Acta Obstetricia Et Gynecologica Scandinavica[JOURNAL]
Sun
200 papers
Methodological considerations regarding predictor selection and model overfitting in a study of emergency cerclage.
Chen W, Xuan X
Acta Obstet Gynecol Scand · 2026 May · PMID 41943515 · Full text
Abstract loading — click title to view on PubMed.
Prediction of spontaneous onset of labor at term using clinical, ultrasound, and biochemical data: A multicenter prospective observational study (the PREDICT study).
Migliorelli F, McCarey C, Ferrero L … +7 more , Pecheux O, Marcenaro S, Tossa O, Geissler F, Othenin-Girard V, Chilin A, Martinez de Tejada B
Acta Obstet Gynecol Scand · 2026 May · PMID 41930568 · Full text
INTRODUCTION: The objective of the study was to develop a predictive model for spontaneous onset of labor between 39 and 41 weeks' gestation using clinical, ultrasound and biochemical features. MATERIAL AND METHODS: We c...
INTRODUCTION: The objective of the study was to develop a predictive model for spontaneous onset of labor between 39 and 41 weeks' gestation using clinical, ultrasound and biochemical features. MATERIAL AND METHODS: We conducted a multicenter, prospective, observational study in two university hospitals in Switzerland. Women with singleton pregnancies in cephalic presentation and intact membranes who opted for expectant management until late term were eligible for the study. Predictors collected at 39 weeks included maternal characteristics, cervical ultrasound measurements and biochemical markers. Competing risks survival regression models were developed, and predictive performance was assessed using time-dependent, receiver operating characteristic curves, calibration plots, and the Brier score. The main outcome measure was spontaneous onset of labor or prelabor rupture of membranes occurring before 41 weeks' gestation. RESULTS: A total of 429 women were recruited. Main outcome occurred in 72.0% of participants. Fourteen percent of women underwent labor induction at or beyond 41 weeks and another 14.0% required earlier induction for medical reasons. The final predictive model included maternal age, body mass index, prior vaginal delivery, cervical length, and a positive fetal fibronectin test. The model showed an area under the curve of 0.71-0.72 and good calibration. Using a dual cutoff approach to predict spontaneous labor or prelabor rupture of membranes within 7 days, participants were classified into three groups: 12.5% in a low-probability group (predicted probability ≤14.9%), 74.7% in an intermediate group (14.9%-56.8%), and 12.8% in a high-probability group (>56.8%). CONCLUSIONS: The model provides individualized probability estimates for spontaneous labor onset and may support shared decision-making in term pregnancies. Predictive accuracy was moderate, but good calibration suggested clinical utility.
The effect of temporary uterine artery ligation on blood loss during laparoscopic myomectomy: A systematic review and meta-analysis.
Witkowiak MM, Bourdakos NE, Zervides ZY … +7 more , Moutzouri O, Dariotis MM, Bitton L, Abdulsalam FAM, Nakanishi H, Than CA, Abacjew-Chmylko A
Acta Obstet Gynecol Scand · 2026 May · PMID 41914717 · Full text
INTRODUCTION: The effectiveness of temporary uterine artery ligation (TUAL) in reducing blood loss during laparoscopic myomectomy (LM) is uncertain, despite increased use as an adjunct to improve surgical safety. This st...
INTRODUCTION: The effectiveness of temporary uterine artery ligation (TUAL) in reducing blood loss during laparoscopic myomectomy (LM) is uncertain, despite increased use as an adjunct to improve surgical safety. This study aims to evaluate the safety and efficacy of TUAL in LM for the management of uterine myomas. MATERIAL AND METHODS: We conducted a systematic review and meta-analysis of comparative studies evaluating LM with and without TUAL. Electronic databases were searched up to October 7, 2024. Eligible studies were randomized controlled trials or observational comparative studies published in English that reported at least one primary outcome. The primary outcomes were intraoperative estimated blood loss and perioperative change in hemoglobin. Secondary outcomes included operative time, number and size of myomas removed, length of hospital stay, recurrence, and complication rates. Data extraction and analysis were performed using a random-effects model. This review was registered prospectively with PROSPERO (CRD42024595684). RESULTS: Seven studies met the inclusion criteria, comprising five randomized controlled trials and two retrospective case-control studies, with a total of 857 women (352 undergoing LM with TUAL and 505 undergoing LM alone). TUAL was associated with a reduction in intraoperative estimated blood loss (mean difference [MD]: -84.7 mL; 95% Cl: -89.0; -80.0) and postoperative reduction in hemoglobin level (MD: -0.4 g/dL; 95% Cl: -0.7; -0.2) compared with LM without TUAL. However, TUAL was associated with increased operative time (MD: 16.5 min; 95% Cl: 3.4; 29.6). CONCLUSIONS: TUAL appears to be a possible adjunct to LM for selected patients in the management of uterine myomas. Our study demonstrated that TUAL with LM could be associated with a reduction in estimated blood loss, despite an increase in operative time. Nonetheless, further studies with a larger sample size and long-term follow-up, as well as stratification of outcomes based on ligation technique, are warranted to elucidate the benefits of TUAL.
The effect of labor epidural analgesia on uterine activity using electrohysterography monitoring: A follow-up study.
