| 4051. |
- Lichtenstein Liljeblad, Karin, et al.
(author)
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Risk of abortion within 1–2 years after childbirth in relation to contraceptive choice : a retrospective cohort study
- 2020
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In: European journal of contraception & reproductive health care. - : Taylor & Francis. - 1362-5187 .- 1473-0782. ; 25:2, s. 141-146
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Journal article (peer-reviewed)abstract
- Objectives: The primary objective of the study was to investigate whether the choice of long-acting reversible contraception (LARC) was associated with the risk of abortion over a period of 24 months postpartum. The secondary objective was to analyse whether other significant factors were affecting the risk of abortion during this period.Methods: In this retrospective cohort study, we analysed 11,066 women who had delivered in three Swedish cities during 2013 and 2014. Demographic and medical variables were obtained from medical records. Attendance at the postpartum visit, choice of postpartum contraception and history of abortion was noted. Logistic regression analysis was performed to assess factors associated with the risk of abortion. The main outcome measure was the proportion of women with abortion up to 24 months postpartum.Results: Data from 11,066 women were included in the final analysis. Within 12-24 months after delivery 2.5% of women had an abortion. The choice of LARC after childbirth reduced the risk of subsequent abortion (odds ratio 0.74; 95% confidence interval [CI] 0.60, 0.91; p = .005). Smoking, age <25 years and have had a previous abortion significantly increased the risk of abortion during follow-up, whereas exclusive breastfeeding decreased the risk.Conclusions: Increasing the proportion of women who choose LARC postpartum could decrease the risk of abortion for up to 2 years after childbirth.
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| 4052. |
- Lichtenstein Liljeblad, Karin, et al.
(author)
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Women's experiences of postpartum contraceptive services when elective caesarean section is the method of birth : a qualitative study
- 2024
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In: BMJ Sexual & Reproductive Health. - : BMJ Publishing Group Ltd. - 2515-1991 .- 2515-2009. ; 50:2, s. 107-113
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Journal article (peer-reviewed)abstract
- BACKGROUND: The unmet need for postpartum contraception is a global challenge. Postpartum placement of an intrauterine device (IUD) within 48 hours of vaginal delivery is available in many settings worldwide, but is not routinely practised in Sweden. To improve contraceptive services and facilitate the informed choice of IUD placement at the time of a caesarean section (CS), we performed this study to identify and describe women's experiences of contraceptive services before, during and after an elective CS.METHODS: A qualitative design and methodology was used. We interviewed 20 women aged 28-42 years who underwent elective CS in Sweden. Interviews were analysed using reflexive thematic analysis.RESULTS: The three main themes found were (1) receptivity to contraceptive counselling in the context of CS, (2) communication and decision-making about postpartum contraception before CS and (3) lack of support and guidance to receive contraceptive services before and after CS. The participants described readiness and interest regarding postpartum contraception. They prefered counselling from around 25 weeks of gestation. Despite this finding, antenatal communication and contraceptive decision-making seemed rare. Participants reported a lack of support and guidance which necessitated a need by women to navigate the contraceptive services themselves in order to receive information about contraception before CS and to receive postpartum support.CONCLUSIONS: Antenatal contraceptive counselling including information about IUD placement during CS was appreciated and welcomed by women with elective CS as their birth method. Most of the women whom we interviewed would prefer to receive contraception counselling on postpartum use during the second half of their pregnancy.
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| 4053. |
- Lidegaard, Ojvind, et al.
(author)
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Hormonal contraception and venous thromboembolism.
- 2012
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In: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 91:7, s. 769-78
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Journal article (peer-reviewed)abstract
- Background. New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published. Aim. To evaluate new epidemiological data and to propose clinical consequences. Design. A literature survey. Methods. Studies assessing the risk of specific types of hormonal contraception were evaluated, compared and set into a clinical perspective. Results. The majority of newer studies have demonstrated a threefold increased risk of VTE in current users of medium- and low-dose combined oral contraceptives (COCs) with norethisterone, levonorgestrel (LNG) or norgestimate compared with non-users. The same studies have demonstrated a sixfold increased risk of VTE in users of combined pills with desogestrel, gestodene, drospirenone or cyproteroneacetate, and in users of the contraceptive vaginal ring, compared with non-users. The rate ratio of VTE between users of COCs with newer progestogens compared with users of COCs with LNG was 1.5-2.8 in seven studies and 1.0 in two studies. Progestogen-only contraception did not confer an increased risk of VTE in any study. The incidence rate of VTE in non-pregnant women aged 15-49 years using non-hormonal contraception is three per 10 000 years. Conclusions. For women starting on hormonal contraception, we recommend medium- or low-dose combined pills with norethisterone, LNG or norgestimate as first-choice preparations. For the many women who are users of COCs with newer progestogens, although the absolute risk of VTE is low, a change to combined pills with norethisterone, LNG or norgestimate may halve their risk of VTE. Finally, we recommend COCs with 20 μg estrogen combined with the older progestogens to be launched in the Scandinavian countries. Women at an increased risk of VTE should consider progestogen-only contraception or non-hormonal contraception.
