BACKGROUND:The risk of perinatal death and severe neonatal morbidity increases gradually after 41 weeks of pregnancy. We evaluated maternal and perinatal outcomes after a national shift from expectancy and induction at 42+0 weeks to a more active management of late-term pregnancies in Sweden offering induction from 41+0 weeks or an individual plan aiming at birth or active labour no later than 42+0 weeks. METHODS AND FINDINGS:Women with a singleton pregnancy lasting 41+0 weeks or more with a fetus in cephalic presentation (N = 150,370) were included in a nationwide, register-based cohort study. Elective cesarean sections were excluded. Outcomes during period 1, January 2017 to December 2019 (before the shift) versus outcomes during period 2, January 2020 to October 1, 2023 (after the shift) were analysed. For comparison, outcomes of pregnancies lasting 39+0 to 40+6 weeks (N = 358,548) were also studied. Primary outcomes were: First, peri/neonatal death (stillbirth or neonatal death before 28 days); second, composite adverse peri/neonatal outcome (peri/neonatal death, Apgar score <4 at 5 min, hypoxic ischemic encephalopathy grades 1-3, meconium aspiration syndrome, birth trauma, or admission to a neonatal intensive care unit (NICU) ≥4 days); third, composite adverse peri/neonatal outcome excluding admission to NICU; and fourth, emergency cesarean section. Secondary outcomes included the components of the primary composite outcomes. Relative risks (RRs) with 95% confidence intervals (CIs) for binary outcomes period 2 versus period 1 were computed using modified Poisson regression analyses with adjustments for maternal age, parity, body mass index (BMI), smoking, and educational level. Induction rates among pregnancies lasting 41+0 weeks or more increased from 33.7% in period 1 to 52.4% in period 2. Mean (standard deviation) gestational age at birth decreased from 290.7 (2.9) days to 289.6 (2.3) days. Infants born during period 2 were at lower risk of peri/neonatal death compared to infants born during period 1; 0.9/1,000 versus 1.7/1,000 born infants (adjusted RR 0.52; 95% CI [0.38, 0.69]; p < 0.001), and they had a lower risk of having the composite adverse neonatal outcome, both including (50.5/1,000 versus 53.9/1,000, adjusted RR 0.92; 95% CI [0.88, 0.96]; p < 0.001) or excluding NICU admission (18.5/1,000 versus 22.5/1,000, adjusted RR 0.79; 95% CI [0.74, 0.85]; p < 0.001). The cesarean section rate increased from 10.5% in period 1 to 11.9% in period 2 (adjusted RR 1.07; 95% CI [1.04, 1.10]; p < 0.001). For births at 39 to 40 weeks the adjusted RR for peri/neonatal death was 0.86 (95% CI [0.72, 1.02]). One limitation of the study is that we had no data on to what extent monitoring of fetal health was performed. CONCLUSIONS:A more active management of pregnancies lasting 41+0 weeks or more was associated with a decrease in peri/neonatal deaths, and a decrease in composite adverse peri/neonatal outcomes. Increased rate of emergency cesarean sections was observed. Women with pregnancies advancing towards 41 gestational weeks should be given balanced information on the benefits and risks of induction of labour at 41 weeks compared to expectant management until 42 weeks and be offered induction of labour at 41 weeks or active surveillance of pregnancies from 41 weeks in order to decrease peri/neonatal mortality.

