Conclusions: </strong>A flat OGTT curve is associated with lower birth weight and reduced risks of LGA, macrosomia, gestational hypertension, and preeclampsia. Identifying the flat curve as a protective factor for LGA, macrosomia, gestational hypertension, and preeclampsia, particularly among women with different maternal ages and preconception BMIs, may facilitate personalized risk assessment and management.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607092","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":"Improving imiquimod use in cervical high-grade squamous intraepithelial lesions: A qualitative study.","authors":"Caroline L P Muntinga, Helena C J Schellekens, Charlotte G J Penders, Hélène van Meir, Gatske M Nieuwenhuyzen-De Boer, Anna J M van de Sande, Heleen J van Beekhuizen, Peggy J de Vos Van Steenwijk, Ruud L M Bekkers, Edith M G van Esch","doi":"10.1111/aogs.70004","DOIUrl":"https://doi.org/10.1111/aogs.70004","url":null,"abstract":"<p><strong>Introduction: </strong>To investigate patient experiences and satisfaction with imiquimod for cervical high-grade squamous intraepithelial lesions and its side effects, possibly influencing the (dis)continuation of treatment. Secondary objectives include evaluating patient counseling and guidance before and during imiquimod treatment for cervical high-grade squamous intraepithelial lesions by gynecologists and nurse practitioners to improve patient guidance.</p><p><strong>Material and methods: </strong>Semi-structured interviews were conducted with patients treated with imiquimod for cervical high-grade squamous intraepithelial lesions and with healthcare professionals from hospitals in the Netherlands. Interviews were transcribed and transcripts were analyzed using thematic analysis.</p><p><strong>Results: </strong>A total of 15 patients, 11 of whom finished imiquimod treatment and four who discontinued imiquimod treatment, and six healthcare professionals were interviewed. Three main themes were identified: counseling and side effects, use of imiquimod, and contact moments during treatment. Many patients believed that sharing patient experiences would help in making treatment decisions. Patients discontinued treatment early due to side effects and the mode of application. Detailed information on application methods and side effect severity during counseling is desirable. Healthcare professionals agreed on the factors that need to be addressed during counseling but held different opinions on imiquimod's side effect severity and application methods.</p><p><strong>Conclusions: </strong>Adequate patient counseling on imiquimod treatment, including the possible application methods and potential side effects, along with optimal guidance during treatment, contributes to a better patient experience and reduces the likelihood of early discontinuation of treatment.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599081","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":"Maternal deaths from sepsis in the Nordic countries during 2005-2021: A descriptive study.","authors":"Sedina Atic Kvalvik, Hanna Åmark, Rikke Bek Helmig, Mika Gissler, Lill Trine Nyfløt, Steinar Skrede, Siri Vangen, Svein Rasmussen, Elham Baghestan","doi":"10.1111/aogs.70011","DOIUrl":"https://doi.org/10.1111/aogs.70011","url":null,"abstract":"<p><strong>Introduction: </strong>Maternal sepsis is a heterogenous condition which can arise from several different infections during and after pregnancy. Common for all etiologies is a high mortality rate. In a global perspective, maternal sepsis is an important contributor to maternal death. This study aimed to evaluate the clinical management of maternal deaths from sepsis in the Nordic countries and identify areas for improved clinical handling.</p><p><strong>Material and methods: </strong>We used data from the Nordic Maternal Mortality Collaboration including maternal deaths from the five Nordic countries from 2005 till 2021, identified through linked registers. The national audit groups assessed each maternal death based on hospital records and classified it according to cause and quality of management. We formulated learning points to improve future clinical care in cases of maternal sepsis.</p><p><strong>Results: </strong>In total, 267 maternal deaths were identified, equaling a maternal mortality rate of 5.9 per 100 000 live births (95% CI 5.25-6.62). Maternal sepsis accounted for 9.7% of the maternal deaths (n = 26), ranking sepsis the fifth leading cause. Nongenital sepsis and genital tract sepsis numbers were almost equal. Substandard care was identified in 57% of cases with nongenital infections, and in 83% of genital tract sepsis cases. Improvements in care that possibly could have influenced the outcome were noted in 29% and 67% of cases, respectively. In nongenital sepsis, delayed recognition of sepsis and delayed administration of antimicrobial therapy were the commonest elements in substandard care. Delayed recognition of sepsis, delayed administration of antimicrobial therapy, and postponed or lacking surgical source control were the main elements in substandard care of genital tract sepsis.