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Publisher: John Wiley and Sons   (Total: 1577 journals)

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Showing 1 - 200 of 1577 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 12, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 64, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 46, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 49, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 148, 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: 56, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 6, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 35, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 6, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 3)
Addiction     Hybrid Journal   (Followers: 35, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 13, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 26, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 26, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 50, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 13, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 255, 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: 5, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
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: 35, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 15, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 10, 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: 45, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 30, SJR: 1.122, h-index: 120)
Alcoholism and Drug Abuse Weekly     Hybrid Journal   (Followers: 7)
Alcoholism Clinical and Experimental Research     Hybrid Journal   (Followers: 7, SJR: 1.416, h-index: 125)
Alimentary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 34, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 50, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 135, 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: 89, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 27, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 33, 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: 16, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 6, SJR: 2.315, h-index: 79)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 37, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 262, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 3, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 17, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 125, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 10, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 16)
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: 219)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 212, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 37, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 9, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 7, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 48, 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: 13)
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: 17, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 15)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 91, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 47, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 7, 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: 68, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 152, 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: 14, 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: 36, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 27, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 15, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 25, 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: 229, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 51, 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: 14)
Asia & the Pacific Policy Studies     Open Access   (Followers: 15)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 312, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (Followers: 1, SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 8, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 4, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 4, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (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: 12, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 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: 13, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 9, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 8, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 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: 4, 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: 44, 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: 7, 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: 27, 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: 14, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 18, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 401, 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: 69, 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: 10, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 5, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 9, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 24, 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: 16, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 3, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 42, 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: 36, 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: 187, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 14, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 19, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 9, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 37, 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)
BJOG : An Intl. J. of Obstetrics and Gynaecology     Partially Free   (Followers: 225, SJR: 2.083, h-index: 125)

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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  [1577 journals]
  • 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
  • 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
  • Women's experiences of continuous fetal monitoring – a
           mixed‐methods systematic review
    • Abstract: IntroductionAntepartum stillbirth is often preceded by detectable signs of fetal compromise, including changes in fetal heart rate and movement. It is hypothesised that continuous fetal monitoring could detect these signs more accurately and objectively than current forms of fetal monitoring and allow for timely intervention. This systematic review aimed to explore available evidence on women's experiences of continuous fetal monitoring to investigate its acceptability prior to clinical implementation and to inform clinical studies.Material and methodsSystematic searching of four electronic databases (Embase, PsycINFO, MEDLINE and CINAHL), using key terms defined by initial scoping searches, identified a total of 35 studies. Following title and abstract screening by two independent researchers five studies met the inclusion criteria. Studies were not excluded based on language, methodology or quality assessment. An integrative methodology was used to synthesise qualitative and quantitative data together.ResultsForms of continuous fetal monitoring used included Monica AN24 monitors (n=4) and phonocardiography (n=1). Four main themes were identified: practical limitations of the device, negative emotions, positive perceptions and device implementation. Continuous fetal monitoring was reported to have high levels of participant satisfaction and was preferred by women to intermittent cardiotocography.ConclusionThis review suggests that continuous fetal monitoring is accepted by women. However, it has also highlighted both the paucity and heterogeneity of current studies and suggests further research should be conducted into women's experiences of continuous fetal monitoring before such devices can be used clinically.This article is protected by copyright. All rights reserved.
  • Intrapartum transperineal ultrasound used to predict cases of complicated
           operative (vacuum and forceps) deliveries in nulliparous women
    • Abstract: IntroductionThe objective of this study was to investigate the predictive value of intrapartum transperineal ultrasound in the identification of complicated operative(vacuum or forceps) deliveries in nulliparous women.Material and methodsProspective observational study of nulliparous women with an indication for operative‐delivery who underwent intrapartum transperineal ultrasound before fetal extraction. Managing obstetricians were blinded to the ultrasound data. Intrapartum transperineal ultrasound was performed immediately before blade application, both at rest and concurrently with contractions and active pushing. Operative delivery was classified as complicated when one or more of the following situations occurred: ≥3 tractions;a 3‐4th degree perineal tear; significant bleeding during the episiotomy repair; major tear or significant traumatic neonatal lesion.Results143 nulliparous women were included in the study[82 vacuum‐assisted deliveries and 61 forceps‐assisted deliveries] with 20 fetuses in occiput posterior position. Forty‐seven operative deliveries were classified as complicated deliveries(28 vacuum‐assisted deliveries, 19 forceps‐assisted deliveries). No differences in obstetric, intrapartum or neonatal characteristics were observed between the study groups, with the following exceptions: birth weight (3,229±482 uncomplicated deliveries vs. 3,623±406 complicated deliveries; P
  • Intraoperative cervical treatment does not affect the prevalence of
           vaginal bleeding one year postoperatively after subtotal hysterectomy. A
           register study from the Swedish National Register for Gynecological
    • Abstract: IntroductionThe objectives were to establish the prevalence of persistent vaginal bleeding (PVB) following subtotal hysterectomy, to analyze the effect of intraoperative cervical treatment on the occurrence of PVB and to evaluate the impact of PVB on the patient‐reported opinion concerning result of surgery and medical condition.Material and methodsRetrospective study with data from the Swedish National Register for Gynecological Surgery including 5240 women undergoing subtotal hysterectomy for benign conditions between January 2004 and June 2016. Demographic and clinical data were obtained from the pre‐ and perioperative forms. Data concerning occurrence of PVB, rating of medical condition and contentment with result of surgery were collected from the one‐year inquiry form. Statistical analyses were performed with multivariable logistic regression models. The results are presented as adjusted odd ratios (aORs) and 95% confidence intervals (CI).ResultsPVB occurred in 18.6%. Intraoperative cervical treatment did not affect the frequency of PVB (aOR 1.48 (95%CI; 0.93‐2.37). More than 90% were satisfied with the result of the hysterectomy, but women with PVB were less content compared with those without PVB (aOR 0.42 (95%CI; 0.26‐0.67). The self‐perception of the medical condition did not differ between the women with and without PVB (aOR 1.16 (95%CI; 0.33‐4.12)).ConclusionsNearly two in ten women may expect PVB following subtotal hysterectomy, and cervical treatment intraoperatively did not affect this. More than 90% were satisfied with the result but women with PVB were less content. Preoperative information on this risk of PVB may be important when choosing hysterectomy technique.This article is protected by copyright. All rights reserved.
  • Doppler‐based fetal heart rate analysis markers for the detection of
           early intrauterine growth restriction
    • Abstract: IntroductionOne indicator for fetal risk of mortality is intra‐uterine growth restriction (IUGR). Whether markers reflecting the impact of growth restriction on the cardiovascular system, computed from a Doppler‐derived heart rate signal, would be suitable in its detection antenatally were studiedMaterial and methodsWe used a cardiotocography archive of 1163 IUGR cases and 1163 healthy controls, matched for gestation and gender. We assessed the discriminative power of short‐term variability (STV) and long‐term variability (LTV) of the fetal heart rate, computed over episodes of high and low variation aiming to separate growth‐restricted fetuses from controls. Metrics characterizing the sleep state distribution within a trace were also considered for inclusion into an IUGR detection modelResultsSignificant differences in the risk markers comparing growth‐restricted with healthy fetuses were found. When used in a logistic regression classifier, their performance for identifying IUGR was considerably superior before 34 weeks gestation. LTV in active sleep was superior to STV (AUROC of 72% compared to 71%). Most predictive was the number of minutes in high variation per hour (AUROC of 75%). A multivariate IUGR prediction model improved the AUROC to 76%.ConclusionWe suggest that heart rate variability markers together with surrogate information on sleep states can contribute to the detection of early‐onset IUGR.This article is protected by copyright. All rights reserved.
