From endometriosis to perineal trauma


  • Reynir Tómas Geirsson

From the Editorial Board we wish all who read this a good and successful year 2013, – it is our official 92nd publication year. We urge all our subscribers in the Nordic countries to register for the online version of the journal, if they have not already done so. We aim as before to present varied material from around the world on reproductive health and the medical issues specific to women, while we strive to raise the quality of what we publish. Most of what you see in AOGS has international relevance over and above what is described at local or regional level.

The question of more open access policies is currently being tackled by science councils and grant givers around the world, not least in the northern part of Europe where AOGS is based. Our publisher, Wiley-Blackwell, did recently update many editorial staff on this. Part of our online move relates to these fast developments in the electronic media world. We aim to not only float along, but to build on our solid foundation, a journal that will continue to serve the Nordic countries and international science in our field.

This first issue commences on the old enigma of endometriosis (note the Nordic Congress on Endometriosis in May), where first colleagues from Austria and Germany led by Dietmar Haas of Linz, Austria, discuss the classification of the condition (pp. 3–7). The widely used revised American Society of Reproductive Medicine system is in many ways insufficient and was originally created for estimating the likelihood of fertility. Thus it does not directly relate to several aspects of the disease which may weigh more nowadays, when couples are content with fewer children and affected women have therefore to counter other aspects of the disease. This discussion is important as correct classification should be part of everyday practice when endometriosis is encountered. This commentary is followed by a systematic review from a leading expert group in Milan, Italy, lead by Paolo Vercellini (pp. 8-16), where they show the truth of a simple truth: oral contraceptives are a major medication to be used in endometriosis after surgery for ovarian endometriomas. This is also true for the levo-norgestrel intrauterine system and for the prevention and amelioration of endometriosis among young women [1-4]. This is a major article to be noticed.

Surgery has undergone dramatic developments in the last decade, not only in terms of technology and equipment, but also in the principles that govern the conduct and preparations for surgical procedures. An important part of this, originating largely in the Nordic countries, is fast-track surgery. In a well written overview Ninnie Borendal Wodlin and Lena Nilsson of Linköping, Sweden (pp. 17–27), present what is involved both before, during and after the surgery itself. For those who already have fast-track principles in their working environment and for those who yet have to adapt this, the article is essential reading.

ST-analysis was a Swedish invention and this journal has seen quite some debate on the usefulness of the technique. Anette Salmelin and co-workers at several Swedish key centers review the evidence in a detailed way on pp. 28–39 and conclude that the additional usefulness over conventional electronic monitoring is limited to a lesser need for scalp pH measurements. This is a major statement. In this matter it is difficult to take all aspects into account and we do not doubt that the argument for and against ST-analysis will continue. We have had a number of contributions on this matter in the journal, and the “gold standard” is again up for scientific debate [5-7]. Even this issue has another study on this topic (Jörg Kessler and co-workers, Bergen, Norway, pp. 75–84), where the findings from an observational study are not so dissimilar, but the conclusions drawn have a different emphasis. This is bound to be the case when rare instances are evaluated, even in randomized trials.

The article by Annika Esscher and colleagues at Uppsala, Sweden (pp. 40–46) is of considerable importance. Even in well regulated Sweden, maternal mortality is underreported to a major degree. The results should concern everyone in our field and related disciplines like midwifery and public health. Ready linking of national birth, assisted reproduction and abortion registries as well as hospital discharge data to information in death certficates for women in the fertile age must be facilitated in Europe to make these vital data as accurate as possible. Health directorates in all the Nordic countries must act now on the need to have check boxes on death certificates for current pregnancy and pregnancy within a year preceding death. This is so simple that it defies understanding why this is not instituted. The study also points to the fact that other countries may be much worse off in this respect and that figures from official international bodies [8] do not tell the whole truth. As this writer was recently told by a colleague with working experience in a central Asian country, even blatant direct maternal deaths may be covered up in repressive political systems.

The Scottish perinatal database in Aberdeen is an old and well known one. Mairead Black and colleagues (pp. 47–52) report on illicit drug use and pregnancy there and find not surprisingly that this worsens outcome over smoking which most of these women are anyway exposed to, and that they have less hypertensive problems. The article from Amsterdam, the Netherlands, on blood pressure measurements in early pregnancy and the development of hypertension later on, is also worth noting (Karlijn Vollebregt and co-workers, pp. 53-60). Observe the curves shown in Figure 2. Then the nationwide study on the role of urinary calculi in pregnancy by Shiu-Dong-Chung and colleagues in Taipei, Taiwan, is also noteworthy. National data of a quality that may approach those of the Nordic registries are not widely available; Taiwan is one place.

The article from Katariina Laine and colleagues in Oslo and Frederikstad, Norway, on pp. 94–100 is the last one to call attention to in this years first Editors Message. The message in clear and worth quoting verbatim: “Obstetric anal sphincter rupture seems to be preventable to a considerable extent, as indicated by the rapid and lasting reduction of OASR incidence after implementation of perineal protection programs in Norway. Improved delivery techniques should be implemented in all delivery units to prevent OASR as much as possible”. Do not by-pass this and consider Figure 1 and Table 1 data in particular. There are two related articles on this as well, not least the one by Anna Palm and associates in Sundsvall and Umeå, Sweden, on quality of life after obstetrics ruptures. Clearly the severe rupures matter most, as we probably all knew, and it is the severe ones of grades 3 and 4 which need prevention. By implementing the changes shown by Katariina Laine and colleagues we have in my Icelandic institution halved our incidence of severe perineal trauma during the preceeding year.

We finish with a little note on history (pp. 116–117). Those who paved the way should be remembered. Such contributions are welcomed.

Please note

The 4th Nordic Endometriosis Congress (NCE2013) in Turku, Finland on 23.–25. May (

The ISSHP European Congress is in Tromsö, Norway, 12.–14. June (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.