Jenni Kinnunen, Hilkka Nikkinen, Elina Keikkala, Sanna Mustaniemi, Mika Gissler, Hannele Laivuori, Johan G. Eriksson, Eero Kajantie, Marja Vääräsmäki
Introduction
Gestational diabetes mellitus (GDM) is associated with various health risks in offspring. We investigated the effect of GDM exposure on offspring morbidity in a population-based cohort, assessed by the utilization of specialized health care services up to 12 years of age.
Material and Methods
This register-based study, part of the Finnish Gestational Diabetes (FinnGeDi) study, included all singleton children born in Finland in 2009, captured from the Medical Birth Registry. Mothers of children in the study cohort underwent comprehensive screening for GDM. The study cohort included 6235 (11.1%) GDM-exposed children and 49 484 unexposed children. Utilization of specialized health care services was measured as the number of outpatient visits and inpatient treatment episodes (including duration in days). Data were obtained from the Finnish Care Register for Health Care up to 12 years of age and were analyzed separately for early childhood (0–2 years), preschool age (3–6 years), and school age (7–12 years) also. Maternal, birth, and child-related factors were considered, including maternal age, pre-pregnancy body mass index (BMI), parity, maternal hypertensive disorders, socioeconomic status (SES), smoking status, mode of delivery, preterm birth, small for gestational age, and child sex in the adjustment model.
Results
Children exposed to maternal GDM had a higher incidence of outpatient visits than unexposed children (adjusted incidence rate ratio [IRR] 1.10, 95% confidence interval [CI] 1.07–1.13). Among children with multiple outpatient care visits (the highest quartile), GDM-exposed children were overrepresented in early childhood (adjusted odds ratio [aOR] 1.08, 95% CI: 1.00–1.15), preschool age (aOR 1.12, 95% CI: 1.05–1.19), and school age (aOR 1.11, 95% CI: 1.04–1.19). Children exposed to GDM were also more likely to require inpatient treatment than unexposed children (adjusted IRR 1.14, 95% CI: 1.10–1.19). The difference was not explained by shorter episodes (adjusted IRR 1.20, 95% CI: 1.16–1.24 for inpatient treatment days).
Conclusions
Children exposed to maternal GDM required more specialized health care services than unexposed children, with increased utilization of specialized health care observed across all age categories up to 12 years of age.
{"title":"Gestational diabetes mellitus and offspring health: A 12-year register-based analysis of specialized health care utilization in Finland","authors":"Jenni Kinnunen, Hilkka Nikkinen, Elina Keikkala, Sanna Mustaniemi, Mika Gissler, Hannele Laivuori, Johan G. Eriksson, Eero Kajantie, Marja Vääräsmäki","doi":"10.1111/aogs.70077","DOIUrl":"10.1111/aogs.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Gestational diabetes mellitus (GDM) is associated with various health risks in offspring. We investigated the effect of GDM exposure on offspring morbidity in a population-based cohort, assessed by the utilization of specialized health care services up to 12 years of age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This register-based study, part of the Finnish Gestational Diabetes (FinnGeDi) study, included all singleton children born in Finland in 2009, captured from the Medical Birth Registry. Mothers of children in the study cohort underwent comprehensive screening for GDM. The study cohort included 6235 (11.1%) GDM-exposed children and 49 484 unexposed children. Utilization of specialized health care services was measured as the number of outpatient visits and inpatient treatment episodes (including duration in days). Data were obtained from the Finnish Care Register for Health Care up to 12 years of age and were analyzed separately for early childhood (0–2 years), preschool age (3–6 years), and school age (7–12 years) also. Maternal, birth, and child-related factors were considered, including maternal age, pre-pregnancy body mass index (BMI), parity, maternal hypertensive disorders, socioeconomic status (SES), smoking status, mode of delivery, preterm birth, small for gestational age, and child sex in the adjustment model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Children exposed to maternal GDM had a higher incidence of outpatient visits than unexposed children (adjusted incidence rate ratio [IRR] 1.10, 95% confidence interval [CI] 1.07–1.13). Among children with multiple outpatient care visits (the highest quartile), GDM-exposed children were overrepresented in early childhood (adjusted odds ratio [aOR] 1.08, 95% CI: 1.00–1.15), preschool age (aOR 1.12, 95% CI: 1.05–1.19), and school age (aOR 1.11, 95% CI: 1.04–1.19). Children exposed to GDM were also more likely to require inpatient treatment than unexposed children (adjusted IRR 1.14, 95% CI: 1.10–1.19). The difference was not explained by shorter episodes (adjusted IRR 1.20, 95% CI: 1.16–1.24 for inpatient treatment days).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Children exposed to maternal GDM required more specialized health care services than unexposed children, with increased utilization of specialized health care observed across all age categories up to 12 years of age.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"146-155"},"PeriodicalIF":3.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trine Damsted Rasmussen, Stine Kjaer Urhoj, Maria C. Magnus, Jonas Söderling, Laura L. Oakley, Anne K. Örtqvist, Hellen M. Edwards, Lone Krebs, Hilde M. Engjom, Olof Stephansson, Siri E. Håberg, Anne-Marie Nybo Andersen, Anna J. M. Aabakke
Introduction
The aim was to evaluate whether SARS-CoV-2 infection during pregnancy was associated with severe postpartum hemorrhage (PPH), as SARS-CoV-2 infection has been shown to affect the coagulation system.
Material and Methods
In this national register-based cohort study in Sweden, Denmark, and Norway, we studied the association between severe PPH according to a registered positive test for SARS-CoV-2 during pregnancy between March 1, 2020 and March 31, 2023 using logistic regression analyses to estimate odds ratios (ORs) with 95% confidence intervals (CI). Country-specific estimates of association were combined in random effects meta-analyses. The primary outcome was severe PPH, defined as a blood loss >1500 mL and/or receiving a blood transfusion.
Results
We included 542 394 singleton deliveries (264 804 in Sweden, 143 775 in Denmark, and 133 815 in Norway), of which 62 606 women (11%) had a positive SARS-CoV-2 test during pregnancy, and 20 786 (3.8%) deliveries were registered with a severe PPH. Overall, we observed no association between testing positive for SARS-CoV-2 during pregnancy and severe PPH (combined adjusted OR 1.04; 95% CI: 0.96–1.12). The results were similar for different calendar periods corresponding to dominant SARS-CoV-2 variants. We did, however, observe an association between severe PPH and women testing positive within 7 days before delivery (combined adjusted OR 1.30; 95% CI: 1.10–1.53).
