| 1. |
- Eisenberg, Tobias, et al.
(författare)
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Cardioprotection and lifespan extension by the natural polyamine spermidine
- 2016
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Ingår i: Nature Medicine. - : Springer Science and Business Media LLC. - 1078-8956 .- 1546-170X. ; 22:12, s. 1428-1438
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Tidskriftsartikel (refereegranskat)abstract
- Aging is associated with an increased risk of cardiovascular disease and death. Here we show that oral supplementation of the natural polyamine spermidine extends the lifespan of mice and exerts cardioprotective effects, reducing cardiac hypertrophy and preserving diastolic function in old mice. Spermidine feeding enhanced cardiac autophagy, mitophagy and mitochondrial respiration, and it also improved the mechano-elastical properties of cardiomyocytes in vivo, coinciding with increased titin phosphorylation and suppressed subclinical inflammation. Spermidine feeding failed to provide cardioprotection in mice that lack the autophagy-related protein Atg5 in cardiomyocytes. In Dahl salt-sensitive rats that were fed a high-salt diet, a model for hypertension-induced congestive heart failure, spermidine feeding reduced systemic blood pressure, increased titin phosphorylation and prevented cardiac hypertrophy and a decline in diastolic function, thus delaying the progression to heart failure. In humans, high levels of dietary spermidine, as assessed from food questionnaires, correlated with reduced blood pressure and a lower incidence of cardiovascular disease. Our results suggest a new and feasible strategy for protection against cardiovascular disease.
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| 2. |
- Agardh, Elisabet, et al.
(författare)
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Fetal growth is not associated with early onset of severe retinopathy in type 1 diabetes mellitus
- 2000
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Ingår i: Diabetes Research and Clinical Practice. - 1872-8227. ; 48:1, s. 61-65
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Tidskriftsartikel (refereegranskat)abstract
- Reduced fetal growth has been suggested as a possible risk factor for diabetic nephropathy. The aim of the present study was to examine whether there could be an association also with rapidly progressing severe retinopathy in younger type 1 diabetic patients. Maternal pregnancy, as well as birth parameters of 27 type 1 diabetic patients with severe retinopathy diagnosis at a median age of 25 years, were studied retrospectively. The control group consisted of 22 type 1 diabetic patients with mild background retinopathy and with similar age, age at onset, and duration of diabetes. Mothers of the subjects with severe retinopathy had a higher body mass index (P = 0.03) but similar age, blood pressure levels, and weight gain during pregnancy as those of the control group. All but four babies, two in each group, were born after 37 completed gestational weeks. There were no differences regarding birth weight or of relative birth weight corrected for gestational length. Head circumference, birth length, and placenta weight were similar. The results indicate that fetal growth is not a factor of major importance for the development of severe retinopathy in younger type 1 diabetic patients.
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| 3. |
- Alhadad, Alaa, et al.
(författare)
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Iliocaval vein stenting: Long term survey of postthrombotic symptoms and working capacity.
- 2011
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Ingår i: Journal of Thrombosis and Thrombolysis. - : Springer Science and Business Media LLC. - 1573-742X .- 0929-5305. ; 31, s. 211-216
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Tidskriftsartikel (refereegranskat)abstract
- To evaluate the long term effect on lower extremity function and working capacity after stenting of iliocaval vein segments for acute deep venous thrombosis (DVT) or chronic venous occlusive disease. During a 14 year period from November 1994 to October 2008, 114 patients with median age 36 (interquartile range [IQR], 27-48) years, 72 (63%) women, 72 (63%) with hypercoagulable disorders, with acute DVT (n = 44, 39%), or chronic occlusions (n = 70, 61%) in the iliocaval vein segment were treated with venous stent placement after catheter-directed thrombolysis, angioplasty or recanalization. The long term impact on lower extremity function and working capacity was evaluated through retrospective evaluation of a prospectively registered database in combination with a questionnaire sent to all 108 surviving patients. The questionnaire was returned by 91/108(84%) patients, 37 (86%) with acute DVT, and 54(83%) with chronic venous occlusions. After a median follow-up of 6.2 (IQR 3.8-10.5) years, 38 (42%) patients were without anticoagulation therapy. Among patients with acute DVT 29 (78%) reported no lower extremity pain, 31 (84%) reported no ulcerations, and 26 (70%) were without lower extremity swelling, and 33(89%) without pelvic or genital pain. In summary, 22 (59%) were free from any symptomatic postthrombotic symptoms (PTS). Among patients with chronic occlusions, corresponding figures were 22 (41%), 45 (80%), 13 (24%), 39 (72%), and 7 (13%). Among patients treated for acute DVT 27 (73%) were working full- or part time, and 2 (5%) were above retirement age. Corresponding figures among patients treated for chronic venous occlusions were 31 (57%), and 10 (19%). Stenting of iliocaval vein segments with or without catheter-directed thrombolysis is a promising treatment of both acute thrombosis and chronic iliocaval vein occlusion that requires further study in comparison to non-interventional treatment concerning long time effects on postthrombotic symptoms and working capacity.
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| 4. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Brain-specific NSE and S-100 proteins in umbilical blood after normal delivery
- 2001
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Ingår i: Clinica Chimica Acta. - 0009-8981. ; 304:1-2, s. 57-63
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To determine normal blood levels of brain-specific proteins S-100 and neuron specific enolase (NSE) in healthy newborns and their mothers following uncomplicated birth. METHODS: Umbilical artery and vein blood and maternal venous blood was collected at 112 consecutive uncomplicated deliveries. Venous blood samples were taken from 18 of the neonates 3 days after birth. S-100 and NSE were analyzed quantitatively by double antibody immunoluminometric assay (Sangtec Medical AB, Sweden). RESULTS: Compared with adults, healthy neonates had higher levels of both S-100 and NSE. For S-100, median levels (range) were 1.10 microg/l (0.38-5.50 microg/l and 0.98 microg/l (0.43-2.70 microg/l) in umbilical artery and vein, respectively. For NSE, median levels (range) in umbilical artery blood and vein were 27 microg/l (10-140 microg/l) and 10.75 microg/l (8.80->/=200 microg/l) respectively. The maternal venous blood levels of both S-100 and NSE were significantly lower than in their infants. At 3 days of life, neonatal venous levels of the proteins were still high: S-100, 0.48-9.70 microg/l; NSE, 17->/=200 microg/l. In contrast to adults, haemolysis affected the S-100 levels in umbilical blood significantly. CONCLUSION: Concentrations of both S-100 and NSE in blood are greater in newborns after normal birth than in healthy adults. The higher levels in umbilical artery blood than in umbilical vein blood are consistent with a fetal origin of these proteins. High levels in venous blood at 3 days of life suggest that the high levels at birth are not related to the birth process but reflect a high activity of these proteins during fetal development.
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| 5. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial
- 2001
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Ingår i: The Lancet. - 1474-547X. ; 358:9281, s. 534-538
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies indicate that analysis of the ST waveform of the fetal electrocardiogram provides information on the fetal response to hypoxia. We did a multicentre randomised controlled trial to test the hypothesis that intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis results in an improved perinatal outcome compared with cardiotocography alone. METHODS: At three Swedish labour wards, 4966 women with term fetuses in the cephalic presentation entered the trial during labour after a clinical decision had been made to apply a fetal scalp electrode for internal cardiotocography. They were randomly assigned monitoring with cardiotocography plus ST analysis (CTG+ST group) or cardiotocography only (CTG group). The main outcome measure was rate of umbilical-artery metabolic acidosis (pH <7.05 and base deficit >12 mmol/L). Secondary outcomes included operative delivery for fetal distress. Results were first analysed according to intention to treat, and secondly after exclusion of cases with severe malformations or with inadequate monitoring. FINDINGS: The CTG+ST group showed significantly lower rates of umbilical-artery metabolic acidosis than the cardiotocography group (15 of 2159 [0.7%] vs 31 of 2079 [2%], relative risk 0.47 [95% CI 0.25-0.86], p=0.02) and of operative delivery for fetal distress (193 of 2519 [8%] vs 227 of 2447 [9%], 0.83 [0.69-0.99], p=0.047) when all cases were included according to intention to treat. The differences were more pronounced after exclusion of 291 in the CTG+ST group and 283 in the CTG group with malformations or inadequate recording. INTERPRETATION: Intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis increases the ability of obstetricians to identify fetal hypoxia and to intervene more appropriately, resulting in an improved perinatal outcome.
