Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Incidence of stillbirth among women with different risk profiles in Stockholm 2001–2020: a repeated cross-sectional study","authors":"Minna Lundén,&nbsp;Ingela Hulthén Varli,&nbsp;Helena Kopp Kallner,&nbsp;Hanna Åmark","doi":"10.1111/aogs.14695","DOIUrl":"10.1111/aogs.14695","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The incidence of stillbirth in Sweden has started to decline. However, some comparable high-income countries in Europe have an even lower incidence, indicating a potential for further reduction. The aim of our study was to investigate how the incidence of stillbirth for singleton pregnancies has changed over the past two decades in the Stockholm Region in different groups of women to detect the groups at highest risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>This was a repeated cross-sectional study with data from the Stockholm Stillbirth Database and the Pregnancy Register including all cases of stillbirth in Stockholm in singleton pregnancies between 2001 and 2020, in total 1804 stillbirths. The time period was divided into four equal groups and the incidence of stillbirth was compared between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall incidence of stillbirth in the Stockholm Region has decreased from 3.8/1000 births in 2001–2005 to 2.9/1000 births in 2016–2020 (<i>P</i>-value &lt;0.001). In most of the groups studied, the incidence decreased, but among women originating from sub-Saharan Africa the incidence significantly rose from 7.9/1000 births in 2001–2005 to 10.1/1000 births in 2016–2020 (<i>P</i>-value 0.025). In this group, stillbirth occurred prematurely to a higher extent and the women were more likely to be multiparous.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The incidence of stillbirth in the Stockholm Region has declined. However, among women originating from sub-Saharan Africa the incidence was significantly higher compared with women originating from other regions and it is still rising. More research is needed to understand why this group is at higher risk and how to monitor their pregnancies to decrease this risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 1","pages":"59-67"},"PeriodicalIF":4.3,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10755135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49673069","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":"Cerebral palsy in children born after assisted reproductive technology; is there a true association?","authors":"Jayapriya Jayakumaran,&nbsp;Mark Trolice,&nbsp;Lucy Chen,&nbsp;Laurel Stadtmauer","doi":"10.1111/aogs.14699","DOIUrl":"10.1111/aogs.14699","url":null,"abstract":"&lt;p&gt;We read the article by Carlsen et al. entitled “Cerebral Palsy in children born after assisted reproductive technology in Norway: Risk, prevalence and clinical characteristics”,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; and we commend the authors for addressing a vital concern. Nevertheless, we would like to express several concerns with their analysis and conclusions.&lt;/p&gt;&lt;p&gt;As presented, several studies suggest an increase in the risk of a child born with cerebral palsy (CP) following assisted reproductive technology (ART), including findings from the Danish National Birth Cohort.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Preterm birth is a known risk factor for CP, and the authors found an adjusted odds ratio (OR) of 1.32 (95% CI 1.02–1.71) in the ART group compared with natural conception. Additional multivariate logistic regression analyses would be helpful to assess whether the higher prevalence of CP was related to the higher prevalence of preterm birth and low birthweight among ART children and to include further adjustments for gestational age, multiplicity and birthweight.&lt;/p&gt;&lt;p&gt;From 2002 to 2015, the study demonstrated a decline in the overall prevalence of CP with an intervening period from 2008 to 2012 (figure 2 in Carlsen et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;) consistent with the worldwide results.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The authors neglected to stratify data based on outcomes of the prenatal, perinatal and postnatal periods, which are metrics that are considered to be potential contributors to the development of CP.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Other key limitations are the lack of analysis regarding the mode/indication of delivery (cesarean vs instrumental delivery) with any acute hypoxic events, and determining the number of embryos transferred, which could increase the risk of a multiple gestation and/or a vanishing twin and could increase the risk of CP from prematurity.&lt;/p&gt;&lt;p&gt;The authors state: “After restriction to multiples, children born at term after ART had nearly 50% higher odds of CP than children born at term after natural conception”. However, the results were not significant by a crude or adjusted odds ratio. Upon further dividing into singletons and multiples, the adjusted ORs were not significant compared with natural conception (table I in Carlsen et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;). Consequently, we disagree with the study's “Key Message” of an increased risk of CP associated with ART “mainly attributed to multiple pregnancies”, as the data do not support a statistically significant relationship.&lt;/p&gt;&lt;p&gt;The unexplained decline in CP prevalence from 2002 to 2015, observed in both groups, contributes to the difficulty interpreting the results, particularly since the ART group demonstrated a steeper drop with an even lower prevalence in 2007 and 2011 (figure 2 in Carlsen et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;) compared with natural conception.&lt;/p&gt;&lt;p&gt;A proposed area for further investigation would include determining the incidence of CP in children born after ovulati","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 1","pages":"188-189"},"PeriodicalIF":4.3,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10755207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49673068","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":"Cancer risk among transgender adults: A growing population with unmet needs","authors":"Sarah S. Jackson,&nbsp;Anne Hammer","doi":"10.1111/aogs.14686","DOIUrl":"10.1111/aogs.14686","url":null,"abstract":"&lt;p&gt;Globally, an estimated 1% of the population identifies as transgender, with 2%–3% of individuals under the age of 25 identifying as transgender or gender diverse.