Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Sonographic diagnosis of fetal eye anomalies and their association with syndromal diseases: A retrospective multicenter analysis of 264 cases.","authors":"Jorge Jiménez Cruz, Paul Böckenhoff, Laura Tascón Padrón, Norah Emrich, Philipp Kosian, Brigitte Strizek, Cristoph Berg, Eva Weber, Ulrich Gembruch, Annegret Geipel","doi":"10.1111/aogs.15085","DOIUrl":"https://doi.org/10.1111/aogs.15085","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to systematically describe eye malformations and correlate these with extraocular findings. Based on these findings, we propose a protocol for ultrasound evaluation of the fetal eye.</p><p><strong>Material and methods: </strong>In this multicentric retrospective cohort study, 264 fetuses with ocular malformations from two tertiary referral centers for prenatal medicine were analyzed. Anophthalmia, microphthalmia, exophthalmos, hyper- or hypotelorism, cataract, aphakia, cyclopia, and retinal detachment were assessed, and their association with extraocular findings and genetic changes was investigated.</p><p><strong>Results: </strong>The majority of the cases (99.2%) were non-isolated and presented further extraocular findings. Most commonly, the brain and central nervous system (65.9%), the limbs and the heart (46.6% each) and the cranial anatomy (41.2%) were affected. Significant associations were found between exophthalmos and anomalies of the fetal skeletal system (OR = 4.8, 95% CI 1.6-14) and cranial malformations (OR = 3.3, 95% CI 1.5-7.4). Hypotelorism showed an increased risk of cardiac anomalies (OR = 1.8, 95% CI 1.1-3.5) and brain malformations (OR = 2.16, 95% CI 1.2-4.1), with holoprosencephaly being the most common one. Fetuses with microphthalmia were more likely to have anomalies in the renal system (OR = 2.3, 95% CI 1.2-4.3). In 51.4% of the cases, a genetic aberration could be found, among them most frequently trisomy 13.</p><p><strong>Conclusions: </strong>There is a significant association between specific fetal eye anomalies and certain extraocular anomalies, as well as genetic changes. Systematic evaluation of the eye using the proposed protocol is simple to learn and highly reproducible and could help to concentrate diagnosis on a certain group of malformations. Data from this study could help to develop targeted diagnostic molecular tools.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555593","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":"Longitudinal study of family formation in 892 women and 193 men 8 years after visiting the Fertility Assessment and (FAC) clinic.","authors":"Randi Sylvest, Ida Vittrup, Ditte Vassard, Marte Saupstad, Søren Ziebe, Elisabeth Larsen, Helene Westring Hvidman, Kathrine Birch Petersen, Henriette S Nielsen, Lone Schmidt, Anja Pinborg","doi":"10.1111/aogs.15071","DOIUrl":"https://doi.org/10.1111/aogs.15071","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, in high-income countries, couples have been delaying family building. However, postponed childbearing implies a higher risk of declining fertility, not achieving desired family size and ultimately involuntary childlessness. The Fertility Assessment and Counseling (FAC) clinic was established to provide information about individuals' current fertility status, aiming to prevent infertility and support the realization of desired family sizes. The aim is to explore the reproductive outcomes and health behaviors 8 years after attending fertility assessment and counseling in the FAC clinic.</p><p><strong>Material and methods: </strong>Cohort study including women and men who attended the FAC clinic in Copenhagen, Denmark, from 2011 to 2017. From June 2011 until July 2017 2635 women and 1073 men attended fertility counseling at the FAC clinic. Eight years later, an electronic questionnaire was distributed to collect information on subsequent pregnancies and deliveries.</p><p><strong>Results: </strong>The follow-up questionnaire had a response rate of 34% (n = 892) for women and 18% for men (n = 193). The mean age for the subgroup of 892 women who responded at 8 years follow-up was 32.6 (±SD 4.4) years at baseline which was equal to the total cohort of 2635 women at baseline (32.7 (±SD 4.7) years). Most of the women (75%) and men (96%) were in a heterosexual relationship at follow-up. A total of 85% of the 892 women had conceived after the baseline FAC visit. Among those having conceived, the mean number of pregnancies was 2.10 per woman (±SD 1.1). In total, 703 (79%) of the 892 women had delivered at least one child. Among women having delivered, the average number of children was 2.0 (±SD 0.6). Among the men, 91% had conceived with their partner. Women and men were smoking less and drinking less alcohol at the follow-up compared to the baseline visit.