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  • 1.
    Albertson, Anna
    et al.
    Uppsala universitet.
    Chandraharan, E.
    St Georges Univ Hosp NHS Fdn Trust, London, England..
    Lowe, V
    St Georges Univ Hosp NHS Fdn Trust, London, England..
    Archer, A.
    St Georges Univ Hosp NHS Fdn Trust, London, England..
    Amer-Wahlin, I
    Karolinska Inst, Stockholm, Sweden..
    Incidence of subacute hypoxia during active maternal pushing during labour2016Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 123, s. 147-147Artikel i tidskrift (Övrigt vetenskapligt)
  • 2.
    Aneblom, Gunilla
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Larsson, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Odlind, Viveca
    Tydén, Tanja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Knowledge, use and attitueds towards emergency contraceptive pills among Swedish women presenting for induced abortion2002Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 109, nr 2, s. 155-160Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate the knowledge, experiences and attitudes towards emergency contraceptive pills (ECP) among women presenting for induced abortion. DESIGN: Survey by self-administered waiting room questionnaires. SETTING: Three large hospitals in the cities of Uppsala, Västerås and Orebro in Sweden. POPULATION: 591 Swedish-speaking women consecutively attending the clinics for an induced abortion during a four-month period in 2000. RESULTS: The response rate was 88% (n = 518). As many as 43% had a history of one or more previous abortions and 43% were daily smokers. Four out of five women, 83%, were aware of ECP, but only 15 women used it to prevent this pregnancy. Fewer, 38%, knew the recommended timeframes for use and 54% had knowledge of the mode of action. The two most common sources of information about ECP were media and friends. One out of five, 22%, had previously used the method, and at the time of conception, 55% would have taken ECP if it had been available at home, and 52% were positive to having ECP available over the counter. CONCLUSIONS: Emergency contraception is well known but is still underused. Lack of awareness of pregnancy risk may be one limiting factor for its use. Making ECP available over the counter may be an important measure towards better availability. Information strategies to the public are needed before ECP will be a widely used back-up method.

  • 3.
    Baba, S
    et al.
    Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Stephansson, O
    Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Cnattingius, S
    Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
    Changes in snuff and smoking habits in Swedish pregnant women and risk for small for gestational age births2013Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, nr 4, s. 456-462Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:

    To examine associations between antenatal exposure to Swedish oral moist snuff (which includes essentially only nicotine) and to smoking and risks of small-for-gestational-age (SGA) births and to compare risks among women who stopped or continued using snuff or smoking during pregnancy.

    DESIGN:

    Population-based cohort study.

    SETTING:

    Sweden.

    POPULATION:

    All live singleton births in Sweden 1999-2010.

    METHODS:

    Odds ratios (OR) with 95% confidence intervals (CI) were calculated using multiple logistic regression analysis.

    MAIN OUTCOME MEASURES:

    SGA birth, also stratified into preterm (≤36 weeks of gestation) and term (≥37 weeks of gestation) SGA births.

    RESULTS:

    Compared with non-tobacco users in early pregnancy, snuff users and above all smokers in early pregnancy had increased risks of SGA births: adjusted ORs (95% CI) were 1.26 (1.09-1.46) and 2.55 (2.43-2.67), respectively). Snuff use had, if anything, a stronger association with preterm SGA than term SGA, whereas the opposite was true for smoking. Compared with non-tobacco users, women who stopped using snuff before their first visit to antenatal care had no increased risks of preterm or term SGA, and women who stopped using snuff later during pregnancy had no increased risk of term SGA. Smoking cessation early in pregnancy was associated with a larger reduction in risk than smoking cessation later in pregnancy.

    CONCLUSIONS:

    As both smoking and snuff use influence risk of SGA, both nicotine but above all tobacco combustion products are involved in the mechanisms by which maternal smoking increases the risk of SGA.

  • 4.
    Belachew, Johanna
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Cnattingius, S
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden.
    Mulic-Lutvica, Ajlana
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Eurenius, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Axelsson, Ove
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Risk of retained placenta in women previously delivered by caesarean section: a population-based cohort study.2014Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 121, nr 2, s. 224-229Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To evaluate whether women with a caesarean section at their first delivery have an increased risk of retained placenta at their second delivery.

    DESIGN: Population-based cohort study.

    SETTING: Sweden.

    POPULATION: All women with their first and second singleton deliveries in Sweden during the years 1994-2006 (n = 258 608). Women with caesarean section or placental abruption in their second pregnancy were not included in the study population.

    METHODS: The risk of retained placenta at second delivery was estimated for women with a first delivery by caesarean section (n = 19 458), using women with a first vaginal delivery as reference (n = 239 150). Risks were calculated as odds ratios by unconditional logistic regression analysis with 95% confidence intervals (95%) after adjustments for maternal, delivery, and infant characteristics.

    MAIN OUTCOME MEASURES: Retained placenta with normal (≤1000 ml) and heavy (>1000 ml) bleeding.

    RESULTS: The overall rate of retained placenta was 2.07%. In women with a previous caesarean section and in women with previous vaginal delivery, the corresponding rates were 3.44% and 1.96%, respectively. Compared with women with a previous vaginal delivery, women with a previous caesarean section had an increased risk of retained placenta (adjusted OR 1.45; 95% CI 1.32-1.59), and the association was more pronounced for retained placenta with heavy bleeding (adjusted OR 1.61; 95% CI 1.44-1.79).

    CONCLUSIONS: Our report shows an increased risk for retained placenta in women previously delivered by caesarean section, a finding that should be considered in discussions of mode of delivery.

