Acta Obstetricia Et Gynecologica Scandinavica[JOURNAL]
Sun
200 papers
Improved risk stratification for placenta-mediated complications through the use of mid-gestational uterine artery Doppler: A retrospective cohort study.
Ammari C, Napolitano R, Stott D … +3 more , Casagrandi D, Nzelu D, Hillman SL
Acta Obstet Gynecol Scand · 2026 May · PMID 42135980 · Publisher ↗
INTRODUCTION: Placenta-mediated complications such as pre-eclampsia (PE), fetal growth restriction (FGR), and preterm birth (PTB) remain leading causes of maternal and perinatal morbidity. First-trimester screening tools...
INTRODUCTION: Placenta-mediated complications such as pre-eclampsia (PE), fetal growth restriction (FGR), and preterm birth (PTB) remain leading causes of maternal and perinatal morbidity. First-trimester screening tools, including the Fetal Medicine Foundation (FMF) algorithm and National Institute for Health and Care Excellence (NICE) criteria, help identify women at risk, but their predictive accuracy remains limited. This study evaluated whether second-trimester uterine artery (UtA) Doppler measurements provided additional risk stratification within risk groups defined by either FMF or NICE-based first-trimester screening. MATERIAL AND METHODS: This was a retrospective cohort study which included 5518 singleton pregnancies managed at University College London Hospital between 2019 and 2022. Women were stratified into four risk groups based on first (1) and second (2) trimester assessments: L1L2 (low risk in both trimesters), L1H2 (low risk in first, high risk in second), H1L2 (high risk in first, low in second), and H1H2 (high risk in both trimesters). First-trimester risk was assessed using FMF or NICE models; second-trimester high risk was defined as a mean UtA pulsatility index (PI) ≥95th centile. Primary outcomes included the incidence of PE, small for gestational age (SGA; birthweight <10th centile), FGR (<3rd centile), PTB before 34 and 37 weeks, stillbirth, and a composite adverse outcome (PE, FGR, PTB, or stillbirth). Secondary outcomes were emergency cesarean section (EMCS), neonatal intensive care unit (NICU) admission, and NICU length of stay. This study was not designed to compare the intrinsic screening performance of NICE and FMF as first-trimester tools. RESULTS: Women classified as low risk in the first trimester but high risk in the second trimester had higher rates of adverse outcomes compared to those who remained low risk in both trimesters in both FMF- and NICE-based stratification. Notably, women classified as high risk in both trimesters had the highest rates of placenta-mediated complications, including PE, FGR, PTB, and stillbirth. This pattern was consistent across both first-trimester risk frameworks. CONCLUSIONS: Mid-gestational UtA Doppler assessment improves prediction of placenta-mediated complications when included with FMF or NICE screening. This two-step approach enhances identification of high-risk pregnancies and supports more personalized antenatal care.
Multiple pregnancies: Nordic perspective and challenges.
Stefanovic V
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42135977 · Full text
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Priming of labor with tafoxiparin in nulliparous term pregnant women with unripe cervix-Proof-of-concept and dose-finding results from a randomized controlled trial.
Ekman-Ordeberg G, Jonsson M, Blomberg M … +9 more , Melin M, Stjernholm-Vladic Y, Gidlöf SB, Wide-Swensson D, Tihtonen K, Olsen IC, Degling-Wikingsson L, Blom P, Rahkonen L
Acta Obstet Gynecol Scand · 2026 May · PMID 42135974 · Publisher ↗
INTRODUCTION: New therapies are needed to improve the risk-benefit profile of intervention for labor induction. Tafoxiparin, a depolymerized form of heparin with no anticoagulant effects, has demonstrated potential to in...
INTRODUCTION: New therapies are needed to improve the risk-benefit profile of intervention for labor induction. Tafoxiparin, a depolymerized form of heparin with no anticoagulant effects, has demonstrated potential to increase cervical ripening and influence the onset and outcome of labor. We assessed the effects of tafoxiparin in women with an unripe cervix scheduled for labor induction. MATERIAL AND METHODS: Phase 2 randomized double-blind placebo-controlled study (PPL17; EudraCT 2019-000620-17), conducted in two parts. The first part compared tafoxiparin 300 mg vs. placebo, while the second part assessed tafoxiparin 150 and 75 mg. Study treatment was administered once daily up to 7 days or until onset of labor or ripened cervix. Study participants were nulliparous women at term with an unripe cervix and planned labor induction. The primary endpoint was the cervical ripening rate during treatment, as measured by Bishop score. RESULTS: Of 348 randomized women, 347 received study treatment. The primary analysis of Bishop score showed statistically significant increases in cervical ripening with tafoxiparin. The difference from placebo was most pronounced in the 300 mg group (mean slope 0.86 vs. 0.62, p = 0.006). Spontaneous onset of labor occurred in 39.8%-42.4% of women treated with tafoxiparin versus 28.4% with placebo. The rate of instrumental vaginal deliveries (vacuum extractions) was lowest in the tafoxiparin 300 mg group (10.0% vs. 24.1% with placebo; p = 0.013). Few serious adverse events were reported, and there was no hypercontractility related to tafoxiparin. CONCLUSIONS: Tafoxiparin was effective in cervical ripening, facilitating spontaneous onset of labor and reducing the need for instrumental delivery. Benefits were most pronounced with the 300 mg dose, and a favorable safety profile was observed. These results suggest that tafoxiparin may be suitable for obstetrical use in outpatient and home-based settings.
