Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Outcomes associated with large loop excision of the cervical transformation zone in women 60-64 years of age: A population-based register study from Denmark.","authors":"Julie Laub Erdal, Reza Rafiolsadat Serizawa, Matejka Rebolj, Jeppe Bennekou Schroll","doi":"10.1111/aogs.15111","DOIUrl":"https://doi.org/10.1111/aogs.15111","url":null,"abstract":"<p><strong>Introduction: </strong>For women treated for cervical dysplasia at 60-64 years in Denmark, we reported the frequency of abnormalities before and after treatment of cervix uteri (most frequently performed as large loop excision of the cervical transformation zone, LLETZ) using population-based real-world data.</p><p><strong>Material and methods: </strong>We conducted a retrospective cohort study based on national data from the Danish Pathology Data Bank and identified women who underwent a LLETZ in 2010-2016 at the age of 60-64. Women were managed according to nationwide evidence-based recommendations proposed by the Danish professional organizations. We retrieved information on all LLETZ specimens, cervical histology, cytology, and human papillomavirus (HPV) tests in the period of 2 years prior to the procedure to 2 years thereafter. We reported the frequencies of abnormalities before, at, or after the procedure.</p><p><strong>Results: </strong>Of the 1014 women who had a LLETZ during the study period, 660 (65%) showed cervical intraepithelial neoplasia grade 1 or worse (CIN1+, including CIN1, CIN2, CIN3, cervical cancer, and CIN not otherwise specified) in their LLETZ specimen, with free resection margins in 255 (39%). Of the 1014 women, 551 (54%) had CIN2+ in a biopsy preceding the LLETZ and in 567 (56%) CIN2+ was found in their LLETZ specimen. In 37 (4%) women, the specimen showed cervical cancer; whereas in the pre-LLETZ biopsies of these 37 women, cancer was detected in only 7 (1%). After LLETZ, 818 (81%) women underwent test-of-cure follow-up which was positive in 406 women (40%). Furthermore, 408 (40%) women had new histological samples registered after LLETZ. These showed CIN2+ in 134 (13%) women, whereas a new cancer was diagnosed in 11 (1%) women.</p><p><strong>Conclusions: </strong>Due to persistent abnormal tests after LLETZ, an extended follow-up is still required for a large proportion of the women in this age group.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802079","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":"Self-collected vaginal HPV samples for long-term non-attendees in the Swedish organized cervical cancer screening program.","authors":"Avalon Sundqvist, Caroline Hellsten, Björn Strander, Magnus Lindh, Christer Borgfeldt","doi":"10.1111/aogs.15112","DOIUrl":"https://doi.org/10.1111/aogs.15112","url":null,"abstract":"<p><strong>Introduction: </strong>Most cervical cancer cases in Sweden are diagnosed among women who have failed to attend screening. The objective of this study was to analyze the effectiveness of offering vaginal HPV (human papillomavirus) self-samples to long-term non-attendees as a routine in this screening program, in which non-attendees had already been the targets of several interventions.</p><p><strong>Material and methods: </strong>Register data from the organized cervical screening program were used in this population-based study. From January 2016 to December 2019, 33 881 high-risk (hr-) HPV self-sample kits were sent to the homes of long-term screening non-attendees (≥7 years without a registered screening test), aged between 29 and 64 years, in Region Västra Götaland, Sweden. All samples returned to the laboratory were analyzed with the Cobas HPV DNA assay (Roche) for HPV16, HPV18, and for 12 other hr-HPV types. HPV-positive women were referred for colposcopy. Compliance and results of follow-up were assessed 12 months after HPV analysis. Descriptive statistics, trend analysis, and risk ratios were used to compare outcomes across groups.</p><p><strong>Results: </strong>The median age of invited women was 49 years; 35% had not been screened before. The response rate was 19.4% (6582/33881). The HPV prevalence was 12.0% (788/6582), and 80.2% of HPV-positive women attended follow-up. Women with no previous cervical sample had a lower response rate: 15.7% (RR (Risk ratio) 0.73 (95% CI (Confidence interval) 0.70-0.77)). They also had lower attendance in follow-up when HPV-positive (71.6% RR 0.86 (CI 0.78-0.94)), compared with women who had previous samples. The proportions of high-grade histopathology (HSIL+) among followed-up women were 31.3% for HPV16, 15.2% for HPV18, and 8.8% for HPVnon-16/18. Nine cervical cancer cases were found among 6582 women, corresponding to a rate of 137 cases per 100,000 women.