  • 5.
    Bjelland, E. K.
    et al.
    Akershus Univ Hosp, Obstet & Gynecol, Lørenskog, Norway.
    Hofvind, S.
    Canc Registry Norway, Dept Mammog Screening, Oslo, Norway.
    Byberg, Liisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Eskild, A.
    Akershus Univ Hosp, Obstet & Gynecol, Lørenskog, Norway.
    The relation of age at menarche with age at natural menopause: A population study of 336 788 women in Norway2018Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 125, nr S1, s. 40-40Artikel i tidskrift (Övrigt vetenskapligt)
  • 6.
    Bolin, Marie
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Åkerud, Helena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Cnattingius, Sven
    Stephansson, Olof
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Hyperemesis gravidarum and risks of placental dysfunction disorders: a population-based cohort study2013Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, nr 5, s. 541-547Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To study whether pregnancies complicated by hyperemesis gravidarum in the first (<12weeks) or second (1221weeks) trimester are associated with placental dysfunction disorders. Design Population-based cohort study. Setting Sweden. Population All pregnancies in the Swedish Medical Birth Register estimated to have started on 1 January 1997 or later and ended in a single birth on 31 December 2009 or earlier (n=1156050). Methods Odds ratios with 95% confidence intervals were estimated for placental dysfunction disorders in women with an inpatient diagnosis of hyperemesis gravidarum, using women without inpatient diagnosis of hyperemesis gravidarum as reference. Risks were adjusted for maternal age, parity, body mass index, height, smoking, cohabitation with the infant's father, infant's sex, mother's country of birth, education, presence of hyperthyreosis, pregestational diabetes mellitus, chronic hypertension and year of infant birth. Main outcome measures Placental dysfunction disorders, i.e. pre-eclampsia, placental abruption, stillbirth and small for gestational age (SGA). Results Women with hyperemesis gravidarum in the first trimester had only a slightly increased risk of pre-eclampsia. Women with hyperemesis gravidarum with first admission in the second trimester had a more than doubled risk of preterm (<37weeks) pre-eclampsia, a threefold increased risk of placental abruption and a 39% increased risk of an SGA birth (adjusted odds ratios [95% confidence intervals] were: 2.09 [1.383.16], 3.07 [1.885.00] and 1.39 [1.061.83], respectively). Conclusions There is an association between hyperemesis gravidarum and placental dysfunction disorders, which is especially strong for women with hyperemesis gravidarum in the second trimester.

  • 7.
    Borneskog, Catrin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Sydsjo, G.
    Lampic, C.
    Bladh, M.
    Svanberg, Agneta Skoog
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Symptoms of anxiety and depression in lesbian couples treated with donated sperm: a descriptive study2013Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, nr 7, s. 839-846Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To investigate symptoms of anxiety and depression in lesbian couples undergoing assisted reproductive treatment (ART), and to study the relationship of demographic data, pregnancy outcome and future reproductive plans with symptoms of anxiety and depression. Design Descriptive, a part of the prospective longitudinal Swedish study on gamete donation'. Setting All university clinics in Sweden performing gamete donation. Population A consecutive sample of 214 lesbian couples requesting assisted reproduction, 165 of whom participated. Methods Participants individually completed three study-specific questionnaires and the Hospital Anxiety and Depression Scale (HADS): time point 1 (T1), at commencement of ART; time point 2 (T2), approximately 2months after treatment; and time point 3 (T3), 25years after first treatment. Main outcome measures Anxiety and depression (HADS), pregnancy outcome and future reproductive plans. Results The vast majority of lesbian women undergoing assisted reproduction reported no symptoms of anxiety and depression at the three assessment points. A higher percentage of the treated women, compared with the partners, reported symptoms of anxiety at T2 (14% versus 5%, P=0.011) and T3 (10% versus 4%, P=0.018), as well as symptoms of depression at T2 (4% versus 0%, P=0.03) and T3 (3% versus 0%, P=0.035). The overall pregnancy outcome was high; almost three-quarters of lesbian couples gave birth 25years after sperm donation treatments. Open-ended comments illustrated joy and satisfaction about family building. Conclusion Lesbian women in Sweden reported good psychological health before and after treatment with donated sperm.

  • 8. Bouvier-Colle, M-H
    et al.
    Mohangoo, A D
    Gissler, M
    Novak-Antolic, Z
    Vutuc, C
    Szamotulska, K
    Zeitlin, J
    What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe.2012Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, nr 7, s. 880-9; discussion 890Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity.

    DESIGN: Analysis of aggregate data from routine statistical systems compiled by the EURO-PERISTAT project and comparison with data from national enquiries.

    SETTING: Twenty-five countries in the European Union and Norway.

    POPULATION: Women giving birth in participating countries in 2003 and 2004.

    METHODS: Application of a common collection of data by selecting specific International Classification of Disease codes from the 'Pregnancy, childbirth and the puerperium' chapter. External validity was assessed by reviewing the results of national confidential enquiries and linkage studies.

    MAIN OUTCOME MEASURES: Maternal mortality ratio, with distribution of specific obstetric causes, and severe acute maternal morbidity, which included: eclampsia, surgery and blood transfusion for obstetric haemorrhage, and intensive-care unit admission.

    RESULTS: In 22 countries that provided data, the maternal mortality ratio was 6.3 per 100,000 live births overall and ranged from 0 to 29.6. Under-ascertainment was evident from comparisons with studies that use enhanced identification of deaths. Furthermore, routine cause of death registration systems in countries with specific systems for audit reported higher maternal mortality ratio than those in countries without audits. For severe acute maternal morbidity, 16 countries provided data about at least one category of morbidity, and only three provided data for all categories. Reported values ranged widely (from 0.2 to 1.6 women with eclampsia per 1000 women giving birth and from 0.2 to 1.0 hysterectomies per 1000 women).

    CONCLUSIONS: Currently available data on maternal mortality and morbidity are insufficient for monitoring trends over time in Europe and for comparison between countries. Confidential enquiries into maternal deaths are recommended.

  • 9. Cea-Soriano, L.
    et al.
    Garcia Rodriguez, L. A.
    Machlitt, A.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Use of prescription contraceptive methods in the UK general population: a primary care study2014Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 121, nr 1, s. 53-61Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To determine prescription contraceptive use in the UK.

    Design: Observational study using a primary care database. SettingThe Health Improvement Network (THIN).

    Population: Women in THIN aged 12-49years in 2008, registered with their primary care doctor for at least 5years, and with a prescription history of at least 1year were included.  

    Methods: THIN was searched using the Read and MULTILEX codes for the following methods: combined oral contraceptives (COCs), progestogen-only pills (POPs), copper intrauterine devices (Cu-IUDs), the levonorgestrel-releasing intrauterine system (LNG-IUS), progestogen-only implants, progestogen-only injections, and contraceptive patches.

    Main outcome measures: Prevalence, switching, and duration of prescriptions.

