Acta Obstetricia Et Gynecologica Scandinavica[JOURNAL]
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200 papers
Toward risk-stratified management of placental site nodules with atypical features.
Xu T, Li S
Acta Obstet Gynecol Scand · 2026 May · PMID 42192594 · Publisher ↗
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Seromucinous borderline ovarian tumors: Clinical and ultrasound characteristics and association with endometriosis.
Del Forno S, Doglioli M, Landolfo C … +8 more , Palomba G, Vicenzi C, Antonelli M, De Meis L, Govoni F, Paradisi R, Raimondo D, Seracchioli R
Acta Obstet Gynecol Scand · 2026 May · PMID 42186794 · Publisher ↗
INTRODUCTION: Seromucinous borderline ovarian tumors represent a distinct borderline ovarian tumor histotype, yet their specific sonographic features and clinical associations remain undercharacterized. The objective of...
INTRODUCTION: Seromucinous borderline ovarian tumors represent a distinct borderline ovarian tumor histotype, yet their specific sonographic features and clinical associations remain undercharacterized. The objective of this study was to describe the ultrasound and clinical characteristics of seromucinous borderline ovarian tumors compared to other borderline tumor histotypes and to evaluate their association with endometriosis. MATERIAL AND METHODS: This single-center observational retrospective cohort study was conducted at a tertiary-level reference ultrasound unit. The primary outcome was to analyze the clinical and ultrasound characteristics of seromucinous borderline ovarian tumors compared to other histotypes. The secondary outcome was to evaluate their association with different endometriotic lesions. In women with borderline ovarian tumors, anamnestic data (age, body mass index, parity, menopausal status), preoperative serum carbohydrate antigens 125 and carbohydrate antigen 19.9 levels, ultrasound characteristics (according to the International Ovarian Tumor Analysis group), surgery type, and histological data, including endometriosis localization (superficial, deep, or ovarian), were extracted from medical records. RESULTS: Among 151 women with borderline ovarian tumors, five had rare histotypes and were excluded. Of the 146 included women, 96 (63.6%) had a serous histotype, 27 (17.9%) a mucinous histotype, and 23 (15.2%) had a seromucinous histotype. Seromucinous borderline ovarian tumors were more commonly left-sided, unilateral unilocular or multilocular solid cysts, with ground-glass content, showing moderate vascularization at color Doppler examination (Color Score 3) of papillary projections/solid component. Moreover, they had higher preoperative levels of carbohydrate antigen 19.9 compared to other histotypes (p < 0.001). Endometriosis was detected in 26% of all study women but was significantly more frequent (70%) in women with seromucinous borderline ovarian tumors (p < 0.001). CONCLUSIONS: Compared to other histotypes, seromucinous borderline ovarian tumors appeared more commonly as left unilateral unilocular or multilocular solid cysts, with ground-glass content, showing moderate vascularization of papillary projections/solid component. Moreover, they showed a higher increase in serum carbohydrate antigen 19.9 and were associated with endometriosis in most cases.
Healthcare professionals' perceptions of the acceptability of the PREVENT-PE trial: A mixed-methods survey and interview study.
Leung A, Goadsby J, Sheen KS … +5 more , Silverio SA, Magee LA, von Dadelszen P, Syngelaki A, Nicolaides KH
Acta Obstet Gynecol Scand · 2026 May · PMID 42186732 · Publisher ↗
INTRODUCTION: There is a lack of published data on how healthcare professionals perceive the acceptability of third-trimester risk screening in pregnancy. The PREVENT-PE trial [ISRCTN41632964] demonstrated that a persona...
INTRODUCTION: There is a lack of published data on how healthcare professionals perceive the acceptability of third-trimester risk screening in pregnancy. The PREVENT-PE trial [ISRCTN41632964] demonstrated that a personalized approach to term pre-eclampsia risk assessment to inform risk-stratified timed birth at term reduced the incidence of term PE by 30%, without increasing Cesarean birth or neonatal morbidity. We aimed to evaluate the acceptability of the PREVENT-PE trial among healthcare professionals. MATERIAL AND METHODS: Staff were invited to an online survey comprising validated metrics of acceptability, which were analyzed descriptively. Also, the staff were invited to one-to-one interviews to probe the acceptability of the trial in more depth. Using template analysis, responses were mapped onto the following domains of acceptability: Sense-making (Intervention Coherence), Commitment (Affective Attitude), Change (Burden), Communication (Ethicality), Motivation (Opportunity Costs), Action (Self-Efficacy), and Evaluation (Perceived Effectiveness). RESULTS: There were 65 completed surveys, whilst 19 healthcare professionals participated in interviews. Forty-one staff participants were from King's College Hospital, and twenty-one staff participants were from Medway Maritime Hospital, in line with the recruitment of participants to the trial. Approximately 29% of staff were of non-White ethnicity. Most staff were doctors or midwives, in similar proportions. One-third of staff participants had no prior involvement in clinical trials. Acceptability was endorsed by the majority of survey respondents (69.2%), as "very acceptable" (44.6%) or "somewhat acceptable" (24.6%). Interview findings endorsed acceptability from most staff toward participating in an evidence-based trial such as PREVENT-PE. Despite some concerns about implementation burden, system-level readiness, and counseling high-risk participants, the staff supported integrating such screening into routine maternity care if effectiveness is confirmed. CONCLUSIONS: The PREVENT-PE trial had a high level of acceptability among healthcare professionals. Staff view risk screening in the third trimester of pregnancy as acceptable, with potential to positively impact patient outcomes.
Pre-eclampsia risk-stratified planned birth at term: A survey of women's perspectives on acceptability and risk communication.
Goadsby J, Leung A, Silverio SA … +5 more , Magee LA, von Dadelszen P, Syngelaki A, Nicolaides KH, Sheen KS
Acta Obstet Gynecol Scand · 2026 May · PMID 42186181 · Publisher ↗
INTRODUCTION: Pre-eclampsia (PE) remains a major complication of pregnancies, globally, and while there is no intervention proven to be effective in decreasing late preterm and term PE; the PREVENT-PE trial aimed to eval...
