Acta Obstetricia et Gynecologica Scandinavica最新文献

Introduction: Sociodemographic and obstetric factors have been shown to impact childbirth experience, but results regarding the effect of certain factors have been heterogeneous. It is important to understand how individual risk factors affect childbirth experience to be able to identify women at risk for negative childbirth experience. The aim of this study was to determine individual associations between sociodemographic and obstetric factors and childbirth experience.

Material and methods: The Labor Progression Study (LaPS-NCT02221427) was a multicenter randomized trial examining clinical consequences of using Zhang's guideline versus the WHO partograph on intrapartum cesarean section rate. Four weeks after delivery, 5810 women received the Childbirth Experience Questionnaire (CEQ) online. The CEQ consists of 19 questions on four subscales (own capacity, professional support, perceived safety, and participation). The total CEQ score is the mean score of each of the subscale scores, ranging from 1 to 4, a higher score indicating a better childbirth experience. Sociodemographic (age, body mass index, education, civil status, and smoking) and obstetric (gestational age, prolonged labor, mode of delivery, and obstetric complications) characteristics of the women were recorded, and associations to total and subscale CEQ scores were examined with log-linear regression.

Results: In all, 3604 women answered the questionnaire, a 62.9% response rate. The mean (SD) total CEQ score was of 3.24 (0.43). The subscale score was highest for professional support, mean 3.68 (0.49), and lowest for own capacity, mean 2.61 (0.54). The total CEQ score was not associated with any of the sociodemographic characteristics examined. Smoking in the first trimester was associated with lower scores on the professional support subscale 3.61 (3.55, 3.67) than nonsmokers, 3.69 (3.68, 3.71); p = 0.001. Of obstetric factors, only delivering in week 37 was significantly associated with a higher total CEQ score, 3.34 (3.28, 3.40), vs. 3.24 (3.22, 3.26) at 40 weeks, p = 0.002. Findings remained significant in adjusted analysis.

Conclusions: In our study, individual sociodemographic factors did not impact overall the childbirth experience. Smoking was associated with a lower score on the professional support subscale. Delivery in week 37 was associated with a better overall childbirth experience. No other obstetric factor influenced the childbirth experience.

Introduction: The outcome following hysteroscopy adhesiolysis of Asherman's syndrome in the puerperal period who appeared to do less well than the participants who developed the syndrome unrelated to child birth. As there is no literature to support or refute the observation, we decided to conduct a retrospective cohort study to compare the outcome of hysteroscopic adhesiolysis in women who developed Asherman's syndrome within or outside the puerperal period.

Material and methods: This retrospective cohort study aimed to compare the outcome of hysteroscopic adhesiolysis in women who developed Asherman's syndrome within the puerperal period and women who developed the Asherman's syndrome outside the puerperal period. Fifty-one women suffered from Asherman's syndrome in the puerperal period and 153 women suffered from Asherman's syndrome which developed outside the puerperal period. Second-look and third-look hysteroscopy were performed 4 and 8 weeks after hysteroscopic adhesiolysis.

Results: The primary outcome measures were the postoperative adhesion reformation rate and the magnitude of reduction in American Fertility Society score as assessed at second-look hysteroscopy. The secondary outcome measure was the change in menstrual pattern at 3 months after surgery. The adhesion reformation rate in puerperal group was 86.3%, which was significantly (p < 0.05) higher than that of 38.6% in the non-puerperal (non-puerperal) group. The median reduction in the adhesion score was 4.5 (4-6) in the puerperal group, which was significantly (p < 0.001) lower than the median reduction 7 (6-8) of the non-puerperal group. In the puerperal group, the reduction rate of American Fertility Society score after hysteroscopic adhesiolysis was 42.4%, which was significantly lower than that of 72.6% in the non-puerperal group. In the puerperal group, only 56.9% of women experienced improvement in menstruation defined as subjective increase in menstrual flow after surgery, which was significantly lower than that of 83.7% observed in the non-puerperal group.

