Acta Obstetricia et Gynecologica Scandinavica最新文献

Introduction: Reports indicate that up to 60% of pregnant women in Ireland consume alcohol and Ireland may have the third highest prevalence of fetal alcohol syndrome in the world. We sought objective evidence of alcohol intake and the acceptability of urinary alcohol screening.

Material and methods: This was a multicenter, prospective study conducted at one urban and two semirural maternity units. Pregnant women at their first visit (≈13 weeks gestation) were invited to participate. Urinary samples were obtained with individual consent. Samples were anonymized and tested for alcohol and ethyl glucuronide at a central laboratory. The rate of sample positivity for ethanol (at a cut-off of 30 mg/dL) and ethyl glucuronide (at a cut-off of 500 ng/mL) was reported. The percentage of women consenting to testing was recorded. Results were compared with previous questionnaire or interview-based studies.

Results: One thousand fifty-three urine samples were analyzed. None tested positive for ethanol but 4/1053 (0.38%) contained ethyl glucuronide. Three samples were positive in the urban cohort, 3/730 (0.41%) and 1/323 (0.31%) in the semirural centers. Consent was obtained in 96% and 98% in two semirural centers compared to 78% in the urban center (565/722 vs. 323/336. p < 0.01). Acceptability in the urban center depended on who requested consent and varied between 65% and 100% (p < 0.01). Consent to participate was significantly higher and detected alcohol use was significantly lower than in previous, interview or questionnaire-based studies.

Conclusions: Alcohol intake appears to be much less common than previously estimated. The consent rates for urinary alcohol testing are high and are influenced by who is requesting consent.

Introduction: We aimed to assess the safety of continuous uterus-preserving treatment among patients with endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) who gave birth after progestin-based fertility-sparing treatment (FST).

Material and methods: From January 2005 to June 2020, we conducted a retrospective cohort study at Peking University People's Hospital, China, comprising 212 patients with EC or AEH who underwent FST. The participants were categorized into two groups based on the reproductive outcome of live birth. Risk factors were analyzed for disease recurrence in the entire cohort, and additional analysis was conducted on postpartum recurrence specifically in the live birth group.

Results: Of 212 eligible patients, 73 had a live birth, and 139 did not have a live birth after FST. Multivariable Cox analysis showed that live birth significantly reduced the risk of disease recurrence (HR 0.326, p = 0.011), while insulin resistance was identified as an adverse factor (HR 3.216, p = 0.014). Except for two patients who underwent hysterectomy, among 71 patients undergoing uterus preservation after live birth, five (7%) patients experienced disease relapse (two EC and three AEH) after a median follow-up of 26 (11, 47.5) months. Four out of these five patients with recurrence achieved a complete response after a second round of FST. Eight other patients (11.3%) experienced hyperplasia without atypical (EH) after live birth. Potential risk factors for postpartum recurrence of EC/AEH included irregular menstruation (80% vs. 39%; p = 0.153), abnormal ultrasonographic findings (60% vs. 18.6%; p = 0.065), and increased endometrial thickness (0.82 cm vs. 0.55 cm; p = 0.017). While postpartum maintenance therapy was identified as a protective factor against recurrence (0% vs. 62.5%; p = 0.012). Notably, patients with postpartum recurrence may achieve a complete response with repeat FST.

Conclusions: Although live birth was associated with improved recurrence-free survival in patients with EC or AEH receiving FST, postpartum recurrence remains a concern. Irregular menstruation and abnormal ultrasound findings were identified as key risk factors for recurrence, while maintenance therapy exhibited a protective effect. These findings highlight the need for vigilant postpartum monitoring in this population.

Introduction: Endometriosis is a heterogeneous pain condition with variable symptom expression. Abuse history has been associated with amplified pain, gastrointestinal symptoms, and central sensitization in varying populations; however, whether these effects are compounded in patients with endometriosis and their intersection has not been well studied. Understanding these associations is clinically relevant, as unrecognized psychosocial contributors may compound diagnostic delay and hinder individualized treatment.

Material and methods: In this retrospective cohort study at a tertiary referral center, 235 patients presenting for pelvic pain evaluation (2018-2023) were stratified into four groups according to endometriosis identified on expert transvaginal ultrasound and self-reported abuse history. Ultrasound examinations followed IDEA consensus standards, with validated accuracy at our site for deep and ovarian endometriosis (site sensitivities 85%-100%, specificities ≥97%). Symptoms were assessed using validated measures: visual analog scales for chronic pelvic pain, the Central Sensitization Inventory (CSI), the Gastrointestinal Quality of Life Index (GIQLI), and the Female Sexual Function Index (FSFI). Primary outcomes were pain intensity, central sensitization, and GIQLI scores; secondary outcomes included prevalence of specific GI symptoms and sexual function. Group comparisons used nonparametric and Chi-squared tests with Bonferroni correction.

