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Publisher: John Wiley and Sons   (Total: 1592 journals)

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Showing 1 - 200 of 1592 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 13, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 66, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 47, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 54, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 171, SJR: 0.101, h-index: 9)
Acta Geologica Sinica (English Edition)     Hybrid Journal   (Followers: 3, SJR: 0.552, h-index: 41)
Acta Neurologica Scandinavica     Hybrid Journal   (Followers: 5, SJR: 1.203, h-index: 74)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 14, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 6, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 56, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 6, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 37, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 7, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 5)
Addiction     Hybrid Journal   (Followers: 36, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 15, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 26, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 26, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 51, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 14, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 279, SJR: 9.021, h-index: 345)
Advanced Materials Interfaces     Hybrid Journal   (Followers: 6, SJR: 1.177, h-index: 10)
Advanced Optical Materials     Hybrid Journal   (Followers: 7, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 18, SJR: 2.729, h-index: 121)
Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 21)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 13)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 11)
African Development Review     Hybrid Journal   (Followers: 33, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 16, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 16, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 11, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 3, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 16, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 45, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 32, SJR: 1.122, h-index: 120)
Alcoholism and Drug Abuse Weekly     Hybrid Journal   (Followers: 7)
Alcoholism Clinical and Experimental Research     Hybrid Journal   (Followers: 7, SJR: 1.416, h-index: 125)
Alimentary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 34, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 51, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 152, SJR: 0.951, h-index: 61)
American Business Law J.     Hybrid Journal   (Followers: 24, SJR: 0.205, h-index: 17)
American Ethnologist     Hybrid Journal   (Followers: 93, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 29, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 35, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 13, SJR: 1.018, h-index: 58)
American J. of Industrial Medicine     Hybrid Journal   (Followers: 16, SJR: 0.993, h-index: 85)
American J. of Medical Genetics Part A     Hybrid Journal   (Followers: 17, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 6, SJR: 2.315, h-index: 79)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 38, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 296, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 4, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 18, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 10, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 141, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 10, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 20)
Anatomia, Histologia, Embryologia: J. of Veterinary Medicine Series C     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 27)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1, SJR: 0.633, h-index: 24)
Andrologia     Hybrid Journal   (Followers: 2, SJR: 0.528, h-index: 45)
Andrology     Hybrid Journal   (Followers: 2, SJR: 0.979, h-index: 14)
Angewandte Chemie     Hybrid Journal   (Followers: 166)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 234, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 41, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 7, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 49, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 8, SJR: 0.336, h-index: 23)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5, SJR: 2.389, h-index: 189)
Annual Bulletin of Historical Literature     Hybrid Journal   (Followers: 12)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 26, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 18, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 15)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 93, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 52, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 8, SJR: 0.432, h-index: 59)
Anzeiger für Schädlingskunde     Hybrid Journal   (Followers: 1)
Apmis     Hybrid Journal   (Followers: 1, SJR: 0.855, h-index: 73)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 73, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 181, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 51, SJR: 0.868, h-index: 13)
Applied Stochastic Models in Business and Industry     Hybrid Journal   (Followers: 5, SJR: 0.613, h-index: 24)
Aquaculture Nutrition     Hybrid Journal   (Followers: 14, SJR: 1.025, h-index: 55)
Aquaculture Research     Hybrid Journal   (Followers: 32, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 36, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 30, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 15, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 27, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 3, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 5)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 13, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 267, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 55, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 27, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 15)
Asia & the Pacific Policy Studies     Open Access   (Followers: 16)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 326, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (Followers: 1, SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 8, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 4, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 4, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (Followers: 1, SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 6, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 12, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 3, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 15, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 9, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 8, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 6, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 14, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 3, SJR: 0.709, h-index: 14)
Australian and New Zealand J. of Family Therapy (ANZJFT)     Hybrid Journal   (Followers: 3, SJR: 0.382, h-index: 12)
Australian and New Zealand J. of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 47, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 13, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 6, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 6, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 31, SJR: 0.23, h-index: 9)
Australian Economic Review     Hybrid Journal   (Followers: 6, SJR: 0.357, h-index: 21)
Australian Endodontic J.     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 24)
Australian J. of Agricultural and Resource Economics     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 36)
Australian J. of Grape and Wine Research     Hybrid Journal   (Followers: 5, SJR: 0.879, h-index: 56)
Australian J. of Politics & History     Hybrid Journal   (Followers: 15, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 18, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 429, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 6, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 74, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 12, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 23, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 37, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 11, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 5, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 9, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 23, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 10, SJR: 0.11, h-index: 5)
Beton- und Stahlbetonbau     Hybrid Journal   (Followers: 2, SJR: 0.493, h-index: 14)
Biochemistry and Molecular Biology Education     Hybrid Journal   (Followers: 6, SJR: 0.311, h-index: 26)
Bioelectromagnetics     Hybrid Journal   (Followers: 1, SJR: 0.568, h-index: 64)
Bioengineering & Translational Medicine     Open Access  
BioEssays     Hybrid Journal   (Followers: 10, SJR: 3.104, h-index: 155)
Bioethics     Hybrid Journal   (Followers: 14, SJR: 0.686, h-index: 39)
Biofuels, Bioproducts and Biorefining     Hybrid Journal   (Followers: 1, SJR: 1.725, h-index: 56)
Biological J. of the Linnean Society     Hybrid Journal   (Followers: 18, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 5, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 41, SJR: 0.12, h-index: 1)
Biology of the Cell     Full-text available via subscription   (Followers: 9, SJR: 1.812, h-index: 69)
Biomedical Chromatography     Hybrid Journal   (Followers: 6, SJR: 0.572, h-index: 49)
Biometrical J.     Hybrid Journal   (Followers: 5, SJR: 0.784, h-index: 44)
Biometrics     Hybrid Journal   (Followers: 37, SJR: 1.906, h-index: 96)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 10, SJR: 0.715, h-index: 44)
Biopolymers     Hybrid Journal   (Followers: 18, SJR: 1.199, h-index: 104)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 44, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 157, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 14, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 20, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 9, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 38, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 7, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)
BJOG : An Intl. J. of Obstetrics and Gynaecology     Partially Free   (Followers: 248, SJR: 2.083, h-index: 125)

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Journal Cover Acta Obstetricia et Gynecologica Scandinavica
  [SJR: 1.197]   [H-I: 81]   [14 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0001-6349 - ISSN (Online) 1600-0412
   Published by John Wiley and Sons Homepage  [1592 journals]
  • Postpartum CT angiography of the fetoplacental macrovasculature in normal
           pregnancies and in those complicated by fetal growth restriction
    • Authors: Mette Østergaard Thunbo; Marianne Sinding, Anne Sofie Korsager, Jens Brøndum Frøkjær, Lasse Riis Østergaard, Astrid Petersen, Charlotte Overgaard, Anne Sørensen
      Abstract: IntroductionCurrent knowledge of the fetoplacental vasculature in fetal growth restriction (FGR) due to placental dysfunction focuses on the microvasculature rather than the macrovasculature. The aim of this study was to investigate the feasibility of computed topography angiography to analyze the fetoplacental macrovasculature in normal and FGR pregnancies.Material and methodsWe included 29 placentas (22‐42 weeks’ gestation) from normal birthweight pregnancies and 8 placentas (26‐37 weeks’ gestation) from FGR pregnancies (birthweight < ‐15% and abnormal umbilical Doppler flow). We performed postpartum placental computed topography angiography followed by semi‐automatic 3D image segmentation.ResultsA median of 9 (range 7‐11) vessel generations was identified. In normal birthweight placentas, gestational age was positively linearly correlated with macrovascular volume (p=0.002), vascular surface area (p
      PubDate: 2018-01-04T10:06:02.077329-05:
      DOI: 10.1111/aogs.13289
  • Antenatal vaccination against Group B streptococcus: Attitudes of pregnant
           women and healthcare professionals in the UK to participation in clinical
           trials and routine implementation
    • Authors: Fiona McQuaid; Christine Jones, Zoe Stevens, Gretchen Meddaugh, Catherine O'Sullivan, Beverly Donaldson, Rhona Hughes, Carolyn Ford, Adam Finn, Saul N Faust, Diane Gbesemete, Helen Bedford, Stephen Hughes, Anu Susan Varghese, Paul T Heath, Matthew D Snape
      Abstract: IntroductionMaternal vaccination is increasingly part of antenatal care in the UK and worldwide. Trials of Group B streptococcus (GBS) vaccines are ongoing. This study investigated the attitudes of pregnant women and healthcare professionals towards antenatal vaccination, both in routine care and a clinical trial setting.Material and methodsSurvey of 269 pregnant women, 273 midwives/obstetricians and 97 neonatal doctors across seven sites in the UK assessing attitudes towards antenatal vaccinations, knowledge of GBS, a hypothetical GBS vaccine and participation in clinical vaccine trials.ResultsSixty‐eight percent of pregnant women intended to receive a vaccine during their current pregnancy (183/269) and 43% (of all respondents, 115/269) reported they would be very/fairly likely to accept a vaccine against GBS despite only 29% (55/269) knowing what GBS was. This increased to 69% after additional information about GBS was provided. Twenty‐four percent of pregnant women reported they would be likely to take part in a clinical trial of an unlicensed GBS vaccine. Fifty‐nine percent of maternity professionals and 74% of neonatologists would be likely to recommend participation in a GBS vaccine trial to women, with the vast majority (>99%) willing to be involved in such a study. Incentives to take part cited by pregnant women included extra antenatal scans and the opportunity to be tested for GBS.ConclusionPregnant women and healthcare professionals were open to the idea of an antenatal GBS vaccine and involvement in clinical trials of such a vaccine. Education and support from midwives would be key to successful implementation.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-02T02:01:09.344936-05:
      DOI: 10.1111/aogs.13288
  • Fetal aneuploidy diagnosed at celocentesis for early prenatal diagnosis of
           congenital hemoglobinopathies
    • Authors: Antonino Giambona; Filippo Leto, Cristina Passarello, Margherita Vinciguerra, Valentina Cigna, Giovanna Schillaci, Francesco Picciotto, Salvatrice Lauricella, Kypros H. Nicolaides, George Makrydimas, Gianfranca Damiani, Aurelio Maggio
      Abstract: IntroductionCurrently, prenatal diagnosis of genetic disorders requires chorionic villus sampling or amniocentesis carried out after 11 and 16 weeks of gestation, respectively. Celocentesis is a procedure for prenatal diagnosis that could be used from as early as seven weeks. The present investigation evaluated the feasibility of performing diagnosis for monogenic diseases using celomic fluid containing cells of fetal origin.Material and methodsAnalysis consisted of 489 singleton pregnancies undergoing celocentesis for the prenatal diagnosis of hemoglobinopathies (n=367) or before surgical termination of pregnancy for social indications (n=122). Embryo‐fetal cells were isolated from celomic fluid using CD71 antibodies or by micromanipulation. Quantitative fluorescent polymerase chain reaction of short tandem repeat sequences of chromosomes 13, 18, 21, X and Y were used to determine the presence of maternal DNA.Results357/489 (73%) of celomic fluid samples were contaminated with maternal cells. In two cases, diagnosis was not possible due to the high contamination of celomic fluid Eighty‐seven (23.8%) fetuses were affected by hemoglobinopathies, and in five cases, chromosomal aneuploidies were found, including three cases of trisomy 21, one of trisomy 13 and one of triploidy. In all cases, the diagnosis of hemoglobinopathies and chromosomal abnormalities were confirmed by molecular and traditional cytogenetic analysis after amniocentesis, chorionic villus or placental tissue collection following pregnancy termination.ConclusionsThe findings of this study demonstrate that embryo‐fetal cell selection from celomic fluid allows reliable and early prenatal diagnosis of hemoglobinopathies and can give more information on eventual fetal aneuploidy following the control of maternal contamination by quantitative fluorescent‐PCR.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-02T02:00:42.212831-05:
