Isis Carton, Ludivine Dion, Vincent Lavoué, Bjorn Morten Hofmann
Introduction
Uterine transplantation is currently intended for women with absolute uterine infertility. Since proof of the concept in 2014, many countries have started research programs and clinical activities. However, access to uterine transplantation remains limited given that only a few hundred transplants have been described worldwide compared with the 1.5 million women of childbearing age who suffer from absolute uterine infertility. The aim of this study was to investigate how limited access to uterine transplantation is perceived by women with Mayer–Rokitansky–Küster–Hauser syndrome and health professionals involved in uterus transplantation programs.
Material and Methods
We conducted a qualitative study with semistructured interviews in France, Norway, and Sweden with women with Mayer–Rokitansky–Küster–Hauser syndrome and health professional involved in uterine transplantation programs. The interviews were analyzed manually using thematic content analysis. The research questions were: How do (a) women with Mayer–Rokitansky–Küster–Hauser syndrome and (b) healthcare professionals involved in uterus transplantation programs perceive uterus transplantation and its accessibility 10 years after proof of concept?
Results
The interviews enabled us to highlight a number of themes addressed by doctors and women with Mayer–Rokitansky–Küster–Hauser syndrome, the main ones being the hope raised by this technique and the disappointment for those who do not have access to it, the lack of perception of the risks associated with the technique, and finally, an inequity of access and the training difficulties this entails for the teams.
Conclusions
Access to uterine transplantation varies widely across Europe owing to legislative restrictions and limited access due to resources or competence. The result is a feeling of injustice/misunderstanding and despair for these women who had planned to become parents and cannot benefit from a transplant. They appear to be poorly supported. Women who are ultimately unable to access a transplant program should perhaps be given psychological support to deal with this disappointment, whereas the minority who finally have had access to transplant programs are supervised by well-trained multidisciplinary teams.
子宫移植目前用于绝对子宫不孕症的妇女。自2014年这一概念得到证实以来,许多国家已经启动了研究项目和临床活动。然而,子宫移植的机会仍然有限,因为全世界只有几百例移植被描述,而150万育龄妇女患有绝对子宫不孕症。本研究的目的是调查患有meyer - rokitansky - k ster- hauser综合征的妇女和参与子宫移植项目的卫生专业人员如何看待有限的子宫移植机会。材料和方法:我们在法国、挪威和瑞典对患有mayer - rokitansky - k ster- hauser综合征的妇女和参与子宫移植项目的卫生专业人员进行了半结构化访谈的定性研究。使用主题内容分析对访谈进行手动分析。研究问题是:(a)患有meyer - rokitansky - k ster- hauser综合征的妇女和(b)参与子宫移植项目的医疗保健专业人员如何看待子宫移植及其概念证明10年后的可及性?结果:访谈使我们能够强调患有mayer - rokitansky - k ster- hauser综合征的医生和妇女所讨论的一些主题,主要是这项技术带来的希望和那些无法获得该技术的人的失望,缺乏对与该技术相关的风险的认识,最后,不公平的获取和培训困难,这给团队带来了困难。结论:由于立法限制和资源或能力限制,子宫移植在欧洲各地的可及性差异很大。结果是这些计划成为父母却不能从移植中受益的妇女感到不公正/误解和绝望。他们似乎得不到足够的支持。最终无法接受移植手术的女性也许应该得到心理支持,以应对这种失望,而少数最终能够接受移植手术的女性则由训练有素的多学科团队进行监督。
{"title":"How do women with Rokitansky syndrome and healthcare professionals reflect on the provision of uterine transplantation? Insights from an interview study in France, Norway, and Sweden","authors":"Isis Carton, Ludivine Dion, Vincent Lavoué, Bjorn Morten Hofmann","doi":"10.1111/aogs.15016","DOIUrl":"10.1111/aogs.15016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Uterine transplantation is currently intended for women with absolute uterine infertility. Since proof of the concept in 2014, many countries have started research programs and clinical activities. However, access to uterine transplantation remains limited given that only a few hundred transplants have been described worldwide compared with the 1.5 million women of childbearing age who suffer from absolute uterine infertility. The aim of this study was to investigate how limited access to uterine transplantation is perceived by women with Mayer–Rokitansky–Küster–Hauser syndrome and health professionals involved in uterus transplantation programs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a qualitative study with semistructured interviews in France, Norway, and Sweden with women with Mayer–Rokitansky–Küster–Hauser syndrome and health professional involved in uterine transplantation programs. The interviews were analyzed manually using thematic content analysis. The research questions were: How do (a) women with Mayer–Rokitansky–Küster–Hauser syndrome and (b) healthcare professionals involved in uterus transplantation programs perceive uterus transplantation and its accessibility 10 years after proof of concept?</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The interviews enabled us to highlight a number of themes addressed by doctors and women with Mayer–Rokitansky–Küster–Hauser syndrome, the main ones being the hope raised by this technique and the disappointment for those who do not have access to it, the lack of perception of the risks associated with the technique, and finally, an inequity of access and the training difficulties this entails for the teams.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Access to uterine transplantation varies widely across Europe owing to legislative restrictions and limited access due to resources or competence. The result is a feeling of injustice/misunderstanding and despair for these women who had planned to become parents and cannot benefit from a transplant. They appear to be poorly supported. Women who are ultimately unable to access a transplant program should perhaps be given psychological support to deal with this disappointment, whereas the minority who finally have had access to transplant programs are supervised by well-trained multidisciplinary teams.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 3","pages":"502-513"},"PeriodicalIF":3.5,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942399","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}
Line Winther Gustafson, Louise Krog, Bayan Sardini, Mette Tranberg, Lone Kjeld Petersen, Berit Andersen, Pinar Bor, Anne Hammer
Introduction
Diagnostic work-up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation zone. To reduce the risk of missing disease, a diagnostic cervical excision may be performed. However, little is known on treatment efficacy and post-treatment surveillance for older women. We aimed to investigate the proportion of women testing negative for human papillomavirus (HPV) following a diagnostic cervical excision due to an abnormal screening test.
