| 1. |
- Holmer, Hampus, et al.
(författare)
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The global met need for emergency obstetric care: a systematic review.
- 2015
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 122:2, s. 183-189
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Forskningsöversikt (refereegranskat)abstract
- Of the 287 000 maternal deaths every year, 99% happen in low- and middle-income countries. The vast majority could be averted with timely access to appropriate emergency obstetric care (EmOC). The proportion of women with complications of pregnancy or childbirth who actually receive treatment is reported as 'Met need for EmOC'.
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| 2. |
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| 4. |
- Norberg, H., et al.
(författare)
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Timing of antenatal corticosteroid administration and survival in extremely preterm infants : A national population-based cohort study
- 2017
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 124:10, s. 1567-1574
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the association between administration-to-birth interval of antenatal corticosteroids (ACS) and survival in extremely preterm infants. Design: Population-based prospective cohort study. Setting: All obstetric and neonatal units in Sweden from 1 April 2004 to 31 March 2007. Population: All live-born infants (n = 707) born at 22-26 completed weeks of gestation. Methods: The relationship between time from first administration of ACS to delivery and survival was investigated using Cox proportional hazards regression analysis. Main outcome measures: Neonatal (0-27 days) and infant (0-365 days) survival, and infant survival without major neonatal morbidity (intraventricular haemorrhage grade ≥ 3, retinopathy of prematurity stage ≥ 3, periventricular leukomalacia, necrotising enterocolitis, or severe bronchopulmonary dysplasia). Results: Five-hundred and ninety-one (84%) infants were exposed to ACS. In the final adjusted model, infant survival was lower in infants unexposed to ACS [hazard ratio (HR) = 0.26; 95% confidence interval 0.15-0.43], in infants born <24 h [HR = 0.53 (0.33-0.87)] and >7 days after ACS [HR = 0.56 (0.32-0.97)], but not in infants born 24-47 h after ACS [HR = 1.60 (0.73-3.50)], as compared with infants born 48 h to 7 days after administration. The findings were similar for neonatal survival. Survival without major neonatal morbidity among live-born infants was 14% in unexposed infants and 30-39% in steroid-exposed groups, indicating that any ACS exposure was valuable. Conclusions: Administration of ACS 24 h to 7 days before extremely preterm birth was associated with significantly higher survival than in unexposed infants and in infants exposed to ACS at shorter or longer administration-to-birth intervals. Tweetable abstract: Timing of antenatal corticosteroids is important for extremely preterm infants' survival.
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| 5. |
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| 6. |
- Skrastad, R. B., et al.
(författare)
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Risk assessment for preeclampsia in nulliparous women at 11-13weeks gestational age: prospective evaluation of two algorithms
- 2015
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Ingår i: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 122:13, s. 1781-1788
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo evaluate two algorithms for prediction of preeclampsia in a population of nulliparous women in Norway. DesignProspective screening study. SettingNational Centre for Fetal Medicine in Trondheim, Norway. PopulationFive hundred and forty-one nulliparous women. MethodsThe women were examined between 11(+0) and 13(+6)weeks with interviews for maternal characteristics and measurements of mean arterial pressure, uterine artery pulsatility index, pregnancy-associated plasma protein A and placental growth factor. The First Trimester Screening Program version 2.8 by The Fetal Medicine Foundation (FMF) was compared with the Preeclampsia Predictor TM version 1 revision 2 by Perkin Elmer (PREDICTOR). Main outcome measuresPrediction of preeclampsia requiring delivery before 37weeks, before 42weeks and late preeclampsia (delivery after 34weeks). ResultsThe performance of the two algorithms was similar, but quite poor, for prediction of preeclampsia requiring delivery before 42weeks with an area under the curve of 0.77 (0.67-0.87) and sensitivity 40% (95% CI 19.1-63.9) at a fixed 10% false positive rate for FMF and 0.74 (0.63-0.84) and sensitivity 30% (95% CI 11.9-54.3) at a fixed 10% false positive rate for PREDICTOR. The FMF algorithm for preeclampsia requiring delivery <37weeks had an area under the curve of 0.94 (0.86-1.0) and sensitivity of 80% (95% CI 28.4-99.5) at a 10% fixed false positive rate. ConclusionsFetal Medicine Foundation and PREDICTOR algorithms had similar and only modest performance in predicting preeclampsia. The results indicate that the FMF algorithm is suitable for prediction of preterm preeclampsia.
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| 7. |
- Spencer, R., et al.
