Acta Obstetricia Et Gynecologica Scandinavica[JOURNAL]
Sun
200 papers
Step-by-step combined surgical approach to successfully repair complex and challenging vesico-vaginal fistulas: Insights from a case series.
Arcieri M, Restaino S, Tius V … +10 more , Lombisani A, Arrigo D, Porto L, Panico G, Caramazza D, Vacca L, Campagna G, Martinelli C, Vizzielli G, Ercoli A
Acta Obstet Gynecol Scand · 2026 Jun · PMID 41992498 · Full text
INTRODUCTION: Several surgical approaches are available for the repair of complex vesico-vaginal fistulas; however, robust clinical evidence and standardization of techniques are lacking. Complex vesico-vaginal fistula i...
INTRODUCTION: Several surgical approaches are available for the repair of complex vesico-vaginal fistulas; however, robust clinical evidence and standardization of techniques are lacking. Complex vesico-vaginal fistula is defined as either a recurrent fistula following primary surgical repair or a fistula related to prior pelvic surgery and/or radiotherapy. The aim of this study was to describe a step-by-step combined vaginal and laparoscopic technique and to assess its feasibility, safety, and efficacy. MATERIAL AND METHODS: A retrospective study was performed between 2016 and 2023, involving patients diagnosed with complex vesico-vaginal fistulas. Clinical, perioperative, and postoperative data were collected. The surgical technique was standardized, described, and executed by an experienced surgeon in each case. Postoperative urogynecological follow-up was scheduled at one month, 3 months, 6 months, and one year. RESULTS: A total of 20 patients were included in the study. Fifteen patients developed vesico-vaginal fistulas after total hysterectomy, four after radical hysterectomy combined with radiotherapy, and one following a cesarean section. Four patients had a prior diagnosis of gynecological cancer, four had received pelvic radiotherapy, and two had undergone previous chemotherapy. Twenty-five percent of the patients exhibited VVF in the trigone area. The median operative time was 317 min (ranging from 250 to 508 min). One minor postoperative complication occurred, and there was no conversion to laparotomy. All repairs were watertight. The median length of hospital stay was 4 days (ranging from 2 to 6 days). No recurrences were observed during the follow-up period, lasting 42 months on average. CONCLUSIONS: This study demonstrated the feasibility and safety of a new surgical approach for repairing complex urogenital fistulas.
Estetrol-based combined oral contraceptives: A systematic review of clinical outcomes.
Råberg M, Vad IR, Axelsdóttir KH … +1 more , Løkkegaard ECL
Acta Obstet Gynecol Scand · 2026 Jun · PMID 41988925 · Full text
INTRODUCTION: Combined oral contraceptive pills (COCs) are a common contraceptive method among women of reproductive age. Ethinylestradiol (EE) is a frequently used estrogen component in COCs. However, EE may increase th...
INTRODUCTION: Combined oral contraceptive pills (COCs) are a common contraceptive method among women of reproductive age. Ethinylestradiol (EE) is a frequently used estrogen component in COCs. However, EE may increase the risk of cardiovascular complications by affecting coagulation, fibrinolysis, and blood pressure. Lowering the dose of EE to minimize the risk has been linked to disadvantageous bleeding patterns. The natural estrogen estetrol (E4) has been introduced as an alternative component to EE. E4 has been suggested to have beneficial effects on targeted tissue with a limited impact on the liver and coagulation, compared to EE-containing COCs, and thus, offers a potential for improving the safety of future COCs. This systematic review examines the safety and efficacy of COCs containing E4 compared to traditional COCs. MATERIAL AND METHODS: A systematic search was conducted in Embase and PubMed databases. Studies investigating the effects of COCs containing E4 in a study population of healthy women of reproductive age were included. All clinical outcomes related to contraceptive efficacy, bleeding patterns, mood and sexual health, endocrine and liver metabolism parameters, and markers for cardiovascular health were evaluated. Literature reviews, meta-analyses, and in vivo and animal studies were excluded. Retrieval and assessment of articles were performed in Covidence software following PRISMA guidelines and Cochrane risk of bias assessment tools. RESULTS: Fourteen studies were included in the review. Results indicate that E4-containing COCs offer a high contraceptive reliability, predictable menstrual cycles, and favorable bleeding patterns. E4-containing COCs effectively suppressed ovulation while allowing for rapid return of ovulation after discontinuation. Furthermore, E4-containing COCs present milder effects on coagulation factors and a more neutral impact on thrombin generation, suggesting a reduced risk for venous thromboembolisms. CONCLUSIONS: E4-containing COCs could potentially be a safer and more effective alternative to contraceptive use. The findings should be interpreted with caution, as study limitations such as design and confounder bias, small study populations, and short follow-up times characterize the studies included in this review. Further, industry sponsorship bias cannot be ruled out. Further independent research is needed to confirm long-term safety and applicability of E4-containing COCs across diverse populations.
Episiotomy is associated with a reduced risk of obstetric anal sphincter injury in nulliparous vacuum-assisted deliveries, particularly in high-risk cases.
Anteby M, Pinchas-Cohen T, Lavie A … +5 more , Maslovitz S, Gold R, Groutz A, Yogev Y, Baruch Y
Acta Obstet Gynecol Scand · 2026 Jul · PMID 41988908 · Full text
INTRODUCTION: Vacuum-assisted delivery is a major risk factor for obstetric anal sphincter injury (OASI), yet agreement is lacking on whether mediolateral episiotomy mitigates risk. The objective of this study was to eva...
