Ingrid Kverndalen Frisch, Trond Melbye Michelsen, Tove Lekva, Marie Cecilie Paasche Roland, Ane Cecilie Westerberg
Introduction
Adhesion molecules are markers of endothelial activation, and they are involved in placentation and inflammation. We compared levels of vascular cell adhesion molecule-1 (VCAM1), intercellular adhesion molecule-1 (ICAM1), and E-selectin (SELE) in maternal and fetal vessels of preeclampsia and healthy pregnancies. Furthermore, we investigated if the placenta releases adhesion molecules.
Material and Methods
Blood was sampled from three maternal (antecubital vein, uterine vein, and radial artery as a proxy for the uterine artery) and two fetal vessels (umbilical vein and artery) in 75 healthy pregnancies and 37 cases of preeclampsia undergoing cesarean delivery. Samples were also collected among 70 healthy pregnancies and 35 preeclampsia cases at three visits (gestational weeks 14–16, 22–24, and 30–32) in a longitudinal cohort. Proteins were relatively quantified on SomaLogic's 5000-multiplex platform. Venoarterial differences on both sides of the placenta were used to indicate placental release and uptake.
Results
Before the onset of preeclampsia, we observed elevated maternal antecubital vein levels of VCAM1 (visits 1 and 3) and ICAM1 (all three visits). At delivery, VCAM1 and SELE were elevated in maternal vessels in preeclampsia compared to healthy, except for VCAM1 in the uterine vein. On the fetal side of the placenta, adhesion molecules were lower in preeclampsia compared to healthy pregnancies. There were no venoarterial differences on the maternal side of the placenta that indicated placental protein release. On the fetal side of the placenta, healthy controls had a positive venoarterial difference of SELE, indicating placental release to the fetus. VCAM1 and SELE levels were higher in fetal circulation as compared to maternal circulation in healthy pregnancies, whereas in preeclampsia, this was only the case for VCAM1. ICAM1 was higher in maternal than fetal circulation in healthy controls and preeclampsia.
Conclusions
Alterations in maternal levels of adhesion molecules were seen before the onset of PE. In preeclampsia, adhesion molecules were elevated in the maternal and lower in the fetal circulation. There was no placental release of the adhesion molecules to the mother, indicating a general systemic endothelial dysfunction. The results highlight new insights into the pathophysiology of preeclampsia that warrant further exploration.
{"title":"Adhesion molecules in the maternal–fetal interface in healthy pregnancies and preeclampsia","authors":"Ingrid Kverndalen Frisch, Trond Melbye Michelsen, Tove Lekva, Marie Cecilie Paasche Roland, Ane Cecilie Westerberg","doi":"10.1111/aogs.70111","DOIUrl":"10.1111/aogs.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Adhesion molecules are markers of endothelial activation, and they are involved in placentation and inflammation. We compared levels of vascular cell adhesion molecule-1 (VCAM1), intercellular adhesion molecule-1 (ICAM1), and E-selectin (SELE) in maternal and fetal vessels of preeclampsia and healthy pregnancies. Furthermore, we investigated if the placenta releases adhesion molecules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Blood was sampled from three maternal (antecubital vein, uterine vein, and radial artery as a proxy for the uterine artery) and two fetal vessels (umbilical vein and artery) in 75 healthy pregnancies and 37 cases of preeclampsia undergoing cesarean delivery. Samples were also collected among 70 healthy pregnancies and 35 preeclampsia cases at three visits (gestational weeks 14–16, 22–24, and 30–32) in a longitudinal cohort. Proteins were relatively quantified on SomaLogic's 5000-multiplex platform. Venoarterial differences on both sides of the placenta were used to indicate placental release and uptake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Before the onset of preeclampsia, we observed elevated maternal antecubital vein levels of VCAM1 (visits 1 and 3) and ICAM1 (all three visits). At delivery, VCAM1 and SELE were elevated in maternal vessels in preeclampsia compared to healthy, except for VCAM1 in the uterine vein. On the fetal side of the placenta, adhesion molecules were lower in preeclampsia compared to healthy pregnancies. There were no venoarterial differences on the maternal side of the placenta that indicated placental protein release. On the fetal side of the placenta, healthy controls had a positive venoarterial difference of SELE, indicating placental release to the fetus. VCAM1 and SELE levels were higher in fetal circulation as compared to maternal circulation in healthy pregnancies, whereas in preeclampsia, this was only the case for VCAM1. ICAM1 was higher in maternal than fetal circulation in healthy controls and preeclampsia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Alterations in maternal levels of adhesion molecules were seen before the onset of PE. In preeclampsia, adhesion molecules were elevated in the maternal and lower in the fetal circulation. There was no placental release of the adhesion molecules to the mother, indicating a general systemic endothelial dysfunction. The results highlight new insights into the pathophysiology of preeclampsia that warrant further exploration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"298-308"},"PeriodicalIF":3.1,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740652","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}
Hanne Sether Lilleberg, Franziska Siafarikas, Kari Bø, Marie Ellström Engh
Introduction: Perineal tears are classified into four degrees based on severity. Second-degree tears, which involve the muscles fusing into the perineal body, but not the anal sphincter, vary in extent and have recently been subcategorized. However, knowledge about their long-term anatomical impact on the perineal body remains limited, as postpartum evaluation has largely relied on inspection and palpation. This study aimed to examine the association between the severity of perineal tears not affecting the anal sphincter, diagnosed at delivery, and deviations in the muscles fusing into the perineal body, assessed by three-dimensional ultrasound 1 year after vaginal delivery.