(författare)
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Achieving orphan designation for placental insufficiency : annual incidence estimations in Europe
- 2019
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Ingår i: BJOG: An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 126:9, s. 1157-1167
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine whether a novel therapy for placental insufficiency could achieve orphan drug status by estimating the annual incidence of placental insufficiency, defined as an estimated fetal weight below the 10th centile in the presence of abnormal umbilical artery Doppler velocimetry, per 10 000 European Union (EU) population as part of an application for European Medicines Agency (EMA) orphan designation. Design: Incidence estimation based on literature review and published national and EU statistics. Setting and population: European Union. Methods: Data were drawn from published literature, including national and international guidelines, international consensus statements, cohort studies and randomised controlled trials, and published national and EU statistics, including birth rates and stillbirth rates. Rare disease databases were also searched. Results: The proportion of affected pregnancies was estimated as 3.17% (95% CI 2.93–3.43%), using a weighted average of the results from two cohort studies. Using birth rates from 2012 and adjusting for a pregnancy loss rate of 1/100 gave an estimated annual incidence of 3.33 per 10 000 EU population (95% CI 3.07–3.60 per 10 000 EU population). This fell below the EMA threshold of 5 per 10 000 EU population. Conclusions: Maternal vascular endothelial growth factor gene therapy for placental insufficiency was granted EMA orphan status in 2015 after we demonstrated that it is a rare, life-threatening or chronically debilitating and currently untreatable disease. Developers of other potential obstetric therapies should consider applying for orphan designation, which provides financial and regulatory benefits. Tweetable abstract: Placental insufficiency meets the European Medicines Agency requirements for orphan disease designation.
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| 10. |
- Cnattingius, S., et al.
(författare)
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Investigating fetal growth restriction and perinatal risks in appropriate for gestational age infants : using cohort and within-sibling analyses
- 2019
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley-Blackwell Publishing Inc.. - 1470-0328 .- 1471-0528. ; 126:7, s. 842-850
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Fetal growth restriction refers to fetuses that fail to reach their growth potential. Studies within siblings may be useful to disclose fetal growth restriction in appropriate for gestational age (AGA) infants. We analysed associations between birthweight percentiles and perinatal risks in AGA infants, using both population-based and within-sibling analyses.Design: Population-based cohort study. Setting and sample Using nation-wide Swedish registries (1987-2012), we identified 2 134 924 singleton AGA births (10th-90th birthweight percentile for gestational age), of whom 1 377 326 were full siblings.Methods: Unconditional Poisson regression was used for population analyses, and conditional (matched) Poisson regression for within-sibling analyses. We estimated associations between birthweight percentiles and stillbirth, neonatal mortality, and morbidity, using incidence rate ratios (IRRs) with 95% confidence intervals (CIs).Results: Stillbirth and neonatal mortality risks declined with increasing birthweight percentiles, but the declines were larger in within-sibling analyses. Compared with the reference group (40th to <60th percentile), IRRs (95% CIs) of stillbirth for the lowest and highest percentile groups (10th to <25th and 75th-90th percentiles, respectively) were 1.87 (1.72-2.03) to 0.76 (0.68-0.85) in population analysis and 2.60 (2.27-2.98) and 0.43 (0.36-0.50) in within-sibling analysis. Neonatal morbidity risks in term non-malformed infants with low birthweight percentiles were generally only increased in within-sibling analyses.Conclusion: Using birthweight information from siblings may help to define fetal growth restriction in AGA infants.
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| 11. |
- Manna, L. B., et al.
(författare)
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Enzymatic quantification of total serum bile acids as a monitoring strategy for women with intrahepatic cholestasis of pregnancy receiving ursodeoxycholic acid treatment: a cohort study
- 2019
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Ingår i: Bjog-an International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 126:13, s. 1633-1640
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate enzymatic total serum bile acid quantification as a monitoring strategy for women with intrahepatic cholestasis of pregnancy (ICP) treated with ursodeoxycholic acid (UDCA). Design Cohort. Setting One UK university hospital. Population 29 ICP cases treated with UDCA. Methods Serial samples were collected prospectively throughout gestation. Total serum bile acids were measured enzymatically and individual bile acids by high-performance liquid chromatography-tandem mass spectrometry. Data were log-transformed and analysed with random effects generalised least square regression. Main outcome measures The relationship between enzymatic total bile acid measurements and individual bile acid concentrations after UDCA treatment. Results In untreated women, cholic acid was the principal bile acid (51%) and UDCA concentrations were <0.5%, whereas UDCA constituted 60% (IQR 43-69) of serum bile acids following treatment and cholic acid fell to <20%. Changes in the total bile acid measurement reflected similar alterations in the concentrations of the pathologically elevated bile acids, e.g. a two-fold increase in enzymatic total bile acids is accompanied by approximately a two-fold increase in cholic acid and chenodeoxycholic acid at most UDCA doses (P < 0.001). Most of the effects of UDCA on cholic acid occur in the first week of treatment (60% relative reduction, P = 0.025, 95% CI 0.2-0.9, from 10 micromol/l (4.7-17.6) to 3.5 micromol/l (1.4-7.5). Conclusion Ursodeoxycholic acid becomes the main component of the bile acid measurement after treatment. Enzymatic total bile acid assays are good predictors of both cholic acid and chenodeoxycholic acid, the primary bile acids that are raised prior to treatment. Tweetable abstract Ursodeoxycholic acid constitutes approximately 60% of the bile acid measurement and reduces pathological cholic acid in treated women.