Berben PBQ, Smolders YL, de Vries IR … +8 more , de Klerk ND, Fransen AF, Regis M, van der Hout-van der Jagt MB, van der Ven M, Schyns-van den Berg AMJV, Oei SG, van Laar JOEH
Acta Obstet Gynecol Scand · 2026 May · PMID 41902441 · Full text
INTRODUCTION: Labor epidural analgesia (LEA) is widely used for intrapartum pain management, but its effects on uterine activity (UA) remain unclear. Electrohysterography (EHG) is a promising non-invasive method for intr...
INTRODUCTION: Labor epidural analgesia (LEA) is widely used for intrapartum pain management, but its effects on uterine activity (UA) remain unclear. Electrohysterography (EHG) is a promising non-invasive method for intrapartum UA monitoring. The aim of this study was to explore the effect of LEA on UA by means of EHG, to develop better understanding of labor physiology, and inform clinical decision-making. MATERIAL AND METHODS: Patients in active labor with singleton, term pregnancies who received electrophysiological monitoring from 60 min before until 120 min after LEA initiation were included. Contraction parameters such as frequency, duration, area under the curve (AUC), baseline, and maximum amplitude were obtained from an EHG-derived tocogram using a computer-based algorithm. The primary outcome was the difference in mean uterine contraction frequency before and after initiation of LEA. Secondary outcomes included the comparison of various contraction parameters, derived from EHG, before and after LEA initiation, as well as their temporal changes over time. The effect of possible confounders on UA was examined. Mixed effects models were used for statistical analyses. RESULTS: In total, 86 patients were included. No significant difference in mean uterine contraction frequency and contraction duration was found before and after LEA initiation. Nevertheless, start of LEA was associated with a significant reduction in AUC, baseline activity, and signal amplitude. CONCLUSIONS: LEA initiation does not affect uterine contraction frequency or duration, but it is associated with a significant reduction in relative EHG-derived amplitude parameters (AUC, baseline tone, and maximum amplitude), which could potentially affect progression of labor. Further studies are required to explore these parameters and their clinical implications.
Monochorionic twin pregnancies conceived through assisted reproduction: Maternal and perinatal clinical outcomes.
Casati D, Lanna MM, Laoreti A … +5 more , Faiola S, Morelli R, Santapaola M, Lista G, Savasi V
Acta Obstet Gynecol Scand · 2026 May · PMID 41841511 · Full text
INTRODUCTION: Monochorionic (MC) twin pregnancies are at high risk of maternal, fetal, and neonatal complications. Assisted reproductive technology (ART) increases the incidence of MC twinning, but its impact on pregnanc...
INTRODUCTION: Monochorionic (MC) twin pregnancies are at high risk of maternal, fetal, and neonatal complications. Assisted reproductive technology (ART) increases the incidence of MC twinning, but its impact on pregnancy outcomes in this subgroup remains unclear. This study aimed to investigate whether conception via ART is associated with adverse maternal and perinatal outcomes in MC twin pregnancies and to highlight key areas for future research. MATERIAL AND METHODS: A retrospective observational study was conducted on MC twin and multifetal pregnancies referred to a tertiary fetal medicine center from 2020 to 2023. A total of 100 ART-conceived MC pregnancies (77 homologous ART and 23 egg donation) were compared to 343 spontaneously conceived MC pregnancies. Maternal, fetal, and neonatal outcomes were analyzed. Adjusted odds ratios (aOR) were estimated using logistic regression, and generalized estimating equations were applied to account for within-twin pair correlation. RESULTS: Results are presented for the entire population and for MC diamniotic (MCDA) pregnancies only. Women with ART-conceived MC pregnancies were older and more often nulliparous compared to those with spontaneous conception (p < 0.01), yet exhibited similar rates of preterm delivery and cesarean section. ART was associated with higher risk of maternal complications (p < 0.01), particularly hypertensive disorders (p = 0.02). Fetal demise and postnatal morbidity occurred more frequently in ART pregnancies, although neither association remained statistically significant after adjustment for within-twin pair correlation or in MCDA-only analyses. ART-conceived twins had lower rates of twin-to-twin transfusion syndrome but poorer survival after laser treatment (p < 0.01). Overall survival did not differ across groups. CONCLUSIONS: ART-conceived MC pregnancies show an increased burden of maternal complications. Fetal and neonatal outcomes did not differ significantly from those of spontaneously conceived pregnancies after adjustments, despite higher point estimates for adverse outcomes. In the context of the global rise in ART use, these findings underscore the need for further clinical and basic-science research to better characterize the magnitude and mechanisms of ART-associated risks in MC pregnancies.
Birth and abortion rates among young women over the past 50 years examined in relation to providers and reimbursement for hormonal contraception across the Nordic countries, an ecological study.
Skjeldestad FE, Gissler M, Geirsson RT … +2 more , Gemzell-Danielsson K, Heikinheimo O
Acta Obstet Gynecol Scand · 2026 May · PMID 41841443 · Full text
INTRODUCTION: With liberalization of abortion laws in the Nordic countries during the 1970s, there were efforts to prevent unplanned pregnancies among young women by improved contraceptive provision. In an ecological des...
