Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"The use of topical vaginal estrogens in postpartum women: A systematic review.","authors":"Aysha Waheed, Annika Taithongchai, Dudley Robinson","doi":"10.1111/aogs.70241","DOIUrl":"https://doi.org/10.1111/aogs.70241","url":null,"abstract":"<p><strong>Introduction: </strong>Topical vaginal estrogens have been used in the management of postmenopausal vulvovaginal atrophy for some time, locally reintroducing exogenous estrogens to the estrogen-receptive tissues of the female urogenital tract following a decline in systemic levels. The postpartum period is similarly a state of relative estrogen depletion due to the antagonistic effect from raised prolactin levels throughout pregnancy and lactation; this is thought to contribute to post-delivery pelvic floor dysfunction and vaginal atrophy. Given the similar etiology, there may be a role for topical vaginal estrogens in postpartum women.</p><p><strong>Material and methods: </strong>A systematic review was performed evaluating the use of topical vaginal estrogens in postpartum women. This was performed as per PRISMA guidelines, with articles screened from online databases from their inception to October 2025.</p><p><strong>Results: </strong>Three studies were identified that met the inclusion criteria, including a total of 85 women. Two studies focused on the molecular and cellular composition of tissues from postpartum women using topical vaginal estrogens, and one double-blind randomized placebo-controlled trial primarily evaluated postpartum atrophy in the presence and absence of vaginal estrogens. Tissues exposed to estrogen appeared to have increased cellular proliferation, while the Vulval Assessment Score (VuAS), a patient-subjective validated scoring system for vaginal atrophy, was found to be lower in those using vaginal estrogen cream for 12 weeks. No statistically significant difference in bladder, bowel, or sexual function was noted. No serious adverse outcomes were reported, and the use of vaginal estrogens appeared acceptable to women.</p><p><strong>Conclusions: </strong>There is a paucity of data currently available regarding the use of topical vaginal estrogens in the post-partum period. Although likely safe for use, further evidence is required to be able to make firm conclusions about their efficacy for postpartum vaginal atrophy, and further high-quality trials are required in the future.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809280","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":"Risk factors for birth trauma and postpartum posttraumatic stress in the United Kingdom: Results from the international survey of childbirth-related trauma.","authors":"Rebecca Webb, Nazihah Uddin, Georgina Constantinou, Susan Ayers","doi":"10.1111/aogs.70236","DOIUrl":"10.1111/aogs.70236","url":null,"abstract":"<p><strong>Introduction: </strong>Recent research shows that 40.6% of women in the United Kingdom experience childbirth as at least moderately traumatic, and 5.9% develop childbirth-related posttraumatic stress disorder (CB-PTSD). However, risk factors for birth trauma ratings and CB-posttraumatic stress symptoms (CB-PTSS) in this sample remain unexplored. Therefore, the aim was to understand risk factors for birth trauma and CB-PTSS in a UK sample.</p><p><strong>Material and methods: </strong>A cross-sectional survey of traumatic birth and CB-PTSD with women (N = 339) from three hospitals in England, two in Wales, and three in Scotland. Participants completed the survey at 6-12 weeks postpartum. It included questions about (i) demographics and mental health; (ii) pregnancy; (iii) labor and birth; and (iv) the infant. Outcome variables were birth trauma rating and CB-PTSS.</p><p><strong>Results: </strong>Higher birth trauma ratings were predicted by women not having other children, maternal complications during birth, lower birth satisfaction, and a mother not having skin-to-skin contact with her baby after birth. Higher CB-PTSS were predicted by younger maternal age, women not having other children, current mental health difficulties, previous trauma, giving birth in Scotland, emergency cesarean section, and lower birth satisfaction.</p><p><strong>Conclusions: </strong>Overall, this paper found that traumatic birth and CB-PTSS symptoms are associated with a range of demographic, mental health, birth-related, and infant-related variables. Results from this study can be used to improve maternity care.