Acta Obstetricia Et Gynecologica Scandinavica[JOURNAL]
Sun
200 papers
Perinatal outcomes of expectant management versus fetal reduction in triplet pregnancies: A single-center retrospective cohort study in Korea.
Lee YJ, Chung JH, Jeong JY … +3 more , Koh J, Lee MY, Won HS
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41742396 · Full text
INTRODUCTION: We aimed to evaluate perinatal outcomes in triplet pregnancies and compare outcomes between pregnancies managed expectantly and those undergoing fetal reduction. MATERIAL AND METHODS: This retrospective stu...
INTRODUCTION: We aimed to evaluate perinatal outcomes in triplet pregnancies and compare outcomes between pregnancies managed expectantly and those undergoing fetal reduction. MATERIAL AND METHODS: This retrospective study included triplet pregnancies confirmed by ultrasound at Asan Medical Center between January 2020 and May 2025. Pregnancies were classified into an expectant management group or a fetal reduction group (reduction to twins or a singleton). Maternal characteristics, obstetric complications, and perinatal outcomes were compared. Within the fetal reduction group, outcomes were further analyzed by indication-multifetal pregnancy reduction versus selective fetal termination-and method-intracardiac injection versus radiofrequency ablation. RESULTS: A total of 208 triplet pregnancies were included; 133 (63.9%) were managed expectantly, and 75 (36.1%) underwent fetal reduction. In the expectant management group, the mean gestational age at delivery was 33.2 weeks, with preterm birth before 32 weeks in 21.6%, and neonatal intensive care unit (NICU) admission in 76.7%. Fetal loss of at least one fetus before 24 weeks occurred in 7.8%, and the incidence of nonviable pregnancy loss was 2.3%. Compared with expectant management, the fetal reduction group demonstrated more favorable perinatal outcomes, including higher Apgar scores and lower rates of oxygen therapy (18.4% vs. 50.2%, p < 0.0001) and NICU admission (34.6% vs. 76.7%, p < 0.0001). No nonviable pregnancy loss or stillbirth occurred after reduction, whereas both were observed in the expectant group. Survival rates were similarly high in both groups (100% vs. 98.4%). Within the reduction group, outcomes did not differ significantly by indication or procedure type. CONCLUSIONS: Triplet pregnancies carry significant maternal and neonatal risks. Fetal reduction appears safe and may improve perinatal outcomes by extending gestation. These findings individualized prenatal counseling and management strategies for triplet pregnancies.
Aligning AI and clinical expertise: A collaborative path for patient education.
Rotem R, O'Sullivan OE
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41742387 · Publisher ↗
Abstract loading — click title to view on PubMed.
Does preimplantation genetic testing for aneuploidy improve live birth rate in women diagnosed with recurrent implantation failure: A systematic review and meta-analysis?
Newnham A, Leeson C, Trunkwala F … +2 more , Odendaal J, Quenby S
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41738632 · Full text
INTRODUCTION: The prevalence of unexplained recurrent implantation failure (RIF) is reported as 2%-15% in the literature. The variation in prevalence reflects the heterogeneity in definition. Recent work has suggested un...
INTRODUCTION: The prevalence of unexplained recurrent implantation failure (RIF) is reported as 2%-15% in the literature. The variation in prevalence reflects the heterogeneity in definition. Recent work has suggested unexplained RIF is unlikely to be endometrial or cycle synchronicity related but is, in fact, an embryological phenomenon. The most likely embryological phenomenon is aneuploidy. Preimplantation genetic testing for aneuploidy (PGT-A) has proven to reduce miscarriage rates in almost all infertility patients, including those with recurrent pregnancy loss, suggesting aneuploidy plays an important role in unsuccessful in vitro fertilization. No guidance for PGT-A use in RIF exists. This review aimed to address this evidence gap. MATERIAL AND METHODS: A systematic search of Medline, Embase, Web of Science, CINAHL, and Cochrane Database from inception until November 2024 was undertaken. Selection criteria included experimental and observational studies comparing euploid blastocyst transfer using PGT-A to standard care. The population included those with RIF or undergoing a minimum of three transfers. The primary outcome was cumulative live birth rate (CLBR). The primary aim of this review is to evaluate the impact of PGT-A on live birth rate (LBR) following a diagnosis of RIF. The secondary aim was to estimate the true prevalence of RIF, using a definition of three failed cycles. A random effects meta-analysis was conducted reporting pooled odds ratios between groups using IBM SPSS v29.0.2.0 (20). The review was prospectively registered on PROSPERO:CRD42024580037. RESULTS: A total of 13 studies were included with low-to-moderate risk of bias. Eleven studies addressed PGT-A after an RIF diagnosis while two studies addressed RIF prevalence after successive PGT-A cycles. Four studies reported a statistically significant increase in CLBR with OR 4.23 [95% CI: 2.14, 8.38]. Similar results were seen in studies reporting a single embryo transfer using PGT-A following an RIF diagnosis, OR 2.79 [95% CI: 1.90, 4.10]. CONCLUSIONS: PGT-A results in a statistically significant increase in both LBR per embryo transfer and CLBR per cycle. This finding supports the hypothesis that RIF may be an embryological phenomenon. Further research is required before routine recommendation of PGT-A for the management of RIF can be inferred.
Prophylactic carbetocin versus oxytocin following vaginal delivery among women with high risk for postpartum hemorrhage: A before-and-after study.
