Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Uterine volume assay after gonadotoxic therapies in childhood, adolescence, and young adulthood: A systematic review and Bayesian network meta-analysis","authors":"Eloïse Fraison,&nbsp;Stephanie Huberlant,&nbsp;Mathilde Cavalieri,&nbsp;Aurore Gueniffey,&nbsp;Justine Riss,&nbsp;Christine Rousset-Jablonski,&nbsp;Blandine Courbiere","doi":"10.1111/aogs.70003","DOIUrl":"10.1111/aogs.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Uterine damage after pelvic radiotherapy or total-body irradiation is well described, with decreased uterine volume and high obstetrical morbidity. Some recent studies have reported a smaller uterus in child, adolescent, and young adult cancer survivors treated with chemotherapy only. This systematic review investigated the long-term effects of gonadotoxic therapy on uterine volume during childhood, adolescence, and young adulthood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Data sources were Medline, Embase, and the Cochrane Library databases from 1990 to April 2023 searched using the following search terms: cancer survivors, bone marrow transplantation, chemotherapy, radiotherapy, and uterine volume. Study selection and synthesis: Only comparative studies reporting uterine volume in adult women who had received chemotherapy and/or radiotherapy during childhood, adolescence, or young adulthood (&lt;25 years) were included. Two independent reviewers performed study selection, bias assessment using the ROBINS-I tool, and data extraction. The main outcome was uterine volume (mL). A Bayesian network meta-analysis with meta-regression for parity and serious risk of bias was performed using a random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After reviewing 2847 abstracts, four studies were selected for the meta-analysis. Uterine volume data were available for 225 women after chemotherapy, 153 women after chemoradiotherapy, and 257 control women without cancer. Uterine volume was significantly lower in the chemoradiotherapy group than in the control group (−29.2 mL [−49.1, −12.5]). Uterine volume was significantly decreased in the chemoradiotherapy group compared to the chemotherapy group (−20.9 mL [−39.1, −0.3]). The difference in the mean uterine volume between the control and chemotherapy groups was 8.2 mL [−11.8, 34.2] and was not significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our meta-analysis confirms the well-known data on chemoradiotherapy-induced uterine damage. Although some studies have suggested the potential impact of high doses of chemotherapy on uterine volume, this meta-analysis did not find any significant decrease in uterine volume after chemotherapy. This result could help counsel age-reproductive women and physicians who perform assisted reproductive technologies in long-term CAYA Cancer survivors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 9","pages":"1616-1626"},"PeriodicalIF":3.1,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482854","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":"Reconsidering the association between maternal Crohn's disease and offspring psychiatric outcomes","authors":"Muhammad Armaghan Akhlaq,&nbsp;Hooria Ejaz,&nbsp;Mavia Habib,&nbsp;Malik Abdullah Rasheed,&nbsp;Mirza M. Hadeed Khawar","doi":"10.1111/aogs.70009","DOIUrl":"10.1111/aogs.70009","url":null,"abstract":"&lt;p&gt;I am writing to express concerns regarding the conclusions of the article by Skott et al., titled “Offspring exposure to Crohn's disease during pregnancy and association with psychiatric regulatory disturbances in childhood,” published in your esteemed journal.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; While the study provides valuable insights into the potential impacts of maternal Crohn's disease (CD) on offspring psychiatric health, several critical issues challenge the robustness of its conclusions.&lt;/p&gt;&lt;p&gt;The confounding influence of maternal use of medication may not have been completely adjusted in the study, especially corticosteroids. The standard treatment of CD exacerbations is corticosteroids, which have been shown to cross the placenta and have been linked to an elevated risk of mental and behavioral disorders in children.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Even though Skott et al. controlled anti-CD drugs, the exact effect of corticosteroids might not have been sufficiently separated, and the observed relationships might be overstated.&lt;/p&gt;&lt;p&gt;The literature is characterized by significant inconsistency when it comes to the relationship between maternal CD and the particular psychiatric conditions in offspring. According to Skott et al., there is no collaboration with autism spectrum disorders (ASD), but a recent study in Nature Medicine discovered a correlation between parental inflammatory bowel disease (IBD) and childhood autism.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; This inconsistency unlocks the possibility that genetic mechanisms are at work, rather than in-utero exposure, making it difficult to render a causal conclusion as done by Skott et al.&lt;/p&gt;&lt;p&gt;Genetic overlap between neuropsychiatric diseases and IBD has been thoroughly established. That statement is strongly supported by a 2023 genome-wide association study (GWAS) published in Med.