</p><p><strong>Conclusions: </strong>In the Nordic countries, sepsis was the fifth leading cause of maternal deaths during 2005-2021. In one-third of maternal deaths from nongenital sepsis and two-thirds of maternal deaths from genital tract sepsis, clinical measures could have reduced the risk of fatal outcome, emphasizing the need for maximal awareness and improved clinical handling.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564290","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":"External validation of the Fetal Medicine Foundation model for preterm pre-eclampsia prediction at 11-14 weeks in an Australian population.","authors":"Sofonyas Abebaw Tiruneh, Daniel Lorber Rolnik, Roshan Selvaratnam, Fabricio da Silva Costa, Andrew McLennan, Jon Hyett, Helena Teede, Joanne Enticott","doi":"10.1111/aogs.70002","DOIUrl":"https://doi.org/10.1111/aogs.70002","url":null,"abstract":"<p><strong>Introduction: </strong>Pre-eclampsia causes adverse maternal and perinatal complications and is preventable through early screening and aspirin treatment. This study evaluates the predictive performance of the Fetal Medicine Foundation first-trimester preterm pre-eclampsia competing risks model in an Australian population.</p><p><strong>Material and methods: </strong>This was a retrospective cohort study of prospectively collected multisite screening data and pregnancy outcomes between 2014 and 2017 in Australia. Individualized risk for preterm pre-eclampsia was calculated using the Fetal Medicine Foundation model at 11-14 weeks by using maternal factors, biophysical biomarkers (mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI)), and serum biochemical biomarkers (placental growth factor (PlGF) and/or pregnancy-associated plasma protein A (PAPP-A)). The predictive performance was evaluated using the area under the receiver-operating characteristic curve (AUC) and calibration. The detection rates for delivery with preterm pre-eclampsia were calculated at a 10% fixed false-positive rate. Decision curve analysis of the model was evaluated.</p><p><strong>Results: </strong>Of 29 609 women screened, 132 (0.45%) experienced preterm pre-eclampsia. The median age (interquartile range) was 34 (30-38) years. Women with pre-eclampsia had higher multiple of the median values of MAP and UtA-PI and lower values of PIGF and PAPP-A compared to those without pre-eclampsia. Combined screening by maternal factors, biophysical, and biochemical biomarkers yielded an AUC of 0.87 (95% CI 0.79-0.92), detecting 71% of preterm pre-eclampsia cases at 10% fixed false-positive rate, with the addition of PlGF improving the detection rate by 31% over sole PAPP-A use. Preterm pre-eclampsia screening using maternal factors with all biomarkers showed better clinical net benefit at preference thresholds between 1% and 12% compared to default strategies.</p><p><strong>Conclusions: </strong>The Fetal Medicine Foundation model, combining maternal factors with biophysical and biochemical biomarkers, demonstrated similar predictive performance in the Australian population compared to previous validation studies in other settings, detecting 71% of preterm pre-eclampsia cases at 10% fixed false-positive rate. The clinical utility analysis showed that early screening and intervention strategies based on a risk-based screening approach is more beneficial than universal or no intervention strategies.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537730","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":"A call for deeper insights into intramural pregnancy: An international data registry.","authors":"Simrit Nijjar, Cecilia Bottomley, Davor Jurkovic","doi":"10.1111/aogs.70007","DOIUrl":"https://doi.org/10.1111/aogs.70007","url":null,"abstract":"<p><p>Intramural pregnancy (IMP) is a rare and potentially life-threatening uterine ectopic pregnancy implanted within the myometrium. Despite its recognition as a distinct clinical entity, diagnostic challenges and a lack of standardized management protocols persist. IMP occurs when a gestational sac implants into the myometrium beyond the endometrial-myometrial junction, often following uterine trauma. Diagnosis is hindered by non-specific symptoms and frequent misclassification. While ultrasound is the primary diagnostic tool, magnetic resonance imaging (MRI) may be needed in unclear cases. Treatment options range from expectant management to surgical intervention, but no consensus exists on the optimal approach. To enhance understanding and improve clinical outcomes, we propose an international IMP registry to collect data on diagnosis, treatment, and fertility outcomes. This collaborative effort aims to inform evidence-based guidelines, facilitating accurate early diagnosis and optimized patient care.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537727","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":"Differences in pain, bleeding, and satisfaction during medical abortion at very early gestations.","authors":"Frida Gyllenberg, Karin Brandell, Tagrid Jar-Allah, Helena Kopp Kallner, John Reynolds-Wright, Clare Boerma, Sharon Cameron, Helena Hognert, Oskari Heikinheimo, Janina Kaislasuo, Kristina Gemzell-Danielsson","doi":"10.1111/aogs.15177","DOIUrl":"https://doi.org/10.1111/aogs.15177","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known regarding the impact of gestation on pain, bleeding duration, and satisfaction in early medical abortion (termination of pregnancy). This study aimed to determine if pain experience, bleeding duration, and overall satisfaction with medical abortion differed across four ultrasound-defined categories of early pregnancy.