| 1. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Fetal electrocardiogram: ST waveform analysis in intrapartum surveillance
- 2007
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Ingår i: Bjog. - : Wiley. ; 114:10, s. 1191-1193
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Tidskriftsartikel (refereegranskat)abstract
- ST waveform analysis of fetal electrocardiogram (ECG) for intrapartum surveillance (STAN) is a newly introduced method for fetal surveillance. The purpose of this commentary is to assist in the proper use of fetal ECG in combination with cardiotocography (CTG) during labour. Guidelines and recommendations concerning CTG and ST waveform interpretation and classification are stated that were agreed on by the European experts on ST waveform analysis for intrapartum surveillance during a meeting in Utretcht, The Netherlands in January 2007.
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| 2. |
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| 3. |
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| 4. |
- Ghosh, Gisela, et al.
(författare)
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Uterine and umbilical artery Doppler are comparable in predicting perinatal outcome of growth-restricted fetuses.
- 2009
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 116:3, s. 424-430
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare umbilical and uterine artery Doppler in predicting outcome of pregnancies suspected of fetal growth restriction (FGR). DESIGN: A prospective study included 353 singleton pregnancies complicated by an FGR fetus. SETTING: University Hospital setting. SAMPLE: Pregnancies suspected of FGR diagnosed by ultrasound fetal biometry during a 5-year period. MAIN OUTCOME MEASURE: Perinatal outcome in relation to uterine and umbilical artery Doppler. METHODS: The women underwent Doppler examination of the umbilical and uterine arteries. Results from the uterine, but not the umbilical artery, were blind to the woman and managing obstetrician. The Doppler results were related to perinatal outcomes including small for gestational age newborns, caesarean delivery, premature delivery (<37 weeks of gestation) and admission of the newborn to a neonatal intensive care unit. RESULTS: Abnormal uterine artery Doppler velocimetry was seen in 120 (33.4%) pregnancies and abnormal umbilical artery Doppler in 102 (28.4%). There was a statistically significant correlation between abnormal Doppler of both the umbilical and uterine arteries and adverse outcome of pregnancy. The two vessels were comparable in predicting adverse outcome. Women with normal umbilical artery Doppler (251) were analysed separately. Abnormal uterine artery Doppler, seen in 61 (24.3%) of those women, showed a statistically significant correlation for adverse outcome of pregnancy. CONCLUSIONS: Doppler examinations of the uterine and/or the umbilical arteries seem to be comparable as predictors of outcome in pregnancies complicated by FGR. Including uterine artery Doppler in the surveillance of growth-restricted fetuses might detect a group of pregnancies at high risk, even though the umbilical artery Doppler was normal.
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| 5. |
- Gudmundsson, Saemundur, et al.
(författare)
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Correlation of birth injury with maternal height and birthweight.
- 2005
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 112:6, s. 764-767
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Tidskriftsartikel (refereegranskat)abstract
- Background Infant or maternal injury during vaginal delivery is a constant threat to all involved, but difficult to predict. Objective To estimate the risk of birth injuries in an institution favouring trial of vaginal birth when there was doubt of the best mode of delivery. Design A retrospective cohort study. Setting University Hospital. Population Singleton 14,359 vaginal deliveries in cephalic presentation during 5½ years. Methods The total caesarean section rate during this period was 9%. The likelihood of injury was evaluated by logistic regression analysis with injury as the dependent variable and maternal height and child birthweight as explanatory variables in birth injury risk estimation. Main outcome measures Infant injury defined as one of the following: shoulder dystocia, clavicle fracture or brachial plexus injury; and maternal injury as anal sphincter rupture (ASR). Results There were a total of 318 infant injuries in 282 infants and 423 ASRs. A strong correlation was found between injury and both fetal macrosomia and short maternal stature, but macrosomia was a stronger indicator of injury. Birth injury risk estimation curves were constructed based on maternal height and birthweight. Conclusions The present results confirm a strong correlation between fetal macrosomia and short maternal stature and the likelihood of injury during vaginal birth. Risk estimation curves were constructed that might be of great value for the obstetrician in choosing the mode of delivery in these cases.
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| 6. |
- Habiba, M, et al.
(författare)
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Caesarean section on request: a comparison of obstetricians' attitudes in eight European countries
- 2006
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 113:6, s. 647-656
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Tidskriftsartikel (refereegranskat)abstract
- Objective To explore the attitudes of obstetricians to performe a caesarean section on maternal request in the absence of medical indication. Design Cluster sampling cross-sectional survey. Setting Neonatal Intensive Care Unit (NICU) associated maternity units in eight European countries. Population Obstetricians with at least 6 months clinical experience. Methods NICU-associated maternity units were chosen by census in Luxembourg, Netherlands and Sweden and by geographically stratified random sampling in France, Germany, Italy, Spain and UK. An anonymous, self-administered questionnaire was used for data collection. Main outcome measures Obstetricians' willingness to perform a caesarean section on maternal request. Results One hundred and five units and 1530 obstetricians participated in the study (response rates of 70 and 77%,respectively). Compliance with a hypothetical woman's request for elective caesarean section simply because it was 'her choice' was lowest in Spain (15%), France (19%) and Netherlands (22%); highest in Germany (75%) and UK (79%) and intermediate in the remaining countries. Using weighted multivariate logistic regression, country of practice (P < 0.001), fear of litigation (P = 0.004) and working in a university-affiliated hospital (P = 0.001) were associated with physicians' likelihood to agree to patient's request. The subset of female doctors with children was less likely to agree (OR 0.29, 95% CI 0.20-0.42). Conclusions The differences in obstetricians' attitudes are not founded on concrete medical evidence. Cultural factors, legal liability and variables linked to the specific perinatal care organisation of the various countries play a role. Greater emphasis should be placed on understanding the motivation, values and fears underlying a woman's request for elective caesarean delivery.
