Acta Obstetricia Et Gynecologica Scandinavica[JOURNAL]
Sun
200 papers
To guide or not to guide: A randomized study on the use of needle guide for chorionic villus sampling training.
Johnsson V, Petersen OB, Svendsen MBS … +6 more , Kulasegaram K, Nørgaard LN, Harmsen L, Noerholk LM, Sundberg K, Tolsgaard MG
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41317014 · Full text
INTRODUCTION: Chorionic villus sampling (CVS) is an invasive prenatal diagnostic procedure used to detect fetal genetic anomalies. CVS is increasingly replaced by noninvasive prenatal testing (NIPT). As a consequence, ma...
INTRODUCTION: Chorionic villus sampling (CVS) is an invasive prenatal diagnostic procedure used to detect fetal genetic anomalies. CVS is increasingly replaced by noninvasive prenatal testing (NIPT). As a consequence, maintaining procedural skills among trainees has become challenging. Despite this, optimal training methods for CVS remain uncertain, particularly regarding whether techniques involving context variation, needle guides, or freehand approaches yield superior skill acquisition and performance. This randomized controlled study aimed to evaluate these training strategies, specifically focusing on skill transfer among novices in ultrasound-guided CVS. MATERIAL AND METHODS: In this randomized controlled trial, 101 ultrasound novices were allocated into three training groups: context variation, needle-guided, and freehand techniques. Participants completed a 1-h training session performing ultrasound-guided needle punctures on ballistic gel models. The context variation group alternated between needle-guided and freehand techniques with varying visual constraints. After training, each participant completed four CVS transfer tests using a CVS simulator manikin, involving two needle-guided and two freehand procedures, with differing placental positions. Blinded expert raters evaluated participant performance using a scoring system with established validity evidence. Statistical analyses included linear mixed-effect models, ANOVA, and Pearson correlation coefficients. RESULTS: There were no significant differences in overall performance scores among the three training groups (F[2, 92.0] = 0.06, p = 0.94). However, performance significantly improved during transfer tests when participants used a needle guide, irrespective of their initial training method (F[1, 266.0] = 49.5, p < 0.001). Specifically, using a needle guide significantly enhanced scores for pre-puncture ultrasound assessment (t[370] = -4.1, p < 0.001), insertion site selection (t[370] = -3.8, p < 0.001), sampling technique (t[370] = -5.8, p < 0.001), and overall procedural performance (t[370] = -5.8, p < 0.001). CONCLUSIONS: Training approaches, including needle-guided, freehand, and context variation techniques, did not differ significantly in their effect on learning ultrasound-guided CVS. However, the consistent improvement in procedural performance with needle-guided techniques suggests that incorporating needle guides into CVS training could promote safer practice for novice learners, particularly as clinical training opportunities become increasingly scarce.
Twenty-year trends in fetal scalp-blood sampling and birth outcomes: A single-center retrospective cohort study of 40 309 women in labor.
Pietilä S, Mönkkönen A, Backman H … +1 more , Keski-Nisula L
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41316915 · Full text
INTRODUCTION: At Kuopio University Hospital (KUH), the rate of fetal blood sampling (FBS) among women undergoing a trial of labor has markedly decreased over the past 20 years. The aim of this study was to evaluate the a...
INTRODUCTION: At Kuopio University Hospital (KUH), the rate of fetal blood sampling (FBS) among women undergoing a trial of labor has markedly decreased over the past 20 years. The aim of this study was to evaluate the association of this decline with birth outcomes and how maternal and delivery characteristics have changed over the extended study period. MATERIAL AND METHODS: This retrospective registry-based study included 40 309 singleton pregnancies with a live vertex-presenting fetus at or beyond 33 weeks of gestation with a trial of labor and deliveries between January 2002 and December 2021. Prenatal and birth data were obtained from the KUH birth registry, and variables were analyzed across four intervals of 5 years. The evaluated birth outcomes included the mode of delivery, labor induction, meconium-stained or bloody amniotic fluid, birthweight, 5-min Apgar scores, physician-diagnosed asphyxia, perinatal death, and admission to the neonatal intensive care unit (NICU). RESULTS: During the 20-year study period, intrapartum FBS was performed in 3486 cases (8.6%), while 36 823 women (91.4%) delivered without FBS. The use of FBS declined from 11.7% to 3.9% (p < 0.001). Concurrently, the rate of spontaneous vaginal deliveries increased from 83.6% to 87.6%, whereas nonelective cesarean deliveries decreased from 8.4% to 4.3%. Fewer newborns were diagnosed with asphyxia by physicians and admitted to the NICU. However, the incidence of low 5-min Apgar scores (<7) peaked with a 77.8% increase during the last study period compared to the preceding one, coinciding with the lowest rate of FBS use. General trends included declines in birth rate, maternal smoking, and gestational age at birth, as well as increases in maternal age, body mass index, and the rate of labor induction. CONCLUSIONS: The change in FBS rate may reflect evolving clinical assessment criteria and more stringent selection strategies for its use. However, it may also be associated with an increased number of cases presenting with low Apgar scores.
Women's real-time pain and stress during medical abortion: An ecological momentary assessment study.
Felnhofer A, Feneberg AC, Weiss L … +3 more , Kothgassner OD, Kafka JX, Fiala C
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41314794 · Full text
INTRODUCTION: Knowledge on women's pain and stress experiences during medical abortion is scarce and evidence mainly relies on retrospective reports, which are prone to recall bias. Hence, our objective was to study real...
