Acta Obstetricia Et Gynecologica Scandinavica[JOURNAL]
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200 papers
Impact of episiotomy on anal incontinence following second- to fourth-degree perineal tears-A cohort study.
Josefsson ML, Uustal E, Sohlberg S … +3 more , Ekéus C, Lampa E, Jonsson M
Acta Obstet Gynecol Scand · 2026 Jul · PMID 41477756 · Full text
INTRODUCTION: Anal incontinence can have a significant negative impact on quality of life. The leading cause of anal incontinence among women of child-bearing age is obstetric-related perineal injury. The objective of th...
INTRODUCTION: Anal incontinence can have a significant negative impact on quality of life. The leading cause of anal incontinence among women of child-bearing age is obstetric-related perineal injury. The objective of this study was to examine the impact of episiotomy on the incidence of anal incontinence among primiparous women with second-, third-, or fourth-degree perineal tears at 8 weeks and 1 year postpartum and to assess change in incidence over time across varying degrees of perineal tears. MATERIAL AND METHODS: This Swedish cohort study included 12 658 primiparous women who sustained a second- (n = 5309), third- (n = 6771), or fourth-degree tear (n = 578), either spontaneously or in association with an episiotomy, between 2014 and 2019. Data were collected from national health and quality registers. The primary outcomes assessed were fecal and gas incontinence at 1 year postpartum. Secondary outcomes included lifestyle alteration and Wexner score. Logistic regression analyses were performed, and results were presented as odds ratios (ORs) with 95% confidence intervals (CIs), using spontaneous tear as the reference group. Models were adjusted for age, body mass index, prepregnancy diabetes, gestational age, mode of delivery, length of the second stage, fetal presentation, birth weight, and head circumference. RESULTS: The incidence of gas incontinence 1 year after second-, third-, or fourth-degree tears was 11.0%, 23.6%, and 37.8%, respectively. The incidence of fecal incontinence was 1.8%, 5.2%, and 14.5% for loose stool, and 0.8%, 2.1%, and 6.6% for solid stool, respectively. Women with a second-degree tear and episiotomy had an adjusted OR of 1.26 (95% CI 1.02-1.55) for gas incontinence and 1.38 (95% CI 0.90-2.10) for fecal incontinence at 1 year postpartum. Episiotomy did not increase the risk of anal incontinence among women with third-degree and fourth-degree tears. Anal incontinence, lifestyle changes, and Wexner score decreased over time across all types of tears. CONCLUSIONS: Anal incontinence increases with the severity of perineal tears; however, the risk of incontinence is primarily determined by the grade of injury rather than the presence or absence of an episiotomy. Symptoms decline over time across all degrees of tears.
Hemodynamic changes in pregnancies with impaired fetal growth: A systematic review and meta-analysis.
Kempener BMJG, Jorissen LM, Mulder EG … +7 more , Ghossein-Doha C, van Drongelen J, Scholten RR, Lees CC, de Haas S, Janssen EBNJ, Spaanderman MEA
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41474107 · Full text
INTRODUCTION: Abnormalities in central hemodynamic functions before and throughout pregnancy may antedate impaired fetal growth. We aimed to assess cardiac output (CO) and total peripheral vascular resistance (TPVR) traj...
INTRODUCTION: Abnormalities in central hemodynamic functions before and throughout pregnancy may antedate impaired fetal growth. We aimed to assess cardiac output (CO) and total peripheral vascular resistance (TPVR) trajectories throughout singleton pregnancies with and without impaired fetal growth by systematic review and meta-analysis. MATERIAL AND METHODS: PubMed and Embase were systematically searched (inception - July 2023), and reference lists were screened. Studies reporting CO and TPVR during singleton pregnancies complicated by impaired fetal growth were included. Studies measuring hemodynamic parameters in women with prepregnancy hypertension and/or cardiac diseases were excluded. Absolute values of hemodynamic parameters were calculated over pregnancy using a random-effects model, and subgroup analyses differentiated more severe clinical phenotypes of impaired fetal growth. The systematic review was registered in the PROSPERO database (CRD42020172252). RESULTS: Thirty-three studies were included, comprising 7816 women. Hemodynamic function in non-pregnant women did not differ between those who subsequently gave birth to a growth-restricted neonate or an appropriately grown neonate. Pregnancies complicated by impaired fetal growth were accompanied by elevated second and third-trimester TPVR and concurrent reduced third-trimester CO. Second and third-trimester TPVR was consistently higher when fetal growth restriction was accompanied by abnormal perfusion indices instead of only low birthweight (centile), concurrent maternal hypertensive disorder of pregnancy, and when small for gestational age was accompanied by preterm birth. CONCLUSIONS: Impaired fetal growth is associated with increased vascular resistance and reduced CO from the second trimester onwards. More severe phenotypes, particularly those with attenuated placental perfusion or lower gestational age at birth, exhibit the most vasoconstrictive hemodynamic profile. Future studies could focus on targeted preventive measures to restore hemodynamic function.
