Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"When two diseases collide: Endometriosis as a risk factor for severe pelvic inflammatory disease","authors":"Marta Camacho,&nbsp;Mariona Rius,&nbsp;Maria Angeles Martínez-Zamora,&nbsp;Meritxell Gracia,&nbsp;Lara Quintas-Marquès,&nbsp;Cristian De Guirior,&nbsp;Francisco Carmona,&nbsp;Cristina Ros","doi":"10.1111/aogs.70306","DOIUrl":"10.1111/aogs.70306","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Our objective was to compare the severity of pelvic inflammatory disease (PID) in hospitalized women with and without endometriosis, and to assess whether deep endometriosis is associated with worse clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A single-center retrospective cohort study was conducted from January 2018 to December 2023, including women hospitalized for PID in a tertiary care endometriosis center. Patients were classified based on the presence of endometriosis, as diagnosed by transvaginal ultrasound (TVUS). Clinical, microbiological, and imaging data were analyzed. Primary outcomes included treatment failure, length of hospital stay, need for urgent surgery, and recurrence. A subgroup analysis was performed within the endometriosis group to assess the impact of deep endometriosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 159, 48 (30.2%) had endometriosis. Compared to those without the disease, women with endometriosis were older and had significantly higher rates of adnexal findings on TVUS (95.8% vs. 73.8%, <i>p</i> = <i>0</i>.<i>01</i>), mostly suspected infected endometrioma. Vaginal and endocervical cultures were negative in 72.9% of endometriosis patients, and only one tested positive for sexually transmitted disease, in contrast to 42.3% positivity in the non-endometriosis group (<i>p &lt;0</i>.<i>01</i>). Patients with endometriosis showed significantly higher rates of treatment failure (35.4% vs. 17.1%, <i>p</i> = <i>0</i>.<i>01</i>), recurrence (31.3% vs. 11.7%, <i>p</i> = <i>0</i>.01), and longer hospital stays (6.1 vs. 3.9). In the deep endometriosis subgroup, treatment failure and recurrence rates were higher, although these differences did not reach statistical significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Endometriosis is a significant risk factor for more severe PID, contributing to worse clinical outcomes, including higher treatment failure, prolonged hospitalization, and greater recurrence. Particularly, those with deep endometriosis seem to have a more severe clinical course.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"2060-2067"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519815","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 approach to standardizing the visual appearance of endometriotic lesions for artificial intelligence recognition","authors":"Antoine Netter,&nbsp;Fanny Duchateau,&nbsp;Henrique Abrao,&nbsp;Michel Canis,&nbsp;Dan C. Martin,&nbsp;Adrien Bartoli,&nbsp;Nicolas Bourdel,&nbsp;the FEMaLe Project Work Group","doi":"10.1111/aogs.70293","DOIUrl":"10.1111/aogs.70293","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;Numerous studies have shown that the diagnostic performance and reproducibility of visual recognition of endometriosis during laparoscopy are poor. The use of artificial intelligence (AI) seems relevant for exhaustive lesion recognition. Standardization of the visual classification of lesions, in the form of an ontology, is an essential prerequisite to enable medical experts to annotate surgical data consistently and subsequently allow engineers to train and build an artificial intelligence tool for endometriosis recognition.&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 systematic search was conducted in the MEDLINE (via PubMed), EMBASE, and the Cochrane Library databases up to May 2022, aiming to identify studies describing the laparoscopic visual appearance of superficial endometriosis, endometriomas, and deep infiltrating endometriosis. The accumulated data in the literature concerning the visual appearance of the different forms of endometriosis were used to create an ontology that could be used for artificial intelligence applications.&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;Out of 932 articles screened, 35 studies were selected based on the inclusion criteria of human subjects with histologically confirmed endometriosis lesions visualized via laparoscopy. The selected studies were reviewed to develop a visual ontology of endometriosis lesions observed via laparoscopy. The lesions were categorized into 4 classes and further subdivided into 11 subclasses: superficial (black, red, white, or subtle), adhesions (dense or filmy), deep (obliteration, retraction, or deformation), and ovarian (endometrioma or chocolate fluid). The positive predictive value (PPV) varied across lesion types: black lesions (PPV 47%–97%), red lesions (PPV 33%–100%), white lesions (PPV 20%–81%), and ovarian endometriosis (PPV 42%–98%). Nonspecific lesions such as adhesions (PPV 16%–50%) and subtle superficial lesions (PPV 0%–67%) presented lower PPVs. Deep endometriosis lesions, often buried within organs, required indirect signs (obliteration, retraction, deformation) for identification.