Ovarian stimulation can cause supraphysiological estradiol levels and adverse effects on endometrial receptivity. Since patients could undergo cleavage or blastocyst stage embryo transfer, the threshold value of peak estradiol level for each transfer stage that impacts the pregnancy outcomes of fresh versus frozen embryo transfer remains unclear. This work aims at answering the following questions: what is the threshold of peak estradiol level that modifies the difference in pregnancy outcomes between fresh and frozen embryo transfer and whether the threshold value varies with the stage of embryo transferred?
Material and Methods
A secondary analysis of data from four multicenter randomized trials with similar design comparing the rate of live birth between fresh and frozen embryo transfer in a total of 6153 patients. Peak serum estradiol level was measured on the day of hCG administration. Live birth rate is the primary outcome.
Results
Multivariable regression modeling showed an interaction between the stage of embryo transferred and the intervention (frozen vs fresh embryo transfer) on the live birth rate (p = 0.016). In the cleavage-stage embryo transfer group, frozen embryo transfer resulted in a higher rate of live birth when peak estradiol level >3900 pg/mL (55.4% vs 44.9%; OR, 1.57; 95% CI, 1.24–1.99) and a similar live birth rate (OR, 1.10; 95% CI, 0.93–1.31) when peak estradiol level was 1600–3900 pg/mL. However, in the blastocyst transfer group, frozen embryo transfers yielded a higher live birth rate when peak estradiol level >2000 pg/mL (54.3% vs 37.7%; OR, 2.00; 95% CI, 1.59–2.51).
Conclusions
A freeze-all strategy may result in a higher rate of live birth when the peak estradiol level >3900 pg/mL for cleavage-stage embryo transfer and when the peak estradiol level >2000 pg/mL for blastocyst transfer.
{"title":"The threshold of estradiol level for fresh embryo transfer differs between blastocyst and cleavage-stage embryo","authors":"Dingying Zhao, Huiying Xiao, Gege Ouyang, Yuan Fang, Qiaoqiao Ding, Yue Niu, Jialin Zou, Yanran Liu, Xue Shang, Ze Wang, Zi-Jiang Chen, Lianlian Liu, Daimin Wei","doi":"10.1111/aogs.70101","DOIUrl":"10.1111/aogs.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Ovarian stimulation can cause supraphysiological estradiol levels and adverse effects on endometrial receptivity. Since patients could undergo cleavage or blastocyst stage embryo transfer, the threshold value of peak estradiol level for each transfer stage that impacts the pregnancy outcomes of fresh versus frozen embryo transfer remains unclear. This work aims at answering the following questions: what is the threshold of peak estradiol level that modifies the difference in pregnancy outcomes between fresh and frozen embryo transfer and whether the threshold value varies with the stage of embryo transferred?</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A secondary analysis of data from four multicenter randomized trials with similar design comparing the rate of live birth between fresh and frozen embryo transfer in a total of 6153 patients. Peak serum estradiol level was measured on the day of hCG administration. Live birth rate is the primary outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Multivariable regression modeling showed an interaction between the stage of embryo transferred and the intervention (frozen vs fresh embryo transfer) on the live birth rate (<i>p</i> = 0.016). In the cleavage-stage embryo transfer group, frozen embryo transfer resulted in a higher rate of live birth when peak estradiol level >3900 pg/mL (55.4% vs 44.9%; OR, 1.57; 95% CI, 1.24–1.99) and a similar live birth rate (OR, 1.10; 95% CI, 0.93–1.31) when peak estradiol level was 1600–3900 pg/mL. However, in the blastocyst transfer group, frozen embryo transfers yielded a higher live birth rate when peak estradiol level >2000 pg/mL (54.3% vs 37.7%; OR, 2.00; 95% CI, 1.59–2.51).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A freeze-all strategy may result in a higher rate of live birth when the peak estradiol level >3900 pg/mL for cleavage-stage embryo transfer and when the peak estradiol level >2000 pg/mL for blastocyst transfer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 2","pages":"257-267"},"PeriodicalIF":3.1,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145522434","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}
Emma Hertting, Lotta Herling, Pelle G. Lindqvist, Eva Wiberg-Itzel
Introduction
Unidentified small for gestational age (SGA) pregnancies have an increased risk for stillbirth. The risk of stillbirth is increased in women born abroad or with low socioeconomic status (SES). The aim of this study was to evaluate potential inequalities in antenatal screening and identification of SGA by examining whether a foreign background or indicators of low SES were associated with unidentified SGA.
Material and Methods
This was a register-based cohort study of all pregnancies delivered in Stockholm in the year 2014 and 2017, including 5487 SGA pregnancies. Data from maternal medical records were linked to nationwide Swedish registers. Exposures were educational level, family income level, recent immigration, social security benefits, civil status, Swedish/foreign background, municipal affiliation, and country of birth. Outcome was unidentified SGA, defined as born SGA with no or normal growth scans performed at or after week 24 + 0 of pregnancy. We used unadjusted and adjusted logistic regression analyses to assess the associations between socioeconomic factors and unidentified SGA. Additionally, an intersectional regression analysis was performed to explore predefined combinations of the exposure factors.
Results
Neither educational level, family income level, Swedish/foreign background, or any combination of these factors, nor recent immigration or civil status was associated with unidentified SGA in the adjusted model. Women receiving social security benefits had decreased odds of unidentified SGA, adjusted odds ratio 0.73, 95% confidence interval 0.55–0.97.
Conclusions
Foreign background or indicators of low SES were not positively associated with unidentified SGA. These findings suggest that antenatal screening and identification of SGA are provided on equal terms.
