| 1. |
- Baldvinsdottir, Tinna, et al.
(author)
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Improved clinical management but not patient outcome in women with postpartum haemorrhage-An observational study of practical obstetric team training
- 2018
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In: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 13:9
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Journal article (peer-reviewed)abstract
- Objective Postpartum haemorrhage (PPH) is the most common obstetric emergency. A well-established postpartum haemorrhage protocol in the labour ward is crucial for effective treatment. The aim of the study was to investigate if practical obstetric team training improves the patient outcome and clinical management of PPH. Setting The practical obstetric team training (PROBE) at Linkoping University Hospital, Sweden, with approximate 3000 deliveries annually, was studied between the years of 2004-2011. Each team consisted of one or two midwives, one obstetrician or one junior doctor and one nurse assistant. Emergency obstetrics cases were trained in a simulation setting. PROBE was scheduled during work hours at an interval of 1.5 years. Population Pre-PROBE women (N = 419 were defined as all women with vaginal birth between the years of 2004-2007 with an estimated blood loss of amp;gt;= 1000 ml within the first 24 hours of delivery. Post-PROBE women (N = 483) were defined as all women with vaginal birth between the years of 2008-2011 with an estimated blood loss of amp;gt;= 1000 ml within the first 24 hours of delivery. The two groups were compared regarding blood loss parameters and management variables using retrospective data from medical records. Results No difference was observed in estimated blood loss, haemoglobin level, blood transfusions or the incidence of postpartum haemorrhage between the two groups. Post-PROBE women had more often secured venous access (pamp;lt;0.001), monitoring of vital signs (pamp;lt;0.001) and received fluid resuscitation (pamp;lt;0.001) compared to pre-PROBE women. The use of uterine massage was also more common among the post-PROBE women compared with the pre-PROBE women (pamp;lt;0.001). Conclusion PROBE improved clinical management but not patient outcome in women with postpartum haemorrhage in the labour ward. These new findings may have clinical implications since they confirm that training was effective concerning the management of postpartum haemorrhage. However, there is still no clear evidence that simulation training improve patient outcome in women with PPH.
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| 2. |
- Björkman, Stina, et al.
(author)
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Microvascular dysfunction in women with a history of hypertensive disorders of pregnancy: A population-based retrospective cohort study
- 2024
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In: British Journal of Obstetrics and Gynecology. - : WILEY. - 1470-0328 .- 1471-0528. ; 131:4, s. 433-443
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Journal article (peer-reviewed)abstract
- ObjectiveTo evaluate microvascular function in women with previous hypertensive disorders of pregnancy (HDP).DesignRetrospective population-based cohort study.SettingLinkoping, Sweden.PopulationWomen aged 50-65 years, participating in the Swedish CArdioPulmonary bioImage Study (SCAPIS) at one site (Linkoping) 2016-18, who underwent microcirculatory assessment (N = 1222).MethodsForearm skin comprehensive microcirculatory assessment was performed with a PeriFlux PF6000 EPOS (Enhanced Perfusion and Oxygen Saturation) system measuring oxygen saturation and total speed resolved perfusion. Obstetric records were reviewed to identify women with previous HDP. Data on cardiovascular risk factors, comorbidities, medication, lifestyle, anthropometric data, and biochemical analyses were obtained from SCAPIS. The microcirculatory data were compared between women with and without previous HDP.Main outcome measuresSkin microcirculatory oxygen saturation and total speed resolved perfusion at baseline and post-ischaemic peak.ResultsWomen with previous pre-eclampsia displayed impaired post-ischaemic peak oxygen saturation compared with women with normotensive pregnancies (88%, interquartile range [IQR] 84-89% vs 91%, IQR 87-94%, p = 0.001) 6-30 years after pregnancy. The difference remained after multivariable adjustment (& beta; -2.69, 95% CI -4.93 to -0.45).ConclusionsThe findings reveal microvascular dysfunction at long-term follow up in women with previous pre-eclampsia and strengthen the possible role of endothelial dysfunction as a link to the increased risk of cardiovascular disease in women with HDP.
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| 3. |
- Bränn, Emma, et al.
(author)
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Who do we miss when screening for postpartum depression? : A population-based study in a Swedish region
- 2021
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In: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 287, s. 165-173
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Journal article (peer-reviewed)abstract
- BackgroundUniversal screening for postpartum depression is crucial for early detection, interventions and support. The aim of this study was to describe the proportion of, and explore risk factors for, women not being offered screening, as well as for declining an offer or not being screened due to any other unknown reason.MethodsSocioeconomic, obstetrical and neonatal data, extracted from the Swedish Pregnancy Registry, for 9,959 pregnancies recorded for the Östergötland county between 2016 and 2018 were linked to Edinburgh Postnatal Depression Scale (EPDS) screening results at 6–8 weeks postpartum, extracted from medical records. Risk factors were assessed using logistic regression models and with a nomogram for easy visualization.ResultsIn total, there were no recorded offers of EPDS screening in the medical records for 30.0% of women at the postpartum follow-up. Women born outside of Sweden and women reporting poor self-rated health were at increased risk of not being offered screening for postpartum depression.LimitationsThere is a possibility that women were offered screening or were screened, but this was incorrectly or never recorded in medical records.ConclusionsThe majority of women were offered screening for postpartum depression, but there is room for improvement in order to achieve universal screening. Awareness among healthcare providers of the risk factors for not screening might increase adherence to guidelines for universal screening. Overcoming barriers for screening and raising the topic of mental-health issues for postpartum women should be prioritized.
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| 4. |
- Landberg, Eva, et al.
(author)
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Evaluation of venous plasma glucose measured by point-of-care testing (Accu-Chek Inform II) and a hospital laboratory hexokinase method (Cobas c701) in oral glucose tolerance testing during pregnancy - a challenge in diagnostic accuracy
- 2021
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In: Scandinavian Journal of Clinical and Laboratory Investigation. - : Taylor & Francis. - 0036-5513 .- 1502-7686. ; 81:8, s. 607-614
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Journal article (peer-reviewed)abstract
- To diagnose gestational diabetes mellitus (GDM), plasma glucose measurements during oral glucose tolerance test (OGTT) put high demands on the methods in terms of accuracy. The aim was to evaluate and compare diagnostic performance of a point-of-care test and a glucose hexokinase laboratory method. Using risk-based screening, 175 pregnant women were included. They underwent a 75 g OGTT in their 28th (median) week of gestation. Venous blood was collected in two different tubes. Plasma glucose was measured on Cobas c701 and in duplicates on AccuChek Inform II (both methods from Roche Diagnostics). Accuracy was assessed by participating in external control programs with reference method assigned values. The methods were compared for all samples (n = 512) by regression analysis; slope of 0.90 (95% CI: 0.89-0.92), intercept of 0.12 (95% CI: 0.011-0.22) and r(s) of 0.968. The average bias between AccuChek Inform II and Cobas c701 was -8%. The proportion of women diagnosed with GDM was 25% based on AccuChek Inform II versus 55% for Cobas c701. Results from the external control program showed a bias of approximately 5% for Cobas c701 and no significant bias for AccuChek Inform II. Cobas c701 showed a large bias both towards Accu-Chek Inform II and the reference method used in the external control program, clearly exceeding the desirable bias of <2.6%. The lack of accuracy has great implications on either over- or under-diagnosis of GDM.
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| 5. |
- Lilliecreutz, Caroline, et al.