INTRODUCTION: Pre-eclampsia (PE) remains a major complication of pregnancies, globally, and while there is no intervention proven to be effective in decreasing late preterm and term PE; the PREVENT-PE trial aimed to evaluate whether the intervention-a strategy of screening for PE risk at 35-36 weeks' gestation, and for a risk of ≥1-in-50, offering risk-stratified, planned early term birth-could reduce the incidence of subsequent PE, compared with usual care. MATERIAL AND METHODS: We aimed to evaluate the acceptability of trial participation and risk communication for women participating in The PREVENT-PE trial [ISRCTN41632964] in the United Kingdom. From March to October 2024, trial participants were invited, antenatally and/or postnatally, to complete an online survey, and acceptability and risk communication measures were compared by trial arm. RESULTS: Of those accessing the survey, 257 out of 478 (48.2%) were antenatal (median 35.4 weeks' gestation), and 485 out of 1617 (30.0%) were postnatal (median 25.6 weeks postnatally) respondents who were eligible. Antenatally, and by trial arm: (i) most women felt: comfortable with the trial (>70%); participation required little/no effort (>75%; 77.9% [intervention] vs. 91.7% [control], p = 0.05); confident in participation (>75%); the trial was acceptable (≈90%); and PE risk screening was fair (>90%), could reduce chances of becoming seriously ill (>90%), and understood how that could be achieved (>90%); (ii) half disagreed that timed birth for PE would interfere with competing priorities, although 20-30% agreed; (iii) ≥80% of participants felt listened to, were able to ask questions and receive helpful answers, had their preferences considered, had clear on the situation being discussed, and were confident about their decision; and (iv) ≈50% were uncertain about what was going to happen. Postnatally, views were more neutral, without an increase in negativity. CONCLUSIONS: Findings indicate that women find third-trimester screening for PE and risk-stratified planned early term birth highly acceptable, understand those risks, and the potential to favorably impact their pregnancy outcome.
Balancing diagnostic accuracy and cost in the follow-up of histological low-grade squamous intraepithelial lesions.
Aarnio R, Ahuja V, Ryen L … +1 more , Bergengren L
Acta Obstet Gynecol Scand · 2026 May · PMID 42175639 · Publisher ↗
INTRODUCTION: Primary cervical screening with testing for human papillomavirus (HPV) brings increased detection of women with low-grade squamous intraepithelial lesion recommended for follow-up with colposcopy. This stud...
INTRODUCTION: Primary cervical screening with testing for human papillomavirus (HPV) brings increased detection of women with low-grade squamous intraepithelial lesion recommended for follow-up with colposcopy. This study evaluates whether co-testing (HPV + cytology) or testing for HPV alone can safely replace colposcopy as follow-up for histologically confirmed low-grade squamous intraepithelial lesions. It estimates these strategies' diagnostic performance in detecting histological high-grade squamous intraepithelial or more severe lesions at follow-up and analyzes their relative cost-effectiveness. MATERIAL AND METHODS: This is a retrospective cohort study on follow-up data of women aged 23-70 with histological low-grade squamous intraepithelial lesion, diagnosed during 2017-2018, with an analysis of data from the Swedish National Cervical Screening Registry. Out of the 14 643 women with low-grade squamous intraepithelial lesions, 4213 women with complete data on HPV, cytology, and histology results were analyzed. The primary outcome was to estimate the diagnostic performance of the strategies of co-testing (HPV + cytology) and human papillomavirus-alone in detecting histological high-grade squamous intraepithelial or more severe lesions in the follow-up of histological low-grade squamous intraepithelial lesions. The secondary outcome was to perform a cost-effectiveness analysis of these strategies. RESULTS: Using co-testing as the primary follow-up and reserving colposcopy for women who tested positive for HPV or cytology results yielded a sensitivity of 96% for high-grade squamous intraepithelial or more severe lesions. HPV-alone testing had 88% sensitivity. Adding colposcopy to co-testing would require 1735 (70%) additional examinations to detect 14 (3.9%) more women with high-grade squamous intraepithelial or more severe lesions. No cancer cases were missed by co-testing or HPV-alone. The cost of detecting one extra high-grade squamous intraepithelial or more severe lesion by adding colposcopy to co-testing was 81 959 EUR. CONCLUSIONS: Histological low-grade squamous intraepithelial lesion follow-up can be safely managed with co-testing, considerably reducing the number of colposcopies and associated costs.
Adverse pregnancy outcomes in women with type 1 diabetes: A nationwide, population-based study, 1999-2021.
Stalheim AM, Nilsen RM, Vangen S … +5 more , Vik ES, Alnæs-Katjavivi P, Iversen MM, Berg TJ, Strandberg RB
Acta Obstet Gynecol Scand · 2026 May · PMID 42169457 · Publisher ↗
INTRODUCTION: For the total population and for groups of non-immigrant and immigrant women, we examined the associations of maternal type 1 diabetes with adverse pregnancy outcomes among women who gave birth in Norway fr...
INTRODUCTION: For the total population and for groups of non-immigrant and immigrant women, we examined the associations of maternal type 1 diabetes with adverse pregnancy outcomes among women who gave birth in Norway from 1999 to 2021. Further, we examined the associations between the two time periods 1999-2014 and 2015-2021 and adverse pregnancy outcomes, and whether these associations differed in women with or without type 1 diabetes. MATERIAL AND METHODS: In this nationwide population-based observational study, with data from the Medical Birth Registry of Norway and Statistics Norway 1999-2021, we used logistic regression to examine the associations between type 1 diabetes and adverse pregnancy outcomes. Moreover, differences in ORs for adverse pregnancy outcomes between those with and without type 1 diabetes were compared for the two time periods 1999-2014 and 2015-2021 using interaction analyses. Analyses were performed for the overall population, as well as separately for non-immigrant (n = 964 542) and immigrant women (n = 257 409). RESULTS: Women with type 1 diabetes (non-immigrant women n = 5067 and immigrant women n = 619) had higher ORs for almost all adverse pregnancy outcomes (OR 1.41-11.04) compared to women without diabetes in the period 1999-2021. In the time period 2015-2021, compared to 1999-2014, women with type 1 diabetes had a notably reduced OR of congenital malformations compared to those without diabetes (p interaction: 0.006). Immigrant women with type 1 diabetes had a higher OR in 2015-2021 vs. 1999-2014 of having large for gestational age infants (p interaction: 0.003). CONCLUSIONS: Women with type 1 diabetes had higher odds of most of the examined adverse pregnancy outcomes, though improvements were observed from 2015 to 2021 compared to 1999-2014, particularly a reduction in congenital malformations. In contrast, immigrants had higher odds of large for gestational age. These findings highlight the continued need for targeted interventions to reduce the burden of adverse outcomes in all women with type 1 diabetes.