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| 12. |
- Ban, L., et al.
(författare)
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Limited risks of major congenital anomalies in children of mothers with coeliac disease : a population-based cohort study
- 2015
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley-Blackwell. - 1470-0328 .- 1471-0528. ; 122:13, s. 1833-1841
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine major congenital anomaly (CA) risks in children of mothers with coeliac disease (CD) compared with mothers without CD.Design: Population-based cohort study.Setting: Linked maternal-child medical records from a large primary care database from the UK.Population: A total of 562332 live singletons of mothers with and without CD in 1990-2013.Methods: We calculated the absolute major CA risks in children whose mothers had CD, and whether this was diagnosed or undiagnosed before childbirth. Logistic regression with a generalised estimating equation was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) for CAs associated with CD.Main outcome measures: Fourteen system-specific major CA groups classified according to the European Surveillance of Congenital Anomalies and neural tube defects (NTDs).Results: Major CA risk in 1880 children of mothers with CD was 293 per 10000 liveborn singletons, similar to the risk in those without CD (282; aOR 0.98, 95% CI 0.74-1.30). The risk was slightly higher in 971 children, whose mothers were undiagnosed (350; aOR 1.14, 95% CI 0.79-1.64), than in 909 children whose mothers were diagnosed (231; aOR 0.80, 95% CI 0.52-1.24). There was a three-fold increase in nervous system anomalies in the children of mothers with undiagnosed CD (aOR 2.98, 95%CI 1.06-8.33, based on five exposed cases and one had an NTD), and these women were all diagnosed with CD at least 4years after their children were born.Conclusions: There was no statistically significant increase in risk of major CAs in children of mothers with coeliac disease overall, compared with the general population.
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| 13. |
- Betran, AP, et al.
(författare)
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WHO Statement on Caesarean Section Rates
- 2016
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 123:5, s. 667-670
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Tidskriftsartikel (refereegranskat)
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| 14. |
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| 15. |
- Gravensteen, Ida Kathrine, et al.
(författare)
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Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth : a prospective study
- 2018
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 125:2, s. 202-210
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate healthcare utilisation, induced labour and caesarean section (CS) in the pregnancy after stillbirth and assess anxiety and dread of childbirth as mediators for these outcomes.DESIGN: Population-based pregnancy cohort study.SETTING: The Norwegian Mother and Child Cohort Study.SAMPLE: 901 pregnant women; 174 pregnant after stillbirth, 362 pregnant after live birth and 365 previously nulliparous.METHODS: Data from questionnaires answered in the second and third trimesters of pregnancy and information from the Medical Birth Registry of Norway.MAIN OUTCOME MEASURES: Self-reported assessment of antenatal care, register-based assessment of onset and mode of delivery.RESULTS: Women with a previous stillbirth had more frequent antenatal visits (mean 10.0; 95% confidence interval [CI] 9.4 - 10.7) compared with women with a previous live birth (6.0; 5.8 - 6.2) and previously nulliparous women (6.3; 6.1 - 6.6). Induced labour and CS, elective and emergency, were also more prevalent in the stillbirth group. The adjusted odds ratio for elective CS was 2.5 (95% CI 1.3 - 5.0) compared with women with previous live birth and 3.7 (1.8 - 7.6) compared with previously nulliparous women. Anxiety was a minor mediator for the association between stillbirth and frequency of antenatal visits, while dread of childbirth was not a significant mediator for elective CS.CONCLUSIONS: Women pregnant after stillbirth were more ample users of healthcare services and had more often induced labour and CS. The higher frequency of antenatal visits and elective CS could not be accounted for by anxiety or dread of childbirth. This article is protected by copyright. All rights reserved.
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| 24. |
- Stephansson, O., et al.
