Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Prevalence and timing of prenatal ultrasound findings in cytomegalovirus-infected pregnancies","authors":"Emma Van den Eede,&nbsp;Bart De Keersmaecker,&nbsp;Katrien Lagrou,&nbsp;Lennart Van der Veeken,&nbsp;Sanne Vanwinkel,&nbsp;Maja Vangoitsenhoven,&nbsp;Michael Aertsen,&nbsp;Luc De Catte","doi":"10.1111/aogs.15018","DOIUrl":"10.1111/aogs.15018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To investigate the prevalence and timing of prenatal neurosonographic abnormalities after primary cytomegalovirus seroconversion by the first trimester of pregnancy. The additional value of magnetic resonance imaging (MRI) and the correlation between cytomegalovirus viral load in amniotic fluid and adverse neonatal outcomes were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A retrospective study between 2006 and 2022 examined data from 440 women with amniocentesis for periconceptional and first-trimester cytomegalovirus seroconversion. Cases with positive amniocentesis and subsequent follow-up were included. Prenatal neurosonography, MRI, and clinical outcomes were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 190 women included, 37% (<i>n</i> = 70) presented with a normal neurosonography. Patients exhibiting abnormal neurosonography findings showed higher viral loads in amniotic fluid compared to those with a normal neurosonography (<i>p</i> = 0.002). In 26% (<i>n</i> = 49) the first abnormal ultrasound sign was already picked up at amniocentesis, and the most common ones were echogenic bowels (49%) and periventricular echogenicity (43%). With increasing gestational age, the likelihood of a new abnormal neurosonography finding decreases. MRI discovered additional abnormalities in 14% (<i>n</i> = 10).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results highlight the importance of combining diagnostic modalities, from amniocentesis to biweekly ultrasound monitoring and subsequent MRI evaluation, to capture the chronological progression and subsequent outcome of congenital cytomegalovirus.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"302-308"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765469","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":"Risk factors for complete uterine rupture in patients with trial of labor after cesarean delivery","authors":"Hortense Didier-Mathon,&nbsp;Gilles Kayem,&nbsp;Thibault Thubert,&nbsp;Loîc Sentilhes,&nbsp;Charles Garabedian,&nbsp;Thomas Schmitz,&nbsp;Diane Korb,&nbsp;Edouard Lecarpentier,&nbsp;François Goffinet,&nbsp;Cyril Raiffort,&nbsp;Marie-Victoire Senat,&nbsp;Elie Azria,&nbsp;Aude Ricbourg,&nbsp;Alix Defline,&nbsp;Pierre Delorme","doi":"10.1111/aogs.15017","DOIUrl":"10.1111/aogs.15017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Vaginal birth after cesarean delivery (VBAC) attempt is promoted to reduce cesarean-related morbidity, but it carries a risk of uterine rupture, posing significant maternal and neonatal risks. This study evaluated uterine rupture incidence and risk factors in a high VBAC attempt population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a 16-year retrospective multicenter case–control cohort study (2002–2018). Eleven French university hospitals participated. Women were included if they had a complete uterine rupture during a VBAC attempt. Two controls, defined as a VBAC attempt without uterine rupture, were randomly included for each case. We analyzed the risk factors of uterine rupture among the overall population and then among women who had labor induction and those who had spontaneous labor. Logistic regression was used to compute crude odds ratios (ORs) and 95% confidence intervals (CIs) for uterine rupture. Multivariable logistic regression was used to calculate adjusted ORs (aORs) and 95% CIs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 48 124 patients with a single prior cesarean section, 31668 (65.8%, 95% CI 65.3–66.2) had a VBAC attempt and 23 086 (72.9% 95% CI 72.4–73.4) had a successful vaginal delivery. The complete uterine rupture frequency was 0.63%. There were 199 cases of complete uterine rupture (0.63%, 95%CI 0.54–0.71) and 396 controls. Among the overall population, the odds of uterine rupture was inversely associated with prior vaginal delivery (adjusted odds ratio [aOR] 0.3, CI 95% 0.2–0.5) and positively with induction of labor (aOR 2.2, 95% CI 1.4–3.4). For women with spontaneous labor, the odds of uterine rupture was positively associated