Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Sequential prenatal diagnosis of fetal skeletal dysplasia: A cohort study","authors":"Mengting Jiang,&nbsp;Bin Zhang,&nbsp;Jing Wang,&nbsp;Wei Qiao,&nbsp;Xiuzhen Mao,&nbsp;Bin Yu","doi":"10.1111/aogs.15095","DOIUrl":"10.1111/aogs.15095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Genetic factors are considered to be the main factors leading to fetal skeletal dysplasia (SD), and chromosomal microarray analysis (CMA) has been used clinically for the detection of SD fetuses. At present, whole exome sequencing (WES) has been applied in SD fetuses, but there is still a lack of data accumulation. The aim of this study is to perform sequential prenatal diagnosis for fetuses with SD indicated by ultrasound and to explore the clinical value of CMA followed by WES.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>From January 2019 to May 2024, 147 fetuses with SD were detected by prenatal ultrasound screening. After the collection of amniotic fluid or abortive tissue, CMA was performed first, then WES was performed in the cases with a negative CMA result.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>147 cases accepted the prenatal CMA test, and 23 cases were reported to have chromosomal abnormalities, including 9 cases of chromosomal aneuploidies, 11 cases of pathogenic copy number variants, and 3 cases of likely pathogenic copy number variants. The detection rate of chromosomal abnormalities by the prenatal CMA test was 15.6% (23/147). 58 cases with negative results of CMA underwent WES, and 21 genes with pathogenic/likely pathogenic variants were detected in 21 cases, including <i>FGFR3</i>, <i>COL2A1</i>, <i>COL1A1</i>, <i>COL1A2</i>, <i>RUNX2</i>, <i>LMX1B</i>, <i>GLI3</i>, <i>SHOX</i>, <i>ALPL</i>, and <i>DYNC2H1</i>. The rate of abnormal prenatal WES was 36.2% (21/58). In the subgroup analysis of the SD phenotype, the detection rate of chromosomal abnormalities in isolated SD fetuses was 7.7% (7/91), which was significantly lower than that in SD fetuses combined with other system abnormalities (28.6%, 16/56) (<i>p</i> = 0.001). The detection rate of monogenic abnormalities in short long bones with other skeletal abnormalities was 62.5% (10/16), which was higher than that in short long bones with non-skeletal abnormalities 10.5% (2/19), and the difference was statistically significant (<i>p</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SD is mostly caused by monogenic abnormalities, and prenatal WES has significantly improved the detection rate of SD fetuses. The prenatal WES can be used as an important molecular genetic testing method combined with CMA in the sequential prenatal diagnosis of SD fetuses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"860-874"},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539415","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 lymph ascites after surgery for endometrial cancer and impact on lymphedema of the legs. A prospective longitudinal Swedish multicenter study","authors":"Madelene Wedin,&nbsp;Karin Glimskär Stålberg,&nbsp;Ulrika Ottander,&nbsp;Åsa Åkesson,&nbsp;Gabriel Lindahl,&nbsp;Ninnie Borendal Wodlin,&nbsp;Preben Kjølhede","doi":"10.1111/aogs.15077","DOIUrl":"10.1111/aogs.15077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The primary aim was to determine the occurrence of lymph ascites 4–6 weeks after surgery for endometrial cancer. Secondary aims were to assess risk factors for lymph ascites and the association with lymphedema of the legs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a post hoc analysis of an observational prospective multicenter study, performed in 14 Swedish hospitals that included 235 women undergoing surgery for early-stage endometrial cancer between June 2014 and January 2018; 116 underwent surgery including pelvic and para-aortic lymphadenectomy and 119 had surgery without lymphadenectomy. Lymph ascites (free intraabdominal fluid or encapsulated pelvic or para-aortic fluid) was assessed by vaginal ultrasound 4–6 weeks postoperatively. Lymphedema was assessed using circumferential measurements of the legs preoperatively and 1 year postoperatively, enabling estimation of leg volume. A BMI-standardized leg volume increase ≥10% was classified as lymphedema. Evaluation of risk factors was performed using multiple logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Lymph ascites 4-6-weeks postoperatively occurred in 28.5% (67/235) of the women. The estimated volume of the lymph ascites in these women was mean 28 mL (standard deviation 48 mL) and median 14 mL (interquartile range 2–36 mL). Lymphadenectomy was a risk factor for lymph ascites (aOR 9.97; 95% CI 4.53–21.97) whereas the use of minimally invasive surgery (aOR 0.50; 95% CI 0.25–0.99) reduced the risk. Twenty-two of 231 women (9.5%) developed lymphedema of the legs 1 year after surgery. The presence of lymph ascites was predictive of lymphedema (aOR 3.90; 95% CI 1.52–9.96).