      DOI: 10.1111/aogs.13287
  • Waterbirth in Sweden ‐ a comparative study
    • Authors: Hanna Ulfsdottir; Sissel Saltvedt, Susanne Georgsson
      Abstract: IntroductionThe literature describes advantages for mothers giving birth in water, but waterbirth is controversial in Sweden and has not been offered at hospitals until recently. This study aimed to describe and compare the characteristics and outcome of waterbirths with spontaneous vaginal births at the same clinics.Material and methodsA retrospective cohort study was conducted on all waterbirths at two maternity units in Sweden from March 2014 to November 2015 (n=306), and a consecutively selected comparison group of 306 women having conventional spontaneous vaginal births. Logistic regression was used to analyze the primary outcome; second‐degree perineal tears.ResultsWomen giving birth in water had a lower risk of second‐degree perineal tears (adj. OR 0.6 [95% CI 0.4‐0.9]). Their labor was shorter (6:03 hrs. vs 7:52 hrs.) and there were significantly less interventions than in the comparison group; amniotomy (13.7% vs. 35.3%), internal cardiotocography (11.1% vs.56.8%), and augmentation with oxytocin (5.2% vs.31.3%). There were no differences in Apgar scores or admissions to neonatal intensive care unit. The experience of childbirth, measured with a numeric rating scale, was higher in the waterbirth group indicating a more positive birth experience. Three newborns born in water had an umbilical cord avulsion.ConclusionsIn this low‐risk population, waterbirth is associated with positive effects on perineal tears, the frequency of interventions, the duration of labor and women's birth experience. Midwives handling waterbirth should be aware of the risk of umbilical cord avulsion.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-29T20:30:26.542079-05:
      DOI: 10.1111/aogs.13286
  • Mullerian tract anomalies and urinary tract infections
    • Authors: Penelope J Teoh; Alexandra Ridout, Jenny Carter, Andrew H Shennan
      Abstract: There is a proven association between urinary tract infections (UTI) and preterm birth. There is a recognized link between genital and urinary anomalies (1); 30‐50% of Mullerian duct anomalies are associated urinary tract defects (2). Given this association, we determined if certain women with uterine anomalies should be monitored more closely for UTI.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-27T08:30:37.114503-05:
      DOI: 10.1111/aogs.13285
  • Congenital diaphragmatic hernia with heart defect has a high risk for
           hypoplastic left heart syndrome and major extra‐cardiac malformations
           – 10‐year national cohort from Finland
    • Authors: Johanna Hautala; Emma Karstunen, Annukka Ritvanen, Risto Rintala, Ilkka P. Mattila, Juha Räsänen, Pertti K. Suominen, Tiina Ojala
      Abstract: IntroductionCongenital diaphragmatic hernia (CDH) has a well‐known risk of congenital heart defects with poor prognosis. This study was conducted to determine the national total prevalence and prenatal detection rates of CDH with heart defects and its association with major extra‐cardiac malformations and to further evaluate the impact of the heart defect severity on survival.Material and methodsA 10‐year national cohort was derived from four national registries, including live births, stillbirths, and terminations of pregnancy for fetal anomalies. The study cohort was sorted according to cardiac defect severityResultsThe total prevalence of CDH with heart defects was 0.6/10 000 births and live birth prevalence 0.3/10 000 live births. Out of 145 cases with CDH, 37 (26%) had a concurrent heart defect. The overall prenatal detection rate of heart defects was 41%. The total prevalence (483/10 000) and live birth prevalence (500/10 000) of hypoplastic left heart syndrome was 124 times and 250 times higher than in the general population in Finland, respectively. Additional major extra‐cardiac malformations were found in 68% of cases. The survival rate for CDH with major heart defects was 11% and 38% with minor heart defectsConclusionsThe total prevalence of hypoplastic left heart syndrome was significantly higher in CDH patients than in the general population in Finland. Prenatal detection rate for heart defects in CDH patients was 41%. Major extra‐cardiac malformations were more common than previously reported. The prognosis of CDH with major heart defects remained poor.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-27T04:40:49.033559-05:
      DOI: 10.1111/aogs.13274
  • Cost‐ effectiveness of curettage versus expectant management in women
           with an incomplete evacuation after misoprostol treatment for first
           trimester miscarriage: a randomized controlled trial and cohort study
    • Authors: Marike Lemmers; Marianne A.C. Verschoor, Patrick M. Bossuyt, Judith A.F. Huirne, Teake Spinder, Theodoor E. Nieboer, Marlies Y. Bongers, Ineke A.H. Janssen, Marcel H.A. van Hooff, Ben Willem J. Mol, Willem M. Ankum, Judith E. Bosmans,
      Abstract: IntroductionCurettage is more effective than expectant management in women with suspected incomplete evacuation after misoprostol treatment for first trimester miscarriage. The cost‐effectiveness of curettage versus expectant management in this group is unknownMaterial and MethodsFrom June 2012 until July 2014, we conducted a randomized controlled trial and parallel cohort study in The Netherlands, comparing curettage to expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. Successful treatment was defined as a sonographic finding of an empty uterus six weeks after study entry, or an uneventful course. Cost‐effectiveness, and cost‐utility analysis were performed. We included costs of healthcare utilization, informal care and lost productivity. Cost‐effectiveness planes and cost‐effectiveness acceptability curves were estimated using bootstrappingResultsWe included 256 women from 27 hospitals; 95 curettage and 161 expectant management. Treatment was successful in 96% of the women treated with curettage versus 83% of the women after expectant management (mean difference 13%, 95% CI 5; 20). Mean costs were significantly higher in the curettage group (mean difference €1,157; 95% CI €955; €1,388). The incremental cost‐effectiveness ratio for curettage versus expectant management was €8,586 per successfully treated woman. The cost‐effectiveness acceptability curve showed that at a willingness‐to‐pay of €18,200/extra successfully treated women, the probability that curettage is cost‐effective is 95%ConclusionsCurettage is not cost‐effective as compared to expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment. This indicates that curettage in this group should be restrained.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-20T05:05:19.802368-05:
      DOI: 10.1111/aogs.13283
  • Low levels of anti‐secretory factor in placenta are associated with
           preterm birth and inflammation
    • Authors: Anna M Gustafsson; Emma Fransson, Aurelija Dubicke, Anna K Hjelmstedt, Gunvor Ekman-Ordeberg, Sven-Arne Silfverdal, Stefan Lange, Eva Jennische, Kajsa Bohlin
      Abstract: IntroductionAnti‐secretory factor (AF) is a protein that regulates secretory and inflammatory processes and preterm birth is associated with inflammation. Therefore, our hypothesis was that AF might play a role in immune reactivity and homeostasis during pregnancy.Material and MethodsFollowing spontaneous onset of labor and preterm or term delivery, placenta biopsies were collected. The levels of AF and markers of inflammation (CD68, CD 163) and vascularization (CD34, smooth muscle actin) were analyzed by immunohistochemistry.ResultsThe 61 placental biopsies included 31 preterm (
      PubDate: 2017-12-19T09:15:31.421194-05:
      DOI: 10.1111/aogs.13282
  • A prospective investigation of perceived stress, infertility‐related
           stress, and cortisol levels in women undergoing in vitro fertilization:
           influence on embryo quality and clinical pregnancy rate
    • Authors: Carolyn E Cesta; Anna L Johansson, Julius Hreinsson, Kenny A Rodriguez-Wallberg, Jan I Olofsson, Jan Holte, Håkan Wramsby, Margareta Wramsby, Sven Cnattingius, Alkistis Skalkidou, Anastasia Nyman Iliadou
      Abstract: IntroductionWomen undergoing fertility treatment experience high levels of stress. However, it remains uncertain if and how stress influences in vitro fertilization (IVF) cycle outcome. This study aimed to investigate whether self‐reported perceived and infertility‐related stress and cortisol levels were associated with IVF cycle outcomes.Material and methodsA prospective cohort of 485 women receiving fertility treatment was recruited from September 2011 to December 2013 and followed until December 2014. Data were collected by online questionnaire prior to IVF start, from clinical charts. Salivary cortisol levels were measured. Associations between stress and cycle outcomes (clinical pregnancy and indicators of oocyte and embryo quality) were measured by logistic or linear regression, adjusted for age, body mass index, education, smoking, alcohol and caffeine consumption, shiftwork and night work.ResultsUltrasound verified pregnancy rate was 26.6% overall per cycle started and 32.9% per embryo transfer. Stress measures were not associated with clinical pregnancy: when compared to the lowest categories, the adjusted odd ratio (OR) and 95% confidence interval (CI) for the highest categories of the perceived stress score was 1.04 (95%CI; 0.58‐1.87), infertility‐related stress score was OR = 1.18 (95%CI; 0.56‐2.47), morning and evening cortisol was OR = 1.18 (95%CI; 0.60‐2.29) and OR = 0.66 (95%CI; 0.34‐1.30), respectively.ConclusionsPerceived stress, infertility‐related stress, and cortisol levels were not associated with IVF cycle outcomes. These findings are potentially reassuring to women undergoing fertility treatment with concerns about the influence of stress on their treatment outcome.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-18T00:26:09.076417-05:
      DOI: 10.1111/aogs.13280
  • Treatment related psychological stress in different IVF therapies with and
           without gonadotropin stimulation
    • Authors: Katja Haemmerli Keller; Gilliane Alder, Lennard Loewer, Monika Faeh, Susanne Rohner, Michael Von Wolff
      Abstract: IntroductionInfertility treatments such as in vitro fertilization (IVF) impose substantial distress. However, the specific role of individual contributory factors remains unclear. We therefore compared treatment related psychological stress in IVF treatments with (cIVF) and without (NC‐IVF) gonadotropin stimulation as cIVF includes potentially stressful factors such as ovarian stimulation, anaesthesia, embryo selection, cryopreservation etc. whereas NC‐IVF does not. Material and MethodsWomen were offered to undergo cIVF or NC‐IVF. Validated psychological questionnaires filled in online before, during and after completed treatment cycle(s) at home were used to analyse psychological distress and treatment related satisfaction and quality of life. To avoid different pregnancy rate in both treatment groups one cIVF was compared with three NC‐IVF therapies, resulting in the same cumulative pregnancy rateResultsData from 57 NC‐IVF and 62 cIVF patients were evaluated. NC‐IVF resulted in a similar overall clinical pregnancy rate than one cIVF. NC‐IVF patients had a significantly lower level of depression (CES‐D, 13.4 vs. 15.7, p
      PubDate: 2017-12-16T16:56:15.94314-05:0
      DOI: 10.1111/aogs.13281
  • Outcome of sonography‐based minimally‐invasive surgery for deep
           infiltrating endometriosis of the ureter and urinary bladder – a
           retrospective cohort study
    • Authors: Gernot Hudelist; Ayman Tammaa, Kristine Aas-Eng, Lisa Kirchner, Nadja Fritzer, Zoltan Nemeth, Michael Lamche
      Abstract: IntroductionTo evaluate the accuracy of transvaginal sonography for preoperative detection of bladder endometriosis and surgical outcomes regarding fertility and pain symptoms of women with urinary tract endometriosis.Material and MethodsRetrospective cohort study of consecutive patients with urinary tract endometriosis undergoing laparoscopic partial cystectomy and/or ureterolysis/decompression, ureteric resection and end‐to‐end anastomosis or ureteroneocystostomy for ureteral stenosis and hydronephrosis.ResultsOut of 207 patients with deep infiltrating endometriosis, 50 exhibited urinary tract endometriosis consisting of 30 patients with bladder endometriosis and 23 women with solitary or additional hydronephrosis. Sensitivity, specificity, positive and negative predicitive value, positive/negative likelihood ratios and test accuracy for transvaginal sonography detecting bladder endometriosis were 93%, 99%, 97%, 99%, 155.5, 0.07 and 98.6%. All women with bladder endometriosis underwent partial cystectomy. In cases of hydronephrosis, 14 conservative ureterolysis/decompressions, 6 ureteral resection anastomoses and 3 ureteroneocystostomies were performed. Duration of surgery was 205 minutes (range 89‐365 minutes), avarage blood loss was 1.6 g/dL (range 0.3‐4.6 g/dL) and hospital stay on average 8 days (range 2‐16 days) and the conversion rate was 4%. We observed 5 grade III complications. After a median follow‐up of 23 months dysmenorrhea (7.6 to 1.6; p
      PubDate: 2017-12-08T20:46:00.539822-05:
      DOI: 10.1111/aogs.13279
  • Comment on “Longitudinal transvaginal ultrasound evaluation of cesarean
           scar niche incidence and depth in the first two years after single‐ or
           double‐layer uterotomy closure: a randomized controlled trial”
    • Authors: Marco Scioscia; Piergiorgio Iannone, Danila Morano, Giovanni Pontrelli, Pantaleo Greco
      Abstract: We read with interest a recent article published by Bamberg et al. (1) that takes up an interesting issue previously published on the same journal by Kataoka et al. (2) on uterine niche after a cesarean section (CS). These two prospective studies assessed the risk to develop a uterine wall defect at the site of cesarean scar according to the surgical closure technique.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-08T09:25:18.393904-05:
      DOI: 10.1111/aogs.13278
  • Prophylactic antibiotics before cord clamping in cesarean delivery: a
           systematic review
    • Authors: Claudia Bollig; Monika Nothacker, Cornelius Lehane, Edith Motschall, Britta Lang, Joerg J. Meerpohl, Christine M. Schmucker
      Abstract: IntroductionThe number of clinical trials investigating the optimal timing of prophylactic antibiotics in cesarean section increased rapidly over the last few years. We conducted a systematic review to inform up‐to date evidence‐based guidelines to prevent postpartum infectious morbidity in the mother and rule out any safety issues related to antepartum antibiotic exposure in infantsMaterial and methodsFour bibliographic databases were searched for published reports of trials. Ongoing or unpublished studies were searched in Clinicaltrials. gov and the World Health Organization registry platform. Randomised controlled trials comparing antibiotic prophylaxis before vs. after cord clamping in cesarean section were eligible. Maternal and neonatal outcomes were assessed, and certainty of evidence gradedResultsIn total, 18 randomised controlled trials met the inclusion criteria. Those women who received antibiotics preoperatively were 28% (RR 0.72; 95% CI; 0.56‐0.92, 9 studies, 4342 women, high quality of evidence) less likely to show infectious morbidity as compared to those who received antibiotics after cord clamping. The risk of endomyometritis and/or endometritis was reduced by 43% (RR 0.57; 95% CI; 0.40‐0.82, 13 studies, 6250 women, high quality of evidence) and the risk of wound infection by 38% (RR 0.62; 95% CI; 0.47‐0.81, 14 studies, 6450 women, high quality of evidence) in those who received antibiotics preoperatively as compared to those who received antibiotics after cord clamping. For other maternal infections no significant differences were identified. The risk for neonatal outcomes, such as deaths attributed to infection, sepsis, neonatal antibiotic treatment, intensive care unit admission or antibiotic‐related adverse events, was not found to be different, neither clinically nor statistically, when antibiotics were given before or after cord clamping (moderate to low quality of evidence)ConclusionsThe evidence in favour of prophylactic antibiotic administration before in comparison to after cord clamping for major maternal infections was of high quality, meaning that further research would be unlikely to change the confidence in these findings. However, we recommend additional research reflecting the precision of the effect estimates for neonatal outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-07T06:30:48.369508-05:
      DOI: 10.1111/aogs.13276
  • Delineating the association between mode of delivery and postpartum
           depression symptoms: a longitudinal study
    • Authors: Patricia Eckerdal; Marios K. Georgakis, Natasa Kollia, Anna-Karin Wikström, Ulf Högberg, Alkistis Skalkidou
      Abstract: IntroductionAlthough a number of perinatal factors have been implied in the etiology of postpartum depression (PPD), the role of mode of delivery remains controversial. Our aim was to explore the association between mode of delivery and PPD, considering the potentially mediating or confounding role of several covariatesMaterial and methodsIn a longitudinal‐cohort study in Uppsala, Sweden, with 3888 unique pregnancies followed‐up postpartum, the effect of mode of delivery (spontaneous vaginal delivery, vacuum extraction, elective cesarean section, emergency cesarean section) on self‐reported PPD symptoms (Edinburgh Postnatal Depression Scale ≥12) at six weeks postpartum was investigated through logistic regression models and path analysisResults The overall prevalence of PPD was 13%. Compared to spontaneous vaginal delivery, women delivered by emergency cesarean section were at higher risk for PPD six weeks after delivery in crude (OR: 1.45, 95%CI: 1.04‐2.01), but not in adjusted analysis. However, the path analysis revealed that emergency cesarean section and vacuum extraction were indirectly associated with increased risk of PPD, by leading to postpartum complications, self‐reported physical symptoms postpartum, and therefore a negative delivery experience. In contrast, history of depression and fear of delivery increased the odds of PPD, but also led more frequently to elective cesarean section, which was however associated with a positive delivery experience. ConclusionsMode of delivery has no direct impact on risk of PPD; nevertheless, several modifiable or non‐modifiable mediators are present in this association. Women delivering at an emergency setting by emergency cesarean section or vacuum extraction, and reporting negatively experienced delivery comprise a high‐risk group for PPD.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-07T06:30:33.980537-05:
      DOI: 10.1111/aogs.13275
  • New FIGO and Swedish intrapartum cardiotocography classification systems
           incorporated in the fetal ECG ST analysis (STAN) interpretation algorithm:
           agreements and discrepancies in cardiotocography classification and
           evaluation of significant ST events
    • Authors: Per Olofsson; Håkan Norén, Ann Carlsson
      Abstract: IntroductionThe updated intrapartum cardiotocography (CTG) classification system by FIGO in 2015 (FIGO2015) and the FIGO2015‐approached classification by the Swedish Society of Obstetricians and Gynecologist in 2017 (SSOG2017) are not harmonized with the fetal ECG ST analysis (STAN) algorithm from 2007 (STAN2007). The study aimed to reveal homogeneity and agreement between the systems in classifying CTG and ST events, and relate to maternal and perinatal outcomesMaterial and methodsAmong CTG traces with ST events, 100 traces originally classified as normal, 100 as suspicious and 100 as pathological were randomly selected from a STAN database and classified by two experts in consensus. Homogeneity and agreement statistics between the CTG classifications were performed. Maternal and perinatal outcomes were evaluated in cases with clinically hidden ST data (N=151). A two‐tailed p
      PubDate: 2017-12-07T06:30:32.046665-05:
      DOI: 10.1111/aogs.13277
  • National screening guidelines and developments in prenatal diagnoses and
           live births of Down syndrome in the period 1973‐2016 in Denmark
    • Authors: Stina Lou; Olav Bjørn Petersen, Finn Stener Jørgensen, Ida Charlotte Bay Lund, Susanne Kjærgaard, , Ida Vogel
      Abstract: IntroductionDenmark was the first country in the world to implement a national, free‐for‐all offer of prenatal screening for Down syndrome to all pregnant women. It has a high uptake (> 90%) compared to other countries. Thus, Denmark offers an interesting case for investigating the consequences of implementing a comprehensive, national prenatal screening guideline. The aim of this study was to describe the historical developments in invasive procedures, pre‐/postnatal diagnoses of Down syndrome and Down syndrome live births in the period 1973‐2016 in DenmarkMaterial and methodsData on invasive procedures, pre‐ and postnatal Down syndrome diagnoses were retrieved from the Danish Cytogenetic Central RegistryResultsFrom 1973‐1993 screening based on maternal age and high‐risk indications resulted in a constant increase in invasive procedures. After the introduction of the triple test in 1994, invasive procedures decreased for the first time in 20 years. Following the introduction of an offer of combined screening to all pregnant women in 2004, the number of invasive procedures decreased markedly while there was a concurrent increase in prenatal diagnoses of Down syndrome. Additionally, the number of Down syndrome live births decreased suddenly and significantly, but subsequently stabilized at 23‐35 annual live births. Of these, the majority was diagnosed postnatallyConclusionsThough prenatal screening technologies constantly improve, it is the introduction of and adherence to national guidelines that resulted in marked shifts in screening procedures and outcome in Denmark.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-01T10:45:19.461074-05:
      DOI: 10.1111/aogs.13273
  • Gestational diabetes in primiparous women – impact of age and adiposity:
           a register‐based cohort study
    • Authors: Merja K. Laine; Hannu Kautiainen, Mika Gissler, Marko Raina, Ilkka Aahos, Kajsa Järvinen, Pirjo Pennanen, Johan G. Eriksson
      Abstract: IntroductionData on risk factors for gestational diabetes mellitus (GDM) in primiparous women is limited. The aim of this study was to assess the prevalence of GDM and to simultaneously evaluate the impact of age and adiposity in primiparous women on GDM riskMaterial and methodsThis is an observational register‐based cohort study from the city of Vantaa, Finland, including all 7750 primiparous women giving birth between 2009 and 2015 without previously diagnosed diabetes mellitusResultsIn primiparous women the prevalence of GDM was 16.5% and mean age was 28.2 (SD 5.2) years. Primiparous women aged ≥ 35 years had a significantly higher risk for GDM than women aged < 25 years (OR 2.67, 95% CI 2.13 to 3.34). Primiparous women with a pre‐pregnancy body mass index (BMI) ≥ 30.0 kg/m2 had significantly higher risk for GDM than women with a pre‐pregnancy BMI < 25 kg/m2 (OR 5.36, 95% CI 4.53 to 6.36). The risk to develop GDM showed an increasing trend with increasing age in all BMI categories except the category BMI ≥ 35 kg/m2. Normal weight women (BMI 20.0 – 24.9 kg/m2) aged 40 years had a significantly higher risk for GDM than normal weight women aged 28 years (OR 1.48, 95% CI 1.01 to 2.19)ConclusionsThe prevalence of GDM is high in primiparous women. Both age and degree of adiposity influenced the risk for GDM. In order to reduce GDM risk, adiposity should be prevented already in childhood and primiparity should be encouraged at younger age.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-01T10:40:26.384615-05:
      DOI: 10.1111/aogs.13271
  • Cohort studies in the context of obstetric and gynecologic research: a
           methodologic overview
    • Authors: Carmen Messerlian; Olga Basso
      Abstract: Observational cohort studies represent one of the most powerful designs in epidemiology. They are also the basis of evidence in many areas of obstetric and gynecologic research, given that randomization of women, couples or pregnancies is often impossible or unethical. Indeed, well‐conceived cohort studies have led to a better understanding of many important clinical and public health questions over time, including the impact of different exposures on perinatal and pediatric outcomes in pregnant women and their children. In this paper, we describe the main features, challenges, and limitations of cohort studies in the context of obstetric and gynecologic research. As with all epidemiologic studies, cohort studies present numerous challenges and are vulnerable to bias. However, as we describe throughout this review, careful design – from formulating the study question to planning statistical analysis – can reduce the potential for bias. When possible, we also provide examples from the gynecological and obstetrical literature to illustrate the epidemiological challenge and suggest specific readings.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-01T10:40:25.130613-05:
      DOI: 10.1111/aogs.13272
  • Risk of preterm birth in women with cervical intraepithelial neoplasia
           grade one: a population‐based cohort study
    • Authors: Annu Heinonen; Mika Gissler, Jorma Paavonen, Anna-Maija Tapper, Maija Jakobsson
      Abstract: IntroductionIn this population‐based register study our objective was to explore the association of cervical intraepithelial neoplasia, grade 1 and loop electrosurcigal excision procedure with preterm birth.Material and methodsOur population consisted of 4759 women diagnosed with cervical intraepithelial neoplasia, grade 1 during 1997–2009 and their 3021 subsequent deliveries analyzed by loop electrosurcigal excision procedure and parity. Hospital Discharge Register was used to identify women diagnosed for cervical intraepithelial neoplasia, grade 1 and these data were linked with the Medical Birth Register data. We calculated odds ratios with 95% confidence intervals.ResultsCervical intraepithelial neoplasia, grade 1 patients with loop electrosurcigal excision procedure had 54 (6.7%) subsequent preterm births and the corresponding figure among cervical intraepithelial neoplasia, grade 1 patients without loop electrosurcigal excision procedure was 116 (5.2%). This results in odds ratios 1.31 (95% confidence interval 0.94–1.83). We assessed the risk before and after diagnosis of cervical intraepithelial neoplasia, grade 1 both for patients with loop electrosurcigal excision procedure (odds ratios 1.47, 95% confidence interval 1.05–2.06) and without loop electrosurcigal excision procedure (odds ratios 0.90, 95% confidence interval 0.71–1.13). An increased risk for preterm birth after diagnosis of cervical intraepithelial neoplasia, grade 1 and loop electrosurcigal excision procedure was observed. We also compared both groups to the background population in the Medical Birth Register. For cervical intraepithelial neoplasia, grade 1 patients without loop electrosurcigal excision procedure the risk for preterm birth was not increased (odds ratios 0.95, 95% confidence interval 0.76–1.21) whereas for cervical intraepithelial neoplasia, grade 1 patients treated with loop electrosurcigal excision procedure the risk for preterm birth was increased (odds ratios 1.45, 95% confidence interval 1.02–1.92).ConclusionsLoop electrosurcigal excision procedure itself increases the risk for preterm birth. Cervical intraepithelial neoplasia, grade 1 as such does not increase the risk for preterm birth.
      PubDate: 2017-12-01T07:05:43.073522-05:
      DOI: 10.1111/aogs.13256
  • Trends in readmission rate by route of hysterectomy – A single
           center experience
    • Authors: Jennifer A Kreuninger; Sarah L Cohen, Elsemieke AIM Meurs, Mary Cox, Allison Vitonis, Frank W Jansen, Jon I Einarsson
      Abstract: IntrodutctionTo assess the 60‐day readmission rates after hysterectomy according to route of surgery and analyze risk factors for postoperative readmission.Material and methodsThis retrospective study included all women who underwent hysterectomy due to benign conditions from 2009‐2015 at a large academic center in Boston. Readmission rates were compared among the following four types of hysterectomies: abdominal (AH), laparoscopic (LH), robotic (RH) and vaginal (VH).ResultsThere were 3,981 hysterectomy cases over the study period (628 AH, 2500 LH, 155 RH and 698 VH). Intra‐operative complications occurred more frequently in women undergoing AH (4.8%), followed by RH (3.9%), VH (1.9%) and LH (1.6%), (p
      PubDate: 2017-11-29T12:15:54.700514-05:
      DOI: 10.1111/aogs.13270
  • Effects of applying universal fetal growth standards in a Scandinavian
           multi‐ethnic population
    • Authors: Line Sletner; Torvid Kiserud, Siri Vangen, Britt Nakstad, Anne Karen Jenum
      Abstract: IntroductionThe question whether universal growth charts can be used in multi‐ethnic settings is of general interest. The Intergrowth‐21st (IG‐21) fetal growth and newborn size standards are suggested to represent optimal fetal growth regardless of country origin. Our aim was to examine whether women fulfilling the strict IG‐21 inclusion criteria were healthier, showed less ethnic differences in fetal growth and newborn size, and less adverse perinatal outcomes.Material and methodsData were drawn from a population‐based multi‐ethnic cohort of 823 presumably healthy pregnant women in Oslo, Norway. We assessed differences in fetal and neonatal gestational age specific z‐scores and compared maternal health parameters, pregnancy‐ and birth complications between pregnancies fulfilling and not fulfilling the IG‐21 criteria.ResultsOnly 21% of pregnancies enrolled in our cohort fulfilled the IG‐21 criteria. Fetal growth deviated substantially from the new standards, in particular for ethnic Europeans. Ethnic differences persisted in pregnancies fulfilling the criteria.In South Asian fetuses estimated fetal weight was ‐0.60 SD (95% CI: ‐1.00, ‐0.20) lower at 24 gestational weeks, and birthweight was ‐0.62 SD (‐0.95, ‐0.29) lower, compared with ethnic Europeans. Corresponding numbers for Middle‐East/N‐Africans were ‐0.13 (‐0.62, 0.36) and ‐0.60 (‐1.00, ‐0.20). Maternal health indicators and birth complications were similar in women fulfilling and not fulfilling the criteria, or the relation depended on ethnic origin.ConclusionsIn an urban multi‐ethnic Norwegian population, applying an extensive list of criteria to define “healthy” pregnancies excludes the majority of women but does not cancel ethnic differences in fetal growth.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-28T07:00:26.437571-05:
      DOI: 10.1111/aogs.13269
  • External validity in perinatal research
    • Authors: Anthony O Odibo; Ganesh Acharya
      Abstract: Recent studies are beginning to focus on the external validity of well conducted internally valid research. This review gives an overview of external validity, the dimensions involved and suggestion for when future intervention trials are designed, using examples from perinatal research. Finally, we remind the perinatal researcher that it is their duty to provide extensive details beyond those needed to establish internal validity. The latter would help clinicians to determine if the intervention is applicable to their population.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-28T02:50:45.946257-05:
      DOI: 10.1111/aogs.13268
  • The Swedish Pregnancy Register – for Quality of Care Improvement and
    • Authors: Olof Stephansson; Kerstin Petersson, Camilla Björk, Peter Conner, Anna-Karin Wikström
