Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Prevalence and impact of vasomotor symptoms associated with menopause among Nordic women: Subgroup analysis from an international cross-sectional survey.","authors":"Angelica Lindén Hirschberg, Päivi Polo-Kantola, Inger Øverlie, Ellen Løkkegaard, Elinor Cockburn, Carol Rea, Janet S Kim","doi":"10.1111/aogs.15139","DOIUrl":"https://doi.org/10.1111/aogs.15139","url":null,"abstract":"<p><strong>Introduction: </strong>The objectives of this study were to evaluate the prevalence and impact of moderate to severe vasomotor symptoms (VMS) on quality of life, sleep, work, and daily activities. We also assessed treatment patterns for VMS, lifestyle changes to mitigate VMS, and attitudes toward available treatments and menopause.</p><p><strong>Material and methods: </strong>Women from Denmark, Finland, Norway, and Sweden aged 40-65 years completed an online survey as part of a larger multinational study. The primary outcome, prevalence of moderate to severe VMS, was assessed in postmenopausal women. Secondary outcomes, including the impact of VMS on quality of life (Menopause-Specific Quality of Life [MENQoL] questionnaire), sleep (Patient-Reported Outcomes Measurement Information System [PROMIS] Sleep Disturbances- Short Form 8b), and work and daily activities (Work Productivity and Activity Impairment [WPAI] questionnaire) were assessed in perimenopausal and postmenopausal women experiencing ≥1 moderate to severe hot flush per day in the prior month. Additionally, survey questions evaluated treatment patterns, lifestyle changes, and opinions toward VMS treatment and menopause in perimenopausal and postmenopausal women.</p><p><strong>Results: </strong>Among 6383 postmenopausal women (primary analysis population), 739 (11.6%) experienced moderate to severe VMS regardless of whether they were receiving treatment. Among 863 symptomatic perimenopausal and postmenopausal women (secondary analysis population), VMS impaired quality of life and sleep. Work and daily activities were impaired by 24.2% and 30.6%, respectively. Around 35% of women sought advice; however, most women (>60%) reported not taking any treatment for VMS. Among those treating VMS, supplements and nonprescription medications were the most common treatments (19.2%); 12.9% of women reported taking menopausal hormone therapy. Over half of women reported taking over-the-counter treatments; 77.8% adopted lifestyle changes to mitigate VMS. One in 4 women (25.6%) expressed concerns about menopausal hormone therapy side effects; 49.5% of women who had used nonmenopausal hormone therapy prescription medication stopped for lack of efficacy. Many women strongly agreed that menopause is a natural part of aging.</p><p><strong>Conclusions: </strong>Over 10% of postmenopausal Nordic women reported suffering from moderate to severe VMS. VMS impaired the quality of life, sleep, work productivity, and daily activities among perimenopausal and postmenopausal Nordic women, emphasizing the need for effective and well-tolerated treatments.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951902","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 diagnostic accuracy of different fetal blood sample lactate cutoffs in labor, utilizing the StatStrip Xpress® lactate-meter: A population-based observational study.","authors":"Magnus B Berge, Jørg Kessler, Anne Cathrine Staff, Anne Flem Jacobsen","doi":"10.1111/aogs.15140","DOIUrl":"https://doi.org/10.1111/aogs.15140","url":null,"abstract":"<p><strong>Introduction: </strong>A recent study recommended 5.2 mmol/L as a cutoff for fetal blood sample (FBS) lactate in labor for the StatStrip Lactate®/Lactate Xpress® lactate meter. In the present study, we validated FBS lactate cutoffs in a larger population-based setting, with different CTG guidelines, testing external validity.</p><p><strong>Material and methods: </strong>We conducted a prospective population-based study at Oslo University Hospital, Ullevål, Norway, a tertiary referral obstetric department with 7000 annual deliveries. Women with a singleton fetus in cephalic presentation in gestational week ≥36 + 0 were included in the analyses. We used ROC curves to calculate the area under the curve (AUC) and estimate the optimal cutoff for the following adverse neonatal outcomes: Umbilical cord pH ≤7.10, umbilical cord pH ≤7.05, metabolic acidosis (pH <7.0 and Base deficit_{extracellular fluid} > 12 mmol/L), 1-minute Apgar score <4, 5-min Apgar score <7, hypoxic ischemic encephalopathy, and transfer to the neonatal intensive care unit. Analyses were restricted to women with a FBS lactate within 25 min prior to delivery. The study is registered in clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT04779294).