Acta Obstetricia et Gynecologica Scandinavica最新文献

{"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}

{"title":"Standardization and quality control of the introduction of a noninvasive cardiac output monitor for pregnancy measurements in a low- and middle-income country","authors":"Helen Perry,&nbsp;Evalyne Tusiimirwe,&nbsp;Allen Nakayenga,&nbsp;Wessel Ganzevoort,&nbsp;Josephine Tumuhamye,&nbsp;Winfred Nakato,&nbsp;Josaphat Byamugisha,&nbsp;Kelvin Mbote,&nbsp;Aris T. Papageorghiou,&nbsp;Sam Ali,&nbsp;the iTECH Consortium Members","doi":"10.1111/aogs.15116","DOIUrl":"10.1111/aogs.15116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is increasing awareness of the role of the maternal cardiovascular system in complicated pregnancies. Despite the high disease burden, noninvasive cardiac output monitors have not been used extensively in low- and middle-income countries. The aim of this study was to evaluate the quality control of the use of the ultrasonic cardiac output monitor (USCOM) 1A® in a LMIC (low an middle income country).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a quality assessment study of the introduction of the USCOM 1A® to measure maternal hemodynamic indices. Inter-observer agreement was assessed across all four study sites by intraclass correlation coefficient. Quality control was assessed using pre-defined acceptability criteria, rated by 2 independent scorers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>On average, nurses or midwives needed to obtain 30.4 (range 24–36) Doppler waveform recordings to be deemed competent to undertake USCOM 1A® measurements. There was very good inter-observer agreement across all 4 sites (intraclass correlation coefficient 0.86–0.93, all <i>p</i> &lt; 0.001). A total of 138 images were randomly selected for quality review. Overall, 79 (89.8%) images were considered acceptable by both scorers; 4 (6.9%) were considered unacceptable by both scorers; and there was disagreement in 5 (5.7%) cases. Overall agreement was 94.3%. Agreement as assessed by Fleiss' kappa, was moderate (0.585 [95% CI 0.376–0.794], <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Using a robust learning package and clearly defined image criteria, a novel cardiac-output monitor can be successfully introduced into low- and middle-income countries, in the context of research. Ongoing quality control measures are imperative to maintain the integrity of planned future studies using USCOM 1A®.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1128-1134"},"PeriodicalIF":3.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778665","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":"Mediators affecting the higher risk of stillbirth among foreign-born women in Sweden: A nationwide cohort study","authors":"Minna Lundén,&nbsp;Ingela Hulthén Varli,&nbsp;Helena Kopp Kallner,&nbsp;Hanna Åmark","doi":"10.1111/aogs.15103","DOIUrl":"10.1111/aogs.15103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In Sweden, a higher incidence of stillbirth has been observed among women originating from sub-Saharan Africa and the Middle East. In this nationwide cohort of more than 2 million births, we assessed the risk factors for stillbirth among foreign-born women with the aim of understanding which mediators have the largest impact on the elevated risk of stillbirth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a nationwide cohort study in Sweden including 2 300 391 births between 2000 and 2021. Data from the National Medical Birth Register were linked to data from Statistics Sweden using the personal identity number of the mother. Differences in maternal characteristics were analyzed between women divided into groups based on maternal country of origin. Logistic regression models were made with a forward selection strategy adjusting for potential mediators on the causal pathway from maternal country of origin to stillbirth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A significantly higher risk of stillbirth was observed among women originating from Eastern Europe, the Middle East/Northern Africa, sub-Saharan Africa, and Asia, with the highest risk observed in women originating from sub-Saharan Africa (OR 2.40, 95% CI 2.16–2.67, <i>p</i>-value &lt;0.001). After adjusting for maternal risk factors, fetuses small for gestational age, and socioeconomic factors, women originating from sub-Saharan Africa still had a significantly higher risk of stillbirth (OR 1.28, 95% CI 1.14–1.44, <i>p</i>-value &lt;0.001) compared to women originating from Sweden. The risk among the other groups of foreign-born women was, however, equal to the risk among women originating from Sweden. Mediation analysis showed that 31.2% of the effect of sub-Saharan origin on stillbirth was mediated through fetuses small for gestational age, 12.7% through educational level, and 16.9% through disposable income level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In Sweden, women originating from sub-Saharan Africa face a significantly higher risk of stillbirth even after adjusting for known risk factors. The higher risk is partly mediated by giving birth to fetuses small for gestational age and socioeconomic factors, but it cannot be explained altogether. This disparity may stem from multifactorial causes, including how risk populations utilize health care during pregnancies. Further studies are needed to find preventive measures to decrease the disparity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1070-1080"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750667","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":"Vaginal breech delivery in all-fours position—Hands off instead of intervention: A prospective observational study","authors":"Gerhard Bogner,&nbsp;Johanna