INTRODUCTION: With liberalization of abortion laws in the Nordic countries during the 1970s, there were efforts to prevent unplanned pregnancies among young women by improved contraceptive provision. In an ecological design, we describe country-specific actions for meeting young women's contraceptive needs and their impact on induced abortion and births. MATERIAL AND METHODS: We used national data from 1974 to 2023 on populations and numbers of induced abortions and births for 15-19- and 20-24-year-old women. Available public documents included information on preventive measures, availability of hormonal contraceptives (providers/dispensation), and reimbursement schemes. Joinpoint regression analysis was used to assess breakpoints in country-specific age trends for annual abortion and birth rates. RESULTS: Sweden authorized midwives to prescribe contraceptives in 1976, Norway in 2002 (and public health nurses), Finland in 2020 (and public health nurses) and Iceland in 2021, while physicians have remained the only provider in Denmark. Sweden set up youth clinics from the late 1970s and clinics opened in Norway from the early 1990s. Partial or full reimbursement for combined oral contraceptives to 16-23-year-old women began gradually in Sweden in the early 1990s and expanded to a national program on contraceptives in 2014/2016. A Norwegian free-of-charge scheme to 16-19-year-old women for combined oral contraceptives from 2002 changed in 2006 to include partial coverage for short-acting reversible contraceptives and was expanded to long-acting reversible contraceptives in 2015/2016. In Finland two large cities offered long-acting reversible contraceptive free-of-charge from 2007/2013. Denmark and Iceland have not had reimbursement schemes for hormonal contraceptives. We found no breakpoints in trends for induced abortions and births that could relate to any preventive actions. Trends were relatively similar in countries with or without expanded prescription rights to midwives/public health nurses and unrelated to reimbursement schemes. Birth rates among women <25 years are now <10% of those seen 50 years ago, while most of the decline in abortion rates took place after 2010. CONCLUSION: Trends for induced abortion and births among women <25 years have developed similarly across the Nordic countries. They are global and appear less likely to be associated with national health services and targeted contraceptive policies.
Impact of combined oral contraceptives and progestin-only pills on psychological and sexual well-being of women with endometriosis: A systematic review.
Salmeri N, Piccini M, Caprara F … +3 more , Somigliana E, Viganò P, Vercellini P
Acta Obstet Gynecol Scand · 2026 May · PMID 41817451 · Full text
INTRODUCTION: Women with endometriosis frequently experience psychological and sexual concerns. Combined oral contraceptives (COCs) and progestin-only pills (POPs) represent first-line treatments for the disease, yet the...
INTRODUCTION: Women with endometriosis frequently experience psychological and sexual concerns. Combined oral contraceptives (COCs) and progestin-only pills (POPs) represent first-line treatments for the disease, yet their potential negative impact on mood and sexuality remains debated. MATERIAL AND METHODS: We conducted a systematic review of PubMed, Embase, and Scopus up to August 1st, 2025, to assess whether COCs or POPs adversely affect psychological well-being or sexual function in this population. Eligible studies included randomized controlled trials (RCTs) and non-randomized studies comparing COCs or POPs with no treatment in women with endometriosis. Outcomes of interest were adverse event rates and patient-reported measures of mood and sexual health. Risk of bias was assessed with RoB 2 and ROBINS-I. Given heterogeneity in outcome measures, we applied vote counting by direction of effect and harvest plots, with confidence intervals (CIs) calculated using the Wilson method, in line with Cochrane guidance. The study protocol was prospectively registered on PROSPERO (CRD420250656420). RESULTS: Of 1424 records screened, seven studies (four RCTs, three observational) met the inclusion criteria. Risk of bias was low in RCTs and moderate-to-serious in observational studies. Six of seven (pooled proportion: 86%; 95% CI: 49%-97%) reported no increased risk of psychological dysfunction in users. None reported increased sexual dysfunction (100%; 95% CI: 65%-100%). Most studies reported significant pain reduction with treatment. Six studies specifically reported on dyspareunia, all of which showed a benefit of treatment over placebo (100%; 95% CI: 61%-100%). No discontinuations for psychological or sexual adverse events were observed when pain remission was achieved. DISCUSSION: Despite the small number of studies, variability in measurement tools, and short follow-up (mean 6 months), the evidence suggests that COCs and POPs are generally well tolerated regarding psychological and sexual health, supporting their continued use for long-term management provided pain remission is achieved. CONCLUSIONS: In women with endometriosis, current evidence does not support a consistent increase in negative psychological or sexual outcomes among COCs or POPs users compared with non-users.
Current practice of colposuspension in the United Kingdom: Results of a national survey.
Lor KY, Taithongchai A, Araklitis G … +4 more , Waheed A, Mohamed-Ahmed R, Rantell A, Robinson D
Acta Obstet Gynecol Scand · 2026 Jul · PMID 41814469 · Full text
INTRODUCTION: Colposuspension procedures have increased in the UK following the 2018 suspension of vaginal mesh for stress urinary incontinence. However, significant variation exists in preoperative assessment, patient s...