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| 7. |
- Habiba, M., et al.
(författare)
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Late termination of pregnancy: a comparison of obstetricians' experience in eight European countries
- 2009
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 116:10, s. 1340-1349
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare the experience and attitude of obstetricians in Europe towards late termination of pregnancy and the factors affecting their responses. Design Cluster sampling cross-sectional survey. All neonatal intensive care unit (NICU)-associated maternity units were recruited (census sampling) in Luxembourg, the Netherlands and Sweden. In France, Germany, Italy, Spain and the UK, units were selected at random. In every recruited unit, all obstetricians with at least 6 months' experience were invited to participate. Setting NICU-associated maternity units in eight European countries. Population Obstetricians with at least 6 months' clinical experience. Methods An anonymous, self-administered questionnaire was used. Multinomial logistic analysis was used to identify factors predicting the obstetricians' views about modifying the law governing late termination in their country. Main outcome measure Obstetricians' experience of late termination of pregnancy and views about national policies. Results One hundred and five units and 1530 obstetricians participated (response rates 70 and 77% respectively). The most common indications for late termination were congenital anomalies and women's physical health. Feticide was not common except in France, Luxembourg and the UK. Active euthanasia of a liveborn was practiced in France and the Netherlands. Obstetricians in Germany were more likely to feel that late termination should be more severely restricted, the opposite was true in Spain and the Netherlands. In Italy, there was dissatisfaction with current status, but opinion was divided, reflecting views on both sides of the debate. Conclusions This research outlines current practice in a difficult and sensitive area and suggests the need for more discussion and support for all those who were involved.
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| 8. |
- Hellsten, Charlotte, et al.
(författare)
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A 2-year follow-up study of anxiety and depression in women referred for colposcopy after an abnormal cervical smear.
- 2008
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 115:2, s. 212-218
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to determine if there were any long-lasting elevated anxiety levels in women attending colposcopy after an abnormal cervical smear. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynaecology, Malmö University Hospital, Sweden. POPULATION: One hundred consecutive women were invited to participate when referred for colposcopy. METHODS: Women in the study group completed the State-Trait Anxiety Inventory, the Montgomery-Asberg Depression Rating Scale-self-rate (MADRS-S) and had a psychosocial interview prior to colposcopy at their two follow-up visits. MAIN OUTCOME MEASURES: State anxiety levels and depression scores at first visit, 6 months and 2 years. RESULTS: At follow up, levels of state anxiety and the depression scores of the women studied had decreased and were comparable to those of Swedish normative data. Two variables from the MADRS-S, 'ability to focus on different activities' and 'emotional involvement with others and in activities' were the most prominent for women with moderate to severe depression. At the 2-year visit, 30% of the women still had a fear of cancer. CONCLUSIONS: Referral for colposcopy after an abnormal cervical smear does not seem to result in long-lasting anxiety and depression. However, a subgroup of women, with the initially highest depression scores, still had at 2-year state anxiety levels and depression scores significantly higher than normal. Almost one-third of the women still had a fear of cancer in spite of lower 2-year state anxiety levels.
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| 9. |
- Hellsten, Charlotte, et al.
(författare)
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A longitudinal study of sexual functioning in women referred for colposcopy: a 2-year follow up.
- 2008
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 115:2, s. 205-211
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Tidskriftsartikel (refereegranskat)abstract
- Objective To elucidate psychosexual problems in women referred for colposcopy after an abnormal cervical smear and a 6-month and 2-year follow up. Design Prospective study. Setting Department of Gynaecology, Malmö University Hospital, Sweden. Population One hundred consecutive women referred for colposcopy for the first time subsequent to receiving notification of an abnormal cervical smear. Methods The women completed the State-Trait Anxiety Inventory, a psychosexual questionnaire and had one psychosocial interview prior to colposcopy at all three visits. Main outcome measures Depending upon the result of the cervical biopsy, women had either a loop electrosurgical excision procedure (LEEP) or not. Psychosexual variables, anxiety measures, and psychosocial variables were used to estimate sexual functioning at the beginning of the study and at follow up. Differences in sexual functioning between LEEP and non-LEEP groups were estimated. Results 'Spontaneous interest in sex', 'frequency of intercourse', and 'sexual arousal' were reported to be statistically significant lower at 6 months compared with the first visit, and at 2 years, 'spontaneous interest in sex' and 'frequency of intercourse' still remained low. There was no difference in sexual functioning between the LEEP and non-LEEP groups at follow up. Conclusions Two years after referral for colposcopy, women still had an effect on sexual functioning, that is, lesser 'spontaneous interest' and decreased 'frequency of intercourse'. We found no support for a relationship between treatment of cervical intraepithelial neoplasia by LEEP and deterioration in sexual functioning.
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| 10. |
- Hellsten, Charlotte, et al.
(författare)
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A prospective Swedish cohort study on psychosocial factors influencing anxiety in women referred for colposcopy.
