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Jonsson, Maria
Publications (10 of 30) Show all publications
Niemeyer Hultstrand, J., Tydén, T., Jonsson, M. & Målqvist, M. (2019). Contraception use and unplanned pregnancies in a peri-urban area of eSwatini (Swaziland). Sexual & Reproductive HealthCare, 20, 1-6
Open this publication in new window or tab >>Contraception use and unplanned pregnancies in a peri-urban area of eSwatini (Swaziland)
2019 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 1-6Article in journal (Refereed) Published
Abstract [en]

Background: Despite reported high levels of contraception use in eSwatini, unplanned pregnancies are common. The aims of this study were to investigate prevalence and determinants of contraception use and unplanned pregnancies in a disadvantaged area in the Kingdom of eSwatini (Swaziland), and to investigate the association between unplanned pregnancies and antenatal care attendance. Methods: This cross-sectional study was conducted at the non-governmental organization Siphilile Maternal and Child Health in Matsapha, a peri-urban industrial area, using data from pre-existing client records. The sample included clients (n = 1436) registered during pregnancy or up to three months postpartum between August 2014 and April 2016. Contraception use before conception and unplanned pregnancies were analysed with logistic regression to find associations with socio-demographic factors and health care utilization. Results: In this population, 59% (n = 737) stated to have used contraception before becoming pregnant. Teenagers and first-time mothers were less likely to have used contraception. Seventy percent (789/1124) of the pregnancies were unplanned. Older women ( 35 years) were less likely while teenagers and multiparas (>= 3 children) were more likely to have an unplanned pregnancy. Women with unplanned pregnancies were less likely to attend the recommended number of antenatal care visits compared to women with planned pregnancies. Conclusion: The rate of unplanned pregnancies is high in this population, especially among teenagers. Family planning interventions need to focus on preconception care for teenagers to enable pregnancy planning including improved antenatal care attendance.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2019
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-387926 (URN)10.1016/j.srhc.2019.01.004 (DOI)000470192400002 ()31084811 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2019-06-26 Created: 2019-06-26 Last updated: 2019-06-26Bibliographically approved
Selin, L., Wennerholm, U.-B., Jonsson, M., Dencker, A., Wallin, G., Wiberg-Itzel, E., . . . Berg, M. (2019). High-dose versus low-dose of oxytocin for labour augmentation: a randomised controlled trial. Women and Birth, 32(4), 356-363
Open this publication in new window or tab >>High-dose versus low-dose of oxytocin for labour augmentation: a randomised controlled trial
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2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, no 4, p. 356-363Article in journal (Refereed) Published
Abstract [en]

Problem: Delayed labour progress is common in nulliparous women, often leading to caesarean section despite augmentation of labour with synthetic oxytocin.

Background: High-or low-dose oxytocin can be used for augmentation of delayed labour, but evidence for promoting high-dose is weak.

Aim: To ascertain the effect on caesarean section rate of high-dose versus low-dose oxytocin for augmentation of delayed labour in nulliparous women.

Methods: Multicentre parallel double-blind randomised controlled trial (ClinicalTrials.gov: NCT01587625) in six labour wards in Sweden. Healthy nulliparous women at term with singleton cephalic fetal presentation, spontaneous labour onset, confirmed delay in labour and ruptured membranes (n = 1351) were randomised to labour augmentation with either high-dose (6.6 mU/minute) or low-dose (3.3 mU/minute) oxytocin infusion.

Findings: 1295 women were included in intention-to-treat analysis (high-dose n = 647; low-dose n = 648). Caesarean section rates did not differ between groups (12.4% and 12.3%, 95% Confidence Interval -3.7 to 3.8). Women with high-dose oxytocin had: shorter labours (-23.4 min); more uterine tachysystole (43.2% versus 33.5%); similar rates of instrumental vaginal births, with more due to fetal distress (43.8% versus 22.7%) and fewer due to failure to progress (39.6% versus 58.8%). There were no differences in neonatal outcomes.

Discussion: Our study could not confirm results of two systematic reviews indicating, with weak evidence, that use of high-dose oxytocin was associated with lower frequency of caesarean section.

Conclusion: We found no advantages for routine use of high-dose oxytocin in the management of delay in labour. Low-dose oxytocin regimen is recommended to avoid unnecessary events of tachysystole and fetal distress. 

