Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Miscarriage treatment-related adverse events: A nationwide registry study from Finland.","authors":"Nea Helle, Maarit Mentula, Tomi Seppälä, Mika Gissler, Maarit Niinimäki, Oskari Heikinheimo","doi":"10.1111/aogs.15174","DOIUrl":"https://doi.org/10.1111/aogs.15174","url":null,"abstract":"<p><strong>Introduction: </strong>The treatment of miscarriage has transformed substantially from surgical to non-surgical. The aim of this study was to evaluate the rates of adverse events related to the treatment of miscarriage and their risk factors.</p><p><strong>Material and methods: </strong>This nationwide retrospective cohort study included 69 593 fertile-aged (15-49 years) women who experienced their first miscarriage during 1998-2016 and received a diagnostic code of missed abortion or blighted ovum in a public hospital. We used data from the Finnish National Hospital Discharge Registry (NHDR). Miscarriage type, treatment modalities, and treatment-related adverse events (secondary surgery for any reason, infection and severe adverse events) were identified using diagnostic and surgical procedure codes.</p><p><strong>Results: </strong>Since 2004, non-surgical management has been the dominant treatment of miscarriage in Finland. Between 1998 and 2016, a total of 11 397 women (16.4%) experienced at least one miscarriage treatment-related adverse event. The need for secondary surgery was the most common adverse event and more common after primary non-surgical treatment (22.0% vs. 3.8%). However, the annual rate of secondary surgery after non-surgical treatment declined from 34.8% in 1998 to 15.9% in 2016. The total number of women undergoing surgical treatment (primary or secondary) declined from 3918 (84.6%) to 651 (23.1%). Age was associated with an increased risk of secondary surgery (age ≥ 25; Adjusted odds ratio [AdjOR] 1.15, 95% CI 1.07-1.24) and with a decreased overall risk of infection (age 40-49 years; AdjOR 0.51 [0.40-0.63]). Parity was associated with lower risk of secondary surgery (one delivery, AdjOR 0.82 [0.78-0.95], and ≥2 deliveries, AdjOR 0.75, [0.71-0.84]) and infection (one delivery, AdjOR 0.85, [0.77-0.95]; ≥2 deliveries, AdjOR 0.74 [0.66-0.84]). Severe adverse events were rare (0.2%-0.4%) and did not differ between the two treatment options for either type of miscarriage.</p><p><strong>Conclusions: </strong>Despite significant changes in miscarriage treatment practices, no substantial or alarming increase in treatment-associated adverse events was detected. Both treatment options proved safe for the two types of miscarriage studied. These findings are important regarding the provision of individualized counseling and for the allocation of healthcare resources.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of local symptoms on health-related quality of life in vulvar cancer survivors—A nationwide prospective study","authors":"Diana Zach,&nbsp;Pernille T. Jensen,&nbsp;Henrik Falconer,&nbsp;Zuzana Kolkova,&nbsp;Katja Stenström Bohlin,&nbsp;Preben Kjølhede,&nbsp;Ivette Raices Cruz,&nbsp;Elisabeth Åvall-Lundqvist,&nbsp;Angelique Flöter Rådestad","doi":"10.1111/aogs.15164","DOIUrl":"10.1111/aogs.15164","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;Vulvar cancer may cause serious local symptoms that may impact negatively on the woman's health-related quality of life (HRQOL). However, knowledge about the prevalence of vulvar and lymphedema symptoms at diagnosis and during follow-up is limited. The aim of this study was to evaluate the longitudinal development of vulvar and lymphedema symptoms as well as the trajectory of HRQOL in women with vulvar cancer. Furthermore, associations between vulvar symptoms and HRQOL were investigated.&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;In this nationwide prospective cohort study, women completed validated patient-reported outcome measures; the EORTC-QLQ C30 and the EORTC-QLQ-VU34 at diagnosis, three, and 12 months post-treatment. Mean scores of symptom- and functioning scales were calculated over time. Heatmaps were used to visualize proportional changes in the prevalence of symptoms at baseline and 12 months after treatment. Linear mixed-effects models with patient-specific random intercepts were specified to estimate changes in mean scores of HRQOL over time. Additionally, adjusted linear mixed-effects models were applied to investigate the effect of the most prevalent vulvar symptom on HRQOL. The study has been registered at ClinicalTrials.gov (NCT 04152512).