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809163","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":"Ultrasound texture-based radiomics of placental and myometrial tissue for predicting postpartum blood loss in women with placenta previa and low-lying placenta.","authors":"Francesco Marasciulo, Elena Sofia Milandri, Ilaria Maffeo, Susanna Reghezza, Angelo Cagnacci, Ambrogio P Londero, Federico Prefumo","doi":"10.1111/aogs.70238","DOIUrl":"https://doi.org/10.1111/aogs.70238","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the role of radiomic analysis applied to ultrasound images in predicting postpartum blood loss at birth in women affected by low-lying placenta or placenta previa.</p><p><strong>Material and methods: </strong>In this retrospective, single-center study, we analyzed singleton pregnancies with placenta previa or a low-lying placenta, initially diagnosed at the second-trimester ultrasound examination. Data were collected from ultrasound examinations conducted in the second and third trimesters, along with birth outcomes. Radiomic analysis was conducted on archival ultrasound images to extract quantitative features. Predictive models were constructed utilizing multivariable generalized linear modeling (Gamma regression with a log link), encompassing radiomics-only, clinical/sonographic-only, and an integrated model.</p><p><strong>Results: </strong>In the final analysis of 107 women, 51 exhibited postpartum blood loss exceeding 500 mL. A prior cesarean delivery was recognized as a notable clinical risk factor. Multiple radiomic features identified in second- and third-trimester ultrasound scans correlated with a heightened risk of significant blood loss during birth. The integrated predictive model exhibited superior accuracy for blood loss exceeding 500 mL, achieving an AUC of 82.32% (95% CI: 74.18%-90.45%). This performance surpassed that of the clinical ultrasound model, which had an AUC of 71.27% (95% CI: 62.27%-80.27%), with a statistically significant difference (p = 0.001). Additionally, it demonstrated a nonsignificant improvement over the radiomics-only model, which recorded an AUC of 77.17% (95% CI: 68.25%-86.09%).</p><p><strong>Conclusions: </strong>Radiomic analysis of ultrasound images enhances risk prediction for postpartum major blood loss in pregnancies affected by placenta previa and low-lying placenta. Integrating radiomics with clinical and sonographic data improves predictive accuracy, offering a promising tool for personalized obstetric risk assessment and management.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809282","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 combined oral contraceptives and progestin-only pills on psychological and sexual well-being of women with endometriosis: A systematic review.","authors":"Noemi Salmeri, Martina Piccini, Francesca Caprara, Edgardo Somigliana, Paola Viganò, Paolo Vercellini","doi":"10.1111/aogs.70183","DOIUrl":"10.1111/aogs.70183","url":null,"abstract":"<p><strong>Introduction: </strong>Women with endometriosis frequently experience psychological and sexual concerns. Combined oral contraceptives (COCs) and progestin-only pills (POPs) represent first-line treatments for the disease, yet their potential negative impact on mood and sexuality remains debated.</p><p><strong>Material and methods: </strong>We conducted a systematic review of PubMed, Embase, and Scopus up to August 1st, 2025, to assess whether COCs or POPs adversely affect psychological well-being or sexual function in this population. Eligible studies included randomized controlled trials (RCTs) and non-randomized studies comparing COCs or POPs with no treatment in women with endometriosis. Outcomes of interest were adverse event rates and patient-reported measures of mood and sexual health. Risk of bias was assessed with RoB 2 and ROBINS-I. Given heterogeneity in outcome measures, we applied vote counting by direction of effect and harvest plots, with confidence intervals (CIs) calculated using the Wilson method, in line with Cochrane guidance. The study protocol was prospectively registered on PROSPERO (CRD420250656420).