Results: Participants with both endometriosis and an abuse history reported significantly higher chronic pelvic pain (p = 0.006, η² = 0.07, 95% CI: 0.02-0.12), greater CSI scores (p = 0.027, η² = 0.04, 95% CI: 0.01-0.09), and lower GIQLI scores (p = 0.010, η² = 0.05, 95% CI: 0.01-0.10) compared with other groups. Nausea (p < 0.001) and bloating (p = 0.008) were also more prevalent in this subgroup. No significant differences were observed for dysmenorrhea, dyspareunia, or FSFI scores (p = 0.091).

Conclusions: A combined history of endometriosis and abuse was associated with a high symptom burden characterized by pain amplification, GI distress, and central sensitization. These findings underscore the importance of early psychosocial screening and trauma-informed care as complements to biomedical management in endometriosis. Prospective studies incorporating validated trauma measures and treatment covariates are warranted to clarify mechanisms and inform multidisciplinary care.

Introduction: Severe fear of childbirth (FOC) during pregnancy holds significant implications for maternal mental health, decisions about mode of birth, and potentially infant development. Until recently, there were no tools available to measure FOC within a UK population that assessed the full construct using acceptable phraseology. A new tool, the Fear of Childbirth Questionnaire, has been developed but requires full psychometric evaluation. This study aimed to assess the validity and reliability of the Fear of Childbirth Questionnaire and examine possible threshold scores indicating clinical severity.

Material and methods: Pregnant women (N = 540) completed the Fear of Childbirth Questionnaire online alongside additional measures for current/previous obstetric history, anxiety, and depression to test dimensions of validity (ISRCTN62032021). Most women (N = 360) then completed the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders 5th Edition (Research Version) Module F (phobia) with trained interviewers over the telephone. Sensitivity and specificity were calculated. A subsample (N = 61) repeated Fear of Childbirth Questionnaire completion 2 weeks later to inform test-retest reliability. Internal consistency, validity (convergent, discriminant, and criterion-related), unidimensionality, and factor structure were examined.

Results: Internal consistency was excellent (α = 0.89; ω = 0.89) and test-retest reliability was good (r = 0.87). Strong association with the Fear of Birth Scale (r = 0.69) indicated convergent validity. Discriminant validity was indicated via moderate correlations with general measures for anxiety (r = 0.40-0.53), and less so with those of depression (r = 0.35). Scores were higher for those with current/previous mental health difficulties, previous birth trauma, those preferring an epidural, and those preferring a planned cesarean section, indicative of criterion-related validity. An optimal cut-off value of ≥33 total score and ≥4 current impact score is recommended to initiate further exploration of support/intervention needs (ROC Area under the curve = 0.80, 95% CI 0.75:0.85; sensitivity 71.9, specificity 85.4, positive predictive value 39.0, negative predictive value 95.9).

Conclusions: The Fear of Childbirth Questionnaire is psychometrically robust and can identify FOC at levels commensurate with a clinical phobia. It is the only tool purposefully developed and clinically validated to identify FOC in a UK population.

Introduction: Ultrasound assessment of superficial endometriosis (SE) is difficult, and it is still mainly diagnosed via surgery. We hypothesized that a thickening of the subperitoneal layer of tissue overlying the anterior pouch of Douglas (POD), labeled the "White line sign" (WLS), could indicate the presence of SE. The aim of the study was to investigate the association between the WLS and the finding of endometriosis at histology.

Material and methods: This prospective diagnostic accuracy study included 100 premenopausal women with chronic pelvic pain who underwent transvaginal ultrasound (TVS) by a single expert operator and subsequent laparoscopy by a specialist surgeon between January 2021 and January 2023. To assess intra- and inter-observer reproducibility of the WLS, 36 consecutive ultrasound scans were recorded and re-evaluated 6 months later by the first operator and an independent, second operator, both blinded to the original and each other's findings. Outcomes of interest were the diagnostic accuracy of the WLS for predicting the presence of SE and deep endometriosis (DE) at histopathology, and the reproducibility of the WLS at TVS. The former was assessed by calculating specificity, sensitivity, and accuracy, and the latter by determining proportions of agreement and Cohen's kappa coefficient (κ), respectively.

