Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Lifetime psychiatric morbidity and maternal smoking behavior in consecutive pregnancies: A Finnish register study","authors":"Hanna P. Wallin, Mika Gissler, Päivi E. Korhonen, Mikael O. Ekblad","doi":"10.1111/aogs.15114","DOIUrl":"10.1111/aogs.15114","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite the adverse effects of smoking during pregnancy, a large proportion of women who smoke during their first pregnancy endure smoking also in their subsequent one. Previous studies have made efforts to explore associated factors, such as maternal mood and stress. This observational register-based historical cohort study aims to investigate the association between prior psychiatric morbidity and maternal smoking during consecutive pregnancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>The study population comprised all women who smoked during their first pregnancy and had two singleton live births between January 1, 2006 and December 31, 2019 in Finland (<i>n</i> = 29 683). The smoking information was obtained from the Finnish Medical Birth Register, categorized as “no smoking,” “quit smoking” (during the first trimester), or “continued smoking” (beyond the first trimester). Maternal psychiatric diagnoses (from the age of 15 until the second delivery) were derived from the Finnish Hospital Discharge Register. The association between (I) any psychiatric diagnosis, (II) separate diagnosis groups, and (III) psychiatric burden (diagnoses from 0 to 5 different diagnosis groups) and maternal smoking during the second pregnancy was analyzed using logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The smoking prevalence during the first pregnancy was 16.0%. Women who continued smoking during their first pregnancy (<i>n</i> = 15 588) were likely smokers in their second: 54.9% continued, and 12.4% quit smoking. Most women who quit smoking during their first pregnancy (<i>n</i> = 14 095) were non-smokers during their second (73.2%). Women who continued smoking during their first pregnancy and had any previous psychiatric diagnosis were more likely to continue smoking (beyond the first trimester) during their second pregnancy (OR 1.44, 95% CI 1.32–1.57) compared to those without such a diagnosis. A similar association was found between psychiatric burden and continued smoking (OR 1.20, 1.14–1.25). Women who quit smoking during their first pregnancy and had any diagnosis or burden showed a similar trend for continued smoking but were not more likely to quit smoking during the second pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Any prior psychiatric diagnosis seems to be associated with continued smoking during the second pregnancy among first-pregnancy smokers. Psychiatric and smoking cessation support should be targeted particularly to women who smoke during their fi","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1092-1100"},"PeriodicalIF":3.5,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750665","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":"Impact of levator ani muscle avulsions on Manchester procedure outcomes: A 5-year follow-up study","authors":"Sissel Hegdahl Oversand, Anne Cathrine Staff, Ingrid Volløyhaug, Rune Svenningsen","doi":"10.1111/aogs.15102","DOIUrl":"10.1111/aogs.15102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Levator ani muscle avulsion is a risk factor for inferior outcomes after native tissue pelvic organ prolapse repair. In a previously published study, we found no such association 1 year after the Manchester procedure (anterior repair combined with cardinal and uterosacral ligament suspension and perineal repair). The aim of the present study was to compare women with and without levator ani muscle avulsions in terms of patient-reported and anatomical outcomes, and failure rates in the same cohort after 5 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Five-year prospective cohort study of 143 women operated on for anterior and/or mid-compartment pelvic organ prolapse with the Manchester procedure between October 2014 and January 2017, Clinical Trial study number NCT02246387. Levator ani muscle avulsions (uni- or bilateral) were diagnosed at inclusion by transperineal ultrasound. Primary outcome at 5-year follow-up was subjective bulge symptoms (question 3, Pelvic Floor Distress Inventory-20). Secondary outcomes were total score from the same questionnaire, sexual distress (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12), subjective cure, Pelvic Organ Prolapse Quantification scale measurements, defining optimal outcomes as anterior compartment stage <0–1 and mid-compartment point C ≤−5, and new surgical or conservative prolapse treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 143 women followed up after 5 years, the avulsion rate was 52.4%. Both groups showed similar reductions in bulge symptoms, pelvic floor symptoms, and anatomical anterior- and mid-compartment measurements. Sexual distress improvement was significantly greater for women with avulsion (Mean change difference: −3.4 (−6.4 to −0.5)). Multivariate regression revealed no significant effect of avulsion on symptom scores, cure rates, or need for new prolapse treatment. Women with avulsion had half the odds of obtaining an optimal anterior compartment outcome compared to those without avulsion (adjusted odds ratio: 0.5 (0.2–0.9)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although women with levator ani muscle avulsion had lower odds of achieving an optimal anterior compartment outcome, the overall anatomical changes from preoperative to 5 years were similar in both groups. Importantly, avulsion did not impact symptom improvement, patient-reported outcomes, or the need for further treatment. These findings