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; In this investigation, which was conducted as a part of the Human Phenotype Project, the analysis of more than 8700 individuals revealed strong associations between Crohn's disease (CD) polygenic risk scores (PRS) and genes related to sleep regulation, feeding behavior, and metabolic properties. Interestingly, some of the CD-risk loci were shared with genes that control circadian rhythm, appetite, and hypothalamic signaling pathways—implicating a common genetic basis between immune dysregulation and neurobehavioral phenotypes. The fact that the authors did not control the psychiatric histories of parents or the genetic information of offspring makes it possible that the observed relationships may be due to inherited vulnerability as opposed to prenatal exposure.&lt;/p&gt;&lt;p&gt;Other cohort studies have reported no increased risk of long-term morbidities in the offspring of mothers with IBD. For instance, Jølving et al. (2017) found no elevated risk for various diseases.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Although these studies may not have specifically targeted the same psychiatric outcomes, they collectively question the g","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":"2015-2016"},"PeriodicalIF":3.1,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482833","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":"First birth and total fertility rate in women with surgically verified endometriosis – A nationwide register study of 18 320 women across reproductive life course","authors":"Anni Tuominen,&nbsp;Liisu Saavalainen,&nbsp;Juuso Saavalainen,&nbsp;Maarit Niinimäki,&nbsp;Mika Gissler,&nbsp;Päivi Härkki,&nbsp;Oskari Heikinheimo","doi":"10.1111/aogs.70001","DOIUrl":"10.1111/aogs.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Endometriosis is associated with pain and infertility. However, little is known about birth rate among women with endometriosis on population level. We studied whether women with endometriosis have lower birth rate than women in the general population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This historical population-based cohort study used data from 18 320 fertile-aged women with first surgical verification of endometriosis in 1998–2012. Women with endometriosis were further divided into sub-cohorts: women with solely peritoneal (<i>n</i> = 5786), ovarian (<i>n</i> = 6519) and deep endometriosis (<i>n</i> = 1267). Women with combined types and rare forms of endometriosis formed a sub-cohort of combined/other endometriosis (<i>n</i> = 4748). The reference cohort comprised 35 788 women. The follow-up started at the age of 15 years and ended at first birth, sterilization/bilateral oophorectomy/hysterectomy, emigration, death, age of 50 years, or December 31, 2019. From Kaplan–Meier survival curves of not giving birth, that is, until the first birth, we assessed the statistical difference of first births with crude and adjusted restricted mean survival time (RMST). In addition, we studied the fertility rate of women until the end of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 12 491 (68.2%) women with endometriosis compared with 28 871 (80.7%) reference women gave birth during follow-up. Women with peritoneal and deep endometriosis had higher first birth rate (73.1% and 71.3%) compared with women with ovarian and combined/other forms of endometriosis (65.2% and 65.5%) (<i>p</i> &lt; 0.001). The RMST of not giving birth was longer in women with endometriosis 18.9 (18.8–19.0) years compared with the reference cohort 15.5 (15.4–15.6) with both crude and adjusted RMST difference (<i>p</i> &lt; 0.001). Moreover, each sub-cohort showed a longer RMST of not giving birth than reference cohort (<i>p</i> &lt; 0.001)<i>.</i> Total fertility rate of women was 1.33 (SD 1.16) in the endometriosis and 1.89 (1.46) in the reference cohort (<i>p</i> &lt; 0.001) with smaller differences among endometriosis sub-cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings suggest that fertility outcome is compromised depending on the endometriosis subtype. Thus, timely diagnosis and appropriate treatment might be beneficial for fertility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 9","pages":"1652-1664"},"PeriodicalIF":3.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332274","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":"Unassisted home births in Norway: A growing concern","authors":"Solveig Bjellmo,&nbsp;Johanne Kolvik Iversen","doi":"10.1111/aogs.15179","DOIUrl":"10.1111/aogs.15179","url":null,"abstract":"&lt;p&gt;Norway has one of the world's lowest maternal and perinatal mortality rates. Cesarean section and operative vaginal delivery rates remain stable, even as induction rates have doubled from 2009 to 2023.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; These outcomes reflect a high-quality maternity care system. Yet, a troubling trend has emerged: the number of planned unassisted home births increased from a total of 20 between 2020 and 2023 to 21 cases in 2024 alone.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;This raises critical questions. Why are some women opting out of a system known for its safety and comprehensive care? Reports suggest factors such as perceived lack of emotional support, previous negative experiences, and a desire for autonomy during childbirth. Some women report feeling traumatized or violated by hospital births, leading to profound mistrust in the system.