Sauvee M, Lefizelier E, Ropers L … +2 more , Dimet J, Ducarme G
Acta Obstet Gynecol Scand · 2026 May · PMID 41736500 · Full text
INTRODUCTION: Data with a high level of evidence is lacking on the use of prophylactic uterotonic drug following vaginal delivery to prevent postpartum hemorrhage (PPH) among women who were considered high-risk for PPH....
INTRODUCTION: Data with a high level of evidence is lacking on the use of prophylactic uterotonic drug following vaginal delivery to prevent postpartum hemorrhage (PPH) among women who were considered high-risk for PPH. Our main objective was to compare the effectiveness of prophylactic carbetocin versus oxytocin in preventing PPH after vaginal delivery among women at high risk. MATERIAL AND METHODS: We conducted a retrospective before-and-after single-center comparative study, including all high-risk women after vaginal births. Two consecutive 14-month periods were compared, where the prophylactic methods to prevent PPH differed: oxytocin (5 IU IV) versus carbetocin (100 μg IV) given immediately after vaginal delivery. High-risk women were defined by at least one of the following criteria: previous PPH (blood loss ≥500 mL), antenatal suspicion of macrosomia (estimated fetal weight >90th p), twin pregnancy, repeated cervical ripening methods, polyhydramnios, multiparity (≥4), and rapid labor (<2 h) without analgesia. The primary outcome was PPH. Secondary outcomes included severe PPH (blood loss ≥1000 mL), second-line uterotonic agents, surgical hemostatic procedures, uterine artery embolization, and maternal morbidity. Groups were matched 1:1 by risk criteria. Outcomes were assessed using univariate analysis, multivariable logistic regression, and propensity score adjustment. RESULTS: A total of 754 women (377 per group) were included. Maternal and labor characteristics were comparable. Rates of PPH and severe PPH were similar with carbetocin versus oxytocin (7.4% vs. 9.3%, p = 0.36; 2.9% vs. 2.7%, p = 0.83). The need for second-line uterotonics (additional oxytocin and/or sulprostone) was significantly lower with carbetocin (3.7% vs. 12.2%, p < 0.001). Other secondary outcomes did not differ. After adjustment for potential confounders (history of PPH, BMI, intrapartum fever), prophylactic carbetocin was not associated with increased risk of PPH (aOR = 1.85, 95% CI [0.97 to 3.57]). Propensity score analysis confirmed these findings (aOR = 1.33, 95% CI [0.74 to 1.72]). CONCLUSIONS: Prophylactic carbetocin was associated with a similar rate of PPH in high-risk women after vaginal delivery, compared with oxytocin, but significantly reduced the use of oxytocin when carbetocin was used as the first-line agent, although there was no difference in the use of prostaglandins or invasive procedures to manage persistent PPH.
Placental pathology in gestational diabetes mellitus: Associations with neonatal outcomes and postpartum dysglycemia.
Chavanisakun C, Tangjitgamol S, Phaloprakarn C
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41736257 · Full text
INTRODUCTION: Gestational diabetes mellitus (GDM) is associated with adverse outcomes in both pregnancy and the postpartum period. Although placental pathology has been extensively studied in relation to neonatal complic...
INTRODUCTION: Gestational diabetes mellitus (GDM) is associated with adverse outcomes in both pregnancy and the postpartum period. Although placental pathology has been extensively studied in relation to neonatal complications, its relevance to maternal health after delivery remains less well defined. This study aimed to compare gross and histologic placental features between GDM and normoglycemic pregnancies according to the Amsterdam Placental Workshop Group Consensus Statement. It also evaluated associations between specific placental lesions and both neonatal outcomes and maternal dysglycemia at 6 weeks postpartum in the GDM cohort. MATERIAL AND METHODS: This prospective observational cohort study included 200 women with GDM and 100 normoglycemic women who delivered at term. Placental examination comprised gross and histologic evaluation of lesions classified according to the Amsterdam criteria, including maternal and fetal vascular malperfusion, as well as commonly reported non-classified lesions such as chorangiosis and delayed villous maturation (DVM). Neonatal outcomes assessed were large-for-gestational-age status, low 1-min Apgar scores (<7), and neonatal hypoglycemia. Postpartum maternal dysglycemia at 6 weeks was assessed using a 75-g, 2-h oral glucose tolerance test and classified as prediabetes or type 2 diabetes mellitus. Associations were evaluated using logistic regression analysis. RESULTS: Placental lesions were significantly more common in GDM than in normoglycemic pregnancies. These included maternal vascular malperfusion (67.5% vs. 39.0%, p < 0.001), fetal vascular malperfusion (49.0% vs. 22.0%, p < 0.001), chorangiosis (51.0% vs. 11.0%, p < 0.001), and DVM (17.0% vs. 8.0%, p = 0.034). DVM was independently associated with large-for-gestational-age infants (adjusted odds ratio [aOR] = 2.54, 95% confidence interval [CI] = 1.03-6.24) and low 1-min Apgar scores (aOR = 4.59, 95% CI = 1.08-19.63). Chorangiosis was independently associated with maternal dysglycemia at 6 weeks postpartum (aOR = 2.33, 95% CI = 1.07-5.07), an association primarily driven by prediabetes (aOR = 2.74, 95% CI = 1.22-6.15). Gross placental measurements did not differ significantly between groups. CONCLUSIONS: GDM is associated with various placental abnormalities, including Amsterdam-classified and non-classified lesions. DVM was associated with adverse neonatal outcomes, whereas chorangiosis was associated with postpartum dysglycemia. Systematic placental examination may aid in identifying women at risk of future metabolic disease.
