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- Bergman, Lina, 1982-
(författare)
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Cerebral biomarkers in women with preeclampsia
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Preeclampsia and eclampsia are among the most common causes of maternal and fetal mortality and morbidity worldwide. There are no reliable means to predict eclampsia or cerebral edema in women with preeclampsia and knowledge of the brain involvement in preeclampsia is still limited. S100B and neuron specific enolase (NSE) are two cerebral biomarkers of glial- and neuronal origin respectively. They are used as predictors for neurological outcome after traumatic brain injuries and cardiac arrest but have not yet been investigated in preeclampsia.This thesis is based on one longitudinal cohort study of pregnant women (n=469, Paper I and III), one cross sectional study of women with preeclampsia and women with normal pregnancies (n=53 and 58 respectively, Paper II and IV) and one experimental animal study of eclampsia (Paper V).In Paper I and III, plasma concentrations of S100B and NSE were investigated throughout pregnancy in women developing preeclampsia (n=16) and in women with normal pregnancies (n=36) in a nested case control study. Plasma concentrations were increased in women developing preeclampsia in gestational week 33 and 37 for S100B and in gestational week 37 for NSE compared to women with normal pregnancies.In Paper II and IV, increased plasma concentrations of S100B and NSE were confirmed among women with preeclampsia compared to women with normal pregnancies. Furthermore, increased plasma concentrations of S100B correlated to visual disturbances among women with preeclampsia (Paper II) and plasma concentrations of S100B and NSE remained increased among women with preeclampsia one year after delivery (Paper IV).In Paper V, an experimental rat model of preeclampsia and eclampsia demonstrated increased serum concentrations of S100B after seizures in normal pregnancy (n=5) and a tendency towards increased plasma concentrations of S100B in preeclampsia (n=5) compared to normal pregnancy (n=5) without seizures. Furthermore, after seizures, animals with magnesium sulphate treatment demonstrated increased serum concentrations of S100B and NSE compared to no treatment.In conclusion; plasma concentrations of S100B and NSE are increased in preeclampsia during late pregnancy and postpartum and S100B correlates to visual disturbances in women with preeclampsia. The findings are partly confirmed in an animal model of eclampsia.
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| 2. |
- Darj, Elisabeth, et al.
(författare)
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STI-prevalence and differences in social background and sexual behavior among urban and rural young women in Uganda
- 2010
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 1:3, s. 111-115
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adolescents in Uganda carry a heavy burden of reproductive health problems. Different environment creates different problems.Objectives: To study the prevalence of STI and to compare social and behavioral risk factors for Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) among sexually experienced young women in one urban and one rural area in Uganda.Methods: Consenting, sexually experienced women, below 20 years, visiting two different youth clinics were asked about social background, genital symptoms and sexual experiences. Vaginal samples were taken for NG and CT and analyzed by PCR.Results: The prevalence of NG and/or CT was 20 (6.8%) in the urban and 23 (7.8%) in the rural study site, a non-significant difference. The rural women were often in marital union, 25.3% compared to 12.2% of the urban women (OR 2.4, 95% CI 1.6-3.8) and had experienced more pregnancies and had more children. Their partners were often more than 10 years older. More urban women (42.2%) knew their HIV status compared to rural women (16.2%), OR 2.1 (1.6–2.7), reported more condom use and more sexual partners.Conclusions: Marital status and few sexual partners does not appear to protect young rural women from sexually transmitted infections (STIs), implying that male sexual behavior may have an important impact on women’s risk to be infected.