Material and Methods
We conducted a prospective cohort study on women aged ≥45 years who were referred for colposcopy due to an abnormal screening test between March 2019 and June 2021. All women had incomplete visualization of the transformation zone and underwent colposcopy and a diagnostic cervical excision at the first visit. Women were followed from date of excision until January 30, 2023. Follow-up data was retrieved from the Danish Pathology Databank, and baseline characteristics were obtained from medical records. Cox regression was used on interval-censored data to estimate crude and adjusted hazard ratios for a negative HPV test after cervical excision, stratified by histology and age.
Results
A total of 100 women underwent a diagnostic cervical excision and had at least one HPV test during follow-up. Median age was 67.4 years, and median follow-up time was 2.9 years. At the end of follow-up, 70% tested HPV negative. Women with cervical intraepithelial neoplasia grade two or worse in their excision specimen were more likely to test HPV negative at the first test after cervical excision compared to women with less than cervical intraepithelial neoplasia grade two, however, not statistically significant (adjusted hazard ratio 1.69, 95% CI 0.92–3.10). Women aged 65–84 years were less likely to test HPV negative compared to women <65 years (adjusted hazard ratio 0.49, 95% CI 0.28–0.87).
Conclusions
In older women undergoing a diagnostic cervical excision, 70% tested HPV negative after 2.9 years, leaving 30% with persistent HPV positivity. More studies are needed to determine the risks associated with continued HPV positivity in the absence of high-grade disease. Furthermore, given the absence of specific guidelines, the optimal surveillance frequency remains unknown.
导读:诊断工作与宫颈癌筛查试验阳性的老年妇女往往是具有挑战性的,由于不完全可视化的转化区。为了减少漏诊的风险,可以进行诊断性宫颈切除术。然而,对老年妇女的治疗效果和治疗后监测知之甚少。我们的目的是调查由于筛查试验异常而行宫颈诊断性切除后人乳头瘤病毒(HPV)检测阴性的妇女比例。材料和方法:我们对2019年3月至2021年6月期间因筛查结果异常而转诊进行阴道镜检查的年龄≥45岁的女性进行了一项前瞻性队列研究。所有妇女都有不完全可见的转化区,并在第一次就诊时接受阴道镜检查和诊断性宫颈切除术。这些女性从切除之日起一直随访到2023年1月30日。随访数据来自丹麦病理数据库,基线特征来自医疗记录。采用Cox回归对区间剔除数据进行分析,估计宫颈切除术后HPV检测阴性的粗风险比和校正风险比,并按组织学和年龄分层。结果:共有100名妇女接受了诊断性宫颈切除术,并在随访期间至少进行了一次HPV检测。中位年龄67.4岁,中位随访时间2.9年。在随访结束时,70%的人HPV检测呈阴性。切除标本中宫颈上皮内瘤变2级或更严重的女性与宫颈上皮内瘤变2级以下的女性相比,宫颈切除后第一次检测HPV阴性的可能性更大,但没有统计学意义(校正风险比1.69,95% CI 0.92-3.10)。结论:在接受诊断性宫颈切除术的老年妇女中,70%的人在2.9年后检测出HPV阴性,剩下30%的人持续HPV阳性。需要更多的研究来确定在没有高级别疾病的情况下持续HPV阳性的风险。此外,由于缺乏具体的指导方针,最佳监测频率仍然未知。
{"title":"High rate of persistent HPV detection after diagnostic cervical excision in older screen-positive women","authors":"Line Winther Gustafson, Louise Krog, Bayan Sardini, Mette Tranberg, Lone Kjeld Petersen, Berit Andersen, Pinar Bor, Anne Hammer","doi":"10.1111/aogs.15019","DOIUrl":"10.1111/aogs.15019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Diagnostic work-up of older women with a positive cervical cancer screening test is often challenging due to incomplete visualization of the transformation zone. To reduce the risk of missing disease, a diagnostic cervical excision may be performed. However, little is known on treatment efficacy and post-treatment surveillance for older women. We aimed to investigate the proportion of women testing negative for human papillomavirus (HPV) following a diagnostic cervical excision due to an abnormal screening test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a prospective cohort study on women aged ≥45 years who were referred for colposcopy due to an abnormal screening test between March 2019 and June 2021. All women had incomplete visualization of the transformation zone and underwent colposcopy and a diagnostic cervical excision at the first visit. Women were followed from date of excision until January 30, 2023. Follow-up data was retrieved from the Danish Pathology Databank, and baseline characteristics were obtained from medical records. Cox regression was used on interval-censored data to estimate crude and adjusted hazard ratios for a negative HPV test after cervical excision, stratified by histology and age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 100 women underwent a diagnostic cervical excision and had at least one HPV test during follow-up. Median age was 67.4 years, and median follow-up time was 2.9 years. At the end of follow-up, 70% tested HPV negative. Women with cervical intraepithelial neoplasia grade two or worse in their excision specimen were more likely to test HPV negative at the first test after cervical excision compared to women with less than cervical intraepithelial neoplasia grade two, however, not statistically significant (adjusted hazard ratio 1.69, 95% CI 0.92–3.10). Women aged 65–84 years were less likely to test HPV negative compared to women <65 years (adjusted hazard ratio 0.49, 95% CI 0.28–0.87).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In older women undergoing a diagnostic cervical excision, 70% tested HPV negative after 2.9 years, leaving 30% with persistent HPV positivity. More studies are needed to determine the risks associated with continued HPV positivity in the absence of high-grade disease. Furthermore, given the absence of specific guidelines, the optimal surveillance frequency remains unknown.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"342-349"},"PeriodicalIF":3.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913223","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}
Azar Mehrabadi, Ya-Hui Yu, Sonia M. Grandi, Robert W. Platt, Kristian B. Filion
Introduction
Evidence suggests that gestational diabetes mellitus (GDM) is associated with subsequent cardiovascular disease; however, it is unclear what impact changes in screening and diagnostic criteria have had on the association of GDM with long-term outcomes such as cardiovascular disease. The purpose of this study was to determine the association between GDM and subsequent cardiovascular disease during a period of rising gestational diabetes diagnosis in England. Specifically, associations were compared before and after 2008, when national guidelines supporting risk factor-based screening were introduced.