</p><p><strong>Conclusions: </strong>Vaginal HPV self-samples increased cervical screening attendance by almost one-fifth among non-attendees who had previously resisted several invitations and interventions. Biopsied women positive for HPV16 or HPV18 had a high prevalence of HSIL or cervical cancer, which strongly supports direct referral to colposcopy. Long-term non-attendees have an exceptionally high risk of cervical cancer and should receive special attention.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794369","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":"Standardization and quality control of the introduction of a noninvasive cardiac output monitor for pregnancy measurements in a low- and middle-income country.","authors":"Helen Perry, Evalyne Tusiimirwe, Allen Nakayenga, Wessel Ganzevoort, Josephine Tumuhamye, Winfred Nakato, Josaphat Byamugisha, Kelvin Mbote, Aris T Papageorghiou, Sam Ali","doi":"10.1111/aogs.15116","DOIUrl":"https://doi.org/10.1111/aogs.15116","url":null,"abstract":"<p><strong>Introduction: </strong>There is increasing awareness of the role of the maternal cardiovascular system in complicated pregnancies. Despite the high disease burden, noninvasive cardiac output monitors have not been used extensively in low- and middle-income countries. The aim of this study was to evaluate the quality control of the use of the ultrasonic cardiac output monitor (USCOM) 1A® in a LMIC.</p><p><strong>Material and methods: </strong>This was a quality assessment study of the introduction of the USCOM 1A® to measure maternal hemodynamic indices. Inter-observer agreement was assessed across all four study sites by intraclass correlation coefficient. Quality control was assessed using pre-defined acceptability criteria, rated by 2 independent scorers.</p><p><strong>Results: </strong>On average, nurses or midwives needed to obtain 30.4 (range 24-36) Doppler waveform recordings to be deemed competent to undertake USCOM 1A® measurements. There was very good inter-observer agreement across all 4 sites (intraclass correlation coefficient 0.86-0.93, all p < 0.001). A total of 138 images were randomly selected for quality review. Overall, 79 (89.8%) images were considered acceptable by both scorers; 4 (6.9%) were considered unacceptable by both scorers; and there was disagreement in 5 (5.7%) cases. Overall agreement was 94.3%. Agreement as assessed by Fleiss' kappa, was moderate (0.585 [95% CI 0.376-0.794], p < 0.001).</p><p><strong>Conclusions: </strong>Using a robust learning package and clearly defined image criteria, a novel cardiac-output monitor can be successfully introduced into low- and middle-income countries, in the context of research. Ongoing quality control measures are imperative to maintain the integrity of planned future studies using USCOM 1A®.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778665","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":"Mediators affecting the higher risk of stillbirth among foreign-born women in Sweden: A nationwide cohort study.","authors":"Minna Lundén, Ingela Hulthén Varli, Helena Kopp Kallner, Hanna Åmark","doi":"10.1111/aogs.15103","DOIUrl":"https://doi.org/10.1111/aogs.15103","url":null,"abstract":"<p><strong>Introduction: </strong>In Sweden, a higher incidence of stillbirth has been observed among women originating from sub-Saharan Africa and the Middle East. In this nationwide cohort of more than 2 million births, we assessed the risk factors for stillbirth among foreign-born women with the aim of understanding which mediators have the largest impact on the elevated risk of stillbirth.</p><p><strong>Material and methods: </strong>This was a nationwide cohort study in Sweden including 2 300 391 births between 2000 and 2021. Data from the National Medical Birth Register were linked to data from Statistics Sweden using the personal identity number of the mother. Differences in maternal characteristics were analyzed between women divided into groups based on maternal country of origin. Logistic regression models were made with a forward selection strategy adjusting for potential mediators on the causal pathway from maternal country of origin to stillbirth.