- 2007
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 114:1, s. 32-38
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To elucidate risk factors for high state anxiety in women referred for colposcopy. Design Prospective cohort study. Setting Department of Gynaecology, Malmo University Hospital, Sweden. Population A total of 100 consecutive women referred for colposcopy for the first time after an abnormal cervical smear. Methods Women in the study group completed prior to colposcopy the State-Trait Anxiety Inventory, the Montgomery-Asberg Depression Rating Scale-self-rate, and were interviewed about their psychosocial situation. Main outcome measures Variables related to high state anxiety were determined in bivariate and multiple logistic regression analysis. Results High depression scores and the wording of the referral letter for colposcopy were related to high state anxiety in a multivariate analysis. Women with high depression scores had a nine-fold risk for higher levels of state anxiety and did not respond with lower state anxiety levels after information and examination. Women who received a letter stating 'some changes' were at a five-fold increased risk for high levels of state anxiety than those who received a letter stating 'light changes'. Conclusion A depressive mood and the wording of the referral letter for colposcopy after an abnormal smear were predictive of high state anxiety levels.
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| 11. |
- Herbst, Andreas, et al.
(författare)
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Diagnosis of early preterm labour.
- 2006
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 113:Suppl 3, s. 60-67
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Tidskriftsartikel (refereegranskat)abstract
- While preterm contractions occur almost as often extremely preterm as they do closer to term, birth due to spontaneous preterm labour before 27 weeks of gestation is rare, accounting for 0.05–0.7% of all births in different populations. Although the likelihood that uterine contractions before 27 weeks of gestation represent true preterm labour is low, the risk of adverse outcome in such cases is high. A correct diagnosis is important, and a useful diagnostic test should have a high sensitivity. In most reports, only 30–40% of women hospitalised for spontaneous preterm labour experience a preterm birth, suggesting a low positive predictive value of clinical diagnosis based on uterine contractions and vaginal examination. Transvaginal ultrasonographic scanning (TVUSS) of cervical length has shown a high sensitivity for preterm birth, 90–100% for preterm birth before 33–35 weeks, using a liberal cutoff at 30 mm. Assessment of cervicovaginal fetal fibronectin (FFN) levels has shown a sensitivity of about 80%. Adding FFN assessment to TVUSS might contribute insignificantly to the prediction of preterm birth. In a retrospective study of 147 women with spontaneous preterm labour and intact membranes before 27 weeks in our department, 61% of hospitalised women and 77% of women receiving tocolytic infusion therapy delivered before 32 weeks. Among 66 singleton pregnancies delivered before 32 weeks, at admission, 94% either had an effaced cervix or cervix with ≥2 cm dilation (74%), vaginal bleeding (61%) or serum C-reactive protein level >20 mg/l (40%), whereas one of these findings only was present in 18% of women who delivered at later gestations. Among 132 women with symptoms of spontaneous preterm contractions before 27 weeks not admitted for hospital care, only 2 (1.5%) delivered before 32 weeks, not significantly higher than for all other women (0.6%). Although TVUSS may be useful when the diagnosis of spontaneous preterm labour is in doubt, the main predicament in early spontaneous preterm labour may not be to predict preterm birth but to prevent it, since many women appear in advanced labour or with manifest chorioamnionitis.
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| 12. |
- Herbst, Andreas, et al.
(författare)
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Influence of mode of delivery on neonatal mortality in the second twin, at and before term.
- 2008
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 115:12, s. 1512-1517
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Tidskriftsartikel (refereegranskat)abstract
- Design To study the association between mode of delivery and neonatal mortality in second twins. To study the association between caesarean delivery and mortality with minimum bias of the indication for the operation, we wanted to compare the outcome of second twins delivered by caesarean due to breech presentation of the sibling with vaginally delivered second twins in uncomplicated pregnancies. Setting Sweden, 1980-2004 Population Twins born during 1980-2004 were identified from the Swedish Medical Birth Registry. Twin pairs delivered by caesarean due to breech presentation of the first twin, and vaginally delivered twins with the first twin in cephalic presentation were included. Pregnancies with antepartum complications were excluded. Methods Odds ratios and 95% CI were calculated using multiple logistic regression analyses, adjusting for year of birth, maternal age, parity and gestational age. Main outcome measures Neonatal mortality. Results Compared with second-born twins delivered vaginally, second-born twins delivered by caesarean (for breech presentation of the sibling) had a lower risk of neonatal death (adjusted OR 0.40; 95% CI 0.19-0.83). The decreased risk after caesarean delivery was significant for births before 34 weeks (2.1 versus 9.0%; adjusted OR 0.40; 95% CI 0.17-0.95). After 34 weeks, neonatal mortality was low in both groups (0.1 and 0.2%, respectively), and the difference was not statistically significant (adjusted OR 0.42; 95% CI 0.10-1.79). Conclusions Neonatal mortality is lower for the second twin after caesarean delivery at birth before 34 weeks. At term, mortality is low irrespective of delivery mode.
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| 13. |
- Håkansson, S, et al.
(författare)
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Impact and risk factors for early-onset group B streptococcal morbidity : analysis of a national, population-based cohort in Sweden 1997-2001.
