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  • 1.
    Ahrne, Malin
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Byrskog, Ulrika
    Dalarna Univ, Sch Hlth & Welf, Falun, Sweden..
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Reproductive Health and Migration.
    Andersson, Ewa
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia..
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Bergen, Norway..
    Group antenatal care (gANC) for Somali-speaking women in Sweden - a process evaluation2022In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 22, no 1, article id 721Article in journal (Refereed)
    Abstract [en]

    Background Language supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public ANC clinic. The women were offered seven 60-min sessions, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-min individual appointment before or after. The aim of this study was to assess the feasibility for participants and midwives of implementing The Hooyo ("mother" in Somali) gANC intervention, including implementation, mechanisms of impact and contextual factors. Methods A process evaluation was performed, using The Medical Research Council (MRC) guidelines for evaluating complex interventions as a framework. A range of qualitative and quantitative data sources were used including observations (n = 9), complementary, in-depth and key-informant interviews (women n = 6, midwives n = 4, interpreters and research assistants n = 3) and questionnaire data (women n = 44; midwives n = 8). Results Language-supported gANC offered more comprehensive ANC that seemed to correspond to existing needs of the participants and could address knowledge gaps related to pregnancy, birth and the Swedish health care system. The majority of women thought listening to other pregnant women was valuable (91%), felt comfortable in the group (98%) and supported by the other women (79%), and they said that gANC suited them (79%). The intervention seemed to enhance knowledge and cultural understanding among midwives, thus contributing to more women-centred care. The intervention was not successful at involving partners in ANC. Conclusions The Hooyo gANC intervention was acceptable to the Somali women and to midwives, but did not lead to greater participation by fathers-to-be. The main mechanisms of impact were more comprehensive ANC and enhanced mutual cultural understanding. The position of women was strengthened in the groups, and the way in which the midwives expanded their understanding of the participants and their narratives was promising. To be feasible at a large scale, gANC might require further adaptations and the "othering" of women in risk groups should be avoided.

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  • 2.
    Ameen, Shafiqul
    et al.
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, 68 Shahid Tajuddin Ahmed Sarani, Dhaka, Bangladesh..
    Siddique, Abu Bakkar
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, 68 Shahid Tajuddin Ahmed Sarani, Dhaka, Bangladesh..
    Peven, Kimberly
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England.;Kings Coll London, Florence Nightingale Fac Nursing Midwifery & Pall, London, England..
    Rahman, Qazi Sadeq-ur
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, 68 Shahid Tajuddin Ahmed Sarani, Dhaka, Bangladesh..
    Day, Louise T.
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England..
    Shabani, Josephine
    Ifakara Hlth Inst IHI, Dept Hlth Syst Impact Evaluat & Policy, Dar Es Salaam, Tanzania..
    KC, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability.
    Boggs, Dorothy
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England..
    Shamba, Donat
    Ifakara Hlth Inst IHI, Dept Hlth Syst Impact Evaluat & Policy, Dar Es Salaam, Tanzania..
    Tahsina, Tazeen
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, 68 Shahid Tajuddin Ahmed Sarani, Dhaka, Bangladesh..
    Rahman, Ahmed Ehsanur
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, 68 Shahid Tajuddin Ahmed Sarani, Dhaka, Bangladesh..
    Zaman, Sojib Bin
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, 68 Shahid Tajuddin Ahmed Sarani, Dhaka, Bangladesh..
    Hossain, Aniqa Tasnim
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, 68 Shahid Tajuddin Ahmed Sarani, Dhaka, Bangladesh..
    Ahmed, Anisuddin
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, 68 Shahid Tajuddin Ahmed Sarani, Dhaka, Bangladesh..
    Basnet, Omkar
    Golden Community, Res Div, Lalitpur, Nepal..
    Malla, Honey
    Golden Community, Res Div, Lalitpur, Nepal..
    Ruysen, Harriet
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England..
    Blencowe, Hannah
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England..
    Arnold, Fred
    ICF, Demog & Hlth Survey Program, Rockville, MD USA..
    Requejo, Jennifer
    United Nations Childrens Fund, Div Data Anal Planning & Monitoring, New York, NY USA..
    El Arifeen, Shams
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, 68 Shahid Tajuddin Ahmed Sarani, Dhaka, Bangladesh..
    Lawn, Joy E.
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England..
    Survey of women's report for 33 maternal and newborn indicators: EN-BIRTH multi-country validation study2021In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 21, no SUPPL, article id 238Article in journal (Refereed)
    Abstract [en]

    BackgroundPopulation-based household surveys, notably the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), remain the main source of maternal and newborn health data for many low- and middle-income countries. As part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study, this paper focuses on testing validity of measurement of maternal and newborn indicators around the time of birth (intrapartum and postnatal) in survey-report.MethodsEN-BIRTH was an observational study testing the validity of measurement for selected maternal and newborn indicators in five secondary/tertiary hospitals in Bangladesh, Nepal and Tanzania, conducted from July 2017 to July 2018. We compared women's report at exit survey with the gold standard of direct observation or verification from clinical records for women with vaginal births. Population-level validity was assessed by validity ratios (survey-reported coverage: observer-assessed coverage). Individual-level accuracy was assessed by sensitivity, specificity and percent agreement. We tested indicators already in DHS/MICS as well as indicators with potential to be included in population-based surveys, notably the first validation for small and sick newborn care indicators.Results33 maternal and newborn indicators were evaluated. Amongst nine indicators already present in DHS/MICS, validity ratios for baby dried or wiped, birthweight measured, low birthweight, and sex of baby (female) were between 0.90-1.10. Instrumental birth, skin-to-skin contact, and early initiation of breastfeeding were highly overestimated by survey-report (2.04-4.83) while umbilical cord care indicators were massively underestimated (0.14-0.22). Amongst 24 indicators not currently in DHS/MICS, two newborn contact indicators (kangaroo mother care 1.00, admission to neonatal unit 1.01) had high survey-reported coverage amongst admitted newborns and high sensitivity. The remaining indicators did not perform well and some had very high "don't know" responses.ConclusionsOur study revealed low validity for collecting many maternal and newborn indicators through an exit survey instrument, even with short recall periods among women with vaginal births. Household surveys are already at risk of overload, and some specific clinical care indicators do not perform well and may be under-powered. Given that approximately 80% of births worldwide occur in facilities, routine registers should also be explored to track coverage of key maternal and newborn health interventions, particularly for clinical care.

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  • 3.
    August, Furaha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili Univ Hlth & Allied Sci, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania..
    Pembe, Andrea B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili Univ Hlth & Allied Sci, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania..
    Mpembeni, Rose
    Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Norwegian Univ Sci & Technol, Dept Publ Hlth & Gen Practice, N-7034 Trondheim, Norway..
    Effectiveness of the Home Based Life Saving Skills training by community health workers on knowledge of danger signs, birth preparedness, complication readiness and facility delivery, among women in Rural Tanzania2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 129Article in journal (Refereed)
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  • 4.
    Baker, Ulrika
    et al.
    Karolinska Inst, Widerstromska Huset, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Tomtebodavagen 18 A, S-17177 Stockholm, Sweden.;Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Nobels Alle 12, S-14183 Huddinge, Sweden..
    Hassan, Farida
    Ifakara Hlth Inst, Plot 463 Kiko Ave,POB 78 373, Dar Es Salaam, Tanzania..
    Hanson, Claudia
    Karolinska Inst, Widerstromska Huset, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Tomtebodavagen 18 A, S-17177 Stockholm, Sweden.;London Sch Hyg & Trop Med, Dept Dis Control, London WC1E 7HT, England..
    Manzi, Fatuma
    Ifakara Hlth Inst, Plot 463 Kiko Ave,POB 78 373, Dar Es Salaam, Tanzania..
    Marchant, Tanya
    London Sch Hyg & Trop Med, Dept Dis Control, London WC1E 7HT, England..
    Peterson, Stefan Swartling
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Karolinska Inst, Widerstromska Huset, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Tomtebodavagen 18 A, S-17177 Stockholm, Sweden. ;Makerere Sch Publ Hlth, Kampala, Uganda..
    Hylander, Ingrid
    Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Nobels Alle 12, S-14183 Huddinge, Sweden..
    Unpredictability dictates quality of maternal and newborn care provision in rural Tanzania: A qualitative study of health workers' perspectives2017In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 17, article id 55Article in journal (Refereed)
    Abstract [en]

    Background: Health workers are the key to realising the potential of improved quality of care for mothers and newborns in the weak health systems of Sub Saharan Africa. Their perspectives are fundamental to understand the effectiveness of existing improvement programs and to identify ways to strengthen future initiatives. The objective of this study was therefore to examine health worker perspectives of the conditions for maternal and newborn care provision and their perceptions of what constitutes good quality of care in rural Tanzanian health facilities. Methods: In February 2014, we conducted 17 in-depth interviews with different cadres of health workers providing maternal and newborn care in 14 rural health facilities in Tandahimba district, south-eastern Tanzania. These facilities included one district hospital, three health centres and ten dispensaries. Interviews were conducted in Swahili, transcribed verbatim and translated into English. A grounded theory approach was used to guide the analysis, the output of which was one core category, four main categories and several sub-categories. Results: `It is like rain' was identified as the core category, delineating unpredictability as the common denominator for all aspects of maternal and newborn care provision. It implies that conditions such as mothers' access to and utilisation of health care are unreliable; that availability of resources is uncertain and that health workers have to help and try to balance the situation. Quality of care was perceived to vary as a consequence of these conditions. Health workers stressed the importance of predictability, of `things going as intended', as a sign of good quality care. Conclusions: Unpredictability emerged as a fundamental condition for maternal and newborn care provision, an important determinant and characteristic of quality in this study. We believe that this finding is also relevant for other areas of care in the same setting and may be an important defining factor of a weak health system. Increasing predictability within health services, and focusing on the experience of health workers within these, should be prioritised in order to achieve better quality of care for mothers and newborns.

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  • 5.
    Bauer, Ilena
    et al.
    Univ Tubingen, German Ctr Diabet Res DZD eV, FMEG Ctr, Inst Diabet Res & Metab Dis,Helmholtz Ctr Munich, Otfried Muller Str 47, D-72076 Tubingen, Germany..
    Hartkopf, Julia
    Univ Tubingen, German Ctr Diabet Res DZD eV, FMEG Ctr, Inst Diabet Res & Metab Dis,Helmholtz Ctr Munich, Otfried Muller Str 47, D-72076 Tubingen, Germany..
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Schaal, Nora K.
    Heinrich Heine Univ, Dept Expt Psychol, Dusseldorf, Germany..
    Preissl, Hubert
    Univ Tubingen, German Ctr Diabet Res DZD eV, FMEG Ctr, Inst Diabet Res & Metab Dis,Helmholtz Ctr Munich, Otfried Muller Str 47, D-72076 Tubingen, Germany.;Univ Hosp Tuebingen, Div Endocrinol Diabetol & Nephrol, Dept Internal Med 4, Tubingen, Germany..
    Derntl, Birgit
    Univ Tubingen, Tuebingen Ctr Mental Hlth TuCMH, Dept Psychiat & Psychotherapy, Tubingen, Germany.;Univ Tubingen, LEAD Grad Sch & Res Network, Tubingen, Germany..
    Schleger, Franziska
    Univ Tubingen, German Ctr Diabet Res DZD eV, FMEG Ctr, Inst Diabet Res & Metab Dis,Helmholtz Ctr Munich, Otfried Muller Str 47, D-72076 Tubingen, Germany..
    Acute relaxation during pregnancy leads to a reduction in maternal electrodermal activity and self-reported stress levels2021In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 21, no 1, article id 628Article in journal (Refereed)
    Abstract [en]

    Background Prenatal maternal stress can have adverse effects on birth outcomes and fetal development. Relaxation techniques have been examined as potential countermeasures. This study investigates different relaxation techniques and their effect on self-reported stress levels and physiological stress levels in pregnant women. Methods In this cross-sectional study, 38 pregnant women in their 30th to 40th gestational week were assigned to one of three, 20-min lasting relaxation groups: listening to music (N = 12), following a guided imagery (N = 12) or resting (N = 12). The intervention, i.e., acute relaxation (music, guided imagery or resting) took place once for each study participant. Study inclusion criteria were age over 18 years, German speaking, singleton and uncomplicated pregnancy during the 30th and 40th week of gestation. The stress levels were determined during the study. Current stress level during the study was assessed by a visual analogue scale. Chronic stress levels were assessed by the Trier Inventory of Chronic Stress and the Pregnancy Distress questionnaire. Multivariate analyses of covariance were performed and dependent measures included stress levels as well as physiological measures, i.e., cardiovascular activity (electrocardiogram) and skin conductance levels. Results All three forms of relaxation led to reduced maternal stress which manifested itself in significantly decreased skin conductance, F(3,94) = 18.011, p = .001, eta(2)(p) = .365, and subjective stress levels after the interventions with no significant group difference. Post-intervention stress ratings were further affected by gestational age, with less subjective relaxation in women later in gestation, F (1, 34)=4.971, p = .032, eta(2)(p) = .128. Conclusion Independent of relaxation technique, single, 20-min relaxation intervention (music, guided imagery or resting) can significantly reduce maternal stress. Notably, women at an earlier stage in their pregnancy reported higher relaxation after the intervention than women later in gestation. Hence, gestational age may influence perceived stress levels and should be considered when evaluating relaxation or stress management interventions during pregnancy.

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  • 6.
    Butler, Eadaoin M.
    et al.
    Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Auckland 92019, New Zealand..
    Reynolds, Abigail J.
    Univ Auckland, Liggins Inst, Auckland 92019, New Zealand.;Dartmouth Coll, Hanover, NH 03755 USA..
    Derraik, José G. B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research. Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Auckland 92019, New Zealand.;Zhejiang Univ, Childrens Hosp, Sch Med, Hangzhou, Peoples R China..
    Wilson, Brooke C.
    Univ Auckland, Liggins Inst, Auckland 92019, New Zealand..
    Cutfield, Wayne S.
    Better Start Natl Sci Challenge, Auckland, New Zealand.;Univ Auckland, Liggins Inst, Auckland 92019, New Zealand..
    Grigg, Celia P.
    Univ Auckland, Liggins Inst, Auckland 92019, New Zealand..
    The views of pregnant women in New Zealand on vaginal seeding: a mixed-methods study2021In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 21, article id 49Article in journal (Refereed)
    Abstract [en]

    Background: Vaginal seeding is the administration of maternal vaginal bacteria to babies following birth by caesarean section (CS), intended to mimic the microbial exposure that occurs during vaginal birth. Appropriate development of the infant gut microbiome assists early immune development and might help reduce the risk of certain health conditions later in life, such as obesity and asthma. We aimed to explore the views of pregnant women on this practice.