Material and methods: This prospective cohort study included 384 primiparous women with vaginal deliveries at Akershus University Hospital, Norway, from January 2021 to July 2022. Perineal tears were classified and sutured according to international standards at delivery. In addition, second-degree tears were subclassified according to the percentage of the perineal body damage (<50% = 2A, ≥50% = 2B, entire perineal body without anal sphincter = 2C). Women with third- or fourth-degree tears were excluded. One year after delivery, participants underwent three-dimensional endovaginal and endoanal ultrasound examinations. The transverse perineal, puboperinealis, and puboanalis muscles were examined at their fusion into the perineal body. A deviation was defined as a muscle discontinuity or absence in at least one of the muscles.
Results: The proportion of women with sonographically detected muscle deviations increased with tear severity: 22% for first-degree (n = 24), 52.7% for 2A (n = 29), 60% for 2B (n = 21) and 86.2% for 2C (n = 25). Among women with episiotomies (n = 126), 60.6% had one or more muscle deviations. A higher number of muscles were affected in the 2C tear group compared to 2B and 2A.
Conclusion: Sonographic deviations in the muscles fusing into the perineal body increase with the severity of perineal tears.
{"title":"Severity of perineal tears and deviations in perineal body anatomy: A three-dimensional ultrasound study.","authors":"Hanne Sether Lilleberg, Franziska Siafarikas, Kari Bø, Marie Ellström Engh","doi":"10.1111/aogs.70114","DOIUrl":"https://doi.org/10.1111/aogs.70114","url":null,"abstract":"<p><strong>Introduction: </strong>Perineal tears are classified into four degrees based on severity. Second-degree tears, which involve the muscles fusing into the perineal body, but not the anal sphincter, vary in extent and have recently been subcategorized. However, knowledge about their long-term anatomical impact on the perineal body remains limited, as postpartum evaluation has largely relied on inspection and palpation. This study aimed to examine the association between the severity of perineal tears not affecting the anal sphincter, diagnosed at delivery, and deviations in the muscles fusing into the perineal body, assessed by three-dimensional ultrasound 1 year after vaginal delivery.</p><p><strong>Material and methods: </strong>This prospective cohort study included 384 primiparous women with vaginal deliveries at Akershus University Hospital, Norway, from January 2021 to July 2022. Perineal tears were classified and sutured according to international standards at delivery. In addition, second-degree tears were subclassified according to the percentage of the perineal body damage (<50% = 2A, ≥50% = 2B, entire perineal body without anal sphincter = 2C). Women with third- or fourth-degree tears were excluded. One year after delivery, participants underwent three-dimensional endovaginal and endoanal ultrasound examinations. The transverse perineal, puboperinealis, and puboanalis muscles were examined at their fusion into the perineal body. A deviation was defined as a muscle discontinuity or absence in at least one of the muscles.</p><p><strong>Results: </strong>The proportion of women with sonographically detected muscle deviations increased with tear severity: 22% for first-degree (n = 24), 52.7% for 2A (n = 29), 60% for 2B (n = 21) and 86.2% for 2C (n = 25). Among women with episiotomies (n = 126), 60.6% had one or more muscle deviations. A higher number of muscles were affected in the 2C tear group compared to 2B and 2A.</p><p><strong>Conclusion: </strong>Sonographic deviations in the muscles fusing into the perineal body increase with the severity of perineal tears.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712733","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}
Karin Heinonen, Terhi Saisto, Mika Gissler, Nanna Sarvilinna
Introduction
Brachial plexus injury (BPI) is one of the major complications associated with shoulder dystocia. This study aimed to identify risk factors for shoulder dystocia-related BPI (SD BPI) in the Finnish population.
Material and Methods
The study included all deliveries in the Hospital District of Helsinki and Uusimaa between 2006 and 2015 (n = 181 352). Singleton deliveries complicated by shoulder dystocia, BPI, and clavicle fracture were identified using ICD-10 codes O66.0, P13.4, P14.0, and P14.1 (n = 1708). Following a thorough review of medical records, 374 cases of BPI were identified, 259 of which were related to shoulder dystocia. The background-matched control group (n = 566) consisted of singleton deliveries without BPI.
Results
The incidences of both BPI with and without shoulder dystocia declined significantly during the study period, from 0.16% to 0.05% and from 0.09% to 0.03%, respectively. Multivariate analysis identified the following independent risk factors for SD BPI: birthweight ≥4000 g (adjusted odds ratio, aOR 15.3), maternal diabetes (aOR 4.0), vacuum extraction (aOR 3.7), and maternal height ≤160 cm (aOR 2.7). A predictive model based on these four risk factors demonstrated a positive predictive value of 48.2% and a negative predictive value of 92.9% for SD BPI cases. The odds of permanent BPI were 2.5-fold for cases associated with shoulder dystocia compared to those without. Antepartum and intrapartum variables were not predictive of permanent SD BPI. Among all BPI cases, 69.3% were associated with shoulder dystocia and 64.2% with birthweight ≥4000 g.