with a Bishop score&lt;6 (aOR 1.8, 95%CI 1.0–3.0), arrest of cervical dilatation of at least 1 hr. (aOR, 1.8 95%CI 1.1–2.9) and oxytocin augmentation (aOR 2.2 95% CI 1.3–3.7). For women undergoing labor induction, no factors were significantly associated with uterine rupture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Uterine rupture frequency was low among women with high rates of VBAC attempt and successful vaginal delivery and was reduced with previous vaginal birth and increased with induction of labor, regardless of the method used. It was associated with any dystocia during spontaneous labor and suspected macrosomia in induced women, which should be managed with caution.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"380-388"},"PeriodicalIF":3.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142764772","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":"Incremental yield of prenatal exome sequencing in fetuses with skeletal system abnormalities: A systematic review and meta-analysis","authors":"Yan Wang,&nbsp;Yuan Lv,&nbsp;Jia Yao,&nbsp;Hao Ding,&nbsp;Gang Li,&nbsp;Jianmin Li,&nbsp;Lizhu Chen","doi":"10.1111/aogs.15025","DOIUrl":"10.1111/aogs.15025","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 skeletal abnormalities can be caused by various factors and genetic cause plays an important role. Prenatal exome sequencing (ES) has been shown to be a powerful approach for accurate prenatal molecular diagnoses. Diagnostic yield of ES in fetal skeletal abnormalities varies significantly across studies. This study aimed to perform a systematic review of the literature and meta-analysis to assess the incremental yield of ES in fetuses with different kinds of skeletal abnormalities and a negative result on chromosome microarray or karyotyping.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Material and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched up to November 26, 2022. Relevant data were collected from observational studies containing five or more cases of skeletal abnormalities who underwent ES. The incremental yield of ES was evaluated by single proportion analysis and 95% confidence interval (CI), both according to the article features and individual phenotypes. This study was registered on PROSPERO as CRD42022382800.&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;Twenty-six studies including 524 individuals met the inclusion criteria. The pooled incremental yield was 60.2% (95% CI, 53.4%–66.9%) for all fetuses with skeletal abnormalities. In subgroup analysis, the additional diagnostic yield was 83.9% (95% CI, 76.4%–90.4%) in isolated dysplasia cases (group I), 52.0% (95% CI, 32.9%–70.9%) in dysplasia with non-skeletal abnormalities cases (group II), 33.3% (95% CI, 19.3%–48.6%) in isolate dysostoses cases (group III), 47.8% (95 % CI, 35.8%–60.0%) in dysostoses with non-skeletal abnormalities cases (group IV), 83.0% (95% CI, 63.7%–97.1%) in combination of the two phenotypes without non-skeletal abnormalities cases (group V), 74.5% (95% CI, 54.9%–90.9%) in combination of the two phenotypes with non-skeletal abnormalities cases (group VI). The origin of the pathogenic variations differed among the groups. Most causative variants were de novo in groups I (97/133, 72.9%), V (14/23, 60.9%), and VI (15/26, 57.7%). Meanwhile, pathogenic variations in III (18/25, 72.0%) and IV (37/67, 55.2%) were more often inherited from a parent.&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;ES had a favorable incremental yield in fetuses with skeletal abnormalities. The common pathogenic variations and genetic patterns of skeletal abnormalities vary among different subtypes. Interpreting this difference is beneficial for personalized clinical consultation.&lt;/p&gt;\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"604-614"},"PeriodicalIF":3.