Acta Obstetricia Et Gynecologica Scandinavica[JOURNAL]
Sun
200 papers
Prospective evaluation of the Simple Fetal Medicine Foundation's first-trimester prediction model for preeclampsia in twin pregnancies.
Liu C, Li J, Chen Y … +4 more , Wu T, Meng Q, Zhang K, Wei Y
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42400128 · Publisher ↗
INTRODUCTION: 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...
INTRODUCTION: 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 weeks' gestation in twin pregnancies. MATERIAL AND METHODS: This was a prospective, non-intervention study in 464 twin pregnancies (including dichorionic twins and monochorionic twins) at 11-13weeks' 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. RESULTS: 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. CONCLUSIONS: 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.
Externally validated risk prediction models for gestational diabetes mellitus: A systematic review and meta-analysis.
Seifu BL, Belsti Y, Yimer NB … +3 more , Goldstein RF, Enticott J, Teede H
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42394160 · Publisher ↗
INTRODUCTION: Risk prediction models for gestational diabetes mellitus (GDM) offer potential for early identification and targeted prevention. External validation is crucial to assess model performance across diverse pop...
INTRODUCTION: Risk prediction models for gestational diabetes mellitus (GDM) offer potential for early identification and targeted prevention. External validation is crucial to assess model performance across diverse populations. Despite the availability of numerous GDM prediction models, limited evidence exists on their external validation frequency, methodological quality, and clinical applicability. This systematic review evaluated externally validated GDM prediction models, focusing on methodological rigor, reporting standards, and clinical relevance to inform future research and implementation. MATERIAL AND METHODS: Databases including Ovid MEDLINE, Embase, Scopus, Emcare, and CINAHL were searched up to May 1, 2025. Studies reporting external validation of GDM risk prediction models were included. Two reviewers independently screened studies. Data were extracted using the CHARMS framework, and risk of bias and applicability were assessed using PROBAST+AI. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251125758). RESULTS: Twenty-six studies validated 33 models, with validation sample sizes ranging from 50 to 75 161. Over half used the IADPSG criteria to define GDM. Discrimination metrics were commonly reported, but calibration, overall performance, and clinical utility were often lacking. Meta-analysis was feasible for only four models: Teede et al., Nanda et al., Naylor et al., and Van Leeuwen et al., each showing fair discrimination. The Teede et al. model was the most widely validated, with 11 external validations across six continents and a pooled AUC of 0.72 (95% CI: 0.67-0.76). Despite fewer validations, the Nanda et al. model achieved the highest pooled discrimination (5 validations; pooled AUC 0.77, 95% CI: 0.74-0.80). The Naylor et al. and van Leeuwen et al. models also underwent meta-analysis, as sufficient external validation studies were available to support comparative performance assessment. Notably, 69.23% of studies had a high risk of bias. CONCLUSIONS: While many models showed acceptable predictive performance, most validations were methodologically weak. Future studies should follow best-practice guidelines and promote scalable validation strategies, such as algorithm sharing, to enhance clinical utility.
Prenatal exome sequencing of fetuses with central nervous system anomalies based on prenatal ultrasound and magnetic resonance imaging diagnosis: A retrospective cohort study with a systematic review and meta-analysis.
Yao J, Wang Y, Li G … +3 more , Zhang Z, Lv Y, Chen L
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42389965 · Publisher ↗
INTRODUCTION: Fetal central nervous system (CNS) abnormalities have diverse etiologies, with genetic factors as a major contributor. Prenatal exome sequencing (ES) is a powerful tool for precise molecular diagnosis of CN...