Conclusions
Birthweight ≥4000 g, maternal diabetes, height ≤160 cm, and vacuum extraction independently increased the risk of SD BPI. Notably, 14.7% of all BPI cases occurred in the absence of both shoulder dystocia and birthweight ≥4000 g.
{"title":"Risk factors for shoulder dystocia-related brachial plexus injuries: A case–control study","authors":"Karin Heinonen, Terhi Saisto, Mika Gissler, Nanna Sarvilinna","doi":"10.1111/aogs.70116","DOIUrl":"10.1111/aogs.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Brachial plexus injury (BPI) is one of the major complications associated with shoulder dystocia. This study aimed to identify risk factors for shoulder dystocia-related BPI (SD BPI) in the Finnish population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>The study included all deliveries in the Hospital District of Helsinki and Uusimaa between 2006 and 2015 (<i>n</i> = 181 352). Singleton deliveries complicated by shoulder dystocia, BPI, and clavicle fracture were identified using ICD-10 codes O66.0, P13.4, P14.0, and P14.1 (<i>n</i> = 1708). Following a thorough review of medical records, 374 cases of BPI were identified, 259 of which were related to shoulder dystocia. The background-matched control group (<i>n</i> = 566) consisted of singleton deliveries without BPI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidences of both BPI with and without shoulder dystocia declined significantly during the study period, from 0.16% to 0.05% and from 0.09% to 0.03%, respectively. Multivariate analysis identified the following independent risk factors for SD BPI: birthweight ≥4000 g (adjusted odds ratio, aOR 15.3), maternal diabetes (aOR 4.0), vacuum extraction (aOR 3.7), and maternal height ≤160 cm (aOR 2.7). A predictive model based on these four risk factors demonstrated a positive predictive value of 48.2% and a negative predictive value of 92.9% for SD BPI cases. The odds of permanent BPI were 2.5-fold for cases associated with shoulder dystocia compared to those without. Antepartum and intrapartum variables were not predictive of permanent SD BPI. Among all BPI cases, 69.3% were associated with shoulder dystocia and 64.2% with birthweight ≥4000 g.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Birthweight ≥4000 g, maternal diabetes, height ≤160 cm, and vacuum extraction independently increased the risk of SD BPI. Notably, 14.7% of all BPI cases occurred in the absence of both shoulder dystocia and birthweight ≥4000 g.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"336-345"},"PeriodicalIF":3.1,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712764","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}
We commend Lia et al. [1] for their innovative study introducing transperineal ultrasound (TPU) to measure the anteroposterior mid-pelvic diameter (AMD) in breech presentation. While the results are promising, several methodological issues undermine the validity of the predictive model and its clinical implications.
First, the multivariable logistic regression analysis risks severe overfitting. With only 17 events (intrapartum cesarean sections), including four variables—AMD, birthweight, head circumference, and obstetric conjugate (OC)—violates the standard of 10 events per variable. This low event-to-variable ratio (~4.25) likely inflates the effect size (adjusted odds ratio 0.25 per 1 cm AMD increase), rendering the model unreliable for clinical application, while established statistical guidelines recommend approximately 10 events per variable (EPV) to ensure the reliability of multivariable logistic regression models [2-5].
Second, the comparison of AMD's predictive performance (AUC 0.77) against traditional diameters such as the OC (AUC 0.60) is biased by study design. The OC was used as a criterion for offering vaginal birth (cutoff ≥ 12.0 cm), restricting its variability and artificially attenuating its predictive power. In contrast, AMD was not constrained, leading to an inequitable comparison that overstates AMD's superiority.
Furthermore, the clinical translation remains vague. Although Figure 5 suggests risk stratification by AMD quartiles, no actionable cutoff is proposed for patient counseling. The model's development without external validation or sample size justification limits its generalizability.
In conclusion, while TPU is a feasible tool, the study's statistical limitations necessitate cautious interpretation. We urge validation in a larger cohort with rigorous design to ensure robust, clinically relevant predictions before widespread adoption.
Medical Science and Technology Project of Zhejiang Province (No: 2024KY755).
We declare no competing interest.
