Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Cervical cancer in Region Skåne, Sweden 2017–2020 after the implementation of primary HPV screening: A quality assurance audit","authors":"Caroline Hellsten,&nbsp;Anna Holmberg,&nbsp;Jennica Astrom,&nbsp;Ola Forslund,&nbsp;Christer Borgfeldt","doi":"10.1111/aogs.14691","DOIUrl":"10.1111/aogs.14691","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Primary human papilloma virus (HPV) screening to detect cervical cancer and dysplastic lesions was implemented in Region Skåne 2017 for women aged 30–70. The aim of this study was to characterize the screening history of women diagnosed with cervical cancer to evaluate the performance of the screening program, as well as to assess the cancer treatments given and shortcomings in the follow-up of women with cervical dysplasia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>We performed a quality assurance audit. The data was collected from the National Cervical Cancer Prevention Registry, Region Skåne Labmedicin database and the Melior Journal system in 2017–2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 247 women diagnosed with invasive cervical cancer in Region Skåne in 2017–2020. Of these, 35 (14.2%) had a screening history over at least two screening rounds before diagnosis. There were 25 (10.1%) women diagnosed with cervical cancer in between screening intervals, i.e., interval cancer. The most common screening history in women with cervical cancer was irregular screening (143, 57.9%), followed by women being above screening age (44, 17.8%). HPV was detected in 96% of the cases, either in cervical cytology or in the tumor tissue. The screening program detected the disease in 96 (38.9%) of the patients, 149 (60.3%) were diagnosed through symptoms and two (0.80%) as a result of incidental findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The most powerful tool in the prevention of cervical cancer is screening program attendance. Prolongation with HPV screening among elderly women will also reduce the incidence of cervical cancer. Today, such cancers are usually discovered when symptoms appear.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 1","pages":"129-137"},"PeriodicalIF":4.3,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10755128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41187848","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":"Clinical effectiveness of routine first-trimester combined screening for pre-eclampsia in Spain with the addition of placental growth factor","authors":"Pablo Garcia-Manau,&nbsp;Erika Bonacina,&nbsp;Berta Serrano,&nbsp;Sara Caamiña,&nbsp;Marta Ricart,&nbsp;Eva Lopez-Quesada,&nbsp;Àngels Vives,&nbsp;Monica Lopez,&nbsp;Elena Pintado,&nbsp;Anna Maroto,&nbsp;Sara Catalan,&nbsp;Marta Dalmau,&nbsp;Ester Del Barco,&nbsp;Alina Hernandez,&nbsp;Marta Miserachs,&nbsp;Marta San Jose,&nbsp;Mireia Armengol-Alsina,&nbsp;Elena Carreras,&nbsp;Manel Mendoza","doi":"10.1111/aogs.14687","DOIUrl":"10.1111/aogs.14687","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pre-eclampsia affects 2%–8% of pregnancies and is one of the leading causes of maternal and perinatal morbidity and mortality. First-trimester screening using an algorithm that combines maternal characteristics, mean arterial blood pressure, uterine artery pulsatility index and biomarkers (pregnancy-associated plasma protein-A and placental growth factor) is the method that achieves a greater diagnostic accuracy. It has been shown that daily salicylic acid administration before 16 weeks in women at a high risk for pre-eclampsia can reduce the incidence of preterm pre-eclampsia. However, no previous studies have evaluated the impact of routine first-trimester combined screening for pre-eclampsia with placental growth factor after being implemented in the clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>This was a multicenter cohort study conducted in eight different maternities across Spain. Participants in the reference group were prospectively recruited between October 2015 and September 2017. Participants in the study group were retrospectively recruited between March 2019 and May 2021. Pre-eclampsia risk was calculated between 11⁺⁰ and 13⁺⁶ weeks using the Gaussian algorithm combining maternal characteristics, mean arterial pressure, uterine arteries pulsatility index, pregnancy-associated plasma protein-A and placental growth factor. Patients with a risk greater than 1/170 were prescribed daily salicylic acid 150 mg until 36 weeks. Patients in the reference group did not receive salicylic acid during gestation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A significant reduction was observed in preterm pre-eclampsia (OR 0.47; 95% CI: 0.30–0.73), early-onset (&lt;34 weeks) pre-eclampsia (OR 0.35; 95% CI: 0.16–0.77), preterm small for gestational age newborn (OR 0.57; 95% CI: 0.40–0.82), spontaneous preterm birth (OR 0.72; 95% CI: 0.57–0.90), and admission to intensive care unit (OR 0.55; 95% CI: 0.37–0.81). A greater treatment adherence resulted in a significant reduction in adverse outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Routine first-trimester screening for pre-eclampsia with placental growth factor leads to a reduction in preterm pre-eclampsia and other pregnancy complications. Aspirin treatment compliance has a great impact on the effectiveness of this screening program.