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ObjectiveTo examine how (a) parity and (b) mode of birth were associated with later Quality of Life (QOL) in young adult women, with a mean follow-up of 11.0 years.DesignProspective cohort study.SettingAustralia.R sampleA total of 7770 women participating in the 1973-1978 cohort of the Longitudinal Study of Women's Health.MethodsLinear regression models were used to estimate (1) prospective associations between parity and mode of birth with eight subscale and two summary scores of the SF36, assessed after a mean follow-up of 11 years., and (2) differences between SF36 scores at follow up for women in different parity and mode of birth categories.Main outcome measureQuality of Life as measured by the SF36.ResultsWomen experiencing no births (parity 0) and one birth (parity 1) had lower scores on all the physical health measures, and on some mental health measures, than women who had 2 births (parity 2) (all p<0.05).ConclusionsParity and mode of birth may have long-term implications for women's physical and mental health. Both childless and women with only one child had poorer physical and mental health than their peers with two children. Women with only caesarean section(s) also had poorer health than women who had vaginal birth/s.

To examine how (a) parity and (b) mode of birth were associated with later Quality of Life (QOL) in young adult women, with a mean follow-up of 11.0 years. Australia Linear regression models were used to estimate (1) prospective associations between parity and mode of birth with eight subscale and two summary scores of the SF36, assessed after a mean follow-up of 11 years., and (2) differences between SF36 scores at follow up for women in different parity and mode of birth categories. Quality of Life as measured by the SF36 Women experiencing no births (parity 0) and one birth (parity 1) had lower scores on all the physical health measures, and on some mental health measures, than women who had 2 births (parity 2) (all p<0.05). Parity and mode of birth may have long-term implications for women's physical and mental health. Both childless and women with only one child had poorer physical and mental health than their peers with two children. Women with only caesarean section(s) also had poorer health than women who had vaginal birth/s.

Background First-void urine (FVU) collection for high-risk human papillomavirus (HPV) testing may reach un(der)-screened women in cervical cancer screening programs. This cross-sectional study investigated the clinical performance of DNA methylation markers ASCL1 and LHX8 in HPV-positive FVU for detecting high-grade cervical intraepithelial neoplasia and cancer (CIN2+ and CIN3+). Additionally, results were compared with paired HPV-positive clinician-collected cervical samples (CS) and HPV genotyping. Methods Paired FVU and CS samples were collected from 286 women aged 23–64 years referred for colposcopy or cervical excision. Histological endpoints included 123 ≤ CIN1 (no dysplasia and CIN1), 38 CIN2, and 123 CIN3/AIS and 2 cancers. Samples were tested for HPV DNA and ASCL1 / LHX8 methylation. Methylation test performance was evaluated by area under the curve (AUC) and logistic regression. Differences between paired samples and across methylation, HPV16/18, and extended HPV16/18/31/33/52 genotyping in FVU were tested using McNemar’s test. Results ASCL1 and LHX8 methylation levels in HPV-positive FVU increased significantly with disease severity. Methylation testing in FVU yielded an AUC of 0.76 (95% CI: 0.70–0.82) for CIN3 + and 0.73 (95% CI: 0.67–0.79) for CIN2 + , with sensitivities of 79.2% (95% CI: 71.0–85.9%) and 75.5% (95% CI: 68.1–81.9%), respectively, and a specificity of 57.0% (95% CI: 47.8–65.8%) for ≤ CIN1. In CS, methylation testing yielded higher AUCs of 0.84 (95% CI: 0.79–0.89) for CIN3 + and 0.80 (95% CI: 0.75–0.85) for CIN2 + , with significantly higher sensitivities ( p  ≤ 0.02) but lower specificity ( p  = 0.04) than FVU. In women aged ≥ 30 years, CIN3 + sensitivity and specificity for ≤ CIN1 were similar between FVU and CS (both p  = 0.09). No significant differences in accuracy were observed between methylation testing and extended genotyping ( p  ≥ 0.35) in FVU, while methylation testing showed higher sensitivity ( p  < 0.01) but lower specificity ( p  < 0.01) than HPV16/18 genotyping. Conclusions ASCL1/LHX8 methylation testing in HPV-positive FVU showed promise for detecting high-grade cervical disease. Its performance in FVU did not differ significantly from extended HPV genotyping and, in women aged ≥ 30 years, was comparable to performance in CS. This supports methylation testing as a complementary triage test alongside HPV genotyping in urine-based cervical cancer screening, removing the need for follow-up cervical sampling. Further validation in HPV-positive FVU from un(der)-screened populations is warranted. Trial registration ClinicalTrials.gov: NCT05065853.

