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  • 1.
    Adolfsson, Annsofie
    et al.
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Berterö, Carina
    Division of Nursing Science, Department of Medicine and Care, Faculty of Health Science, Linköping University, Linköping, Sweden.
    Larsson, Per-Göran
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Effect of a structured follow-up visit to a midwife on women with early miscarriage: a randomized study2006Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, nr 3, s. 330-335Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Women's grief after miscarriage is substantial and important. Women who experience early miscarriage do not constitute a homogenous group. The aim of this study is to measure whether a structured follow-up visit to a midwife (group 1) at 21-28 days after early miscarriage could reduce the women's grief, measured using the perinatal grief scale Swedish short version (PGS) after a further 3 months (i.e. 4 months after the miscarriage), compared to a regular follow-up visit to a midwife (group 2).

    Methods: We performed an open randomized study of women who experienced early miscarriage (n = 88). The midwife's attitude in group 1 came from Swanson science theory of midwifery. In group 2, the women were offered only the ordinary type of consultation at a regular visit. A questionnaire with the PGS was used in both groups. Four months after the miscarriage, a second questionnaire with the same perinatal grief scale was sent by post.

    Results: There was a 30% greater reduction in grief in group 1 than that in group 2, when comparing the first and second measurements (not significant). The biggest differences were in the subscales active grief and difficulty in coping. Women with the subdiagnosis missed abortions had, as a group, significantly higher PGS scores at both visits, especially in active grief and difficulty in coping, regardless of the type of follow-up visit.

    Conclusions: A structured follow-up visit did not, in comparison with a regular follow-up visit, imply any significant reduction in grief as measured using the PGS scale. However, the subgroup missed abortion had more extensive grief than the other women with miscarriage. Structured follow-up visits are not imperative for all women with early miscarriage.

  • 2. Adolfsson, Annsofie
    et al.
    Larsson, Per-Göran
    Cumulative incidence of previous spontaneous abortion in Sweden in 1983-2003: a register study2006Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, nr 6, s. 741-747Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study is to find out how common miscarriages are among women who have delivered a child. METHODS: The numbers of deliveries and miscarriages were extracted from the Swedish Medical Birth Register between 1983 and 2003. Linear regression was performed in order to investigate whether the increasing mean age of mothers or differences in pregnancy identification methods could explain the increased frequency of miscarriage. RESULTS: The reported number of miscarriages increased each year during the 21-year period, with a marked increase between 1991 and 1993 and only a slight increase during the final 10 years. For primiparous women, the frequency of reported miscarriages per delivery increased from 8.6% in 1983 to 13.9% in 2003. The corresponding figures for 2-parous women showed an increase from 14.5% to 21.3% respectively. Women aged 30-34 years had an odds ratio of 1.43 (95% CI 1.40-1.45) to suffer spontaneous abortion compared to the age group 25-29 years. Linear regression showed that an increase in mean age at delivery could only partly explain the increase in the frequency of reported miscarriages. A possible explanation could be differences in methods of identifying early pregnancy. CONCLUSION: Of all women who deliver a child, nearly 20% have experienced previous miscarriage. The increased mean age of women could only explain a small portion of the seen increase in miscarriage. The marked increase from 1991 to 1993 is interesting. Possible reasons for the increase are discussed.

  • 3.
    Adolfsson, Annsofie
    et al.
    Department of Obstetrics and Gynecology, Central Hospital Skövde, Skövde, Sweden; School of Life Sciences, University of Skövde, Skövde, Sweden.
    Tullander-Tjörnstrand, Karin
    Department of Obstetrics and Gynecology, Central Hospital Skövde, Skövde, Sweden.
    Larsson, Per-Göran
    Department of Obstetrics and Gynecology, Central Hospital Skövde, Skövde, Sweden; School of Life Sciences, University of Skövde, Skövde, Sweden.
    Decreased need for emergency services after changing management for suspected miscarriage2011Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, nr 8, s. 921-923Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 4. Crafoord, Kristina
    et al.
    Sydsjö, Adam
    Nilsson, Kerstin
    Örebro universitet, Institutionen för klinisk medicin.
    Kjølhede, Preben
    Primary surgery of genital prolapse: a shift in treatment tradition2006Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, nr 9, s. 1104-1108Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The use of complete repairs in genital prolapse surgery has been questioned because of the possible adverse effects of the surgery on the urogenital and sexual function and selective repairs have been advocated. The aims of this study were to establish information about genital prolapse surgery and to analyze whether a shift from extensive prolapse surgery with complete repairs to selective repairs occurred during a 10-year period. METHODS: A retrospective study of 610 consecutive patients operated upon for genital prolapse during 1983 (Period I) and 1993 (Period II) in a sample of three Swedish hospitals was conducted. Data were obtained from the patient records. 542 women had primary surgery and were analyzed with emphasis on demographic, clinical, and surgical data. RESULTS: The demographic and clinical data of the patients showed no significant differences between the two periods. In Period I, 69% of the patients underwent complete repair compared with 37% in Period II (p<0.001). The proportion of prolapse operations without posterior colporrhaphy increased significantly from the first to the second period from 14 to 43% (p<0.001). CONCLUSION: The surgery for genital prolapse seems to have changed from complete repairs towards selective repairs and posterior colporrhaphy was more often avoided in the second period. The implication of this shift in surgical treatment on pelvic floor function is not known. Further studies are needed to disclose the effect of the surgery on pelvic floor function and dysfunction in the long term.