</p><p><strong>Results: </strong>Of 1424 records screened, seven studies (four RCTs, three observational) met the inclusion criteria. Risk of bias was low in RCTs and moderate-to-serious in observational studies. Six of seven (pooled proportion: 86%; 95% CI: 49%-97%) reported no increased risk of psychological dysfunction in users. None reported increased sexual dysfunction (100%; 95% CI: 65%-100%). Most studies reported significant pain reduction with treatment. Six studies specifically reported on dyspareunia, all of which showed a benefit of treatment over placebo (100%; 95% CI: 61%-100%). No discontinuations for psychological or sexual adverse events were observed when pain remission was achieved.</p><p><strong>Discussion: </strong>Despite the small number of studies, variability in measurement tools, and short follow-up (mean 6 months), the evidence suggests that COCs and POPs are generally well tolerated regarding psychological and sexual health, supporting their continued use for long-term management provided pain remission is achieved.</p><p><strong>Conclusions: </strong>In women with endometriosis, current evidence does not support a consistent increase in negative psychological or sexual outcomes among COCs or POPs users compared with non-users.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"805-818"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430149","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":"The effect of labor epidural analgesia on uterine activity using electrohysterography monitoring: A follow-up study.","authors":"Phebe B Q Berben, Yannick L Smolders, Ivar R de Vries, Nadine D de Klerk, Annemarie F Fransen, Marta Regis, M Beatrijs van der Hout-van der Jagt, Myrthe van der Ven, Alexandra M J V Schyns-van den Berg, S Guid Oei, Judith O E H van Laar","doi":"10.1111/aogs.70187","DOIUrl":"10.1111/aogs.70187","url":null,"abstract":"<p><strong>Introduction: </strong>Labor epidural analgesia (LEA) is widely used for intrapartum pain management, but its effects on uterine activity (UA) remain unclear. Electrohysterography (EHG) is a promising non-invasive method for intrapartum UA monitoring. The aim of this study was to explore the effect of LEA on UA by means of EHG, to develop better understanding of labor physiology, and inform clinical decision-making.</p><p><strong>Material and methods: </strong>Patients in active labor with singleton, term pregnancies who received electrophysiological monitoring from 60 min before until 120 min after LEA initiation were included. Contraction parameters such as frequency, duration, area under the curve (AUC), baseline, and maximum amplitude were obtained from an EHG-derived tocogram using a computer-based algorithm. The primary outcome was the difference in mean uterine contraction frequency before and after initiation of LEA. Secondary outcomes included the comparison of various contraction parameters, derived from EHG, before and after LEA initiation, as well as their temporal changes over time. The effect of possible confounders on UA was examined. Mixed effects models were used for statistical analyses.</p><p><strong>Results: </strong>In total, 86 patients were included. No significant difference in mean uterine contraction frequency and contraction duration was found before and after LEA initiation. Nevertheless, start of LEA was associated with a significant reduction in AUC, baseline activity, and signal amplitude.</p><p><strong>Conclusions: </strong>LEA initiation does not affect uterine contraction frequency or duration, but it is associated with a significant reduction in relative EHG-derived amplitude parameters (AUC, baseline tone, and maximum amplitude), which could potentially affect progression of labor. Further studies are required to explore these parameters and their clinical implications.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"912-921"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147525340","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":"The TRUFFLE monitoring protocol for early-onset fetal growth restriction: A clinical effectiveness study.","authors":"Claire Pegorie, Basia Chmielewska, Michelle Jie, Nishita Mehta, Daniel McStay, Amar Bhide, Basky Thilaganathan","doi":"10.1111/aogs.70240","DOIUrl":"https://doi.org/10.1111/aogs.70240","url":null,"abstract":"<p><strong>Introduction: </strong>The randomized control Trial (RCT) of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE study) established its clinical efficacy for monitoring preterm fetal growth restriction (FGR). The objective of this study was to assess the clinical effectiveness of this protocol in a routine clinical setting with regards to the clinical outcomes, both overall and stratified by gestational age at FGR diagnosis.