    Methods: We conducted a sequential mixed-methods study on the views of pregnant women in New Zealand (NZ) on vaginal seeding. Phase one: brief semi-structured interviews with pregnant women participating in a clinical trial of vaginal seeding (n=15); and phase two: online questionnaire of pregnant women throughout NZ (not in the trial) (n=264). Reflexive thematic analysis was applied to interview and open-ended questionnaire data. Closed-ended questionnaire responses were analysed using descriptive statistics.

    Results: Six themes were produced through analysis of the open-ended data: "seeding replicates a natural process", "microbiome is in the media", "seeding may have potential benefits", "seeking validation by a maternity caregiver", "seeding could help reduce CS guilt", and "the unknowns of seeding". The idea that vaginal seeding replicates a natural process was suggested by some as an explanation to help overcome any initial negative perceptions of it. Many considered vaginal seeding to have potential benefit for the gut microbiome, while comparatively fewer considered it to be potentially beneficial for specific conditions such as obesity. Just under 30% of questionnaire respondents (n=78; 29.5%) had prior knowledge of vaginal seeding, while most (n=133; 82.6%) had an initially positive or neutral reaction to it. Few respondents changed their initial views on the practice after reading provided evidence-based information (n=60; 22.7%), but of those who did, most became more positive (n=51; 86.4%).

    Conclusions: Given its apparent acceptability, and if shown to be safe and effective for the prevention of early childhood obesity, vaginal seeding could be a non-stigmatising approach to prevention of this condition among children born by CS. Our findings also highlight the importance of lead maternity carers in NZ remaining current in their knowledge of vaginal seeding research.

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  • 7.
    Byrskog, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Olsson, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Allvin, Marie-Klingberg
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Being a bridge: Swedish antenatal care midwives' encounters with Somali-born women and questions of violence; a qualitative study2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 1, p. 1-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence.

    METHODS:

    Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis.

    RESULTS:

    The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women's' strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman's access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women.

    CONCLUSION:

    Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives' ability to identify Somali born woman's resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

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  • 8.
    Byrskog, Ulrika
    et al.
    Dalarna Univ, Sch Educ Hlth & Social Sci, Falun, Sweden.
    Small, Rhonda
    La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic 3086, Australia; Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Tomtebodavägen 18a, S-17177 Stockholm, Sweden.
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Tomtebodavägen 18a, S-17177 Stockholm, Sweden; Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Mollendalsveien 6,Postboks 7030, N-5020 Bergen, Norway.
    Community-based bilingual doulas for migrant women in labour and birth: findings from a Swedish register-based cohort study2020In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, no 1, article id 721Article in journal (Refereed)
    Abstract [en]

    Background

    Community-based bilingual doula (CBD) services have been established to respond to migrant women’s needs and reduce barriers to high quality maternity care. The aim of this study was to compare birth outcomes for migrant women who received CBD support in labour with birth outcomes for (1) migrant women who experienced usual care without CBD support, and (2) Swedish-born women giving birth during the same time period and at the same hospitals.

    Methods

    Register study based on data retrieved from a local CBD register in Gothenburg, the Swedish Medical Birth Register and Statistics Sweden. Birth outcomes for migrant women with CBD support were compared with those of migrant women without CBD support and with Swedish-born women. Associations were investigated using multivariable logistic regression, reported as odds ratios (aORs) with 95% confidence intervals (CI), adjusted for birth year, maternal age, marital status, hypertension, diabetes, BMI, disposable income and education.

    Results

    Migrant women with CBD support (n = 880) were more likely to have risk factors for adverse pregnancy outcomes than migrant women not receiving CBD support (n = 16,789) and the Swedish-born women (n = 129,706). In migrant women, CBD support was associated with less use of pain relief in nulliparous women (epidural aOR 0.64, CI 0.50–0.81; bath aOR 0.64, CI 0.42–0.98), and in parous women with increased odds of induction of labour (aOR 1.38, CI 1.08–1.76) and longer hospital stay after birth (aOR 1.19, CI 1.03–1.37). CBD support was not associated with non-instrumental births, perineal injury or low Apgar score. Compared with Swedish-born women, migrant women with CBD used less pain relief (nulliparous women: epidural aOR 0.50, CI 0.39–0.64; nitrous oxide aOR 0.71, CI 0.54–0.92; bath aOR 0.55, CI 0.36–0.85; parous women: nitrous oxide aOR 0.68, CI 0.54–0.84) and nulliparous women with CBD support had increased odds of emergency caesarean section (aOR 1.43, CI 1.05–1.94) and longer hospital stay after birth (aOR 1.31, CI 1.04–1.64).

    Conclusions

    CBD support appears to have potential to reduce analgesia use in migrant women with vulnerability to adverse outcomes. Further studies of effects of CBD support on mode of birth and other obstetric outcomes and women’s experiences and well-being are needed.

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  • 9.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Sophiahemmet Univ, Box 5605, SE-11486 Stockholm, Sweden.
    Balbas, Banaz
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Ersta Skondal Bracke Univ Coll, Dept Hlth Care Sci, Stockholm, Sweden.
    Written narratives from immigrants following a prenatal diagnosis: qualitative exploratory study2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 154Article in journal (Refereed)
    Abstract [en]

    Background

    Expectant parents often have optimistic expectations of the obstetric ultrasound examination and are unprepared for a diagnosis of foetal anomaly. Research that gives voice to the experiences of immigrants faced with a prenatal diagnosis is scarce, and there is a need for more exploratory research that provides insights into the experiences of these persons. The aim of this study was to explore narratives of experiences of immigrants with Arabic or Sorani interpreter needs when presented with a prenatal diagnosis of foetal anomaly.

    Methods

    A web-based tool with open-ended questions was distributed via Arabic and Kurdish non-profit associations and general women's associations in Sweden. Responses were received from six women and analysed with qualitative content analysis.

    Results

    The analysis resulted in three themes: (1) an unexpected hurricane of emotions, (2) trying to understand the situation though information in an unfamiliar language, and (3) being cared for in a country with accessible obstetric care and where induced abortion is legal.

    Conclusions

    Immigrant women described an unexpected personal tragedy when faced with a prenatal diagnosis of foetal anomaly, and emphasised the importance of respectful and empathic psychological support. Their experiences of insufficient and incomprehensible information call attention to the importance of tailored approaches and the use of adequate medical interpreting services. There is a need for more descriptive studies that investigate decision-making and preparedness for induced abortion among immigrants faced with a prenatal diagnosis.

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  • 10.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Landqvist, Mats
    Södertörn Univ, Sch Culture & Educ, Stockholm, Sweden.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Ersta Skondal Univ Coll, Dept Hlth Care Sci, Stockholm, Sweden.
    Communication of support and critique in Swedish virtual community threads about prenatal diagnoses of fetal anomalies2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 199Article in journal (Refereed)
    Abstract [en]

    Background: A prenatal diagnosis of a fetal anomaly involves acute grief and psychological distress. The Internet has the potential to provide virtual support following the diagnosis. The overall aim was to explore communication of support and critique in Swedish virtual community threads about prenatal diagnoses of fetal anomalies.

    Methods: Systematic searches in Google resulted in 117 eligible threads. Fifteen of these were purposefully selected and subjected to deductive content analysis.

    Results:The virtual support involved mainly emotional support (meaning units n = 1,992/3,688, 54 %) and was described as comforting and empowering. Posters with experience of a prenatal diagnosis appreciated the virtual support, including the opportunity to gain insight into other cases and to write about one’s own experience. Critique of the decision to continue or terminate the pregnancy occurred, primarily against termination of pregnancy. However, it was met with defense.

    Conclusions: Peer support, mainly emotional, is provided and highly appreciated in threads about prenatal diagnoses of a fetal anomaly. Critique of the decision to terminate the pregnancy occurs in virtual community threads about prenatal diagnoses, but the norm is to not question the decision. Future studies need to investigate if virtual peer support promotes psychosocial function following a prenatal diagnosis and what medium would be most suitable for these types of supportive structures.

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  • 11.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Marttala, Ulla Melander
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Languages, Department of Scandinavian Languages.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Ringnér, Anders
    Department of Nursing, Umeå University, Umeå, Sweden.
    Experiences and preferences of care among Swedish immigrants following a prenatal diagnosis of congenital heart defect in the fetus: a qualitative interview study2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, no 130Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Immigrants experience significant challenges when in contact with healthcare and report less satisfaction with maternity care compared to native Swedes. Research that gives voice to pregnant immigrant women and their partners following a prenatal diagnosis of a fetal anomaly is scarce. Thus, the aim of this study was to explore experiences and preferences of care following a prenatal diagnosis of congenital heart defect among Swedish immigrants.

    METHODS: Pregnant immigrants and their partners were consecutively recruited following a prenatal diagnosis of a congenital heart defect in the fetus. Nine respondents were interviewed in five interviews, four with the aid of a professional interpreter. The material was analyzed using manifest qualitative content analysis.

    RESULTS: The analysis resulted in five categories: 1) "Trustworthy information", 2) "Language barriers", 3) "Psychosocial situation", 4) "Peer support", and 5) "Religious positions".

    CONCLUSION: The potential need for interpreter services, visual information, psychosocial support, coordination with welfare officers, and respect for religious positions about termination of pregnancy are all important aspects for health professionals to consider when consulting immigrants faced with a prenatal diagnosis of fetal anomaly in the fetus. Peer support within this context needs to be further explored in future studies.

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  • 12.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Ersta Skondal Univ Coll, Dept Hlth Care Sci, SE-10061 Stockholm, Sweden.
    Emotional and cognitive experiences during the time of diagnosis and decision-making following a prenatal diagnosis: a qualitative study of males presented with congenital heart defect in the fetus carried by their pregnant partner2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, article id 26Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Expectant fathers consider the second-trimester obstetric ultrasound examination as an important step towards parenthood, but are ill prepared for a detection of a fetal anomaly. Inductive research is scarce concerning their experiences and needs for support. Consequently, the aim of this study was to explore the emotional and cognitive experiences, during the time of diagnosis and decision-making, among males presented with congenital heart defect in the fetus carried by their pregnant partner.

    METHODS:

    Twelve expectant fathers were consecutively recruited through two tertiary referral centers for fetal cardiology in Sweden, after they had been presented with a prenatal diagnosis of congenital heart defect in the fetus carried by their pregnant partner. The respondents were interviewed via telephone, and the interviews were analyzed using inductive qualitative content analysis.

    RESULTS:

    The respondents experienced an intense emotional shock in connection with detection. However, they set their own needs aside to attend to the supportive needs of their pregnant partner, and stressed the importance of an informed joint decision regarding whether to continue or terminate the pregnancy. When terminating the pregnancy, they experienced a loss of a wanted child, an emotionally intense termination procedure, needs of support neglected by professionals, and worries about the risk of recurrence in future pregnancies. When continuing the pregnancy, they tried to keep a positive attitude about the coming birth, but were simultaneously worried about the postnatal situation.

    CONCLUSIONS:

    The findings illustrate the importance of inclusive care and adequate follow-up routines for both expectant parents following a prenatal diagnosis. This includes the initial emotional shock, the decisional process, and depending on decision reached, the termination or continuation of the pregnancy. Expectant fathers presented with a fetal anomaly need adequate follow-up routines to address worries about risk of recurrence in future pregnancies and worries about the postnatal situation.

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  • 13.
    Cato, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Sylvén, Sara M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Georgakis, Marios K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Univ Athens, Dept Hyg Epidemiol & Med Stat, Athens, Greece.
    Kollia, Natasa
    Harokopio Univ, Sch Hlth Sci & Educ, Dept Nutr & Dietet, Athens, Greece.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Antenatal depressive symptoms and early initiation of breastfeeding in association with exclusive breastfeeding six weeks postpartum: a longitudinal population-based study2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 49Article in journal (Refereed)
    Abstract [en]

    Background

    Depressive symptoms negatively impact on breastfeeding duration, whereas early breastfeeding initiation after birth enhances the chances for a longer breastfeeding period. Our aim was to investigate the interplay between depressive symptoms during pregnancy and late initiation of the first breastfeeding session and their effect on exclusive breastfeeding at six weeks postpartum.

    Methods

    In a longitudinal study design, web-questionnaires including demographic data, breastfeeding information and the Edinburgh Postnatal Depression Scale (EPDS) were completed by 1217 women at pregnancy weeks 17–20, 32 and/or at six weeks postpartum. A multivariable logistic regression model was fitted to estimate the effect of depressive symptoms during pregnancy and the timing of the first breastfeeding session on exclusive breastfeeding at six weeks postpartum.

    Results

    Exclusive breastfeeding at six weeks postpartum was reported by 77% of the women. Depressive symptoms during pregnancy (EPDS> 13); (OR:1.93 [1.28–2.91]) and not accomplishing the first breastfeeding session within two hours after birth (OR: 2.61 [1.80–3.78]), were both associated with not exclusively breastfeeding at six weeks postpartum after adjusting for identified confounders. Τhe combined exposure to depressive symptoms in pregnancy and late breastfeeding initiation was associated with an almost 4-fold increased odds of not exclusive breastfeeding at six weeks postpartum.

    Conclusions

    Women reporting depressive symptoms during pregnancy seem to be more vulnerable to the consequences of a postponed first breastfeeding session on exclusive breastfeeding duration. Consequently, women experiencing depressive symptoms may benefit from targeted breastfeeding support during the first hours after birth.

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  • 14.
    Chaulagain, Dipak
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Global Health Research on Implementation and Sustainability.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Global Health Research on Implementation and Sustainability.
    Wrammert, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Global Health Research on Implementation and Sustainability.
    Gurung, Rejina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Global Health Research on Implementation and Sustainability.
    Brunell, Olivia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Global Health Research on Implementation and Sustainability.
    Basnet, Omkar
    Golden Community.
    KC, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Global Health Research on Implementation and Sustainability.
    Service readiness and availability of perinatal care in public hospitals - a multi-centric baseline study in Nepal2022In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 22, no 1, article id 842Article in journal (Refereed)
    Abstract [en]

    Background

    Poor quality of maternal and newborn care contributes to nearly two million deaths of mothers and their newborns worldwide annually. Assessment of readiness and availability of perinatal care services in health facilities provides evidence to underlying bottlenecks for improving quality of care. This study aimed to evaluate the readiness and availability of perinatal care services in public hospitals of Nepal using WHO’s health system framework.