{"title":"The importance of socioeconomic factors on antenatal identification of small for gestational age pregnancies: Exploring health inequalities in the antenatal care in Sweden","authors":"Emma Hertting, Lotta Herling, Pelle G. Lindqvist, Eva Wiberg-Itzel","doi":"10.1111/aogs.70091","DOIUrl":"10.1111/aogs.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Unidentified small for gestational age (SGA) pregnancies have an increased risk for stillbirth. The risk of stillbirth is increased in women born abroad or with low socioeconomic status (SES). The aim of this study was to evaluate potential inequalities in antenatal screening and identification of SGA by examining whether a foreign background or indicators of low SES were associated with unidentified SGA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a register-based cohort study of all pregnancies delivered in Stockholm in the year 2014 and 2017, including 5487 SGA pregnancies. Data from maternal medical records were linked to nationwide Swedish registers. Exposures were educational level, family income level, recent immigration, social security benefits, civil status, Swedish/foreign background, municipal affiliation, and country of birth. Outcome was unidentified SGA, defined as born SGA with no or normal growth scans performed at or after week 24 + 0 of pregnancy. We used unadjusted and adjusted logistic regression analyses to assess the associations between socioeconomic factors and unidentified SGA. Additionally, an intersectional regression analysis was performed to explore predefined combinations of the exposure factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Neither educational level, family income level, Swedish/foreign background, or any combination of these factors, nor recent immigration or civil status was associated with unidentified SGA in the adjusted model. Women receiving social security benefits had decreased odds of unidentified SGA, adjusted odds ratio 0.73, 95% confidence interval 0.55–0.97.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Foreign background or indicators of low SES were not positively associated with unidentified SGA. These findings suggest that antenatal screening and identification of SGA are provided on equal terms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"125-135"},"PeriodicalIF":3.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145501463","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}
Oumaima Ammar, Maria Teresa Martini, Sara Lazzarin, Anna Luna Tramontano, Cristina Plevani, Francesca Bonati, Viola Seravalli, Fabio Facchinetti, Anna Locatelli, Sara Ornaghi, Mariarosaria Di Tommaso
Introduction
Pregnancies at very and extremely advanced maternal age (VAMA, 45–49 years and EAMA, ≥50 years) are increasingly common, particularly regarding the influence of assisted reproductive technology (ART), yet their obstetric and perinatal outcomes remain underexplored. This study aimed to investigate maternal and neonatal outcomes in singleton pregnancies among women aged ≥45 years, with a specific focus on ART conception and oocyte source.
Material and Methods
This multicenter retrospective cohort study included women aged ≥45 years with singleton pregnancies delivered ≥22 weeks' gestation between 2016 and 2022 across five Italian academic hospitals. Pregnancies were categorized by mode of conception (spontaneous conception [SC] vs. ART), and ART pregnancies were further stratified by oocyte origin (homologous [ART-HO] vs. heterologous [ART-HE]). Multivariable logistic regression was used to evaluate associations between mode of conception and obstetric outcomes, adjusting for key confounders.
Results
Among 557 included pregnancies, 495 (88.9%) involved women aged 45–49 years, and 62 (11.1%) women aged ≥50. Compared to SC, ART pregnancies were associated with higher adjusted odds of cesarean delivery (aOR 4.20, 95% CI 2.99–4.92; p < 0.001) and postpartum hemorrhage (aOR 2.72, 95% CI 1.75–4.23; p < 0.001). No significant differences in neonatal outcomes were observed. In the ART subgroup analysis, ART-HE was associated with increased odds of gestational diabetes (aOR 1.97, 95% CI 1.10–3.55; p = 0.024) and manual placental removal (aOR 10.45, 95% CI 1.23–88.46; p = 0.031) compared to ART-HO.
Conclusions
ART pregnancies in women ≥45 years are associated with increased maternal morbidity, particularly when involving heterologous oocytes. These findings underscored the need for tailored counseling and multidisciplinary perinatal care in this growing population.
引言：产妇高龄和极高龄（VAMA， 45-49岁，EAMA，≥50岁）妊娠越来越普遍，特别是关于辅助生殖技术（ART）的影响，但其产科和围产期结局仍未得到充分探讨。本研究旨在调查年龄≥45岁的单胎妊娠的孕产妇和新生儿结局，特别关注ART受孕和卵母细胞来源。材料和方法：这项多中心回顾性队列研究纳入了2016年至2022年间意大利五家学术医院年龄≥45岁、单胎妊娠≥22周的女性。根据受孕方式（自然受孕[SC] vs. ART）对妊娠进行分类，ART妊娠进一步根据卵母细胞来源（同源[ART- ho] vs.异源[ART- he]）进行分层。多变量逻辑回归用于评估受孕方式与产科结局之间的关系，并对关键混杂因素进行调整。结果：在纳入的557例妊娠中，495例（88.9%）为45-49岁的女性，62例（11.1%）为≥50岁的女性。与SC相比，ART妊娠与更高的剖宫产调整几率相关（aOR 4.20, 95% CI 2.99-4.92; p）结论：≥45岁的女性ART妊娠与母体发病率增加相关，特别是涉及异源卵母细胞时。这些发现强调了在这个不断增长的人口中需要量身定制的咨询和多学科围产期护理。
{"title":"Perinatal outcomes in pregnancies with very and extremely advanced maternal age: An Italian multicenter retrospective cohort study","authors":"Oumaima Ammar, Maria Teresa Martini, Sara Lazzarin, Anna Luna Tramontano, Cristina Plevani, Francesca Bonati, Viola Seravalli, Fabio Facchinetti, Anna Locatelli, Sara Ornaghi, Mariarosaria Di Tommaso","doi":"10.1111/aogs.70084","DOIUrl":"10.1111/aogs.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pregnancies at very and extremely advanced maternal age (VAMA, 45–49 years and EAMA, ≥50 years) are increasingly common, particularly regarding the influence of assisted reproductive technology (ART), yet their obstetric and perinatal outcomes remain underexplored. This study aimed to investigate maternal and neonatal outcomes in singleton pregnancies among women aged ≥45 years, with a specific focus on ART conception and oocyte source.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This multicenter retrospective cohort study included women aged ≥45 years with singleton pregnancies delivered ≥22 weeks' gestation between 2016 and 2022 across five Italian academic hospitals. Pregnancies were categorized by mode of conception (spontaneous conception [SC] vs. ART), and ART pregnancies were further stratified by oocyte origin (homologous [ART-HO] vs. heterologous [ART-HE]). Multivariable logistic regression was used to evaluate associations between mode of conception and obstetric outcomes, adjusting for key confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 557 included pregnancies, 495 (88.9%) involved women aged 45–49 years, and 62 (11.1%) women aged ≥50. Compared to SC, ART pregnancies were associated with higher adjusted odds of cesarean delivery (aOR 4.20, 95% CI 2.99–4.92; <i>p</i> < 0.001) and postpartum hemorrhage (aOR 2.72, 95% CI 1.75–4.23; <i>p</i> < 0.001). No significant differences in neonatal outcomes were observed. In the ART subgroup analysis, ART-HE was associated with increased odds of gestational diabetes (aOR 1.97, 95% CI 1.10–3.55; <i>p</i> = 0.024) and manual placental removal (aOR 10.45, 95% CI 1.23–88.46; <i>p</i> = 0.031) compared to ART-HO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ART pregnancies in women ≥45 years are associated with increased maternal morbidity, particularly when involving heterologous oocytes. These findings underscored the need for tailored counseling and multidisciplinary perinatal care in this growing population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"117-124"},"PeriodicalIF":3.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145501476","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}
