| 51. |
|
|
| 52. |
- Soikkeli, Pia, et al.
(författare)
-
Doppler velocimetry for predicting fetal death in a twin pregnancy.
- 2002
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:8, s. 783-785
-
Tidskriftsartikel (refereegranskat)abstract
- Diagnosis of discordant twins is easily accomplished with modern ultrasound equipment, though diagnosing twin-to-twin transfusion syndrome (TTS) at an early stage might be a problem. The possibility of excluding TTS by Doppler ultrasound is demonstrated in a case with early severe growth restriction of one fetus. Characteristic blood velocity changes in a dying fetus are also illustrated. The Doppler technique has become an accepted method in obstetrics for antenatal surveillance, permitting evaluation of fetal circulation in a non-invasive manner and providing important physiological information on the fetal condition. Absent end-diastolic flow in the umbilical artery (UA) can warrant operative delivery for fetal distress (1). Perinatal mortality is increased fivefold in multiple gestation, as compared with singleton pregnancy (2). The major complications include preterm labor, intrauterine growth retardation (IUGR), TTS, polyhydramnios, oligohydramnios, fetal malformations, and pre-eclampsia. Twin fetuses are generally smaller than singletons and IUGR and intrauterine fetal deaths are more common (3). Before the introduction of the Doppler technique, ultrasound-imaging evaluation of discordant fetal size in twin pregnancy was a problem. Differential diagnosis of TTS and a true growth retardation of one fetus was a frequent worry for the clinician. Doppler examination of the fetal venous circulation with pulsating flow in the umbilical vein has been found helpful in the diagnosis of fetal congestive heart failure (4, 5). The general ultrasound imaging and Doppler findings in TTS are listed in Fig. 1. The information provided by ultrasound imaging and Doppler can thus distinguish between TTS and growth retardation of one fetus and assist the clinician in making a diagnosis and predict the outcome. The following case illustrates characteristic blood velocity findings in a dying fetus.
|
|
| 53. |
- Stafne, Signe N., et al.
(författare)
-
Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial
- 2012
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:5, s. 552-559
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To study lumbopelvic pain in women randomized to a regular exercise program during pregnancy in comparison to women receiving standard antenatal care. Design. A two-armed, two-center, randomized controlled trial. Setting. St Olavs Hospital, Trondheim University Hospital and Stavanger University Hospital. Population. A total of 855 pregnant women were randomized to intervention or control groups. Methods. The intervention was a 12 week exercise program, including aerobic and strengthening exercises, conducted between 20 and 36 weeks of pregnancy. One weekly group session was led by physiotherapists, and home exercises were encouraged twice a week. The control group received standard antenatal care. Main outcome measures. Self-reports of lumbopelvic pain and sick leave due to lumbopelvic pain. The data were analysed according to the intention-to-treat principle. Results. There were no significant differences between groups of women reporting lumbopelvic pain at 36 weeks (74 vs. 75%, p=0.76). The proportion of women on sick leave due to lumbopelvic pain was lower in the intervention group (22% vs 31%, p=0.01). Conclusions. Exercise during pregnancy does not influence the prevalence of lumbopelvic pain, but women offered a regular exercise course seem to handle the disorder better.
|
|
| 54. |
- Steinwall, Margareta, et al.
(författare)
-
Inhibitory effects of SR 49059 on oxytocin-and vasopressin-induced uterine contractions in non-pregnant women.
- 2004
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 83:1, s. 12-18
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Compounds that block uterine oxytocin and vasopressin V1a receptors have a therapeutic potential in preterm labor and primary dysmenorrhoea. The orally active vasopressin V1a receptor antagonist, SR49059, inhibits the effect of vasopressin on human uterine activity in vivo, but the influence on the response to oxytocin is unknown. Methods. In a placebo-controlled, double-blind, parallel-group, four-dose comparison, the inhibitory effect of SR 49059 on oxytocin- and vasopressin-induced uterine contractions in humans was investigated. Sixteen healthy female subjects, who had previously undergone sterilization with tubal ligation, participated in intrauterine pressure recordings at one of the first 3 days of bleeding of two menstrual cycles. Intravenous bolus injections of 10 pmol/kg body weight of vasopressin (Period 1) and of 50 pmol/kg body weight of oxytocin (Period 2) were given 1 h before and 1 , 2 and 4 h after oral administration of 0 (placebo), 25 , 75 or 200 mg of SR 49059. The area between the recording curve and zero level of intrauterine pressure (AUC) was calculated. Vital signs as well as urine and plasma safety parameters were measured. The plasma concentrations of oxytocin, vasopressin and the study drug were also estimated. Results. The plasma concentrations of SR 49059 appeared to be dose related, with mean maximal values of 62.0, 163.7 and 468.0 ng/ml in the 25, 75 and 200 mg dose groups, respectively, in Period 1 with vasopressin and 34.4, 116.7 and 418.0 ng/mL, respectively, in Period 2 with oxytocin. Tmax was observed at about 1 h. The cumulative AUC over 50 min after vasopressin injection per se was significantly higher than that after oxytocin in spite of a five times lower dose and lower plasma concentrations. Pretreatment by SR 49059 caused a dose-related reduction in AUCs for vasopressin, whereas no such effect was seen for oxytocin. With vasopressin as an agonist, a lower diastolic blood pressure was observed in all SR 49059 treatment groups, but not with oxytocin. Conclusions. The much higher potency of vasopressin compared with oxytocin on uterine activity in non-pregnant women at menstruation was confirmed. SR 49059 dose-dependently inhibits vasopressin-induced contractions, whereas such an effect was not seen with the present doses of SR 49059 and oxytocin. A marked reduction by SR 49059 of diastolic blood pressure after vasopressin injection was observed, indicating an inhibition by this compound of vascular vasopressin receptors.
|
|
| 55. |
- Strevens, Helena, et al.
(författare)
-
Blood pressure during pregnancy in a Swedish population; impact of parity
- 2001
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 80:9, s. 824-829
-
Tidskriftsartikel (refereegranskat)abstract
- SUBJECT: Hypertension represents the most commonly encountered complication of pregnancy. Normal levels of blood pressure (BP) need to be established in each pregnant population in order to recognize pathology. A lack of studies from our own country and certain methodological objections to early studies motivated this study. PATIENTS AND METHODS: Six hundred pregnant women were included in a historical cohort. The maternal BP had been measured with a mercury sphygmomanometer and standardized routines at each antenatal visit. Data regarding age, baseline BMI, weight gain and smoking habits as well as parity had been recorded. RESULTS: BP values were overall somewhat higher than in international studies, the SBP increasing slightly towards term. The diastolic blood pressure (DBP) decreased slightly until 25-28 weeks of gestation. A steady increase thereafter led to values at term 7.3% above initial values. In nulliparae the increase was significantly greater, 9.9% versus 5.4% in multiparae. Primigravidae showed mean DBP levels significantly higher than all multigravidae towards term. The DBP was correlated with the baseline BMI, but not with age or weight gain. In smoking pregnant women the DBP showed a significantly greater initial decrease and failed to follow the subsequent rise to the same degree as in non-smokers. CONCLUSION: Slightly higher blood pressure levels were found in this study compared to other international studies. Multiple regression analysis showed that parity, baseline BMI and smoking all significantly influenced the DBP at term. Multiparae have significantly lower DBP levels in pregnancy compared to nulliparae. The first pregnancy seems to have the greatest impact in lowering the blood pressure in subsequent pregnancies.
|
|
| 56. |
- Stuart, Andrea, et al.
(författare)
-
Association between 5 min Apgar scores and planned mode of delivery in diabetic pregnancies.