</p><p><strong>Results: </strong>Of 7816 included women, 1466 (19%) had a FBS lactate measurement within 25 min prior to delivery. The calculated optimal cutoff for FBS lactate varied by outcomes: 5-min Apgar score <7: AUC 0.69 (0.57-0.80), cutoff 4.0 mmol/L; metabolic acidosis: AUC 0.92 (0.78-1.00), cutoff 7.0 mmol/L; hypoxic ischemic encephalopathy: AUC 0.95 (0.86-1.00), cutoff 4.7 mmol/L. Sensitivity increased for some of the outcomes with a decreasing cutoff. Specificity increased for all outcomes with an increasing cutoff.</p><p><strong>Conclusions: </strong>We consider an FBS lactate cutoff of ≥5.2 mmol/L a good balance between high sensitivity for adverse neonatal outcomes and an acceptable number of needed interventions.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959357","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":"Maternal and fetal outcomes in subsequent pregnancies after peripartum cardiomyopathy: A systematic review and meta-analysis","authors":"Rebecca Man,&nbsp;Jack Le Vance,&nbsp;Hafsa Abdullahi,&nbsp;Clare Davenport,&nbsp;Mengshi Yuan,&nbsp;Laura Ormesher,&nbsp;Sana Usman,&nbsp;James Castleman,&nbsp;Caroline Fox,&nbsp;Lucy Hudsmith,&nbsp;R. Katie Morris,&nbsp;Victoria Hodgetts Morton","doi":"10.1111/aogs.15117","DOIUrl":"10.1111/aogs.15117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We aim to determine the pregnancy and cardiovascular outcomes of subsequent pregnancies following a previous diagnosis of peripartum cardiomyopathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Medline, Embase, CINAHL, and Web of Science were searched from inception to November 2023. Primary research studies of any design providing data for any of our outcomes of interest with greater than five subsequent pregnancies were eligible for inclusion. Primary outcomes included relapse of cardiac failure in the first subsequent pregnancy and death during any subsequent pregnancy. Secondary outcomes included a range of maternal and fetal outcomes. Proportional meta-analysis, applying a random effects model, was performed using R software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine studies involving 779 women were included, performed across 13 countries. The risk of relapse of cardiac failure in the first subsequent pregnancy (20 studies, 376 women) was 32%, 95% confidence interval [CI] 0.23–0.43. In those with recovered (11 studies, 123 pregnancies) and non-recovered (10 studies, 55 pregnancies) cardiac function at subsequent pregnancy outset, the risk of cardiac failure relapse was 24%, 95% CI 0.16–0.35 and 36%, 95% CI 0.24–0.50, respectively. There was a high chance of preterm birth &lt;37 weeks (12 studies, 212 pregnancies) at 22%, 95% CI 0.17–0.29.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Subsequent pregnancy after peripartum cardiomyopathy presents significant maternal and fetal risks. This study provides quantification of risks to begin to fill the current evidence gap, however is limited by the paucity of existing primary research investigating this population. Robust observational studies of current practice are needed to provide answers in specific populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1009-1025"},"PeriodicalIF":3.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951917","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 between migraine, migraine subtype, and adverse pregnancy outcomes: A systematic review and meta-analysis","authors":"Anna Steen Hansen,&nbsp;Cecilie Holm Christiansen,&nbsp;Ane Lilleøre Rom,&nbsp;Nina Olsen Nathan,&nbsp;Marie Stampe Emborg,&nbsp;Line Rode,&nbsp;Hanne Kristine Hegaard","doi":"10.1111/aogs.15115","DOIUrl":"10.1111/aogs.15115","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;Migraine is one of the most prevalent conditions worldwide. This systematic review aimed to evaluate the association between migraine, its subtypes, and adverse pregnancy outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Material and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Eligible cohort and retrospective case–control studies were included from PubMed and Embase databases from their inception to May 2024. Adverse pregnancy outcomes of interest were preeclampsia, preterm birth, low birthweight, small for gestational age, and placental abruption. Study quality was assessed using the Newcastle-Ottawa Scale. Meta-analyses of the outcomes with their odds ratios (ORs) and adjusted ORs (aOR), including a 95% confidence interval (CI), were performed using RevMan. Outcomes were pooled using random effects models, with separate analyses for cohort and retrospective case–control studies. The protocol was registered with PROSPERO (no. CRD42023404759).