Results: The WLS had high specificity [100% (95% CI, 2.5-100%)], but low sensitivity and accuracy for the detection of SE [30.6% (95% CI, 20.2-42.5%) and 31.5% (95% CI, 21.1-43.4%)], respectively. The WLS was highly sensitive, specific, and accurate for the identification of DE [79.7% (95% CI, 67.8-88.7%), 100% (95% CI, 66.4-100%), and 82.2% (95% CI, 71.5-90.2%)], respectively. The WLS was reproducible, demonstrated by good inter- and intra-rater agreement and reliability for its diagnosis on TVS [proportions of agreement 0.86 (95% CI, 0.69-0.95) and 0.83 (95% CI, 0.66-0.93), κ 0.72 (95% CI 0.49-0.94) and 0.64 (95% CI, 0.38-0.89)], respectively.

Conclusions: Our study demonstrated that the WLS could be a valuable soft marker of both SE and DE. This is particularly useful in cases where no other or only subtle signs of endometriosis are present on scan.

Introduction: Our objective was to develop a Core Outcome Set for Research on Critically Ill Obstetric Patients (COSCO) through international consensus, with the aim of improving consistency, comparability, and clinical relevance across studies involving this population.

Material and methods: This international, multi-method study was conducted between February 16, 2023, and January 18, 2024. The process included a two-round online Delphi survey, three small group discussions, and a final consensus meeting. Participants comprised health service users (HSUs) with lived experience of critical illness during pregnancy and healthcare professionals from diverse specialties and geographic regions.

Results: Sixty-eight participants (11 HSUs and 57 healthcare professionals) from 16 countries scored 23 candidate items identified through a systematic review and qualitative interviews. Through consensus, 10 core outcomes and 7 reporting checklist items were selected for inclusion in all research on critical illness in obstetrics. Core outcomes included maternal all-cause mortality; cardiac arrest and the need for cardiopulmonary resuscitation (not resulting in death); severe (maternal) organ dysfunction; length of stay in the intensive care unit (ICU) and total hospital stay; readmission to hospital or ICU or repeated hospital/emergency department visits following discharge from ICU; presence of a new medical condition at the time of discharge from hospital, which was not present at the time of admission to the hospital; permanent infertility as a consequence of critical illness or intervention; perinatal loss; severe neonatal morbidity requiring prolonged neonatal ICU admission; and gestational age/preterm birth. Four additional noncore outcomes were identified as important but may be challenging to measure consistently; these should be reported when relevant and feasible.

Conclusions: COSCO provides a standardized, consensus-based framework for outcome reporting in research on critically ill obstetric patients. Its adoption will strengthen methodological rigor, reduce reporting heterogeneity, enhance comparability across studies, and support evidence-based, patient-centered guideline development.

Introduction: Hydronephrosis, commonly detected during second trimester ultrasound screenings, can signal underlying renal abnormalities. In 2018, Sweden introduced a national guideline recommending follow-up for fetal renal pelves with an anteroposterior diameter (APD) ≥6 mm at the second trimester ultrasound. This study evaluates the impact of the guideline by assessing the incidence and resolution of hydronephrosis and other renal abnormalities. Secondary outcomes included postnatal renal function, frequency of febrile urinary tract infections (UTI), and the need for surgical intervention before the age of 2.

Material and methods: This prospective cohort study included fetuses diagnosed with hydronephrosis or other renal abnormalities during second trimester ultrasounds between November 2019 and October 2022. Maternal and child characteristics were compared with data from the Swedish Pregnancy Register. Pre- and postnatal outcomes up to 2 years of age were assessed for fetuses detected antenatally. Outcomes were compared to children diagnosed postnatally within the first 2 years of life and not identified prenatally.

Results: Over 3 years, 31 094 second trimester ultrasounds were performed. Hydronephrosis or other renal anomalies were identified in 0.5% (n = 155); approximately 40% resolved by week 32, and seven additional third-trimester detections brought the total number of antenatal cases to 162. By age 2, only 42% had persistent renal abnormalities. A retrospective ICD-10 review identified 45 additional children diagnosed postnatally following symptoms before age 2, yielding an antenatal detection rate of 78.3% (162/207). Baseline demographics were similar between antenatal and postnatal groups and matched those in the Swedish Pregnancy Register. Antenatally detected cases showed diverse anomalies-primarily multicystic dysplastic kidney, duplex kidney, pelviureteric junction obstruction, and vesicoureteral reflux (VUR)-whereas postnatally detected cases were predominantly VUR. Febrile UTI requiring admission occurred in 11.8% of antenatal versus 71.7% of postnatal children (p < 0.0001); surgery rates were similar between groups.