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lymph ascites was common 4–6 weeks after surgery but in a low and clinically insignificant volume. Lymphadenectomy was a strong risk factor for lymph ascites and the use of minimally invasive surgery seemed to reduce the risk. Detection of lymph ascites at early postoperative follow-up may be a means of selecting patients at high risk of developing lymphedema after treatment with endometrial cancer for preventive measures against lymphedema progression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"976-987"},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539964","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":"Longitudinal study of family formation in 892 women and 193 men 8 years after visiting the Fertility Assessment and Counselling (FAC) clinic","authors":"Randi Sylvest,&nbsp;Ida Vittrup,&nbsp;Ditte Vassard,&nbsp;Marte Saupstad,&nbsp;Søren Ziebe,&nbsp;Elisabeth Larsen,&nbsp;Helene Westring Hvidman,&nbsp;Kathrine Birch Petersen,&nbsp;Henriette S. Nielsen,&nbsp;Lone Schmidt,&nbsp;Anja Pinborg","doi":"10.1111/aogs.15071","DOIUrl":"10.1111/aogs.15071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Globally, in high-income countries, couples have been delaying family building. However, postponed childbearing implies a higher risk of declining fertility, not achieving desired family size and ultimately involuntary childlessness. The Fertility Assessment and Counseling (FAC) clinic was established to provide information about individuals' current fertility status, aiming to prevent infertility and support the realization of desired family sizes. The aim is to explore the reproductive outcomes and health behaviors 8 years after attending fertility assessment and counseling in the FAC clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Cohort study including women and men who attended the FAC clinic in Copenhagen, Denmark, from 2011 to 2017. From June 2011 until July 2017 2635 women and 1073 men attended fertility counseling at the FAC clinic. Eight years later, an electronic questionnaire was distributed to collect information on subsequent pregnancies and deliveries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The follow-up questionnaire had a response rate of 34% (<i>n</i> = 892) for women and 18% for men (<i>n</i> = 193). The mean age for the subgroup of 892 women who responded at 8 years follow-up was 32.6 (±SD 4.4) years at baseline which was equal to the total cohort of 2635 women at baseline (32.7 (±SD 4.7) years). Most of the women (75%) and men (96%) were in a heterosexual relationship at follow-up. A total of 85% of the 892 women had conceived after the baseline FAC visit. Among those having conceived, the mean number of pregnancies was 2.10 per woman (±SD 1.1). In total, 703 (79%) of the 892 women had delivered at least one child. Among women having delivered, the average number of children was 2.0 (±SD 0.6). Among the men, 91% had conceived with their partner. Women and men were smoking less and drinking less alcohol at the follow-up compared to the baseline visit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This follow-up study emphasizes the importance of fertility assessment and counseling for women and couples during reproductive age, a critical period when decisions about family building are made.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"922-936"},"PeriodicalIF":3.5,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536334","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 severity of second-degree perineal tears and dyspareunia during one year postpartum: A prospective cohort study","authors":"Jeanette Risløkken,&nbsp;Marthe Dalevoll Macedo,&nbsp;Kari Bø,&nbsp;Marie Ellström Engh,&nbsp;Franziska Siafarikas","doi":"10.1111/aogs.15084","DOIUrl":"10.1111/aogs.15084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Childbirth-related injuries of the pelvic floor may impact women's sexual health with symptoms such as dyspareunia. A better understanding of dyspareunia based on tissue trauma severity in second-degree tears is needed. The primary aim of this study was to assess differences in dyspareunia according to the severity of perineal tears, with a focus on subcategories of second-degree tears at three and twelve months postpartum. The secondary aim was to assess the time to resumption of intercourse after birth according to the severity of second-degree tears.