Acta Obstetricia et Gynecologica Scandinavica最新文献

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.

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.

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.

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.

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.

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.

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.

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.

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.