Material and Methods
We conducted a cohort study using routinely collected data from the Clinical Practice Research Datalink linked to the Hospital Episode Statistics and Office for National Statistics databases. The study consisted of persons aged 15–45 years with a livebirth or stillbirth between 1998 and 2017 and without a history of cardiovascular disease or pre-pregnancy diabetes mellitus. Cox proportional hazards models, with propensity score weighting using matching weights, were used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for the association of GDM diagnosis in the first recorded pregnancy with subsequent cardiovascular disease.
Results
Among 232 315 individuals, the incidence of cardiovascular disease was 6.6 per 1000 person-years among those with GDM and 2.2 per 1000 person-years among those without GDM over a mean follow-up duration of 5.8 years. The overall aHR, 95% CI was 1.91 (1.41, 2.60). Diagnosis of GDM increased over the study period, from 0.7% in 1998–99 to 5.3% in 2017. The effect size was not markedly different in the years before (1998–2007: adjusted HR 2.05, 95% CI 2.05 1.35, 3.12) and after 2008 (2008–2017: adjusted HR 1.79, 95% CI 1.15, 2.80).
Conclusions
There was a strong association of GDM with cardiovascular disease after accounting for social and demographic factors and multiple comorbidities, and this association was present both before and after 2008, when national gestational diabetes screening criteria were established.
有证据表明妊娠期糖尿病(GDM)与随后的心血管疾病相关;然而,目前尚不清楚筛查和诊断标准的变化对GDM与心血管疾病等长期预后的关联有何影响。本研究的目的是在英国妊娠期糖尿病诊断上升期间确定GDM与随后心血管疾病之间的关系。具体来说,在2008年引入支持基于风险因素筛查的国家指南后,比较了前后的关联。材料和方法:我们进行了一项队列研究,使用常规收集的数据,这些数据来自与医院事件统计和国家统计办公室数据库相连的临床实践研究数据链。该研究包括年龄在15-45岁之间,在1998年至2017年期间活产或死产,且无心血管疾病史或孕前糖尿病史的人。Cox比例风险模型,使用匹配权重的倾向评分加权,用于估计具有95%置信区间(CIs)的调整风险比(ahr),以确定首次记录妊娠中GDM诊断与随后心血管疾病的关联。结果:在23315例受试者中,GDM患者心血管疾病发病率为6.6 / 1000人年,非GDM患者为2.2 / 1000人年,平均随访时间为5.8年。总aHR, 95% CI为1.91(1.41,2.60)。在研究期间,GDM的诊断率从1998-99年的0.7%上升到2017年的5.3%。2008年之前(1998-2007年:调整后危险度2.05,95% CI 2.05 1.35, 3.12)和2008年之后(2008-2017年:调整后危险度1.79,95% CI 1.15, 2.80)的效应量无显著差异。结论:在考虑了社会人口因素和多种合并症后,GDM与心血管疾病有很强的相关性,这种相关性在2008年国家妊娠糖尿病筛查标准建立之前和之后都存在。
{"title":"Gestational diabetes mellitus and subsequent cardiovascular disease in a period of rising diagnoses: Cohort study","authors":"Azar Mehrabadi, Ya-Hui Yu, Sonia M. Grandi, Robert W. Platt, Kristian B. Filion","doi":"10.1111/aogs.15022","DOIUrl":"10.1111/aogs.15022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Evidence suggests that gestational diabetes mellitus (GDM) is associated with subsequent cardiovascular disease; however, it is unclear what impact changes in screening and diagnostic criteria have had on the association of GDM with long-term outcomes such as cardiovascular disease. The purpose of this study was to determine the association between GDM and subsequent cardiovascular disease during a period of rising gestational diabetes diagnosis in England. Specifically, associations were compared before and after 2008, when national guidelines supporting risk factor-based screening were introduced.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a cohort study using routinely collected data from the Clinical Practice Research Datalink linked to the Hospital Episode Statistics and Office for National Statistics databases. The study consisted of persons aged 15–45 years with a livebirth or stillbirth between 1998 and 2017 and without a history of cardiovascular disease or pre-pregnancy diabetes mellitus. Cox proportional hazards models, with propensity score weighting using matching weights, were used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for the association of GDM diagnosis in the first recorded pregnancy with subsequent cardiovascular disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 232 315 individuals, the incidence of cardiovascular disease was 6.6 per 1000 person-years among those with GDM and 2.2 per 1000 person-years among those without GDM over a mean follow-up duration of 5.8 years. The overall aHR, 95% CI was 1.91 (1.41, 2.60). Diagnosis of GDM increased over the study period, from 0.7% in 1998–99 to 5.3% in 2017. The effect size was not markedly different in the years before (1998–2007: adjusted HR 2.05, 95% CI 2.05 1.35, 3.12) and after 2008 (2008–2017: adjusted HR 1.79, 95% CI 1.15, 2.80).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was a strong association of GDM with cardiovascular disease after accounting for social and demographic factors and multiple comorbidities, and this association was present both before and after 2008, when national gestational diabetes screening criteria were established.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"331-341"},"PeriodicalIF":3.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913220","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}
Sidsel Hogh-Poulsen, Sif Emilie Carlsen, Jane M. Bendix, Tine D. Clausen, Ellen C. L. Lokkegaard, Paul Vignir Bryde Axelsson
<div> <section> <h3> Introduction</h3> <p>Induction of labor is a common procedure, and in Denmark, approximately one in four vaginal deliveries are induced. The association between induction and maternal postpartum infections such as endometritis, surgical site infection after cesarean section, urinary tract infection, and sepsis has been sparsely investigated. Our objective was to investigate the association between induction of labor and risk of maternal postpartum infection and to identify potential risk factors for infection.</p> </section> <section> <h3> Material and Methods</h3> <p>In a nationwide cohort study, all deliveries with live-born singletons from January 1, 2007, to December 31, 2017 (<i>n</i> = 546 864) were included. Deliveries were grouped into categories of spontaneous onset of labor, induction of labor, and elective cesarean section. The primary outcome was any infection within 30 days postpartum based on discharge diagnosis codes and redeemed antibiotic prescriptions for endometritis, surgical site infection, urinary tract infection, and sepsis. Analyses were done using logistic regression.