  • 5.
    Fadl, Helena E.
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Gärdefors, Susanne
    Department of Obstetrics and Gynecology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Hjertberg, Ragnhild
    UltraGyn Clinic, Stockholm, Sweden.
    Nord, Eva
    Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
    Persson, Bengt
    Karolinska Institute, Stockholm, Sweden.
    Schwarcz, Erik
    Department of Internal Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden .
    Åman, Jan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid K.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Hanson, Ulf S. B.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Children’s and Women’s Health, Uppsala University, Uppsala, Sweden.
    Randomized controlled study in pregnancy on treatment of marked hyperglycemia that is short of overt diabetes2015Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, nr 11, s. 1181-1187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: A randomized multicenter study was conducted in the Stockholm-orebro areas in Sweden to evaluate how treatment aiming at normoglycemia affects fetal growth, pregnancy and neonatal outcome in pregnant women with severe hyperglycemia.

    Material and methods: Pregnant women with hyperglycemia defined as fasting capillary plasma glucose <7.0 mmol/L and a two-hour plasma glucose value 10.0 and <12.2 mmol/L following a 75-g oral glucose tolerance test (OGTT) diagnosed before 34 weeks of gestation were randomized to treatment (n=33) or controls (n=36). Women assigned to the control group were blinded for the OGTT results and received routine care. The therapeutic goal was fasting plasma glucose 4-5 mmol/L, and <6.5 mmol/L after a meal. Primary outcomes were size at birth and number of large-for-gestational age (>90th percentile) neonates. Secondary outcomes were pregnancy complications, neonatal morbidity and glycemic control.

    Results: The planned number of participating women was not reached. There was a significantly reduced rate of large-for-gestational age neonates, 21 vs. 47%, P<0.05. Group differences in pregnancy complications and neonatal morbidity were not detected because of limited statistical power. In total, 66.7% of the women in the intervention group received insulin. Of all measured plasma glucose values, 64.1% were in the target range, 7.2% in the hypoglycemic range and 28.7% above target values. There were no cases of severe hypoglycemia.

    Conclusions: Aiming for normalized glycemia in a pregnancy complicated by severe hyperglycemia reduces fetal growth but is associated with an increased rate of mild hypoglycemia.

  • 6.
    Fadl, Helena
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Maternal Health Care Unit, Primary Care, Örebro County, Örebro, Sweden; Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid K. M.
    Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Women’s and Children’ Health, Uppsala University, Uppsala, Sweden.
    Outcomes of gestational diabetes in Sweden depending on country of birth2012Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, nr 11, s. 1326-1330Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 7.
    Franzén, Karin
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Johansson, Jan-Erik
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Karlsson, Jan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Nilsson, Kerstin
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Validation of the Swedish version of the incontinence impact questionnaire and the urogenital distress inventory2013Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, nr 5, s. 555-561Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 8.
    Hogström, Lars
    et al.
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Johansson, Marianne
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Health Sciences, University of Borås, Borås, Sweden.
    Janson, Per Olof
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Francis, Jynfiaf
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sogn, Jan
    Department of Obstetrics and Gynecology, Central Hospital, Uddevalla, Sweden.
    Hellström, Anna-Lena
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden; School of Life Sciences, University of Skövde, Skövde, Sweden.
    Quality of life after adopting compared with childbirth with or without assisted reproduction2012Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, nr 9, s. 1077-1085Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 9.
    Hägglund, Doris
    et al.
    Örebro universitet, Hälsoakademin.
    Walker-Engström, Marie-Louise
    Larsson, Gregor
    Leppert, Jerzy
    Quality of life and seeking help in women with urinary incontinence2001Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 80, nr 11, s. 1051-1055Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    The aims of this population-based study were to compare the quality of life (QoL) in; (a) women with urinary incontinence (UI) and women without urinary incontinence (wUI) in relation to age, (b) women with stress incontinence and women with urge incontinence, and (c) women who had, vs. women who had not, consulted a health care service because of UI.

    METHODS:

    Totally, 787 women who reported symptoms of UI and 787 women who did not report symptoms of UI, aged 18-72 years, were mailed the Short Form-36 QoL questionnaire (SF-36) and a question concerning professional consultation. They were also mailed the Detrusor Instability Score questionnaire, which was used to clarify the women as being stress vs. urge incontinent.