Place, publisher, year, edition, pages
ELSEVIER, 2019
Keywords
Augmentation of labour, Delayed labour, Oxytocin, Caesarean, Nulliparous
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-390491 (URN)10.1016/j.wombi.2018.09.002 (DOI)000475555500018 ()30341003 (PubMedID)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-12Bibliographically approved
Granfors, M., Stephansson, O., Endler, M., Jonsson, M., Sandström, A. & Wikström, A.-K. (2019). Placental location and pregnancy outcomes in nulliparous women: A population-based cohort study. Acta Obstetricia et Gynecologica Scandinavica, 98(8), 988-996
Open this publication in new window or tab >>Placental location and pregnancy outcomes in nulliparous women: A population-based cohort study
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2019 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 8, p. 988-996Article in journal (Refereed) Published
Abstract [en]

Introduction: The impact of placenta previa on pregnancy, delivery and infant outcomes has been extensively studied. However, less is known about the possible association of placental location other than previa with pregnancy outcomes. The aim of this study was to investigate if placental location other than previa is associated with adverse pregnancy, delivery and infant outcomes.

Material and methods: This is a population-based cohort study, with data from the regional population-based Stockholm-Gotland Obstetric Cohort, Sweden, from 2008 to 2014. The study population included 74 087 nulliparous women with singleton pregnancies resulting in live-born infants, with information about placental location from the second-trimester ultrasound screening. The association between placental location (fundal, lateral, anterior or posterior) and pregnancy outcomes was estimated using logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated, and adjustments were made for maternal age, height, country of birth, smoking in early pregnancy, sex of the infant and in vitro fertilization. Main outcome measures were pregnancy, delivery and infant outcomes.

Results: Compared with posterior placental location, fundal and lateral placental locations were associated with a number of adverse pregnancy outcomes, the most important being: very preterm birth (<32 weeks of gestation) (adjusted OR [aOR] 1.78, 95% CI 1.18-2.63 and aOR 2.12, 95% CI 1.39-2.25, respectively), moderate preterm birth (32-36 weeks of gestation) (aOR 1.23, 95% CI 1.001-1.51 and aOR 1.62, 95% CI 1.32-2.00, respectively), small-for-gestational-age birth (aOR 1.67, 95% CI 1.34-2.07 and aOR 1.77, 95% CI 1.39-2.25, respectively) and manual removal of the placenta in vaginal births (aOR 3.27, 95% CI 2.68-3.99 and aOR 3.27, 95% CI 2.60-4.10, respectively). Additionally, lateral placental location was associated with preeclampsia (aOR 1.30, 95% CI 1.03-1.65) and severe postpartum hemorrhage (aOR 1.42, 95% CI 1.27-1.82).

Conclusions: Compared with posterior placental location, fundal and lateral placental locations are associated with a number of adverse pregnancy, delivery and infant outcomes.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
placenta, placental location, pregnancy outcome, second trimester, ultrasound
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-391288 (URN)10.1111/aogs.13578 (DOI)000476678100006 ()30767210 (PubMedID)
Funder
Swedish Research Council, 523-2013-2429Swedish Research Council, 2014-3561Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00251Stockholm County Council
Available from: 2019-08-22 Created: 2019-08-22 Last updated: 2019-08-22Bibliographically approved
Sjömark, J., Parling, T., Jonsson, M., Larsson, M. & Skoog Svanberg, A. (2018). A longitudinal, multi-centre, superiority, randomized controlled trial of internet-based cognitive behavioural therapy (iCBT) versus treatment-as-usual (TAU) for negative experiences and posttraumatic stress following childbirth: the JUNO study protocol. BMC Pregnancy and Childbirth, 18, Article ID 387.
Open this publication in new window or tab >>A longitudinal, multi-centre, superiority, randomized controlled trial of internet-based cognitive behavioural therapy (iCBT) versus treatment-as-usual (TAU) for negative experiences and posttraumatic stress following childbirth: the JUNO study protocol
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2018 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, article id 387Article in journal (Refereed) Published
Abstract [en]

