Acta Obstetricia et Gynecologica Scandinavica最新文献

{"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}

{"title":"Prediction of spontaneous onset of labor at term using clinical, ultrasound, and biochemical data: A multicenter prospective observational study (the PREDICT study).","authors":"Federico Migliorelli, Catherine McCarey, Ludovica Ferrero, Océane Pecheux, Sara Marcenaro, Oriane Tossa, Franziska Geissler, Véronique Othenin-Girard, Antonina Chilin, Begoña Martinez de Tejada","doi":"10.1111/aogs.70188","DOIUrl":"10.1111/aogs.70188","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of the study was to develop a predictive model for spontaneous onset of labor between 39 and 41 weeks' gestation using clinical, ultrasound and biochemical features.</p><p><strong>Material and methods: </strong>We conducted a multicenter, prospective, observational study in two university hospitals in Switzerland. Women with singleton pregnancies in cephalic presentation and intact membranes who opted for expectant management until late term were eligible for the study. Predictors collected at 39 weeks included maternal characteristics, cervical ultrasound measurements and biochemical markers. Competing risks survival regression models were developed, and predictive performance was assessed using time-dependent, receiver operating characteristic curves, calibration plots, and the Brier score. The main outcome measure was spontaneous onset of labor or prelabor rupture of membranes occurring before 41 weeks' gestation.</p><p><strong>Results: </strong>A total of 429 women were recruited. Main outcome occurred in 72.0% of participants. Fourteen percent of women underwent labor induction at or beyond 41 weeks and another 14.0% required earlier induction for medical reasons. The final predictive model included maternal age, body mass index, prior vaginal delivery, cervical length, and a positive fetal fibronectin test. The model showed an area under the curve of 0.71-0.72 and good calibration. Using a dual cutoff approach to predict spontaneous labor or prelabor rupture of membranes within 7 days, participants were classified into three groups: 12.5% in a low-probability group (predicted probability ≤14.9%), 74.7% in an intermediate group (14.9%-56.8%), and 12.8% in a high-probability group (>56.8%).</p><p><strong>Conclusions: </strong>The model provides individualized probability estimates for spontaneous labor onset and may support shared decision-making in term pregnancies. Predictive accuracy was moderate, but good calibration suggested clinical utility.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"922-929"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607473","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":"Management of preterm pre-labor rupture of membranes between 24 and 34 weeks: A before-and-after study of the implementation and modifications of an outpatient management protocol.","authors":"Antonin Seyral, Mathilde Barrois, Aude Girault, Bruna Perrella, François Goffinet, Camille Le Ray","doi":"10.1111/aogs.70162","DOIUrl":"10.1111/aogs.70162","url":null,"abstract":"<p><strong>Introduction: </strong>In preterm pre-labor rupture of membranes (PPROM) before 34 weeks, expectant management is preferred in the absence of infection to reduce neonatal morbidity. Outpatient management (OM) has emerged as a potential alternative to prolonged hospitalization, but selection criteria remain ill-defined. Our objective was to evaluate latency between PPROM and delivery, and obstetric and neonatal outcomes before and after the implementation of an OM protocol and its subsequent extensions.</p><p><strong>Material and methods: </strong>We included all women with PPROM before 34 weeks admitted between January 1, 2011, and December 31, 2021. Two periods were compared: Period A (January 2011-April 2013), when all patients were hospitalized until delivery, and Period B (May 2013-December 2021), when eligible patients were offered OM. Period B was subdivided into three phases (B1-B3) reflecting progressive expansion of eligibility criteria-from stable singleton pregnancies with cephalic presentation and normal amniotic fluid (B1), to inclusion of twins and shorter stabilization periods (B2), and finally cases with oligohydramnios or non-cephalic presentations (B3). The primary outcome was latency period (days between PPROM and delivery). Secondary outcomes included obstetric and neonatal complications. Comparisons were made between Periods A and B and across OM subperiods.