| 1. |
- Borneskog, Catrin, et al.
(författare)
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Symptoms of anxiety and depression in lesbian couples treated with donated sperm : a descriptive study
- 2013
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley-Blackwell. - 1470-0328 .- 1471-0528. ; 120:7, s. 839-846
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo investigate symptoms of anxiety and depression in lesbian couples undergoing assisted reproductive treatment (ART), and to study the relationship of demographic data, pregnancy outcome and future reproductive plans with symptoms of anxiety and depression.DesignDescriptive, a part of the prospective longitudinal ‘Swedish study on gamete donation’.SettingAll university clinics in Sweden performing gamete donation.PopulationA consecutive sample of 214 lesbian couples requesting assisted reproduction, 165 of whom participated.MethodsParticipants individually completed three study-specific questionnaires and the Hospital Anxiety and Depression Scale (HADS): time point 1 (T1), at commencement of ART; time point 2 (T2), approximately 2 months after treatment; and time point 3 (T3), 2–5 years after first treatment.Main outcome measuresAnxiety and depression (HADS), pregnancy outcome and future reproductive plans.ResultsThe vast majority of lesbian women undergoing assisted reproduction reported no symptoms of anxiety and depression at the three assessment points. A higher percentage of the treated women, compared with the partners, reported symptoms of anxiety at T2 (14% versus 5%, P = 0.011) and T3 (10% versus 4%, P = 0.018), as well as symptoms of depression at T2 (4% versus 0%, P = 0.03) and T3 (3% versus 0%, P = 0.035). The overall pregnancy outcome was high; almost three-quarters of lesbian couples gave birth 2–5 years after sperm donation treatments. Open-ended comments illustrated joy and satisfaction about family building.ConclusionLesbian women in Sweden reported good psychological health before and after treatment with donated sperm.
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| 2. |
- Andolf, E., et al.
(författare)
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Caesarean section and risk for endometriosis: a prospective cohort study of Swedish registries
- 2013
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 120:9, s. 1061-1065
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate the association between caesarean section and later endometriosis. Design A prospective cohort study. Setting The Swedish Patient Register (PAR) and the Swedish Medical Birth Registry (MBR). Sample Women who were delivered in Sweden between 1986 and 2004. Methods Women with the diagnosis of endometriosis, defined as codes 617 (International Classification of Diseases, ninth revision, ICD-9) or N80 (ICD-10), were retrieved from the PAR. Obstetric outcome was assessed through linkage with the MBR. Out of 709090 women, 3110 were treated as inpatients with a first diagnosis of endometriosis after their first delivery. Women with a diagnosis of endometriosis before their first delivery were excluded. Cox analyses were performed to obtain hazard ratios for endometriosis and adjusted for maternal age at first delivery, body mass index, maternal smoking, and years of involuntary childlessness at study entry. Kaplan-Meier estimates were performed to calculate the risk according to time elapsed. Main outcome In-hospital diagnosis of endometriosis. Results The Cox analyses yielded a hazard ratio of 1.8 (95%CI 1.7-1.9) for endometriosis in women who had had a previous caesarean section compared with women with vaginal deliveries only. The risk of endometriosis increased over time: one additional case of endometriosis was found for every 325 women undergoing caesarean section within 10years. No increase in risk could be seen after two caesarean deliveries. The risk of caesarean scar endometrioma was 0.1%. Conclusion In addition to the recognised risk of scar endometrioma, we found an association between caesarean section and general pelvic endometriosis. Further studies are needed to confirm our findings.
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| 3. |
- Mokarami, Parisa, et al.
(författare)
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Hidden acidosis: an explanation of acid-base and lactate changes occurring in umbilical cord blood after delayed sampling.
- 2013
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 120:8, s. 996-1002
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To explore the 'hidden acidosis' phenomenon, in which there is a washout of acid metabolites from peripheral tissues in both vaginal and abdominal deliveries, by investigating temporal umbilical cord blood acid-base and lactate changes after delayed blood sampling. DESIGN: Prospective comparative study. SETTING: University hospital. SAMPLE: Umbilical cord blood from 124 newborns. METHODS: Arterial and venous cord blood was sampled immediately after birth (T0 ), and at 45 seconds (T45 ), from unclamped cords with intact pulsations taken from 66 neonates born vaginally and 58 neonates born via planned caesarean section at 36-42 weeks of gestation. Non-parametric tests were used for statistical comparisons, with P < 0.05 considered significant. MAIN OUTCOME MEASURES: Temporal changes (T0 -T45 ) in umbilical cord blood pH, the partial pressure of CO2 (\prod a) and O2 (\prod a), and in the concentrations of lactate, haematocrit (Hct), and haemoglobin (Hb). RESULTS: In both groups all arterial parameters, except for \prod a in the group delivered by caesarean section, changed significantly (pH decreased and the other variables increased). There were corresponding changes in venous acid-base parameters. When temporal arterial changes were compared between the two groups, the decrease in pH and increase in \prod a were more pronounced in the group delivered vaginally. Neonates born vaginally had significantly lower pH and higher lactate, Hct, and Hb concentrations at T0 and T45 in both the artery and the vein. At T45 , arterial \prod a and \prod a levels in the group delivered vaginally were also significantly higher. CONCLUSIONS: Delayed umbilical cord sampling affected the acid-base balance and haematological parameters after both vaginal and caesarean deliveries, although the effect was more marked in the group delivered vaginally. The hidden acidosis phenomenon explains this change towards acidaemia and lactaemia. Arterial haemoconcentration was not the explanation of the acid-base drift.
