Acta Obstetricia et Gynecologica Scandinavica最新文献_第7页

Predicting vaginal delivery after labor induction using machine learning: Development of a multivariable prediction model 利用机器学习预测引产后的阴道分娩：开发多变量预测模型。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2024-11-27 DOI: 10.1111/aogs.14953

Iolanda Ferreira, Joana Simões, João Correia, Ana Luísa Areia

Introduction

Induction of labor, often used for pregnancy termination, has globally rising rates, especially in high-income countries where pregnant women present with more comorbidities. Consequently, concerns on a potential rise in cesarean section (CS) rates after induction of labor (IOL) demand for improved counseling on delivery mode within this context.

Material and Methods

We aim to develop a prognostic model for predicting vaginal delivery after labor induction using computational learning. Secondary aims include elaborating a prognostic model for CS due to abnormal fetal heart rate and labor dystocia, and evaluation of these models' feature importance, using maternal clinical predictors at IOL admission. The best performing model was assessed in an independent validation data using the area under the receiver operating curve (AUROC). Internal model validation was performed using 10-fold cross-validation. Feature importance was calculated using SHAP (SHapley Additive exPlanation) values to interpret the importance of influential features. Our main outcome measures were mode of delivery after induction of labor, dichotomized as vaginal or cesarean delivery and CS indications, dichotomized as abnormal fetal heart rate and labor dystocia.

Results

Our sample comprised singleton term pregnant women (n = 2434) referred for IOL to a tertiary Obstetrics center between January 2018 and December 2021. Prediction of vaginal delivery obtained good discrimination in the independent validation data (AUROC = 0.794, 95% CI 0.783–0.805), showing high positive and negative predictive values (PPV and NPV) of 0.752 and 0.793, respectively, high specificity (0.910) and sensitivity (0.766). The CS model showed an AUROC of 0.590 (95% CI 0.565–0.615) and high specificity (0.893). Sensitivity, PPV and NVP values were 0.665, 0.617, and 0.7, respectively. Labor features associated with vaginal delivery were by order of importance: Bishop score, number of previous term deliveries, maternal height, interpregnancy time interval, and previous eutocic delivery.

Conclusions

This prognostic model produced a 0.794 AUROC for predicting vaginal delivery. This, coupled with knowing the features influencing this outcome, may aid providers in assessing an individual's risk of CS after IOL and provide personalized counseling.

导言：引产常被用于终止妊娠，其比例在全球范围内不断上升，尤其是在高收入国家，因为这些国家的孕妇合并症较多。因此，人们担心引产（IOL）后剖宫产（CS）率可能会上升，这就要求在这种情况下改进分娩方式的咨询：我们的目标是利用计算学习技术开发一个预测引产后阴道分娩的预后模型。其次，我们还利用产妇入院时的临床预测指标，建立了一个针对胎心率异常和难产导致的CS的预后模型，并对这些模型的重要特征进行了评估。在独立验证数据中，使用接收者操作曲线下面积（AUROC）对表现最佳的模型进行评估。内部模型验证采用 10 倍交叉验证。使用 SHAP（SHapley Additive exPlanation）值计算特征的重要性，以解释有影响的特征的重要性。我们的主要结果指标是引产后的分娩方式（二分法分为阴道分娩或剖宫产）和CS指征（二分法分为胎心率异常和难产）：我们的样本包括2018年1月至2021年12月期间转诊至三级产科中心进行IOL的单胎足月孕妇（n = 2434）。阴道分娩预测在独立验证数据中获得了良好的区分度（AUROC = 0.794，95% CI 0.783-0.805），显示出较高的阳性预测值（PPV）和阴性预测值（NPV），分别为 0.752 和 0.793，特异性（0.910）和灵敏度（0.766）均较高。CS 模型的 AUROC 为 0.590（95% CI 0.565-0.615），特异性高（0.893）。灵敏度、PPV 和 NVP 值分别为 0.665、0.617 和 0.7。与阴道分娩相关的分娩特征依次为结论：该预后模型预测阴道分娩的 AUROC 为 0.794。结论：该预后模型预测阴道分娩的AUROC为0.794，再加上了解影响这一结果的特征，可帮助医疗服务提供者评估个体在人工晶体植入术后发生CS的风险，并提供个性化咨询。

{"title":"Predicting vaginal delivery after labor induction using machine learning: Development of a multivariable prediction model","authors":"Iolanda Ferreira, Joana Simões, João Correia, Ana Luísa Areia","doi":"10.1111/aogs.14953","DOIUrl":"10.1111/aogs.14953","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Induction of labor, often used for pregnancy termination, has globally rising rates, especially in high-income countries where pregnant women present with more comorbidities. Consequently, concerns on a potential rise in cesarean section (CS) rates after induction of labor (IOL) demand for improved counseling on delivery mode within this context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We aim to develop a prognostic model for predicting vaginal delivery after labor induction using computational learning. Secondary aims include elaborating a prognostic model for CS due to abnormal fetal heart rate and labor dystocia, and evaluation of these models' feature importance, using maternal clinical predictors at IOL admission. The best performing model was assessed in an independent validation data using the area under the receiver operating curve (AUROC). Internal model validation was performed using 10-fold cross-validation. Feature importance was calculated using SHAP (SHapley Additive exPlanation) values to interpret the importance of influential features. Our main outcome measures were mode of delivery after induction of labor, dichotomized as vaginal or cesarean delivery and CS indications, dichotomized as abnormal fetal heart rate and labor dystocia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our sample comprised singleton term pregnant women (<i>n</i> = 2434) referred for IOL to a tertiary Obstetrics center between January 2018 and December 2021. Prediction of vaginal delivery obtained good discrimination in the independent validation data (AUROC = 0.794, 95% CI 0.783–0.805), showing high positive and negative predictive values (PPV and NPV) of 0.752 and 0.793, respectively, high specificity (0.910) and sensitivity (0.766). The CS model showed an AUROC of 0.590 (95% CI 0.565–0.615) and high specificity (0.893). Sensitivity, PPV and NVP values were 0.665, 0.617, and 0.7, respectively. Labor features associated with vaginal delivery were by order of importance: Bishop score, number of previous term deliveries, maternal height, interpregnancy time interval, and previous eutocic delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This prognostic model produced a 0.794 AUROC for predicting vaginal delivery. This, coupled with knowing the features influencing this outcome, may aid providers in assessing an individual's risk of CS after IOL and provide personalized counseling.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"164-173"},"PeriodicalIF":3.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724625","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}

引用次数: 0

Scientific integrity and Nordic quality will remain the hallmark of Acta Obstetricia et Gynecologica Scandinavica 科学诚信和北欧品质仍将是《斯堪的纳维亚产科和妇科杂志》的标志。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2024-11-25 DOI: 10.1111/aogs.15026

Ganesh Acharya

<p>After serving 10 years, I will finish my term as the Chief Editor of <i>Acta Obstetricia et Gynecologica Scandinavica</i> (AOGS) in the end of December 2024. It gives me an immense pleasure to know that our more than a century old journal<span><sup>1, 2</sup></span> is in very good condition and I am leaving it in the hands of an excellent team of editors, which will be led by Prof Amarnath Bhide from St. George's Hospital and City St. George's, University of London, UK, who has more than 15 years of editorial experience and has been a Deputy Chief Editor of AOGS for the last 6 years. It is a historical moment for our journal as Amar is the first Chief Editor of AOGS appointed from outside Scandinavia, emphasizing and reflecting the international spirit, authorship, and readership of the journal. Reaching beyond Scandinavia has been one of our priorities in the last decade, which has been only possible by the support of an International Editorial Board consisting of highly qualified experts in their respective fields, and I am very grateful to them all.</p><p>In my first editorial as the 12th Chief Editor of AOGS in January 2015 entitled “<i>AOGS: An international journal with Scandinavian quality</i>,” I wrote “…our focus will be on improving the quality of publications and their visibility, assuring ethical conduct in research, promoting dissemination of important findings and improving service to our authors.”<span><sup>1</sup></span> A number of steps were taken to ensure quality and scientific integrity of published articles including a close collaboration with Chief Editors of other journals in our specialty.<span><sup>3, 4</sup></span></p><p>What is the measure of quality of a peer-reviewed medical journal can be debated, but there is no single acceptable indicator of quality. In my opinion, what are the aims of a journal and what does the society that owns it really stand for are as important as how often the journal articles are read and cited. AOGS is owned by the Nordic Federation of Societies of Obstetrics and Gynecology (NFOG), a professional nonprofit organization that aims to promote scientific collaboration among obstetricians and gynecologists in the Nordic countries and beyond to improve health and well-being of girls and women globally. Shared attributes of Nordic quality are creativity/innovativeness, openness/transparency, compassion/equality, mutual respect and trust (social cohesion), and commitment to sustainable development. We have tried to assure the quality of AOGS sticking to Nordic values. Self-discipline, involvement of the whole team in planning, implementation and governance supported by direct open communication, and regular educational activities have been crucial for continuously improving the quality of our journal.</p><p>The importance of responsible ethical conduct cannot be overemphasized in scientific research and publication. We have meticulously and systematically worked together with the authors (and