Pelvic pain and lower urinary tract symptoms; long-term comparison between women with and without mid-urethral sling insertion.
Lundmark Drca A, Alexandridis V, Söderberg MW … +2 more , Teleman P, Ek M
Acta Obstet Gynecol Scand · 2026 Jul · PMID 41472493 · Full text
INTRODUCTION: Stress urinary incontinence is the most prevalent type of incontinence among women, with mid-urethral sling (MUS) surgery considered the gold standard surgical treatment. Despite its widespread use, the rol...
INTRODUCTION: Stress urinary incontinence is the most prevalent type of incontinence among women, with mid-urethral sling (MUS) surgery considered the gold standard surgical treatment. Despite its widespread use, the role of mesh in this procedure has sparked controversy over the past decade. The primary objective of this study was to compare pelvic pain in women who have undergone MUS surgery with those who have not. The secondary objective was to evaluate lower urinary tract symptoms in both groups. MATERIAL AND METHODS: This prospective cohort study included Swedish women who underwent MUS surgery between 2006 and 2010 and were registered in the GynOp database, and a reference group of Swedish women without MUS, self-registered in Lifegene, a national cohort launched in 2009. The women completed the Urogenital Distress Inventory questionnaire-6 (UDI-6) assessing pelvic pain and lower urinary tract symptoms, administered ~10 years after MUS surgery or at matched ages. RESULTS: Pelvic pain was analyzed at least 10 years post-MUS surgery and in the reference group at matched ages. Significant differences in pelvic pain were observed among women aged ≥50 years. Logistic regression analysis, incorporating an interaction between MUS surgery and age, revealed adjusted odds ratios (aOR) for pelvic pain among women with MUS as follows: 0.82 (CI: 0.51-1.31) for women aged <50 years, 1.79 (CI: 1.13-2.42) for women aged 50-59 years, 1.85 (CI: 1.13-3.00) for women aged 60-69 years, and 2.08 (CI: 1.30-3.32) for women ≥70 years. Women with previous MUS surgery reported higher UDI-6 scores, indicating more bothersome lower urinary tract symptoms, except among those aged <50 years, compared with the reference group. CONCLUSIONS: Women aged 50 years or older, who have undergone MUS surgery ≥10 years earlier, report more frequent pelvic pain and lower urinary tract symptoms than those who have not undergone MUS surgery. Whether this is related to the MUS surgery or an expression of a progressing pelvic floor dysfunction is unclear.
Assessing signal loss, accuracy, and acceptability of an ambulatory fetal electrocardiography with cardiotocography in the antepartum and intrapartum phases.
Tan MMT, Ong KJY, Tiong MMY … +7 more , Sultana R, Luong C, Thain S, Kanagalingam D, Chan JKY, Loy SL, Ku CW
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41468283 · Full text
INTRODUCTION: Electronic fetal heart rate (FHR) monitoring is integral to antepartum and intrapartum care to detect fetal compromise, reducing neonatal morbidity and mortality. Conventional wired cardiotocography (CTG) l...
INTRODUCTION: Electronic fetal heart rate (FHR) monitoring is integral to antepartum and intrapartum care to detect fetal compromise, reducing neonatal morbidity and mortality. Conventional wired cardiotocography (CTG) limits mobility, birthing positions, and potentially increases instrumental births. Wireless non-invasive fetal electrocardiography (NIFECG) aims to address these challenges. However, NIFECG has limitations, including signal interference and limited accuracy data for FHR and uterine contraction (UC) monitoring. This study aimed to (i) quantify acceptable NIFECG traces based on signal loss in women ≥37 weeks' gestation; (ii) compare FHR and UC monitoring accuracy between NIFECG and CTG; (iii) and assess NIFECG acceptability. MATERIAL AND METHODS: A prospective cohort involving women with singleton pregnancies ≥37 weeks' gestation was conducted between August 2020 and April 2023 in KK Women's and Children's Hospital, Singapore. Women underwent 40 min of concurrent NIFECG and CTG monitoring during antepartum and intrapartum phases. Data were compared in 3.75-s epochs. Based on the International Federation of Gynecology and Obstetrics guidelines, NIFECG traces with signal loss ≤20% were accepted. FHR monitoring accuracy was assessed using Bland-Altman and Passing-Bablok regression analyses. UC monitoring accuracy was determined by a fourfold contingency table with CTG as a gold standard. Acceptability was assessed via post-monitoring feedback questionnaire. RESULTS: One hundred and three women contributed to 124 paired traces. Seventy-three traces (58.9%) were acceptable, comprising 52 antepartum (56.5%) and 21 intrapartum traces (65.6%). Bland-Altman (bias: -0.4 beats per minute, 95% limits of agreement: [-9.0, 8.1]) and Passing-Bablok (slope = 0.97, 95% confidence interval (CI) 0.97-0.98) analyses showed high agreement between NIFECG and CTG FHR measurements. NIFECG showed a specificity of 0.96 (95% CI 0.94-0.97) and sensitivity of 0.90 (95% CI 0.89-0.92) for UC monitoring. Additionally, 90.1% of women and 88.9% of nurses preferred NIFECG. CONCLUSIONS: NIFECG has comparable accuracy to CTG for FHR and UC monitoring during the antepartum and intrapartum phases and is well-accepted by women and nurses. Given that 41.1% of NIFECG traces were rejected due to signal loss, further research on improving the technology to reduce signal loss, and re-evaluating the criteria for rejecting traces is vital to achieve broader clinical implementation of NIFECG.