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90:4, s. 325-331
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. Due to the high incidence of neonatal complications in diabetic pregnancies, the aim of our study was to investigate whether elective cesarean section could prevent adverse neonatal outcome. Design. Population-based study. Setting. Data were extracted from the Swedish Medical Birth Registry. Population. All women (n=13 491) with diabetic pregnancies during the period 1990-2007. Methods. Neonatal outcome in diabetic pregnancies was compared after elective cesarean section at 38 completed gestational weeks with planned vaginal delivery at 39 completed weeks of gestation or later. Odds ratios with 95% confidence intervals for Apgar scores <7 at 5 min after birth were calculated using multiple logistic regression. Main Outcome Measures. Apgar score <7 at 5 min after birth. Results. A significantly decreased risk of Apgar score <7 at 5 min after birth in the group who underwent an elective cesarean section at 38 completed gestational weeks was found compared with those who continued pregnancy to 39 completed weeks of gestation or more, irrespective of final mode of delivery. Conclusions. Our results indicate a protective effect of planned cesarean section on the risk of low Apgar scores in diabetic pregnancies.
|
|
| 57. |
|
|
| 58. |
- Teleman, Pia, et al.
(författare)
-
Validation of the Swedish short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic floor distress inventory (PFDI-20) and Pelvic organ prolapse/Urinary incontinence sexual questionnaire (PISQ-12).
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90, s. 483-487
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To psychometrically evaluate the Swedish translations of the short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20) and Pelvic organ prolapse/Urinary incontinence Sexual questionnaire (PISQ-12). Design and setting. University hospital. Sample. Forty-four patients awaiting prolapse surgery. Methods. The dual panel translation method followed by an evaluation of validity and reliability in prolapse patients. Main outcome measures. Construct, convergent and discriminant validity, reliability via test-retest and internal consistency. Results. Item response rates were high (range: 95.5-100%) for PFIQ-7 and PFDI-20. The corrected item-total correlations showed acceptable construct validity for PFIQ-7 (r= 0.338-0.826) but low for PFDI-20 (r= 0.116-0.581) and PISQ-12 (r= 0.024-0.735). Acceptable convergent validity was found in all three instruments with a negative correlation with the SF-12. There were no floor- or ceiling effects in the three instruments. In the test-retest analysis intraclass correlation coefficients (ICC) were significant (r= 0.888 - 0.943). Cronbach´s alpha varied between 0.57 and 0.94. Conclusion. This is the first validated translation of the PFIQ-7, PFDI-20 and PISQ-12 in Swedish. All three instruments indicated acceptable psychometric properties.
|
|
| 59. |
- Torkildsen, Erik A, et al.
(författare)
-
Predictive value of ultrasound assessed fetal head position in primiparous women with prolonged first stage of labor.
- 2012
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:11, s. 1300-1305
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine how well ultrasound assessed occipitoposterior (OP) position or high sagittal (HS) position in primiparous women with a prolonged first stage of labor predicts a vaginal delivery and the duration of labor. Design: Prospective observational study. Setting. Stavanger University Hospital, a secondary referral center in Norway. Population. 105 primiparous women with prolonged first stage of labor. Methods. Ultrasound assessment of fetal head position. Main outcome measures. Vaginal delivery vs. cesarean section and duration of labor. Results: Twenty-five fetuses (24%) were delivered with cesarean section (CS), 45 (43%) had operative vaginal delivery and 35 (33%) delivered spontaneously. Eleven (27%) of 41 fetuses in OP position at the time of inclusion were born in OP position. Ten (24%) of the 41 fetuses in OP position at inclusion were delivered with CS compared to 15/64 (23%) fetuses in other positions (p = 0.91). Twenty-eight fetuses were in sagittal position and 12 in HS position, assessed with ultrasound at the time of diagnosed prolonged labor. Seven (58%) of 12 in HS position delivered vaginally and five (42%) had a CS (p = 0.89). Time from inclusion to labor was not significant longer neither for fetuses in OP compared to non-OP positions nor for fetuses in HS compared to non-HS positions. Conclusions: Most fetuses in OP or HS positions in the first stage of labor will rotate spontaneously and have a high probability of being delivered vaginally.
|
|
| 60. |
- Ullberg, Ulla, et al.
(författare)
-
Hyrtl's anastomosis is normally developed in placentas from small for gestational age infants.
- 2003
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 82:8, s. 716-721
-
Tidskriftsartikel (refereegranskat)abstract
- Background. The aim of this study was to investigate the occurrence and appearance of the anastomosis between the two umbilical arteries in placentas from infants small for gestational age (SGA). Methods. The arterial systems of 64 placentas from singleton pregnancies resulting in SGA infants were visualized by angiography. The method allowed study of the anastomosis between the umbilical arteries and calculation of the relative placental area supplied by each artery. The results were compared with findings in a previous study of appropriate for gestational age (AGA) infants. One-way analysis of variance (anova) and chi2-analyses were used for statistics. Results. In 56 placentas the anastomosis was represented by a true vessel, in two by a fenestration, and in another two cases by fusion of the umbilical arteries. The anastomosis was absent in one case and another three cases had a single umbilical artery (SUA). When the diameter of the anastomosis was thinner than that of the umbilical arteries, their supply areas were significantly (p <= 0.001) more symmetrical than in cases with a wider anastomosis. The anatomy of the anastomosis and the relationship between its width and the symmetry between the supply areas of each umbilical artery did not differ in placentas from SGA and AGA infants, despite various types of cord insertion and placentation. Conclusion. Static measurements of Hyrtl's anastomosis do not indicate a contributing part for intrauterine growth retardation.
|
|
| 61. |
- Wangel, Anne-Marie, et al.
(författare)
-
Emergency cesarean sections can be predicted by markers for stress, worry and sleep disturbances in first-time mothers
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 90:3, s. 238-244
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective: To identify predictors as free-text markers for mental ill-health from an electronic perinatal record (EMR) system and the association for emergency cesarean section (CS) in nulliparous women. Design: Population-based study using an EMR system. Setting: The catchment area of Malmö University Hospital in Sweden. Population: 6 467 women with complete perinatal electronic records (EMR) were selected of 10 662 nulliparous women presenting with a singleton cephalic baby for vaginal delivery between 2001 and 2006. Methods: Free-text search of markers for mental ill-health and multivariate logistic regression. Main Outcome Measures: Eleven markers for mental ill-health were tested with Cohen’s kappa for agreement and used as exposure variables. Odds ratios (OR) with 95% confidence interval (CI) were calculated for emergency CS, and adjusted for maternal age, diabetes, epidural anesthesia, and gestational weeks <37 and >41 by a multivariate logistic regression model with vaginal delivery as the reference. Results: Three markers identified from the EMR system reached statistically significant associations with an increased risk for emergency CS in nulliparous women: stress adjusted OR 1.66 (95% CI 1.34–2.06), sleep adjusted OR 1.57 (1.14–2.16), and worry adjusted OR 1.41 (1.10–1.79). Conclusions: Free-text words in medical records, indicating stress, sleep disturbances, or worry predicted increased adjusted OR for emergency CS in first-time mothers. Recognizing pregnant women’s reporting of their mental health status could have a predictive bearing on delivery outcomes.
|
|
| 62. |
- Wendt, Eva, et al.
(författare)
-
Trust and confirmation in a gynecologic examination situation : A critical incident technique analysis
- 2004
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - Copenhagen : Blackwell. - 0001-6349 .- 1600-0412. ; 83, s. 1208-15
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Gynecologic examination is a common measure in reproductive health care. Many women experience the examination as a more or less negative event, with shortcomings in the examiner's behavior. The aim of the study was to describe, in terms of critical incidences, women's experiences concerning the personnel's behavior in the situation of gynecologic examination. Methods. The informants were strategically chosen and consisted of 30 Swedish women between the ages of 18-82 years old. The data collection method was qualitative research interviews analyzed by critical incident technique. Results. The result consisted of 30 subcategories, five categories, and two main areas - trust and confirmation. The personnel enabled trust when they promoted participation, created confidence, and were supportive. The opposite behavior contributed to the lack of trust. Confirmation described behavior that confirmed, respectively, did not confirm the women. This was shown through the presence or lack of respect and engagement. Conclusion. The personnel's positive behavior enabled trust and confirmed the women as individuals, while negative behavior was decisive in an unfavorable way. A complexity of patterns of knowing in nursing was identified. Participation through information that contributed to trust was important and amounted to one fourth of the incidents in the material. Respect and engagement, which confirmed the women, facilitated a positive caring relationship. The examination situation can be improved through reflection of the personnel's own behavior and further research about women's own experiences.
|
|
| 63. |
- Westergren Soderberg, M, et al.
