Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Induction at 41 weeks: Are we overestimating the benefit?","authors":"Anna E. Seijmonsbergen-Schermers, Bahareh Goodarzi, Ank de Jonge","doi":"10.1111/aogs.15151","DOIUrl":"10.1111/aogs.15151","url":null,"abstract":"<p>Sir,</p><p>With great interest, we read the paper by Ravelli et al., published in Acta Obstetricia et Gynecologica Scandinavica.<span><sup>1</sup></span> The study demonstrated a reduced stillbirth rate following induction of labor (IOL) from 41 weeks onwards, compared to expectant management (EM). In addition, it reported a higher incidence of low Apgar score, NICU admissions and increased cesarean section rates.</p><p>We acknowledge the importance of the topic, particularly as IOL at 41 weeks is routinely offered in many countries. However, it is important to note that the perinatal mortality rate may have been overestimated in the EM group due to differences in how stillbirths were included in the two groups. Specifically, stillbirths were excluded from the IOL group but not consistently from the EM group.</p><p>We believe that the construction of the EM group may have introduced a slight but important overestimation of stillbirths. In the study, IOL at 41+0/41+1 weeks was compared with spontaneous onset between 41+0 and 42+0, or IOL between 41+3 and 42+0. Since IOL is offered after stillbirth, all stillbirths were excluded from the IOL group. However, women who had a planned IOL at 41+0/41+1 weeks but experienced a stillbirth along with a spontaneous onset before IOL were assigned to the EM group. To ensure comparability between the groups and avoid overestimation of perinatal mortality in the EM group, stillbirths occurring in the first 2 days (i.e. before scheduled IOL) should have been excluded, as was done in the IOL group.</p><p>More importantly, we would like to highlight the high number needed to treat (NNT) for IOL to prevent one perinatal death. In the study by Ravelli et al., the perinatal mortality rate was 0.07% (27/21 963) in the IOL group (41+0/41+1 weeks) versus 0.12% (15/21 963) in the EM group, resulting in a NNT of 1830. This means that 1830 women would need to undergo IOL to prevent one perinatal death. This is substantially higher than the NNT of 326 reported in the meta-analysis by Alkmark et al.,<span><sup>2</sup></span> which is currently used to inform pregnant women.</p><p>Furthermore, Ravelli et al. showed that IOL did not lead to a significant reduction in perinatal mortality at 41+0/41+1 weeks. The difference became significant from 41+2/41+3 weeks onwards. This finding was consistent across both nulliparous and multiparous women. Considering the aforementioned methodological limitations, it is plausible that the actual NNT is even higher, given the likely overestimation of mortality in the EM group. Additionally, the higher rates of low Apgar score, NICU admissions and cesarean sections suggest that the disadvantages of IOL after 41 weeks may be more substantial than currently communicated to pregnant women.</p><p>It is concerning that many women are currently opting for IOL at 41+0 weeks based on data from a meta-analysis that may overestimate the benefits of IOL. We therefore recommend reviewing current guide","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 9","pages":"1798-1799"},"PeriodicalIF":3.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15151","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054092","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":"Validation of data quality in the Swedish quality register of gynecologic cancer for cervical cancer and vulvar cancer—a Swedish gynecologic cancer group (Swe-GCG) study","authors":"Maria Bjurberg,&nbsp;Kristina Hellman,&nbsp;Tim A. Säll,&nbsp;Christian Staf,&nbsp;Christer Borgfeldt,&nbsp;Erik Holmberg,&nbsp;Jenny Jönsson,&nbsp;Gabriel Lindahl,&nbsp;Angelique Flöter Rådestad,&nbsp;Camilla Sköld,&nbsp;Katja Stenström Bohlin,&nbsp;Karin Stålberg,&nbsp;Elisabeth Åvall-Lundqvist,&nbsp;Preben Kjølhede,&nbsp;Pernilla Dahm-Kähler","doi":"10.1111/aogs.15152","DOIUrl":"10.1111/aogs.15152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Population-based registers provide an important source of real-world data. The growing number of large cohort studies using data from cancer registers makes validation of such registers important. The Swedish Quality Register of Gynecologic Cancer (SQRGC) is a nationwide population-based register containing data on patient and tumor characteristics, treatment, and follow-up. To ensure that the results from research and quality assurance reports using SQRGC data are robust and reliable, the accuracy and completeness of the register need to be validated. The aim of this study was to evaluate the quality of data on cervical cancer and vulvar cancer in the SQRGC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Quality of data in the SQRGC was investigated by evaluating completeness, timeliness, comparability, and validity in accordance with