</p><p><strong>Conclusions: </strong>This follow-up study emphasizes the importance of fertility assessment and counseling for women and couples during reproductive age, a critical period when decisions about family building are made.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536334","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":"The severity of second-degree perineal tears and dyspareunia during one year postpartum: A prospective cohort study.","authors":"Jeanette Risløkken, Marthe Dalevoll Macedo, Kari Bø, Marie Ellström Engh, Franziska Siafarikas","doi":"10.1111/aogs.15084","DOIUrl":"https://doi.org/10.1111/aogs.15084","url":null,"abstract":"<p><strong>Introduction: </strong>Childbirth-related injuries of the pelvic floor may impact women's sexual health with symptoms such as dyspareunia. A better understanding of dyspareunia based on tissue trauma severity in second-degree tears is needed. The primary aim of this study was to assess differences in dyspareunia according to the severity of perineal tears, with a focus on subcategories of second-degree tears at three and twelve months postpartum. The secondary aim was to assess the time to resumption of intercourse after birth according to the severity of second-degree tears.</p><p><strong>Material and methods: </strong>This single-center observational cohort study was conducted between January 2021 and July 2022. Women meeting the inclusion criteria were included during pregnancy. After birth, all perineal tears were classified according to RCOG recommendation, and second-degree tears were further subcategorized based on the percentage of damage to the perineum (2A, 2B, 2C). Dyspareunia and time to resumption of intercourse were collected through an electronic questionnaire at three and twelve months postpartum.</p><p><strong>Results: </strong>Our study included 857 women; of them, 51.6% (n = 442) were primipara and 48.4% (n = 415) were multipara. The percentages of women reporting dyspareunia according to the degree of the tear at three months postpartum were as follows: no tear/first-degree tear 60%, 2A-tear 60%, 2B-tear 52%, 2C-tear 77%, and episiotomy 77%; and at twelve months postpartum: no tear/first-degree tear 52%, 2A-tear 50%, 2B-tear 40%, 2C-tear 69%, and episiotomy 64%. When comparing dyspareunia between the no tear/first-degree tear category and the second-degree subcategories, no statistically significant differences were found. Women in all second-degree subcategories resumed intercourse approximately 4.8 months postpartum, compared to 3.8 months postpartum for those with no tear or first-degree tear (p < 0.05).</p><p><strong>Conclusions: </strong>There was no statistically significant association between the severity of second-degree tears and dyspareunia. The proportion of women reporting dyspareunia is noticeable for all perineal tear categories, with the highest rate among women with the most severe second-degree perineal tear. Women in all second-degree subcategories resumed intercourse approximately one month later than those with no tear or first-degree tear.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514337","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":"Endothelial damage and complement dysregulation in fetuses from pregnancies complicated by preeclampsia.","authors":"Alex Ramos, Lina Youssef, Patricia Molina, Julia Martinez-Sanchez, Ana Belen Moreno-Castaño, Miquel Blasco, Blanca De Moner, Marta Tortajada, Marta Camacho, Maria Borrell, Francesca Crovetto, Marc Pino, Gines Escolar, Enric Carreras, Eduard Gratacos, Maribel Diaz-Ricart, Marta Palomo, Fatima Crispi","doi":"10.1111/aogs.15072","DOIUrl":"https://doi.org/10.1111/aogs.15072","url":null,"abstract":"<p><strong>Introduction: </strong>Our objective was to evaluate the endothelial function profile and complement system in fetuses from preeclamptic pregnancies using ex vivo and in vitro approaches.</p><p><strong>Material and methods: </strong>A total of 66 singleton pregnancies were prospectively recruited comprising 34 cases of preeclampsia and 32 normotensive pregnancies matched for baseline characteristics. In the ex vivo approach, soluble tumor necrosis factor-a receptor 1 (sTNFR1), vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1), Von Willebrand factor (sVWF), terminal complement complex (sC5b-9), Factor H, complement component C3a and Factor Bb were analyzed in fetal cord blood samples. In the in vitro model, vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), Von Willebrand factor (VWF), vascular endothelial cadherin (VE-Cadherin), endothelial nitric oxide synthase (eNOS), reactive oxygen species (ROS) and C5b-9 deposits were evaluated on endothelial cells in culture exposed to fetal sera or plasma.