Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Efficacy of transabdominal cerclage by open laparotomy relative to existing risk factors","authors":"Cecile C. Hulshoff,&nbsp;Marc E. A. Spaanderman,&nbsp;Ralph R. Scholten,&nbsp;Joris van Drongelen","doi":"10.1111/aogs.15065","DOIUrl":"10.1111/aogs.15065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To prevent extreme preterm birth, women with cervical insufficiency are eligible for transabdominal cerclage in case of prior failure or technical impossibility for transvaginal cerclage. This study aimed to identify patient characteristics that affect the success rate of transabdominal cerclage to prevent extreme preterm birth in women with cervical insufficiency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Single-center retrospective cohort study in 87 women who underwent transabdominal cerclage by open laparotomy during first and early second trimester of pregnancy over a 20-year period. Participants were divided into subgroups according to indication for the intervention. Linear regression and meta-regression-analyses were performed to assess the effect of mean cervical length (before and after transabdominal cerclage placement) and gestational age of previous preterm birth, on gestational age at delivery. Kaplan–Meier analysis was performed to evaluate treatment effects on gestational age at delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 87 women, 62 women underwent a history-indicated and 25 an ultrasound-indicated transabdominal cerclage. Fetal survival was 92%: 91% in the history-indicated and 96% in the ultrasound-indicated group. Median gestational age at delivery was 37.3 weeks, with a median pregnancy prolongation of 163.0 days and with 92% of deliveries ≥34 weeks. Between groups, irrespective of singleton and twin pregnancies, outcomes were comparable. Gestational age at delivery was neither affected by cervical length before transabdominal cerclage, distance between transabdominal cerclage and external os, gestational age of previous preterm birth nor additional progesterone treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The efficacy of transvaginal cerclage placement via open laparotomy during high-risk pregnancy is favorable and relates to fetal survival of 92%. Regardless of indication, pregnancy outcomes after transabdominal cerclage are similar, and independent of gestational age at previous preterm birth, cervical length before transabdominal cerclage placement, distance between transabdominal cerclage and external os, and additional progesterone administration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"685-696"},"PeriodicalIF":3.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What to do when the second twin is non-vertex?","authors":"Katrine Vasehus Schou,&nbsp;Marianne Johansen","doi":"10.1111/aogs.15067","DOIUrl":"10.1111/aogs.15067","url":null,"abstract":"&lt;p&gt;The incidence of twin deliveries is still increasing in many countries, as a consequence of higher maternal age, and assisted reproduction technology. The choice of planned mode of delivery in twin gestations and intrapartum clinical management are still debated with many discrepancies between countries and centers.&lt;/p&gt;&lt;p&gt;A lot of factors influence the physician's recommendation for mode of delivery in a twin gestation. In high income countries there seems to be consensus that vaginal delivery is a reasonable and likely the preferred option for delivery in near term uncomplicated twin pregnancies with the first twin in a vertex presentation.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; For many years it has been assumed that trial of labor (TOL) with the second twin being in a non-vertex presentation is associated with a higher maternal and neonatal risk, including an increased risk of combined delivery, and hence maternal and neonatal morbidity. However, more recent research has identified other independent risk factors such as higher gestational age, nulliparity, and the use of medical induction of labor. Several studies have now confirmed that TOL in twin pregnancies is a safe option, irrespective of second twin presentation if certain well-defined criteria are met, including a recent ultrasound regarding fetal position and estimated fetal weight focusing on weight con- or dis-cordance, and with the appropriate infrastructure and clinical expertise being accessible on labor ward. A sub-analysis of The Twin Birth Study, however, found that transverse/oblique lie of twin B after the birth of twin A was a risk factor for combined delivery and combined delivery a risk factor for adverse neonatal outcome.