Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"A call for deeper insights into intramural pregnancy: An international data registry","authors":"Simrit Nijjar,&nbsp;Cecilia Bottomley,&nbsp;Davor Jurkovic","doi":"10.1111/aogs.70007","DOIUrl":"10.1111/aogs.70007","url":null,"abstract":"<p>Intramural pregnancy (IMP) is a rare and potentially life-threatening uterine ectopic pregnancy implanted within the myometrium. Despite its recognition as a distinct clinical entity, diagnostic challenges and a lack of standardized management protocols persist. IMP occurs when a gestational sac implants into the myometrium beyond the endometrial-myometrial junction, often following uterine trauma. Diagnosis is hindered by non-specific symptoms and frequent misclassification. While ultrasound is the primary diagnostic tool, magnetic resonance imaging (MRI) may be needed in unclear cases. Treatment options range from expectant management to surgical intervention, but no consensus exists on the optimal approach. To enhance understanding and improve clinical outcomes, we propose an international IMP registry to collect data on diagnosis, treatment, and fertility outcomes. This collaborative effort aims to inform evidence-based guidelines, facilitating accurate early diagnosis and optimized patient care.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1420-1423"},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537727","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":"Differences in pain, bleeding, and satisfaction during medical abortion at very early gestations.","authors":"Frida Gyllenberg, Karin Brandell, Tagrid Jar-Allah, Helena Kopp Kallner, John Reynolds-Wright, Clare Boerma, Sharon Cameron, Helena Hognert, Oskari Heikinheimo, Janina Kaislasuo, Kristina Gemzell-Danielsson","doi":"10.1111/aogs.15177","DOIUrl":"https://doi.org/10.1111/aogs.15177","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known regarding the impact of gestation on pain, bleeding duration, and satisfaction in early medical abortion (termination of pregnancy). This study aimed to determine if pain experience, bleeding duration, and overall satisfaction with medical abortion differed across four ultrasound-defined categories of early pregnancy.</p><p><strong>Material and methods: </strong>This is a secondary analysis of the multicenter VEMA-trial, a randomized clinical trial on the efficacy and safety of very early medical abortion before confirming pregnancy location (the VEMA-trial, EudraCT 2018-003675-35, ClinicalTrials.gov NCT03989869). The present study included participants with normally developing pregnancies and known abortion outcomes, including complete abortion, incomplete abortion, and ongoing pregnancy, that is, pregnancy still progressing after medical abortion. Participants were grouped by ultrasound findings at the time of abortion into pregnancy of unknown location, early, normally sited pregnancy (empty sac), and normally sited pregnancy with visible yolk sac or visible embryo. Pain experience was measured on the 0-10 numeric rating scale (higher values for more pain), duration of bleeding in days, and satisfaction on a 0-6 scale (higher values indicating greater satisfaction).</p><p><strong>Results: </strong>Altogether 1253 participants were included: 18% (224 participants) with pregnancy of unknown location, 38% (476) with early, normally sited pregnancy, 24% (301) with visible yolk sac, and 20% (252) with visible embryo. Pain scores were lowest in the pregnancy of unknown location group (mean 5.2 ± SD 2.3) and highest in the pregnancy with visible embryo group (6.2 ± 2.4). Bleeding duration was shortest for pregnancies of unknown location (4.9 ± 3.2) and longest for those with visible embryo (7.5 ± 5.3). Mean satisfaction was over 5 in all groups, highest in early, normally sited pregnancies (5.7 ± 0.7). In regression analyses, both pain scores and bleeding duration increased with advancing ultrasound findings. The pregnancy of unknown location group reported the least pain (1.02 points lower, 95% Confidence Interval [CI] -1.46 to -0.57) and the shortest bleeding duration (34% shorter, incidence rate ratio 0.66, 95% CI 0.61 to 0.71) compared to pregnancies with visible embryo.</p><p><strong>Conclusions: </strong>More advanced ultrasound findings are associated with higher pain scores and longer bleeding duration in very early medical abortion, whereas satisfaction is high across ultrasound-defined categories.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537729","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":"Assessment of childbirth experience over time-A prospective cohort study.","authors":"Susanne Hesselman, Wilma Sten, Yvonne Skogsdal, Anna Wikman, Frida Viirman","doi":"10.1111/aogs.70010","DOIUrl":"https://doi.org/10.1111/aogs.70010","url":null,"abstract":"<p><strong>Introduction: </strong>A woman's childbirth experience is multifaceted and has a great impact on not only the woman, but also the family's health and well-being. Changes in childbirth experience over time have been evaluated with a variety of instruments, at different time points, and with inconsistent findings. In Sweden, the rating of birth experience is routinely collected after birth, but it is still unknown which time point is preferred from a clinical perspective. The primary aim was to investigate changes in childbirth experience over time from childbirth to 6 months postpartum, assessed by both a single and a multi-item instrument. A secondary aim was to test the correlation between these instruments.