Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Preeclampsia screening and prevention—A Nordic perspective","authors":"Charlotte K. Ekelund, Ylva Carlsson, Lina Bergman, Anna-Karin Wikström, Kjell Å. B. Salvesen, Vedran Stefanovic, Pia M. Villa, Jóhanna Gunnarsdóttir, Line Rode","doi":"10.1111/aogs.15073","DOIUrl":"10.1111/aogs.15073","url":null,"abstract":"<p>Preeclampsia, particularly if onset is early, possess a significant challenge for obstetricians. Despite advances in maternal healthcare, the global incidence of preeclampsia remains at 2%–8%, with Nordic countries reporting rates around 3%–4%. Delivery is the only effective treatment, resulting in high perinatal mortality and morbidity due to preterm birth. Furthermore, preeclampsia currently remains one of the leading causes of maternal mortality and severe maternal morbidity worldwide.</p><p>Over time, various preventive strategies have been explored, and while ongoing pharmaceutical studies aim to identify alternative options, a low-dose of acetylsalicylic acid (aspirin) has, so far, proven to be the most effective. Meta-analyses indicate that aspirin at a dose around 100 mg/day, administered to high-risk women before 16 weeks of gestation, can reduce the risk of preterm preeclampsia (preeclampsia with delivery before 37 weeks of gestation).<span><sup>1</sup></span> However, the exact dose and possible benefit if treatment is started after 16 weeks of gestation is still being explored.</p><p>The definition of ‘high-risk’ for preeclampsia and eligibility for aspirin prophylaxis varies across national obstetric guidelines. In the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden), guidelines recommend aspirin treatment for women based on maternal or obstetric risk factors. This can be either a single high-risk factor, such as pregestational diabetes, or a history of preeclampsia. In some national guidelines women with multiple moderate-risk factors like high body mass index and nulliparity are also eligible for aspirin prophylaxis. However, this screening approach, based solely on maternal/obstetric risk factors, has limited predictive accuracy. A Danish study found that screening by maternal high-risk factors alone detects less than 30% of preterm preeclampsia cases,<span><sup>2</sup></span> and a similar study evaluating the current Swedish guidelines showed only 20%–30% of women eventually developing preeclampsia are detected.<span><sup>3</sup></span></p><p>Recently, a novel screening method using a multi-marker algorithm proposed by the Fetal Medicine Foundation has attracted attention. This first-trimester screening algorithm combines maternal risk factors with measurement of mean arterial pressure, uterine artery Doppler pulsatility index, and biochemical markers, such as placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A). Studies indicate this method can identify up to 70%–75% of women at risk for preterm preeclampsia for a screen-positive rate of 10%,<span><sup>4</sup></span> surpassing the predictive accuracy of current guidelines using maternal and obstetric risk factors alone. Additionally, the ASPRE (Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention) trial demonstrated that women, identified as high-risk using this Fe","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"790-791"},"PeriodicalIF":3.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposure to potentially teratogenic medications before and during the first trimester of pregnancy compared to women of childbearing age: A retrospective analysis of Swiss claims data (2015–2021)","authors":"Carole A. Marxer, Sereina M. Graber, Daniel Surbek, Alice Panchaud, Christoph R. Meier, Julia Spoendlin","doi":"10.1111/aogs.15052","DOIUrl":"10.1111/aogs.15052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Exposure to potentially teratogenic medications during pregnancy is underinvestigated in Switzerland. We aimed to assess exposure to potential teratogens preconceptionally, during the first trimester, and in women of childbearing age, and specifically explore the effectiveness of the valproate pregnancy prevention program (2018).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Retrospective study using the Swiss Helsana claims database. In a pregnancy cohort (2015–2021) and a cohort of women of childbearing age (2021 and 2018), we defined three 90-day time periods: (1) first trimester, (2) preconceptional period (days 180–90 before pregnancy), and (3) January 01, 2021, and March 31, 2021 (women of childbearing age). During all periods, we quantified the exposure prevalence to at least one dispensed weak, proven, and unequivocally potent teratogen overall and by age strata. We quantified the exposure prevalence to each individual teratogen, and to valproate during pregnancy by calendar year to compare its use before and after the introduction of a pregnancy prevention program (2018). We investigated the use of systemic retinoids particularly isotretinoin in women of childbearing age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 34 584 