Salivary uric acid remote serial self-testing for prediction of adverse pregnancy outcomes of uteroplacental dysfunction.
Chmielewska B, Wang C, Macklon N … +2 more , Bhide A, Thilaganathan B
Acta Obstet Gynecol Scand · 2026 May · PMID 42135969 · Publisher ↗
INTRODUCTION: Hypertensive disorders of pregnancy (HDP) and fetal growth restriction (FGR) are major manifestations of uteroplacental dysfunction and remain leading causes of maternal and perinatal morbidity. Current str...
INTRODUCTION: Hypertensive disorders of pregnancy (HDP) and fetal growth restriction (FGR) are major manifestations of uteroplacental dysfunction and remain leading causes of maternal and perinatal morbidity. Current strategies for risk assessment rely on hospital-based screening or diagnostic triage and do not provide continuous, personalized monitoring throughout pregnancy. Uric acid is closely linked to placental dysfunction, and salivary uric acid (sUA) reflects circulating concentrations, enabling noninvasive remote measurement. This study evaluated whether serial, smartphone-enabled self-testing of sUA could predict adverse pregnancy outcomes related to uteroplacental dysfunction. MATERIAL AND METHODS: In this prospective observational cohort study, pregnant women were recruited at 20-22 weeks' gestation at a tertiary hospital. Participants performed weekly salivary self-testing using colorimetric uric acid strips until delivery, with results captured via a smartphone application. Images were analyzed using RGB color metrics. Primary outcomes were HDP and/or FGR, defined using ISSHP and FIGO criteria, respectively. Logistic regression models incorporated 4 weeks of lagged RGB-derived sUA metrics together with maternal characteristics. Model performance was assessed using area under the receiver operating characteristic curve (AUC) and calibration metrics, stratified by gestational age at outcome. RESULTS: Of 495 recruited participants, 318 women with complete longitudinal data were included in the final analysis; 36 (11.3%) developed HDP and/or FGR. A multivariable model combining maternal risk factors with 4 weeks of serial sUA measurements demonstrated good predictive performance. Discrimination was highest for preterm outcomes, with an AUC of 0.814 for prediction within 1 week at <37 weeks' gestation and prediction remained acceptable at term (AUC 0.732). CONCLUSIONS: Remote serial self-testing of salivary uric acid is feasible and shows good predictive ability for adverse pregnancy outcomes related to uteroplacental dysfunction. This noninvasive approach has potential to complement existing screening and surveillance strategies by enabling continuous, personalized risk assessment throughout pregnancy. Prospective validation in larger and more diverse populations is warranted.
The effect of antihypertensive treatment on longitudinal changes in PLGF and sFlt-1 in women with new onset hypertension in pregnancy.
Tyrell E, Lau KGY, Bednorz M … +2 more , Nicolaides KH, Kametas NA
Acta Obstet Gynecol Scand · 2026 May · PMID 42130096 · Publisher ↗
INTRODUCTION: To assess longitudinal changes in serum sFlt-1 and PLGF in women with newly diagnosed hypertension in pregnancy before and after commencing antihypertensive therapy, aiming at tight BP control (<135/85 mmHg...
INTRODUCTION: To assess longitudinal changes in serum sFlt-1 and PLGF in women with newly diagnosed hypertension in pregnancy before and after commencing antihypertensive therapy, aiming at tight BP control (<135/85 mmHg). MATERIAL AND METHODS: This was a prospective study that assessed women at presentation with hypertension and after 1 and 2 weeks of antihypertensive therapy. At each visit, blood pressure (BP) and blood tests to obtain levels of sFlt-1 and PLGF were taken. A multilevel linear mixed-effects model was performed to compare the repeated measurements of sFlt-1 and PLGF, controlling for maternal demographics, diagnosis at presentation, and antihypertensive agent used. The cohort was further subdivided into two groups based on how quickly they achieved target BP control to assess whether the degree of initial control influenced the angiogenic profile. Group 1 achieved BP < 135/85 after 1 week, while group 2 after 2 weeks of treatment. RESULTS: A total of 133 women were recruited into the study, 47 in group 1 and 86 in group 2. For the total cohort, both systolic blood pressure (SBP) and diastolic blood pressure (DBP) dropped after 1 week on antihypertensive medication (p < 0.001) and remained stable thereafter. LogPLGF demonstrated a continuous fall (p < 0.001) while LogsFlt-1 did not change after 1 and 2 weeks on medication. Group 1 had persistently higher LogPLGF than group 2 (p = 0.015). Both groups showed a reduction in LogPLGF at a similar rate over 2 weeks on antihypertensive medication. There was no difference between groups throughout the study in LogsFlt-1 and no change over time. There was a significant interaction between groups for SBP and DBP (p < 0.001) but no interaction between groups for LogPLGF or Log sFlt-1. CONCLUSIONS: In pregnant women with new-onset hypertension, tight BP control leads to a reduction in SBP and DBP within the first week of antihypertensive treatment. LogPLGF declines, but LogsFlt-1 shows no change with time. Women who achieved BP control within 1 week, compared to 2 weeks from commencing treatment, had higher LogPLGF but no difference in Log sFlt-1. Both groups demonstrated similar changes, with LogPLGF declining but LogsFlt-1 remaining static with time.
