Erin A. Brennand, Natalie V. Scime, Beili Huang, Pauline McDonagh Hull
Introduction
Hysterectomy is a common surgery with discernible practice variations that could be influenced by socioeconomic factors. We examined the association between level of educational attainment and the occurrence and timing of hysterectomy in Canadian women.
Material and Methods
We conducted a prospective cohort study of 30 496 females in the Alberta's Tomorrow Project (2000–2015) followed approximately every 4 years using self-report questionnaires. Educational attainment was defined as high school diploma or less, college degree, university degree (reference group), and postgraduate degree. We used logistic regression analyzing hysterectomy occurrence at any time and before menopause, separately, and flexible parametric survival models analyzing hysterectomy timing with age as the time scale. Multivariable models controlled for race/ethnicity, rural/urban residence, parity, oral contraceptive use, and smoking.
Results
Overall, 39.1% of females reported a high school diploma or less, 28.9% reported a college degree, 23.5% reported a university degree, and 8.5% reported a postgraduate degree. A graded association was observed between lower education and higher odds of hysterectomy (high school or less: adjusted odds ratio [AOR] 1.68, 95% CI 1.55–1.82; college degree: AOR 1.58, 95% CI 1.45–1.72); results were similar for premenopausal hysterectomy. A graded association between lower education and earlier timing of hysterectomy was also observed up to approximately age 60 (eg at age 40: high school or less adjusted hazard ratio [AHR] 1.61, 95% CI 1.49–1.75; college degree AHR 1.53, 95% CI 1.40–1.67).
Conclusions
Women with lower levels of education were more likely to experience hysterectomy, including hysterectomy before menopause and at younger ages.
导言：子宫切除术是一种常见的外科手术，但在实践中存在明显的差异，这可能受到社会经济因素的影响。我们研究了加拿大妇女的教育程度与子宫切除术的发生和时间之间的关系：我们对阿尔伯塔省 "明天 "项目（2000-2015 年）中的 30 496 名女性进行了前瞻性队列研究，使用自我报告问卷每 4 年进行一次跟踪调查。教育程度被定义为高中或高中以下文凭、大学学位、大学学位（参照组）和研究生学位。我们使用逻辑回归分别分析了任何时间和绝经前的子宫切除情况，并使用灵活的参数生存模型分析了以年龄为时间尺度的子宫切除时间。多变量模型控制了种族/民族、农村/城市居住地、奇偶数、口服避孕药使用情况和吸烟情况：总体而言，39.1%的女性拥有高中或以下文凭，28.9%的女性拥有大学学位，23.5%的女性拥有大学学位，8.5%的女性拥有研究生学位。教育程度越低，子宫切除的几率越高（高中或以下：调整后的几率比 [AOR]为 1.68，95% CI 为 1.55-1.82；大学学历：调整后的几率比 [AOR]为 1.58，95% CI 为 1.82）：绝经前子宫切除术的结果类似。在大约 60 岁之前，也观察到教育程度较低与较早进行子宫切除术之间的分级关系（例如，在 40 岁时：高中或高中以下调整后危险比 [AHR] 1.61，95% CI 1.49-1.75；大学学历调整后危险比 1.53，95% CI 1.40-1.67）：结论：受教育程度较低的女性更有可能接受子宫切除术，包括在绝经前和更年轻时接受子宫切除术。
{"title":"Education level is associated with the occurrence and timing of hysterectomy: A cohort study of Canadian women","authors":"Erin A. Brennand, Natalie V. Scime, Beili Huang, Pauline McDonagh Hull","doi":"10.1111/aogs.14959","DOIUrl":"10.1111/aogs.14959","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hysterectomy is a common surgery with discernible practice variations that could be influenced by socioeconomic factors. We examined the association between level of educational attainment and the occurrence and timing of hysterectomy in Canadian women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a prospective cohort study of 30 496 females in the Alberta's Tomorrow Project (2000–2015) followed approximately every 4 years using self-report questionnaires. Educational attainment was defined as high school diploma or less, college degree, university degree (reference group), and postgraduate degree. We used logistic regression analyzing hysterectomy occurrence at any time and before menopause, separately, and flexible parametric survival models analyzing hysterectomy timing with age as the time scale. Multivariable models controlled for race/ethnicity, rural/urban residence, parity, oral contraceptive use, and smoking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 39.1% of females reported a high school diploma or less, 28.9% reported a college degree, 23.5% reported a university degree, and 8.5% reported a postgraduate degree. A graded association was observed between lower education and higher odds of hysterectomy (high school or less: adjusted odds ratio [AOR] 1.68, 95% CI 1.55–1.82; college degree: AOR 1.58, 95% CI 1.45–1.72); results were similar for premenopausal hysterectomy. A graded association between lower education and earlier timing of hysterectomy was also observed up to approximately age 60 (eg at age 40: high school or less adjusted hazard ratio [AHR] 1.61, 95% CI 1.49–1.75; college degree AHR 1.53, 95% CI 1.40–1.67).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Women with lower levels of education were more likely to experience hysterectomy, including hysterectomy before menopause and at younger ages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2211-2220"},"PeriodicalIF":3.5,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118676","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}
Elin Collins, Per Liv, Annika Strandell, Maria Furberg, Sophia Ehrström, Mathias Pålsson, Annika Idahl
Introduction
The evidence on complication rates after gynecological surgery is based on multiple types of studies, and the level of evidence is generally low. We aimed to validate the registration of complications in the Swedish National Quality Register of Gynecological Surgery (GynOp), by cross-linkage to multiple national registers.