&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 visual ontology proposed in this systematic search could facilitate the detection and classification of endometriosis lesions using artificial intelligence. This study highlights the challenges of reaching a consensus on lesion recognition and classification in AI projects due to the diverse visual presentations of endometriosis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 &lt;","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"1904-1917"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417725","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":"Longitudinal Doppler assessment and perinatal outcomes in early-set intrauterine growth restriction fetuses","authors":"Edurne Mazarico,&nbsp;Eva Meler,&nbsp;Anna Peguero,&nbsp;Edda Marimon,&nbsp;Núria Prat,&nbsp;David Boada,&nbsp;Alba González,&nbsp;Ana Contreras,&nbsp;Claudia Pumarola,&nbsp;M. Dolores Gomez-Roig,&nbsp;Francesc Figueras","doi":"10.1111/aogs.70246","DOIUrl":"10.1111/aogs.70246","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The objective of this study is to evaluate, in fetuses with early-onset fetal growth-restricted (FGR) requiring delivery before 30 weeks, the relationship between the longitudinal Doppler changes and severe morbidity and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A retrospective cohort was constructed of singleton pregnancies between January 2013 and December 2021 with antenatal suspicion of FGR, born before 30 weeks in a single tertiary center in Barcelona (Hospital Sant Joan de Déu and Hospital Clínic). A total of 103 cases of FGR fetuses were included. Accurate anatomical examination, fetal biometry, and prenatal Doppler ultrasound examination were performed by experienced operators. The association between the intervals from diagnosis to abnormal Doppler and severe adverse outcome was evaluated with Cox and logistic regression, adjusted for gestational age at onset and preeclampsia. The primary outcome was a composite of severe adverse outcomes defined as mortality or severe neurological morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 83 pregnancies with ductus venosus (DV) pulsatility index (PI) ≤95th centile at admission, the median time to a DV PI &gt;95th centile was 16 days in pregnancies presenting severe adverse outcomes and 20 days in those without (<i>p</i> = 0.007). Among the 64 pregnancies with a positive umbilical artery (UA) end-diastolic velocity (EDV), the median time to be absent/reversed was 11 days in pregnancies presenting severe adverse outcome and 14 days in those without (<i>p</i> = 0.016). Among the 86 pregnancies with nonreversed UA EDV, the median time to reversed flow was 18 days in pregnancies destined to present severe outcomes and 26 days in those without (<i>p</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The prediction of mortality or severe morbidity could be better achieved with longitudinal Doppler assessment in FGR fetuses born before 30 weeks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"1965-1973"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13434498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668115","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":"Social reintegration of women after obstetric fistula surgery: Evidence from a longitudinal multilevel mixed-effects study in Zambia","authors":"Sianga Mutola,&nbsp;Bwalya Magawa Chomba,&nbsp;Nawi Ng,&nbsp;Menda M. Dhally,&nbsp;Valérie R. Louis,&nbsp;Lowery Wilson Michael","doi":"10.1111/aogs.70296","DOIUrl":"10.1111/aogs.70296","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;Obstetric fistula remains a persistent maternal health challenge in sub-Saharan Africa, severely impairing women's physical, social, and psychological well-being. Although surgical repair restores continence, less is known about the factors influencing women's social reintegration after treatment. This study examined the association of continence status and follow-up time on social reintegration among women who underwent obstetric fistula repair in Zambia.&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 prospective cohort study included 2172 women who underwent fistula repair between 2017 and 2023 at eight hospitals across Zambia. Multilevel mixed-effects models were used to assess the effects of continence and follow-up time on a composite social reintegration score (0–100), derived from the five domains using principal component factor analysis (eigenvalue = 4.02) and demonstrating internal consistency (Cronbach's α = 0.94), while adjusting for baseline covariates.