      Abstract: IntroductionThe objective was to present the Swedish Pregnancy Register and to explore regional differences in maternal characteristics, antenatal care, first trimester combined screening and delivery outcomes in SwedenMaterial and methodsThe Pregnancy Register (w w w . collects data on pregnancy and childbirth, starting at the first visit to antenatal care and ending at the follow‐up visit to the antenatal care, which usually occurs at around 8‐16 weeks postpartum. The majority of data is collected directly from the electronic medical records. The Register includes demographic, reproductive and maternal health data, as well information on prenatal diagnostics, and pregnancy outcome for the mother and the new‐bornResultsToday the Register covers more than 90% of all deliveries in Sweden with the aim to include all deliveries within 2018. The care providers can visualise quality measures over time and compare results with other clinics, regionally and nationally by creating reports on an aggregated level or by using case‐mix adjusted Dash Boards in real time. Detailed data can be extracted after Ethical approval for research. In this report, we showed regional differences in patient characteristics, antenatal care, fetal diagnosis and delivery outcomes in SwedenConclusionsOur report indicates that quality in antenatal and delivery care in Sweden varies between regions which warrants further actions. The Swedish Pregnancy Register is a new and valuable resource for benchmarking, quality improvement and research in pregnancy, fetal diagnosis and delivery.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-24T18:40:25.557802-05:
      DOI: 10.1111/aogs.13266
  • Maternal body mass index as a predictor for delivery method
    • Authors: Anita Pettersen-Dahl; Gulim Murzakanova, Leiv Sandvik, Katariina Laine
      Abstract: IntroductionHigh maternal body mass index (BMI) is associated with complications during pregnancy and delivery, such as gestational diabetes, hypertensive disorders, perineal injuries and macrosomia. The aim of this study was to assess the association between maternal BMI and delivery method in non‐breech, singleton deliveries, after 36 weeks of gestation, in women with no more than one previous cesarean section, in Oslo University hospital, Ullevål.Material and methodsThis retrospective register study used data from the hospital obstetrical database in 2011‐2012, forming a cohort of 8821 women. Women were categorized into 5 different BMI classes and stratified into subgroups according to parity and previous cesarean delivery. Mode of delivery was categorized to spontaneous delivery, instrumental vaginal delivery, planned cesarean section and emergency cesarean section.ResultsIncidence of emergency cesarean delivery increased with increasing maternal BMI. Among primiparous women with overweight or obesity, the caesarean delivery rate was doubled (23.2% and 29.1% respectively), compared with women with underweight or normal weight (12.5% and 13.7%). Also among parous women, maternal BMI ≥ 30 doubled the risk for cesarean delivery. The strongest risk factor for planned or emergency cesarean delivery was previous cesarean section (adjusted odds ratio 16.41 (confidence interval 12.19‐22.08) and 8.72 (6.33‐12.02)), respectively). Maternal BMI ≥ 30 increased the risk of planned cesarean delivery with 77%, and doubled the risk of emergency cesarean delivery.ConclusionsPrepregnancy BMI ≥ 30 was an independent risk factor for delivery by emergency cesarean section for both primiparous and parous women.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-22T03:55:53.202581-05:
      DOI: 10.1111/aogs.13265
  • Absent fetal nasal bone in the second trimester and risk of abnormal
           karyotype in a prescreened population of Chinese women
    • Authors: Yan Du; Yunyun Ren, Yingliu Yan, Li Cao
      Abstract: IntroductionTo evaluate the value of absent fetal nasal bone in the prediction of fetal chromosomal abnormalities, according to whether it was associated with other soft markers or structural abnormalities in a prescreened population of Chinese pregnant women.Material and methodsIn this retrospective cohort study, women whose fetuses had absent nasal bone detected during the second trimester ultrasound scan were followed. Fetal karyotyping was performed and pregnancy outcomes were recorded. The association between absent fetal nasal bone with abnormal karyotype was evaluated according to whether soft markers or structural abnormalities were also observed.ResultsFetal nasal bone was assessed in a total of 56 707 singleton pregnancies. After exclusion of unqualified cases, a total of 71 (71/56 707, 0.13%) fetuses were included in the final analyses, of which 16 (16/71, 22.54%) were detected to have chromosomal abnormalities, including 12 cases of trisomy‐21, three trisomy‐18, and one case of micro‐deletion (in 7q). Among the 42 cases with isolated absence of nasal bone, two had trisomy‐21 and one had micro‐deletion. Absence of nasal bone in association with other structural abnormalities had a higher rate of abnormal karyotypes compared with isolated absence of nasal bone [83.33% (10/12) vs. 7.14% (3/42), Fisher's exact test χ2=25.620,p
      PubDate: 2017-11-21T21:20:48.853273-05:
      DOI: 10.1111/aogs.13263
  • Clinical decision analysis in perinatology
    • Authors: Rohan D'Souza; Prakesh S Shah, Beate Sander
      Abstract: Clinical decision‐making in perinatology involves tradeoffs between two intricately related individuals – mother and fetus. Decision‐making in perinatology is challenging due to competing interests of the mother and the fetus. Although decision analytic methods are increasingly used to develop processes for clinical and cost‐effectiveness analyses in perinatology, there are no guidelines on the conduct and reporting of decision analysis studies that takes into account the complexities of the mother‐fetus dyad. This article describes the basics of decision analysis and highlights areas that require special consideration in the perinatal context. It emphasizes the importance of obtaining patient‐preferences related to combined maternal‐fetal health states, stresses the relevance of both maternal and offspring health outcomes over appropriate time horizons, and explains challenges around the use of quality‐adjusted life years as an outcome measure in perinatology. It also provides insight on the complexities of dyad status in clinical and cost‐effectiveness analyses in perinatology.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-21T21:20:47.292041-05:
      DOI: 10.1111/aogs.13264
  • Cervical HPV prevalence and genotype distribution in immunosuppressed
           Danish women
    • Authors: Mette T. Roensbo; Jan Blaakær, Karin Skov, Anne Hammer
      Abstract: IntroductionWomen receiving immunosuppressive treatment due to organ transplantation are at increased risk of Human papilloma virus (HPV)‐related diseases, including cervical neoplasia. This pilot study aimed to describe the cervical HPV prevalence and genotype distribution in immunosuppressed Danish women.Material and MethodsWe included women who underwent renal‐ (RTR) or bone marrow transplantation (BMTR) in 2009‐2012 or 2014 at Aarhus University Hospital, Denmark. Women undergoing transplantation in 2009‐2012 had one cervical cytology performed, whereas women undergoing transplantation in 2014 had three cervical cytologies performed; one before and two after transplantation. The samples were examined for cytological abnormalities and tested for HPV using Cobas® HPV Test and CLART® HPV2 Test.ResultsOf 94 eligible cases we included 60 RTR and BMTR. The overall prevalence of high‐risk HPV was 15.0 (95% CI; 7.1–26.6) and the prevalence was higher among BMTR (29.4, CI; 10.3–56.0) than in RTR (9.3%, CI; 2.6–22.1) although this was not statistically significant (p=0.10). The distribution of high‐risk HPV was broad with HPV 45 as the most common genotype (3.3%). The prevalences of high‐risk HPV types included in the bivalent/quadrivalent and the nonavalent vaccines were 1.7% and 8.3%, respectively. The prevalence of low‐grade and high‐grade cytological abnormalities was 6.7% and 5.0%, respectively.ConclusionsImmunosuppressed women were infected with a broad range of high‐risk HPV genotypes and the prevalence of cytological abnormalities was higher than found in previous studies of the general population. The nonavalent HPV vaccine will offer immunosuppressed individuals a greater protection against HPV‐related diseases compared to the bivalent/quadrivalent HPV vaccines.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-20T12:10:23.929425-05:
      DOI: 10.1111/aogs.13261
  • Decreasing trends in number of depot medroxyprogesterone acetate starters
           in Norway – a cross‐sectional study
    • Authors: Ingvild Roksvaag; Finn Egil Skjeldestad
      Abstract: IntroductionIn this study, we examined changes in depot medroxyprogesterone acetate (DMPA) prescriptions over a time‐period when new professions started prescribing, and when the method gained some negative media attention.Material and methodsThe Norwegian Prescription Database provided data on hormonal contraception from 2006 through 2012. We estimated annual number of DMPA users by calculating doses sold per day/1000 women and calculated, for each contraceptive method on annual basis, a proportion of defined daily doses of all hormonal contraceptives in 5‐year age groups at reproductive age. All analyses were done in SPSS, version 22, with chi‐square test, t‐test, and survival analysis with p < 0.05 as significance level.ResultsThere were minor differences in overall DMPA use during the study years. The take‐out rate was equivalent to 11–12 per 1000 women aged 15–49 years. DMPA sales amounted to nearly 4% of all daily doses of hormonal contraceptives sold. General practitioners and physicians without a specialty were the major prescribers. The number of starters decreased by nearly 40% during the study years and was consistent across age groups. The average use duration among starters was 17.7 (95% CI: 17.5–17.9) months (range 0–90). There were minor changes in the relative proportion of long‐term users beyond 24 months during the study years.ConclusionsDMPA plays a minor role in the overall use of hormonal contraception in Norway, even among teenagers. The number of starters is decreasing, indicating a more restrictive attitude toward first use, especially among general practitioners.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-20T12:05:23.875524-05:
      DOI: 10.1111/aogs.13262
  • Long‐term evaluation of painful symptoms and fertility after surgery for
           large rectovaginal endometriosis nodule: a retrospective study
    • Authors: Nicolas Bourdel; Aurélie Comptour, Paméla Bouchet, Anne-Sophie Gremeau, Jean-Luc Pouly, Karem Slim, Bruno Pereira, Michel Canis
      Abstract: Optimal surgical treatment of rectovaginal endometriosis remains a controversial topic. The objective of this study was to evaluate long term postoperative outcomes after rectal shaving or colorectal resection for rectovaginal endometriosisMaterial and methods195 patients underwent surgery (172 managed by shaving, 23 by colorectal resection) between January 2000 and June 2013 for rectovaginal endometriosis (>2cm) involving at least the serosa of the rectum. Primary outcome measures were pain and fertility. Secondary outcome measures were complications, recurrence rates and quality of lifeResultsMean follow‐up was 60±42 months in the shaving group and 67±47 months in the resection group. The mean VAS score for pelvic pain between the pre and postoperative period decreased from 5.5±3.5 (shaving group) and 7.3±2.9 (resection group) to 2.3±2.4 (p
      PubDate: 2017-11-15T21:45:23.207535-05:
      DOI: 10.1111/aogs.13260
  • Diagnostic accuracy of magnetic resonance imaging in detecting the
           severity of abnormal invasive placenta: a systematic review and
    • Authors: Alessandra Familiari; Marco Liberati, Philip Lim, Giorgio Pagani, Giuseppe Cali, Danilo Buca, Lamberto Manzoli, Maria Elena Flacco, Giovanni Scambia, Francesco D'Antonio
      Abstract: IntroductionAccurate prenatal diagnosis of abnormally invasive placenta (AIP) is fundamental because it significantly reduces maternal morbiditiesMaterial and MethodsMedline, Embase, CINAHL and The Cochrane databases were searched. The primary aim of the present review was to elucidate the diagnostic accuracy of prenatal magnetic resonance imaging (MRI) in recognizing the severity of AIP, defined as the depth and topography of invasion. The secondary aim was to ascertain the strength of association between each MRI sign and the depth of placental invasion and to test their individual predictive accuracy in detecting such invasion. Inclusion criteria were studies on women who had prenatal MRI for ultrasound suspicion or the presence of clinical risk factors for AIP. Estimates of sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratio were calculated using the hierarchical summary receiver characteristics curve model, while individual data random‐effect logistic regression, was used to calculate ORResultsTwenty studies (1080 pregnancies undergoing MRI mainly for the ultrasound suspicion of AIP) were included. MRI showed a sensitivity of 94.4% (95% CI 15.8‐99.9), 100% (95% CI 75.3‐100) and 86.5% (95% CI 74.2‐94.4) for detection of placenta accreta, increta, and percreta; the corresponding for specificity were 98.8% (95% CI 70.7‐100), 97.3% (95% CI 93.3‐99.3), 96.8% (95% CI 93.5‐98.7). MRI identified 100% of cases with S1 and 100% of those with S2 invasion confirmed at surgery. Among the different MRI signs, intra‐placental dark bands showed the best sensitivity for the detection of placenta accreta, increta and percreta respectively, as well as abnormal intra‐placental vascularity, uterine bulging was associated with a higher risk of increta and percreta, exophitic mass and bladder tenting with placenta percretaConclusionPrenatal MRI has an excellent diagnostic accuracy in identifying the depth and the topography of placental invasion. However, these findings come mainly from studies in which MRI was performed as a secondary imaging tool in women already screened for AIP on ultrasound and might not reflect its actual diagnostic performance in detecting the severity of these disorders.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-14T12:11:00.907546-05:
      DOI: 10.1111/aogs.13258
  • Placental development and function in women with a history of
           placenta‐related complications: a systematic review
    • Authors: Ignatia F. Reijnders; Annemarie G. M. G. J. Mulders, Maria P. H. Koster
      Abstract: IntroductionWomen with a history of placenta‐related pregnancy complications, such as preeclampsia, intra‐uterine growth restriction or preterm delivery, have an increased risk for recurrence of such complications. This recurrence is likely the result of underlying endothelial dysfunction that leads to abnormal placentation, especially in complications with an early onset. This study provides an overview of biomarkers of placental development and function in pregnancies from women with a history of pregnancy‐related complications.Material and methodsA systematic literature search was conducted limited to human studies and including keywords related to a history of placenta‐related complications and markers of placental development and function. Two independent reviewers assessed eligibility and quality of 1,553 retrieved unique articles.ResultsFive articles reporting on placental development and function in women with an obstetric history of preeclampsia (n=3), intra‐uterine growth restriction (n=1) and preterm delivery (n=2) were eligible for quality assessment. We identified associations between a history of preeclampsia and abnormal placental histological findings at term in the current pregnancy, but found contradicting results regarding presence of uterine artery notching. In women with a history of very preterm delivery (
      PubDate: 2017-11-10T10:16:56.869245-05:
      DOI: 10.1111/aogs.13259
  • Very tight versus tight control: which should be the criteria for
           pharmacologic therapy dose adjustment in diabetes in pregnancy'
           Evidence from randomized controlled trials
    • Authors: Claudia Caissutti; Gabriele Saccone, Andrea Ciardulli, Vincenzo Berghella
