| 1. |
- Ahnström, Josefin, et al.
(författare)
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Plasma levels of apolipoprotein M in normal and complicated pregnancy.
- 2010
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 89:9, s. 1214-1217
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Tidskriftsartikel (refereegranskat)abstract
- Apolipoprotein M (apoM) is mainly associated with high-density lipoprotein in human plasma. Despite several studies suggesting apoM as an anti-atherogenic, its function is not yet fully understood. Plasma apoM was measured in normal pregnancies at four different gestational ages and in the postpartum period to investigate whether the concentration of apoM changes during pregnancy. In addition, apoM was measured at 13 weeks in women who subsequently developed preeclampsia, gestational diabetes, recurrent miscarriage, or small-for-gestational age babies, and in women with uncomplicated pregnancies. The plasma concentrations of apoM increased during pregnancy to reach highest levels in the postpartum period. Thus, plasma apoM in non-pregnant women was around 0.77 micromol/l, 0.88 micromol/l at 40 gestational weeks, and 1.05 micromol/l in the postpartum period (p < 0.0001). No differences in plasma concentrations of apoM were found among the studied pregnancy complications.
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| 2. |
- Amini, Hashem
(författare)
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Fetal Anomalies : Surveillance and Diagnostic Accuracy of Ultrasound and Magnetic Resonance Imaging
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims were to investigate the accuracy of ultrasound in diagnosis of structural fetal anomalies with special focus on false positive findings (I), to evaluate the additional value of second trimester fetal MRI on pregnancy management (II-III) and to estimate the ascertainment in the Swedish Birth Defects Registry and incidence of spina bifida and cleft lip/palate (IV). Retrospectively, 328 fetal autopsies were identified where pregnancies were terminated due to ultrasonographically diagnosed fetal anomalies. In 175 (53.4 %) cases ultrasound and fetal autopsy were identical, in 124 (37.8 %) ultrasound was almost correct, in 23 (7.0 %) ultrasound diagnoses could not be verified, but fetal autopsy showed other anomalies with at least the same prognostic value and in six (1.8 %) ultrasound diagnosis could not be verified and autopsy showed no or less severe anomalies (I). Prospectively, 29 pregnancies with CNS- (II) and 63 with non-CNS-anomalies (III) were included. In the CNS study MRI provided no additional information in 18 fetuses (62 %), additional information without changing the management in 8 (28 %) and additional information altering the pregnancy management in 3 (10%). In the non-CNS study the corresponding figures were 43 (68 %), 17 (27 %) and three (5 %), respectively. MRI in the second trimester might be a clinically valuable adjunct to ultrasound for the evaluation of CNS anomalies, especially when the ultrasound is inconclusive due to maternal obesity (II) and in non-CNS anomalies in cases of diaphragmatic hernia or oligohydramnios (III). In newborns, the ascertainments of birth defects are relatively high and assessable, but in pregnancy terminations they are lower or unknown. The incidence of newborns with spina bifida has decreased because of an increased rate of pregnancy terminations (>60%). There is room for improvement concerning the reporting of anomalies from terminated pregnancies (IV).
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| 3. |
- Dabo Pettersson, Fatimah, 1975-
(författare)
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Genetics and Labor Pain Behavior
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Labor may perhaps be the most painful a woman might experience, although characterized by large inter-individual variability. The perceived pain during labor is the result of diverse factors, i.e. her previous pain experiences, the analgesia she receives and maybe also her genes. The overall aim of this thesis was to investigate biological and psychological mechanisms underlying inter-individual differences in labor pain related behaviors. The mechanisms that characterize endogenous pain relief during labor are not fully understood, though it is known to be partly explained by the effects of β-endorphin (BE). BE plasma levels were followed longitudinally in a cohort of pregnant women and were found to remain unchanged between early and late pregnancy, although with a nadir in the beginning of the third trimester. Furthermore, women with low levels of BE in plasma at the end of the third trimester, required second line labor analgesia to a significantly higher extent than women with normal levels. In a population-based sample of 814 pregnant women we investigated if inter-individual differences in labor pain related behavior was influenced by the pain-protective single nucleotide polymorphism (SNP) combination of guanosine triphosphate cyclohydrolase (GCH1) and the opioid receptor µ-1 gene (OPRM1) A118G SNP. We identified a possible association between the pain-protective SNP combination of GCH1 and use of second line analgesia. No association was found between the OPRM1 and use of analgesia or labor pain related behavior. The association between self-rated antenatal depressed mood and anxiety in relation to pain behaviors and self-reported pain during labor was investigated. We found that depressed mood during pregnancy is associated with early arrival to the delivery department, whereas antenatal anxiety is associated with increased self-rated pain prior to labor analgesia. In conclusion, although an increasing number of studies strongly suggest that genetic predisposition plays an important role in pain and pain-related mechanisms, GCH1 and OPRM1 has little to offer in terms of individual counseling on labor analgesia. To enable the future use of genetic variability for pre-labor testing and counseling, a number of different genes reflecting pain mediation pathways, involving biological and psychological mechanisms, need to be analyzed in combination.
