Acta Obstetricia et Gynecologica Scandinavica最新文献

Introduction: Electronic fetal heart rate (FHR) monitoring is integral to antepartum and intrapartum care to detect fetal compromise, reducing neonatal morbidity and mortality. Conventional wired cardiotocography (CTG) limits mobility, birthing positions, and potentially increases instrumental births. Wireless non-invasive fetal electrocardiography (NIFECG) aims to address these challenges. However, NIFECG has limitations, including signal interference and limited accuracy data for FHR and uterine contraction (UC) monitoring. This study aimed to (i) quantify acceptable NIFECG traces based on signal loss in women ≥37 weeks' gestation; (ii) compare FHR and UC monitoring accuracy between NIFECG and CTG; (iii) and assess NIFECG acceptability.

Material and methods: A prospective cohort involving women with singleton pregnancies ≥37 weeks' gestation was conducted between August 2020 and April 2023 in KK Women's and Children's Hospital, Singapore. Women underwent 40 min of concurrent NIFECG and CTG monitoring during antepartum and intrapartum phases. Data were compared in 3.75-s epochs. Based on the International Federation of Gynecology and Obstetrics guidelines, NIFECG traces with signal loss ≤20% were accepted. FHR monitoring accuracy was assessed using Bland-Altman and Passing-Bablok regression analyses. UC monitoring accuracy was determined by a fourfold contingency table with CTG as a gold standard. Acceptability was assessed via post-monitoring feedback questionnaire.

Results: One hundred and three women contributed to 124 paired traces. Seventy-three traces (58.9%) were acceptable, comprising 52 antepartum (56.5%) and 21 intrapartum traces (65.6%). Bland-Altman (bias: -0.4 beats per minute, 95% limits of agreement: [-9.0, 8.1]) and Passing-Bablok (slope = 0.97, 95% confidence interval (CI) 0.97-0.98) analyses showed high agreement between NIFECG and CTG FHR measurements. NIFECG showed a specificity of 0.96 (95% CI 0.94-0.97) and sensitivity of 0.90 (95% CI 0.89-0.92) for UC monitoring. Additionally, 90.1% of women and 88.9% of nurses preferred NIFECG.

Conclusions: NIFECG has comparable accuracy to CTG for FHR and UC monitoring during the antepartum and intrapartum phases and is well-accepted by women and nurses. Given that 41.1% of NIFECG traces were rejected due to signal loss, further research on improving the technology to reduce signal loss, and re-evaluating the criteria for rejecting traces is vital to achieve broader clinical implementation of NIFECG.

Introduction: Bell's palsy appears to be more common in pregnancy, but incidence numbers differ. Risk factors for pregnancy-associated Bell's palsy have been discussed, but larger studies are needed to receive significant results.

Material and methods: This study aimed to investigate the incidence and maternal risk factors of pregnancy-associated Bell's palsy. It is a nationwide register-based cohort study. Women with Bell's palsy in Sweden from 2005 to 2015 were identified in the National Patient Register. Women giving birth at ≥22 gestational weeks during the same period were identified in the Medical Birth Register. Pregnancy-associated Bell's palsy was defined as the first diagnosis of Bell's palsy during pregnancy or within the first 2 months postpartum, identified by linking the data sets. Childbirths in women without a history of Bell's palsy were used as a comparison group. Risk factors were identified using backward conditional multivariable logistic regression and presented with adjusted odds ratios (aOR) with 95% confidence intervals (CIs).

Results: A total of 2051 childbirths in women with pregnancy-associated Bell's palsy were identified. For a comparison 1 188 489 childbirths in women without a history of Bell's palsy were used. The incidence of pregnancy-associated Bell's palsy was 171.6 per 100 000 childbirths. Pregnancy-associated Bell's palsy was associated with high BMI (e.g., BMI 30-34.9, aOR 1.30, 95% CI 1.12-1.50), being born in Asia (aOR 1.19, 95% CI 1.04-1.37), Africa (aOR 1.76, 95% CI 1.47-2.11), or South America (aOR 1.85, 95% CI 1.35-2.55), multiple pregnancy (aOR 1.83, 95% CI 1.48-2.26), and a diagnosis of herpes zoster (aOR 6.55, 95% CI 2.93-14.67), borreliosis (aOR 3.70, 95% CI 1.38-9.89), gestational diabetes (aOR 1.68, 95% CI 1.31-2.15), or preeclampsia (aOR 2.02, 95% CI 1.74-2.35).

Conclusions: The incidence of pregnancy-associated Bell's palsy was 171.6 per 100 000 childbirths. Risk factors related to metabolic stress were associated with pregnancy-associated Bell's palsy, although the causal pathway remains unclear.

Introduction: Living in a deprived neighborhood is associated with an increased risk of severe maternal morbidity (SMM), but the specific deprivation factors or individual SMM conditions driving this risk remain unclear. This study examined how different domains and subdomains of the Index of Multiple Deprivation (IMD) are associated with SMM, identifying key contributors.

