Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Women with congenital heart disease: Other factors affecting labor onset and delivery mode","authors":"Javed Iqbal, Nisha Khatri, Mohammad Aitzaz Hassan, Muhammad Shaheer Bin Faheem","doi":"10.1111/aogs.15107","DOIUrl":"10.1111/aogs.15107","url":null,"abstract":"<p>We read the paper “Labor onset and delivery mode in women with congenital heart disease—a nationwide cohort study,” by Sandberg et al. published in <i>Acta Obstetricia et Gynecologica Scandinavica</i>. We commend the authors for their remarkable efforts. This study comprehensively finds the association between maternal congenital heart diseases, labor onset, and different delivery modes.<span><sup>1</sup></span> While providing valuable insights, it is important to acknowledge certain concerns that merit our attention.</p><p>With the control group (<i>n</i> = 1 214 902) dwarfing 2425 (20.0 per 10 000) childbirths of women with mild congenital heart disease (CHD), 603 (4.9 per 10 000) of women with moderate/severe CHD, and 522 (4.3 per 10 000) of women with other CHD, such differences risk inflated statistical significance for marginal effects and reduced power to identify clinically meaningful associations in smaller groups, especially moderate/severe CHD.<span><sup>2</sup></span> Additionally, although the authors account for certain comorbidities like diabetes and hypertension, they neglected several critical factors including lifestyle choices like physical activity, obesity, and dietary factors, which can significantly influence decisions about delivery methods and their associated outcomes. This study illustrates that obesity presents an individual risk of cesarean sections and adverse maternal and neonatal outcomes,<span><sup>3</sup></span> underscoring the importance of consideration of these elements in clinical decision-making.</p><p>Apart from the use of anticoagulants, several risk factors like uterine atony (particularly in patients with restricted use of oxytocin), placental abnormalities, uterine rupture, and obstetric trauma are worth mentioning, which may lead to misclassification of bleeding risks.<span><sup>3</sup></span> Moreover, the lack of recognition of varying anesthetic techniques employed during labor hinders their potential impact on adverse outcomes, including the risk of postpartum bleeding.<span><sup>4</sup></span> The study focuses only on the Norwegian population, which limits its generalizability due to Norway's healthcare system, characterized by universal access, high-quality care, and relatively low cesarean section rates compared to high-income countries.<span><sup>5</sup></span> This setting establishes these findings as particularly relevant to Norway while engrossing us to consider their applicability in other regions.</p><p>Sandberg et al. show significant findings that highlight a compelling association between the severity of congenital heart diseases in pregnant women and the various modes of delivery. However, the need for more comprehensive research remains paramount—studies that not only consider lifestyle choices and the use of medications during pregnancy but also examine their profound impact on maternal health. These insights underscore the urgent call for broader, more inclusive studies that ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1223-1224"},"PeriodicalIF":3.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699324","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":"Inpatient vaginal dinoprostone vs outpatient balloon catheters for cervical ripening in induction of labor: An individual participant data meta-analysis of randomized controlled trials","authors":"Fei Chan, Malitha Patabendige, Michelle R. Wise, John M. D. Thompson, Lynn Sadler, Michael Beckmann, Amanda Henry, Madeleine N. Jones, Ben W. Mol, Wentao Li","doi":"10.1111/aogs.15092","DOIUrl":"10.1111/aogs.15092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Outpatient cervical ripening and induction of labor might offer potential benefits. There are a few randomized controlled trials (RCTs) comparing outpatient balloon catheters with inpatient vaginal dinoprostone, but the reported outcomes among these trials were inconsistent, justifying the need for a meta-analysis. We aimed to evaluate the effectiveness and safety of inpatient vaginal dinoprostone compared to outpatient balloon catheters for cervical ripening in labor induction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Eligible RCTs were identified using MEDLINE, Emcare, Embase, Scopus, CINAHL Plus, Cochrane Pregnancy and Childbirth Group's