Acta Obstetricia Et Gynecologica Scandinavica[JOURNAL]
Sun
200 papers
Home telemonitoring in high-risk pregnancies: A Finnish retrospective cohort study.
Stark T, Kruit H, Rahkonen L
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42272129 · Publisher ↗
INTRODUCTION: High-risk pregnancies require close monitoring and frequent hospital visits. Home telemonitoring offers a potential alternative to improve access and satisfaction while reducing healthcare use. This retrosp...
INTRODUCTION: High-risk pregnancies require close monitoring and frequent hospital visits. Home telemonitoring offers a potential alternative to improve access and satisfaction while reducing healthcare use. This retrospective cohort study characterized the clinical course and events during home telemonitoring including home-based cardiotocography during a pilot program for women with high-risk pregnancies at an urban tertiary hospital. MATERIAL AND METHODS: This retrospective three-year cohort study included 117 singleton pregnancies enrolled in a home telemonitoring program at Helsinki University Hospital between January 2021 and December 2023. Participants were grouped by primary indication: premature rupture of membranes, preeclampsia and/or fetal growth restriction, or other high-risk conditions. The main outcomes included the course and duration of home telemonitoring, rates of hospital visits and readmissions, the onset of labor or emergency cesarean delivery, and severe complications during home telemonitoring, including maternal or fetal death, placental abruption, prolapse of umbilical cord, placenta previa with bleeding, chorioamnionitis, eclampsia, and worsening of preeclampsia. RESULTS: The median gestational age at initiation of home telemonitoring was 32.4 weeks, and the median monitoring duration was 7 days (IQR 2.5-13.5). Thirty-eight women (32.6%) were readmitted. The median gestational age at delivery was 34.6 (range 25.1-41.4) weeks, and 87.2% (102/117) delivered preterm. The overall cesarean rate was 47.0% (55/117). Spontaneous onset of labor occurred in 11 (9.4%) women during the home telemonitoring period; no home deliveries were recorded. 38 women (32.5%) underwent an emergency cesarean delivery. No maternal or intrauterine fetal deaths occurred. Complications occurred in 36 cases (30.8%). The most common complications were chorioamnionitis (n = 21,17.9%) and worsening of preeclampsia (n = 11, 9.4%). No eclampsia was observed. Two cases of placental abruption (n = 2, 1.7%) and two cases of bleeding due to placenta previa (n = 2, 1.7%) occurred. In all the preceding cases, immediate readmission and prompt management resulted in favorable maternal and neonatal outcomes. CONCLUSIONS: This pilot study suggests that home telemonitoring represents an acceptable approach for the management of selected high-risk pregnancies. However, careful patient selection and strict adherence to evidence-based clinical protocols are essential to ensure safe and effective implementation.
An attempt to improve recognition of fetal acidemia by a remodeled intrapartum cardiotocography classification: A case-control study.
Fogelberg M, Bjurström JW, Dahlbäck C … +4 more , Ekengård F, Rickle G, Källén K, Herbst A
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42272108 · Publisher ↗
INTRODUCTION: Current international (FIGO) and Swedish cardiotocography (CTG) interpretation templates exhibit limited diagnostic accuracy for the detection of fetal acidemia. The objective of this study was to develop a...
INTRODUCTION: Current international (FIGO) and Swedish cardiotocography (CTG) interpretation templates exhibit limited diagnostic accuracy for the detection of fetal acidemia. The objective of this study was to develop a novel intrapartum CTG classification template incorporating CTG parameters demonstrated to be strongly associated with acidemia, and to evaluate the diagnostic performance of the models by assessing their sensitivity and specificity in identifying CTG recordings from neonates with acidemia. MATERIAL AND METHODS: A retrospective case-control study based on 1092 births in Region Skåne. The study material included 364 cases with umbilical cord blood pH <7.05, or <7.10 after 1st stage cesarean, and 728 controls with pH ≥7.15 and Apgar scores ≥9 at 5 and 10 min. CTG patterns were systematically evaluated across a set of predefined variables, and associations between specific patterns and fetal acidemia were quantified using ORs. Two models defining pathological patterns were created: Model 1 based on the presence of one of several listed criteria resulting in a positive test and Model 2 also including the presence of ≥2 B-criteria resulting in a positive test. The main outcomes, sensitivity, and specificity to identify fetal acidemia at birth were calculated and compared with the current FIGO, NICE, and SWE guidelines. RESULTS: The sensitivity to identify fetal acidemia was 86.3%, 86.5%, 50.8%, 57.1%, and 87.4% for Model 1, Model 2, FIGO, SWE, and NICE, respectively. The corresponding specificity was 77.9%, 76.4%, 92.6%, 91.2%, and 70.6%. The sensitivity to identify severe acidemia (pH <7.0) was 90.4% for Model 1 and for NICE; 64.4% for SWE, and 56.7% for FIGO. A variable not included in current classification systems, "fetal heart rate below baseline for >50% of the time during 30 minutes" was the criterion contributing most to the sensitivity. CONCLUSIONS: Our models show higher sensitivity but lower specificity for the defined outcome compared with SWE and FIGO, and similar sensitivity but higher specificity compared with NICE. Validating the model on a new material is essential before considering clinical use.
Freebirth and professional responsibility: Respect for autonomy does not justify clinical neutrality on preventable fetal and neonatal harm.