</p><p><strong>Material and methods: </strong>This is a retrospective cohort study of singleton pregnancies with preterm FGR between January 2013 and July 2024 in a tertiary Fetal Medicine Unit. FGR was defined as an estimated fetal weight or abdominal circumference <10th centile with an elevated umbilical artery pulsatility index >95th centile. Main outcomes collected included perinatal survival, interval from diagnosis to delivery, and delivery indications.</p><p><strong>Results: </strong>171 pregnancies met inclusion criteria. The median (IQR) gestation at FGR diagnosis and birth was 27⁺⁶ (25⁺⁵-29⁺⁴) and 30⁺³ (28⁺⁰-32⁺⁴) weeks, respectively. Overall intact neonatal survival was 90.6%, with the rate of stillbirth and neonatal death being 2.9% and 5.8%, respectively. FGR diagnosis prior to 26 weeks was associated with a three-fold longer interval to birth compared with FGR diagnosis at 26⁺⁰-29⁺⁶ and ≥30 weeks (median of 31.0 vs. 10.0 and 14.0 days; p < 0.001). Below 32 weeks, the predominant indication for elective birth was abnormal computerized CTG with low short-term variation (STV). Beyond 32 weeks' gestation, abnormal umbilical artery Doppler and maternal indications such as preeclampsia were more frequent.</p><p><strong>Conclusions: </strong>The TRUFFLE monitoring protocol is clinically effective in managing early-onset FGR outside a trial environment, achieving comparable perinatal outcomes to the original RCT. Routine integration of both Doppler and cCTG monitoring is crucial for optimal timing of birth with early FGR. Further research is needed to explore the benefits of more frequent or remote fetal monitoring.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809176","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":"Contraction frequency and acidemia at birth: A case-control study.","authors":"Johanna Wagner Bjurström, Gisela Rickle, Maria Fogelberg, Frida Ekengård, Andreas Herbst","doi":"10.1111/aogs.70181","DOIUrl":"10.1111/aogs.70181","url":null,"abstract":"<p><strong>Introduction: </strong>Consensus is lacking regarding the upper limit for a safe contraction frequency during labor. We aimed to assess the association between different contraction frequencies and acidemia at birth, and whether an association was affected by oxytocin augmentation, concomitant cardiotocography (CTG) classification, and stage of labor.</p><p><strong>Material and methods: </strong>This is a case-control study based on CTG traces from births in southern Sweden during 2012-2017. Cases (N = 364) had umbilical artery pH <7.1 if born by first-stage cesarean section and pH <7.05 if born vaginally or by second-stage cesarean. Controls were included with a 1:2 ratio (N = 728) and had pH ≥7.15. CTG traces from the hour prior to birth were assessed blinded to the clinical outcome. Logistic regression was used to estimate odds ratios (OR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>After excluding insufficient topography traces, 328 cases and 677 controls remained for analysis. Contraction frequencies 5, 5-6, and ≥6 per 10 min occurred in 15.2%, 19.5%, and 29.6% of cases and in 15.1%, 16.5%, and 11.1% of controls, respectively. The OR (95% CI) for acidemia were 1.6 (1.1-2.4), 1.9 (1.3-2.7), and 4.3 (3.0-6.2), respectively, compared with a reference group of <5. When comparing two separate binary cut-offs of >5 and ≥5 contractions, similar strengths of association with acidemia were demonstrated with OR 2.7 (2.1-3.6) and 2.5 (1.9-3.3), respectively. The effect of contraction frequency >5 was similar in spontaneous (n = 586) and oxytocin-augmented (n = 419) labor (OR 2.5, 1.7-3.8 vs. OR 2.4, 1.6-3.6), and whether the CTG was normal, suspicious, or pathological according to the Swedish CTG template (OR 2.1, 1.3-3.3; OR 3.5, 1.6-7.6; and OR 2.6, 1.4-4.7, respectively). The study lacked power to study any association during the first stage of labor.</p><p><strong>Conclusions: </strong>Increasing contraction frequency is incrementally associated with fetal acidemia. Although an increased risk of acidosis is evident at contraction frequencies as low as five, such frequencies are common while acidemia is uncommon, implying a poor positive predictive value. A contraction frequency of more than five is associated with acidemia in both spontaneous and oxytocin-augmented labor, and even when the fetal heart trace is normal.