| 1. |
- Novikova, Natalia, et al.
(författare)
-
Characterization of women with a history of recurrent vulvovaginal candidosis.
- 2002
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:11, s. 1047-1052
-
Tidskriftsartikel (refereegranskat)abstract
- Background. To characterize history, signs, and symptoms in women with a history of recurrent vulvovaginal candidosis (RVVC) and who had consulted with symptoms generally associated with the condition. Methods. Eighty-three women with a history consistent with RVVC were interviewed regarding 32 parameters and 10 signs found at the clinical examination were noted. Candida cultures were made from the introitus and the posterior vaginal fornix. Results. Only in a few of the 43 women with and the 40 without a positive yeast culture could any of the many etiological factors that have been associated with RVVC be traced. Only two factors differed between the groups, namely yogurt intake, which was reported by 28 (68%) and 38 (95%) women in these groups, respectively. Vaginal douching was performed by 10 (23%) women in the Candida-positive group and by 17 (42%) women in the Candida-negative group. Pruritis and burning occurred in 31 (72%) and 22 (51%) of culture-positive patients, which was less frequent than in the culture-negative group, i.e. reported by 19 (47%) and 9 (22%) patients, respectively (p = 0.022 and p = 0.007). Edema (p = 0.026) of the vulva as well as erythema (p = 0.019) and edema (p = 0.008) of the vaginal mucosa, caseous discharge (p = 0.016), were found more often in the Candida culture-positive cases. Conclusions. History and results of clinical examination of patients with RVVC are not enough to distinguish those who are culture-positive from those who are culture-negative for Candida from the genital tract.
|
|
| 2. |
- Bergelin, Ingrid, et al.
(författare)
-
Normal cervical changes in parous women during the second half of pregnancy--a prospective, longitudinal ultrasound study.
- 2002
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:1, s. 31-38
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine what constitutes normal cervical changes during the second half of pregnancy in parous women delivering at term. DESIGN: The study comprises 21 healthy, pregnant parous women who all gave birth at term. They were examined with transvaginal ultrasound every two weeks from 24 gestational weeks until delivery. Cervical length and width were measured. The inner cervical os was assessed as being closed or open, the length and width of any opening were measured, and dynamic cervical changes (i.e. opening and closing of the inner cervical os during examination) were noted. RESULTS: Median cervical length was 41 mm (range 26-55) at the first examination and 29 mm (range 8-56) at the last examination. The corresponding figures for cervical width were 38 mm (range 29-47) and 46 mm (range 38-64). Cervical length decreased in 18 women but remained unchanged in three. Three patterns of change in cervical length were observed: in 12 women there was a steady, continuous decrease in cervical length (median decrease rate 1.1 mm/week, range 0.6-2.4); in four women the decrease rate accelerated towards the end of pregnancy, the median decrease rate after the change being 3.0 mm/week (range 1.5-4.8); and in two women there was a sudden drop in cervical length at term. Cervical width increased in 16 women but remained unchanged in five. Two patterns of change in cervical width were seen: 14 women manifested a steady continuous increase in cervical width (median 0.8 mm/week, range 0.4-1.8); in two women the increase rate accelerated from around 34 gestational weeks, the increase rate after the change being 4.1 and 5.9 mm/week, respectively. Opening of the internal cervical os was observed at least once in 11 (52%) women and was seen as early as at 24 and 25 gestational weeks in two women. The opening was always V-shaped (median length 6 mm, range 4-17; median width 7 mm, range 3-20). Dynamic changes of the internal cervical os were seen in three women (14%) at 25, 30 and 41 gestational weeks, respectively. CONCLUSION: The cervix of parous women decreases in length and increases in width from midpregnancy to term, but the pattern of change varies between individuals. Knowledge of the different patterns of normal change forms the basis of transvaginal ultrasound studies of pathological cervical changes during pregnancy.
|
|
| 3. |
|
|
| 4. |
- Aardal Lönnerfors, Celine, et al.
(författare)
-
Pregnancy following robot-assisted laparoscopic myomectomy in women with deep intramural myomas.
