Acta Obstetricia et Gynecologica Scandinavica最新文献

Introduction: Endometriosis is a chronic and estrogen-dependent disorder that affects about 10% of women of reproductive age worldwide. Endometriosis has been associated with chronic inflammation and an atherogenic lipid profile, two conditions that increase the risk of atherothrombotic cardiovascular diseases.

Material and methods: A literature search for relevant studies published from the earliest record to 31 March 2025 was conducted in MEDLINE and EMBASE databases. The following MESH terms were searched: "stroke," "cerebrovascular disease," "cardiovascular disease," "coronary heart disease," "ischemic heart disease," "mortality," and "endometriosis." The results of each study were pooled, and an overall estimate of relative risk was obtained with a random-effect model. Homogeneity between studies was analyzed using I² statistics. This review was not registered.

Results: Ten studies were eligible for inclusion in this meta-analysis. Five studies reported an increased risk of stroke with endometriosis, with a pooled risk of 1.18 (95% confidence intervals [95% CI] [1.13-1.22]). Four studies reported an increased risk of coronary heart disease with endometriosis, with a pooled risk of 1.36 (95% CI [1.32-1.40]). Four studies reported an increased risk of composite cardiovascular disease with endometriosis, with a pooled risk of 1.16 (95% CI [1.12-1.20]). Although the homogeneity is high in results, the confounding factors considered in the different studies vary. Thus, these results must be interpreted with caution.

Conclusions: Endometriosis is associated with an increased risk of cardiovascular disease. Further research is required to confirm these findings. However, these results highlight the importance of considering primary cardiovascular prevention strategies for women with endometriosis.

As medical knowledge and technologies rapidly evolve, curricula have become increasingly dense, and designing effective OB-GYN education that prepares learners for diverse medical careers within limited timeframes is a global challenge. This review provides an international overview of contemporary medical education in obstetrics and gynecology (OB-GYN) across undergraduate, postgraduate, and continuing professional development levels. A narrative review of recent peer-reviewed literature, international guidelines, and global initiatives (2023–2025) was conducted, identifying key innovations, trends, and challenges in OB-GYN education worldwide, with a focus on curriculum reforms, competency-based education, simulation, telemedicine, AI applications, global standardization, and equity-oriented initiatives. Undergraduate OB-GYN curricula are increasingly standardized, integrating core competencies, early clinical exposure, and reproductive health. Postgraduate training adopts competency-based frameworks, enhanced by simulation, virtual reality, and tele-education, while continuing medical education has shifted toward flexible digital platforms and structured credentialing. Innovations, such as AI-driven learning tools, simulation drills, and telemedicine-based training, have improved skill acquisition, and global bodies, such as FIGO, RCOG, and ACOG, promote curriculum harmonization and equity. The COVID-19 pandemic accelerated digital adoption but revealed gaps in surgical training and support. Overall, OB-GYN education is in a transformative phase, marked by technology, standardization, and equity, yet significant disparities persist, especially in resource-limited settings. Continued global collaboration, investment in educational infrastructure, and adaptive curriculum development are essential to prepare OB-GYN professionals for evolving clinical demands and healthcare inequities in the postpandemic era.

Introduction: Further prolapse in the same or a different vaginal compartment is common, particularly following native tissue surgery. This study aims to report the rates of reoperations for prolapse and subjective recurrence after native tissue and mesh-augmented surgeries. Additionally, it seeks to describe the methods of repeat surgery for prolapse and to evaluate long-term mesh complications.

Material and methods: This is a follow-up study of the nationwide cohort (ClinicalTrials.gov [NCT02716506]) of pelvic organ prolapse surgeries performed in 2015 in Finland. Prolapse recurrence, reoperations and mesh complications were studied utilizing data from patient questionnaires and the national register. Reoperation rates, timing, methods of repeat surgery, and rates of subjective recurrence were compared among native tissue, transvaginal mesh and abdominal mesh surgeries. Predictive factors for reoperation were studied with logistic regression analysis. Mesh-related complications were evaluated after transvaginal and abdominal mesh repair.

Results: The mean follow-up of 3321 women was 7.4 years, during which 443 (13%) underwent reoperation for prolapse; 13.9% after native tissue, 10.1% after transvaginal mesh, and 12.1% after abdominal mesh repair (p = 0.09). Up to one third of women reported symptoms of vaginal bulging during follow-up, with significantly lower rates after transvaginal mesh surgery at 2- and 5-year follow-ups. The majority of reoperations for prolapse were single-site; anterior or apical repair was most common after native tissue and abdominal mesh surgery, while reoperations after transvaginal repair involved mainly posterior or apical compartments. Mesh was used in 40% of all reoperations. Prolapse surgery involving both posterior and apical compartments was the only factor associated with increased risk for reoperation (aOR 1.95 CI 1.30-2.92). Only 1.6% of women had a surgically treated mesh complication based on the register data, while the rates of patient-reported mesh exposures and mesh-related reoperations were 6.5% and 6.4%, with no significant difference between the two mesh groups.

Conclusions: The long-term risk of reoperation for prolapse was similar after native tissue and mesh-augmented surgery, while the site of reoperation differed based on the type of surgical treatment. Mesh complication rates were similar after transvaginal and abdominal mesh repair, and the majority of mesh exposures did not require surgical treatment.