Background Turner syndrome (TS) is a complex genetic disorder with raised mortality. Our objective was to investigate mortality and causes of death in TS. Methods A matched retrospective observational study of women with TS recruited from the Turner centers in Sweden were conducted. A total of 472 women with TS, ≥ 16 years old with a cytogenetically verified diagnosis and 2357 controls, matched for birthyear and sex, were examined and followed since 1995 for up to 26 years. Survival analyses were performed with Cox proportional hazard models. Kaplan-Meier curves were generated. Cumulative incidence rates were evaluated by competing risks analysis, using cumulative incidence function. Results During a mean follow-up of 17 years, 35 (7.4%) women with TS and 70 (3.0%) controls died. All-cause mortality was elevated in TS, hazard ratio (HR) 2.90 (95% CI 1.92-4.37), mainly due to circulatory diseases and notably aortic dissection, with HR of 9.11 (95% CI 4.54-18.25) and 21.79 (95% CI 4.62-102.82), respectively. Aortic dissection was the single largest cause of death in TS, accounting for 23% (8/35) of total deaths. Death by cancer or external causes were not raised in TS. In individuals below 45 years of age death, aortic dissections were greatly increased compared to controls, HR 55.59 (95% CI 2.33-1325.69). From the ages 46 to 80 years a notably higher risk of dying by heart diseases, aortic dissection excluded, was shown in TS compared to controls HR, 7.7 (2.65-22.36). The median survival time was 8 years shorter in TS compared to controls. Conclusions The increased mortality in TS was mainly driven by aortic dissections in the young and by heart diseases in the older. Healthcare professionals should prioritize detection and monitoring, with emphasis on cardiovascular diseases.

ObjectivesTo assess the incidence of hospital admissions for covid-19 disease in pregnant women, severity of covid-19 disease, and medical treatment provided to pregnant women with moderate to severe covid-19 during the first 10 months of the pandemic.DesignIndividual patient data meta-analysis of population based cohorts in International Obstetric Survey Systems.Setting10 European countries with national or regional surveillance within the International Obstetric Survey Systems (INOSS) collaboration using aligned definitions and case report forms: Belgium, France (regional), Italy, the Netherlands, Denmark, Finland, Iceland, Norway, Sweden (regional), and the UK. The dominant variant of the SARS-CoV-2 virus was the wild-type variant in all countries during the study period (1 March 2020 to 31 December 2020).ParticipantsThe source population was 1.7 million women giving birth (maternities) from 1 March 2020 to 31 December 2020; pregnant women were included if they were admitted to hospital and had a positive polymerase chain reaction test for the SARS-CoV-2 virus ≤7 days before hospital admission, during admission, or up to two days after giving birth. We further categorised the hospital admission in two groups; covid-19 admission (hospital admission due to covid-19 or with reported symptoms of covid-19 disease) or non-covid-19 admission (admission to hospital for obstetric healthcare or no symptoms of covid-19 disease).Main outcome measuresIncidence of hospital admissions for covid-19 per 1000 maternities, frequency of moderate to severe covid-19 disease, and number of women who received specific medical treatment for SARS-CoV-2 infection. Moderate to severe covid-19 disease was defined as maternal death, admission to an intensive care unit, or need for respiratory support.ResultsAmong 1.7 million maternities, 9003 women were included in the study: 2350 (26.1%) were admitted to hospital because of covid-19 disease or had symptoms of disease. The pooled incidence of hospital admissions for covid-19 per 1000 maternities was 0.8 (95% confidence interval (CI) 0.5 to 1.2, τ2=0.44), ranging from no hospital admissions in Iceland to 1.7 in France and 1.9 in the UK. 13 women died due to covid-19. Among 2219 women admitted to hospital for covid-19 in countries with complete information on respiratory support, 820 women (39.5%, 95% CI 34.6% to 44.4%, τ2=0.02) had moderate to severe covid-19 disease. At most, 16.8% (95% CI 7.7% to 32.9%, I2=81.8%, τ2=0.7) of women with moderate to severe covid-19 received specific medical treatment for SARS-CoV-2 infection with corticosteroids, although 66.6% (59.4% to 73.2%, I2=50.1, τ2=0.06) were given thromboprophylaxis.ConclusionsPopulation based surveillance in 10 European countries during the first 10 months of the covid-19 pandemic showed variations in the risk of hospital admissions for covid-19 in pregnant women. This finding indicates that national public health policies likely had a substantial and previously unrecognised role in protecting pregnant women. Few pregnant women with moderate to severe covid-19 were given specific medical treatment for SARS-CoV-2 disease, even when there were no or minor safety concerns. Lessons for future pandemics include the importance of rapid, robust surveillance systems for maternal and perinatal health, and of including use for pregnant women early in the development and testing of medicines and vaccines for public health emergencies.