INTRODUCTION: Knowledge on women's pain and stress experiences during medical abortion is scarce and evidence mainly relies on retrospective reports, which are prone to recall bias. Hence, our objective was to study real-time self-reported pain and stress throughout the medical abortion process, their fluctuation over time, and to examine whether age, parity, gestational age, adverse childhood events (ACE), and contextual factors (e.g., analgesics intake, bleeding) were associated with pain and stress. MATERIAL AND METHODS: This one-group, single center, exploratory cohort study (conducted 2020-2023) used ecological momentary assessment (EMA). A population-based sample of women ≥18 years of age presenting for first trimester medical abortion at ≤9th week of gestation was approached after mifepristone intake. Sixty women aged 30.40 ± 6.61 years were included in this study. EMA commenced with mifepristone intake and entailed four prompts per day over a consecutive 7-day period. Main outcomes included self-reported pain and stress measured using visual analog scales (VAS). Secondary outcomes were clinical and demographic data as well as psychological measures. Data were analyzed using multilevel models. RESULTS: Reported pain and stress varied not only throughout the abortion process but also between women, showing an increase on Day 3 (misoprostol intake) and a gradual decrease thereafter. While age, gestational age, and parity were not significantly related to pain, higher self-reported stress, more bleeding, more analgesic intake, and a higher number of ACEs were associated with higher pain levels. Higher stress levels, in turn, were associated with more ACEs, parity, analgesics intake, treatment-related events, and weekdays. CONCLUSIONS: Our results highlight large interindividual variations in women's pain and stress experiences during first trimester medical abortion and thus emphasize the need for individualized counseling and pain treatment. Screening for ACEs, along with using event-based EMA protocols for future pain-management research, may promote tailored care.
Introduction of robot-assisted obstetric ultrasound in rural Northern Norway.
Olsen IP, Mannsverk CA, Pulk AB … +2 more , Fagertun H, Fors M
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41311004 · Full text
INTRODUCTION: Robot-assisted obstetric ultrasound is a method where the obstetrician in the hospital can control an ultrasound probe and assess biometric measurements and biophysical observations of a fetus, at a remote...
INTRODUCTION: Robot-assisted obstetric ultrasound is a method where the obstetrician in the hospital can control an ultrasound probe and assess biometric measurements and biophysical observations of a fetus, at a remote location. This two-aimed study evaluates the diagnostic accuracy of robot-assisted ultrasound compared to traditional ultrasound and explores patient experiences. MATERIAL AND METHODS: Forty-six middle-risk pregnant women in 2nd and 3rd trimester were recruited. Thirty women were recruited for an intra observer study to compare the quality of the robot-assisted obstetrical ultrasound and traditional obstetric ultrasound. Fifteen traditional ultrasound examinations and 15 robotic-assisted ultrasound examinations were performed and head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), amniotic fluid index (AFI), Doppler in the umbilical arteria, and biophysical observations of the fetus were registered. Another 16 women were recruited to a mixed design study aiming to explore the women's experiences with the robot-assisted ultrasound method. These women completed a questionnaire of 20 questions about patient experience, using a 5-point Likert scale. Two of them also participated in qualitative interviews to provide deeper insights. RESULTS: Biometric measurements showed excellent reliability (intraclass correlation coefficient 0.990-0.993) with acceptable limits of agreement. Twenty questions about patient experiences were asked and 94% of the women scored for highest level of satisfaction. Interviews revealed the value of avoiding long-distance travel when image quality and digital communication experiences are good. CONCLUSIONS: Robot-assisted obstetric ultrasound is a reliable alternative to traditional ultrasound for middle-risk pregnancies in rural areas, offering high diagnostic accuracy and patient satisfaction. Most women would agree to a robotic ultrasound scan examination again. The patients' experiences are thus in line with the Norwegian governments' intention to use technology to secure equality in health care in rural areas.
Risk of cardiovascular disease and mortality among women with endometriosis: A systematic review and meta-analysis.
Cavadias I, Maitrot-Mantelet L, Perol S … +5 more , Bourdon M, Santulli P, Marcellin L, Chapron C, Plu-Bureau G
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41310987 · Full text
INTRODUCTION: Endometriosis is a chronic and estrogen-dependent disorder that affects about 10% of women of reproductive age worldwide. Endometriosis has been associated with chronic inflammation and an atherogenic lipid...
INTRODUCTION: Endometriosis is a chronic and estrogen-dependent disorder that affects about 10% of women of reproductive age worldwide. Endometriosis has been associated with chronic inflammation and an atherogenic lipid profile, two conditions that increase the risk of atherothrombotic cardiovascular diseases. MATERIAL AND METHODS: A literature search for relevant studies published from the earliest record to 31 March 2025 was conducted in MEDLINE and EMBASE databases. The following MESH terms were searched: "stroke," "cerebrovascular disease," "cardiovascular disease," "coronary heart disease," "ischemic heart disease," "mortality," and "endometriosis." The results of each study were pooled, and an overall estimate of relative risk was obtained with a random-effect model. Homogeneity between studies was analyzed using I statistics. This review was not registered. RESULTS: Ten studies were eligible for inclusion in this meta-analysis. Five studies reported an increased risk of stroke with endometriosis, with a pooled risk of 1.18 (95% confidence intervals [95% CI] [1.13-1.22]). Four studies reported an increased risk of coronary heart disease with endometriosis, with a pooled risk of 1.36 (95% CI [1.32-1.40]). Four studies reported an increased risk of composite cardiovascular disease with endometriosis, with a pooled risk of 1.16 (95% CI [1.12-1.20]). Although the homogeneity is high in results, the confounding factors considered in the different studies vary. Thus, these results must be interpreted with caution. CONCLUSIONS: Endometriosis is associated with an increased risk of cardiovascular disease. Further research is required to confirm these findings. However, these results highlight the importance of considering primary cardiovascular prevention strategies for women with endometriosis.