  • Mortality and causes of death among women with a history of placental
    • Abstract: IntroductionWomen with a history of placental abruption have an increased later morbidity, but not much is known of the later mortality.Material and MethodsData on women with placental abruption (index cohort) between 1969 and 2005 (n=7805) were collected from the Finnish Hospital Discharge Register and the Finnish Medical Birth Register. A matched reference cohort consisted of women without placental abruption (n=23 523). The causes of death were retrieved from the Cause-of-Death Register. Cause-specific mortality was compared by hazard ratios (HR). Standardized mortality ratios were calculated to compare both cohorts with the general female population. The main outcome measure was subsequent mortality.ResultsBy the end of 2013 there were 395 deaths in the index cohort and 863 deaths in the reference cohort. The overall mortality was increased in the index cohort compared with the reference cohort (HR 1.39, 95% confidence interval 1.24–1.57). The index cohort had an increased risk of death from respiratory tract malignancies (HR 1.72, 1.05–2.82), alcohol-related causes (HR 1.84, 1.25–2.72), and external causes (HR 1.63, 1.19–2.22), especially suicide (HR 1.71, 1.07–2.74). The mortality from cardiovascular diseases did not differ. The standardized mortality ratio was increased in the index cohort compared to the general Finnish female population (1.13, 1.02–1.24), especially for respiratory tract malignancies (1.79, 1.16–2.64). The index cohort women tended to die younger than referent women (p
  • Propensity score method for analyzing the effect of labor induction in
           prolonged pregnancy
    • Abstract: IntroductionThere is an ongoing debate on the optimal time of labor induction to reduce the risks associated with prolonged pregnancyMaterial and methodsRegistry-based study of 212,716 term, singleton cephalic deliveries between 2006 and 2012 in Finland comparing the outcomes of labor induction to those of expectant management in five three-day gestational age periods between 40 and 42 weeks (Group 1:40+0-40+2; 2:40+3-40+5;3: 40+6-41+1;4: 41+2-41+4;5: 41+5-42+0). Using Poisson regression, induced deliveries in each of the gestational age periods were compared to all ongoing pregnancies. Propensity score matching was applied to reduce confounding by indicationResultsIn the gestational age groups 1-2 labor induction significantly decreased the risk meconium aspiration syndrome (RR 0.40, 95% CI 0.18-0.91, RR 0.44, 95% CI 0.21-0.91) but in contrast, increased the risk for prolonged hospitalization of a neonate (RR 1.30, 95% CI 1.10-1.54 and RR 1.23, 95% CI 1.03-1.47). In the groups 3-4, labor induction significantly increased the risk for emergency cesarean section (RR 1.17, 95% CI 1.06-1.28 and RR 1.19, 95% CI 1.09-1.29) still reducing the risk for meconium aspiration syndrome. In the group 5, labor induction did not affect the risk for any of the studied outcomes (operative delivery, obstetric trauma, neonatal mortality, respirator treatment, Apgar
  • Longitudinal transvaginal ultrasound evaluation of cesarean scar niche
           incidence and depth in the first two years after single- or double-layer
           uterotomy closure: a randomized controlled trial
    • Abstract: IntroductionCesarean deliveries are the most common abdominal surgery procedure globally, and the optimal way to suture the hysterotomy remains a matter of debate. The aim of this study was to assess the incidence of cesarean scar niches and the depth after single- or double-layer uterine closure.Material and methodsWe performed a randomized controlled trial in which women were allocated to three uterotomy suture techniques: continuous single-layer unlocked, continuous locked single-layer, or double-layer sutures. Transvaginal ultrasound was performed six weeks and 6–24 months after cesarean delivery. Clinicaltrials. gov (NCT02338388).ResultsThe study included 435 women. Six weeks after delivery, the incidence of niche was not significantly different between the groups (p=0.52): 40% for single-layer unlocked, 32% for single-layer locked and 43% for double-layer sutures. The mean±SD niche depths were 3.0±1.4 mm for single-layer unlocked, 3.6±1.7 mm for single-layer locked and 3.3±1.3 mm for double-layer sutures (p=1.0). There were no significant differences (p=0.58) in niche incidence between the three groups at the second ultrasound follow-up: 30% for single-layer unlocked, 23% for single-layer locked and 29% for double-layer sutures. The mean±SD niche depth was 3.1±1.5 mm after single-layer unlocked, 2.8±1.5 mm after single-layer locked and 2.5±1.2 mm after double-layer sutures (p=0.61). There was a trend (p=0.06) for the residual myometrium thickness to be thicker after double-layer repair at the long-term follow-up.ConclusionsThe incidence of cesarean scar niche formation and the niche depth was independent of the hysterotomy closure technique.This article is protected by copyright. All rights reserved.
  • Reduced incidence of neonatal early onset group B streptococcal infection
           after promulgation of guidelines for risk-based intrapartum antibiotic
           prophylaxis in Sweden: analysis of a national population-based cohort
    • Abstract: IntroductionTo investigate the incidence of neonatal early onset group B streptococcal (GBS) infection in Sweden after promulgation of guidelines (2008) for risk factor-based intrapartum antibiotic prophylaxis, and evaluate presence of risk factors and obstetric management in mothers.Material and methodsNational registers were searched for infants with early onset GBS infection during 2006-11. Medical records of cases and case mothers were abstracted. Verified cases of sepsis/meningitis and cases with clinical sepsis/pneumonia were documented, as well as risk factors in case mothers and timeliness of intrapartum antibiotic prophylaxis administration.ResultsThere were 227 cases with verified infection, with an incidence of 0.34 ‰ of live births during the whole period. There was a significant decrease after promulgation of guidelines, from 0.40 to 0.30‰ (OR 0.75, 95% CI; 0.57-0.99). A significant decrease in number of cases with clinical GBS sepsis/pneumonia was also observed. In parturients with ≥1 risk factor the incidence of any GBS infection was reduced by approximately 50% (OR 0.47, 95% CI; 0.35-0.64), yet there were many cases where the opportunity for timely administration of intrapartum antibiotic prophylaxis was missed. In infants of mothers without risk factor there was no reduction in early onset GBS morbidity. The mortality in verified cases was 4,8% (95% CI; 2.1-7.6).ConclusionsThe introduction of national guidelines for risk based intrapartum antibiotic prophylaxis coincided with a significant, 50% risk reduction of neonatal early onset GBS infection in infants of parturients presenting with ≥1 risk factor. A stricter adherence to guidelines could probably have reduced the infant morbidity further.This article is protected by copyright. All rights reserved.
