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- Elvander, Charlotte
(författare)
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Epidemiological studies of vacuum extraction delivery : incidence, risk factors and subsequent childbearing
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to bring focus on factors and outcomes associated with vacuum extraction delivery (VE). Delivery by VE is associated with both maternal risks (such as obstetric anal sphincter ruptures, postpartum hemorrhage and a negative birth experience) and infant risks (such as scalp lacerations, cephalohematoma, intracranial hemorrhage and brachial plexus injury). In Sweden, every seventh first time mother is delivered by VE, yet little is known about risk factors, incidence over time, birth experience and subsequent childbearing. In study I we used the Medical Birth Register (MBR) to investigate factors related to VE and use over time among 589 108 primiparous women with singleton, term births in 1992-2010. We found that rates of VE increased from 11.5% in 1992 to 14.8% in 2010. The risk of VE increased with maternal age and gestational length, but decreased with increasing maternal height. Logistic regression analyses showed that the increased use of VE over time was partly explained by increasing maternal age and increased use of epidural anesthesia (EDA). Among women with and without EDA, the increase in VE over time was confined to VE due to the indication non-reassuring fetal status. In study II we included a total of 265 456 singleton neonates born to nulliparous women at term between 1999 and 2008. Compared with women giving birth to a neonate with average size head circumference (35 cm), women giving birth to an infant with a very large head circumference (39–41 cm) had significantly higher odds of being diagnosed with prolonged labor (OR 1.49, 95% CI 1.33–1.67), signs of fetal distress (OR 1.73, 95% CI 1.49– 2.03) and maternal distress (OR 2.40, 95% CI 1.96–2.95). The odds ratios for VE and cesarean section were thereby elevated to 3.47 (95% CI 3.10–3.88) and 1.22 (95% CI 1.04– 1.42), respectively. In study III, 3006 women were interviewed in their third trimester and one month after first childbirth to assess fear of birth and birth experience. Logistic regression was performed to examine the interactions and associations between fear of birth, mode of delivery and birth experience. Compared to women with low levels of fear of birth, women with higher levels of fear had a more negative birth experience and were more affected by an EmCS or VE. Compared to women with low levels of fears with a SVD, women with high levels of fear who were delivered by VE had a 10-fold increased risk of reporting a negative birth experience (OR 10.35, 95% CI 5.25-20.39). A SVD was associated with the most positive birth experience among the women in this study. In study IV we used a cohort of 771 690 women who delivered their first singleton infant in Sweden between 1992 and 2010 to investigate the relationship between mode of first delivery and probability of subsequent childbearing. Using Cox’s proportional-hazards regression models, risks of subsequent childbearing were compared across four modes of delivery. Compared with women who had a SVD, women who delivered by VE were less likely to have a second pregnancy (HR 0.96, 95% CI 0.95–0.97), and the probabilities of a second childbirth were substantially lower among women with a previous EmCS (HR 0.85, 95% CI 0.84–0.86) or an elective caesarean section (HR 0.82, 95% CI 0.80–0.83). There were no clinically important differences in the median time between first and second pregnancy by mode of first delivery.
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- Elvander, Charlotte, et al.
(författare)
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Mode of delivery and the probability of subsequent childbearing : a population-based register study
- 2015
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 122:12, s. 1593-1600
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the relationship between mode of first delivery and probability of subsequent childbearing.Design: Population-based study.Setting: Nationwide study in Sweden.Population: A cohort of 771 690 women who delivered their first singleton infant in Sweden between 1992 and 2010.Methods: Using Cox's proportional-hazards regression models, risks of subsequent childbearing were compared across four modes of delivery. Hazard ratios (HRs) were calculated, using 95% confidence intervals (95% CIs).Main outcome measures: Probability of having a second and third child; interpregnancy interval.Results: Compared with women who had a spontaneous vaginal first delivery, women who delivered by vacuum extraction were less likely to have a second pregnancy (HR 0.96, 95% CI 0.95–0.97), and the probabilities of a second childbirth were substantially lower among women with a previous emergency caesarean section (HR 0.85, 95% CI 0.84–0.86) or an elective caesarean section (HR 0.82, 95% CI 0.80–0.83). There were no clinically important differences in the median time between first and second pregnancy by mode of first delivery. Compared with women younger than 30 years of age, older women were more negatively affected by a vacuum extraction with respect to the probability of having a second child. A primary vacuum extraction decreased the probability of having a third child by 4%, but having two consecutive vacuum extraction deliveries did not further alter the probability.Conclusions: A first delivery by vacuum extraction does not reduce the probability of subsequent childbearing to the same extent as a first delivery by emergency or elective caesarean section.
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- Elvander, Charlotte, et al.
