Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Indeed, safety comes first for the use of GLP-1RAs","authors":"Amruta D. S. Pathare, Alberto Sola-Leyva, Apostol Apostolov, Ganesh Acharya, Andres Salumets","doi":"10.1111/aogs.15090","DOIUrl":"10.1111/aogs.15090","url":null,"abstract":"<p>Sir,</p><p>Thank you for the opportunity to respond to a letter to the editor by Viganò et al. regarding our recently published review article in Acta Obstetricia et Gynecologica Scandinavica (AOGS).<span><sup>1</sup></span> They felt that the issue of possible teratogenicity and clinical safety has not been sufficiently addressed by our review.<span><sup>2</sup></span></p><p>Glucagon-like peptide-1 (GLP-1), an incretin hormone, plays a crucial role in maintaining glucose homeostasis, insulin sensitivity, and body weight under normal physiological circumstances. Thus, a normally functioning GLP-1 system would evidently have a direct positive impact on female reproductive health, predominantly regulating hormonal balance and optimal ovarian function that could support natural conception. Disruptions in the GLP-1 system, as seen in conditions like obesity and polycystic ovary syndrome (PCOS), can interfere with female reproductive health. GLP-1 receptor agonists (GLP-1RAs) mimic the action of GLP-1 and have been proven effective in improving glycemic control, showing remarkable potential in managing obesity and PCOS. Furthermore, the occurrence of numerous unplanned pregnancies during GLP-1RAs treatment underscores the need to understand the mechanism of GLP-1 (RAs) on female fertility and its safety during the pre-implantation period, on exposed fetuses, and long-term effects on children after birth.</p><p>In our recent review, we addressed this knowledge gap by outlining the effect of GLP-1RAs on female fertility, especially in obese and PCOS patients, with a specific focus on endometrium and implantation.<span><sup>2</sup></span> Based on initial animal model studies and clinical studies in women, the GLP-1RAs treatment could be promising for alleviating female infertility. However, as mentioned in the key message of our review, “it is crucial to understand the limited evidence available, and their use should be approached with caution, considering potential side effects.”</p><p>Viganò et al. raised a concern that our review should have better addressed the safety concerns related to potential teratogenicity and adverse developmental outcomes,<span><sup>1</sup></span> citing some animal studies that have shown evidence of adverse outcomes after exposure to GLP-1RA during pregnancy. However, a recent observational population-based cohort study among women with type 2 diabetes exposed to GLP-1RA from 90 days before pregnancy to the end of the first trimester did not show a significantly higher risk of major congenital malformations beyond the baseline risk associated with type 2 diabetes.<span><sup>3</sup></span> Similarly, no major birth defects were reported in another cohort study among the women exposed to GLP-1RA in early pregnancy, either for diabetes or obesity treatment.<span><sup>4</sup></span> Nevertheless, ambiguous study design and data analysis of recent clinical studies have resulted in debatable conclusions on teratogenicity, emb","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"1000-1001"},"PeriodicalIF":3.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of oral contraceptives and risk of endometrial cancer: A systematic review and meta-analysis","authors":"András Harajka,&nbsp;Tímea Hercsik,&nbsp;Isabel Pinto Amorim das Virgens,&nbsp;Izabella Máthé,&nbsp;Zsófia Tornyossy,&nbsp;Ali AlFarwi,&nbsp;Fanni Adél Meznerics,&nbsp;Szilvia Kiss-Dala,&nbsp;Péter Fehérvári,&nbsp;Rita Nagy,&nbsp;Ferenc Bánhidy,&nbsp;Attila Majoros,&nbsp;Sándor Valent,&nbsp;Péter Hegyi,&nbsp;Nándor Ács","doi":"10.1111/aogs.15043","DOIUrl":"10.1111/aogs.15043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although the relationship between the use of oral contraceptives and reduced endometrial cancer risk has now long been established, the need for female patients to be informed on this matter based on the latest results of scientific research remains. To help the evidence-based decision-making of women when choosing contraception methods, we aimed to provide them with an up-to-date overview and summary of past and recent findings on the association between the use of oral contraceptives and endometrial cancer risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This study was registered in PROSPERO: CRD42022379871. PubMed, Embase, and Cochrane Library databases were searched on the December 5, 2022, to identify eligible articles. We included all experimental and observational studies that reported the number of users and non-users of oral contraceptives among patients diagnosed or not with endometrial cancer. Data were extracted, and random-effects meta-analysis was performed to obtain summary odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity across studies was assessed using Higgins &amp; Thompson's <i>I</i>² statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-six studies were eligible for qualitative synthesis, of which twenty-five were eligible for quantitative analysis. The use of oral contraceptives was inversely associated with the odds of having endometrial cancer (OR = 0.61, CI: 0.46–0.80). The long-term use of oral contraceptives led to the greatest odds reduction in having endometrial cancer (≥10 years: OR = 0.31, CI: 0.13–0.70), while shorter periods were also associated with a significant decrease in these odds, although to a lesser extent (≥5 years: OR = 0.39, CI: 0.23–0.64; &lt;5 years: OR = 0.66, CI: 0.48–0.91).