任职10年后，我将于2024年12月底结束《斯堪的纳维亚妇产科学报》（AOGS）主编的任期。我非常高兴地得知，我们拥有一个多世纪历史的期刊《1,2》状况良好，我将把它交给一个优秀的编辑团队，由英国伦敦大学圣乔治医院和圣乔治城的Amarnath Bhide教授领导，他拥有超过15年的编辑经验，在过去的6年里一直担任AOGS的副主编。对于我们的期刊来说，这是一个历史性的时刻，因为Amar是第一位从斯堪的纳维亚以外任命的AOGS主编，强调并反映了期刊的国际精神，作者和读者。在过去十年中，向斯堪的纳维亚半岛以外的地区发展一直是我们的优先事项之一，这只有在由各自领域的高素质专家组成的国际编辑委员会的支持下才有可能实现，我非常感谢他们所有人。2015年1月，作为AOGS第12任主编，我在题为《AOGS：具有斯堪的纳维亚品质的国际期刊》的第一篇社论中写道：“我们的重点将是提高出版物的质量和知名度，确保研究中的道德行为，促进重要发现的传播，改善对作者的服务。”“我们采取了一系列措施来确保已发表文章的质量和科学完整性，包括与我们专业领域其他期刊的主编密切合作。衡量同行评议医学期刊质量的标准是什么是有争议的，但没有一个可以接受的质量指标。在我看来，期刊的目标是什么，拥有它的社会真正代表什么，与期刊文章被阅读和引用的频率一样重要。AOGS隶属于北欧妇产科协会联合会（NFOG），这是一个专业的非营利性组织，旨在促进北欧国家及其他地区的妇产科医生之间的科学合作，以改善全球女孩和妇女的健康和福祉。北欧品质的共同特征是创造力/创新性、开放/透明、同情/平等、相互尊重和信任（社会凝聚力）以及对可持续发展的承诺。我们努力保证AOGS坚持北欧价值观的质量。自律、整个团队在计划、实施和管理方面的参与，以及直接公开的沟通和定期的教育活动，对不断提高我们期刊的质量至关重要。在科学研究和出版中，负责任的道德行为的重要性怎么强调都不为过。十多年来，我们与作者（以及他们的机构）、编辑、审稿人和出版商进行了细致而系统的合作，以确保在AOGS发表的所有研究文章都符合道德标准。最近发生的一个重大发展是世界医学协会（WMA）于2024年10月19日在《美国医学会杂志》上发表的《赫尔辛基宣言》（Declaration of Helsinki）的第十次修订。它引入了一些重要的变化，可能对科学研究的进行和发表产生积极影响。除其他事项外，它包括关于即使在突发公共卫生事件中也要坚持伦理原则的声明，保护参与研究的患者和健康志愿者，要求进行涉及人类参与者的医学研究必须具备足够的资格、能力和科学诚信，并避免任何不当行为和研究浪费。良好的意图并不总是导致期望的实践或结果。一个这样的例子是，孕妇被排除在某些研究之外，特别是干涉性临床试验，因为误解了WMA关于弱势参与者（如孕妇或少数民族和种族）应该受到保护的声明。然而，在较不脆弱的群体（如男性或非孕妇）中进行的研究结果可能不适用于孕妇，并且排除孕妇的危害可能大于纳入孕妇所造成的危害。因此，在确保孕妇安全的同时参与研究是很重要的。这一点已在最近修订的赫尔辛基WMA宣言中得到承认。希望这将导致更多的孕妇参与临床试验，从而大大改善目前的状况。我们是一份国际期刊，我们追求卓越。我们倡导公平、开放、平等。据我所知，我们的期刊是第一本完全开放获取的学会所有的普通妇产科期刊。向开放获取出版模式的过渡相对顺利，它有助于在世界范围内传播和分享好的科学，为我们的读者提供对AOGS发表的原始研究文章、评论和评论的无限制访问，这将继续帮助他们提高科学知识，促进循证临床实践，对妇女健康产生积极影响。作为AOGS的主编，我感到非常荣幸。我得到了NFOG董事会、AOGS编辑委员会和世界各地同事的无条件支持。在你的帮助下，作为一个团队把事情做好，而不是从我自己或别人的错误或失败中学习，这是一次令人满意的经历。我知道未来会有很多挑战和机遇。人工智能等新技术带来的一些挑战已经开始敲门了然而，我真的相信AOGS有一个光明的未来，科学诚信和北欧品质将在未来几年继续保持它的标志。

{"title":"Scientific integrity and Nordic quality will remain the hallmark of Acta Obstetricia et Gynecologica Scandinavica","authors":"Ganesh Acharya","doi":"10.1111/aogs.15026","DOIUrl":"10.1111/aogs.15026","url":null,"abstract":"<p>After serving 10 years, I will finish my term as the Chief Editor of <i>Acta Obstetricia et Gynecologica Scandinavica</i> (AOGS) in the end of December 2024. It gives me an immense pleasure to know that our more than a century old journal<span><sup>1, 2</sup></span> is in very good condition and I am leaving it in the hands of an excellent team of editors, which will be led by Prof Amarnath Bhide from St. George's Hospital and City St. George's, University of London, UK, who has more than 15 years of editorial experience and has been a Deputy Chief Editor of AOGS for the last 6 years. It is a historical moment for our journal as Amar is the first Chief Editor of AOGS appointed from outside Scandinavia, emphasizing and reflecting the international spirit, authorship, and readership of the journal. Reaching beyond Scandinavia has been one of our priorities in the last decade, which has been only possible by the support of an International Editorial Board consisting of highly qualified experts in their respective fields, and I am very grateful to them all.</p><p>In my first editorial as the 12th Chief Editor of AOGS in January 2015 entitled “<i>AOGS: An international journal with Scandinavian quality</i>,” I wrote “…our focus will be on improving the quality of publications and their visibility, assuring ethical conduct in research, promoting dissemination of important findings and improving service to our authors.”<span><sup>1</sup></span> A number of steps were taken to ensure quality and scientific integrity of published articles including a close collaboration with Chief Editors of other journals in our specialty.<span><sup>3, 4</sup></span></p><p>What is the measure of quality of a peer-reviewed medical journal can be debated, but there is no single acceptable indicator of quality. In my opinion, what are the aims of a journal and what does the society that owns it really stand for are as important as how often the journal articles are read and cited. AOGS is owned by the Nordic Federation of Societies of Obstetrics and Gynecology (NFOG), a professional nonprofit organization that aims to promote scientific collaboration among obstetricians and gynecologists in the Nordic countries and beyond to improve health and well-being of girls and women globally. Shared attributes of Nordic quality are creativity/innovativeness, openness/transparency, compassion/equality, mutual respect and trust (social cohesion), and commitment to sustainable development. We have tried to assure the quality of AOGS sticking to Nordic values. Self-discipline, involvement of the whole team in planning, implementation and governance supported by direct open communication, and regular educational activities have been crucial for continuously improving the quality of our journal.</p><p>The importance of responsible ethical conduct cannot be overemphasized in scientific research and publication. We have meticulously and systematically worked together with the authors (and","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 12","pages":"2328-2329"},"PeriodicalIF":3.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.15026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708956","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}

引用次数: 0

Maternal and perinatal outcomes of live births after uterus transplantation: A systematic review. 子宫移植后活产的产妇和围产期结局：系统综述。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2024-11-23 DOI: 10.1111/aogs.15003

Mats Brännström, Hans Bokström, Henrik Hagberg, Ylva Carlsson

Introduction: Uterus transplantation (UTx) is a treatment for absolute uterine factor infertility. The results of pregnancies of this complex infertility treatment should be established. The aim of the study was to systematically review maternal and neonatal outcomes in the pregnancies of women who have undergone UTx.