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This single-center observational cohort study was conducted between January 2021 and July 2022. Women meeting the inclusion criteria were included during pregnancy. After birth, all perineal tears were classified according to RCOG recommendation, and second-degree tears were further subcategorized based on the percentage of damage to the perineum (2A, 2B, 2C). Dyspareunia and time to resumption of intercourse were collected through an electronic questionnaire at three and twelve months postpartum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our study included 857 women; of them, 51.6% (<i>n</i> = 442) were primipara and 48.4% (<i>n</i> = 415) were multipara. The percentages of women reporting dyspareunia according to the degree of the tear at three months postpartum were as follows: no tear/first-degree tear 60%, 2A-tear 60%, 2B-tear 52%, 2C-tear 77%, and episiotomy 77%; and at twelve months postpartum: no tear/first-degree tear 52%, 2A-tear 50%, 2B-tear 40%, 2C-tear 69%, and episiotomy 64%. When comparing dyspareunia between the no tear/first-degree tear category and the second-degree subcategories, no statistically significant differences were found. Women in all second-degree subcategories resumed intercourse approximately 4.8 months postpartum, compared to 3.8 months postpartum for those with no tear or first-degree tear (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was no statistically significant association between the severity of second-degree tears and dyspareunia. The proportion of women reporting dyspareunia is noticeable for all perineal tear categories, with the highest rate among women with the most severe second-degree perineal tear. Women in all second-degree subcategories resumed intercourse approximately one month later than those with no tear or first-degree tear.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"968-975"},"PeriodicalIF":3.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514337","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":"Endothelial damage and complement dysregulation in fetuses from pregnancies complicated by preeclampsia","authors":"Alex Ramos,&nbsp;Lina Youssef,&nbsp;Patricia Molina,&nbsp;Julia Martinez-Sanchez,&nbsp;Ana Belen Moreno-Castaño,&nbsp;Miquel Blasco,&nbsp;Blanca De Moner,&nbsp;Marta Tortajada,&nbsp;Marta Camacho,&nbsp;Maria Borrell,&nbsp;Francesca Crovetto,&nbsp;Marc Pino,&nbsp;Gines Escolar,&nbsp;Enric Carreras,&nbsp;Eduard Gratacos,&nbsp;Maribel Diaz-Ricart,&nbsp;Marta Palomo,&nbsp;Fatima Crispi","doi":"10.1111/aogs.15072","DOIUrl":"10.1111/aogs.15072","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;Our objective was to evaluate the endothelial function profile and complement system in fetuses from preeclamptic pregnancies using ex vivo and in vitro approaches.&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 total of 66 singleton pregnancies were prospectively recruited comprising 34 cases of preeclampsia and 32 normotensive pregnancies matched for baseline characteristics. In the ex vivo approach, soluble tumor necrosis factor-a receptor 1 (sTNFR1), vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1), Von Willebrand factor (sVWF), terminal complement complex (sC5b-9), Factor H, complement component C3a and Factor Bb were analyzed in fetal cord blood samples. In the in vitro model, vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), Von Willebrand factor (VWF), vascular endothelial cadherin (VE-Cadherin), endothelial nitric oxide synthase (eNOS), reactive oxygen species (ROS) and C5b-9 deposits were evaluated on endothelial cells in culture exposed to fetal sera or plasma.&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;Increased sVCAM-1, sICAM- l and decreased Factor H and Factor Bb concentrations were detected in preeclampsia fetuses as compared to fetuses from normotensive mothers (509.4 ± 28 vs. 378.4 ± 34.3 ng/mL, 161.1 ± 11.9 vs. 114.8 ± 6.8, 199.6 ± 18.3 vs. 267.1 ± 15.4 ng/mL and 6.6 ± 0.7 vs. 10.3 ± 1.4 μg/mL respectively, &lt;i&gt;p&lt;/i&gt; &lt; 0.05) with similar results in sTNFR1, sVWF, sC5b-9 and C3a. Endothelial cells exposed to fetal sera from preeclampsia showed incremented expression of VCAM-1(38.1 ± 1.4% vs. 28.3 ± 1.6%, &lt;i&gt;p&lt;/i&gt; &lt; 0.01), ICAM-1 (12 ± 0.9% vs. 8.6 ± 0.6%, &lt;i&gt;p&lt;/i&gt; &lt; 0.05), VWF (43.5 ± 2.9% vs. 3.7 ± 0.3%, &lt;i&gt;p&lt;/i&gt; &lt; 0.05), and ROS (5 × 10&lt;sup&gt;13&lt;/sup&gt; ± 1 × 10&lt;sup&gt;12&lt;/sup&gt; vs. 3.5 × 10&lt;sup&gt;13&lt;/sup&gt; ± 1.4 × 10&lt;sup&gt;12&lt;/sup&gt;, &lt;i&gt;p&lt;/i&gt; &lt; 0.01) with similar expression of VE-Cadherin and eNOS as compared to those exposed to control fetuses. While soluble C5b-9 was similar between the study groups (851.4 ± 177.5 vs. 751.4 ± 132.81 ng/mL, &lt;i&gt;p&lt;/i&gt; &gt; 0.05), significantly less C5b-9 deposits on endothelial cells were induced by fetal plasma from preeclamptic compared to normotensive mothers (fold change 0.08 ± 0.02 vs. 0.48 ± 0.13, &lt;i&gt;p&lt;/i&gt; &lt; 0.01).&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;High levels of endothelial adhesion molecules and oxidative stress products suggest endothelial damage and reduced in vitro deposition of C5b-9 indicates complement dysregulation in preeclamps","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"829-838"},"PeriodicalIF":3.