    RESULTS:

    Women with UI had significantly lower scores on all eight dimensions of the SF-36. There were low correlations between age and the QoL scores in women with or without UI. Both women with stress incontinence and women with urge incontinence had significantly lower scores on all eight QoL dimensions compared with the women without UI. However, the absolute difference was smaller for women with stress incontinence. Women with urge incontinence consult health care service more often than women with stress incontinence. Women with UI who had consulted health care had significantly lower QoL scores than women with UI who had not consulted health care in seven out of eight dimensions.

    CONCLUSIONS:

    The QoL, in this female general population, is more affected by women with urge incontinence than women with stress incontinence. Help seeking is associated with substantially lower QoL scores and with urge incontinence.

  • 10.
    Johansson, Marianne
    et al.
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden,.
    Adolfsson, Annsofie
    Berg, Marie
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Francis, Jynfiaf
    Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hogström, Lars
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Janson, Per Olof
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sogn, Jan
    Department of Obstetrics and Gynecology, Central Hospital, Uddevalla, Sweden.
    Hellström, Anna-Lena
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Gender perspective on quality of life, comparisons between groups 4-5.5 years after unsuccessful or successful IVF treatment2010Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, nr 5, s. 683-691Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe and compare quality of life in men and women who had in vitro fertilization (IVF) within the Swedish public health system 4-5.5 years previously, either unsuccessfully and were subsequently living without children, or successfully, having children aged 4-5.5 years. These groups were compared to a control group of men and women with children born at the same time as in the successful group.

    DESIGN: Cross-sectional study.

    SETTING: Reproductive Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.

    SAMPLE: Twenty-six men and 37 women in the unsuccessful group, 135 men and 154 women in the successful group and 93 men and 118 women in the control group.

    METHODS: Questionnaire study. The respective gender differences were studied in the control and study groups.

    MAIN OUTCOME MEASURES: Psychological general well-being (PGWB), sense of coherence (SOC), experience of infertility, demographic-socio-economic, and health characteristics.

    RESULTS: Men in the unsuccessful IVF group scored lower in total PGWB and SOC indices than the successful group men. They reported more depression, lower PGWB and lower SOC than the control group men. Women in the unsuccessful IVF group reported more anxiety, depression, and lower SOC than the successful group women and more depression and lower SOC indices than control group women. Men and women in the unsuccessful IVF group did not differ in any of the parameters. Men in the successful IVF group had higher PGWB, less signs of depression and more self-confidence than women in that group.

    CONCLUSION: Quality of life in men seems more negatively affected by involuntary infertility than reported in earlier studies.

  • 11.
    Johansson, Marianne
    et al.
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Adolfsson, Annsofie
    Berg, Marie
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Francis, Jynfiaf
    Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hogström, Lars
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Janson, Per Olof
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sogn, Jan
    Department of Obstetrics and Gynecology, Central Hospital, Uddevalla, Sweden.
    Hellström, Anna-Lena
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Quality of life for couples 4-5.5 years after unsuccessful IVF treatment2009Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, nr 3, s. 291-300Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe quality of life in men and women who had terminated in vitro fertilization (IVF) within the public health system 4-5.5 years previously, and for whom treatment did not result in childbirth.

    DESIGN: Cross-sectional study.

    SETTING: Reproductive Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.

    SAMPLE: Four hundred pairs were invited to participate, 71% accepted and 68% completed questionnaires.

    METHODS: Questionnaire study. Study subgroups were compared with a control group with children and with each other.

    MAIN OUTCOME MEASURE: Psychological General Well-Being (PGWB), Sense of Coherence (SOC), experience of infertility, demographic-socio-economic and health characteristics were measured.

    RESULTS: Surprisingly, 76.7% had or lived together with children; 39.6% had biological children, 34.8% had adopted and 3.7% were parents to both biological and adopted children. No differences were found between the study and the control groups, except in SOC which scored lower in the study group. The study group with children had a higher PGWB index than the 23.3% without children and the controls. SOC scored higher in the subgroup with than those without children. Infertility was still a central issue in the subgroup without children.

    CONCLUSION: Despite having undergone unsuccessful IVF within the public health system, more than 75% lived with children 4-5.5 years later. This subgroup had a better quality of life, compared to those without children. Additional IVF treatment may result in increased quality of life.