INTRODUCTION:The Coronavirus 2019 Disease (COVID-19) pandemic reached the Nordic countries in March 2020. Public health interventions to limit viral transmission varied across different countries both in timing and in magnitude. Interventions indicated by an Oxford Stringency Index ≥50 were implemented early (March 13-17, 2020) in Denmark, Finland, Norway and Iceland, and on March 26, 2020 in Sweden. The aim of the current study was to assess the incidence of COVID-19-related admissions of pregnant women in the Nordic countries in relation to the different national public health strategies during the first year of the pandemic. MATERIAL AND METHODS:This is a meta-analysis of population-based cohort studies in the five Nordic countries with national or regional surveillance in the Nordic Obstetric Surveillance System (NOSS) collaboration: national data from Denmark, Finland, Iceland and Norway, and regional data covering 31% of births in Sweden. The source population consisted of women giving birth in the included areas March 1-December 31, 2020. Pregnant women with a positive SARS-CoV-2 PCR test ≤14 days before hospital admission were included, and admissions were stratified as either COVID-19-related or non-COVID (other obstetric healthcare). Information about public health policies was retrieved retrospectively. RESULTS:In total, 392 382 maternities were considered. Of these, 600 women were diagnosed with SARS-CoV-2 infection and 137 (22.8%) were admitted for COVID-19 symptoms. The pooled incidence of COVID-19 admissions per 1000 maternities was 0.5 (95% confidence interval [CI] 0.2 to 1.2, I2 = 77.6, tau2 = 0.68, P = 0.0), ranging from no admissions in Iceland to 1.9 admissions in the Swedish regions. Interventions to restrict viral transmission were less stringent in Sweden than in the other Nordic countries. CONCLUSIONS:There was a clear variation in pregnant women's risk of COVID-19 admission across countries with similar healthcare systems but different public health interventions to limit viral transmission. The meta-analysis indicates that early suppression policies protected pregnant women from severe COVID-19 disease prior to the availability of individual protection with vaccines.

Background and aims Pre-eclampsia complicates 3–5% of pregnancies worldwide and is associated with adverse outcomes for the mother and the offspring. Pre-eclampsia and heart failure have common risk factors, including hypertension, obesity and diabetes. It is not known whether heart failure increases the risk of pre-eclampsia. This study examines whether pregestational heart failure increases the risk of pre-eclampsia.Methods In a registry-based case–cohort study that included all pregnancies in Sweden (n=3 125 527) between 1990 and 2019, all pregnancies with pre-eclampsia (n=90 354) were identified and up to five control pregnancies (n=451 466) for each case were chosen, matched on the mother’s birth year. Multiple logistic regression analysis was used to evaluate the impact of heart failure on the risk of pre-eclampsia, with adjustment for established risk factors and other cardiovascular diseases.Results Women with heart failure had no increased risk for pre-eclampsia, OR 1.02 (95% CI 0.69 to 1.50). Women with valvular heart disease had an increased OR of preterm pre-eclampsia, with an adjusted OR of 1.78 (95% CI 1.04 to 3.06). Hypertension and diabetes were independent risk factors for pre-eclampsia. Obesity, multifetal pregnancies, in vitro fertilisation, older age, Nordic origin and nulliparity were more common among women who developed pre-eclampsia compared with controls.Conclusion Women with heart failure do not have an increased risk of pre-eclampsia. However, women with valvular heart disease prior to pregnancy have an increased risk of developing preterm pre-eclampsia independent of other known risk factors.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

