Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Association of maternal asthma with congenital heart defects in offspring","authors":"Mari Kemppainen,&nbsp;Turkka Kirjavainen,&nbsp;Emmi Helle,&nbsp;Mika Gissler","doi":"10.1111/aogs.70032","DOIUrl":"10.1111/aogs.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Asthma is the most common chronic disease among pregnant women. Some studies have linked maternal asthma to an increased risk of congenital malformations, particularly congenital heart defects (CHDs). Among these, ventricular septal defect (VSD) is the most common, accounting for nearly half of all CHD cases. We investigated the association between maternal asthma and the risk of CHD in offspring. As a sensitivity analysis, we also examined the associations between maternal atopic predisposition, maternal use of asthma medication, and CHD risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This retrospective, population-based study utilized a comprehensive birth cohort of all singleton births in Finland between 1996 and 2018. Data were derived by linking four high-coverage national health registers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort included 1 274 540 eligible mother–child pairs. A total of 106 544 (8.4%) mothers had a diagnosis of asthma or had purchased asthma medication during pregnancy. Of the offspring, 18 772 (1.5%) were diagnosed with a congenital heart defect (CHD), and 8855 (0.7%) had a diagnosis of ventricular septal defect (VSD). Maternal asthma was weakly associated with overall CHD (OR 1.18; 95% CI, 1.12 to 1.24) and with VSD (OR 1.19; 95% CI, 1.10 to 1.27). The association between maternal asthma and CHD was observed in both allergic asthma (OR 1.33; 95% CI, 1.18 to 1.50) and nonallergic asthma (OR 1.27; 95% CI, 1.04 to 1.56). Maternal allergic conditions, such as atopic dermatitis and allergic rhinitis, were also associated with CHD overall (OR 1.13; 95% CI, 1.02 to 1.25) and with VSD (OR 1.20; 95% CI, 1.04 to 1.38).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Maternal asthma and allergic tendency are associated with a modestly increased risk of CHD in offspring, particularly VSD. Nonallergic asthma was also linked to CHD, especially right-sided defects. These findings suggest that maternal allergic inflammation may have teratogenic effects during fetal cardiac development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":"1849-1858"},"PeriodicalIF":3.1,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774464","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":"Availability of deceased uterus donor: Is it a real case scenario in Spain?","authors":"Mariona Rius,&nbsp;Marta Camacho,&nbsp;Jaume Tort,&nbsp;Antonio Alcaraz,&nbsp;Berta Diaz-Feijoo,&nbsp;David Paredes-Zapata,&nbsp;Meritxell Gracia,&nbsp;Francisco Carmona","doi":"10.1111/aogs.70020","DOIUrl":"10.1111/aogs.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Absolute uterine factor infertility, historically considered untreatable, remained without proven effective treatment until 2014, when the first birth following uterus transplantation from a living donor occurred in Sweden. Since then, the procedure has been performed by other groups using living and deceased donors. Interest in deceased donors is increasing; however, global experience remains limited. The availability of potential deceased donors is unknown in many regions, and there is no clear consensus on inclusion criteria. Hence, the aim of this study is to determine the availability of potential deceased donors in our region and critically analyze actual inclusion criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A retrospective review of our organ procurement organization's database was conducted between January 1st 2015, and December 31st 2019, to identify potential deceased uterine donors. During this period, 201 women aged 18–50 were included in a multi-organ donation program after circulatory and brain death. Only brain death donors were considered, as described in the literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After applying exclusion criteria, 14 and 48 potential deceased uterine donors were identified using standard and extended donor criteria. This corresponds to 1.8 and 6.3 deceased donors per million people throughout the entire period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We believe the number of potential candidates remains low, and expanding inclusion criteria could increase organ availability, especially in those regions with emerging transplantation