pregnant women, 1.4% were exposed to potential teratogens during the first trimester (weak: 1.3%, proven: 0.06%, unequivocally potent: 0.04%). During the preconceptional period, 2.9% were exposed to any teratogen compared to 4.7% of women of childbearing age (<i>N</i><sub>total</sub> = 95 059). Systemic glucocorticoids were the most prevalent weak teratogens during all time periods (75% of all claimed teratogens during the first trimester). In the first trimester, the antibiotic cotrimoxazole and the thyreostatic thiamazole (weak teratogens), ranked second and third, followed by the antiseizure medications carbamazepine and topiramate (proven teratogens). Among women of childbearing age, exposure to weak and proven teratogens increased with age, whereas exposure to unequivocally potent teratogens decreased with age. This was due to 2.3% of women <26 years who claimed systemic isotretinoin. Valproate use during pregnancy decreased after the introduction of a pregnancy prevention program (2.39/10 000 pregnancies [2015–2018] vs. 0.93/10 000 pregnancies [2019–2021]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most medications with potential teratogenic effects dispensed to women of childbearing age and pregnant women were in the group of weak teratogenicity","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"707-719"},"PeriodicalIF":3.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors for regression and progression of actively surveilled cervical intraepithelial neoplasia grade 2: A prospective cohort study","authors":"Laura Bergqvist,&nbsp;Anni Virtanen,&nbsp;Ilkka Kalliala,&nbsp;Ralf Bützow,&nbsp;Maija Jakobsson,&nbsp;Annu Heinonen,&nbsp;Karolina Louvanto,&nbsp;Joakim Dillner,&nbsp;Pekka Nieminen,&nbsp;Karoliina Aro","doi":"10.1111/aogs.15032","DOIUrl":"10.1111/aogs.15032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two years of active surveillance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a single-center prospective observational cohort study. Women under 31 years of age giving written informed consent with histologically confirmed CIN2 were followed with colposcopy, cytology, and biopsies every 6 months up to 24 months. At baseline, HPV genotyping was performed on cervical samples. The rates of regression and progression were recorded for every timepoint and at the end of study overall and stratified according to clinical factors and HPV genotypes at baseline. Risk ratio (RR) was used to estimate the relative risks for regression and progression. The study was registered in the ISRCTN registry (ISRCTN91953024).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 205/243 (84.4%) women completed the study. Complete regression (normal histology and/or normal or atypical squamous cells of undetermined significance (ASC-US) cytology) was detected in 64.4.% (<i>n</i> = 132) while 16.1% (<i>n</i> = 33) of the lesions progressed to CIN grade 3 (CIN3) or worse including 31 CIN3 cases, one adenocarcinoma in situ and one cervical cancer case. Factors associated with progression were initial large (&gt;50% of the transformation zone) lesion size, risk ratio (RR) 3.06 (95% confidence interval (CI) 1.40–6.69), and high-grade referral cytology RR 4.73 (95% CI 1.18–19.03). Compared with baseline HPV negativity or having only low-risk HPV genotypes present, high-risk HPV (hrHPV) positivity was associated with lower likelihood of regression RR 0.74 (95% CI 0.60–0.91). Age, cigarette smoking, use of combined oral contraceptives or baseline high-risk HPV genotype, including HPV16, were not associated with the outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The majority of CIN2 lesions regress in young women. Women with large lesions and/or high-grade referral cytology should perhaps more often be treated instead of active surveillance. Initial hrHPV genotype does not appear to predict outcomes while not harboring hrHPV favors regression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"763-773"},"PeriodicalIF":3.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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,&nbsp;Mingyi Liu,&nbsp;Yan Jing,&nbsp;Zikang Yin,&nbsp;Nianxin Kong,&nbsp;Chenggen Guo","doi":"10.1111/aogs.15042","DOIUrl":"10.1111/aogs.15042","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;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.&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;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).&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 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 (&lt;i&gt;p&lt;/i&gt; = 0.00), 95% CI [−2.26 to −1.31]) and pain duration (weighted mean difference (WMD) = −12.53 h, &lt;i&gt;p&lt;/i&gt; = 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.&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;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 aero","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"815-828"},"PeriodicalIF":3.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15042","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}