</p><p><strong>Results: </strong>A significantly higher risk of stillbirth was observed among women originating from Eastern Europe, the Middle East/Northern Africa, sub-Saharan Africa, and Asia, with the highest risk observed in women originating from sub-Saharan Africa (OR 2.40, 95% CI 2.16-2.67, p-value <0.001). After adjusting for maternal risk factors, fetuses small for gestational age, and socioeconomic factors, women originating from sub-Saharan Africa still had a significantly higher risk of stillbirth (OR 1.28, 95% CI 1.14-1.44, p-value <0.001) compared to women originating from Sweden. The risk among the other groups of foreign-born women was, however, equal to the risk among women originating from Sweden. Mediation analysis showed that 31.2% of the effect of sub-Saharan origin on stillbirth was mediated through fetuses small for gestational age, 12.7% through educational level, and 16.9% through disposable income level.</p><p><strong>Conclusions: </strong>In Sweden, women originating from sub-Saharan Africa face a significantly higher risk of stillbirth even after adjusting for known risk factors. The higher risk is partly mediated by giving birth to fetuses small for gestational age and socioeconomic factors, but it cannot be explained altogether. This disparity may stem from multifactorial causes, including how risk populations utilize health care during pregnancies. Further studies are needed to find preventive measures to decrease the disparity.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750667","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":"Vaginal breech delivery in all-fours position-Hands off instead of intervention: A prospective observational study.","authors":"Gerhard Bogner, Johanna Schuller, Carina Gargitter, Eva Dölzlmüller, Thorsten Fischer, Claudius Fazelnia","doi":"10.1111/aogs.15078","DOIUrl":"https://doi.org/10.1111/aogs.15078","url":null,"abstract":"<p><strong>Introduction: </strong>Vaginal delivery in cases of breech presentation is considered potentially stressful for the newborn. The maternal upright position may represent a more physiological approach to facilitating birth. We compare the safety and efficacy of two maternal positions in vaginal breech delivery.</p><p><strong>Material and methods: </strong>A prospective, single-center, observational cohort study from October 2006 to January 2021 in a high-level obstetric center, in Salzburg, Austria. Vaginal breech deliveries in maternal all-fours position (n = 140) were compared with those in assisted supine position (n = 92). The primary outcome measures for neonatal morbidity included Apgar scores, pH levels, and the rate of transfer to the Neonatal Intensive Care Unit (NICU) postdelivery.</p><p><strong>Results: </strong>In the all-fours position, 51.4% (n = 72) of deliveries occurred without obstetric intervention. The second stage of labor was significantly shorter in the supine position (39.5 min [95% CI 28-47] versus all fours position 52 min [95% CI 42-63], p = 0.042). Umbilical artery pH levels did not differ significantly (7.21 [95% CI 7.19-7.23] versus 7.19 [95% CI 7.17-7.21] vs. p = 0.06). Nor did the APGAR scores at 5 and 10 min below eight (p = 0.697; p = 0.760). Maternal and neonatal morbidity also did not significantly differ. Transfer of neonates to NICU n = 12 (13%) versus n = 11 (7.9%), p = 0.097, transfer birth-related n = 6 (6.5%) versus n = 8 (5.7%), p = 0.803. The number of postpartum umbilical artery pH < 7.10 were n = 9 (9.8%) versus n = 28 (20%), p = 0.065. There was one reported neonatal death due to intracerebral hemorrhage in the supine position group.</p><p><strong>Conclusions: </strong>Our results indicate that vaginal breech delivery in the all-fours position seems to be comparable to supine position regarding neonatal safety. Additionally, the all-fours position shows potential for emergency management for unplanned breech deliveries by inexperienced attendants.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750669","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":"Atrioventricular conduction abnormalities are associated with poor outcome following intermittent umbilical cord occlusions in fetal sheep.","authors":"Juulia Lantto, Jonas Johnson, Heikki Huhta, Mervi Haapsamo, Panu Kiviranta, Kati Räsänen, Hanna-Marja Voipio, Sven-Erik Sonesson, Juha Voipio, Juha Räsänen, Ganesh Acharya","doi":"10.1111/aogs.15109","DOIUrl":"https://doi.org/10.1111/aogs.15109","url":null,"abstract":"<p><strong>Introduction: </strong>Fetal arrhythmias have been described with intrapartum hypoxemia; however, they cannot be accurately diagnosed with currently used fetal heart rate (FHR) monitoring systems due to low resolution and signal averaging. We used a Holter device to record electrocardiogram (ECG) at 250 Hz in term sheep fetuses that developed severe metabolic acidosis induced by intermittent umbilical cord occlusions (UCOs), mimicking human labor contractions. We hypothesized that UCOs leading to worsening fetal metabolic acidosis provoke distinct fetal arrhythmias that could indicate impending fetal death.