</p><p><strong>Results: </strong>A total of 539 patients were included: 145 in Period A and 394 in Period B, of whom 126 (32%) received OM. Mean gestational age at PPROM was similar between periods (28.9 ± 3.1 vs. 28.9 ± 3.3 weeks; p = 0.94), as were latency (median 7 [3-17] days vs. 8 [2-21]; p = 0.66) and gestational age at delivery (30.8 ± 3.3 vs. 30.9 ± 3.8 weeks; p = 0.62). Early neonatal bacterial infection was significantly lower in Period B (24.2% vs. 34.5%; p = 0.01). OM use increased steadily from B1 to B3 without prolonging latency or worsening outcomes.</p><p><strong>Conclusion: </strong>Following OM protocol implementation, one-third of eligible women with PPROM before 34 weeks were managed at home. Outpatient care, even with broadened eligibility, appeared safe, did not increase maternal or neonatal morbidity, and may reduce early neonatal infections without extending latency.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"896-903"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147626816","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":"Methodological considerations regarding predictor selection and model overfitting in a study of emergency cerclage.","authors":"Weizeng Chen, Xiaofang Xuan","doi":"10.1111/aogs.70197","DOIUrl":"10.1111/aogs.70197","url":null,"abstract":"","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"969"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147626844","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":"Preoperative risk factors and their cumulative impact on nonsatisfaction after benign hysterectomy: A population-based nation-wide register study.","authors":"Lollo Makdessi Björkström, Mats Fredrikson, Ninnie Borendal Wodlin, Lena Nilsson, Christer Borgfeldt, Preben Kjølhede","doi":"10.1111/aogs.70200","DOIUrl":"10.1111/aogs.70200","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to determine preoperative risk factors for nonsatisfaction 1 year after hysterectomy for benign indication and to analyze whether multiple co-occurring preoperative risk factors increase the rate of nonsatisfaction.</p><p><strong>Material and methods: </strong>A historical register study was conducted using data from the Swedish National Register for Gynecological Surgery of women aged 18-56 years, who underwent hysterectomy for benign conditions between 2004 and 2023. Satisfaction 1 year postoperatively was dichotomized into satisfaction or nonsatisfaction. Multiple logistic regression was used to evaluate preoperative risk factors, with results presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Nagelkerke's coefficient of determination (R²) assessed the explanatory power of the models.</p><p><strong>Results: </strong>Among the 38 044 participating women, 3335 (8.8%) were not satisfied after 1 year. Preoperative risk factors for nonsatisfaction were smoking (aOR 1.34, 95% CI: 1.18-1.53), not being gainfully employed (aOR 1.60, 95% CI: 1.40-1.82), and the main symptoms leading to hysterectomy (pain (aOR 1.91, 95% CI: 1.70-2.15), pressure/heaviness (aOR 1.90, 95% CI: 1.53-2.21), other symptoms (aOR 2.24, 95% CI: 1.95-2.59), or several main symptoms (aOR 1.92, 95% CI: 1.53-2.41)). Protective factors for nonsatisfaction were age 46-50 years (aOR 0.87, 95% CI: 0.76-1.00) and minimally invasive hysterectomy (vaginal [aOR 0.69, 95% CI: 0.59-0.81], laparoscopic [aOR 0.79, 95% CI: 0.68-0.91], and robot-assisted laparoscopic [aOR 0.82, 95% CI: 0.71-0.95]). The likelihood of being nonsatisfied rose with the accumulation of preoperative risk factors, as reflected by the full model's explanatory power (R² = 0.141). Among individual predictors, the main symptom leading to hysterectomy contributed most to the explained variance (R² = 0.029), followed by employment status (R² = 0.009), while other factors, such as surgical route, age, and smoking only marginally contributed to the variance.</p><p><strong>Conclusions: </strong>Nearly, 9% of the women were nonsatisfied with the outcome of the hysterectomy after 1 year. Lack of satisfaction appeared predictable from preoperative factors, notably smoking, not being gainfully employed, and nonbleeding symptoms leading to hysterectomy. These findings emphasize the need for individualized counseling before surgery. Given that most preoperative risk factors are resistant to immediate modification, more research is needed to develop targeted interventions that can reduce nonsatisfaction and enhance patient outcomes.