Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Carbon monoxide levels, smoking and adverse pregnancy outcomes","authors":"Katarzyna Galka,&nbsp;Michael Shea,&nbsp;Christina Y. L. Aye,&nbsp;Lawrence Impey","doi":"10.1111/aogs.70068","DOIUrl":"10.1111/aogs.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Identifying pregnant smokers is crucial for cessation support and increased fetal surveillance, but some patients may not disclose their smoking. Biochemical markers like breath carbon monoxide (CO) can improve detection, yet the optimal CO threshold for predicting smoking-related risks remains unknown. Our objective was to assess the relationship between smoking, CO levels, and adverse pregnancy outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analyzed 1 year of pregnancies (2023) in Oxford. Birthweight and adverse outcomes, small for gestational age (SGA), preterm birth (PTB), and extended perinatal mortality (EPM) were compared across CO categories and between self-reported smokers and nonsmokers with CO ≤2 and &gt;2 ppm. Statistical analyses included changepoint analysis, one-way ANOVA, the Cochran–Armitage test for trend, binary logistic regression, and univariate linear regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 6963 pregnancies, 5041 (72.4%) had recorded CO levels. The mean gestation at birth was 39 + 6 weeks, and the mean birthweight (BW) was 3439 g (560); the mean BW centile was 54.25 (28.00). The prevalence of SGA, PTB, and EPM was 6.7%, 5.0%, and 0.6%, respectively. CO levels were &gt;2 ppm in 11.7% of the cohort, including 5.0% of self-reported non-smokers. Changepoint analysis identified 2 ppm as the threshold for mean birthweight. Above this level, each 1 ppm increase in CO was associated with a 69.35 g decrease in BW and a 3.15-point decrease in BW centile, indicating a dose–response relationship. Above 2 ppm, the odds of adverse outcomes were significantly increased: for SGA, OR 2.05–3.37; for PTB, OR 1.50–3.21; and for EPM, OR 2.52–4.22. Compared to non-smokers with low CO, smokers with high CO had the highest risk of all outcomes. Non-smokers with high CO had increased risks, but not significantly.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>At a threshold of &gt;2 ppm, CO was associated with lower mean birthweight and higher rates of SGA and PTB, with a dose–response relationship. Universal CO testing could help identify and quantify risk in pregnancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2237-2243"},"PeriodicalIF":3.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290657","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}

{"title":"Umbilical venous blood flow and its association with placental pathology in pregnancies complicated by gestational diabetes mellitus","authors":"Chadakarn Phaloprakarn,&nbsp;Petcharat Jenkumwong,&nbsp;Sasiwan Suthasmalee,&nbsp;Chutima Chavanisakun,&nbsp;Siriwan Tangjitgamol","doi":"10.1111/aogs.70073","DOIUrl":"10.1111/aogs.70073","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Umbilical venous blood flow (UV-Q) reflects fetoplacental circulation and contributes to an understanding of fetal physiology. It may also serve as a basis for developing new diagnostic tools to assess fetal wellbeing. This study aimed to investigate UV-Q patterns in pregnancies complicated by gestational diabetes mellitus (GDM) and to examine the associations between absolute and fetal weight-normalized UV-Q and placental size and histologic features.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Material and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This prospective study was conducted at a university hospital in Bangkok, Thailand, between December 2021 and May 2024. A total of 200 singleton pregnancies complicated by GDM underwent ultrasound assessment between 35 and 36 weeks of gestation. Measurements included estimated fetal weight, umbilical vein diameter, and Doppler-derived flow velocity. Absolute and normalized UV-Q values were calculated and categorized into three groups: &lt;10th, 10th–90th (reference), and &gt;90th percentiles. After delivery, placental morphometry (weight, diameter, circumference, and volume) and histologic features—including maternal and fetal vascular malperfusion, delayed villous maturation (DVM), and chorangiosis—were evaluated. Associations between UV-Q and placental size were assessed using one-way analysis of covariance, adjusting for parity, insulin use, gestational age at delivery, birthweight, and infant sex. These covariates were also included in the multivariable logistic regression models to examine associations between UV-Q and histologic findings.