Acta Obstetricia Et Gynecologica Scandinavica[JOURNAL]
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200 papers
Placenta accreta spectrum and uterine SCAR dehiscence: Distinct entities or a continuum? An expert debate and call for standardization.
Adu-Bredu T, Aryananda RA, Walker SP … +11 more , Owusu YG, Braun T, Soleymani Majd H, Viana Pinto P, Morel O, Mousa A, Bartels HC, Al Naimi A, Morlando M, Fox KA, Collins SL
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41673376 · Full text
Placenta accreta spectrum and uterine scar dehiscence in cases of low-lying or previa placentas have become an issue of intense debate among experts due to their common etiological origin. Some authors argue both conditi...
Placenta accreta spectrum and uterine scar dehiscence in cases of low-lying or previa placentas have become an issue of intense debate among experts due to their common etiological origin. Some authors argue both conditions as a continuum while others maintain their distinct nature, while acknowledging both conditions could occur simultaneously. This ongoing debate has significant implications for diagnosis, patient counseling, and management. In this article, we present both sides of this debate, discuss diagnostic and management challenges, and call for standardization of terminology.
Exposure to anesthesia during delivery and risk of autism spectrum disorder: A retrospective cohort study.
Ben Kish A, Binyamin Y, Michaelovski A … +2 more , Meiri G, Menashe I
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41672961 · Full text
INTRODUCTION: Despite the growing use of pain management during delivery, evidence regarding the association between different modes of obstetric anesthesia and autism spectrum disorder in offspring is mixed. MATERIAL AN...
INTRODUCTION: Despite the growing use of pain management during delivery, evidence regarding the association between different modes of obstetric anesthesia and autism spectrum disorder in offspring is mixed. MATERIAL AND METHODS: We conducted a retrospective cohort study of 98 630 singleton live births at a single hospital (2011-2019), with follow-up through January 2023. Participants were grouped by delivery and anesthesia type: (1) vaginal delivery without analgesia, (2) vaginal delivery with epidural, (3) cesarean with neuraxial anesthesia, and (4) cesarean with general anesthesia. Autism spectrum disorder (ASD) diagnosis was the primary outcome. Kaplan-Meier plots and Cox regression were used to assess cumulative incidence and hazard ratios. RESULTS: Of the cohort (51.2% male, 62.0% Bedouin), 21.2% were born by vaginal delivery with epidural, 3.8% by cesarean with neuraxial anesthesia, and 11.4% by cesarean with general anesthesia. Cumulative ASD incidence was higher in all exposure groups (vaginal delivery with epidural: 1.25%, cesarean with neuraxial anesthesia: 1.56%, cesarean with general anesthesia: 1.50%) than in vaginal delivery without analgesia (0.55%). Nevertheless, after adjustment for covariates, only cesarean with general anesthesia was significantly associated with increased ASD risk (aHR = 1.571; 99% CI: 1.12-2.22). CONCLUSIONS: These findings suggest that general anesthesia during cesarean delivery, but not neuraxial anesthesia or epidural use, might be associated with ASD risk. Further studies are needed to understand the underlying mechanisms.
Induced abortion, miscarriage, and the risk of breast cancer-A registry-based study from Finland.
Katuwal S, Männistö J, Niinimäki M … +2 more , Pukkala E, Heikinheimo O
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41668566 · Full text
INTRODUCTION: The potential effect of induced abortion and miscarriage on the risk of breast cancer has remained debated and has been a persistent source of misinformation. Many previous studies have been small and based...
INTRODUCTION: The potential effect of induced abortion and miscarriage on the risk of breast cancer has remained debated and has been a persistent source of misinformation. Many previous studies have been small and based on self-reported data. We assessed the associations of induced abortion and miscarriage with the risk of pre- and postmenopausal breast cancer using high-quality Finnish registry data. MATERIAL AND METHODS: This is a case-control study based on population-based registry data. It includes 31 687 women with breast cancer diagnosed between 1972 and 2021, and their 158 433 female population controls matched by birth year and parity. Data on induced abortions, miscarriages, deliveries, use of postmenopausal hormone therapy, socioeconomic status (SES), and occupation were collected from the Finnish national registries. Multivariate conditional logistic regression analysis was performed. RESULTS: The odds ratio (OR) of breast cancer among women with a history of induced abortion as compared with women with no history of induced abortion was 1.01 (95% confidence interval [CI] 0.92-1.10) in premenopausal (age <50 years) and 0.96 (95% CI 0.87-1.07) in postmenopausal (≥50 years) women. The corresponding ORs for miscarriage were 1.02 (95% CI 0.89-1.16) and 0.93 (95% CI 0.80-1.09). The OR did not vary significantly by the number of induced abortions or miscarriages, nor by the age at the time of first induced abortion or miscarriage. CONCLUSION: A history of induced abortion and miscarriage, regardless of their number or age of the woman, is not associated with an increased risk of subsequent pre- or postmenopausal breast cancer.
Enthusiasm to learn and standardization: Outdated concepts?
Matsubara S
Acta Obstet Gynecol Scand · 2026 Apr · PMID 41630381 · Full text
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Validity and accuracy of the Whooley questions to identify symptoms of depression in Norwegian postpartum women.
Rognmo K, Haga S, Garthus-Niegel S … +2 more , Wang CEA, Eberhard-Gran M
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41630375 · Full text
INTRODUCTION: Screening for postnatal depression is widely acknowledged as an important public health initiative. The Whooley case-finding questions are well suited for screening purposes in primary health care settings,...