&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;This meta-analysis included 19 studies (11 cohort and 8 retrospective case–control) encompassing 1 420 690 deliveries. Significant associations were observed between migraine and increased risk of preeclampsia (cohort: aOR 1.28 [95% CI: 1.11–1.47], &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%), (retrospective case–control: aOR 3.4 [95% CI: 1.81–6.4], &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 83%) and preterm birth (cohort: aOR 1.30 [95% CI: 1.17–1.44], &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 11%). The meta-analyses of adjusted data on low birthweight and small for gestational age were inconsistent with respect to statistical significance (cohort: aOR 1.27 [95% CI: 0.89–1.82], &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 36% and cohort: aOR 1.07 [95% CI: 1.03–1.12], &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%, respectively). In addition, migraine without aura (MO) (cohort: OR 1.62 [95% CI: 1.30–2.01], &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%; retrospective case–control: aOR 4.91 [95% CI: 2.78–8.67], &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%) and migraine with aura (MA) (cohort: OR 2.06 [95% CI: 1–4.27], &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 29%) were significantly associated with the risk of preeclampsia. Similarly, MO (cohort: OR 1.28 [95% CI: 1.11–1.49], &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%) and MA (cohort: OR 1.25 [95% CI: 1.07–1.47], &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%) were associated with preterm birth risk.&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;Pregnant women with migraines have a higher risk of preeclampsia and preterm birth compared with those without migraines. Migraine could be associated with an increased risk of low birth weight and small for gestational age. Sub-analyses indicate an elevated r","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1026-1040"},"PeriodicalIF":3.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960408","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":"Magnetic resonance guided high intensity focused ultrasound (MR-HIFU) effectively reduces fibroid-related symptoms and improves quality of life—A prospective single-centre 12-month follow-up study","authors":"Saara Otonkoski,&nbsp;Antti Viitala,&nbsp;Gaber Komar,&nbsp;Teija Sainio,&nbsp;Anna Yanovskiy,&nbsp;Roberto Blanco Sequieros,&nbsp;Antti Perheentupa,&nbsp;Kirsi Joronen","doi":"10.1111/aogs.15086","DOIUrl":"10.1111/aogs.15086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Uterine fibroids are the most common benign tumors among women, and it is estimated that approximately 70% of women have one or multiple fibroids by the age of menopause. About 30% of these women suffer from symptoms related to the fibroids. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a novel, non-invasive treatment method for symptomatic uterine fibroids.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In this prospective, single-centre follow-up study, 175 women with symptomatic uterine fibroids were treated with MR-HIFU. The effect of MR-HIFU on fibroid symptoms and quality of life was evaluated using a uterine fibroid-specific quality of life questionnaire (UFS-QoL). The main outcome measure was the symptom severity score and quality of life (QoL) before the MR-HIFU and 3 and 12 months after the treatment. This study was registered at clinicaltrials.gov (NCT03937401).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median symptom severity score decreased from 56 (IQR 44–69) at baseline to 28 (IQR 16–44) at 3 months (<i>p</i> &lt; 0.01) and 25 (IQR 16–38) at 12 months (<i>p</i> &lt; 0.01) after treatment. The QoL score increased from a median of 48 (IQR 33–66) at baseline to 73 (IQR 59–93) at 3 months (<i>p</i> &lt; 0.01) and 78 (IQR 66–90) at 12 months after treatment (<i>p</i> &lt; 0.01). The reintervention rate during the 12-month follow-up was 2%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MR-HIFU significantly reduces the severity of fibroid-related symptoms in selected patients as early as 3 months after MR-HIFU. The effect persists at 12 months. There is also a significant improvement in the quality of life 3 months after treatment, which further increases at 12 months.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1172-1180"},"PeriodicalIF":3.