Medical education in obstetrics and gynecology: A global update from 2025.
Recker F, Neubauer R, Adams J … +3 more , Ludwig S, Taran FA, Groten T
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41292053 · Full text
As medical knowledge and technologies rapidly evolve, curricula have become increasingly dense, and designing effective OB-GYN education that prepares learners for diverse medical careers within limited timeframes is a g...
As medical knowledge and technologies rapidly evolve, curricula have become increasingly dense, and designing effective OB-GYN education that prepares learners for diverse medical careers within limited timeframes is a global challenge. This review provides an international overview of contemporary medical education in obstetrics and gynecology (OB-GYN) across undergraduate, postgraduate, and continuing professional development levels. A narrative review of recent peer-reviewed literature, international guidelines, and global initiatives (2023-2025) was conducted, identifying key innovations, trends, and challenges in OB-GYN education worldwide, with a focus on curriculum reforms, competency-based education, simulation, telemedicine, AI applications, global standardization, and equity-oriented initiatives. Undergraduate OB-GYN curricula are increasingly standardized, integrating core competencies, early clinical exposure, and reproductive health. Postgraduate training adopts competency-based frameworks, enhanced by simulation, virtual reality, and tele-education, while continuing medical education has shifted toward flexible digital platforms and structured credentialing. Innovations, such as AI-driven learning tools, simulation drills, and telemedicine-based training, have improved skill acquisition, and global bodies, such as FIGO, RCOG, and ACOG, promote curriculum harmonization and equity. The COVID-19 pandemic accelerated digital adoption but revealed gaps in surgical training and support. Overall, OB-GYN education is in a transformative phase, marked by technology, standardization, and equity, yet significant disparities persist, especially in resource-limited settings. Continued global collaboration, investment in educational infrastructure, and adaptive curriculum development are essential to prepare OB-GYN professionals for evolving clinical demands and healthcare inequities in the postpandemic era.
Negative margins and negative HPV tests after large loop excision of the transformation zone: A nationwide historical cohort study.
Knudsen AS, Randrup TH, Kesmodel US … +4 more , Booth BB, Gustafson LW, Grønborg TK, Hammer A
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41288155 · Full text
INTRODUCTION: Adequate treatment of cervical precancer, defined as negative margins and a negative HPV test post-treatment, is essential for cervical cancer prevention, as inadequate excision of cervical precancer and a...
INTRODUCTION: Adequate treatment of cervical precancer, defined as negative margins and a negative HPV test post-treatment, is essential for cervical cancer prevention, as inadequate excision of cervical precancer and a positive HPV test are associated with increased risk of recurrence. Here, we aimed to describe trends in the proportion of women receiving adequate treatment in Denmark. MATERIAL AND METHODS: Nationwide historical cohort study including Danish women ≥18 years treated with large loop excision of the transformation zone (LLETZ) from 2013 to 2022. Using the Danish Pathology Register, we collected information on all LLETZ procedures performed due to cervical intraepithelial neoplasia grade 1 or worse (CIN1+). We calculated the proportion of negative margins and negative HPV tests post-treatment, overall and stratified by histology, age, calendar time, and residing region. Results were mainly reported descriptively. RESULTS: We included 41 128 women (median age: 35 years, interquartile range: 28-44). A total of 20 744 (50.4%) had negative margins, with the lowest proportion in women with CIN3 (47.2%) or adenocarcinoma in situ (38.3%). The proportion of negative margins declined with increasing age, from 54.1% in women aged 18-29 years to 43.6% in women aged ≥50 years. Overall, 62.4% had a negative HPV test, with no major differences observed across histology groups. The proportion of negative HPV tests ranged from 62.8% to 66.9% in women aged 18-49, whereas it was lower in women aged ≥50 years (48.4%). CONCLUSIONS: Women aged ≥50 years were less likely to have negative margins and a negative HPV test post-treatment compared to women aged 18-49. These findings prompt a need to optimize treatment in this group of women to reduce the risk of cervical cancer.
Objective and comprehensive characterization of uterine peristaltic activity throughout the menstrual cycle by means of intracavitary electrohysterography, a cohort study.
Alberola-Rubio J, Mira-Tomas JM, Diaz-Martinez A … +6 more , Alama Faubel P, Caballero Sanz S, Castillón Cortés G, de Arriba-Garcia M, Llácer J, Garcia-Casado J
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41284469 · Full text
INTRODUCTION: The uterus exhibits dynamic peristaltic activity across the menstrual cycle, playing a critical role in reproductive processes such as sperm transport and embryo implantation. However, current imaging metho...