Perinatal outcomes following single intrauterine death in monochorionic twin pregnancies complicated by twin anemia polycythemia sequence: Systematic review and meta-analysis.
Piergianni M, Khalil A, Rizzo G … +6 more , Mappa I, Valle LD, Mustafa HJ, Galindo A, Shamshisaz AA, D'Antonio F
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42106586 · Full text
INTRODUCTION: Most of the studies reporting the outcome of the surviving twin after single intra-uterine fetal death (sIUFD) focused on uncomplicated pregnancies or those affected by twin-to-twin transfusion syndrome, wh...
INTRODUCTION: Most of the studies reporting the outcome of the surviving twin after single intra-uterine fetal death (sIUFD) focused on uncomplicated pregnancies or those affected by twin-to-twin transfusion syndrome, while there is a paucity of data for those complicated by twin anemia polycythemia sequence (TAPS). The aim of this systematic review was to report perinatal outcomes in monochorionic diamniotic (MCDA) twin pregnancies complicated by TAPS after sIUFD, according to gestational age at fetal loss and the presence of pregnancy-related comorbidities. MATERIAL AND METHODS: MEDLINE, EMBASE, and The Cochrane Library were searched for studies reporting the outcome of monochorionic twin pregnancies complicated by TAPS experiencing single IUFD. The primary outcome was the occurrence of co-twin IUFD. Secondary outcomes were neonatal death (NND), preterm birth (PTB) <34, <32, and <28 weeks of gestation, cerebral abnormalities detected at follow-up prenatal ultrasound, fetal magnetic resonance imaging (MRI) or postnatal imaging (ultrasound or MRI), and adverse neurodevelopmental outcome. Random-effects meta-analysis of proportions was used to analyze the data, and results were reported as pooled proportions or odd ratios (OR) with 95% CI. RESULTS: Eleven studies (83 twin pregnancies affected by TAPS, either spontaneous or post-laser, and complicated by single IUFD) were included in the systematic review and 10 (78 pregnancies) in the meta-analysis. Co-twin IUFD occurred in 4.9% (95% CI 1.1-11.3) after a single IUFD in pregnancies affected by TAPS, while there was no case of NND. PTB, either spontaneous or iatrogenic, occurred in 80.4% (95% CI 44.3-99.5) <34 weeks, and 50.0% (95% CI 16.3-83.7) <28 weeks of cases. Intra-uterine transfusion was required in 8.0% (95% CI 0.9-38.3). Cerebral anomalies at follow-up ultrasound or fetal MRI were reported in 15.0% (95% CI 8.2-78.3) and 11.4% (95% CI 2.4-55.7) of cases, while anomalies at post-natal imaging in 9.4% (95% CI 5.6-57.6) of cases. It was not possible to perform a meaningful pooled data synthesis on the observed outcomes according to the type and staging of TAPS and according to the donor or recipient twin. CONCLUSIONS: The occurrence of co-twin death after single IUFD in pregnancies complicated by TAPS appears low, while cerebral abnormalities detected either pre- or post-natally occur in 10-15% of cases. Further evidence is needed to elucidate the long-term neurological and neurodevelopmental risk of these children.
Risk factors for birth trauma and postpartum posttraumatic stress in the United Kingdom: Results from the international survey of childbirth-related trauma.
Webb R, Uddin N, Constantinou G … +1 more , Ayers S
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42077168 · Full text
INTRODUCTION: Recent research shows that 40.6% of women in the United Kingdom experience childbirth as at least moderately traumatic, and 5.9% develop childbirth-related posttraumatic stress disorder (CB-PTSD). However,...
INTRODUCTION: Recent research shows that 40.6% of women in the United Kingdom experience childbirth as at least moderately traumatic, and 5.9% develop childbirth-related posttraumatic stress disorder (CB-PTSD). However, risk factors for birth trauma ratings and CB-posttraumatic stress symptoms (CB-PTSS) in this sample remain unexplored. Therefore, the aim was to understand risk factors for birth trauma and CB-PTSS in a UK sample. MATERIAL AND METHODS: A cross-sectional survey of traumatic birth and CB-PTSD with women (N = 339) from three hospitals in England, two in Wales, and three in Scotland. Participants completed the survey at 6-12 weeks postpartum. It included questions about (i) demographics and mental health; (ii) pregnancy; (iii) labor and birth; and (iv) the infant. Outcome variables were birth trauma rating and CB-PTSS. RESULTS: Higher birth trauma ratings were predicted by women not having other children, maternal complications during birth, lower birth satisfaction, and a mother not having skin-to-skin contact with her baby after birth. Higher CB-PTSS were predicted by younger maternal age, women not having other children, current mental health difficulties, previous trauma, giving birth in Scotland, emergency cesarean section, and lower birth satisfaction. CONCLUSIONS: Overall, this paper found that traumatic birth and CB-PTSS symptoms are associated with a range of demographic, mental health, birth-related, and infant-related variables. Results from this study can be used to improve maternity care.
The use of topical vaginal estrogens in postpartum women: A systematic review.
