Introduction: The aim was to describe and compare contraceptive use, fertility, birth and abortion rates in the Nordic countries.
Material And Methods: National data on births, abortions, fertility rate (1975-2013), redeemed prescriptions of hormonal contraceptives and sales figures of copper intrauterine devices (2008-2013) among women 15-49 years of age in the Nordic countries were collected and analysed.
Results: Use of hormonal contraceptives and copper intrauterine devices varied between 31-44%. Read More
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Delayed cord clamping for at least 60 seconds in both term and preterm babies is a major recent change in clinical care. Delayed cord clamping has several effects on other possible interventions. One of these is the effect of delayed cord clamping on umbilical artery gas analysis. Read More
Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St. Mary's Hospital, Manchester.
Introduction: Antepartum stillbirth is often preceded by detectable signs of fetal compromise, including changes in fetal heart rate and movement. It is hypothesised that continuous fetal monitoring could detect these signs more accurately and objectively than current forms of fetal monitoring and allow for timely intervention. This systematic review aimed to explore available evidence on women's experiences of continuous fetal monitoring to investigate its acceptability prior to clinical implementation and to inform clinical studies. Read More
Introduction: The objective of this study was to investigate the predictive value of intrapartum transperineal ultrasound in the identification of complicated operative(vacuum or forceps) deliveries in nulliparous women.
Material And Methods: Prospective observational study of nulliparous women with an indication for operative-delivery who underwent intrapartum transperineal ultrasound before fetal extraction. Managing obstetricians were blinded to the ultrasound data. Read More
Introduction: The objectives were to establish the prevalence of persistent vaginal bleeding (PVB) following subtotal hysterectomy, to analyze the effect of intraoperative cervical treatment on the occurrence of PVB and to evaluate the impact of PVB on the patient-reported opinion concerning result of surgery and medical condition.
Material And Methods: Retrospective study with data from the Swedish National Register for Gynecological Surgery including 5240 women undergoing subtotal hysterectomy for benign conditions between January 2004 and June 2016. Demographic and clinical data were obtained from the pre- and perioperative forms. Read More
Introduction: One indicator for fetal risk of mortality is intra-uterine growth restriction (IUGR). Whether markers reflecting the impact of growth restriction on the cardiovascular system, computed from a Doppler-derived heart rate signal, would be suitable in its detection antenatally were studied MATERIAL AND METHODS: We used a cardiotocography archive of 1163 IUGR cases and 1163 healthy controls, matched for gestation and gender. We assessed the discriminative power of short-term variability (STV) and long-term variability (LTV) of the fetal heart rate, computed over episodes of high and low variation aiming to separate growth-restricted fetuses from controls. Read More
Introduction: There is an ongoing debate on the optimal time of labor induction to reduce the risks associated with prolonged pregnancy.
Material And Methods: Registry-based study of 212 716 term, singleton cephalic deliveries between 2006 and 2012 in Finland comparing the outcomes of labor induction with those of expectant management in five, three-day gestational age periods between 40 and 42 weeks (group 1: 40(+0) -40(+2) ; group 2: 40(+3) -40(+5) ; group 3: 40(+6) -41(+1) ; group 4: 41(+2) -41(+4) ; group 5: 41(+5) -42(+0) ). Using Poisson regression, induced deliveries in each of the gestational age periods were compared with all ongoing pregnancies. Read More
Introduction: To investigate the incidence of neonatal early-onset group B streptococcal (GBS) infection in Sweden after promulgation of guidelines (2008) for risk factor-based intrapartum antibiotic prophylaxis, and evaluate the presence of risk factors and obstetric management in mothers.
Material And Methods: National registers were searched for infants with early-onset GBS infection during 2006-2011. Medical records of cases and case mothers were abstracted. Read More
Introduction: Women with a history of placental abruption have an increased later morbidity, but not much is known of the later mortality.
Material And Methods: Data on women with placental abruption (index cohort) between 1969 and 2005 (n = 7805) were collected from the Finnish Hospital Discharge Register and the Finnish Medical Birth Register. A matched reference cohort consisted of women without placental abruption (n = 23 523). Read More
Introduction: Accurate prediction of birthweight prior to delivery is necessary to establish periconceptional strategies to reduce the rates of adverse pregnancy outcomes. This study was performed to determine whether maternal, clinical, or ultrasound estimation provides the best predictor of birthweight.