Schuller,&nbsp;Carina Gargitter,&nbsp;Eva Dölzlmüller,&nbsp;Thorsten Fischer,&nbsp;Claudius Fazelnia","doi":"10.1111/aogs.15078","DOIUrl":"10.1111/aogs.15078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Vaginal delivery in cases of breech presentation is considered potentially stressful for the newborn. The maternal upright position may represent a more physiological approach to facilitating birth. We compare the safety and efficacy of two maternal positions in vaginal breech delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A prospective, single-center, observational cohort study from October 2006 to January 2021 in a high-level obstetric center, in Salzburg, Austria. Vaginal breech deliveries in maternal all-fours position (<i>n</i> = 140) were compared with those in assisted supine position (<i>n</i> = 92). The primary outcome measures for neonatal morbidity included Apgar scores, pH levels, and the rate of transfer to the Neonatal Intensive Care Unit (NICU) postdelivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the all-fours position, 51.4% (<i>n</i> = 72) of deliveries occurred without obstetric intervention. The second stage of labor was significantly shorter in the supine position (39.5 min [95% CI 28–47] versus all fours position 52 min [95% CI 42–63], <i>p</i> = 0.042). Umbilical artery pH levels did not differ significantly (7.21 [95% CI 7.19–7.23] versus 7.19 [95% CI 7.17–7.21] vs. <i>p</i> = 0.06). Nor did the APGAR scores at 5 and 10 min below eight (<i>p</i> = 0.697; <i>p</i> = 0.760). Maternal and neonatal morbidity also did not significantly differ. Transfer of neonates to NICU <i>n</i> = 12 (13%) versus <i>n</i> = 11 (7.9%), <i>p</i> = 0.097, transfer birth-related <i>n</i> = 6 (6.5%) versus <i>n</i> = 8 (5.7%), <i>p</i> = 0.803. The number of postpartum umbilical artery pH &lt; 7.10 were <i>n</i> = 9 (9.8%) versus <i>n</i> = 28 (20%), <i>p</i> = 0.065. There was one reported neonatal death due to intracerebral hemorrhage in the supine position group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results indicate that vaginal breech delivery in the all-fours position seems to be comparable to supine position regarding neonatal safety. Additionally, the all-fours position shows potential for emergency management for unplanned breech deliveries by inexperienced attendants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1153-1161"},"PeriodicalIF":3.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750669","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":"Atrioventricular conduction abnormalities are associated with poor outcome following intermittent umbilical cord occlusions in fetal sheep","authors":"Juulia Lantto,&nbsp;Jonas Johnson,&nbsp;Heikki Huhta,&nbsp;Mervi Haapsamo,&nbsp;Panu Kiviranta,&nbsp;Kati Räsänen,&nbsp;Hanna-Marja Voipio,&nbsp;Sven-Erik Sonesson,&nbsp;Juha Voipio,&nbsp;Juha Räsänen,&nbsp;Ganesh Acharya","doi":"10.1111/aogs.15109","DOIUrl":"10.1111/aogs.15109","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;Fetal arrhythmias have been described with intrapartum hypoxemia; however, they cannot be accurately diagnosed with currently used fetal heart rate (FHR) monitoring systems due to low resolution and signal averaging. We used a Holter device to record electrocardiogram (ECG) at 250 Hz in term sheep fetuses that developed severe metabolic acidosis induced by intermittent umbilical cord occlusions (UCOs), mimicking human labor contractions. We hypothesized that UCOs leading to worsening fetal metabolic acidosis provoke distinct fetal arrhythmias that could indicate impending fetal death.&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;Thirteen pregnant sheep (gestational age 133–135/145 days) were instrumented under general anesthesia. Three electrodes were placed on the fetal chest and connected to a Holter device for continuous ECG recording at a sampling rate of 250 Hz. The fetal axillary artery was catheterized and an inflatable occluder was placed around the umbilical cord. After a 4–5 day recovery, complete UCOs were induced by inflating the occluder for 1 min, followed by deflation for 2 min, until the fetal arterial pH dropped &lt;7.0 and/or base excess (BE) &lt;−16. Thereafter, an emergency cesarean section was performed to deliver the fetus.&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;Eight sheep fetuses were included in the final analysis. All fetuses had normal baseline arterial blood gases and lactate values. During the first two UCOs, all fetuses demonstrated isolated benign arrhythmias. Three fetuses that developed severe metabolic acidosis after five UCOs showed persistent atrioventricular (AV) conduction abnormalities during the last UCO and its release, requiring cardiopulmonary resuscitation (CPR) at birth. One fetus with third-degree AV block had no detectable QRS complexes at birth, developed ventricular tachycardia and fibrillation (VT/VF) during CPR, and was successfully defibrillated. Five fetuses tolerated ≥10 UCOs before developing severe metabolic acidosis, and none of these showed any persistent AV-conduction abnormalities, though one fetus died after developing VT/VF after the 10th UCO.&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;Metabolic acidemia induced by intermittent UCOs in term sheep fetuses is associated with various arrhythmias, some of which may be life-threatening. Continuous intrapartum fetal ECG recording at a sample rate of ≥250 Hz coupled with a software capable of automatically detecting significant arrhythmias could enhance intrapartum fetal moni","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1207-1217"},"PeriodicalIF":3.5,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750662","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}