Background: About one-third of women report their childbirth as traumatic and up to 10% have severe traumatic stress responses to birth. The prevalence of Posttraumatic stress disorder following childbirth (PTSD FC) is estimated to 3%. Women with PTSD FC report the same symptoms as other patients with PTSD following other types of trauma. The effect of psychological treatment for women with PTSD FC has only been studied in a few trials. Similarly, studies on treatment needs for women not diagnosed as having PTSD FC but who nevertheless face psychological problems are lacking. Methods/design: Women who rate their overall birth experience as negative on a Likert scale, and/or had an immediate caesarean section and/or a major postpartum haemorrhage are randomized to either internet delivered cognitive behaviour therapy (iCBT) plus treatment as usual (TAU) or TAU. The iCBT is to be delivered in two steps. The first step consists of six weekly modules for both the woman and her partner (if they wish to participate) with minimal therapeutic support. Step 2 consists of eight weekly modules with extended therapeutic support and will be offered to participants whom after step 1 report PTSD FC. Assessments will be made at baseline, 6 weeks, 14 weeks, and at follow-ups at 1, 2, 3 and 4 years after baseline. The primary outcome measures are symptoms of posttraumatic stress and depression. Secondary outcomes are quality of life, parent-child bonding, marital satisfaction, coping strategies, experience regarding the quality of care received, health-related quality of life, number of re-visits to the clinic and number of appointments for counselling during the 4 years' period after the negative childbirth experience, time until the woman gets pregnant again, and the type of birth in the subsequent pregnancy. A health economic evaluation in the form of a cost utility analysis will be conducted. Discussion: This study protocol describes a randomized controlled trial that will provide information about the effectiveness of iCBT in women with negative experiences, posttraumatic stress, and PTSD FC.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Study protocol, iCBT, Immediate caesarean section, Negative birth experience, Postpartum haemorrhage, Posttraumatic stress following childbirth, PTSD following childbirth, PTSD
National Category
Obstetrics, Gynecology and Reproductive Medicine Psychiatry
Identifiers
urn:nbn:se:uu:diva-367411 (URN)10.1186/s12884-018-1988-6 (DOI)000446222700001 ()30285758 (PubMedID)
Funder
Swedish Research Council
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2018-12-03Bibliographically approved
Hesselman, S., Högberg, U., Råssjö, E.-B., Schytt, E., Löfgren, M. & Jonsson, M. (2018). Abdominal adhesions in gynaecologic surgery after caesarean section: a longitudinal population-based register study.. British Journal of Obstetrics and Gynecology, 125(5), 597-603
Open this publication in new window or tab >>Abdominal adhesions in gynaecologic surgery after caesarean section: a longitudinal population-based register study.
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2018 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 125, no 5, p. 597-603Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of the study was to evaluate the association between abdominal adhesions at the time of gynaecologic surgery and a history of caesarean delivery, and to investigate obstetric factors contributing to adhesion formation after caesarean section (CS).

DESIGN: Longitudinal population-based register study.

SETTING: Sweden.

POPULATION: Women undergoing benign hysterectomy and/or adnexal surgery in Sweden, 2000-2014, with a previous delivery during 1973-2013 (n = 15 479).

METHODS: Information about abdominal adhesions during gynaecological surgery, prior medical history, pregnancies and deliveries were retrieved from Swedish National Health and Quality registers.

MAIN OUTCOME MEASURES: Adhesions.

RESULTS: In women with previous CS, adhesions were present in 37%, compared with 10% of women with no previous CS [odds ratio (OR): 5.18, 95% confidence interval (CI): 4.70-5.71]. Adhesions increased with the number of caesarean sections: 32% after one CS; 42% after two CS and 59% after three or more CS (P < 0.001). Regardless of the number of CS, factors at CS such as age ≥35 years (aOR: 1.28, 95% CI: 1.05-1.55), body mass index (BMI) ≥30 [adjusted OR (aOR): 1.91, 95% CI: 1.49-2.45] and postpartum infection (aOR: 1.55, 95% CI: 1.05-2.30) increased the risk of adhesions.

CONCLUSIONS: Presence of adhesions in abdominal gynaecological surgery is associated with women's personal history of caesarean delivery. The number of caesarean sections was the important predictor of adhesions; advanced age, obesity and postpartum infection further increased the incidence.