Grünebaum A, Chervenak FA
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42268242 · Publisher ↗
The freebirth movement, planned birth without any qualified professional attendant, is expanding internationally, including in Scandinavia, where rising rates and incomplete outcome reporting have raised clinical and eth...
The freebirth movement, planned birth without any qualified professional attendant, is expanding internationally, including in Scandinavia, where rising rates and incomplete outcome reporting have raised clinical and ethical concerns. A recent editorial in this journal emphasizes respectful engagement with women considering out-of-hospital birth and the importance of rebuilding trust through less coercive models of care. We argue that insufficient distinction between professionally attended home birth and planned unassisted birth risks conflating two distinct professional obligations: respecting patient autonomy and maintaining clinical neutrality in the face of preventable fetal and neonatal harm. These are not equivalent obligations. Respect for autonomy requires accurate, complete, evidence-based counseling and a clear professional recommendation when the evidence warrants one, while preserving the patient's right to decline. After viability, the fetus acquires patient status with corresponding beneficence-based obligations that planned unassisted birth forecloses entirely. Directive counseling against a practice associated with increased risk of preventable fetal and neonatal death is not coercion. It is what informed consent requires of the clinician. Professional responsibility does not ask clinicians to choose between compassion and clarity. It requires both.
Immediate placement of intrauterine device after second-trimester medical abortion-Secondary outcomes with one-year follow-up.
Hogmark S, Westermark C, Envall N … +2 more , Gemzell-Danielsson K, Kopp Kallner H
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42266170 · Publisher ↗
INTRODUCTION: Intrauterine devices (IUDs) effectively prevent unwanted pregnancies. Little is known about long-term outcomes of women choosing an IUD after second-trimester medical abortion. MATERIAL AND METHODS: We perf...
INTRODUCTION: Intrauterine devices (IUDs) effectively prevent unwanted pregnancies. Little is known about long-term outcomes of women choosing an IUD after second-trimester medical abortion. MATERIAL AND METHODS: We performed a 12-month follow-up of a multicenter randomized controlled trial comparing IUD placement within 48 h (intervention) with placement at 2-4 weeks (control) after medical abortion with 85 to 153 days' gestation. Secondary outcomes such as proportions of long-term IUD use, subsequent pregnancies and abortions, and participant satisfaction are presented (ClinicalTrials.gov NCT03603145). RESULTS: A total of 179 women were included. The 12-month follow-up rate was 71.1% (64/90) in the intervention group and 73.0% (65/89) in the control group. Fewer women in the intervention group were using an IUD after 12 months: 51.6% (33/64) vs. 69.2% (45/65, p = 0.04). The total expulsion rate over 12 months was 36.4% (24/66) in the intervention group compared to 3.1% (2/65) in the control group (p < 0.001), with only two IUDs being expelled between 6 and 12 months, both in the intervention group. The most common contraceptive method at 12 months was any hormonal IUD at 54.3% (70/129). Among IUD users at 12 months, the overall satisfaction with their contraceptive method was high, at 88.3% (68/77). In the intervention group, 26.2% (16/61) had at least one subsequent pregnancy within 12 months compared to 13.6% (9/66, p = 0.08) in the control group. We found no significant difference in the number of subsequent abortions; 13.1% (8/61) in the intervention group and 6.1% (4/66) in the control group reported at least one subsequent abortion (p = 0.23). CONCLUSIONS: Immediate IUD placement after second-trimester medical abortion did not lead to a higher proportion of IUD use at 12 months compared to delayed placement. Rather, immediate IUD placement was associated with a higher incidence of expulsion and lower use; however, no significant increase in subsequent pregnancies or abortions was observed. High satisfaction levels with IUD use were reported in both groups, but women with immediate placement were less likely to recommend a friend to use an IUD post abortion.
Population-specific validation of fetal weight formulas: Evidence from a multicenter near-delivery cohort.
Nagasaki S, Suzuki R, Sugo F … +7 more , Tachihara M, Mori T, Shimizu S, Sakuma J, Ito A, Takano M, Nakata M
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42265933 · Publisher ↗
INTRODUCTION: Accurate ultrasound estimated fetal weight (EFW) supports key perinatal decisions. This study aimed to compare the accuracy of a population-specific formula with that of a widely used global model in pregna...
INTRODUCTION: Accurate ultrasound estimated fetal weight (EFW) supports key perinatal decisions. This study aimed to compare the accuracy of a population-specific formula with that of a widely used global model in pregnancies examined near delivery. MATERIAL AND METHODS: This was a secondary analysis of a prospective Japanese cohort study to develop a new fetal ultrasound biometry reference chart. Fetal ultrasound measurements were obtained by Japan Society of Ultrasonics in Medicine-certified sonographers or under their supervision and submitted to the coordinating center, where EFW was calculated using the Shinozuka and Hadlock-3 formulas. Analyses were restricted to cases with EFW available from both formulas. The primary analysis included examinations within 7 days before delivery; a sensitivity analysis restricted the interval to ≤3 days. A subgroup analysis was performed in fetuses classified as small for gestational age (SGA). RESULTS: In the primary analysis (n = 310), the median signed error was -75.8 g for Shinozuka and -223.3 g for Hadlock-3 (Wilcoxon p < 0.001). The median absolute percentage signed error was 4.81% for Shinozuka and 7.93% for Hadlock-3 (Wilcoxon p < 0.001). The proportion within ±10% of BW was 83.9% with Shinozuka versus 61.6% with Hadlock-3 (McNemar p < 0.001). In the sensitivity analysis (n = 176), similar findings were observed. In the SGA subgroup (n = 40), the signed error and absolute percentage error were significantly lower with the Shinozuka formula than with Hadlock-3. CONCLUSIONS: In this multicenter cohort examined near delivery, the population-specific Shinozuka formula produced EFW closer to BW and a higher proportion within ±10% than Hadlock-3, which showed greater systematic underestimation. These findings support the use of locally validated, population-specific EFW formulas when available, particularly for clinical decision-making near delivery.
