Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Mediation of socioeconomic inequalities in preterm birth. A cohort analysis of Welsh linked data","authors":"Philip McHale, Daniela K. Schlüter, Hoda Abbasizanjani, Ashley Akbari, Ben Barr, David Taylor-Robinson","doi":"10.1111/aogs.15101","DOIUrl":"10.1111/aogs.15101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Consistent socioeconomic inequalities in preterm birth prevalence are seen internationally. Understanding the pathways to inequalities in preterm birth and the mediators that contribute to these inequalities is essential to inform policies and interventions to reduce health inequalities across the life course.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a causal mediation analysis using routinely collected, anonymised population-scale, individual-level linked data within the SAIL Databank on all singleton live births in Wales between 1 January, 2000 and 30 September, 2019. Our outcome was preterm birth, and exposure was area-based deprivation. Mediators were smoking during pregnancy, maternal mental health, hospitalisation due to maternal physical health and obstetric conditions. We calculated inequalities in preterm birth (dichotomised as before or after 37 weeks) and estimated two measures of mediation: proportion eliminated, the percentage of the effect of deprivation on preterm birth eliminated by removing the mediators, through the Controlled Direct Effects; and proportion mediated, the percentage of the inequality removed by equalising the distribution of the mediators across socioeconomic strata. Multiple multivariate imputations by chained equations were used to deal with missing data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final sample included 609 610 live births with 6.1% preterm. Socioeconomic gradients were seen in preterm birth and exposure to mediators, with a higher occurrence in mothers residing in the most compared to the least deprived quintiles. Compared with the least deprived quintile, the odds ratio for preterm births in the most deprived quintile was 1.26 (95% confidence interval 1.22–1.31). The proportion eliminated by the removal of all mediators at the same time was 21%. The proportion mediated by maternal smoking during pregnancy was 26%, and less than 10% for other mediators.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Smoking during pregnancy is a significant mediator of preterm birth inequalities. Maternal mental and physical health during pregnancy and obstetric conditions also lie on the pathway from socioeconomic status to preterm birth but mediate the relationship to a lesser extent. Significant socioeconomic inequalities remained after the effect of mediators was removed. These findings suggest that there is a need to reduce inequalities in smoking during pregnancy and direct action on socioeconomic status during pregnancy.</p>\u0000","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1081-1091"},"PeriodicalIF":3.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955280","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":"Gentle fundal pressure to facilitate vaginal delivery: A randomized clinical trial","authors":"Qing Guo,&nbsp;Hui Du,&nbsp;Ying Feng,&nbsp;Ruifen Jiao,&nbsp;Xu Xie,&nbsp;Mingwei Li,&nbsp;Dean V. Coonrod,&nbsp;Thomas Q. Zheng","doi":"10.1111/aogs.15130","DOIUrl":"10.1111/aogs.15130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Fundal pressure during the second stage of labor is widely practiced but understudied. Violent fundal pressure can cause maternal and fetal injuries. Many providers believe the maneuver is effective. Administrative efforts to ban fundal pressure are unsuccessful and only drive the procedure to an underground practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In this single-center, open-label, randomized trial, nulliparous women with term singleton cephalic pregnancy under epidural analgesia were assigned to receive gentle manual fundal pressure (GMFP) or routine labor care. The GMFP was designed not to exceed a maximum of 120 mmHg. Women were randomized after 30 min of pushing in the second stage of labor. The primary outcome was the time from randomization to delivery. Secondary outcomes were mode of delivery, episiotomy, perineal laceration, cord blood pH, and other maternal and fetal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between July 2023 and January 2024, 164 women were randomized to GMFP (<i>n</i> = 82) or to routine care (<i>n</i> = 82). The time from randomization to vaginal delivery did not show statistical significance between the fundal pressure group and the control group (mean [SD], 46.3 [33.3] vs. 55.9 [45.8] min; <i>p</i> = 0.13). Significantly fewer women in the fundal pressure group had operative vaginal deliveries (4 of 82 [4.9%]) than women in the control group (13 of 82 [15.9%]; relative