Physiological cardiotocography interpretation and neonatal morbidity: A historical pre-post cohort study in a tertiary perinatal center.
Andres S, Schäffler H, Stankov K … +6 more , Schmid A, Khodawandi M, Dimpfl M, Janni W, Hüner B, Reister F
Acta Obstet Gynecol Scand · 2026 May · PMID 42163581 · Publisher ↗
INTRODUCTION: Cardiotocography (CTG) interpretation is prone to inter-observer variability and may contribute to both missed fetal compromise and potentially avoidable intrapartum intervention. Physiological CTG interpre...
INTRODUCTION: Cardiotocography (CTG) interpretation is prone to inter-observer variability and may contribute to both missed fetal compromise and potentially avoidable intrapartum intervention. Physiological CTG interpretation (PCI) reframes fetal surveillance around fetal physiology and the intensity of hypoxic stress, but real-world outcome data after unit-wide implementation remain limited. MATERIAL AND METHODS: Historical pre-post cohort study with case-mix adjustment at University Hospital Ulm, a tertiary perinatal center in Germany (~3200 births/year). We included term singleton pregnancies (≥37 + 0 weeks) with intended vaginal birth, comparing a pre-implementation period (January 01-December 31, 2018) with a post-implementation period after full adoption (May 01, 2022-April 30, 2023). PCI was introduced as a multicomponent implementation strategy (training, bedside facilitation, documentation changes, and sustainment). PRIMARY OUTCOME: composite neonatal morbidity defined as neonatal unit (NNU) transfer plus ≥1 of: umbilical artery pH <7.15, base deficit >16 mmol/L, or 5-min Apgar score <7. SECONDARY OUTCOMES: umbilical artery acid-base status, Apgar scores, NNU transfer, intrapartum interventions (e.g., oxytocin, tocolysis, fetal scalp blood sampling), mode of birth, and postpartum blood loss. Outcomes were compared using multivariable regression and propensity score matching. RESULTS: A total of 4484 births met the inclusion criteria (2352 pre-implementation; 2132 post-implementation). Composite neonatal morbidity decreased from 4.10% to 2.92% (OR 0.67; 95% CI 0.434-0.958; p = 0.0259). Neonatal acidosis decreased (umbilical artery pH <7.10: 3.87%-2.53%; OR 0.649; 95% CI 0.450-0.919; p = 0.014), and NNU transfers declined (13.18%-9.19%; OR 0.667; 95% CI 0.59-0.808; p < 0.001). Cesarean section rates were not increased after adjustment (OR 0.880; 95% CI 0.722-1.071). Postpartum blood loss was higher post-implementation (438 vs 497 mL; p < 0.001). CONCLUSIONS: Unit-wide implementation of PCI was associated with improved neonatal outcomes, including fewer NNU admissions, without an increase in adjusted cesarean section rates. These findings support PCI as a promising framework for intrapartum fetal surveillance, warranting confirmation in multicenter studies and evaluation across different care settings.
Can universal cervical length screening with vaginal progesterone for a short cervix reduce preterm birth? A systematic review and meta-analyses.
Zethelius M, Bergman L, Ekelund AC … +9 more , Vala CH, Jacobsson B, Kuusela P, Liljegren A, Lindkvist B, Petzold M, Sjögren P, Wennerholm UB, Wikström T
Acta Obstet Gynecol Scand · 2026 May · PMID 42161360 · Publisher ↗
INTRODUCTION: The global rate of preterm birth (PTB) is not declining, resulting in approximately one million deaths annually among children under five due to complications related to PTB. Universal cervical length scree...
INTRODUCTION: The global rate of preterm birth (PTB) is not declining, resulting in approximately one million deaths annually among children under five due to complications related to PTB. Universal cervical length screening followed by progesterone treatment in women with a short cervix has been proposed as a preventive strategy. We systematically assessed the accuracy of this approach in reducing the incidence of PTB and improving neonatal outcomes. MATERIAL AND METHODS: We conducted a systematic literature search and meta-analysis registered in PROSPERO (CRD42024605203). Medline, Embase, and the Cochrane Library were searched in October 2024 and updated in September 2025. Eligible studies included randomized controlled trials (RCTs), cohort studies, and systematic reviews comparing universal cervical length screening with vaginal ultrasound in mid-trimester followed by progesterone treatment versus no screening in asymptomatic women with a singleton pregnancy. Outcomes of interest were any PTB, spontaneous PTB (sPTB), and neonatal outcomes. The certainty of evidence was assessed separately for RCTs and cohort studies using the GRADE approach. RESULTS: Two RCTs (1634 participants) and four cohort studies (425 735 participants) were included. Results from RCTs showed no statistically significant reduction in any PTB, sPTB, peri/neonatal mortality, or morbidity after screening versus no screening. In contrast, meta-analyses of cohort studies demonstrated a significant reduction for any PTB < 37 weeks; adjusted odds ratio 0.87, 95% confidence interval (CI) 0.78-0.98, and sPTB < 37 weeks; relative risk 0.82, 95% CI 0.70-0.96. Meta-analyses of cohort studies also demonstrated a significant reduction in sPTB < 34 and <32 weeks. The cohort studies presented no data on neonatal outcomes. The certainty of evidence from RCTs was rated very low due to limited precision and lack of significant results. Although meta-analyses of cohort studies showed significant associations, the certainty of evidence was also very low because of indirectness and a high risk of bias inherent in observational study designs. CONCLUSIONS: It is uncertain, based on very low certainty of evidence, whether universal cervical length screening followed by progesterone treatment for women with a short cervix reduces PTB or affects neonatal outcomes, compared with no screening. More adequately powered trials are needed before a recommendation can be made.
