| 1. |
- Armstrong, P. M., et al.
(författare)
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Prevalence of Vitamin D Insufficiency and Its Determinants among Women Undergoing In Vitro Fertilization Treatment for Infertility in Sweden
- 2023
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Ingår i: Nutrients. - 2072-6643. ; 15:12
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of research on women with infertility in the northern latitudes, where vitamin D insufficiency is high. Therefore, this study aimed to assess the prevalence and determinants of vitamin D insufficiency (serum 25(OH)D concentration < 50 nmol/L) among women undergoing in vitro fertilization (IVF) treatment. Thus, 265 women scheduled for IVF/intracytoplasmic sperm injection (ICSI) between September 2020 and August 2021 at Sahlgrenska University Hospital in Gothenburg, Sweden, were included. Data on serum 25(OH)D concentration, vitamin D intake, and sun exposure were collected via questionnaires and blood samples. Approximately 27% of the women had 25(OH)D insufficiency, which was associated with longer infertility duration. The likelihood of insufficiency was higher among women from non-Nordic European countries (OR 2.92, 95% CI 1.03-8.26, adjusted p = 0.043), the Middle East (OR 9.90, 95% CI 3.32-29.41, adjusted p < 0.001), and Asia (OR 5.49, 95% CI 1.30-23.25, adjusted p = 0.020) than among women from Nordic countries. Women who did not use vitamin D supplements were more likely to have insufficiency compared with supplement users (OR 3.32, 95% CI 1.55-7.10, adjusted p = 0.002), and those who avoided sun exposure had higher odds of insufficiency compared to those who stayed "in the sun all the time" (OR 3.24, 95% CI 1.22-8.62, adjusted p = 0.018). Women with infertility in northern latitudes and those from non-Nordic countries who avoid sun exposure and do not take vitamin supplements have a higher prevalence of 25(OH)D insufficiency and longer infertility duration.
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| 2. |
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| 3. |
- Gyhagen, Maria, et al.
(författare)
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Faecal incontinence 20years after one birth: a comparison between vaginal delivery and caesarean section.
- 2014
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Ingår i: International urogynecology journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 25:10, s. 1411-1418
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Tidskriftsartikel (refereegranskat)abstract
- The aetiology of bowel incontinence in middle-aged women is multifactorial and the contribution of birth-related factors later in life is still poorly defined. The aim was to assess prevalence, risk factors and severity of faecal (FI, defined as the involuntary loss of faeces-solid or liquid) and anal incontinence (AI, includes FI as well as the involuntary loss of flatus) 20years after one vaginal (VD) or one caesarean section (CS).
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| 4. |
- Gyhagen, Maria, et al.
(författare)
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Prevalence and risk factors for pelvic organ prolapse 20years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery.
- 2013
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 120:2, s. 152-60
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Tidskriftsartikel (refereegranskat)abstract
- Please cite this paper as: Gyhagen M, Bullarbo M, Nielsen T, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG 2012; DOI : 10.1111/1471-0528.12020. Objective To investigate prevalence and risk factors for symptomatic pelvic organ prolapse (sPOP) and sPOP concomitant with urinary incontinence (UI) in women 20years after one vaginal delivery or one caesarean delivery. Design Registry-based national cohort study. Setting Women who returned a postal questionnaire in 2008 (response rate 65.2%). Population Singleton primiparae with a birth in 1985-88 and no further births (n=5236). Methods The SWEPOP study used validated questionnaires about sPOP and UI. Main outcome measures Prevalence rate and risk of sPOP with or without concomitant UI. Results Prevalence of sPOP was higher after vaginal delivery compared with caesarean section (14.6 versus 6.3%, odds ratio [OR] 2.55; 95% confidence interval [95% CI] 1.98-3.28) but was not increased after acute compared with elective caesarean section. Episiotomy, vacuum extraction and second-degree or more laceration were not associated with increased risk of sPOP compared with spontaneous vaginal delivery. Symptomatic POP increased 3% (OR 1.03; 95% CI 1.01-1.05) with each unit increase of current BMI and by 3% (OR 1.03; 95% CI 1.02-1.05) for each 100g increase of infant birthweight. Mothers ≤160cm who delivered a child with birthweight ≥4000g had a doubled prevalence of sPOP compared with short mothers who delivered an infant weighing <4000g (24.2 versus 13.4%, OR 2.06; 95% CI 1.19-3.55). Women with sPOP had UI and UI>10years more often than women without prolapse. Conclusion The prevalence of sPOP was doubled after vaginal delivery compared with caesarean section, two decades after one birth. Infant birthweight and current BMI were risk factors for sPOP after vaginal delivery.
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| 5. |
- Gyhagen, Maria, et al.
(författare)
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The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery.