Rebecca Man, Jack Le Vance, Yasmine Popa, Danielle Wilson, Sue Tohill, John Maltby, Victoria Hodgetts Morton, R. Katie Morris, the CHAPTER group
Introduction
Approximately 85% of women who undergo vaginal birth sustain childbirth-related perineal trauma. Worldwide, 21% of women give birth by cesarean section. These wounds therefore affect the vast majority of women after birth; however, there is a lack of validated tools to accurately identify women with abnormal wound healing in the postpartum period. Consequently, in clinical settings, validated wound-assessment tools are not generally used to assess wound healing in this population. We performed a scoping review to identify and characterize wound-assessment tools that have been used to determine the healing of childbirth-related wounds in existing research (to include women who experience perineal trauma or a cesarean section).
Material and Methods
Medline, EMBASE, CINAHL, and Google Scholar were searched from inception to April 2024. Studies were included where wound-assessment tools were used to assess wound healing, after women had sustained either childbirth-related perineal trauma or a cesarean section, as an outcome of a primary research article. For studies that assessed wound healing in women with perineal trauma, this included all types of childbirth-related perineal trauma, sustained at spontaneous or assisted vaginal birth. Studies were eligible for inclusion where the wound-assessment tool was used at any time-point in the postpartum period.
Results
There were 95 studies eligible for inclusion; 72 of which utilized wound-assessment tools for the assessment of healing after women sustained childbirth-related perineal trauma and 23 for women with cesarean section wounds. The REEDA tool (redness, oedema, ecchymosis, discharge, approximation) was used in 91 of the 95 studies, with the remainder using alternative wound-assessment tools, including the use of the ASEPSIS tool (additional treatment, serous discharge, erythema, purulent exudate, separation of deep tissues, isolation of bacteria, and length of inpatient stay).
Conclusions
There are limited wound-assessment tools to determine healing after women sustain childbirth-related wounds. The REEDA tool is the most commonly used in research settings. There is a clear need for the development of a clinically robust and inclusive wound- assessment tools, which comprehensively reflect the postpartum healing process among diverse populations.
{"title":"Healing-assessment tools for perineal and cesarean section wounds in postpartum women: A scoping review","authors":"Rebecca Man, Jack Le Vance, Yasmine Popa, Danielle Wilson, Sue Tohill, John Maltby, Victoria Hodgetts Morton, R. Katie Morris, the CHAPTER group","doi":"10.1111/aogs.70089","DOIUrl":"10.1111/aogs.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Approximately 85% of women who undergo vaginal birth sustain childbirth-related perineal trauma. Worldwide, 21% of women give birth by cesarean section. These wounds therefore affect the vast majority of women after birth; however, there is a lack of validated tools to accurately identify women with abnormal wound healing in the postpartum period. Consequently, in clinical settings, validated wound-assessment tools are not generally used to assess wound healing in this population. We performed a scoping review to identify and characterize wound-assessment tools that have been used to determine the healing of childbirth-related wounds in existing research (to include women who experience perineal trauma or a cesarean section).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Medline, EMBASE, CINAHL, and Google Scholar were searched from inception to April 2024. Studies were included where wound-assessment tools were used to assess wound healing, after women had sustained either childbirth-related perineal trauma or a cesarean section, as an outcome of a primary research article. For studies that assessed wound healing in women with perineal trauma, this included all types of childbirth-related perineal trauma, sustained at spontaneous or assisted vaginal birth. Studies were eligible for inclusion where the wound-assessment tool was used at any time-point in the postpartum period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 95 studies eligible for inclusion; 72 of which utilized wound-assessment tools for the assessment of healing after women sustained childbirth-related perineal trauma and 23 for women with cesarean section wounds. The REEDA tool (redness, oedema, ecchymosis, discharge, approximation) was used in 91 of the 95 studies, with the remainder using alternative wound-assessment tools, including the use of the ASEPSIS tool (additional treatment, serous discharge, erythema, purulent exudate, separation of deep tissues, isolation of bacteria, and length of inpatient stay).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There are limited wound-assessment tools to determine healing after women sustain childbirth-related wounds. The REEDA tool is the most commonly used in research settings. There is a clear need for the development of a clinically robust and inclusive wound- assessment tools, which comprehensively reflect the postpartum healing process among diverse populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"18-29"},"PeriodicalIF":3.1,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145487269","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}
Turner syndrome (TS) seriously impacts women's health and quality of life, yet research on its global burden remains limited. This study aimed to evaluate the burden and between-country inequalities of TS using global population data.
Material and Methods
Data on prevalence, years lived with disability (YLDs), and incidence of TS were obtained from the Global Burden of Disease (GBD) 2021 database for comprehensive analysis. Geographic and socioeconomic disparities were assessed using decomposition analysis, cross-country health inequality analysis, and frontier analysis. Future trends were projected using an autoregressive integrated moving average (ARIMA) model.
