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Publisher: John Wiley and Sons   (Total: 1583 journals)

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Showing 1 - 200 of 1583 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 11, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 54, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 43, SJR: 0.547, h-index: 30)
ACEP NOW     Free  
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 50, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 135, 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: 15, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 5, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 54, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 7, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 35, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 5, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 2)
Addiction     Hybrid Journal   (Followers: 32, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 12, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 24, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 24, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 48, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 13, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 246, 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: 4, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 4)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 17, 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: 19)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 12)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 9)
African Development Review     Hybrid Journal   (Followers: 32, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 14, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 9, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 6, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 14, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 44, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 28, 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: 33, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 49, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 127, 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: 90, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 28, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 30, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 12, 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: 15, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 3, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 5, SJR: 2.315, h-index: 79)
American J. of Orthopsychiatry     Hybrid Journal   (Followers: 4, SJR: 0.756, h-index: 69)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 35, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 237, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 14, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 3, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 15, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 116, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 11, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 15)
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: 153)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 204, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 34, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 5, 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: 8, 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: 42, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 2, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 9, 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: 24, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 16, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 14)
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: 45, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 6, 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: 66, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 6, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 133, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 48, 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: 13, SJR: 1.025, h-index: 55)
Aquaculture Research     Hybrid Journal   (Followers: 31, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 34, 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: 27, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 14, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 24, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 4)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 12, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 206, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 48, 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: 13)
Asia & the Pacific Policy Studies     Open Access   (Followers: 15)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 319, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 7, 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: 3, 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: 3, 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   (SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 4, 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: 13, 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: 2, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 12, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 10, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 7, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 7, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 13, 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: 42, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 11, 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: 4, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 22, 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: 13, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 16, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 382, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 4, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 64, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 11, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 19, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 31, 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: 9, 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: 3, 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: 8, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 22, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 9, 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: 14, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 2, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 44, 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: 45, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 135, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 13, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 17, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 10, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 33, 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: 5, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)

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Journal Cover Acta Obstetricia et Gynecologica Scandinavica
  [SJR: 1.197]   [H-I: 81]   [15 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  [1583 journals]
  • Fetal head circumference and subpubic angle are independent risk factors
           for unplanned cesarean and operative delivery
    • Authors: Giuseppe Rizzo; Elisa Aiello, Costanza Bosi, Francesco D’ Antonio, Domenico Arduini
      Abstract: IntroductionTo ascertain whether combined ultrasound assessment of fetal head circumference (HC) and maternal subpubic angle (SPA) prior to the onset of labour may predict the likelihood of an unplanned operative delivery (UOD) in nulliparous women at term.Material and methodsProspective cohort study of singleton pregnancies in cephalic presentation. Pregnancies experiencing UOD secondary to fetal distress were excluded. HC was assessed transabdominally while SPA values were obtained from a reconstructed coronal plane on three-dimensional(3D) ultrasound performed trans-labially at 36-38 weeks of gestation. Maternal characteristics, HC expressed as multiple of median and SPA were compared according to the mode of delivery. Logistic regression and receiver operating characteristics curve analyses were used to analyse the data.Results597 pregnancies were included in the study. Spontaneous vaginal delivery occurred in 70.2% of the cases, while UOD was required in 29.8%. There was no difference in pregnancy characteristics and birthweight between women who had a spontaneous vaginal birth compared to UOD. HC multiple of median was larger (1.00±0.02 vs 1.03±0.02 p≤0.0001), while SPA was narrower in the UOD group (124.02±13.64 vs 102.61±16.13 p≤0.0001). At logistic regression, SPA (OR 0.91, 95%CI 0.89-0.93), HC multiple of median (OR 1.13, 95% CI 1.09-1.17) and maternal height (OR 0.95, 95% CI 0.92-0.99) were independently associated with UOD. When combined, the diagnostic accuracy of a predictive model integrating HC, SPA and maternal height was highly predictive of UOD with an area under the curve of 0.904 (95%CI 0.88-0.93).ConclusionsUltrasound assessment of fetal HC and maternal SPA after 36 weeks of gestation can identify a sub-set of women at higher risk of UOD during labour, for whom early planned delivery might be beneficial.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-27T16:58:06.920911-05:
      DOI: 10.1111/aogs.13162
       
  • Predictors of success of external cephalic version and cephalic
           presentation at birth among 1,253 women with non-cephalic presentation
           using logistic regression and classification tree analyses
    • Authors: Eileen K Hutton; Julia C Simioni, Lehana Thabane,
      Abstract: IntroductionAmong women with a fetus in non-cephalic presentation, external cephalic version (ECV) has been shown to reduce the rate of breech presentation at birth and cesarean birth. Compared to ECV at term, beginning ECV prior to 37 weeks gestation decreases the number of infants in a non-cephalic presentation at birth. The purpose of this secondary analysis was to investigate factors associated with a successful ECV procedure and to present this in a clinically useful format.Material and methodsData were collected as part of the Early ECV Pilot and Early ECV2 Trials, which randomised 1,776 women with a fetus in breech presentation to either early ECV (34 to 36 weeks gestation) or delayed ECV (at or after 37 weeks). The outcome of interest was successful ECV, defined as the fetus being in a cephalic presentation immediately following the procedure, as well as at the time of birth. The importance of several factors in predicting successful ECV was investigated using two statistical methods: logistic regression and classification and regression tree (CART) analyses.ResultsAmong nulliparas, non-engagement of the presenting part and an easily palpable fetal head were independently associated with success. Among multiparas, non-engagement of the presenting part, gestation less than 37 weeks and an easily palpable fetal head were found to be independent predictors of success. These findings were consistent with results of the CART analyses.ConclusionsRegardless of parity, descent of the presenting part was the most discriminating factor in predicting successful ECV and cephalic presentation at birth.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-27T16:57:53.705565-05:
      DOI: 10.1111/aogs.13161
       
  • Full dilatation cesarean section: a risk factor for recurrent
           second-trimester loss and preterm birth
    • Authors: Helena A. Watson; Jenny Carter, Anna L David, Paul T Seed, Andrew H Shennan
      Abstract: IntroductionA previous cesarean section at full dilatation (FDCS) is a risk factor for preterm birth. To provide insight on the risk to subsequent pregnancies, this cohort study compares the outcomes of pregnant women with a previous preterm birth associated either with a prior FDCS or a prior term vaginal delivery.Material and methodsWe identified women attending two inner-city preterm surveillance clinics (Guy's and St Thomas Hospital and University College London Hospital, London, UK) who had a spontaneous late miscarriage (14+0–23+6 weeks) or sPTB (
      PubDate: 2017-04-27T16:57:52.351053-05:
      DOI: 10.1111/aogs.13160
       
  • Uterine adenomyosis and infertility, review of reproductive outcome after
           in vitro fertilization and surgery
    • Authors: Margit Dueholm
      Abstract: This review includes: a) analysis of the clinical studies evaluating reproductive outcome and adenomyosis, and b) a review of studies on reproductive outcome and surgical treatment options for adenomyosis. Strict diagnostic criteria and classification of disease are needed for an image diagnosis of adenomyosis. Studies of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) populations and women with surgically treated deep endometriosis suggested that adenomyosis has a negative impact on reproductive outcome, although there are substantial variations between studies. Little data are available on the relation between the extent of disease and impact on reproductive outcome, but a correlation appears to exist. Case series seem to confirm a positive effect of gonadotropin-releasing hormone analog treatment and surgery on reproductive outcome, but there are no controlled trials. Evidence is impaired by the poor quality of many studies, deficient strict image diagnosis, and the absence of a classification of the extent of disease. Selection of the most optimal evidence-based treatment options for adenomyosis in the fertility clinic is difficult because of a lack of evidence regarding the relation between fertility and the degree and composition of adenomyosis. Adenomyosis may reduce implantation so severely that surgical or other treatment options should be recommended, but the benefit of these treatment options needs to be verified. Referral of women with adenomyosis and recurrent miscarriage and repeated failure of assisted reproductive technology to centers with a special interest in adenomyosis research and treatment may be critical.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T10:10:30.45927-05:0
      DOI: 10.1111/aogs.13158
       
  • High intensity focused ultrasound for the treatment of adenomyosis:
           selection criteria, efficacy, safety and fertility
    • Authors: Lian Zhang; Fangwen Rao, Raymond Setzen
      Abstract: IntroductionAdenomyosis is a disorder of uterus in which endometrial glands and stroma are present within the uterine musculature. The main clinical manifestations are dysmenorrhea and menorrhagia. Adenomyosis has a great impact on both the quality of life and fertility of women. The treatment of adenomyosis remains an immense challengeMaterial and methodsRelevant articles were searched through MEDLINE, Pubmed between 2000 and March 2017. The search terms of adenomyosis, magnetic resonance imaging (MRI) features of adenomyosis, high intensity focused ultrasound (HIFU), Ultrasound-guided HIFU and MRgFUS were used. There were no language restrictionsResultsHIFU is a non-invasive local thermal ablation technique which has been used in the treatment of both focal and diffuse adenomyosis. Several case studies have demonstrated that HIFU presents low rate of minor and / or major complications and at the same time long symptom relief period. Multiple factors such as the enhancement type of the adenomyotic lesion, volume of the adenomyotic lesions, number of hyperintense foci on T2WI, location of the uterus, location of adenomyotic lesions, thickness of the abdominal wall and distance from the skin to the adenomyotic lesions contribute to the efficacy of HIFU. Consequently, based on these contributing factors, specific and strict selection criteria have been used in order to achieve higher efficacy. Thus, patients with pelvic endometriosis, adhesions between the bowel and the uterus, or an abdominal surgical scar wider than 10mm, are not suitable for HIFU treatment. Moreover, HIFU treated patients with adenomyosis, who wished to conceive, showed high conception and live birth rateConclusionHIFU is a new and promising treatment option for patients with adenomyosis, but its efficacy, safety, cost-effectiveness and fertility outcome must be evaluated by randomised control trials.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T10:10:28.11385-05:0
      DOI: 10.1111/aogs.13159
       
  • Parenting stress and its association with perceived agreement about the
           disclosure decision in parents following donor conception
    • Authors: Anja J. Gebhardt; Gunilla Sydsjö, Agneta Skoog Svanberg, Astrid Indekeu, Claudia Lampic
      Abstract: IntroductionFor many donor-conceiving heterosexual parents, the process of deciding whether and what to tell children about their genetic origin is challenging. We hypothesized that incomplete couple agreement about disclosure could be associated with parenting stress. The aim of the study was to investigate (1) parenting stress levels among heterosexual parents of young children following gamete donation and (2) whether parenting stress is related to perceived agreement about disclosure of the donor conception to the childrenMaterial and methodsThis study is part of the longitudinal multicenter Swedish Study on Gamete Donation and included a total of 213 heterosexual parents with children age 1–4 years following oocyte donation (n = 103) and sperm donation (n = 110). Parents individually completed a questionnaire that included validated instruments on parenting stress (SPSQ) and relationship quality (ENRICH), as well as a study-specific measure on disclosure agreement. Multiple regression analysis was appliedResultsIncomplete couple agreement on disclosure to the children was not statistically significantly associated with increased levels of parenting stress. Relationship satisfaction consistently accounted for the statistically significant variation in parenting stress levels, indicating that relationship satisfaction had a buffering impact on parenting stressConclusionsParental stress does not appear to be negatively influenced by incomplete couple agreement about disclosure to children. As children grow up, reaching agreement about what to tell the child about the donor conception might become more relevant for couples’ stress related to parenthood.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-22T09:55:47.445824-05:
      DOI: 10.1111/aogs.13157
       
  • Progesterone resistance in endometriosis: origins, consequences and
           interventions
    • Authors: Bansari G. Patel; Martin Rudnicki, Jie Yu, Yimin Shu, Robert N. Taylor
      Abstract: Endometriosis is a common cause of pelvic pain and affects up to 10% of women of reproductive age. Aberrant progesterone signaling in the endometrium plays a significant role in impaired decidualization and establishment of ectopic endometrial implants. Eutopic endometrial cells from women with endometriosis fail to downregulate genes needed for decidualization, such as those involved in cell cycle regulation, leading to unbridled proliferation. Several causes of progesterone resistance in the endometrium have been postulated, including congenital “preconditioning”, whereby the in utero environment renders infants susceptible to neonatal uterine bleeding and endometriosis. Progesterone action is crucial to decreasing inflammation in the endometrium, and deviant progesterone signaling results in a proinflammatory phenotype. Conversely, chronic inflammation can induce a progesterone resistant state. Repetitive retrograde endometrial shedding begets chronic peritoneal inflammation, which further exacerbates progesterone resistance. Genetic causes of progesterone resistance include progesterone receptor gene polymorphisms, altered microRNA expression, and epigenetic modifications to progesterone receptors and their targets. Environmental toxins, such as dioxin, play a possible role in the genesis of endometriosis by permitting an inflammatory milieu. A consequence of impaired progesterone action is that hormonal therapy is rendered ineffective for a subset of women with endometriosis. Synthetic progestins, such as dienogest, may overcome this phenomenon by increasing progesterone receptor expression and decreasing pro-inflammatory cytokines. Other modalities include high dose depot formulations of progestins, medicated intrauterine devices and the likely advent of oral GnRH antagonists. Unearthing root causes of progesterone inaction in endometriosis will aid in development of novel therapeutics geared toward prevention and treatment.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-19T17:58:19.87825-05:0
      DOI: 10.1111/aogs.13156
       