INTRODUCTION: The uterus exhibits dynamic peristaltic activity across the menstrual cycle, playing a critical role in reproductive processes such as sperm transport and embryo implantation. However, current imaging methods to assess this activity provide little information and are limited by subjectivity and lack of sensitivity. A recent pilot study has shown the potential of intracavitary electrohysterography (IC-EHG) to study peristalsis in the uterine fundus. This study aimed to generalize previous results, compare peristalsis in other uterine regions, and study more peristaltic features. MATERIAL AND METHODS: This prospective multicenter cohort study included 40 healthy women with proven fertility. IC-EHG signals were recorded from different uterine sites for 30 min during three menstrual phases: mid-follicular (MF), early luteal (EL), and late luteal (LL) using a custom-designed multipolar catheter. PRIMARY OUTCOMES: contraction frequency (CT/min) and amplitude (μV); secondary outcomes: basal amplitude, contraction time percentage, contractility index and local organization index. Statistical comparisons between phases and regions were performed using Wilcoxon signed-rank tests. RESULTS: A total of 95 fundal and 90 lower-segment IC-EHG recordings were analyzed. Contraction frequency peaked during the EL phase (fundus: 3.91 CT/min; lower segment: 4.01 CT/min) and was lowest during MF (fundus: 3.28 CT/min, p = 0.042; lower segment: 3.65 CT/min, p = 0.024). Fundal contraction amplitude decreased progressively from MF (16.27 μV) to LL phase (10.56 μV, p < 0.001). Basal amplitude, contraction time percentage and contractility index were also lowest in the LL phase for both uterine regions. Except for frequency, fundus peristaltic activity features were smaller than those of the lower segment, significantly during the MF phase. Local coordination index revealed lower local cell organization in the fundus across all phases, with maximum coordination during EL in both regions (p < 0.01). CONCLUSIONS: IC-EHG technique enables objective, reproducible, and quantitative assessment of multiple aspects of uterine peristalsis, revealing distinct regional and cycle-phase-dependent patterns. The decline in most contractile features during the LL phase supports the physiological uterine quiescence required for embryo implantation. The uterine fundus is more active during the MF phase. This study provided reference values for healthy, fertile conditions and could inform further investigation of alterations due to disorders or intervention strategies.
Prolapse recurrence, methods of reoperation, and long-term mesh complications-A nationwide follow-up study.
Wihersaari O, Karjalainen P, Tolppanen AM … +3 more , Mattsson N, Jalkanen J, Nieminen K
Acta Obstet Gynecol Scand · 2026 Jul · PMID 41277806 · Full text
INTRODUCTION: Further prolapse in the same or a different vaginal compartment is common, particularly following native tissue surgery. This study aims to report the rates of reoperations for prolapse and subjective recur...
INTRODUCTION: Further prolapse in the same or a different vaginal compartment is common, particularly following native tissue surgery. This study aims to report the rates of reoperations for prolapse and subjective recurrence after native tissue and mesh-augmented surgeries. Additionally, it seeks to describe the methods of repeat surgery for prolapse and to evaluate long-term mesh complications. MATERIAL AND METHODS: This is a follow-up study of the nationwide cohort (ClinicalTrials.gov [NCT02716506]) of pelvic organ prolapse surgeries performed in 2015 in Finland. Prolapse recurrence, reoperations and mesh complications were studied utilizing data from patient questionnaires and the national register. Reoperation rates, timing, methods of repeat surgery, and rates of subjective recurrence were compared among native tissue, transvaginal mesh and abdominal mesh surgeries. Predictive factors for reoperation were studied with logistic regression analysis. Mesh-related complications were evaluated after transvaginal and abdominal mesh repair. RESULTS: The mean follow-up of 3321 women was 7.4 years, during which 443 (13%) underwent reoperation for prolapse; 13.9% after native tissue, 10.1% after transvaginal mesh, and 12.1% after abdominal mesh repair (p = 0.09). Up to one third of women reported symptoms of vaginal bulging during follow-up, with significantly lower rates after transvaginal mesh surgery at 2- and 5-year follow-ups. The majority of reoperations for prolapse were single-site; anterior or apical repair was most common after native tissue and abdominal mesh surgery, while reoperations after transvaginal repair involved mainly posterior or apical compartments. Mesh was used in 40% of all reoperations. Prolapse surgery involving both posterior and apical compartments was the only factor associated with increased risk for reoperation (aOR 1.95 CI 1.30-2.92). Only 1.6% of women had a surgically treated mesh complication based on the register data, while the rates of patient-reported mesh exposures and mesh-related reoperations were 6.5% and 6.4%, with no significant difference between the two mesh groups. CONCLUSIONS: The long-term risk of reoperation for prolapse was similar after native tissue and mesh-augmented surgery, while the site of reoperation differed based on the type of surgical treatment. Mesh complication rates were similar after transvaginal and abdominal mesh repair, and the majority of mesh exposures did not require surgical treatment.
Does craniocaudal extension of the hysterotomy reduce intraoperative complications compared with transverse extension in the case of emergency caesarean section?
Lesur P, Ramdane N, Garabedian C
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41271201 · Full text
INTRODUCTION: The main objective was to study the occurrence of intraoperative complications after emergency caesarean section during labor according to the type of hysterotomy extension performed. MATERIAL AND METHODS:...