  • Is the incidence of recurrent pregnancy loss increasing': a
           retrospective register-based study in Sweden
    • Abstract: IntroductionThe aim of this study was to estimate the incidence of recurrent pregnancy loss (RPL). The prevalence of RPL defined as ≥3 consecutive miscarriages before gestation week 22, is often stated to be 1%. To our knowledge no study has estimated the incidence of RPL, which might be more informative and clinically relevant than the prevalence.Material and MethodsThis retrospective register-based study was conducted from 2003 until 2012 in Sweden with data provided by the Swedish National Board of Health and Welfare. 6852 women were registered with the diagnoses of RPL in the National Patient Register. The incidence of RPL is the number of new women receiving the RPL diagnosis per year in the numerator and population at risk in the denominator.ResultsFor each year, from 2003 to 2012, the incidence was calculated in two different risk populations, 1) all women aged 18-42 years, and 2) all women registered as being pregnant (deliveries or miscarriages). The average incidence in the study period was 53 per 100 000 (0.05%) in women aged 18-42 years and 650 per 100 000 (0.65%) in women who had achieved pregnancy in the period. The incidence of RPL in the two risk populations increased by 74% and 58%, respectively, during the study period.ConclusionThis study suggests that the incidence of RPL increased during the ten-year period studied. Causes can only be speculated upon in this study design, but might be associated with environmental changes, as the increase was fairly rapid.This article is protected by copyright. All rights reserved.
  • Complications in operative hysteroscopy – is prevention
    • Abstract: Operative hysteroscopy in a hospital setting has revolutionized surgical treatment of benign uterine disorders. It is minimally invasive, cost and time-effective and may spare patients from major surgical interventions. Operative hysteroscopy in a day-case hospital setting is regarded as a safe and well-tolerated procedure with low complication rates. However, prevention of adverse events is crucial in daily practice to optimize patient care. Complications in operative hysteroscopy can be divided into early complications, including bleeding, uterine perforation, infection and fluid overload, or late complications and suboptimal outcomes, such as incomplete resection and intrauterine adhesions. Awareness and knowledge of management of adverse events as well as the use of possible preventative measures will increase the quality and safety of hysteroscopic surgery. The present commentary focuses on these issues as an up to date basis for everyday clinical practice.This article is protected by copyright. All rights reserved.
  • Thrombocalc: Implementation and uptake of personalized postpartum venous
           thromboembolism risk assessment in a high throughput obstetric environment
    • Abstract: IntroductionVenous thromboembolism risk assessment (VTERA) is recommended in all pregnant and postpartum women. Our objective was to develop, pilot and implement a user-friendly electronic VTERA toolMaterials and methodsWe developed ‘Thrombocalc’, an electronic VTERA tool using Microsoft Excel™. Thrombocalc was designed as a score-based tool to facilitate rapid assessment of all women after childbirth. Calculation of a total score estimated risk of venous thromboembolism in line with consensus guidelines. Recommendations for thromboprophylaxis were included in the VTERA output. Implementation was phased. Uptake of the VTERA tool was prospectively assessed by monitoring the proportion of women who gave birth in our institution and had a completed risk assessment. Factors affecting completion and accuracy of risk assessments were also assessedResultsThrombocalc was used to prospectively risk assess 8380 women between September 2014 and December 2015. Compliance with this tool increased dramatically throughout the study period; over 92% of women were risk assessed in the last quarter of data collection. Compliance was not adversely affected if delivery took place out of working hours (aOR 1.14, 95% CI; 1.04-1.25). Risk assessment was less likely in the case of caesarean deliveries (aOR=0.66, 95% CI 0.60-0.73) and stillborn infants (aOR=0.48, 95% CI; 0.29-0.79). Misclassification of risk factors led to approximately 207 (2.5%) inaccurate thromboprophylaxis recommendationsConclusionOur electronic, score-based VTERA tool, provides a highly effective mechanism for rapid, assessment of individual postpartum venous thromboembolism risk in a high throughput environment.This article is protected by copyright. All rights reserved.
  • Declining prevalence of cytological squamous intraepithelial lesions of
           the cervix among women living with well-controlled HIV – Most women
           living with HIV do not need annual PAP smear screening
    • Abstract: IntroductionCervical screening by means of annual Papanicolaou (PAP) smears has been recommended for all women living with HIV. We analysed the results of our annual PAP smear screening programme in order to identify low-risk subgroups for less rigorous screeningMaterial and methodsThe study comprised 369 women followed at the Helsinki University Hospital 2002–2013, with a total of 2033 PAP smear results. We analysed the temporal changes in PAP smear findings. Logistic regression analysis for binominal dependent variables was used for assessing risk factors for ever having cytological SIL (hereafter referred as SIL) using Generalized Estimating Equations taking into account multiple observations of each patientResultsMost women had well-controlled HIV especially towards the end of the study. PAP smear results improved substantially. At the time of each individual's last PAP-smear, 90.0% of the findings displayed normal results. Conversely, the rate of SIL decreased from 16.8% to 4.6% from 2002 to 2013. In multivariate analysis the risk of SIL was significantly lower in women with consecutive normal PAP smear findings during the first two years of follow-up (OR 0.21, 95% CI; 0.10–0.45, p500 cells/μL (OR 0.11, 95% CI; 0.05–0.26, p
  • Comparing the accuracy of maternal, clinical, and ultrasound estimations
           to predict birthweight: a meta-analysis
    • Abstract: IntroductionAccurate prediction of birthweight prior to delivery is necessary to establish periconceptional strategies to reduce the rates of adverse pregnancy outcomes. This study was performed to determine whether maternal, clinical, or ultrasound estimation provides the best predictor of birthweightMaterial and methodsMeta-analysis was performed to summarize the relative ratios of the rate of one of maternal, clinical, and ultrasound estimation within 10% of actual birthweight to that of each of the others within the same range and the difference in correlation coefficient of actual birthweight between clinical and ultrasound estimations. Study quality was assessed with regard to the representativeness of participants, verification bias, and review bias. Publication bias was assessed using Egger's testResultsThirty-seven relatively good quality studies were included in the analysis. There was no significant difference in the rates of estimates within 10% of actual birthweight between clinical and maternal estimations (n = 8 and P = 0.491) or between ultrasound and maternal estimations (n = 6 and P = 0.568), or in the correlation coefficient of actual birthweight with ultrasound estimation compared with clinical estimation (n = 5 and P = 0.621). However, the rate of ultrasound estimations within 10% of actual birthweight was significantly higher than that of clinical estimations (n = 18 and P = 0.033). The data showed no publication bias (P = 0.058 – 0.854)ConclusionsUltrasound estimation may be the best predictor of birthweight.This article is protected by copyright. All rights reserved.
  • Clusters of week-specific maternal gestational weight gain pattern and
           their association with birthweight:an observational cohort study
    • Abstract: IntroductionGestational weight gain (GWG) varies widely among different populations, and an inappropriate GWG is associated with adverse pregnancy outcomes. We aimed to investigate week-specific serial changes in GWG in an urban Chinese population to derive clusters of GWG pattern and explore the impact of GWG patterns on birthweight.Material and methodsThis was an observational cohort study of 6130 women delivered at a university hospital in Shanghai, China. Pre-pregnancy bodyweight, height, week-specific and total GWG, pregnancy outcome and birthweight were extracted using electronic medical records. The association between GWG and gestational age was tested using linear regression and week-specific reference percentiles for GWG were calculated. Hierarchical clustering was used to derive GWG clusters. Mean birthweight among the clusters was compared using Dunnet′s test.ResultsWe found a significant linear association between GWG and gestational age (r=0.56; p
  • Adjustable mini-sling compared to conventional mid-urethral slings in
           women with urinary incontinence. A randomized controlled trial
    • Abstract: IntroductionThe primary aim was to compare the objective and subjective outcomes and short-term complication rates of an adjustable single-incision mini-sling (SIMS) versus standard mid-urethral slings (SMUS). The secondary aim was reporting pain perception and complications at one-year follow-up.Material and methodsThe study was designed as a multicenter prospective randomized trial where women were included by eight centers in Denmark, Norway and Sweden. The trial was registered at ClinicalTrials. gov: NCT01754558. A total of 305 women less than 60 years old with verified stress urinary incontinence were included. All women were randomized to SIMS (Ajust®; N=155) or SMUS (TVT, TVT-O or TOT; N=150) and were evaluated by stress test and bladder diary before and after surgery and symptoms related to incontinence using ICIQ-SF, PISQ-12 and PGI-S and PGI-I. Objective cure was defined as no leakage during a stress test and subjective cure defined as no leakage stated in the bladder diary or no indication of urinary leakage in the ICIQ-SF. Furthermore, mesh exposure and dyspareunia were recorded.ResultsIn total 280 women (141 (91%) in the SIMS and 139 (94%) in the SMUS groups) participated in the one-year follow-up. No difference between the groups was observed regarding objective and subjective outcomes. VAS score disclosed a lower postoperative pain perception in the SIMS group compared to the SMUS group.ConclusionsAjust® appears to be as efficient as SMUS regarding objective and subjective outcomes and was associated with less pain perception during the postoperative period.This article is protected by copyright. All rights reserved.