Material And Methods: Meta-analysis was performed to summarize the relative ratios of the rate of one of maternal, clinical, and ultrasound estimation within 10% of actual birthweight to that of each of the others within the same range and the difference in correlation coefficient of actual birthweight between clinical and ultrasound estimations. Read More
Introduction: Cesarean deliveries are the most common abdominal surgery procedure globally, and the optimal way to suture the hysterotomy remains a matter of debate. The aim of this study was to assess the incidence of cesarean scar niches and the depth after single- or double-layer uterine closure.
Material And Methods: We performed a randomized controlled trial in which women were allocated to three uterotomy suture techniques: continuous single-layer unlocked, continuous locked single-layer, or double-layer sutures. Read More
Operative hysteroscopy in a hospital setting has revolutionized surgical treatment of benign uterine disorders. It is minimally invasive, cost and time-effective and may spare patients from major surgical interventions. Operative hysteroscopy in a day-case hospital setting is regarded as a safe and well-tolerated procedure with low complication rates. Read More
Introduction: Venous thromboembolism risk assessment (VTERA) is recommended in all pregnant and postpartum women. Our objective was to develop, pilot and implement a user-friendly electronic VTERA tool MATERIALS AND METHODS: We developed 'Thrombocalc', an electronic VTERA tool using Microsoft Excel(™) . Thrombocalc was designed as a score-based tool to facilitate rapid assessment of all women after childbirth. Read More
Introduction: Cervical screening by means of annual Papanicolaou (PAP) smears has been recommended for all women living with HIV. We analysed the results of our annual PAP smear screening program to identify low-risk subgroups for less rigorous screening.
Material And Methods: The study comprised 369 women followed at the Helsinki University Hospital 2002-2013, with a total of 2033 PAP smear results. Read More
Introduction: The aim of this study was to estimate the incidence of recurrent pregnancy loss (RPL). The prevalence of RPL defined as ≥3 consecutive miscarriages before gestation week 22, is often stated to be 1%. To our knowledge no study has estimated the incidence of RPL, which might be more informative and clinically relevant than the prevalence. Read More
Acta Obstet Gynecol Scand 2017 Aug 16. Epub 2017 Aug 16.
Department of Women's Health, Women's University Hospital, Center for Rare Female Genital Malformations, Tübingen University Hospital, Tübingen.
Introduction: Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) is characterized by congenital absence of the uterus and the upper two-thirds of the vagina in otherwise phenotypically normal females. It is found isolated or associated with renal, skeletal and other malformations. Despite of ongoing research, the etiology is mainly unknown. Read More
Introduction: Borderline ovarian tumors are typically indolent neoplasms. Since many are diagnosed in younger women, fertility conservation is an important consideration and has been advocated based on retrospective data. The objective of this study was to identify features impacting on recurrence and survival in a series of borderline ovarian tumors, and to assess the safety of a fertility-sparing approach. Read More
Introduction: The primary aim of this study was to compare the objective and subjective outcomes and short-term complication rates of an adjustable single-incision mini-sling (SIMS) vs. standard mid-urethral slings (SMUS). The secondary aim was to report pain perception and complications at the one-year follow up. Read More
Introduction: Gestational weight gain (GWG) varies widely among different populations, and an inappropriate GWG is associated with adverse pregnancy outcomes. We aimed to investigate week-specific serial changes in GWG in an urban Chinese population to derive clusters of GWG pattern and explore the impact of GWG patterns on birthweight.
Material And Methods: This was an observational cohort study of 6130 women delivered at a university hospital in Shanghai, China. Read More
Introduction: Abnormally invasive placenta involves abnormal adherence of the placenta to the myometrium and is associated with severe pregnancy complications such as blood transfusion and hysterectomy. Knowledge of outcomes has been limited by small sample sizes and a focus on maternal rather than neonatal outcomes. This study uses population-level data collected over 10 years to investigate maternal and neonatal outcomes and trends in incidence of abnormally invasive placenta (also known as placenta accreta, increta and percreta). Read More
Introduction: Polycystic ovary syndrome is associated with obesity and insulin resistance in the non-pregnant state, but little is known about insulin sensitivity in the pregnant state. Our objective was to compare insulin resistance in pregnant women with and without polycystic ovary syndrome and explore the impact of polycystic ovary syndrome on body composition in offspring at birth and at three years of age.