recommendations from the International Agency for Research on Cancer and the national Swedish guidelines on validation of cancer registers. Completeness was evaluated by coverage relative to the Swedish National Cancer Register, and timeliness as the time from diagnosis until entry into the SQRGC. We randomly selected 276 women diagnosed with cervical cancer (<i>n</i> = 138) and vulvar cancer (<i>n</i> = 138) between 2014 and 2019 for validation. An external monitor manually re-abstracted data on 10 core variables per sub-register from the patients' medical records. Comparability was assessed by reviewing the adherence to international standards regarding coding. Validity was evaluated by the agreement between re-abstracted data and original data in the SQRGC. Correlations were estimated using Pearson's correlation coefficient and Cohen's kappa coefficient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For cervical cancer, the completeness was 99% and the timeliness was 87.1% within 12 months. The corresponding figures for vulvar cancer were 100% and 87.9%, respectively. Adherence to international coding standards was satisfactory. The median degree of agreement between re-abstracted data and data in the SQRGC was 90.8% (range 73.2%–100%) for cervical cancer, and 85.4% (range 59.6%–98.2%) for vulvar cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The data on cervical and vulvar cancer in the SQRGC are of adequate quality and may well be used for research and clinical purposes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1530-1538"},"PeriodicalIF":3.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960420","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":"Prenatal diagnostic accuracy and epidemiology of congenital lung malformations: A retrospective review of cases in a tertiary referral center in northern Finland in 2010–2020","authors":"Topias Puumalainen,&nbsp;Tuomas Kauppinen,&nbsp;Hilkka Nikkinen","doi":"10.1111/aogs.15100","DOIUrl":"10.1111/aogs.15100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Our objective was to investigate the accuracy of prenatal diagnoses of congenital lung malformations (CLM) compared to postnatal diagnoses in a population in northern Finland and to estimate the birth prevalence of CLMs in the same population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A retrospective review of all CLM cases in a tertiary referral center, Oulu University Hospital, Finland, in 2010–2020. Data were collected from medical records. The final postnatal diagnosis was recorded as the pathologic-anatomic diagnosis, if available, and otherwise as the postnatal radiologic diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our case series comprises 37 CLM cases. The prenatal detection rate of CLMs was 100%. The prenatal diagnosis was congenital pulmonary airway malformation (CPAM) in 34/37 cases (92%). The accuracy of prenatal CLM diagnoses was 60% compared to postnatal radiologic diagnoses and 51% compared to final postnatal diagnoses. Relative frequencies of different diagnoses in postnatally confirmed CLM cases were CPAM 47% (16/34 cases), bronchopulmonary sequestration (BPS) 15% (5/34), hybrid CPAM/BPS 15% (5/34), congenital lobar overinflation (CLO) 15% (5/34), bronchial atresia 6% (2/34), and bronchogenic cyst 3% (1/34). Postnatally confirmed cases of CPAM were more likely to have a higher CPAM-volume ratio at diagnosis (<i>p</i> = 0.002), a higher maximum CPAM-volume ratio during pregnancy (<i>p</i> &lt; 0.001), macrocystic appearance on ultrasonography (<i>p</i> = 0.026), and mediastinal shift (<i>p</i> &lt; 0.001) compared with the rest of the cases in this study. The prevalence of all CLMs combined was 3.71 cases per 10 000 live births. The prevalences of CPAM, BPS, hybrid CPAM/BPS, and CLO were 1.69, 0.56, 0.56, and 0.56 cases per 10 000 live births, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found that all CLMs were detected prenatally, but almost half of the prenatal diagnoses were inaccurate compared to postnatal diagnoses. Most lesions were diagnosed prenatally as CPAM, but postnatally many of them turned out to be BPS, hybrid CPAM/BPS, or CLO. Postnatally confirmed CPAM cases were more likely to have a high CPAM-volume ratio, mediastinal shift, and macrocystic appearance on prenatal ultrasonography compared with other CLMs. The prevalence of CLMs is still relatively poorly documented, but we provide new estimates in Finland.