Introduction The objective of the study was to provide a comprehensive description of perioperative morbidity associated with robot‐assisted surgery (RAS) in a gynecological oncology setting in order to improve the preoperative counseling of women and support shared decision‐making. Material and Methods All women scheduled for intended RAS between January 2015 and December 2022 were prospectively included in an electronic morbidity database for the analyses of perioperative complications. Results In total, 2225 women were included. Sixty‐four patients (2.9%) experienced an intraoperative complication. Intraoperative complications were associated with a higher rate of conversion to laparotomy (15.6% vs. 1.8%, p < 0.001), a higher rate of major postoperative morbidity (9.3% vs. 2.4%, p < 0.001), and a higher rate of reoperation (9.3% vs. 1.7%, p < 0.001), compared to cases without intraoperative complications. Thirty‐day postoperative morbidity was evaluated according to the Memorial Sloan‐Kettering Cancer Center Surgical Secondary Events Grading System. Grade 3–5 events were considered major. A total of 57 patients (2.6%) experienced a major event after surgery, postoperative rupture of the vaginal vault being the most common complication requiring surgical intervention. Conversion to laparotomy occurred in 49 cases (2.2%) and was associated with higher intraoperative blood loss (300 mL vs. 25 mL, p < 0.001), a higher rate of postoperative major events (20.4% vs. 2.2%, p < 0.001), and a higher rate of reoperation (11.8% vs. 1.6%, p < 0.001). Conclusions Our study demonstrates low rates of major perioperative morbidity and conversion to laparotomy after RAS performed by trained high‐volume surgeons in a gynecological oncology setting. Our study presents data from 2225 women that were prospectively included for the analyses of perioperative morbidity following robot‐assisted surgery (RAS) in a gynecological oncology setting. In this study, the use of RAS was associated with low rates of mortality, major perioperative morbidity, and conversion to laparotomy. The most common postoperative major event was the rupture of the vaginal vault. Conversion to laparotomy represented the highest risk for major perioperative morbidity in our current cohort.

Introduction Adverse birth outcomes, such as preterm birth, low birthweight, and small for gestational age, are critical indicators of neonatal health. While the impact of biomedical risk factors is well established, the role of psychosocial stressors, including intimate partner violence, remains less understood. This study investigates the association between intimate partner violence among pregnant women and adverse birth outcomes in a Danish context. Material and Methods Based on routinely collected Patient‐Reported Outcomes, we conducted a cohort study, including 28 697 pregnant individuals. Enrolled in the period from November 2019 to September 2022, the women were followed until childbirth, leading to 22 799 mothers–offspring pairs with valid data. Data on IPV exposure were collected through the Abuse Assessment Screen, detecting physical, psychological, and sexual violence and fear of partner. Birth outcomes were obtained from the Danish registries, including the Danish medical birth registry. Generalized linear models (GLMs) were used to calculate risk ratios (RRs) and 95% confidence intervals (CIs), adjusting for confounders, such as maternal age, socioeconomic position, smoking status, and psychiatric disorders. Results Of the 22 799 mothers, 5.3% screened positive for intimate partner violence, and 1.9% reported intimate partner violence within the last year. Intimate partner violence was positively associated with preterm birth and low birthweight, with an increased risk of preterm birth (adjusted RR: 1.24, 95% CI 1.06, 1.45) and increased risk for low birthweight (adjusted RR: 1.35, 95% CI 1.04, 1.75) but showed no significant association with small for gestational age (adjusted RR: 0.93, 95% CI 0.78, 1.11). Conclusions Our analysis demonstrates a significantly heightened risk of preterm birth and low birthweight among pregnant women who screened positive for intimate partner violence. These results underscore the need for targeted intimate partner violence screening and intervention strategies during prenatal care to reduce the burden of adverse birth outcomes. Our results demonstrate a significantly heightened risk of adverse birth outcomes, such as preterm birth and low birthweight in a large cohort of pregnant women in Denmark among women who screened positive for intimate partner violence.