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;A survey conducted for the Norwegian Broadcasting Corporation (NRK) found that 1 in 10 Norwegians aged 18–39 believe unassisted home birth is safe, and a further 18% were unsure.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; This stands in stark contrast to medical evidence: perinatal mortality is estimated to be three times higher, and maternal mortality up to 100 times higher with unassisted birth.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; These numbers reveal a serious information gap, one that must be addressed urgently to prevent misinformation from putting lives at risk.&lt;/p&gt;&lt;p&gt;Global data are sobering. According to the WHO, approximately 800 women die every day from preventable pregnancy and childbirth-related causes, roughly one every two minutes.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; While these numbers primarily reflect countries without organized prenatal care and access to safe delivery facilities, they serve as a chilling reminder: childbirth is inherently risky. Norway's excellent outcomes are the result of decades of structured, evidence-based care.&lt;/p&gt;&lt;p&gt;Presenting statistics is not meant to invoke fear, but to promote an evidence- based understanding of risks. So-called “freebirth” activists in Norway have countered by asserting that “statistics and science is not the most important.”&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Healthcare professionals, including obstetricians and midwives, find this development deeply troubling. The associated risk became tragically clear in 2024, when a newborn died following an unassisted home birth in Norway. The subsequent public debate included inflammatory accusations, including labeling midwives rapists.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; The emotional toll on providers is significant, and there is growing concern about the future of the profession.&lt;/p&gt;&lt;p&gt;The debate touches on longstanding ethical dilemmas at the intersection of maternal autonomy and fetal rights. A recent commentary in &lt;i&gt;Aftenposten&lt;/i&gt; by two legal experts and a pediatrician highlights the lack of legal clarity on when a fetus acquires independent rights, especially during labor.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; While Norwegian","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1418-1419"},"PeriodicalIF":3.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324140","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":"Lack of consensus in calculation of interval cancer rates for cervical cancer screening","authors":"Patricia Fitzpatrick,&nbsp;Therese Mooney,&nbsp;Yvonne Williams,&nbsp;Caroline Mason Mohan,&nbsp;Jesper Bonde,&nbsp;Julia Gao,&nbsp;Andrzej Nowakowski,&nbsp;Annemie Haelens,&nbsp;Urska Ivanus,&nbsp;Maiju Pankakoski,&nbsp;Tina Karapetyan,&nbsp;Noirin E. Russell","doi":"10.1111/aogs.15172","DOIUrl":"10.1111/aogs.15172","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In 2018, nondisclosure of results of retrospective audits of cytology in interval cancers precipitated a crisis in the Irish national cervical screening programme. In response, an Expert Reference Group was convened which recommended a collaborative approach to the development of a new key performance indicator, the interval cancer rate. The Expert Reference Group also recommended that the Irish programme should collaborate with international colleagues to reach consensus on (i) the definition of an interval cervical cancer, (ii) the methodology to calculate the interval cancer rate, and (iii) benchmarking with other international programs. This study was undertaken to determine if a consensus regarding the definition of an interval cervical cancer and the calculation of an interval cancer rate exists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A web-based questionnaire was sent to 18 population-based cervical screening programs. Inclusion criteria involved (1) a national or regional population-based cervical screening prograe; (2) a country or region with a population ≥population of Ireland; (3) programs located in Europe, Australia, or Canada; (4) programs that had responded to a previously published international survey on the disclosure of retrospective cytology reviews in cervical cancer cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The response rate was nine out of 18. Of nine respondents, six had an agreed definition of interval cervical cancer, and four of these calculated an interval cancer rate. Three programs neither calculated interval cancer rates nor had any guidelines related to this. Of the six with an agreed definition, all respondents defined the numerator as invasive cancers in the screening age group, with four including microinvasive disease. Respondents included cancers diagnosed 3–5 years after the last screening test had been taken. Three respondents also included cancers diagnosed in women up to 3.5 years after they exited the screening program. Countries use different denominators, including (i) per women years, (ii) per number of screens, and (iii) per total cancers in screened population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There is variation in the parameters used in interval cancer rate calculation. To allow benchmarking of cervical screening program performance, there is a need for consensus on a standardized method of interval cancer definition and interval cancer rate calculation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 9","pages":"1705-1711"},"PeriodicalIF":3.