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| 4. |
- Rudnicki, M., et al.
(författare)
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Anterior colporrhaphy compared with collagen-coated transvaginal mesh for anterior vaginal wall prolapse: a randomised controlled trial
- 2014
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 121:1, s. 102-110
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo investigate the anatomical cure rate and complications related to collagen-coated mesh for cystocele, compared with a conventional anterior colporrhaphy. DesignA randomised controlled study. SettingSix departments of obstetrics and gynaecology in Norway, Sweden, Finland, and Denmark. PopulationWomen aged 55years or older, referred for surgery with a prolapse of the anterior vaginal wall of stage2 or higher. MethodsWomen scheduled for primary cystocoele surgery were randomised to either anterior colporrhaphy or a collagen-coated Prolene mesh. Power analysis indicated that 130 patients had to be randomised. All patients were evaluated using the Pelvic Organ Prolapse-Quantification (POP-Q) measurement. Quality of life, symptoms, and sexual function were evaluated using the Pelvic Floor Impact Questionnaire, the Pelvic Floor Distress Inventory, and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. Main outcome measuresThe primary outcome was objective cure, defined as prolapse below POP-Q stage2 at the 12-months follow-up. Secondary outcomes were quality of life, symptoms, and presence (or not) of complications. ResultsIn total, 161 women were randomised to either anterior colporrhaphy or mesh (participant ages 64.96.4years versus 64.7 +/- 6.6years, respectively; mean +/- SD). The objective cure rate was 39.8% (95%CI 28.6-50.9%) in the anterior colporrhaphy group, compared with 88.1% (95%CI 80.7-95.6%) in the mesh group (P<0.001). Vaginal mesh exposure occurred in ten women (13.3%) and dyspareunia occurred in two women (2.7%, not significant) in the mesh group at the 12-months follow-up. Questionnaires revealed no difference between the groups. ConclusionsOur study demonstrates a significantly improved objective cure rate associated with a high exposure rate among women with mesh surgery as opposed to conventional surgery.
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| 7. |
- Bolin, Marie, et al.
(författare)
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Hyperemesis gravidarum and risks of placental dysfunction disorders : a population-based cohort study
- 2013
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 120:5, s. 541-547
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Tidskriftsartikel (refereegranskat)abstract
- Objective To study whether pregnancies complicated by hyperemesis gravidarum in the first (<12weeks) or second (1221weeks) trimester are associated with placental dysfunction disorders. Design Population-based cohort study. Setting Sweden. Population All pregnancies in the Swedish Medical Birth Register estimated to have started on 1 January 1997 or later and ended in a single birth on 31 December 2009 or earlier (n=1156050). Methods Odds ratios with 95% confidence intervals were estimated for placental dysfunction disorders in women with an inpatient diagnosis of hyperemesis gravidarum, using women without inpatient diagnosis of hyperemesis gravidarum as reference. Risks were adjusted for maternal age, parity, body mass index, height, smoking, cohabitation with the infant's father, infant's sex, mother's country of birth, education, presence of hyperthyreosis, pregestational diabetes mellitus, chronic hypertension and year of infant birth. Main outcome measures Placental dysfunction disorders, i.e. pre-eclampsia, placental abruption, stillbirth and small for gestational age (SGA). Results Women with hyperemesis gravidarum in the first trimester had only a slightly increased risk of pre-eclampsia. Women with hyperemesis gravidarum with first admission in the second trimester had a more than doubled risk of preterm (<37weeks) pre-eclampsia, a threefold increased risk of placental abruption and a 39% increased risk of an SGA birth (adjusted odds ratios [95% confidence intervals] were: 2.09 [1.383.16], 3.07 [1.885.00] and 1.39 [1.061.83], respectively). Conclusions There is an association between hyperemesis gravidarum and placental dysfunction disorders, which is especially strong for women with hyperemesis gravidarum in the second trimester.
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| 8. |
- Fadl, Helena, 1965-, et al.