  • Fertility preservation in women with borderline ovarian tumors- how does
           it impact disease outcome' A cohort study
    • Abstract: IntroductionBorderline ovarian tumors are typically indolent neoplasms. Since many are diagnosed in younger women, fertility conservation is an important consideration and has been advocated based on retrospective data. The objective of this study was to identify features impacting on recurrence and survival in a series of borderline ovarian tumors, and to assess the safety of a fertility-sparing approach.Material and methodsA historical cohort study of consecutive borderline ovarian tumors cases treated at a single institution over 30 years (1981-2011). Data on surgical approach (fertility sparing or otherwise), disease stage, CA125 levels, histological features, adjuvant treatment and follow up data were collected. Recurrence and survival were assessed using the Kaplan Meier method and associations with the variables of interest were evaluated using a multivariate Cox proportional hazards model.Results213 patients were included. Of 132 women age 40 years and below at diagnosis, 112 (85%) had a fertility-sparing procedure and 60 (46%) had conservation of an involved ovary. Fifty patients (24%) developed recurrences; fertility preservation (hazard ratio= 2.57; CI 1.1-6; p=0.029) and advanced stage (hazard ratio=4.15; CI 2.3-7.6; p
  • Sequence variants in ESR1 and OXTR are associated with
           Mayer-Rokitansky-Küster-Hauser syndrome
    • Abstract: IntroductionMayer-Rokitansky-Küster-Hauser syndrome (MRKHS) is characterized by congenital absence of the uterus and the upper two-thirds of the vagina in otherwise phenotypically normal females. It is found isolated or associated with renal, skeletal and other malformations. Despite of ongoing research, the etiology is mainly unknown. For a long time, the hypothesis of deficient hormone receptors as cause for MRKHS exists, and is supported by previous findings of our group. The aim of the present study was to identify unknown genetic causes for MRKHS and to compare them with data banks including a review of the literature.Material and methodsDNA sequence analysis of the oxytocin receptor (OXTR) and estrogen receptor-1 gene (ESR1) was performed in a group of 93 clinically well-defined patients with uterovaginal aplasia (68 with the isolated form and 25 with associated malformations).ResultsIn total, we detected three OXTR variants in 18 MRKHS patients with one leading to a missense mutation, and six ESR1 variants in 21 MRKHS patients, two of these causing amino acid changes and therefore potentially disease causing.ConclusionsThe identified variants on DNA level might impair receptor function through different molecular mechanisms. Mutations of ESR1 and OXTR are associated with MRKHS. Thus, we consider these genes as potential candidates in the manifestation of MRKHS.This article is protected by copyright. All rights reserved.
  • Maternal and neonatal outcomes following abnormally invasive placenta: a
           population-based record linkage study
    • Abstract: IntroductionAbnormally invasive placenta (AIP) involves abnormal adherence of the placenta to the myometrium, and is associated with severe pregnancy complications such as blood transfusion and hysterectomy. Knowledge of outcomes has been limited by small sample sizes and a focus on maternal rather than neonatal outcomes. This study uses population-level data collected over ten years to investigate maternal and neonatal outcomes and trends in incidence of AIP (also known as placenta accreta, increta and percreta).Material and methodsA population-based record linkage study was performed, including all women who gave birth in New South Wales, Australia, between 2003 and 2012. Data were obtained from birth records, hospital admissions and deaths registrations. Modified Poisson regression models were used to quantify the effect of AIP on adverse maternal and neonatal outcomes.ResultsAbnormally invasive placenta was significantly associated with morbidity for mothers (aRR 17.6, 99%CI; 14.5-21.2) and infants (aRR 3.1, 99%CI; 2.7-3.5). AIP increased risk of stillbirth (RR 5.4, 99%CI; 4.0-7.3) and neonatal death (RR 8.0, 99%CI; 1.5-41.6). The overall rate of AIP was 24.8 per 10,000 deliveries, and 22.7 per 10,000 among primiparae. Incidence increased by 30%, from 20.6 to 26.9 per 10,000 over the ten-year study period.ConclusionsAbnormally invasive placenta substantially increases risk of severe adverse outcomes for mothers and babies, and incidence is increasing. Delivery should occur in tertiary hospitals equipped with neonatal intensive care units. Clinicians should be cognizant of the risks, particularly to infants, and maintain a high index of suspicion of AIP, including in primiparae.This article is protected by copyright. All rights reserved.
  • Insulin resistance in pregnant women with and without polycystic ovary
           syndrome, and measures of body composition in offspring at birth and 3
           years of age
    • Abstract: IntroductionPolycystic ovary syndrome (PCOS) is associated with obesity and insulin resistance in the non-pregnant state, but little is known about insulin sensitivity in the pregnant state. Our objective was to compare insulin resistance in pregnant women with and without PCOS and explore the impact of PCOS on body composition in offspring at birth and at 3 years of ageMaterial and methodsA prospective cohort study including 2548 live born singleton mother-child pairs residing in Odense municipality, Denmark, during 2010-2013. Of the 2548 women, 241 (9.4%) had PCOSResultsHomeostatic model assessment for insulin resistance (HOMA-IR) assessments were comparable in women with and without PCOS. However, the subgroup of overweight women with PCOS had significantly higher levels of HOMA-IR than overweight women without PCOS (mean ±2SD): 4.4 (3.1) vs. 3.6 (3.4), p = 0.004. Maternal PCOS did not affect offspring birthweight after accounting for age. PCOS, adjusted for maternal BMI, was however, associated with increased BMI at 3 years of age (mean ±2SD): 16.0 (2.2) vs. 15.7 (2.1) kg/m2, p = 0.04ConclusionIn our cohort, maternal PCOS was not associated with insulin resistance after correcting for BMI and was not an independent predictor of offspring birthweight. However, both PCOS and high maternal BMI may increase risk of childhood obesity at 3 years of age.This article is protected by copyright. All rights reserved.