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Higher absolute UV-Q was significantly associated with greater placental weight, diameter, circumference, and volume (&lt;i&gt;p&lt;/i&gt; = 0.018–0.049). Additionally, in multivariable analysis, pregnancies with absolute UV-Q &gt;90th percentile had a significantly increased risk of DVM (adjusted odds ratio 2.75, 95% confidence interval 1.02–7.86). In contrast, normalized UV-Q showed no significant associations with placental morphometric features or DVM. Furthermore, neither absolute nor normalized UV-Q was significantly associated with other histologic placental abnormalities, including maternal or fetal vascular malperfusion or chorangiosis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In pregnancies complicated by GDM, elevated absolute UV-Q was associated with increased placental size and a higher risk of DVM. These findings suggest that absolute UV-Q may serve as a noninvasive indicator of placental structural adapt","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2244-2253"},"PeriodicalIF":3.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290628","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}

{"title":"Placental pathology and its association with duration of abnormal fetal heart tracing in near-term and term infants with hypoxic–ischemic encephalopathy: A retrospective study","authors":"Áine Fox,&nbsp;Emma Doyle,&nbsp;Adam Reynolds,&nbsp;Maria Farren,&nbsp;Rocco Cuzzilla,&nbsp;Michael Geary,&nbsp;Breda Hayes,&nbsp;Claire M. McCarthy","doi":"10.1111/aogs.70064","DOIUrl":"10.1111/aogs.70064","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Specific fetal heart rate (FHR) patterns are associated with fetal compromise. Several placental histopathological findings are associated with neonatal morbidity and adverse neurodevelopment. The relationships between intrapartum FHR patterns and placental histopathology in infants with hypoxic–ischemic encephalopathy (HIE) remain uncertain. This study hypothesized that in infants with HIE, placental histopathology findings are related to abnormal FHR patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was an observational study performed on a historical cohort from a single tertiary neonatal intensive care unit. Infants were born at ≥36 weeks' gestation with moderate or severe HIE between September 2006 and December 2021. Placental histopathology was assessed by a perinatal pathologist using the Amsterdam Working Group Criteria. FHR, recorded from intrapartum cardiotocography (CTG) was assessed by an obstetrician using a structured proforma. Assessors were blinded to clinical course and outcomes. Duration and type of FHR abnormality were compared across categories of placental histopathology findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty infants with moderate or severe HIE (with complete data relating to intrapartum CTG and placental histopathology) were included. Increased duration of FHR abnormality was associated with the presence of histological chorioamnionitis (HCA) (<i>p</i> = 0.013) but not with other placental histopathological lesions. There was no evidence of associations between placental histopathology findings and specific FHR features on intrapartum CTG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study demonstrates an association between HCA and increased duration of CTG abnormality in infants with moderate or severe HIE. Intrapartum CTG alone is limited in its ability to identify the presence or absence of placental histopathology. Multimodal intrapartum assessment, such as CTG with placental NIRs or Doppler assessment, may improve the maternal–placental–fetal triad assessment. This could lead to improved intrapartum risk stratification and infant outcomes. Future research should investigate the utility of multimodal assessment to improve risk stratification in labor.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2254-2262"},"PeriodicalIF":3.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290664","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}

{"title":"Toward structured fellowships in fetal neuroimaging","authors":"Shiri Shinar,&nbsp;Elka Miller","doi":"10.1111/aogs.70078","DOIUrl":"10.1111/aogs.70078","url":null,"abstract":"&lt;p&gt;Fetal neuroimaging has become one of the most dynamic and demanding areas within maternal–fetal medicine. Advances in ultrasound resolution, the widespread availability of fetal MRI, and the integration of genomic testing have transformed the way anomalies of the developing brain are detected, interpreted, and communicated to families. These advances raise a fundamental question: how can clinicians gain comprehensive expertise in the diagnosis, prognostication, and management of fetal neurological conditions?&lt;/p&gt;&lt;p&gt;The first challenge lies in imaging itself. At the foundation of fetal neuroimaging is neurosonography, defined by ISUOG as a dedicated, multiplanar diagnostic examination of the fetal brain and spine in pregnancies at high risk for neurological malformations.