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- Danerek, Margaretha, et al.
(författare)
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Attitudes of Midwives in Sweden Toward a Woman's Refusal of an Emergency Cesarean Section or a Cesarean Section on Request.
- 2011
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Ingår i: Birth. - 0730-7659. ; 38:1, s. 71-79
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Tidskriftsartikel (refereegranskat)abstract
- Background: A woman's refusal or request for a cesarean section can be a problem for midwives and obstetricians working in maternity units. The objective of this study was to describe the attitudes of midwives in Sweden toward the obstetrician's decision making in relation to a woman's refusal of an emergency cesarean section and to a woman's request for a cesarean section without a medical indication. Methods: The study has a cross-sectional multicenter design and used an anonymous, structured, and standardized questionnaire for data collection. The study group comprised midwives who had experience working at a delivery ward at 13 maternity units with neonatal intensive care units in Sweden (n = 259). Results: In the case of a woman's refusal to undergo an emergency cesarean section for fetal reasons, most midwives (89%) thought that the obstetrician should try to persuade the woman to agree. Concerning a woman's request for a cesarean section without any medical indications, most midwives thought that the obstetrician should agree if the woman had previous maternal or fetal complications. The reason was to support the woman's decision out of respect for her autonomy; the midwives at six university hospitals were less willing to accept the woman's autonomy in this situation. If the only reason was "her own choice," 77 percent of the midwives responded that the obstetrician should not comply. Conclusions: The main focus of midwives seems to be the baby's health, and therefore they do not always agree with respect to a woman's refusal or request for a cesarean section. The midwives prefer to continue to explain the situation and persuade the woman to agree with the recommendation of the obstetrician. (BIRTH 38:1 March 2011).
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| 2. |
- Danerek, Margaretha, et al.
(författare)
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Attitudes of Swedish midwives towards management of extremely preterm labour and birth
- 2012
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Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 28:6, s. e857-e864
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Tidskriftsartikel (refereegranskat)abstract
- Objective the aim of the study was to ascertain the attitudes of Swedish midwives towards management of very preterm labour and birth and to compare the attitudes of midwives at university hospitals with those at general hospitals. Design this cross-sectional descriptive and comparative study used an anonymous self-administrated questionnaire for data collection. Descriptive and analytic statistics were carried out for analysis. Participants the answers from midwives (n=259) were collected in a prospective SWEMID study. Setting the midwives had experience of working on delivery wards in maternity units with neonatal intensive care units (NICU) in Sweden. Findings in the management of very preterm labour and birth, midwives agreed to initiate interventions concerning steroid prophylaxis at 23 gestational weeks (GW), caesarean section for preterm labour only at 25 GW, when to give information to the neonatologist before birth at 23 GW, and when to suggest transfer to NICU at 23 GW. Midwives at university hospitals were prone to start interventions at an earlier gestational age than the midwives at general hospitals. Midwives at university hospitals seemed to be more willing to disclose information to the parents. Key conclusions midwives with experience of handling very preterm births at 21–28 GW develop a positive attitude to interventions at an earlier gestational age as compared to midwives without such experience. Implications for practice based on these results we suggest more communication and transfer of information about the advances in perinatal care and exchange of knowledge between the staff at general and university hospitals. Establishment of platforms for inter-professional discussions about ethically difficult situations in perinatal care, might benefit the management of very preterm labour and birth.
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| 3. |
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| 4. |
- Sorensen, Anne, et al.
(författare)
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Changes in human fetal oxygenation during maternal hyperoxia as estimated by BOLD MRI
- 2013
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Ingår i: Prenatal Diagnosis. - : Wiley. - 1097-0223 .- 0197-3851. ; 33:2, s. 141-145
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Tidskriftsartikel (refereegranskat)abstract
- Objective Changes in blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) signal are closely related to changes in fetal oxygenation. In this study, we aimed to investigate the changes in human fetal oxygenation during maternal hyperoxia by using the non-invasive BOLD MRI technique. Method Eight healthy pregnant women in gestational week 28 to 34 were included. With the use of a facial oxygen mask, we induced maternal hyperoxia and measured changes in the BOLD MRI signal of selected fetal organs. Results In a number of fetal organs, the BOLD MRI signal increased significantly (P<0.01) during maternal hyperoxia (mean change in %+/- SEM): liver (14.3 +/- 3.7%), spleen (15.2 +/- 3.5%) and kidney (6.2 +/- 1.8%) as well as the placenta (6.5 +/- 1.6%). In the fetal brain, however, the BOLD MRI signal remained constant (0.3 +/- 0.2%). Conclusion During maternal hyperoxia, we demonstrated an increased oxygenation in a number of human fetal organs by using the non-invasive BOLD technique. The oxygenation of the fetal brain remained constant, thus a reversed' brain sparing mechanism could be considered in healthy fetuses subjected to hyperoxia. (c) 2012 John Wiley & Sons, Ltd.