我们赞扬Lia等人的创新研究，他们采用经会阴超声（TPU）来测量臀位骨盆前后正中直径（AMD）。虽然结果是有希望的，但几个方法学问题破坏了预测模型的有效性及其临床意义。首先，多变量logistic回归分析存在严重的过拟合风险。只有17个事件（产时剖宫产），包括四个变量——amd、出生体重、头围和产科妊娠（OC）——违反了每个变量10个事件的标准。这种低事件变量比（~4.25）可能会夸大效应大小（调整后的比值比为0.25 / 1 cm AMD增加），使模型不可靠，不适合临床应用，而已建立的统计指南建议每个变量（EPV）约10个事件，以确保多变量逻辑回归模型的可靠性[2-5]。其次，AMD的预测性能（AUC 0.77）与传统直径（如OC (AUC 0.60)）的比较因研究设计而存在偏差。OC被用作阴道分娩的标准（临界值≥12.0 cm），限制了其可变性并人为地削弱了其预测能力。相比之下，AMD没有受到约束，导致了不公平的比较，夸大了AMD的优势。此外，临床翻译仍然模糊不清。虽然图5显示了AMD四分位数的风险分层，但没有为患者咨询提出可行的截止值。该模型的发展没有外部验证或样本大小的证明限制了它的普遍性。总之，虽然TPU是一个可行的工具，但该研究的统计局限性需要谨慎解释。我们敦促在更大的队列中进行验证，并进行严格的设计，以确保在广泛采用之前进行稳健的临床相关预测。浙江省医学科技项目（No: 2024KY755）。我们声明没有竞争利益。
{"title":"Methodological concerns in the feasibility study on ultrasound pelvimetry for breech birth","authors":"Weizeng Chen, Xiaofang Xuan","doi":"10.1111/aogs.70118","DOIUrl":"10.1111/aogs.70118","url":null,"abstract":"<p>We commend Lia et al. [<span>1</span>] for their innovative study introducing transperineal ultrasound (TPU) to measure the anteroposterior mid-pelvic diameter (AMD) in breech presentation. While the results are promising, several methodological issues undermine the validity of the predictive model and its clinical implications.</p><p>First, the multivariable logistic regression analysis risks severe overfitting. With only 17 events (intrapartum cesarean sections), including four variables—AMD, birthweight, head circumference, and obstetric conjugate (OC)—violates the standard of 10 events per variable. This low event-to-variable ratio (~4.25) likely inflates the effect size (adjusted odds ratio 0.25 per 1 cm AMD increase), rendering the model unreliable for clinical application, while established statistical guidelines recommend approximately 10 events per variable (EPV) to ensure the reliability of multivariable logistic regression models [<span>2-5</span>].</p><p>Second, the comparison of AMD's predictive performance (AUC 0.77) against traditional diameters such as the OC (AUC 0.60) is biased by study design. The OC was used as a criterion for offering vaginal birth (cutoff ≥ 12.0 cm), restricting its variability and artificially attenuating its predictive power. In contrast, AMD was not constrained, leading to an inequitable comparison that overstates AMD's superiority.</p><p>Furthermore, the clinical translation remains vague. Although Figure 5 suggests risk stratification by AMD quartiles, no actionable cutoff is proposed for patient counseling. The model's development without external validation or sample size justification limits its generalizability.</p><p>In conclusion, while TPU is a feasible tool, the study's statistical limitations necessitate cautious interpretation. We urge validation in a larger cohort with rigorous design to ensure robust, clinically relevant predictions before widespread adoption.</p><p>Medical Science and Technology Project of Zhejiang Province (No: 2024KY755).</p><p>We declare no competing interest.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706954","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}
Linda Lindström, Olof Stephansson, Sven Cnattingius, Allen Wilcox, Michaela Granfors
Introduction
Small fetal size is the most important risk factor for stillbirth. To our knowledge, no previous study has considered combinations of mid-trimester measures of fetal size as predictors of stillbirth risk. The aim of this cohort study was to assess whether small fetal measurements by mid-pregnancy ultrasound, in conjunction with maternal factors, can predict the risk of stillbirth.
Material and Methods
In this historical cohort study, we identified 377 563 singleton pregnancies in the Swedish Pregnancy Register between 2014 and 2021, with delivery at ≥22+0 gestational weeks with a first trimester (6+0–13+6 weeks) dating ultrasound, and second trimester (16+0–21+6 weeks) measurements of biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). Relative risks (RR) with a 95% confidence interval (CI) for stillbirth were calculated for fetuses with any second-trimester biometry <5th centile, and adjusted for maternal characteristics. Odds ratios (ORs) with 95% CI were used to assess the individual contributions of fetal biometry and maternal characteristics to stillbirth risk. Significant factors were included in a multivariate prediction model, and the area under the receiver operating characteristic curve (AUC) was used to assess predictive performance.
Results
Short second-trimester FL was associated with increased risk of stillbirth, especially when combined with small AC or both small BPD and AC (aRR [95% CI] 2.78 [1.44–5.34] and 2.40 [1.14–5.06], respectively), whereas normal FL with small BPD and/or AC was not. In the multivariable model, short FL in combination with small AC was the strongest contributor to stillbirth risk assessment. The AUC of the prediction model, including both maternal characteristics, small AC, and short FL, was 0.623 for stillbirth in all pregnancies, 0.635 for term stillbirth, and 0.591 for preterm stillbirth.
Conclusions
We found evidence of increased risk of stillbirth among fetuses with short FL, especially in combination with small AC, but not with normal FL, regardless of other small fetal dimensions. However, maternal characteristics and mid-gestational biometry perform poorly in predicting stillbirth.