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| 6. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Fetal heart-rate monitoring - Reply
- 2002
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Ingår i: The Lancet. - 1474-547X. ; 359:9302, s. 261-262
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 7. |
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| 8. |
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| 9. |
- Amini, Mahdi, et al.
(författare)
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Sublingual misoprostol vs. oral misoprostol solution for induction of labor : A retrospective study
- 2022
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Ingår i: Frontiers in surgery. - : Frontiers Media SA. - 2296-875X. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Induction of labor (IOL) is one of the most common obstetrical procedures, with an increasing rate. The prostaglandin E1 analogue misoprostol is frequently used as a primary method of labor induction. The optimal dose and route of administration is yet to be ascertained. Aim: To compare efficiacy and safety between a regimen of sublingually administered misoprostol and a regimen of orally administered misoprostol, with cesarean delivery as primary outcome. Methods: A retrospective study was conducted including women carrying a live, singleton fetus in a cephalic position with labor induced at >37 + 0 gestational weeks at Skåne University hospital, Lund, between January 1st 2013 to December 31st 2017. Data was obtained from computerized obstetrical charts. Results: Totally 2,404 women were included; 974 induced with sublingual misoprostol and 1,430 with oral solution. In primiparous women the cesarean delivery rate was lower in primiparous women induced with oral compared to sublingual misoprostol (20.5% vs. 28.6%, p < 0.001), whereas in parous women the rates did not differ significantly 4.9% vs. 7.5%; NS). The increased risk of caesarean remained after controlling for potential confounding factors (adjusted odds ratio 1.49 (1.14–1.95). Women induced with sublingual misoprostol had a shorter time to vaginal delivery when compared to oral solution (primiparous median 16.7 h vs. 21.7 h; p < 0.001, parous median 9.9 h vs. 13.3 h; p = 0.01), and a higher rate of vaginal delivery within 24 h (primiparas 77.7% vs. 63.3%, p < 0.001, parous 93.2% vs. 84.2%; p = 0.01). Conclusion: IOL with oral misoprostol solution was associated with a significantly higher vaginal delivery rate when compared to sublingual misoprostol, whereas sublingual misoprostol was associated with a significantly shorter time from induction to vaginal delivery. Oral administration is considered the most safe and efficient administration of misoprostol, although more studies are needed to find the optimal route and dosage of misoprostol for IOL.
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| 10. |
- Andersgaard, Alice Beathe, et al.
(författare)
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Eclampsia in Scandinavia: incidence, substandard care, and potentially preventable cases
- 2006
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 85:8, s. 929-936
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Tidskriftsartikel (refereegranskat)abstract
- Background. Description of incidence, clinical signs, symptoms, and consequences of eclampsia in Scandinavia, and assessment of substandard care and potential preventability. Methods. A descriptive cohort study including all women giving birth in a 2-year period (mid-1998-mid-2000) in Scandinavia. Notifications of eclampsia cases were obtained from all obstetric units at 3-monthly intervals. All patient files were reviewed, and systematic audit was performed to identify potentially preventable cases by using predefined criteria. Main outcome measures. Signs and symptoms preceding the eclamptic seizure, the standard of medical care, maternal and perinatal morbidity, and mortality were all recorded. Potentially preventable cases through improved care and cases eligible for primary prophylactic magnesium sulfate (MgSO4) were estimated. Results. The incidence of eclampsia was 5.0/10 000 maternities (CI = 4.3-5.7/ 10 000). Eighty-six percent had a diagnosis of pre-eclampsia before the seizure. Nine of 10 had at least one physical complaint before the first seizure, severe headache being the most common symptom, occurring in two-thirds. Most seizures (90%) occurred after admission to hospital. By audit, 89 cases (42%) were classified as having received substandard care. Prophylactic use of magnesium sulfate might have reduced the number of eclampsia cases by 35 (17%). Conclusions. Eclampsia occurred mainly in hospital and the majority of women had symptoms heralding the seizure. In retrospect, nearly half of the cases were found potentially preventable by timely intervention, improved medical care, and systematic use of prophylactic treatment with MgSO4.
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| 11. |
- Andersgaard, Alice Beathe, et al.
(författare)
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Follow-Up Interviews after Eclampsia
- 2008
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Ingår i: Gynecologic and Obstetric Investigation. - : S. Karger AG. - 1423-002X .- 0378-7346. ; 67:1, s. 49-52
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: The aim of the study was to assess the prevalence of persisting symptoms 6 months or more after eclampsia. Methods: During a 2-year period (mid-1998 to mid-2000), 210 patients with eclampsia were included in a prospective cohort study of eclampsia in Denmark, Norway and Sweden. One hundred and twenty-three women (59%) were followed up with a structured telephone interview, 6-24 months (median 11) after their eclamptic fit. Results: At the time of follow-up, 63 women (51%) had at least one persistent symptom; 2 patients had severe neurological sequels (hemiparesis and dysarthria), 11% had visual disturbances, 22% had problems concentrating or recalling phone numbers and messages, 18% reported frequent headaches and 10% had vertigo or balance problems. Conclusion: Although few women suffered from severe sequels, many women had persisting symptoms following eclampsia indicating a need for follow-up of these patients. A case-control study comparing the health and symptoms between women having suffered from eclampsia and women without this complication may therefore be justified. Copyright (C) 2008 S. Karger AG, Basel
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| 12. |
- Duan, Rui-Dong, et al.
(författare)
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Human meconium contains significant amounts of alkaline sphingomyelinase, neutral ceramidase, and sphingolipid metabolites.
- 2007
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Ingår i: Pediatric Research. - : Springer Science and Business Media LLC. - 1530-0447 .- 0031-3998. ; 61:1, s. 61-66
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Tidskriftsartikel (refereegranskat)abstract
- Intestinal alkaline sphingomyelinase (Alk-SMase) and neutral ceramidase may catalyze the hydrolysis of endogenous sphin-gomyelin (SM) and milk SM in human-milk fed infants. The enzymes generate sphingolipid metabolites that may influence gut maturation. Alk-SMase also inactivates platelet-activating factor (PAF) that is involved in the pathogenesis of necrotizing enterocolitis (NEC). We examined whether the two enzymes are expressed in both preterm and term infants and analyzed Alk-SMase, neutral ceramidase, SM, and sphingolipid metabolites in meconium. Meconium was collected from 46 preterm (gestational ages 23-36 wk) and 38 term infants (gestational ages 37-42 wk) and analyzed for Alk-SMase using C-14-choline-labeled SM and for neutral ceramidase using C-14-octanoyl-sphingosine as substrates. Molecular species of SM, ceramide, and sphingosine were analyzed by high-performance liquid chromatography mass spectroscopy. Meconium contained significant levels of Alk-SMase and ceramidase at all gestational ages. It also contained 16-24 carbon molecular species of SM, palmitoyl-and stearoyl-sphingosine, and sphingosine. There were positive correlations between levels of SM and ceramide and between ceramide and sphingosine levels. In conclusion, Alk-SMase and ceramidase are expressed in the gut of both preterm and term newborn infants and may generate bioactive sphingolipid messengers.
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| 13. |
- Echternach, Matthias, et al.