Menopausal hormone therapy after ovarian cancer: A 10-year survival analysis in premenopausal women.
von Kartaschew ÅE, Dahm-Kähler P, Rodriguez Wallberg K … +2 more , Holmberg E, Flöter-Rådestad A
Acta Obstet Gynecol Scand · 2026 May · PMID 42161357 · Publisher ↗
INTRODUCTION: Premenopausal women treated with bilateral salpingo-oophorectomy (BSO) for ovarian cancer (OC) enter surgical menopause. Our objective was to evaluate whether postoperative systemic menopausal hormone thera...
INTRODUCTION: Premenopausal women treated with bilateral salpingo-oophorectomy (BSO) for ovarian cancer (OC) enter surgical menopause. Our objective was to evaluate whether postoperative systemic menopausal hormone therapy (MHT) after BSO due to treatment for epithelial ovarian cancer (EOC), non-epithelial ovarian cancer (NEOC), or borderline ovarian tumor (BOT) has an impact on long-term overall survival (OS). MATERIAL AND METHODS: A nationwide Swedish population-based cohort study of women aged 18-50 diagnosed with OC (FIGO stage I-IV) and treated with BSO between 2008 and 2015, identified from The Swedish Quality Register for Gynecological Cancer. Exposure to postoperative MHT from 1 month before to 5 years after surgery was assessed by linking the cohort to the National Prescribed Drug Register to capture drug dispensing data. Standardized OS was estimated for MHT users and non-users, adjusted for covariates included in multivariable models. EOC, NEOC, and BOT were analyzed separately. RESULTS: A cohort of 779 premenopausal women with a median age of 45 years at BSO, of whom 472 had an EOC, 68 a NEOC and 239 a BOT, was identified. Median follow-up in the total cohort was 11.7 (9.6-13.6) years. Among women with EOC, 33% were postoperative MHT users. For the EOCs, the 10-year OS for postoperative MHT users versus non-users was 52.4% (95% CI 46.7-58.8) and 51.7% (95% CI 47.4-56.4), respectively. No significant difference in 10-year OS was found between postoperative MHT users and non-users (HR 0.97; 95% CI 0.73-1.30; p = 0.84). Among 367 women with EOC and no residual disease at surgery, there was no difference in 10-year OS between postoperative MHT users and non-users (HR 1.00; 95% CI 0.70-1.43; p = 0.98). For women with a BOT, the 10-year OS was 96.2% (95% CI 91.6-98.2) for postoperative MHT users versus 95.3% (95% CI 87.8-98.2) for non-users. Among women with a NEOC, OS was not analyzed due to the few events. CONCLUSIONS: In this nationwide cohort, postoperative MHT use after surgically treated OC was not associated with impaired 10-year survival. These findings offer reassurance about the safety of MHT in young ovarian cancer survivors.
Prolactin in high-metabolic risk pregnancies: Associations with maternal obesity and metabolic health.
Rassie K, Alesi S, Neven ACH … +9 more , Mason T, Jona E, Ellery SJ, Enticott J, Mousa A, Joham AE, Simmons D, Teede H, TOBOGM Core Investigator Group
Acta Obstet Gynecol Scand · 2026 May · PMID 42157583 · Publisher ↗
INTRODUCTION: Low prolactin levels during pregnancy have been linked to adverse maternal metabolic health. We examined pregnancy prolactin levels in relation to maternal metabolic characteristics within an ethnically div...
INTRODUCTION: Low prolactin levels during pregnancy have been linked to adverse maternal metabolic health. We examined pregnancy prolactin levels in relation to maternal metabolic characteristics within an ethnically diverse cohort at high metabolic risk. MATERIAL AND METHODS: In this observational cohort study, pregnant women (n = 130) with metabolic risk factors were characterized in early pregnancy, with sampling of serum prolactin and metabolic parameters. Fifty-four women with gestational diabetes consented to serial profiling across pregnancy. Univariable and multivariable simple and mixed-effects regression models examined relationships between prolactin and maternal variables. RESULTS: Women with obesity (BMI ≥30 kg/m) had lower early pregnancy prolactin levels than women without obesity (35.1 vs 44.3 μg/L, p = 0.03). Lower prolactin in early pregnancy was associated with higher parity and higher early pregnancy BMI, fasting insulin, insulin resistance, and diastolic blood pressure, but only relationships with parity and BMI persisted after adjustment for covariates. In the serially sampled cohort, lower prolactin levels across pregnancy were independently associated with higher pre-pregnancy maternal BMI (adjusted β = -3.25, p = 0.04). Lower absolute prolactin increment from early to late pregnancy was independently associated with higher pre-pregnancy and early pregnancy maternal BMI (p = 0.046 and p = 0.04, respectively). CONCLUSIONS: Maternal metabolic status, particularly higher BMI before and during early pregnancy, was associated with lower prolactin levels in early pregnancy and across gestation, and a smaller prolactin increase over pregnancy. Lower prolactin levels may reflect underlying metabolic health and may be relevant to the suboptimal lactation outcomes observed in women with obesity and metabolic disease.
Effect of opportunistic salpingectomy at hysterectomy on anti-Müllerian hormone: A substudy of a randomized trial.
Darelius A, Idahl A, Sundfeldt K … +1 more , Strandell A
Acta Obstet Gynecol Scand · 2026 May · PMID 42157582 · Publisher ↗
INTRODUCTION: Opportunistic salpingectomy during benign hysterectomy with ovarian preservation has become a preventive approach to epithelial ovarian cancer, particularly high-grade serous carcinoma, given evidence that...