  • 12. Jonsson, Maria
    et al.
    Nordén-Lindeberg, Solveig
    Östlund, Ingrid
    Örebro universitet, Institutionen för klinisk medicin.
    Hanson, Ulf
    Örebro universitet, Hälsoakademin.
    Acidemia at birth, related to obstetric characteristics and to oxytocin use, during the last two hours of labor2008Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, nr 7, s. 745-750Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. Evaluate obstetric characteristics during the last two hours of labor in neonates born with acidemia. Design. Case-control study. Setting. Delivery units at two university hospitals in Sweden. Study population. Out of 28,486 deliveries during 1994-2004, 305 neonates had an umbilical artery pH value <7.05 at birth. Methods. Cases: neonates with an umbilical artery pH < 7.05. Controls were neonates with pH ≥ 7.05 and an Apgar score ≥7 at 5 minutes. Obstetric characteristics, cardiotocographic patterns and oxytocin treatment during the last two hours of labor were recorded. Results. In the univariate analysis, ≥6 contractions/10 minutes (odds ratio (OR) 4.94, 95% confidence interval (CI) 3.25-7.49), oxytocin use (OR 2.20, 95% CI 1.66-2.92), bearing down ≥45 minutes (OR 1.77, 95% CI 1.31-2.38) and occipito-posterior position (OR 2.18, 95% CI 1.19-3.98) were associated with acidemia at birth. In the multivariate analysis, only ≥6 contractions/10 minutes (OR 5.36, 95% CI 3.32-8.65) and oxytocin use (OR 1.89, 95% CI 1.21-2.97) were associated with acidemia at birth. Among cases with ≥6 contractions/10 minutes, 75% had been treated with oxytocin. Pathological cardiotocographic patterns occurred in 68.8% of cases and in 26.1% of controls (p<0.001). Conclusion. A hyperactive uterine contraction pattern and oxytocin use are the most important risk factors for acidemia at birth. The increased uterine activity was related to overstimulation in the majority of cases. The duration of bearing down is less important when uterine contraction frequency has been considered.

  • 13.
    Jonsson, Maria
    et al.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Ågren, Johan
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Norden-Lindeberg, Solveig
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Ohlin, Andreas
    Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Suboptimal care and metabolic acidemia is associated with neonatal encephalopathy but not with neonatal seizures alone: a population-based clinical audit2014Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, nr 5, s. 477-482Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To determine the incidence of moderate to severe neonatal encephalopathy (NE) and neonatal seizures without encephalopathy, and the association with metabolic acidemia. Secondly, to investigate the occurrence of suboptimal intrapartum care and its impact on neonatal outcome.

    Design: Clinical audit.

    Setting: Two university hospitals in Sweden.

    Population: Neonates 34weeks with moderate or severe NE and neonatal seizures alone, i.e. without encephalopathy, from a population of 71189 births, where umbilical blood gases were routinely analyzed.

    Methods: Neonates were categorized depending on the presence of metabolic acidemia at birth by umbilical artery pH<7.00, base deficit 12mmol/L. Records were audited for suboptimal care and a decision was made on whether management was assessed to have impacted neonatal outcome.

    Main outcome measures: Encephalopathy and seizures alone.

    Results: We identified 80 neonates with NE and 30 with seizures alone, of which 48 (60%) and none, respectively, had metabolic acidemia. Suboptimal care could be assessed in 77 and occurred in 28 (36%) NE cases and in one neonate with seizures alone (p<0.001). In 47 NE cases with metabolic acidemia, suboptimal care occurred in 22 (47%) vs. 6/30 (20%) without metabolic acidemia (p=0.02). Suboptimal care had an impact on outcome in 18/77 (23%) NE cases but in no cases with seizures alone.

    Conclusion: Suboptimal care was commonly seen with NE, particularly in neonates with metabolic acidemia, and also affected neonatal outcome. No such associations were found in neonates with seizures alone.

  • 14.
    Larsson, Amanda
    et al.
    Department of Obstetrics and Gynecology, University Hospital Örebro, Örebro, Sweden.
    Rönnberg, Ann-Kristin
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics and Gynecology, University Hospital Örebro, Örebro, Sweden.
    Expanding a woman's options to include home use of misoprostol for medical abortion up until 76 days: An observational study of efficacy and safety2019Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, nr 6, s. 747-752Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Home use of misoprostol for medical abortion is increasingly being practiced. With gestational length up until 70 days, it is considered effective, safe and acceptable by women. Knowledge of safety and efficacy with higher gestational lengths is limited and studies are required in order to further expand women's options to include this method of abortion.

    MATERIAL AND METHODS: A retrospective cohort study was designed to compare home use of misoprostol for medical abortion at gestational length 64-76 days to its use at 57-63 days. Primary outcome was success rate. Success was defined as complete uterine evacuation without need of surgical intervention due to incomplete abortion and no failed abortion with ongoing pregnancy. Secondary outcomes were rates of unscheduled return visits, telephone consultations, admissions to hospital, infections and the need for blood transfusion.

    RESULTS: We included 397 women, 270 within 57-63 days and 127 within 64-76 days of gestation at abortion. Success rate was 95.6% at 57-63 days and 93.7% at 64-76 days. The difference was not statistically significant (p=0.431). The rate of unscheduled return visits was high overall but not significantly different in relation to gestational length at abortion (>63d; 20.5% vs. <64d; 16.3%, p=0.308).

    CONCLUSIONS: Our study indicates that home use of misoprostol for medical abortion at 64-76 days gestation may be as safe and effective as at 57-63 days. Further studies with larger sample size are needed to confirm our findings and to explore the acceptance of and experiences among women performing abortion at home at higher gestational length, before further implementation in clinical practice.