(författare)
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Prolonged second stage of labour, maternal infectious disease, urinary retention and other complications in the early postpartum period
- 2016
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 123:4, s. 608-616
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo study the association between duration of second stage of labour and risks of maternal complications (infection, urinary retention, haematoma or ruptured sutures) in the early postpartum period. DesignPopulation-based cohort study. Setting and sampleWe included 72593 mothers with singleton vaginal deliveries at 37weeks of gestation in cephalic presentation, using the obstetric database from the Stockholm-Gotland region in Sweden, 2008-12. MethodsLogistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated and adjustments were made for maternal age, body mass index, height, smoking, cohabitation, gestational age, labour induction, epidural analgesia and oxytocin augmentation. ResultsRates of any complication varied by parity from 7.3% in parous women with previous caesarean section, 4.8% in primiparas and 1.7% in parous women with no previous caesarean section. Compared with a second stage <1hour, the adjusted ORs for any complication (95% CI) in primiparas were for 1 to <2hours 1.28 (1.11-1.47); 2 to <3hours 1.54 (1.32-1.79), 3 to <4hours 1.63 (1.38-1.93) and 4hours 2.08 (1.74-2.49). The corresponding adjusted ORs for parous women without previous caesarean were 2.27 (1.78-2.90), 2.97 (2.09-4.22), 3.65 (2.25-5.94) and 3.16 (1.44-6.94), respectively. The adjusted ORs for women with previous caesarean were for 1 to <2hours 1.62 (1.13-2.32); 2 to <3hours 1.56 (1.00-2.43), 3 to <4hours 2.42 (1.52-3.87), and 4hours 2.31 (1.25-4.24). ConclusionsRisks of maternal complications in the postpartum period increase with duration of second stage of labour also after accounting for maternal, pregnancy and delivery characteristics. Special attention has to be given to parous women with previous caesarean deliveries.
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| 25. |
- Sydsjö, Gunilla, et al.
(författare)
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Psychiatric illness in women requesting caesarean section
- 2015
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley: 12 months. - 1470-0328 .- 1471-0528. ; 122:3, s. 351-358
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare psychiatric in-and outpatient care during the 5 years before first delivery in primiparae delivered by caesarean section on maternal request with all other primiparae women who had given birth during the same time period. Design Prospective, population-based register study. Setting Sweden. Sample Women giving birth for the first time between 2002 and 2004 (n = 64 834). Methods Women giving birth by caesarean section on maternal request (n = 1009) were compared with all other women giving birth (n = 63 825). The exposure of interest was any psychiatric diagnosis according to the International Statistical Classification of Diseases and Related Health Problems (ninth revision, ICD-9, 290-319; tenth revision, ICD-10, F00-F99) in The Swedish national patient register during the 5 years before first delivery. Main outcome measures Psychiatric diagnoses and delivery data. Results The burden of psychiatric illnesses was significantly higher in women giving birth by caesarean section on maternal request (10 versus 3.5%, P less than 0.001). The most common diagnoses were ` Neurotic disorders, stress-related disorders and somatoform disorders (5.9%, aOR 3.1, 95% CI 1.1-2.9), and ` Mood disorders (3.4%, aOR 2.4, 95% CI 1.7-3.6). The adjusted odds ratio for caesarean section on maternal request was 2.5 (95% CI 2.0-3.2) for any psychiatric disorder. Women giving birth by caesarean section on maternal request were older, used tobacco more often, had a lower educational level, higher body mass index, were more often married, unemployed, and their parents were more often born outside of Scandinavia (P less than 0.05). Conclusions Women giving birth by caesarean section on maternal request more often have a severe psychiatric disease burden. This finding points to the need for psychological support for these women as well as the need to screen and treat psychiatric illness in pregnant women.
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| 30. |
- Bizjak, I., et al.
(författare)
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Efficacy and safety of very early medical termination of pregnancy: a cohort study
- 2017
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Ingår i: BJOG: An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 124:13, s. 1993-1999
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 Royal College of Obstetricians and Gynaecologists Objective: To assess the efficacy and safety of medical termination of pregnancy (MTOP) when no intrauterine pregnancy (IUP) is confirmed on ultrasound. Design: Retrospective case-note review. Setting: Two gynaecological clinics in Vienna, Austria, and Gothenburg, Sweden. Population: All women with gestations of ≤49days undergoing an MTOP during 2004–14 (Vienna) and 2012–15 (Gothenburg). Methods: Two study cohorts were created: women with and women without a confirmed IUP. An IUP was defined as the intrauterine location of a yolk sac or fetal structure visible by ultrasound. Women with an IUP were selected randomly and included in the IUP cohort. Main outcome measures: Efficacy of MTOP, defined as no continuing pregnancy and with no need of surgery for incomplete TOP. Results: After excluding 11 women diagnosed with an extra-uterine or molar pregnancy, 2643 cases were included in the final analysis; 1120 (98.2%) had a successful TOP in the no-IUP group, compared with 1458 (97.1%) in the IUP group, with a risk difference of 1.09% (95% confidence interval, 95%CI, −0.14, 2.32%; P=0.077). Significantly more women with confirmed IUP were diagnosed with incomplete TOP, and were treated with either surgery or additional medical treatment of misoprostol [64 (4.3%) versus 21 (1.8%); risk difference −2.42%; 95%CI −3.9, −1.1%; P < 0.001]. Conclusions: There was no difference between the groups in efficacy of MTOP, whereas early treatment resulted in significantly fewer interventions for incomplete TOP. The risk of ectopic pregnancy needs to be considered if treatment is initiated before an IUP is confirmed, but with structured clinical protocols the possibility of the early detection of an ectopic pregnancy in an asymptomatic phase may increase. Tweetable abstract: MTOP before confirmed intrauterine pregnancy is as effective as at later gestation with less incomplete TOP.