</p><p><strong>Results: </strong>Increased sVCAM-1, sICAM- l and decreased Factor H and Factor Bb concentrations were detected in preeclampsia fetuses as compared to fetuses from normotensive mothers (509.4 ± 28 vs. 378.4 ± 34.3 ng/mL, 161.1 ± 11.9 vs. 114.8 ± 6.8, 199.6 ± 18.3 vs. 267.1 ± 15.4 ng/mL and 6.6 ± 0.7 vs. 10.3 ± 1.4 μg/mL respectively, p < 0.05) with similar results in sTNFR1, sVWF, sC5b-9 and C3a. Endothelial cells exposed to fetal sera from preeclampsia showed incremented expression of VCAM-1(38.1 ± 1.4% vs. 28.3 ± 1.6%, p < 0.01), ICAM-1 (12 ± 0.9% vs. 8.6 ± 0.6%, p < 0.05), VWF (43.5 ± 2.9% vs. 3.7 ± 0.3%, p < 0.05), and ROS (5 × 10¹³ ± 1 × 10¹² vs. 3.5 × 10¹³ ± 1.4 × 10¹², p < 0.01) with similar expression of VE-Cadherin and eNOS as compared to those exposed to control fetuses. While soluble C5b-9 was similar between the study groups (851.4 ± 177.5 vs. 751.4 ± 132.81 ng/mL, p > 0.05), significantly less C5b-9 deposits on endothelial cells were induced by fetal plasma from preeclamptic compared to normotensive mothers (fold change 0.08 ± 0.02 vs. 0.48 ± 0.13, p < 0.01).</p><p><strong>Conclusions: </strong>High levels of endothelial adhesion molecules and oxidative stress products suggest endothelial damage and reduced in vitro deposition of C5b-9 indicates complement dysregulation in preeclampsia fetuses. More research is necessary to study the impact of preeclampsia on fetal vascular health and innate immunity.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497656","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":"Maternal postpartum six-week check and short-term health outcomes for women with hypertensive disorders in pregnancy: An observational study using the Clinical Practice Research Datalink (CPRD).","authors":"Rema Ramakrishnan, Diane Korb, Yangmei Li, Marian Knight, Claire Carson","doi":"10.1111/aogs.15068","DOIUrl":"https://doi.org/10.1111/aogs.15068","url":null,"abstract":"<p><strong>Introduction: </strong>In the UK, in addition to the recommended blood pressure check, women with hypertensive disorders of pregnancy are offered a postpartum six-week check (SWC) with either a specialist or general practitioner. We aimed to describe the prevalence and disparities in the provision of SWC, and describe short-term postpartum outcomes among women with hypertensive disorders of pregnancy by SWC status.</p><p><strong>Material and methods: </strong>Data were from the UK Clinical Practice Research Datalink GOLD for women aged 15-49 years at childbirth in 2000-2018, who were diagnosed with hypertensive disorders of pregnancy, and were registered for ≥12 months postpartum. Trends in SWC prevalence and differences in characteristics and short-term postpartum outcomes of women by SWC status were described. Multivariable modified Poisson regression was used to compute risk ratio of a SWC for severe hypertensive disorders of pregnancy.</p><p><strong>Results: </strong>Of 30 483 women, 61.4% had a SWC. The proportion of women who received a SWC check was highest in 2007 (66.8%) but subsequently decreased. Women were less likely to have a SWC record if they were younger, of a minoritised ethnicity, living in more deprived areas, were multiparous, had severe hypertensive disorders of pregnancy, preterm birth, caesarean birth, or had a low birthweight baby. Compared to women who did not have a SWC, a higher proportion of women with SWC had their blood pressure recorded (SWC 47.4%, no SWC 39.9%), and had a diagnosis of postpartum depression (SWC 13.6%, no SWC 11.1%). There were no substantial differences in other short-term postpartum outcomes by SWC status.</p><p><strong>Conclusions: </strong>There may be missed opportunities in postpartum care among women with hypertensive disorders of pregnancy. Our findings highlight the need to ensure that general postpartum care is not overlooked in women with specific morbidities in pregnancy.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490345","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":"Sexual function and pelvic floor function five years after hysterectomy.","authors":"Catharina Forsgren, Ulrika Johannesson","doi":"10.1111/aogs.15069","DOIUrl":"https://doi.org/10.1111/aogs.15069","url":null,"abstract":"<p><strong>Introduction: </strong>The effects of benign hysterectomy on sexual function and pelvic floor remain uncertain. Our objective was to investigate the effects of hysterectomy on pelvic floor and sexual function 5 years postoperatively.