- 2006
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Ingår i: BJOG. - : Wiley. - 1470-0328 .- 1471-0528. ; 113:12, s. 1452-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study early-onset group B streptococcal (EOGBS) morbidity, mortality, and maternal risk factors. Design: Observational, population-based, retrospective. Data from national registers and medical records. SETTING: Sweden, 1997-2001. POPULATION: Cohort of 640 infants with a diagnosis of GBS infection out of 435 070 live births. METHOD: Infants with diagnoses GBS sepsis (P36.0) and/or pneumonia (P23.3) were analysed. In cases with P36.0, register data were validated against infant and maternal medical records. Odds ratios (OR) were estimated by multiple logistic regression. MAIN OUTCOME MEASURES: Incidence of EOGBS morbidity, mortality, frequency of maternal risk factors and administration of intrapartum antibiotics. RESULTS: There were 319 cases with EOGBS sepsis. Blood culture verified 174 cases. There were 145 with clinical sepsis and 180 with pneumonia only. The incidences were 0.40, 0.33, and 0.41 per 1000 live births, respectively. The mortality was 7.5, 0.7, and 2.2% in respective groups. The frequencies of established maternal risk factors were: membrane rupture > or =18 hours, 44%; prematurity, 26%; temperature during labour > or =38 degrees C, 22%. Novel maternal risk factors identified in verified cases were gestational age (GA) of 37 completed weeks (OR 3.5, 1.8-6.5) and gestational diabetes (OR 3.7, 1.8-8.5). When including clinical sepsis, also epidural anaesthesia, infant large for GA, postmaturity, and high maternal age were significant risk factors. CONCLUSION: The incidence of verified EOGBS disease was 0.4 per 1000 live births with a total burden of EOGBS morbidity approximately three times higher. GA of 37 completed weeks and gestational diabetes were identified as additional significant risk factors.
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| 14. |
- Ingemarsson, Ingemar
(författare)
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Combination therapy.
- 2005
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 112, s. 89-93
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Tidskriftsartikel (refereegranskat)
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| 15. |
- Ingemarsson, Ingemar, et al.
(författare)
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ST analysis
- 2007
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 114:11, s. 1445-1445
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 16. |
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| 17. |
- Källén, Bengt, et al.
(författare)
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In vitro fertilisation in Sweden: obstetric characteristics, maternal morbidity and mortality
- 2005
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Ingår i: Bjog. - : Wiley. ; 112:11, s. 1529-1535
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate obstetric characteristics, maternal morbidity and mortality among Swedish women giving birth after in vitro fertilisation (IVF) treatment. DESIGN: Register study. SETTING: Nationwide study in Sweden. SAMPLE: All women known to have had IVF in Sweden 1982-2001. METHODS: Using Swedish health registers, women who had given birth after IVF were identified from all Swedish IVF clinics and compared with all women who gave birth. Analysis was performed with the Mantel-Haenszel technique. MAIN OUTCOME MEASURES: Diagnoses during pregnancy, at delivery and at re-admission within 60 days after delivery and risk of cancer. RESULTS: IVF women had an increased risk of bleeding in early pregnancy [odds ratio (OR) = 4.59, 95% confidence interval (95% CI) 4.08-5.15] and of ovarian torsion during pregnancy (OR = 10.6, 5.69-10.7). They were also more likely to encounter pre-eclampsia (OR = 1.63, 1.53-1.74), placental abruption (2.17, 1.74-2.72), placenta praevia (3.65, 3.15-4.23), bleeding in association with vaginal delivery (1.40, 1.38-1.50) and premature rupture of membranes (PROM) (2.54, 2.34-2.76). Interventions including caesarean sections (1.38, 1.32-1.43) and induction of labour (1.37, 1.29-1.46) in singleton pregnancies was more frequent. The type of IVF method had little effect on these results, but there was a tendency for women who had received intra-cytoplasmatic sperm injection (ICSI) to have slightly fewer complications than women having standard IVF. There was a significant decrease in cancer risk after IVF (0.79, 0.69-0.91) but a suggested increase in the risk of ovarian cancer both before (2.70, 1.49-4.91) and after (2.08, 1.15-3.76) IVF. No change in mortality was observed. CONCLUSIONS: Women treated with IVF had an increased obstetric morbidity. This seems to contribute little to the well-known increased risk of preterm delivery.
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| 18. |
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| 19. |
- Melin, M, et al.
(författare)
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Changes in the ST-interval segment of the fetal electrocardiogram in relation to acid-base status at birth.
- 2008
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 115:13, s. 1669-1675
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess the occurrence of ST-interval segment changes of the fetal electrocardiogram (ECG) and cardiotocographic (CTG) abnormalities preceding acidaemia at birth. Design Case-control study. Setting University hospital labour ward. Sample Newborns with severe cord artery metabolic acidaemia (pH < 7.00 and lactate >/= 10 mmol/l; n= 24), moderate metabolic acidaemia (pH 7.00-7.09 and lactate >/= 10; n= 48), acidaemia (pH 7.00-7.09; n= 52), pre-acidaemia (pH 7.10-7.19; n= 265), and controls (pH >/= 7.20; n= 117). Methods Monitoring traces were assessed blinded to outcome. Main outcome measures CTG and ST changes. Results Any ST event occurred significantly more often among cases with severe (79%) and moderate (75%) metabolic acidaemia than among controls (50%). The difference was restricted to baseline T/QRS rises and to the second stage of labour, during which any event only occurred significantly more often among cases with severe metabolic acidaemia (62%) than among controls (38%). ST events coincided with abnormal CTG patterns in 67, 44, 40, and 28% of cases with severe and moderate metabolic acidaemia, acidaemia, and pre-acidaemia, respectively, and in 12% of controls. ST events with intermediary CTG were similarly frequent in the case groups (0-6%) as in the controls (4%). The ST guidelines stated intervention in 96, 62, 73, and 49% of case groups and 23% of controls. Conclusions Only two of three cases with severe and less than half of cases with moderate metabolic acidaemia were preceded by ST events coinciding with CTG abnormalities. It is therefore important to intervene for long-lasting, rapidly deteriorating or marked (preterminal) CTG abnormalities, also in the absence of ST events.