programs to establish cadaveric donor-based solutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":"1869-1874"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758878","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":"COVID-19 vaccination around the time of conception and risk of placenta-mediated adverse pregnancy outcomes","authors":"Annette K. Regan,&nbsp;Liam Bruce,&nbsp;Carolina Lavin Venegas,&nbsp;Eszter Török,&nbsp;Robert W. Platt,&nbsp;Christopher A. Gravel,&nbsp;Gillian D. Alton,&nbsp;Sheryll Dimanlig-Cruz,&nbsp;Prakesh S. Shah,&nbsp;Jon Barrett,&nbsp;Mark C. Walker,&nbsp;Darine El-Chaâr,&nbsp;Kumanan Wilson,&nbsp;Ann E. Sprague,&nbsp;Sarah A. Buchan,&nbsp;Jeffrey C. Kwong,&nbsp;Sarah E. Wilson,&nbsp;Siri E. Håberg,&nbsp;Nannette Okun,&nbsp;Tavleen Dhinsa,&nbsp;Sandra Dunn,&nbsp;Deshayne B. Fell","doi":"10.1111/aogs.70025","DOIUrl":"10.1111/aogs.70025","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;Although numerous studies have documented no association between COVID-19 vaccination during pregnancy and maternal and fetal health outcomes, fewer studies have evaluated fetal health effects after COVID-19 vaccination around the time of conception and early pregnancy, a time when maternal exposures may affect early placentation and the subsequent risk of placenta-mediated adverse pregnancy outcomes.&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;We used province-wide databases in Ontario to conduct a population-based cohort study including all live and stillbirths ≥20 weeks' gestation with a last menstrual period (LMP) between April 1 and December 31, 2021. We deterministically linked birth registry data to the vaccine registry for all 80 253 eligible pregnancies; 31 209 (38.9%) received ≥1 dose of the COVID-19 vaccine around the time of conception or first trimester. Using Cox regression, we estimated propensity score weighted hazard ratios (aHR) and 95% confidence intervals (CI) for associations between ≥1 dose of mRNA COVID-19 vaccine during the periconceptional/first trimester exposure window (28 days before the LMP to the end of first trimester) and study outcomes: hypertensive disorders (gestational hypertension, preeclampsia, eclampsia), placental abruption, preterm birth (&lt;37 weeks), small-for-gestational-age (SGA) birth (&lt;10th percentile), and stillbirth.&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;COVID-19 vaccination around the time of conception or first trimester was associated with a small increased risk of hypertensive disorders in pregnancy in exposed versus unexposed individuals (7.4% vs. 6.1%; aHR: 1.10, 95% CI: 1.03–1.17), mostly attributed to gestational hypertension (5.0% vs. 4.1%; aHR 1.13, 95% CI: 1.05–1.22). There was no increased risk of preeclampsia (1.8% vs. 1.5%; aHR 1.08, 95% CI: 0.95–1.22), eclampsia (0.1% vs. 0.1%; aHR: 1.12, 95% CI 0.65–1.95), placental abruption (0.8% vs. 1.0%; aHR: 0.77, 95%CI: 0.65–0.91), preterm birth (8.0% vs. 8.9%; aHR: 0.92, 95%CI: 0.87–0.97), SGA birth (8.9% vs. 9.3%; aHR: 1.00, 95%CI: 0.95–1.06), or stillbirth (0.4% vs. 0.6%; aHR: 0.66, 95%CI: 0.52–0.82).&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;This population-based Canadian study provides additional evidence evaluating COVID-19 vaccine administration around the start of pregnancy. While we identified no association with most placenta-mediated outcomes, we report a slight increase in the rate of gestational hypertension. This could be a true association or attributed t","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":"1883-1896"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758879","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":"What is the role of Ob&Gyn specialists in alleviating the declining fertility rates in the Nordic countries?","authors":"Rauni Klami,&nbsp;Antti Perheentupa","doi":"10.1111/aogs.70033","DOIUrl":"10.1111/aogs.70033","url":null,"abstract":"&lt;p&gt;Low fertility has been apparent in several European countries for many decades. The Nordic countries have fallen below the level of replacement (i.e., total fertility index [TFI] of 2.1) already in the 1970s. However, this has not been reflected in the population numbers that have continued growing as a result of prolonged life expectancy as well as immigration. Alarmingly, the low total fertility index is quickly becoming a global trend rather than solely a phenomenon of the developed Western European countries. Currently, the TFI of half of all countries is below replacement value, and according to available data and models, the TFI of more than 90% of all countries will fall below 2.1 by the end of this century. The global population is estimated to peak at around 10 billion near the year 2100. Thereafter, a significant population decline is expected. There are also more dramatic forecasts, which suggest that the population peak will be reached by mid-century and a substantial decrease will already be seen by the end of the century.