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749683","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":"Prenatal exposure to maternal hypertension and higher body mass index and risks of neurodevelopmental and psychiatric disorders during childhood","authors":"Samson Nivins,&nbsp;Parvin Kumar,&nbsp;Xinxia Chen,&nbsp;Mika Gissler,&nbsp;Catharina Lavebratt","doi":"10.1111/aogs.15021","DOIUrl":"10.1111/aogs.15021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hypertensive disorders of pregnancy (HDP) or prepregnancy overweight/obesity are independently associated with the risk for certain neurodevelopmental and psychiatric disorders in offspring. These two conditions often co-exist but the risk from combined exposure is unknown. We investigated whether specific subtypes of maternal HDP, along with prepregnancy overweight/obesity, were associated with the distinct risk of neurodevelopmental and psychiatric disorders in offspring during childhood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This prospective, population-based cohort study used data from 652 732 singleton children born alive in Finland between 2004 and 2014 and followed until 2018. The Cox proportional hazards model was used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Children exposed to both chronic hypertension and obesity exhibited a 2.4–3.5-fold higher risk for mood disorders, specific developmental disorder, autism spectrum disorders, and attention-deficit/hyperactivity disorders. Similarly, exposure to both gestational hypertension and overweight increased the risk for anxiety disorders and attention-deficit hyperactivity disorders by 2.4-fold. Meanwhile, combined exposure to preeclampsia and overweight increased the risk of mood and anxiety disorders, specific developmental disorders, and other behavioral disorders, by 1.8–2.2-fold. The effect size of combined exposure to HDP and overweight/obesity was greater than that of the individual exposure to HDP subtypes or overweight/obesity. Furthermore, overweight/obesity synergistically modified these associations between the HDP subtype exposure and offspring mental disorders, except for specific developmental disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that combined exposure to different subtypes of HDP and higher prepregnancy BMI have distinct impacts on the mental health of offspring. Notably, a more pronounced effect was observed in cases where chronic hypertension and obesity coexisted. Future research should focus on exploring dose-related relationships rather than amalgamating maternal HDP for investigating the offspring outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"319-330"},"PeriodicalIF":3.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749684","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":"Surgical outcomes of women undergoing radical resection of deep endometriosis of the sacral plexus: A prospective cohort study","authors":"Gernot Hudelist,&nbsp;Ezgi Darici Kurt,&nbsp;Gábor Szabó,&nbsp;Dominika Miklos,&nbsp;Theresa Hudelist,&nbsp;Attila Bokor","doi":"10.1111/aogs.15015","DOIUrl":"10.1111/aogs.15015","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;Surgical resection of sacral plexus endometriosis (SPE) is contemplated in severely symptomatic patients not responding to medical or hormonal therapy. However, there is only limited data on the effects of surgery on pain and neurological symptoms. This study aims to report on the surgical outcomes in terms of pain and neurological symptom reduction in women undergoing surgical resection of SPE.&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;Thirty premenopausal patients with histologically confirmed SPE who underwent surgical resection of the disease between 2018 and 2024 were included in this multicenter prospective analysis. The primary outcome was the change in neurological symptoms reflected by sacral radiculopathy including dysaesthesia, paraesthesia, hyperaesthesia, and pain. The secondary outcome was post-surgical morbidity reflected by rates of major intra- and postoperative complications.&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;All patients exhibited DE affecting the sacral roots S1-S4, whereas no case of isolated supracardinal sciatic nerve involvement was observed. Out of 30 patients, one was lost to follow-up leaving 29 patients for final analysis. Six (20%) of the 30 patients underwent partial resection of the sacral root because of endometriotic infiltration of the nerval tissue. In all other patients, dissection and shaving with cold scissors were sufficient to remove DE affecting the sacral root. Dysaesthesia was observed in 13/30 (43.3%), paraesthesia in 16/30 (53.3%), hyperaesthesia in 5/30 (16.7%), and secondary motor dysfunction in 4/30 (13.3%), preoperatively. The mean follow-up interval was 25.5 ± 20.2 months showing an overall improvement in sacral radiculopathy in 93.1% (27/29) of the patients. A significant decrease in numeric rating scale (NRS) scores of dysaesthesia (&lt;i&gt;p&lt;/i&gt; = 0.003), paraesthesia (&lt;i&gt;p&lt;/i&gt; ≤ 0.001) and hyperaesthesia (&lt;i&gt;p&lt;/i&gt; = 0.068) were observed post-surgically. Equally, reduced pain symptoms including dysmenorrhea, dyspareunia and dyschezia (all &lt;i&gt;p&lt;/i&gt; ≤ 0.001) with a relevant increase in post-surgical quality of life scores (&lt;i&gt;p&lt;/i&gt; ≤ 0.001) were recorded. De novo hyperaesthesia and paraesthesia occurred in 6.8% (2/29) and 3.4% (1/29) of the patients, respectively. Major Clavien-Dindo grade III complications occurred in 13.3% (4/30) of the cases.