Material and methods: The population of this review were women that have undergone UTx and delivered child(ren). Cesarean delivery after UTx were planned to be compared with studies reporting maternal mortality/morbidity and perinatal mortality/morbidity after delivery by elective cesarean section without UTx. Systematic literature searches were performed utilizing Medline, Embase, the Cochrane Library, Cinahl, PsycInfo, Web of Science, and clinicaltrials.gov for studies written in English language and published between January 1, 2010, and November 08, 2023. No study design limitation was applied. If no comparative studies were identified, we planned to report the outcomes from the case reports and case series. Included studies were assessed for risk of bias using a checklist for case series. The study protocol was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (registration number: INPLASY202310052).

Results: Twenty-four articles were identified, containing data on 40 unique live births. Multiple publications including same cases were identified and clearly indicated. No comparative studies were identified. The certainty of evidence was very low, as all studies were either case reports (n = 15) or case series (n = 9). All deliveries were by cesarean section and 47.5% of them resulted in emergency cesarean sections. Out of the 21 elective cesarean sections, 52.4% were performed before 37 weeks' gestation. Historical comparison to population data on pregnancies delivered by cesarean section found a markedly increased risk for both the mother and child following cesarean section for UTx. Risks for placenta previa and preterm birth were notably high after UTx; however, some of the later may reflect the results of provider-initiated births.

Conclusions: The maternal and perinatal outcomes of 40 live births post-UTx indicate that these pregnancies may be at high risk of maternal and perinatal complications. Aiming to delay elective cesarean section beyond 37 weeks' gestation could potentially reduce some of these risks. Registration of maternal and perinatal outcomes after UTx through quality registries are essential and obstetrical care guidelines for these women should be established.

简介子宫移植（UTx）是一种治疗绝对子宫因素不孕症的方法。这种复杂的不孕症治疗方法的妊娠结果应予以确定。本研究旨在系统回顾接受过子宫移植手术的妇女的妊娠结局和新生儿结局：本次研究的对象是接受过UTx并分娩过婴儿的妇女。计划将UTx后的剖宫产与未进行UTx的选择性剖宫产的产妇死亡率/发病率和围产期死亡率/发病率的研究报告进行比较。通过Medline、Embase、Cochrane图书馆、Cinahl、PsycInfo、Web of Science和clinicaltrials.gov对2010年1月1日至2023年11月8日期间发表的英文研究进行了系统的文献检索。研究设计不受限制。如果未发现对比研究，我们计划报告病例报告和系列病例的结果。我们使用病例系列检查表对纳入的研究进行了偏倚风险评估。研究方案已在注册系统综述和荟萃分析方案国际平台注册（注册号：INPLASY202310052）：结果：共发现 24 篇文章，包含 40 例活产的数据。发现并明确指出了包含相同病例的多篇文献。未发现对比研究。由于所有研究均为病例报告（15 例）或系列病例（9 例），因此证据的确定性非常低。所有分娩均采用剖宫产，其中 47.5% 为急诊剖宫产。在21例选择性剖宫产中，52.4%是在妊娠37周前进行的。与剖腹产孕妇的人口数据进行历史比较后发现，UTx剖腹产后母婴的风险都明显增加。UTx术后前置胎盘和早产的风险明显较高；不过，有些早产可能反映了由提供者主动分娩的结果：40例UTx后活产的孕产妇和围产期结果表明，这些孕妇可能面临孕产妇和围产期并发症的高风险。将选择性剖宫产的时间推迟到妊娠 37 周以后可能会降低部分风险。通过高质量的登记册对UTx后的孕产妇和围产期结果进行登记至关重要，并应为这些妇女制定产科护理指南。

{"title":"Maternal and perinatal outcomes of live births after uterus transplantation: A systematic review.","authors":"Mats Brännström, Hans Bokström, Henrik Hagberg, Ylva Carlsson","doi":"10.1111/aogs.15003","DOIUrl":"https://doi.org/10.1111/aogs.15003","url":null,"abstract":"<p><strong>Introduction: </strong>Uterus transplantation (UTx) is a treatment for absolute uterine factor infertility. The results of pregnancies of this complex infertility treatment should be established. The aim of the study was to systematically review maternal and neonatal outcomes in the pregnancies of women who have undergone UTx.</p><p><strong>Material and methods: </strong>The population of this review were women that have undergone UTx and delivered child(ren). Cesarean delivery after UTx were planned to be compared with studies reporting maternal mortality/morbidity and perinatal mortality/morbidity after delivery by elective cesarean section without UTx. Systematic literature searches were performed utilizing Medline, Embase, the Cochrane Library, Cinahl, PsycInfo, Web of Science, and clinicaltrials.gov for studies written in English language and published between January 1, 2010, and November 08, 2023. No study design limitation was applied. If no comparative studies were identified, we planned to report the outcomes from the case reports and case series. Included studies were assessed for risk of bias using a checklist for case series. The study protocol was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (registration number: INPLASY202310052).</p><p><strong>Results: </strong>Twenty-four articles were identified, containing data on 40 unique live births. Multiple publications including same cases were identified and clearly indicated. No comparative studies were identified. The certainty of evidence was very low, as all studies were either case reports (n = 15) or case series (n = 9). All deliveries were by cesarean section and 47.5% of them resulted in emergency cesarean sections. Out of the 21 elective cesarean sections, 52.4% were performed before 37 weeks' gestation. Historical comparison to population data on pregnancies delivered by cesarean section found a markedly increased risk for both the mother and child following cesarean section for UTx. Risks for placenta previa and preterm birth were notably high after UTx; however, some of the later may reflect the results of provider-initiated births.</p><p><strong>Conclusions: </strong>The maternal and perinatal outcomes of 40 live births post-UTx indicate that these pregnancies may be at high risk of maternal and perinatal complications. Aiming to delay elective cesarean section beyond 37 weeks' gestation could potentially reduce some of these risks. Registration of maternal and perinatal outcomes after UTx through quality registries are essential and obstetrical care guidelines for these women should be established.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Uterus transplantation: A bibliometric review of six-decade study from 1960 to 2024. 子宫移植：1960年至2024年六十年研究的文献计量学回顾。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2024-11-23 DOI: 10.1111/aogs.14977

Razieh Akbari, Marjan Ghaemi, Zahra Panahi

Introduction: Some women are unable to become pregnant because they do not have a functional uterus. Over the last decade, it has become possible for these women to get pregnant through uterus transplantation, which has been the subject of numerous research studies. Therefore, the purpose of this study is to review published articles in the uterus transplantation area.

Material and methods: We conducted a cross-sectional bibliometric review to study the 100 highly cited papers in the Web of Science and Scopus databases from 1960 to 2024. Our research applied bibliometric analysis to these top 100 highly cited papers. Document citation and co-occurrence analysis were used for the data study. VOSviewer along with Bibliometrix® software was used to design the maps.

Results: The trend of uterus transplantation publications increased exponentially after 2010. Sweden is the leading country, followed by the USA and Spain. Fertility and Sterility, Lancet, American Journal of Transplantation, and Human Reproduction were the highly cited journals. Collaboration among countries showed that the most collaboration took place between Sweden and Spain (18), Sweden and the USA (14), the USA and Spain (8), Sweden and Australia (6), and the USA and the United Kingdom (6). Furthermore, the results found that more than one-third of the highly cited papers were review papers (39%) and 27% were clinical trial studies.

Conclusions: This bibliometric review provides a valuable contribution to the literature on uterine transplantation by synthesizing and analyzing existing research findings. It offers insights into current trends, key themes, geographic distribution, and potential areas for future research within this rapidly evolving field.