&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;Among all participants, 86.3% achieved continence, whereas 13.7% remained incontinent at discharge. The null model yielded negligible between-patient variance (intraclass correlation coefficient, ICC &lt;0.001). In the fully adjusted model, continent women had higher reintegration scores than their incontinent counterparts (&lt;i&gt;β&lt;/i&gt; = 38.62; 95% CI: 36.10–41.14). Social reintegration improved substantially within the first 3 months after surgery (&lt;i&gt;β&lt;/i&gt; = 10.83; 95% CI: 8.23–13.43), and remained stable at 6 months (&lt;i&gt;β&lt;/i&gt; = 9.34; 95% CI: 6.70–11.98), and 12 months (&lt;i&gt;β&lt;/i&gt; = 9.66; 95% CI: 6.97–12.34). Interaction analyses indicated that although continent women consistently reported higher social reintegration scores, the difference between continent and incontinent women narrowed over time, reflecting gradual improvements in social reintegration among incontinent women (&lt;i&gt;β&lt;/i&gt; = −4.85; 95% CI: −6.30 to −3.40).&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;Restoration of continence was the strongest predictor of improved social reintegration following fistula repair. However, the largest social reintegration improvement was observed among incontinent women within the first 3 months after surgery. These findings highlight the importance of combining high-quality surgical care with structured early postoperative follow-up and reintegration support to sustain recovery among women affected by obstetric fistula, regardless of the surgical repair outcome.&lt;/p&gt;\u0000 &lt;/se","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"2048-2059"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306714","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":"Prenatal exome sequencing of fetuses with central nervous system anomalies based on prenatal ultrasound and magnetic resonance imaging diagnosis: A retrospective cohort study with a systematic review and meta-analysis","authors":"Jia Yao,&nbsp;Yan Wang,&nbsp;Gang Li,&nbsp;Zhitao Zhang,&nbsp;Yuan Lv,&nbsp;Lizhu Chen","doi":"10.1111/aogs.70297","DOIUrl":"10.1111/aogs.70297","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Fetal central nervous system (CNS) abnormalities have diverse etiologies, with genetic factors as a major contributor. Prenatal exome sequencing (ES) is a powerful tool for precise molecular diagnosis of CNS anomalies, but its diagnostic yield varies among studies. This study aimed to evaluate the additional diagnostic yield of prenatal ES compared with chromosomal microarray analysis (CMA) in fetuses with CNS anomalies detected by prenatal imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We collected ES results from fetuses diagnosed with CNS anomalies by prenatal imaging (2019–2024) who had negative results. Subgroup analyses assessed phenotype-specific ES diagnostic yield for associated genes and variants. A systematic review and meta-analysis incorporating our data and published studies further explored the association between phenotype and diagnostic yield.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the cohort study of 219 cases, ES identified pathogenic/likely pathogenic single nucleotide variations in 36 cases (16%). The highest diagnostic yield of ES was in cases with multisystem malformations (25%, 14/55), followed by multiple CNS anomalies (15%, 2/13) and isolated CNS anomalies (13%, 20/151). The most commonly identified isolated CNS anomaly was agenesis of the corpus callosum (31%, 5/16). Neural tube defects with urogenital anomalies were associated with a positive ES finding in 57% (4/7) of cases. The meta-analysis of 989 cases from 22 studies showed a pooled diagnostic yield of ES of 27% (95% CI, 21%–34%). The highest diagnostic yield of ES was in cases of corpus callosum anomalies with facial abnormalities (75%, 8/11) and neural tube defects with urogenital malformations (80%, 12/15). The diagnostic yield of ES for three or more CNS abnormalities was 43% (95% CI, 31%–58%), significantly higher than that for only two abnormalities (10%, 95% CI, 4%–18%). No significant difference in diagnostic yield was found between cases identified by prenatal MRI combined with ultrasound (27%, 95% CI, 20%–36%) and those identified by ultrasound alone (25%, 95% CI, 17%–35%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ES provided a significantly higher diagnostic yield than CMA for fetal CNS abnormalities, with diagnostic yields varying by phenotype. The systematic review and meta-analysis confirmed that the complexity and combination of malformations are key factors associated with differences in ES diagnostic yield.