  • Surgery versus conservative management of endometriomas in subfertile
           women. A systematic review
    • Authors: Jacob Brink Laursen; Jeppe Bennekou Schroll, Kirsten T Macklon, Martin Rudnicki
      Abstract: IntroductionEndometriomas are present in up to 44% of all women with endometriosis and have a detrimental effect on fertility. However, it is controversial whether endometriomas should be surgically removed before assisted reproduction technology (ART). Our purpose was to evaluate whether surgical stripping of endometriomas in subfertile women improves the chance of a live birth. Secondary outcomes were impact on ovarian reserve and pain. Material and methodsWe conducted a systematic review and metaanalysis with results reported in accordance to the PRISMA guidelines. Summary of findings table was developed using GRADE. We searched Medline and Embase. Two reviewers performed the screening.ResultsOut of 686 manuscripts we included one randomized controlled trial and nine retrospective cohort studies most of low quality. Odds ratio for live birth after surgery (compared with conservative management before in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI)) was 0.87 (95% CI; 0.64-1.18, six studies, I2 = 3%; ⨁◯◯◯, VERY LOW quality). The mean difference of antral follicle count was -2.09 (95% CI; -4.84 - +0.67, four studies). No difference was observed regarding antral follicle count between the two groups (MD -2.09, 95% CI -4.84 to +0.67, four studies, ⨁◯◯◯, VERY LOW quality). Pain outcome was not reported in the included studies.ConclusionVery low quality evidence suggests no difference in odds ratio of live birth between women who underwent surgery for endometriomas before IVF/ICSI compared to conservative management. Further high quality studies are needed, but due to lack of convincing evidence favoring surgery we recommend considering conservative treatment if the only indication is subfertility.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-19T01:37:30.907796-05:
      DOI: 10.1111/aogs.13154
       
  • Association of external cephalic version before term with late preterm
           birth
    • Authors: Kristie L. Poole; Sarah D. McDonald, Lauren E. Griffith, Eileen K. Hutton
      Abstract: IntroductionWhile evidence suggests that beginning an external cephalic version (ECV) before term (340/7 to 366/7) compared to after term may be associated with an increase in late preterm birth (340/7 to 366/7 weeks), it remains unknown what might account for this risk. The objective of the present study is to further investigate the association between ECV before term and late preterm birthMaterial and methodsSecondary analysis of data collected from the international, multicenter Early ECV trials. We evaluated the relation between ECV exposure and late preterm birth (340/7 to 366/7 weeks), as well as if additional risk factors for preterm birth (e.g., maternal age, height, body mass index, parity, placental location, and perinatal mortality rate) moderated this relation. Generalized linear mixed methods were used to account for center effect and adjust for covariatesResultsAmong 1,765 women with breech pregnancies and without a prior preterm birth, 749 (42.4%) received at least one ECV before term. Exposure to an ECV before term was not significantly independently associated with odds of preterm birth. However, placenta location moderated the association between early ECV exposure and late preterm birth. Women who were exposed to an ECV before term and had an anterior placenta were at double the odds of preterm birth (OR: 2.05; 95% CI: 1.12–3.71; p=.02)ConclusionIn a large cohort of women without known risks for preterm birth, those with an anterior placenta who undergo an ECV before term constitute a subgroup at particular risk for late preterm birth.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T14:50:24.732049-05:
      DOI: 10.1111/aogs.13153
       
  • Does surgery for deep infiltrating bowel endometriosis improve
           fertility' A review
    • Authors: Maja Lundegaard Iversen; Mikkel Seyer-Hansen, Axel Forman
      Abstract: IntroductionReduced fertility is a major concern in women with endometriosis. The influence of surgery of deep infiltrating endometriosis (DIE) affecting the bowel wall on fertility is controversial and the literature on this field is heterogenous. In this review we addressed if surgery for bowel DIE improves spontaneous pregnancy rate and results of in vitro fertilization (IVF), and the potential risk of such surgery.Material and methodsWe conducted a literature search including the terms “deep”, “deep infiltrating”, “bowel”, rectovaginal”, “endometriosis”, “fertility”, “infertility” and “IVF” in Pubmed.ResultsNo randomized controlled studies were found. Other publications of relevance included four retrospective and three prospective observational studies. Moreover, one retrospective study compared results of IVF treatment with or without previous surgery for bowel DIE. All studies included reported detailed data on surgical complications. The poor data quality precluded firm conclusions. The results indicate, however, the possibility that surgery for bowel DIE may improve the spontaneous pregnancy rate, and positive effects on IVF outcome cannot be excluded. Such surgery will be associated with risk of major complications.ConclusionThe lack of proper data preclude conclusions on the potential role for bowel DIE surgery to improve the spontaneous pregnancy rate and results of IVF treatment. Positive effects cannot be excluded, but the definite risk of major complications must be taken into account.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T03:01:28.169231-05:
      DOI: 10.1111/aogs.13152
       
  • Women's attitude towards routine HPA-screening in pregnancy
    • Authors: Dian Winkelhorst; Rosanne M. Loeff, Elske van den Akker - van Marle, Masja de Haas, Dick Oepkes
      Abstract: IntroductionFetal and neonatal alloimmune thrombocytopenia (FNAIT) is a potentially life-threatening disease with excellent preventative treatment available for subsequent pregnancies. In order to prevent index cases, the effectiveness of a population-based screening program has been suggested repeatedly. Therefore, we aimed to evaluate women's attitude towards possible future human platelet antigen (HPA)-screening in pregnancyMaterial and methodsWe performed a cross-sectional questionnaire study amongst healthy pregnant women receiving prenatal care in one of seven participating midwifery practices. Attitude was assessed using a questionnaire based on the validated Multidimensional Measurement of Informed Choice model, containing questions assessing knowledge, attitude and intention to participateResultsA total of 143 of the 220 women (65%) completed and returned the questionnaire. A positive attitude towards HPA-screening was expressed by 91% of participants, of which 94% was based on sufficient knowledge. Attitude was more likely to be negatively influenced by the opinion that screening can be frightening. Informed choices were made in 87% and occurred significantly less in women from non-European origin, 89% in European women vs. 60% in non-European women (p = 0.03)ConclusionsPregnant women in the Netherlands expressed a positive attitude towards HPA-screening in pregnancy. We therefore expect a high rate of informed uptake when HPA-screening is implemented. In future counselling on HPA-screening, ethnicity and possible anxiety associated with screening test need to be specifically addressed.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-12T03:15:54.138663-05:
      DOI: 10.1111/aogs.13150
       
  • Exercise during pregnancy and risk of gestational hypertensive disorders:
           a systematic review and meta-analysis
    • Authors: Elena Rita Magro-Malosso; Gabriele Saccone, Mariarosaria Di Tommaso, Amanda Roman, Vincenzo Berghella
      Abstract: IntroductionGestational hypertensive disorders, including gestational hypertension and preeclampsia, are one of the leading causes of maternal morbidity and mortality. The aim of our study was to evaluate the effect of exercise during pregnancy on the risk of gestational hypertensive disordersMaterial and methodsElectronic databases were searched from their inception to February 2017. Selection criteria included only randomized controlled trials of uncomplicated pregnant women assigned before 23 weeks to an aerobic exercise regimen or not. The summary measures were reported as relative risk (RR) with 95% confidence intervals (CI). The primary outcome was the incidence of gestational hypertensive disorders, defined as either gestational hypertension or preeclampsiaResultsSeventeen trials, including 5,075 pregnant women, were analyzed. Of them, seven contributed data to quantitative meta-analysis for the primary outcome. Women who were randomized in early pregnancy to aerobic exercise for about 30-60 minutes 2-7 times per week had a significant lower incidence of gestational hypertensive disorders (5.9% vs 8.5%; RR 0.70, 95% CI 0.53 to 0.83; 7 studies, 2,517 participants), specifically a lower incidence of gestational hypertension (2.5% vs 4.6%; RR 0.54, 95% CI 0.40 to 0.74; 16 studies, 4,641 participants) compared to controls. The incidence of preeclampsia (2.3% vs 2.8%; RR 0.79, 95% CI 0.45 to 1.38; 6 studies, 2,230 participants) was similar in both groups. The incidence of cesarean delivery was decreased by 16% in the exercise groupConclusionsAerobic exercise for about 30-60 minutes 2-7 times per week during pregnancy, as compared to being more sedentary, is associated with a significantly reduced risk of gestational hypertensive disorders overall, gestational hypertension, and cesarean delivery.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-12T03:15:49.216376-05:
      DOI: 10.1111/aogs.13151
       
  • Prevalence of urinary incontinence among women and analysis of potential
           risk factors in Germany and Denmark
    • Authors: Louise Schreiber Pedersen; Gunnar Lose, Mette Terp Høybye, Susanne Elsner, Annika Waldmann, Martin Rudnicki
      Abstract: IntroductionUrinary incontinence (UI) is a prevalent condition that interferes with women's health-related quality of life. Prevalence rates from earlier studies are wide-ranging, due to heterogeneity in methodology, definition of UI and the populations included. We aimed to determine the prevalence of UI and associated risk factors in Germany and Denmark by using the same methodology, definition and populationMaterial and methodsPostal survey conducted in two regions Germany and Denmark, including 8000 women aged 18+ years. UI was defined as any complaint of involuntary loss of urine. The questionnaire contained socio-demographic questions and the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF)ResultsThe response rate in Germany and Denmark was 46.2% and 66.6% (p
      PubDate: 2017-04-12T03:15:42.736738-05:
      DOI: 10.1111/aogs.13149
       
  • Endometriosis, an everlasting challenge
    • Authors: Mette Haase Moen
      Abstract: Endometriosis is one of the most common benign gynecological diseases affecting 5-10% of women of fertile age, and the condition has received much attention. In spite of this, there are still challenges concerning diagnosing and treatment. The diagnostic delay can be more than ten years, and is especially long concerning teenagers. The symptoms can start already in adolescence, but this knowledge has not fully reached out to the medical profession, for example to general practitioners and pediatricians. As no hormonal treatment has proved to be superior, the least complicated drugs such as combined oral contraceptives or progestins should be the first choice for control of pain. Endometriosis is associated with infertility and in this respect hormone treatment has no role and will only further delay the chance to conceive, whereas in vitro fertilisation (IVF) is mostly successful. Proper information about endometriosis to the public and medical profession is a challenge.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-07T02:36:56.078685-05:
      DOI: 10.1111/aogs.13148
       
  • Maternal super obesity and risk for intensive care unit admission in the
           MFMU Cesarean Registry
    • Authors: Marcela C Smid; Sarah K Dotters-Katz, Arthur J Vaught, Catherine J Vladutiu, Kim A. Boggess, David M Stamilio
      Abstract: IntroductionObesity is risk factor for intensive care unit (ICU) admission in non-pregnant populations. Less is known about maternal obesity and ICU admission risk. The objective of this study was to estimate the association between maternal obesity and ICU admission among women who delivered via cesarean or vaginal birth after cesarean (VBAC).Material and methodThis is a retrospective cohort analysis of women who delivered via VBAC or cesarean in the Maternal-Fetal Medicine Unit (MFMU) Cesarean Registry. We defined exposure as body mass index (BMI) at delivery stratified as non-obese (BMI 18.5-29.9 kg/m2), class I/II obese (BMI 30-39.9 kg/m2), morbidly obese (BMI 40-49.9 kg/m2), and super obese (BMI ≥ 50 kg/m2). The primary outcome was ICU admission. Modified Poisson regression models estimated relative risk (RR) of ICU admission by obesity strata, after adjusting for confounders. Mediation analysis was used to estimate the proportion of ICU admission risk attributable specifically to obesity.ResultsWe included 68,455 women; 40% non-obese, 46% class I/II obese, 12% morbidly obese, and 2% super obese. Super obese women were at higher risk for ICU admission compared to non-obese women (0.7 vs 1.3%, adjusted RR 1.61 (95% confidence interval 1.01-2.65), after adjusting for confounders. Among super obese women, medical co-morbidities mediated 58% of ICU admission risk, suggesting that a significant proportion of ICU admission is driven by maternal obesity.ConclusionsSuper obese women who deliver via cesarean or VBAC are at increased risk of peripartum ICU admission. Obstetricians and critical care specialists should consider possible ICU admission during delivery planning.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-06T02:30:49.929348-05:
      DOI: 10.1111/aogs.13145
       
  • Long-acting recombinant FSH in random start ovarian stimulation protocols
           for fertility preservation in women with cancer
    • Authors: Veronica Sarais; Alessio Paffoni, Luca Pagliardini, Francesca Filippi, Fabio Martinelli, Giorgia Mangili, Massimo Candiani, Enrico Papaleo
      Abstract: IntroductionThe objective of this study was to assess effectiveness and the potential benefits of the use of long-acting recombinant follicle-stimulating hormone (FSH) in random-start protocol for fertility preservation in women with cancer.Material and methodsThis is a retrospective before and after study performed between February 2013 and December 2015 in women that underwent ovarian hyper-stimulation for oocyte cryobanking using a random start approach. In the first part of the study period, the subjects were treated with daily recombinant FSH whereas in the second part the stimulation was initiated with long-acting recombinant FSH. The primary aim of the study was to compare the number of oocytes stored in the two study periods. 140 women were ultimately selected.ResultsCompared to daily recombinant FSH, the use of the long-acting compound was associated with a reduced number of injections (12.5 ± 3.5 vs 16.4 ± 0.3; p
      PubDate: 2017-04-06T02:30:45.956081-05:
      DOI: 10.1111/aogs.13146
       