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In this context it is important to remember that the majority of second twins present in a vertex position and that up to one tenth of second twins in non-vertex presentation experience a spontaneous version during labor affecting the likelihood of successful vaginal delivery.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Still, up to 4% of women opting for vaginal twin delivery ends up with “the worst of two worlds” going through a combined delivery with the burden of undergoing a vaginal delivery followed by an emergency cesarean section with its inborn risks. When choosing the most appropriate mode of delivery, this potential scenario of combined delivery seems to affect women's choice.&lt;/p&gt;&lt;p&gt;Almost 9 out of 10 second twins starting labor in a non-vertex presentation (approximately one third of all twins) end up in a final non-vertex presentation and may challenge the attending obstetrician with a decision on how to deliver. In some centers the clinicians choose to perform an intrapartum external version (external cephalic version [ECV]) or correction of fetal position of the non-vertex second twin, to achieve a vertex presentation, whilst others opt for either spontaneous breech delivery or breech extraction, whichever comes most natural, in order to ac","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"582-583"},"PeriodicalIF":3.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363183","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":"Are the uterosacral ligaments detached in young women with pelvic floor symptoms after birth?","authors":"John O L DeLancey, Wenjin Cheng, Luyun Chen","doi":"10.1111/aogs.15058","DOIUrl":"https://doi.org/10.1111/aogs.15058","url":null,"abstract":"","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363174","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":"Frequency of fetal blood sampling, delivery mode and neonatal outcome after revised CTG-classification and updated lactate meter in Sweden: An observational study","authors":"Klara Gröndal,&nbsp;Erika Gyllencreutz,&nbsp;Stina Wretler,&nbsp;Kari Johansson,&nbsp;Malin Holzmann","doi":"10.1111/aogs.15063","DOIUrl":"10.1111/aogs.15063","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;A revised cardiotocography (CTG) classification was implemented in Sweden in 2017. Simultaneously, an updated version of the lactate meter, Lactate Pro 2™, proved to measure 50% higher than the previous, necessitating new cutoffs for fetal blood sampling (FBS). We aimed to investigate frequencies of FBS, delivery modes, and neonatal outcomes. We hypothesized that with the revised CTG classification, which accepts more fetal heart rate patterns as normal than the previous, the frequency of FBS would be lower, the proportion of acidemia at FBS and adverse neonatal outcomes would be higher among sampled fetuses, but not among the entire laboring population, and the higher lactate readings might increase the proportion of cesarean delivery in general anesthesia and cesarean delivery above vacuum extraction.&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 population-based cohort study of electronic medical records of labors in Stockholm-Gotland during 2014–2015 and 2018–2019, including singleton pregnancies &gt;34 weeks, cephalic presentation, with spontaneous or induced start of labor. Outcome measures were FBS frequency, proportion of fetal acidemia, delivery modes, and neonatal outcomes with comparison between the two periods among sampled and nonsampled fetuses.&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;There were 28 841 and 30 192 births during the two periods. In the latter period, the FBS frequency was lower (8.2% vs. 11.9% [&lt;i&gt;p&lt;/i&gt; &lt; 0.001]), and the proportion of acidemia at FBS was higher, both among sampled fetuses (12.5% vs. 7.1% [&lt;i&gt;p&lt;/i&gt; &lt; 0.001]), and in the total population (1.0% vs. 0.8% [&lt;i&gt;p&lt;/i&gt; = 0.022]). Immediate cesareans in general anesthesia due to fetal distress were more frequent among sampled fetuses (3.1% vs. 2.0% [&lt;i&gt;p&lt;/i&gt; = 0.006]) but not among nonsampled fetuses (0.4 vs. 0.4%). Incidence of Apgar scores &lt; 4 at 5 min was unchanged after FBS (&lt;i&gt;p&lt;/i&gt; = 0.66) but higher among nonsampled newborns (0.2 vs. 0.1 [&lt;i&gt;p&lt;/i&gt; = 0.033]). Apgar scores &lt;7 at 5 min were more frequent among both sampled and nonsampled groups.&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;After implementation of a revised CTG classification and a differently calibrated lactate meter in Sweden, the use of FBS was substantially lower. Acidemia at FBS and immediate cesarean due to fetal distress were more frequent among sampled fetuses but still low in the total laboring population. Low Apgar scores were more frequent among newborns both with and without FBS.&lt;/p&gt;\u0000 &lt;/s","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"676-684"},"PeriodicalIF":3.