Abstract Introduction With liberalization of abortion laws in the Nordic countries during the 1970s, there were efforts to prevent unplanned pregnancies among young women by improved contraceptive provision. In an ecological design, we describe country‐specific actions for meeting young women's contraceptive needs and their impact on induced abortion and births. Material and Methods We used national data from 1974 to 2023 on populations and numbers of induced abortions and births for 15–19‐ and 20–24‐year‐old women. Available public documents included information on preventive measures, availability of hormonal contraceptives (providers/dispensation), and reimbursement schemes. Joinpoint regression analysis was used to assess breakpoints in country‐specific age trends for annual abortion and birth rates. Results Sweden authorized midwives to prescribe contraceptives in 1976, Norway in 2002 (and public health nurses), Finland in 2020 (and public health nurses) and Iceland in 2021, while physicians have remained the only provider in Denmark. Sweden set up youth clinics from the late 1970s and clinics opened in Norway from the early 1990s. Partial or full reimbursement for combined oral contraceptives to 16–23‐year‐old women began gradually in Sweden in the early 1990s and expanded to a national program on contraceptives in 2014/2016. A Norwegian free‐of‐charge scheme to 16–19‐year‐old women for combined oral contraceptives from 2002 changed in 2006 to include partial coverage for short‐acting reversible contraceptives and was expanded to long‐acting reversible contraceptives in 2015/2016. In Finland two large cities offered long‐acting reversible contraceptive free‐of‐charge from 2007/2013. Denmark and Iceland have not had reimbursement schemes for hormonal contraceptives. We found no breakpoints in trends for induced abortions and births that could relate to any preventive actions. Trends were relatively similar in countries with or without expanded prescription rights to midwives/public health nurses and unrelated to reimbursement schemes. Birth rates among women <25 years are now <10% of those seen 50 years ago, while most of the decline in abortion rates took place after 2010. Conclusion Trends for induced abortion and births among women <25 years have developed similarly across the Nordic countries. They are global and appear less likely to be associated with national health services and targeted contraceptive policies.

Background During the 1970s the Nordic countries liberalized their abortion laws.Objective We assessed epidemiological trends for induced abortion on all Nordic countries, considered legal similarities and diversities, effects of new medical innovations and changes in practical and legal provisions during the subsequent years.Methods New legislation strengthened surveillance of induced abortion in all countries and mandated hospitals that performed abortions to report to national abortion registers. Published data from the Nordic abortion registers were considered and new comparative analyses done. The data cover complete national populations.Results and conclusions After an increase in abortion rates during the first years following liberalization, the general abortion rates stabilized and even decreased in all Nordic countries, especially for women under 25 years. From the mid-1980s higher awareness about pregnancy termination led women to present at an earlier gestational age, which was accelerated by the introduction of medical abortion some years later. Most terminations (80-86%) are now done before the 9th gestational week in all countries, primarily by medical rather than surgical means. Introduction of routine ultrasound screening in pregnancy during the late 1980s, increased the number of 2nd trimester abortions on fetal anomaly indications without an overall increase in the proportion of 2nd relative to 1st trimester abortions. Further refinement of ultrasound screening and non-invasive prenatal diagnostic methods led to a slight increase in the proportion of early 2nd trimester abortions after the year 2000. Country-specific differences in abortion rates have remained stable over the 50 years of liberalized abortion laws.