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal postpartum six-week check and short-term health outcomes for women with hypertensive disorders in pregnancy: An observational study using the Clinical Practice Research Datalink (CPRD)","authors":"Rema Ramakrishnan,&nbsp;Diane Korb,&nbsp;Yangmei Li,&nbsp;Marian Knight,&nbsp;Claire Carson","doi":"10.1111/aogs.15068","DOIUrl":"10.1111/aogs.15068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In the UK, in addition to the recommended blood pressure check, women with hypertensive disorders of pregnancy are offered a postpartum six-week check (SWC) with either a specialist or general practitioner. We aimed to describe the prevalence and disparities in the provision of SWC, and describe short-term postpartum outcomes among women with hypertensive disorders of pregnancy by SWC status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Data were from the UK Clinical Practice Research Datalink GOLD for women aged 15–49 years at childbirth in 2000–2018, who were diagnosed with hypertensive disorders of pregnancy, and were registered for ≥12 months postpartum. Trends in SWC prevalence and differences in characteristics and short-term postpartum outcomes of women by SWC status were described. Multivariable modified Poisson regression was used to compute risk ratio of a SWC for severe hypertensive disorders of pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 30 483 women, 61.4% had a SWC. The proportion of women who received a SWC check was highest in 2007 (66.8%) but subsequently decreased. Women were less likely to have a SWC record if they were younger, of a minoritised ethnicity, living in more deprived areas, were multiparous, had severe hypertensive disorders of pregnancy, preterm birth, caesarean birth, or had a low birthweight baby. Compared to women who did not have a SWC, a higher proportion of women with SWC had their blood pressure recorded (SWC 47.4%, no SWC 39.9%), and had a diagnosis of postpartum depression (SWC 13.6%, no SWC 11.1%). There were no substantial differences in other short-term postpartum outcomes by SWC status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There may be missed opportunities in postpartum care among women with hypertensive disorders of pregnancy. Our findings highlight the need to ensure that general postpartum care is not overlooked in women with specific morbidities in pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"937-947"},"PeriodicalIF":3.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490345","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":"Sexual function and pelvic floor function five years after hysterectomy","authors":"Catharina Forsgren,&nbsp;Ulrika Johannesson","doi":"10.1111/aogs.15069","DOIUrl":"10.1111/aogs.15069","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 effects of benign hysterectomy on sexual function and pelvic floor remain uncertain. Our objective was to investigate the effects of hysterectomy on pelvic floor and sexual function 5 years postoperatively.&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 conducted a prospective cohort study involving 260 women scheduled for hysterectomy, who were followed for 5 years' post-surgery. Participants completed three validated questionnaires: Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20) and Female Sexual Function Index (FSFI). Nonparametric statistics and mixed effect models were used to analyze the data.&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;After exclusion, 242 women were included, with a response rate of 145/242 (60%) for all questionnaires at the five-year follow-up. There was an overall reduction of more than 50% in pelvic floor symptoms after 5 years (mean PFIQ-7 score 42.5) (SD 51.7) to 20.3 (SD 40.7) (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The degree of bother and distress caused by pelvic floor symptoms also significantly decreased (mean PFDI-20 score 69.6) (SD 51.1) to 58.2 (SD 53.2) (&lt;i&gt;p&lt;/i&gt; &lt; 0.01). No significant change in overall sexual function was observed 5 years' post-hysterectomy (mean FSFI score 17.9) (SD 11.7) to 18.1 (SD 11.6) (&lt;i&gt;p&lt;/i&gt; = 0.73). However, participants who were sexually active at the time of hysterectomy, reported a decline in sexual function over time, (mean FSFI 25.2) (SD 6.6) to 19.6 (SD 10.8) (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). In contrast, women non-sexually active at the time of hysterectomy reported an improvement of sexual function. Additionally, there was an association before surgery, between pelvic floor dysfunction (mean PFDI-20 score) and low sexual function (mean FSFI score) (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). The route of hysterectomy (robotic assisted total laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy), age at surgery, and the number of vaginal deliveries had no impact on pelvic floor function or sexual function (mean PFIQ-7, PFDI-20, FSFI scores).&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;Five years after hysterectomy, women experienced less pelvic floor symptoms compared to preoperatively. Women reported no change in overall sexual function, nevertheless there was a decline of sexual function among those who were sexually active before surgery. In contrast, non-sexually active women recognized improved sexual function after 5 years, indicating a plausible surgery-related symptom relief","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"948-957"},"PeriodicalIF":3.