Results
In 2021, TS accounted for an estimated 531 784 (95% UI: 420 532–697 786) prevalent cases, 9177 (95% UI: 4254–15 926) YLDs, and 23 929 (95% UI: 17 948–32 035) incident cases globally. From 1990 to 2021, the numbers of prevalence and YLDs increased by 27.7% and 29.2%, respectively, while their ASRs remained stable. Decomposition analysis indicated that population growth was the main driver of increases in prevalence and YLDs. Persistent between-country inequalities were observed: prevalence and YLDs were predominantly concentrated in high Socio-demographic Index (SDI) regions, whereas incidence remained higher in low-SDI countries. Frontier analysis revealed notable efficiency gaps in high-SDI countries, while low-SDI countries were near optimal levels. The ARIMA model projected a steady rise in the absolute number of TS cases from 2021 to 2050, alongside slight declines in age-standardized prevalence, YLDs, and incidence rates.
Conclusions
The global burden of TS has continued to rise, accompanied by persistent between-country disparities. These findings highlight the need for improved disease management strategies and more equitable resource allocation to address the growing burden.
{"title":"Global burden and between-country inequalities in Turner syndrome from 1990 to 2021","authors":"Xicui Long, Yong Hu, Mingjie Wu, Lijuan Yang, Wenjiao Jin, Xuesong Han","doi":"10.1111/aogs.70082","DOIUrl":"10.1111/aogs.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Turner syndrome (TS) seriously impacts women's health and quality of life, yet research on its global burden remains limited. This study aimed to evaluate the burden and between-country inequalities of TS using global population data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Data on prevalence, years lived with disability (YLDs), and incidence of TS were obtained from the Global Burden of Disease (GBD) 2021 database for comprehensive analysis. Geographic and socioeconomic disparities were assessed using decomposition analysis, cross-country health inequality analysis, and frontier analysis. Future trends were projected using an autoregressive integrated moving average (ARIMA) model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2021, TS accounted for an estimated 531 784 (95% UI: 420 532–697 786) prevalent cases, 9177 (95% UI: 4254–15 926) YLDs, and 23 929 (95% UI: 17 948–32 035) incident cases globally. From 1990 to 2021, the numbers of prevalence and YLDs increased by 27.7% and 29.2%, respectively, while their ASRs remained stable. Decomposition analysis indicated that population growth was the main driver of increases in prevalence and YLDs. Persistent between-country inequalities were observed: prevalence and YLDs were predominantly concentrated in high Socio-demographic Index (SDI) regions, whereas incidence remained higher in low-SDI countries. Frontier analysis revealed notable efficiency gaps in high-SDI countries, while low-SDI countries were near optimal levels. The ARIMA model projected a steady rise in the absolute number of TS cases from 2021 to 2050, alongside slight declines in age-standardized prevalence, YLDs, and incidence rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The global burden of TS has continued to rise, accompanied by persistent between-country disparities. These findings highlight the need for improved disease management strategies and more equitable resource allocation to address the growing burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2339-2354"},"PeriodicalIF":3.1,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457011","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}
Lise Qvirin Krogh, Tine Brink Henriksen, Katja Albert Taastrøm, Sidsel Boie, Anne Cathrine Maqving Kjeldsen, Jim Thornton, Jens Fuglsang, Julie Glavind
Introduction
Induction of labor (IOL) is a common intervention in industrialized countries. Failed induction is frequently reported, yet there is no consensus on its definition. Since the primary goal of IOL is to initiate labor, progress to the active phase is a more relevant measure of success than the surrogate of caesarean birth. Previous studies on the influence of body mass index (BMI) on the risk of failed IOL are limited. Most rely on data from the United States and define failed IOL primarily by caesarean delivery. This study aims to explore the association between maternal BMI and failed IOL, defined as failure to progress to the active phase of labor.
Material and Methods
We studied 22 114 term, singleton women undergoing IOL in the Central Denmark Region from 2013 to 2022. Women with spontaneous prelabor rupture of membranes, uterine scar, or fetal demise were excluded. The main outcome measure was failed IOL, defined as not reaching cervical dilation of 6 cm or more. BMI, our exposure, was modeled as a continuous variable using restricted cubic splines and as a categorical variable stratified according to the World Health Organization BMI groups. Adjusted logistic regression was used in both models to assess the association between BMI and failed IOL.
Results
Proportions of nulliparous women with failed IOL ranged between 4% for normal weight and 10% for obesity class III. Adjusted odds ratios for nulliparous women for failed IOL were 1.5 (95% confidence intervals [CI] 1.3, 1.7) for overweight, 1.8 (95% CI 1.4, 2.3) for obesity class I, 2.7 (95% CI 2.2, 3.3) for obesity class II, and 2.9 (95% CI 1.4, 6.0) for obesity class III compared to women with normal weight. In parous women, there was a similar but less pronounced association between BMI and failed IOL with a <2% absolute risk of failed IOL. A similar pattern was found when BMI and failed IOL were modeled using restricted cubic splines.
Conclusions
In singleton women with induced labor at term, increasing BMI was associated with higher odds of failed IOL; this association was more pronounced in nulliparous women.