It is with sadness that we received the message that Karel Maršál passed away on March 6, 2023. Karel Maršál, MD, PhD, Professor Emeritus at Lund University and Director of the WHO Collaborating Center in Lund, was born in Prague, former Czechoslovakia, in 1943. After completing his undergraduate studies at Charles University in Prague, he and his fiancée Lida moved as political refugees to Sweden in 1968. They came to Malmö General Hospital in 1973, where Karel gained his specialty in obstetrics and gynecology. Already then, Malmö was a nursery for research on fetal physiology and monitoring, and Karel was soon involved. He defended his PhD thesis, “Ultrasonic Measurements of Fetal Breathing Movements in Man”, at Lund University in 1977. With the introduction of Doppler ultrasonography to measure blood flow velocity, an era of prolific research commenced, leading to a growing international collaboration under Karel's leadership. In a series of PhD theses, normal fetal circulation was mapped to form the basis for the clinical assessment of the compromised fetus, and for studying the effects of medications and smoking during pregnancy. Experimental work on fetal lambs added further insights into circulatory pathophysiology. The introduction of routine ultrasound in Malmö in 1972 paved the way for identifying and studying fetal growth restriction and its underlying circulatory changes, today a major clinical field. Karel was the Head of the Perinatal Division at the University Hospital in Malmö and his personality as an enthusiastic, persevering, and meticulous scientist earned him a professorship in Malmö in 1991. In 1997, Karel moved to Lund to become Professor in Obstetrics and Gynecology, and later head of the clinical department. In 1995, he became Honorary Professor at Charles University in Prague, Czech Republic. He also served as Director of the undergraduate program of the Medical School at Lund University and as Chief Medical Officer in the county of Skåne, Sweden. Karel was the main tutor of 21 PhD students and co-tutor of another 14 research students. He published 354 original papers, 132 book chapters and reviews, and 14 textbooks. He was editor or co-editor of the Journal of Maternal and Fetal Investigation, of Fetal and Maternal Medicine Review, and of Seminars in Fetal and Neonatal Medicine, and was a member of the editorial board of 10 international scientific journals. His primary areas of experience and research were in perinatology, obstetrics, fetal monitoring, obstetric and gynecologic ultrasound, Doppler ultrasound, fetal physiology, ultrasound safety, and obstetric quality assurance. Throughout the years, Karel's research was supported by numerous grants, among them from the prestigious Swedish Research Council. He was the principal investigator in numerous national and international multicenter studies, such as the EXPRESS study on extremely preterm infants in Sweden, and he was national coordinator for Sweden in three EU studies. Karel served as president of the International Society of Ultrasound in Obstetrics and Gynecology, he was an honorary member of various national and international institutions and a board member of European Federation of Societies for Ultrasound in Medicine and Biology, World Federation for Ultrasound in Medicine and Biology, and other societies. In the past, he was the main organizer of 15 international scientific congresses, including two world congresses on ultrasound in obstetrics and gynecology. He received several prestigious awards, such as the Ian Donald Gold Medal and the Haackert Gold Medal in Prenatal Medicine. Karel was elected Doctor Honoris Causae at universities in Olomouc, Czech Republic, and Poznan, Poland. He was course leader of 38 national and international postgraduate courses in perinatal medicine, obstetrics, ultrasound, and obstetric Doppler ultrasound. His last participation in such an event was in February 2023. Karel's wife, Lida, gave him unending support throughout his career. Had Karel not injured his leg in a skiing accident, their paths may never have crossed. He had to take a break from medical school, and when he returned to his studies, he and Lida became classmates. Innumerable mothers and children all over the globe have benefited from Karel's ground-breaking scientific work, leadership, and deeds. His 50-year career as a clinician, scientist, teacher, coach, role model, and—most of all—the best friend of the unborn baby is now at an end. Among his friends and co-workers, he will be vividly remembered as a quietly jovial, sharp-witted gentleman with a human perspective and a friendly attitude toward each of us. He is sorely missed.

INTRODUCTION: Maternal deaths are rare and an indirect measure of the societal framework surrounding pregnancy and childbirth. We surveyed and classified maternal mortality in Iceland using international guidelines, calculating changes over a 40-year period. MATERIAL AND METHODS: Information from Statistics Iceland on women aged 15-49 years who died in 1985-2015 were cross-checked against birth registration and hospital admission data to identify women who died in pregnancy or ≤42 and within 43-365 days from birth or termination of a pregnancy. Data for 1976-1984 were searched manually. Case records and autopsy reports were scrutinized. Deaths were classified as direct, indirect or coincidental and as early or late. RESULTS: Among 1600 women 48 died in pregnancy or within a year after pregnancy. Births totaled 172369 and overall maternal mortality was 27.8/100.000 births. Maternal mortality by World Health Organization criteria (direct/indirect ≤42 days) occurred in 14 instances giving a maternal mortality ratio (MMR) of 8.1/100.000. Rates lowered between the first and last 10-year periods, particularly initially followed by a lesser downward trend. Direct deaths were 6, indirect 20, coincidental 22 (accidents, diseases). Causes of direct deaths were severe preeclampsia, pulmonary embolism and choriocarcinoma. Underlying causes of indirect deaths included cancer, diabetes, brain/heart conditions and suicide. No deaths occurred from ectopic pregnancy, hemorrhage or anesthesia. CONCLUSIONS: Maternal mortality in Iceland is among the lowest reported. Women died because of the pregnancy, from worsening of underlying conditions or coincidentally. Risk groups require better support. Continued attention to adverse health connected to maternity is essential.

