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Åkerud, Helena
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Publications (10 of 73) Show all publications
Wiberg-Itzel, E., Wray, S. & Åkerud, H. (2018). A randomized controlled trial of a new treatment for labor dystocia. The Journal of Maternal-Fetal & Neonatal Medicine, 31(17), 2237-2244
Open this publication in new window or tab >>A randomized controlled trial of a new treatment for labor dystocia
2018 (English)In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 31, no 17, p. 2237-2244Article in journal (Refereed) Published
Abstract [en]

Objective: Labor dystocia is an intransigent, high-profile issue in obstetric care. Amniotic fluid lactate (AFL) reflects the uterine metabolic status. High levels associate with subsequent need for operative intervention due to dystocia. In sports medicine, it is known that lactic acid can affect muscular performance and can be decreased by bicarbonate given orally before physical activity.

Material and methods: Two hundred dystocic deliveries were included. At the confirmation of dystocia, the AFL-level was analyzed. Deliveries were randomized to an intake of bicarbonate or not. In the non-bicarbonate-group, stimulation with oxytocin was started immediately. In the bicarbonate-group, bicarbonate was given; and oxytocin was started 1hour after the intake. New sampling of AF was performed after 1hour in both groups. Outcome measured: if an oral intake of bicarbonate changes the AFL levels and enhances delivery outcome in dystocic deliveries.

Results: Bicarbonate decreases the AFL levels (p<.001). The spontaneous vaginal delivery rate after treatment with bicarbonate was increased (p=.007), without affecting the fetal outcome.

Conclusions: An increase of spontaneous vaginal deliveries resulted from bicarbonate ingestion by dystocic women. A decreased level of AFL-level was shown. This simple, low cost treatment has the potential to improve maternal morbidity and satisfaction worldwide.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
Keywords
AFL, bicarbonate, caesarean, dystocia, labor
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-356816 (URN)10.1080/14767058.2017.1339268 (DOI)000432700800002 ()28587493 (PubMedID)
Available from: 2018-08-16 Created: 2018-08-16 Last updated: 2018-08-16Bibliographically approved
Sterpu, I. S., Åkerud, H., Kaihola, H. & Itzel, E. W. (2018). Angiogenic factors as biomarkers for fetal wellbeing during delivery. Paper presented at 38th Annual Meeting and Pregnancy Meeting of the Society-for-Maternal-Fetal-Medicine, JAN 29-FEB 03, 2018, Dallas, TX. American Journal of Obstetrics and Gynecology, 218(1: Supplement), S186-S186
Open this publication in new window or tab >>Angiogenic factors as biomarkers for fetal wellbeing during delivery
2018 (English)In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 218, no 1: Supplement, p. S186-S186Article in journal, Meeting abstract (Other academic) Published
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-350205 (URN)10.1016/j.ajog.2017.10.224 (DOI)000422946900296 ()
Conference
38th Annual Meeting and Pregnancy Meeting of the Society-for-Maternal-Fetal-Medicine, JAN 29-FEB 03, 2018, Dallas, TX
Note

Meeting Abstract: 295

Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-05-08Bibliographically approved
Bergman, L., Zetterberg, H., Kaihola, H., Hagberg, H., Blennow, K. & Åkerud, H. (2018). Blood-based cerebral biomarkers in preeclampsia: Plasma concentrations of NfL, tau, S100B and NSE during pregnancy in women who later develop preeclampsia - A nested case control study. PLoS ONE, 13(5), Article ID e0196025.
Open this publication in new window or tab >>Blood-based cerebral biomarkers in preeclampsia: Plasma concentrations of NfL, tau, S100B and NSE during pregnancy in women who later develop preeclampsia - A nested case control study
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 5, article id e0196025Article in journal (Refereed) Published
Abstract [en]