</p> </section> <section> <h3> Results</h3> <p>Infection within 30 days postpartum was found among 8.5% of the women undergoing induction of labor compared to 6.8% of the women with spontaneous onset of labor. In adjusted logistic regression analyses, the risk of postpartum infection was significantly increased after induction of labor compared to spontaneous onset of labor (adjusted ORs [aOR], 1.24; 95% confidence interval [CI], 1.21–1.27). Women with rupture of membranes were not at increased risk of postpartum infection (aOR 1.01; 95%CI 0.94–1.09). The risk of postpartum maternal sepsis was not significantly associated with induction of labor. Antibiotic treatment during pregnancy, pre-eclampsia, and long education were all associated with increased risk of maternal postpartum infection, while either a low or high body mass index and previous deliveries were associated with decreased risk.</p> </section> <section> <h3> Conclusions</h3> <p>Induction of labor was associated with an increased risk of maternal postpartum infection. However, the absolute risk was 1.7% higher for the women with induced labor compared to spontaneous onset of labor, which we believe should not be a cause for concern. Unexpectedly, low and high body mass index was associated with decreased risk of infection, and rupture of membranes was not associated with increased risk after induction of labor, which might reflect actual clinical management.</p>
{"title":"Maternal postpartum infection risk following induction of labor: A Danish national cohort study","authors":"Sidsel Hogh-Poulsen, Sif Emilie Carlsen, Jane M. Bendix, Tine D. Clausen, Ellen C. L. Lokkegaard, Paul Vignir Bryde Axelsson","doi":"10.1111/aogs.15035","DOIUrl":"10.1111/aogs.15035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Induction of labor is a common procedure, and in Denmark, approximately one in four vaginal deliveries are induced. The association between induction and maternal postpartum infections such as endometritis, surgical site infection after cesarean section, urinary tract infection, and sepsis has been sparsely investigated. Our objective was to investigate the association between induction of labor and risk of maternal postpartum infection and to identify potential risk factors for infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>In a nationwide cohort study, all deliveries with live-born singletons from January 1, 2007, to December 31, 2017 (<i>n</i> = 546 864) were included. Deliveries were grouped into categories of spontaneous onset of labor, induction of labor, and elective cesarean section. The primary outcome was any infection within 30 days postpartum based on discharge diagnosis codes and redeemed antibiotic prescriptions for endometritis, surgical site infection, urinary tract infection, and sepsis. Analyses were done using logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Infection within 30 days postpartum was found among 8.5% of the women undergoing induction of labor compared to 6.8% of the women with spontaneous onset of labor. In adjusted logistic regression analyses, the risk of postpartum infection was significantly increased after induction of labor compared to spontaneous onset of labor (adjusted ORs [aOR], 1.24; 95% confidence interval [CI], 1.21–1.27). Women with rupture of membranes were not at increased risk of postpartum infection (aOR 1.01; 95%CI 0.94–1.09). The risk of postpartum maternal sepsis was not significantly associated with induction of labor. Antibiotic treatment during pregnancy, pre-eclampsia, and long education were all associated with increased risk of maternal postpartum infection, while either a low or high body mass index and previous deliveries were associated with decreased risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Induction of labor was associated with an increased risk of maternal postpartum infection. However, the absolute risk was 1.7% higher for the women with induced labor compared to spontaneous onset of labor, which we believe should not be a cause for concern. Unexpectedly, low and high body mass index was associated with decreased risk of infection, and rupture of membranes was not associated with increased risk after induction of labor, which might reflect actual clinical management.</p>\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"309-318"},"PeriodicalIF":3.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906194","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}
Léa Karpel, Margaux Nicaise, Marie Carbonnel, Mathilde Le Marchand, Catherine Racowsky, Paul Pirtea, Jean-Marc Ayoubi
Introduction
Since 2017, women with absolute uterine infertility due to Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome have been eligible to participate in a uterine transplantation clinical trial conducted by Foch Hospital in France. The aim of this study is to assess the psychological state of potential candidates, including recipients, their partners, and their living-related donors.
Material and Methods
Sixteen potential uterus transplant candidates, including recipients, partners, and living-related donors, participated in the study. The psychological evaluation of these candidates was conducted using three validated questionnaires: the Dyadic Adjustment Scale (DAS-16), the Hospital Anxiety and Depression Scale (HADS), and the Fertility Quality of Life (FertiQoL) questionnaire.
Results
No depression symptoms were observed in any participant according to the HADS. Most recipients did not exhibit signs of anxiety; however, three partners and three donors reported moderate to high anxiety levels. A positive correlation was found between the recipient's psychological distress related to infertility (FertiQoL) and the anxiety scores of their donors. The emotional aspect of infertility was identified as the most distressing factor for the recipients.
Conclusions
While the overall psychological state of the participants was generally good, anxiety was notably present among donors and partners. Therefore, providing psychological support throughout the uterine transplantation process is essential for not only the recipients but also their partners and donors.