Conclusions
There was no association identified between SARS-CoV-2 test positivity and PPH of >1500 mL and/or blood transfusion in pregnant women from three Scandinavian countries. However, we observed a 30% higher odds of severe PPH among pregnant women who tested positive within one week before delivery.
{"title":"Postpartum hemorrhage after SARS-CoV-2 infection in pregnancy: A Scandinavian register-based cohort study","authors":"Trine Damsted Rasmussen, Stine Kjaer Urhoj, Maria C. Magnus, Jonas Söderling, Laura L. Oakley, Anne K. Örtqvist, Hellen M. Edwards, Lone Krebs, Hilde M. Engjom, Olof Stephansson, Siri E. Håberg, Anne-Marie Nybo Andersen, Anna J. M. Aabakke","doi":"10.1111/aogs.70069","DOIUrl":"10.1111/aogs.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The aim was to evaluate whether SARS-CoV-2 infection during pregnancy was associated with severe postpartum hemorrhage (PPH), as SARS-CoV-2 infection has been shown to affect the coagulation system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In this national register-based cohort study in Sweden, Denmark, and Norway, we studied the association between severe PPH according to a registered positive test for SARS-CoV-2 during pregnancy between March 1, 2020 and March 31, 2023 using logistic regression analyses to estimate odds ratios (ORs) with 95% confidence intervals (CI). Country-specific estimates of association were combined in random effects meta-analyses. The primary outcome was severe PPH, defined as a blood loss >1500 mL and/or receiving a blood transfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 542 394 singleton deliveries (264 804 in Sweden, 143 775 in Denmark, and 133 815 in Norway), of which 62 606 women (11%) had a positive SARS-CoV-2 test during pregnancy, and 20 786 (3.8%) deliveries were registered with a severe PPH. Overall, we observed no association between testing positive for SARS-CoV-2 during pregnancy and severe PPH (combined adjusted OR 1.04; 95% CI: 0.96–1.12). The results were similar for different calendar periods corresponding to dominant SARS-CoV-2 variants. We did, however, observe an association between severe PPH and women testing positive within 7 days before delivery (combined adjusted OR 1.30; 95% CI: 1.10–1.53).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was no association identified between SARS-CoV-2 test positivity and PPH of >1500 mL and/or blood transfusion in pregnant women from three Scandinavian countries. However, we observed a 30% higher odds of severe PPH among pregnant women who tested positive within one week before delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2355-2365"},"PeriodicalIF":3.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zdenek Rusavy, Adela Marinic Veverkova, Martin Smazinka, Vladimir Kalis
<div> <section> <h3> Introduction</h3> <p>While the role of vaginal packing following vaginal reconstructive surgery and vaginal hysterectomy was well-explored, data regarding laparoscopic reconstructive surgery are lacking. No effect on early postoperative pain, complications, and satisfaction after laparoscopic sacrocolpopexy (LSC) was observed as presented earlier. No data concerning the effect of vaginal packing on the surgical outcome of LSC exist. Our objective was to test the hypothesis that vaginal packing after laparoscopic sacrocolpopexy is associated with a reduced risk of pelvic organ prolapse recurrence.</p> </section> <section> <h3> Material and Methods</h3> <p>All women planned for laparoscopic sacrocolpopexy for pelvic organ prolapse (POPQ stage >2) in the period 11/2016–6/2022 were included in this randomized controlled trial. Those that underwent other surgery, concomitant vaginal surgery, or where the vagina was opened (e.g., during concurrent hysterectomy) were excluded. The women randomly received vaginal packing after the surgery. The primary outcome was defined as prolapse beyond the hymen, symptomatic prolapse, or retreatment in one-year follow-up. Secondary outcomes included anatomical recurrence, quality of life, and complications. Clinical trial registration: Registered on October 21, 2016, initial participant enrollment on November 14, 2016, clinical trial identification number: NCT02943525, URL of the registration site: https://clinicaltrials.gov/study/NCT02943525.</p> </section> <section> <h3> Results</h3> <p>Four hundred and fifty-five (89%) women completed the one-year follow-up. Vaginal pack was inserted in 214 (47%) women. The groups did not differ in most preoperative characteristics, except BMI (26.2 ± 3.4 vs. 26.9 ± 3.6, <i>p</i> = 0.008), preoperative POPDI (64.6 vs. 77.7, <i>p</i> = 0.004), operative time (103 vs. 111 min, <i>p</i> < 0.001), and estimated blood loss (137 vs. 157 mL, <i>p</i> = 0.029), which all were higher in the packing group. No differences in the primary outcome (2.8 vs. 1.7%, <i>p</i> = 0.527) nor any of the recorded variables including the POPQ points position, anatomical recurrence, PGI-I, ICIQ-UI, PFDI, PISQ-12 and complication rate were observed between the groups. No differences in surgical outcomes in subgroups according to concomitant surgery on the uterus (previous hysterectomy, concomitant supracervical hysterectomy, sacrohysterocolpopexy) were observed. There was no difference in the rate of complications. No mesh exposure was observed.</p> </section> <section> <h3> Conclusions</h3>
虽然阴道填充物在阴道重建手术和阴道子宫切除术后的作用已经得到了很好的探讨，但关于腹腔镜重建手术的数据缺乏。如前所述，腹腔镜骶colpop固定术（LSC）对术后早期疼痛、并发症和满意度没有影响。没有关于阴道填充物对LSC手术结果影响的资料。我们的目的是验证腹腔镜骶colpop固定术后阴道填充物与盆腔器官脱垂复发风险降低相关的假设。材料和方法：本随机对照试验纳入2016年11月11日至2022年6月6日期间计划行腹腔镜骶结肠固定术治疗盆腔器官脱垂（POPQ期>2）的所有女性。那些接受过其他手术、同时进行阴道手术或阴道被打开（例如，同时进行子宫切除术）的患者被排除在外。这些妇女在手术后随机接受阴道填充物。主要结局被定义为处女膜外脱垂、症状性脱垂或在一年随访中再次治疗。次要结果包括解剖性复发、生活质量和并发症。临床试验注册：2016年10月21日注册，2016年11月14日首次入组，临床试验识别号：NCT02943525，注册网址：https://clinicaltrials.gov/study/NCT02943525.Results: 455名（89%）女性完成了为期一年的随访。214例（47%）妇女插入阴道包。除了BMI（26.2±3.4 vs. 26.9±3.6,p = 0.008）、术前POPDI （64.6 vs. 77.7, p = 0.004）、手术时间（103 vs. 111 min, p）外，两组在大多数术前特征上没有差异。结论：腹腔镜骶colpopplasty术后阴道填塞与解剖性复发、复合手术失败或生活质量等手术结果的改善无关。鉴于增强术后恢复的建议，腹腔镜骶髋固定术后常规阴道填塞不推荐。