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90, s. 972-977
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To describe fecundity after robot-assisted laparoscopic myomectomy for deep intramural myomas. Design. Prospective observational study. Setting. University Hospital. Population. Women undergoing robot-assisted laparoscopic myomectomy. Methods. Expanding on a previous prospective feasibility study 31 consecutive women in whom a robot-assisted laparoscopic myomectomy was performed between April 2006 and July 2010 were included. The women, of which 14 had known infertility, were selected for having symptomatic, deep intramural myomas with a possible impact on fertility. Using a prospective protocol, relevant peri-operative and follow-up data were retrieved. Main Outcome Measures. Fertility and pregnancy outcome. Results. The 31 women included had a median age of 35 years (range 28-42 years) and median Body Mass Index of 22.0 kg/m(2) (range 20.1-24.7 kg/m(2) ). Fifteen of the 22 (68%) women with an active wish of conceiving have become pregnant at a median time of 10 months after surgery. A total of 18 pregnancies occurred resulting in three miscarriages, two terminated pregnancies, 10 successful term deliveries and three ongoing pregnancies. The subgroup of 14 women with a known but otherwise unexplained infertility had a similar pregnancy rate (69%) and of those, (55%) conceived naturally. The women who conceived naturally were on average eight years younger than the women becoming pregnant after IVF and all miscarriages occurred in an IVF pregnancy. Conclusions. In women with symptomatic, deep intramural myomas and either otherwise unexplained infertility or myomas with possible effect on conception the pregnancy rate following robot-assisted laparoscopic myomectomy was 68%.
|
|
| 5. |
|
|
| 6. |
- Amer-Wåhlin, I, et al.
(författare)
-
Swedish randomized controlled trial of cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram revisited : analysis of data according to standard versus modified intention-to-treat principle.
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons Ltd.. - 0001-6349 .- 1600-0412. ; 90:9, s. 990-996
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To undertake a renewed analysis of data from the previously published Swedish randomized controlled trial on intrapartum fetal monitoring with cardiotocography (CTG-only) vs. CTG plus ST analysis of fetal electrocardiogram (CTG+ST), using current standards of intention-to-treat (ITT) analysis and to compare the results with those of the modified ITT (mITT) and per protocol analyses. METHODS: Renewed extraction of data from the original database including all cases randomized according to primary case allocation (n=5 049). MAIN OUTCOME MEASURE: Metabolic acidosis in umbilical artery at birth (pH <7.05, base deficit in extracellular fluid >12.0 mmol/l) including samples of umbilical vein blood or neonatal blood if umbilical artery blood was missing. RESULTS: The metabolic acidosis rates were 0.66% (17 of 2 565) and 1.33% (33 of 2 484) in the CTG+ST and CTG-only groups, respectively [relative risk (RR) 0.50; 95% confidence interval (CI) 0.28-0.88; p=0.019]. The original mITT gave RR 0.47, 95%CI 0.25-0.86 (p=0.015), mITT with correction for 10 previously misclassified cases RR 0.48, 95%CI 0.24-0.96 (p=0.038) and per protocol analysis RR 0.40, 95%CI 0.20-0.80 (p=0.009). The level of significance of the difference in metabolic acidosis rates between the two groups remained unchanged in all analyses. CONCLUSION: Re-analysis of data according to the ITT principle showed that regardless of the method of analysis, the Swedish randomized controlled trial maintained its ability to demonstrate a significant reduction in metabolic acidosis rate when using CTG+ST analysis for fetal surveillance in labor.
|
|
| 7. |
- Anderberg, Eva, et al.
(författare)
-
Prevalence of impaired glucose tolerance and diabetes after gestational diabetes mellitus comparing different cut-off criteria for abnormal glucose tolerance during pregnancy.
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90, s. 1252-1258
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To determine the prevalence of diabetes and impaired glucose tolerance after gestational diabetes mellitus in relation to different categories of glucose tolerance during pregnancy. Design. Prospective study. Setting. Four delivery departments and three hospitals in southern Sweden took part in recruitment and follow-up. Population. Women undergoing a 75 g oral glucose tolerance test during pregnancy delivering in 2003-2005. Methods. At first follow-up, 1-2 years after delivery, 29% of eligible women with abnormal glucose tolerance during pregnancy had an oral glucose tolerance test; 160 with gestational diabetes, 309 with gestational impaired glucose tolerance, in addition to 167 control women. Cut-off levels defining gestational diabetes and impaired glucose tolerance were 2-hour capillary blood glucose levels 9.0 and 7.8 mmol/l or plasma glucose 10.0 and 8.6 mmol/l, respectively. Main outcome measures. Frequency of abnormal test results at follow-up. Results: Diabetes was diagnosed in 11% and impaired glucose tolerance in 24% of women with gestational diabetes vs. 4% and 23% in those with gestational impaired glucose tolerance. Combining women with abnormal test results during pregnancy revealed diabetes or impaired glucose tolerance in 29% as compared to 10% among controls; the odds ratio (95% confidence interval) for having abnormal test results was 3.3 (1.8-5.9) in a multivariate logistic regression analysis. Conclusions: Lowering the cut-off level for gestational diabetes to also include the category of impaired glucose tolerance would identify a high percentage of women with diabetes and impaired glucose tolerance postpartum, they constitute target groups for intervention and/or diabetes prevention.
|
|
| 8. |
- Andersson, S, et al.