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363180","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 unnecessary focus on racialized pelvic stereotypes","authors":"Patji Alnæs-Katjavivi","doi":"10.1111/aogs.15074","DOIUrl":"10.1111/aogs.15074","url":null,"abstract":"&lt;p&gt;AOGS interest in publishing original research from low-resource settings is appreciated. Using serial intrapartum examinations of laboring women in Moshi, northern Tanzania, Bagandanshwa et al. demonstrate the association persistent fetal occipito-posterior (OP) position has with prolonged labor, and a higher incidence of operative (almost exclusively cesarean) deliveries.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; However, there are some interpretations and assumptions that should be scrutinized.&lt;/p&gt;&lt;p&gt;The introduction draws attention to the high incidence of persistent OP position in the population studied, compared to “white”/“European” parturients. The authors explain that the observed difference is by virtue of the single ethnicity of their study population being “black African women,” and that the anthropoid-shaped pelvis is more common in “Black African women.” The supporting radiological investigation cited is a study by Handa et al., studying magnetic resonance imaging (MRI) to compare pelvic dimensions in a sample of (self-reporting) African-American and white women. However, Handa states not to “use previously described categories to classify pelvic type in our research because those categories are founded on qualitative comparisons rather than quantitative measures.” Though differences observed between 40 racialized female cadavers in South Africa are cited, ignored is the study that finds one single anthropoid pelvis among 47 South African Zulu parturients.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; No other pelvic surveys from the African continent are mentioned. Despite literature that casts doubt upon its usefulness,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Bagandanshwa et al. assume that anthropoid proportions for the entire population of the “black” African continent are equal to the 40% found in the 121 “negro female” skeletons surveyed by Caldwell and Moloy. A questionable assumption, given the “one-drop rule” of racial categorization that operated in the USA prior to 1938, supported by genetic studies demonstrating up to 24% European ancestry among African Americans. Based on mtDNA haplotypes, African Americans share minimal ancestry with East Africans.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The study by Bagandanshwa et al. involves “only one ethnicity.” I question whether this single sample is representative of the several thousand ethnicities within the African continent alone. The greatest genetic variation between groups on the planet is found in Africa.&lt;/p&gt;&lt;p&gt;Bagandanshwa et al. do not provide radiological evidence to support persistent OP position in labor due to the anthropoid pelvic shape alone. Little is offered to the reader regarding the labors conducted at Moshi. Other than the absence of regional analgesia, little is documented regarding the parturient's mobility, doula support, and one-to-one midwifery care, all of which have been shown to reduce complications associated with persistent OP position in labor. No discussion of attitudes and possible biases of the local ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"782-783"},"PeriodicalIF":3.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363173","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":"Menstrual-related symptoms as red flags for school absenteeism among Norwegian adolescents (MINA): A cross-sectional study","authors":"Oline Friestad Gravdahl,&nbsp;Rune Svenningsen,&nbsp;Peter Majak,&nbsp;Guri Majak","doi":"10.1111/aogs.15062","DOIUrl":"10.1111/aogs.15062","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;Severe dysmenorrhea is prevalent among adolescents, yet it remains undertreated, potentially leading to substantial absenteeism from social and academic activities. This study aimed to evaluate the prevalence of severe dysmenorrhea among Norwegian adolescents, as well as associations between severe dysmenorrhea and academic or social absenteeism. Moreover, the study sought to assess the prevalence of accompanying symptoms and their potential as red flags for absenteeism, thus providing healthcare workers a more robust tool for identifying students for intensified treatment and/or referral. Furthermore, differences in the prevalence of severe dysmenorrhea, accompanying symptoms, and absenteeism based on ethnicity and place of residence were evaluated.