Material and methods: We conducted a nationwide, population-based cohort study using English Hospital Episode Statistics Admitted Patient Care (HES APC) data. The cohort included 4 040 106 women aged 10-55 years who gave birth in NHS facilities in England between January 1, 2013, and March 31, 2023, with pregnancies of ≥20 weeks' gestation. Multilevel multivariable Poisson regression estimated adjusted risk ratios (aRR) and 95% confidence intervals (CI) of composite SMM and key individual SMM conditions for each IMD quintile compared to the least deprived quintile, and aRR (95% CI) of composite SMM in each IMD domain/subdomain quintile compared to the least deprived quintile.

Results: IMD domains showed varying associations with SMM. Income and employment deprivation had the strongest associations, with women living in the most deprived quintile having aRRs of 1.16 (95% CI 1.12-1.20) and 1.15 (95% CI 1.11-1.19) compared to those living in the least deprived quintile, respectively. Contrastingly, high geographical barriers to services were associated with a lower risk of SMM (aRR: 0.92 (95% CI 0.88-0.95)). Sepsis, acute cardiac events, and embolism play a key role in the association between composite deprivation and SMM, with women living in the most deprived areas having risk ratios of 1.43 (95% CI 1.36-1.50), 1.24 (95% CI 1.09-1.41), and 1.97 (95% CI 1.69-2.29), respectively, for each of the conditions, compared to women living in the least deprived areas.

Conclusions: There appears to be a widening gap in the risk of SMM between women living in the least and most deprived areas in England, with sepsis, cardiac events, and embolism having the strongest association with deprivation. Composite measures of area-level deprivation may obscure the diverse impacts of specific deprivation factors, and individual-level socioeconomic measures are needed to clarify pathways contributing to SMM risk.

Introduction: Persistent tumor after combined chemoradiation for locally advanced cervical cancer is an established prognostic factor. Detection may include magnetic resonance imaging, positron emission tomography (PET) combined with CT scan, ultrasound, or biopsies; however, no agreement about the best method and time point has been reached. In our institution, a standardized biopsy protocol of at least four punch biopsies is routinely performed at the last brachytherapy with re-biopsies 6 weeks later in cases not showing histologic complete response (hCR). This study aims to assess the prognostic relevance of these biopsies, especially with respect to the time point of hCR.

Material and methods: This investigation was a retrospective single-center observational cohort study that included all patients treated for locally advanced or node-positive cervical cancer with combined chemoradiation at the University Hospital Innsbruck between 2008 and 2023. Patients with a hCR at the end of radiotherapy were classified as primary negative and otherwise as primary positive. Primary positive patients that achieved complete response at a control biopsy 6 weeks later were classified as secondary negative, and the remaining patients with residual tumor as secondary positive. Progression-free survival (PFS) and overall survival (OS) were compared between all these groups.

Results: We included 184 patients in this study, from which 46 (25%) were classified as primary positive. These patients experienced a significantly worse PFS compared to primary negative patients (p = 0.008, HR = 2.03, 95% CI [1.20, 3.45]). The difference in PFS was also evidenced when comparing primary negative patients to those who had a hCR 6 weeks after radiotherapy (secondary negative) (p = 0.018, HR = 2.00, 95% CI [1.13, 3.56]). However, in primary positive patients, OS was not significantly reduced (p = 0.29, HR = 1.45, 95% CI [0.73, 2.86]).

Conclusions: Early response evaluation using punch biopsies at the time of the last brachytherapy can identify patients with residual tumor, which exhibit a statistically significant and clinically meaningful risk of disease progression. This risk was not reversed even in the case of a delayed hCR 6 weeks after completion of chemoradiation.

Introduction: Understanding what patients prioritize when seeking care for endometriosis and chronic pelvic pain (CPP) is crucial for delivering personalized, responsive care. However, patient-defined goals remain poorly characterized across various life stages and disease phenotypes. This study aimed to explore and rank patient priorities at the time of tertiary referral to inform patient-centered care models.

Material and methods: We conducted a convergent mixed-methods study of 649 new patients referred to a tertiary endometriosis center between 2021 and 2024. Participants completed a standardized intake form including two open-ended questions on their goals and reasons for seeking care. Qualitative data were analyzed using codebook thematic analysis, generating five overarching themes and 20 subthemes. Frequencies of coded themes were descriptively compared across age groups and ultrasound-confirmed endometriosis phenotypes. Quantitative data were analyzed using descriptive statistics, with subgroup comparisons based on age (18-24, 25-34, 35-44, 45-54, 55+) and phenotype (superficial, ovarian, deep, combined). The primary outcome was the ranked frequency of care priorities by subgroup. Secondary outcomes included cross-theme variation and co-occurrence patterns.