{"title":"Vaginal packing after laparoscopic sacrocolpopexy and surgical outcome after one year: A randomized controlled trial","authors":"Zdenek Rusavy, Adela Marinic Veverkova, Martin Smazinka, Vladimir Kalis","doi":"10.1111/aogs.70067","DOIUrl":"10.1111/aogs.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While the role of vaginal packing following vaginal reconstructive surgery and vaginal hysterectomy was well-explored, data regarding laparoscopic reconstructive surgery are lacking. No effect on early postoperative pain, complications, and satisfaction after laparoscopic sacrocolpopexy (LSC) was observed as presented earlier. No data concerning the effect of vaginal packing on the surgical outcome of LSC exist. Our objective was to test the hypothesis that vaginal packing after laparoscopic sacrocolpopexy is associated with a reduced risk of pelvic organ prolapse recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>All women planned for laparoscopic sacrocolpopexy for pelvic organ prolapse (POPQ stage >2) in the period 11/2016–6/2022 were included in this randomized controlled trial. Those that underwent other surgery, concomitant vaginal surgery, or where the vagina was opened (e.g., during concurrent hysterectomy) were excluded. The women randomly received vaginal packing after the surgery. The primary outcome was defined as prolapse beyond the hymen, symptomatic prolapse, or retreatment in one-year follow-up. Secondary outcomes included anatomical recurrence, quality of life, and complications. Clinical trial registration: Registered on October 21, 2016, initial participant enrollment on November 14, 2016, clinical trial identification number: NCT02943525, URL of the registration site: https://clinicaltrials.gov/study/NCT02943525.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four hundred and fifty-five (89%) women completed the one-year follow-up. Vaginal pack was inserted in 214 (47%) women. The groups did not differ in most preoperative characteristics, except BMI (26.2 ± 3.4 vs. 26.9 ± 3.6, <i>p</i> = 0.008), preoperative POPDI (64.6 vs. 77.7, <i>p</i> = 0.004), operative time (103 vs. 111 min, <i>p</i> < 0.001), and estimated blood loss (137 vs. 157 mL, <i>p</i> = 0.029), which all were higher in the packing group. No differences in the primary outcome (2.8 vs. 1.7%, <i>p</i> = 0.527) nor any of the recorded variables including the POPQ points position, anatomical recurrence, PGI-I, ICIQ-UI, PFDI, PISQ-12 and complication rate were observed between the groups. No differences in surgical outcomes in subgroups according to concomitant surgery on the uterus (previous hysterectomy, concomitant supracervical hysterectomy, sacrohysterocolpopexy) were observed. There was no difference in the rate of complications. No mesh exposure was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2331-2338"},"PeriodicalIF":3.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iván Rabinovich Orlandi, Guido Patricio Gromadzyn, Marta C. Cohen
<div> <section> <h3> Introduction</h3> <p>Placental abruption is a significant obstetric complication characterized by the premature separation of the placenta from the uterine wall, affecting 2–3 per 100 pregnancies. This condition presents a dual diagnostic challenge: obstetricians rely on clinical signs such as antepartum hemorrhage, abdominal pain, and ultrasound findings to suspect abruption, often leading to emergency cesarean delivery. Conversely, pathologists diagnose abruption through macroscopic and microscopic examination of placental tissue, identifying hematomas and signs of maternal vascular malperfusion. Notably, there is often a poor correlation between clinical diagnosis and pathological findings, with sensitivity reported as low as 30.2%. This study seeks to elucidate placental conditions associated with antepartum hemorrhage that may indicate abruption and emphasizes the importance of histopathological referral in understanding recurrence risks in subsequent pregnancies. By enhancing diagnostic accuracy, we aim to improve clinical outcomes for affected patients. Our objective is to evaluate placental conditions associated with antepartum hemorrhage and assess the correlation between clinical diagnoses and histopathological findings.</p> </section> <section> <h3> Material and Methods</h3> <p>A retrospective analysis of 285 placental histopathology reports from Sheffield Children NHS FT (January–December 2021) was conducted. This included 181 cases with clinical diagnoses of antepartum hemorrhage/abruption and 104 controls with well-controlled gestational diabetes mellitus. Histopathological findings were compared between groups.</p> </section> <section> <h3> Results</h3> <p>Significant placental findings associated with clinical antepartum hemorrhage/abruption included adherent blood clots (OR = 3.89, 95% CI: 1.88–8.04), umbilical cord hypercoiling (OR = 0.56, 95% CI: 0.33–0.96), and ascending infection/chorioamnionitis (OR = 3.08, 95% CI: 1.38–6.91). Histological abruption and chorioamnionitis were independently associated with antepartum hemorrhage (OR = 3.15, 95% CI: 1.21–9.87 and 3.13, 95% CI: 1.42–7.65 respectively), but there was no significant association with maternal vascular malperfusion (OR = 1.46, 95% CI: 0.65–3.30). Gestational age was lower in the antepartum hemorrhage group (33 weeks) versus controls (39 weeks).</p> </section> <section> <h3> Conclusions</h3> <p>The most frequent placental conditions presenting as antepartum hemorrhage are ascending infection (leading to acute deciduitis) and histological abruption,
{"title":"Ascending infection is the leading cause of antepartum hemorrhage: A case–control study","authors":"Iván Rabinovich Orlandi, Guido Patricio Gromadzyn, Marta C. Cohen","doi":"10.1111/aogs.70063","DOIUrl":"10.1111/aogs.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Placental abruption is a significant obstetric complication characterized by the premature separation of the placenta from the uterine wall, affecting 2–3 per 100 pregnancies. This condition presents a dual diagnostic challenge: obstetricians rely on clinical signs such as antepartum hemorrhage, abdominal pain, and ultrasound findings to suspect abruption, often leading to emergency cesarean delivery. Conversely, pathologists diagnose abruption through macroscopic and microscopic examination of placental tissue, identifying hematomas and signs of maternal vascular malperfusion. Notably, there is often a poor correlation between clinical diagnosis and pathological findings, with sensitivity reported as low as 30.2%. This study seeks to elucidate placental conditions associated with antepartum hemorrhage that may indicate abruption and emphasizes the importance of histopathological referral in understanding recurrence risks in subsequent pregnancies. By enhancing diagnostic accuracy, we aim to improve clinical outcomes for affected patients. Our objective is to evaluate placental conditions associated with antepartum hemorrhage and assess the correlation between clinical diagnoses and histopathological findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A retrospective analysis of 285 placental histopathology reports from Sheffield Children NHS FT (January–December 2021) was conducted. This included 181 cases with clinical diagnoses of antepartum hemorrhage/abruption and 104 controls with well-controlled gestational diabetes mellitus. Histopathological findings were compared between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant placental findings associated with clinical antepartum hemorrhage/abruption included adherent blood clots (OR = 3.89, 95% CI: 1.88–8.04), umbilical cord hypercoiling (OR = 0.56, 95% CI: 0.33–0.96), and ascending infection/chorioamnionitis (OR = 3.08, 95% CI: 1.38–6.91). Histological abruption and chorioamnionitis were independently associated with antepartum hemorrhage (OR = 3.15, 95% CI: 1.21–9.87 and 3.13, 95% CI: 1.42–7.65 respectively), but there was no significant association with maternal vascular malperfusion (OR = 1.46, 95% CI: 0.65–3.30). Gestational age was lower in the antepartum hemorrhage group (33 weeks) versus controls (39 weeks).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The most frequent placental conditions presenting as antepartum hemorrhage are ascending infection (leading to acute deciduitis) and histological abruption, ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2300-2308"},"PeriodicalIF":3.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giovanni Delli Carpini, Zahid Mammadov, Simon Leeson, Anne Hammer, Mihaela Grigore, Andrea Ciavattini