</p><p><strong>Material and methods: </strong>In a prospective cohort study, 320 women were recruited from two Swedish hospitals. Study participants completed a survey at the maternity ward after giving birth, and again three and 6 months postpartum, rating their overall childbirth experience on a single item 10-point numeric rating scale (NRS) and a multi-item instrument, the Childbirth Experience Questionnaire 2 (CEQ2), encompassing four known dimensions of childbirth: Perceived safety, Own capacity, Participation and Professional support. Changes in childbirth experience (NRS and CEQ2) over time were analyzed using the Friedman test. NRS ratings were analyzed in relation to CEQ2 dimensions with Spearman's correlation.</p><p><strong>Results: </strong>Overall childbirth experience rated using NRS did not change over time. The total CEQ2 score decreased significantly from childbirth to 6 months postpartum (p < 0.001). This change was driven by decreased scoring of the domains Participation and Professional support. The correlations between NRS and CEQ scores were consistent over time, with a moderate to weak correlation of NRS with Participation and Professional support.</p><p><strong>Conclusions: </strong>Women perceive their birthing experience more negatively over time when assessed using the CEQ2 questionnaire, but this was not captured by a single-item question assessing overall childbirth experience.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537728","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":"A comparative study on infant growth between assisted reproductive technology pregnancy and natural pregnancy.","authors":"Anni Chen, Dongyang Wang, Yuyu Zhang, Qianqian Dai, Weixia Yang, Zixiao Zhou, Xuan Shi, Ziyue Zhou, Zijun Ni, Xun Zhuang","doi":"10.1111/aogs.15178","DOIUrl":"https://doi.org/10.1111/aogs.15178","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, the number of assisted reproductive technology (ART) infants has surpassed 10 million, with its utilization steadily increasing. Numerous studies have shown that ART pregnancies are more prone to adverse pregnancy outcomes. ART infants are at a higher risk for adverse birth outcomes. However, the differences in growth between ART and natural pregnancy (NP) infants remain controversial. This study aims to explore differences in pregnancy outcomes, birth outcomes, and growth rates between ART and NP infants during the first year of life, and to analyze the association between ART and rapid growth.</p><p><strong>Material and methods: </strong>Birth records of the Nantong area, China, from January 2020 to June 2021 were extracted. A total of 29 886 pregnant women and 30 051 infants were included in the characteristic analysis. Based on the use of ART recorded in the database, the pregnant women and infants were categorized into ART and NP groups, with the NP serving as the control group. For the growth analysis, 29 447 singleton infants were included. Growth within 12 months was examined using the LMS method. The association between reproductive methods, perinatal sociodemographic characteristics, infant birth characteristics, and rapid growth was analyzed using GEE model. To further explore the association between ART and rapid growth, we performed subgroup analyses based on infants' sex, birth weight, and perinatal residence, which were statistically associated with rapid growth in the multivariate GEE model.</p><p><strong>Results: </strong>ART infants had higher rates of preterm birth (7.4% vs. 4.8%) and cesarean section (57.7% vs. 49.1%; p < 0.001 for both). Growth analysis displayed faster overall growth rates and higher rapid growth incidence in ART singleton infants. Multivariate GEE analysis showed that ART was associated with a higher incidence of rapid growth in both length (OR = 1.415, 95% CI: 1.316-1.521) and weight (OR = 1.236, 95% CI: 1.134-1.348).</p><p><strong>Conclusions: </strong>ART singleton infants demonstrated a greater likelihood of experiencing rapid growth, despite being at higher risk of SGA, and achieved growth trajectories comparable to NP singleton infants. The findings suggest that ART may not influence postnatal growth. These results underscore the importance of tailored clinical monitoring and interventions for ART infants to ensure optimal growth and long-term health.