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1.
  • Aardal Lönnerfors, Celine, et al. (författare)
  • Pregnancy following robot-assisted laparoscopic myomectomy in women with deep intramural myomas.
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90, s. 972-977
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To describe fecundity after robot-assisted laparoscopic myomectomy for deep intramural myomas. Design. Prospective observational study. Setting. University Hospital. Population. Women undergoing robot-assisted laparoscopic myomectomy. Methods. Expanding on a previous prospective feasibility study 31 consecutive women in whom a robot-assisted laparoscopic myomectomy was performed between April 2006 and July 2010 were included. The women, of which 14 had known infertility, were selected for having symptomatic, deep intramural myomas with a possible impact on fertility. Using a prospective protocol, relevant peri-operative and follow-up data were retrieved. Main Outcome Measures. Fertility and pregnancy outcome. Results. The 31 women included had a median age of 35 years (range 28-42 years) and median Body Mass Index of 22.0 kg/m(2) (range 20.1-24.7 kg/m(2) ). Fifteen of the 22 (68%) women with an active wish of conceiving have become pregnant at a median time of 10 months after surgery. A total of 18 pregnancies occurred resulting in three miscarriages, two terminated pregnancies, 10 successful term deliveries and three ongoing pregnancies. The subgroup of 14 women with a known but otherwise unexplained infertility had a similar pregnancy rate (69%) and of those, (55%) conceived naturally. The women who conceived naturally were on average eight years younger than the women becoming pregnant after IVF and all miscarriages occurred in an IVF pregnancy. Conclusions. In women with symptomatic, deep intramural myomas and either otherwise unexplained infertility or myomas with possible effect on conception the pregnancy rate following robot-assisted laparoscopic myomectomy was 68%.
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3.
  • Amer-Wåhlin, I, et al. (författare)
  • Swedish randomized controlled trial of cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram revisited : analysis of data according to standard versus modified intention-to-treat principle.
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons Ltd.. - 0001-6349 .- 1600-0412. ; 90:9, s. 990-996
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To undertake a renewed analysis of data from the previously published Swedish randomized controlled trial on intrapartum fetal monitoring with cardiotocography (CTG-only) vs. CTG plus ST analysis of fetal electrocardiogram (CTG+ST), using current standards of intention-to-treat (ITT) analysis and to compare the results with those of the modified ITT (mITT) and per protocol analyses. METHODS: Renewed extraction of data from the original database including all cases randomized according to primary case allocation (n=5 049). MAIN OUTCOME MEASURE: Metabolic acidosis in umbilical artery at birth (pH <7.05, base deficit in extracellular fluid >12.0 mmol/l) including samples of umbilical vein blood or neonatal blood if umbilical artery blood was missing. RESULTS: The metabolic acidosis rates were 0.66% (17 of 2 565) and 1.33% (33 of 2 484) in the CTG+ST and CTG-only groups, respectively [relative risk (RR) 0.50; 95% confidence interval (CI) 0.28-0.88; p=0.019]. The original mITT gave RR 0.47, 95%CI 0.25-0.86 (p=0.015), mITT with correction for 10 previously misclassified cases RR 0.48, 95%CI 0.24-0.96 (p=0.038) and per protocol analysis RR 0.40, 95%CI 0.20-0.80 (p=0.009). The level of significance of the difference in metabolic acidosis rates between the two groups remained unchanged in all analyses. CONCLUSION: Re-analysis of data according to the ITT principle showed that regardless of the method of analysis, the Swedish randomized controlled trial maintained its ability to demonstrate a significant reduction in metabolic acidosis rate when using CTG+ST analysis for fetal surveillance in labor.
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4.
  • Anderberg, Eva, et al. (författare)
  • Prevalence of impaired glucose tolerance and diabetes after gestational diabetes mellitus comparing different cut-off criteria for abnormal glucose tolerance during pregnancy.
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90, s. 1252-1258
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To determine the prevalence of diabetes and impaired glucose tolerance after gestational diabetes mellitus in relation to different categories of glucose tolerance during pregnancy. Design. Prospective study. Setting. Four delivery departments and three hospitals in southern Sweden took part in recruitment and follow-up. Population. Women undergoing a 75 g oral glucose tolerance test during pregnancy delivering in 2003-2005. Methods. At first follow-up, 1-2 years after delivery, 29% of eligible women with abnormal glucose tolerance during pregnancy had an oral glucose tolerance test; 160 with gestational diabetes, 309 with gestational impaired glucose tolerance, in addition to 167 control women. Cut-off levels defining gestational diabetes and impaired glucose tolerance were 2-hour capillary blood glucose levels 9.0 and 7.8 mmol/l or plasma glucose 10.0 and 8.6 mmol/l, respectively. Main outcome measures. Frequency of abnormal test results at follow-up. Results: Diabetes was diagnosed in 11% and impaired glucose tolerance in 24% of women with gestational diabetes vs. 4% and 23% in those with gestational impaired glucose tolerance. Combining women with abnormal test results during pregnancy revealed diabetes or impaired glucose tolerance in 29% as compared to 10% among controls; the odds ratio (95% confidence interval) for having abnormal test results was 3.3 (1.8-5.9) in a multivariate logistic regression analysis. Conclusions: Lowering the cut-off level for gestational diabetes to also include the category of impaired glucose tolerance would identify a high percentage of women with diabetes and impaired glucose tolerance postpartum, they constitute target groups for intervention and/or diabetes prevention.
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5.
  • Erlandsson, Kerstin, et al. (författare)
  • Women's' premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell.
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:1, s. 28-33
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To identify if mothers to stillborn babies had had a premonition that their unborn child might not be well and how they dealt with that premonition. Design. A mixed method approach. Setting: 1 034 women answered a web questionnaire. Sample: 614 women fulfilled the inclusion criteria of having a stillbirth after the 22(nd) gestational week and answered questions about premonition. Methods. Qualitative content analysis was used for the open questions and descriptive statistics for questions with fixed alternatives. Main Outcome.Measure: The premonition of an unwell unborn baby. Results. In all 392/614 (64%) of the women had had a premonition that their unborn baby might be unwell; 274/614 (70%) contacted their clinic and were invited to come in for a check-up, but by then it was too late as the baby was already dead. A further 88/614 (22%) decided to wait until their next routine check-up, believing that the symptoms were part of the normal cycle of pregnancy, and that the fetus would move less towards the end of a pregnancy. Thirty women (8%) contacted their clinic, but were told that everything appeared normal without an examination of the baby. Conclusion. Women need to know that a decrease in fetal movements is an important indicator of their unborn baby´s health. Health care professionals should not delay an examination if a mother-to-be is worried of her unborn baby´s wellbeing.
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6.
  • Finnström, Orvar, et al. (författare)
  • Maternal and child outcome after in-vitro fertilization-a review of 25 years population based data from Sweden.
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90:5, s. 494-500
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To summarize data on deliveries after IVF performed in Sweden up to 2006. Design. Cohort study of women and children, conceived after IVF with comparisons of deliveries after IVF before and after April 1, 2001. Setting. Study based on Swedish health registers. Population. Births registered in the Swedish Medical Birth Register with information on IVF from all IVF clinics in Sweden. Methods. Results from the second study period are summarized and outcomes between the two periods are compared. Long term follow-up is based on data from both periods. Main outcome measures. Maternal and perinatal outcomes, long term sequels. Results. Some maternal pregnancy complications decreased in rate, notably preeclampsia and PROM. The rate of multiple births and preterm births decreased dramatically with a better neonatal outcome, including neonatal mortality. No difference in outcome existed between IVF and ICSI or between the use of fresh and cryopreserved embryos, but children born after blastocyst transfer had a slightly higher risk for preterm birth and congenital malformations than children born after cleavage stage transfer. An increased risk for cerebral palsy, possibly for attention deficit and hyperactivity disorder, for impaired visual acuity, and for childhood cancer was noted but these outcomes were rare also after IVF. An increased risk for asthma was demonstrated. No effect on maternal cancer risk was seen. Conclusions. A marked decrease in multiple births was the main reason for better pregnancy and neonatal outcome and may also have a beneficial effect on long-term results, notably cerebral palsy.
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7.