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; This requires technical mastery in both transabdominal and transvaginal approaches, as well as growing competence in three-dimensional imaging. Yet even with the most skilled hands, ultrasound has limitations, and fetal MRI is increasingly used to complement sonography. Interpreting prenatal MRI, however, is a specialized skill in its own right. Few maternal–fetal medicine specialists or radiologists receive structured and formal training in acquisition protocols or in the nuanced interpretation of congenital and acquired brain abnormalities. The result is highly variable expertise, dependent largely on local mentorship or exposure.&lt;/p&gt;&lt;p&gt;Interpretation of findings constitutes the next major hurdle. Imaging phenotypes are often complex, subtle, and overlapping across different etiologies. A finding that suggests a vascular pathology may mimic infection or genetic disease, while subtle and focal cortical malformations may escape recognition altogether without careful review. Furthermore, even after a diagnosis is reached, terminology in the literature remains inconsistent, with definitions used inaccurately and interchangeably (i.e. anomalies in the spectrum of Dandy–Walker, or those involving the corpus callosum&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;). This lack of standardization hampers meaningful data comparison and undermines the reliability of prognostic assessments.&lt;/p&gt;&lt;p&gt;These challenges are compounded by the timing of assessment. Gestational age influences the spectrum of findings that can be visualized, as many anomalies, particularly those associated with cortical development, evolve over time and require follow-up to clarify their progression and clinical significance. Early fetal MRI can provide valuable complementary information to ultrasound, but is often limited by motion artifacts that obscure subtle abnormalities. Later sonographic and MRI assessments may yield more definitive insights; however, these options may not be available in settings where termination of pregnancy is legally restricted beyond certain gestational age thresholds.&lt;/p&gt;&lt;p&gt;Postmortem imaging is an emerging technique that adds further dimensions&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; clinicians ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 11","pages":"2024-2027"},"PeriodicalIF":3.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70078","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278714","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}

{"title":"Predicting spontaneous preterm birth with cervical length and fetal fibronectin for symptomatic women of threatened preterm labor: A prospective study","authors":"Joanna C. Y. Fung,&nbsp;Piya Chaemsaithong,&nbsp;Yunyu Chen,&nbsp;Nutnaree Yuenyongdechawat,&nbsp;Hillary H. Y. Leung,&nbsp;Patricia N. P. Ip,&nbsp;Caitlyn S. L. Lau,&nbsp;Liona C. Poon","doi":"10.1111/aogs.70062","DOIUrl":"10.1111/aogs.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The aim of this study was to assess the effectiveness of fetal fibronectin (fFN) in combination with cervical length for predicting spontaneous preterm birth (sPTB) in women presenting with threatened preterm labor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a prospective study involving singleton pregnancies at 20–36 weeks of gestation with symptoms of threatened preterm labor. Upon admission, cervical length (CL) and fFN test in cervicovaginal secretions were measured. Logistic regression analysis was performed to develop the following models: CL alone, fFN at various thresholds, and their combined models for the prediction of sPTB. Area under the receiver operating characteristic curve (AUROC) was calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 398 cases were analyzed. The median gestational age at recruitment was 30.1 weeks. Among these cases, 55 (13.8%) cases had sPTB at &lt;37 weeks of gestation. A history of preterm birth (HxPTB), shorter CL, and increased fFN level were independently associated with an increased risk of sPTB. AUROC of the fFN test, at ≥50 ng/mL or ≥200 ng/mL, was significantly higher than that of ≥500 ng/mL for predicting sPTB. For the prediction of sPTB, the AUROCs were 0.78 for CL, 0.78 for fFN, and 0.84 for the combination of HxPTB, CL, and fFN ≥50 ng/mL. The ROC curves showed that, at a false-positive rate of 10%, the sensitivities were 53% for CL ≤2.44 cm, 33.9% for fFN ≥50 ng/mL, and 60% for the combination of HxPTB, CL, and fFN ≥50 ng/mL (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In women symptomatic of threatened preterm labor, a combination of fFN and CL has improved the predictive performance of sPTB compared with either measure alone.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2292-2299"},"PeriodicalIF":3.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278666","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}

