| 1. |
- Aarnio, Riina, et al.
(author)
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Diagnostic excision of the cervix in women over 40 years with human papilloma virus persistency and normal cytology
- 2019
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In: European journal of obstetrics & gynecology and reproductive biology: X. - : Elsevier BV. - 2590-1613. ; 3
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Journal article (peer-reviewed)abstract
- Objective: Persistent infection with human papillomavirus (HPV) is recognized as the main risk factor of cervical cancer. Investigation via cytology and colposcopy have lower sensitivity than HPV testing in the diagnosis of high-grade cervical intraepithelial neoplasia (CIN2+). Despite normal cytology and colposcopy findings women with persistent HPV infection have an increased risk of CIN2+. The aim of the study was to evaluate the proportion of histologically confirmed CIN2+ in women with persistent HPV infection and normal Pap smears.Study design: From April 2013 until March 2016 we prospectively recruited 91 women over 40 years with persistent HPV infection without any abnormalities in cytology. Of these, 40 women attended a gynecological examination including an HPV test, Pap smear, endocervical cytology, colposcopy with biopsies and diagnostic loop electrosurgical excision procedure (LEEP). Biopsy and LEEP samples were subjected to histological examination.Results: CIN2+ was verified by histological examination of the LEEP sample in 6/40 (15%) of the women. All the cytological samples were normal and none of the biopsies confirmed CIN2+. Only 19/40 women still had a persistent HPV infection at the study visit. None of the 21/40 women who had cleared their HPV infection at the study visit had CIN2+ in histology of the LEEP sample.Conclusions: A persistent HPV infection needs to be monitored despite normal Pap smears, since 6/40 (15%) women older than 40 years, was revealed to have an undiagnosed CIN2+ when LEEP was performed. Counseling women regarding the risk of cervical cancer and the expected effect of an eventual LEEP can help them to make an optimal informed choice.
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| 2. |
- Aberšek, Nina, et al.
(author)
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Characterizing of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta marked by elevated amniotic fluid interferon gamma-induced protein 10 (IP-10) in pregnancies complicated by preterm prelabor rupture of membranes.
- 2024
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In: European Journal of Obstetrics and Gynecology and Reproductive Biology: X. - 2590-1613 .- 1872-7654. ; 296, s. 292-298
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Journal article (peer-reviewed)abstract
- This study aimed to determine the occurrence of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta, marked by elevated levels of interferon gamma-induced protein 10 (IP-10) (≥2200pg/mL) in the amniotic fluid of women with preterm prelabor rupture of membranes (PPROM). Specifically, the study investigated whether these intra-amniotic inflammatory changes were more common in women with microbial invasion of amniotic cavity (MIAC) and intra-amniotic inflammation (IAI), as indicated by increased amniotic fluid interleukin (IL)-6 concentration (≥3000pg/mL).A cohort of 114 women with singleton pregnancies complicated by PPROM between 24+0 and 36+6 weeks of gestation were included. Amniotic fluid samples were obtained via amniocentesis upon admission. MIAC diagnosis involved aerobic and anaerobic cultures, as well as polymerase chain reaction (PCR) analysis of the amniotic fluid. Immunoassay tests and enzyme-linked immunosorbent assay (ELISA) were used to determine IL-6 and IP-10 concentrations, respectively.Among the participants, 19.3% and 15.8% had MIAC and IAI, respectively. The occurrence of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta was similar between women with and without MIAC (25% vs. 40.9%, p=0.136, adjusted p=0.213). The rate of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta was significantly higher in women with IAI compared to those without, after adjusting for gestational age at sampling (55.6% vs. 22.9%, p=0.005, adjusted p=0.011).This study revealed comparable rates of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta in women with and without MIAC, but a higher prevalence of intra-amniotic inflammatory changes associated with chronic inflammation in the placenta in women with IAI. These findings suggest involvement of chronic inflammation even in women with PPROM with acute intra-amniotic inflammation.
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| 3. |
- Ayres-de-Campos, Diogo, et al.