INTRODUCTION:The prevalence of cardiovascular disease during pregnancy (cardiovascular disease diagnosed before, during or up to 6 months after childbirth) and the risk of adverse outcomes associated with it have not been previously described in Sweden. This study examined trends in prevalence of cardiovascular disease and its association with maternal and perinatal outcomes, overall and by timing of diagnosis in relation to pregnancy. MATERIAL AND METHODS:This population-based observational retrospective cohort study consisted of women aged 15-49 years who were registered in the Swedish Medical Birth Register 2000-2019. Prevalence was defined as annual diagnosis of cardiovascular disease per pregnant woman as numerator and all pregnant women per year as denominator. Adverse maternal and perinatal outcomes were analyzed using time-dependent Cox regression and Poisson regression models. Outcomes were obtained during and after childbirth up to 1 year postpartum, depending on the outcome. RESULTS:There were 2 069 107 births to 1 186 137 women (911 101 primiparous). The prevalence of cardiovascular disease among pregnant women in Sweden during 2000-2019 increased from 0.31% to 1.34%, for non-congenital cardiovascular disease, this was primarily driven by arrythmia (0.11%-0.58%). Primiparous women with cardiovascular disease had a higher risk of eclampsia over-all (aHR 4.50, 95% CI 2.01-10.05) and when diagnosed during pregnancy (aHR 3.22, 95% CI 1.21-8.61); admission to psychiatric ward overall (aHR 2.51, 95% CI 1.30-4.83), and when diagnosed during pregnancy (aHR 2.54, 95% CI 1.21-5.34); and one-year mortality when diagnosed before pregnancy (aHR 1.67, 95% CI 1.16-2.42) and when diagnosed postpartum (aHR 6.59, 95% CI 3.38-12.84), compared to those without cardiovascular disease. Children born to women with cardiovascular disease diagnosed both overall and in relation to timing of diagnosis had an increased risk of being born preterm and small for gestational age. CONCLUSIONS:Cardiovascular disease prevalence among pregnant women in Sweden increased during 2000-2019, primarily driven by arrhythmias. In primiparous women, the timing of diagnosis of cardiovascular disease is important for maternal and perinatal outcomes, including when diagnosed postpartum. This calls for awareness among all staff when planning pregnancy and monitoring women with cardiovascular disease throughout pregnancy and in the postpartum period.

Objective To assess whether prostaglandin among multiparous women have an increased risk of uterine rupture compared to primiparous and women with one previous delivery. Design Retrospective observational population-based cohort study. Setting All maternity wards in Sweden Population Women that have undergone induction with prostaglandin between May 1996 and December 2019, (n=59,019). Methods The study cohort was obtained by using data from the Swedish Medical Birth Register, which contains information from maternity and delivery records. Results are presented as odds ratios with 95% confidence intervals. Main Outcome Measures Uterine rupture Results Multiparous women without a previous caesarean section giving birth after induction with prostaglandins had an increased absolute risk (0.11%) of uterine rupture compared to primiparous (0.03%) (crude OR 3.57; 95% Cl 1.49-8.59, p-value 0.004). Multiparous women without a previous caesarean section had a lower absolute risk (0.04%) of uterine rupture compared to women with a previous caesarean section (1.62%). Multiparous women with one previous caesarean section, had a decreased risk (0.83%) of uterine rupture compared to women with one previous delivery with caesarean section (2.02%) (crude OR 0.4; 95% Cl 0.21-0.78, p-value 0.006). Conclusion Our study implies that multiparity is a risk factor for uterine rupture when induced with prostaglandin in women with no previous caesarean section and this should be taken into account when deciding on the appropriate method of induction.