INTRODUCTION: Vacuum-assisted delivery is a major risk factor for obstetric anal sphincter injury (OASI), yet agreement is lacking on whether mediolateral episiotomy mitigates risk. The objective of this study was to evaluate whether episiotomy during vacuum-assisted delivery in nulliparous women affects the risk of OASI and to identify subgroups who may benefit from it. MATERIAL AND METHODS: A retrospective cohort study including all nulliparous singleton pregnancies delivered by vacuum-assisted delivery at a tertiary center (January 2011-December 2022). Twin deliveries and multiparous women were excluded. Mediolateral episiotomy was performed according to the physician's preference and clinical judgment. The primary outcome was the risk of OASI. The diagnosis of OASI was based on a clinical assessment immediately after delivery. Multivariable logistic regression was used to assess the association between mediolateral episiotomy and OASI while adjusting for potential confounders: maternal age, prepregnancy BMI, gestational age, prolonged second stage, occiput posterior, and epidural analgesia. RESULTS: Among 7951 vacuum-assisted deliveries, 7201 (90.6%) had an episiotomy and 750 (9.4%) did not. The groups were similar, though episiotomy cases more often had a prolonged second stage (32.0% vs 25.9%, p = 0.001), occiput posterior (12.7% vs 9.6%, p = 0.03), and birthweight ≥3500 g (25.4% vs 21.7%, p = 0.03). OASI occurred twice as often without episiotomy (2.8% vs 1.4%, p = 0.01). After adjustment, episiotomy remained (adjusted odds ratio 0.42, 95% CI 0.25-0.70). The number needed to treat (NNT) with episiotomy to prevent one OASI was 64 overall, and was lower in the presence of intrapartum risk factors: 16 with prolonged second stage, 33 with occiput posterior, and 27 when birthweight exceeded 3500 g. Postpartum hemorrhage requiring transfusion occurred more frequently with episiotomy (3.9% vs 1.5%; p = 0.001), corresponding to a number needed to harm (NNH) of 43. Neonatal outcomes did not differ significantly. CONCLUSIONS: In nulliparous women, mediolateral episiotomy during vacuum-assisted delivery was associated with a 50% reduction in OASI. The preventive effect of mediolateral episiotomy was greater when multiple intrapartum risk factors were present.
The Manchester procedure: A systematic review of recurrence, perioperative measures, and financial cost, and a scoping review of sexual dysfunction, gynecologic cancer, and obstetric outcomes.
Elissaoui S, Issaoui ME, Klarskov N … +1 more , Husby K
Acta Obstet Gynecol Scand · 2026 Jul · PMID 41969167 · Full text
INTRODUCTION: The Manchester procedure (MP) is increasingly used to treat uterine prolapse. This combined systematic and scoping review aims to comprehensively evaluate clinical outcomes of the MP in comparison with othe...
INTRODUCTION: The Manchester procedure (MP) is increasingly used to treat uterine prolapse. This combined systematic and scoping review aims to comprehensively evaluate clinical outcomes of the MP in comparison with other surgical techniques for uterine prolapse. MATERIAL AND METHODS: PRISMA guidelines were applied for the systematic part of the review and PRISMA-ScR guidelines for the scoping part. PubMed and Embase were searched up to September 30, 2024. The study population comprised women >18 years undergoing MP or other surgical treatments for uterine prolapse. The primary outcome was recurrence of pelvic organ prolapse defined as anatomical or subjective recurrence or reoperation. Secondary outcomes were surgical and operative complications, operative outcome, lower urinary tract symptoms, sexual dysfunction, quality of life and satisfaction, gynecological cancer, obstetric outcome, and financial costs. Data collection was carried out as per PRISMA and PRISMA-ScR guidelines. Quality of the randomized clinical trials was assessed by the Cochrane risk of bias tool and non-randomized studies were assessed using the Newcastle-Ottawa Scale. PROSPERO (no.: CRD42024551520). RESULTS: A total of 19 articles were included: 11 were eligible for the systematic review and 11 for the scoping review, with three articles overlapping. Large cohort studies and one randomized controlled trial demonstrated lower risks of prolapse recurrence and reoperation following the MP compared with alternative surgical approaches. Blood loss, organ injury, and overall surgical complication rates were low across all procedures. Operative time and length of hospital stay were shorter after the MP than after vaginal hysterectomy and comparable to sacrospinous hysteropexy. Cost analyses showed significantly lower costs associated with the MP. Sexual function and dyspareunia outcomes were generally comparable between procedures. Cervical stenosis and risk of cancer after MP is low, with no evidence of increased gynecological cancer incidence or worse prognosis compared with anterior colporrhaphy for cystocele. Due to limited and concerning data on pregnancy outcomes, the MP should be reserved for women who have completed childbearing. CONCLUSION: Despite limited high-quality evidence, the existing literature supports the MP as a clinically effective and cost-efficient uterus-preserving surgical option for uterine prolapse.
Prediction of preterm birth using 3D volume cesarean scar morphology in pregnant women with previous advanced labor cesarean delivery.
Ivan M, Banerjee A, Pazukhina E … +6 more , UCLH Preterm Birth Clinic Research Group, Blyuss O, Zaikin A, Jurkovic D, David A, Napolitano R
Acta Obstet Gynecol Scand · 2026 Jun · PMID 41964133 · Full text
INTRODUCTION: This study aimed to develop a multiparameter predictive model for spontaneous preterm birth in pregnant women with a history of advanced labor cesarean delivery, using cesarean scar ultrasound characteristi...