Material and Methods
A national register-based study using prospectively collected data was conducted, including women who had surgery on the uterus or adnexa for benign indications from January 1, 2017, to December 31, 2020. In Sweden, complications after gynecological surgery are registered in GynOp, and if the complication has rendered any interaction with healthcare, it is also in national health registers. The GynOp register, the National Patient Register, the Prescribed Drugs Register, and the Cause of Death Register were cross-linked. Complications in GynOp and complications according to ICD10 were analyzed, as well as the cause of death if occurring within 3 months of surgery and prescription of antibiotics ≤30 days. Comparisons between the registries were descriptive.
Results
During the study period 32 537 surgeries were performed, of which 26 214 (80.6%) were minimally invasive. Complications were reported in GynOp for 569 women (1.7%) at surgery, 1045 (3.2%) while admitted, and 3868 (13.7%) from discharge to 3 months after surgery. In comparison, according to the Patient Register, 2254 women (6.9%) had postoperative complications within 3 months of discharge (difference of 6.8 percentage points [95% confidence interval 6.2–7.2]). Furthermore, 4117 individuals (12.7%) had a prescription of antibiotics ≤30 days which could indicate a postoperative infection. The rates of hemorrhage, wound dehiscence, and thrombosis were comparable between GynOp and the Patient Register while diagnoses not leading to contact with specialized care had higher rates in the quality register. The coverage of complications was 79.1% in GynOp and 46.1% in the Patient Register, using the total number of complications from both registers as the denominator.
Conclusions
A higher frequency of complications is captured in GynOp than in the National Patient Register. Patient-reported outcomes assessed by a physician are beneficial in identifying complications indicating the importance of structured pre-defined follow-up over a set period.
{"title":"Complications after benign gynecologic surgery—How are they captured in register-based research? A national register study in Sweden","authors":"Elin Collins, Per Liv, Annika Strandell, Maria Furberg, Sophia Ehrström, Mathias Pålsson, Annika Idahl","doi":"10.1111/aogs.14960","DOIUrl":"10.1111/aogs.14960","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The evidence on complication rates after gynecological surgery is based on multiple types of studies, and the level of evidence is generally low. We aimed to validate the registration of complications in the Swedish National Quality Register of Gynecological Surgery (GynOp), by cross-linkage to multiple national registers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A national register-based study using prospectively collected data was conducted, including women who had surgery on the uterus or adnexa for benign indications from January 1, 2017, to December 31, 2020. In Sweden, complications after gynecological surgery are registered in GynOp, and if the complication has rendered any interaction with healthcare, it is also in national health registers. The GynOp register, the National Patient Register, the Prescribed Drugs Register, and the Cause of Death Register were cross-linked. Complications in GynOp and complications according to ICD10 were analyzed, as well as the cause of death if occurring within 3 months of surgery and prescription of antibiotics ≤30 days. Comparisons between the registries were descriptive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study period 32 537 surgeries were performed, of which 26 214 (80.6%) were minimally invasive. Complications were reported in GynOp for 569 women (1.7%) at surgery, 1045 (3.2%) while admitted, and 3868 (13.7%) from discharge to 3 months after surgery. In comparison, according to the Patient Register, 2254 women (6.9%) had postoperative complications within 3 months of discharge (difference of 6.8 percentage points [95% confidence interval 6.2–7.2]). Furthermore, 4117 individuals (12.7%) had a prescription of antibiotics ≤30 days which could indicate a postoperative infection. The rates of hemorrhage, wound dehiscence, and thrombosis were comparable between GynOp and the Patient Register while diagnoses not leading to contact with specialized care had higher rates in the quality register. The coverage of complications was 79.1% in GynOp and 46.1% in the Patient Register, using the total number of complications from both registers as the denominator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A higher frequency of complications is captured in GynOp than in the National Patient Register. Patient-reported outcomes assessed by a physician are beneficial in identifying complications indicating the importance of structured pre-defined follow-up over a set period.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2221-2231"},"PeriodicalIF":3.5,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118675","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}
Damaris Erhardt, Anda-Petronela Radan, Jérôme Mathis, Daniel Surbek
Introduction
Labor induction exhibits considerable variations in protocols and medication regimens. Limited studies compare vaginal dinoprostone inserts with different oral misoprostol dosages, considering parity influence. This study explores the distinctions among 10 mg vaginal dinoprostone inserts and oral misoprostol 25 μg every 2 and every 4 h for labor induction, stratified by parity.
Material and Methods
This retrospective cohort study involved 607 participants across two hospitals. The primary outcome, time from induction to delivery, and secondary outcomes, including mode of delivery and maternal and fetal safety, were assessed.
Results
Patient characteristics revealed differences in indication for labor induction, with the dinoprostone cohort having fewer post-term and premature rupture of membranes cases but more intrauterine growth restriction/small-for-gestational age. Both oral misoprostol regimens showed a shorter time to delivery interval compared to the dinoprostone cohort (median: 1380 min [IQR 1381.0] and 1127.0 min [IQR 1214.0] vs 1631.5 [IQR 1736.2], p < 0.001 and p = 0.014). Only the difference between oral misoprostol q2h and vaginal dinoprostone remained significant for nulliparous but not multiparous women, losing significance over all the population after adjusting for confounding factors. The proportion of women giving birth within 24 h did not significantly differ between misoprostol q2h and dinoprostone after adjusting for confounders. When comparing misoprostol q4h with dinoprostone after confounder adjustment, an increased time to delivery interval for misoprostol q4h was found (p = 0.001). Both oral misoprostol regimens exhibited fewer meconium-stained liquor (miso q4h: OR 0.44, miso q2h: OR 0.34) and cesarean sections (miso q4h: OR 0.48, miso q2h: OR 0.53) compared to dinoprostone, even after adjustment for confounders.