自2017年以来,因MRKH综合征(mayer - rokitansky - k ster- hauser综合征)导致的绝对子宫不孕的女性有资格参加法国Foch医院进行的子宫移植临床试验。这项研究的目的是评估潜在候选人的心理状态,包括接受者、他们的伴侣和与他们生活相关的捐赠者。材料和方法:16名潜在的子宫移植候选人,包括受体、伴侣和活体供体,参与了这项研究。对这些候选者的心理评估采用三份有效问卷:二元调整量表(DAS-16)、医院焦虑和抑郁量表(HADS)和生育生活质量问卷(FertiQoL)。结果:根据HADS,所有参与者均未观察到抑郁症状。大多数接受者没有表现出焦虑的迹象;然而,三个伴侣和三个捐赠者报告了中度到高度的焦虑水平。受赠者与不孕相关的心理困扰(FertiQoL)与其供者的焦虑评分呈正相关。不孕不育的情感方面被确定为接受者最痛苦的因素。结论:虽然参与者的整体心理状态总体良好,但在捐赠者和合作伙伴中明显存在焦虑。因此,在整个子宫移植过程中提供心理支持不仅对受者,而且对其伴侣和供体都是至关重要的。
{"title":"Psychological evaluation of candidates for the uterus transplantation French trial","authors":"Léa Karpel, Margaux Nicaise, Marie Carbonnel, Mathilde Le Marchand, Catherine Racowsky, Paul Pirtea, Jean-Marc Ayoubi","doi":"10.1111/aogs.15004","DOIUrl":"10.1111/aogs.15004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Since 2017, women with absolute uterine infertility due to Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome have been eligible to participate in a uterine transplantation clinical trial conducted by Foch Hospital in France. The aim of this study is to assess the psychological state of potential candidates, including recipients, their partners, and their living-related donors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Sixteen potential uterus transplant candidates, including recipients, partners, and living-related donors, participated in the study. The psychological evaluation of these candidates was conducted using three validated questionnaires: the Dyadic Adjustment Scale (DAS-16), the Hospital Anxiety and Depression Scale (HADS), and the Fertility Quality of Life (FertiQoL) questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No depression symptoms were observed in any participant according to the HADS. Most recipients did not exhibit signs of anxiety; however, three partners and three donors reported moderate to high anxiety levels. A positive correlation was found between the recipient's psychological distress related to infertility (FertiQoL) and the anxiety scores of their donors. The emotional aspect of infertility was identified as the most distressing factor for the recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While the overall psychological state of the participants was generally good, anxiety was notably present among donors and partners. Therefore, providing psychological support throughout the uterine transplantation process is essential for not only the recipients but also their partners and donors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 3","pages":"522-527"},"PeriodicalIF":3.5,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906209","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}
Within normal variation, higher hemoglobin (Hb) levels are associated with poorer metabolic profile in population cohorts, underlying the link between oxygen delivery and cell metabolism. Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women and is commonly accompanied by metabolic derangements. In this study we sought to investigate Hb levels, and their metabolic associations, in women with PCOS.
Material and Methods
We used data from Northern Finland Birth Cohort 1966 to evaluate Hb levels in women with or without PCOS at the ages of 31 and 46 years. Linear regression models were used to investigate associations between Hb levels and essential metabolic parameters in both groups.
Results
Women with PCOS had higher Hb levels than controls at the age of 31 years but not at the age of 46 years. Hb levels were associated positively with most of the metabolic parameters tested (body mass index, waist circumference, fasting insulin, homeostatic model assessment–insulin resistance (HOMA-IR), blood pressure, inflammatory markers, and blood lipids), with stronger associations in women with PCOS than in non-PCOS controls. There were fewer associations at the age of 46 than at 31 years, and body mass index seemed to explain many, though not all, differences between the PCOS and non-PCOS groups.
Conclusions
Women with PCOS have higher Hb levels at the age of 31 years. In both women with and without PCOS, Hb levels associate with poorer metabolic profile.
{"title":"Association of hemoglobin levels with metabolic traits in women with PCOS","authors":"Nikke Virtanen, Emilia Pesonen, Ulla Saarela, Elisa Hurskainen, Riikka K. Arffman, Peppi Koivunen, Terhi Piltonen","doi":"10.1111/aogs.15047","DOIUrl":"10.1111/aogs.15047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Within normal variation, higher hemoglobin (Hb) levels are associated with poorer metabolic profile in population cohorts, underlying the link between oxygen delivery and cell metabolism. Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women and is commonly accompanied by metabolic derangements. In this study we sought to investigate Hb levels, and their metabolic associations, in women with PCOS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We used data from Northern Finland Birth Cohort 1966 to evaluate Hb levels in women with or without PCOS at the ages of 31 and 46 years. Linear regression models were used to investigate associations between Hb levels and essential metabolic parameters in both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Women with PCOS had higher Hb levels than controls at the age of 31 years but not at the age of 46 years. Hb levels were associated positively with most of the metabolic parameters tested (body mass index, waist circumference, fasting insulin, homeostatic model assessment–insulin resistance (HOMA-IR), blood pressure, inflammatory markers, and blood lipids), with stronger associations in women with PCOS than in non-PCOS controls. There were fewer associations at the age of 46 than at 31 years, and body mass index seemed to explain many, though not all, differences between the PCOS and non-PCOS groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Women with PCOS have higher Hb levels at the age of 31 years. In both women with and without PCOS, Hb levels associate with poorer metabolic profile.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"357-367"},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909114","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}
Hanna Hautamäki, Mika Gissler, Jenni Heikkinen-Eloranta, Aila Tiitinen, Pirkko Peuranpää