Conclusions: The centralized structure of care enabled a comprehensive, population-based cohort with near-complete follow-up. The detection rate of hydronephrosis during second trimester ultrasound is high, reaching ~80%. Given the high rate of spontaneous resolution, the national guideline threshold (APD ≥6 mm) appears to strike a reasonable balance between sensitivity and clinical practicality.

Introduction: It is well known that urinary tract infection (UTI) during pregnancy is associated with preterm birth, but information about the risk of preterm birth depending on gestational week of infection is sparingly described in the literature.

Material and methods: An observational study based on data from Swedish registers including women giving birth 2014-2020 (n = 684 595). Pregnant women with UTI diagnosis were identified by the ICD-10 codes (O230-O239, N300, N309, and N390) from the national patient registry. Hazard ratios (HR) for preterm birth after UTI diagnosis were calculated, considering the time elapsed after infection and interactions with gestational week at UTI diagnosis. Adjustments were made for maternal age, parity, previous caesarean section, body mass index, diabetes, and smoking.

Results: A diagnosis of UTI was detected in 2.8% of pregnant women. A significant association between UTI diagnosis and preterm birth was found. The aHR for preterm birth was most pronounced during the first week after a UTI diagnosis and was dependent on gestational week. The aHRs (with 95% CI) for preterm birth 0-6 days after UTI diagnosis were 18.5 (13.5-25.4), 13.5 (10.4-17.6), and 6.7 (5.6-8.0) for infections debuting week 22-27, 28-31, and 32-36, respectively. The corresponding aHRs for preterm birth 7-13 days after UTI diagnosis were 10.5 (7.2-15.2), 3.7 (2.4-5.7), and 2.9 (1.9-4.5). The increased risk for preterm birth was still significant 3 weeks or more after UTI diagnosis debuting at 22-27 weeks (aHR 2.5; 95% CI: 2.1-3.1) or at 28-31 weeks (aHR 3.2; 95% CI 2.0-4.6).

Conclusions: UTI diagnosis during pregnancy is an important risk factor for preterm birth. The magnitude of the increased risk is highest 0-6 days after diagnosis; thereafter, it declines but remains significant throughout pregnancy until 37 weeks. The increased risk is especially elevated (and especially concerning) if UTI diagnosis was confirmed before 28 weeks of gestation.

Introduction: Despite mounting evidence on Long COVID, data regarding its impact on women infected during pregnancy remains scarce. This study aimed to assess the development of Long COVID in women who had been infected with SARS-CoV-2 during pregnancy, focusing on possible risk factors and potential protective elements associated with its development.

Material and methods: We analyzed a cohort of 348 pregnant women with laboratory-confirmed SARS-CoV-2 infection admitted to ASST-Spedali Civili (Brescia, Italy) between March 2020 and May 2022. Data collection included demographics, comorbidities, COVID-19 severity markers, and vaccination status. To assess the possible association between the analyzed risk factors and Long Covid, beyond standard multivariable models, we employed inverse probability weighting techniques (IPTW) and calculated e-values to assess unmeasured confounding.

Results: Among study participants, 27.0% (94/348) developed Long COVID. Risk factors included preexisting respiratory comorbidities (adjusted OR = 3.171, 95% CI 0.99-10.1), pneumonia at admission (adjusted OR = 4.48, 95% CI 2.16-9.28), and earlier pregnancy stage at infection (adjusted OR = 0.96 per week, 95% CI 0.93-0.99). COVID-19 vaccination was associated with a significantly lower risk of Long COVID (15.5% in vaccinated vs. 31.8% in unvaccinated women; IPTW-adjusted OR = 0.38, 95% CI: 0.20-0.71, p-value: 0.003). The most common symptoms were fatigue (46.8%) and memory impairment (38.3%), with unvaccinated patients exhibiting a higher prevalence of neuropsychiatric symptoms.

Conclusions: Our data suggest that one in four pregnant women hospitalized with COVID-19 develop persistent symptoms. The most frequently affected women had preexisting respiratory disease, pneumonia at admission, and infection earlier in pregnancy. COVID-19 vaccination appears to reduce risk and alter symptom presentation. These findings underscore the importance of vaccination throughout pregnancy and highlight the need for targeted surveillance in high-risk subgroups.