INTRODUCTION: Fetal central nervous system (CNS) abnormalities have diverse etiologies, with genetic factors as a major contributor. Prenatal exome sequencing (ES) is a powerful tool for precise molecular diagnosis of CNS anomalies, but its diagnostic yield varies among studies. This study aimed to evaluate the additional diagnostic yield of prenatal ES compared with chromosomal microarray analysis (CMA) in fetuses with CNS anomalies detected by prenatal imaging. MATERIAL AND METHODS: We collected ES results from fetuses diagnosed with CNS anomalies by prenatal imaging (2019-2024) who had negative results. Subgroup analyses assessed phenotype-specific ES diagnostic yield for associated genes and variants. A systematic review and meta-analysis incorporating our data and published studies further explored the association between phenotype and diagnostic yield. RESULTS: In the cohort study of 219 cases, ES identified pathogenic/likely pathogenic single nucleotide variations in 36 cases (16%). The highest diagnostic yield of ES was in cases with multisystem malformations (25%, 14/55), followed by multiple CNS anomalies (15%, 2/13) and isolated CNS anomalies (13%, 20/151). The most commonly identified isolated CNS anomaly was agenesis of the corpus callosum (31%, 5/16). Neural tube defects with urogenital anomalies were associated with a positive ES finding in 57% (4/7) of cases. The meta-analysis of 989 cases from 22 studies showed a pooled diagnostic yield of ES of 27% (95% CI, 21%-34%). The highest diagnostic yield of ES was in cases of corpus callosum anomalies with facial abnormalities (75%, 8/11) and neural tube defects with urogenital malformations (80%, 12/15). The diagnostic yield of ES for three or more CNS abnormalities was 43% (95% CI, 31%-58%), significantly higher than that for only two abnormalities (10%, 95% CI, 4%-18%). No significant difference in diagnostic yield was found between cases identified by prenatal MRI combined with ultrasound (27%, 95% CI, 20%-36%) and those identified by ultrasound alone (25%, 95% CI, 17%-35%). CONCLUSIONS: ES provided a significantly higher diagnostic yield than CMA for fetal CNS abnormalities, with diagnostic yields varying by phenotype. The systematic review and meta-analysis confirmed that the complexity and combination of malformations are key factors associated with differences in ES diagnostic yield.
Active surveillance of cervical intraepithelial neoplasia and adverse pregnancy outcomes: A register-based cohort study.
Katholm KK, Eriksen LK, Lycke KD … +4 more , Larsen NL, Sundtoft I, Randrup TH, Hammer A
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42383805 · Publisher ↗
INTRODUCTION: Previous studies have suggested that human papillomavirus (HPV) and HPV-related disease may be associated with increased risk of adverse pregnancy outcomes, e.g., hypertensive disorders of pregnancy, small...
INTRODUCTION: Previous studies have suggested that human papillomavirus (HPV) and HPV-related disease may be associated with increased risk of adverse pregnancy outcomes, e.g., hypertensive disorders of pregnancy, small for gestational age (SGA), and gestational diabetes mellitus (GDM). As active surveillance for cervical intraepithelial neoplasia grade 2 (CIN2) leaves the lesion and underlying infection untreated, we aimed to investigate whether the risk of adverse pregnancy outcomes differs between women who undergo active surveillance for CIN2 compared to women having an immediate large loop excision of the transformation zone (LLETZ). MATERIAL AND METHODS: We conducted a nationwide register-based cohort study in Denmark. Individual-level data was collected from Danish healthcare registers. We included women aged 18-40 with a first-time diagnosis of CIN2 between January 1, 1998, and December 31, 2018, and a subsequent singleton birth. We estimated the risk of hypertensive disorder of pregnancy, SGA, and/or GDM in a subsequent pregnancy. We calculated crude and adjusted relative risks (aRR) adjusting for potential confounders using modified Poisson regression. RESULTS: We included 10 537 women with CIN2 and a subsequent singleton birth; 4430 women (42%) underwent active surveillance, and 6107 women (58%) had a LLETZ. We identified 548 (5.2%) cases of hypertensive disorders of pregnancy, 379 cases of SGA (3.6%), and 315 cases of GDM (3.0%). For all three outcomes, the adjusted relative risk was comparable between active surveillance and immediate LLETZ (aRR 1.08 (95% CI 0.91-1.29), aRR 0.94 (95% CI 0.74-1.19), aRR 0.92 (95% CI 0.73-1.16), respectively). Stratified analyses revealed insignificant differences in the risk of hypertensive disorders of pregnancy, SGA, and GDM. CONCLUSIONS: No association was found between CIN2 management and risks of hypertensive disorders, SGA, or GDM in later pregnancy. These findings suggest that untreated HPV-related lesions do not increase adverse pregnancy risks and may help reassure women during clinical counseling about future pregnancies after CIN2 treatment.
Commentary on central sensitization in chronic pelvic pain.
Gulfishan S, Raza A, Aman A
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42381362 · Publisher ↗
Abstract loading — click title to view on PubMed.
Clinicopathological phenotypes of singleton stillbirth: A retrospective cohort study.
Bjarnadottir RI, Steffensen TS, Smarason AK … +3 more , Pettersson K, Papadogiannakis N, Gunnarsdottir J
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42358097 · Publisher ↗
INTRODUCTION: Interpreting the histopathology report after stillbirth and applying it to care in a subsequent pregnancy can be challenging. MATERIAL AND METHODS: A retrospective cohort study of singleton stillbirths in I...
