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- Elgemark, Karin, et al.
(författare)
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The 13.5-mg, 19.5-mg, and 52-mg Levonorgestrel-Releasing Intrauterine Systems and Risk of Ectopic Pregnancy
- 2022
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Ingår i: Obstetrics and Gynecology. - : NLM (Medline). - 0029-7844 .- 1873-233X. ; 140:2, s. 227-233
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the Pearl Index for risk of ectopic pregnancy in women using levonorgestrel-releasing intrauterine systems (LNG-IUS) with hormonal reservoirs of 13.5 mg, 19.5 mg, or 52 mg. METHODS: This was a retrospective cohort study. Women diagnosed with an ectopic pregnancy in Stockholm County, Sweden, between January 1, 2014, and December 31, 2019, were identified through the electronic medical record system. The final analysis included 2,252 cases of ectopic pregnancy. Information on age, reproductive and medical history, as well as current use of contraception was retrieved. The time of intrauterine device (IUD) insertion before ectopic pregnancy and the numbers of sold LNG-IUS during the study period were used to calculate the incidence rate for ectopic pregnancy during use per 100 woman-years (Pearl Index). RESULTS: Among women with an ectopic pregnancy diagnosis, 105 presented with a known type of hormonal IUD in situ, of whom 94 were included in the calculations of the Pearl Index. The estimated Pearl Index for ectopic pregnancy was 0.136 (95% CI 0.106-0.176) for the LNG-IUS 13.5-mg, 0.037 (95% CI 0.021-0.067) for the LNG-IUS 19.5-mg, and 0.009 (95% CI 0.006-0.014) for the LNG-IUS 52-mg. With the 52-mg LNG-IUS as referent, the relative risk (RR) for ectopic pregnancy was higher during the first year for LNG 13.5-mg (RR 20.59, 95% CI 12.04-35.21), and for both 13.5-mg (RR 14.49, 95% CI 9.01-23.3) and 19.5-mg (RR 4.44, 95% CI 1.64-12.00) during the total study period. CONCLUSION: The absolute risk of ectopic pregnancy during the use of LNG-IUS at any doses was low. The results show that the lower the dose of the IUD, the higher the risk of an ectopic pregnancy. Higher-dose LNG-IUS should be considered when providing contraceptive counseling to a woman with known risk factors for ectopic pregnancy who are considering a hormonal IUD. Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
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- Holmlund, Sophia, et al.
(författare)
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Sub-optimal use of ultrasound examinations may result in underperformance of Vietnamese maternity care : A qualitative study of midwives’ experiences and views
- 2020
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 24
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore Vietnamese midwives’ experiences and views on the role of obstetric ultrasound in relation to clinical management, including ethical aspects.Methods: Using a qualitative design, content analysis of focus group discussions with midwives (N = 25) working at Departments of Obstetrics and Gynecology at three hospitals in urban, semi-urban and rural parts of Hanoi were performed.Results: Obstetric ultrasound was reported as being a highly valuable tool, although replacing ordinary antenatal care surveillance with ultrasound examinations and misuse of ultrasound without medical indication was perceived as troubling. Participants generally viewed the fetus as a human being already at an early stage of pregnancy. However, when complications occurred, the pregnant woman’s health was mostly prioritised.Conclusion: Although the use of ultrasound has many benefits during pregnancy, replacing ordinary antenatal care surveillance with ultrasound examinations and misuse of ultrasound without medical indication is concerning and needs to be addressed. There is also a need to communicate the benefits of adequate antenatal care to pregnant women and caution about the non-beneficial use of repeated ultrasound examinations without medical indication. Additionally, non-medical ultrasounds consume limited healthcare resources and its use needs to be better regulated in Vietnam.
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- Holmlund, Sophia, et al.
(författare)
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Vietnamese midwives' experiences of working in maternity care : A qualitative study in the Hanoi region
- 2022
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 31
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aimed to explore Vietnamese midwives’ experiences of working in maternity care.Methods: A descriptive qualitative study was undertaken, which involved four focus group discussions with midwives (n = 25) working at three different hospitals in urban, semi-urban and rural parts of Hanoi region, Vietnam. Data were analysed using qualitative content analysis.Results: The overall theme, “Practising midwifery requires commitment” showed that Vietnamese midwives’ dedication to their work and to women's reproductive health helped them to cope with stress, pressure and negative aspects of their work environment. In the first category “Being the central link in the web of care”, midwives described themselves as having a key role in maternity care although collaborations with other health professions were important. In the second category “Rewarding role but also vulnerable position”, positive aspects of midwifery were expressed although the great pressure of the work midwives do was prominent. High workload, patients’ demands, and being negatively exposed and vulnerable, when adverse events occurred, were reported. In the third category “Morally challenging tasks”, ultrasound examinations to reveal fetal sex and working with abortion services were described as emotionally stressful.Conclusions: Although participating Vietnamese midwives experienced midwifery as essentially positive, they felt exposed to significant workload pressure, ethically highly demanding work and being blamed when adverse obstetric events occurred. Public health interventions to inform Vietnamese citizens about reproductive issues, as well as specific antenatal education measures may increase the understanding of evidence-based maternity care and complications that can occur during pregnancy and birth.
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- Åkerström, Magnus, 1981, et al.
(författare)
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The COPE Staff study : Study description and initial report regarding job satisfaction, work-life conflicts, stress, and burnout among Swedish maternal and neonatal healthcare workers during the COVID-19 pandemic
- 2023
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Ingår i: International Journal of Gynecology & Obstetrics. - : John Wiley & Sons. - 0020-7292 .- 1879-3479. ; 162:3, s. 989-997
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo describe the study design of the COPE Staff cohort study on working conditions for maternal and neonatal healthcare workers (MNHCWs), and present baseline data regarding job satisfaction, work-life conflicts, stress, and burnout. MethodsBetween January and April 2021, 957 MNHCWs (administrative and medical staff) completed a baseline survey. Average levels of job satisfaction, work-life conflicts, stress, and burnout, and associations to perceived workload were assessed. ResultsThe average levels of job satisfaction, work-life conflicts, stress, and burnout were 68.6 (95% confidence interval [CI] 64.3-72.8), 42.6 (95% CI 37.3-48.0), 42.0 (95% CI 37.7-46.3), and 1.9 (95% CI 1.6-2.2), respectively. The respondents scoring above critical values indicating clinical burnout ranged between 3% and 18%, respectively, for the four burnout sub-dimensions. Women reported significantly higher levels of stress and burnout. Younger participants had lower job satisfaction and higher levels of work-life conflicts, stress, and burnout. Higher perceived workload was significantly associated with lower job satisfaction levels and higher levels of work-life conflicts, stress, and burnout. ConclusionsOur results indicate associations between MNHCWs perceived workload and job satisfaction, work-life conflicts, stress, and burnout during the COVID-19 pandemic. Eighteen percent scored above critical values for exhaustion.
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