- 2013
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 120:2, s. 144-151
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate the prevalence and risk factors for urinary incontinence (UI) 20years after one vaginal delivery or one caesarean section. Design Registry-based national cohort study. Setting Women who returned postal questionnaires (response rate 65.2%) in 2008. Population Singleton primiparae who delivered in the period 1985-1988 with no further births (n=5236). Methods The Swedish Pregnancy, Obesity and Pelvic Floor (SWEPOP) study linked Medical Birth Register (MBR) data to a questionnaire about UI. Main outcome measures Prevalence of UI and UI for more than 10years (UI>10years) were assessed 20years after childbirth. Results The prevalence of UI (40.3 versus 28.8%; OR1.67; 95%CI 1.45-1.92) and UI>10years (10.1 versus 3.9%; OR2.75; 95%CI 2.02-3.75) was higher in women after vaginal delivery than after caesarean section. There was no difference in the prevalence of UI or UI>10years after an acute caesarean section or an elective caesarean section. We found an 8% increased risk of UI per current body mass index (BMI) unit, and age at delivery increased the UI risk by 3% annually. Conclusions Two decades after one birth, vaginal delivery was associated with a 67% increased risk of UI, and UI>10years increased by 275% compared with caesarean section. Our data indicate that it is necessary to perform eight or nine caesarean sections to avoid one case of UI. Weight control is an important prophylactic measure to reduce UI. Current BMI was the most important BMI-determinant for UI, which is important, as BMI is modifiable.
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| 6. |
- Hallingström, Maria, et al.
(författare)
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Proteomic Analysis of Early Mid-Trimester Amniotic Fluid Does Not Predict Spontaneous Preterm Delivery
- 2016
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:5
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Tidskriftsartikel (refereegranskat)abstract
- Objective The aim of this study was to identify early proteomic biomarkers of spontaneous preterm delivery (PTD) in mid-trimester amniotic fluid from asymptomatic women. This is a case-cohort study. Amniotic fluid from mid-trimester genetic amniocentesis (14-19 weeks of gestation) was collected from 2008 to 2011. The analysis was conducted in 24 healthy women with subsequent spontaneous PTD (cases) and 40 randomly selected healthy women delivering at term (controls). An exploratory phase with proteomics analysis of pooled samples was followed by a verification phase with ELISA of individual case and control samples. The median (interquartile range (IQR: 25th; 75th percentiles) gestational age at delivery was 35+5 (33+6-36+6) weeks in women with spontaneous PTD and 40+0 (39+1-40+5) weeks in women who delivered at term. In the exploratory phase, the most pronounced differences were found in C-reactive protein (CRP) levels, that were approximately two-fold higher in the pooled case samples than in the pooled control samples. However, we could not verify these differences with ELISA. The median (25th; 75th IQR) CRP level was 95.2 ng/mL (64.3; 163.5) in women with spontaneous PTD and 86.0 ng/mL (51.2; 145.8) in women delivering at term (p = 0.37; t-test). Proteomic analysis with mass spectrometry of mid-trimester amniotic fluid suggests CRP as a potential marker of spontaneous preterm delivery, but this prognostic potential was not verified with ELISA.
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| 7. |
- Hallingström, Maria, et al.
(författare)
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The association between selected mid-trimester amniotic fluid candidate proteins and spontaneous preterm delivery
- 2020
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Ingår i: Journal of Maternal-Fetal and Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 33:4, s. 583-592
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to explore inflammatory response and identify early potential biomarkers in mid-trimester amniotic fluid associated with subsequent spontaneous preterm delivery (PTD). Methods: A cohort study was performed at Sahlgrenska University Hospital/Östra, Gothenburg, Sweden, between 2008 and 2010. Amniotic fluid was collected from consecutive women undergoing mid-trimester transabdominal genetic amniocentesis at 14–19 gestational weeks. Clinical data and delivery outcome variables were obtained from medical records. The analysis included 19 women with spontaneous PTD and 118 women who delivered at term. A panel of 26 candidate proteins was analyzed using Luminex xMAP technology. Candidate protein concentrations were analyzed with ANCOVA and adjusted for plate effects. Results: The median gestational age at delivery was 35 + 3 weeks in women with spontaneous PTD and 40 + 0 weeks in women who delivered at term. Nominally significantly lower amniotic fluid levels of adiponectin (PTD: median 130,695 pg/mL (IQR 71,852–199,414) vs term: median 185,329 pg/mL (IQR (135,815–290,532)), granulocyte-macrophage colony stimulating factor (PTD: median 137 pg/mL (IQR 74–156) vs term: median 176 pg/mL (IQR 111–262)), and macrophage migration inhibitory factor (PTD: median 3025 pg/mL (IQR 1885–3891) vs term: median 3400 pg/mL (IQR 2181–5231)) were observed in the spontaneous PTD group, compared with the term delivery group, after adjusting for plate effects. No significant differences remained after Bonferroni correction for multiple comparisons. Conclusions: Our results are important in the process of determining the etiology behind spontaneous PTD but due to the non-significance after Bonferroni correction, the results should be interpreted with caution. Further analyses of larger sample size will be required to determine whether these results are cogent and to examine whether microbial invasion of the amniotic cavity or intra-amniotic inflammation occurs in asymptomatic women in the mid-trimester with subsequent spontaneous PTD.