    Results: A cohort of 194054 women was identified. The prevalence of contraceptive use was: COCs, 16.2% (95%confidence interval, 95%CI 16.1-16.3%); POPs, 5.6% (95%CI 5.5-5.6%); Cu-IUD, 4.5% (95%CI 4.4-4.5%); LNG-IUS, 4.2% (95%CI 4.1-4.2%); progestogen-only implants, 1.5% (95%CI 1.5-1.6%); progestogen-only injections, 2.4% (95%CI 2.3-2.4%); and contraceptive patches, 0.1% (95%CI 0.1-0.2%). Within 1year, 9.8% of new COC users switched to alternative COCs, and 9.0% changed to a different method. Among new COC users who did not switch method, 34.8% did not continue use beyond 3months, and were no longer using a prescription contraceptive.

    Conclusions: Among users of oral contraceptives who did not switch method, over one-third did not continue use beyond 3months. This supports current UK guidelines recommending a follow-up consultation with a healthcare professional 3months after the first prescription of COCs.

  • 10.
    Dahlin, S.
    et al.
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden..
    Gunnerbeck, A.
    Karolinska Inst, Dept Womens & Childrens Hlth, Neonatal Res Unit, Stockholm, Sweden.;Karolinska Univ Hosp, Astrid Lindgrens Children Hosp, Stockholm, Sweden..
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden..
    Cnattingius, S.
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden..
    Bonamy, A-K Edstedt
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Unit, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Neonatal Res Unit, Stockholm, Sweden.;Soder Sjukhuset, Sachs Children & Youth Hosp, Stockholm, Sweden..
    Maternal tobacco use and extremely premature birth - a population-based cohort study2016Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 123, nr 12, s. 1938-1946Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To study the associations of maternal tobacco use (smoking or use of snuff) and risk of extremely preterm birth, and if tobacco cessation before antenatal booking influences this risk. To study the association between tobacco use and spontaneous or medically indicated onset of delivery. Design Population-based cohort study. Setting Sweden. Population All live singleton births, registered in the Swedish Medical Birth Register, 1999-2012. Methods Odds ratios (OR) with 95% confidence intervals (CI) were calculated using multiple logistic regression analysis. Main outcome measures Extremely preterm birth (<28 weeks of gestation), very preterm birth (28-31 weeks), moderately preterm birth (32-36 weeks). Results Maternal snuff use (OR 1.58; 95% CI: 1.14-2.21) and smoking (OR 1.61; 95% CI: 1.39-1.87 and OR 1.91; 95% CI: 1.53-2.39 for moderate and heavy smoking, respectively) were associated with an increased risk of extremely preterm birth. When cessation of tobacco use was obtained there was no increased risk of preterm birth. Snuff use was associated with a twofold risk increase of medically indicated extremely preterm birth, whereas smoking was associated with increased risks of both medically indicated and spontaneous extremely preterm birth. Conclusions Snuff use and smoking in pregnancy were associated with increased risks of extremely preterm birth. Women who stopped using tobacco before the antenatal booking had no increased risk. These findings indicate that nicotine, the common substance in cigarettes and snuff, is involved in the mechanisms behind preterm birth. The use of nicotine should be minimized in pregnancy.

  • 11.
    Endler, M.
    et al.
    Karolinska Inst, Dept Clin Sci & Educ, Södersjukhuset, Stockholm, Sweden.
    Cnattingius, S.
    Karolinska Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden.
    Granfors, Michaela
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk obstetrik. Karolinska Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden.
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk obstetrik. Karolinska Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden.
    The inherited risk of retained placenta: a population based cohort study.2018Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 125, nr 6, s. 737-744Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate whether retained placenta in the first generation is associated with an increased risk of retained placenta in the second generation.

    Design: Population‐based cohort study.

    Setting: Sweden.

    Population: Using linked generational data from the Swedish Medical Birth Register 1973–2012, we identified 494 000 second‐generation births with information on the birth of the mother (first‐generation index birth). For 292 897 of these births there was information also on the birth of the father.

    Methods: Risk of retained placenta in the second generation was calculated as adjusted odds ratios (aOR) by unconditional logistic regression with 95% confidence intervals (95% CI) according to whether retained placenta occurred in a first generation birth or not.

    Main outcome: Retained placenta in the second generation.

    Results: The risk of retained placenta in a second‐generation birth was increased if retained placenta had occurred at the mother's own birth (aOR 1.66, 95% CI 1.52–1.82), at the birth of one of her siblings (aOR 1.58, 95% CI 1.43–1.76) or both (aOR 2.75, 95% CI 2.18–3.46). The risk was slightly increased if retained placenta had occurred at the birth of the father (aOR 1.23, 95% CI 1.07–1.41). For preterm births in both generations, the risk of retained placenta in the second generation was increased six‐fold if retained placenta had occurred at the mother's birth (OR 6.55, 95% CI 2.68–16.02).

    Conclusion: There is an intergenerational recurrence of retained placenta on the maternal and most likely also on the paternal side. The recurrence risk seems strongest in preterm pregnancies.

    Tweetable abstract: A population‐based cohort study suggests that there is an intergenerational recurrence of retained placenta.

  • 12. Endler, M.
    et al.
    Saltvedt, S.
    Cnattingius, S.
    Stephansson, O.
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Retained placenta is associated with pre-eclampsia, stillbirth, giving birth to a small-for-gestational-age infant, and spontaneous preterm birth: a national register-based study2014Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 121, nr 12, s. 1462-1470Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ObjectiveTo evaluate whether defective placentation disorders, i.e. pre-eclampsia, stillbirth, small for gestational age (SGA), and spontaneous preterm birth, are associated with risk of retained placenta. DesignPopulation-based cohort study. SettingSweden. PopulationPrimiparous women in Sweden with singleton vaginal deliveries between 1997 and 2009 at 32-41weeks of gestation (n=386607), without placental abruption or infants with congenital malformations. MethodsRisks were calculated as odds ratios (ORs) by unconditional logistic regression with 95% confidence intervals (95%CIs) after adjustments for maternal, delivery, and infant characteristics. Main outcome measureRetained placenta, defined by the presence of both a diagnostic code (of retained placenta) and a procedure code (for the manual removal of the placenta). ResultsThe overall rate of retained placenta was 2.17%. The risk of retained placenta was increased for women with pre-eclampsia (adjusted OR, aOR, 1.37, 95%CI 1.21-1.54), stillbirth (aOR1.71, 95%CI 1.28-2.29), SGA birth (aOR1.47, 95%CI 1.28-1.70), and spontaneous preterm birth (32-34weeks of gestation, aOR2.35, 95%CI 1.97-2.81; 35-36weeks of gestation, aOR1.55, 95%CI 1.37-1.75). The risk was further increased for women with preterm pre-eclampsia (aOR1.69, 95%CI 1.25-2.28) and preterm SGA birth (aOR2.19, 95%CI 1.42-3.38). There was no association between preterm stillbirth (aOR1.10, 95%CI 0.63-1.92) and retained placenta, but the exposed group comprised only 15 cases. ConclusionsDefective placentation disorders are associated with an increased risk of retained placenta. Whether these relationships indicate a common pathophysiology remains to be investigated.

  • 13. Fadl, H.
    et al.
    Magnuson, A.
    Ostlund, I.
    Montgomery, S.
    Hanson, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Schwarcz, E.
    Gestational diabetes mellitus and later cardiovascular disease: a Swedish population based case-control study2014Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 121, nr 12, s. 1530-1536Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ObjectiveTo identify if gestational diabetes mellitus (GDM) is a clinically useful marker of future cardiovascular disease (CVD) risk and if GDM combined with other risks (smoking, hypertension or body mass) identifies high-risk groups. DesignPopulation-based matched case-control study. SettingNational Swedish register data from 1991 to 2008. PopulationA total of 2639 women with a cardiovascular event and matched controls. MethodsConditional logistic regression examined associations with CVD before and after adjustment for conventional risk factors and confounders. Effect modification for the association of GDM with CVD by body mass index (BMI), smoking and chronic hypertension was assessed by stratification and interaction testing. Adjustment for diabetes post-pregnancy evaluated its mediating role. Main outcome measuresInpatient diagnoses or causes of death identifying ischemic heart disease, ischemic stroke, atherosclerosis or peripheral vascular disease. ResultsThe adjusted odds ratios (and 95% confidence intervals) for the association of CVD with GDM are 1.51 (1.07-2.14), 2.23 (2.01-2.48) for smoking, 1.98 (1.71-2.29) for obesity and 5.10 (3.18-8.18) for chronic hypertension. In stratified analysis the association of CVD with GDM was only seen among women with BMI 25, with an odds ratio of 2.39 (1.39-4.10), but only women with a BMI <30 accounted for this increased risk. Adjustment for post-pregnancy diabetes attenuated it somewhat to 1.99 (1.13-3.52). ConclusionsIn the absence of other recognised cardiovascular risk factors, such as smoking, obesity or chronic hypertension, GDM is a useful marker of raised CVD risk among women with BMI between 25 and 29.

  • 14. Fadl, H.
    et al.
    Ostlund, I.
    Nilsson, K.
    Hanson, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Fasting capillary glucose as a screening test for gestational diabetes mellitus2007Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, nr 3, s. 373-373Artikel i tidskrift (Refereegranskat)
  • 15. Fadl, H.
    et al.
    Ostlund, I.
    Nilsson, K.
    Hanson, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Fasting capillary glucose as a screening test for gestational diabetes mellitus: Author's reply2007Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, nr 2, s. 238-239Artikel i tidskrift (Refereegranskat)
  • 16.
    Fonnes, T.
    et al.
    Univ Bergen, Dept Clin Sci, Ctr Canc Biomarkers, CCBIO, Bergen, Norway;Haukeland Hosp, Dept Obstet & Gynaecol, Bergen, Norway.
    Trovik, J.
    Univ Bergen, Dept Clin Sci, Ctr Canc Biomarkers, CCBIO, Bergen, Norway;Haukeland Hosp, Dept Obstet & Gynaecol, Bergen, Norway.
    Edqvist, Per-Henrik D
    Uppsala universitet, Science for Life Laboratory, SciLifeLab. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Experimentell och klinisk onkologi.
    Fasmer, K. E.
    Haukeland Hosp, Dept Radiol, Ctr Nucl Med PET, Bergen, Norway;Haukeland Hosp, Dept Radiol, Bergen, Norway.
    Marcickiewicz, J.
    Univ Gothenburg, Dept Gynaecol, Sahlgrenska Acad, Gothenburg, Sweden;Hallands Hosp Varberg, Dept Obstet & Gynaecol, Varberg, Sweden.
    Tingulstad, S.
    St Olavs Hosp, Dept Gynaecol, Trondheim, Norway.
    Staff, A. C.
    Oslo Univ Hosp, Dept Gynaecol, Oslo, Norway;Univ Oslo, Oslo, Norway.
    Bjorge, L.
    Univ Bergen, Dept Clin Sci, Ctr Canc Biomarkers, CCBIO, Bergen, Norway;Haukeland Hosp, Dept Obstet & Gynaecol, Bergen, Norway.
    Amant, F.
    Katholieke Univ Leuven, Dept Gynaecol Oncol, UZGasthuisberg, Leuven, Belgium;Netherlands Canc Inst, Ctr Gynaecol Oncol, Amsterdam, Netherlands;Acad Med Ctr, Amsterdam, Netherlands.
    Haldorsen, I. S.
    Haukeland Hosp, Dept Radiol, Bergen, Norway;Univ Bergen, Sect Radiol, Dept Clin Med, Bergen, Norway.
    Werner, H. M. J.
    Univ Bergen, Dept Clin Sci, Ctr Canc Biomarkers, CCBIO, Bergen, Norway;Haukeland Hosp, Dept Obstet & Gynaecol, Bergen, Norway.
    Akslen, L. A.
    Univ Bergen, Sect Pathol, Dept Clin Med, Ctr Canc Biomarkers CCBIO, Bergen, Norway;Haukeland Hosp, Dept Pathol, Bergen, Norway.
    Tangen, I. L.
    Univ Bergen, Dept Clin Sci, Ctr Canc Biomarkers, CCBIO, Bergen, Norway;Haukeland Hosp, Dept Obstet & Gynaecol, Bergen, Norway.
    Krakstad, C.
    Univ Bergen, Dept Clin Sci, Ctr Canc Biomarkers, CCBIO, Bergen, Norway;Haukeland Hosp, Dept Obstet & Gynaecol, Bergen, Norway.
    Asparaginase-like protein 1 expression in curettage independently predicts lymph node metastasis in endometrial carcinoma: a multicentre study2018Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 125, nr 13, s. 1695-1703Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Design Correct preoperative identification of high-risk patients is important to optimise surgical treatment and improve survival. We wanted to explore if asparaginase-like protein 1 (ASRGL1) expression in curettage could predict lymph node metastases and poor outcome, potentially improving preoperative risk stratification. Multicentre study. Setting Population Ten hospitals in Norway, Sweden and Belgium. Women diagnosed with endometrial carcinoma. Methods Main outcome measures ASRGL1 expression in curettage specimens from 1144 women was determined by immunohistochemistry. ASRGL1 status related to disease-specific survival, lymph node status, preoperative imaging parameters and clinicopathological data. Results Conclusions ASRGL1 expression had independent prognostic value in multivariate survival analyses, both in the whole patient population (hazard ratio (HR) 1.63, 95% CI 1.11-2.37, P = 0.012) and in the low-risk curettage histology subgroup (HR 2.54, 95% CI 1.44-4.47, P = 0.001). Lymph node metastases were more frequent in women with low expression of ASRGL1 compared with women with high ASRGL1 levels (23% versus 10%, P < 0.001), and low ASRGL1 level was found to independently predict lymph node metastases (odds ratio 2.07, 95% CI 1.27-3.38, P = 0.003). Low expression of ASRGL1 in curettage independently predicts lymph node metastases and poor disease-specific survival.