    Methods

    This was a mixed methods study conducted in 12 public hospitals in Nepal. A cross-sectional study design was used to assess the readiness and availability of perinatal care services. Three different data collection tools were developed. The tools were pretested in a tertiary maternity hospital and the discrepancies in the tools were corrected before administering in the study hospitals. The data were collected between July 2017 to July 2018.

    Results

    Only five out of 12 hospitals had the availability of all the basic newborn care services under assessment. Kangaroo mother care (KMC) service was lacking in most of the hospitals (7 out of 12). Only two hospitals had all health workers involved in perinatal care services trained in neonatal resuscitation. All of the hospitals were found not to have all the required equipment for newborn care services. Overall, only 60% of the health workers had received neonatal resuscitation training. A small proportion (3.2%) of the newborn infants with APGAR < 7 at one minute received bag and mask ventilation. Only 8.2% of the mothers initiated breastfeeding to newborn infants before transfer to the post-natal ward, 73.4% of the mothers received counseling on breastfeeding, and 40.8% of the mothers kept their newborns in skin-to-skin contact immediately after birth.

    Conclusion

    The assessment reflected the gaps in the availability of neonatal care services, neonatal resuscitation training, availability of equipment, infrastructure, information system, and governance. Rapid scale-up of neonatal resuscitation training and increased availability of equipment is needed for improving the quality of neonatal care services.

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  • 15.
    Dahlqvist, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics. Örnsköldsvik Hospital, Örnsköldsvik, Sweden.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Neonatal outcomes of deliveries in occiput posterior position when delayed pushing is practiced: a cohort study2017In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 17, article id 377Article in journal (Refereed)
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  • 16.
    Edqvist, Malin
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Arvid Wallgrens Backe Hus 1,Box PO 457405 30, Gothenburg, Sweden..
    Blix, Ellen
    Oslo & Akershus Univ, Fac Hlth Sci, Res Grp Maternal Reprod & Childrens Hlth, Coll Appl Sci, Oslo, Norway..
    Hegaard, Hanne K.
    Copenhagen Univ Hosp, Rigshosp, Juliane Marie Ctr Women Children & Reprod, Res Unit,Womens & Childrens Hlth, Copenhagen, Denmark..
    Olafsdottir, Olöf Asta
    Univ Iceland, Fac Nursing, Dept Midwifery, Reykjavik, Iceland..
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Ingversen, Karen
    Homebirth Assoc Sealand, Copenhagen, Denmark..
    Mollberg, Margareta
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Arvid Wallgrens Backe Hus 1,Box PO 457405 30, Gothenburg, Sweden..
    Lindgren, Helena
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Arvid Wallgrens Backe Hus 1,Box PO 457405 30, Gothenburg, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Perineal injuries and birth positions among 2992 women with a low risk pregnancy who opted for a homebirth2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 196Article in journal (Refereed)
    Abstract [en]

    Background: Whether certain birth positions are associated with perineal injuries and severe perineal trauma (SPT) is still unclear. The objective of this study was to describe the prevalence of perineal injuries of different severity in a low-risk population of women who planned to give birth at home and to compare the prevalence of perineal injuries, SPT and episiotomy in different birth positions in four Nordic countries.

    Methods: A population-based prospective cohort study of planned home births in four Nordic countries. To assess medical outcomes a questionnaire completed after birth by the attending midwife was used. Descriptive statistics, bivariate analysis and logistic regression were used to analyze the data.

    Results: Two thousand nine hundred ninety-two women with planned home births, who birthed spontaneously at home or after transfer to hospital, between 2008 and 2013 were included. The prevalence of SPT was 0.7 % and the prevalence of episiotomy was 1.0 %. There were differences between the countries regarding all maternal characteristics. No association between flexible sacrum positions and sutured perineal injuries was found (OR 1.02; 95 % CI 0.86-1.21) or SPT (OR 0.68; CI 95 % 0.26-1.79). Flexible sacrum positions were associated with fewer episiotomies (OR 0.20; CI 95 % 0.10-0.54).

    Conclusion: A low prevalence of SPT and episiotomy was found among women opting for a home birth in four Nordic countries. Women used a variety of birth positions and a majority gave birth in flexible sacrum positions. No associations were found between flexible sacrum positions and SPT. Flexible sacrum positions were associated with fewer episiotomies.

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  • 17.
    Edvinsson, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Hellgren, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Kallak, Theodora Kunovac
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Stener-Victorin, Elisabet
    Fornes, Romina
    Spigset, Olav
    Lager, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Olivier, Jocelien
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    The effect of antenatal depression and antidepressant treatment on placental tissue: a protein-validated gene expression study.2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 479Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Antenatal depression affects 10-20% of pregnant women. Around 2-4% of European pregnant women use antidepressant treatment, most commonly selective serotonin reuptake inhibitors (SSRIs). Poor pregnancy outcomes, such as preterm birth and low birth weight, have been described in women with antenatal depression and in pregnant women on SSRI treatment. However, the effects of antenatal depression and antidepressant treatment on the placenta are largely unknown. The aim of this work was to compare placental gene and protein expression in healthy women, women with untreated antenatal depression and women on antidepressant treatment during pregnancy.

    METHODS: Placental samples from 47 controls, 25 depressed and 45 SSRI-treated women were analysed by means of qPCR using custom-designed TaqMan low-density arrays (TLDAs) for 44 genes previously known to be involved in the pathophysiology of depression, and expressed in the placenta. Moreover, placental protein expression was determined by means of immunohistochemistry in 37 healthy controls, 13 women with untreated depression and 21 women on antidepressant treatment. Statistical comparisons between groups were performed by one-way ANOVA or the Kruskal-Wallis test.

    RESULTS: Nominally significant findings were noted for HTR1A and NPY2R, where women with untreated depression displayed higher gene expression than healthy controls (p < 0.05), whereas women on antidepressant treatment had similar expression as healthy controls. The protein expression analyses revealed higher expression of HTR1A in placentas from women on antidepressant treatment, than in placentas from healthy controls (p < 0.05).

    CONCLUSION: The differentially expressed HTR1A, both at the gene and the protein level that was revealed in this study, suggests the involvement of HTR1A in the effect of antenatal depression on biological mechanisms in the placenta. More research is needed to elucidate the role of depression and antidepressant treatment on the placenta, and, further, the effect on the fetus.

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  • 18.
    Ekelöf, Katarina
    et al.
    Lund Univ, Dept Clin Sci Lund, Pediat Neonatol, Lund, Sweden..
    Saether, Elisabeth
    Alesund Hosp, More & Romsdal Hosp Trust, Dept Women Children & Adolescents, Alesund, Norway..
    Santesson, Anna
    Lund Univ, Dept Clin Sci Lund, Child & Adolescent Psychiat, Lund, Sweden..
    Wilander, Maria
    Lund Univ, Dept Clin Sci Lund, Pediat Neonatol, Lund, Sweden.;Hosp Halland, Dept Pediat, Halmstad, Sweden..
    Patriksson, Katarina
    Univ West, Dept Hlth Sci, Trollhättan, Sweden.;NU Hosp Grp, Div Pediat, Trollhättan, Sweden..
    Hesselman, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna.
    Thies-Lagergren, Li
    Lund Univ, Dept Midwifery Res Reprod Perinatal & Sexual Hlth, Lund, Sweden..
    Rabe, Heike
    Univ Sussex, Brighton & Sussex Med Sch, Brighton, E Sussex, England.;Sussex Univ Hosp NHS Trust, Dept Neonatol, Brighton, E Sussex, England..
    Andersson, Ola
    Lund Univ, Dept Clin Sci Lund, Pediat Neonatol, Lund, Sweden.;Skane Univ Hosp, Dept Neonatol, Malmö, Sweden..
    A hybrid type I, multi-center randomized controlled trial to study the implementation of a method for Sustained cord circulation And VEntilation (the SAVE-method) of late preterm and term neonates: a study protocol2022In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 22, no 1, article id 593Article in journal (Refereed)
    Abstract [en]

    Background

    An intact umbilical cord allows the physiological transfusion of blood from the placenta to the neonate, which reduces infant iron deficiency and is associated with improved development during early childhood. The implementation of delayed cord clamping practice varies depending on mode of delivery, as well as gestational age and neonatal compromise. Emerging evidence shows that infants requiring resuscitation would benefit if respiratory support were provided with the umbilical cord intact. Common barriers to providing intact cord resuscitation is the availability of neonatal resuscitation equipment close to the mother, organizational readiness for change as well as attitudes and beliefs about placental transfusion within the multidisciplinary team. Hence, clinical evaluations of cord clamping practice should include implementation outcomes in order to develop strategies for optimal cord management practice.

    Methods

    The Sustained cord circulation And Ventilation (SAVE) study is a hybrid type I randomized controlled study combining the evaluation of clinical outcomes with implementation and health service outcomes. In phase I of the study, a method for providing in-bed intact cord resuscitation was developed, in phase II of the study the intervention was adapted to be used in multiple settings. In phase III of the study, a full-scale multicenter study will be initiated with concurrent evaluation of clinical, implementation and health service outcomes. Clinical data on neonatal outcomes will be recorded at the labor and neonatal units. Implementation outcomes will be collected from electronic surveys sent to parents as well as staff and managers within the birth and neonatal units. Descriptive and comparative statistics and regression modelling will be used for analysis. Quantitative data will be supplemented by qualitative methods using a thematic analysis with an inductive approach.

    Discussion

    The SAVE study enables the safe development and evaluation of a method for intact cord resuscitation in a multicenter trial. The study identifies barriers and facilitators for intact cord resuscitation. The knowledge provided from the study will be of benefit for the development of cord clamping practice in different challenging clinical settings and provide evidence for development of clinical guidelines regarding optimal cord clamping.

    Trial registration

    Clinicaltrials.gov, NCT04070560. Registered 28 August 2019.

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  • 19. Ekeus, Cecilia
    et al.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Norman, Mikael
    Vacuum assisted birth and risk for cerebral complications in term newborn infants: a population-based cohort study2014In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, p. 36-Article in journal (Refereed)
    Abstract [en]

    Background: Few studies have focused on cerebral complications among newborn infants delivered by vacuum extraction (VE). The aim of this study was to determine the risk for intracranial haemorrhage and/or cerebral dysfunction in newborn infants delivered by VE and to compare this risk with that after cesarean section in labour (CS) and spontaneous vaginal delivery, respectively. Methods: Data was obtained from Swedish national registers. In a population-based cohort from 1999 to 2010 including all singleton newborn infants delivered at term after onset of labour by VE (n = 87,150), CS (75,216) or spontaneous vaginal delivery (n = 851,347), we compared the odds for neonatal intracranial haemorrhage, traumatic or non-traumatic, convulsions or encephalopathy. Logistic regressions were used to calculate adjusted (for major risk factors and indication) odds ratios (AOR), using spontaneous vaginal delivery as reference group. Results: The rates of traumatic and non-traumatic intracranial hemorrhages were 0.8/10,000 and 3.8/1,000. VE deliveries provided 58% and 31.5% of the traumatic and non-traumatic cases, giving a ten-fold risk [AOR 10.05 (4.67-21.65)] and double risk [AOR 2.23 (1.57-3.16)], respectively. High birth weight and short mother were associated with the highest risks. Infants delivered by CS had no increased risk for intracranial hemorrhages. The risks for convulsions or encephalopathy were similar among infants delivered by VE and CS, exceeding the OR after non-assisted spontaneous vaginal delivery by two-to-three times. Conclusion: Vacuum assisted delivery is associated with increased risk for neonatal intracranial hemorrhages. Although causality could not be established in this observational study, it is important to be aware of the increased risk of intracranial hemorrhages in VE deliveries, particularly in short women and large infants. The results warrant further studies in decision making and conduct of assisted vaginal delivery.

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  • 20.
    Ekström, Niina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Gurung, Rejina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, SWEDESD - Sustainability Learning and Research Centre. Golden Community, Res Div, Jawgal 11, Lalitpur, Nepal..
    Humagain, Urja
    Golden Community, Res Div, Jawgal 11, Lalitpur, Nepal..
    Basnet, Omkar
    Golden Community, Res Div, Jawgal 11, Lalitpur, Nepal..
    Bhattarai, Pratiksha
    Golden Community, Res Div, Jawgal 11, Lalitpur, Nepal..
    Thakur, Nishant
    Golden Community, Res Div, Jawgal 11, Lalitpur, Nepal..
    Dhakal, Riju
    Golden Community, Res Div, Jawgal 11, Lalitpur, Nepal..
    KC, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, SWEDESD - Sustainability Learning and Research Centre. Univ Gothenburg, Sahlgrenska Acad, Sch Publ Hlth & Community Med, Medicinaregatan 18, Gothenburg, Sweden..
    Axelin, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, SWEDESD - Sustainability Learning and Research Centre. Univ Turku, Dept Nursing Sci, Turku, Finland..
    Facilitators and barriers for implementation of a novel resuscitation quality improvement package in public referral hospitals of Nepal2023In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 23, article id 662Article in journal (Refereed)
    Abstract [en]

    Background: Improving the healthcare providers (HCP) basic resuscitation skills can reduce intrapartum related mortality in low- and middle-income countries. However, the resuscitation intervention's successful implementation is largely dependent on proper facilitation and context. This study aims to identify the facilitators and barriers for the implementation of a novel resuscitation package as part of the quality improvement project in Nepal.

    Methods: The study used a qualitative descriptive design. The study sites included four purposively chosen public hospitals in Nepal, where the resuscitation package (Helping Babies Breathe [HBB] training, resuscitation equipment and NeoBeat) had been implemented as part of the quality improvement project. Twenty members of the HCP, who were trained and exposed to the package, were selected through convenience sampling to participate in the study interviews. Data were collected through semi-structured interviews conducted via telephone and video calls. Twenty interview data were analyzed with a deductive qualitative content analysis based on the core components of the i-PARiHS framework.