INTRODUCTION: Colposuspension procedures have increased in the UK following the 2018 suspension of vaginal mesh for stress urinary incontinence. However, significant variation exists in preoperative assessment, patient selection, surgical approach, and postoperative care. This survey aims to explore current national practice. MATERIAL AND METHODS: A questionnaire was distributed to members of the British Society of Urogynaecology (BSUG) and the British Association of Urological Surgeons (BAUS). RESULTS: Fifty-three clinicians responded; most were gynecologists with a special interest in urogynecology (60%) or urogynecology subspecialists (34%). Response rates were 12% (51/442) among BSUG members and <1% (2/2622) among BAUS members. Annual case volume was 5 to 10 for 43%, fewer than 5 for 36%, 10-20 for 19%, and >20 for 2%. Most surgeons (85%) perform preoperative urodynamics in all patients, while 15% restrict testing to women with mixed symptoms. Almost all (98.1%) would treat detrusor overactivity or symptomatic overactive bladder prior to offering colposuspension. Forty-five percent will perform colposuspension at any functional or maximum cytometric capacity; others use cutoffs of >400 mL (19%), >300 mL (26%) or >200 mL (10%). Fifty-five percent reported a BMI limit of <35, while 19% have no limit. Most surgeons favored an open approach (58%), followed by laparoscopic (38%) and robotic (4%). Sutures were usually suspended tension-free (75%) using Ethibond (53%) or PDS (40%), with 72% consenting for the use of non-absorbable sutures. For open colposuspension, two sutures bilaterally were preferred (49%), followed by three (40%) and four (11%). Laparoscopic or robotic procedures were mostly intra-peritoneal (89%), with surgeons placing two sutures bilaterally (88%) and tying their knots extracorporeally (75%). Thirty-nine percent close the peritoneum over their sutures. Routine check cystoscopy was performed by 60%. Postoperatively, indwelling urinary catheters are mostly left on free drainage (69%); 17% always use a suprapubic catheter and 4% preferred clean intermittent self-catheterization. Trial without catheter is most commonly attempted on Day 1 post-colposuspension (74%), with variable voiding criteria and acceptable post-void residuals. CONCLUSION: This national survey highlights marked heterogeneity in UK colposuspension practice. There is a need for comparative studies and national consensus on core technical steps to ensure safety and favorable long-term outcomes.
Port-site hernia following laparoscopic gynecological surgery: A systematic review and meta-analysis.
Ługowski F, Włodarczyk Z, Owczarek A … +2 more , Zaborowska Ł, Ludwin A
Acta Obstet Gynecol Scand · 2026 May · PMID 41805035 · Full text
INTRODUCTION: Port-site hernia (PSH) is a rare but clinically relevant complication of laparoscopic gynecologic surgery. Despite the widespread adoption of minimally invasive techniques, no prior systematic review has co...
INTRODUCTION: Port-site hernia (PSH) is a rare but clinically relevant complication of laparoscopic gynecologic surgery. Despite the widespread adoption of minimally invasive techniques, no prior systematic review has comprehensively evaluated PSH incidence and risk factors in this population. MATERIAL AND METHODS: A systematic review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42025649280). PubMed, Scopus, Web of Science, and Embase were searched without language or date restrictions. Eligible studies included randomized or cohort designs reporting PSH incidence after laparoscopic gynecologic procedures. Pooled incidence was calculated using a random-effects model. RESULTS: Twenty-two studies comprising 70 346 patients were included. The overall pooled PSH incidence was 0.29% (95% CI: 0.00 to 0.02), with significant heterogeneity (I = 99.3%). Sensitivity analysis excluding outliers reduced heterogeneity (I = 83.1%) without altering direction or significance. Elevated body mass index (BMI), diabetes mellitus, and advanced age were consistent patient-related risk factors, while larger trocar size (≥10 mm), single-port access, and inadequate fascial closure were major surgical contributors. CONCLUSIONS: PSH following laparoscopic gynecologic surgery remains a rare but clinically significant occurrence. Surgical technique, particularly trocar size selection and fascial closure, plays a decisive role in risk reduction. Attention to modifiable intraoperative factors is crucial for optimizing patient safety and preventing postoperative hernia formation.
Clinical characteristics of adolescents and young adults requesting labiaplasty - A Finnish cross-sectional study.
Kilpeläinen A, Rönö K, Holopainen E
Acta Obstet Gynecol Scand · 2026 May · PMID 41804576 · Full text
INTRODUCTION: Women request labiaplasty due to both physical symptoms and aesthetic concerns. Adolescent labiaplasty may carry higher complication risks than in adults; however, data are scarce. The primary aim of this s...
INTRODUCTION: Women request labiaplasty due to both physical symptoms and aesthetic concerns. Adolescent labiaplasty may carry higher complication risks than in adults; however, data are scarce. The primary aim of this study was to describe characteristics and comorbidities of adolescents and young adults requesting labiaplasty. The secondary aim was to examine labial dimensions in relation to reported physical and nonphysical symptoms. MATERIAL AND METHODS: This cross-sectional study was conducted at the Pediatric and Adolescent Gynecology Outpatient Clinic at Helsinki University Hospital, Finland. The study population includes all young women <25 years of age seeking labiaplasty between January 1, 2021, and December 31, 2023. The participants were followed up to August 30, 2024. Data on several subjective physical and psychological symptoms, as well as objective measurements of labia, were collected from patient records. The proportion of young women referred to a plastic surgeon's assessment was recorded. RESULTS: Altogether 65 young women were included. The median age was 20.2 years (range 11.9-25.4), and 22 (33.8%) of the patients were minors. The median body mass index of the participants was 19.7 kg/m (range 14.9-34.6 kg/m), and 18 (27.7%) of the patients were underweight. Twenty-six (40.0%) had at least one psychiatric or neuropsychiatric diagnostic code registered. Fourteen (21.5%) had a current psychotropic medication, and 14 (21.5%) had either a current or previous self-reported eating disorder or disordered eating behavior. Labia minora widths were ≤5 cm in 36 (55.4%) of the patients. There were no significant differences in physical symptoms between those with labia minora ≤5 cm and >5 cm. Of self-reported nonphysical symptoms, anxiety was reported more often among those with labia width >5 cm (p < 0.005). In all, 37 (56.9%) were further referred to a plastic surgeon's assessment. CONCLUSIONS: Psychiatric morbidity was common among young women seeking labiaplasty, underlining the importance of exploring mental health issues among these patients. Most women lacked obvious labial hypertrophy. Reported physical symptoms did not correlate with labia size. We suggest that all young women requesting labiaplasty should be met by a specialist team for appropriate patient counseling and evaluation.