&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;Radical resection of symptomatic deep endometriosis affecting the sacral plexus reduces neurological and pain symptoms and leads to an increa","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"95-101"},"PeriodicalIF":3.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749686","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":"Correction to “Incidence and risk factors for umbilical cord prolapse in labor when amniotomy is used and with spontaneous rupture of membranes: A Swedish nationwide register study”","authors":"","doi":"10.1111/aogs.15027","DOIUrl":"10.1111/aogs.15027","url":null,"abstract":"<p>\u0000 \u0000 <span>Tallhage, S</span>, <span>Årestedt, K</span>, <span>Schildmeijer, Oscarsson M</span>. <span>Incidence and risk factors for umbilical cord prolapse in labor when amniotomy is used and with spontaneous rupture of membranes: a Swedish nationwide register study</span>. <i>Acta Obstet Gynecol Scand</i>. <span>2024</span>; <span>103</span>: <span>304</span>–<span>312</span>. doi:10.1111/aogs.14717.\u0000 </p><p>There is an error in Table 4, Country of origin, Born outside Sweden but in the EU, SROM. The current numbers are 247 (7.8), but the correct values are 24 (7.8). A total of 24 women with SROM were born outside of Sweden but in the EU.</p><p>We apologize for this error.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"245"},"PeriodicalIF":3.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737991","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":"Ultrasound visualization and blood flow velocity measurements of the adrenal arteries in the fetus","authors":"Øystein Bergøy,&nbsp;Torvid Kiserud,&nbsp;Jørg Kessler,&nbsp;Ingvild Dalen,&nbsp;Kristine Moi Økland,&nbsp;Ragnar Kvie Sande","doi":"10.1111/aogs.15011","DOIUrl":"10.1111/aogs.15011","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Detection and surveillance of fetal growth restriction (FGR) is well established, but there is still room for improvement. Animal studies indicate that compromised fetuses increase adrenal blood flow. Modern ultrasound equipment allows us to measure vascular impedance in the fetal adrenal arteries despite their modest size. However, extensive anatomical variance is a challenge to standardizing measurements. We set out to improve this.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We included 75 low-risk pregnant women in a prospective cross-sectional study aiming to develop a reliable technique to visualize and measure flow velocity in human fetal adrenal arteries. We used commercially available ultrasound equipment: a GE Voluson 10 2019 with a C2-9 probe (GE Healthcare, Zipf, Austria), and a Philips Epiq Elite with a V9-2 probe (Philips Medical Systems International B.V., Best, The Netherlands), exploiting the modern sensitive power Doppler modes in both scanners to visualize small vessels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 72 fetuses, the inferior adrenal artery was the most consistently visualized and measured artery to the gland. Doppler velocimetry was achieved in 66 (92%) participants. We found the anatomical variation described previously but were able to develop visualization strategies to identify the common arteries and use a consistent Doppler technique for the second half of pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>It is possible to visualize and measure flow velocity in the adrenal arteries of human fetuses. The success rate was highest for the inferior adrenal artery making this vessel a candidate for clinical studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"102-108"},"PeriodicalIF":3.