Greta Lisa Carlin, Christina Tanja Grech, Wolfgang Umek, Engelbert Hanzal, Marianne Koch, Barbara Bodner-Adler
Mid-urethral slings (MUS) such as tension-free vaginal tape (TVT) are the established gold standard surgical approach for treating stress urinary incontinence (SUI). While generally effective, complications such as bladder injury, urinary retention, and bleeding can occur. This article focuses on a rare but significant complication: postoperative hemorrhage into the retropubic space (Cavum Retzii) following MUS/TVT placement. Key challenges, diagnostic options, and management strategies for this condition are assessed. Additionally, a structured clinical guideline to support a systematic approach to diagnosis and treatment of complications is provided.
{"title":"Retropubic hemorrhage following Midurethral sling surgery: Diagnosis, clinical challenges, and management.","authors":"Greta Lisa Carlin, Christina Tanja Grech, Wolfgang Umek, Engelbert Hanzal, Marianne Koch, Barbara Bodner-Adler","doi":"10.1111/aogs.70129","DOIUrl":"https://doi.org/10.1111/aogs.70129","url":null,"abstract":"<p><p>Mid-urethral slings (MUS) such as tension-free vaginal tape (TVT) are the established gold standard surgical approach for treating stress urinary incontinence (SUI). While generally effective, complications such as bladder injury, urinary retention, and bleeding can occur. This article focuses on a rare but significant complication: postoperative hemorrhage into the retropubic space (Cavum Retzii) following MUS/TVT placement. Key challenges, diagnostic options, and management strategies for this condition are assessed. Additionally, a structured clinical guideline to support a systematic approach to diagnosis and treatment of complications is provided.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899016","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}
Dina O. Eriksen, Louise Krog, Eva B. Ostenfeld, Pernille T. Jensen, Kathrine D. Lycke, Therese K. Grønborg, Nicolas Wentzensen, Megan A. Clarke, Anne Hammer
Introduction
Human papillomavirus (HPV) vaccination is associated with a significantly reduced risk of cervical cancer when administered before initial exposure to HPV. Women with high-grade cervical intraepithelial neoplasia (CIN) have an increased risk of subsequent HPV-related disease, including recurrent high-grade CIN, compared to women without CIN. Some clinicians have advised women with high-grade CIN to undergo HPV vaccination to reduce their subsequent risk, despite a lack of evidence for this practice. We aimed to evaluate whether HPV vaccination of women undergoing active surveillance for CIN grade 2 (CIN2) is associated with a decreased risk of progression to cervical intraepithelial neoplasia grade 3 or worse (CIN3+).
Material and Methods
We conducted a nationwide population-based historical cohort study in Denmark on women aged 18–40 years undergoing active surveillance for CIN2 from 2007 to 2020. We compared women receiving at least one HPV vaccine dose within 6 months after their CIN2 diagnosis to women not receiving the vaccine. Our primary outcome was progression to CIN3+. We stratified by age at CIN2 diagnosis (18–29, 30–40), calendar year (2007–2012, 2013–2020), and index cytology (high-grade, nonhigh-grade). We used Cox proportional hazards regression to estimate hazard ratios of the outcomes with unvaccinated women as the reference. Age at diagnosis, calendar year, index cytology, income, and educational level were adjusted for.
Results
We included 4585 women, of whom 583 (12.7%) were vaccinated within 6 months after CIN2 diagnosis. A total of 1391 (30.3%) progressed to CIN3+ during follow-up. The 5-year cumulative risk was 29.9% (28.5–31.3). Overall, no protective effect of vaccination after CIN2 diagnosis was found (aHR 1.45 [1.24–1.69]). Stratified analyses showed increased progression risk with vaccination among women <30 years, in the early calendar period (2007–2012), and across both non-high-grade and high-grade index cytology; no significant difference in risk was observed in women ≥30 years or in the latest calendar period (2013–2020).
Conclusions
HPV vaccination did not reduce the risk of progression in women undergoing active surveillance for CIN2. This finding indicates that HPV vaccination should not be recommended in this group of women.