<div> <section> <h3> Introduction</h3> <p>Recurrent pregnancy loss (RPL), defined as two or more pregnancy losses, might be associated with elevated obstetrical and perinatal risks in the following pregnancies. RPL and pregnancy problems related to placental development may have similar etiological features. This study explores the incidences of pregnancy and perinatal outcomes in women with RPL.</p> </section> <section> <h3> Material and Methods</h3> <p>This retrospective case–control study investigated the outcomes of the next subsequent singleton pregnancy after thorough RPL examination (<i>n</i> = 360) in Helsinki University Hospital, Finland, in 2007–2016. Data for cases and four control women for each case, matched for age, parity, delivery month, year, and hospital (<i>n</i> = 1440), were retrieved from the Medical Birth Register. Primary outcomes were pregnancy and delivery complications, perinatal outcomes, and characteristics of pregnancy follow-up. Secondary outcomes were maternal and neonatal diagnoses. Associations between RPL and outcomes were estimated with risk ratios with 95% confidence intervals (CI). In sub-analyses, we compared the outcomes of secondary RPL with multipara controls and women with unexplained or explained RPL.</p> </section> <section> <h3> Results</h3> <p>Women with RPL had a higher risk for gestational hypertension (3.1% vs. 1.4%, risk ratio [RR] 2.20 [Confidence interval (CI) 1.06–4.55], <i>p</i> = 0.03), preterm birth (8.9% vs. 5.8%, RR 1.54 [CI 1.04–2.28], <i>p</i> = 0.04), malpresentation of the fetus (3.3% vs. 1.5%, RR 2.18 [CI 1.09–4.37], <i>p</i> = 0.02), premature rupture of membranes (5.6% vs. 2.4%, RR 2.35 [CI 1.37–4.04], <i>p</i> = 0.002), and had more prenatal visits than controls. Mode of delivery was comparable between the study groups, although RPL women had more induced labor (28.1% vs. 22.2%, RR 1.26 [CI 1.04–1.53], <i>p</i> = 0.02). Mean birthweight was lower (3387 ± 680 g) in RPL women's newborns than in the control group (3482 ± 564 g, <i>p</i> = 0.02), and the risk of umbilical artery pH <7.10 (6.7% vs. 3.6%, RR 1.85 [CI 1.15–2.95], <i>p</i> = 0.03) was higher. Risk ratio for small for gestational age was higher in the secondary RPL group than in multipara controls (5.1% vs. 2.0%, RR 2.50 [CI 1.15–5.42], <i>p</i> = 0.02).</p> </section> <section> <h3> Conclusions</h3> <p>Women with a history of RPL seem to have higher risks in their subsequent pregnancies and should therefore be monitored carefully. These findings support the theory of placental development being the common nominator behin
复发性妊娠丢失(RPL),定义为两次或两次以上妊娠丢失,可能与后续妊娠的产科和围产期风险升高有关。RPL和与胎盘发育有关的妊娠问题可能具有相似的病因学特征。本研究探讨了RPL妇女的妊娠发生率和围产期结局。材料和方法:本回顾性病例对照研究调查了2007-2016年在芬兰赫尔辛基大学医院进行RPL检查后的下一次单胎妊娠结局(n = 360)。病例和每个病例的四名对照妇女的数据,匹配年龄、胎次、分娩月份、年份和医院(n = 1440),从医学出生登记册中检索。主要结局是妊娠和分娩并发症、围产期结局和妊娠随访特征。次要结局是产妇和新生儿的诊断。RPL与结果之间的关联用95%可信区间(CI)的风险比进行估计。在亚分析中,我们比较了继发性RPL与多段对照和不明原因或解释性RPL妇女的结果。结果:RPL患者发生妊娠期高血压(3.1%比1.4%,风险比[RR] 2.20[置信区间(CI) 1.06-4.55], p = 0.03)、早产(8.9%比5.8%,RR 1.54 [CI 1.04-2.28], p = 0.04)、胎儿胎位不良(3.3%比1.5%,RR 2.18 [CI 1.09-4.37], p = 0.02)、胎膜早破(5.6%比2.4%,RR 2.35 [CI 1.37-4.04], p = 0.002)的风险较高,且产前就诊次数多于对照组。虽然RPL妇女有更多的引产(28.1%比22.2%,RR 1.26 [CI 1.04-1.53], p = 0.02),但各研究组之间的分娩方式具有可比性。RPL组新生儿的平均出生体重(3387±680 g)低于对照组(3482±564 g, p = 0.02),且脐动脉pH风险较高。结论:有RPL病史的妇女在随后的妊娠中似乎有更高的风险,因此应仔细监测。这些发现支持胎盘发育是高血压妊娠障碍和RPL背后的共同推手的理论。
{"title":"Pregnancy and perinatal outcomes in women with recurrent pregnancy loss—A case–control study","authors":"Hanna Hautamäki, Mika Gissler, Jenni Heikkinen-Eloranta, Aila Tiitinen, Pirkko Peuranpää","doi":"10.1111/aogs.15039","DOIUrl":"10.1111/aogs.15039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Recurrent pregnancy loss (RPL), defined as two or more pregnancy losses, might be associated with elevated obstetrical and perinatal risks in the following pregnancies. RPL and pregnancy problems related to placental development may have similar etiological features. This study explores the incidences of pregnancy and perinatal outcomes in women with RPL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This retrospective case–control study investigated the outcomes of the next subsequent singleton pregnancy after thorough RPL examination (<i>n</i> = 360) in Helsinki University Hospital, Finland, in 2007–2016. Data for cases and four control women for each case, matched for age, parity, delivery month, year, and hospital (<i>n</i> = 1440), were retrieved from the Medical Birth Register. Primary outcomes were pregnancy and delivery complications, perinatal outcomes, and characteristics of pregnancy follow-up. Secondary outcomes were maternal and neonatal diagnoses. Associations between RPL and outcomes were estimated with risk ratios with 95% confidence intervals (CI). In sub-analyses, we compared the outcomes of secondary RPL with multipara controls and women with unexplained or explained RPL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Women with RPL had a higher risk for gestational hypertension (3.1% vs. 1.4%, risk ratio [RR] 2.20 [Confidence interval (CI) 1.06–4.55], <i>p</i> = 0.03), preterm birth (8.9% vs. 5.8%, RR 1.54 [CI 1.04–2.28], <i>p</i> = 0.04), malpresentation of the fetus (3.3% vs. 1.5%, RR 2.18 [CI 1.09–4.37], <i>p</i> = 0.02), premature rupture of membranes (5.6% vs. 2.4%, RR 2.35 [CI 1.37–4.04], <i>p</i> = 0.002), and had more prenatal visits than controls. Mode of delivery was comparable between the study groups, although RPL women had more induced labor (28.1% vs. 22.2%, RR 1.26 [CI 1.04–1.53], <i>p</i> = 0.02). Mean birthweight was lower (3387 ± 680 g) in RPL women's newborns than in the control group (3482 ± 564 g, <i>p</i> = 0.02), and the risk of umbilical artery pH <7.10 (6.7% vs. 3.6%, RR 1.85 [CI 1.15–2.95], <i>p</i> = 0.03) was higher. Risk ratio for small for gestational age was higher in the secondary RPL group than in multipara controls (5.1% vs. 2.0%, RR 2.50 [CI 1.15–5.42], <i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Women with a history of RPL seem to have higher risks in their subsequent pregnancies and should therefore be monitored carefully. These findings support the theory of placental development being the common nominator behin","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"368-379"},"PeriodicalIF":3.5,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875729","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}
