Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Reframing spontaneous preterm birth as a preventable adverse outcome-A clinical audit of a preventative toolbox.","authors":"Aparna Ramachandran, Darazel Perez, Adrienne Gordon, Jon Hyett","doi":"10.1111/aogs.15079","DOIUrl":"https://doi.org/10.1111/aogs.15079","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous preterm birth is a major cause of perinatal morbidity and mortality and has traditionally been viewed as an inevitable event affecting a small proportion of pregnancies. Clinical practice guidelines recommend measures to predict pregnancies at risk of spontaneous preterm birth and prophylactic treatments. We performed this study to assess adherence to current guidelines for prediction and prevention of spontaneous preterm birth and to evaluate the effectiveness of current predictive tools.</p><p><strong>Material and methods: </strong>Retrospective audit of all spontaneous preterm birth in singleton pregnancies preceded by spontaneous labor or preterm prelabor rupture of membranes less than 37 weeks at an Australian metropolitan hospital from January 1, 2019, and December 31, 2020. Termination of pregnancy and fetal abnormalities were excluded. Electronic medical record data was collected for maternal demographic information, antenatal care and use of current predictive measures, use of prophylactic treatments, and pregnancy and newborn outcomes.</p><p><strong>Results: </strong>Two hundred sixty-seven spontaneous preterm births were included, comprising 3.5% of all births over the study period. Seventy-eight percent of these were in women defined as low-risk for preterm birth. Screening for bacteriuria was performed in 59.1% and 65.9% of low- and high-risk women, respectively. Cervical length measurement was performed in 65% and 72% of low- and high-risk women; only 10.7% of low-risk and 11.4% of high-risk women with sPTB had a short cervix prior to 24⁺⁶ weeks gestation. The mean gestational age at birth was 34⁺⁰ and 35⁺⁰ weeks for low- and high-risk women (p = 0.38); the rate of perinatal death was 9.6% in low-risk pregnancies and 4.2% in high-risk pregnancies (p = 0.39).</p><p><strong>Conclusions: </strong>Adherence to clinical guideline recommendations for prediction and prevention of sPTB was suboptimal in this cohort. The majority of spontaneous preterm births occur in women without risk factors and most women with sPTB in this cohort were not identified as having a short cervix in the early second trimester; these preterm births are therefore not identified by current predictive tools. Preterm birth continues to be associated with an increased risk of perinatal death despite the use of current predictive and preventative measures.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456585","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 decade of human uterus transplantation","authors":"Mats Brännström","doi":"10.1111/aogs.15080","DOIUrl":"10.1111/aogs.15080","url":null,"abstract":"&lt;p&gt;On September 4, 2014, the birth of the first child from a transplanted uterus marked a monumental milestone in the fields of gynecology, reproductive medicine, and obstetrics.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This historic achievement, realized in Sweden, established uterus transplantation (UTx) as a groundbreaking treatment for absolute uterine factor infertility—a condition affecting approximately 1 in 500 women. Since that pioneering UTx birth, over 70 children have been born globally following more than 130 UTx procedures.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The world's first eight live births after UTx took place at Sahlgrenska University Hospital, Sweden.&lt;/p&gt;&lt;p&gt;On September 5, 2024, the International Society of Uterus Transplantation convened in Gothenburg for its 4th State-of-the-Art Meeting. The event began with a heartwarming moment: the first UTx child born, who had celebrated his 10th birthday the day before, addressed the audience. Speaking in fluent English, he described himself as “an ordinary boy who loves sports, especially golf and ice hockey.” He shared how proud his parents were of him and encouraged the attendees to continue their work to make UTx widely accessible. His words deeply moved the delegates, many of whom shed tears of joy, reflecting on the remarkable progress made in just a decade and the profound human impact of this groundbreaking medical advancement within our medical field.