INTRODUCTION: This study aimed to develop a multiparameter predictive model for spontaneous preterm birth in pregnant women with a history of advanced labor cesarean delivery, using cesarean scar ultrasound characteristics. MATERIAL AND METHODS: This prospective observational cohort study included pregnant women with a history of advanced labor cesarean delivery (≥8 cm cervical dilatation) at University College London Hospitals (August 2019-August 2023). Participants underwent transvaginal ultrasound using validated protocols for cesarean scar evaluation. Measurements included scar distance to the internal os, niche dimensions (length, depth, and width), residual and adjacent myometrial thickness, and 3D niche and cervical volumes. Predictive models for spontaneous preterm birth and short cervical length ≤25 mm were developed using multivariable logistic regression, adjusting for potential confounders. RESULTS: During the surveillance period, 12.6% (21/166) of women developed a short cervix, and 23.5% (39/166) received preterm birth prophylactic interventions. Spontaneous preterm birth rate was 7.8% (13/166) <37 weeks and 4.8% (8/166) <34 weeks. The cesarean scar was visualized in 89.8% (149/166), with a niche identified in 48.3% (72/149) of women. Scars positioned at or caudal to the internal cervical os were associated with significantly higher risks of short cervix and/or spontaneous preterm birth compared to scars cranial to the internal os (aOR 5.26, 95% CI 1.59, 17.32, p = 0.006; aOR 5.00, 95% CI 1.10, 22.78, p = 0.037, respectively). Traditional predictive models based on cervical length and obstetric history demonstrated modest performance. Scar distance to the internal os consistently emerged as the strongest independent predictor of short cervix across all models (p < 0.001-0.005). Models incorporating 3D ultrasound scar parameters improved predictive accuracy, with the final model achieving AUC 0.91 (95% CI 0.81, 0.98) and 91% (95% CI 0.73, 1.00) sensitivity at FPR of 25% for spontaneous preterm birth. For short cervix prediction, the AUC was 0.89 (95% CI 0.80, 0.96), at 88% (95% CI 0.62, 1.00) sensitivity for the same FPR. CONCLUSIONS: 3D transvaginal ultrasound assessment of cesarean scar morphology was associated with improved prediction of spontaneous preterm birth in pregnant women with a history of advanced labor cesarean delivery; however, scar position relative to the internal os remained the strongest individual predictor.
Perinatal and long-term implications of diagnosing gestational diabetes mellitus using only fasting and one-hour post-load glucose concentrations: Secondary analysis of the GEMS trial and its five-year follow-up.
Liu Q, Harding JE, Gamble GD … +3 more , Eagleton C, Dawes L, Crowther CA
Acta Obstet Gynecol Scand · 2026 Jun · PMID 41958348 · Full text
INTRODUCTION: The proposed revised diagnostic criteria for gestational diabetes (GDM) in New Zealand include a fasting plasma glucose (FPG) concentration ≥5.3 mmol/L and 1-h post-load glucose (PLG) concentration ≥10.6 mm...
INTRODUCTION: The proposed revised diagnostic criteria for gestational diabetes (GDM) in New Zealand include a fasting plasma glucose (FPG) concentration ≥5.3 mmol/L and 1-h post-load glucose (PLG) concentration ≥10.6 mmol/L on a 75 g oral glucose tolerance test (OGTT), but no 2-h PLG. This study evaluates the impact of GDM diagnosis based on FPG and/or 1-h PLG abnormalities on perinatal and long-term outcomes. MATERIAL AND METHODS: This secondary analysis of data from GEMS, a multicentre, randomized trial and its follow-up, included women and their children who met the proposed revised GDM criteria and received treatment. Participants were classified into three groups: (1) both group: elevated FPG and 1-h PLG, (2) fasting group: elevated FPG alone, and (3) one-hour group: elevated 1-h PLG alone. Between-group pairwise comparisons were made using log-binomial and normal-identity regressions. RESULTS: Of 217 eligible women-child pairs, 85 (39.2%) were in the fasting group, 61 (28.1%) in the both group, and 71 (32.7%) in the one-hour group. Women in the fasting and both groups, compared with the one-hour group, were more likely to be overweight or obese both at the first antenatal visit and five-year follow-up, more likely to have required pharmacotherapy for GDM (85.9% and 88.5% vs. 69.0%; p < 0.0001), and had higher rates of type 2 diabetes/prediabetes at 5 years (50.0% and 48.8% vs. 28.3%; p = 0.03). Their infants were born earlier (38.1 and 38.0 vs. 38.6 weeks; p = 0.02) with higher birthweight z-scores (0.2 and 0.1 vs. -0.2; p = 0.03). Infants in the fasting group, compared with infants in the one-hour group, had higher rates of being large-for-gestational age and neonatal intensive care unit admission. At 5 years, children in the fasting group, compared with those in the one-hour group, had higher mean z-scores in weight and height, and were more likely to have an abnormal developmental screening questionnaire score (24.4% vs. 5.1%; p = 0.04). CONCLUSIONS: Women diagnosed with GDM based on an elevated FPG, compared with those with only an elevated 1-h PLG, may have had increased diabetes risks at five-year follow-up, while their children may have greater infant health risks and greater growth at 5 years.
Intrapartum CTG characteristics associated with isolated single umbilical artery in term fetuses: A matched case-control study.
Berben PBQ, de Vries IR, Vullings R … +3 more , van der Hout-van der Jagt MB, Oei SG, van Laar JOEH
Acta Obstet Gynecol Scand · 2026 May · PMID 41954049 · Full text
INTRODUCTION: Isolated single umbilical artery (iSUA) is associated with a fivefold increased risk for perinatal mortality, even though placental blood flow is not reduced compared to healthy fetuses. In recent work, the...