INTRODUCTION: Screening for postnatal depression is widely acknowledged as an important public health initiative. The Whooley case-finding questions are well suited for screening purposes in primary health care settings, as the instrument is quick and easy to administer. However, the validity and diagnostic accuracy among postpartum women remain unclear. The purpose of the present study was to evaluate the validity and diagnostic accuracy of the Whooley questions compared to the Edinburgh postnatal depression scale (EPDS) in a community sample of postpartum women in Norway. The diagnostic accuracy of the Whooley questions was examined across different EPDS thresholds and compared to the measures of related constructs, including symptoms of childbirth-related post-traumatic stress disorder (PTSD) and anxiety. MATERIAL AND METHODS: Cross-sectional data were collected through an online questionnaire by postpartum women (0-52 weeks postpartum), recruited via social media, well-baby clinics, and other locations frequently visited by postpartum women. In total, 1154 women participated. The diagnostic accuracy of the Whooley questions was compared to three commonly used EPDS cutoffs (≥10, ≥12, and ≥13). RESULTS: The sensitivity of the Whooley questions relative to the EPDS was high and increased with higher thresholds for defining depression, correctly identifying 89% (EPDS ≥10), 96% (EPDS ≥12), and 97% (EPDS ≥13) of cases. Specificity was somewhat lower, at 0.82 (EPDS ≥10), 0.77 (EPDS ≥12), and 0.75 (EPDS ≥13). Positive predictive values were low, whereas negative predictive values were excellent, ranging from 0.97 (EPDS ≥10), through 0.99 (EPDS ≥12) to 1.00 (EPDS ≥13), increasing with higher thresholds. Convergent and divergent validity were supported by strong correlations with EPDS scores and moderate correlations with symptoms of childbirth-related PTSD and anxiety. CONCLUSIONS: The Norwegian version of the Whooley questions demonstrates strong psychometric properties, supporting their usefulness as a case-finding tool for depression among postnatal women.
Nine years' experience of trial of labor after two previous cesarean sections at a tertiary hospital - A retrospective cohort study.
Lee KZX, Sesurajan BP, Ramlal H … +7 more , Lim TY, Choolani M, Kalaichelvan V, Su LL, Ismail-Pratt I, Mattar CNZ, Li SWL
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41610023 · Full text
INTRODUCTION: The global cesarean section (CS) rate has increased to 21.1% between 1990 and 2018. In Singapore, the annual CS rate has increased by ~ 0.6%, reaching an overall rate of 37.4%. Almost one-third of all cesar...
INTRODUCTION: The global cesarean section (CS) rate has increased to 21.1% between 1990 and 2018. In Singapore, the annual CS rate has increased by ~ 0.6%, reaching an overall rate of 37.4%. Almost one-third of all cesarean deliveries are performed for at least one previous CS. Women with two CSs are often denied a "trial of vaginal delivery" due to the increased risk of uterine scar rupture. This study aims to examine maternal and neonatal outcomes of women undergoing trials of labor following two CSs (TOLAC-2). MATERIAL AND METHODS: We conducted a retrospective observational study of women with singleton, term pregnancies in cephalic presentation who underwent TOLAC-2 at the National University Hospital, Singapore, between September 2013 and June 2022. Data were obtained through a detailed review of electronic medical records. RESULTS: Among 898 women with two previous CSs, 7.0% (63/898) attempted TOLAC-2, of whom 55.6% (35/63) achieved a successful vaginal birth (VBAC-2). Successful TOLAC-2 was associated with a significantly shorter duration of active labor (5.0 vs. 7.7 h, p = 0.013) and lower estimated blood loss (242mLs vs. 423mLs, p ≤ 0.001) compared with failed TOLAC-2. There were no perinatal complications of uterine rupture, APGAR <7 at 5 minutes, meconium aspiration syndrome or hypoxic-ischemic encephalopathy. We observed a trend toward successful VBAC-2 in women with a history of prior vaginal birth (74.6% vs. 48.9% p = 0.07). CONCLUSIONS: In our cohort, more than half of the women attempting TOLAC-2 at term achieved a successful vaginal birth without serious perinatal or maternal complications. TOLAC-2 is a safe and reasonable option for appropriately selected women following adequate counseling, even in the absence of a prior vaginal delivery.
Differences in prediction of adverse perinatal outcome in term pregnancies by choice of fetal growth reference: A validation study.
Lindström L, Ahlsson F, Axelsson O … +4 more , Granfors M, Lampa E, Nelander M, Wikström AK
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41606993 · Full text
INTRODUCTION: Our objectives were to evaluate the association between fetal growth abnormalities and adverse perinatal outcomes in term pregnancies using four different fetal growth references: the recently published Swe...