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"948-959"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632241","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":"Women with PCOS have a later menopausal transition and a lower prevalence of menopausal symptoms at age 46: A population-based birth cohort study.","authors":"Johanna Lavi, Susanna Savukoski, Elisa Hurskainen, Meri-Maija Ollila, Laure Morin-Papunen, Maarit Niinimäki, Terhi T Piltonen","doi":"10.1111/aogs.70198","DOIUrl":"10.1111/aogs.70198","url":null,"abstract":"<p><strong>Introduction: </strong>Women with polycystic ovary syndrome (PCOS) have been suggested to experience later menopause, yet population-based studies are lacking. The present study aimed to assess, in a population-based birth cohort, whether women with PCOS are more likely to experience late peri-/postmenopause or to have menopausal symptoms in their mid-40s than women without the syndrome.</p><p><strong>Material and methods: </strong>The present study is a long-term, population-based prospective cohort study from the Northern Finland Birth Cohort 1966 (NFBC1966). The PCOS group (n = 380) was identified based on the Rotterdam criteria (oligomenorrhea, hyperandrogenism, or polycystic ovarian morphology according to anti-Müllerian hormone levels). Women who did not meet the Rotterdam criteria for PCOS were considered as controls (n = 1469). Late peri-/postmenopause was defined as at least 60 days of amenorrhea accompanied by elevated follicle-stimulating hormone levels (>25 IU/L) or the use of menopausal hormone therapy. In women who had undergone hysterectomy or were using progestins, menopausal status was defined as elevated follicle-stimulating hormone levels (>25 IU/L). Menopausal symptoms were self-reported via questionnaire during a follow-up visit at age 46.</p><p><strong>Results: </strong>Women with PCOS had a significantly lower likelihood of being late peri-/postmenopausal in their mid-40s compared with controls (PCOS: 3.1% vs. Controls: 18.4%; adjusted odds ratio 0.15, 95% confidence interval 0.07-0.32). To support this result, women with PCOS more often reported having regular menstrual cycles and had a lower risk of menopausal symptoms at age 46, even after adjusting for body mass index, education, and smoking status (adjusted odds ratio 0.68, 95% confidence interval 0.51-0.92). Hot flashes and sleep disturbances were less frequent among women with PCOS, but there were no differences in other menopause-related symptoms, such as vaginal dryness, affective symptoms, memory disturbances, or sexual dysfunction between the study groups.</p><p><strong>Conclusions: </strong>From the nonselective population data, it was shown that late peri-/postmenopausal status and symptoms were less frequent in women with PCOS at age 46, supporting the idea of prolonged ovarian function in affected women. This should be considered in patient counseling and future studies of fertility, contraception, and menopausal hormone therapy.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"836-846"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632234","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":"Prophylactic carbetocin versus oxytocin following vaginal delivery among women with high risk for postpartum hemorrhage: A before-and-after study.","authors":"Margot Sauvee, Emelyne Lefizelier, Louen Ropers, Jerome Dimet, Guillaume Ducarme","doi":"10.1111/aogs.70180","DOIUrl":"10.1111/aogs.70180","url":null,"abstract":"<p><strong>Introduction: </strong>Data with a high level of evidence is lacking on the use of prophylactic uterotonic drug following vaginal delivery to prevent postpartum hemorrhage (PPH) among women who were considered high-risk for PPH. Our main objective was to compare the effectiveness of prophylactic carbetocin versus oxytocin in preventing PPH after vaginal delivery among women at high risk.</p><p><strong>Material and methods: </strong>We conducted a retrospective before-and-after single-center comparative study, including all high-risk women after vaginal births. Two consecutive 14-month periods were compared, where the prophylactic methods to prevent PPH differed: oxytocin (5 IU IV) versus carbetocin (100 μg IV) given immediately after vaginal delivery. High-risk women were defined by at least one of the following criteria: previous PPH (blood loss ≥500 mL), antenatal suspicion of macrosomia (estimated fetal weight >90th p), twin pregnancy, repeated cervical ripening methods, polyhydramnios, multiparity (≥4), and rapid labor (<2 h) without analgesia. The primary outcome was PPH. Secondary outcomes included severe PPH (blood loss ≥1000 mL), second-line uterotonic agents, surgical hemostatic procedures, uterine artery embolization, and maternal morbidity. Groups were matched 1:1 by risk criteria. Outcomes were assessed using univariate analysis, multivariable logistic regression, and propensity score adjustment.