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Axfors, C., Hellgren, C., Volgsten, H., Skoog Svanberg, A., Ekselius, L., Wikström, A.-K., . . . Sundström-Poromaa, I. (2019). Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women. Acta Obstetricia et Gynecologica Scandinavica, 98(4), 470-478
Open this publication in new window or tab >>Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women
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2019 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 4, p. 470-478Article in journal (Refereed) Published
Abstract [en]

Introduction

Elevated neuroticism is associated with higher health care utilization in the general population. This study aimed to investigate the association between neuroticism and the use of publicly financed antenatal care in obstetric low‐risk women, taking predisposing and need factors for health care utilization into consideration.

Material and methods

Participants comprised 1052 obstetric low‐risk women (no chronic diseases or adverse pregnancy conditions) included in several obstetrics/gynecology studies in Uppsala, Sweden. Neuroticism was self‐rated on the Swedish universities Scales of Personality. Medical records of their first subsequent pregnancy were scanned for antenatal care use. Associations between antenatal care use and neuroticism were analyzed with logistic regression (binary outcomes) or negative binomial regression (count outcomes) comparing the 75th and 25th neuroticism percentiles. Depending on the Akaike information criterion the exposure was modeled as either linear or with restricted cubic splines. Analyses were adjusted for predisposing (sociodemographic and parity) and need factors (body mass index and psychiatric morbidity).

Results

After adjustment, women with higher neuroticism had more fetal ultrasounds (incidence rate ratio = 1.09, 95% confidence interval (CI) 1.02‐1.16), more emergency visits to an obstetrician/gynecologist (incidence rate ratio = 1.22, 95% CI 1.03‐1.45) and were more likely to visit a fear‐of‐childbirth clinic (odds ratio = 2.71, 95% CI 1.71‐4.29). Moreover, they more often consulted midwives in specialized antenatal care facilities (significant J‐shaped association).

Conclusions

Neuroticism was associated with higher utilization of publicly financed antenatal care in obstetric low‐risk women, even after adjusting for predisposing and need factors. Future studies should address the benefits of interventions as a complement to routine antenatal care programs to reduce subclinical anxiety.

Keywords
antenatal care, health care utilization, neuroticism, personality, pregnancy, prenatal care
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-364260 (URN)10.1111/aogs.13506 (DOI)000460954800008 ()30457176 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-1955Marianne and Marcus Wallenberg Foundation, MMW2011.0115The Swedish Medical Association, SLS-250581Swedish Research Council, 521-2010-3293Swedish Research Council, K2008-54X-20642-01-3Swedish Society of MedicineStiftelsen Söderström - Königska sjukhemmetTore Nilsons Stiftelse för medicinsk forskning
Available from: 2018-10-24 Created: 2018-10-24 Last updated: 2019-04-15Bibliographically approved
Volgsten, H., Jansson, C., Skoog Svanberg, A., Darj, E. & Stavreus-Evers, A. (2018). Longitudinal study of emotional experiences, grief and depressive symptoms in women and men after miscarriage. Midwifery, 64, 23-28
Open this publication in new window or tab >>Longitudinal study of emotional experiences, grief and depressive symptoms in women and men after miscarriage
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2018 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 64, p. 23-28Article in journal (Refereed) Published
Abstract [en]

Objective: Although miscarriage is common and affects up to 20 % of pregnant women, little is known about these couples’ short term and long term experiences after miscarriage.The aim of the present study was to study emotional experience, grief and depressive symptoms in women and men,one week and four months after miscarriage. Research design /setting:Women, (n=103), and their male partner (n=78), were recruited at the gynecological clinic after miscarriage. Control women were recruitedfrom the general population.Three validated questionnaires concerning psychological wellbeing and mental health, RIMS, PGS and MADRS-S were answered by the participants one week and four months after the miscarriage. Findings: It was shown that for women, the emotional experiences of miscarriage, grief and depressive symptoms were more pronounced than for their male partners. Grief and depressive symptoms were reduced with time, which was not the case for the emotional experiences of miscarriage. Previous children was favorable for emotional experience while previous miscarriage or infertility treatment made the emotional experience worse. Conclusion: Grief and depressive symptoms is reducedover time while emotional experiences such as isolation, loss of baby and a devastating event persist for longer time than four months. Lack of previous children, previous miscarriageand infertility diagnosis could increase negative emotional experiencesafter miscarriage, this was especially pronounced for grief reaction.The questionnaires could be used both clinically and in research to understand the emotional experiences after miscarriage.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Spontaneous abortion, grief, emotion, RIMS, PGS, MADRS-S
National Category
Obstetrics, Gynecology and Reproductive Medicine Psychology (excluding Applied Psychology) Nursing
Identifiers
urn:nbn:se:uu:diva-351713 (URN)10.1016/j.midw.2018.05.003 (DOI)000439641700004 ()29864578 (PubMedID)
Funder
VINNOVA
Available from: 2018-05-29 Created: 2018-05-29 Last updated: 2018-10-16Bibliographically approved
Volgsten, H., Schmidt, L., Skoog Svanberg, A., Ekselius, L. & Sundström Poromaa, I. (2018). Psychiatric disorders in women and men up to five years after undergoing assisted reproductive technology treatment: a prospective cohort study. Human Fertility, 1-6
Open this publication in new window or tab >>Psychiatric disorders in women and men up to five years after undergoing assisted reproductive technology treatment: a prospective cohort study
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2018 (English)In: Human Fertility, ISSN 1464-7273, E-ISSN 1742-8149, p. 1-6Article in journal (Refereed) Epub ahead of print
Abstract [en]