&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;Between 2019 and 2021, 153 women consented to participate in the study, and 140 (92%) completed the patient-reported outcome measures at least once. In total, 105 (69%) completed the patient-reported outcome measures at all three time points. The most prevalent reported symptom was itchy, irritated skin in the vulva, which decreased from 82% at diagnosis to 56% 12 months after treatment. All vulvar symptoms, except narrowing of the vaginal entrance, improved over time but persisted in large proportions of the women. Women with severe vulvar symptoms reported a significant decline in HRQOL. A deterioration of leg swelling symptoms was reported by 33% of the women. Emotional-, role-, social-, and cognitive functioning, global and mental health improved significantly after treatment.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Local vulvar symptoms were highly prevalent at diagnosis; however, as most aspects of HRQOL, they improved significantly during the first year of follow-up. Severe vulvar symptoms were associated with impaired HRQOL. Symptoms of leg lymphedema increased after treatment. © 2025 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley &amp; Sons ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1517-1529"},"PeriodicalIF":3.5,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257081","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":"Implementation of opportunistic salpingectomy for ovarian cancer prevention: Analyzing clinical practice and key characteristics","authors":"Charlotte Fisch,&nbsp;Malou E. Gelderblom,&nbsp;Brigitte Slangen,&nbsp;Angèle L. M. Oei,&nbsp;Alexandra A. van Ginkel,&nbsp;Huy Ngo,&nbsp;Joanne de Hullu,&nbsp;Jurgen Piek,&nbsp;Rosella Hermens","doi":"10.1111/aogs.15128","DOIUrl":"10.1111/aogs.15128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Ovarian cancer (OC) is the most lethal gynecologic cancer, often diagnosed at an advanced stage due to nonspecific symptoms and lack of effective screening. Over 90% of all ovarian cancer cases are epithelial in origin, which is thought to originate from the fallopian tubes in approximately 70% of cases. Opportunistic salpingectomy (OS), the additional removal of fallopian tubes during abdominal surgery, has emerged as a preventive strategy. Despite growing evidence, the implementation of OS varies widely. This study examines OS counseling and performance trends in the Netherlands from 2019 to 2022 and identifies associated patient, surgical, physician, and institutional characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A historical cohort study was performed, analyzing electronic medical records from six Dutch hospitals, including two academic, two teaching, and two nonteaching hospitals. Patients undergoing elective gynecologic surgery from January 2019 to December 2022 were considered eligible. Multilevel logistic regression analyses identified characteristics associated with counseling and performance of OS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 2716 eligible patients, 51% were counseled about OS, of whom 92% opted for the procedure. The counseling rate increased from 38% in 2019 to 57% in 2022, while the performance rate rose from 39% to 56%. OS was more common among patients undergoing hysterectomy, laparoscopic surgery, and treatment at teaching hospitals. OS was less common during vaginal surgery. Physician characteristics accounted for 18% of counseling and 12% of performance variations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although OS implementation improved, substantial variability remains in counseling and performance, largely driven by surgical approach and type of surgery. Targeted interventions to enhance uptake among underutilized surgical types, including vaginal procedures, are necessary to standardize OS practice and ensure wider adoption across all eligible patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1539-1549"},"PeriodicalIF":3.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15128","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223932","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":"The advance grading of intracervical hypervascularity in transvaginal ultrasound indicates a significant risk in Placenta Accreta Spectrum.","authors":"Rozi Aditya Aryananda, Heleen J Van Beekhuizen, Arie Franx, Johannes J Duvekot","doi":"10.1111/aogs.15171","DOIUrl":"https://doi.org/10.1111/aogs.15171","url":null,"abstract":"","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214529","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":"Timing of progesterone treatment to prevent preterm birth in pregnancies with a short cervix: A population-based historical cohort study","authors":"Anders Einum,&nbsp;Roy Miodini Nilsen,&nbsp;Quaker E. Harmon,&nbsp;Linn Marie Sørbye,&nbsp;Nils-Halvdan Morken","doi":"10.1111/aogs.15147","DOIUrl":"10.1111/aogs.15147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Randomized trials have shown that progesterone treatment in mothers with a short cervix