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| 20. |
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| 21. |
- Rööst, Mattias, et al.
(författare)
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Priorities in emergency obstetric care in Bolivia : maternal mortality and near-miss morbidity in metropolitan La Paz
- 2009
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Ingår i: BJOG : An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 116:9, s. 1210-1217
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia. DESIGN: Facility-based cross-sectional study. SETTING: Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government-subsidised programme. POPULATION: All maternal deaths and women with near-miss morbidity. METHODS: Inclusion of near-miss using clinical and management-based criteria. MAIN OUTCOME MEASURES: Maternal mortality ratio (MMR), severe morbidity ratio (SMR), mortality indices and proportion of near-miss cases at hospital admission. RESULTS: MMR was 187/100,000 live births and SMR was 50/1000 live births, with a relatively low mortality index of 3.6%. Severe haemorrhage and severe hypertensive disorders were the main causes of near-miss, with 26% of severe haemorrhages occurring in early pregnancy. Sepsis was the most common cause of death. The majority of near-miss cases (74%) were in critical condition at hospital admission and differed from those fulfilling the criteria after admission as to diagnostic categories and socio-demographic variables. CONCLUSIONS: Pre-hospital barriers remain to be of great importance in a setting of this type, where there is wide availability of free maternal health care. Such barriers, together with haemorrhage in early pregnancy, pre-eclampsia detection and referral patterns, should be priority areas for future research and interventions to improve maternal health. Near-miss upon arrival and near-miss after arrival at hospital should be analysed separately as that provides additional information about factors that contribute to maternal ill-health.
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| 22. |
- Saltvedt, S, et al.
(författare)
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Detection of malformations in chromosomally normal fetuses by routine ultrasound at 12 or 18 weeks of gestation - a randomised controlled trial in 39 572 pregnancies
- 2006
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 113:6, s. 664-674
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare the antenatal detection rate of malformations in chromosomally normal fetuses between a strategy of offering one routine ultrasound examination at 12 gestational weeks (gws) and a strategy of offering one routine examination at 18 gws. Design Randomised controlled trial. Setting Multicentre trial including eight hospitals. Population A total of 39 572 unselected pregnant women. Methods Women were randomised either to one routine ultrasound scan at 12 (12-14) gws including nuchal translucency (NT) measurement or to one routine scan at 18 (15-22) gws. Anomaly screening was performed in both groups following a check-list. A repeat scan was offered in the 12-week scan group if the fetal anatomy could not be adequately seen at 12-14 gws or if NT was >= 3.5 mm in a fetus with normal or unknown chromosomes. Main outcome measures Antenatal detection rate of malformed fetuses. Results The antenatal detection rate of fetuses with a major malformation was 38% (66/176) in the 12-week scan group and 47% (72/152) in the 18-week scan group (P = 0.06). The corresponding figures for detection at < 22 gws were 30% (53/176) and 40% (61/152) (P = 0.07). In the 12-week scan group, 69% of fetuses with a lethal anomaly were detected at a scan at 12-14 gws. Conclusions None of the two strategies for prenatal diagnosis is clearly superior to the other. The 12-week strategy has the advantage that most lethal malformations will be detected at < 15 gws, enabling earlier pregnancy termination. The 18-week strategy seems to be associated with a slightly higher detection rate of major malformations, although the difference was not statistically significant.
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| 23. |
- Thunell, Louise, et al.
(författare)
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Scientific evidence changes prescribing practice--a comparison of the management of the climacteric and use of hormone replacement therapy among Swedish gynaecologists in 1996 and 2003
- 2006
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Ingår i: Bjog. - : Wiley. ; 113:1, s. 15-20
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study changes in attitudes, knowledge and management strategies concerning hormone replacement therapy (HRT) among gynaecologists in Sweden. DESIGN: Comparative questionnaire study. SETTING: National survey. POPULATION: Practising gynaecologists. METHODS: In 1996, gynaecologists in Sweden (n= 1323) were invited to return a postal questionnaire concerning their attitudes, knowledge and management strategies concerning HRT. They were also asked about their own use of HRT. In 2003, a similar questionnaire was sent to practising gynaecologists (n= 1320) in Sweden. MAIN OUTCOME MEASURES: Attitudes to and personal use of HRT. RESULTS: The response rate was 76% in 2003 when 11% of the gynaecologists thought that all women without contraindications should be offered HRT compared with 44% in 1996 and 89% found it difficult to evaluate pros and cons with HRT in a clinical situation (74% in 1996). More gynaecologists in 2003 believed that HRT increased the risk for breast cancer (95% vs 71%). Twenty-five percent in 2003 stated that risk factors for osteoporosis were absolute indications for HRT (60% in 1996). Current ischaemic heart disease was considered to be an indication for HRT by 7% in 2003 (60% in 1996). In 2003, current use of HRT was reported by 71% of female menopausal gynaecologists (88% in 1996). CONCLUSIONS: Swedish gynaecologists were more cautious in their management strategies concerning HRT in 2003 compared with 1996, probably influenced by results from the Heart and Estrogen/Progestin Replacement Study (HERS) and Women's Health Initiative (WHI) studies. Current use of HRT was still high among female gynaecologists, although it had decreased since 1996.