(författare)
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Laryngeal evidence for the first and second passaggio in professionally trained sopranos
- 2017
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Ingår i: PLOS ONE. - : Public Library Science. - 1932-6203. ; 12:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Due to a lack of empirical data, the current understanding of the laryngeal mechanics in the passaggio regions (i.e., the fundamental frequency ranges where vocal registration events usually occur) of the female singing voice is still limited. Material and methods In this study the first and second passaggio regions of 10 professionally trained female classical soprano singers were analyzed. The sopranos performed pitch glides from A3 (f(o) = 220 Hz) to A4 (f(o) = 440 Hz) and from A4 (f(o) = 440 Hz) to A5 (f(o) = 880 Hz) on the vowel [i:]. Vocal fold vibration was assessed with trans-nasal high speed videoendoscopy at 20,000 fps, complemented by simultaneous electroglottographic (EGG) and acoustic recordings. Register breaks were perceptually rated by 12 voice experts. Voice stability was documented with the EGG-based sample entropy. Glottal opening and closing patterns during the passaggi were analyzed, supplemented with open quotient data extracted from the glottal area waveform. Results In both the first and the second passaggio, variations of vocal fold vibration patterns were found. Four distinct patterns emerged: smooth transitions with either increasing or decreasing durations of glottal closure, abrupt register transitions, and intermediate loss of vocal fold contact. Audible register transitions (in both the first and second passaggi) generally coincided with higher sample entropy values and higher open quotient variance through the respective passaggi. Conclusions Noteworthy vocal fold oscillatory registration events occur in both the first and the second passaggio even in professional sopranos. The respective transitions are hypothesized to be caused by either (a) a change of laryngeal biomechanical properties; or by (b) vocal tract resonance effects, constituting level 2 source-filter interactions.
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| 14. |
- Ekengård, Frida, et al.
(författare)
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CTG interpretation templates affect residents’ decision making
- 2023
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Ingår i: European Journal of Obstetrics and Gynecology and Reproductive Biology. - 0301-2115. ; 285, s. 148-152
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study whether a revision of CTG guidelines and educational program influenced the perceived need for intervention by residents in obstetrics and gynecology. A secondary aim was to study the sensitivity and specificity of the classification pathological after classification by residents using two different guidelines in identifying neonates with acidemia. Study design: Cardiotocograms, CTGs, from 223 neonates with acidemia at birth (cord blood pH < 7.05 at vaginal birth or second stage cesarean, or pH < 7.10 at first stage cesarean) were included, as well as 223 CTGs from neonates with cord blood pH ≥ 7.15. Two separate groups of residents, who each were educated in and had clinical experience only from either of the two different guidelines, SWE09 and SWE17, classified the patterns according to the at the time current template and judged whether the patterns indicated an intervention. Sensitivity, specificity, and agreement were calculated. Results: Residents using SWE09 found indication to intervene in a higher proportion of neonates with acidemia (84.8%) than residents using SWE17 (75.8%; p = 0.002), as well as in cases without acidemia (29.6% vs 22.4%; p = 0.038). Among residents using SWE09 the perceived need for intervention had a sensitivity of 85% and a specificity of 70% to identify acidemia. With SWE17 the corresponding rates were 76% and 78%. The sensitivity to identify neonates with acidemia by classification pathological was 91% with SWE09 and 72% with SWE17. The specificity was 53% and 76% respectively. The agreement rate between perception of indication to intervene and classification pathological using the SWE09 was κ 0.73, moderate, and with the SWE17 κ 0.77, moderate. The agreement on subjective perception of necessity to intervene between users of the two templates was weak to moderate, κ 0.60, and on classification pathological weak, κ 0.47. Conclusion: The perceived need for intervention by residents interpreting CTGs was significantly affected by the guidelines in use. The difference in decisions were less pronounced than the difference in classification. The sensitivity for both perceived need for intervention and for classification pathological to identify acidosis was higher with SWE09, and the specificity higher with SWE17, when assessed by the two comparable groups of residents.
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| 15. |
- Ekengård, Frida, et al.
(författare)
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Impaired validity of the new FIGO and Swedish CTG classification templates to identify fetal acidosis in the first stage of labor
- 2022
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Ingår i: Journal of Maternal-Fetal and Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 35:25, s. 4853-4860
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Cardiotocography (CTG) is the main method of intrapartum fetal surveillance. In 2015 a new guideline was introduced by the International Federation of Gynecology and Obstetrics (FIGO), FIGO-15. In Sweden it was adjusted to SWE-17, replacing the previous national template, SWE-09. This study, conducted at one university hospital and one regional hospital in southern Sweden, evaluated the diagnostic validity of these three templates to detect fetal acidosis during the first stage of labor. Material and methods: A total of 73 neonates with pH <7.1 in umbilical cord artery or vein at cesarean delivery during the first stage of labor were identified retrospectively. For each acidotic neonate, three non-acidemic neonates, with a pH ≥7.2 in cord artery and vein, and Apgar scores ≥9 at five and ten minutes, in all 219 neonates, were selected. The CTG tracings before birth in acidemic neonates, and tracings at the same cervical dilatation in the non-acidemic neonates, were independently assessed by three professionals from the obstetric staff, blinded to group and clinical data. Based on their categorizations of the included variables (baseline, variability, accelerations, decelerations and contraction rate), each CTG tracing was systematically classified according to the three templates. The sensitivity and specificity to identify acidemia by the classification pathological were determined for each template. Interobserver agreement in the assessments of tracings as pathological or not was analyzed, using free-marginal Kappa index. Results: The sensitivity for patterns classified as pathological to identify acidemia was similar for FIGO-15 (71%) and SWE-17 (77%, p =.13), and the specificity was 97% for both. SWE-09 had a significantly higher sensitivity (95%, p <.001) albeit with a lower specificity (90%, p <.001) than the other two templates. Among acidemic neonates, the fraction of tracings classified as normal was higher with SWE-17 (9.6%) than with SWE-09 (0%; p =.01) and FIGO-15 (1.4%; p =.06). For tracings from neonates with acidemia, agreement for three independent assessors was strong (κ 0.85) with SWE-09, and weak for FIGO-15 (κ 0.47), and SWE-17 (κ 0.51). For tracings from neonates without acidemia, the agreement was almost perfect for FIGO-15 (κ 0.91), strong withSWE-17 (κ 0.90) and moderate with SWE-09 (κ 0.78). Conclusions: The ability of FIGO-15 and SWE-17 to identify fetal acidosis is considered insufficient. The combination of a high sensitivity and a high specificity makes SWE-09 the most discriminatory template during the first stage of labor.
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| 16. |
- Ekengård, Frida, et al.
(författare)
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Low sensitivity of the new FIGO classification system for electronic fetal monitoring to identify fetal acidosis in the second stage of labor
- 2021
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Ingår i: European Journal of Obstetrics & Gynecology and Reproductive Biology: X. - : Elsevier BV. - 2590-1613. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Objective In 2015, new FIGO guidelines for CTG interpretation were presented (FIGO-15). In 2017, the previous Swedish guidelines (SWE-09) were replaced with guidelines adapted to FIGOs (SWE-17). The performance of these three templates had not been scientifically evaluated before its clinical implementation. The objective of this study was to compare the sensitivity and specificity to detect fetal acidosis at birth using these three templates during the second stage of labor. Study design This case-control study included 295 neonates with cord blood pH < 7.05 and 591 controls with pH ≥ 7.15, born 2012−2017. Tracings from the last 30−80 min of labor were classified independently by three assessors (midwives, residents and obstetricians), blinded to group and outcome. Results The classification pathological using FIGO-15 had a sensitivity of 50 % and specificity of 88 % in detecting fetuses with acidosis. For SWE-17, the sensitivity was 62 % and the specificity 85 %. For SWE-09 the sensitivity was 87 % and the specificity 56 %. By combining suspicious and pathological patterns the sensitivity for FIGO-15 increased to 97 %, and for SWE-17 to 83 %, whereas the specificity decreased to 23 % and 68 % respectively. Conclusions The FIGO classification seemed to be insufficiently discriminative in the second stage of labor; most patterns in acidotic cases were classified as merely suspicious with this template, and the sensitivity of pathological patterns was low at 50 %. Combined pathological and suspicious patterns detected fetal acidosis at a specificity that was too low to be useful (23 %). SWE-09 showed the best ability to detect acidosis with pathological patterns (sensitivity 87 %). SWE-17 reached almost the same sensitivity (83 %) with the combination of suspicious and pathological patterns, and at a higher specificity (68 %).
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| 17. |
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| 18. |
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| 19. |
- Ekengård, Frida, et al.