Risk factors for pregnancy-associated Bell's palsy: A nationwide population-based register study.
Lansing L, Marsk E, Wendel SB
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41466531 · Full text
INTRODUCTION: Bell's palsy appears to be more common in pregnancy, but incidence numbers differ. Risk factors for pregnancy-associated Bell's palsy have been discussed, but larger studies are needed to receive significan...
INTRODUCTION: Bell's palsy appears to be more common in pregnancy, but incidence numbers differ. Risk factors for pregnancy-associated Bell's palsy have been discussed, but larger studies are needed to receive significant results. MATERIAL AND METHODS: This study aimed to investigate the incidence and maternal risk factors of pregnancy-associated Bell's palsy. It is a nationwide register-based cohort study. Women with Bell's palsy in Sweden from 2005 to 2015 were identified in the National Patient Register. Women giving birth at ≥22 gestational weeks during the same period were identified in the Medical Birth Register. Pregnancy-associated Bell's palsy was defined as the first diagnosis of Bell's palsy during pregnancy or within the first 2 months postpartum, identified by linking the data sets. Childbirths in women without a history of Bell's palsy were used as a comparison group. Risk factors were identified using backward conditional multivariable logistic regression and presented with adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULTS: A total of 2051 childbirths in women with pregnancy-associated Bell's palsy were identified. For a comparison 1 188 489 childbirths in women without a history of Bell's palsy were used. The incidence of pregnancy-associated Bell's palsy was 171.6 per 100 000 childbirths. Pregnancy-associated Bell's palsy was associated with high BMI (e.g., BMI 30-34.9, aOR 1.30, 95% CI 1.12-1.50), being born in Asia (aOR 1.19, 95% CI 1.04-1.37), Africa (aOR 1.76, 95% CI 1.47-2.11), or South America (aOR 1.85, 95% CI 1.35-2.55), multiple pregnancy (aOR 1.83, 95% CI 1.48-2.26), and a diagnosis of herpes zoster (aOR 6.55, 95% CI 2.93-14.67), borreliosis (aOR 3.70, 95% CI 1.38-9.89), gestational diabetes (aOR 1.68, 95% CI 1.31-2.15), or preeclampsia (aOR 2.02, 95% CI 1.74-2.35). CONCLUSIONS: The incidence of pregnancy-associated Bell's palsy was 171.6 per 100 000 childbirths. Risk factors related to metabolic stress were associated with pregnancy-associated Bell's palsy, although the causal pathway remains unclear.
Methodological concerns in the feasibility study on ultrasound pelvimetry for breech birth-A tempest in a teapot.
Lia M, Kabbani N
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41466361 · Full text
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Risk of cardiovascular disease and mortality among women with endometriosis: Genetic insights.
Zervou MI, Tarlatzi TB, Tarlatzis BC … +1 more , Goulielmos GN
Acta Obstet Gynecol Scand · 2026 Mar · PMID 41466341 · Full text
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The association between different aspects of socioeconomic deprivation and severe maternal morbidity.
Geddes-Barton D, Ramakrishnan R, Goldacre R … +1 more , Knight M
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41466203 · Full text
INTRODUCTION: Living in a deprived neighborhood is associated with an increased risk of severe maternal morbidity (SMM), but the specific deprivation factors or individual SMM conditions driving this risk remain unclear....
