State of the art review
This September issue of AOGS is especially stimulating with a blend of articles from different sub specialities using various methodologies: randomized controlled trials, experimental studies, cohort studies, questionnaire surveys and register based follow up studies. The guest editorial on how to reduce obesity starts with a first fresh reference to a Swedish register study that found a dose response dependent correlation between increase in BMI/weight gain between first and second delivery, and subsequent stillbirth and infant mortality! Importantly, pregnancy and the time period between first and second pregnancy is both a window of opportunity and key to the outcome of the second pregnancy. We may still be challenged by wishful thinking the observational studies make us conclude that an intervention is beneficial even though RCTs do not show the expected change. For a moment we may be disappointed, but then we reconsider and realize that the chosen outcome measures are not appropriate, but a result of the limitation of the short follow up of the RCTs. The theme of obesity is different from many other issues; obesity may change the intrauterine environment and the future health of the offspring for generations. Also, the September issue presents the first stateof the art review in AOGS. At the last editorial board meeting we discussed how to categorize reviews. For at least the last decade, epidemiologists have seen to that all reviews are systematic: when we receive a narrative review it has usually been condensed to a commentary in its own right. However, we needed a category that combines physiological, experimental and epidemiological perspectives written in a systematic fashion: not too far from a textbook chapter, but printed years before it would have been available in a textbook. We thought of "overview" but chose "state of the art" Although some might consider this terminology preposterous, we think that when you read the publication on "Fetal movements" you will know what we mean. We present a high level review beyond the scope of a limited systematic literature search, including clinical experience and a large spread of references covering decades of relevant publications. Many articles in this issue are not obstetric. The first original research paper is a Danish population based survey on gynecological cancer symptoms showing that in women who experienced one of five symptoms that might be associated with gynecologic cancer, only 20% mentioned it to their general practitioner and of these 40% were referred to or seen by a specialist. Among most women in Norway with leiomyosarcoma the diagnosis was not suspected prior to surgery, and since most women were menopausal the authors argue that morcellation could still be used in premenopausal women with fibromas. The authors present a balanced discussion of the use of a mechanical morcellator in laparoscopic hysterectomy, including the fear of spread of tumor cells in very few as opposed to the advantages of laparoscopic surgery. Mats BrEURannstrEUR om was the first to perform a successful uterus transplantation in the world. You may re read his intriguing story of how he pursued the idea based on an urge to help a young woman, who had been hysterectomized (1) Now, Japanese researchers have performed experimental studies on technical issues: for how long can a uterus of the cynomolgus monkey "survive" warm ischaemia? (Answer: about four hours) A Swedish study on antenatal lifestyle intervention to reduce weight gain in pregnancy compared standard antenatal care with a composite of monitoring, personalized graph and specific education. The study shows that the intervention was actually associated with a reduced weight gain shortly after delivery. However, the difference disappeared within a year! Observational data within the trial showed that excessive weight gain shortly after delivery was associated with an even higher increase in body weight after one year. The short presentation of remaining articles in the following will illustrate the impressive coverage of this issue and may serve as appetizers: An Australian observational study of the effect of a hemostatic matrix used for hysterectomies was inconclusive, yet the authors still consider the matrix to be useful. See for yourself if you agree. Fertility manuscripts increasingly find their way to AOGS: A paper on Nordic ovarian tissue cryopreservation and transplantation report 20 years of experience. A total
Acta obstetricia et gynecologica Scandinavica