  • 15.
    Maghsoudlou, Siavash
    et al.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
    Cnattingius, Sven
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
    Aarabi, Mohsen
    Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
    Montgomery, Scott M.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Semnani, Shahriar
    Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
    Stephansson, Olof
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Wikström, Anna-Karin
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Bahmanyar, Shahram
    Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran; Clinical Epidemiology Unit, Center for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
    Consanguineous marriage, prepregnancy maternal characteristics and stillbirth risk: a population-based case-control study2015Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, nr 10, s. 1095-1101Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Consanguineous marriage is associated with increased risks for congenital anomalies, low birthweight, and other adverse perinatal outcomes. In this population-based, case-control study we investigated the association between consanguineous marriage (first-cousin marriage) and stillbirth risk, using prospectively collected information from prepregnancy visits.

    Material and methods: From 2007 to 2009, we identified 283 stillbirths (cases) and 2088 randomly selected live control births through prepregnancy visits in rural Golestan, Iran. The associations between consanguinity and prepregnancy maternal characteristics and stillbirth risk were examined using multivariate logistic regression.

    Results: The rate of consanguineous marriage was 19.4% among cases and 13.6% among controls. Consanguinity was associated with increased stillbirth risk [ odds ratio (OR) 1.53; 95% CI 1.10-2.14]. The association was significantly increased for preterm stillbirth (< 37 gestational weeks) (OR 2.43; 95% CI 1.46-4.04) but not for term stillbirth (>= 37 weeks) (OR 1.14; 95% CI 0.75-1.74). Low and high maternal age, underweight, obesity, nulliparity, a history of infertility or miscarriage, previous obstetric complications (preeclampsia, preterm delivery, and stillbirth in previous pregnancies) were also associated with increased stillbirth risks.

    Conclusions: Consanguineous marriage is associated with increased risk of stillbirth, particularly preterm stillbirth. Findings for other maternal risk factors for stillbirth in rural Iran are consistent with previously reported findings from high-income countries.

  • 16.
    Murto, Tiina
    et al.
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Kallak, Theodora Kunovac
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Hoas, Annica
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Altmäe, Signe
    Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain; Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia.
    Salumets, Andres
    Competence Centre on Reproductive Medicine and Biology, Tartu, Estonia; Institute of Biomedicine, University of Tartu, Tartu, Estonia.
    Nilsson, Torbjörn K
    Department of Medical Biosciences, Umeå University, Umeå, Sweden.
    Skoog Svanberg, Agneta
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Wånggren, Kjell
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan. Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden.
    Stavreus-Evers, Anneli
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Folic acid supplementation and methylenetetrahydrofolate reductase (MTHFR) gene variations in relation to IVF pregnancy outcome2014Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, nr 1, s. 65-71Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study folic acid intake, folate status and pregnancy outcome after infertility treatment in women with different infertility diagnoses in relation to methylenetetrahydrofolate reductase (MTHFR) 677C>T, 1298A>C and 1793G>A polymorphisms. Also the use of folic acid supplements, folate status and the frequency of different gene variations were studied in women undergoing infertility treatment and fertile women.

    DESIGN: Observational study.

    SETTING: University hospital.

    POPULATION: Women undergoing infertility treatment and healthy, fertile, non-pregnant women.

    METHODS: A questionnaire was used to assess general background data and use of dietary supplements. Blood samples were taken to determine plasma folate and homocysteine levels, and for genomic DNA extraction. A comparison of four studies was performed to assess pregnancy outcome in relation to MTHFR 677 TT vs. CC, and 1298 CC vs. AA polymorphisms.

    MAIN OUTCOME MEASURES: Folic acid supplement intake, and plasma folate, homocysteine and genomic assays.

    RESULTS: Women in the infertility group used significantly more folic acid supplements and had better folate status than fertile women, but pregnancy outcome after fertility treatment was not dependent on folic acid intake, folate status or MTHFR gene variations.

    CONCLUSION: High folic acid intakes and MTHFR gene variations seem not associated with helping women to achieve pregnancy during or after fertility treatment.

  • 17. Olsson, C.
    et al.
    Buer, Nina
    Örebro universitet, Hälsoakademin.
    Holm, K.
    Nilsson-Wikmar, L.
    Lumbopelvic pain associated with catastrophizing and fear-avoidance beliefs in early pregnancy2009Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, nr 4, s. 378-385Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. To examine and compare levels of catastrophizing, fear-avoidance beliefs, physical ability, and health-related quality of life in women with and without lumbopelvic pain (LP and NLP) in early pregnancy. Design. A cross-sectional study of early pregnancy. Setting. Five midwife clinics, one in the center, two in the outskirts of Stockholm, and two in a medium-sized town. Population. Three hundred and twenty-four women in the 19th-21st week of pregnancy. Methods. Questionnaires. Main outcome measures. The Pain Catastrophizing Scale of exaggerated negative thoughts about pain experiences, the Fear-Avoidance Beliefs Questionnaire of beliefs about how physical activity and work affect back pain, the Disability Rating Index of physical ability, and the Nottingham Health Profile to assess health-related quality of life. Results. Two groups were defined: LP (n=141) and NLP (n=183). The Mann-Whitney U-test was used for comparisons. Pregnant women with LP had significantly (p0.05) higher levels of exaggerated negative thoughts and fear-avoidance beliefs. They also had lower physical ability and health-related quality of life compared to women in the NLP group. Conclusions. It is important to consider exaggerated negative thoughts about pain experiences and fear-avoidance beliefs when treating women with LP during pregnancy and to be aware of the great impact lumbopelvic pain has on women's lives during early pregnancy.