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| 3. |
- Hesselman, Susanne, 1973-
(författare)
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Caesarean Section : Short- and long-term maternal complications
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Caesarean section is a common major surgical procedure and long-term complications have not been fully investigated. By longitudinal population based register studies, based on National health registers and medical data records, maternal complications after caesarean delivery at subsequent labour (N=7 683), among extremely preterm births (N=406), and at remote gynaecologic surgery (N=25 354) were explored.In Paper I, uterine closure was investigated in respect to uterine rupture in a subsequent delivery after caesarean section. Uterine rupture occurred in 1.3 % of women with a previous caesarean section. There was no increased risk of uterine rupture with single compared with double layers for closure of the uterus (adjusted Odds Ratio 1.17, 95 % CI 0.78-1.70). Modifiable risk factors of uterine rupture in a trial of labour after caesarean section included induction of labour and use of epidural analgesia.In Paper II, maternal outcomes and surgical aspects of caesarean section in the extremely preterm period were assessed. Maternal complications were more frequently reported in extremely preterm- compared with term caesarean delivery. No increase in short-term morbidity was observed at 22-24 compared with 25-27 gestational weeks, but uterine corporal incisions were performed more frequently (18.1 % vs. 9.6 %, p=0.02).Furthermore, risk factors for abdominal adhesions after caesarean section and organ injury in remote gynaecologic surgery were analysed (Paper III and IV). Numbers of prior caesarean sections were the most important factor for formation of adhesions. Advanced maternal age, obesity, infection and delivery year 1997-2013 were factors associated with adhesions in conjunction with caesarean section. Organ injury occurred in 2.2 % of women undergoing benign hysterectomy. A history of caesarean section increased the risk (adjusted Odds Ratio 1.74, 95 % CI 1.41-2.15), but was only partly explained by the presence of adhesions. The organ affected depended on medical history; prior caesarean predisposed for bladder injury, prior bowel/pelvic surgery for bowel injury and endometriosis was associated with ureter injury at time of hysterectomy. In conclusion; data from National health registers indicates that caesarean delivery is associated with long-term complications, although the absolute risk of severe complications for the woman is low.
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| 4. |
- Hesselman, Susanne, et al.
(författare)
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Maternal complications in settings where two-thirds of extremely preterm births are delivered by cesarean section
- 2017
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Ingår i: Journal of Perinatal Medicine. - : Walter de Gruyter GmbH. - 0300-5577 .- 1619-3997. ; 45:1, s. 121-127
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the maternal complications associated with cesarean section (CS) in the extremely preterm period according to the gestational week (GW) and to indication of delivery. Study design: This is a retrospective case-referent study with a review of medical records of women who delivered at 22-27 weeks of gestation (n = 647) at two level III units in Sweden. For abdominal delivery, gestational length was stratified into 22-24 (n = 105) and 25-27 (n = 301) weeks. For comparison, data on women who underwent a CS at term were identified in a register-based database. Results: The rate of CS in extremely preterm births was 62.8%. There was no difference in the complication rates, but types of incisions other than the low transverse incision were required more often at 22-24 (18.1%) weeks than at 25-27 GWs (9.6%) (P = 0.02). Major maternal complications occurred in 6.6% compared with 2.1% in the extremely preterm and term CS, respectively (P < 0.01). A maternal indication of extremely preterm CS increased the risk of complications. Conclusions: Almost two-thirds of the births at 22-27 GWs had an abdominal delivery. No increase in short-term morbidity was observed at 22-24 weeks compared to 25-27 weeks. CS performed extremely preterm had more major complications recorded than cesarean at term. The complications are driven by the underlying maternal condition.
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| 7. |
- Råssjö, Eva-Britta, et al.