(författare)
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Sporadic accelerations during labor strongly indicate normal pH, whereas periodic accelerations do not: a case-control study
- 2023
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 36:1
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Tidskriftsartikel (refereegranskat)abstract
- PurposeTo determine the association between the occurrence of sporadic and periodic fetal heart rate accelerations during labor and acidemia at birth.Materials and methodsThis is a case–control study of fetal heart rate patterns from 364 neonates with acidemia at birth (cord blood pH ResultsDuring the first stage, ≥2 sporadic accelerations were present in 16% of cases and 78% of controls; OR for acidemia (compared to 0–1 accelerations) 0.05 (0.02–0.10). In the second stage, the corresponding rates were 13% and 60%, OR 0.09 (0.06–0.14). Isolated periodic accelerations were infrequent. A weak negative association between ≥2 periodic accelerations and acidemia (compared with 0–1 accelerations) was found in the second stage, OR 0.51 (0.30–0.86), but was not significant in the first stage, OR 0.24 (0.04–1.4). Even among fetuses with normal fetal heart rate variability (5–25 beats per minute) the occurrence of less than two sporadic accelerations was associated with an increased risk of acidemia, OR 10.3 (7.2–14.8).ConclusionsSporadic accelerations indicate a very low probability of acidosis but are absent in 40% of fetuses with normal pH during a 30–60 min second-stage recording.
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| 20. |
- Fogelberg, Maria, et al.
(författare)
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Underreporting of complete uterine rupture and uterine dehiscence in women with previous cesarean section
- 2017
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Ingår i: Journal of Maternal-Fetal and Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 30:17, s. 2058-2061
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine the true incidence of complete uterine rupture and uterine dehiscence among women delivered by cesarean section after a previous cesarean section. Methods: Medical records of all women who delivered at University Hospital in Malmö, Sweden, during 2005–2009 (n = 21 420) were retrieved from the electronic patient record system (EPRS). After adjustment for inaccuracies, 716 women who had undergone repeat cesarean section were identified and their operation reports were reviewed. Descriptions of complete uterine rupture or uterine dehiscence in operation reports were compared with diagnoses registered in EPRS with International Classification of Diseases codes version 10 (ICD-10). Sensitivity and specificity of complete uterine rupture registration were calculated. Results: There were 13 women with a registered diagnosis of uterine rupture. After reviewing medical records of women with repeat cesarean section, seven additional cases of complete uterine rupture, 33 cases of uterine dehiscence and 39 cases of extremely thin myometrium were identified. The incidence of complete uterine rupture and uterine dehiscence for women who delivered by repeat cesarean section was 2.8% and 10.1%, respectively. Conclusions: Diagnosis of complete uterine rupture was underreported in the EPRS by 35% and diagnosis of uterine dehiscence was missing in 100% of cases.
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| 21. |
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| 22. |
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| 23. |
- Hallén, Natalie, et al.
(författare)
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Outpatient vs inpatient induction of labor with oral misoprostol : A retrospective study
- 2023
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 102:5, s. 605-611
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Induction of labor is one of the most common obstetrical procedures today, with a successively rising rate. With a limited number of hospital beds, the option of starting induction at home has gained increasing attention. The primary aim of this study was to compare the proportion of women achieving vaginal delivery and the duration of hospital stay before delivery in induction of labor with oral misoprostol starting at home and induction with oral misoprostol at the hospital, in a low-risk population. Material and methods: Women with home induction (n = 282) were individually matched to controls induced at the hospital during the same time period regarding parity, age, body mass index, labor unit and indication for induction. Results: The rates of vaginal birth were similar in outpatients and inpatients (84.8% vs 86.2%; p = 0.5). Time from hospital admission to delivery in the outpatient group was significantly shorter than in the inpatient group (12.8 vs 20.6 h; p < 0.001), as was total hospital stay (2 vs 3 days; p < 0.001). There were no significant differences between the groups in neonatal or maternal outcomes. One patient undergoing outpatient induction had an unplanned home birth. Conclusions: Starting induction at home reduced the time spent in hospital without affecting the vaginal delivery rate. Although underpowered to assess safety, this study did not show any differences in adverse maternal and perinatal outcomes between inpatients and outpatients. Further research is needed to evaluate the safety of outpatient induction of labor with misoprostol.
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| 24. |
- Hellström, Sara, et al.
(författare)
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A follow up on the feasibility after national implementation of magnesium sulfate for neuroprotection prior to preterm birth.
- 2023
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : John Wiley & Sons. - 1600-0412 .- 0001-6349. ; 102:12, s. 1741-1748
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Tidskriftsartikel (refereegranskat)abstract
- The risk for brain injury manifested as cerebral palsy is higher in very preterm born children than in term. Prenatal administration of magnesium sulfate (MgSO4 ) has been shown to be neuroprotective and reduces the proportion of very preterm born children later diagnosed with cerebral palsy. A Swedish national clinical practice guideline was implemented in March 2020, stipulating the administration of a single intravenous dose of 6g MgSO4 1-24h prior to delivery before gestational age 32+0, aiming for 90% treatment coverage. The aim of this study was to evaluate the feasibility of this new clinical practice guideline in the first year of its implementation.Data on MgSO4 treatment were collected by reviewing the medical charts of women who gave birth to live born children in gestational age 22+0-31+6 during the period of March 1, 2020 to February 28, 2021, at five Swedish university hospitals. Women with pre-eclampsia, eclampsia, or high elevated liver enzymes low platelets (HELLP) were excluded.A total of 388 women were eligible and 79% received treatment with MgSO4 . Of the 21% not receiving treatment, 9% did not receive treatment due to lack of knowledge about the clinical practice guideline, 9% were not possible to treat and 3% had missing data. The proportion treated increased from 72% to 87% from the first to the last 3months. Of those treated, 81% received the drug within the stipulated timeframe (mean 8.7h, median 3.4h).There was a positive trend over time in the proportion of women receiving MgSO4 treatment, but the a priori target of 90% was not reached during the first year of implementation. Our findings indicate that this target could be reached with additional information to clinicians.
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| 25. |
- Hemann, Michael T, et al.
(författare)
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Evasion of the p53 tumour surveillance network by tumour-derived MYC mutants.
- 2005
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Ingår i: Nature. - 1476-4687. ; 436:7052, s. 807-11
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Tidskriftsartikel (refereegranskat)abstract
- The c-Myc oncoprotein promotes proliferation and apoptosis, such that mutations that disable apoptotic programmes often cooperate with MYC during tumorigenesis. Here we report that two common mutant MYC alleles derived from human Burkitt's lymphoma uncouple proliferation from apoptosis and, as a result, are more effective than wild-type MYC at promoting B cell lymphomagenesis in mice. Mutant MYC proteins retain their ability to stimulate proliferation and activate p53, but are defective at promoting apoptosis due to a failure to induce the BH3-only protein Bim (a member of the B cell lymphoma 2 (Bcl2) family) and effectively inhibit Bcl2. Disruption of apoptosis through enforced expression of Bcl2, or loss of either Bim or p53 function, enables wild-type MYC to produce lymphomas as efficiently as mutant MYC. These data show how parallel apoptotic pathways act together to suppress MYC-induced transformation, and how mutant MYC proteins, by selectively disabling a p53-independent pathway, enable tumour cells to evade p53 action during lymphomagenesis.
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| 26. |
- Herbst, Andreas
(författare)
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Acidaemia at Birth: Risk factors, diagnosis and prognosis, with special reference to maternal fever in labour
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Acidaemia at birth is a result of an impaired intrauterine gas exchange. Between 1988 and 1996, acid-base balance in cord artery blood pH was assessed in 23 016 of 27 064 newborns (85%). Obstetric risk factors for acidaemia (cord artery pH < 7.05) were identified in a case-control study. Independent risk factors were breech delivery, administration of oxytocin or pethidine, cord entanglement and male gender. In a matched-pair study, factors associated with the development of maternal fever during term labour were identified: epidural analgesia, long interval between rupture of the membranes and delivery, and long latency phase of labour. Maternal fever during term labour was associated with neonatal infectious morbidity, but not with newborn acidaemia. Two regimens for fetal surveillance in low-risk labour were compared in a randomised study; continuous and intermittent electronic fetal monitoring with two-hour intervals. No significant differences were found in rates of detected abnormal fet
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| 27. |
- Herbst, Andreas
(författare)
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Att förebygga förlossningsasfyxi. Kan vi komma längre med fosterövervakning?