简介有些妇女因为没有功能性子宫而无法怀孕。近十年来，通过子宫移植，这些妇女有可能怀孕，这已成为众多研究的主题。因此，本研究旨在回顾子宫移植领域已发表的文章：我们进行了横向文献计量学回顾，研究了 1960 年至 2024 年期间在 Web of Science 和 Scopus 数据库中引用率较高的 100 篇论文。我们的研究对这前 100 篇高被引论文进行了文献计量学分析。数据研究采用了文献引用和共现分析。VOSviewer 和 Bibliometrix® 软件被用来设计地图：结果：2010 年后，子宫移植论文呈指数增长趋势。瑞典居首位，其次是美国和西班牙。Fertility and Sterility》、《Lancet》、《American Journal of Transplantation》和《Human Reproduction》是高被引期刊。国家间的合作显示，瑞典与西班牙（18）、瑞典与美国（14）、美国与西班牙（8）、瑞典与澳大利亚（6）以及美国与英国（6）之间的合作最多。此外，研究结果还发现，超过三分之一的高被引论文是综述论文（39%），27%是临床试验研究：这篇文献计量学综述通过综合分析现有研究成果，为子宫移植文献做出了宝贵贡献。它为这一快速发展的领域提供了关于当前趋势、关键主题、地理分布和未来潜在研究领域的见解。

{"title":"Uterus transplantation: A bibliometric review of six-decade study from 1960 to 2024.","authors":"Razieh Akbari, Marjan Ghaemi, Zahra Panahi","doi":"10.1111/aogs.14977","DOIUrl":"https://doi.org/10.1111/aogs.14977","url":null,"abstract":"<p><strong>Introduction: </strong>Some women are unable to become pregnant because they do not have a functional uterus. Over the last decade, it has become possible for these women to get pregnant through uterus transplantation, which has been the subject of numerous research studies. Therefore, the purpose of this study is to review published articles in the uterus transplantation area.</p><p><strong>Material and methods: </strong>We conducted a cross-sectional bibliometric review to study the 100 highly cited papers in the Web of Science and Scopus databases from 1960 to 2024. Our research applied bibliometric analysis to these top 100 highly cited papers. Document citation and co-occurrence analysis were used for the data study. VOSviewer along with Bibliometrix® software was used to design the maps.</p><p><strong>Results: </strong>The trend of uterus transplantation publications increased exponentially after 2010. Sweden is the leading country, followed by the USA and Spain. Fertility and Sterility, Lancet, American Journal of Transplantation, and Human Reproduction were the highly cited journals. Collaboration among countries showed that the most collaboration took place between Sweden and Spain (18), Sweden and the USA (14), the USA and Spain (8), Sweden and Australia (6), and the USA and the United Kingdom (6). Furthermore, the results found that more than one-third of the highly cited papers were review papers (39%) and 27% were clinical trial studies.</p><p><strong>Conclusions: </strong>This bibliometric review provides a valuable contribution to the literature on uterine transplantation by synthesizing and analyzing existing research findings. It offers insights into current trends, key themes, geographic distribution, and potential areas for future research within this rapidly evolving field.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fetal rotation examined with ultrasound in a sub-Saharan population: A longitudinal cohort study 用超声波检查撒哈拉以南人口的胎儿旋转情况：纵向队列研究。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2024-11-20 DOI: 10.1111/aogs.15013

Kenneth Bagandanshwa, Bariki Mchome, Upendo Kibona, Raziya Gaffur, Ibrahim Salum, Adelaida Kavishe, Cecilia Mushi, Pendo Mlay, Gileard Masenga, Signe Egenberg, Torbjørn Moe Eggebø

Introduction

Occiput posterior (OP) position rates at birth are 5%–8% in studies mainly comprising white European women. The anthropoid pelvis is common in black African women. This pelvic shape has a narrow anterior segment and an ample room posteriorly. The fetal head is wider posteriorly, and the OP position may be favorable in women with an anthropoid pelvic shape. We aimed to examine the fetal rotation with ultrasound longitudinally during the active phase of labor in a sub-Saharan population. We also aimed to examine associations between fetal position, delivery mode, and duration of labor.

Material and Methods

The study was conducted at Kilimanjaro Christian Medical Centre in Moshi, Tanzania from the 19th of November 2023 to 13th of April 2024. Women with a single fetus in cephalic presentation, gestational age >37 weeks, without previous or pre-labor cesarean section were eligible. Fetal position was classified as occiput anterior (OA) from 10 to 2 o'clock, occiput transverse (OT) at 3 or 9 o'clock, and OP position from 4 to 8 o'clock.

Results

The study participants comprised 215 women. Fetal positions at admission, in the first and second stage of labor and at birth are presented in the graphical figure. In all, 65/215 (30.2%) fetuses were in OP position at admission, 59/204 (28.9%) in the first stage, 38/210 (18.1%) in the second stage and 35/215 (16.3%) were delivered in OP position. The OP rates at birth were 25/92 (27.2%) in nulliparous and 10/123 (8.1%) in parous women. The operative delivery rate was 10/157 (6.4%) in women with ultrasound assessed fetal position as OA in the second stage (six cesarean section and four vacuum extractions), and 28/48 (58.3%) in the non-OA group (27 cesarean section and one vacuum extraction) (p < 0.01). The hazard ratio for delivery in the second stage was 0.26 (95% CI 0.13–0.52) for the non-OA vs the OA group in nulliparous women and 0.25 (95% CI 0.12–0.52) in parous women.

Conclusions

The persistent OP position rate at birth was higher than previously reported, and the operative intervention rate was nine time higher in women with the fetus in non-OA vs OA position in the second stage.

简介在主要由欧洲白人妇女进行的研究中，出生时枕后位的比例为 5%-8%。非洲黑人妇女常见的骨盆形状为 "anthropoid"。这种骨盆形状前段狭窄，后段宽敞。胎儿头部后部较宽，OP 位置可能对骨盆呈扁平状的女性有利。我们的目的是在撒哈拉以南地区的人群中，用超声波纵向检查活跃产程中胎儿的旋转情况。我们还旨在研究胎位、分娩方式和产程之间的关联：研究于 2023 年 11 月 19 日至 2024 年 4 月 13 日在坦桑尼亚莫希的乞力马扎罗基督教医疗中心进行。单胎头位、胎龄大于 37 周、既往或产前未进行过剖宫产手术的产妇均符合条件。胎位分为枕前位（OA）（10 点至 2 点）、枕横位（OT）（3 点或 9 点）和枕后位（OP）（4 点至 8 点）：研究对象包括 215 名妇女。入院时、第一产程、第二产程和分娩时的胎位见下图。共有 65/215 (30.2%) 的胎儿在入院时为 OP 位，59/204 (28.9%) 的胎儿在第一产程为 OP 位，38/210 (18.1%) 的胎儿在第二产程为 OP 位，35/215 (16.3%) 的胎儿在分娩时为 OP 位。无阴道产妇的 OP 分娩率为 25/92（27.2%），准阴道产妇的 OP 分娩率为 10/123（8.1%）。在第二阶段超声评估胎位为 OA 的产妇中，手术分娩率为 10/157（6.4%）（6 例剖宫产和 4 例真空吸引术），而在非 OA 组中，手术分娩率为 28/48（58.3%）（27 例剖宫产和 1 例真空吸引术）：出生时持续OP胎位率高于之前的报道，在第二阶段胎儿为非OA胎位的产妇中，手术干预率是OA胎位产妇的9倍。

{"title":"Fetal rotation examined with ultrasound in a sub-Saharan population: A longitudinal cohort study","authors":"Kenneth Bagandanshwa, Bariki Mchome, Upendo Kibona, Raziya Gaffur, Ibrahim Salum, Adelaida Kavishe, Cecilia Mushi, Pendo Mlay, Gileard Masenga, Signe Egenberg, Torbjørn Moe Eggebø","doi":"10.1111/aogs.15013","DOIUrl":"10.1111/aogs.15013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Occiput posterior (OP) position rates at birth are 5%–8% in studies mainly comprising white European women. The anthropoid pelvis is common in black African women. This pelvic shape has a narrow anterior segment and an ample room posteriorly. The fetal head is wider posteriorly, and the OP position may be favorable in women with an anthropoid pelvic shape. We aimed to examine the fetal rotation with ultrasound longitudinally during the active phase of labor in a sub-Saharan population. We also aimed to examine associations between fetal position, delivery mode, and duration of labor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>The study was conducted at Kilimanjaro Christian Medical Centre in Moshi, Tanzania from the 19th of November 2023 to 13th of April 2024. Women with a single fetus in cephalic presentation, gestational age >37 weeks, without previous or pre-labor cesarean section were eligible. Fetal position was classified as occiput anterior (OA) from 10 to 2 o'clock, occiput transverse (OT) at 3 or 9 o'clock, and OP position from 4 to 8 o'clock.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study participants comprised 215 women. Fetal positions at admission, in the first and second stage of labor and at birth are presented in the graphical figure. In all, 65/215 (30.2%) fetuses were in OP position at admission, 59/204 (28.9%) in the first stage, 38/210 (18.1%) in the second stage and 35/215 (16.3%) were delivered in OP position. The OP rates at birth were 25/92 (27.2%) in nulliparous and 10/123 (8.1%) in parous women. The operative delivery rate was 10/157 (6.4%) in women with ultrasound assessed fetal position as OA in the second stage (six cesarean section and four vacuum extractions), and 28/48 (58.3%) in the non-OA group (27 cesarean section and one vacuum extraction) (<i>p</i> < 0.01). The hazard ratio for delivery in the second stage was 0.26 (95% CI 0.13–0.52) for the non-OA vs the OA group in nulliparous women and 0.25 (95% CI 0.12–0.52) in parous women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The persistent OP position rate at birth was higher than previously reported, and the operative intervention rate was nine time higher in women with the fetus in non-OA vs OA position in the second stage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"225-234"},"PeriodicalIF":3.5,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680491","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}

引用次数: 0

The complexity and challenges of fertility preservation in women with cervix cancer—A prospective cohort study reporting on reproductive outcome and overall survival 宫颈癌妇女生育力保存的复杂性和挑战--一项前瞻性队列研究，报告生育结果和总生存率。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2024-11-20 DOI: 10.1111/aogs.15007

Anna Marklund, Yanyu Jiang, Hanna Röjlar, Fotios Sergouniotis, Hanna Nilsson, Frida E. Lundberg, Kenny A. Rodriguez-Wallberg

Introduction

Our objective was to assess the feasibility of fertility preservation (FP) in women referred for cervix cancer, the long-term reproductive outcome, and overall survival.