(author)
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An open trial with cognitive behavioral therapy for blood- and injection phobia in pregnant women-a group intervention program
- 2010
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In: ARCHIVES OF WOMENS MENTAL HEALTH. - : Springer Science Business Media. - 1434-1816 .- 1435-1102. ; 13:3, s. 259-265
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Journal article (peer-reviewed)abstract
- Around 7% of pregnant women suffer from blood- and injection phobia. The aim was to investigate if cognitive behavior group therapy (CBT) is effective in treating pregnant womens blood- and injection phobia. Thirty pregnant women with blood- and injection phobia according to DSM-IV took part in an open treatment intervention. A two-session cognitive behavior group therapy was conducted. As controls, 46 pregnant women with untreated blood- and injection phobia and 70 healthy pregnant women were used. Repeated measures ANOVA were performed. The scores for the CBT treatment group on the "Injection Phobia Scale-Anxiety" were reduced both after each treatment session and postpartum (p andlt; 0.001). Anxiety and depressive symptoms were also reduced (p andlt; 0.001). Cognitive-behavior group therapy for pregnant women with blood- and injection phobia is effective and stable up to at least 3 months postpartum. It seems also to reduce anxiety and depressive symptoms during pregnancy.
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| 6. |
- Lilliecreutz, Caroline
(author)
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Blood-and Injection Phobia in Pregnancy : Epidemiological, Biological and Treatment aspects
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Introduction: Blood- and injection phobia is an anxiety disorder with a prevalence of approximately 3-5% in the general population. The etiology is often a combination of genetic factors and a conditioning experience. The symptoms of blood- and injection phobia are dizziness, confusion, nausea, epigastria discomfort, anxiety and sometimes panic attacks when receiving injections, seeing blood or having a blood sample taken. Unique for this specific phobia is the high probability of fainting when the phobic situation is encountered if there is no possibility to escape or to avoid the stimuli.During pregnancy and labor, women with blood- and injection phobia are exposed to most of their fears and they therefore find themselves in anxiety-ridden situations. Stress and anxiety during pregnancy is known to be risk factors for adverse obstetric and neonatal outcomes. Studies have shown an altered hypothalamic-adrenal-pituitary axis in women with stress or/and anxiety during pregnancy and increased cortisol concentrations can imply negative consequences for the unborn child. Cognitive behavioral therapy (CBT) is known to be effective in treating specific phobias such as blood- and injection phobia.Aim: The prevalence, obstetric and neonatal consequences, impact on the hypothalamic adrenal-pituitary axis and treatment aspects of blood- and injection phobia in a pregnant population have not been investigated before. The aims of this thesis were to study each of these phenomena.Material and methods: During 2005 a total of 1606 pregnant women were approached at their first visit in an antenatal care clinic in the southeast region in Sweden. They were asked to complete the “Injection Phobia Scale-Anxiety” questionnaire. All women who scored ≥ 20 on the “Injection Phobia Scale-Anxiety” questionnaire (N=347), were interviewed and either diagnosed for blood- and injection phobia or dismissed. In total, 110 women were diagnosed as having blood- and injection phobia. Among the women who scored <20 on the “Injection Phobia Scale-Anxiety” questionnaire, 220 women were randomly stratified for age and parity as a control group. The women in the study population answered questionnaires in gestational week 25, 36 and postpartum concerning symptoms of blood- and injection phobia, depression and anxiety. Samples of cortisol in the saliva were collected in the morning and evening in gestational week 25 and 36 in both groups of pregnant women. The medical records from the antenatal care visits, the delivery and postpartum check-up was used to collect data of importance. A treatment study was conducted using a two session cognitive behavioral therapy in a group of pregnant woman with blood- and injection phobia.Results: The prevalence of blood- and injection phobia is 7 % in a pregnant population. Pregnant women with blood- and injection phobia stated more often a fear of childbirth (p<0.001) and were more frequently delivered by elective cesarean section (p=0.032). The incidence of having a baby diagnosed with a complication (p=0.001) was also higher among these women. The women with blood- and injection phobia had increased cortisol concentrations in the saliva compared to the healthy controls (p=0.014). A two-session CBT in group for pregnant women with blood- and injection phobia reduced phobic (p<0.001) anxiety (p<0.001) and depressive (p<0.001) symptoms during pregnancy.Conclusions: Blood- and injection phobia during pregnancy is rather common. Pregnant women with blood- and injection phobia are more likely to be delivered by elective cesarean section and having a baby born with a complication compared to women not suffering from this specific phobia. Untreated blood- and injection phobia during pregnancy increases salivary cortisol concentrations indicating an altered hypothalamic-adrenal-pituitary axis during these weeks of pregnancy. To enhance psychological well being in pregnant women with blood- and injection phobia a two-session program providing CBT for groups of pregnant women is valuable and produces stable results for at least 3 months after delivery.
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| 7. |
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| 8. |
- Lilliecreutz, Caroline, et al.
(author)
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Effect of maternal stress during pregnancy on the risk for preterm birth
- 2016
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In: BMC Pregnancy and Childbirth. - : BIOMED CENTRAL LTD. - 1471-2393 .- 1471-2393. ; 16:5
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Journal article (peer-reviewed)abstract
- Background: Preterm birth defined as birth prior to 37 weeks of gestation is caused by different risk factors and implies an increased risk for disease and early death for the child. The aim of the study was to investigate the effect of maternal stress during pregnancy on the risk of preterm birth. Methods: A case-control study that included 340 women; 168 women who gave birth preterm and 172 women who gave birth at term. Data were manually extracted from standardized medical records. If the medical record contained a psychiatric diagnosis or a self-reported stressor e.g., depression or anxiety the woman was considered to have been exposed to stress during pregnancy. Adjusted odds ratio (AOR) was used to calculate the attributable risk (AR) of maternal stress during pregnancy on preterm birth, both for the women exposed to stress during pregnancy (AR1 = (AOR-1)/AOR) and for the whole study population (AR2 = AR1*case fraction). Results: Maternal stress during pregnancy was more common among women who gave birth preterm compared to women who gave birth at term (p <0.000, AOR 2.15 (CI = 1.18-3.92)). Among the women who experienced stress during pregnancy 54 % gave birth preterm with stress as an attributable risk factor. Among all of the women the percentage was 23 %. Conclusions: Stress seems to increase the risk of preterm birth. It is of great importance to identify and possibly alleviate the exposure to stress during pregnancy and by doing so try to decrease the preterm birth rate.
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| 9. |
- Lilliecreutz, Caroline, et al.
(author)
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Mental disorders and risk factors among pregnant women with depressive symptoms in Sweden : A case-control study
- 2021
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In: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 100:6, s. 1068-1074
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Journal article (peer-reviewed)abstract
- Introduction Identification of pregnant women suffering from depression or other mental disorders is a challenge for antenatal caregivers. The purpose of this case-control study was to describe mental disorders and the risk factors for mental disorders in women with depressive symptoms assessed with the Edinburgh Postnatal Depression Scale during the first trimester and to compare them with pregnant women without depressive symptoms. Material and methods In total, 2271 women answered the Edinburgh Postnatal Depression Scale at the first antenatal visit with a midwife. An Edinburgh Postnatal Depression Scale score of 13 or higher was considered to be screen-positive and these women were further assessed. Screen-negative pregnant women, matched for age and parity, were chosen as controls. Results In total, 149 (6.6%) women were found to be screen-positive. The majority (126, 85%) had at least one mental disorder or risk factor for mental disorder, such as depression (36.0%), anxiety (14.8%), or severe fear of childbirth (20.8%). The screen-positive women were more often smokers (16.1% vs 1.3%), unemployed (19.9% vs 1.3%), or on sick leave (25.3% vs 14.1%) during pregnancy and more often used selective serotonin reuptake inhibitor during pregnancy (14.2% vs 2.7%) compared with the screen-negative women (P<.001). Among the screen-negative women (n = 150) only three (2%) presented with symptoms of depression during pregnancy. Conclusions The Edinburgh Postnatal Depression Scale seems to be a valuable screening tool to detect depressive symptoms as well as other mental disorders during early pregnancy.
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| 10. |
- Lilliecreutz, Caroline, et al.