&lt;/p&gt;&lt;p&gt;The UTx journey from concept to reality is widely regarded as a prime example of a translational project in innovative surgery, meticulously prepared and monitored according to the highest standards outlined in the Moore Criteria&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; and the IDEAL framework&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; for introducing major surgical innovations. As part of this rigorous approach, systematic animal research was conducted across several species,&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; before the first clinical UTx-trial started in 2012–2013.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The field of UTx has evolved rapidly over the past decade, with continuous methodological advancements aimed at improving both the safety and efficacy of the procedure. The surgery itself, particularly live donor (LD) hysterectomy, is highly complex. For a LD-UTx, the total surgical time—including hysterectomy, back-table preparation, and transplantation—is around 15 h.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; To reduce tissue trauma, robotic surgery has been introduced for LD hysterectomy, leading to shorter hospital stays and reduced recovery time.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; However, this approach has not yet resulted in a reduction in overall surgical duration. In terms of immunosuppression (IS), the initial high-IS induction regimen with antithymocyte globulin and high tacrolimus levels has now been adjusted to a moderate-IS induction protocol using basiliximab and moderate tacrolimus levels. Our experience is that this modified IS protocol does not increase the risk of rejection episodes and has reduced the prev","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 3","pages":"434-436"},"PeriodicalIF":3.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447678","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":"Associations between sociodemographic and obstetric factors, and childbirth experience","authors":"Daniella Rozsa,&nbsp;Ragnar Kvie Sande,&nbsp;Stine Bernitz,&nbsp;Ingvild Dalen,&nbsp;Geir Sverre Braut,&nbsp;Pål Øian,&nbsp;Torbjørn M. Eggebø,&nbsp;Rebecka Dalbye","doi":"10.1111/aogs.15076","DOIUrl":"10.1111/aogs.15076","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;Sociodemographic and obstetric factors have been shown to impact childbirth experience, but results regarding the effect of certain factors have been heterogeneous. It is important to understand how individual risk factors affect childbirth experience to be able to identify women at risk for negative childbirth experience. The aim of this study was to determine individual associations between sociodemographic and obstetric factors and childbirth experience.&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;The Labor Progression Study (LaPS-NCT02221427) was a multicenter randomized trial examining clinical consequences of using Zhang's guideline vs the WHO partograph on intrapartum cesarean section rate. Four weeks after delivery, 5810 women received the Childbirth Experience Questionnaire (CEQ) online. The CEQ consists of 19 questions on four subscales (own capacity, professional support, perceived safety, and participation). The total CEQ score is the mean score of each of the subscale scores, ranging from 1 to 4, a higher score indicating a better childbirth experience. Sociodemographic (age, body mass index, education, civil status, and smoking) and obstetric (gestational age, prolonged labor, mode of delivery, and obstetric complications) characteristics of the women were recorded, and associations to total and subscale CEQ scores were examined with log-linear regression.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In all, 3604 women answered the questionnaire, a 62.9% response rate. The mean (SD) total CEQ score was of 3.24 (0.43). The subscale score was highest for professional support, mean 3.68 (0.49), and lowest for own capacity, mean 2.61 (0.54). The total CEQ score was not associated with any of the sociodemographic characteristics examined. Smoking in the first trimester was associated with lower scores on the professional support subscale 3.61 (3.55, 3.67) than nonsmokers, 3.69 (3.68, 3.71); &lt;i&gt;p&lt;/i&gt; = 0.001. Of obstetric factors, only delivering in week 37 was significantly associated with a higher total CEQ score, 3.34 (3.28, 3.40), vs. 3.24 (3.22, 3.26) at 40 weeks, &lt;i&gt;p&lt;/i&gt; = 0.002. Findings remained significant in adjusted analysis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In our study, individual sociodemographic factors did not impact overall the childbirth experience. Smoking was associated with a lower score on the professional support subscale. Delivery in week 37 was associated with a better overall childbirth experience. No other obstetric factor influenced the c","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"637-646"},"PeriodicalIF":3.