    Results: The findings suggest that there was a move to more systematic resuscitation practices among the staff after the quality improvement project's implementation. This positive change was supported by a neonatal heart rate monitor (NeoBeat), which guided resuscitation and made it easier. In addition, seeing the positive outcomes of successful resuscitation motivated the HCPs to keep practicing and developing their resuscitation skills. Facilitation by the project staff enabled the change. At the same time, facilitators provided extra support to maintain the equipment, which can be a challenge in terms of sustainability, after the project. Furthermore, a lack of additional resources, an unclear leadership role, and a lack of coordination between nurses and medical doctors were barriers to the implementation of the resuscitation package.

    Conclusion: The introduction of the resuscitation package, as well as the continuous capacity building of local multidisciplinary healthcare staff, is important to continue the accelerated efforts of improving newborn care. To secure sustainable change, facilitation during implementation should focus on exploring local resources to implement the resuscitation package sustainably.Trial RegistrationNot applicable. Factors such as the context, facilitation, and site of implementation influence the successful implementation of the resuscitation bundle.The introduction of innovation for quality healthcare requires adequate facilitation and continuous capacity-building efforts.

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  • 21.
    Elden, Helen
    et al.
    Gothenburg Univ, Sahlgrenska Acad, Inst Hlth & Caring Sci, S-40530 Gothenburg, Sweden..
    Hagberg, Henrik
    Gothenburg Univ, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Perinatal Ctr,Dept Obstet & Gynecol,Inst Clin Sci, S-41685 Gothenburg, Sweden..
    Wessberg, Anna
    Gothenburg Univ, Sahlgrenska Acad, Inst Hlth & Caring Sci, S-40530 Gothenburg, Sweden..
    Sengpiel, Verena
    Gothenburg Univ, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Perinatal Ctr,Dept Obstet & Gynecol,Inst Clin Sci, S-41685 Gothenburg, Sweden..
    Herbst, Andreas
    Skane Univ Hosp, S-21428 Malmo, Sweden..
    Bullarbo, Maria
    Gothenburg Univ, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Perinatal Ctr,Dept Obstet & Gynecol,Inst Clin Sci, S-41685 Gothenburg, Sweden..
    Bergh, Christina
    Gothenburg Univ, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Dept Obstet & Gynecol,Inst Clin Sci,Reprod Med, S-41685 Gothenburg, Sweden..
    Bolin, Kristian
    Gothenburg Univ, Sch Business Econ & Law, Dept Econ & Stat, POB 640, S-40530 Gothenburg, Sweden..
    Malbasic, Snezana
    South Alvsborg Cty Hosp, Dept Obstet & Gynecol, S-50182 Boras, Sweden..
    Saltvedt, Sissel
    Karolinska Univ Hosp, Dept Obstet & Gynecol, S-17176 Stockholm, Sweden..
    Stephansson, Olof
    Karolinska Inst, Dept Med, Clin Epidemiol Unit, S-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Womens & Childrens Hlth, Div Obstet & Gynecol, S-17176 Stockholm, Sweden..
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ladfors, Lars
    Gothenburg Univ, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Perinatal Ctr,Dept Obstet & Gynecol,Inst Clin Sci, S-41685 Gothenburg, Sweden..
    Wennerholm, Ulla-Britt
    Gothenburg Univ, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Perinatal Ctr,Dept Obstet & Gynecol,Inst Clin Sci, S-41685 Gothenburg, Sweden.;Karolinska Univ Hosp, Dept Obstet & Gynecol, S-17176 Stockholm, Sweden..
    Study protocol of SWEPIS a Swedish multicentre register based randomised controlled trial to compare induction of labour at 41 completed gestational weeks versus expectant management and induction at 42 completed gestational weeks2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 49Article in journal (Refereed)
    Abstract [en]

    Background: Observational data shows that postterm pregnancy (>= 42 gestational weeks, GW) and late term pregnancy (>= 41 GW), as compared to term pregnancy, is associated with an increased risk for adverse outcome for the mother and infant. Standard care in many countries is induction of labour at 42 GW. There is insufficient scientific support that induction of labour at 41 GW, as compared with expectant management and induction at 42 GW will reduce perinatal mortality and morbidity without an increase in operative deliveries, negative delivery experiences or higher costs. Large randomised studies are needed since important outcomes; such as perinatal mortality and hypoxic ischaemic encephalopathy are rare events. Methods/Design: A total of 10 038 healthy women >= 18 years old with a normal live singleton pregnancy in cephalic presentation at 41 GW estimated with a first or second trimester ultrasound, who is able to understand oral and written information will be randomised to labour induction at 41 GW (early induction) or expectant management and induction at 42 GW (late induction). Women will be recruited at university clinics and county hospitals in Sweden comprising more than 65 000 deliveries per year. Primary outcome will be a composite of stillbirth, neonatal mortality and severe neonatal morbidity. Secondary outcomes will be other adverse neonatal and maternal outcomes, mode of delivery, women's experience, cost effectiveness and infant morbidity up to 3 months of age. Data on background variables, obstetric and neonatal outcomes will be obtained from the Swedish Pregnancy Register and the Swedish Neonatal Quality Register. Data on women's experiences will be collected by questionnaires after randomisation and 3 months after delivery. Primary analysis will be intention to treat. The statistician will be blinded to group and intervention. Discussion: It is important to investigate if an intervention at 41 GW is superior to standard care in order to reduce death and lifelong disability for the children. The pregnant population, >41 GW, constitutes 15-20 % of all pregnancies and the results of the study will thus have a great impact. The use of registries for randomisation and collection of outcome data represents a unique and new study design.

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  • 22.
    Elenis, Evangelia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Svanberg Skoog, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Lampic, Claudia
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Solna, Sweden..
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sydsjö, Gunilla
    Linkoping Univ, Fac Hlth Sci, Dept Clin Expt Med, Obstet & Gynaecol, Linkoping, Sweden..
    Adverse obstetric outcomes in pregnancies resulting from oocyte donation: a retrospective cohort case study in Sweden2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, article id 247Article in journal (Refereed)
    Abstract [en]

    Background: Oocyte donation has been associated to gestational diabetes, hypertensive disorders, placental abnormalities, preterm delivery and increased rate of caesarean delivery while simultaneously being characterized by high rates of primiparity, advanced maternal age and multiple gestation constituting the individual risk of mode of conception difficult to assess. This study aims to explore obstetrical outcomes among relatively young women with optimal health status conceiving singletons with donated versus autologous oocytes (via IVF and spontaneously). Methods: National retrospective cohort case study involving 76 women conceiving with donated oocytes, 150 nulliparous women without infertility conceiving spontaneously and 63 women conceiving after non-donor IVF. Data on obstetric outcomes were retrieved from the National Birth Medical Register and the medical records of oocyte recipients from the treating University Hospitals of Sweden. Demographic and logistic regression analysis were performed to examine the association of mode of conception and obstetric outcomes. Results: Women conceiving with donated oocytes (OD) had a higher risk of hypertensive disorders [adjusted Odds Ratio (aOR) 2.84, 95 % CI (1.04-7.81)], oligohydramnios [aOR 12.74, 95 % CI (1.24-130.49)], postpartum hemorrhage [aOR 7.11, 95 % CI (2.02-24.97)] and retained placenta [aOR 6.71, 95 % CI (1.58-28.40)] when compared to women who conceived spontaneously, after adjusting for relevant covariates. Similar trends, though not statistically significant, were noted when comparing OD pregnant women to women who had undergone non-donor IVF. Caesarean delivery [aOR 2.95, 95 % CI (1.52-5.71); aOR 5.20, 95 % CI (2.21-12.22)] and induction of labor [aOR 3.00, 95 % CI (1.39-6.44); aOR 2.80, 95 % CI (1.10-7.08)] occurred more frequently in the OD group, compared to the group conceiving spontaneously and through IVF respectively. No differences in gestational length were noted between the groups. With regard to the indication of OD treatment, higher intervention was observed in women with diminished ovarian reserve but the risk for hypertensive disorders did not differ after adjustment. Conclusion: The selection process of recipients for medically indicated oocyte donation treatment in Sweden seems to be effective in excluding women with severe comorbidities. Nevertheless, oocyte recipients-despite being relatively young and of optimal health status-need careful counseling preconceptionally and closer monitoring prenatally for the development of hypertensive disorders.

  • 23.
    Elenis, Evangelia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Simic, Marija
    Karolinska Univ Hosp & Inst, Dept Med Solna, Clin Epidemiol Unit, SE-17176 Stockholm, Sweden.
    Accelerated fetal growth in early pregnancy and risk of preterm birth: a prospective cohort study2020In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, no 1, article id 764Article in journal (Refereed)
    Abstract [en]

    Background

    Preterm birth (occurring before 37 completed weeks of gestation) affects 15 million infants annually, 7.5% of which die due to related complications. The detection and early diagnosis are therefore paramount in order to prevent the development of prematurity and its consequences. So far, focus has been laid on the association between reduced intrauterine fetal growth during late gestation and prematurity. The aim of the current study was to investigate the association between accelerated fetal growth in early pregnancy and the risk of preterm birth.

    Methods

    This prospective cohort study included 69,617 singleton pregnancies without congenital malformations and with available biometric measurements during the first and second trimester. Estimation of fetal growth was based on measurements of biparietal diameter (BPD) at first and second trimester scan. We investigated the association between accelerated fetal growth and preterm birth prior to 37 weeks of gestation. The outcome was further stratified into very preterm birth (before 32 weeks of gestation) or moderate preterm birth (between 32 and 37 weeks of gestation) and medically induced or spontaneous preterm birth and was further explored.

    Results

    The odds of prematurity were increased among fetuses with accelerated BPD growth (> 90th centile) estimated between first and second ultrasound scan, even after adjustment for possible confounders (aOR 1.36; 95% CI 1.20–1.54). The findings remained significant what regards moderate preterm births but not very preterm births. Regarding medically induced preterm birth, the odds were found to be elevated in the group of fetuses with accelerated growth in early pregnancy (aOR 1.34; 95% CI 1.11–1.63). On the contrary, fetuses with delayed fetal growth exhibited lower odds for both overall and spontaneous preterm birth.

    Conclusions

    Fetuses with accelerated BPD growth in early pregnancy, detected by ultrasound examination during the second trimester, exhibited increased odds of being born preterm. The findings of the current study suggest that fetal growth in early pregnancy should be taken into account when assessing the risk for preterm birth.

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  • 24.
    Endler, Margit
    et al.
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.;Soder Sjukhuset, Dept Obstet & Gynecol, Sjukhusbacken 10, S-11883 Stockholm, Sweden..
    Saltvedt, Sissel
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Obstet & Gynecol, Stockholm, Sweden..
    Eweida, Mohamed
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden..
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Oxidative stress and inflammation in retained placenta: a pilot study of protein and gene expression of GPX1 and NF kappa B2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 384Article in journal (Refereed)
    Abstract [en]

    Background: Retained placenta is associated with severe postpartum hemorrhage. Its etiology is unknown and its biochemistry has not been studied. We aimed to assess whether levels of the antioxidative enzyme Glutathione Peroxidase 1 (GPX1) and the transcription factor Nuclear Factor kappa beta (NF kappa beta), as markers of oxidative stress and inflammation, were affected in retained placentas compared to spontaneously released placentas from otherwise normal full term pregnancies. Methods: In a pilot study we assessed concentrations of GPX1 by ELISA and gene (mRNA) expression of GPX1, NF kappa beta and its inhibitor I kappa beta alpha, by quantitative real-time-PCR in periumbilical and peripheral samples from retained (n = 29) and non-retained (n = 31) placental tissue. Results: Median periumbilical GPX1 concentrations were 13.32 ng/ml in retained placentas and 17.96 ng/ml in nonretained placentas (p = 0.22), peripheral concentrations were 13.27 ng/ml and 19.09 ng/ml (p = 0.08). Retained placental tissue was more likely to have a low GPX1 protein concentration (OR 3.82, p = 0.02 for periumbilical and OR 3.95, p = 0. 02 for peripheral samples). Median periumbilical GPX1 gene expressions were 1.13 for retained placentas and 0.88 for non-retained placentas (p = 0.08), peripheral expression was 1.32 and 1.18 (p = 0.46). Gene expressions of NF kappa beta and I kappa beta alpha were not significantly different between retained and non-retained placental tissue. Conclusions: Women with retained placenta were more likely to have a low level of GPX1 protein concentration in placental tissue compared to women without retained placenta and retained placental tissue showed a tendency of lower median concentrations of GPX1 protein expression. This may indicate decreased antioxidative capacity as a component in this disorder but requires a larger sample to corroborate results.

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  • 25.
    Eriksson, Leif
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Duc, Duong M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Eldh, Ann Catrine
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet.
    Thanh, Vu Pham N
    Institute of Sociology, Public Health and Environment Depertment, Hanoi, Vietnam.
    Huy, Tran Q
    Nursing office, Department of Medical Services Administration, Ministry of Health Vietnam.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wallin, Lars
    School of Health and Social Studies, Dalarna University, SE-791 88, Falun.
    Lessons learned from stakeholders in a facilitation intervention targeting neonatal health in Quang Ninh province, Vietnam2013In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, p. 234-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In northern Vietnam the Neonatal health - Knowledge Into Practice (NeoKIP, Current Controlled Trials ISRCTN44599712) trial has evaluated facilitation as a knowledge translation intervention to improve neonatal survival. The results demonstrated that intervention sites, each having an assigned group including local stakeholders supported by a facilitator, lowered the neonatal mortality rate by 50% during the last intervention year compared with control sites. This process evaluation was conducted to identify and describe mechanisms of the NeoKIP intervention based on experiences of facilitators and intervention group members.

    METHODS: Four focus group discussions (FGDs) were conducted with all facilitators at different occasions and 12 FGDs with 6 intervention groups at 2 occasions. Fifteen FGDs were audio recorded, transcribed verbatim, translated into English, and analysed using thematic analysis.

    RESULTS: Four themes and 17 sub-themes emerged from the 3 FGDs with facilitators, and 5 themes and 18 sub-themes were identified from the 12 FGDs with the intervention groups mirroring the process of, and the barriers to, the intervention. Facilitators and intervention group members concurred that having groups representing various organisations was beneficial. Facilitators were considered important in assembling the groups. The facilitators functioned best if coming from the same geographical area as the groups and if they were able to come to terms with the chair of the groups. However, the facilitators' lack of health knowledge was regarded as a deficit for assisting the groups' assignments. FGD participants experienced the NeoKIP intervention to have impact on the knowledge and behaviour of both intervention group members and the general public, however, they found that the intervention was a slow and time-consuming process. Perceived facilitation barriers were lack of money, inadequate support, and the function of the intervention groups.