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| 34. |
- Carlander, C., et al.
(författare)
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Assessing cervical intraepithelial neoplasia as an indicator disease for HIV in a low endemic setting: a population-based register study
- 2017
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Ingår i: Bjog-an International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 124:11, s. 1680-1687
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To analyse whether the prevalence of undiagnosed HIV among (1) all women in Sweden and (2) migrant women, diagnosed with cervical intraepithelial neoplasia grade 2 or worse CIN2+ reaches the threshold of 0.1%, which has been suggested to be cost-effective for HIV testing. Design Population-based register study. Setting Counties of Stockholm and Gothenburg, Sweden, 1990-2014. Population All women, born between 1940 and 1990, with at least one cervical cytology or histology registered in the Swedish National Cervical Screening Register (NKCx). Methods Data were collected from the NKCx and the Swedish National HIV register. The proportion of women with undiagnosed HIV among women with CIN2+ compared with women with a normal/mildly abnormal cytology/histology was assessed. Results The proportion of undiagnosed HIV was higher among all women with CIN2+ than among those without CIN2+: 0.06% (95% CI 0.04-0.08) versus 0.04% (95% CI 0.04-0.04); P = 0.017). Among migrant women, the proportion of undiagnosed HIV was higher among those with CIN2+ than among those without [0.30% (95% CI 0.20-0.43) versus 0.08% (95% CI 0.07-0.10); P < 0.001] and exceeded 0.1%, suggesting the cost-effectiveness of HIV testing. Women with undiagnosed HIV at the time of CIN2+ had a significantly lower nadir CD4+ T-cell count, as a measure of immunosuppression, compared with women without CIN2+ before HIV diagnosis ( median nadir CD4, 95 cells/mm(3) versus 210 cells/mm(3); P < 0.01). Conclusions HIV testing should be performed in migrant women with unknown HIV status diagnosed with CIN2+.
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| 37. |
- Cluver, C. A., et al.
(författare)
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The association of prenatal alcohol exposure on the cognitive abilities and behaviour profiles of 4-year-old children: a prospective cohort study
- 2019
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Ingår i: Bjog-an International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 126:13, s. 1588-1597
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo examine the association of prenatal alcohol exposure (PAE) on cognitive abilities and behaviour profiles of 4-year-old children. DesignProspective cohort study. SettingCape Town, South Africa. PopulationA cohort of 500 children. MethodsChildren from the Safe Passage Study, which prospectively collected PAE, were included. Cognition and behavioural profiles were assessed. Children with and without PAE were compared. Mean scores were compared, with P <= 0.05 considered significant. Results were adjusted for confounding factors. Main outcome measuresThe Kaufman Assessment Battery for children measured intellectual and mental ability; the NEPSY-II instrument assessed neurocognitive performance. The caregiver completed the Preschool Child Behaviour checklist to rate the child's problem behaviours and competencies. ResultsTwo hundred children had no PAE, 117 children had mild to moderate PAE (with no binge episodes), 113 children had heavy PAE (with one or two binge episodes), and 70 children had very heavy PAE (with three or more binge episodes). Women who binge drank had significantly higher rates of smoking, marijuana use, and methamphetamine use. Low to moderate PAE had no effect on cognitive ability and behaviour. Very heavy PAE was associated with problems performing simultaneous as well as sequential functions, lower scores in the language and sensorimotor domain, and more attention and pervasive developmental problems. ConclusionsLow to moderate PAE was not associated with cognitive processing or developmental problems. Women who had many binge drinking episodes during pregnancy were the most at risk for cognitive processing, neurocognitive, and behaviour problems in their children at 4 years of age. Tweetable abstractLow to moderate prenatal alcohol use was not associated with cognitive or behavioural problems in 4-year-olds. Tweetable abstract Low to moderate prenatal alcohol use was not associated with cognitive or behavioural problems in 4-year-olds.
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| 38. |
- Dahlin, S., et al.