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| 8. |
- Augustin, Hanna, et al.
(författare)
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Late Pregnancy Vitamin D Deficiency is Associated with Doubled Odds of Birth Asphyxia and Emergency Caesarean Section: A Prospective Cohort Study
- 2020
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Ingår i: Maternal and Child Health Journal. - : Springer Science and Business Media LLC. - 1092-7875 .- 1573-6628. ; 24, s. 1412-1418
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this prospective cohort study was to investigate the associations between maternal vitamin D status in late pregnancy and emergency caesarean section (EMCS) and birth asphyxia, in a population based sample of women in Sweden. Methods Pregnant women were recruited at the antenatal care in Sweden and 1832 women were included after exclusion of miscarriages, terminated pregnancies and missing data on vitamin D status. Mode of delivery was retrieved from medical records. EMCS was defined as caesarean section after onset of labour. Birth asphyxia was defined as either 5 min Apgar score < 7 or arterial umbilical cord pH < 7.1. Serum was sampled in the third trimester of pregnancy (T3) and 25-hydroxyvitamin D (25OHD) was analysed by liquid chromatography tandem mass spectrometry. Vitamin D deficiency was defined as 25OHD < 30 nmol/L, and associations were studied using logistic regression analysis and expressed as adjusted odds ratios (AOR). Results In total, 141 (7.7%) women had an EMCS and 58 (3.2%) children were born with birth asphyxia. Vitamin D deficiency was only associated with higher odds of EMCS in women without epidural anaesthesia (AOR = 2.01, p = 0.044). Vitamin D deficiency was also associated with higher odds of birth asphyxia (AOR = 2.22, p = 0.044). Conclusions for Practice In this Swedish prospective population-based cohort study, vitamin D deficiency in late pregnancy was associated with doubled odds of birth asphyxia and with EMCS in deliveries not aided by epidural anaesthesia. Prevention of vitamin D deficiency among pregnant women may reduce the incidence of EMCS and birth asphyxia. The mechanism behind the findings require further investigation.
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| 9. |
- Bullarbo, Maria, 1958, et al.
(författare)
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Diastolic blood pressure increase is a risk indicator for pre-eclampsia.
- 2015
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Ingår i: Archives of gynecology and obstetrics. - : Springer Science and Business Media LLC. - 1432-0711 .- 0932-0067. ; 291:4, s. 819-823
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Tidskriftsartikel (refereegranskat)abstract
- A previous study demonstrated that the increase in diastolic blood pressure during pregnancy was reduced by supplementation with magnesium. The present study was undertaken to explore if increases in diastolic blood pressure could be useful for early identification of pre-eclampsia.
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| 10. |
- Bullarbo, Maria, 1958, et al.
(författare)
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Isosorbide mononitrate induces increased cervical expression of cyclooxygenase-2, but not of cyclooxygenase-1, at term
- 2007
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Ingår i: Eur J Obstet Gynecol Reprod Biol. ; 130:2, s. 160-4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Prostaglandin and nitric oxide (NO) are both known to be involved in cervical ripening at term. The aim of the study was to investigate if NO has an effect on cervical expression of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), the two main isoenzymes involved in prostaglandin synthesis, and to localize these enzymes within the cervix. STUDY DESIGN: Women with an unripe cervix scheduled for elective caesarean section at term were randomly selected to receive vaginally either the NO donor isosorbide mononitrate (IMN) or placebo 4h before surgery. At the operating theatre, cervical tissue specimens were obtained for immunoblotting and immunohistochemistry. RESULTS: Increased expression of COX-2 was found in specimens exposed to IMN compared to specimens obtained from women in the placebo group. There was no difference in the expression of COX-1. Immunohistochemistry revealed similar localization of the two enzymes in treated and untreated women. CONCLUSIONS: Vaginal administration of IMN induces increased cervical expression of COX-2, but not of COX-1. This pathway may be of importance in the process of cervical ripening at term.
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| 11. |
- Bullarbo, Maria, 1958, et al.