Accuracy of human papillomavirus testing in detecting persistent or recurrent disease at follow-up after conization.
Alaref G, Petersen LK
Acta Obstet Gynecol Scand · 2026 May · PMID 41801253 · Full text
INTRODUCTION: Currently, the Test of Cure after conization consists of two elements, namely human papillomavirus (HPV) testing and cytology. Given the high sensitivity of HPV testing and its modest resource requirements,...
INTRODUCTION: Currently, the Test of Cure after conization consists of two elements, namely human papillomavirus (HPV) testing and cytology. Given the high sensitivity of HPV testing and its modest resource requirements, we will explore its potential as a stand-alone test for identifying persistent/recurrent cervical intraepithelial neoplasia (CIN) during follow-up after conization, including women at increased risk, such as those with involved resection margins. MATERIAL AND METHODS: This retrospective study examined 473 women who underwent conization in Funen, Denmark, between January 1, 2020, and December 31, 2024. During the post-conization follow-up period, data were manually extracted from patients' medical records and PatoBank. RESULTS: At the follow-up, cervical intraepithelial neoplasia grade 1 or worse (CIN1+) persistent/recurrence was experienced by 55 women (11.6%) (median age of 42 years (range 22-87 years)). Among those with involved margins, 30.3% (40/132) experienced persistent/recurrent CIN1+ compared to 3.6% (7/193) with free margins; and 66.4% (314/473) tested negative for high-risk HPV after conization, and only four of them developed persistent/recurrent CIN1+. HPV testing alone predicted the risk of CIN1+ persistence/recurrence with 93% sensitivity and 98.7% negative predictive value (NPV). Combining negative HPV test results with free resection margins yielded a sensitivity and NPV of 100%. Co-testing combined with free margins also provided a sensitivity and NPV of 100%. CONCLUSIONS: Using HPV testing as a stand-alone test after conization demonstrates an NPV nearly equal to that of the Test of Cure. Adding free margins to HPV testing further enhanced sensitivity and NPV for detecting CIN1+ persistence or relapse during follow-up. Our results indicate that HPV testing alone can be used as post-conization follow-up for women with negative margins.
The microbiome research in obstetrics and gynecology is getting attention-Some reasons why.
Shabana H, Rodriguez-Wallberg KA
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41795148 · Full text
Abstract loading — click title to view on PubMed.
History-indicated cerclage versus ultrasound cervical length screening in women with a history of one extremely preterm birth: A comparative observational cohort study.
Terral M, Lieng C, Goffinet F … +3 more , Guerby P, Athiel Y, Loussert L
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41793210 · Full text
INTRODUCTION: In women with a history of one extremely preterm birth, the current literature suggests that ultrasound cervical length screening offers a more favorable risk-benefit ratio than history-indicated cerclage....
INTRODUCTION: In women with a history of one extremely preterm birth, the current literature suggests that ultrasound cervical length screening offers a more favorable risk-benefit ratio than history-indicated cerclage. However, some of the women included in previous studies were at a low risk of cervical insufficiency. Therefore, the efficacy of history-indicated cerclage may have been underestimated. Our objective was to compare history-indicated cerclage with ultrasound cervical length screening in women with a history of one second-trimester loss or extremely preterm birth suggestive of cervical insufficiency. MATERIAL AND METHODS: We conducted a retrospective cohort study comparing two centers with different management strategies for women with a history of one second-trimester loss or extremely preterm birth suggestive of cervical insufficiency. This study was conducted from January 1, 2015 to December 31, 2022 in two French tertiary care maternity units. In the first center, women were offered a cerclage in the first trimester (cerclage center). In the second center, women were offered an ultrasound screening with cerclage only for women with cervical shortening (ultrasound center). To target a population at high risk for cervical insufficiency, we included women with a history of one second-trimester loss or spontaneous preterm birth before 28 weeks of gestation. We excluded women who had any of the following complications in their previous pregnancy: bleeding from placenta previa or placental abruption, intrauterine fetal death, or delivery after invasive prenatal testing. We also excluded women with a history of more than one preterm delivery. Our primary outcome was delivery before 34 weeks. A multivariable analysis was performed. RESULTS: The rate of delivery before 34 weeks was significantly lower in the cerclage center compared with that in the ultrasound center (26/165 (15.8%) vs. 38/149 (25.5%), p = 0.032). After adjusting for confounding factors, history-indicated cerclage was associated with a twofold decreased risk of delivery before 34 weeks compared with ultrasound cervical length screening (aOR 0.46, 95% CI 0.23-0.95). CONCLUSIONS: In women with a history of one second-trimester loss or extremely preterm birth suggestive of cervical insufficiency, history-indicated cerclage is associated with a lower risk of delivery before 34 weeks compared with ultrasound cervical length screening.
A concept for a new approach to combined oral contraception from adolescence to perimenopause: Continuous use of the oral GnRH antagonist Relugolix and the fetal estrogen Estetrol.