Consent, pornography use, and perceived impact on sexual behavior among women.
Casper M, Tydén T, Sundström-Poromaa I … +1 more , Gyllenberg F
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41729062 · Publisher ↗
INTRODUCTION: The aim was to explore how women in Sweden report use of pornography and how they perceive the impact of pornography on their own sexuality and that of others, particularly in relation to sexual consent. MA...
INTRODUCTION: The aim was to explore how women in Sweden report use of pornography and how they perceive the impact of pornography on their own sexuality and that of others, particularly in relation to sexual consent. MATERIAL AND METHODS: This cross-sectional study included 557 women visiting a gynecological clinic for contraceptive counseling in 2023. A mixed-methods approach was used, combining quantitative and qualitative analyses. RESULTS: Three quarters of women (78%, n = 431) reported having used pornography at least once. Among users, 73% used pornography less than once a month, 20% monthly, and 7% weekly or daily. Participants were more likely to report that others' sexual behavior was influenced by pornography than their own. Thematic analysis of open-ended answers identified several key perceived effects of pornography, including the creation of unrealistic expectations, impacts on relational intimacy, reinforcement of unattainable beauty standards, normalization of non-consensual acts and harmful gender roles, as well as its role in sexual discovery. Regarding sexual consent, 63% reported being asked for consent during their most recent sexual encounter, although 98% affirmed having experienced consent on that occasion. Overall, pornography users were less likely to have been asked for consent as compared to non-users (p = 0.03), and regular pornography users were more likely to report not experiencing consent during the latest sexual encounter (p = 0.03) as compared to non-regular users. CONCLUSIONS: Based on the thematic analysis, use of pornography had the potential to influence perceptions of sexuality and intimacy, with both positive and negative aspects. Additionally, pornography use was associated with a decreased likelihood of sexual consent. Considering Sweden's sexual education programs and the Consent Law (2018), these findings highlight the need to integrate pornography literacy into sexual education.
Discrepancy in menstrual and ultrasound-based gestational age is associated with chromosomal aberrations and adverse pregnancy outcomes-Results from a nationwide cohort study.
Hansen S, Petersen OB, Vogel I … +7 more , Pedersen NG, Pedersen LH, Kristensen SE, Sundberg K, Thorup E, Vedel C, Gadsbøll K
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41725333 · Full text
INTRODUCTION: In women with a regular cycle, reliable last menstrual period (LMP), and accurate crown-rump length (CRL) estimation, discrepancies in estimated date of delivery (EDD) may indicate impaired fetal growth and...
INTRODUCTION: In women with a regular cycle, reliable last menstrual period (LMP), and accurate crown-rump length (CRL) estimation, discrepancies in estimated date of delivery (EDD) may indicate impaired fetal growth and increased risk of morbidity. This study examines whether discrepancies between EDD based on LMP (EDD) and CRL (EDD) are associated with chromosomal aberrations, adverse pregnancy outcomes, and obstetric complications. MATERIAL AND METHODS: A Danish nationwide register-based cohort study including all singleton pregnancies with both CRL and LMP registered between 2008 and 2018. Exclusion criteria were uncertain LMP, irregular menstrual cycle, EDD discrepancies >±28 days, assisted reproductive technology, and missing outcome data. The cohort was stratified into seven groups according to EDD-EDD discrepancy. Negative discrepancies indicated smaller-than-expected CRL, positive discrepancies indicated larger-than-expected CRL, and ±3 days served as reference. Outcomes included chromosomal aberrations, major structural malformations, pregnancy loss, termination of pregnancy, fetal growth restriction, preterm birth, and obstetric complications (preeclampsia, preterm pre-labour rupture of membranes, placenta previa, and placental abruption). Prevalence with 95% confidence intervals and adjusted odds ratios (aOR) were calculated. RESULTS: A total of 262 329 pregnancies were included; 16% had smaller and 21% had larger CRL than expected from LMP. Negative discrepancies were significantly associated with increased risk of chromosomal aberrations, adverse pregnancy outcomes, and obstetric complications. In the -8 to -14 days group, 1.28% had a chromosomal abnormality (aOR 2.77 [95% CI 2.30-3.31]), and risk remained elevated among pregnancies at low combined first-trimester screening risk (aOR 1.95 [1.55-2.43]). For triploidy and trisomy 18, 91% and 59% of cases, respectively, had discrepancies of <-3 days. In the -8 to -14 days group, adverse pregnancy outcome occurred in 11.0% (aOR 1.49 [1.40-1.59]), and 6.5% had obstetric complications, mainly preeclampsia (aOR 1.19 [1.10-1.29]). Conversely, positive discrepancies were associated with reduced risk of chromosomal abnormalities (aOR 0.67 [0.44-0.96]) and adverse pregnancy outcomes (aOR 0.77 [0.69-0.86]) in the +8 to +14 days group. CONCLUSIONS: A smaller than expected CRL was strongly associated with chromosomal aberrations, adverse pregnancy outcomes, and obstetric complications. Incorporating EDD discrepancies into risk algorithms for genetic disease, growth restriction, and preeclampsia may improve prediction and warrants further study.