INTRODUCTION: Living in a deprived neighborhood is associated with an increased risk of severe maternal morbidity (SMM), but the specific deprivation factors or individual SMM conditions driving this risk remain unclear. This study examined how different domains and subdomains of the Index of Multiple Deprivation (IMD) are associated with SMM, identifying key contributors. MATERIAL AND METHODS: We conducted a nationwide, population-based cohort study using English Hospital Episode Statistics Admitted Patient Care (HES APC) data. The cohort included 4 040 106 women aged 10-55 years who gave birth in NHS facilities in England between January 1, 2013, and March 31, 2023, with pregnancies of ≥20 weeks' gestation. Multilevel multivariable Poisson regression estimated adjusted risk ratios (aRR) and 95% confidence intervals (CI) of composite SMM and key individual SMM conditions for each IMD quintile compared to the least deprived quintile, and aRR (95% CI) of composite SMM in each IMD domain/subdomain quintile compared to the least deprived quintile. RESULTS: IMD domains showed varying associations with SMM. Income and employment deprivation had the strongest associations, with women living in the most deprived quintile having aRRs of 1.16 (95% CI 1.12-1.20) and 1.15 (95% CI 1.11-1.19) compared to those living in the least deprived quintile, respectively. Contrastingly, high geographical barriers to services were associated with a lower risk of SMM (aRR: 0.92 (95% CI 0.88-0.95)). Sepsis, acute cardiac events, and embolism play a key role in the association between composite deprivation and SMM, with women living in the most deprived areas having risk ratios of 1.43 (95% CI 1.36-1.50), 1.24 (95% CI 1.09-1.41), and 1.97 (95% CI 1.69-2.29), respectively, for each of the conditions, compared to women living in the least deprived areas. CONCLUSIONS: There appears to be a widening gap in the risk of SMM between women living in the least and most deprived areas in England, with sepsis, cardiac events, and embolism having the strongest association with deprivation. Composite measures of area-level deprivation may obscure the diverse impacts of specific deprivation factors, and individual-level socioeconomic measures are needed to clarify pathways contributing to SMM risk.
Biopsy-proven residual cervical cancer at the end of combined chemoradiation predicts poor outcome-Retrospective single-center cohort study.
Ebner C, Purtscheller R, Feroz B … +10 more , Rieker J, Ebner L, Mantovan M, Skvortsov S, Brüggl M, Leitner K, Wieser V, Tsibulak I, Marth C, Zeimet AG
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41423908 · Full text
INTRODUCTION: Persistent tumor after combined chemoradiation for locally advanced cervical cancer is an established prognostic factor. Detection may include magnetic resonance imaging, positron emission tomography (PET)...
INTRODUCTION: Persistent tumor after combined chemoradiation for locally advanced cervical cancer is an established prognostic factor. Detection may include magnetic resonance imaging, positron emission tomography (PET) combined with CT scan, ultrasound, or biopsies; however, no agreement about the best method and time point has been reached. In our institution, a standardized biopsy protocol of at least four punch biopsies is routinely performed at the last brachytherapy with re-biopsies 6 weeks later in cases not showing histologic complete response (hCR). This study aims to assess the prognostic relevance of these biopsies, especially with respect to the time point of hCR. MATERIAL AND METHODS: This investigation was a retrospective single-center observational cohort study that included all patients treated for locally advanced or node-positive cervical cancer with combined chemoradiation at the University Hospital Innsbruck between 2008 and 2023. Patients with a hCR at the end of radiotherapy were classified as primary negative and otherwise as primary positive. Primary positive patients that achieved complete response at a control biopsy 6 weeks later were classified as secondary negative, and the remaining patients with residual tumor as secondary positive. Progression-free survival (PFS) and overall survival (OS) were compared between all these groups. RESULTS: We included 184 patients in this study, from which 46 (25%) were classified as primary positive. These patients experienced a significantly worse PFS compared to primary negative patients (p = 0.008, HR = 2.03, 95% CI [1.20, 3.45]). The difference in PFS was also evidenced when comparing primary negative patients to those who had a hCR 6 weeks after radiotherapy (secondary negative) (p = 0.018, HR = 2.00, 95% CI [1.13, 3.56]). However, in primary positive patients, OS was not significantly reduced (p = 0.29, HR = 1.45, 95% CI [0.73, 2.86]). CONCLUSIONS: Early response evaluation using punch biopsies at the time of the last brachytherapy can identify patients with residual tumor, which exhibit a statistically significant and clinically meaningful risk of disease progression. This risk was not reversed even in the case of a delayed hCR 6 weeks after completion of chemoradiation.
Menopause in nonhuman mammals-What does it mean for the gynecologist?
Gidlöf S, Engberg H, Jakson I
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41423881 · Full text
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Patient-centered priorities in endometriosis and chronic pelvic pain: A mixed-methods and thematic analysis of intake narratives.
Freger SM, Kalani N, Cornea M … +2 more , Cavalier S, Leonardi M
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41400460 · Full text
INTRODUCTION: Understanding what patients prioritize when seeking care for endometriosis and chronic pelvic pain (CPP) is crucial for delivering personalized, responsive care. However, patient-defined goals remain poorly...
