Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Emergency delivery in case of suspected placenta accreta spectrum: Can it be predicted?","authors":"Petra Hanulikova, Egle Savukyne, Karin A. Fox, Lukas Sobisek, Mina Mhallem, Heleen J. van Beekhuizen, Vedran Stefanovic, Thorsten Braun, Alexander Paping, Charline Bertholdt, Olivier Morel","doi":"10.1111/aogs.14931","DOIUrl":"https://doi.org/10.1111/aogs.14931","url":null,"abstract":"The main goal of placenta accreta spectrum (PAS) screening is to enable delivery in an expert center in the presence of an experienced team at an appropriate time. Our study aimed to identify independent risk factors for emergency deliveries within the IS-PAS 2.0 database cohort and establish a multivariate predictive model.","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"26 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142211572","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":"Antepartum vs postpartum amoxicillin oral challenge in pregnant patients with a reported penicillin allergy: A two-center prospective cohort study","authors":"Jeffrey Man Hay Wong,&nbsp;Xiaoqing Liu,&nbsp;Raymond Mak,&nbsp;Stephanie C. Erdle,&nbsp;Colin Barber,&nbsp;Julianne van Schalkwyk,&nbsp;Melissa Watt,&nbsp;Sudharsana Rao Ande,&nbsp;Dozie Ochulor,&nbsp;Chelsea Elwood,&nbsp;Vanessa Poliquin","doi":"10.1111/aogs.14964","DOIUrl":"10.1111/aogs.14964","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While 10% of pregnant individuals report a penicillin allergy, there is no established best practice for penicillin allergy delabeling in pregnancy. To better understand options for penicillin delabeling, we aimed to evaluate two penicillin allergy delabeling protocols in pregnancy regarding efficacy, adverse events, and patient satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>From July 2019 to December 2022, we completed a two-center prospective cohort study, where each site recruited pregnant patients over 24 weeks gestational age with a reported penicillin allergy. One center offered antepartum amoxicillin oral challenges, either directly or after negative skin testing (i.e., antepartum oral challenge site). Our other centers completed a two-step approach with antepartum penicillin skin testing only and deferred oral challenges to the postpartum period (i.e., postpartum oral challenge site). Our primary outcome was the rate of penicillin allergy delabeling, defined as tolerating an antibiotic challenge with penicillin or amoxicillin. Univariate analyses were completed using chi-squared, Fisher's exact, and Wilcoxon rank tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study period, 276 pregnant patients were assessed, with 207 in the antepartum oral challenge site and 69 in the postpartum oral challenge site. Among the 204 patients who completed antepartum oral challenges, 201 (98%) passed without reactions. Deferring oral challenges to the postpartum period led to a loss of follow-up for 37/53 (70%) of eligible individuals. Overall, 97% (201/207) of patients at the antepartum oral challenge site were delabeled from their penicillin allergy—compared to 38% (26/69) of patients referred to the postpartum oral challenge site (<i>p</i> &lt; 0.0001). Three antepartum oral challenge reactions were noted, including two mild cutaneous reactions and a case of transient abdominal discomfort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Antepartum amoxicillin oral challenge is a more effective method to delabel pregnant patients from their penicillin allergy. Deferral of oral challenges to the postpartum period introduces a significant barrier for penicillin allergy delabeling.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2289-2295"},"PeriodicalIF":3.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.14964","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142211587","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":"Causal relationships between gut microbiota and polycystic ovarian syndrome: A bidirectional Mendelian randomization study","authors":"Ruo-Lin Mao,&nbsp;Xiang-Fei Wang,&nbsp;Jue-Pu Zhou,&nbsp;Meng Wang,&nbsp;Rui Long,&nbsp;Lei Jin,&nbsp;Li-Xia Zhu","doi":"10.1111/aogs.14957","DOIUrl":"10.1111/aogs.14957","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Previous studies have established a link between gut microbiota and polycystic ovary syndrome (PCOS), but little is known about their precise causal relationship. Therefore, this study aims to explore whether there are precise causal