Waheed A, Taithongchai A, Robinson D
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42077139 · Full text
INTRODUCTION: Topical vaginal estrogens have been used in the management of postmenopausal vulvovaginal atrophy for some time, locally reintroducing exogenous estrogens to the estrogen-receptive tissues of the female uro...
INTRODUCTION: Topical vaginal estrogens have been used in the management of postmenopausal vulvovaginal atrophy for some time, locally reintroducing exogenous estrogens to the estrogen-receptive tissues of the female urogenital tract following a decline in systemic levels. The postpartum period is similarly a state of relative estrogen depletion due to the antagonistic effect from raised prolactin levels throughout pregnancy and lactation; this is thought to contribute to post-delivery pelvic floor dysfunction and vaginal atrophy. Given the similar etiology, there may be a role for topical vaginal estrogens in postpartum women. MATERIAL AND METHODS: A systematic review was performed evaluating the use of topical vaginal estrogens in postpartum women. This was performed as per PRISMA guidelines, with articles screened from online databases from their inception to October 2025. RESULTS: Three studies were identified that met the inclusion criteria, including a total of 85 women. Two studies focused on the molecular and cellular composition of tissues from postpartum women using topical vaginal estrogens, and one double-blind randomized placebo-controlled trial primarily evaluated postpartum atrophy in the presence and absence of vaginal estrogens. Tissues exposed to estrogen appeared to have increased cellular proliferation, while the Vulval Assessment Score (VuAS), a patient-subjective validated scoring system for vaginal atrophy, was found to be lower in those using vaginal estrogen cream for 12 weeks. No statistically significant difference in bladder, bowel, or sexual function was noted. No serious adverse outcomes were reported, and the use of vaginal estrogens appeared acceptable to women. CONCLUSIONS: There is a paucity of data currently available regarding the use of topical vaginal estrogens in the post-partum period. Although likely safe for use, further evidence is required to be able to make firm conclusions about their efficacy for postpartum vaginal atrophy, and further high-quality trials are required in the future.
Ultrasound texture-based radiomics of placental and myometrial tissue for predicting postpartum blood loss in women with placenta previa and low-lying placenta.
Marasciulo F, Milandri ES, Maffeo I … +4 more , Reghezza S, Cagnacci A, Londero AP, Prefumo F
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42077135 · Full text
INTRODUCTION: This study aimed to evaluate the role of radiomic analysis applied to ultrasound images in predicting postpartum blood loss at birth in women affected by low-lying placenta or placenta previa. MATERIAL AND...
INTRODUCTION: This study aimed to evaluate the role of radiomic analysis applied to ultrasound images in predicting postpartum blood loss at birth in women affected by low-lying placenta or placenta previa. MATERIAL AND METHODS: In this retrospective, single-center study, we analyzed singleton pregnancies with placenta previa or a low-lying placenta, initially diagnosed at the second-trimester ultrasound examination. Data were collected from ultrasound examinations conducted in the second and third trimesters, along with birth outcomes. Radiomic analysis was conducted on archival ultrasound images to extract quantitative features. Predictive models were constructed utilizing multivariable generalized linear modeling (Gamma regression with a log link), encompassing radiomics-only, clinical/sonographic-only, and an integrated model. RESULTS: In the final analysis of 107 women, 51 exhibited postpartum blood loss exceeding 500 mL. A prior cesarean delivery was recognized as a notable clinical risk factor. Multiple radiomic features identified in second- and third-trimester ultrasound scans correlated with a heightened risk of significant blood loss during birth. The integrated predictive model exhibited superior accuracy for blood loss exceeding 500 mL, achieving an AUC of 82.32% (95% CI: 74.18%-90.45%). This performance surpassed that of the clinical ultrasound model, which had an AUC of 71.27% (95% CI: 62.27%-80.27%), with a statistically significant difference (p = 0.001). Additionally, it demonstrated a nonsignificant improvement over the radiomics-only model, which recorded an AUC of 77.17% (95% CI: 68.25%-86.09%). CONCLUSIONS: Radiomic analysis of ultrasound images enhances risk prediction for postpartum major blood loss in pregnancies affected by placenta previa and low-lying placenta. Integrating radiomics with clinical and sonographic data improves predictive accuracy, offering a promising tool for personalized obstetric risk assessment and management.
The TRUFFLE monitoring protocol for early-onset fetal growth restriction: A clinical effectiveness study.
Pegorie C, Chmielewska B, Jie M … +4 more , Mehta N, McStay D, Bhide A, Thilaganathan B
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42068043 · Full text
INTRODUCTION: The randomized control Trial (RCT) of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE study) established its clinical efficacy for monitoring preterm fetal growth restriction (FGR). The objective of...