Material and Methods

Prospective cohort study of patients referred for FP counseling between 1999 and 2021 to the FP program of Karolinska University Hospital, Stockholm, Sweden. Baseline data included age, parity, disease stage, treatment characteristics, and FP methods applied. Data on reproductive outcomes and overall survival (by October 19, 2023) were retrieved from clinical registries and a population-based register. Trial registration number: ClinicalTrials.gov NTC04602962.

Results

In total, 91 women were referred, 67% with stage I cancers and 25%, 7%, and 1% with stages II, III, and IV, respectively. Cancers were diagnosed during pregnancy or postpartum in six cases. Cancer treatments included fertility-sparing surgery in 14%, hysterectomy in 30%, and radiochemotherapy in 79% of cases. The treatment modality did not rule out the possibility to undergo FP, and following counseling, 68 patients elected to undergo FP by cryopreservation of embryos or oocytes (N = 11), ovarian tissue (N = 54), or both (N = 3). After a mean follow-up of 8.1 years, 25 women (37%) returned to the center, five women achieved conception either spontaneously or through assisted reproduction, and 11 women became mothers through adoption or surrogacy. In the group of women receiving radical surgery or chemo/radiotherapy, no live births using cryopreserved specimens have yet been achieved. During follow-up, 7 women (10%) in the FP group and 5 women (24%) in the group without FP had died of their disease. Cancer recurrence was documented in 19 patients.

Conclusions

Our findings underscore the complexity and challenges associated with FP in the context of cervix cancer. Results of this study demonstrate that many women diagnosed with cervix cancer at reproductive age desire to achieve parenthood. While fertility-sparing surgery can allow pregnancy, those who undergo a hysterectomy are limited to adoption, surrogacy, or the emerging possibility of uterus transplantation.

导言我们的目的是评估因宫颈癌转诊的妇女进行生育力保存（FP）的可行性、长期生育结果和总生存率：对1999年至2021年间转诊至瑞典斯德哥尔摩卡罗林斯卡大学医院FP项目接受FP咨询的患者进行前瞻性队列研究。基线数据包括年龄、奇偶数、疾病分期、治疗特征以及所采用的 FP 方法。生殖结果和总生存期（截至2023年10月19日）的数据来自临床登记和人口登记：试验注册号：ClinicalTrials.gov NTC04602962：共有 91 名妇女被转诊，其中 67% 为 I 期癌症，25%、7% 和 1% 分别为 II、III 和 IV 期癌症。有 6 例癌症患者是在怀孕期间或产后确诊的。癌症治疗包括14%的保胎手术、30%的子宫切除术和79%的放射化疗。在接受咨询后，68名患者选择通过冷冻保存胚胎或卵母细胞（11例）、卵巢组织（54例）或两者（3例）的方式进行计划生育。经过平均 8.1 年的随访，25 名妇女（37%）重返该中心，5 名妇女自然受孕或通过辅助生殖受孕，11 名妇女通过领养或代孕成为母亲。在接受根治性手术或化疗/放疗的妇女群体中，尚未有使用冷冻保存标本的活产案例。在随访期间，FP 组中有 7 名妇女（10%）和未接受 FP 组中有 5 名妇女（24%）死于癌症。19名患者癌症复发：我们的研究结果凸显了 FP 在宫颈癌治疗中的复杂性和挑战性。这项研究结果表明，许多在育龄期被诊断出患有宫颈癌的妇女都希望能够生儿育女。虽然保胎手术可以让她们怀孕，但那些接受子宫切除术的妇女只能选择收养、代孕或新出现的子宫移植。

{"title":"The complexity and challenges of fertility preservation in women with cervix cancer—A prospective cohort study reporting on reproductive outcome and overall survival","authors":"Anna Marklund, Yanyu Jiang, Hanna Röjlar, Fotios Sergouniotis, Hanna Nilsson, Frida E. Lundberg, Kenny A. Rodriguez-Wallberg","doi":"10.1111/aogs.15007","DOIUrl":"10.1111/aogs.15007","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Our objective was to assess the feasibility of fertility preservation (FP) in women referred for cervix cancer, the long-term reproductive outcome, and overall survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Prospective cohort study of patients referred for FP counseling between 1999 and 2021 to the FP program of Karolinska University Hospital, Stockholm, Sweden. Baseline data included age, parity, disease stage, treatment characteristics, and FP methods applied. Data on reproductive outcomes and overall survival (by October 19, 2023) were retrieved from clinical registries and a population-based register. Trial registration number: ClinicalTrials.gov NTC04602962.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 91 women were referred, 67% with stage I cancers and 25%, 7%, and 1% with stages II, III, and IV, respectively. Cancers were diagnosed during pregnancy or postpartum in six cases. Cancer treatments included fertility-sparing surgery in 14%, hysterectomy in 30%, and radiochemotherapy in 79% of cases. The treatment modality did not rule out the possibility to undergo FP, and following counseling, 68 patients elected to undergo FP by cryopreservation of embryos or oocytes (<i>N</i> = 11), ovarian tissue (<i>N</i> = 54), or both (<i>N</i> = 3). After a mean follow-up of 8.1 years, 25 women (37%) returned to the center, five women achieved conception either spontaneously or through assisted reproduction, and 11 women became mothers through adoption or surrogacy. In the group of women receiving radical surgery or chemo/radiotherapy, no live births using cryopreserved specimens have yet been achieved. During follow-up, 7 women (10%) in the FP group and 5 women (24%) in the group without FP had died of their disease. Cancer recurrence was documented in 19 patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings underscore the complexity and challenges associated with FP in the context of cervix cancer. Results of this study demonstrate that many women diagnosed with cervix cancer at reproductive age desire to achieve parenthood. While fertility-sparing surgery can allow pregnancy, those who undergo a hysterectomy are limited to adoption, surrogacy, or the emerging possibility of uterus transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"86-94"},"PeriodicalIF":3.5,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680495","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}

引用次数: 0

Decreased expression of Syndecan- 1 (CD138) in the endometrium of adenomyosis patients suggests a potential pathogenetic role 子宫腺肌症患者的子宫内膜中 Syndecan- 1 (CD138) 的表达量减少，表明其可能具有致病作用。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2024-11-20 DOI: 10.1111/aogs.15012

Walid Shaalan, Mohamed Gamal Ibrahim, Ariana Plasger, Nourhan Hassan, Ludwig Kiesel, Andreas N. Schüring, Martin Götte

Introduction

Adenomyosis is a special subtype of endometriosis, affecting the myometrium, affecting about 20% of women in the reproductive age period. Clinical symptoms and intensity are diverse and can vary from heavy menstrual bleeding and dysmenorrhea to infertility and repeated pregnancy losses. Thus, patients often present with a long history of illness pending presumptive clinical or surgical diagnosis. A definitive diagnosis of adenomyosis is made upon histopathological examination verifying ectopic endometrial tissue (endometrial glands and/or stroma) within the myometrium, surrounded by hyperplastic and hypertrophic smooth muscles. However, nowadays ultrasonographic and/or MRI signs can precisely detect it as well. The precise etiology and pathogenesis remain unclear. One theory assumes that adenomyosis occurs through metaplastic transformation or migration of stem cell-like cells.

Material and Methods

Our study examined the immunohistochemical expression of the transmembrane proteoglycan Syndecan-1 (CD 138), a multifunctional matrix receptor and signaling co-receptor, in the endometrium of 35 patients (n = 21 with adenomyosis and n = 14 as a control group) in the period 2016–2017.