{"title":"Prediction of obstetric outcome in vaginal breech birth using ultrasound pelvimetry in nulliparous women—A feasibility study","authors":"Massimiliano Lia,&nbsp;Anne Dathan-Stumpf,&nbsp;Julia Franke,&nbsp;Beatrice Vogt,&nbsp;Noura Kabbani,&nbsp;Holger Stepan,&nbsp;Anne Tauscher","doi":"10.1111/aogs.70072","DOIUrl":"10.1111/aogs.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Magnetic resonance (MR) pelvimetry is widely used in planning vaginal breech birth and may support women's informed decision-making regarding their preferred mode of birth. This feasibility study aimed to assess whether transperineal ultrasound (TPU) could measure the maternal pelvis as accurately as MR pelvimetry and thus predict the outcome of vaginal breech birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In this prospective cohort study, nulliparous women with a singleton fetus in breech presentation received TPU for the measurement of the anteroposterior mid-pelvic diameter (AMD). These measurements were compared with those in MR pelvimetry to assess agreement and reliability. In women choosing to attempt vaginal breech birth, we additionally examined the association between the AMD (adjusted for possible confounders) and intrapartum cesarean section. The predictive performance of the AMD and traditional pelvic diameters (i.e., obstetric conjugate, interspinous, and intertuberous distance) was compared by means of the area under the receiver operating characteristic curve (AUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 67 nulliparous women with breech presentation received both TPU and MR pelvimetry, of which 47 chose a vaginal breech birth (30 successful vaginal births and 17 intrapartum cesarean sections). The repeatability coefficients and intraclass correlation coefficient for the AMD were 0.38 cm and 0.97 (95% CI 0.96–0.98), respectively. Bland–Altman analysis between the AMD measured in TPU and MR pelvimetry yielded a mean difference of −0.0052 cm (95% CI −0.066 to 0.056 cm) with upper and lower limits of agreement of 0.48 cm (95% CI 0.38–0.59 cm) and −0.49 cm (95% CI −0.6 cm to −0.39 cm), respectively. In the subgroup of women who attempted vaginal breech birth, AMD was significantly associated with intrapartum cesarean section (adjusted odds ratio 0.25; 95% CI 0.06–0.81; AUC 0.77), while the obstetric conjugate, interspinous, and intertuberous distances were not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TPU can accurately and reliably measure the AMD, a novel pelvic diameter in breech presentation. Importantly, a smaller AMD was associated with an increased risk of intrapartum cesarean section if vaginal breech birth was attempted. Consequently, TPU could represent an alternative to MR pelvimetry and support women in deciding their preferred mode of birth in breech presentation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2263-2272"},"PeriodicalIF":3.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278690","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}

{"title":"Gestational diabetes mellitus and offspring health: A 12-year register-based analysis of specialized health care utilization in Finland","authors":"Jenni Kinnunen,&nbsp;Hilkka Nikkinen,&nbsp;Elina Keikkala,&nbsp;Sanna Mustaniemi,&nbsp;Mika Gissler,&nbsp;Hannele Laivuori,&nbsp;Johan G. Eriksson,&nbsp;Eero Kajantie,&nbsp;Marja Vääräsmäki","doi":"10.1111/aogs.70077","DOIUrl":"10.1111/aogs.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Gestational diabetes mellitus (GDM) is associated with various health risks in offspring. We investigated the effect of GDM exposure on offspring morbidity in a population-based cohort, assessed by the utilization of specialized health care services up to 12 years of age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This register-based study, part of the Finnish Gestational Diabetes (FinnGeDi) study, included all singleton children born in Finland in 2009, captured from the Medical Birth Registry. Mothers of children in the study cohort underwent comprehensive screening for GDM. The study cohort included 6235 (11.1%) GDM-exposed children and 49 484 unexposed children. Utilization of specialized health care services was measured as the number of outpatient visits and inpatient treatment episodes (including duration in days). Data were obtained from the Finnish Care Register for Health Care up to 12 years of age and were analyzed separately for early childhood (0–2 years), preschool age (3–6 years), and school age (7–12 years) also. Maternal, birth, and child-related factors were considered, including maternal age, pre-pregnancy body mass index (BMI), parity, maternal hypertensive disorders, socioeconomic status (SES), smoking status, mode of delivery, preterm birth, small for gestational age, and child sex in the adjustment model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Children exposed to maternal GDM had a higher incidence of outpatient visits than unexposed children (adjusted incidence rate ratio [IRR] 1.10, 95% confidence interval [CI] 1.07–1.13). Among children with multiple outpatient care visits (the highest quartile), GDM-exposed children were overrepresented in early childhood (adjusted odds ratio [aOR] 1.08, 95% CI: 1.00–1.15), preschool age (aOR 1.12, 95% CI: 1.05–1.19), and school age (aOR 1.11, 95% CI: 1.04–1.19). Children exposed to GDM were also more likely to require inpatient treatment than unexposed children (adjusted IRR 1.14, 95% CI: 1.10–1.19). The difference was not explained by shorter episodes (adjusted IRR 1.20, 95% CI: 1.16–1.24 for inpatient treatment days).