Abstract Introduction Preeclampsia complicates 3-5% of pregnancies worldwide and accounts for approximately 45 000 maternal deaths yearly. Preeclampsia is defined as new onset hypertension with organ dysfunction after 20 weeks’ gestation. Preeclampsia and cardiovascular disease have common risk factors such as chronic hypertension, obesity, and diabetes. In addition, preeclampsia is an independent risk factor for later cardiovascular disease. Preeclampsia might result from maladaptation of the cardiovascular system to pregnancy, but it is not known if other cardiac diagnoses are also risk factors for developing preeclampsia. Purpose The aim of this study was to evaluate the impact of heart failure and other cardiovascular disease on the risk of developing preeclampsia. Methods This was a registry-based case-control study using data form Swedish national registers including the medical birth register, national patient register and the LISA register. For every case with preeclampsia (90 354 pregnancies) five controls were chosen (Figure 1). Controls were matched to cases on mother’s year of birth. A sub-analysis investigated the risk for preterm preeclampsia (delivery <37 gestational weeks) by risk-factor. Potential cardiac risk factors were congenital heart disease, pulmonary hypertension, aortic/peripheral artery disease, valvular heart disease, myocardial infarction, other coronary artery disease, arrythmia, hypertension, myocarditis/pericarditis. Also known cardiometabolic risk factors were analyzed. All diagnoses were defined by ICD-9 and ICD-10 codes. We used multiple logistic regression analysis adjusted for confounders (BMI, age, smoking, assisted reproductive technology, parity, multifetal pregnancy, and comorbidities before pregnancy). Results Women with preeclampsia were more often obese, less often nulliparous and had more often multifetal pregnancies compared with women with normotensive pregnancies. Heart failure, valvular heart disease, hypertension, and diabetes (type 1+2) were independent risk factors for preeclampsia (Figure 2). Women with heart failure (n=273) had an adjusted odds ratio (aOR) of 2.09 (95% confidence interval (CI) 1.58-2.75) for developing any preeclampsia and an aOR of 2.90 (95% CI 1.82-4.61) for developing preterm preeclampsia. For women with valvular heart disease (n=424), the aOR was 1.50 (95% CI 1.17-1.92) for any preeclampsia and 2.55 (1.62-4.01) for preterm preeclampsia. The remaining seven cardiac diseases were not independent risk factors for preeclampsia. Conclusion Women with heart failure and valvular heart disease are at increased risk of developing preeclampsia. This association was particularly strong in women with preterm preeclampsia. Our results support the theory of preeclampsia as a stress test for cardiovascular disease. Although a rare patient group, these women have to be monitored closely during pregnancy, both for cardiac complications and for development of preeclampsia.Figure 1.Flow chart.Figure 2.Results.

(JAMA. 2023;329:393–404) Some lifestyle and genetic risk factors for coronary artery disease (CAD) are common between women and men, but others affect only women, such as preeclampsia, gestational hypertension, preterm delivery, and other adverse pregnancy complications and outcomes. Each of these has been linked to an increased risk in CAD, which has long been a leading cause of death. Risk factors for CAD associated with pregnancy outcomes are often overlooked because they tend to occur in younger women who may have otherwise good cardiovascular health. One method used to analyze and diagnose risks related to CAD is coronary computed tomography (CT) angiography; it is a noninvasive technique used to visualize the coronary arteries and screen for occlusion or other markers of subclinical CAD. Previous research has been unclear about the effect of cardiovascular complications during pregnancy on overall later cardiovascular health. This study aimed to understand associations between subclinical CAD as examined by coronary CT angiography and a history of adverse pregnancy outcomes.