(författare)
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Prevalence of seuxally transmitted infections among adolescents in Kampala, Uganda, and theoretical models for improving syndromic management
- 2006
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Ingår i: Journal of Adolescent Health. - : Elsevier BV. - 1054-139X .- 1879-1972. ; 38:3, s. 213-221
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To estimate the prevalence of treatable sexually transmitted infections (STI) in adolescents visiting a youth health clinic. To evaluate the algorithm for management of the abnormal vaginal discharge (AVD) syndrome recommended in Uganda's national guidelines and compare it with other theoretical flowchart models.METHODS: Sexually experienced adolescents who were visiting an urban youth health clinic in Kampala, Uganda were examined and interviewed (with their consent) about their socio-demographic background, sexual risk factors, and genital symptoms. Samples taken for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), and Trichomonas vaginalis (TV) were analyzed by polymerase chain reaction (PCR). Rapid plasma reagin (RPR) was used with confirming treponema pallidum hem agglutination (TPHA) for syphilis diagnosis. One hundred ninety-nine females and 107 males were examined. Performance of the national algorithm was compared with different theoretical algorithms.RESULTS: Prevalence of CT, NG, TV and syphilis was 4.5%, 9.0%, 8.0%, and 4.0%, respectively, for girls and 4.7%, 5.7%, 0%, and 2.8%, respectively, for boys. We found that 20.6% of the females and 13.2% of the males had at least one STI. The national AVD flow chart had a sensitivity of 61%, a specificity of 38.5% and a positive predictive value (PPV) of 11.6%. All the models had PPV of less than 20% and sensitivity less than 85%. The best performing algorithm using risk and protective factors, rather than symptoms, implicated a sensitivity/specificity and PPV of 82.6%/47% and 17.3%, respectively (p = .012).CONCLUSIONS: An algorithm for management of STI using behavioral and demographic factors in this population demonstrated enhanced sensitivity, specificity, and PPV.
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| 8. |
- Råssjö, Eva-Britta, et al.
(författare)
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Responses to VCT for HIV among young people in Kampala, Uganda
- 2007
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Ingår i: African Journal of AIDS Research. - : National Inquiry Services Center (NISC). - 1608-5906 .- 1727-9445. ; 6:3, s. 215-222
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Tidskriftsartikel (refereegranskat)abstract
- Attitudes to voluntary counselling and testing (VCT) for HIV among young men and women in a slum area of Kampala, Uganda, were studied through 22 individual semi-structured interviews and 5 focus group discussions. Attitudes to VCT ranged from having no problem with the procedure to being very reluctant. Despite fear of stigma, the participants perceived 'positive living' after HIV testing as realistic. VCT was regarded as an important step to avoid HIV infection, but informants expressed the need for the service to be more accessible in terms of cost, time and quality of pre- and post-test counselling. We argue that counselling without HIV testing should be available for those who are reluctant to test. Poverty and gender power imbalances appeared to limit youths' possibility of making rational decisions about sexual behaviour and accessing VCT. The importance of considering the context in which such issues are being negotiated and decided is highlighted.
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| 9. |
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| 10. |
- Råssjö, Eva-Britta, et al.
(författare)
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“Safe sex advice is good - but so difficult to follow”. Views and experiences of the youth in a health centre in Kampala : From Kiswa Youth Clinic, Kampala, Uganda
- 2002
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Ingår i: African Health Sciences. - 1680-6905 .- 1729-0503. ; 2:3, s. 107-113
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Tidskriftsartikel (refereegranskat)abstract
- Background Young people in Uganda are advised by the Ministry of Health and other authorities to abstain from sex in order to avoid the human immunodeficiency virus (HIV), other sexually transmitted diseases (STD) and early pregnancies. If they cannot abstain they should use condoms and they should stay faithful to their partner. Objective To find out how young people perceive this advice and if they find it possible and realistic to follow. Method In May and June 2000 twenty informants were selected by purposeful sampling and were interviewed in English. Given items were discussed. The interviews were recorded on tape, transcribed, extracted and sorted into categories in a qualitative research method. Results Most of the interviewed youth claimed that the advice is good and helpful but there are many obstacles. The results showed that information given in schools about condom use and safer sex behaviour is not always adequate. However, despite lack of clear health education messages, the risk of being HIV positive is of major concern to many youth. In addition, the expected lack of support if the test is positive is a common reason for abstaining from HIV testing. Conclusions More discussions in society are needed to create consensus on safe sex messages presented to young people. HIV infection is a major concern but many young people abstain from testing, as they expect to receive inadequate support.
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