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• W2160793251 abstract "As men spending a life-times work on looking after the health of women, we are so well aware of the tremendous strength that women have. Calling us men the “stronger” sex is wrong, – we just have a different kind of strength. To make it fully possible for women to share equally in the constant task of building a good society is a prime challenge in this 21st century, not least in the many parts of the world where female emancipation is still far behind compared with the situation in western countries. Yet this is the key to a better and more just world and to tackling overpopulation, food and water shortages, even peace. The NFOG Congress in Bergen in June is drawing closer and should be a celebration of our achievements in this direction in the Nordic countries, as well as a show of strength of Nordic obstetrics and gynecology, – a time for flexing our scientific and professional muscles for the benefit of women, referring to the front cover this month. We start this issue with a commentary from the strong London, UK, group working in evidence-based medicine, writing on the need to ensure adequate vitamin D status in pregnancy. Vitamin D has been receiving increasing attention in recent years as a major contributor to health, even through effects in pregnancy and with breastfeeding on later health. Sarah Finer and colleagues (pp. 159–163) go in a clear way through the main issues now in the limelight. Even at northerly altitudes changes in diet do necessitate that we as medical practitioners ensure an adequate supply of ingested vitamin D. Riika Korja and colleagues from Turku, Finland, present on pp. 164–173 a good review of the evidence surrounding preterm birth and bonding. This is an area where obstetrics and neonatology interact and where support from the obstetric side is vital through adequate organization and a supportive attitude within both postnatal and neonatology wards. As so often one can be surprised at the limited prospective evidence available where it would seem possible to gather this in a better way than in many other fields. In medicine we must not only be knowledgeable about our own sometimes narrow specialist field, but be reasonably updated on major developments within the speciality as a whole, to be able to answer questions from our patients and others. This will give us credibility as specialists. Sentinel lymph nodes and the importance of getting at these for guiding treatment in gynecologic cancer management is reviewed by Noortje van Oostrum and colleagues from Antwerp and Ghent, Belgium (pp. 174–181). This is an approach which obstetricians/gynecologists need to know about, even if they are not themselves involved in such surgical procedures, since this has altered the way surgery is conducted in cervical, endometrial and vulvar cancer. Here it is well explained, with a view to state-of the-art and to where knowledge is still insufficient. Gynecologic oncologists have in many ways been exemplary in how they have organized large-scale randomized studies and it is to be expected that in this field we will see solid evidence emerging to close the knowledge gaps. We have in the last few months had articles and discussion items on the fetal T-QRS ratio or ST-analysis on our pages in AOGS (1,2,3). Jeroen Becker and colleagues, from several centers in the Netherlands, have again investigated aspects of the method on pp. 189–197. The material is reasonably large, but retrospective. End-points such as suspected fetal distress and adverse neonatal outcome are moreover loose terms. While we frequently suspect fetal distress in clinical practice or admit babies to neonatal intensive care units, the severe instances resulting in death or serious disability are not common. Therefore the added value of a method like ST-analysis will easily appear as marginal and not easy to prove or disprove. Further prospective studies on the method are still needed to establish its value. A similar contentious issue is liberal induction policies at term. Rosalie Grivell and colleagues in Adelaide, Australia (pp. 198–203), using a large dataset, caution against too liberal policies. Epidemiological studies using registry data are immensely valuable, as we know from the Nordic birth registries, but there are also drawbacks in such studies which often are only resolved prospectively. In the meantime it may be best to hold a moderate and open-minded attitude and let nature take its own course where possible, but keeping a low threshold for intervention when adverse signs are detected. Another Australian study this month, from Lindsey Watson and colleagues in Melbourne and neighboring Prahran (pp. 204–210) on the effect of intracervical procedures and the risk of very preterm delivery is also worth your attention. Their findings require further substantiation, but indicate that curettage of the cervix should be limited during the childbearing age, using medical means for evacuation instead. HPV vaccination may have a secondary benefit in this respect as well. The link from childbirth injury to later prolapse-associated problems is discussed in the article by Hans Dietz and co-workers in a expert group from Penrith Australia and London, UK on pp. 211–214. This is an interesting and important new view on the complexity of what subtle effects childbirth may have on the pelvic structures. Studies like this one hold promise for understanding and ultimately improving management of pelvic weakness syndromes. The article from Tanja Tydén and colleagues in Uppsala, Sweden (p. 215–219) on sexual behavior among the young educated elite attending university, shows worrying trends, no matter how liberal one may be. One may think that this is just something peculiar to this part of the world, but with rapidly increasing globalization, the trend for multiple, less inhibited and careless sexual encounters is likely to be seen elsewhere as well, as evidenced for example by the high teenage pregnancy rates in the United States (4). Obstetricians/gynecologists have a clear duty towards sexual responsibility education in society. From the Norwegian Mother-Child study cohort (MoBa study) we have again confirmation of the relation between increasing birthweight with higher BMI and higher weight gain in pregnancy, something that with changed diets and more prevalent obesity is of considerable concern. Unni Koepp and co-workers in Kristiansand and Oslo, Norway (pp. 243–249) show this well, including by their Figure 2, and discuss several factors that influence this, such as the social determinants. Prolonged second stage of labor is a common situation in all labor wards. The obstetrician has three options; do a cesarean section, perform a vacuum extraction or deliver by forceps. The delivering woman is often exhausted and scared and an informed consent is difficult to achieve. An operative vaginal delivery is usually recommended when the fetal head is lower than the ischial spine and a cesarean section when the fetal head is at high stations. In many departments there is a changing trend from forceps to vacuum deliveries. Vacuum is easier for inexperienced physicians, the fetal head can rotate passively and vacuum is less associated with perineal tears. However, forceps protects the fetal skull and reduces the risk of a failed operative delivery. Amy Swanson and colleagues in Melbourne, Australia remind us about subgaleal hemorrhage on pp. 260–263. This is rare but severe complication is more commonly associated with vacuum compared to forceps. Sequential procedures are associated with highest risk of severe fetal complications. The knowledge and skill in forceps deliveries should not be lost. The authors discuss several therapeutic options in managing subgaleal hemorrhage and emphasise the importance of early diagnosis and early implementation of novel therapies. A successful operative delivery depends, however, on a precise diagnosis of the presentation, position and level of the fetal head. All birth attendants should focus on the basic digital clinical examination, and recent studies have documented that ultrasound might add important objective information related to fetal station and position. For a journal like AOGS, catering for specialist and subspecialist interests, variety in what we publish matters. This is not only reflected in the main research articles, but also in the short research reports and the correspondence. We encourage the readers to go through these pages and note the various conditions of interest covered. Lastly you may have noticed that we are gradually introducing a new component, the “Key message” box, for each major article. Triglyceride levels may be a cardiovascular risk marker, pathophysiologically and independently associated with endothelial dysfunction in nondiabetic women who previously had gestational diabetes (pp. 182–188). “Women on Web” is a telemedicine service for advice on termination of pregnancy aimed i.a. at women in countries with poor access to such services (pp. 222–231). Visit http://www.nfog.org for information on the 38th NFOG Congress on June 16th–19th 2012 in Bergen, Norway, and for a short-cut to AOGS on the NFOG website or at Wiley-Online Library. Establish YOUR personal on-line access to AOGS." @default.
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• W2160793251 title "Strength of women" @default.
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