</p><p><strong>Material and methods: </strong>Thirteen pregnant sheep (gestational age 133-135/145 days) were instrumented under general anesthesia. Three electrodes were placed on the fetal chest and connected to a Holter device for continuous ECG recording at a sampling rate of 250 Hz. The fetal axillary artery was catheterized and an inflatable occluder was placed around the umbilical cord. After a 4-5 day recovery, complete UCOs were induced by inflating the occluder for 1 min, followed by deflation for 2 min, until the fetal arterial pH dropped <7.0 and/or base excess (BE) <-16. Thereafter, an emergency cesarean section was performed to deliver the fetus.</p><p><strong>Results: </strong>Eight sheep fetuses were included in the final analysis. All fetuses had normal baseline arterial blood gases and lactate values. During the first two UCOs, all fetuses demonstrated isolated benign arrhythmias. Three fetuses that developed severe metabolic acidosis after five UCOs showed persistent atrioventricular (AV) conduction abnormalities during the last UCO and its release, requiring cardiopulmonary resuscitation (CPR) at birth. One fetus with third-degree AV block had no detectable QRS complexes at birth, developed ventricular tachycardia and fibrillation (VT/VF) during CPR, and was successfully defibrillated. Five fetuses tolerated ≥10 UCOs before developing severe metabolic acidosis, and none of these showed any persistent AV-conduction abnormalities, though one fetus died after developing VT/VF after the 10th UCO.</p><p><strong>Conclusions: </strong>Metabolic acidemia induced by intermittent UCOs in term sheep fetuses is associated with various arrhythmias, some of which may be life-threatening. Continuous intrapartum fetal ECG recording at a sample rate of ≥250 Hz coupled with a software capable of automatically detecting significant arrhythmias could enhance intrapartum fetal monitoring in the future.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750662","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":"Lifetime psychiatric morbidity and maternal smoking behavior in consecutive pregnancies: A Finnish register study.","authors":"Hanna P Wallin, Mika Gissler, Päivi E Korhonen, Mikael O Ekblad","doi":"10.1111/aogs.15114","DOIUrl":"https://doi.org/10.1111/aogs.15114","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the adverse effects of smoking during pregnancy, a large proportion of women who smoke during their first pregnancy endure smoking also in their subsequent one. Previous studies have made efforts to explore associated factors, such as maternal mood and stress. This observational register-based historical cohort study aims to investigate the association between prior psychiatric morbidity and maternal smoking during consecutive pregnancies.</p><p><strong>Material and methods: </strong>The study population comprised all women who smoked during their first pregnancy and had two singleton live births between January 1, 2006 and December 31, 2019 in Finland (n = 29 683). The smoking information was obtained from the Finnish Medical Birth Register, categorized as \"no smoking,\" \"quit smoking\" (during the first trimester), or \"continued smoking\" (beyond the first trimester). Maternal psychiatric diagnoses (from the age of 15 until the second delivery) were derived from the Finnish Hospital Discharge Register. The association between (I) any psychiatric diagnosis, (II) separate diagnosis groups, and (III) psychiatric burden (diagnoses from 0 to 5 different diagnosis groups) and maternal smoking during the second pregnancy was analyzed using logistic regression.</p><p><strong>Results: </strong>The smoking prevalence during the first pregnancy was 16.0%. Women who continued smoking during their first pregnancy (n = 15 588) were likely smokers in their second: 54.9% continued, and 12.4% quit smoking. Most women who quit smoking during their first pregnancy (n = 14 095) were non-smokers during their second (73.2%). Women who continued smoking during their first pregnancy and had any previous psychiatric diagnosis were more likely to continue smoking (beyond the first trimester) during their second pregnancy (OR 1.44, 95% CI 1.32-1.57) compared to those without such a diagnosis. A similar association was found between psychiatric burden and continued smoking (OR 1.20, 1.14-1.25). Women who quit smoking during their first pregnancy and had any diagnosis or burden showed a similar trend for continued smoking but were not more likely to quit smoking during the second pregnancy.