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"904-911"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353443","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":"Understanding the consequences of being RhD immunized during pregnancy 10 years after introduction of targeted routine antenatal anti-D prophylaxis: A retrospective nationwide cohort study.","authors":"Anna Parhamaa, Riina Jernman, Mika Gissler, Katri Haimila, Inna Sareneva, Kati Sulin, Tiina Teivaanmäki, Suvi Toivonen, Susanna Sainio","doi":"10.1111/aogs.70195","DOIUrl":"10.1111/aogs.70195","url":null,"abstract":"<p><strong>Introduction: </strong>Targeted routine antenatal anti-D prophylaxis (RAADP) was introduced in Finland in 2014. The aim of this study was to assess the prevalence of anti-D immunizations among pregnant women and the severity of hemolytic disease of the fetus and newborn (HDFN) in affected pregnancies 10 years after RAADP was added to the national prevention program in the context of a rapidly declining birthrate in Finland.</p><p><strong>Material and methods: </strong>A nationwide, retrospective cohort study included all RhD-negative pregnancies in Finland between 2014 and 2023. Information on antenatal screening was obtained from the Finnish Red Cross Blood Service database, and obstetric and neonatal data from hospitals' records. Primary outcomes were prevalence of anti-D immunization and severity of HDFN defined as severe (intrauterine transfusion, IUT), moderate (neonatal exchange transfusion/intravenous immunoglobulin, IVIG/top-up transfusion), and mild (phototherapy). The secondary outcome was the effect of declining birth rates on the absolute numbers of anti-D pregnancies.</p><p><strong>Results: </strong>The study included a total of 518 pregnancies of 383 women with anti-D (367 pregnancies with RhD-positive fetus/neonate). In 10 years, the prevalence of anti-D among RhD-negative pregnant women declined from 1.33% to 0.48% (reduction of 64%), and of severe HDFN from 0.20% to 0.06% (reduction of 72%). For an RhD-positive fetus, the risk of severe HDFN was 17.7% (95% CI 13.9% to 22.0%), with an overall survival rate of 90.8%. For a RhD-positive neonate not treated with IUTs, the risks of moderate and mild HDFN were each 33.0% (95% CI 24.4% to 42.6%). In addition to the effect of RAADP, the actual number of anti-D cases decreased by 34.0% due to the 24% fall in the birth rate during the study period.</p><p><strong>Conclusions: </strong>Ten years after the introduction of targeted RAADP, the prevalence of anti-D immunizations was reduced by more than half. Declining birth rates further reduce overall case numbers but do not lessen the complexity of care needed. A significant proportion of anti-D pregnancies still require close monitoring or intervention. Optimizing screening strategies, referral pathways, and readiness for neonatal treatment remains essential in the evolving landscape of HDFN prevention and management.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"887-895"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632266","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":"Normative range for MRI amniotic fluid volume from 16 to 36 gestational weeks: Absolute and relative values, and correlation to ultrasound.","authors":"Amine Bouachba, Julie Chabourlin, David Grévent, Joana De Jesus Neves, Laurence Bussières, Sunniva Vaillant, Laurent Julien Salomon, Guillaume Gorincour","doi":"10.1111/aogs.70153","DOIUrl":"10.1111/aogs.70153","url":null,"abstract":"<p><strong>Introduction: </strong>Amniotic fluid volume (AFV) is clinically important, yet ultrasound-based indices correlate poorly with true volume. MRI provides accurate volumetry, but normative reference data for AFV remain scarce. This study aimed to establish MRI-based gestational-age reference ranges for AFV and the AFV-to-fetal body volume ratio (AFV/FBV) from 16 to 36 weeks' gestation and to compare ultrasound amniotic fluid index (AFI) with MRI-derived AFV.