Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Prospective evaluation of the Simple Fetal Medicine Foundation's first-trimester prediction model for preeclampsia in twin pregnancies","authors":"Cuilian Liu,&nbsp;Jiaxin Li,&nbsp;Yang Chen,&nbsp;Tianchen Wu,&nbsp;Qingnan Meng,&nbsp;Kuo Zhang,&nbsp;Yuan Wei","doi":"10.1111/aogs.70263","DOIUrl":"10.1111/aogs.70263","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There is no widely applicable prediction model for preeclampsia (PE) in twins, the existing models lack strict external validation. Therefore, this study aimed to evaluate the predictive performance of the Simple Fetal Medicine Foundation model (i.e., Simple FMF model, only including the maternal risk factors and mean arterial pressure [MAP]) for the prediction of PE at 11–13^+ 6 weeks' gestation in twin pregnancies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a prospective, non-intervention study in 464 twin pregnancies (including dichorionic twins and monochorionic twins) at 11–13^{+ 6}weeks' gestation in a tertiary center between September 1, 2021 and October 31, 2024. Maternal characteristics, medical, obstetric, and drug history were recorded. MAP was measured according to regular protocol. The FMF's algorithm is freely available online, which was used for the calculation of patient-specific risk of PE in each participant. The performance of screening for PE occurring at different gestational weeks by the Simple FMF model was evaluated with the adjustment of aspirin use. The efficiency of the screening strategy with maternal factors and MAP was evaluated using the receiver operating characteristic curve, and the detection performance for PE at a fixed false-positive rate was also analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 464 women included, 24.14% (112/464) developed PE, among which 1.29% (6/464) occurred before 30 weeks, 2.80% (13/464) occurred before 32 weeks, 6.47% (30/464) occurred before 34 weeks, 19.18% (89/464) occurred before 37 weeks, 4.96% (23/464) (including 21 cases of dichorionic diamniotic twins and 2 cases of monochorionic diamniotic twins) occurred at 37 weeks or later. The Simple FMF model had area under the receiver operating characteristic curves of 0.911 (95% confidence interval [CI]: 0.830–0.992), 0.799 (95% CI: 0.668–0.930), 0.797 (95% CI: 0.712–0.882), and 0.767 (95% CI: 0.706–0.828) for the screening of PE occurring before 30, 32, 34, and 37 weeks, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study has demonstrated that the Simple FMF model was effective in predicting PE in twin pregnancies, especially for cases of PE occurring before 30, 32, 34, and 37 weeks. This approach only uses maternal characteristics, medical history, and MAP, making it suitable for implementation in resource-limited settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 9","pages":"1707-1716"},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381428","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":"Immediate placement of intrauterine device after second-trimester medical abortion—Secondary outcomes with one-year follow-up","authors":"Sara Hogmark,&nbsp;Caroline Westermark,&nbsp;Niklas Envall,&nbsp;Kristina Gemzell-Danielsson,&nbsp;Helena Kopp Kallner","doi":"10.1111/aogs.70259","DOIUrl":"10.1111/aogs.70259","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Intrauterine devices (IUDs) effectively prevent unwanted pregnancies. Little is known about long-term outcomes of women choosing an IUD after second-trimester medical abortion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We performed a 12-month follow-up of a multicenter randomized controlled trial comparing IUD placement within 48 h (intervention) with placement at 2–4 weeks (control) after medical abortion with 85 to 153 days' gestation. Secondary outcomes such as proportions of long-term IUD use, subsequent pregnancies and abortions, and participant satisfaction are presented (ClinicalTrials.gov NCT03603145).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 179 women were included. The 12-month follow-up rate was 71.1% (64/90) in the intervention group and 73.0% (65/89) in the control group. Fewer women in the intervention group were using an IUD after 12 months: 51.6% (33/64) vs. 69.2% (45/65, <i>p</i> = 0.04). The total expulsion rate over 12 months was 36.4% (24/66) in the intervention group compared to 3.1% (2/65) in the control group (<i>p</i> &lt; 0.001), with only two IUDs being expelled between 6 and 12 months, both in the intervention group. The most common contraceptive method at 12 months was any hormonal IUD at 54.3% (70/129). Among IUD users at 12 months, the overall satisfaction with their contraceptive method was high, at 88.3% (68/77). In the intervention group, 26.2% (16/61) had at least one subsequent pregnancy within 12 months compared to 13.6% (9/66, <i>p</i> = 0.08) in the control group. We found no significant difference in the number of subsequent abortions; 13.1% (8/61) in the intervention group and 6.1% (4/66) in the control group reported at least one subsequent abortion (<i>p</i> = 0.23).