  • Thromboembolism and in-vitro fertilization -NDASH- a systematic review
    • Authors: Maria Sennström; Karin Rova, Margareta Hellgren, Ragnhild Hjertberg, Eva Nord, Lars Thurn, Pelle G Lindqvist
      Abstract: IntroductionThere is no accepted consensus on thromboprophylaxis in relation to in-vitro fertilization (IVF). We aimed to study the frequency of thromboembolism and to assess thromboprophylaxis in relation to IVF.Material and methodsWe performed a systematic review. All study designs were accepted except single case reports. Language of included articles was restricted to English.ResultsOf 338 articles, 21 relevant articles (9 cohort studies, 6 case-control studies, 3 case series, and 3 reviews of case series) were identified. The antepartum risk of venous thromboembolism (VTE) after IVF is doubled, (OR 2.18, 95% CI; 1.63–2.92), compared to the background pregnant population. This is due to a 5-10-fold increased risk during the first trimester in IVF pregnancies, in turn related to a very high risk of VTE after ovarian hyperstimulation syndrome (OHSS), i.e. up to a 100-fold increase or an absolute risk of 1.7%. The interval from embryo transfer to VTE was 3-112 days and the interval from embryo transfer to arterial thromboembolism was 3-28 days. No robust study on thromboprophylaxis was found.ConclusionsThe antepartum risk of VTE after IVF is doubled, compared to the background pregnant population, and is in turn related to a very high risk of VTE after OHSS in the first trimester. Our group of authors and clinical experts recommend that IVF patients with OHSS be prescribed low-molecular-weight heparin during the first trimester, while other IVF patients should be given thromboprophylaxis based on the same risk factors as other pregnant women.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-06T02:30:41.08944-05:0
      DOI: 10.1111/aogs.13147
       
  • Cervical collagen is reduced in non-pregnant women with a history of
           cervical insufficiency and a short cervix
    • Authors: Iben Sundtoft; Jens Langhoff-Roos, Puk Sandager, Steffen Sommer, Niels Uldbjerg
      Abstract: IntroductionPreterm cervical shortening and cervical insufficiency may be caused by a constitutional weakness of the cervix. The aim of this study was to assess the cervical collagen concentration in non-pregnant women with a history of cervical insufficiency or a history of a short cervix in the second trimester of pregnancy.Material and methodsIn this case-control study we included non-pregnant women one year or more after pregnancy: 55 controls with a history of normal delivery; 27 women with a history of cervical insufficiency; and 10 women with a history of a short cervix (95th percentile) at gestation weeks 18–20. We obtained biopsies (3 x 3-4 mm) from the ectocervix and determined the collagen concentration by measuring the hydroxyproline concentration.ResultsWomen with cervical insufficiency had lower collagen concentrations (63.5 ± 5.1%; mean ± SD) than controls (68.2 ± 5.4%; p=0.0004); area under the ROC curve 0.73 (95% CI 0.62-0.84). A cut-off value at 67.6% collagen resulted in a positive likelihood ratio of 3.2, a sensitivity of 60%, and a specificity of 81%. Also, women with a short cervix in the second trimester had lower collagen concentrations in a non-pregnant state (62.1% ± 4.9%) than women with a long cervix (67.8% ± 5.0%; p=0.02).ConclusionsBoth cervical insufficiency and a short cervix in the second trimester of pregnancy are associated with low cervical collagen concentrations in a non-pregnant state more than one year after pregnancy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-04T05:45:47.251362-05:
      DOI: 10.1111/aogs.13143
       
  • Predictive value of plasma hCG measured 14 days after Day-2 single embryo
           transfer
    • Authors: Kristine Løssl; Anna Oldenburg, Mette Toftager, Jeanette Bogstad, Lisbeth Prætorius, Anne Zedeler, Claus Yding Andersen, Marie Louise Grøndahl, Anja Pinborg
      Abstract: IntroductionPrediction of pregnancy outcome after IVF is important for patients and clinicians. Early plasma hCG (p-hCG) levels are the best known predictor of pregnancy outcome, but no studies has been restricted to single embryo transfer (SET) of Day-2 embryos. The aim of the present study was to investigate the predictive value of p-hCG measured exactly 14 days after the most commonly used Day-2 SET on pregnancy, delivery and perinatal outcome.Materials And MethodsA retrospective analysis of prospectively collected data on 466 women who had p-hCG measured exactly 14 days after Day-2 SET during a randomized trial including 1050 unselected women (aged 18-40 years) undergoing their first IVF/ICSI treatment.ResultsP-hCG predicted clinical pregnancy (AUC 0.953; 95% CI 0.915-0.992) significantly better than ongoing pregnancy (AUC 0.803, 95% CI; 0.717-0.890) and delivery (AUC 0.772, 95% CI; 0.691-0.854). Women with p-hCG levels in the lowest quartile had significantly lower clinical pregnancy, ongoing pregnancy, and delivery rates (p
      PubDate: 2017-04-04T05:45:43.07235-05:0
      DOI: 10.1111/aogs.13144
       
  • Patient selection for later delivery timing with suspected previa-accreta
    • Authors: Nicola C. Perlman; Sarah E. Little, Ann Thomas, David E. Cantonwine, Daniela A. Carusi
      Abstract: IntroductionWe identified patients with previa and suspected accreta who are at lowest risk of unscheduled delivery or major morbidity with planned delivery beyond 34 weeks gestation.Material and methodsThis was a retrospective cohort study of patients who had reached 34.0 weeks gestational age with a suspected previa-accreta. We evaluated rates of unscheduled and emergent delivery based on known risk factors for premature birth. In a second analysis, we stratified patients based on level of preoperative morbidity concern and evaluated rates of major transfusion and Intensive Care Unit admission by delivery week (34w, 35w or 36w and beyond).ResultsOf 84 available patients, we classified 31 patients as low risk for unscheduled delivery and 52 as high risk. The low risk group was scheduled later (36.6w vs. 36.0w; p
      PubDate: 2017-04-04T04:06:04.327257-05:
      DOI: 10.1111/aogs.13140
       
  • Live birth outcome, spontaneous pregnancy and adoption up to five years
           after undergoing assisted reproductive technology treatment
    • Authors: Helena Volgsten; Lone Schmidt
      Abstract: IntroductionThis study is part of a longitudinal cohort undertaken in both women and men to describe live birth outcome after undergoing assisted reproductive technology (ART) treatment in a clinical setting. Another objective was to follow women and men living with children from other alternatives after ART, such as adoption.Material and methodsA total of 439 (80.5%) women and 423 (77.6%) men were included in the baseline cohort (2005-2007). Live birth rate after ART was 24.8% at baseline. Up to five years later (2010-2011) the same participants were sent individual postal questionnaires (n=439).ResultsOverall, 278 (63.3%) women and 183 (41.7%) men filled in and returned the questionnaire at follow-up. The majority of women (91.7%) and men (93.4%) were living with children. A total of 225 (80.9%) women had a live birth at follow-up. Of these; almost three out of four (71.6%) had a live birth after ART and more than one out of four (28.0%) after spontaneous pregnancies or both. Of these, 52 (26.1%) women had a subsequent live birth after successful ART and 26 (32.9%) women after unsuccessful ART. Nine-teen (6.8%) women and 13 (7,1%) men had a child after adoption. Almost one out of five (19.1%) women had no live birth at follow-up.ConclusionThe majority of women and men were living with children; such as live birth after ART, spontaneous pregnancy and/or adoption up to five years later. However, almost one out of five had no live birth at follow-up.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-04T04:00:38.151966-05:
      DOI: 10.1111/aogs.13139
       
  • Incidence and risk factors of venous thromboembolism during
           postpartum-period: a population-based cohort-study
    • Authors: Päivi Johanna Galambosi; Mika Gissler, Risto Juhani Kaaja, Veli-Matti Ulander
      Abstract: IntroductionThe awareness of the incidence and timing of postpartum venous thromboembolic event (VTE) guides the use of thrombophophylaxis. Our aims were to assess the incidence and mortality of VTE and identify its associated risk factors during different postpartum periodsMaterial and methodsA population-based controlled cohort-study by combining four large registers in 2001-2011. All women with a recent delivery were identified. The incidence, risk factors and mortality of VTE 0-180 days after delivery were assessed by using all healthy delivered women as the control group. The incidence was compared to that of the non-pregnant womenResultsAmong the 634.292 delivered women 1169 had VTE 0-180 days postpartum. The incidence of VTE was highest during the first week postpartum: 37-fold compared to non-pregnant women, declining to 2-fold immediately after that. Almost half of the VTEs occurred between 43-180 days of postpartum. The incidence of VTE was four-fold compared to that of non-pregnant women. Three VTE-related deaths occurred. Older age, higher body mass index, thrombophilia, multiple pregnancy, gestational diabetes, anemia, chorioamnionitis, threatening premature birth, in vitro fertilization with ovarian hyperstimulation, primiparity, Cesarean section, cardiac/renal diseases and varicose veins were associated with an increased risk for postpartum VTE. The risk remained elevated for 180 days in women with thrombophilia, Cesarean section, multiple pregnancy, varicose veins and cardiac diseaseConclusionsThe risk of VTE remained elevated compared to that of the non-pregnant women after the usually defined postpartum period (six weeks). The results might assist in selecting women in need for thrombophophylaxis.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-30T10:55:29.139582-05:
      DOI: 10.1111/aogs.13137
       
  • Worldwide prevalence of tocophobia in pregnant women: systematic review
           and meta-analysis
    • Authors: Maeve A. O'Connell; Patricia Leahy-Warren, Ali S. Khashan, Louise C. Kenny, Sinéad M. O'Neill
      Abstract: IntroductionTocophobia is defined as a severe fear of pregnancy and childbirth. There is increasing evidence that tocophobia may have short and long-term adverse effects on mother and baby. We performed a systematic review and meta-analysis to determine the global prevalence of tocophobia in pregnancyMaterial and methodsRelevant articles were identified through searching six relevant databases: MEDLINE, CINAHL, Pubmed, PsycINFO, Maternity & Infant Care and Scopus between 1946 and April 2016. We used search terms for tocophobia prevalence in pregnant women which we agreed with a medical librarian. There were no language restrictions. Two review authors independently assessed data for inclusion, extracted data and assessed quality using a standardized appraisal tool. Meta-analysis was performed to determine the overall pooled-prevalence of tocophobia. Several subgroup and sensitivity analysis were conductedResultsThirty-three studies were included in the systematic review from 18 countries of which data from 29 studies were used in the meta-analysis of 853,988 pregnant women. Definition of tocophobia varied, while prevalence rates ranged between 3.7% and 43%. The overall pooled prevalence of tocophobia, using a random-effects model, was 14% (95% CI; 0.12-0.16). Significant heterogeneity was observed (I2=99.25%, p=0.00) which was not explained in subgroup analyses including tocophobia definition used, screening trimester and parityConclusionThe prevalence of tocophobia is estimated at 14% and appears to have increased in recent years (2000 onwards). Considerable heterogeneity (99.25%) was noted which may be attributed to lack of consensus on the definition of tocophobia therefore our results should be interpreted with caution.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-30T10:55:26.566593-05:
      DOI: 10.1111/aogs.13138
       
  • Computerized data-driven interpretation of the intrapartum cardiotocogram:
           a cohort study
    • Authors: Antoniya Georgieva; Christopher W.G. Redman, Aris T. Papageorghiou
      Abstract: IntroductionContinuous intrapartum fetal monitoring remains a significant clinical challenge. We propose utilising cohorts of routinely collected data. We aim to combine non-classical (data-driven) and classical cardiotocography (CTG) features with clinical features into a system (OxSys), which generates automated alarms for the fetus at risk of intrapartum hypoxia. We hypothesise that OxSys can outperform clinical diagnosis of ‘fetal distress’, when optimised and tested over large retrospective datasetsMaterial and methodsWe studied a cohort of 22,790 labouring women (≥36 weeks gestation). Paired umbilical blood analyses were available. Perinatal outcomes were defined by objective criteria (Normal; Severe, Moderate or Mild compromise). We used the data retrospectively to develop a prototype of OxSys, by relating its alarms to perinatal outcome, and comparing its performance against standards achieved by bedside diagnosisResultsOxSys1.5 triggers an alarm if the initial trace is nonreactive or the Decelerative Capacity (a non-classical CTG feature), exceeds a threshold, adjusted for preeclampsia and thick meconium. There were 187 newborns with Severe, 613 with Moderate and 3,197 with Mild compromise; and 18,793 with Normal outcome. OxSys1.5 increased the sensitivity for compromise detection: 43.3% vs. 38.0% for Severe (p=0.3) and 36.1% vs. 31.0% for Moderate (p=0.06); and reduced the false positive rate (14.4% vs. 16.3%, p
      PubDate: 2017-03-28T10:01:59.997142-05:
      DOI: 10.1111/aogs.13136
       
  • Obstetrical and perinatal complications of twin pregnancies: is there a
           link with the type of infertility treatment'
    • Authors: Sophie Deltombe-Bodart; Philippe Deruelle, Elodie Drumez, Sophie Cordiez, Sophie Catteau-Jonard, Charles Garabedian
      Abstract: IntroductionThe aim of this study was to compare the maternal and perinatal data from spontaneous twin pregnancies with twin pregnancies conceived via assisted reproductive technology, and to evaluate the outcomes depending on the type of treatmentMaterial and methodsA historical cohort of all twin live births between 1997 and 2014 was used to create two groups: spontaneous pregnancies and pregnancies after infertility treatment (ovulation induction, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection). The population characteristics and pregnancy, childbirth, and neonatal complications were compared, and the data were adjusted for age, parity, chorionicity, and the mother's body mass index to assess only the impact of the infertility treatmentsResultsIn total, 1,580 twin pregnancies were included, with 575 requiring assisted conception. We did not observe any differences between the assisted conception pregnancies and the spontaneous twin pregnancies with regard to the obstetric and childbirth complications and neonatal outcomes. In addition, there were no statistically significant differences between the types of infertility treatmentConclusionAfter adjusting for the maternal parameters and chorionicity, the twin pregnancies conceived via assisted reproductive technology were not at an increased risk of obstetric and neonatal complications. Moreover, the type of treatment did not alter the obstetric and neonatal complications. Therefore, the higher complication rate was related to the patient's medical specifics, rather than to the infertility treatment.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-28T10:01:55.336076-05:
      DOI: 10.1111/aogs.13135
       