Objective To evaluate if concentrations of the neuronal proteins neurofilament light chain and tau are changed in women developing preeclampsia and to evaluate the ability of a combination of neurofilament light chain, tau, S100B and neuron specific enolase in identifying neurologic impairment before diagnosis of preeclampsia. Methods A nested case-control study within a longitudinal study cohort was performed. 469 healthy pregnant women were enrolled between 2004-2007 and plasma samples were collected at gestational weeks 10, 25, 28, 33 and 37. Plasma concentrations of tau and neurofilament light chain were analyzed in 16 women who eventually developed preeclampsia and 36 controls throughout pregnancy with single molecule array (Simoa) method and compared within and between groups. S100B and NSE had been analyzed previously in the same study population. A statistical model with receiving characteristic operation curve was constructed with the four biomarkers combined. Results Plasma concentrations of neurofilament light chain were significantly increased in women who developed preeclampsia in gestational week 33 (11.85 ng/L, IQR 7.48-39.93 vs 6.80 ng/L, IQR 5.65-11.40) and 37 (22.15 ng/L, IQR 10.93-35.30 vs 8.40 ng/L, IQR 6.40-14.30) and for tau in gestational week 37 (4.33 ng/L, IQR 3.97-12.83 vs 3.77 ng/L, IQR 1.91-5.25) in contrast to healthy controls. A combined model for preeclampsia with tau, neurofilament light chain, S100B and neuron specific enolase in gestational week 25 displayed an area under the curve of 0.77, in week 28 it was 0.75, in week 33 it was 0.89 and in week 37 it was 0.83. Median week for diagnosis of preeclampsia was at 38 weeks of gestation. Conclusion Concentrations of both tau and neurofilament light chain are increased in the end of pregnancy in women developing preeclampsia in contrast to healthy pregnancies. Cerebral biomarkers might reflect cerebral involvement before onset of disease.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine Neurosciences
Identifiers
urn:nbn:se:uu:diva-358098 (URN)10.1371/journal.pone.0196025 (DOI)000431281900042 ()29719006 (PubMedID)
Funder
EU, European Research CouncilKnut and Alice Wallenberg FoundationSwedish Research Council, D 2013-2546Swedish Research Council, D0277902Swedish Research Council, D0277901Torsten Söderbergs stiftelse
Available from: 2018-08-24 Created: 2018-08-24 Last updated: 2018-08-24Bibliographically approved
Skírnisdottir, I., Åkerud, H. & Seidal, T. (2018). Clinical significance of growth factor receptor EGFR and angiogenesis regulator VEGF‑R2 in patients with ovarian cancer at FIGO stages I-II.. International Journal of Oncology, 53(4), 1633-1642
Open this publication in new window or tab >>Clinical significance of growth factor receptor EGFR and angiogenesis regulator VEGF‑R2 in patients with ovarian cancer at FIGO stages I-II.
2018 (English)In: International Journal of Oncology, ISSN 1019-6439, Vol. 53, no 4, p. 1633-1642Article in journal (Refereed) Published
Abstract [en]

The aim of the present retrospective cohort study was to investigate the prognostic effect of epidermal growth factor receptor (EGFR) and the angiogenesis regulator vascular endothelial growth factor receptor 2 (VEGF‑R2) on disease-free survival (DFS) rate and recurrent disease, and their association with clinicopathological characteristics in 131 patients with International Federation of Gynecology and Obstetrics (FIGO) stages I-II epithelial ovarian cancer. The techniques of tissue microar-rays and immunohistochemistry were used for the positive detection of the markers. The frequency of positive staining in tumors for EGFR was 24% and for VEGF‑R2 was 77%. Across the cohort, there was a total of 34/131 recurrences (26%) and the 5‑year DFS rate was 68%. In a multivariate logistic regression analysis with recurrent disease as the endpoint, FIGO stage (OR=9.7), type (I/II) of tumor (OR=3.0) and VEGF‑R2 status (OR=0.2) were all found to be independent predictive factors in the cohort of patients (n=131). For patients with non‑serous tumors (n=78), the FIGO stage (OR=76), type (I/II) of tumor (OR=44), EGFR status (OR=0.05) and VEGF‑R2 status (OR=0.008) were all significant and independent predictive factors. On comparing the four subgroups, in terms of concomitant EGFR and VEGF‑R2 status, in a survival analysis, the subgroup of patients (n=21) with concomitant positive expression of EGFR and VEGF‑R2 had a 5‑year DFS rate of 100%. Therefore, the prognostic effect of EGFR and VEGF‑R2 for recurrent disease and survival rates was confirmed by the above findings. Certain results in the present study were not in line with results from previous studies on the prognostic effect of EGFR and VEGF‑R2. An increasing number of preclinical and clinical observations have shown that the process of angiogenesis remains to be fully elucidated. Therefore, one of the challenges for future ovarian cancer investigations is to identify which biomarkers may be used as predictive and prognostic markers.