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Children exposed to maternal GDM required more specialized health care services than unexposed children, with increased utilization of specialized health care observed across all age categories up to 12 years of age.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"146-155"},"PeriodicalIF":3.1,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278703","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}

{"title":"Postpartum hemorrhage after SARS-CoV-2 infection in pregnancy: A Scandinavian register-based cohort study","authors":"Trine Damsted Rasmussen,&nbsp;Stine Kjaer Urhoj,&nbsp;Maria C. Magnus,&nbsp;Jonas Söderling,&nbsp;Laura L. Oakley,&nbsp;Anne K. Örtqvist,&nbsp;Hellen M. Edwards,&nbsp;Lone Krebs,&nbsp;Hilde M. Engjom,&nbsp;Olof Stephansson,&nbsp;Siri E. Håberg,&nbsp;Anne-Marie Nybo Andersen,&nbsp;Anna J. M. Aabakke","doi":"10.1111/aogs.70069","DOIUrl":"10.1111/aogs.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The aim was to evaluate whether SARS-CoV-2 infection during pregnancy was associated with severe postpartum hemorrhage (PPH), as SARS-CoV-2 infection has been shown to affect the coagulation system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In this national register-based cohort study in Sweden, Denmark, and Norway, we studied the association between severe PPH according to a registered positive test for SARS-CoV-2 during pregnancy between March 1, 2020 and March 31, 2023 using logistic regression analyses to estimate odds ratios (ORs) with 95% confidence intervals (CI). Country-specific estimates of association were combined in random effects meta-analyses. The primary outcome was severe PPH, defined as a blood loss &gt;1500 mL and/or receiving a blood transfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 542 394 singleton deliveries (264 804 in Sweden, 143 775 in Denmark, and 133 815 in Norway), of which 62 606 women (11%) had a positive SARS-CoV-2 test during pregnancy, and 20 786 (3.8%) deliveries were registered with a severe PPH. Overall, we observed no association between testing positive for SARS-CoV-2 during pregnancy and severe PPH (combined adjusted OR 1.04; 95% CI: 0.96–1.12). The results were similar for different calendar periods corresponding to dominant SARS-CoV-2 variants. We did, however, observe an association between severe PPH and women testing positive within 7 days before delivery (combined adjusted OR 1.30; 95% CI: 1.10–1.53).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was no association identified between SARS-CoV-2 test positivity and PPH of &gt;1500 mL and/or blood transfusion in pregnant women from three Scandinavian countries. However, we observed a 30% higher odds of severe PPH among pregnant women who tested positive within one week before delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2355-2365"},"PeriodicalIF":3.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145273367","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}

{"title":"Vaginal packing after laparoscopic sacrocolpopexy and surgical outcome after one year: A randomized controlled trial","authors":"Zdenek Rusavy,&nbsp;Adela Marinic Veverkova,&nbsp;Martin Smazinka,&nbsp;Vladimir Kalis","doi":"10.1111/aogs.70067","DOIUrl":"10.1111/aogs.70067","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;While the role of vaginal packing following vaginal reconstructive surgery and vaginal hysterectomy was well-explored, data regarding laparoscopic reconstructive surgery are lacking. No effect on early postoperative pain, complications, and satisfaction after laparoscopic sacrocolpopexy (LSC) was observed as presented earlier. No data concerning the effect of vaginal packing on the surgical outcome of LSC exist. Our objective was to test the hypothesis that vaginal packing after laparoscopic sacrocolpopexy is associated with a reduced risk of pelvic organ prolapse recurrence.