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| 24. |
- Westin, Maria-Dorothea, et al.
(författare)
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Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomised controlled trial comprising 36 299 fetuses.
- 2006
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 113:6, s. 675-682
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare the rate of prenatal diagnosis of heart malformations between two policies of screening for heart malformations. Design Randomised controlled trial. Setting Six university hospitals, two district general hospitals. Sample A total of 39 572 unselected pregnancies randomised to either policy. Methods The 12-week policy implied one routine scan at 12 weeks including measurement of nuchal translucency (NT), and the 18 week policy implied one routine scan at 18 weeks. Fetal anatomy was scrutinised using the same check-list in both groups, and in both groups, indications for fetal echocardiography were ultrasound findings of any fetal anomaly, including abnormal four-chamber view, or other risk factors for heart malformation. In the 12-week scan group, NT 3.5 mm was also an indication for fetal echocardiography. Main outcome measure Prenatal diagnosis of major congenital heart malformation. Results In the 12-week scan group, 7 (11%) of 61 major heart malformations were prenatally diagnosed versus 9 (15%) of 60 in the 18-week scan group (P = 0.60). In four (6.6%) women in the 12-week scan group, the routine scan was the starting point for investigations resulting in a prenatal diagnosis versus in 9 (15%) women in the 18-week scan group (P = 0.15). The diagnosis was made <= 22 weeks in 5% (3/61) of the cases in the 12-week scan group versus in 15% (9/60) in the 18-week scan group (P = 0.08). Conclusions The prenatal detection rate of major heart malformations was low with both policies. The 18-week scan policy seemed to be superior to the 12-week scan policy, although the differences in prenatal detection rates were not statistically significant.
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| 25. |
- Wiberg, Nana, et al.
(författare)
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Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations
- 2008
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 115:6, s. 697-703
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Tidskriftsartikel (refereegranskat)abstract
- BJECTIVE: To estimate the influence of delayed umbilical cord clamping at birth on arterial and venous umbilical cord blood gases, bicarbonate (HCO3-), base excess (BE) and lactate in vigorous newborns. SETTING: University hospital. DESIGN: Prospective observational. SAMPLE: Vaginally delivered term newborns. MATERIAL AND METHODS: Umbilical cord arterial and venous blood was sampled repeatedly every 45 seconds (T(0)= time zero; T(45)= 45 seconds, T(90)= 90 seconds) until the cord pulsations spontaneously ceased in 66 vigorous singletons with cephalic vaginal delivery at 36-42 weeks. Longitudinal comparisons were performed with the Wilcoxon signed-ranks matched pairs test. Mixed effect models were used to describe the shape of the regression curves. MAIN OUTCOME MEASURES: Longitudinal changes of umbilical cord blood gases and lactate. RESULTS: In arterial cord blood, there were significant decreases of pH (7.24-7.21), HCO3- (18.9-18.1 mmol/l) and BE (-4.85 to -6.14 mmol/l), and significant increases of PaCO(2) (7.64-8.07 kPa), PO(2) (2.30-2.74 kPa) and lactate (5.3-5.9 mmol/l) from T(0) to T(90), with the most pronounced changes at T(0)-T(45). Similar changes occurred in venous blood pH (7.32-7.31), HCO3- (19.54-19.33 mmol/l), BE (-4.93 to -5.19 mmol/l), PaCO(2) (5.69-5.81 kPa) and lactate (5.0-5.3 mmol/l), although the changes were smaller and most pronounced at T(45)-T(90). No significant changes were observed in venous PO(2). CONCLUSION: Persistent cord pulsations and delayed cord clamping at birth result in significantly different measured values of cord blood acid-base parameters.
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| 26. |
- Wiberg, Nana, et al.
(författare)
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Lactate concentration in umbilical cord blood is gestational age-dependent: a population-based study of 17 867 newborns.
- 2008
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 115:6, s. 704-709
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the influence of gestational age on lactate concentration in arterial and venous umbilical cord blood at birth and to define gestational age-specific reference values for lactate in vigorous newborns. DESIGN: Population-based comparative. SETTING: University hospitals. SAMPLE: Vigorous newborns with validated umbilical cord blood samples. MATERIAL AND METHODS: From 2000 to 2004, routine cord blood gases, lactate and obstetric data from two university hospitals were available for 17 867 newborns from gestational week 24 to 43. After validation of blood samples and inclusion only of singleton pregnancies aimed for vaginal delivery, 10 700 women remained. Among those, reference values were defined in 10 169 vigorous newborns, that is in newborns with a 5-minute Apgar score corresponding to the gestational age-specific median value minus 1 point score, or better. MAIN OUTCOME MEASURES: Cord lactate concentration relative to gestational age. RESULTS: The arterial and venous lactate concentrations increased monotonously with gestational age from 34 weeks. Considerable differences were found between mean and median values, but after logarithmic transformation the log-lactate values were normally distributed. Simple linear regression analysis showed a significant association between the log-lactate values and gestational age (P < 10(-6), R(2)= 0.024). Reference curves were constructed after anti-logarithmic transformation. Both the gestational age and the time of the second stage of labour influenced, independently of each other, the lactate concentrations. CONCLUSIONS: Lactate concentrations in arterial and venous umbilical cord blood are increasing significantly with advancing gestational age.