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737996","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":"A novel multiple marker microarray analyzer and methodology to predict major obstetric syndromes using surface markers of circulating extracellular vesicles from maternal plasma","authors":"Malene Møller Jørgensen,&nbsp;Rikke Bæk,&nbsp;Jenni K. Sloth,&nbsp;Rami Sammour,&nbsp;Adi Sharabi-Nov,&nbsp;Manu Vatish,&nbsp;Hamutal Meiri,&nbsp;Marei Sammar","doi":"10.1111/aogs.15020","DOIUrl":"10.1111/aogs.15020","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;Placental-derived extracellular vesicles (EVs) are nano-organelles that facilitate intercellular communication between the feto-placental unit and the mother. We evaluated a novel Multiple Microarray analyzer for identifying surface markers on plasma EVs that predict preterm delivery and preeclampsia compared to term delivery controls.&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;In this prospective exploratory cohort study pregnant women between 24 and 40 gestational weeks with preterm delivery (&lt;i&gt;n&lt;/i&gt; = 16), preeclampsia (&lt;i&gt;n&lt;/i&gt; = 19), and matched term delivery controls (&lt;i&gt;n&lt;/i&gt; = 15) were recruited from Bnai Zion Medical Center, Haifa, Israel. Plasma samples were tested using a multiple microarray analyzer. Glass slides with 17 antibodies against EV surface receptors - were incubated with raw plasma samples, detected by biotinylated secondary antibodies specific to EVs or placental EVs (PEVs), and labeled with cyanine 5–streptavidin. PBS and whole human IgG served as controls. The fluorescent signal ratio to negative controls was log 2 transformed and analyzed for sensitivity and specificity using the area under the receiver operating characteristics curves (AUROC). Best pair ratios of general EVs/PEVs were used for univariate analysis, and top pairs were combined for multivariate analysis. Results were validated by comparison with EVs purified using standard procedures.&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;Heatmaps differentiated surface profiles of preeclampsia, preterm delivery, and term delivery receptors on total EVs and PEVs. Similar results were obtained with enriched EVs and EVs from raw plasma. Univariate analyses identified markers predicting preterm delivery and preeclampsia over term delivery controls with AUC &gt;0.6 and sensitivity &gt;50% at 80% specificity. Combining the best markers in a multivariate model, preeclampsia prediction over term delivery had an AUC of 0.89 (95% CI: 0.72–1.0) with 90% sensitivity and 90% specificity, marked by inflammation (TNF RII), relaxation (placenta protein 13 (PP13)), and immune-modulation (LFA1) receptors. Preterm delivery prediction over term delivery had an AUC of 0.97 (0.94–1.0), 84% sensitivity, and 90% specificity, marked by cell adhesion (ICAM), immune suppression, and general EV markers (CD81, CD82, and Alix). Preeclampsia prediction over preterm delivery had an AUC of 0.91 (0.79–0.99) with 80% sensitivity and 90% specificity with markers for complement activation (C1q) and autoimmunity markers.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"151-163"},"PeriodicalIF":3.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737979","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":"Strong evidence of an association between hysterectomy and urinary incontinence","authors":"Karen Ruben Husby,&nbsp;Niels Klarskov","doi":"10.1111/aogs.15024","DOIUrl":"10.1111/aogs.15024","url":null,"abstract":"<p>Sir,</p><p>We would like to express our gratitude to the authors for publishing their important and thought-provoking study on risk of urinary incontinence (UI) subsequent to hysterectomy.<span>¹</span></p><p>We agree with the authors on the need for a thorough investigation into long-term complications after hysterectomy including risk of subsequent urinary incontinence.</p><p>However, we have concerns regarding the study's methodology, which may account for the study's finding of no association between hysterectomy and UI, in contrast to the robust evidence supporting such an association in previous well-designed population-based studies.<span>^{2, 3}</span></p><p>First, we note that women in the hysterectomy group with a pre-existing diagnosis of UI were excluded (7.8%), while no such exclusions were applied to the control group. This creates a substantial imbalance between the compared groups, as the hysterectomy cohort is selectively screened to include only women without UI at the time of surgery. While we understand the authors' intention to isolate the effect of the hysterectomy itself by excluding pre-existing symptoms, such an approach necessitates similar exclusion criteria for the control group to ensure comparability between the two groups.