&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 cross-sectional study utilized a digital questionnaire comprising 67 questions divided into three categories: “demographics,” “dysmenorrhea-related complaints,” and “consequences and actions related to complaints.” Data were analyzed using Chi-square tests and a multivariate logistic regression model.&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;A total of 987 high school students completed the questionnaire and were included in the final analyses. Of them, 38.1% had scores of ≥8 on the Numeric Rating Scale, classified as severe dysmenorrhea. Participants with severe dysmenorrhea reported a significantly higher degree of absenteeism from both school (85.0% vs. 53.1%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and social settings (84.3% vs. 53.9%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) than those with mild-to-moderate dysmenorrhea. Menorrhagia (odds ratio [OR] = 1.55, &lt;i&gt;p&lt;/i&gt; = 0.012), dyschezia (OR = 1.63, &lt;i&gt;p&lt;/i&gt; = 0.007), vomiting (OR = 1.97, &lt;i&gt;p&lt;/i&gt; = 0.009), and fatigue (OR = 1.97, &lt;i&gt;p&lt;/i&gt; = 0.026) were significant predictors of academic absenteeism in a logistic regression analysis. These can serve as relevant red flags for caretakers. Higher rates of social (74.4% vs. 57.0%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and academic absenteeism (72.9% vs. 57.5%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) due to dysmenorrhea were observed among participants of non-Norwegian ethnicity.&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;A high prevalence of severe dysmenorrhea and associated symptoms was observed among Norwegian adolescents, leading to a high degree of absenteeism from school and social activities. The highest prevalence of absenteeism was observed among participants of non-Norwegian ethnicity. Symptoms accompanying severe dysmenorrhea should serve as red flag","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"746-754"},"PeriodicalIF":3.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187886","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":"Aerobic exercise to alleviate primary dysmenorrhea in adolescents and young women: A systematic review and meta-analysis of randomized controlled trials.","authors":"Jingjie Cai, Mingyi Liu, Yan Jing, Zikang Yin, Nianxin Kong, Chenggen Guo","doi":"10.1111/aogs.15042","DOIUrl":"https://doi.org/10.1111/aogs.15042","url":null,"abstract":"<p><strong>Introduction: </strong>Aerobic exercise has been confirmed to alleviate primary dysmenorrhea (PD) in adolescents and young women. However, the effect of the aerobic exercise type and dosage on PD alleviation was unclear. This research aims to assess the effect of aerobic exercise on PD and investigate the dose-response relationships.</p><p><strong>Material and methods: </strong>Systematic literature searches of Web of Science, Embass, Cochrane Library, PubMed, PsycNET, CINAHL, CNKI, Baidu Scholar, Google Scholar, and other Complimentary Medicine Database. PICOS standards were adopted in this research: participants were nonathlete women with PD; intervention was aerobic exercise of at least one menstruation cycle; comparator was any comparator; outcomes were pain intensity or pain duration; and study type was randomized controlled trials. The Cochrane Collaboration risk of bias tool was used to assess the quality of the research. Random-effect meta-analysis was conducted for pain intensity and pain duration, with prespecified subgroup analyses based on aerobic exercise components. The strength of the evidence was assessed using GRADE. This systematic review and meta-analysis was registered in PROSPERO (CRD42024533544).</p><p><strong>Results: </strong>The study identified 16 eligible studies, with 15 involving adolescents, totaling 918 participants aged 15 to 43, with an average age of 21.26 ± 13.15. The results confirmed that aerobic exercise can alleviate PD's pain intensity (standard mean difference (SMD) = -1.728 (p = 0.00), 95% CI [-2.26 to -1.31]) and pain duration (weighted mean difference (WMD) = -12.53 h, p = 0.01, 95% CI: -21.38 to -3.68). However, the heterogeneity of these two results was high. Subgroup analysis showed that Pilates (SMD = -3.17, 95% CI [-4.26 to -2.07]), low intensity (SMD = -1.64, 95% CI [-2.10 to -1.19]), 31-45 min duration (SMD = -3.05, 95% CI [-5.36 to -0.75]), ≤2 times per week frequency (SMD = -2.24, 95% CI [-3.36 to -1.12]), and a period cycle of 2 menstrual cycles (SMD = -2.21, 95% CI [-3.13 to -1.28]) had the maximum effect size.</p><p><strong>Conclusions: </strong>Aerobic exercise was able to alleviate pain intensity and pain duration in adolescents and young women with PD. Moderate-quality evidence indicates that Pilates, low intensity, 46-60 min, ≤two times per week, or two menstrual cycles showed more efficiency in alleviating PD. Due to the limited data, future research should prioritize conducting randomized controlled trials of aerobic exercise interventions in younger age groups to develop personalized treatment strategies for adolescents.