INTRODUCTION: Interpreting the histopathology report after stillbirth and applying it to care in a subsequent pregnancy can be challenging. MATERIAL AND METHODS: A retrospective cohort study of singleton stillbirths in Iceland 1996-2021 (n = 338). Clinical information and description of placenta and umbilical cord were reviewed, and microscopic slides re-evaluated according to the Amsterdam Consensus. Clinical and histopathological findings, including major patterns of placental injury and umbilical cord at risk, were correlated and compared between gestational age groups: <28 weeks (n = 102), ≥28 but <37 weeks (n = 114), and ≥37 weeks (n = 122). RESULTS: Placental slides were reviewed for 96.4% (326/338) of singleton stillbirths and classified into major patterns of placental injury. Maternal vascular malperfusion (MVM) was diagnosed in 19.0% of placentas (62/326), fetal vascular malperfusion (FVM) in 31.6% (103/326), acute chorioamnionitis (ACA) in 32.2% (105/326), chronic villitis of unknown etiology (VUE) in 15.9% (52/326), and none of the major patterns in 27.9% (91/326). More than one pattern of placental injury was found in 7.7% of placentas (25/326), most often at term. A similar proportion of MVM was found irrespective of gestational age; FVM was more common after 28 weeks, ACA before 28 weeks, but VUE most frequent at term. A higher proportion of MVM was found in stillbirths with small for gestational age (SGA) infants than non-SGA (23.0 vs. 6.1%), as well as in stillbirths with maternal hypertensive disorder of pregnancy than in stillbirths with a normotensive mother (23.9 vs. 11.8%). The latter association was not seen with high-grade FVM nor VUE. The umbilical cord was at risk in 53.8% (175/326) of singleton stillbirths, increasing with gestational age to 71.7% (86/120) at term. Hypercoiled, excessive long, and wrapped cords were most common. Term stillbirths with cord at risk often also had placental MVM or VUE. CONCLUSIONS: Understanding major patterns of placental injury and their correlation with clinical phenotypes can help counseling after stillbirth. Stillbirths with placental MVM often had clinical signs suggesting a high-risk pregnancy. However, term stillbirths with placental VUE or FVM and umbilical cord at risk were commonly without recognized risk factors.
Human papillomavirus persistence and clearance in women living with HIV: A five-year retrospective analysis from an Italian university center.
Carlea A, Colacurci D, D'Apice G … +8 more , Mazzarelli LL, Pellicano M, Falco L, Sepe G, Imperatore O, Maruotti GM, Guida M, Sarno L
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42347691 · Publisher ↗
INTRODUCTION: Human papillomavirus infection is one of the most prevalent sexually transmitted infections worldwide. Women living with HIV are at increased risk of acquiring and developing persistent infection with high-...
INTRODUCTION: Human papillomavirus infection is one of the most prevalent sexually transmitted infections worldwide. Women living with HIV are at increased risk of acquiring and developing persistent infection with high-risk HPV genotypes, leading to higher rates of cervical dysplasia and cancer. However, limited data are available regarding the timing and determinants of HPV clearance in this population. MATERIAL AND METHODS: This is a retrospective, single-center study including women living with HIV with confirmed high-risk HPV infection, followed at an Italian university hospital between 2019 and 2024. Clinical, virological, and immunological data were collected, including HIV viral load, CD4+ T-cell count, and adherence to antiretroviral therapy. HPV persistence, clearance, and time to clearance were assessed over a 5-year follow-up period. Statistical analyses were performed using SPSS version 29, with p < 0.05 considered significant. RESULTS: Seventy-seven women living with HIV were recruited, and fifty-one met the inclusion criteria for analysis. Most participants (92%) were adherent to ART. HR-HPV clearance occurred in 76.5% of patients, with a mean clearance time of 2.08 years. No significant correlation was observed between HPV clearance time and HIV viremia, CD4+ T-cell count, or cytological/colposcopic findings at baseline. However, baseline positivity for the high-risk HPV pool was significantly associated with longer clearance time (p = 0.011). CONCLUSIONS: Women living with HIV showed a high-risk HPV clearance time of approximately 2 years under ART. Our findings suggest that HPV screening every 2 years may represent an appropriate interval in this population, potentially increasing adherence and optimizing healthcare resources. Larger multicenter prospective studies are needed to confirm this observation.
Social reintegration of women after obstetric fistula surgery: Evidence from a longitudinal multilevel mixed-effects study in Zambia.