</p><p><strong>Results: </strong>A total of 754 women (377 per group) were included. Maternal and labor characteristics were comparable. Rates of PPH and severe PPH were similar with carbetocin versus oxytocin (7.4% vs. 9.3%, p = 0.36; 2.9% vs. 2.7%, p = 0.83). The need for second-line uterotonics (additional oxytocin and/or sulprostone) was significantly lower with carbetocin (3.7% vs. 12.2%, p < 0.001). Other secondary outcomes did not differ. After adjustment for potential confounders (history of PPH, BMI, intrapartum fever), prophylactic carbetocin was not associated with increased risk of PPH (aOR = 1.85, 95% CI [0.97 to 3.57]). Propensity score analysis confirmed these findings (aOR = 1.33, 95% CI [0.74 to 1.72]).</p><p><strong>Conclusions: </strong>Prophylactic carbetocin was associated with a similar rate of PPH in high-risk women after vaginal delivery, compared with oxytocin, but significantly reduced the use of oxytocin when carbetocin was used as the first-line agent, although there was no difference in the use of prostaglandins or invasive procedures to manage persistent PPH.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"940-947"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147281799","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":"Birth and abortion rates among young women over the past 50 years examined in relation to providers and reimbursement for hormonal contraception across the Nordic countries, an ecological study.","authors":"Finn Egil Skjeldestad, Mika Gissler, Reynir Tómas Geirsson, Kristina Gemzell-Danielsson, Oskari Heikinheimo","doi":"10.1111/aogs.70173","DOIUrl":"10.1111/aogs.70173","url":null,"abstract":"<p><strong>Introduction: </strong>With liberalization of abortion laws in the Nordic countries during the 1970s, there were efforts to prevent unplanned pregnancies among young women by improved contraceptive provision. In an ecological design, we describe country-specific actions for meeting young women's contraceptive needs and their impact on induced abortion and births.</p><p><strong>Material and methods: </strong>We used national data from 1974 to 2023 on populations and numbers of induced abortions and births for 15-19- and 20-24-year-old women. Available public documents included information on preventive measures, availability of hormonal contraceptives (providers/dispensation), and reimbursement schemes. Joinpoint regression analysis was used to assess breakpoints in country-specific age trends for annual abortion and birth rates.</p><p><strong>Results: </strong>Sweden authorized midwives to prescribe contraceptives in 1976, Norway in 2002 (and public health nurses), Finland in 2020 (and public health nurses) and Iceland in 2021, while physicians have remained the only provider in Denmark. Sweden set up youth clinics from the late 1970s and clinics opened in Norway from the early 1990s. Partial or full reimbursement for combined oral contraceptives to 16-23-year-old women began gradually in Sweden in the early 1990s and expanded to a national program on contraceptives in 2014/2016. A Norwegian free-of-charge scheme to 16-19-year-old women for combined oral contraceptives from 2002 changed in 2006 to include partial coverage for short-acting reversible contraceptives and was expanded to long-acting reversible contraceptives in 2015/2016. In Finland two large cities offered long-acting reversible contraceptive free-of-charge from 2007/2013. Denmark and Iceland have not had reimbursement schemes for hormonal contraceptives. We found no breakpoints in trends for induced abortions and births that could relate to any preventive actions. Trends were relatively similar in countries with or without expanded prescription rights to midwives/public health nurses and unrelated to reimbursement schemes. Birth rates among women <25 years are now <10% of those seen 50 years ago, while most of the decline in abortion rates took place after 2010.</p><p><strong>Conclusion: </strong>Trends for induced abortion and births among women <25 years have developed similarly across the Nordic countries. They are global and appear less likely to be associated with national health services and targeted contraceptive policies.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"847-858"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497270","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":"Port-site hernia following laparoscopic gynecological surgery: A systematic review and meta-analysis.","authors":"Franciszek Ługowski, Zofia Włodarczyk, Anna Owczarek, Łucja Zaborowska, Artur Ludwin","doi":"10.1111/aogs.70176","DOIUrl":"10.1111/aogs.70176","url":null,"abstract":"<p><strong>Introduction: </strong>Port-site hernia (PSH) is a rare but clinically relevant complication of laparoscopic gynecologic surgery. Despite the widespread adoption of minimally invasive techniques, no prior systematic review has comprehensively evaluated PSH incidence and risk factors in this population.