Acta Obstetricia et Gynecologica Scandinavica最新文献

Introduction: Screening for postnatal depression is widely acknowledged as an important public health initiative. The Whooley case-finding questions are well suited for screening purposes in primary health care settings, as the instrument is quick and easy to administer. However, the validity and diagnostic accuracy among postpartum women remain unclear. The purpose of the present study was to evaluate the validity and diagnostic accuracy of the Whooley questions compared to the Edinburgh postnatal depression scale (EPDS) in a community sample of postpartum women in Norway. The diagnostic accuracy of the Whooley questions was examined across different EPDS thresholds and compared to the measures of related constructs, including symptoms of childbirth-related post-traumatic stress disorder (PTSD) and anxiety.

Material and methods: Cross-sectional data were collected through an online questionnaire by postpartum women (0-52 weeks postpartum), recruited via social media, well-baby clinics, and other locations frequently visited by postpartum women. In total, 1154 women participated. The diagnostic accuracy of the Whooley questions was compared to three commonly used EPDS cutoffs (≥10, ≥12, and ≥13).

Results: The sensitivity of the Whooley questions relative to the EPDS was high and increased with higher thresholds for defining depression, correctly identifying 89% (EPDS ≥10), 96% (EPDS ≥12), and 97% (EPDS ≥13) of cases. Specificity was somewhat lower, at 0.82 (EPDS ≥10), 0.77 (EPDS ≥12), and 0.75 (EPDS ≥13). Positive predictive values were low, whereas negative predictive values were excellent, ranging from 0.97 (EPDS ≥10), through 0.99 (EPDS ≥12) to 1.00 (EPDS ≥13), increasing with higher thresholds. Convergent and divergent validity were supported by strong correlations with EPDS scores and moderate correlations with symptoms of childbirth-related PTSD and anxiety.

Conclusions: The Norwegian version of the Whooley questions demonstrates strong psychometric properties, supporting their usefulness as a case-finding tool for depression among postnatal women.

Introduction: Atypical placental site nodule (APSN) is a rare diagnosis, representing remnants of a previous pregnancy and extravillous trophoblast tissue. These lesions are potential precursor lesions to rare forms of Gestational trophoblastic neoplasia (GTN). Recent data suggest up to a 15% risk of malignancy occurring either concurrently or manifesting within a few months of diagnosis. These patients are often young with future fertility considerations. Prognosis, treatment, and clinical follow-up of APSN cases currently remain a matter of debate. This study aimed to address and explore some of these issues.

Material and methods: Retrospective case series analysis was performed between 1st January 2000 and 31st December 2023 at the Sheffield Trophoblastic Disease Centre, Sheffield, UK. Patients on conservative management were asked at routine follow-up telephone consultations if they would consider a completion hysterectomy in light of the risk of progression to GTN.

Results: Twenty-two cases of APSN were registered, of which 10 (45%) received surgical management. Two (20%) cases were incidentally diagnosed following total abdominal hysterectomy (TAH) for other indications and eight (80%) had a TAH within twelve months of their initial diagnosis as part of primary management. None had histological evidence of GTN. Of the twelve (55%) patients initially opting primarily for conservative management, three (25%) decided to have a TAH performed based on the current evidence for risk of malignant transformation, eight (67%) indicated they would have a TAH based on advice from the center, and one (8%) was uncertain. No patients were diagnosed with GTN.

Conclusions: In this study, we found no evidence of malignant transformation in our patients, which conflicts with other published data conferring an 11%-14% risk of malignant transformation. An international consensus opinion needs to be reached within the Gestational trophoblastic community regarding the optimal advice, management, and follow-up regimens for patients diagnosed with APSN.

Introduction: Infertility is a common reproductive health issue, associated with increased risks of pregnancy complications. However, shared underlying risk factors such as age, BMI, PCOS, endometriosis, and lifestyle may partly explain these associations. In a population-based cohort of women, this study aimed to determine whether a history of fertility problems is independently associated with adverse pregnancy and birth outcomes, including gestational diabetes, hypertensive disorders of pregnancy, low birthweight, and preterm birth.

Material and methods: This was a secondary analysis of data from the 1973 to 1978 cohort of the Australian Longitudinal Study on Women's Health, that included surveys from 2003 to 2018 (n = 9854). We examined associations between self-reported fertility problems and four adverse outcomes: gestational diabetes, hypertensive disorders of pregnancy, low birthweight, and preterm birth. Generalized estimating equations with an exchangeable correlation structure were used, with sequential adjustment for socio-demographic, health, and lifestyle-related characteristics.