Trials Register, WHO International Clinical Trials Registry Platform, and clinicaltrials.gov from inception to July 2024. Women with live singleton pregnancies at 34 or more weeks of gestation were eligible. The authors of eligible trials were invited to share their de-identified data. The main outcomes were vaginal birth and a composite adverse perinatal and maternal outcome. All analyses were adjusted for age and parity. Two-stage random effects meta-analysis was the main analysis strategy with the intention-to-treat principle. This meta-analysis was registered with PROSPERO (CRD42022313183) on 27-04-2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified three eligible RCTs, and all three shared data (<i>N</i> = 1636); inpatient vaginal dinoprostone (<i>n</i> = 832), outpatient balloon catheter (<i>n</i> = 804). The odds of vaginal birth were higher after inpatient vaginal dinoprostone than outpatient balloon catheter (67.8% vs 61.7%, adjusted odds ratio [aOR] 1.30, 95% CI 1.05–1.62, <i>I</i><sup>2</sup> = 0%). There was no significant difference in the composite adverse perinatal outcome (13.7% vs 13.1%, aOR 1.09, 95% CI 0.75–1.58, <i>I</i><sup>2</sup> = 28.7%) or the composite adverse maternal outcome (16.6% vs 19.8%, aOR 0.81, 95% CI 0.61–1.07, <i>I</i><sup>2</sup> = 11.5%). The difference in effect on vaginal birth rate varied according to body mass index. Overweight and obese women had a lower vaginal birth rate after outpatient induction, whereas for those with underweight/normal weight, the rates of vaginal birth were similar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Balloon catheter used in an outpatient labor induction setting probably leads to fewer vaginal births compared to vaginal dinoprostone in an inpatient setting. In pre-planned subgroup analysis, for pregnant women with underweight/normal weight, both inpatient va","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1041-1055"},"PeriodicalIF":3.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708038","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":"Exploring the risks of postpartum infections: Insights from labor induction practices","authors":"Mei Zhao,&nbsp;Lianwei Xu","doi":"10.1111/aogs.15106","DOIUrl":"10.1111/aogs.15106","url":null,"abstract":"<p>Sir,</p><p>We read with great interest the article by Hogh-Poulsen et al. titled “Maternal postpartum infection risk following induction of labor: A Danish national cohort study” published in Acta Obstetricia et Gynecologica Scandinavica (2025).<span>¹</span> The study provides valuable insights into the association between induction of labor (IOL) and maternal postpartum infection risk, particularly in a large, nationwide cohort. The study included a substantial number of deliveries (<i>n</i> = 546 864) over an 11-year period, providing robust statistical power to detect associations between IOL and postpartum infections. The use of national registries ensured a comprehensive dataset, including both hospital discharge diagnoses and antibiotic prescriptions, which captures both severe and mild infections. However, we would like to highlight several aspects of the study that warrant further discussion and consideration.</p><p>First, while the study demonstrates an association between IOL and postpartum infections, it cannot establish causality. The authors acknowledge this limitation, but it is important to emphasize that unmeasured confounders, such as the specific methods of IOL (e.g., Foley catheter vs. prostaglandins), could influence the results. Future studies should aim to explore these factors to better understand the mechanisms behind the observed associations.</p><p>Second, the study found that women with rupture of membranes (ROM) prior to IOL were not at increased risk of infection, which may reflect effective clinical management, such as the use of prophylactic antibiotics.<span>²</span> However, the study did not have data on antibiotic prophylaxis, which could be a significant confounder. Including this information in future research would provide a more complete picture of the factors influencing postpartum infection risk.</p><p>Third, the study focused on infections within 30 and 60 days postpartum, which aligns with the WHO definition of the postpartum period. However, some infections, particularly those related to surgical sites or endometritis, may manifest or persist beyond this timeframe.<span>³</span> Extending the follow-up period could provide additional insights into the long-term consequences of IOL.