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"102 12","pages":"1711-1718"},"PeriodicalIF":4.3,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41181754","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":"Probability of second live birth after first natural and medically assisted reproduction-mediated live birth: A historical cohort study","authors":"Giovanna Esposito,&nbsp;Fabio Parazzini,&nbsp;Paola Viganò,&nbsp;Matteo Franchi,&nbsp;Sonia Cipriani,&nbsp;Francesco Fedele,&nbsp;Giovanni Corrao,&nbsp;Edgardo Somigliana","doi":"10.1111/aogs.14685","DOIUrl":"10.1111/aogs.14685","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Evidence on the role of medically assisted reproduction (MAR) in achieving the desired number of children is very limited. The aim of the current investigation was to assess the probability and the mode of conception of a second live birth according to the mode of conception of the first one.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>This historical cohort study was based on administrative data from regional healthcare databases. Women hospitalized for childbirth in Lombardy between January 1, 2007 and December 31, 2017 were identified. The probability of a second live birth up to 2021 was estimated using the Kaplan–Meier method. We calculated this probability according to the mode of conception of the first birth, and the analysis was also performed in strata of maternal age at first birth. Cox proportional hazards models were fitted to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the association between mode of conception at first live birth and the probability of having a second live birth. Mothers were right-censored if they moved out of the region, died, or did not have a second live birth by the end of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 431 333 women who had their first live birth after a natural conception and 16 837 who had their first live birth after MAR. The probability of having a second live birth was 58.6% and 32.1%, respectively in the two groups (HR = 0.68, 95% CI: 0.66–0.70). Considering solely women who naturally conceived their first live birth, the probability to have a second child with MAR was 1.1% and to have a second child naturally 59.3%. The corresponding values were 11.5% and 25.2% in the group of women with a first MAR-mediated live birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In our cohort, one woman out of 10 having a first MAR-mediated live birth underwent MAR programs again. Considering women who had a first natural live birth, this proportion was drastically reduced. In the field of MAR, more attention should be given to the capacity of a couple to achieve the number of desired children.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 1","pages":"121-128"},"PeriodicalIF":4.3,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10755134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41181755","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":"Sacral neuromodulation in endometriosis – A promising treatment option for chronic pelvic pain","authors":"Adrian Zegrea,&nbsp;Emilia Ojala,&nbsp;Pia Suvitie,&nbsp;Pirita Varpe,&nbsp;Heikki Huhtinen,&nbsp;Johanna Mäkelä-Kaikkonen,&nbsp;Tero Rautio,&nbsp;Päivi Härkki,&nbsp;Sinikka Salmenkylä,&nbsp;Mika Ukkonen,&nbsp;Maija Lavonius,&nbsp;Tarja Pinta","doi":"10.1111/aogs.14690","DOIUrl":"10.1111/aogs.14690","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Chronic pelvic pain (CPP) affects over one fifth of women worldwide, and endometriosis is one of the most common causes. In the present study, we examined whether sacral neuromodulation (SNM) is effective in the treatment of refractory chronic pelvic pain in women with endometriosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>This multicenter prospective pilot study was started in 2017 and includes patients with chronic pelvic pain with no other obvious pathology than endometriosis. Other treatment options have been tried or they are unsuitable. Patients underwent SNM implantation. The main outcome was postoperative pain reduction and secondary outcome was quality of life. The following questionnaires were used to assess the outcomes: Brief pain inventory (BPI), clinical global impression - improvement (CGI-I), 15D-measure of health-related quality of life, and Biberoglu and Behrman (B&amp;B) score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 35 patients underwent the SNM procedure and, at the time of analysis, 15 patients had returned one-year questionnaires. The patients had a history of endometriosis for a median of 5.5 (interquartile range 2–9) years, with no correlation between the severity of symptoms and the duration of the disease (<i>p</i> = 0.158). A total of 31 patients (89%) were implanted with the internal pulse generator. There were statistically significant changes in BPI pain-related items. Worst experienced daily pain decreased among those who returned 12-month questionnaires from median 9 to 5 (<i>p</i> = 0.006), average daily pain from 6 to 3.5 (<i>p</i> = 0.004), and least daily pain from 3 to 1 (<i>p</i> = 0.004). Based on the CGI questionnaire (<i>n</i> = 14), at 12 months nine patients (60%) experienced great improvement in their symptoms, three patients (20%) much improvement and two patients (13%) minimal improvement. None of the patients experienced worsening of their symptoms. There was a statistically significant change in overall 15D score at 1 month (<i>p</i> &lt; 0.001), 6 months (<i>p</i> = 0.001) and 12 months (<i>p</i> = 0.018), when the results were compared to baseline values. Median B&amp;B score also improved significantly and decreased from a baseline value of 8 (4–12) to 4.5 (0–6), <i>p</i> = 0.002.