(författare)
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Maternal tobacco use and extremely premature birth - a population-based cohort study
- 2016
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 123:12, s. 1938-1946
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Tidskriftsartikel (refereegranskat)abstract
- Objective To study the associations of maternal tobacco use (smoking or use of snuff) and risk of extremely preterm birth, and if tobacco cessation before antenatal booking influences this risk. To study the association between tobacco use and spontaneous or medically indicated onset of delivery. Design Population-based cohort study. Setting Sweden. Population All live singleton births, registered in the Swedish Medical Birth Register, 1999-2012. Methods Odds ratios (OR) with 95% confidence intervals (CI) were calculated using multiple logistic regression analysis. Main outcome measures Extremely preterm birth (<28 weeks of gestation), very preterm birth (28-31 weeks), moderately preterm birth (32-36 weeks). Results Maternal snuff use (OR 1.58; 95% CI: 1.14-2.21) and smoking (OR 1.61; 95% CI: 1.39-1.87 and OR 1.91; 95% CI: 1.53-2.39 for moderate and heavy smoking, respectively) were associated with an increased risk of extremely preterm birth. When cessation of tobacco use was obtained there was no increased risk of preterm birth. Snuff use was associated with a twofold risk increase of medically indicated extremely preterm birth, whereas smoking was associated with increased risks of both medically indicated and spontaneous extremely preterm birth. Conclusions Snuff use and smoking in pregnancy were associated with increased risks of extremely preterm birth. Women who stopped using tobacco before the antenatal booking had no increased risk. These findings indicate that nicotine, the common substance in cigarettes and snuff, is involved in the mechanisms behind preterm birth. The use of nicotine should be minimized in pregnancy.
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| 39. |
- Darelius, A, et al.
(författare)
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Efficacy of salpingectomy at hysterectomy to reduce the risk of epithelial ovarian cancer: a systematic review.
- 2017
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Ingår i: BJOG : an international journal of obstetrics and gynaecology. - 1471-0528 .- 1471-0528. ; 124:6, s. 880-889
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Forskningsöversikt (refereegranskat)abstract
- It has been argued that salpingectomy would reduce the risk of epithelial ovarian cancer (EOC), based on the theory of the tube being the site of origin.To conduct a systematic review of 'salpingectomy' associated with ovarian cancer risk and 'salpingectomy with concomitant hysterectomy' on outcomes of complications including endocrine function.A comprehensive search was conducted in PubMed, Embase, and the Cochrane library.Original studies and systematic reviews were eligible.Each article was quality assessed. Data were extracted and, when possible, pooled in meta-analyses. The certainty of evidence across studies was evaluated using GRADE.Of 844 articles found, 11 were included. No study evaluated risk reduction for EOC after salpingectomy in conjunction with hysterectomy. Two retrospective studies reported a reduced ovarian cancer risk after indicated salpingectomy, compared with no surgery: adjusted hazard ratio 0.65 (95% confidence interval, 95% CI 0.52-0.81) and adjusted odds ratio 0.58 (95% CI 0.36-0.95). Complications did not differ between groups with or without salpingectomy, but were non-systematically reported. Ovarian endocrine function, measured with surrogate outcomes, did not differ at short-term follow-up in randomised or observational studies. The certainty of evidence was very low or low for all outcomes.There is currently insufficient evidence to state that opportunistic salpingectomy reduces the risk of EOC. The impact on long-term endocrine function is unknown. The heterogeneity in results and identified knowledge gaps stress the need for a prospective trial.Insufficient evidence for prophylactic removal of the fallopian tubes for risk reduction of ovarian cancer.
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| 40. |
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| 41. |
- Elvander, Charlotte, et al.
(författare)
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Mode of delivery and the probability of subsequent childbearing : a population-based register study
- 2015
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 122:12, s. 1593-1600
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the relationship between mode of first delivery and probability of subsequent childbearing.Design: Population-based study.Setting: Nationwide study in Sweden.Population: A cohort of 771 690 women who delivered their first singleton infant in Sweden between 1992 and 2010.Methods: Using Cox's proportional-hazards regression models, risks of subsequent childbearing were compared across four modes of delivery. Hazard ratios (HRs) were calculated, using 95% confidence intervals (95% CIs).Main outcome measures: Probability of having a second and third child; interpregnancy interval.Results: Compared with women who had a spontaneous vaginal first delivery, women who delivered by vacuum extraction were less likely to have a second pregnancy (HR 0.96, 95% CI 0.95–0.97), and the probabilities of a second childbirth were substantially lower among women with a previous emergency caesarean section (HR 0.85, 95% CI 0.84–0.86) or an elective caesarean section (HR 0.82, 95% CI 0.80–0.83). There were no clinically important differences in the median time between first and second pregnancy by mode of first delivery. Compared with women younger than 30 years of age, older women were more negatively affected by a vacuum extraction with respect to the probability of having a second child. A primary vacuum extraction decreased the probability of having a third child by 4%, but having two consecutive vacuum extraction deliveries did not further alter the probability.Conclusions: A first delivery by vacuum extraction does not reduce the probability of subsequent childbearing to the same extent as a first delivery by emergency or elective caesarean section.