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958078","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":"Primiparous and multiparous women's birthing experiences and satisfaction with pain management in the first and second stages of vaginal delivery—A prospective cohort study","authors":"Katja Mäkelä,&nbsp;Outi Palomäki,&nbsp;Mika Helminen,&nbsp;Jukka Uotila","doi":"10.1111/aogs.15083","DOIUrl":"10.1111/aogs.15083","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;Most women are satisfied with their delivery experience but the effects of pain relief and different pain relief methods on the birthing experience remain inconsistent. We wanted to evaluate the impact of pain relief on the birthing experience during the first and second stages of labor among primiparous and multiparous women.&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;A total of 2042 parturients (953 primiparous and 1089 multiparous women) completed a questionnaire on the second day after vaginal delivery and, using visual analogue scale (VAS), assessed their experience and satisfaction with their pain management during the first and second stages of labor. The experiences of primiparous and multiparous women were compared, and the factors associated with positive and negative birthing experiences were ascertained.&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;Overall birthing experience was better among multiparous than among primiparous women (VAS 8.6 vs. 8.0; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Reported satisfaction with pain management revealed no significant differences between multiparous and primiparous women during the first stage of labor (VAS 8.2 vs. 8.1) or the second stage of labor (VAS 7.8 vs. 7.7). Some variation was reported in satisfaction with the various pain management methods, epidural and spinal block having the highest ratings during both stages of labor. However, despite differences in satisfaction with pain management, in overall birthing experience, no difference according to pain relief administered was reported among multiparous and only minor differences in primiparous women in the second stage of labor. Those parturients reporting negative birthing experiences (VAS ≤5) reported relatively high satisfaction with pain management during the first stage of labor (medians 8 and 8 in multiparous and primiparous women respectively) while satisfaction with second-stage pain management was clearly lower (respective medians 2 and 5). In a regression model satisfaction with pain management during the second stage of labor varied significantly with birthing experience.&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 childbirth experience was slightly better among multiparous than among primiparous women, although there were no significant differences regarding satisfaction with pain management according to parity during the first or second stage of labor. Satisfaction with pain relief during the second stage of labor was significantly associated with overall birthing experience.&lt;/p","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1143-1152"},"PeriodicalIF":3.5,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968564","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 relationship between crowding in the delivery ward and the risk of postpartum hemorrhage","authors":"Linnea V. Ladfors,&nbsp;Natalie Holowko,&nbsp;Can Liu,&nbsp;Louise Lundborg,&nbsp;Mia Ahlberg,&nbsp;Fredrik Granath,&nbsp;Olof Stephansson","doi":"10.1111/aogs.15137","DOIUrl":"10.1111/aogs.15137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Postpartum hemorrhage (PPH) is a key concern in maternal health, with early identification important for preventing severe complications. In a crowded delivery ward, where the number of births exceeds the normal range, labor management, and PPH prevention may be compromised. Although previous research has mainly focused on crowding over the entire day, it remains unclear whether crowding in the hours surrounding birth influences PPH risk. Therefore, our study aimed to assess the association between delivery ward crowding, adjacent to birth, and PPH and to explore whether births during periods of potentially lower staffing, such as summer months or weekends, could amplify this risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>This case-control study included 1 027 620 births in Sweden (2004–2019) from the Medical Birth Register. PPH, defined as estimated blood loss &gt;1000 mL, cases were identified using a diagnostic code for PPH and were matched (1:10) with controls by the standardization criteria: delivery ward, year, and time of birth (night/day). The secondary outcome was PPH with blood transfusion. After standardization, crowding was defined as the number of births in