</p><p>In conclusion, the study by Hogh-Poulsen et al. is a significant contribution to the literature on maternal health, particularly in understanding the risks associated with IOL. The findings suggest that IOL is associated with a modest increase in postpartum infection risk, but the absolute risk remains low. However, the study also highlights the need for further research to explore causality, the role of prophylactic antibiotics, and the generalizability of these findings to other populations. We commend the authors for their rigorous methodology and encourage future studies to build on these findings to optimize clinical practices and improve maternal outcomes.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699322","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":"Why not vaginal?—Nationwide trends and surgical outcomes in low-risk hysterectomies: A retrospective cohort study","authors":"Johanna Wagenius,&nbsp;Sophia Ehrström,&nbsp;Karin Källén,&nbsp;Jan Baekelandt,&nbsp;Andrea Stuart","doi":"10.1111/aogs.15099","DOIUrl":"10.1111/aogs.15099","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 rate of vaginal hysterectomies is declining globally. We investigated surgical techniques, outcomes, and costs in a large national cohort of benign hysterectomies with prerequisites for vaginal surgery.&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 retrospective register-based cohort study with benign hysterectomies in the Swedish GynOp registry 2014–2023 (&lt;i&gt;n&lt;/i&gt; = 17 804). Inclusion criteria were non-prolapse, non-endometriosis with uterus weight &lt;300 g. The cohort was divided into a low-risk and a standard group, with the low-risk group having optimal conditions for vaginal hysterectomy: no previous caesarian section (CS), no previous abdominal surgery, Body Mass Index (BMI) &lt;30, and no nulliparous patients. Surgical outcomes were quantified using crude and adjusted risk ratios (RR, ARR). Costs were calculated and compared between abdominal (AH), laparoscopic (LH), robot-assisted (RH), and vaginal hysterectomies (VH).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The rate of AH and VH decreased during the period studied. RH increased and was the most common surgical technique 2021–2023 (33.2%). VH had the shortest surgical time and was the cheapest method. In the low-risk group, 25.2% of the patients were operated on vaginally. AH had more postoperative complications and longer hospitalization compared to VH in the low-risk group. LH had less severe intraoperative complications, ARR = 0.38 (95% CI 0.17–0.86) but more mild postoperative complications, ARR = 1.24 (95% CI 1.05–1.46) compared to VH in the low-risk group. LH had more conversions, ARR = 1.46 (95% CI 1.00–2.12), longer surgical time, ARR = 2.73 (95% CI 2.46–3.00) and longer hospital stay, ARR = 1.26 (95% CI 1.12–1.43) compared to VH. Mild (ARR = 0.33, 95% CI 0.16–0.66) and severe (ARR = 0.17, 95% CI 0.05–0.58) intraoperative complications and bleeding &gt;500 mL (ARR = 0.12, 95% CI 0.04–0.34) were less common in RH versus VH in the low-risk group. There were no differences between RH and VH regarding postoperative complications and reoperations. Surgical time &lt;45 min was less common in RH versus VH (ARR = 0.47, 95% CI 0.42–0.54) and RH had a significantly longer postoperative hospital stay (ARR = 1.16, 95% CI 1.02–1.33).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A decline of vaginal hysterectomies in Sweden 2014–2023 among patients with prerequisites for vaginal surgery was shown. VH was the cheapest method with few postoperative complications and short hospitalization. Our results support the vaginal route ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"958-967"},"PeriodicalIF":3.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655810","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":"Perinatal outcomes following nonadherence to guideline-based screening for gestational diabetes: A population-based cohort study","authors":"Elizabeth Nethery,&nbsp;Kelly Pickerill,&nbsp;Luba Butska,&nbsp;Michelle Turner,&nbsp;Jennifer A. Hutcheon,&nbsp;Patricia A. Janssen,&nbsp;Laura Schummers","doi":"10.1111/aogs.15098","DOIUrl":"10.1111/aogs.15098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The optimal approach for gestational diabetes mellitus (GDM) screening remains controversial. Since 2003, all Canadian guidelines have recommended universal GDM screening. Some countries, such as Sweden, use selective GDM screening among those with pre-existing risk factors. In Canada, antenatal care model (midwife, general practitioner or obstetrician) is partially self-selected; thus, patient populations may differ between care models. Despite the Canadian policy of universal GDM screening, screening nonadherence is more frequent in midwife-led care. We examined perinatal outcomes according to GDM screening adherence vs. nonadherence in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a population-based cohort study of singleton pregnancies and infants using linked administrative data from the province of British Columbia, Canada. We restricted the study to pregnancies with midwife-led antenatal care where GDM screening nonadherence occurred more frequently and was more likely by choice. We estimated adjusted risk ratios (aRR) according to GDM screening, comparing no glucose tests during pregnancy (21.4%), early glucose testing &lt;20 weeks (5.5%), and glucose testing with alternate methods ≥20 weeks (4.0%) vs. normoglycemic pregnancies (69%) using multivariable log binomial regression. We stratified by known GDM risk factors. Our primary outcome was large for gestational age (LGA) infants. Secondary outcomes were small for gestational age infants (SGA), stillbirth, 5-min Apgar &lt;7, birth trauma, preterm birth, cesarean birth, and obstetric anal sphincter injury (OASI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this cohort of 83 522 pregnancies, having no glucose tests in pregnancy was associated with lower risks of LGA and cesarean birth (LGA aRR 0.82; 95% CI 0.79–0.86; cesarean birth aRR 0.75; 95% CI 0.72–0.78) and higher risks of stillbirth and SGA (stillbirth aRR 1.6; 95% CI 1.0–2.2; SGA aRR 1.2; 95% CI 1.1–1.3) compared with normoglycemic pregnancies. Stillbirth risks were further elevated (aRR 2.5; 95% CI 1.2–5.0) in strata with GDM risk factors, but not in strata without risk factors, while higher SGA risks persisted across strata.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Nonadherence to GDM screening guidelines was associated with lower risks for excess fetal growth-related outcomes (LGA, cesarean birth), but higher risks of stillbirth and SGA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"839-849"},"PeriodicalIF":3.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646639","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":"Even low levels of anticardiolipin antibodies are associated with pregnancy-related complications: A monocentric cohort study","authors":"Veronika Viktoria Matraszek,&nbsp;Ladislav Krofta,&nbsp;Ilona Hromadnikova","doi":"10.1111/aogs.15096","DOIUrl":"10.1111/aogs.15096","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;Moderate and high levels of anticardiolipin antibodies (aCL), especially in the setting of the antiphospholipid syndrome, are associated with adverse obstetric outcomes. However, the clinical relevance of low aCL levels (&lt;40 MPL/GPL units) is still a matter of debate. The aim of the study was to evaluate obstetric outcomes in pregnancies with low immunoglobulin M (IgM) and/or immunoglobulin G (IgG) aCL positivity. The association between low aCL positivity and maternal baseline characteristics was also studied.&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;The retrospective monocentric cohort study of prospectively collected data involved a total 3047 singleton pregnancies that underwent the first-trimester screening involving an aCL test and delivered on site. Obstetric outcomes were compared between the low-titer aCL group (IgM ≥7 MPL units and &lt;40 MPL units and/or IgG ≥10 GPL units and &lt;40 GPL units) and the aCL negative group (IgM &lt;7 MPL units and IgG &lt;10 GPL units, reference group). In addition, obstetric outcomes were evaluated with regard to the antibody isotype: IgM-positive group (IgM &lt;40 MPL units, IgG negative) and IgG-positive group (IgG &lt;40 GPL units, IgM negative or &lt;40 MPL units).&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;Overall, the occurrence of pregnancy-related complications was significantly higher (27.91% vs. 19.32%, &lt;i&gt;p&lt;/i&gt; = 0.034) in the low-titer aCL group. Concerning the antibody isotype, a higher rate of pregnancy-related complications was observed in the IgG-positive group (54.55% vs. 19.32%, &lt;i&gt;p&lt;/i&gt; = 0.001), but not in the IgM-positive group (22.43% vs. 19.32%, &lt;i&gt;p&lt;/i&gt; = 0.454). The stillbirth rate did not reach statistical significance. Low-titer aCL pregnancies were more frequently of advanced maternal age (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), suffered from autoimmune diseases (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), chronic hypertension (&lt;i&gt;p&lt;/i&gt; = 0.040), and hereditary thrombophilia (&lt;i&gt;p&lt;/i&gt; = 0.040). In addition, they had more often a positive history of stillbirth (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), underwent conception via assisted reproductive technologies (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), were administered low-dose aspirin (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), low-molecular-weight heparin (&lt;i&gt;p&lt;/i&gt; = 0.018) and immunomodulatory drugs (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), and delivered earlier (&lt;i&gt;p&lt;/i&gt; = 0.018).