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Axelsson, Ove
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Publications (10 of 56) Show all publications
Marusik, C., Frykholm, C., Ericson, K., Wikström, J. & Axelsson, O. (2017). Diagnosis of Placental Mesenchymal Dysplasia with a focus on magnetic resonance imaging (MRI) [Letter to the editor]. Ultrasound in Obstetrics and Gynecology, 49(3), 410-412
Open this publication in new window or tab >>Diagnosis of Placental Mesenchymal Dysplasia with a focus on magnetic resonance imaging (MRI)
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2017 (English)In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 49, no 3, p. 410-412Article in journal, Letter (Refereed) Published
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-312400 (URN)10.1002/uog.15930 (DOI)27062337 (PubMedID)
Available from: 2017-01-09 Created: 2017-01-09 Last updated: 2017-11-29Bibliographically approved
Kallak, T. K., Hellgren, C., Skalkidou, A., Sandelin-Francke, L., Ubhayasekera, K., Bergquist, J., . . . Sundström Poromaa, I. (2017). Maternal and female fetal testosterone levels are associated with maternal age and gestational weight gain. European Journal of Endocrinology, 177(4), 379-388
Open this publication in new window or tab >>Maternal and female fetal testosterone levels are associated with maternal age and gestational weight gain
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2017 (English)In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 177, no 4, p. 379-388Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Prenatal androgen exposure has been suggested to play a role in polycystic ovary syndrome. Given the limited information on what maternal characteristics influence maternal testosterone levels, and the even less explored routes by which female fetus androgen exposure would occur, the aim of this study was to investigate the impact of maternal age, BMI, weight gain, depressed mood and aromatase SNPs on testosterone levels in maternal serum and amniotic fluid of female fetuses.

METHODS: Blood samples from pregnant women (n = 216) obtained in gestational weeks 35-39, and pre-labor amniotic fluid samples from female fetuses (n = 56), taken at planned Caesarean section or in conjunction with amniotomy for induction of labor, were analyzed. Maternal serum testosterone and amniotic fluid testosterone and cortisol were measured by tandem mass spectrometry.

RESULTS: Multiparity (β = -0.28, P < 0.001), self-rated depression (β = 0.26, P < 0.001) and weight gain (β = 0.18, P < 0.05) were independent explanatory factors for the maternal total testosterone levels. Maternal age (β = -0.34, P < 0.001), weight gain (β = 0.19, P < 0.05) and amniotic fluid cortisol levels (β = 0.44, P < 0.001) were independent explanatory factors of amniotic fluid testosterone in female fetuses, explaining 64.3% of the variability in amniotic fluid testosterone.

WIDER IMPLICATIONS OF THE FINDINGS: Young maternal age and excessive maternal weight gain may increase the prenatal androgen exposure of female fetuses. Further studies are needed to explore this finding.

National Category
Obstetrics, Gynecology and Reproductive Medicine Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-330914 (URN)10.1530/EJE-17-0207 (DOI)000414730300015 ()28705923 (PubMedID)
Funder
Swedish Research Council, 2015-4870 2013-2339 523-2014-2342 2015-00495Swedish Society of Medicine, SLS-331991EU, FP7, Seventh Framework Programme, INCA 600398
Available from: 2017-10-06 Created: 2017-10-06 Last updated: 2018-02-13Bibliographically approved
Carlsson, T. & Axelsson, O. (2017). Patient Information Websites About Medically Induced Second-Trimester Abortions: A Descriptive Study of Quality, Suitability, and Issues. Journal of Medical Internet Research, 19(1), Article ID e8.
Open this publication in new window or tab >>Patient Information Websites About Medically Induced Second-Trimester Abortions: A Descriptive Study of Quality, Suitability, and Issues
2017 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 19, no 1, article id e8Article in journal (Refereed) Published
Abstract [en]

Background: Patients undergoing medically induced second-trimester abortions feel insufficiently informed and use the Web for supplemental information. However, it is still unclear how people who have experience with pregnancy termination appraise the quality of patient information websites about medically induced second-trimester abortions, whether they consider the websites suitable for patients, and what issues they experience with the websites.