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063092","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":"Labor onset and delivery mode in women with congenital heart disease—A nationwide cohort study","authors":"Marit Sandberg,&nbsp;Tatiana Fomina,&nbsp;Ferenc Macsali,&nbsp;Gottfried Greve,&nbsp;Nina Øyen,&nbsp;Elisabeth Leirgul","doi":"10.1111/aogs.15064","DOIUrl":"10.1111/aogs.15064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>More women with congenital heart disease (CHD) are pursuing pregnancy. Their cardiac condition may impact the pregnancy and necessitate interventions during childbirth. We aimed to investigate labor onset and delivery mode in women with CHD relative to women without heart disease and explore the time trends of induced labor and cesarean deliveries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In a nationwide cohort in Norway from 1994 to 2014, we compared childbirths of women with mild, moderate/severe, or other CHD to childbirths of women without heart disease. Associations between maternal CHD and labor onset and delivery mode were estimated using log-binomial regression. Time trends were assessed using Joinpoint regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1 218 452 childbirths, 2425 (20 per 10 000) had mild maternal CHD, 603 (5 per 10 000) moderate/severe maternal CHD, and 522 (4 per 10 000) other maternal CHD. Mild maternal CHD was associated with induced labor (aRR 1.11, 95% CI 1.01–1.22) and cesarean delivery (aRR 1.27, 95% CI 1.18–1.39), and the associations were stronger with moderate/severe CHD (induced labor: aRR 1.34, 95% CI 1.13–1.58; cesarean delivery: aRR 1.80, 95% CI 1.57–2.05) and other CHD (induced labor: aRR 1.39, 95% CI 1.17–1.66; cesarean delivery: aRR 1.62, 95% CI 1.39–1.89). From the first seven years (1994–2000) to the last (2008–2014), the cesarean delivery occurrence rose about 2% per year in childbirths without maternal heart disease and with mild maternal CHD (from 12.4% to 16.4% and from 14.2% to 21.2%, respectively), but remained stable in childbirths with moderate/severe maternal CHD (23.3% to 25.6%). For induced labor, there was a 2% increase per year in childbirths without maternal heart disease, contrasting a 3%–4% increase in those with mild and moderate/severe maternal CHD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Maternal CHD was associated with higher risks of induced labor and cesarean delivery. From 1994 to 2014, the increase in induced labor was steeper in childbirths of women with CHD than in those of women without heart disease. The occurrence of cesarean deliveries rose in childbirths of women with mild CHD but was stable in childbirths of women with moderate/severe CHD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"666-675"},"PeriodicalIF":3.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057692","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":"Clinical outcomes and feasibility of implementing outpatient labor induction with misoprostol: A prospective cohort study","authors":"Kjersti Engen Marsdal,&nbsp;Ingvil Krarup Sørbye,&nbsp;Stine Bernitz,&nbsp;Nasreen Adan,&nbsp;Elin Baustad Grødal,&nbsp;Anne Flem Jacobsen,&nbsp;Mirjam Lukasse","doi":"10.1111/aogs.15029","DOIUrl":"10.1111/aogs.15029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In response to the increasing rates of induction of labor (IOL), outpatient IOL has emerged as a potential approach to enhance women's satisfaction while reducing costs and staffing requirements. There is a growing interest in oral misoprostol as an outpatient IOL method, particularly in the Nordic region. This study aims to evaluate the clinical outcomes and feasibility of implementing IOL with oral misoprostol as an outpatient procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This multicenter, prospective cohort study is part of the Labor Induction Inpatient and Outpatient (LINO) project (ClinicalTrials.gov Identifier: NCT04746248). Women with low-risk pregnancies undergoing IOL with oral misoprostol were offered outpatient treatment as an alternative to the standard inpatient approach. The primary outcome was the proportion of births and adverse events occurring before or within 30 min after admission, comparing outpatient and inpatient groups. Secondary outcomes included maternal and neonatal safety and efficacy endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study period, 212 women were included in the study: 123 (58.0%) in the outpatient group and 89 (42.0%) in the inpatient group. No births occurred before admission to the hospital or within the first 30 min after admission. Adverse