Endometriosis is a common condition associated with debilitating pelvic pain and infertility. A genome-wide association study meta-analysis, including 60,674 cases and 701,926 controls of European and East Asian descent, identified 42 genome-wide significant loci comprising 49 distinct association signals. Effect sizes were largest for stage 3/4 disease, driven by ovarian endometriosis. Identified signals explained up to 5.01% of disease variance and regulated expression or methylation of genes in endometrium and blood, many of which were associated with pain perception/maintenance (SRP14/BMF, GDAP1, MLLT10, BSN and NGF). We observed significant genetic correlations between endometriosis and 11 pain conditions, including migraine, back and multisite chronic pain (MCP), as well as inflammatory conditions, including asthma and osteoarthritis. Multitrait genetic analyses identified substantial sharing of variants associated with endometriosis and MCP/migraine. Targeted investigations of genetically regulated mechanisms shared between endometriosis and other pain conditions are needed to aid the development of new treatments and facilitate early symptomatic intervention. Meta-analyses of genome-wide association studies for endometriosis identify 49 distinct association signals. Fine-mapping of causal variants explores functional effects across various tissues. Genetic correlations between endometriosis and other pain conditions are also highlighted.

IntroductionThe incidence and prevalence of pelvic endometriosis is still being debated. Population-based studies have shown annual incidences between 0.1% and 0.3%, which translates to a prevalence of symptom-giving disease of between 2% and 6% over a 20-year span in the reproductive years. However, a prevalence of 10% or higher is often assumed. We used Iceland's extensive record linkage possibilities, secure access to patient data and personal identification numbers to search for all cases with a surgical and/or histological first diagnosis over a 15-year study period. Material and methodsInformation was obtained from all healthcare facilities where an operative and/or histological diagnosis of pelvic endometriosis might have been made during 2001-2015. Hospital discharge diagnostic data and private clinic data sources were scrutinized and double-checked through a central register. Individual medical records, operation notes and pathology records were inspected. Visually and pathologically diagnosed cases were included. The data covered women aged 15-69 years, but the age range 15-49 (reproductive years) was specifically considered. Annual incidence was estimated per 10 000 person-years and prevalence possibilities calculated for varying disease durations. Disease severity was staged (revised American Society for Reproductive Medicine classification) and main lesion sites determined. ResultsA total of 1634 women 15-69 years old were diagnosed; 1487 of them between 15 and 49 years old. Histological verification was obtained for 57.1%. The age-standardized annual incidence for all confirmed endometriosis diagnoses was 12.5/10 000 person-years among women in their reproductive years. The overall estimate of prevalence was 0.6%-3.6%, dependent on duration of symptoms from 5 up to 30 years. The most common sites by order of frequency were ovaries, deep pelvis, central pelvis, vesicouterine pouch and uterine appendages. Of the women, 1080 (66.1%) had minimal/mild and 553 (33.8%) moderate/severe disease. ConclusionsWe have in a comprehensive study covering a recent 15-year period confirmed an annual incidence of pelvic endometriosis of between 0.1% and 0.15% in the female population of reproductive age. Endometriosis is variably severe but, depending on the duration of symptomatic disease, the approximated prevalence during women's reproductive years could range from 1% to 4%.