  • Fu, Jing, et al. (författare)
  • Relations between fetal brain-sparing circulation, oxytocin challenge test, mode of delivery and fetal outcome in growth-restricted term fetuses.
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90:3, s. 227-230
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The study was designed as a prospective non-interventional, observational study to elucidate the potential value of fetal middle cerebral artery Doppler velocimetry to identify brain-sparing flow in a surveillance program for suspected intrauterine growth restriction (IUGR). Material and methods. The study was carried out at Skåne University Hospital, Malmö, Sweden. One hundred and twenty-six single pregnancies suspected of IUGR at ≥36 gestational weeks were assessed. The main outcome measures were positive/negative oxytocin challenge test (OCT) and cesarean/vaginal delivery. The pregnancies were managed with ultrasound fetometry, uterine and umbilical artery Doppler flow velocimetry, nonstress test, and an OCT to decide the optimal time and mode of delivery. Cases with a positive OCT were promptly delivered by cesarean section, whereas negative cases were allowed a trial of labor. Middle cerebral artery Doppler flow velocimetry results were blinded to the managing obstetricians. Brain-sparing flow was defined as a middle cerebral artery-to-umbilical artery pulsatility index ratio of <1.08. Nonparametric statistics with significance set at p < 0.05 were used, and Cohen's kappa coefficient was calculated for congruence of brain-sparing flow with OCT and mode of delivery, respectively. Results. The positive predictive value and sensitivity figures of brain-sparing flow to indicate a positive OCT and cesarean delivery were 33-63%. The inter-rater reliability of brain-sparing flow vs. positive OCT showed a kappa coefficient of 0.19, and brain-sparing flow vs. cesarean section among OCT-negative cases a kappa coefficient of 0.23. Conclusion. Fetal brain-sparing flow is a poor predictor of a positive OCT, and of cesarean section in OCT-negative cases.
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8.
  • Gemzell-Danielsson, Kristina, et al. (författare)
  • Comprehensive counseling about combined hormonal contraceptives changes the choice of contraceptive methods : results of the CHOICE program in Sweden
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:8, s. 869-877
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To study the influence of counseling on women's contraceptive decisions. Design. A cross-sectional multicenter study. Setting. Seventy Swedish family planning clinics. Population. Women aged 15-40 years attending for a contraceptive consultation who expressed interest in a combined hormonal contraceptive (CHC) method. Methods. Structured counseling about three CHCs and questionnaires completed after counseling from the healthcare professional. Main Outcome Measures. Method originally requested, perceptions of CHC attributes, method chosen and reasons for the choice. Results. In all, 173 healthcare professionals and 1 944 women participated. The mean standard deviation (SD) age of the women was 22.6(6.1) years. After structured counseling, a majority of women (56.0%; n=1 069; 95% confidence interval (CI) 53.1-58.9) chose the daily pill, 6.2% (n=118; 95% CI 4.9-7.8) chose the weekly patch, and 22.5% ( n=430; 95% CI 20.2-25.1) chose the monthly ring. The weekly patch was chosen more often after counseling (6.2 vs 2.4% before counseling; p<0.0001). The greatest change was in the proportion of women who chose the contraceptive ring after counseling (22.5% vs. 8.5% before counseling; p<0.0001). The proportion of undecided women after counseling was reduced considerably (3.9% vs. 27.8% before counseling). Among the 523 women who were undecided before counseling, 50.6% chose the pill, 10.2% the patch and 24.6% the ring, while 20.9% of women who initially requested the pill changed to another method. Conclusions. Structured counseling facilitated choice of contraceptive method for most women, leading to changes in women's selection of a CHC method.
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9.
  • Geppert, Barbara, et al. (författare)
  • Robot-assisted laparoscopic hysterectomy in obese and morbidly obese women: surgical technique and comparison with open surgery.
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90, s. 1210-1217
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. Comparison of surgical results on obese patients undergoing hysterectomy by robot-assisted laparoscopy or laparotomy. Setting. University hospital. Methods. All women (n=114) with a BMI ≥30 kg/m(2) who underwent a simple hysterectomy as the main surgical procedure between November 2005 and November 2009 were identified. Robot-assisted procedures (n=50) were separated into an early (learning phase) and a late (consolidated phase) group; open hysterectomy was considered an established method. Relevant data was retrieved from prospective protocols (robot) or from computerized patient charts (laparotomy) until 12 months after surgery. Complications leading to prolonged hospital stay, readmission/reoperation, intravenous antibiotic treatment or blood transfusion were considered significant. The surgical technique used for morbidly obese patients is described. Results. Women in the late robot group (n=25) had shorter inpatient time (1.6 compared to 3.8 days, p<0.0001), less bleeding (100 compared to 300 mL, p<0.0001) and fewer complications (2/25 compared to 23/64, p=0.006) than women with open surgery (n=64) but a longer operating time (136 compared to 110 minutes, p=0.0004). For women with a BMI ≥35 kg/m(2) , surgical time in the late robot group and the laparotomy group was equal (136 compared to 128 minutes, p=0.31). Conclusions. Robot-assisted laparoscopic hysterectomy in a consolidated phase in obese women is associated with shorter hospital stay, less bleeding and fewer complications compared to laparotomy but, apart from women with BMI ≥35, a longer operative time.
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10.
  • Grunewald, Charlotta, et al. (författare)
  • Significant effects on neonatal morbidity and mortality after regional change in management of post-term pregnancy
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:1, s. 26-32
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To evaluate the effects on neonatal morbidity of a regional change in induction policy for post-term pregnancy from 43(+0) to 42(+0) gestational weeks (GWs). Design and setting. Nationwide retrospective register study between 2000 and 2007. Population. All singleton pregnancies with a gestational age of >41(+2) GW (n= 119,198). Methods. All Swedish counties were divided into three groups where study group allocation was designated by the proportion of pregnancies >42(+2) GW among all pregnancies of >41(+2) GW. Stockholm county formed a separate group. Main outcome measures. Perinatal morbidity. Results. In counties with the most active management, 19% of pregnancies >41(+2) GW were delivered at >42(+2) GW during 2000-2004 compared to 7.1% in 2005-2007. In the least active counties, corresponding figures were 21.0% compared to 19.4%. During 2005-2007, the odds ratios for meconium aspiration and 5-minute Apgar score of ≤6 in the least compared to most active counties, were 1.55 (95% CI: 1.03-2.33) and 1.26 (95% CI: 1.06-1.51). In Stockholm >42(+2) GW seen among pregnancies of >41(+2) decreased from 21.0% in 2000-2004 to 5.9% in 2005-2007. Reduced perinatal death risks by 48%, meconium aspiration of 51% and low Apgar scores by 31% in 2005-2007 compared with 2000-2004 were observed. Rates of operative deliveries at >41(+2) GW in Stockholm were unaltered. Conclusion. A significant reduction in perinatal morbidity was found, with no influence on operative delivery rates for post-term pregnancy in Stockholm. We advocate a nationwide change toward more active management of post-term pregnancies.
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11.
  • Lindell, Gun, et al. (författare)
  • Ultrasound weight estimation of large fetuses.
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:10, s. 1218-1225
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To compare the accuracy of fetal weight estimation in large fetuses using four ultrasound formulas. Design: Prospective comparative study. Setting: University Hospital, Lund, Sweden. Population: Large-for-gestational age fetuses (n = 114) at a routine ultrasound examination in the third trimester. Methods: Persson & Weldner two-dimensional formula was compared with Hart et al. two-dimensional formula incorporating maternal weight, and Lee et al. and Lindell & Maršál three-dimensional formulas. The formulas are based on two-dimensional measurements of fetal head, abdomen, and femur, and three-dimensional volumetry of fetal abdomen and thigh. Main outcome measure: Accuracy in detection of fetuses with birth weight >4 000 g and >4 500 g. Results: For fetuses >4 000 g, Lindell & Maršál three-dimensional formula showed significantly smaller mean absolute percentage error than Persson & Weldner two-dimensional, and Lee et al. three-dimensional formulas (p = 0.04 and p < 0.001, respectively). No significant difference between Lindell & Maršál three-dimensional and Hart et al. two-dimensional formulas was found. Receiver operating characteristic curve showed higher detection rate for fetuses with birth weight >4 500 g using three-dimensional compared to two-dimensional technique. The best performance in detecting fetuses with birth weight >4 500 g showed Lindell & Maršál three-dimensional formula: for estimated fetal weight >4 300 g the detection rate was 93% and false positive rate 38%. Conclusion: The ability to detect macrosomic fetuses in a preselected high-risk group was higher using the fetal weight estimation with a three-dimensional compared to a two-dimensional ultrasound technique, with or without maternal weight included.
