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Lindgren, Peter
Publications (10 of 17) Show all publications
Hellkvist, A., Wikström, J., Mulic-Lutvica, A., Ericson, K., Eriksson-Falkerby, C., Lindgren, P., . . . Axelsson, O. (2019). Postmortem magnetic resonance imaging vs autopsy of second trimester fetuses terminated due to anomalies. Acta Obstetricia et Gynecologica Scandinavica, 98(7), 865-876
Open this publication in new window or tab >>Postmortem magnetic resonance imaging vs autopsy of second trimester fetuses terminated due to anomalies
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2019 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 7, p. 865-876Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Our aim was to investigate the accuracy of postmortem fetal magnetic resonance imaging (MRI) compared to fetal autopsy in second trimester pregnancies terminated due to fetal anomalies. A secondary aim was to compare the MRI evaluations of two senior radiologists.

MATERIAL AND METHODS: This was a prospective study including 34 fetuses from pregnancies terminated in the second trimester due to fetal anomalies. All women accepted a postmortem MRI and an autopsy of the fetus. Two senior radiologists performed independent evaluations of the MRI images. A senior pathologist performed the fetal autopsies. The degree of concordance between the MRI evaluations and the autopsy reports was estimated as well as the consensus between the radiologists.

RESULTS: Thirty-four fetuses were evaluated. Sixteen cases were associated with the central nervous system (CNS), five musculoskeletal, one cardiovascular, one urinary tract, and 11 cases had miscellaneous anomalies such as chromosomal aberrations, infections, and syndromes. In the 16 cases related to the CNS, both radiologists reported all or some, including the most clinically significant anomalies in 15 (94%; CI 70-100%) cases. In the 18 non-CNS cases, both radiologists reported all or some, including the most clinically significant anomalies in six (33%; CI 5-85%) cases. In 21 cases (62%; CI 44-78%) cases, both radiologists held opinions that were consistent with the autopsy reports. The degree of agreement between the radiologists was high, with a Cohen's Kappa of 0.87.

CONCLUSIONS: Postmortem fetal MRI can replace autopsy for second trimester fetuses with CNS anomalies. For non-CNS anomalies, the concordance is lower but postmortem MRI can still be of value when autopsy is not an option.

Keywords
Fetal anomalies, Fetal diagnosis, Post-mortem fetal MRI, Prenatal diagnosis, Prospective study, Second trimester
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-375605 (URN)10.1111/aogs.13548 (DOI)000472678200006 ()30694559 (PubMedID)
Funder
Swedish Society of Medicine
Available from: 2019-01-31 Created: 2019-01-31 Last updated: 2019-09-13Bibliographically 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
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
Khamisi, S., Lindgren, P. & Karlsson, F. A. (2014). A rare case of dyshormonogenetic fetal goiter responding to intra-amniotic thyroxine injections. European thyroid journal, 3(1), 51-56
Open this publication in new window or tab >>A rare case of dyshormonogenetic fetal goiter responding to intra-amniotic thyroxine injections
2014 (English)In: European thyroid journal, ISSN 2235-0640, Vol. 3, no 1, p. 51-56Article in journal (Refereed) Published
Abstract [en]