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1120-1127"},"PeriodicalIF":3.1,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952489","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":"Health-related quality of life in adult-type ovarian granulosa cell tumor survivors","authors":"Ulla-Maija Haltia,&nbsp;Saku Torvinen,&nbsp;Saara Bryk,&nbsp;Harri Sintonen,&nbsp;Johanna Tapper","doi":"10.1111/aogs.15144","DOIUrl":"10.1111/aogs.15144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Adult-type granulosa cell tumor (AGCT) is a rare, slow-growing ovarian neoplasm with a tendency for late relapses. Surgery is the cornerstone of the treatment, and chemotherapy and hormonal treatment are administered in advanced and recurrent disease. The objective of our study was to assess health-related quality of life (HRQoL) in AGCT survivors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>15D and European Organization for Research and Treatment of Cancer (EORTC-QLQ-C30) questionnaires were collected from our prospective AGCT patient cohort, consisting of 171 AGCT survivors. The age-standardized general female population was used as a reference for 15D comparison. Clinical and sociodemographic variables and EORTC-QLQ-C30 symptom and function scales were used as independent variables in regression analysis explaining the variance in the 15D score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-six women (50.3%), with a mean age of 68 years, returned the questionnaires. The HRQoL of AGCT survivors was similar to the general female population. The mean 15D score in our patient group was 0.891 (reference population score 0.899, <i>p</i> = 0.454). The scores were slightly lower on the 15D dimensions of excretion and sexual activity, whereas mental function scores were higher compared with the reference population. A history of tumor recurrence, an increasing number of other chronic illnesses, and financial difficulties each diminished HRQoL in our patient cohort. Regressing the EORTC variables on 15D produced a high explanatory power and accurate predictions of 15D scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HRQoL of AGCT survivors was equal to that of the controls. Mapping EORTC-QLQ-C30 to 15D validly predicted 15D scores in AGCT survivors, confirming the usefulness of generic 15D for estimating quality-adjusted life years in cancer patient trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 7","pages":"1382-1389"},"PeriodicalIF":3.1,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952226","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 recurrence risk of gestational diabetes according to the number of abnormal values in the oral glucose tolerance test","authors":"Jenni Pukkila,&nbsp;Marja Vääräsmäki,&nbsp;Sanna Eteläinen,&nbsp;Sanna Mustaniemi,&nbsp;Hilkka Nikkinen,&nbsp;Mika Gissler,&nbsp;Tuija Männistö,&nbsp;Hannele Laivuori,&nbsp;Eero Kajantie,&nbsp;Elina Keikkala,&nbsp;the FinnGeDi Study Group","doi":"10.1111/aogs.15148","DOIUrl":"10.1111/aogs.15148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Oral glucose tolerance test (OGTT) results may be used to estimate the risk of recurrent gestational diabetes mellitus (GDM) in a subsequent pregnancy in the different study settings. This study assesses the association between the number of abnormal glucose values in the OGTT in the first pregnancy and GDM recurrence in a subsequent pregnancy in a Nordic cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This register-based cohort study included 1677 women who had their first singleton delivery in 2009, underwent a 75 g 2-h OGTT during the pregnancy, and gave birth at least once more within 10 years according to the Finnish Medical Birth Register. The cut-off values were as follows: ≥5.3 mmol/L at fasting, ≥10.0 mmol/L at 1 h, and ≥8.6 mmol/L at 2 h. The odds ratio (OR) for GDM recurrence in the second pregnancy was analyzed via multivariable logistic regression adjusted for other potential factors associated with recurrence risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the first pregnancy, GDM was diagnosed in 331 (24.5%) women based on one (<i>n</i> = 250) or two or three (<i>n</i> = 81) abnormal glucose values in the OGTT. The total recurrence rate for GDM in the subsequent pregnancy was 56.2%. The rate differed significantly between women with one (51.6%) and women with two or three (70.4%) abnormal values in first-pregnancy OGTT. Compared with those with normal OGTT results, the adjusted OR (aOR) for GDM in the subsequent pregnancy in women with one abnormal glucose value was 6.00 (95% CI, 4.34–8.30), while it was 13.37 (7.52–23.76) in women with two or three abnormal values. The odds for GDM recurrence among those with two or three abnormal glucose values was double compared to those with only one abnormal value (aOR 2.03, 1.12–3.68).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Primiparous women with one abnormal glucose value in the first OGTT have remarkable odds of GDM recurrence, with the odds doubling when there are two or three abnormal values during the first pregnancy. These findings can be used when planning effective counseling, prevention, and screening strategies for GDM in the subsequent pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1452-1462"},"PeriodicalIF":3.