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12.
  • Mokarami, Parisa, et al. (författare)
  • An overlooked aspect on metabolic acidosis at birth: blood gas analyzers calculate base deficit differently.
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:5, s. 574-579
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Metabolic acidosis (MA) at birth is commonly defined as umbilical cord arterial pH <7.0 plus base deficit (BD) ≥12.0 mmol/L. BD is not a measured entity but calculated from pH and pCO(2) values, with the hemoglobin (Hb) concentration included in the calculation algorithm as a fixed or actual value. Various blood gas analyzers use different algorithms, indicating variations in the MA diagnosis. Objective. To calculate the prevalence of MA in blood and extracellular fluid (ecf) with algorithms from three blood gas analyzer brands relative to the Clinical and Laboratory Standards Institute (CLSI) algorithm. Design: Comparative study. Setting. University hospital. Sample. Arterial cord blood from 15354 newborns. Main outcome measure. Prevalence of MA. Methods. Blood was analyzed in a Radiometer ABL 735 analyzer. BD was calculated post hoc with algorithms from CLSI and Corning and Roche blood gas analyzers, and with actual and fixed (9.3 mmol/L) Hb values. Results: The prevalence of BD ≥12.0 mmol/L in blood was with the CLSI algorithm 1.97%, Radiometer 5.18%, Corning 3.84%, and Roche 3.29% (CLSI vs other; McNemar test, P <0.000001). Similarly, MA prevalences were 0.58%, 0.66%, 0.64% and 0.64% (P≤0.02). BD ≥12.0 and MA rates were lower in ecf than in blood (P≤0.002). Algorithms with actual or fixed Hb concentration made no differences in MA rates (P≥0.1). Conclusion. The neonatal metabolic acidosis rate varied significantly with blood gas analyzer brand and fetal fluid compartment for calculation of BD.
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13.
  • Olofsson, Per, et al. (författare)
  • How mathematics warp biology: round-off of umbilical cord blood gas case value decimals distorts calculation of metabolic acidosis at birth.
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91, s. 39-43
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To illustrate the impact on settling neonatal metabolic acidosis diagnosis by rounding off pH and base deficit (BD) case value decimals. Design. Comparative study. Setting. University maternity units. Sample. Umbilical cord arterial blood gas values from 18 831 newborns. Main outcome measures. Prevalences of pH <7.05 and metabolic acidosis diagnosis (pH <7.05 plus BD >12.0 mmol/L). Methods. Calculation of BD from pH and pCO(2) values, and calculating the prevalences of metabolic acidosis before and after rounding off three-decimal values to two or one decimals. The 'round to half even' and 'round half up' round-off rules were used for digit 5. Results. Arterial pH was ≤7.049 in 339 newborns (1.8%). In 27 (8.0%) pH was 7.045-7.049, rounded off to 7.05 when truncated to two decimals (crude vs. round-off values; McNemar´s test, p<0.000001). Depending on round-offs of pH case value decimals before or after calculation of BD, and round-offs of resulting three-decimal BD values to one decimal, metabolic acidosis 'disappeared' or 'appeared' in eight of totally 75 metabolic acidosis cases (10.7%). With different modes of calculation, the number of metabolic acidosis cases varied between 75 and 71 cases (p≥0.1). Conclusion. Due to pH and BD case value decimal round-offs, a diagnostic discrepancy of acidotic pH values occurred in 8%, and of metabolic acidosis diagnosis in 10.7% of cases. A drift of a dichotomy parameter value cut-off due to decimal round-offs will result in a shift in distribution of positive and negative cases in a population sample.
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14.
  • Stafne, Signe N., et al. (författare)
  • Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:5, s. 552-559
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To study lumbopelvic pain in women randomized to a regular exercise program during pregnancy in comparison to women receiving standard antenatal care. Design. A two-armed, two-center, randomized controlled trial. Setting. St Olavs Hospital, Trondheim University Hospital and Stavanger University Hospital. Population. A total of 855 pregnant women were randomized to intervention or control groups. Methods. The intervention was a 12 week exercise program, including aerobic and strengthening exercises, conducted between 20 and 36 weeks of pregnancy. One weekly group session was led by physiotherapists, and home exercises were encouraged twice a week. The control group received standard antenatal care. Main outcome measures. Self-reports of lumbopelvic pain and sick leave due to lumbopelvic pain. The data were analysed according to the intention-to-treat principle. Results. There were no significant differences between groups of women reporting lumbopelvic pain at 36 weeks (74 vs. 75%, p=0.76). The proportion of women on sick leave due to lumbopelvic pain was lower in the intervention group (22% vs 31%, p=0.01). Conclusions. Exercise during pregnancy does not influence the prevalence of lumbopelvic pain, but women offered a regular exercise course seem to handle the disorder better.
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15.
  • Stuart, Andrea, et al. (författare)
  • Association between 5 min Apgar scores and planned mode of delivery in diabetic pregnancies.
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90:4, s. 325-331
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. Due to the high incidence of neonatal complications in diabetic pregnancies, the aim of our study was to investigate whether elective cesarean section could prevent adverse neonatal outcome. Design. Population-based study. Setting. Data were extracted from the Swedish Medical Birth Registry. Population. All women (n=13 491) with diabetic pregnancies during the period 1990-2007. Methods. Neonatal outcome in diabetic pregnancies was compared after elective cesarean section at 38 completed gestational weeks with planned vaginal delivery at 39 completed weeks of gestation or later. Odds ratios with 95% confidence intervals for Apgar scores <7 at 5 min after birth were calculated using multiple logistic regression. Main Outcome Measures. Apgar score <7 at 5 min after birth. Results. A significantly decreased risk of Apgar score <7 at 5 min after birth in the group who underwent an elective cesarean section at 38 completed gestational weeks was found compared with those who continued pregnancy to 39 completed weeks of gestation or more, irrespective of final mode of delivery. Conclusions. Our results indicate a protective effect of planned cesarean section on the risk of low Apgar scores in diabetic pregnancies.
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16.
  • Teleman, Pia, et al. (författare)
  • Validation of the Swedish short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic floor distress inventory (PFDI-20) and Pelvic organ prolapse/Urinary incontinence sexual questionnaire (PISQ-12).
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90, s. 483-487
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To psychometrically evaluate the Swedish translations of the short forms of the Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20) and Pelvic organ prolapse/Urinary incontinence Sexual questionnaire (PISQ-12). Design and setting. University hospital. Sample. Forty-four patients awaiting prolapse surgery. Methods. The dual panel translation method followed by an evaluation of validity and reliability in prolapse patients. Main outcome measures. Construct, convergent and discriminant validity, reliability via test-retest and internal consistency. Results. Item response rates were high (range: 95.5-100%) for PFIQ-7 and PFDI-20. The corrected item-total correlations showed acceptable construct validity for PFIQ-7 (r= 0.338-0.826) but low for PFDI-20 (r= 0.116-0.581) and PISQ-12 (r= 0.024-0.735). Acceptable convergent validity was found in all three instruments with a negative correlation with the SF-12. There were no floor- or ceiling effects in the three instruments. In the test-retest analysis intraclass correlation coefficients (ICC) were significant (r= 0.888 - 0.943). Cronbach´s alpha varied between 0.57 and 0.94. Conclusion. This is the first validated translation of the PFIQ-7, PFDI-20 and PISQ-12 in Swedish. All three instruments indicated acceptable psychometric properties.
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17.
  • Torkildsen, Erik A, et al. (författare)
  • Predictive value of ultrasound assessed fetal head position in primiparous women with prolonged first stage of labor.