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| 5. |
- Sorensen, A., et al.
(författare)
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Changes in human placental oxygenation during maternal hyperoxia estimated by blood oxygen level-dependent magnetic resonance imaging (BOLD MRI)
- 2013
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 42:3, s. 310-314
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate changes in human placental oxygenation during maternal hyperoxia using non-invasive blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI). Methods Eight healthy pregnant women with uncomplicated singleton pregnancies at gestational weeks 28-36 were examined with BOLD MRI, over two consecutive 5-min periods of different oxygenation: first normoxia (21% O-2) and then hyperoxia (12 L O-2/min), achieved by controlling the maternal oxygen supply with a non-rebreather facial mask. Selecting three slices showing cross-sections of the central part of the placenta, we investigated total placental oxygenation by drawing regions of interest (ROIs) covering the entire placenta, and regional placental oxygenation by drawing smaller ROIs in the darker and brighter areas of the placenta. For each ROI, the difference in BOLD signal between the two episodes was determined and the percentage increase in BOLD signal during hyperoxia (BOLD) was calculated. Results In the BOLD image, the normoxic placenta appeared heterogeneous, with darker areas located to the fetal side and brighter areas to the maternal side. During hyperoxia, the placenta became brighter and the structure more homogeneous, and the BOLD signal of the total placenta increased (BOLDtot, 15.2 +/- 3.2% (mean +/- SD), P<0.0001). The increase was seen predominantly in the dark areas in the fetal part of the placenta (BOLDfet, 32.1 +/- 9.3%) compared with in the bright areas in the maternal part of the placenta (BOLDmat, 5.4 +/- 3.5%). Conclusion During hyperoxia, placental oxygenation was increased predominantly in the darker placental areas, which, given their anatomical location, represent the fetal circulation of the placenta. To our knowledge, this is the first study to successfully visualize changes in placental oxygenation using BOLD MRI. Copyright (c) 2013 ISUOG. Published by John Wiley & Sons Ltd.
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| 6. |
- Thuring, Ann, et al.
(författare)
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Operator auditory perception and spectral quantification of umbilical artery Doppler ultrasound signals
- 2013
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: An experienced sonographer can by listening to the Doppler audio signals perceive various timbres that distinguish different types of umbilical artery flow despite an unchanged pulsatility index (PI). Our aim was to develop an objective measure of the Doppler audio signals recorded from fetoplacental circulation in a sheep model.METHODS: Various degrees of pathological flow velocity waveforms in the umbilical artery, similar to those in human complicated pregnancies, were induced by microsphere embolization of the placental bed (embolization model, 7 lamb fetuses, 370 Doppler recordings) or by fetal hemodilution (anemia model, 4 lamb fetuses, 184 recordings). A subjective 11-step operator auditory scale (OAS) was related to conventional Doppler parameters, PI and time average mean velocity (TAM), and to sound frequency analysis of Doppler signals (sound frequency with the maximum energy content [MAXpeak] and frequency band at maximum level minus 15 dB [MAXpeak-15 dB] over several heart cycles).RESULTS: WE FOUND A NEGATIVE CORRELATION BETWEEN THE OAS AND PI: median Rho -0.73 (range -0.35- -0.94) and -0.68 (range -0.57- -0.78) in the two lamb models, respectively. There was a positive correlation between OAS and TAM in both models: median Rho 0.80 (range 0.58-0.95) and 0.90 (range 0.78-0.95), respectively. A strong correlation was found between TAM and the results of sound spectrum analysis; in the embolization model the median r was 0.91 (range 0.88-0.97) for MAXpeak and 0.91 (range 0.82-0.98) for MAXpeak-15 dB. In the anemia model, the corresponding values were 0.92 (range 0.78-0.96) and 0.96 (range 0.89-0.98), respectively.CONCLUSION: Audio-spectrum analysis reflects the subjective perception of Doppler sound signals in the umbilical artery and has a strong correlation to TAM-velocity. This information might be of importance for clinical management of complicated pregnancies as an addition to conventional Doppler parameters.
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