(author)
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Obstetric and perinatal outcomes among women with blood- and injection phobia during pregnancy
- 2011
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In: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 129:1-3, s. 289-295
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Journal article (peer-reviewed)abstract
- Backgroun: Little is known about how anxiety disorders affect pregnancy outcomes. Therefore we investigated the impact of one anxiety disorder, blood- and injection phobia, on obstetric and neonatal outcomes. Method: From a population-based prospectively collected cohort we compared an index group of 110 women with blood- and injection phobia with a control group of 220 women. Standardized medical records were used to collect data. Obstetric and neonatal outcomes e.g. elective cesarean, prematurity, and small for gestational age were used as the main outcome measures. Result: Women with blood- and injection phobia stated more often a fear of childbirth (p < 0.001) and were more frequently delivered by elective cesarean section (p = 0.032). The incidence of premature delivery (p = 0.028), neonatal morbidity (p = 0.001) and the risk of having a baby born small for gestational age (p = 0.009) was higher among women with blood- and injection phobia. Limitation: The medical records, from which all information is drawn, despite standardization, sometimes may lack some information. However, this dilemma exists in both groups. Conclusions: Women with an anxiety disorder such as blood- and injection phobia are at increased risk for adverse obstetric outcomes, premature delivery and for having a baby born with higher neonatal morbidity. It therefore seems important to identify and treat women with anxiety disorders without delay early during pregnancy in an effort to minimize risks of complications for the woman herself and the child.
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| 11. |
- Lilliecreutz, Caroline, et al.
(author)
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Participation in interventions and recommended follow-up for non-attendees in cervical cancer screening-taking the womens own preferred test method into account-A Swedish randomised controlled trial
- 2020
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In: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 15:7
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Journal article (peer-reviewed)abstract
- Background Cervical cancer is a highly preventable disease. To not attend an organized cervical cancer screening program increases the risk for cervical dysplasia and cervical cancer. The aim was to investigate the participation rate in three different intervention groups for non- attendees in the Swedish national program for cervical screening. The participation in the recommended follow up, and the histology found were also examined. Method Population-based randomized control trial. It included10,614 women that had not participated in the cervical cancer screening programme during the last six years (ages 30-49) and the last eight years (ages 50-64) were randomised 1:1:1(telephone call from a midwife (offering the choice between a visit for a pap smear or an HPV self-sampling test); an HPV self-sampling test only; or the routine procedure with a yearly invitation). Results In the intention to treat analysis the participation rates were 25.5% (N = 803/3146) vs 34.1% (N = 1047/3068) and 7.0% (N = 250/3538) (p<0.001) for telephone, HPV self-test and control groups respectively. In the by protocol analysis including women that answered the phone call the participation rates were 31.7% (N = 565/1784) vs 26.1% (N = 788/3002) and 7.0% (N = 250/3538) (p<0.001) for telephone, HPV self-test and control groups. The corresponding results in the by protocol analysis including women that did not answer the phone call was 19.7% (N = 565/2870) vs 26.1% (N = 788/3002) and 7.0% (N = 250/3538) (p< 0.001). The majority of the women 63,4% (1131/1784) who answered the telephone wanted to participate either by booking a visit for pap smear (38,5%) or to be sent a HPV self- sampling test (24,9%) (p<0.001). Women who chose an HPV self-test were older and gave anxiety/ fear as a reason to decline participation, and they were also less likely to participate in the follow-up if found to be HPV-positive compared to the women who chose a Pap smear. The attendance to the recommended follow-up after abnormality was in total 87%. The non-attendees had a three or eight times higher risk of having a cytology result of HSIL or suspected SCC respectively, in the index sample compared to women screened as recommended (OR 3.3 CI 95% 1.9-5.2, OR 8.6 CI 1.6-30). A total of ten SCC and one adenocarcinoma were found in the histopathology results from the non-attendee group with a study intervention, while there was only one SCC in the non-attendee group without any study intervention (p = 0.02, OR 8.1 CI 95% 1.2-350). Conclusions Our study suggests, according to intention to treat analysis, that the best intervention to get as many non-attendees as possible to participate is to send an HPV self-sampling test together with an invitation letter. Almost 90% of women in the study with an abnormal index sample attended follow-up. This is high enough to indicate that interventions to increase the participation among non-attendees are meaningful. Registry International Standard Randomised Controlled Trial Number (ISRCTN) Registration number.
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| 12. |
- Lilliecreutz, Caroline, et al.
(author)
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Prevalence of blood and injection phobia among pregnant women
- 2008
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 87:12, s. 1276-1279
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Journal article (peer-reviewed)abstract
- Objective: The aim of the study was to investigate the prevalence of blood and injection phobia in an unselected pregnant population, in order to estimate the need for curative intervention programmes. Design: A cross-sectional study. Setting. Antenatal care clinics in the southeast region of Sweden. Sample: In total, 1,606 consecutively registered pregnant women attending their first visit with a midwife. Methods: The women were asked to complete the Injection Phobia-Anxiety scale, measuring phobic symptoms. Women who scored 20 on the questionnaire were telephone-interviewed and then diagnosed or dismissed according to the DSM-IV criteria for blood and injection phobia. Main outcome measures. Prevalence of blood and injection phobia according to the DSM-IV. Results: Of 1,529 women who chose to participate (92.5%), 110 women or 7.2% fulfilled the DSM-IV criteria for blood and injection phobia. The mean age of the women was 29.1 years. Conclusions: Blood and injection phobia is hitherto unreported in the literature, but seems to be relatively common and needs to be recognized during pregnancy as it causes a great deal of discomfort and fear among pregnant women. The Injection Phobia-Anxiety scale is suitable as a screening tool in an antenatal care clinic setting.
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| 13. |
- Lilliecreutz, Caroline, et al.
(author)
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Salivary cortisol in pregnant women suffering from blood-and injection phobia
- 2011
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In: Archives of Women's Mental Health. - : Springer Berlin/Heidelberg. - 1434-1816 .- 1435-1102. ; 14:5, s. 405-411
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Journal article (peer-reviewed)abstract
- Purpose: Stress and/or anxiety during pregnancy affect maternal and fetal wellbeing and can cause premature delivery and postnatal pathology in the child. Women suffering from phobias related to blood and injections are prone to high levels of stress including anxiety and sometimes panic attacks during pregnancy. Cortisol is amongst the mediators through which the neurohormonal expressions of maternal psychological factors may be transduced to the fetus. The aim was to investigate if pregnant women suffering from blood- and injection phobia have raised cortisol levels or are characterized by unusual diurnal salivary cortisol profiles compared to healthy controls. Methods: The sample consisted of 110 pregnant women with blood- and injection phobia and 110 pregnant healthy controls. Both groups provided morning and evening saliva samples in week 25 and 36 for the assay of cortisol. In gestational week 25 when blood was drawn for the mandatory blood testing extra blood was taken to analyze corticotrophin releasing factor (CRF), adrenocorticotropic hormone (ACTH) and cortisol in serum. Results: The expected diurnal decline in salivary cortisol was observed as well as increased cortisol levels during pregnancy. Pregnant women suffering from blood- and injection phobia had higher output of cortisol compared to women without the phobia (F=6.25 df=1 p=0.014) but no marked difference in the diurnal cortisol rhythm was found between the groups. Conclusion: Our findings indicate that untreated blood- and injection phobia during pregnancy increases cortisol concentrations. Blood- and injection phobia is treatable and cognitive behavioral therapy can be used.
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| 14. |
- Lilliecreutz, Caroline, et al.
(author)
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Student-led clinic cervical cancer screening-medical students views on progression of learning, quality of Pap smears and women s experiences of the visit - a mixed methods study
- 2023
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In: BMC Medical Education. - : BMC. - 1472-6920. ; 23:1
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Journal article (peer-reviewed)abstract
- BackgroundStudent-led clinics (SLC) have been described, but not in gynecology. Gynecology is a subject typically covered in the last terms of medical training, however it includes few opportunities for students to tackle all phases of a consultation and a shortage of opportunities to perform gynecological examinations. Therefore, we started a student-led clinic for cervical cancer screening (SLC-CCS) in Linkoping, Sweden and aimed to evaluate students views on the progression of learning, the quality of the Papanicolaou (Pap) smear, and women s experiences of the visit, using mixed methodology.MethodsThe implementation of the SLC-CCS is described in detail. Students (n = 61) taking part in the SLC-CCS between January and May 2021 were invited to participate in a follow-up discussion (n = 24) focused around four themes: attitudes and expectations prior to participation, experiences of the patient encounter, organization of the placement, and reflections on and suggestions for further development of the placements. The group meetings were conducted in Swedish, recorded, transcribed verbatim and subjected to a qualitative, descriptive thematic analysis. Thematic analysis is considered an appropriate method of analysis for seeking to understand experiences, thoughts, or behaviors across a data set. The proportion of Pap smears lacking cells from the squamous epithelium during the study period was compared with data from the same clinic before the SLC-CCS started. A validated questionnaire on womens experience of the Pap smear visit was provided. Answers were compared between women who had the Pap smear taken by a student or a healthcare provider.ResultsThree different themes were generated: growing confidence in the clinical situation, embodied awareness of variation in anatomy, doubting accuracy of ones own performance. The percentage of Pap smears lacking cells from the squamous epithelium were equal (2%) during the study period compared to the period before the SLC-CCS started (p = 0.28). No difference was found in the satisfaction index between the women examined by a student, those examined by a healthcare provider, or women who did not know who the examiner was (p = 0.112).ConclusionsThe students expressed a growing confidence in the clinical situation and there was high satisfaction from the women. The quality of the Pap smears taken by the students was equal to the quality of those taken by the health care staff. All these findings indicate that high patient safety was maintained during this activity support the recommendation to include SLC-CCS as part of the medical training.
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| 15. |
- Möller, Louise, 1989-
(author)
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Health, obstetric outcomes and reproduction in women with vulvar pain or primary fear of childbirth
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Fear of childbirth (FOC) is common and affects approximately 5-20 % of all pregnant women. FOC is associated with giving birth by caesarean section on maternal request (CSMR). The rate of caesarean sections (CS) and CSMR has increased during the last decades. To decrease these women’s fear, the rate of CSMR and to promote a more positive birth experience, many treatments for FOC have been evaluated. In Sweden, the treatment is individualized and given by obstetricians, midwives, psychologists or psychotherapists in the specialist care.Women with FOC suffer more often from psychiatric illness and rate their general health as less good, which is important to consider when counselling these women and deciding on mode of delivery. Little is known about the long term obstetric and reproductive outcomes for women with FOC. Therefore, the aim of the studies on which this thesis is based was to compare psychiatric care before and after childbirth in women giving birth by CSMR to women giving birth by other modes of delivery and to follow the subsequent obstetric and reproductive outcomes in women receiving counselling for FOC in their first childbirth. Furthermore, we hypothesized that women with localized provoked vulvodynia (LPV) and/or vaginismus might fear vaginal childbirth and little is known about their reproduction and obstetric outcomes which is why we investigated the parity and obstetric outcomes in women diagnosed with LPV/vaginismus before first childbirth.Based on data linked from several Swedish National registers, the prevalence of psychiatric in- and outpatient care before (paper I) and after first childbirth (paper II) was compared in primiparae giving birth by CSMR to primiparae giving birth by other modes of delivery. The prevalence of psychiatric disorders was found to be significantly higher in women giving birth by CSMR, indicating a severe burden of psychiatric illness in these women.In paper III, also based on data from several Swedish National registers, a diagnosis of LPV/vaginismus before childbirth was shown to decrease the odds of giving birth. When giving birth these women had an increased risk of CS, especially CSMR. This could possibly indicate FOC in these women. Further, women with vaginismus had an increased risk of pelvic floor injuries.Paper IV was a follow-up study of women who received counselling for FOC in their first pregnancy leading to parturition. It was based on data from medical records and a questionnaire. The women were followed 7-14 years after their first childbirth. Women treated for FOC more often gave birth by CS, rated their first birth experience as less positive and more often required counselling for FOC in their subsequent pregnancies compared to women without FOC in their first pregnancy. There were no significant differences in the rate of complications during pregnancy and childbirth compared to the other women. Women treated for FOC less often gave birth more than twice. Despite being given counselling and being exposed to childbirth almost one in five women felt fearful towards childbirth 7-14 years after the first childbirth.In conclusion, women with FOC are a vulnerable group suffering from a significant burden of psychiatric illness. FOC is not easily treated; many women require counselling in subsequent pregnancies and many still fear childbirth after the childbearing years. Furthermore, LPV/vaginismus is a risk factor for giving birth by CSMR, possibly indicating FOC, and these women are less likely to give birth. Our study shows it is important not only to address sexual function in these women but reproductive function as well. Further studies are needed to establish how to optimize their care regarding fertility, antenatal, obstetric and post-partum care.
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| 16. |
- Möller, Louise, et al.
(author)
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Mental health after first childbirth in women requesting a caesarean section; a retrospective register-based study
- 2017
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In: BMC Pregnancy and Childbirth. - : BIOMED CENTRAL LTD. - 1471-2393 .- 1471-2393. ; 17
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Journal article (peer-reviewed)abstract
- Background: Psychiatric illness before delivery increases the risk of giving birth by caesarean section on maternal request (CSMR) but little is known about these womens mental health after childbirth. In this study we aimed to compare the prevalence of psychiatric disorders five years before and after delivery in primiparae giving birth by CS on maternal request to all other primiparae giving birth, indifferent on their mode of delivery. Methods: The study population comprised all women born in Sweden 1973-1983 giving birth for the first time in 2002-2004. Psychiatric diagnoses, in- and outpatient care were retrieved from the National Patient Register in Sweden. The risk of psychiatric care after childbirth was estimated using CSMR, previous mental health and sociodemographic variables as covariates. Results: Psychiatric disorders after childbirth were more common in women giving birth by CSMR compared to the other women (11.2% vs 5.5%, p amp;lt; 0.001). CSMR increased the risk of psychiatric disorders after childbirth (aOR 1. 5, 95% CI 1.2-1.9). The prevalence of psychiatric disorders had increased after compared to before childbirth (mean difference 0.02 +/- 0.25, 95% CI 0.018-0.022, p amp;lt; 0.001). Women giving birth by CSMR tended to be diagnosed in the inpatient care more often (54.9% vs. 45.8%, p = 0.056) and were more likely to have been diagnosed before childbirth as well (39.8% vs. 24.2%, p amp;lt; 0.001). Conclusions: Women giving birth by CSMR more often suffer from psychiatric disorders both before and after delivery. This indicates that these women are a vulnerable group requiring special attention from obstetric-and general health-care providers. This vulnerability should be taken into account when deciding on mode of delivery.
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| 17. |
- Möller, Louise, et al.
(author)
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Reproduction and mode of delivery in women with vaginismus or localised provoked vestibulodynia: a Swedish register-based study
- 2015
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In: British Journal of Obstetrics and Gynecology. - : Wiley: 12 months. - 1470-0328 .- 1471-0528. ; 122:3, s. 329-334
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Journal article (peer-reviewed)abstract
- Objective To compare sociodemographics, parity and mode of delivery between women diagnosed with vaginismus or localised provoked vestibulodynia (LPV) to women without a diagnosis before first pregnancy. Design Retrospective, population-based register study. Setting Sweden. Sample All women born in Sweden 1973-83 who gave birth for the first time or remained nulliparous during the years 2001-09. Methods Nationally linked registries were used to identify the study population. Women diagnosed with vaginismus or LPV were compared to all other women. Odds ratios for parity and mode of delivery were calculated using multinominal regression analysis and logistic regression. Main outcome measures Parity and mode of delivery. Results Women with vaginismus/LPV were more likely to be unmarried (P = 0.001), unemployed (P = 0.012), have a higher educational level (P less than 0.001), a lower body mass index (P less than 0.001) and use nicotine during pregnancy (P = 0.008). They were less likely to give birth (adjusted odds ratio [OR] 0.61, 95% confidence interval [95% CI] 0.56-0.67). Women with vaginismus/LPV more often delivered by caesarean section (P less than 0.001) especially for maternal request (adjusted OR 3.48, 95% CI 2.45-4.39). In women having vaginal delivery, those with vaginismus/LPV were more likely to suffer a perineal laceration (adjusted OR 1.87, 95% CI 1.56-2.25). Conclusions Women with vaginismus/LPV are less likely to give birth and those that do are more likely to deliver by caesarean section and have a caesarean section based upon maternal request. Those women delivering vaginally are more likely to suffer perineal laceration. These findings point to the importance of not only addressing sexual function in women with vaginismus/LPV but reproductive function as well.
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| 18. |
- Möller, Louise, et al.
(author)
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Reproduction, fear of childbirth and obstetric outcomes in women treated for fear of childbirth in their first pregnancy: A historical cohort
- 2019
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In: Acta Obstetricia et Gynecologica Scandinavica. - : WILEY. - 0001-6349 .- 1600-0412. ; 98:3, s. 374-381
-
Journal article (peer-reviewed)abstract
- Introduction About 8% of the pregnant women in Sweden receive counseling for fear of childbirth (FOC) during pregnancy. Little is known about the long-term reproductive and obstetric outcomes after counseling for FOC: Therefore, the objective of this historical cohort study was to compare the long-term reproductive and obstetric outcomes in women treated for FOC in their first pregnancy to women without FOC. Material and methods All nulliparas consecutively referred for treatment of severe FOC between 2001 and 2007 (n = 608) were compared with all other nulliparas giving birth on the same day (n = 431). Women who were not fluent in Swedish, missing a postal address, had moved out of the area, given birth at another hospital or had a late spontaneous abortion were excluded (n = 555). A total of 235 women agreed to participate in the study, 63 (39%) women in the index group and 172 (53%) in the reference group. The women were contacted by letter in 2015, ie 7-14 years after first childbirth, and asked to permit access to their medical charts from pregnancies and childbirths and to fill out a study specific questionnaire. Based on data from the medical charts and questionnaire, the mode of delivery, birth experience, obstetric complications, FOC, counseling for FOC and number of childbirths were compared in the two groups. Results Women in the index group less often gave birth more than twice compared with the reference group (8.2% vs 22.0%, P = 0.012). We found no significant differences in complications during subsequent pregnancies and deliveries. Women in the index group more often gave birth by CS in their first (P = 0.002) and second childbirth (P = 0.001), more often had a less positive birth experience (index group NRS: median 6.0, interquartile range 6 vs reference group NRS: 7.0, interquartile range 5, P = 0.004) in their first delivery and more often received counseling for FOC (58.7% vs 12.5%, P amp;lt; 0.001) in subsequent pregnancies. Women in the index group more often experienced FOC (18% vs 5.3%, P = 0.001) 7-14 years after first childbirth. Conclusions FOC is not easily treated. Despite treatment and exposure to childbirth many women received treatment in their next pregnancy and still suffered from FOC 7-14 years after the first childbirth.
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| 19. |
- Nevander, Sofia, et al.
(author)
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Comparison of Venous and Capillary Sampling in Oral Glucose Testing for the Diagnosis of Gestational Diabetes Mellitus: A Diagnostic Accuracy Cross-Sectional Study Using Accu-Chek Inform II
- 2020
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In: Diagnostics (Basel). - : MDPI. - 2075-4418. ; 10:12
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Journal article (peer-reviewed)abstract
- Gestational diabetes mellitus (GDM) is a common complication with negative impacts on mother and child. The primary aim of this study was to examine whether plasma glucose cutoffs for GDM diagnosis based on venous sampling can be replaced by cutoffs based on capillary sampling. A prospective cross-sectional study was performed at an antenatal care clinic including 175 pregnant women undergoing an oral glucose tolerance test (OGTT). Duplicate samples were collected by capillary and venous puncture while fasting and 1 h and 2 h after an OGTT. Both samples were analyzed on Accu-Chek Inform II. The cutoffs for a GDM diagnosis using capillary samples were corrected from 5.1 to 5.3 mmol/L for the fasting sample, from 10.0 to 11.1 mmol/L for the 1 h sample, and from 8.5 to 9.4 mmol/L for the 2-h sample using half of the dataset. Applying these cutoffs to the remaining dataset resulted in a sensitivity, specificity, and accuracy of 85.0%, 95.0%, and 90.3%, respectively, with a positive predictive value (PPV) of 83%, an negative predictive value (NPV) of 96%, and a positive negative likelihood ratio (LHR) of 16.4 using capillary sampling for the GDM diagnosis at fasting and 2-h after. Corrected cutoffs and capillary samples can be used for the diagnosis of GDM with maintained diagnostic accuracy using Accu-Chek Inform II.
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| 20. |
- Nevander, Sofia, et al.
(author)
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Gestational diabetes mellitus and time in active labor: A population-based cohort study
- 2023
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In: Acta Obstetricia et Gynecologica Scandinavica. - : WILEY. - 0001-6349 .- 1600-0412. ; 102:7, s. 873-882
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Journal article (peer-reviewed)abstract
- IntroductionWomen with gestational diabetes mellitus (GDM) have higher rates of adverse perinatal outcomes compared with women without GDM, including an increased risk for having labor induced and for cesarean section. The findings from previous studies analyzing duration of labor in women with GDM are contradictory.The aim of the study was to evaluate the impact of GDM on time in spontaneous and induced active labor. Material and methodsThis was a population-based cohort study including 247 524 primiparous women who gave birth to a singleton fetus with cephalic presentation, >= 34(+0) (completed gestational weeks + additional days) between January 2014 and May 2020 in Sweden. Data was obtained from the Swedish Pregnancy Register. Time in active labor was compared between women with GDM and without GDM with a spontaneous labor onset or induction of labor using Kaplan Meier survival analysis and Cox regression analysis. ResultsWomen with GDM had significantly longer time in active labor, both with a spontaneous onset and induction of labor compared to women without GDM. Women with GDM had a decreased chance of vaginal delivery at a certain time-point compared to women without GDM, with adjusted hazard ratio of 0.92 (0.88-0.96) and 0.83 (0.76-0.90) for those with spontaneous onset and induction of labor, respectively. Women with GDM had increased risk for time in active labor >= 12 h both in spontaneous labor onset (adjusted odds ratio 1.14 [1.04-1.25]) and in induction of labor (adjusted odds ratio 1.55 [1.28-1.87]). ConclusionsWomen with GDM seem to spend a longer time in active labor, both in spontaneous and induced active labor compared to women without GDM. To be able to individualize care intrapartum, there is a need for more studies demonstrating the impact of hyperglycemia during pregnancy on outcomes during childbirth.
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| 21. |
- Nevander, Sofia, 1979-
(author)
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Hyperglycemia in pregnancy : diagnostics and duration of labor
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Objectives: The overall aim of this thesis was to evaluate the impact of maternal hyperglycemia in pregnancy on the duration of active labor, to evaluate indications for cesarean section and further, to examine cut-offs for gestational diabetes mellitus diagnosis based on capillary sampling.Material and methods: Study I was a cross-sectional study on diagnostic accuracy performed at an antenatal care clinic at the University Hospital in Linköping, Sweden. The study included 175 women undergoing an oral glucose tolerance test (OGTT) and aimed to compare capillary and venous sampling in the diagnosis of gestational diabetes mellitus (GDM) using Accu-Chek Inform II.Studies II and III were population-based, nationwide, Swedish register studies using data from the Swedish Pregnancy Register (SPR). In these, 247 524 primiparous women who delivered a singleton fetus, ≥34+0 (completed gestational weeks + additional days) with a cephalic presentation between 1 January 2014 and 30 May 2020 and had their data available in the SPR were included. Time in active labor was compared between women with GDM and women without diabetes (study II) and between women with type 1 diabetes and women without diabetes (study III) using Kaplan- Meier survival analysis and Cox regression analysis.In study III, we also evaluated indications for elective and emergency cesarean section (CS) in women with type 1 diabetes and women without diabetes.Results: In study I, the cut-offs for a GDM diagnosis using capillary samples were corrected from 5.1 to 5.3 mmol/L for the fasting sample, from 10.0 to 11.1 mmol/L for the 1 h sample and from 8.5 to 9.4 mmol/L for the 2 h sample using half of the dataset. Applying these cut-offs to the remaining dataset resulted in a sensitivity, specificity and accuracy of 85.0%, 95.0% and 90.3% respectively, with a positive predictive value (PPV) of 83%, a negative predictive value (NPV) of 96% and a positive likelihood ratio (LHR) of 16.4 using capillary sampling for the GDM diagnosis at fasting and 2-h.In study II, women with GDM had a significantly longer time in active labor, both with a spontaneous onset and induction of labor compared to women without diabetes. Women with GDM also had a decreased chance of vaginal delivery at a certain time-point compared to women without diabetes, with an adjusted hazard ratio (aHR) of 0.92 (0.88- 0.96) and 0.83 (0.76-0.90) for those with spontaneous onset and induction of labor respectively. Women with GDM had an increased risk for time in active labor ≥12 h both in spontaneous labor onset (adjusted odds ratio (aOR) 1.14 (1.04-1.25)) and in induction of labor (aOR 1.55 (1.28-1.87)).Women with type 1 diabetes had a significantly longer time in active labor, both in spontaneous onset and induced labor compared to women without diabetes. They also had a decreased chance of vaginal delivery at a certain time-point compared to women without diabetes with an aHR of 0.65 (0.60-0.70). The total rate of CS was 34.6% in the group of women with type 1 diabetes and 9.5% in the group of women without diabetes (both elective and emergency CS). The most common indication for elective CS among women with type 1 diabetes was suspected macrosomia (50.4%) whereas the corresponding number was 8.7% among women without diabetes. For emergency CS, the most common indication was fetal distress in women with type 1 diabetes (31.9%) and the corresponding number in women without diabetes was 35.9%.Conclusions: Regarding the diagnosis of GDM, we propose that capillary fasting and 2-hour post-prandial glucose samples, analyzed using the Accu-Chek Inform II system, could be used for the diagnosis of GDM during pregnancy. This approach would involve the use of adjusted cut-off values and demonstrates an acceptable level of accuracy within an antenatal care setting. It is imperative to obtain duplicate samples in order to maintain adequate precision. Furthermore, it is advisable to continue with the OGTT when the fasting samples fall within the normal range, as this leads to a greater number of women receiving a GDM diagnosis.Regarding time in active labor, both women with GDM and type 1 diabetes seemed to spend a longer time in active labor and were less likely to have a vaginal delivery at any given time compared to their non-diabetic counterparts. In order to customize and individualize intrapartum care, it is imperative to conduct further investigations that illustrate the influence of hyperglycemia in pregnancy on the duration of active labor and on the outcomes during childbirth. In subsequent studies, it will be determined whether the observed difference in the duration of active labor, as indicated in the current studies, remains consistent when employing new definitions of active labor and labor progression.Suspected fetal macrosomia is the main reason for elective CS among women with type I diabetes and needs to be addressed further.
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| 22. |
- Sederholm Lawesson, Sofia, 1973-, et al.
(author)
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Association Between History of Adverse Pregnancy Outcomes and Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography.
- 2023
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In: JAMA. - : American Medical Association (AMA). - 1538-3598 .- 0098-7484. ; 329:5, s. 393-404
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Journal article (peer-reviewed)abstract
- Adverse pregnancy outcomes are recognized risk enhancers for cardiovascular disease, but the prevalence of subclinical coronary atherosclerosis after these conditions is unknown.To assess associations between history of adverse pregnancy outcomes and coronary artery disease assessed by coronary computed tomography angiography screening.Cross-sectional study of a population-based cohort of women in Sweden (n=10528) with 1 or more deliveries in 1973 or later, ascertained via the Swedish National Medical Birth Register, who subsequently participated in the Swedish Cardiopulmonary Bioimage Study at age 50 to 65 (median, 57.3) years in 2013-2018. Delivery data were prospectively collected.Adverse pregnancy outcomes, including preeclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant, and gestational diabetes. The reference category included women with no history of these exposures.Coronary computed tomography angiography indexes, including any coronary atherosclerosis, significant stenosis, noncalcified plaque, segment involvement score of 4 or greater, and coronary artery calcium score greater than 100.A median 29.6 (IQR, 25.0-34.9) years after first registered delivery, 18.9% of women had a history of adverse pregnancy outcomes, with specific pregnancy histories ranging from 1.4% (gestational diabetes) to 9.5% (preterm delivery). The prevalence of any coronary atherosclerosis in women with a history of any adverse pregnancy outcome was 32.1% (95% CI, 30.0%-34.2%), which was significantly higher (prevalence difference, 3.8% [95% CI, 1.6%-6.1%]; prevalence ratio, 1.14 [95% CI, 1.06-1.22]) compared with reference women. History of gestational hypertension and preeclampsia were both significantly associated with higher and similar prevalence of all outcome indexes. For preeclampsia, the highest prevalence difference was observed for any coronary atherosclerosis (prevalence difference, 8.0% [95% CI, 3.7%-12.3%]; prevalence ratio, 1.28 [95% CI, 1.14-1.45]), and the highest prevalence ratio was observed for significant stenosis (prevalence difference, 3.1% [95% CI, 1.1%-5.1%]; prevalence ratio, 2.46 [95% CI, 1.65-3.67]). In adjusted models, odds ratios for preeclampsia ranged from 1.31 (95% CI, 1.07-1.61) for any coronary atherosclerosis to 2.21 (95% CI, 1.42-3.44) for significant stenosis. Similar associations were observed for history of preeclampsia or gestational hypertension among women with low predicted cardiovascular risk.Among Swedish women undergoing coronary computed tomography angiography screening, there was a statistically significant association between history of adverse pregnancy outcomes and image-identified coronary artery disease, including among women estimated to be at low cardiovascular disease risk. Further research is needed to understand the clinical importance of these associations.
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| 23. |
- Stålberg, Valerie, et al.
(author)
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Study protocol for a modified antenatal care program for pregnant women with a low risk for adverse outcomes - a stepped wedge cluster non-inferiority randomized trial
- 2022
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In: BMC Pregnancy and Childbirth. - London, United Kingdom : BioMed Central. - 1471-2393 .- 1471-2393. ; 22:1
-
Journal article (peer-reviewed)abstract
- Background: It is crucial to provide care based on individual needs. Swedish health care is obliged to give care on equal conditions for the entire population. The person with the greatest need should be given the most care, and the health care system should strive to be cost-efficient. Medical and technical advances have been significant during the last decades and the recent Covid-19 pandemic has caused a shift in health care, from in-person visits to virtual visits. The majority of pregnant women with a low risk assessment have an uncomplicated antenatal course without adverse events. These women probably receive excessive and unnecessary antenatal care. This study will investigate if an antenatal care program for healthy pregnant women with a low risk for adverse outcomes could be safely monitored with fewer in-person visits to a midwife, and with some of them replaced by virtual visits.Methods: This is a non-inferiority trial where a stepped wedge cluster randomized controlled design will be used. Data collection includes register data and questionnaires that concern antenatal, obstetric and neonatal outcomes, patient- and caregiver-reported experiences, healthcare-economy, and implementation aspects. The modified antenatal care (MAC) study is performed in parts of the southeast of Sweden, which has approximately 8200 childbirths annually. At the start of the study, all antenatal care centers included in the study will use the same standard antenatal care (SAC) program. In the MAC program the in-person visits to a midwife will be reduced to four instead of eight, with two additional virtual meetings compared with the SAC program.Discussion: This presented study protocol is informed by research knowledge. The protocol is expected to provide a good structure for future studies on changed antenatal care programs that introduce virtual visits for healthy pregnant women with a low risk for adverse outcomes, without risking quality, safety, and increased costs.
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| 24. |
- Stålberg, Valerie, et al.
(author)
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The risk of postpartum hemorrhage when lowering the oxytocin dose in planned cesarean section, a pilot study
- 2021
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In: Sexual & Reproductive HealthCare. - : ELSEVIER IRELAND LTD. - 1877-5756 .- 1877-5764. ; 29
-
Journal article (peer-reviewed)abstract
- Objectives: Oxytocin is the drug of choice in preventing postpartum hemorrhage (PPH). The aim was to compare the peroperative- and total blood loss within two hours and PPH after planned cesarean section (CS) when receiving 2.5 IU vs 5.0 IU of oxytocin in different risk groups for PPH. Study design: A pilot study including 927 women undergoing planned CS where women receiving 2.5 IU of oxytocin were compared to women receiving 5.0 IU of oxytocin. Main outcome measures: Data comparing peroperative blood loss, total blood loss within two hours and PPH were analyzed. Results: The women receiving 2.5 IU of oxytocin had a slightly higher peroperative blood loss, compared to the 5.0 IU group (476 ml vs 426 ml, p = 0.029). The total blood loss two hours after surgery showed no significant difference between the groups (626 ml vs 595 ml, p = 0.230). In the 2.5 IU group 13% had a blood loss > 1000 ml vs 10% in the 5 IU group (aOR 1.64, 95% CI = 1.05-2.56). When the women considered to be at high risk for postpartum hemorrhage were excluded, we found no difference in the likelihood for postpartum hemorrhage between the groups (aOR 1.13, 95% CI = 0.64-1.99). Conclusions: Women undergoing planned CS and receiving 2.5 IU of oxytocin had a slightly higher risk for postpartum hemorrhage in this study. However, a lower dose of 2.5 IU of oxytocin seems to be a safe option in planned CS for women without known risk factors for postpartum hemorrhage, but further research is needed to confirm these findings.
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| 25. |
- Sydsjö, Gunilla, et al.
(author)
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Obstetric outcomes for nulliparous women who received routine individualized treatment for severe fear of childbirth - a retrospective case control study
- 2014
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In: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 14:126
-
Journal article (peer-reviewed)abstract
- Background: To study pregnancy and delivery outcomes in nulliparous women with severe FOC (fear of childbirth), all of whom had received routine treatment for their FOC and to make comparisons with a healthy reference group of nulliparous women. To study the possible relationship between the number of FOC-treatment sessions and the delivery method. Methods: All nulliparous women with a diagnose FOC who received routine treatment for FOC (n = 181) and a reference group of nulliparous women without FOC (n = 431) at a university and a county hospital in the south east region of Sweden were analysed. Data from antenatal and delivery medical records were used to study outcome. Results: The majority of women with severe FOC had a vaginal delivery. The incidence of elective CS was greater in the index group than in the reference group (p less than 0.001). The total number of women with a planned CS in the index group was 35 (19.4%) and in the control group 14 (3.2%). Thus, on average five women per year received an elective CS during the study years due to severe FOC. The women in the index group who wished to have a CS were similar to the other women in the index group with reference to age, BMI, chronic disease but had been in in-patient care more often during their pregnancy than those who did not ask for CS (p = 0.009). Conclusion: In this study of women treated for severe FOC, the majority gave birth vaginally and no relationship was found between number of treatment sessions and mode of childbirth.
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| 26. |
- Sydsjö, Gunilla, et al.
(author)
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Psychiatric illness in women requesting caesarean section
- 2015
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In: British Journal of Obstetrics and Gynecology. - : Wiley: 12 months. - 1470-0328 .- 1471-0528. ; 122:3, s. 351-358
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Journal article (peer-reviewed)abstract
- Objective To compare psychiatric in-and outpatient care during the 5 years before first delivery in primiparae delivered by caesarean section on maternal request with all other primiparae women who had given birth during the same time period. Design Prospective, population-based register study. Setting Sweden. Sample Women giving birth for the first time between 2002 and 2004 (n = 64 834). Methods Women giving birth by caesarean section on maternal request (n = 1009) were compared with all other women giving birth (n = 63 825). The exposure of interest was any psychiatric diagnosis according to the International Statistical Classification of Diseases and Related Health Problems (ninth revision, ICD-9, 290-319; tenth revision, ICD-10, F00-F99) in The Swedish national patient register during the 5 years before first delivery. Main outcome measures Psychiatric diagnoses and delivery data. Results The burden of psychiatric illnesses was significantly higher in women giving birth by caesarean section on maternal request (10 versus 3.5%, P less than 0.001). The most common diagnoses were ` Neurotic disorders, stress-related disorders and somatoform disorders (5.9%, aOR 3.1, 95% CI 1.1-2.9), and ` Mood disorders (3.4%, aOR 2.4, 95% CI 1.7-3.6). The adjusted odds ratio for caesarean section on maternal request was 2.5 (95% CI 2.0-3.2) for any psychiatric disorder. Women giving birth by caesarean section on maternal request were older, used tobacco more often, had a lower educational level, higher body mass index, were more often married, unemployed, and their parents were more often born outside of Scandinavia (P less than 0.05). Conclusions Women giving birth by caesarean section on maternal request more often have a severe psychiatric disease burden. This finding points to the need for psychological support for these women as well as the need to screen and treat psychiatric illness in pregnant women.
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| 27. |
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| 28. |
- Tornblom-Paulander, Sara, et al.
(author)
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Novel topical formulation of lidocaine provides significant pain relief for intrauterine device insertion: pharmacokinetic evaluation and randomized placebo-controlled trial
- 2015
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In: Fertility and Sterility. - : Elsevier. - 0015-0282 .- 1556-5653. ; 103:2, s. 422-427
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Journal article (peer-reviewed)abstract
- Objective: To investigate the pharmacokinetics, safety, and analgesic efficacy of a novel topical formulation of lidocaine at insertion of an intrauterine device (IUD). Design: Randomized controlled trial; phase-I and phase-II studies. Setting: University and public hospitals. Patient(s): Women aged greater than= 18 years who wanted to receive an IUD. Four women were parous in phase I; all in phase II were nulliparous. Intervention(s): A single, 8.5-mL dose of lidocaine formulation (SHACT) was administered (to the portio, cervix, and uterus) with a specially designed applicator. Main Outcome Measure(s): The phase-I study (single-arm) was designed for pharmacokinetic assessment; the phase-II study (randomized) was intended for investigation of efficacy and safety. Result(s): From the phase-I study (15 participants), mean pharmacokinetic values were: maximum plasma concentration: 351 +/- 205 ng/mL; time taken to reach maximum concentration: 68 +/- 41 minutes; and area under the concentration-time curve from 0 to 180 minutes: 717 +/- 421 ng*h/mL. Pain relief was observed with lidocaine vs. placebo in the phase-II study (218 women, randomized). Mean visual analog scale score for maximum pain during the first 10 minutes after IUD insertion was 36% lower with lidocaine than with placebo (28.3 +/- 24.6 vs. 44.2 +/- 26.0). Pain intensity was also significantly lower in the lidocaine group at 30 minutes. On average, 3 of 4 patients will have less pain with lidocaine than with placebo. Adverse events were similar in the placebo and lidocaine groups. No serious adverse events were reported. Conclusion(s): Lidocaine provides pain relief lasting for 30-60 minutes for women undergoing IUD insertion, without any safety concerns. Further studies of this lidocaine formulation, for IUD insertion and other clinical applications, are planned. (C) 2015 by American Society for Reproductive Medicine.
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| 29. |
- Wolgast, Emelie, 1982-
(author)
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Drug use during pregnancy with focus on antidepressants
- 2020
-
Doctoral thesis (other academic/artistic)abstract
- Background: More than half of pregnant women use at least one prescribed medication during pregnancy, and almost all pregnant women use some kind of over-the-counter medication. Depression is one of the most common diseases in the world today, also during the peripartum period. The prevalence of pregnant women using antidepressant medication is increasing. General knowledge about the use of medication during pregnancy needs to improve. The overall aim of the studies on which this thesis is based is therefore to examine different aspects of medication use during pregnancy, with a focus on antidepressants.Material and methods: Study I was a questionnaire study where 850 pregnant women were asked about their perceptions on medication use during pregnancy. In Study II, plasma samples from 200 women were obtained at gestational weeks 10-12 and 25, and screened for drugs. The results of the analysis were compared with medication use noted in antenatal medical care records. Study III was a national register‐based cohort study including 262,329 pregnant women, and their first child born in 2012-2015. Maternal obstetric and neonatal outcomes were studied in three groups: women diagnosed with depression and who had redeemed an antidepressant before becoming pregnant and women who were diagnosed with depression and who had redeemed an antidepressant both before and during pregnancy, were compared with each other and with women who had neither been diagnosed with depression nor been prescribed antidepressants. Study IV was a pharmacokinetic study that included 81 pregnant women with ongoing antidepressant medical treatment. Antidepressant drug and metabolite concentrations were measured throughout pregnancy. Participants were genotyped for enzymes involved in antidepressant drug metabolism, i.e. CYP2D6 and CYP2C19. Results and conclusions: The majority of pregnant women in our study considered the use of medication during pregnancy as either “probably harmful” or “harmful”, and this perception was associated with non-use of medication. The women had high confidence in health care professionals when seeking advice about medication.There was a good coherence between reported drug intake in antenatal care records and presence of the drug in the pregnant women’s blood. For drugs prescribed for continuous use the coherence was 100%; thus, the reported use of medication in antenatal records is reliable. Women with major depressive disorder and antidepressant medication prior to becoming pregnant were at increased risk for adverse obstetric and neonatal outcomes compared with women without major depressive disorder. Continuation of antidepressant medication during pregnancy somewhat increased the risk of adverse obstetric and neonatal outcomes. The dose-adjusted concentrations of sertraline and citalopram and their metabolites, did not change significantly throughout pregnancy. Observed concentrations of escitalopram, mirtazapine and venlafaxine did not appear to change.
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| 30. |
- Wolgast, Emelie, et al.
(author)
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Drug use in pregnant women-a pilot study of the coherence between reported use of drugs and presence of drugs in plasma
- 2018
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In: European Journal of Clinical Pharmacology. - : Springer. - 0031-6970 .- 1432-1041. ; 74:4, s. 535-539
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Journal article (peer-reviewed)abstract
- In Sweden, information on drug use during pregnancy is obtained through an interview and recorded in a standardized medical record at every visit to the antenatal care clinic throughout the pregnancy. Antenatal, delivery, and neonatal records constitute the basis for the Swedish Medical Birth Register (MBR). The purpose of this exploratory study was to investigate the reliability of reported drug use by simultaneous screening for drug substances in the blood stream of the pregnant woman and thereby validate self-reported data in the MBR. Plasma samples from 200 women were obtained at gestational weeks 10-12 and 25 and screened for drugs by using ultra-high performance liquid chromatography with time of flight mass spectrometry (UHPLC-TOF-MS). The results from the analysis were then compared to medical records. At the first sampling occasion, the drugs found by screening had been reported by 86% of the women and on the second sampling, 85.5%. Missed reported information was clearly associated with drugs for occasional use. The most common drugs in plasma taken in early and mid-pregnancy were meclizine and paracetamol. Two types of continuously used drugs, selective serotonin reuptake inhibitors and propranolol, were used. All women using them reported it and the drug screening revealed a 100% coherence. This study shows good coherence between reported drug intake and the drugs found in plasma samples, which in turn positively validates the MBR.
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| 31. |
- Wolgast, Emelie, et al.
(author)
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The impact of major depressive disorder and antidepressant medication before and during pregnancy on obstetric and neonatal outcomes : A nationwide population-based study
- 2021
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In: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier. - 0301-2115 .- 1872-7654. ; 257, s. 42-50
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Journal article (peer-reviewed)abstract
- Objective: To investigate the impact of major depressive disorder (MDD) and antidepressant medication before and during pregnancy on obstetric and neonatal outcomes. Study design: A national register-based cohort study of pregnant women born in Sweden, and their first child born in 2012-2015 (n = 262 329). Women diagnosed with MDD and who had redeemed an antidepressant one year before becoming pregnant ("before pregnancy") and women who were diagnosed with MDD and who had redeemed an antidepressant both before and during pregnancy ("before and during pregnancy") were compared with each other and with women who had neither been diagnosed with MDD nor been prescribed antidepressants (population controls). Results: In comparison to population controls, the "before pregnancy" and the "before and during pregnancy" groups had increased likelihoods of operative childbirth (aOR = 1.19, 95 % CI 1.12-1.27, aOR = 1.38, 95 % CI 1.28-1.48 respectively), and with an increased likelihood for the child being admitted to a neonatal intensive care unit (NICU) (aOR = 1.51, 95 % CI 1.17-1.95, aOR = 1.55, 95 % CI 1.14-2.11). Children born to mothers in the "before and during pregnancy" group had an increased likelihood of preterm birth (aOR = 1.72, 95 % CI 1.52-1.95,), while children to mothers in the "before pregnancy" group had an increased likelihood of low birthweight (aOR = 1.15, 95 % CI 1.00-1.33) compared to population controls. Women in the "before and during pregnancy" group had an increased likelihood for hyperemesis during pregnancy (aOR =1.93, 95 % CI = 1.60-2.32), having an operative childbirth (aOR =1.17, 95 % CI = 1.06-1.29) or a preterm birth (aOR = 1.53, 95 % CI = 1.28-1.81) compared to the "before pregnancy" group. Conclusions: Women with MDD and antidepressant medication prior to becoming pregnant are at increased risk for adverse obstetric and neonatal outcomes compared to women without an MDD. Continuation of antidepressant medication during pregnancy somewhat increased the risk for adverse obstetric and neonatal outcomes. (C) 2020 Published by Elsevier B.V.
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| 32. |
- Wolgast, Emelie, et al.
(author)
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Womens perceptions of medication use during pregnancy and breastfeeding-A Swedish cross-sectional questionnaire study
- 2019
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In: Acta Obstetricia et Gynecologica Scandinavica. - : WILEY. - 0001-6349 .- 1600-0412. ; 98:7, s. 856-864
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Journal article (peer-reviewed)abstract
- Introduction Use of medication for different kinds of symptoms and diseases during pregnancy is common. When counseling the pregnant woman, an understanding of her perceptions concerning the use of medication as well as possible associated anxiety and obstacles is important to ensure high adherence to the treatment regimen. Material and methods A questionnaire was developed regarding the use of medication, perceptions on use of medication, as well as perceptions about pregnancy outcomes in association with medication use during pregnancy. In total, 850 pregnant women in gestational weeks 25-29 participated in the study. Results The response rate was 92.7% (n = 832/898). About 19.4% of the respondents (n = 160/824) were frequent users (medication use daily to several times a week) and 28.4% (n = 234/824) were non-frequent users (medication use once a week to once a month). The majority perceived medication use during early pregnancy (61.4%, n = 501/816), late pregnancy (55.6%, n = 455/819) and breastfeeding (57.7%, n = 474/821) as probably harmful or harmful. These findings were more common in non-users (medication used rarely or never) than frequent users (P-value amp;lt;0.001, amp;lt;0.001 and 0.007). The pregnant women had great confidence in advice from a physician (83.8%, n = 666/795) or a midwife (77.0%, n = 620/805) concerning medication during pregnancy. Conclusions The majority of pregnant women in Sweden consider the use of medication during pregnancy either probably harmful or harmful and this perception is associated with non-use of medication. The pregnant women in our study had high confidence in healthcare professionals when seeking advice; thus, actively asking about perceptions could lead to better counseling.
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