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; At the moment, about 50% of all nations have a fertility rate below the replacement value of 2.1. Several countries are predicted to have a population decrease of &gt;50% between 2017 and 2100. For clarity, it is important to understand that a TFI of 1.5 means that the number of children born will be halved in two generations.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;It is clear that in socioeconomically well-developed countries, for example, the Nordic countries, far too many adults are unable to achieve the number of children that they would desire. According to the Family Federation of Finland, the Finns on average desire a family of two children; however, it is clear from the latest numbers that many families fail to reach this desired family size. Whereas the number of women and couples who choose voluntary childlessness may have increased, there is an evident gap in the number of children that couples wish to have and end up having.&lt;/p&gt;&lt;p&gt;There are multiple reasons behind the significant decrease in total fertility index. Social, economic, and educational factors are bringing the TFI down, particularly in advanced societies. Ecological conscience and fear of ecosystem collapse are sometimes given as reasons for choosing not to have children. Yet in a fairly recent evaluation in Sweden, 96% of high school students were planning to have children, girls slightly more than boys.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The highly regarded importance of education and employment, particularly among women wishing for autonomy and independence, is causing a delay in establishing a family.&lt;/p&gt;&lt;p&gt;The rapid development of the “online lifestyle” is resulting in “dopamine culture” where instant gratification is expected. Research is showing that relationships have become shorter, and there are fewer marriages, more divorces, and consequently fewer opportunities to bring a child to an established partnership.&lt;span&gt;&lt;sup&gt;4","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 9","pages":"1596-1598"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758881","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":"Long-term cardiovascular risk in women with hypertensive disorders of pregnancy: Insights from polygenic risk scores","authors":"Anna Kivioja,&nbsp;Jaakko Tyrmi,&nbsp;Elli Toivonen,&nbsp;Heini Huhtala,&nbsp;FinnGen,&nbsp;Tiina Jääskeläinen,&nbsp;Johannes Kettunen,&nbsp;Tanja Saarela,&nbsp;Hannele Laivuori","doi":"10.1111/aogs.70021","DOIUrl":"10.1111/aogs.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The association between preeclampsia (PE) and an elevated risk of cardiovascular disease (CVD) is well documented. Recent genome-wide association studies of PE have further highlighted their possible common genetic background. We investigated how the history of hypertensive disorders of pregnancy (HDP), including the PE phenotype, and normotensive pregnancy, combined with polygenic risk scores (PRSs) for PE (PE-PRS), high systolic blood pressure (SBP-PRS), coronary artery disease (CAD-PRS) or stroke (stroke-PRS), affects the risk for CVD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>The study was conducted in the FinnGen cohort of 213 942 Finnish women, including 8858 women with PE, 17916 women with any HDP, and 196 026 parous controls. PE women were included in the HDP phenotype. Participants were classified based on their PRSs into three groups: low (&lt;20%), moderate (20–80%) and high (&gt;80%) genetic risk. Women with normotensive pregnancies and moderate PRSs served as controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Women with PE and a high genetic risk for PE, high SBP, CAD, and stroke had a significantly increased risk of CVD compared to women with normotensive pregnancies and a moderate genetic risk. The hazard ratios (HRs) for CVD were 1.87 for PE-PRS, 2.31 for SBP-PRS, 1.94 for CAD-PRS, and 2.07 for stroke-PRS, all <i>p</i>-values 2 × 10⁻¹⁶. A similar pattern was observed in women with any HDP. Among women with normotensive pregnancies, a high genetic risk led to only a modest increase in CVD risk. The corresponding HRs were 1.07 for PE-PRS (<i>p</i> = 5 × 10⁻⁵), 1.32 for SBP-PRS, 1.19 for CAD-PRS, and 1.16 for stroke-PRS (all <i>p</i> values 2 × 10⁻¹⁶). Across all four PRSs, the impact of PE and any HDP on CVD risk was greater than that of genetic risk alone. The elevated CVD risk persisted up to the age of 80.