  • A national, prospective observational study of first recurrence after
           primary treatment for gynecological cancer in Norway
    • Abstract: IntroductionGynecological cancer patients are routinely followed up for 5 years after primary treatment. However, the value of such follow-up has been debated, as retrospective studies indicate that first recurrence is often symptomatic and occurs within 2-3 years of primary treatment. We prospectively investigated time to first recurrence, symptoms at recurrence, diagnostic procedures, and recurrence treatment in gynecological cancer patients after primary curative treatment.Material and methodsClinicians from 21 hospitals in Norway interviewed 680 patients with first recurrence of gynecological cancer (409 ovarian, 213 uterine, and 58 cervical cancer patients) between 2012 and 2016. A standardized questionnaire was used to collect information on self-reported and clinical variables.ResultsWithin 2 years of primary treatment, 72% of ovarian, 64% of uterine, and 66% of cervical cancer patients were diagnosed with first recurrence, and 54%, 67%, and 72%, respectively, had symptomatic recurrence. 25-50% of symptomatic patients failed to make an appointment before their next scheduled follow-up visit. Computer tomography was the most common diagnostic procedure (89% of ovarian, 76% of uterine, and 62% of cervical cancer patients), and recurrence treatment in terms of chemotherapy was most frequently planned (86% of ovarian, 46% of uterine, and 62% of cervical cancer patients).ConclusionsA majority of patients experienced symptomatic recurrence, but many patients failed to make an appointment earlier than scheduled. Most first recurrences occurred within 2 years of primary treatment; the mean annual incidence rate for years 3-5 after primary treatment was
  • E-cigarette use in pregnancy: a human rights-based approach to policy and
    • Abstract: The health risks associated with e-cigarette use in pregnancy are mostly unknown. Guidelines by the World Health Organization and national health agencies warn women against using e-cigarettes in pregnancy, however, in the UK, a recent multiagency guideline takes a different approach by not discouraging e-cigarette use in pregnancy. Furthermore, e-Voke™, an e-cigarette, has been approved for use in pregnancy in the UK. We analyze United Nations’ human rights treaties to examine how they might inform best practice recommendations for e-cigarette use in pregnancy. These treaties oblige Parties to adopt policies that protect children's and women's right to health, appropriate pregnancy services, and health education. We argue that clinical practice guidelines related to use of e-cigarettes in pregnancy should consider both evidence and human rights principles, and ensure that healthcare providers and patients are given clear, accurate messages about the known and potential risks associated with e-cigarette use in pregnancy.This article is protected by copyright. All rights reserved.
  • Issue Information
  • Seven dangerous Ps of pregnancy and challenges of caring for pregnant
           women with complex needs
  • Prematurity and neonatal outcome including congenital malformations after
           maternal malignancy within six months prior or during pregnancy
    • Abstract: IntroductionThe proportion of women who postpone childbearing is increasing. As malignancy risk increases with age, pregnancy in connection with malignancy will become more common.Material and methodsWe compared infants born 1994-2011 to women with a malignancy within six months prior to the last menstrual period or during pregnancy with offspring of women without a previous malignancy. Five national registers were usedResultsA total of 790 women with a malignancy diagnosis from six months prior to the last menstrual period up to delivery were identified. Their 802 infants were compared with 1 742 757 infants of women without a malignancy. A high rate of prematurity was found, especially when the malignancy was diagnosed during the 2nd or 3rd trimesters (33%). Most of these premature births were the result of induced delivery before 35 weeks (91%). The most remarkable finding is the observation that these premature infants had a significantly higher risk for neonatal morbidity than premature infants in the control group with an adjusted odds ratio of 2.67 (95% confidence interval; 1.86-3.84). We found a significantly increased risk of mainly relatively mild malformations among infants of women with a malignancy diagnosis within six months prior to the last menstrual period or during the first trimester with a risk ratio of 1.81 (95% confidence interval; 1.20-2.61)ConclusionsA high incidence of prematurity, mostly due to induced delivery, was found including an increased risk for neonatal morbidity among these infants. An increased risk for relatively mild malformations was also found.This article is protected by copyright. All rights reserved.
  • Fertility options in transgender and gender diverse adolescents
    • Abstract: Transgender coverage in media is becoming more commonplace and children and adolescents from resource-rich countries are accessing transgender healthcare at an exponentially increasing rate. What factors should care providers, adolescents and parents/guardians or caretakers take into consideration with respect to fertility' The World Professional Association for Transgender Health (WPATH) is the only global interdisciplinary association that is solely devoted to transgender health.This article is protected by copyright. All rights reserved.
  • Information about first trimester screening and self-reported distress
           among pregnant women and partners – Comparing two methods of information
           giving in Sweden
    • Abstract: IntroductionBalanced information prior to prenatal diagnosis (PND) aims to help expectant parents to make an informed choice. However, it is important that the information does not increase the expectant parents’ psychological distress. The aim was to examine psychological distress among expectant parents, before and after receiving information about PND, to evaluate the possible differences between two different procedures of information giving, and to evaluate the association between satisfaction with the information and psychological distress.Material and methodsA longitudinal design, based on questionnaire data from 380 expectant parents from four counties in Sweden. The measurement points; T1, before the information about PND was given and T2, two weeks after the prenatal screening or 15 weeks of gestation. The Hospital Anxiety and Depression Scale (HADS) and the Swedish version of the Cambridge Worrying Scale (CWS) measured psychological distress. The Satisfaction with Genetic Counseling Scale (SCS) measured satisfaction with information about PND.ResultsThe rate of psychological distress was stable among the pregnant women, but decreased among their partners, after the information was received. General anxiety and the social-medical dimension of pregnancy-related worry decreased among the participants who received information, using the more distinct two-stage process (group A), but was unchanged in group B (less distinct two-stage process). Health-related worry decreased in both groups, whereas relational worry and level of depressive symptoms were unchanged in both groups.ConclusionInformation about PND does not increase the psychological distress among expectant parents. A more distinct two-stage process of information giving might even decrease their anxiety.This article is protected by copyright. All rights reserved.
  • Response to “Telling the whole story about simulation-based
    • Abstract: We thank Barsuk et al. for their letter, “Telling the whole story about simulation-based education” (1).We acknowledge that our paper, “The cost of local, multi-professional obstetric emergencies training”(2), focussed on the cost of training and did not elaborate on cost savings, value for money or return on investment (ROI). The authors’ call for a ROI analysis is welcome. Others have estimated the potential savings of obstetric training (3).This article is protected by copyright. All rights reserved.
  • The fetuses-at-risk approach: survival analysis from a fetal perspective
    • Abstract: Several phenomena in contemporary perinatology create challenges for analyzing pregnancy outcomes. These include recent increases in iatrogenic delivery at late preterm and early term gestation which are incongruent with the belief that stillbirth and neonatal death risk decrease exponentially with advancing gestational age. Perinatal epidemiologists have also puzzled over the paradox of intersecting birth weight- and gestational age-specific perinatal mortality curves for decades. For example, neonatal mortality rates among preterm infants of women who smoke are substantially lower than neonatal mortality rates among preterm infants of non-smoking women, whereas the reverse pattern occurs at term gestation. This mortality crossover is observed across several contrasts (women with hypertensive disorders of pregnancy vs normotensive women, older vs younger women, twins vs singletons, etc.) and outcomes (stillbirth, neonatal death, sudden infant death syndrome and cerebral palsy), and irrespective of how advancing “maturity” is defined (birth weight or gestational age). One approach proposed to address and explain these unexpected phenomena is the fetuses-at-risk model. This formulation involves a reconceptualization of the denominator for perinatal outcome rates from births to surviving fetuses. In this overview of the fetuses-at-risk model, we discuss the central tenets of the births-based and the fetuses-based formulations. We also describe the extension of the fetuses-at-risk approach to outcomes into and beyond the neonatal period and to a multivariable adaptation. Finally, we provide a substantive context by discussing biological mechanisms underlying the fetuses-at-risk model and contemporary obstetric phenomena that are better understood from that model than from one based on births.This article is protected by copyright. All rights reserved.