{"title":"HPV vaccination following cervical intraepithelial neoplasia grade 2 diagnosis and risk of progression","authors":"Dina O. Eriksen, Louise Krog, Eva B. Ostenfeld, Pernille T. Jensen, Kathrine D. Lycke, Therese K. Grønborg, Nicolas Wentzensen, Megan A. Clarke, Anne Hammer","doi":"10.1111/aogs.70128","DOIUrl":"10.1111/aogs.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Human papillomavirus (HPV) vaccination is associated with a significantly reduced risk of cervical cancer when administered before initial exposure to HPV. Women with high-grade cervical intraepithelial neoplasia (CIN) have an increased risk of subsequent HPV-related disease, including recurrent high-grade CIN, compared to women without CIN. Some clinicians have advised women with high-grade CIN to undergo HPV vaccination to reduce their subsequent risk, despite a lack of evidence for this practice. We aimed to evaluate whether HPV vaccination of women undergoing active surveillance for CIN grade 2 (CIN2) is associated with a decreased risk of progression to cervical intraepithelial neoplasia grade 3 or worse (CIN3+).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a nationwide population-based historical cohort study in Denmark on women aged 18–40 years undergoing active surveillance for CIN2 from 2007 to 2020. We compared women receiving at least one HPV vaccine dose within 6 months after their CIN2 diagnosis to women not receiving the vaccine. Our primary outcome was progression to CIN3+. We stratified by age at CIN2 diagnosis (18–29, 30–40), calendar year (2007–2012, 2013–2020), and index cytology (high-grade, nonhigh-grade). We used Cox proportional hazards regression to estimate hazard ratios of the outcomes with unvaccinated women as the reference. Age at diagnosis, calendar year, index cytology, income, and educational level were adjusted for.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 4585 women, of whom 583 (12.7%) were vaccinated within 6 months after CIN2 diagnosis. A total of 1391 (30.3%) progressed to CIN3+ during follow-up. The 5-year cumulative risk was 29.9% (28.5–31.3). Overall, no protective effect of vaccination after CIN2 diagnosis was found (aHR 1.45 [1.24–1.69]). Stratified analyses showed increased progression risk with vaccination among women <30 years, in the early calendar period (2007–2012), and across both non-high-grade and high-grade index cytology; no significant difference in risk was observed in women ≥30 years or in the latest calendar period (2013–2020).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>HPV vaccination did not reduce the risk of progression in women undergoing active surveillance for CIN2. This finding indicates that HPV vaccination should not be recommended in this group of women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"377-385"},"PeriodicalIF":3.1,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888633","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}
Mette L Josefsson, Eva Uustal, Sara Sohlberg, Cecilia Ekéus, Erik Lampa, Maria Jonsson
Introduction: Anal incontinence can have a significant negative impact on quality of life. The leading cause of anal incontinence among women of child-bearing age is obstetric-related perineal injury. The objective of this study was to examine the impact of episiotomy on the incidence of anal incontinence among primiparous women with second-, third-, or fourth-degree perineal tears at 8 weeks and 1 year postpartum and to assess change in incidence over time across varying degrees of perineal tears.
Material and methods: This Swedish cohort study included 12 658 primiparous women who sustained a second- (n = 5309), third- (n = 6771), or fourth-degree tear (n = 578), either spontaneously or in association with an episiotomy, between 2014 and 2019. Data were collected from national health and quality registers. The primary outcomes assessed were fecal and gas incontinence at 1 year postpartum. Secondary outcomes included lifestyle alteration and Wexner score. Logistic regression analyses were performed, and results were presented as odds ratios (ORs) with 95% confidence intervals (CIs), using spontaneous tear as the reference group. Models were adjusted for age, body mass index, prepregnancy diabetes, gestational age, mode of delivery, length of the second stage, fetal presentation, birth weight, and head circumference.
Results: The incidence of gas incontinence 1 year after second-, third-, or fourth-degree tears was 11.0%, 23.6%, and 37.8%, respectively. The incidence of fecal incontinence was 1.8%, 5.2%, and 14.5% for loose stool, and 0.8%, 2.1%, and 6.6% for solid stool, respectively. Women with a second-degree tear and episiotomy had an adjusted OR of 1.26 (95% CI 1.02-1.55) for gas incontinence and 1.38 (95% CI 0.90-2.10) for fecal incontinence at 1 year postpartum. Episiotomy did not increase the risk of anal incontinence among women with third-degree and fourth-degree tears. Anal incontinence, lifestyle changes, and Wexner score decreased over time across all types of tears.
Conclusions: Anal incontinence increases with the severity of perineal tears; however, the risk of incontinence is primarily determined by the grade of injury rather than the presence or absence of an episiotomy. Symptoms decline over time across all degrees of tears.