Objectives To study effects of physiotherapist-guided pelvic floor muscle training on pelvic organ prolapse (POP) early postpartum period. Design Assessor-blinded, randomized controlled trial. Setting Physiotherapy Clinic, Reykjavik. Sample Eighty-four primiparous women with a singleton delivery. Methods Participants were screened for eligibility 6-13 weeks postpartum. Women randomized to the training group conducted 12 weekly individual sessions with a physiotherapist, starting on average 9 weeks after childbirth. Outcomes were assessed after the last session (short-term) and at 12 months postpartum (long-term). The control group received no instructions after the initial assessment. Main outcome measures Self-evaluated POP symptoms by the Australian Pelvic Floor Questionnaire. Results Forty-one and 43 women were randomized to the training and control groups, respectively. At recruitment, 17 (42.5%) of the training and 15 (37%) of the control group reported prolapse symptoms (p=0.6). Five (13%) from the training and 9 (21%) controls were bothered by the symptoms (p=0.3). There was a gradual decrease in the number of women with symptoms and no significant short-term (p=0.08 at 6 months) or long-term (p=0.6 at 12 months) differences between the groups regarding rates of women with POP sympoms. No difference was between groups regarding bother in the short (p=0.3) or longer term (p=0.4). Repeated measure analyses using Proc Genmod in SAS did not indicate a significant effect of the intervention over time, p>0.05. Conclusions There was an overall decrease in postpartum symptoms of POP and bother during the first year. Physiotherapist-lead pelvic floor muscle training did not change the outcomes.

As the world's human population is nearing eight billion,1 there are definite indications that a slow-down in population-growth is likely in this century with rapidly falling birthrates in not only middle- and high-resource countries, but also those with lower resources.2 The reasons are largely socioeconomic, related to better survival and longer life expectancies, and also and not least tied to improved education, particularly among women. Outlook on life has shifted, at least in better off societies, and procreation is no longer the same goal in life for everyone.2 Environmental impacts affecting hormonal balances and gamete production in both sexes also count in and may do so increasingly in the near future.2 After no more than two or three additional billions of people towards the end of this 21st century a balance may hopefully be achieved. This would be good news for the planet if it would at the same time be possible to adopt the vital steps which have been agreed upon by most nations of the world for halting climate changes and global warming, reducing pollution, and providing for greater equity among nations, amidst different groups in society and individuals.3 Continuous economic growth in better off societies must also be curtailed. Endless growth will have it's limits, as was pointed out 50 years ago.4 Man is the source of most global problems with his insatiable drive for more. Humans have to find the balance by themselves and drastically reduce their own multiplication − not leave the field to viruses that cause pandemics where people perish not only in their thousands, but in millions. That the SARS Covid virus is a threat to even healthy women in pregnancy is now shown in a landmark nationwide study in this issue of AOGS by Karen Vousden and colleagues from the UK National Perinatal Unit in Oxford, a major epidemiologic center.5 It is worthwhile studying this article carefully to note how especially older, overweight and of course unvaccinated mothers do face added risk from Covid infection. Even if the risk is small, it is tangible and measurable. That is no surprise. And if this is the case in a high-resource country like the UK, then we know that women in poorer societies will have to counter more adversities. In addition to Covid we also now have to live once again with short-sighted despots who yet again cause untold suffering through war and devastation. When will it end? The world must change course no later than now, we all agree. Yet the universal will to effect that is still far off. While we as individuals have each to add our own contribution, − the rich far more than those who are poorer − in the end systems that govern our habits and daily life must change in order to bring about the wide-ranging measures required to allow us to survive and progress as humanity. The falling population growth expected in the next decennia will in addition necessitate widespread adjustment to a relatively high number of older people before the new population equilibrium is reached. Societies, even if rich, will find it problematic to provide for large numbers of older people. New solutions will have to be found to allow the older generations to contribute gainfully and thus sustain themselves, at least in part. Retirement ages between 60 and 70 will not be sustenable and must be raised to higher and flexible levels within the next decade. The majority of people reaching the common retirement age of 67–70 in the Nordic countries are in good health. In other Europan countries retirement ages are even lower. A large majority of these older people feel they have a capacity to carry on, perhaps in less than full employment or in a different scene, while still contributing to society. The former Chief Editor of AOGS writing these words that you are reading, is now well into his seventies, but fortunately in good health. I have enjoyed a more leisurely life and have not missed my former everyday clinical activities, the excitement of the labor ward or that of the operating room. These are now part of the past. I did my share in my time as a clinician and was glad to enter a new phase at the age of almost 68. Being able to continue with some academic activities, to interact with masters- and PhD students, to do committee work and contribute to educational matters in medicine has been a blessing. I have as many colleagues of my age developed new interests and activities that may matter a little for others, even with respect to obstetrics and gynecology. Work for some hours most days, including in a Covid-telephone center giving advice to those stricken by variouly severe viral infection symptoms. Combining more free time with new committments could be a goal for many of us as we grow older, a goal that takes us beyond the golf course or time spent on sunny southern beaches. Societies have to find ways of making it possible for retirees to carry on after withdrawing from an official and busy position and not make it obligatory to leave. Let us work towards giving older colleagues the chance to use their hard won knowledge and experience gainfully as long as they wish and can.