Results

As a pilot study, we concluded that Syndecan-1 is downregulated in adenomyosis patients compared to the control group, supporting its potential role in the development of adenomyosis. Our study did not find a correlation between the immune-expression of Syndecan-1 and the menstrual cycle phase.

Conclusions

For clinical significance in relation to our results, the investigated data showed that the downregulation of Syndecan-1 in adenomyotic patients in our study may suggest a role in promoting the invasiveness of endometriotic islands within the myometrium. However, further studies are still needed to understand the mechanistic contribution of Syndecan-1 to the pathogenesis of adenomyosis.

导言子宫腺肌症是子宫内膜异位症的一种特殊亚型，影响子宫肌层，约有 20% 的育龄期妇女会患病。临床症状和强度多种多样，从大量月经出血和痛经到不孕和反复妊娠失败。因此，患者往往病史较长，有待临床或手术推断诊断。子宫腺肌症的明确诊断是在组织病理学检查证实子宫肌层内有异位的子宫内膜组织（子宫内膜腺体和/或间质），周围有增生和肥厚的平滑肌。不过，如今超声波和/或核磁共振成像也能精确检测出异位内膜。确切的病因和发病机制仍不清楚。一种理论认为，子宫腺肌症是通过干细胞样细胞的变态转化或迁移而发生的：我们的研究检测了2016-2017年期间35例患者（n=21例腺肌症患者，n=14例为对照组）子宫内膜中跨膜蛋白多糖Syndecan-1（CD 138）的免疫组化表达，Syndecan-1是一种多功能基质受体和信号共受体：作为一项试验性研究，我们得出结论：与对照组相比，子宫腺肌症患者体内的Syndecan-1下调，支持其在子宫腺肌症发病过程中的潜在作用。我们的研究没有发现 Syndecan-1 的免疫表达与月经周期阶段之间存在相关性：就临床意义而言，我们的研究结果表明，在我们的研究中，子宫腺肌症患者体内的 Syndecan-1 下调可能在促进子宫内膜异位岛在子宫肌层内的侵袭性方面发挥了作用。然而，要了解 Syndecan-1 在子宫腺肌症发病机制中的作用还需要进一步的研究。

{"title":"Decreased expression of Syndecan- 1 (CD138) in the endometrium of adenomyosis patients suggests a potential pathogenetic role","authors":"Walid Shaalan, Mohamed Gamal Ibrahim, Ariana Plasger, Nourhan Hassan, Ludwig Kiesel, Andreas N. Schüring, Martin Götte","doi":"10.1111/aogs.15012","DOIUrl":"10.1111/aogs.15012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Adenomyosis is a special subtype of endometriosis, affecting the myometrium, affecting about 20% of women in the reproductive age period. Clinical symptoms and intensity are diverse and can vary from heavy menstrual bleeding and dysmenorrhea to infertility and repeated pregnancy losses. Thus, patients often present with a long history of illness pending presumptive clinical or surgical diagnosis. A definitive diagnosis of adenomyosis is made upon histopathological examination verifying ectopic endometrial tissue (endometrial glands and/or stroma) within the myometrium, surrounded by hyperplastic and hypertrophic smooth muscles. However, nowadays ultrasonographic and/or MRI signs can precisely detect it as well. The precise etiology and pathogenesis remain unclear. One theory assumes that adenomyosis occurs through metaplastic transformation or migration of stem cell-like cells.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Our study examined the immunohistochemical expression of the transmembrane proteoglycan Syndecan-1 (CD 138), a multifunctional matrix receptor and signaling co-receptor, in the endometrium of 35 patients (<i>n</i> = 21 with adenomyosis and <i>n</i> = 14 as a control group) in the period 2016–2017.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>As a pilot study, we concluded that Syndecan-1 is downregulated in adenomyosis patients compared to the control group, supporting its potential role in the development of adenomyosis. Our study did not find a correlation between the immune-expression of Syndecan-1 and the menstrual cycle phase.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>For clinical significance in relation to our results, the investigated data showed that the downregulation of Syndecan-1 in adenomyotic patients in our study may suggest a role in promoting the invasiveness of endometriotic islands within the myometrium. However, further studies are still needed to understand the mechanistic contribution of Syndecan-1 to the pathogenesis of adenomyosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"77-85"},"PeriodicalIF":3.5,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680485","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}

引用次数: 0

Hospital obstetric volume and maternal outcomes: Does hospital size matter? 医院产科数量与产妇结局：医院规模是否重要？

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2024-11-17 DOI: 10.1111/aogs.14980

Natalie Holowko, Linnea V. Ladfors, Anne K. Örtqvist, Mia Ahlberg, Olof Stephansson

<div> <section> <h3> Introduction</h3> <p>In recent decades, centralization of health care has resulted in a number of obstetric unit closures. While studies support better infant outcomes in larger facilities, few have investigated maternal outcomes. We investigated obstetric unit closures over time and whether obstetric volume is associated with onset of labor, postpartum hemorrhage (PPH) and obstetric anal sphincter injury (OASIS).</p> </section> <section> <h3> Material and Methods</h3> <p>All births registered in Sweden between 1992 and 2019 (Medical Birth Register, <i>N</i> = 2 931 140), linked with data on sociodemographic characteristics and maternal/infant diagnoses, were used to describe obstetric unit closures. After excluding congenital malformations, obstetric volume was categorized (low: 0–1999, medium: 2000–3999, high: ≥4000 births per year). Restricting to 2004 onwards (after most closures), the association between volume and onset of labor (spontaneous as reference) was estimated. Restricting to spontaneous, full-term (≥37 weeks gestation) cephalic births, we then investigated the association between volume and PPH and, after excluding planned cesarean sections, OASIS. Odds ratios from multilevel (logistic) models clustered by hospital were estimated.</p> </section> <section> <h3> Results</h3> <p>The 20 dissolved obstetric units (1992–2019) had relatively stable volume until their closure. Compared to the average, women birthing in the highest volume hospitals were older (31.3 years vs. 30.4) and a higher proportion had >12 years of education (57 vs. 51%). Compared to high-volume hospitals, there was no significant difference in labor starting by elective cesarean section or induction, rather than spontaneously, among low (OR 0.88, 95% CI: 0.73–1.06) and medium (OR 0.84, 95% CI 0.71–1.01) volume hospitals. There were lower odds of PPH among low (OR 0.72, 95% CI 0.63–0.85) and medium (OR 0.83, 95% CI 0.72–0.97) volume hospitals. No significant association was found between obstetric volume and OASIS (low: OR 0.98, 95% CI 0.82–1.18; medium: OR 0.90, 95% CI 0.77–1.05).</p> </section> <section> <h3> Conclusions</h3> <p>There was not a strong relationship between obstetric volume and maternal outcomes. Reduced odds of PPH for women birthing in smaller units may be due to triaging high-risk pregnancies to larger hospitals. While there was no significant association between obstetric volume and onset of labor or OASIS, other important factors related to closures, such as workload and overcrowding, should be investigated.</p>

介绍：近几十年来，医疗保健的集中化导致了许多产科机构的关闭。尽管有研究表明，在规模较大的医疗机构中，婴儿的预后会更好，但很少有研究对产妇的预后进行调查。我们调查了随着时间推移关闭产科病房的情况，以及产科数量是否与分娩、产后出血（PPH）和产科肛门括约肌损伤（OASIS）有关：1992年至2019年期间瑞典登记的所有新生儿（出生医学登记，N = 2 931 140）与社会人口特征和母婴诊断数据相关联，用于描述产科关闭情况。在排除先天性畸形后，对产科数量进行分类（低：0-1999，中：2000-3999，高：每年≥4000 个新生儿）。限于 2004 年以后（大多数关闭之后），对产科分娩量与分娩（以自然分娩为参考）之间的关系进行了估算。限于自然分娩、足月（妊娠≥37 周）头位分娩，我们随后调查了分娩量与 PPH 和（排除计划剖宫产后）OASIS 之间的关系。我们根据按医院分组的多层次（逻辑）模型估算了几率比：20 家解散的产科医院（1992-2019 年）在关闭前的住院量相对稳定。与平均水平相比，在分娩量最高的医院分娩的妇女年龄更大（31.3 岁对 30.4 岁），受过 12 年以上教育的比例更高（57% 对 51%）。与分娩量大的医院相比，分娩量小的医院（OR 0.88，95% CI：0.73-1.06）和分娩量中等的医院（OR 0.84，95% CI 0.71-1.01）在通过选择性剖宫产或引产而非自然分娩开始分娩方面没有显著差异。低（OR 0.72，95% CI 0.63-0.85）和中（OR 0.83，95% CI 0.72-0.97）量医院发生 PPH 的几率较低。产科数量与 OASIS 之间无明显关联（低：OR 0.98，95% CI 0.82-1.18；中：OR 0.90，95% CI 0.77-1.05）：结论：产科分娩量与产妇结局之间的关系并不密切。在较小产科分娩的产妇发生 PPH 的几率较低，这可能是由于将高危妊娠分流到了较大的医院。虽然产科容量与分娩开始或 OASIS 之间没有明显的关联，但仍应调查与关闭有关的其他重要因素，如工作量和过度拥挤。