肛门失禁会对生活质量产生显著的负面影响。育龄妇女肛门失禁的主要原因是产科相关的会阴损伤。本研究的目的是研究会阴切开术对产后8周和1年伴有二度、三度或四度会阴撕裂的初产妇肛门失禁发生率的影响，并评估不同程度会阴撕裂的发生率随时间的变化。材料和方法：这项瑞典队列研究包括12658名初产妇女，她们在2014年至2019年期间自发或与会阴切开术相关地遭受了二度撕裂（n = 5309）、三度撕裂（n = 6771）或四度撕裂（n = 578）。数据是从国家卫生和质量登记处收集的。评估的主要结果是产后1年的大便和气体失禁。次要结局包括生活方式改变和Wexner评分。进行逻辑回归分析，以自发性撕裂为参照组，结果以95%置信区间（ci）的优势比（ORs）表示。模型根据年龄、体重指数、孕前糖尿病、胎龄、分娩方式、第二阶段长度、胎儿表现、出生体重和头围进行调整。结果：二度、三度、四度撕裂1年后气体失禁的发生率分别为11.0%、23.6%和37.8%。大便失禁的发生率，稀便组分别为1.8%、5.2%、14.5%，实便组分别为0.8%、2.1%、6.6%。二度撕裂和会阴切开的妇女产后1年气体失禁的调整OR为1.26 (95% CI 1.02-1.55)，大便失禁的调整OR为1.38 （95% CI 0.90-2.10）。会阴切开术并没有增加三度和四度撕裂的女性发生肛门失禁的风险。随着时间的推移，肛门失禁、生活方式的改变和Wexner评分在所有类型的眼泪中都有所下降。结论：肛门失禁随会阴撕裂程度的加重而加重；然而，失禁的风险主要取决于损伤的程度，而不是是否进行会阴切开术。随着时间的推移，所有程度的眼泪症状都会减轻。
{"title":"Impact of episiotomy on anal incontinence following second- to fourth-degree perineal tears-A cohort study.","authors":"Mette L Josefsson, Eva Uustal, Sara Sohlberg, Cecilia Ekéus, Erik Lampa, Maria Jonsson","doi":"10.1111/aogs.70124","DOIUrl":"https://doi.org/10.1111/aogs.70124","url":null,"abstract":"<p><strong>Introduction: </strong>Anal incontinence can have a significant negative impact on quality of life. The leading cause of anal incontinence among women of child-bearing age is obstetric-related perineal injury. The objective of this study was to examine the impact of episiotomy on the incidence of anal incontinence among primiparous women with second-, third-, or fourth-degree perineal tears at 8 weeks and 1 year postpartum and to assess change in incidence over time across varying degrees of perineal tears.</p><p><strong>Material and methods: </strong>This Swedish cohort study included 12 658 primiparous women who sustained a second- (n = 5309), third- (n = 6771), or fourth-degree tear (n = 578), either spontaneously or in association with an episiotomy, between 2014 and 2019. Data were collected from national health and quality registers. The primary outcomes assessed were fecal and gas incontinence at 1 year postpartum. Secondary outcomes included lifestyle alteration and Wexner score. Logistic regression analyses were performed, and results were presented as odds ratios (ORs) with 95% confidence intervals (CIs), using spontaneous tear as the reference group. Models were adjusted for age, body mass index, prepregnancy diabetes, gestational age, mode of delivery, length of the second stage, fetal presentation, birth weight, and head circumference.</p><p><strong>Results: </strong>The incidence of gas incontinence 1 year after second-, third-, or fourth-degree tears was 11.0%, 23.6%, and 37.8%, respectively. The incidence of fecal incontinence was 1.8%, 5.2%, and 14.5% for loose stool, and 0.8%, 2.1%, and 6.6% for solid stool, respectively. Women with a second-degree tear and episiotomy had an adjusted OR of 1.26 (95% CI 1.02-1.55) for gas incontinence and 1.38 (95% CI 0.90-2.10) for fecal incontinence at 1 year postpartum. Episiotomy did not increase the risk of anal incontinence among women with third-degree and fourth-degree tears. Anal incontinence, lifestyle changes, and Wexner score decreased over time across all types of tears.</p><p><strong>Conclusions: </strong>Anal incontinence increases with the severity of perineal tears; however, the risk of incontinence is primarily determined by the grade of injury rather than the presence or absence of an episiotomy. Symptoms decline over time across all degrees of tears.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877435","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}
Britt M. J. G. Kempener, Laura M. Jorissen, Eva G. Mulder, Chahinda Ghossein-Doha, Joris van Drongelen, Ralph R. Scholten, Christoph C. Lees, Sander de Haas, Emma B. N. J. Janssen, Marc E. A. Spaanderman
Introduction
Abnormalities in central hemodynamic functions before and throughout pregnancy may antedate impaired fetal growth. We aimed to assess cardiac output (CO) and total peripheral vascular resistance (TPVR) trajectories throughout singleton pregnancies with and without impaired fetal growth by systematic review and meta-analysis.