risk [RR] 0.308, 95% confidence interval [CI] 0.105–0.904; <i>p</i> = 0.021). Similarly, mediolateral episiotomy was performed in fewer women in the fundal pressure group (6 of 82 [7.32%]) than in the control group (16 of 82 [19.51%], RR 0.375, 95% CI 0.154–0.910; <i>p</i> = 0.022). Other maternal and fetal outcomes were similar in the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>GMFP resulted in a nonsignificant reduction in the second stage of labor and a significant reduction in operative vaginal delivery and episiotomy without an increase in adverse outcomes. Fundal pressure during the second stage of labor deserves further investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 7","pages":"1357-1365"},"PeriodicalIF":3.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957942","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":"Partial agenesis of the corpus callosum: Prenatal ultrasound characteristics, associations, and outcome","authors":"Changrong Zhou,&nbsp;Hezhou Li,&nbsp;Ruizheng Han,&nbsp;Hongrui Ren,&nbsp;Bin Shen,&nbsp;Xinxia Wang,&nbsp;Fangfang Feng,&nbsp;Mengmeng Wang,&nbsp;Ling Liu","doi":"10.1111/aogs.15121","DOIUrl":"10.1111/aogs.15121","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;To investigate prenatal ultrasound characteristics, associated abnormalities, and outcomes of partial agenesis of the corpus callosum (pACC).&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 total of 118 fetuses with pACC diagnosed using prenatal ultrasound were studied, and their prenatal ultrasound characteristics, associated abnormalities, genetics, and outcomes were collected. The fetuses were categorized into three groups according to gestational age: &lt;24 weeks, 24–28 weeks, and &gt;28 weeks, and the brain transverse plane ultrasound signs were compared among the three groups.&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;Prenatal ultrasound revealed the presence of abnormal cavum septi pellucidi (CSP), distention of the interhemispheric fissure (IF), dilated and elevated third ventricle (TV), and ventriculomegaly in 102 (86.4%), 91 (77.1%), 56 (47.4%), and 42 (35.6%) cases, respectively, in the transverse plane of the brain. Among the cases with dilatation and elevation of the TV, 38 (67.8%) showed posterior displacement, manifested by a cystic mass in the midline that communicated with the TV. There were statistically significant differences in the incidence of ventriculomegaly and abnormal CSP among the three groups at &lt;24 weeks, 24–28 weeks, and &gt;28 weeks. However, there were no statistically significant differences in the distention of the IF and TV among the three groups. Moreover, our cohort studies demonstrated that 32.2% (38/118), 18.6% (22/118), and 17.8% (21/118) of the cases were associated with intracranial, extracranial, and intra-extracranial anomalies, respectively. The most common intracranial and extracranial anomalies were cerebral cortical dysplasia and cardiovascular anomalies. Genetic analysis demonstrated that 37.8% (17/41) of patients had genetic abnormalities. 25% (4/16) and 52% (13/25) of isolated and non-isolated pACC cases showed genetic abnormalities. Eight isolated cases were born, with an average age of 28 months, and their neurological development was normal.&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;Abnormal CSP was the most common indirect sign of pACC. A cystic mass in the midline communicating with the TV can be another indirect sign of a pACC. pACC is likely to be accompanied by intracranial and extracranial abnormalities. The detection rate of genetic abnormalities was higher in non-isolated pACC cases than in isolated cases. Isolated pACC has a good prognosis but requires long-term follow-up of neurological development.&lt;/p&gt;\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 7","pages":"1304-1317"},"PeriodicalIF":3.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951700","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":"Placental size and umbilical vein volume blood flow","authors":"Kari Flo,&nbsp;Carl Petter Skaar Kulseng,&nbsp;Helene Fjeldvik Peterson,&nbsp;Vigdis Hillestad,&nbsp;Silje Sommerfelt,&nbsp;Anne Eskild","doi":"10.1111/aogs.15110","DOIUrl":"10.1111/aogs.15110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The fetus receives oxygen and nutrition from the placenta through the umbilical vein. There is a large variation in placental size and placental size relative to fetal size (placental–fetal ratio). We studied whether placental size or placental–fetal ratio is related to blood flow in the umbilical vein.