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Nilsson, Kerstin
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Publications (10 of 48) Show all publications
Jansson, M., Nilsson, K. & Franzén, K. (2019). Development and validation of a protocol for documentation of obstetric perineal lacerations. International Urogynecology Journal, 30(12), 2069-2076
Open this publication in new window or tab >>Development and validation of a protocol for documentation of obstetric perineal lacerations
2019 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 30, no 12, p. 2069-2076Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION AND HYPOTHESIS: The aim of this study was to develop a new protocol for documentation of perineal lacerations and to validate the latter against the most common obstetric record system in Sweden. The hypothesis was that the new protocol would render more complete data on perineal lacerations than the current documentation method.

METHODS: A protocol for documentation of perineal lacerations was developed to be sufficiently comprehensive to serve research purposes. All women delivering their first child vaginally from 13 October 2015 to 1 February 2016 at Örebro University Hospital were eligible for the validation study. Perineal lacerations were documented using the protocol in parallel with the regular obstetric record system (ObstetriX). Cross tabulations were used to compare the coverage regarding perineal lacerations between the two documentation methods. McNemar's test was used to evaluate systematic differences between the methods.

RESULTS: A total of 187 women were included. The coverage of documentation regarding perineal laceration was significantly higher (p < 0.001) in the new protocol (89%) compared with ObstetriX (18%). Incidence of second-degree perineal tears was 26% according to the new protocol and 11% according to ObstetriX. The incidence of third-degree perineal tears A, B, and C was 2.7%, 2.1%, and 2.1%, respectively, according to the new protocol, and 3.2%, 2.7%, and 1.1% according to ObstetriX.

CONCLUSIONS: This validation study of a new documentation protocol showed that it delivered significantly more comprehensive information regarding perineal lacerations than the most common obstetric record system in Sweden.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Health administrative data, Obstetric anal sphincter injuries, Perineal tear, Validation studies
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-73244 (URN)10.1007/s00192-019-03915-y (DOI)30888454 (PubMedID)2-s2.0-85063196573 (Scopus ID)
Available from: 2019-03-20 Created: 2019-03-20 Last updated: 2019-12-11Bibliographically approved
Allbrand, M., Åman, J., Nilsson, K., Cao, Y. & Lodefalk, M. (2019). Expression of genes involved in inflammation and growth: does sampling site in human full-term placenta matter?. Journal of Perinatal Medicine, 47(5), 539-546
Open this publication in new window or tab >>Expression of genes involved in inflammation and growth: does sampling site in human full-term placenta matter?
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2019 (English)In: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 47, no 5, p. 539-546Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the placental gene expression of substances in the inflammatory cascade and growth factors at nine different well-defined sampling sites in full-term placentas from 12 normal weight healthy non-smoking women with an uncomplicated singleton pregnancy.

Methods: All placentas (six girls and six boys) were delivered vaginally. Quantitative real-time polymerase chain reaction was used to analyze toll receptor-2 and -4, interleukin-6 and -8, tumor necrosis factor-α, leptin, ghrelin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor (IR).

Results: The leptin gene and the IR gene showed higher expression in lateral regions near the chorionic plate compared to central regions near the basal plate (P = 0.028 and P = 0.041, respectively).

Conclusion: Our results suggest that the sampling site may influence the gene expression for leptin and IR in placental tissue obtained from full-term normal pregnancies. We speculate that this may be due to differences in placental structure and perfusion and may be important when future studies are designed.

Place, publisher, year, edition, pages
Walter de Gruyter, 2019
Keywords
Cytokines, gene expression, growth factors, placenta, sampling
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-73427 (URN)10.1515/jpm-2018-0290 (DOI)000473532900008 ()30920955 (PubMedID)2-s2.0-85063721684 (Scopus ID)
Note

Funding Agencies:

Research Committee of Region Örebro County  

Nyckelfonden, Örebro University Hospital  

Available from: 2019-04-04 Created: 2019-04-04 Last updated: 2019-08-08Bibliographically approved
Wijk, L., Ljungqvist, O. & Nilsson, K. (2019). Female sex hormones in relation to insulin resistance after hysterectomy: A pilot study. Clinical Nutrition, 38(6), 2721-2726
Open this publication in new window or tab >>Female sex hormones in relation to insulin resistance after hysterectomy: A pilot study
2019 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, no 6, p. 2721-2726Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIM: Surgery causes development of insulin resistance. Women undergoing hysterectomy have different female sex hormonal status, ranging from premenopausal to postmenopausal. The aim of the study was to explore the relation between the female sex hormones and insulin resistance (IR%) after hysterectomy.

METHODS: A secondary analysis from a randomised controlled single-centre study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women were randomised to robot-assisted laparoscopic or abdominal hysterectomy. Blood were drawn before and after surgery for measurement of oestrogens, progesterone, and gonadotropins alongside determination of insulin sensitivity using the hyperinsulinemic normolycaemic clamp.

RESULTS: Female sex hormonal status was not correlated to insulin sensitivity before operation. Premenopausal women developed more IR% than postmenopausal women (p = 0.012). Premenopausal women also showed a significant decrease in absolute levels of oestradiol (E2) (p = 0.016), and the relative decrease in E2 from preoperative to postoperative values (E2%) was significantly higher (p = 0.001). There was a significant positive correlation in the entire study population between E2% and IR% (r = 0.72, p = 0.001, r2 0.51) that remained when adjusted for age (p = 0.028), BMI (p = 0.001), and preoperative insulin sensitivity (p = 0.011) separately.

CONCLUSIONS: Premenopausal women developed a higher degree of postoperative insulin resistance that was associated with a parallel relative change in oestradiol levels compared with the postmenopausal women. It remains unclear whether these are independent phenomena in the overall stress response or whether a causal relationship exists.

Place, publisher, year, edition, pages
Churchill Livingstone, 2019
Keywords
Female sex hormones, Hysterectomy, Insulin resistance, Oestrogen
National Category
Clinical Medicine Surgery
Identifiers
urn:nbn:se:oru:diva-71432 (URN)10.1016/j.clnu.2018.11.027 (DOI)30573354 (PubMedID)2-s2.0-85058499475 (Scopus ID)
Note

Funding agencies:

Stiftelsen för Gynekologisk Onkologi

Nyckelfonden

Lisa och Johan Grönbergs Stiftelse

Available from: 2019-01-12 Created: 2019-01-12 Last updated: 2019-12-11Bibliographically approved
Jansson, M., Cao, Y., Nilsson, K., Larsson, P.-G. & Hagberg, L. (2018). Cost-effectiveness of antibiotic prophylaxis in elective cesarean section. Cost Effectiveness and Resource Allocation, 16, Article ID 66.
Open this publication in new window or tab >>Cost-effectiveness of antibiotic prophylaxis in elective cesarean section
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2018 (English)In: Cost Effectiveness and Resource Allocation, ISSN 1478-7547, E-ISSN 1478-7547, Vol. 16, article id 66Article in journal (Refereed) Published
Abstract [en]

Background: The proportion of pregnant women delivered by cesarean section has increased steadily during the past three decades. The risk of infection is 10-fold augmented after elective cesarean section compared to vaginal delivery. Antibiotic prophylaxis may reduce endometritis by 62% and superficial wound infection by 38% after elective cesarean section. International guidelines recommend antibiotic prophylaxis in elective cesarean section, but this procedure is not routinely followed in Sweden. Studies of costs of antibiotic prophylaxis in cesarean section show conflicting results and are based on substantially different incidence of postoperative infections. No study of costs of antibiotic prophylaxis in elective cesarean section in a Swedish or Nordic context has been pursued. The aim of this study was to investigate if antibiotic prophylaxis is cost-reducing in elective cesarean section in orebro County, Sweden.

Methods: All women undergoing elective cesarean in the Region orebro County health care system during 2011-2012 were eligible for inclusion. Postoperative infections and risk factors for infections were registered. A hypothetical situation in which all participants had received antibiotic prophylaxis was compared to the actual situation, in which none of them had received antibiotic prophylaxis. The reduction in the risk of postoperative infections resulting from antibiotic prophylaxis was based on a meta-analysis. Costs for in-patient care of postoperative infections were extracted from the accounting system, and costs for out-patient care were calculated according to standard costs. Costs for antibiotic prophylaxis were calculated and compared with the cost reduction that would be implied by the introduction of such prophylaxis.

Results: The incidences of deep and superficial surgical site infection were 3.5% and 1.3% respectively. Introduction of antibiotic prophylaxis would reduce health care costs by 31 Euro per cesarean section performed (95% credible interval 4-58 Euro). The probability of cost-saving was 99%.

Conclusions: Antibiotic prophylaxis in elective cesarean section is cost-reducing in this health care setting. Our results indicate that the introduction of antibiotic prophylaxis in elective cesarean section can also be cost-saving in low infection rate settings.

Trial registration Ethical approval was given by the Regional Ethical Review Board in Uppsala (registration number 2013/484).

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Cesarean section, Surgical wound infection, Antibiotic prophylaxis, Costs and cost analysis
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-71239 (URN)10.1186/s12962-018-0168-x (DOI)000453740600001 ()30574024 (PubMedID)2-s2.0-85058818087 (Scopus ID)
Available from: 2019-01-09 Created: 2019-01-09 Last updated: 2019-01-09Bibliographically approved
Wijk, L., Nilsson, K. & Ljungqvist, O. (2018). Metabolic and inflammatory responses and subsequent recovery in robotic versus abdominal hysterectomy: A randomised controlled study. Clinical Nutrition, 37(1), 99-106
Open this publication in new window or tab >>Metabolic and inflammatory responses and subsequent recovery in robotic versus abdominal hysterectomy: A randomised controlled study
2018 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 1, p. 99-106Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: Surgery causes inflammatory and metabolic responses in the body. The aim of the study was to investigate whether robotic-assisted total laparoscopic hysterectomy induces less insulin resistance than abdominal hysterectomy, and to compare inflammatory response and clinical recovery between the two techniques.

METHODS: A randomised controlled study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women scheduled for a planned total hysterectomy with or without salpingo-oophorectomy between October 2014 and May 2015, were randomly allocated to robotic-assisted total laparoscopic hysterectomy or abdominal hysterectomy. Insulin resistance after surgery was measured by the hyperinsulinemic normoglycaemic clamp method, inflammatory response measured in blood samples, and clinical recovery outcomes registered.

RESULTS: There were no differences in development of insulin resistance between the robotic group and the abdominal group (mean ± SD: 39% ± 22 vs. 40% ± 19; p = 0.948). The robotic group had a significantly shorter hospital stay (median 1 vs. 2 days; p = 0.005). Inflammatory reaction differed; in comparison to the robotic group, the abdominal group showed significantly higher increases in serum interleukin 6 levels, white blood cell count and cortisol from preoperative values to postoperative peak values.

CONCLUSIONS: Robotic laparoscopic surgery reduced inflammatory responses and recovery time, but these changes were not accompanied by decreased insulin resistance.

CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov Identifier no NCT02291406.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Robotic-assisted hysterectomy; Insulin resistance; Hysterectomy; Inflammatory response
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-58062 (URN)10.1016/j.clnu.2016.12.015 (DOI)000425564200010 ()28043722 (PubMedID)
Note

Funding Agencies:

Research Committee of Örebro County Council

Nyckelfonden

Stiftelsen Gynekologisk Onkologi

Lisa och Göran Grönbergs Stiftelse

Available from: 2017-06-16 Created: 2017-06-16 Last updated: 2018-08-16Bibliographically approved
Alexopoulou, S., Fart, F., Jonsson, A.-S., Karni, L., Kenalemang, L. M., Krishna, S., . . . Widell, B. (2018). Successful ageing in an interdisciplinary context: popular science presentations. Örebro: Örebro University
Open this publication in new window or tab >>Successful ageing in an interdisciplinary context: popular science presentations
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2018 (English)Book (Other (popular science, discussion, etc.))
Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 127
National Category
Gerontology, specialising in Medical and Health Sciences Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:oru:diva-66306 (URN)978-91-87789-18-2 (ISBN)
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2019-03-26Bibliographically approved
Rönnberg, A.-K., Hanson, U. & Nilsson, K. (2017). Effects of an antenatal lifestyle intervention on offspring obesity: a 5-year follow-up of a randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica, 96(9), 1093-1099
Open this publication in new window or tab >>Effects of an antenatal lifestyle intervention on offspring obesity: a 5-year follow-up of a randomized controlled trial
2017 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 9, p. 1093-1099Article in journal (Refereed) Published
Abstract [en]

Introduction: Strategies to limit excessive maternal gestational weight gain could also have positive health effects for the offspring. This study informs us on the effect of an antenatal lifestyle intervention on offspring body mass index (BMI) trajectory until age five.

Material and methods: A secondary analysis of a randomized controlled trial aimed at reducing gestational weight gain, set in Orebro, Sweden (Clinical Trials.gov Id NCT00451425). Offspring were followed with standardized measures of weight and height until age five. Mean BMI z-score and proportion (%) of over- and undernutrition (BMI z-score > 2 standard deviations) was compared between groups. Risk estimates for obesity at age five were analyzed in relation to maternal gestational weight gain and prepregnancy BMI as a secondary outcome.

Results: We analyzed 374 children at birth and 300 at age five. No significant difference in mean BMI z-score was seen at birth (0.68 (I) vs 0.56 (C), p = 0.242) or at age five (0.34 (I) vs 0.26 (C), p = 0.510) and no significant difference in proportion of over- or undernutrition was seen. Excessive maternal gestational weight gain was an independent risk factor for offspring obesity at birth (OR = 4.51, p < 0.001) but not at age five. Maternal obesity was an independent risk factor for offspring obesity at age five (OR = 4.81, p = 0.006).

Conclusions: Our composite antenatal lifestyle intervention did not significantly reduce the risk of obesity in offspring up until age five.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Exercise, midwifery, obesity, pregnancy, prenatal care
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:oru:diva-60594 (URN)10.1111/aogs.13168 (DOI)000407745700009 ()2-s2.0-85020964495 (Scopus ID)
Note

Funding Agency:

Research Committee at Örebro County Council

Available from: 2017-09-05 Created: 2017-09-05 Last updated: 2018-08-05Bibliographically approved
Rönnberg, A., Hanson, U., Östlund, I. & Nilsson, K. (2016). Effects on postpartum weight retention after antenatal lifestyle intervention: a secondary analysis of a randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica, 95(9), 999-1007
Open this publication in new window or tab >>Effects on postpartum weight retention after antenatal lifestyle intervention: a secondary analysis of a randomized controlled trial
2016 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 9, p. 999-1007Article in journal (Refereed) Published
Abstract [en]

Introduction: High weight retention after pregnancy is related to an increased risk of future obesity. The objective was to evaluate if an antenatal intervention, compared to standard care, could reduce postpartum weight retention (PPWR).

Material and methods: Women with body mass index >19, age ≥18 years, knowledge of Swedish, and pregnancy ≤16 weeks' gestation were randomized. Standard care was compared to a composite intervention including a personalized weight graph, education on recommended weight gain, prescription of exercise, and monitoring of weight until one year after delivery. Mean (kg) PPWR was compared between the groups and risk estimates (odds ratio) for excessive weight retention were calculated.

Results: Of 445 women randomized, 267 remained for analysis at ≤16 weeks postpartum and 168 at one year postpartum. The intervention group had a significantly lower mean PPWR at ≤16 weeks (1.81 kg (standard deviation, SD, 4.52) vs. 3.19 kg (SD 4.77), p=0.016). At one year postpartum, mean retention was still 0.7 kg lower in the intervention group (0.30 kg (SD 5.52) vs. 1.00 kg (SD 5.46)), the difference was not statistically significant (p=0.414). Gestational weight gain above Institute of Medicine recommendations was a significant risk factor for excessive weight retention (>5 kg) one year after delivery (OR 2.44; 95% CI; 1.08-5.52, p=0.029).

Conclusions: A composite lifestyle intervention during pregnancy reduced short-term weight retention, but the effect of the intervention did not remain at one year postpartum. A gestational weight gain above Institute of Medicine recommendations increases the risk of excessive long-term weight retention.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
Prenatal care, obesity, women´s health issues, pregnancy
National Category
Obstetrics, Gynecology and Reproductive Medicine Nutrition and Dietetics
Identifiers
urn:nbn:se:oru:diva-49940 (URN)10.1111/aogs.12910 (DOI)000386782100007 ()27100375 (PubMedID)2-s2.0-84982221108 (Scopus ID)
Note

Funding Agency:

Research Committee at Orebro County Council

Available from: 2016-04-26 Created: 2016-04-26 Last updated: 2018-07-10Bibliographically approved
Wijk, L., Franzén, K., Ljungqvist, O. & Nilsson, K. (2016). Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease. Gynecologic and Obstetric Investigation, 81(5), 461-467
Open this publication in new window or tab >>Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease
2016 (English)In: Gynecologic and Obstetric Investigation, ISSN 0378-7346, E-ISSN 1423-002X, Vol. 81, no 5, p. 461-467Article in journal (Refereed) Published
Abstract [en]

Background: The enhanced recovery after surgery (ERAS) protocol combines unimodal evidence-based interventions aiming to enhance recovery after surgery and reduce length of stay (LOS). We introduced an ERAS protocol in gynecological surgery and compared outcomes after hysterectomies performed for malignant vs. benign indications.

Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Örebro University Hospital, Sweden, among 121 consecutive patients undergoing abdominal hysterectomy and salpingo-oophorectomy for malignant (n = 40) or benign (n = 81) indications between 2012 and 2014. Clinical data were prospectively collected and extracted from the patient records and from a specific database. The primary outcomes were LOS and proportion of patients achieving target LOS (2 days).

Results: Patients operated for malignant vs. benign disease did not differ significantly in terms of LOS (2 (1-5) vs. 2 (1-11) days; p = 0.505), proportion discharged at target LOS (62 vs. 69%; p = 0.465; OR 0.74, 95% CI 0.3-1.6), complications (2 vs. 7% in primary stay, 8 vs. 11% within 30 days after discharge), re operations (0 vs. 2%), or readmissions (2 vs. 1%).

Conclusion: The ERAS protocol may be equally applicable to patients undergoing hysterectomy either for a malignant or for a benign disease.

Place, publisher, year, edition, pages
Basel: S. Karger, 2016
Keywords
ERAS, Fast-track, Hysterectomy, Length of stay, Perioperative care
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-53181 (URN)10.1159/000443396 (DOI)000384034700012 ()26799328 (PubMedID)2-s2.0-84955604181 (Scopus ID)
Note

Funding Agencies:

Research Committee of Örebro County Council

Nyckelfonden, Örebro, Sweden

Available from: 2016-10-24 Created: 2016-10-24 Last updated: 2018-07-17Bibliographically approved
Wijk, L., Nilsson, K. & Ljungqvist, O. (2016). Robotic versus abdominal hysterectomy; metabolic and inflammatory responses and subsequent recovery: A randomised controlled study. Clinical Nutrition ESPEN, 12, Article ID e47.
Open this publication in new window or tab >>Robotic versus abdominal hysterectomy; metabolic and inflammatory responses and subsequent recovery: A randomised controlled study
2016 (English)In: Clinical Nutrition ESPEN, ISSN 2405-4577, Vol. 12, article id e47Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim was to study if robotic assisted total hysterectomy (RTLH) would induce less insulin resistance than abdominal hysterectomy (AH). In addition, inflammatory response and clinical recovery were compared.

Methods: We conducted a randomised controlled study at the Department of Obstetrics & Gynaecology, Örebro University Hospital; Sweden. Twenty women scheduled for a planned total hysterectomy with or without salpingo-oophorectomy, between October 2014 and May 2015, were randomly allocated to robotic assisted laparoscopic hysterectomy or abdominal hysterectomy. Insulin resistance after surgery was measured by the hyperinsulinemic normoglycemic clamp method. Inflammatory response was measured in blood samples and clinical recovery outcomes registered.

Results: There were no differences in development of insulin resistance (mean ± SD) for robotic group (39±22%) vs abdominal group (40±19%; p=0.948). The robotic group had a significantly shorter hospital stay (median 1 vs. 2 days, p=0.005). Inflammatory reaction differed in form of significantly greater increase in serum interleukin 6 levels and white blood cell count, from preoperative value to postoperative peak value, in abdominal group compared with robotic group.

Conclusion: Robotic assisted hysterectomy reduced inflammatory responses and recovery time but these changes were not accompanied by less insulin resistance.

Place, publisher, year, edition, pages
Elsevier, 2016
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-63764 (URN)10.1016/j.clnesp.2016.02.055 (DOI)28531718 (PubMedID)
Available from: 2018-01-03 Created: 2018-01-03 Last updated: 2019-02-01Bibliographically approved
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