Conclusions: Following hysteroscopic adhesiolysis, the outcome of Asherman's syndrome in women who developed the condition in the puerperal period was worse than those who developed the condition outside the puerperal period. Strategies to minimize damage and promote regeneration of the endometrium in the puerperal period in women at risk of developing intrauterine adhesions should be promoted.

Introduction: Women living with overweight, or obesity are at risk of pregnancy and birth complications. This study investigated the trend and associations between overweight and obesity on cesarean births and their contribution to cesarean births among low-risk primiparous women in Australia.

Material and methods: Body mass index data were obtained for 219, 950 primipara (aged 20─34 years) with singleton, term pregnancies without malpresentations from the Victorian Perinatal Data Collection registry (2010─2019). Women were grouped according to body mass index and logistic regression analyses were performed to assess the trend and associations of overweight and obesity with cesarean births. The contribution of overweight and obesity to cesarean births were estimated using population attributable fraction.

Results: The prevalence of cesarean birth was 29.7%, and the prevalence increased by 20%, from 27.6% in 2010 to 33.2% in 2019. Being overweight or obese was independently associated with an increased likelihood of cesarean births in the overall sample (adjusted OR (AOR) 1.46; 95% CI 1.42-1.50 and AOR 2.05, 95% CI 1.98-2.11, respectively). However, overweight was not an independent risk factor when the analysis was limited to elective cesarean births. Induction of labor was significantly higher among women who were overweight (AOR 1.38; 95% CI 1.35-2.42), or obese (AOR 2.18 95% CI 2.12-2.25). The combined overweight and obesity contributed to 14.8% of cesarean births but the increasing trend of cesarean births was not explained solely by changes in overweight or obesity rates.

Conclusions: Obesity and overweight, combined, are responsible for a significant proportion of cesarean births. However, overweight and obesity alone do not provide enough insight into the increasing trend of cesarean birth. While further investigation of potential contributors is needed, initiatives to reduce cesarean births in Australia may benefit better by including measures, such as health education to prevent overweight and obesity prior to conception.

Introduction: Decisions concerning nuchal translucency (NT) between 3.0 and 3.4 mm remain controversial, particularly regarding whether to first calculate the combined first trimester screening test or to proceed directly with invasive testing. The literature suggests an increased risk of chromosomal aberration, as well as pathogenic copy number variations (CNVs) on chromosomal microarray, for fetuses with NT between 3.0 and 3.4 mm. The aim of this study was to describe genetic findings of fetuses with NT between 3.0 and 3.4 mm in the first trimester. The secondary objective was to describe ultrasound findings and adverse outcomes for these fetuses. The third objective was to compare genetic, ultrasound findings and adverse outcomes of fetuses with NT between 3.0 and 3.4 mm to those with NT ≥3.5 mm.

Material and methods: We conducted an observational, retrospective study in a referral center between 2017 and 2022. Genetic and ultrasound findings were compared between fetuses with NT between 3.0 and 3.4 mm and those with NT≥3.5 mm. An adverse outcome was defined as one of the following: miscarriage, perinatal death (stillbirth or neonatal death) or termination of pregnancy at parental request, and all major abnormalities or genetic disorders diagnosed before or after delivery.

Results: We included 404 fetuses with NT≥3.0 mm who had invasive testing with available karyotype and chromosomal microarray, among whom 20.8% (84/404) had NT between 3.0 and 3.4 mm. The rate of adverse outcomes among fetuses with NT between 3.0 and 3.4 mm was 32.1% (27/84). The rates of chromosomal aberration, pathogenic CNVs, and major ultrasound abnormalities were 16.7% (14/84), 6.0%(5/84), and 9.2% (6/65), respectively, for fetuses with NT between 3.0 and 3.4 mm. In comparison, fetuses with NT greater than 3.5 mm had higher rates of chromosomal aberration and major ultrasound abnormalities, with rates of 47.5% (152/320) and 30.2% (49/162) respectively compared to 16.7% (14/84) and 9.2% (6/65) for fetuses with NT between 3.0 and 3.4 mm (p < 0.001 for both comparisons). However, the rate of pathogenic CNVs was not significantly different between the two groups, with rates of 1.9% (6/320) for NT≥3.5 mm and 6.0% (5/84) for NT between 3.0 and 3.4 mm (p = 0.06).