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-359900 (URN)10.3892/ijo.2018.4511 (DOI)000442971100018 ()30066848 (PubMedID)
Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2018-10-03Bibliographically approved
Elenis, E., Skalkidou, A., Skoog Svanberg, A., Sydsjö, G., Stavreus-Evers, A. & Åkerud, H. (2018). HRG C633T polymorphism and risk of gestational hypertensive disorders: a pilot study. BMC Medical Genetics, 19, Article ID 44.
Open this publication in new window or tab >>HRG C633T polymorphism and risk of gestational hypertensive disorders: a pilot study
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2018 (English)In: BMC Medical Genetics, ISSN 1471-2350, E-ISSN 1471-2350, Vol. 19, article id 44Article in journal (Refereed) Published
Abstract [en]

Background: Preeclampsia and gestational hypertensive disorders are thought to occur due to endothelial cell dysfunction and abnormal placentation, triggered by angiogenesis-related factors yet undetermined. The aim of this study was to investigate whether a genetic polymorphism (SNP) of Histidine-rich glycoprotein (HRG), HRG C633T SNP, is associated with gestational hypertensive disorders.

Methods: It was performed a nested case-control study from the BASIC Cohort of Uppsala University Hospital comprising 92 women diagnosed with gestational hypertensive disorders without other comorbidities and 200 women with full term uncomplicated pregnancies, all genotyped regarding HRG C633T SNP.

Results: The genetic analysis of the study sample showed that C/C genotype was more prevalent among controls. The presence of the T-allele showed a tendency towards an increased risk of gestational hypertensive disorders. After clustering the study participants based on their genotype, it was observed that the odds for gestational hypertensive disorders among heterozygous C/T or homozygous T/T carriers were higher compared to homozygous C/C carriers [OR 1.72, 95% CI (1.04-2.84)]. The association remained significant even after adjustment for maternal age, BMI and parity.

Conclusions: The HRG C633T genotype seems to be associated with gestational hypertensive disorders, and as part of a greater algorithm, might contribute in the future to the prediction of the individual susceptibility to the condition.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2018
Keywords
Angiogenesis, Gestational hypertensive disorders, HRG, HRG C633T SNP, Preeclampsia
National Category
Obstetrics, Gynecology and Reproductive Medicine Medical Genetics
Identifiers
urn:nbn:se:uu:diva-351434 (URN)10.1186/s12881-018-0550-8 (DOI)000427996000001 ()29540166 (PubMedID)
Funder
Swedish Research Council, D0277902Swedish Research Council, D0277901
Available from: 2018-05-31 Created: 2018-05-31 Last updated: 2018-05-31Bibliographically approved
Wallstrom, T., Bjorklund, J., Frykman, J., Jarnbert-Pettersson, H., Åkerud, H., Darj, E., . . . Wiberg-Itzel, E. (2018). Induction of labor after one previous Cesarean section in women with an unfavorable cervix: A retrospective cohort study. PLoS ONE, 13(7), Article ID e0200024.
Open this publication in new window or tab >>Induction of labor after one previous Cesarean section in women with an unfavorable cervix: A retrospective cohort study
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 7, article id e0200024Article in journal (Refereed) Published
Abstract [en]

Objective Uterine rupture is a well-known but unusual complication in vaginal deliveries with a Cesarean section in the history. The risk of uterine rupture is at least two-fold when labor is induced. In Sweden, women are allowed to deliver vaginally after one previous Cesarean section, regardless if labor starts spontaneously or is induced. The aim of the study is to compare the proportion of uterine ruptures between the three methods (balloon catheter, Minprostin (R) and Cytotec (R)) for induction of labor in women with an unfavorable cervix and one previous Cesarean section. Material and methods Retrospective cohort study of all women with one previous Cesarean section and induction of labor with an unfavorable cervix at the four largest clinics in Stockholm during 20122015. Inclusion criteria: Women with a previous Cesarean section and induction of labor with a viable fetus, cephalic presentation, singleton, at >= 34 w, (n = 910). Results 3.0% (27/910) of the women with induction of labor had a uterine rupture, 91% of them had no previous vaginal delivery. The proportion of uterine ruptures was 2.0% (6/295) with orally administrated Cytotec (R), 2.1% (7/335) with balloon catheter and 5.0% (14/ 281) when Minprostin (R) was used. Conclusions No difference in the proportion of uterine ruptures was shown when orally administrated Cytotec (R) and balloon catheter were compared (p = 0.64). Orally administrated Cytotec (R) and balloon catheter give a high success rate of vaginal deliveries (almost 70%) despite an unfavorable cervix.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-361282 (URN)10.1371/journal.pone.0200024 (DOI)000437224100039 ()29965989 (PubMedID)
Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2018-09-27Bibliographically approved
Wallström, T., Jarnbert-Pettersson, H., Stenson, D., Åkerud, H., Darj, E., Gemzell-Danielsson, K. & Wiberg-Itzel, E. (2017). Labor Induction with Orally Administrated Misoprostol: A Retrospective Cohort Study. BioMed Research International, Article ID 6840592.
Open this publication in new window or tab >>Labor Induction with Orally Administrated Misoprostol: A Retrospective Cohort Study
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2017 (English)In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, article id 6840592Article in journal (Refereed) Published
Abstract [en]

Introduction. One great challenge in obstetric care is labor inductions. Misoprostol has advantages in being cheap and stable at room temperature and available in resource-poor settings.