TWEETABLE ABSTRACT: Repeat caesarean, age, obesity and infection increased the risk of pelvic adhesions after caesarean section.

Keywords
Adhesions, adhesive disease, caesarean section, gynaecologic surgery
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-327111 (URN)10.1111/1471-0528.14708 (DOI)000428368900022 ()28444984 (PubMedID)
Funder
Swedish Research Council, 2012-00087
Available from: 2017-08-03 Created: 2017-08-03 Last updated: 2018-06-20Bibliographically approved
Liljeström, L., Wikström, A.-K., Ågren, J. & Jonsson, M. (2018). Antepartum risk factors for moderate to severe neonatal hypoxic ischemic encephalopathy: a Swedish national cohort study. Acta Obstetricia et Gynecologica Scandinavica, 97(5), 615-623
Open this publication in new window or tab >>Antepartum risk factors for moderate to severe neonatal hypoxic ischemic encephalopathy: a Swedish national cohort study
2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 5, p. 615-623Article in journal (Refereed) Published
Abstract [en]

Introduction

Our aim was to identify antepartum risk factors for neonatal hypoxic ischemic encephalopathy, with a focus on maternal body mass index and height.

Material and methods

National population-based cohort study of 692 428 live-born infants 36 gestational weeks in Sweden, 2009-2015. Data from the Swedish Medical Birth Register and the Swedish Neonatal Quality Register were linked. Short maternal stature was defined as 155 cm, and overweight as body mass index 25 kg/m(2). Therapeutic hypothermia served as surrogate marker of moderate to severe hypoxic ischemic encephalopathy. Associations between maternal and infant characteristics and hypoxic ischemic encephalopathy were calculated with logistic regression analyses, and risks were presented as odds ratios with 95% confidence intervals.

Results

Moderate to severe hypoxic ischemic encephalopathy occurred in 0.67/1000 infants. Nulliparity, previous cesarean delivery, short stature, overweight, gestational age, occiput posterior presentation and birthweight were all independently associated with hypoxic ischemic encephalopathy. The risk of hypoxic ischemic encephalopathy increased with decreasing maternal height and increasing body mass index. Compared with non-short women (156 cm) with normal weight (body mass index <25 kg/m(2)), those with both short stature and overweight had increased risk of hypoxic ischemic encephalopathy (odds ratio 3.66; 95% confidence intervals 2.41-5.55). Among parous women with both short stature and overweight, the risk was almost sixfold (odds ratio 5.74; 95% confidence intervals 3.41-9.66).

Conclusions

Antepartum risk factors for moderate to severe hypoxic ischemic encephalopathy included nulliparity, previous cesarean delivery, short stature, overweight, gestational age, occiput posterior presentation and birthweight. The combination of maternal short stature and overweight was associated with a more than threefold risk of subsequent hypoxic ischemic encephalopathy.

Keywords
Asphyxia, body mass index, hypoxic ischemic encephalopathy, maternal height, overweight, risk factors, short stature, therapeutic hypothermia
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-354099 (URN)10.1111/aogs.13316 (DOI)000430099900014 ()29450878 (PubMedID)
Funder
Swedish Research Council, 20143561Swedish Research Council, 2012-00087
Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-06-19Bibliographically approved
Liljeström, L., Jonsson, M. & Wikström, A.-K. (2018). Obstetric emergencies as antecedents to neonatal hypoxic ischemic encephalopathy, does parity matter?. Acta Obstetricia et Gynecologica Scandinavica, 97(11), 1396-1404
Open this publication in new window or tab >>Obstetric emergencies as antecedents to neonatal hypoxic ischemic encephalopathy, does parity matter?
2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 11, p. 1396-1404Article in journal (Refereed) Published
Abstract [en]

Introduction: Our aim was to investigate the risk of moderate to severe hypoxic ischemic encephalopathy (HIE) by obstetric emergencies, with focus on the distribution of obstetric emergencies by parity, taking the history of a previous cesarean into account.

Material and methods: Population-based cohort study of 692 428 live births at >= 36 weeks of gestation in Sweden, 2009-2015. Data were retrieved by linking the Swedish Medical Birth Register with the Swedish Neonatal Quality Register. Therapeutic hypothermia served as surrogate for moderate to severe HIE. Logistic regression analysis was used to estimate associations between HIE and placental abruption, eclampsia, cord prolapse, uterine rupture, and shoulder dystocia, presented as adjusted odds ratios (aORs) with 95% CI.

