| 1. |
- Wiberg, Nana, et al.
(författare)
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Infant outcome at four years of age after intrapartum sampling of scalp blood lactate for fetal assessment. A cohort study
- 2018
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective To correlate the value of lactate in fetal scalp blood at delivery and the outcomes of the offspring at four years of age. Methods Cases where scalp blood lactate was taken within sixty minutes before delivery were identified from the randomized trial "Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress”. Data were grouped according to the generally accepted cutoffs for normality, pre-acidemia, acidemia and concentrations above mean +2 SD during the second stage. The outcome measures included gross-/fine motor function, vision, hearing, speaking and cognitive disorders, signs of central motor damage and referral to specialized pediatric services. Results 307 cases were available for final analyse. With normal scalp lactate concentration, the number of children with a diagnosed disorder was lower compared to the pre-acidemic/ acidemic groups, although the findings were only significant for fine motor dysfunction (p = 0.036). Elevated lactate values were significantly associated with increased risk for a poorer capacity of attention and understanding of instructions (OR 1.37, 95% CI 1.07–1.74), and for fine motor dysfunction (OR 1.22, 95% CI 1.00–1.49) at the age of four. Conclusion Higher levels of lactate in fetal scalp blood seems to be associated with increased risk of an aberrant developmental outcome at four years of age in some areas.
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| 2. |
- Akerud, Helena, et al.
(författare)
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Lactate distribution in culture medium of human myometrial biopsies incubated under different conditions
- 2009
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Ingår i: American Journal of Physiology. Endocrinology and Metabolism. - : American Physiological Society. - 0193-1849 .- 1522-1555. ; 297:6, s. E1414-E1419
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Tidskriftsartikel (refereegranskat)abstract
- It is generally believed that a relationship exists between muscle fatigue and intracellular accumulation of lactate. This reasoning is relevant to obstetrical issues. Myocytes in uterus work together during labor, and the contractions need to be strong and synchronized for a child to be delivered. At labor dystocia, the progress of labor becomes slow or arrested after a normal beginning. It has been described that, during labor dystocia, when the force of the contractions is low, the uterus is under hypoxia, and anaerobic conditions with high levels of lactate in amniotic fluid dominate. The purpose of this study was to examine whether myometrial cells are involved in the production of lactate in amniotic fluid and whether there are differences in production and distribution of lactate in cells incubated under aerobic and anaerobic conditions. We also wanted to elucidate the involvement of specific membrane-bound lactate carriers. Women undergoing elective caesarean section were included. Myometrial biopsies from uteri were collected and subjected to either immunohistochemistry to identify lactate carriers or in vitro experiments to analyze production of lactate. The presence of lactate carriers named monocarboxylate transporters 1 and 4 was verified. Myometrial cells produced lactate extracellularly, and the lactate carriers operated differently under anaerobic and aerobic conditions; while being mainly unidirectional under anaerobic conditions, they became bidirectional under aerobic conditions. Human myometrial cells produced and delivered lactate to the extracellular medium under both anaerobic and aerobic conditions. The delivery was mediated by lactate carriers.
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| 3. |
- Bolin, Marie, et al.
(författare)
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Angiopoietin-1/angiopoietin-2 ratio for prediction of preeclampsia
- 2009
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Ingår i: American Journal of Hypertension. - : Oxford University Press (OUP). - 0895-7061 .- 1941-7225. ; 22:8, s. 891-895
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A number of different biophysical and biochemical markers have been proposed as predictors of preeclampsia. Factors involved in the angiogenic balance are suggested as candidate markers. The purpose of this prospective, longitudinal cohort study was to determine whether a ratio between Angiopoietin-1 (Ang-1) and Angiopoietin-2 (Ang-2) can be used to predict preeclampsia in a low-risk population. METHODS: A cohort of healthy pregnant women (n = 469) were enrolled at gestational weeks 8-12. Plasma samples were collected at gestational weeks 10, 25, 28, 33, and 37. By using commercially available enzyme-linked immunosorbent assay kits Ang-1 and Ang-2 were analyzed. RESULTS: The median Ang-1/Ang-2 ratio increased during pregnancy in all women, but the ratios were significantly lower at gestational weeks 25 and 28 in women who later developed preeclampsia than in normal pregnant women (1.49 compared to 2.19 and 2.12 compared to 3.54, P < 0.05 and P < 0.05). CONCLUSION: Our data indicate that in a low-risk population of women the Ang-1/Ang-2 ratio in plasma constitutes a possible biomarker for prediction of later onset of preeclampsia.
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| 4. |
- Bolin, Marie, et al.
(författare)
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Prediction of Preeclampsia by Combining Serum Histidine-Rich Glycoprotein and Uterine Artery Doppler
- 2012
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Ingår i: American Journal of Hypertension. - : Oxford University Press (OUP). - 0895-7061 .- 1941-7225. ; 25:12, s. 1305-1310
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPreeclampsia is associated with both maternal and perinatal morbidity and mortality. Histidine-rich glycoprotein (HRG) is a protein interacting with angiogenesis, coagulation, and inflammatory responses, processes known to be altered in preeclamptic pregnancies. Significantly lower levels of HRG have been demonstrated as early as in the first trimester in women later developing preeclampsia compared with normal pregnancies. The aim of this study was to investigate whether the combination of HRG and uterine artery Doppler ultrasonography can be used as a predictor of preeclampsia.MethodsA total of 175 women were randomly selected from a case-control study; 86 women had an uncomplicated pregnancy and 89 women later developed preeclampsia. Blood samples and pulsatility index (PI) were obtained from both cases and controls in gestational week 14.ResultsHRG levels were significantly lower in women who developed preterm preeclampsia compared with controls, but not for women developing preeclampsia in general. PI was significantly higher in the preeclampsia group compared with controls, especially in preterm preeclampsia. The combination of HRG and PI revealed a sensitivity of 91% and a specificity of 62% for preterm preeclampsia.ConclusionsThe combination of HRG and uterine artery Doppler may predict preterm preeclampsia in early pregnancy.
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| 5. |
- Fransson, Emma, PhD, 1973-, et al.
(författare)
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Cohort profile : the Swedish Maternal Microbiome project (SweMaMi) - assessing the dynamic associations between the microbiome and maternal and neonatal adverse events
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:10
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The Swedish Maternal Microbiome (SweMaMi) project was initiated to better understand the dynamics of the microbiome in pregnancy, with longitudinal microbiome sampling, shotgun metagenomics, extensive questionnaires and health registry linkage. Participants Pregnant women were recruited before the 20th gestational week during 2017-2021 in Sweden. In total, 5439 pregnancies (5193 unique women) were included. For 3973 pregnancies (73%), samples were provided at baseline, and for 3141 (58%) at all three timepoints (second and third trimester and postpartum). In total, 38 591 maternal microbiome samples (vaginal, faecal and saliva) and 3109 infant faecal samples were collected. Questionnaires were used to collect information on general, reproductive and mental health, diet and lifestyle, complemented by linkage to the nationwide health registries, also used to follow up the health of the offspring (up to age 10). Findings to date The cohort is fairly representative for the total Swedish pregnant population (data from 2019), with 41% first-time mothers. Women with university level education, born in Sweden, with normal body mass index, not using tobacco-products and aged 30-34 years were slightly over-represented. Future plans The sample and data collection were finalised in November 2021. The next steps are the characterisation of the microbial DNA and linkage to the health and demographic information from the questionnaires and registries. The role of the microbiome on maternal and neonatal outcomes and early-childhood diseases will be explored (including preterm birth, miscarriage) and the role and interaction of other risk factors and confounders (including endometriosis, polycystic ovarian syndrome, diet, drug use). This is currently among the largest pregnancy cohorts in the world with longitudinal design and detailed and standardised microbiome sampling enabling follow-up of both mothers and children. The findings are expected to contribute greatly to the field of reproductive health focusing on pregnancy and neonatal outcomes.
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| 6. |
- Goldberg, Alexandra, et al.
(författare)
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Swedish guidelines for type 1 diabetes and pregnancy outcomes : A nationwide descriptive study of consensus and adherence
- 2021
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Ingår i: Primary Care Diabetes. - : Elsevier. - 1751-9918 .- 1878-0210. ; 15:6, s. 1040-1051
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Type 1 diabetes (DM1) during pregnancy and labor is associated with an increased risk of maternal and fetal complications. Evidence-based care is therefore provided in accordance with guidelines. In this study, we aimed to compare all the Swedish guidelines for DM1 during pregnancy and labor in terms of the variables emphasized in the national guidelines from the US and from England and Wales. The second aim was to measure adherence to local guidelines at the four hospitals in Stockholm that cared for pregnant women with DM1 during 2016 and to describe the pregnancy and labor outcomes. Methods: All the Swedish guidelines for DM1 during pregnancy and labor were reviewed on 31 variables. The medical records of 114 women were reviewed according to whether >= 70% of 22 variables in the guidelines were followed. Results: No consensus was found in the Swedish guidelines for any of the 31 variables. Some guidelines were contradictory. The pregnancy guidelines were followed in 17.5% of the medical records, 18.4% followed the labor guidelines, and 5.3% followed both guidelines. The onset of labor, mode of delivery and HbA1c in the third trimester varied significantly, depending on the adherence to guidelines. Conclusions: The Swedish guidelines for DM1 during pregnancy and labor lack both consensus and adherence. A national guideline on DM1 during pregnancy and childbirth with high adherence could improve care for pregnant Swedish women with DM1 and their fetuses.
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| 7. |
- Gudnadottir, Unnur, et al.
(författare)
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Pre-pregnancy complications-associated factors and wellbeing in early pregnancy : a Swedish cohort study
- 2023
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central (BMC). - 1471-2393 .- 1471-2393. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many couples experience difficulties to become pregnant or carry a pregnancy to term due to unknown causes. Here we define pre-pregnancy complications as having prior recurrent pregnancy loss, prior late miscarriages, time to pregnancy more than one year, or the use of artificial reproductive technologies. We aim to identify factors associated with pre-pregnancy complications and poor well-being in early pregnancy.Methods: Online questionnaire data from 5330 unique pregnancies in Sweden were collected from November 2017 - February 2021. Multivariable logistic regression modelling was used to investigate potential risk factors for pre-pregnancy complications and differences in early pregnancy symptoms.Results: Pre-pregnancy complications were identified in 1142 participants (21%). Risk factors included diagnosed endometriosis, thyroid medication, opioids and other strong pain medication, body mass index > 25 kg/m(2) and age over 35 years. Different subgroups of pre-pregnancy complications had unique risk factors. The groups also experienced different pregnancy symptoms in early pregnancy, where women that had experienced recurrent pregnancy loss were at higher risk of depression in their current pregnancy.Conclusion: We report one of the largest pregnancy cohorts with high frequency of pre-pregnancy complications compared to the Swedish population. Prescribed drug use and body weight were the top potentially modifiable risk factors in all groups. Participants that experienced pre-pregnancy complications also had higher risk of depression and pregnancy problems in early pregnancy.
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| 8. |
- Jonsson, Maria, 1966-, et al.
(författare)
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Assessment of pain in women randomly allocated to speculum or digital insertion of the Foley catheter for induction of labor
- 2011
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:9, s. 997-1004
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe primary aim was to assess pain subjectively and objectively in women during insertion of a Foley catheter for induction of labor. A secondary aim was to assess pain during cervical ripening and to evaluate maternal satisfaction.DesignRandomized controlled trial. Setting. University hospital, Sweden. Population. Forty-two women undergoing induction of labor and cervical ripening with a Foley catheter.MethodsWomen were randomly allocated to digital (n=21) or to speculum (n=21) placement of a Foley catheter. A visual analogue scale (VAS) was used for subjective assessment of pain and, for objective measurements, a skin conductance algesimeter was used and the area under the curve (AUC) was calculated (mu Ss). Maternal satisfaction was evaluated in a questionnaire. Main outcome measures. Pain sensation during placement of the Foley catheter.ResultsThere was a significant difference between groups in pain measurements during insertion of the Foley catheter. The speculum group had higher median pain scores than the digital group, VAS=5 vs. = 3 (p=0.03) and greater median AUC measurements: 1840 vs. 823 mu Ss (p=0.04). There was no difference in pain assessments during cervical ripening. Overall satisfaction scores were high and comparable between groups.ConclusionDigital placement of the Foley catheter is subjectively and objectively less painful compared to the use of a speculum. Digital placement should therefore be considered as an alternative in the management of these patients. Ripening of the cervix with the Foley catheter is well tolerated and the overall satisfaction rate among patients induced with this method is high.
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| 9. |
- Kaplan-Sturk, Rebecka, et al.
(författare)
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Outcome of deliveries in healthy but obese women : obesity and delivery outcome
- 2013
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Ingår i: BMC Research Notes. - : BioMed Central. - 1756-0500. ; 6:50
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Obesity among fertile women is a global problem. 25% of pregnant Swedish women are overweight at admission to the antenatal clinic and 12% of them are considered as obese. Previous studies have shown an increased risk of delivery complications with an elevated maternal BMI. The aim of this study was to evaluate delivery outcomes in relation to maternal BMI on admission to the antenatal clinic.A healthy group of 787 women with full-term pregnancies and spontaneous onset of labor were included in the study. Delivery outcome was assessed in relation to maternal BMI when attending the antenatal clinic.RESULTS:The results indicated that in deliveries where the maternal BMI was >30 a high frequency of abnormal CTG trace during the last 30 minutes of labor was shown. A blood sample for evaluation of risk of fetal hypoxia was performed in only eight percent of these deliveries. A spontaneous vaginal delivery without intervention was noted in 85.7%, and 12% of neonates were delivered with an adverse fetal outcome compared to 2.8% in the group with a maternal BMI<30 (p<0.001).CONCLUSION:These results indicate an increased risk at delivery for healthy, but obese women in labor. Furthermore, the delivery management may not always be optimal in these deliveries.
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| 10. |
- Lindgren, Karin E, 1984-
(författare)
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The Histidine-rich Glycoprotein in Reproduction
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Infertility affects 15% of reproductive-aged couples. The milieu surrounding the growing embryo is of outmost importance, and should be optimised during in vitro fertilisation (IVF). Many biological processes, such as angiogenesis, coagulation, and immune processes need to be well regulated for a pregnancy to occur and progress normally. Histidine-rich glycoprotein (HRG) is a plasma protein that regulates components of these systems by building complexes with various ligands. A single nucleotide polymorphism (SNP) in HRG, denoted HRG C633T, seem to be of importance for IVF treatment outcomes. The aim of this thesis was to further investigate the proposed human fertility effects of the HRG C633T SNP.According to the findings of this thesis, the HRG C633T genotype is associated with primary recurrent miscarriage. Male HRG C633T genotype is associated with semen characteristics in infertile men, and pregnancy rates following IVF. However, the distribution of the HRG C633T SNP does not differ between infertile and fertile couples.We further examined the role of the region surrounding the HRG C633T SNP for regulation of endometrial angiogenesis and human embryo development. The region affects primary endometrial endothelial cell migration, proliferation and tube-formation in vitro but does not appear to affect human embryo development. No effect of the HRG peptide was noted on the secretome of human embryos. However, early embryos secrete proteins into the surrounding culture media and the level of secretion of VEGF-A, IL-6, EMMPRIN and PlGF is greater in embryos of higher developmental stages.In conclusion, the HRG C633T genotype appears to play a role only if infertility is established. The region surrounding HRG C633T SNP is of relevance in vitro for regulation of human endometrial endothelial cell angiogenesis. To predict which embryos to transfer in IVF, we have highlighted a number of proteins of interest for further investigation.
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| 11. |
- Selin, Lotta, et al.
(författare)
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High-dose versus low-dose of oxytocin for labour augmentation : a randomised controlled trial
- 2019
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Ingår i: Women and Birth. - : ELSEVIER. - 1871-5192 .- 1878-1799. ; 32:4, s. 356-363
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Tidskriftsartikel (refereegranskat)abstract
- Problem: Delayed labour progress is common in nulliparous women, often leading to caesarean section despite augmentation of labour with synthetic oxytocin.Background: High-or low-dose oxytocin can be used for augmentation of delayed labour, but evidence for promoting high-dose is weak.Aim: To ascertain the effect on caesarean section rate of high-dose versus low-dose oxytocin for augmentation of delayed labour in nulliparous women.Methods: Multicentre parallel double-blind randomised controlled trial (ClinicalTrials.gov: NCT01587625) in six labour wards in Sweden. Healthy nulliparous women at term with singleton cephalic fetal presentation, spontaneous labour onset, confirmed delay in labour and ruptured membranes (n = 1351) were randomised to labour augmentation with either high-dose (6.6 mU/minute) or low-dose (3.3 mU/minute) oxytocin infusion.Findings: 1295 women were included in intention-to-treat analysis (high-dose n = 647; low-dose n = 648). Caesarean section rates did not differ between groups (12.4% and 12.3%, 95% Confidence Interval -3.7 to 3.8). Women with high-dose oxytocin had: shorter labours (-23.4 min); more uterine tachysystole (43.2% versus 33.5%); similar rates of instrumental vaginal births, with more due to fetal distress (43.8% versus 22.7%) and fewer due to failure to progress (39.6% versus 58.8%). There were no differences in neonatal outcomes.Discussion: Our study could not confirm results of two systematic reviews indicating, with weak evidence, that use of high-dose oxytocin was associated with lower frequency of caesarean section.Conclusion: We found no advantages for routine use of high-dose oxytocin in the management of delay in labour. Low-dose oxytocin regimen is recommended to avoid unnecessary events of tachysystole and fetal distress.
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| 12. |
- Stenson, David, et al.
(författare)
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Induction of labor in women with a uterine scar
- 2016
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Ingår i: The Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 29:20, s. 3286-3291
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the frequency of uterine rupture following induction of labor in women with a previous cesarean section. Misoprostol was compared to other methods of induction.Methods: A retrospective cohort study of 208 women attempting induction of labor after one previous cesarean section. Delivery data were collected retrospectively and compared. Group 1(2009-2010) was compared with Group 2 (2012-2013). In Group 1, the main method of induction was vaginal PGE(2) (prostaglandin-E-2), amniotomy, oxytocin or a balloon catheter. In Group 2, the dominant method of induction was an oral solution of misoprostol. Main outcome measures: frequency of uterine rupture in the two groups.Results: Nine cases (4.3%) of uterine rupture occurred. There was no significant difference in the frequency of uterine rupture following the change of method of induction from PGE(2), amniotomy, oxytocin or mechanical dilatation with a balloon catheter to orally administered misoprostol (4.1 versus 4.6%, p=0.9). All ruptures occurred in women with no prior vaginal delivery.Conclusion: The shift to oral misoprostol as the primary method of induction in women with a previous cesarean section did not increase the frequency of uterine rupture in the cohort studied.
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| 13. |
- Sterpu, Irene, et al.
(författare)
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No evidence for a placental microbiome in human pregnancies at term
- 2021
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier. - 0002-9378 .- 1097-6868. ; 224:3, s. 296.e1-296.e23
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Tidskriftsartikel (refereegranskat)abstract
- Background: The placenta plays an important role in the modulation of pregnancy immunity; however, there is no consensus regarding the existence of a placental microbiome in healthy full-term pregnancies.Objective: This study aimed to investigate the existence and origin of a placental microbiome.Study Design: A cross-sectional study comparing samples (3 layers of placental tissue, amniotic fluid, vernix caseosa, and saliva, vaginal, and rectal samples) from 2 groups of full-term births: 50 women not in labor with elective cesarean deliveries and 26 with vaginal deliveries. The comparisons were performed using polymerase chain reaction amplification and DNA sequencing techniques and bacterial culture experiments.Result: There were no significant differences regarding background characteristics between women who delivered by elective cesarean and those who delivered vaginally. Quantitative measurements of bacterial content in all 3 placental layers (quantitative polymerase chain reaction of the 16S ribosomal RNA gene) did not show any significant difference among any of the sample types and the negative controls. Here, 16S ribosomal RNA gene sequencing of the maternal side of the placenta could not differentiate between bacteria in the placental tissue and contamination of the laboratory reagents with bacterial DNA. Probe-specific quantitative polymerase chain reaction for bacterial taxa suspected to be present in the placenta could not detect any statistically significant difference between the 2 groups. In bacterial cultures, substantially more bacteria were observed in the placenta layers from vaginal deliveries than those from cesarean deliveries. In addition, 16S ribosomal RNA gene sequencing of bacterial colonies revealed that most of the bacteria that grew on the plates were genera typically found in human skin; moreover, it revealed that placentas delivered vaginally contained a high prevalence of common vaginal bacteria. Bacterial growth inhibition experiments indicated that placental tissue may facilitate the inhibition of bacterial growth.Conclusion: We found no evidence to support the existence of a placental microbiome in our study of 76 term pregnancies, which used polymerase chain reaction amplification and sequencing techniques and bacterial culture experiments. Incidental findings of bacterial species could be due to contamination or to low-grade bacterial presence in some locations; such bacteria do not represent a placental microbiome per se.
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| 14. |
- Sterpu, Irene, et al.
(författare)
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Predictive factors in pregnancies with reduced fetal movements : a pilot study
- 2022
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Ingår i: The Journal of Maternal-Fetal & Neonatal Medicine. - : Taylor & Francis. - 1476-7058 .- 1476-4954. ; 35:23, s. 4543-4551
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Tidskriftsartikel (refereegranskat)abstract
- Background Pregnancies with reduced fetal movements (RFM) are at risk for poor neonatal outcomes and stillbirth. Aim To investigate whether Doppler measurements or angiogenic factors are good predictors of adverse neonatal outcomes in pregnancies with RFM. Methods This is a prospective pilot cohort study of 3243 women seeking care for RFM. Standard care was carried out in all cases. An extra Doppler examination was performed in 128 women to assess the flow in the middle cerebral artery, the umbilical artery, and the uterine artery. In 62/128 pregnancies, a maternal blood sample was obtained for angiogenic and antiangiogenic factors. The composite neonatal outcome of the study was one or more of the following factors: Apgar score <7 at 5 ', arterial aPh in the umbilical cord <= 7.1, transfer to Neonatal Intensive Care (NICU), stillbirth, and small for gestational age (SGA). Results In 14.1% (18/128) of the Doppler group and 11.7% (365/3115) of the standard care group, there was an adverse neonatal outcome (p = .51). A higher intervention rate was found in the Doppler group (28% vs. 5.4%, p < .01). The predictive model of adverse neonatal outcomes in women with RFM with angiogenic factors was 0.73 (95% CI 0.54-0.92). The area under the curve improved to 0.89 (CI 95% 0.81-0.97) when parity was added to the model. Conclusion Angiogenic factors may have a place in the prediction of the neonatal outcome of RFM pregnancies. The prediction model's capacity was driven by parity. The obstetrical intervention rate increased with additional Doppler examinations.
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| 15. |
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| 16. |
- Sterpu, Irene, et al.
(författare)
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The association of second trimester biomarkers in amniotic fluid and fetal outcome
- 2019
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Ingår i: The Journal of Maternal-Fetal & Neonatal Medicine. - : TAYLOR & FRANCIS LTD. - 1476-7058 .- 1476-4954. ; 32:21, s. 3627-3632
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To identify the level of amniotic fluid lactate (AFL), placental growth factor (PLGF), and vascular endothelial growth factor (VEGF) at second trimester amniocentesis, and to compare levels in normal pregnancies with pregnancies ending in a miscarriage, an intrauterine growth restricted fetus (IUGR) or decreased fetal movements.Study design: A prospective cohort study. Amniotic fluid was consecutively collected at amniocentesis in 106 pregnancies. Fetal wellbeing at delivery was evaluated from medical files and compared with the levels of AFL, VEGF, and PLGF at the time of amniocentesis.Results: The median level of AFL was 6.9 mmol/l, VEGF 0.088 pg/ml, and PLGF 0.208 pg/ml. The median levels of AFL in pregnancies ended in miscarriage were significantly higher (10.7 mmol/l) compared to those with a live new-born (6.9 mmol/L, p = .02). The levels of VEGF (p = .2) and PLGF (p = .7) were not affected. In pregnancies with an IUGR, the median level of AFL was higher compared to those with normal fetal growth (p = .003). No differences VEGF (p = .5), but significant lower PLGF were found in IUGR pregnancies (p = .03).Conclusions: Pregnancies ending in a miscarriage or with IUGR had significantly higher median values of AFL but lower values of PLGF in the amniotic fluid at the time of second trimester amniocentesis compared to normal pregnancies.
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| 17. |
- Wallstrom, Tove, et al.
(författare)
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Induction of labor after one previous Cesarean section in women with an unfavorable cervix : A retrospective cohort study
- 2018
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 13:7
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Tidskriftsartikel (refereegranskat)abstract
- Objective Uterine rupture is a well-known but unusual complication in vaginal deliveries with a Cesarean section in the history. The risk of uterine rupture is at least two-fold when labor is induced. In Sweden, women are allowed to deliver vaginally after one previous Cesarean section, regardless if labor starts spontaneously or is induced. The aim of the study is to compare the proportion of uterine ruptures between the three methods (balloon catheter, Minprostin (R) and Cytotec (R)) for induction of labor in women with an unfavorable cervix and one previous Cesarean section. Material and methods Retrospective cohort study of all women with one previous Cesarean section and induction of labor with an unfavorable cervix at the four largest clinics in Stockholm during 20122015. Inclusion criteria: Women with a previous Cesarean section and induction of labor with a viable fetus, cephalic presentation, singleton, at >= 34 w, (n = 910). Results 3.0% (27/910) of the women with induction of labor had a uterine rupture, 91% of them had no previous vaginal delivery. The proportion of uterine ruptures was 2.0% (6/295) with orally administrated Cytotec (R), 2.1% (7/335) with balloon catheter and 5.0% (14/ 281) when Minprostin (R) was used. Conclusions No difference in the proportion of uterine ruptures was shown when orally administrated Cytotec (R) and balloon catheter were compared (p = 0.64). Orally administrated Cytotec (R) and balloon catheter give a high success rate of vaginal deliveries (almost 70%) despite an unfavorable cervix.
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| 18. |
- Wallström, Tove, et al.
(författare)
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Labor Induction with Orally Administrated Misoprostol : A Retrospective Cohort Study
- 2017
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Ingår i: BioMed Research International. - : Hindawi Limited. - 2314-6133 .- 2314-6141.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. One great challenge in obstetric care is labor inductions. Misoprostol has advantages in being cheap and stable at room temperature and available in resource-poor settings.Material and Methods. Retrospective cohort study of 4002 singleton pregnancies with a gestational age >= 34w at Sodersjukhuset, Stockholm, during 2009-2010 and 2012-2013. Previously usedmethods of labor induction were compared with misoprostol given as a solution to drink, every second hour. Main outcome is as follows: Cesarean Section (CS) rate, acid-base status in cord blood, Apgar score < 7,5 ', active time of labor, and blood loss > 1500 ml (PPH).Results. The proportion of CS decreased from 26% to 17% when orally given solution of misoprostol was introduced at the clinic (p < 0.001). No significant difference in the frequency of low Apgar score (p = 0.3), low aPh in cord blood (p = 0.1), or PPH (p = 0.4) between the differentmethods of induction was studied. After adjustment for different risk factor for CS the only method of induction which was associated with CS was dinoproston** (Propess (R)) (aor = 2.9 (1.6-5.2)).Conclusion. Induction of labor with misoprostol, given as an oral solution to drink every second hour, gives a low rate of CS, without affecting maternal or fetal outcome.
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| 19. |
- Wallström, Tove, et al.
(författare)
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Skin conductance activity in post-term pregnancies
- 2015
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Ingår i: The Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 28:16, s. 1912-1916
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The pain threshold in humans rises during late pregnancy, and the woman becomes less sensitive to stress. The aim of this study was to investigate whether monitoring the sympathetic nervous system response to stimuli by skin conductance activity might be a useful predictor of spontaneous onset of labour in post-term pregnancies. Study design: A prospective observational study. Fifty-two healthy pregnant women were consecutively asked for inclusion in the study at their post-term pregnancy examination. Initially, a Ctg (cardiotocography) registration was performed, followed by 5 min of skin conductance measurement including a ''cold pressor test''. Finally, a vaginal examination with a cervical assessment were performed according to clinical guidelines. Results: A statistically significant lower pain reaction during the period of provocation was seen in deliveries close to spontaneous onset of labour compared with induced deliveries with an non-spontaneous onset of labour before 294 days (p = 0.02). Sixty-three per cent (19/30) of the women with spontaneous onset had a negative value at provocation compared with 30% (6/20) in the induced group. Conclusions: Decreased response to pain stimuli, as an indication of decreased activity in the sympathetic nervous system, has a correlation to spontaneous onset of labour in post-term pregnancies.
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| 20. |
- Wiberg-Itzel, Eva, et al.
(författare)
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A randomized controlled trial of a new treatment for labor dystocia
- 2018
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Ingår i: The Journal of Maternal-Fetal & Neonatal Medicine. - : TAYLOR & FRANCIS LTD. - 1476-7058 .- 1476-4954. ; 31:17, s. 2237-2244
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Labor dystocia is an intransigent, high-profile issue in obstetric care. Amniotic fluid lactate (AFL) reflects the uterine metabolic status. High levels associate with subsequent need for operative intervention due to dystocia. In sports medicine, it is known that lactic acid can affect muscular performance and can be decreased by bicarbonate given orally before physical activity.Material and methods: Two hundred dystocic deliveries were included. At the confirmation of dystocia, the AFL-level was analyzed. Deliveries were randomized to an intake of bicarbonate or not. In the non-bicarbonate-group, stimulation with oxytocin was started immediately. In the bicarbonate-group, bicarbonate was given; and oxytocin was started 1hour after the intake. New sampling of AF was performed after 1hour in both groups. Outcome measured: if an oral intake of bicarbonate changes the AFL levels and enhances delivery outcome in dystocic deliveries.Results: Bicarbonate decreases the AFL levels (p<.001). The spontaneous vaginal delivery rate after treatment with bicarbonate was increased (p=.007), without affecting the fetal outcome.Conclusions: An increase of spontaneous vaginal deliveries resulted from bicarbonate ingestion by dystocic women. A decreased level of AFL-level was shown. This simple, low cost treatment has the potential to improve maternal morbidity and satisfaction worldwide.
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| 21. |
- Wiberg-Itzel, Eva
(författare)
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Ante partum determination of lactate in amniotic fluid
- 2005
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The present studies were conducted to investigate whether lactate determination in vaginal fluids, 'Lac-test', could be used as a diagnostic test for prelabour rupture of membranes (PROM). To derive the best cut-off value for a positive test and to asses weather lactate determination in vaginal fluid was associated with, and could predict, onset of labour for woman with suspect PROM. Lactate concentration was measured with the commercially available Lactate ProTM an electrochemical test strip method which needs only 5ul of fluid to analyze the lactate concentration. The test was carried out bedside and the result was available after 60 seconds. The studies were made as prospective observational studies in labour ward at Söder hospital Stockholm years 2002-2003. Paper I. Two hundred women with a history of suspect PROM after 34 weeks gestation were selected for determination of lactate concentrations in vaginal fluid. In 100 of these cases, actim PROM testTM were also analyzed. Sensitivity, specificity, positive and negative predictive values and Kappa indices were calculated. Results: A lactate concentration > 4.5 mmol/l was found to be the best cut-off value for a positive test. 'Lac-test' had a sensitivity of 86% (95% C.I. 77-96%), specificity 92% (95% C.I 84-99%), positive and negative predictive values of 92% and 87%, respectively. Likelihood ratio (LR) for a positive Lac-test was 10.75 and for a negative test 0. 15. The Kappa index for the 'Lactest' was 78%. Paper II. One hundred and seventy nine women attending labour ward at Söder hospital with suspect PROM after 34 weeks gestation were selected for determination of lactate concentrations in vaginal fluid. Association between time to spontaneous onset of labour within 24 hours and 48 hours and lactate concentration in vaginal fluid was analyzed. Results: The median time interval between examination and spontaneous onset of labour was 8.4 hours for those with "high" lactate (> 4.5 mmol/l) and 54 hours for those with "low" lactate concentrations (< 4.5 mmol/l). Among women with "high" lactate concentrations 76 (88%) started in labour within 24 hours, as compared with 20 (21%) for those with "low" lactate concentration, giving an Odds Ratio (OR) of 27.7; 95% C.I. 12-63.3. Conclusion: Lactate determination is a valid test in cases with a history of suspects PROM. High lactate concentration (> 4.5 mmol/l) in vaginal fluid is strongly associated with, and can predict, woman with suspect PROM spontaneous onset of labour within 24 hours and 48 hours.
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| 22. |
- Wiberg-Itzel, Eva, et al.
(författare)
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Association Between Adverse Neonatal Outcome and Lactate Concentration in Amniotic Fluid
- 2011
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Ingår i: Obstetrics and Gynecology. - 0029-7844 .- 1873-233X. ; 118:1, s. 135-142
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To estimate whether a high lactate concentration in amniotic fluid, together with cardiotocography, can be used as an indicator for an increased risk of adverse neonatal outcome at delivery. METHOD: A prospective cohort study was performed at two tertiary center labor wards in Sweden. Healthy women with full-term, singleton pregnancies and cephalic presentation in spontaneous active labor were included in the study (N=825). Lactate concentration in samples of amniotic fluid collected in the course of vaginal examinations during labor were correlated with cardiotocography 30 minutes before delivery and a composite score for adverse neonatal outcome. RESULTS: High lactate concentration in amniotic fluid (greater than 10.1 mmol/L) was associated with an adverse neonatal outcome (odds ratio [OR] 4.4, 95% confidence interval [CI] 2.3-8.2). Fetal bradycardia within 30 minutes before delivery was also associated with an increased risk of adverse neonatal outcome (OR 7.4, 95% CI 3.04-18.11). If lactate in amniotic fluid was greater than 10.1 mmol/L and bradycardia was seen together, the risk of delivering a neonate with an adverse neonatal outcome was increased 11-fold (OR 10.7, 95% CI 3.7-31.7). CONCLUSION: High lactate concentration in amniotic fluid and fetal bradycardia during the last 30 minutes before delivery indicate an increased risk of adverse neonatal outcome at delivery.
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| 23. |
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| 24. |
- Wiberg-Itzel, Eva, et al.
(författare)
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Lactate concentration in amniotic fluid : a good predictor of labor outcome
- 2010
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier BV. - 0301-2115 .- 1872-7654. ; 152:1, s. 34-38
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Previous publications have suggested that high levels of lactate in amniotic fluid (AF) correlate with dysfunctional labor. The aim of this study was to investigate whether lactate concentration in AF together with the partogram is a better predictor of operative intervention in dysfunctional labor than the partogram alone. Study design: A prospective observational study was carried out of 825 laboring women. Samples of AF were collected and the lactate concentration was analyzed at the bedside during labor. The main outcome of the study was the method of delivery (operative/spontaneous vaginal) in relation to the concentration of lactate in AF. Logistic regression was used to estimate the association between lactate concentration in AF and labor outcome and to adjust for well-known risk factors for dysfunctional labor. Results: 385/825 women had an arrested labor according to the partogram, and 193 of them were delivered operatively. High lactate in AF (> 10.1 mmol/l) when labor arrested was associated with an increased risk of operative intervention due to dysfunctional labor (adjusted OR, 5.4, 95% CI. 3.2-9.1). Low levels of lactate in AF (< 10.1 mmol/l) were associated with an increased probability of spontaneous vaginal delivery (adjusted OR, 2.7, 95% CI, 1.7-4.8). Conclusion: The partogram together with the concentration of lactate in AF is a better predictor of operative intervention in dysfunctional labor than the partogram alone.
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| 25. |
- Wiberg-Itzel, Eva
(författare)
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Lactate determination in ante- and intrapartum surveillance
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Lactate concentration is reported to be high in amniotic fluid (AF). Prelabour rupture of membranes (PROM) occur in about 20% of all pregnancies. The condition is associated with fetal and maternal complications, and might be a marker of imminent delivery. Therefore among women with suspected prelabour rupture of the membranes (PROM), it is of great importance to accurately confirm the diagnosis. In our studies we wanted to assess whether lactate determination in vaginal/amniotic fluid could be used as a diagnostic test for prelabour rupture of membranes, and could predict onset of labour in women with suspected PROM. We selected women with a history of suspect PROM after 34 weeks gestation for determination of lactate concentrations in vaginal fluid. A lactate concentration > 4.5 mmol/l was found to be the best cut-off value for a positive ‘Lactest’ and showed a sensitivity of 86% and specificity 92%.The median time interval between examination and spontaneous onset of labour among the women with `high´ lactate (> 4.5 mmol/l) were 8.4 hours and for those with `low´ lactate concentration (< 4.5 mmol/l) 54 hours. Among women with `high´ lactate concentration 88% started in labour within 24 hours, as compared with 21% for those with `low´ lactate concentration. Labour dystocia is clinically defined as slow or arrest of progress during labour and is a common obstetrical problem worldwide. In our study we looked for an association between high lactate concentration in amniotic fluid and labour dystocia. We selected women in active labour attending labour ward, and performed at least two consecutive measurements of lactate concentration in amniotic fluid during labour. Among women with spontaneous vaginal deliveries (n=23) the mean lactate concentration in AF during labour was 8.9 mmol/l and among women with labour dystocia (n=31) the corresponding value was 10.9 mmol/l (p <0.001). Of 29 women with a high lactate concentration (>10.1 mmol/l) in at least two consecutive measures, 86% were delivered instrumentally/operatively due to dystocia. Using this definition of a positive test gives a sensitivity of 81% a specificity of 82%, a positive predictive value of 86%, and a negative predictive value of 76%. Fetal surveillance during labor is often based on fetal heart rate monitoring using the cardiotocograph (CTG). A normal CTG is reassuring for a well oxygenated fetus. However, a non-reassuring trace occurs in up to 50% of all recordings, but only a small proportion of these fetuses are at risk of hypoxia. In a multicentre trial we wanted to compare pH vs. lactate analysis, regarding prevention of acidemia at birth. 2992 women in labour were randomised to pH (n=1,496) or lactate analysis (n=1,496). Protocol violations were significantly less frequent in women randomised to lactate compared with women randomised to pH analysis, 11.0% vs. 1.5%. There were no significant differences between the groups in the rate of metabolic acidemia (RR 0.96) or pH <7.00 (RR 0.88) in cord artery blood at birth. We have with this thesis shown the usefulness of determination of lactate in AF and fetal blood sampling. Lactate in AF can be used in the diagnosis of suspected PROM, in the prediction of spontaneous onset of labour for women with suspected PROM, and also in the diagnosis of labour dystocia. We have shown lactate analysis of fetal scalp blood to be at least as good as pH analysis in the management of intrapartum fetal distress.
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| 26. |
- Wiberg-Itzel, Eva, et al.
(författare)
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Lactate in Amniotic Fluid : Predictor of Labor Outcome in Oxytocin-Augmented Primiparas' Deliveries
- 2016
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:10
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: One of the major complications related to delivery is labor dystocia, or an arrested labor progress. Many dystocic deliveries end vaginally after administration of oxytocin, but a large numbers of women with labor dystocia will undergo a long and unsafe parturition. As a result of the exertion required in labor, the uterus produces lactate. The uterine production of lactate is mirrored by the level of lactate in amniotic fluid (AFL).OBJECTIVES: To evaluate whether the level of AFL, analysed in a sample of amniotic fluid collected vaginally at arrested labor when oxytocin was needed, could predict labor outcome in nulliparous deliveries.METHODS: A prospective multicentre study including 3000 healthy primiparous women all with a singleton pregnancy, gestational age 37 to 42 weeks and no maternal /fetal chronic and/or pregnancy-related conditions. A spontaneous onset of labor, regular contractions and cervical dilation ≥ 3 cm were required before the women were invited to take part in the study.RESULTS: AFL, analysed within 30 minutes before augmentation, provides information about delivery outcome. Sensitivity for an acute cesarean section according to high (≥10.1mmol/l) or low (< 10.1mmol/l) AFL values was 39.0% (95% CI; 27-50), specificity 90.3% (95% CI; 87-93) PPV 37.3% (95% CI; 27-48) and NPV was 91.0% (95% CI; 88-93). The overall percentage of correct predictions of delivery outcome when the AFL level was used was 83.7%. Deliveries with a high AFL-level correlated with delivery time >12h (p = 0.04), post-partum fever (>38°C, p = 0.01) and post-partum haemorrhage >1.5L (p = 0.04).CONCLUSION: The AFL is a good predictor of delivery outcome in arrested nulliparous deliveries. Low levels of AFL may support the decision to continue a prolonged vaginal labor by augmentation with oxytocin. A high level of AFL correlates with operative interventions and post-partum complications.
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| 27. |
- Wiberg-Itzel, Eva, et al.
(författare)
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Level of lactate in amniotic fluid and its relation to the use of oxytocin and adverse neonatal outcome
- 2014
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 93:1, s. 80-85
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo assess whether the frequency of adverse neonatal outcome at delivery is related to the level of lactate in amniotic fluid and to the use of oxytocin. DesignProspective observational study. SettingSoder Hospital, Stockholm, Sweden. PopulationSeventy-four women in active labor with a gestational age 36weeks and mixed parity. MethodsLevels of lactate in amniotic fluid were analyzed bedside from an intrauterine catheter every 30min during labor. Deliveries were divided into groups with and without oxytocin. Main outcome measuresThe frequency of adverse neonatal outcome at delivery. ResultOf the deliveries 13.5% (10/74) concluded with an adverse neonatal outcome. The levels of lactate in amniotic fluid increased during labor, more so in deliveries where oxytocin was used. In the group with an adverse neonatal outcome, the level of lactate in amniotic fluid was significantly higher in the final sample before delivery (p=0.04). In 18 deliveries, stimulation with oxytocin was temporarily halted for at least 30min due to overly stimulated labor contractions. A decreasing level of lactate in amniotic fluid was shown within a median 5%/30min. In the group where the administration of oxytocin was halted, there was no adverse neonatal outcome. ConclusionThe frequency of adverse neonatal outcome was associated with the level of lactate in amniotic fluid and with the use of oxytocin. The level of lactate in amniotic fluid may be an additional valuable tool when oxytocin is administered during labor.
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| 28. |
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| 29. |
- Wiberg-Itzel, Eva, et al.
(författare)
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The association between dystocic labors and circadian signals
- 2013
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier. - 0002-9378 .- 1097-6868. ; 208:1, s. S139-S140
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: Human deliveries commonly occur during the dark period of the day. Melatonin hormone is released as a circadian signal from the human brain, and has been shown to have a synergistic effect together with oxytocin in facilitating the uterine contractions during labor. Melatonin is inhibited by light and energized by dark. During winter the numbers of light hours per day in Sweden are few, but during the summer they are numerous. In Tanzania there is no season difference.Study Design: In 2011,452 Tanzanian and 919 Swedish healthy primiparas with a normal pregnancy and a spontaneous onset of labor were included in the study. Time and date together with the length and outcome of delivery were studied, and a statistical comparison was made.Results: 47% of the Swedish deliveries started in early morning, and 48% ended at midnight. The median time of active labor was significantly longer during the summer season (May to August vs. November to February, p=0.05). The frequency of labor dystocia was increased during summer season, and significantly more in the region on Sweden with midnight sun (29 vs. 40%, p=0.03).48% of Tanzania labors started at midnight, and 41% ended at lunch time. Among Tanzanian women, no difference in median time of active delivery (p=0.5) or the frequency of dystocic labors was shown, according to season of the year (13.7 vs. 14.1 %, p=0.8).Oxytocin was used in 68% of the Swedish deliveries, and the use was higher during the summer season. Oxytocin was used in 31% of the Tanzanian deliveries. No difference in use of oxytocin was shown according to season.Conclusion: In this project a variation of labor dystocia according to season of the year has been studied. A significant overrepresentation of prolonged and dystocic deliveries were shown during the summer season in Sweden. This new knowledge may be of a great importance, when handling a dysfunctional labor.
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| 30. |
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| 31. |
- Wiberg-Itzel, Eva, et al.
(författare)
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The dysfunctional labor study
- 2014
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 0002-9378 .- 1097-6868. ; 210:1, s. S328-S329
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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