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447680","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":"A comparison of the treatment outcome of Asherman's syndrome which developed within and outside the puerperal period: A matched cohort study","authors":"Lingling Yang,&nbsp;Tingting Tian,&nbsp;Xue Yang,&nbsp;Yan Guo,&nbsp;Xiaowu Huang,&nbsp;Enlan Xia,&nbsp;Tin Chiu Li,&nbsp;Dongmei Song","doi":"10.1111/aogs.15057","DOIUrl":"10.1111/aogs.15057","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The outcome following hysteroscopy adhesiolysis of Asherman’s syndrome in the puerperal period who appeared to do less well than the participants who developed the syndrome unrelated to child birth. As there is no literature to support or refute the observation, we decided to conduct a retrospective cohort study to compare the outcome of hysteroscopic adhesiolysis in women who developed Asherman's syndrome within or outside the puerperal period.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Material and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This retrospective cohort study aimed to compare the outcome of hysteroscopic adhesiolysis in women who developed Asherman's syndrome within the puerperal period and women who developed the Asherman's syndrome outside the puerperal period. Fifty-one women suffered from Asherman's syndrome in the puerperal period and 153 women suffered from Asherman's syndrome which developed outside the puerperal period. Second-look and third-look hysteroscopy were performed 4 and 8 weeks after hysteroscopic adhesiolysis.&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;The primary outcome measures were the postoperative adhesion reformation rate and the magnitude of reduction in American Fertility Society score as assessed at second-look hysteroscopy. The secondary outcome measure was the change in menstrual pattern at 3 months after surgery. The adhesion reformation rate in puerperal group was 86.3%, which was significantly (&lt;i&gt;p &lt;&lt;/i&gt; 0.05) higher than that of 38.6% in the non-puerperal (non-puerperal) group. The median reduction in the adhesion score was 4.5 (4–6) in the puerperal group, which was significantly (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) lower than the median reduction 7 (6–8) of the non-puerperal group. In the puerperal group, the reduction rate of American Fertility Society score after hysteroscopic adhesiolysis was 42.4%, which was significantly lower than that of 72.6% in the non-puerperal group. In the puerperal group, only 56.9% of women experienced improvement in menstruation defined as subjective increase in menstrual flow after surgery, which was significantly lower than that of 83.7% observed in the non-puerperal group.&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;Following hysteroscopic adhesiolysis, the outcome of Asherman's syndrome in women who developed the condition in the puerperal period was worse than those who developed the condition outside the puerperal period. Strategies to minimize damage and promote regeneration of the endometrium in the puerperal period in women at risk of developing intrauterin","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"774-780"},"PeriodicalIF":3.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447677","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":"Obesity and cesarean section rate among low-risk primiparous women in Victoria, Australia: A population-based study","authors":"Alemayehu Mekonnen,&nbsp;Glyn Teale,&nbsp;Vidanka Vasilevski,&nbsp;Linda Sweet","doi":"10.1111/aogs.15054","DOIUrl":"10.1111/aogs.15054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Women living with overweight, or obesity are at risk of pregnancy and birth complications. This study investigated the trend and associations between overweight and obesity on cesarean births and their contribution to cesarean births among low-risk primiparous women in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Body mass index data were obtained for 219, 950 primipara (aged 20─34 years) with singleton, term pregnancies without malpresentations from the Victorian Perinatal Data Collection registry (2010─2019). Women were grouped according to body mass index and logistic regression analyses were performed to assess the trend and associations of overweight and obesity with cesarean births. The contribution of overweight and obesity to cesarean births were estimated using population attributable fraction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of