Fecal incontinence from early pregnancy to 12 months postpartum: A longitudinal cohort study from Tuscany.
Ferrari A, Pisacreta E, Bonciani M … +3 more , Montt-Guevara MM, Simoncini T, Mannella P
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42265907 · Full text
INTRODUCTION: Fecal incontinence (FI) during pregnancy and after childbirth is an underrecognized condition that may affect women's physical, psychological, and social well-being. Evidence on its prevalence and determina...
INTRODUCTION: Fecal incontinence (FI) during pregnancy and after childbirth is an underrecognized condition that may affect women's physical, psychological, and social well-being. Evidence on its prevalence and determinants over the full perinatal period remains limited. This study aimed to assess the evolution of FI from early pregnancy to 12 months postpartum and to identify sociodemographic, clinical, obstetric, and care-related factors associated with symptom severity and occurrence. MATERIAL AND METHODS: We conducted a prospective cohort study using data from a regional longitudinal maternity survey administered through the hAPPyMamma application in Tuscany, Italy. Women who completed all questionnaires, including the Wexner scale, between March 2019 and March 2023 were included. The time points were first and third trimesters (T0-T1), and three, six, and 12 months postpartum (T2-T4). FI prevalence and mean Wexner scores were calculated at each time point. Determinants of FI occurrence and severity were examined, respectively, through panel logistic and linear regression models adjusted for sociodemographic, clinical, obstetric, and pathway-related variables. RESULTS: A total of 10 576 women completed all follow-up assessments with no missing data. FI prevalence ranged from 3.5% at T0 to 5.5% at T2, declining to 3.0% at T4. Mean Wexner scores varied only modestly across the study period, from 5.6 at T0 to 4.2 at T4, indicating overall mild but persistent symptoms throughout pregnancy and the postpartum period. Adjusted panel regression models confirmed the significant association of older age, overweight, non-Italian nationality, lower education, lower income, high-risk pregnancy, discomfort during pregnancy, operative delivery, perineal tears, episiotomy, higher neonatal birthweight, difficult access to services, and examinations not booked by the women themselves with FI severity or occurrence. FI symptoms were more severe at T1-T2 and more likely to occur at T1-T3 compared with T0. Pelvic floor muscle training was not protective. CONCLUSIONS: FI affects a minority of women but persists across pregnancy and postpartum, with several identifiable risk factors. Systematically integrating FI screening into antenatal and postnatal care may support earlier identification and more timely management, thus improving maternal health outcomes and strengthening continuity of care.
Placental basal plate with attached myofibers and adverse pregnancy outcomes: A systematic scoping review.
Jauniaux E, Bartels HC, Downey P … +1 more , D'Antonio F
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42265883 · Publisher ↗
INTRODUCTION: The finding of basal plate myometrial fibers (BPMF) delivered with the placenta has been associated with many different pregnancy and delivery complications. This study aims to evaluate the clinical utility...
INTRODUCTION: The finding of basal plate myometrial fibers (BPMF) delivered with the placenta has been associated with many different pregnancy and delivery complications. This study aims to evaluate the clinical utility of this histopathological finding in obstetrics. MATERIAL AND METHODS: We searched PubMed, Google Scholar, and Embase for studies published in English reporting an association between obstetric complications and placental BPMF, using combinations of relevant medical subject heading terms and keywords, published between March 1996 and December 2025. Study characteristics were evaluated by two independent reviewers using a predesigned protocol. The PRISMA Extension for Scoping Review (PRISMA-ScR) was used to extract data and report the results. RESULTS: Sixteen studies met our eligibility criteria for inclusion in this review. There were five cohorts and 11 studies, involving 5770 participants from four different countries. Nine studies reported on the association between BPMF on histopathologic examination in the setting of a delivered placenta and maternal or fetal pregnancy and delivery complications, and the remaining seven studies investigated the association between BPMF at birth in the index pregnancy and abnormal placental attachment at the next delivery. The most common prenatal and perinatal disorders were hypertensive disorders of pregnancy, placenta previa, preterm delivery, pre-labor rupture of the membranes, suspicion of intrauterine infection, diabetes, stillbirth, and fetal growth restriction, and the most common intrapartum complications were placental abruption and placental retention. A higher incidence of abnormal placental attachment was reported in the subsequent pregnancy in cases where BPMF were found in the first pregnancy, but wide heterogeneity was observed across the included studies, particularly in the clinical criteria used to report placental attachment at delivery and interpretations of corresponding results. CONCLUSIONS: The clinical usefulness of reporting on BPMF in delivered placentas from pregnancies complicated by maternal or fetal disorders is currently difficult to evaluate due to variability in inclusion criteria, methodological protocols, and reported outcomes. The study of BPMF in delivered placentas may help fill evidence gaps in our knowledge of the pathophysiology of placental-related pregnancy disorders involving the uteroplacental interface and the link between these disorders and long-term maternal cardiovascular complications.