<div> <section> <h3> Introduction</h3> <p>The healthcare reorganization during the COVID-19 pandemic affected colposcopy services and cervical cancer prevention, particularly in those countries where healthcare systems were already under-resourced. This review aimed to quantify the reduction in colposcopy services across countries during the COVID-19 pandemic and to determine whether the data source per study and cervical cancer screening coverage per country influenced the extent of these reductions.</p> </section> <section> <h3> Material and Methods</h3> <p>Studies reporting comparative data on colposcopy services between the COVID-19 pre-pandemic and pandemic period were included. MEDLINE, Embase, EMCare, Covid-19 Research, British Nursing Index, APA PsycINFO, and Allied and Complimentary Medicine databases were searched for studies published from March 2020 to December 2023. The Newcastle−Ottawa scale was used for risk of bias assessment. The number of colposcopies, cervical treatments, pre-invasive lesions diagnoses, and cervical cancer diagnoses per month were compared between the pre-pandemic (before March 2020) and pandemic period (after March 2020). The effect measure was the standardized mean difference. Heterogeneity was evaluated with the chi-squared test and quantified with the <i>I</i><sup>2</sup> method. A meta-regression was performed, considering the data source (regional/national databases/registries or institutional databases) and the screening coverage according to World Health Organization data (≥70% or <70%) as moderators. The review was registered on PROSPERO (CRD42023447188).</p> </section> <section> <h3> Results</h3> <p>Thirteen studies were included. Twelve were of good/high quality according to the Newcastle−Ottawa scale. The standardized mean difference between the pre-pandemic and pandemic periods was −1.60 (95% CI −2.49 to −0.72, <i>p</i> = 0.004) for colposcopies (4 studies, <i>I</i><sup>2</sup> = 60.97%, <i>p</i> = 0.075), −1.70 (95% CI −2.50 to −0.90, <i>p</i> < 0.001) for cervical treatments (5 studies, <i>I</i><sup>2</sup> = 52.92%, <i>p</i> = 0.081), −4.61 (95% CI -7.90 to −1.33, <i>p</i> = 0.006) for pre-invasive lesion diagnoses (4 studies, <i>I</i><sup>2</sup> = 92.45%, p < 0.001), and −0.85 (95% CI −1.52 to −0.19, <i>p</i> = 0.012) for cervical cancer diagnoses (9 studies, <i>I</i><sup>2</sup> = 71.07%, <i>p</i> = 0.002). At meta-regression, further reductions for cervical treatments and pre-invasive lesion diagnoses were observed in the case of screening coverage <70%.</p> </section> <section> <h3> Conclusions</h3>
导言：COVID-19大流行期间的卫生保健重组影响了阴道镜检查服务和宫颈癌预防，特别是在卫生保健系统资源不足的国家。本综述旨在量化2019冠状病毒病大流行期间各国阴道镜检查服务的减少情况，并确定每个研究的数据源和每个国家的宫颈癌筛查覆盖率是否影响了这些减少的程度。材料和方法：纳入报告COVID-19大流行前和大流行期间阴道镜服务比较数据的研究。检索了MEDLINE、Embase、EMCare、Covid-19 Research、British Nursing Index、APA PsycINFO以及Allied and complementary Medicine数据库，检索了从2020年3月至2023年12月发表的研究。采用纽卡斯尔-渥太华量表进行偏倚风险评估。比较大流行前（2020年3月之前）和大流行期间（2020年3月之后）每月阴道镜检查次数、宫颈治疗次数、侵袭前病变诊断次数和宫颈癌诊断次数。效应测量为标准化平均差。异质性采用卡方检验评估，I2方法量化。考虑数据源（区域/国家数据库/登记处或机构数据库）和世界卫生组织数据的筛查覆盖率（≥70%或结果：纳入13项研究），进行meta回归。根据纽卡斯尔-渥太华量表，有12个为好/高质量。阴道镜检查（4项研究，I2 = 60.97%, p = 0.075）和侵入性病变前诊断（4项研究，I2 = 92.45%, p = 71.07%, p = 0.002）的标准化平均差值分别为-1.60 （95% CI -2.49 ~ -0.72, p = 0.004）、-1.70 （95% CI -2.50 ~ -0.90, p = 52.92%, p = 0.081）、-4.61 （95% CI -7.90 ~ -1.33, p = 0.006）。结论：在COVID-19大流行期间，阴道镜检查、宫颈治疗、浸润前病变诊断和浸润性癌症诊断均有所减少。自放映以来的报道
{"title":"The effect of healthcare disruptions during the COVID-19 pandemic on colposcopy services and practice: A systematic review and meta-analysis","authors":"Giovanni Delli Carpini, Zahid Mammadov, Simon Leeson, Anne Hammer, Mihaela Grigore, Andrea Ciavattini","doi":"10.1111/aogs.70066","DOIUrl":"10.1111/aogs.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The healthcare reorganization during the COVID-19 pandemic affected colposcopy services and cervical cancer prevention, particularly in those countries where healthcare systems were already under-resourced. This review aimed to quantify the reduction in colposcopy services across countries during the COVID-19 pandemic and to determine whether the data source per study and cervical cancer screening coverage per country influenced the extent of these reductions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Studies reporting comparative data on colposcopy services between the COVID-19 pre-pandemic and pandemic period were included. MEDLINE, Embase, EMCare, Covid-19 Research, British Nursing Index, APA PsycINFO, and Allied and Complimentary Medicine databases were searched for studies published from March 2020 to December 2023. The Newcastle−Ottawa scale was used for risk of bias assessment. The number of colposcopies, cervical treatments, pre-invasive lesions diagnoses, and cervical cancer diagnoses per month were compared between the pre-pandemic (before March 2020) and pandemic period (after March 2020). The effect measure was the standardized mean difference. Heterogeneity was evaluated with the chi-squared test and quantified with the <i>I</i><sup>2</sup> method. A meta-regression was performed, considering the data source (regional/national databases/registries or institutional databases) and the screening coverage according to World Health Organization data (≥70% or <70%) as moderators. The review was registered on PROSPERO (CRD42023447188).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen studies were included. Twelve were of good/high quality according to the Newcastle−Ottawa scale. The standardized mean difference between the pre-pandemic and pandemic periods was −1.60 (95% CI −2.49 to −0.72, <i>p</i> = 0.004) for colposcopies (4 studies, <i>I</i><sup>2</sup> = 60.97%, <i>p</i> = 0.075), −1.70 (95% CI −2.50 to −0.90, <i>p</i> < 0.001) for cervical treatments (5 studies, <i>I</i><sup>2</sup> = 52.92%, <i>p</i> = 0.081), −4.61 (95% CI -7.90 to −1.33, <i>p</i> = 0.006) for pre-invasive lesion diagnoses (4 studies, <i>I</i><sup>2</sup> = 92.45%, p < 0.001), and −0.85 (95% CI −1.52 to −0.19, <i>p</i> = 0.012) for cervical cancer diagnoses (9 studies, <i>I</i><sup>2</sup> = 71.07%, <i>p</i> = 0.002). At meta-regression, further reductions for cervical treatments and pre-invasive lesion diagnoses were observed in the case of screening coverage <70%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2215-2225"},"PeriodicalIF":3.