(författare)
-
Young women with genital prolapse have a low collagen concentration
- 2004
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 83:12, s. 1193-1198
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Genital prolapse is a common and handicapping form of pelvic floor dysfunction. To explain its genesis as a result of endopelvic connective tissue weakness, the collagen state was analyzed in women with and without genital prolapse. Methods. Punch biopsies from the paraurethral ligaments were obtained during the operation from 22 women undergoing surgery for genital prolapse. As controls, similar biopsies were taken from 13 women who underwent gynecologic surgery for other benign reasons. Collagen concentration as hydroxyproline and its extractability by pepsin digestion were studied in relation to age by multiple regression, two-way ANOVA, Levene's test, and Student's t-test. Histological examination was also performed. Results. Women, younger than 53 years, with genital prolapse had a 30% lower collagen concentration than age-matched controls, which reached significance, P = 0.01. The extractability by pepsin digestion, an indicator of cross-links in the collagen molecule, did not significantly differ between groups. It did, however, decrease significantly with age in both prolapse patient and control groups. Morphology supported these findings with a less-dense extracellular matrix composition subepithelially in genital prolapse compared to a healthy control. Conclusion. For the first time, we show that young women with genital prolapse have a decreased collagen concentration, suggesting a different organization of the endopelvic connective tissue extracellular matrix. Furthermore, these alterations differ from those earlier found in younger women with stress urinary incontinence.
|
|
| 64. |
|
|
| 65. |
- Åberg, Anders E, et al.
(författare)
-
Predictive factors of developing diabetes mellitus in women with gestational diabetes.
- 2002
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:1, s. 11-16
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To investigate which factors during gestational diabetes pregnancies correlate with the risk of developing impaired glucose tolerance or diabetes 1 year postpartum and to compare this risk in women with gestational diabetes and women with a normal oral glucose tolerance test during pregnancy. METHODS: Of 315 women with gestational diabetes, defined as a 2-hr blood glucose value of at least 9.0 mmol/l at a 75-g oral glucose tolerance test, who delivered in Lund 1991-99, 229 (73%) performed a new test 1 year postpartum. We compared maternal and fetal factors during pregnancy with the test value at follow up. A control group of 153 women with a 2-hr test value below 7.8 mmol/l during pregnancy were invited to a new test 1 year postpartum and 60 (39%) accepted. RESULTS: At 1 year follow up, 31% of the women with gestational diabetes but only one of the 60 controls showed pathologic glucose tolerance and one had developed diabetes. The following factors in women with gestational diabetes were identified as predicting impaired glucose tolerance or diabetes at 1 year follow up: maternal age over 40 and--in a multiple regression analysis, independent of each other--a high 2-hr value at oral glucose tolerance test during pregnancy and insulin treatment during pregnancy. CONCLUSION: The risk of developing manifest diabetes after gestational diabetes may be high enough to justify a general screening or diagnostic procedure in all pregnant women to identify women with gestational diabetes and a postpartum follow up program for them. This study did not identify any particular factor during pregnancy with enough precision to predict a later progression to diabetes.
|
|
| 66. |
- Pakbaz, Mojgan, 1962-, et al.
(författare)
-
Vaginal prolapse : perceptions and healthcare-seeking behaviour among women prior to gynecological surgery
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 90:10, s. 1115-1120
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate perceptions of vaginal prolapse and healthcare-seeking behavior in women prior to gynecological surgery. Design. Prospective, cross-sectional study using a web-based questionnaire. Setting. Clinics including patients in the Swedish National Register for Gynecological Surgery (Gynop-register). Population. 214 women with vaginal prolapse and 347 women without prolapse as reference patients. Methods. A questionnaire was developed for assessment of women's perception of prolapse and their healthcare-seeking behavior. Data were collected through the Gynop-register. For comparisons between the study groups, Student's t-test and the chi-squared test were used. Main outcome measures. Perceptions of prolapse, healthcare-seeking behavior, and source of information. Results. The most common definition of prolapse reported by the women was presence of a vaginal bulge. Reasons for seeking healthcare were interference with physical activity and increasing symptoms. One in five women with prolapse could not relate the symptoms to prolapse. Participants in the prolapse group gained less information on their own condition from brochures and public media compared to participants in the reference group ( p<0.001). Conclusion. There appeared to be a lack of information on pelvic organ prolapse in the public domain. Healthcare professionals have a significant role to play in informing women about symptoms related to the condition and the available treatment options. [ABSTRACT FROM AUTHOR]
|
|
| 67. |
- Georgsson Öhman, Susanne, et al.
(författare)
-
Does fetal screening affect women's worries about the health of their baby? : a randomized controlled trial of ultrasound screening for Down's syndrome versus routine ultrasound screening
- 2004
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 83:7, s. 634-40
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Screening for fetal abnormality may increase women's anxiety as attention is directed at the possibility of something being wrong with the baby. The aim of this study was to evaluate the effect of ultrasound screening for Down's syndrome on women's anxiety in mid-pregnancy and 2 months after delivery. METHOD: Two thousand and twenty-six women were randomly allocated to an ultrasound examination at 12-14 gestational weeks (gws) including risk assessment for Down's syndrome or to a routine scan at 15-20 gws. Questionnaires including the State-Trait Anxiety Inventory (STAI), the Cambridge Worry Scale (CWS), and the Edinburgh Postnatal Depression Scale (EPDS) were filled in at baseline in early pregnancy, at 24 gws and 2 months after delivery. RESULTS: No statistically significant differences were found between the trial groups regarding women's worries about the health of the baby, general anxiety and depressive symptoms during pregnancy or 2 months after delivery. Women's worries about something being wrong with the baby in the early ultrasound group and routine group, respectively, decreased from baseline (39.1% versus 36.0%) to mid-pregnancy (29.2% versus 27.8%), and finally to 2 months after delivery (5.2% versus 6.6%). CONCLUSION: Fetal screening for Down's syndrome by an early ultrasound scan did not cause more anxiety or concerns about the health of the baby in mid-pregnancy or 2 months after birth than in women who had a routine scan.
|
|
| 68. |
|
|
| 69. |
- Höglund, Berit, 1955-, et al.
(författare)
-
Newborns of mothers with intellectual disability have a higher risk of perinatal death and being small-for-gestational age
- 2012
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:12, s. 1409-1414
-
Tidskriftsartikel (refereegranskat)abstract
- Objective.To study mode of birth, perinatal health and death in children born to mothers with intellectual disability (ID) in Sweden.Design. Population based register study.Setting. National registers; the National Patient Register linked to the Medical Birth Register.Sample. Children of first-time mothers with ID (n = 326) (classified in the ICD 8–10) were identified and compared to 340 624 children of first-time mothers without ID or any other psychiatric diagnosis during 1999 and 2007.Methods. Population-based data were extracted from the National Patient Register and the Medical Birth Register.Main Outcome Measures. Mode of birth, preterm birth, small-for-gestational age, Apgar score, stillbirth and perinatal death.Results. Children born to mothers with ID were more often stillborn (1.2% vs. 0.3%) or died perinatally (1.8% vs. 0.4%) than children born to mothers without ID. They had a higher proportion of cesarean section birth (24.5% vs. 17.7%), preterm birth (12.2% vs. 6.1%), were small-for-gestational age (8.4% vs. 3.1%) and had lower Apgar scores <7 points at 5 minutes (3.7% vs 1.5%), compared to children born to mother without ID. Logistic regression adjusted for maternal characteristics confirmed an increased risk of small-for-gestational age (odds ratio 2.25), stillbirth (odds ratio 4.53) and perinatal death (odds ratio 4.25) in children born to mothers with ID.Conclusions. Unborn and newborn children of mothers with ID should be considered a risk group, and their mothers may need better individual-based care and support.
|
|
| 70. |
- Höglund, Berit, 1955-, et al.