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:11, s. 1300-1305
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To examine how well ultrasound assessed occipitoposterior (OP) position or high sagittal (HS) position in primiparous women with a prolonged first stage of labor predicts a vaginal delivery and the duration of labor. Design: Prospective observational study. Setting. Stavanger University Hospital, a secondary referral center in Norway. Population. 105 primiparous women with prolonged first stage of labor. Methods. Ultrasound assessment of fetal head position. Main outcome measures. Vaginal delivery vs. cesarean section and duration of labor. Results: Twenty-five fetuses (24%) were delivered with cesarean section (CS), 45 (43%) had operative vaginal delivery and 35 (33%) delivered spontaneously. Eleven (27%) of 41 fetuses in OP position at the time of inclusion were born in OP position. Ten (24%) of the 41 fetuses in OP position at inclusion were delivered with CS compared to 15/64 (23%) fetuses in other positions (p = 0.91). Twenty-eight fetuses were in sagittal position and 12 in HS position, assessed with ultrasound at the time of diagnosed prolonged labor. Seven (58%) of 12 in HS position delivered vaginally and five (42%) had a CS (p = 0.89). Time from inclusion to labor was not significant longer neither for fetuses in OP compared to non-OP positions nor for fetuses in HS compared to non-HS positions. Conclusions: Most fetuses in OP or HS positions in the first stage of labor will rotate spontaneously and have a high probability of being delivered vaginally.
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18.
  • Wangel, Anne-Marie, et al. (författare)
  • Emergency cesarean sections can be predicted by markers for stress, worry and sleep disturbances in first-time mothers
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 90:3, s. 238-244
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract Objective: To identify predictors as free-text markers for mental ill-health from an electronic perinatal record (EMR) system and the association for emergency cesarean section (CS) in nulliparous women. Design: Population-based study using an EMR system. Setting: The catchment area of Malmö University Hospital in Sweden. Population: 6 467 women with complete perinatal electronic records (EMR) were selected of 10 662 nulliparous women presenting with a singleton cephalic baby for vaginal delivery between 2001 and 2006. Methods: Free-text search of markers for mental ill-health and multivariate logistic regression. Main Outcome Measures: Eleven markers for mental ill-health were tested with Cohen’s kappa for agreement and used as exposure variables. Odds ratios (OR) with 95% confidence interval (CI) were calculated for emergency CS, and adjusted for maternal age, diabetes, epidural anesthesia, and gestational weeks <37 and >41 by a multivariate logistic regression model with vaginal delivery as the reference. Results: Three markers identified from the EMR system reached statistically significant associations with an increased risk for emergency CS in nulliparous women: stress adjusted OR 1.66 (95% CI 1.34–2.06), sleep adjusted OR 1.57 (1.14–2.16), and worry adjusted OR 1.41 (1.10–1.79). Conclusions: Free-text words in medical records, indicating stress, sleep disturbances, or worry predicted increased adjusted OR for emergency CS in first-time mothers. Recognizing pregnant women’s reporting of their mental health status could have a predictive bearing on delivery outcomes.
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19.
  • Pakbaz, Mojgan, 1962-, et al. (författare)
  • Vaginal prolapse : perceptions and healthcare-seeking behaviour among women prior to gynecological surgery
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 90:10, s. 1115-1120
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To investigate perceptions of vaginal prolapse and healthcare-seeking behavior in women prior to gynecological surgery. Design. Prospective, cross-sectional study using a web-based questionnaire. Setting. Clinics including patients in the Swedish National Register for Gynecological Surgery (Gynop-register). Population. 214 women with vaginal prolapse and 347 women without prolapse as reference patients. Methods. A questionnaire was developed for assessment of women's perception of prolapse and their healthcare-seeking behavior. Data were collected through the Gynop-register. For comparisons between the study groups, Student's t-test and the chi-squared test were used. Main outcome measures. Perceptions of prolapse, healthcare-seeking behavior, and source of information. Results. The most common definition of prolapse reported by the women was presence of a vaginal bulge. Reasons for seeking healthcare were interference with physical activity and increasing symptoms. One in five women with prolapse could not relate the symptoms to prolapse. Participants in the prolapse group gained less information on their own condition from brochures and public media compared to participants in the reference group ( p<0.001). Conclusion. There appeared to be a lack of information on pelvic organ prolapse in the public domain. Healthcare professionals have a significant role to play in informing women about symptoms related to the condition and the available treatment options. [ABSTRACT FROM AUTHOR]
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20.
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21.
  • Höglund, Berit, 1955-, et al. (författare)
  • Newborns of mothers with intellectual disability have a higher risk of perinatal death and being small-for-gestational age
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:12, s. 1409-1414
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective.To study mode of birth, perinatal health and death in children born to mothers with intellectual disability (ID) in Sweden.Design. Population based register study.Setting. National registers; the National Patient Register linked to the Medical Birth Register.Sample. Children of first-time mothers with ID (n = 326) (classified in the ICD 8–10) were identified and compared to 340 624 children of first-time mothers without ID or any other psychiatric diagnosis during 1999 and 2007.Methods. Population-based data were extracted from the National Patient Register and the Medical Birth Register.Main Outcome Measures. Mode of birth, preterm birth, small-for-gestational age, Apgar score, stillbirth and perinatal death.Results. Children born to mothers with ID were more often stillborn (1.2% vs. 0.3%) or died perinatally (1.8% vs. 0.4%) than children born to mothers without ID. They had a higher proportion of cesarean section birth (24.5% vs. 17.7%), preterm birth (12.2% vs. 6.1%), were small-for-gestational age (8.4% vs. 3.1%) and had lower Apgar scores <7 points at 5 minutes (3.7% vs 1.5%), compared to children born to mother without ID. Logistic regression adjusted for maternal characteristics confirmed an increased risk of small-for-gestational age (odds ratio 2.25), stillbirth (odds ratio 4.53) and perinatal death (odds ratio 4.25) in children born to mothers with ID.Conclusions. Unborn and newborn children of mothers with ID should be considered a risk group, and their mothers may need better individual-based care and support.
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22.
  • Höglund, Berit, 1955-, et al. (författare)
  • Pregnancy and birth outcomes of women with intellectual disability in Sweden : a national register study between 1999 and 2007
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:12, s. 1381-1387
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To investigate the antenatal health and demographic factors as well as pregnancy and delivery outcomes in women with intellectual disability (ID) in Sweden.Design. A population-based register study.Setting. The National Patient Register (NPR) linked to the Medical Birth Register (MBR). Sample. Women with ID classified as International Classification of Diseases (ICD) 8–10 who gave birth in 1999–2007 (n = 326), identified from the NPR linked to the MBR, were compared with all first-time, singleton mothers without ID or any other psychiatric diagnoses during this period in Sweden (n = 340 624).Methods. Population-based data were extracted from the NPR and the MBR.Main outcome measures. Health and socio-demography at first antenatal visit, mode of delivery, pain relief during labor, preterm birth and discharge from hospital.Results. A higher proportion of women with ID were teenagers (18.4 vs. 3.3%), obese (20.1 vs. 8.6%) and single (36.6 vs. 6.2%) compared with women without ID, and women with ID smoked more often (27.9 vs. 7.9%). Women with ID had more often a preterm birth (12.2 vs. 6.1%), a cesarean section (CS) (24.5 vs. 17.7%) and used less nitrous oxide as pain relief during labor (59.5 vs. 75.8%). Women with ID had a higher risk for preterm birth [odds ratio (OR) 1.68], CS (OR1.55), non-use of nitrous oxide (OR 1.89) and discharge from hospital to a place other than home (OR 2.24). Conclusion. Pregnant women with ID should be considered a risk group suggesting that better tailored pre- and intrapartum care and support are needed for these women.
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23.
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24.