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We would like to thank Zhao and Zhou for their insightful comments on our article “Perinatal outcomes and maternal health before and after single motherhood through assisted conception: A multiregistry study in Sweden.”<span><sup>1</sup></span> Indeed, previous psychiatric history, adverse childhood experiences, and chronic stress may significantly influence both the development of mental illness and the formation of social bonds. However, the register-based design of our study imposes certain limitations on the scope of research questions that can be explored.<span><sup>2</sup></span></p><p>In Sweden, a national quality register for child and adolescent psychiatric care (Q-BUP) exists, covering more than half of the adolescent population. It collects information on psychiatric diagnoses, symptoms, psychosocial stressors, level of functioning, and treatment measures, including both pharmacological interventions and CBT. Unfortunately, this register was only established in 2015—long after the participants in our study had reached adulthood—and therefore could not be utilized.</p><p>Regarding social networks and the support available to individuals entering parenthood, the Swedish Multigeneration Register provides data on biological parents and siblings of study participants. However, it does not capture the quality of these relationships or the actual support they may offer to intended single mothers during the transition to parenthood. As shown by Af Sandeberg et al.,<span><sup>3</sup></span> while emotional support was often perceived as sufficient, many intended single mothers in Sweden expressed a need for greater practical assistance, particularly from family (22%) and friends (41%). It is important to note that most participants in that study became mothers during the COVID-19 pandemic, which likely restricted opportunities for hands-on support due to reduced social interaction.<span><sup>3</sup></span></p><p>At present, we are conducting a multicenter, national, longitudinal cohort study in Sweden: <i>Family Formation in Transition: Single Women Having Children through Sperm, Double-, or Embryo Donation</i>. This study includes both intended single mothers and partnered women undergoing IVF treatment, combining survey data with medical record information. A key focus is the participants' social networks, investigating both their composition (e.g., number, age, occupation, relationship to the respondent, and geographic proximity, assessed through study-specific items) and the perceived quality of support, using validated instruments such as the Multidimensional Scale of Perceived Social Support (MSPSS). Preliminary, unpublished findings indicate that intended single mothers by choice most often identify their parents—particularly their mother—as their primary supporters. Notably, despite lacking a partner, they report overall social support levels comparable to those of partnered women, along with higher anticipated support from friends.<
{"title":"Understanding family formation and support in single mothers by choice: Insights from Swedish cohort studies","authors":"Evangelia Elenis, Cecilia Mitt Holm, Ove Axelsson, Agneta Skoog Svanberg, Gunilla Sydsjö, Claudia Lampic","doi":"10.1111/aogs.70070","DOIUrl":"10.1111/aogs.70070","url":null,"abstract":"<p>We would like to thank Zhao and Zhou for their insightful comments on our article “Perinatal outcomes and maternal health before and after single motherhood through assisted conception: A multiregistry study in Sweden.”<span><sup>1</sup></span> Indeed, previous psychiatric history, adverse childhood experiences, and chronic stress may significantly influence both the development of mental illness and the formation of social bonds. However, the register-based design of our study imposes certain limitations on the scope of research questions that can be explored.<span><sup>2</sup></span></p><p>In Sweden, a national quality register for child and adolescent psychiatric care (Q-BUP) exists, covering more than half of the adolescent population. It collects information on psychiatric diagnoses, symptoms, psychosocial stressors, level of functioning, and treatment measures, including both pharmacological interventions and CBT. Unfortunately, this register was only established in 2015—long after the participants in our study had reached adulthood—and therefore could not be utilized.</p><p>Regarding social networks and the support available to individuals entering parenthood, the Swedish Multigeneration Register provides data on biological parents and siblings of study participants. However, it does not capture the quality of these relationships or the actual support they may offer to intended single mothers during the transition to parenthood. As shown by Af Sandeberg et al.,<span><sup>3</sup></span> while emotional support was often perceived as sufficient, many intended single mothers in Sweden expressed a need for greater practical assistance, particularly from family (22%) and friends (41%). It is important to note that most participants in that study became mothers during the COVID-19 pandemic, which likely restricted opportunities for hands-on support due to reduced social interaction.<span><sup>3</sup></span></p><p>At present, we are conducting a multicenter, national, longitudinal cohort study in Sweden: <i>Family Formation in Transition: Single Women Having Children through Sperm, Double-, or Embryo Donation</i>. This study includes both intended single mothers and partnered women undergoing IVF treatment, combining survey data with medical record information. A key focus is the participants' social networks, investigating both their composition (e.g., number, age, occupation, relationship to the respondent, and geographic proximity, assessed through study-specific items) and the perceived quality of support, using validated instruments such as the Multidimensional Scale of Perceived Social Support (MSPSS). Preliminary, unpublished findings indicate that intended single mothers by choice most often identify their parents—particularly their mother—as their primary supporters. Notably, despite lacking a partner, they report overall social support levels comparable to those of partnered women, along with higher anticipated support from friends.<","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2368-2369"},"PeriodicalIF":3.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145230944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yun Lin, Honghong Pan, Yupeng Chen, Chenshan Dong, Yijia Luo
Introduction: The assessment of pelvic floor muscle function is crucial for managing pelvic floor dysfunctions, yet digital palpation is subjective and lacks reproducibility. This study aimed to correlate pelvic floor muscle contractility assessed by digital palpation with transperineal ultrasound measurements and evaluate the reliability of the Modified Oxford Scale and key ultrasound-derived parameters. By comparing these methods, the study sought to establish transperineal ultrasound as a reliable, objective, and non-invasive tool for assessing pelvic floor muscle contractility.