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958210","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":"Performance of radiomics analysis in ultrasound imaging for differentiating benign from malignant adnexal masses: A systematic review and meta-analysis","authors":"Francesca Moro,&nbsp;Marianna Ciancia,&nbsp;Maria Sciuto,&nbsp;Giulia Baldassari,&nbsp;Huong Elena Tran,&nbsp;Antonella Carcagnì,&nbsp;Anna Fagotti,&nbsp;Antonia Carla Testa","doi":"10.1111/aogs.15146","DOIUrl":"10.1111/aogs.15146","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We present the state of the art of ultrasound-based machine learning (ML) radiomics models in the context of ovarian masses and analyze their accuracy in differentiating between benign and malignant adnexal masses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Web of Science, PubMed, and Scopus databases were searched. All studies were imported into RAYYAN QCRI software. All studies that developed and internally or externally validated ML models using only radiomics features extracted from ultrasound images were included. The overall quality of the included studies was assessed using the QUADAS-AI tool. Summary sensitivity and specificity analyses with corresponding 95% confidence intervals (CIs) were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>12 studies developed ML models including only radiomics features extracted from ultrasound images, and six of them were included in the meta-analysis. The overall sensitivity and specificity for differentiating benign from malignant adnexal masses were 0.80 (95% CI 0.74–0.87) and 0.86 (95% CI 0.80–0.90), respectively, in the validation set. All studies demonstrated a high risk of bias in <i>subject selection</i> (e.g., lack of details on image sources or scanner models; absence of image preprocessing), and the majority also showed a high risk in the <i>index test</i> (e.g., models were not validated on external datasets) domain. In contrast, the risk of bias was generally low for the <i>reference standard</i> (i.e., most studies used a reference that accurately identified the target condition) and the testing <i>workflow</i> (i.e., the time interval between the index test and reference standard was appropriate) domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The good performance of ultrasound-based radiomics models in the validation set supports that radiomics is worth exploring to improve the diagnosis of adnexal masses. So far, the studies have a high risk of bias due to the small sample size, single-setting design, and no external validation included.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1433-1442"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957944","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":"Dienogest vs. combined oral contraceptive: A systematic review and meta-analysis of efficacy and side effects to inform evidence-based guidelines","authors":"Ilaria Piacenti,&nbsp;Veronica Tius,&nbsp;Maria Federica Viscardi,&nbsp;Anna Biasioli,&nbsp;Martina Arcieri,&nbsp;Stefano Restaino,&nbsp;Ludovico Muzii,&nbsp;Giuseppe Vizzielli,&nbsp;Maria Grazia Porpora","doi":"10.1111/aogs.15145","DOIUrl":"10.1111/aogs.15145","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Dienogest is a synthetic fourth-generation progestin that has been approved for the medical treatment of endometriosis, and its efficacy on pain symptoms and quality of life is well established even in the long term. Nowadays, only a few controlled trials evaluating the safety of dienogest compared with other hormonal therapies have been published. This systematic review and meta-analysis aims to compare efficacy and tolerability data between dienogest and combined oral contraceptives (COC) in patients taking hormonal therapy for endometriosis treatment in order to inform evidence-based guidelines.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Material and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;PubMed (Medline), Web of Science, and Google Scholar were systematically searched from the inception of each database until October 2024. Selection criteria included any articles comparing efficacy outcomes and at least one tolerability data between dienogest and COC in patients diagnosed with endometriosis. Studies comparing COC containing Dienogest or another type of hormonal treatment were excluded. A random-effects meta-analysis was conducted if adequate data were available from at least three studies, reporting pooled mean differences and odds ratios between groups using Review Manager V.7.9.0. PROSPERO registration number: CRD42024598455.