  • Is there a revision needed of the current FIGO staging system'
    • Abstract: The FIGO staging system has undergone many modifications since it first appeared in about the middle of the previous century. Due to the use of modern diagnostic tools, namely computed tomography, magnetic resonance imaging, positron emission tomography, sentinel lymph node biopsy and of neoadjuvant chemotherapy, certain gynecological cancer cases cannot be allocated to a specific stage if one wishes to adhere strictly to FIGO requirements. In these circumstances such cases remain actually unstaged. This should prompt appropriate modifications of the current FIGO staging system so that it fulfills its aims.This article is protected by copyright. All rights reserved.
  • Targeted antenatal anti-D prophylaxis program for RhD-negative pregnant
    • Abstract: IntroductionThe aim of this study was to assess the accuracy of the non-invasive fetal RHD test at 24-26 weeks of gestation as part of the national antenatal screening programme to target routine antenatal anti-D prophylaxis (RAADP) at 28-30 weeks at women carrying an RhD-positive fetusMaterial and methodsA prospective cohort study involving all maternity care centres and delivery hospitals in Finland between February 2014 and January 2016. Fetal RHD genotyping using cell-free fetal DNA in maternal plasma was performed with real-time polymerase chain reaction in a centralised setting. The results were systematically compared with the serological newborn RhD typing. The main outcome measure was the accuracy of the fetal RHD assay; the secondary variable was compliance with the newly introduced RAADP programmeResultsFetal RHD was screened from 10 814 women. For the detection of fetal RHD, sensitivity was 99.99% (95% CI: 99.92-99.99) and specificity 99.81% (95% CI: 99.60-99.92). One false negative and seven false positive results were reported by the delivery hospitals during two years. The negative predictive value of the test was 99.97% (95% CI: 99.81-99.99). At the end of the study period, over 98% of the RhD-negative women participated in the new screening programConclusionsThe targeted RAAPD program was implemented effectively in the national maternity care programme in Finland. An accurate fetal RHD screening test allows discontinuation of newborn testing without risking the postnatal prophylaxis programme. In the future, the main area to investigate will be the clinical effect of RAADP on subsequent pregnancies.This article is protected by copyright. All rights reserved.
  • Self-management of stress urinary incontinence via a mobile app: 2-year
           follow-up of a randomized controlled trial
    • Abstract: IntroductionWe investigated the long-term effects of using a mobile app to treat stress urinary incontinence with a focus on pelvic floor muscle training (PFMT)Material and methodsA previous randomized controlled trial of 123 women aged 27–72 years found that 3 months of self-managing stress urinary incontinence with support from the Tät® app was effective. We followed-up the women in the app group (n=62) two years after the initial trial with the same primary outcomes for symptom severity (International Consultation on Incontinence Questionnaire Short Form [ICIQ-UI SF]) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptom Quality of Life [ICIQ-LUTSqol]) and compared the scores with those at baselineResultsOf the 62 women, 61 and 46 (75.4%), respectively, participated in 3-month and 2-year follow-ups. Baseline data did not differ between responders and non-responders at follow-up. The mean decreases in ICIQ-UI SF and ICIQ-LUTSqol scores after two years were 3.1 (95%CI; 2.0–4.2) and 4.0 (95%CI; 2.1–5.9), respectively. Of the 46 women, four (8.7%) rated themselves as very much better, nine (19.6%) as much better, and 16 (34.8%) as a little better. The use of incontinence protection products decreased significantly (p = 0.04), and the proportion of women who felt they could contract their pelvic muscles correctly increased from 14/46 (30.4%) at baseline to 31/46 (67.4%) at follow-up (p
  • Human papillomavirus infects placental trophoblast and Hofbauer cells, but
           appears not to play a causal role in miscarriage and preterm labor
    • Abstract: IntroductionRecently, an association between human papillomavirus (HPV) infection and both spontaneous abortion and spontaneous preterm delivery was suggested. However, the reported HPV prevalence in pregnant women varies considerably and reliable conclusions are difficult. We aimed to investigate HPV infection in placental tissue of a Danish study cohort. Furthermore, we studied the cellular localization of HPV.Material and methodsIn this prospective case-control study, placental tissue was analyzed for HPV infection by nested PCR in the following four study groups: full-term delivery (n=103), spontaneous preterm delivery (n=69), elective abortion (n=54), and spontaneous abortion (n=44). Moreover, HPV cellular target was identified by the use of in situ hybridization.ResultsHPV prevalence in placental tissue was 8.7% in full-term deliveries, 8.8% in spontaneous preterm deliveries, 10.9% in spontaneous abortions, and 20.4% in elective abortions. 12 different HPV-types were detected and placental HPV infection was associated to a disease history of cervical cancer. HPV DNA was identified in trophoblast cells, cells of the placental villi mesenchyme including Hofbauer cells, and in parts of the encasing endometrium.ConclusionWe conclude that placental HPV infections are not likely to constitute a risk factor for spontaneous preterm labor or spontaneous abortions in the Danish population, although an effect of HPV DNA in placental cells cannot be excluded.This article is protected by copyright. All rights reserved.
  • Accelerated fetal growth in early pregnancy and risk of severe large for
           gestational age and macrosomic infant: a cohort study in a low-risk
    • Abstract: IntroductionThe aim of the study was to examine the association between fetal growth in early pregnancy and risk of severely large for gestational age (LGA) and macrosomia at birth in a low-risk populationMaterial and methodsCohort study that included 68 771 women with non-anomalous singleton pregnancies, without history of diabetes or hypertension, based on electronic database on pregnancies and deliveries in Stockholm - Gotland Region, Sweden, 2008-2014. We performed multivariable logistic regression to estimate the association between accelerated fetal growth occurring in the first through early second trimester as measured by ultrasound and LGA and macrosomia at birth. Restricted analyses were performed in the groups without gestational diabetes and with normal body mass index (18.5-24.9 kg/m2).ResultsWhen adjusting for confounders, the odds of having a severely LGA or macrosomic infant were elevated in mothers with fetuses that were at least 7 days larger than expected as compared with mothers without age discrepancy at the second trimester scan (adjusted odds ratio 1.80; 95% confidence interval 1.23-2.64 and adjusted odds ratio 2.15; 95% confidence interval 1.55-2.98, respectively). Additionally, mothers without gestational diabetes and mothers with normal weight had an elevated risk of having a severely LGA or macrosomic infant when the age discrepancy by second trimester ultrasound was at least 7 days.ConclusionsIn a low-risk population, ultrasound-estimated accelerated fetal growth in early pregnancy was associated with an increased risk of having a severely LGA or macrosomic infant.This article is protected by copyright. All rights reserved.
  • Telling the whole story about simulation-based education
    • Abstract: The work of Draycott et al. using simulators to train professionals on obstetric emergencies clearly shows that rigorous simulation-based education improves perinatal outcomes, safety attitudes, and teamwork climate (1). We read “The cost of local, multi-professional obstetric emergencies training” (2) with great interest. In their study, the authors report an annual cost for the obstetric training intervention of up to €148,000. Although this is important information, we are concerned that telling only half the story about simulation-based education may have a paradoxical effect.This article is protected by copyright. All rights reserved.