</p><p><strong>Material and methods: </strong>We conducted a prospective cohort study involving 260 women scheduled for hysterectomy, who were followed for 5 years' post-surgery. Participants completed three validated questionnaires: Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20) and Female Sexual Function Index (FSFI). Nonparametric statistics and mixed effect models were used to analyze the data.</p><p><strong>Results: </strong>After exclusion, 242 women were included, with a response rate of 145/242 (60%) for all questionnaires at the five-year follow-up. There was an overall reduction of more than 50% in pelvic floor symptoms after 5 years (mean PFIQ-7 score 42.5) (SD 51.7) to 20.3 (SD 40.7) (p < 0.001). The degree of bother and distress caused by pelvic floor symptoms also significantly decreased (mean PFDI-20 score 69.6) (SD 51.1) to 58.2 (SD 53.2) (p < 0.01). No significant change in overall sexual function was observed 5 years' post-hysterectomy (mean FSFI score 17.9) (SD 11.7) to 18.1 (SD 11.6) (p = 0.73). However, participants who were sexually active at the time of hysterectomy, reported a decline in sexual function over time, (mean FSFI 25.2) (SD 6.6) to 19.6 (SD 10.8) (p < 0.001). In contrast, women non-sexually active at the time of hysterectomy reported an improvement of sexual function. Additionally, there was an association before surgery, between pelvic floor dysfunction (mean PFDI-20 score) and low sexual function (mean FSFI score) (p < 0.05). The route of hysterectomy (robotic assisted total laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy), age at surgery, and the number of vaginal deliveries had no impact on pelvic floor function or sexual function (mean PFIQ-7, PFDI-20, FSFI scores).</p><p><strong>Conclusions: </strong>Five years after hysterectomy, women experienced less pelvic floor symptoms compared to preoperatively. Women reported no change in overall sexual function, nevertheless there was a decline of sexual function among those who were sexually active before surgery. In contrast, non-sexually active women recognized improved sexual function after 5 years, indicating a plausible surgery-related symptom relief.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490346","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":"Ensuring safety first: GLP-1RAs in reproductive and endometrial research.","authors":"Paola Viganò, Maira Casalechi, Andrea Salonia, Edgardo Somigliana","doi":"10.1111/aogs.15060","DOIUrl":"https://doi.org/10.1111/aogs.15060","url":null,"abstract":"","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482003","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":"Indeed, safety comes first for the use of GLP-1RAs.","authors":"Amruta D S Pathare, Alberto Sola-Leyva, Apostol Apostolov, Ganesh Acharya, Andres Salumets","doi":"10.1111/aogs.15090","DOIUrl":"https://doi.org/10.1111/aogs.15090","url":null,"abstract":"","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481948","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":"Association of oral contraceptives and risk of endometrial cancer: A systematic review and meta-analysis","authors":"András Harajka,&nbsp;Tímea Hercsik,&nbsp;Isabel Pinto Amorim das Virgens,&nbsp;Izabella Máthé,&nbsp;Zsófia Tornyossy,&nbsp;Ali AlFarwi,&nbsp;Fanni Adél Meznerics,&nbsp;Szilvia Kiss-Dala,&nbsp;Péter Fehérvári,&nbsp;Rita Nagy,&nbsp;Ferenc Bánhidy,&nbsp;Attila Majoros,&nbsp;Sándor Valent,&nbsp;Péter Hegyi,&nbsp;Nándor Ács","doi":"10.1111/aogs.15043","DOIUrl":"10.1111/aogs.15043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although the relationship between the use of oral contraceptives and reduced endometrial cancer risk has now long been established, the need for female patients to be informed on this matter based on the latest results of scientific research remains. To help the evidence-based decision-making of women when choosing contraception methods, we aimed to provide them with an up-to-date overview and summary of past and recent findings on the association between the use of oral contraceptives and endometrial cancer risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This study was registered in PROSPERO: CRD42022379871. PubMed, Embase, and Cochrane Library databases were searched on the December 5, 2022, to identify eligible articles. We included all experimental and observational studies that reported the number of users