Material and Methods. Retrospective cohort study of 4002 singleton pregnancies with a gestational age >= 34w at Sodersjukhuset, Stockholm, during 2009-2010 and 2012-2013. Previously usedmethods of labor induction were compared with misoprostol given as a solution to drink, every second hour. Main outcome is as follows: Cesarean Section (CS) rate, acid-base status in cord blood, Apgar score < 7,5 ', active time of labor, and blood loss > 1500 ml (PPH).

Results. The proportion of CS decreased from 26% to 17% when orally given solution of misoprostol was introduced at the clinic (p < 0.001). No significant difference in the frequency of low Apgar score (p = 0.3), low aPh in cord blood (p = 0.1), or PPH (p = 0.4) between the differentmethods of induction was studied. After adjustment for different risk factor for CS the only method of induction which was associated with CS was dinoproston** (Propess (R)) (aor = 2.9 (1.6-5.2)).

Conclusion. Induction of labor with misoprostol, given as an oral solution to drink every second hour, gives a low rate of CS, without affecting maternal or fetal outcome.

National Category
Medical Biotechnology (with a focus on Cell Biology (including Stem Cell Biology), Molecular Biology, Microbiology, Biochemistry or Biopharmacy)
Identifiers
urn:nbn:se:uu:diva-335766 (URN)10.1155/2017/6840592 (DOI)000411050600001 ()
Available from: 2017-12-15 Created: 2017-12-15 Last updated: 2017-12-15Bibliographically approved
Kumaresan, A., Johannisson, A., Nordqvist, S., Kårehed, K., Åkerud, H., Lindgren, K. E. & Morrell, J. M. (2017). Relationship of DNA integrity to HRG C633T SNP and ART outcome in infertile couples. Reproduction, 153(6), 865-876
Open this publication in new window or tab >>Relationship of DNA integrity to HRG C633T SNP and ART outcome in infertile couples
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2017 (English)In: Reproduction, ISSN 1470-1626, E-ISSN 1476-3990, Vol. 153, no 6, p. 865-876Article in journal (Refereed) Published
Abstract [en]

The status of sperm DNA fragmentation, protamine deficiency, free thiols and disulphide bonds in colloid-selected samples and its relationship to ART outcome or HRG C633T SNP is not known. The objective of this study was to determine these relationships in spermatozoa from men with male factor or unknown factor infertility (n=118) undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Sperm DNA integrity was analysed by flow cytometry using three fluorescent probes (acridine orange, monobromobimane and chromomycin A3). Principal component analysis (PCA) was used to identify the parameters that most influenced fertility. The relationships of sperm DNA integrity with seminal parameters, HRG C633T SNP and ART outcome were established using ANOVA and t-test. Sperm concentration and yield after preparation accounted for 27% of the total variance; sperm DNA integrity (% DFI and disulphide bonds) accounted for 16% of the variance in men from infertile couples. Sperm % DFI was significantly higher (P < 0.05) in older men than in younger men. A significant difference (P < 0.01) was observed in % DFI between smokers and non-smokers. Sperm % DFI was significantly higher (P < 0.01) in male factor infertility compared to either female factor or unknown factor infertility while free thiols were significantly higher (P < 0.01) in unknown infertility factor. No significant difference was observed between IVF success/failure in any of the seminal parameters studied. There was a tendency for protamine deficiency to be higher and disulphide concentration to be lower in men with HRG 633T. Such assessments may provide additional useful information about the prognosis for ART outcome, although more research is needed before clinical guidelines can be provided.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-329724 (URN)10.1530/REP-17-0058 (DOI)000403589700017 ()28356499 (PubMedID)
Available from: 2017-09-21 Created: 2017-09-21 Last updated: 2017-09-21Bibliographically approved
Bjersand, K., Seidal, T., Sundström Poromaa, I., Åkerud, H. & Skírnisdottir, I. (2017). The clinical and prognostic correlation of HRNPM and SLC1A5 in pathogenesis and prognosis in epithelial ovarian cancer. PLoS ONE, 12(6), Article ID e0179363.
Open this publication in new window or tab >>The clinical and prognostic correlation of HRNPM and SLC1A5 in pathogenesis and prognosis in epithelial ovarian cancer
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 6, article id e0179363Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate the prognostic effect of the Heterogeneous nuclear ribonucleoprotein type M (HNRPM) and Solute carrier 1A5 (SLC1A5) in FIGO-stages I-II epithelial ovarian cancer.