Importance Adverse pregnancy outcomes are recognized risk enhancers for cardiovascular disease, but the prevalence of subclinical coronary atherosclerosis after these conditions is unknown.Objective To assess associations between history of adverse pregnancy outcomes and coronary artery disease assessed by coronary computed tomography angiography screening.Design, Setting, and Participants Cross-sectional study of a population-based cohort of women in Sweden (n = 10 528) with 1 or more deliveries in 1973 or later, ascertained via the Swedish National Medical Birth Register, who subsequently participated in the Swedish Cardiopulmonary Bioimage Study at age 50 to 65 (median, 57.3) years in 2013-2018. Delivery data were prospectively collected.Exposures Adverse pregnancy outcomes, including preeclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant, and gestational diabetes. The reference category included women with no history of these exposures.Main Outcomes and Measures Coronary computed tomography angiography indexes, including any coronary atherosclerosis, significant stenosis, noncalcified plaque, segment involvement score of 4 or greater, and coronary artery calcium score greater than 100.Results A median 29.6 (IQR, 25.0-34.9) years after first registered delivery, 18.9% of women had a history of adverse pregnancy outcomes, with specific pregnancy histories ranging from 1.4% (gestational diabetes) to 9.5% (preterm delivery). The prevalence of any coronary atherosclerosis in women with a history of any adverse pregnancy outcome was 32.1% (95% CI, 30.0%-34.2%), which was significantly higher (prevalence difference, 3.8% [95% CI, 1.6%-6.1%]; prevalence ratio, 1.14 [95% CI, 1.06-1.22]) compared with reference women. History of gestational hypertension and preeclampsia were both significantly associated with higher and similar prevalence of all outcome indexes. For preeclampsia, the highest prevalence difference was observed for any coronary atherosclerosis (prevalence difference, 8.0% [95% CI, 3.7%-12.3%]; prevalence ratio, 1.28 [95% CI, 1.14-1.45]), and the highest prevalence ratio was observed for significant stenosis (prevalence difference, 3.1% [95% CI, 1.1%-5.1%]; prevalence ratio, 2.46 [95% CI, 1.65-3.67]). In adjusted models, odds ratios for preeclampsia ranged from 1.31 (95% CI, 1.07-1.61) for any coronary atherosclerosis to 2.21 (95% CI, 1.42-3.44) for significant stenosis. Similar associations were observed for history of preeclampsia or gestational hypertension among women with low predicted cardiovascular risk.Conclusions and Relevance Among Swedish women undergoing coronary computed tomography angiography screening, there was a statistically significant association between history of adverse pregnancy outcomes and image-identified coronary artery disease, including among women estimated to be at low cardiovascular disease risk. Further research is needed to understand the clinical importance of these associations.

Abstract Background/Introduction Spontaneous coronary artery dissection (SCAD) is an acute myocardial event. Previous studies suggest female predominance. It is an unusual underlying cause of myocardial infarction. However, it is thought to be the most common cause of myocardial infarction associated with pregnancy. Purpose The aim of the study was to collect data on all women of reproductive age that had been diagnosed with SCAD in Sweden, including both pregnant and non-pregnant women, using the national Swedish health registers of the last two decades to describe the cohort and compare clinical characteristics. Methods Retrospective data on individuals with a diagnosis of SCAD (ICD-I25.4) occurring before fifty years of age were collected from four Swedish registers; the national patient register, the national medical birth register, the national cause of death register and the LISA register. Women diagnosed with SCAD between the years 1997 and 2019 and <50 years of age at diagnosis were included. SCAD during pregnancy or within 14 weeks post-partum was considered pregnancy-associated. Results A total of 75 women comprised the final cohort, seven of which met the criteria for pregnancy-associated SCAD. Nine percent of all women that had SCAD in Sweden before 50 years of age had it in association with pregnancy and in SCAD that occurred before 40 years of age, 28% arose in association with pregnancy. There were no clinically significant differences in height between women with pregnancy-associated SCAD and those with SCAD not associated with pregnancy. History of smoking, diabetes mellitus, hyperthyroidism, hypothyroidism and hyperlipidemia were not prominent in the cohort (9.3, 4, 1.3, 2.7 and 2.7% respectively). Seventeen percent of patients had had no pregnancies prior to first event of SCAD. Two patients (2.6%) were deceased due to ischemic heart disease, one had had SCAD associated with pregnancy. Conclusion Spontaneous coronary artery dissections are uncommon. However, when they do occur in women under forty years of age more than one in four (28%) is associated with pregnancy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish heart lung foundation.