Conclusions: The rate of chromosomal aberration and pathogenic CNVs on chromosomal microarray is high among fetuses with NT between 3.0 and 3.4 mm, although these rates remain lower than those observed among fetuses with NT≥3.5 mm.

Introduction: Patients who have undergone colorectal surgery for symptomatic deep endometriosis may still encounter persistent or worsening digestive complaints. The aim of the present work was to analyze gastrointestinal function outcomes after radical and conservative colorectal surgery to further elucidate the effect of surgery on postoperative bowel function.

Material and methods: PubMed, EMBASE, Web of Science, Clinical Trials.gov and the Cochrane Database databases were searched from January 1, 2010 until April 1, 2024. The quality of included studies was assessed by the Downs and Black quality checklist. Studies including patients with colorectal endometriosis who either underwent segmental resection (SR) or conservative approaches and reported data on bowel function were included.

Results: From the initial pool of 55 studies, 14 reported patient reported outcome measures eligible to be pooled in the meta-analysis. Conservative surgery was less associated with constipation and increased number of daily stool (>3/day) when compared to SR (p = 0.02 and p = 0,0004, respectively). No difference was found in the occurrence of gas and stool incontinence (p = 0.72), postsurgical defecation pain (p = 0.44) and time to defer defecation (≤ 15 min; p = 0.64). Patients in the conservative surgery group reported higher postoperative Gastrointestinal Quality of Life Index (GIQLI) when compared to SR (p = 0.01). However, when comparing changes between pre- and postsurgical patient reported outcome measures within the respective groups, rather than evaluating postsurgical outcomes alone, none of the intervention groups showed significant changes between pre- and postsurgical GIQLI, Knowles Eccersley Scott Symptom Score(KESS) and Wexner scores (p = 0.28, p = 0.94 and p = 0.78, respectively).

Conclusions: Segmental resection seems to be associated with higher rates of post-operative constipation and lower GIQLI scores when compared to conservative surgery. However, when comparing the change of gastrointestinal function symptoms reflected by changes of gastrointestinal function parameters from pre- to postoperative rather than focusing on purely postoperative parameters alone, no significant difference of these parameters was observed between surgical techniques.

Introduction: Exposure to potentially teratogenic medications during pregnancy is underinvestigated in Switzerland. We aimed to assess exposure to potential teratogens preconceptionally, during the first trimester, and in women of childbearing age, and specifically explore the effectiveness of the valproate pregnancy prevention program (2018).

Material and methods: Retrospective study using the Swiss Helsana claims database. In a pregnancy cohort (2015-2021) and a cohort of women of childbearing age (2021 and 2018), we defined three 90-day time periods: (1) first trimester, (2) preconceptional period (days 180-90 before pregnancy), and (3) January 01, 2021, and March 31, 2021 (women of childbearing age). During all periods, we quantified the exposure prevalence to at least one dispensed weak, proven, and unequivocally potent teratogen overall and by age strata. We quantified the exposure prevalence to each individual teratogen, and to valproate during pregnancy by calendar year to compare its use before and after the introduction of a pregnancy prevention program (2018). We investigated the use of systemic retinoids particularly isotretinoin in women of childbearing age.

Results: Of 34 584 pregnant women, 1.4% were exposed to potential teratogens during the first trimester (weak: 1.3%, proven: 0.06%, unequivocally potent: 0.04%). During the preconceptional period, 2.9% were exposed to any teratogen compared to 4.7% of women of childbearing age (N_total = 95 059). Systemic glucocorticoids were the most prevalent weak teratogens during all time periods (75% of all claimed teratogens during the first trimester). In the first trimester, the antibiotic cotrimoxazole and the thyreostatic thiamazole (weak teratogens), ranked second and third, followed by the antiseizure medications carbamazepine and topiramate (proven teratogens). Among women of childbearing age, exposure to weak and proven teratogens increased with age, whereas exposure to unequivocally potent teratogens decreased with age. This was due to 2.3% of women <26 years who claimed systemic isotretinoin. Valproate use during pregnancy decreased after the introduction of a pregnancy prevention program (2.39/10 000 pregnancies [2015-2018] vs. 0.93/10 000 pregnancies [2019-2021]).