INTRODUCTION: Opportunistic salpingectomy during benign hysterectomy with ovarian preservation has become a preventive approach to epithelial ovarian cancer, particularly high-grade serous carcinoma, given evidence that it originates in the Fallopian tubes. However, the long-term impact of the procedure on ovarian function remains unknown. This study assessed whether opportunistic salpingectomy at benign hysterectomy affects ovarian function compared with no salpingectomy 1 year after surgery. MATERIAL AND METHODS: This is a noninferiority substudy of the national register-based randomized controlled trial HOPPSA (Hysterectomy and OPPortunistic SAlpingectomy), registered at clinicaltrials.gov (NCT03045965) on 8 February 2017. Women under 55 years planned for a benign hysterectomy at the Sahlgrenska University Hospital were randomized to hysterectomy with opportunistic salpingectomy or hysterectomy-only. Blood samples were collected preoperatively and 1 year postoperatively and analyzed for anti-Müllerian hormone (AMH) by Access2 immunoassay. The primary outcome was absolute change in AMH over time in the per-protocol population. Secondary outcomes were the relative change in AMH and level of AMH 1 year after surgery. The difference between groups was estimated by analysis of covariance, adjusted for baseline AMH, age groups, operative route, and time from surgery to second sampling. Multiple imputation was applied on missing samples. The noninferiority margin was set to 0.125 μg/L. RESULTS: Between 16 August 2018 and 6 September 2023, 89 women were randomized to hysterectomy with opportunistic salpingectomy (n = 46) or hysterectomy-only (n = 43). After exclusions due to prior ovarian surgery or not receiving the allocated surgery, 37 women were analyzed in each group. Mean age was 45.1 and 46.3 years in respective groups and mean body mass index was 29.5 and 27.2 kg/m. Baseline characteristics did not differ between the groups. Both groups had reduced AMH levels 1 year postoperatively. The adjusted mean difference in the reduction was -0.03 μg/L (95% CI -0.23 to 0.18), with 0.18 exceeding the predefined noninferiority limit. CONCLUSIONS: Noninferiority was not demonstrated for opportunistic salpingectomy at hysterectomy compared with hysterectomy-only regarding ovarian function assessed by AMH. Absolute reduction in AMH levels appeared to be similar in both groups, with an unexpectedly large variability in AMH reduction suggesting a more pronounced decline in some individuals.
Association between maternal and fetal characteristics and levator hiatal dimensions in the second stage of labor.
Kovalenko M, Zamagni G, Montero Carreras C … +5 more , Usman S, Hanidu A, Stampalija T, Monasta L, Lees C
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42157565 · Full text
INTRODUCTION: Little is known about the pelvic floor hiatal dimensions in labor, despite this being the soft tissue complex through which the fetus passes in a vaginal delivery. Intrapartum assessment of pelvic floor hia...
INTRODUCTION: Little is known about the pelvic floor hiatal dimensions in labor, despite this being the soft tissue complex through which the fetus passes in a vaginal delivery. Intrapartum assessment of pelvic floor hiatal dimensions, particularly in the second stage of labor, may improve understanding of the variation in levator hiatal measurements and their change between maternal and fetal characteristics. STUDY DESIGN: To assess the levator hiatal dimensions at rest during the passive second stage of labor using three-dimensional (3D) transperineal ultrasound, participants were consented prospectively, and ultrasound assessment was performed. The study population comprised nulliparous women at term (37-42 gestation) with a live singleton pregnancy. MATERIAL AND METHODS: Participants eligible for participation were recruited for the "SONO-BIRTH" study. Transperineal ultrasound was performed in the second stage of labor. The 3D pelvic floor volumes were uploaded into software to measure the levator hiatal area, levator hiatal circumference, transverse hiatal diameter, and the anteroposterior hiatal distance. Maternal characteristics (age, body mass index, and ethnicity) were collected from antenatal booking forms. Other variables including gestational age and head-perineum distance (HPD) were recorded at the time of the ultrasound assessment, as well as birthweight. RESULTS: Of 186 participants consecutively recruited, 153 ultrasound volumes were measured. For the maternal characteristic of age, a significant association was observed with increasing maternal age and levator hiatal area (LHa) (β = 0.26 cm, 95% CI 0.08; 0.43, p = 0.004). Differences were also observed in ethnicity, with Asian and other non-European ethnicities associated with a smaller LHa compared to White British (β = -2.92 cm, 95% CI -5.20; -0.0.64, p = 0.012) and (β = -2.70 cm, 95% CI -5.29; -0.11, p = 0.041), respectively. LHa decreased significantly and HPD increased (β = -0.35 cm, 95% CI -0.45; -0.26, p < 0.001). No association was found between hiatal dimensions and body mass index (BMI). In LHa measurements across gestations, a trend was observed toward a larger area with advancing gestational age, although the magnitude of the correlation was small (rho = 0.17, p = 0.031). CONCLUSIONS: We report the relationship between the levator muscle pelvic floor dimensions in the passive second stage of labor and maternal age, BMI, ethnicity, and gestational age. A higher fetal head station is associated with smaller pelvic floor dimensions as is non European ethnicity.
The socioeconomic burden of pelvic floor disorders.
Milsom I, Nilsson IEK, Othman JA … +3 more , Larsudd-Kåverud J, Wagg A, Gyhagen M
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42157408 · Full text
Pelvic floor disorders (PFDs) such as pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) affect millions of women throughout the world. The aim of this review was to describe the socioeco...