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Immediate IUD placement after second-trimester medical abortion did not lead to a higher proportion of IUD use at 12 months compared to delayed placement. Rather, immediate IUD placement was associated with a higher incidence of expulsion and lower use; however, no significant increase in subsequent pregnancies or abortions was observed. High satisfaction levels with IUD use were reported in both groups, but women with immediate placement were less likely to recommend a friend to use an IUD post abortion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 9","pages":"1672-1679"},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148209697","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":"Management of congenital female genital tract anomalies related to primary amenorrhea and/or cyclic abdominal pain: A retrospective cohort study","authors":"Grigoris F. Grimbizis,&nbsp;Sofia Tsiapakidou,&nbsp;Eirini Iordanidou,&nbsp;Georgios Kioussis,&nbsp;Anastasia Vatopoulou,&nbsp;Theodoros Theodoridis","doi":"10.1111/aogs.70256","DOIUrl":"10.1111/aogs.70256","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Surgical treatment for patients with complex female genital anomalies (FGA) depends on the specific type of anomaly, its level of complexity, the symptoms experienced by the patient, and a thorough understanding of the embryological origins of the anomaly. The aim of this study is to analyze the results of the surgical treatment of young female patients with complex FGA presented with primary amenorrhea and/or cyclic pelvic pain and present their treatment algorithm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analyzed prospectively collected data of adolescents and young women with FGA presented with primary amenorrhea and/or cyclic pelvic pain. Forty-eight patients of 11 different types of FGA, evaluated and treated in our Department between January 2007 and June 2025, were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All patients were treated surgically. The design of the surgical treatment was based on the existing uterine body, cervical, and vaginal anatomy. Immediate surgery was performed in patients with obstructive pain, whereas nonobstructive cases were treated near anticipated sexual activity. Neovagina creation was performed in 26 cases of vaginal aplasia; isthmo-neovagina anastomosis was performed in one patient with cervical aplasia and a normal uterus and in two patients with a rudimentary cavity, while excision of the rudimentary cavity was performed in a third one. Two patients developed rectovaginal fistula, which was managed successfully. Surgical treatment of a patient with an obstructed bicorporeal complete uterus combined with cervical and vaginal aplasia was unsuccessful, leading to hysterectomy. All transverse vaginal septae were excised, one through posterior colpotomy. One patient with a complete bicorporeal uterus and unilateral cervical aplasia underwent successful anastomosis and another one underwent excision of the obstructed uterine body. Rudimentary cavities of unicorporeal uteri were removed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Surgical treatment of FGA presenting with primary amenorrhea and/or cyclic pelvic pain should be anatomy-driven, with priority given to symptom relief and preservation of reproductive potential by restoring genital tract continuity, when feasible, or removing obstructed parts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 9","pages":"1810-1822"},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969433","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":"Learning opportunities in eclampsia care: A ten-year audit from Norway, 2013–2022","authors":"Camilla Tjønneland Mentzoni,&nbsp;Kjerstine Røe,&nbsp;Solveig Bjellmo,&nbsp;Marte Irene Skille Carlsen,&nbsp;Marit Halonen Christiansen,&nbsp;Tora Sandvik Fjeldstad,&nbsp;Lena Henriksen,&nbsp;Truc Trung Nguyen,&nbsp;Lill Trine Nyfløt,&nbsp;Leiv Arne Rosseland,&nbsp;Chen Sun,&nbsp;Oddvar Uleberg,&nbsp;Siri Vangen,&nbsp;Kari Klungsøyr,&nbsp;Hilde Marie Engjom,&nbsp;OCINOR—Eclampsia Working Group","doi":"10.1111/aogs.70280","DOIUrl":"10.1111/aogs.70280","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The World Health Organization recommends surveillance, including audits with case reviews of severe maternal morbidities such as eclampsia, to improve obstetric outcomes. We aimed to audit eclampsia and to identify learning opportunities in eclampsia care in Norway.