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"1950-1964"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366582","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":"Loss to follow-up in patients diagnosed with or treated for low- and high-grade squamous intraepithelial lesions: A comparison of general practitioner- and gynecologist-led surveillance","authors":"Lieke van de Kam,&nbsp;Albert Siebers,&nbsp;Ruud Bekkers,&nbsp;Dennis van Hamont,&nbsp;Jurgen Piek","doi":"10.1111/aogs.70301","DOIUrl":"10.1111/aogs.70301","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cervical carcinoma can be prevented by treating precancerous lesions, which are classified as low-grade (LSIL) and high-grade (HSIL) squamous intraepithelial lesions. Follow-up of patients diagnosed with LSIL or treated HSIL is typically conducted in secondary care by a gynecologist. However, this may also be conducted in a primary care setting at the general practitioner. This latter approach offers potential benefits such as lower healthcare costs and care closer to home. However, the effectiveness of follow-up by general practitioners is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included patients diagnosed with LSIL or treated HSIL by the gynecologist, with no prior history of SIL or cervical cancer, who either underwent cytological follow-up at the gynecologist or the general practitioner. The primary outcome was loss to follow-up at 12 months for LSIL and 24 months for treated HSIL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 691 patients were followed up by the gynecologist, and 1172 by the general practitioner. In the LSIL group, 38.1% (333/874) of patients followed up by a general practitioner were lost to follow-up at 12 months, compared with 16.6% (92/554) of those followed up by a gynecologist (<i>p</i> &lt; 0.001). For treated HSIL, 44.3% (132/298) were lost to follow-up at 24 months in the general practitioner group, versus 24.1% (33/137) in the gynecologist group (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Follow-up by a general practitioner after a diagnosis of LSIL or treated HSIL is associated with nearly twice the rate of loss to follow-up compared to follow-up by a gynecologist.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"2081-2088"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547675","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":"Uterus-preserving surgery for placenta accreta spectrum: An expert, illustrated review of techniques and its outcomes","authors":"Pedro Viana Pinto,&nbsp;Albaro José Nieto-Calvache,&nbsp;Rafael José Vieira,&nbsp;Abdalla Mousa,&nbsp;Hooman Soleymani majd,&nbsp;Rozi Aditya Aryananda,&nbsp;José Miguel Palacios-Jaraquemada","doi":"10.1111/aogs.70291","DOIUrl":"10.1111/aogs.70291","url":null,"abstract":"<p>Placenta accreta spectrum (PAS) disorders are associated with substantial maternal morbidity and remain one of the most challenging conditions in modern obstetrics. Although cesarean hysterectomy with the placenta left in situ is widely regarded as the standard treatment, uterus-preserving surgical strategies have emerged as viable alternatives in carefully selected cases managed in specialized centers. Building on our recently published systematic review and meta-analysis, this expert-illustrated review provides a comprehensive and critical appraisal of conservative surgical approaches for PAS, with a particular focus on operative techniques, patient selection, and short- and long-term outcomes. We clearly differentiate two fundamentally distinct conservative strategies: myometrial resection techniques and leaving the placenta in situ. For each approach, we synthesize current evidence, describe procedural nuances, highlight technical prerequisites, and discuss expected intraoperative and delayed complications. The most commonly performed myometrial resection techniques—including one-step conservative surgery, the Triple-P procedure, and the Kasr Alainy technique—are detailed step-by-step and illustrated to emphasize key surgical principles. Expectant management with the placenta left in situ is also reviewed, with particular attention to indications, postoperative surveillance, delayed morbidity, and fertility outcomes. Data from 50 studies encompassing 2659 patients undergoing myometrial resection and 552 managed with the placenta left in situ are integrated to contextualize reported outcomes and failure rates. This expert review aims to support clinical decision-making by clarifying the indications, limitations, and risks of conservative PAS management. We argue that uterus-preserving strategies can be safely and effectively implemented in selected patients when performed by experienced multidisciplinary teams, while emphasizing that readiness to convert to hysterectomy remains essential. By distinguishing techniques and aligning them with patient-specific factors, this review provides practical guidance for maternal–fetal medicine specialists managing PAS in contemporary clinical practice.