{"title":"Fetal biometry and maternal characteristics for second trimester prediction of stillbirth","authors":"Linda Lindström, Olof Stephansson, Sven Cnattingius, Allen Wilcox, Michaela Granfors","doi":"10.1111/aogs.70112","DOIUrl":"10.1111/aogs.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Small fetal size is the most important risk factor for stillbirth. To our knowledge, no previous study has considered combinations of mid-trimester measures of fetal size as predictors of stillbirth risk. The aim of this cohort study was to assess whether small fetal measurements by mid-pregnancy ultrasound, in conjunction with maternal factors, can predict the risk of stillbirth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In this historical cohort study, we identified 377 563 singleton pregnancies in the Swedish Pregnancy Register between 2014 and 2021, with delivery at ≥22<sup>+0</sup> gestational weeks with a first trimester (6<sup>+0</sup>–13<sup>+6</sup> weeks) dating ultrasound, and second trimester (16<sup>+0</sup>–21<sup>+6</sup> weeks) measurements of biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). Relative risks (RR) with a 95% confidence interval (CI) for stillbirth were calculated for fetuses with any second-trimester biometry <5th centile, and adjusted for maternal characteristics. Odds ratios (ORs) with 95% CI were used to assess the individual contributions of fetal biometry and maternal characteristics to stillbirth risk. Significant factors were included in a multivariate prediction model, and the area under the receiver operating characteristic curve (AUC) was used to assess predictive performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Short second-trimester FL was associated with increased risk of stillbirth, especially when combined with small AC or both small BPD and AC (aRR [95% CI] 2.78 [1.44–5.34] and 2.40 [1.14–5.06], respectively), whereas normal FL with small BPD and/or AC was not. In the multivariable model, short FL in combination with small AC was the strongest contributor to stillbirth risk assessment. The AUC of the prediction model, including both maternal characteristics, small AC, and short FL, was 0.623 for stillbirth in all pregnancies, 0.635 for term stillbirth, and 0.591 for preterm stillbirth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found evidence of increased risk of stillbirth among fetuses with short FL, especially in combination with small AC, but not with normal FL, regardless of other small fetal dimensions. However, maternal characteristics and mid-gestational biometry perform poorly in predicting stillbirth.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"309-319"},"PeriodicalIF":3.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145675884","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}
Saana Pietilä, Arttu Mönkkönen, Heli Backman, Leea Keski-Nisula
Introduction
At Kuopio University Hospital (KUH), the rate of fetal blood sampling (FBS) among women undergoing a trial of labor has markedly decreased over the past 20 years. The aim of this study was to evaluate the association of this decline with birth outcomes and how maternal and delivery characteristics have changed over the extended study period.
Material and Methods
This retrospective registry-based study included 40 309 singleton pregnancies with a live vertex-presenting fetus at or beyond 33 weeks of gestation with a trial of labor and deliveries between January 2002 and December 2021. Prenatal and birth data were obtained from the KUH birth registry, and variables were analyzed across four intervals of 5 years. The evaluated birth outcomes included the mode of delivery, labor induction, meconium-stained or bloody amniotic fluid, birthweight, 5-min Apgar scores, physician-diagnosed asphyxia, perinatal death, and admission to the neonatal intensive care unit (NICU).
Results
During the 20-year study period, intrapartum FBS was performed in 3486 cases (8.6%), while 36 823 women (91.4%) delivered without FBS. The use of FBS declined from 11.7% to 3.9% (p < 0.001). Concurrently, the rate of spontaneous vaginal deliveries increased from 83.6% to 87.6%, whereas nonelective cesarean deliveries decreased from 8.4% to 4.3%. Fewer newborns were diagnosed with asphyxia by physicians and admitted to the NICU. However, the incidence of low 5-min Apgar scores (<7) peaked with a 77.8% increase during the last study period compared to the preceding one, coinciding with the lowest rate of FBS use. General trends included declines in birth rate, maternal smoking, and gestational age at birth, as well as increases in maternal age, body mass index, and the rate of labor induction.
Conclusions
The change in FBS rate may reflect evolving clinical assessment criteria and more stringent selection strategies for its use. However, it may also be associated with an increased number of cases presenting with low Apgar scores.
{"title":"Twenty-year trends in fetal scalp-blood sampling and birth outcomes: A single-center retrospective cohort study of 40 309 women in labor","authors":"Saana Pietilä, Arttu Mönkkönen, Heli Backman, Leea Keski-Nisula","doi":"10.1111/aogs.70110","DOIUrl":"10.1111/aogs.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>At Kuopio University Hospital (KUH), the rate of fetal blood sampling (FBS) among women undergoing a trial of labor has markedly decreased over the past 20 years. The aim of this study was to evaluate the association of this decline with birth outcomes and how maternal and delivery characteristics have changed over the extended study period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This retrospective registry-based study included 40 309 singleton pregnancies with a live vertex-presenting fetus at or beyond 33 weeks of gestation with a trial of labor and deliveries between January 2002 and December 2021. Prenatal and birth data were obtained from the KUH birth registry, and variables were analyzed across four intervals of 5 years. The evaluated birth outcomes included the mode of delivery, labor induction, meconium-stained or bloody amniotic fluid, birthweight, 5-min Apgar scores, physician-diagnosed asphyxia, perinatal death, and admission to the neonatal intensive care unit (NICU).