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300939","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":"Cross-sectional and longitudinal metabolomics-based profiles associated with oral contraceptive and progestin-only pill use: A Finnish population-based study","authors":"Elena Toffol,&nbsp;Jari Haukka,&nbsp;Pekka Jousilahti,&nbsp;Lara Lehtoranta,&nbsp;Anni Joensuu,&nbsp;Timo Partonen,&nbsp;Iris Erlund,&nbsp;Oskari Heikinheimo","doi":"10.1111/aogs.15176","DOIUrl":"10.1111/aogs.15176","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;The use of combined oral contraceptives (COCs), but not of progestin-only pills (POPs) is associated with an increased risk of cardiovascular events. A detailed examination of how different oral contraceptives impact the metabolism in the short- and long-term has not been conducted. This study comparatively examines cross-sectional and longitudinal metabolomics-based profiles of different COCs and POPs, and explores how they perform relative to a metabolically safer contraceptive option.&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;Data were obtained from a population-based survey (Health 2000) and its 11-year follow-up (Health 2011). Altogether, 212 metabolic measures in OC users (&lt;i&gt;n&lt;/i&gt; = 299; COC, &lt;i&gt;n&lt;/i&gt; = 245; POP, &lt;i&gt;n&lt;/i&gt; = 33) were compared to those in non-users of hormonal contraception (HC; &lt;i&gt;n&lt;/i&gt; = 1422), and in users of a levonorgestrel intrauterine device (LNG-IUD; &lt;i&gt;n&lt;/i&gt; = 341) via multivariable general estimating equations models adjusted for age, body mass index, duration of use, study cohort, diseases, medication use, alcohol use, smoking, and physical activity. Participants with complete longitudinal information (&lt;i&gt;n&lt;/i&gt; = 327) were divided into continuers, stoppers, starters, switchers, and never-user groups, and the 11-year changes in the levels of each metabolite were compared.&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;Use of COCs, but not of POPs, was associated with altered levels of several metabolic measures compared to HC non-use or to use of LNG-IUD: higher concentrations and ratios of monounsaturated fatty acids but lower ratios of polyunsaturated fatty acids, and higher concentrations and ratios of triglycerides in lipoproteins. Additionally, in comparison to HC non-use or to use of LNG-IUD, users of third generation or other COCs had higher levels of inflammation markers and of cholesterol, but a lower percentage of cholesterol and a higher percentage of triglycerides in lipoproteins. Continuation or starting of LNG-IUD was not related to changes in metabolic profiles, while women who changed or stopped using COCs had greater levels of unsaturation and lower levels of total and lipoprotein triglycerides and other lipids.&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 use of COCs, especially of third generation and other COCs, is related to various metabolic alterations suggestive of increased cardiovascular risk. Conversely, the use of POPs and LNG-IUD appeared metabolically safe. These associations were mostly reversible after interruption of u","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 9","pages":"1640-1651"},"PeriodicalIF":3.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15176","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273851","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 and safety of laparoscopic lateral suspension with mesh for pelvic organ prolapse: A systematic review and meta-analysis","authors":"Qi Wang,&nbsp;Stefano Manodoro,&nbsp;Xiaoxiang Jiang,&nbsp;Chaoqin Lin","doi":"10.1111/aogs.15170","DOIUrl":"10.1111/aogs.15170","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Laparoscopic lateral suspension (LLS) with mesh is an alternative treatment for pelvic organ prolapse, offering enhanced apical vaginal suspension. This review aims to comprehensively evaluate the efficacy and safety of LLS for the treatment of pelvic organ prolapse through systematic review and meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Original studies including randomized controlled trials, prospective, or retrospective studies reporting outcomes on the efficacy and safety of LLS with mesh for pelvic organ prolapse were retrieved from PubMed and Web of Science up to November 30, 2024. Case reports, reviews, and non-English literature were excluded. Primary outcomes included anatomical and subjective success rates. Secondary outcomes were recurrence rates, reoperation rates, and complications. Random-effects meta-analysis was performed where appropriate. This study has been registered in PROSPERO with the registration number CRD42024620632.