Coelingh Bennink HJT, Afors K, Bahamondes L … +7 more , Graziottin A, Bateson D, Bombas T, Osuga Y, Palacios S, Westhoff CL, Gemzell-Danielsson K
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41793206 · Full text
The introduction of oral GnRH antagonists has created the possibility to replace progestins in combined oral contraceptives as the suppressor of ovarian function. A concept for this new approach to oral hormonal contrace...
The introduction of oral GnRH antagonists has created the possibility to replace progestins in combined oral contraceptives as the suppressor of ovarian function. A concept for this new approach to oral hormonal contraception is the combination of 40 mg relugolix, known to inhibit ovulation, and a low dose of the fetal estrogen estetrol. Major noncontraceptive benefits of this regimen will be the establishment of continuous amenorrhea and a smooth and symptomless perimenopausal transition to the postmenopausal status, creating a life cycle endocrine management approach for women (the RE4Women concept). An additional long-term effect of RE4W is the expected strong reduction of the incidence of breast cancer due to the absence of luteal progesterone and progestins. The dose of estetrol maintaining estrogen function, preventing perimenopausal symptoms, and not causing unacceptable endometrial growth and/or breakthrough bleeding will be assessed in two Phase 2 studies in women aged 18-35 and 36-51 years, respectively.
Outcomes from blind versus ultrasound-guided uterine evacuation: A retrospective cohort analysis.
Dowthwaite S, Quinton A, Thomas S … +2 more , Schlub TE, Clarke J
Acta Obstet Gynecol Scand · 2026 May · PMID 41792920 · Full text
INTRODUCTION: Women may need a surgical uterine evacuation for miscarriage, surgical termination, or retained products of conception. Previous research has indicated possible complications of uterine dilatation and curet...
INTRODUCTION: Women may need a surgical uterine evacuation for miscarriage, surgical termination, or retained products of conception. Previous research has indicated possible complications of uterine dilatation and curettage and potential benefits of an ultrasound-guided procedure. This study aimed to compare the rate of complications for uterine evacuation when performed blind or with ultrasound guidance, including whether the presence of patient risk factors determined the use of ultrasound guidance. MATERIAL AND METHODS: This retrospective cohort study included 733 cases in an Australian hospital between January 2019 and December 2023. Medical records, imaging, and surgical reports were searched for patient demographics, risk factors, and the presence of surgical complications. Primary outcomes were complications of uterine perforation, false passage, incomplete curettage, heavy blood loss, or laparoscopy. Secondary outcomes were patient demographics and potential presurgical complication factors. The study created two cohorts: patients receiving evacuation performed blind or with ultrasound guidance. RESULTS: The uterine evacuation was performed blind for 421/733 (57%) women and ultrasound-guided for 312/733 (43%) women. The ultrasound-guided group included higher gestational ages 8 [7-11] weeks vs blind 8 [7-9] weeks, more patients with risk factors (OR 1.7, CI: 1.3 to 2.3), more patients for surgical termination (OR 15.3, CI: 5.4 to 43.3), or postpartum RPOC removal (OR 2.3, CI: 1.3 to 3.9). The ultrasound group had lower overall blood loss (20 mLs vs 30 mL) and clinically significantly lower volumes of continuing retained products of conception, 0.66 cm [0.53-1.23] vs 8.35 cm [1.49-18.94]. There was no difference in complications between groups after adjusting for gestational age (OR 1.0, CI: 0.5 to 2.0). CONCLUSIONS: There were low complication rates for blind and ultrasound-guided uterine evacuations. However, ultrasound guidance was utilized for higher-risk cases and significantly reduced the volume of retained tissue in complicated cases. The use of ultrasound guidance by doctors and sonographers for uterine evacuation is a compelling choice where available.
Self-reported pelvic floor dysfunction 12 months after an obstetric anal sphincter injury in relation to maternal body mass index.
Hjertberg L, Uustal E, Blomberg M … +1 more , Pihl S
Acta Obstet Gynecol Scand · 2026 Jul · PMID 41787673 · Full text
INTRODUCTION: The aim of this study was to evaluate self-reported pelvic floor symptoms 12 months postpartum, in women after a first-time vaginal delivery complicated by an obstetric anal sphincter injury, according to b...
INTRODUCTION: The aim of this study was to evaluate self-reported pelvic floor symptoms 12 months postpartum, in women after a first-time vaginal delivery complicated by an obstetric anal sphincter injury, according to body mass index. The hypothesis was that dyspareunia, urinary incontinence, and anal incontinence would be more common in overweight and obese women compared with normal weight women 12 months postpartum. MATERIAL AND METHODS: This is a population-based cohort study. Altogether, 6595 primiparous women with a first-time vaginal delivery complicated by an obstetric anal sphincter injury in Sweden between 2014 and 2019 were included in the Swedish Perineal Laceration Registry. Self-reported pre-pregnancy data and data from the 12-month follow-up questionnaire were retrieved from the Perineal Laceration Registry. Uni- and multivariate analyses were used to compare normal weight (BMI ≤ 24.9), overweight (25.0-29.9), and obese (≥30) women in regard to the self-reported prevalence of dyspareunia, urinary incontinence, and anal incontinence 12 months postpartum. RESULTS: Overweight and obese women had a decreased risk of dyspareunia compared with normal weight women, aOR 0.82 (CI = 0.68-0.98) and aOR 0.71 (CI = 0.54-0.93), respectively. The absolute rate of dyspareunia was 41% among normal weight women, 38% among overweight women, and 33% among the obese group. In the univariate analyses, episiotomy and the grade of anal sphincter injury did not affect the risk of dyspareunia. There was an increased risk of urinary incontinence among overweight (aOR = 1.51, CI = 1.11-2.04) and obese women (aOR = 2.82, CI = 1.94-4.12) compared with normal weight women. The risk of anal incontinence did not differ between the BMI groups. CONCLUSIONS: Dyspareunia 12 months after an obstetric anal sphincter injury was less common among overweight and obese women than in normal-weight women. Self-reported anal incontinence one year after an obstetric anal sphincter injury was equally distributed over the BMI groups 12 months after delivery, which is a new finding and clinically relevant.