Material And Methods: A prospective cohort study including 2548 live-born singleton mother-child pairs residing in Odense municipality, Denmark, during 2010-2013. Read More
Introduction: Gynecological cancer patients are routinely followed up for 5 years after primary treatment. However, the value of such follow-up has been debated, as retrospective studies indicate that first recurrence is often symptomatic and occurs within 2-3 years of primary treatment. We prospectively investigated time to first recurrence, symptoms at recurrence, diagnostic procedures, and recurrence treatment in gynecological cancer patients after primary curative treatment. Read More
The health risks associated with e-cigarette use in pregnancy are mostly unknown. Guidelines by the World Health Organization and national health agencies warn women against using e-cigarettes in pregnancy; however, in the UK, a recent multiagency guideline takes a different approach by not discouraging e-cigarette use in pregnancy. Furthermore, e-Voke(™) , an e-cigarette, has been approved for use in pregnancy in the UK. Read More
Introduction: The proportion of women who postpone childbearing is increasing. As malignancy risk increases with age, pregnancy in connection with malignancy will become more common.
Material And Methods: We compared infants born 1994-2011 to women with a malignancy within six months prior to the last menstrual period or during pregnancy with offspring of women without a previous malignancy. Read More
Vancouver Coastal Health & Provincial Health Services, Vancouver, BC.
Transgender coverage in media is becoming more commonplace and children and adolescents from resource-rich countries are accessing transgender healthcare at an exponentially increasing rate. What factors should care providers, adolescents and parents/guardians or caretakers take into consideration with respect to fertility? The World Professional Association for Transgender Health (WPATH) is the only global interdisciplinary association that is solely devoted to transgender health. This article is protected by copyright. Read More
Introduction: Balanced information before prenatal diagnosis (PND) aims to help expectant parents to make an informed choice. However, it is important that the information does not increase the expectant parents' psychological distress. The aim was to examine psychological distress among expectant parents, before and after receiving information about PND, to evaluate the possible differences between two different procedures of information giving, and to evaluate the association between satisfaction with the information and psychological distress. Read More
Several phenomena in contemporary perinatology create challenges for analyzing pregnancy outcomes. These include recent increases in iatrogenic delivery at late preterm and early term gestation, which are incongruent with the belief that stillbirth and neonatal death risks decrease exponentially with advancing gestational age. Perinatal epidemiologists have also puzzled over the paradox of intersecting birthweight-specific and gestational age-specific perinatal mortality curves for decades. Read More
The FIGO staging system has undergone many modifications since it first appeared in about the middle of the previous century. Due to the use of modern diagnostic tools, namely computed tomography, magnetic resonance imaging, positron emission tomography, sentinel lymph node biopsy and neoadjuvant chemotherapy, certain gynecological cancer cases cannot be allocated to a specific stage if one wishes to adhere strictly to FIGO requirements. In these circumstances such cases actually remain unstaged. Read More
Introduction: We investigated the long-term effects of using a mobile app to treat stress urinary incontinence with a focus on pelvic floor muscle training.
Material And Methods: A previous randomized controlled trial of 123 women aged 27-72 years found that three months of self-managing stress urinary incontinence with support from the Tät(®) app was effective. We followed up the women in the app group (n = 62) two years after the initial trial with the same primary outcomes for symptom severity (International Consultation on Incontinence Questionnaire Short Form) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptom Quality of Life) and compared the scores with those at baseline. Read More
Introduction: The aim of this study was to assess the accuracy of the non-invasive fetal RHD test at 24-26 weeks of gestation as part of the national antenatal screening program to target routine antenatal anti-D prophylaxis (RAADP) at 28-30 weeks at women carrying an RhD-positive fetus.
Material And Methods: A prospective cohort study involving all maternity care centers and delivery hospitals in Finland between February 2014 and January 2016. Fetal RHD genotyping using cell-free fetal DNA in maternal plasma was performed with real-time polymerase chain reaction in a centralized setting. Read More
Introduction: Recently, an association between human papillomavirus infection and both spontaneous abortion and spontaneous preterm delivery was suggested. However, the reported human papillomavirus prevalence in pregnant women varies considerably and reliable conclusions are difficult. We aimed to investigate human papillomavirus infection in placental tissue of a Danish study cohort. Read More
Introduction: The objective was to examine the association between fetal growth in early pregnancy and risk of severe large-for-gestational-age (LGA) and macrosomia at birth in a low-risk population.