(författare)
-
Pregnancy and birth outcomes of women with intellectual disability in Sweden : a national register study between 1999 and 2007
- 2012
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:12, s. 1381-1387
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the antenatal health and demographic factors as well as pregnancy and delivery outcomes in women with intellectual disability (ID) in Sweden.Design. A population-based register study.Setting. The National Patient Register (NPR) linked to the Medical Birth Register (MBR). Sample. Women with ID classified as International Classification of Diseases (ICD) 8–10 who gave birth in 1999–2007 (n = 326), identified from the NPR linked to the MBR, were compared with all first-time, singleton mothers without ID or any other psychiatric diagnoses during this period in Sweden (n = 340 624).Methods. Population-based data were extracted from the NPR and the MBR.Main outcome measures. Health and socio-demography at first antenatal visit, mode of delivery, pain relief during labor, preterm birth and discharge from hospital.Results. A higher proportion of women with ID were teenagers (18.4 vs. 3.3%), obese (20.1 vs. 8.6%) and single (36.6 vs. 6.2%) compared with women without ID, and women with ID smoked more often (27.9 vs. 7.9%). Women with ID had more often a preterm birth (12.2 vs. 6.1%), a cesarean section (CS) (24.5 vs. 17.7%) and used less nitrous oxide as pain relief during labor (59.5 vs. 75.8%). Women with ID had a higher risk for preterm birth [odds ratio (OR) 1.68], CS (OR1.55), non-use of nitrous oxide (OR 1.89) and discharge from hospital to a place other than home (OR 2.24). Conclusion. Pregnant women with ID should be considered a risk group suggesting that better tailored pre- and intrapartum care and support are needed for these women.
|
|
| 71. |
- Josefsson, Ann, et al.
(författare)
-
Prevalence of depressive symptoms in late pregnancy and postpartum
- 2001
-
Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 80:3, s. 251-255
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Postnatal depression refers to a non-psychotic depressive episode that begins in or extends into the postpartum period. The aims of this study were to examine the prevalence of depressive symptoms in a pregnant and later postnatal population, to determine the natural course of these symptoms and whether there is an association between antenatal and postnatal depressive symptomatology. METHODS: A longitudinal study with a total population of 1,558 consecutively registered pregnant women in the southeast region of Sweden. Presence of depressive symptoms was measured with the Edinburgh Postnatal Depression Scale on four occasions namely in gestational week 35-36, in the maternity ward, 6-8 weeks and 6 months postpartum. RESULTS: The prevalence of depressive symptoms during late pregnancy was 17%; in the maternity ward 18%; 6-8 weeks postnatally 13%; and 6 months postnatally, 13%. A correlation between antenatal and postnatal depressive symptoms was found (r=0.50, p<0.0001). CONCLUSION: Detection of women at risk for developing postnatal depressive symptoms can be done during late pregnancy. Antenatal care clinics constitute a natural and useful environment for recognition of women with depressive symptoms.
|
|
| 72. |
- Tolockiene, Egle, et al.
(författare)
-
Intrauterine infection may be a major cause of stillbirth in Sweden
- 2001
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 80:6, s. 511-518
-
Tidskriftsartikel (refereegranskat)abstract
- Aim of the study. To investigate intrauterine infection as a cause for unexplained stillbirth. Methods. Chorioamnionitis was studied in a material of stillbirths (117 subjects from the years 1985-1994) from a region in the south Sweden. Control material (126 alive and healthy newborns and with healthy mothers) was gathered from the same region. Results. Chorioamnionitis was a common diagnosis both with stillbirths and 'healthy' deliveries (82 and 68%, respectively). Extension of the inflammation to decidua basalis was seven times more common among stillbirths than among controls (odds ratio 7.2, confidence interval 2.8-21.9). The most common bacteria found at cultures were Escherichia coli , Coagulase negative staphylococcus, Enterococcus faecalis and group B Streptococcus. The risk for stillbirth was doubled if both inflammation and bacteria were present (odds ratio 2.3, confidence interval 0.92-5.8). Meconium discharge was more common among stillbirths than controls (odds ratio=4.7, confidence interval 1.7-14). There were no differences in any respect regarding macerated and non-macerated stillbirths. Our findings are similar to the results from studies in developing countries except for the higher incidence of stillbirths in such countries. Conclusions. Thus, a large part of otherwise unexplained stillbirths might be due to ascending infections.
|
|
| 73. |
|
|
| 74. |
- Borendal Wodlin, Ninnie, et al.
(författare)
-
Health-related quality of life and postoperative recovery in fast-track hysterectomy
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare. - 0001-6349 .- 1600-0412. ; 90:4, s. 362-368
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To determine whether health-related quality of life (HRQoL) and postoperative recovery of women who undergo abdominal hysterectomy in a fast-track program under general anesthesia (GA) differ from women who receive spinal anesthesia with intrathecal morphine (SA). Design. Secondary analysis from an open randomized controlled multicenter study. Setting. Five hospitals in south-east Sweden. Population. One hundred and eighty women admitted for abdominal hysterectomy for benign disease were randomized; 162 completed the study, 80 with GA and 82 with SA. Methods. The HRQoL was measured preoperatively using the EuroQoL EQ-5D and the Short-Form-36 health survey (SF-36) questionnaires. The EQ-5D was used daily for 1 week; thereafter, once weekly for 4 weeks and again 6 months after operation. The SF-36 was completed at 5 weeks and 6 months. Dates of commencing and ending sick leave were registered. Main Outcome Measures. Changes in HRQoL; duration of sick leave. Results. The HRQoL improved significantly faster in women after SA than after GA. Sick leave was significantly shorter after SA than after GA (median 22.5 vs. 28 days). Recovery of HRQoL and duration of sick leave were negatively influenced by postoperative complications. In particular, the mental component of HRQoL was negatively affected by minor complications, even 6 months after the operation. Conclusions. Spinal anesthesia with intrathecal morphine provided substantial advantages in fast-track abdominal hysterectomy for benign gynecological disorders by providing faster recovery and shorter sick leave compared with general anesthesia.
|
|
| 75. |
- Borendal Wodlin, Ninnie, et al.
(författare)
-
Mode of anesthesia and postoperative symptoms following abdominal hysterectomy in a fast-track setting
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare. - 0001-6349 .- 1600-0412. ; 90:4, s. 369-379
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To determine whether postoperative symptoms differ between women who undergo abdominal benign hysterectomy in a fast-track model under general anesthesia or spinal anesthesia with intrathecal morphine. Design. Secondary analysis from a randomized, open, multicenter study. Setting. Five hospitals in south-east Sweden. Population. One-hundred and eighty women scheduled for benign hysterectomy were randomized; 162 completed the study; 82 were allocated to spinal and 80 to general anesthesia. Methods. The Swedish Postoperative Symptoms Questionnaire, completed daily for 1 week and thereafter once a week until 5 weeks postoperatively. Main Outcome Measures. Occurrence, intensity and duration of postoperative symptoms. Results. Women who had hysterectomy under spinal anesthesia with intrathecal morphine experienced significantly less discomfort postoperatively compared with those who had the operation under general anesthesia. Spinal anesthesia reduced the need for opioids postoperatively. The most common symptoms were pain, nausea and vomiting, itching, drowsiness and fatigue. Abdominal pain, drowsiness and fatigue occurred significantly less often and with lower intensity among the spinal anesthesia group. Although postoperative nausea and vomiting was reported equally in the two groups, vomiting episodes were reported significantly more often during the first day after surgery in the spinal anesthesia group. Spinal anesthesia was associated with a higher prevalence of postoperative itching. Conclusions. Spinal anesthesia with intrathecal morphine carries advantages regarding postoperative symptoms and recovery following fast-track abdominal hysterectomy.
|
|
| 76. |
- Kjölhede, Preben, et al.