Objective: Our objective was to investigate the quality of, suitability of, and issues with patient information websites about medically induced second-trimester abortions and potential differences between websites affiliated with the health care system and private organizations.

Methods: We set out to answer the objective by using 4 laypeople who had experience with pregnancy termination as quality assessors. The first 50 hits of 26 systematic searches were screened (N=1300 hits) using search terms reported by the assessors. Of these hits, 48% (628/1300) were irrelevant and 51% (667/1300) led to websites about medically induced second-trimester abortions. After correcting for duplicate hits, 42 patient information websites were included, 18 of which were affiliated with the health care system and 24 with private organizations. The 4 assessors systematically assessed the websites with the DISCERN instrument (total score range 16-80), the Ensuring Quality Information for Patients (EQIP) tool (total score range 0-100), as well as questions concerning website suitability and perceived issues.

Results: The interrater reliability was 0.8 for DISCERN and EQIP, indicating substantial agreement between the assessors. The total mean score was 36 for DISCERN and 40 for EQIP, indicating poor overall quality. Websites from the health care system had greater total EQIP (45 vs 37, P>.05) and reliability scores (22 vs 20, P>.05). Only 1 website was recommended by all assessors and 57% (24/42) were rated as very unsuitable by at least one assessor. The most reported issues with the websites involved lack of information (76%, 32/42), and poor design (36%, 15/42).

Conclusions: The high number of irrelevant hits and poor quality of patient information websites are considerable issues that must be addressed and considered when consulting patients awaiting medically induced second-trimester abortions. In clinical encounters, health professionals should initiate discussions concerning websites about medically induced second-trimester abortions and inform patients about the issues and quality deficits associated with these websites.

Keywords
consumer health information; induced abortion; information literacy; Internet; popular works; second pregnancy trimester
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-309950 (URN)10.2196/jmir.6380 (DOI)000392330900017 ()28073735 (PubMedID)
Available from: 2016-12-08 Created: 2016-12-08 Last updated: 2017-11-29Bibliographically approved
Belachew, J., Eurenius, K., Mulic-Lutvica, A. & Axelsson, O. (2017). Placental location, postpartum hemorrhage and retained placenta in women with a previous cesarean section delivery: a prospective cohort study. Upsala Journal of Medical Sciences, 122(3), 185-189
Open this publication in new window or tab >>Placental location, postpartum hemorrhage and retained placenta in women with a previous cesarean section delivery: a prospective cohort study
2017 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 3, p. 185-189Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Women previously giving birth with cesarean section have an increased risk of postpartum hemorrhage (PPH) and retained placenta. The objective of this study was to determine if anterior placental location increased the risk of PPH and retained placenta in such women.

MATERIALS AND METHODS: We performed a prospective cohort study on 400 women with cesarean section delivery in a previous pregnancy. Ultrasound examinations were performed at gestational week 28-30, and placental location, myometrial thickness, and three-dimensional vascularization index (VI) were recorded. Data on maternal age, parity, BMI, smoking, gestational week at delivery, induction, delivery mode, oxytocin, preeclampsia, PPH, retained placenta, and birth weight were obtained for all women. Outcome measures were PPH (≥1,000 mL) and retained placenta.

RESULTS: The overall incidence of PPH was 11.0% and of retained placenta 3.5%. Twenty-three women (11.8%) with anterior placenta had PPH compared to 12 (6.9%) with posterior or fundal locations. The odds ratio was 1.94, but it did not reach statistical significance. There was no significant risk increase for retained placenta in women with anterior placentae. Seven of eight women with placenta previa had PPH, and four had retained placenta.

CONCLUSIONS: The overall risk of PPH and retained placenta was high for women with previous cesarean section. Anterior location of the placenta in such women tended to impose an increased risk for PPH but no risk increase of retained placenta. Placenta previa in women with previous cesarean section is associated with a high risk for PPH and retained placenta.