INTRODUCTION: Our objectives were to evaluate the association between fetal growth abnormalities and adverse perinatal outcomes in term pregnancies using four different fetal growth references: the recently published Swedish references by Lindström et al., the currently used Swedish references by Maršál et al., and the international standards by the WHO and INTERGROWTH-21st (IG21st). The study aimed to evaluate the performance of each reference and determine which reference most accurately identifies small for gestational age (SGA) infants at risk of perinatal mortality and morbidity. MATERIAL AND METHODS: This population-based cohort study included 1 126 059 singleton term births in Sweden from 2010 to 2020. Data were obtained from national registers, including the Swedish Medical Birth Register and the Swedish Neonatal Quality Register. Birthweight centiles were calculated using each growth reference. Adverse perinatal outcomes were categorized by severity and included stillbirth, neonatal death, and serious neonatal morbidity. Logistic regression models were used to assess predictive performance, and sensitivity and false positive rates (FPR) were calculated for SGA thresholds (<3rd and <10th centiles). RESULTS: The distribution of birthweight centiles varied significantly across references. For SGA <3rd centile, the rate ranged from 9.6% for Lindström, 2.5% for Maršál, 1.9% for WHO, to 0.7% for IG21st. All references showed similar overall predictive performance (C-index ≈ 0.67) but with different discriminatory ability. The predicted risk of perinatal death increased at lower centiles for the Lindström reference than for the Maršál and WHO references, and at higher centiles for the IG21st reference. The Lindström reference identified the highest proportion of infants as SGA and had the highest sensitivity but also the highest FPR for detecting adverse outcomes. The IG21st reference classified the smallest proportion as SGA, resulting in the lowest sensitivity and FPR. CONCLUSIONS: While all fetal growth references showed comparable predictive ability for adverse perinatal outcomes, they differed substantially in sensitivity and FPR. When the top priority is to identify as many at-risk fetuses as possible, Lindström et al.'s reference seems to be the best choice. However, when the top priority is a balanced sensitivity versus FPR, the WHO reference seems most suitable for clinical practice in this population of term births.
Prognostic value of fetal growth and prenatal functional echocardiography in tetralogy of FALLOT.
Nogué L, Bennasar M, Guirado L … +9 more , Zölner F, Reitz J, Axt-Fliedner R, Escobar-Díaz MC, Martínez JM, Gratacós E, Crispi F, Gómez O, BCNatal and Gießen and Marburg University investigators
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41604333 · Full text
INTRODUCTION: Tetralogy of Fallot (ToF) shows variability in neonatal outcomes, and identifying reliable prenatal predictors is essential for optimizing perinatal management. The aim of this study was to determine the pr...
INTRODUCTION: Tetralogy of Fallot (ToF) shows variability in neonatal outcomes, and identifying reliable prenatal predictors is essential for optimizing perinatal management. The aim of this study was to determine the prognostic value of feto-placental data and prenatal echocardiography in the third trimester in ToF and to compare these findings with a matched control population. MATERIAL AND METHODS: Multicenter prospective cohort study (2011-2023) at two referral centers (BCNatal and University Hospital of Gießen and Marburg). The cohort included 63 fetuses with isolated ToF and 66 healthy controls. All fetuses underwent a third trimester ultrasound and comprehensive echocardiography with 2D speckle tracking. Severe small-for-gestational age (SGA) was defined as estimated fetal weight (EFW) below the third percentile. Adverse composite outcomes were defined as the need for prostaglandin infusion, surgery or ductal stenting, corrective surgery before 3 months, and/or neonatal intensive care unit stay ≥7 days. The association of feto-placental and cardiac data with adverse composite outcome was evaluated. RESULTS: Compared with controls, ToF fetuses showed higher rates of severe SGA (19% vs. 0%, p < 0.001). Cardiac findings showed mild biventricular concentric hypertrophy (relative wall thickness ToF 0.7 [0.5-0.9] vs. controls 0.5 [0.5-0.6], p = 0.001), and reduced deformation (right and left ventricular global longitudinal strain: ToF -17.3% ± 3.8 vs. controls -19.3% ± 3.1, p = 0.001; ToF -18.0% ± 3.8 vs. controls -20.9% ± 3.45, p < 0.001), regardless of placental dysfunction. The adverse composite outcome occurred in 29.3% of ToF cases with pulmonary stenosis. Within this group, EFW <3rd centile (adjusted OR 9.17) and PV peak systolic velocity (aOR 1.03) showed the strongest association with adverse outcomes. Their combined performance yielded an AUC of 0.734, with a predictive value of 71.4% at a 20% false-positive rate. Assessed individually, the AUC was 0.650 for PV peak systolic velocity and 0.639 for estimated fetal weight. Optimal PV Doppler cutoff values were >70 cm/s when EFW was <3rd centile, and >144 cm/s when EFW was above the 3rd centile. CONCLUSIONS: Combining EFW with PV artery Doppler may allow identification of a high-risk subgroup of ToF-PS fetuses who may benefit from closer prenatal monitoring and prompt neonatal care.
Comparison of severe maternal morbidity between pregnancy with subclinical hypothyroidism and overt hypothyroidism.
Aberle LS, Bayard KE, Juarez KM … +8 more , Yao JA, Matsuzaki S, Miyake T, Masjedi AD, Mandelbaum RS, Nguyen CT, Ouzounian JG, Matsuo K
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41591760 · Full text
INTRODUCTION: Maternal outcomes of pregnancy with subclinical hypothyroidism continue to be active areas of research interest. The objective of this study was to compare severe maternal morbidity at delivery between preg...