and non-users of oral contraceptives among patients diagnosed or not with endometrial cancer. Data were extracted, and random-effects meta-analysis was performed to obtain summary odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity across studies was assessed using Higgins &amp; Thompson's <i>I</i>² statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-six studies were eligible for qualitative synthesis, of which twenty-five were eligible for quantitative analysis. The use of oral contraceptives was inversely associated with the odds of having endometrial cancer (OR = 0.61, CI: 0.46–0.80). The long-term use of oral contraceptives led to the greatest odds reduction in having endometrial cancer (≥10 years: OR = 0.31, CI: 0.13–0.70), while shorter periods were also associated with a significant decrease in these odds, although to a lesser extent (≥5 years: OR = 0.39, CI: 0.23–0.64; &lt;5 years: OR = 0.66, CI: 0.48–0.91).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The administration of oral contraceptives is time dependently associated with lower odds of having endometrial cancer, suggesting a protective association between the use of oral contraceptives and endometrial cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"591-603"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466699","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":"Fetal rotation examined with ultrasound","authors":"Kenneth Bagandanshwa,&nbsp;Bariki Mchome,&nbsp;Signe Egenberg,&nbsp;Torbjørn Moe Eggebø","doi":"10.1111/aogs.15081","DOIUrl":"10.1111/aogs.15081","url":null,"abstract":"<p>We would like to thank Patji Alnæs-Katjavivi for his interest and comments on our article and for referring to the recently published work of VanSickle et al. challenging the myth of the perfect obstetric pelvis.<span>^{1, 2}</span> The aim of our study was to examine fetal rotation longitudinally with ultrasound in a sub-Saharan population. We observed a higher rate of persistent occiput posterior position at birth than reported in studies mainly comprising white European women.<span>³</span></p><p>The shape of the birth canal has been thought to influence fetal rotation. Four classical pelvic shapes were described in the 1930s, but demarcations between these are not clear. Variations with regard to pelvic shape between ethnicities have been published and referred to in our article. However, the evidence on this is from old studies as pointed out by Alnæs-Katjavivi, and we agree that paying attention to the pelvic shape has limited clinical value. The clinical examination of the female pelvis is unreliable. The obstetrical conjugate can be measured with ultrasound (recently published),<span>⁴</span> and also the sub-pubic arch angle can be measured.<span>⁵</span> However, these measurements do not provide information on the shape of the pelvis and assessing this was not an objective in our study. Our focus was on the process of rotation, to what degree this occurred in the study population, and what effects fetal rotation had on labor outcome.</p><p>It is important to identify women at risk for arrested labor in a reliable way and these women should have added surveillance in labor. Persistent occiput posterior position is associated with prolonged labor and operative interventions,<span>⁶</span> as also shown in our study.<span>³</span> Timely diagnosis of this is important and ultrasound is a valuable tool to make this possible. We showed a proportional difference between our study population and what has been assumed before. We acknowledge that this observation calls for more information about fetal rotation from other populations in Africa as well as from different parts of the world.</p><p>In our setting, maternal mobility, including ambulation, squatting, and the use of birthing balls, is encouraged during the active first and early second stages of labor to promote fetal rotation and descent. Continuous midwifery care is provided, sometimes with a companion, but not on a one-to-one basis.</p><p>Our main clinical message is thus to recommend the active use of ultrasound during labor for diagnosing rotation failure. This will lead to enhanced surveillance and appropriate management of persistent occiput posterior positions, while also helping to avoid unnecessary interventions in women with the fetus in the occiput anterior position.</p><p>Laerdal Foundation for Acute Medicine.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"784-785"},"PeriodicalIF":3.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456584","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}