导言：人工引产（IOL）是工业化国家常见的干预措施。归纳失败的报道屡见不鲜，但对其定义尚无共识。由于人工晶状体的主要目标是启动分娩，进展到活跃期是比代孕或剖腹产更相关的成功衡量标准。以往关于身体质量指数（BMI）对人工晶状体失败风险影响的研究较少。大多数依赖于美国的数据，并主要通过剖腹产来定义失败的人工晶状体。本研究旨在探讨母体BMI与IOL失败的关系，IOL失败定义为未能进入产程主动期。材料和方法：我们研究了2013年至2022年在丹麦中部地区接受人工晶状体植入术的22 114例妊娠期单胎妇女。排除了自发性产前胎膜破裂、子宫瘢痕或胎儿死亡的妇女。主要观察指标为人工晶状体植入失败，定义为宫颈扩张未达到或大于6cm。BMI，我们的暴露，被建模为使用受限三次样条的连续变量，并作为分类变量根据世界卫生组织BMI组分层。两个模型均采用调整后的逻辑回归来评估BMI与人工晶状体失败之间的关系。结果：未生育女性人工晶状体失败的比例在正常体重的4%和肥胖III级的10%之间。与体重正常的女性相比，未生育女性人工晶界失败的校正优势比为：超重1.5(95%可信区间[CI] 1.3, 1.7)，肥胖I级1.8(95%可信区间[CI] 1.4, 2.3)，肥胖II级2.7 (95% CI 2.2, 3.3)，肥胖III级2.9 （95% CI 1.4, 6.0）。在已产妇女中，BMI与人工晶状体植入失败之间存在类似但不太明显的关联。结论：在足月引产的单胎妇女中，BMI升高与人工晶状体植入失败的几率较高相关；这种关联在未生育妇女中更为明显。
{"title":"Body mass index and failed induction of labor: A cohort study","authors":"Lise Qvirin Krogh, Tine Brink Henriksen, Katja Albert Taastrøm, Sidsel Boie, Anne Cathrine Maqving Kjeldsen, Jim Thornton, Jens Fuglsang, Julie Glavind","doi":"10.1111/aogs.70081","DOIUrl":"10.1111/aogs.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Induction of labor (IOL) is a common intervention in industrialized countries. Failed induction is frequently reported, yet there is no consensus on its definition. Since the primary goal of IOL is to initiate labor, progress to the active phase is a more relevant measure of success than the surrogate of caesarean birth. Previous studies on the influence of body mass index (BMI) on the risk of failed IOL are limited. Most rely on data from the United States and define failed IOL primarily by caesarean delivery. This study aims to explore the association between maternal BMI and failed IOL, defined as failure to progress to the active phase of labor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We studied 22 114 term, singleton women undergoing IOL in the Central Denmark Region from 2013 to 2022. Women with spontaneous prelabor rupture of membranes, uterine scar, or fetal demise were excluded. The main outcome measure was failed IOL, defined as not reaching cervical dilation of 6 cm or more. BMI, our exposure, was modeled as a continuous variable using restricted cubic splines and as a categorical variable stratified according to the World Health Organization BMI groups. Adjusted logistic regression was used in both models to assess the association between BMI and failed IOL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Proportions of nulliparous women with failed IOL ranged between 4% for normal weight and 10% for obesity class III. Adjusted odds ratios for nulliparous women for failed IOL were 1.5 (95% confidence intervals [CI] 1.3, 1.7) for overweight, 1.8 (95% CI 1.4, 2.3) for obesity class I, 2.7 (95% CI 2.2, 3.3) for obesity class II, and 2.9 (95% CI 1.4, 6.0) for obesity class III compared to women with normal weight. In parous women, there was a similar but less pronounced association between BMI and failed IOL with a <2% absolute risk of failed IOL. A similar pattern was found when BMI and failed IOL were modeled using restricted cubic splines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In singleton women with induced labor at term, increasing BMI was associated with higher odds of failed IOL; this association was more pronounced in nulliparous women.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2282-2291"},"PeriodicalIF":3.1,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145443610","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}
Elisabeth R. Knorren, Joke M. Schutte, Judith A. F. Huirne, Martijn F. Boomsma
<p>With great interest, we read the original article by Otonkoski et al.<span><sup>1</sup></span> This prominent Finnish research group on magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) showed remarkable improvement in clinical outcomes for patients with symptomatic uterine fibroids. Significant symptom relief was reported from 3 months post-treatment, persisting up to 12 months. Additionally, they reported an impressively low reintervention rate of 2% after 12 months.</p><p>Several predictive factors for MR-HIFU treatment success are already known, but a universally accepted, well-designed prediction tool is not yet available. This makes the authors' reported outcomes after what they describe as “meticulous screening” especially noteworthy. Nevertheless, only a rather brief and freely interpretable screening protocol is provided by the authors, corresponding to other available screening protocols.<span><sup>2-4</sup></span> This makes it impossible to exactly understand what “meticulous screening” entails, which is needed to replicate their results.</p><p>We believe that determining eligibility for MR-HIFU treatment largely depends on the hands-on experience and intuition of physicians. Therefore, we call upon all MR-HIFU communities to report their screening considerations in greater detail, including considerations regarding patient- and fibroid-specific characteristics on both ultrasound and MRI. More transparent documentation of inclusion and exclusion decisions would add nuance to reported clinical outcomes and guidance for the community to move forward.</p><p>Emphasizing that every patient case is unique and must be assessed individually, a shared understanding of screening criteria is nevertheless essential for developing an optimal protocol. By pooling insights from different centers, we can work toward a minimum standard of care, ensuring consistent treatment quality and better global outcomes for fibroid patients.</p><p>In this context, some nuance is also required in interpreting “meticulous screening.” We agree with the authors that screening is vital in reaching favorable clinical outcomes. However, we believe there is a delicate balance. Too restrictive screening limits clinical adoption, while too liberal inclusion results in poor clinical outcomes. Therefore, the real challenge, in our opinion, lies in defining this balance, optimizing both effectiveness and clinical adoption.</p><p>In conclusion, Otonkonski et al. have done excellent work for the MR-HIFU community, but more can be learned from their results by gaining insight into their considerations regarding screening during the study period. This knowledge is key to refining protocols, ensuring high-quality outcomes, and advancing MR-HIFU as a reliable treatment option for symptomatic fibroids worldwide.</p><p><b>Elisabeth R. Knorren:</b> Writing – original draft, <b>Joke M. Schutte:</b> Writing – review and editing, <b>Judith A. F. Huirne:</b> Writing