Mutola S, Chomba BM, Ng N … +3 more , Dhally MM, Louis VR, Michael LW
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42338089 · Publisher ↗
INTRODUCTION: Obstetric fistula remains a persistent maternal health challenge in sub-Saharan Africa, severely impairing women's physical, social, and psychological well-being. Although surgical repair restores continenc...
INTRODUCTION: Obstetric fistula remains a persistent maternal health challenge in sub-Saharan Africa, severely impairing women's physical, social, and psychological well-being. Although surgical repair restores continence, less is known about the factors influencing women's social reintegration after treatment. This study examined the association of continence status and follow-up time on social reintegration among women who underwent obstetric fistula repair in Zambia. MATERIAL AND METHODS: This prospective cohort study included 2172 women who underwent fistula repair between 2017 and 2023 at eight hospitals across Zambia. Multilevel mixed-effects models were used to assess the effects of continence and follow-up time on a composite social reintegration score (0-100), derived from the five domains using principal component factor analysis (eigenvalue = 4.02) and demonstrating internal consistency (Cronbach's α = 0.94), while adjusting for baseline covariates. RESULTS: Among all participants, 86.3% achieved continence, whereas 13.7% remained incontinent at discharge. The null model yielded negligible between-patient variance (intraclass correlation coefficient, ICC <0.001). In the fully adjusted model, continent women had higher reintegration scores than their incontinent counterparts (β = 38.62; 95% CI: 36.10-41.14). Social reintegration improved substantially within the first 3 months after surgery (β = 10.83; 95% CI: 8.23-13.43), and remained stable at 6 months (β = 9.34; 95% CI: 6.70-11.98), and 12 months (β = 9.66; 95% CI: 6.97-12.34). Interaction analyses indicated that although continent women consistently reported higher social reintegration scores, the difference between continent and incontinent women narrowed over time, reflecting gradual improvements in social reintegration among incontinent women (β = -4.85; 95% CI: -6.30 to -3.40). CONCLUSIONS: Restoration of continence was the strongest predictor of improved social reintegration following fistula repair. However, the largest social reintegration improvement was observed among incontinent women within the first 3 months after surgery. These findings highlight the importance of combining high-quality surgical care with structured early postoperative follow-up and reintegration support to sustain recovery among women affected by obstetric fistula, regardless of the surgical repair outcome.
Risk factors associated with deep perineal wound dehiscence after second-degree perineal tears or episiotomy.
Golmann D, Hedström J, Epstein E … +1 more , Bergman I
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42316915 · Publisher ↗
INTRODUCTION: Second-degree perineal tears and episiotomies, involving the bulbocavernosus and/or superficial transverse perineal muscles, are common after vaginal birth and may lead to wound dehiscence, infection, and l...
INTRODUCTION: Second-degree perineal tears and episiotomies, involving the bulbocavernosus and/or superficial transverse perineal muscles, are common after vaginal birth and may lead to wound dehiscence, infection, and long-term pelvic floor dysfunction. Despite this, risk factors for deep wound dehiscence involving perineal musculature remain insufficiently studied. This study aimed to identify risk factors for wound dehiscence in second-degree tears and episiotomies to inform potential use of antibiotic prophylaxis. MATERIAL AND METHODS: A single-center case-control study (1:2 ratio) was conducted including 105 cases with 2nd degree perineal tears or episiotomies complicated by deep wound dehiscence, diagnosed within two weeks postpartum and 210 controls with second-degree tears or episiotomies without dehiscence. Exposure data were retrieved from medical records. Univariate analyses were performed on a priori selected exposure variables, using Mann-Whitney U and Fisher's exact tests. Variable selection used Lasso regression with leave-one-out cross-validation. Multivariate logistic regression generated adjusted odds ratios (aOR). Statistical significance was set at p < 0.05. RESULTS: Women with wound dehiscence were more often vaginal primiparas (87% vs 69%, p < 0.001) and had higher rates of episiotomy (33% vs 7%, p < 0.001). Intrapartum antibiotics were administered less frequently among cases (7% vs 20%, p = 0.002). Cases had longer second stage of labor, more active pushing, and greater postpartum bleeding. After multivariate adjustment, only episiotomy (aOR 4.40, 95% CI 2.10-9.64) and intrapartum antibiotic administration (aOR 0.21, 95% CI 0.07-0.50) remained significantly associated with wound dehiscence. CONCLUSIONS: Episiotomy substantially increased the risk of deep perineal wound dehiscence compared with spontaneous second-degree perineal tears, while intrapartum antibiotics were protective. These findings support selective episiotomy use and suggest that antibiotic prophylaxis may reduce this risk in women with second-degree perineal tears or episiotomies.