Material and methods: A cross-sectional study was conducted at Shengli Provincial Hospital from November 2019 to July 2024. 442 of 512 screened women were included. Digital palpation was performed by two independent clinicians, and ultrasound measurements were conducted by two separate raters. Ultrasound raters were blinded to palpation (Modified Oxford Scale) findings. Transperineal ultrasound quantified multiple pelvic floor parameters, including proximal urethral axis angle change (maximal contraction-rest) and levator hiatus area. Inter-rater reliability was assessed using intraclass correlation coefficients for ultrasound measures and Cohen's kappa for MOS ratings. Correlations between ultrasound and palpation scores were analyzed using Spearman's rank. Cut-off values for key ultrasound parameters corresponding to palpation grades were determined via receiver operating characteristic curve analysis.
Results: Significant correlations (p < 0.001) were found between ultrasound parameters and MOS scores, with the strongest correlations observed for proximal urethral axis angle change (maximal contraction-rest) (rs = 0.727) and proportional change in levator hiatus area (rs = 0.717). Ultrasound assessments showed high inter-rater reliability (intraclass correlation coefficient = 0.92 for proximal urethral axis angle change), while palpation demonstrated moderate agreement (Cohen's kappa = 0.55). Cut-off values for key parameters were derived, such as proximal urethral axis angle change <9.5° for absent contraction and >16.5° for strong contraction.
Conclusions: Transperineal ultrasound demonstrated high reliability and provided an objective, non-invasive method for assessing pelvic floor muscle contractility. While digital palpation assessed functional strength, ultrasound visualized structural displacement during contraction. The two methods addressed complementary aspects of pelvic floor function, and their combined use enhanced clinical assessment.
{"title":"Transperineal ultrasound versus digital palpation: Identifying key parameters for objective pelvic floor muscle contraction assessment.","authors":"Yun Lin, Honghong Pan, Yupeng Chen, Chenshan Dong, Yijia Luo","doi":"10.1111/aogs.70065","DOIUrl":"https://doi.org/10.1111/aogs.70065","url":null,"abstract":"<p><strong>Introduction: </strong>The assessment of pelvic floor muscle function is crucial for managing pelvic floor dysfunctions, yet digital palpation is subjective and lacks reproducibility. This study aimed to correlate pelvic floor muscle contractility assessed by digital palpation with transperineal ultrasound measurements and evaluate the reliability of the Modified Oxford Scale and key ultrasound-derived parameters. By comparing these methods, the study sought to establish transperineal ultrasound as a reliable, objective, and non-invasive tool for assessing pelvic floor muscle contractility.</p><p><strong>Material and methods: </strong>A cross-sectional study was conducted at Shengli Provincial Hospital from November 2019 to July 2024. 442 of 512 screened women were included. Digital palpation was performed by two independent clinicians, and ultrasound measurements were conducted by two separate raters. Ultrasound raters were blinded to palpation (Modified Oxford Scale) findings. Transperineal ultrasound quantified multiple pelvic floor parameters, including proximal urethral axis angle change (maximal contraction-rest) and levator hiatus area. Inter-rater reliability was assessed using intraclass correlation coefficients for ultrasound measures and Cohen's kappa for MOS ratings. Correlations between ultrasound and palpation scores were analyzed using Spearman's rank. Cut-off values for key ultrasound parameters corresponding to palpation grades were determined via receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>Significant correlations (p < 0.001) were found between ultrasound parameters and MOS scores, with the strongest correlations observed for proximal urethral axis angle change (maximal contraction-rest) (r<sub>s</sub> = 0.727) and proportional change in levator hiatus area (r<sub>s</sub> = 0.717). Ultrasound assessments showed high inter-rater reliability (intraclass correlation coefficient = 0.92 for proximal urethral axis angle change), while palpation demonstrated moderate agreement (Cohen's kappa = 0.55). Cut-off values for key parameters were derived, such as proximal urethral axis angle change <9.5° for absent contraction and >16.5° for strong contraction.</p><p><strong>Conclusions: </strong>Transperineal ultrasound demonstrated high reliability and provided an objective, non-invasive method for assessing pelvic floor muscle contractility. While digital palpation assessed functional strength, ultrasound visualized structural displacement during contraction. The two methods addressed complementary aspects of pelvic floor function, and their combined use enhanced clinical assessment.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lisa Tangnes Leeves, Trond Melbye Michelsen, Anne Flem Jacobsen, Aslak Vimme Solhoff, Nina Gunnes, Ingvil Krarup Sørbye
<div> <section> <h3> Introduction</h3> <p>Few previous studies have examined the association between the indication for induction of labor (IOL) and the mode of delivery. To improve information for clinicians and women undergoing IOL, our study aimed to assess the association between the indication for IOL and the risk of cesarean and operative vaginal birth among nulliparous women with single cephalic term pregnancies. Furthermore, we examined whether associations varied by gestational length. Lastly, we evaluated reasons for cesarean and operative vaginal birth across indications for IOL.</p> </section> <section> <h3> Material and Methods</h3> <p>Data were extracted from the Medical Birth Registry of Norway from 2020 to 2021. We used the registered main indication for IOL. Multinomial logistic regression was applied to estimate relative risk ratios (RRRs) with associated 95% confidence intervals (CIs) of cesarean and operative vaginal birth versus spontaneous vaginal birth for the different IOL indications, using prelabor rupture of membranes (PROM) as the reference indication.