INTRODUCTION: The randomized control Trial (RCT) of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE study) established its clinical efficacy for monitoring preterm fetal growth restriction (FGR). The objective of this study was to assess the clinical effectiveness of this protocol in a routine clinical setting with regards to the clinical outcomes, both overall and stratified by gestational age at FGR diagnosis. MATERIAL AND METHODS: This is a retrospective cohort study of singleton pregnancies with preterm FGR between January 2013 and July 2024 in a tertiary Fetal Medicine Unit. FGR was defined as an estimated fetal weight or abdominal circumference <10th centile with an elevated umbilical artery pulsatility index >95th centile. Main outcomes collected included perinatal survival, interval from diagnosis to delivery, and delivery indications. RESULTS: 171 pregnancies met inclusion criteria. The median (IQR) gestation at FGR diagnosis and birth was 27 (25-29) and 30 (28-32) weeks, respectively. Overall intact neonatal survival was 90.6%, with the rate of stillbirth and neonatal death being 2.9% and 5.8%, respectively. FGR diagnosis prior to 26 weeks was associated with a three-fold longer interval to birth compared with FGR diagnosis at 26-29 and ≥30 weeks (median of 31.0 vs. 10.0 and 14.0 days; p < 0.001). Below 32 weeks, the predominant indication for elective birth was abnormal computerized CTG with low short-term variation (STV). Beyond 32 weeks' gestation, abnormal umbilical artery Doppler and maternal indications such as preeclampsia were more frequent. CONCLUSIONS: The TRUFFLE monitoring protocol is clinically effective in managing early-onset FGR outside a trial environment, achieving comparable perinatal outcomes to the original RCT. Routine integration of both Doppler and cCTG monitoring is crucial for optimal timing of birth with early FGR. Further research is needed to explore the benefits of more frequent or remote fetal monitoring.
Laparoscopically guided transversus abdominis plane block versus local wound infiltration analgesia in laparoscopic surgery for peritoneal endometriosis: A prospective randomized controlled double-blinded LTAP-trial.
Terho AM, Puhto T, Laru J … +4 more , Uimari O, Ohtonen P, Rautio T, Koivurova S
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42062238 · Full text
INTRODUCTION: Endometriosis patients often suffer from more severe pain in association with surgical procedures. The aim of this study was to investigate whether laparoscopically guided transversus abdominis plane block...
INTRODUCTION: Endometriosis patients often suffer from more severe pain in association with surgical procedures. The aim of this study was to investigate whether laparoscopically guided transversus abdominis plane block (LTAP) offers an opioid-sparing effect compared to local wound infiltration (LWI) analgesia in laparoscopic surgery performed for suspected peritoneal endometriosis. MATERIAL AND METHODS: In this single-center prospective, randomized, controlled, double-blinded clinical study, 46 patients were randomized to receive either levobupivacaine inserted in the four quadrants of the abdomen at LTAP points and saline at trocar sites (n = 23) or saline at the LTAP points and levobupivacaine at trocar sites (n = 23). The study size was based on a power calculation. The primary outcome, opioid consumption 24 h postoperatively, was measured using patient-controlled analgesia pumps. Secondary outcomes included postoperative pain scores and other enhanced recovery after surgery (ERAS) measures, as well as patient outcome questionnaires at six months after surgery. Statistical analyses were performed on an intention-to-treat basis. The study was prospectively registered in Clinicaltrials.gov, ID: NCT04735770, Jan 19, 2021; https://clinicaltrials.gov/study/NCT04735770?term=LTAP&rank=2. RESULTS: There was no significant difference in the mean opioid consumption (iv morphine equivalents) between the study groups: 31.8 ± 25.5 mg in the LTAP group and 27.5 ± 19.3 mg in the LWI group (mean difference 4.3 mg, 95% CI -9.2 to 17.7, p = 0.52). No significant differences were found in the postoperative pains scores, mean operation times, mean total blood loss, or mobilization between the study groups. 17 (73.9%) patients in each group received histological diagnosis of peritoneal endometriosis of the samples obtained during surgery. Times to discharge were 24.4 ± 4.3 (LTAP) and 28.1 ± 14.8 h (LWI), p = 0.25. No complications related to LTAP or LWI were reported. CONCLUSIONS: In this study performed on women suffering from long-term abdominal pain preoperatively, no significant differences were found between LTAP and LWI as regards to postoperative opioid consumption, postoperative pain, ERAS factors, or safety.
Probiotic supplementation during pregnancy for vaginal microbiota improvement and pathogen clearance: A systematic review and meta-analysis.
Liu Z, Huang R, Sun T … +1 more , Zhu L
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42047468 · Full text
INTRODUCTION: Pregnancy is associated with susceptibility to vaginal dysbiosis, including Group B Streptococcus (GBS), bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC). Probiotic supplementation has emerged a...