METHODS: A retrospective cohort study was designed to investigate the prognostic effect of HNRPM and SLC1A5, and the association with clinical-pathologic characteristics in 131 patients with FIGO-stages I-II epithelial ovarian cancer. Tissue microarrays were constructed and protein levels were assessed by immunohistochemistry (IHC).

RESULTS: Positive HRNPM status was associated with positive staining for PUMA (P = 0.04), concomitant PUMA and p21 staining (P = 0.005), and VEGF-R2 (P = 0.003). Positive SLC1A5 staining was associated with positive staining of p27 (P = 0.030), PUMA (P = 0.039), concomitant PUMA and p27 staining, and VEGF-R2 (P = 0.039). In non-serous tumors (n = 72), the SLC1A5 positivity was associated with recurrent disease (P = 0.01). In a multivariable logistic regression analysis FIGO-stage (OR = 12.4), tumor grade (OR = 5.1) and SLC1A5 positivity (OR = 0.1) were independent predictive factors for recurrent disease. Disease-free survival (DFS) in women with SLC1A5-positive non-serous tumors was 92% compared with of 66% in patients with SLC1A5-negative non-serous tumors (Log-rank = 15.343; P = 0.008). In Cox analysis with DFS as endpoint, FIGO-stage (HR = 4.5) and SLC1A5 status (HR = 0.3) were prognostic factors.

CONCLUSIONS: As the proteins HRNPM and SLC1A5 are associated with the cell cycle regulators p21 or p27, the apoptosis regulators PTEN and PUMA, and the VEGF-R2 it is concluded that both proteins have role in the pathogenesis of ovarian cancer. In patients with non-serous ovarian cancer SLC1A5 protects from recurrent disease, presumably by means of biological mechanisms that are unrelated to cytotoxic drug sensitivity.

National Category
Obstetrics, Gynecology and Reproductive Medicine Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-327289 (URN)10.1371/journal.pone.0179363 (DOI)000403274700031 ()28609484 (PubMedID)
Available from: 2017-08-08 Created: 2017-08-08 Last updated: 2018-04-23Bibliographically approved
Dabo Pettersson, F., Hellgren, C., Nyberg, F., Åkerud, H. & Sundström Poromaa, I. (2016). Anxiety, Depressed Mood and the Use of Labor Analgesia. Archives of Women's Mental Health, 19(1), 11-16
Open this publication in new window or tab >>Anxiety, Depressed Mood and the Use of Labor Analgesia
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2016 (English)In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 19, no 1, p. 11-16Article in journal (Refereed) Published
Abstract [en]

Relatively little is known about mental health and labor pain. The aim of this study was to assess if self-rated antenatal depressed mood and anxiety are associated with pain-related behaviors and self-reported labor pain. We also wanted to replicate our previous finding of altered labor pain behavior in carriers of a specific guanosine triphosphate cyclohydrolase 1 gene (GCH1) haplotype. Ninety-nine women in gestational weeks 37 to 40 filled out questionnaires on depression and anxiety symptoms and later rated their labor pain by use of visual analog scales. Each subject was also genotyped for GCH1. Following adjustment for relevant confounders, women who arrived early to the delivery unit (cervical dilation < 5 cm) had a significantly higher antenatal Montgomery-sberg Depression Rating Scale (MADRS-S) score, p < 0.05, than late arrivers (cervical dilation > 5 cm). Women with increased Spielberger State-Trait Anxiety Inventory (STAI-T) scores reported higher self-rated pain prior to labor analgesia, p < 0.05, than women with low STAI-T scores. No association between the GCH1 pain-protective haplotype and cervical dilation was found, but a previously demonstrated association with increased use of second-line analgesia was confirmed. Depressed mood during pregnancy is associated with early arrival to the delivery department, whereas antenatal anxiety is associated with increased self-rated pain prior to labor analgesia.

Keywords
anxiety, depression, GCH1, labor pain
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-162544 (URN)10.1007/s00737-015-0572-6 (DOI)000369012400003 ()26392364 (PubMedID)
Projects
Genetics and Labor Pain Behavior
Available from: 2011-12-01 Created: 2011-12-01 Last updated: 2017-12-08Bibliographically approved
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