  • Hideharu Kanzaki, editor. Uterine Endometrial Function. 1st Edition. 155
           pages. Springer Japan, 2016. ISBN 978-4-431-55972-6. Price: €110.
           Hardback
    • Authors: Sebastian Gidlöf; Emma Öberg
      Abstract: Understanding uterine endometrial function is important in many areas of obstetric and gynecological practice, not just in reproductive medicine. Despite active research within the field many aspects of endometrial physiology remain elusive. This book thoroughly describes the current knowledge on endometrial function in respect to receptivity and implantation. The text covers both human and murine endometrial function describing important aspects of immunological, endocrine and regulatory physiology.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-17T17:50:46.0655-05:00
      DOI: 10.1111/aogs.13132
       
  • Ovarian reserve after salpingectomy: a systematic review and meta-analysis
    • Authors: Ahmed Aboelfadle Mohamed; Ali Haroun Yosef, Cathryn James, Tarek Khalaf Al-Hussaini, Mohamed Ali Bedaiwy, Saad Ali Amer
      Abstract: IntroductionAlthough there has been a growing concern over the possible damaging effect of salpingectomy on ovarian reserve, this issue remains uncertain. The purpose of this meta-analysis was to test the hypothesis that salpingectomy may compromise ovarian reserveMaterial and methodsA detailed search was conducted using MEDLINE, Embase, Dynamed Plus, ScienceDirect, TRIP database and the Cochrane Library from January 2000 to November 2016. All cohort, cross-sectional and randomized controlled studies investigating changes in circulating anti-Müllerian hormone (AMH) after salpingectomy were considered. Thirty-seven studies were identified, of which eight were eligible. Data were extracted and entered into RevMan software for calculation of the weighted mean difference (WMD) and 95% confidence interval (CI). Two groups of studies were analyzed separately including group 1 (six studies, n=464) comparing data before and after salpingectomy and group 2 (two studies) comparing data in women who have undergone salpingectomy (n=169) vs. healthy controls (n=154)ResultsPooled results of group 1 studies showed no statistically significant change in serum AMH concentration after salpingectomy (WMD, -0.10ng/ml; 95% CI; -0.19 – 0.00, I2=0%). Similarly, meta-analysis of group 2 showed no statistically significant difference in serum AMH concentration between salpingectomy group and controls (WMD, -0.11ng/ml; 95% CI; -0.37 – 0.14, I2=77%). Subgroup analyses based on laterality of surgery, type of AMH kit and participants’ age (
      PubDate: 2017-03-17T17:50:43.768576-05:
      DOI: 10.1111/aogs.13133
       
  • Efficacy, safety and tolerability of the CCR1 antagonist BAY 86-5047 for
           the treatment of endometriosis-associated pelvic pain: a randomized
           controlled trial
    • Authors: Dietmar Trummer; Anja Walzer, Esther Groettrup-Wolfers, Heinz Schmitz
      Abstract: IntroductionAntagonism of CC chemokine receptor type 1 (CCR1) may provide a novel treatment approach for women with symptomatic endometriosis. Studies of CCR1 antagonists in these patients have not been reported.Material and methodsWomen (n = 110; 18–45 years) with symptomatic endometriosis were randomized to BAY 86-5047 or placebo for 12 weeks. Pelvic pain was assessed using the visual analogue scale (VAS) and women recorded the intake of pain medication in a diary. The primary efficacy outcome was a composite of the absolute change in VAS score and the cumulative change in consumption of analgesics between baseline and the end of treatment. Safety assessments included adverse events, blood and urine evaluation and electrocardiography.ResultsMean VAS scores decreased from 64.8 mm at baseline to 49.2 mm at week 12 in the BAY 86-5047 group and from 67.2 mm to 47.8 mm in the placebo group. The proportion of women using analgesics decreased from 33.9% to 11.5% or from 44.4% to 15.4% for patients who received BAY 86-5047 or placebo, respectively. There was no significant difference between the two treatment groups in terms of change in VAS scores (p = 0.45) or intake of analgesics (p = 0.82). A three-step sensitivity analysis failed to show superiority of BAY 86-5047 over placebo (p = 0.67). BAY 86-5047 was well tolerated and no significant safety concerns arose during the study.ConclusionsBased on these results, BAY 86-5047 is unlikely to be useful in the treatment of women with endometriosis-associated pelvic pain.
      PubDate: 2017-03-16T08:35:38.944118-05:
      DOI: 10.1111/aogs.13105
       
  • Sterol regulatory element binding protein-1 (SREBP1) gene expression is
           similarly increased in polycystic ovary syndrome and endometrial cancer
    • Authors: Mohamad N. Shafiee; Nigel Mongan, Claire Seedhouse, Caroline Chapman, Suha Deen, Jafaru Abu, William Atiomo
      Abstract: IntroductionWomen with polycystic ovary syndrome have a three-fold higher risk of endometrial cancer. Insulin resistance and hyperlipidemia may be pertinent factors in the pathogenesis of both conditions. The aim of this study was to investigate endometrial sterol regulatory element binding protein-1 gene expression in polycystic ovary syndrome and endometrial cancer endometrium, and to correlate endometrial sterol regulatory element binding protein-1 gene expression with serum lipid profiles.Material and methodsA cross-sectional study was performed at Nottingham University Hospital, UK. A total of 102 women (polycystic ovary syndrome, endometrial cancer and controls; 34 participants in each group) were recruited. Clinical and biochemical assessments were performed before endometrial biopsies were obtained from all participants. Taqman real-time polymerase chain reaction for endometrial sterol regulatory element binding protein-1 gene and its systemic protein expression were analyzed.ResultsThe body mass indices of women with polycystic ovary syndrome (29.28 ± 2.91 kg/m2) and controls (28.58 ± 2.62 kg/m2) were not significantly different. Women with endometrial cancer had a higher mean body mass index (32.22 ± 5.70 kg/m2). Sterol regulatory element binding protein-1 gene expression was significantly increased in polycystic ovary syndrome and endometrial cancer endometrium compared with controls (p 
      PubDate: 2017-03-16T08:35:31.363072-05:
      DOI: 10.1111/aogs.13106
       
  • Validation of data in the Medical Birth Registry of Norway on delivery
           after a previous cesarean section
    • Authors: Sjur Lehmann; Elham Baghestan, Per Børdahl, Marta Ebbing, Lorentz Irgens, Svein Rasmussen
      Abstract: IntroductionTrial of labor (TOL) is an option in most deliveries after a previous cesarean section (CS). The Medical Birth Registry of Norway (MBRN) has received compulsory notification of all deliveries in the country since 1967, including data that could identify TOL in epidemiologic research. The objective of this study was to validate MBRN data for identification of TOL deliveries after a previous cesarean section (CS).Material and methodsThe MBRN provided a random national sample of 500 birth order two deliveries during 1989–2012 in women with a registered birth order one CS delivery. The reporting maternity units were asked to complete a questionnaire on data items in both deliveries, using hospital record data as the gold standard.ResultsCompleted questionnaires were returned for 477 women (95.5%) with data on both deliveries. An algorithm to identify TOL using MBRN data from the birth order two delivery had a positive predictive value of 93.2%, a negative predictive value of 93.5%, a sensitivity of 96.1%, and a specificity of 88.8%. Validity of MBRN data on mode and onset of delivery, CS subtype, and planned mode of delivery is also reported.ConclusionsMBRN data on planned and actual mode of delivery, CS subtype, and the algorithm to identify TOL in deliveries after a previous CS had satisfactory quality for a registry-based study of TOL.
      PubDate: 2017-03-15T08:56:18.248793-05:
      DOI: 10.1111/aogs.13115
       
  • Enlarged posterior fossa on prenatal imaging: Differential diagnosis,
           associated anomalies and post-natal outcome
    • Authors: Anja Wüest; Daniel Surbek, Roland Wiest, Christian Weisstanner, Harald Bonel, Maja Steinlin, Luigi Raio, Boris Tutschek
      Abstract: IntroductionThe primary aim of this study was to ascertain the prevalence the individual conditions and of associated anomalies in fetuses with the prenatal diagnosis of enlarged posterior fossa and to explore the diagnostic accuracy of ultrasound in these anomalies. The secondary aim was to evaluate the post-natal outcome of children affected by posterior fossa anomalies.Material and methodsAll fetuses with enlarged posterior fossa detected by prenatal sonography at a referral center from 2001-2015 were analyzed retrospectively. Some were also studied by fetal magnetic resonance imaging (MRI) or volume ultrasound examinations. Fetal sonographic and MRI were compared using following classification: Dandy-Walker malformation; Megacisterna magna (MCM); Blake's pouch cyst; isolated vermian hypoplasia; vermian agenesis; posterior fossa arachnoid cyst; and cerebellar hypoplasia.ResultsAmong the 69 fetuses the ultrasound diagnoses were: MCM (n=29; of these isolated n=15), Dandy-Walker malformation (n=28, isolated n=4), vermian hypoplasia (n=5, isolated n=4), Blake's pouch cyst (n=4, isolated n=1), cerebellar hypoplasia (n=2; none isolated) and arachnoid cyst in the posterior fossa (n=1, isolated). 13 of the 41 karyotyped fetuses were aneuploid, including seven with Dandy-Walker malformation. Associated malformations were found in 37/69 cases. There were 39 live births, including 11 with confirmed Dandy-Walker malformation six of whom show a normal development. 12 infants with truly isolated MCM show normal development. There were eight false-positive prenatal diagnoses (or resolution until birth) of “enlarged posterior fossa”: Three with Blake's pouch cyst, two MCM and one with vermian hypoplasia.ConclusionsAn enlarged posterior fossa requires specific diagnoses for best possible counseling. The term “Dandy-Walker variant” should not be used any more. Isolated MCM and Blake's pouch cyst can either resolve or be normal variants, but may also indicate the presence of a more severe anomaly or associated malformations.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-14T09:45:37.172281-05:
      DOI: 10.1111/aogs.13131
       
  • Impact of uterine balloon tamponade on the use of invasive procedures in
           severe postpartum hemorrhage
    • Authors: Emilie Gauchotte; Manuela De La Torre, Estelle Perdriolle-Galet, Catherine Lamy, Guillaume Gauchotte, Olivier Morel
      Abstract: IntroductionThe aim of this study was to assess the impact of tamponade, when uterotonic agents fail, on the need for surgery or interventional radiology.Material and MethodsAll women who received sulprostone for postpartum hemorrhage were retrospectively compared over two periods: December 2008 to December 2010 without use of tamponade (period 1) and June 2011 to June 2013 with use of tamponade (period 2), in the case of sulprostone failure (STROBE compliant retrospective cohort study). During period 2, interventional radiology or surgery was used only in the case of tamponade failure.Results165 women were included (74 for period 1, 91 for period 2). The rate of interventional radiology or surgery significantly decreased between period 1 (21 of 74 women, 28.4%) and period 2 (six of 91 women, 6.6%, p = 0.0003). The rate of assumed failure of uterotonic agents was higher for period 2: 22 of 74 women (29.7%) during period 1, and 41 of 91 (45.1%, p=0.0439) during period 2. The success rate of tamponade was 92.1% (35 of 38 women).ConclusionsAlthough the efficacy of tamponade should be viewed in the light of its widespread use, our findings confirm that tamponade significantly reduces the need for interventional radiology or surgery for postpartum hemorrhage treatment.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-12T04:50:31.330489-05:
      DOI: 10.1111/aogs.13130
       
  • Hysterectomy for cesarean scar pregnancy: No or minimal bladder separation
           technique
    • Authors: Shigeki Matsubara; Shiho Nagayama, Risa Narumi, Rie Usui, Tatsuya Suzuki
      Abstract: For cesarean scar pregnancy (CSP), various uterus-preserving treatments have been proposed (1, 2); however, hysterectomy is eventually required in some cases (1, 2). Hysterectomy-related adverse events should be avoided, especially in CSP-hysterectomy, considering that patients are usually exhausted or compromised both mentally and physically after failed uterus-preserving therapy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-12T03:50:23.273596-05:
      DOI: 10.1111/aogs.13129
       
  • Antecedents and neuroimaging patterns in cerebral palsy with epilepsy and
           cognitive impairment: a population-based study in children born at term
    • Authors: Kristina Ahlin; Bo Jacobsson, Staffan Nilsson, Kate Himmelmann
      Abstract: IntroductionAntecedents of accompanying impairments in cerebral palsy (CP) and their relation to neuroimaging patterns need to be explored.Material and methodsA population-based study of 309 children with CP born at term in 1983-1994. Pre-, intra- and postpartum variables previously studied as antecedents of CP type and motor severity were analysed in children with CP and cognitive impairment and/or epilepsy, and in children with CP without these accompanying impairments. Neuroimaging patterns and their relation to identified antecedents were analysed. Data were retrieved from the CP register of western Sweden, obstetric and neonatal records.ResultsChildren with CP and accompanying impairments more often had low birth weight (kg) (OR 0.5 95% CI; 0.3-0.8), brain maldevelopment known at birth (p=0.007, OR ∞) and neonatal infection (OR 5.4 (1.04-28.4). Moreover, neuroimaging patterns of maldevelopment (OR 7.2 95% CI; 2.9-17.2), cortical/subcortical lesions (OR 5.3 95% CI; 2.3-12.2) and basal ganglia lesions (OR 7.6 95% CI; 1.4-41.3) were more common, wheras white matter injury was found significantly less often (OR 0.2 95% CI; 0.1-0.5). In most children with maldevelopment, the intra- and postpartum period was uneventful (p
      PubDate: 2017-03-12T03:45:28.308925-05:
      DOI: 10.1111/aogs.13128
       