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Based on the preliminary findings of our study, SNM might be a promising treatment of CPP in endometriosis patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"102 12","pages":"1634-1642"},"PeriodicalIF":4.3,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41181756","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":"Fetal sex and the development of gestational diabetes mellitus in gravidae with multiple gestation pregnancies","authors":"Alexa M. Sassin,&nbsp;Haleh Sangi-Haghpeykar,&nbsp;Kjersti M. Aagaard","doi":"10.1111/aogs.14625","DOIUrl":"10.1111/aogs.14625","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;There is an increasing incidence of pregnancies with twin gestations. One outcome more likely to occur with multiple gestations is gestational diabetes mellitus. Studies have suggested that in singleton pregnancies, fetal sex may affect insulin resistance. However, the effects of fetal sex in twins and the development of gestational diabetes mellitus are unknown. We hypothesized that rates of gestational diabetes mellitus and degree of insulin resistance might vary in twin gestations based on the fetal sex pairing: male–male, male–female or female–female. We aimed to employ a large population-based database to ascertain any correlations between fetal sex and gestational diabetes mellitus in multifetal gestations.&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;A two-hospital, single academic institution database comprised of over 39 000 participants with pregnancy data from August 2011 to January 2022 was employed. All twin deliveries of live-born neonates &gt;24 weeks’ gestational age from gravidae without preexisting diabetes or twin–twin transfusion syndrome were included. Entries were then grouped based on the fetal sex of the pairing. The presence or absence of gestational diabetes and type of gestational diabetes – diet-controlled (gestational diabetes mellitus classification A1) vs medication-controlled (gestational diabetes mellitus classification A2) – were identified. Statistical analysis was performed using a generalized linear mixed method, and a &lt;i&gt;P&lt;/i&gt;-value ≤0.05 was considered statistically significant.&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;We identified 1924 twin deliveries that met the inclusion criteria in our database (male–male =652; male–female = 638; female–female = 634). We found no association between fetal sex pairing and the development of gestational diabetes mellitus. There was a significant association between the fetal sex pairing and the type of gestational diabetes mellitus developed, with 32.0% of male–male twins, 33.3% of male–female twins and 58.3% of the female–female twin deliveries associated with medication-controlled gestational diabetes classification A2: male–female vs female–female (&lt;i&gt;P&lt;/i&gt; = 0.05) and male–male vs female–female (&lt;i&gt;P&lt;/i&gt; = 0.046).&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;While gestational diabetes mellitus is of multifactorial origin, we found a significant association between the fetal sex pairing and the treatment needed for gravidae with twins who develop gestational diabetes mellitus. A higher proportion of femal","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"102 12","pages":"1703-1710"},"PeriodicalIF":4.3,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41097615","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":"Understanding and addressing female pelvic pain - a multifaceted challenge","authors":"Tina Tellum,&nbsp;Davor Jurkovic","doi":"10.1111/aogs.14682","DOIUrl":"10.1111/aogs.14682","url":null,"abstract":"&lt;p&gt;Chronic pelvic pain (CPP) is a major health issue which blights the lives of one in five women around the world.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This persistent and often debilitating condition can have a profound negative impact on the quality of life for women which affects their physical, emotional, and social well-being. The broader societal implications include the economic burden through lost workdays and healthcare costs, not to mention the strain on relationships and families which many women experience as a result of CPP.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Pelvic pain can represent a diagnostic challenge as multiple pelvic pain syndromes often overlap in the same patient, as well as nonpelvic conditions, such as migraine, chronic fatigue, and fibromyalgia.