      Abstract: IntroductionThere is inconclusive evidence from randomized controlled trials (RCTs) to support any specific criteria for pharmacologic therapy dose adjustment in diabetes in pregnancy. Our objective was to analyze the criteria for dose adjustment of pharmacologic treatment for diabetes mellitus (DM) in pregnancy.Material and methodsData sources: MEDLINE, OVID and Cochrane Library were searched from their inception to September 2017. Selection criteria included all trials of DM in pregnancy managed by oral hypoglycemic agents or insulin reporting criteria for pharmacologic therapy dose adjustment. RCTs in women with pregestational DM and gestational DM (GDM) were included. For each trial, data regarding glucose values used for pharmacologic therapy dose adjustment were extracted and carefully reviewed.ResultsOf 51 RCTs on therapy for GDM or pregestational DM, 17 (4,230 women) were included as they reported criteria for pharmacologic therapy dose adjustment. Most of them (88%, 15/17) included women with GDM only. For RCTs including women with GDM, 12/16 (75%) used the two step approach; 3 (19%) used the one step approach; 1 (6%) used either the one or two step approach. Regarding the type of initial therapy, 13 (77%) RCTs used different types and doses of insulin; 9 (53%) used metformin; 5 (30%) used glyburide; and 1 (6%) used placebo. In most RCTs glucose monitoring was assessed four times daily, i.e. fasting (all RCTs) and 2 hours (15 RCTs, 88%) after each of the three main meals – breakfast, lunch, and dinner. For fasting glucose target, all used a value 50%, 1 (6%) used >30%, and 1 (6%) used >20% of the values higher than the target value; while 1 (6%) used appearance of glycosuria.ConclusionsWhen evaluating RCTs which included criteria for pharmacologic GDM therapy dose adjustment, the most common criteria for diagnosis was the two step test, and the most common used therapies were insulin and metformin. Regarding glucose monitoring, the most common frequency was four times per day, fasting and 2 hours after each main meal, using as target glucose values 95mg/dL and 120mg/dL, respectively. Importantly, we found six different criteria for pharmacologic GDM therapy dose adjustment, with the majority using very tight criteria of either 1 or 2 values per week higher than the target values, of which two thirds used only 1 value, and one third 2 values.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-10T10:16:23.454869-05:
      DOI: 10.1111/aogs.13257
  • Are women positive for the One Step but negative for the Two Step
           screening tests for gestational diabetes at higher risk for adverse
    • Authors: Claudia Caissutti; Adeeb Khalifeh, Gabriele Saccone, Vincenzo Berghella
      Abstract: IntroductionTo evaluate if women meeting criteria for gestational diabetes mellitus (GDM) by the One Step test as per International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria but not by other less strict criteria have adverse pregnancy outcomes compared to GDM negative controls. The primary outcome was the incidence of macrosomia, defined as birth weight >4,000 grams.Material and methodsElectronic databases were searched from their inception until May 2017. All studies identifying pregnant women negative at the Two Step test, but positive at the One Step test for IADPSG criteria. We excluded studies that randomized women to the One Step versus the Two Step tests; studies that compared different criteria within the same screening method; randomized studies comparing treatments for GDM; and studies comparing incidence of GDM in women doing the One Step test versus the Two Step test.ResultsEight retrospective cohort studies, including 29,983 women, were included. 5 study groups and 4 control groups were identified. The heterogeneity between the studies was high. Gestational hypertension, preeclampsia, and large for gestational age, as well as in some analyses cesarean delivery, macrosomia and preterm birth, were significantly more frequent, and small for gestational age in some analyses significantly less frequent, in women GDM positive by the One Step, but not the Two Step.ConclusionWomen meeting criteria for GDM by IADPSG criteria but not by other less strict criteria have an increased risk of adverse pregnancy outcomes such as gestational hypertension, preeclampsia, and large for gestational age, compared to GDM negative controls. Based on these findings, and evidence from other studies that treatment decrease these adverse outcomes, we suggest screening for GDM using the IADPSG criteria.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-01T08:45:40.849087-05:
      DOI: 10.1111/aogs.13254
  • Small fetal thymus and adverse obstetrical outcome: a systematic review
           and a meta‐analysis
    • Authors: Claudia Caissutti; Alessandra Familiari, Asma Khalil, Maria Elena Flacco, Lamberto Manzoli, Giovanni Scambia, Angelo Cagnacci, Francesco D'Antonio
      Abstract: IntroductionTo explore the association between small fetal thymus on ultrasound and adverse obstetrical outcome.Material and methodsMedline, Embase, Cochrane and Web of Science databases were searched. Primary outcome was the risk of preterm birth before 37 and 34 weeks in fetuses with compared to those without a small thymus on ultrasound. Secondary outcomes: occurrence of chorioamnionitis, intra‐uterine growth restriction, neonatal sepsis, gestational age at birth, birthweight, neonatal morbidity and pre‐eclampsia.ResultsTwelve studies including 1744 fetuses who had ultrasound assessment of thymus during pregnancy were included. Women with preterm premature rupture of the membranes (PPROM) or with preterm labour with a small fetal thymus were at higher risk of preterm birth
      PubDate: 2017-10-23T01:35:30.308403-05:
      DOI: 10.1111/aogs.13249
  • Propensity score method for analyzing the effect of labor induction in
           prolonged pregnancy
    • Authors: Aura Pyykönen; Anna-Maija Tapper, Mika Gissler, Jari Haukka, Jari Petäjä, Lasse Lehtonen
      Abstract: IntroductionThere is an ongoing debate on the optimal time of labor induction to reduce the risks associated with prolonged pregnancyMaterial and methodsRegistry-based study of 212,716 term, singleton cephalic deliveries between 2006 and 2012 in Finland comparing the outcomes of labor induction to those of expectant management in five three-day gestational age periods between 40 and 42 weeks (Group 1:40+0-40+2; 2:40+3-40+5;3: 40+6-41+1;4: 41+2-41+4;5: 41+5-42+0). Using Poisson regression, induced deliveries in each of the gestational age periods were compared to all ongoing pregnancies. Propensity score matching was applied to reduce confounding by indicationResultsIn the gestational age groups 1-2 labor induction significantly decreased the risk meconium aspiration syndrome (RR 0.40, 95% CI 0.18-0.91, RR 0.44, 95% CI 0.21-0.91) but in contrast, increased the risk for prolonged hospitalization of a neonate (RR 1.30, 95% CI 1.10-1.54 and RR 1.23, 95% CI 1.03-1.47). In the groups 3-4, labor induction significantly increased the risk for emergency cesarean section (RR 1.17, 95% CI 1.06-1.28 and RR 1.19, 95% CI 1.09-1.29) still reducing the risk for meconium aspiration syndrome. In the group 5, labor induction did not affect the risk for any of the studied outcomes (operative delivery, obstetric trauma, neonatal mortality, respirator treatment, Apgar
      PubDate: 2017-09-19T03:11:51.786037-05:
      DOI: 10.1111/aogs.13214
  • The fetuses-at-risk approach: survival analysis from a fetal perspective
    • Authors: K.S. Joseph; Michael S. Kramer
      Abstract: 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 risk decrease exponentially with advancing gestational age. Perinatal epidemiologists have also puzzled over the paradox of intersecting birth weight- and gestational age-specific perinatal mortality curves for decades. For example, neonatal mortality rates among preterm infants of women who smoke are substantially lower than neonatal mortality rates among preterm infants of non-smoking women, whereas the reverse pattern occurs at term gestation. This mortality crossover is observed across several contrasts (women with hypertensive disorders of pregnancy vs normotensive women, older vs younger women, twins vs singletons, etc.) and outcomes (stillbirth, neonatal death, sudden infant death syndrome and cerebral palsy), and irrespective of how advancing “maturity” is defined (birth weight or gestational age). One approach proposed to address and explain these unexpected phenomena is the fetuses-at-risk model. This formulation involves a reconceptualization of the denominator for perinatal outcome rates from births to surviving fetuses. In this overview of the fetuses-at-risk model, we discuss the central tenets of the births-based and the fetuses-based formulations. We also describe the extension of the fetuses-at-risk approach to outcomes into and beyond the neonatal period and to a multivariable adaptation. Finally, we provide a substantive context by discussing biological mechanisms underlying the fetuses-at-risk model and contemporary obstetric phenomena that are better understood from that model than from one based on births.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-29T23:21:51.450774-05:
      DOI: 10.1111/aogs.13194
  • Is sonographically measured cervical length at 37 weeks’ gestation
           associated with intrapartum cesarean section' A prospective cohort
    • Abstract: IntroductionCesarean section rates continue to increase globally. Prediction of intrapartum cesarean section could lead to preventative measures. Our aim was to assess the association between sonographically measured cervical length at 37 weeks’ gestation and cesarean section among women planning a vaginal birth. The population was women with a low risk pregnancy or with gestational diabetesMaterial and methodsThis was a prospective cohort study conducted in a tertiary referral hospital in Sydney, Australia. 212 women with a low risk pregnancy or with gestational diabetes were recruited including 158 nulliparous and 54 parous women. Maternal demographic, clinical and ultrasound characteristics were collected at 37 weeks’ gestation. Semi‐Bayesian logistic regression and Markov chain Monte Carlo simulation was used to assess the relationship between cervical length and cesarean section in laborResultsRates of cesarean section were 5% (2/55) for cervical length ≤ 20mm; 17% (17/101) for cervical length 20‐32mm; and 27% (13/56) for cervical length > 32mm. These rates were 4%, 22%, and 33% respectively in nulliparous women. In the semi‐bayesian analysis, the odds ratio for cesarean section was 6.2 (95%CI 2.2 – 43) for cervical length 20‐32mm and 10 (95%CI 4.8 – 74) for cervical length > 32mm compared with the lowest quartile of cervical length, after adjusting for maternal age, parity, height, pre‐pregnancy body mass index, gestational diabetes, induction of labor, neonatal sex, and birthweight centileConclusionsCervical length at 37 weeks’ gestation is associated with intrapartum cesarean section.This article is protected by copyright. All rights reserved.
  • Antepartum risk factors for moderate to severe neonatal hypoxic ischemic
           encephalopathy: a Swedish national cohort study
    • Abstract: IntroductionOur aim was to identify antepartum risk factors for neonatal hypoxic ischemic encephalopathy (HIE), with a focus on maternal body mass index and height.Material and methodsNational population‐based cohort study of 692 428 live‐born infants ≥ 36 gestational weeks in Sweden, 2009–2015. Data from the Swedish Medical Birth Register and the Swedish Neonatal Quality Register were linked. Short maternal stature was defined as ≤ 155 cm, and overweight as body mass index ≥ 25 kg/m2. Therapeutic hypothermia served as surrogate marker of moderate to severe HIE. Associations between maternal and infant characteristics and HIE were calculated with logistic regression analyses, and risks were presented as odds ratios (ORs) with 95% confidence intervals (CIs).ResultsModerate to severe HIE occurred in 0.67/1000 infants. Nulliparity, previous cesarean delivery, short stature, overweight, gestational age, occiput posterior presentation, and birthweight were all independently associated with HIE. The risk of HIE increased with decreasing maternal height and increasing body mass index. Compared with non‐short women (>155 cm) with normal weight (body mass index < 25), those with both short stature and overweight had increased risk of HIE (OR: 3.66; 95% CI: 2.41‐5.55). Among parous women with both short stature and overweight, the risk was almost sixfold (OR: 5.74; 95% CI: 3.41–9.66).ConclusionsAntepartum risk factors for moderate to severe HIE included nulliparity, previous cesarean delivery, short stature, overweight, gestational age, occiput posterior presentation, and birthweight. The combination of maternal short stature and overweight was associated with a more than threefold risk of subsequent HIE.This article is protected by copyright. All rights reserved.
  • Alcohol binge drinking in early pregnancy and the effect on fetal growth:
           A cohort study
    • Abstract: IntroductionAlcohol binge drinking is common in early pregnancy and is a well‐established risk factor for subsequent child health. Yet very few studies have investigated the effect on fetal growth. Furthermore it has also been speculated whether the timing of binge drinking is a determining factor for neonatal growth. The objective of this study was to assess the potential effect of binge drinking and different drinking patterns (timing and number of binge drinking episodes) in early pregnancy on fetal growth estimated by birthweight and birth length.Material and methodsFrom March 1 to August 31 2000, 1836 pregnant Danish women from Aarhus University Hospital and Fredericia Hospital were included in the study and interviewed around the early second trimester about their drinking habits during their pregnancy. Information on anthropometric measures at birth was obtained from the Danish Medical Birth Registry. The potential effect of binge drinking and different drinking patterns was estimated using a multivariate general linear model adjusted for potential confounders that were selected a priori based on the currently available scientific literature.ResultsThe women who reported any binge drinking gave birth to children with a reduction in birth length of ‐0.02 cm (95% CI; ‐0.23‐0.18) and an increase in birthweight of 0.2 g (95% CI; ‐42.8‐43.2). Number of binge episodes and timing of these episodes were also not associated with fetal growth.ConclusionsThe study suggests that binge drinking and different drinking patterns in early pregnancy do not affect fetal growth.This article is protected by copyright. All rights reserved.
  • Adverse childhood experiences and depressive symptomatology among pregnant
    • Abstract: IntroductionAdverse childhood experiences (ACE) result in somatic and mental health disturbances. Its influence on antenatal depression is scarcely studied. This study examined the association between experience of ACE and antenatal depressive symptomatology.Material and methods1257 women from 172 antenatal clinics in Sweden were surveyed during pregnancy and one year after delivery. Demographics, previous medical history and Edinburgh Postpartum Depression Scale (EPDS) were collected in pregnancy and postpartum and ACE one year postpartum. ACEs were partitioned into 10 categories. Statistical analyses used linear and logistic regression with EPDS score as main outcome measure.Results736 (58.6%) women reported at least one ACE category and 88 women (7%) reported five or more ACE categories. An EPDS score of ≥13, which qualifies for a probable depression diagnosis, was reported by 277 (23%) women. In simple regression analyses the EPDS score was positively associated with the number of ACEs, cigarette smoking before pregnancy, body mass index and psychiatric disorders while education level was inversely associated. In a multiple regression analysis ACEs, education level and psychiatric disorder remained associated to the EPDS score. Among women with an ACE score ≥5 the odds ratio of having an EPDS score indicating probable depression was 4.2 (CI; 2.5‐7.0).ConclusionsACE was commonly reported. ACE and depressive symptomatology in late pregnancy were strongly associated in a dose‐response manner. Women with several ACEs had high odds of depressive symptomatology in late pregnancy and were more likely to report depressive symptoms both in late pregnancy and postpartum.This article is protected by copyright. All rights reserved.