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In women with PE or any HDP, a high genetic risk for PE, high SBP, CAD, and stroke further increases the overall risk of CVD. Among women with normotensive pregnancies, a high genetic risk confers only a modest increase in CVD risk. In evaluating long-term CVD risk, clinical risk assessment, including obstetric history, appears to outperform genetic risk evaluation using PRSs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":"1907-1917"},"PeriodicalIF":3.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758880","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":"Feasibility and acceptability of a brief online acceptance and commitment therapy intervention to reduce fear of childbirth: A novel application of a third-wave cognitive behavioral therapy focused on psychological flexibility and acceptance","authors":"Abbey A. Ashton,&nbsp;Jane Wilson,&nbsp;Pauline Slade","doi":"10.1111/aogs.70023","DOIUrl":"10.1111/aogs.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Fear of childbirth (FOC) is a significant issue for many women. However, findings from studies of psychological interventions to reduce FOC are equivocal. Resource constraints highlight the need for brief interventions. Previous research demonstrated that a face-to-face single session acceptance and commitment therapy (ACT) intervention showed promise. The National Health Service (NHS) Long Term Plan for England highlights a wish to increase digitalization. There is a need to test online adaptations of interventions. This study aimed to assess the feasibility and acceptability, and preliminary indications of effectiveness of an online ACT group intervention for individuals who experience FOC in their first pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Participants were recruited via an NHS maternity service to attend an online two-session, small group, ACT intervention. Information on recruitment, retention, and qualitative and quantitative feedback on the sessions was gathered. Primary outcome measures (FOC and anxiety) and secondary measures (psychological flexibility and coping style) to identify potential mechanisms of change were completed pre-intervention and 2 weeks following the second session.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven two-session groups ran with 25 individuals participating in both sessions, indicating good feasibility. All participants were retained and provided follow-up data. Feedback information suggested that the intervention was highly acceptable. Statistical and clinical reductions in FOC and anxiety were found. Statistically significant changes in psychological flexibility and coping style offer preliminary hypotheses regarding potential mechanisms of change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A two-session online ACT group intervention tailored for FOC appears feasible and acceptable and shows promise in terms of impact. A pilot randomized controlled trial is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":"1939-1948"},"PeriodicalIF":3.1,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752045","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":"Burnout, wellbeing and defensive medical practice in obstetricians and gynecologists in the UK before and after the COVID pandemic: A repeated cross-sectional survey study","authors":"Nina Parker,&nbsp;Nora Falconieri,&nbsp;Harsha Shah,&nbsp;Christoph Lees,&nbsp;Dirk Timmerman,&nbsp;Ben Van Calster,&nbsp;Tom Bourne","doi":"10.1111/aogs.70006","DOIUrl":"10.1111/aogs.70006","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is evidence that burnout rates in doctors are high following the COVID pandemic, but with considerable variation across geographical location and specialty. In 2018, we performed a UK-wide survey of obstetrics and gynecology (O&amp;G) doctors, providing baseline data on burnout, wellbeing, and defensive medical practice (DMP) directly before the pandemic. This study aims to determine the prevalence of burnout, poor wellbeing, and DMP in obstetricians and gynecologists after the pandemic, to compare these to pre-pandemic levels, and to explore the relationship between burnout, poor wellbeing, and DMP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a repeated national cross-sectional survey study. Practicing obstetrics and gynecology doctors registered with the Royal College of Obstetricians and Gynaecologists (RCOG) were eligible to participate. In 2022, an email containing a survey link was sent to 7388 UK doctors registered with the RCOG. The same method and measures were used as in our previous 2018 study. Burnout prevalence was assessed using the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI). Wellbeing and DMP were assessed using self-report questionnaires.