cesarean birth was 29.7%, and the prevalence increased by 20%, from 27.6% in 2010 to 33.2% in 2019. Being overweight or obese was independently associated with an increased likelihood of cesarean births in the overall sample (adjusted OR (AOR) 1.46; 95% CI 1.42–1.50 and AOR 2.05, 95% CI 1.98–2.11, respectively). However, overweight was not an independent risk factor when the analysis was limited to elective cesarean births. Induction of labor was significantly higher among women who were overweight (AOR 1.38; 95% CI 1.35–2.42), or obese (AOR 2.18 95% CI 2.12–2.25). The combined overweight and obesity contributed to 14.8% of cesarean births but the increasing trend of cesarean births was not explained solely by changes in overweight or obesity rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Obesity and overweight, combined, are responsible for a significant proportion of cesarean births. However, overweight and obesity alone do not provide enough insight into the increasing trend of cesarean birth. While further investigation of potential contributors is needed, initiatives to reduce cesarean births in Australia may benefit better by including measures, such as health education to prevent overweight and obesity prior to conception.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"729-737"},"PeriodicalIF":3.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447681","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":"Outcomes associated with fetal nuchal translucency between 3.0 and 3.4 mm in the first trimester","authors":"Manon D. E. Vriendt,&nbsp;Caroline Rooryck,&nbsp;Hugo Madar,&nbsp;Frédéric Coatleven,&nbsp;Marie Vincienne,&nbsp;Perrine Prier,&nbsp;Sophie Naudion,&nbsp;Loïc Sentilhes,&nbsp;Hanane Bouchghoul","doi":"10.1111/aogs.15055","DOIUrl":"10.1111/aogs.15055","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;Decisions concerning nuchal translucency (NT) between 3.0 and 3.4 mm remain controversial, particularly regarding whether to first calculate the combined first trimester screening test or to proceed directly with invasive testing. The literature suggests an increased risk of chromosomal aberration, as well as pathogenic copy number variations (CNVs) on chromosomal microarray, for fetuses with NT between 3.0 and 3.4 mm. The aim of this study was to describe genetic findings of fetuses with NT between 3.0 and 3.4 mm in the first trimester. The secondary objective was to describe ultrasound findings and adverse outcomes for these fetuses. The third objective was to compare genetic, ultrasound findings and adverse outcomes of fetuses with NT between 3.0 and 3.4 mm to those with NT ≥3.5 mm.&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 conducted an observational, retrospective study in a referral center between 2017 and 2022. Genetic and ultrasound findings were compared between fetuses with NT between 3.0 and 3.4 mm and those with NT≥3.5 mm. An adverse outcome was defined as one of the following: miscarriage, perinatal death (stillbirth or neonatal death) or termination of pregnancy at parental request, and all major abnormalities or genetic disorders diagnosed before or after delivery.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We included 404 fetuses with NT≥3.0 mm who had invasive testing with available karyotype and chromosomal microarray, among whom 20.8% (84/404) had NT between 3.0 and 3.4 mm. The rate of adverse outcomes among fetuses with NT between 3.0 and 3.4 mm was 32.1% (27/84). The rates of chromosomal aberration, pathogenic CNVs, and major ultrasound abnormalities were 16.7% (14/84), 6.0%(5/84), and 9.2% (6/65), respectively, for fetuses with NT between 3.0 and 3.4 mm. In comparison, fetuses with NT greater than 3.5 mm had higher rates of chromosomal aberration and major ultrasound abnormalities, with rates of 47.5% (152/320) and 30.2% (49/162) respectively compared to 16.7% (14/84) and 9.2% (6/65) for fetuses with NT between 3.0 and 3.4 mm (&lt;i&gt;p&lt;/i&gt; &lt; 0.001 for both comparisons). However, the rate of pathogenic CNVs was not significantly different between the two groups, with rates of 1.9% (6/320) for NT≥3.5 mm and 6.0% (5/84) for NT between 3.0 and 3.4 mm (&lt;i&gt;p&lt;/i&gt; = 0.06).&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;The rate of chromosomal aberration and pathogenic CNVs on chromosomal microarray is high among fetuses with NT between 3.0 and 3.4 mm, although these rat","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"629-636"},"PeriodicalIF":3.