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Transgender is an umbrella term for individuals whose gender identity differs from their sex assigned at birth. Nonbinary individuals are those whose identity falls outside of the gender binary (eg man or woman) and include genderqueer, gender nonconforming, agender, and other identities.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Some transgender individuals may take gender affirming hormones or undergo gender affirmation surgery (collectively known as gender affirming care) so that their outward gender expression matches their internal gender identity. It is important to note that gender affirming care is very individualized, with some people choosing to postpone or forgo some treatments to preserve fertility, or for personal or financial reasons. Some individuals may choose not to undergo a physical transition&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; or they may feel that neither the masculine or feminine gender expression matches their identity.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Cancer is an understudied topic in transgender health due to paucity of available data.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Gender identity is not collected in the census, cancer registries, or most population-based cohort studies.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Therefore, research on cancer in this population has been limited to a few case reports.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The incidence of cancers among transgender persons may be different than that of cisgender persons for reasons related to sex hormones and gender affirming surgery, differential exposure to viral infections, and increased exposure to stigma and discrimination. A summary of available evidence is presented in the Box 1.&lt;/p&gt;&lt;p&gt;Increased circulating estradiol levels from both endogenous and exogenous sources are associated with breast cancer risk in cis women; however, the evidence on the risk of breast cancer in transgender women is mixed. An analysis among United States (US) veterans found no increased incidence of breast cancer among 5135 transgender women who used estrogen compared to cisgender men.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; On the other hand, a Dutch study found an elevated risk of breast cancer among 2260 transgender women on estrogen therapy compared to a Dutch cisgender male population (Standardized Incidence Ratio (SIR): 46.7). The risk of breast cancer among transgender women was lower than that of a Dutch cisgender female population (SIR: 0.30).&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Among transgender men who have undergone bilateral mastectomy, the risk of breast cancer is decreased compared to cisgender women, yet still significantly elevated when compared to cisgender men.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Importantly, the age of breast cancer diagnosis was lower in both transgender women (52 years) and transgender men (46 years) than the average age of diagnosis for Dutch cisg","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"102 11","pages":"1428-1430"},"PeriodicalIF":4.3,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.14686","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41231537","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":"TP53 mutation and human papilloma virus status as independent prognostic factors in a Norwegian cohort of vulva squamous cell carcinoma","authors":"Harsh Nitin Dongre,&nbsp;Rammah Elnour,&nbsp;Stian Tornaas,&nbsp;Siren Fromreide,&nbsp;Liv Cecilie Vestrheim Thomsen,&nbsp;Ingrid Benedicte Moss Kolseth,&nbsp;Elisabeth Sivy Nginamau,&nbsp;Anne Christine Johannessen,&nbsp;Olav Karsten Vintermyr,&nbsp;Daniela Elena Costea,&nbsp;Line Bjørge","doi":"10.1111/aogs.14689","DOIUrl":"10.1111/aogs.14689","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Vulva squamous cell carcinoma (VSCC) develops through two separate molecular pathways—one involving high-risk human papilloma virus infection (HPV-associated), and the other without HPV infection (HPV-independent) often involving <i>TP53</i> mutation. HPV-associated VSCC generally has a better progression-free survival than HPV-independent VSCC. The aim of this study was to determine <i>TP53</i> mutation status using immunohistochemistry, compare different methods of HPV detection and correlate both with survival in a retrospective cohort of 123 patients with VSCC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>Immunohistochemistry for p53, Ki67 and p16^INK4A (a surrogate marker for HPV infection) was performed on formalin-fixed paraffin-embedded tissues from a cohort of surgically treated VSCC patients to identify molecular subtypes of VSCC. Presence of HPV infection was detected by HPV DNA PCR and HPV mRNA in situ hybridization (ISH). The Pearson chi-square test and multivariable Cox regression model were used to investigate the association of different parameters with progression-free survival and disease-specific survival (DSS), and Kaplan–Meier curves were used to show the association of different parameters with survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results of p53 and p16^INK4A immunohistochemistry confirmed three VSCC subtypes associated with different prognosis. The <i>TP53</i> mutation status was identified as an independent prognostic factor of worse progression-free survival (<i>p</i> = 0.024) after adjustment for FIGO stage. p16^INK4A immunohistochemistry, mRNA ISH, and DNA PCR had excellent concordance in terms of HPV detection. According to the multivariable Cox regression model, the presence of hrHPV mRNA correlated significantly with increased progression-free survival (<i>p</i> = 0.040) and DSS (<i>p</i> = 0.045), after adjustment for other confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>p53 and p16^INK4A immunohistochemistry stratify VSCC cohort into three subtypes with <i>TP53</i>mutated patients having the worst prognosis. The detection of hrHPV mRNA by ISH was an independent predictor of increased survival. Thus, the combined detection of p53 and HPV mRNA might improve risk stratification in VSCC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 1","pages":"165-175"},"PeriodicalIF":4.3,"publicationDate":"2023-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10755123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41231536","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":"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}