a ±2-h interval around the index birth exceeding the 75th percentile. Unadjusted conditional logistic regression was used to study the association between crowding and PPH, PPH with blood transfusion, and to examine whether giving birth during a weekend or summer vacation month (June–August) modified these associations. Results were presented as odds ratios (OR) with 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Labor induction and emergency cesarean delivery were less common in births that occurred during crowded compared to noncrowded time intervals. Crowding was not associated with an increased risk of PPH (OR: 0.97; 95% CI: 0.95–0.99) or PPH with blood transfusion (OR: 0.99; 95% CI: 0.92–1.07). Giving birth during a summer month or a weekend did not change the estimates for the association between crowding and PPH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Focusing on a narrow time frame around birth, crowding in the delivery ward was not associated with an increased, but instead a modest reduction, in risk of PPH. Future studies should investigate how staffing in relation to crowding influences the risk of PPH and other adverse birth outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 7","pages":"1295-1303"},"PeriodicalIF":3.5,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958986","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":"Assessment of the internal validity of the Swedish National Quality Register in Gynecological Surgery (GynOp)","authors":"Sammy-Jo Geara,&nbsp;Clara Nygren,&nbsp;Christer Borgfeldt,&nbsp;Ida Bergman","doi":"10.1111/aogs.15136","DOIUrl":"10.1111/aogs.15136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Swedish National Quality Register in Gynecological Surgery (GynOp) is widely used in gynecological and obstetric departments throughout Sweden. With a coverage rate of 91%–98%, it collects a substantial amount of data, fulfilling a crucial role in quality assurance and research. This study aimed to assess the internal validity of key variables within the GynOp register.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A multicenter, single-blinded study was conducted across 10 healthcare providers. Data were collected for 150 patients at each center, with 25 patients selected from each sub-register, totaling 1500 patients. Source data were extracted from medical records and compared to the data in the GynOp register for validation. Agreement was evaluated by calculating the exact agreement and the within-interval agreement using Pearson correlation (0–1) for numerical variables and Cohen's kappa (0–1) for ordinal variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The primary finding was that the overall validity of key variables in the GynOp register was high when compared with source data. For example, the correlation between source data and GynOp register data was 1.00 for uterine weight and 0.97 for date of delivery, and exact agreement was 97% for grade of perineal rupture and 100% for pathological–anatomical diagnosis. Some variables such as ASA-classification, genital prolapse stage, and devices for intrauterine surgery showed moderate agreement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The comparison between the GynOp register and source data demonstrates strong internal validity. This study has identified several areas for improvement, leading to the initiation of an update in the registration module of the sub-register for intrauterine surgery. Additionally, certain categorical variables, such as ASA classification and prolapse stage, should be grouped and presented as dichotomized data to enhance data quality. In the future, integrating extraction of data from the Swedish Perioperative Register (SPOR) and providing education to urogynecologists on the POP-Q system could further contribute to the improvement of data quality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 7","pages":"1390-1398"},"PeriodicalIF":3.5,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054039","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 systematic review on the determinants of long-term kidney sequelae after hypertensive diseases of pregnancy","authors":"Marie Haudiquet,&nbsp;Marion D'Incau,&nbsp;Vincent Letouzey,&nbsp;Olivier Moranne","doi":"10.1111/aogs.15127","DOIUrl":"10.1111/aogs.15127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Preeclampsia is a pregnancy syndrome defined by high blood pressure (≥140/90 mmHg) and at least one other associated complication, including proteinuria, maternal organ dysfunction, or uteroplacental dysfunction, after 20 weeks of gestation. The long-term effects of this disease on the kidneys are still not fully understood. This systematic review aimed to evaluate the risk of chronic kidney disease after preeclampsia and the determinants of these sequelae.