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525951","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":"Metabolic associations of human placental lactogen in pregnancies at high metabolic risk: An observational cohort study.","authors":"Kate Rassie, Simon Alesi, Adriana C H Neven, Taitum Mason, Eveline Jona, Stacey J Ellery, Joanne Enticott, Aya Mousa, Anju E Joham, David Simmons, Helena Teede","doi":"10.1111/aogs.70000","DOIUrl":"https://doi.org/10.1111/aogs.70000","url":null,"abstract":"<p><strong>Introduction: </strong>Human placental lactogen (hPL) is a placental hormone which, according to preclinical research, appears to have key metabolic roles in pregnancy. We aimed to examine pregnancy hPL levels in relation to maternal metabolic parameters and fetal outcomes within an ethnically diverse cohort at high metabolic risk. Design was an observational cohort study, nested within a randomized controlled trial.</p><p><strong>Material and methods: </strong>Pregnant women (n = 130), recruited for high metabolic risk, underwent measurement of hPL, plus clinical and metabolic parameters, in early pregnancy (15.8 ± 2.5 weeks of gestation). Univariable and multivariable simple linear regression models were used to examine relationships between early pregnancy hPL and key maternal anthropometric and biochemical variables. Fifty-four women progressed to serial measurement of hPL and metabolic parameters across pregnancy. Univariable and multivariable mixed effects regression models were used to explore relationships between hPL and maternal variables across pregnancy, with repeated measures adjusted for using random effects.</p><p><strong>Results: </strong>In early pregnancy, lower hPL levels were independently associated with higher maternal fasting glucose (β = -1.03, p < 0.01). Early pregnancy hPL was not significantly related to maternal obesity, gestational diabetes mellitus (GDM), or polycystic ovary syndrome status. In women with GDM, sampled serially across pregnancy, maternal hPL and leptin levels were inversely associated (adjusted β = -0.098, p ≤ 0.001). There was a significant relationship between higher late pregnancy hPL and increased infant birthweight in the serially sampled GDM cohort, both before (β = 50.81, p = 0.01) and after (β = 41.78, p = 0.02) adjustment for gestational age at birth.</p><p><strong>Conclusions: </strong>Maternal hPL may play a role in maternal metabolic adaptation to pregnancy, particularly in relation to glucose and leptin dynamics. hPL in late pregnancy is positively associated with infant birthweight in women with GDM. Future studies of hPL in well-defined contemporary populations are warranted, both to understand mechanistic interactions in pregnancy and potentially as a biomarker for infant birthweight.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482832","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":"Uterine volume assay after gonadotoxic therapies in childhood, adolescence, and young adulthood: A systematic review and Bayesian network meta-analysis.","authors":"Eloïse Fraison, Stephanie Huberlant, Mathilde Cavalieri, Aurore Gueniffey, Justine Riss, Christine Rousset-Jablonski, Blandine Courbiere","doi":"10.1111/aogs.70003","DOIUrl":"https://doi.org/10.1111/aogs.70003","url":null,"abstract":"<p><strong>Introduction: </strong>Uterine damage after pelvic radiotherapy or total-body irradiation is well described, with decreased uterine volume and high obstetrical morbidity. Some recent studies have reported a smaller uterus in child, adolescent, and young adult cancer survivors treated with chemotherapy only. This systematic review investigated the long-term effects of gonadotoxic therapy on uterine volume during childhood, adolescence, and young adulthood.</p><p><strong>Material and methods: </strong>Data sources were Medline, Embase, and the Cochrane Library databases from 1990 to April 2023 searched using the following search terms: cancer survivors, bone marrow transplantation, chemotherapy, radiotherapy, and uterine volume. Study selection and synthesis: Only comparative studies reporting uterine volume in adult women who had received chemotherapy and/or radiotherapy during childhood, adolescence, or young adulthood (<25 years) were included. Two independent reviewers performed study selection, bias assessment using the ROBINS-I tool, and data extraction. The main outcome was uterine volume (mL). A Bayesian network meta-analysis with meta-regression for parity and serious risk of bias was performed using a random-effects model.</p><p><strong>Results: </strong>After reviewing 2847 abstracts, four studies were selected for the meta-analysis. Uterine volume data were available for 225 women after chemotherapy, 153 women after chemoradiotherapy, and 257 control women without cancer. Uterine volume was significantly lower in the chemoradiotherapy group than in the control group (-29.2 mL [-49.1, -12.5]). Uterine volume was significantly decreased in the chemoradiotherapy group compared to the chemotherapy group (-20.9 mL [-39.1, -0.3]). The difference in the mean uterine volume between the control and chemotherapy groups was 8.2 mL [-11.8, 34.2] and was not significant.</p><p><strong>Conclusions: </strong>Our meta-analysis confirms the well-known data on chemoradiotherapy-induced uterine damage. Although some studies have suggested the potential impact of high doses of chemotherapy on uterine volume, this meta-analysis did not find any significant decrease in uterine volume after chemotherapy. This result could help counsel age-reproductive women and physicians who perform assisted reproductive technologies in long-term CAYA Cancer survivors.