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the 20-year study period, intrapartum FBS was performed in 3486 cases (8.6%), while 36 823 women (91.4%) delivered without FBS. The use of FBS declined from 11.7% to 3.9% (<i>p <</i> 0.001). Concurrently, the rate of spontaneous vaginal deliveries increased from 83.6% to 87.6%, whereas nonelective cesarean deliveries decreased from 8.4% to 4.3%. Fewer newborns were diagnosed with asphyxia by physicians and admitted to the NICU. However, the incidence of low 5-min Apgar scores (<7) peaked with a 77.8% increase during the last study period compared to the preceding one, coinciding with the lowest rate of FBS use. General trends included declines in birth rate, maternal smoking, and gestational age at birth, as well as increases in maternal age, body mass index, and the rate of labor induction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The change in FBS rate may reflect evolving clinical assessment criteria and more stringent selection strategies for its use. However, it may also be associated with an increased number of cases presenting with low Apgar scores.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"346-355"},"PeriodicalIF":3.1,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627435","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}
Vilma Johnsson, Olav B. Petersen, Morten Bo Søndergaard Svendsen, Kulamakan Kulasegaram, Lone Nikoline Nørgaard, Lotte Harmsen, Laerke Marijke Noerholk, Karin Sundberg, Martin G. Tolsgaard
<div> <section> <h3> Introduction</h3> <p>Chorionic villus sampling (CVS) is an invasive prenatal diagnostic procedure used to detect fetal genetic anomalies. CVS is increasingly replaced by noninvasive prenatal testing (NIPT). As a consequence, maintaining procedural skills among trainees has become challenging. Despite this, optimal training methods for CVS remain uncertain, particularly regarding whether techniques involving context variation, needle guides, or freehand approaches yield superior skill acquisition and performance. This randomized controlled study aimed to evaluate these training strategies, specifically focusing on skill transfer among novices in ultrasound-guided CVS.</p> </section> <section> <h3> Material and Methods</h3> <p>In this randomized controlled trial, 101 ultrasound novices were allocated into three training groups: context variation, needle-guided, and freehand techniques. Participants completed a 1-h training session performing ultrasound-guided needle punctures on ballistic gel models. The context variation group alternated between needle-guided and freehand techniques with varying visual constraints. After training, each participant completed four CVS transfer tests using a CVS simulator manikin, involving two needle-guided and two freehand procedures, with differing placental positions. Blinded expert raters evaluated participant performance using a scoring system with established validity evidence. Statistical analyses included linear mixed-effect models, ANOVA, and Pearson correlation coefficients.</p> </section> <section> <h3> Results</h3> <p>There were no significant differences in overall performance scores among the three training groups (<i>F</i>[2, 92.0] = 0.06, <i>p</i> = 0.94). However, performance significantly improved during transfer tests when participants used a needle guide, irrespective of their initial training method (<i>F</i>[1, 266.0] = 49.5, <i>p</i> < 0.001). Specifically, using a needle guide significantly enhanced scores for pre-puncture ultrasound assessment (<i>t</i>[370] = −4.1, <i>p</i> < 0.001), insertion site selection (<i>t</i>[370] = −3.8, <i>p</i> < 0.001), sampling technique (<i>t</i>[370] = −5.8, <i>p</i> < 0.001), and overall procedural performance (<i>t</i>[370] = −5.8, <i>p</i> < 0.001).</p> </section> <section> <h3> Conclusions</h3> <p>Training approaches, including needle-guided, freehand, and context variation techniques, did not differ significantly in their effect on learning ultrasound-guided CVS. However, the consistent improvement in procedural perform
简介：绒毛膜绒毛取样（CVS）是一种侵入性产前诊断程序，用于检测胎儿遗传异常。CVS越来越多地被无创产前检查（NIPT）所取代。因此，在受训者中保持程序技能变得具有挑战性。尽管如此，CVS的最佳训练方法仍然不确定，特别是涉及上下文变化、针导或徒手方法的技术是否能获得更好的技能和表现。本随机对照研究旨在评估这些训练策略，特别关注超声引导CVS新手的技能转移。材料和方法：在本随机对照试验中，101名超声新手被分为三个训练组：环境变化训练组、针引导训练组和徒手训练组。参与者完成了1小时的训练课程，在弹道凝胶模型上进行超声引导针穿刺。上下文变化组在不同的视觉限制下交替使用针引导和徒手技术。训练后，每个参与者使用CVS模拟器模型完成了四次CVS转移测试，包括两次针引导和两次徒手操作，不同的胎盘位置。盲法专家评分员使用具有既定有效性证据的评分系统评估参与者的表现。统计分析包括线性混合效应模型、方差分析和Pearson相关系数。结果：三个训练组的综合成绩得分差异无统计学意义（F[2,92.0] = 0.06, p = 0.94）。然而，在转移测试中，当参与者使用导针器时，无论他们最初的训练方法如何，他们的表现都有显著提高（F[1,266.0] = 49.5, p）。结论：包括针引导、徒手和情境变化技术在内的训练方法对学习超声引导CVS的影响没有显著差异。然而，针头引导技术的持续改进表明，将针头引导纳入CVS培训可以促进新手学习者更安全的实践，特别是在临床培训机会越来越少的情况下。
{"title":"To guide or not to guide: A randomized study on the use of needle guide for chorionic villus sampling training","authors":"Vilma Johnsson, Olav B. Petersen, Morten Bo Søndergaard Svendsen, Kulamakan Kulasegaram, Lone Nikoline Nørgaard, Lotte Harmsen, Laerke Marijke Noerholk, Karin Sundberg, Martin G. Tolsgaard","doi":"10.1111/aogs.70108","DOIUrl":"10.1111/aogs.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Chorionic villus sampling (CVS) is an invasive prenatal diagnostic procedure used to detect fetal genetic anomalies. CVS is increasingly replaced by noninvasive prenatal testing (NIPT). As a consequence, maintaining procedural skills among trainees has become challenging. Despite this, optimal training methods for CVS remain uncertain, particularly regarding whether techniques involving context variation, needle guides, or freehand approaches yield superior skill acquisition and performance. This randomized controlled study aimed to evaluate these training strategies, specifically focusing on skill transfer among novices in ultrasound-guided CVS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In this randomized controlled trial, 101 ultrasound novices were allocated into three training groups: context variation, needle-guided, and freehand techniques. Participants completed a 1-h training session performing ultrasound-guided needle punctures on ballistic gel models. The context variation group alternated between needle-guided and freehand techniques with varying visual constraints. After training, each participant completed four CVS transfer tests using a CVS simulator manikin, involving two needle-guided and two freehand procedures, with differing placental positions. Blinded expert raters evaluated participant performance using a scoring system with established validity evidence. Statistical analyses included linear mixed-effect models, ANOVA, and Pearson correlation coefficients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were no significant differences