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Not only gynecologists, but a range of different healthcare professionals meet people with pelvic pain. Asking specialists about which condition comes to mind first when thinking of pelvic pain, you will likely receive a myriad of responses – from endometriosis to pelvic floor disorders to biosocial models, each expert offering a perspective colored by their background and special interest.&lt;/p&gt;&lt;p&gt;While this diversity of viewpoints is expected, it might represent a problem when field-specific blinders are put on. This might inadvertently lead to misdiagnoses and, worse yet, disregard for patients' experiences. The consequences of such oversight are significant, as undiagnosed conditions can result in patients being dismissed,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; or inappropriate and possible harmful treatments initiated. On the other hand, medical practitioners may often find it hard to discern the root causes of CPP and decide on the most appropriate treatment.&lt;/p&gt;&lt;p&gt;In this themed issue, we have brought together studies with a broad range of interests and expertise to cover various aspects of pelvic pain, aiming to bring awareness and broaden perspectives to this complex subject.&lt;/p&gt;&lt;p&gt;Endometriosis stands as a leading cause of chronic pelvic pain. Three studies in this issue look at deep- and bowel endometriosis from different perspectives. While Chaggar et al.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; demonstrate the reproducibility of ultrasound predictors important for optimizing surgery planning, Hudelist et al.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; show the association of different surgical techniques for bowel endometriosis with pelvic pain and bowel function. Knez et al.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; on the other hand complete the perspective by investigating what happens when deep endometriosis is left untreated - will it automatically progress, as often feared by doctors and patients? The answer is no, demonstrating that expectant management can the best “treatment” for the right patient. What can be done for the patient suffering from endometriosis associated pain, who has no benefit from either surgery or medication? A broad grasp of pain mechanisms, including central sensitization, mandates that physi","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"102 10","pages":"1248-1249"},"PeriodicalIF":4.3,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.14682","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41099855","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":"Factors in early pregnancy predicting pregnancy-related pain in the second and third trimester","authors":"Ruth K. Ertmann,&nbsp;Dagny R. Nicolaisdottir,&nbsp;Volkert Siersma,&nbsp;Gritt Overbeck,&nbsp;Sarah Strøyer de Voss,&nbsp;Frederikke Agerbo Modin,&nbsp;Melissa C. Lutterodt","doi":"10.1111/aogs.14670","DOIUrl":"10.1111/aogs.14670","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pain during pregnancy affects women's well-being, causes worry and is a risk factor for the child and the mother during labor. The aim was to investigate the relative importance of an extensive set of pregnancy-related physiological symptoms and psychosocial factors assessed in the first trimester compared with the occurrence of pregnancy-related pain symptoms later in the pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>Included were all women who booked an appointment for a first prenatal visit in one of 125 randomly selected general practitioner practices in Eastern Denmark from April 2015 to August 2016. These women answered an electronic questionnaire containing questions on the occurrence of five pregnancy-related pain symptoms: back pain, leg cramps, pelvic cavity pain, pelvic girdle pain and uterine contractions. The questionnaire also included sociodemographic questions and questions on chronic diseases, physical symptoms, mental health symptoms, lifestyle and reproductive background. The questionnaire was repeated in each trimester. The relative importance of this set of factors from the first trimester on the five pregnancy-related pain symptoms compared with the second and third trimesters was assessed in a dominance analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1491 women were included. The most important factor for pregnancy-related pain in the second trimester and third trimester is the presence of the corresponding pain in the first trimester. Parity was associated with pelvic cavity pain and uterine contractions in the following pregnancies. For back pain and pelvic cavity pain, the odds increased as the women's estimated low self-assessed fitness decreased and had low WHO-5 wellbeing scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>When including physical risk factors, sociodemographic factors, psychological factors and clinical risk factors, women's experiences of pregnancy-related pain in the first trimester are the most important predictors for pain later in pregnancy. Beyond the expected positive effects of pregnancy-related pain, notably self-assessed fitness, age and parity were predictive for pain later in pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"102 10","pages":"1269-1280"},"PeriodicalIF":4.3,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4e/a2/AOGS-102-1269.PMC10541159.