Material and Methods
PubMed and Embase were systematically searched (inception – July 2023), and reference lists were screened. Studies reporting CO and TPVR during singleton pregnancies complicated by impaired fetal growth were included. Studies measuring hemodynamic parameters in women with prepregnancy hypertension and/or cardiac diseases were excluded. Absolute values of hemodynamic parameters were calculated over pregnancy using a random-effects model, and subgroup analyses differentiated more severe clinical phenotypes of impaired fetal growth. The systematic review was registered in the PROSPERO database (CRD42020172252).
Results
Thirty-three studies were included, comprising 7816 women. Hemodynamic function in non-pregnant women did not differ between those who subsequently gave birth to a growth-restricted neonate or an appropriately grown neonate. Pregnancies complicated by impaired fetal growth were accompanied by elevated second and third-trimester TPVR and concurrent reduced third-trimester CO. Second and third-trimester TPVR was consistently higher when fetal growth restriction was accompanied by abnormal perfusion indices instead of only low birthweight (centile), concurrent maternal hypertensive disorder of pregnancy, and when small for gestational age was accompanied by preterm birth.
Conclusions
Impaired fetal growth is associated with increased vascular resistance and reduced CO from the second trimester onwards. More severe phenotypes, particularly those with attenuated placental perfusion or lower gestational age at birth, exhibit the most vasoconstrictive hemodynamic profile. Future studies could focus on targeted preventive measures to restore hemodynamic function.
{"title":"Hemodynamic changes in pregnancies with impaired fetal growth: A systematic review and meta-analysis","authors":"Britt M. J. G. Kempener, Laura M. Jorissen, Eva G. Mulder, Chahinda Ghossein-Doha, Joris van Drongelen, Ralph R. Scholten, Christoph C. Lees, Sander de Haas, Emma B. N. J. Janssen, Marc E. A. Spaanderman","doi":"10.1111/aogs.70102","DOIUrl":"10.1111/aogs.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Abnormalities in central hemodynamic functions before and throughout pregnancy may antedate impaired fetal growth. We aimed to assess cardiac output (CO) and total peripheral vascular resistance (TPVR) trajectories throughout singleton pregnancies with and without impaired fetal growth by systematic review and meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>PubMed and Embase were systematically searched (inception – July 2023), and reference lists were screened. Studies reporting CO and TPVR during singleton pregnancies complicated by impaired fetal growth were included. Studies measuring hemodynamic parameters in women with prepregnancy hypertension and/or cardiac diseases were excluded. Absolute values of hemodynamic parameters were calculated over pregnancy using a random-effects model, and subgroup analyses differentiated more severe clinical phenotypes of impaired fetal growth. The systematic review was registered in the PROSPERO database (CRD42020172252).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-three studies were included, comprising 7816 women. Hemodynamic function in non-pregnant women did not differ between those who subsequently gave birth to a growth-restricted neonate or an appropriately grown neonate. Pregnancies complicated by impaired fetal growth were accompanied by elevated second and third-trimester TPVR and concurrent reduced third-trimester CO. Second and third-trimester TPVR was consistently higher when fetal growth restriction was accompanied by abnormal perfusion indices instead of only low birthweight (centile), concurrent maternal hypertensive disorder of pregnancy, and when small for gestational age was accompanied by preterm birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Impaired fetal growth is associated with increased vascular resistance and reduced CO from the second trimester onwards. More severe phenotypes, particularly those with attenuated placental perfusion or lower gestational age at birth, exhibit the most vasoconstrictive hemodynamic profile. Future studies could focus on targeted preventive measures to restore hemodynamic function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"215-224"},"PeriodicalIF":3.1,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861692","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}
Anna Lundmark Drca, Vasileios Alexandridis, Marie Westergren Söderberg, Pia Teleman, Marion Ek
Introduction: Stress urinary incontinence is the most prevalent type of incontinence among women, with mid-urethral sling (MUS) surgery considered the gold standard surgical treatment. Despite its widespread use, the role of mesh in this procedure has sparked controversy over the past decade. The primary objective of this study was to compare pelvic pain in women who have undergone MUS surgery with those who have not. The secondary objective was to evaluate lower urinary tract symptoms in both groups.