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| 4. |
- Epstein, Elisabeth, et al.
(författare)
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Sonographic characteristics of squamous cell cancer and adenocarcinoma of the uterine cervix.
- 2010
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Ingår i: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 1469-0705. ; Apr 8, s. 512-516
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the sonographic characteristic of squamous cell cancer (SCC) and adenocarcinoma (AC) of the cervix using transvaginal ultrasound. METHODS: Women with early stage cervical cancer undergoing transvaginal ultrasound examination prior to surgery were prospectively included. The sonographic characteristics were assessed with regard to tumor morphology, vascularization, size, extension and location. Histological assessment of tumor subtype, size, growth pattern, extension, location was performed. Both sonographic and histological assessments were done according to a standardized protocol. RESULTS: Fifty-five women were recruited. Ten were excluded since no tumor was seen on ultrasound and 5 because radical surgery was aborted due to positive lymph nodes, detected by the sentinel node technique. Among the remaining 40 women 20 had AC and 20 SCC. At pathological examination 34 women had tumors confined to the cervix, 3 had parametrial and 3 vaginal invasion. Hypoechoic echogenicity was associated with SCC in 73% (11/15), while isoechoic echogenicity indicated AC in 68% (13/19) of the women (p=0.03). Mixed echogenicity (n=4) showed a non-significant relation to larger tumor volume (p=0.23). Hyperechoic echogenicity was found in 2 women, both with the less malignant villoglandular AC. Color Doppler signals were found in all AC and 90% (18/20) of the SCC, as compared to most normal cervical tissue with virtually no detectable vascularization. CONCLUSIONS: We found that the sonographic appearance of SCC and AC differs, a knowledge that can be of use in the clinical evaluation of cervical tumors. Copyright (c) 2010 ISUOG. Published by John Wiley & Sons, Ltd.
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| 5. |
- Isma, Nazim, et al.
(författare)
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The effect of low molecular weight heparin (dalteparin) on duration and initiation of labour.
- 2010
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Ingår i: Journal of Thrombosis and Thrombolysis. - : Springer Science and Business Media LLC. - 1573-742X .- 0929-5305. ; 30, s. 149-153
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Tidskriftsartikel (refereegranskat)abstract
- It has recently been reported that women treated with low molecular weight heparin (LMWH) during pregnancy had 3 h shorter duration of delivery. The aim of the present study was to evaluate whether LMWH (dalteparin) affects labour. From January 1996 to December 2005, 217 consecutive pregnancies, out of 34 216 newborn (prevalence 0.6%) that were given thromboprophylaxis with dalteparin (usually 5,000 IU once daily). These 217 consecutive pregnancies were compared to an unselected control group (n = 1,499) of gravidae. Main outcome was time in first and second stage of labour and gestational age at delivery. Among nulliparous women, there were significantly fewer women with prolonged first stage of labour as compared to controls (4.1% vs. 8.5%, P = 0.047). In addition, the duration of first stage of labour was 1 h shorter among those treated with LMWH (5.2 vs. 6.2 h, P = 0.06). There were no such differences among parous women. The risk of prematurity, profuse blood loss, and postpartum anaemia was almost doubled among those treated with LMWH (11.5% vs. 5.9%, P = 0.002, 10.6% vs. 5.9%, P < 0.001, and 12.9% vs. 8.7%, P = 0.048, respectively). Treatment with a prophylactic dose of LMWH (dalteparin) during pregnancy was related to fewer women with prolonged first stage of labour, but also to an increased risk of prematurity and blood loss complications.
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| 6. |
- Langhoff-Roos, Jens, et al.
(författare)
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The Nordic medical birth registers - a potential goldmine for clinical research
- 2014
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 93:2, s. 132-137
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The Nordic medical birth registers have long been used for valuable clinical research. Their collection of data for more than four decades offers unusual possibilities for research across generations. At the same time, serum and blotting paper blood samples have been stored from most neonates. Two large cohorts (approximately 100000 births) in Denmark and Norway have been described by questionnaires, interviews and collection of biological samples (blood, urine and milk teeth), as well as a systematic prospective follow-up of the offspring. National patient registers provide information on preceding, underlying and present health problems of the parents and their offspring. Researchers may, with permission from the national authorities, obtain access to individualized or anonymized data from the registers and tissue-banks. These data allow for multivariate analyses but their usefulness depends on knowledge of the specific registers and biological sample banks and on proper validation of the registers.
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| 7. |
- Lindqvist, Pelle, et al.
(författare)
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Characteristics and outcome of brachial plexus birth palsy in neonates.