(författare)
-
Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery
- 2011
-
Ingår i: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA. - : Informa Healthcare. - 0001-6349 .- 1600-0412. ; 90:1, s. 63-71
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate whether preoperative vaginal preparation routines influence postoperative infectious morbidity in vaginal hysterectomy and to analyze risk factors for postoperative infectious morbidity. Design. Retrospective, longitudinal cohort study. Setting. Forty -three hospitals in Sweden, participating in the Swedish National Register for Gynecological Surgery. Population. All 6,496 women who were enrolled in the Register and underwent vaginal or laparoscopically assisted vaginal hysterectomy between 1 January 2000 and 1 February 2008. Methods. Register data were collected prospectively using doctors forms and patient questionnaires. Information about vaginal preparation routines in the clinics were achieved retrospectively by an e-mail survey. Multiple logistic regression analyses models were used to determine associations and risk factors. Main outcome measures. Infectious morbidity within 6-8 weeks postoperatively. Results. No significant differences were seen in postoperative infectious morbidity in long term between vaginal preparation using saline or chlorhexidine solution or no cleansing. At discharge from hospital, those who had had vaginal cleansing using saline solution had a significantly higher risk of postoperative infections. Risk factors for infectious morbidity were young age, obesity, peroperative injury of the urinary bladder, operative time and duration of hospital stay. Protective were prophylactic antibiotics and concomitant prolapse surgery. Conclusions. Saline solution should not be used for vaginal cleansing due to a higher risk of infectious morbidity in the immediate postoperative period. Infectious morbidity may be reduced further by employing preventive measures such as meticulous surgical technique, preoperative weight reduction in obese women and minimizing time in hospital.
|
|
| 77. |
- Claesson, Ing-Marie, 1953-, et al.
(författare)
-
Weight after childbirth : A 2-year follow-up of obese women in a weight-gain restriction program
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare. - 0001-6349 .- 1600-0412. ; 90:1, s. 103-110
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate the effects of a weight gain restriction program on weight development or weight maintenance two years after childbirth. Methods: The intervention group consisted of 155 obese pregnant women who participated in a weight gain restriction program with weekly support duringpregnancy. The control group consisted of 193 obese pregnant women. Follow-up weight measurements were done at 12 and 24 months postpartum. Results: The mean value of weight change in the intervention group was -2.2 kg compared to + 0.4 kg in the control group from early pregnancy to the follow-up 12 months after childbirth (p = .046). A greater percentage of women in the intervention group showed a weight loss 24 months after delivery than did women in the control group at that same time (p = .034). Women in the intervention group who gained less than 7 kg during pregnancy had a significantly lower weight than the controls at the 24 months follow-up (p = .018). Conclusion: An intervention program with weekly motivational support visits during pregnancy and every 6 months after childbirth seems to have an impact on weight gain up to 24 months after childbirth for those women in the intervention group who succeeded in restricting their gestational weight gain to less than 7 kg.
|
|
| 78. |
- Adolfsson, Annsofie, et al.
(författare)
-
Decreased need for emergency services after changing management for suspected miscarriage
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 90:8, s. 921-923
-
Tidskriftsartikel (refereegranskat)abstract
- We investigated the effect of a changed routine to identify women with a nonviable pregnancy, in order to utilize health care resources more efficiently during office hours rather than relying on emergency care services. From hospital register data about where and when women with miscarriages were treated, there was a significant trend during a nine-year period for miscarriages to be more rarely diagnosed (p-value<0.001) in the emergency ward after office hours. The proportion of miscarriages that were diagnosed and handled at the emergency ward decreased from 31% in 2001 to 17% in 2009. Furthermore, the number of women showing up with bleeding at the emergency ward, but who also had a normal viable pregnancy, declined during the same period (p-value<0.01). Women with suspected miscarriage benefit from structured information and standardized management and can effectively be scheduled for day-time assessment including ultrasound with a concomitant reduced need for emergency services.
|
|
| 79. |
- Aittomaki, K, et al.
(författare)
-
Genetics and assisted reproduction technology
- 2005
-
Ingår i: Acta Obstet Gynecol Scand. - : Wiley. ; 84:5, s. 463-473
-
Tidskriftsartikel (refereegranskat)abstract
- In the past 20 years, a significant improvement has been shown in the treatment for infertility in both women and men through the development of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Only donated sperm could be previously used for treatment; now oocytes can also be donated. Furthermore, the combination of IVF and ICSI with advanced genetic methods has made preimplantation genetic diagnosis possible for many genetic conditions. These methods enable genetic testing of the early human embryo by using only a single cell, one blastomere biopsied from the embryo, as the sample from which the diagnosis of many chromosome rearrangements and other inherited diseases can be made. It has also been established that a considerable proportion of infertility is caused by genetic defects, which have several implications for infertility treatment. The purpose of this review is to give a concise introduction on how genetics is involved in assisted reproduction technology to specialists who may not be working in this particular field of gynecology, but who would need some knowledge of this for proper care of their patients.
|
|
| 80. |
- Alehagen, Siw, 1953-, et al.
(författare)
-
Fear during labor
- 2001
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 80:4, s. 315-320
-
Tidskriftsartikel (refereegranskat)abstract
- Background. The aims of the present study were to compare primiparous and multiparous women’s experiences of fear of delivery during an early stage of active labor (cervix dilatation 3–5 centimeters) and to study whether fear of delivery, measured during the early stage of active labor, was a predictor of the amount of pain relief received during the remaining part of labor (cervix dilatation 5 cm – partus), of the duration of the remaining part of labor, and of the occurrence of instrumental vaginal delivery and emergency cesarean section.Method. Thirty-five primiparous and 39 multiparous women answered the Delivery Fear Scale (DFS) once during the early stage of labor and before they had received any pain relief.Results. Primiparous women reported higher levels of fear than multiparous women did. Fear during the first phase of labor predicted only the total amount of pain relief received during labor.Conclusion. The clinical implications of the study are that the delivery staff should consider women’s fear during labor and pay attention especially to primiparous women’s increased risk of higher levels of fear during an early stage of active labor, as compared with multiparous women’s. The challenge for staff of a delivery ward is to support the woman in labor in a way that decreases fear, which in turn might reduce the woman’s need of pain relief.
|
|
| 81. |
- Amini, Hashem, et al.
(författare)
-
Second trimester fetal magnetic resonance imaging improves diagnosis of non-central nervous system anomalies
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:4, s. 380-389
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives. To evaluate the additional information of second trimester magnetic resonance imaging (MRI) compared to ultrasound in fetuses with identified or suspected non-CNS anomalies and to study the clinical impact of the MRI information on pregnancy management. Design. Prospective study during 2003-2007. The fetal MRI examination was planned to be performed within three days after the ultrasound. Setting. Uppsala University hospital. Material and methods. Sixty-three women, where the second trimester ultrasound identified or raised suspicion of fetal anomalies were included. Ultrasound was compared to MRI in relation to the final diagnosis, which was based on the assessment of all available data including post-partum clinical follow-up and autopsy results. Main outcome measures. Evaluation of the additional information gained from MRI and the consequences it had on pregnancy management. Results. The mean interval between ultrasound and MRI was 2.6 days (range 0-15). In 42 (67%) cases MRI was performed within three days. All MRI examinations were assessable. In 43 (68%) fetuses MRI provided no additional information, in 17 (27%) MRI added information without changing the management and in three (5%) MRI provided additional information which changed the management. All these three cases had oligohydramnios. In all six cases of diaphragmatic hernia MRI provided additional information. Conclusions. Fetal MRI of non-CNS anomalies in the second trimester seems to be a valuable adjunct to ultrasound diagnosis of non-CNS anomalies, especially in cases of oligohydramnios and diaphragmatic hernia.
|
|
| 82. |
- Andersson, Ola, et al.