    CONCLUSIONS: This qualitative process evaluation contributes to explain the improved neonatal survival and why this occurred after a latent period in the NeoKIP project. The used knowledge translation intervention, where facilitators supported multi-stakeholder coalitions with the mandate to impact upon attitudes and behaviour in the communes, has low costs and potential for being scaled-up within existing healthcare systems.

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  • 26.
    Esscher, Annika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Binder-Finnema, Pauline
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Bødker, Birgit
    Department of Obstetrics and Gynaecology, Hillerød hospital, Denmark.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Suboptimal care and maternal mortality among foreign-born women in Sweden: Maternal death audit with application of the 'migration three delays' model2014In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, p. 141-Article in journal (Other academic)
    Abstract [en]

    Background: Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths that occurred in Sweden from 1988-2010. Methods: A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases of maternal death. An assessment protocol was developed that applied both the 'migration three delays' framework and a modified version of the Confidential Enquiry from the United Kingdom. The main outcomes were major and minor suboptimal factors associated with maternal death in this high-income, low-maternal mortality context. Results: Major and minor suboptimal factors were associated with a majority of maternal deaths and significantly more often to foreign-born women (p = 0.01). The main delays to care-seeking were non-compliance among foreign-born women and communication barriers, such as incongruent language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups. Conclusions: Suboptimal care factors, major and minor, were present in more than 2/3 of maternal deaths in this high-income setting. Those related to migration were associated to miscommunication, lack of professional interpreters, and limited knowledge about rare diseases and pregnancy complications. Increased insight into a migration perspective is advocated for maternity clinicians who provide care to foreign-born women.

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  • 27.
    Fadl, Helena
    et al.
    Örebro Univ, Fac Med & Hlth, Dept Obstet & Gynaecol, Örebro, Sweden.
    Saeedi, Maryam
    Örebro Univ, Fac Med & Hlth, Dept Obstet & Gynaecol, Örebro, Sweden.
    Montgomery, Scott
    Örebro Univ, Sch Med Sci, Clin Epidemiol & Biostat, Örebro, Sweden; Karolinska Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden; UCL, Dept Epidemiol & Publ Hlth, London, England.
    Magnuson, Anders
    Univ Hosp Örebro, Clin Epidemiol & Biostat, Örebro, Sweden.
    Schwarcz, Erik
    Örebro Univ Hosp, Sch Med Hlth & Sci, Dept Internal Med, Örebro, Sweden.
    Berntorp, Kerstin
    Lund Univ, Dept Endocrinol, Skane Univ Hosp, Clin Res Ctr Malmö, Lund, Sweden.
    Sengpiel, Verena
    Univ Gothenburg, Dept Obstet & Gynaecol, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Gothenburg, Sweden.
    Storck-Lindholm, Elisabeth
    Söder Sjukhuset, Dept Obstet & Gynaecol, Stockholm, Sweden.
    Strevens, Helena
    Lund Univ, Skåne Univ Hosp, Dept Obstet & Gynaecol, Clin Res Ctr Lund, Lund, Sweden.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Brismar-Wendel, Sophia
    Karolinska Inst, Dept Clin Sci, Danderyd Hosp, Stockholm, Sweden.
    Persson, Martina
    Sachsska Childrens & Youth Hosp, Dept Paediat, Stockholm, Sweden; Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.
    Jansson, Stefan
    Örebro Univ, Univ Hlth Care Res Ctr, Sch Med Sci, Örebro, Sweden.
    Ahlsson, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Ursing, Carina
    Söder Sjukhuset, Dept Endocrinol, Stockholm, Sweden.
    Ryen, Linda
    Örebro Univ, Fac Med & Hlth, Ctr Hlth Care Sci, Örebro, Sweden.
    Petersson, Kerstin
    Umeå Univ, Dept Clin Sci Obstet & Gynaecol, Umeå, Sweden.
    Wennerholm, Ulla-Britt
    Univ Gothenburg, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Dept Obstet & Gynaecol, Inst Clin Sci, Gothenburg, Sweden.
    Hilden, Karin
    Örebro Univ, Fac Med & Hlth, Dept Obstet & Gynaecol, Örebro, Sweden.
    Simmons, David
    Western Sydney Univ, Macarthur Clin Sch, Campbelltown, NSW, Australia; Örebro Univ, Fac Med & Hlth, Örebro, Sweden.
    Changing diagnostic criteria for gestational diabetes in Sweden-a stepped wedge national cluster randomised controlled trial-the CDC4G study protocol2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, no 1, article id 398Article in journal (Refereed)
    Abstract [en]

    Background: The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agreed that the shift to new guidelines should be in a scientific and structured way. The aim of the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) in Sweden (www.cdc4g.se/en) is to evaluate the clinical and health economic impacts of changing diagnostic criteria for GDM in Sweden and to create a prospective cohort to compare the many long-term outcomes in mother and baby under the old and new diagnostic approaches.

    Methods: This is a stepped wedge cluster randomised controlled trial, comparing pregnancy outcomes before and after the switch in GDM criteria across 11 centres in a randomised manner. The trial includes all pregnant women screened for GDM across the participating centres during January–December 2018, approximately two thirds of all pregnancies in Sweden in a year. Women with pre-existing diabetes will be excluded. Data will be collected through the national Swedish Pregnancy register and for follow up studies other health registers will be included.

    Discussion: The stepped wedge RCT was chosen to be the best study design for evaluating the shift from old to new diagnostic criteria of GDM in Sweden. The national quality registers provide data on the whole pregnant population and gives a possibility for follow up studies of both mother and child. The health economic analysis from the study will give a solid evidence base for future changes in order to improve immediate pregnancy, as well as long term, outcomes for mother and child.

    Trial registration: CDC4G is listed on the ISRCTN registry with study ID ISRCTN41918550 (15/12/2017)

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  • 28.
    Gagnon, Anita J
    et al.
    Ingram School of Nursing and Department of Obstetrics and Gynaecology, McGill University, Montreal, Quebec, Canada.
    DeBruyn, Rebecca
    Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Gissler, Mika
    THL National Institute for Health and Welfare, Helsinki, Finland and NHV Nordic School of Public Health, Gothenburg, Sweden.
    Heaman, Maureen
    Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
    Jeambey, Zeinab
    Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.
    Korfker, Dineke
    Netherlands Organization for Applied Scientific Research TNO, Department of Child Health, Leiden, Netherlands.
    McCourt, Christine
    Midwifery and Child Health, School of Community and Health Sciences, City University, London, UK.
    Roth, Carolyn
    School of Nursing & Midwifery, Faculty of Health, Keele University, Staffordshire, UK.
    Zeitlin, Jennifer
    INSERM, UMR S953 Epidemiological Research Unit on Perinatal Health and Women's and Children’s Health, Université Pierre et Marie Curie-Paris 6, Paris, France.
    Small, Rhonda
    Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
    Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies: an international Delphi consensus process.2014In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, no 1, p. 200-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Through the World Health Assembly Resolution, 'Health of Migrants', the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries.

    METHODS: This study was conducted in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC) Questionnaire, developed in Australia and revised for use in Canada to capture the maternity care experiences of migrant women, and combined to create an initial MFMC questionnaire. Second, a Delphi consensus process in three rounds with a panel of 89 experts in perinatal health and migration from 17 countries was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth, the questionnaire was piloted with migrant women who had recently given birth in Montreal, Canada.

    RESULTS: A 112-item questionnaire on maternity care from pregnancy, through labour and birth, to postpartum care, and including items on maternal socio-demographic, migration and obstetrical characteristics, and perceptions of care, has been created - the Migrant Friendly Maternity Care Questionnaire (MFMCQ) - in three languages (English, French and Spanish). It is completed in 45 minutes via interview administration several months post-birth.

    CONCLUSIONS: A 4-stage process of questionnaire development with international experts in migrant reproductive health and research resulted in the MFMCQ, a questionnaire measuring key aspects of migrant-sensitive maternity care. The MFMCQ is available for further translation and use to examine and compare care and perceptions of care within and across countries, and by key socio-demographic, migration, and obstetrical characteristics of migrant women.

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  • 29.
    Georgsson, Susanne
    et al.
    The Swedish Red Cross University College, Box 1059, SE-14121, Huddinge, Sweden; Karolinska Institutet, Department of Clinical science, Intervention and technology, SE-17177, Stockholm, Sweden.
    Carlsson, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. The Swedish Red Cross University College, Box 1059, SE-14121, Huddinge, Sweden.
    Quality of consumer-oriented websites containing information about the second trimester ultrasound examination during pregnancy2020In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, no 1, article id 235Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Providing information about prenatal tests is a clinical challenge and the public frequently accesses the Web to read pregnancy-related information. The overarching aim of this study was to investigate the quality of consumer-oriented websites addressing obstetric ultrasound examination in the second trimester of pregnancy.

    METHODS: Swedish websites were identified with Google, using 20 search strings and screening 400 hits (n = 71 included websites). Reliability and information about the examination were assessed with the DISCERN instrument, completeness was assessed according to national guidelines, and readability analyzed with the Readability Index. Popularity was determined with the ALEXA tool and search rank was determined according to Google hit lists.

    RESULTS: The mean total DISCERN score was 29.7/80 (SD 11.4), with > 50% having low quality for 15 of the 16 questions. The mean completeness score was 6.8/24 (SD 4.5). The Readability Index ranged between 22 and 63, with a mean of 42.7 (SD 6.8), indicating difficult readability. Weak and non-significant correlations were observed between ALEXA/search rank and the investigated quality variables, except for search rank and reliability.

    CONCLUSIONS: The quality of consumer-oriented websites addressing the second trimester ultrasound examination is low. Health professionals need to discuss this with expectant parents considering undergoing the examination. There is a need for efforts that aim to improve the poor quality of online sources in the field of prenatal examinations.

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  • 30.
    Gudnadottir, Unnur
    et al.
    Karolinska Inst, Ctr Translat Microbiome Res, Dept Microbiol Tumor & Cell Biol MTC, S-17165 Solna, Sweden..
    Du, Juan
    Karolinska Inst, Ctr Translat Microbiome Res, Dept Microbiol Tumor & Cell Biol MTC, S-17165 Solna, Sweden..
    Hugerth, Luisa W. W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Karolinska Inst, Ctr Translat Microbiome Res, Dept Microbiol Tumor & Cell Biol MTC, S-17165 Solna, Sweden..
    Engstrand, Lars
    Karolinska Inst, Ctr Translat Microbiome Res, Dept Microbiol Tumor & Cell Biol MTC, S-17165 Solna, Sweden..
    Schuppe-Koistinen, Ina
    Karolinska Inst, Ctr Translat Microbiome Res, Dept Microbiol Tumor & Cell Biol MTC, S-17165 Solna, Sweden.;Sci Life Lab, S-17165 Solna, Sweden..
    Itzel, Eva Wiberg
    Soder Sjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden..
    Fransson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Karolinska Inst, Ctr Translat Microbiome Res, Dept Microbiol Tumor & Cell Biol MTC, S-17165 Solna, Sweden..
    Brusselaers, Nele
    Karolinska Inst, Ctr Translat Microbiome Res, Dept Microbiol Tumor & Cell Biol MTC, S-17165 Solna, Sweden.;Univ Antwerp, Global Hlth Inst, B-2610 Antwerp, Belgium.;Univ Ghent, Dept Head & Skin, B-9000 Ghent, Belgium..
    Pre-pregnancy complications-associated factors and wellbeing in early pregnancy: a Swedish cohort study2023In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 23, article id 153Article in journal (Refereed)
    Abstract [en]

    Background: Many couples experience difficulties to become pregnant or carry a pregnancy to term due to unknown causes. Here we define pre-pregnancy complications as having prior recurrent pregnancy loss, prior late miscarriages, time to pregnancy more than one year, or the use of artificial reproductive technologies. We aim to identify factors associated with pre-pregnancy complications and poor well-being in early pregnancy.

    Methods: Online questionnaire data from 5330 unique pregnancies in Sweden were collected from November 2017 - February 2021. Multivariable logistic regression modelling was used to investigate potential risk factors for pre-pregnancy complications and differences in early pregnancy symptoms.

    Results: Pre-pregnancy complications were identified in 1142 participants (21%). Risk factors included diagnosed endometriosis, thyroid medication, opioids and other strong pain medication, body mass index > 25 kg/m(2) and age over 35 years. Different subgroups of pre-pregnancy complications had unique risk factors. The groups also experienced different pregnancy symptoms in early pregnancy, where women that had experienced recurrent pregnancy loss were at higher risk of depression in their current pregnancy.

    Conclusion: We report one of the largest pregnancy cohorts with high frequency of pre-pregnancy complications compared to the Swedish population. Prescribed drug use and body weight were the top potentially modifiable risk factors in all groups. Participants that experienced pre-pregnancy complications also had higher risk of depression and pregnancy problems in early pregnancy.

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  • 31.
    Gunnarsdóttir, Jóhanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Akhter, Tansim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Cnattingius, Sven
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, and Institutet.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics. Department of Clinical Sciences, Danderyds sjukhus, Karolinska Institutet.
    Elevated diastolic blood pressure until mid-gestation is associated with preeclampsia and small-for-gestational-age birth: a population-based register study2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, p. 1-8, article id 186Article in journal (Refereed)
    Abstract [en]

    Background: Gestational hemodynamic adaptations, including lowered blood pressure (BP) until mid-gestation, might benefit placental function. We hypothesized that elevated BP from early to mid-gestation increases risks of preeclampsia and small-for-gestational-age birth (SGA), especially in women who also deliver preterm (< 37 weeks). Methods: In 64,490 healthy primiparous women, the change in systolic and diastolic BP from early to midgestation was categorized into lowered (≥ 0 mmHg decreased), and elevated (≥ 1 mmHg increase). Women with chronic hypertension, chronic renal disease, pre-gestational diabetes and systemic lupus erythematosus were excluded. Risks of preeclampsia and SGA birth were estimated by logistic regression, presented with adjusted odds ratio (aOR) and 95% confidence intervals (CI). Further, the effect of BP change in combination with stage 1 hypertension (systolic BP 130–139 mmHg or diastolic BP 80–89 mmHg) in early gestation was estimated. Results: Compared to women with lowered diastolic BP from early to mid-gestation, those with elevated diastolic BP had increased risks of preeclampsia (aOR: 1.8 [1.6–2.0]) and SGA birth (aOR: 1.3 [1.2–1.5]). The risk estimates were higher for preeclampsia and SGA when combined with preterm birth (aORs: 2.2 [1.8–2.8] and 2.3 [1.8–3.0], respectively). The highest rate of preeclampsia (9.9%) was seen in women with stage 1 hypertension in early gestation and a diastolic BP that was elevated until mid-gestation. This was three times the risk, compared to women with normal BP in early gestation and a diastolic BP that was decreased until mid-gestation. The association between elevated systolic BP from early to mid-gestation and preeclampsia was weak, and no significant association was found between changes in systolic BP and SGA births. Conclusion: Elevated diastolic BP from early to mid-gestation was associated with increased risks of preeclampsia and SGA, especially for women also delivering preterm. The results may imply that the diastolic BP starts to increase around mid-gestation in women later developing placental dysfunction disorders

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  • 32.
    Gurung, Rejina
    et al.
    Golden Community, Jawagal, Lalitpur, Nepal.
    Gurung, Abhishek
    Golden Community, Jawagal, Lalitpur, Nepal.
    Basnet, Omkar
    Golden Community, Jawagal, Lalitpur, Nepal.
    Eilevstjønn, Joar
    Laerdal Med Laerdal Global Hlth, Stavanger, Norway.
    Myklebust, Helge
    Laerdal Med Laerdal Global Hlth, Stavanger, Norway.
    Girnary, Sakina
    Laerdal Med Laerdal Global Hlth, Stavanger, Norway.
    Shrestha, Shree Krishna
    Pokhara Academy of Health Sciences, Pokhara, Nepal.
    Singh, Dela
    Pokhara Academy of Health Sciences, Pokhara, Nepal.
    Bastola, Laxman
    Pokhara Academy of Health Sciences, Pokhara, Nepal.
    Paudel, Prajwal
    Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal.
    Baral, Sandhya
    Golden Community, Jawagal, Lalitpur, Nepal.
    KC, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability. Society of Public Health Physician Nepal, Kathmandu, Nepal.
    REFINE (Rapid Feedback for quality Improvement in Neonatal rEsuscitation): an observational study of neonatal resuscitation training and practice in a tertiary hospital in Nepal.2020In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, no 1, article id 756Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Simulation-based training in neonatal resuscitation is more effective when reinforced by both practice and continuous improvement processes. We aim to evaluate the effectiveness of a quality improvement program combined with an innovative provider feedback device on neonatal resuscitation practice and outcomes in a public referral hospital of Nepal.

    METHODS: A pre- and post-intervention study will be implemented in Pokhara Academy of Health Sciences, a hospital with 8610 deliveries per year. The intervention package will include simulation-based training (Helping Babies Breathe) enhanced with a real-time feedback system (the NeoBeat newborn heart rate meter with the NeoNatalie Live manikin and upright newborn bag-mask with PEEP) accompanied by a quality improvement process. An independent research team will collect perinatal data and conduct stakeholder interviews.

    DISCUSSION: This study will provide further information on the efficiency of neonatal resuscitation training and implementation in the context of new technologies and quality improvement processes.

    TRIAL REGISTRATION: https://doi.org/10.1186/ISRCTN18148368 , date of registration-31 July 2018.

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  • 33.
    Gurung, Rejina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Global Health Research on Implementation and Sustainability. Golden Community, Res Div, Lalitpur, Nepal..
    Moinuddin, Md
    Edge Hill Univ, Med Sch, Ormskirk, England.;UCL, Inst Child Hlth, London, England..
    Sunny, Avinash K.
    Golden Community, Res Div, Lalitpur, Nepal..
    Bhandari, Amit
    Golden Community, Res Div, Lalitpur, Nepal.;Soc Publ Hlth Phys Nepal, Kathmandu, Nepal..
    Axelin, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Global Health Research on Implementation and Sustainability. Univ Turku, Dept Nursing Sci, Turku, Finland..
    KC, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Global Health Research on Implementation and Sustainability. Soc Publ Hlth Phys Nepal, Kathmandu, Nepal..
    Mistreatment during childbirth and postnatal period reported by women in Nepal -a multicentric prevalence study2022In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 22, no 1, article id 319Article in journal (Refereed)
    Abstract [en]

    Introduction Trust of women and families toward health institutions has led to increased use of their services for childbirth. Whilst unpleasant experience of care during childbirth will halt this achievement and have adverse consequences. We examined the experience of women regarding the care received during childbirth in health institutions in Nepal. Method A prospective cohort study conducted in 11 hospitals in Nepal for a period of 18 months. Using a semi-structured questionnaire based on the typology of mistreatment during childbirth, information on childbirth experience was gathered from women (n = 62,926) at the time of discharge. Using those variables, principal component analysis was conducted to create a single mistreatment index. Bivariate and multivariate linear regression analyses were conducted to assess the association of the mistreatment index with sociodemographic, obstetric and newborn characteristics. Result A total of 62,926 women were consented and enrolled in the study. Of those women, 84.3% had no opportunity to discuss any concerns, 80.4% were not adequately informed before providing care, and 1.5% of them were refused for care due to inability to pay. According to multivariate regression analysis, women 35 years or older (beta, - 0.3587; p-value, 0.000) or 30-34 years old (beta,- 0.38013; p-value, 0.000) were less likely to be mistreated compared to women aged 18 years or younger. Women from a relatively disadvantaged (Dalit) ethnic group were more likely to be mistreated (beta, 0.29596; p-value, 0.000) compared to a relatively advantaged (Chettri) ethnic group. Newborns who were born preterm (beta, - 0.05988; p-value, 0.000) were less likely to be mistreated than those born at term. Conclusion The study reports high rate of some categories of mistreatment of women during childbirth. Women from disadvantaged ethnic group, young women, and term newborns are at higher risk of mistreatment. Strengthening health system and improving health workers' readiness and response will be key in experience respectful care during childbirth.

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  • 34.
    Gurung, Rejina
    et al.
    Golden Community, Lalitpur, Nepal.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability.
    Hong, Zhou
    Peking Univ, Dept Maternal & Child Hlth, Hlth Sci Ctr, Beijing, Peoples R China.
    Poudel, Pragya Gautam
    Univ Tennessee, Dept Publ Hlth, Knoxville, TN USA.
    Sunny, Avinash K.
    Golden Community, Lalitpur, Nepal.
    Sharma, Srijana
    Golden Community, Lalitpur, Nepal.
    Mishra, Sangeeta
    Koshi Zonal Hosp, Minist Hlth & Populat, Koshi, Nepal.
    Nurova, Nisso
    Marie Stopes Int, London, England.
    KC, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability.
    The burden of adolescent motherhood and health consequences in Nepal2020In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, no 1, article id 318Article in journal (Refereed)
    Abstract [en]

    Background: Annually, 18 million babies are born to mothers 18 years or less. Two thirds of these births take place in South Asia and Sub-Saharan Africa. Due to social and biological factors, adolescent mothers have a higher risk of adverse birth outcomes. We conducted this study to assess the incidence, risk factors, maternal and neonatal health consequences among adolescent mothers.

    Methods: We conducted an observational study in 12 hospitals of Nepal for a period of 12 months. Patient medical record and semi-structured interviews were used to collect demographic information of mothers, intrapartum care and outcomes. The risks of adverse birth outcomes among adolescent compared to adult mothers were assessed using multivariate logistic regression.

    Results: During the study period, among the total 60,742 deliveries, 7.8% were adolescent mothers. Two third of the adolescent mothers were from disadvantaged ethnic groups, compared to half of adult mothers (66.1% vs 47.8%, p-value< 0.001). One third of the adolescent mothers did not have formal education, while one in nine adult mothers did not have formal education (32.6% vs 14.2%, p-value< 0.001). Compared to adult mothers, adolescent mothers had higher odds of experiencing prolonged labour (aOR-1.56, 95% CI, 1.17-2.10, p-0.003), preterm birth (aOR-1.40, 95% CI, 1.26-1.55, p < 0.001) and of having a baby being small for gestational age (aOR-1.38, 95% CI 1.25-1.52, p < 0.001). The odds of major malformation increased by more than two-fold in adolescent mothers compared to adult mothers (aOR-2.66, 95% CI 1.12-6.33, p-0.027).

    Conclusion: Women from disadvantaged ethnic group have higher risk of being pregnant during adolescent age. Adolescent mothers were more likely to have prolonged labour, a preterm birth, small for gestational age baby and major congenital malformation. Special attention to this high-risk group during pregnancy, labour and delivery is critical.

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  • 35.
    Gurung, Rejina
    et al.
    Golden Community, Res Div, Lalitpur, Nepal..
    Ruysen, Harriet
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England..
    Sunny, Avinash K.
    Golden Community, Res Div, Lalitpur, Nepal..
    Day, Louise T.
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England..
    Penn-Kekana, Loveday
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England..
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability.
    Ghimire, Binda
    Minist Hlth & Populat, Kathmandu, Nepal..
    Singh, Dela
    Minist Hlth & Populat, Kathmandu, Nepal..
    Basnet, Omkar
    Golden Community, Res Div, Lalitpur, Nepal..
    Sharma, Srijana
    Golden Community, Res Div, Lalitpur, Nepal..
    Shaver, Theresa
    USAID, Washington, DC USA..
    Moran, Allisyn C.
    WHO, Dept Maternal Newborn Child & Adolescent Hlth & A, Geneva, Switzerland..
    Lawn, Joy E.
    London Sch Hyg & Trop Med, Ctr Maternal Adolescent Reprod & Child Hlth MARCH, London, England..
    KC, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability.
    Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal2021In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 21, no SUPPL, article id 228Article in journal (Refereed)
    Abstract [en]

    BackgroundRespectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns.MethodsAt one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017-July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health - ethnicity, age, sex, mode of birth - as possible predictors for reporting poor care.ResultsAmong 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (beta =0.23, p-value <0.0001). Women from Madeshi (a disadvantaged ethnic group) were more likely to report poor care (<beta>=-0.34; p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (beta=-0.42; p-value <0.0001) than women with a vaginal birth. However, babies born by caesarean had a 98% decrease in the odds (aOR=0.02, 95% CI, 0.01-0.05) of receiving skin-to-skin contact than those with vaginal births.ConclusionsMeasurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women's age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.

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  • 36.
    Haines, Helen M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Pallant, Julie F.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth2012In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 12, p. 55-Article in journal (Refereed)
    Abstract [en]

    Background: Women's fears and attitudes to childbirth may influence the maternity care they receive and the outcomes of birth. This study aimed to develop profiles of women according to their attitudes regarding birth and their levels of childbirth related fear. The association of these profiles with mode and outcomes of birth was explored.

    Methods: Prospective longitudinal cohort design with self report questionnaires containing a set of attitudinal statements regarding birth (Birth Attitudes Profile Scale) and a fear of birth scale (FOBS). Pregnant women responded at 18-20 weeks gestation and two months after birth from a regional area of Sweden (n = 386) and a regional area of Australia (n = 123). Cluster analysis was used to identify a set of profiles. Odds ratios (95% CI) were calculated, comparing cluster membership for country of care, pregnancy characteristics, birth experience and outcomes.

    Results: Three clusters were identified - 'Self determiners' (clear attitudes about birth including seeing it as a natural process and no childbirth fear), 'Take it as it comes' (no fear of birth and low levels of agreement with any of the attitude statements) and 'Fearful' (afraid of birth, with concerns for the personal impact of birth including pain and control, safety concerns and low levels of agreement with attitudes relating to women's freedom of choice or birth as a natural process). At 18 - 20 weeks gestation, when compared to the 'Self determiners', women in the 'Fearful' cluster were more likely to: prefer a caesarean (OR = 3.3 CI: 1.6-6.8), hold less than positive feelings about being pregnant (OR = 3.6 CI: 1.4-9.0), report less than positive feelings about the approaching birth (OR = 7.2 CI: 4.4-12.0) and less than positive feelings about the first weeks with a newborn (OR = 2.0 CI 1.2-3.6). At two months post partum the 'Fearful' cluster had a greater likelihood of having had an elective caesarean (OR = 5.4 CI 2.1-14.2); they were more likely to have had an epidural if they laboured (OR = 1.9 CI 1.1-3.2) and to experience their labour pain as more intense than women in the other clusters. The 'Fearful' cluster were more likely to report a negative experience of birth (OR = 1.7 CI 1.02-2.9). The 'Take it as it comes' cluster had a higher likelihood of an elective caesarean (OR 3.0 CI 1.1-8.0).

    Conclusions: In this study three clusters of women were identified. Belonging to the 'Fearful' cluster had a negative effect on women's emotional health during pregnancy and increased the likelihood of a negative birth experience. Both women in the 'Take it as it comes' and the 'Fearful' cluster had higher odds of having an elective caesarean compared to women in the 'Self determiners'. Understanding women's attitudes and level of fear may help midwives and doctors to tailor their interactions with women.

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  • 37.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Rubertsson, Christine
    Lund Univ, Dept Hlth Sci, Lund, Sweden..
    Postpartum bonding and association with depressive symptoms and prenatal attachment in women with fear of birth2022In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 22, article id 66Article in journal (Refereed)
    Abstract [en]

    Background: Co-morbidity is prevalent in women with fear of birth. Depressive symptoms and lack of prenatal attachment might influence the postpartum bonding between the mother and the new-born.

    Aim: To examine the underlying dimensions of the Postpartum Bonding Questionnaire and to investigate associations between depressive symptoms, prenatal attachment and postpartum bonding in women with fear of birth.

    Methods: A longitudinal study comprising 172 women with fear of birth. Data were collected by questionnaires in mid- and late pregnancy and two months after birth. The Edinburgh Postnatal Depressive Scale, Prenatal Attachment Inventory and Postpartum Bonding Questionnaire were investigated.

    Results: Two factors of the Postpartum Bonding Questionnaire were identified: Factor 1 mirrored caring activities and the women's perceptions of motherhood, whereas Factor 2 reflected negative feelings towards the baby. The Postpartum Bonding Questionnaire was negatively correlated with the Prenatal Attachment Inventory and positively with The Edinburgh Postnatal Depressive Scale. Women with fear of birth and depressive symptoms both during pregnancy and postpartum showed the highest risk of impaired bonding after birth. Primiparity and being single were also associated with impaired bonding.