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| 42. |
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| 43. |
- Endler, M., et al.
(författare)
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The inherited risk of retained placenta : a population based cohort study.
- 2018
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 125:6, s. 737-744
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate whether retained placenta in the first generation is associated with an increased risk of retained placenta in the second generation.Design: Population‐based cohort study.Setting: Sweden.Population: Using linked generational data from the Swedish Medical Birth Register 1973–2012, we identified 494 000 second‐generation births with information on the birth of the mother (first‐generation index birth). For 292 897 of these births there was information also on the birth of the father.Methods: Risk of retained placenta in the second generation was calculated as adjusted odds ratios (aOR) by unconditional logistic regression with 95% confidence intervals (95% CI) according to whether retained placenta occurred in a first generation birth or not.Main outcome: Retained placenta in the second generation.Results: The risk of retained placenta in a second‐generation birth was increased if retained placenta had occurred at the mother's own birth (aOR 1.66, 95% CI 1.52–1.82), at the birth of one of her siblings (aOR 1.58, 95% CI 1.43–1.76) or both (aOR 2.75, 95% CI 2.18–3.46). The risk was slightly increased if retained placenta had occurred at the birth of the father (aOR 1.23, 95% CI 1.07–1.41). For preterm births in both generations, the risk of retained placenta in the second generation was increased six‐fold if retained placenta had occurred at the mother's birth (OR 6.55, 95% CI 2.68–16.02).Conclusion: There is an intergenerational recurrence of retained placenta on the maternal and most likely also on the paternal side. The recurrence risk seems strongest in preterm pregnancies.Tweetable abstract: A population‐based cohort study suggests that there is an intergenerational recurrence of retained placenta.
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| 44. |
- Fobelets, M., et al.
(författare)
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Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section
- 2019
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Ingår i: BJOG: An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 126:8, s. 1043-1051
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To perform a health economic analysis of an intervention designed to increase rates of vaginal birth after caesarean, compared with usual care. Design: Economic analysis alongside the cluster-randomised OptiBIRTH trial (Optimising childbirth by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care). Setting: Fifteen maternity units in three European countries – Germany (five), Ireland (five), and Italy (five) – with relatively low VBAC rates. Population: Pregnant women with a history of one previous lower-segment caesarean section; sites were randomised (3:2) to intervention or control. Methods: A cost–utility analysis from both societal and health-services perspectives, using a decision tree. Main outcome measures: Costs and resource use per woman and infant were compared between the control and intervention group by country, from pregnancy recognition until 3months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental cost–utility ratios were calculated per country. Results: The mean difference in costs per quality-adjusted life years (QALYs) gained from a societal perspective between the intervention and the control group, using a probabilistic sensitivity analysis, was: €263 (95%CI €258–268) and 0.008QALYs (95%CI 0.008–0.009QALYs) for Germany, €456 (95%CI €448–464) and 0.052QALYs (95%CI 0.051–0.053QALYs) for Ireland, and €1174 (95%CI €1170–1178) and 0.006QALYs (95%CI 0.005–0.007 QALYs) for Italy. The incremental cost–utility ratios were €33,741/QALY for Germany, €8785/QALY for Ireland, and €214,318/QALY for Italy, with a 51% probability of being cost-effective for Germany, 92% for Ireland, and 15% for Italy. Conclusion: The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany. Tweetable abstract: The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland. © 2019 Royal College of Obstetricians and Gynaecologists
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| 45. |
- Fonnes, T., et al.
(författare)
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Asparaginase-like protein 1 expression in curettage independently predicts lymph node metastasis in endometrial carcinoma: a multicentre study
- 2018
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Ingår i: Bjog-an International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 125:13, s. 1695-1703
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Tidskriftsartikel (refereegranskat)abstract
- Objective Design Correct preoperative identification of high-risk patients is important to optimise surgical treatment and improve survival. We wanted to explore if asparaginase-like protein 1 (ASRGL1) expression in curettage could predict lymph node metastases and poor outcome, potentially improving preoperative risk stratification. Multicentre study. Setting Population Ten hospitals in Norway, Sweden and Belgium. Women diagnosed with endometrial carcinoma. Methods Main outcome measures ASRGL1 expression in curettage specimens from 1144 women was determined by immunohistochemistry. ASRGL1 status related to disease-specific survival, lymph node status, preoperative imaging parameters and clinicopathological data. Results Conclusions ASRGL1 expression had independent prognostic value in multivariate survival analyses, both in the whole patient population (hazard ratio (HR) 1.63, 95% CI 1.11-2.37, P = 0.012) and in the low-risk curettage histology subgroup (HR 2.54, 95% CI 1.44-4.47, P = 0.001). Lymph node metastases were more frequent in women with low expression of ASRGL1 compared with women with high ASRGL1 levels (23% versus 10%, P < 0.001), and low ASRGL1 level was found to independently predict lymph node metastases (odds ratio 2.07, 95% CI 1.27-3.38, P = 0.003). Low expression of ASRGL1 in curettage independently predicts lymph node metastases and poor disease-specific survival.