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We included observational studies on kidney outcomes from cohorts of women with a history of preeclampsia from the PubMed, Web of Science, and Cochrane databases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred and seventy-seven articles were evaluated. Thirty-one (published between 2000 and 2022) were included in this systematic review. Twenty-two authors focused on the risk of chronic kidney disease and/or persistent proteinuria. Five authors found a more significant risk of kidney disease after preeclampsia, with a risk ranging from two to three times higher. Regarding end-stage kidney disease, most studies found a risk of between 4 and 14 times higher of developing end-stage kidney disease after preeclampsia. For several authors, early preeclampsia, preterm delivery, and recurrent pregnancies complicated by preeclampsia seemed to be the three major factors for determining the risk of kidney sequelae or proteinuria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Women with a history of preeclampsia have a greater risk of chronic kidney disease or end-stage kidney disease. Some determinants seem to increase the risk. Further research is required to identify these determinants of kidney sequelae.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 7","pages":"1254-1273"},"PeriodicalIF":3.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955277","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":"Uptake of orally administered tranexamic acid in women during active labor: A pilot intervention study on prophylactic treatment of postpartum hemorrhage","authors":"Gita Strindfors,&nbsp;Pelle G. Lindqvist,&nbsp;Margit Endler","doi":"10.1111/aogs.15129","DOIUrl":"10.1111/aogs.15129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Postpartum hemorrhage is the leading cause of maternal mortality worldwide. Several studies have confirmed that tranexamic acid is effective in treating postpartum hemorrhage once started, but its prophylactic effect is under debate. As of now, most studies involve intravenous administration, and the uptake of tranexamic acid in women during active labor is unknown. This is a pilot study in preparation for a larger randomized controlled trial on the prophylactic effect of oral tranexamic acid on postpartum hemorrhage. The study aims to assess the uptake of oral tranexamic acid during active labor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Our study is a pilot intervention study. The study population consisted of 51 women ≥36 gestational weeks with planned vaginal delivery at Södersjukhuset, Stockholm, from December 2022 through February 2023. The participants were randomized 1:1:1:1 to receive 2 g of tranexamic acid as an oral solution, tablets, effervescent tablets, or 1 g of intravenous tranexamic acid, near full cervical dilatation. Blood samples were taken before and 30, 60, 120, 240, 360, and 480 min after tranexamic acid administration. Plasma concentration of tranexamic acid was measured using liquid chromatography–tandem mass spectrometry. Mean values were compared between groups using analysis of variance. Our main outcome measures were time to therapeutic level, duration in therapeutic interval, and maximum plasma concentration of tranexamic acid.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Therapeutic level (5.0 mg/L) was reached at the 2-h time point for oral (7.11 ± 3.31 mg/L) and the 30-min time point for intravenous forms (30.6 ± 15.0 mg/L). Duration in therapeutic intervals for oral and intravenous forms was 6 and 3.5 h (<i>p</i> &lt; 0.007). Peak plasma concentrations for oral and intravenous forms were 10.2 ± 3.9 mg/L and 30.6 ± 15.0 mg/L, respectively (<i>p</i> &lt; 0.001). Time-to-therapeutic level (<i>p</i> = 0.08), duration in therapeutic interval (<i>p</i> = 0.92), or peak concentration (<i>p</i> = 0.73) did not differ between oral forms. Overall, 37 women (88%) found the intake of oral tranexamic acid during active labor acceptable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>All oral forms of tranexamic acid show similar and adequate uptake when administered during labor. Uptake is lower and slower compared with intravenous administration, but the duration in the therapeutic interval is longer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 7","pages":"1347-1356"},"PeriodicalIF":3.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957841","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}