| 3521. |
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| 3522. |
- Cuttini, Marina, et al.
(författare)
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Patient refusal of emergency cesarean delivery - A study of obstetricians' attitudes in Europe
- 2006
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Ingår i: Obstetrics and Gynecology. - 1873-233X. ; 108:5, s. 1121-1129
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the attitudes of a large sample of obstetricians from eight European countries toward a competent woman's refusal to consent to an emergency cesarean delivery for acute fetal distress. METHODS: Obstetricians' attitudes in response to a hypothetical clinical case were surveyed through an anonymous, self-administered questionnaire. The sample included 1,530 obstetricians (response rate 77%) from 105 maternity units (response rate 70%) in eight countries: France, Germany, Italy, Luxembourg, Netherlands, Spain, Sweden and the United Kingdom. RESULTS: In every country, the majority of obstetricians would keep trying to persuade the woman, telling her that failure to perform cesarean delivery might result in the fetus surviving with disability, or even that her own life might be endangered. In Spain, France, Italy, and, to a lesser extent, Germany and Luxembourg, a consistent proportion of physicians would seek a court order to protect fetal welfare or avoid possible legal liability or both. In the United Kingdom, Sweden, and Netherlands, several respondents (59%, 41%, and 37%, respectively) would accept the woman's decision and assist vaginal delivery. Only a small minority (from 0 in the United Kingdom to 10% in France) would proceed with cesarean delivery without a court order. CONCLUSION: Case law arising from a few countries (United States, Canada, and the United Kingdom) and professional guidelines favoring women's autonomy have not solved the underlying ethical conflict, and in Europe acceptance of a woman's right to refuse cesarean delivery, at least in emergency situations, is not uniform. Differing attitudes between obstetricians from the eight countries may reflect diverse legal and ethical environments.
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| 3523. |
- Daemen, Anneleen, et al.
(författare)
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Improved modeling of clinical data with kernel methods
- 2012
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Ingår i: Artificial Intelligence in Medicine. - : Elsevier BV. - 1873-2860 .- 0933-3657. ; 54:2, s. 103-114
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Despite the rise of high-throughput technologies, clinical data such as age, gender and medical history guide clinical management for most diseases and examinations. To improve clinical management, available patient information should be fully exploited. This requires appropriate modeling of relevant parameters. Methods: When kernel methods are used, traditional kernel functions such as the linear kernel are often applied to the set of clinical parameters. These kernel functions, however, have their disadvantages due to the specific characteristics of clinical data, being a mix of variable types with each variable its own range. We propose a new kernel function specifically adapted to the characteristics of clinical data. Results: The clinical kernel function provides a better representation of patients' similarity by equalizing the influence of all variables and taking into account the range r of the variables. Moreover, it is robust with respect to changes in r. Incorporated in a least squares support vector machine, the new kernel function results in significantly improved diagnosis, prognosis and prediction of therapy response. This is illustrated on four clinical data sets within gynecology, with an average increase in test area under the ROC curve (AUC) of 0.023, 0.021, 0.122 and 0.019, respectively. Moreover, when combining clinical parameters and expression data in three case studies on breast cancer, results improved overall with use of the new kernel function and when considering both data types in a weighted fashion, with a larger weight assigned to the clinical parameters. The increase in AUC with respect to a standard kernel function and/or unweighted data combination was maximum 0.127, 0.042 and 0.118 for the three case studies. Conclusion: For clinical data consisting of variables of different types, the proposed kernel function which takes into account the type and range of each variable - has shown to be a better alternative for linear and non-linear classification problems. (C) 2011 Elsevier B.V. All rights reserved.
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| 3524. |
- Dahiri, Bouchra, et al.
(författare)
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Assessment of the oxidative status in mother-child couples from Seville (Spain) : A prospective cohort study
- 2023
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Ingår i: Free Radical Biology & Medicine. - 0891-5849 .- 1873-4596. ; 207, s. 308-319
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Tidskriftsartikel (refereegranskat)abstract
- Pregnancy requires a high demand of energy, which leads to an increase of oxidative stress. The aim of this study was to assess the oxidative status in 200 couples of pregnant women-newborns at the time of delivery, for the first time, who gave birth in two University Hospitals from the province of Seville. Recruited women filled an epidemiological questionnaire with their demographic characteristics and dietary habits during pregnancy. At the time of delivery, both maternal and cord blood samples were collected. Protein oxidation, superoxide dismutase, and catalase levels were measured to assess the oxidative status of these women, together with the levels of vitamins D, B12, Zn, Se, and Cu. Our results showed a tendency for all biomarkers measured to be higher in cord blood than in maternal blood. For the correlations established between the OS markers and sociodemographic characteristics, only significant differences for carbonyl groups values were found on both maternal and cord blood, relating these higher values to the use of insecticides in the women’s homes. For newborns, only a significant correlation was detected between antioxidant enzymes and the newborn’s weight, specifically for superoxide dismutase activity. Additionally, the higher values obtained in cord blood might suggest metabolization, while a higher production of ROS and antioxidant enzymes might be required to maintain the balance. Measured levels for Se were similar in both maternal and cord blood, unlike Cu and Zn, where higher levels were found for maternal blood than cord blood, indicating a correlation between maternal Se values and SOD as OS biomarker. Furthermore, vitamin D levels were around the optimum values established, finding a relationship between vitamin D and new-born’s height, unlike for vitamin B12 values, where a correlation with maternal food consumption characteristics was established. Overall values were inside normal ranges and consistent for our population.