{"title":"Hospital obstetric volume and maternal outcomes: Does hospital size matter?","authors":"Natalie Holowko, Linnea V. Ladfors, Anne K. Örtqvist, Mia Ahlberg, Olof Stephansson","doi":"10.1111/aogs.14980","DOIUrl":"10.1111/aogs.14980","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In recent decades, centralization of health care has resulted in a number of obstetric unit closures. While studies support better infant outcomes in larger facilities, few have investigated maternal outcomes. We investigated obstetric unit closures over time and whether obstetric volume is associated with onset of labor, postpartum hemorrhage (PPH) and obstetric anal sphincter injury (OASIS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>All births registered in Sweden between 1992 and 2019 (Medical Birth Register, <i>N</i> = 2 931 140), linked with data on sociodemographic characteristics and maternal/infant diagnoses, were used to describe obstetric unit closures. After excluding congenital malformations, obstetric volume was categorized (low: 0–1999, medium: 2000–3999, high: ≥4000 births per year). Restricting to 2004 onwards (after most closures), the association between volume and onset of labor (spontaneous as reference) was estimated. Restricting to spontaneous, full-term (≥37 weeks gestation) cephalic births, we then investigated the association between volume and PPH and, after excluding planned cesarean sections, OASIS. Odds ratios from multilevel (logistic) models clustered by hospital were estimated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 20 dissolved obstetric units (1992–2019) had relatively stable volume until their closure. Compared to the average, women birthing in the highest volume hospitals were older (31.3 years vs. 30.4) and a higher proportion had >12 years of education (57 vs. 51%). Compared to high-volume hospitals, there was no significant difference in labor starting by elective cesarean section or induction, rather than spontaneously, among low (OR 0.88, 95% CI: 0.73–1.06) and medium (OR 0.84, 95% CI 0.71–1.01) volume hospitals. There were lower odds of PPH among low (OR 0.72, 95% CI 0.63–0.85) and medium (OR 0.83, 95% CI 0.72–0.97) volume hospitals. No significant association was found between obstetric volume and OASIS (low: OR 0.98, 95% CI 0.82–1.18; medium: OR 0.90, 95% CI 0.77–1.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was not a strong relationship between obstetric volume and maternal outcomes. Reduced odds of PPH for women birthing in smaller units may be due to triaging high-risk pregnancies to larger hospitals. While there was no significant association between obstetric volume and onset of labor or OASIS, other important factors related to closures, such as workload and overcrowding, should be investigated.</p>\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"55-67"},"PeriodicalIF":3.5,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646753","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}

引用次数: 0

Prediction of uterine rupture in singleton pregnancies with one prior cesarean birth undergoing TOLAC: A cross-sectional study 曾有过一次剖宫产经历的单胎妊娠接受 TOLAC 的子宫破裂预测：一项横断面研究。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2024-11-17 DOI: 10.1111/aogs.15009

Brittany J. Arkerson, Giulia M. Muraca, Nisha Thakur, Ali Javinani, Asma Khalil, Rohan D'Souza, Hiba J. Mustafa

Introduction

Being able to counsel patients with one prior cesarean birth on the risk of uterine rupture with a trial of labor after cesarean, (TOLAC) is an important aspect of prenatal care. Despite uterine rupture being a catastrophic event, there is currently no successful, validated prediction model to predict its occurrence.

Material and Methods

This was a cross-sectional study using US national birth data between 2014 and 2021. The primary objective was to identify risk factors for uterine rupture during TOLAC and to generate a prediction model for uterine rupture among singleton gestations with one prior cesarean as their only prior birth. The secondary objective was to describe the maternal and neonatal morbidity associated with uterine rupture. The association of all candidate variables with uterine rupture was tested with uni- and multi-variable logistic regression analyses. We included term and preterm singleton pregnancies with one prior birth that was cesarean birth (CB) with cephalic presentation undergoing TOLAC. We excluded pregnancies with major structural anomalies and chromosomal abnormalities. The Receiver Operating Characteristics (ROC) Curve was generated. p value <0.001 was considered statistically significant.

Results

Of the 270 329 singleton pregnancies with one prior CB undergoing TOLAC during the study period, there were 957 cases of uterine rupture (3.54 cases per 1000). Factors associated with uterine rupture in multivariable models were an interpregnancy interval < 18 months vs the reference interval of 24–35 months (aOR 1.55; 95% CI, 1.19–2.02), induction of labor (aOR 2.31; 95% CI, 2.01–2.65), and augmentation of labor (aOR 1.94; 95% CI, 1.70–2.21). Factors associated with reduced rates of uterine rupture were maternal age < 20 years (aOR 0.33, 95% CI 0.15–0.74) and 20–24 years (aOR 0.79, 95% CI 0.64–0.97) vs the reference of 25–29 years and gestational age at delivery 32–36 weeks vs the reference of 37–41 weeks (aOR 0.55, 95% CI 0.38–0.79). Incorporating these factors into a predictive model for uterine rupture yielded an area under the receiver-operating curve of 0.66. Additionally, all analyzed maternal and neonatal morbidities were increased in the setting of uterine rupture compared to non-rupture.

Conclusions

Uterine rupture prediction models utilizing TOLAC characteristics have modest performance.

导言：产前护理的一个重要方面是，能够向曾有过一次剖宫产经历的患者提供有关剖宫产后试产（TOLAC）子宫破裂风险的咨询。尽管子宫破裂是一个灾难性事件，但目前还没有一个成功、有效的预测模型来预测其发生：这是一项横断面研究，使用的是 2014 年至 2021 年间的美国全国出生数据。主要目的是确定在 TOLAC 分娩过程中发生子宫破裂的风险因素，并在之前仅有一次剖宫产的单胎妊娠中建立子宫破裂预测模型。次要目标是描述与子宫破裂相关的孕产妇和新生儿发病率。我们通过单变量和多变量逻辑回归分析检验了所有候选变量与子宫破裂的关系。我们纳入了接受TOLAC手术的头位剖宫产（CB）的足月和早产单胎妊娠。我们排除了有重大结构异常和染色体异常的孕妇。生成接收者操作特征曲线（ROC）：在研究期间接受 TOLAC 的 270 329 例先兆 CB 单胎妊娠中，有 957 例发生子宫破裂（每 1000 例中有 3.54 例）。在多变量模型中，与子宫破裂相关的因素是妊娠间隔：利用TOLAC特征的子宫破裂预测模型性能一般。

{"title":"Prediction of uterine rupture in singleton pregnancies with one prior cesarean birth undergoing TOLAC: A cross-sectional study","authors":"Brittany J. Arkerson, Giulia M. Muraca, Nisha Thakur, Ali Javinani, Asma Khalil, Rohan D'Souza, Hiba J. Mustafa","doi":"10.1111/aogs.15009","DOIUrl":"10.1111/aogs.15009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Being able to counsel patients with one prior cesarean birth on the risk of uterine rupture with a trial of labor after cesarean, (TOLAC) is an important aspect of prenatal care. Despite uterine rupture being a catastrophic event, there is currently no successful, validated prediction model to predict its occurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a cross-sectional study using US national birth data between 2014 and 2021. The primary objective was to identify risk factors for uterine rupture during TOLAC and to generate a prediction model for uterine rupture among singleton gestations with one prior cesarean as their only prior birth. The secondary objective was to describe the maternal and neonatal morbidity associated with uterine rupture. The association of all candidate variables with uterine rupture was tested with uni- and multi-variable logistic regression analyses. We included term and preterm singleton pregnancies with one prior birth that was cesarean birth (CB) with cephalic presentation undergoing TOLAC. We excluded pregnancies with major structural anomalies and chromosomal abnormalities. The Receiver Operating Characteristics (ROC) Curve was generated. <i>p</i> value <0.001 was considered statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 270 329 singleton pregnancies with one prior CB undergoing TOLAC during the study period, there were 957 cases of uterine rupture (3.54 cases per 1000). Factors associated with uterine rupture in multivariable models were an interpregnancy interval < 18 months vs the reference interval of 24–35 months (aOR 1.55; 95% CI, 1.19–2.02), induction of labor (aOR 2.31; 95% CI, 2.01–2.65), and augmentation of labor (aOR 1.94; 95% CI, 1.70–2.21). Factors associated with reduced rates of uterine rupture were maternal age < 20 years (aOR 0.33, 95% CI 0.15–0.74) and 20–24 years (aOR 0.79, 95% CI 0.64–0.97) vs the reference of 25–29 years and gestational age at delivery 32–36 weeks vs the reference of 37–41 weeks (aOR 0.55, 95% CI 0.38–0.79). Incorporating these factors into a predictive model for uterine rupture yielded an area under the receiver-operating curve of 0.66. Additionally, all analyzed maternal and neonatal morbidities were increased in the setting of uterine rupture compared to non-rupture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Uterine rupture prediction models utilizing TOLAC characteristics have modest performance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"185-193"},"PeriodicalIF":3.5,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646754","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}