INTRODUCTION: The main objective was to study the occurrence of intraoperative complications after emergency caesarean section during labor according to the type of hysterotomy extension performed. MATERIAL AND METHODS: This was a single-center comparative study of hysterotomy extension by transverse traction (January 2015 to April 2017) versus cephalocaudal traction (May 2021 to February 2022). All women who underwent an emergency caesarean section (orange or red code) during these two periods were included. The primary endpoint was a composite of the occurrence of unintended extension, uterine pedicle injury, postpartum hemorrhage >1 L, and the blood product transfusion. RESULTS: The study included 767 patients. At least one intraoperative complication occurred in 122 women (21.4%) in the transverse traction group and in 33 (16.8%) women in the cephalocaudal traction group (OR 0.74, 95% CI [0.48-1.13]; p = 0.16). The incidence of these complications did not differ between groups after weighting (adjusted OR 0.78, 95% CI [0.52-1.19]; adjusted p = 0.25). Individual analysis of each component of the composite endpoint also showed no differences between groups. CONCLUSIONS: In this study of emergency caesarean sections, the type of hysterotomy extension did not significantly influence the rate or type of intraoperative complications.
Pregnancy and perinatal outcomes after day 5 versus day 6 blastocyst-stage embryo transfer: A systematic review and meta-analysis.
Hou W, Wang Z, Wen T … +4 more , Ma Y, Lu M, Fan X, Zhao F
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41268807 · Full text
INTRODUCTION: Embryo transfer at the blastocyst stage has become popular in assisted reproductive technology, but it is still a challenge for embryologists to select the embryos with the highest implantation potential. W...
INTRODUCTION: Embryo transfer at the blastocyst stage has become popular in assisted reproductive technology, but it is still a challenge for embryologists to select the embryos with the highest implantation potential. We aimed to investigate whether blastocyst development speed and blastocyst quality affect pregnancy and perinatal outcomes in single frozen-thawed blastocyst transfer (SFBT) cycles. MATERIAL AND METHODS: We therefore conducted a meta-analysis to compare the pregnancy and perinatal outcomes after day 5 versus day 6 SFBT. Pregnancy and perinatal outcomes of SFBT included HCG positive rate, clinical pregnancy rate (CPR), live birth rate (LBR), miscarriage rate (MR), multiple pregnancy rate (MPR), ongoing pregnancy rate (OPR), ectopic pregnancy rate (EPR), mean birth weight, low birth weight (LBW) rate, rate of macrosomia, mean gestational age at birth, preterm birth rate, birth defects rate, and sex ratio (female/male). RESULTS: A total of 106 316 participants were included in this meta-analysis and were assigned to the D5 (n = 66 329) and D6 (n = 39 987) SFBT groups. Pooled analysis showed that the D5 SFBT group had a higher HCG positive rate (RR 1.24, 95% CI 1.14-1.34), CPR (RR 1.28, 95% CI 1.22-1.34), OPR (RR 1.36, 95% CI 1.21-1.53), LBR (RR 1.39, 95% CI 1.32-1.47), and a lower MR (RR 0.78, 95% CI 0.73-0.83) than the D6 SFBT group. No significant difference was observed between the D5 and D6 SFBT groups in other pregnancy and perinatal outcomes. Subgroup analysis comparing poor-quality D5 blastocysts with high-quality D6 blastocysts revealed no significant differences in most outcomes, except for a lower HCG positive rate (RR 0.92, 95% CI 0.87-0.97) and a higher rate of macrosomia (RR 2.13, 95% CI 1.05-4.31) in the poor-quality D5 group. CONCLUSIONS: The findings suggested that transfer D5 blastocysts should be prioritized over D6 blastocysts in SFBT in clinical practice. Besides, poor-quality D5 blastocysts and D6 high-quality blastocysts exhibited comparable outcomes. Given the overall low quality of available evidence, the association between the pregnancy outcomes and blastocyst development speed requires further investigation.
Association between induction of labor and birth experience: A national population-based study.
Braund S, Goffinet F, Girault A … +3 more , Seco A, Le Ray C, ENP2021 study group
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41267610 · Full text
INTRODUCTION: Because induction of labor (IOL) is increasingly frequent in high-income countries, studying its impact on birth experience needs further attention. Our objective was to assess the association between IOL a...
INTRODUCTION: Because induction of labor (IOL) is increasingly frequent in high-income countries, studying its impact on birth experience needs further attention. Our objective was to assess the association between IOL and birth experience, compared with spontaneous onset of labor (SOL), in routine practice using a national population-based survey. MATERIAL AND METHODS: The French National Perinatal Survey (Enquête Nationale Périnatale (ENP)) is a nationwide study aimed at monitoring maternal and neonatal health in 2021. Women from mainland France, with live births, face-to-face interviews, and who participated at the 2-month follow-up were included. At 2 months, women answered the question 'What kind of memories do you have about your childbirth?' and were classified into two groups: 'positive' and 'negative' birth experiences. We used univariate and multivariable logistic regression to compare birth experiences between women with SOL and IOL. We performed three sensitivity analyses: (1) with the onset of labor as a three-class variable (SOL, IOL, cervical ripening), (2) according to the presence of a medical indication for IOL, and (3) among a subgroup of low-risk women. Finally, we identified potential mediators on the pathway between IOL and a negative birth experience (birth with complication or operative delivery, pain at delivery, labor duration) and used mediation modeling to estimate indirect and residual effects. RESULTS: Among the 6200 women included, 1777 (28.7%) had an IOL. Women with IOL reported negative birth experiences more often than women with SOL (16.4% vs. 8.8%, p < 0.001). In the case of cervical ripening, the rate of negative birth experience increased to 18.8% (p < 0.001). After adjustment, the association between IOL and negative birth experience remained significant (aOR = 1.78, 95% CI [1.47-2.16]). We found similar results according to medical indication for IOL and among women at low risk. We estimated that 26% (95% CI, 12%-41%) of the association between IOL and a negative birth experience was mediated by birth with complications or operative delivery. CONCLUSIONS: Women with IOL had a significantly higher risk of negative birth experience, compared with those with SOL. Our findings underline the need for appropriate antenatal information for women about IOL, shared decision-making, and better follow-up for women at risk of negative birth experience.