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439345","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":"Gastrointestinal function outcomes following radical and conservative colorectal surgery for deep endometriosis: A systematic review and meta-analysis","authors":"Ezgi Darici,&nbsp;Attila Bokor,&nbsp;Daria Pashkunova,&nbsp;Birgit Senft,&nbsp;Nilüfer Cimşit,&nbsp;Gernot Hudelist","doi":"10.1111/aogs.15023","DOIUrl":"10.1111/aogs.15023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients who have undergone colorectal surgery for symptomatic deep endometriosis may still encounter persistent or worsening digestive complaints. The aim of the present work was to analyze gastrointestinal function outcomes after radical and conservative colorectal surgery to further elucidate the effect of surgery on postoperative bowel function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>PubMed, EMBASE, Web of Science, Clinical Trials.gov and the Cochrane Database databases were searched from January 1, 2010 until April 1, 2024. The quality of included studies was assessed by the Downs and Black quality checklist. Studies including patients with colorectal endometriosis who either underwent segmental resection (SR) or conservative approaches and reported data on bowel function were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From the initial pool of 55 studies, 14 reported patient reported outcome measures eligible to be pooled in the meta-analysis. Conservative surgery was less associated with constipation and increased number of daily stool (&gt;3/day) when compared to SR (<i>p</i> = 0.02 and <i>p</i> = 0,0004, respectively). No difference was found in the occurrence of gas and stool incontinence (<i>p</i> = 0.72), postsurgical defecation pain (<i>p</i> = 0.44) and time to defer defecation (≤ 15 min; <i>p</i> = 0.64). Patients in the conservative surgery group reported higher postoperative Gastrointestinal Quality of Life Index (GIQLI) when compared to SR (<i>p</i> = 0.01). However, when comparing changes between pre- and postsurgical patient reported outcome measures within the respective groups, rather than evaluating postsurgical outcomes alone, none of the intervention groups showed significant changes between pre- and postsurgical GIQLI, Knowles Eccersley Scott Symptom Score(KESS) and Wexner scores (<i>p</i> = 0.28, <i>p</i> = 0.94 and <i>p</i> = 0.78, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Segmental resection seems to be associated with higher rates of post-operative constipation and lower GIQLI scores when compared to conservative surgery. However, when comparing the change of gastrointestinal function symptoms reflected by changes of gastrointestinal function parameters from pre- to postoperative rather than focusing on purely postoperative parameters alone, no significant difference of these parameters was observed between surgical techniques.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"615-628"},"PeriodicalIF":3.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439327","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":"Preeclampsia screening and prevention-A Nordic perspective.","authors":"Charlotte K Ekelund, Ylva Carlsson, Lina Bergman, Anna-Karin Wikström, Kjell Å B Salvesen, Vedran Stefanovic, Pia M Villa, Jóhanna Gunnarsdóttir, Line Rode","doi":"10.1111/aogs.15073","DOIUrl":"https://doi.org/10.1111/aogs.15073","url":null,"abstract":"","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424637","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":"Exposure to potentially teratogenic medications before and during the first trimester of pregnancy compared to women of childbearing age: A retrospective analysis of Swiss claims data (2015–2021)","authors":"Carole A. Marxer,&nbsp;Sereina M. Graber,&nbsp;Daniel Surbek,&nbsp;Alice Panchaud,&nbsp;Christoph R. Meier,&nbsp;Julia Spoendlin","doi":"10.1111/aogs.15052","DOIUrl":"10.1111/aogs.15052","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;Exposure to potentially teratogenic medications during pregnancy is underinvestigated in Switzerland. We aimed to assess exposure to potential teratogens preconceptionally, during the first trimester, and in women of childbearing age, and specifically explore the effectiveness of the valproate pregnancy prevention program (2018).&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;Retrospective study using the Swiss Helsana claims database. In a pregnancy cohort (2015–2021) and a cohort of women of childbearing age (2021 and 2018), we defined three 90-day time periods: (1) first trimester, (2) preconceptional period (days 180–90 before pregnancy), and (3) January 01, 2021, and March 31, 2021 (women of childbearing age). During all periods, we quantified the exposure prevalence to at least one dispensed weak, proven, and unequivocally potent teratogen overall and by age strata. We quantified the exposure prevalence to each individual teratogen, and to valproate during pregnancy by calendar year to compare its use before and after the introduction of a pregnancy prevention program (2018). We investigated the use of systemic retinoids particularly isotretinoin in women of childbearing age.