Conclusions
Our study suggests that oral misoprostol 25 μg q4h is less effective than 10 mg vaginal dinoprostone for labor induction if parity and indication for induction are adjusted for, particularly in multiparous women. In terms of side effects, oral misoprostol regimens seem superior to vaginal dinoprostone. Our data support the individualized use of different agents for labor induction according to parity, indication for induction, bishop score, and women's preference.
{"title":"Vaginal dinoprostone insert compared with two different oral misoprostol regimens for labor induction in nulliparous and multiparous women","authors":"Damaris Erhardt, Anda-Petronela Radan, Jérôme Mathis, Daniel Surbek","doi":"10.1111/aogs.14956","DOIUrl":"10.1111/aogs.14956","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Labor induction exhibits considerable variations in protocols and medication regimens. Limited studies compare vaginal dinoprostone inserts with different oral misoprostol dosages, considering parity influence. This study explores the distinctions among 10 mg vaginal dinoprostone inserts and oral misoprostol 25 μg every 2 and every 4 h for labor induction, stratified by parity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This retrospective cohort study involved 607 participants across two hospitals. The primary outcome, time from induction to delivery, and secondary outcomes, including mode of delivery and maternal and fetal safety, were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patient characteristics revealed differences in indication for labor induction, with the dinoprostone cohort having fewer post-term and premature rupture of membranes cases but more intrauterine growth restriction/small-for-gestational age. Both oral misoprostol regimens showed a shorter time to delivery interval compared to the dinoprostone cohort (median: 1380 min [IQR 1381.0] and 1127.0 min [IQR 1214.0] vs 1631.5 [IQR 1736.2], <i>p</i> < 0.001 and <i>p</i> = 0.014). Only the difference between oral misoprostol q2h and vaginal dinoprostone remained significant for nulliparous but not multiparous women, losing significance over all the population after adjusting for confounding factors. The proportion of women giving birth within 24 h did not significantly differ between misoprostol q2h and dinoprostone after adjusting for confounders. When comparing misoprostol q4h with dinoprostone after confounder adjustment, an increased time to delivery interval for misoprostol q4h was found (<i>p</i> = 0.001). Both oral misoprostol regimens exhibited fewer meconium-stained liquor (miso q4h: OR 0.44, miso q2h: OR 0.34) and cesarean sections (miso q4h: OR 0.48, miso q2h: OR 0.53) compared to dinoprostone, even after adjustment for confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study suggests that oral misoprostol 25 μg q4h is less effective than 10 mg vaginal dinoprostone for labor induction if parity and indication for induction are adjusted for, particularly in multiparous women. In terms of side effects, oral misoprostol regimens seem superior to vaginal dinoprostone. Our data support the individualized use of different agents for labor induction according to parity, indication for induction, bishop score, and women's preference.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2306-2313"},"PeriodicalIF":3.5,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142118677","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}
Marta Ricart, Erika Bonacina, Pablo Garcia-Manau, Monica López, Sara Caamiña, Àngels Vives, Eva Lopez-Quesada, Anna Maroto, Laura de Mingo, Elena Pintado, Roser Ferrer-Costa, Lourdes Martín, Alicia Rodriguez-Zurita, Esperanza Garcia, Mar Pallarols, Laia Pratcorona, Mireia Teixidor, Carmen Orizales-Lago, Vanesa Ocaña, Esther del Barco, Elena Carreras, Anna Suy, Manel Mendoza
Introduction
This study aims to evaluate the safety of discontinuing aspirin treatment at 24–28 weeks in women at high risk after first-trimester combined screening for preeclampsia (PE) and normal placental growth factor (PlGF) levels at 24–28 weeks of gestation.
Material and Methods
This is a post hoc analysis of the StopPRE trial, conducted at nine Spanish maternity hospitals from September 2019 to September 2021. In the StopPRE trial, all high-risk single pregnancies identified during first-trimester screening for PE were treated with 150 mg of daily aspirin. Out of 1604 eligible women with a soluble fms-like tyrosine kinase-1 to PlGF ratio (sFlt-1/PlGF) ≤38 at 24–28 weeks, 968 were randomly assigned in a 1:1 ratio to either continue aspirin until 36 weeks (control group) or discontinue it (intervention group). In this secondary analysis, only women with PlGF ≥100 pg/mL at 24–28 weeks were included. As in the StopPRE trial, the non-inferiority margin was set at a 1.9% difference in preterm PE incidence between the groups.
Results
Among the 13 983 screened pregnant women, 1984 (14.2%) were deemed high-risk for preterm PE, of which 397 (20.0%) were ineligible, 636 declined participation, and 32 were excluded. Ultimately, 919 women with PlGF >100 pg/mL were randomized and included in this analysis. Preterm PE occurred in 0.9% of the intervention group (4 out of 465) and 1.5% of the control group (7 out of 454), indicating non-inferiority of aspirin discontinuation. There were no significant differences between the groups in adverse pregnancy outcomes before 37 weeks, at <34 weeks, or ≥37 weeks. Minor antepartum hemorrhage incidence was significantly lower in the intervention group (absolute difference, −5.96; 95% CI, −10.10 to −1.82).