Predictive factors for the absence of high-grade intraepithelial lesions in LLETZ specimens following a prior histological diagnosis.
Assirlikian S, Mancini J, Philip CA … +8 more , Canlorbe G, Azaïs H, Fuss-Blanco E, Lecointre L, Carval KLB, Nkounawa D, Ravelojaona A, Carcopino X
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42316784 · Full text
INTRODUCTION: To identify predictive factors of the absence of high-grade intraepithelial lesion on large loop excision of the transformation zone specimen of patients with a previous histological diagnosis of high-grade...
INTRODUCTION: To identify predictive factors of the absence of high-grade intraepithelial lesion on large loop excision of the transformation zone specimen of patients with a previous histological diagnosis of high-grade intraepithelial lesion. MATERIAL AND METHODS: We conducted a multicenter retrospective study in nine hospitals. All patients treated by large loop excision of the transformation zone following histological diagnosis of high-grade intraepithelial lesion between 2015 and 2021 were included. All patients had initial diagnosis of high-grade intraepithelial lesion performed on cervical biopsy and/or endocervical curettage. Clinical, cytological, colposcopic, and high-grade intraepithelial lesion data were extracted from medical files. The primary endpoint was the absence of high-grade intraepithelial lesion on the specimen, defined either by the identification of a low-grade intraepithelial lesion only or by the absence of any intraepithelial lesion. RESULTS: A total of 2037 patients were included. The absence of high-grade intraepithelial lesion was identified in 191 (9.4%) patients. Three predictive factors of high-grade intraepithelial lesion absence on large loop excision of the transformation zone specimen were identified: a small abnormal transformation zone defined by cervical involvement less than or equal to one quadrant (aOR: 2.01; 95%CI: 1.47-2.75; p < 0.001), a colposcopic impression of normal cervix or minor changes (aOR: 1.73; 95%CI: 1.24-2.42; p = 0.001), and normal or low-grade or ASC-US cytology (aOR: 1.37; 95%CI: 1.00-1.87; p = 0.049). CONCLUSIONS: Predictive factors of high-grade intraepithelial lesion absence on large loop excision of the transformation zone specimen of patients with a histological diagnosis of high-grade intraepithelial lesion are a small abnormal transformation zone, a colposcopic impression of normal cervix or minor changes, and normal, low-grade or ASC-US cytology. Practitioners should take these three elements into account when considering large loop excision of the transformation zone treatment in women with a proven diagnosis of high-grade intraepithelial lesion.
Three-dimensional endoanal ultrasound measurements for the assessment of perineal body size in a cohort of Swedish nulligravidae.
Rotstein E, Rose N, Starck M … +1 more , Engberg H
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42308411 · Full text
INTRODUCTION: Despite the perineal body's important functional role, few studies have specifically evaluated its size in women. Existing three-dimensional ultrasound studies typically involve small samples, often includi...
INTRODUCTION: Despite the perineal body's important functional role, few studies have specifically evaluated its size in women. Existing three-dimensional ultrasound studies typically involve small samples, often including both nulliparous and parous women, and focus on measuring internal and external sphincter thickness rather than the perineal body itself. MATERIAL AND METHODS: This cross-sectional study primarily aimed to measure the size of the perineal body in a population of nulligravidae (n = 148) using three-dimensional endoanal ultrasonography. Secondary aims were to (1) evaluate the feasibility and reproducibility of 3D ultrasound interpretation across raters with varying levels of experience and (2) investigate how perineal body measurements correlated with body composition. RESULTS: The study participants had a mean age of 31 years (SD ± 6), a mean height of 167 cm (SD ± 5.9), and a mean body mass index (BMI) of 25.3 kg/m (SD ± 5.6). The perineal body had a mean proximal-distal length of 17.5 mm (SD ± 3.0), with excellent interrater reliability (ICC = 0.89; 95% CI: 0.85-0.92). The mean antero-posterior height was 9.7 mm (SD ± 1.4; ICC = 0.67, 95% CI: 0.57-0.75), and the mean perineal body area was 120 mm (SD ± 28; ICC = 0.84, 95% CI: 0.77-0.88). Results suggest that perineal body measurements obtained through standardized 3D endoanal ultrasonography are reproducible across raters, supporting the method's feasibility regardless of prior ultrasound experience. BMI and weight showed a moderate positive correlation with both the length and the area of the perineal body (p = 0.05). CONCLUSIONS: Standardized 3D endoanal ultrasonography provides reproducible measurements of the perineal body in nulligravid women and measurements correlated moderately with body composition. This suggests the use of this imaging method in asymptomatic populations and future research on pelvic floor function.