(författare)
-
A comparison of the human papillomavirus test and Papanicolaou smear as a second screening method for women with minor cytological abnormalities
- 2005
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 84:10, s. 996-1000
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Of the estimated one million Papanicolaou (pap) smears performed annually in Sweden, about 4% show any degree of abnormality. Approximately, 1% of these cases contain moderate or severe atypia (high-grade squamous intraepithelial lesions) and the rest contain low-grade atypia. Recommendations for the management of minor abnormalities vary in various parts of Sweden. Generally, a second Pap smear is obtained 4-6 months after the first one showing low-grade atypia. The aim of this study is to compare the sensitivity of human papilloma virus (HPV)-DNA testing for the detection of cervical intraepithelial neoplasia (CIN) 2-3 with that of a second Pap smear in women, who had low-grade atypia in their first Pap smear. Methods. Women with low-grade atypia in the Stockholm area, detected at a population-based cytology screening, were enrolled. A repeat Pap smear, HPV test, and colposcopically directed biopsies were obtained. For the detection of HPV, Hybrid Capture II (HC II) was used. Results. The HPV-DNA test was positive in 66% of the 177 participating women. The sensitivity of the second Pap smear and HPV-DNA test to detect CIN 2-3 was 61 (95% CI = 45-74) and 82% (95% CI = 67-91), respectively. The positive and negative predictive values of HPV testing were 27 (95% CI = 18-35) and 89% (95% CI = 80-97), respectively. Conclusions. In Sweden, a second Pap smear is often obtained for the follow-up of women with low-grade atypia. The results of our study show that compared to the second Pap smear, HPV testing with HC II is a more sensitive method for detecting high-grade lesions.
|
|
| 9. |
- Borgfeldt, Christer, et al.
(författare)
-
Cancer risk after hospital discharge diagnosis of benign ovarian cysts and endometriosis.
- 2004
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 83:4, s. 395-400
-
Tidskriftsartikel (refereegranskat)abstract
- Background. The aim was to evaluate whether patients with benign ovarian cysts, functional ovarian cysts, or endometriosis have an increased risk of developing gynecologic cancer. Methods. The Swedish Hospital Discharge Register was used to identify a cohort of women discharged from hospital with the diagnoses of ovarian cyst (n = 42 217), functional ovarian cyst (n = 17 998), or endometriosis (n = 28 163). To each case, three controls were matched. The National Swedish Cancer Register matched all incident cancers diagnosed among cases and controls. From the Fertility Register, the date of birth of children born to the cases and controls were obtained. Results. Women with endometriosis had an increased risk for ovarian cancer (OR 1.34; 95% CI 1.03-1.75), but no association was found between ovarian cysts or functional cysts and ovarian malignancy, including all ages. Young women (15-29 years old) discharged from hospital for ovarian cysts and functional cysts showed an increased risk of developing ovarian cancer later in life (OR 2.2; 95% CI 1.3-3.9 and OR 1.8; 95% CI 1.5-2.0), as well as women with ovarian cysts who had undergone ovarian cyst resection or unilateral oophorectomy (OR 8.8; 95% CI 5.2-15). The risk of developing ovarian cancer was inversely related to parity. Mean age at diagnosis was significantly lower in all three study groups. Conclusion. In this study women with endometriosis and young women who had undergone surgery with removal of an ovarian cyst had an increased risk of developing ovarian cancer.
|
|
| 10. |
- Brodszki, Jana, et al.
(författare)
-
Management of pregnancies with suspected intrauterine growth retardation in Sweden. Results of a questionnaire
- 2000
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 79:9, s. 723-728
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Diagnosis and management of intrauterine growth retardation during pregnancy remain a major challenge in obstetric care. The objective of this survey was to evaluate the routine clinical management of pregnancies with suspected intrauterine growth retardation at obstetric departments in Sweden. METHODS: In 1997, a questionnaire was sent to all 59 obstetric departments in Sweden. Forty-two departments, caring for 83% of all deliveries in Sweden, replied. Four major topics were addressed: definition and diagnosis of intrauterine growth retardation; magnitude of the problem; clinical management; use of Doppler ultrasound in clinical decision-making. RESULTS: Intrauterine growth retardation is diagnosed by a combination of serial fundal height measurements and ultrasonic fetal biometry at 40 departments, two departments perform routine fetal biometry at 32 weeks. The diagnosis is most often made at 32-36 gestational weeks. Five departments use 1.5 s.d. below the mean as cut-off point for diagnosis of small for gestational age fetuses; 35 departments use mean - 2 s.d. and two departments mean - 2.5 s.d. Intrauterine growth retardation is suspected in 1.6-6.3% pregnancies. About 19% of patients with suspected intrauterine growth retardation are hospitalized. On average, 63% of all small-for-gestational age babies are diagnosed prenatally. Thirty-nine out of 42 obstetric departments use formalized management protocols. All departments use cardiotocography, repeat ultrasound scans and Doppler ultrasound for antenatal surveillance. CONCLUSIONS: In Swedish obstetric units, the diagnostic procedures and methods of fetal surveillance in pregnancies suspected of intrauterine growth retardation are more or less uniform. Doppler examination of umbilical artery is used at all responding departments and is considered a valuable asset in clinical decision-making.