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We performed a prospective study at Akershus University Hospital in Norway and a total of 73 women were examined in gestational weeks 27 and 37. Fifty-six women were examined at both time points. B-mode ultrasound and Doppler ultrasonography were used to measure the umbilical vein volume blood flow per minute. Magnetic resonance imaging was used to measure placental and fetal volume. Pearson's and Spearman's correlation coefficients were applied for estimations of associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In gestational week 27, the umbilical vein volume blood flow was positively correlated with fetal size (Pearson's correlation coefficient <i>r</i> = 0.372, <i>p</i> = 0.003, and Spearman's correlation coefficient r = 0.384, <i>p</i> = 0.002), but not with placental size (Pearson's r = 0.130, <i>p</i> = 0.317, and Spearman's r = − 0.53, <i>p</i> = 0.687) or placental–fetal ratio (Pearson's r = − 0.61, <i>p</i> = 0.641, and Spearman's r = − 0.218, <i>p</i> = 0.092). In gestational week 37, we found positive correlations of the umbilical vein volume blood flow with fetal size (Pearson's r = 0.428, p = &lt;0.001, and Spearman's r = 0.391, <i>p</i> &lt;0.001), placental size (Pearson's r = 0.400, <i>p</i> = 0.001, and Spearman's r = 0.643, p &lt;0.001), and with placental–fetal ratio (Pearson's r = 0.224, <i>p</i> = 0.066, and Spearman's r = 0.266, <i>p</i> = 0.028).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A large placenta and a high placental–fetal ratio are associated with increased umbilical vein blood flow.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1135-1142"},"PeriodicalIF":3.5,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956501","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":"Effects of strength training on quality of life in pregnant women: A systematic review","authors":"Paula Redondo-Delgado,&nbsp;Paula Blanco-Giménez,&nbsp;Susana López-Ortiz,&nbsp;Celia García-Chico,&nbsp;Juan Vicente-Mampel,&nbsp;Sergio Maroto-Izquierdo","doi":"10.1111/aogs.15122","DOIUrl":"10.1111/aogs.15122","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Physical activity is known to improve physical and psychological outcomes in pregnant women. While aerobic exercise is typically emphasized in physical activity guidelines for pregnant women, emerging research suggests that strength training may offer unique benefits beyond those provided by aerobic exercise alone. This systematic review aimed to systematically explore the effects and characteristics of strength training interventions on the health-related quality of life of pregnant women, with the goal of informing more comprehensive and specific exercise guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A systematic literature search was conducted across PubMed, Web of Science, and EBSCO Host databases without time restrictions, following PRISMA guidelines (PROSPERO ID: CRD42024511477). Nine randomized controlled trials met the inclusion criteria, involving a total of 1581 participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The studies reviewed demonstrated that strength training during pregnancy can mitigate excessive weight gain, alleviate low back and sciatic pain, enhance mood, and improve various aspects of health-related quality of life. These aspects include physical activity levels, muscular strength, flexibility, sleep quality, energy expenditure, and psychological well-being.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite these promising findings, this review highlights the need for standardized methodologies and detailed reporting in future research. Incorporating strength training into general exercise recommendations for pregnant women has the potential to optimize maternal health outcomes such as muscle strength, weight gain, physical activity levels, low back pain, pelvic pain, fatigue, anxiety, energy levels, vitality, sleep duration, and health status.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 7","pages":"1231-1243"},"PeriodicalIF":3.5,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054091","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":"International multicenter prospective evaluation of PAS management in 23 IS-PAS member centers","authors":"Thorsten Braun,&nbsp;Sally Collins,&nbsp;Olivier Morel,&nbsp;Ammar Al Naimi,&nbsp;Charline Bertholdt,&nbsp;Albaro Jose Nieto-Calvache,&nbsp;Frederic Chantraine,&nbsp;Alexander Paping,&nbsp;Vedran Stefanovic","doi":"10.1111/aogs.15120","DOIUrl":"10.1111/aogs.15120","url":null,"abstract":"&lt;p&gt;The International Society for Placenta Accreta Spectrum (IS-PAS) has transitioned from a small European Working Group (EW-AIP) into an international interdisciplinary group of centers with expertise in placenta accreta spectrum (PAS) management. Such expertise typically encompasses maternal-fetal medicine, gynecologic surgery, gynecologic oncology, vascular surgery, trauma surgery, urologic surgery, transfusion medicine, critical care specialists (intensivists), neonatologists, interventional radiologists, anesthesiologists, specialized nursing staff, and ancillary personnel, as described by Silver et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Since its inception in 2017, IS-PAS has grown to 71 active members from 47 centers across 27 countries with varying income levels.