  • 17. Gambadauro, Pietro
    et al.
    Magos, Adam
    Watching the screen during hysteroscopy: a patient choice2009Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 116, nr 7, s. 1006-7Artikel i tidskrift (Refereegranskat)
  • 18. Gissler, M
    et al.
    Fronteira, I
    Jahn, A
    Karro, H
    Moreau, C
    Oliveira da Silva, M
    Olsen, J
    Savona-Ventura, C
    Temmerman, M
    Hemminki, E
    Terminations of pregnancy in the European Union.2012Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, nr 3, s. 324-32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study the current legislation and trends in terminations of pregnancy in the European Union (EU).

    DESIGN: Data were collected on legislation and statistics for terminations of pregnancy.

    SETTING: Population-based statistics from the EU member states.

    POPULATION: Women in reproductive age in the 27 EU member states.

    METHODS: Information on legislation was collected for all 27 EU member states. Statistical information until 2008 was compiled from international (n = 24) and national sources (n = 17). Statistical data were not available for Austria, Cyprus and Luxembourg.

    MAIN OUTCOMES MEASURES: Terminations of pregnancy per 1000 women aged 15-49 years.

    RESULTS: Ireland, Malta and Poland have restrictive legislation. Luxembourg permits termination of pregnancy on physical and mental health indications; Cyprus, Finland, and the UK further include socio-economic indications. In all other EU member states termination of pregnancy can be performed in early pregnancy on a women's request. In general, the rates of termination of pregnancy have declined in recent years. In total, 10.3 terminations were reported per 1000 women aged 15-49 years in the EU in 2008. The rate was 12.3/1000 for countries requiring a legal indication for termination, and 11.0/1000 for countries allowing termination on request. Northern Europe (10.9/1000) and Central and Eastern Europe (10.8/1000) had higher rates than Southern Europe (8.9/1000). Northern Europe, however, had substantially higher rates of termination of pregnancy among teenagers.

    CONCLUSION: A more consistent and coherent reporting of terminations of pregnancy is needed in the EU. The large variation of termination rates between countries suggests that termination of pregnancy rates may be reduced in some countries without restricting women's access to termination. Sexual education and provision of access to reliable and affordable contraception are essential to achieve low rates of termination of pregnancy.

  • 19. Hellerstedt, W. L.
    et al.
    Phelan, S. M.
    Cnattingius, S.
    Hultman, C. M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Harlow, B. L.
    Are prenatal, obstetric, and infant complications associated with postpartum psychosis among women with pre-conception psychiatric hospitalisations?2013Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, nr 4, s. 446-455Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To examine the associations of maternal and infant complications with postpartum hospitalisation for psychosis in women with a pre-conception history of psychiatric hospitalisation. Design Population-based study. Setting Swedish medical birth register. Population Primiparous women who gave birth between 1January1987 and 31December2001, and who had a pre-conception history of psychiatric hospitalisation but who were not hospitalised during pregnancy (n=1842). Methods International Classification of Diseases (ICD) codes were used to identify prenatal, obstetric, postpartum maternal complications, and newborn health conditions. We used multivariable logistic regression to describe the associations between maternal and infant health conditions and the odds for postpartum hospitalisation for psychosis. Main outcome measure Psychiatric hospitalisation within 90days of delivery. Results Compared with women who did not have a postpartum psychiatric hospitalisation, hospitalised women were at 2.3 times higher odds (95%CI 1.04.9) of having non-psychiatric puerperium complications (e.g. infection, lactation problems or venous complications). No other maternal complications were associated with postpartum psychiatric hospitalisation. Although their infants were at no higher odds for health complications, the offspring of women who had a postpartum psychiatric hospitalisation were at 4.1 times higher odds (95%CI 1.312.6) of death within the first 365days of life than those of women who were not hospitalised. Conclusions We found no prenatal indicators of postpartum risk for psychiatric hospitalisation among high-risk women, but they had higher odds of postpartum pregnancy-related medical problems and, rarely, offspring death.

  • 20.
    Hesselman, Susanne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk obstetrik. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Authors' reply re: Abdominal adhesions in gynaecologic surgery after caesarean section: a longitudinal populationbased register study2018Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 125, nr 5, s. 631-631Artikel i tidskrift (Övrigt vetenskapligt)
  • 21.
    Hesselman, Susanne
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Högberg, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Ekholm Selling, Katarina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Råssjö, E-B
    Center for Clinical Research, Dalarna, Falun, Sweden.
    Jonsson, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    The risk of uterine rupture is not increased with single- compared with double-layer closure: a Swedish cohort study2015Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 122, nr 11, s. 1535-1541Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:

    To compare single- with double-layer closure of the uterus for the risk of uterine rupture in women attempting vaginal birth after one prior caesarean delivery.

    DESIGN:

    Cohort study.

    SETTING:

    Sweden.

    POPULATION:

    From a total of 19 604 nulliparous women delivered by caesarean section in the years 2001-2007, 7683 women attempting vaginal birth in their second delivery were analysed.

    METHODS:

    Data from population-based registers were linked to hospital-based registers that held data from maternity and delivery records. Logistic regression was used to estimate the risk of uterine rupture after single- or double-layer closure of the uterus. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).

    MAIN OUTCOME MEASURE:

    Uterine rupture.