|
|
| 11. |
- Cluff, AH, et al.
(författare)
-
Normal labor associated with changes in uterine heparan sulfate proteoglycan expression and localization
- 2005
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 84:3, s. 217-224
-
Tidskriftsartikel (refereegranskat)abstract
- Proteoglycans are well-known modulators of intercellular communication and signaling. Remodeling of the proteoglycans in the human uterus occurs throughout pregnancy, and during labor. We therefore hypothesize that heparan sulfate proteoglycans (HSPGs) play an important role in establishing normal labor. In this study HSPGs were characterized and localized in human uterine tissue. Uterine biopsies were obtained from four nonpregnant women, four women during elective cesarean section and four during emergency cesarean section. The biopsies were extracted using 4 mguanidinium hydrochloride (GuHCL). HSPGs were then purified by repeated ion-exchange chromatography on dehydroepiandrosterone (DEAE)-cellulose after digestion with chondroitinase ABC and finally precipitated with Alcian blue. HSPGs were identified by agarose gel electrophoresis and Western blotting. Controlled degradation of the heparan sulfate (HS) side-chains was performed using heparitinase or deglycosylation with trifluoromethanesulfonic acid (TFMS). The resulting core proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and visualized by Coomassie staining. HSPGs were localized in uterine tissue by immunohistochemistry. SDS-PAGE after deglycosylation indicated the presence of multiple distinct core proteins tentatively identified as syndecans 1-4 and glypican 1. Western blots confirmed the presence of these proteoglycans and also perlecan. Immunohistochemistry revealed that the HSPGs were localized mainly in the smooth muscle with few in the extracellular matrix (ECM). Syndecan 3, the dominant proteoglycan, showed the most pronounced changes during pregnancy and labor. For the first time several heparan sulfate proteoglycans have been identified and localized in the human uterus and shown to vary in expression during pregnancy and labor. Syndecan 3 had the most outstanding features in this respect.
|
|
| 12. |
- Danerek, Margaretha, et al.
(författare)
-
Sympathetic responsibility in ethically difficult situations*.
- 2005
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 84:12, s. 1164-1171
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Ethical issues arise in many obstetric situations and demand constant consideration by obstetricians. The aim of this study was to highlight the meaning of being in an ethically difficult situation as narrated by obstetricians. Methods. A descriptive design with a qualitative approach using a hermeneutic phenomenological method for analysis. Interviews were performed with 14 obstetricians working in a Swedish hospital setting. Results. The overriding theme was Sympathetic responsibility in the decisions of critical importance for the mother and her infant. Five related themes were to: (i) proceed with a moral reasoning that leads to the choice of a possible solution; (ii) balance one's own medical knowledge and moral insight with the needs and requests of the parents; (iii) be aware of one's medical and moral responsibility in relation to the decision made; (iv) experience the ability to take action and to make and carry out difficult and important decisions relating to the health of the mother and infant; and (v) reflect on a given situation in a manner leading to a rational acceptance of one's own conduct. Conclusions. Sympathetic responsibility is the structure of the meaning of the obstetricians' lived experience, which means that the obstetricians with the help of their medical knowledge and their desire to support the mother's autonomy do what is best for the mother and her infant. Implications include that an exchange of ethical thoughts and moral reasoning should lead to a higher degree of mutual understanding between colleagues and between the different professionals. Co-operation is important to achieve the best outcome for the mother and her infant.
|
|
| 13. |
- Epstein, Elisabeth, et al.