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| 27. |
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| 28. |
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| 29. |
- Moen, V, et al.
(författare)
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Hyponatremia complicating labour-rare or unrecognised? A prospective observational study
- 2009
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Ingår i: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY. - : Wiley. - 1470-0328 .- 1471-0528. ; 116:4, s. 552-561
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate the occurrence of hyponatraemia following delivery, with a hypothesis that hyponatraemia has a high prevalence in labouring women. Prospective observational study. Consultant-led delivery suite in County Hospital, Kalmar, Sweden. A total of 287 pregnant women at term (37 full gestational weeks). Oral fluids were allowed during labour. Blood samples were collected on admission, after delivery, and from the umbilical artery and vein. Hyponatraemia defined as plasma sodium <= 130 mmol/l after delivery. Hyponatraemia was found in 16 (26%) of the 61 mothers who received more than 2500 ml of fluid during labour. Two-thirds of fluids were orally ingested. Decrease in plasma sodium concentration during labour correlated with duration of labour and the total fluid volume administered. Analysis by multivariate logistic regression showed that hyponatraemia was significantly correlated with fluid volume (P < 0.001) but not with oxytocin administration or epidural analgesia. Hyponatraemia correlated significantly with prolonged second stage of labour, instrumental delivery, and emergency caesarean section for failure to progress (P = 0.002). Hyponatraemia is not uncommon following labour. Tolerance to a water load is diminished during labour; therefore, even moderate fluid volumes may cause hyponatraemia. Women should not be encouraged to drink excessively during labour. Oral fluids, when permitted, should be recorded, and intravenous administration of hypotonic fluids should be avoided. When abundant drinking is unrecognised or intravenous fluid administration liberal, life-threatening hyponatraemia may develop. The possibility that hyponatraemia may influence uterine contractility merits further investigation.
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| 33. |
- Blohm, Febe, 1951, et al.
(författare)
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A randomised double blind trial comparing misoprostol or placebo in the management of early miscarriage
- 2005
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Ingår i: Bjog. - : Wiley. - 1470-0328. ; 112:8, s. 1090-5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study if misoprostol 400 microg, administered vaginally, increased the successful resolution of early miscarriage compared with placebo. DESIGN: Randomised, double blind placebo controlled study. SETTING: Sahlgrenska University Hospital, Goteborg, Sweden. SAMPLE: One hundred and twenty-six women seeking medical attention for early miscarriage. METHOD: Women with a non-viable, first trimester miscarriage were randomised to vaginal administration of misoprostol 400 microg or placebo. MAIN OUTCOME MEASURES: Main outcome measure was the proportion of successful complete resolution of miscarriage. Secondary outcomes were incidence of infection, bleeding, gastrointestinal side effects, pain, use of analgesics and length of sick leave between groups. RESULTS: Sixty-four patients were randomised to misoprostol and 62 to placebo. Eighty-one percent in the misoprostol and 52% in the placebo group had a complete miscarriage within one week of the primary visit (RR 1.57; 95% CI 1.20-2.06). Patients in the misoprostol group reported more pain as assessed on a visual analogue scale (60.4 [31.0] vs 43.8 [37.1] mm; P < 0.007) and required analgesics more often (83%vs 61%, RR 1.35; 95% CI 1.08-1.70). There were no significant differences in the occurrence of gastrointestinal side effects, infection, reduction in haemoglobin or sick leave between the groups. CONCLUSIONS: Treatment with 400 mug misoprostol administered vaginally increased the success rate of resolvement of uncomplicated early miscarriages compared with placebo. However, women who received misoprostol experienced more pain and required more analgesics than those who did not.
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| 34. |
- Braekken, I H, et al.
(författare)
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Pelvic floor function is independently associated with pelvic organ prolapse.
- 2009
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 116:13, s. 1706-14
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the risk factors for pelvic organ prolapse (POP), including physical activity, clinically measured joint mobility and pelvic floor muscle (PFM) function.
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| 35. |
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| 36. |
- Claesson, Ing-Marie, 1953-, et al.
(författare)
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Weight gain restriction for obese pregnant women : A case-control intervention study
- 2008
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 115:1, s. 44-50
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To minimise obese women's total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome. Design: A prospective case-control intervention study. Setting: Antenatal care clinics in the southeast region of Sweden. Population: One hundred fifty-five pregnant women in an index group and one hundred ninety-three women in a control group. Methods: An intervention programme with weekly motivational talks and aqua aerobic classes for obese pregnant women. Main outcome measures: Weight gain in kilograms, delivery and neonatal outcome. Results: The index group had a significantly lower weight gain during pregnancy compared with the control group (P < 0.001). The women in the index group weighed less at the postnatal check-up compared with the weight registered in early pregnancy (P < 0.001). The percentage of women in the index group who gained less than 7 kg was greater than that of women in the control group who gained less than 7 kg (P = 0.003). The percentage of nulliparous women in this group was greater than that in the control group (P = 0.018). In addition, the women in the index group had a significantly lower body mass index at the postnatal check-up, compared with the control group (P < 0.001). There were no differences between the index group and the control group regarding birthweight, gestational age and mode of delivery. Conclusion: The intervention programme was effective in controlling weight gain during pregnancy and did not affect delivery or neonatal outcome.