    RESULTS:

    Uterine rupture during labour occurred in 103 (1.3%) women. There was no increased risk of uterine rupture when single- was compared with double-layer closure of the uterus (OR 1.17; 95% CI 0.78-1.76). Maternal factors associated with uterine rupture were: age ≥35 years and height ≤160 cm. Factors from the first delivery associated with uterine rupture in a subsequent delivery were: infection and giving birth to an infant large for gestational age. Risk factors from the second delivery were induction of labour, use of epidural analgesia, and a birthweight of ≥4500 g.

    CONCLUSIONS:

    There was no significant difference in the rate of uterine rupture when single-layer closure was compared with double -layer closure of the uterus.

  • 22.
    Hesselman, Susanne
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk obstetrik.
    Högberg, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Råssjö, E-B
    Schytt, E
    Löfgren, M
    Jonsson, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk obstetrik.
    Abdominal adhesions in gynaecologic surgery after caesarean section: a longitudinal population-based register study.2018Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 125, nr 5, s. 597-603Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

    DESIGN: Longitudinal population-based register study.

    SETTING: Sweden.

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

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

    MAIN OUTCOME MEASURES: Adhesions.

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

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

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

  • 23.
    Hesselman, Susanne
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk obstetrik. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Ctr Clin Res, Falun, Sweden.
    Högberg, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Råssjö, Eva-Britta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Shytt, Erica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Jonsson, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk obstetrik.
    Prevalence and risk factors of abdominal adhesions after caesarean section2017Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, nr S1, s. 108-108Artikel i tidskrift (Övrigt vetenskapligt)
  • 24.
    Hildingsson, Ingegerd
    et al.
    Department of Nursing, Karolinska Institute, Stockholm, Sweden.
    Rådestad, Ingela
    Rubertsson, Christine
    Department of Nursing, Karolinska Institute, Stockholm, Sweden.
    Waldenström, Ulla
    Few women wish to be delivered by caesarean section2002Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 109, nr 6, s. 618-623Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective

    To investigate how many women wish to have a caesarean section when asked in early pregnancy, and to identify background variables associated with such a wish.

    Design

    National survey.

    Setting

    Swedish antenatal clinics.

    Population

    3283 Swedish-speaking women booked for antenatal care, at approximately 600 Swedish antenatal clinics, during three weeks spread over one year (1999–2000).

    Methods

    A questionnaire was mailed shortly after the first antenatal visit.

    Main outcome measures

    Women's preferences for mode of delivery.

    Results

    3061 women completed the first questionnaire, corresponding to 94% of those who consented to participate after exclusion of reported miscarriages. The background characteristics of the study sample were very similar to a one-year cohort of women giving birth in Sweden during 1999. The result showed that 8.2% of the women would prefer to have a caesarean section. A wish for caesarean section was associated with parity, age, civil status, residential area and obstetric history. Women preferring caesarean section were more depressed and worried, not only about giving birth, but also about other things in life. A multivariate logistic regression model showed three factors being statistically associated with a wish for caesarean section: a previous caesarean section, fear of giving birth and a previous negative birth experience.

    Conclusions

    Relatively few women wish to have a caesarean section when asked in early pregnancy, and these women seem to be a vulnerable group.

  • 25. Johansson, M.
    et al.
    Radestad, I.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Karlstrom, A.
    Hildingsson, Ingegerd
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Few fathers-to-be prefer caesarean section for the birth of their baby2010Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, nr 6, s. 761-764Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The objective of this study was to investigate prospective fathers' preferences for caesarean section and associated factors. Data were collected by means of a questionnaire given in mid-pregnancy to 1105 fathers-to-be in northern Sweden. In total, 6.4% of fathers preferred a caesarean section. The factors associated with a preference for caesarean section were a wish to plan the date of the baby's birth [prevalence ratio (PR) 6.0], a previous negative birth experience (PR 8.6) and previous experience of a caesarean section (PR 5.7).

  • 26.
    Jonsson, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Metabolic acidosis at birth and suboptimal care - illustration of the gap between knowledge and clinical practice: author's reply2010Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, nr 5, s. 633-634Artikel i tidskrift (Refereegranskat)
  • 27.
    Jonsson, Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    The role of bacterial vaginosis, aerobic vaginitis, abnormal vaginal flora and the risk of preterm birth2010Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, nr 1, s. 119-119Artikel i tidskrift (Refereegranskat)
  • 28.
    Jonsson, Maria
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Hanson, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Lidell, C.
    Nordén-Lindeberg, Solveig
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    ST depression at caesarean section and the relation to oxytocin dose: a randomised controlled trial : authors' reply2010Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, nr 9, s. 1165-1166Artikel i tidskrift (Refereegranskat)
  • 29.
    Kamala, B.
    et al.
    Univ Stavanger, Dept Hlth Sci, Stavanger, Norway;Muhimbili Natl Hosp, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania.
    Mgaya, Andrew
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Muhimbili Natl Hosp, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania.
    Ngarina, M.
    Muhimbili Natl Hosp, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania.
    Kidanto, Hussein L.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Muhimbili Natl Hosp, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania.
    Predictors of low birthweight and 24-hour survival rate at Muhimbili National Hospital in Dar es Salaam: A 5-year retrospective analysis of obstetric records2017Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, s. 20-20Artikel i tidskrift (Övrigt vetenskapligt)
  • 30.
    Karlström, A
    et al.
    Department of Health Science, Mid Sweden University, Sundsvall, Sweden.
    Lindgren, H
    Institute of Health and Care Sciences, Sahlgrenska Academy at the Gothenburg, Sweden.
    Hildingsson, Ingegerd
    Department of Health Science, Mid Sweden University, Sundsvall, Sweden.
    Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case-control study.2013Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, nr 4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To compare maternal complications and infant outcomes for women undergoing elective caesarean sections based on a maternal request and without recorded medical indication with those of women who underwent spontaneous onset of labour with the intention to have a vaginal birth.

    DESIGN: Retrospective register study.

    SETTING: Sweden; Medical Birth Register used for data collection.

    METHODS: A case-control study of 5877 birth records of women undergoing caesarean sections without medical indication and a control group of 13 774 women undergoing births through spontaneous onset of labour. The control group was further divided into women who actually had a vaginal birth and women who ended up with an emergency caesarean section.