in overall performance scores among the three training groups (<i>F</i>[2, 92.0] = 0.06, <i>p</i> = 0.94). However, performance significantly improved during transfer tests when participants used a needle guide, irrespective of their initial training method (<i>F</i>[1, 266.0] = 49.5, <i>p</i> < 0.001). Specifically, using a needle guide significantly enhanced scores for pre-puncture ultrasound assessment (<i>t</i>[370] = −4.1, <i>p</i> < 0.001), insertion site selection (<i>t</i>[370] = −3.8, <i>p</i> < 0.001), sampling technique (<i>t</i>[370] = −5.8, <i>p</i> < 0.001), and overall procedural performance (<i>t</i>[370] = −5.8, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Training approaches, including needle-guided, freehand, and context variation techniques, did not differ significantly in their effect on learning ultrasound-guided CVS. However, the consistent improvement in procedural perform","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"70-75"},"PeriodicalIF":3.1,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627406","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 Felnhofer, Anja C. Feneberg, Lisa Weiss, Oswald D. Kothgassner, Johanna X. Kafka, Christian Fiala
Introduction
Knowledge on women's pain and stress experiences during medical abortion is scarce and evidence mainly relies on retrospective reports, which are prone to recall bias. Hence, our objective was to study real-time self-reported pain and stress throughout the medical abortion process, their fluctuation over time, and to examine whether age, parity, gestational age, adverse childhood events (ACE), and contextual factors (e.g., analgesics intake, bleeding) were associated with pain and stress.
Material and Methods
This one-group, single center, exploratory cohort study (conducted 2020–2023) used ecological momentary assessment (EMA). A population-based sample of women ≥18 years of age presenting for first trimester medical abortion at ≤9th week of gestation was approached after mifepristone intake. Sixty women aged 30.40 ± 6.61 years were included in this study. EMA commenced with mifepristone intake and entailed four prompts per day over a consecutive 7-day period. Main outcomes included self-reported pain and stress measured using visual analog scales (VAS). Secondary outcomes were clinical and demographic data as well as psychological measures. Data were analyzed using multilevel models.
Results
Reported pain and stress varied not only throughout the abortion process but also between women, showing an increase on Day 3 (misoprostol intake) and a gradual decrease thereafter. While age, gestational age, and parity were not significantly related to pain, higher self-reported stress, more bleeding, more analgesic intake, and a higher number of ACEs were associated with higher pain levels. Higher stress levels, in turn, were associated with more ACEs, parity, analgesics intake, treatment-related events, and weekdays.
Conclusions
Our results highlight large interindividual variations in women's pain and stress experiences during first trimester medical abortion and thus emphasize the need for individualized counseling and pain treatment. Screening for ACEs, along with using event-based EMA protocols for future pain-management research, may promote tailored care.
{"title":"Women's real-time pain and stress during medical abortion: An ecological momentary assessment study","authors":"Anna Felnhofer, Anja C. Feneberg, Lisa Weiss, Oswald D. Kothgassner, Johanna X. Kafka, Christian Fiala","doi":"10.1111/aogs.70109","DOIUrl":"10.1111/aogs.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Knowledge on women's pain and stress experiences during medical abortion is scarce and evidence mainly relies on retrospective reports, which are prone to recall bias. Hence, our objective was to study real-time self-reported pain and stress throughout the medical abortion process, their fluctuation over time, and to examine whether age, parity, gestational age, adverse childhood events (ACE), and contextual factors (e.g., analgesics intake, bleeding) were associated with pain and stress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This one-group, single center, exploratory cohort study (conducted 2020–2023) used ecological momentary assessment (EMA). A population-based sample of women ≥18 years of age presenting for first trimester medical abortion at ≤9th week of gestation was approached after mifepristone intake. Sixty women aged 30.40 ± 6.61 years were included in this study. EMA commenced with mifepristone intake and entailed four prompts per day over a consecutive 7-day period. Main outcomes included self-reported pain and stress measured using visual analog scales (VAS). Secondary outcomes were clinical and demographic data as well as psychological measures. Data were analyzed using multilevel models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Reported pain and stress varied not only throughout the abortion process but also between women, showing an increase on Day 3 (misoprostol intake) and a gradual decrease thereafter. While age, gestational age, and parity were not significantly related to pain, higher self-reported stress, more bleeding, more analgesic intake, and a higher number of ACEs were associated with higher pain levels. Higher stress levels, in turn, were associated with more ACEs, parity, analgesics intake, treatment-related events, and weekdays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results highlight large interindividual variations in women's pain and stress experiences during first trimester medical abortion and thus emphasize the need for individualized counseling and pain treatment. Screening for ACEs, along with using event-based EMA protocols for future pain-management research, may promote tailored care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"176-185"},"PeriodicalIF":3.1,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627421","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}
Ingrid Petrikke Olsen, Charlotte Agnethe Mannsverk, Anne Berit Pulk, Hans Fagertun, Malin Fors
Introduction
Robot-assisted obstetric ultrasound is a method where the obstetrician in the hospital can control an ultrasound probe and assess biometric measurements and biophysical observations of a fetus, at a remote location. This two-aimed study evaluates the diagnostic accuracy of robot-assisted ultrasound compared to traditional ultrasound and explores patient experiences.