</p><p><strong>Material and methods: </strong>A systematic review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42025649280). PubMed, Scopus, Web of Science, and Embase were searched without language or date restrictions. Eligible studies included randomized or cohort designs reporting PSH incidence after laparoscopic gynecologic procedures. Pooled incidence was calculated using a random-effects model.</p><p><strong>Results: </strong>Twenty-two studies comprising 70 346 patients were included. The overall pooled PSH incidence was 0.29% (95% CI: 0.00 to 0.02), with significant heterogeneity (I² = 99.3%). Sensitivity analysis excluding outliers reduced heterogeneity (I² = 83.1%) without altering direction or significance. Elevated body mass index (BMI), diabetes mellitus, and advanced age were consistent patient-related risk factors, while larger trocar size (≥10 mm), single-port access, and inadequate fascial closure were major surgical contributors.</p><p><strong>Conclusions: </strong>PSH following laparoscopic gynecologic surgery remains a rare but clinically significant occurrence. Surgical technique, particularly trocar size selection and fascial closure, plays a decisive role in risk reduction. Attention to modifiable intraoperative factors is crucial for optimizing patient safety and preventing postoperative hernia formation.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"778-794"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147388809","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":"Intrapartum CTG characteristics associated with isolated single umbilical artery in term fetuses: A matched case-control study.","authors":"Phebe B Q Berben, Ivar R de Vries, Rik Vullings, M Beatrijs van der Hout-van der Jagt, S Guid Oei, Judith O E H van Laar","doi":"10.1111/aogs.70190","DOIUrl":"10.1111/aogs.70190","url":null,"abstract":"<p><strong>Introduction: </strong>Isolated single umbilical artery (iSUA) is associated with a fivefold increased risk for perinatal mortality, even though placental blood flow is not reduced compared to healthy fetuses. In recent work, the umbilical cord was shown to have a protective effect against intrapartum fetal acidosis, which is reduced in the case of relevant cord anomalies like iSUA. This study aimed to investigate the protective effect of the umbilical cord against fetal acidosis by comparing cardiotocogram (CTG) characteristics of fetuses with iSUA against controls.</p><p><strong>Material and methods: </strong>In this retrospective, matched case-control study in a tertiary care center in the Netherlands, computerized CTG analyses were performed on intrapartum registrations for 9 iSUA patients and 35 case-matched controls. CTGs were analyzed for stages of hypoxia classification, CTG characteristics of fetal heart rate such as baseline, variability, (late) decelerations, overshoots, FHR recovery duration, and characteristics of uterine contractions. Linear regression analyses were performed for the CTG parameters, adjusted for uterine contraction frequency and average inter-contraction duration. Neonatal outcome parameters were compared between the iSUA group and healthy controls.</p><p><strong>Results: </strong>The prevalence of decelerations followed by an overshoot was two to three times higher in the iSUA group (p = 0.011 for stage 1 and p = 0.001 for stage 2 of labor) and a longer average fetal heart rate recovery duration for stage 1 of labor was found as well (p = 0.001). Furthermore, iSUA was found to have a higher prevalence of late decelerations in stage 1 (p = 0.042) and shorter decelerations (p = 0.046) along with less decelerations exceeding 1 min (p = 0.017) during stage 2. No differences in hypoxia staging or the presence of saltatory patterns were found. Neonatal outcomes indicative of birth asphyxia did not occur in the study population.</p><p><strong>Conclusions: </strong>These findings support epidemiological findings that term fetuses with iSUA are more susceptible to hypoxia, warranting further research into tailored management strategies.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":"930-939"},"PeriodicalIF":3.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637605","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}