Aims To estimate potential differences in neonatal metabolomic profiles at birth and at the time of newborn screening by delivery mode. Methods A prospective study at Women's Clinic at Landspitali—The National University Hospital of Iceland. Women having normal vaginal birth or elective caesarean section from November 2013 to April 2014 were offered participation. Blood samples from mothers before birth and umbilical cord at birth were collected and amino acids and acylcarnitines measured by tandem mass spectrometry. Results from the Newborn screening programme in Iceland were collected. Amino acids and acylcarnitines from different samples were compared by delivery mode. Results Eighty three normal vaginal births and 32 elective caesarean sections were included. Mean differences at birth were higher for numerous amino acids, and some acylcarnitines in neonates born vaginally compared to elective caesarean section. Maternal blood samples and newborn screening results showed small differences that lost significance after correction for multiple testing. Many amino acids and some acylcarnitines were numerically higher in cord blood compared to maternal. Many amino acids and most acylcarnitines were numerically higher in newborn screening results compared to cord blood. Conclusion We observed transient yet distinct differences in metabolomic profiles between neonates by delivery mode.

Professor Emeritus Per Olof Janson, former Chief Editor of Acta Obstetricia et Gynecologica Scandinavica (AOGS), passed away at the age of 80 years on 8 November 2020 . Peo, as he was called with affection by his family and many friends across the world, left behind a legacy of outstanding professional work as a dedicated scientist, teacher, mentor, organizer, and editor. He was from Gothenburg, grew up there, studied medicine at the University of Gothenburg and worked at Sahlgrenska University Hospital for the entirety of his life, apart from a year spent in Australia in 1975. He acquired solid academic training centering on reproductive physiology and endocrinology with a doctorate in this field in 1974, becoming Associate Professor in 1975 and Professor of Obstetrics and Gynecology at the University of Gothenburg in 1992. There, he contributed considerably to the development of fertility microsurgery and IVF, becoming an internationally acknowledged fertility expert and a pioneer in research on ovulation mechanisms. Together with professor Gunnar Selstam from Umeå and Wim LeMaire from Miami he developed a truly novel ovarian in-vitro perfusion system that was used to systematically study and map out several important intraovarian mediators of ovulation. The group around Peo had a leading international role in ovulation research for several decades after this invention, largely due to Peo's vast knowledge of this field and his innovative mind. At the same time, he took an active part in establishing IVF in the Nordic countries, laying the groundwork for the now internationally renowned Reproductive Medicine Unit at the Sahlgrenska University Hospital in Gothenburg. He was among the most active and influential researchers in the field of obstetrics and gynecology in Sweden, and a source of inspiration to many as a supervisor, mentor, and colleague. Even up to May of this year, he was still actively stimulating his coworkers and junior colleagues clinically and academically: he was a true leader. But he also took time to enjoy life, culture, and friendships. Being a natural organizer he became involved with the Swedish and Nordic obstetric and gynecological societies, contributing notably to the reorganization of the Nordic Federation of Societies of Obstetrics and Gynecology (NFOG) around 1990. This strengthened Nordic collaboration and enhanced the international reputation of NFOG. Thus, it came as no surprise that he was elected to lead both the Swedish Society of Obstetrics and Gynecology (SFOG), as well as NFOG. The list of committees and working groups where he served is long and Peo's influence and contributions to Swedish, Nordic, and European education in obstetrics and gynecology will live on. Two prominent examples of this were his work on establishing organized postgraduate specialization in obstetrics and gynecology in Sweden and editing a textbook on gynecology that underpins teaching in this field in Sweden. He joined AOGS as Editor, later serving as the journal's Chief Editor from the year 2000 until 2007—a time when the journal gained in strength and diversity. On a personal level, Peo was a jovial, approachable, and decent man, happy in his personal life right up to the serious illness that made his last weeks difficult, but also content when he looked back on his 80 years. At AOGS he will be remembered with warmth and gratitude.