Psychometric and clinical validation of the fear of childbirth questionnaire in a UK population.
Sheen K, Hunter R, Lyon C … +5 more , Houghton G, Lane S, Wilson J, Quigley TL, Slade P
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41703693 · Full text
INTRODUCTION: Severe fear of childbirth (FOC) during pregnancy holds significant implications for maternal mental health, decisions about mode of birth, and potentially infant development. Until recently, there were no t...
INTRODUCTION: Severe fear of childbirth (FOC) during pregnancy holds significant implications for maternal mental health, decisions about mode of birth, and potentially infant development. Until recently, there were no tools available to measure FOC within a UK population that assessed the full construct using acceptable phraseology. A new tool, the Fear of Childbirth Questionnaire, has been developed but requires full psychometric evaluation. This study aimed to assess the validity and reliability of the Fear of Childbirth Questionnaire and examine possible threshold scores indicating clinical severity. MATERIAL AND METHODS: Pregnant women (N = 540) completed the Fear of Childbirth Questionnaire online alongside additional measures for current/previous obstetric history, anxiety, and depression to test dimensions of validity (ISRCTN62032021). Most women (N = 360) then completed the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders 5th Edition (Research Version) Module F (phobia) with trained interviewers over the telephone. Sensitivity and specificity were calculated. A subsample (N = 61) repeated Fear of Childbirth Questionnaire completion 2 weeks later to inform test-retest reliability. Internal consistency, validity (convergent, discriminant, and criterion-related), unidimensionality, and factor structure were examined. RESULTS: Internal consistency was excellent (α = 0.89; ω = 0.89) and test-retest reliability was good (r = 0.87). Strong association with the Fear of Birth Scale (r = 0.69) indicated convergent validity. Discriminant validity was indicated via moderate correlations with general measures for anxiety (r = 0.40-0.53), and less so with those of depression (r = 0.35). Scores were higher for those with current/previous mental health difficulties, previous birth trauma, those preferring an epidural, and those preferring a planned cesarean section, indicative of criterion-related validity. An optimal cut-off value of ≥33 total score and ≥4 current impact score is recommended to initiate further exploration of support/intervention needs (ROC Area under the curve = 0.80, 95% CI 0.75:0.85; sensitivity 71.9, specificity 85.4, positive predictive value 39.0, negative predictive value 95.9). CONCLUSIONS: The Fear of Childbirth Questionnaire is psychometrically robust and can identify FOC at levels commensurate with a clinical phobia. It is the only tool purposefully developed and clinically validated to identify FOC in a UK population.
Abuse history as a modifier of symptom phenotype in endometriosis: Insights from a multidimensional retrospective cohort.
Freger SM, Cavalier S, Cornea M … +3 more , Aharoni S, Shetty R, Leonardi M
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41703692 · Full text
INTRODUCTION: Endometriosis is a heterogeneous pain condition with variable symptom expression. Abuse history has been associated with amplified pain, gastrointestinal symptoms, and central sensitization in varying popul...
INTRODUCTION: Endometriosis is a heterogeneous pain condition with variable symptom expression. Abuse history has been associated with amplified pain, gastrointestinal symptoms, and central sensitization in varying populations; however, whether these effects are compounded in patients with endometriosis and their intersection has not been well studied. Understanding these associations is clinically relevant, as unrecognized psychosocial contributors may compound diagnostic delay and hinder individualized treatment. MATERIAL AND METHODS: In this retrospective cohort study at a tertiary referral center, 235 patients presenting for pelvic pain evaluation (2018-2023) were stratified into four groups according to endometriosis identified on expert transvaginal ultrasound and self-reported abuse history. Ultrasound examinations followed IDEA consensus standards, with validated accuracy at our site for deep and ovarian endometriosis (site sensitivities 85%-100%, specificities ≥97%). Symptoms were assessed using validated measures: visual analog scales for chronic pelvic pain, the Central Sensitization Inventory (CSI), the Gastrointestinal Quality of Life Index (GIQLI), and the Female Sexual Function Index (FSFI). Primary outcomes were pain intensity, central sensitization, and GIQLI scores; secondary outcomes included prevalence of specific GI symptoms and sexual function. Group comparisons used nonparametric and Chi-squared tests with Bonferroni correction. RESULTS: Participants with both endometriosis and an abuse history reported significantly higher chronic pelvic pain (p = 0.006, η = 0.07, 95% CI: 0.02-0.12), greater CSI scores (p = 0.027, η = 0.04, 95% CI: 0.01-0.09), and lower GIQLI scores (p = 0.010, η = 0.05, 95% CI: 0.01-0.10) compared with other groups. Nausea (p < 0.001) and bloating (p = 0.008) were also more prevalent in this subgroup. No significant differences were observed for dysmenorrhea, dyspareunia, or FSFI scores (p = 0.091). CONCLUSIONS: A combined history of endometriosis and abuse was associated with a high symptom burden characterized by pain amplification, GI distress, and central sensitization. These findings underscore the importance of early psychosocial screening and trauma-informed care as complements to biomedical management in endometriosis. Prospective studies incorporating validated trauma measures and treatment covariates are warranted to clarify mechanisms and inform multidisciplinary care.