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482854","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":"Reconsidering the association between maternal Crohn's disease and offspring psychiatric outcomes.","authors":"Muhammad Armaghan Akhlaq, Hooria Ejaz, Mavia Habib, Malik Abdullah Rasheed, Mirza M Hadeed Khawar","doi":"10.1111/aogs.70009","DOIUrl":"https://doi.org/10.1111/aogs.70009","url":null,"abstract":"","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482833","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":"First birth and total fertility rate in women with surgically verified endometriosis - A nationwide register study of 18 320 women across reproductive life course.","authors":"Anni Tuominen, Liisu Saavalainen, Juuso Saavalainen, Maarit Niinimäki, Mika Gissler, Päivi Härkki, Oskari Heikinheimo","doi":"10.1111/aogs.70001","DOIUrl":"10.1111/aogs.70001","url":null,"abstract":"<p><strong>Introduction: </strong>Endometriosis is associated with pain and infertility. However, little is known about birth rate among women with endometriosis on population level. We studied whether women with endometriosis have lower birth rate than women in the general population.</p><p><strong>Material and methods: </strong>This historical population-based cohort study used data from 18 320 fertile-aged women with first surgical verification of endometriosis in 1998-2012. Women with endometriosis were further divided into sub-cohorts: women with solely peritoneal (n = 5786), ovarian (n = 6519) and deep endometriosis (n = 1267). Women with combined types and rare forms of endometriosis formed a sub-cohort of combined/other endometriosis (n = 4748). The reference cohort comprised 35 788 women. The follow-up started at the age of 15 years and ended at first birth, sterilization/bilateral oophorectomy/hysterectomy, emigration, death, age of 50 years, or December 31, 2019. From Kaplan-Meier survival curves of not giving birth, that is, until the first birth, we assessed the statistical difference of first births with crude and adjusted restricted mean survival time (RMST). In addition, we studied the fertility rate of women until the end of follow-up.</p><p><strong>Results: </strong>Altogether 12 491 (68.2%) women with endometriosis compared with 28 871 (80.7%) reference women gave birth during follow-up. Women with peritoneal and deep endometriosis had higher first birth rate (73.1% and 71.3%) compared with women with ovarian and combined/other forms of endometriosis (65.2% and 65.5%) (p < 0.001). The RMST of not giving birth was longer in women with endometriosis 18.9 (18.8-19.0) years compared with the reference cohort 15.5 (15.4-15.6) with both crude and adjusted RMST difference (p < 0.001). Moreover, each sub-cohort showed a longer RMST of not giving birth than reference cohort (p < 0.001). Total fertility rate of women was 1.33 (SD 1.16) in the endometriosis and 1.89 (1.46) in the reference cohort (p < 0.001) with smaller differences among endometriosis sub-cohorts.</p><p><strong>Conclusions: </strong>Findings suggest that fertility outcome is compromised depending on the endometriosis subtype. Thus, timely diagnosis and appropriate treatment might be beneficial for fertility.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332274","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":"Unassisted home births in Norway: A growing concern","authors":"Solveig Bjellmo,&nbsp;Johanne Kolvik Iversen","doi":"10.1111/aogs.15179","DOIUrl":"10.1111/aogs.15179","url":null,"abstract":"&lt;p&gt;Norway has one of the world's lowest maternal and perinatal mortality rates. Cesarean section and operative vaginal delivery rates remain stable, even as induction rates have doubled from 2009 to 2023.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; These outcomes reflect a high-quality maternity care system. Yet, a troubling trend has emerged: the number of planned unassisted home births increased from a total of 20 between 2020 and 2023 to 21 cases in 2024 alone.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;This raises critical questions. Why are some women opting out of a system known for its safety and comprehensive care? Reports suggest factors such as perceived lack of emotional support, previous negative experiences, and a desire for autonomy during childbirth. Some women report feeling traumatized or violated by hospital births, leading to profound mistrust in the system.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;A survey conducted for the Norwegian Broadcasting Corporation (NRK) found that 1 in 10 Norwegians aged 18–39 believe unassisted home birth is safe, and a further 18% were unsure.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; This stands in stark contrast to medical evidence: perinatal mortality is estimated to be three times higher, and maternal mortality up to 100 times higher with unassisted birth.