This is a prospective cohort study with the objective to describe psychiatric disorders, such as any mood and anxiety disorders, in both women and men five years after assisted reproductive technology (ART). The Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire, based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), was used as the diagnostic tool to evaluate psychiatric disorders. Logistic regression analysis was used to calculate odds ratios (ORs) and confidence interval (CI) for factors associated with psychiatric disorders at the follow-up. Overall, 278 (63.3%) women and 183 (41.7%) men filled in and returned the questionnaire. Approximately 11.5% of women and 5.5% of men fulfilled the criteria for any psychiatric diagnosis. Of these, any mood disorder was present in 9.4% of women and 4.4% of men. The major risk factor for mood or anxiety disorders at follow-up was mood or anxiety disorders at the time of the index ART. Mood disorders were not more common in women who remained childless after ART. In conclusion, these findings indicate that psychiatric disorders at five years follow-up after ART are less common than at the baseline assessment in conjunction with the ART.

Keywords
Assisted reproductive technology, cohort study, depression, follow-up, infertility, psychiatric disorders
National Category
Psychiatry Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-351123 (URN)10.1080/14647273.2018.1474279 (DOI)29768933 (PubMedID)
Available from: 2018-05-19 Created: 2018-05-19 Last updated: 2018-09-12Bibliographically approved
Volgsten, H., Jansson, C., Darj, E. & Stavreus-Evers, A. (2018). Women's experiences of miscarriage related to diagnosis, duration, and type of treatment. Acta Obstetricia et Gynecologica Scandinavica, 97(12), 1491-1498
Open this publication in new window or tab >>Women's experiences of miscarriage related to diagnosis, duration, and type of treatment
2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 12, p. 1491-1498Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Women with miscarriage experience several negative emotional feelings such as grief, isolation, coping, and despair. However, less is known about how the type of treatment and diagnosis of miscarriage influence the emotional experience.

MATERIAL AND METHODS: The present study was a randomized prospective longitudinal cohort study, in which women with spontaneous miscarriage (n = 35), and women with missed miscarriage (n = 67), were included to answer 3 validated questionnaires: Revised Impact of Miscarriage Scale, Perinatal Grief Scale, and Montgomery and Åsberg Depression Rating Scale, concerning experience of miscarriage, psychological well-being, and mental health 1 week and 4 months after finalized treatment.

RESULTS: There was no difference between the 2 diagnosis groups in feelings as measured by Revised Impact of Miscarriage Scale, Montgomery and Åsberg Depression Rating Scale, and Perinatal Grief Scale 1 week after the miscarriage. However, the psychological well-being improved significantly 4 months after the miscarriage. Separated by treatment, women treated with misoprostol alone had more depressive symptoms than women treated with misoprostol and subsequent vacuum aspiration.

CONCLUSIONS: It can be concluded that diagnosis of miscarriage had limited influence on the experiences of miscarriage, but shorter duration of treatment with misoprostol and subsequent vacuum aspiration resulted in fewer depressive symptoms.