Results: Among 5653 women who reported a live birth, 897 (15.9%) reported a history of fertility problems, of whom 71.6% had sought help. After adjusting for socio-demographic factors alone, there was a statistically significant increased risk of adverse pregnancy outcomes for women with a history of fertility problems compared to those without. However, after further adjustment for health characteristics and pregnancy-related variables, the associations were no longer statistically significant: gestational diabetes [Relative risk (RR): 0.98; 95% confidence interval (CI) (0.78 to 1.22)], hypertensive disorders of pregnancy [RR: 1.08; 95% CI (0.82 to 1.43)], preterm birth [RR: 1.01; 95% CI (0.81 to 1.26)], or low birthweight [RR: 1.04; 95% CI (0.80 to 1.34)].

Conclusions: In this large cohort of women in Australian, initial associations between fertility problems and adverse pregnancy outcomes were attenuated after adjustment for key health and lifestyle factors. The absence of associations in fully adjusted models suggests that previously reported risks may reflect shared underlying maternal characteristics rather than infertility itself and highlights the importance of cautious interpretation of statistical significance in large observational studies.

Introduction: The prevalence of unexplained recurrent implantation failure (RIF) is reported as 2%-15% in the literature. The variation in prevalence reflects the heterogeneity in definition. Recent work has suggested unexplained RIF is unlikely to be endometrial or cycle synchronicity related but is, in fact, an embryological phenomenon. The most likely embryological phenomenon is aneuploidy. Preimplantation genetic testing for aneuploidy (PGT-A) has proven to reduce miscarriage rates in almost all infertility patients, including those with recurrent pregnancy loss, suggesting aneuploidy plays an important role in unsuccessful in vitro fertilization. No guidance for PGT-A use in RIF exists. This review aimed to address this evidence gap.

Material and methods: A systematic search of Medline, Embase, Web of Science, CINAHL, and Cochrane Database from inception until November 2024 was undertaken. Selection criteria included experimental and observational studies comparing euploid blastocyst transfer using PGT-A to standard care. The population included those with RIF or undergoing a minimum of three transfers. The primary outcome was cumulative live birth rate (CLBR). The primary aim of this review is to evaluate the impact of PGT-A on live birth rate (LBR) following a diagnosis of RIF. The secondary aim was to estimate the true prevalence of RIF, using a definition of three failed cycles. A random effects meta-analysis was conducted reporting pooled odds ratios between groups using IBM SPSS v29.0.2.0 (20). The review was prospectively registered on PROSPERO:CRD42024580037.

Results: A total of 13 studies were included with low-to-moderate risk of bias. Eleven studies addressed PGT-A after an RIF diagnosis while two studies addressed RIF prevalence after successive PGT-A cycles. Four studies reported a statistically significant increase in CLBR with OR 4.23 [95% CI: 2.14, 8.38]. Similar results were seen in studies reporting a single embryo transfer using PGT-A following an RIF diagnosis, OR 2.79 [95% CI: 1.90, 4.10].

Conclusions: PGT-A results in a statistically significant increase in both LBR per embryo transfer and CLBR per cycle. This finding supports the hypothesis that RIF may be an embryological phenomenon. Further research is required before routine recommendation of PGT-A for the management of RIF can be inferred.

Introduction: We aimed to evaluate perinatal outcomes in triplet pregnancies and compare outcomes between pregnancies managed expectantly and those undergoing fetal reduction.

Material and methods: This retrospective study included triplet pregnancies confirmed by ultrasound at Asan Medical Center between January 2020 and May 2025. Pregnancies were classified into an expectant management group or a fetal reduction group (reduction to twins or a singleton). Maternal characteristics, obstetric complications, and perinatal outcomes were compared. Within the fetal reduction group, outcomes were further analyzed by indication-multifetal pregnancy reduction versus selective fetal termination-and method-intracardiac injection versus radiofrequency ablation.

Results: A total of 208 triplet pregnancies were included; 133 (63.9%) were managed expectantly, and 75 (36.1%) underwent fetal reduction. In the expectant management group, the mean gestational age at delivery was 33.2 weeks, with preterm birth before 32 weeks in 21.6%, and neonatal intensive care unit (NICU) admission in 76.7%. Fetal loss of at least one fetus before 24 weeks occurred in 7.8%, and the incidence of nonviable pregnancy loss was 2.3%. Compared with expectant management, the fetal reduction group demonstrated more favorable perinatal outcomes, including higher Apgar scores and lower rates of oxygen therapy (18.4% vs. 50.2%, p < 0.0001) and NICU admission (34.6% vs. 76.7%, p < 0.0001). No nonviable pregnancy loss or stillbirth occurred after reduction, whereas both were observed in the expectant group. Survival rates were similarly high in both groups (100% vs. 98.4%). Within the reduction group, outcomes did not differ significantly by indication or procedure type.