INTRODUCTION: Understanding what patients prioritize when seeking care for endometriosis and chronic pelvic pain (CPP) is crucial for delivering personalized, responsive care. However, patient-defined goals remain poorly characterized across various life stages and disease phenotypes. This study aimed to explore and rank patient priorities at the time of tertiary referral to inform patient-centered care models. MATERIAL AND METHODS: We conducted a convergent mixed-methods study of 649 new patients referred to a tertiary endometriosis center between 2021 and 2024. Participants completed a standardized intake form including two open-ended questions on their goals and reasons for seeking care. Qualitative data were analyzed using codebook thematic analysis, generating five overarching themes and 20 subthemes. Frequencies of coded themes were descriptively compared across age groups and ultrasound-confirmed endometriosis phenotypes. Quantitative data were analyzed using descriptive statistics, with subgroup comparisons based on age (18-24, 25-34, 35-44, 45-54, 55+) and phenotype (superficial, ovarian, deep, combined). The primary outcome was the ranked frequency of care priorities by subgroup. Secondary outcomes included cross-theme variation and co-occurrence patterns. RESULTS: Five key themes emerged: (1) managing pain and symptoms across a broad spectrum; (2) pursuing diagnostic clarity and validation; (3) balancing symptom relief with fertility planning and preservation; (4) restoring daily function, relationships, and mental well-being; and (5) seeking knowledge to navigate the disease and its management. Subgroup analysis revealed that though management and diagnosis were most frequently prioritized among all groups, fertility was more frequently prioritized by participants aged 25-34 (24.1%) and those with ovarian endometriosis (27.8%), while older participants more often prioritized quality of life and education. Participants with superficial or presumptive diagnoses more commonly emphasized diagnostic clarity and frustration with fragmented care. Many participants expressed a desire for alternatives to hormonal therapy and reported feeling unheard or unsupported in prior encounters. CONCLUSIONS: Patient priorities differ meaningfully across age and endometriosis phenotype, with fertility, education, and quality of life shifting in relative importance over time. These findings support the need for personalized, life-stage-responsive models of care that adapt to evolving patient goals and integrate both medical and psychosocial domains.
Prenatal diagnosis and perinatal outcomes of fetuses with congenital duodenal obstruction: A nine-year retrospective study from China.
Lu J, Fu F, Guo F … +14 more , Zhou H, Huang R, Chen H, Ma C, Liu L, Jing X, Yuan S, Zhou X, Yu Q, Yang M, Han J, Li D, Li R, Liao C
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41398988 · Full text
INTRODUCTION: Congenital duodenal obstruction (CDO) is one of the most common fetal gastrointestinal anomalies, but previous prenatal studies tend to investigate CDO as a portion of gastrointestinal obstruction. Few stud...
INTRODUCTION: Congenital duodenal obstruction (CDO) is one of the most common fetal gastrointestinal anomalies, but previous prenatal studies tend to investigate CDO as a portion of gastrointestinal obstruction. Few studies describe the genetic findings of CDO, especially copy number variants, in fetal cohorts with a relatively large sample size. The study aims to investigate the detection rate of genetic causes at different levels and to explore the potential influencing factors of perinatal outcomes of fetuses with CDO. MATERIAL AND METHODS: This retrospective study analyzed karyotype, chromosomal microarray analysis, and trio-whole exome sequencing (trio-WES) results of singleton fetuses suspected of CDO in a tertiary center between January 2014 and September 2023. In addition, perinatal outcomes and postnatal medical records of enrolled cases were followed up and analyzed. RESULTS: A total of 98 fetuses were included in the study, of which 69 (70.4%) were classified as isolated CDO and 29 (29.6%) were classified as non-isolated. The overall rate of genetic anomalies was 20.4% (20/98). Trisomy 21 (9/98 [9.2%]) and microduplication of the 17q12 region (3/98 [3.2%]) were the most common chromosomal numerical abnormalities and pathogenic copy number variants found in this cohort, respectively. Compared to chromosomal microarray analysis, no additional pathogenic or likely pathogenic variants were found in seven cases undergoing trio-WES. The rate of chromosomal numerical and structural abnormalities was significantly higher in the non-isolated group (8/29 [27.6%] vs. 6/69 [8.7%], p < 0.05). In terms of perinatal outcomes, the live birth rate was significantly higher in the isolated group (52/69 [75.4%] vs. 15/29 [51.7%], p < 0.05) largely due to fewer terminations of pregnancy. All cases with positive genetic results elected to terminate the pregnancy, and 82% of those with negative results opted to continue the pregnancy. Neonatal mortality was significantly higher in the non-isolated group (2/15 [13.3%] vs. 0/52 [0.0%], p < 0.05). The overall neonatal survival rate was 97.0% (65/67). CONCLUSIONS: The present study highlights the value of prenatal diagnostic testing for fetuses suspected of CDO, both in isolated and non-isolated cases. Genetic diagnostic outcomes exert substantial influence on pregnancy decision-making. Perinatal outcome and short-term prognosis of affected fetuses are reasonably favorable when known genetic causes are excluded.
Sociodemographic and occupational risk factors for premenstrual mood disorders among female workers.
Shimoda M, Kurosawa T, Takizawa R
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41392336 · Full text
INTRODUCTION: Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome, collectively referred to as premenstrual mood disorders (PMDs), are common among working women and can significantly impact their well-being...