INTRODUCTION: Isolated single umbilical artery (iSUA) is associated with a fivefold increased risk for perinatal mortality, even though placental blood flow is not reduced compared to healthy fetuses. In recent work, the umbilical cord was shown to have a protective effect against intrapartum fetal acidosis, which is reduced in the case of relevant cord anomalies like iSUA. This study aimed to investigate the protective effect of the umbilical cord against fetal acidosis by comparing cardiotocogram (CTG) characteristics of fetuses with iSUA against controls. MATERIAL AND METHODS: In this retrospective, matched case-control study in a tertiary care center in the Netherlands, computerized CTG analyses were performed on intrapartum registrations for 9 iSUA patients and 35 case-matched controls. CTGs were analyzed for stages of hypoxia classification, CTG characteristics of fetal heart rate such as baseline, variability, (late) decelerations, overshoots, FHR recovery duration, and characteristics of uterine contractions. Linear regression analyses were performed for the CTG parameters, adjusted for uterine contraction frequency and average inter-contraction duration. Neonatal outcome parameters were compared between the iSUA group and healthy controls. RESULTS: The prevalence of decelerations followed by an overshoot was two to three times higher in the iSUA group (p = 0.011 for stage 1 and p = 0.001 for stage 2 of labor) and a longer average fetal heart rate recovery duration for stage 1 of labor was found as well (p = 0.001). Furthermore, iSUA was found to have a higher prevalence of late decelerations in stage 1 (p = 0.042) and shorter decelerations (p = 0.046) along with less decelerations exceeding 1 min (p = 0.017) during stage 2. No differences in hypoxia staging or the presence of saltatory patterns were found. Neonatal outcomes indicative of birth asphyxia did not occur in the study population. CONCLUSIONS: These findings support epidemiological findings that term fetuses with iSUA are more susceptible to hypoxia, warranting further research into tailored management strategies.
Subsequent pregnancies after a diagnosis of pregnancy-associated cancer.
Esposito G, Peccatori FA, Franchi M … +5 more , Trojano G, Corrao G, La Vecchia C, Parazzini F, Cantarutti A
Acta Obstet Gynecol Scand · 2026 Jun · PMID 41952355 · Full text
INTRODUCTION: Pregnancy-associated cancer is a rare but clinically significant event. Decisions regarding subsequent pregnancies after such a diagnosis are complex and influenced by medical, psychological, and social fac...
INTRODUCTION: Pregnancy-associated cancer is a rare but clinically significant event. Decisions regarding subsequent pregnancies after such a diagnosis are complex and influenced by medical, psychological, and social factors. This study aimed to investigate the probability of having a subsequent pregnancy following a diagnosis of a pregnancy-associated cancer. MATERIAL AND METHODS: We conducted a record-linkage cohort study using the regional health databases of Lombardy, including the hospital discharge records and the certificate of delivery assistance. Pregnancies were deliveries and abortions occurring between 1 January 2007 and 31 December 2017. Pregnancy-associated cancer was defined as any malignant neoplasm first diagnosed during pregnancy or within 1 year after the end of pregnancy, identified through hospital admissions carrying a new cancer diagnosis. To ascertain subsequent pregnancies after a diagnosis of pregnancy-associated cancer, we tracked deliveries and abortions through 31 December 2023. We estimated the incidence of pregnancy-associated cancer per 1000 pregnancies with the corresponding 95% confidence intervals (CIs) and calculated the cumulative probability of a post-diagnosis pregnancy using the cumulative incidence function that accounts for the competing risk of death. RESULTS: A total of 832 incident pregnancy-associated cancers were recorded among deliveries and 325 among abortions, corresponding to incidence rates of 1.12 per 1000 deliveries (95% CI, 1.04-1.19) and 1.27 per 1000 abortions (95% CI, 1.13-1.41). Breast cancer was the most frequent diagnosis in both groups (31% among deliveries, 40% among abortions), followed by thyroid cancer; the third most common site was lymphoma among deliveries and cervical cancer among abortions. During follow-up, 77 women had a subsequent pregnancy (59 deliveries, 18 abortions), yielding a cumulative probability of 7.3%. Stratified by age at diagnosis, women under 35 had a substantially higher probability of subsequent pregnancy compared to women aged 35 or older (14.0% vs. 3.5%, p < 0.01). Furthermore, the cumulative probability of subsequent pregnancy was lower among women treated with antineoplastic therapy than among those who were not treated (4.3% vs. 10.1%, p < 0.01). CONCLUSIONS: Subsequent pregnancies following a pregnancy-associated cancer diagnosis were relatively uncommon, highlighting the need for integrated reproductive counseling within a multidisciplinary approach.
Is colorectal resection necessary to improve pain and fertility outcomes in patients with deep endometriosis?
Hudelist G, Bastu E, Bokor A … +2 more , Basta P, Darici E
Acta Obstet Gynecol Scand · 2026 Jun · PMID 41952314 · Full text
Bowel endometriosis is often considered an indication for extensive surgical management, including colorectal resection, in women undergoing surgery for concomitant endometriosis at other sites. However, several contempo...
Bowel endometriosis is often considered an indication for extensive surgical management, including colorectal resection, in women undergoing surgery for concomitant endometriosis at other sites. However, several contemporary studies show little or no correlation between the anatomical extent of bowel endometriosis and symptom severity, and current data do not support a direct relationship between bowel disease extent and fertility impairment. Furthermore, the evidence supporting an additional benefit of colorectal resection with respect to pain relief and fertility outcomes remains limited in patients undergoing surgery for deep endometriosis and/or peritoneal and ovarian endometriosis. Notably, when applying strict methodological criteria, only a single comparative cohort evaluated outcomes in women with colorectal endometriosis undergoing surgery with versus without colorectal resection. This cohort did not demonstrate superior pain or fertility outcomes associated with bowel resection. Considering the well-known potential of severe complications of colorectal surgery, these findings challenge the assumption that anatomical completeness equates to clinical benefit. Given the sparse evidence demonstrating a clear proven clinical benefit of adding bowel surgery to surgical removal of endometriosis at other sites, a critical re-evaluation of surgical proportionality is warranted. Robust comparative studies are urgently needed to justify systematic colorectal resection in bowel endometriosis.
Women with PCOS have a later menopausal transition and a lower prevalence of menopausal symptoms at age 46: A population-based birth cohort study.