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The administration of oral contraceptives is time dependently associated with lower odds of having endometrial cancer, suggesting a protective association between the use of oral contraceptives and endometrial cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"591-603"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal rotation examined with ultrasound","authors":"Kenneth Bagandanshwa,&nbsp;Bariki Mchome,&nbsp;Signe Egenberg,&nbsp;Torbjørn Moe Eggebø","doi":"10.1111/aogs.15081","DOIUrl":"10.1111/aogs.15081","url":null,"abstract":"<p>We would like to thank Patji Alnæs-Katjavivi for his interest and comments on our article and for referring to the recently published work of VanSickle et al. challenging the myth of the perfect obstetric pelvis.<span>^{1, 2}</span> The aim of our study was to examine fetal rotation longitudinally with ultrasound in a sub-Saharan population. We observed a higher rate of persistent occiput posterior position at birth than reported in studies mainly comprising white European women.<span>³</span></p><p>The shape of the birth canal has been thought to influence fetal rotation. Four classical pelvic shapes were described in the 1930s, but demarcations between these are not clear. Variations with regard to pelvic shape between ethnicities have been published and referred to in our article. However, the evidence on this is from old studies as pointed out by Alnæs-Katjavivi, and we agree that paying attention to the pelvic shape has limited clinical value. The clinical examination of the female pelvis is unreliable. The obstetrical conjugate can be measured with ultrasound (recently published),<span>⁴</span> and also the sub-pubic arch angle can be measured.<span>⁵</span> However, these measurements do not provide information on the shape of the pelvis and assessing this was not an objective in our study. Our focus was on the process of rotation, to what degree this occurred in the study population, and what effects fetal rotation had on labor outcome.</p><p>It is important to identify women at risk for arrested labor in a reliable way and these women should have added surveillance in labor. Persistent occiput posterior position is associated with prolonged labor and operative interventions,<span>⁶</span> as also shown in our study.<span>³</span> Timely diagnosis of this is important and ultrasound is a valuable tool to make this possible. We showed a proportional difference between our study population and what has been assumed before. We acknowledge that this observation calls for more information about fetal rotation from other populations in Africa as well as from different parts of the world.</p><p>In our setting, maternal mobility, including ambulation, squatting, and the use of birthing balls, is encouraged during the active first and early second stages of labor to promote fetal rotation and descent. Continuous midwifery care is provided, sometimes with a companion, but not on a one-to-one basis.</p><p>Our main clinical message is thus to recommend the active use of ultrasound during labor for diagnosing rotation failure. This will lead to enhanced surveillance and appropriate management of persistent occiput posterior positions, while also helping to avoid unnecessary interventions in women with the fetus in the occiput anterior position.</p><p>Laerdal Foundation for Acute Medicine.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"784-785"},"PeriodicalIF":3.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing spontaneous preterm birth as a preventable adverse outcome—A clinical audit of a preventative toolbox","authors":"Aparna Ramachandran,&nbsp;Darazel Perez,&nbsp;Adrienne Gordon,&nbsp;Jon Hyett","doi":"10.1111/aogs.15079","DOIUrl":"10.1111/aogs.15079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>p</i> = 0.38); the rate of perinatal death was 9.6% in low-risk pregnancies and 4.2% in high-risk pregnancies (<i>p</i> = 0.39).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"906-912"},"PeriodicalIF":3.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15079","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":"OA","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}