引用次数: 0

Maternal asthma during pregnancy and the likelihood of neurodevelopmental disorders in offspring 孕期母亲哮喘与后代神经发育障碍的可能性。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica

Pub Date : 2024-11-14 DOI: 10.1111/aogs.15008

Mari Kemppainen, Mika Gissler, Turkka Kirjavainen

Introduction

Asthma is the most common chronic disease during pregnancy. Maternal asthma has been associated with a multitude of unwanted pregnancy outcomes, in some studies also with neurodevelopmental disorders. Here we investigated associations between maternal asthma and neurodevelopmental disorders.

Material and Methods

We studied a retrospective population-based cohort of 1 271 439 mother–child pairs from singleton live births in Finland between the years 1996–2018. We used multiple high-cover registers for data collection. Adjusted unconditional Cox regression models were used to investigate associations between maternal asthma, asthma medication used during pregnancy, and offspring's neurodevelopmental disorder diagnoses.

Results

We identified 106 163 mother–child pairs affected by maternal asthma. We found that maternal asthma was associated with offspring neurodevelopmental disorders, but the differences in absolute prevalence between the control and exposure groups were small. Attention-deficit hyperactivity disorder (ADHD) was found in 4114 (3.9%) offspring with maternal asthma and in 32 122 (3.0%) controls (adjusted hazard ratio (HR): 1.49; 95% CI 1.44–1.54); autism in 1617 (1.5%) offspring vs 13 701 (1.3%) controls (HR: 1.33; 95% CI 1.26–1.40); motor-developmental disorder in 1569 (1.5%) offspring vs 12 147 (1.1%) controls (HR: 1.37; 95% CI 1.30–1.45); language disorder in 3057 (2.9%) offspring vs 28 421 (2.7%) controls (HR: 1.13; 95% CI 1.08–1.17), learning disabilities in 849 (0.8%) offspring vs 6534 (0.6%) controls (HR: 1.51; 95% CI 1.41–1.62); mixed developmental disorder in 1633 (1.5%) offspring vs 14 434 (1.3%) controls (HR 1.20; 95% CI, 1.14–1.26); and intellectual disability in 908 (0.9%) vs 9155 (0.9%) controls (HR: 1.12; 95% CI 1.04–1.20). No substantial differences were found between allergic and non-allergic asthma phenotypes, and neither allergic tendency nor respiratory infection was associated with a similar likelihood of neurodevelopmental disorders.

Conclusions

Maternal asthma and allergic and non-allergic phenotypes showed weak associations with the offspring's neurodevelopmental disorders. The association is concerned especially with learning disabilities, ADHD, motor development, and autism.

导言哮喘是孕期最常见的慢性疾病。孕产妇哮喘与多种不良妊娠结局有关，在一些研究中还与神经发育障碍有关。在此，我们研究了孕产妇哮喘与神经发育障碍之间的关系：我们对 1996-2018 年间芬兰单胎活产的 1 271 439 对母子进行了基于人群的回顾性队列研究。我们使用多个高覆盖率登记册收集数据。我们使用调整后的无条件 Cox 回归模型来研究母亲哮喘、孕期使用的哮喘药物和后代神经发育障碍诊断之间的关联：我们确定了 106 163 对母子受母亲哮喘影响。我们发现，母亲哮喘与后代神经发育障碍有关，但对照组和接触组之间的绝对患病率差异很小。在 4114 名（3.9%）患有母体哮喘的后代和 32 122 名（3.0%）对照组中发现了注意力缺陷多动障碍（ADHD）（调整后危险比（HR）：1.49；95% CI 1.44-1.54）；在 1617 名（1.5%）的后代与 13 701（1.3%）的对照（HR：1.33；95% CI 1.26-1.40）；1569（1.5%）的后代与 12 147（1.1%）的对照（HR：1.37；95% CI 1.30-1.45）；3057（3.0%）的后代患有语言障碍。45）；3057例（2.9%）后代与28 421例（2.7%）对照组相比出现语言障碍（HR：1.13；95% CI 1.08-1.17）；849例（0.8%）后代与6534例（0.6%）对照组相比出现学习障碍（HR：1.51；95% CI 1.41-1.62）；1569例（1.5%）后代与12 147例（1.1%）对照组相比出现混合发育障碍（HR：1.37；95% CI 1.30-1.45）。62）；1633 名（1.5%）后代与 14 434 名（1.3%）对照组相比出现混合发育障碍（HR 1.20；95% CI，1.14-1.26）；908 名（0.9%）后代与 9155 名（0.9%）对照组相比出现智力障碍（HR：1.12；95% CI 1.04-1.20）。过敏性哮喘表型与非过敏性哮喘表型之间没有实质性差异，过敏倾向或呼吸道感染都与神经发育障碍的相似可能性无关：结论：母体哮喘、过敏性和非过敏性表型与后代的神经发育障碍关系不大。这种关联尤其与学习障碍、多动症、运动发育和自闭症有关。

{"title":"Maternal asthma during pregnancy and the likelihood of neurodevelopmental disorders in offspring","authors":"Mari Kemppainen, Mika Gissler, Turkka Kirjavainen","doi":"10.1111/aogs.15008","DOIUrl":"10.1111/aogs.15008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Asthma is the most common chronic disease during pregnancy. Maternal asthma has been associated with a multitude of unwanted pregnancy outcomes, in some studies also with neurodevelopmental disorders. Here we investigated associations between maternal asthma and neurodevelopmental disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We studied a retrospective population-based cohort of 1 271 439 mother–child pairs from singleton live births in Finland between the years 1996–2018. We used multiple high-cover registers for data collection. Adjusted unconditional Cox regression models were used to investigate associations between maternal asthma, asthma medication used during pregnancy, and offspring's neurodevelopmental disorder diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 106 163 mother–child pairs affected by maternal asthma. We found that maternal asthma was associated with offspring neurodevelopmental disorders, but the differences in absolute prevalence between the control and exposure groups were small. Attention-deficit hyperactivity disorder (ADHD) was found in 4114 (3.9%) offspring with maternal asthma and in 32 122 (3.0%) controls (adjusted hazard ratio (HR): 1.49; 95% CI 1.44–1.54); autism in 1617 (1.5%) offspring vs 13 701 (1.3%) controls (HR: 1.33; 95% CI 1.26–1.40); motor-developmental disorder in 1569 (1.5%) offspring vs 12 147 (1.1%) controls (HR: 1.37; 95% CI 1.30–1.45); language disorder in 3057 (2.9%) offspring vs 28 421 (2.7%) controls (HR: 1.13; 95% CI 1.08–1.17), learning disabilities in 849 (0.8%) offspring vs 6534 (0.6%) controls (HR: 1.51; 95% CI 1.41–1.62); mixed developmental disorder in 1633 (1.5%) offspring vs 14 434 (1.3%) controls (HR 1.20; 95% CI, 1.14–1.26); and intellectual disability in 908 (0.9%) vs 9155 (0.9%) controls (HR: 1.12; 95% CI 1.04–1.20). No substantial differences were found between allergic and non-allergic asthma phenotypes, and neither allergic tendency nor respiratory infection was associated with a similar likelihood of neurodevelopmental disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Maternal asthma and allergic and non-allergic phenotypes showed weak associations with the offspring's neurodevelopmental disorders. The association is concerned especially with learning disabilities, ADHD, motor development, and autism.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 1","pages":"235-244"},"PeriodicalIF":3.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611871","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}

引用次数: 0