Predictive factors for emergency cervical cerclage efficacy in singleton and twin pregnancies: A retrospective cohort study.
Hulshoff CC, Spaanderman MEA, Scholten RR … +1 more , van Drongelen J
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41263472 · Full text
INTRODUCTION: An emergency (rescue, exam-indicated) cervical cerclage can be offered to pregnant women presenting with cervical dilatation and prolapsed fetal membranes in the second trimester of pregnancy due to suspect...
INTRODUCTION: An emergency (rescue, exam-indicated) cervical cerclage can be offered to pregnant women presenting with cervical dilatation and prolapsed fetal membranes in the second trimester of pregnancy due to suspected cervical insufficiency. MATERIAL AND METHODS: This study aimed to evaluate the efficacy of emergency cerclage in preventing extreme preterm birth in singleton and twin pregnancies, and to identify predictors of unsuccessful outcomes. We conducted a 15-year observational cohort study at a tertiary care center in the Netherlands, including all women who underwent emergency cerclage. Analyses were conducted for the total population and stratified by pregnancy type, with direct comparisons between singleton and twin pregnancies. Outcomes included gestational age at delivery, offspring survival, and pregnancy prolongation. Kaplan-Meier analysis assessed pregnancy prolongation, with survival curves compared using the log-rank test. Multivariable logistic regression identified predictors of preterm birth <28 weeks, using backward stepwise selection. Results were reported as adjusted odds ratios with 95% confidence intervals, and model performance was evaluated using AUC. RESULTS: A total of 99 women were included: 64 singleton pregnancies and 35 twin pregnancies. We observed an overall survival of 77%, a median gestational age at delivery of 29.4 weeks, and pregnancy prolongation after cerclage placement of 53.0 days. For pregnancies that passed 24 weeks of gestation, overall survival was 92%. Outcomes were comparable between singleton and twin pregnancies. Key factors associated with reduced pregnancy prolongation were vaginal bleeding, prolapsed membranes beyond external os, cervical dilation ≥4.0 cm, elevated white blood cell count (≥13.600 mm) and CRP levels (≥15.0 mg/L). Multivariable analysis revealed prolapsed membranes beyond external os and gestational age at cerclage placement to be the most important independent predictors for preterm birth <28 weeks. CONCLUSIONS: Emergency cerclage is associated with high offspring survival in both singletons and twins. Clinical factors, among advanced cervical dilation and elevated infectious parameters prior to placement, significantly affect its efficacy, although prolapsed membranes and GA at cerclage placement emerged to be the most critical predictors for preterm birth <28 weeks. These findings provide valuable insights that can be used in the counseling of couples about the pros and cons of an emergency cerclage.
Fetal and neonatal brain protection at term-The role of translational experimental models.
Lantto J, Kiviranta P, Voipio J
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41261995 · Full text
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Cardiac dysfunction during adverse maternal outcomes in hypertensive disorders of pregnancy.
Giorgione V, Kitt J, Leeson P … +3 more , Khalil A, O'Driscoll J, Thilaganathan B
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41250558 · Full text
INTRODUCTION: Hypertensive disorders of pregnancy are associated with significant cardiac remodeling and diastolic dysfunction during pregnancy and are important contributors to maternal morbidity and mortality. Whether...
INTRODUCTION: Hypertensive disorders of pregnancy are associated with significant cardiac remodeling and diastolic dysfunction during pregnancy and are important contributors to maternal morbidity and mortality. Whether acute adverse maternal outcomes during hypertensive disorders of pregnancy are associated with abnormal left ventricular geometry and function has not been widely studied. MATERIAL AND METHODS: A prospective observational study was conducted on 255 women with hypertensive disorders of pregnancy who underwent transthoracic echocardiography during the peripartum period. Maternal echocardiographic parameters, including left ventricular morphology and function, were analyzed to determine their association with composite adverse maternal outcomes by univariate and multivariate analyses. The composite adverse maternal outcome was defined as at least one of the following: admission to a high dependency unit (an intermediate-care ward, providing enhanced cardiac monitoring), acute renal injury, adverse cardiopulmonary events, stroke, and disseminated intravascular coagulation. RESULTS: Adverse maternal outcomes occurred in 68 (26.7%) participants. Women with adverse outcomes had significantly higher left atrial volume index (28.8 [23.4-32.3] mL/m vs. 26.6 [22.2-30.9] mL/m, p = 0.045) and E/e' ratio (7.8 [6.6-9.2] vs. 7.0 [5.9-8.1], p = 0.002) compared to those without complications. Other diastolic indices, namely, mitral inflow E/A and tissue-Doppler e' velocities at the lateral and septal mitral annulus, showed no statistically significant between-group. In multivariable analysis, both left atrial volume index and E/e' ratio remained independently associated with adverse maternal outcomes after adjusting for maternal factors and clinical variables. Right ventricular indices, such as tricuspid annular plane systolic excursion and systolic velocity S', were independently associated with adverse maternal outcomes, while fractional area change remained unchanged, indicating hyperkinetic circulatory adaptation rather than enhanced intrinsic right systolic function. CONCLUSIONS: Cardiac abnormalities, particularly in left ventricular diastolic function and in right ventricular function, are more common in women with adverse maternal outcomes in hypertensive disorders of pregnancy than in hypertensive women without adverse maternal outcomes. Further studies are needed to determine whether these echocardiographic abnormalities could help identify women at increased risk of complications.