Fertility outcomes and ovarian function recovery after anti-NMDAR encephalitis: A retrospective cohort study.
Wang J, Ding J, Cai H … +2 more , Wang Y, Wu H
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42260927 · Publisher ↗
INTRODUCTION: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis predominantly affects women of reproductive age and is frequently associated with ovarian teratomas. While acute neurological outcomes are well d...
INTRODUCTION: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis predominantly affects women of reproductive age and is frequently associated with ovarian teratomas. While acute neurological outcomes are well described, the long-term impact on ovarian endocrine function and fertility-particularly in tumor-associated cases-remains poorly understood, creating significant uncertainty in survivorship counseling. MATERIAL AND METHODS: We conducted a retrospective cohort study involving 106 women diagnosed with anti-NMDAR encephalitis at a tertiary academic hospital between 2015 and 2024. Primary outcomes included the recovery of ovarian endocrine function, measured by serial sex hormone levels and fertility outcomes. Secondary analyses assessed disease severity, tumor markers, and neuroimaging features between teratoma-associated cases and non-teratoma cases. RESULTS: Patients with teratoma-associated encephalitis (n = 23) exhibited greater acute disease severity, necessitating higher rates of ICU admission (p = 0.012) and mechanical ventilation (p = 0.021). During the acute phase of illness, 38% of all patients experienced HPO axis suppression, primarily manifesting as amenorrhea. However, longitudinal monitoring revealed substantial recovery, with significant improvements in both luteinizing hormone (p = 0.01) and estradiol levels (p = 0.01) during convalescence. Notably, pregnancy rates were comparable between the teratoma (80%) and non-teratoma (83.3%) groups (p = 0.68). CONCLUSIONS: Ovarian dysfunction in anti-NMDAR encephalitis is often reversible, and long-term fertility remains favorable even in teratoma-associated cases. These findings provide valuable guidance for fertility counseling and highlight the importance of incorporating reproductive health monitoring into the long-term care of young women with tumor-related autoimmune encephalitis.
Introducing self-sampling for cervical cancer screening: A regional implementation study in Pirkanmaa, Finland.
Kyllönen S, Saloranta S, Kares S … +2 more , Mustila A, Louvanto K
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42244134 · Publisher ↗
INTRODUCTION: HPV primary testing is the preferred method for cervical cancer screening worldwide and enables vaginal self-sampling at home. Self-sampling performs comparably to clinician-collected samples and can improv...
INTRODUCTION: HPV primary testing is the preferred method for cervical cancer screening worldwide and enables vaginal self-sampling at home. Self-sampling performs comparably to clinician-collected samples and can improve participation, especially among non-attenders. In Finland, self-sampling has so far been piloted in the Helsinki region. This study evaluated the feasibility and acceptability of self-sampling in Pirkanmaa, providing a representative model of implementation outside the capital region. MATERIAL AND METHODS: The self-sampling in cervical cancer routine screening (FALCON) study (NCT06931184) targeted women living in Pirkanmaa who did not respond to the initial cervical cancer screening invitation. In a reminder letter, they were offered an opt-in model self-sampling option. Participants ordered a self-sampling kit containing a FLOQSwab (Copan), instructions, and a prepaid return envelope. Samples were analyzed with the Roche Cobas 4800 HPV assay at Fimlab Laboratories. HPV-positive women were referred for cytology testing and managed according to national guidelines. Participants completed two online questionnaires: one at kit order and another 60 days later. RESULTS: Of 16 289 reminder letters, 329 kits were ordered, and 304 (1.9%) samples were returned. Participants (mean age 48 [range 29.9-65.8]) were mostly well-educated with previous screening history. Time-saving, reduced discomfort, and lower embarrassment were the main reasons for choosing home-sampling. HPV was detected in 6.9% of the samples, with one case of histological HSIL identified. Most participants found self-sampling easy and comfortable, and nearly all would recommend it to others. CONCLUSION: Despite the small number of participants in this first year, the study offers early evidence of the strong acceptability and practicality of self-sampling among women in Pirkanmaa, warranting further evaluation at a larger scale.
Feasibility and reproducibility of a novel introital exo-anal ultrasound approach for assessment of the external anal sphincter.
Youssef A, Bernardi V, Paoli M … +4 more , Fioravanti I, Fortuna E, Del Magno A, Brunelli E
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42240190 · Full text
INTRODUCTION: Obstetric anal sphincter injuries are a major cause of anal incontinence and are frequently underdiagnosed at delivery. Imaging techniques that are feasible, reproducible, and applicable in obstetric practi...