INTRODUCTION: Pregnancy is associated with susceptibility to vaginal dysbiosis, including Group B Streptococcus (GBS), bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC). Probiotic supplementation has emerged as a potential strategy to restore vaginal microecology, yet its effectiveness during pregnancy remains uncertain. MATERIAL AND METHODS: To evaluate whether probiotic supplementation during pregnancy increases the likelihood of clearance of GBS colonization, BV, and VVC. We systematically searched PubMed, Embase, Cochrane CENTRAL, and Web of Science from inception to 16 April 2025. Eligible studies were randomized or non-randomized studies comparing probiotic supplementation with placebo or no treatment in pregnant women, reporting outcomes related to vaginal microbiota, pathogen decolonization, or infection resolution. Two reviewers independently screened studies and extracted data. Randomized controlled trials (RCT) were evaluated using the Cochrane ROB-1 tool, and the single non-RCT was assessed using ROBINS-I. Meta-analyses were performed for co-primary outcomes, with subgroup analyses by timing, comparator type (placebo-controlled vs. no-treatment control), and duration of intervention. RESULTS: Eighteen studies (n = 3705) were included. For the co-primary outcomes, a statistically significant increase in the odds of GBS decolonization was observed (OR 1.38, 95% CI 1.08-1.76; I = 2%). This association was no longer statistically significant in analyses restricted to RCTs (OR = 1.28, 95% CI 0.93-1.76; I = 9%) and remained non-significant when further restricted to placebo-controlled RCTs (OR = 1.32, 95% CI 0.94-1.85; I = 31%). No significant effects were found for BV (OR 0.91) or VVC (OR 0.65). An exploratory pooled analysis across infection types showed no significant overall improvement in infection clearance (OR 1.13, 95% CI 0.94-1.36; I = 16%). Subgroup analysis indicated greater efficacy in interventions initiated during the third trimester or lasting ≤4 weeks, though interaction tests were not significant. CONCLUSIONS: Probiotic supplementation during pregnancy may increase the likelihood of GBS decolonization. However, this association was not statistically significant in sensitivity analyses restricted to randomized and placebo-controlled trials. No consistent benefit was observed for BV or VVC. Standardized probiotic regimens and harmonized diagnostic frameworks are needed.
Women's motivations for and experiences with transabdominal cerclage: A qualitative study.
Lou S, Hansen LK, Jensen LG … +6 more , Uldbjerg N, Jensen PT, Kallesen T, Sandager P, Helmig RB, Glavind J
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42032918 · Full text
INTRODUCTION: Transabdominal cerclage (TAC) is used to prevent pregnancy loss and preterm birth in women with previous failed transvaginal cerclage or insufficient cervical tissue. TAC requires laparoscopic or open abdom...
INTRODUCTION: Transabdominal cerclage (TAC) is used to prevent pregnancy loss and preterm birth in women with previous failed transvaginal cerclage or insufficient cervical tissue. TAC requires laparoscopic or open abdominal surgery, cesarean birth, and the potential long-term effect are currently unknown. While the procedural aspects, indications, and pregnancy outcomes associated with TAC are subject to ongoing research, little is known about how women experience the decision to undergo a TAC and the pregnancy that follows. MATERIAL AND METHODS: We conducted a qualitative interview study with 12 Danish women who had undergone laparoscopic TAC. Participants were recruited through a national online support group. Interviews lasted 58-90 min. Data were analyzed thematically using Braun and Clarke's approach. RESULTS: Two overarching themes were identified. The first theme, What it takes, describes how the decision to undergo TAC was often considered self-evident and necessary in light of previous pregnancy losses. Thus, the decision-making was shaped by prior trauma and urgent hope, but also grounded in careful assessment of risks, benefits, and prior experiences. The women downplayed the potential drawbacks of TAC (cesarean birth, long-term complications) in favor of the chance to carry a healthy baby to term. The second theme, Feeling safe(-r), describes how the TAC offered reassurance and allowed the woman to be more active during pregnancy compared to previous pregnancy experiences. However, anxiety and emotional vulnerability persisted, rooted in prior losses. Trusting relationships with healthcare providers were described as essential to navigate worry and uncertainty during pregnancy. All women with a TAC pregnancy achieved a live birth. CONCLUSIONS: For the women who underwent TAC, the intervention represented hope, and the downsides were perceived to be outweighed by an increased probability of having a healthy baby. The findings highlight the importance of continuity in care and patient-centered counseling that addresses the clinical and emotional dimensions of TAC. Future research should explore long-term physical and psychological outcomes and develop supportive interventions to improve care for this high-risk population.
Effects of vaginal microbiota transfer on social-emotional and neurodevelopment in cesarean-born infants: 12-month follow-up of a pilot randomized clinical trial.
Zhou C, Zhou L, Liu H … +7 more , Tang L, Li M, Shang H, Krewski D, Wen SW, He Y, Xie RH
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42028884 · Full text
INTRODUCTION: To evaluate the effects of vaginal microbiota transfer (VMT) on social-emotional development and to assess whether neurodevelopmental benefits observed at 6 months persist at 12 months in cesarean-born infa...