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490346","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":"Ensuring safety first: GLP-1RAs in reproductive and endometrial research","authors":"Paola Viganò,&nbsp;Maira Casalechi,&nbsp;Andrea Salonia,&nbsp;Edgardo Somigliana","doi":"10.1111/aogs.15060","DOIUrl":"10.1111/aogs.15060","url":null,"abstract":"&lt;p&gt;Sir,&lt;/p&gt;&lt;p&gt;Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have recently revolutionized the pharmacological management of type 2 diabetes and demonstrated significant potential in addressing other diseases, most notably obesity and metabolic disorders. Furthermore, these novel therapeutics show promise in treating conditions such as neurodegenerative diseases, fatty liver disease, dyslipidemia, atherosclerosis, and cardiovascular diseases.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Sola-Leyva and coauthors recently reviewed the role of GLP-1 and GLP-1R in modulating female reproductive function and proposed a future research agenda to elucidate the molecular mechanisms underlying the effects of GLP-1 and its agonists on the endometrium.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Their review emphasized the impact of GLP-1RAs on various cellular activities within endometrial tissue. On the one hand, available evidence suggests that GLP-1RAs induce autophagy and inhibit cell growth in endometrial cancer cell lines; on the other, they reduce histological degeneration and fibrosis in the endometrium of animal models, primarily by counteracting inflammation and oxidative stress. Based on this evidence, the authors proposed that GLP-1RAs might &lt;i&gt;alleviate endometrial dysfunction&lt;/i&gt; and potentially &lt;i&gt;enhance assisted reproductive technology&lt;/i&gt; (&lt;i&gt;ART&lt;/i&gt;) &lt;i&gt;outcomes&lt;/i&gt; in women with obesity or polycystic ovary syndrome. Their proposed research agenda included investigating the effects of GLP-1RAs on the multiomics landscape and metabolic profile of endometrial tissue, as well as their impact on in vitro embryo implantation models.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Overall, the review of Sola-Leyva and coauthors&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; provides us several points with an interesting link to different aspects in the field of human reproduction. However, while the review abstract mentioned the potential teratogenic effects of GLP-1RAs, surprisingly this critical clinical issue was not adequately addressed throughout the main text. According to recent US Food and Drug Administration labels for semaglutide, the drug should be discontinued at least 2 months before any planned pregnancy due to its potential adverse developmental outcomes and long washout period.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; The notes reported embryofetal mortality, structural abnormalities and alterations to growth in pregnant rats. In rabbits, early pregnancy losses and increased incidences of minor visceral (kidney, liver) and skeletal abnormalities were documented at clinically relevant exposures. Similarly, in a pre- and postnatal development study in cynomolgus monkeys, subcutaneous administration from gestation Day 16 to 140 resulted in increased early pregnancy losses and smaller offspring at doses ≥2× human exposure levels.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; Likewise, the European Medicines Agency also informed in 2024 that women of childbearing potential should use contraception during semaglutide treatment. T","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"998-999"},"PeriodicalIF":3.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482003","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":"Indeed, safety comes first for the use of GLP-1RAs","authors":"Amruta D. S. Pathare,&nbsp;Alberto Sola-Leyva,&nbsp;Apostol Apostolov,&nbsp;Ganesh Acharya,&nbsp;Andres Salumets","doi":"10.1111/aogs.15090","DOIUrl":"10.1111/aogs.15090","url":null,"abstract":"&lt;p&gt;Sir,&lt;/p&gt;&lt;p&gt;Thank you for the opportunity to respond to a letter to the editor by Viganò et al. regarding our recently published review article in Acta Obstetricia et Gynecologica Scandinavica (AOGS).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; They felt that the issue of possible teratogenicity and clinical safety has not been sufficiently addressed by our review.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Glucagon-like peptide-1 (GLP-1), an incretin hormone, plays a crucial role in maintaining glucose homeostasis, insulin sensitivity, and body weight under normal physiological circumstances. Thus, a normally functioning GLP-1 system would evidently have a direct positive impact on female reproductive health, predominantly regulating hormonal balance and optimal ovarian function that could support natural conception. Disruptions in the GLP-1 system, as seen in conditions like obesity and polycystic ovary syndrome (PCOS), can interfere with female reproductive health. GLP-1 receptor agonists (GLP-1RAs) mimic the action of GLP-1 and have been proven effective in improving glycemic control, showing remarkable potential in managing obesity and PCOS. Furthermore, the occurrence of numerous unplanned pregnancies during GLP-1RAs treatment underscores the need to understand the mechanism of GLP-1 (RAs) on female fertility and its safety during the pre-implantation period, on exposed fetuses, and long-term effects on children after birth.