Why do the Nordic countries allow colposcopy to be a weak link in the cervical cancer screening chain?
Kalliala I, Milerad H, Trope AEC … +1 more , Hammer A
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41703657 · Full text
Abstract loading — click title to view on PubMed.
Urinary alcohol and ethyl glucuronide as a screening tool for alcohol use in pregnancy: A multicenter prospective study.
McCormick CA, Mealy G, Donaghy C … +8 more , Gordon P, Dunn E, Carroll P, Rodriguez-Herrera A, Cusnaider CM, Ebbitt W, McCormick PA, McAuliffe FM
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41703595 · Full text
INTRODUCTION: Reports indicate that up to 60% of pregnant women in Ireland consume alcohol and Ireland may have the third highest prevalence of fetal alcohol syndrome in the world. We sought objective evidence of alcohol...
INTRODUCTION: Reports indicate that up to 60% of pregnant women in Ireland consume alcohol and Ireland may have the third highest prevalence of fetal alcohol syndrome in the world. We sought objective evidence of alcohol intake and the acceptability of urinary alcohol screening. MATERIAL AND METHODS: This was a multicenter, prospective study conducted at one urban and two semirural maternity units. Pregnant women at their first visit (≈13 weeks gestation) were invited to participate. Urinary samples were obtained with individual consent. Samples were anonymized and tested for alcohol and ethyl glucuronide at a central laboratory. The rate of sample positivity for ethanol (at a cut-off of 30 mg/dL) and ethyl glucuronide (at a cut-off of 500 ng/mL) was reported. The percentage of women consenting to testing was recorded. Results were compared with previous questionnaire or interview-based studies. RESULTS: One thousand fifty-three urine samples were analyzed. None tested positive for ethanol but 4/1053 (0.38%) contained ethyl glucuronide. Three samples were positive in the urban cohort, 3/730 (0.41%) and 1/323 (0.31%) in the semirural centers. Consent was obtained in 96% and 98% in two semirural centers compared to 78% in the urban center (565/722 vs. 323/336. p < 0.01). Acceptability in the urban center depended on who requested consent and varied between 65% and 100% (p < 0.01). Consent to participate was significantly higher and detected alcohol use was significantly lower than in previous, interview or questionnaire-based studies. CONCLUSIONS: Alcohol intake appears to be much less common than previously estimated. The consent rates for urinary alcohol testing are high and are influenced by who is requesting consent.
Correction to "Importance of antenatal identification of small for gestational age fetuses on perinatal and childhood outcomes: A register-based cohort study".
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41703430 · Full text
Abstract loading — click title to view on PubMed.
Is it safe to preserve uterus after live birth following progestin-based fertility-sparing treatment for endometrial cancer or atypical hyperplasia: A long-term retrospective cohort study.
Wang Y, Liu Y, Feng Y … +7 more , Bo L, Xiao Z, Wang H, Tian L, Lu Q, Zhou R, Wang J
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41700096 · Full text
INTRODUCTION: We aimed to assess the safety of continuous uterus-preserving treatment among patients with endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) who gave birth after progestin-based fertility-...
INTRODUCTION: We aimed to assess the safety of continuous uterus-preserving treatment among patients with endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) who gave birth after progestin-based fertility-sparing treatment (FST). MATERIAL AND METHODS: From January 2005 to June 2020, we conducted a retrospective cohort study at Peking University People's Hospital, China, comprising 212 patients with EC or AEH who underwent FST. The participants were categorized into two groups based on the reproductive outcome of live birth. Risk factors were analyzed for disease recurrence in the entire cohort, and additional analysis was conducted on postpartum recurrence specifically in the live birth group. RESULTS: Of 212 eligible patients, 73 had a live birth, and 139 did not have a live birth after FST. Multivariable Cox analysis showed that live birth significantly reduced the risk of disease recurrence (HR 0.326, p = 0.011), while insulin resistance was identified as an adverse factor (HR 3.216, p = 0.014). Except for two patients who underwent hysterectomy, among 71 patients undergoing uterus preservation after live birth, five (7%) patients experienced disease relapse (two EC and three AEH) after a median follow-up of 26 (11, 47.5) months. Four out of these five patients with recurrence achieved a complete response after a second round of FST. Eight other patients (11.3%) experienced hyperplasia without atypical (EH) after live birth. Potential risk factors for postpartum recurrence of EC/AEH included irregular menstruation (80% vs. 39%; p = 0.153), abnormal ultrasonographic findings (60% vs. 18.6%; p = 0.065), and increased endometrial thickness (0.82 cm vs. 0.55 cm; p = 0.017). While postpartum maintenance therapy was identified as a protective factor against recurrence (0% vs. 62.5%; p = 0.012). Notably, patients with postpartum recurrence may achieve a complete response with repeat FST. CONCLUSIONS: Although live birth was associated with improved recurrence-free survival in patients with EC or AEH receiving FST, postpartum recurrence remains a concern. Irregular menstruation and abnormal ultrasound findings were identified as key risk factors for recurrence, while maintenance therapy exhibited a protective effect. These findings highlight the need for vigilant postpartum monitoring in this population.
The "White line sign": A novel sonographic soft marker of pelvic endometriosis.