带着极大的兴趣，我们阅读了Otonkoski等人的原始文章1。这个芬兰著名的研究小组在磁共振引导下的高强度聚焦超声（MR-HIFU）方面的研究表明，有症状的子宫肌瘤患者的临床结果有显著改善。治疗后3个月症状明显缓解，持续12个月。此外，他们报告了12个月后2%的再干预率，令人印象深刻。MR-HIFU治疗成功的几个预测因素已经为人所知，但目前还没有一个普遍接受的、设计良好的预测工具。这使得作者在经过他们所谓的“细致筛选”后报告的结果特别值得注意。然而，作者只提供了一个相当简短和可自由解释的筛选方案，与其他可用的筛选方案相对应。2-4这使得我们不可能确切地理解“细致筛选”的含义，这是复制他们的结果所需要的。我们认为，确定MR-HIFU治疗的资格在很大程度上取决于医生的实践经验和直觉。因此，我们呼吁所有MR-HIFU社区更详细地报告他们的筛查考虑，包括超声和MRI对患者和子宫肌瘤特异性特征的考虑。更透明的纳入和排除决定文件将为报告的临床结果增加细微差别，并为社区前进提供指导。强调每个病例都是独特的，必须单独评估，但对筛查标准的共同理解对于制定最佳方案至关重要。通过汇集来自不同中心的见解，我们可以为纤维瘤患者制定最低标准的护理，确保一致的治疗质量和更好的全球结果。在这种情况下，在解释“细致筛选”时也需要一些细微的差别。我们同意作者的观点，筛查对于达到良好的临床结果至关重要。然而，我们相信存在一种微妙的平衡。过于严格的筛查限制了临床采用，而过于宽松的纳入导致临床结果不佳。因此，在我们看来，真正的挑战在于确定这种平衡，优化有效性和临床应用。总之，Otonkonski等人为MR-HIFU社区做了出色的工作，但通过深入了解他们在研究期间对筛查的考虑，可以从他们的结果中学到更多。这方面的知识是完善方案、确保高质量结果和推动MR-HIFU成为世界范围内症状性肌瘤可靠治疗选择的关键。Elisabeth R. Knorren：写作-原稿，Joke M. Schutte：写作-评论和编辑，Judith A. F. Huirne：写作-评论和编辑，Martijn F. Boomsma：写作-评论和编辑。数据共享不适用于本文，因为在当前研究期间没有生成或分析数据集。
{"title":"Understanding clinical outcomes of MR-HIFU treatment of uterine fibroids by gaining insight in screening protocols","authors":"Elisabeth R. Knorren, Joke M. Schutte, Judith A. F. Huirne, Martijn F. Boomsma","doi":"10.1111/aogs.70087","DOIUrl":"10.1111/aogs.70087","url":null,"abstract":"<p>With great interest, we read the original article by Otonkoski et al.<span><sup>1</sup></span> This prominent Finnish research group on magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) showed remarkable improvement in clinical outcomes for patients with symptomatic uterine fibroids. Significant symptom relief was reported from 3 months post-treatment, persisting up to 12 months. Additionally, they reported an impressively low reintervention rate of 2% after 12 months.</p><p>Several predictive factors for MR-HIFU treatment success are already known, but a universally accepted, well-designed prediction tool is not yet available. This makes the authors' reported outcomes after what they describe as “meticulous screening” especially noteworthy. Nevertheless, only a rather brief and freely interpretable screening protocol is provided by the authors, corresponding to other available screening protocols.<span><sup>2-4</sup></span> This makes it impossible to exactly understand what “meticulous screening” entails, which is needed to replicate their results.</p><p>We believe that determining eligibility for MR-HIFU treatment largely depends on the hands-on experience and intuition of physicians. Therefore, we call upon all MR-HIFU communities to report their screening considerations in greater detail, including considerations regarding patient- and fibroid-specific characteristics on both ultrasound and MRI. More transparent documentation of inclusion and exclusion decisions would add nuance to reported clinical outcomes and guidance for the community to move forward.</p><p>Emphasizing that every patient case is unique and must be assessed individually, a shared understanding of screening criteria is nevertheless essential for developing an optimal protocol. By pooling insights from different centers, we can work toward a minimum standard of care, ensuring consistent treatment quality and better global outcomes for fibroid patients.</p><p>In this context, some nuance is also required in interpreting “meticulous screening.” We agree with the authors that screening is vital in reaching favorable clinical outcomes. However, we believe there is a delicate balance. Too restrictive screening limits clinical adoption, while too liberal inclusion results in poor clinical outcomes. Therefore, the real challenge, in our opinion, lies in defining this balance, optimizing both effectiveness and clinical adoption.</p><p>In conclusion, Otonkonski et al. have done excellent work for the MR-HIFU community, but more can be learned from their results by gaining insight into their considerations regarding screening during the study period. This knowledge is key to refining protocols, ensuring high-quality outcomes, and advancing MR-HIFU as a reliable treatment option for symptomatic fibroids worldwide.</p><p><b>Elisabeth R. Knorren:</b> Writing – original draft, <b>Joke M. Schutte:</b> Writing – review and editing, <b>Judith A. F. Huirne:</b> Writing","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"207-208"},"PeriodicalIF":3.1,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145385828","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}
Giovanna Esposito, Anna Cantarutti, Matteo Franchi, Fedro Alessandro Peccatori, Giovanna Scarfone, Eva Negri, Giovanni Corrao, Fabio Parazzini, Carlo La Vecchia
<div> <section> <h3> Introduction</h3> <p>Fertility after cancer represents a growing clinical concern. This study assessed childbearing outcomes among women diagnosed with cancer during reproductive age between 2012 and 2017 in Lombardy, the largest region in Italy.</p> </section> <section> <h3> Material and Methods</h3> <p>Women aged 15–45 years with a primary diagnosis of cancer recorded in hospital discharge records from regional healthcare databases were selected. Each woman diagnosed with cancer was matched with up to five cancer-free women of the same age at diagnosis. The cumulative probability of childbirth up to December 31, 2022 was estimated using the Kalbfleisch–Prentice cumulative incidence function estimator. Cox regression models were used to estimate the cause-specific hazard ratios (HRs) and the 95% confidence intervals (CIs) of childbirth according to the cancer diagnosis. Furthermore, in the group of cancer survivors, exposure to antineoplastic treatment was considered and included in the model as a time-dependent covariate. Finally, a log-binomial regression model was used to assess the association between antineoplastic therapy and medically assisted reproduction.