events were rare, and there were no significant differences in safety outcomes between the groups. The duration from hospital admission to giving birth was significantly shorter among women in the outpatient group as compared to the inpatient group (12.3 h vs. 28.1 h, <i>p</i> = 0.001). In the outpatient group, 76.4% of the women completed the misoprostol treatment as outpatients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this study of 212 women undergoing IOL with oral misoprostol, we found similar safety outcomes between women who chose outpatient IOL and those who chose inpatient IOL. The outpatient group had significantly shorter hospital stays before giving birth, and more than three in four women in the outpatient group completed the misoprostol treatment as outpatients. While larger studies are needed to draw definitive conclusions, our study suggests that implementing oral misoprostol in an outpatient IOL protocol may represent a safe and feasible alternative.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"647-657"},"PeriodicalIF":3.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057426","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":"Digital healthcare as a solution for global challenges: A call for action","authors":"Mireille N. Bekker,&nbsp;Olof Stephansson,&nbsp;Nerea Maiz,&nbsp;Michèle van der Kemp,&nbsp;Kees Ahaus,&nbsp;Arie Franx","doi":"10.1111/aogs.15066","DOIUrl":"10.1111/aogs.15066","url":null,"abstract":"&lt;p&gt;In an era of rising technological advancements, healthcare systems worldwide are facing a coincidence of challenges: a growing shortage of healthcare professionals, unsustainable growth of the costs of care, and an alarming rise in chronic conditions. The global healthcare workforce is stretched to its limits, with the World Health Organization (WHO) projecting a shortfall of 10 million healthcare workers by 2030.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Compounding this crisis are aging populations and the rising prevalence of chronic conditions, such as diabetes and cardiovascular diseases. The global economic burden of diabetes alone is expected to surpass $845 billion annually by 2045.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;These pressures demand innovative solutions. Digital health care—enabled by, for example, telemonitoring, artificial intelligence, and remote care platforms—emerges as a promising response. However, despite its potential to revolutionize care delivery, its implementation remains scarce. Research is urgently needed to validate its safety, efficacy, and cost-effectiveness, ensuring sustainable integration into healthcare systems.&lt;/p&gt;&lt;p&gt;Digital home healthcare can alleviate system burdens by replacing hospital visits and/or admissions, enabling continuous monitoring, early detection of complications, and personalized care tailored to the individual patient's needs. For patients, digital home healthcare offers convenience, reduces the need for hospital visits, and empowers them to manage their health. Providers benefit from real-time data, enabling proactive interventions and efficient resource allocation.&lt;/p&gt;&lt;p&gt;Premature adoption of digital home healthcare without robust evidence carries significant risks. Poorly designed systems may exacerbate health disparities, particularly for patients with limited digital access. Overdiagnosis and overtreatment could lead to unnecessary anxiety, medical interventions, additional strain for healthcare workers, and inflated costs. A cautious, evidence-based approach is essential to ensure digital solutions deliver on their promise of safer, more efficient care.&lt;/p&gt;&lt;p&gt;Research plays a pivotal role in overcoming these barriers. Well-designed studies are needed to confirm the safety, efficacy, and scalability of digital health solutions across diverse populations. Assessing cost-effectiveness is equally crucial to designing sustainable funding models. Value-based reimbursement—rewarding outcomes rather than service volume—offers a promising framework for digital home healthcare. Furthermore, understanding both practical and psychological barriers and facilitators of systemic adoption is critical for scaling digital solutions. Research can identify best practices for integrating digital tools into existing workflows and addressing resistance among providers and patients.&lt;/p&gt;&lt;p&gt;There are about 4 million childbirths in Europe every year,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; and globally about 140 million.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/spa","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"250-252"},"PeriodicalIF":3.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051009","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}