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of four randomized control trials and one observational study were included, showing moderate risk at bias assessment. Meta-analysis did not show any statistical difference in improving pelvic pain after treatment [CI 95% (−1.45–1.17); &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 86%; &lt;i&gt;p&lt;/i&gt; = 0.84]. In contrast, dyspareunia after treatment was significantly lower in the COC group [CI 95% (0.64–1.33); &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%; &lt;i&gt;p&lt;/i&gt; &lt; 0.00001]. No statistical difference was found in terms of vaginal bleeding [OR = 0.88; CI 95% (0.39–1.96); &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 41%; &lt;i&gt;p&lt;/i&gt; = 0.75], nausea and vomiting [OR = 0.51; CI 95% (0.16–1.63); &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 67%; &lt;i&gt;p&lt;/i&gt; = 0.26], headache [OR = 0.91; CI 95% (0.38–2.21); &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 59%; &lt;i&gt;p&lt;/i&gt; = 0.84], hot flushes [OR = 1.16; CI 95% (0.54–2.48); &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%; &lt;i&gt;p&lt;/i&gt; = 0.71], and hair loss [OR = 1.69; CI 95% (0.52–5.53); &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 46%; &lt;i&gt;p&lt;/i&gt; = 0.39]. Treatment discontinuation rate was similar between groups.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Dienogest is comparable to COC in terms of efficacy and tolerability. The therapeutic choice should be based on the patient's ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1424-1432"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964535","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":"Long-term gastrointestinal function outcomes of women undergoing nerve-vessel sparing segmental or full-thickness discoid resection for deep colorectal endometriosis","authors":"Daria Pashkunova,&nbsp;Ezgi Darici Kurt,&nbsp;Theresa Hudelist,&nbsp;Anna Rath,&nbsp;Attila Bokor,&nbsp;Gernot Hudelist","doi":"10.1111/aogs.15142","DOIUrl":"10.1111/aogs.15142","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Patients undergoing colorectal surgery for symptomatic deep endometriosis may experience postoperative impairment of gastrointestinal function. However, there is limited information on long-term follow-up of this surgical sequela. We aimed to analyze 5-year postsurgical outcomes of gastrointestinal function in these patients, reflected by lower anterior resection syndrome (LARS) scores and gastrointestinal quality of life index (GIQLI).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Material and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This prospective study included patients who either underwent nerve-vessel-sparing segmental resection (NVSSR) or full-thickness discoid resection (FTDR) for symptomatic colorectal deep endometriosis from April 2017 to May 2022 at two tertiary referral centers. As published previously, gastrointestinal function was evaluated by LARS and GIQLI scores pre- and postsurgically (postoperative visit 1) and was now re-evaluated (postoperative visit 2) to gain information on long-term outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Out of 121 patients, 92 were eligible for the final analysis at postoperative visit 2. The mean follow-up interval was 58.5 ± 17.9 months in the NVSSR group and 61.6 ± 10.7 months in the FTDR group. As published previously, presurgical LARS-like symptoms were observed in 42/92 (45.7%) of patients, including 37/76 (48.7%) in the NVSSR group and 5/16 (31.3%) in the FTDR group. Compared to preoperative LARS scores, patients in the NVSSR group showed a significant reduction of LARS scores at long-term postoperative visit 2 (&lt;i&gt;p&lt;/i&gt; = &lt;0.001), with LARS scores remaining stable over postoperative visit 1 and visit 2 (&lt;i&gt;p&lt;/i&gt; = 0.09) at 5 years postoperatively. In women following FTDR, presurgical and long-term postoperative visit 2 LARS scores remained statistically unchanged (&lt;i&gt;p&lt;/i&gt; &lt; 0.73), with worsening of LARS scores between postoperative visit 1 and visit 2 (&lt;i&gt;p&lt;/i&gt; = 0.02). In contrast, significant improvement of GIQLI was observed between the preoperative visit and postoperative visit 2 at 5 years follow-up in both NVSSR and FTDR groups (&lt;i&gt;p&lt;/i&gt; ≤ 0.001 and &lt;i&gt;p&lt;/i&gt; = 0.001, respectively).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Compared to presurgical values, long-term gastrointestinal function reflected by LARS scores remains improved following NVSSR, whereas it remains unchanged following FTDR. However, when GIQLI is applied as patient-reported outcome measurement (PROM), patients show permanent, long-term improvement of gastrointestinal function following either","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1550-1557"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964693","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":"Prevalence and impact of vasomotor symptoms associated with menopause among Nordic women: Subgroup analysis from an international cross-sectional survey","authors":"Angelica Lindén Hirschberg,&nbsp;Päivi Polo-Kantola,&nbsp;Inger Øverlie,&nbsp;Ellen Løkkegaard,&nbsp;Elinor Cockburn,&nbsp;Carol Rea,&nbsp;Janet S. Kim","doi":"10.1111/aogs.15139","DOIUrl":"10.1111/aogs.15139","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The objectives of this study were to evaluate the prevalence and impact of moderate to severe vasomotor symptoms (VMS) on quality of life, sleep, work, and daily activities. We also assessed treatment patterns for VMS, lifestyle changes to mitigate VMS, and attitudes toward available treatments and menopause.