    RESULTS: Maternal complications occurred more frequently among women undergoing caesarean section with odds ratios (OR) for bleeding complications of 2.5 (95% CI 2.1-3.0) in the elective caesarean group and 2.0 (95% CI 1.5-2.6) in the emergency caesarean group. The OR for infections was 2.6 in both groups. Breastfeeding complications were most common in women having an elective caesarean section: 6.8 (95% CI 3.2-14.5). Infant outcomes showed a higher incidence of respiratory distress with an OR of 2.7 (95% CI 1.8-3.9) in the elective caesarean section group compared with infants born by emergency caesarean section. The risk of hypoglycaemia was at least twice as high for infants in the caesarean group.

    CONCLUSIONS: Caesarean sections without medical indication as well as emergency caesarean sections were associated with higher risks for maternal and infant morbidity.

  • 31.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Author response to: Reference values for clinical chemistry tests during normal pregnancy2008Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 115, nr 13, s. 1716-1717Artikel i tidskrift (Refereegranskat)
  • 32.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Reference values for clinical chemistry tests during normal pregnancy. Author reply.2008Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 115, nr 13, s. 1716-1717Artikel i tidskrift (Refereegranskat)
  • 33.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Reference values for clinical chemistry tests during normal pregnancy: Author's reply2008Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 115, nr 12, s. 1580-1581Artikel i tidskrift (Refereegranskat)
  • 34.
    Larsson, Anders
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Palm, M
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Hansson, L-O
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Axelsson, O
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Reference values for clinical chemistry tests during normal pregnancy2008Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 115, nr 7, s. 874-881Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Reference values are usually defined based on blood samples from healthy men or nonpregnant women. This is not optimal as many biological markers changes during pregnancy and adequate reference values are of importance for correct clinical decisions. There are only few studies on the variations of laboratory tests during normal pregnancies, especially during the first two trimesters. It is thus a need to establish such reference values. DESIGN: Longitudinal study of laboratory markers in normal pregnancies. SETTING: Uppsala University Hospital, Sweden. POPULATION: Healthy pregnant females. METHODS: We have studied 25 frequently used laboratory tests during 52 normal pregnancies. Each woman was sampled up to nine times and the samples were divided according to collection time into the following groups: gestational week 7-17; week 17-24; week 24- 28; week 28-31; week 31-34; week 34-38; predelivery (0-2 weeks before delivery) and postpartum (> 6 weeks after delivery). The 2.5 and 97.5 percentiles for these markers were calculated according to the recommendations of the International Federation of Clinical Chemistry on the statistical treatment of reference values. RESULTS: Reference intervals are reported for plasma alanine aminotransferase, albumin, alkaline phosphatase, pancreas amylase, apolipoprotein A1, apolipoprotein B, aspartate aminotransferase, bilirubin, calcium, chloride, creatinine, cystatin C, ferritin, gamma-glutamyltransferase, iron, lactate dehydrogenase, magnesium, phosphate, potassium, sodium, transferrin, triglycerides, thyroid-stimulating hormone, urate and urea during these pregnancy periods. CONCLUSIONS: Most of the analytes change during normal pregnancy. It is thus of importance to use special reference values during pregnancy.

  • 35. Lindell, Monica
    et al.
    Sanner, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Wikström, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Wilander, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi, Molekylär och morfologisk patologi.
    Self-sampling of vaginal fluid and high-risk human papillomavirus testing in women aged 50 years or older not attending Papanicolaou smear screening2012Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, nr 2, s. 245-248Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Please cite this paper as: Lindell M, Sanner K, Wikström I, Wilander E. Self-sampling of vaginal fluid and high-risk human papillomavirus testing in women aged 50 years or older not attending Papanicolaou smear screening. BJOG 2012;119:245-248.

    Objectives 

    To study the value of self-sampling of vaginal fluid at home in combination with high-risk human papillomavirus (HPV) testing in a cohort of older women not attending Papanicolaou (Pap) smear screening.

    Design 

    Women (n = 3618), aged 50-65 years, who had not attended screening for at least 6 years were offered self-sampling of vaginal fluid at home (study cohort). The collected material was analysed for the presence of high-risk HPV (using Hybrid capture 2; Hc2). Women with a positive HPV test were referred for colposcopy. These results were compared with the results of Pap smear screening in a corresponding age group of women (controls). The end point of the study was identification of a histological cervical intraepithelial neoplasia stage 2 (CIN2) and above (CIN2+).

    Results 

    In all, 39.4% (n = 1426) women participated and 4.6% (n = 66) were high-risk HPV positive. Of the HPV-positive women 56 chose to attend a surgery (84.8%) after a mean time of 2.1 months and ten of these women (17.9%) showed CIN2+, corresponding to 0.70% of all participating women. In the controls, who participated in organised Pap smear screening, the prevalence of CIN2+ was 0.25% (15/6048). The odds ratio for identification of CIN2+ in women aged 50 years or older performing self-sampling and HPV test in comparison with Pap smear was: 2.84 (95% CI 1.14-6.77, P = 0.0174). In older women primary high-risk HPV testing (Hc2) and Pap smear screening showed equal specificity of around 96%.

    Conclusions

    Self-sampling of vaginal fluid in combination with high-risk HPV testing appears to be an attractive method to improve screening coverage and decrease the prevalence of cervical cancer in women aged 50 years or older.

  • 36.
    Lindgren, Peter
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Cederholm, Maria
    Haglund, Bengt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Axelsson, Ove
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Invasive procedures for fetal karyotyping: no cause of subsequent gestational hypertension or pre-eclampsia2010Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, nr 11, s. 1422-1425Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to estimate the risk of maternal hypertensive complications following first- or second-trimester invasive diagnostic procedures, i.e. chorionic villus sampling (CVS) and amniocentesis (AC). Odds ratios (ORs) for gestational hypertension, mild pre-eclampsia or severe pre-eclampsia were calculated for women who underwent CVS (n = 1 984) or AC (n = 21 748) compared with non-exposed women (n = 47 854). No increase in the development of gestational hypertension, mild pre-eclampsia or severe pre-eclampsia was observed. The results do not support an association between invasive procedures for fetal karyotyping and subsequent gestational hypertension or pre-eclampsia.