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; These numbers reveal a serious information gap, one that must be addressed urgently to prevent misinformation from putting lives at risk.&lt;/p&gt;&lt;p&gt;Global data are sobering. According to the WHO, approximately 800 women die every day from preventable pregnancy and childbirth-related causes, roughly one every two minutes.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; While these numbers primarily reflect countries without organized prenatal care and access to safe delivery facilities, they serve as a chilling reminder: childbirth is inherently risky. Norway's excellent outcomes are the result of decades of structured, evidence-based care.&lt;/p&gt;&lt;p&gt;Presenting statistics is not meant to invoke fear, but to promote an evidence- based understanding of risks. So-called “freebirth” activists in Norway have countered by asserting that “statistics and science is not the most important.”&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Healthcare professionals, including obstetricians and midwives, find this development deeply troubling. The associated risk became tragically clear in 2024, when a newborn died following an unassisted home birth in Norway. The subsequent public debate included inflammatory accusations, including labeling midwives rapists.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; The emotional toll on providers is significant, and there is growing concern about the future of the profession.&lt;/p&gt;&lt;p&gt;The debate touches on longstanding ethical dilemmas at the intersection of maternal autonomy and fetal rights. A recent commentary in &lt;i&gt;Aftenposten&lt;/i&gt; by two legal experts and a pediatrician highlights the lack of legal clarity on when a fetus acquires independent rights, especially during labor.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; While Norwegian","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1418-1419"},"PeriodicalIF":3.5,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324140","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":"Lack of consensus in calculation of interval cancer rates for cervical cancer screening.","authors":"Patricia Fitzpatrick, Therese Mooney, Yvonne Williams, Caroline Mason Mohan, Jesper Bonde, Julia Gao, Andrzej Nowakowski, Annemie Haelens, Urska Ivanus, Maiju Pankakoski, Tina Karapetyan, Noirin E Russell","doi":"10.1111/aogs.15172","DOIUrl":"https://doi.org/10.1111/aogs.15172","url":null,"abstract":"<p><strong>Introduction: </strong>In 2018, nondisclosure of results of retrospective audits of cytology in interval cancers precipitated a crisis in the Irish national cervical screening programme. In response, an Expert Reference Group was convened which recommended a collaborative approach to the development of a new key performance indicator, the interval cancer rate. The Expert Reference Group also recommended that the Irish programme should collaborate with international colleagues to reach consensus on (i) the definition of an interval cervical cancer, (ii) the methodology to calculate the interval cancer rate, and (iii) benchmarking with other international programs. This study was undertaken to determine if a consensus regarding the definition of an interval cervical cancer and the calculation of an interval cancer rate exists.</p><p><strong>Material and methods: </strong>A web-based questionnaire was sent to 18 population-based cervical screening programs. Inclusion criteria involved (1) a national or regional population-based cervical screening prograe; (2) a country or region with a population ≥population of Ireland; (3) programs located in Europe, Australia, or Canada; (4) programs that had responded to a previously published international survey on the disclosure of retrospective cytology reviews in cervical cancer cases.</p><p><strong>Results: </strong>The response rate was nine out of 18. Of nine respondents, six had an agreed definition of interval cervical cancer, and four of these calculated an interval cancer rate. Three programs neither calculated interval cancer rates nor had any guidelines related to this. Of the six with an agreed definition, all respondents defined the numerator as invasive cancers in the screening age group, with four including microinvasive disease. Respondents included cancers diagnosed 3-5 years after the last screening test had been taken. Three respondents also included cancers diagnosed in women up to 3.5 years after they exited the screening program. Countries use different denominators, including (i) per women years, (ii) per number of screens, and (iii) per total cancers in screened population.</p><p><strong>Conclusions: </strong>There is variation in the parameters used in interval cancer rate calculation. To allow benchmarking of cervical screening program performance, there is a need for consensus on a standardized method of interval cancer definition and interval cancer rate calculation.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300939","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}