INTRODUCTION: Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome, collectively referred to as premenstrual mood disorders (PMDs), are common among working women and can significantly impact their well-being and productivity. This study investigated the prevalence of PMDs and identified sociodemographic and occupational factors that contribute to the risk of PMDs among Japanese working women. MATERIAL AND METHODS: This was a cross-sectional study based on a two-wave online survey conducted between January and June 2023. The study targeted individuals who were biologically female, aged 20-44 years, and currently employed in Japan. Data were collected on sociodemographic characteristics (e.g., age, marital status, education, income), occupational factors (e.g., working hours, job type), and health-related variables. The primary outcome was the presence of premenstrual disorders (PMDs), assessed using the Premenstrual Dysphoric Disorder Scale. Participants were classified as having PMDs if they met criteria for either PMDD or moderate-to-severe premenstrual syndrome (PMS). Those reporting no or only mild symptoms were categorized as not having PMDs. The secondary outcome was the identification of sociodemographic and occupational factors associated with the presence of PMDs. To examine these associations, logistic regression analysis was performed, comparing individuals with and without PMDs. RESULTS: Among 908 participants (mean age = 33.48, SD = 6.20), 13.66% had PMDD, and 30.51% had moderate-to-severe premenstrual syndrome. Greater PMD risk was associated with younger age, non-regular employment, working ≥60 h weekly, employment in small companies, the presence of children, and lower educational attainment. In contrast, a lower PMD risk was associated with having a manufacturing job. CONCLUSIONS: Sociodemographic and occupational factors have a strong impact on PMDs among Japanese female workers. Promoting work-life balance and providing tailored mental health support in the workplace can help reduce PMDs. Future studies should further investigate these complex relationships.
Longitudinal maternal hemodynamics from late pregnancy to postpartum in uncomplicated twin pregnancies-A glimpse into long-term cardiovascular risk?
Zekert HF, Biermann AL, Dütemeyer V … +5 more , Meier N, Radomsky L, Hillemanns P, von Kaisenberg C, Brodowski L
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41387307 · Full text
INTRODUCTION: Twin pregnancies impose greater cardiovascular demands than singleton gestations, potentially increasing long-term cardiovascular risk even in the absence of hypertensive disorders. Nevertheless, longitudin...
INTRODUCTION: Twin pregnancies impose greater cardiovascular demands than singleton gestations, potentially increasing long-term cardiovascular risk even in the absence of hypertensive disorders. Nevertheless, longitudinal assessments of maternal hemodynamics in uncomplicated twin pregnancies remain limited, and most available studies focus solely on the antenatal period. Chorionicity has been shown to markedly influence cardiovascular adaptation during twin gestation. This study aimed to investigate whether distinct hemodynamic adaptations occur in twin compared with singleton pregnancies during late gestation, 1 day and 6 weeks postpartum. MATERIAL AND METHODS: In this prospective longitudinal cohort study conducted at Hannover Medical School from 08/24 to 05/2025, 36 women with twin pregnancies (8 monochorionic (MC), 28 dichorionic (DC)) and 37 with singleton pregnancies underwent noninvasive hemodynamic assessment at 34 weeks' gestation, 1 day postpartum, and 6 weeks postpartum. RESULTS: MC twin pregnancies exhibited significantly higher cardiac output (MC: 7.72 L/min; DC: 5.62 L/min; S: 6.27 L/min; p = 0.01) and lower systemic vascular resistance (MC: 958.83 dynes × s/cm; DC: 1206.86 dynes × s/cm; S: 1119.45 dynes × s/cm; p = 0.01) during the third trimester, with a similar hemodynamic pattern appearing to persist in the postpartum period. MC twins also showed significant decreases in heart rate (T1: 86.37 bpm; T2: 77.73 bpm; T3: 66.67 bpm; p = 0.002), mean arterial pressure (T1: 93.0 mmHg; T2: 85.5 mmHg; T3: 78.0 mmHg; p = 0.03), and inotropism postpartum (T1: 1.92 W/m; T2: 1.67 W/m; T3: 1.54 W/m; p = 0.04), whereas DC twins demonstrated a trend to higher stroke volume (T1: 69.6 mL; T2: 80.31 mL; T3: 82.63 mL; p = 0.01) and gradual increase of vascular resistance (T1: 1206.86 dynes × s/cm; T2:1099.86 dynes × s/cm; T3: 1426.78 dynes × s/cm; p = 0.08). CONCLUSIONS: Monochorionic twin pregnancies are characterized by elevated cardiac output and reduced vascular resistance in late pregnancy, with a similar hemodynamic pattern appearing to persist in the postpartum period. This persistent cardiovascular strain may underlie the elevated short-term cardiovascular risk observed after twin births. Our findings highlight the need for larger longitudinal studies to explore the transition from physiological adaptation to potential cardiovascular maladaptation.
Adhesion molecules in the maternal-fetal interface in healthy pregnancies and preeclampsia.