&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;Even low aCL levels are associated with a higher incidence of pregnancy-related complications, but only in the case of IgG antibody isotype presence.","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"897-905"},"PeriodicalIF":3.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646635","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":"Influence of instrument choice on fear of childbirth after assisted vaginal delivery: A secondary analysis of the Bergen birth study","authors":"Sindre Grindheim,&nbsp;Svein Rasmussen,&nbsp;Johanne Kolvik Iversen,&nbsp;Jørg Kessler,&nbsp;Elham Baghestan","doi":"10.1111/aogs.15097","DOIUrl":"10.1111/aogs.15097","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;Assisted vaginal delivery has been associated with a negative childbirth experience and the development of secondary fear of childbirth, although it is less consistent than emergency Cesarean delivery. Whether the choice of instrument influences this, and the woman's preference for delivery mode in a potential subsequent pregnancy, is unknown. Our objective was to assess the association between the choice of instrument during assisted vaginal delivery, secondary fear of childbirth, and preference for an elective Cesarean delivery in a potential subsequent pregnancy.&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;Study design: Secondary analysis of Bergen birth study, a prospective observational study assessing maternal and neonatal outcomes after assisted vaginal delivery in primiparas at term, inclusion period: June 2021–April 2023. Wijma Delivery Expectancy/Experience Questionnaire version B was completed within a week after delivery. This validated instrument has 33 questions, a total score range from 0 to 165, and a score of ≥85 was used as a cutoff to define fear of childbirth. Preferred mode of delivery in a potential subsequent pregnancy, pain, and overall birth experience was also measured. Main outcome measures: Secondary fear of childbirth and request for Cesarean delivery in the next pregnancy.&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;132 women after forceps, 160 after vacuum, and 139 after spontaneous delivery answered the questionnaires. Overall prevalence of secondary fear of childbirth was 12.2% after spontaneous and 14.4% after both forceps and vacuum deliveries. Compared with spontaneous delivery, the adjusted odds ratio of developing fear of childbirth was aOR 1.63 (95% CI 0.45–5.17, &lt;i&gt;p&lt;/i&gt; = 0.4) after vacuum and aOR 1.71 (95% CI 0.43–6.14, &lt;i&gt;p&lt;/i&gt; = 0.4) after forceps delivery. Secondary fear of childbirth (aOR: 11.3 (95% CI 5.30–24.6), &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and maternal age ≥35 (aOR: 3.66 (95% CI: 1.49–8.81), &lt;i&gt;p&lt;/i&gt; = 0.004) were associated with a preference for cesarean delivery in a potential subsequent pregnancy. Severe pain was reported just as often in the spontaneous delivery cohort (33.8%) as in the vacuum (25.6%) and forceps (24.2%) cohorts. Less than 5% in each cohort indicated that they were very unsatisfied with their birth experience.&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 choice of instrument during assisted vaginal delivery was not associated with secondary fear of childbirth or preference for cesarean delivery in a potential subsequent ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"886-896"},"PeriodicalIF":3.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603299","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":"Bidirectional associations between endometriosis and Sjögren's syndrome in the era of multi-omics","authors":"Li-Tzu Wang,&nbsp;Naoko Sasamoto,&nbsp;Jon Ivar Einarsson,&nbsp;Marc R. Laufer,&nbsp;Kevin Sheng-Kai Ma","doi":"10.1111/aogs.15089","DOIUrl":"10.1111/aogs.15089","url":null,"abstract":"&lt;p&gt;We appreciate Zervou and Goulielmos' interest in our research on the bidirectional associations between endometriosis and Sjögren's syndrome (SS). We fully agree that certain genetic factors are critically shared among patients afflicted with both conditions, as these factors could play a pivotal role in identifying potential therapeutic targets for treating both diseases.