(författare)
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Severe perineal trauma among women undergoing vaginal birth after cesarean delivery : A population-based cohort study
- 2019
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Ingår i: Birth. - : Wiley. - 0730-7659 .- 1523-536X. ; 46:2, s. 379-386
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Tidskriftsartikel (refereegranskat)abstract
- Background: To examine risk of severe perineal trauma among nulliparous women and those undergoing vaginal birth after cesarean delivery (VBAC). Methods: This is a population-based cohort study of all births to women with their two first consecutive singleton pregnancies in Stockholm-Gotland Sweden between 2008 and 2014. Risk of severe perineal trauma was compared between nulliparous women and those undergoing VBAC with severe perineal trauma being the main outcome measure. Associations between indication and timing of primary cesarean delivery and risk of severe perineal trauma in subsequent vaginal birth were analyzed using Poisson regression analysis. Results: The rate of severe perineal trauma among nulliparous women and those undergoing VBAC was 7.0% and 12.3%, respectively. Compared with nulliparous women, those undergoing VBAC were significantly older, had a shorter stature, and gave birth in a non-upright position to heavier infants with larger head circumferences. The rate of instrumental vaginal delivery among nulliparous women and those undergoing VBAC was 19.3% and 20.2%, respectively (P = 0.331). An increased risk of severe perineal trauma remained after adjustments among those undergoing VBAC (adjusted risk ratio 1.42, 95% CI 1.23-1.63). Level of risk was not associated with indication (dystocia or signs of fetal distress) of primary cesarean delivery, nor how far the woman had progressed in labor (fully dilated versus planned cesarean delivery) before delivering by cesarean. Conclusions: Compared with nulliparous women, those undergoing VBAC are at increased risk of severe perineal trauma, irrespective of indication and timing of primary cesarean delivery.
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- Elvander, Charlotte, et al.
(författare)
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The influence of fetal head circumference on labor outcome : a population-based register study
- 2012
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:4, s. 470-475
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the association between postnatal head circumference and the occurrence of the three main indications for instrumental delivery, namely prolonged labor, signs of fetal distress and maternal distress. We also studied the association between postnatal fetal head circumference and the use of vacuum extraction and emergency cesarean section. Design. Population-based register study. Setting. Nationwide study in Sweden. Population. A total of 265 456 singleton neonates born to nulliparous women at term between 1999 and 2008 in Sweden. Methods. Register study with data from the Swedish Medical Birth Register. Main outcome measures. Prolonged labor, signs of fetal distress, maternal distress, use of vacuum extraction and emergency cesarean section. Results. The prevalence of each outcome increased gradually as the head circumference increased. Compared with women giving birth to a neonate with average size head circumference (35 cm), women giving birth to an infant with a very large head circumference (3941 cm) had significantly higher odds of being diagnosed with prolonged labor [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.331.67], signs of fetal distress (OR 1.73, 95% CI 1.492.03) and maternal distress (OR 2.40, 95% CI 1.962.95). The odds ratios for vacuum extraction and cesarean section were thereby elevated to 3.47 (95% CI 3.103.88) and 1.22 (95% CI 1.041.42), respectively. The attributable risk proportion percentages associated with vacuum extraction and cesarean section were 46 and 39%, respectively among the cases exposed to a head circumference of 3741 cm. Conclusions. Large fetal head circumference is associated with complicated labor and is etiological to a considerable proportion of assisted vaginal births and emergency cesarean sections.
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- Savchenko, Julia, et al.
(författare)
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Key outcomes in childbirth : Development of a perinatal core outcome set for management of labor and delivery at or near term
- 2023
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 102:6, s. 728-734
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Consistency and relevance of perinatal outcome measures are necessary basics for obstetric research, audit, and clinical counseling. Still, there is an unwarranted variation in reported perinatal outcomes, which impairs research synthesis, validity, and implementation, as well as clinical benchmarking and longitudinal comparisons. The aim of this study was to develop a short-term perinatal (fetal and neonatal) Core Outcome Set to be used in research and quality assurance of management of labor and delivery at or near term.Material and methods: The methods were guided by the Core Outcome Measures in Effectiveness Trials Initiative Handbook. The project was prospectively registered on July 2, 2020 in the Core Outcome Measures in Effectiveness Trials (COMET) data base (reference number 1593). A list of potential outcomes was created based on a systematic review of studies evaluating interventions for peripartum management at or near term (>= 34 weeks of gestation), including decisions regarding timing and type of onset of labor, intrapartum care, and mode of delivery. The list was entered into a two-round Delphi survey with predefined consensus criteria. Participants (n = 67) included clinicians, researchers, lay persons with experience of childbirth (patient representatives), and other stakeholders. A consensus meeting was held to reach a final agreement.Results: Response rates were 82.1% (55/67) and 92.7% (51/55) for the first and second Delphi rounds, respectively. In total, 17 outcomes were included in the final core outcome set, reflecting mortality, health or morbidity, including asphyxia, central nervous system status, infection, neonatal resuscitation and admission, breastfeeding and mother-infant interaction, operative delivery due to fetal distress, as well as birthweight and gestational age. Two of these outcomes were suggested by patient representatives.Conclusions: The Swedish Perinatal Core Outcome Set (SPeCOS) study involved a broad circle of relevant stakeholders and reached consensus on a minimal set of perinatal outcomes that should be collected and reported in a standardized way in all future studies on management of labor and delivery at or near term, regardless of the specific population or condition studied. This could improve obstetric research, evidence synthesis, uptake, implementation, and adherence, as well as clinical practice, audit, and comparisons in childbirth care.
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