Material and methods: This prospective cohort study included Swedish women who underwent MUS surgery between 2006 and 2010 and were registered in the GynOp database, and a reference group of Swedish women without MUS, self-registered in Lifegene, a national cohort launched in 2009. The women completed the Urogenital Distress Inventory questionnaire-6 (UDI-6) assessing pelvic pain and lower urinary tract symptoms, administered ~10 years after MUS surgery or at matched ages.
Results: Pelvic pain was analyzed at least 10 years post-MUS surgery and in the reference group at matched ages. Significant differences in pelvic pain were observed among women aged ≥50 years. Logistic regression analysis, incorporating an interaction between MUS surgery and age, revealed adjusted odds ratios (aOR) for pelvic pain among women with MUS as follows: 0.82 (CI: 0.51-1.31) for women aged <50 years, 1.79 (CI: 1.13-2.42) for women aged 50-59 years, 1.85 (CI: 1.13-3.00) for women aged 60-69 years, and 2.08 (CI: 1.30-3.32) for women ≥70 years. Women with previous MUS surgery reported higher UDI-6 scores, indicating more bothersome lower urinary tract symptoms, except among those aged <50 years, compared with the reference group.
Conclusions: Women aged 50 years or older, who have undergone MUS surgery ≥10 years earlier, report more frequent pelvic pain and lower urinary tract symptoms than those who have not undergone MUS surgery. Whether this is related to the MUS surgery or an expression of a progressing pelvic floor dysfunction is unclear.
{"title":"Pelvic pain and lower urinary tract symptoms; long-term comparison between women with and without mid-urethral sling insertion.","authors":"Anna Lundmark Drca, Vasileios Alexandridis, Marie Westergren Söderberg, Pia Teleman, Marion Ek","doi":"10.1111/aogs.70079","DOIUrl":"https://doi.org/10.1111/aogs.70079","url":null,"abstract":"<p><strong>Introduction: </strong>Stress urinary incontinence is the most prevalent type of incontinence among women, with mid-urethral sling (MUS) surgery considered the gold standard surgical treatment. Despite its widespread use, the role of mesh in this procedure has sparked controversy over the past decade. The primary objective of this study was to compare pelvic pain in women who have undergone MUS surgery with those who have not. The secondary objective was to evaluate lower urinary tract symptoms in both groups.</p><p><strong>Material and methods: </strong>This prospective cohort study included Swedish women who underwent MUS surgery between 2006 and 2010 and were registered in the GynOp database, and a reference group of Swedish women without MUS, self-registered in Lifegene, a national cohort launched in 2009. The women completed the Urogenital Distress Inventory questionnaire-6 (UDI-6) assessing pelvic pain and lower urinary tract symptoms, administered ~10 years after MUS surgery or at matched ages.</p><p><strong>Results: </strong>Pelvic pain was analyzed at least 10 years post-MUS surgery and in the reference group at matched ages. Significant differences in pelvic pain were observed among women aged ≥50 years. Logistic regression analysis, incorporating an interaction between MUS surgery and age, revealed adjusted odds ratios (aOR) for pelvic pain among women with MUS as follows: 0.82 (CI: 0.51-1.31) for women aged <50 years, 1.79 (CI: 1.13-2.42) for women aged 50-59 years, 1.85 (CI: 1.13-3.00) for women aged 60-69 years, and 2.08 (CI: 1.30-3.32) for women ≥70 years. Women with previous MUS surgery reported higher UDI-6 scores, indicating more bothersome lower urinary tract symptoms, except among those aged <50 years, compared with the reference group.</p><p><strong>Conclusions: </strong>Women aged 50 years or older, who have undergone MUS surgery ≥10 years earlier, report more frequent pelvic pain and lower urinary tract symptoms than those who have not undergone MUS surgery. Whether this is related to the MUS surgery or an expression of a progressing pelvic floor dysfunction is unclear.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861687","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}
Marie Min Tse Tan, Kirsten Jie Ying Ong, Michelle Mei Ying Tiong, Rehena Sultana, Chuyen Luong, Serene Thain, Devendra Kanagalingam, Jerry Kok Yen Chan, See Ling Loy, Chee Wai Ku