Keywords
Montgomery and Åsberg Depression Rating Scale, Perinatal Grief Scale, Revised Impact of Miscarriage Scale, emotion, grief, miscarriage, spontaneous abortion
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-361417 (URN)10.1111/aogs.13432 (DOI)000449515200011 ()30063247 (PubMedID)
Funder
Vinnova
Available from: 2018-09-24 Created: 2018-09-24 Last updated: 2019-06-27Bibliographically approved
Hedberg Nyqvist, K., Rosenblad, A., Volgsten, H., Funkquist, E.-L. & Mattsson, E. (2017). Early skin-to-skin contact between healthy late preterm infants and their parents: an observational cohort study. PeerJ, 5, Article ID e3949.
Open this publication in new window or tab >>Early skin-to-skin contact between healthy late preterm infants and their parents: an observational cohort study
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2017 (English)In: PeerJ, ISSN 2167-8359, E-ISSN 2167-8359, Vol. 5, article id e3949Article in journal (Refereed) Published
Abstract [en]

Background

Skin-to-skin contact (SSC) is an important factor to consider in the care of late preterm infants (born between 34 0/7 and 36 6/7 completed weeks of gestation). The literature suggests that SSC between preterm infants and their mothers facilitates breastfeeding. However, more studies are needed to explore potential dose-response effects between SSC and breastfeeding as well as studies that explicitly investigate SSC by fathers among late preterm infants. The aim was to investigate the duration of healthy late preterm infants’ SSC with the mother and father, respectively, during the first 48 h after birth and the associations with breastfeeding (exclusive/partial at discharged), clinical and demographic variables.

Methods

This was an observational cohort study in which parents to healthy late preterm infants, born between 34 5/7 and 36 6/7 completed weeks of gestation, recorded duration of SSC provided by mother and father, respectively. Demographic and clinical variables were retrieved from the medical records and were used as predictors. Multiple linear regression analysis was used to assess the association between the predictors and the outcome, SSC (hours), separately for mothers and fathers.

Results

The mean (standard deviation [SD]) time per day spent with SSC with mothers (n = 64) and fathers (n = 64), was 14.7 (5.6) and 4.4 (3.3) hours during the first day (24 h) after birth and 9.2 (7.1) and 3.1 (3.3) hours during the second day (24 h), respectively. Regarding SSC with mothers, no variable was significantly associated with SSC during the first day, while the mean (95% confidence interval [CI]) time of SSC during the second day was 6.9 (1.4–12.4) hours shorter for each additional kg of birthweight (p = 0.014). Concerning SSC with fathers, the mean (95% CI) time of SSC during the first day was 2.1 (0.4–3.7) hours longer for infants born at night (p = 0.015), 1.7 (0.1–3.2) hours longer for boys (p = 0.033), 3.2 (1.2–5.2) hours longer for infants born by caesarean section (p = 0.003), and 1.6 (0.1–3.1) hours longer for infants exclusively breastfed at discharge (p = 0.040). During the second day, the mean (95% CI) time of SSC with fathers was 3.0 (0.6–5.4) hours shorter for each additional kg of birthweight (p = 0.014), 2.0 (0.5–3.6) hours longer for infants born during night-time (p = 0.011), 2.9 (1.4–4.4) hours longer if the mother was primipara (p < 0.001), and 1.9 (0.3–3.5) hours shorter if supplementary artificial milk feeds were given. None of the other predictors, i.e., mother’s age, gestational age, or induction of labor were significantly associated with infants’ SSC with mothers or fathers during any of the first two days after birth.

Conclusion

Future studies are warranted that investigate duration of SSC between late preterm infants and their parents separately and the associations with breastfeeding and other variables of clinical importance.

Keywords
Preterminfants, Skin-to-skincontact, Breastfeeding, Latepreterminfants, Mothers, Fathers
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-333035 (URN)10.7717/peerj.3949 (DOI)000413966900002 ()29104822 (PubMedID)
Available from: 2017-11-06 Created: 2017-11-06 Last updated: 2018-02-08Bibliographically approved
Volgsten, H. & Schmidt, L. (2017). Live birth outcome, spontaneous pregnancy and adoption up to five years after undergoing assisted reproductive technology treatment. Acta Obstetricia et Gynecologica Scandinavica, 96(8), 954-959
Open this publication in new window or tab >>Live birth outcome, spontaneous pregnancy and adoption up to five years after undergoing assisted reproductive technology treatment
2017 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 8, p. 954-959Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: This study is part of a longitudinal cohort undertaken in both women and men to describe live birth outcome after undergoing assisted reproductive technology (ART) treatment in a clinical setting. Another objective was to follow women and men living with children from other alternatives after ART, such as adoption.

MATERIAL AND METHODS: A total of 439 (80.5%) women and 423 (77.6%) men were included in the baseline cohort (2005-2007). Live birth rate after ART was 24.8% at baseline. Up to 5 years later (2010-2011) the same participants were sent individual postal questionnaires (n = 439).