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"1932-1949"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429527","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":"Disparities in antenatal care utilization and stillbirth risk among women of other origin than high-income Western countries in Stockholm 2000–2020: A retrospective cohort study","authors":"Minna Lundén,&nbsp;Ingela Hulthén Varli,&nbsp;Helena Kopp Kallner,&nbsp;Hanna Åmark","doi":"10.1111/aogs.70310","DOIUrl":"10.1111/aogs.70310","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;Foreign-born women face a higher risk of adverse pregnancy outcomes, including stillbirth, compared to Swedish-born women, and this disparity cannot be fully explained by known risk factors. This study investigates differences in pregnancy-related health care by maternal origin and whether such differences may contribute to disparities in stillbirth risk.&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 was a retrospective cohort study including all singleton births in the Stockholm region between 2000 and 2020 (&lt;i&gt;n&lt;/i&gt; = 518 792 births). Data from the National Medical Birth Register was linked to data from Statistics Sweden and the VAL databases using the personal identity number of the mother. Maternal and fetal characteristics, inpatient care occasions, length of hospital stay, outpatient visits, and antenatal care visits were compared between women divided by maternal origin, experiencing live births, and stillbirths. Regression models using a forward selection strategy were performed, adjusting for different potential mediators on the causal pathway from maternal country of origin to stillbirth.&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;Among women with live births, those originating from Middle East/Northern Africa, sub-Saharan Africa, and South America had significantly higher proportions of inpatient care occasions than women originating from high-income Western Countries. Women with live births originating from other regions than high-income Western Countries had significantly less antenatal care visits, regardless of parity. Among women with stillbirths, women originating from sub-Saharan Africa had significantly more inpatient care occasions and fewer antenatal care visits than women originating from high-income Western Countries. After adjusting for maternal risk factors, SGA infants, socioeconomic factors, multiple inpatient care occasions, and few antenatal care visits during pregnancy, women from sub-Saharan Africa had a slightly elevated risk of stillbirth (aOR 1.29, 95% CI 1.00–1.66, &lt;i&gt;p&lt;/i&gt;-value 0.047) compared to women from high-income Western Countries.&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;Women originating from other regions than high-income Western Countries, especially those from sub-Saharan Africa, attended fewer antenatal care visits and had more inpatient care occasions compared to women from high-income Western Countries. Reduced attendance in antenatal care could potentially be associated with their elevated stillbirth risk. Improving access to ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"2030-2040"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519792","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":"Beyond the symptoms: Helping without Medicalizing","authors":"Sebastian Gidlöf","doi":"10.1111/aogs.70351","DOIUrl":"10.1111/aogs.70351","url":null,"abstract":"&lt;p&gt;Medicine is built on recognizing disease. Yet one of the most important and perhaps most overlooked skills in obstetrics and gynecology is to recognize what is &lt;i&gt;not&lt;/i&gt; a sign of disease.&lt;/p&gt;&lt;p&gt;Almost every consultation starts with a symptom, but it is not always the symptom that brings the patient to our clinic.&lt;/p&gt;&lt;p&gt;A pregnant woman with nausea may really be concerned whether her baby is well. Perhaps she is not at all interested in symptom relief as long as she knows her symptoms are not caused by any dangers to herself or her baby.&lt;/p&gt;&lt;p&gt;A young woman with irregular bleeding may be concerned that she may ever become pregnant. She may not be interested in regulating her periods if she is reassured that there are no signs of future infertility.&lt;/p&gt;&lt;p&gt;A woman in her midlife may be seeking an explanation of the changes in her body mean, rather than simply only relief from hot flushes.&lt;/p&gt;&lt;p&gt;Obstetrics and gynecology differ from many other medical specialties in that much of what we encounter reflects normal physiology rather than disease, including puberty, menstruation, pregnancy, and menopause. All of these give rise to symptoms that may vary from minor to debilitating, yet they remain part of healthy human biology.