Learning opportunities in eclampsia care: A ten-year audit from Norway, 2013-2022.
Mentzoni CT, Røe K, Bjellmo S … +13 more , Carlsen MIS, Christiansen MH, Fjeldstad TS, Henriksen L, Nguyen TT, Nyfløt LT, Rosseland LA, Sun C, Uleberg O, Vangen S, Klungsøyr K, Engjom HM, OCINOR—Eclampsia Working Group
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42306880 · Publisher ↗
INTRODUCTION: 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...
INTRODUCTION: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Inter- and intra-observer agreement of 2D and 3D transperineal ultrasound of pelvic floor hiatal measurements in the second stage of labor.
Kovalenko M, Zamagni G, Volløyhaug I … +7 more , Carreras CM, Usman S, Hanidu A, Stampalija T, Monasta L, Salvesen K, Lees C
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42304666 · Full text
INTRODUCTION: Transperineal ultrasound has emerged as a reliable measure to monitor labor progress non-invasively. This sonographic method enables fetal head descent to be measured by determining the relationship of the...
INTRODUCTION: Transperineal ultrasound has emerged as a reliable measure to monitor labor progress non-invasively. This sonographic method enables fetal head descent to be measured by determining the relationship of the fetal head to the maternal symphysis pubis and the fetal head in reference to the perineum. As the pelvic floor plays an important role in childbirth, measuring the levator hiatal dimensions may provide additional understanding of the mechanisms, particularly in the second stage of labor. MATERIAL AND METHODS: The objective was to assess both inter- and intra-observer agreement in measuring the levator hiatal dimensions at rest during the passive second stage of labor using two- and three-dimensional (2D, 3D) transperineal ultrasound. Women were prospectively recruited for ultrasound assessment in the second stage of labor. The study population consisted of nulliparous women at term (37 + 0-42 + 0 weeks' gestation) with a live singleton pregnancy. Study participants eligible for recruitment were approached in active labor and consented to participate in the "SONO-BIRTH" study. Transabdominal and transperineal ultrasound were performed following clinical assessments in labor. The 3D pelvic floor volumes were uploaded into the software to calculate the levator hiatal area (LHa), transverse hiatal diameter (TD), and the anteroposterior hiatal distance (APD). The quality of visualization from the 3D volumes of the symphysis pubis (SP), puborectalis (PR), and levator hiatus (LH) was scored between 0 and 2 (SP, PR) and 0-4 (LH) and was assessed by two independent observers. RESULTS: Of 95 participants consecutively recruited, 75 had ultrasound volumes available for assessment. The inter-observer agreement for APD in 3D was slightly better compared with APD in 2D measurements, the mean difference being -0.22 cm (intraclass correlation coefficient = 0.85; p < 0.001) and - 0.35 cm (intraclass correlation coefficient = 0.79; p < 0.001), respectively. Intra-observer agreement for APD in 2D demonstrated a mean difference of -0.03 cm (intraclass correlation coefficient = 0.91; p < 0.001). Image quality of 3D ultrasound volumes gave a Kappa score of 0.40 for SP and a Kappa score of 0.72 and 0.77, respectively, for PR and LH. CONCLUSIONS: Assessment of the levator hiatal dimensions in the second stage of labor using 2D and 3D ultrasound demonstrates good inter- and intra-observer agreement. Agreement between two operators for quality of imaging of the pelvic floor structures obtained from 3D imaging was lowest for the symphysis pubis and highest for the levator hiatus.
Career-stage patterns in burnout and intention to leave the current hospital among obstetric physicians.
Stöcker A, Bäckmann M, Nübling M … +5 more , Okumu MR, Strizek B, Volkert A, Weigl M, Scholten N
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42304644 · Publisher ↗
INTRODUCTION: To examine associations between personal burnout symptoms and the intention to leave the current hospital across different career stages among physicians in obstetric care in Germany. In addition, we compar...