INTRODUCTION: Obstetric anal sphincter injuries are a major cause of anal incontinence and are frequently underdiagnosed at delivery. Imaging techniques that are feasible, reproducible, and applicable in obstetric practice may be useful to support assessment in selected clinical situations. This study evaluated a three-dimensional exo-anal introital ultrasound technique combining linear freehand reconstruction (Polyline OmniView) and contrast enhancement using Volume Contrast Imaging (VCI) to enable coronal reconstruction and measurement of the anterior external anal sphincter (EAS). MATERIAL AND METHODS: This was a prospective feasibility and reproducibility study conducted at Sant'Orsola University Hospital, Bologna, Italy. Nulliparous women with singleton pregnancies were recruited between September 2023 and September 2024. 3D introital exo-anal ultrasound volumes were acquired using a high-frequency transvaginal probe. Volumes were reconstructed using Polyline OmniView combined with VCI to obtain a coronal view of the anterior EAS. The primary outcome was the feasibility of measuring the coronal length of the anterior portion of the EAS. The secondary outcome was intra- and interobserver reproducibility of this measurement, obtained after standardized offline volume analysis. RESULTS: Seventy women were included. Measurement of the anterior EAS length was feasible in all cases (100%). Reproducibility was excellent, with minimal mean differences, intraclass correlation coefficient values of 0.96 (95% CI, 0.94-0.98) for intraobserver agreement and 0.97 (95% CI, 0.96-0.99) for interobserver agreement, and narrow limits of agreement on Bland-Altman analysis. The mean length of the anterior EAS was 14.4 ± 1.5 mm for the first measurement by Operator 1, 14.4 ± 1.6 mm for the second measurement by Operator 1, and 14.6 ± 1.6 mm for measurements by Operator 2. CONCLUSIONS: Three-dimensional exo-anal introital ultrasound incorporating linear freehand reconstruction and contrast enhancement allows feasible and highly reproducible measurement of the anterior external anal sphincter. This approach may represent a feasible imaging option for anal sphincter assessment and warrants further evaluation not only in women with suspected obstetric anal sphincter injuries but also in the longitudinal follow-up of women with OASIS and in the assessment of patients presenting with anal incontinence.
Self-administered tele-ultrasound in fetal telemonitoring: Prospective study.
Kariman SS, Lekkerkerker S, Ummels J … +3 more , Adriaanse B, van den Heuvel JFM, Bekker MN
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42226706 · Publisher ↗
INTRODUCTION: Digital innovations in ultrasound are enabling tele-ultrasound and remote guidance, offering new opportunities to strengthen hospital-at-home care. This study evaluated the feasibility and user experience o...
INTRODUCTION: Digital innovations in ultrasound are enabling tele-ultrasound and remote guidance, offering new opportunities to strengthen hospital-at-home care. This study evaluated the feasibility and user experience of self-administered ultrasound by pregnant women with real-time guidance. MATERIAL AND METHODS: This prospective observational cohort study included pregnant women with uncomplicated singleton pregnancies between 24 and 37 weeks of gestation. Participants used the portable tele-ultrasound device Pulsenmore ES (Pulsenmore Ltd., Omer) at home to perform clinician-guided, real-time transabdominal 2D scans twice weekly, completing eight scans over a 28-day period. Real-time guidance was provided by experienced obstetric healthcare professionals. Primary outcome was feasibility, including image acquisition, interpretability, interobserver agreement for saved images, and technical aspects. Secondary outcomes included the System Usability Scale and the self-developed Telemonitoring Survey for user experience. Additionally, a focus group meeting assessed obstetric healthcare professionals' perspectives on the system. RESULTS: Thirty pregnant women participated, with a mean age of 32.6 years, median body mass index of 23.3 kg/m, and a mean gestational age of 29 weeks (range 24.3-34.5). All participants completed eight ultrasound scans, resulting in 240 tele-ultrasound examinations with a 100% success rate for predefined parameters, including fetal position, fetal heart activity, deepest pocket of amniotic fluid, and placental location. Across the study, remote connection and image acquisition times shortened to a median of 5 and 4 min, respectively. Retrospective analysis was possible for 226 scans, yielding a 99.9% parameter identification rate and perfect interobserver agreement (100%). Technical errors occurred in 16.3% of examinations, mainly due to connection issues. No association was found between scan duration and maternal or pregnancy characteristics such as gestational age, body mass index, and placental location. Participant experience was highly positive, with a mean System Usability Scale score of 80.7 and a satisfaction score of 4.4/5 on the Telemonitoring Survey, reflecting excellent usability. Ultrasound experts found the system user-friendly, with sufficient image quality and functionality. CONCLUSIONS: Self-administered fetal tele-ultrasound is feasible and associated with high user satisfaction and usability. This study supported its potential as a complementary tool in obstetric care, highlighting tele-ultrasound's promise to enhance accessibility, patient engagement, and strengthen hospital-at-home strategies.
Underpowered study design invalidates conclusions of LTAP versus LWI in peritoneal endometriosis surgery.
Li D, Ye S
Acta Obstet Gynecol Scand · 2026 May · PMID 42216623 · Publisher ↗
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Ancestry-based antihypertensive therapy: Beware of pitfalls.
Sugulle M, Alnæs-Katjavivi P
Acta Obstet Gynecol Scand · 2026 May · PMID 42216456 · Publisher ↗
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Modification of a breast pump suction pattern increases milk yield during the first 4 days postpartum.
Manshanden TMN, Prime DK, Scheele F … +1 more , Velzel J
Acta Obstet Gynecol Scand · 2026 May · PMID 42212560 · Publisher ↗
INTRODUCTION: This prospective study aimed to assess if the addition of 5 min nutritive suction cycles, following 15 min of predominantly non-nutritive suction cycles used to initiate breastfeeding, would result in an in...
