Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Social reintegration of women after obstetric fistula surgery: Evidence from a longitudinal multilevel mixed-effects study in Zambia","authors":"Sianga Mutola, Bwalya Magawa Chomba, Nawi Ng, Menda M. Dhally, Valérie R. Louis, Lowery Wilson Michael","doi":"10.1111/aogs.70296","DOIUrl":"10.1111/aogs.70296","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 <0.001). In the fully adjusted model, continent women had higher reintegration scores than their incontinent counterparts (<i>β</i> = 38.62; 95% CI: 36.10–41.14). Social reintegration improved substantially within the first 3 months after surgery (<i>β</i> = 10.83; 95% CI: 8.23–13.43), and remained stable at 6 months (<i>β</i> = 9.34; 95% CI: 6.70–11.98), and 12 months (<i>β</i> = 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 (<i>β</i> = −4.85; 95% CI: −6.30 to −3.40).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </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}

{"title":"Human papillomavirus persistence and clearance in women living with HIV: A five-year retrospective analysis from an Italian university center","authors":"Annunziata Carlea,&nbsp;Dario Colacurci,&nbsp;Giorgia D'Apice,&nbsp;Laura Letizia Mazzarelli,&nbsp;Massimiliano Pellicano,&nbsp;Luigi Falco,&nbsp;Ginevra Sepe,&nbsp;Oriana Imperatore,&nbsp;Giuseppe Maria Maruotti,&nbsp;Maurizio Guida,&nbsp;Laura Sarno","doi":"10.1111/aogs.70299","DOIUrl":"10.1111/aogs.70299","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Human papillomavirus infection is one of the most prevalent sexually transmitted infections worldwide. Women living with HIV are at increased risk of acquiring and developing persistent infection with high-risk HPV genotypes, leading to higher rates of cervical dysplasia and cancer. However, limited data are available regarding the timing and determinants of HPV clearance in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This is a retrospective, single-center study including women living with HIV with confirmed high-risk HPV infection, followed at an Italian university hospital between 2019 and 2024. Clinical, virological, and immunological data were collected, including HIV viral load, CD4+ T-cell count, and adherence to antiretroviral therapy. HPV persistence, clearance, and time to clearance were assessed over a 5-year follow-up period. Statistical analyses were performed using SPSS version 29, with <i>p</i> &lt; 0.05 considered significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-seven women living with HIV were recruited, and fifty-one met the inclusion criteria for analysis. Most participants (92%) were adherent to ART. HR-HPV clearance occurred in 76.5% of patients, with a mean clearance time of 2.08 years. No significant correlation was observed between HPV clearance time and HIV viremia, CD4+ T-cell count, or cytological/colposcopic findings at baseline. However, baseline positivity for the high-risk HPV pool was significantly associated with longer clearance time (<i>p</i> = 0.011).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Women living with HIV showed a high-risk HPV clearance time of approximately 2 years under ART. Our findings suggest that HPV screening every 2 years may represent an appropriate interval in this population, potentially increasing adherence and optimizing healthcare resources. Larger multicenter prospective studies are needed to confirm this observation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"2041-2047"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315080","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":"All-cause mortality after self-reported vs. hospital-reported gynecological surgery: The HUNT study.","authors":"Tina Ellinor Rosland, Nora Johansen, Astrid Helene Liavaag, Bjørn Olav Åsvold, Are Hugo Pripp, Trond Melbye Michelsen","doi":"10.1111/aogs.70354","DOIUrl":"10.1111/aogs.70354","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of hysterectomy and bilateral oophorectomy on future mortality risk is still debated. Self-reported exposure may be a major source of bias in many studies. We aimed to determine mortality following hospital-reported hysterectomy and bilateral oophorectomy and compare to results based on self-reported surgeries.</p><p><strong>Material and methods: </strong>We included 37 140 women from the second (1995-1997) and third (2006-2008) HUNT surveys. HUNT (the Trøndelag Health Study) is a population-based Norwegian cohort study, and we linked to the Norwegian Cause of Death Registry, the Cancer Registry of Norway, and hospital surgical codes. The participants were followed from inclusion in HUNT until December 2020. Women were classified as unexposed, exposed to hysterectomy alone, exposed to bilateral oophorectomy alone, or exposed to both surgeries. Hospital-reported exposure was determined using surgical procedure codes, whereas self-reported exposure was obtained from the HUNT questionnaires. To be classified as exposed based on self-report, a woman had to indicate that she had undergone the surgery and provide her age at the time of the procedure. We compared the hazard of death in unexposed vs. exposed groups using Cox regression analysis, adjusting for relevant covariates.</p><p><strong>Results: </strong>Compared with unexposed women, hospital-reported hysterectomy was associated with a reduced hazard of death (HR 0.72 [95% CI 0.62-0.84]), while self-reported hysterectomy showed no association (HR 1.06 [95% CI 0.97-1.16]). For bilateral oophorectomy, hospital-reported cases showed an HR of 0.83 (95% CI 0.64-1.07), while self-reported cases indicated an HR of 1.14 (95% CI 0.97-1.33). Women who had both hysterectomy and bilateral oophorectomy demonstrated no significant association with mortality, regardless of whether the surgeries were hospital-reported (HR 1.13 [95% CI 0.96-1.34]) or self-reported (0.93 [95% CI 0.82-1.06]). Early hospital-reported bilateral oophorectomy was associated with an increased hazard of death, particularly when performed before the age of 50.</p><p><strong>Conclusions: </strong>Results differed between hospital-reported and self-reported exposure. This could explain the heterogeneity observed in previous studies on mortality risk after hysterectomy and oophorectomy. In this study, hospital-reported hysterectomy and bilateral oophorectomy were not associated with increased mortality, whereas early bilateral oophorectomy was.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975289","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":"Abortion—A brief description of the evolution of methods","authors":"Laura Slade,&nbsp;Andrea Deussen,&nbsp;Jodie Dodd","doi":"10.1111/aogs.70282","DOIUrl":"10.1111/aogs.70282","url":null,"abstract":"<p>Throughout history, women across the world have undergone abortion. This is despite a variety of religious and legal oppositions that remain present in many countries today. Procedures for abortion have evolved considerably and now include safe and effective methods, and access has improved in many settings. There are however many individuals across the world living in environments with restricted access to safe methods because of legal, logistical and social barriers. We discuss a brief history of methods used to terminate pregnancy in the first and second trimesters of pregnancy.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 10","pages":"1898-1903"},"PeriodicalIF":3.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148617904","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}