INTRODUCTION: To examine associations between personal burnout symptoms and the intention to leave the current hospital across different career stages among physicians in obstetric care in Germany. In addition, we compared burnout levels among surveyed obstetricians relative to the general physician and the German working population. MATERIAL AND METHODS: In this nationwide, cross-sectional study, physicians from all 595 obstetric departments in Germany were invited to complete an anonymous, standardized survey. We assessed burnout, intentions to leave the workplace within the next 5 years, career stage, age, gender, and employment status. Comparative data on burnout were obtained from a national database on mental stress in the workplace. Data were analyzed visually using Sankey plots and Firth-corrected multivariable logistic regression. RESULTS: A total of 872 obstetricians responded. Overall, 380 physicians (50.9%) reported intention to leave the current hospital within the next 5 years. Moderate personal burnout was reported by 332 physicians (40.2%), while 168 (20.4%) reported high or severe burnout. Average burnout levels among surveyed obstetricians (mean: 50.6) were comparable to those of other physicians (mean: 51.4) and the general working population (mean: 49.9) in Germany. Intentions to leave were most frequent among residents (176, 74.2%), followed by specialists (46, 57.5%). Regression analyses showed that higher burnout scores were significantly associated with intention to leave the current hospital (OR = 1.03, 95%-CI: 1.02, 1.04, p < 0.001), particularly among physicians in earlier career stages. With each one-point increase in burnout scores, odds of intending to leave increased by 3.3% for residents (95%-CI: 1.02, 1.05, p < 0.001), 3.2% for specialists (95%-CI: 1.01, 1.06, p = 0.005), and 3.2% for consultants without executive responsibilities (95%-CI: 1.02, 1.05, p < 0.001). CONCLUSIONS: Personal burnout symptoms are significantly associated with the intention to leave the current hospital, particularly among early-career obstetricians. While career-stage-related mobility can partly explain turnover, burnout appears to be an independent determinant. Our findings highlight the importance of addressing burnout early in medical careers to support physician retention in obstetric care.
Lack of association between second-degree tears and pelvic floor symptoms one year postpartum.
Hu S, Auger N
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42295032 · Publisher ↗
Abstract loading — click title to view on PubMed.
Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) therapy of uterine fibroids effectively reduces both bleeding and bulk symptoms-A prospective single-center 12-month follow-up study.
Otonkoski S, Viitala A, Komar G … +6 more , Sainio T, Yanovskiy A, Lehtonen I, Blanco Sequeiros R, Perheentupa A, Joronen K
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42294814 · Publisher ↗
INTRODUCTION: Uterine fibroids are common benign neoplasms in women. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a noninvasive treatment that has been shown to reduce fibroid-related symptoms...
INTRODUCTION: Uterine fibroids are common benign neoplasms in women. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a noninvasive treatment that has been shown to reduce fibroid-related symptoms and improve quality of life (QoL). In this study, we aimed to clarify symptom reduction in patients with isolated bleeding or bulk symptoms. MATERIAL AND METHODS: This prospective study with a 12-month follow-up included 163 women with uterine fibroids causing either bleeding or bulk symptoms and deemed suitable for MR-HIFU treatment. Treatments were carried out using an extracorporeal tabletop MR-HIFU system (Sonalleve V2, Profound Medical Inc., Mississauga, Canada). The non-perfused volume ratio (NPV%) was determined after treatment. Symptom severity and QoL were assessed using the Uterine Fibroid Symptom and Quality of Life questionnaire at baseline, 3 months, and 12 months after treatment. The study was registered at ClinicalTrials.gov (NCT02914704). RESULTS: A total of 122 women with bleeding and 41 women with bulk symptoms were included. The overall mean NPV% for all patients was 62%. The median symptom severity score (SSS) at baseline was 56 (IQR 47-69) and 46 (34-63), at 3 months 28 (16-44) and 19 (6-30), and at 12 months 25 (13-31) and 19 (6-41) for the bleeding and bulk groups, respectively. The reduction of SSS was statistically significant between baseline and 3 months (p < 0.001) and between baseline and 12 months (p < 0.001) in both groups. The median of QoL at baseline was 43 (IQR 31-58) and 74 (45-83), at 3 months 70 (53-82) and 89 (74-97), and at 12 months 82 (69-91) and 82 (67-100) for the bleeding and bulk groups, respectively. In the bleeding patients, the increase in QoL was statistically significant between all the time points compared (p < 0.05). In the bulk group, the increase in QoL was statistically significant from baseline to 3 months (p < 0.001) and from baseline to 12 months (p < 0.01). CONCLUSIONS: MR-HIFU resulted in significant symptom reduction and improved QoL in patients with both bleeding and bulk-related fibroid symptoms. When successful, MR-HIFU provides effective and rapid symptom relief for both symptom types.
The pelvic floor dysfunction: Where obstetrics meets urogynecology.
Volloyhaug I, Teleman P, Robinson D
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42286864 · Full text
Abstract loading — click title to view on PubMed.
Validity of hypertensive disorders of pregnancy diagnoses in the Swedish pregnancy register using a contemporary cohort.