support the Manchester procedure as an effective and durable surgical option for","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1200-1206"},"PeriodicalIF":3.5,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750663","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":"Trends in the use of induction of labor by methods and indications: A population-based study","authors":"Samia Aziz,&nbsp;Fiona Bruinsma,&nbsp;Kara Blackburn,&nbsp;Caroline S. E. Homer,&nbsp;Joshua P. Vogel","doi":"10.1111/aogs.15087","DOIUrl":"10.1111/aogs.15087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Induction of labor is a widely used obstetric intervention, with rates increasing globally. In Australia in 2022, over one-third of women gave birth following the induction of labor. Though the rate of induction has increased, changes in methods and indications for induction have not been analyzed for the state of Victoria. This study aims to analyze these trends in Victoria, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted using de-identified data from the Victorian Perinatal Data Collection (VPDC) that includes all births statewide of at least 28 completed weeks' gestation from 2012 to 2020. The study analyzed trends in the onset of labor, methods used, and indications for induction over the study period, using descriptive statistics and average annual percentage change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 701 324 births occurred during the study period, of which 223 672 (31.9%) were inductions. Induction of labor rates increased significantly from 25.4% in 2012 to 37.7% in 2020, with a notable rise at 38 and 39 weeks' gestation. Significant changes were observed in induction methods—the use of combination methods, particularly balloon catheter followed by pharmacological agents, increased, while the use of a standalone method declined. The findings suggest that gestational diabetes and fetal indications were major drivers of induction in recent years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Labor induction practices in Victoria have changed significantly, reflecting shifts in clinical practices and changes in health profiles of pregnant women. Further research is needed to investigate the rising use of induction at early term gestation and the role of maternal preferences in driving induction in Victoria.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"875-885"},"PeriodicalIF":3.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727343","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":"Evaluation of a patient decision aid for opportunistic salpingectomy and salpingectomy as sterilization method to prevent ovarian cancer","authors":"Malou E. Gelderblom,&nbsp;Charlotte Fisch,&nbsp;Jurgen M. J. Piek,&nbsp;Laura A. M. van Lieshout,&nbsp;Justine Briet,&nbsp;Lauren Bullens,&nbsp;Sjors F. P. J. Coppus,&nbsp;Inge Ebisch,&nbsp;Alexandra A. van Ginkel,&nbsp;Rafli van de Laar,&nbsp;Natascha de Lange,&nbsp;Marloes Maassen,&nbsp;Huy Ngo,&nbsp;Angele L. M. Oei,&nbsp;Brenda Pijlman,&nbsp;Brigitte Slangen,&nbsp;Regina The,&nbsp;Dineke Smedts,&nbsp;Caroline Vos,&nbsp;Joanna IntHout,&nbsp;Joanne A. de Hullu,&nbsp;Rosella P. M. G. Hermens","doi":"10.1111/aogs.15091","DOIUrl":"10.1111/aogs.15091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A patient decision aid on opportunistic salpingectomy and salpingectomy as a sterilization method has been developed to provide uniform counseling and reduce practice variation. The aim of this study was to evaluate the use of the patient decision aid in daily clinical practice to ensure its effectiveness and usability, as well as its influence on the decision-making process and the decision of opportunistic salpingectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>As part of the STOPOVCA-implementation study, we conducted a multicenter observational study in 16 hospitals between July 2020 and February 2024. Patients who were eligible for opportunistic salpingectomy were invited to use the decision aid while they considered whether or not to undergo opportunistic salpingectomy. Digital questionnaires were used to evaluate the decision aid, the decision process, and patients' decisions 6–8 weeks post-surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>425 out of 542 patients participated in the questionnaire. A majority of these 425 patients received (<i>N</i> = 357; 84%) and used the decision aid (<i>N</i> = 347; 82%). Two thirds (<i>N</i> = 234; 67%) of those who used the decision aid stated that it increased their knowledge of opportunistic salpingectomy. Patients considered the decision aid a usable aid, allocating a score of 8.1 out of 10 and would recommend it to other patients facing the decision regarding opportunistic salpingectomy. Patients considered the extent to which they were involved in the decision-making process as high, and the decisional conflict low. The majority of patients who used the decision aid opted for opportunistic salpingectomy (<i>N</i> = 326; 95%). Main reasons for choosing opportunistic salpingectomy were the risk-reducing effect of ovarian cancer (<i>N</i> = 311; 90%) and the lack of functionality of the fallopian tubes after childbearing (<i>N</i> = 320; 92%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The patient decision aid was used by a majority of patients who received it. The decision aid was regarded by patients as user-friendly, and it was recommended to be used in the decision-making process for opportunistic salpingectomy. Patients stated that the decision aid provides reliable information and increases patients' knowledge of opportunistic salpingectomy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 6","pages":"1190-1199"},"PeriodicalIF":3.