relationships between gut microbiota and PCOS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We performed a bidirectional two-sample Mendelian randomization (MR) analysis. Datasets were from the largest published meta-analysis on gut microbiota composition and the FinnGen cohort of the IEU Open Genome-Wide Association Study Project database. Inverse variance weighted (IVW), MR-Egger, constrained maximum likelihood-based Mendelian randomization, weighted median, weighted mode, and simple mode were used. Cochran's Q and MR-Egger intercept tests were employed to measure the heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 211 gut microbiota taxa were identified in MR analysis. Nine taxa of bacteria, including Alphaproteobacteria (0.55, 0.30–0.99, <i>p</i> = 0.04), Bacilli (1.76, 1.07–2.91, <i>p</i> = 0.03), <i>Bilophila</i> (0.42, 0.23–0.77, <i>p</i> &lt; 0.01), <i>Blautia</i> (0.16, 0.03–0.79, <i>p</i> = 0.02), Burkholderiales (2.37, 1.22–4.62, <i>p</i> = 0.01), <i>Candidatus Soleaferrea</i> (0.65, 0.43–0.98, <i>p</i> = 0.04), Cyanobacteria (0.51, 0.31–0.83, <i>p</i> = 0.01), <i>Holdemania</i> (0.53, 0.35–0.81, <i>p</i> &lt; 0.01), and Lachnospiraceae (1.86, 1.04–3.35, <i>p</i> = 0.03), were found to be associated with PCOS in the above MR methods included at least IVW method. Cochran's <i>Q</i> statistics and MR-Egger intercept test suggested no significant heterogeneity. In addition, 69 taxa were shown significant for at least the IVW method in reverse MR analysis, of these, 25 had a positive correlation, and 37 had a negative correlation. Additionally, Alphaproteobacteria and Lachnospiraceae (0.95, 0.91–0.98, <i>p</i> &lt; 0.01; 0.97, 0.94–0.99, <i>p</i> = 0.02, respectively) were shown a bidirected causally association with PCOS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study provides evidence of the bidirectional causal association between gut microbiota and PCOS from a genetic perspective.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2232-2241"},"PeriodicalIF":3.5,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.14957","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142211586","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 body mass index, gestational weight gain, and early childhood growth: A register-based cohort study","authors":"Anna Österroos,&nbsp;Linda Lindström,&nbsp;Per Wikman,&nbsp;Anders Forslund,&nbsp;Anna-Karin Wikström,&nbsp;Inger Sundström Poromaa,&nbsp;Fredrik Ahlsson","doi":"10.1111/aogs.14961","DOIUrl":"10.1111/aogs.14961","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Childhood obesity is associated with maternal obesity, but the link to gestational weight gain (GWG) is not fully elucidated. We examined the relationship between early pregnancy maternal body mass index (BMI) and GWG on early childhood growth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Data from 30 197 mother–child pairs from Uppsala County Mother and Child Cohort were divided into 15 groups according to maternal BMI and GWG, based on World Health Organization classification and Institute of Medicine guidelines, respectively. Postnatal growth patterns were analyzed with linear mixed regression models within maternal BMI groups. Odds ratios of overweight and obesity at 4 years of age were assessed with logistic regression analyses. We treated children of mothers with normal weight and adequate GWG as the reference group, and all analyses were adjusted for potential confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>GWG was associated with infant BMI <i>z</i>-score at birth, independent of potential confounding factors. Independent of GWG, we observed an overall decrease in BMI <i>z</i>-score from 18 months to 5 years in children of mothers who were underweight, while an increase in BMI <i>z</i>-score was seen in children of mothers who were overweight or obese. In children of normal- and overweight mothers, the risk of childhood overweight and obesity was associated with excessive compared to adequate GWG (adjusted odds ratio [aOR] 1.17, 95% confidence interval [CI] 1.01–1.36 for normal-weight mothers, and aOR 1.25, 95% CI 1.04–1.51 for overweight mothers, respectively). Children of mothers with obesity and excessive GWG had the highest risk of being overweight or obese at 4 years (aOR 2.88, 95% CI 2.40–3.44, and 4.38, 95% CI 3.37–5.67, respectively). Associations did not differ between children of mothers with obesity class 1 and 2–3 when comparing excessive and adequate GWG (aOR 1.33, 95% CI 0.96–1.85, and 1.12, 95% CI 0.74–1.70, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Maternal GWG affects infant birth size and growth until 18 months, although maternal BMI is more crucial for childhood growth beyond 18 months. Further, children of mothers who are normal- or overweight and experience excessive GWG have an increased risk of obesity at 4 years.