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Our study population included all women discharged with a diagnosis of eclampsia (ICD-10: O15) and with a documented generalized seizure in medical records at two university hospitals in Norway from 2013 to 2022. An eclampsia working group developed a digital eclampsia case report form for gathering clinical information from medical records. Based on a structured summary of information from the digital case report form, the group reviewed the care for women with eclampsia. Each case was discussed and reviewed according to the clinical guidelines by the group. Learning opportunities to improve care were identified and classified according to whether they contributed to the outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 93 139 deliveries, 22 women with an initial eclampsia diagnosis were identified (2.4 per 10 000). Subsequent clinical information identified an alternative probable etiology of seizures in five women. None of the 22 women received magnesium sulfate prior to the seizure, and cerebral imaging was performed in 11 of 22 women. In 18 women, learning opportunities were identified, and for eight women, a different management could potentially have prevented eclampsia. The eclampsia working group identified learning opportunities related to underuse of magnesium sulfate prophylaxis when indicated, inadequate management of hypertension both before and after eclamptic seizure, underuse of cerebral imaging as a diagnostic tool, and lack of follow-up consultation with an obstetrician in women diagnosed with eclampsia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Learning opportunities were found in 18 of 22 women, and improvements in care could potentially have changed the outcome for eight of the women. This audit highlights the importance of differential diagnostic consideration for seizures in pregnant and postpartum women, the use of prophylactic magnesium sulfate when indicated, and the diagnosis and management of hypertension in pregnancy. Eclampsia audits should be incorporated into national routine surveillance and learning systems to improve obstetric care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 9","pages":"1767-1777"},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148262788","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":"Induction of labor after one previous cesarean: Time for the MIBAC trial","authors":"Sophia Brismar Wendel,&nbsp;Tove Wallström","doi":"10.1111/aogs.70327","DOIUrl":"10.1111/aogs.70327","url":null,"abstract":"&lt;p&gt;Induction of labor after one previous cesarean has become a common clinical problem. Cesarean delivery is among the most frequently performed major operations in women, and in the Nordic countries, one in five births is by cesarean. Induction now precedes roughly a third of all births, and its indications continue to broaden to include diabetes, preeclampsia, fetal growth restriction or acceleration, prelabor rupture of the membranes, post-term pregnancy, and more. As a consequence, an increasing number of women reach term with one uterine scar and an indication for delivery and are offered induction of labor rather than repeat cesarean. How best to induce these women is therefore a question of growing clinical relevance.&lt;/p&gt;&lt;p&gt;Labor induction in a scarred uterus differs from spontaneous labor. The principal safety concern is uterine rupture, a rare but potentially catastrophic event. In women with one previous cesarean and spontaneous onset of labor, the risk of uterine rupture is generally below 1%. With induction, it rises to 2%–5% in Nordic cohorts, depending on the method.&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The choice of method is therefore important. Major guidelines from FIGO, the RCOG, and ACOG concur in recommending mechanical cervical ripening, principally the transcervical balloon catheter, and in listing misoprostol as contraindicated after a previous cesarean.&lt;span&gt;&lt;sup&gt;4-6&lt;/sup&gt;&lt;/span&gt; Notably, the balloon catheter, most often a Foley catheter, is itself generally used off-label for cervical ripening.&lt;/p&gt;&lt;p&gt;However, the evidence underlying this contraindication is weaker than its near-universal status suggests. The original concern arose largely from older studies using high doses of vaginal or sequential prostaglandins, in which induction was rarely separable from oxytocin augmentation. In Norwegian population data, the highest risk of complete uterine rupture is associated not with any single agent but with sequential prostaglandin-then-oxytocin regimens.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; The frequently cited estimate of an approximately 15-fold increase in rupture with induction derives from a cohort analysis that pooled all prostaglandins rather than isolating any individual agent or dose.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Low-dose oral misoprostol differs in important respects. Some clinical scenarios favor oral misoprostol over a vaginal method (mechanical or pharmacological), for example, in prelabor rupture of membranes, where a device or repeated vaginal examinations carry a theoretical infection risk, or when the patient declines vaginal examination. Balloon placement specifically is often discouraged when the fetal head is not engaged, given the associated risk of cord prolapse. Moreover, misoprostol's short half-life allows titration against uterine activity. In the general obstetric population, a 25-μg oral regimen is at least as effective as vaginal dinoprostone, with fewer cesarean deliveries and substantially less uterine