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen studies (3 randomized controlled trials, 9 prospective studies, and 6 retrospective studies) involving 1430 LLS patients with a mean follow-up of 20.27 months were included. The pooled anatomical success rates for the apical and anterior compartments were 92.9% (95% confidence interval [CI]: 89.8–95.1) and 86.9% (95% CI: 81.4–90.9), respectively. The subjective success rate was 88.9% (95% CI: 85.3–91.7). The pooled recurrence rate was 9.6% (95% CI: 7.0–13.2), and the reoperation rate was 6.2% (95% CI: 4.3–8.9). Overall complication and mesh-related complication rates were 5.7% (95% CI: 3.4–9.4) and 1.9% (95% CI: 1.0–3.8), respectively. The incidence of Clavien-Dindo grade ≥3 complications was only 1.9% (16/848).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LLS demonstrates favorable anatomical and subjective success rates, indicating its reliability and safety for pelvic organ prolapse treatment. However, longer follow-up is needed to validate its long-term efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 9","pages":"1603-1615"},"PeriodicalIF":3.1,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15170","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265030","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":"Offspring exposure to Crohn's disease during pregnancy and association with milder psychiatric regulatory disturbances in childhood","authors":"Elin Skott,&nbsp;Gustav Söderberg,&nbsp;MaiBritt Giacobini,&nbsp;Samson Nivins,&nbsp;Xinxia Chen,&nbsp;Daniel Lindqvist,&nbsp;Mika Gissler,&nbsp;Klas Sjöberg,&nbsp;Catharina Lavebratt","doi":"10.1111/aogs.15167","DOIUrl":"10.1111/aogs.15167","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Prenatal exposure to inflammatory states has been suggested to influence offspring neurodevelopment. The aim was to investigate if offspring exposure to maternal Inflammatory bowel disorder (IBD), or specifically the IBD disorder Crohn's disease, during gestation is associated with neurodevelopmental or psychiatric disorders in childhood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a population-based registry study in Finland. All live births from 1996 until 2014 in Finland were included and followed up until December 2018. Exposure was maternal IBD or Crohn's disease. Outcome was a broad range of neurodevelopmental and psychiatric disorders in offspring. Cox proportional hazards regression was applied to assess association. Sensitivity analyses included assessing, for example, exposure to severe episode of IBD or Crohn's disease, the outcome psychotropic medication for the children, and influence from perinatal risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the participants (<i>N</i> = 1 105 997), 0.55% (<i>N</i> = 6067) were exposed to maternal IBD 0.18% (<i>N</i> = 1959) to maternal Crohn's disease. Among the children exposed to IBD or the subgroup Crohn's disease, 6.3% or 7.3%, respectively, had received an outcome diagnosis during the follow-up. There were higher risks for Sleeping disorders HR = 1.77 (95% CI, 1.13–2.78), Other feeding disorders HR = 1.83 (95% CI, 1.19, 2.19), and Incontinence HR = 1.42 (95% CI, 1.02–1.97) in children exposed to maternal Crohn's disease compared to unexposed children. This was supported by even higher point risk estimates for Incontinence HR = 2.43 (95% CI, 1.34–4.38) and Other feeding disorders HR = 2.83 (95% CI, 1.35–5.91) in offspring where the mother was hospitalized for Crohn's disease during pregnancy. Furthermore, there was a higher risk of dispensed antipsychotic, anxiolytic, hypnotic, and/or sedative medications for children with maternal Crohn's disease HR = 1.38 (95% CI, 1.03–1.85). These associations were not explained by cesarean section, preterm birth, or small birth size.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Offspring exposed to maternal Crohn's disease during pregnancy had modestly higher risks of early sleeping, continence, and feeding disturbances. The exposure had no detectable association with any of the other psychiatric disorders studied.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1463-1474"},"PeriodicalIF":3.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257080","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":"Balancing harm and benefit for induction of labor at 41 weeks: Slow acting is the problem","authors":"Anita C. J. Ravelli,&nbsp;Joris A. M. van der Post,&nbsp;Christianne J. M. de Groot,&nbsp;Ameen Abu-Hanna,&nbsp;Martine Eskes","doi":"10.1111/aogs.15173","DOIUrl":"10.1111/aogs.15173","url":null,"abstract":"&lt;p&gt;We thank Seijmonsbergen-Schermers et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; for their interest in and comments on our paper from 2023 in AOGS.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; We acknowledge their observation about overestimating perinatal death risk with expectant management at 41 weeks of gestational age, as we pointed out in the discussion section of our article.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; In the Dutch perinatal registry, there is no information on the date and time of the antepartum death and no information on a possible planned induction date. Therefore, we made an informed choice about dealing with the inability to distinguish between antepartum and peripartum death for expectant management when IUFD is first detected after spontaneous labor had started, as was reported.