  • Borendal Wodlin, Ninnie, et al. (författare)
  • Health-related quality of life and postoperative recovery in fast-track hysterectomy
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare. - 0001-6349 .- 1600-0412. ; 90:4, s. 362-368
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To determine whether health-related quality of life (HRQoL) and postoperative recovery of women who undergo abdominal hysterectomy in a fast-track program under general anesthesia (GA) differ from women who receive spinal anesthesia with intrathecal morphine (SA). Design. Secondary analysis from an open randomized controlled multicenter study. Setting. Five hospitals in south-east Sweden. Population. One hundred and eighty women admitted for abdominal hysterectomy for benign disease were randomized; 162 completed the study, 80 with GA and 82 with SA. Methods. The HRQoL was measured preoperatively using the EuroQoL EQ-5D and the Short-Form-36 health survey (SF-36) questionnaires. The EQ-5D was used daily for 1 week; thereafter, once weekly for 4 weeks and again 6 months after operation. The SF-36 was completed at 5 weeks and 6 months. Dates of commencing and ending sick leave were registered. Main Outcome Measures. Changes in HRQoL; duration of sick leave. Results. The HRQoL improved significantly faster in women after SA than after GA. Sick leave was significantly shorter after SA than after GA (median 22.5 vs. 28 days). Recovery of HRQoL and duration of sick leave were negatively influenced by postoperative complications. In particular, the mental component of HRQoL was negatively affected by minor complications, even 6 months after the operation. Conclusions. Spinal anesthesia with intrathecal morphine provided substantial advantages in fast-track abdominal hysterectomy for benign gynecological disorders by providing faster recovery and shorter sick leave compared with general anesthesia.
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25.
  • Borendal Wodlin, Ninnie, et al. (författare)
  • Mode of anesthesia and postoperative symptoms following abdominal hysterectomy in a fast-track setting
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare. - 0001-6349 .- 1600-0412. ; 90:4, s. 369-379
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To determine whether postoperative symptoms differ between women who undergo abdominal benign hysterectomy in a fast-track model under general anesthesia or spinal anesthesia with intrathecal morphine. Design. Secondary analysis from a randomized, open, multicenter study. Setting. Five hospitals in south-east Sweden. Population. One-hundred and eighty women scheduled for benign hysterectomy were randomized; 162 completed the study; 82 were allocated to spinal and 80 to general anesthesia. Methods. The Swedish Postoperative Symptoms Questionnaire, completed daily for 1 week and thereafter once a week until 5 weeks postoperatively. Main Outcome Measures. Occurrence, intensity and duration of postoperative symptoms. Results. Women who had hysterectomy under spinal anesthesia with intrathecal morphine experienced significantly less discomfort postoperatively compared with those who had the operation under general anesthesia. Spinal anesthesia reduced the need for opioids postoperatively. The most common symptoms were pain, nausea and vomiting, itching, drowsiness and fatigue. Abdominal pain, drowsiness and fatigue occurred significantly less often and with lower intensity among the spinal anesthesia group. Although postoperative nausea and vomiting was reported equally in the two groups, vomiting episodes were reported significantly more often during the first day after surgery in the spinal anesthesia group. Spinal anesthesia was associated with a higher prevalence of postoperative itching. Conclusions. Spinal anesthesia with intrathecal morphine carries advantages regarding postoperative symptoms and recovery following fast-track abdominal hysterectomy.
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26.
  • Kjölhede, Preben, et al. (författare)
  • Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery
  • 2011
  • Ingår i: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA. - : Informa Healthcare. - 0001-6349 .- 1600-0412. ; 90:1, s. 63-71
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To evaluate whether preoperative vaginal preparation routines influence postoperative infectious morbidity in vaginal hysterectomy and to analyze risk factors for postoperative infectious morbidity. Design. Retrospective, longitudinal cohort study. Setting. Forty -three hospitals in Sweden, participating in the Swedish National Register for Gynecological Surgery. Population. All 6,496 women who were enrolled in the Register and underwent vaginal or laparoscopically assisted vaginal hysterectomy between 1 January 2000 and 1 February 2008. Methods. Register data were collected prospectively using doctors forms and patient questionnaires. Information about vaginal preparation routines in the clinics were achieved retrospectively by an e-mail survey. Multiple logistic regression analyses models were used to determine associations and risk factors. Main outcome measures. Infectious morbidity within 6-8 weeks postoperatively. Results. No significant differences were seen in postoperative infectious morbidity in long term between vaginal preparation using saline or chlorhexidine solution or no cleansing. At discharge from hospital, those who had had vaginal cleansing using saline solution had a significantly higher risk of postoperative infections. Risk factors for infectious morbidity were young age, obesity, peroperative injury of the urinary bladder, operative time and duration of hospital stay. Protective were prophylactic antibiotics and concomitant prolapse surgery. Conclusions. Saline solution should not be used for vaginal cleansing due to a higher risk of infectious morbidity in the immediate postoperative period. Infectious morbidity may be reduced further by employing preventive measures such as meticulous surgical technique, preoperative weight reduction in obese women and minimizing time in hospital.
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27.
  • Claesson, Ing-Marie, 1953-, et al. (författare)
  • Weight after childbirth : A 2-year follow-up of obese women in a weight-gain restriction program
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare. - 0001-6349 .- 1600-0412. ; 90:1, s. 103-110
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Objective: To investigate the effects of a weight gain restriction program on weight development or weight maintenance two years after childbirth. Methods: The intervention group consisted of 155 obese pregnant women who participated in a weight gain restriction program with weekly support duringpregnancy. The control group consisted of 193 obese pregnant women. Follow-up weight measurements were done at 12 and 24 months postpartum. Results: The mean value of weight change in the intervention group was -2.2 kg compared to + 0.4 kg in the control group from early pregnancy to the follow-up 12 months after childbirth (p = .046). A greater percentage of women in the intervention group showed a weight loss 24 months after delivery than did women in the control group at that same time (p = .034). Women in the intervention group who gained less than 7 kg during pregnancy had a significantly lower weight than the controls at the 24 months follow-up (p = .018). Conclusion: An intervention program with weekly motivational support visits during pregnancy and every 6 months after childbirth seems to have an impact on weight gain up to 24 months after childbirth for those women in the intervention group who succeeded in restricting their gestational weight gain to less than 7 kg.
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28.
  • Adolfsson, Annsofie, et al. (författare)
  • Decreased need for emergency services after changing management for suspected miscarriage
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 90:8, s. 921-923
  • Tidskriftsartikel (refereegranskat)abstract
    • We investigated the effect of a changed routine to identify women with a nonviable pregnancy, in order to utilize health care resources more efficiently during office hours rather than relying on emergency care services. From hospital register data about where and when women with miscarriages were treated, there was a significant trend during a nine-year period for miscarriages to be more rarely diagnosed (p-value<0.001) in the emergency ward after office hours. The proportion of miscarriages that were diagnosed and handled at the emergency ward decreased from 31% in 2001 to 17% in 2009. Furthermore, the number of women showing up with bleeding at the emergency ward, but who also had a normal viable pregnancy, declined during the same period (p-value<0.01). Women with suspected miscarriage benefit from structured information and standardized management and can effectively be scheduled for day-time assessment including ultrasound with a concomitant reduced need for emergency services.
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29.
  • Amini, Hashem, et al. (författare)
  • Second trimester fetal magnetic resonance imaging improves diagnosis of non-central nervous system anomalies
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:4, s. 380-389
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives. To evaluate the additional information of second trimester magnetic resonance imaging (MRI) compared to ultrasound in fetuses with identified or suspected non-CNS anomalies and to study the clinical impact of the MRI information on pregnancy management. Design. Prospective study during 2003-2007. The fetal MRI examination was planned to be performed within three days after the ultrasound. Setting. Uppsala University hospital. Material and methods. Sixty-three women, where the second trimester ultrasound identified or raised suspicion of fetal anomalies were included. Ultrasound was compared to MRI in relation to the final diagnosis, which was based on the assessment of all available data including post-partum clinical follow-up and autopsy results. Main outcome measures. Evaluation of the additional information gained from MRI and the consequences it had on pregnancy management. Results. The mean interval between ultrasound and MRI was 2.6 days (range 0-15). In 42 (67%) cases MRI was performed within three days. All MRI examinations were assessable. In 43 (68%) fetuses MRI provided no additional information, in 17 (27%) MRI added information without changing the management and in three (5%) MRI provided additional information which changed the management. All these three cases had oligohydramnios. In all six cases of diaphragmatic hernia MRI provided additional information. Conclusions. Fetal MRI of non-CNS anomalies in the second trimester seems to be a valuable adjunct to ultrasound diagnosis of non-CNS anomalies, especially in cases of oligohydramnios and diaphragmatic hernia.
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30.