    Conclusion: A focus on women's mental health during pregnancy is necessary in order to avoid the negative effects of impaired bonding on the infant. Depressive symptoms could be concurrent with fear of birth and, therefore, it is important to determine both fear of birth and depressive symptoms in screening procedures during pregnancy. Caregivers who meet women during pregnancy need to acknowledge prenatal attachment and thereby influence adaptation to motherhood.

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  • 38.
    Högberg, Ulf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Claeson, Catrin
    Karolinska Univ Hosp, Dept Obstet & Gynecol, S-17176 Solna, Sweden..
    Krebs, Lone
    Univ Copenhagen, Dept Obstet & Gynecol, Copenhagen, Denmark.;Holbaek Cent Hosp, Copenhagen, Denmark..
    Svanberg, Agneta Skoog
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Kidanto, Hussein
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili Natl Hosp, Dept Obstet & Gynecol, Dar Es Salaam, Tanzania..
    Breech delivery at a University Hospital in Tanzania2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 342Article in journal (Refereed)
    Abstract [en]

    Background: There is a global increase in rates of Cesarean delivery (CD). A minor factor in this increase is a shift towards CD for breech presentation. The aim of this study was to analyze breech births by mode of delivery and investigate short-term fetal and maternal outcomes in a low-income setting.

    Methods: The study design was cross-sectional and the setting was Muhimbili National Hospital (MNH), Dar-es-Salaam, Tanzania. Subjects were drawn from a clinical database (1999-2010) using the following inclusion criteria: breech presentation, birth weight >= 2,500 g, single pregnancy, fetal heart sound at admission, and absence of pregnancy-related complication as indication for CD. Of 2,765 mothers who had a breech delivery, 1,655 met the inclusion criteria. Analyses were stratified by mode of delivery, taking into account also other birth characteristics. The outcome measures were perinatal death (stillbirths + in-hospital neonatal deaths) and moderate asphyxia. Maternal outcomes, such as death, hemorrhage, and length of hospital stay, were also described.

    Results: The CD rate for breech presentation increased from 28 % in 1999 to 78 % in 2010. Perinatal deaths were associated with vaginal delivery (VD) (adjusted odds ratio (aOR) 6.2; 95 % confidence interval (CI) 3.0-12.6) and referral (aOR 2.1; 95 % CI 1.1-3.9), but not with parity, birth weight, or delivery year. Overall perinatal mortality was 5.8 % and this did not decline, due to an increase in stillbirths among vaginal breech deliveries. Mothers with CD had more hemorrhage compared to those with VD. One mother died in association with CD, and one died in association with VD.

    Conclusion: A breech VD, compared to a breech CD, in this setting was associated with adverse perinatal outcome. However, despite a significant increase in CD rate, no overall improvement was observed due to an increase in stillbirths among VDs.

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  • 39.
    Höglund, Berit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Radestad, Ingela
    Sophiahemmet Univ, Stockholm, Sweden.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Few women receive a specific explanation of a stillbirth - an online survey of women's perceptions and thoughts about the cause of their baby's death2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 139Article in journal (Refereed)
    Abstract [en]

    Background: In Sweden, three to four out of every 1000 pregnancies end in stillbirth each year. The aim of this study was to investigate whether women who had experienced stillbirth perceived that they had received an explanation of the death and whether they believed that healthcare professionals were responsible for the death of the baby.

    Methods: An online survey of 356 women in Sweden who had experienced a stillbirth from January 2010 to April 2014. A mixed-methods approach with qualitative content analysis was used to examine the women's responses.

    Results: Nearly half of the women (48.6%) reported that they had not received any explanation as to why their babies had died. Of the women who reported that they had received an explanation, 84 (23.6%) had a specific explanation, and 99 (27.8%) had a vague explanation. In total, 73 (30.0%) of the 243 women who answered the question Do you believe that healthcare personnel were responsible for the stillbirth? stated Yes. The women reported that the healthcare staff had not acknowledged their intuition that the pregnancy was proceeding poorly. Furthermore, they perceived that the staff met them with nonchalance and arrogance. Additionally, the midwife had ignored or normalised the symptoms that could indicate that their pregnancy was proceeding poorly. Some women added that neglect and avoidance among the healthcare staff could have led to a lack of monitoring, which could have been crucial for the outcome of the pregnancy.

    Conclusions: Half of the women surveyed reported that they had not received an explanation of their baby's death, and more than one-fourth held healthcare professionals responsible for the death.

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  • 40.
    Johansson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Alvan, Jonatan
    Swedish Agcy Hlth Technol Assessment & Assessme, Stockholm, Sweden..
    Pettersson, Agneta
    Swedish Agcy Hlth Technol Assessment & Assessme, Stockholm, Sweden..
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Conflicting attitudes between clinicians and women regarding maternal requested caesarean section: a qualitative evidence synthesis2023In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 23, no 1, article id 210Article in journal (Refereed)
    Abstract [en]

    Background

    Caesarean section (CS) can be a life-saving operation but might also negatively affect the health of both the woman and the baby. The aim of this study was to synthesize and contrast women’s and clinicians’ attitudes toward maternal-requested CS, and their experiences of the decision-making process around CS.

    Methods

    The databases of CINAHL, MEDLINE, PsycInfo and Scopus were screened. All qualitative studies that answered the study question and that were assessed to have minor or moderate methodological limitations were included. Synthesised findings were assessed using GRADE-CERQual.

    Results

    The Qualitative Evidence Synthesis included 14 qualitative studies (published 2000–2022), involving 242 women and 141 clinicians. From the women’s perspectives, two themes arose: women regarded CS as the safest mode of birth; and women’s rights to receive support and acceptance for a CS request. From the clinicians’ perspectives, four themes emerged: clinicians were concerned about health risks associated with CS; demanding experience to consult women with a CS request; conflicting attitudes about women’s rights to choose a CS; and the importance of respectful and constructive dialogue about birthing options.

    Conclusion

    Women and clinicians often had different perceptions regarding the right of a woman to choose CS, the risks associated with CS, and the kind of support that should be part of the decision-making process. While women expected to receive acceptance for their CS request, clinicians perceived that their role was to support the woman in the decision-making process through consultation and discussion. While clinicians thought it was important to show respect for a woman’s birth preferences, they also felt the need to resist a woman’s request for CS and encourage her to give birth vaginally due to the associated increases in health risks.

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  • 41.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Induction of twin pregnancy and the risk of caesarean delivery: a cohort study2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, article id 136Article in journal (Refereed)
    Abstract [en]

    Background: Complications are common in twin pregnancies and induction of labour is often indicated. Most methods for induction are used but data on risks related to induction methods are sparse. The aim of this study was to investigate the association between induction of labour and caesarean delivery in twin pregnancies, and to assess the influence of induction method. Methods: Cohort study of twin pregnancies >= 34 weeks, planned for vaginal delivery, from two University Hospitals in Sweden. Data were collected from medical records during the periods 1994 (Orebro) and 2004 (Uppsala) to 2013. During the study period there were 78,180 live born births and 1,282 were twin births. Women with previous caesarean section were excluded. Induction methods were categorized into amniotomy, oxytocin and cervical ripening (intra cervical Foley catheter or prostaglandin). Adjusted odds ratios (AOR) with 95 % confidence interval (CI) for caesarean section were calculated by logistic regression and were adjusted for parity, maternal age, gestational length, complications to the pregnancy, infant birth weight and year of birth. Spontaneous labour onsets were used as the reference group. The main outcome measure was caesarean section. Results: In 462 twin pregnancies, 220 (48 %) had induction of labour and 242 (52 %) a spontaneous labour onset. Amniotomy was performed in 149 (68 %) of these inductions, oxytocin was administered in 11 (5 %) and cervical ripening was used in 60 (27 %). The rate of caesarean sections was 21 % in induced and 12 % in spontaneous labours (p 0.01). The absolute risk of caesarean section following induction was: 15 % with amniotomy; 36 % with oxytocin and 37 % with Foley/prostaglandin. Induction of labour increased the risk of caesarean section by 90 % compared with spontaneous labour onset (AOR 1.9, 95 % CI 1.1-3.5) and, when cervical ripening was used, the risk increased more than two fold (AOR 2.5, 95 % CI 1.2-5.3). Conclusion: Induction of labour in twin pregnancies increases the risk of caesarean section compared with spontaneous labour onset, especially if Foley catheter or prostaglandins are required. However, approximately 80 % of induced labours are delivered vaginally.

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  • 42.
    Kalliokoski, Paul
    et al.
    Primary Care Center Jakobsgårdarna, Jaxtorget 7A, Box 100 33 Borlänge S-781 10, Sweden.
    Bergqvist, Yngve
    Löfvander, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Physical performance and 25-hydroxyvitamin D: a cross-sectional study of pregnant Swedish and Somali immigrant women and new mothers2013In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, article id 237Article in journal (Refereed)
    Abstract [en]

    Background:

    Severe vitamin D deficiency can impair muscle strength. The study aims were to examine physical performance in the hands and upper legs, and analyze plasma 25-hydroxyvitamin D (25(OH) D) concentrations in women with presumably low (veiled, Somali-born) and high levels (unveiled, Swedish-born).

    Methods:

    Women (n = 123, 58% Swedish) enrolled at a Swedish antenatal clinic, latitude 60 degrees N, were recruited. Plasma 25(OH) D was analyzed, measured as nmol/L, then categorized as <10 = undetectable, 10-24, 25-49, 50-74 or >75. Muscle strength was tested: maximal hand grip strength (in Newtons, N), and upper leg performance (categorized as able/unable to perform squatting, standing on one leg, standing from a chair, and lifting their hips). Social and anthropometric data were collected. Non-parametric statistics tested the data for differences in their ability to perform the tests across 25(OH) D categories. Undetectable values (< 10 nmol/L) were replaced with '9' in the linear correlation statistics. A final main effect model for grip strength (in N) was calculated using stepwise linear regression for independent variables: country of birth, 25(OH) D levels, age, height, weight, physical activity, lactation status, parity, and gestational age.

    Results:

    Somali participants (35%) had 25(OH) D levels of < 10 nmol/L, and 90% had < 25 nmol/L; 10% of Swedish participants had < 25 nmol/L of 25(OH) D, and 54% had < 50 nmol/L. Somali women had a relatively weak grip strength compared with Swedish women: median 202 N (inter-quartile range 167-246) vs. median 316 N (inter-quartile range 278-359), respectively. Somali women were also weak in upper leg performance: 73% were unable to squat, 29% unable to stand on one leg, and 21% could not lift their hips (not significant across 25(OH) D categories); most Swedish women could perform these tests. In the final model, grip strength (N) was significantly associated with 25(OH) D levels (B 0.94, p=0.013) together with Somali birth (B -63.9, p<0.001), age (B 2.5, p=0.02) and height (B 2.6, p=0.01).

    Conclusions:

    Many Somali women had undetectable/severely low 25(OH) D concentrations and pronounced hand and upper leg weakness; grip strength was strongly associated with 25(OH) D. Maternity health care personnel should be aware of this increased frequency and manage care accordingly.

  • 43.
    Kalliokoski, Paul
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Primary Hlth Care Ctr Jakobsgardarna, Jaxtorget 7A,Box 100 33, S-78110 Borlange, Sweden.
    Rodhe, Nils
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Bergqvist, Yngve
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Löfvander, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
    Long-term adherence and effects on grip strength and upper leg performance of prescribed supplemental vitamin D in pregnant and recently pregnant women of Somali and Swedish birth with 25-hydroxyvitamin D deficiency: a before-and-after treatment study2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 353Article in journal (Refereed)
    Abstract [en]

    Background: Muscular weakness and severe vitamin D deficiency is prevalent in Somali (veiled) pregnant women, Sweden. The study aims here were to explore adherence to prescribed supplemental vitamin D in new mothers with vitamin D deficiency and its effects on grip strength and upper leg performance in Somali (target group TG) and Swedish women (reference group RG) from spring through winter.

    Methods: A before-and after study was designed. A cross-sectional sample of women in antenatal care with serum 25-OHD <= 50 nmol/L were prescribed one or two tablets daily (800 or 1600 IU vitamin D3 with calcium) for 10 months. Reminders were made by Somali nurses (TG) or Swedish doctors (RG). Baseline and 10 month measurements of plasma nmol/L 25-OHD, maximal grip strength held for 10 s (Newton, N) and ability to squat (yes; no) were done. Total tablet intake (n) was calculated. Outcome variables were changes from baseline in grip strength and ability to squat. Predicting variables for change in grip strength and ability to squat were calculated using linear and binary regression in final models. Undetectable 25-OHD values (< 10 nmol/L) were replaced with '9' in statistic calculations.

    Results: Seventy-one women (46 TG, 1/3 with undetectable baseline 25-OHD; 25 RG) participated. At the 10-month follow up, 17% TG and 8% RG women reported having refrained from supplement. Mean 25-OHD increased 16 to 49 nmol/L (TG) and 39 nmol/L to 67 nmol/L (RG), (both p < 0.001). Grip strength had improved from 153 to 188 N (TG) (p < 0.001) and from 257 to 297 N (RG) (p = 0.003) and inability to squat had decreased in TG (35 to 9, p < 0. 001). Intake of number of tablets predicted increased grip strength (B 0.067, 95% CI 0.008-0.127, p = 0.027). One tablet daily (> 300 in total) predicted improved ability to squat (OR 16; 95% CI 1.8-144.6).

    Conclusions: Adherence to supplemental vitamin D and calcium should be encouraged as an even moderate intake was associated to improved grip strength and upper leg performance, which was particularly useful for the women with severe 25-OHD deficiency and poor physical performance at baseline.

