| 1. |
- Berggren, Vanja, 1972-, et al.
(author)
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Infibulated women have an increased risk of anal sphincter tears at delivery : a population-based Swedish register study of 250 000 births
- 2013
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In: Acta Obstetricia et Gynecologica Scandinavica. - 0001-6349 .- 1600-0412. ; 92:1, s. 101-108
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Journal article (peer-reviewed)abstract
- Objective. To investigate the risk for anal sphincter tears (AST) in infibulated women. Design. Population-based cohort study. Setting. Nationwide study in Sweden. Population. The study population included 250 491 primiparous women with a vaginal singleton birth at 37–41 completed gestational weeks during 1999–2008. We only included women born in Sweden and in Africa. The African women were categorized into three groups; a Somalian-group, n = 929, where over 95% are infibulated; the Eritrea-Ethiopia-Sudan-group, n = 955, where the majority is infibulated, compared to other African countries, n = 1035, where few individuals are infibulated, but had otherwise similar anthropometric characteristics. These women were compared to 247 572 Swedish-born women. Methods. Register study with data from the National Medical Birth Registry. Main outcome measures. AST in non-instrumental and instrumental vaginal delivery. Results. Compared to Swedish-born women, women from Somalia had the highest odds ratio for AST in all vaginal deliveries: 2.72 (95% CI 2.08–3.54), followed by women from Eritrea-Ethiophia-Sudan 1.80 (1.41–2.32) and other African countries 1.23 (0.89–1.53) after adjustment for major risk factors. Mediolateral episiotomy was associated with a reduced risk of AST in instrumental deliveries. Conclusion. Delivering African women from countries where infibulation is common have an increased risk of AST compared with Swedish-born women, despite delivering in a highly technical quality healthcare setting. AST can cause anal incontinence and it is important to investigate risk factors for this and try to improve clinical routines during delivery to reduce the incidence of this complication.
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| 2. |
- Ahlberg, Mia, et al.
(author)
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Birth by vacuum extraction delivery and school performance at 16 years of age
- 2013
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In: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 0002-9378 .- 1097-6868. ; 210:4, s. 361.e1-361.e8
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Journal article (peer-reviewed)abstract
- Objective The aim of the present study was to investigate cognitive competence, as indicated by school performance, at 16 years of age, in children delivered by vacuum extraction.Study design This was a register study of a national cohort of 126,032 16 year olds born as singletons, with a vertex presentation, at a gestational age of 34 weeks or older, with Swedish-born parents, delivered between 1990 and 1993 without major congenital malformations. Linear regression was used to analyze mode of delivery in relation to mean scores from national tests in mathematics (40.2; scale, 10-75; SD, 14.9) and mean average grades (223.8; scale, 10-320; SD, 52.3), with adjustment for perinatal and sociodemographic confounders.ResultsChildren delivered by vacuum extraction (-0.51; 95% confidence interval [CI], -0.76 to 0.26) as well as by nonplanned cesarean section (-0.51; 95% CI, -0.82 to -0.20) had slightly lower mean mathematics test scores than children born vaginally without instruments, after adjustment for major confounders. Mean average grades in children delivered by vacuum extraction were -1.05 (95% CI, -1.87 to -0.23) and -1.20 (95% CI,-2.24 to -0.16) in children delivered by nonplanned cesarean section compared with children born vaginally.ConclusionChildren delivered by vacuum extraction had slightly lower grades at age 16 years compared with those born by noninstrumental vaginal delivery but very similar to those delivered by nonplanned cesarean. This suggests that vacuum extraction and nonplanned cesarean are equivalent alternatives for terminating deliveries with respect to cognitive outcomes.
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| 3. |
- Alken, Jenny, et al.
(author)
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Rates of Extreme Neonatal Hyperbilirubinemia and Kernicterus in Children and Adherence to National Guidelines for Screening, Diagnosis, and Treatment in Sweden
- 2019
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In: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 2:3
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Journal article (peer-reviewed)abstract
- IMPORTANCE Neonatal hyperbilirubinemia can cause lifelong neurodevelopmental impairment (kernicterus) even in high-resource settings. A better understanding of the incidence and processes leading to kernicterus may help in the design of preventive measures. OBJECTIVES To determine incidence rates of hazardous hyperbilirubinemia and kernicterus among near-term to term newborns and to evaluate health care professional adherence to best practices. DESIGN, SETTING, AND PARTICIPANTS This population-based nationwide cohort study used prospectively collected data on the highest serum bilirubin level for all infants born alive at 35 weeks' gestation or longer and admitted to neonatal care at all 46 delivery and 37 neonatal units in Sweden from 2008 to 2016. Medical records for newborns with hazardous hyperbilirubinemia were evaluated for best neonatal practices and for a diagnosis of kernicterus up to 2 years of age. Data analyses were performed between September 2017 and February 2018. EXPOSURES Extreme (serum bilirubin levels, 25.0-29.9mg/dL [425-509 mu mol/L]) and hazardous (serum bilirubin levels, >30.0mg/dL [>510 mu mol/L]) neonatal hyperbilirubinemia. MAIN OUTCOMES AND MEASURES The primary outcome was kernicterus, defined as hazardous neonatal hyperbilirubinemia followed by cerebral palsy, sensorineural hearing loss, gaze paralysis, or neurodevelopmental retardation. Secondary outcomeswere health care professional adherence to national guidelines using a predefined protocol with 10 key performance indicators for diagnosis and treatment as well as assessment of whether bilirubin-associated brain damage might have been avoidable. RESULTS Among 992 378 live-born infants (958 051 term births and 34 327 near-term births), 494 (320 boys; mean [SD] birth weight, 3505 [527] g) developed extreme hyperbilirubinemia (50 per 100 000 infants), 6.8 per 100 000 infants developed hazardous hyperbilirubinemia, and 1.3 per 100 000 infants developed kernicterus. Among 13 children developing kernicterus, brain injury was assessed as potentially avoidable for 11 children based on the presence of 1 or several of the following possible causes: untimely or lack of predischarge bilirubin screening (n = 6), misinterpretation of bilirubin values (n = 2), untimely or delayed initiation of treatment with intensive phototherapy (n = 1), untimely or no treatment with exchange transfusion (n = 6), or lack of repeated exchange transfusions despite indication (n = 1). CONCLUSIONS AND RELEVANCE Hazardous hyperbilirubinemia in near-term or term newborns still occurs in Sweden and was associated with disabling brain damage in 13 per million births. For most of these cases, health care professional noncompliance with best practices was identified, suggesting that a substantial proportion of these cases might have been avoided.
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| 4. |
- Bengtsson, Frida, et al.
(author)
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Neonatal outcomes of elective labor induction in low-risk term pregnancies
- 2023
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In: Scientific Reports. - : Springer Nature. - 2045-2322. ; 13
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Journal article (peer-reviewed)abstract
- The rate of labor induction has increased in recent years. The results of previously conducted studies examining associations between elective induction of labor (IOL) and neonatal outcomes have been contradictory. The aim of this study was to examine the intrinsic neonatal risks following IOL. We conducted a population-based cohort study, including all women with recorded low-risk singleton pregnancies at a gestational age between 37+0 and 41+6 weeks in Sweden from 1999 to 2017. Data were collected from the Swedish Medical Birth register. Two study groups were compared-the elective induction group with the spontaneous labor onset group. The results showed that the rate of elective IOL increased from 7.2% in 1999 to 16.4% in 2017. Elective IOL was associated with a higher OR for chorioamnionitis, bacterial sepsis, intracranial hemorrhage, assisted ventilation, hyperbilirubinemia, APGAR<7 at 5 min, and neonatal seizures compared to deliveries with spontaneous labor onset. Regarding mortality outcomes, no significant differences were shown between the groups for either early term or full-term deliveries. We conclude that IOL is associated with neonatal complications, although causality could not be established in this observational study. It is important to be aware of the increased risk and perform IOL with caution.
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| 5. |
- Berg, Jenny, et al.
(author)
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Economic Evaluation of Elective Cesarean Section on Maternal Request Compared With Planned Vaginal Birth-Application to Swedish Setting Using National Registry Data
- 2023
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In: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 26:5, s. 639-648
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Journal article (peer-reviewed)abstract
- Objectives: There is a lack of consensus around the definition of delivery by cesarean section (CS) on maternal request, and clinical practice varies across and within countries. Previous economic evaluations have focused on specific populations and selected complications. Our aim was to evaluate the cost-effectiveness of CS on maternal request compared with planned vaginal birth in a Swedish context, based on a systematic review of benefits and drawbacks and national registry data on costs.Methods: We used the results from a systematic literature review of somatic risks for long-and short-term complications for mother and child, in which certainty was rated low, moderate, or high using the Grading of Recommendations Assessment, Development and Evaluation. Swedish national registry data were used for healthcare costs of delivery and complications. Utilities for long-term complications were based on a focused literature review. We constructed a decision tree and conducted separate analyses for primi-and multiparous women. Costs and effects were discounted by 3% and the time horizon was varied between 1 and 20 years.Results: Planned vaginal birth leads to lower healthcare costs and somatic health gains compared with elective CS without medical indication over up to 20 years. Although there is uncertainty around, for example, quality-of-life effects, results remain stable across sensitivity analyses.Conclusions: CS on maternal request leads to increased hospitalization costs in a Swedish setting, taking into account short -and long-term consequences for both mother and child. Future research needs to study the psychological consequences related to different delivery methods, costs in outpatient care, and productivity losses.
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| 6. |
- Berggren, Vanja, et al.
(author)
-
Infibulated women have an increased risk of anal sphincter tears at delivery : a population-based Swedish register study of 250 000 births
- 2013
-
In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 92:1, s. 101-108
-
Journal article (peer-reviewed)abstract
- Objective. To investigate the risk for anal sphincter tears (AST) in infibulated women. Design. Population-based cohort study. Setting. Nationwide study in Sweden. Population. The study population included 250 491 primiparous women with a vaginal singleton birth at 37–41 completed gestational weeks during 1999–2008. We only included women born in Sweden and in Africa. The African women were categorized into three groups; a Somalian-group, n = 929, where over 95% are infibulated; the Eritrea-Ethiopia-Sudan-group, n = 955, where the majority is infibulated, compared to other African countries, n = 1035, where few individuals are infibulated, but had otherwise similar anthropometric characteristics. These women were compared to 247 572 Swedish-born women. Methods. Register study with data from the National Medical Birth Registry. Main outcome measures. AST in non-instrumental and instrumental vaginal delivery. Results. Compared to Swedish-born women, women from Somalia had the highest odds ratio for AST in all vaginal deliveries: 2.72 (95% CI 2.08–3.54), followed by women from Eritrea-Ethiophia-Sudan 1.80 (1.41–2.32) and other African countries 1.23 (0.89–1.53) after adjustment for major risk factors. Mediolateral episiotomy was associated with a reduced risk of AST in instrumental deliveries. Conclusion. Delivering African women from countries where infibulation is common have an increased risk of AST compared with Swedish-born women, despite delivering in a highly technical quality healthcare setting. AST can cause anal incontinence and it is important to investigate risk factors for this and try to improve clinical routines during delivery to reduce the incidence of this complication.
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| 7. |
- Bråbäck, Lennart, et al.
(author)
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Confounding with familial determinants affects the association between mode of delivery and childhood asthma medication : a national cohort study
- 2013
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In: Allergy, Asthma & Clinical Immunology. - : BioMed Central. - 1710-1484 .- 1710-1492. ; 9:1, s. 14-
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Journal article (peer-reviewed)abstract
- BACKGROUND: Mode of delivery may affect the risk of asthma but the findings have not been consistent and factors shared by siblings may confound the associations in previous studies. METHODS: The association between mode of delivery and dispensed inhaled corticosteroid (ICS) (a marker of asthma) was examined in a register based national cohort (n=199 837). A cohort analysis of all first born children aged 2-5 and 6-9 years was performed. An age-matched sibling-pair analysis was also performed to account for shared genetic and environmental risk factors. RESULTS: Analyses of first-borns demonstrated that elective caesarean section was associated with an increased risk of dispensed ICS in both 2-5 (adjusted odds ratio (aOR)=1.19, 95% confidence interval (CI) 1.09-1.29) and 6-9 (aOR=1.21, 1.09-1.34) age groups. In the sibling-pair analysis, the increased risk associated with elective caesarean section was confirmed in 2-5 year olds (aOR=1.22, 1.05-1.43) but not in 6-9 year olds (aOR=1.06, 0.78-1.44). Emergency caesarean section and vacuum extraction had some association with dispensed ICS in the analyses of first-borns but these associations were not confirmed in the sibling-pair analyses. CONCLUSIONS: Confounding by familial factors affects the association between mode of delivery and dispensed ICS. Despite this confounding, there was some evidence that elective caesarean section contributed to a modestly increased risk of dispensed ICS but only up to five years of age.
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| 8. |
- Ekeus, Cecilia, et al.
(author)
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Epidural analgesia during labor among immigrant women in Sweden
- 2010
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 89:2, s. 243-249
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Journal article (peer-reviewed)abstract
- Objective. To investigate differences in the use of epidural analgesia (EDA) during labor between native Swedish and immigrant women and whether such possible differences could be explained by other maternal factors or birthweight. Design. Population-based register study. Setting. Nationwide study in Sweden. Population. A total of 455,274 primiparous women, who gave birth to a singleton infant at 37-41 completed gestational weeks during 1992-2005. Of the 72,086 (16%) immigrants, data on 31,148 women from the eight most common countries of origin were analyzed to test our hypotheses. Methods. Register study with perinatal data from the Medical Birth Register and socio-demographic variables from national income and population registers. Main outcome measure. Use of EDA during vaginal delivery. Results. Compared with native Swedish women, EDA was more often used by women from Chile, odds ratio (OR) 1.39 (95% confidence interval (CI) 1.23-1.57); Iran, OR 1.38 (1.26-1.53); Poland, OR 1.22 (1.08-1.37) and Finland, OR 1.10 (1.03-1.17) after adjustments for perinatal and socio-demographic confounders, while EDA was less often used among women from Somalia, OR 0.57 (0.46-0.70); Iraq, OR 0.71 (0.64-0.78); Turkey, OR 0.77(0.69-0.86) and Yugoslavia, OR 0.85 (0.79-0.91). Having a native Swedish partner increased the use of EDA in immigrant women. Conclusion. EDA use during labor varies more by maternal country of origin than by socio-economic factors. This suggests that expectations of care from the country of origin continue to influence the use of EDA after immigration to Sweden.
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| 9. |
- Ekéus, Cecilia, et al.
(author)
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Short stature, smoking habits and birth outcome in international adoptees in Sweden.
- 2008
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In: Acta Obstet Gynecol Scand. - : Wiley. - 1600-0412 .- 0001-6349. ; 87:12, s. 1309-14
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Journal article (peer-reviewed)abstract
- Short stature, smoking habits and birth outcome in international adoptees in Sweden.Ekéus C, Lindblad F, Hjern A.Department of Woman and Child Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden. cecilia.ekeus@ki.seOBJECTIVE: To investigate short stature and smoking habits as risk factors for birth outcome in international adoptees in comparison with non-adopted mothers. DESIGN: Prospective cohort study. SETTING: Nationwide study in Sweden. POPULATION: Two study groups were identified from mothers who were born 1968-1979 and gave birth during 1982-2001-3,610 mother-child dyads with a mother adopted from a non-European country and 336,992 mother-child dyads with a mother born in Sweden. METHOD: Register study. OUTCOME MEASURES: Pre-eclampsia, instrumental delivery, preterm delivery, small for gestational age (SGA), Apgar score, cephalhematoma and perinatal mortality and birth weight. RESULTS: Short stature and smoking were more common in international adoptees compared with non-adopted, odds ratios (ORs) 29.07 (95% C.I.: 25.29-33.42) and 1.39 (1.27-1.52), respectively. International adoptees had a slightly increased risk for instrumental delivery (OR: 1.42; 1.32-1.54) and preterm delivery (<37 weeks) (OR: 1.39; 1.24-1.56) and there was a slightly increased risk for SGA (OR: 1.24; 1.01-1.52) in their offspring. However, when we adjusted for maternal height, preterm delivery was the only outcome that remained statistically significant. Adjustment for smoking habits had marginal effects on all outcomes. CONCLUSION: The short stature of international adoptees increased their risk for delivery and birth complications in a predictable manner, but otherwise outcomes were very similar to the general population. No special obstetric monitoring is indicated by adoption status in itself.
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| 10. |
- Ekéus, Cecilia, et al.
(author)
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Stillbirth among foreign-born women in Sweden
- 2011
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In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 21:6, s. 788-792
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Journal article (peer-reviewed)abstract
- BACKGROUND: The aims of this study were: (i) to investigate stillbirth risk in offspring to foreign-born women by region of birth; (ii) if disparities in risks can be explained by socio-economic factors, pregnancy complications or maternal morbidity; and (iii) if the risk varies by time since immigration. METHODS: This was a population-based register study with data from the Swedish Medical Birth Register and socio-economic variables from national income and population registers. We studied single births from 1992 to 2005, and included 219 832 births to foreign-born women and 1 094 146 births to Swedish-born women. Logistic regression analysis was used to calculate odds ratios (ORs), using 95% confidence intervals (CIs). RESULTS: In all, 4104 antepartal and 255 intrapartal stillbirths occurred. Compared with births to Swedish women, the OR of stillbirth was 2.27 (95% CI 1.84-2.80) for births to women from Africa and 1.41 (95% CI 1.22-1.64) for births to women from Middle East, after adjustment for confounding factors. The risk of stillbirth was higher in immigrants who had been in Sweden for a short time period (<5 years) compared with those who had been in Sweden for a longer period, OR 1.21 (95% CI 1.05-1.40). CONCLUSIONS: The risk of stillbirth in immigrant women varies by region of birth and time since immigration, being highest in women from Africa and the Middle East, and the recently settled. Further studies are needed to identify the mechanisms behind these patterns.
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