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2171-2182"},"PeriodicalIF":3.5,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131478","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":"Education level is associated with the occurrence and timing of hysterectomy: A cohort study of Canadian women","authors":"Erin A. Brennand,&nbsp;Natalie V. Scime,&nbsp;Beili Huang,&nbsp;Pauline McDonagh Hull","doi":"10.1111/aogs.14959","DOIUrl":"10.1111/aogs.14959","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hysterectomy is a common surgery with discernible practice variations that could be influenced by socioeconomic factors. We examined the association between level of educational attainment and the occurrence and timing of hysterectomy in Canadian women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a prospective cohort study of 30 496 females in the Alberta's Tomorrow Project (2000–2015) followed approximately every 4 years using self-report questionnaires. Educational attainment was defined as high school diploma or less, college degree, university degree (reference group), and postgraduate degree. We used logistic regression analyzing hysterectomy occurrence at any time and before menopause, separately, and flexible parametric survival models analyzing hysterectomy timing with age as the time scale. Multivariable models controlled for race/ethnicity, rural/urban residence, parity, oral contraceptive use, and smoking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 39.1% of females reported a high school diploma or less, 28.9% reported a college degree, 23.5% reported a university degree, and 8.5% reported a postgraduate degree. A graded association was observed between lower education and higher odds of hysterectomy (high school or less: adjusted odds ratio [AOR] 1.68, 95% CI 1.55–1.82; college degree: AOR 1.58, 95% CI 1.45–1.72); results were similar for premenopausal hysterectomy. A graded association between lower education and earlier timing of hysterectomy was also observed up to approximately age 60 (eg at age 40: high school or less adjusted hazard ratio [AHR] 1.61, 95% CI 1.49–1.75; college degree AHR 1.53, 95% CI 1.40–1.67).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Women with lower levels of education were more likely to experience hysterectomy, including hysterectomy before menopause and at younger ages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2211-2220"},"PeriodicalIF":3.5,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118676","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":"Complications after benign gynecologic surgery—How are they captured in register-based research? A national register study in Sweden","authors":"Elin Collins,&nbsp;Per Liv,&nbsp;Annika Strandell,&nbsp;Maria Furberg,&nbsp;Sophia Ehrström,&nbsp;Mathias Pålsson,&nbsp;Annika Idahl","doi":"10.1111/aogs.14960","DOIUrl":"10.1111/aogs.14960","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The evidence on complication rates after gynecological surgery is based on multiple types of studies, and the level of evidence is generally low. We aimed to validate the registration of complications in the Swedish National Quality Register of Gynecological Surgery (GynOp), by cross-linkage to multiple national registers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A national register-based study using prospectively collected data was conducted, including women who had surgery on the uterus or adnexa for benign indications from January 1, 2017, to December 31, 2020. In Sweden, complications after gynecological surgery are registered in GynOp, and if the complication has rendered any interaction with healthcare, it is also in national health registers. The GynOp register, the National Patient Register, the Prescribed Drugs Register, and the Cause of Death Register were cross-linked. Complications in GynOp and complications according to ICD10 were analyzed, as well as the cause of death if occurring within 3 months of surgery and prescription of antibiotics ≤30 days. Comparisons between the registries were descriptive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study