</p><p><strong>Conclusions: </strong>Any prior psychiatric diagnosis seems to be associated with continued smoking during the second pregnancy among first-pregnancy smokers. Psychiatric and smoking cessation support should be targeted particularly to women who smoke during their first pregnancy and have psychiatric conditions in their medical history.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750665","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":"Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5-year follow-up study.","authors":"Sissel Hegdahl Oversand, Anne Cathrine Staff, Ingrid Volløyhaug, Rune Svenningsen","doi":"10.1111/aogs.15102","DOIUrl":"10.1111/aogs.15102","url":null,"abstract":"<p><strong>Introduction: </strong>Levator ani muscle avulsion is a risk factor for inferior outcomes after native tissue pelvic organ prolapse repair. In a previously published study, we found no such association 1 year after the Manchester procedure (anterior repair combined with cardinal and uterosacral ligament suspension and perineal repair). The aim of the present study was to compare women with and without levator ani muscle avulsions in terms of patient-reported and anatomical outcomes, and failure rates in the same cohort after 5 years.</p><p><strong>Material and methods: </strong>Five-year prospective cohort study of 143 women operated on for anterior and/or mid-compartment pelvic organ prolapse with the Manchester procedure between October 2014 and January 2017, Clinical Trial study number NCT02246387. Levator ani muscle avulsions (uni- or bilateral) were diagnosed at inclusion by transperineal ultrasound. Primary outcome at 5-year follow-up was subjective bulge symptoms (question 3, Pelvic Floor Distress Inventory-20). Secondary outcomes were total score from the same questionnaire, sexual distress (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12), subjective cure, Pelvic Organ Prolapse Quantification scale measurements, defining optimal outcomes as anterior compartment stage <0-1 and mid-compartment point C ≤-5, and new surgical or conservative prolapse treatment.</p><p><strong>Results: </strong>Among 143 women followed up after 5 years, the avulsion rate was 52.4%. Both groups showed similar reductions in bulge symptoms, pelvic floor symptoms, and anatomical anterior- and mid-compartment measurements. Sexual distress improvement was significantly greater for women with avulsion (Mean change difference: -3.4 (-6.4 to -0.5)). Multivariate regression revealed no significant effect of avulsion on symptom scores, cure rates, or need for new prolapse treatment. Women with avulsion had half the odds of obtaining an optimal anterior compartment outcome compared to those without avulsion (adjusted odds ratio: 0.5 (0.2-0.9)).</p><p><strong>Conclusions: </strong>Although women with levator ani muscle avulsion had lower odds of achieving an optimal anterior compartment outcome, the overall anatomical changes from preoperative to 5 years were similar in both groups. Importantly, avulsion did not impact symptom improvement, patient-reported outcomes, or the need for further treatment. These findings support the Manchester procedure as an effective and durable surgical option for women with POP, regardless of avulsion status.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750663","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":"Trends in the use of induction of labor by methods and indications: A population-based study","authors":"Samia Aziz,&nbsp;Fiona Bruinsma,&nbsp;Kara Blackburn,&nbsp;Caroline S. E. Homer,&nbsp;Joshua P. Vogel","doi":"10.1111/aogs.15087","DOIUrl":"10.1111/aogs.15087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Induction of labor is a widely used obstetric intervention, with rates increasing globally. In Australia in 2022, over one-third of women gave birth following the induction of labor. Though the rate of induction has increased, changes in methods and indications for induction have not been analyzed for the state of Victoria. This study aims to analyze these trends in