OBJECTIVE:To evaluate whether the results of a previous study that showed a decrease in blood loss and transfusions with a multidisciplinary approach, including a fixed team when delivering women diagnosed with placenta accreta spectrum at Sahlgrenska University Hospital, remained low throughout time, and to investigate hospital stay and maternal and neonatal complications during a time period with varying team structure compared with previous periods.METHODS:A retrospective observational cohort study comparing data from medical records including three cohorts of women diagnosed with placenta accreta spectrum between October 2003 and December 2020. Cohort 1 consisted of women delivered before the multidisciplinary approach was introduced. Cohort 2 and cohort 3 were both managed in a multidisciplinary manner, but while cohort 2 was managed by a fixed team, cohort 3 was managed by several different senior specialists. The data were analyzed using Kruskal-Wallis test.RESULTS:Blood loss and need for transfusion were significantly lower for cohort 3 and cohort 2 compared with cohort 1. No significant difference was found between cohort 3 and cohort 2.CONCLUSION:The multidisciplinary management and surgical method employed at Sahlgrenska University Hospital have lowered blood loss and the need for transfusions, even over time.

International Journal of Gynecology & ObstetricsVolume 159, Issue 1 p. 332-332 CORRESPONDENCE Response: Implementing research activities, an earmark of placenta accreta spectrum reference centers Teresia Svanvik, Corresponding Author Teresia Svanvik maria-teresia.svanvik@gu.se Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden Correspondence Teresia Svanvik, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Email: maria-teresia.svanvik@gu.seSearch for more papers by this authorYlva Carlsson, Ylva Carlsson Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, SwedenSearch for more papers by this authorRalph Peeker, Ralph Peeker Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenSearch for more papers by this author Teresia Svanvik, Corresponding Author Teresia Svanvik maria-teresia.svanvik@gu.se Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden Correspondence Teresia Svanvik, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Email: maria-teresia.svanvik@gu.seSearch for more papers by this authorYlva Carlsson, Ylva Carlsson Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, SwedenSearch for more papers by this authorRalph Peeker, Ralph Peeker Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenSearch for more papers by this author First published: 11 August 2022 https://doi.org/10.1002/ijgo.14382 Linked article: This correspondence comments on the Clinical Article from Uddén et al. https://doi.org/10.1002/ijgo.14285 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume159, Issue1October 2022Pages 332-332 RelatedInformation

Abstract Background Data from previous studies indicate on increase in incidence of cardiomyopathies in Sweden. Another study confirmed high validity of diagnosis cardiomyopathy in western Sweden suggesting that a real increase in cardiomyopathy diagnosis might have occurred. Peripartum cardiomyopathy is a potentially dangerous condition that occurs few months before or up to five months after delivery. Purpose To assess incidence and mortality rates of women diagnosed with PPCM over last two decades in Sweden. Methods All women 18 to 50 years of age registered in the National Patient Register (NPR) in the period 1st January 1997 to 31st December 2019 were included. With the use of personal identification number (PIN), the data was than linked to other registers. Data on pregnancies were obtained from the Swedish Medical Birth Register (MBR) and data on the time of death and causes of death were gained from the Cause of Death Register. Women with PPCM were identified in the NPR using the international classification code for disease ICD-10 codes 090.3 as well as other coexisting conditions. The observation time was divided into fallowing periods: 1997–2001, 2002–2004, 2005–2007, 2008–2010, 2011–2013, 2014–2016 and 2017–2019. Results In total, over the period of 23 years we identified 2376988 deliveries. There were 23 women diagnosed with PPCM. The prevalence of women who received the diagnostic code for PPCM increased over time from 0.003% in the first time period to 0.012% in the last time period (Figure 1). In total 4.5% of women diagnosed with PPCM died during the observation time. Conclusion In this national, register-based study 187 women had diagnose PPCM. Total mortality over twenty years of time was low. Worryingly, we observed a four-fold increase in the use of diagnostic code for PPCM, suggesting an increse in incidence of PPCM over the last twenty-three years. More research is needed to investigate reasons for that. Funding Acknowledgement Type of funding sources: None.