Pelvic floor disorders (PFDs) such as pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) affect millions of women throughout the world. The aim of this review was to describe the socioeconomic burden of PFDs in women. A comprehensive literature search was performed in relevant databases to identify articles on this topic. The prevalence of pelvic floor disorders reaches up to 46% in adult women and many have >1 PFD. PFDs impair a woman's well-being, quality of life, and sexual function and prevent many women from participating in recreational and sporting activities. UI alone constitutes a major health problem affecting the lives of more than 500 million persons worldwide. Combined FI and UI have been reported in 10% of women living in the community, increasing to almost 50% in nursing home residents. The prevalence of symptomatic pelvic organ prolapse in women has been reported to be between 4% and 11%. The costs of PFDs to health care systems and society are enormous, and approximately one in five women will undergo surgery for genital prolapse or UI by the age of 85 years. Global demographic trends regarding the aging population indicate that the prevalence of both UI and FI will rise in the coming years, significantly increasing the health and societal burden as well as the economic costs for both patients and health service payer. At present, PFDs incur a huge socioeconomic burden on women throughout the world. Management strategies during delivery should be individualized to reduce the burden of pelvic floor dysfunction currently occurring following vaginal birth.
A Nordic perspective on female stress urinary incontinence care: Lessons for shared clinical practice.
Linna E, Rossi HR, Klarskov N … +7 more , Svenningsen R, Mikkola T, Kuismanen K, Jónsdóttir K, Cheema R, Piltonen T, Olsen IP
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42156336 · Full text
Stress urinary incontinence (SUI) affects up to 36% of women. It reduces the quality of life and increases the economic burden of individuals and societies. From an international perspective, the populations of each Nord...
Stress urinary incontinence (SUI) affects up to 36% of women. It reduces the quality of life and increases the economic burden of individuals and societies. From an international perspective, the populations of each Nordic country are relatively small; however, shared ethnicities and economic approaches allow a collective view of the Nordic population. We have conducted a state-of-the-art review of diagnostic criteria, treatment strategies, follow-up procedures, and economic aspects of female SUI in the Nordic countries to identify and discuss common themes to advocate a combined and harmonized Nordic data pool. A 21-question survey concerning female SUI was created and refined by an expert group comprising experienced and leading urogynecologists from the Nordic countries. Data were gathered from the questionnaire, available national guidelines and Nordic registries, and clinical practices within the five Nordic countries. Additionally, a literature search for SUI from the Nordic countries was conducted. Diagnostic criteria and preoperative evaluation are mostly consistent across the Nordic countries. Differences were noted in the utilization of stress test and uroflowmetry measures. Norway reported the highest prevalence of invasive treatments. In Denmark, Norway, and Sweden, patients undergo a postoperative follow-up, documented in the national registries, while no such follow-up is conducted in Finland and Iceland. The literature review revealed a strong interest in the long-term effects of mid-urethral sling (MUS) operations, comparability of MUS versus injection treatments, the efficacy of conservative treatment strategies, and the overall quality of life associated with SUI pre- and postoperatively. We examined current practices for treating female SUI across the Nordic countries. National guidelines and registries are important tools for monitoring, evaluating, and improving quality and cost efficiency. Differences in the frequency of invasive treatments and the lack of follow-up procedures in Finland and Iceland call for further discussion about developing common Nordic strategies. Increasing costs necessitate efficient preventive and management strategies, and a more harmonized Nordic database would help to achieve these goals. Current Nordic literature lacks studies on costs and cost-effective strategies for SUI, and more research on the subject is needed.
Patterns of menopausal hormone therapy dispensing over 15 years-A Swedish register-based cohort study.
Götze Eriksson R, Söderquist F, Bai G … +7 more , Wikman P, Giunta DH, Sundström Poromaa I, Elenis E, Hirschberg AL, Skalkidou A, Iliadis SI
Acta Obstet Gynecol Scand · 2026 May · PMID 42153426 · Publisher ↗
INTRODUCTION: Menopausal hormone therapy (MHT) is used to manage menopausal symptoms. Dispensing patterns are influenced by evolving guidelines, clinical practice, and public perceptions, which have shifted considerably...
INTRODUCTION: Menopausal hormone therapy (MHT) is used to manage menopausal symptoms. Dispensing patterns are influenced by evolving guidelines, clinical practice, and public perceptions, which have shifted considerably over the past two decades. This study aims to describe patterns and age-specific trajectories of MHT dispensing in Sweden in a closed cohort of women aged 45-60 years at baseline, followed from 2006 to 2020. MATERIAL AND METHODS: A population-based closed cohort study linking several Swedish national health registers was performed. A total of 951 455 women aged 45-60 years residing in Sweden were included on January 1, 2006, and followed up until December 31, 2020. MHT dispensing was examined through three approaches: 1) local or no MHT versus systemic MHT, 2) oral versus transdermal estrogen, and 3) based on progestogen type and administration route. Analyses were also stratified by age at baseline (45-49, 50-54, 55-60 years). RESULTS: Systemic MHT dispensing was 9.6% in 2006 and 3.8% in 2020, while 6.7% and 16.7% used local MHT, respectively. The oldest age group consistently dispensed systemic MHT to a greater extent through the years. Oral estrogen dominated, although relative transdermal estrogen use increased modestly toward the end of follow-up. Dispensing of systemic MHT was less common among women born outside Europe, while dispensing of transdermal estrogen, compared to oral, was higher among those with higher education and income. Synthetic progestogens remained the most common type of progestogen, whereas dispensing of bioidentical progesterone/dydrogesterone and hormonal intrauterine devices was rare. CONCLUSIONS: In this large, population-based, closed cohort of women in Sweden, dispensing of systemic MHT declined with increasing age, while local MHT increased. Dispensing patterns, including route of estrogen administration and type of progestogen, varied by age cohort and sociodemographic characteristics. These findings illustrate how MHT dispensing is shaped by aging, cohort effects, evolving clinical practices, and updated guidelines, as well as by social determinants of health. Overall, the results underscore the importance of continued monitoring of MHT dispensing and efforts to ensure that prescribing remains evidence-based and equitable.
Management of congenital female genital tract anomalies related to primary amenorrhea and/or cyclic abdominal pain: A retrospective cohort study.
Grimbizis GF, Tsiapakidou S, Iordanidou E … +3 more , Kioussis G, Vatopoulou A, Theodoridis T
Acta Obstet Gynecol Scand · 2026 May · PMID 42153281 · Publisher ↗
INTRODUCTION: Surgical treatment for patients with complex female genital anomalies (FGA) depends on the specific type of anomaly, its level of complexity, the symptoms experienced by the patient, and a thorough understa...
