Autumn advances towards 2013

The young colleagues in our speciality carry knowledge forward which the older ones have built up and add their own new science work, new views and attitudes to each years’ changing and dynamic reality. The current front cover can remind us, who are from the older generations of obstetricians and gynecologists, of our own self-assured progression years and let us delight in the privilege that we have in advancing and aiding our trainees and younger colleagues. Inside what is perhaps an older building four young people walk together, – they might have their background in medicine, nursing, physiotherapy or some other branch of the health sciences, but they have in common a better understanding and respect for each others potentiality than prevailed in bygone decades. When caring for patients this is an integral part of today's medical environment. An advance from older more rigid divisions between the professions. One of the areas where such understanding and co-operation is vital is in assisted reproductive sciences. There people with a background in biology, medicine and nursing must work in harmony to meet the needs of those seeking care. From such a setting comes our first commentary this month, written by Anja Pinborg and colleagues in Copenhagen, Denmark (pp. 1245–1246), where they take on a publication in one of the foremost journals in the world and argue that the data presented there give insufficient information and fail to take into account work from one of the major Nordic registers. This is the old debate about whether children produced „in vitro“ will be somehow different from those conceived in the traditional way under varying circumstances. Selective reporting happens often and through this a picture may emerge that is not the whole truth. So far nothing has really indicated that test tube babies are more than randomly different from those produced in the natural way. A debating issue like this is good for AOGS and is hereby encouraged. Jesper Brok and colleagues in Copenhagen, Denmark and Hamilton, Canada, then suggest on pp. 1247–1251 that meta-analyses are likewise subject to such “spurious chance findings” and discuss a new method, trial sequential analysis, which helps to reduce this. Considering their arguments is worthwhile. We have as other journals published meta-analyses where reliable evidence is narrowed down to few studies that meet inclusion criteria, sometimes even with a limited number of observations. There is the obvious danger of jumping to conclusions in that, but it fuels additional research and new meta-analyses, which hopefully will be developed to encompass more reliable methodology. There follow two relevant reviews, first on anti-Müllerian hormone (AMH) by Anna Grynnerup and co-workers in Hvidovre, Denmark (pp. 1252–1260; note the figure explaining AMH on p. 1255), and the second from a group based in Odense and Aarhus, Denmark, and London, UK, on what provides risk for post-traumatic stress after childbirth (Louise Andersen et al., pp. 1261–1272; note Table 5 on p. 1268 and Fig. 2 on p. 1270). Ingvild Vistad and co-workers in Kristiansand, Oslo and Bergen, Norway, have surveyed European gynecologic oncologists about follow-up routines for women with gynecologic cancer (pp. 1286–1292). Current guidelines on how often the women should return for a check-up appear similar, but the content as regards surveillance tests proved variable. Then it was perhaps not altogether surprising that in areas with lesser resources it was not possible to place the same reliance on general practitioners as done in countries enjoying a better economic situation.The need for rethinking in this respect has been pointed to before by two of the authors (1). While prospective studies on what type of follow-up may suffice are required, much future information should also become available through the strong Nordic cancer and hospital discharge registers. We are used to rely on the vaginal digital examination supplemented by abdominal palpation to follow descent and rotation of the fetal head through the birth canal during labor. Modern imaging in the form of ultrasound has been used both in an investigational and clinical setting to augment this, but has not gained widespread attention. Erik Torkildsen and colleagues from Stavanger and Trondheim, Norway, and Lund, Sweden, write about an aspect of this on pp. 1300–1305, namely the predictive value of observing an occipitoposterior or direct sagittal position at the pelvic brim in protracted labor. There is the danger that someone might use such perceived more adverse positions as a pretext for cesarean section, but the authors show clearly that this would be nonsense. Use of ultrasound can help with containing section rates even at full dilatation (2). Prolonged labor can be treated in other ways and waiting is a virtue in labor when the maternal and fetal condition allows for that to be done. Who will become a teenage mother? Venla Lethi and colleagues at four centers in Finland (Turku, Tampere, Kuopio, Helsinki, pp. 1319–1325), have looked into this and show that these are preferentially young girls with behaviour problems in childhood or adverse family situations. This is a problem that calls for much added effort everywhere, but as the authors point to, the problem is much more prevalent elsewhere compared to in the Nordic countries where education on sexual health and access to contraception is after all better than widely around the world. This article merits attention, not least in its concluding remarks. Prevention is likely to have an effect crossing two generations or more, from mother to child and onwards. AOGS is heading towards 2013 and a year where we aim to reduce the printed journal and get as many of our readers as possible to log into the journal, and start to read and use it on-line only. This fits with modern practice. At the same time we have just signed an agreement of co-operation with the Australian-New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) and the Japanese-Asian Journal of Obstetric and Gynaecology Research (JOGR), which will allow mutual electronic access among these sister journals at the same publisher (Wiley-Blackwell). This is a distinct 2013 advantage for AOGS and NFOG. Of 150 women having a vaginal hysterectomy 84% could be discharged after a 4–6 hour observation period with minimal complications and satisfaction with the received care (pp. 1293–1299). Laparoscopic abdominal cerclage is an effective, safe and a relatively easy operative procedure (pp. 1314–1318). Trying manually to rotate a brow presentation at full dilatation can lead to successful vaginal delivery without complications (pp. 1342–1345). Please note: The short-cut to AOGS on the NFOG website or at Wiley-Online Library is there to help the readers who are members of NFOG to establish a PERSONAL ON-LINE ACCESS to AOGS, at home and at work. For 2013 start to prepare for the 4th Nordic Endometriosis Congress in Turku, Finland on 23.-25. May (http://www.NCE2013.fi) and for the ISSHP European Congress in Tromsö, Norway, 12.-14. June (International Society for the Study of Hypertension in Pregnancy, http://www.isshp.org). 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.

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