</p> </section> <section> <h3> Results</h3> <p>Risk of cesarean versus spontaneous vaginal birth was four times higher for women induced due to large fetus compared to women induced due to PROM (adjusted RRR: 4.39; 95% CI: 3.21 to 5.99). Indications such as maternal request, post-term pregnancy, oligo−/polyhydramnios, preeclampsia/hypertension, and diabetes were associated with a 40%–91% increased relative risk of cesarean versus spontaneous vaginal birth compared to PROM. Relative risk of operative vaginal versus spontaneous vaginal birth was increased by 23%–29% for oligo−/polyhydramnios, diabetes, and post-term pregnancy compared to PROM. Indication large fetus had similar relative risk ratios at all gestational lengths. Rate of operative delivery for fetal distress was highest for IOL due to intrauterine growth restriction (IUGR). For secondary outcomes, IOL due to IUGR had the highest proportions of cesarean and operative vaginal birth for fetal distress. Indication post-term pregnancy had the highest proportion of cesarean birth for prolonged labor, while large fetus had the highest proportion of operative vaginal birth for prolonged labor.</p> </section> <section> <h3> Conclusions</h3> <p>Nulliparous women undergoing IOL for indications such as large fetus, post-term pregnancy, oligo-/polyhydramnios, preeclampsia/hypertension, and diabetes are at an elevated relative risk of cesarean versus spontaneous vaginal birth compared to IOL for PROM. In contrast, the relative
{"title":"Is indication for induction of labor associated with mode of delivery in term first births? A Norwegian registry-based study","authors":"Lisa Tangnes Leeves, Trond Melbye Michelsen, Anne Flem Jacobsen, Aslak Vimme Solhoff, Nina Gunnes, Ingvil Krarup Sørbye","doi":"10.1111/aogs.70060","DOIUrl":"10.1111/aogs.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Few previous studies have examined the association between the indication for induction of labor (IOL) and the mode of delivery. To improve information for clinicians and women undergoing IOL, our study aimed to assess the association between the indication for IOL and the risk of cesarean and operative vaginal birth among nulliparous women with single cephalic term pregnancies. Furthermore, we examined whether associations varied by gestational length. Lastly, we evaluated reasons for cesarean and operative vaginal birth across indications for IOL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Data were extracted from the Medical Birth Registry of Norway from 2020 to 2021. We used the registered main indication for IOL. Multinomial logistic regression was applied to estimate relative risk ratios (RRRs) with associated 95% confidence intervals (CIs) of cesarean and operative vaginal birth versus spontaneous vaginal birth for the different IOL indications, using prelabor rupture of membranes (PROM) as the reference indication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Risk of cesarean versus spontaneous vaginal birth was four times higher for women induced due to large fetus compared to women induced due to PROM (adjusted RRR: 4.39; 95% CI: 3.21 to 5.99). Indications such as maternal request, post-term pregnancy, oligo−/polyhydramnios, preeclampsia/hypertension, and diabetes were associated with a 40%–91% increased relative risk of cesarean versus spontaneous vaginal birth compared to PROM. Relative risk of operative vaginal versus spontaneous vaginal birth was increased by 23%–29% for oligo−/polyhydramnios, diabetes, and post-term pregnancy compared to PROM. Indication large fetus had similar relative risk ratios at all gestational lengths. Rate of operative delivery for fetal distress was highest for IOL due to intrauterine growth restriction (IUGR). For secondary outcomes, IOL due to IUGR had the highest proportions of cesarean and operative vaginal birth for fetal distress. Indication post-term pregnancy had the highest proportion of cesarean birth for prolonged labor, while large fetus had the highest proportion of operative vaginal birth for prolonged labor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Nulliparous women undergoing IOL for indications such as large fetus, post-term pregnancy, oligo-/polyhydramnios, preeclampsia/hypertension, and diabetes are at an elevated relative risk of cesarean versus spontaneous vaginal birth compared to IOL for PROM. In contrast, the relative","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 11","pages":"2165-2177"},"PeriodicalIF":3.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lyndsay Creswell, Pranav Pandya, Daniel Stott, Donald Peebles, George Attilakos, Eleni Nastouli, Haley Alchin, Kelly Pegoretti Baruteau, Raffaele Napolitano
Following the COVID-19 pandemic, Northwestern Europe has experienced a marked increase in congenital parvovirus infections. This rise is attributed to social distancing measures which disrupted the usual seasonal variation of parvovirus B19. Fetal infection may cause severe anemia, thrombocytopenia, and hydrops fetalis, with significant risk of intrauterine death. Therefore, when acute parvovirus B19 infection is confirmed by maternal serology, serial ultrasound surveillance of the middle cerebral artery peak systolic velocity is recommended. Intrauterine transfusion remains the only established therapeutic option for cases of suspected fetal anemia or hydrops but carries risks of fetal loss and procedural-related complications including fetal hemorrhage and exsanguination. This review critically examines current literature on diagnosis, management, perinatal outcomes, and long-term neurodevelopmental sequelae following congenital parvovirus infection and intrauterine transfusion. Additionally, we report our tertiary fetal medicine center's experience during the 2024 epidemic, highlighting a novel conservative management approach for fetuses with parvovirus-related anemia and hydrops fetalis.