  • Andersson, Ola, et al. (författare)
  • Effects of delayed compared with early umbilical cord clamping on maternal postpartum hemorrhage and cord blood gas sampling : a randomized trial
  • 2013
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 92:5, s. 567-574
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To investigate the effect of delayed cord clamping (DCC) compared with early cord clamping (ECC) on maternal postpartum hemorrhage (PPH) and umbilical cord blood gas sampling. Design. Secondary analysis of a parallel-group, single-center, randomized controlled trial. Setting. Swedish county hospital. Population. 382 term deliveries after a low-risk pregnancy. Methods. Deliveries were randomized to DCC (>= 180 seconds, n = 193) or ECC (<= 10 seconds, n = 189). Maternal blood loss was estimated by the midwife. Samples for blood gas analysis were taken from one umbilical artery and the umbilical vein, from the pulsating unclamped cord in the DCC group and from the double-clamped cord in the ECC group. Samples were classified as valid when the arterial-venous difference was -0.02 or less for pH and 0.5 kPa or more for pCO(2). Main outcome measures. PPH and proportion of valid blood gas samples. Results. The differences between the DCC and ECC groups with regard to PPH(1.2%, p = 0.8) and severe PPH(-2.7%, p = 0.3) were small and non-significant. The proportion of valid blood gas samples was similar between theDCC (67%, n = 130) and ECC (74%, n = 139) groups, with 6% (95% confidence interval: -4%-16%, p = 0.2) fewer valid samples after DCC. Conclusions. Delayed cord clamping, compared with early, did not have a significant effect on maternal postpartum hemorrhage or on the proportion of valid blood gas samples. We conclude that delayed cord clamping is a feasible method from an obstetric perspective.
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31.
  • Antonsen, Sofie L, et al. (författare)
  • Subspecialist training in surgical gynecologic oncology in the Nordic countries.
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:8, s. 917-920
  • Tidskriftsartikel (refereegranskat)abstract
    • To survey the centers that can provide subspecialty surgical training and education in gynecological oncology in the Nordic countries, we developed an online questionnaire in co-operation with the Nordic Society of Gynecological Oncology. The link to the survey was mailed to 22 Scandinavian gynecological centers in charge of surgical treatment of cancer patients. Twenty (91%) centers participated. Four centers reported to be accredited European subspecialty training centers, a further six were interested in being accredited, and 11 centers were accredited by the respective National Board. Fourteen (74%) centers were interested in being listed for exchange of fellows. Our data show a large Nordic potential and interest in improving the gynecologic oncology standards and can be used to enhance the awareness of gynecologic oncology training in Scandinavia and to facilitate the exchange of fellows between Nordic countries.
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32.
  • Belachew, Johanna, 1976-, et al. (författare)
  • Longitudinal study of the uterine body and cavity with three-dimensional ultrasonography in the puerperium
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:10, s. 1184-1190
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To describe uterine involution in the puerperium with three-dimensional ultrasound.Design. Prospective, longitudinal study.Setting. Fetal medicine unit, department of obstetrics and gynecology, university referral hospital, Uppsala, Sweden.Population. Fifty women with uncomplicated deliveries and puerperium between February 2009 and February 2010.Methods. Three-dimensional ultrasound was used to measure the uterine body and cavity volumes. The volume data set was analysed using virtual organ computer-aided analysis (VOCAL) with a 30 degree rotation step. Measurements were performed transabdominally on days 1, 7 and 14 and transvaginally on days 28 and 56 postpartum. Parity, gestational age, birthweight, smoking, breastfeeding and blood loss were recorded.Main outcome measures. Uterine body and cavity volumes. Results. Median uterine body volume was 756 cm3 on day 1, 440 cm3 on day 7, 253 cm3 on day 14, 125 cm3 on day 28 and 68 cm3 on day 56. Median cavity volume was 22 cm3 on day 1, 18 cm3 on day 7, 6 cm3 on day 14, 1 cm3 on day 28 and not measurable on day 56. The interindividual variation of uterine body and cavity volumes was most pronounced on day 1 and decreased throughout the observation period. Intrauterine content was found in 36% of the women on day 1, 95% on day 7, 87% on day 14 and 28% on day 28.Conclusions. Three-dimensional ultrasound is a non-invasive tool suitable for measurement of the uterine body and cavity volumes during the puerperium. The volumes decreased in a similar pattern in the study population.
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33.
  • Bergman, Eva, 1959-, et al. (författare)
  • Relative growth estimated from self-administered symphysis fundal measurements
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:2, s. 179-185
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To establish absolute-and relative-growth reference curves for the detection of intrauterine growth restriction from weekly self-administered symphysis-fundus (SF) measurements and to assess the influence of fetal sex, maternal obesity and parity. Design. Prospective longitudinal study. Setting. Pregnant women from six primary antenatal care centres. Population. Three hundred women with singleton ultrasound dated pregnancies. Methods. Weekly self-administered SF measurements from gestational week 25 until delivery were obtained. A linear mixed longitudinal model was used to estimate the absolute SF growth using the natural logarithm (lnSF). Relative lnSF growth was calculated as the lnSF measurement in one gestational week subtracted by the lnSF measurement in the previous gestational week. The influence of fetal sex, maternal obesity and parity was assessed in regression models and by a graphical display. Main Outcome Measures. Absolute lnSF and relative lnSF growth curves and influence of fetal sex, maternal obesity and parity on these. Results. SF measurements from 191 women were used to establish an SF-growth reference. The absolute lnSF growth was influenced by maternal obesity, and for fetal sex and parity, borderline significance was recorded; while there was no evidence that the relative lnSF growth could depend on these variables. Conclusions. Weekly self-administered SF measurements can be obtained and used to estimate SF growth. Relative growth of the lnSF height seems to be independent of fetal sex, maternal obesity and parity.
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34.
  • Bergman, Eva, 1959-, et al. (författare)
  • Self-administered symphysis-fundus measurements analyzed with a novel statistical method for detection of intrauterine growth restriction : a clinical evaluation
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:8, s. 890-896
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To assess the ability of self-administered symphysis fundus measurements used with the Shiryaev-Roberts statistical method (SR method) to identify growth-restricted (IUGR) fetuses and compare it with the traditional SF method (symphysis fundus measurements used with a population-based reference curve). Design. Longitudinal study. Setting. Pregnant women attending primary antenatal care centres. Population. From a population of 1 888 women with singleton ultrasound-dated pregnancies, we analyzed data from 1 122 women. Methods. Weekly self-administered SF measurements from gestational week 25 until delivery were analyzed according to the SR method. Neonatal morbidity and small for gestational age (SGA) were used as proxies for IUGR. Small for gestational age was defined as a birthweight less than two standard deviations (SD) and <10th percentile. We assessed the sensitivity of the SR and the SF methods to detect neonatal morbidity and SGA. Main Outcome Measures. Birth-related mortality, respiratory distress, hypoglycemia, Apgar score <= 6 at five minutes, pH <= 7.00 in the umbilical artery, neonatal care, preterm delivery, operative delivery for fetal distress and SGA. Results. For the SR method, the sensitivity for neonatal morbidity was between 6.0 and 36.4%, for SGA <2SD 36.8%, and for SGA <10th percentile 20.9%. The SF method had a sensitivity between 6.0 and 13.8% for neonatal morbidity, 52.3% for SGA <2SD and 28.6% for SGA <10th percentile. Conclusions. The SR and the SF methods had low sensitivities for neonatal morbidity.
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35.
  • Borendal Wodlin, Ninnie, et al. (författare)
  • The development of fast-track principles in gynecological surgery
  • 2013
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare / Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 92:1, s. 17-27
  • Forskningsöversikt (refereegranskat)abstract
    • Fast-track is a multimodal strategy aimed at reducing the physiological burden of surgery to achieve an enhanced postoperative recovery. The strategy combines unimodal evidence-based interventions in the areas of preoperative preparation, anesthesia, surgical factors and postoperative care. The advantages of fast-track most likely extend to gynecology, although so far have scarcely been reported. This review summarizes current evidence concerning use of fast-track in general and in gynecological surgery. The main findings of this review are that there are benefits within elective gynecological surgery, but studies of quality of life, patient satisfaction and health economics in elective surgery are needed. Studies of fast-track within the field of non-elective gynecological surgery are lacking. Widespread education is needed to improve the rate of implementation of fast-track. Close involvement of the entire surgical team is imperative to ensure a structured perioperative care aiming for enhanced postoperative recovery.