  • Identification of first stage labor arrest by electromyography in term
           nulliparous women after induction of labor
    • Authors: Blanka Vasak; Elisabeth M. Graatsma, Elske Hekman-Drost, Marinus J. Eijkemans, Jules H Schagen Van Leeuwen, Gerard H.A. Visser, Benoit C. Jacod
      Abstract: IntroductionWorldwide induction and cesarean delivery rates have increased rapidly, with consequences for subsequent pregnancies. The majority of intra-partum cesarean deliveries are performed for failure to progress, typically in nulliparous women at term. Current uterine registration techniques fail to identify inefficient contractions leading to first stage labor arrest. An alternative technique, uterine electromyography has been shown to identify inefficient contractions leading to first stage arrest of labor in nulliparous women with spontaneous onset of labor at term. The objective of this study was to determine whether this finding can be reproduced in induction of laborMaterial and methodsUterine activity was measured in 141 nulliparous women with singleton term pregnancies and a fetus in cephalic position during induced labor. Electrical activity of the myometrium during contractions was characterized by its power density spectrumResultsNo significant differences were found in contraction characteristics between women with induced labor delivering vaginally with or without oxytocin and women with arrested labor with subsequent cesarean deliveryConclusionUterine electromyography shows no correlation with progression of labor in induced labor, which is in contrast to spontaneous labor.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-12T03:45:26.856445-05:
      DOI: 10.1111/aogs.13127
       
  • An update on the diagnosis, surgical management, and fertility outcomes
           for women with endometrioma
    • Authors: Ryan Cranney; George Condous, Shannon Reid
      Abstract: Endometriosis is estimated to affect up to 50% of infertile women, and severity of endometriosis stage appears to correlate with reduced fertility. Ovarian endometriomas are found in up to 44% of women with endometriosis, and are significantly associated with the presence of pelvic deep infiltrating endometriosis, ovarian adhesions, and pouch of Douglas obliteration. Through the use of MEDLINE and PubMed databases, we conducted a literature review of all available research related to the diagnosis, surgical management and fertility outcomes for women with endometrioma. The evolving use of specialized transvaginal ultrasound for the diagnosis of endometrioma and related endometriotic pathologies can allow for preoperative mapping/staging of the disease, as well as appropriate surgical planning and fertility counseling. Surgical management of endometriomas appears to reduce markers of ovarian reserve, such as anti-Mullerian hormone, prompting concern of reduced fertility following surgery. Ovarian cystectomy appears to be superior to ablation in terms of endometrioma recurrence, pain symptoms and increased spontaneous conception rate among subfertile patients. Research is inconclusive as to which surgical method least damages ovarian reserve in the long term; however, bipolar hemostasis appears to be the most damaging technique and should be avoided. Surgical management should be individualized for women with endometrioma, and strong consideration should be given to the preoperative ovarian reserve status prior to performing ovarian cystectomy. Current evidence suggests that ovarian cystectomy does not improve reproductive outcomes for women with endometrioma undergoing assisted reproductive technology; however, the majority of studies have been performed retrospectively and more prospective studies are needed.
      PubDate: 2017-03-11T06:50:34.104886-05:
      DOI: 10.1111/aogs.13114
       
  • Endometriosis increases the risk of obstetrical and neonatal complications
    • Authors: Janne Foss Berlac; Dorthe Hartwell, Charlotte Wessel Skovlund, Jens Langhoff-Roos, Øjvind Lidegaard
      Abstract: IntroductionThe objective was to assess obstetrical complications and neonatal outcomes in women with endometriosis as compared with women without endometriosis.Material and methodsNational cohort including all delivering women and their newborns in Denmark 1997–2014. Data were extracted from the Danish Health Register and the Medical Birth Register. Logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI). Sub-analyses were made for primiparous women with a singleton pregnancy and for women with endometriosis who underwent gynecological surgery before pregnancy.ResultsIn 19 331 deliveries, women with endometriosis had a higher risk of severe preeclampsia (OR 1.7, 95% CI 1.5–2.0), hemorrhage in pregnancy (OR 2.3, 95% CI 2.0–2.5), placental abruption (OR 2.0, 95% CI 1.7–2.3), placenta previa (OR 3.9, 95% CI 3.5–4.3), premature rupture of membranes (OR 1.7, 95% CI 1.5–1.8), and retained placenta (OR 3.1, 95% CI 1.4–6.6). The neonates had increased risks of preterm birth before 28 weeks (OR 3.1, 95% CI 2.7–3.6), being small for gestational age (OR 1.5, 95% CI 1.4–1.6), being diagnosed with congenital malformations (OR 1.3, 95% CI 1.3–1.4), and neonatal death (OR 1.8, 95% CI 1.4–2.1). Results were similar in primiparous women with a singleton pregnancy. Gynecological surgery for endometriosis before pregnancy carried a further increased risk.ConclusionWomen with endometriosis had a significantly higher risk of several complications, such as preeclampsia and placental complications in pregnancy and at delivery. The newborns had increased risk of being delivered preterm, having congenital malformations, and having a higher neonatal death rate. Pregnant women with endometriosis require increased antenatal surveillance.
      PubDate: 2017-03-11T06:50:30.035428-05:
      DOI: 10.1111/aogs.13111
       
  • Cause of and factors associated with stillbirth: a systematic review of
           classification systems
    • Authors: Mamuda Aminu; Sarah Bar-Zeev, Nynke van den Broek
      Abstract: IntroductionAn estimated 2.6 million stillbirths occur worldwide each year. A standardised classification system setting out possible cause of death and contributing factors is useful to help obtain comparative data across different settings. We undertook a systematic review of stillbirth classification systems to highlight their strengths and weaknesses for practitioners and policymakersMaterial and methodsWe conducted a systematic search and review of the literature undertaken to identify classification systems used to aggregate information for stillbirth and perinatal deaths. Narrative synthesis used to compare range and depth of information required to apply the systems, the different categories provided cause of and factors contributing to stillbirth. Results: A total of 118 documents were screened; 31 classification systems were included, of which 6 were designed specifically for stillbirth, 14 for perinatal death, 3 systems include neonatal and 2 include infant deaths. The majority (27/31) were developed in and first tested using data obtained from high-income settings. All systems require information from clinical records. One-third of the classification systems (11/31) include information obtained from histology or autopsy. The percentage where cause of death remained unknown ranged from 0.39% using the Nordic-Baltic classification to 46.4% using the Keeling systemConclusionOver time, classification systems have become more complex. The success of application is dependent on the availability of detailed clinical information and laboratory investigations. Systems which adopt a layered approach allow for classification of cause of death to a broad as well as to a more detailed level.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-10T17:50:27.923722-05:
      DOI: 10.1111/aogs.13126
       
  • What is the impact of preconception abdominal cerclage on fertility:
           evidence from a randomized controlled trial
    • Authors: Nicola J. Vousden; Jenny Carter, Paul T. Seed, Andrew H. Shennan
      Abstract: IntroductionThere is documented concern that cerclage may cause cervical stenosis or changes to the cervical mucus, which may reduce fertility. The aim of this study is to determine whether placement of a preconception abdominal cerclage affects fertility.Material and methodsThis was a planned subgroup analysis of a randomized controlled trial comparing abdominal cerclage, high vaginal cerclage or low vaginal cerclage. Women with a history of previous second-trimester miscarriage or preterm birth despite having a low vaginal cerclage, presenting to specialist preterm birth services in the UK, were eligible for inclusion. Only women randomized before conception were included in this analysis. Women randomized to abdominal cerclage had the surgery performed before conception (abdominal group). Women randomized to high or low transvaginal cerclage received it in the subsequent pregnancy (control group).ResultsAbdominal cerclage was performed in 19 women and transvaginal cerclage in 48 women. Overall, there was no statistically significant difference between time to conception between the two groups (hazard ratio 1.34; 95% confidence interval 0.72–2.50, p = 0.35). Rates of conception at 6, 12, and 18 months were similar – 37% in abdominal group vs. 35% in control group at 6 months (relative risk 1.04; 95% confidence interval 0.52–2.10; p = 0.91); 58% in abdominal group vs. 42% in control group at 12 months (relative risk 1.39; 95% confidence interval 0.84–2.31, p = 0.21); 74% in abdominal group vs. 56% in control group at 18 months (relative risk 1.31; 95% confidence interval 0.91–1.89; p = 0.15).ConclusionThis subgroup analysis of randomized data indicates that abdominal cerclage does not affect fertility rates.
      PubDate: 2017-03-09T08:25:31.729877-05:
      DOI: 10.1111/aogs.13107
       
  • Glucose homeostasis, beta cell function, and insulin resistance in
           relation to vitamin D status after gestational diabetes mellitus
    • Authors: Nael Shaat; Claes Ignell, Anastasia Katsarou, Kerstin Berntorp
      Abstract: IntroductionWe wanted to determine vitamin D status after gestational diabetes mellitus (GDM) and to evaluate whether levels of 25-hydroxyvitamin D3 (25OHD3) are associated with beta cell function, insulin resistance, or a diagnosis of diabetes after GDM.Material and methodsGlucose homeostasis was assessed during a 75-g oral glucose tolerance test 1–2 years after delivery in 376 women with previous GDM (287 European and 78 non-European, including 33 Arab and 35 Asian women). Insulin resistance was estimated using homeostasis model assessment of insulin resistance (HOMA-IR). The insulinogenic index (I/G30) and the disposition index [(I/G30)/HOMA-IR] were used to calculate insulin secretion. Concentrations of serum 25OHD3 were determined.ResultsMean (± SD) 25OHD3 concentration was 50.0 ± 22.3 nmol/L and differed significantly among subgroups of body mass index, ethnicity, and glucose tolerance status; 53% had 25OHD3 levels
      PubDate: 2017-03-09T07:55:26.379421-05:
      DOI: 10.1111/aogs.13124
       
  • Introduction of robot-assisted radical hysterectomy for early stage
           cervical cancer: impact on complications, costs and oncologic outcome
    • Authors: Emelie Wallin; Angelique Flöter Rådestad, Henrik Falconer
      Abstract: IntroductionThe objective was to assess the impact of robot-assisted radical hysterectomy (RRH) on surgical and oncologic outcome and costs compared with open radical hysterectomy (ORH) at a tertiary referral center in Sweden.Material and methodsIn this retrospective analysis all patients treated with radical hysterectomy and pelvic lymphadenectomy for early stage uterine cervical cancer during 2006–2015 were included (n = 304). The patients were divided into two groups, ORH (n = 155) and RRH (n = 149). Patient characteristics, FIGO stage, histology, adjuvant therapy, operation time, length of stay (LOS), lymph node yield, recurrence rate and survival were retrieved from medical records. Complications were graded according to the Clavien–Dindo classification. In addition, costs related to the surgical treatments were calculated.ResultsBlood loss, LOS and intraoperative complications were significantly lower as well as lymph node yield after RRH. No differences in postoperative complications or costs were observed between the two groups. Recurrence of disease was detected in 13.4 and 10.3% after RRH and ORH, respectively. Regression analysis demonstrated that histology, tumor size, positive lymph nodes and type of operation (RRH) were significantly associated with recurrence.ConclusionThe introduction of RRH was accompanied by similar postoperative complication rates and costs but lower LOS compared with ORH. An initial learning curve may account for the higher recurrence rate observed after RRH. These data reinforce the need for structured training and monitoring of outcomes when novel treatment modalities are introduced.
      PubDate: 2017-03-06T07:50:28.20654-05:0
      DOI: 10.1111/aogs.13112
       
  • Is the first urinary albumin/creatinine ratio (ACR) in women with
           suspected pre-eclampsia a prognostic factor for maternal and neonatal
           adverse outcome' A retrospective cohort study
    • Authors: Eleni G. Elia; Amy O. Robb, Karla Hemming, Malcolm J. Price, Richard D. Riley, Anna French-Constant, Fiona C. Denison, Mark D. Kilby, Rachel K. Morris, Sarah J. Stock
      Abstract: IntroductionThe aim of this study was to determine the prognostic value of the first urinary albumin/creatinine ratio (ACR) for adverse maternal and neonatal outcomes and how it relates to other prognostic factors.Material and methodsWe performed a retrospective cohort study from December 2009 to February 2012 with analysis of demographic, clinical and biochemical data from two obstetric day assessment units in hospitals in Southeast Scotland. We included 717 pregnant women, with singleton pregnancies after 20 weeks gestation, referred for evaluation of suspected pre-eclampsia and having their first ACR performed. The ability of ACR to predict future outcomes was assessed in both univariable and multivariable logistic regression models. The latter assessed its prognostic value independent to (adjusting for) existing prognostic factors. Primary outcome measures were maternal and neonatal composite adverse outcomes, and a secondary outcome was gestation at delivery.Results204 women (28.5%) experienced a composite adverse maternal outcome. 146 women (20.4%) experienced a composite adverse neonatal outcome. Multivariate analysis of log-transformed ACR, demonstrated that a 1-unit increase in log ACR is associated with an increased odds of adverse maternal (Odds Ratio 1.60, 95% CI 1.45-1.80) and adverse neonatal (Odds Ratio 1.15, 95% CI 1.02-1.29) composite outcomes, and with reduced gestational age at delivery (coefficient: -0.46, 95% CI -0.54 to -0.38).ConclusionsACR is an independent prognostic factor for maternal and neonatal adverse outcomes in suspected pre-eclampsia. ACR may be useful to inform risk predictions within a prognostic model.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-01T02:10:34.550749-05:
      DOI: 10.1111/aogs.13123
       