(författare)
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Low Prevalence of Active Tuberculosis among High-Risk Pregnant and Postpartum Women in Sweden: A Retrospective Epidemiological Cohort Study Using and Evaluating TST as Screening Method
- 2018
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Ingår i: Infectious Diseases in Obstetrics and Gynecology. - : Hindawi Limited. - 1064-7449 .- 1098-0997. ; 2018
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Studies on the prevalence of active tuberculosis (TB) and latent tuberculosis infection (LTBI) among high-risk pregnant and postpartum women are few and prevalence is not well known. The methods used for diagnosing and treating TB and LTBI also differ both within and between countries. The aim of the study was to investigate the prevalence of TB and LTBI among high-risk pregnant and postpartum women in a Western Region of Sweden using tuberculin skin test (TST) as screening method. Secondary aims were to evaluate the effectiveness of the screening method and possible negative labour and neonatal outcomes among TST-positive women. Methods. Pregnant women attending an antenatal care unit (ACU) allocated for TST screening were investigated and followed up for two years postpartum. Results. Only one woman out of 902 screened women in the study group was diagnosed with active TB because of TB symptoms and not because of positive TST. 36% of the skin-tested women fulfilled criteria for LTBI. No difference in perinatal outcome was found between women with and without positive TST. Conclusions. Our findings suggest that TST screening of high-risk women may not be an effective strategy, since the prevalence of active TB is low. Investigating pregnant and postpartum women with TB symptoms instead of TST for screening could be an option in low TB prevalence areas. The criteria for diagnosing and treating LTBI should be clearly stated.
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| 12. |
- Bullarbo, Maria, 1958, et al.
(författare)
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Magnesium Supplementation and Blood Pressure in Pregnancy: A Double-Blind Randomized Multicenter Study
- 2018
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Ingår i: Journal of Pregnancy. - : Hindawi Limited. - 2090-2727 .- 2090-2735.
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the effect of magnesium (Mg) supplementation in healthy pregnant women for prevention of blood pressure increase. Secondary outcomes were comparison of biomarkers for hypertensive disorders and labour and fetal outcomes between the groups. Methods. Two hundred nulliparous healthy pregnant women were double-blind randomized to receive Mg daily or placebo. Results. There were no differences in blood pressure increase. However, among the Mg-treated women, there was a significant negative correlation between increase in blood levels of magnesium and increase in systolic blood pressure (p = 0.042). Magnesium supplementation seems to be safe for both mother and infant. Conclusion. Magnesium supplementation in healthy first-time pregnant women is not to be recommended for prevention of blood pressure increase. Supplementation in risk pregnancies needs to be further investigated.
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| 13. |
- Bullarbo, Maria, 1958, et al.
(författare)
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Magnesium supplementation to prevent high blood pressure in pregnancy: a randomised placebo control trial.
- 2013
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Ingår i: Archives of gynecology and obstetrics. - : Springer Science and Business Media LLC. - 1432-0711 .- 0932-0067. ; 288:6, s. 1269-1274
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To assess if hypertension during the last part of pregnancy could be prevented by magnesium supplementation. METHODS: Pregnant primagravida women from a local antenatal care unit were given an oral supply of 300mg magnesium as citrate or placebo from pregnancy week 25 in a randomised double-blind setup. Blood pressure was recorded during pregnancy as well as pregnancy outcome. RESULTS: In the magnesium-supplemented group, the average diastolic blood pressure at week 37 was significantly lower than in the placebo group (72/1.4 mean/SEM vs 77/1.4, p=0.031). The number of women with an increase in diastolic blood pressure of ≥15mmHg was significantly lower in the magnesium group compared with the women who received placebo (p=0.011). There was an inverse relation between the urinary excretion of magnesium during pregnancy and the diastolic blood pressure (p=0.005). CONCLUSIONS: Magnesium supplementation prevented an increase in diastolic blood pressure during the last weeks of pregnancy. The relation between diastolic blood pressure and urinary excretion of magnesium suggests that magnesium is involved in the regulation of blood pressure and that the increase in diastolic blood pressure in pregnancy could be due to a lack of magnesium.