(författare)
-
Comparison of Endorette and dilatation and curettage for sampling of the endometrium in women with postmenopausal bleeding
- 2001
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 80:10, s. 959-964
-
Tidskriftsartikel (refereegranskat)abstract
- MAIN QUESTION: To compare the diagnostic properties of Endorette and D&C in women with postmenopausal bleeding, to relate the properties to endometrial thickness as measured by ultrasound, and to assess the women's experiences of the two methods. METHODS: In a prospective study, 133 consecutive women with postmenopausal bleeding were examined with transvaginal ultrasound. After measuring the endometrial thickness, Endorette sampling was performed without anesthesia. Dilatation and curettage (D&C) was carried out under general anesthesia within six weeks. After completion of each sampling procedure the women filled in a questionnaire regarding their experience of the sampling. RESULTS: Endorette sampling failed in 16% (21/133) of the women. More than half (56%) of the women experienced moderate or strong pain during Endorette sampling, and the doctor underestimated the pain in 62% of the women. Endorette failed to diagnose two of seven (29%) endometrial cancers found at D&C. In one of these two cases, the examiner suspected that the Endorette device had not reached the uterine fundus. In women with endometrium < 7 mm, Endorette and D&C showed similar results with regard to obtaining a sufficient endometrial sample and to distinguishing normal endometrium, benign pathological endometrium and malignancy. In women with endometrium > or =7 mm, Endorette yielded insufficient samples significantly more often than D&C (23% vs 6%, p=0.02; the McNemar test) and missed all polyps and most (77%) hyperplasias diagnosed by D&C. CONCLUSION: Endorette and D&C have similar diagnostic properties in women with postmenopausal bleeding and endometrium < 7 mm. D&C is superior to Endorette in women with endometrium > or =7 mm.
|
|
| 14. |
- Epstein, Elisabeth, et al.
(författare)
-
Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding
- 2001
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 80:12, s. 1131-1136
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the prevalence of focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > or = 5 mm and the extent to which such lesions can be correctly diagnosed by D&C. METHODS: In a prospective study, 105 women with postmenopausal bleeding and endometrium > or = 5 mm at transvaginal ultrasound examination underwent diagnostic hysteroscopy, D&C and hysteroscopic resection of any focally growing lesion still left in the uterine cavity after D&C. Twenty-four women also underwent hysterectomy. If the histological diagnosis differed between specimens from the same patient, the most relevant diagnosis was considered the final one. RESULTS: Eighty percent (84/105) of the women had pathology in the uterine cavity, and 98% (82/84) of the pathological lesions manifested a focal growth pattern at hysteroscopy. In 87% of the women with focal lesions in the uterine cavity, the whole or parts of the lesion remained in situ after D&C. D&C missed 58% (25/43) of polyps, 50% (5/10) of hyperplasias, 60% (3/5) of complex atypical hyperplasias, and 11% (2/19) of endometrial cancers. The agreement between the D&C diagnosis and the final diagnosis was excellent (94%) in women without focally growing lesions at hysteroscopy. CONCLUSION: If there are focal lesions in the uterine cavity, hysteroscopy with endometrial resection is superior to D&C for obtaining a representative endometrial sample in women with postmenopausal bleeding and endometrium > or = 5 mm.
|
|
| 15. |
- Epstein, Elisabeth
(författare)
-
Management of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy.
- 2004
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 83:1, s. 89-95
-
Tidskriftsartikel (refereegranskat)abstract
- Background. The objective was to determine how postmenopausal bleeding (PMB) is managed in Sweden today, and to relate the findings to a new evidence-based algorithm for the management of PMB. Methods. A questionnaire regarding the role of ultrasound and the use of different endometrial biopsy methods in the management of PMB was sent to all 61 gynecologic departments in Sweden. Results. Fifty-nine of the 61 departments (97%) satisfactorily answered the questionnaire. Ultrasound was either always (n = 54, 92%) or most commonly (n = 5, 8%) used in the diagnostic work-up of PMB. In women with endometrial thickness <=4 mm, 18 of the departments (31%) routinely sampled the endometrium; 12 (15%) followed the women with ultrasound; three (5%) did both sampling and follow-up with ultrasound; and the remaining 29 (49%) used expectant management (i.e. no biopsy or routine follow-up). In women with endometrium >=5 mm, hydrosonography was performed routinely in two departments (3%), occasionally in 37 departments (63%), and never in 20 departments (34%). In women with endometrium >=5 mm, endometrial biopsy was obtained routinely by Endorette®/Pipelle® in 39 departments (66%), while in 26 departments (44%) operative hysteroscopy was never performed. Conclusion. More than one-third of the gynecologic departments in Sweden never perform hydrosonography to rule out focal lesions or operative hysteroscopy for the removal of such lesions. Hydrosonography and hysteroscopy have a central role in the new guidelines for the management of PMB. Therefore, a need exists to broaden the use of hydrosonography and hysteroscopy.
|
|
| 16. |
- Erlandsson, Kerstin, et al.
(författare)
-
Women's' premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell.