Frick M, Bergman L, Carlsson Y … +9 more , Imberg H, Lindgren P, Conner P, Hansson SR, Kublickas M, Larsson A, Hellström S, Wikström AK, Sandström A
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42283402 · Publisher ↗
INTRODUCTION: The validity of hypertensive disorders of pregnancy (HDP), including preeclampsia, gestational hypertension, and chronic hypertension, is essential for both clinical management and research. The Swedish Pre...
INTRODUCTION: The validity of hypertensive disorders of pregnancy (HDP), including preeclampsia, gestational hypertension, and chronic hypertension, is essential for both clinical management and research. The Swedish Pregnancy Register automatically retrieves diagnostic codes based on the Swedish version of the International Classification of Diseases 10th revision (ICD-10), as recorded in antenatal, obstetric, and neonatal electronic medical records. The aim of the study was, for the first time, to assess the validity of HDP diagnoses within the Swedish Pregnancy Register in a contemporary population. MATERIAL AND METHODS: A multicenter validation study of women with deliveries from 2021 to 2023 who participated in the prospective Swedish study for Improving Maternal Pregnancy And Child ouTcomes (IMPACT) cohort. Women with a HDP diagnosis in the Swedish Pregnancy Register were retrospectively validated through standardized reviews of electronic medical records. The gold standard for classification followed the Swedish guidelines from the Swedish Society of Obstetrics and Gynecology (SFOG), updated in 2019. Incidence, sensitivity, and positive predictive value (PPV) were calculated and reported with 95% confidence intervals (CIs), using the Wilson score method. In addition, the study includes a descriptive analysis of preeclampsia disease characteristics and clinical diagnostic practices. RESULTS: Among 7443 women included in the validation study, 843 (11.3%, 95% CI 10.6-12.1) had a HDP diagnosis recorded in the Swedish Pregnancy Register and underwent validation. Within the study population, the register-based incidence of preeclampsia was 5.0% (95% CI 4.5-5.5%), while the minimum validated incidence was 5.1% (95% CI 4.6-5.6). The positive predictive value (PPV) of register diagnoses was 79.0% (95% CI 74.5-82.8%) for preeclampsia, 72.8% (95% CI 68.2-76.9%) for gestational hypertension, and 49.3% (95% CI 38.3-60.4%) for chronic hypertension, yielding an overall PPV for any hypertensive disorder of pregnancy diagnosis of 73.4% (95% CI 70.3-76.3%). Among validated cases of preeclampsia, 78% had proteinuria and the remaining cases were classified as preeclampsia based on other organ dysfunctions. CONCLUSIONS: In this contemporary Swedish cohort, a diagnosis of preeclampsia recorded in the Swedish Pregnancy Register demonstrated good validity, comparable to that reported in previous Nordic register validation studies.
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.
Jackson H, Grzeskowiak L, Enticott J … +2 more , Wise S, Callander E
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42281148 · Publisher ↗
INTRODUCTION: 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 regula...
INTRODUCTION: 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. MATERIAL AND METHODS: 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. RESULTS: 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 < -0.10) and moderate pro-poor inequalities in public expenditure (C > -0.25) were observed across all antiemetics. (Medication access: C = -0.07, 95% CI (-0.080 to -0.068); C = -0.09, 95% CI (-0.114 to -0.075); C = -0.08, 95% CI (-0.109 to -0.045). Government expenditure: C = -0.30, 95% CI (-0.316 to -0.285); C = -0.25, 95% CI (-0.297 to -0.198); C = -0.28, 95% CI (-0.350 to -0.205)). CONCLUSIONS: 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 pregnant women's needs. While pro-poor access and public subsidies for antiemetics align with the equity elements embedded in the design of the Pharmaceutical Benefits Scheme, they may also be reflective of inequitable access to other unsubsidized, guideline-recommended pharmacotherapies for nausea and vomiting in pregnancy.
Adherence to aspirin use during pregnancy among women at risk of preeclampsia: A cross-sectional study.
Swift EM, Guðnadóttir SA, Haraldsdóttir EH … +7 more , Hjartardóttir H, Atladóttir LÓ, Helgadóttir H, Guðmundsson LS, Sigurvinsdóttir R, Ásbjörnsdóttir KH, Gunnarsdóttir J
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42273987 · Publisher ↗
INTRODUCTION: 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 ad...
INTRODUCTION: 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. MATERIAL AND METHODS: 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 (<6). Prevalence ratios (PR) for inadequate adherence were calculated with 95% confidence intervals (CI), with the high-risk group as reference. RESULTS: 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. CONCLUSIONS: 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.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe