| 1. |
- Ahlberg, Mia
(författare)
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Birth by vacuum extraction
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In Sweden, vacuum extraction (VE) is used in almost every tenth woman to facilitate vaginal birth. VE is an important obstetric instrument that is used when shortening of the second stage of labor is necessary. VE has been associated with increased neonatal morbidity such as extracranial and cranial injuries. The outcome of the VE depends on the right selection of patients and how the VE is performed. Despite its common use, little is known about the performance of VEs, how many extractions fail, and if failure is dangerous for the child. It is also unclear whether VE delivery has negative long-term consequences for the child. Materials and Methods: In Study I, we investigated clinical performance as described in medical records in 596 VE deliveries and compared this with recommendations in local practice guidelines for VE. Detailed data on performance was collected from six different delivery units, each contributing with information about 100 VEs performed in 2013. In Study II, we investigated if women delivered by VE receive adequate pain relief and the risk factors associated with not receiving pain relief. We identified 62,568 women delivered by VE between 1999 and 2008 in the Swedish Medical Birth Register (SMBR). In Study III, the aim was to investigate the incidence of failed VEs, risk factors for failure, and neonatal morbidity in failed VEs. We collected information on singleton pregnancies delivered at term (>36+6) by either a successful VE (n=83,671) or a failed VE (n= 4747) from the SMBR. Failed VE was defined as a VE attempt with a subsequent cesarean section (CS), the use of forceps, or both. In Study IV, the aim was to investigate if birth by VE affects cognitive development as indicated by school performance at sixteen years of age. We identified 126,032 infants born as singletons without major congenital malformations, in a vertex presentation at a gestational week of 34 or more, with Swedish-born parents, and delivered between 1990 and 1993 in the SMBR. These children were followed up at sixteen years of age in the school grade registry containing all final grades in compulsory school. Results: Clinical performances in VEs were mostly conducted according to evidence-based safe practice; however, in a few cases, inappropriate and potentially harmful performance was used. In 6% of all extractions, more than six pulls were used to deliver the infant, and in 2.3% the procedure took more than 20 minutes. Fourteen extractions (2.3%) were conducted from a high station in the maternal pelvis. The local practice guidelines on VE were incomplete and were not updated or evidence-based. Every third woman was delivered by VE without potent pain relief. VE failure occurred in 5.4% of cases. Identified risk factors for failure were for example nulliparity, fetal malposition, and mid-pelvic extractions. Failure with the extractor was associated with increased risks of subgaleal hematoma, convulsions, and low Apgar scores but not intracranial hemorrhage in the infant. Children delivered by VE had significantly lower mean mathematics test scores and mean merit grades than children born vaginally without instruments, after adjustment for major confounders. Infants delivered by emergency cesarean section had similar results as children delivered by VE. Conclusion: Improvements in the clinical performance of VEs can be accomplished, and practice guidelines need to be improved to support safe and evidence-based practice in VE procedures. In addition, more women should receive pain relief prior to the extraction. Failed VE can be dangerous for the child, and risk factors for failure should be closely evaluated prior to the extraction to avoid this dangerous situation. In the case of failure, a subsequent CS should be performed. Birth by VE has marginal negative effects on final school grades at 16 years of age compared with children born by spontaneous vaginal delivery. Similar marginal effects were found in children delivered by emergency CS, indicating that these lower grades are rather due to difficult labor occurring prior to birth and not to the instrument itself.
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| 2. |
- Ahlberg, Mia, et al.
(författare)
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Birth by vacuum extraction delivery and school performance at 16 years of age
- 2013
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 0002-9378 .- 1097-6868. ; 210:4, s. 361.e1-361.e8
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Tidskriftsartikel (refereegranskat)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. |
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| 4. |
- Elvander, Charlotte, et al.
(författare)
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Severe perineal trauma among women undergoing vaginal birth after cesarean delivery : A population-based cohort study
- 2019
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Ingår i: Birth. - : Wiley. - 0730-7659 .- 1523-536X. ; 46:2, s. 379-386
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Tidskriftsartikel (refereegranskat)abstract
- Background: To examine risk of severe perineal trauma among nulliparous women and those undergoing vaginal birth after cesarean delivery (VBAC). Methods: This is a population-based cohort study of all births to women with their two first consecutive singleton pregnancies in Stockholm-Gotland Sweden between 2008 and 2014. Risk of severe perineal trauma was compared between nulliparous women and those undergoing VBAC with severe perineal trauma being the main outcome measure. Associations between indication and timing of primary cesarean delivery and risk of severe perineal trauma in subsequent vaginal birth were analyzed using Poisson regression analysis. Results: The rate of severe perineal trauma among nulliparous women and those undergoing VBAC was 7.0% and 12.3%, respectively. Compared with nulliparous women, those undergoing VBAC were significantly older, had a shorter stature, and gave birth in a non-upright position to heavier infants with larger head circumferences. The rate of instrumental vaginal delivery among nulliparous women and those undergoing VBAC was 19.3% and 20.2%, respectively (P = 0.331). An increased risk of severe perineal trauma remained after adjustments among those undergoing VBAC (adjusted risk ratio 1.42, 95% CI 1.23-1.63). Level of risk was not associated with indication (dystocia or signs of fetal distress) of primary cesarean delivery, nor how far the woman had progressed in labor (fully dilated versus planned cesarean delivery) before delivering by cesarean. Conclusions: Compared with nulliparous women, those undergoing VBAC are at increased risk of severe perineal trauma, irrespective of indication and timing of primary cesarean delivery.
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| 6. |
- Ghouse, Jonas, et al.
(författare)
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Association of Variants Near the Bradykinin Receptor B2 Gene With Angioedema in Patients Taking ACE Inhibitors
- 2021
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Ingår i: Journal of the American College of Cardiology. - : Elsevier. - 0735-1097 .- 1558-3597. ; 78:7, s. 696-709
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Angioedema is a rare but potentially life-threatening adverse reaction associated with angiotensinconverting enzyme (ACE) inhibitors. Identification of potential genetic factors related to this adverse event may help identify at-risk patients. OBJECTIVES The aim of this study was to identify genetic factors associated with ACE inhibitor-associated angioedema. METHODS A genomewide association study involving patients of European descent, all taking ACE inhibitors, was conducted in a discovery cohort (Copenhagen Hospital Biobank), and associations were confirmed in a replication cohort (Swedegene). Cases were defined as subjects with angioedema events and filled prescriptions for ACE inhibitors #180 days before the events. Control subjects were defined as those with continuous treatment with ACE inhibitors without any history of angioedema. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed for angioedema risk using logistic mixed model regression analysis. Summary statistics from the discovery and replication cohorts were analyzed using a fixed-effects meta-analysis model. RESULTS The discovery cohort consisted of 462 cases and 53,391 ACE inhibitor-treated control subjects. The replication cohort consisted of 142 cases and 1,345 ACE inhibitor-treated control subjects. In the discovery cohort, 1 locus, residing at chromosome 14q32.2, was identified that associated with angioedema at the genomewide significance level of P <5 x 10-8. The lead variant at this locus, rs34485356, is an intergenic variant located 60 kb upstream of BDKRB2 (OR: 1.62; 95% CI: 1.38 to 1.90; P = 4.3 x 10-9). This variant was validated in our replication cohort with a similar direction and effect size (OR: 1.60; 95% CI: 1.13 to 2.25; P = 7.2 x 10-3). We found that carriers of the risk allele had significantly lower systolic (-0.46 mm Hg per T allele; 95% CI:-0.83 to-0.10; P = 0.013) and diastolic (-0.26 mm Hg per T allele; 95% CI:-0.46 to-0.05; P = 0.013) blood pressure. CONCLUSIONS In this genomewide association study involving individuals treated with ACE inhibitors, we found that common variants located in close proximity to the bradykinin receptor B2 gene were associated with increased risk for ACE inhibitor-related angioedema.
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| 7. |
- Johansson, Mia, 1977, et al.
(författare)
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"Setting boundaries" - Mental adjustment to cancer in laryngeal cancer patients: An interview study.
- 2012
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Ingår i: European journal of oncology nursing. - : Elsevier BV. - 1532-2122 .- 1462-3889. ; 16:4, s. 419-425
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To increase the understanding of mental adjustment responses in laryngeal cancer patients, as well as the outcome of these responses. Further, to evaluate the content validity of the Swedish version of the Mini-MAC (Mental Adjustment to Cancer) Scale with regard to findings from the patient interviews. METHOD: Data was collected with semi-structured interviews and analyzed using a constant comparison technique consistent with Grounded Theory. Eighteen participants were selected according to the idea of theoretical sampling. RESULTS: The core category arising was "Setting boundaries". This seemed to be a prerequisite for mental adjustment to diagnosis and treatment without major negative impact on mental health or health-related quality of life (HRQL). Five descriptive categories also emerged: Fighting Spirit; Avoidance; Comparisons; Anxious Preoccupation; and Social Interactions. When comparing these results with the domains of the Mini-MAC Scale, the Fighting Spirit, Cognitive Avoidance and Anxious Preoccupation domains were clearly represented. Concerning the Fatalism and the Hopeless-Helpless domains the support was somewhat weaker. CONCLUSION: Central theme of mental adjustment responses in laryngeal cancer patients was "Setting Boundaries", concerning above all patients' attitude to information and thoughts about the cancer. This response seems to be the dividing line between good and poor adjustment. The results emphasize the importance of adapting the information given and rehabilitation options to each individual patient. The findings largely support the Swedish version of the Mini-MAC, but some deviations were found which should be considered when interpreting results from the Mini-MAC in laryngeal cancer patients.
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| 8. |
- Liu, Can, et al.
(författare)
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Perinatal health of refugee and asylum-seeking women in Sweden 2014-17 : a register-based cohort study
- 2019
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 29:6, s. 1048-1055
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAn increasing number of migrants have fled armed conflict, persecution and deteriorating living conditions, many of whom have also endured risky migration journeys to reach Europe. Despite this, little is known about the perinatal health of migrant women who are particularly vulnerable, such as refugees, asylum-seekers, and undocumented migrants, and their access to perinatal care in the host country.MethodsUsing the Swedish Pregnancy Register, we analyzed indicators of perinatal health and health care usage in 31 897 migrant women from the top five refugee countries of origin between 2014 and 2017. We also compared them to native-born Swedish women.ResultsCompared to Swedish-born women, migrant women from Syria, Iraq, Somali, Eritrea and Afghanistan had higher risks of poor self-rated health, gestational diabetes, stillbirth and infants with low birthweight. Within the migrant population, asylum-seekers and undocumented migrants had a higher risk of poor maternal self-rated health than refugee women with residency, with an adjusted risk ratio (RR) of 1.84 and 95% confidence interval (95% CI) of 1.72–1.97. They also had a higher risk of preterm birth (RR 1.47, 95% CI 1.21–1.79), inadequate antenatal care (RR 2.56, 95% CI 2.27–2.89) and missed postpartum care visits (RR 1.15, 95% CI 1.10–1.22).ConclusionRefugee, asylum-seeking and undocumented migrant women were vulnerable during pregnancy and childbirth. Living without residence permits negatively affected self-rated health, pregnancy and birth outcomes in asylum-seekers and undocumented migrants. Pregnant migrant women’s special needs should be addressed by those involved in the asylum reception process and by health care providers.
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| 9. |
- Looft, Emelie, et al.
(författare)
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Duration of second stage of labour at term and pushing time : risk factors for postpartum haemorrhage
- 2017
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Ingår i: Paediatric and Perinatal Epidemiology. - Stockholm : Karolinska Institutet, Dept of Medicine, Solna. - 0269-5022 .- 1365-3016.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Prolonged labour is associated with increased risk of postpartum haemorrhage (PPH), but the role of active pushing time and the relation with management during labour remains poorly understood. METHODS: A population-based cohort study from electronic medical record data in the Stockholm-Gotland Region, Sweden. We included 57 267 primiparous women with singleton, term gestation, livebirths delivered vaginally in cephalic presentation in 2008-14. We performed multivariable Poisson regression to estimate the association between length of second stage, pushing time, and PPH (estimated blood loss >500 mL during delivery), adjusting for maternal, delivery, and fetal characteristics as potential confounders. RESULTS: The incidence of PPH was 28.9%. The risk of PPH increased with each passing hour of second stage: compared with a second stage <1 h, the adjusted relative risk (RR) for PPH were for 1 to <2 h 1.10 (95% confidence interval (CI) 1.07, 1.14); for 2 to <3 h 1.15 (95% CI 1.10, 1.20); for 3 to <4 h 1.28 (95% CI 1.22, 1.33); and for ≥4 h 1.40 (95% CI 1.33, 1.46). PPH also increased with pushing time exceeding 30 min. Compared to pushing time between 15 and 29 min, the RR for PPH were for <15 min 0.98 (95% CI 0.94, 1.03); for 30-44 min 1.08 (95% CI 1.04, 1.12); for 45-59 min 1.11 (95% CI 1.06, 1.16); and for ≥60 min 1.20 (95% CI 1.15, 1.25). CONCLUSIONS: Increased length of second stage and pushing time during labour are both associated with increased risk of PPH.
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| 10. |
- Lundborg, Louise, et al.
(författare)
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First stage progression in women with spontaneous onset of labor : A large population-based cohort study
- 2020
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Ingår i: PLOS ONE. - : Public Library Science. - 1932-6203. ; 15:9
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the duration, progression and patterns of first stage of labor among Swedish women.Design: Population-based cohort study.Population: Data from Stockholm-Gotland Obstetric Cohort 2008–2014 including ¼ of all births in Sweden, the final sample involved a total of 85,408 women with term, singleton, vertex, live fetuses experiencing spontaneous labor onset and vaginal delivery with normal neonatal outcomes.Main outcome measures: Time to progress during first stage of labor using three approaches: 1) Traverse time in hours to progress centimeter to centimeter, 5th, 50th (and 95th percentile); 2) Dilation curves for different percentiles, and; 3) Cumulative duration for the 95th percentile by parity and dilation at admission.Results: Variation in both the total duration and the trajectory of cervical change over time is large. Similar to the general held view, the rate of cervical dilation accelerates at 5–6 centimeters. Among nulliparous women, the median time found in our population was faster than their counterparts in studies conducted on American and African cohorts. Among nulliparous and multiparous women our data suggest that the median cervical change over time is faster than 1 cm per hour during the first stage of labor. However, traverse time of cervical change at and beyond the 95th percentile is longer than 1 cm per hour.Conclusions: Labor progression varies widely and labors experiencing a prolonged first stage can still result in normal outcomes. The assumption of 1 cm per hour cervical dilation rate for the first stage of labor may not be universally meaningful. There are differences in progression for women during first stage of labor in different populations. For prolonged labor progression to be more clinically meaningful, the association with adverse birth outcomes needs to be further investigated in specific populations.
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