<div> <section> <h3> Introduction</h3> <p>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.</p> </section> <section> <h3> Material and Methods</h3> <p>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.</p> </section> <section> <h3> Results</h3> <p>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.</p> </section> <section> <h3> Conclusions</h3> <p>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 ac
电子胎心率（FHR）监测是不可或缺的产前和产时护理，以发现胎儿损害，降低新生儿发病率和死亡率。传统的有线心脏造影（CTG）限制了机动性，分娩姿势，并可能增加器械分娩。无线无创胎儿心电图（NIFECG）旨在解决这些挑战。然而，NIFECG有其局限性，包括信号干扰和监测FHR和子宫收缩（UC）数据的准确性有限。本研究旨在(i)量化妊娠≥37周妇女信号丢失的可接受NIFECG痕迹；（ii）比较NIFECG和CTG监测FHR和UC的准确性；（iii）评估NIFECG的可接受性。材料和方法：2020年8月至2021年6月，在新加坡KK妇女儿童医院对单胎妊娠≥37周的妇女进行了前瞻性队列研究。妇女在产前和产时同时进行40分钟的NIFECG和CTG监测。数据以3.75-s为周期进行比较。根据国际妇产科联合会指南，接受信号损失≤20%的NIFECG迹线。采用Bland-Altman和Passing-Bablok回归分析评估FHR监测准确性。以CTG为金标准，采用四重列联表确定UC监测精度。通过监测后反馈问卷评估可接受性。结果：103名女性贡献了124个配对痕迹。其中产前52例（56.5%），产时21例（65.6%），可接受73例（58.9%）。Bland-Altman（偏差：-0.4次/分钟，95%一致性限：[-9.0,8.1]）和Passing-Bablok（斜率= 0.97,95%可信区间（CI） 0.97-0.98）分析显示NIFECG和CTG FHR测量结果高度一致。NIFECG监测UC的特异性为0.96 (95% CI 0.94-0.97)，敏感性为0.90 （95% CI 0.89-0.92）。此外，90.1%的女性和88.9%的护士更倾向于使用NIFECG。结论：NIFECG在产前和产时监测FHR和UC的准确性与CTG相当，被妇女和护士广泛接受。鉴于41.1%的NIFECG导线因信号丢失而被拒绝，进一步研究改进技术以减少信号丢失，并重新评估拒绝导线的标准对于实现NIFECG更广泛的临床应用至关重要。
{"title":"Assessing signal loss, accuracy, and acceptability of an ambulatory fetal electrocardiography with cardiotocography in the antepartum and intrapartum phases","authors":"Marie Min Tse Tan, Kirsten Jie Ying Ong, Michelle Mei Ying Tiong, Rehena Sultana, Chuyen Luong, Serene Thain, Devendra Kanagalingam, Jerry Kok Yen Chan, See Ling Loy, Chee Wai Ku","doi":"10.1111/aogs.70113","DOIUrl":"10.1111/aogs.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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 ac","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"327-335"},"PeriodicalIF":3.1,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861732","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}
Maria I Zervou, Theoni B Tarlatzi, Basil C Tarlatzis, George N Goulielmos
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<p>We are delighted to learn that our article, “Prediction of obstetric outcome in vaginal breech birth using ultrasound pelvimetry in nulliparous women—A feasibility study”,<span><sup>1</sup></span> sparked interest even outside the obstetric community and was read by colleagues in laboratory medicine. Naturally, we would like to address the concerns expressed by the correspondents, Weizeng Chen and Xiaofang Xuan, in their recent letter to you.<span><sup>2</sup></span></p><p>First, we agree wholeheartedly that the cohort size is too small to develop an accurate multivariable prediction model. Consequently, the adjusted odds ratios from our multivariable regression are likely inflated and thus may overestimate or underestimate the risk of intrapartum cesarean section. We would like to refer the correspondents to the discussion section in our article, where this aspect is clearly pointed out. Despite these limitations, multivariable regression is still useful, as it shows that the association between the anteroposterior mid-pelvic diameter (AMD) and intrapartum cesarean section was independent of the obstetric conjugate (OC), head circumference, and birthweight. That said, we do not agree with the correspondents regarding the standard of 10 events per variable. As stated by Riley et al.—this article was also cited by the correspondents—“A concern is that any blanket rule of thumb is too simplistic, and that the number of participants required will depend on many intricate aspects”.<span><sup>3</sup></span></p><p>Second, we concur that the comparison between the performance of the AMD and the OC is indeed biased, as the latter influenced the planned birth mode in breech presentation. Even this limitation has been addressed by us in the article's discussion. Still, we maintain that such comparisons are informative to the reader, as they show that none of the three pelvic diameters measured in magnetic resonance (MR) pelvimetry—of which two were not used as criterion to offer vaginal breech birth—could outperform the sonographically measured AMD.