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41104040","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":"Universal cervical length screening for preterm birth is not useful after 24 weeks of gestation","authors":"Viola Seravalli,&nbsp;Isabella Abati,&nbsp;Noemi Strambi,&nbsp;Lorenzo Tofani,&nbsp;Claudia Tucci,&nbsp;Enrico Tartarotti,&nbsp;Mariarosaria Di Tommaso","doi":"10.1111/aogs.14683","DOIUrl":"10.1111/aogs.14683","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;Cervical length measurement using transvaginal sonography at 18&lt;sup&gt;+0&lt;/sup&gt;–24&lt;sup&gt;+0&lt;/sup&gt; weeks of gestation is used to identify women at risk of preterm delivery, who may benefit from treatment with progesterone to prevent premature birth. Few and conflicting data exist regarding the predictive value of cervical length measurement performed at later gestational ages. The primary objective of this study was to evaluate the predictive accuracy for spontaneous preterm birth of a single cervical length measurement performed between 24 and 32 weeks of gestation in asymptomatic singleton pregnancies at low risk for spontaneous preterm birth. The secondary objective was to test the predictive accuracy of different cervical length thresholds in the same population.&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 was a historical cohort study conducted in a tertiary referral hospital. A total of 2728 asymptomatic women with singleton pregnancy at low risk for spontaneous preterm birth were recruited. Of these women, 1548 had cervical length measured at 24&lt;sup&gt;+0&lt;/sup&gt;–27&lt;sup&gt;+6&lt;/sup&gt; weeks of gestation and 2191 women at 28&lt;sup&gt;+0&lt;/sup&gt;–32&lt;sup&gt;+0&lt;/sup&gt; weeks. In all, 1010 women were present in both gestational age windows. Maternal demographics, medical and obstetrical history, and pregnancy outcome were reviewed. The predictive value of cervical length for spontaneous preterm birth was evaluated through logistic regression analysis. Results were adjusted for confounding factors.&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;Overall, spontaneous preterm birth occurred in 53/2728 women (1.9%). In both the 24&lt;sup&gt;+0&lt;/sup&gt;–27&lt;sup&gt;+6&lt;/sup&gt; and 28&lt;sup&gt;+0&lt;/sup&gt;–32&lt;sup&gt;+0&lt;/sup&gt; weeks groups, a shorter cervical length was significantly associated with spontaneous preterm birth (&lt;i&gt;p&lt;/i&gt; &lt; 0.01), but it had a low predictive value, as shown by the receiver operating characteristics curve analysis (areas under the curve 0.62, 95% CI 0.50–0.74 for the 24&lt;sup&gt;+0&lt;/sup&gt;–27&lt;sup&gt;+6&lt;/sup&gt; weeks group, and 0.61, 95% CI 0.52–0.70 in the 28&lt;sup&gt;+0&lt;/sup&gt;–32&lt;sup&gt;+0&lt;/sup&gt; weeks group). When the predictive accuracy for preterm delivery of different cervical length cut-offs was evaluated, the sensitivity and positive predictive value were low in both gestational age windows, irrespective of the threshold used.&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;In asymptomatic women with singleton pregnancy at low risk for spontaneous preterm birth, the predictive value of cervical length after 24&lt;sup&gt;+0&lt;/sup&gt; weeks of ge","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"102 11","pages":"1541-1548"},"PeriodicalIF":4.3,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.14683","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41095038","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":"Critical care, maternal and neonatal outcomes of pregnant women with COVID-19 admitted to eight intensive care units during the wildtype, alpha and delta waves of the pandemic across the North West of England—a retrospective review","authors":"Kailash Bhatia,&nbsp;Malachy Columb,&nbsp;Bhaskar Narayan,&nbsp;Anthony Wilson,&nbsp;Group of Obstetric Anesthetists of Lancashire; Greater Manchester and Mersey (GOAL-GM) Study Collaborators","doi":"10.1111/aogs.14681","DOIUrl":"10.1111/aogs.14681","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;Few studies have described obstetric and critical care outcomes in pregnant women with COVID-19 needing intensive care unit (ICU) admission.