</p> </section> <section> <h3> Results</h3> <p>A total of 13,877 women were diagnosed with cancer at reproductive age during the study period (1.16 per 1000 person-years). The cumulative probability of childbirth was lower among women diagnosed with cancer compared to cancer-free women across all age groups: 31.4% vs 32.2% (<i>p</i> = 0.02) among those diagnosed under 30, 13.3% vs 22.7% (<i>p</i> < 0.01) among those aged 30–39, and 0.8% vs 1.6% (<i>p</i> < 0.01) among those aged 40 and over. The corresponding HRs were 0.93 (95% CI: 0.83–1.05), 0.58 (95% CI: 0.53–0.64), and 0.52 (95% CI: 0.40–0.68). When analyses were stratified by time since diagnosis, the reduced probability among cancer survivors was confirmed to be significant only within the first 5 years after diagnosis, also for younger individuals. Antineoplastic treatment was associated with a reduced probability of subsequent birth (HR = 0.46, 95% CI: 0.39–0.52). Moreover, the therapy was positively associated with medically assisted reproduction (RR = 1.71, 95% CI: 1.14–2.56).</p> </section> <section> <h3> Conclusions</h3> <p>The probability of childbearing was reduced within the first 5 years of diagnosis, regardless of the patient's age. A more pronounced reduction was observed in women diagnosed after the age of 30. Age and antineoplastic therapy were key factors in determining childbearing in women
{"title":"Childbearing in women diagnosed with cancer during reproductive age","authors":"Giovanna Esposito, Anna Cantarutti, Matteo Franchi, Fedro Alessandro Peccatori, Giovanna Scarfone, Eva Negri, Giovanni Corrao, Fabio Parazzini, Carlo La Vecchia","doi":"10.1111/aogs.70071","DOIUrl":"10.1111/aogs.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Fertility after cancer represents a growing clinical concern. This study assessed childbearing outcomes among women diagnosed with cancer during reproductive age between 2012 and 2017 in Lombardy, the largest region in Italy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Women aged 15–45 years with a primary diagnosis of cancer recorded in hospital discharge records from regional healthcare databases were selected. Each woman diagnosed with cancer was matched with up to five cancer-free women of the same age at diagnosis. The cumulative probability of childbirth up to December 31, 2022 was estimated using the Kalbfleisch–Prentice cumulative incidence function estimator. Cox regression models were used to estimate the cause-specific hazard ratios (HRs) and the 95% confidence intervals (CIs) of childbirth according to the cancer diagnosis. Furthermore, in the group of cancer survivors, exposure to antineoplastic treatment was considered and included in the model as a time-dependent covariate. Finally, a log-binomial regression model was used to assess the association between antineoplastic therapy and medically assisted reproduction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 13,877 women were diagnosed with cancer at reproductive age during the study period (1.16 per 1000 person-years). The cumulative probability of childbirth was lower among women diagnosed with cancer compared to cancer-free women across all age groups: 31.4% vs 32.2% (<i>p</i> = 0.02) among those diagnosed under 30, 13.3% vs 22.7% (<i>p</i> < 0.01) among those aged 30–39, and 0.8% vs 1.6% (<i>p</i> < 0.01) among those aged 40 and over. The corresponding HRs were 0.93 (95% CI: 0.83–1.05), 0.58 (95% CI: 0.53–0.64), and 0.52 (95% CI: 0.40–0.68). When analyses were stratified by time since diagnosis, the reduced probability among cancer survivors was confirmed to be significant only within the first 5 years after diagnosis, also for younger individuals. Antineoplastic treatment was associated with a reduced probability of subsequent birth (HR = 0.46, 95% CI: 0.39–0.52). Moreover, the therapy was positively associated with medically assisted reproduction (RR = 1.71, 95% CI: 1.14–2.56).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The probability of childbearing was reduced within the first 5 years of diagnosis, regardless of the patient's age. A more pronounced reduction was observed in women diagnosed after the age of 30. Age and antineoplastic therapy were key factors in determining childbearing in women","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2309-2319"},"PeriodicalIF":3.1,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375522","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}
Sofie Gellert, Sara Norrestam, Alexandra Tidstedt, Claes Ignell, Per-Erik Isberg, Nana Wiberg, Linda Iorizzo
<div> <section> <h3> Introduction</h3> <p>This multicenter, prospective observational study aimed to evaluate the performance of the StatStrip<sup>®</sup> Lactate 2 (Nova Biomedical, Waltham, US) point-of-care device for fetal blood lactate measurement and to determine the corresponding lactate value equivalent to the established intervention cutoff used with the outgoing StatStrip<sup>®</sup> Lactate device.</p> </section> <section> <h3> Material and Methods</h3> <p>The study was conducted from August 2024 to February 2025 at two maternity clinics in Sweden and one in Denmark. It included women with singleton pregnancies (≥35 + 0 weeks) undergoing fetal blood sampling due to non-reassuring intrapartal fetal heart rate patterns during labor. Fetal scalp blood sampling (FBS) lactate concentrations were measured using both StatStrip<sup>®</sup> Lactate and StatStrip<sup>®</sup> Lactate2. The first StatStrip<sup>®</sup> Lactate measurement guided clinical decisions, while subsequent StatStrip<sup>®</sup> Lactate2 measurements were recorded for validation and establishment of a conversion equation by linear regression. Additionally, arterial and venous umbilical cord blood samples were analyzed by both ABL 800 (Radiometer, Denmark) and StatStrip<sup>®</sup> Lactate2 for validation.</p> </section> <section> <h3> Results</h3> <p>Blood samples from 349 fetuses were included, with 549 parallel FBS lactate samples. StatStrip<sup>®</sup> Lactate2 concentrations correlated with StatStrip<sup>®</sup> Lactate (<i>r</i> = 0.94;<i>p</i> ≤ 0.001). A conversion equation was retrieved: StatStrip<sup>®</sup> Lactate2 = (1.4 × StatStrip<sup>®</sup> Lactate) − 0.28. From 37 paired umbilical cord blood samples, the correlation between lactate concentrations by StatStrip<sup>®</sup> Lactate2 and ABL800 was <i>r</i> = 0.99 (<i>p</i> ≤ 0.001) in arterial blood and r = 0.98 (<i>p</i> ≤ 0.001) in venous blood. Mean coefficients of variation for lactate concentrations >3.0 mmol/L were 8.2% in fetal scalp blood and 3.8% in umbilical cord blood.</p> </section> <section> <h3> Conclusions</h3> <p>A fetal blood lactate concentration ≥7.0 mmol/L measured by StatStrip<sup>®</sup>Lactate2 corresponds to the established intervention cutoff lactate value ≥5.2 mmol/L measured by StatStrip<sup>®</sup>Lactate. Precision was acceptable but may be improved by using the mean of two measurements, particularly when the first result falls between 6.0 and 8.0 mmol/L. We also recommend ensuring the correct sampling techniques to minimize preanalytical variation.</p> </section>