Objective To examine the detection rate of placenta previa and placenta accreta spectrum (PAS) by routine mid-pregnancy obstetric ultrasound and to estimate risk factors and prevalence within this cohort. Methods This was an observational cohort study with prospectively collected data. Women attending routine mid-pregnancy obstetric ultrasound at the Sahlgrenska University Hospital with a suspected cup-shaped placenta (cohort 1, n = 339) and women diagnosed with placenta previa or PAS (cohort 2, n = 227) were analyzed according to detection rate, risk factors, and prevalence. Results The detection rates of placenta previa and PAS were 49% (98) and 25% (14), respectively. However, 216 (99%) women with placenta previa were diagnosed prenatally, as were 14 (50%) women with PAS. In vitro fertilization was identified as the strongest independent risk factor for placenta previa (odds ratio 6.96; 95% confidence interval 4.77-10.16, P < 0.001). Risk factors were present for all women with PAS. The prevalence of placenta previa was 44/10 000 deliveries, and for PAS, 5.6/10 000 deliveries. Conclusion The existing routine mid-pregnancy obstetric ultrasound screening showed low detection rate for placenta previa and PAS. Adding risk factors could improve the detection rate.

Introduction Population-based studies about the consequences of SARS-CoV-2 infection (COVID-19) in pregnancy are few and have limited generalizability to the Nordic population and health care systems. Material and method This study examines pregnant women with COVID-19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between March 1 and June 30, 2020 and had a positive SARS-CoV-2 PCR test 14 days or fewer prior to the admission. Cause of admission was classified as either obstetric or COVID-19 related. Results In the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women needed hospital care due to COVID-19. The rate of admission due to COVID-19 was 0.4 per 1000 deliveries in Denmark, Finland, and Norway and 3.8 per 1000 deliveries in the Swedish regions. Women hospitalized because of COVID-19 were more frequently obese (P < 0.001) and had migrant background (P < 0.001) compared to the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Preterm delivery (n=12, 25%, P < 0.001) and cesarean delivery (n=21, 43,8%, P < 0.001) were more frequent in women with COVID-19 compared to the women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported. Conclusion The risk of admission due to severe COVID-19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the rates of admission due to severe COVID-19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.

Introduction Pre-eclampsia, a multisystem disorder in pregnancy, is one of the most common causes of maternal morbidity and mortality worldwide. However, we lack methods for objective assessment of organ function in pre-eclampsia and predictors of organ impairment during and after pre-eclampsia. The women’s and their partners’ experiences of pre-eclampsia have not been studied in detail. To phenotype different subtypes of the disorder is of importance for prediction, prevention, surveillance, treatment and follow-up of pre-eclampsia. The aim of this study is to set up a multicentre database and biobank for pre-eclampsia in order to contribute to a safer and more individualised treatment and care. Methods and analysis This is a multicentre cohort study. Prospectively recruited pregnant women ≥18 years, diagnosed with pre-eclampsia presenting at Sahlgrenska University Hospital, Uppsala University Hospital and at Södra Älvsborgs Hospital, Sweden, as well as normotensive controls are eligible for participation. At inclusion and at 1-year follow-up, the participants donate biosamples that are stored in a biobank and they are also asked to participate in various organ-specific evaluations. In addition, questionnaires and interviews regarding the women’s and partner’s experiences are distributed at follow-up. Ethics and dissemination By creating a database and biobank, we will provide the means to explore the disorder in a broader sense and allow clinical and laboratory discoveries that can be translated to clinical trials aiming at improved care of women with pre-eclampsia. Further, to evaluate experiences and the psychological impact of being affected by pre-eclampsia can improve the care of pregnant women and their partners. In case of incidental pathological findings during examinations performed, they will be handled in accordance with clinical routine. Data are stored in a secure online database. Biobank samples are identified through the women’s personal identification number and pseudonymised after identification in the biobank before analysis. This study was approved by the regional ethical review board in Gothenburg on 28 December 2018 (approval number 955-18) and by the Swedish Ethical Review Authority on 27 February 2019 (approval number 2019-00309). Results from the study will be published in international peer-reviewed journals. Trial registration number ISRCTN13060768