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717623","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":"Instrument selection in assisted vaginal delivery: Reassessing its role in maternal fear of childbirth","authors":"Javed Iqbal,&nbsp;Muna A. Al-Maslamani","doi":"10.1111/aogs.15113","DOIUrl":"10.1111/aogs.15113","url":null,"abstract":"<p>We read with great interest the recently published study by Grindheim et al. (2025) titled “Influence of Instrument Choice on Fear of Childbirth After Assisted Vaginal Delivery: A Secondary Analysis of the Bergen Birth Study.”<span>¹</span> While the study aims to evaluate the association between instrument choice in assisted vaginal delivery (AVD) and secondary fear of childbirth (FOC), we would like to highlight several critical concerns regarding the study's methodology, statistical power, and interpretation of findings.</p><p>The study does not account for preexisting maternal FOC, a well-established risk factor for postpartum FOC. Previous research, by Li et al. (2025), has demonstrated that antenatal FOC significantly influences postpartum perceptions of childbirth.<span>²</span> The authors' failure to adjust for this variable limits the ability to attribute FOC development solely to the mode of delivery.</p><p>The study reports no significant differences in FOC prevalence between spontaneous vaginal delivery and AVD. However, given the relatively small sample size, the study may be underpowered to detect a clinically meaningful difference. A recent study by Märthesheimer et al. (2025) has identified significant associations between instrumental deliveries and FOC.<span>³</span> A post hoc power analysis would be necessary to confirm the robustness of the findings.</p><p>The study assessed FOC within 1 week postpartum. However, literature suggests that childbirth experiences evolve over time, with recall bias potentially underestimating FOC prevalence. Khademi et al. (2024) demonstrated that assessments performed later in the postpartum period yield more stable and reliable data on birth-related psychological outcomes.<span>⁴</span> The lack of longitudinal follow-up weakens the conclusions drawn.</p><p>While the study discusses perineal trauma and obstetric anal sphincter injuries, it does not adequately analyze their impact on FOC. A study by Muraca et al. (2023) found that forceps deliveries were significantly associated with maternal trauma and long-term psychological distress.<span>⁵</span> Given the higher rate of episiotomies and perineal trauma in AVD cohorts, it is crucial to explore whether these factors contribute to FOC rather than attributing it solely to the choice of instrument.</p><p>While the study by Grindheim et al. contributes to an important area of obstetric research, the aforementioned limitations call into question the reliability and generalizability of its conclusions. Future studies should employ larger, multicenter cohorts; incorporate preexisting maternal fear factors; and utilize a longitudinal follow-up design to more accurately assess the psychological consequences of AVD.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 7","pages":"1410-1411"},"PeriodicalIF":3.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708039","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":"Women with congenital heart disease: Other factors affecting labor onset and delivery mode","authors":"Javed Iqbal,&nbsp;Nisha Khatri,&nbsp;Mohammad Aitzaz Hassan,&nbsp;Muhammad Shaheer Bin Faheem","doi":"10.1111/aogs.15107","DOIUrl":"10.1111/aogs.15107","url":null,"abstract":"&lt;p&gt;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 &lt;i&gt;Acta Obstetricia et Gynecologica Scandinavica&lt;/i&gt;. 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.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; While providing valuable insights, it is important to acknowledge certain concerns that merit our attention.&lt;/p&gt;&lt;p&gt;With the control group (&lt;i&gt;n&lt;/i&gt; = 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.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; 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,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; underscoring the importance of consideration of these elements in clinical decision-making.&lt;/p&gt;&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; This setting establishes these findings as particularly relevant to Norway while engrossing us to consider their applicability in other regions.&lt;/p&gt;&lt;p&gt;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,&nbsp;Malitha Patabendige,&nbsp;Michelle R. Wise,&nbsp;John M. D. Thompson,&nbsp;Lynn Sadler,&nbsp;Michael Beckmann,&nbsp;Amanda Henry,&nbsp;Madeleine N. Jones,&nbsp;Ben W. Mol,&nbsp;Wentao Li","doi":"10.1111/aogs.15092","DOIUrl":"10.1111/aogs.15092","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;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.&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;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.&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;We identified three eligible RCTs, and all three shared data (&lt;i&gt;N&lt;/i&gt; = 1636); inpatient vaginal dinoprostone (&lt;i&gt;n&lt;/i&gt; = 832), outpatient balloon catheter (&lt;i&gt;n&lt;/i&gt; = 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, &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 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, &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 28.7%) or the composite adverse maternal outcome (16.6% vs 19.8%, aOR 0.81, 95% CI 0.61–1.07, &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 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.&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;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}