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Understanding these shared genetic influences is essential, given that they may help guide interventions that could significantly improve the quality of life for those affected by endometriosis and SS.&lt;/p&gt;&lt;p&gt;Our population-based cohort study, coupled with our transcriptomics analysis, fortifies this perspective by demonstrating that “dendritic cell maturation” and the “hepatic fibrosis signaling pathway” were significantly enriched in both endometriosis and SS.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; These findings suggest that similar underlying mechanisms may drive the pathophysiology of these disorders. Zervou and Goulielmos' observations regarding the upregulation of key proteins such as B-cell activating factor (&lt;i&gt;BAFF&lt;/i&gt;), &lt;i&gt;HLA-DQA1&lt;/i&gt;, and &lt;i&gt;HLA-DRA&lt;/i&gt; in both diseases further underline the importance of adaptive immunity and inflammatory pathways,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; which we believe are fundamental components that intersect across these conditions.&lt;/p&gt;&lt;p&gt;Moreover, Zervou and Goulielmos' observations highlighted that interleukin (IL)-1 receptor antagonist (&lt;i&gt;IL1-Ra&lt;/i&gt;) and cytotoxic T-lymphocyte-associated protein 4 (&lt;i&gt;CTLA-4&lt;/i&gt;) were upregulated in both diseases.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This upregulation indicates the complexity of the biological interactions at play, illustrating how interconnected immune responses may contribute to the development of both diseases. We agree that more efforts are always warranted to investigate the effects of other contributing factors on both disease entities. For instance, environmental factors, such as air pollutants, may as well exacerbate primary SS by upregulating inflammatory pathways through the involvement of the IL-6 pathway and NF-kB signaling.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Collectively, these findings are clinically relevant not only in elucidating the associations between endometriosis and SS but also in providing a solid framework for studying the established links between endometriosis and the long-term risk of other illnesses, including malignancies such as endometrial cancer and uterine sarcoma.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; For example, pathways involving &lt;i&gt;CTLA-4&lt;/i&gt; and &lt;i&gt;IL1-Ra&lt;/i&gt; have also been implicated in the pathogenesis of endometrial malignancies.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; By investigating the shared genetic factors between endometriosis and SS, we may identify novel biomarkers that could predict the onset of these comorbidities in high-risk populations, as well as other long-term conditions.&lt;/p&gt;&lt;p&gt;Additionally, since our transcriptomic analyses were derived from bulk RNA samp","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1220-1221"},"PeriodicalIF":3.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596094","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":"The association of placental to fetal ratio with pregnancy duration","authors":"Carl P. S. Kulseng,&nbsp;Silje Sommerfelt,&nbsp;Kari Flo,&nbsp;Kjell-Inge Gjesdal,&nbsp;Helene F. Peterson,&nbsp;Vigdis Hillestad,&nbsp;Karianne Sagberg,&nbsp;Anne Eskild","doi":"10.1111/aogs.15082","DOIUrl":"10.1111/aogs.15082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Our objective was to study the association of placental size, fetal size, and placental size relative to fetal size (placental to fetal ratio) at gestational week 27 with time to spontaneous delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We included 100 pregnancies in a follow-up study from gestational week 27 until spontaneous delivery. Placental and fetal volume (in cm³) were measured at gestational week 27 by magnetic resonance imaging (MRI), and the association of placental to fetal ratio (placental volume/fetal volume) with delivery after spontaneous onset of labor was estimated as hazard ratios (HR) by applying Cox regression models. Pregnancies with deliveries after planned cesarean section or induction of labor provided follow-up time until these events. An HR lower than 1.0 indicates decreased risk of spontaneous delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean placental volume was 532 cm³ (SD 136 cm³) at gestational week 27, and fetal volume