  • 18.
    Rönnberg, Ann-Kristin
    et al.
    Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Obstetrics and Gynecology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Effects of an antenatal lifestyle intervention on offspring obesity: a 5-year follow-up of a randomized controlled trial2017Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, nr 9, s. 1093-1099Artikel i tidskrift (Refereegranskat)
    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.

  • 19.
    Rönnberg, AnnKristin
    et al.
    Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Hanson, Ulf
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Östlund, Ingrid
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden.
    Effects on postpartum weight retention after antenatal lifestyle intervention: a secondary analysis of a randomized controlled trial2016Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, nr 9, s. 999-1007Artikel i tidskrift (Refereegranskat)
    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.

  • 20. Salmelin, Anette
    et al.
    Wiklund, Ingela
    Bottinga, Roger
    Brorsson, Bengt
    Ekman-Ordeberg, Gunvor
    Grimfors, Eva Eneroth
    Hanson, Ulf
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Blom, May
    Persson, Elisabeth
    Fetal monitoring with computerized ST analysis during labor: a systematic review and meta-analysis2013Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, nr 1, s. 28-39Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background. Computerized ST analysis of fetal electrocardiography (ECG) combined with cardiotochography (CTG) has been introduced for intrapartum monitoring and is the prevailing method when ST analysis (STAN®) is used. Objective. To assess the evidence that computerized ST analysis during labor reduces the incidence of fetal metabolic acidosis, hypoxic ischemic encephalopathy, cesarean section, instrumental vaginal delivery or the number of instances where fetal scalp blood sampling is used as compared with CTG only. Methods. Search of PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL and CRD databases. Selection criteria. CTG only compared with CTG + computerized ST analysis. Data collection and analysis. Studies were assessed using pre-designed templates. Meta-analyses of included randomized controlled trials were performed using a random effects model. Results. Risk ratio for cord metabolic acidosis with STAN® was 0.96 [95% confidence interval (CI) 0.49-1.88]. Risk ratio for cesarean sections or instrumental vaginal deliveries for fetal distress was 0.93 (95%CI 0.80-1.08) and for fetal scalp blood sampling 0.55 (95%CI 0.40-0.76). Encephalopathy cases were not assessed due to their low incidence. Conclusions. There is not enough scientific evidence to conclude that computerized ST analysis reduces the incidence of metabolic acidosis. Cesarean sections and instrumental vaginal deliveries due to fetal distress or other indications are the same, regardless of method, but STAN® reduces the number of instances which require scalp blood sampling.

  • 21.
    Skogsdal, Yvonne Rosalie Elisabeth
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Maternal Health Care Unit.
    Karlsson, Jan Åke
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynecology.
    Tydén, Tanja Adele
    Department of Women’s and Children’s Health, Academic Hospital, Uppsala, Sweden.
    Contraceptive use and reproductive intentions among women requesting contraceptive counseling2018Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, nr 11, s. 1349-1357Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Limited attention has been paid to the use of contraception in relation to women's family planning intentions. The aim of this study was to investigate the use of contraception during the most recent intercourse as well as the reproductive intentions of Swedish-speaking women requesting contraceptive counseling.

    Material and methods: Across-sectional baseline survey in a randomized controlled trial regarding reproductive life planning (before randomization). Women requesting contraceptive counseling answered questions about contraception and whether they wanted to have children/more children in the future.

    Results: In total, 1946 women participated: 33.7% (n = 656) parous and 65.7% (n = 1279) nulliparous. The majority, 87.1% (n = 1682), had used contraception during their latest intercourse; 64.6% (n = 1239) used short-acting reversible contraception, 22.8% (n = 443) used long-acting reversible contraception (LARC), and 12.9% (n = 251) had not used any contraception. A combined oral contraceptive was more common among nulliparous and LARC among parous. Among all women, 64.8% (n = 1253) intended to have children/more children in the future, among parous women 35.7% (n = 220) and among nulliparous 80.0% (n = 1033). Among women who did not intend to have children/more children, 22.6% (n = 60) of parous and 10% (n = 8) of nulliparous had not used contraceptives during their most recent intercourse.

    Conclusions: Women did not always use contraceptives that were suitable for their reproductive intentions. Questioning women who request contraceptive counseling about their pregnancy intention can give healthcare providers better opportunities for individualized counseling.

  • 22.
    Sundelin, Heléne
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. University Hospital, Linköping, Sweden.
    Stephansson, Olof
    Karolinska University Hospital and Institute, Stockholm, Sweden; University of California, Berkeley CA, USA .
    Johansson, Kari
    Karolinska University Hospital and Institute, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Region Örebro län. Karolinska Institute, Stockholm, Sweden; Department of Pediatrics, University Hospital, Örebro, Sweden; School of Medicine, University of Nottingham, Nottingham, UK .
    Pregnancy outcome in joint hypermobility syndrome and Ehlers-Danlos syndrome2017Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, nr 1, s. 114-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: An increased risk of preterm birth in women with joint hypermobility syndrome or Ehlers-Danlos syndrome is suspected.

    MATERIAL AND METHODS: In this nationwide cohort study from 1997 through 2011, women with either joint hypermobility syndrome or Ehlers-Danlos syndrome or both disorders were identified through the Swedish Patient Register, and linked to the Medical Birth Register. Thereby, 314 singleton births to women with joint hypermobility syndrome/Ehlers-Danlos syndrome before delivery were identified. These births were compared with 1 247 864 singleton births to women without a diagnosis of joint hypermobility syndrome/Ehlers-Danlos syndrome. We used logistic regression, adjusted for maternal age, smoking, parity, and year of birth, to calculate adjusted odds ratios for adverse pregnancy outcomes.

    RESULTS: Maternal joint hypermobility syndrome/Ehlers-Danlos syndrome was not associated with any of our outcomes: preterm birth (adjusted odds ratio = 0.6, 95% confidence interval 0.3-1.2), preterm premature rupture of membranes (adjusted odds ratio = 0.8; 95% confidence interval 0.3-2.2), cesarean section (adjusted odds ratio = 0.9, 95% confidence interval 0.7-1.2), stillbirth (adjusted odds ratio = 1.1, 95% confidence interval 0.2-7.9), low Apgar score (adjusted odds ratio = 1.6, 95% confidence interval 0.7-3.6), small for gestational age (adjusted odds ratio = 0.9, 95% confidence interval 0.4-1.8) or large for gestational age (adjusted odds ratio = 1.2, 95% confidence interval 0.6-2.1). Examining only women with Ehlers-Danlos syndrome (n = 62), we found a higher risk of induction of labor (adjusted odds ratio = 2.6; 95% confidence interval 1.4-4.6) and amniotomy (adjusted odds ratio = 3.8; 95% confidence interval 2.0-7.1). No excess risks for adverse pregnancy outcome were seen in joint hypermobility syndrome.

    CONCLUSION: Women with joint hypermobility syndrome/Ehlers-Danlos syndrome do not seem to be at increased risk of adverse pregnancy outcome.

  • 23.
    Thorell, Eva
    et al.
    Örebro universitet, Hälsoakademin.
    Svardsudd, Kurt
    Dept Publ Hlth & Caring Sci, Uppsala Univ, Uppsala, Sweden.
    Andersson, Kjell
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Kristiansson, Per
    Dept Publ Hlth & Caring Sci, Uppsala Univ, Uppsala, Sweden; Dept Publ Hlth & Clin Med, Umeå Univ, Umeå, Sweden.
    Moderate impact of full-term pregnancy on estimated peak oxygen uptake, physical activity and perceived health2010Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, nr 9, s. 1140-1148Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. To study the impact of pregnancy on estimated peak oxygen uptake ((V) over dotO(2) (peak, est.)), physical activity and perceived health. Design. Prospective cohort study. Setting. Maternal health centers. Population. A cohort of pregnant women. Methods. Cycle ergometer test and questionnaires in early pregnancy and 5 months postpartum. Main outcome measures. (V) over dotO(2) (peak, est.), physical activity and perceived health. Results. Regular physical activity was reported by a successively lower proportion of women as pregnancy advanced but the proportion was regained postpartum. Despite this the difference between average absolute (V) over dotO(2) (peak, est.) in early pregnancy and postpartum of 2.44 and 2.42 l/minute, respectively, was not significant. The adjusted absolute (V) over dotO(2) (peak, est.) in early pregnancy successively increased with age to a maximum at 35 years, after which it decreased and among women of the same age the time between 8 and 12 weeks lowered the (V) over dotO(2) (peak, est.) by 0.130 l/minute. With the Short Form 36 (SF-36) questionnaire in early pregnancy the women scored their mean mental health to 72.0 and mean physical health to 79.7. At the postpartum appointment these scores were higher (p < 0.0001). Absolute and relative (V) over dotO(2) (peak, est.) in early pregnancy were positively correlated to the variation of SF-36' s mean physical health in early pregnancy (p < 0.0001) and postpartum (p < 0.0001). Conclusions. Pregnancy had a moderate influence on physical fitness and perceived health half a year postpartum despite less regular physical activity during pregnancy. (V) over dotO(2) (peak, est.) in early pregnancy was positively correlated to perceived physical health.