- 2000
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Ingår i: Läkartidningen. - 0023-7205. ; 97:32, s. 3484-3488
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Tidskriftsartikel (refereegranskat)abstract
- Intrapartum death has become a rare event since the introduction of electronic fetal monitoring (EFM). Randomized studies of EFM versus intermittent auscultation show that EFM reduces the risk of low Apgar score at birth and of neonatal seizures, although it may be possible to ensure low perinatal mortality even with intermittent auscultation alone. The rate of operative deliveries may increase with EFM, at least if scalp blood sampling is not used. Since scalp blood sampling is an invasive procedure providing only temporary information, the search goes on for new methods as complements to EFM. Fetal pulse oximetry and ST-analysis of fetal ECG (STAN) are two methods currently being tested in clinical studies. Regardless of the efficiency of monitoring methods that we may develop, there will always be a need for competent staff at our labor wards. Ongoing training of staff is necessary if asphyxia is to be avoided as far as possible.
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| 28. |
- Herbst, Andreas, et al.
(författare)
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Diagnosis of early preterm labour.
- 2006
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 113:Suppl 3, s. 60-67
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Tidskriftsartikel (refereegranskat)abstract
- While preterm contractions occur almost as often extremely preterm as they do closer to term, birth due to spontaneous preterm labour before 27 weeks of gestation is rare, accounting for 0.05–0.7% of all births in different populations. Although the likelihood that uterine contractions before 27 weeks of gestation represent true preterm labour is low, the risk of adverse outcome in such cases is high. A correct diagnosis is important, and a useful diagnostic test should have a high sensitivity. In most reports, only 30–40% of women hospitalised for spontaneous preterm labour experience a preterm birth, suggesting a low positive predictive value of clinical diagnosis based on uterine contractions and vaginal examination. Transvaginal ultrasonographic scanning (TVUSS) of cervical length has shown a high sensitivity for preterm birth, 90–100% for preterm birth before 33–35 weeks, using a liberal cutoff at 30 mm. Assessment of cervicovaginal fetal fibronectin (FFN) levels has shown a sensitivity of about 80%. Adding FFN assessment to TVUSS might contribute insignificantly to the prediction of preterm birth. In a retrospective study of 147 women with spontaneous preterm labour and intact membranes before 27 weeks in our department, 61% of hospitalised women and 77% of women receiving tocolytic infusion therapy delivered before 32 weeks. Among 66 singleton pregnancies delivered before 32 weeks, at admission, 94% either had an effaced cervix or cervix with ≥2 cm dilation (74%), vaginal bleeding (61%) or serum C-reactive protein level >20 mg/l (40%), whereas one of these findings only was present in 18% of women who delivered at later gestations. Among 132 women with symptoms of spontaneous preterm contractions before 27 weeks not admitted for hospital care, only 2 (1.5%) delivered before 32 weeks, not significantly higher than for all other women (0.6%). Although TVUSS may be useful when the diagnosis of spontaneous preterm labour is in doubt, the main predicament in early spontaneous preterm labour may not be to predict preterm birth but to prevent it, since many women appear in advanced labour or with manifest chorioamnionitis.
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| 29. |
- Herbst, Andreas, et al.
(författare)
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Different types of acid-base changes at birth, fetal heart rate patterns, and infant outcome at 4 years of age
- 1997
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 76:10, s. 953-958
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To study the relationship between different types of acidemia in umbilical artery blood at birth, fetal heart rate (FHR) patterns during labor, and infant long-term outcome. METHODS: Case-control study of 48 infants with pure high base deficit (base deficit (BD) > or = 12 mmol/L and pCO2 < 8.0 kPa), 51 with mixed acidemia (BD > or = 12 mmol/L and pCO2 > or = 8.0 kPa), born at or after term, and controls matched for maternal age, parity, and gestational age at birth. FHR patterns during labor and the results of developmental screening at age 4 were compared between the groups. RESULTS: Late decelerations were associated with pure high base deficit and complicated variable decelerations with mixed acidemia. Both types of acidemia were correlated with Apgar scores below 7 at 1 minute, and mixed acidemia with more admissions to the neonatal intensive care unit. Developmental screening at age 4 years showed no significant differences between infants with mixed acidemia or pure high base deficit and controls. Twelve infants with mixed acidemia and six controls had deficits in language/speech development. CONCLUSIONS: Late decelerations may be an indicator of a metabolic component of acidemia and complicated variable decelerations an indicator of mixed acidemia. The higher rate of admissions to the neonatal intensive care unit in cases with mixed acidemia may suggest that a concomitant hypercapnia (resulting in lower pH) in metabolic acidemia at birth may be of importance for the outcome. A possible relation between acidemia at birth and deficits in speech/language development should be further evaluated.
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| 30. |
- Herbst, Andreas, et al.
(författare)
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Infections and antibiotic prophylaxis in reconstructive vascular surgery
- 1989
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Ingår i: European Journal of Vascular Surgery. - 0950-821X. ; 3:4, s. 303-307
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Tidskriftsartikel (refereegranskat)abstract
- In 98 patients undergoing elective vascular surgery, specimens for bacterial cultures were obtained from urine, ischaemic ulcers, incisional wounds and the implanted grafts. Wound and graft infections were registered and compared with the results of these cultures and suspected risk factors in an attempt to find the source of infections. Antibiotic prophylaxis with cefuroxime was given for 24 h beginning at the start of surgery. Patients with ischaemic ulcers also received "spread prophylaxis", directed against isolated bacteria, for ten days. Three cases of graft infection and twelve cases of wound infection occurred. Positive postoperative cultures from wounds did not correlate with pre- or peroperative cultures. Peroperative cultures revealed small numbers of staphylococcus epidermidis in eleven patients, and none of them developed graft infection. Ischaemic ulcers, diabetes or re-do procedures were not accompanied by a significantly increased frequency of wound or graft infection, although each of three patients with graft infection had one of these risk factors. Bacteria, sensitive to cefuroxime, were found in one graft infection, six wound infections, and in two patients with urosepsis, whereas cefuroxime resistant organisms were isolated from one graft infection and three infected wounds. One of the three graft infections was probably caused by bacteria originating from the patient's ischaemic ulcer. In the other two patients the source of bacteria could not be determined. Cefuroxime seems to be an adequate alternative for prophylaxis of vascular graft infection, but in some patients with bacteriuria or indwelling catheters, a one day regimen may be too short.
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| 31. |
- Herbst, Andreas, et al.
(författare)
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Influence of mode of delivery on neonatal mortality and morbidity in spontaneous preterm breech delivery.
- 2007
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier BV. - 0301-2115. ; 133:1, s. 25-29
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study the association between mode of delivery and neonatal outcome in singleton pregnancy with breech presentation and preterm birth, due to premature tabour (PTL) and/or preterm premature rupture of the membranes (pPROM). Design and methods: Information on preterm (gestational week 25-36) singleton births in breech presentation in Sweden during 1990-2002 was obtained from the Swedish Medical Birth Registry and the Swedish Hospital Discharge Registry. The study groups included 1975 caesarean and 699 vaginal deliveries with a diagnosis of PTL or pPROM, without pregnancy complications implying a high risk of fetal compromise. The rates of infant respiratory distress syndrome (IRDS), intraventricular haemorrhage (IVH), low Apgar scores, and neonatal deaths were compared between infants delivered vaginally and by caesarean section. Odds ratios were calculated with adjustment for gestational age, year of birth, maternal age and parity. Results: The risk of neonatal death and the risk of an Apgar score below 5 min postnatally were both lower after caesarean delivery (OR 0.4; 95% CI 0.2-0.7, and OR 0.4; 95% CI 0.3-0.7, respectively), whereas the risk of IRDS was increased (OR 2.1; 95% CI 1.4-3.2). A diagnosis of IRDS was not associated with mortality (OR 0.8; 95% CI 0.5-1.5). IVH was not associated with mode of delivery (OR 1.2; 95% CI 0.5-2.8). Conclusion: The lower neonatal mortality after CS supports a policy of caesarean delivery of the preterm breech. (C) 2006 Elsevier Ireland Ltd. All rights reserved.
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| 32. |
- Herbst, Andreas, et al.
(författare)
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Influence of mode of delivery on neonatal mortality in the second twin, at and before term.
- 2008
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 115:12, s. 1512-1517
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Tidskriftsartikel (refereegranskat)abstract
- Design To study the association between mode of delivery and neonatal mortality in second twins. To study the association between caesarean delivery and mortality with minimum bias of the indication for the operation, we wanted to compare the outcome of second twins delivered by caesarean due to breech presentation of the sibling with vaginally delivered second twins in uncomplicated pregnancies. Setting Sweden, 1980-2004 Population Twins born during 1980-2004 were identified from the Swedish Medical Birth Registry. Twin pairs delivered by caesarean due to breech presentation of the first twin, and vaginally delivered twins with the first twin in cephalic presentation were included. Pregnancies with antepartum complications were excluded. Methods Odds ratios and 95% CI were calculated using multiple logistic regression analyses, adjusting for year of birth, maternal age, parity and gestational age. Main outcome measures Neonatal mortality. Results Compared with second-born twins delivered vaginally, second-born twins delivered by caesarean (for breech presentation of the sibling) had a lower risk of neonatal death (adjusted OR 0.40; 95% CI 0.19-0.83). The decreased risk after caesarean delivery was significant for births before 34 weeks (2.1 versus 9.0%; adjusted OR 0.40; 95% CI 0.17-0.95). After 34 weeks, neonatal mortality was low in both groups (0.1 and 0.2%, respectively), and the difference was not statistically significant (adjusted OR 0.42; 95% CI 0.10-1.79). Conclusions Neonatal mortality is lower for the second twin after caesarean delivery at birth before 34 weeks. At term, mortality is low irrespective of delivery mode.
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| 33. |
- Herbst, Andreas, et al.
(författare)
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Intermittent versus continuous electronic monitoring in labour: a randomised study
- 1994
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Ingår i: British Journal of Obstetrics and Gynaecology. - 1365-215X. ; 101:8, s. 663-668
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the efficacy in detecting signs of fetal hypoxia in labour of intermittent (I-group) versus continuous (C-group) electronic fetal monitoring in women with low or moderate risk factors for fetal distress. DESIGN: A prospective, randomised study. SETTING: A tertiary referral centre. SUBJECTS: Four thousand and forty-four parturients at low risk for obstetric complications with a reactive fetal heart rate admission test at arrival in labour. During the study period (October 5 1989 to May 31 1991), 5647 women were delivered in the labour ward. Of these, 1178 women (20.9%) were excluded because of high risk factors in pregnancy or at admission for labour, including women undergoing elective caesarean section. Of the remaining 4469 women 4044 (90.5%) were randomised to either intermittent (n = 2015) or continuous monitoring (n = 2029) during the first stage of labour. METHODS: In the C-group the fetal heart rate was recorded continuously with electronic fetal monitoring during the first stage of labour. In the I-group the fetal heart rate was recorded with electronic fetal monitoring for 10 to 30 min every 2 to 2.5 h during the first stage of labour, and the fetal heart rate was auscultated every 15 to 30 min in between recording periods. If complications occurred, recording was changed to continuous. In the second stage of labour all the women were monitored continuously. Umbilical cord artery acid-base status was assessed at birth. MAIN OUTCOME MEASURES: Duration of electronic fetal monitoring, rates of abnormal fetal heart rate patterns, caesarean section for fetal distress, acidosis in umbilical cord arterial blood at birth, Apgar scores of less than 7 at 1 or 5 min, and referrals to the neonatal intensive care unit. RESULTS: There were no significant differences between the study groups in the incidence of ominous fetal heart rate recordings: 6.3% (I-group) versus 6.6% (C-group), or the interval from arrival to first detected abnormal fetal heart rate, although the number of suspicious fetal heart rate patterns was higher in the C-group (28.6%) than in the I-group (24.6%). In the I-group electronic fetal monitoring was performed for (median monitoring time) 38.8% of the first stage of labour as compared with 78.6% in the C-group. The incidence of caesarean section for fetal distress was similarly low in both groups: 1.2% versus 1.0%. There were no significant differences in the immediate neonatal outcome in terms of umbilical artery pH, Apgar scores, or admissions to the neonatal care unit. CONCLUSIONS: Intermittent use of electronic fetal monitoring at regular intervals (with stethoscopic auscultation in between) appears to be as safe as continuous electronic fetal monitoring in low risk labours.
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| 34. |
- Herbst, Andreas, et al.
(författare)
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Long term outcome after acidemia at birth.
- 1998
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Ingår i: Contemporary reviews in obstetrics and gynaecology.. - 0953-9182. ; 10:2, s. 107-114
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Tidskriftsartikel (refereegranskat)
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| 35. |
- Herbst, Andreas, et al.
(författare)
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Maternal fever in term labour in relation to fetal tachycardia, cord artery acidaemia and neonatal infection
- 1997
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Ingår i: British Journal of Obstetrics and Gynaecology. - : Wiley. - 1365-215X .- 1470-0328 .- 1471-0528. ; 104:3, s. 363-366
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine 1. whether maternal fever during term labour is associated with acidaemia at birth and neonatal infection and 2. whether fetal tachycardia precedes maternal fever and is associated with neonatal infection. DESIGN: Retrospective matched-pair case-control study. SUBJECTS: Two hundred and forty-eight newborn infants whose mothers developed fever during term labour (cases) and 248 control infants. The women were matched for parity and duration of labour. MAIN OUTCOME MEASURES: Cord artery acid-base status, Apgar scores, neonatal infections, and fetal heart rate before maternal fever. RESULTS: Mean pH, as well as the rate of cord artery acidaemia at birth (pH < 7.10) was equal in cases and controls (in both groups 7.24% and 6%, respectively). Signs of septicaemia and/or pneumonia were identified in 17 case newborns (7%) and in one control (0.4%; OR 17.0, P < 0.001). Of 212 pairs with complete heart rate data, fetal tachycardia preceded maternal fever in 39 cases (18%) and in 16 controls (8%) (OR 2.6, P = 0.003). Tachycardia before maternal fever was not associated with increased neonatal infectious morbidity. CONCLUSIONS: Maternal fever during term labour was associated with perinatal infection, but not with acidaemia at birth. Elevated fetal heart rate preceded maternal fever in a minority of cases and was not associated with perinatal infection.
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| 36. |
- Herbst, Andreas, et al.
(författare)
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Mode of delivery in breech presentation at term: increased neonatal morbidity with vaginal delivery
- 2001
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 80:8, s. 731-737
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the neonatal outcome in planned vaginal delivery and planned cesarean section in term singleton pregnancies with breech presentation in a Scandinavian clinic with a high rate of vaginal breech delivery. METHODS: A retrospective study including 1050 term singleton breech pregnancies delivered at a Swedish tertiary referral center during 1988 to 2000. For 699 patients (67%) a vaginal delivery was planned, of whom 603 (86%) were delivered vaginally. In 327 (31%) cases a cesarean section was planned and performed. These two groups were compared regarding rates of acidemia at birth (cord artery pH <7.05), low Apgar scores and neonatal neurological morbidity. Long term sequels among infants with a complicated neonatal course were also identified. RESULTS: Acidemia at birth, Apgar score below 7 at 5 minutes, and referral to neonatal intensive care unit all occurred at higher rates in planned vaginal delivery (5.3%, 3.6%, and 8.9%, respectively), than in planned cesarean delivery (0, 0, and 4.0%). The rate of neonatal neurological morbidity was 24/699 (3.4%) in planned vaginal delivery (18 cases with cerebral symptoms and six cases of brachial plexus palsy) compared to one case (cerebral symptoms) after a planned cesarean. These differences were all statistically significant (p< or =0.002). Of the neurologically affected neonates, two died and four had cerebral palsy (one delivered by planned cesarean section) at follow up. CONCLUSION: Neonatal morbidity may be reduced with planned cesarean delivery in breech presentation, also in a Scandinavian setting.
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| 37. |
- Herbst, Andreas, et al.
(författare)
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Risk factors for acidemia at birth
- 1997
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Ingår i: Obstetrics and Gynecology. - 1873-233X. ; 90:1, s. 125-130
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To identify risk factors for acidemia at birth. METHODS: From September 1988 to December 1996, cord arterial blood pH was measured in 23,016 of 27,064 live-born infants (85.0%). Values below 7.05 were observed in 264 newborns (1.1%), of whom 14 born by cesarean delivery before labor and one triplet infant were excluded from the study. The remaining 249 newborns with acidemia and their mothers were compared with 249 unmatched controls with normal pH (the first infant with umbilical arterial pH above 7.10 born after each case). Multivariate logistic regression was used to adjust for potentially confounding variables. RESULTS: Variables significantly and independently associated with acidemia at birth were labor with breech presentation (adjusted odds ratio [OR]2.9), oxytocin administration (OR 2.1), meperidine administration (OR 2.0), cord entanglement (OR 1.7), and male gender of the infant (OR 1.4). Clinical evidence of chorioamnionitis also was associated with acidemia, although after adjustment for prematurity, the association was not statistically significant (OR 3.9, 95% confidence interval 0.8, 19). CONCLUSION: Labor with breech presentation, administration of oxytocin and meperidine, cord entanglement, and male gender are associated with an increased risk for insufficient fetomaternal gas exchange.
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| 38. |
- Herbst, Andreas, et al.
(författare)
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Risk factors for fever in labor
- 1995
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Ingår i: Obstetrics and Gynecology. - 1873-233X. ; 86:5, s. 790-794
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To identify risk factors for fever in labor. METHODS: A retrospective case-control study was conducted. Maternal sublingual temperature was measured every 2-4 hours during labor in 3109 of 3860 consecutive term parturients presenting from September 1992 through December 1993. Women who had fever (at least one recorded temperature of 38C or more, n = 72) during labor were compared with those who remained afebrile (n = 3037). Furthermore, a matched-pair case-control study was conducted, involving 250 women at term who developed fever in labor and 250 controls matched for parity and duration of labor; all delivered between January 1989 and December 1993. A conditional multiple logistic regression analysis was used to identify independent risk factors for fever during labor. RESULTS: In the case-control study, fever was associated with epidural analgesia, nulliparity, and a long duration of labor. These three variables were also related among themselves. However, multiple regression analysis showed that all three variables were independently associated with maternal temperature. In the matched-pair study, epidural analgesia, rupture of membranes longer than 24 hours, latency phase exceeding 8 hours, and a temperature in the upper normal range (37.5-37.9C) at admission were independent risk factors for developing fever in labor. CONCLUSION: Epidural analgesia, duration of labor, and a long interval from rupture of membranes to delivery were independent risk factors for maternal fever in labor.
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| 39. |
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| 40. |
- Herbst, Andreas, et al.
(författare)
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Term breech delivery.
- 2005
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Ingår i: Fetal and Maternal Medicine Review. - 0965-5395. ; 16:4, s. 289-322
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Tidskriftsartikel (refereegranskat)
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| 41. |
- Herbst, Andreas
(författare)
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Term breech delivery in Sweden: mortality relative to fetal presentation and planned mode of delivery
- 2005
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 84:6, s. 593-601
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To compare perinatal and infant mortality in breech and cephalic presentations and between planned vaginal and cesarean section (CS) breech deliveries in Sweden. Methods. The study comprised two parts. Study A is a national cohort study for the period 1991-2001, including 22 549 breech presentations and 875 249 cephalic presentations born at >= 38 completed weeks. Study B is a case-control study, including all 164 breech deliveries with perinatal or 1-year infant death (during 1991-1999 in Sweden) and controls. Results. Study A: Among non-malformed infants, the total mortality rate was 0.46% in breech and 0.28% in cephalic presentations [adjusted odds ratio (OR) 1.6; 95% confidence interval 1.3-1.9]. Non-malformed breech babies were at an increased risk of antenatal death (breech versus cephalic hazard ratio: 2.7, 2.1-3.6). The infant mortality among non-malformed breech deliveries was higher in vaginal birth than in delivery by CS before labor (OR 2.5, 1.2-5.3). The perinatal + infant mortality among non-malformed breech babies was higher at delivery after 39 completed weeks than at CS delivery at 38 weeks (0.53% versus 0.14%; OR 3.5, 1.9-6.4). The estimated needed number of CS to avoid one death was 400. Study B: In breech presentations without malformations, OR for perinatal or infant death was 3.1 (1.7-5.8) at planned vaginal delivery compared with planned CS delivery, and when breech presentations not diagnosed at 37 gestational weeks were excluded, OR was 3.7 (1.6-9.2). Conclusions. These large population-based and case-control studies both show a significant reduction of perinatal and infant mortality with planned CS in term breech pregnancy.
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| 42. |
- Herbst, Andreas, et al.
(författare)
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Time between membrane rupture and delivery and septicemia in term neonates
- 2007
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Ingår i: Obstetrics and Gynecology. - 1873-233X. ; 110:3, s. 612-618
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate how the interval between membrane rupture and delivery affects the risk of neonatal sepsis and whether duration of labor influences the risk. METHODS: A registry study included 113,568 singleton infants born at term after a trial of labor (elective cesarean deliveries excluded). The incidence of a diagnosis of sepsis during the neonatal period was correlated to the interval between membrane rupture and delivery. Multiple logistic regression analysis was done with adjustments for maternal age, parity, infant gender, gestational age, birth weight, and duration of labor. Receiver operating characteristics curves were created to estimate the optimal cutoff of membrane rupture time associated with an increased risk of neonatal septicemia. RESULTS: The rate of neonatal sepsis was 0.3% at a membrane rupture,to delivery interval below 6 hours, 0.5% at 6-18 hours, 0.8% at 18-24 hours, and 1.1% after 24 hours. The risk of neonatal sepsis increased independently and nearly linearly with duration of membrane rupture up to 36 hours, with an odds ratio of 1.29 for each 6-hour increase in membrane rupture duration. The risk also increased with birth weight, gestational age, primiparity, and male infant gender. Duration of labor was not an independent risk factor for neonatal sepsis. Receiver operating characteristics curve analysis revealed an area under the curve of 0.66, but a superior cutoff time limit for the risk of sepsis was not found. CONCLUSION: The risk of neonatal sepsis increases with duration of membrane rupture in a linear fashion during the first 36 hours, independently of labor duration.
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| 43. |
- Herbst, Andreas, et al.
(författare)
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Vaginal breach delivery
- 2002
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:11, s. 1092-1092
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Tidskriftsartikel (refereegranskat)
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| 44. |
- Herbst, Michael F., et al.
(författare)
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adcc : A versatile toolkit for rapid development of algebraic-diagrammatic construction methods
- 2020
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Ingår i: Wiley Interdisciplinary Reviews. Computational Molecular Science. - : Wiley. - 1759-0876 .- 1759-0884. ; 10:6
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Tidskriftsartikel (refereegranskat)abstract
- ADC-connect (adcc) is a hybrid python/C++ module for performing excited state calculations based on the algebraic-diagrammatic construction scheme for the polarization propagator (ADC). Key design goal is to restrict adcc to this single purpose and facilitate connection to external packages, for example, for obtaining the Hartree-Fock references, plotting spectra, or modeling solvents. Interfaces to four self-consistent field codes have already been implemented, namely pyscf, psi4, molsturm, and veloxchem. The computational workflow, including the numerical solvers, is implemented in python, whereas the working equations and other expensive expressions are done in C++. This equips adcc with adequate speed, making it a flexible toolkit for both rapid development of ADC-based computational spectroscopy methods as well as unusual computational workflows. This is demonstrated by three examples. Presently, ADC methods up to third order in perturbation theory are available in adcc, including the respective core-valence separation and spin-flip variants. Both restricted or unrestricted Hartree-Fock references can be employed.This article is categorized under: Software > Simulation Methods Electronic Structure Theory > Ab Initio Electronic Structure Methods Theoretical and Physical Chemistry > Spectroscopy Software > Quantum Chemistry
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| 45. |
- Hogan, Linda, et al.
(författare)
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How often is a low 5-min Apgar score in term newborns due to asphyxia?