<p>After 10 years at the helm, Professor Ganesh Acharya has passed on the mantle of chief editorship of AOGS. Under his leadership the journal has gone from strength to strength. I am excited and intimidated in equal measures to step up as the 13th Chief Editor and the first one from outside Scandinavia. Although the team is not new to me—I have been a Deputy Chief Editor of AOGS for the last 6 years—the responsibility and expectations are certainly new. I am aware that I would be standing on the shoulders of giants.</p><p>In his editorial last month (AOGS-24-1372.R1),<span><sup>1</sup></span> Professor Acharya looked back at his time at AOGS. The journal successfully transitioned to open access publishing, maintained its ranking in the O & G journals, maintained the reputation for publishing reliable, good quality research in our specialty, and strengthened the reputation for quick and effective decision making for the submitted manuscripts. He outlined our principles—excellence, fairness, openness, and equality, that he has eschewed and I hope to emulate.</p><p>We are experiencing a marked increase in the number of submissions. Last year (2023) we dealt with 1185 submitted manuscripts, this year we are already past 1500. This makes editorial work challenging. With the support of the Nordic Federation of Societies of Obstetrics and Gynecology (NFOG), we now have two Deputy Chief Editors instead of one. I am looking forward to working with them.</p><p>We have been on the receiving end of the wrath of some of our authors for transitioning to open-access publishing. In their view, we were becoming no different from “predatory journals” that have mushroomed over the last few years. A list of such journals (beallslist.net) is available to view on the internet, and I am proud to note that AOGS does not figure on it. The Directory of Open Access Journals (DOAJ, www.doaj.org) was developed in response to discussions about predatory publishing. The decision to transform to open access publishing was that of NFOG rather than our publishers. The decision did not stem from profit making. On the contrary, the NFOG was of the opinion that research that benefits mankind should not be hidden behind paywalls and should be accessible to all. Governments of Scandic nations—bar the exception of Denmark and Iceland—support open access publishing by entering into transformational agreements with the publishers, so that the publishing charges are not borne by either the authors or the readers. However, several of our competitors are still publishing in a hybrid format and not fully open access. Another publishing model is “diamond access,” where the authors do not pay publication charges but the manuscripts are still free to view. Many such journals are published by university departments and publication charges are borne by their internal budgets or through charity support. This model has been successfully used in South America.<span><sup>2</sup></span> Unfortuna
{"title":"AOGS in 2025: Opportunities and challenges","authors":"Amarnath Bhide","doi":"10.1111/aogs.15044","DOIUrl":"10.1111/aogs.15044","url":null,"abstract":"<p>After 10 years at the helm, Professor Ganesh Acharya has passed on the mantle of chief editorship of AOGS. Under his leadership the journal has gone from strength to strength. I am excited and intimidated in equal measures to step up as the 13th Chief Editor and the first one from outside Scandinavia. Although the team is not new to me—I have been a Deputy Chief Editor of AOGS for the last 6 years—the responsibility and expectations are certainly new. I am aware that I would be standing on the shoulders of giants.</p><p>In his editorial last month (AOGS-24-1372.R1),<span><sup>1</sup></span> Professor Acharya looked back at his time at AOGS. The journal successfully transitioned to open access publishing, maintained its ranking in the O & G journals, maintained the reputation for publishing reliable, good quality research in our specialty, and strengthened the reputation for quick and effective decision making for the submitted manuscripts. He outlined our principles—excellence, fairness, openness, and equality, that he has eschewed and I hope to emulate.</p><p>We are experiencing a marked increase in the number of submissions. Last year (2023) we dealt with 1185 submitted manuscripts, this year we are already past 1500. This makes editorial work challenging. With the support of the Nordic Federation of Societies of Obstetrics and Gynecology (NFOG), we now have two Deputy Chief Editors instead of one. I am looking forward to working with them.</p><p>We have been on the receiving end of the wrath of some of our authors for transitioning to open-access publishing. In their view, we were becoming no different from “predatory journals” that have mushroomed over the last few years. A list of such journals (beallslist.net) is available to view on the internet, and I am proud to note that AOGS does not figure on it. The Directory of Open Access Journals (DOAJ, www.doaj.org) was developed in response to discussions about predatory publishing. The decision to transform to open access publishing was that of NFOG rather than our publishers. The decision did not stem from profit making. On the contrary, the NFOG was of the opinion that research that benefits mankind should not be hidden behind paywalls and should be accessible to all. Governments of Scandic nations—bar the exception of Denmark and Iceland—support open access publishing by entering into transformational agreements with the publishers, so that the publishing charges are not borne by either the authors or the readers. However, several of our competitors are still publishing in a hybrid format and not fully open access. Another publishing model is “diamond access,” where the authors do not pay publication charges but the manuscripts are still free to view. Many such journals are published by university departments and publication charges are borne by their internal budgets or through charity support. This model has been successfully used in South America.<span><sup>2</sup></span> Unfortuna","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"4-5"},"PeriodicalIF":3.5,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875726","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}
Helena Kopp Kallner, Ingela Lindh, Kristina Gemzell-Danielsson
Despite great societal efforts promoting female autonomy, Sweden still faces unmet contraceptive needs, with abortion rates being the highest in the Nordic countries. In this commentary, we discuss using non-daily contraception options to combat these unmet needs. Non-daily methods include transdermal (i.e., patch), ring, injectables, and long-acting reversible contraception (LARC). Numerous studies have revealed that users prefer non-daily methods, and studies implementing structured counseling have revealed an increase in non-daily methods. Relative to LARC, the patch and the ring are non-daily parenteral methods that offer the possibility for self-management. Ultimately, client-centered counseling and shared decision-making are crucial for increasing awareness of all methods and enhancing method utilization and adherence. Finally, dispelling myths surrounding reversible hormonal contraception is essential for empowering women to make informed choices and improving overall reproductive health outcomes.