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| 14. |
- Bullarbo, Maria, 1958
(författare)
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Nitric oxide donors in labor management
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- ABSTRACT Nitric oxide donors in labor management Maria Bullarbo Department of Obstetrics and Gynecology Institute of Clinical Sciences Background: Nitric oxide (NO), a free radical with ultra-short half-life synthesized from L- arginine by the enzyme nitric oxide synthase (NOS), is in the human involved in many physiological and pathophysiological processes, including different reproductive processes. During pregnancy NO is produced endogenously in the human uterine cervix and placenta. Different effects of NO can be studied by administering NO donors. Aims and methods: The aims of the thesis were to perform experimental and clinical studies on late pregnant women to examine the effects of NO donors on cervical ripening and labor induction and to evaluate possible effects of NO on the management of retained placenta. In Paper I the effects of the NO donor isosorbide mononitrate (IMN) administered vaginally were examined by measuring cervical distensibility using a cervical tonometer. In addition, maternal and fetal side effects of the medication were evaluated. In Paper II the efficiency of vaginally adminstered IMN to induce cervical ripening and labor induction in an outpatient setting was examined. The safety and side effects of this treatment were also evaluated. In Paper III cervical biopsies were obtained prior to elective caesarean section following vaginal administration of IMN. Western blotting was used for semiquantitative measurements of cyclooxygenase-1 and -2 (COX-1 and COX-2), enzymes involved in prostaglandin synthesis as well as cervical ripening. Immunohistochemistry was used for localizing these enzymes within the cervical tissue. Paper IV describes the efficiency of sequential treatment with oxytocin and nitroglycerin for management of retained placenta. Results: Treatment with IMN resulted in a significantly increased cervical distensibility. Headache and palpitations of little to moderate intensity were common maternal side effects. A significant decrease in maternal blood pressure and increase in pulse rate were registered. However, the effects were modest and not of clinical importance. No fetal side effects were observed according to CTG, Doppler ultrasound, Apgar score and umbilical pH. Vaginally administered IMN seemed to be effective in promoting labor induction within 24 hours (22 patients compared to 8 in the placebo group). There were no differences in fetal side effects and the rate of caesarean section between women treated with IMN and women in the placebo group. Semiquantitative measurements by immunoblotting revealed increased expression of COX-2, but not of COX-1 in the NO donor group compared to placebo group. Immunohistchemistry showed similar localizations of COX-1 and COX-2 in the two groups. Sublingually administered nitroglycerin in combination with oxytocin resulted in successfully delivered placenta among all 12 women compared to only 1 woman in the control group. Maternal hemodynamic effects were mild to moderate. Blood loss was increased in women who needed manual removal of placenta. Conclusion: The data suggest that IMN administered vaginally at term and postterm for cervical ripening and labor induction seems to be effective and safe. Combined treatment with oxytocin and nitroglycerin seems to promote detachment of retained placenta. Key Words: cervical ripening, labor induction, nitric oxide donor, retained placenta.
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| 15. |
- Bullarbo, Maria, 1958, et al.
(författare)
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Nitroglycerin for management of retained placenta: a multicenter study.
- 2012
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Ingår i: Obstetrics and gynecology international. - : Hindawi Limited. - 1687-9597 .- 1687-9589. ; 2012
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim was to determine if sequential administration of oxytocin and nitroglycerin is effective for management of retained placenta when performed by obstetricians with no experience of the method. Secondary aims were to examine possible adverse effects of nitroglycerin. One hundred and five women with retained placenta were randomly selected to receive either 1mg nitroglycerin or placebo tablets sublingually if intravenous oxytocin had failed to expel the placenta. At two of the hospitals some of the midwives were familiar with the use of nitroglycerin. The other midwives and all the participating obstetricians had no clinical experience of the method. In the treatment group, detachment of placenta following nitroglycerin occurred in 37.3% of the women compared to 20.4% in the placebo group (P = 0.056). In the two hospitals with some experience of the method, placenta was removed in 9 of 19 (47.4%) women in the nitroglycerin group compared to 3 of 17 (15.0%) women in the placebo group. No adverse effects of clinical importance were registered. Although the difference between the two groups did not reach statistical significance, the higher success rate in the two hospitals with some experience could indicate that clinical experience is of importance in order to achieve placental detachment.
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| 16. |
- Bullarbo, Maria, 1958, et al.
(författare)
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Outpatient vaginal administration of the nitric oxide donor isosorbide mononitrate for cervical ripening and labor induction postterm: a randomized controlled study
- 2007
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Ingår i: Am J Obstet Gynecol. ; 196:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Our aim was to examine the efficacy, safety, and acceptability of isosorbide mononitrate for cervical ripening and labor induction in women in an outpatient setting. STUDY DESIGN: Two hundred pregnant women of at least 42 weeks' gestation with an unripe cervix were randomly selected to receive vaginally either 40 mg isosorbide mononitrate or placebo tablets. RESULTS: Twenty-two women treated with isosorbide mononitrate went into labor within 24 hours compared to 8 women in the placebo group (P < .05). In women who did not go into labor, cervical status was similar in the 2 groups the next day. Headache was a common side effect. No maternal or fetal side effects of clinical importance were registered. CONCLUSION: Outpatient cervical ripening and labor induction with isosorbide mononitrate seems to be an effective, safe, and well tolerated procedure. The definitive clinical efficacy and safety needs to be evaluated in larger series of patients.
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| 17. |
- Bullarbo, Maria, 1958, et al.