hyper","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 9","pages":"1644-1645"},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547602","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-administered tele-ultrasound in fetal telemonitoring: Prospective study","authors":"Shariva S. Kariman,&nbsp;Sophie Lekkerkerker,&nbsp;Judith Ummels,&nbsp;Bauke Adriaanse,&nbsp;Josephus F. M. van den Heuvel,&nbsp;Mireille N. Bekker","doi":"10.1111/aogs.70252","DOIUrl":"10.1111/aogs.70252","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;Digital innovations in ultrasound are enabling tele-ultrasound and remote guidance, offering new opportunities to strengthen hospital-at-home care. This study evaluated the feasibility and user experience of self-administered ultrasound by pregnant women with real-time guidance.&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 prospective observational cohort study included pregnant women with uncomplicated singleton pregnancies between 24 and 37 weeks of gestation. Participants used the portable tele-ultrasound device Pulsenmore ES (Pulsenmore Ltd., Omer) at home to perform clinician-guided, real-time transabdominal 2D scans twice weekly, completing eight scans over a 28-day period. Real-time guidance was provided by experienced obstetric healthcare professionals. Primary outcome was feasibility, including image acquisition, interpretability, interobserver agreement for saved images, and technical aspects. Secondary outcomes included the System Usability Scale and the self-developed Telemonitoring Survey for user experience. Additionally, a focus group meeting assessed obstetric healthcare professionals' perspectives on the system.&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;Thirty pregnant women participated, with a mean age of 32.6 years, median body mass index of 23.3 kg/m&lt;sup&gt;2&lt;/sup&gt;, and a mean gestational age of 29 weeks (range 24.3–34.5). All participants completed eight ultrasound scans, resulting in 240 tele-ultrasound examinations with a 100% success rate for predefined parameters, including fetal position, fetal heart activity, deepest pocket of amniotic fluid, and placental location. Across the study, remote connection and image acquisition times shortened to a median of 5 and 4 min, respectively. Retrospective analysis was possible for 226 scans, yielding a 99.9% parameter identification rate and perfect interobserver agreement (100%). Technical errors occurred in 16.3% of examinations, mainly due to connection issues. No association was found between scan duration and maternal or pregnancy characteristics such as gestational age, body mass index, and placental location. Participant experience was highly positive, with a mean System Usability Scale score of 80.7 and a satisfaction score of 4.4/5 on the Telemonitoring Survey, reflecting excellent usability. Ultrasound experts found the system user-friendly, with sufficient image quality and functionality.&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;Self-administered fetal tele-ultrasound is feasible and associated with hi","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 9","pages":"1698-1706"},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142362","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":"Pharmaceutical policy and off-label prescribing in pregnancy: A population-based historical cohort study analyzing inequality in access to antiemetics within Australia's Pharmaceutical Benefits Scheme","authors":"Hannah Jackson,&nbsp;Luke Grzeskowiak,&nbsp;Joanne Enticott,&nbsp;Sarah Wise,&nbsp;Emily Callander","doi":"10.1111/aogs.70283","DOIUrl":"10.1111/aogs.70283","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;Nausea and vomiting in pregnancy is highly prevalent and can significantly impact pregnant women's quality of life. Despite this, access to effective pharmacotherapies can be constrained by stringent regulatory controls and socioeconomic barriers. The objective of this study was to examine the socioeconomic distribution of antiemetics (metoclopramide, ondansetron, and prochlorperazine) dispensed to pregnant women through Australia's publicly subsidized Pharmaceutical Benefits Scheme.&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;We used the Maternity1000 linked administrative dataset to characterize antiemetics dispensed during 297 630 pregnancies in Queensland, Australia (July 2013 to June 2018). Using a population-based historical cohort study design, we analyzed dispensing volume, prevalence, and government expenditure across socioeconomic quintiles, with socioeconomic disadvantage defined using the Australian Bureau of Statistics' Index of Relative Socioeconomic Disadvantage. Inequalities in medication access and public expenditure were assessed using concentration indices (C) and concentration curves.