INTRODUCTION: This prospective study aimed to assess if the addition of 5 min nutritive suction cycles, following 15 min of predominantly non-nutritive suction cycles used to initiate breastfeeding, would result in an increase in milk yield during an expression session in the first 4 days postpartum. MATERIAL AND METHODS: A prospective interventional study was conducted in the Netherlands, enrolling 90 breastfeeding patients who delivered at ≥36 weeks gestation and had infants aged ≤96 h old with a clinical indication to express milk using a breast pump. One of the participants' clinically indicated pumping sessions was used for a 20-min breast expression assessment. The session comprised 15 min of predominantly non-nutritive standard suction followed by 5 min of nutritive suction using a hospital-grade electric breast pump. The primary outcome measured the difference in milk volume between 15- and 20-min pumping in total and per postpartum day in the first 4 days postpartum. Secondary outcomes included expression volume at 15 and 20 min pumping per patient characteristic and milk yielded milliliters per minute. RESULTS: The primary outcome measure of the difference in milk volume between 15- and 20-min pumping was significantly increased both overall (1.39 vs. 2.83 mL, p < 0.001) and per postpartum day (p < 0.001). Milk yield per minute was significantly lower during the initial 15 min compared to the additional 5 minutes pumping (0.09 vs. 0.29 mL/min, p < 0.001). CONCLUSIONS: This study demonstrates a significant incremental improvement in milk removed during pumping episodes conducted in the first 4 days postpartum by the implementation of a 5 minute additional nutritive suction pattern to a 15 min predominantly non-nutritive suction cycle pattern. These findings could play a crucial role in supporting early access to colostrum and improving long-term breastfeeding outcomes.
Reproductive outcomes in women with Hodgkin's lymphoma in a Danish fertility preservation cohort.
Colmorn LB, Larsen EC, Pedersen AT … +2 more , Kristensen SG, Macklon KT
Acta Obstet Gynecol Scand · 2026 May · PMID 42212548 · Publisher ↗
INTRODUCTION: The risk of premature ovarian insufficiency (POI) after Hodgkin's lymphoma depends on female age, type, and dose of gonadotoxic treatment. Treatment with ABVD rarely results in POI and impaired fertility, w...
INTRODUCTION: The risk of premature ovarian insufficiency (POI) after Hodgkin's lymphoma depends on female age, type, and dose of gonadotoxic treatment. Treatment with ABVD rarely results in POI and impaired fertility, whereas treatment with BEACOPP or stem cell transplantation is associated with higher risks of ovarian failure. Reports on parenthood rates are reassuring, although some studies report reduced fertility after treatment. In this study, we evaluate the reproductive outcomes after Hodgkin's lymphoma and the risk of POI after different types of chemotherapy. MATERIAL AND METHODS: This cohort study was conducted at the Fertility Clinic at Rigshospitalet University Hospital, Copenhagen, Denmark. Data was collected retrospectively from medical records from 1999 to 2020 and prospectively from 2020 to 2023. We included all female patients with Hodgkin's lymphoma, referred for fertility preservation between 1999 and 2022. End of follow-up was December 31, 2023. Information about diagnoses, gonadotoxic treatment, and gynecologic and obstetric history was retrieved from medical records. RESULTS: A total of 59 women were included: 21 received low-dose, 15 moderate-dose, and 20 high-dose chemotherapy (3 unknown). Ovarian tissue cryopreservation (OTC) was done for fertility preservation in 86%. Mean age at diagnosis was 23.9 (SD 4.9) years. While no women developed POI after low-dose chemotherapy, 4 (27%) did after moderate-dose and 10 (50%) after high-dose chemotherapy. Among 38 women with a pregnancy wish, 30 achieved at least one livebirth after cancer. Mean age at first pregnancy was 29.7 (SD 4.0) years. The chance of delivery after high dose was lower compared with low-dose chemotherapy (OR 0.06, 95% CI:0.01-0.68) (p = 0.020). Among 33 women with OTC, 21 achieved pregnancy and delivery without ovarian tissue transplantation (OTT). Nine women underwent OTT of whom four delivered (44%) a total of five children. CONCLUSIONS: The likelihood of livebirth and risk of POI depended on the type of chemotherapy, with the least number of deliveries and the highest risk of POI after high-dose chemotherapy. Pregnancy rates were reassuringly high even among women with a single ovary after OTC, with only 20% returning for OTT. Our findings support that fertility preservation in Hodgkin's lymphoma patients should primarily be offered to those receiving moderate- to high-dose chemotherapy.
Cardiovascular outcomes for Australian women with rheumatic heart disease during pregnancy: A retrospective linked data analysis, 2002-2017.
Stacey I, Junaid M, Unger HW … +6 more , Vaughan G, Berman Y, Wade V, Nedkoff L, Marangou J, Katzenellenbogen JM
Acta Obstet Gynecol Scand · 2026 May · PMID 42210517 · Publisher ↗
INTRODUCTION: Rheumatic heart disease (RHD) is the acquired autoimmune heart valve damage resulting from untreated infection with the Streptococcus pyogenes bacterium, which affects people experiencing socioeconomic disa...