Keywords
Postpartum hemorrhage, previous cesarean section, retained placenta, ultrasound, vascularization index
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-331203 (URN)10.1080/03009734.2017.1356405 (DOI)000414107800005 ()28826360 (PubMedID)
Available from: 2017-10-12 Created: 2017-10-12 Last updated: 2018-02-14Bibliographically approved
Carlsson, T., Melander, M. U., Wadensten, B., Bergman, G., Axelsson, O. & Mattsson, E. (2017). Quality of Patient Information Websites About Congenital Heart Defects: Mixed-Methods Study of Perspectives Among Individuals With Experience of a Prenatal Diagnosis. Interactive Journal of Medical Research, 6(2), Article ID e15.
Open this publication in new window or tab >>Quality of Patient Information Websites About Congenital Heart Defects: Mixed-Methods Study of Perspectives Among Individuals With Experience of a Prenatal Diagnosis
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2017 (English)In: Interactive Journal of Medical Research, E-ISSN 1929-073X, Vol. 6, no 2, article id e15Article in journal (Refereed) Published
Abstract [en]

Background: When a heart defect is prenatally diagnosed in the fetus, expectant parents experience a great need for information about various topics. After the diagnosis, the Web is used for supplemental information, and the scarcity of research calls attention to the need to explore patient information websites from the perspectives of the intended consumers.

Objective: The overarching aim of this study was to explore the quality of Swedish patient information websites about congenital heart defects, from the perspectives of individuals with experience of a prenatal diagnosis of congenital heart defect in the fetus.

Methods: This was a mixed-methods study of websites identified through systematic searches in the two most used Web-based search engines. Of the total 80 screened hits, 10 hits led to patient information websites about congenital heart defects. A quality assessment tool inspired by a previous study was used to evaluate each website’s appearance, details, relevance, suitability, information about treatment choices, and overall quality. Answers were given on a 5-point Likert scale, ranging from 1, representing the lowest score, to 5, representing the highest score. Each website was assessed individually by persons with experience of continued (n=4) and terminated (n=5) pregnancy following a prenatal diagnosis. Assessments were analyzed with Kendall’s coefficient of concordance W, Mann-Whitney U test, Friedman’s test, and a Wilcoxon-Nemenyi-McDonald-Thompson test. In addition, each assessor submitted written responses to open-ended questions in the quality assessment tool, and two joint focus group discussions were conducted with each group of assessors. The qualitative data were analyzed with inductive manifest content analysis.

Results: Assessments represented a low score (median=2.0) for treatment choices and moderate scores (median=3.0) for appearance, details, relevance, suitability, and overall quality. No website had a median of the highest achievable score for any of the questions in the quality assessment tool. Medians of the lowest achievable score were found in questions about treatment choices (n=4 websites), details (n=2 websites), suitability (n=1 website), and overall quality (n=1 website). Websites had significantly different scores for appearance (P=.01), details (P<.001), relevance (P<.001), suitability (P<.001), treatment choices (P=.04), and overall quality (P<.001). The content analysis of the qualitative data generated six categories: (1) advertisements, (2) comprehensiveness, (3) design, (4) illustrations and pictures, (5) language, and (6) trustworthiness. Various issues with the included websites were highlighted, including the use of inappropriate advertisements, biased information, poor illustrations, complex language, and poor trustworthiness.

Conclusions: From the perspectives of the intended consumers, patient information websites about congenital heart defects are, to a large extent, inadequate tools for supplemental information following a prenatal diagnosis. Health professionals should initiate discussions with patients about their intentions to use the Web, inform them about the varied quality in the Web-based landscape, and offer recommendations for appropriate Web-based sources.

Keywords
congenital heart defects, consumer health information, information literacy, Internet, popular works, pregnancy, prenatal diagnosis
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-328480 (URN)10.2196/ijmr.7844 (DOI)000415945500008 ()28899846 (PubMedID)
Available from: 2017-08-23 Created: 2017-08-23 Last updated: 2017-12-19Bibliographically approved
Ternby, E., Axelsson, O., Annerén, G., Lindgren, P. & Ingvoldstad, C. (2016). Why do pregnant women accept or decline prenatal diagnosis for Down syndrome?. Journal of community genetics, 7(3), 237-242
Open this publication in new window or tab >>Why do pregnant women accept or decline prenatal diagnosis for Down syndrome?
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2016 (English)In: Journal of community genetics, ISSN 1868-310X, Vol. 7, no 3, p. 237-242Article in journal (Refereed) Published
Abstract [en]