Results: Five key themes emerged: (1) managing pain and symptoms across a broad spectrum; (2) pursuing diagnostic clarity and validation; (3) balancing symptom relief with fertility planning and preservation; (4) restoring daily function, relationships, and mental well-being; and (5) seeking knowledge to navigate the disease and its management. Subgroup analysis revealed that though management and diagnosis were most frequently prioritized among all groups, fertility was more frequently prioritized by participants aged 25-34 (24.1%) and those with ovarian endometriosis (27.8%), while older participants more often prioritized quality of life and education. Participants with superficial or presumptive diagnoses more commonly emphasized diagnostic clarity and frustration with fragmented care. Many participants expressed a desire for alternatives to hormonal therapy and reported feeling unheard or unsupported in prior encounters.

Conclusions: Patient priorities differ meaningfully across age and endometriosis phenotype, with fertility, education, and quality of life shifting in relative importance over time. These findings support the need for personalized, life-stage-responsive models of care that adapt to evolving patient goals and integrate both medical and psychosocial domains.

Introduction: Congenital duodenal obstruction (CDO) is one of the most common fetal gastrointestinal anomalies, but previous prenatal studies tend to investigate CDO as a portion of gastrointestinal obstruction. Few studies describe the genetic findings of CDO, especially copy number variants, in fetal cohorts with a relatively large sample size. The study aims to investigate the detection rate of genetic causes at different levels and to explore the potential influencing factors of perinatal outcomes of fetuses with CDO.

Material and methods: This retrospective study analyzed karyotype, chromosomal microarray analysis, and trio-whole exome sequencing (trio-WES) results of singleton fetuses suspected of CDO in a tertiary center between January 2014 and September 2023. In addition, perinatal outcomes and postnatal medical records of enrolled cases were followed up and analyzed.

Results: A total of 98 fetuses were included in the study, of which 69 (70.4%) were classified as isolated CDO and 29 (29.6%) were classified as non-isolated. The overall rate of genetic anomalies was 20.4% (20/98). Trisomy 21 (9/98 [9.2%]) and microduplication of the 17q12 region (3/98 [3.2%]) were the most common chromosomal numerical abnormalities and pathogenic copy number variants found in this cohort, respectively. Compared to chromosomal microarray analysis, no additional pathogenic or likely pathogenic variants were found in seven cases undergoing trio-WES. The rate of chromosomal numerical and structural abnormalities was significantly higher in the non-isolated group (8/29 [27.6%] vs. 6/69 [8.7%], p < 0.05). In terms of perinatal outcomes, the live birth rate was significantly higher in the isolated group (52/69 [75.4%] vs. 15/29 [51.7%], p < 0.05) largely due to fewer terminations of pregnancy. All cases with positive genetic results elected to terminate the pregnancy, and 82% of those with negative results opted to continue the pregnancy. Neonatal mortality was significantly higher in the non-isolated group (2/15 [13.3%] vs. 0/52 [0.0%], p < 0.05). The overall neonatal survival rate was 97.0% (65/67).

Conclusions: The present study highlights the value of prenatal diagnostic testing for fetuses suspected of CDO, both in isolated and non-isolated cases. Genetic diagnostic outcomes exert substantial influence on pregnancy decision-making. Perinatal outcome and short-term prognosis of affected fetuses are reasonably favorable when known genetic causes are excluded.

Introduction: Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome, collectively referred to as premenstrual mood disorders (PMDs), are common among working women and can significantly impact their well-being and productivity. This study investigated the prevalence of PMDs and identified sociodemographic and occupational factors that contribute to the risk of PMDs among Japanese working women.

Material and methods: This was a cross-sectional study based on a two-wave online survey conducted between January and June 2023. The study targeted individuals who were biologically female, aged 20-44 years, and currently employed in Japan. Data were collected on sociodemographic characteristics (e.g., age, marital status, education, income), occupational factors (e.g., working hours, job type), and health-related variables. The primary outcome was the presence of premenstrual disorders (PMDs), assessed using the Premenstrual Dysphoric Disorder Scale. Participants were classified as having PMDs if they met criteria for either PMDD or moderate-to-severe premenstrual syndrome (PMS). Those reporting no or only mild symptoms were categorized as not having PMDs. The secondary outcome was the identification of sociodemographic and occupational factors associated with the presence of PMDs. To examine these associations, logistic regression analysis was performed, comparing individuals with and without PMDs.

Results: Among 908 participants (mean age = 33.48, SD = 6.20), 13.66% had PMDD, and 30.51% had moderate-to-severe premenstrual syndrome. Greater PMD risk was associated with younger age, non-regular employment, working ≥60 h weekly, employment in small companies, the presence of children, and lower educational attainment. In contrast, a lower PMD risk was associated with having a manufacturing job.

Conclusions: Sociodemographic and occupational factors have a strong impact on PMDs among Japanese female workers. Promoting work-life balance and providing tailored mental health support in the workplace can help reduce PMDs. Future studies should further investigate these complex relationships.