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Material and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Women from Denmark, Finland, Norway, and Sweden aged 40–65 years completed an online survey as part of a larger multinational study. The primary outcome, prevalence of moderate to severe VMS, was assessed in postmenopausal women. Secondary outcomes, including the impact of VMS on quality of life (Menopause-Specific Quality of Life [MENQoL] questionnaire), sleep (Patient-Reported Outcomes Measurement Information System [PROMIS] Sleep Disturbances-Short Form 8b), and work and daily activities (Work Productivity and Activity Impairment [WPAI] questionnaire) were assessed in perimenopausal and postmenopausal women experiencing ≥1 moderate to severe hot flush per day in the prior month. Additionally, survey questions evaluated treatment patterns, lifestyle changes, and opinions toward VMS treatment and menopause in perimenopausal and postmenopausal women.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among 6383 postmenopausal women (primary analysis population), 739 (11.6%) experienced moderate to severe VMS regardless of whether they were receiving treatment. Among 863 symptomatic perimenopausal and postmenopausal women (secondary analysis population), VMS impaired quality of life and sleep. Work and daily activities were impaired by 24.2% and 30.6%, respectively. Around 35% of women sought advice; however, most women (&gt;60%) reported not taking any treatment for VMS. Among those treating VMS, supplements and nonprescription medications were the most common treatments (19.2%); 12.9% of women reported taking menopausal hormone therapy. As many as 54.3% of women reported taking over-the-counter treatments; 77.8% adopted lifestyle changes to mitigate VMS. One in 4 women (25.6%) expressed concerns about menopausal hormone therapy side effects; 49.5% of women who had used nonmenopausal hormone therapy prescription medication stopped for lack of efficacy. Many women strongly agreed that menopause is a natural part of aging.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Over 10% of postmenopausal Nordic women reported suffering from moderate to severe VMS. VMS impaired the quality of life, sleep, work productivity, and daily activities among perimen","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1575-1586"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951902","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":"Maternal and fetal outcomes in subsequent pregnancies after peripartum cardiomyopathy: A systematic review and meta-analysis","authors":"Rebecca Man,&nbsp;Jack Le Vance,&nbsp;Hafsa Abdullahi,&nbsp;Clare Davenport,&nbsp;Mengshi Yuan,&nbsp;Laura Ormesher,&nbsp;Sana Usman,&nbsp;James Castleman,&nbsp;Caroline Fox,&nbsp;Lucy Hudsmith,&nbsp;R. Katie Morris,&nbsp;Victoria Hodgetts Morton","doi":"10.1111/aogs.15117","DOIUrl":"10.1111/aogs.15117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We aim to determine the pregnancy and cardiovascular outcomes of subsequent pregnancies following a previous diagnosis of peripartum cardiomyopathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Medline, Embase, CINAHL, and Web of Science were searched from inception to November 2023. Primary research studies of any design providing data for any of our outcomes of interest with greater than five subsequent pregnancies were eligible for inclusion. Primary outcomes included relapse of cardiac failure in the first subsequent pregnancy and death during any subsequent pregnancy. Secondary outcomes included a range of maternal and fetal outcomes. Proportional meta-analysis, applying a random effects model, was performed using R software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine studies involving 779 women were included, performed across 13 countries. The risk of relapse of cardiac failure in the first subsequent pregnancy (20 studies, 376 women) was 32%, 95% confidence interval [CI] 0.23–0.43. In those with recovered (11 studies, 123 pregnancies) and non-recovered (10 studies, 55 pregnancies) cardiac function at subsequent pregnancy outset, the risk of cardiac failure relapse was 24%, 95% CI 0.16–0.35 and 36%, 95% CI 0.24–0.50, respectively. There was a high chance of preterm birth &lt;37 weeks (12 studies, 212 pregnancies) at 22%, 95% CI 0.17–0.29.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Subsequent pregnancy after peripartum cardiomyopathy presents significant maternal and fetal risks. This study provides quantification of risks to begin to fill the current evidence gap, however is limited by the paucity of existing primary research investigating this population. Robust observational studies of current practice are needed to provide answers in specific populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1009-1025"},"PeriodicalIF":3.1,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951917","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}