period 32 537 surgeries were performed, of which 26 214 (80.6%) were minimally invasive. Complications were reported in GynOp for 569 women (1.7%) at surgery, 1045 (3.2%) while admitted, and 3868 (13.7%) from discharge to 3 months after surgery. In comparison, according to the Patient Register, 2254 women (6.9%) had postoperative complications within 3 months of discharge (difference of 6.8 percentage points [95% confidence interval 6.2–7.2]). Furthermore, 4117 individuals (12.7%) had a prescription of antibiotics ≤30 days which could indicate a postoperative infection. The rates of hemorrhage, wound dehiscence, and thrombosis were comparable between GynOp and the Patient Register while diagnoses not leading to contact with specialized care had higher rates in the quality register. The coverage of complications was 79.1% in GynOp and 46.1% in the Patient Register, using the total number of complications from both registers as the denominator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A higher frequency of complications is captured in GynOp than in the National Patient Register. Patient-reported outcomes assessed by a physician are beneficial in identifying complications indicating the importance of structured pre-defined follow-up over a set period.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2221-2231"},"PeriodicalIF":3.5,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118675","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":"Vaginal dinoprostone insert compared with two different oral misoprostol regimens for labor induction in nulliparous and multiparous women","authors":"Damaris Erhardt,&nbsp;Anda-Petronela Radan,&nbsp;Jérôme Mathis,&nbsp;Daniel Surbek","doi":"10.1111/aogs.14956","DOIUrl":"10.1111/aogs.14956","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Labor induction exhibits considerable variations in protocols and medication regimens. Limited studies compare vaginal dinoprostone inserts with different oral misoprostol dosages, considering parity influence. This study explores the distinctions among 10 mg vaginal dinoprostone inserts and oral misoprostol 25 μg every 2 and every 4 h for labor induction, stratified by parity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This retrospective cohort study involved 607 participants across two hospitals. The primary outcome, time from induction to delivery, and secondary outcomes, including mode of delivery and maternal and fetal safety, were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patient characteristics revealed differences in indication for labor induction, with the dinoprostone cohort having fewer post-term and premature rupture of membranes cases but more intrauterine growth restriction/small-for-gestational age. Both oral misoprostol regimens showed a shorter time to delivery interval compared to the dinoprostone cohort (median: 1380 min [IQR 1381.0] and 1127.0 min [IQR 1214.0] vs 1631.5 [IQR 1736.2], <i>p</i> &lt; 0.001 and <i>p</i> = 0.014). Only the difference between oral misoprostol q2h and vaginal dinoprostone remained significant for nulliparous but not multiparous women, losing significance over all the population after adjusting for confounding factors. The proportion of women giving birth within 24 h did not significantly differ between misoprostol q2h and dinoprostone after adjusting for confounders. When comparing misoprostol q4h with dinoprostone after confounder adjustment, an increased time to delivery interval for misoprostol q4h was found (<i>p</i> = 0.001). Both oral misoprostol regimens exhibited fewer meconium-stained liquor (miso q4h: OR 0.44, miso q2h: OR 0.34) and cesarean sections (miso q4h: OR 0.48, miso q2h: OR 0.53) compared to dinoprostone, even after adjustment for confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study suggests that oral misoprostol 25 μg q4h is less effective than 10 mg vaginal dinoprostone for labor induction if parity and indication for induction are adjusted for, particularly in multiparous women. In terms of side effects, oral misoprostol regimens seem superior to vaginal dinoprostone. Our data support the individualized use of different agents for labor induction according to parity, indication for induction, bishop score, and women's preference.