Frisch IK, Michelsen TM, Lekva T … +2 more , Roland MCP, Westerberg AC
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41387088 · Full text
INTRODUCTION: Adhesion molecules are markers of endothelial activation, and they are involved in placentation and inflammation. We compared levels of vascular cell adhesion molecule-1 (VCAM1), intercellular adhesion mole...
INTRODUCTION: Adhesion molecules are markers of endothelial activation, and they are involved in placentation and inflammation. We compared levels of vascular cell adhesion molecule-1 (VCAM1), intercellular adhesion molecule-1 (ICAM1), and E-selectin (SELE) in maternal and fetal vessels of preeclampsia and healthy pregnancies. Furthermore, we investigated if the placenta releases adhesion molecules. MATERIAL AND METHODS: Blood was sampled from three maternal (antecubital vein, uterine vein, and radial artery as a proxy for the uterine artery) and two fetal vessels (umbilical vein and artery) in 75 healthy pregnancies and 37 cases of preeclampsia undergoing cesarean delivery. Samples were also collected among 70 healthy pregnancies and 35 preeclampsia cases at three visits (gestational weeks 14-16, 22-24, and 30-32) in a longitudinal cohort. Proteins were relatively quantified on SomaLogic's 5000-multiplex platform. Venoarterial differences on both sides of the placenta were used to indicate placental release and uptake. RESULTS: Before the onset of preeclampsia, we observed elevated maternal antecubital vein levels of VCAM1 (visits 1 and 3) and ICAM1 (all three visits). At delivery, VCAM1 and SELE were elevated in maternal vessels in preeclampsia compared to healthy, except for VCAM1 in the uterine vein. On the fetal side of the placenta, adhesion molecules were lower in preeclampsia compared to healthy pregnancies. There were no venoarterial differences on the maternal side of the placenta that indicated placental protein release. On the fetal side of the placenta, healthy controls had a positive venoarterial difference of SELE, indicating placental release to the fetus. VCAM1 and SELE levels were higher in fetal circulation as compared to maternal circulation in healthy pregnancies, whereas in preeclampsia, this was only the case for VCAM1. ICAM1 was higher in maternal than fetal circulation in healthy controls and preeclampsia. CONCLUSIONS: Alterations in maternal levels of adhesion molecules were seen before the onset of PE. In preeclampsia, adhesion molecules were elevated in the maternal and lower in the fetal circulation. There was no placental release of the adhesion molecules to the mother, indicating a general systemic endothelial dysfunction. The results highlight new insights into the pathophysiology of preeclampsia that warrant further exploration.
Patient education materials by ChatGPT: Real intention and interpretation.
Matsubara S
Acta Obstet Gynecol Scand · 2025 Dec · PMID 41386744 · Publisher ↗
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Severity of perineal tears and deviations in perineal body anatomy: A three-dimensional ultrasound study.
Sether Lilleberg H, Siafarikas F, Bø K … +1 more , Ellström Engh M
Acta Obstet Gynecol Scand · 2026 Jul · PMID 41368971 · Full text
INTRODUCTION: Perineal tears are classified into four degrees based on severity. Second-degree tears, which involve the muscles fusing into the perineal body, but not the anal sphincter, vary in extent and have recently...
INTRODUCTION: Perineal tears are classified into four degrees based on severity. Second-degree tears, which involve the muscles fusing into the perineal body, but not the anal sphincter, vary in extent and have recently been subcategorized. However, knowledge about their long-term anatomical impact on the perineal body remains limited, as postpartum evaluation has largely relied on inspection and palpation. This study aimed to examine the association between the severity of perineal tears not affecting the anal sphincter, diagnosed at delivery, and deviations in the muscles fusing into the perineal body, assessed by three-dimensional ultrasound 1 year after vaginal delivery. MATERIAL AND METHODS: This prospective cohort study included 384 primiparous women with vaginal deliveries at Akershus University Hospital, Norway, from January 2021 to July 2022. Perineal tears were classified and sutured according to international standards at delivery. In addition, second-degree tears were subclassified according to the percentage of the perineal body damage (<50% = 2A, ≥50% = 2B, entire perineal body without anal sphincter = 2C). Women with third- or fourth-degree tears were excluded. One year after delivery, participants underwent three-dimensional endovaginal and endoanal ultrasound examinations. The transverse perineal, puboperinealis, and puboanalis muscles were examined at their fusion into the perineal body. A deviation was defined as a muscle discontinuity or absence in at least one of the muscles. RESULTS: The proportion of women with sonographically detected muscle deviations increased with tear severity: 22% for first-degree (n = 24), 52.7% for 2A (n = 29), 60% for 2B (n = 21) and 86.2% for 2C (n = 25). Among women with episiotomies (n = 126), 60.6% had one or more muscle deviations. A higher number of muscles were affected in the 2C tear group compared to 2B and 2A. CONCLUSION: Sonographic deviations in the muscles fusing into the perineal body increase with the severity of perineal tears.