INTRODUCTION: Maternal outcomes of pregnancy with subclinical hypothyroidism continue to be active areas of research interest. The objective of this study was to compare severe maternal morbidity at delivery between pregnant patients with subclinical hypothyroidism and those with overt hypothyroidism. MATERIAL AND METHODS: This cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. Study population included 11 620 hospital deliveries with a diagnosis code of subclinical hypothyroidism and 697 320 hospital deliveries with a diagnosis code of overt hypothyroidism. Main outcome was severe maternal morbidity per the Centers for Disease Control and Prevention definition (20 indicators), assessed with multivariable generalized linear model. RESULTS: Pregnancy with subclinical hypothyroidism was associated with a 54% higher rate of severe maternal morbidity at delivery compared with those with overt hypothyroidism (18.1 and 11.1 per 1000 deliveries, adjusted-incidence rate ratio [aIR] 1.54, 95% confidence interval [CI] 1.34-1.76). Among the individual severe maternal morbidity indicators, the incidence rate of eclampsia (2.2 versus 0.7 per 1000 deliveries, aIR 2.73, 95% CI: 1.83-4.09) was particularly higher among pregnancies with subclinical hypothyroidism compared with pregnancies with overt hypothyroidism. In an exploratory evaluation according to patient demographics, maternal age younger than 25 years (31.9 vs. 9.4 per 1000 deliveries, aIR 3.62, 95% CI: 2.62-5.01), Black individuals (55.2 vs. 24.7 per 1000 deliveries, aIR 2.21, 95% CI: 1.60-3.06), pregestational hypertension (70.2 vs. 27.2 per 1000 deliveries, aIR 2.20, 95% CI: 1.60-3.03), and obesity disorder (35.2 vs. 16.7 per 1000 deliveries, aIR 1.87, 95% CI: 1.48-2.35) were associated with higher rates of severe maternal morbidity for subclinical hypothyroidism compared with overt hypothyroidism. Severe maternal morbidity rates were more than twice as high for subclinical hypothyroidism compared with overt hypothyroidism among pregnant patients younger than 25 years with obesity disorder (79.4 vs. 10.1 per 1000 deliveries, aIR 7.89, 95% CI: 4.78-13.02), Black individuals with pregestational hypertension (157.9 vs. 40.2 per 1000 deliveries, aIR 3.15, 95% CI: 1.77-5.61), and Black individuals with obesity disorder (102.0 vs. 33.9 per 1000 deliveries, aIR 2.81, 95% CI: 1.83-4.32). CONCLUSIONS: The results of this cross-sectional study suggest that subclinical hypothyroidism may be associated with higher rates of severe maternal morbidity at delivery compared with overt hypothyroidism.
Validation of the City Birth Trauma Scale in a sample of Norwegian mothers.
Haga SM, Bergunde L, Seefeld L … +3 more , Ayers S, Eberhard-Gran M, Garthus-Niegel S
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41588651 · Full text
INTRODUCTION: Approximately 3%-4% of women experience childbirth-related posttraumatic stress disorder (CB-PTSD). The City Birth Trauma Scale (City BiTS) is a questionnaire developed to assess CB-PTSD, following the crit...
INTRODUCTION: Approximately 3%-4% of women experience childbirth-related posttraumatic stress disorder (CB-PTSD). The City Birth Trauma Scale (City BiTS) is a questionnaire developed to assess CB-PTSD, following the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders. The aim of the present study was to evaluate the psychometric properties of the Norwegian version of this questionnaire (City BiTS-Nor). MATERIAL AND METHODS: A community sample of 1079 mothers completed a cross-sectional online survey. The survey included questions on sociodemographic and obstetric characteristics, the City BiTS-Nor, the Impact of Event Scale-Revised, the Edinburgh Postnatal Depression Scale, the 10-item anxiety subscale of the Hopkins Symptom Checklist, and the Bergen Insomnia Scale. RESULTS: Confirmatory factor analysis supported a bifactor model comprising Birth-related Symptoms and General Symptoms in CB-PTSD, along with a General CB-PTSD factor that explained 58.4% of the variance. The study found high internal consistency (≥0.90), and good convergent and divergent validity were shown. Discriminant validity was evaluated by examining factors such as mode of birth, maternal complications, infant complications, parity, history of traumatic childbirth, and previous traumatic experiences. Higher General and Birth-related scores were observed in women who experienced emergency cesarean sections or instrumental vaginal births. This trend was observed in primiparous women, cases involving pregnancy and birth complications, and individuals with prior traumatic experiences. CONCLUSIONS: The City BiTS-Nor presents appropriate psychometric properties for assessing CB-PTSD symptoms according to DSM-5 criteria. The findings suggest that using the total score, along with the individual subscale scores, is justified and enhances the comprehensive assessment of CB-PTSD symptoms. These findings support the clinical utility of the City BiTS-Nor as a screening tool for CB-PTSD, with potential to differentiate childbirth-related trauma from general psychopathology and to guide targeted interventions in perinatal care.
The application of artificial intelligence in blind ultrasound sweep diagnostics for prenatal medicine: A systematic literature review.
Schott J, Wilmes M, Walter A … +4 more , Plöger R, Gottschalk I, Groten T, Recker F
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41574472 · Full text
INTRODUCTION: Obstetric ultrasound is fundamental in prenatal care for gestational age (GA) estimation, fetal monitoring, and complication screening. However, access to quality ultrasound is limited in many low- and midd...