</p><p><strong>Material and methods: </strong>Prospective observational cohort study conducted at a single tertiary fetal imaging center (LUMIERE, Necker Hospital, Paris, France). Healthy singleton pregnancies between 16 and 36 gestational weeks were included; pregnancies with fetal anomalies or maternal complications were excluded. T2-weighted MRI with manual segmentation was performed to quantify AFV and fetal body volume. In a predefined subset, AFI was measured on same-day ultrasound. The main outcomes were AFV, AFV/FBV ratio, and their gestational-age normative ranges. The secondary outcome was the correlation between AFI and MRI-derived AFV. Percentile curves were derived using quadratic polynomial modeling.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT04142606.</p><p><strong>Results: </strong>322 pregnancies were included (median gestational age 27.9 weeks; 45% male). AFV increased with gestational age (β = 6.61), peaking around 31 weeks, whereas AFV/FBV ratio declined (β = -0.08). No sex differences were observed. Weekly distributions were normally distributed. Quadratic polynomial modeling yielded physiologically plausible percentile curves (R² = 0.74 for AFV/FBV). In the ultrasound-MRI subset (n = 103), AFI significantly correlated with AFV (Spearman ρ = 0.77), although with wide individual variability.</p><p><strong>Conclusions: </strong>This study provides the first MRI-based normative charts for AFV and AFV/FBV ratio between 16 and 36 weeks' gestation. The AFV/FBV ratio represents a novel physiological marker integrating fetal growth and fluid balance. These reference ranges may support future research and clinical decision-making.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"878-886"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632140","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":"The effect of temporary uterine artery ligation on blood loss during laparoscopic myomectomy: A systematic review and meta-analysis.","authors":"Maria M Witkowiak, Natalie E Bourdakos, Zoe Y Zervides, Olga Moutzouri, Marisa M Dariotis, Liranne Bitton, Fatma A M Abdulsalam, Hayato Nakanishi, Christian A Than, Anna Abacjew-Chmylko","doi":"10.1111/aogs.70177","DOIUrl":"10.1111/aogs.70177","url":null,"abstract":"<p><strong>Introduction: </strong>The effectiveness of temporary uterine artery ligation (TUAL) in reducing blood loss during laparoscopic myomectomy (LM) is uncertain, despite increased use as an adjunct to improve surgical safety. This study aims to evaluate the safety and efficacy of TUAL in LM for the management of uterine myomas.</p><p><strong>Material and methods: </strong>We conducted a systematic review and meta-analysis of comparative studies evaluating LM with and without TUAL. Electronic databases were searched up to October 7, 2024. Eligible studies were randomized controlled trials or observational comparative studies published in English that reported at least one primary outcome. The primary outcomes were intraoperative estimated blood loss and perioperative change in hemoglobin. Secondary outcomes included operative time, number and size of myomas removed, length of hospital stay, recurrence, and complication rates. Data extraction and analysis were performed using a random-effects model. This review was registered prospectively with PROSPERO (CRD42024595684).</p><p><strong>Results: </strong>Seven studies met the inclusion criteria, comprising five randomized controlled trials and two retrospective case-control studies, with a total of 857 women (352 undergoing LM with TUAL and 505 undergoing LM alone). TUAL was associated with a reduction in intraoperative estimated blood loss (mean difference [MD]: -84.7 mL; 95% Cl: -89.0; -80.0) and postoperative reduction in hemoglobin level (MD: -0.4 g/dL; 95% Cl: -0.7; -0.2) compared with LM without TUAL. However, TUAL was associated with increased operative time (MD: 16.5 min; 95% Cl: 3.4; 29.6).</p><p><strong>Conclusions: </strong>TUAL appears to be a possible adjunct to LM for selected patients in the management of uterine myomas. Our study demonstrated that TUAL with LM could be associated with a reduction in estimated blood loss, despite an increase in operative time. Nonetheless, further studies with a larger sample size and long-term follow-up, as well as stratification of outcomes based on ligation technique, are warranted to elucidate the benefits of TUAL.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"795-804"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580148","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}