Conclusions
Discontinuation of aspirin treatment at 24–28 weeks in women with PlGF levels ≥100 pg/mL was non-inferior to continuing until 36 weeks for preventing preterm PE. However, these findings should be interpreted with caution, as they originate from a subanalysis of the StopPRE trial.
{"title":"Placental growth factor at 24–28 weeks for aspirin discontinuation in pregnancies at high risk for preterm preeclampsia: Post hoc analysis of StopPRE trial","authors":"Marta Ricart, Erika Bonacina, Pablo Garcia-Manau, Monica López, Sara Caamiña, Àngels Vives, Eva Lopez-Quesada, Anna Maroto, Laura de Mingo, Elena Pintado, Roser Ferrer-Costa, Lourdes Martín, Alicia Rodriguez-Zurita, Esperanza Garcia, Mar Pallarols, Laia Pratcorona, Mireia Teixidor, Carmen Orizales-Lago, Vanesa Ocaña, Esther del Barco, Elena Carreras, Anna Suy, Manel Mendoza","doi":"10.1111/aogs.14955","DOIUrl":"10.1111/aogs.14955","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study aims to evaluate the safety of discontinuing aspirin treatment at 24–28 weeks in women at high risk after first-trimester combined screening for preeclampsia (PE) and normal placental growth factor (PlGF) levels at 24–28 weeks of gestation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This is a post hoc analysis of the StopPRE trial, conducted at nine Spanish maternity hospitals from September 2019 to September 2021. In the StopPRE trial, all high-risk single pregnancies identified during first-trimester screening for PE were treated with 150 mg of daily aspirin. Out of 1604 eligible women with a soluble fms-like tyrosine kinase-1 to PlGF ratio (sFlt-1/PlGF) ≤38 at 24–28 weeks, 968 were randomly assigned in a 1:1 ratio to either continue aspirin until 36 weeks (control group) or discontinue it (intervention group). In this secondary analysis, only women with PlGF ≥100 pg/mL at 24–28 weeks were included. As in the StopPRE trial, the non-inferiority margin was set at a 1.9% difference in preterm PE incidence between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 13 983 screened pregnant women, 1984 (14.2%) were deemed high-risk for preterm PE, of which 397 (20.0%) were ineligible, 636 declined participation, and 32 were excluded. Ultimately, 919 women with PlGF >100 pg/mL were randomized and included in this analysis. Preterm PE occurred in 0.9% of the intervention group (4 out of 465) and 1.5% of the control group (7 out of 454), indicating non-inferiority of aspirin discontinuation. There were no significant differences between the groups in adverse pregnancy outcomes before 37 weeks, at <34 weeks, or ≥37 weeks. Minor antepartum hemorrhage incidence was significantly lower in the intervention group (absolute difference, −5.96; 95% CI, −10.10 to −1.82).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Discontinuation of aspirin treatment at 24–28 weeks in women with PlGF levels ≥100 pg/mL was non-inferior to continuing until 36 weeks for preventing preterm PE. However, these findings should be interpreted with caution, as they originate from a subanalysis of the StopPRE trial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2273-2280"},"PeriodicalIF":3.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Shoulder dystocia is a feared, yet well-known, complication in Obstetrics. For the fetus and newborn, shoulder dystocia holds the potential of dramatic consequences. Perinatal death is the most severe complication but asphyxia, trauma to the central nervous system, to the brachial nerve plexus, and bone fractures may also leave permanent sequelae.<span><sup>1</sup></span> For the birthing parent, perineal lesions and a traumatic experience of childbirth may have a lasting influence on life quality.</p><p>All obstetricians and midwives are aware of the risk of sudden shoulder dystocia in vaginal delivery and can, therefore, draw on an array of procedures to intervene in such cases. Trainees in obstetrics and gynecology and midwives will have learned various mnemotechnical acronyms to help in solving these emergency situations and, in many hospitals, team training programs exist with shoulder dystocia as one of the most frequent learning focuses. Individuals are trained in both hands-on procedures as well as the coordination of team efforts in order to minimize damage incurred to the child and parent in case of shoulder dystocia. Hence, a great deal of awareness surrounds shoulder dystocia. However, the definition of shoulder dystocia is nevertheless difficult to pinpoint and there is some subjectivity involved in its definition.<span><sup>1</sup></span></p><p>Four papers on shoulder dystocia are published in this issue of <i>Acta Obstetricia et Gynecologica Scandinavica</i>,<span><sup>2-5</sup></span> and these may boost our knowledge in managing and counseling on shoulder dystocia.</p><p>In the paper by Heinonen and colleagues, the manual maneuvers that midwives and obstetricians apply in case of a recognized shoulder dystocia are brought into play.<span><sup>2</sup></span> In their study, Heinonen et al report that the use of obstetric maneuvers has increased during the study period from 2006 to 2015.<span><sup>2</sup></span> At the same time, the rate of neonatal complications has declined. It, therefore, appears that the awareness and the treatment modalities for shoulder dystocia among birth attendants have increased, and this heightened awareness may have benefited in shoulder dystocia cases. Not unexpectedly, worse outcomes are demonstrated when the specific obstetric maneuvers directed toward shoulder dystocia are omitted and the higher the number of maneuvers the higher the risk of perineal lacerations,<span><sup>2</sup></span> which is likely indicative of the most severe cases of shoulder dystocia.</p><p>This success nevertheless may come with a price. It is more difficult to ascertain whether the awareness of the risk of shoulder dystocia leads to a higher likelihood of ascribing a shoulder dystocia diagnosis to a delivery or whether obstetric maneuvers might be applied very early or even in cases that did not represent ‘real’ shoulder dystocia. It all comes down to the definition of shoulder dystocia.</p><p>Another take on the flow