(author)
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European Association of Perinatal Medicine (EAPM), European Board and College of Obstetricians and Gynaecologists (EBCOG), European Midwives Association (EMA). Joint position statement : Substandard and disrespectful care in labour - because words matter
- 2024
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In: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier. - 0301-2115 .- 1872-7654 .- 2590-1613. ; 296, s. 205-207
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Journal article (peer-reviewed)abstract
- Substandard or disrespectful care during labour should be of serious concern for healthcare professionals, as it can affect one of the most important events in a woman's life. Substandard care refers to the use of interventions that are not considered best -practice, to the inadequate execution of interventions, to situations where bestpractice interventions are withheld from patients, or there is lack of adequate informed consent. Disrespectful care refers to forms of verbal and non-verbal communication that affect patients' dignity, individuality, privacy, intimacy, or personal beliefs. There are many possible underlying causes for substandard and disrespectful care in labour, including difficulties in modifying behaviours, judgmental or paternalistic attitudes, personal interests and individualism, and a human tendency to make less arduous, less difficult, or less stressful clinical decisions. The term "obstetric violence" is used in some parts of the world to describe various forms of substandard and disrespectful care in labour, but suggests that it is mainly carried out by obstetricians and is a serious form of aggression, carried out with the intent to cause harm. We believe that this term should not be used, as it does not help to identify the underlying problem, its causes, or its correction. In addition, it is generally seen by obstetricians and other healthcare professionals as an unjust and offensive term, generating a defensive and less collaborative mindset. We reach out to all individuals and institutions sharing the common goal of improving women's experience during labour, to work together to address the underlying causes of substandard and disrespectful care, and to develop common strategies to deal with this problem, based on mutual comprehension, trust and respect
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| 4. |
- Ayres-de-Campos, Diogo, et al.
(author)
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EUROPEAN ASSOCIATION OF PERINATAL MEDICINE (EAPM) EUROPEAN MIDWIVES ASSOCIATION (EMA) Joint position statement: Caesarean delivery rates at a country level should be in the 15-20 % range
- 2024
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In: European Journal of Obstetrics and Gynecology and Reproductive Biology: X. - 2590-1613. ; 294, s. 76-78
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Journal article (peer-reviewed)abstract
- While cesarean deliveries performed for health indications can save lives, unnecessary cesareans cause unjustifiable health risks for the mother, newborn, and for future pregnancies. Previous recommendations for cesarean delivery rates at a country level in the 10-15% range are currently unrealistic, and the proposed concept that striving to achieve specific rates is not important has resulted in a confusing message reaching healthcare professionals and the public. It is important to have a clear understanding of when cesarean delivery rates are deviating from internationally acceptable ranges, to trigger the implementation of healthcare policies needed to correct this problem. Based on currently existing scientific evidence, we recommend that cesarean delivery rates at a country level should be in the 15-20% range. This advice is based on the demonstration of decreased maternal and neonatal mortalities when national cesarean delivery rates rise to circa 15%, but values exceeding 20% are not associated with further benefits. It is also based on real-world experiences from northern European countries, where cesarean delivery rates in the 15-20% range are associated with some of the best maternal and perinatal quality indicators in the world. With the increase in cesarean delivery rates projected for the coming years, experience in provision of intrapartum care may come under threat in many hospitals, and recovering from this situation is likely to be a major challenge. Professional and scientific societies, together with healthcare authorities and governments need to prioritize actions to reverse the upward trend in cesarean delivery rates observed in many countries, and to strive to achieve values as close as possible to the recommended range.
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| 5. |
- Ekengård, Frida, et al.
(author)
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Low sensitivity of the new FIGO classification system for electronic fetal monitoring to identify fetal acidosis in the second stage of labor
- 2021
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In: European Journal of Obstetrics & Gynecology and Reproductive Biology: X. - : Elsevier BV. - 2590-1613. ; 9
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Journal article (peer-reviewed)abstract
- Objective In 2015, new FIGO guidelines for CTG interpretation were presented (FIGO-15). In 2017, the previous Swedish guidelines (SWE-09) were replaced with guidelines adapted to FIGOs (SWE-17). The performance of these three templates had not been scientifically evaluated before its clinical implementation. The objective of this study was to compare the sensitivity and specificity to detect fetal acidosis at birth using these three templates during the second stage of labor. Study design This case-control study included 295 neonates with cord blood pH < 7.05 and 591 controls with pH ≥ 7.15, born 2012−2017. Tracings from the last 30−80 min of labor were classified independently by three assessors (midwives, residents and obstetricians), blinded to group and outcome. Results The classification pathological using FIGO-15 had a sensitivity of 50 % and specificity of 88 % in detecting fetuses with acidosis. For SWE-17, the sensitivity was 62 % and the specificity 85 %. For SWE-09 the sensitivity was 87 % and the specificity 56 %. By combining suspicious and pathological patterns the sensitivity for FIGO-15 increased to 97 %, and for SWE-17 to 83 %, whereas the specificity decreased to 23 % and 68 % respectively. Conclusions The FIGO classification seemed to be insufficiently discriminative in the second stage of labor; most patterns in acidotic cases were classified as merely suspicious with this template, and the sensitivity of pathological patterns was low at 50 %. Combined pathological and suspicious patterns detected fetal acidosis at a specificity that was too low to be useful (23 %). SWE-09 showed the best ability to detect acidosis with pathological patterns (sensitivity 87 %). SWE-17 reached almost the same sensitivity (83 %) with the combination of suspicious and pathological patterns, and at a higher specificity (68 %).