&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;Obstetric and critical care outcomes of COVID-19 women admitted to eight ICUs from April 1, 2020 to September 15, 2021, in the North West of England were retrospectively analyzed. Women admitted to ICU were assigned to three groups: antepartum women discharged from ICU prior to delivery (antepartum ICU-discharged group), antepartum women who had expedited delivery (antepartum ICU-delivered group) and a postpartum group. Our aims were to describe maternal characteristics and assess how delivery influenced the obstetric and critical care outcomes in these 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;During the study period, 615 women tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), of whom 62 (10.1%) needed ICU admission due to symptomatic COVID-19. Pregnancy loss (3.2%) was recorded in two women. Detailed obstetric and critical outcomes from 60 women are reported. Nine antepartum women (15%) admitted to ICU were discharged and continued their pregnancy, 13 antepartum women (21.7%) had expedited delivery by cesarean birth after ICU admission and 38 (63.3%) women were admitted to ICU during the postpartum period. Antepartum ICU-discharged women contracted the SARS-CoV-2 at an earlier median gestational age (23 weeks; &lt;i&gt;p&lt;/i&gt; = 0.0003) and needed ICU admission at an earlier median gestational age (28 weeks, &lt;i&gt;p&lt;/i&gt; = 0.03) compared with antepartum ICU-delivered (28 and 32 weeks) and postpartum women (35.5 and 36 weeks). Antepartum ICU-discharged women had the lowest rate of mechanical ventilation receipt (11.1%) compared with antepartum ICU-delivered women (52.3%) and postpartum women (44.3%) but the difference was not statistically significant (&lt;i&gt;p&lt;/i&gt; = 0.13). No significant differences were observed in the frequency and severity of critical care complications in the antepartum ICU-discharged, antepartum-ICU delivered and postpartum women.&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;Of the women admitted to ICU antepartum, 40% were discharged while remaining pregnant and 60% had expedited delivery. Antepartum women who were discharged from ICU without giving birth may receive lower rates of mechanical ventilation than those who delivered in ICU or admitted postpartum; however, further studies are needed to confirm or refute this association.&lt;/p&gt;\u0000 &lt;/s","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"102 12","pages":"1719-1729"},"PeriodicalIF":4.3,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41099011","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":"Small-for-gestational-age fetus diagnosed in the second trimester: Possible etiologies and short-term neonatal outcomes","authors":"Lucia Pasquini,&nbsp;Giulia Masini,&nbsp;Greta Cagninelli,&nbsp;Teresa Polimeno,&nbsp;Nicola Fratelli,&nbsp;Anna Fichera,&nbsp;Federico Prefumo","doi":"10.1111/aogs.14679","DOIUrl":"10.1111/aogs.14679","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 aim of our study was to investigate the causes of fetal growth &lt;10th centile diagnosed &lt;26 weeks’ gestation in singleton pregnancies and compare pregnancy outcomes in relation to the identified etiology.&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;Historical cohort study conducted in two Italian hospitals which included all small-for-gestational-age fetuses diagnosed between 18+0 and 26+0 weeks over a 10-year period. Fetuses were divided into three groups depending on the prenatally suspected etiology: chromosomal abnormalities (Group 1), malformations (Group 2) and isolated (Group 3). These groups were compared regarding pregnancy outcomes. Fetuses in Group 3 were divided into small-for-gestational-age and fetal growth restriction following the Delphi Consensus criteria and the outcomes were further compared. Fisher's Exact or Mann–Whitney test were used for comparison of groups.&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;In all, 435 fetuses were included. Of these, 20 cases (4.6%) were associated with chromosomal abnormalities (Group 1), 98 (22.5%) with fetal malformations (Group 2) and 317 (72.9%) were isolated (Group 3). A higher percentage of live births was reported for Group 3 (&lt;i&gt;P&lt;/i&gt; &lt; 0.001). Termination of pregnancy was more common in Group 1 (&lt;i&gt;P&lt;/i&gt; &lt; 0.001). No differences in gestational age at delivery, birthweight, intrauterine death or neonatal death were detected within groups. Growth-restricted fetuses had lower gestational age at delivery, birthweight and number of live births (&lt;i&gt;P&lt;/i&gt; &lt; 0.001), higher rates of termination of pregnancy, intrauterine death (&lt;i&gt;P&lt;/i&gt; &lt; 0.001) and neonatal death &lt;10 days (&lt;i&gt;P =&lt;/i&gt; 0.002) compared to small-for-gestational-age. In 17 cases a chromosomal abnormality, genetic syndrome or adverse neurological outcome was diagnosed after birth: six from Group 2 (11.3% of live births in this group) and 11 from Group 3 (4.3%).&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;We report that fetal growth &lt;10th percentile diagnosed before 26 weeks is not isolated before birth in 27% of cases. Malformations and chromosomal abnormalities are common etiologies; therefore, detailed anomaly scans and invasive testing should be offered. In addition, there is a residual risk of neonatal death and postnatal diagnosis of a genetic syndrome or neurodevelopmental impairment despite normal prenatal tests. These results expand the small amount of information on the outcome of cases with very early diagnosis of impaired fetal grow","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"102 12","pages":"1749-1755"},"PeriodicalIF":4.3,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10312584","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}