  • Characterising levator-ani muscle stiffness pre- and post-childbirth in
           European and Polynesian women in New Zealand: a pilot study
    • Abstract: IntroductionThe influence of levator-ani muscles on second stage labour is poorly understood. The ability of these muscles to stretch without damage may affect birth outcomes, but little is known about material properties, effects of pregnancy and/or ethnicity on levator-ani stiffness. There are strong associations between muscle damage and subsequent pelvic floor disorders. This study aimed to quantify levator-ani muscle stiffness during the third trimester of pregnancy and postpartum in European and Polynesian women. Associations between stiffness, obstetric variables, and the risk of intrapartum levator-ani injury (avulsion) were investigated.Materials and methodsThis was a prospective observational pilot study. 167 nulliparous women were recruited antenatally; 106 European and 61 Polynesian, 129 returned postnatally. Participants were assessed between 36 and 38 weeks gestation and 3 to 5 months postpartum. Assessments included pelvic floor ultrasound, elastometry testing, and validated questionnaires on pelvic floor function. Logistic regression, Student t, Chi-squared and Mann-Whitney tests were used as appropriate.ResultsThere are significant differences between antenatal and postnatal muscle stiffness measurements (p 
  • Pregnancy outcome in women with cystic fibrosis related diabetes
    • Abstract: IntroductionWith increasing life expectancy more women with cystic fibrosis and diabetes mellitus become pregnant. We investigated how pre-gestational diabetes (cystic fibrosis related diabetes) influenced pregnancy outcome and the clinical status of these womenMaterial and methodsWe analyzed all pregnancies reported to the French cystic fibrosis registry between 2001 and 2012, and compared forced expiratory volume (FEV1) and body mass index before and after pregnancy in women with and without pre-gestational diabetes having a first deliveryResultsA total 249 women delivered 314 infants. Among these, 189 women had a first delivery and 29 of these had pre-gestational diabetes. There was a trend towards a higher rate of assisted conception among diabetic women (53.8%) as compared to non-diabetic women (34.5%, p=0.06), and the rate of cesarean section was significantly higher in diabetic women (48% versus 21.4%, p=0.005). The rate of preterm birth and mean infant birth weight did not differ significantly between diabetic and non-diabetic women. Before pregnancy forced expiratory volume was significantly lower in the diabetic group. The decline in forced expiratory volume and body mass index following pregnancy did not differ between the women with and without pre-gestational diabetesConclusionPre-gestational diabetes in cystic fibrosis women is associated with a higher rate of cesarean section, but does not seem to have a clinically significant impact on fetal growth or preterm delivery. The changes in maternal pulmonary and nutritional status following pregnancy in cystic fibrosis women were not influenced by pre-gestational diabetes.This article is protected by copyright. All rights reserved.
  • Early insights into Zika's microcephaly physiopathology, from the
           epicentre of the outbreak: teratogenic apoptosis on the central nervous
    • Abstract: Foetal infection by the Zika virus has been implicated in the exceptional rise in the number of mycrocephalic newborns recorded by the end of 2015 in Brazil. The mechanism by which this teratogenic effect is produced in the developing brain has not been entirely established. Very early in the outbreak, we addressed this question by evaluating available initial data from a gestational and post-natal clinical investigation in the Brazilian state of Pernambuco. The present study was undertaken to test the hypothesis that the subtractive dysmorphic brain malformations observed in Zika′s microcephaly are primarily due to the massive induction of apoptosis of neuroprogenitor cells. We have designed a physiopatological algorithm based on the examination of the following medical findings: epidemiological data, ultrasound images, computed tomography scans, placental tissue, cerebral fluid analysis, eye fundoscopy, neurological examination and necroscopic findings.This article is protected by copyright. All rights reserved.
  • Hysterectomy trends in Australia, 2000-01 to 2013-14: Joinpoint regression
    • Abstract: IntroductionHysterectomy is a common gynecological procedure, particularly in middle and high income countries. The aim of this paper was to describe and examine hysterectomy trends in Australia from 2000-01 to 2013-14.Material and MethodsFor women aged 25 years and over, data on the number of hysterectomies performed in Australia annually were sourced from the National Hospital and Morbidity Database. Age-specific and age-standardized hysterectomy rates per 10,000 women were estimated with adjustment for hysterectomy prevalence in the population. Using joinpoint regression analysis, we estimated the average annual percentage change over the whole study period (2000-2014) and the annual percentage change for each identified trend line segment.ResultsA total of 431 162 hysterectomy procedures were performed between 2000-01 and 2013-14; an annual average of 30 797 procedures (for women aged 25+ years). The age-standardized hysterectomy rate, adjusted for underlying hysterectomy prevalence, decreased significantly -3.5%, -2.2%). The trend was not linear with one joinpoint detected in 2008-09. Between 2000-01 and 2008-09 there was a significant decrease in incidence (annual percentage change -4.4% 95% CI: -5.2%, -3.7%) from 2008-09 to 2013-14 the decrease was minimal and not significantly different from zero (annual percentage change -0.1% 95% CI: -1.7%, 1.5%). A similar change in trend was seen in all age groups.ConclusionsHysterectomy rates in Australian women aged 25 years and over have declined in the first decade of the 21st century. However, in the last five years rates appear to have stabilized.This article is protected by copyright. All rights reserved.
  • Delivery parameters, neonatal parameters and incidence of urinary
           incontinence 6 months postpartum: a cohort study
    • Abstract: IntroductionContradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors.Material and methodThis study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health during 1998-2008. This substudy was based on 7561 primiparous women who were continent before and during pregnancy. Data were obtained from questionnaires answered at weeks 15 and 30 of pregnancy and 6 months postpartum. Data were linked to the Medical Birth Registry of Norway. Single and combined delivery- and neonatal parameters were analyzed by logistic regression analyses.ResultsBirthweight was associated with significantly higher risk of urinary incontinence 6 months postpartum (3541 – 4180 g; OR 1.4, 95% CI: 1.2-1.6, > 4180 g: OR 1.6, 95% CI: 1.2-2.0). Fetal presentation, obstetric anal sphincter injuries, episiotomy and epidural analgesia were not significantly associated with increased risk of urinary incontinence. The following combinations of risk factors among women delivering by spontaneous vaginal delivery increased the risk of urinary incontinence 6 months postpartum; birthweight ≥ 3540 g and ≥ 36 cm head circumference; birthweight ≥ 3540 g and forceps, birthweight ≥ 3540 g and episiotomy; and ≥ 36 cm head circumference and episiotomy.ConclusionSome combinations of delivery parameters and neonatal parameters seem to act together and may increase the risk of incidence of urinary incontinence 6 months postpartum in a synergetic way.This article is protected by copyright. All rights reserved.