Chaggar P, Barton-Smith P, Saridogan E … +2 more , Tellum T, Jurkovic D
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41693065 · Full text
INTRODUCTION: Ultrasound assessment of superficial endometriosis (SE) is difficult, and it is still mainly diagnosed via surgery. We hypothesized that a thickening of the subperitoneal layer of tissue overlying the anter...
INTRODUCTION: Ultrasound assessment of superficial endometriosis (SE) is difficult, and it is still mainly diagnosed via surgery. We hypothesized that a thickening of the subperitoneal layer of tissue overlying the anterior pouch of Douglas (POD), labeled the "White line sign" (WLS), could indicate the presence of SE. The aim of the study was to investigate the association between the WLS and the finding of endometriosis at histology. MATERIAL AND METHODS: This prospective diagnostic accuracy study included 100 premenopausal women with chronic pelvic pain who underwent transvaginal ultrasound (TVS) by a single expert operator and subsequent laparoscopy by a specialist surgeon between January 2021 and January 2023. To assess intra- and inter-observer reproducibility of the WLS, 36 consecutive ultrasound scans were recorded and re-evaluated 6 months later by the first operator and an independent, second operator, both blinded to the original and each other's findings. Outcomes of interest were the diagnostic accuracy of the WLS for predicting the presence of SE and deep endometriosis (DE) at histopathology, and the reproducibility of the WLS at TVS. The former was assessed by calculating specificity, sensitivity, and accuracy, and the latter by determining proportions of agreement and Cohen's kappa coefficient (κ), respectively. RESULTS: The WLS had high specificity [100% (95% CI, 2.5-100%)], but low sensitivity and accuracy for the detection of SE [30.6% (95% CI, 20.2-42.5%) and 31.5% (95% CI, 21.1-43.4%)], respectively. The WLS was highly sensitive, specific, and accurate for the identification of DE [79.7% (95% CI, 67.8-88.7%), 100% (95% CI, 66.4-100%), and 82.2% (95% CI, 71.5-90.2%)], respectively. The WLS was reproducible, demonstrated by good inter- and intra-rater agreement and reliability for its diagnosis on TVS [proportions of agreement 0.86 (95% CI, 0.69-0.95) and 0.83 (95% CI, 0.66-0.93), κ 0.72 (95% CI 0.49-0.94) and 0.64 (95% CI, 0.38-0.89)], respectively. CONCLUSIONS: Our study demonstrated that the WLS could be a valuable soft marker of both SE and DE. This is particularly useful in cases where no other or only subtle signs of endometriosis are present on scan.
Outcomes of antenatal hydronephrosis and other renal abnormalities in a population-based cohort.
Evertsson A, Bäckstrand J, Öhman MO … +2 more , Sjöström S, Carlsson Y
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41693016 · Full text
INTRODUCTION: Hydronephrosis, commonly detected during second trimester ultrasound screenings, can signal underlying renal abnormalities. In 2018, Sweden introduced a national guideline recommending follow-up for fetal r...
INTRODUCTION: Hydronephrosis, commonly detected during second trimester ultrasound screenings, can signal underlying renal abnormalities. In 2018, Sweden introduced a national guideline recommending follow-up for fetal renal pelves with an anteroposterior diameter (APD) ≥6 mm at the second trimester ultrasound. This study evaluates the impact of the guideline by assessing the incidence and resolution of hydronephrosis and other renal abnormalities. Secondary outcomes included postnatal renal function, frequency of febrile urinary tract infections (UTI), and the need for surgical intervention before the age of 2. MATERIAL AND METHODS: This prospective cohort study included fetuses diagnosed with hydronephrosis or other renal abnormalities during second trimester ultrasounds between November 2019 and October 2022. Maternal and child characteristics were compared with data from the Swedish Pregnancy Register. Pre- and postnatal outcomes up to 2 years of age were assessed for fetuses detected antenatally. Outcomes were compared to children diagnosed postnatally within the first 2 years of life and not identified prenatally. RESULTS: Over 3 years, 31 094 second trimester ultrasounds were performed. Hydronephrosis or other renal anomalies were identified in 0.5% (n = 155); approximately 40% resolved by week 32, and seven additional third-trimester detections brought the total number of antenatal cases to 162. By age 2, only 42% had persistent renal abnormalities. A retrospective ICD-10 review identified 45 additional children diagnosed postnatally following symptoms before age 2, yielding an antenatal detection rate of 78.3% (162/207). Baseline demographics were similar between antenatal and postnatal groups and matched those in the Swedish Pregnancy Register. Antenatally detected cases showed diverse anomalies-primarily multicystic dysplastic kidney, duplex kidney, pelviureteric junction obstruction, and vesicoureteral reflux (VUR)-whereas postnatally detected cases were predominantly VUR. Febrile UTI requiring admission occurred in 11.8% of antenatal versus 71.7% of postnatal children (p < 0.0001); surgery rates were similar between groups. CONCLUSIONS: The centralized structure of care enabled a comprehensive, population-based cohort with near-complete follow-up. The detection rate of hydronephrosis during second trimester ultrasound is high, reaching ~80%. Given the high rate of spontaneous resolution, the national guideline threshold (APD ≥6 mm) appears to strike a reasonable balance between sensitivity and clinical practicality.
A core outcome set and reporting checklist for research on critically ill obstetric patients: An international consensus study.