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| 6. |
- Hermansson, Ruth S., et al.
(author)
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History of HPV in HPV-positive elderly women
- 2024
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In: European journal of obstetrics & gynecology and reproductive biology: X. - : Elsevier. - 2590-1613. ; 22
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Journal article (peer-reviewed)abstract
- BACKGROUND: The aim of this study was to examine the natural course of HPV infection in women of 60 years and older who were HPV positive at inclusion, and any association between HPV positivity in historical samples and dysplasia outcome. METHODS: Eighty-nine women aged 60-82 years, who tested positive for HPV between 2012 and 2016 were included. Sampling for cytology and/or histology was also performed. HPV genotyping was carried out on archived material back to 1999.RESULTS: Of the 89 HPV-positive women 16 had HSIL, 34 had LSIL and 39 were benign at inclusion. Of the women with HSIL, 50.0% had the same HPV type in the archive samples, 12.5% had another type, and 37.5% were HPV negative. Among the 34 women with LSIL, 47.1% had the same HPV type in archive samples, 5.8% had another type, and 47.1% were HPV negative. Of the 39 women without dysplasia at inclusion, 25.6% had the same HPV type in archive samples, 5.1% had another HPV type and 69.2% were HPV negative.CONCLUSION: Surprisingly few of the elderly women thus seem to have a history with the same or any HPV infection the years before being diagnosed with an HPV infection and dysplasia. The significance of an HPV infection for dysplasia development in elderly women is still not fully understood.
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| 7. |
- Hesselman, Susanne, 1973-, et al.
(author)
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Duration of labor among women with thromboembolic events: A Swedish register study
- 2021
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In: European Journal of Obstetrics and Gynecology and Reproductive Biology: X. - : Elsevier BV. - 2590-1613. ; 11
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Journal article (peer-reviewed)abstract
- Introduction: Inflammation is central to initiation of labor and coagulation is closely interlinked with inflammation. Low-molecular-weight-heparin (LMWH) promotes inflammatory cervical remodeling, myometrium contractility and has been associated with shorter duration of labor. Material and methods: This was a cohort study of 136,661 deliveries 2013–2017, identified in the Swedish Pregnancy Register with prospectively collected pregnancy and labor characteristics. Information of duration of labor was retrieved from the electronic birth records and analyzed with Cox proportional hazard regressions according to previous or current thromboembolic disease (overall) with or without LMWH treatment with non-exposed as reference. Results: The crude hazard ratio for vaginal delivery was not different between women with thromboembolic disease and women without thromboembolic disease (HR 0.99, 95 % CI 0.91–1.09). A lower hazard ratio for vaginal delivery was observed among women with venous thromboembolism (VTE) with concomitant LMWH use/treatment (adjusted HR 0.86, 95 % CI 0.76−0.98) compared to non-exposed, implying a longer duration of labor in these cases. Conclusion: Thromboembolic disease was not associated with shorter duration of labor and in presence of LMWH these women experienced longer duration of labor. © 2021 The Authors
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| 8. |
- Lindberger, Emelie, 1987-, et al.