INTRODUCTION: Obstetric ultrasound is fundamental in prenatal care for gestational age (GA) estimation, fetal monitoring, and complication screening. However, access to quality ultrasound is limited in many low- and middle-income countries (LMICs), where nearly half of pregnant women receive no scans during pregnancy. Even in high-income countries, disparities in care persist. Recently, artificial intelligence (AI) applied to "blind" ultrasound sweeps-standardized transabdominal sweeps performed by minimally trained personnel-has emerged as a promising tool to improve access to diagnostic-quality prenatal ultrasound. MATERIAL AND METHODS: A systematic review following PRISMA guidelines was conducted. PubMed was searched through April 2025 using terms such as [blind sweep], [prenatal ultrasound], and [deep learning]. Studies were included if they assessed AI models applied to blind-sweep ultrasound for prenatal diagnostics. Fourteen studies (12 original, 2 reviews/meta-analyses) met eligibility. Data were extracted on study design, population, acquisition protocol, AI models, and diagnostic performance. Risk of bias was assessed using QUADAS-2. RESULTS: AI models demonstrated comparable or superior performance to expert sonographers in mid-trimester GA estimation, with mean absolute errors of 3-5 days. In a large multicenter study, AI outperformed traditional biometry (3.9 vs. 4.7 days error). Accuracy remained high even with minimally trained operators. AI also performed well in detecting breech presentation (AUC ~0.98), assessing amniotic fluid (Dice ~0.88; AFI accuracy ~91%), and segmenting fetal anatomy for biometry. Limitations included reduced accuracy in late pregnancy and limited validation in early gestation or anomaly detection. CONCLUSIONS: AI-based blind sweep ultrasound holds transformative potential for global prenatal care, enabling scalable, low-cost diagnostics in LMICs and underserved settings. While promising, clinical adoption requires broader validation, improved interpretability, and integration into healthcare systems. With further development, this technology could significantly contribute to equitable prenatal diagnostics and reduced maternal-fetal morbidity worldwide.
Risk factors for vaginal cuff dehiscence after robot-assisted total laparoscopic hysterectomy: A retrospective cohort study.
Denstad SE, Volløyhaug I, Lieng M … +2 more , Moawad G, Lonnee-Hoffmann RAM
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41562329 · Full text
INTRODUCTION: Minimally invasive surgery is preferred over laparotomy due to shorter hospital stays, faster recovery, and reduced risk of complications. Despite these advantages, studies indicate an increased risk of vag...
INTRODUCTION: Minimally invasive surgery is preferred over laparotomy due to shorter hospital stays, faster recovery, and reduced risk of complications. Despite these advantages, studies indicate an increased risk of vaginal cuff dehiscence (VCD) after laparoscopic and especially robotic-assisted total hysterectomy (RA-TLH). Over the past decades, the use of laparoscopic and robotic surgery has increased in the Western world, including the Nordic countries. It remains unclear who is at higher risk of VCD. This study aims to identify patient-related and surgical risk factors for VCD following RA-TLH. MATERIAL AND METHODS: A retrospective review of medical records of women who underwent RA-TLH at Trondheim University Hospital, Norway, from 2010 to 2021. Women experiencing VCD were identified and compared to women without VCD. Demographic and surgical data were compared between the groups using univariate and multivariate logistic regression analyses to identify risk factors for VCD. RESULTS: Out of 1549 eligible women, 684 (44.2%) consented to participate. Twenty-eight women (4.2%) were diagnosed with VCD at a median of 73 days (range 28-278) after surgery. Vaginal intercourse was identified as the triggering event in 23 (82%) women. Younger age, lower BMI, longer surgery duration, and higher uterine weight were associated with an increased risk of VCD in univariate analyses. Multivariate analysis showed that each unit increase in BMI reduced the odds, aOR 0.87 (95% CI 0.78-0.97), whereas each 100 g increase in uterine weight increased the odds, aOR 1.30 (95% CI 1.06-1.60). CONCLUSIONS: VCD occurred in 4.2% of included women. Vaginal intercourse was the most common trigger of VCD. High BMI protected against VCD after RA-TLH. Women with a large uterus had an increased risk of VCD. Our findings underline the importance of preoperative counseling, discussing the advantages and risks of different surgical approaches according to each woman's risk factors.
Risk of recurrent spontaneous preterm birth following preterm full dilatation cesarean delivery.
Banerjee A, Glazewska-Hallin A, Ivan M … +12 more , Nazarenko T, Colley C, Suff N, Story L, Casagrandi D, Tetteh A, Greenwold N, Chandiramani M, Carter J, Napolitano R, Shennan AH, David AL
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41555680 · Full text
INTRODUCTION: Term full dilatation cesarean delivery (FDCD) is associated with an increased risk of subsequent spontaneous preterm birth (sPTB). The impact of preterm FDCD on recurrent sPTB is unknown. We investigated th...
INTRODUCTION: Term full dilatation cesarean delivery (FDCD) is associated with an increased risk of subsequent spontaneous preterm birth (sPTB). The impact of preterm FDCD on recurrent sPTB is unknown. We investigated the relationship between recurrent sPTB and the mode of prior sPTB. MATERIAL AND METHODS: This is a retrospective cohort study of singleton pregnant women attending two high-risk preterm birth surveillance clinics (University College London Hospital and St Thomas' Hospital London, UK), with one previous sPTB (24-36 + 6 weeks). Women were categorized according to their mode of birth in the index sPTB pregnancy: (1) preterm FDCD, (2) preterm vaginal birth and (3) preterm cesarean delivery at <10 cm cervical dilatation (CD < 10 cm). The primary outcome was recurrent sPTB <37 weeks of gestation. Secondary outcomes included sPTB <34 weeks, <28 weeks, spontaneous late miscarriage and short cervical length (≤25 mm). In a subgroup of women with preterm FDCD, CD scar characteristics were assessed during the second trimester of pregnancy using transvaginal ultrasound. RESULTS: Median gestation of prior sPTB was similar across all groups (32 weeks; p = 0.454). Recurrent sPTB <37 weeks was significantly more common in women with previous preterm FDCD, 38.1% (8/21) compared to vaginal birth, 15.1% (16/106) or CD < 10 cm, 13.8% (15/109); aOR 4.4 (95% CI 1.3-14.9; p = 0.023) and 5.1 (95% CI 1.6-16.5; p = 0.022), respectively. Recurrent sPTB <34 weeks was even higher in the previous preterm FDCD group, 23.8% (5/21) compared to vaginal birth 4.7% (5/106) or CD < 10 cm 8.3% (9/109); aOR 16.6 (95% CI 2.8-97.2; p = 0.016) and 5.7 (95% CI 1.4-23.1; p = 0.022), respectively. CD scar location was assessed in 15 women with preterm FDCD in one centre. Scar visualization was 87%, with 77% (10/13) of scars being located within the cervix or <5 mm above the internal cervical os. CONCLUSIONS: Women undergoing FDCD following preterm labor have a significantly higher risk of recurrent sPTB at <37 and <34 weeks of gestation compared to women with previous preterm vaginal birth or CD prior to the second stage of labor. These findings suggest that preterm FDCD may further compromise cervical function. It is important that clinicians are aware of this increased risk of recurrent sPTB to guide patient counseling and management accordingly.