- 2012
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Ingår i: Acta paediatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 101:6, s. 579-582
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To relate pregnancy characteristics to extent and reversibility of brachial plexus birth palsy (BPBP) in neonates. Methods: Retrospective case-control study: newborns with a registered diagnosis of BPBP (n = 168) 1990-2005 were compared to data from a randomly selected control group (n = 1000). Characteristics were related to the level of injury, reversibility and outcome. Results: Among 51 841 newborns, 168 cases with BPBP were found (incidence 3.2/1000 newborns/year). Extent and reversibility of lesion did not differ with respect to characteristics of mothers, foetuses or deliveries. Children with C5-C6 and C5-C6-C7 injuries had complete recovery in 86% and 38%, respectively. Global injuries (C5-Th1) always had permanent disability. Accelerators (foetal weight gain >35 g/day after 32 weeks of gestation) and foetuses with estimated weight deviation ≥ +22% at 32 weeks were at seven- and ninefold increased risk of BPBP. Parous women were at doubled risk as compared to nulliparous women. Conclusion: Maternal and foetal characteristics influence risk of BPBP, but not the extent of injury or reversibility of injury. Because of the high risk of permanent disability and modest risk of low Apgar or pH among newborns with BPBP, the recommendation of prompt delivery may need to be re-evaluated.
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| 8. |
- Lindqvist, Pelle G., et al.
(författare)
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A modified surgical approach to women with obstetric anal sphincter tears by separate suturing of external and internal anal sphincter. A modified approach to obstetric anal sphincter injury
- 2010
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Long-term results after obstetric anal sphincter injury (OASI) are poor. We aimed to improve the long-term outcome after OASI by lessening symptoms of anal incontinence. Methods: In a prospective study at Malmo University Hospital, twenty-six women with at least grade 3B OASI were classified and sutured in a systematic way, including separate suturing of the internal and external sphincter muscles with monofilament absorbable sutures. The principal outcome assessed by answers given to six questions, was a difference in anal incontinence score, between the study group and two control groups (women with prior OASI [n = 180] and primiparous women delivered vaginally without a diagnose of OASI [n = 100]). Results: An anal incontinence score of zero (i.e., no symptoms) was found in 74% of the study group, 47% of the OASI control group, and 66% of the vaginal control group (p = 0.02 and 0.5, as compared to the study group). Conclusions: A modified suturing technique was followed by significant improved one-year symptoms of anal incontinence as compared to historical cases.
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| 9. |
- Lindqvist, Pelle G., et al.
(författare)
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Are active sun exposure habits related to lowering risk of type 2 diabetes mellitus in women, a prospective cohort study?
- 2010
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 1872-8227 .- 0168-8227. ; 90:1, s. 109-114
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Tidskriftsartikel (refereegranskat)abstract
- Aim An inverse relationship exists between vitamin D levels and diabetes mellitus However, little is known about the correlation of sun exposure habits and type 2 diabetes mellitus (DM) Methods A South Swedish cohort study comprising 1000 women from each age group between 25 and 64 (n = 40,000) drawn from the Southern Swedish population registry 1990-1992 At the inception of the study 74% answered the inquiry (n = 29,518) and provided detailed information on their sun exposure habits and other variables A follow-up inquiry was sent 2000-2002 which 24,098 women answered The mean follow-up time was 11 years Logistic regression analysis was used and the main outcome was the relationship between type 2 DM and sun exposure habits. Results Our findings indicated that women with active sun exposure habits were at a 30% lower risk of having DM, as compared to those with non-active habits. There was an inverse relation between this risk reduction and BMI Conclusion Our investigation gives possible epidemiological explanation to ethnic and seasonal differences in type 2 DM and metabolic control The study supports that sunlight is involved in the glucose metabolism (C) 2010 Elsevier Ireland Ltd All rights reserved.
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| 10. |
- Lindqvist, Pelle G., et al.
(författare)
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Identification of pregnancies at increased risk of brachial plexus birth palsy - the construction of a weighted risk score
- 2014
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 27:3, s. 252-256
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Since it is difficult to identify women at increased risk of fetal brachial plexus birth palsy (BPBP) during labor and delivery, we aimed to construct and validate a risk score. Methods: A retrospective case-control study was undertaken in 2001 and 2006 in an urban context in Malmo, Sweden. A risk score was constructed for all women who had received routine municipal maternal health care at Skane University Hospital (n = 10 459). The model was validated among all pregnant women with BPBP and controls in Sweden between 2006 and 2007. Results: The likelihood of BPBP increased as the risk score rose: 3.1% of the women studied had a risk score >= 5, including 32.1% of the BPBP cases, where the risk showed a 38-fold increase, as compared to those with a risk score <= 1 (2/3 of the population). Conclusion: Our findings indicate that it is possible to identify women at increased risk of having a child with BPBP by using variables observable in advance of delivery.
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