Contraction frequency and acidemia at birth: A case-control study.
Bjurström JW, Rickle G, Fogelberg M … +2 more , Ekengård F, Herbst A
Acta Obstet Gynecol Scand · 2026 May · PMID 41782222 · Full text
INTRODUCTION: Consensus is lacking regarding the upper limit for a safe contraction frequency during labor. We aimed to assess the association between different contraction frequencies and acidemia at birth, and whether...
INTRODUCTION: Consensus is lacking regarding the upper limit for a safe contraction frequency during labor. We aimed to assess the association between different contraction frequencies and acidemia at birth, and whether an association was affected by oxytocin augmentation, concomitant cardiotocography (CTG) classification, and stage of labor. MATERIAL AND METHODS: This is a case-control study based on CTG traces from births in southern Sweden during 2012-2017. Cases (N = 364) had umbilical artery pH <7.1 if born by first-stage cesarean section and pH <7.05 if born vaginally or by second-stage cesarean. Controls were included with a 1:2 ratio (N = 728) and had pH ≥7.15. CTG traces from the hour prior to birth were assessed blinded to the clinical outcome. Logistic regression was used to estimate odds ratios (OR) with 95% confidence intervals (CI). RESULTS: After excluding insufficient topography traces, 328 cases and 677 controls remained for analysis. Contraction frequencies 5, 5-6, and ≥6 per 10 min occurred in 15.2%, 19.5%, and 29.6% of cases and in 15.1%, 16.5%, and 11.1% of controls, respectively. The OR (95% CI) for acidemia were 1.6 (1.1-2.4), 1.9 (1.3-2.7), and 4.3 (3.0-6.2), respectively, compared with a reference group of <5. When comparing two separate binary cut-offs of >5 and ≥5 contractions, similar strengths of association with acidemia were demonstrated with OR 2.7 (2.1-3.6) and 2.5 (1.9-3.3), respectively. The effect of contraction frequency >5 was similar in spontaneous (n = 586) and oxytocin-augmented (n = 419) labor (OR 2.5, 1.7-3.8 vs. OR 2.4, 1.6-3.6), and whether the CTG was normal, suspicious, or pathological according to the Swedish CTG template (OR 2.1, 1.3-3.3; OR 3.5, 1.6-7.6; and OR 2.6, 1.4-4.7, respectively). The study lacked power to study any association during the first stage of labor. CONCLUSIONS: Increasing contraction frequency is incrementally associated with fetal acidemia. Although an increased risk of acidosis is evident at contraction frequencies as low as five, such frequencies are common while acidemia is uncommon, implying a poor positive predictive value. A contraction frequency of more than five is associated with acidemia in both spontaneous and oxytocin-augmented labor, and even when the fetal heart trace is normal.
Three-dimensional patient-derived endometriosis model for drug evaluation.
Li Y, Shao W, Gao X … +8 more , Wang Y, Li J, Zhang L, Xing Y, Su W, Cheng Y, Wang L, Liu S
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41772890 · Full text
INTRODUCTION: Endometriomsis (EMs) is a complex and chronic gynecological disease characterized by distressing symptoms. Its pathogenesis remains unknown, and there is no effective treatment. Therefore, establishing pati...
INTRODUCTION: Endometriomsis (EMs) is a complex and chronic gynecological disease characterized by distressing symptoms. Its pathogenesis remains unknown, and there is no effective treatment. Therefore, establishing patient-derived models is crucial for elucidating disease mechanisms and identifying potential therapeutic agents. We developed a coculture system combining epithelial organoids and stromal cells, enabling the study of their dynamic interactions. Using this model, we assessed the therapeutic efficacy of dienogest, a drug clinically used for treating endometriomas. MATERIAL AND METHODS: The epithelial gland-like organoids and stromal cells derived from patients with endometriomas were isolated and cultured, respectively. Both of them were cocultured in matrix for partially mimicking in vivo pathological features. Immunohistochemical (IHC) assay was used to identify their biomarkers. Cell viability was quantitatively assessed using the CellTiter-Glo assay following drug treatment. RESULTS: We successfully cultured patient-derived epithelial gland-like organoids and stromal cells derived from patients with endometriomas, a form of endometriosis characterized by ovarian cysts. Morphological and immunohistochemical analyses confirmed high consistency with native endometriotic lesions. These models exhibited comparable expression profiles for key biological markers, including estrogen receptors (ERs), progesterone receptors (PRs), E-cadherin, CD44, Intercellular Adhesion Molecule-1 (ICAM1), Integrin Beta 3 (ITGB3), Cytokeratin 7 (CK7), Matrix Metalloproteinase 2/9 (MMP2/9), Tissue Inhibitor of Metalloproteinases 1 (TIMP1), and TIMP2. Notably, drug responsiveness varied among the patient-derived models by coculturing two types of cells, indicating potential interpatient heterogeneity in treatment outcomes. We propose that this patient-specific endometriomas model serves as a valuable platform for investigating disease mechanisms and screening drug in endometriomas. CONCLUSIONS: We established a novel coculture system integrating epithelial organoids and stromal cells to recapitulate the intricate cellular interactions within the endometriotic microenvironment, providing a more relevant in vitro representation of the disease. Upon evaluation with dienogest, a clinically used therapeutic agent for endometriomas, the patient-derived models exhibited heterogeneous drug responses.