&lt;/p&gt;&lt;p&gt;In our recent review, we addressed this knowledge gap by outlining the effect of GLP-1RAs on female fertility, especially in obese and PCOS patients, with a specific focus on endometrium and implantation.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Based on initial animal model studies and clinical studies in women, the GLP-1RAs treatment could be promising for alleviating female infertility. However, as mentioned in the key message of our review, “it is crucial to understand the limited evidence available, and their use should be approached with caution, considering potential side effects.”&lt;/p&gt;&lt;p&gt;Viganò et al. raised a concern that our review should have better addressed the safety concerns related to potential teratogenicity and adverse developmental outcomes,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; citing some animal studies that have shown evidence of adverse outcomes after exposure to GLP-1RA during pregnancy. However, a recent observational population-based cohort study among women with type 2 diabetes exposed to GLP-1RA from 90 days before pregnancy to the end of the first trimester did not show a significantly higher risk of major congenital malformations beyond the baseline risk associated with type 2 diabetes.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Similarly, no major birth defects were reported in another cohort study among the women exposed to GLP-1RA in early pregnancy, either for diabetes or obesity treatment.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Nevertheless, ambiguous study design and data analysis of recent clinical studies have resulted in debatable conclusions on teratogenicity, emb","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 5","pages":"1000-1001"},"PeriodicalIF":3.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481948","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":"Association of oral contraceptives and risk of endometrial cancer: A systematic review and meta-analysis","authors":"András Harajka,&nbsp;Tímea Hercsik,&nbsp;Isabel Pinto Amorim das Virgens,&nbsp;Izabella Máthé,&nbsp;Zsófia Tornyossy,&nbsp;Ali AlFarwi,&nbsp;Fanni Adél Meznerics,&nbsp;Szilvia Kiss-Dala,&nbsp;Péter Fehérvári,&nbsp;Rita Nagy,&nbsp;Ferenc Bánhidy,&nbsp;Attila Majoros,&nbsp;Sándor Valent,&nbsp;Péter Hegyi,&nbsp;Nándor Ács","doi":"10.1111/aogs.15043","DOIUrl":"10.1111/aogs.15043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although the relationship between the use of oral contraceptives and reduced endometrial cancer risk has now long been established, the need for female patients to be informed on this matter based on the latest results of scientific research remains. To help the evidence-based decision-making of women when choosing contraception methods, we aimed to provide them with an up-to-date overview and summary of past and recent findings on the association between the use of oral contraceptives and endometrial cancer risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This study was registered in PROSPERO: CRD42022379871. PubMed, Embase, and Cochrane Library databases were searched on the December 5, 2022, to identify eligible articles. We included all experimental and observational studies that reported the number of users and non-users of oral contraceptives among patients diagnosed or not with endometrial cancer. Data were extracted, and random-effects meta-analysis was performed to obtain summary odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity across studies was assessed using Higgins &amp; Thompson's <i>I</i>² statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-six studies were eligible for qualitative synthesis, of which twenty-five were eligible for quantitative analysis. The use of oral contraceptives was inversely associated with the odds of having endometrial cancer (OR = 0.61, CI: 0.46–0.80). The long-term use of oral contraceptives led to the greatest odds reduction in having endometrial cancer (≥10 years: OR = 0.31, CI: 0.13–0.70), while shorter periods were also associated with a significant decrease in these odds, although to a lesser extent (≥5 years: OR = 0.39, CI: 0.23–0.64; &lt;5 years: OR = 0.66, CI: 0.48–0.91).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The administration of oral contraceptives is time dependently associated with lower odds of having endometrial cancer, suggesting a protective association between the use of oral contraceptives and endometrial cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 4","pages":"591-603"},"PeriodicalIF":3.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466699","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}