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Material and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;All women planned for laparoscopic sacrocolpopexy for pelvic organ prolapse (POPQ stage &gt;2) in the period 11/2016–6/2022 were included in this randomized controlled trial. Those that underwent other surgery, concomitant vaginal surgery, or where the vagina was opened (e.g., during concurrent hysterectomy) were excluded. The women randomly received vaginal packing after the surgery. The primary outcome was defined as prolapse beyond the hymen, symptomatic prolapse, or retreatment in one-year follow-up. Secondary outcomes included anatomical recurrence, quality of life, and complications. Clinical trial registration: Registered on October 21, 2016, initial participant enrollment on November 14, 2016, clinical trial identification number: NCT02943525, URL of the registration site: https://clinicaltrials.gov/study/NCT02943525.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Four hundred and fifty-five (89%) women completed the one-year follow-up. Vaginal pack was inserted in 214 (47%) women. The groups did not differ in most preoperative characteristics, except BMI (26.2 ± 3.4 vs. 26.9 ± 3.6, &lt;i&gt;p&lt;/i&gt; = 0.008), preoperative POPDI (64.6 vs. 77.7, &lt;i&gt;p&lt;/i&gt; = 0.004), operative time (103 vs. 111 min, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), and estimated blood loss (137 vs. 157 mL, &lt;i&gt;p&lt;/i&gt; = 0.029), which all were higher in the packing group. No differences in the primary outcome (2.8 vs. 1.7%, &lt;i&gt;p&lt;/i&gt; = 0.527) nor any of the recorded variables including the POPQ points position, anatomical recurrence, PGI-I, ICIQ-UI, PFDI, PISQ-12 and complication rate were observed between the groups. No differences in surgical outcomes in subgroups according to concomitant surgery on the uterus (previous hysterectomy, concomitant supracervical hysterectomy, sacrohysterocolpopexy) were observed. There was no difference in the rate of complications. No mesh exposure was observed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2331-2338"},"PeriodicalIF":3.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257050","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}

{"title":"Ascending infection is the leading cause of antepartum hemorrhage: A case–control study","authors":"Iván Rabinovich Orlandi,&nbsp;Guido Patricio Gromadzyn,&nbsp;Marta C. Cohen","doi":"10.1111/aogs.70063","DOIUrl":"10.1111/aogs.70063","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Placental abruption is a significant obstetric complication characterized by the premature separation of the placenta from the uterine wall, affecting 2–3 per 100 pregnancies. This condition presents a dual diagnostic challenge: obstetricians rely on clinical signs such as antepartum hemorrhage, abdominal pain, and ultrasound findings to suspect abruption, often leading to emergency cesarean delivery. Conversely, pathologists diagnose abruption through macroscopic and microscopic examination of placental tissue, identifying hematomas and signs of maternal vascular malperfusion. Notably, there is often a poor correlation between clinical diagnosis and pathological findings, with sensitivity reported as low as 30.2%. This study seeks to elucidate placental conditions associated with antepartum hemorrhage that may indicate abruption and emphasizes the importance of histopathological referral in understanding recurrence risks in subsequent pregnancies. By enhancing diagnostic accuracy, we aim to improve clinical outcomes for affected patients. Our objective is to evaluate placental conditions associated with antepartum hemorrhage and assess the correlation between clinical diagnoses and histopathological findings.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Material and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A retrospective analysis of 285 placental histopathology reports from Sheffield Children NHS FT (January–December 2021) was conducted. This included 181 cases with clinical diagnoses of antepartum hemorrhage/abruption and 104 controls with well-controlled gestational diabetes mellitus. Histopathological findings were compared between groups.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Significant placental findings associated with clinical antepartum hemorrhage/abruption included adherent blood clots (OR = 3.89, 95% CI: 1.88–8.04), umbilical cord hypercoiling (OR = 0.56, 95% CI: 0.33–0.96), and ascending infection/chorioamnionitis (OR = 3.08, 95% CI: 1.38–6.91). Histological abruption and chorioamnionitis were independently associated with antepartum hemorrhage (OR = 3.15, 95% CI: 1.21–9.87 and 3.13, 95% CI: 1.42–7.65 respectively), but there was no significant association with maternal vascular malperfusion (OR = 1.46, 95% CI: 0.65–3.30). Gestational age was lower in the antepartum hemorrhage group (33 weeks) versus controls (39 weeks).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The most frequent placental conditions presenting as antepartum hemorrhage are ascending infection (leading to acute deciduitis) and histological abruption, ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2300-2308"},"PeriodicalIF":3.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249223","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}