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2306-2313"},"PeriodicalIF":3.5,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118677","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":"Placental growth factor at 24–28 weeks for aspirin discontinuation in pregnancies at high risk for preterm preeclampsia: Post hoc analysis of StopPRE trial","authors":"Marta Ricart,&nbsp;Erika Bonacina,&nbsp;Pablo Garcia-Manau,&nbsp;Monica López,&nbsp;Sara Caamiña,&nbsp;Àngels Vives,&nbsp;Eva Lopez-Quesada,&nbsp;Anna Maroto,&nbsp;Laura de Mingo,&nbsp;Elena Pintado,&nbsp;Roser Ferrer-Costa,&nbsp;Lourdes Martín,&nbsp;Alicia Rodriguez-Zurita,&nbsp;Esperanza Garcia,&nbsp;Mar Pallarols,&nbsp;Laia Pratcorona,&nbsp;Mireia Teixidor,&nbsp;Carmen Orizales-Lago,&nbsp;Vanesa Ocaña,&nbsp;Esther del Barco,&nbsp;Elena Carreras,&nbsp;Anna Suy,&nbsp;Manel Mendoza","doi":"10.1111/aogs.14955","DOIUrl":"10.1111/aogs.14955","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study aims to evaluate the safety of discontinuing aspirin treatment at 24–28 weeks in women at high risk after first-trimester combined screening for preeclampsia (PE) and normal placental growth factor (PlGF) levels at 24–28 weeks of gestation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This is a post hoc analysis of the StopPRE trial, conducted at nine Spanish maternity hospitals from September 2019 to September 2021. In the StopPRE trial, all high-risk single pregnancies identified during first-trimester screening for PE were treated with 150 mg of daily aspirin. Out of 1604 eligible women with a soluble fms-like tyrosine kinase-1 to PlGF ratio (sFlt-1/PlGF) ≤38 at 24–28 weeks, 968 were randomly assigned in a 1:1 ratio to either continue aspirin until 36 weeks (control group) or discontinue it (intervention group). In this secondary analysis, only women with PlGF ≥100 pg/mL at 24–28 weeks were included. As in the StopPRE trial, the non-inferiority margin was set at a 1.9% difference in preterm PE incidence between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 13 983 screened pregnant women, 1984 (14.2%) were deemed high-risk for preterm PE, of which 397 (20.0%) were ineligible, 636 declined participation, and 32 were excluded. Ultimately, 919 women with PlGF &gt;100 pg/mL were randomized and included in this analysis. Preterm PE occurred in 0.9% of the intervention group (4 out of 465) and 1.5% of the control group (7 out of 454), indicating non-inferiority of aspirin discontinuation. There were no significant differences between the groups in adverse pregnancy outcomes before 37 weeks, at &lt;34 weeks, or ≥37 weeks. Minor antepartum hemorrhage incidence was significantly lower in the intervention group (absolute difference, −5.96; 95% CI, −10.10 to −1.82).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Discontinuation of aspirin treatment at 24–28 weeks in women with PlGF levels ≥100 pg/mL was non-inferior to continuing until 36 weeks for preventing preterm PE. However, these findings should be interpreted with caution, as they originate from a subanalysis of the StopPRE trial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2273-2280"},"PeriodicalIF":3.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016009","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":"Shoulder dystocia—Still a feared complication. How can we improve?","authors":"Jens Fuglsang","doi":"10.1111/aogs.14952","DOIUrl":"10.1111/aogs.14952","url":null,"abstract":"&lt;p&gt;Shoulder dystocia is a feared, yet well-known, complication in Obstetrics. For the fetus and newborn, shoulder dystocia holds the potential of dramatic consequences. Perinatal death is the most severe complication but asphyxia, trauma to the central nervous system, to the brachial nerve plexus, and bone fractures may also leave permanent sequelae.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; For the birthing parent, perineal lesions and a traumatic experience of childbirth may have a lasting influence on life quality.&lt;/p&gt;&lt;p&gt;All obstetricians and midwives are aware of the risk of sudden shoulder dystocia in vaginal delivery and can, therefore, draw on an array of procedures to intervene in such cases. Trainees in obstetrics and gynecology and midwives will have learned various mnemotechnical acronyms to help in solving these emergency situations and, in many hospitals, team training programs exist with shoulder dystocia as one of the most frequent learning focuses. Individuals are trained in both hands-on procedures as well as the coordination of team efforts in order to minimize damage incurred to the child and parent in case of shoulder dystocia. Hence, a great deal of awareness surrounds shoulder dystocia. However, the definition of shoulder dystocia is nevertheless difficult to pinpoint and there is some subjectivity involved in its definition.