Somatization and experience of physical, psychological, and sexual violence among women consulting gynecological clinics: a waiting room survey.
Iloson C, Bernhardsson S, Björk MP … +2 more , Sundfeldt K, Möller A
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41545902 · Full text
INTRODUCTION: Somatization disorders belong to a category of psychiatric conditions in which psychological distress and impairment are manifested as physical symptoms. Affected patients tend to utilize specialist healthc...
INTRODUCTION: Somatization disorders belong to a category of psychiatric conditions in which psychological distress and impairment are manifested as physical symptoms. Affected patients tend to utilize specialist healthcare services more frequently and have more emergency visits than those without somatization. From a gynecological perspective, it is of relevance to investigate whether any specific somatic symptoms are linked to previous experience of physical, psychological, or sexual violence. The study aimed to explore whether any specific symptoms could be associated with level of somatization among women consulting a gynecologist; whether experience of physical, psychological, or sexual violence could be associated with level of somatization; and whether experience of violence is associated with self-rated state of health. MATERIAL AND METHODS: A cross-sectional survey was conducted at three gynecological clinics in western Sweden between February and May 2024. A project-specific questionnaire was distributed to women who consulted the clinic and completed in the waiting room. The survey consisted of 13 items, including sociodemographic variables, reasons for the current gynecological consultation, self-rated health, history of physical, psychological or sexual violence, discomfort during gynecological examination, and somatic symptom severity. Data were analyzed using descriptive statistics, chi-square tests, ANOVA, and multivariable linear regression analyses. RESULTS: Of 2000 questionnaires distributed, 1766 were completed (response rate 88.3%). Among participants, 21.8% reported experience of sexual violence, 16.8% psychological violence, and 13.6% physical violence. Among those reporting any form of violence (n = 653), overlap was common: 236/653 (36.1%) had experienced only sexual violence, while 191/653 (29.2%) had experienced all three types. Somatic symptom severity was significantly associated with both sexual and psychological violence, but not physical violence. Clinical predictors of somatization included abdominal pain, dysmenorrhea, and multiple symptoms including pain. High somatic symptom severity was strongly associated with worse self-rated health. Somatic symptoms and specific consultation reasons, but not violence experiences, were significantly associated with self-rated health. CONCLUSIONS: Somatization is common among women seeking gynecological care and is associated with a history of sexual and psychological violence. The findings underscore the importance of assessing underlying symptom patterns and the value of trauma-informed assessment to optimize patient management.
National implementation of vaginal Natural Orifice Transluminal Endoscopic Surgery for benign hysterectomies: A historical cohort study of Swedish data 2021-2023.
Wagenius J, Ehrström S, Källén K … +2 more , Baekelandt J, Stuart A
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41531274 · Full text
INTRODUCTION: Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a technique combining vaginal entrance to the abdomen with endoscopic overview. Previous studies have shown that vNOTES decreases operatin...
INTRODUCTION: Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a technique combining vaginal entrance to the abdomen with endoscopic overview. Previous studies have shown that vNOTES decreases operating time, hospitalization, postoperative complications, and pain. We aimed to present patient demographics, costs, and surgical outcomes following the implementation of vNOTES for benign hysterectomies in Sweden. MATERIAL AND METHODS: We conducted a historical cohort study with the first vNOTES hysterectomies in Sweden 2021-2023 involving 8 hospitals. Data was extracted from the Swedish National Quality Register for Gynecological Surgery (GynOp). Our main outcomes were intraoperative and postoperative complications, costs, and patient satisfaction. As a secondary objective, the odds ratios (OR) for any intraoperative or postoperative complication, respectively, were computed for BMI ≥30 versus <30, and for uterus weight ≥500 g versus <500 g. RESULTS: A total of 545 patients were included in the study. The mean age of the patients was 49.9 ± 10.7 years. Of the included patients, 8.1% (n = 44) were nullipara, 19.3% (n = 105) had a BMI ≥30, 17.4% (n = 95) had a previous cesarean section, and 16.7% (n = 91) had other previous abdominal surgery. The median uterus weight was 148 g (interquartile range, IQR 86-299). The median surgical time was 65 minutes (IQR 48-91), and the median blood loss was 40 mL (IQR 25-90). Conversions to laparotomy occurred in 2% (n = 11), and reoperations occurred in 0.6% (n = 3) of the cases. The total intraoperative complication rate was 2.2% and the total postoperative complication rate was 8.4%. No significant differences in intraoperative and postoperative complications were found between BMI ≥30 and <30 and between uterus weight ≥500 and <500 g. Most of the patients (57.1%, n = 311) left the hospital the same day as the surgery. The 1-year follow-up after surgery showed that 90% of the patients were satisfied or very satisfied with the result. CONCLUSIONS: The implementation of vNOTES hysterectomies in Sweden has been safe showing similar complication rates compared to studies of other minimally invasive hysterectomy techniques. Surgical time, intraoperative bleeding, and conversions were in analogy with previous observational vNOTES studies. The 1-year follow-up after surgery showed high patient satisfaction.