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The response rate for the post-pandemic survey was 19% (1400/7388) and 55% (3102/5661) for the pre-pandemic survey. A total of 1114 out of 1400 (80%) met the inclusion criteria and completed the MBI. Burnout criteria were met in 72%, compared with 36% before the pandemic (adjusted odds ratio [AOR] 4.7, 95% confidence interval [CI] 4.0 to 5.5). Highest levels were seen in trainees (80%). Thirty-nine percent of doctors reported DMP compared with 13% pre-pandemic. Worse doctor wellbeing was reported across all items; 62% of doctors reported anxiety, 31% depression, and 9% suicidal thoughts compared with 33%, 14%, and 3% pre-pandemic. Burnout was associated with DMP and poor wellbeing, including suicidal thoughts, depression, and anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This national study suggests high levels of burnout in obstetricians and gynecologists compared with pre-pandemic levels, particularly in trainees. There was a probable decline in wellbeing compared with pre-pandemic levels. Poor wellbeing and DMP were associated with burnout. Burnout interventions to improve doctor wellbeing, quality of care, and patient safety are urgently needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 9","pages":"1683-1693"},"PeriodicalIF":3.1,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740817","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":"Kristeller misunderstood?","authors":"Matthias David","doi":"10.1111/aogs.70030","DOIUrl":"10.1111/aogs.70030","url":null,"abstract":"<p>Samuel Kristeller (1820–1900) was active in Berlin/Germany; he died there 125 years ago. The authors, led by Guo (2025), examine an “obstetric old-fashioned” technique that has been intensively discussed since at least the 1990s: Kristeller maneuvers or “fundal pressure.” Studies on this topic are rare, which is why the authors are to be thanked for this RCT!</p><p>In the introduction, Guo et al. write in the July issue of AOGS that Samuel Kristeller used this technique to accelerate vaginal delivery in emergency situations.<span>¹</span></p><p>In the almost 160 years that have passed since Samuel Kristeller's publication,<span>²</span> Kristeller maneuvers have certainly been performed countless times worldwide during the expulsion period in both out-of-hospital and hospital births, without most users being familiar with the original publication. It is also not cited in the abovementioned article and is not included in the references. Therefore, a brief explanation:</p><p>Samuel Kristeller first published his method for supporting labor in 1867 in a “preliminary communication” in the Berliner Klinische Wochenschrift (Berlin Clinical Weekly).<span>²</span> Reading the original report, it becomes clear that Kristeller used the hand grip regardless of the completeness of the cervix, the position of the fetus, or the height of the uterus, essentially as a substitute for a lack of or no labor activity or the absence of labor-inducing medication. Three quotes from Kristeller's work are provided to illustrate his approach at the time: “The pressure lasts 5–8 s….Then I take a break of 0.5–3 mins….I repeat the compressions 10–40 times. In difficult cases, after a series of 10–15 compressions, I take a longer break of 10–15 mins…” Kristeller further notes, “…that the expressio procedure competes excellently with extraction…” and “…that the procedure should be performed with the necessary moderation….”<span>²</span> It becomes clear that the Kristeller maneuver was intended to prevent complications from the so-called internal maneuvers or the use of forceps in an era of poor hygiene and high risk of infection. Moreover, Kristeller was probably well aware of the dangers of “expressio fetus”<span>²</span>—discussed today in other contexts.