{"title":"Shoulder dystocia—Still a feared complication. How can we improve?","authors":"Jens Fuglsang","doi":"10.1111/aogs.14952","DOIUrl":"10.1111/aogs.14952","url":null,"abstract":"<p>Shoulder dystocia is a feared, yet well-known, complication in Obstetrics. For the fetus and newborn, shoulder dystocia holds the potential of dramatic consequences. Perinatal death is the most severe complication but asphyxia, trauma to the central nervous system, to the brachial nerve plexus, and bone fractures may also leave permanent sequelae.<span><sup>1</sup></span> For the birthing parent, perineal lesions and a traumatic experience of childbirth may have a lasting influence on life quality.</p><p>All obstetricians and midwives are aware of the risk of sudden shoulder dystocia in vaginal delivery and can, therefore, draw on an array of procedures to intervene in such cases. Trainees in obstetrics and gynecology and midwives will have learned various mnemotechnical acronyms to help in solving these emergency situations and, in many hospitals, team training programs exist with shoulder dystocia as one of the most frequent learning focuses. Individuals are trained in both hands-on procedures as well as the coordination of team efforts in order to minimize damage incurred to the child and parent in case of shoulder dystocia. Hence, a great deal of awareness surrounds shoulder dystocia. However, the definition of shoulder dystocia is nevertheless difficult to pinpoint and there is some subjectivity involved in its definition.<span><sup>1</sup></span></p><p>Four papers on shoulder dystocia are published in this issue of <i>Acta Obstetricia et Gynecologica Scandinavica</i>,<span><sup>2-5</sup></span> and these may boost our knowledge in managing and counseling on shoulder dystocia.</p><p>In the paper by Heinonen and colleagues, the manual maneuvers that midwives and obstetricians apply in case of a recognized shoulder dystocia are brought into play.<span><sup>2</sup></span> In their study, Heinonen et al report that the use of obstetric maneuvers has increased during the study period from 2006 to 2015.<span><sup>2</sup></span> At the same time, the rate of neonatal complications has declined. It, therefore, appears that the awareness and the treatment modalities for shoulder dystocia among birth attendants have increased, and this heightened awareness may have benefited in shoulder dystocia cases. Not unexpectedly, worse outcomes are demonstrated when the specific obstetric maneuvers directed toward shoulder dystocia are omitted and the higher the number of maneuvers the higher the risk of perineal lacerations,<span><sup>2</sup></span> which is likely indicative of the most severe cases of shoulder dystocia.</p><p>This success nevertheless may come with a price. It is more difficult to ascertain whether the awareness of the risk of shoulder dystocia leads to a higher likelihood of ascribing a shoulder dystocia diagnosis to a delivery or whether obstetric maneuvers might be applied very early or even in cases that did not represent ‘real’ shoulder dystocia. It all comes down to the definition of shoulder dystocia.</p><p>Another take on the flow","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 10","pages":"1908-1909"},"PeriodicalIF":3.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.14952","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016010","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}
Magdalena Kolak, Stephen Gerry, Hubert Huras, Ammar Al Naimi, Karin A Fox, Thorsten Braun, Vedran Stefanovic, Heleen van Beekhuizen, Olivier Morel, Alexander Paping, Charline Bertholdt, Pavel Calda, Zdenek Lastuvka, Andrzej Jaworowski, Egle Savukyne, Sally Collins
Introduction: This study aimed to validate the Sargent risk stratification algorithm for the prediction of placenta accreta spectrum (PAS) severity using data collected from multiple centers and using the multicenter data to improve the model.
Material and methods: We conducted a multicenter analysis using data collected for the IS-PAS database. The Sargent model's effectiveness in distinguishing between abnormally adherent placenta (FIGO grade 1) and abnormally invasive placenta (FIGO grades 2 and 3) was evaluated. A new model was developed using multicenter data from the IS-PAS database.
Results: The database included 315 cases of suspected PAS, of which 226 had fully documented standardized ultrasound signs. The final diagnosis was normal placentation in 5, abnormally adherent placenta/FIGO grade 1 in 43, and abnormally invasive placenta/FIGO grades 2 and 3 in 178. The external validation of the Sargent model revealed moderate predictive accuracy in a multicenter setting (C-index 0.68), compared to its higher accuracy in a single-center context (C-index 0.90). The newly developed model achieved a C-index of 0.74.
Conclusions: The study underscores the difficulty in developing universally applicable PAS prediction models. While models like that of Sargent et al. show promise, their reproducibility varies across settings, likely due to the interpretation of the ultrasound signs. The findings support the need for updating the current ultrasound descriptors and for the development of any new predictive models to use data collected by different operators in multiple clinical settings.