was 961 cm³ (SD 112 cm³). This yielded a mean placental to fetal ratio of 0.55 (SD 0.12). The HR of spontaneous delivery decreased with increasing placental to fetal ratio (HR 0.013 (95% CI: 0.001–0.121), Wald statistic 14.704 (<i>p</i> &lt; 0.001)), indicating a longer duration of pregnancy with a higher placental to fetal ratio at gestational week 27. The HR of spontaneous delivery also decreased with increasing placental size, but the association was less prominent than the HR associated with placental to fetal ratio (HR 0.997 [95% CI: 0.995–0.999], Wald statistic 7.638 [<i>p</i> = 0.006]). We estimated no association with fetal size (HR 1.001 [95% CI 0.999–1.003], Wald statistic 1.728 [<i>p</i> = 0.189]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that the placental to fetal ratio at gestational week 27 may be an indicator of the remaining duration of pregnancy until the onset of spontaneous labor.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"913-921"},"PeriodicalIF":3.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555595","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":"Hyperthermic intraperitoneal chemotherapy after upfront cytoreductive surgery for stage III epithelial ovarian cancer: Follow-up of long-term survival","authors":"Ziying Lei,&nbsp;Yue Wang,&nbsp;Runya Fang,&nbsp;Ke Wang,&nbsp;Jun Tian,&nbsp;Yangxiao Chen,&nbsp;Yingsi Wang,&nbsp;Jiali Luo,&nbsp;Jinfu He,&nbsp;Binghui Ding,&nbsp;Xianzi Yang,&nbsp;Li Wang,&nbsp;Shuzhong Cui,&nbsp;Hongsheng Tang,&nbsp;the Chinese Peritoneal Oncology Study group (Gynecologic Oncology Study group)","doi":"10.1111/aogs.15094","DOIUrl":"10.1111/aogs.15094","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 survival benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) has been well defined at the time of interval cytoreductive surgery, but the role of HIPEC remains uncertain for patients with newly diagnosed advanced ovarian cancer in the upfront setting. The present study aimed to report the updated long-term survival outcomes after 5 years of follow-up from our previous multicenter retrospective cohort study to compare primary cytoreductive surgery (PCS) plus HIPEC with PCS alone among women with stage III epithelial ovarian cancer.&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 study was conducted at five high-volume gynecological medical centers in China from January 2010 to May 2017. Eligible patients with complete data were treated with either PCS combined with HIPEC or PCS alone. The 5-year overall survival (OS) rate was updated to compare PCS plus HIPEC with PCS alone. The inverse probability of treatment weighting (IPTW) method based on a propensity score model for each patient was used to control the confounding factors and evaluate the effect of HIPEC.&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;Data from 789 patients, a total of 584 eligible stage III epithelial ovarian cancer patients were ultimately included in the analysis (PCS-plus-HIPEC group, &lt;i&gt;n&lt;/i&gt; = 425; PCS-alone group, &lt;i&gt;n&lt;/i&gt; = 159). After IPTW adjustment, the median OS was 44.5 (95% CI, 40.1–49.1) months in the PCS-plus-HIPEC group and 32.4 (95% CI, 28.8–40.3) months in the PCS-alone group (weighted hazard ratio, 0.74; 95% CI, 0.59–0.93; &lt;i&gt;p&lt;/i&gt; = 0.006). At 5 years, the OS rates were 37.9% (95% CI, 33.0%–42.8%) in the PCS-plus-HIPEC group and 26.4% (95% CI, 18.9%–34.6%) in the PCS-alone group (&lt;i&gt;p&lt;/i&gt; = 0.007). After stratification into optimal and suboptimal cytoreduction subgroups, patients in the PCS-plus-HIPEC group maintained a greater association with improved OS than those in the PCS-alone group. Among the women who underwent optimal cytoreduction in the PCS-plus-HIPEC group and PCS-alone group, the median OS was 49.9 (95% CI, 45.2–58.4) months and 37.8 (95% CI, 30.5–53.0) months (&lt;i&gt;p&lt;/i&gt; = 0.042) while the 5-year OS rate was 43.7% (95% CI, 37.7%–49.6%) and 33.2% (95% CI, 23.3%–43.5%), respectively (&lt;i&gt;p&lt;/i&gt; = 0.040). Meanwhile, for those treated with suboptimal cytoreduction subgroup in the PCS-plus-HIPEC and PCS-alone groups, the median OS was 28.4 (95% CI, 22.2–39.9) months and 20.6 (95% CI, 10.6–32.4) months (&lt;i&gt;p&lt;/i&gt; = 0.099) while the 5-year OS rate was 22.4% (95% CI, 15.1%–30.5%) and 12.2% (95% CI, 4.4%–24.2%), respectively (&lt;i&gt;p&lt;/i&gt; = 0.060). The median follow-up period was 87.2 (95% ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"988-997"},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539963","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}