&lt;/p&gt;&lt;p&gt;IS-PAS aims to generate high-quality research on all aspects of PAS, including diagnostics and management, while enhancing education for healthcare professionals and patients. The organization has developed informative flyers in multiple languages to assist women in understanding PAS, available for free on its website (www.is-pas.org). To become a registered center, applicants must demonstrate the management of at least ten PAS cases (Grades 2–3) over three years and submit relevant documentation, including data collection forms and intraoperative photographs. Once these criteria are met, the board reviews the application.&lt;/p&gt;&lt;p&gt;Affordable membership fees, with reduced rates for those from low-income countries, primarily support administrative costs and database maintenance. In this supplement, we present a unique international multicenter prospective evaluation of PAS management. The web-based database of pregnancies complicated by PAS has been completely revised and adapted to meet the current requirements and latest findings from the literature.&lt;/p&gt;&lt;p&gt;In 2021, IS-PAS published a series of articles in &lt;i&gt;Acta Obstetricia et Gynecologica Scandinavica&lt;/i&gt; focusing on the diagnosis and management of placenta accreta spectrum (PAS), based on a newly developed multicenter database.&lt;span&gt;&lt;sup&gt;2-7&lt;/sup&gt;&lt;/span&gt; The custom-made, web-based, secure online database FetView (FetView; Zeitgeist Health SE) was implemented in 2016 and can receive strictly anonymized woman-related textual data and allows statistical queries. After the analysis of the first data set, numerous measures were taken to further improve the data quality. The new database incorporates both the IS-PAS grading&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; and the updated FIGO classification for intraoperative PAS assessment,&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; allowing for direct comparisons between the systems. Possibilities of more detailed descriptions of antenatal ultrasound (US) or magnetic resonance imaging (MRI) markers were incorporated, and the full terminology of markers defined by IS-PAS was embedded in the new query. Numerous query fields were made mandatory fields to obtain a complete data set with high quality.&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; This ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 S1","pages":"4-7"},"PeriodicalIF":3.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963214","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":"Assessment of novel sonographic and biochemical tools for spontaneous preterm birth prediction in asymptomatic twin pregnancies","authors":"Júlia Ponce,&nbsp;Teresa Cobo,&nbsp;Clara Murillo,&nbsp;Anna Gonce,&nbsp;Ana B. Sánchez-García,&nbsp;Ana P. Dantas,&nbsp;David Coronado,&nbsp;Francesca Crovetto,&nbsp;Laura Guirado,&nbsp;Judit Bruch,&nbsp;Eduard Gratacós,&nbsp;Montse Palacio,&nbsp;Mar Bennasar","doi":"10.1111/aogs.15118","DOIUrl":"10.1111/aogs.15118","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;Prematurity is a major global health issue. Twin pregnancies are a group at especially high risk of preterm birth. Sonographic mid-trimester cervical length has limited accuracy in predicting preterm birth. This study aimed to evaluate the association between mid-trimester sonographic markers of early cervical remodeling and cervical inflammatory biomarkers and fetal fibronectin, alone or in combination, as predictors of preterm birth before 34+0 weeks in asymptomatic twin pregnancies.&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;Prospective cohort study, including uncomplicated dichorionic or monochorionic-diamniotic twin pregnancies, recruited and assessed between 18+0 and 24+6 weeks, from a single tertiary referral center between 2020 and 2023. At inclusion, transvaginal ultrasound was performed to assess the following sonographic markers (cervical length, uterocervical angle, cervical consistency index, cervical texture) and an endocervical sample was obtained prior to ultrasound to quantify the following cervical inflammatory biomarkers (tumor necrosis factor alpha, interleukins 1b, 6, 8, 18, matrix metalloproteinase-8 and 9) and fetal fibronectin. The diagnostic performance of those sonographic and biochemical markers independently associated with spontaneous preterm birth before 34 weeks was analyzed by receiver operating characteristic curves and assessed through sensitivity and specificity analysis for several cutoffs.