{"title":"External validation of and improvement upon a model for the prediction of placenta accreta spectrum severity using prospectively collected multicenter ultrasound data.","authors":"Magdalena Kolak, Stephen Gerry, Hubert Huras, Ammar Al Naimi, Karin A Fox, Thorsten Braun, Vedran Stefanovic, Heleen van Beekhuizen, Olivier Morel, Alexander Paping, Charline Bertholdt, Pavel Calda, Zdenek Lastuvka, Andrzej Jaworowski, Egle Savukyne, Sally Collins","doi":"10.1111/aogs.14941","DOIUrl":"https://doi.org/10.1111/aogs.14941","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to validate the Sargent risk stratification algorithm for the prediction of placenta accreta spectrum (PAS) severity using data collected from multiple centers and using the multicenter data to improve the model.</p><p><strong>Material and methods: </strong>We conducted a multicenter analysis using data collected for the IS-PAS database. The Sargent model's effectiveness in distinguishing between abnormally adherent placenta (FIGO grade 1) and abnormally invasive placenta (FIGO grades 2 and 3) was evaluated. A new model was developed using multicenter data from the IS-PAS database.</p><p><strong>Results: </strong>The database included 315 cases of suspected PAS, of which 226 had fully documented standardized ultrasound signs. The final diagnosis was normal placentation in 5, abnormally adherent placenta/FIGO grade 1 in 43, and abnormally invasive placenta/FIGO grades 2 and 3 in 178. The external validation of the Sargent model revealed moderate predictive accuracy in a multicenter setting (C-index 0.68), compared to its higher accuracy in a single-center context (C-index 0.90). The newly developed model achieved a C-index of 0.74.</p><p><strong>Conclusions: </strong>The study underscores the difficulty in developing universally applicable PAS prediction models. While models like that of Sargent et al. show promise, their reproducibility varies across settings, likely due to the interpretation of the ultrasound signs. The findings support the need for updating the current ultrasound descriptors and for the development of any new predictive models to use data collected by different operators in multiple clinical settings.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008072","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}
Merle R van Dijk, Christiaan Papatsonis, Wessel Ganzevoort, Etelka Moll, Fedde Scheele, Joost Velzel
Introduction: The optimal mode of delivery for vaginal breech presentation remains a clinical dilemma. Planned vaginal delivery offers maternal advantages because it avoids major abdominal surgery and has no consequences for following pregnancies, while elective cesarean delivery proves advantageous for the neonate because adverse outcomes are less frequent. Patient selection for vaginal breech delivery is important based on the individual risk balance. A lack of consensus exists regarding the specific contraindications for vaginal breech delivery, largely due to limited scientific evidence. This systematic review aims to give an overview of contraindications for vaginal breech delivery, as presented in guidelines, analyze relevant literature, and offer evidence-based recommendations for the contraindications stated in the guidelines.
Material and methods: To identify national guidelines PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, NICE, UpToDate, and ClinicalKey were searched using two keywords: "breech presentation" and "vaginal delivery." We systematically reviewed the literature for existing evidence for contraindications for term vaginal breech delivery. The following databases were searched: PubMed (April 2024), the Cochrane Central Register of Controlled Trials, and EMBASE (1947 to 2024).
Results: Our search identified eight guidelines that stated a total of 11 contraindications for vaginal breech delivery. Among these guidelines, agreement was limited, with the sole consensus in all guidelines on the contraindication of footling breech. Our comprehensive literature search yielded 43 articles discussing 14 potential contraindications. We found supportive evidence for 7 of 11 contraindications from the guidelines, with only substantial and satisfactory evidence for two contraindications.
Conclusions: The findings of this study underscore the lack of consensus among national guidelines regarding contraindications for term vaginal breech delivery. Furthermore, we found a notable lack of substantial scientific evidence to support these contraindications. In light of these findings, we suggest a reduced list of contraindications in vaginal breech deliveries.