Conclusions: Most medications with potential teratogenic effects dispensed to women of childbearing age and pregnant women were in the group of weak teratogenicity level, and many women discontinued treatment before pregnancy. Preliminary evidence suggests the valproate pregnancy prevention program in Switzerland may be beneficial.

Introduction: To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two years of active surveillance.

Material and methods: This was a single-center prospective observational cohort study. Women under 31 years of age giving written informed consent with histologically confirmed CIN2 were followed with colposcopy, cytology, and biopsies every 6 months up to 24 months. At baseline, HPV genotyping was performed on cervical samples. The rates of regression and progression were recorded for every timepoint and at the end of study overall and stratified according to clinical factors and HPV genotypes at baseline. Risk ratio (RR) was used to estimate the relative risks for regression and progression. The study was registered in the ISRCTN registry (ISRCTN91953024).

Results: In total, 205/243 (84.4%) women completed the study. Complete regression (normal histology and/or normal or atypical squamous cells of undetermined significance (ASC-US) cytology) was detected in 64.4.% (n = 132) while 16.1% (n = 33) of the lesions progressed to CIN grade 3 (CIN3) or worse including 31 CIN3 cases, one adenocarcinoma in situ and one cervical cancer case. Factors associated with progression were initial large (>50% of the transformation zone) lesion size, risk ratio (RR) 3.06 (95% confidence interval (CI) 1.40-6.69), and high-grade referral cytology RR 4.73 (95% CI 1.18-19.03). Compared with baseline HPV negativity or having only low-risk HPV genotypes present, high-risk HPV (hrHPV) positivity was associated with lower likelihood of regression RR 0.74 (95% CI 0.60-0.91). Age, cigarette smoking, use of combined oral contraceptives or baseline high-risk HPV genotype, including HPV16, were not associated with the outcomes.

Conclusions: The majority of CIN2 lesions regress in young women. Women with large lesions and/or high-grade referral cytology should perhaps more often be treated instead of active surveillance. Initial hrHPV genotype does not appear to predict outcomes while not harboring hrHPV favors regression.

Introduction: To prevent extreme preterm birth, women with cervical insufficiency are eligible for transabdominal cerclage in case of prior failure or technical impossibility for transvaginal cerclage. This study aimed to identify patient characteristics that affect the success rate of transabdominal cerclage to prevent extreme preterm birth in women with cervical insufficiency.

Material and methods: Single-center retrospective cohort study in 87 women who underwent transabdominal cerclage by open laparotomy during first and early second trimester of pregnancy over a 20-year period. Participants were divided into subgroups according to indication for the intervention. Linear regression and meta-regression-analyses were performed to assess the effect of mean cervical length (before and after transabdominal cerclage placement) and gestational age of previous preterm birth, on gestational age at delivery. Kaplan-Meier analysis was performed to evaluate treatment effects on gestational age at delivery.

Results: Of 87 women, 62 women underwent a history-indicated and 25 an ultrasound-indicated transabdominal cerclage. Fetal survival was 92%: 91% in the history-indicated and 96% in the ultrasound-indicated group. Median gestational age at delivery was 37.3 weeks, with a median pregnancy prolongation of 163.0 days and with 92% of deliveries ≥34 weeks. Between groups, irrespective of singleton and twin pregnancies, outcomes were comparable. Gestational age at delivery was neither affected by cervical length before transabdominal cerclage, distance between transabdominal cerclage and external os, gestational age of previous preterm birth nor additional progesterone treatment.

Conclusions: The efficacy of transvaginal cerclage placement via open laparotomy during high-risk pregnancy is favorable and relates to fetal survival of 92%. Regardless of indication, pregnancy outcomes after transabdominal cerclage are similar, and independent of gestational age at previous preterm birth, cervical length before transabdominal cerclage placement, distance between transabdominal cerclage and external os, and additional progesterone administration.