Risk factors for shoulder dystocia-related brachial plexus injuries: A case-control study.
Heinonen K, Saisto T, Gissler M … +1 more , Sarvilinna N
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41367186 · Full text
INTRODUCTION: Brachial plexus injury (BPI) is one of the major complications associated with shoulder dystocia. This study aimed to identify risk factors for shoulder dystocia-related BPI (SD BPI) in the Finnish populati...
INTRODUCTION: Brachial plexus injury (BPI) is one of the major complications associated with shoulder dystocia. This study aimed to identify risk factors for shoulder dystocia-related BPI (SD BPI) in the Finnish population. MATERIAL AND METHODS: The study included all deliveries in the Hospital District of Helsinki and Uusimaa between 2006 and 2015 (n = 181 352). Singleton deliveries complicated by shoulder dystocia, BPI, and clavicle fracture were identified using ICD-10 codes O66.0, P13.4, P14.0, and P14.1 (n = 1708). Following a thorough review of medical records, 374 cases of BPI were identified, 259 of which were related to shoulder dystocia. The background-matched control group (n = 566) consisted of singleton deliveries without BPI. RESULTS: The incidences of both BPI with and without shoulder dystocia declined significantly during the study period, from 0.16% to 0.05% and from 0.09% to 0.03%, respectively. Multivariate analysis identified the following independent risk factors for SD BPI: birthweight ≥4000 g (adjusted odds ratio, aOR 15.3), maternal diabetes (aOR 4.0), vacuum extraction (aOR 3.7), and maternal height ≤160 cm (aOR 2.7). A predictive model based on these four risk factors demonstrated a positive predictive value of 48.2% and a negative predictive value of 92.9% for SD BPI cases. The odds of permanent BPI were 2.5-fold for cases associated with shoulder dystocia compared to those without. Antepartum and intrapartum variables were not predictive of permanent SD BPI. Among all BPI cases, 69.3% were associated with shoulder dystocia and 64.2% with birthweight ≥4000 g. CONCLUSIONS: Birthweight ≥4000 g, maternal diabetes, height ≤160 cm, and vacuum extraction independently increased the risk of SD BPI. Notably, 14.7% of all BPI cases occurred in the absence of both shoulder dystocia and birthweight ≥4000 g.
Methodological concerns in the feasibility study on ultrasound pelvimetry for breech birth.
Chen W, Xuan X
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41361926 · Full text
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Fetal biometry and maternal characteristics for second trimester prediction of stillbirth.
Lindström L, Stephansson O, Cnattingius S … +2 more , Wilcox A, Granfors M
Acta Obstet Gynecol Scand · 2026 Feb · PMID 41345859 · Full text
INTRODUCTION: Small fetal size is the most important risk factor for stillbirth. To our knowledge, no previous study has considered combinations of mid-trimester measures of fetal size as predictors of stillbirth risk. T...
INTRODUCTION: Small fetal size is the most important risk factor for stillbirth. To our knowledge, no previous study has considered combinations of mid-trimester measures of fetal size as predictors of stillbirth risk. The aim of this cohort study was to assess whether small fetal measurements by mid-pregnancy ultrasound, in conjunction with maternal factors, can predict the risk of stillbirth. MATERIAL AND METHODS: In this historical cohort study, we identified 377 563 singleton pregnancies in the Swedish Pregnancy Register between 2014 and 2021, with delivery at ≥22 gestational weeks with a first trimester (6-13 weeks) dating ultrasound, and second trimester (16-21 weeks) measurements of biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). Relative risks (RR) with a 95% confidence interval (CI) for stillbirth were calculated for fetuses with any second-trimester biometry <5th centile, and adjusted for maternal characteristics. Odds ratios (ORs) with 95% CI were used to assess the individual contributions of fetal biometry and maternal characteristics to stillbirth risk. Significant factors were included in a multivariate prediction model, and the area under the receiver operating characteristic curve (AUC) was used to assess predictive performance. RESULTS: Short second-trimester FL was associated with increased risk of stillbirth, especially when combined with small AC or both small BPD and AC (aRR [95% CI] 2.78 [1.44-5.34] and 2.40 [1.14-5.06], respectively), whereas normal FL with small BPD and/or AC was not. In the multivariable model, short FL in combination with small AC was the strongest contributor to stillbirth risk assessment. The AUC of the prediction model, including both maternal characteristics, small AC, and short FL, was 0.623 for stillbirth in all pregnancies, 0.635 for term stillbirth, and 0.591 for preterm stillbirth. CONCLUSIONS: We found evidence of increased risk of stillbirth among fetuses with short FL, especially in combination with small AC, but not with normal FL, regardless of other small fetal dimensions. However, maternal characteristics and mid-gestational biometry perform poorly in predicting stillbirth.
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