INTRODUCTION: Surgical treatment for patients with complex female genital anomalies (FGA) depends on the specific type of anomaly, its level of complexity, the symptoms experienced by the patient, and a thorough understanding of the embryological origins of the anomaly. The aim of this study is to analyze the results of the surgical treatment of young female patients with complex FGA presented with primary amenorrhea and/or cyclic pelvic pain and present their treatment algorithm. MATERIAL AND METHODS: This retrospective cohort study analyzed prospectively collected data of adolescents and young women with FGA presented with primary amenorrhea and/or cyclic pelvic pain. Forty-eight patients of 11 different types of FGA, evaluated and treated in our Department between January 2007 and June 2025, were included. RESULTS: All patients were treated surgically. The design of the surgical treatment was based on the existing uterine body, cervical, and vaginal anatomy. Immediate surgery was performed in patients with obstructive pain, whereas nonobstructive cases were treated near anticipated sexual activity. Neovagina creation was performed in 26 cases of vaginal aplasia; isthmo-neovagina anastomosis was performed in one patient with cervical aplasia and a normal uterus and in two patients with a rudimentary cavity, while excision of the rudimentary cavity was performed in a third one. Two patients developed rectovaginal fistula, which was managed successfully. Surgical treatment of a patient with an obstructed bicorporeal complete uterus combined with cervical and vaginal aplasia was unsuccessful, leading to hysterectomy. All transverse vaginal septae were excised, one through posterior colpotomy. One patient with a complete bicorporeal uterus and unilateral cervical aplasia underwent successful anastomosis and another one underwent excision of the obstructed uterine body. Rudimentary cavities of unicorporeal uteri were removed. CONCLUSIONS: Surgical treatment of FGA presenting with primary amenorrhea and/or cyclic pelvic pain should be anatomy-driven, with priority given to symptom relief and preservation of reproductive potential by restoring genital tract continuity, when feasible, or removing obstructed parts.
Age-related long-term effects of vaginal delivery, pregnancy, and sphincter injury on anal continence: A matched cohort study.
Nilsson IEK, Al-Mukhtar Othman J, Larsudd-Kåverud J … +4 more , Åkervall S, Molin M, Milsom I, Gyhagen M
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42148784 · Full text
INTRODUCTION: It is still poorly understood to what extent various obstetric and non-obstetric factors contribute to anal incontinence in women from a lifetime perspective. This study aimed to assess the contribution of...
INTRODUCTION: It is still poorly understood to what extent various obstetric and non-obstetric factors contribute to anal incontinence in women from a lifetime perspective. This study aimed to assess the contribution of pregnancy, delivery mode, obstetric anal sphincter injury (OASI), and age on anal incontinence in women aged 40-64 years. MATERIAL AND METHODS: Data from the Swedish Medical Birth Register and the Total Population Register were linked to responses to an anal incontinence questionnaire collected in 2014 and 2015. The study included 13 480 women, 20 years from first birth, with BMI data: 4192 nulliparas, 2411 with two cesarean deliveries, and 6877 with two vaginal deliveries. Women were matched by exact age and BMI (±3 units), yielding three cohorts of 1961 women each. A subgroup analysis compared vaginally delivered women without OASI to those with one or two OASIs. RESULTS: The prevalence of fecal incontinence was highest in women with 2 vaginal deliveries (14.2%) and lowest in those with 2 cesarean deliveries (10.2%, p < 0.001). Fecal incontinence was significantly higher in nulliparous women (12.9%) compared with the cesarean group (p < 0.01). Both bothersome fecal (p = 0.001) and anal (p < 0.001) incontinence were more common following vaginal delivery compared to cesarean delivery. Among women with 2 vaginal deliveries, the prevalence of fecal incontinence nearly doubled in those with OASI compared to those without (23.3% vs. 13.7%, p < 0.01). Women with OASI reported a greater symptom burden, demonstrated by a higher Jorge-Wexner score (2.38 vs. 1.42, p < 0.001), increased use of protective products (7.8% vs. 3.0%, p = 0.025), and a higher reported impact on daily lifestyle (20.7% vs. 10.1%, p = 0.002). Only women with two vaginal deliveries showed a significant age-related increase in fecal incontinence. CONCLUSIONS: Long-term fecal incontinence was more common and severe after vaginal delivery, particularly with OASI. An age-related effect on fecal incontinence was observed only among vaginal deliveries. Even with complete prevention of OASI through perineal protection, a significant age-related increase in fecal incontinence between 40 and 62 years would remain, arising solely from the effect of vaginal delivery. Preventing OASI remains an important obstetric target to reduce fecal incontinence later in life.
Assessing the clinical value of cervical biopsies in individuals with transformation zone type 3 at colposcopy: A cross-sectional study.
Bertelsen VM, Booth BB, Tranberg M … +2 more , Petersen LK, Bor P
Acta Obstet Gynecol Scand · 2026 May · PMID 42141730 · Publisher ↗
INTRODUCTION: To evaluate the diagnostic performance of systematic multiple biopsies in individuals with a transformation zone type 3 (TZ3) at colposcopy and to assess the influence of referral status and the use of dyna...
