The light is on for on line



The last cover picture for 2012 is a reminder about the end of an eventful year (with the highlight of the NFOG Congress in Bergen) and of the festive season where in most Nordic and many European countries the 13th December is a celebration of Saint Lucia's day. This nice tradition for a young girl with a crown of candles, leading a procession of young people, evolved in the 18th-20th centuries. The candlelights can symbolize life, which is the essence of our profession. This time of the year offers a welcome respite from everyday activites at the height of the dark northern winter, a time for resting with family and friends, – and lighting candles. You might then even grasp this issue of AOGS to have a look at what it contains. But now it is also time to tell you that we are planning to move forward to modernity as of the new year. AOGS in the printed form will be reduced and you are now all encouraged to activate your online subscription and read the journal on your desk computer, laptop or even more importantly your mobile communication devices (iPad, iPhone). In this issue there is an insert telling you the simple steps of how this can be done. There will also in every department be a colleague who is a wizard in web-access and they should be able to assist. So will your national society officers and we at the Editorial Office. Through our publisher, Wiley-Blackwell, we will also alert you when every new monthly issue has appeared. We know that there are those who still like to have paper and print in their hands, and that is not wholly out. You can let a national society representative know, so that a print issue will continue to be delivered without extra cost. We will also try to ensure that an issue is available in print at your workplace as the journal must still be seen in that way as well. The advantages of this change for the subscribers and NFOG are detailed in the announcement. This means i.e. better access and navigation of the journal, full color, several additional features and links to other sites of interest, and speedier actual delivery.

On pp. 1353–1356 of this isue we have a Commentary on an important topic which is also featured in two articles in this issue: women who have intellectual disabilities. Women who have the same needs and wishes as the rest of us, including for a family. Gwynnyth Llewellyn (Sydney, Australia) is an acknowledged authority in this field who writes this invited commentary and she refers to the two articles by Berit Höglund and her co-workers in Uppsala, Sweden, on maternal and neonatal outcome among women with such disability (pp. 1381–1387 and 1409–1414). We do all encounter these women. Attitudes have changed in society, from barring them from fertility to helping them to achieve a good outcome when they become pregnant and when they need support during child-rearing. As shown in these articles they are nontheless a risk group in terms of perinatal outcome. This warrants our attention with respect to gynecology and reproduction in general, where intellectually less able women must have provision tailored to their needs and rights. An Australian handbook called “Me and my baby” produced by a parenting research center at the University of Sydney ( has now been translated into a Swedish version called “To be pregnant and give birth” (Vänta och föda barn– en broschyr inför förlossningen”, downloadable at That intiative ought to spread to other countries on this side of the globe.

We feature two review articles from a team based in Odense, Denmark and London, UK (Henrik Christesen and colleagues), on vitamin D (pp. 1357–1367 and 1368–1380), where the evidence for the wide-ranging effects of this nutrition and sunlight essential is dissected in a comprehensive way. As often seen in systematic reviews, evidence for much of what we once learnt on the role of this vitamin in relation to general health is rather sparse and circumstantial. There is currently much interest in vitamin D because of its significance within the human endocrine system and the common prevalence of maternal and childhood vitamin D deficiency (1, 2). This is clearly demonstrated in these two comprehensive articles.

Lars Vatten and co-workers in Oslo and Trondheim, Norway, are adding to the evidence on the central role of angiogenic factors in preeclampsia on pp. 1388–1394, also with regard to intrauterine growth. A central part of the early response to trophoblast invasion in the placental bed and the development of the clinical syndrome of preeclampsia later in pregnancy, involves an imbalance of angiogenic effects, where soluble fms-like tyrosine kinase (sFlt) and placental growth factor, – both substances that activate vascular endothelial growth, and endoglin, a vascular remodeling glycoprotein (part of the TGF beta receptor complex) play a major pathophysiological role. This is new knowledge from the last few years and it has in addition a perspective on later cardiovascular health (3). A study which provides important data.

The article from Lena Eriksson and colleagues in Uppsala and Stockholm (pp. 1415–1421) on the effects of antenatal corticosteroid administration is also notable, since concerns have always lingered as to whether steroid treatment may produce adverse effects. For preterm infants minimizing respiratory distress syndrome is clearly an overriding importance, but administration closer to term may not have the beneficial effects that would justify administration of such a potent and wide-ranging medication to the mother, and thus her fetus, at that time of pregnancy (4, 5). Careful selection of who should have antenatal steroids and when they are given, is prudent practice.

Robson's classification for monitoring trends in delivery mode has proven its value and should be much more universally applied. An article from Singapore by Cheryl Chong and colleagues (pp. 1422–1427) is thus relevant, as it also casts light on the adverse later effects of high cesarean section rates (30% in their hospital) and the problems that this will bring for future cohorts of delivering women. The goal must be to minimize section rates among primiparous women.

An article from general practice is not so usual in this journal, but Peder Ahnfeldt-Mollerup and colleagues in Odense, Vejle and Horsens, Denmark (pp. 1440–1444) point out an important message, namely that minor postpartum problems in relation to breast-feeding are very common, yet receive insufficient attention, investigation and management. The women may stop their breastfeeding unnecessarily. This article has already received some media attention (

We present this month a largely obstetrical issue, reflecting that about 55% of the material we receive and publish is obstetrics, and 45% gynecology. It also shows the impact of more established sub-specialties and their journals within gynecology. There is a much greater choice for journals to submit to in gynecology compared to obstetrics. We are aware of this in the Editorial Board and we try to keep a reasonable balance, – which we most often manage to do. But we also call for increased submissions of quality manuscripts from within general gynecology, contraception, fertility/infertility, urogynecology and gynecologic oncology, primarily work where there are direct clinical implications.

Points for observance:

African and South-Asian women have a higher risk, but possibly lesser adverse effects with regard to preterm birth than seen for Caucasian or East-Asian women. There may be ethnic variation in the optimal time of delivery (pp. 1402–1408).

Bupivacaine with adrenaline injected at closure into the surgical wound decreases the need for postoperative morphine after cesarean section (pp. 1433–1439).

Women with acute intermittent porphyria, a hepatic condition, have an altered 5α-reductase steroid metabolism which may explain the higher prevalence of the disease among women during the fertile age (pp.1445–1452).

Please note:

The 4th Nordic Endometriosis Congress (NCE2013) will be in Turku, Finland on 23.-25. May 2013 (

The ISSHP European Congress is in Tromsö, Norway, 12.-14. June 2013 (International Society for the Study of Hypertension in Pregnancy,

The first global conference on contraception, reproductive and sexual health is in Copenhagen, Denmark on 22.-25. May 2013, organized by the European Society of Contraception and Reproductive Health.