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Obviously, we support that information from studies on induction at 41 weeks, like for instance,&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; and our study,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; should be included in systematic reviews to make the evidence more accessible to health care providers and pregnant women.&lt;/p&gt;&lt;p&gt;In obstetrics, weighing the value of possible gain and associated loss in advance is a difficult task for pregnant women and their caregivers, and a gestational age of 41 weeks is only a weak predictor of harm. ‘Gain and loss’ differ between nulliparous and parous women, and between countries like Sweden and the Netherlands, where induction takes place in the hospital and home delivery is part of a perinatal care system for spontaneous labor in healthy pregnant women.&lt;/p&gt;&lt;p&gt;Whether a certain number needed to treat or harm (NNT/NNH) is an important factor for a woman to choose for induction is a matter of debate. The range for NNT to prevent perinatal death in uncomplicated pregnancy at 41 weeks will indeed be somewhere between 326 and 1830, or slightly higher. From a clinical perspective, an NNT exceeding 300 may reasonably justify recommending labor induction. However, in the context of shared decision-making, it remains essential to explore the woman's values, preferences, ensuring that the decision aligns with her personal circumstances and informed choice. Nevertheless, an individual woman can decide that the increased risk due to an emergency cesarean section or an intensive care admission of her newborn, and the inability to deliver at home, weighs more for her, that she may choose to decline induction even when the NNT is below 300.&lt;/p&gt;&lt;p&gt;Decreasing the NNT by continuously implementing new RCTs to determine who really benefits from induction of labor, monitoring outcomes of daily care, and developing proper information strategies for patients and, not least, minimizing harm through training of professionals, are all essential parts of this goal. It took the INDEX study 10 years to finalize a paper on the basic question of whether induction of labor at 41 weeks is beneficial in the Netherlands alone.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Given the annual cohort of 29,000 pregnant wome","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 9","pages":"1800-1801"},"PeriodicalIF":3.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257079","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":"Miscarriage treatment-related adverse events: A nationwide registry study from Finland","authors":"Nea Helle,&nbsp;Maarit Mentula,&nbsp;Tomi Seppälä,&nbsp;Mika Gissler,&nbsp;Maarit Niinimäki,&nbsp;Oskari Heikinheimo","doi":"10.1111/aogs.15174","DOIUrl":"10.1111/aogs.15174","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The treatment of miscarriage has transformed substantially from surgical to non-surgical. The aim of this study was to evaluate the rates of adverse events related to the treatment of miscarriage and their risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This nationwide retrospective cohort study included 69 593 fertile-aged (15–49 years) women who experienced their first miscarriage during 1998–2016 and received a diagnostic code of missed abortion or blighted ovum in a public hospital. We used data from the Finnish National Hospital Discharge Registry (NHDR). Miscarriage type, treatment modalities, and treatment-related adverse events (secondary surgery for any reason, infection and severe adverse events) were identified using diagnostic and surgical procedure codes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Since 2004, non-surgical management has been the dominant treatment of miscarriage in Finland. Between 1998 and 2016, a total of 11 397 women (16.4%) experienced at least one miscarriage treatment-related adverse event. The need for secondary surgery was the most common adverse event and more common after primary non-surgical treatment (22.0% vs. 3.8%). However, the annual rate of secondary surgery after non-surgical treatment declined from 34.8% in 1998 to 15.9% in 2016. The total number of women undergoing surgical treatment (primary or secondary) declined from 3918 (84.6%) to 651 (23.1%). Age was associated with an increased risk of secondary surgery (age ≥ 25; Adjusted odds ratio [AdjOR] 1.15, 95% CI 1.07–1.24) and with a decreased overall risk of infection (age 40–49 years; AdjOR 0.51 [0.40–0.63]). Parity was associated with lower risk of secondary surgery (one delivery, AdjOR 0.82 [0.78–0.95], and ≥2 deliveries, AdjOR 0.75, [0.71–0.84]) and infection (one delivery, AdjOR 0.85, [0.77–0.95]; ≥2 deliveries, AdjOR 0.74 [0.66–0.84]). Severe adverse events were rare (0.2%–0.4%) and did not differ between the two treatment options for either type of miscarriage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite significant changes in miscarriage treatment practices, no substantial or alarming increase in treatment-associated adverse events was detected. Both treatment options proved safe for the two types of miscarriage studied. These findings are important regarding the provision of individualized counseling and for the allocation of healthcare resources.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 9","pages":"1720-1730"},"PeriodicalIF":3.1,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245598","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}