The paradox of early pregnancy care: Overtreatment amid systemic neglect.
Tellum T, Naftalin J
Acta Obstet Gynecol Scand · 2025 Dec · PMID 41249885 · Full text
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Obstetric outcome in women with congenital heart disease: A nationwide cohort in Sweden.
Wedlund F, Widing E, von Wowern E … +8 more , Christensson C, Lindstedt S, Sörensson P, Trzebiatowska-Krzynska A, Mandalenakis Z, Bay A, Johansson B, Hlebowicz J
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41239781 · Full text
INTRODUCTION: Survival and healthcare for patients with congenital heart disease have improved, and the number of pregnancies among women of childbearing age with congenital heart disease has increased. Our aim was to in...
INTRODUCTION: Survival and healthcare for patients with congenital heart disease have improved, and the number of pregnancies among women of childbearing age with congenital heart disease has increased. Our aim was to investigate obstetric outcomes in a large retrospective, national registry study of women with congenital heart disease compared to controls. MATERIAL AND METHODS: The study included women over 18 years of age from the Swedish Registry of Congenital Heart Disease. Each case was matched with 10 controls from Statistics Sweden, based on the mother's birth year and birth county and all were subsequently linked to the Swedish Medical Birth Register. We included 7998 pregnancies in women with congenital heart disease and 84 799 in controls during 1973-2020. RESULTS: The mean age at delivery for women with congenital heart disease and controls was 28.7 (±5.0) and 28.7 (±5.1) years, respectively. Women with congenital heart disease smoked less, had a shorter gestation and a higher incidence of delivery by Cesarean section compared to controls. The likelihood of Cesarean section was increased in women with congenital heart disease compared to controls: odds ratio 1.45 (95% confidence interval (CI) 1.37-1.54). Compared to controls, women with congenital heart disease had an increased likelihood of giving birth to small-for-gestational-age neonates: odds ratio 1.40 (95% CI 1.23-1.58). The association regarding small-for-gestational-age remained after adjusting for body mass index, age, smoking, comorbid diseases and preeclampsia. Women with congenital heart disease had an increased likelihood of prematurity compared to controls: odds ratio 1.47 (95% CI 1.35-1.59). The likelihood of Cesarean section, small-for-gestational-age neonates and prematurity was higher in women with severe congenital heart disease than mild/moderate congenital heart disease, both compared to controls. CONCLUSIONS: In this large national case-control study in women with congenital heart disease, we showed an increased likelihood of giving birth prematurely by Cesarean section, and having a small-for-gestational-age neonate compared to matched controls. The likelihood seems even higher in women with severe congenital heart disease. Further research is needed to explore the underlying reasons for the high rates of Cesarean section in women with congenital heart disease.
The threshold of estradiol level for fresh embryo transfer differs between blastocyst and cleavage-stage embryo.
Zhao D, Xiao H, Ouyang G … +10 more , Fang Y, Ding Q, Niu Y, Zou J, Liu Y, Shang X, Wang Z, Chen ZJ, Liu L, Wei D
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41239764 · Full text
INTRODUCTION: Ovarian stimulation can cause supraphysiological estradiol levels and adverse effects on endometrial receptivity. Since patients could undergo cleavage or blastocyst stage embryo transfer, the threshold val...
INTRODUCTION: Ovarian stimulation can cause supraphysiological estradiol levels and adverse effects on endometrial receptivity. Since patients could undergo cleavage or blastocyst stage embryo transfer, the threshold value of peak estradiol level for each transfer stage that impacts the pregnancy outcomes of fresh versus frozen embryo transfer remains unclear. This work aims at answering the following questions: what is the threshold of peak estradiol level that modifies the difference in pregnancy outcomes between fresh and frozen embryo transfer and whether the threshold value varies with the stage of embryo transferred? MATERIAL AND METHODS: A secondary analysis of data from four multicenter randomized trials with similar design comparing the rate of live birth between fresh and frozen embryo transfer in a total of 6153 patients. Peak serum estradiol level was measured on the day of hCG administration. Live birth rate is the primary outcome. RESULTS: Multivariable regression modeling showed an interaction between the stage of embryo transferred and the intervention (frozen vs fresh embryo transfer) on the live birth rate (p = 0.016). In the cleavage-stage embryo transfer group, frozen embryo transfer resulted in a higher rate of live birth when peak estradiol level >3900 pg/mL (55.4% vs 44.9%; OR, 1.57; 95% CI, 1.24-1.99) and a similar live birth rate (OR, 1.10; 95% CI, 0.93-1.31) when peak estradiol level was 1600-3900 pg/mL. However, in the blastocyst transfer group, frozen embryo transfers yielded a higher live birth rate when peak estradiol level >2000 pg/mL (54.3% vs 37.7%; OR, 2.00; 95% CI, 1.59-2.51). CONCLUSIONS: A freeze-all strategy may result in a higher rate of live birth when the peak estradiol level >3900 pg/mL for cleavage-stage embryo transfer and when the peak estradiol level >2000 pg/mL for blastocyst transfer.