may reduce the risk of preterm birth, but the optimal time window for treatment remains unknown. We aimed to investigate progesterone treatment for the prevention of preterm birth by gestational age at diagnosis and initiation of treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a population-based historical cohort study of 1162 mothers with singleton pregnancies diagnosed with a cervix &lt;20 mm from 16 to 31 gestational weeks receiving progesterone treatment (<i>n</i> = 390) or no preventive treatment (<i>n</i> = 772). Data were collected from the Medical Birth Registry of Norway from 2014 to 2020 and linked to national health registries providing demographic, diagnostic, and prescription information. Risks of preterm birth &lt;28, &lt;34, and &lt;37 gestational weeks were compared between mothers with and without progesterone treatment in the full study sample and in three periods of gestational age at diagnosis (16–21, 22–27, and 28–31 weeks) using log-binomial regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The absolute risk of preterm birth &lt;28 gestational weeks was 0.8% in mothers treated with progesterone and 3.4% in mothers who did not receive treatment (adjusted relative risk (aRR) 0.25, 95% confidence interval (CI) 0.08–0.81). The strongest protective association was observed in mothers diagnosed from 16 to 21 weeks (aRR 0.13, 95% CI 0.02–0.98). Preterm birth &lt;34 weeks occurred in 8.7% of mothers in the progesterone group and 11.1% in the untreated group (aRR 0.80, 95% CI 0.54–1.17), and the relative risk reduction associated with treatment diminished with increasing gestational age at diagnosis: aRR 0.27 (95% CI 0.08–0.96) from 16 to 21 weeks; aRR 0.68 (95% CI 0.38–1.23) from 22 to 27 weeks; and aRR 1.30 (95% CI 0.71–2.39) from 28 to 31 weeks. There was no difference in the risk of birth &lt;37 weeks in mothers treated with progesterone (23.1%) and untreated mothers (22.3%), and the risk estimates were similar in the three periods of gestational age at diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Compared to no treatment, progesterone treatment is associated with a reduced risk of preterm birth &lt;28 gestational weeks in pregnancies with a short cervix. The preventive effect of treatment may extend to 34 weeks if treatment is initiated early in the second trimester.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1443-1451"},"PeriodicalIF":3.5,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207351","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":"Risk factors and risk-indicating model for early-onset neonatal sepsis after preterm prelabor rupture of membranes: A historical cohort study","authors":"Brynhildur Tinna Birgisdottir,&nbsp;Tomas Andersson,&nbsp;Ingela Hulthén Varli,&nbsp;Sissel Saltvedt,&nbsp;Farhad Abtahi,&nbsp;Ulrika Åden,&nbsp;Malin Holzmann","doi":"10.1111/aogs.15168","DOIUrl":"10.1111/aogs.15168","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Early-onset neonatal sepsis (EONS) is an important cause of neonatal morbidity and mortality and is strongly associated with intra-amniotic infection. The risk of intra-amniotic infection increases after preterm prelabor rupture of membranes (PPROM). Better tools are needed for monitoring women with PPROM for intra-amniotic infection and identifying those at high risk of EONS so that intervention can be made timely. This study aimed to identify antepartum risk factors for EONS in a PPROM population and develop a risk-indicating model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We performed a historical cohort study on PPROM pregnancies delivering between gestational weeks 24 + 0 and 33 + 6 in Stockholm, Sweden. Using logistic regression, we evaluated the risk of the outcome EONS associated with maternal background characteristics, symptoms and signs, and cardiotocography. We combined variables associated with high risk into a risk-indicating model and estimated its performance by calculating its sensitivity, specificity, accuracy, positive and negative predictive values, positive likelihood ratio, and area under the ROC curve.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 709 women and their neonates, out of which 29 developed EONS. Variables most strongly associated with EONS were maternal diabetes (OR 4.37, 95% CI 1.41–13.56), maternal temperature ≥ 38°C (OR 6.42, 95% CI 2.94–14.02), positive urinary or vaginal/cervical culture (OR 2.62, 95% CI 1.14–6.03), and cardiotocography parameters. Fetal baseline frequency above 160 bpm was associated with a 3.75 times increased risk of EONS (95% CI 1.51–9.33). Meanwhile, short-term variation was negatively associated with EONS risk, and a value below 4 ms had a 4.17 times increased risk of EONS (95% CI 1.77–9.83). A risk-indicating model for EONS combining the mentioned variables had an area under the ROC curve of 0.7348. This model performed better at indicating risk for EONS than the clinicians' suspicion of intra-amniotic infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Maternal diabetes, maternal fever, positive urinary or vaginal/cervical culture, fetal tachycardia, and decreasing short-term variation were associated with an increased risk for EONS in a PPROM population. A risk-indicating model combining these risk factors performed better than the clinicians' suspicion of intra-amniotic infection in identifying high-risk pregnancies for EONS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1475-1486"},"PeriodicalIF":3.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198027","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":"Spontaneous preterm birth predictors in asymptomatic twin pregnancies","authors":"Júlia Ponce","doi":"10.1111/aogs.15169","DOIUrl":"10.1111/aogs.15169","url":null,"abstract":"&lt;p&gt;We appreciate the opportunity to address the concerns raised in the recent Letter to the Editor by Sathian et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; about our recent study. We value constructive feedback and believe it contributes to the improvement of scientific knowledge. In response to the questions highlighted, we would like to clarify the following points:&lt;/p&gt;&lt;p&gt;Regarding the generalizability of our study, we acknowledged in our discussion that the small number of cases of sPTB is the principal limitation of our work, as they may impact the diagnostic accuracy of all the markers evaluated, especially the predictive value of parameters other than uterocervical angle and cervical length that may be underestimated. For this reason, we concluded that these other parameters (CCI, cervical texture and cervical inflammatory biomarkers/fetal fibronectin) did not achieve an association with sPTB &lt;34 weeks in our study, but further prospective series are needed to confirm these findings, as they cannot be completely excluded due to the small number of sPTB &lt;34 weeks cases observed in our cohort.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;This is of special importance due to the differences observed by other authors like Van der Merwe et al.,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; regarding CCI as an sPTB predictor in twins. Regarding cervical texture, our results are in line with Van der Merwe et al.,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; but contrast with what is found in singletons. The role of this biomarker in sPTB in twins has yet to be elucidated, as some authors found differences between cervical stiffness and tissue composition and microstructure between singleton and multiple pregnancies.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; On the other hand, the role of inflammatory biomarkers and intraamniotic inflammation in the pathogenesis of sPTB in twins must be interpreted with caution, as stated in our discussion. An association between cervical inflammatory biomarkers and sPTB could not be demonstrated in our study, but this does not mean that intraamniotic inflammation does not play a relevant role in sPTB later than midtrimester, as other authors like Wennerholm et al.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; find an association with IL-8 levels at 28 weeks and an association with PTB in twin pregnancies. Regarding the study by Amabebe et al.,&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; they excluded multiple pregnancies, stating once again the differences in the mechanisms of sPTB between singletons and twins, suggesting a more significant role of intraamniotic inflammation in singletons and perhaps a more mechanical one in twins.&lt;/p&gt;&lt;p&gt;Finally, uterocervical angle's contribution to sPTB prediction in twins has been observed in previous publications,&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; indeed, in our study, uterocervical angle remained statistically significant after adjusting for potential confounders like cervical length, maternal age, ethnicity, risk factor for preterm birth, chorionicity, assisted reproductive technology, use of progeste","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1589-1590"},"PeriodicalIF":3.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15169","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155442","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":"An obstetric toolbox: Important to maintain, to share, and to evaluate","authors":"Julia Savchenko","doi":"10.1111/aogs.15166","DOIUrl":"10.1111/aogs.15166","url":null,"abstract":"<p>Thank you for the opportunity to read the important and thought-provoking discussion between Grindheim et al. and Iqbal et Al-Maslamani regarding instrumental delivery and its impact on fear of childbirth, in which both sides raise valid points.<span>^1-3</span> I would like to offer a few reflections on the topic.</p><p>As Iqbal and Al-Maslamani point out, instrumental delivery can negatively affect birth outcomes, both medically (e.g., pelvic floor injuries) and in terms of subjective experience (e.g., contributing to secondary fear of childbirth). At the same time, the same concerns apply to a prolonged second stage, which—even in cases of spontaneous birth—may be associated with various risks, as well as to second-stage cesarean sections.</p><p>Instrumental delivery undoubtedly helps avoid some complications of second-stage cesarean and can even be life-saving.<span>⁴</span> As Grindheim et al. correctly remind us, spontaneous vaginal delivery is sometimes no longer an option. However, determining exactly when this is the case is a matter of clinical judgment—and this judgment is not always straightforward. Research on intrapartum care is challenging; randomization is often not feasible or ethically justifiable, and decisions to proceed with instrumental delivery often rely more on local tradition or individual obstetricians' preferences than on clear evidence.</p><p>In Bergen, the proportion of instrumental vaginal deliveries is relatively high, as is the use of forceps. 11% of primiparous women give birth via assisted vaginal delivery in Bergen, compared to 5% in Sweden.<span>^1-5</span> Is this difference due to variations in the population characteristics, intrapartum management, or indications for instrumental delivery—for example, local opinions on acceptable length of the second stage or approaches to pushing? Which practice leads to better short- and long-term outcomes, including patient experience?</p><p>To conclude, forceps, vacuum, and even second-stage cesarean sections all have an important place in obstetrics, but each also carries some drawbacks. Ongoing careful and multidimensional evaluation of intrapartum management and its outcomes is essential to better understand when each intervention is appropriate—and when supportive care and watchful waiting may still be an option.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 7","pages":"1412-1413"},"PeriodicalIF":3.5,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144155441","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":"Quality of life 1 year after uterine artery embolization vs hysterectomy for symptomatic adenomyosis (QUESTA study)","authors":"Lisa M. Trommelen,&nbsp;Annika Semmler,&nbsp;Annefleur M. de Bruijn,&nbsp;Marissa Harmsen,&nbsp;Marieke Smink,&nbsp;Petra F. Janssen,&nbsp;Ilse van Rooij,&nbsp;Jeroen van Bavel,&nbsp;Peggy Geomini,&nbsp;Jacques W. M. Maas,&nbsp;Celine M. Radder,&nbsp;Paul van Kesteren,&nbsp;Janet Kwee,&nbsp;Erica Bakkum,&nbsp;Marleen de Lange,&nbsp;Robert A. de Leeuw,&nbsp;Freek Groenman,&nbsp;Velja Mijatovic,&nbsp;Anne Timmermans,&nbsp;Rutger Lely,&nbsp;Armand Lamers,&nbsp;Douwe Vos,&nbsp;Gretel van Hoecke,&nbsp;Otto Elgersma,&nbsp;Huib A. A. M. van Vliet,&nbsp;Lonneke S. F. Yo,&nbsp;Andries R. H. Twijnstra,&nbsp;Frank W. Jansen,&nbsp;Catharina S. P. van Rijswijk,&nbsp;Han Kruimer,&nbsp;Carroll M. E. S. N. Tseng,&nbsp;Sjors Coppus,&nbsp;Mark Arntz,&nbsp;Aloys F. J. Wust,&nbsp;Joost G. A. M. Blomjous,&nbsp;Laurens van Boven,&nbsp;Alexander Venmans,&nbsp;Jos W. R. Twisk,&nbsp;Judith A. F. Huirne,&nbsp;Paul N. M. Lohle,&nbsp;Wouter J. K. Hehenkamp","doi":"10.1111/aogs.15165","DOIUrl":"10.1111/aogs.15165","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;Uterine artery embolization (UAE) is a less-invasive alternative for hysterectomy in therapy-resistant symptomatic adenomyosis. Comparative data are lacking. Our objective is to evaluate the non-inferiority of UAE compared with hysterectomy in improving health-related quality of life (HRQOL) for symptomatic adenomyosis, 1 year post-treatment.&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 multicenter randomized controlled trial was converted into a prospective cohort study. It was prospectively registered at 27-07-2015 (NL-OMON55436, https://onderzoekmetmensen.nl/en/trial/55436). From November 2015 to March 2022 participants with symptomatic adenomyosis eligible for hysterectomy were included and offered UAE as an alternative treatment. Primary endpoint was difference in 1-year HRQOL scores between UAE and hysterectomy, using WHO-QOL-Bref and SF-12. Non-inferiority margin was set at five points. Secondary endpoints: WHO-QOL-100 facets “Pain and Discomfort” and “Sexual Activity”, adenomyosis-related symptoms, and satisfaction. Multivariable linear mixed models were used. All outcomes were analyzed in the per-protocol population, and repeated in the intention-to-treat population.