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| 46. |
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| 47. |
- Ginstman, Charlotte, et al.
(författare)
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Plasma concentrations of etonogestrel in women using oral desogestrel before and after Roux‐en‐Y gastric bypass surgery : a pharmacokinetic study
- 2019
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Ingår i: British Journal of Obstetrics and Gynecology. - : Blackwell Publishing. - 1470-0328 .- 1471-0528. ; 126:4, s. 486-492
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate whether Roux-en-Y gastric bypass (RYGB) affects oral desogestrel (etonogestrel) pharmacokinetics.Design: Single centre, open label, phase-2 pharmacokinetic study.Setting: University hospital of Linkoping, Sweden.Population: Fourteen women with planned RYGB surgery were included; nine women aged 18-45 years using 75 micrograms desogestrel completed the study.Methods: Steady-state etonogestrel pharmacokinetic (PK) parameters were measured on three occasions for each individual (at 8 6 weeks before surgery, and at 12 2 and 52 2 weeks after surgery). Each patient served as her own control. On each occasion, serum samples were collected during a 24-hour period and etonogestrel concentrations were determined with ultra-performance liquid chromatography/tandem mass spectrometry.Main outcome measures: Area under the plasma concentration time curve of etonogestrel (AUC(0-24 hours)).Results: All women had significant postoperative weight loss. There were no significant differences in AUC(0-24 hours), terminal half-lives (t(1/2)), time to peak serum concentrations (T-max), or apparent oral clearances of etonogestrel (CLoral) before and after gastric bypass surgery on any occasion. Peak serum concentrations (C-max) increased after 52 +/- 2 weeks compared with preoperative values (0.817 ng/ml versus 0.590 ng/ml, P = 0.024).Conclusion: To our knowledge, this is the first study to investigate the effects on desogestrel pharmacokinetics after RYGB. This study did not reveal any clinically significant changes in etonogestrel pharmacokinetics, suggesting that oral desogestrel may be used by women after RYGB surgery. The sample size was limited, however, and therefore the results should be interpreted cautiously.
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| 48. |
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| 49. |
- Hesselman, Susanne, 1973-, et al.
(författare)
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Abdominal adhesions in gynaecologic surgery after caesarean section : a longitudinal population-based register study.
- 2018
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 125:5, s. 597-603
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of the study was to evaluate the association between abdominal adhesions at the time of gynaecologic surgery and a history of caesarean delivery, and to investigate obstetric factors contributing to adhesion formation after caesarean section (CS).DESIGN: Longitudinal population-based register study.SETTING: Sweden.POPULATION: Women undergoing benign hysterectomy and/or adnexal surgery in Sweden, 2000-2014, with a previous delivery during 1973-2013 (n = 15 479).METHODS: Information about abdominal adhesions during gynaecological surgery, prior medical history, pregnancies and deliveries were retrieved from Swedish National Health and Quality registers.MAIN OUTCOME MEASURES: Adhesions.RESULTS: In women with previous CS, adhesions were present in 37%, compared with 10% of women with no previous CS [odds ratio (OR): 5.18, 95% confidence interval (CI): 4.70-5.71]. Adhesions increased with the number of caesarean sections: 32% after one CS; 42% after two CS and 59% after three or more CS (P < 0.001). Regardless of the number of CS, factors at CS such as age ≥35 years (aOR: 1.28, 95% CI: 1.05-1.55), body mass index (BMI) ≥30 [adjusted OR (aOR): 1.91, 95% CI: 1.49-2.45] and postpartum infection (aOR: 1.55, 95% CI: 1.05-2.30) increased the risk of adhesions.CONCLUSIONS: Presence of adhesions in abdominal gynaecological surgery is associated with women's personal history of caesarean delivery. The number of caesarean sections was the important predictor of adhesions; advanced age, obesity and postpartum infection further increased the incidence.TWEETABLE ABSTRACT: Repeat caesarean, age, obesity and infection increased the risk of pelvic adhesions after caesarean section.
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