(författare)
-
Effects of delayed compared with early umbilical cord clamping on maternal postpartum hemorrhage and cord blood gas sampling : a randomized trial
- 2013
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 92:5, s. 567-574
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the effect of delayed cord clamping (DCC) compared with early cord clamping (ECC) on maternal postpartum hemorrhage (PPH) and umbilical cord blood gas sampling. Design. Secondary analysis of a parallel-group, single-center, randomized controlled trial. Setting. Swedish county hospital. Population. 382 term deliveries after a low-risk pregnancy. Methods. Deliveries were randomized to DCC (>= 180 seconds, n = 193) or ECC (<= 10 seconds, n = 189). Maternal blood loss was estimated by the midwife. Samples for blood gas analysis were taken from one umbilical artery and the umbilical vein, from the pulsating unclamped cord in the DCC group and from the double-clamped cord in the ECC group. Samples were classified as valid when the arterial-venous difference was -0.02 or less for pH and 0.5 kPa or more for pCO(2). Main outcome measures. PPH and proportion of valid blood gas samples. Results. The differences between the DCC and ECC groups with regard to PPH(1.2%, p = 0.8) and severe PPH(-2.7%, p = 0.3) were small and non-significant. The proportion of valid blood gas samples was similar between theDCC (67%, n = 130) and ECC (74%, n = 139) groups, with 6% (95% confidence interval: -4%-16%, p = 0.2) fewer valid samples after DCC. Conclusions. Delayed cord clamping, compared with early, did not have a significant effect on maternal postpartum hemorrhage or on the proportion of valid blood gas samples. We conclude that delayed cord clamping is a feasible method from an obstetric perspective.
|
|
| 83. |
- Andersson, T, et al.
(författare)
-
Swedish maternal mortality in the 19th century by different definitions : previous stillbirths but not multiparity risk factor for maternal death.
- 2000
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 79:8, s. 679-86
-
Tidskriftsartikel (refereegranskat)abstract
- In conclusion, this study shows that the mother's reproductive history was the most important risk factor measured for all definitions of maternal death. Grand multiparity did not increase the risk of maternal death. Maternal mortality ratio varied threefold in the study population, depending on the definition used. The high mortality ratios found in this study, only declining by the end of the century, should be interpreted as a general condition of the society since no significant differences could be perceived regarding social class, while unmarried women were more at risk.
|
|
| 84. |
- Antonsen, Sofie L, et al.
(författare)
-
Subspecialist training in surgical gynecologic oncology in the Nordic countries.
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:8, s. 917-920
-
Tidskriftsartikel (refereegranskat)abstract
- To survey the centers that can provide subspecialty surgical training and education in gynecological oncology in the Nordic countries, we developed an online questionnaire in co-operation with the Nordic Society of Gynecological Oncology. The link to the survey was mailed to 22 Scandinavian gynecological centers in charge of surgical treatment of cancer patients. Twenty (91%) centers participated. Four centers reported to be accredited European subspecialty training centers, a further six were interested in being accredited, and 11 centers were accredited by the respective National Board. Fourteen (74%) centers were interested in being listed for exchange of fellows. Our data show a large Nordic potential and interest in improving the gynecologic oncology standards and can be used to enhance the awareness of gynecologic oncology training in Scandinavia and to facilitate the exchange of fellows between Nordic countries.
|
|
| 85. |
- Belachew, Johanna, 1976-, et al.
(författare)
-
Longitudinal study of the uterine body and cavity with three-dimensional ultrasonography in the puerperium
- 2012
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:10, s. 1184-1190
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To describe uterine involution in the puerperium with three-dimensional ultrasound.Design. Prospective, longitudinal study.Setting. Fetal medicine unit, department of obstetrics and gynecology, university referral hospital, Uppsala, Sweden.Population. Fifty women with uncomplicated deliveries and puerperium between February 2009 and February 2010.Methods. Three-dimensional ultrasound was used to measure the uterine body and cavity volumes. The volume data set was analysed using virtual organ computer-aided analysis (VOCAL) with a 30 degree rotation step. Measurements were performed transabdominally on days 1, 7 and 14 and transvaginally on days 28 and 56 postpartum. Parity, gestational age, birthweight, smoking, breastfeeding and blood loss were recorded.Main outcome measures. Uterine body and cavity volumes. Results. Median uterine body volume was 756 cm3 on day 1, 440 cm3 on day 7, 253 cm3 on day 14, 125 cm3 on day 28 and 68 cm3 on day 56. Median cavity volume was 22 cm3 on day 1, 18 cm3 on day 7, 6 cm3 on day 14, 1 cm3 on day 28 and not measurable on day 56. The interindividual variation of uterine body and cavity volumes was most pronounced on day 1 and decreased throughout the observation period. Intrauterine content was found in 36% of the women on day 1, 95% on day 7, 87% on day 14 and 28% on day 28.Conclusions. Three-dimensional ultrasound is a non-invasive tool suitable for measurement of the uterine body and cavity volumes during the puerperium. The volumes decreased in a similar pattern in the study population.
|
|
| 86. |
- Bergman, Eva, 1959-, et al.
(författare)
-
Relative growth estimated from self-administered symphysis fundal measurements
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:2, s. 179-185
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To establish absolute-and relative-growth reference curves for the detection of intrauterine growth restriction from weekly self-administered symphysis-fundus (SF) measurements and to assess the influence of fetal sex, maternal obesity and parity. Design. Prospective longitudinal study. Setting. Pregnant women from six primary antenatal care centres. Population. Three hundred women with singleton ultrasound dated pregnancies. Methods. Weekly self-administered SF measurements from gestational week 25 until delivery were obtained. A linear mixed longitudinal model was used to estimate the absolute SF growth using the natural logarithm (lnSF). Relative lnSF growth was calculated as the lnSF measurement in one gestational week subtracted by the lnSF measurement in the previous gestational week. The influence of fetal sex, maternal obesity and parity was assessed in regression models and by a graphical display. Main Outcome Measures. Absolute lnSF and relative lnSF growth curves and influence of fetal sex, maternal obesity and parity on these. Results. SF measurements from 191 women were used to establish an SF-growth reference. The absolute lnSF growth was influenced by maternal obesity, and for fetal sex and parity, borderline significance was recorded; while there was no evidence that the relative lnSF growth could depend on these variables. Conclusions. Weekly self-administered SF measurements can be obtained and used to estimate SF growth. Relative growth of the lnSF height seems to be independent of fetal sex, maternal obesity and parity.
|
|
| 87. |
- Bergman, Eva, 1959-, et al.
(författare)
-
Self-administered symphysis-fundus measurements analyzed with a novel statistical method for detection of intrauterine growth restriction : a clinical evaluation
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:8, s. 890-896
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To assess the ability of self-administered symphysis fundus measurements used with the Shiryaev-Roberts statistical method (SR method) to identify growth-restricted (IUGR) fetuses and compare it with the traditional SF method (symphysis fundus measurements used with a population-based reference curve). Design. Longitudinal study. Setting. Pregnant women attending primary antenatal care centres. Population. From a population of 1 888 women with singleton ultrasound-dated pregnancies, we analyzed data from 1 122 women. Methods. Weekly self-administered SF measurements from gestational week 25 until delivery were analyzed according to the SR method. Neonatal morbidity and small for gestational age (SGA) were used as proxies for IUGR. Small for gestational age was defined as a birthweight less than two standard deviations (SD) and <10th percentile. We assessed the sensitivity of the SR and the SF methods to detect neonatal morbidity and SGA. Main Outcome Measures. Birth-related mortality, respiratory distress, hypoglycemia, Apgar score <= 6 at five minutes, pH <= 7.00 in the umbilical artery, neonatal care, preterm delivery, operative delivery for fetal distress and SGA. Results. For the SR method, the sensitivity for neonatal morbidity was between 6.0 and 36.4%, for SGA <2SD 36.8%, and for SGA <10th percentile 20.9%. The SF method had a sensitivity between 6.0 and 13.8% for neonatal morbidity, 52.3% for SGA <2SD and 28.6% for SGA <10th percentile. Conclusions. The SR and the SF methods had low sensitivities for neonatal morbidity.
|
|
| 88. |
- Bergmark, Karin, et al.