(author)
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Impact of maternal central adiposity on infant anthropometry and perinatal morbidity: A systematic review
- 2020
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In: European journal of obstetrics & gynecology and reproductive biology: X. - : Elsevier BV. - 2590-1613 .- 2590-1613. ; 8, s. 1-8
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Journal article (peer-reviewed)abstract
- Overweight and obesity during pregnancy are risk factors for a large number of perinatal complications, both for the mother and the infant. Risk stratification and early interventions are therefore highly clinically important to minimize future complications. Currently, body mass index (BMI) in early pregnancy is used for risk stratification of pregnant women, but a disadvantage of BMI is that it does not distinguish muscle from fat tissue and central from peripheral adiposity. Maternal fat distribution is suggested to be a better predictor than BMI of obesity-related adverse pregnancy outcomes, with central adiposity posing a greater risk than peripheral subcutaneous fat. With this study, we aimed to systematically review the evidence of what impact maternal central adiposity in early to mid-pregnancy or at most 365 days prior to conception has on infant anthropometry and perinatal morbidity. The databases PubMed/MEDLINE, Web of Science Core Collection, CINAHL, SCOPUS, Clinical Trials, and Open Grey were searched from inception until November 2019. Eligible studies assessed the association between maternal central adiposity, in early to mid-pregnancy or at most 365 days prior to conception, and any of the following infant outcomes: preterm delivery (< 37 weeks of gestation), birthweight, macrosomia, large for gestational age, congenital malformations, hypoglycemia, hyperbilirubinemia, care at neonatal intensive care unit, and death. Two authors independently screened titles and abstracts, read the included full-text studies, and extracted data. The Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to evaluate the quality of and risk of bias in the studies. A total of 720 records were identified, 20 full-text studies assessed for eligibility, and 10 cohort studies included in the review. The results suggest that central adiposity in early to mid-pregnancy or at most 365 days prior to conception may contribute to increased birthweight and increased likelihood of delivery by cesarean section. There is also some evidence of associations between central adiposity and preterm delivery (< 37 weeks of gestation), and admission to neonatal intensive care unit. A meta-analysis was not possible to perform due to substantial heterogeneity among the included studies regarding the exposure, outcome, and statistical methods used. Hence, central adiposity in early to mid-pregnancy or at most 365 days prior to conception could be a possible risk marker in addition to BMI for risk stratification of pregnant women. However, since the topic is only scarcely researched, and the results not unanimous, more studies are needed to further clarify the associations between maternal central adiposity and adverse neonatal complications, before any altered recommendations of guidelines could be made. To enable a future meta-analysis, studies using similar methods for central adiposity assessment,and similar outcome measures, are required. Keywords: BMI, body mass index kg/m2; Birthweight; CT, computed tomography; Central adiposity; LGA, large for gestational age; MRI, magnetic resonance imaging; Macrosomia; NICU, neonatal intensive care unit; Perinatal morbidity; Pregnancy; SFT, subcutaneous fat thickness; VAT, visceral adipose tissue; WC, waist circumference; WHR, waist-to-hip ratio
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| 9. |
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| 10. |
- Turkmen, Sahruh, et al.
(author)
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Foeto–Maternal outcomes of pregnancies beyond 41 weeks of gestation after induced or spontaneous labour
- 2024
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In: European Journal of Obstetrics and Gynecology and Reproductive Biology: X. - : Elsevier. - 2590-1613. ; 24
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Journal article (peer-reviewed)abstract
- Objective: It has been suggested that induction of labour before 42 weeks of pregnancy prevents foetal complications. To evaluate the maternal and foetal outcomes of induced and spontaneous labour beyond gestational week 41 + 0.Study design: We conducted a register-based nationwide cohort study that included pregnant women who were delivered in Sweden in 2016–2021. Women were classified into two groups: induction of labour (IOL) or spontaneous onset of labour (SOL). Maternal and foetal outcomes after IOL in gestational week 41 were compared with SOL in gestational week 41 and 42.Results: Comparison between the IOL (n = 23,772) and SOL (n = 62,611) groups in gestational weeks 41 showed that various parameters were higher in the IOL group: caesarean deliveries (12.3 % and 4.6 %, P < 0.001), vacuum extraction (8.7 % and 6.9 %, P < 0.001), blood loss of > 1000 ml during labour (11 % vs 8.3 %, P < 0.001). The risks were remained significant even after adjusting for potential confounders (caesarean delivery: aOR 2.36; 95 % CI, 2.23–2.50, vacuum delivery: aOR 1.09; 95 % CI, 1.03–1.16, P = 0.002, and blood loss of >1000 ml: aOR 1.25; 95 % CI 1.18–1.31). The proportions of stillbirths (0.07 % and 0.18, P < 0.001), and newborns with apgar scores < 4 at five minutes (0.4 % vs 0.3 %, P < 0.001), were also higher in the IOL group. The risk of stillbirth after IOL in gestational week 41 was increased relative to SOL in the same week and remained high after adjusting for potential confounders (aOR 1.75; 95 % CI 1.07–2.80, P = 0.025). The IOL group in gestational weeks 41 comprised a higher proportion of caesarean deliveries (12.3 % and 8.5 %, P < 0.001), but a lower (8.7 % and 9.7 %, P = 0.006) proportion of deliveries by vacuum extraction than the SOL group (n = 4548) in week 42.Conclusions: Inducing labour at gestational week 41 in women with prolonged pregnancies may have adverse effects on foetal and maternal outcomes compared to those who experience spontaneous labour onset at the same gestational age. The risk of negative foetal outcomes after induction at week 41 appears similar to that in women who give birth after spontaneous labour at week 42.
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