To investigate if actual knowledge of Down syndrome (DS), influences the decision to accept or decline prenatal diagnosis (PND). Secondary aims were to elucidate reasons for accepting or declining PND and investigate differences between the accepting and declining group in perceived information, knowing someone with DS and thoughts about decision-making. A questionnaire was completed by 76 pregnant women who underwent invasive testing and 65 women who declined tests for chromosomal aberrations in Uppsala, Sweden. Apart from one question no significant differences were found in knowledge of DS between women declining or accepting PND for DS. Both groups had varying and in several respects low levels of knowledge about DS and its consequences. Most common reasons to accept PND were 'to ease my worries' and 'to do all possible tests to make sure the baby is healthy'. Corresponding statements declining PND were 'termination of pregnancy is not an option' and 'because invasive tests increase the risk of miscarriage'. More women declining PND knew someone with DS. Knowledge of DS at these levels is not a major factor when women decide to accept or decline PND for DS. Their choice is mostly based on opinions and moral values.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-300828 (URN)10.1007/s12687-016-0272-6 (DOI)000386778700007 ()27438596 (PubMedID)
Available from: 2016-08-15 Created: 2016-08-15 Last updated: 2016-12-07Bibliographically approved
Dumitrescu, B., Axelsson, O. & Strand, R. (2015). Bed rest when the water breaks early: in accordance with the evidence or old habit?. Läkartidningen, 112
Open this publication in new window or tab >>Bed rest when the water breaks early: in accordance with the evidence or old habit?
2015 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Refereed) Published
Abstract [en]

Bed rest is often prescribed as part of the treatment plan for women with preterm premature rupture of membranes in the hope of avoiding premature birth. The purpose of this study was to determine the routine care of these patients in Swedish hospitals.A survey was sent to all hospitals in Sweden with an obstetrics department (n=45). Out of these, 31 answered our survey (69 %). The women were separated into three groups depending on gestation length (22+0-26+6, 27+0-32+6 and 33+0-36+6).Most hospitals chose to admit the women and to recommend total or partial bed rest. The earlier in the pregnancy the rupture occurred, the more likely the patient was to be confined to total bed rest.The study shows that this topic is controversial. Most hospitals use bed rest even though there is no evidence to support that it is of benefit for the patient. More studies in this area are required in order to find an optimal treatment for this patient group.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-260547 (URN)26241811 (PubMedID)
Available from: 2015-08-20 Created: 2015-08-20 Last updated: 2017-12-05
Ternby, E., Ingvoldstad, C., Annerén, G., Lindgren, P. & Axelsson, O. (2015). Information and knowledge about Down syndrome among women and partners after first trimester combined testing. Acta Obstetricia et Gynecologica Scandinavica, 94(3), 329-32
Open this publication in new window or tab >>Information and knowledge about Down syndrome among women and partners after first trimester combined testing
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2015 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 3, p. 329-32Article in journal (Refereed) Published
Abstract [en]

We assessed reasons among women and partners for choosing combined ultrasound-biochemistry testing, information and knowledge about Down syndrome and decisions concerning invasive procedures and termination of pregnancy in a prospective cohort study in Uppsala County. In all 105 pregnant women and 104 partners coming for a combined ultrasound-biochemistry test answered a questionnaire. The most common reason for a combined ultrasound-biochemistry test was "to perform all tests possible to make sure the baby is healthy". Internet and midwives were the most common sources of information. Seventy-two percent had not received information on what it means to live with a child with Down syndrome. Many expectant parents perceived information as insufficient. Both women and partners had varying or low levels of knowledge about medical, cognitive and social consequences of Down syndrome. Twenty-five percent had not decided on an invasive test if indicated and only 42% would consider termination of pregnancy with a Down syndrome diagnosis.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-245332 (URN)10.1111/aogs.12560 (DOI)000349603600016 ()25582972 (PubMedID)
Available from: 2015-02-26 Created: 2015-02-26 Last updated: 2017-12-04Bibliographically approved
Ternby, E., Ingvoldstad, C., Annerén, G. & Axelsson, O. (2015). Midwives and information on prenatal testing with focus on Down syndrome. Prenatal Diagnosis, 35(12), 1202-1207
Open this publication in new window or tab >>Midwives and information on prenatal testing with focus on Down syndrome
2015 (English)In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 35, no 12, p. 1202-1207Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate midwives' knowledge of prenatal diagnosis especially Down syndrome, information given by midwives to parents, expectant parents' requests for information and how midwives perceive their own competence to give information.