(författare)
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Sublingual nitroglycerin for management of retained placenta
- 2005
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Ingår i: Int J Gynaecol Obstet. ; 91:3, s. 228-32
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of the study was to investigate the effect of sublingual nitroglycerin for management of retained placenta and to assess possible adverse effects of the treatment. METHOD: Twenty-four women were randomly selected to receive either 1 mg nitroglycerin or placebo tablets sublingually if intravenous oxytocin and controlled umbilical cord traction had failed to expel the placenta. Success rate for delivery of placenta, blood pressure, pulse rate, blood loss, and various side effects were examined. RESULT: All 12 women in the nitroglycerin group had successful delivery of placenta, while removal of placenta was successful in only one of the 12 women in the placebo group. No adverse effects of clinical importance were registered. CONCLUSION: Sublingual nitroglycerin for treatment of retained placenta seems to be effective without causing serious adverse effects. However, the definite clinical value needs to be evaluated in larger series of patients.
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| 18. |
- Bärebring, Linnea, et al.
(författare)
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Preeclampsia and Blood Pressure Trajectory during Pregnancy in Relation to Vitamin D Status
- 2016
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 11:3
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Tidskriftsartikel (refereegranskat)abstract
- Every tenth pregnancy is affected by hypertension, one of the most common complications and leading causes of maternal death worldwide. Hypertensive disorders in pregnancy include pregnancy-induced hypertension and preeclampsia. The pathophysiology of the development of hypertension in pregnancy is unknown, but studies suggest an association with vitamin D status, measured as 25-hydroxyvitamin D (25(OH) D). The aim of this study was to investigate the association between gestational 25(OH) D concentration and preeclampsia, pregnancy-induced hypertension and blood pressure trajectory. This cohort study included 2000 women. Blood was collected at the first (T1) and third (T3) trimester (mean gestational weeks 10.8 and 33.4). Blood pressure at gestational weeks 10, 25, 32 and 37 as well as symptoms of preeclampsia and pregnancy-induced hypertension were retrieved from medical records. Serum 25(OH) D concentrations (LC-MS/MS) in T1 was not significantly associated with preeclampsia. However, both 25(OH) D in T3 and change in 25 (OH) D from T1 to T3 were significantly and negatively associated with preeclampsia. Women with a change in 25(OH) D concentration of >= 30 nmol/L had an odds ratio of 0.22 (p = 0.002) for preeclampsia. T1 25(OH) D was positively related to T1 systolic (beta = 0.03, p = 0.022) and T1 diastolic blood pressure (beta = 0.02, p = 0.016), and to systolic (beta = 0.02, p = 0.02) blood pressure trajectory during pregnancy, in adjusted analyses. There was no association between 25(OH) D and pregnancy-induced hypertension in adjusted analysis. In conclusion, an increase in 25(OH) D concentration during pregnancy of at least 30 nmol/L, regardless of vitamin D status in T1, was associated with a lower odds ratio for preeclampsia. Vitamin D status was significantly and positively associated with T1 blood pressure and gestational systolic blood pressure trajectory but not with pregnancy-induced hypertension.
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| 19. |
- Bärebring, Linnea, et al.
(författare)
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Trajectory of vitamin D status during pregnancy in relation to neonatal birth size and fetal survival: a prospective cohort study
- 2018
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: We investigated the associations between vitamin D status in early and late pregnancy with neonatal small for gestational age (SGA), low birth weight (LBW) and preterm delivery. Furthermore, associations between vitamin D status and pregnancy loss were studied. Methods: Serum 25-hydroxyvitamin D (25OHD) was sampled in gestational week <= 16 (trimester 1 (T1), N = 2046) and > 31 (trimester 3 (T3), N = 1816) and analysed using liquid chromatography tandem mass spectrometry. Pregnant women were recruited at antenatal clinics in south-west Sweden at latitude 57-58 degrees N. Gestational and neonatal data were retrieved from medical records. Multiple gestations and terminated pregnancies were excluded from the analyses. SGA was defined as weight and/or length at birth < 2 SD of the population mean and LBW as < 2500 g. Preterm delivery was defined as delivery < 37 + 0 gestational weeks and pregnancy loss as spontaneous abortion or intrauterine fetal death. Associations between neonatal outcomes and 25OHD at T1, T3 and change in 25OHD (T3-T1) were studied using logistic regression. Results: T1 25OHD was negatively associated with pregnancy loss and 1 nmol/L increase in 25OHD was associated with 1% lower odds of pregnancy loss (OR 0.99, p = 0.046). T3 25OHD >= 100 nmol/L (equal to 40 ng/ml) was associated with lower odds of SGA (OR 0.3, p = 0.031) and LBW (OR 0.2, p = 0.046), compared to vitamin D deficiency (25OHD < 30 nmol/L, or 12 ng/ml). Women with a >= 30 nmol/L increment in 25OHD from T1 to T3 had the lowest odds of SGA, LBW and preterm delivery. Conclusions: Vitamin D deficiency in late pregnancy was associated with higher odds of SGA and LBW. Lower 25OHD in early pregnancy was only associated with pregnancy loss. Vitamin D status trajectory from early to late pregnancy was inversely associated with SGA, LBW and preterm delivery with the lowest odds among women with the highest increment in 25OHD. Thus, both higher vitamin D status in late pregnancy and gestational vitamin D status trajectory can be suspected to play a role in healthy pregnancy.