  • Term twin birth – impact of mode of delivery on outcome
    • Authors: Elina Ylilehto; Outi Palomäki, Heini Huhtala, Jukka Uotila
      Abstract: IntroductionThe main aims of this study were to compare maternal and neonatal outcomes in term twin birth according to the planned mode of delivery and to study the effects of chorionicity and inter-twin delivery time on neonatal outcomeMaterial and methodsA single-center cohort study of 495 women with twin deliveries at ≥ 37+0 weeks of gestation. Term twin deliveries were divided into a trial of labor group (TOL, 69.3%) and a planned cesarean section (CS) group (30.7%). The primary outcomes were maternal and neonatal morbidityResults80.8% of women attempting TOL achieved vaginal birth. In the TOL group, mothers had less bleeding (median 500 ml [range 150–2700 ml] vs. 950 ml [range 150–3500 ml], p
      PubDate: 2017-02-27T05:45:27.771821-05:
      DOI: 10.1111/aogs.13122
       
  • Intravenous fluid rate for reduction of cesarean delivery rate in
           nulliparous women: a systematic review and meta-analysis
    • Authors: Robert M. Ehsanipoor; Gabriele Saccone, Neil S. Seligman, Rebecca Pierce-Williams, Andrea Ciardulli, Vincenzo Berghella
      Abstract: IntroductionThe National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine have emphasized the need to promote vaginal delivery and have offered recommendations to safely prevent primary cesarean delivery. However, there has been limited discussion regarding management of intravenous fluids and other aspects of labor management that may influence labor. Therefore the aim of our study was to determine if an intravenous fluid rate of 250 vs 125 mL/hour is associated with a difference in cesarean delivery rateMaterial and methodsSearches were performed in Medline, OVID, Scopus, ClinicalTrials. gov, the PROSPERO International Prospective Register of Systematic Reviews, Embase, Web of Science, and the Cochrane Library for randomized controlled trials. We included all randomized controlled trials comparing intravenous fluid rates of 125 mL/hour vs. 250 mL/hour in nulliparous women in spontaneous labor at term with singleton pregnancies at ≥ 36 weeks. Studies were included regardless of the type of intravenous fluids used and regardless of whether or not oral intake was restricted during labor. Studies including multiparous women or women whose labor was induced were excluded. The primary outcome was the incidence of cesarean delivery. We planned to assess a sensitivity analysis according to type of fluids used and according to restriction of oral fluid intakeResultsSeven trials including 1,215 nulliparous women in spontaneous labor at term were analyzed. 593 (48.8%) were in the 250 mL/hour group, and 622 (51.2%) in the 125 mL/hour group. Five studies used lactated Ringer's solution, one used normal saline in dextrose water, and in one study it was unclear which intravenous fluid was used. Women who received intravenous fluids 250 mL/hour had a significantly lower incidence of cesarean delivery for any indication (12.5% vs 18.1%; RR 0.70, 95% CI 0.53 to 0.92; 7 studies, 1,215 participants; I2=0%) and for dystocia (4.9% vs 7.7%; RR 0.60, 95% CI 0.38 to 0.97; 5 studies, 1,093 participants; I2=18%) and a significantly shorter mean of duration of labor of about one hour (mean difference -64.38 minutes, 95% CI -121.88 to -6.88; 6 studies, 1,155 participants; I2=83%) and of length of second stage of labor (mean difference -2.80 minutes, 95% CI -4.49 to -1.10; 899 participants; I2=22%) compared to those who received intravenous fluid 125 mL/hour. No differences were found in the other secondary outcomes. There were no maternal or perinatal deaths and only one woman, in the 125 ml/hr group, developed pulmonary edema. The findings persisted regardless of the type of intravenous fluid used. No significant reduction in the incidence of cesarean delivery was demonstrated in women with unrestricted oral intake; however, this was limited to only 2 studies evaluating 254 womenConclusionsIn conclusion, our findings provide evidence that the duration of labor in low-risk nulliparous women may be shortened by a policy of intravenous fluids at a rate of 250 mL/hours rather than 125 mL/hours. This could also lead to a reduction in the incidence of cesarean delivery. The number needed to treat to prevent one cesarean delivery is 18 women. Our data support for increased hydration amongst nulliparous women in labor when oral intake is restricted. Further study is needed regarding risks and benefits of increased hydration among women with unrestricted oral intake, those undergoing induction of labor, and those with medical comorbidities.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-25T15:35:26.493393-05:
      DOI: 10.1111/aogs.13121
       
  • Use of hormone replacement therapy after risk-reducing
           salpingo-oophorectomy
    • Authors: Nora Johansen; Astrid H. Liavaag, Ole-Erik Iversen, Anne Dørum, Tonje Braaten, Trond M. Michelsen
      Abstract: IntroductionAfter premenopausal risk-reducing salpingo-oophorectomy (RRSO) to prevent ovarian cancer, the non-cancer related morbidity and mortality may be increased if sex hormones are not replaced. Several guidelines recommend systemic hormone replacement therapy (HRT) to these women until the expected age of menopause. We aimed to study the use of HRT after RRSOMaterial and methodsParticipants were 324 women after RRSO and 11 160 postmenopausal controls. A subsample of 950 controls had undergone bilateral salpingo-oophorectomy (BSO). All participants completed the same questionnaire regarding HRT use. We compared HRT use in the RRSO group with the BSO controls by use of logistic regressionResultsAmong the women aged ≤ 52 years without a history of breast cancer, 51.7% of the RRSO group and 48.7% of the BSO controls reported current use of systemic HRT (odds ratio 1.13, 95% confidence interval 0.72, 1.76). Among the HRT users, systemic estrogen was used by 35.1% and 58.7% in the RRSO and BSO control groups, respectively (P = 0.001). Among the women aged> 52 years, 16.8% of the RRSO group and 38.4% of the BSO controls (P < 0.001) used systemic HRTConclusionsAmong the RRSO women and BSO controls ≤ 52 years without a history of breast cancer, relatively few were current users. If no contraindications, these women would benefit from systemic HRT. Additionally, almost 40% of the BSO controls> 52 years used systemic HRT. Doctors should be aware of this practice, and prescribe systemic HRT when indicated.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-25T02:50:27.763989-05:
      DOI: 10.1111/aogs.13120
       
  • Relevant human tissue resources and laboratory models for use in
           endometriosis research
    • Authors: Erin Greaves; Hilary O D Critchley, Andrew W Horne, Philippa T K Saunders
      Abstract: Endometriosis is characterised by the growth of endometrial-like tissue outside the uterus, most commonly on the pelvic peritoneum and ovaries. Whilst it may be asymptomatic in some women in others it can cause debilitating pain, infertility or other symptoms including fatigue. Current research is directed both at understanding the complex aetiology and pathophysiology of the disorder and the development of new non-surgical approaches to therapy which lack the unwanted side effects of current medical management. Tools for endometriosis research fall into two broad categories; 1) patient derived tissues, and fluids (and cells isolated from these sources) or 2) models based on the use of cells or animals. In this review, we discuss the literature that has reported data from use of these tools in endometriosis research and we highlight the strengths and weaknesses of each. Whilst many different models are reported in the literature, hypothesis driven research will only be facilitated with careful experimental design and selection of the most appropriate human tissue from patients with and without endometriosis and combinations of physiologically relevant in vitro and in vivo laboratory models.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-24T07:05:27.125388-05:
      DOI: 10.1111/aogs.13119
       
  • Impact of microbial invasion of amniotic cavity and the type of
           microorganisms on short-term neonatal outcome in women with preterm labor
           and intact membranes
    • Authors: Teresa Cobo; Irene Vives, Adriano Rodríguez-Trujillo, Clara Murillo, Martina A. Ángeles, Jordi Bosch, Andrea Vergara, Eduard Gratacós, Montse Palacio
      Abstract: IntroductionThe objective was to evaluate the impact of microbial invasion of the amniotic cavity and the type of microorganisms on pregnancy and short-term neonatal outcomes in women with preterm labor.Material and methodsProspective observational cohort study including women with preterm labor from 22.0 to 36.0 weeks. Microbial invasion of the amniotic cavity was defined based on amniotic fluid aerobic/anaerobic/mycoplasma cultures, and intra-amniotic inflammation on amniotic fluid interleukin-6 levels. Demographic data and pregnancy outcomes were compared among women exposed to microbial invasion of the amniotic cavity by Ureaplasma spp., women with microbial invasion of the amniotic cavity by other microorganisms, and a No-microbial invasion of the amniotic cavity/No-intra-amniotic inflammation group. The short-term neonatal outcome was evaluated in women delivering after 24.0 weeks.ResultsWe included 228 women with preterm labor. Microbial invasion of the amniotic cavity occurred in 35% (80/228), 28% (22/80) being caused by Ureaplasma spp. Gestational age at admission and at delivery were significantly earlier and the rate of delivery at
      PubDate: 2017-02-23T08:35:23.682268-05:
      DOI: 10.1111/aogs.13095
       
  • Case mix adjusted variation in cesarean section rate in Sweden
    • Authors: Johan Mesterton; Lars Ladfors, Anna Ekenberg Abreu, Peter Lindgren, Sissel Saltvedt, Marianne Weichselbraun, Isis Amer-Wåhlin
      Abstract: IntroductionCesarean section (CS) rate is a well-established indicator of performance in maternity care and is also related to resource use. Case mix adjustment of CS rates when performing comparisons between hospitals is important. The objective of this study was to estimate case mix adjusted variation in CS rate between hospitals in Sweden.Material and methodsIn total, 139756 deliveries in 2011 and 2012 were identified in administrative systems in 7 regions covering 67% of all deliveries in Sweden. Data were linked to the Medical birth register and population data. Twenty-three different sociodemographic and clinical characteristics were used for adjustment. Analyses were performed for the entire study population as well as for two subgroups. Logistic regression was used to analyze differences between hospitals.ResultsThe overall CS rate was 16.9% (hospital min-max: 12.1%-22.6%). Significant variations in CS rate between hospitals were observed after case mix adjustment: Hospital odds ratios for CS varied from 0.62 (CI; 0.53-0.73) to 1.45 (CI; 1.37-1.52). In nulliparous, cephalic, full-term, singletons the overall CS rate was 14.3% (hospital min-max: 9.0%-19.0%), while it was 4.7% in multiparous, cephalic, full-term, singletons with no previous CS (hospital min-max: 3.2%-6.7%). In both subgroups significant variations were observed in case mix adjusted CS rates.ConclusionsSignificant differences in CS rate remain between Swedish hospitals were found after adjusting for differences in case mix. This indicates a potential for fewer interventions and lower resource use in Swedish childbirth care. Best practice sharing and continuous monitoring are important tools for improving childbirth care.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-21T14:10:40.439433-05:
      DOI: 10.1111/aogs.13117
       
  • Thrombolysis with intravenous recombinant tissue plasminogen activator
           during early postpartum period: A review of the literature
    • Authors: Munetoshi Akazawa; Makoto Nishida
      Abstract: Thromboembolic events are one of the leading causes of maternal death during the postpartum period. Postpartum thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is controversial because the treatment may lead to massive bleeding. Data centralization may be beneficial for analyzing the safety and effectiveness of systemic thrombolysis during the early postpartum period. We performed a computerized MEDLINE and EMBASE search. We collected data for 13 cases of systemic thrombolytic therapy during the early postpartum period, when limiting the early postpartum period to 48 hours after delivery. Blood transfusion was necessary in all cases except for one (12/13; 92%). In 7 cases (7/13; 54%), a large amount of blood was required for transfusion. Subsequent laparotomy to control bleeding was required in 5 cases (5/13; 38%), including 3 cases of hysterectomy and 2cases of hematoma removal, all of which involved cesarean delivery. In cases of transvaginal delivery, there was no report of laparotomy. The occurrence of severe bleeding was high in relation to cesarean section, compared with vaginal deliveries. Using rt-PA in relation to cesarean section might be worth avoiding. However, the paucity of data in the literature makes it difficult to assess the ultimate outcomes and safety of this treatment.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-21T13:56:42.495589-05:
      DOI: 10.1111/aogs.13116
       
  • Conservative approach to rectosigmoid endometriosis: a cohort study
    • Authors: Anne G. Egekvist; Edvard Marinovskij, Axel Forman, Ulrik S. Kesmodel, Mads Riiskjær, Mikkel Seyer-Hansen
      Abstract: IntroductionThe aim of the study was to assess the risk of surgery after initial conservative treatment of rectosigmoid endometriosis in relation to demographic data.Material and methodsThe study was conducted on the tertiary endometriosis referral unit, Aarhus University Hospital. Medical records, from patients seen from January 2009 onwards with a diagnosis of rectosigmoid endometriosis and more than 6 months’ follow up were audited. Demographic data, results of magnetic resonance imaging and time to secondary surgery for rectosigmoid endometriosis were registered.ResultsData on 238 patients diagnosed with rectosigmoid endometriosis were included. In all, 78 (32.8%) patients had primary surgery, 27 (11.3%) had secondary surgery and 133 (55.9%) continued conservative treatment throughout the observation period. Patients who underwent primary or secondary surgery were younger than patients continuing conservative treatment.ConclusionsIn a tertiary referral center where about half of patients with rectosigmoid endometriosis were scheduled for conservative treatment, more than 80% of these avoided surgery.
      PubDate: 2017-02-15T07:55:28.268287-05:
      DOI: 10.1111/aogs.13094
       