{"title":"Parvovirus: Conservative management of fetal anemia and hydrops","authors":"Lyndsay Creswell, Pranav Pandya, Daniel Stott, Donald Peebles, George Attilakos, Eleni Nastouli, Haley Alchin, Kelly Pegoretti Baruteau, Raffaele Napolitano","doi":"10.1111/aogs.70055","DOIUrl":"10.1111/aogs.70055","url":null,"abstract":"<p>Following the COVID-19 pandemic, Northwestern Europe has experienced a marked increase in congenital parvovirus infections. This rise is attributed to social distancing measures which disrupted the usual seasonal variation of parvovirus B19. Fetal infection may cause severe anemia, thrombocytopenia, and hydrops fetalis, with significant risk of intrauterine death. Therefore, when acute parvovirus B19 infection is confirmed by maternal serology, serial ultrasound surveillance of the middle cerebral artery peak systolic velocity is recommended. Intrauterine transfusion remains the only established therapeutic option for cases of suspected fetal anemia or hydrops but carries risks of fetal loss and procedural-related complications including fetal hemorrhage and exsanguination. This review critically examines current literature on diagnosis, management, perinatal outcomes, and long-term neurodevelopmental sequelae following congenital parvovirus infection and intrauterine transfusion. Additionally, we report our tertiary fetal medicine center's experience during the 2024 epidemic, highlighting a novel conservative management approach for fetuses with parvovirus-related anemia and hydrops fetalis.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 11","pages":"2028-2037"},"PeriodicalIF":3.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amanda Wei Mun Tan, Shi Hui Lee, Rehena Sultana, Deepak Mathur, Shephali Tagore, Manisha Mathur
<div> <section> <h3> Introduction</h3> <p>Effective measurement of blood loss during delivery is key in timely diagnosis of hemorrhage and prevention of postpartum hemorrhage (PPH). Blood loss estimation in cesarean deliveries is challenging, with the risk of contamination of measured blood with amniotic and irrigation fluid. The objective of this study is to assess the level of agreement of visually estimated blood loss (vEBL), quantitative blood loss (QBL), and calculated estimated blood loss (cEBL) in cesarean deliveries.</p> </section> <section> <h3> Material and Methods</h3> <p>This is a secondary analysis of a double-blinded, randomized controlled trial in the largest maternity unit in Singapore. Medical records from 200 patients enrolled in the prior study were analyzed, and their blood loss data reviewed for comparison. Blood loss estimation was assessed by vEBL (by the anesthetic and surgical teams), QBL (weighing of soiled gauzes and measuring fluid volume) and cEBL (formula-based calculation using pre- and postdelivery hemoglobin). Mean estimated blood losses (EBLs) obtained from all three methods were compared.</p> </section> <section> <h3> Results</h3> <p>The use of vEBL yielded the lowest mean blood loss, lowest proportion of women with EBL ≥500 and ≥1000 mL, while cEBL was the highest for all three outcomes. Intraclass correlation ranged from 0.29 (low <0.5) between vEBL and cEBL to 0.68 (moderate: 0.5–0.75) between vEBL and QBL. On average, vEBL was 249.7 mL (95% CI: −822.7–323.3) less than QBL, and 287.9 mL (95% CI: −1143.9–568.0) less than cEBL. Although vEBL tends to underestimate blood loss compared with QBL and cEBL on average, the wide confidence intervals suggest that these differences are not statistically significant. As blood loss increased, vEBL was more likely to underestimate blood loss. Women with body mass index (BMI) ≥30 kg/m<sup>2</sup> were more likely to have EBL ≥500 mL by cEBL (OR 1.13, 95% CI: 1.05–1.21, <i>p</i> < 0.01). Women with longer operative duration have higher odds of having EBL ≥500 mL by vEBL or QBL.</p> </section> <section> <h3> Conclusions</h3> <p>vEBL appears to grossly underestimate actual blood loss when compared with QBL and cEBL methods. Although the observed differences were not statistically significant, the wide confidence intervals suggest potential for substantial underestimation. Given this limitation, reliance solely on vEBL may lead to under-recognition and delayed management of PPH. Therefore, it is recommended that QBL and cEBL be incorporated into routine practice, particular
{"title":"Accurate estimation of blood loss during cesarean deliveries: A secondary analysis of a randomized controlled trial comparing visual, quantitative and calculated approaches","authors":"Amanda Wei Mun Tan, Shi Hui Lee, Rehena Sultana, Deepak Mathur, Shephali Tagore, Manisha Mathur","doi":"10.1111/aogs.70052","DOIUrl":"10.1111/aogs.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Effective measurement of blood loss during delivery is key in timely diagnosis of hemorrhage and prevention of postpartum hemorrhage (PPH). Blood loss estimation in cesarean deliveries is challenging, with the risk of contamination of measured blood with amniotic and irrigation fluid. The objective of this study is to assess the level of agreement of visually estimated blood loss (vEBL), quantitative blood loss (QBL), and calculated estimated blood loss (cEBL) in cesarean deliveries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This is a secondary analysis of a double-blinded, randomized controlled trial in the largest maternity unit in Singapore. Medical records from 200 patients enrolled in the prior study were analyzed, and their blood loss data reviewed for comparison. Blood loss estimation was assessed by vEBL (by the anesthetic and surgical teams), QBL (weighing of soiled gauzes and measuring fluid volume) and cEBL (formula-based calculation using pre- and postdelivery hemoglobin). Mean estimated blood losses (EBLs) obtained from all three methods were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The use of vEBL yielded the lowest mean blood loss, lowest proportion of women with EBL ≥500 and ≥1000 mL, while cEBL was the highest for all three outcomes. Intraclass correlation ranged from 0.29 (low <0.5) between vEBL and cEBL to 0.68 (moderate: 0.5–0.75) between vEBL and QBL. On average, vEBL was 249.7 mL (95% CI: −822.7–323.3) less than QBL, and 287.9 mL (95% CI: −1143.9–568.0) less than cEBL. Although vEBL tends to underestimate blood loss compared with QBL and cEBL on average, the wide confidence intervals suggest that these differences are not statistically significant. As blood loss increased, vEBL was more likely to underestimate blood loss. Women with body mass index (BMI) ≥30 kg/m<sup>2</sup> were more likely to have EBL ≥500 mL by cEBL (OR 1.13, 95% CI: 1.05–1.21, <i>p</i> < 0.01). Women with longer operative duration have higher odds of having EBL ≥500 mL by vEBL or QBL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>vEBL appears to grossly underestimate actual blood loss when compared with QBL and cEBL methods. Although the observed differences were not statistically significant, the wide confidence intervals suggest potential for substantial underestimation. Given this limitation, reliance solely on vEBL may lead to under-recognition and delayed management of PPH. Therefore, it is recommended that QBL and cEBL be incorporated into routine practice, particular","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 11","pages":"2146-2154"},"PeriodicalIF":3.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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