</p><p>Two other ideas by Kristeller, which also pursued the goal of a more gentle (operative) birth, have been virtually forgotten: A (bloody) incision of the cervix was intended to shorten the expulsion period in emergency cases.<span>³</span> Finally, in 1862, Kristeller first described a dynamometric device in forceps, which was intended to measure and regulate the pressure on the fetal skull.<span>⁴</span></p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726427","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":"Survey of practices in the European Federation for Colposcopy: HPV vaccination after treatment for cervical precancerous lesions","authors":"Annu Heinonen,&nbsp;Ilkka Kalliala,&nbsp;Anne Hammer,&nbsp;Maggie Cruickshank,&nbsp;Xavier Carcopino,&nbsp;Björn Strander,&nbsp;Pekka Nieminen","doi":"10.1111/aogs.70027","DOIUrl":"10.1111/aogs.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients treated for cervical precancerous lesions have a long-term increased risk for cervical cancer compared with the general population. As human papillomavirus (HPV) vaccination is effective in preventing cervical cancer and its precursors when given prior to sexual debut, adjuvant HPV vaccination in relation to the treatment of precursor lesions has been of great interest. Existing supporting data are of low quality, and recent meta-analyses called for high-quality randomized controlled trials. The European Federation for Colposcopy (EFC) observed a heterogeneity in clinical practices of adjuvant vaccination, and this survey aimed to assess potential differences in vaccination practices across Europe.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A survey was sent out to 100 representatives of the 32 member countries of the EFC. The survey was in English and contained questions on current general HPV vaccination programs, whether guidelines on vaccination after treatment exist, and questions on respondents' own practices of recommending vaccination after treatment. The survey was constructed using the Google Forms web platform and sent by email to representatives of each National Colposcopy Society.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 44 answers from 32 different European countries were received. Overall, 12 countries (12/32, 37.5%) reported having a national guideline on HPV vaccination at the time of treatment for precursor lesions, and in nine of these countries, adjuvant HPV vaccination is recommended. A third, 31.8%, of respondents (14/44) found the available evidence sufficient to recommend vaccination at the time of treatment, and 54.5% (24/44) found the evidence to be nearly sufficient. Only 13.6% (6/44) of the respondents found the current evidence insufficient to be able to recommend vaccination. Altogether, 29.5% (13/44) of respondents would recommend vaccination, even if future randomized controlled trials would not show benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The varying practices regarding adjuvant HPV vaccination across European countries are concerning and call for ethical evidence-based practices across Europe and reliance on high-quality evidence to assess whether vaccination at the time of treatment is effective.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":"1980-1985"},"PeriodicalIF":3.1,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726428","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":"Endometriosis—The scapegoat for pelvic pain?","authors":"Gernot Hudelist,&nbsp;Ezgi Darici Kurt,&nbsp;Davor Jurkovic,&nbsp;Tina Tellum","doi":"10.1111/aogs.70014","DOIUrl":"10.1111/aogs.70014","url":null,"abstract":"<p>Cyclic and noncyclic chronic pelvic pain (CPP) represent a major problem for both affected patients and healthcare providers due to its effects on physical and mental health. In times of social media and digitalization, awareness of endometriosis as a leading cause of CPP is increasing. However, a close look at the current literature does not support endometriosis as the predominant and most common cause of pelvic pain syndromes and associated morbidities. Consequently, other or additional factors may be overlooked, complex pain mechanisms simplified, and symptoms misunderstood, resulting in less optimal treatment concepts. This commentary underlines the necessity to evaluate patients with CPP and suspected endometriosis in a multifactorial and holistic context to provide a better framework of patient care.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 9","pages":"1599-1602"},"PeriodicalIF":3.1,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717162","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}