Yeretsian T, Viau-Lapointe J, Ashraf R … +2 more , D'Souza R, Lapinsky SE
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41693014 · Full text
INTRODUCTION: Our objective was to develop a Core Outcome Set for Research on Critically Ill Obstetric Patients (COSCO) through international consensus, with the aim of improving consistency, comparability, and clinical...
INTRODUCTION: Our objective was to develop a Core Outcome Set for Research on Critically Ill Obstetric Patients (COSCO) through international consensus, with the aim of improving consistency, comparability, and clinical relevance across studies involving this population. MATERIAL AND METHODS: This international, multi-method study was conducted between February 16, 2023, and January 18, 2024. The process included a two-round online Delphi survey, three small group discussions, and a final consensus meeting. Participants comprised health service users (HSUs) with lived experience of critical illness during pregnancy and healthcare professionals from diverse specialties and geographic regions. RESULTS: Sixty-eight participants (11 HSUs and 57 healthcare professionals) from 16 countries scored 23 candidate items identified through a systematic review and qualitative interviews. Through consensus, 10 core outcomes and 7 reporting checklist items were selected for inclusion in all research on critical illness in obstetrics. Core outcomes included maternal all-cause mortality; cardiac arrest and the need for cardiopulmonary resuscitation (not resulting in death); severe (maternal) organ dysfunction; length of stay in the intensive care unit (ICU) and total hospital stay; readmission to hospital or ICU or repeated hospital/emergency department visits following discharge from ICU; presence of a new medical condition at the time of discharge from hospital, which was not present at the time of admission to the hospital; permanent infertility as a consequence of critical illness or intervention; perinatal loss; severe neonatal morbidity requiring prolonged neonatal ICU admission; and gestational age/preterm birth. Four additional noncore outcomes were identified as important but may be challenging to measure consistently; these should be reported when relevant and feasible. CONCLUSIONS: COSCO provides a standardized, consensus-based framework for outcome reporting in research on critically ill obstetric patients. Its adoption will strengthen methodological rigor, reduce reporting heterogeneity, enhance comparability across studies, and support evidence-based, patient-centered guideline development.
Long COVID following SARS-CoV-2 infection during pregnancy: An observational study in a large Italian hospital during the COVID-19 pandemic.
Fichera A, Biancareddu E, Bozzo M … +5 more , Ezenwa M, Ongarini EP, Ferrari FG, Prefumo F, Odicino FE
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41685877 · Full text
INTRODUCTION: Despite mounting evidence on Long COVID, data regarding its impact on women infected during pregnancy remains scarce. This study aimed to assess the development of Long COVID in women who had been infected...
INTRODUCTION: Despite mounting evidence on Long COVID, data regarding its impact on women infected during pregnancy remains scarce. This study aimed to assess the development of Long COVID in women who had been infected with SARS-CoV-2 during pregnancy, focusing on possible risk factors and potential protective elements associated with its development. MATERIAL AND METHODS: We analyzed a cohort of 348 pregnant women with laboratory-confirmed SARS-CoV-2 infection admitted to ASST-Spedali Civili (Brescia, Italy) between March 2020 and May 2022. Data collection included demographics, comorbidities, COVID-19 severity markers, and vaccination status. To assess the possible association between the analyzed risk factors and Long Covid, beyond standard multivariable models, we employed inverse probability weighting techniques (IPTW) and calculated e-values to assess unmeasured confounding. RESULTS: Among study participants, 27.0% (94/348) developed Long COVID. Risk factors included preexisting respiratory comorbidities (adjusted OR = 3.171, 95% CI 0.99-10.1), pneumonia at admission (adjusted OR = 4.48, 95% CI 2.16-9.28), and earlier pregnancy stage at infection (adjusted OR = 0.96 per week, 95% CI 0.93-0.99). COVID-19 vaccination was associated with a significantly lower risk of Long COVID (15.5% in vaccinated vs. 31.8% in unvaccinated women; IPTW-adjusted OR = 0.38, 95% CI: 0.20-0.71, p-value: 0.003). The most common symptoms were fatigue (46.8%) and memory impairment (38.3%), with unvaccinated patients exhibiting a higher prevalence of neuropsychiatric symptoms. CONCLUSIONS: Our data suggest that one in four pregnant women hospitalized with COVID-19 develop persistent symptoms. The most frequently affected women had preexisting respiratory disease, pneumonia at admission, and infection earlier in pregnancy. COVID-19 vaccination appears to reduce risk and alter symptom presentation. These findings underscore the importance of vaccination throughout pregnancy and highlight the need for targeted surveillance in high-risk subgroups.
Impact of National Screening Programs on Down syndrome prevalence and outcomes.
Nordklev CB, Costa DR, Nilsen RM … +3 more , Morken NH, Vangen S, Sitras V
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41685714 · Full text
INTRODUCTION: Over the past five decades, antenatal screening programs have evolved significantly, primarily through advancements in ultrasound technology and the shift from invasive to non-invasive prenatal testing meth...