{"title":"Non-daily contraception: Reinforcing the choice of users and addressing unmet needs of reproductive health","authors":"Helena Kopp Kallner, Ingela Lindh, Kristina Gemzell-Danielsson","doi":"10.1111/aogs.15014","DOIUrl":"10.1111/aogs.15014","url":null,"abstract":"<p>Despite great societal efforts promoting female autonomy, Sweden still faces unmet contraceptive needs, with abortion rates being the highest in the Nordic countries. In this commentary, we discuss using non-daily contraception options to combat these unmet needs. Non-daily methods include transdermal (i.e., patch), ring, injectables, and long-acting reversible contraception (LARC). Numerous studies have revealed that users prefer non-daily methods, and studies implementing structured counseling have revealed an increase in non-daily methods. Relative to LARC, the patch and the ring are non-daily parenteral methods that offer the possibility for self-management. Ultimately, client-centered counseling and shared decision-making are crucial for increasing awareness of all methods and enhancing method utilization and adherence. Finally, dispelling myths surrounding reversible hormonal contraception is essential for empowering women to make informed choices and improving overall reproductive health outcomes.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"253-257"},"PeriodicalIF":3.5,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871040","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}
<div> <section> <h3> Introduction</h3> <p>Pre-labor rupture of membranes (PROM) occurs in about 8% of term pregnancies with over 70% delivering spontaneously within 24 h. However, prolonged PROM increases the risk of chorioamnionitis and neonatal sepsis. While misoprostol and oxytocin are considered safe and effective methods of labor induction, most guidelines do not encourage balloon catheter (BC) use following PROM given concerns about increased risk of chorioamnionitis. However, lack of robust evidence exists. This study aimed to compare BC and low-dose oral misoprostol (OM) regarding infectious morbidity and assess the impact of routine antibiotic prophylaxis during BC use on infection prevention.</p> </section> <section> <h3> Material and Methods</h3> <p>A randomized controlled trial comparing BC and low-dose 25 μg OM for pre-induction cervical ripening in an inpatient setting and assessing the preventive effect of prophylactic antibiotics during BC use in 175 women with PROM was carried out between 1.2.2021 and 31.12.2023 in Helsinki University Hospital. The study protocol was registered in the ISCTN registry (ISRCTN10972090). The primary outcome measures of the study were the mode of delivery, and maternal and neonatal infections.</p> </section> <section> <h3> Results</h3> <p>Eighty-nine women (50.9%) were allocated in the BC arm and 86 women (49.1%) in the OM arm. The cesarean delivery rates were comparable (BC 19.1% [<i>n</i> = 17] vs. OM 11.6% [<i>n</i> = 10]; <i>p</i> = 0.17). The rate of chorioamnionitis (BC 9.1% [<i>n</i> = 8] vs. OM 3.5% [<i>n</i> = 3]; <i>p</i> = 0.21) or neonatal infection (BC 4.5% [<i>n</i> = 4] vs. OM 2.3% [<i>n</i> = 2]; <i>p</i> = 0.68) were not statistically significantly different between the groups, although there was a trend towards higher frequency of infections in the BC arm. There were no differences in the incidence of chorioamnionitis or neonatal infections when routine antibiotic prophylaxis was administered during the BC use compared to those who did not receive antibiotics (chorioamnionitis 10.9% with antibiotics vs. 8.0% without antibiotics; <i>p</i> = 0.68, and neonatal infection 5.3% vs. 3.9%; <i>p</i> = 1.00). Maternal childbirth satisfaction was similar in the BC and OM groups.</p> </section> <section> <h3> Conclusions</h3> <p>Our results showed almost threefold frequency of chorioamnionitis and twofold frequency of neonatal infections following the use of BC compared to OM, although the study was underpowered for reaching statistical significance. The use of prophylactic antibiotics during BC
{"title":"Comparison of balloon catheter and oral misoprostol for cervical ripening in women with pre-labor rupture of membranes: A Finnish randomized controlled trial","authors":"Heidi Kruit, Leena Rahkonen","doi":"10.1111/aogs.15036","DOIUrl":"10.1111/aogs.15036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pre-labor rupture of membranes (PROM) occurs in about 8% of term pregnancies with over 70% delivering spontaneously within 24 h. However, prolonged PROM increases the risk of chorioamnionitis and neonatal sepsis. While misoprostol and oxytocin are considered safe and effective methods of labor induction, most guidelines do not encourage balloon catheter (BC) use following PROM given concerns about increased risk of chorioamnionitis. However, lack of robust evidence exists. This study aimed to compare BC and low-dose oral misoprostol (OM) regarding infectious morbidity and assess the impact of routine antibiotic prophylaxis during BC use on infection prevention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A randomized controlled trial comparing BC and low-dose 25 μg OM for pre-induction cervical ripening in an inpatient setting and assessing the preventive effect of prophylactic antibiotics during BC use in 175 women with PROM was carried out between 1.2.2021 and 31.12.2023 in Helsinki University Hospital. The study protocol was registered in the ISCTN registry (ISRCTN10972090). The primary outcome measures of the study were the mode of delivery, and maternal and neonatal infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-nine women (50.9%) were allocated in the BC arm and 86 women (49.1%) in the OM arm. The cesarean delivery rates were comparable (BC 19.1% [<i>n</i> = 17] vs. OM 11.6% [<i>n</i> = 10]; <i>p</i> = 0.17). The rate of chorioamnionitis (BC 9.1% [<i>n</i> = 8] vs. OM 3.5% [<i>n</i> = 3]; <i>p</i> = 0.21) or neonatal infection (BC 4.5% [<i>n</i> = 4] vs. OM 2.3% [<i>n</i> = 2]; <i>p</i> = 0.68) were not statistically significantly different between the groups, although there was a trend towards higher frequency of infections in the BC arm. There were no differences in the incidence of chorioamnionitis or neonatal infections when routine antibiotic prophylaxis was administered during the BC use compared to those who did not receive antibiotics (chorioamnionitis 10.9% with antibiotics vs. 8.0% without antibiotics; <i>p</i> = 0.68, and neonatal infection 5.3% vs. 3.9%; <i>p</i> = 1.00). Maternal childbirth satisfaction was similar in the BC and OM groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results showed almost threefold frequency of chorioamnionitis and twofold frequency of neonatal infections following the use of BC compared to OM, although the study was underpowered for reaching statistical significance. The use of prophylactic antibiotics during BC ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 2","pages":"400-407"},"PeriodicalIF":3.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852029","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}