  • 24.
    Wijk, Lena
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Dept Obstet & Gynecol, Univ Örebro, Örebro, Sweden.
    Franzén, Karin
    Örebro universitet, Institutionen för läkarutbildning. Dept Obstet & Gynecol, Univ Örebro, Örebro, Sweden; Sch Hlth & Med Sci, Univ Örebro, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Dept Surg.
    Nilsson, Kerstin
    Örebro universitet, Institutionen för läkarutbildning. Dept Obstet & Gynecol, Örebro University Hospital, Örebro, Sweden.
    Implementing a structured Enhanced Recovery After Surgery (ERAS) protocol reduces length of stay after abdominal hysterectomy2014Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, nr 8, s. 749-756Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To study the effects of introducing an Enhanced Recovery After Surgery (ERAS) protocol, modified for gynecological surgery, on length of stay and complications following abdominal hysterectomy.

    Design: Observational study.

    Setting: Department of Obstetrics and Gynecology, Orebro University Hospital, Sweden.

    Population: Eighty-five patients undergoing abdominal hysterectomy for benign or malignant indications between January and December 2012, with or without salpingo-oophorectomy. Outcomes were compared with all consecutive patients who had undergone the same surgery from January to December 2011, immediately before establishing the ERAS protocol (n = 120).

    Methods: The ERAS protocol was initiated in January 2012 as part of a targeted implementation program. Data were extracted from patient records and from a specific database.

    Main outcome measures: Length of stay and the proportion of patients achieving target length of stay (2 days).

    Results: Length of stay was significantly reduced in the study population after introducing the ERAS protocol from a mean of 2.6 (SD 1.1) days to a mean of 2.3 (SD 1.2) days (p = 0.011). The proportion of patients discharged at 2 days was significantly increased from 56% pre-ERAS to 73% after ERAS (p = 0.012). No differences were found in complications (5% vs. 3.5% in primary stay, 12% vs. 15% within 30 days after discharge), reoperations (2% vs. 1%) or readmission (4% vs. 4%).

    Conclusions: Introducing the ERAS protocol for abdominal hysterectomy reduced length of stay without increasing complications or readmissions.

  • 25.
    Östlund, Ingrid
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Hanson, Ulf
    Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test2003Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 82, nr 2, s. 103-108Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    The objective of the present study was to determine prevalence of gestational diabetes mellitus (GDM) in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), and the value of traditional anamnestic risk factors for predicting outcome of the oral glucose tolerance test (OGTT).

    METHODS:

    A prospective population-based study in a defined geographic area in Sweden. All pregnant nondiabetic women (n = 4918) attending maternal health care from July 1994 to June 1996 were offered a 75g OGTT in gestational weeks 28-32. Traditional anamnestic risk factors, as well as results of the OGTT in terms of fasting-B-glucose and 2h-B-glucose, were registered.

    RESULTS:

    3616 (73.5%) women agreed to perform the OGTT. Sixty-one (1.7%) of those had GDM [47 (1.3%) had impaired glucose tolerance and 14 (0.4%) had diabetes mellitus]. 15.8% fulfilled traditional risk factor criteria. Traditional anamnestic risk factors as an indicator to perform an OGTT identified 29/61 GDM women and 9/14 women with DM. Among primiparas, 4/21 with gestational diabetes mellitus were detected.

    CONCLUSION:

    Using traditional risk factors as an indicator to perform an OGTT gives a low sensitivity to detect GDM and even DM especially among primiparas.

  • 26.
    Östlund, Ingrid
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Hanson, Ulf
    Repeated random blood glucose measurements as universal screening test for gestational diabetes mellitus2004Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, nr 1, s. 46-51Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    To determine the value of repeated random blood glucose (R-B-glucose) measurements alone or in combination with traditional risk factors [family history of diabetes, obesity, prior large-for-gestational-age (LGA) infant or prior gestational diabetes mellitus (GDM)] to predict the outcome of the oral glucose tolerance test (OGTT).

    METHODS:

    A prospective population-based study was undertaken in a Swedish county. All pregnant nondiabetic women (n = 4918) visiting the maternal health care clinics over a 2-year period were offered a 75-g OGTT in gestational weeks 28-32. Traditional risk factors and values of repeated R-B-glucose measurements were registered, as well as the results of the OGTT, in terms of fasting B-glucose and 2-h B-glucose.

    RESULTS:

    A total of 3616 women (73.5%) had an OGTT. Of these, 1.7% had GDM, 1.3% impaired glucose tolerance (IGT) and 0.4% diabetes mellitus (DM). An R-B-glucose cut-off level > or =8.0 mmol/L as the only indicator for an OGTT was optimal for detecting GDM with regard to sensitivity (47.5%) and specificity (97.0%). It has the same sensitivity for detecting GDM as using traditional risk factors, but reduces the need to carry out the OGTT from 15.8% to 3.8% of the population. Combined with prior LGA infant or prior GDM as indications for the OGTT in the present study, all women with DM and 44.7% of those with IGT will be identified. Only 7.3% of the population will have to take the OGTT.

    CONCLUSION:

    A random B-glucose level > or = 8.0 mmol/L prior LGA infant or prior GDM as an indicator for taking the OGTT is a simple and effective first step in a two-step screening model for GDM.

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