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| 20. |
- Bärebring, Linnea, et al.
(författare)
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Vitamin D Status during Pregnancy in a Multi-Ethnic Population-Representative Swedish Cohort.
- 2016
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 8:10
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Tidskriftsartikel (refereegranskat)abstract
- There is currently little information on changes in vitamin D status during pregnancy and its predictors. The aim was to study the determinants of change in vitamin D status during pregnancy and of vitamin D deficiency (<30 nmol/L) in early pregnancy. Blood was drawn in the first (T1) and third trimester (T3). Serum 25-hydroxyvitamin D (25(OH)D) (N = 1985) was analysed by liquid chromatography tandem-mass spectrometry. Season-corrected 25(OH)D was calculated by fitting cosine functions to the data. Mean (standard deviation) 25(OH)D was 64.5(24.5) nmol/L at T1 and 74.6(34.4) at T3. Mean age was 31.3(4.9) years, mean body mass index (BMI) was 24.5(4.2) kg/m² and 74% of the women were born in Sweden. Vitamin D deficiency was common among women born in Africa (51%) and Asia (46%) and prevalent in 10% of the whole cohort. Determinants of vitamin D deficiency at T1 were of non-North European origin, and had less sun exposure, lower vitamin D intake and lower age. Season-corrected 25(OH)D increased by 11(23) nmol/L from T1 to T3. The determinants of season-corrected change in 25(OH)D were origin, sun-seeking behaviour, clothing style, dietary vitamin D intake, vitamin D supplementation and recent travel <35° N. In conclusion, season-corrected 25(OH)D concentration increased during pregnancy and depended partly on lifestyle factors. The overall prevalence of vitamin D deficiency was low but common among women born in Africa and Asia. Among them, the determinants of both vitamin D deficiency and change in season-corrected vitamin D status were fewer, indicating a smaller effect of sun exposure.
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| 21. |
- Ekerhovd, Erling, et al.
(författare)
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Sublingual nitroglycerin seems to be effective in the management of retained placenta
- 2008
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 87:2, s. 222-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A common approach in the management of retained placenta is administration of oxytocin followed by controlled cord traction. Previously it has also been demonstrated that intravenously administered nitroglycerin facilitates manual extraction of retained placenta. The purpose of the present trial was to examine the success rate and safety of sequential administration of intravenous oxytocin in combination with sublingual nitroglycerin for the delivery of retained placenta. METHODS: The report is a chart review of 24 women with retained placenta despite intravenously administered oxytocin. The women were given sublingual nitroglycerin (1 mg) to promote detachment of the placenta. Some 5 min after resorption of the tablets, controlled cord traction was carried out for a maximum of 5 min. In addition, changes in blood pressure following treatment with nitroglycerin and total blood loss during delivery were registered. RESULTS: Twenty-one of the women delivered the placenta successfully following sublingual administration of nitroglycerin. The procedure failed in 3 women and operative manual removal under regional or general anesthesia was undertaken. No complications due to nitroglycerin were registered. CONCLUSIONS: Sequential administration of oxytocin and nitroglycerin seems to be an effective and safe procedure in the management of retained placenta. However, larger studies are needed to confirm the encouraging results of the present trial.
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| 22. |
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| 23. |
- Elden, Helen, 1959, et al.
(författare)
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Study protocol of SWEPIS a Swedish multicentre register based randomised controlled trial to compare induction of labour at 41 completed gestational weeks versus expectant management and induction at 42 completed gestational weeks
- 2016
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Ingår i: Bmc Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 16:49
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Tidskriftsartikel (refereegranskat)abstract
- Background: Observational data shows that postterm pregnancy (>= 42 gestational weeks, GW) and late term pregnancy (>= 41 GW), as compared to term pregnancy, is associated with an increased risk for adverse outcome for the mother and infant. Standard care in many countries is induction of labour at 42 GW. There is insufficient scientific support that induction of labour at 41 GW, as compared with expectant management and induction at 42 GW will reduce perinatal mortality and morbidity without an increase in operative deliveries, negative delivery experiences or higher costs. Large randomised studies are needed since important outcomes; such as perinatal mortality and hypoxic ischaemic encephalopathy are rare events. Methods/Design: A total of 10 038 healthy women >= 18 years old with a normal live singleton pregnancy in cephalic presentation at 41 GW estimated with a first or second trimester ultrasound, who is able to understand oral and written information will be randomised to labour induction at 41 GW (early induction) or expectant management and induction at 42 GW (late induction). Women will be recruited at university clinics and county hospitals in Sweden comprising more than 65 000 deliveries per year. Primary outcome will be a composite of stillbirth, neonatal mortality and severe neonatal morbidity. Secondary outcomes will be other adverse neonatal and maternal outcomes, mode of delivery, women's experience, cost effectiveness and infant morbidity up to 3 months of age. Data on background variables, obstetric and neonatal outcomes will be obtained from the Swedish Pregnancy Register and the Swedish Neonatal Quality Register. Data on women's experiences will be collected by questionnaires after randomisation and 3 months after delivery. Primary analysis will be intention to treat. The statistician will be blinded to group and intervention. Discussion: It is important to investigate if an intervention at 41 GW is superior to standard care in order to reduce death and lifelong disability for the children. The pregnant population, >41 GW, constitutes 15-20 % of all pregnancies and the results of the study will thus have a great impact. The use of registries for randomisation and collection of outcome data represents a unique and new study design.