Atypical placental site nodules: A retrospective case series.
Parker VL, Singh K, McDonald K … +3 more , Jabbar I, Winter MC, Palmer JE
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41755649 · Full text
INTRODUCTION: Atypical placental site nodule (APSN) is a rare diagnosis, representing remnants of a previous pregnancy and extravillous trophoblast tissue. These lesions are potential precursor lesions to rare forms of G...
INTRODUCTION: Atypical placental site nodule (APSN) is a rare diagnosis, representing remnants of a previous pregnancy and extravillous trophoblast tissue. These lesions are potential precursor lesions to rare forms of Gestational trophoblastic neoplasia (GTN). Recent data suggest up to a 15% risk of malignancy occurring either concurrently or manifesting within a few months of diagnosis. These patients are often young with future fertility considerations. Prognosis, treatment, and clinical follow-up of APSN cases currently remain a matter of debate. This study aimed to address and explore some of these issues. MATERIAL AND METHODS: Retrospective case series analysis was performed between 1st January 2000 and 31st December 2023 at the Sheffield Trophoblastic Disease Centre, Sheffield, UK. Patients on conservative management were asked at routine follow-up telephone consultations if they would consider a completion hysterectomy in light of the risk of progression to GTN. RESULTS: Twenty-two cases of APSN were registered, of which 10 (45%) received surgical management. Two (20%) cases were incidentally diagnosed following total abdominal hysterectomy (TAH) for other indications and eight (80%) had a TAH within twelve months of their initial diagnosis as part of primary management. None had histological evidence of GTN. Of the twelve (55%) patients initially opting primarily for conservative management, three (25%) decided to have a TAH performed based on the current evidence for risk of malignant transformation, eight (67%) indicated they would have a TAH based on advice from the center, and one (8%) was uncertain. No patients were diagnosed with GTN. CONCLUSIONS: In this study, we found no evidence of malignant transformation in our patients, which conflicts with other published data conferring an 11%-14% risk of malignant transformation. An international consensus opinion needs to be reached within the Gestational trophoblastic community regarding the optimal advice, management, and follow-up regimens for patients diagnosed with APSN.
Association between history of fertility problems and pregnancy and birth complications: A longitudinal population-based cohort study.
Tully CA, Schoenaker D, Pacella-Ince L … +2 more , Hodge AM, Grieger JA
Acta Obstet Gynecol Scand · 2026 May · PMID 41744442 · Full text
INTRODUCTION: Infertility is a common reproductive health issue, associated with increased risks of pregnancy complications. However, shared underlying risk factors such as age, BMI, PCOS, endometriosis, and lifestyle ma...
INTRODUCTION: Infertility is a common reproductive health issue, associated with increased risks of pregnancy complications. However, shared underlying risk factors such as age, BMI, PCOS, endometriosis, and lifestyle may partly explain these associations. In a population-based cohort of women, this study aimed to determine whether a history of fertility problems is independently associated with adverse pregnancy and birth outcomes, including gestational diabetes, hypertensive disorders of pregnancy, low birthweight, and preterm birth. MATERIAL AND METHODS: This was a secondary analysis of data from the 1973 to 1978 cohort of the Australian Longitudinal Study on Women's Health, that included surveys from 2003 to 2018 (n = 9854). We examined associations between self-reported fertility problems and four adverse outcomes: gestational diabetes, hypertensive disorders of pregnancy, low birthweight, and preterm birth. Generalized estimating equations with an exchangeable correlation structure were used, with sequential adjustment for socio-demographic, health, and lifestyle-related characteristics. RESULTS: Among 5653 women who reported a live birth, 897 (15.9%) reported a history of fertility problems, of whom 71.6% had sought help. After adjusting for socio-demographic factors alone, there was a statistically significant increased risk of adverse pregnancy outcomes for women with a history of fertility problems compared to those without. However, after further adjustment for health characteristics and pregnancy-related variables, the associations were no longer statistically significant: gestational diabetes [Relative risk (RR): 0.98; 95% confidence interval (CI) (0.78 to 1.22)], hypertensive disorders of pregnancy [RR: 1.08; 95% CI (0.82 to 1.43)], preterm birth [RR: 1.01; 95% CI (0.81 to 1.26)], or low birthweight [RR: 1.04; 95% CI (0.80 to 1.34)]. CONCLUSIONS: In this large cohort of women in Australian, initial associations between fertility problems and adverse pregnancy outcomes were attenuated after adjustment for key health and lifestyle factors. The absence of associations in fully adjusted models suggests that previously reported risks may reflect shared underlying maternal characteristics rather than infertility itself and highlights the importance of cautious interpretation of statistical significance in large observational studies.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe