| 1. |
- Arechvo, Anastasija, et al.
(författare)
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Fusion imaging in brain structure measurements on a fetus phantom, combining real-time ultrasound with magnetic resonance imaging
- 2021
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Ingår i: Australasian Journal of Ultrasound in Medicine. - : Wiley. - 1836-6864 .- 2205-0140. ; 24:3, s. 161-172
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To assess synchronisation of MRI and US in measuring foetus phantom head structures; inter-method, intra- and inter-observer differences on biparietal diameter (BPD), head diameter, anterio-posterior head diameter (HAP) and lateral ventricle structures (VS). Methods: Fusion Imaging (FI) has been performed by combining MRI and US simultaneously. Axial scans of 1.5 Tesla MRI on a foetus phantom were acquired and uploaded on a US machine (EPIQ 7G, Philips). A PercuNav US tracker allowed the system to recognise and display the position of the transducer. A fetal phantom tracker was used as a phantom reference. Real-time US of the phantom head was performed by synchronising the uploaded MRI images using different landmarks. Synchronisation has been assessed by taking measurements after rotating the US probe by 90. Measurements were taken by three different observers twice. Differences in measurements between MRI and US, inter-, intra-observer differences in all measurements were assessed. Results: BPD, HAP and VS measurements before rotation were 0.13 ± 0.06 cm, 0.46 ± 0.09 cm and 0.4 ± 0.23 cm (width) and mean 0.6 ± 0.25 cm (length) larger at MRI than at US using any number of landmarks. After US probe rotation VS were 0.3 ± 0.24 cm in width and 0.3 ± 0.27 cm in length. Intra- and inter-observer differences in all measurements were small. Conclusions: FI showed good synchronisation in measurements. BPD, HAP and VS were larger at MRI than US, likely a result of the way images are generated. Intra-, inter-observer differences between measurements were small. This can be important when reporting geometric measures from FI.
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| 2. |
- Bjelke, Maria, et al.
(författare)
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Mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour : A retrospective cohort study of nulliparous women
- 2023
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women.Methods and findings: A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to <2 h), 120–239 min (2- <4h) and ≥240 min (≥4h). Differences between the groups were examined using t-test and Chi2-tests and regression analyses were used to analyse adjusted odds ratio with 95% confidence intervals. The primary outcome was mode of delivery in relation to the duration of the passive second stage and the secondary outcomes covered a series of adverse maternal and neonatal birth outcomes. The rates of instrumental and caesarean deliveries increased as the duration of the passive second stage increased. A ≥4-hour duration of the passive second stage was associated with a nine-times increased risk of caesarean section, and a four-times risk of instrumental delivery compared to a duration of <2 hours in the adjusted analyses. No differences were found in the maternal birth outcomes. The risk of a 5-minute Apgar score <7 was increased in the 2-<4h group. A longer passive second stage was not associated with an increased risk of negative birth experience.Conclusions: Our study demonstrates an increased risk of operative delivery for a longer duration (>2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged.
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| 3. |
- Bjelke, Maria, et al.
(författare)
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Nulliparous women’s lived experiences of the prolonged passive stage of labour: A thematic analysis based on descriptive phenomenology
- 2024
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 41, s. 100985-100985
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Prolonged progress can occur in the first and second stages of labour and may contribute to a negative birth experience. However, previous studies have mainly focused on quantitative aspects or overall birth experience, and little is known about women's experiences of a prolonged passive second stage. Objective: To describe the lived experiences of a prolonged passive second stage of labour in nulliparous women. Methods: A qualitative study was conducted with 15 nulliparous women with a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. Results: The analysis resulted in four themes: “An unknown phase” that entailed remaining in a phase that the women lacked an awareness of. “Trust and mistrust in the body's ability” represents the mindset for vaginal birth as well as feelings of powerlessness and self-guilt. The theme “Loss of control” included experiences of frustration, fatigue, and having to deny bodily instincts. “Support through presence and involvement” signifies support through the midwife's presence in the birthing room, although there were also descriptions of emotional or physical absence. Conclusions: The findings contribute to the understanding of prolonged labour based on women's lived experiences and add to the body of knowledge about the prolonged passive second stage. This study highlights that women need support through information, presence, and encouragement to remain in control. It can be beneficial during birth preparation to include knowledge about the passive second stage together with unexpected or complicated situations during birth, such as prolonged labour.
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| 4. |
- Bjelke, Maria, et al.
(författare)
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Prolonged passive second stage of labor in nulliparous women-Prevalence and risk factors : A historical cohort study
- 2022
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 101:5, s. 499-505
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Tidskriftsartikel (refereegranskat)abstract
- Introduction This study examined the prevalence of and risk factors for a prolonged passive second stage of labor in nulliparous women. Material and Methods This was a historical cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. Duration of the passive second stage was measured as time from retracted cervix to start of pushing. Prolonged passive second stage was defined as >= 2 h. Prevalence was calculated and associations between prolonged passive second stage and maternal, obstetric and neonatal characteristics and potential risk factors were assessed using logistic regression models. Results The prevalence of prolonged passive second stage was 37.6%. Factors associated with an increased risk of prolonged passive second stage were epidural analgesia (adjusted odds ratio [aOR] 3.93; 95% confidence interval [CI] 2.90-5.34), malpresentation (aOR 2.26; 95% CI 1.27-4.05), maternal age >= 30 years (aOR 2.00; 95% CI 1.50-2.65) and birth weight >= 4 kg (aOR 1.50; 95% CI 1.05-2.15). Maternal body mass index >= 30 (aOR 0.52; 95% CI 0.34-0.79) and noncohabiting (aOR 0.51; 95% CI 0.30-0.89) reduced the odds of prolonged passive second stage. Conclusions A prolonged passive second stage of labor in nulliparous women is common (n = 425 [38%]). We found epidural analgesia, malpresentation, maternal age >= 30 years and birthweight >= 4 kg to be major risk factors associated with an increased risk of a prolonged passive second stage. Birth outcomes for prolonged passive second stage need to be investigated to strengthen evidence for the management of the second stage of labor.
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| 5. |
- Bjelke, Maria
(författare)
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Prolonged passive second stage of labour in nulliparous women : A multi perspective study
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: This study aimed to describe the prolonged passive second stage of labour in nulliparous women in relation to its prevalence, risk factors, birth outcomes, midwives’ intrapartum management, and women's birth experiences. Methods: Study I was a qualitative study in which 36 midwives participated in seven focus group discussions. Data were analysed using qualitative content analysis. Studies II and III were retrospective observational cohort studies where medical records from 1131 nulliparous women in Sweden were reviewed. Analyses were performed using descriptive statistics and multivariable logistic regression. Study IV included 15 individual interviews with nulliparous women who had a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology.Results: Midwives’ management of the passive phase is complex, especially if progress is slow. Guidelines were considered, but women were preferably managed individually. The prevalence of prolonged passive second stage (≥2h) was 38%. Epidural analgesia, malpresentation, maternal age ≥30 years, and birth weight of ≥4 kg were identified as risk factors for prolonged passive second stage. Longer duration of the passive second stage was associated with an increased risk of operative delivery. There were no associations with adverse maternal outcomes. Associations with adverse neonatal outcomes were found, although the rate of adverse neonatal outcomes were low in the study population. Women’s experiences of prolonged passive second stage were described in four themes: “An unknown phase”, “Trust and mistrust in the body’s ability”, ”Loss of control“, and “Support through presence and involvement”.Conclusion: This thesis describes the prolonged passive second stage from multiple perspectives, including midwives, epidemiological data, and women’s experiences. The midwives’ management of the passive second stage included a complex continuous process of assessment and balancing options for the next step. A prolonged passive second stage was common and did not result in increased risks of adverse maternal outcomes, although further fetal surveillance can be called for. Nulliparous women experienced the passive second stage as an unknown phase and expected a different path for birth, and the experience could include loss of control and increased need for emotional and physical support.
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| 6. |
- Colmorn, Lotte B., et al.
(författare)
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The Nordic Obstetric Surveillance Study: a study of complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery
- 2015
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 94:7, s. 734-744
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the rates and characteristics of women with complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery in the Nordic countries. Design: Prospective, Nordic collaboration. Setting: The Nordic Obstetric Surveillance Study (NOSS) collected cases of severe obstetric complications in the Nordic countries from April 2009 to August 2012. Sample and methods: Cases were reported by clinicians at the Nordic maternity units and retrieved from medical birth registers, hospital discharge registers, and transfusion databases by using International Classification of Diseases, 10th revision codes on diagnoses and the Nordic Medico-Statistical Committee Classification of Surgical Procedure codes. Main outcome measures: Rates of the studied complications and possible risk factors among parturients in the Nordic countries. Results: The studied complications were reported in 1019 instances among 605362 deliveries during the study period. The reported rate of severe blood loss at delivery was 11.6/10000 deliveries, complete uterine rupture was 5.6/10000 deliveries, abnormally invasive placenta was 4.6/10000 deliveries, and peripartum hysterectomy was 3.5/10000 deliveries. Of the women, 25% had two or more complications. Women with complications were more often >35years old, overweight, with a higher parity, and a history of cesarean delivery compared with the total population. Conclusion: The studied obstetric complications are rare. Uniform definitions and valid reporting are essential for international comparisons. The main risk factors include previous cesarean section. The detailed information collected in the NOSS database provides a basis for epidemiologic studies, audits, and educational activities.
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| 7. |
- Engjom, Hilde, et al.
(författare)
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COVID-19 in pregnancy—characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries
- 2021
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 100:9, s. 1611-1619
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Population-based studies about the consequences of SARS-CoV-2 infection (COVID-19) in pregnancy are few and have limited generalizability to the Nordic population and healthcare systems. Material and methods: This study examines pregnant women with COVID-19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between 1 March and 30 June 2020 and had a positive SARS-CoV-2 PCR test ≤14 days prior to admission. Cause of admission was classified as obstetric or COVID-19-related. Results: In the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women required hospital care due to COVID-19. The risk of admission due to COVID-19 was 0.4/1000 deliveries in Denmark, Finland and Norway, and 3.8/1000 deliveries in the Swedish regions. Women hospitalized because of COVID-19 were more frequently obese (p < 0.001) and had a migrant background (p < 0.001) compared with the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Among the 56 women admitted due to COVID-19, 48 women delivered 51 infants. Preterm delivery (n = 12, 25%, p < 0.001) and cesarean delivery (n = 21, 43.8%, p < 0.001) were more frequent in women with COVID-19 compared with women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported. Conclusions: The risk of admission due to COVID-19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the risk of admission due to severe COVID-19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.
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| 8. |
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| 9. |
- Lindstrom, Mats B, et al.
(författare)
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Effect of pancreatic phospholipase A2 and gastric lipase on the action of pancreatic carboxyl ester lipase against lipid substrates in vitro
- 1991
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Ingår i: Biochimica et Biophysica Acta. - 0006-3002. ; 1084:2, s. 194-197
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Tidskriftsartikel (refereegranskat)abstract
- Preincubation of a triolein/phospholipid/cholesteryl oleate-emulsion in vitro with either pancreatic phospholipase A2 (PLA2) or gastric lipase (GL) resulted in hydrolysis (measured by pH-stat-titration) of cholesteryl [3H]oleate only after human pancreatic carboxyl ester lipase (CEL) was added to the system. No appreciable hydrolysis was observed when CEL was added alone. Consequently, a concerted action either of PLA2 and CEL or of GL and CEL made the substrate cholesteryl oleate available for hydrolysis by CEL. This was the case when cholesteryl oleate was solubilised in a phospholipid-stabilised triglyceride emulsion, which is the physico-chemical form in which the major part of dietary cholesteryl esters are presented to the gastro-intestinal tract of man.
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| 10. |
- Thurn, Lars
(författare)
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Massive transfusion in relation to obstetric hemorrhage : with special attention to placenta accreta
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall purpose of this thesis was to assess risk factors, incidences, and complications of massive blood transfusions in relation to obstetric hemorrhage postpartum. Obstetric hemorrhage requiring blood transfusion postpartum has recently shown an increasing trend in many high resource countries. Massive transfusion, defined as more than 10 units of RBC within 24 hours is well described in surgery and trauma care, however little is known about its occurrence and risk factors in obstetric patients. Most blood transfusions are safe and necessary, but there are potential complications, including transfusion reactions, transfusion transmitted infections, and post transfusion thrombosis, which have to be taken into consideration when choosing between blood transfusion and other alternatives. The increasing rate of cesarean deliveries since the 1970’s, has contributed to complications in sequential pregnancies. One of the more severe complications is abnormally invasive placenta, a condition with a high risk of requiring massive blood transfusion and peripartum hysterectomy. In Study 1, the incidence, risk factors, and rate of antenatal detection of abnormally invasive placenta in the Nordic countries were investigated. The study was conducted as a Nordic collaboration from 2009 to 2012, and included 605,000 deliveries. Cases of abnormally invasive placenta were reported on a monthly basis directly from maternity wards, and were complemented with data from the National Health Registries to confirm or to identify missing cases. In total, 205 cases of invasive placentas associated with a laparotomy were identified, corresponding to a prevalence of 3.4 per 10,000 deliveries. Major risk factors were placenta previa (OR = 290) and prior cesarean section (OR = 7). Only one third of the cases identified as invasive placentas were detected antenatally, and among those cases not detected, more than one third had had a prior cesarean section. Study 2 was a retrospective population-based cohort study investigating risk factors, incidence, and trends over time for massive blood transfusion in women who gave birth in the County of Stockholm between 1990 and 2011. Data from the Medical Birth Registry was cross-linked to the Stockholm Transfusion Database. Massive transfusion was defined as transfusion of >10 units of red blood cells from time of partus through the next day. Altogether 517,874 pregnancies were included. The study found the incidence of massive transfusion to be 5.3 per 10,000 deliveries and showed an increasing trend over time. Major antenatal risk factors were abnormal placentation (OR = 41) and prior cesarean section (OR = 4). Study 3 was a retrospective cohort study investigating whether postpartum hemorrhage and red blood transfusion are significant and independent major risk factors for venous thromboembolism postpartum. Women who gave birth between 1999 and 2002 in the Stockholm region were included in the study. A time period before the implementation of national thromboprophylaxis guidelines was chosen. Data from the Medical Birth Registry was linked to the transfusion database and to the National Discharge Registry. Among 82,376 deliveries 56 cases of venous thromboembolism were identified. The study found transfusion of red blood cells postpartum (OR = 5) - but not postpartum hemorrhage without blood transfusion - to be a significant major risk factor for venous thromboembolism postpartum. In Study 4 the aim was to assess the risk of transfusion reactions in women receiving postpartum blood transfusion. This populations based cohort study is based on the same cohort as Study 2. Data on pregnancies from the Medical Birth Registry was linked to the Stockholm Transfusion Database. Women with postpartum blood transfusion and a transfusion reaction within seven days from partus were identified. The study found a twofold increased risk (OR = 2.0) of a transfusion reaction in women postpartum compared to non-pregnant women receiving a blood transfusion. Among all women who had a blood transfusion postpartum, women with preeclampsia were twice as likely to have a transfusion reaction. In summary, abnormally invasive placenta occurs in 3.4 out of 10,000 deliveries and is the major risk factor for massive blood transfusion postpartum. A reduction in the rate of cesarean deliveries might be the best way to lower the incidence of both invasive placenta and massive blood transfusion postpartum. A focused ultrasound in pregnant women with a placenta previa or a low-lying placenta covering the scar of a previous cesarean section might improve antenatal detection of abnormally invasive placentas and allow better planning for delivery, thereby reducing maternal morbidity in those complicated pregnancies. Postpartum blood transfusion and especially massive blood transfusion are independent major risk factors for postpartum thromboembolism. As such, they should be implemented in the Swedish thromboprophylactic guidelines during pregnancy. The risk of transfusion reactions in women during pregnancy seems to be increased, especially in pregnancies complicated by preeclampsia. Therefore, a heightened attention is recommended to women with preeclampsia when a blood transfusion is to be administrated.
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| 11. |
- Varpula, Reetta, et al.
(författare)
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Early suppression policies protected pregnant women from COVID-19 in 2020 : A population-based surveillance from the Nordic countries
- 2024
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - 0001-6349. ; 103:6, s. 1063-1072
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The Coronavirus 2019 Disease (COVID-19) pandemic reached the Nordic countries in March 2020. Public health interventions to limit viral transmission varied across different countries both in timing and in magnitude. Interventions indicated by an Oxford Stringency Index ≥50 were implemented early (March 13–17, 2020) in Denmark, Finland, Norway and Iceland, and on March 26, 2020 in Sweden. The aim of the current study was to assess the incidence of COVID-19-related admissions of pregnant women in the Nordic countries in relation to the different national public health strategies during the first year of the pandemic. Material and methods: This is a meta-analysis of population-based cohort studies in the five Nordic countries with national or regional surveillance in the Nordic Obstetric Surveillance System (NOSS) collaboration: national data from Denmark, Finland, Iceland and Norway, and regional data covering 31% of births in Sweden. The source population consisted of women giving birth in the included areas March 1–December 31, 2020. Pregnant women with a positive SARS-CoV-2 PCR test ≤14 days before hospital admission were included, and admissions were stratified as either COVID-19-related or non-COVID (other obstetric healthcare). Information about public health policies was retrieved retrospectively. Results: In total, 392 382 maternities were considered. Of these, 600 women were diagnosed with SARS-CoV-2 infection and 137 (22.8%) were admitted for COVID-19 symptoms. The pooled incidence of COVID-19 admissions per 1000 maternities was 0.5 (95% confidence interval [CI] 0.2 to 1.2, I2 = 77.6, tau2 = 0.68, P = 0.0), ranging from no admissions in Iceland to 1.9 admissions in the Swedish regions. Interventions to restrict viral transmission were less stringent in Sweden than in the other Nordic countries. Conclusions: There was a clear variation in pregnant women's risk of COVID-19 admission across countries with similar healthcare systems but different public health interventions to limit viral transmission. The meta-analysis indicates that early suppression policies protected pregnant women from severe COVID-19 disease prior to the availability of individual protection with vaccines.
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