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36.
  • Cobo, Teresa, et al. (författare)
  • Intra-amniotic inflammation predicts microbial invasion of the amniotic cavity but not spontaneous preterm delivery in preterm prelabor membrane rupture.
  • 2012
  • Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349.
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To predict microbial invasion of the amniotic cavity (MIAC) and spontaneous preterm delivery within seven days using a panel of selected proteins from amniotic fluid in a Swedish population of preterm prelabor membrane rupture (PPROM). Design. Prospective cohort study. Setting. Evaluation of intra-amniotic inflammation in preterm premature rupture of membranes. Population. Sixty-six pregnant women with preterm prelabor membrane rupture at 22(+0-) 33(+6) weeks' gestational age. Methods. Twenty-seven amniotic fluid proteins were assayed by a multiple immunoassay. Main outcome measures. The intra-amniotic inflammatory response was evaluated according to the presence of MIAC and the risk of spontaneous preterm delivery within seven days. A prediction model was constructed using logistic regression. Results. The overall rates of MIAC and spontaneous preterm delivery within seven days were 20% and 50%, respectively. There was a higher inflammatory response in women with MIAC than without. Earlier gestational age at delivery and lower birthweight were observed in the presence of microbial invasion of the amniotic cavity. Amniotic fluid Interleukin (IL)-6 and IL-10 were the best predictors of MIAC in terms of sensitivity (69%), specificity (81%), positive predictive value (47%), negative predictive value (91%) and positive likelihood ratio of 3.6. There were no differences in intra-amniotic inflammatory response according to the risk of spontaneous preterm delivery within seven days. Conclusion. Amniotic fluid IL-6 and IL-10 are the best inflammatory biomarkers to predict MIAC in women with PPROM. Intra-amniotic inflammation does not predict the occurrence of spontaneous preterm delivery within seven days of PPROM.
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37.
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38.
  • Dahlgren, Eva, et al. (författare)
  • Long-term outcome of porcine skin graft in surgical treatment of recurrent pelvic organ prolapse. An open randomized controlled multicenter study
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare / Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 90:12, s. 1393-1401
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To determine the long-term objective and subjective outcomes of use of a porcine skin graft (Pelvicol(TM)) compared with conventional colporrhaphy in recurrent pelvic organ prolapse surgery and to analyze risk factors and safety. Design. Open randomized controlled multicenter study. Setting. Eight Swedish hospitals. Population. 135 consecutive women with recurrent cystocele and/or rectocele admitted for vaginal prolapse surgery; 132 completed the study, 64 were randomly allocated to receive conventional colporrhaphy and 68 to Pelvicol. Methods. Conventional anterior and posterior colporrhaphy and colporrhaphy with use of Pelvicol(TM) mesh reinforcement. Clinical evaluation by means of pelvic organ prolapse quantification (POP-Q) and symptom questionnaire preoperatively, three months and three years postoperatively. Main outcome measures. Anatomical and subjective outcome.? Recurrence was defined as POP-Q=stage 2. Results. At three-month follow-up, early recurrence/surgical failures occurred significantly more often in the Pelvicol(TM) group, but at the three-year follow-up the recurrence rates were similar. The recurrence rates in the anterior compartment were 5762% and 4423% in the posterior compartment for the colporrhaphy and Pelvicol(TM) groups, respectively. Symptoms were substantially and equally reduced in the two groups after surgery. Sexual activity and function did not seem to be affected adversely in any group. The complication rate was low. Risk factors for anatomical recurrence were age, body mass index and preoperative stage of the prolapse. Conclusions. With the surgical technique used in this study, Pelvicol(TM) did not provide advantages over conventional colporrhaphy in recurrent pelvic organ prolapse concerning anatomical and subjective outcomes.
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39.
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40.
  • Ekenros, Linda, et al. (författare)
  • Postural control in women with premenstrual symptoms during oral contraceptive treatment
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:1, s. 97-102
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. This study investigates postural control among women with and without premenstrual symptoms (PMS) on oral contraceptive (OC) treatment. Design. Prospective repeated measures design. Setting. Women's health clinical research unit at a university hospital. Population. Fifteen women using low-dose monophasic oral contraceptives participated in the study. Depending on premenstrual symptoms, the women were divided into one PMS group and one non-PMS group. Methods. Postural control (displacement area) was measured using an AMTI® force platform during the active hormone phase (OC phase) and the hormone-free phase (non-OC phase) of the pill chart. Premenstrual symptoms were evaluated prospectively using the Cyclicity Diagnoser. Main Outcome Measures. Displacement area as a measure of postural control. Results. Six of 15 women showed premenstrual symptoms (primarily negative mood symptoms) between the phases and were considered having premenstrual symptoms. When analyzing postural control, the PMS group displayed a significantly greater displacement area in the OC-phase compared to the non-OC phase. In contrast, the non-PMS group did not show any significant difference between the phases. Furthermore, the PMS group had significantly greater displacement area during the OC phase compared to the non-PMS group. Conclusions. The present study shows that women with premenstrual symptoms have greater displacement area than those without premenstrual symptoms during the active phase of oral contraceptive treatment. Negative mood symptoms may affect the maintenance of postural control by central interactions. Further studies are needed to clarify the precise mechanism for altered postural control in women with premenstrual symptoms.
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41.
  • Elvander, Charlotte, et al. (författare)
  • The influence of fetal head circumference on labor outcome : a population-based register study
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:4, s. 470-475
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To investigate the association between postnatal head circumference and the occurrence of the three main indications for instrumental delivery, namely prolonged labor, signs of fetal distress and maternal distress. We also studied the association between postnatal fetal head circumference and the use of vacuum extraction and emergency cesarean section. Design. Population-based register study. Setting. Nationwide study in Sweden. Population. A total of 265 456 singleton neonates born to nulliparous women at term between 1999 and 2008 in Sweden. Methods. Register study with data from the Swedish Medical Birth Register. Main outcome measures. Prolonged labor, signs of fetal distress, maternal distress, use of vacuum extraction and emergency cesarean section. Results. The prevalence of each outcome increased gradually as the head circumference increased. Compared with women giving birth to a neonate with average size head circumference (35 cm), women giving birth to an infant with a very large head circumference (3941 cm) had significantly higher odds of being diagnosed with prolonged labor [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.331.67], signs of fetal distress (OR 1.73, 95% CI 1.492.03) and maternal distress (OR 2.40, 95% CI 1.962.95). The odds ratios for vacuum extraction and cesarean section were thereby elevated to 3.47 (95% CI 3.103.88) and 1.22 (95% CI 1.041.42), respectively. The attributable risk proportion percentages associated with vacuum extraction and cesarean section were 46 and 39%, respectively among the cases exposed to a head circumference of 3741 cm. Conclusions. Large fetal head circumference is associated with complicated labor and is etiological to a considerable proportion of assisted vaginal births and emergency cesarean sections.
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42.
  • Fadl, Helena, 1965-, et al. (författare)
  • Outcomes of gestational diabetes in Sweden depending on country of birth
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - Hoboken, USA : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 91:11, s. 1326-1330
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To analyze maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden, depending on country of birth (Nordic vs. non-Nordic women).Design: Population-based cohort study using the Swedish Medical Birth register.Setting: Data on pregnant women in Sweden with diagnosed GDM.Population: All singleton births to women with GDM between 1998 and 2007 (n = 8560).Methods: Logistic regression in an adjusted model to assess the risk of adverse maternal and neonatal outcomes. Chi-squared tests or Student's unpaired t-tests were used to analyze differences between maternal and fetal characteristics.Main outcome measures: Maternal and neonatal complications.Results: GDM incidence was higher at 2.0% among non-Nordic women, compared with 0.7% in the Nordic group. The non-Nordic women were older, had less chronic hypertensive disease, smoked less, and had lower BMI and shorter height. Preeclampsia was significantly lower in the non-Nordic group. The mean birthweight (3561 vs. 3698 g, p < 0.001) and the large-for-gestational age rate (11.7 vs. 17.5%, p < 0.001) were significantly lower in the non-Nordic group. Large-for-gestational age was dependent on maternal height [crude odds ratio 0.6 (0.5-0.7) and adjusted odds ratio 0.8 (0.6-0.9)].Conclusions: Non-Nordic women with GDM in Sweden have better obstetrical and neonatal outcomes than Nordic women. These results do not support the idea of inequality of health care. Large-for-gestational age as a diagnosis is highly dependent on maternal height, which raises the question of the need for individualized growth curves.