(författare)
-
Patient-rating of distressful symptoms after treatment for early cervical cancer.
- 2002
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 81:5, s. 443-450
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: More refined information on sources of symptom-induced distress in a patient population can improve the quality of pretreatment information, make follow-up visits more efficient and guide research priorities in the efforts to modify treatments.METHODS: In a population-based epidemiological study covering all of Sweden, data were collected 1996-97 by means of an anonymous postal questionnaire. We attempted to enroll all 332 patients with stage IB-IIA cervical cancer registered in 1991-92 at the seven departments of gynecological oncology in Sweden.RESULTS: A total of 256 cases (77%) completed the questionnaire. After surgery, alone or in combination with intracavitary radiotherapy, several symptoms related to sexual dysfunction are the primary sources of symptom-induced distress (reduced orgasm frequency: much distress 23% (surgery alone) and 23% (intracavitary radiotherapy and surgery), respectively, overall intercourse dysfunction: much distress 17% and 20%, respectively, followed by lymphedema (much distress 14% and 14%, respectively). Dyspareunia (much distress 24%) and defecation urgency (much distress 22%) are two leading causes of distress after surgery and external radiotherapy. After treatment with radiotherapy alone, loose stool and dyspareunia were the two most distressful symptoms (much distress 19% each). When a symptom occurs, fecal leakage and reduced orgasm frequency are the two most distressful ones (measured as much distress, 38% each).CONCLUSIONS: The observed symptoms are distressful and should, if one focuses on patient satisfaction, be given priority.
|
|
| 89. |
- Borendal Wodlin, Ninnie, et al.
(författare)
-
The development of fast-track principles in gynecological surgery
- 2013
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare / Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 92:1, s. 17-27
-
Forskningsöversikt (refereegranskat)abstract
- Fast-track is a multimodal strategy aimed at reducing the physiological burden of surgery to achieve an enhanced postoperative recovery. The strategy combines unimodal evidence-based interventions in the areas of preoperative preparation, anesthesia, surgical factors and postoperative care. The advantages of fast-track most likely extend to gynecology, although so far have scarcely been reported. This review summarizes current evidence concerning use of fast-track in general and in gynecological surgery. The main findings of this review are that there are benefits within elective gynecological surgery, but studies of quality of life, patient satisfaction and health economics in elective surgery are needed. Studies of fast-track within the field of non-elective gynecological surgery are lacking. Widespread education is needed to improve the rate of implementation of fast-track. Close involvement of the entire surgical team is imperative to ensure a structured perioperative care aiming for enhanced postoperative recovery.
|
|
| 90. |
|
|
| 91. |
- Challis, K, et al.
(författare)
-
Gestational diabetes mellitus and fetal death in Mozambique: an incident case-referent study
- 2002
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 81:6, s. 560-563
-
Tidskriftsartikel (refereegranskat)abstract
- Background. Third trimester fetal death is a common problem in Mozambique, occurring in approximately 5% of parturient women. Objective. To elucidate the magnitude of the gestational diabetes mellitus problem, and to estimate its prevalence in a group of women with unexplained late fetal deaths and in women with live fetuses (referents). Methods. An incident case-referent study of 109 pregnant Mozambican women with fetal deaths and 110 women delivering liveborns, regarding fasting B-glucose, oral glucose tolerance test and glycosylated hemoglobin. Result. The difference in gestational diabetes mellitus prevalence in the two groups is not significant. The prevalence of gestational diabetes mellitus was high in both groups: 11% and 7%, respectively.
|
|
| 92. |
- Cobo, Teresa, et al.
(författare)
-
Intra-amniotic inflammation predicts microbial invasion of the amniotic cavity but not spontaneous preterm delivery in preterm prelabor membrane rupture.
- 2012
-
Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349.
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To predict microbial invasion of the amniotic cavity (MIAC) and spontaneous preterm delivery within seven days using a panel of selected proteins from amniotic fluid in a Swedish population of preterm prelabor membrane rupture (PPROM). Design. Prospective cohort study. Setting. Evaluation of intra-amniotic inflammation in preterm premature rupture of membranes. Population. Sixty-six pregnant women with preterm prelabor membrane rupture at 22(+0-) 33(+6) weeks' gestational age. Methods. Twenty-seven amniotic fluid proteins were assayed by a multiple immunoassay. Main outcome measures. The intra-amniotic inflammatory response was evaluated according to the presence of MIAC and the risk of spontaneous preterm delivery within seven days. A prediction model was constructed using logistic regression. Results. The overall rates of MIAC and spontaneous preterm delivery within seven days were 20% and 50%, respectively. There was a higher inflammatory response in women with MIAC than without. Earlier gestational age at delivery and lower birthweight were observed in the presence of microbial invasion of the amniotic cavity. Amniotic fluid Interleukin (IL)-6 and IL-10 were the best predictors of MIAC in terms of sensitivity (69%), specificity (81%), positive predictive value (47%), negative predictive value (91%) and positive likelihood ratio of 3.6. There were no differences in intra-amniotic inflammatory response according to the risk of spontaneous preterm delivery within seven days. Conclusion. Amniotic fluid IL-6 and IL-10 are the best inflammatory biomarkers to predict MIAC in women with PPROM. Intra-amniotic inflammation does not predict the occurrence of spontaneous preterm delivery within seven days of PPROM.
|
|
| 93. |
|
|
| 94. |
- Dahlgren, Eva, et al.
(författare)
-
Long-term outcome of porcine skin graft in surgical treatment of recurrent pelvic organ prolapse. An open randomized controlled multicenter study
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare / Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 90:12, s. 1393-1401
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To determine the long-term objective and subjective outcomes of use of a porcine skin graft (Pelvicol(TM)) compared with conventional colporrhaphy in recurrent pelvic organ prolapse surgery and to analyze risk factors and safety. Design. Open randomized controlled multicenter study. Setting. Eight Swedish hospitals. Population. 135 consecutive women with recurrent cystocele and/or rectocele admitted for vaginal prolapse surgery; 132 completed the study, 64 were randomly allocated to receive conventional colporrhaphy and 68 to Pelvicol. Methods. Conventional anterior and posterior colporrhaphy and colporrhaphy with use of Pelvicol(TM) mesh reinforcement. Clinical evaluation by means of pelvic organ prolapse quantification (POP-Q) and symptom questionnaire preoperatively, three months and three years postoperatively. Main outcome measures. Anatomical and subjective outcome.? Recurrence was defined as POP-Q=stage 2. Results. At three-month follow-up, early recurrence/surgical failures occurred significantly more often in the Pelvicol(TM) group, but at the three-year follow-up the recurrence rates were similar. The recurrence rates in the anterior compartment were 5762% and 4423% in the posterior compartment for the colporrhaphy and Pelvicol(TM) groups, respectively. Symptoms were substantially and equally reduced in the two groups after surgery. Sexual activity and function did not seem to be affected adversely in any group. The complication rate was low. Risk factors for anatomical recurrence were age, body mass index and preoperative stage of the prolapse. Conclusions. With the surgical technique used in this study, Pelvicol(TM) did not provide advantages over conventional colporrhaphy in recurrent pelvic organ prolapse concerning anatomical and subjective outcomes.
|
|
| 95. |
- Darj, Elisabeth, et al.