Laparoscopic cervical cerclage and pregnancy outcomes in consecutive pregnancies: An observational study.
Krogh LQ, Hansen LK, Helmig RB … +5 more , Sundtoft I, Kloster A, Forman A, Ulbjerg N, Glavind J
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41525199 · Full text
INTRODUCTION: Laparoscopic cervical cerclage is an intervention for the prevention of preterm birth, for example, in women with a weak cervix due to prior cervical surgery or prior failed vaginal cerclage. Little is know...
INTRODUCTION: Laparoscopic cervical cerclage is an intervention for the prevention of preterm birth, for example, in women with a weak cervix due to prior cervical surgery or prior failed vaginal cerclage. Little is known about pregnancy outcomes when a cerclage is left in situ across consecutive pregnancies; this study aims to investigate neonatal outcomes following laparoscopic cervical cerclage placement in first and subsequent pregnancies and to compare pre- and postconception placement of the laparoscopic cervical cerclage on neonatal survival. MATERIAL AND METHODS: We performed an observational study in women who had a laparoscopic cervical cerclage at Aarhus University Hospital, Denmark, between 2011 and 2021. Data on the timing of the procedure (pre- vs post-conception), surgical complications, obstetric, and neonatal outcomes were collected from electronic patient records and analyzed descriptively. The primary outcome was neonatal survival. Secondary outcomes were neonatal survival without major morbidity, preterm birth, and gestational age at birth. RESULTS: A total of 170 women had a laparoscopic cervical cerclage during the study period. Uterine wall perforation occurred in 10/170 procedures (6%), postoperative infection in 4/170 (2%), and 125/170 (74%) were discharged on the same day as the procedure. There were 145 women with at least one subsequent pregnancy and 229 registered pregnancies in total. In the 185 pregnancies that progressed beyond 20 weeks, 166/181 (92%) delivered ≥34 weeks of gestation. Neonatal survival was 183/186 (98%), and survival without major morbidity was 181/186 (97%). Neonatal outcomes were similar between women with a cerclage placed pre- or postconception. Fifty of 145 women (34%) with a cerclage left in situ had more than one pregnancy beyond 20 weeks of gestation. These repeated pregnancies showed consistently favorable outcomes, with neonatal survival rates of 100% in second pregnancies (44/44) and 100% in third pregnancies (4/4). CONCLUSIONS: Laparoscopic cervical cerclage supports favorable neonatal outcomes in first and subsequent pregnancies. Neonatal outcomes did not appear to differ based on whether the cerclage was placed pre- or postconception. Pregnancies in which the cerclage was left in situ demonstrated high neonatal survival rates and favorable obstetric outcomes in both second and third pregnancies.
Beyond evidence hierarchies: Leveraging randomized controlled trials and real-world data to advance the value of maternity care.
Hu Y, Slavin V, Enticott J … +1 more , Callander E
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41513458 · Full text
While existing literature has compared the methodological strengths and limitations of randomized controlled trials (RCTs) and real-world data (RWD) in general medical research, two critical gaps remain unaddressed: (1)...
While existing literature has compared the methodological strengths and limitations of randomized controlled trials (RCTs) and real-world data (RWD) in general medical research, two critical gaps remain unaddressed: (1) no prior communication papers have specifically examined this comparison in the context of maternity care where unique ethical and practical considerations exist, and (2) no studies have systematically compared cost-effectiveness analyses derived from RCTs versus RWD approaches-a crucial dimension for value-based maternity care decisions. This article examines how both approaches can strengthen the evidence base and support the delivery of value-based maternity care. We argue that neither RCTs nor RWD should be regarded as inherently superior in guiding decision-making. Each study design offers valuable insights, and their findings must be critically appraised in light of methodological rigor, context, and relevance, particularly when their results diverge.
Early versus late termination for fetal anomalies: Women's perspectives and psychological impact in a mixed methods study.
Lust EER, Bronsgeest K, Henneman L … +13 more , Crombag NMTH, Bilardo CM, Galjaard RH, Sikkel E, Coumans ABC, Elvan-Taşpınar A, Galjaard S, Go ATJI, Manten GTR, Pajkrt E, van Leeuwen E, Haak MC, Bekker MN
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41510803 · Full text
INTRODUCTION: A frequently cited benefit of the first-trimester anomaly scan (FTAS) is that it reduces psychological impact by enabling earlier termination of pregnancy (TOP). However, the impact of early versus late TOP...