  • Medical treatment in the management of deep endometriosis infiltrating the
           proximal rectum and sigmoid colon: a comprehensive literature review
    • Abstract: A comprehensive literature review was performed to evaluate the effect of various hormonal therapies, in terms of variations of intestinal and pain complaints and of patient satisfaction with treatment, in women with symptomatic, non‐severely sub‐occlusive endometriosis infiltrating the proximal rectum and sigmoid colon. A MEDLINE search through PubMed from 2000 to 2018 was conducted to identify all original English language articles published on medical treatment for colorectal endometriosis. Additional reports were identified by systematically reviewing reference lists and using the “similar articles” function in PubMed. A total of 420 women with colorectal endometriosis treated with combined oral contraceptives, progestins, gonadotropin releasing‐hormone (GnRH) agonists, and aromatase inhibitors have been described in eight case series, two retrospective cohort studies, and four case reports. Published data consistently suggest that several hormonal medications can control most symptoms associated with intestinal endometriosis, provided the relative bowel lumen stenosis is less than 60%. Patients with irritative‐type symptoms appear to respond better than those with constipation. Overall, about two thirds of women were satisfied with the treatment received, independently of the drug used. Progestins are the compound supported by the largest body of evidence. The addition of aromatase inhibitors or, alternatively, the use of GnRH agonists, do not seem to be associated with better outcomes. Long‐term treatment with a progestin should be proposed as an alternative to surgery to patients with non‐severely sub‐occlusive endometriosis infiltrating the proximal rectum and sigmoid colon not seeking conception. The final decision should be shared together with the woman, respecting her preferences and priorities.This article is protected by copyright. All rights reserved.
  • HELLP syndrome, risk factors in first and second pregnancy: a
           population‐based cohort study
    • Abstract: IntroductionHELLP syndrome may have specific risk factors and risk factors varying from first to second pregnancy. The aims of the study were to estimate the risk of HELLP syndrome by potential risk factors in first and second pregnancy, respectively.Material and methodsA population based cohort study including all women in Norway having their first baby (≥22 gestational weeks) during 1999 to 2014, registered in the Medical Birth Registry (n=418 897). A subset of women with at least two births (n=249 070) was used for estimates in second pregnancy. Relative risks with 95% confidence intervals (CIs) for HELLP syndrome were estimated using logistic regression and adjusted for maternal age and year of childbirth.ResultsBody mass index ≥ 30 and diabetes were associated with HELLP syndrome in first, but not in second pregnancy. Chronic hypertension and multiple pregnancy were associated with HELLP syndrome both in first and second pregnancy. In second pregnancy the strongest risk factors were a history of HELLP syndrome or preterm preeclampsia in the first. The risk was inversely correlated with gestational age at first delivery. The relative risk for recurrence of HELLP syndrome over all was 54.4 (CI; 34.3‐86.2) and 129.5 (CI; 45.7‐367.2) after HELLP syndrome before 29 weeks of gestation in first pregnancyConclusionsImportant risk factors for HELLP syndrome differ from first to second pregnancy. HELLP syndrome in second pregnancy is rare, but the relative risk is very high in women with HELLP syndrome or preterm preeclampsia in their first pregnancy.This article is protected by copyright. All rights reserved.
  • Comparison of self‐reported and directly measured weight and height
           among women of reproductive age: a systematic review and meta‐analysis
    • Abstract: IntroductionThe use of self‐report as a strategy for collecting data of women's weight and height is broadly spread both in clinical practice and epidemiological studies. This study aimed to compare self‐reported and directly measured weight and height among women of reproductive age.Material and methodsIn July 2015 we searched MEDLINE, EMBASE, COCHRANE, CINHAL, LILACS and grey literature. We included women of reproductive age (12 to 49 years old) independently of their weight or height at the time of the study. Women with any condition that implies regular track of their weight (e.g., eating disorder) were excluded. Two reviewers independently selected, extracted and assessed the risk of bias of the studies. We used RevMan 5.3 to perform the meta‐analysis. Heterogeneity was assessed using the I2 statistic.ResultsFollowing eligibility assessment, 21 studies including 18 749 women met the inclusion criteria. The results of the meta‐analysis showed an underestimation of weight by ‐0.94kg (95%CI ‐1.17, ‐0.71kg; p
  • HPV‐testing vs. HPV‐cytology co‐testing to predict the
           outcome after conization
    • Abstract: IntroductionThe purpose of this study was to determine the feasibility of human papillomavirus (HPV) testing alone as prognostic tool to predict recurrent disease within a three years follow‐up period after treatment for cervical intraepithelial neoplasia (CIN)2+.Material and methodsRetrospectively 128 women, with histologically verified CIN2+, who had a conization performed at Southern Jutland Hospital in Denmark between January 1st 2013 and December 31st 2013 were included. Histology, cytology and HPV test results were obtained for a 3 years follow‐up period.Results4.7% (6/128) of the cases developed recurrent disease during follow‐up. Of the cases without free margins, recurrent dysplasia was detected in 10.4% (5/48), while in the group with free margins it was 1.3% (1/80). Post‐conization HPV test was negative in 67.2% (86/128) and pap smear normal in 93.7% (120/128). Combining resection margins, cytology and HPV had a sensitivity for prediction of recurrent dysplasia of 100%. Specificity was 45.8%, positive predictive value (PPV) 8.5% and negative predictive value (NPV) 100%. Using HPV test alone as predictor of recurrent dysplasia gave a sensitivity of 83.3%, specificity 69.7%, PPV 11.9% and NPV 98.8%. Combining resection margin and HPV test had a sensitivity of 100%, specificity 45.9%, PPV 8.3% and NPV 100%.ConclusionsHPV test at 6 months control post‐conization gave a NPV of 98.8% and can be used as a solitary test to identify women at risk for recurrent disease three years after treatment for precursor lesions. Using both resection margin and HPV test had a sensitivity of 100% and NPV 100%. Adding cytology did not increase the predictive value.This article is protected by copyright. All rights reserved.
  • Perinatal outcome of monochorionic and dichorionic twins after spontaneous
           and assisted conception: a retrospective cohort study
    • Abstract: IntroductioThe aim of this study was to compare pregnancy outcomes in twin pregnancies after ACand spontaneous conception, according to chorionicity.Material and methodsRetrospective cohort study of 1305 twin pregnancies between 1995 and 2015. All spontaneous (n=731) and assisted conception conceived twin pregnancies (n=574) with antenatal care and delivery in University Medical Center Utrecht, The Netherlands, a tertiary obstetric care center were studied according to chorionicity.ResultsMaternal age and incidence of nulliparity were higher among the assisted conception twins. Hypertensive disorders also appeared to be more frequent in assisted conception pregnancies, which could largely be explained by the higher proportion of elderly nulliparous women in this group. Spontaneously conceived twins were born earlier than twins after assisted conception, with subsequent lower birthweights and more admissions to a neonatal intensive care unit with increased neonatal morbidity. Monochorionic twins have worse pregnancy outcomes compared to dichorionic twins, irrespective of mode of conception; monochorionic twins conceived by assisted reproduction had more neonatal morbidity (mainly respiratory distress syndrome and necrotizing enterocolitis) and late neonatal deaths compared to spontaneously conceived monochorionic twins.ConclusionsSpontaneous conceived twins have worse pregnancy outcome compared to twins after assisted conception, probably due to a lower incidence of monochorionicity in the assisted conception group. The already increased perinatal risks in monochorionic twins are even higher in monochorionic twins conceived after infertility treatments compared to spontaneous conceived monochorionic twins which warrants extra attention to these high risk pregnancies.This article is protected by copyright. All rights reserved.
  • How to investigate and adjust for selection bias in cohort studies
    • Abstract: Longitudinal cohort studies can provide important evidence about preventable causes of disease, but the success relies heavily on the commitment of their participants, both at recruitment and during follow‐up. Initial participation rates have decreased in recent decades as have willingness to participate in subsequent follow‐ups. It is important to examine how such selection affects the validity of the results. In this article, we described the conceptual framework for selection bias due to non‐participation and loss to follow‐up in cohort studies, using both a traditional epidemiological approach and directed acyclic graphs (DAGs). Methods to quantify selection bias are introduced together with analytical strategies to adjust for the bias including controlling for covariates associated with selection, inverse probability weighting, and bias analysis. We used several studies conducted in the Danish National Birth Cohort (DNBC) as examples on how to quantify selection bias and also understand the underlying selection mechanisms. Although women who chose to participate in the cohort were typically of higher social status, healthier and with less disease than all those eligible for study, differential selection was modest and the influence of selection bias on several selected exposure‐outcome associations was limited. These findings are assuring and support enrolling a subset of motivated participants who would engage in long‐term follow‐up rather than prioritize representativeness. Some of the presented methods are applicable even with limited data on non‐participants and those lost to follow‐up, and can also be applied to other study designs such as case‐control studies and surveys.This article is protected by copyright. All rights reserved.
  • Associations between parity and maternal BMI in a population‐based
           cohort study
    • Abstract: IntroductionWe aimed to investigate the change in prevalence of overweight and obesity in pregnant Danish women from 2004 to 2012 and investigate whether increasing parity was associated with a change in BMI prevalence.Material and methodsWe obtained a population‐based cohort from the Danish Medical Birth registry consisting of all Danish women giving birth from 2004‐2012 (n=572 321). This registry contains information on 99.8% of all births in Denmark. We calculated the overall change in pre‐pregnancy BMI‐status among pregnant women in Denmark, and a multiple linear regression model with adjustment for several potential confounders in combination with a paired t‐test was used to examine the change in pre‐pregnancy BMI with increasing parity.ResultsIn 2004, the prevalence of prepregnancy overweight and obesity (BMI≥25) and obesity alone (BMI≥30) was 31.9% and 11%, respectively. In 2012, the prevalence had reached 34.2% and 12.8%. The mean BMI increased for every additional parity from 23.80 (95%CI; 23.77‐23.82) in parity group 1 to 26.70 (26.52‐26.90) in parity group 5+. A multiple linear regression adjusted for potential confounders showed that women on average gained 0.62 (0.58‐0.65) BMI‐units after every additional birth.ConclusionsThis study showed a 7.2% increase in overweight and obesity (BMI≥25) and a 16.4% increase in obesity alone (BMI≥30) for pregnant women in Denmark from 2004 to 2012. In addition, an increase in interpregnancy BMI was seen at every additional delivery, suggesting obesity to be an increasing challenge in obstetrics.This article is protected by copyright. All rights reserved.
  • Screening for fetal and neonatal alloimmune thrombocytopenia ‐ lessons
           learned from a Norwegian screening program
    • Abstract: An important issue on human platelet antigen (HPA)‐1a screening has recently been addressed in Acta Obstetrica et Gynecologica Scandinavia. Winkelhorst et al. reported that the vast majority of women in the general pregnant population were positive about screening (1). Here we report that there was also a positive attitude towards screening among Norwegian HPA‐1a‐immunized pregnant women. Further, we report that insufficient information may have led to unnecessary anxiety in this high‐risk population.This article is protected by copyright. All rights reserved.
  • Clinical Gynecologic Oncology. Ninth Edition
    • Abstract: In clinical practice, there is always need for a good comprehensive textbook, which covers the full scope of needed clinical information and principles. For Gynecologic Oncologists, the textbook of Clinical Gynecologic Oncology, with Drs. Philip J. Di Saia and William T. Creasman as main editors, has been one of the classic textbooks. In 2018, the 9th edition of this textbook is published.This article is protected by copyright. All rights reserved.
  • Can pelvic floor trauma be predicted antenatally'
    • Abstract: IntroductionLevator trauma is a risk factor for development of pelvic organ prolapse. We aimed to identify antenatal predictors for significant damage to the levator ani muscle during first vaginal delivery.Materials and MethodsA retrospective observational study utilising data from two studies with identical inclusion criteria and assessment protocols between 2005 and 2014. 1148 primiparae with an uncomplicated singleton pregnancy were recruited and assessed with translabial ultrasound at 36 weeks antepartum and 871 (76%) returned for reassessment 3‐6 months postpartum. The ultrasound data of vaginally parous women were analysed for levator avulsion and microtrauma. The former was diagnosed if muscle insertion at the inferior pubic ramus in the plane of minimal hiatal dimensions and within 5mm above are abnormal on tomographic ultrasound imaging. Microtrauma was diagnosed in those with an intact levator and there was a postpartum increase in hiatal area on Valsalva by >20% with the resultant area ≥ 25cm2.ResultsThe complete data sets of 844 women were analyzed. Among them 609 delivered vaginally. This was a norml vaginal delivery in 452 (54%), a vacuum birth in 102 (12%) and forceps in 55 (6%). Levator avulsion was diagnosed in 98; microtrauma in 97. On multivariate analysis increasing maternal age, lower body mass index and lower bladder neck descent were associated with avulsion. Increased bladder neck descent and a family history of casesrean section (CS) were associcated with microtrauma.ConclusionsMaternal age, body mass index, bladder neck descent and family history of CS are antenatal predictors for levator trauma.This article is protected by copyright. All rights reserved.
  • An overview of cervical cancer epidemiology and prevention in Scandinavia
    • Abstract: New technologies such as human papillomavirus (HPV) testing and vaccination necessitates comprehensive policy analyses to optimize cervical cancer prevention. To inform future Scandinavian‐specific policy analyses, we aimed to provide an overview of cervical cancer epidemiology and existing prevention efforts in Denmark, Norway and Sweden. We compiled and summarized data on current prevention strategies, population demography, and epidemiology (e.g. age‐specific HPV prevalence and cervical cancer incidence over time) for each Scandinavian country by reviewing published literature and official guidelines, performing registry‐based analyses using primary data, and discussions with experts in each country. In Scandinavia, opportunistic screening occurred as early as the 1950s, and by 1996, all countries had implemented nationwide organized cytology‐based screening. Prior to implementation of widespread screening and during years 1960‐1966, cervical cancer incidence was considerably higher in Denmark than in Norway and Sweden. Decades of cytology‐based screening later (i.e., years 2010‐14), cervical cancer incidence has considerably been reduced and has converged across the countries since the 1960s, yet remains lowest in Sweden. Generally, Scandinavian countries face similar cervical cancer burden and utilize similar prevention approaches; however, important differences remain. Future policy analyses will need to evaluate whether these differences warrant differential prevention policies, or whether efforts can be streamlined across Scandinavia.This article is protected by copyright. All rights reserved.