导言：阴道臀位的最佳分娩方式仍然是临床上的一个难题。有计划的阴道分娩对产妇有利，因为它避免了腹部大手术，对以后的妊娠也没有影响；而选择剖宫产对新生儿有利，因为不良后果较少。根据个体风险平衡选择阴道臀位分娩的患者非常重要。关于阴道臀位分娩的具体禁忌症缺乏共识，这主要是由于科学证据有限。本系统综述旨在概述指南中提出的阴道臀位分娩禁忌症，分析相关文献，并针对指南中提出的禁忌症提出循证建议：为了确定国家指南，使用两个关键词搜索了 PubMed、Cochrane Central Register of Controlled Trials、EMBASE、NICE、UpToDate 和 ClinicalKey："臀先露 "和 "阴道分娩"。我们系统地回顾了有关足月阴道臀位分娩禁忌症的现有证据文献。我们检索了以下数据库：PubMed（2024 年 4 月）、Cochrane Central Register of Controlled Trials 和 EMBASE（1947 年至 2024 年）：结果：我们的搜索发现了 8 份指南，共列出了 11 个阴道臀位分娩禁忌症。在这些指南中，一致意见有限，所有指南的唯一共识是足月臀位分娩禁忌症。我们对文献进行了全面的检索，发现有 43 篇文章讨论了 14 个潜在的禁忌症。我们从指南中找到了 11 个禁忌症中 7 个的支持性证据，只有 2 个禁忌症有实质性和令人满意的证据：结论：本研究的结果表明，各国指南对足月阴道臀位分娩的禁忌症缺乏共识。此外，我们还发现这些禁忌症明显缺乏实质性的科学证据支持。鉴于这些发现，我们建议减少阴道臀位分娩的禁忌症。
{"title":"Contraindications in national guidelines for vaginal breech delivery at term: Comparison, consensus, and controversy.","authors":"Merle R van Dijk, Christiaan Papatsonis, Wessel Ganzevoort, Etelka Moll, Fedde Scheele, Joost Velzel","doi":"10.1111/aogs.14947","DOIUrl":"https://doi.org/10.1111/aogs.14947","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal mode of delivery for vaginal breech presentation remains a clinical dilemma. Planned vaginal delivery offers maternal advantages because it avoids major abdominal surgery and has no consequences for following pregnancies, while elective cesarean delivery proves advantageous for the neonate because adverse outcomes are less frequent. Patient selection for vaginal breech delivery is important based on the individual risk balance. A lack of consensus exists regarding the specific contraindications for vaginal breech delivery, largely due to limited scientific evidence. This systematic review aims to give an overview of contraindications for vaginal breech delivery, as presented in guidelines, analyze relevant literature, and offer evidence-based recommendations for the contraindications stated in the guidelines.</p><p><strong>Material and methods: </strong>To identify national guidelines PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, NICE, UpToDate, and ClinicalKey were searched using two keywords: \"breech presentation\" and \"vaginal delivery.\" We systematically reviewed the literature for existing evidence for contraindications for term vaginal breech delivery. The following databases were searched: PubMed (April 2024), the Cochrane Central Register of Controlled Trials, and EMBASE (1947 to 2024).</p><p><strong>Results: </strong>Our search identified eight guidelines that stated a total of 11 contraindications for vaginal breech delivery. Among these guidelines, agreement was limited, with the sole consensus in all guidelines on the contraindication of footling breech. Our comprehensive literature search yielded 43 articles discussing 14 potential contraindications. We found supportive evidence for 7 of 11 contraindications from the guidelines, with only substantial and satisfactory evidence for two contraindications.</p><p><strong>Conclusions: </strong>The findings of this study underscore the lack of consensus among national guidelines regarding contraindications for term vaginal breech delivery. Furthermore, we found a notable lack of substantial scientific evidence to support these contraindications. In light of these findings, we suggest a reduced list of contraindications in vaginal breech deliveries.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999248","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}
Malin Edqvist, Gunilla Ajne, Pia Teleman, Gunilla Tegerstedt, Christine Rubertsson
Introduction
Postnatal perineal pain is prevalent following childbirth and can impact women both physically and emotionally. The aim of the study was to study the effect of collegial midwifery assistance on perineal pain and pain medication 1 month after birth and to investigate the associations between the type of tear and perineal pain, satisfaction with healing, and resumption of intercourse.
Material and Methods
A follow-up questionnaire was sent 1 month postpartum to women with a first spontaneous vaginal birth participating in a randomized controlled trial (Oneplus trial). Data were collected from December 2019 to May 2020. Differences in perineal pain between women attended by one or two midwives were analyzed according to intention-to-treat using bivariate analyses. Associations between the type of tear and perineal pain, satisfaction with healing, and resumption of sexual intercourse were investigated using univariable and multivariable logistic regression. The category no tear/first-degree tear was compared separately to each of the other tear categories. Trial registration number: ClinicalTrials.gov, NCT03770962.
Results
Out of 2233 women, 1762 responded within 30–60 days postpartum. Of women in the no tear/first-degree tear category, 27.7% reported perineal pain during the past week, in contrast to women with OASI, where 64.2% reported perineal pain. Women with OASI experienced the highest odds of perineal pain (aOR 4.51, 95% CI 2.72–7.47) compared to those with no tear/first-degree tear, followed by women with major second-degree tears (aOR 1.87, 95% CI 1.45–2.41), women with an episiotomy (aOR 1.78, 95% CI 1.11–2.87), and those with minor second-degree tears (aOR 1.43, 95% CI 1.06–1.94). Women with episiotomy reported the highest odds ratios for dissatisfaction with tear healing (aOR 3.48, 95% CI 1.92–6.31). No significant differences in perineal pain and pain medication were observed between women allocated to collegial midwifery assistance and those allocated to standard care.
Conclusions
Women with OASI reported the highest odds of perineal pain 30–60 days after birth compared to women with no tear or first-degree tear, followed by women with major second-degree tears. Women subjected to an episiotomy reported highest odds ratios of dissatisfaction with tear healing.