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43.
  • Franzén, Karin, et al. (författare)
  • Validation of the Swedish version of the incontinence impact questionnaire and the urogenital distress inventory
  • 2013
  • Ingår i: Acta Obstetricia Et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 92:5, s. 555-561
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To validate the Swedish versions of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6). Design and setting. Prospective study, university hospital. Population and method. We analyzed reliability, validity, and responsiveness in a clinical sample of 96 women with urinary incontinence. Main outcome measures. Construct and criterion validity, reliability via test–retest and internal consistency. Responsiveness via calculation of effect size. Result. Test–retest reliability ranged from moderate to almost perfect. Cronbach's alpha was 0.39 (UDI-6) and 0.83 (IIQ-7). Effect size calculation of change after treatment demonstrated good responsiveness. The effect size at six months was moderate in the Stress Urinary Incontinence group and small in the Urge Urinary Incontinence + Mixed Urinary Incontinence group. There was a moderate to strong correlation between UDI-6 and IIQ-7 and treatment satisfaction at six, 12, and 24 months for both groups. Conclusion. The UDI-6 scale did not produce the same solid result in the psychometric analysis as the IIQ-7 scale, but these newly translated Swedish forms of UDI-6 and IIQ-7 show good responsiveness and are easy to administer and to fill out.
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44.
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45.
  • Gottvall, Tomas, et al. (författare)
  • External cephalic version of non-cephalic presentation; is it worthwhile?
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Informa Healthcare / Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 90:12, s. 1443-1445
  • Tidskriftsartikel (refereegranskat)abstract
    • A retrospective study of 186 consecutive external cephalic versions (ECV) late in the third trimester was done. Logistic regression analysis of background factors leading to a successful ECV showed that multiparity, a larger amount of amniotic fluid, measured as amniotic fluid index, and a transverse fetal position were each significantly correlated with a successful version. The total success rate was 62%, and after a successful ECV 84% of the fetuses were delivered vaginally. No severe complications were registered during the ECVs, and all babies had normal Apgar scores at delivery. Attempting ECV at least once or even twice seems to be appropriate because a successful ECV can decrease the rate of cesarean section in this group of patients and by so doing may also decrease the risk of cesarean section in future pregnancies.
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46.
  • Hamad, Rangeen Rafik, et al. (författare)
  • Impaired endothelial function and elevated levels of pentraxin 3 in early-onset preeclampsia
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:1, s. 50-56
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To study endothelial function in relation to anti-angiogenic biomarkers and the inflammatory process in preeclampsia. Design: Observational study. Setting: Data were obtained from pregnant women who were admitted to the obstetrical ward at the Karolinska University Hospital, Solna, Stockholm, Sweden. Population. Thirty-five women with newly developed and untreated preeclampsia and 30 healthy controls. Methods: Flow-mediated dilation of the brachial artery, levels of anti-angiogenic and inflammatory markers were measured in plasma during pregnancy and 3-6 months after delivery. Main outcome measures. Flow-mediated dilation of the brachial artery, anti-angiogenic and inflammatory markers. Results: Flow-mediated dilation was decreased in the preeclamptic group at inclusion and at follow-up (p<0.05). Pentraxin 3 (PTX3) and ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) were elevated in women with preeclampsia during pregnancy (p<0.001). Furthermore flow-mediated dilation was lower and the ratio sFlt-1/PlGF and PTX3 were higher in early-onset preeclampsia than late preeclampsia (p=0.018, 0.002 and 0.039). Levels of PTX3 at inclusion correlated inversely with flow-mediated dilation at follow-up both in the preeclampsia and control groups (Spearman, r(s) =-0.47, p=0.02 and r(s) =-0.46, p=0.02 respectively). Conclusion: Impaired endothelial function and increased ratio sFlt/PlGF, elevated PTX3 is present in women with preeclampsia and is especially pronounced in women with early-onset preeclampsia.
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47.
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48.
  • Henningsen, Anna-Karina A, et al. (författare)
  • Infant and maternal health monitoring using a combined Nordic database on ART and safety.
  • 2011
  • Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 90:7, s. 683-691
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To evaluate infant and maternal health after assisted reproductive technology (ART), using data on over 90 000 ART children and their mothers in Denmark, Finland, Norway and Sweden. Data have been combined and will be compared with a control group of spontaneously conceived children and their mothers. The overall aim of this project is to evaluate the safety of ART. The size of the cohort should enable estimation of the prevalence of rare conditions such as birth defects, cancers, neurological impairments and imprinting diseases in the ART population compared to control children. Outcome data on the mothers of ART children can be used to study risks during pregnancy and obstetric complications after ART. Methods. A personal identification number given to all Nordic residents allows cross-linkage of the national health registers and enables long-term follow-up of ART children. The medical birth registers in the Nordic countries make it possible to cross-link data from mother and child. When a child is identified as conceived by ART, we can obtain a list of all International Classification of Diseases (ICD) codes ever registered on that specific child. Conclusion. Combining the Nordic ART and health registers is a complicated but feasible task. The main strengths of this ongoing study are the size of the cohort of ART children and their mothers and the possibility to follow the children through the health registers. The limitations are related to the national differences in reporting and recording of data together with the heterogeneity of data.
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49.
  • Himmelmann, Kate, 1959, et al. (författare)
  • Risk factors for cerebral palsy in children born at term.
  • 2011
  • Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349.
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To provide an overview of current research on risk factors for cerebral palsy (CP) in children born at term and hypothesize how new findings can affect the content of the CP registers worldwide. Data Source. A systematic search in PubMed for original articles, published from 2000 to 2010 regarding risk factors for CP in children born at term was conducted. Methods of study selection. Factors from the prenatal, perinatal and neonatal period considered as possible contributors to the causal pathway to CP in children born at term were regarded as risk factors. Full text review was made of 266 articles. Results. Sixty-two articles met the criteria for an original report on risk factors for CP in children born at term. Perinatal adverse events including stroke were the focus of most publications, followed by genetic studies. Malformations, infections, perinatal adverse events and multiple gestation were risk factors associated with CP. The evidence regarding for example thrombophilic factors and non-CNS abnormalities was inconsistent. Conclusion. Information on maternal and neonatal infections, umbilical cord blood gases at birth, mode of delivery and placental status should be collected in a standardized way in CP registers. Information on social factors such as education level, family income and area of residence is also of importance. More research is needed to understand the risk factors of CP and specifically of how they relate to causal pathways of cerebral palsy.
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50.
  • Hogström, Lars, et al. (författare)
  • Quality of life after adopting compared with childbirth with or without assisted reproduction.
  • 2012
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - Hoboken, USA : John Wiley & Sons Ltd.. - 0001-6349 .- 1600-0412. ; 91:9, s. 1077-1085
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. This study compares quality of life among couples who had adopted a child 4–5.5 years previously with couples whose conception was spontaneous, as well as with couples who had successful or unsuccessful in vitro fertilization (IVF) treatment. Design. Cross-sectional study. Setting. Tertiary level university hospital. Sample. From the following groups, 979 responses were obtained: adoption; successful IVF; unsuccessful IVF–living with children; unsuccessful IVF–living without children; and childbirth after spontaneous conception (controls). Methods. Quality of life was studied with the Psychological General Well Being (PGWB) and Sense of Coherence (SOC) instruments. Demographic, socio-economic and health data were obtained with additional questionnaires. Multiple variance analysis was applied. Main outcome measures. The PGWB and SOC scores. Results. After adjustment for seven confounders, the adoption group had higher PGWB scores than the unsuccessful IVF–living without children and the controls and higher SOC scores than all other groups. The unsuccessful IVF–living without children had lower PGWB and SOC scores than all other groups. The PGWB and SOC scores among controls did not differ from those with successful IVF or unsuccessful IVF–living with children. Conclusions. Adjusted PGWB and SOC scores revealed a high quality of life in the adoption group. However, the group unsuccessful IVF–living without children had low quality of life scores. Quality of life appears to be independent of the outcome of IVF treatment as long as there are children in the family.
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