- 2012
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:1, s. 28-33
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To identify if mothers to stillborn babies had had a premonition that their unborn child might not be well and how they dealt with that premonition. Design. A mixed method approach. Setting: 1 034 women answered a web questionnaire. Sample: 614 women fulfilled the inclusion criteria of having a stillbirth after the 22(nd) gestational week and answered questions about premonition. Methods. Qualitative content analysis was used for the open questions and descriptive statistics for questions with fixed alternatives. Main Outcome.Measure: The premonition of an unwell unborn baby. Results. In all 392/614 (64%) of the women had had a premonition that their unborn baby might be unwell; 274/614 (70%) contacted their clinic and were invited to come in for a check-up, but by then it was too late as the baby was already dead. A further 88/614 (22%) decided to wait until their next routine check-up, believing that the symptoms were part of the normal cycle of pregnancy, and that the fetus would move less towards the end of a pregnancy. Thirty women (8%) contacted their clinic, but were told that everything appeared normal without an examination of the baby. Conclusion. Women need to know that a decrease in fetal movements is an important indicator of their unborn baby´s health. Health care professionals should not delay an examination if a mother-to-be is worried of her unborn baby´s wellbeing.
|
|
| 17. |
- Essén, Birgitta, et al.
(författare)
-
Female genital mutilation in the West: traditional circumcision versus genital cosmetic surgery.
- 2004
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 83:7, s. 611-613
-
Tidskriftsartikel (refereegranskat)abstract
- This article intends to present the Scandinavian legislation on female genital mutilation and explore the implications of the laws. Juxtaposing trends of plastic genital surgery in the West with claims that female circumcision may be a practice generally abandoned in Scandinavia, we highlight the double morality inherent in current public discussions. Finally, we pose the question: Is the legal principle of equality before the law regarded when it comes to alterations of the female genitals?
|
|
| 18. |
|
|
| 19. |
- Finnström, Orvar, et al.
(författare)
-
Maternal and child outcome after in-vitro fertilization-a review of 25 years population based data from Sweden.
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90:5, s. 494-500
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To summarize data on deliveries after IVF performed in Sweden up to 2006. Design. Cohort study of women and children, conceived after IVF with comparisons of deliveries after IVF before and after April 1, 2001. Setting. Study based on Swedish health registers. Population. Births registered in the Swedish Medical Birth Register with information on IVF from all IVF clinics in Sweden. Methods. Results from the second study period are summarized and outcomes between the two periods are compared. Long term follow-up is based on data from both periods. Main outcome measures. Maternal and perinatal outcomes, long term sequels. Results. Some maternal pregnancy complications decreased in rate, notably preeclampsia and PROM. The rate of multiple births and preterm births decreased dramatically with a better neonatal outcome, including neonatal mortality. No difference in outcome existed between IVF and ICSI or between the use of fresh and cryopreserved embryos, but children born after blastocyst transfer had a slightly higher risk for preterm birth and congenital malformations than children born after cleavage stage transfer. An increased risk for cerebral palsy, possibly for attention deficit and hyperactivity disorder, for impaired visual acuity, and for childhood cancer was noted but these outcomes were rare also after IVF. An increased risk for asthma was demonstrated. No effect on maternal cancer risk was seen. Conclusions. A marked decrease in multiple births was the main reason for better pregnancy and neonatal outcome and may also have a beneficial effect on long-term results, notably cerebral palsy.
|
|
| 20. |
- Fu, Jing, et al.
(författare)
-
Relations between fetal brain-sparing circulation, oxytocin challenge test, mode of delivery and fetal outcome in growth-restricted term fetuses.
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90:3, s. 227-230
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. The study was designed as a prospective non-interventional, observational study to elucidate the potential value of fetal middle cerebral artery Doppler velocimetry to identify brain-sparing flow in a surveillance program for suspected intrauterine growth restriction (IUGR). Material and methods. The study was carried out at Skåne University Hospital, Malmö, Sweden. One hundred and twenty-six single pregnancies suspected of IUGR at ≥36 gestational weeks were assessed. The main outcome measures were positive/negative oxytocin challenge test (OCT) and cesarean/vaginal delivery. The pregnancies were managed with ultrasound fetometry, uterine and umbilical artery Doppler flow velocimetry, nonstress test, and an OCT to decide the optimal time and mode of delivery. Cases with a positive OCT were promptly delivered by cesarean section, whereas negative cases were allowed a trial of labor. Middle cerebral artery Doppler flow velocimetry results were blinded to the managing obstetricians. Brain-sparing flow was defined as a middle cerebral artery-to-umbilical artery pulsatility index ratio of <1.08. Nonparametric statistics with significance set at p < 0.05 were used, and Cohen's kappa coefficient was calculated for congruence of brain-sparing flow with OCT and mode of delivery, respectively. Results. The positive predictive value and sensitivity figures of brain-sparing flow to indicate a positive OCT and cesarean delivery were 33-63%. The inter-rater reliability of brain-sparing flow vs. positive OCT showed a kappa coefficient of 0.19, and brain-sparing flow vs. cesarean section among OCT-negative cases a kappa coefficient of 0.23. Conclusion. Fetal brain-sparing flow is a poor predictor of a positive OCT, and of cesarean section in OCT-negative cases.
