Ninety years of AOGS

Acta Obstetricia et Gynecologica Scandinavica is commencing its 90th year of publication since the first issue appeared in 1921, then with articles in French, German and English. That was at the start truly international, as we still are. We can be proud of a journal that holds respect around the world, is enjoying a steady and long-term impact (newest impact factor 1.618) and where we manage to keep a good balance towards most major aspects of obstetrics, gynecology and reproductive medicine in general. Among that type of specialist journal in this field we hold our place after the two American and the British journals. For obstetrics and gynecology as a discipline we are a necessary Nordic forum, and European as well, but we also appreciate and need the support of our NFOG readers and the many helpful expert reviewers we have in our countries and around the world. We aim to keep the momentum we have and to add to it. You will notice some difference to the look of the journal's lay-out. This is the first issue with a new publisher, Wiley-Blackwell. Following a tender for the publication last summer it was decided to join forces with this strong publishing house with its world-wide operations to make use of the links and opportunities that this provides. We hope this will strengthen the journal further. The front cover winter scene is in line with our expectations for the future for AOGS. The 90th volume starts with a Commentary (pp. 4) by one of the editors, Jens Langhoff-Roos (Copenhagen, Denmark) focusing on the article by Areej Elkamil and colleagues from Trondheim, Tönsberg and Bergen in Norway (pp. 80–88) showing a possible link between cerebral palsy and induction of labor. Though this feared condition is less prevalent now as a complication of childbirth, a relation to induced labor is a serious matter pointing to the need for detailed evaluation of causal factors. What links a higher chance of neurodevelopmental damage to induced labor? Is it the induction process itself or the underlying condition, such as intrauterine growth restriction and fetoplacental insufficiency? Knowledge on the complex molecular basis of cerebral ischemic damage is steadily increasing and with that comes new hope of finding ways to limit the consequences (1,2). Rehabilitation of these individuals has been much improved and the way in which society can assist them to achieve their maximum potential has also been optimized in many ways. Prevention is, however, much better than a cure. The day 11.09.2001 will live in memory. No one forgets what happened. Did it affect pregnancies indirectly? A systematic review from a well-known Canadian group in Toronto, headed in this case by Arne Ohlsson, should not be by-passed (pp. 3–15). What care is required for women in vulnerable situations, not least if they are pregnant, in the aftermath such disaster conditions? Such adverse conditions are common and very persistent in some areas of the world. This aspect of women's health must not go unnoticed even in more affluent societies. We have a responsibility here. Are mild–moderate and severe preeclampsia related? This is an old question and is still debated. The study on placental infarction by Marie-ThereseVinnars and colleagues from Stockholm, Sweden (pp. 15–22), says that this is so, confirming what for most of us is common clinical knowledge. It is not surprising that placental trophoblast damage, a combination of necrosis and accelerated apoptosis will induce such more profound histological damage as placental infarction, but this needed better scientific demonstration, which is provided here. A study which should be noticed, not least the Discussion. Continuing on the obstetric theme, the study by Charlotta Grünewald and colleagues in Stockholm, (pp. 23–29) has already aroused considerable interest when aspects of it were reported at recent conferences earlier in the year, because it shows that a more active policy of not letting women go past 42 weeks results in lesser perinatal mortality without appreciable cost in terms of operative delivery rates or complications. More women must have labor induced with an active intervention policy, but if this is achieved at this late time of gestation with the benefit of saving the life and quality of life for a number of babies and at no disadvantage to the mothers at large, it seems worthwhile not to stall, but recommend induction to the mother between 41 and 42 weeks. This also falls broadly in line with the current literature which was summarized well in a systematic review in this journal one year ago (3). At least it is clear that there is probably a benefit of such a policy for women where gestational length is securely established. The woman herself will anyway always have the last word on this. How are postoperative infections best prevented in vaginal surgery? This is another currently debated question. Large population-based register studies are one way of ascertaining what works best. Preben Kjölhede and colleagues from Linköping and Umeå in Sweden (pp.60–68) have looked at this in a large material and found that no vaginal preparation or saline only to cleanse the vagina before vaginal hysterectomy is inferior to using a chorhexidine solution. They also confirmed the existence of some risk factors, among which obesity, operation time and length of hospital stay matter most. Prophylactic antibiotic treatment was also shown to be protective. It is good to have this reaffirmed and the evidence strengthened by this study. However, Sofie Antonsen and colleagues in Copenhagen, Denmark (pp. 69–73) also suggest that there may be severe under-reporting into such databases, at least in this country, which of course could affect results and is by itself a serious organizational deficiency that needs to be addressed for all similar databases in order to provide secure information for the future. Should one try to repeat a cerclage suture when the first one seems to be failing? Ji-Eun Song and co-workers in Seoul, Korea, suggest that this may be so (pp. 108–110). A new decade is starting for AOGS. The journal will as before be open towards good research and debate from anywhere in the world and, considering the journal's origins, have some emphasis on the Nordic countries. We will focus in a broad and varied way on clinical issues in reproductive health admixed with basic research in relation to obstetrics and gynecology, which are alwaus our prime medical areas. Suffering childhood abuse is later on associated with fear of childbirth and preference for cesarean section during a second pregnancy (pp. 30–37). An elevated vaginal pH is associated with different types of abnormal vaginal flora and the presence of sperm cells as well as a tendency for lower abdominal pain (pp. 38–43). The presence of insulin-like growth factor binding protein-1 (IGFBP-1) in cervical secretions may predict spontaneous labor onset and successful induction in post-term pregnancy at least as well as the Bishop score and cervical length measurements (pp. 54–59). Clinical guidelines on acupuncture for childbirth-related symptoms lack information to support administration of acupuncture and the guidelines can be unclear, inconclusive and even irrelevant, as well as being deficient with regard to information on indications and techniques (pp. 74–79). The Nordic Federation's website is a source of information for members of the Nordic societies and others interested in what is happening within obstetrics and gynecology in this part of the world. It is easy for members to register for the online version of Acta Obstetricia et Gynecologica Scandinavica. To access the site, and to register, please visit http://nfog.org Wiley-Blackwell is the publisher of Acta on behalf of the Nordic Federation of Obstetricians and Gynecologists (NFOG)

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