简介产后会阴疼痛是产后的常见病，会对妇女的身体和情绪造成影响。本研究的目的是研究助产士共同协助对产后 1 个月会阴疼痛和止痛药物的影响，并调查撕裂类型与会阴疼痛、愈合满意度和恢复性交之间的关联：对参与随机对照试验（Oneplus 试验）的首次自然阴道分娩的产妇进行产后 1 个月的随访问卷调查。数据收集时间为 2019 年 12 月至 2020 年 5 月。根据意向治疗，使用双变量分析法对由一名或两名助产士护理的产妇会阴疼痛的差异进行了分析。使用单变量和多变量逻辑回归分析了撕裂类型与会阴疼痛、愈合满意度和恢复性交之间的关系。无撕裂/一级撕裂类别与其他撕裂类别分别进行了比较：试验注册号：ClinicalTrials.gov, NCT03770962.Results：在 2233 名妇女中，有 1762 名妇女在产后 30-60 天内做出了反应。在无撕裂/一级撕裂的妇女中，27.7%的人在过去一周内报告过会阴疼痛，而在患有OASI的妇女中，64.2%的人报告过会阴疼痛。与无撕裂/一度撕裂的妇女相比，OASI 妇女发生会阴疼痛的几率最高（aOR 4.51，95% CI 2.72-7.47），其次是二度撕裂的妇女（aOR 1.87，95% CI 1.45-2.41）、进行过会阴切开术的妇女（aOR 1.78，95% CI 1.11-2.87）和二度轻微撕裂的妇女（aOR 1.43，95% CI 1.06-1.94）。接受外阴切开术的妇女对撕裂愈合不满意的几率最高（aOR 3.48，95% CI 1.92-6.31）。在会阴疼痛和止痛药物方面，接受联合助产协助的产妇与接受标准护理的产妇没有明显差异：结论：与无撕裂或一级撕裂的产妇相比，患有OASI的产妇在产后30-60天出现会阴疼痛的几率最高，其次是患有二级撕裂的产妇。接受会阴切开术的产妇对撕裂愈合不满意的几率最高。
{"title":"Postpartum perineal pain and its association with sub-classified second-degree tears and perineal trauma—A follow-up of a randomized controlled trial","authors":"Malin Edqvist, Gunilla Ajne, Pia Teleman, Gunilla Tegerstedt, Christine Rubertsson","doi":"10.1111/aogs.14938","DOIUrl":"10.1111/aogs.14938","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Postnatal perineal pain is prevalent following childbirth and can impact women both physically and emotionally. The aim of the study was to study the effect of collegial midwifery assistance on perineal pain and pain medication 1 month after birth and to investigate the associations between the type of tear and perineal pain, satisfaction with healing, and resumption of intercourse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A follow-up questionnaire was sent 1 month postpartum to women with a first spontaneous vaginal birth participating in a randomized controlled trial (Oneplus trial). Data were collected from December 2019 to May 2020. Differences in perineal pain between women attended by one or two midwives were analyzed according to intention-to-treat using bivariate analyses. Associations between the type of tear and perineal pain, satisfaction with healing, and resumption of sexual intercourse were investigated using univariable and multivariable logistic regression. The category no tear/first-degree tear was compared separately to each of the other tear categories. Trial registration number: ClinicalTrials.gov, NCT03770962.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 2233 women, 1762 responded within 30–60 days postpartum. Of women in the no tear/first-degree tear category, 27.7% reported perineal pain during the past week, in contrast to women with OASI, where 64.2% reported perineal pain. Women with OASI experienced the highest odds of perineal pain (aOR 4.51, 95% CI 2.72–7.47) compared to those with no tear/first-degree tear, followed by women with major second-degree tears (aOR 1.87, 95% CI 1.45–2.41), women with an episiotomy (aOR 1.78, 95% CI 1.11–2.87), and those with minor second-degree tears (aOR 1.43, 95% CI 1.06–1.94). Women with episiotomy reported the highest odds ratios for dissatisfaction with tear healing (aOR 3.48, 95% CI 1.92–6.31). No significant differences in perineal pain and pain medication were observed between women allocated to collegial midwifery assistance and those allocated to standard care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Women with OASI reported the highest odds of perineal pain 30–60 days after birth compared to women with no tear or first-degree tear, followed by women with major second-degree tears. Women subjected to an episiotomy reported highest odds ratios of dissatisfaction with tear healing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2314-2323"},"PeriodicalIF":3.5,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987178","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}
Hans Ivar Hanevik, Christina Bergh, Hannele Laivuori, Anne Lærke Spangmose, Åsa Magnusson, Anja Pinborg, Terhi Piltonen
It is not controversial to state that parental age is increasing in several countries. But how to deal with this increase might be. Some Nordic countries have set an upper age limit for females seeking assisted reproduction in their national legislation, but none have done so for males. There are also recommendations in place that restrict access to publicly funded assisted reproduction for both females and males of advanced age in some Nordic countries. As recent data now show somatic and psychiatric health risks related to advanced paternal age, we ask if the time has come for countries to set an upper age limit for males seeking assisted reproduction like there already is for females, and summarize some of the risks and rewards involved in treating couples with advanced age in fertility clinics.
{"title":"Limiting access to assisted reproductive technologies for males of advanced age—Pros and cons from a Nordic perspective","authors":"Hans Ivar Hanevik, Christina Bergh, Hannele Laivuori, Anne Lærke Spangmose, Åsa Magnusson, Anja Pinborg, Terhi Piltonen","doi":"10.1111/aogs.14944","DOIUrl":"10.1111/aogs.14944","url":null,"abstract":"<p>It is not controversial to state that parental age is increasing in several countries. But how to deal with this increase might be. Some Nordic countries have set an upper age limit for females seeking assisted reproduction in their national legislation, but none have done so for males. There are also recommendations in place that restrict access to publicly funded assisted reproduction for both females and males of advanced age in some Nordic countries. As recent data now show somatic and psychiatric health risks related to advanced paternal age, we ask if the time has come for countries to set an upper age limit for males seeking assisted reproduction like there already is for females, and summarize some of the risks and rewards involved in treating couples with advanced age in fertility clinics.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"103 11","pages":"2124-2129"},"PeriodicalIF":3.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974778","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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