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| 37. |
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| 38. |
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| 39. |
- Ekholm Selling, Katarina, et al.
(författare)
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Intergenerational effects of preterm birth and reduced intrauterine growth: A population-based study of Swedish mother-offspring pairs
- 2006
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Ingår i: British Journal of Obstetrics and Gynaecology. - : Wiley. - 0306-5456 .- 1365-215X .- 1470-0328 .- 1471-0528. ; 113:4, s. 430-440
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Tidskriftsartikel (refereegranskat)abstract
- Objective To estimate the intergenerational effects of preterm birth and reduced intrauterine growth. Design Population-based cohort study. Settings Mother–first-born offspring pairs recorded in the Swedish Medical Birth Registry. Population Children born before 2001 to 38 720 women born in 1973–75. Methods The relationships between the mother's and the child's birth characteristics were estimated using logistic regression analysis. Adjustments were made for smoking habits, body mass index (BMI), and current and childhood socio-economic conditions. Analyses were performed on all mother–offspring pairs and on the pairs for which information on neither of the included background variables was missing (n= 24 520). Main outcome measures Preterm birth (<37 weeks of gestation) and small for gestational age (SGA) (<−2 SD of the Swedish standard). Results Mothers who themselves had been born preterm were not significantly more likely to deliver their own children preterm, compared with those who had been born at term (adjusted OR 1.24, 95% CI 0.95–1.62). Also, preterm birth in the mothers did not influence the occurrence of SGA in the children. However, the odds ratio for giving birth to SGA and preterm children, respectively, was higher among SGA mothers (OR 2.68, 95% CI 2.11–3.41 and OR 1.30, 95% CI 1.05–1.61). Mothers whose intrauterine growth was moderately reduced but who did not meet the criterion of being born SGA were also at higher risk of giving birth to both preterm and SGA children, respectively. Conclusions The present study showed evidence of intergenerational effects of reduced intrauterine growth even when socio-economic factors as well as BMI and smoking were adjusted for. There was, however, no consistent intergenerational effect of preterm birth.
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| 40. |
- Elden, Helen, 1959, et al.
(författare)
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Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham acupuncture
- 2008
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 115:13, s. 1655-68
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether acupuncture has a greater treatment effect than non-penetrating sham acupuncture in women with pelvic girdle pain (PGP) during pregnancy. DESIGN: Randomised double-blinded controlled trial. SETTING: East Hospital, Gothenburg, and 25 antenatal primary care units in the region of Västra Götaland, Sweden. POPULATION: A total of 115 pregnant women with a clinical diagnosis of PGP who scored > or =50 on a 100-mm visual analogue scale (VAS). METHOD: Women were randomly allocated to standard treatment plus acupuncture or to standard treatment plus non-penetrating sham acupuncture for 8 weeks. MAIN OUTCOME MEASURES: Main outcome measure was pain. Secondary outcomes were frequency of sick leave, functional status, discomfort of PGP, health-related quality of life and recovery of severity of PGP as assessed by the independent examiner. RESULTS: After treatment, median pain decreased from 66 to 36 in the acupuncture group and from 69 to 41 in the non-penetrating sham group (P = 0.493) as assessed on a VAS. Women in the acupuncture group were in regular work to a higher extent than women in the sham group (n = 28/57 versus 16/57, P = 0.041). The acupuncture group had superior ability to perform daily activities measured with the disability rating index (DRI) (44 versus 55, P = 0.001). There were no significant differences in quality of life, discomfort of PGP and recovery from severity of PGP between the groups. CONCLUSIONS: Acupuncture had no significant effect on pain or on the degree of sick leave compared with non-penetrating sham acupuncture. There was some improvement in performing daily activities according to DRI. The data imply that needle penetration contributes to a limited extent to the previously reported beneficial effects of acupuncture.
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| 41. |
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| 43. |
- Fadl, Helena, 1965-, et al.
(författare)
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Fasting capillary glucose as a screening test for gestational diabetes mellitus
- 2006
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Ingår i: BJOG: an International Journal of Obstetrics and Gynaecology. - Oxford : Blackwell Publishing. - 1470-0328 .- 1471-0528. ; 113:9, s. 1067-71
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate fasting capillary glucose as a screening test for gestational diabetes mellitus (GDM) compared with traditional risk factors and repeated random capillary glucose measurements.Design: Cross-sectional, population-based study.Setting: Maternal Health Care Clinics in Orebro County, Sweden.Population: An unselected population of women without diabetes.Methods: Fasting capillary glucose levels were measured at gestational weeks 28-32. Random capillary glucose levels were measured four to six times during pregnancy. Traditional risk factors for GDM were registered. GDM was diagnosed using a 75-g oral glucose tolerance test.Main outcome measures: Sensitivity, specificity, likelihood ratios.Results: In 55 of 3616 women participating in the study, GDM was diagnosed before 34 weeks of gestation. For fasting capillary glucose cutoff values between 4.0 and 5.0 mmol/l, sensitivity was in the range between 87 and 47% and specificity between 51 and 96%. Using a combined screening model of traditional risk factors with fasting capillary glucose at various cutoff values increased the sensitivity only slightly compared with using fasting capillary glucose alone.Conclusion: In this Swedish, unselected, low-risk population, fasting capillary glucose measurements were found to be an acceptable and useful screening test for GDM.
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