Lavi J, Savukoski S, Hurskainen E … +4 more , Ollila MM, Morin-Papunen L, Niinimäki M, Piltonen TT
Acta Obstet Gynecol Scand · 2026 May · PMID 41949217 · Full text
INTRODUCTION: Women with polycystic ovary syndrome (PCOS) have been suggested to experience later menopause, yet population-based studies are lacking. The present study aimed to assess, in a population-based birth cohort...
INTRODUCTION: Women with polycystic ovary syndrome (PCOS) have been suggested to experience later menopause, yet population-based studies are lacking. The present study aimed to assess, in a population-based birth cohort, whether women with PCOS are more likely to experience late peri-/postmenopause or to have menopausal symptoms in their mid-40s than women without the syndrome. MATERIAL AND METHODS: The present study is a long-term, population-based prospective cohort study from the Northern Finland Birth Cohort 1966 (NFBC1966). The PCOS group (n = 380) was identified based on the Rotterdam criteria (oligomenorrhea, hyperandrogenism, or polycystic ovarian morphology according to anti-Müllerian hormone levels). Women who did not meet the Rotterdam criteria for PCOS were considered as controls (n = 1469). Late peri-/postmenopause was defined as at least 60 days of amenorrhea accompanied by elevated follicle-stimulating hormone levels (>25 IU/L) or the use of menopausal hormone therapy. In women who had undergone hysterectomy or were using progestins, menopausal status was defined as elevated follicle-stimulating hormone levels (>25 IU/L). Menopausal symptoms were self-reported via questionnaire during a follow-up visit at age 46. RESULTS: Women with PCOS had a significantly lower likelihood of being late peri-/postmenopausal in their mid-40s compared with controls (PCOS: 3.1% vs. Controls: 18.4%; adjusted odds ratio 0.15, 95% confidence interval 0.07-0.32). To support this result, women with PCOS more often reported having regular menstrual cycles and had a lower risk of menopausal symptoms at age 46, even after adjusting for body mass index, education, and smoking status (adjusted odds ratio 0.68, 95% confidence interval 0.51-0.92). Hot flashes and sleep disturbances were less frequent among women with PCOS, but there were no differences in other menopause-related symptoms, such as vaginal dryness, affective symptoms, memory disturbances, or sexual dysfunction between the study groups. CONCLUSIONS: From the nonselective population data, it was shown that late peri-/postmenopausal status and symptoms were less frequent in women with PCOS at age 46, supporting the idea of prolonged ovarian function in affected women. This should be considered in patient counseling and future studies of fertility, contraception, and menopausal hormone therapy.
Female pelvic floor protection-Where do we have to go?
Deniz M, Wirth L, Beilecke K … +2 more , Tunn R, Huebner M
Acta Obstet Gynecol Scand · 2026 Jul · PMID 41949181 · Full text
Pelvic floor protection has a growing awareness and importance in long lasting strategies to provide female pelvic floor health. This state-of-the-art review article aims to summarize important future directions in this...
Pelvic floor protection has a growing awareness and importance in long lasting strategies to provide female pelvic floor health. This state-of-the-art review article aims to summarize important future directions in this area. A literature search has been conducted within the last 20 years with pelvic floor protection-specific search terms. Four major work packages have been identified. (1) Epidemiology and risk stratification. (2) Mechanistic and translational research. (3) Diagnostic and preventive strategies. (4) Implementation and knowledge translation. A systematic literature search was performed and after assessing inclusion criteria and quality on expert opinion, 82 out of 1636 articles were included. The alignment for future research has been part of the analysis as well as ways of how to implement evidence based information to a day-to-day clinical routine.
1 g/h magnesium sulfate maintenance for eclampsia prevention is enough.
Petrecca A, Bina B, Ghi T … +1 more , Berghella V
Acta Obstet Gynecol Scand · 2026 May · PMID 41949178 · Full text
We conducted two systematic reviews including only randomized controlled trials (RCTs) comparing magnesium sulfate vs placebo/no treatment, as well as 2 g/h vs 1 g/h magnesium sulfate maintenance regimens for prevention...
We conducted two systematic reviews including only randomized controlled trials (RCTs) comparing magnesium sulfate vs placebo/no treatment, as well as 2 g/h vs 1 g/h magnesium sulfate maintenance regimens for prevention of eclampsia. Medline, Cochrane Library, EMBASE, PubMed Central, Scopus, ClinicalTrial.gov were electronically searched from their inception to February 2025. In the five RCTs comparing magnesium sulfate vs placebo/no treatment, a 2-g maintenance dose was used in two RCTs including 176 pregnancies, while a 1 g maintenance dose was used in three RCTs including 5447 pregnancies. Eclampsia incidence was 0.57% with the 2 g/h regimen and 0.76% with the 1 g/h regimen (OR 1.33, 95% CI: 0.18-9.60), while maternal side effects were significantly higher in the 2 g/h regimen (67% vs 22%, OR 7.05, 95% CI: 4.22-11.78). In the five RCTs (n = 283) comparing 2 g/h vs 1 g/h maintenance regimens, no case of eclampsia was reported with either regimen, and maternal side effects were significantly higher in the 2 g/h group (71% vs 42%, OR 1.69, 95% CI: 1.06-2.71). In conclusion, magnesium sulfate maintenance regimen of 1 g/h seems as effective as the 2 g/h regimen for the prevention of eclampsia, with decreased incidence of maternal side effects.
Preoperative risk factors and their cumulative impact on nonsatisfaction after benign hysterectomy: A population-based nation-wide register study.
Makdessi Björkström L, Fredrikson M, Borendal Wodlin N … +3 more , Nilsson L, Borgfeldt C, Kjølhede P
Acta Obstet Gynecol Scand · 2026 May · PMID 41949176 · Full text
INTRODUCTION: This study aimed to determine preoperative risk factors for nonsatisfaction 1 year after hysterectomy for benign indication and to analyze whether multiple co-occurring preoperative risk factors increase th...