&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;Off-label ondansetron dispensings for nausea and vomiting in pregnancy (i.e., use outside Therapeutic Goods Administration-approved indications and not subsidized under the Pharmaceutical Benefits Scheme) accounted for the largest share of public expenditure (53.5%), followed by metoclopramide (45.2%) and prochlorperazine (1.3%). Across all three antiemetics, prevalence was highest among women in the most socioeconomically disadvantaged quintiles and declined progressively across the two least disadvantaged groups. Small pro-poor inequalities in access (C &lt; −0.10) and moderate pro-poor inequalities in public expenditure (C &gt; −0.25) were observed across all antiemetics. (Medication access: C&lt;sub&gt;metoclopramide&lt;/sub&gt; = −0.07, 95% CI (−0.080 to −0.068); C&lt;sub&gt;ondansetron&lt;/sub&gt; = −0.09, 95% CI (−0.114 to −0.075); C&lt;sub&gt;prochlorperazine&lt;/sub&gt; = −0.08, 95% CI (−0.109 to −0.045). Government expenditure: C&lt;sub&gt;metoclopramide&lt;/sub&gt; = −0.30, 95% CI (−0.316 to −0.285); C&lt;sub&gt;ondansetron&lt;/sub&gt; = −0.25, 95% CI (−0.297 to −0.198); C&lt;sub&gt;prochlorperazine&lt;/sub&gt; = −0.28, 95% CI (−0.350 to −0.205)).&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;Off-label ondansetron access accounted for the majority of public expenditure on antiemetics dispensed during pregnancy, revealing a disconnect between health policy, clinical practice, public expenditure, and preg","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 9","pages":"1789-1799"},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148222391","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":"Adherence to aspirin use during pregnancy among women at risk of preeclampsia: A cross-sectional study","authors":"Emma M. Swift,&nbsp;Sigurbjörg A. Guðnadóttir,&nbsp;Eygló H. Haraldsdóttir,&nbsp;Hulda Hjartardóttir,&nbsp;Lilja Ó. Atladóttir,&nbsp;Helga Helgadóttir,&nbsp;Lárus S. Guðmundsson,&nbsp;Rannveig Sigurvinsdóttir,&nbsp;Kristjana H. Ásbjörnsdóttir,&nbsp;Jóhanna Gunnarsdóttir","doi":"10.1111/aogs.70281","DOIUrl":"10.1111/aogs.70281","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Aspirin prevents severe preeclampsia, but its effectiveness depends on its use. Aspirin is recommended in pregnancy for women at risk of preeclampsia. However, evidence on prophylactic aspirin uptake and adherence is limited. The aim was to examine whether women at risk received recommendations to use aspirin and estimate the prevalence of inadequate adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Cross-sectional internet survey conducted in Iceland. Pregnancies were classified as low, moderate, and high risk for preeclampsia according to guidelines. The Morisky-Medicine-Adherence-Scale© (MMAS-8) was used to estimate adherence, classified as good (8 points), moderate (6–7.9), and inadequate (&lt;6). Prevalence ratios (PR) for inadequate adherence were calculated with 95% confidence intervals (CI), with the high-risk group as reference.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Survey responses were received from 887 women with gestational age between 12 + 0 and 36+ 6, with 122 at high and 137 at moderate preeclampsia risk. In total, 229 women reported being recommended aspirin: 87 at high risk (71%), 92 at moderate risk (67%), and 50 at low risk (8%). Nonadherence was reported by 13 women (5.7%). The prevalence of inadequate adherence was 25% among high-risk, 21% among moderate-risk (PR 0.83; 95% CI: 0.47–1.46), and 27% among low-risk respondents. No individual risk factors were significantly associated with inadequate adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Respondents at risk of preeclampsia commonly did not remember receiving appropriate recommendations for aspirin. This may considerably limit the effectiveness of screening and aspirin prevention in Iceland, and a more systematic approach could be needed. However, adherence to aspirin in our population was comparable to previously reported adherence to medication for chronic illnesses and not related to risk status.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 9","pages":"1778-1788"},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148215775","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 uterine scar dilemma: Outcomes of a restricted elective repeat cesarean section policy in a high-fertility, resource-limited setting","authors":"Raffaela Baiocchi,&nbsp;Giovanni Di Lorenzo,&nbsp;Keren Picucci,&nbsp;Laura Lamparelli,&nbsp;Khatera Wafa,&nbsp;Rabila Wafa,&nbsp;Najla Amiri,&nbsp;Sonia Saiedi,&nbsp;Mitra Omery,&nbsp;Tania Sayad,&nbsp;Spozhmai Asadzoi,&nbsp;Elena Magni,&nbsp;Giulia Butera,&nbsp;Davide De Santo,&nbsp;Federico Romano,&nbsp;Giuseppe Ricci,&nbsp;Martin Langer","doi":"10.1111/aogs.70219","DOIUrl":"10.1111/aogs.70219","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The global increase in cesarean section (CS) rates poses particular challenges in low- and middle-income countries (LMICs). In high-fertility, resource-limited settings, deciding the optimal mode of delivery for women with a uterine scar is complex. Elective repeat CS (ERCS) is often preferred over trial of labor after cesarean (TOLAC), despite limited evidence on its safety and feasibility. This study aimed to describe clinical management and birth outcomes among women