A C TA Obstetricia et Gynecologica


Women, power, advance  REYNIR TOMAS GEIRSSON

DOI: 10.1111/aogs.12225

Most of the journal′s cover photos come from a Nordic collection of about 5 million photographs from about 300 professional Nordic photographers. The themes have always been women in their varied life circumstances, from professionalism to leisure, alone and with their families, friends or workmates, young, middle-aged and old, reflecting the goal of the journal to portray manifold issues on women′s health from an obstetric and gynecologic perspective. Most of the front covers are scenes relating to women in the Nordic countries, but in between we have gone to other countries around the globe, in line with our global readership. We plan this for one year ahead, and by chance this month of September shows a scene captured in an Islamic country. We have many readers there and in some of the Nordic countries there is a sizeable contingent of people who adhere to that religion, its customs and outlook on life, not least as regards women. Here there are three generations, perhaps the old grandmother, the grown-up more enlightened mother and the young daughter. The little girl′s demeanour gives hope for strides forward with her strikingly less restrained look. There is a need for changed, more tolerant and open societies in these countries, which currently are in many places torn apart by internal dissent, war and violence. Women are more likely than men to prevent this and therefore must have a much greater say in the running of society. This can only come through the crucial role of education, also when it comes to enhancing the health of women. Nelson Mandela said that “education is the most powerful weapon which you can use to change the world”. In July many of us will also have listened to and seen the brave teenager Malala Yousafzai speaking on this issue at the United Nations. If not, then you should take time to watch this, on for example www. bbc.co.uk/news/world-asia-23291897. Her powerful, eloquent and memorable speech surely must give hope for the future and that the values which we in the Nordic countries have evolved in the last two centuries will prevail and be adapted to cultural differences, which in the end will also enrich humanity. And then to the September issue. The review article this month is on the role of a group of key substances for

fetal growth. The insulin-like growth factors (IGF), are three closely related proteins that participate in the growth and function of all organs of the body with a wide range of biologic effects, i.e. insulin itself, and the two ligands or co-ordinating substances IGF-1 and IGF-2 (1). All three have a large sequence of their protein structure in common. While insulin is synthetized by the pancreatic islet cells as pro-insulin (cleaved into insulin and C-peptide), the IGFs are produced by almost all tissues, - primarily the liver, and keep the C-peptide. IGFs are tied to IGF binding proteins and act on two receptors (IGFR1 and IGFR2), while a set of related protease degrading enzymes help to regulate the system, which collectively is called the IGF/growth hormone axis. This is a central part of maintaining cell proliferation and regulating programmed cell death (apoptosis). Agazail Elhddad and Hany Lashen (Albeida, Libya and Sheffield, UK) review on pp. 997-1006 what is known on key elements in this axis in relation to fetal growth. Despite a multitude of publications, there is, as often, a considerable need to clarify better the role of these proteins in regulating normal fetal growth and understand how they may function to program excessive or suboptimal growth. You might also look at another recently published review (2), where the intermediary role of the placenta is highlighted and the complex relation of these growth-regulators to maternal/fetal nutrition is considered. It happens to all doctors that we confront a patient who asks for a sickness certificate, but we are not certain that this is really warranted. Catharina Gustavsson and colleagues in Stockholm, Sweden, discuss these situations in an article worth our consideration on pp. 1007–1016. In the Nordic welfare states and similar insurance schemes elsewhere this matters with regard to both personal and national economy. It can further be seen as an issue of prudent use of resources and even of justice. Figure 1 shows the extent of the problem. The authors discuss the situation with reference to parental leave, where conflict situations are bound to arise. This is a sensitive field where guidelines based on research will be of use. Anette Glasø and her two colleagues in Trondheim, Norway (pp. 1057–1062), have looked at who opts for

ª 2013 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 92 (2013) 995–996


Editors Message

vaginal delivery as opposed to cesarean section when the baby presents by the breech. This work casts a valuable light on what influences these women in their own choice and can provide professionals with guidance on how to influence individual decisions and also attitudes in society. The trend for abdominal delivery of breech presentation (3) has been debated and vaginal delivery as an option for well selected cases has come in again (3,4). This is likely to be a never-ending debate, but hopefully gradually leading to better and updated guidelines to meet most eventualities when the baby happens to be in breech presentation. We generally like simple and good explanations. In their article on electrohysterography techniques, Eva Mikkelsen and co-workers in Aarhus, Denmark (pp. 1070–1078) shake up convention and show that uterine contractions do not only travel downwards from the right uterine cornu, but also in the opposite direction. Thus they challenge the famous theory of Caldeyro-Barcia and Alvarez (5). You also gain an insight into a novel technique currently receiving increased attention by considering the contents of this article. Rhesus problems have receded in prominence in the recent 2-3 decades, but they are still there and over time and populations they add up, even in high- and mediumresource countries, let alone where resources are poor. Rational anti-isoimmunization programs are thus vital and technological advances to determine who should receive anti-D prophylaxis during pregnancy make this now much better applicable. This is discussed by Eleonor Tiblad and colleagues in Stockholm, Sweden and London, UK, on pp. 1079–1085. A major article for AOGS and shows the way forward, now and not later. We suggest that all those readers involved in obstetrics should not bypass this. Joint action for the Nordic countries on

Rhesus isoimmunization prevention and management could be thought of and discussed at next year′s NFOG in Stockholm in June. References 1. Le Roith D. The insulin-like growth factor system. Exp Diabesity Res. 2003;4(4):205–12. 2. Bloomfield FH, Spiroski AM, Harding JE. Fetal growth factors and fetal nutrition. Semin Fetal Neonatal Med. 2013 Apr 30. doi:10.1016/j.siny.2013.03.003. 3. Hartnack Tharin JE, Rasmussen S, Krebs L. Consequences of the Term Breech Trial in Denmark. Acta Obstet Gynecol Scand. 2011 Jul;90(7):767–71. 4. Toivonen E, Palom€aki O, Huhtala H, Uotila J. Selective vaginal breech delivery at term - still an option. Acta Obstet Gynecol Scand. 2012 Oct;91(10):1177–83. 5. Caldeyro Barcia R, Alvarez H. Abnormal uterine action in labour. J Obstet Gynaecol Br Emp. 1952;59:646–56.

Point for observance Oocyte and sperm donors are usually happy with their decision to donate, but those ambivalent before remain so afterwards as well. Donor selection is important (pp. 1049– 1056). Obese pregnant women sometimes experience prejudice, accusations and lack of respect from health care professionals (pp. 1101–1107). Enquiring about the family occurrence of cholestasis and liver dysfunction among pregnant women is helpful (pp. 1108–1110). Extremely fat women and their babies face several added risks in pregnancy (pp. 1111–1114).

Useful attendance suggestions RCOG World Congress 2014, Hyderabad, India 28-30 March 2014 (www.rcog2014.com) 23rd European Congress of Obstetrics and Gynaecology, Glasgow, Scotland 7-10 May 2014 (www.ebcog2014.org) 1st European Spontaneous Preterm Birth Congress and 2nd PREBIC International Satellite Symposium, Svendborg, Denmark, 22-24 May 2014 (www.espbc.eu) The 39th Nordic Congress of Obstetrics and Gynecology (NFOG 2014) in Stockholm, Sweden, 10-12th June 2014 (www.nfog2014.se)


ª 2013 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 92 (2013) 995–996

Women, power, advance.

A C TA Obstetricia et Gynecologica AOGS EDIT ORS M ES SAGE Women, power, advance  REYNIR TOMAS GEIRSSON DOI: 10.1111/aogs.12225 Most of the journ...
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