ObjectiveTo assess the evidence of the association between exposure to intimate partner violence (IPV) and postpartum depression. IPV during pregnancy can have immediate and long-term physical and mental health consequences for the family. Therefore, it has been hypothesised that IPV may affect the risk of developing postpartum depression.MethodsA systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Global Health Library, Scopus and Google scholar were searched for published studies without restrictions on language, time or study design (up to May 2020). Studies were included if they assessed postpartum depression using the Edinburg Postnatal Depression Scale (cut-off≥10), among women who had been exposed to IPV (emotional, physical and/or sexual abuse). The quality of studies was judged according to the Newcastle-Ottawa scale.ResultsA total of 33 studies were included in the review (participants n=131 131). The majority of studies found an association between exposure to IPV and the development of signs of postpartum depression. Overall, studies measured both exposure and outcome in various ways and controlled for a vast number of different confounders. Thirty percent of the studies were set in low-income and lower-middle-income countries while the rest were set in upper-middle-income and high-income countries and the association did not differ across settings. Among the studies reporting adjusted OR (aOR) (n=26), the significant aOR ranged between 1.18 and 6.87 (95% CI 1.12 to 11.78). The majority of the studies were judged as ‘good quality’ (n=20/33).ConclusionWe found evidence of an association between exposure to IPV and the development of signs of postpartum depression. Meta-analysis or individual patient data meta-analysis is required to quantify the magnitude of the association between IPV and postpartum depression.PROSPERO registration numberCRD42020209435.

Although rare, placental abruption is implicated in disproportionately high rates of perinatal morbidity and mortality. Understanding geographic and temporal variations may provide insights into possible amenable factors of abruption. We examined abruption frequencies by maternal age, delivery year, and maternal birth cohorts over three decades across seven countries. Women that delivered in the US (n = 863,879; 1979-10), Canada (4 provinces, n = 5,407,463; 1982-11), Sweden (n = 3,266,742; 1978-10), Denmark (n = 1,773,895; 1978-08), Norway (n = 1,780,271, 1978-09), Finland (n = 1,411,867; 1987-10), and Spain (n = 6,151,508; 1999-12) were analyzed. Abruption diagnosis was based on ICD coding. Rates were modeled using Poisson regression within the framework of an age-period-cohort analysis, and multi-level models to examine the contribution of smoking in four countries. Abruption rates varied across the seven countries (3-10 per 1000), Maternal age showed a consistent J-shaped pattern with increased rates at the extremes of the age distribution. In comparison to births in 2000, births after 2000 in European countries had lower abruption rates; in the US there was an increase in rate up to 2000 and a plateau thereafter. No birth cohort effects were evident. Changes in smoking prevalence partially explained the period effect in the US (P = 0.01) and Sweden (P<0.01). There is a strong maternal age effect on abruption. While the abruption rate has plateaued since 2000 in the US, all other countries show declining rates. These findings suggest considerable variation in abruption frequencies across countries; differences in the distribution of risk factors, especially smoking, may help guide policy to reduce abruption rates.

Background The detection of an abnormality during prenatal screening implies that the parents are informed about possible treatment and management of the pregnancy, birth, and postnatal course. This information should enable the parents to make decisions regarding the pregnancy, especially in cases where termination of pregnancy may be an option. The objectives of this study were to investigate how often doctors informed parents about pregnancy termination when the fetus had an anomaly and which demographic factors were related to parental decision-making. Methods This was a retrospective cohort study with prospectively collected data of fetuses diagnosed with an abnormality during prenatal screening between 2014 and 2016 in Denmark. We categorized the abnormalities into five long-term prognosis groups and analyzed their association with the doctor provided information about termination. We tested the association between demographic variables and parental decisions using univariate and multivariate statistical analyses. Results Three hundred and twenty fetuses were diagnosed with an abnormality. In 67% of these cases, the parents were informed about termination. All parents whose fetus had a lethal prognosis were informed about termination. By comparison, the parents of 98% of fetuses with genetic disorders, 96% of fetuses with poor prognosis, 69% of fetuses with uncertain prognosis, and 12% of fetuses with good prognosis were informed about termination. Of these parents, 92% chose to terminate. A lethal long-term prognosis was the only factor related to parental decision to terminate a pregnancy. Conclusions Doctors mainly informed parents about the option of pregnancy termination for conditions with a poor or lethal long-term prognosis or for genetic disorders. Only conditions with a lethal prognosis were significantly related to the parental decision to terminate the pregnancy.