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| 4054. |
- Liedman, Ragner, et al.
(author)
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Endometrial expression of vasopressin, oxytocin and their receptors in patients with primary dysmenorrhoea and healthy volunteers at ovulation.
- 2008
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In: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier BV. - 0301-2115. ; 137:2, s. 189-192
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate gene expressions for neurohypophyseal and ovarian hormones as well as their receptors in the endometrium of women with primary dysmenorrhoea and healthy subjects at ovulation. STUDY DESIGN: A group of eight women with moderate to severe dysmenorrhoea and eight healthy subjects were compared in parallel between 18 and 35 years of age, regularly menstruating, non-overweight and nulliparous. The study was performed at The Department of Obstetrics and Gynecology, University Hospital of Lund, Sweden. Endometrial biopsies were taken around the time of ovulation, which was determined by repeated ultrasound examinations. Receptor and gene expressions for oxytocin and vasopressin in the tissue were measured. RESULTS: The gene expression for oxytocin receptor was significantly lower in dysmenorrhoic than in healthy women, in median 1.21 and 3.44oxytocin-receptor/actin, respectively (p=0.048). The expressions for oxytocin peptide, vasopressin V(1a) receptor, oestrogen receptor alpha, beta and progesterone receptor did not differ between the two groups. Expression of vasopressin peptide was not detectable. CONCLUSION: A lower oxytocin receptor gene expression at mid-cycle could be involved in the aetiology of primary dysmenorrhoea. However, the importance of a paracrine effect of oxytocin and its receptor at ovulation warrants further investigation.
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| 4055. |
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| 4056. |
- Liedman, Ragner, et al.
(author)
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Myometrial oxytocin receptor mRNA concentrations at preterm and term delivery-the influence of external oxytocin
- 2009
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In: Gynecological Endocrinology. - : Informa UK Limited. - 0951-3590 .- 1473-0766. ; 25:3, s. 188-193
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Journal article (peer-reviewed)abstract
- The hormonal system for induction of term and preterm labour is not fully understood. Therefore, we investigated myometrial gene expressions for neurohypophyseal hormones and their receptors, prostaglandin F2 and ovarian steroid receptors in women delivered by Caesarean section. Myometrial tissue for real time PCR was collected from 39 women delivered at term before and after the onset of labour and preterm. Women delivered electively at term had significantly higher oxytocin receptor mRNA expressions (2.520.37 oxytocin receptor/actin; medianSEM) than those delivered with ongoing labour at term (1.010.34; p=0.015) and those at preterm (1.080.25; p=0.004). Sub-analyses revealed that the difference at term pregnancies solely was related to patients receiving oxytocin during labour (p=0.007). These patients had higher oxytocin peptide mRNA levels than those without labour at term (p=0.009). PGF2 receptor mRNA concentrations were 27.803.55, 11.462.87 and 19.545.52 PGF receptor/actin, respectively, for the groups. Women without labour at term had higher concentration than those with labour (p=0.005). Our results suggest that oxytocin, its receptor and the PGF2 receptor are involved in the regulation of labour through a paracrine mechanism.