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| 3525. |
- Dahlbäck, Charlotte, et al.
(författare)
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Alterations in ductus venosus velocity indices in relation to umbilical venous pulsations and perinatal outcome.
- 2015
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349.
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Tidskriftsartikel (refereegranskat)abstract
- Abnormal blood velocity in the ductus venosus is more frequently detected than pulsations in the umbilical vein, but both are considered indicators of fetal compromise. The aim of this study was to investigate blood flow patterns in the ductus venosus and the association between individual blood velocity ratios and pulsations in the umbilical vein and perinatal outcome.
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| 3526. |
- Dahlbäck, Charlotte
(författare)
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Fetal Cardiac Function and Venous Circulation - Experiences with Velocity Vector Imaging
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Placental dysfunction resulting in intrauterine growth restriction (IUGR) is a common complication of pregnany and severe IUGR, with ensuing fetal hypoxia is an important cause of perinatal mortality and morbidity. Doppler studies of fetal and maternal vessels are routinely used for fetal surveillance and alterations in fetal venous blood flow has been demonstrated as a late sign of fetal compromise. However, the role of venous blood flow investigations in decisions on delivery has not been clearly defined and abnormal ductus venosus blood flow has shown moderate accuracy in predicting adverse perinatal outcome. The mechanisms behind ductus venosus dilatation in fetal hypoxia, the transmissions of pulses in the fetal venous system and the association between venous blood flow and cardiac function have also not been completely clarified. We investigated ductus venosus and umbilical venous blood flow patterns and the association between alterations in the two vessels and adverse perinatal outcome. Changes in ductus venosus blood flow during systole occurred more rarely than diastolic changes and were more often associated with adverse periatal outcome. UV-pulsations seemed to be an independent indicator of fetal compromise, regardless of ductus venosus pulsatility index for veins (PIV), which was not a reliable indicator of fetal compromise as an isolated finding. The heart is a crucial organ for fetal adaptation to placental insufficiency. Studies have indicated cardiac damage and remodelling during chronic hypoxia and estimations of cardiac function may therefore be useful for fetal surveillance in IUGR. The best suited parameters, however, remain to be established. Methods that analyze cardiac deformation have recently been developed and have shown promise. Using the novel speckle tracking technique Velocity Vector Imaging, strain, strain rate and velocity of the ventricular and atrial walls were measured in a cohort of 250 healthy fetuses and compared to results in a group of 38 fetuses with signs of impaired placental function. Reference ranges were constructed for the control group. Cardiac strain did not differ between the control and study groups and there was no association between ductus venosus PIV, umbilical vein pulsations and ventricular or atrial strain, strain rate or velocity. This indicates that during fetal hypoxia, circulatory redistribution results in preservation of cardiac deformation thereby maintaining cardiac output intact
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| 3527. |
- Dahlbäck, Charlotte, et al.
(författare)
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Increased pulsatility in the fetal ductus venosus is not related to altered cardiac strain in high-risk pregnancies.
- 2016
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 29:8, s. 1328-1333
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Tidskriftsartikel (refereegranskat)abstract
- Blood flow velocity patterns in fetal veins are considered to reflect cardiac function, but have not been convincingly documented. The aim of this study was to generate reference values for fetal cardiac strain and compare it with results in fetuses with signs of increased venous pulsatility.
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| 3528. |
- Dahlbäck, Charlotte, et al.
(författare)
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Investigations on atrial function in fetuses with signs of impaired placental function.
- 2015
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Ingår i: Prenatal Diagnosis. - : Wiley. - 1097-0223 .- 0197-3851. ; 35:6, s. 605-611
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Tidskriftsartikel (refereegranskat)abstract
- Cardiac dysfunction has been shown in cases of placental insufficiency, but few reports exist on fetal atrial function. The aim of this study was to generate reference values for atrial strain and compare them to results in fetuses with signs of increased placental resistance and abnormal venous circulation.
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| 3529. |
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| 3530. |
- Dahlgren, Hedda, et al.
(författare)
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Sexual function in primiparous women : a prospective study
- 2022
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Ingår i: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 33:6, s. 1567-1582
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION AND HYPOTHESIS: The aim of this prospective study was to examine the impact of sociodemographic, pregnancy and obstetric characteristics on sexual function 12 months postpartum in primiparous women. We hypothesized that sexual function would decrease after childbirth.METHODS: Between 1 October 2014 and 1 October 2017, all nulliparous women in early pregnancy registering for maternity health care in Region Örebro County, Sweden, were invited to participate in this prospective study. A total of 958 women were included. Sexual activity and function were measured at early pregnancy, 8 weeks postpartum and 12 months postpartum using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The associations between sociodemographic, pregnancy and obstetric characteristics and sexual activity and function from early pregnancy to 12 months postpartum were examined using linear and logistic models based on generalized estimating equations.RESULTS: We found that the prevalence of sexually active women decreased from 98.0% in early pregnancy to 66.7% at 8 weeks postpartum, but increased to 90.0% at 12 months postpartum. Age ≥ 35 years, second-degree perineal tear and current breastfeeding were statistically significant risk factors for sexual inactivity at 12 months postpartum. Poor self-reported health in early pregnancy was statistically significantly associated with decreased sexual function at 12 months postpartum.CONCLUSIONS: A majority of women resumed sexual activity at 8 weeks postpartum and most women at 12 months postpartum; the decrease in sexual function at 12 months postpartum was small and few risk factors were observed.
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