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| 24. |
- Nestler, A., et al.
(författare)
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Blood pressure in pregnancy and magnesium sensitive genes
- 2014
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Ingår i: Pregnancy Hypertension. - : Elsevier BV. - 2210-7789. ; 4:1, s. 41-45
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Tidskriftsartikel (refereegranskat)abstract
- Objectives High blood pressure during the last part of pregnancy is a risk indicator of pre-eclampsia and eclampsia which augment infant and maternal morbidity and mortality. Magnesium deficiency has been related to the risk of hypertension. A study was performed to assess the relation between pregnancy induced hypertension, excretion of urinary magnesium and expression of magnesium sensitive genes (MgSG). Methods A cohort of healthy, nulliparous women with singleton pregnancies was recruited. Blood pressure was recorded throughout pregnancy. Urinary magnesium excretion and expression of MgSGs in leukocytes were determined. Results The expression of the gene TRPM6 was higher among pregnant women compared to non-pregnant controls at week 12. All other genes had lower expressions in pregnant women. At week 37 the expressions of all genes were lower than at week 12. The expressions of SLC41A1, SLC41A3, and TRPM7 were related to the systolic and diastolic blood pressures. Furthermore, the expression of TRPM6 was related to the urinary excretion of magnesium and the change in diastolic blood pressure weeks 12-37 was inversely related to the change in magnesium excretion. Conclusions Systolic and diastolic blood pressure and the excretion of magnesium during pregnancy were related to the expression of different MgSGs. The results suggest that magnesium is involved in the regulation of blood pressure during pregnancy . © 2013 International Society for the Study of Hypertension in Pregnancy Published by Elsevier B.V. All rights reserved.
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| 25. |
- Norström, Anders, et al.
(författare)
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Mast cell involvement in human cervical ripening
- 2019
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Ingår i: European Journal of Obstetrics & Gynecology and Reproductive Biology. - : Elsevier BV. - 0301-2115. ; 238, s. 157-163
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Cervical ripening resembles an inflammatory process in many aspects, involving invasion of inflammatory cells, collagen breakdown and remodelling of the extracellular matrix. Mast cells produce a variety of inflammatory agents and are attributed a functional role in cervical ripening. The aim of this study was to examine if cervical mast cells are increased in number and stimulated during pregnancy. Study design: Cervical biopsies were obtained with a biopsy needle prior to surgical termination of pregnancy in the first trimester, surgery for first-trimester miscarriage, elective caesarean section, and benign gynaecological surgery in non-pregnant women. After fixation, semithin sections were prepared and stained with toluidine blue. The number of mast cells was counted under a light microscope and their secretory activity was scored (0.5-4) according to specified criteria and further visualised with electron microscopy. For pairwise comparison between groups Fisher's nonparametric permutation test was used. Results: The number of mast cells was increased from 3.4 +/- 1.65 mast cells per 10 visual fields in nonpregnant women to 7.70 +/- 0.35 per 10 visual fields in first trimester control women (p < 0.05). The highest number of mast cells was observed at term with 10.8 +/- 2.1 per 10 visual fields, a number that was significantly higher than in first trimester control women (p < 0.05). At term mast cell activity scores were 3.39 +/- 0.37 compared with 2.69 +/- 0.27 in control first trimester women and 2.21 +/- 0.86 in women with missed miscarriage (p < 0.05). The percentage of mast cells with activity score 4 was significantly higher at term compared with in the first trimester. Free mast cell granules were predominantly observed in areas with disorganized collagen fibres. Conclusion: The findings confirm that an increased influx of mast cells to the cervix occurs during pregnancy. The stimulated mast cell secretory activity in conditions associated with cervical tissue remodelling, such as term pregnancy and symptomatic miscarriage, provides further evidence that mast cells play a physiological role in cervical ripening. (C) 2019 Elsevier B.V. All rights reserved.
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