Endometriosis is a chronic condition causing menstrual pain, irregular bleeding and infertility among women. Although usually in the pelvis, it can manifest in atypical places. We describe a 39-year old woman with a previous endometriosis diagnosis who presented three times on the second menstrual day with dyspnea and chest pain. Imaging showed right-sided pneumothorax on all three occasions. Thoraco-scopy revealed endometriosis-like lesions. Histology was suggestive of endometriosis. After treatment with chemical pleurodesis and hormonal suppression she has remained symptom-free. Diagnosis should be obtained by concomitant thoraco- and laparoscopy with biopsies to verify the disease and give a basis for appropriate treatment.

To estimate potential differences in neonatal metabolomic profiles at birth and at the time of newborn screening by delivery mode. A prospective study at Women's Clinic at Landspitali—The National University Hospital of Iceland. Women having normal vaginal birth or elective caesarean section from November 2013 to April 2014 were offered participation. Blood samples from mothers before birth and umbilical cord at birth were collected and amino acids and acylcarnitines measured by tandem mass spectrometry. Results from the Newborn screening programme in Iceland were collected. Amino acids and acylcarnitines from different samples were compared by delivery mode. Eighty three normal vaginal births and 32 elective caesarean sections were included. Mean differences at birth were higher for numerous amino acids, and some acylcarnitines in neonates born vaginally compared to elective caesarean section. Maternal blood samples and newborn screening results showed small differences that lost significance after correction for multiple testing. Many amino acids and some acylcarnitines were numerically higher in cord blood compared to maternal. Many amino acids and most acylcarnitines were numerically higher in newborn screening results compared to cord blood. We observed transient yet distinct differences in metabolomic profiles between neonates by delivery mode.