The objective of this study was to examine whether exposure to Intimate Partner Violence (IPV) is associated with premature termination of Exclusive Breastfeeding (EB). Per WHO recommendations, this was defined as ceasing breastfeeding or supplementing with other foods or liquids before the child was 6 months old. It is a prospective cohort study set in Moshi, Tanzania consisting of 1128 pregnant women with live singleton births. Women were enrolled during pregnancy and followed up with interviews during pregnancy, after birth and 2-3 years postpartum, using structured questionnaires. Emotional, physical and sexual IPV exerted by the current partner was assessed at 34 weeks gestational age with WHO questionnaires. Months of EB was assessed 2-3 years postpartum. Premature termination of EB was defined as less than 6 months of EB. Analyses were made using a logistic regression model adjusted for maternal age, education, HIV-status, alcohol use during pregnancy and parity. Confounding variables were determined using a theoretical framework approach, i.e. a Directed Acyclic Graph model to minimize bias. Women who were exposed to IPV had more than 50% higher odds of terminating EB before the child was 6 months old compared to women who were not exposed (aOR = 1.62, 95%CI: 1.27-2.06). Women exposed to all three types of IPV had twice the odds of early termination of EB (aOR = 1.95, 1.12; 3.37). Furthermore, the odds were tripled if exposure happened specifically during the index pregnancy (aOR = 2.93 95%CI: 1.3; 6.6). Stratified analyses showed the most severely affected groups were the mothers older than 30 and those who gave birth to girls. The results indicated that exposure to IPV is associated with increased risk of premature termination of EB. The odds increase with multiple types of the IPV, especially when exposed during the index pregnancy.

Introduction Intimate partner violence against women is a global health issue. Exposure to intimate partner violence during pregnancy leads to health‐related problems for both the mother and the newborn. However, current knowledge on its occurrence varies widely and assessing the problem using standardized tools in different contexts is needed. This study aimed to estimate the prevalence and associated factors of IPV in pregnant women in Denmark and Spain through digital screening tools. Material and Methods A cross‐sectional design was used to systematically screen for intimate partner violence among pregnant women attending antenatal care by using standardized digital screening tools, Woman Abuse Screening Tool and Abuse Assessment Screen. Results A total of 17 220 pregnant women in Denmark and 2222 pregnant women in Spain were invited to participate. The response rate was high in both countries (77.3% and 92.5%, respectively). Overall, 6.9% (n = 913) and 13.7% (n = 282) screened positive in Denmark and Spain, respectively. Logistic regressions estimated crude and adjusted odds ratio with 95% confidence intervals of the relationship between sociodemographic variables and intimate partner violence. In both countries, being unmarried and lacking social support were risk factors of intimate partner violence. Additionally, in Denmark, pregnant women older than 40 years, unemployed or foreign, were at higher risk, while having higher educational levels was a protective factor. In Spain, not having a partner at the time of questionnaire completion and having at least one child prior to the current pregnancy were risk factors of intimate partner violence. Conclusions Prevalence results and found associated factors contribute to a more comprehensive understanding of the occurrence of intimate partner violence during pregnancy in Denmark and Spain, while highlighting the feasibility of digital systematic screening in antenatal settings. A total of 13 306 and 2055 pregnant women underwent digital intimate partner violence (IPV) screening in Denmark and Spain, respectively. In Denmark, 6.6% of screened pregnant women were IPV‐positive, while in Spain, the figure was 13.7%. Notably, lack of social support and being unmarried emerged as risk factors in both countries.