&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;Of the 172 women included, cervical length was shorter (36 mm vs. 40 mm; &lt;i&gt;p&lt;/i&gt; = 0.025) and uterocervical angle was wider (137° vs. 120°; &lt;i&gt;p&lt;/i&gt; = 0.004) in the preterm group. Cervical consistency index, cervical texture score, cervical inflammatory biomarkers, and fetal fibronectin were similar among the study groups. The area under the curve to predict spontaneous preterm birth before 34+0 weeks was 0.722 (95% CI 0.577 to 0.866) for cervical length, 0.789 (95% CI 0.683 to 0.895) for uterocervical angle, and 0.852 (95% CI 0.752 to 0.952) for a combination of both. Based on the receiver operating characteristics curve cutoff, sensitivity and specificity for cervical length ≤37 mm was 55.6% and 66.3%, for an uterocervical angle ≥135° was 77.8% and 76.1%, and for both criteria present 44.4% and 93.3%, respectively.&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;This finding of this study suggests that the combination of cervical length and uterocervical angle in mid-trimester sonographic assessment may improve the pred","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1162-1171"},"PeriodicalIF":3.5,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962269","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":"Maternal time interval between menarche and childbirth is associated with daughter's age at menarche","authors":"Mari Landås Warp,&nbsp;Thea Grindstad,&nbsp;Karoline H. Skåra,&nbsp;Maria C. Magnus,&nbsp;Siri E. Håberg,&nbsp;Nils-Halvdan Morken,&nbsp;Liv Bente Romundstad,&nbsp;Cecilia H. Ramlau-Hansen,&nbsp;Hans Ivar Hanevik","doi":"10.1111/aogs.15088","DOIUrl":"https://doi.org/10.1111/aogs.15088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Women's reproductive lifespan has increased over the past two decades. Simultaneously, female reproductive behavior has changed, with increasing age at first birth. Early menarche has been associated with adverse health outcomes, but research investigating the association between maternal age at childbirth and daughter's age at menarche is, so far, inconclusive. Whether the interval between menarche and childbirth or between childbirth and menopause among mothers is associated with age at menarche in daughters is not known.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a cohort study with retrospectively collected data including mothers and daughters participating in the Norwegian Mother, Father and Child Cohort Study. Within this cohort, we identified two study populations. First, we included 14 576 mother-daughter pairs with complete information on maternal age at menarche and childbirth and the daughter's age at menarche. Second, we included 1350 mother-daughter pairs with complete information on maternal age at childbirth and natural menopause, and daughter's age at menarche. We calculated odds ratios (OR) with 95% confidence intervals (CIs) in a discrete survival analysis for daughters' age at menarche by time intervals from menarche to childbirth or from childbirth to menopause in mothers. We adjusted for relevant covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found 5% lower yearly odds (partially adjusted OR 0.95 (CI 0.90–0.99)) of reaching menarche among daughters born by mothers &lt;16 years after menarche compared to the reference category born 16–20 years following menarche. After additionally adjusting for maternal birth year, the effect estimate was further reduced (fully adjusted OR 0.79 (CI 0.74–0.84)). Among daughters born by mothers &gt;20 years after menarche, the likelihood of early menarche was higher (fully adjusted OR 1.19 (CI 1.13–1.27)) compared to the reference category. Regarding the childbirth-menopause interval, our findings did not reach statistical significance in either of our models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Daughters born to mothers with a shorter time interval (&lt;16 years) between menarche and childbirth have a lower likelihood of experiencing early menarche compared to the reference category (16–20 years), and daughters born to mothers with a longer time interval from menarche to childbirth (&gt;20 years) have a higher likelihood of reaching early menarche.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1101-1111"},"PeriodicalIF":3.