INTRODUCTION: Rheumatic heart disease (RHD) is the acquired autoimmune heart valve damage resulting from untreated infection with the Streptococcus pyogenes bacterium, which affects people experiencing socioeconomic disadvantage globally. This study measured RHD-associated major adverse cardiovascular events (MACE) and the increased risk associated with pregnancy among women diagnosed with RHD. MATERIAL AND METHODS: Population-level analysis of all births to women with RHD in four Australian jurisdictions was conducted, which covered 71% of the total population and 88% of the Aboriginal and Torres Strait Islander population (a group who experience some of the highest RHD rates reported globally). A retrospective cohort study using linked RHD register and midwives, hospital, and death data collections was designed. Females with at least one birth record aged 12-44 years, whose first RHD diagnosis occurred prior to 20 weeks' gestation and age < 35 years, were identified during 2002-2017. Survival methods (incorporating mixed effects and time-varying covariates) estimated proportions and hazard ratios. Probability of hospitalization for new RHD-associated MACE was measured for pulmonary hypertension secondary to left heart disease, heart failure, valvular surgery, stroke, infective endocarditis, atrial fibrillation, acute pulmonary edema, cardiomyopathy, and/or death. RESULTS: We identified 558 pregnancies in women with uncomplicated RHD (345 women) and 88 pregnancies in women with complicated RHD (60 women). During pregnancy, 4.5% of women with uncomplicated RHD and 31.8% of women with complicated RHD experienced new RHD-associated MACE. Risk of RHD-associated MACE was three- to six-fold higher during periods of pregnancy (compared with non-pregnancy) and did not differ by RHD stage. CONCLUSIONS: After 20 weeks of gestation, women with RHD experienced RHD-associated MACE outcomes at frequencies that were contingent upon RHD stage at 20 weeks of gestation. Awareness of RHD status before 20 weeks of gestation, especially in regions where RHD is endemic, is critical for ensuring women's cardiovascular health in pregnancy and beyond.
Central sensitization in patients with chronic pelvic pain resistant to hormonal therapy: A cross-sectional study of prevalence and clinical correlates in a tertiary referral cohort.
Alawadi H, Cid M, Delotte J … +1 more , Gauci PA
Acta Obstet Gynecol Scand · 2026 May · PMID 42206475 · Publisher ↗
INTRODUCTION: Chronic pelvic pain (CPP) affects over 25% of women, with endometriosis being a predominant cause. Central sensitization, particularly pelvic and perineal pain central sensitization (PPCS), is increasingly...
INTRODUCTION: Chronic pelvic pain (CPP) affects over 25% of women, with endometriosis being a predominant cause. Central sensitization, particularly pelvic and perineal pain central sensitization (PPCS), is increasingly recognized as a key mechanism in CPP, yet its prevalence and clinical implications across the broader CPP population are underexplored. MATERIAL AND METHODS: The aim was to determine the prevalence of PPCS among patients with CPP unresponsive to hormonal therapy and to assess its impact on symptomatology, analgesic consumption, and quality of life. This retrospective study included 270 consecutive patients presenting for the first time with CPP resistant to hormonal therapy, with or without endometriosis, at a tertiary referral center in France (2024-2025). PPCS was defined using the Convergences PP criteria (score ≥5), and neuropathic-like features using the DN4 score (≥4). Data collected included pain features, comorbid symptoms, quality of life (EHP-5), history of violence, and prior treatments. Multivariable logistic and linear regression analyses were conducted to assess associations with analgesic use and EHP-5 scores. RESULTS: PPCS was present in 54.4% of patients and associated with more severe, multisystem symptoms, including urinary, gastrointestinal, and sexual dysfunction. Patients with PPCS had significantly higher use of strong analgesics (adjusted OR 2.48, 95% CI: 1.05-5.83, p = 0.038) and markedly impaired quality of life (+5.19 EHP-5 points, p < 0.001). A history of gender-based violence, reported by 25.9% of patients, was independently associated with higher analgesic consumption (aOR 2.56, p = 0.028) and was more prevalent among those with PPCS. Neuropathic-like features were associated with lower quality of life but not with increased analgesic use. CONCLUSIONS: These findings support routine screening for central sensitization and trauma history in gynecological practice and advocate for multidisciplinary, trauma-informed, and neuromodulation-focused approaches to CPP management.
Induction of labor versus cesarean section after 36 + 0 weeks in twin pregnancy: A review of maternal and neonatal outcomes.
Gent J, Oliver E, Williams G … +3 more , Lane S, Navaratnam K, Sharp A
Acta Obstet Gynecol Scand · 2026 May · PMID 42203674 · Publisher ↗
INTRODUCTION: Our aim was to assess maternal and perinatal morbidity associated with induction of labor (IOL) and elective cesarean section (ECS) in uncomplicated twin pregnancies delivered >36 weeks' gestation. MATERIAL...