Conclusions: Triplet pregnancies carry significant maternal and neonatal risks. Fetal reduction appears safe and may improve perinatal outcomes by extending gestation. These findings individualized prenatal counseling and management strategies for triplet pregnancies.

Introduction: Gestational diabetes mellitus (GDM) is associated with adverse outcomes in both pregnancy and the postpartum period. Although placental pathology has been extensively studied in relation to neonatal complications, its relevance to maternal health after delivery remains less well defined. This study aimed to compare gross and histologic placental features between GDM and normoglycemic pregnancies according to the Amsterdam Placental Workshop Group Consensus Statement. It also evaluated associations between specific placental lesions and both neonatal outcomes and maternal dysglycemia at 6 weeks postpartum in the GDM cohort.

Material and methods: This prospective observational cohort study included 200 women with GDM and 100 normoglycemic women who delivered at term. Placental examination comprised gross and histologic evaluation of lesions classified according to the Amsterdam criteria, including maternal and fetal vascular malperfusion, as well as commonly reported non-classified lesions such as chorangiosis and delayed villous maturation (DVM). Neonatal outcomes assessed were large-for-gestational-age status, low 1-min Apgar scores (<7), and neonatal hypoglycemia. Postpartum maternal dysglycemia at 6 weeks was assessed using a 75-g, 2-h oral glucose tolerance test and classified as prediabetes or type 2 diabetes mellitus. Associations were evaluated using logistic regression analysis.

Results: Placental lesions were significantly more common in GDM than in normoglycemic pregnancies. These included maternal vascular malperfusion (67.5% vs. 39.0%, p < 0.001), fetal vascular malperfusion (49.0% vs. 22.0%, p < 0.001), chorangiosis (51.0% vs. 11.0%, p < 0.001), and DVM (17.0% vs. 8.0%, p = 0.034). DVM was independently associated with large-for-gestational-age infants (adjusted odds ratio [aOR] = 2.54, 95% confidence interval [CI] = 1.03-6.24) and low 1-min Apgar scores (aOR = 4.59, 95% CI = 1.08-19.63). Chorangiosis was independently associated with maternal dysglycemia at 6 weeks postpartum (aOR = 2.33, 95% CI = 1.07-5.07), an association primarily driven by prediabetes (aOR = 2.74, 95% CI = 1.22-6.15). Gross placental measurements did not differ significantly between groups.

Conclusions: GDM is associated with various placental abnormalities, including Amsterdam-classified and non-classified lesions. DVM was associated with adverse neonatal outcomes, whereas chorangiosis was associated with postpartum dysglycemia. Systematic placental examination may aid in identifying women at risk of future metabolic disease.

Introduction: Data with a high level of evidence is lacking on the use of prophylactic uterotonic drug following vaginal delivery to prevent postpartum hemorrhage (PPH) among women who were considered high-risk for PPH. Our main objective was to compare the effectiveness of prophylactic carbetocin versus oxytocin in preventing PPH after vaginal delivery among women at high risk.

Material and methods: We conducted a retrospective before-and-after single-center comparative study, including all high-risk women after vaginal births. Two consecutive 14-month periods were compared, where the prophylactic methods to prevent PPH differed: oxytocin (5 IU IV) versus carbetocin (100 μg IV) given immediately after vaginal delivery. High-risk women were defined by at least one of the following criteria: previous PPH (blood loss ≥500 mL), antenatal suspicion of macrosomia (estimated fetal weight >90th p), twin pregnancy, repeated cervical ripening methods, polyhydramnios, multiparity (≥4), and rapid labor (<2 h) without analgesia. The primary outcome was PPH. Secondary outcomes included severe PPH (blood loss ≥1000 mL), second-line uterotonic agents, surgical hemostatic procedures, uterine artery embolization, and maternal morbidity. Groups were matched 1:1 by risk criteria. Outcomes were assessed using univariate analysis, multivariable logistic regression, and propensity score adjustment.

Results: A total of 754 women (377 per group) were included. Maternal and labor characteristics were comparable. Rates of PPH and severe PPH were similar with carbetocin versus oxytocin (7.4% vs. 9.3%, p = 0.36; 2.9% vs. 2.7%, p = 0.83). The need for second-line uterotonics (additional oxytocin and/or sulprostone) was significantly lower with carbetocin (3.7% vs. 12.2%, p < 0.001). Other secondary outcomes did not differ. After adjustment for potential confounders (history of PPH, BMI, intrapartum fever), prophylactic carbetocin was not associated with increased risk of PPH (aOR = 1.85, 95% CI [0.97 to 3.57]). Propensity score analysis confirmed these findings (aOR = 1.33, 95% CI [0.74 to 1.72]).