Fetal goiter was detected by routine ultrasound in early pregnancy, gestational week (GW) 18, in a 28-year-old woman with no thyroid history, normal thyroid hormone levels and no TSH receptor or thyroid peroxidase antibodies. An umbilical cord blood sample was drawn in GW 23. The analysis indicated fetal hypothyroidism with TSH >100 mU/l (reference value 6.8 ± 2.9, mean ± SD), fT4 3.8 pmol/l (reference value 16.5 ± 5.3, mean ± SD). Intra-amniotic injections of thyroxine were given in conjunction with ultrasound every 7-10 days, in total nine times during GW 24-33. A dose of 10 µg thyroxine/kg of estimated fetal weight per day was administered on six occasions, and 5 µg/kg/day the last three times. Upon injections of thyroxine further growth of the goiter was reduced. Elevated amniotic TSH levels fell from 13 to 2.5 mU/l (reference range 0.04-0.51). Throughout pregnancy, fetal heart rate and skeletal maturation were within normal limits. In week 34, chorioamnionitis was suspected and the child was delivered by cesarean section. Cord blood revealed TSH 596 mU/l (reference value 8.0 ± 5.12, mean ± SD), fT4 4.4 pmol/l (reference value 19.3 ± 4.3, mean ± SD) and total T3 1.18 nmol/l (reference value 0.5 ± 0.3, mean ± SD); the newborn was put on thyroxine supplementation. Psychomotor development of the child, now 3 years old, has been uneventful. The reported experience of treating dyshormonogenetic fetal goiter is limited but growing, creating a need for guidelines on administration of intra-amniotic thyroxine and monitoring treatment.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-278418 (URN)10.1159/000357973 (DOI)24847466 (PubMedID)
Available from: 2016-02-24 Created: 2016-02-24 Last updated: 2017-05-02Bibliographically approved
Ingvoldstad, C., Ohman, S. G. & Lindgren, P. (2014). Implementation of combined ultrasound and biochemistry for risk evaluation of chromosomal abnormalities during the first trimester in Sweden. Acta Obstetricia et Gynecologica Scandinavica, 93(9), 868-873
Open this publication in new window or tab >>Implementation of combined ultrasound and biochemistry for risk evaluation of chromosomal abnormalities during the first trimester in Sweden
2014 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 9, p. 868-873Article in journal (Refereed) Published
Abstract [en]

Objective. To investigate how the first trimester risk evaluation for Down syndrome is offered and performed. Setting. Sweden. Sample. All 52 known units working with obstetric ultrasound. Methods. Study-specific questionnaire and descriptive statistical analyses. Main outcome measures. Routines for offering combined ultrasound and biochemistry (CUB), questions about information, questions about tests and analysis used for diagnosis. Results. CUB was performed in 28 600 (26%) of the expected 110 000 pregnancies in Sweden during 2011. Of all pregnant women, 15% were living in a county not offering CUB (only invasive prenatal diagnosis); 44% regardless of age; 15% to women = 33 years; 24% to women = 35 years; and 2% to women = 38 years old. Amniocentesis was the most common method offered when the risk was estimated as high. Of the 47 units that replied, 29 (61.7%) offered only amniocentesis. On the questions about information, 40 (95.2%) stated that they gave verbal information. In addition to verbal information, 17 (40.5%) gave written information. Forty-one of the units (71.9%) stated that the CUB is offered to non-Swedish-speaking women. Conclusion. Without consistent national guidelines, the prenatal diagnostic CUB method is offered in an inequitable manner to pregnant women in Sweden. More than half of all pregnant women live in a county where CUB is not offered or is only offered based on age. The results demonstrate the importance of national consistency before the introduction of new prenatal tests, to enhance equal care for all pregnant women.

Keywords
Prenatal examinations, risk assessment, Down syndrome, information, ethical principles
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-232573 (URN)10.1111/aogs.12445 (DOI)000340618400006 ()
Available from: 2014-09-24 Created: 2014-09-22 Last updated: 2017-12-05Bibliographically approved
Sohlberg, S., Wikström, A.-K., Olovsson, M., Lindgren, P., Axelsson, O., Mulic-Lutvica, A., . . . Wikström, J. (2014). In vivo(31)P-MR spectroscopy in normal pregnancy, early and late preeclampsia: A study of placental metabolism. Placenta, 35(5), 318-323
Open this publication in new window or tab >>In vivo(31)P-MR spectroscopy in normal pregnancy, early and late preeclampsia: A study of placental metabolism
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2014 (English)In: Placenta, ISSN 0143-4004, E-ISSN 1532-3102, Vol. 35, no 5, p. 318-323Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Preeclampsia affects about 3% of pregnancies and the placenta is believed to play a major role in its pathophysiology. Lately, the role of the placenta has been hypothesised to be more pronounced in preeclampsia of early (<34 weeks) rather than late (≥34 weeks) onset. (31)P Magnetic Resonance Spectroscopy (MRS) enables non-invasive, in vivo studies of placental metabolism. Our aim was to study placental energy and membrane metabolism in women with normal pregnancies and those with early and late onset preeclampsia.