with prior cesarean section managed under a restricted ERCS policy and to identify prognostic factors to inform delivery decisions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective observational cohort study at EMERGENCY Hospital, Panjshir Province, Afghanistan, from October 2016 to December 2021. ERCS was limited to women with clear medical indications. Maternal and neonatal outcomes were described separately for women scheduled for TOLAC and those scheduled for ERCS. Within the TOLAC group, logistic regression analyses identified predictors of successful vaginal birth after cesarean (VBAC) and adverse maternal and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2730 eligible women, 2621 (96.0%) attempted TOLAC, achieving a VBAC success rate of 88.2%. Uterine rupture occurred in 30 cases, all within the TOLAC group. Placenta accreta spectrum was the strongest predictor of adverse maternal outcomes, particularly in the ERCS group. Induction of labor with misoprostol was independently associated with neonatal mortality. Successful VBAC was associated with a single prior CS performed for indications other than obstructed labor and with spontaneous labor onset, particularly among women with a history of prior vaginal delivery. Maternal mortality was rare and unrelated to uterine scar complications. Overall, neonatal outcomes were favorable, with high rates of discharge in good condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Vaginal birth was achieved in the majority of women attempting TOLAC. A single prior CS performed for a non-obstructed labor indication and spontaneous labor onset was associated with higher VBAC success and favorable neonatal outcomes. Promoting VBAC, alongside careful decision-making regarding primary CSs, may reduce long-term maternal and neonatal risks associated with repeat CS and help mitigate the growing burden of operative deliveries in LMICs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 9","pages":"1717-1730"},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395451","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":"Salivary uric acid remote serial self-testing for prediction of adverse pregnancy outcomes of uteroplacental dysfunction","authors":"Basia Chmielewska,&nbsp;Chao Wang,&nbsp;Nick Macklon,&nbsp;Amar Bhide,&nbsp;Basky Thilaganathan","doi":"10.1111/aogs.70257","DOIUrl":"10.1111/aogs.70257","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hypertensive disorders of pregnancy (HDP) and fetal growth restriction (FGR) are major manifestations of uteroplacental dysfunction and remain leading causes of maternal and perinatal morbidity. Current strategies for risk assessment rely on hospital-based screening or diagnostic triage and do not provide continuous, personalized monitoring throughout pregnancy. Uric acid is closely linked to placental dysfunction, and salivary uric acid (sUA) reflects circulating concentrations, enabling noninvasive remote measurement. This study evaluated whether serial, smartphone-enabled self-testing of sUA could predict adverse pregnancy outcomes related to uteroplacental dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In this prospective observational cohort study, pregnant women were recruited at 20–22 weeks' gestation at a tertiary hospital. Participants performed weekly salivary self-testing using colorimetric uric acid strips until delivery, with results captured via a smartphone application. Images were analyzed using RGB color metrics. Primary outcomes were HDP and/or FGR, defined using ISSHP and FIGO criteria, respectively. Logistic regression models incorporated 4 weeks of lagged RGB-derived sUA metrics together with maternal characteristics. Model performance was assessed using area under the receiver operating characteristic curve (AUC) and calibration metrics, stratified by gestational age at outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 495 recruited participants, 318 women with complete longitudinal data were included in the final analysis; 36 (11.3%) developed HDP and/or FGR. A multivariable model combining maternal risk factors with 4 weeks of serial sUA measurements demonstrated good predictive performance. Discrimination was highest for preterm outcomes, with an AUC of 0.814 for prediction within 1 week at &lt;37 weeks' gestation and prediction remained acceptable at term (AUC 0.732).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Remote serial self-testing of salivary uric acid is feasible and shows good predictive ability for adverse pregnancy outcomes related to uteroplacental dysfunction. This noninvasive approach has potential to complement existing screening and surveillance strategies by enabling continuous, personalized risk assessment throughout pregnancy. Prospective validation in larger and more diverse populations is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 9","pages":"1761-1766"},"PeriodicalIF":3.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13394806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147939834","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}