INTRODUCTION: This study aimed to determine preoperative risk factors for nonsatisfaction 1 year after hysterectomy for benign indication and to analyze whether multiple co-occurring preoperative risk factors increase the rate of nonsatisfaction. MATERIAL AND METHODS: A historical register study was conducted using data from the Swedish National Register for Gynecological Surgery of women aged 18-56 years, who underwent hysterectomy for benign conditions between 2004 and 2023. Satisfaction 1 year postoperatively was dichotomized into satisfaction or nonsatisfaction. Multiple logistic regression was used to evaluate preoperative risk factors, with results presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Nagelkerke's coefficient of determination (R) assessed the explanatory power of the models. RESULTS: Among the 38 044 participating women, 3335 (8.8%) were not satisfied after 1 year. Preoperative risk factors for nonsatisfaction were smoking (aOR 1.34, 95% CI: 1.18-1.53), not being gainfully employed (aOR 1.60, 95% CI: 1.40-1.82), and the main symptoms leading to hysterectomy (pain (aOR 1.91, 95% CI: 1.70-2.15), pressure/heaviness (aOR 1.90, 95% CI: 1.53-2.21), other symptoms (aOR 2.24, 95% CI: 1.95-2.59), or several main symptoms (aOR 1.92, 95% CI: 1.53-2.41)). Protective factors for nonsatisfaction were age 46-50 years (aOR 0.87, 95% CI: 0.76-1.00) and minimally invasive hysterectomy (vaginal [aOR 0.69, 95% CI: 0.59-0.81], laparoscopic [aOR 0.79, 95% CI: 0.68-0.91], and robot-assisted laparoscopic [aOR 0.82, 95% CI: 0.71-0.95]). The likelihood of being nonsatisfied rose with the accumulation of preoperative risk factors, as reflected by the full model's explanatory power (R = 0.141). Among individual predictors, the main symptom leading to hysterectomy contributed most to the explained variance (R = 0.029), followed by employment status (R = 0.009), while other factors, such as surgical route, age, and smoking only marginally contributed to the variance. CONCLUSIONS: Nearly, 9% of the women were nonsatisfied with the outcome of the hysterectomy after 1 year. Lack of satisfaction appeared predictable from preoperative factors, notably smoking, not being gainfully employed, and nonbleeding symptoms leading to hysterectomy. These findings emphasize the need for individualized counseling before surgery. Given that most preoperative risk factors are resistant to immediate modification, more research is needed to develop targeted interventions that can reduce nonsatisfaction and enhance patient outcomes.
Pregnancies in women with rare diseases: Selected maternal and perinatal outcomes.
Kosian P, Niederhöfer K, Jost E … +4 more , Gembruch U, Bender T, Grigull L, Merz WM
Acta Obstet Gynecol Scand · 2026 Jun · PMID 41949150 · Full text
INTRODUCTION: Rare diseases (RD) are characterized by chronicity and may be associated with reduced life expectancy and quality of life. Case series and reports regarding pregnancies in individuals with specific RD exist...
INTRODUCTION: Rare diseases (RD) are characterized by chronicity and may be associated with reduced life expectancy and quality of life. Case series and reports regarding pregnancies in individuals with specific RD exist, but there is no data on the outcome of pregnancies in the overall group. MATERIAL AND METHODS: A retrospective analysis was conducted of all pregnancies in women with RD who were managed at our center between January 2018 and July 2022. Maternal, fetal, and obstetric parameters were recorded. RESULTS: During the study period, 388 pregnant women with 434 RD were managed. Of these, 11.9% had more than one RD. The breakdown of conditions was as follows: 50.7% acquired diseases, 21% congenital diseases excluding malformations, 17.5% malformations, and 10.8% tumors. Disease-specific complications occurred in 23.2% of women, and pregnancy-specific complications in 25.1% of live births. Women with preconception stability experienced significantly fewer complications. The cesarean section rate was 50.6%. Preterm birth occurred in 15.3% of cases, and 20.4% of newborns required admission to the neonatal intensive care unit. CONCLUSIONS: Women with RD experience a high rate of disease-specific and pregnancy complications. Preconception stability is a key factor for an uncomplicated course of pregnancy and birth.
Real-world evaluation of a population-based vaginal self-sampling program for cervical cancer prevention in Region Skåne, Sweden.
Hellsten C, Forslund O, Borgfeldt C
Acta Obstet Gynecol Scand · 2026 Jun · PMID 41949117 · Full text
INTRODUCTION: Cervical cancer represents a significant public health challenge worldwide. To improve screening accessibility and participation, we implemented vaginal human papilloma virus (HPV) self-sampling as part of...
INTRODUCTION: Cervical cancer represents a significant public health challenge worldwide. To improve screening accessibility and participation, we implemented vaginal human papilloma virus (HPV) self-sampling as part of an organized cervical cancer prevention strategy. This study aimed to evaluate the implementation and outcomes of the self-sampling program in a real-world setting. MATERIAL AND METHODS: Between September 1, 2021 and December 31, 2024, a total of 557 976 vaginal self-sampling kits were distributed. Follow-up with cervical sampling continued through April 2025. Data were collected using the Laboratory Information Management System (LIMS) and the Melior Journal system. RESULTS: Of the distributed kits, 208 386 were returned, yielding an adherence rate of 37% (208 386/557 976). Among the valid samples, 19% (39 697/204 763) tested positive for HPV. Follow-up adherence among HPV-positive women was 81% (32 305/39 697), defined as attendance at follow-up clinics by the end of the fourth subsequent calendar month. Cervical samples were HPV-positive in 39% (12 495/32 305) and HPV16 or HPV18/45 were detected in 2157 cases (17%). Cytological analysis identified high-grade cervical dysplasia in 759 women (6.1%, 759/12 505) and histopathology confirmed its presence in 980 cases (13%, 980/7641). Cervical cancer was diagnosed in 32 cervical biopsies (0.4%, 32/7647). CONCLUSIONS: The vaginal self-sampling program was effective in detecting HPV. Its capacity to identify HPV types and significant cytological abnormalities underscores its potential for facilitating early detection, enhancing screening coverage and timely clinical intervention, thereby reducing the incidence of cervical cancer.