Conclusions: Prophylactic carbetocin was associated with a similar rate of PPH in high-risk women after vaginal delivery, compared with oxytocin, but significantly reduced the use of oxytocin when carbetocin was used as the first-line agent, although there was no difference in the use of prostaglandins or invasive procedures to manage persistent PPH.

Introduction: The aim was to explore how women in Sweden report use of pornography and how they perceive the impact of pornography on their own sexuality and that of others, particularly in relation to sexual consent.

Material and methods: This cross-sectional study included 557 women visiting a gynecological clinic for contraceptive counseling in 2023. A mixed-methods approach was used, combining quantitative and qualitative analyses.

Results: Three quarters of women (78%, n = 431) reported having used pornography at least once. Among users, 73% used pornography less than once a month, 20% monthly, and 7% weekly or daily. Participants were more likely to report that others' sexual behavior was influenced by pornography than their own. Thematic analysis of open-ended answers identified several key perceived effects of pornography, including the creation of unrealistic expectations, impacts on relational intimacy, reinforcement of unattainable beauty standards, normalization of non-consensual acts and harmful gender roles, as well as its role in sexual discovery. Regarding sexual consent, 63% reported being asked for consent during their most recent sexual encounter, although 98% affirmed having experienced consent on that occasion. Overall, pornography users were less likely to have been asked for consent as compared to non-users (p = 0.03), and regular pornography users were more likely to report not experiencing consent during the latest sexual encounter (p = 0.03) as compared to non-regular users.

Conclusions: Based on the thematic analysis, use of pornography had the potential to influence perceptions of sexuality and intimacy, with both positive and negative aspects. Additionally, pornography use was associated with a decreased likelihood of sexual consent. Considering Sweden's sexual education programs and the Consent Law (2018), these findings highlight the need to integrate pornography literacy into sexual education.

Introduction: In women with a regular cycle, reliable last menstrual period (LMP), and accurate crown-rump length (CRL) estimation, discrepancies in estimated date of delivery (EDD) may indicate impaired fetal growth and increased risk of morbidity. This study examines whether discrepancies between EDD based on LMP (EDD_LMP) and CRL (EDD_CRL) are associated with chromosomal aberrations, adverse pregnancy outcomes, and obstetric complications.

Material and methods: A Danish nationwide register-based cohort study including all singleton pregnancies with both CRL and LMP registered between 2008 and 2018. Exclusion criteria were uncertain LMP, irregular menstrual cycle, EDD discrepancies >±28 days, assisted reproductive technology, and missing outcome data. The cohort was stratified into seven groups according to EDD_LMP-EDD_CRL discrepancy. Negative discrepancies indicated smaller-than-expected CRL, positive discrepancies indicated larger-than-expected CRL, and ±3 days served as reference. Outcomes included chromosomal aberrations, major structural malformations, pregnancy loss, termination of pregnancy, fetal growth restriction, preterm birth, and obstetric complications (preeclampsia, preterm pre-labour rupture of membranes, placenta previa, and placental abruption). Prevalence with 95% confidence intervals and adjusted odds ratios (aOR) were calculated.

Results: A total of 262 329 pregnancies were included; 16% had smaller and 21% had larger CRL than expected from LMP. Negative discrepancies were significantly associated with increased risk of chromosomal aberrations, adverse pregnancy outcomes, and obstetric complications. In the -8 to -14 days group, 1.28% had a chromosomal abnormality (aOR 2.77 [95% CI 2.30-3.31]), and risk remained elevated among pregnancies at low combined first-trimester screening risk (aOR 1.95 [1.55-2.43]). For triploidy and trisomy 18, 91% and 59% of cases, respectively, had discrepancies of <-3 days. In the -8 to -14 days group, adverse pregnancy outcome occurred in 11.0% (aOR 1.49 [1.40-1.59]), and 6.5% had obstetric complications, mainly preeclampsia (aOR 1.19 [1.10-1.29]). Conversely, positive discrepancies were associated with reduced risk of chromosomal abnormalities (aOR 0.67 [0.44-0.96]) and adverse pregnancy outcomes (aOR 0.77 [0.69-0.86]) in the +8 to +14 days group.

Conclusions: A smaller than expected CRL was strongly associated with chromosomal aberrations, adverse pregnancy outcomes, and obstetric complications. Incorporating EDD discrepancies into risk algorithms for genetic disease, growth restriction, and preeclampsia may improve prediction and warrants further study.