  • Decline in stillbirths and perinatal mortality after implementation of a
           more aggressive induction policy in post-date pregnancies: A nationwide
           register study
    • Authors: Anne R. Zizzo; Ida Kirkegaard, Anja Pinborg, Niels Ulbjerg
      Abstract: IntroductionIn 2011 the Danish national guidelines were changed towards a more aggressive induction and fetal surveillance policy from 1) induction of labor at gestational age (GA) of 42+0 weeks and 2) no fetal surveillance after 40+0 to 1) induction of labor between 41+2-41+6, 2) earlier induction at 41+0 weeks in case of maternal age> 40 years or body mass index (BMI)> 35 kg/m2 and 3) fetal surveillance at GA 41+0.Material and methodsThis national cohort study included all pregnancies that reached 41+0 weeks of gestation from 2008 to 2014 (N=102 167). Multivariate logistic regression analyses were used to estimate risks in the years after (2012-2014) versus before (2008-2010) new national guidelines, adjusted for maternal age, BMI, and parity.ResultsWe observed a decline in stillbirths from 0.9‰ to 0.5 ‰ (odds ratio (OR)adjusted 0.50, 95%CI;0.29-0.89, p=0.018). Furthermore a decline in perinatal deaths from 1.3‰ to 0.8‰ (ORadjusted 0.62, 95%CI;0.39-0.96, p=0.033) and vacuum extraction (ORadjusted 0.86, 95%CI;0.82-0.90, p=0.007) was observed. The risk of Cesarean section (ORadjusted 0.98, 95%CI;0.94-1.02, p=0.251), Apgar score below 7 at 5 minutes (ORadjusted 0.96, 95%CI;0.81-1.14, p=0.0.678) and admissions to the neonatal department (ORadjusted 1.04, 95%CI;1.00-1.14, p=0.064) did not change, while induction of labor increased from 28.2% to 42.6% (ORadjusted 1.89, 95%CI;1.84-1.95, p
      PubDate: 2017-02-10T11:55:33.856787-05:
      DOI: 10.1111/aogs.13113
       
  • Diagnosing gestational diabetes mellitus in the Danish National Birth
           Cohort
    • Authors: Sjurdur F. Olsen; Azedeh Houshmand-Oeregaard, Charlotta Granström, Jens Langhoff-Roos, Peter Damm, Bodil H. Bech, Allan A. Vaag, Cuilin Zhang
      Abstract: IntroductionThe Danish National Birth Cohort (DNBC) contains comprehensive information on diet, lifestyle, constitutional and other major characteristics of women during pregnancy. It provides a unique source for studies on health consequences of gestational diabetes mellitus. Our aim was to identify and validate the gestational diabetes mellitus cases in the cohort.Material and methodsWe extracted clinical information from hospital records for 1609 pregnancies included in the Danish National Birth Cohort with a diagnosis of diabetes during or before pregnancy registered in the Danish National Patient Register and/or from a Danish National Birth Cohort interview during pregnancy. We further validated the diagnosis of gestational diabetes mellitus in 2126 randomly selected pregnancies from the entire Danish National Birth Cohort. From the individual hospital records, an expert panel evaluated gestational diabetes mellitus status based on results from oral glucose tolerance tests, fasting blood glucose and Hb1c values, as well as diagnoses made by local obstetricians.ResultsThe audit categorized 783 pregnancies as gestational diabetes mellitus, corresponding to 0.89% of the 87 792 pregnancies for which a pregnancy interview for self-reported diabetes in pregnancy was available. From the randomly selected group the combined information from register and interviews could correctly identify 96% (95% CI 80–99.9%) of all cases in the entire Danish National Birth Cohort population. Positive predictive value, however, was only 59% (56–61%).ConclusionsThe combined use of data from register and interview provided a high sensitivity for gestational diabetes mellitus diagnosis. The low positive predictive value, however, suggests that systematic validation by hospital record review is essential not to underestimate the health consequences of gestational diabetes mellitus in future studies.
      PubDate: 2017-02-09T08:21:18.769672-05:
      DOI: 10.1111/aogs.13083
       
  • Cesarean section trends in the Nordic Countries – a comparative analysis
           with the Robson classification
    • Authors: Aura Pyykönen; Mika gissler, Ellen Løkkegaard, Thomas Bergholt, Steen C. Rasmussen, Alexander Smárason, Ragnheiður I. Bjarnadóttir, Birna Björg Másdóttir, Karin Källén, Kari Klungsoyr, Susanne Albrechtsen, Finn Egil Skjeldestad, Anna-Maija Tapper
      Abstract: IntroductionThe cesarean rates are low but increasing in most Nordic countries. Using the Robson classification, we analyzed which obstetric groups have contributed to the changes in the cesarean rates.Material and methodsRetrospective population-based registry study including all deliveries (3,398,586) between 2000 and 2011 in Denmark, Finland, Iceland, Norway and Sweden. The Robson group distribution, cesarean rate and contribution of each Robson group were analyzed nationally for four three-year time periods. For each country, we analyzed which groups contributed to the change in the total cesarean rate.ResultsBetween the first and the last time period studied, the total cesarean rates increased in Denmark (16.4-20.7%), Norway (14.4-16.5%) and Sweden (15.5-17.1%), but towards the end of our study, the cesarean rates stabilized or even decreased. The increase was explained mainly by increases in the absolute contribution from R5 (women with previous cesarean) and R2a (induced labor on nulliparous). In Finland, the cesarean rate decreased slightly (16.5-16.2%) mainly due to decrease among R5 and R6-R7 (breech presentation, nulliparous/multiparous). In Iceland, the cesarean rate decreased in all parturient groups (17.6-15.3%), most essentially among nulliparous women despite the increased induction rates.ConclusionsThe increased total cesarean rates in the Nordic countries are explained by increased cesarean rates among nulliparous women, and by an increased percentage of women with previous cesarean. Meanwhile, induction rates on nulliparous increased significantly, but the impact on the total cesarean rate was unclear. The Robson classification facilitates benchmarking and targeting efforts for lowering the cesarean rates.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-07T20:28:15.867683-05:
      DOI: 10.1111/aogs.13108
       
  • Women treated for epilepsy during pregnancy: outcomes from a nationwide
           population-based cohort study
    • Authors: Miia Artama; Jemina Ahola, Jani Raitanen, Jukka Uotila, Mika Gissler, Jouko Isojärvi, Anssi Auvinen
      Abstract: IntroductionWomen with epilepsy (WWE) are generally treated as a risk group during pregnancy, but over 90% of pregnant WWE have favorable pregnancies. However, the risk of some pregnancy and delivery complications may be increased among WWE, especially regarding those on antiepileptic drugs.Material and methodsThis nationwide, retrospective population-based cohort study includes WWE who gave birth in Finland during 1987-2008 (n=1737) and the reference cohort of random sample of women without epilepsy (n=4357). Identification of the cohorts, information on hospitalizations and deliveries was obtained from the Finnish Health Registers and population statistics. Multivariate analyses were conducted by binomial regression.ResultsWWE were more often hospitalized during pregnancy for accidents or other external causes (adjusted risk ratio; aRR 1.74, 95% confidence interval (CI) 0.98−3.09), premature rupture of membranes (aRR 1.75, 95% CI 1.14−2.69) and premature contractions (aRR 1.75, 95% CI 1.36−2.23). Hospitalizations for infections were more frequent in WWE (1.4% vs. 0.4%, aRR 3.15, 95% CI 1.72−5.76). The risk for induction of delivery or a Cesarean section was increased in WWE. There was no difference in premature deliveries between the groups, but the risk of being small for gestational age (aRR 1.57, 95% CI 1.23-2.01), admission to neonatal intensive care unit (aRR 1.66, 95% CI 1.39-1.97), and need for respiratory care (aRR 2.37, 95% CI 1.57-3.60) was clearly increased in the offspring of WWE.ConclusionsWWE are at an increased risk of complications and hospitalizations during pregnancy and delivery. However, the majority of WWE have normal pregnancy and delivery.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-07T20:25:56.578029-05:
      DOI: 10.1111/aogs.13109
       
  • Endometriosis: an old problem without a current solution
    • Authors: Lone Hummelshoj
      PubDate: 2017-02-04T03:35:27.591283-05:
      DOI: 10.1111/aogs.13075
       
  • Endometriosis-associated infertility: aspects of pathophysiological
           mechanisms and treatment options
    • Authors: Tom Tanbo; Peter Fedorcsak
      Abstract: Endometriosis is a common condition in women of reproductive age. In addition to pain, endometriosis may also reduce fertility. The causes of infertility in women with endometriosis may range from anatomical distortions due to adhesions and fibrosis to endocrine abnormalities and immunological disturbances. In some cases, the various pathophysiological disturbances seem to interact through mechanisms so far not fully understood. Whether surgery should be offered as a treatment option in endometriosis-associated infertility has become controversial, partly due to its modest or undocumented effect. Medical or hormonal treatment alone has little or no effect and should only be used in conjunction with assisted reproductive technology (ART). Of the various methods of ART, intrauterine insemination, due to its simplicity, can be recommended in women with minimal or mild peritoneal endometriosis, even though insemination may yield a lower success rate than in women without endometriosis. In vitro fertilization (IVF) is an effective treatment option in less-advanced disease stages, and the success rates are similar to the results in other causes of infertility. However, women with more advanced stages of endometriosis have lower success rates with IVF.
      PubDate: 2017-01-30T07:06:11.570141-05:
      DOI: 10.1111/aogs.13082
       
  • Issue Information
    • First page: 513
      PubDate: 2017-04-20T22:25:50.297752-05:
      DOI: 10.1111/aogs.12979
       
  • Role of microbes in maternal and child health – Friends or foes'
    • Authors: Ganesh Acharya
      First page: 517
      PubDate: 2017-04-20T22:25:51.46557-05:0
      DOI: 10.1111/aogs.13134
       
  • Endometriosis and uterine malformations: infertility may increase severity
           of endometriosis
    • Authors: Jeremy Boujenah; Eleonora Salakos, Mélodie Pinto, Joanna Shore, Christophe Sifer, Christophe Poncelet, Alexandre Bricou
      Abstract: IntroductionThe aim of our study was to compare the stage and severity of endometriosis in fertile and infertile women with congenital uterine malformations.Material and methodsWe performed an observational study from September 2007 to December 2015 in a tertiary care university hospital and assisted reproductive technology center. A total of 52 patients with surgically proven uterine malformations were included. We compared 41 infertile patients with uterine malformations with 11 fertile patients with uterine malformation. The main outcome was the stage, score and type of endometriosis in regard to infertility and class of uterine malformation.ResultsThe rate of endometriosis did not differ between the two groups (43.9 vs. 36.4%). The mean revised American Fertility Society score was higher in infertile patients with uterine malformations (19.02 vs. 6, p < 0.05). No significant difference was found in the rate of superficial peritoneal endometriosis (43.9 vs. 37.5%). Endometrioma and deep infiltrating endometriosis were associated with uterine malformations in infertile women, respectively 14.6 and 0%. No difference in the characteristics of endometriosis was found regarding the class of malformation.ConclusionsThe association of uterine malformations and infertility may increase the severity of endometriosis and raise the issue of their diagnosis and management.
      PubDate: 2016-11-11T08:06:07.035361-05:
      DOI: 10.1111/aogs.13040
       
  • When love hurts. A systematic review on the effects of surgical and
           
    • Authors: Giussy Barbara; Federica Facchin, Michele Meschia, Nicola Berlanda, Maria P. Frattaruolo, Paolo VercellinI
      Abstract: IntroductionEndometriosis is associated with an increased risk of dyspareunia, therefore this chronic gynecologic disease should be considered as a major cause of sexual dysfunctions. The aims of this study were to review the literature on the effects of surgical and pharmacological treatments for endometriosis on female sexual functioning, and to provide suggestions for future treatment strategies.Material and methodsWe followed the PRISMA guidelines to conduct this systematic review, which involved an electronic database search of studies on the association between endometriosis and sexuality published between 2000 and 2016.ResultsAs a result of the screening process, 22 studies were included in this systematic review. The 22 studies included were divided into two categories: (a) surgical intervention studies (n = 17), examining postoperative sexual outcomes of surgery for endometriosis; (b) pharmacological intervention studies (n = 5), evaluating the effects of pharmacological endometriosis treatments on sexual functioning. The studies considered showed that overall surgical and pharmacological interventions for endometriosis can lead to medium-/long-term improvement, but not necessarily to a definitive resolution of female sexual dysfunctions due to endometriosis.ConclusionsSexual functioning is a multidimensional phenomenon and the ideal treatment for endometriosis-related sexual dysfunctions should be conducted by a multidisciplinary team that involves not only gynecologists, but also sexologists and psychologists/psychotherapists. Improving global sexual functioning, and not just reducing pain at intercourse, should be considered as a major clinical goal of endometriosis treatment.
      PubDate: 2016-11-05T02:52:38.574436-05:
      DOI: 10.1111/aogs.13031
       
  • Risk factors of epithelial ovarian carcinomas among women with
           endometriosis: a systematic review
    • Authors: Line H. Thomsen; Tine H. Schnack, Kristina Buchardi, Lone Hummelshoj, Stacey A. Missmer, Axel Forman, Jan Blaakaer
      Abstract: IntroductionTo evaluate the published literature on epidemiologic risk factors for epithelial ovarian cancer among women with a diagnosis of endometriosis.Material and methodsA systematic literature search was conducted in PubMed and Scopus. Studies comparing epidemiologic risk factors of epithelial ovarian cancer among women with endometriosis were included. A quality assessment was conducted using the Newcastle-Ottawa Scale.ResultsEight of 794 articles met the inclusion criteria. A lower risk of epithelial ovarian cancer was observed in women with documented complete surgical excision of endometriotic tissue and suggested among women with unilateral oophorectomy. The use of oral contraceptives (≥10 years) may be associated with a lower risk of epithelial ovarian cancer among women with endometriosis, whereas older age at endometriosis diagnosis (≥45 years, pre- or postmenopausal), nulliparity, hyperestrogenism (endogenous or exogenous), premenopausal status at endometriosis diagnosis, solid compartments as well as larger size of endometrioma (≥9 cm in diameter at endometriosis diagnosis) were all associated with an increased risk of ovarian cancer.ConclusionsA subgroup of women with endometriosis characterized by endometriosis observed through surgery or imaging after the age of 45 years, nulliparity, postmenopausal status at endometriosis diagnosis, larger size of endometrioma (>9 cm) at endometriosis diagnosis, hyperestrogenism (endogenous or exogenous) and/or cysts with solid compartments may have an elevated risk of epithelial ovarian cancer. However, due to the limited number and size of studies in this area we cannot draw definitive conclusions. Further research into a risk factor profile among women with endometriosis is needed before clear recommendations can be made.
      PubDate: 2016-10-02T20:05:33.273522-05:
      DOI: 10.1111/aogs.13010
       