|
|
| 21. |
- Gemzell-Danielsson, Kristina, et al.
(författare)
-
Comprehensive counseling about combined hormonal contraceptives changes the choice of contraceptive methods : results of the CHOICE program in Sweden
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:8, s. 869-877
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To study the influence of counseling on women's contraceptive decisions. Design. A cross-sectional multicenter study. Setting. Seventy Swedish family planning clinics. Population. Women aged 15-40 years attending for a contraceptive consultation who expressed interest in a combined hormonal contraceptive (CHC) method. Methods. Structured counseling about three CHCs and questionnaires completed after counseling from the healthcare professional. Main Outcome Measures. Method originally requested, perceptions of CHC attributes, method chosen and reasons for the choice. Results. In all, 173 healthcare professionals and 1 944 women participated. The mean standard deviation (SD) age of the women was 22.6(6.1) years. After structured counseling, a majority of women (56.0%; n=1 069; 95% confidence interval (CI) 53.1-58.9) chose the daily pill, 6.2% (n=118; 95% CI 4.9-7.8) chose the weekly patch, and 22.5% ( n=430; 95% CI 20.2-25.1) chose the monthly ring. The weekly patch was chosen more often after counseling (6.2 vs 2.4% before counseling; p<0.0001). The greatest change was in the proportion of women who chose the contraceptive ring after counseling (22.5% vs. 8.5% before counseling; p<0.0001). The proportion of undecided women after counseling was reduced considerably (3.9% vs. 27.8% before counseling). Among the 523 women who were undecided before counseling, 50.6% chose the pill, 10.2% the patch and 24.6% the ring, while 20.9% of women who initially requested the pill changed to another method. Conclusions. Structured counseling facilitated choice of contraceptive method for most women, leading to changes in women's selection of a CHC method.
|
|
| 22. |
- Geppert, Barbara, et al.
(författare)
-
Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery.
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90, s. 1210-1217
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. Comparison of surgical results on obese patients undergoing hysterectomy by robot-assisted laparoscopy or laparotomy. Setting. University hospital. Methods. All women (n=114) with a BMI ≥30 kg/m(2) who underwent a simple hysterectomy as the main surgical procedure between November 2005 and November 2009 were identified. Robot-assisted procedures (n=50) were separated into an early (learning phase) and a late (consolidated phase) group; open hysterectomy was considered an established method. Relevant data was retrieved from prospective protocols (robot) or from computerized patient charts (laparotomy) until 12 months after surgery. Complications leading to prolonged hospital stay, readmission/reoperation, intravenous antibiotic treatment or blood transfusion were considered significant. The surgical technique used for morbidly obese patients is described. Results. Women in the late robot group (n=25) had shorter inpatient time (1.6 compared to 3.8 days, p<0.0001), less bleeding (100 compared to 300 mL, p<0.0001) and fewer complications (2/25 compared to 23/64, p=0.006) than women with open surgery (n=64) but a longer operating time (136 compared to 110 minutes, p=0.0004). For women with a BMI ≥35 kg/m(2) , surgical time in the late robot group and the laparotomy group was equal (136 compared to 128 minutes, p=0.31). Conclusions. Robot-assisted laparoscopic hysterectomy in a consolidated phase in obese women is associated with shorter hospital stay, less bleeding and fewer complications compared to laparotomy but, apart from women with BMI ≥35, a longer operative time.
|
|
| 23. |
- Ghosh, Gisela, et al.
(författare)
-
Amniotic fluid index in low-risk pregnancy as an admission test to the labor ward.