INTRODUCTION: To evaluate the diagnostic performance of systematic multiple biopsies in individuals with a transformation zone type 3 (TZ3) at colposcopy and to assess the influence of referral status and the use of dynamic spectral imaging (DSI) colposcopy on the detection of CIN2+ lesions. MATERIAL AND METHODS: In this multicentre cross-sectional study, a total of 189 individuals referred with abnormal cytology and/or hrHPV positivity with a TZ3 at colposcopy were included at three colposcopy clinics in the Central Denmark Region. Data were obtained from questionnaires, electronic medical records and the Danish National Pathology Registry. All participants underwent colposcopy with four cervical biopsies. Histological outcomes were based on the combined results of all four biopsies and, when available, compared with the corresponding large loop excision of the transformation zone (LLETZ) specimens. One centre employed DSI colposcopy, while two centres used conventional colposcopy. Main outcome measures were CIN2+ detection rate and sensitivity of individual and combined biopsies, assessed overall and stratified by referral status and colposcopy method. RESULTS: The overall CIN2+ detection rate was 16.9%. The detection rate increased with each additional biopsy, with the highest sensitivity observed at the fourth biopsy (71.4%). The detection rate was significantly higher among individuals referred with high-grade abnormalities (42.6%) compared with low-grade referrals (6.4%) (p < 0.001). The use of DSI colposcope did not significantly improve biopsy sensitivity. Concordance between biopsy and LLETZ histology was 85.3%. CONCLUSIONS: Systematic multiple biopsies improve CIN2+ detection in women with TZ3 but may lead to overtreatment in those referred with low-grade abnormalities. Despite this approach, the true CIN2+ detection rate may still be underestimated.
A single centre multidisciplinary team retrospective review of fifty cases of robot-assisted surgery for diaphragmatic and thoracic endometriosis.
Barton-Smith P, Kawka M, Routledge T … +2 more , Arora R, Jiao LR
Acta Obstet Gynecol Scand · 2026 May · PMID 42136046 · Publisher ↗
INTRODUCTION: Diaphragmatic and thoracic endometriosis (DTE) is considered rare, often presenting with non-specific cyclical thoracic symptoms. Diagnosis and surgical management remain challenging due to the need for cro...
INTRODUCTION: Diaphragmatic and thoracic endometriosis (DTE) is considered rare, often presenting with non-specific cyclical thoracic symptoms. Diagnosis and surgical management remain challenging due to the need for cross-specialty expertise. This study reports the first series of robot-assisted surgeries for DTE performed by a single, consistent multidisciplinary team. MATERIAL AND METHODS: This was a retrospective case series of 50 consecutive DTE surgeries performed between July 2020 and March 2023 in a specialist private hospital in the United Kingdom. Procedures involving robot-assisted laparoscopy (RAL) for pelvic/diaphragmatic disease and/or robot-assisted video-assisted thoracoscopic surgery (RAVATS) for thoracic disease were included. All cases involved a multidisciplinary collaboration between gynecological, hepato-pancreato-biliary, and thoracic robotic surgeons. Data on presentation, operative metrics, histology, and 90-day outcomes were collected and analyzed. RESULTS: Forty-six women underwent 50 procedures; 29 involved RAL only, 13 involved RAL with RAVATS, and 5 were RAVATS only. Median operative time was 236 min for three-compartment cases. No cases required conversion to open surgery. Endometriosis was confirmed histologically in 64.4% of abdominal diaphragm cases and 45% of thoracic cases. The right hemidiaphragm was most commonly affected. No Clavien-Dindo ≥II complications occurred. Combined three-compartment procedures were significantly shorter overall than staged approaches (p = 0.01). CONCLUSIONS: Robot-assisted surgery for DTE is safe, feasible, and may enhance disease recognition and excision, particularly when conducted by a dedicated multidisciplinary team. Simultaneous multi-compartment surgery improves operative efficiency and reduces the risk of incomplete treatment. DTE warrants evaluation in specialized centers, in a multidisciplinary fashion.
Risks of gynecological and breast cancers in women with endometriosis or adenomyosis: A nationwide cohort study.
Moberg L, Li X, Herbst F … +4 more , Jansåker F, Dobilas A, Sundquist K, Borgfeldt C
Acta Obstet Gynecol Scand · 2026 May · PMID 42136042 · Publisher ↗
INTRODUCTION: Endometriosis has been associated with several risk factors for cancer, and population-based research has shown that women with endometriosis have a higher risk of several types of cancer. The aim of this s...
INTRODUCTION: Endometriosis has been associated with several risk factors for cancer, and population-based research has shown that women with endometriosis have a higher risk of several types of cancer. The aim of this study was to examine the risks of gynecological and breast cancers among women diagnosed with endometriosis or adenomyosis. MATERIAL AND METHODS: A nationwide cohort study was conducted between 1997 and 2018. All women diagnosed with endometriosis or adenomyosis (the first recorded diagnosis during the study period) in Sweden were followed for cancer diagnosis. The reference population was women not diagnosed with endometriosis or adenomyosis during the study period. Data were obtained from the National Patient Register (in patient and out patient specialist care settings), the Swedish Cancer Register, and the Total Population Register. Adjusted standardized incidence ratios with 95% confidence intervals were calculated for cancer. Women with prior gynecological organ removal or mastectomy were not excluded. RESULTS: A total of 49 133 women were diagnosed with endometriosis or adenomyosis at a mean age of 42.7 years (standard deviation: 9.97 years). Of these, 1784 (3.6%) were diagnosed with gynecological or breast cancer. The overall standardized incidence ratio for gynecological and breast cancer in women with endometriosis or adenomyosis for the whole study period was 1.4 (95% confidence interval, 1.3-1.5) compared to those without. For cancers diagnosed in the same calendar year as endometriosis or adenomyosis (n = 370), the standardized incidence ratios were particularly high for endometrial cancer (standardized incidence ratio 47.0) and ovarian (standardized incidence ratio 39.6) cancer. For cancers diagnosed in subsequent calendar years (n = 1414), the standardized incidence ratios were 0.6 (0.5-0.8) for endometrial cancer, 0.7 (0.5-0.9) for cervical cancer, 1.2 (1.1-1.3) for breast cancer, and 1.9 (1.6-2.2) for epithelial ovarian cancers overall. When looking at ovarian cancer subtypes, the standardized incidence ratios were 1.5 (1.1-2.0), 2.8 (1.7-4.2), and 7.7 (5.4-10.6), for low-grade serous, endometrioid, and ovarian clear cell cancers, respectively. CONCLUSIONS: Women with endometriosis or adenomyosis have a higher subsequent risk of ovarian and breast cancers compared to women without. This may represent important information for clinicians and a foundation for further studies on prophylactic interventions.
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