INTRODUCTION: Over the past five decades, antenatal screening programs have evolved significantly, primarily through advancements in ultrasound technology and the shift from invasive to non-invasive prenatal testing methods. This study aimed to evaluate the impact of these developments in prenatal screening for Down syndrome (DS) on the prevalence of live and stillbirths, as well as terminations of pregnancy (TOP) with DS. MATERIAL AND METHODS: This population-based registry study included all pregnancies in Norway from 1967 to 2021, with data on TOPs available from 1999. Information on DS pregnancies was obtained from the Medical Birth Registry of Norway. Logistic regression models were applied to evaluate time trends and maternal characteristics associated with TOP. RESULTS: Among 3 231 159 pregnancies, 4764 (0.147%) were affected by DS. The prevalence of DS pregnancies increased from 0.165% in 1999 to 0.251% in 2021. During this period, the proportion of TOP rose from 20% to 55%, while prenatal detection rates improved from 18% to 70%. Despite increased detection, the proportion of TOP following prenatal diagnosis remained stable at approximately 80%. The prevalence of live births with DS remained stable at approximately 0.106%, while the prevalence of stillbirths was around 0.008%. Maternal age, parity, country of birth, and region of residence were associated with TOP decisions. Mean gestational age at termination decreased from 17.5 to 15.7 weeks. CONCLUSIONS: Over recent decades, prenatal detection and termination of DS pregnancies have increased. However, the proportion of women continuing pregnancies after a prenatal diagnosis and the prevalence of live- and stillbirths with DS have remained stable.
Urinary tract infection during pregnancy and time relation to preterm birth-a Swedish observational study.
Dahlquist K, Stuart A, Källén K
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41684314 · Full text
INTRODUCTION: It is well known that urinary tract infection (UTI) during pregnancy is associated with preterm birth, but information about the risk of preterm birth depending on gestational week of infection is sparingly...
INTRODUCTION: It is well known that urinary tract infection (UTI) during pregnancy is associated with preterm birth, but information about the risk of preterm birth depending on gestational week of infection is sparingly described in the literature. MATERIAL AND METHODS: An observational study based on data from Swedish registers including women giving birth 2014-2020 (n = 684 595). Pregnant women with UTI diagnosis were identified by the ICD-10 codes (O230-O239, N300, N309, and N390) from the national patient registry. Hazard ratios (HR) for preterm birth after UTI diagnosis were calculated, considering the time elapsed after infection and interactions with gestational week at UTI diagnosis. Adjustments were made for maternal age, parity, previous caesarean section, body mass index, diabetes, and smoking. RESULTS: A diagnosis of UTI was detected in 2.8% of pregnant women. A significant association between UTI diagnosis and preterm birth was found. The aHR for preterm birth was most pronounced during the first week after a UTI diagnosis and was dependent on gestational week. The aHRs (with 95% CI) for preterm birth 0-6 days after UTI diagnosis were 18.5 (13.5-25.4), 13.5 (10.4-17.6), and 6.7 (5.6-8.0) for infections debuting week 22-27, 28-31, and 32-36, respectively. The corresponding aHRs for preterm birth 7-13 days after UTI diagnosis were 10.5 (7.2-15.2), 3.7 (2.4-5.7), and 2.9 (1.9-4.5). The increased risk for preterm birth was still significant 3 weeks or more after UTI diagnosis debuting at 22-27 weeks (aHR 2.5; 95% CI: 2.1-3.1) or at 28-31 weeks (aHR 3.2; 95% CI 2.0-4.6). CONCLUSIONS: UTI diagnosis during pregnancy is an important risk factor for preterm birth. The magnitude of the increased risk is highest 0-6 days after diagnosis; thereafter, it declines but remains significant throughout pregnancy until 37 weeks. The increased risk is especially elevated (and especially concerning) if UTI diagnosis was confirmed before 28 weeks of gestation.
Endometrial microbiota-targeted therapies for chronic endometritis-associated recurrent implantation failure and their impact on IVF outcomes: A systematic review and methodological quality assessment.
Doroftei B, Ilie OD, Dabuleanu Cretu AM … +4 more , Selaru I, Lunguleac G, Doroftei M, Ilea C
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41684313 · Full text
INTRODUCTION: Recurrent implantation failure (RIF) is a multifactorial reproductive disorder, often associated with chronic endometritis (CE) and alterations of the intrauterine microbiota. MATERIAL AND METHODS: This sys...
INTRODUCTION: Recurrent implantation failure (RIF) is a multifactorial reproductive disorder, often associated with chronic endometritis (CE) and alterations of the intrauterine microbiota. MATERIAL AND METHODS: This systematic review evaluated whether microbiota-targeted therapeutic interventions improve pregnancy outcomes in women with CE-associated RIF undergoing in vitro fertilization (IVF)-embryo transfer (ET). Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS) and the Revised Cochrane Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I). RESULTS: Four studies met the inclusion criteria, encompassing antibiotic, probiotic, and nutraceutical interventions. Considerable heterogeneity was observed in study design, diagnostic criteria, and microbiota assessment methods. Across studies, the reproductive outcomes revealed a clinical pregnancy rate of 50.5% (187/370), ongoing pregnancy rate of 40.1% (107/267), and live birth rate of 41.2% (105/255). Other reported outcomes included seven multiple pregnancies (8.3%), 39 miscarriages (20.0%), 35 biochemical pregnancies (17.9%), and one stillbirth (1.17%). CONCLUSIONS: Microbiota-targeted treatments may improve reproductive outcomes in women with CE-associated RIF; however, the limited number of available studies, small sample sizes, and methodological variability reduce the strength of current evidence. High-quality, prospective, confounder-adjusted trials with rigorous participant selection processes and standardized, validated diagnostic and implementation criteria are needed to confirm these findings and inform clinical practice.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe