A C TA Obstetricia et Gynecologica
AOGS EDIT ORS M ES SAGE
Ebola and adverse circumstances REYNIR TOMAS GEIRSSON
DOI: 10.1111/aogs.12493
The summer months of 2014 have brought sad and difficult global news. We live in a world where press coverage is such that those in the peaceful parts of the globe can easily observe horrors that happen elsewhere, such as in the Middle East where thousands have been killed and maimed in a ghetto situation not seen for over 70 years, or where brutal civil war, religious fundamentalist or nationalistic atrocities go beyond what can be imagined. Even the closer Eastern Europe is not exempt. We see this live on television and can not escape the necessity of considering what is happening. Why do people do such things to each other? How long is it going to continue and how can those in power who fuel these situations be stopped? Inevitably war is followed by massive trauma to body and soul when the fabric of society is destroyed and diseases come in as a result of the conditions created by such catastrophes. But diseases also go their own way as seen in the serious ebola virus outbreak in West Africa. This is now threatening several countries where weak health services are breaking down. As ebola spreads some health facilities close down for fear of contagiousness, while more seriously people avoid the hospitals that are still open, because they are so afraid to get the disease in those places. A relevant example familiar to our profession would be a mother who needs competent care and facilities for safe delivery, but now she may rather choose to go to a traditional helper in her own or a nearby village. A colleague from the region and working in his African homeland sent to one of the editors a message and said “I am getting worried. Our lives are at stake. There is no hope for our families if ones dies of this disease. As a health worker, one’s chance of getting the infection is very high. I really feel sorry for my two kids when I imagine the risk involved in being a health worker in my country at the moment”. Can you imagine yourself and your family in this situation? For many of us this is far away, but it might spread to Europe too. Our African colleague said that there are now so many more people out there who are carrying the ebola virus, – either symptomatic or asymptomatic. But they will not report to the health facilities for the necessary tests, posing a serious threat to entire nations in this huge and populous part of the world. The health staff are working under extremely difficult circumstances, already
partly decimated by the disease in poorly equipped health facilities where the required skills to deal with the situation are lacking. They are in the opinion of our colleague the ones most at risk. That is obviously true. There is also a state of denial in these countries where people prefer to take their sick relatives to traditional healers or keep them at home, exposing other family members to the high risk of infection. To break the chain of transmission of this virus is a huge challenge. In a complex situation of traditional values being superimposed on a health system which is struggling to cope, it may not be possible to contain the disease. Our colleague reminds us that “the outbreak should not be looked on as a national or regional issue. A global approach should be taken to stop its spread. The world today is a global village and it will take just a couple of days, if not hours for anything that happens in one part of the world to affect other areas as well”. This is a stark reminder of the situations that some doctors have to face. We who are more fortunate must stand by them and urge our health systems and governments to do what they can to help. Now. This October issue contains several articles of importance. Once again we have made international press releases to call attention to some AOGS articles. Wide coverage has ensued, for example about the article by Floortje Vlemmix and colleagues in the Netherlands on term breech delivery, published in the September issue (1). That article was i.a. featured on the RCOG homepage. In the current issue we have a valuable commentary by Hiroyoki Seki, a colleague in Kawagoe, Japan (pp. 959–964), on the role of angiogenic and anti-angiogenic factors in the pathogenesis of preeclampsia, – a topic which is now at the center of interest for understanding this major cause of maternal-fetal morbidity and mortality, not least in the low resource parts of the world, where also the struggles against the ravages of ebola are ongoing. Then we feature two reviews; the first by Lior Drukker and colleagues in Jerusalem, Israel (pp. 965–972), on perimortem resuscitation in pregnancy, – a fortunately rare occurrence, but one which many of us may still encounter once or twice in a professional life-time in high-resource countries, let alone elsewhere. How this should be handled and what has to be kept in mind is well portrayed. From
ª 2014 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 93 (2014) 957–958
957
Editors Message
Rebecca Allen and an expert group based in London, UK, who specialize in systematic reviews, comes on pp. 973–985 a meta-analysis on the effects of dietary and life-style interventions in preeclampsia, – something that links up with modern theories on the etiology of this disease. Adverse life-style factors provide the substrate for abnormal lipid oxidation and derangement of angiogenic substances in preeclampsia, superimposed on a genetic predisposition. A forthcoming issue will be dedicated to the related topic of fetal programming, where emphasis is also on the way in which adverse maternal health influences the offspring from the supposedly sheltered intrauterine environment up to adulthood. Continuing with the obstetric issues, Bj€ orn Gunnarsson and colleagues in Drøbak and Trondheim, Norway and in Akureyri, Iceland (pp. 103–1010), are calling our attention to the hazards associated with unplanned birth and emergency transfer from outlying areas, – a situation which is well known in more thinly populated highresource countries in both the northern and southern hemisphere, and can of course also apply to areas where transport is difficult in under-developed countries lacking the necessary infrastructure. Organization of services is paramount to increase survival in such situations, but the social fabric must also be improved in order to reduce these birth-related hazards. Ultrasound is increasingly being used during delivery to determine descent and rotation of the fetal head through the pelvis. This is a logical step as an adjunct to assessment of progress in labor, where vaginal manual examination will though remain an essential element. The two articles by Aly Youssef and co-workers of Bologna, Italy (pp. 1011–1017) and Hala Phipps and colleagues in Sidney, Australia (pp.1018–1024), describe aspects of this work, but some ground-breaking work has also been published from the unit in Stavanger, Norway (2,3). Ultrasound is an integral part of everyday obstetric and gynecologic modern activity, but has not until recently been applied to monitoring the progress of labor. This still requires considerable research to evolve the principles to be used, and therefore these two articles merit attention. Related to this is the work of Elena Br€ane and colleagues in Stockholm, Sweden (pp. 1042–1049) on early induction measures compared to awaiting spontaneous onset of labor in women with a long latent phase in a term first delivery. There was minimal difference in outcome between the groups, with both having a relatively high risk of eventual cesarean delivery. Discriminatory power was, however, borderline. Thus the study indicates that more research of a similar kind is needed to evolve better the optimal management for this group of women in labor.
958
Karin Glavind and colleagues in Aalborg, Denmark, show on pp. 986–990 that sexual function is subjectively improved after tension-free vaginal tape operations for stress urinary incontinence. Long-term follow-up on these women is needed to clarify various aspects of tape placement for stress incontinence and uterine prolapse problems. Then Christian Busch and co-workers in Heidelberg and T€ ubingen, Germany (pp. 991–996) have investigated the role of relaxin and oxytocin in uterine prolapse and find that while receptors are to be found for all these substances in parts of the uterosacral ligaments, it is relaxin which is likely to be most related to the development of vaginal prolapse. There is much to note in this issue of AOGS, as before. The good news this summer is that our impact factor has again risen and stands now at 1.985. So close to the figure of 2.0. Reaching that goal would mean an additional incentive to submit quality manuscripts to the journal and raise our impact even further. We ask for active support from members of the Nordic Federation of Societies for Obstetrics and Gynecology in order to get there, – both from potential authors and the reviewers. This is your journal and it is now as before a part of the future for the specialty in our region and for numerous other countries from where we get so many submissions. We are an old and dignified journal, but young at heart as our front cover illustrates. References 1. Vlemmix F, Bergenhenegouwen L, Schaaf JM, Ensing S, Rosman AN, Ravelli AC, der van Post JA, Verhoeven A, Visser GH, Mol BW, Kok M. Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study. Acta Obstet Gynecol Scand. 2014 Aug 11. doi: 10.1111/aogs.12449. 2. Eggebø TM. Ultrasound is the future diagnostic tool in active labor. Ultrasound Obstet Gynecol. 2013 Apr;41 (4):361–3. 3. Hassan WA, Eggebø T, Ferguson M, Gillett A, Studd J, Pasupathy D, Lees CC. The sonopartogram: a novel method for recording progress of labor by ultrasound. Ultrasound Obstet Gynecol. 2014 Feb;43(2):189–94. doi: 10.1002/uog.13212.
Points for observance: Cesarean sections, and especially emergency procedures, are followed by reduced subsequent fecundity, compared to when a vaginal delivery is achieved (pp. 1034–1041). Fetal middle cerebral artery serial velocimetry is useful to identify women whose neonates will require postnatal transfusions for hemolytic disease (pp.1059–1064)
ª 2014 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 93 (2014) 957–958
AOGS EDIT ORS M ES SAGE
Ebola and adverse circumstances REYNIR TOMAS GEIRSSON
DOI: 10.1111/aogs.12493
The summer months of 2014 have brought sad and difficult global news. We live in a world where press coverage is such that those in the peaceful parts of the globe can easily observe horrors that happen elsewhere, such as in the Middle East where thousands have been killed and maimed in a ghetto situation not seen for over 70 years, or where brutal civil war, religious fundamentalist or nationalistic atrocities go beyond what can be imagined. Even the closer Eastern Europe is not exempt. We see this live on television and can not escape the necessity of considering what is happening. Why do people do such things to each other? How long is it going to continue and how can those in power who fuel these situations be stopped? Inevitably war is followed by massive trauma to body and soul when the fabric of society is destroyed and diseases come in as a result of the conditions created by such catastrophes. But diseases also go their own way as seen in the serious ebola virus outbreak in West Africa. This is now threatening several countries where weak health services are breaking down. As ebola spreads some health facilities close down for fear of contagiousness, while more seriously people avoid the hospitals that are still open, because they are so afraid to get the disease in those places. A relevant example familiar to our profession would be a mother who needs competent care and facilities for safe delivery, but now she may rather choose to go to a traditional helper in her own or a nearby village. A colleague from the region and working in his African homeland sent to one of the editors a message and said “I am getting worried. Our lives are at stake. There is no hope for our families if ones dies of this disease. As a health worker, one’s chance of getting the infection is very high. I really feel sorry for my two kids when I imagine the risk involved in being a health worker in my country at the moment”. Can you imagine yourself and your family in this situation? For many of us this is far away, but it might spread to Europe too. Our African colleague said that there are now so many more people out there who are carrying the ebola virus, – either symptomatic or asymptomatic. But they will not report to the health facilities for the necessary tests, posing a serious threat to entire nations in this huge and populous part of the world. The health staff are working under extremely difficult circumstances, already
partly decimated by the disease in poorly equipped health facilities where the required skills to deal with the situation are lacking. They are in the opinion of our colleague the ones most at risk. That is obviously true. There is also a state of denial in these countries where people prefer to take their sick relatives to traditional healers or keep them at home, exposing other family members to the high risk of infection. To break the chain of transmission of this virus is a huge challenge. In a complex situation of traditional values being superimposed on a health system which is struggling to cope, it may not be possible to contain the disease. Our colleague reminds us that “the outbreak should not be looked on as a national or regional issue. A global approach should be taken to stop its spread. The world today is a global village and it will take just a couple of days, if not hours for anything that happens in one part of the world to affect other areas as well”. This is a stark reminder of the situations that some doctors have to face. We who are more fortunate must stand by them and urge our health systems and governments to do what they can to help. Now. This October issue contains several articles of importance. Once again we have made international press releases to call attention to some AOGS articles. Wide coverage has ensued, for example about the article by Floortje Vlemmix and colleagues in the Netherlands on term breech delivery, published in the September issue (1). That article was i.a. featured on the RCOG homepage. In the current issue we have a valuable commentary by Hiroyoki Seki, a colleague in Kawagoe, Japan (pp. 959–964), on the role of angiogenic and anti-angiogenic factors in the pathogenesis of preeclampsia, – a topic which is now at the center of interest for understanding this major cause of maternal-fetal morbidity and mortality, not least in the low resource parts of the world, where also the struggles against the ravages of ebola are ongoing. Then we feature two reviews; the first by Lior Drukker and colleagues in Jerusalem, Israel (pp. 965–972), on perimortem resuscitation in pregnancy, – a fortunately rare occurrence, but one which many of us may still encounter once or twice in a professional life-time in high-resource countries, let alone elsewhere. How this should be handled and what has to be kept in mind is well portrayed. From
ª 2014 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 93 (2014) 957–958
957
Editors Message
Rebecca Allen and an expert group based in London, UK, who specialize in systematic reviews, comes on pp. 973–985 a meta-analysis on the effects of dietary and life-style interventions in preeclampsia, – something that links up with modern theories on the etiology of this disease. Adverse life-style factors provide the substrate for abnormal lipid oxidation and derangement of angiogenic substances in preeclampsia, superimposed on a genetic predisposition. A forthcoming issue will be dedicated to the related topic of fetal programming, where emphasis is also on the way in which adverse maternal health influences the offspring from the supposedly sheltered intrauterine environment up to adulthood. Continuing with the obstetric issues, Bj€ orn Gunnarsson and colleagues in Drøbak and Trondheim, Norway and in Akureyri, Iceland (pp. 103–1010), are calling our attention to the hazards associated with unplanned birth and emergency transfer from outlying areas, – a situation which is well known in more thinly populated highresource countries in both the northern and southern hemisphere, and can of course also apply to areas where transport is difficult in under-developed countries lacking the necessary infrastructure. Organization of services is paramount to increase survival in such situations, but the social fabric must also be improved in order to reduce these birth-related hazards. Ultrasound is increasingly being used during delivery to determine descent and rotation of the fetal head through the pelvis. This is a logical step as an adjunct to assessment of progress in labor, where vaginal manual examination will though remain an essential element. The two articles by Aly Youssef and co-workers of Bologna, Italy (pp. 1011–1017) and Hala Phipps and colleagues in Sidney, Australia (pp.1018–1024), describe aspects of this work, but some ground-breaking work has also been published from the unit in Stavanger, Norway (2,3). Ultrasound is an integral part of everyday obstetric and gynecologic modern activity, but has not until recently been applied to monitoring the progress of labor. This still requires considerable research to evolve the principles to be used, and therefore these two articles merit attention. Related to this is the work of Elena Br€ane and colleagues in Stockholm, Sweden (pp. 1042–1049) on early induction measures compared to awaiting spontaneous onset of labor in women with a long latent phase in a term first delivery. There was minimal difference in outcome between the groups, with both having a relatively high risk of eventual cesarean delivery. Discriminatory power was, however, borderline. Thus the study indicates that more research of a similar kind is needed to evolve better the optimal management for this group of women in labor.
958
Karin Glavind and colleagues in Aalborg, Denmark, show on pp. 986–990 that sexual function is subjectively improved after tension-free vaginal tape operations for stress urinary incontinence. Long-term follow-up on these women is needed to clarify various aspects of tape placement for stress incontinence and uterine prolapse problems. Then Christian Busch and co-workers in Heidelberg and T€ ubingen, Germany (pp. 991–996) have investigated the role of relaxin and oxytocin in uterine prolapse and find that while receptors are to be found for all these substances in parts of the uterosacral ligaments, it is relaxin which is likely to be most related to the development of vaginal prolapse. There is much to note in this issue of AOGS, as before. The good news this summer is that our impact factor has again risen and stands now at 1.985. So close to the figure of 2.0. Reaching that goal would mean an additional incentive to submit quality manuscripts to the journal and raise our impact even further. We ask for active support from members of the Nordic Federation of Societies for Obstetrics and Gynecology in order to get there, – both from potential authors and the reviewers. This is your journal and it is now as before a part of the future for the specialty in our region and for numerous other countries from where we get so many submissions. We are an old and dignified journal, but young at heart as our front cover illustrates. References 1. Vlemmix F, Bergenhenegouwen L, Schaaf JM, Ensing S, Rosman AN, Ravelli AC, der van Post JA, Verhoeven A, Visser GH, Mol BW, Kok M. Term breech deliveries in the Netherlands: did the increased cesarean rate affect neonatal outcome? A population-based cohort study. Acta Obstet Gynecol Scand. 2014 Aug 11. doi: 10.1111/aogs.12449. 2. Eggebø TM. Ultrasound is the future diagnostic tool in active labor. Ultrasound Obstet Gynecol. 2013 Apr;41 (4):361–3. 3. Hassan WA, Eggebø T, Ferguson M, Gillett A, Studd J, Pasupathy D, Lees CC. The sonopartogram: a novel method for recording progress of labor by ultrasound. Ultrasound Obstet Gynecol. 2014 Feb;43(2):189–94. doi: 10.1002/uog.13212.
Points for observance: Cesarean sections, and especially emergency procedures, are followed by reduced subsequent fecundity, compared to when a vaginal delivery is achieved (pp. 1034–1041). Fetal middle cerebral artery serial velocimetry is useful to identify women whose neonates will require postnatal transfusions for hemolytic disease (pp.1059–1064)
ª 2014 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 93 (2014) 957–958
