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| 2. |
- Noren, Håkan, 1948, et al.
(författare)
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STAN in clinical practice--the outcome of 2 years of regular use in the city of Gothenburg
- 2006
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Ingår i: Am J Obstet Gynecol. ; 195:1, s. 7-15
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The purpose of this study was to monitor the introduction of the STAN-methodology (Noventa Medical, Moelndal, Sweden). STUDY DESIGN: This was a prospective observational study covering the total population of deliveries at term during 2 years. Four thousand eight hundred and thirty out of 14,687 term pregnancies were monitored using the STAN S 21 fetal heart monitor and the associated clinical guidelines. Cord artery metabolic acidosis, neonatal outcome, and rates of operative deliveries for fetal distress were assessed. RESULTS: The annual rate of STAN usage increased from 28.1% to 37.7% and was associated with a significant reduction in metabolic acidosis rate in the total population from 0.76% to 0.44% (P < .05). The compliance with the clinical guidelines increased in cases requiring intervention. The rates for moderate/severe hypoxic neonatal encephalopathy were consistently low, 0.55 and 0.68 per 1000 deliveries, respectively, and corresponding to previous findings. The rate of operative delivery did not change during the 2 years in the total population. CONCLUSION: Increasing STAN usage provided consistent improvements in fetal outcome equalling those noted in the Swedish randomized controlled trial (RCT) without increasing operative interventions for fetal distress.
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| 3. |
- Thorek, D L J, et al.
(författare)
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Prostate-specific kallikrein-related peptidases and their relation to prostate cancer biology and detection. Established relevance and emerging roles.
- 2013
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Ingår i: Thrombosis and haemostasis. - 0340-6245. ; 110:3, s. 484-92
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Tidskriftsartikel (refereegranskat)abstract
- Kallikreins are a family of serine proteases with a range of tissue-specific and essential proteolytic functions. Among the best studied are the prostate tissue-specific KLK2 and KLK3 genes and their secreted protease products, human kallikrein 2, hk2, and prostate-specific antigen (PSA). Members of the so-called classic kallikreins, these highly active trypsin-like serine proteases play established roles in human reproduction. Both hK2 and PSA expression is regulated by the androgen receptor which has a fundamental role in prostate tissue development and progression of disease. This feature, combined with the ability to sensitively detect different forms of these proteins in blood and biopsies, result in a crucially important biomarker for the presence and recurrence of cancer. Emerging evidence has begun to suggest a role for these kallikreins in critical vascular events. This review discusses the established and developing biological roles of hK2 and PSA, as well as the historical and advanced use of their detection to accurately and non-invasively detect and guide treatment of prostatic disease.
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| 4. |
- Aladdin Haglund, Berit, et al.
(författare)
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Unexpected out-of-hospital deliveries--experiences from the Gothenburg area. Centralized obstetrical care requires competent ambulance staff
- 2004
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Ingår i: Lakartidningen. ; 101:41, s. 3148-50
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Tidskriftsartikel (refereegranskat)abstract
- One hundred and sixty-seven women gave birth before arrival at the hospital during a six-year period in the Goteborg area. Most of these women had given birth before. The actual delivery most often started at term during the night, proceeded normally but rapidly and the neonatal outcome was good. Sixty-two per cent of the women delivered at home. Complicated lacerations or major hemorrhages were uncommon. The distance to the delivery ward was one of the risk factors for prehospital delivery. This is important to take into consideration in the ongoing process of centralizing the delivery clinics. Basic knowledge in obstetrics is mandatory for the ambulance personnel, as well as regular observation visits to the delivery ward and practice in birth simulators.
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| 5. |
- Bergqvist, Liselotte, et al.
(författare)
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Labor augmentation by means of oxytocin – women's experiences
- 2007
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Ingår i: American Journal of Obstetrics and Gynecology. ; 195:6
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective To study labor experiences in women exposed to oxytocin treatment vs no or delayed treatment of spontaneous, but prolonged labor in nulliparos women. Study design A randomised controlled study. If labor was prolonged during the active phase with no further opening of the cervix for two hours, the subject were randomly allocated to either labor augmentation by means of oxytocin (SG) or expectancy (EG). 461 women filled out a questionnaire including the following items: level of sense of security, pain, sense of control, experience of their own role in labor, and satisfaction with healthcare. Results The oxytocin-treated women's labor experiences did not differ in secondary inertia as compared with the women who chose to delay oxytocin treatment for three hours. The number of women who experienced a labor that met with their expectations was significantly higher in the oxytocin group than in the delay group. Both groups had a high level of lasting memories from their labor experience that resulted in a state of depression or low-spiritedness one month postpartum, SG (41%) and EG (35%), with no significant difference between the two groups. Conclusion Although the labor experiences of both groups were equivalent, the women of the oxytocin group felt that their labor process had proceeded as expected to a higher degree than the women who postponed oxytocin treatment for three hours. Hence, this study does not support the assertion that there would be a difference in labor experience if oxytocin stimulation is postponed. Many patients with inertia have lasting memories from the labor process which result in a state of depression or low-spiritedness one month postpartum, SG (41%) and EG (35%). Questionnaires filled out from women without inertia showed that the group giving spontaneous birth withouth any intravenous drip the proportion for depression was 12%.
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| 6. |
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| 7. |
- Bullarbo, Maria, 1958, et al.
(författare)
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Nitroglycerin for management of retained placenta: a multicenter study.
- 2012
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Ingår i: Obstetrics and gynecology international. - : Hindawi Limited. - 1687-9597 .- 1687-9589. ; 2012
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim was to determine if sequential administration of oxytocin and nitroglycerin is effective for management of retained placenta when performed by obstetricians with no experience of the method. Secondary aims were to examine possible adverse effects of nitroglycerin. One hundred and five women with retained placenta were randomly selected to receive either 1mg nitroglycerin or placebo tablets sublingually if intravenous oxytocin had failed to expel the placenta. At two of the hospitals some of the midwives were familiar with the use of nitroglycerin. The other midwives and all the participating obstetricians had no clinical experience of the method. In the treatment group, detachment of placenta following nitroglycerin occurred in 37.3% of the women compared to 20.4% in the placebo group (P = 0.056). In the two hospitals with some experience of the method, placenta was removed in 9 of 19 (47.4%) women in the nitroglycerin group compared to 3 of 17 (15.0%) women in the placebo group. No adverse effects of clinical importance were registered. Although the difference between the two groups did not reach statistical significance, the higher success rate in the two hospitals with some experience could indicate that clinical experience is of importance in order to achieve placental detachment.
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| 8. |
- Dencker, Anna, 1956, et al.
(författare)
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A randomized trial of labor augmentation by oxytocin vs delayed oxytocin treatment or no oxytocin in nulliparous women with spontaneous contractions
- 2005
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Ingår i: American Journal of Obstetrics and Gynecology. ; 193:6
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective To study the effects of oxytocin treatment vs. no or delayed oxytocin treatment on the obstetrical and neonatal outcome of spontaneous but prolonged labor in nulliparous women. Study design A randomized controlled study of healthy nulliparous women at term with normal pregnancies and spontaneous labor. If labor was prolonged during the active phase with no further opening of the cervix or descent of the head for two hours the women were randomly allocated to either labor augmentation by oxytocin infusion (standard care group= SG) or to expectancy (Expectant care group=EG) and observed for another 3 hours. If the women in the EG after the 3 hours still do not progress in their labor, a reassessment regarding the need for labor augmentation was done. Results Totally 516 women participated in the study, 276 in the SG and 241 in the EG. All 241 women in the SG received oxytocin vs 211 (87.6%) in the EG (p<0,001). There were no differences in gestational age between the groups. Mean gestational age was 40 weeks in both groups. There were no difference in cervical dilatation at randomization, cx dilatation in centimeters was 5,7 (SD1,5) in the SG vs 5,5 (SD 1,3), p= 0.17 in the EG. The time from randomization to delivery differed, 332 (SD=211) minutes in the SG vs 457 (SD=238) minutes in the EG (p <.0001). There was no differences in mode of delivery, Caesarean sectio 23 (8,3%) in the SG vs 21 (8,7%) in the EG, (p=0.9), operative vaginal delivery 44 (15,9%) SG vs 25 (10,4%) EG p=0.07, Spontaneous vaginal delivery 209 (75,7%) SG vs 195 (80,9%) EG p=0.2,. Usage of epidural anesthesia was 29 (10,5%) SG vs 39 (16,2%) EG p=0.07. Apgar score below 7 after 5 minutes was found in 5 (1.8%) in SG vs 9 (3.7%) in EG. Conclusion In nulliparous women at term with spontaneous contractions a policy of delaying the initiation of oxytocininfusion in prolonged active phase for 180 minutes resulted in no difference in mode of delivery, usage of epidural anesthesia or neonates with apgar score below 7 at 5 minutes. The time from randomization to delivery differed by 125 minutes.
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| 9. |
- Dencker, Anna, 1956, et al.
(författare)
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Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument.
- 2010
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Ingår i: BMC pregnancy and childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 10:81
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Tidskriftsartikel (refereegranskat)abstract
- Background: Negative experiences of first childbirth increase risks for maternal postpartum depression and may negatively affect mothers' attitudes toward future pregnancies and choice of delivery method. Postpartum questionnaires assessing mothers' childbirth experiences are needed to aid in identifying mothers in need of support and counselling and in isolating areas of labour and birth management and care potentially in need of improvement. The aim of this study was to develop and evaluate a questionnaire for assessing different aspects of first-time mothers' childbirth experiences. Methods: Childbirth domains were derived from literature searches, discussions with experienced midwives and interviews with first-time mothers. A draft version of the Childbirth Experience Questionnaire (CEQ) was pilot tested for face validity among 25 primiparous women. The revised questionnaire was mailed one month postpartum to 1177 primiparous women with a normal pregnancy and spontaneous onset of active labor and 920 returned evaluable questionnaires. Exploratory factor analysis using principal components analysis and promax rotation was performed to identify dimensions of the childbirth experience. Multitrait scaling analysis was performed to test scaling assumptions and reliability of scales. Discriminant validity was assessed by comparing scores from subgroups known to differ in childbirth experiences. Results: Factor analysis of the 22 item questionnaire yielded four factors accounting for 54% of the variance. The dimensions were labelled Own capacity, Professional support, Perceived safety, and Participation. Multitrait scaling analysis confirmed the fit of the four-dimensional model and scaling success was achieved in all four sub-scales. The questionnaire showed good sensitivity with dimensions discriminating well between groups hypothesized to differ in experience of childbirth. Conclusion: The CEQ measures important dimensions of the first childbirth experience and may be used to measure different aspects of maternal satisfaction with labour and birth.
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| 10. |
- Dencker, Anna, 1956, et al.
(författare)
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Deficiency in rest and nutrition increase the risk for prolonged labor in nulliparous women
- 2007
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Ingår i: American Journal of Obstetrics and Gynecology. ; 195:6
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Konferensbidrag (refereegranskat)abstract
- Objective To identify factors that may influence the labor progress in nulliparous women with spontaneous contractions. Study design A prospective study of healthy nulliparous women at term with normal pregnancies and spontaneous labor. At inclusion the women were asked to measure levels of pain and sense of security on a Visual Analogue Scale and asked to report amount of rest/sleep and intake of food during the last 24 hours before onset of active labor. The progress of labor was followed every 2-3 hours and new VAS-measurements were made postpartum. Prolonged labor was defined as no further opening of the cervix for two hours after amniotomy or rupture of the membranes in the first stage of labor. Results After informed consent 2,086 nulliparous women in active labor with spontaneous contractions were included in the study. Prolonged labor was defined in 29% of the women (n=614). The women who developed a prolonged labor reported fewer hours of rest/sleep (p<0.0001) and a lower intake of food (p<0.0001) during the last 24 hours than the women with normal progress in the first stage of labor. At inclusion the women with normal progress measured higher levels of labor pain (p=0.002) together with more frequent contractions (p<0.0001) at onset of active labor. Cesarean section was more often performed among the women with prolonged labor, 11.7% versus 1,3% (p<0.0001). Postpartum the women with prolonged labor measured lower levels of experienced sense of security during the delivery (p=0.0009). There was no difference in mean of experienced labor pain between the groups postpartum. Conclusion Low intake of food and few hours of rest can contribute to prolonged labor among low risk nulliparous women with spontaneous contractions.
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| 11. |
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| 12. |
- Dencker, Anna, 1956, et al.
(författare)
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Identification of latent phase factors associated with active labor duration in low-risk nulliparous women with spontaneous contractions
- 2010
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Ingår i: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA. - 0001-6349. ; 89:8, s. 1034-1039
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The aim of this prospective study was to identify latent phase predictors of active labor duration. Design. Prospective clinical study. Setting. Two delivery units in Sweden. Sample. Healthy nulliparous women with a normal pregnancy, spontaneous onset of active labor at term, and a cervical dilatation of 4 cm or more on admission to the delivery ward (n = 2,072). Methods. The women were asked to answer questions concerning their food and fluid intake, amount of rest and sleep during the preceding 24 hours and to assess their labor pain, sense of security and expectations of the childbirth on a visual analog scale (VAS). Duration and intervals of contractions, cervical dilatation, and position of the fetal head were noted by the midwife. A multiple regression analysis was performed with active labor duration as the outcome variable. Main outcome measure. Predictive factors of active labor duration. Results. Normal food intake during the preceding 24 hours was associated with short labor duration. A long latent phase, low levels of assessed labor pain and few hours of rest and sleep during the preceding 24 hours were significant independent predictors of extended active labor duration, when high birth weight, long contraction intervals, slight cervical dilatation, intact membranes within 2 hours of admission, high maternal age and malposition of the fetal head were controlled for. Conclusion. New findings are that latent phase duration as well as food intake and the amount of rest and sleep during the preceding 24 hours are independent predictors of labor duration. Read More: http://informahealthcare.com/doi/abs/10.3109/00016349.2010.499446
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| 13. |
- Dencker, Anna, 1956, et al.
(författare)
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Predictive factors related to labour duration in healthy nulliparous women with spontaneous onset of active labour - a prospective study
- 2011
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Ingår i: ICM 29th Triennial Congress i Durban, Sydafrika 19 - 23 Juni 2011.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Slow progress in labour is a major problem among nulliparous women as it is one of the main indications for emergency caesarean deliveries and related to several other adverse maternal and neonatal outcomes. Aim: To identify predictive factors of labour duration in healthy nulliparous women. Setting: Two delivery units in Sweden, between October 1998 and December 2003. Participants: Healthy nulliparous women (n=2.072) with a normal pregnancy, spontaneous onset of active labour at term and a cervical dilatation of 4 – 9 centimetres at admission to the delivery ward. All gave informed consent. Methods: At admission to the delivery ward the women were asked to answer questions concerning food and fluid intake, amount of rest/sleep the last 24 hours and to assess labour pain. Contractions, cervical dilation and the number and timing of interventions as epidural analgesia and oxytocin augmentation were noted by the midwife during childbirth. Key findings: Normal food intake during the preceding 24 hours was associated with short labor duration. A long latent phase, low levels of assessed labor pain and few hours of rest and sleep during the preceding 24 hours were significant independent predictors of extended active labor duration, when high birth weight, long contraction intervals, slight cervical dilatation, intact membranes within two hours of admission, high maternal age and malposition of the fetal head were controlled for. Amniotomy decreased and epidural analgesia increased labour duration. Use of oxytocin augmentation had most influence on decreased labour duration. Clinical implications: More attention should be devoted to latent phase factors in clinical practice and counseling to women who are about to give birth should include information about the benefits of food intake and rest during the latent phase.
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| 14. |
- Fagevik Olsén, Monika, 1964, et al.
(författare)
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A comparison of high- versus low-intensity, high-frequency transcutaneous electric nerve stimulation for painful postpartum uterine contractions
- 2007
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 86:3, s. 310-4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Breast-feeding in the postpartum period is known to induce intense uterine contractions with pain in the lower abdomen. AIMS: The primary aim of this study was to compare the effects of high and low intensity, high frequency Transcutaneous Electric Nerve Stimulation (TENS) on pain and discomfort of postpartum uterine contractions. The secondary aim was to evaluate discomfort experienced from the stimulation itself. METHODS: Twenty-one newly delivered women participated in this single-blind trial, 12 women received high intensity, high-frequency TENS (HI TENS) and 9 women received low intensity, high-frequency TENS (LI TENS). The electrodes were placed abdominally on each side of the uterus. Stimulation was done during one minute. Visual analogue scales were used to evaluate the intensity of the pain before and after stimulation. A verbal scale was used to estimate sensation of discomfort before, during and after stimulation. RESULTS: The median decrease in pain ratings before and after treatment by VAS was larger in the HI TENS group -49 mm (95% CI -66.5--33.2) than in the LI TENS group -21 mm (95% CI -39.0--20.0). The reduction of pain was most pronounced in the HI TENS group (median difference 28 (95% CI was 14.0-53.0). Furthermore, the HI TENS group experienced significantly less discomfort of the uterine contractions after stimulation (p<0.01) but they also experienced more discomfort of the stimulation than women in the LI TENS group (p<0.01). CONCLUSION: The women treated with HI TENS, experienced significantly less postpartum pain and discomfort to those treated with LI TENS even though the discomfort from the stimulation with HI TENS was greater.
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| 15. |
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| 16. |
- Mollberg, Margareta, 1953, et al.
(författare)
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High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population-based study
- 2005
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Ingår i: Acta Obstet Gynecol Scand. ; 84:7, s. 654-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Obstetrical brachial plexus palsy (OBPP) is a serious form of neonatal morbidity. OBJECTIVE: The aim of this work was to study the incidence of OBPP and to analyze its risk factors. METHODS: This is a population-based retrospective case-control study. All deliveries recorded in the Swedish Medical Birth Registry between 1987 and 1997 (n = 1 213 987) were investigated. Cases (n = 2399) with OBPP were compared to all other cases. RESULTS: The incidence of OBPP increased from 0.17 in 1987 to 0.27% in 1997 (p = 0.002). During the same time period, the mean birthweight increased from 3483 to 3525 g. Birthweight increasing from 4000 g was associated with a progressive rise in OBPP risk. Other significant risk factors associated with the injury were shoulder dystocia, breech presentation in vaginal delivery, operative vaginal delivery, diabetes mellitus, induction of labor, protracted active phase, secondary arrest of dilatation, and epidural anesthesia. Cesarean section was associated with a decreased risk of OBPP. If 5000 g is chosen as cut-off for cesarean section, 85% of the infants in this weight class are underestimated using ultrasonography. Approximately, 331 abdominal deliveries have to be performed to avoid one case of OBPP. CONCLUSIONS: Shoulder dystocia and infant birthweight of 4500 g and more are the strongest risk factors for OBPP in a Swedish population.
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| 17. |
- Mollberg, Margareta, 1953, et al.
(författare)
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Risk factors for obstetric brachial plexus palsy among neonates delivered by vacuum extraction
- 2005
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Ingår i: Obstet Gynecol. ; 106:5 Pt 1, s. 913-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The risk of obstetric brachial plexus palsy (OBPP) is increased in infants delivered instrumentally. The aim of this study was to identify risk factors for OBPP and to evaluate the association between possible risk factors linked to the duration of the vacuum extraction procedure and the subsequent risk. METHODS: A population-based retrospective design was adopted. Using a national registry of operative vaginal deliveries linked to the Medical Birth Registry in Sweden, we evaluated by univariate and multiple logistic regression analyses the risk factors for OBPP in 13,716 women delivered by vacuum extraction. The variables assessed in the multiple logistic regression analysis were shoulder dystocia, fetal birth weight of 3,999 g or greater, fundal pressure, number of tractions, vacuum application time, parity, vacuum silicone cup, epidural anesthesia, and fetal head at the level of the ischial spines at vacuum application time. RESULTS: Obstetric brachial plexus palsy was recorded in 153 (1.1%) infants. The following variables increased significantly the risk of OBPP in the newborn: shoulder dystocia (odds ratio 16.0; 95% confidence interval 8.9-28.7), fetal birth weight of 3,999 g or greater (7.1; 4.8-10.5), and administration of fundal pressure (1.6; 1.1-2.3). The probability of the risk of OBPP in vacuum-assisted deliveries increased in relation to vacuum extraction time (minutes). CONCLUSION: Shoulder dystocia in the setting of vacuum extraction is a prominent risk factor for OBPP in the newborn. The risk of OBPP increases with the time required for vacuum extraction. LEVEL OF EVIDENCE: II-3.
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| 21. |
- Wiklund, Ingela, et al.
(författare)
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Indications for cesarean section on maternal request - Guidelines for counseling and treatment
- 2012
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 3:3, s. 99-106
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim was to find scientific evidence and, based on this, to develop national medical guidelines in Sweden for cesarean section on mother's request. Background: More than 17% of all births in Sweden in 2008 were cesarean sections, compared to 5% at the beginning of the 1970s. About 8% of the cesarean sections were performed at mother's request. The predominant reason for this preference is fear of childbirth. When deciding whether to perform an elective cesarean section, the obstetrician must emphasize the long- and short-term health consequences for the mother and her baby, as well as weigh the risks associated with the procedure itself against not performing the procedure. Clarification is needed to determine for which conditions it is appropriate to comply with the mother's request. Materials and method: A literature review was conducted to identify factors that were relevant as an argument to meet the request for cesarean section on maternal request. The authors analyzed these factors individually to determine. Findings: The guidelines suggest that it is appropriate to comply with a woman's request for cesarean section if the reason for her request is deemed sufficiently serious and if, after participating in a counseling program, the woman persists in her request for cesarean section. Conclusion: A request for cesarean section where no medical indication is present should not be met without considerations concerning the safety of the mother and her baby, while also weighing the risk of adverse outcomes for mother and baby. © 2012 Elsevier B.V..
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