METHODS: The study population included fourteen women with preeclampsia (five with early onset and nine with late onset preeclampsia) and sixteen women with normal pregnancy (seven with early and nine with late pregnancy). All women underwent a (31)P-MRS examination of the placenta.

RESULTS: The phosphodiester (PDE) spectral intensity fraction of the total (31)P signal and the phosphodiester/phosphomonoester (PDE/PME) spectral intensity ratio was higher in early onset preeclampsia than in early normal pregnancy (p = 0.03 and p = 0.02). In normal pregnancy the PDE spectral intensity fraction and the PDE/PME spectral intensity ratio increased with increasing gestational age (p = 0.006 and p = 0.001).

DISCUSSION: Since PDE and PME are related to cell membrane degradation and formation, respectively, our findings indicate increased cell degradation and maybe also decreased cell proliferation in early onset preeclampsia compared to early normal pregnancy, and with increasing gestational age in normal pregnancy.

CONCLUSIONS: Our findings could be explained by increased apoptosis due to ischaemia in early onset preeclampsia and also increased apoptosis with increasing gestational age in normal pregnancy.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-221881 (URN)10.1016/j.placenta.2014.02.005 (DOI)000335614500006 ()24612844 (PubMedID)
Available from: 2014-04-07 Created: 2014-04-07 Last updated: 2017-12-05Bibliographically approved
Sohlberg, S., Mulic-Lutvica, A., Lindgren, P., Ortiz-Nieto, F., Wikström, A.-K. & Wikström, J. (2014). Placental perfusion in normal pregnancy and early and late preeclampsia: A magnetic resonance imaging study.. Placenta, 35(3), 202-206
Open this publication in new window or tab >>Placental perfusion in normal pregnancy and early and late preeclampsia: A magnetic resonance imaging study.
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2014 (English)In: Placenta, ISSN 0143-4004, E-ISSN 1532-3102, Vol. 35, no 3, p. 202-206Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Our primary aim was to investigate if women with early or late preeclampsia have different placental perfusion compared with normal pregnancies. A secondary aim was to investigate if placental perfusion changes with increasing gestational age in normal pregnancy.

METHODS: The study population included thirteen women with preeclampsia (five with early and eight with late preeclampsia) and nineteen women with normal pregnancy (ten with early and nine with late pregnancy). Early was defined as <34 weeks and late as ≥34 weeks gestation. All women underwent a magnetic resonance imaging (MRI) examination including a diffusion weighted sequence at 1.5 T. The perfusion fraction was calculated.

RESULTS: Women with early preeclampsia had a smaller placental perfusion fraction (p = 0.001) and women with late preeclampsia had a larger placental perfusion fraction (p = 0.011), compared to women with normal pregnancies at the corresponding gestational age. The placental perfusion fraction decreased with increasing gestational age in normal pregnancies (p = 0.001).

CONCLUSION: Both early and late preeclampsia differ in placental perfusion from normal pregnant women. Observed differences are however in the opposite direction, suggesting differences in pathophysiology. Placental perfusion decreases with increasing gestational age in normal pregnancy.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-221884 (URN)10.1016/j.placenta.2014.01.008 (DOI)000333495900008 ()24529946 (PubMedID)
Available from: 2014-04-07 Created: 2014-04-07 Last updated: 2017-12-05Bibliographically approved
Åhman, A., Axelsson, O., Maras, G., Rubertsson, C., Sarkadi, A. & Lindgren, P. (2014). Ultrasonographic fetal soft markers in a low-risk population: prevalence, association with trisomies and invasive tests. Acta Obstetricia et Gynecologica Scandinavica, 93(4), 367-373
Open this publication in new window or tab >>Ultrasonographic fetal soft markers in a low-risk population: prevalence, association with trisomies and invasive tests
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2014 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 4, p. 367-373Article in journal (Refereed) Published
Abstract [en]

Objective

To investigate the prevalence of soft markers identified at second trimester ultrasound in a low-risk population and the association of these markers with trisomies and invasive testing.

Design

Prospective observational study.

Setting

Swedish University Hospital.

Population

All women with fetuses examined by ultrasound at 15+0–22+0 weeks gestation between July 2008 and March 2011.