Predictive value of alcohol use questionnaires for adverse pregnancy outcomes: Evidence from a Finnish birth cohort.
Nuttunen P, Purmonen T, Ålander U … +2 more , Kärkkäinen O, Keski-Nisula L
Acta Obstet Gynecol Scand · 2026 Jun · PMID 41949076 · Full text
INTRODUCTION: Prenatal alcohol exposure is associated with preterm birth (PTB) and impaired fetal growth, but identification of risky alcohol use during pregnancy remains challenging. Brief self-report screening tools ar...
INTRODUCTION: Prenatal alcohol exposure is associated with preterm birth (PTB) and impaired fetal growth, but identification of risky alcohol use during pregnancy remains challenging. Brief self-report screening tools are widely used, highlighting the need to evaluate Alcohol Use Disorders Identification Test (AUDIT)-based measures in pregnancy. We assessed the ability of the full AUDIT, its abbreviated versions (AUDIT-C and AUDIT-4), and selected items to identify women at increased risk of PTB and small for gestational age (SGA) in the Kuopio Birth Cohort (KuBiCo) and to detect hazardous alcohol use. MATERIAL AND METHODS: In this population-based cohort study, 7141 singleton pregnancies in KuBiCo between 2012 and 2023 were analyzed. Pregnancies with delivery at ≥22 + 0 gestational weeks and completion of an electronic AUDIT questionnaire during the first trimester were included. Birth outcomes (SGA and PTB) were obtained from the birth register. Associations between pre-pregnancy alcohol use and adverse birth outcomes were analyzed using logistic regression to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Predictive performance of the full and abbreviated AUDIT measures and selected items for hazardous alcohol use (AUDIT ≥6) was evaluated using receiver operating characteristic analysis with area under the curve and optimal cut-offs based on Youden's index. RESULTS: Alcohol use in the year before pregnancy was primarily captured by AUDIT items assessing drinking frequency and typical quantity. Using established thresholds, alcohol use defined by the AUDIT (≥6) and AUDIT-4 (≥5) was associated with an increased risk of PTB (aOR 1.43; 95% CI 1.05-1.95 and aOR 1.42; 95% CI 1.04-1.95, respectively). Heavy episodic drinking, identified by AUDIT item 3 (score ≥2), was associated with an increased risk of SGA, whereas concern expressed by others about drinking (AUDIT item 10 ≥2) was associated with PTB. For hazardous alcohol use, AUDIT-4 and AUDIT-C demonstrated excellent discrimination, with an optimal cut-off of ≥4. CONCLUSIONS: Abbreviated versions of the AUDIT, particularly AUDIT-4, appear comparable to the full AUDIT for identifying risky alcohol use and PTB risk. Women reporting recurrent heavy episodic drinking may benefit from targeted counseling before and during pregnancy.
Understanding the consequences of being RhD immunized during pregnancy 10 years after introduction of targeted routine antenatal anti-D prophylaxis: A retrospective nationwide cohort study.
Parhamaa A, Jernman R, Gissler M … +6 more , Haimila K, Sareneva I, Sulin K, Teivaanmäki T, Toivonen S, Sainio S
Acta Obstet Gynecol Scand · 2026 May · PMID 41949075 · Full text
INTRODUCTION: Targeted routine antenatal anti-D prophylaxis (RAADP) was introduced in Finland in 2014. The aim of this study was to assess the prevalence of anti-D immunizations among pregnant women and the severity of h...
INTRODUCTION: Targeted routine antenatal anti-D prophylaxis (RAADP) was introduced in Finland in 2014. The aim of this study was to assess the prevalence of anti-D immunizations among pregnant women and the severity of hemolytic disease of the fetus and newborn (HDFN) in affected pregnancies 10 years after RAADP was added to the national prevention program in the context of a rapidly declining birthrate in Finland. MATERIAL AND METHODS: A nationwide, retrospective cohort study included all RhD-negative pregnancies in Finland between 2014 and 2023. Information on antenatal screening was obtained from the Finnish Red Cross Blood Service database, and obstetric and neonatal data from hospitals' records. Primary outcomes were prevalence of anti-D immunization and severity of HDFN defined as severe (intrauterine transfusion, IUT), moderate (neonatal exchange transfusion/intravenous immunoglobulin, IVIG/top-up transfusion), and mild (phototherapy). The secondary outcome was the effect of declining birth rates on the absolute numbers of anti-D pregnancies. RESULTS: The study included a total of 518 pregnancies of 383 women with anti-D (367 pregnancies with RhD-positive fetus/neonate). In 10 years, the prevalence of anti-D among RhD-negative pregnant women declined from 1.33% to 0.48% (reduction of 64%), and of severe HDFN from 0.20% to 0.06% (reduction of 72%). For an RhD-positive fetus, the risk of severe HDFN was 17.7% (95% CI 13.9% to 22.0%), with an overall survival rate of 90.8%. For a RhD-positive neonate not treated with IUTs, the risks of moderate and mild HDFN were each 33.0% (95% CI 24.4% to 42.6%). In addition to the effect of RAADP, the actual number of anti-D cases decreased by 34.0% due to the 24% fall in the birth rate during the study period. CONCLUSIONS: Ten years after the introduction of targeted RAADP, the prevalence of anti-D immunizations was reduced by more than half. Declining birth rates further reduce overall case numbers but do not lessen the complexity of care needed. A significant proportion of anti-D pregnancies still require close monitoring or intervention. Optimizing screening strategies, referral pathways, and readiness for neonatal treatment remains essential in the evolving landscape of HDFN prevention and management.
