While we are waiting for NFOG 2012 and summer, enjoy this issue of AOGS

The 38th Nordic Congress of Obstetrics and Gynecology will take place 16–19 June 2012 in Bergen, Norway (http://www.mednet.no/nfog2012/index.html). In Bergen front-line research and up-to-date knowledge in our field will be presented. Thus, visiting Norway for some days in the magnificent western parts of Norway is an opportunity that should not be missed. In this issue, AOGS offers three articles on endometriosis. Endometriosis is a cause of pain in many women, but may be difficult to diagnose and treat. Rectovaginal endometriosis represents a severe stage of the disease and may be suspected in patients with perimenstrual or chronic pain, especially in cases with dyschezia or severe dyspareunia. Christina Kruse and her colleagues in Aarhus, Denmark (pp. 648–657) conclude in their review article, that for diagnostic purposes, clinical examination should be supplemented with diagnostic imaging, of which transvaginal sonography seems promising. They also conclude that medical treatment, such as oral contraceptives or progestins, should always be recommended in women with severe endometriosis. Stefano Ferrari and co-workers from Milan, Italy (pp. 699–703) present an observational study of 26 patients with bowel endometriosis-associated symptoms. They conclude that continuous low-dose oral contraceptive therapy may reduce the symptoms and the presence of colorectal plaques as evaluated by endoscopic ultrasonography. In addition, surgery for treatment of severe endometriosis seems to be effective and sexual functioning and quality of life were improved 12 months after endometriosis surgery, Marjaleena Setälä and co-workers in Lathi, Helsinki and Turku, Finland, conclude after having followed their patients in Finland for a year. The degree of pelvic pain was also reduced (pp. 692–698). In an article from Athens, Greece, Stavros Athanasiou et al. (pp. 704–709) have studied whether pelvic organ prolapse is associated with sexual dysfunction. They report that prolapse only partly explains impaired sexual function and that sexual dysfunction appears not related to the grade of pelvic organ prolapse. Pregnancy outcomes and the effect of metformin treatment in women with polycystic ovary syndrome (PCOS) is another important review in this issue of AOGS. Gina Ghazeeri, and her co-workers from Beirut, Lebanon, present on pp. 658–678 an impressive overview of previous studies, and conclude that PCOS has been associated with several adverse pregnancy outcomes (1), but they state that most previous studies suffer from lack of statistical power or lack of adjustment for potentially confounding factors, such as high body mass index. Thus, the therapeutic benefits of metformin for adverse pregnancy outcomes in women with PCOS remain controversial. Also, only a small proportion of adverse pregnancy outcomes may be attributed to PCOS. The authors conclude that metformin has proven efficient in improving ovulation and pregnancy rates among patients receiving other fertility-enhancing agents. However, the use of metformin as a primary ovulation induction agent is questioned (2). PCOS patients are prone to develop ovarian hyperstimulation syndrome during ART treatment. Shakar Kol and colleagues from Haifa and Ashkelon, Israel, London, UK and Skive and Odense, Denmark, suggest in the Commentary at the front of the issue (pp. 643–647) that the gonadotropin-releasing hormone (GnRh) antagonist protocol should be the protocol of choice for PCOS patients undergoing ovarian stimulation with gonadotropins for in-vitro fertilization. In combination with induction of final oocyte maturation with a GnRh agonist, which has a much shorter half life than hCG, a complete elimination of ovarian hyperstimulation syndrome and high ongoing pregnancy rates may be achieved when all fresh embryos are cryopreserved and subsequently used for transfer in unstimulated cycles. In a third study on PCOS done at seven centers in Poland (Robert Kowalczyk, et al., pp. 710–714) psychological gender among women with polycystic ovary syndrome was investigated. Women with PCOS seem to have problems with psychological gender identification when compared to women without PCOS. This finding is of interest and encourages re-testing of the hypothesis in a larger study sample. An important study of women with postmenopausal bleeding by Nikolaos Burbos and co-workers in Norwich, UK (pp. 686–691) deserves to be read. How can we best identify the women with high risk of endometrial cancer? In their study of more than 4400 women in the U K, the odds ratio for endometrial cancer in women in whom the endometrial thickness was not visualized, was found to be five times higher than in women with an endometrial thickness of 5–9.9 mm. Among these women there was a 15% risk of endometrial malignancy. This is an important finding and the authors suggest that for women presenting with postmenopausal bleeding and where endometrial thickness cannot be adequately visualized on ultrasonography, hysteroscopic evaluation with endometrial biopsies should be performed. Intrahepatic cholestasis is an uncommon and unpleasant condition in pregnancy. Intrahepatic cholestasis has also been associated with adverse pregnancy outcomes. Whether the mother runs an increased risk of diseases after pregnancy is an interesting question. Kaisa Turunen and co-workers in Tampere, Finland, contribute to the answer on pp. 679–685. They found few differences between women with or without intrahepatic cholestasis in pregnancy, except for a higher prevalence of hepatobiliary disease, breast cancer and hypothyreosis many years after the pregnancy. These findings warrant further research. Also, they report that a large proportion of these women had died prior to their questionnaire study. Enquiry into possible differences in mortality and cause of death according to the woman's intrahepatic cholestasis status during her pregnancies would give insight in the nature and prognosis of this disease. In recent years there has been an increasing interest in the association of symptoms that appear in pregnancy and subsequent morbidity and mortality in the mother (3), the father (4) and the offspring (5). Blood concentrations of lipids are associated with risk of cardiovascular disease. Lanay Mudd and colleagues at four centers in the USA recruited pregnant women at different hospitals to study the association of maternal lipids at mid-pregnancy and the risk of preterm delivery (pp. 726–735). The report that extremely low lipid concentrations were associated with a modest increase in risk of medically indicated preterm delivery, whereas high lipids increased the risk of spontaneous preterm delivery. Given that a large proportion of women are dyslipidemic, the authors conclude that it is important to better understand the impact of maternal lipids on pregnancy outcome. Prevention of disease on a population level may be discouraging. Among three thousand pregnant women in Sweden, intervention with extensive counseling in antenatal care did not seem to reduce the proportion of alcohol consuming women in pregnancy, as reported by Per Nilsen and his co-authors in Linköping, Sweden (pp. 736–743). This issue of AOGS presents many interesting articles on obstetrics from different parts of the world. A study from France reports on the value of a prediction score for preterm delivery after emergency cervical cerclage (pp. 744–749). A study from Sierra Leone on pp. 750–753 suggests an increasing trend for health care assisted deliveries. A Swedish study on the sequelae after anal sphincter tear at delivery, reports a high prevalence of gas incontinence four years after sphincter tear or after vacuum extraction (pp. 715–718). Cesarean section rates are high in the western world, and a part of the increase in rates may be explained by a high recurrence rate of cesarean section in subsequent deliveries. Complications during surgery and the high prevalence of postoperative pain in mothers have not been adequately in focus. Therefore, the article by Vanja Sikirica and co-authors in the USA on possible preventive effects of the use of adhesiolysis during repeat cesarean delivery is of interest (pp. 719–725). Enjoy the reading of this AOGS issue and welcome to Bergen in June for additional inspiration at the 38th Nordic Congress of Obstetrics and Gynecology. Go through http://www.nfog.org to the short-cut to AOGS or enter the publisher's Wiley-Online Library at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1600-0412 to establish YOUR personal on-line access to AOGS at home and at work. We need many more NFOG members, who through their national societies are all subscribers to AOGS, to switch over to a primarily on-line electronic subscription.