INTRODUCTION: To evaluate the effects of vaginal microbiota transfer (VMT) on social-emotional development and to assess whether neurodevelopmental benefits observed at 6 months persist at 12 months in cesarean-born infants. MATERIAL AND METHODS: This 12-month follow-up study extended a prior randomized, placebo-controlled trial at a tertiary hospital in southern China. Cesarean-born infants were randomly assigned in a 1:1 ratio to receive maternal vaginal fluid (VMT group) or sterile saline-soaked gauze (Con group) immediately after delivery. Vaginally delivered mother-infant dyads served as a natural reference group (VD group). The primary endpoint of the original trial was infant neurodevelopment at 6 months. In this follow-up, social-emotion and neurodevelopment at 12 months were assessed using the Ages and Stages Questionnaires: Social-Emotional, Second Edition (ASQ:SE-2) and Third Edition (ASQ-3). Lower ASQ:SE-2 scores indicate better social-emotion skills, while higher ASQ-3 scores indicate better neurodevelopmental performance. This trial was registered with the Chinese Clinical Trial Registry, ChiCTR2000031326. RESULTS: A total of 210 mother-infant dyads were enrolled (VMT, Con, VD: n = 70 each) from December 10, 2020, to November 11, 2022. Infants in the VMT group had significantly lower ASQ:SE-2 total scores than those in the Con group (31.01% decrease; mean difference [MD]: -9.24; 95% confidence interval [95% CI]: -16.04 to -2.45), with improvements in self-regulation, social communication, and interaction with people. The VMT group also had higher ASQ-3 scores in the personal-social subdomain (MD: 4.65; 95% CI: 0.15 to 9.15), but no significant difference in total ASQ-3 scores (MD: 8.90; 95% CI, -2.9 to 20.70). No significant differences were found between the VMT and VD groups. The VMT group had a lower prevalence of social-emotional risk (adjusted RR: 0.39 [95% CI, 0.19 to 0.80]) than the Con group. CONCLUSIONS: This pilot randomized clinical trial suggests that VMT may be associated with improved social-emotional development at 12 months in cesarean-born infants, although the neurodevelopmental benefits observed earlier appear to diminish over time. Given the small sample size and exploratory nature, the findings should be interpreted with caution. Larger, multi-center randomized controlled trials with longer follow-up are needed to confirm these results and further evaluate the VMT's effectiveness.
Pelvic floor symptoms and quality of life 1 year postpartum in Swedish primiparous women-A follow-up of a randomized controlled trial.
Edqvist M, Häggsgård C, Teleman P … +7 more , Tegerstedt G, Ajne G, Ullén S, Tern H, Ängeby K, Dahlen HG, Rubertsson C
Acta Obstet Gynecol Scand · 2026 Jul · PMID 42027115 · Full text
INTRODUCTION: Long-term pelvic floor symptoms after childbirth may impair women's quality of life. The aim of this study was to assess the prevalence of self-reported pelvic floor symptoms 1 year postpartum in primiparou...
INTRODUCTION: Long-term pelvic floor symptoms after childbirth may impair women's quality of life. The aim of this study was to assess the prevalence of self-reported pelvic floor symptoms 1 year postpartum in primiparous women by degree of perineal tear, with a focus on minor and major second-degree tears, and their association with quality of life. MATERIAL AND METHODS: This prospective cohort study was based on data collected within a randomized controlled trial (the Oneplus trial). Women in the trial who had a vaginal birth and responded to a 1-year postpartum follow-up questionnaire were included. Data were collected between January 2020 and May 2021. The main outcome measures were pelvic floor symptoms assessed using the Pelvic Floor Distress Inventory (PFDI-20), the Pelvic Floor Impact Questionnaire (PFIQ-7), and study-specific items related to suturing and perceived body image. Associations between type of perineal tear and pelvic floor symptoms and their impact on quality of life were examined using generalized linear models, estimating adjusted risk ratios (aRRs) with 95% confidence intervals (CIs). TRIAL REGISTRATION: ClinicalTrials.gov, NCT03770962. RESULTS: The cohort consisted of 1911 primiparous women. Among the tear categories investigated, major second-degree tears were the most common (30.4%), followed by minor second-degree tears (18.4%), episiotomy (9.8%), and obstetric anal sphincter injury (OASI) (5.3%). PFD symptoms were reported by 31.4-51.5% of the women. Women with OASI had an increased risk of colorectal-anal distress compared with those with no tear or a first-degree tear (aRR 1.56, 95% CI 1.24-1.96). No associations were observed between minor or major second-degree tears and pelvic floor symptoms. Increasing tear severity was associated with a higher likelihood of perceiving the vagina as narrow. No differences between tear categories were observed regarding impact on quality of life. Episiotomy was associated with a negative body image related to vaginal symptoms (aRR 1.45, 95% CI 1.03-1.99). CONCLUSIONS: Pelvic floor symptoms and their impact on quality of life were common 1 year postpartum, irrespective of perineal tear category. Minor and major second-degree tears were not associated with an increased risk of pelvic floor dysfunction or reduced quality of life.
The freebirth debate: Respecting autonomy while reflecting on our own practices.
Gunnarsdóttir J, Hjartardóttir H
Acta Obstet Gynecol Scand · 2026 May · PMID 42017795 · Full text
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Fat reduction mediates the efficacy of intensive lifestyle interventions on fertility-sparing treatment in overweight patients with endometrial cancer and intraepithelial neoplasia.
Liu S, Li L, Wu P … +8 more , Wang L, Gama Q, Wang M, Zhang J, Jin L, Luo X, Shan W, Yang B
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42015911 · Full text
INTRODUCTION: Fertility-sparing treatment (FST) for endometrial cancer (EC), and its precursor, endometrial intraepithelial neoplasia (EIN), is gaining attention. However, being overweight impairs the therapeutic efficac...