  • Oocyte competence in in vitro fertilization and intracytoplasmic sperm
           injection patients suffering from endometriosis and its possible
           association with subsequent treatment outcome: a matched case–control
           study
    • Authors: Omar Shebl; Ida Sifferlinger, Alwin Habelsberger, Peter Oppelt, Richard B. Mayer, Erwin Petek, Thomas Ebner
      Abstract: IntroductionEndometriosis affects up to 15% of women of reproductive age. There is an obvious lack of studies dealing with morphological parameters of oocyte morphology in endometriosis patients in assisted reproduction. One aim of the study is to describe oocyte morphology in patients undergoing intracytoplasmic sperm injection suffering from endometriosis. In addition, the impact of endometriosis on in vitro fertilization results is analyzed. Both in vitro fertilization and intracytoplasmic sperm injection patients are then matched with an endometriosis-free control group for highlighting the possible association of endometriosis with pregnancy outcome.Material and methodsOocyte morphology of endometriosis patients was assessed in two groups. Both study group and control group consisted of 129 in vitro fertilization/intracytoplasmic sperm injection cycles each. Patients were matched according to anti-Müllerian hormone, female age, previous treatment cycles, and method of fertilization. Endometriosis was graded according to the revised American Society for Reproductive Medicine guidelines of 1997.ResultsPatients with endometriosis had a significantly lower rate of mature oocytes (p 
      PubDate: 2016-07-22T08:26:44.341144-05:
      DOI: 10.1111/aogs.12941
       
  • Early gestational age at preeclampsia onset is associated with subclinical
           atherosclerosis 12 years after delivery
    • Abstract: IntroductionWomen with a history of preeclampsia have increased risk of cardiovascular disease later in life. However, it is unclear if early gestational age at preeclampsia onset is associated with higher cardiovascular disease risk. This study aimed to test the association between gestational age at preeclampsia onset (including the early-onset/late-onset preeclampsia distinction) and subclinical atherosclerosis and arterial stiffness in age-matched women 12 years after index pregnancyMaterial and methodsEligible participants were identified in two Danish registries. Main outcome measures were carotid plaque presence, carotid intima-media thickness, aortic pulse wave velocity, and augmentation index adjusted for heart rateResultsTwenty-four women with previous early-onset preeclampsia, 24 with previous late-onset preeclampsia and 24 with previous normotensive pregnancies were included after matching on age (+/- 2 years) and time since delivery (+/- 1 year). In all outcome measures, the early-onset group had the highest percentage or mean value. In the adjusted analysis, the early-onset group significantly differed from the late-onset group in all outcome measures except aortic pulse wave velocity. The early-onset group also had significantly higher carotid intima-media thickness (average and left) compared to the normotensive group. Noteworthy, gestational age at preeclampsia onset as a continuous variable was significantly associated to both carotid plaque presence and carotid intima-media thickness (average and right)ConclusionsGestational age at preeclampsia onset is negatively associated with markers of subclinical atherosclerosis 12 years after delivery. Potentially, gestational age at preeclampsia onset might be helpful in directing cardiovascular disease prevention after preeclampsia.This article is protected by copyright. All rights reserved.
       
  • Maternal deaths in the Nordic countries
    • Abstract: IntroductionDespite the seriousness of the event, maternal deaths are substantially underreported. There is often a missed opportunity to learn from such tragedies. The aim of the study was to identify maternal deaths in the five Nordic countries, to classify causes of death based on internationally acknowledged criteria, and to identify areas that would benefit from further teaching, training or research to possibly reduce the number of maternal deaths.Material and methodsWe present data for the years 2005-2013. National audit groups collected data by linkage of registers and direct reporting from hospitals. Each case was then assessed to determine the cause of death, and level of care provided. Potential improvements to care were evaluated.ResultsWe registered 168 maternal deaths, 90 direct and 78 indirect cases. The maternal mortality ratio was 7.2/100 000 live births ranging from 6.8-8.1 between the countries. Cardiac disease (n=29) was the most frequent cause of death followed by preeclampsia (n=24), thromboembolism (n=20), and suicide (n=20). Improvements to care which could potentially have made a difference to the outcome were identified in 1/3 of the deaths, i.e. in as many as 60% of preeclamptic, 45% of thromboembolic, and 32% of the deaths from cardiac disease.ConclusionDirect deaths exceeded indirect maternal deaths in the Nordic countries. To reduce maternal deaths increased efforts to better implement existing clinical guidelines seem warranted, particularly for preeclampsia, thromboembolism and cardiac disease. More knowledge is also needed about what contributes to suicidal maternal deaths.This article is protected by copyright. All rights reserved.
       
  • Textbook of Caesarean Section. Edited by Eric Jauniaux and William A.
           Grobman. 224 pages. Oxford University Press. 2016. ISBN:
           978-0-19-875856-3. 77€
    • Abstract: Cesarean section is the most commonly performed major operation around the world and it has become one of the first major surgical procedures performed independently by residents and trainees in Obstetrics and Gynecology. This first edition of a new textbook of cesarean section, aims to provide an overview of the topic, including history, the technical details of the procedure, and the different techniques currently used around the world. Global epidemiological perspective, complication rates, anesthetic and neonatal implications are also presented.This article is protected by copyright. All rights reserved.
       
  • Cardiotocography interpretation skills and the association with size of
           maternity unit, years of obstetric work experience and healthcare
           professional background: a national cross-sectional study
    • Abstract: IntroductionWe aimed to examine whether cardiotocography (CTG) knowledge, interpretation skills and decision-making measured by a written assessment were associated with size of maternity unit, years of obstetric work experience and healthcare professional background.Material and methodsA national cross-sectional study in the setting of a CTG teaching intervention involving all 24 maternity units in Denmark. Participants were midwives (n=1260) and specialists (n=269) and residents (n=142) in obstetrics and gynecology who attended a one-day CTG course and answered a 30-item multiple-choice question test. Associations between mean test score and work conditions were analyzed using multivariable robust regression, in which the three variables were mutually adjusted.ResultsParticipants from units with >3000 deliveries/year scored higher on the test than participants from units with 20 years experience: mean difference -0.9, p
       
  • Diagnostic accuracy of polymerase chain reaction for intrapartum detection
           of group B Streptococcus colonization
    • Abstract: Many pregnant women are treated with antibiotics during labor to prevent transmission of group B Streptococcus (GBS, Streptococcus agalactiae) to their baby during the passage of the birth canal, and thus reducing the risk of serious infection of the newborn. Methods for intrapartum testing for GBS has been introduced to select women for whom intrapartum antibiotic prophylaxis should be offered. For such an intrapartum test to be useful in clinical practice, it has to be specific as well as sensitive. The aim of the present study is to evaluate the accuracy of the polymerase chain reaction (PCR) assay compared to an optimized culture method for GBSMaterial and methodsIn the period from 12.05.2015 to 18.12.2015 we collected rectovaginal swabs on 106 women at the labor ward presenting in labor between gestational week 35+0-36+6 or presenting with prelabor rupture of membranes (PROM/PPROM) for >14 hours after gestational week 34+0. We performed GBS culture (reference standard) and a molecular GBS test (Xpert GBS®, Cepheid Ltd., Sunnyvale, USA)Results Based on intrapartum culture 23.6% (25/106) were colonized with GBS. Intrapartum PCR showed a colonization rate of 25.7% (27/105). The sensitivity of the test was 100% (86,28% -100%). The specificity of the test was 97.5% (91,26%-99,70%). The positive predictive value is 92.6%. In one case, we had no result with PCR testing giving an invalid test rate of less than 1%Conclusions PCR test has sufficient accuracy to direct intrapartum antibiotic prophylaxis for GBS transmission during delivery.This article is protected by copyright. All rights reserved.
       
  • Effects of an antenatal lifestyle intervention on offspring obesity – a
           five year follow-up of a randomised controlled trial
    • Abstract: IntroductionStrategies to limit excessive maternal gestational weight gain could also have positive health effects for the offspring. This study informs us on the effect of an antenatal lifestyle intervention on offspring body mass index (BMI) trajectory until age fiveMaterial and methodsA secondary analysis of a randomized controlled trial aimed at reducing gestational weight gain, set in Ørebro, Sweden.Offspring were followed with standardised measures of weight and height until age five. Mean BMI z-score and proportion (%) of over- and undernutrition (BMI z-score >+2 standard deviation) was compared between groups. Risk estimates for obesity at age five were analysed in relation to maternal gestational weight gain and prepregnancy BMI as a secondary outcomeResultsWe analysed 374 children at birth and 300 at age five. No significant difference in mean BMI z-score was seen at birth (0.68 (I) vs 0.56 (C), p=0.242) or at age five (0.34 (I) vs 0.26 (C), p=0.510) and no significant difference in proportion of over- or undernutrition was seen. Excessive maternal gestational weight gain was an independent risk factor for offspring obesity at birth (OR=4.51, p
       
  • Risk of labor dystocia increases with maternal age irrespective of parity:
           a population-based register study
    • Abstract: IntroductionAdvanced maternal age is associated with labor dystocia (LD) in nulliparous women. This study investigates the age-related risk of LD in first, second and third birthsMaterial and methodsAll live singleton cephalic births at term (≥37 gestational weeks) recorded in the Swedish Medical Birth Register from1999 to 2011, except elective cesarean sections and fourth births and more, in total 998 675 pregnancies, were included in the study. LD was defined by ICD10 codes (O620, O621, O622, O629, O630, O631, and O639). In each parity group risks of LD at age 25-29 years, 30-34 years, 35-39 years and ≥40 years compared with age
       
  • Timing of surgery for placenta previa with suspected abnormally invasive
           placentation: A test of team competency'
    • Abstract: For patients with placenta previa (PP) with a suspected abnormally invasive placenta (AIP), “the higher the ‘concern’ for preterm delivery and severity of AIP, the earlier the surgery date” may be better. Perlman et al. (1) showed that “scheduled surgery” at ≥36 weeks was possible for many patients. The incidence of massive bleeding did not differ among 34, 35 vs. ≥36 weeks. They concluded “patients with ‘no concern’ for percreta/increta or no prior cesarean section (and no preterm-delivery risk) may be candidates for later delivery”. Thus, later (≥36 weeks) delivery was permitted in some cases, with which we agree.This article is protected by copyright. All rights reserved.
       
  • Placenta, cord and membranes: A dual center validation study of
           midwives’ classifications and notifications to the Medical Birth
           Registry of Norway
    • Abstract: IntroductionA validation of data regarding the placenta, cord and membranes in Medical Birth Registry of Norway (MBRN) is lacking. Here we investigate the inter- and intra-observer agreement of observations regarding the placenta, cord and membranes to the MBRN in two institutionsMaterial and methodsWe conducted a dual center validation study of data regarding placenta, cord and membranes. In the inter-observer study, 196 placentas in two institutions were examined by the attending midwife and a blinded colleague, whereas in the intra-observer study registrations by the attending midwife on 195 placentas were compared with her own registrations the MBRN. In a separate sample consisting of n=51 placental pathology reports, midwives’ registrations to the MBRN were compared with the pathology report. For categorical and continuous variables agreement was assessed by kappa value and paired sample t-test, respectivelyResultsInter-observer agreement between two midwives for cord insertion site and bi-placenta, cord knots and vessel anomalies were good (kappa values >0.79 and >0.96, respectively). The inter- and intra-observer study showed no significant differences regarding placental weight and cord length (p-value 0.31 and 0.28 and p-value 0.71 and 0.39, respectively). The inter-observer agreement between the pathology reports and midwives’ registrations was good for gross placental and cord variants (kappa 0.73 -1.0), but there were significant differences in placental weight and cord length (p-value
       
  • Mode of first delivery and severe maternal complications in the subsequent
           pregnancy
    • Abstract: IntroductionSevere obstetric complications increase by the number of previous cesarean deliveries. In the Nordic countries most women have two children. We present the risk of severe obstetric complications at the delivery following a first elective or emergency cesarean and the risk by intended mode of second delivery.Material and methodA two-year population-based data-collection of severe maternal complications in women with two deliveries in the Nordic countries (n=213 518). Denominators were retrieved from the national medical birth registers.ResultsOut of 35 450 first cesarean deliveries (17%), 75% were emergency and 25% elective. Severe complications at second delivery were more frequent in women with a first cesarean than a first vaginal delivery and rates of abnormally invasive placenta, uterine rupture and severe postpartum hemorrhage were higher after a first elective than a first emergency cesarean delivery (RR 4.1 CI; 2.0-8.1, RR 1.8 CI; 1.3-2.5, RR 2.3 CI; 1.5-3.5). A first cesarean accounted for up to 97% of the severe complications in the second pregnancy. Induction of labor was associated with an increased risk of uterine rupture and severe hemorrhage.ConclusionElective repeat cesarean nearly prevents complete uterine rupture at the second delivery, while the risk of severe obstetric hemorrhage, abnormally invasive placenta and peripartum hysterectomy is unchanged by the intended mode of second delivery in women with a first cesarean. Women with a first elective versus emergency cesarean have increased risk of severe complications in the second pregnancy.This article is protected by copyright. All rights reserved.
       
 
 
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