METHOD: A cross-sectional, prospective study with a questionnaire was completed by 64 out of 70 midwives working in the outpatient antenatal care in Uppsala County, Sweden.

RESULTS: The midwives had varying and in some areas low levels of knowledge about Down syndrome. Information about Down syndrome was most often given only when asked for or when there was an increased probability of a Down syndrome pregnancy. The most common questions from expectant parents concerned test methods and risk assessments while questions regarding symptoms of Down syndrome and consequences of having a child with Down syndrome were uncommon. The majority (83-89%) had insufficient or no education regarding different prenatal tests. Only 2 midwives (3%) had received education about Down syndrome and 10% felt they had sufficient knowledge to inform about the syndrome. More education about prenatal tests and Down syndrome was desired by 94%.

CONCLUSION: It is important to ensure that midwives in antenatal care have sufficient knowledge to inform expectant parents about the conditions screened for.

National Category
Obstetrics, Gynecology and Reproductive Medicine Medical Genetics
Identifiers
urn:nbn:se:uu:diva-268688 (URN)10.1002/pd.4676 (DOI)000368442000007 ()26279318 (PubMedID)
Available from: 2015-12-09 Created: 2015-12-09 Last updated: 2018-01-10Bibliographically approved
Sohlberg, S., Mulic-Lutvica, A., Olovsson, M., Weis, J., Axelsson, O., Wikström, J. & Wikström, A.-K. (2015). MRI estimated placental perfusion in fetal growth assessment. Ultrasound in Obstetrics and Gynecology, 46(6), 700-705
Open this publication in new window or tab >>MRI estimated placental perfusion in fetal growth assessment
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2015 (English)In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 46, no 6, p. 700-705Article in journal (Refereed) Published
Abstract [en]

Objective

This study aimed to evaluate placental perfusion fraction estimated by magnetic resonance imaging (MRI) in vivo as a marker of placental function.

Methods

The study population included 35 pregnant women, of whom 13 had preeclampsia, examined at gestational weeks 22 to 40. Each woman underwent, within a 24 hour period: a MRI diffusion-weighted sequence (from which we calculated the placental perfusion fraction); venous blood sampling; and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. We compared the perfusion fraction in pregnancies with and without fetal growth restriction and estimated correlations between the perfusion fraction and ultrasound estimates and plasma markers with linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of preeclampsia (p < 0.05) and therefore we included an interaction term between preeclampsia and the covariates in the models.

Results

The median placental perfusion fraction in pregnancies with and without fetal growth restriction was 21% and 32%, respectively (p = 0.005). The correlations between the placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (p-values 0.002 to 0.0001). The highest coefficient of determination (R2= 0.56) for placental perfusion fraction was found for a model including pulsatility index in ductus venosus, plasma level of sFlt1, estimated fetal weight and presence of preeclampsia.

Conclusion

The placental perfusion fraction has potential to contribute to the clinical assessment in cases of placental insufficiency.

Keywords
Intrauterine growth restriction, Small for gestational age, Magnetic resonance imaging, Placenta, Perfusion, Perfusion fraction
National Category
Obstetrics, Gynecology and Reproductive Medicine Radiology, Nuclear Medicine and Medical Imaging
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-239293 (URN)10.1002/uog.14786 (DOI)000365855700011 ()25640054 (PubMedID)
Funder
Swedish Research Council, 2014-3561
Available from: 2014-12-21 Created: 2014-12-21 Last updated: 2017-12-05Bibliographically approved
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