Normative range for MRI amniotic fluid volume from 16 to 36 gestational weeks: Absolute and relative values, and correlation to ultrasound.
Bouachba A, Chabourlin J, Grévent D … +5 more , Neves JJ, Bussières L, Vaillant S, Salomon LJ, Gorincour G
Acta Obstet Gynecol Scand · 2026 May · PMID 41949001 · Full text
INTRODUCTION: Amniotic fluid volume (AFV) is clinically important, yet ultrasound-based indices correlate poorly with true volume. MRI provides accurate volumetry, but normative reference data for AFV remain scarce. This...
INTRODUCTION: Amniotic fluid volume (AFV) is clinically important, yet ultrasound-based indices correlate poorly with true volume. MRI provides accurate volumetry, but normative reference data for AFV remain scarce. This study aimed to establish MRI-based gestational-age reference ranges for AFV and the AFV-to-fetal body volume ratio (AFV/FBV) from 16 to 36 weeks' gestation and to compare ultrasound amniotic fluid index (AFI) with MRI-derived AFV. MATERIAL AND METHODS: Prospective observational cohort study conducted at a single tertiary fetal imaging center (LUMIERE, Necker Hospital, Paris, France). Healthy singleton pregnancies between 16 and 36 gestational weeks were included; pregnancies with fetal anomalies or maternal complications were excluded. T2-weighted MRI with manual segmentation was performed to quantify AFV and fetal body volume. In a predefined subset, AFI was measured on same-day ultrasound. The main outcomes were AFV, AFV/FBV ratio, and their gestational-age normative ranges. The secondary outcome was the correlation between AFI and MRI-derived AFV. Percentile curves were derived using quadratic polynomial modeling. TRIAL REGISTRATION: ClinicalTrials.gov NCT04142606. RESULTS: 322 pregnancies were included (median gestational age 27.9 weeks; 45% male). AFV increased with gestational age (β = 6.61), peaking around 31 weeks, whereas AFV/FBV ratio declined (β = -0.08). No sex differences were observed. Weekly distributions were normally distributed. Quadratic polynomial modeling yielded physiologically plausible percentile curves (R = 0.74 for AFV/FBV). In the ultrasound-MRI subset (n = 103), AFI significantly correlated with AFV (Spearman ρ = 0.77), although with wide individual variability. CONCLUSIONS: This study provides the first MRI-based normative charts for AFV and AFV/FBV ratio between 16 and 36 weeks' gestation. The AFV/FBV ratio represents a novel physiological marker integrating fetal growth and fluid balance. These reference ranges may support future research and clinical decision-making.
Beyond complication rates: Surgical instrumentation, clinical decision-making, and long-term outcomes in uterine evacuation.
Zhao M, Zhou F, Qiu C
Acta Obstet Gynecol Scand · 2026 Jun · PMID 41947691 · Full text
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Management of preterm pre-labor rupture of membranes between 24 and 34 weeks: A before-and-after study of the implementation and modifications of an outpatient management protocol.
Seyral A, Barrois M, Girault A … +3 more , Perrella B, Goffinet F, Le Ray C
Acta Obstet Gynecol Scand · 2026 May · PMID 41944365 · Full text
INTRODUCTION: In preterm pre-labor rupture of membranes (PPROM) before 34 weeks, expectant management is preferred in the absence of infection to reduce neonatal morbidity. Outpatient management (OM) has emerged as a pot...
INTRODUCTION: In preterm pre-labor rupture of membranes (PPROM) before 34 weeks, expectant management is preferred in the absence of infection to reduce neonatal morbidity. Outpatient management (OM) has emerged as a potential alternative to prolonged hospitalization, but selection criteria remain ill-defined. Our objective was to evaluate latency between PPROM and delivery, and obstetric and neonatal outcomes before and after the implementation of an OM protocol and its subsequent extensions. MATERIAL AND METHODS: We included all women with PPROM before 34 weeks admitted between January 1, 2011, and December 31, 2021. Two periods were compared: Period A (January 2011-April 2013), when all patients were hospitalized until delivery, and Period B (May 2013-December 2021), when eligible patients were offered OM. Period B was subdivided into three phases (B1-B3) reflecting progressive expansion of eligibility criteria-from stable singleton pregnancies with cephalic presentation and normal amniotic fluid (B1), to inclusion of twins and shorter stabilization periods (B2), and finally cases with oligohydramnios or non-cephalic presentations (B3). The primary outcome was latency period (days between PPROM and delivery). Secondary outcomes included obstetric and neonatal complications. Comparisons were made between Periods A and B and across OM subperiods. RESULTS: A total of 539 patients were included: 145 in Period A and 394 in Period B, of whom 126 (32%) received OM. Mean gestational age at PPROM was similar between periods (28.9 ± 3.1 vs. 28.9 ± 3.3 weeks; p = 0.94), as were latency (median 7 [3-17] days vs. 8 [2-21]; p = 0.66) and gestational age at delivery (30.8 ± 3.3 vs. 30.9 ± 3.8 weeks; p = 0.62). Early neonatal bacterial infection was significantly lower in Period B (24.2% vs. 34.5%; p = 0.01). OM use increased steadily from B1 to B3 without prolonging latency or worsening outcomes. CONCLUSION: Following OM protocol implementation, one-third of eligible women with PPROM before 34 weeks were managed at home. Outpatient care, even with broadened eligibility, appeared safe, did not increase maternal or neonatal morbidity, and may reduce early neonatal infections without extending latency.
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