&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;Of 34 584 pregnant women, 1.4% were exposed to potential teratogens during the first trimester (weak: 1.3%, proven: 0.06%, unequivocally potent: 0.04%). During the preconceptional period, 2.9% were exposed to any teratogen compared to 4.7% of women of childbearing age (&lt;i&gt;N&lt;/i&gt;&lt;sub&gt;total&lt;/sub&gt; = 95 059). Systemic glucocorticoids were the most prevalent weak teratogens during all time periods (75% of all claimed teratogens during the first trimester). In the first trimester, the antibiotic cotrimoxazole and the thyreostatic thiamazole (weak teratogens), ranked second and third, followed by the antiseizure medications carbamazepine and topiramate (proven teratogens). Among women of childbearing age, exposure to weak and proven teratogens increased with age, whereas exposure to unequivocally potent teratogens decreased with age. This was due to 2.3% of women &lt;26 years who claimed systemic isotretinoin. Valproate use during pregnancy decreased after the introduction of a pregnancy prevention program (2.39/10 000 pregnancies [2015–2018] vs. 0.93/10 000 pregnancies [2019–2021]).&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;Most medications with potential teratogenic effects dispensed to women of childbearing age and pregnant women were in the group of weak teratogenicity","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"707-719"},"PeriodicalIF":3.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389841","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":"Predictors for regression and progression of actively surveilled cervical intraepithelial neoplasia grade 2: A prospective cohort study","authors":"Laura Bergqvist,&nbsp;Anni Virtanen,&nbsp;Ilkka Kalliala,&nbsp;Ralf Bützow,&nbsp;Maija Jakobsson,&nbsp;Annu Heinonen,&nbsp;Karolina Louvanto,&nbsp;Joakim Dillner,&nbsp;Pekka Nieminen,&nbsp;Karoliina Aro","doi":"10.1111/aogs.15032","DOIUrl":"10.1111/aogs.15032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two years of active surveillance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a single-center prospective observational cohort study. Women under 31 years of age giving written informed consent with histologically confirmed CIN2 were followed with colposcopy, cytology, and biopsies every 6 months up to 24 months. At baseline, HPV genotyping was performed on cervical samples. The rates of regression and progression were recorded for every timepoint and at the end of study overall and stratified according to clinical factors and HPV genotypes at baseline. Risk ratio (RR) was used to estimate the relative risks for regression and progression. The study was registered in the ISRCTN registry (ISRCTN91953024).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 205/243 (84.4%) women completed the study. Complete regression (normal histology and/or normal or atypical squamous cells of undetermined significance (ASC-US) cytology) was detected in 64.4.% (<i>n</i> = 132) while 16.1% (<i>n</i> = 33) of the lesions progressed to CIN grade 3 (CIN3) or worse including 31 CIN3 cases, one adenocarcinoma in situ and one cervical cancer case. Factors associated with progression were initial large (&gt;50% of the transformation zone) lesion size, risk ratio (RR) 3.06 (95% confidence interval (CI) 1.40–6.69), and high-grade referral cytology RR 4.73 (95% CI 1.18–19.03). Compared with baseline HPV negativity or having only low-risk HPV genotypes present, high-risk HPV (hrHPV) positivity was associated with lower likelihood of regression RR 0.74 (95% CI 0.60–0.91). Age, cigarette smoking, use of combined oral contraceptives or baseline high-risk HPV genotype, including HPV16, were not associated with the outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The majority of CIN2 lesions regress in young women. Women with large lesions and/or high-grade referral cytology should perhaps more often be treated instead of active surveillance. Initial hrHPV genotype does not appear to predict outcomes while not harboring hrHPV favors regression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"763-773"},"PeriodicalIF":3.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389842","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}