Methods

Cases with soft markers were compared with non-cases with regard to trisomies and invasive testing.

Main outcome measures

Prevalence of soft markers, likelihood ratio for trisomies and risk ratio for invasive tests after detection of soft markers.

Results

Second trimester ultrasound was performed on 10 710 fetuses. Markers were detected in 5.9% of fetuses. 5.1% were isolated, 0.7% were multiple and 0.1% were combined with an anomaly. Presence of markers showed a positive likelihood ratio for Down syndrome, but the association (likelihood ratio = 7.1) was only statistically significant for the combined category of any marker (isolated, multiple or combined with anomaly). The risk ratio for invasive testing after the second trimester ultrasound was 24.0 in pregnancies with isolated soft markers compared with those without markers.

Conclusion

In a low-risk population, soft markers were found in 5.9% of fetuses at second trimester ultrasound. The likelihood ratio for Down syndrome was significant only for any marker (isolated, multiple or combined with anomaly). The presence of soft markers increased the incidence of invasive procedures substantially. Soft markers should be noted when information on second trimester ultrasound is formulated, and all units performing fetal ultrasound examinations should have established routines concerning information management when soft markers are identified.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-219104 (URN)10.1111/aogs.12334 (DOI)000333150700007 ()24433283 (PubMedID)
Available from: 2014-02-21 Created: 2014-02-21 Last updated: 2017-12-05Bibliographically approved
Höglund, B., Lindgren, P. & Larsson, M. (2013). Midwives’ knowledge of, attitudes towards and experiences of caring for women with intellectual disability during pregnancy and childbirth: a cross-sectional study in Sweden. Midwifery, 29(8), 950-955
Open this publication in new window or tab >>Midwives’ knowledge of, attitudes towards and experiences of caring for women with intellectual disability during pregnancy and childbirth: a cross-sectional study in Sweden
2013 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 8, p. 950-955Article in journal (Refereed) Published
Abstract [en]

Objective: to investigate midwives' knowledge of, attitudes towards andexperiences of caring for women with intellectual disability (ID) during pregnancy andchildbirth. Design/setting: a cross-sectional study among six hundred midwives working at antenatal care and labour wards in Sweden. Results: more than four out of five (81.5%) midwives had experience of caring for womenwith ID. Almost all midwives (97.1%) reported that caring for women with ID is different fromcaring for women without ID. Almost one-half (47.3%) had not received any education aboutpregnancy and delivery of women with ID, and a majority of the midwives (95.4%) requested evidence-based knowledge of women with ID in relation to childbirth. High proportion (69.7%) of the midwives were of the opinion that women with ID cannot satisfactorily manage the mother role, and more than one-third (35.7%) of the midwives considered that womenwith ID should not be pregnant and give birth at all. Most midwives partly/totally agreed that children of women with ID should grow up with their parents supported by the social authorities, but nearly one-fifth (19.1%) partly/totally agreed that the children should grow up in foster care. Conclusions: even if the majority of midwives had experience of caring for women with ID, they were uncertain about how to adapt and give advice and they needed more knowledgeabout these women. Some midwives had negative attitudes towards childbearing amongwomen with ID. Health Service providers should encourage midwives to update theirknowledge and provide supportive supervision in midwifery care for women with ID. 

National Category
Other Medical Sciences
Identifiers
urn:nbn:se:uu:diva-183018 (URN)10.1016/j.midw.2012.12.002 (DOI)000321431200019 ()
Projects
Berit Höglund
Available from: 2012-10-20 Created: 2012-10-20 Last updated: 2017-12-07Bibliographically approved
Åhman, A., Lindgren, P. & Sarkadi, A. (2012). Facts first, then reaction: expectant fathers' experiences of an ultrasound screening identifying soft markers. Acta Obstetricia et Gynecologica Scandinavica, 91, 60-61
Open this publication in new window or tab >>Facts first, then reaction: expectant fathers' experiences of an ultrasound screening identifying soft markers
2012 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, p. 60-61Article in journal, Meeting abstract (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-177434 (URN)000304987600093 ()
Available from: 2012-12-13 Created: 2012-07-13 Last updated: 2017-12-06Bibliographically approved
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