Results: An obstetric emergency occurred in 133/464 (29%) of all HIE cases, more commonly in the parous (overall 37%; 48% with and 31% without a previous cesarean) than in the nulliparous (21%). Among nulliparas, shoulder dystocia was the most common obstetric emergency with the strongest association with HIE (aOR 48.2; 95% CI 28.2-82.6). In parous women without a previous cesarean, shoulder dystocia was most common, but placental abruption had the strongest association with HIE. Among parous women with a previous cesarean, uterine rupture was the most prevalent obstetric emergency with the strongest association with HIE (aOR 45.6; 95% CI 24.5-84.6).

Conclusions: Obstetric emergencies are common among cases of moderate to severe HIE. The strong association with shoulder dystocia in nullipara, and with uterine rupture in women with previous cesarean deliveries, implies an opportunity for reducing the incidence of HIE.

Keywords
Asphyxia, hypoxic ischemic encephalopathy, obstetric emergencies, parity, risk factors, therapeutic hypothermia
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-341718 (URN)10.1111/aogs.13423 (DOI)000446155300016 ()29978451 (PubMedID)
Funder
Swedish Research Council, 2014-3561Swedish Research Council, 2012-00087
Note

Title in dissertation reference list: Obstetric emergencies as antecedents to neonatal hypoxic ischemic encephalopathy, does parity matter? : a Swedish national cohort study

Available from: 2018-02-13 Created: 2018-02-13 Last updated: 2018-11-28Bibliographically approved
Hesselman, S., Bergman, L., Högberg, U. & Jonsson, M. (2018). Risk of fistula formation and long-term health effects after a benign hysterectomy complicated by organ injury: A population-based register study. Acta Obstetricia et Gynecologica Scandinavica, 97(12), 1463-1470
Open this publication in new window or tab >>Risk of fistula formation and long-term health effects after a benign hysterectomy complicated by organ injury: A population-based register study
2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 12, p. 1463-1470Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: There is a paucity of data on the impact of organ injury on long-term outcomes after a hysterectomy for benign indications. The aim of this study was to investigate fistula formation and patient-reported long-term health outcomes after organ injury at the time of a hysterectomy.

MATERIAL AND METHODS: This was a population-based study of 22 538 women undergoing a hysterectomy between 2000 and 2014 in Sweden. Their medical history, characteristics of their surgery, and patient-reported outcomes were retrieved from Swedish national health and quality registers. Predictors for fistula formation were investigated with logistic regression and are presented as odds ratios with a 95% CI.

RESULTS: Fistulas were reported in 7% of women with organ injuries, compared with 0.4% of those without organ injuries (adjusted odds ratio 15.29 [9.81-23.85]). Laparotomy and postoperative infection were associated with postoperative fistulas. Most of the women reported having better health 1 year after the hysterectomy, but 7% of those with organ injuries and 24% of those with fistulas reported deteriorated health, compared with 2% of women without injuries.

CONCLUSION: Organ injury at the time of hysterectomy is associated with the development of fistulas involving the female genital tract and increases the proportion of women reporting deteriorated health 1 year after surgery.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-364827 (URN)10.1111/aogs.13450 (DOI)000449515200007 ()30168129 (PubMedID)
Funder
Swedish Research Council, 2012-00087
Available from: 2018-11-04 Created: 2018-11-04 Last updated: 2019-06-27Bibliographically approved
Sylvén, S. M., Thomopoulos, T. P., Kollia, N., Jonsson, M. & Skalkidou, A. (2017). Correlates of postpartum depression in first time mothers without previous psychiatric contact. European psychiatry, 40, 4-12
Open this publication in new window or tab >>Correlates of postpartum depression in first time mothers without previous psychiatric contact
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2017 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 40, p. 4-12Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Postpartum depression (PPD) is a common disorder after childbirth. The strongest known predictors are a history of depression and/or a history of PPD. However, for a significant proportion of women, PPD constitutes their first depressive episode. This study aimed to gain further insight into the risk factors for PPD in first time mothers without previous psychiatric contact.

METHODS: Women delivering in Uppsala University Hospital, Sweden, from May 2006 to June 2007, were asked to participate and filled out questionnaires five days and six weeks postpartum, containing inter alia the Edinburgh Postnatal Depression Scale (EPDS). Univariate logistic regression models, as well as a path analysis, were performed to unveil the complex interplay between the study variables.

RESULTS: Of the 653 participating primiparas, 10.3% and 6.4% reported depressive symptoms (EPDS≥12 points) five days and six weeks postpartum, respectively. In the path analysis, a positive association between anxiety proneness and depressive symptoms at five days and six weeks postpartum was identified. For depressive symptoms six weeks after delivery, additional risk factors were detected, namely depressive symptoms five days postpartum and subjective experience of problems with the baby. Caesarean section and assisted vaginal delivery were associated with fewer depressive symptoms at 6 six weeks postpartum.

CONCLUSIONS: Identification of anxiety proneness, delivery mode and problems with the baby as risk factors for self-reported depressive symptoms postpartum in this group of primiparas can be important in helping health care professionals identify women at increased risk of affective disorders in the perinatal period, and provide a base for early intervention.

Keywords
Depression, Path analysis, Peripartum, Postpartum, Primipara
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-319199 (URN)10.1016/j.eurpsy.2016.07.003 (DOI)000396967600002 ()27837672 (PubMedID)
Funder
Marianne and Marcus Wallenberg FoundationSwedish Research CouncilThe Swedish Medical AssociationStiftelsen Söderström - Königska sjukhemmet
Available from: 2017-03-31 Created: 2017-03-31 Last updated: 2018-09-17Bibliographically approved
Hesselman, S., Högberg, U. & Jonsson, M. (2017). Effect of remote cesarean delivery on complications during hysterectomy: a cohort study. American Journal of Obstetrics and Gynecology, 217(5), 564.e1-564.e8, Article ID S0002-9378(17)30863-3.
Open this publication in new window or tab >>Effect of remote cesarean delivery on complications during hysterectomy: a cohort study
2017 (English)In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 217, no 5, p. 564.e1-564.e8, article id S0002-9378(17)30863-3Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cesarean section is frequently performed worldwide, and follow-up studies reporting complications at subsequent surgery are warranted.

OBJECTIVES: The aim of the study was to investigate the association between a previous abdominal delivery and complications during a subsequent hysterectomy, and to estimate the fraction of complications driven by the presence of adhesions.

STUDY DESIGN: This was a longitudinal population based register study of 25354 women undergoing a benign hysterectomy at 46 hospital units in Sweden 2000-2014.

RESULTS: Adhesions were found in 45 % of the women with a history of cesarean delivery. Organ injury affected 2.2 %. The risk of organ injury (aOR 1.74, 95 % CI 1.41-2.15) and post-operative infection (aOR 1.26, 95 % CI 1.15-1.39) was increased with prior cesarean section, irrespective of whether adhesions were present or not. The direct effect on organ injury by a personal history of cesarean delivery was estimated to 73 %, and only 27 % was mediated by the presence of adhesions. Previous cesarean was a predictor of bladder injury (aOR 1.86, 95 % CI 1.40-2.47) and bowel injury (aOR 1.83, 95 % CI 1.10-3.03) but not ureter injury. A personal history of other abdominal surgeries was associated with bowel injury (aOR 2.27, 95 % CI 1.37-3.78), and the presence of endometriosis increased the risk of ureter injury (aOR 2.15, 95 % CI 1.34-3.44).

CONCLUSIONS: Prior cesarean delivery is associated with an increased risk of complications during a subsequent hysterectomy, but the risk is only partly attributable to the presence of adhesions. Previous cesarean delivery and presence of endometriosis were major predisposing factors of organ injury at the time of the hysterectomy whereas background and perioperative characteristics were of minor importance.

Keywords
Adhesive disease, adhesions, cesarean section, complications, endometriosis, hysterectomy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-327110 (URN)10.1016/j.ajog.2017.07.021 (DOI)000414073300012 ()28735704 (PubMedID)
Funder
Swedish Research Council, 2012-00087
Available from: 2017-08-03 Created: 2017-08-03 Last updated: 2018-02-16Bibliographically approved
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