Exploring endometrial cancer in premenopausal women-A nationwide PremEnCa cohort study.
Ioannou C, Malmsten C, Ehn P … +3 more , Holmberg E, Dahm-Kähler P, Stålberg K
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41239761 · Full text
INTRODUCTION: An increased incidence of endometrial cancer has been noted, especially in premenopausal women in countries with rapid socioeconomic transition. In one of the largest patient cohorts of women ≤50 years, wit...
INTRODUCTION: An increased incidence of endometrial cancer has been noted, especially in premenopausal women in countries with rapid socioeconomic transition. In one of the largest patient cohorts of women ≤50 years, with manually validated register data, we aim to examine the pattern of disease of endometrial cancer and to evaluate the prognosis according to tumor and patient characteristics, focusing on body mass index. MATERIAL AND METHODS: This is a nationwide population-based study on women ≤50 years with endometrial cancer, 2010-2021, using data from Swedish registries complemented by the reviewing of medical records. Overall survival and disease-free survival were calculated by the Kaplan-Meier method and the log-rank test. Multivariable regression analyses were performed. RESULTS: Of the total endometrial cancer cohort, 797 (5%) patients were ≤50 years of age (the PremEnCa cohort) with 0.9% under 40 years of age. Women ≤50 years of age had a higher prevalence of stage IA and endometrioid histology than older women. Among women ≤50 years of age, 46% met the criteria for obesity. No associations between socioeconomic factors and stage at diagnosis were found. Notably, women with lower Body Mass Index <20, had a higher proportion of non-endometrioid histology and higher stage of disease at the time of diagnosis. Median follow-up time was 4.2 (IOR 1.9-5.4) years. The recurrence rate was 6.1% in the PremEnCa cohort during the follow-up period, and the 5-year overall survival was 94.6% (95% CI: 92.6-96.0) for endometrioid and 68.5% (95% CI: 51.1-80.8) for non-endometrioid endometrial cancer. Only 36 of the 74 deaths were caused by endometrial cancer. In adjusted analyses for disease-free survival, non-endometrioid histology and International Federation of Gynecology and Obstetrics (FIGO) stage were associated with worse prognosis. CONCLUSIONS: Endometrial cancer in premenopausal women is very rare and is associated with an excellent prognosis. Histology and FIGO stage were the strongest prognostic factors. Half of the deaths were due to other causes, which emphasizes the importance of focusing on general health aspects in this young endometrial cancer population.
Impact of double versus single blastocyst biopsy and vitrification on clinical and neonatal outcomes in PGT cycles: A systematic review and meta-analysis of embryo retesting.
Vireque AA, Berteli TS, Stolakis V … +2 more , Bertero M, Kofinas J
Acta Obstet Gynecol Scand · 2026 Jan · PMID 41235754 · Full text
INTRODUCTION: As PGT advances in assisted reproduction, more embryos with inconclusive results, yet potentially transferable, have emerged. Current studies reveal a disparity between the reproductive potential of reteste...
INTRODUCTION: As PGT advances in assisted reproduction, more embryos with inconclusive results, yet potentially transferable, have emerged. Current studies reveal a disparity between the reproductive potential of retested blastocysts and the supporting evidence. This systematic review and meta-analysis compared clinical outcomes of rebiopsied and revitrified blastocysts with those biopsied and vitrified once. MATERIAL AND METHODS: Searches were conducted on June 26, 2024, across PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar, using thesaurus and free-text terms. Selection, data extraction, and risk of bias were assessed by three independent reviewers. The primary outcomes were live birth rate (LBR) and singleton birthweight; secondary outcomes were clinical pregnancy rate (CPR), clinical pregnancy loss rate (CPLR), positive pregnancy rate, very early pregnancy loss rate, and neonatal outcomes. Quantitative analyzes were performed using a random-effects model, pooling dichotomous outcomes as odds ratios (OR) and 95% CI and continuous outcomes as mean differences (MD) using the inverse variance model. Subgroup analyses based on "biopsy day" and "morphological grades" were performed. RESULTS: Seventeen studies were included, reporting 36,441 SET cycles. Very low-quality evidence suggests that rebiopsy and revitrification were associated with a decreased likelihood of LBR compared with single biopsy and vitrification (OR = 0.54, 95% CI = 0.44-0.67; I = 12%; p < 0.00001, Pred Int = 0.38-0.79; 13 studies). No effect of retesting was found on the birthweight of 141 newborns (MD = 21.05, 95% CI = -64.83-106.94; I = 0%; p = 0.63, six studies). The odds of pregnancy were decreased for both positive pregnancy (OR = 0.58, Pred Int = 0.30-1.12; I = 41%; p = 0.001, eight studies) and CPR (OR = 0.60, 95% CI = 0.51-0.70; I = 0%; p < 0.00001, 14 studies), leading to a higher CPLR (OR = 1.56, 95% CI = 1.14-2.12; I = 0%; p = 0.005, 13 studies). No statistically significant subgroup effects were detected; however, the "biopsy at D5" and "high-quality" subgroups showed 10%-20% higher odds of LBR, which may hold clinical value and warrant further investigation. CONCLUSIONS: Decision-making on retesting embryos for PGT should be done with caution, as it might reduce live birth rate in order to obtain the precise genetic diagnosis. Larger and well-designed studies, controlling for the main sources of bias, are still needed in order to improve the quality of the available evidence.
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