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  • 44.
    Karlstrom, Annika
    et al.
    Mid Sweden Univ, Dept Nursing, SE-70 Sundsvall, Sweden..
    Nystedt, Astrid
    Umea Univ, Dept Nursing, Umea, Sweden..
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Mid Sweden Univ, Dept Nursing, SE-70 Sundsvall, Sweden..
    The meaning of a very positive birth experience: focus groups discussions with women2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, article id 251Article in journal (Refereed)
    Abstract [en]

    Background: The experience of giving birth has long-term implications for a woman's health and wellbeing. The birth experience and satisfaction with birth have been associated with several factors and emotional dimensions of care and been shown to influence women's overall assessment. Individualized emotional support has been shown to empower women and increase the possibility of a positive birth experience. How women assess their experience and the factors that contribute to a positive birth experience are of importance for midwives and other caregivers. The aim of this study was to describe women's experience of a very positive birth experience. Method: The study followed a qualitative descriptive design. Twenty-six women participated in focus group discussions 6-7 years after a birth they had assessed as very positive. At the time of the birth, they had all taken part in a large prospective longitudinal cohort study performed in northern Sweden. In the present study, thematic analysis was used to review the transcribed data. Results: All women looked back very positively on their birth experience. Two themes and six sub-themes were identified that described the meaning of a very positive birth experience. Women related their experience to internal (e.g., their own ability and strength) and external (e.g., a trustful and respectful relationship with the midwife) factors. A woman's sense of trust and support from the father of the child was also important. The feeling of safety promoted by a supportive environment was essential for gaining control during birth and for focusing on techniques that enabled the women to manage labour. Conclusion: It is an essential part of midwifery care to build relationships with women where mutual trust in one another's competence is paramount. The midwife is the active guide through pregnancy and birth and should express a strong belief in a woman's ability to give birth. Midwives are required to inform, encourage and to provide the tools to enable birth, making it important for midwives to invite the partner to be part of a team, in which everyone works together for the benefit of the woman and child.

  • 45.
    KC, Ashish
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, SWEDESD - Sustainability Learning and Research Centre. Univ Gothenburg, Sahlgrenska Acad, Sch Publ Hlth & Community Med, Gothenburg, Sweden.
    Acharya, Ankit
    Res Div Golden Community, Lalitpur, Nepal..
    Bhattarai, Pratiksha
    Res Div Golden Community, Lalitpur, Nepal..
    Basnet, Omkar
    Res Div Golden Community, Lalitpur, Nepal..
    Shrestha, Anisha
    Res Div Golden Community, Lalitpur, Nepal..
    Rijal, Garima
    Res Div Golden Community, Lalitpur, Nepal..
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Association of disrespectful care after childbirth and COVID-19 exposure with postpartum depression symptoms: a longitudinal cohort study in Nepal2023In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 23, no 1, article id 145Article in journal (Refereed)
    Abstract [en]

    Background

    The COVID-19 pandemic has led to unprecedented mental stress to women after childbirth. In this study, we assessed the association of disrespectful care after childbirth and COVID-19 exposure before/during labour with postpartum depression symptoms assessed at 7 and 45 days in Nepal.

    Methods

    A longitudinal cohort study was conducted in 9 hospitals of Nepal among 898 women. The independent data collection system was established in each hospital to collection information on disrespectful care after birth via observation, exposure to COVID-19 infection before/during labour and other socio-demographic via interview. The information on depressive symptoms at 7 and 45 days was collected using the validated Edinburg Postnatal Depression Scale (EPDS) tool. Multi-level regression was performed to assess the association of disrespectful care after birth and COVID-19 exposure with postpartum depression.

    Result

    In the study, 16.5% were exposed to COVID-19 before/during labour and 41.8% of them received disrespectful care after childbirth. At 7 and 45 days postpartum, 21.3% and 22.4% of women reported depressive symptoms respectively. In the multi-level analysis, at the 7th postpartum day, women who had disrespectful care and no COVID-19 exposure still had 1.78 higher odds of having depressive symptom (aOR, 1.78; 95% CI; 1.16, 2.72). In the multi-level analysis, at 45th postpartum day, women who had disrespectful care and no COVID-19 exposure had 1.37 higher odds of having depressive symptoms (aOR, 1.37; 95% CI; 0.82, 2.30), but not statistically significant.

    Conclusion

    Disrespectful care after childbirth was strongly associated with postpartum depression symptoms irrespective of COVID-19 exposure during pregnancy. Caregivers, even during the global pandemic, should continue to focus their attention for immediate breast feeding and skin-to-skin contact, as this might reduce the risk for depressive symptoms postpartum.

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  • 46.
    K.C, Ashish
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nelin, Viktoria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Wrammert, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Vitrakoti, Ravi
    Baral, Geha Nath
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Risk factors for antepartum stillbirth: a case-control study in Nepal2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, article id 146Article in journal (Refereed)
    Abstract [en]

    Background: Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting. Methods: This case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analysis was completed to determine the association between those risk factors and antepartum stillbirth. Results: During the study period, 4567 women who delivered at the hospital were enrolled as referents, of which 62 had antepartum stillbirths and were re-categorized into the case population. In total, there were 307 antepartum stillbirths. An association was found between the following risk factors and antepartum stillbirth: increasing maternal age (aOR 1.0, 95 % CI 1.0-1.1), less than five years of maternal education (aOR 2.4, 95 % CI 1.7-3.2), increasing parity (aOR 1.2, 95 % CI 1.0-1.3), previous stillbirth (aOR 2.6, 95 % CI 1.6-4.4), no antenatal care attendance (aOR 4.2, 95 % CI 3.2-5.4), belonging to the poorest family (aOR 1.3, 95 % CI 1.0-1.8), antepartum hemorrhage (aOR 3.7, 95 % CI 2.4-5.7), maternal hypertensive disorder during pregnancy (aOR 2.1, 95 % CI 1.5-3.1), and small weight-for-gestational age babies (aOR 1.5, 95 % CI 1.2-2.0). Conclusion: Lack of antenatal care attendance, which had the strongest association with antepartum stillbirth, is a potentially modifiable risk factor, in that increasing the access to and availability of these services can be targeted. Antenatal care attendance provides an opportunity to screen for other potential risk factors for antepartum stillbirth, as well as to provide counseling to women, and thus, helps to ensure a successful pregnancy outcome.

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  • 47.
    KC, Ashish
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability.
    Peven, Kimberly
    London Sch Hyg & Trop Med, Maternal Adolescent Reprod & Child Hlth MARCH, Keppel St, London WC1E 7HT, England.;Kings Coll London, Florence Nightingale Fac Nursing Midwifery & Pall, London, England..
    Ameen, Shafiqul
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, Dhaka, Bangladesh..
    Msemo, Georgina
    Ifakara Hlth Inst, Dept Hlth Syst Impact Evaluat & Policy, Dar Es Salaam, Tanzania.;Minist Hlth & Social Welf, Dar Es Salaam, Tanzania..
    Basnet, Omkar
    Golden Community, Res Div, Lalitpur, Nepal..
    Ruysen, Harriet
    London Sch Hyg & Trop Med, Maternal Adolescent Reprod & Child Hlth MARCH, Keppel St, London WC1E 7HT, England..
    Zaman, Sojib Bin
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, Dhaka, Bangladesh..
    Mkony, Martha
    Ifakara Hlth Inst, Dept Hlth Syst Impact Evaluat & Policy, Dar Es Salaam, Tanzania..
    Sunny, Avinash K.
    Golden Community, Res Div, Lalitpur, Nepal..
    Rahman, Qazi Sadeq-ur
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, Dhaka, Bangladesh..
    Shabani, Josephine
    Ifakara Hlth Inst, Dept Hlth Syst Impact Evaluat & Policy, Dar Es Salaam, Tanzania..
    Bastola, Ram Chandra
    Pokhara Acad Hlth Sci, Pokhara, Nepal.;Minist Hlth & Populat, Kathmandu, Nepal..
    Assenga, Evelyne
    Muhimbili Univ Hlth & Allied Sci MUHAS, Dar Es Salaam, Tanzania..
    Kc, Naresh P.
    Soc Publ Hlth Phys Nepal, Kathmandu, Nepal..
    El Arifeen, Shams
    Int Ctr Diarrhoeal Dis Res Bangladesh Icddr B, Maternal & Child Hlth Div, Dhaka, Bangladesh..
    Kija, Edward
    Ifakara Hlth Inst, Dept Hlth Syst Impact Evaluat & Policy, Dar Es Salaam, Tanzania..
    Malla, Honey
    Golden Community, Res Div, Lalitpur, Nepal..
    Kong, Stefanie
    London Sch Hyg & Trop Med, Maternal Adolescent Reprod & Child Hlth MARCH, Keppel St, London WC1E 7HT, England..
    Singhal, Nalini
    Univ Calgary, Dept Paediat, Calgary, AB, Canada..
    Niermeyer, Susan
    Univ Colorado, Sch Med, Colorado Sch Publ Hlth, Aurora, CO USA..
    Lincetto, Ornella
    WHO, Dept Maternal Newborn Child & Adolescent Hlth & A, Geneva, Switzerland..
    Day, Louise T.
    London Sch Hyg & Trop Med, Maternal Adolescent Reprod & Child Hlth MARCH, Keppel St, London WC1E 7HT, England..
    Lawn, Joy E.
    London Sch Hyg & Trop Med, Maternal Adolescent Reprod & Child Hlth MARCH, Keppel St, London WC1E 7HT, England..
    Neonatal resuscitation: EN-BIRTH multi-country validation study2021In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 21, no SUPPL, article id 235Article in journal (Refereed)
    Abstract [en]

    BackgroundAnnually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscitation coverage.MethodsThe EN-BIRTH study, in five hospitals in Bangladesh, Nepal, and Tanzania (2017-2018), collected time-stamped data for care around birth, including neonatal resuscitation. Researchers surveyed women and extracted data from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage to survey-reported and register-recorded coverage, using absolute difference, validity ratios, and individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two resuscitation numerators (stimulation, BMV) and three denominators (live births and fresh stillbirths, non-crying, non-breathing). We also examined timeliness of BMV. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine recording of resuscitation.ResultsAmong 22,752 observed births, 5330 (23.4%) babies did not cry and 3860 (17.0%) did not breathe in the first minute after birth. 16.2% (n =3688) of babies were stimulated and 4.4% (n =998) received BMV. Survey-report underestimated coverage of stimulation and BMV. Four of five labour ward registers captured resuscitation numerators. Stimulation had variable accuracy (sensitivity 7.5-40.8%, specificity 66.8-99.5%), BMV accuracy was higher (sensitivity 12.4-48.4%, specificity >93%), with small absolute differences between observed and recorded BMV. Accuracy did not vary by denominator option. <1% of BMV was initiated within 1 min of birth. Enablers to register recording included training and data use while barriers included register design, documentation burden, and time pressure.ConclusionsPopulation-based surveys are unlikely to be useful for measuring resuscitation coverage given low validity of exit-survey report. Routine labour ward registers have potential to accurately capture BMV as the numerator. Measuring the true denominator for clinical need is complex; newborns may require BMV if breathing ineffectively or experiencing apnoea after initial drying/stimulation or subsequently at any time. Further denominator research is required to evaluate non-crying as a potential alternative in the context of respectful care. Measuring quality gaps, notably timely provision of resuscitation, is crucial for programme improvement and impact, but unlikely to be feasible in routine systems, requiring audits and special studies.

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  • 48.
    Kc, Ashish
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). UN Childrens Fund, Nepal Country Off, UN House, Pulchowk, Nepal.
    Wrammert, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Clark, Robert B
    Latter-day Saint Charities, Salt Lake City, UT, USA.
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Inadequate fetal heart rate monitoring and poor use of partogram associated with intrapartum stillbirth: a case-referent study in Nepal2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 233Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Newborns are at the greatest risk for dying during the intrapartum period, including labor and delivery, and the first day of life. Fetal heart rate monitoring (FHRM) and partogram use to track labor progress are evidence-based techniques that can help to identify maternal and fetal risk factors so that these can be addressed early. The objective of this study was to assess health worker adherence to protocols for FHRM and partogram use during the intrapartum period, and to assess the association between adherence and intrapartum stillbirth in a tertiary hospital of Nepal.

    METHODS: A case-referent study was conducted over a 15-month period. Cases included all intrapartum stillbirths, while 20 % of women with live births were randomly selected on admission to make up the referent population. The frequency of FHRM and the use of partogram were measured and their association to intrapartum stillbirth was assessed using logistic regression analysis.

    RESULTS: During the study period, 4,476 women with live births were enrolled as referents and 136 with intrapartum stillbirths as cases. FHRM every 30 min was only completed in one-fourth of the deliveries, and labor progress was monitored using a partogram in just over half. With decreasing frequency of FHRM, there was an increased risk of intrapartum stillbirth; FHRM at intervals of more than 30 min resulted in a four-fold risk increase for intrapartum stillbirth (aOR 4.17, 95 % CI 2.0-8.7), and the likelihood of intrapartum stillbirth increased seven times if FHRM was performed less than every hour or not at all (aOR 7.38, 95 % CI 3.5-15.4). Additionally, there was a three-fold increased risk of intrapartum stillbirth if the partogram was not used (aOR 3.31, 95 % CI 2.0-5.4).

    CONCLUSION: The adherence to FHRM and partogram use was inadequate for monitoring intrapartum progress in a tertiary hospital of Nepal. There was an increased risk of intrapartum stillbirth when fetal heart rate was inadequately monitored and when the progress of labor was not monitored using a partogram. Further exploration is required in order to determine and understand the barriers to adherence; and further, to develop tools, techniques and interventions to prevent intrapartum stillbirth.

    CLINICAL TRIAL REGISTRATION: ISRCTN97846009 .

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  • 49. Kelley, M
    et al.
    Rubens, C
    Rodriguez, Alina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Global report on preterm birth and stillbirth (6 of 7): erhical considerations2010In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 10, p. 6-6Article in journal (Refereed)
  • 50.
    Kidanto, Hussein L
    et al.
    Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Mogren, Ingrid
    Department of Clinical Science, Obstetrics and Gynaecology, Umeå University, Umeå, Sweden.
    van Roosmalen, Jos
    Department of Obstetrics, Leiden University Medical Centre and Section of Health care and Culture, VU University Medical Centre, Amsterdam, The Netherlands.
    Thomas, Angela N
    Department of Obstetrics and Gynaecology, Muhimbili National Hospital, Dar es Salaam, Tanzania.
    Massawe, Siriel N
    Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Nystrom, Lennarth
    Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania2009In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 9, p. 45-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR).

    METHODS:

    From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133) with birth weight 1500 g or more at Muhimbili National Hospital (MNH). The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care). The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient.

    RESULTS:

    The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors.

    CONCLUSION:

    There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality.

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