{"title":"Validation and proposal of a clinical intervention cutoff in fetal scalp blood for the point-of care-lactate meter StatStrip®2","authors":"Sofie Gellert, Sara Norrestam, Alexandra Tidstedt, Claes Ignell, Per-Erik Isberg, Nana Wiberg, Linda Iorizzo","doi":"10.1111/aogs.70080","DOIUrl":"10.1111/aogs.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This multicenter, prospective observational study aimed to evaluate the performance of the StatStrip<sup>®</sup> Lactate 2 (Nova Biomedical, Waltham, US) point-of-care device for fetal blood lactate measurement and to determine the corresponding lactate value equivalent to the established intervention cutoff used with the outgoing StatStrip<sup>®</sup> Lactate device.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>The study was conducted from August 2024 to February 2025 at two maternity clinics in Sweden and one in Denmark. It included women with singleton pregnancies (≥35 + 0 weeks) undergoing fetal blood sampling due to non-reassuring intrapartal fetal heart rate patterns during labor. Fetal scalp blood sampling (FBS) lactate concentrations were measured using both StatStrip<sup>®</sup> Lactate and StatStrip<sup>®</sup> Lactate2. The first StatStrip<sup>®</sup> Lactate measurement guided clinical decisions, while subsequent StatStrip<sup>®</sup> Lactate2 measurements were recorded for validation and establishment of a conversion equation by linear regression. Additionally, arterial and venous umbilical cord blood samples were analyzed by both ABL 800 (Radiometer, Denmark) and StatStrip<sup>®</sup> Lactate2 for validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Blood samples from 349 fetuses were included, with 549 parallel FBS lactate samples. StatStrip<sup>®</sup> Lactate2 concentrations correlated with StatStrip<sup>®</sup> Lactate (<i>r</i> = 0.94;<i>p</i> ≤ 0.001). A conversion equation was retrieved: StatStrip<sup>®</sup> Lactate2 = (1.4 × StatStrip<sup>®</sup> Lactate) − 0.28. From 37 paired umbilical cord blood samples, the correlation between lactate concentrations by StatStrip<sup>®</sup> Lactate2 and ABL800 was <i>r</i> = 0.99 (<i>p</i> ≤ 0.001) in arterial blood and r = 0.98 (<i>p</i> ≤ 0.001) in venous blood. Mean coefficients of variation for lactate concentrations >3.0 mmol/L were 8.2% in fetal scalp blood and 3.8% in umbilical cord blood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A fetal blood lactate concentration ≥7.0 mmol/L measured by StatStrip<sup>®</sup>Lactate2 corresponds to the established intervention cutoff lactate value ≥5.2 mmol/L measured by StatStrip<sup>®</sup>Lactate. Precision was acceptable but may be improved by using the mean of two measurements, particularly when the first result falls between 6.0 and 8.0 mmol/L. We also recommend ensuring the correct sampling techniques to minimize preanalytical variation.</p>\u0000 </section>\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2273-2281"},"PeriodicalIF":3.1,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145371998","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}
Roman Chmel Jr., Nikoleta Chubanovova, Jan Balko, Roman Chmel, Zlatko Pastor
Approximately 25 million people worldwide do not identify with the sex assigned at birth. Treatment options for gender dysphoria are multidisciplinary and include gender-affirming hormone therapy and surgery. Uterus transplantation in women without a uterus is promising for treating absolute uterine factor infertility, and its efficacy has been demonstrated through successful transplant surgeries and subsequent births via cesarean section following single embryo transfer. Transgender men undergoing gender-affirming hysterectomy to alleviate gender dysphoria symptoms should be considered as potential uterus donors for transplantation. Although transgender men show positive attitudes toward uterus donation to women with infertility, who do not have a uterus, long-term gender-affirming testosterone therapy induces uterine changes that necessitate assessment before donation for transplantation should be considered. This commentary highlights the major challenges associated with uterus donation by transgender men for transplantation.
{"title":"Transgender men as uterus donors for transplantation: A theoretical perspective","authors":"Roman Chmel Jr., Nikoleta Chubanovova, Jan Balko, Roman Chmel, Zlatko Pastor","doi":"10.1111/aogs.70086","DOIUrl":"10.1111/aogs.70086","url":null,"abstract":"<p>Approximately 25 million people worldwide do not identify with the sex assigned at birth. Treatment options for gender dysphoria are multidisciplinary and include gender-affirming hormone therapy and surgery. Uterus transplantation in women without a uterus is promising for treating absolute uterine factor infertility, and its efficacy has been demonstrated through successful transplant surgeries and subsequent births via cesarean section following single embryo transfer. Transgender men undergoing gender-affirming hysterectomy to alleviate gender dysphoria symptoms should be considered as potential uterus donors for transplantation. Although transgender men show positive attitudes toward uterus donation to women with infertility, who do not have a uterus, long-term gender-affirming testosterone therapy induces uterine changes that necessitate assessment before donation for transplantation should be considered. This commentary highlights the major challenges associated with uterus donation by transgender men for transplantation.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2210-2214"},"PeriodicalIF":3.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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