&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 101 participants, 51 chose hysterectomy and 50 UAE. Both treatment groups were comparable at baseline, except for employment status, dysmenorrhea score, uterine volume, hemoglobin and CA125 (all adjusted for). Both treatments led to a significant increase in all HRQOL scores after 1 year. The effect differences between UAE and hysterectomy on all HRQOL domains in the per-protocol population were: SF-12 physical &lt;i&gt;β&lt;/i&gt; −4.20, (95% CI −9.53 to 1.12), SF-12 mental &lt;i&gt;β&lt;/i&gt; −4.95 (95% CI −10.83 to 0.94); WHO-QOL-Bref physical &lt;i&gt;β&lt;/i&gt; −7.42 (95% CI −18.51 to 3.68), psychological &lt;i&gt;β&lt;/i&gt; −4.28 (95% CI −13.30 to 4.74), social relations &lt;i&gt;β&lt;/i&gt; −2.23 (95% CI −13.09 to 8.63) and environment &lt;i&gt;β&lt;/i&gt; 0.35 (95% CI −8.39 to 9.09). Non-inferiority of UAE was not demonstrated within the predefined margin. Both hysterectomy and UAE improved “Pain and Discomfort” and “Sexual Activity”, with greater effect on pain after hysterectomy (&lt;i&gt;β&lt;/i&gt; 17.17, 95% CI 4.94 to 29.41, &lt;i&gt;p&lt;/i&gt; = 0.007). More participants were satisfied after hysterectomy (95%) than after UAE (73%).&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;Both UAE and hysterectomy significantly increased HRQOL for symptomatic adenomyosis. Neither non-inferiority nor inferiority of UAE could be established. One-year HRQ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1558-1574"},"PeriodicalIF":3.5,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148795","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":"Regional differences in the prevalence of obstetric complications in relation to maternal obesity and food purchases","authors":"Outi Pellonperä,&nbsp;Jelena Meinilä,&nbsp;Jaakko Nevalainen,&nbsp;Heidi Sormunen-Harju,&nbsp;Johanna Metsälä,&nbsp;Mika Gissler,&nbsp;Mikael Fogelholm,&nbsp;Maijaliisa Erkkola,&nbsp;Hannu Saarijärvi,&nbsp;Saila Koivusalo","doi":"10.1111/aogs.15075","DOIUrl":"10.1111/aogs.15075","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;Regional variations exist in the prevalence of type 2 diabetes and cardiovascular disease in Finland. As these conditions share risk factors with major obstetric complications, we aimed to investigate whether there are geographical differences in the prevalence of pregnancy complications and if these differences could be explained by known risk factors such as maternal obesity or dietary intake.&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;In this observational study, data from the Finnish Medical Birth Register and the Hospital Discharge Register were analyzed for primiparous women who had singleton births in Finland from 2013 to 2017. We calculated regional prevalence rates of gestational diabetes, gestational hypertension, preeclampsia, and premature birth. Loyalty card data from the largest food retailer were utilized to assess the regional average of food purchases of fertile-age women living in single- or two-adult households between September 2016 and December 2017. The datasets were merged by postal codes and organized by cardinal direction regions.&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 birth register included 109 306 women, and data from 3937 purchasers were analyzed. Compared with women living in Southern Finland, those living in the North had higher odds for gestational hypertension (adjusted OR 1.36, 95% CI 1.10–1.68, &lt;i&gt;p&lt;/i&gt; = 0.005), while women living in Eastern Finland had greater odds for preeclampsia (adjusted OR 1.21, 95% CI 1.02–1.44, &lt;i&gt;p&lt;/i&gt; = 0.030). We did not find regional differences in the prevalence of gestational diabetes or preterm birth. Higher average areal fiber content of the purchases decreased the odds of gestational hypertension (OR 0.90, 95% CI 0.89–0.99, &lt;i&gt;p&lt;/i&gt; = 0.022), and diminished gestational hypertension's geographical disparity. Higher means in areal red and processed meat purchases were associated with preterm birth (OR 1.29, 95% CI 1.02–1.62, &lt;i&gt;p&lt;/i&gt; = 0.031), and a high maternal body mass index was related to all pregnancy complications (OR 1.3–9.8, &lt;i&gt;p&lt;/i&gt; &lt; 0.001 in all comparisons), but they did not account for regional differences.&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;Compared with Southern Finland, hypertensive pregnancy complications were more prevalent in women living in Eastern and Northern Finland. Obesity did not explain regional differences, whereas lower fiber content of purchases in these regions may have contributed to the prevalence of pregnancy hypertension.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 7","pages":"1274-1285"},"PeriodicalIF":3.5,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141029","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}