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091279","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":"Outcomes associated with large loop excision of the cervical transformation zone in women 60–64 years of age: A population-based register study from Denmark","authors":"Julie Laub Erdal,&nbsp;Reza Rafiolsadat Serizawa,&nbsp;Matejka Rebolj,&nbsp;Jeppe Bennekou Schroll","doi":"10.1111/aogs.15111","DOIUrl":"10.1111/aogs.15111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>For women treated for cervical dysplasia at 60–64 years in Denmark, we reported the frequency of abnormalities before and after treatment of cervix uteri (most frequently performed as large loop excision of the cervical transformation zone, LLETZ) using population-based real-world data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study based on national data from the Danish Pathology Data Bank and identified women who underwent a LLETZ in 2010–2016 at the age of 60–64. Women were managed according to nationwide evidence-based recommendations proposed by the Danish professional organizations. We retrieved information on all LLETZ specimens, cervical histology, cytology, and human papillomavirus (HPV) tests in the period of 2 years prior to the procedure to 2 years thereafter. We reported the frequencies of abnormalities before, at, or after the procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1014 women who had a LLETZ during the study period, 660 (65%) showed cervical intraepithelial neoplasia grade 1 or worse (CIN1+, including CIN1, CIN2, CIN3, cervical cancer, and CIN not otherwise specified) in their LLETZ specimen, with free resection margins in 255 (39%). Of the 1014 women, 551 (54%) had CIN2+ in a biopsy preceding the LLETZ and in 567 (56%) CIN2+ was found in their LLETZ specimen. In 37 (4%) women, the specimen showed cervical cancer; whereas in the pre-LLETZ biopsies of these 37 women, cancer was detected in only 7 (1%). After LLETZ, 818 (81%) women underwent test-of-cure follow-up which was positive in 406 women (40%). Furthermore, 408 (40%) women had new histological samples registered after LLETZ. These showed CIN2+ in 134 (13%) women, whereas a new cancer was diagnosed in 11 (1%) women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Due to persistent abnormal tests after LLETZ, an extended follow-up is still required for a large proportion of the women in this age group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1112-1119"},"PeriodicalIF":3.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802079","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":"Self-collected vaginal HPV samples for long-term non-attendees in the Swedish organized cervical cancer screening program","authors":"Avalon Sundqvist,&nbsp;Caroline Hellsten,&nbsp;Björn Strander,&nbsp;Magnus Lindh,&nbsp;Christer Borgfeldt","doi":"10.1111/aogs.15112","DOIUrl":"10.1111/aogs.15112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Most cervical cancer cases in Sweden are diagnosed among women who have failed to attend screening. The objective of this study was to analyze the effectiveness of offering vaginal HPV (human papillomavirus) self-samples to long-term non-attendees as a routine in this screening program, in which non-attendees had already been the targets of several interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Register data from the organized cervical screening program were used in this population-based study. From January 2016 to December 2019, 33 881 high-risk (hr-) HPV self-sample kits were sent to the homes of long-term screening non-attendees (≥7 years without a registered screening test), aged between 29 and 64 years, in Region Västra Götaland, Sweden. All samples returned to the laboratory were analyzed with the Cobas HPV DNA assay (Roche) for HPV16, HPV18, and for 12 other hr-HPV types. HPV-positive women were referred for colposcopy. Compliance and results of follow-up were assessed 12 months after HPV analysis. Descriptive statistics, trend analysis, and risk ratios were used to compare outcomes across groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age of invited women was 49 years; 35% had not been screened before. The response rate was 19.4% (6582/33881). The HPV prevalence was 12.0% (788/6582), and 80.2% of HPV-positive women attended follow-up. Women with no previous cervical sample had a lower response rate: 15.7% (RR (Risk ratio) 0.73 (95% CI (Confidence interval) 0.70–0.77)). They also had lower attendance in follow-up when HPV-positive (71.6% RR 0.86 (CI 0.78–0.94)), compared with women who had previous samples. The proportions of high-grade histopathology (HSIL+) among followed-up women were 31.3% for HPV16, 15.2% for HPV18, and 8.8% for HPVnon-16/18. Nine cervical cancer cases were found among 6582 women, corresponding to a rate of 137 cases per 100,000 women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Vaginal HPV self-samples increased cervical screening attendance by almost one-fifth among non-attendees who had previously resisted several invitations and interventions. Biopsied women positive for HPV16 or HPV18 had a high prevalence of HSIL or cervical cancer, which strongly supports direct referral to colposcopy. Long-term non-attendees have an exceptionally high risk of cervical cancer and should receive special attention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1181-1189"},"PeriodicalIF":3.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794369","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}