</p><p>Third, the correspondents criticize that we did not propose an “actionable cutoff”. We assure them that this omission was intentional. Dichotomizing continuous variables (i.e., defining cutoffs) has been widely criticized by methodologists for causing information loss, decreasing statistical power, and misrepresenting complex biological processes.<span><sup>4, 5</sup></span> Additionally, it is needless to say that the cohort size in our study is too small to establish a robust cutoff. Therefore, we provided all reasonable representations of the data (figures 4 and 5 in our original study<span><sup>1</sup></span>) to allow the reader to draw their own conclusions as to how to implement the AMD in clinical practice.</p><p>To conclude, we want to emphasize that this analysis aimed primarily to assess the accuracy of transperineal ultrasound (TPU) in measuring the maternal pelvis in breech presentation. T
{"title":"Methodological concerns in the feasibility study on ultrasound pelvimetry for breech birth—A tempest in a teapot","authors":"Massimiliano Lia, Noura Kabbani","doi":"10.1111/aogs.70133","DOIUrl":"10.1111/aogs.70133","url":null,"abstract":"<p>We are delighted to learn that our article, “Prediction of obstetric outcome in vaginal breech birth using ultrasound pelvimetry in nulliparous women—A feasibility study”,<span><sup>1</sup></span> sparked interest even outside the obstetric community and was read by colleagues in laboratory medicine. Naturally, we would like to address the concerns expressed by the correspondents, Weizeng Chen and Xiaofang Xuan, in their recent letter to you.<span><sup>2</sup></span></p><p>First, we agree wholeheartedly that the cohort size is too small to develop an accurate multivariable prediction model. Consequently, the adjusted odds ratios from our multivariable regression are likely inflated and thus may overestimate or underestimate the risk of intrapartum cesarean section. We would like to refer the correspondents to the discussion section in our article, where this aspect is clearly pointed out. Despite these limitations, multivariable regression is still useful, as it shows that the association between the anteroposterior mid-pelvic diameter (AMD) and intrapartum cesarean section was independent of the obstetric conjugate (OC), head circumference, and birthweight. That said, we do not agree with the correspondents regarding the standard of 10 events per variable. As stated by Riley et al.—this article was also cited by the correspondents—“A concern is that any blanket rule of thumb is too simplistic, and that the number of participants required will depend on many intricate aspects”.<span><sup>3</sup></span></p><p>Second, we concur that the comparison between the performance of the AMD and the OC is indeed biased, as the latter influenced the planned birth mode in breech presentation. Even this limitation has been addressed by us in the article's discussion. Still, we maintain that such comparisons are informative to the reader, as they show that none of the three pelvic diameters measured in magnetic resonance (MR) pelvimetry—of which two were not used as criterion to offer vaginal breech birth—could outperform the sonographically measured AMD.</p><p>Third, the correspondents criticize that we did not propose an “actionable cutoff”. We assure them that this omission was intentional. Dichotomizing continuous variables (i.e., defining cutoffs) has been widely criticized by methodologists for causing information loss, decreasing statistical power, and misrepresenting complex biological processes.<span><sup>4, 5</sup></span> Additionally, it is needless to say that the cohort size in our study is too small to establish a robust cutoff. Therefore, we provided all reasonable representations of the data (figures 4 and 5 in our original study<span><sup>1</sup></span>) to allow the reader to draw their own conclusions as to how to implement the AMD in clinical practice.</p><p>To conclude, we want to emphasize that this analysis aimed primarily to assess the accuracy of transperineal ultrasound (TPU) in measuring the maternal pelvis in breech presentation. T","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"387-388"},"PeriodicalIF":3.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852917","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}
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.