</p><p><strong>Material and methods: </strong>This is a secondary analysis of the multicenter VEMA-trial, a randomized clinical trial on the efficacy and safety of very early medical abortion before confirming pregnancy location (the VEMA-trial, EudraCT 2018-003675-35, ClinicalTrials.gov NCT03989869). The present study included participants with normally developing pregnancies and known abortion outcomes, including complete abortion, incomplete abortion, and ongoing pregnancy, that is, pregnancy still progressing after medical abortion. Participants were grouped by ultrasound findings at the time of abortion into pregnancy of unknown location, early, normally sited pregnancy (empty sac), and normally sited pregnancy with visible yolk sac or visible embryo. Pain experience was measured on the 0-10 numeric rating scale (higher values for more pain), duration of bleeding in days, and satisfaction on a 0-6 scale (higher values indicating greater satisfaction).</p><p><strong>Results: </strong>Altogether 1253 participants were included: 18% (224 participants) with pregnancy of unknown location, 38% (476) with early, normally sited pregnancy, 24% (301) with visible yolk sac, and 20% (252) with visible embryo. Pain scores were lowest in the pregnancy of unknown location group (mean 5.2 ± SD 2.3) and highest in the pregnancy with visible embryo group (6.2 ± 2.4). Bleeding duration was shortest for pregnancies of unknown location (4.9 ± 3.2) and longest for those with visible embryo (7.5 ± 5.3). Mean satisfaction was over 5 in all groups, highest in early, normally sited pregnancies (5.7 ± 0.7). In regression analyses, both pain scores and bleeding duration increased with advancing ultrasound findings. The pregnancy of unknown location group reported the least pain (1.02 points lower, 95% Confidence Interval [CI] -1.46 to -0.57) and the shortest bleeding duration (34% shorter, incidence rate ratio 0.66, 95% CI 0.61 to 0.71) compared to pregnancies with visible embryo.</p><p><strong>Conclusions: </strong>More advanced ultrasound findings are associated with higher pain scores and longer bleeding duration in very early medical abortion, whereas satisfaction is high across ultrasound-defined categories.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537729","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":"Assessment of childbirth experience over time-A prospective cohort study.","authors":"Susanne Hesselman, Wilma Sten, Yvonne Skogsdal, Anna Wikman, Frida Viirman","doi":"10.1111/aogs.70010","DOIUrl":"https://doi.org/10.1111/aogs.70010","url":null,"abstract":"<p><strong>Introduction: </strong>A woman's childbirth experience is multifaceted and has a great impact on not only the woman, but also the family's health and well-being. Changes in childbirth experience over time have been evaluated with a variety of instruments, at different time points, and with inconsistent findings. In Sweden, the rating of birth experience is routinely collected after birth, but it is still unknown which time point is preferred from a clinical perspective. The primary aim was to investigate changes in childbirth experience over time from childbirth to 6 months postpartum, assessed by both a single and a multi-item instrument. A secondary aim was to test the correlation between these instruments.</p><p><strong>Material and methods: </strong>In a prospective cohort study, 320 women were recruited from two Swedish hospitals. Study participants completed a survey at the maternity ward after giving birth, and again three and 6 months postpartum, rating their overall childbirth experience on a single item 10-point numeric rating scale (NRS) and a multi-item instrument, the Childbirth Experience Questionnaire 2 (CEQ2), encompassing four known dimensions of childbirth: Perceived safety, Own capacity, Participation and Professional support. Changes in childbirth experience (NRS and CEQ2) over time were analyzed using the Friedman test. NRS ratings were analyzed in relation to CEQ2 dimensions with Spearman's correlation.</p><p><strong>Results: </strong>Overall childbirth experience rated using NRS did not change over time. The total CEQ2 score decreased significantly from childbirth to 6 months postpartum (p < 0.001). This change was driven by decreased scoring of the domains Participation and Professional support. The correlations between NRS and CEQ scores were consistent over time, with a moderate to weak correlation of NRS with Participation and Professional support.</p><p><strong>Conclusions: </strong>Women perceive their birthing experience more negatively over time when assessed using the CEQ2 questionnaire, but this was not captured by a single-item question assessing overall childbirth experience.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537728","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}