(författare)
-
Insulin-like growth factor binding protein-1, a quick way to detect amniotic fluid
- 1998
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 77:3, s. 295-297
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The detection of premature rupture of membranes (PROM) is essential to the management of pregnancy. Various tests, all with different limitations, have been used to diagnose PROM. Insulin-like growth factor binding protein-1 (IGFBP-1) is present in an essentially higher concentration in amniotic fluid, than in serum, cervical mucous, urine and seminal plasma. A commercial kit, with monoclonal antibodies to IGFBP-1 attached to a stick, is available. The aim of this study was to investigate whether a rapid dipstick test could confirm or exclude the presence of amniotic fluid. METHODS: A multicenter study, involving six departments of obstetrics and gynecology in Sweden, was designed to evaluate the new dipstick technique of diagnosing the presence of amniotic fluid in the vagina. One hundred and seventy-four women were examined. Forty-six women with obvious PROM, 29 women without PROM and 99 women with suspected PROM. RESULTS: Forty-four out of forty-six women with obvious PROM had a positive PROM-TEST. Twenty-seven out of twenty-nine women without PROM had a negative PROM-TEST, giving a sensitivity of 95.7% and a specificity of 93.1%. Among the women with suspected rupture of membranes, the sensitivity was 70.8%, the specificity 88.2% and the positive predictive value (PPV) 92%. CONCLUSION: IGFBP is present in high concentration in amniotic fluid. The dipstick test with monoclonal antibodies to IGFBP-1 is rapid and has a high PPV, sensitivity and specificity. It is a useful complement to the existing arsenal of tests to detect PROM.
|
|
| 96. |
|
|
| 97. |
- Ekenros, Linda, et al.
(författare)
-
Postural control in women with premenstrual symptoms during oral contraceptive treatment
- 2011
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:1, s. 97-102
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. This study investigates postural control among women with and without premenstrual symptoms (PMS) on oral contraceptive (OC) treatment. Design. Prospective repeated measures design. Setting. Women's health clinical research unit at a university hospital. Population. Fifteen women using low-dose monophasic oral contraceptives participated in the study. Depending on premenstrual symptoms, the women were divided into one PMS group and one non-PMS group. Methods. Postural control (displacement area) was measured using an AMTI® force platform during the active hormone phase (OC phase) and the hormone-free phase (non-OC phase) of the pill chart. Premenstrual symptoms were evaluated prospectively using the Cyclicity Diagnoser. Main Outcome Measures. Displacement area as a measure of postural control. Results. Six of 15 women showed premenstrual symptoms (primarily negative mood symptoms) between the phases and were considered having premenstrual symptoms. When analyzing postural control, the PMS group displayed a significantly greater displacement area in the OC-phase compared to the non-OC phase. In contrast, the non-PMS group did not show any significant difference between the phases. Furthermore, the PMS group had significantly greater displacement area during the OC phase compared to the non-PMS group. Conclusions. The present study shows that women with premenstrual symptoms have greater displacement area than those without premenstrual symptoms during the active phase of oral contraceptive treatment. Negative mood symptoms may affect the maintenance of postural control by central interactions. Further studies are needed to clarify the precise mechanism for altered postural control in women with premenstrual symptoms.
|
|
| 98. |
- Ekstrand, Maria, et al.
(författare)
-
Swedish teenager perceptions of teenage pregnancy, abortion, sexual behavior, and contraceptive habits : a focus group study among 17-year-old female high-school students
- 2005
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 84:10, s. 980-986
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sweden has the highest abortion numbers among the Nordic countries. Since 1995, the abortion rate among teenagers has increased by nearly 50%. We therefore undertook a study where the overall aim was to gain a deeper understanding on which factors female teenagers believe may explain the increasing numbers of teenage abortions. Teenagers' perceptions of teenage pregnancy, abortion, sexual behavior, and contraceptive habits were investigated. METHODS: Six focus group interviews with 17-year-old Swedish girls were conducted. The interviews were tape-recorded, transcribed verbatim, and analyzed by manifest content analysis. RESULTS: Negative attitudes toward teenage pregnancy and supportive attitudes toward abortion were expressed. Risk-taking behaviors such as negligence in contraceptive use and intercourse under the influence of alcohol were suggested as main reasons behind the increasing numbers of abortions among Swedish teenagers. The contemporary, sexualized, media picture was believed to influence adolescents' sexual behavior, and liberal attitudes toward casual sex were expressed. Girls were perceived as more obliged than boys in taking responsibility for contraceptive compliance and avoidance of pregnancy. The apprehension that hormonal contraceptives cause negative side-effects was widely spread, and the participants were found to have a somewhat limited knowledge of abortion. The majority were unsatisfied with the quality of sexual education provided by the schools. CONCLUSION: Possible reasons for increased abortion numbers among teenagers in Sweden could be liberal attitudes toward casual sex in combination with negligence in contraceptive use, use of alcohol followed by sexual risk-taking, fear of hormonal contraceptives, and a deterioration of sexual education in the schools.
|
|
| 99. |
- Elvander, Charlotte, et al.
(författare)
-
The influence of fetal head circumference on labor outcome : a population-based register study
- 2012
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:4, s. 470-475
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the association between postnatal head circumference and the occurrence of the three main indications for instrumental delivery, namely prolonged labor, signs of fetal distress and maternal distress. We also studied the association between postnatal fetal head circumference and the use of vacuum extraction and emergency cesarean section. Design. Population-based register study. Setting. Nationwide study in Sweden. Population. A total of 265 456 singleton neonates born to nulliparous women at term between 1999 and 2008 in Sweden. Methods. Register study with data from the Swedish Medical Birth Register. Main outcome measures. Prolonged labor, signs of fetal distress, maternal distress, use of vacuum extraction and emergency cesarean section. Results. The prevalence of each outcome increased gradually as the head circumference increased. Compared with women giving birth to a neonate with average size head circumference (35 cm), women giving birth to an infant with a very large head circumference (3941 cm) had significantly higher odds of being diagnosed with prolonged labor [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.331.67], signs of fetal distress (OR 1.73, 95% CI 1.492.03) and maternal distress (OR 2.40, 95% CI 1.962.95). The odds ratios for vacuum extraction and cesarean section were thereby elevated to 3.47 (95% CI 3.103.88) and 1.22 (95% CI 1.041.42), respectively. The attributable risk proportion percentages associated with vacuum extraction and cesarean section were 46 and 39%, respectively among the cases exposed to a head circumference of 3741 cm. Conclusions. Large fetal head circumference is associated with complicated labor and is etiological to a considerable proportion of assisted vaginal births and emergency cesarean sections.
|
|
| 100. |
- Fadl, Helena, 1965-, et al.
(författare)
-
Outcomes of gestational diabetes in Sweden depending on country of birth
- 2012
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - Hoboken, USA : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 91:11, s. 1326-1330
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyze maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden, depending on country of birth (Nordic vs. non-Nordic women).Design: Population-based cohort study using the Swedish Medical Birth register.Setting: Data on pregnant women in Sweden with diagnosed GDM.Population: All singleton births to women with GDM between 1998 and 2007 (n = 8560).Methods: Logistic regression in an adjusted model to assess the risk of adverse maternal and neonatal outcomes. Chi-squared tests or Student's unpaired t-tests were used to analyze differences between maternal and fetal characteristics.Main outcome measures: Maternal and neonatal complications.Results: GDM incidence was higher at 2.0% among non-Nordic women, compared with 0.7% in the Nordic group. The non-Nordic women were older, had less chronic hypertensive disease, smoked less, and had lower BMI and shorter height. Preeclampsia was significantly lower in the non-Nordic group. The mean birthweight (3561 vs. 3698 g, p < 0.001) and the large-for-gestational age rate (11.7 vs. 17.5%, p < 0.001) were significantly lower in the non-Nordic group. Large-for-gestational age was dependent on maternal height [crude odds ratio 0.6 (0.5-0.7) and adjusted odds ratio 0.8 (0.6-0.9)].Conclusions: Non-Nordic women with GDM in Sweden have better obstetrical and neonatal outcomes than Nordic women. These results do not support the idea of inequality of health care. Large-for-gestational age as a diagnosis is highly dependent on maternal height, which raises the question of the need for individualized growth curves.
|
|