贝尔氏麻痹似乎在怀孕期间更常见，但发病率不同。怀孕相关的贝尔氏麻痹的危险因素已经被讨论过，但需要更大规模的研究才能得到显著的结果。材料与方法：本研究旨在探讨妊娠相关性贝尔氏麻痹的发生率及产妇危险因素。这是一项全国性的基于登记的队列研究。2005年至2015年，瑞典贝尔氏麻痹症女性患者在国家患者登记册中被确认。在同一时期分娩≥22孕周的妇女在医疗出生登记册中得到确认。妊娠相关性贝尔氏麻痹定义为妊娠期间或产后2个月内首次诊断出贝尔氏麻痹，通过连接数据集确定。没有贝尔氏麻痹病史的分娩妇女被用作对照组。使用后向条件多变量逻辑回归确定危险因素，并以95%置信区间（ci）的调整优势比（aOR）表示。结果：共确定了2051例妊娠相关贝尔氏麻痹妇女的分娩。为了进行比较，研究人员使用了1184889名没有贝尔氏麻痹病史的产妇。妊娠相关贝尔氏麻痹的发生率为每10万例分娩中有171.6例。妊娠相关性贝尔氏麻痹与高BMI（例如，BMI 30-34.9, aOR 1.30, 95% CI 1.12-1.50）、出生在亚洲（aOR 1.19, 95% CI 1.04-1.37）、非洲（aOR 1.76, 95% CI 1.47-2.11）或南美（aOR 1.85, 95% CI 1.35-2.55）、多胎妊娠（aOR 1.83, 95% CI 1.48-2.26）、带状疱疹（aOR 6.55, 95% CI 2.93-14.67）、螺旋体病（aOR 3.70, 95% CI 1.38-9.89）、妊娠期糖尿病（aOR 1.68, 95% CI 1.31-2.15）或先兆子痫（aOR 2.02, 95% CI 1.74-2.35）相关。结论：妊娠相关性贝尔氏麻痹的发生率为每10万例分娩171.6例。与代谢应激相关的危险因素与妊娠相关性贝尔氏麻痹有关，尽管因果途径尚不清楚。
{"title":"Risk factors for pregnancy-associated Bell's palsy: A nationwide population-based register study","authors":"Lovisa Lansing, Elin Marsk, Sophia Brismar Wendel","doi":"10.1111/aogs.70135","DOIUrl":"10.1111/aogs.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"320-326"},"PeriodicalIF":3.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852940","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}
Dorothea Geddes-Barton, Rema Ramakrishnan, Raph Goldacre, Marian Knight
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.
生活在贫困社区与严重孕产妇发病率（SMM）的风险增加有关，但具体的贫困因素或个体SMM条件导致这种风险尚不清楚。本研究考察了多重剥夺指数（IMD）的不同域和子域如何与SMM相关，并确定了关键因素。材料和方法：我们使用英国医院事件统计住院病人护理（HES APC）数据进行了一项全国性的、基于人群的队列研究。该队列包括4040106名年龄在10-55岁之间的妇女，她们在2013年1月1日至2023年3月31日期间在英格兰NHS设施分娩，妊娠≥20周。多水平多变量泊松回归估计了与最贫困五分位数相比，每个IMD五分位数中复合SMM和关键个体SMM条件的调整风险比（aRR）和95%置信区间（CI），以及与最贫困五分位数相比，每个IMD域/子域五分位数中复合SMM的aRR （95% CI）。结果：IMD域与SMM有不同的相关性。收入和就业剥夺的相关性最强，与生活在最贫困五分之一的妇女相比，生活在最贫困五分之一的妇女的arr分别为1.16 （95% CI 1.12-1.20）和1.15 （95% CI 1.11-1.19）。相比之下，较高的服务地理障碍与较低的SMM风险相关（aRR: 0.92 (95% CI 0.88-0.95)）。脓毒症、急性心脏事件和栓塞在复合剥夺和SMM之间的关联中起着关键作用，与生活在最贫困地区的妇女相比，生活在最贫困地区的妇女在每种情况下的风险比分别为1.43 （95% CI 1.36-1.50）、1.24 （95% CI 1.09-1.41）和1.97 （95% CI 1.69-2.29）。结论：在英格兰生活在最贫困地区和最贫困地区的女性之间，SMM的风险差距似乎在扩大，败血症、心脏事件和栓塞与剥夺的相关性最强。区域层面剥夺的综合措施可能会模糊特定剥夺因素的多种影响，需要个人层面的社会经济措施来阐明导致SMM风险的途径。
{"title":"The association between different aspects of socioeconomic deprivation and severe maternal morbidity","authors":"Dorothea Geddes-Barton, Rema Ramakrishnan, Raph Goldacre, Marian Knight","doi":"10.1111/aogs.70134","DOIUrl":"10.1111/aogs.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"247-256"},"PeriodicalIF":3.1,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852915","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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