Material And Methods: Cohort study that included 68 771 women with non-anomalous singleton pregnancies, without history of diabetes or hypertension, based on an electronic database on pregnancies and deliveries in Stockholm-Gotland Region, Sweden, 2008-2014. We performed multivariable logistic regression to estimate the association between accelerated fetal growth occurring in the first through early second trimester as measured by ultrasound and LGA and macrosomia at birth. Read More
Introduction: The influence of levator-ani muscles on second-stage labor is poorly understood. The ability of these muscles to stretch without damage may affect birth outcomes, but little is known about material properties, effects of pregnancy and/or ethnicity on levator-ani stiffness. There are strong associations between muscle damage and subsequent pelvic floor disorders. Read More
Introduction: With increasing life expectancy, more women with cystic fibrosis and diabetes mellitus become pregnant. We investigated how pre-gestational diabetes (cystic fibrosis-related diabetes) influenced pregnancy outcome and the clinical status of these women.
Material And Methods: We analyzed all pregnancies reported to the French cystic fibrosis registry between 2001 and 2012, and compared forced expiratory volume (FEV1 ) and body mass index before and after pregnancy in women with and without pre-gestational diabetes having a first delivery. Read More
Fetal infection by the Zika virus has been implicated in the exceptional rise in the number of microcephalic newborns recorded by the end of 2015 in Brazil. The mechanism by which this teratogenic effect is produced in the developing brain has not been fully established. Very early in the outbreak, we addressed this question by evaluating available initial data from a gestational and postnatal clinical investigation in the Brazilian state of Pernambuco. Read More
Introduction: Hysterectomy is a common gynecological procedure, particularly in middle and high income countries. The aim of this paper was to describe and examine hysterectomy trends in Australia from 2000-2001 to 2013-2014.
Material And Methods: For women aged 25 years and over, data on the number of hysterectomies performed in Australia annually were sourced from the National Hospital and Morbidity Database. Read More
Introduction: Contradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between the incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors.
Material And Methods: This study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health during 1998-2008. Read More
Introduction: Although endometriosis is a benign disease, it shares some features with cancers, such as invasiveness and the potential to metastasize. This study sought to investigate the epithelial-mesenchymal transition status in human endometriotic lesions.
Material And Methods: Thirteen endometriosis patients and 10 control women without endometriosis undergoing surgery for benign indications were recruited. Read More
Introduction: The aim was to evaluate whether vitamin D insufficiency is associated with preterm delivery and preeclampsia in women with type 1 diabetes.
Material And Methods: An observational study of 198 pregnant women with type 1 diabetes. 25-Hydroxy-Vitamin D and HbA1c were measured in blood samples in early (median 8 weeks, range 5-14) and late (34 weeks, range 32-36) pregnancy. Read More
Introduction: We conducted a prospective health service evaluation to assess the feasibility and acceptability of routinely offering insertion of intrauterine contraception at cesarean section in a maternity setting in the UK.
Material And Methods: One month before scheduled cesarean section, women were sent information about postpartum contraception including the option of insertion of an intrauterine contraception at cesarean. Women choosing intrauterine contraception (copper intrauterine device or levonorgestrel intrauterine system) were followed up in person at six weeks, and telephone contact was made at three, six and 12 months postpartum. Read More
Introduction: Active resistance is considered to be the 'normal' reaction during rape. However, studies have indicated that similar to animals, humans exposed to extreme threat may react with a state of involuntary, temporary motor inhibition known as tonic immobility. The aim of the present study was to assess the occurrence of tonic immobility during rape and subsequent post-traumatic stress disorder and severe depression. Read More
Introduction: This study aimed to investigate the possible benefits of a complete cytoreduction in patients with advanced ovarian cancer and concomitant rectal invasion. Furthermore, we evaluated the morbidity associated with radical surgery.
Material And Methods: A retrospective analysis examined 35 women who underwent radical surgery in the form of modified posterior pelvic exenteration. Read More
Introduction: Pregnancy after liver transplantation is possible but associated with increased risk of obstetrical complications. We report here for the first time the pregnancy outcomes after liver transplantation in Finland.
Material And Methods: All of the 25 pregnancies ending in deliveries after liver transplantation in Finland in 1998-2015 were analyzed. Read More
Introduction: The purpose of this study was to describe the echographic features and perinatal outcomes of fetuses with absence of ductus venosus.
Material And Methods: Retrospective review of 10 cases with absence of ductus venosus diagnosed by prenatal ultrasonography between January 2014 and February 2016 at a single referral center. Prenatal findings, umbilical shunting type, perinatal outcomes, and autopsy reports were reviewed. Read More