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Four papers on shoulder dystocia are published in this issue of &lt;i&gt;Acta Obstetricia et Gynecologica Scandinavica&lt;/i&gt;,&lt;span&gt;&lt;sup&gt;2-5&lt;/sup&gt;&lt;/span&gt; and these may boost our knowledge in managing and counseling on shoulder dystocia.&lt;/p&gt;&lt;p&gt;In the paper by Heinonen and colleagues, the manual maneuvers that midwives and obstetricians apply in case of a recognized shoulder dystocia are brought into play.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In their study, Heinonen et al report that the use of obstetric maneuvers has increased during the study period from 2006 to 2015.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; At the same time, the rate of neonatal complications has declined. It, therefore, appears that the awareness and the treatment modalities for shoulder dystocia among birth attendants have increased, and this heightened awareness may have benefited in shoulder dystocia cases. Not unexpectedly, worse outcomes are demonstrated when the specific obstetric maneuvers directed toward shoulder dystocia are omitted and the higher the number of maneuvers the higher the risk of perineal lacerations,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; which is likely indicative of the most severe cases of shoulder dystocia.&lt;/p&gt;&lt;p&gt;This success nevertheless may come with a price. It is more difficult to ascertain whether the awareness of the risk of shoulder dystocia leads to a higher likelihood of ascribing a shoulder dystocia diagnosis to a delivery or whether obstetric maneuvers might be applied very early or even in cases that did not represent ‘real’ shoulder dystocia. It all comes down to the definition of shoulder dystocia.&lt;/p&gt;&lt;p&gt;Another take on the flow","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 10","pages":"1908-1909"},"PeriodicalIF":3.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.14952","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016010","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":"External validation of and improvement upon a model for the prediction of placenta accreta spectrum severity using prospectively collected multicenter ultrasound data.","authors":"Magdalena Kolak, Stephen Gerry, Hubert Huras, Ammar Al Naimi, Karin A Fox, Thorsten Braun, Vedran Stefanovic, Heleen van Beekhuizen, Olivier Morel, Alexander Paping, Charline Bertholdt, Pavel Calda, Zdenek Lastuvka, Andrzej Jaworowski, Egle Savukyne, Sally Collins","doi":"10.1111/aogs.14941","DOIUrl":"https://doi.org/10.1111/aogs.14941","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to validate the Sargent risk stratification algorithm for the prediction of placenta accreta spectrum (PAS) severity using data collected from multiple centers and using the multicenter data to improve the model.</p><p><strong>Material and methods: </strong>We conducted a multicenter analysis using data collected for the IS-PAS database. The Sargent model's effectiveness in distinguishing between abnormally adherent placenta (FIGO grade 1) and abnormally invasive placenta (FIGO grades 2 and 3) was evaluated. A new model was developed using multicenter data from the IS-PAS database.</p><p><strong>Results: </strong>The database included 315 cases of suspected PAS, of which 226 had fully documented standardized ultrasound signs. The final diagnosis was normal placentation in 5, abnormally adherent placenta/FIGO grade 1 in 43, and abnormally invasive placenta/FIGO grades 2 and 3 in 178. The external validation of the Sargent model revealed moderate predictive accuracy in a multicenter setting (C-index 0.68), compared to its higher accuracy in a single-center context (C-index 0.90). The newly developed model achieved a C-index of 0.74.</p><p><strong>Conclusions: </strong>The study underscores the difficulty in developing universally applicable PAS prediction models. While models like that of Sargent et al. show promise, their reproducibility varies across settings, likely due to the interpretation of the ultrasound signs. The findings support the need for updating the current ultrasound descriptors and for the development of any new predictive models to use data collected by different operators in multiple clinical settings.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008072","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}