Material and Methods
Forty-six middle-risk pregnant women in 2nd and 3rd trimester were recruited. Thirty women were recruited for an intra observer study to compare the quality of the robot-assisted obstetrical ultrasound and traditional obstetric ultrasound. Fifteen traditional ultrasound examinations and 15 robotic-assisted ultrasound examinations were performed and head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), amniotic fluid index (AFI), Doppler in the umbilical arteria, and biophysical observations of the fetus were registered. Another 16 women were recruited to a mixed design study aiming to explore the women's experiences with the robot-assisted ultrasound method. These women completed a questionnaire of 20 questions about patient experience, using a 5-point Likert scale. Two of them also participated in qualitative interviews to provide deeper insights.
Results
Biometric measurements showed excellent reliability (intraclass correlation coefficient 0.990–0.993) with acceptable limits of agreement. Twenty questions about patient experiences were asked and 94% of the women scored for highest level of satisfaction. Interviews revealed the value of avoiding long-distance travel when image quality and digital communication experiences are good.
Conclusions
Robot-assisted obstetric ultrasound is a reliable alternative to traditional ultrasound for middle-risk pregnancies in rural areas, offering high diagnostic accuracy and patient satisfaction. Most women would agree to a robotic ultrasound scan examination again. The patients' experiences are thus in line with the Norwegian governments' intention to use technology to secure equality in health care in rural areas.
{"title":"Introduction of robot-assisted obstetric ultrasound in rural Northern Norway","authors":"Ingrid Petrikke Olsen, Charlotte Agnethe Mannsverk, Anne Berit Pulk, Hans Fagertun, Malin Fors","doi":"10.1111/aogs.70099","DOIUrl":"10.1111/aogs.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Robot-assisted obstetric ultrasound is a method where the obstetrician in the hospital can control an ultrasound probe and assess biometric measurements and biophysical observations of a fetus, at a remote location. This two-aimed study evaluates the diagnostic accuracy of robot-assisted ultrasound compared to traditional ultrasound and explores patient experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Forty-six middle-risk pregnant women in 2nd and 3rd trimester were recruited. Thirty women were recruited for an intra observer study to compare the quality of the robot-assisted obstetrical ultrasound and traditional obstetric ultrasound. Fifteen traditional ultrasound examinations and 15 robotic-assisted ultrasound examinations were performed and head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), amniotic fluid index (AFI), Doppler in the umbilical arteria, and biophysical observations of the fetus were registered. Another 16 women were recruited to a mixed design study aiming to explore the women's experiences with the robot-assisted ultrasound method. These women completed a questionnaire of 20 questions about patient experience, using a 5-point Likert scale. Two of them also participated in qualitative interviews to provide deeper insights.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Biometric measurements showed excellent reliability (intraclass correlation coefficient 0.990–0.993) with acceptable limits of agreement. Twenty questions about patient experiences were asked and 94% of the women scored for highest level of satisfaction. Interviews revealed the value of avoiding long-distance travel when image quality and digital communication experiences are good.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Robot-assisted obstetric ultrasound is a reliable alternative to traditional ultrasound for middle-risk pregnancies in rural areas, offering high diagnostic accuracy and patient satisfaction. Most women would agree to a robotic ultrasound scan examination again. The patients' experiences are thus in line with the Norwegian governments' intention to use technology to secure equality in health care in rural areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"136-145"},"PeriodicalIF":3.1,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627309","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}
Iphigénie Cavadias, Lorraine Maitrot-Mantelet, Sandrine Perol, Mathilde Bourdon, Pietro Santulli, Louis Marcellin, Charles Chapron, Geneviève Plu-Bureau
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.
{"title":"Risk of cardiovascular disease and mortality among women with endometriosis: A systematic review and meta-analysis","authors":"Iphigénie Cavadias, Lorraine Maitrot-Mantelet, Sandrine Perol, Mathilde Bourdon, Pietro Santulli, Louis Marcellin, Charles Chapron, Geneviève Plu-Bureau","doi":"10.1111/aogs.70104","DOIUrl":"10.1111/aogs.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>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 <i>I</i><sup>2</sup> statistics. This review was not registered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"225-237"},"PeriodicalIF":3.1,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627418","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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