- 2007
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier BV. - 0301-2115. ; 130:2, s. 169-175
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate how often low 5-min Apgar scores (AS(5-min)) at term are associated with asphyxia. Study design: A cohort- and case-control study, including all 183 term infants with AS(5-min) below 7 born at Lund University Hospital during 1993-2002, antepartum deaths excluded. The control group included 183 randomly selected term newborns with AS(5-min) 9-10. Cardiotocography (CTG) traces were assessed blinded to group and outcome. Obstetric and pediatric files were reviewed. Results: After excluding infants with severe malformations, indications of hypoxia were found at the following rates in cases with AS(5-min) below 4 (N = 30), scores 4-6 (N = 143), and controls (N = 182)-abnormal admission CTG: 38%, 8% and 0.6%; abnormal CTG before birth: 88%, 69% and 18%; obstetrical catastrophe: 28%, 6% and 0.6%; interventions for fetal distress: 83%, 48% and 9%; cord artery pH below 7.15: 69%, 54% and 7%; hypoxic ischemic encephalopathy or hypoxic death: 70%, 14% and none. All differences between each case group and controls were statistically significant (p < 0.0001). Conclusions: In the absence of severe malformations, the vast majority of AS(5-min) below 4, and at least half of scores 4-6 could be attributed to birth asphyxia. Signs of hypoxia usually appeared during labor, but were present at admission in 38% of cases with AS(5-min) below 4.
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| 46. |
- Ingemarsson, Ingemar, et al.
(författare)
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Long term outcome after umbilical artery acidaemia at term birth: influence of gender and duration of fetal heart rate abnormalities
- 1997
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Ingår i: British Journal of Obstetrics and Gynaecology. - : Wiley. - 1365-215X .- 1470-0328 .- 1471-0528. ; 104:10, s. 1123-1127
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the outcome after acidaemia at term birth, and the relation to gender and duration of pathological fetal heart rate changes. DESIGN: Population based study of 154 infants with umbilical artery pH < 7.05 at term birth. Neonatal outcome and the result of developmental screening at age four years were compared with a control group with pH > 7.10. Fetal heart rate traces in infants with acidaemia were reviewed, and the relation between duration of fetal heart rate changes and outcome was analysed. RESULTS: Of the 154 newborns with acidaemia at birth, 10 had encephalopathy, of which two died and two developed cerebral palsy. Nine of these 10 infants were boys, and eight had pH < 7.00. Male newborns (n = 39) more often had pronounced acidaemia (pH < 7.00) than females (n = 22). Although few infants had severe impairment, infants born with acidaemia significantly more often had speech problems at follow up than controls (19/102 versus 8/98; P = 0.03). In infants with acidaemia, duration of abnormal fetal heart rate changes was significantly associated with neonatal encephalopathy and speech problems at age four years. CONCLUSIONS: Acidaemia at term birth was associated with neonatal encephalopathy and with speech problems at four years of age. Boys had more often pronounced acidaemia and a complicated course. A protracted abnormal fetal heart rate trace was associated with poor outcome.
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| 47. |
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| 48. |
- Jönsson, Eva Rubin, et al.
(författare)
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Modified Ritgen's maneuver for anal sphincter injury at delivery: a randomized controlled trial.
- 2008
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Ingår i: Obstetrics and Gynecology. - 1873-233X. ; 112:2 Pt 1, s. 212-217
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether Ritgen's maneuver decreases the risk of third- to fourth-degree perineal tears compared with simple perineal support. METHODS: A total of 1,623 nulliparous women in term labor, singleton pregnancy, and cephalic presentation were randomly assigned to Ritgen's maneuver or standard care. Ritgen's maneuver denotes extracting the fetal head, using one hand to pull the fetal chin from between the maternal anus and the coccyx, and the other on the fetal occiput to control speed of delivery. Ritgen's maneuver was performed during a uterine contraction, rather than, as originally recommended, between contractions. Our standard care entailed perineal support with one hand and control of the speed of crowning with the other, and use of Ritgen's maneuver only on specific indications. Women delivered by cesarean delivery (n=10) or instrumentally (n=142) were excluded, as well as 39 erroneously included women (parous or in preterm labor), six inaccurately assigned participants, one with missing data, and two participants who withdrew consent. For the remaining 1,423 women, the result was analyzed according to intention to treat. RESULTS: Ritgen's maneuver was performed in 554 (79.6%) of 696 women randomly assigned to this procedure and in 31 (4.3%) of 727 women randomly assigned to simple perineal support. The rate of third- to fourth-degree tears was 5.5% (n=38) in women assigned to Ritgen's maneuver and 4.4% (n=32) in those assigned to simple perineal support (relative risk 1.24; 95% confidence interval 0.78-1.96). CONCLUSION: Ritgen's maneuver does not decrease the risk of anal sphincter injury at delivery, at least not when performed during a contraction.
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| 49. |
- Kolkova, Zuzana, et al.
(författare)
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Obstetric and intensive-care strategies in a high-risk pregnancy with critical respiratory failure due to COVID-19 : A case report
- 2020
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Ingår i: Case Rep Womens Health. - : Elsevier BV. - 2214-9112. ; 27, s. e00240-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: With the disease burden increasing daily, there is a lack of evidence regarding the impact of COVID-19 in pregnancy. Healthy pregnant women are still not regarded as a susceptible group despite physiological changes that make pregnant women more vulnerable to severe infection. However, high-risk pregnancies may be associated with severe COVID-19 disease with respiratory failure, as outlined in this report. We discuss the importance of timely delivery and antenatal steroid administration in a critically ill patient. CASE: A 27-year-old pregnant woman (gravida 2, para 1) with type I diabetes, morbid obesity, hypothyroidism and a previous Caesarean section presented with critical respiratory failure secondary to COVID-19 at 32 weeks of gestation. A preterm emergency Caesarean section was performed, after steroid treatment for foetal lung maturation. The patient benefited from prone positioning; however, transient acute renal injury, rhabdomyolysis and sepsis led to prolonged intensive care and mechanical ventilation for 30 days. The baby had an uncomplicated recovery. CONCLUSION: COVID-19 infection in high-risk pregnancies may result in severe maternal and neonatal outcomes such as critical respiratory failure requiring mechanical ventilation and premature termination of the pregnancy. Antenatal steroids may be of benefit for foetal lung maturation but should not delay delivery in severe cases.
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| 50. |
- Liljeström, Lena, 1977-
(författare)
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Birth asphyxia : Fetal scalp blood sampling and risk factors for hypoxic ischemic encephalopathy
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Preventing birth asphyxia is a major challenge in delivery care. The aims of this thesis were to evaluate fetal scalp blood sampling (FBS) and explore risk factors for moderate to severe neonatal hypoxic ischemic encephalopathy (HIE).In a study of 241 deliveries monitored by FBS, a discrepancy between pH and lactate (one abnormal and one normal value) was common (55%) in combined FBS. We found that the frequency of operative deliveries for fetal distress (ODFD) was lower when both pH and lactate were analysed in FBS compared with analysis of only pH or lactate, without affecting neonatal outcome. (Study I)In a questionnaire study, women (n = 51) monitored by FBS generally tolerated the test well. Women without epidural, with higher body mass index (BMI), and with less cervical dilatation had higher pain ratings compared with their counterparts. The obstetricians that performed the test generally experienced the test as easy to perform, but more complicated with high maternal BMI, less cervical dilatation, and higher station of the fetal head. (Study II)In a national cohort of 692 428 live births ≥ 36 weeks, risk factors for moderate to severe HIE were identified. We found a linear association between increasing maternal BMI and decreasing maternal height and risk of HIE. Compared with non-short (≥156 cm) and normal weight (BMI<25 kg/m2) women, short and overweight women had a threefold risk of HIE. (Study III)Obstetric emergencies occurred in 29% of HIE cases, more commonly in parous (37%) than in nulliparous (21%) women. Among nulliparous women, shoulder dystocia was most common, with the strongest association to HIE. In parous women without previous caesarean, shoulder dystocia was most common, but placental abruption had the strongest association to HIE. Among parous women with previous caesarean, uterine rupture was the most prevalent, with the strongest association to HIE. (Study IV)Conclusions: Combined FBS might decrease the frequency of ODFD. FBS is well tolerated in women and generally uncomplicated for the obstetrician to perform. Women with short stature and overweight have increased risk of having an infant with HIE. Obstetric emergencies are common underlying causes of HIE, especially in parous women.
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