INTRODUCTION: A frequently cited benefit of the first-trimester anomaly scan (FTAS) is that it reduces psychological impact by enabling earlier termination of pregnancy (TOP). However, the impact of early versus late TOP due to fetal anomalies remains unclear. This study evaluates the psychological impact and perspectives associated with early versus late TOP. MATERIAL AND METHODS: A prospective mixed methods study was conducted. The early group (TOP <18 weeks) included women with an abnormal FTAS; the late group (TOP 20-24 weeks) included women with an abnormal second-trimester scan (SAS), abnormal FTAS, or normal FTAS followed by abnormal SAS. Women completed questionnaires 2 (T1) and 6 months (T2) postpartum addressing psychological impact using validated scales (State-Trait Anxiety Inventory, Edinburgh Depression Scale, Impact of Event Scale, Perinatal Grief Scale) and study-specific questions. Semi-structured interviews were conducted with women and their partners 3-6 months after termination. RESULTS: 149 women with early TOP (15 + 2 weeks, range 14 + 4-16 + 1) and 129 with late TOP (22 + 0, 21 + 0-23 + 1) completed T1. In both groups, the majority had clinically relevant anxiety at T1 and T2 and moderate/severe distress at T1. The late TOP group had higher median depression and mean grief scores at T1 (5.0, range 3.0-8.0 vs. 4.0, range 2.0-7.0, p = 0.004) (85.9 ± 21.0 vs. 76.5 ± 22.4, p < 0.001) and at T2 (4.0, 1.0-7.0 vs. 3.0, 1.0-6.0, p = 0.043) (81.3 ± 22.9 vs. 70.8 ± 22.6, p < 0.001), respectively, and higher mean distress scores at T1 (33.8 ± 13.3 vs. 30.2 ± 14.7, p = 0.034). Of 51 interviews with women and partners (22 early, 29 late TOP), four themes were identified: fetal attachment, time pressure, grief, and reflections on gestational age. Most late TOP participants expressed strong fetal attachment; for early TOP participants, the experiences were more variable. Half of the late TOP participants reported time pressure due to the legal limit. Perceived grief and impact were substantial in both groups. CONCLUSIONS: Our findings suggest that early TOP is associated with lower psychological impact compared to late TOP, mainly in the first months postpartum. This may reflect less intense fetal attachment and more time for reproductive decision-making for some parents, supporting the presumed benefit of earlier intervention. Nevertheless, TOP causes a significant emotional impact at any gestational age.
Retropubic hemorrhage following Midurethral sling surgery: Diagnosis, clinical challenges, and management.
Carlin GL, Grech CT, Umek W … +3 more , Hanzal E, Koch M, Bodner-Adler B
Acta Obstet Gynecol Scand · 2026 Jul · PMID 41485144 · Full text
Mid-urethral slings (MUS) such as tension-free vaginal tape (TVT) are the established gold standard surgical approach for treating stress urinary incontinence (SUI). While generally effective, complications such as bladd...
Mid-urethral slings (MUS) such as tension-free vaginal tape (TVT) are the established gold standard surgical approach for treating stress urinary incontinence (SUI). While generally effective, complications such as bladder injury, urinary retention, and bleeding can occur. This article focuses on a rare but significant complication: postoperative hemorrhage into the retropubic space (Cavum Retzii) following MUS/TVT placement. Key challenges, diagnostic options, and management strategies for this condition are assessed. Additionally, a structured clinical guideline to support a systematic approach to diagnosis and treatment of complications is provided.
HPV vaccination following cervical intraepithelial neoplasia grade 2 diagnosis and risk of progression.
Eriksen DO, Krog L, Ostenfeld EB … +6 more , Jensen PT, Lycke KD, Grønborg TK, Wentzensen N, Clarke MA, Hammer A
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41480949 · Full text
INTRODUCTION: Human papillomavirus (HPV) vaccination is associated with a significantly reduced risk of cervical cancer when administered before initial exposure to HPV. Women with high-grade cervical intraepithelial neo...
INTRODUCTION: Human papillomavirus (HPV) vaccination is associated with a significantly reduced risk of cervical cancer when administered before initial exposure to HPV. Women with high-grade cervical intraepithelial neoplasia (CIN) have an increased risk of subsequent HPV-related disease, including recurrent high-grade CIN, compared to women without CIN. Some clinicians have advised women with high-grade CIN to undergo HPV vaccination to reduce their subsequent risk, despite a lack of evidence for this practice. We aimed to evaluate whether HPV vaccination of women undergoing active surveillance for CIN grade 2 (CIN2) is associated with a decreased risk of progression to cervical intraepithelial neoplasia grade 3 or worse (CIN3+). MATERIAL AND METHODS: We conducted a nationwide population-based historical cohort study in Denmark on women aged 18-40 years undergoing active surveillance for CIN2 from 2007 to 2020. We compared women receiving at least one HPV vaccine dose within 6 months after their CIN2 diagnosis to women not receiving the vaccine. Our primary outcome was progression to CIN3+. We stratified by age at CIN2 diagnosis (18-29, 30-40), calendar year (2007-2012, 2013-2020), and index cytology (high-grade, nonhigh-grade). We used Cox proportional hazards regression to estimate hazard ratios of the outcomes with unvaccinated women as the reference. Age at diagnosis, calendar year, index cytology, income, and educational level were adjusted for. RESULTS: We included 4585 women, of whom 583 (12.7%) were vaccinated within 6 months after CIN2 diagnosis. A total of 1391 (30.3%) progressed to CIN3+ during follow-up. The 5-year cumulative risk was 29.9% (28.5-31.3). Overall, no protective effect of vaccination after CIN2 diagnosis was found (aHR 1.45 [1.24-1.69]). Stratified analyses showed increased progression risk with vaccination among women <30 years, in the early calendar period (2007-2012), and across both non-high-grade and high-grade index cytology; no significant difference in risk was observed in women ≥30 years or in the latest calendar period (2013-2020). CONCLUSIONS: HPV vaccination did not reduce the risk of progression in women undergoing active surveillance for CIN2. This finding indicates that HPV vaccination should not be recommended in this group of women.
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