  • Is TWEAK a valid screening questionnaire to identify alcohol risk drinkers
           among pregnant women in Denmark'
    • Abstract: IntroductionIdentification of pregnant alcohol risk drinkers is crucial to prevent adverse birth outcomes. The TWEAK screening instrument has shown promising results for identifying risk drinkers. However, as the effectiveness of the screening questionnaire has only been investigated among American women with mainly low socioeconomic status, we aimed to investigate the ability of TWEAK to identify alcohol risk drinkers among pregnant Danish women.Material and methodsDuring 2000, Danish‐speaking women referred to the Midwife Centre at Aarhus University Hospital (n = 1554) and Frederica Hospital (n = 499) for routine antenatal care were invited to participate in the study at their first visit. The women were interviewed about their periconceptional and current drinking habits including average weekly alcohol consumption and binge drinking. Additionally, the women were also asked the questions related to TWEAK questionnaire.ResultsWe found that the sensitivity of TWEAK to identify periconceptional risk drinking was quite low, whereas TWEAK's ability to identify risk drinkers during pregnancy was marginally higher. Our results suggested that older age (odd ratio 1.46, 95% CI; 0.95 to 2.23), current smoking (odd ratio 2.33, 95% CI; 1.63 to 3.33), being single (odd ratio 2.38, 95% CI; 1.38 to 4.11) and a TWEAK score with a cut off score of ≥1 (odd ratio 2.75, 95% CI; 2.02 to 3.76) increased the risk of high‐risk drinking during pregnancy.ConclusionsIn a Danish setting, TWEAK does not seem as an optimal screening tool to identify periconceptional risk drinkers, but it may be useful in identifying high‐risk drinking during pregnancy.This article is protected by copyright. All rights reserved.
  • Brainstem auditory abnormality in extremely premature babies and the
           impact of neonatal bronchopulmonary dysplasia
    • Abstract: IntroductionExtremely premature babies, particularly those who have neonatal bronchopulmonary dysplasia (BPD), are at risk of brain damage and neurodevelopmental impairment. This study aimed to examine functional status of the brainstem auditory pathway in extremely premature babies and assess the impact of BPD on the function.Material and methodsBrainstem auditory evoked response was studied at term in babies born at 27 or less weeks of gestation with or without neonatal BPD. The normal controls were term babies without perinatal problems.ResultsCompared with the normal controls, the extremely premature babies showed an elevated response threshold, increased latencies of waves I, III and particularly V. They also showed significantly increased I‐V and III‐V intervals. The amplitudes of waves I and V were moderately reduced. These abnormalities were clearly more significant in those with BPD than those without BPD. A direct comparison between the two groups of extremely premature babies revealed that wave V latency, and I‐V and particularly III‐V intervals were significantly longer in the babies with BPD than those without BPD.ConclusionsExtremely premature babies have functional impairment of the brainstem auditory pathway. The impairment is clearly more significant in those with BPD than those without BPD. Neonatal BPD and associated unfavorable conditions are major contributors to brainstem auditory impairment in extremely premature babies.This article is protected by copyright. All rights reserved.
  • Non‐invasive diagnostic tools for pelvic congestion syndrome: a
           systematic review
    • Abstract: IntroductionIn the work‐up of patients with suspected pelvic congestion syndrome, venography is currently the gold standard. Yet if non‐invasive diagnostic tools are found to be accurate, invasive venography might no longer be indicated as necessary.Material and methodsA literature search in Pubmed and EMBASE was performed from inception until May 6th 2017. Studies comparing non‐invasive diagnostic tools to a reference standard in the work‐up of patients with (suspected) pelvic congestion syndrome were included. Relevant data were extracted and methodological quality of individual included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2) tool.ResultsNine studies matched our inclusion criteria. Six studies compared ultrasonography to venography and three studies described a magnetic resonance imaging technique. In using transvaginal ultrasonography, the occurrence of a vein greater than five mm crossing the uterine body had a specificity of 91% (95% CI; 77%‐98%) and occurrence of pelvic varicoceles a sensitivity and specificity of 100% (95% CI; 89%‐100%) and 83‐100% (95% CI; 66%‐93%), respectively. In transabdominal ultrasonography, reversed caudal flow in the ovarian vein accounted for a sensitivity of 100% (95% CI; 84%‐100%). Detection of pelvic congestion syndrome with magnetic resonance imaging techniques resulted in a sensitivity varying from 88‐100%.ConclusionsThe sensitivity of ultrasonography and magnetic resonance imaging seem to be adequate, which indicates a role for both tests in an early stage of the diagnostic workup. However, due to methodological flaws and diversity in outcome parameters, more high standard research is necessary to establish a clear advice for clinical practice.This article is protected by copyright. All rights reserved.
  • A simplified guide to randomized controlled trials
    • Abstract: A randomized controlled trial (RCT) is a prospective, comparative, quantitative study/experiment performed under controlled conditions with random allocation of interventions to comparison groups. The RCT is the most rigorous and robust research method of determining whether a cause‐effect relationship exists between an intervention and an outcome. High quality evidence can be generated by performing an RCT when evaluating the effectiveness and safety of an intervention. Furthermore, RCTs yield themselves well to systematic review and meta‐analysis providing a solid base for synthesizing evidence generated by such studies. Evidence‐based clinical practice improves patient outcomes, safety, and is generally cost‐effective. Therefore, RCTs are becoming increasingly popular in all areas of clinical medicine including perinatology. However, designing and conducting an RCT, analyzing data, interpreting findings and disseminating results can be challenging as there are several practicalities to be considered. In this review, we provide a simple descriptive guidance on planning, conducting, analyzing and reporting RCTs.This article is protected by copyright. All rights reserved.
  • Coffee, tea and caffeine consumption and risk of primary infertility in
           women: a Danish cohort study
    • Abstract: IntroductionThe aim of this study was to investigate whether consumption of coffee, tea and caffeine affects the risk of primary infertility in women.Material and methodsWe selected nulliparous Danish women aged 20–29 years from a prospective cohort and retrieved information on coffee and tea consumption from a questionnaire and an interview at enrollment. We assessed the women's fertility by linkage to the Danish Infertility Cohort and retrieved information on children and vital status from the Civil Registration System. All 7574 women included for analysis were followed for primary infertility from the date of enrollment (1991–1993) until 31 December 2010. Analyses were performed with Cox proportional hazard models.ResultsDuring follow‐up, primary infertility was diagnosed in 822 women. Compared to never consumers, the risk of primary infertility among women who drank coffee or tea was not affected. The risk of primary infertility was neither associated with an increasing number of daily servings of coffee (hazard ratio 1.00; 95% confidence interval (CI), 0.97–1.03) or tea (hazard ratio 1.01; 95% CI, 0.99–1.03) in consumers only. Concerning total caffeine consumption (from coffee and tea), the risk of infertility was similar among consumers compared to never consumers. Finally, each additional daily 100 mg of caffeine did not affect the risk among consumers only (hazard ratio 1.00; 95% CI, 0.98–1.02).ConclusionsIn this population‐based cohort study, not restricted to women seeking pregnancy, we found no association between coffee, tea or total caffeine consumption and the risk of primary infertility in women.This article is protected by copyright. All rights reserved.
  • Antenatal corticosteroids: a retrospective cohort study on timing,
           indications and neonatal outcome
    • Abstract: IntroductionAn antenatal corticosteroids (ACS)‐delivery interval of 24 hours to 7 days is commonly referred to as optimal timing. We aimed to investigate whether the ACS‐delivery interval was associated with the obstetric indication for treatment and with neonatal complications.Material and methodsThe study was a retrospective chart review of clinical data from preterm neonates delivered at the Skåne University Hospital, Lund University, Sweden from January 1st, 2013, to December 31st, 2016. The ACS‐delivery intervals were compared between groups of women with various clinical scenarios and related to neonatal outcomes.ResultsThe study included 498 preterm neonates from 431 women. 41% of the women received ACS one to seven days before delivery. Women with preterm prelabour rupture of membranes or vaginal bleeding had median ACS‐delivery interval 7.5 and 8 days, respectively, compared to women with maternal/fetal indications or preterm labour 3 and 2 days, respectively (p7 days were at a higher risk of respiratory distress syndrome (OR 2.00, 95% CI; 1.05‐3.79) and moderate or severe bronchopulmonary dysplasia (OR 2.49, 95% CI; 1.35‐4.58) compared to neonates with an ACS‐delivery interval of one to seven days.ConclusionOptimal timing of ACS treatment varied significantly based on the clinical indication. Women with preterm prelabour rupture of membranes or vaginal bleeding were more likely to have an ACS‐delivery interval >7 days. A prolonged ACS‐delivery interval was associated with an increased risk of neonatal respiratory morbidity and a prolonged stay in the neonatal care unit, but not with neonatal mortality.This article is protected by copyright. All rights reserved.
  • Association of miRNA‐200c expression levels with clinicopathological
           factors and prognosis in endometrioid endometrial cancer
    • Abstract: IntroductionMicroRNAs (miRNAs) are regulators of gene expression, which play an important role in many critical cellular processes including apoptosis, proliferation and cell differentiation. Aberrant miRNA expression has been reported in variety of human malignancies. Therefore, miRNAs may be potentially used as cancer biomarkers. MiRNA‐200c, which is a member of miRNA‐200 family, might play an essential role in tumour progression. The purpose of this study was to evaluate the prognostic and clinical significance of miRNA‐200c in endometrioid endometrial cancer patients.Material and methodsTotal RNA extraction from 90 archival formalin‐fixed paraffin‐embedded tissue samples of endometrioid endometrial cancer and 10 normal endometrium samples was performed. After cDNA synthesis, real time polymerase chain reaction was conducted and relative expression of miRNA‐200c was assessed. Then, miRNA‐200c expression levels were evaluated in regard to clinicopathological characteristics.ResultsThe expression levels of miRNA‐200c were significantly increased in endometrioid endometrial cancer samples. MiRNA‐200c expression maintained at significantly higher levels in the early stage endometrioid endometrial cancer as compared to more advanced stages. In the Kaplan‐Meier analysis, lower levels of miRNA‐200c expression were associated with inferior survival.ConclusionsMiRNA‐200c expression levels might be associated with clinicopathological factors and survival in endometrioid endometrial cancer.This article is protected by copyright. All rights reserved.
  • Laeverin protein expression in normal and preeclamptic placentas using
           tissue microarray analysis
    • Abstract: IntroductionLaeverin is a placenta‐specific protein that is normally expressed in the plasma membrane of human trophoblasts. In previous studies, we showed higher expression levels of laeverin gene in preeclamptic compared to normal placentas and found that laeverin protein was ectopically expressed in the cytoplasma of the preeclamptic placentas. Our objective was to investigate laeverin protein expression in normal and preeclamptic placentas combining immunohistochemistry and immunofluorescence.Material and methodsTissue microarray analysis of 72 placentas, obtained from 33 preeclamptic and 39 uncomplicated pregnancies was performed. Laeverin was labelled with a specific antibody for immunohistochemistry and immunofluorescence studies.ResultsImmunohistochemistry showed that laeverin was expressed in syncytiotrophoblasts, cytotrophoblasts and extravillous trophoblasts in all placentas examined. In preeclamptic placentas (n=33) compared to normal placentas (n=39), laeverin was expressed in the cell membrane in 21 (64%) vs 21 (54%) of samples (p=0.726), in the cytoplasm in 3 (9%) vs 2 (5%) of samples (p=0.795) and in both the cytoplasm and membrane in 9 (27%) vs 16 (41%) of samples (p=0.0522). All placental samples that showed cytoplasmic expression of laeverin were obtained from women delivered before 34 weeks of gestation (early‐onset preeclampsia). Further, immunofluorescence studies showed laeverin expression in the cytoplasm of six preeclamptic (three early‐onset and three late‐onset) and one normal placenta but did not reveal any simultaneous cell membrane and cytoplasmic expression of laeverin.ConclusionLaeverin is expressed in all trophoblast cell types of normal and preeclamptic placentas. Expression pattern of laeverin in trophoblast cells is heterogeneous and not necessarily membrane‐bound.This article is protected by copyright. All rights reserved.
  • Accuracy of fetal fibronectin for assessing preterm birth risk in
           asymptomatic pregnant women: a systematic review and meta‐analysis
    • Abstract: IntroductionFetal fibronectin (fFN) is a validated test for assessing risk of preterm birth for women presenting with symptoms. Our aim was to evaluate the accuracy of fFN to detect the risk of preterm birth in asymptomatic women.Material and methodsSearches were conducted to identify studies where fFN was performed in asymptomatic women beyond 22 weeks’ gestation. EMBASE, MEDLINE, CINHAL, AMED and BNI were searched between 2005 and 2017. Studies before 2005 were identified from a published systematic review. Women were grouped as singleton pregnancies, with and without risk factors for preterm birth, and multiple pregnancy. Quality assessment was performed using QUADAS‐2. When possible, data were pooled using a hierarchical, bivariate random effects model.ResultsFifteen studies met the inclusion criteria: six studies of singleton pregnancies in women without risk factors (1,236 women), four in women with risk factors for preterm birth (2,628 women) and five studies were of multiple pregnancy (1,427 women). The pooled sensitivity and specificity of fFN in ‘no risk factors singletons’ were 0.48 (95% CI 0.20–0.77), and 0.96 (95% CI 0.86–0.99) respectively. The likelihood ratio of a positive test result was 12 (95% CI 4.70‐30.68). The pooled sensitivity and specificity of fFN in ‘risk factors singletons’ were 0.34 (95% CI 0.24–0.43), and 0.91 (95% CI 0.88–0.93). Accuracy of fFN in multiple pregnancies was inconclusive.ConclusionOur findings suggest in asymptomatic singleton pregnancies without risk factors a positive fFN result indicates a large shift from pre to post‐test probability, possibly identifying women at increased risk of preterm birth.This article is protected by copyright. All rights reserved.