BACKGROUND: Identifying predictive factors for a normal outcome at admission in the labor ward would be of value for planning labor care, timing interventions, and preventing labor dystocia. Clinical assessments of fetal head station and position at the start of labor have some predictive value, but the value of ultrasound methods for this purpose has not been investigated. Studies using transperineal ultrasound before labor onset show possibilities of using these methods to predict outcomes. OBJECTIVE: This study aimed to investigate whether ultrasound measurements during the first examination in the active phase of labor were associated with the duration of labor phases and the need for operative delivery. STUDY DESIGN: This was a secondary analysis of a prospective cohort study at Landspitali University Hospital, Reykjavik, Iceland. Nulliparous women at >= 37 weeks' gestation with a single fetus in cephalic presentation and in active spontaneous labor were eligible for the study. The recruitment period was from January 2016 to April 2018. Women were examined by a midwife on admission and included in the study if they were in active labor, which was defined as regular contractions with a fully effaced cervix, dilatation of >= 4 cm. An ultrasound examination was performed by a separate examiner within 15 minutes; both examiners were blinded to the other's results. Transabdominal and transperineal ultrasound examinations were used to assess fetal head position, cervical dilatation, and fetal head station, expressed as head-perineum distance and angle of progression. Duration of labor was estimated as the hazard ratio for spontaneous delivery using Kaplan-Meier curves and Cox regression analysis. The hazard ratios were adjusted for maternal age and body mass index. The associations between study parameters and mode of delivery were evaluated using receiver operating characteristic curves. RESULTS: Median times to spontaneous delivery were 490 minutes for a head-perineum distance of <= 45 mm and 682 minutes for a head-perineum distance of >45 mm (log-rank test, P=.009; adjusted hazard ratio for a shorter head-perineum distance, 1.47 [95% confidence interval, 0.83-2.60]). The median durations were 506 minutes for an angle of progression of >= 93 degrees and 732 minutes for an angle of progression of <93 degrees (log-rank test, P=.008; adjusted hazard ratio, 2.07 [95% confidence interval, 1.15-3.72]). The median times to delivery were 506 minutes for nonocciput posterior positions and 677 minutes for occiput posterior positions (log-rank test, P=.07; adjusted hazard ratio, 1.52 [95% confidence interval, 0.96-2.38]) Median times to delivery were 429 minutes for a dilatation of >= 6 cm and 704 minutes for a dilatation of 4 to 5 cm (log-rank test, P=.002; adjusted hazard ratio, 3.11 [95% confidence interval, 1.68-5.77]). Overall, there were 75 spontaneous deliveries; among those deliveries, 16 were instrumental vaginal deliveries (1 forceps delivery and 15 ventouse deliveries), and 8 were cesarean deliveries. Head-perineum distance and angle of progression were associated with a spontaneous delivery with area under the receiver operating characteristic curves of 0.68 (95% confidence interval, 0.55-0.80) and 0.67 (95% confidence interval, 0.55-0.80), respectively. Ultrasound measurement of cervical dilatation or position at inclusion was not significantly associated with spontaneous delivery. CONCLUSION: Ultrasound examinations showed that fetal head station and cervical dilatation were associated with the duration of labor; however, measurements of fetal head station were the variables best associated with operative deliveries.

(Abstracted from Am J Obstet Gynecol 2021;224:514.e1–514.e9) The position of the fetal head is an important factor to consider during labor. Occiput posterior (OP) and transverse positions are associated with poor delivery outcomes for the mother and infant.