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| 4057. |
- Liedman, Ragner
(author)
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Receptor-mediated uterine effects of oxytocin and vasopressin
- 2007
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Doctoral thesis (other academic/artistic)abstract
- The neurohypophyseal hormones oxytocin and vasopressin are important in the regulation of uterine contractility. These hormones, as well as prostaglandin F2α, are most forceful myometrial tissue contractors. Vasopressin is probably a causative factor in primary dysmenorrhoea, whereas oxytocin is the major uterine stimulator of labour, both at term and preterm. In a prospective study we investigated the endometrial gene expression of oxytocin, vasopressin and their receptors by real time PCR in dysmenorrheic and healthy women at time of ovulation (I). Furthermore, we analysed hypophyseal and ovarian hormones as well as prostaglandin F2α metabolite concentrations in plasma in different phases of the menstrual cycle in these women (II). In the pregnant uterus we assayed oxytocin, vasopressin peptide and receptor mRNA’s and prostaglandin F and ovarian steroid receptor mRNA (III). Finally, in double blind, placebo-controlled, cross-over trials in dysmenorrheic and healthy women we validated a model for recording effects of oxytocin and vasopressin V1a antagonists (IV, V). Women with dysmenorrhoea showed a lower endometrial oxytocin receptor mRNA expression at ovulation and had higher oxytocin plasma concentrations at menstruation than healthy women. The vasopressin levels were lower at ovulation. The dysmenorrheic women also had higher levels of FSH in menstrual and oestradiol-17β in late follicle phase. In the pregnant uterus, we found lower oxytocin mRNA and higher oxytocin and prostaglandin F2α receptor mRNA expressions in myometrial tissue before onset of labour at term. In the validation studies we established the influence of vasopressin on uterine contractility in dysmenorrheic and healthy women and on experienced pain in dysmenorrhoea. These effects were inhibited by a non-selective oxytocin and vasopressin V1a receptor antagonist. The results suggest an importance of oxytocin and its receptor in primary dysmenorrhoea. In the pregnant uterus at time of parturition oxytocin seems to be involved in a paracrine system. The high reproducibility and accuracy of the model for measuring effects of vasopressin on the uterus makes it usful in clinical development of antagonists.
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| 4058. |
- Liedman, Ragner, et al.
(author)
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Reproductive hormones in plasma over the menstrual cycle in primary dysmenorrhea compared with healthy subjects.
- 2008
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In: Gynecological Endocrinology. - : Informa UK Limited. - 0951-3590 .- 1473-0766. ; 24:9, s. 508-513
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Journal article (peer-reviewed)abstract
- The pathogenesis of primary dysmenorrhea is still poorly understood. The objective of the present investigation was to study differences in plasma concentrations of reproductive hormones in women with primary dysmenorrhea vs. healthy controls. In a prospective, parallel-group study we determined the plasma concentrations of oxytocin, vasopressin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17beta-estradiol (17beta-E2), progesterone and prostaglandin F 2alpha metabolite (15-keto-13,14-dihydro-PGF 2alpha) over one menstrual cycle in eight women with primary dysmenorrhea and eight healthy volunteers. In dysmenorrheic women the plasma concentration of oxytocin was significantly higher at menstruation (p = 0.0084) and that of vasopressin significantly lower at ovulation (p = 0.0281) compared with healthy women. They had also higher FSH levels in the early follicular phase (p = 0.0087) and at menstruation (p = 0.0066) and the 17beta-E2 concentration was higher in the late follicular phase (p = 0.0449). No differences were seen for LH, progesterone and PGF 2alpha metabolite. The differences of oxytocin, vasopressin, FSH and 17beta-E2 concentrations found in plasma suggest an involvement of these hormones in mechanisms of primary dysmenorrhea. These mechanisms seem to be mainly regulated through the hypothalamus and pituitary. The influence of oxytocin on the non-pregnant uterus seems to be more important than earlier believed.
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| 4059. |
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| 4060. |
- Liest, Lisbeth, et al.
(author)
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RMI and ROMA are equally effective in discriminating between benign and malignant gynecological tumors : A prospective population-based study
- 2019
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In: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 98:1, s. 24-33
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Journal article (peer-reviewed)abstract
- Introduction Our primary objective was to test the hypothesis that human epididymal protein 4 (HE4) and risk of ovarian malignancy index outperform the CA 125 and risk of malignancy index tests in categorizing a pelvic mass into high or low risk of malignancy in a Swedish population. Furthermore, cut-off values needed to be defined for HE4 and ROMA in premenopausal and postmenopausal women prior to their introduction to clinical practice. A third objective was to investigate the correlation between HE4 levels in serum and urine. Material and methods Women with a pelvic mass scheduled for surgery were recruited from nine hospitals in south-east Sweden. Preoperative blood samples were taken for analyzing CA125 and HE4 as well as urine samples for analyzing HE4. Results We enrolled a total of 901 women, of whom 784 were evaluable. In the premenopausal and postmenopausal groups, no significant differences were found for sensitivity, positive and negative predictive value, either for RMI vs ROMA or for CA125 vs HE4 using a fixed specificity of 75%. Cut-off values indicating malignancy were established for HE4 and ROMA in premenopausal and postmenopausal women. We found no correlation between HE4 concentration in serum and urine. Conclusions We could not confirm that ROMA had diagnostic superiority over RMI in categorizing women with a pelvic mass into low-risk or high-risk groups for malignancy in a Swedish population. We have defined cut-off values for HE4 and ROMA. The lack of correlation between serum and urine HE4 obviates the introduction of urine HE4 analysis in clinical diagnostics.
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