INTRODUCTION: Our aim was to assess maternal and perinatal morbidity associated with induction of labor (IOL) and elective cesarean section (ECS) in uncomplicated twin pregnancies delivered >36 weeks' gestation. MATERIAL AND METHODS: A retrospective review of all twin pregnancies, irrespective of chorionicity, that underwent ECS and IOL at the Liverpool Women's Hospital (LWH) over a 10-year period. RESULTS: Three hundred and eighty-two women underwent IOL and 326 had ECS between January 2010 and December 2020 at LWH. 71.2% (n = 272) achieved vaginal delivery of both babies in the IOL group, 4.2% (n = 16) required CS for the second twin. There was no difference in blood loss >1500 mLs (7.4% vs. 6.8%, RR 0.92 (0.54-1.58), p = 0.77). Admission of one or both twins to the neonatal unit was higher following IOL than ECS (13.5% vs. 10%, RR 1.35 (1.01-1.81), p = 0.04 and 5.1% vs. 2.9%, RR 1.75 (1.03-2.97), p = 0.04, respectively). There was no impact of chorionicity on outcomes. CONCLUSIONS: Existing consensus on mode of delivery of twins at term suggests both IOL and ECS are safe options. We found an association between increased neonatal admissions following IOL compared to ECS, which has also been observed in line with previous epidemiological studies. Our study broadens our knowledge and strengthens the case that this should be discussed when counseling women about intended mode of birth.
Trends in risk factors associated with the increasing labor induction rate: A nationwide register study in Finland 2005-2023.
Vihtonen V, Virtanen A, Kekki M … +3 more , Helminen M, Gissler M, Tihtonen K
Acta Obstet Gynecol Scand · 2026 May · PMID 42200222 · Publisher ↗
INTRODUCTION: Induction of labor (IOL) rates have been increasing in high-income countries. Although IOL aims to reduce maternal and neonatal morbidity, the benefits for many common indications remain uncertain. Because...
INTRODUCTION: Induction of labor (IOL) rates have been increasing in high-income countries. Although IOL aims to reduce maternal and neonatal morbidity, the benefits for many common indications remain uncertain. Because IOL may also have disadvantages and place a burden on the health-care system, it is important to clarify the factors underlying the rising national IOL rates. MATERIAL AND METHODS: This descriptive study included all singleton births in cephalic presentation delivered at 37 gestational weeks or later between January 1, 2005, and December 31, 2023, in Finland. Data from the Finnish Medical Birth Register were used to examine temporal trends in maternal characteristics, gestational age at delivery, pregnancy complications, and other pregnancy-related problems across three periods: 2005-2010, 2011-2016, and 2017-2023. Induced deliveries were analyzed separately. Risk ratios with 95% confidence intervals were calculated to describe changes over time, and odds ratios with 95% confidence intervals were estimated to assess associations between IOL and risk factors. Logistic regression models were adjusted for maternal age, body mass index (BMI), and parity. RESULTS: The study sample included 880 478 births. The IOL rate doubled from 18% to 36%. In the IOL group, the most prevalent and increasingly common factors were maternal age ≥35 years, BMI ≥30 kg/m, and gestational diabetes. Prelabor rupture of membranes, fear of childbirth, and other pregnancy-related problems-despite their lower overall proportions-showed the steepest increases. Similar but less pronounced trends were seen in the total study cohort. The odds of IOL remained stable across the study periods for maternal age ≥35 years, BMI ≥30 kg/m, gestational diabetes, prelabor rupture of membranes, fear of childbirth, and other pregnancy-related problems; and all associations remained statistically significant after adjustment. The proportion of post-term pregnancy decreased significantly in both the total study cohort and the IOL group. In the IOL group, gestational age at birth shifted from post-term to late- and full term. CONCLUSIONS: The main contributors to the increasing IOL rate were the increased prevalence of advanced maternal age, obesity, and gestational diabetes. The increases in the prevalence of other IOL indications were less extensive.
Occurrence of wound infections after perineal tears and perineal assessment in postpartum care: A prospective cohort study.
Risløkken J, Macedo MD, Bø K … +2 more , Engh ME, Siafarikas F
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42192609 · Full text
INTRODUCTION: There is considerable variation in reported perineal wound infection occurrences and limited knowledge of postpartum follow-up for perineal injuries. The primary aim of this study was to assess the occurren...
INTRODUCTION: There is considerable variation in reported perineal wound infection occurrences and limited knowledge of postpartum follow-up for perineal injuries. The primary aim of this study was to assess the occurrence of symptoms of perineal wound infections and infections requiring medical intervention within the first 30 days postpartum. The secondary aim was to investigate perineal assessment by healthcare providers in postpartum care. MATERIAL AND METHODS: This single-center cohort study was conducted between October 2020 and October 2022. In this analysis, participants with perineal tears and episiotomies following vaginal deliveries were included. Women were contacted via telephone seven to 10 days postpartum and asked about symptoms for infection recommended by the "Surgical Site Infection Surveillance Service." At 3 months postpartum, participants reported via questionnaire on receiving medical interventions for wound infection and whether a healthcare provider inspected their perineal tear. RESULTS: The study sample comprises a total of 748 primi- and multiparous women (58.3% primipara, 41.7% multipara). Sixteen participants (2.2%) reported wound infection symptoms. Wound infections requiring medical interventions were identified in seven women (1.1%), all of whom were primipara. This included five cases with an episiotomy and two cases with a second-degree tear. Half of the participants had their perineal tear inspected during the 6-week follow-up visit. Depending on tear category, between 25% and 72% of women who did not undergo an inspection would have preferred one. CONCLUSIONS: In our population, symptoms of perineal wound infection were 2.2% and infections requiring medical intervention were 1.1%. Half of the participants received a perineal tear inspection at the 6-week follow-up visit.
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