INTRODUCTION: Fertility-sparing treatment (FST) for endometrial cancer (EC), and its precursor, endometrial intraepithelial neoplasia (EIN), is gaining attention. However, being overweight impairs the therapeutic efficacy of FST. We analyzed the association of intensive lifestyle intervention (ILI)-based weight management with clinical outcomes in overweight patients with EC/EIN undergoing FST. MATERIAL AND METHODS: This retrospective study at the Obstetrics & Gynecology Hospital of Fudan University included overweight patients with EC/EIN who received FST. Patients were categorized into the intervention group and the control group based on their weight management approach. The primary outcomes were the complete remission (CR) rate at 24 weeks and body composition changes, including weight, body fat mass (BFM), visceral fat area (VFA), and skeletal muscle mass (SMM); the secondary outcomes were the relapse rate, pregnancy rate, and live birth rate. Cox regression models were performed and hazard ratios (HR) with 95% confidence intervals (CI) were calculated. Mediation analysis was conducted and mediated effects with proportions were calculated. RESULTS: A total of 141 patients were retrospectively analyzed: 97 (68.8%) cases were in the intervention group undergoing ILIs and 44 (31.2%) cases were in the control group. The intervention group demonstrated significant reductions in weight (-4.2% vs. +1.5%), BFM (-8.3% vs. +3.6%), and VFA (-6.7% vs. +3.9%) (all p < 0.001). The 24-week CR rate was higher in the intervention group (44.3% vs. 25.0%, p = 0.026), with ILIs identified as an independent protective factor (HR 2.13, 95% CI 1.08-4.22, p = 0.030). A parabolic relationship was observed between weight change and CR rate (p-nonlinear = 0.038), peaking at a 3.0% weight reduction. Patients with BFM loss (48.5% vs. 28.8%, p = 0.047) or VFA loss (51.8% vs. 27.3%, p = 0.010) presented higher CR rates. Mediation analysis revealed that both VFA and BFM partially mediated the effects of ILIs (14.2% and 19.3% of the total effect). Among patients attempting natural pregnancy, the intervention group showed a strong trend toward a higher pregnancy rate (81.8% vs. 46.2%, p = 0.066). CONCLUSIONS: ILI-based weight management, particularly targeting fat reduction, is associated with enhanced FST efficacy in overweight EC/EIN patients. Our findings advocate the integration of body composition-guided ILIs into standardized FST protocols.
Further consideration of long-term outcomes, utilization decisions, and surgical technique could inform clinical guidelines for ultrasound guided uterine evacuation.
Dowthwaite S, Quinton A, Thomas S … +2 more , Schlub T, Clarke J
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42015849 · Full text
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Maternal smoking during pregnancy and gestational diabetes mellitus: Interactions and independent associations on pregnancy duration and perinatal outcomes.
Holopainen LS, Tähtinen HH, Gissler M … +2 more , Korhonen PE, Ekblad MO
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42011978 · Full text
INTRODUCTION: To examine the independent and joint associations of maternal smoking during pregnancy and gestational diabetes mellitus (GDM) on the risk of preterm birth and newborn perinatal complications in a large nat...
INTRODUCTION: To examine the independent and joint associations of maternal smoking during pregnancy and gestational diabetes mellitus (GDM) on the risk of preterm birth and newborn perinatal complications in a large national cohort of primiparous women, with an area of limited existing research. MATERIAL AND METHODS: This register-based cohort study included 318 783 singleton births among primiparous women in Finland (2004-2018), of which 290 602 were full-term. Data on GDM, smoking status, maternal characteristics, pregnancy duration, newborn hospitalization, and mortality were obtained from the Finnish Medical Birth Register. Associations were examined using linear, logistic, and Poisson regression. Interaction between GDM and maternal smoking was assessed on multiplicative and additive scales. RESULTS: GDM and continued smoking were independently associated with shorter pregnancy duration and an increased risk of newborn hospitalization beyond 1 week. Continued smoking also increased the risks of preterm birth and perinatal mortality. On the additive scale, combined exposure to GDM and maternal continued smoking produced higher absolute risks than expected from either exposure alone. Additive interaction was observed for preterm birth (RERI = 0.44, 95% CI: 0.16-0.67), gestational duration (RERI = 2.05 days, 95% CI: 1.07-3.04), and delayed hospital discharge (RERI = 0.36, 95% CI: 0.27-0.39). On the multiplicative scale, interaction was detected only for gestational duration (p = 0.008). CONCLUSION: Both GDM and maternal smoking contribute independently to adverse perinatal outcomes, but their combined exposure elevates absolute risks more than either factor alone, particularly for reduced gestational length, preterm birth, and delayed newborn discharge. These findings highlight the importance of addressing both smoking and GDM in prenatal care, even among generally low-risk primiparous women.
"And then I got strangled": Dangerous trends of sexual choking among young people.
Kero K, Lauerma H, Wahlsten P
Acta Obstet Gynecol Scand · 2026 Jun · PMID 42007644 · Full text
Sexual choking has become increasingly normalized among young people, largely driven by media, pornography, and peer norms. Although often framed as consensual, breath-control practices are physiologically unpredictable...
Sexual choking has become increasingly normalized among young people, largely driven by media, pornography, and peer norms. Although often framed as consensual, breath-control practices are physiologically unpredictable and can cause rapid loss of consciousness, brain injury, or even death within seconds. Once consciousness is lost, consent cannot be given or verified. Clinical and forensic experience in Finland indicates that choking is frequently reported in younger patients, yet national prevalence data are lacking. We argue that sexual choking is never medically safe, that clinicians should routinely ask about it, assess for injury, and provide clear risk counseling, and that medical ethics require engagement with harmful trends in patient care. Further research is needed to quantify prevalence and harms in Finland.
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