  • ZEB1 expression is a potential indicator of invasive endometriosis
    • Abstract: IntroductionAlthough endometriosis is a benign disease, it shares some features with cancers, such as invasiveness and the potential to metastasize. This study sought to investigate the epithelial-mesenchymal transition (EMT) status in human endometriotic lesions.Material and methodsThirteen endometriosis patients and ten control women without endometriosis undergoing surgery for benign indications were recruited. We examined the expression of E-cadherin, vimentin, and EMT-induced transcriptional factors, such as Snail and ZEB1, by immunohistochemistry. We evaluated the expression of each marker in epithelial cells of both endometriotic lesions (ovarian endometrioma, deep infiltrating endometriosis, adenomyosis) and normal endometria. The correlation between ZEB1 expression and serum level of CA125 was also investigated.ResultsImmunohistochemical analysis revealed that although E-cadherin, vimentin, and Snail were expressed in epithelia of normal endometria and endometriotic lesions, ZEB1 expression was only expressed in epithelia of endometriotic lesions. Additionally, ZEB1 was most frequently observed in epithelial cells of invasive endometriosis. The endometriosis patients with high serum CA125 level were more likely to have ZEB1-positive lesions.ConclusionThis is the first observation of ZEB1 expression in epithelial cells of benign disease. The preferential expression of ZEB1 in epithelial cells of endometriotic lesions suggests that these cells may have, at least in part, higher mesenchymal features possibly via ZEB1-driven EMT than normal endometria and that ZEB1 can be a potential indicator of invasiveness or severity of endometriosis.This article is protected by copyright. All rights reserved.
  • Routine provision of intrauterine contraception at elective cesarean
           section in a national public health service: a service evaluation
    • Abstract: IntroductionWe conducted a prospective health service evaluation to assess the feasibility and acceptability of routinely offering insertion of intrauterine contraception (IUC) at cesarean section in a maternity setting in the UK.Material and methodsOne month before scheduled cesarean section, women were sent information about postpartum contraception including the option of insertion of IUC at cesarean. Women choosing IUC (copper intrauterine device or levonorgestrel intrauterine system) were followed up in person at six weeks; telephone contact was made at three, six and 12 months postpartum. Our main outcome measures were uptake of IUC and complications by six weeks. Secondary outcomes were continuation and satisfaction with IUC at 12 months.Results120/877 women opted to have IUC (13.7%), of which 114 were fitted. By six weeks, there were seven expulsions (6.1%). The expulsion rate by one year was 8.8%. There were been no cases of uterine perforations and one case of infection (0.8%). Follow up rates were 82.5% at 12 months, and continuation rates with IUC at 12 months were 84.8% of those contacted. At 12 months 92.7% of respondents asked were either ‘very’ or ‘fairly’ happy with their IUC.ConclusionsRoutine provision of IUC at elective cesarean for women in a public maternity service is feasible and acceptable to women. It is associated with good uptake and good continuation rates for the first year. This could be an important strategy to increase use of IUC and prevent short inter-pregnancy intervals and unintended pregnancies.This article is protected by copyright. All rights reserved.
  • Vitamin D insufficiency, preterm delivery and preeclampsia in women with
           type 1 diabetes – an observational study
    • Abstract: IntroductionThe aim was to evaluate whether vitamin D insufficiency is associated with preterm delivery and preeclampsia in women with type 1 diabetes.Material and methodsAn observational study of 198 pregnant women with type 1 diabetes. 25-Hydroxy-Vitamin D and HbA1c were measured in blood samples in early (median 8 weeks, range 5-14) and late (34 weeks, 32-36) pregnancy. Kidney involvement (microalbuminuria or nephropathy) at inclusion, smoking status at inclusion, preterm delivery (
  • Modified posterior pelvic exenteration for advanced ovarian malignancies:
           a single-institution study of 35 cases
    • Abstract: IntroductionThis study aimed to investigate the possible benefits of a complete cytoreduction in patients with advanced ovarian cancer and concomitant rectal invasion. Furthermore, we evaluated the morbidity associated with radical surgery.Material and methodsA retrospective analysis examined 35 cases that underwent radical surgery in the form of modified posterior pelvic exenteration (MPPE). Descriptive statistics, Kaplan-Meier survival curves and Log-Rank test were used for statistical estimations. Surgical complications were analyzed using the Clavien-Dindo classification.ResultsThe analysis of survival in relation to residual disease assessed according to Sugarbaker confirmed an optimistic prognosis in patients with optimal debulking with a mean disease-free survival period of 33.6 months in R0 patients, 19.6 months in R1 patients and 14.3 months in R2 patients. A statistically significant difference in disease-free survival (p = 0.023) was observed between the R0 (without residual disease) and R1+2 (with residual disease) groups. Surgical complications occurred in 83% of patients, with early postoperative complications being most frequent (65.7%). While grade III–IV complications occurred in 37.7% of all patients, no cases of surgery-associated mortality occurred.ConclusionsMPPE is a highly effective method for achieving optimal debulking in cases of advanced ovarian cancer with the direct invasion of the rectum. MPPE does not delay the beginning of complementary chemotherapy. However, it is necessary to take into account surgery-related morbidity. As MPPE represents an extremely invasive technique, the surgical plan and perioperative care should be personalized in order to address the individual medical and surgical conditions of each patient.This article is protected by copyright. All rights reserved.
  • Echographic features and perinatal outcomes in fetuses with congenital
           absence of ductus venosus
    • Abstract: IntroductionThe purpose of this study was to describe the echographic features and perinatal outcomes of fetuses with absence of ductus venosus (ADV)Material and methodsRetrospective review of 10 cases with ADV diagnosed by prenatal ultrasonography between January 2014 and February 2016 at a single referral center. Prenatal findings, umbilical shunting type, perinatal outcomes, and autopsy reports were reviewedResultsA total of 11 491 fetuses underwent a first and second trimester screening during the study period. 10 cases of ADV were diagnosed. All of the cases presented an extrahepatic shunt: three cases from the umbilical vein to the right atrium and the seven remaining cases from the umbilical vein to the inferior vena cava. Major structural defects and fetal effusions were detected in six cases. There were two cases of chromosomal abnormalities. Five patients underwent legal termination of pregnancy and five decided to carry to term. In two of the cases, the ADV anomaly was isolated and had a normal outcome. In the remaining three cases, a follow-up of the children showed a variety of adverse outcomesConclusionsThe ADV is associated with high rates of adverse perinatal outcomes. The prognosis for this group of anomalies depends on the additional findings with targeted ultrasound. This pathology should lead to a detailed anatomical study and be closely monitored for signs of congestive heart failure.This article is protected by copyright. All rights reserved.
  • Pregnancy outcomes after liver transplantation in Finland
    • Abstract: IntroductionPregnancy after liver transplantation (LT) is possible but associated with increased risk of obstetrical complications. We report here for the first time the pregnancy outcomes after LT in FinlandMaterial and methodsAll of the 25 pregnancies ending in deliveries after LT in Finland in 1998-2015 were analyzed. The data were collected from the mothers′ medical records. The main outcome measures included pregnancy complications and the mode of the delivery. Neonatal outcome measures were birth weight, 5 minute Apgar score and umbilical artery pHResultsThere were 26 infants born. Of all deliveries, 76% occurred at the gestational weeks of 37 or more and the average birth weight was 3040g. Apgar scores were 7 or more in 25/26 (96%) of the infants and cases of birth asphyxia (umbilical artery pH ≤7.05) were not detected. Cesarean section rate was 32%. Pre-eclampsia occurred in 12% of the women and the preterm delivery rate was 24%. Co-morbidities (hypertension, intrahepatic cholestasis of pregnancy, Hodgkin′s disease, Colitis ulcerosa, epileptic attacks, cholangitis, splenic artery rupture, renal insufficiency and graft rejection) complicated 52% of pregnanciesConclusionPregnancies after LT in Finland result in good perinatal outcome with healthy, mostly full-term, normally grown off-springs, however, serious maternal complications related to underlying liver pathology, transplant surgery and immunosuppressive medication occur frequently.This article is protected by copyright. All rights reserved.
  • 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
  • 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
    • 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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