RESULTS: Overall, 278 (63.3%) women and 183 (41.7%) men filled in and returned the questionnaire at follow up. The majority of women (91.7%) and men (93.4%) were living with children. A total of 225 (80.9%) women had a live birth at follow up. Of these, almost three of four (71.6%) had a live birth after ART and more than one of four (28.0%) after spontaneous pregnancies or both. Of these, 52 (26.1%) women had a subsequent live birth after successful ART and 26 (32.9%) women after unsuccessful ART. Nineteen (6.8%) women and 13 (7.1%) men had a child after adoption. Almost one of five (19.1%) women had no live birth at follow up.

CONCLUSION: The majority of women and men were living with children, resulting from a live birth after ART, spontaneous pregnancy and/or adoption up to 5 years later. However, almost one of five had no live birth at follow up.

Keywords
Adoption, assisted reproductive technology, follow up, infertility, longitudinal cohort study, spontaneous pregnancy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-332227 (URN)10.1111/aogs.13139 (DOI)000405929100007 ()28374421 (PubMedID)
Available from: 2017-10-25 Created: 2017-10-25 Last updated: 2017-11-17Bibliographically approved
Jansson, C., Volgsten, H., Huffman, C., Skoog Svanberg, A., Swanson, K. M. & Stavreus-Evers, A. (2017). Validation of the Revised Impact of Miscarriage Scale for Swedish conditions and comparison between Swedish and American couples' experiences after miscarriage. European journal of contraception & reproductive health care, 22(6), 412-417
Open this publication in new window or tab >>Validation of the Revised Impact of Miscarriage Scale for Swedish conditions and comparison between Swedish and American couples' experiences after miscarriage
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2017 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 22, no 6, p. 412-417Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: There is a lack of knowledge in women's and men's experience of miscarriage. The Revised Impact of Miscarriage Scale (RIMS) has been used in United States to measure the experiences after miscarriage. The first objective was to test the consistency of RIMS for Swedish conditions. The second purpose of this study was to compare Swedish and American couples' experience of miscarriage by use of the RIMS.

METHODS: Forward and back translation was used for translating RIMS into Swedish. This is a hospital-based comparative study including Swedish couples (n = 70) and American couples (n = 70). The couples were matched by the women's age, week of miscarriage and number of children. All participants answered socio-demographic, fertility and depression-scale questions in addition to RIMS.

RESULTS: Cronbach's alpha analysis was above 0.650, the mean value was 0.824. There was no significant difference between the Swedish and American participants on the factors 'Isolation/Guilt' and 'Devastating event', but the Swedish women and men scored significantly lower on the factor 'Loss of baby' than the American women and men. The men, Swedish and American combined, scored lower than the women in all factors but the correlation within the couples was similar for both Swedish and American couples.

CONCLUSIONS: The high consistency between the countries suggests that the RIMS questionnaire is reliable for both women and men to be used in both countries and two of three factors were similar between the two countries.

Keywords
Spontaneous abortion, pregnancy loss, stressful event
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-339293 (URN)10.1080/13625187.2017.1409346 (DOI)000423156000004 ()29250992 (PubMedID)
Available from: 2018-01-17 Created: 2018-01-17 Last updated: 2018-10-02Bibliographically approved
Mattsson, E., Funkquist, E.-L., Wickström, M., Nyqvist, K. H. & Volgsten, H. (2015). Healthy late preterm infants and supplementary artificial milk feeds: Effects on breast feeding and associated clinical parameters. Midwifery, 31(4), 426-431
Open this publication in new window or tab >>Healthy late preterm infants and supplementary artificial milk feeds: Effects on breast feeding and associated clinical parameters
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2015 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 4, p. 426-431Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: to compare the influence of supplementary artificial milk feeds on breast feeding and certain clinical parameters among healthy late preterm infants given regular supplementary artificial milk feeds versus being exclusively breast fed from birth.

DESIGN: a comparative study using quantitative methods. Data were collected via a parental diary and medical records.

METHODS: parents of 77 late preterm infants (34 5/7-36 6/7 weeks), whose mothers intended to breast feed, completed a diary during the infants׳ hospital stay.

FINDINGS: infants who received regular supplementary artificial milk feeds experienced a longer delay before initiation of breast feeding, were breast fed less frequently and had longer hospital stays than infants exclusively breast fed from birth. Exclusively breast-fed infants had a greater weight loss than infants with regular artificial milk supplementation. A majority of the mothers (65%) with an infant prescribed artificial milk never expressed their milk and among the mothers who used a breast-pump, milk expression commenced late (10-84 hours after birth). At discharge, all infants were breast fed to some extent, 43% were exclusively breast fed.

KEY CONCLUSIONS: clinical practice and routines influence the initiation of breast feeding among late preterm infants and may act as barriers to the mothers׳ establishment of exclusive breast feeding.

National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-242501 (URN)10.1016/j.midw.2014.12.004 (DOI)000353526100004 ()25596897 (PubMedID)
Available from: 2015-01-26 Created: 2015-01-26 Last updated: 2017-12-05Bibliographically approved
Gerhardsson, E., Nyqvist, K. H., Mattsson, E., Volgsten, H., Hildingsson, I. & Funkquist, E.-L. (2014). The Swedish Version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and Validity Assessment. Journal of Human Lactation, 30(3), 340-345
Open this publication in new window or tab >>The Swedish Version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and Validity Assessment
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2014 (English)In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 30, no 3, p. 340-345Article in journal (Refereed) Published
Abstract [en]

Background:

Among Swedish mothers, breastfeeding duration has been declining in recent years. An instrument for early identification of women at risk for shorter breastfeeding duration may be useful in reversing this trend.

Objectives:

The aims of this study were to translate and psychometrically test the Swedish version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), examine the relationship between breastfeeding self-efficacy and demographic variables, and evaluate associations with breastfeeding continuation plans in Swedish mothers.

Methods:

The BSES-SF was translated into Swedish using forward and back translation. The sample consisted of 120 mothers who, during the first week postpartum, came for a routine follow-up visit at the postnatal unit in a university hospital. The mothers were compared based on demographic data and their future breastfeeding plans.

Results:

The Cronbach's alpha coefficient for internal consistency for the BSES-SF was 0.91 and the majority of correlation coefficients exceeded 0.3. A 1-factor solution was found that explained 46% of the total variance. There was no difference in confidence in breastfeeding between mothers with early hospital discharge and mothers who received postnatal care at the hospital. Primiparas who stayed longer at the hospital were less confident in breastfeeding than primiparas who had a shorter hospital stay. Breastfeeding mothers who planned to partially breastfeed in the near future had lower BSES-SF scores, compared to those who planned to continue exclusive breastfeeding.

Conclusion:

The Swedish version of the BSES-SF has good reliability, validity, and agreement with mothers' plans regarding breastfeeding continuation and exclusivity.

National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine Pediatrics
Identifiers
urn:nbn:se:uu:diva-219398 (URN)10.1177/0890334414523836 (DOI)000340424100016 ()24574154 (PubMedID)
Available from: 2014-02-28 Created: 2014-02-28 Last updated: 2017-12-05Bibliographically approved
Kaplan-Sturk, R., Åkerud, H., Volgsten, H., Hellström-Westas, L. & Wiberg-Itzel, E. (2013). Outcome of deliveries in healthy but obese women: obesity and delivery outcome. BMC Research Notes, 6, 50
Open this publication in new window or tab >>Outcome of deliveries in healthy but obese women: obesity and delivery outcome
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2013 (English)In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 6, p. 50-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Obesity among fertile women is a global problem. 25% of pregnant Swedish women are overweight at admission to the antenatal clinic and 12% of them are considered as obese. Previous studies have shown an increased risk of delivery complications with an elevated maternal BMI. The aim of this study was to evaluate delivery outcomes in relation to maternal BMI on admission to the antenatal clinic.

A healthy group of 787 women with full-term pregnancies and spontaneous onset of labor were included in the study. Delivery outcome was assessed in relation to maternal BMI when attending the antenatal clinic.

RESULTS:

The results indicated that in deliveries where the maternal BMI was >30 a high frequency of abnormal CTG trace during the last 30 minutes of labor was shown. A blood sample for evaluation of risk of fetal hypoxia was performed in only eight percent of these deliveries. A spontaneous vaginal delivery without intervention was noted in 85.7%, and 12% of neonates were delivered with an adverse fetal outcome compared to 2.8% in the group with a maternal BMI<30 (p<0.001).

CONCLUSION:

These results indicate an increased risk at delivery for healthy, but obese women in labor. Furthermore, the delivery management may not always be optimal in these deliveries.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-197560 (URN)10.1186/1756-0500-6-50 (DOI)23388378 (PubMedID)
Available from: 2013-03-27 Created: 2013-03-27 Last updated: 2017-12-06Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0180-0280

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