Victoria, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted using de-identified data from the Victorian Perinatal Data Collection (VPDC) that includes all births statewide of at least 28 completed weeks' gestation from 2012 to 2020. The study analyzed trends in the onset of labor, methods used, and indications for induction over the study period, using descriptive statistics and average annual percentage change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 701 324 births occurred during the study period, of which 223 672 (31.9%) were inductions. Induction of labor rates increased significantly from 25.4% in 2012 to 37.7% in 2020, with a notable rise at 38 and 39 weeks' gestation. Significant changes were observed in induction methods—the use of combination methods, particularly balloon catheter followed by pharmacological agents, increased, while the use of a standalone method declined. The findings suggest that gestational diabetes and fetal indications were major drivers of induction in recent years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Labor induction practices in Victoria have changed significantly, reflecting shifts in clinical practices and changes in health profiles of pregnant women. Further research is needed to investigate the rising use of induction at early term gestation and the role of maternal preferences in driving induction in Victoria.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"875-885"},"PeriodicalIF":3.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a patient decision aid for opportunistic salpingectomy and salpingectomy as sterilization method to prevent ovarian cancer.","authors":"Malou E Gelderblom, Charlotte Fisch, Jurgen M J Piek, Laura A M van Lieshout, Justine Briet, Lauren Bullens, Sjors F P J Coppus, Inge Ebisch, Alexandra A van Ginkel, Rafli van de Laar, Natascha de Lange, Marloes Maassen, Huy Ngo, Angele L M Oei, Brenda Pijlman, Brigitte Slangen, Regina The, Dineke Smedts, Caroline Vos, Joanna IntHout, Joanne A de Hullu, Rosella P M G Hermens","doi":"10.1111/aogs.15091","DOIUrl":"https://doi.org/10.1111/aogs.15091","url":null,"abstract":"<p><strong>Introduction: </strong>A patient decision aid on opportunistic salpingectomy and salpingectomy as a sterilization method has been developed to provide uniform counseling and reduce practice variation. The aim of this study was to evaluate the use of the patient decision aid in daily clinical practice to ensure its effectiveness and usability, as well as its influence on the decision-making process and the decision of opportunistic salpingectomy.</p><p><strong>Material and methods: </strong>As part of the STOPOVCA-implementation study, we conducted a multicenter observational study in 16 hospitals between July 2020 and February 2024. Patients who were eligible for opportunistic salpingectomy were invited to use the decision aid while they considered whether or not to undergo opportunistic salpingectomy. Digital questionnaires were used to evaluate the decision aid, the decision process, and patients' decisions 6-8 weeks post-surgery.</p><p><strong>Results: </strong>425 out of 542 patients participated in the questionnaire. A majority of these 425 patients received (N = 357; 84%) and used the decision aid (N = 347; 82%). Two thirds (N = 234; 67%) of those who used the decision aid stated that it increased their knowledge of opportunistic salpingectomy. Patients considered the decision aid a usable aid, allocating a score of 8.1 out of 10 and would recommend it to other patients facing the decision regarding opportunistic salpingectomy. Patients considered the extent to which they were involved in the decision-making process as high, and the decisional conflict low. The majority of patients who used the decision aid opted for opportunistic salpingectomy (N = 326; 95%). Main reasons for choosing opportunistic salpingectomy were the risk-reducing effect of ovarian cancer (N = 311; 90%) and the lack of functionality of the fallopian tubes after childbearing (N = 320; 92%).</p><p><strong>Conclusions: </strong>The patient decision aid was used by a majority of patients who received it. The decision aid was regarded by patients as user-friendly, and it was recommended to be used in the decision-making process for opportunistic salpingectomy. Patients stated that the decision aid provides reliable information and increases patients' knowledge of opportunistic salpingectomy.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717623","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}