</p><p>Secondly, there is a notable difference in the timeframes during which women in the two groups were eligible to be diagnosed with UI or to undergo UI surgery. The study includes women up to the age of 54, while the mean age for hysterectomy in the group is 45 years. This leaves limited follow-up time after hysterectomy and may skew the risk of being diagnosed or undergo surgery for UI in the two groups. It does not appear that the authors have adjusted for timeframes or differences in age distribution between the two groups.</p><p>The authors themselves acknowledge that the evidence on the association between hysterectomy and UI is conflicting. However, this is largely due to two smaller studies of questionable nature including one study following women for 30 days post hysterectomy only<span>⁴</span> and one study excluding all women undergoing a UI surgery post hysterectomy (5%) in the hysterectomy group.<span>⁵</span> In contrast, larger, well-designed studies have consistently found a significant association,<span>^{2, 3}</span> providing robust evidence of the increased risk of UI following hysterectomy.</p><p>Given the substantial evidence supporting an association between hysterectomy and subsequent UI, it is essential for gynecologists to be aware of this risk and to discuss it with patients as part of the decision-making process when considering hysterectomy.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"781"},"PeriodicalIF":3.5,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142737993","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":"Predicting vaginal delivery after labor induction using machine learning: Development of a multivariable prediction model","authors":"Iolanda Ferreira,&nbsp;Joana Simões,&nbsp;João Correia,&nbsp;Ana Luísa Areia","doi":"10.1111/aogs.14953","DOIUrl":"10.1111/aogs.14953","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Induction of labor, often used for pregnancy termination, has globally rising rates, especially in high-income countries where pregnant women present with more comorbidities. Consequently, concerns on a potential rise in cesarean section (CS) rates after induction of labor (IOL) demand for improved counseling on delivery mode within this context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We aim to develop a prognostic model for predicting vaginal delivery after labor induction using computational learning. Secondary aims include elaborating a prognostic model for CS due to abnormal fetal heart rate and labor dystocia, and evaluation of these models' feature importance, using maternal clinical predictors at IOL admission. The best performing model was assessed in an independent validation data using the area under the receiver operating curve (AUROC). Internal model validation was performed using 10-fold cross-validation. Feature importance was calculated using SHAP (SHapley Additive exPlanation) values to interpret the importance of influential features. Our main outcome measures were mode of delivery after induction of labor, dichotomized as vaginal or cesarean delivery and CS indications, dichotomized as abnormal fetal heart rate and labor dystocia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our sample comprised singleton term pregnant women (<i>n</i> = 2434) referred for IOL to a tertiary Obstetrics center between January 2018 and December 2021. Prediction of vaginal delivery obtained good discrimination in the independent validation data (AUROC = 0.794, 95% CI 0.783–0.805), showing high positive and negative predictive values (PPV and NPV) of 0.752 and 0.793, respectively, high specificity (0.910) and sensitivity (0.766). The CS model showed an AUROC of 0.590 (95% CI 0.565–0.615) and high specificity (0.893). Sensitivity, PPV and NVP values were 0.665, 0.617, and 0.7, respectively. Labor features associated with vaginal delivery were by order of importance: Bishop score, number of previous term deliveries, maternal height, interpregnancy time interval, and previous eutocic delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This prognostic model produced a 0.794 AUROC for predicting vaginal delivery. This, coupled with knowing the features influencing this outcome, may aid providers in assessing an individual's risk of CS after IOL and provide personalized counseling.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"164-173"},"PeriodicalIF":3.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724625","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}