&lt;/p&gt;&lt;p&gt;Recognizing physiology from disease must never mean dismissing suffering. Symptoms arising from normal physiological processes may have a severe impact on quality of life and deserve careful attention, thoughtful management, and, when needed, effective treatment. At the same time, physiology deserves to be recognized as just physiology.&lt;/p&gt;&lt;p&gt;Modern obstetrics and gynecology has revolutionized women's health by extraordinary scientific breakthroughs. When we meet suffering, our basic instinct is to act. We prescribe medication, arrange investigations, and plan follow-up visits. Often, these interventions are exactly what our patients need. But every clinical decision has at least two consequences: the intervention itself and the &lt;i&gt;meaning it conveys&lt;/i&gt;.&lt;/p&gt;&lt;p&gt;Every prescription, every investigation and every follow-up visit communicate something about how we, as doctors, understand the patient's body. Mostly the message is appropriate. But sometimes we may, in our honest will to help, unintentionally reinforce the belief that a normal physiological process is a sign of disease. Our interventions therefore shape not only treatment but also the way patients understand their bodies.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;I recognize this as I have often done so myself. Both earlier in my career, and sometimes still, I have felt that a consultation is not complete if it does not include a prescription, ultrasound, or a blood test. Merely explaining physiology somehow feels like offering less than modern medicine at its best.&lt;/p&gt;&lt;p&gt;Gradually, experience has taught me otherwise. Explanation is not the absence of action. It is a clinical intervention in itself. When built upon thorough clinical assessment and a thoughtful exclusion o","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"1896-1897"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849557","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":"Clinicopathological phenotypes of singleton stillbirth: A retrospective cohort study","authors":"Ragnheidur I. Bjarnadottir,&nbsp;Thora S. Steffensen,&nbsp;Alexander K. Smarason,&nbsp;Karin Pettersson,&nbsp;Nikos Papadogiannakis,&nbsp;Johanna Gunnarsdottir","doi":"10.1111/aogs.70294","DOIUrl":"10.1111/aogs.70294","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Interpreting the histopathology report after stillbirth and applying it to care in a subsequent pregnancy can be challenging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of singleton stillbirths in Iceland 1996–2021 (<i>n</i> = 338). Clinical information and description of placenta and umbilical cord were reviewed, and microscopic slides re-evaluated according to the Amsterdam Consensus. Clinical and histopathological findings, including major patterns of placental injury and umbilical cord at risk, were correlated and compared between gestational age groups: &lt;28 weeks (<i>n</i> = 102), ≥28 but &lt;37 weeks (<i>n</i> = 114), and ≥37 weeks (<i>n</i> = 122).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Placental slides were reviewed for 96.4% (326/338) of singleton stillbirths and classified into major patterns of placental injury. Maternal vascular malperfusion (MVM) was diagnosed in 19.0% of placentas (62/326), fetal vascular malperfusion (FVM) in 31.6% (103/326), acute chorioamnionitis (ACA) in 32.2% (105/326), chronic villitis of unknown etiology (VUE) in 15.9% (52/326), and none of the major patterns in 27.9% (91/326). More than one pattern of placental injury was found in 7.7% of placentas (25/326), most often at term. A similar proportion of MVM was found irrespective of gestational age; FVM was more common after 28 weeks, ACA before 28 weeks, but VUE most frequent at term. A higher proportion of MVM was found in stillbirths with small for gestational age (SGA) infants than non-SGA (23.0 vs. 6.1%), as well as in stillbirths with maternal hypertensive disorder of pregnancy than in stillbirths with a normotensive mother (23.9 vs. 11.8%). The latter association was not seen with high-grade FVM nor VUE. The umbilical cord was at risk in 53.8% (175/326) of singleton stillbirths, increasing with gestational age to 71.7% (86/120) at term. Hypercoiled, excessive long, and wrapped cords were most common. Term stillbirths with cord at risk often also had placental MVM or VUE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Understanding major patterns of placental injury and their correlation with clinical phenotypes can help counseling after stillbirth. Stillbirths with placental MVM often had clinical signs suggesting a high-risk pregnancy. However, term stillbirths with placental VUE or FVM and umbilical cord at risk were commonly without recognized risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"1974-1984"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148325354","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}