- 2002
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:9, s. 852-855
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Oligohydramnios has been shown to be a predictor of intrapartal fetal distress. In a selected group of low-risk pregnancies, however, it has not yet been established that oligohydramnios contributes to intrapartal fetal distress. Methods. Ultrasonically estimated four-quadrant amniotic fluid index as a test for admission to the labor ward was evaluated as a predictive factor for fetal distress during labor in a prospective 'blind' study comprising 600 low-risk pregnancies. Oligohydramnios was defined as an amniotic fluid index <= 50 mm. The parturients were divided into two groups according to the status of the fetal membranes. The amniotic fluid index results were correlated to fetal outcome: Apgar score at 1 and 5 min, pH of blood in umbilical artery and vein, operative delivery because of fetal distress, cesarean delivery because of fetal distress, and number of babies referred to the neonatal intensive care unit. Results. Two-hundred and sixty-seven women had ruptured membranes. Among these a significant increase in operative delivery because of fetal distress was seen in cases of oligohydramnios compared with the normal amount of amniotic fluid (odds ratio 3.86, confidence interval = 1.25-11.9). No significant differences were seen regarding other variables of perinatal outcome. The group with intact membranes comprised 333 parturients. Among these, no significant differences in perinatal outcome could be seen in relationship to the amniotic fluid index, although a 50% increase in emergency operations for fetal distress was seen in women with oligohydramnios. A significant correlation might have been evident even in that group if a larger sample had been studied. Conclusion. The results indicate that measurement of the amniotic fluid index in low-risk pregnant women admitted for labor might identify parturients with an increased risk of intrapartal fetal distress.
|
|
| 24. |
- Grunewald, Charlotta, et al.
(författare)
-
Significant effects on neonatal morbidity and mortality after regional change in management of post-term pregnancy
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:1, s. 26-32
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate the effects on neonatal morbidity of a regional change in induction policy for post-term pregnancy from 43(+0) to 42(+0) gestational weeks (GWs). Design and setting. Nationwide retrospective register study between 2000 and 2007. Population. All singleton pregnancies with a gestational age of >41(+2) GW (n= 119,198). Methods. All Swedish counties were divided into three groups where study group allocation was designated by the proportion of pregnancies >42(+2) GW among all pregnancies of >41(+2) GW. Stockholm county formed a separate group. Main outcome measures. Perinatal morbidity. Results. In counties with the most active management, 19% of pregnancies >41(+2) GW were delivered at >42(+2) GW during 2000-2004 compared to 7.1% in 2005-2007. In the least active counties, corresponding figures were 21.0% compared to 19.4%. During 2005-2007, the odds ratios for meconium aspiration and 5-minute Apgar score of ≤6 in the least compared to most active counties, were 1.55 (95% CI: 1.03-2.33) and 1.26 (95% CI: 1.06-1.51). In Stockholm >42(+2) GW seen among pregnancies of >41(+2) decreased from 21.0% in 2000-2004 to 5.9% in 2005-2007. Reduced perinatal death risks by 48%, meconium aspiration of 51% and low Apgar scores by 31% in 2005-2007 compared with 2000-2004 were observed. Rates of operative deliveries at >41(+2) GW in Stockholm were unaltered. Conclusion. A significant reduction in perinatal morbidity was found, with no influence on operative delivery rates for post-term pregnancy in Stockholm. We advocate a nationwide change toward more active management of post-term pregnancies.
|
|
| 25. |
- Gudmundsson, Saemundur, et al.
(författare)
-
New score indicating placental vascular resistance.
- 2003
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 82:9, s. 807-812
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Umbilical artery Doppler velocimetry is a routine method for fetal surveillance in high-risk pregnancy. Uterine artery Doppler seems to give comparable information, but it can be difficult to interpret as there are two arteries, which might show notching and/or increased pulsatility index (PI) as signs of increased vascular impedance. Combining the information on vascular resistance on both sides in a new score might simplify and improve evaluation of placental circulation. Methods. Uterine and umbilical artery Doppler velocimetry was evaluated in 633 high-risk pregnancies. The managing clinician was informed only about the umbilical artery flow. The umbilical artery flow spectrum was semiquantitatively divided into four blood flow classes (BFC), expressing signs of increasing vascular resistance. The uterine artery Doppler flow spectrum was divided into five uterine artery scores (UAS), taking into account presence/absence of notching and/or increase in PI. By adding UAS to BFC, a new placental score (PLS) was constructed with values ranging from 0 to 7, indicating general placental vascular resistance. The scores were related to three outcome variables: small-for-gestational age (SGA), premature delivery (<37 weeks), and cesarean section. Results. All three score systems showed a significant relationship between signs of increasing vascular resistance and outcome. The new PLS showed the best association to adverse outcomes, with optimal cut-off at values exceeding score 3. Conclusion. Doppler velocimetry on both sides of the placenta showed a strong relationship to an adverse outcome of pregnancy. The new PLS showed a better relationship to adverse perinatal outcome than the BFC and the UAS. The PLS can simplify evaluation of uteroplacental and fetoplacental Doppler velocimetry.
|
|