(författare)
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Gestational diabetes mellitus and later cardiovascular disease : a Swedish population based case-control study
- 2014
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley-Blackwell. - 1470-0328 .- 1471-0528. ; 121:12, s. 1530-1536
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To identify if gestational diabetes mellitus (GDM) is a clinically useful marker of future cardiovascular disease (CVD) risk and if GDM combined with other risks (smoking, hypertension or body mass) identifies high-risk groups.Design: Population-based matched case-control study.Setting: National Swedish register data from 1991 to 2008.Population: A total of 2639 women with a cardiovascular event and matched controls.Methods: Conditional logistic regression examined associations with CVD before and after adjustment for conventional risk factors and confounders. Effect modification for the association of GDM with CVD by body mass index (BMI), smoking and chronic hypertension was assessed by stratification and interaction testing. Adjustment for diabetes post-pregnancy evaluated its mediating role.Main outcome measures: Inpatient diagnoses or causes of death identifying ischemic heart disease, ischemic stroke, atherosclerosis or peripheral vascular disease.Results: The adjusted odds ratios (and 95% confidence intervals) for the association of CVD with GDM are 1.51 (1.07-2.14), 2.23 (2.01-2.48) for smoking, 1.98 (1.71-2.29) for obesity and 5.10 (3.18-8.18) for chronic hypertension. In stratified analysis the association of CVD with GDM was only seen among women with BMI 25, with an odds ratio of 2.39 (1.39-4.10), but only women with a BMI <30 accounted for this increased risk. Adjustment for post-pregnancy diabetes attenuated it somewhat to 1.99 (1.13-3.52).Conclusions: In the absence of other recognised cardiovascular risk factors, such as smoking, obesity or chronic hypertension, GDM is a useful marker of raised CVD risk among women with BMI between 25 and 29.
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| 9. |
- Josefsson, Ann, et al.
(författare)
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Risk for congenital malformations in offspring of women who have undergone bariatric surgery. A national cohort
- 2013
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley-Blackwell. - 1470-0328 .- 1471-0528. ; 120:12, s. 1477-1482
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo study the risk for congenital anomalies in the first child of women after bariatric surgery compared with all other women giving birth to their first child and divided by maternal body mass index (BMI) groups.DesignProspective, population-based register study.SettingSweden.SampleAll firstborn children to women born 1973–83 were studied to determine if they had a congenital anomaly and a mother who had undergone bariatric surgery before pregnancy.MethodsA total of 270 805 firstborns; of which 341 had mothers who had had bariatric surgery before delivery. We retrieved information on the women's marital or cohabitation status, smoking, BMI, diabetes and hypertension during pregnancy.Main outcome measuresCongenital malformations.ResultsOf the firstborn children to mothers who had had bariatric surgery before pregnancy, 4.1% (95% confidence interval [95% CI] 2.2–6.0) were malformed compared with 3.4% (95% CI 3.3–3.5) of those whose mothers had not undergone bariatric surgery. The risk for congenital malformation in firstborn children increased with increasing maternal BMI. The adjusted odds ratio (OR) for congenital malformation among children whose mothers' BMI ranged between 25 and 29 kg/m2 was 1.09 (95% CI 1.03–1.15), whose mothers' BMI ranged between 30 and 34 kg/m2 was 1.14 (1.05–1.24) and whose mothers' BMI was ≥35 kg/m2 was 1.30 (95% CI 1.16–1.45) compared with those whose mothers had a normal BMI. Bariatric surgery before pregnancy did not have any effect on the odds ratio for having congenital malformation (OR = 1.09, 95% CI 0.63–1.91).ConclusionsPreconception bariatric surgery does not seem to affect the risk for congenital malformations but a high to very high BMI does appear to increase the risk.
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| 10. |
- Urquia, ML, et al.
(författare)
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Disparities in pre-eclampsia and eclampsia among immigrant women giving birth in six industrialised countries
- 2014
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Ingår i: Obstetrics and Gynecology. - : Wiley. - 0029-7844 .- 1873-233X. ; 121:12, s. 1492-1500
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo assess disparities in pre‐eclampsia and eclampsia among immigrant women from various world regions giving birth in six industrialised countries.DesignCross‐country comparative study of linked population‐based databases.SettingProvincial or regional obstetric delivery data from Australia, Canada, Spain and the USA and national data from Denmark and Sweden.PopulationAll immigrant and non‐immigrant women delivering in the six industrialised countries within the most recent 10‐year period available to each participating centre (1995–2010).MethodsData was collected using standardised definitions of the outcomes and maternal regions of birth. Pooled data were analysed with multilevel models. Within‐country analyses used stratified logistic regression to obtain odds ratios (OR ) with 95% confidence intervals (95% CI ).Main outcome measuresPre‐eclampsia, eclampsia and pre‐eclampsia with prolonged hospitalisation (cases per 1000 deliveries).ResultsThere were 9 028 802 deliveries (3 031 399 to immigrant women). Compared with immigrants from Western Europe, immigrants from Sub‐Saharan Africa and Latin America & the Caribbean were at higher risk of pre‐eclampsia (OR : 1.72; 95% CI : 1.63, 1.80 and 1.63; 95% CI : 1.57, 1.69) and eclampsia (OR : 2.12; 95% CI : 1.61, 2.79 and 1.55; 95% CI : 1.26, 1. 91), respectively, after adjustment for parity, maternal age and destination country. Compared with native‐born women, European and East Asian immigrants were at lower risk in most industrialised countries. Spain exhibited the largest disparities and Australia the smallest.ConclusionImmigrant women from Sub‐Saharan Africa and Latin America & the Caribbean require increased surveillance due to a consistently high risk of pre‐eclampsia and eclampsia.
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