BackgroundPelvic floor dysfunction, including urinary and anal incontinence, is a common postpartum complaint and likely to reduce quality of life.ObjectiveTo study the effects of individualized physical therapist–guided pelvic floor muscle training in the early postpartum period on urinary and anal incontinence and related bother, as well as pelvic floor muscle strength and endurance.Materials and MethodsThis was an assessor-blinded, parallel-group, randomized controlled trial evaluating effects of pelvic floor muscle training by a physical therapist on the rate of urinary and/or anal leakage (primary outcomes); related bother and muscle strength and endurance in the pelvic floor were secondary outcomes. Between 2016 and 2017, primiparous women giving birth at Landspitali University Hospital in Reykjavik, Iceland, were screened for eligibilty 6–10 weeks after childbirth. Of those identified as urinary incontinent, 95 were invited to participate, of whom 84 agreed. The intervention, starting at ∼9 weeks postpartum consisted of 12 weekly sessions with a physical therapist, after which the main outcomes were assessed (endpoint, ∼6 months postpartum). Additional follow-up was conducted at ∼12 months postpartum. The control group received no instructions after the initial assessment. The Fisher exact test was used to test differences in the proportion of women with urinary and anal incontinence between the intervention and control groups, and independent-sample t tests were used for mean differences in muscle strength and endurance. Significance levels were set as α = 0.05.ResultsA total of 41 and 43 women were randomized to the intervention and control groups, respectively. Three participants and 1 participant withdrew from these respective groups. Measurement variables and main delivery outcomes were not different at recruitment. At the endpoint, urinary incontinence was less frequent in the intervention group, with 21 participants (57%) still symptomatic, compared to 31 controls (82%) (P = .03), as was bladder-related bother with 10 participants (27%) in the intervention vs 23 (60%) in the control group (P = .005). Anal incontinence was not influenced by pelvic floor muscle training (P = .33), nor was bowel-related bother (P = .82). The mean differences between groups in measured pelvic floor muscle strength changes at endpoint was 5 hPa (95% confidence interval, 2–8; P = .003), and for pelvic floor muscle endurance changes, 50 hPa/s (95% confidence interval, 23–77; P = .001), both in favor of the intervention group. The mean between-group differences for anal sphincter strength changes was 10 hPa (95% confidence interval, 2–18; P = .01) and for anal sphincter endurance changes 95 hPa/s (95% confidence interval, 16–173; P = .02), both in favor of the intervention. At the follow-up visit 12 months postpartum, no differences were observed between the groups regarding rates of urinary and anal incontinence and related bother. Pelvic floor- and anal muscle strength and endurance favoring the intervention group were maintained.ConclusionPostpartum pelvic floor mucle training decreased the rate of urinary incontinence and related bother 6 months postpartum and increased muscle strength and endurance. Pelvic floor dysfunction, including urinary and anal incontinence, is a common postpartum complaint and likely to reduce quality of life. To study the effects of individualized physical therapist–guided pelvic floor muscle training in the early postpartum period on urinary and anal incontinence and related bother, as well as pelvic floor muscle strength and endurance. This was an assessor-blinded, parallel-group, randomized controlled trial evaluating effects of pelvic floor muscle training by a physical therapist on the rate of urinary and/or anal leakage (primary outcomes); related bother and muscle strength and endurance in the pelvic floor were secondary outcomes. Between 2016 and 2017, primiparous women giving birth at Landspitali University Hospital in Reykjavik, Iceland, were screened for eligibilty 6–10 weeks after childbirth. Of those identified as urinary incontinent, 95 were invited to participate, of whom 84 agreed. The intervention, starting at ∼9 weeks postpartum consisted of 12 weekly sessions with a physical therapist, after which the main outcomes were assessed (endpoint, ∼6 months postpartum). Additional follow-up was conducted at ∼12 months postpartum. The control group received no instructions after the initial assessment. The Fisher exact test was used to test differences in the proportion of women with urinary and anal incontinence between the intervention and control groups, and independent-sample t tests were used for mean differences in muscle strength and endurance. Significance levels were set as α = 0.05. A total of 41 and 43 women were randomized to the intervention and control groups, respectively. Three participants and 1 participant withdrew from these respective groups. Measurement variables and main delivery outcomes were not different at recruitment. At the endpoint, urinary incontinence was less frequent in the intervention group, with 21 participants (57%) still symptomatic, compared to 31 controls (82%) (P = .03), as was bladder-related bother with 10 participants (27%) in the intervention vs 23 (60%) in the control group (P = .005). Anal incontinence was not influenced by pelvic floor muscle training (P = .33), nor was bowel-related bother (P = .82). The mean differences between groups in measured pelvic floor muscle strength changes at endpoint was 5 hPa (95% confidence interval, 2–8; P = .003), and for pelvic floor muscle endurance changes, 50 hPa/s (95% confidence interval, 23–77; P = .001), both in favor of the intervention group. The mean between-group differences for anal sphincter strength changes was 10 hPa (95% confidence interval, 2–18; P = .01) and for anal sphincter endurance changes 95 hPa/s (95% confidence interval, 16–173; P = .02), both in favor of the intervention. At the follow-up visit 12 months postpartum, no differences were observed between the groups regarding rates of urinary and anal incontinence and related bother. Pelvic floor- and anal muscle strength and endurance favoring the intervention group were maintained. Postpartum pelvic floor mucle training decreased the rate of urinary incontinence and related bother 6 months postpartum and increased muscle strength and endurance.

Preeclampsia is a serious complication of pregnancy, affecting both maternal and fetal health. In genome-wide association meta-analysis of European and Central Asian mothers, we identify sequence variants that associate with preeclampsia in the maternal genome at ZNF831/20q13 and FTO/16q12. These are previously established variants for blood pressure (BP) and the FTO variant has also been associated with body mass index (BMI). Further analysis of BP variants establishes that variants at MECOM/3q26, FGF5/4q21 and SH2B3/12q24 also associate with preeclampsia through the maternal genome. We further show that a polygenic risk score for hypertension associates with preeclampsia. However, comparison with gestational hypertension indicates that additional factors modify the risk of preeclampsia.