  • The effect of ethnicity on the performance of protein‐creatinine ratio
           in the prediction of significant proteinuria in pregnancies at risk of or
           with established hypertension: an implementation audit and cost
    • Abstract: IntroductionThe replacement of 24‐hour urine collection by protein‐creatinine ratio (PCR) for the diagnosis of pre‐eclampsia has been recently recommended. However, the literature is conflicting and there are concerns on the impact of demographic characteristics on the performance of PCR.Materials and methodsThis was an implementation audit of the introduction of PCR in a London Tertiary obstetric unit. The performance of PCR in the prediction of proteinuria ≥300mg/day was assessed in 476 women with suspected pre‐eclampsia who completed a 24‐hour urine collection and an untimed urine sample for PCR calculation. Multivariate logistic regression was used to assess the independent predictors of significant proteinuria.ResultsIn a pregnant population ethnicity and PCR are the main predictors of ≥300mg proteinuria in a 24‐hour urine collection. A PCR cut‐off of 30mg/mmol would have incorrectly classified as non‐proteinuric 41.4% and 22.9% of black and non‐black women, respectively. Sensitivity of 100% is achieved at cut‐offs of 8.67 and 20.56 mg/mmol for black and non‐black women, respectively. Applying these levels as a screening tool to inform for the need to perform a 24‐hour urine collection in 1000 women, it would lead to a financial saving of €2911 in non‐black and to an additional cost of €3269 in black women, respectively.ConclusionsOur data suggest that a move from screening for proteinuria with a 24‐hour urine collection to screening with urine PCR is not appropriate for black populations. However the move may lead to cost saving if used in the white population with a PCR cut‐off of 20.5This article is protected by copyright. All rights reserved.
  • Pelvic floor muscle function and quality of life in post‐menopausal
           women with and without pelvic floor dysfunction
    • Abstract: IntroductionThis study aims to compare pelvic floor muscle (PFM) function in post‐menopause women with and without pelvic floor dysfunction (PFD) and the relationship between PFM function and quality of lifeMaterial and methodsa case‐control study with 216 post‐menopause women with (n=126) and without PFD (n=90). PFM function was assessed by digital vaginal palpation using PERFECT scale. Specific quality of life was evaluated by King's Health Questionnaire for women with urinary incontinence and Prolapse Quality‐of‐Life Questionnaire for women with pelvic organ prolapse. We analyzed women with PFD into two categories: Oxford's grade ≤2 or ≥ 3 using a Qui Square testResultsOut of 126 womem with PFD 44/34.9% presented stress urinary incontinence, 21/16.6% pelvic organ prolapse and 61/48.4% urinary incontinence + pelvic organ prolapse. Strength had a median value 2 (0‐5) in all women studied and most of them had insufficient strength, reduced endurance and repetition without statistical difference between groups. Incontinent women with strength ≤ 2 had worse perception of general health domain of King's Health Questionnaire (p= 0.007). No association was found between PFM function and Prolapse Quality‐of‐Life QuestionnaireConclusionsPFM function assessed by bidigital palpation in post‐menopausal women was not enough sensitive to differentiate between women with vs. without PFM dysfunction and was not related with specific quality of life in women with urinary incontinence and pelvic organ prolapse, respectively. These date should be used to reinforce the widespread recommendation that PFM training is essencial in PFD treatment.This article is protected by copyright. All rights reserved..
  • Systematic misclassification of gestational age by ultrasound biometry:
           implications for clinical practice and research methodology in the Nordic
    • Abstract: Historically, pregnancy dating has been based on self‐reported information on first day of the last menstrual period. In the 1970s, ultrasound biometry was introduced as an alternative for pregnancy dating, and is now the leading method in Nordic countries. The use of ultrasound led to a reduction of postterm births and fewer inductions and is considered more precise than last menstrual period‐based methods for pregnancy dating. Nevertheless, differences in early growth and specific situations, such as maternal obesity, can render its estimates less precise, leading to gestational age misclassification. Clinical implications of ultrasound dating include effect on timely induction in case of postterm pregnancies, treatment with corticosteroids in cases of anticipated preterm delivery and decision on viability in cases of extreme prematurity. Furthermore, gestational age misclassification may influence the numbers and the magnitude of some adverse perinatal outcomes, closely related to gestational age, which are recorded in the Nordic birth registers.This article is protected by copyright. All rights reserved.
  • Low semen quality and experiences of masculinity and family building
    • Abstract: IntroductionInfertility is a concern for men and women.There is limited knowledge on how male factor infertility affects the couple in fertility treatment. The aim of this study was to explore how severe male factor infertility affects men's sense of masculinity, the couple's relationship and intentions about family formation.Material and methodsSemi‐structured qualitative interview study at the Fertility Clinic at Copenhagen University Hospital, Hvidovre, Denmark. Ten men with very poor semen quality initiating fertility treatment were interviewed between November 2014 and May 2015. Data were analysed using qualitative content analysis.ResultsThree themes were identified: ‘Threatened masculinity’, ‘Being the strong one: impact on the couple’ and ‘Consideration of family building options: a chapter not willing to start’. The men felt that they could not fulfill their role as a man. Some couples had conflicts and discussions because the women in general wanted to talk more about infertility than the men. The men focused on having a biological child. They wanted to focus on achieving biological parenthood and postpone consideration of other family building options such as adoption or the use of semen donation in order to become a parent.ConclusionsThe consequence of severe male factor infertility was a threatened sense of masculinity. Fertility specialists and nurses should recognize the impact of male infertility and create space to give their patients an opportunity to verbalize their concerns and questions related to male factor infertility and the different challenges that the couple faces during the fertility treatment.This article is protected by copyright. All rights reserved.
  • Positive view and increased likely uptake of follow‐up testing with
           analysis of cell‐free fetal DNA as alternative to invasive testing among
           Danish pregnant women
    • Abstract: IntroductionTo investigate the attitude (view, likely uptake and preferred strategy) towards cell‐free fetal DNA (cfDNA) testing among pregnant women before a first trimester risk assessment for trisomy 21 (unselected women) and after obtaining a high risk.Material and methodsUnselected and high‐risk women attending first trimester screening (Rigshospitalet, Copenhagen University Hospital) were invited to fill out the questionnaire “Antenatal testing for Down's syndrome” as an online survey.ResultsThe survey included 203 unselected and 50 high‐risk women (response rate of 74.8% and 84.7%, respectively). Nearly all considered cfDNA testing a positive development in antenatal care, and 97.2% would like it to be offered. Offering cfDNA testing as alternative to invasive testing would increase the uptake of follow‐up testing compared to invasive testing alone (98.8% vs. 90.7%, p
  • Preeclampsia and scleroderma: a prospective nation‐wide analysis
    • Abstract: In a preliminary case‐control study, women with scleroderma more frequently reported having had hypertensive complications during pregnancy compared with healthy women. To prospectively investigate this possible association, we conducted a nation‐wide cohort analysis of a major hypertensive complication during pregnancy, namely preeclampsia, and later scleroderma. Analyses were based on Danish register‐based birth and hospital contact data on preeclampsia and scleroderma. We followed 778,758 women from time of giving birth between 1978 and 2010 to end of follow‐up, emigration, death, or scleroderma diagnosis, whichever occurred first. The association was evaluated by incidence rate ratios, obtained in Poisson regression models. We report that preeclampsia is associated with a 69% significantly increased risk of later developing scleroderma. Though these findings do not impact clinical care directly, the association of preeclampsia with scleroderma underscores the significant relationship of preeclampsia and other adverse pregnancy outcomes with later disease in women and should be included in patient counseling and education.This article is protected by copyright. All rights reserved.
  • An overview of confounding Part 1: The concept and how to address it
    • Abstract: Confounding is an important source of bias, but it is often misunderstood. We consider how confounding occurs and how to address confounding using examples. Study results are confounded when the exposure's effect on the outcome mixes with the effects of other risk and protective factors for the outcome. This problem arises when these factors are present to different degrees among the exposed and unexposed study participants, but not all differences between the groups result in confounding. Thinking about an ideal study where all of the population of interest is exposed in one universe and is unexposed in a parallel universe helps to distinguish confounders from other differences. In an actual study, an observed unexposed population is chosen to stand in for the unobserved parallel universe. Differences between this substitute population and the parallel universe result in confounding. Confounding by identified factors can be addressed analytically and through study design, but only randomization has the potential to address confounding by unmeasured factors. Nevertheless, a given randomized study may still be confounded. Confounded study results can lead to incorrect conclusions about the effect of the exposure of interest on the outcome.This article is protected by copyright. All rights reserved.
  • An overview of confounding Part 2: How to identify it and special
    • Abstract: Confounding biases study results when the exposure's effect on the outcome mixes with the effects of other risk and protective factors for the outcome that are present differentially by exposure status. However, not all differences between the exposed and unexposed group cause confounding. Thus, sources of confounding must be identified before they can be addressed. Confounding is absent in an ideal study where all of the population of interest is exposed in one universe and is unexposed in a parallel universe. In an actual study, an observed unexposed population represents the unobserved parallel universe. Thinking about differences between this substitute population and the unexposed parallel universe helps identify sources of confounding. These differences can then be represented in a diagram that shows how risk and protective factors for the outcome are related to the exposure. Sources of confounding identified in the diagram should be addressed analytically and through study design. However, treating all factors that differ by exposure status as confounders without considering the structure of their relation to the exposure can introduce bias. For example, conditions affected by the exposure are not confounders. There are also special types of confounding, such as time‐varying confounding and unfixable confounding. It is important to carefully evaluate whether factors of interest contribute to confounding because bias can be introduced both by ignoring potential confounders and by adjusting for factors that are not confounders. The resulting bias can result in misleading conclusions about the effect of the exposure of interest on the outcome.This article is protected by copyright. All rights reserved.
  • The influence of delayed cord clamping and cord milking on inflammatory
           cytokines in umbilical vein and neonatal circulation
    • Abstract: IntroductionThe purpose of the present study was to compare the levels of tumor necrosis factor a (TNF‐a), and interleukins (IL) 1, 6, 8 and 10 in the umbilical cord and neonatal circulation among neonates with early and late cord clampingMaterial and methodsA consecutive series of 76 cases that had an uncomplicated pregnancy and an uneventful parturition was evaluated. In 40 cases delayed cord clamping was used and in the remaining 36 cases early cord clamping was practiced. Blood samples were collected from the umbilical vein immediately after cord clamping and at 24 hours from the median cubital or basilic vein of the neonateResultsSignificant differences were noted in the hematocrit and hemoglobin levels at 24 hours that favored delayed clamping. None of the evaluated markers of inflammation differ between the two groups. Spearman's rho revealed a significant correlation between umbilical cord TNF‐a and TNF‐a neonatal values at 24 hours (r=.551, p=.022) in the early clamped group. Significant correlations were also noted between umbilical cord TNF‐a and TNF‐a neonatal values at 24 hours (r=.728, p=.001), umbilical cord IL‐10 and neonatal IL‐10 at 24 hours (r=.487, p=.047) and umbilical cord IL‐1b and neonatal IL‐1b at 24 hours (r=.516, p=.034)ConclusionsDelayed cord clamping or cord milking does not alter the levels of inflammatory cytokines in cord blood and neonatal serum. Future studies should evaluate the impact of delayed cord clamping in selected high‐risk pregnancies.This article is protected by copyright. All rights reserved.
  • Cesarean scar niche and uterotomy closure technique
    • Abstract: We would like to thank the authors (1) for taking a keen interest in our recently published randomized controlled trial, where we examined the outcome of a single‐ vs. double‐layer hysterotomy closure during cesarean delivery. In that study, we used ultrasound to assess the uterine scar niche incidence (2). Our results suggested that the risk of developing a cesarean scar defect and the niche depth were independent of the uterotomy closure technique, at six weeks and 6‐24 months after surgery. However, the residual myometrium showed a trend (p=0.06) of being thicker after the double‐layer suture than after single‐layer suture.This article is protected by copyright. All rights reserved.
  • Preventing Posttraumatic Stress Disorder following childbirth and
           traumatic birth experiences: A systematic review
    • Abstract: IntroductionBetween 9 and 44% of women experience giving birth as traumatic, and 3% of women develop a posttraumatic stress disorder following childbirth. Knowledge on risk factors is abundant, but studies on treatment are limited. This study aimed to present an overview of means to prevent traumatic birth experiences and childbirth‐related posttraumatic stress disorder.Material and methodsMajor databases (Cochrane; Embase; PsycINFO; PubMed (Medline)) were searched using combinations of the key words and their synonyms.ResultsAfter screening titles and abstracts and reading 135 full‐text articles, 13 studies were included. All evaluated secondary prevention, and none primary prevention. Interventions included debriefing, structured psychological interventions, expressive writing interventions, encouraging skin‐to‐skin contact with healthy newborns directly postpartum and holding or seeing the newborn after stillbirth. The large heterogeneity of study characteristics precluded pooling of data. The writing interventions to express feelings appeared to be effective in prevention. A psychological intervention including elements of exposure and psycho‐education seemed to lead to fewer posttraumatic stress disorder symptoms in women who delivered via emergency cesarean section.ConclusionsNo research has been done on primary prevention of traumatic childbirth. Research on secondary prevention of traumatic childbirth and posttraumatic stress disorder following delivery provides insufficient evidence that the described interventions are effective in unselected groups of women. In certain subgroups, results are inhomogeneous.This article is protected by copyright. All rights reserved.
  • Intraoperative adverse events associated with extremely preterm cesarean
    • Abstract: IntroductionAt the same time as survival is increasing among premature babies born before 26 weeks of gestation, the rates of cesarean deliveries before 26 weeks is also rising. Our purpose was to compare the frequency of intraoperative adverse events during cesarean deliveries at two gestational age groups: 24‐25 weeks and 26‐27 weeks.Material and methodsThis single‐center retrospective cohort study included all women with cesarean deliveries performed before 28+0 weeks from 2007 through 2015. It compared the frequency of intraoperative adverse events between two groups: those at 24‐25 weeks of gestation and at 26‐27 weeks. Intraoperative adverse events were a classical incision, transplacental incision, difficulty in fetal extraction (explicitly mentioned in the surgical report), postpartum hemorrhage (≥500 mL of blood loss), and injury to internal organs. A composite outcome including at least one of these events enabled us to analyze the risk factors for intraoperative adverse events with univariate and multivariable analysis. Stratified analyses by the indication for the cesarean were performed.ResultsWe compared 74 cesarean deliveries at 24‐25 weeks of gestation and 214 at 26‐27 weeks. Intraoperative adverse events occurred at higher rates in the 24‐25‐week group (63.5% vs. 30.8%, p
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  • Crisis in healthcare: Time for academic clinicians to assume leadership
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