  • 37.
    Lovvik, T. S.
    et al.
    Norwegian Univ Sci & Technol, Inst Lab Med Childrens & Womens Hlth, N-7034 Trondheim, Norway.;St Olavs Hosp, Dept Obstet & Gynaecol, N-7006 Trondheim, Norway..
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Karolinska Inst, Clin Epidemiol Unit, Dept Med, Stockholm, Sweden..
    Neovius, M.
    Karolinska Inst, Clin Epidemiol Unit, Dept Med, Stockholm, Sweden..
    Stephansson, O.
    Karolinska Inst, Clin Epidemiol Unit, Dept Med, Stockholm, Sweden.;Karolinska Inst, Div Obstet & Gynaecol, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Roos, N.
    Karolinska Inst, Clin Epidemiol Unit, Dept Med, Stockholm, Sweden.;Karolinska Inst, Div Obstet & Gynaecol, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Vanky, E.
    Norwegian Univ Sci & Technol, Inst Lab Med Childrens & Womens Hlth, N-7034 Trondheim, Norway.;St Olavs Hosp, Dept Obstet & Gynaecol, N-7006 Trondheim, Norway..
    Pregnancy and perinatal outcomes in women with polycystic ovary syndrome and twin births: a population-based cohort study2015Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 122, nr 10, s. 1295-1302Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective:To investigate pregnancy and perinatal outcomes in twin births among women with and without polycystic ovary syndrome (PCOS) diagnosis. Design: Population-based cohort study. Setting: Sweden. Population: We identified 20965 women with twin births between 1995 and 2009 of whom 226 had a PCOS diagnosis through linkage between the Swedish Medical Birth Register and the Swedish National Patient Register. Methods: Calculating risk ratios (RR) with 95% confidence intervals (CI) using a log-binomial regression model and hazard ratios (HR) with 95% CI for preterm birth. Main outcome measures: Preterm birth, low birthweight, caesarean section, pre-eclampsia, Apgar score <7 at 5minutes and perinatal mortality. Results: PCOS diagnosis in twin pregnancy was associated with increased risk of preterm delivery (51% versus 43%, RR 1.18 [95% CI 1.03-1.37]), particularly spontaneous preterm delivery (37% versus 28%; RR 1.30 [95% CI 1.09-1.55]) and very preterm birth (<32weeks) (14% versus 8%, RR 1.62 [95% CI 1.10-2.37]). Twins of PCOS mothers had more often low birthweight (48% versus 39%, adjusted RR 1.40 [95% CI 1.09-1.80]). This difference disappeared when adjusting for gestational age. No risk difference was found for caesarean section, pre-eclampsia, low 5-minute Apgar score or perinatal mortality. Conclusions: The risk of preterm delivery in twin pregnancies is increased by having a PCOS diagnosis. This should be considered in risk estimation and antenatal follow-up of twin pregnancies.

  • 38.
    Majoko, Franz
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Munjanja, Stephen
    Nyström, Lennarth
    Mason, Elizabeth
    Lindmark, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Randomised controlled trial of two antenatal care models in rural Zimbabwe2007Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, nr 7, s. 802-811Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To compare a five-visit antenatal care (ANC) model with specified goals with the standard model in a rural area in Zimbabwe. Design Cluster randomised controlled trial with the clinic as the randomisation unit. Setting Primary care setting in a developing country where care was provided by nurse-midwives. Population Women booking for ANC in the clinics were eligible. Main outcome measures Number of antenatal visits, antepartum and intrapartum referrals, utilization of health centre for delivery and perinatal outcomes. Methods Twenty-three rural health centres were stratified prior to random allocation to the new (n= 11) or standard (n= 12) model of care. Results We recruited 13 517 women (new, n= 6897 and standard, n= 6620) in the study, and 78% (10 572) of their pregnancy records were retrieved. There was no difference in median maternal age, parity and gestational age at booking between women in the standard model and those in the new model. The median number of visits was four for both models. The proportion of women with five or less visits was 77% in the new and 69% in the standard model (OR 1.5; 95% CI 1.08-2.2). The likelihood of haemoglobin testing was higher in the new model (OR 2.4; 95% CI 1.0-5.7) but unchanged for syphilis testing. There were fewer intrapartum transfers (5.4 versus 7.9% [OR 0.66; 95% CI 0.44-0.98]) in the new model but no difference in antepartum or postpartum transfers. There was no difference in rates of preterm delivery or low birthweight. The perinatal mortality was 25/1000 in standard model and 28/1000 in new model. Conclusion In Gutu district, a focused five-visit schedule did not change the number of contacts but was more effective as expressed by increased adherence to procedures and better use of institutional health care.

  • 39.
    Misaeli, C.
    et al.
    Muhimbili Univ Hlth & Allied Sci, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania.
    Mgaya, Andrew
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Muhimbili Natl Hosp, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania.
    Kamala, B.
    Muhimbili Natl Hosp, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania;Univ Stavanger, Dept Hlth Sci, Stavanger, Norway.
    Kidanto, H.
    Muhimbili Natl Hosp, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania;Minist Hlth Community Dev Gender Elders & Childre, Reprod Maternal & Child Hlth, Dar Es Salaam, Tanzania.
    Factors associated with women's intention of requesting caesarean delivery in Dar es Salaam, Tanzania2017Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, s. 126-126Artikel i tidskrift (Övrigt vetenskapligt)
  • 40.
    Mocumbi, Sibone
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Univ Eduardo Mondlane, Fac Med, Maputo, Mozambique.
    Boene, H.
    Manhica Hlth Res Ctr CISM, Manhica, Mozambique.
    Munguambe, K.
    Univ Eduardo Mondlane, Fac Med, Maputo, Mozambique; Manhica Hlth Res Ctr CISM, Manhica, Mozambique.
    Högberg, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden..
    Hanson, C.
    Karolinska Inst, Dept Publ Hlth, Stockholm, Sweden.
    Bergström, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Sevene, E.
    Univ Eduardo Mondlane, Fac Med, Maputo, Mozambique; Manhica Hlth Res Ctr CISM, Manhica, Mozambique.
    Obstetric fistulae in southern Mozambique, incidence, risk factors and obstacles for care2017Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, nr S1, s. 49-49Artikel i tidskrift (Övrigt vetenskapligt)
  • 41. Persson, M.
    et al.
    Pasupathy, D.
    Hanson, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Norman, M.
    Disproportionate body composition and perinatal outcome in large-for-gestational-age infants to mothers with type 1 diabetes2012Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, nr 5, s. 565-572Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To determine if disproportionate body composition is a risk factor for perinatal complications in large-for-gestational-age infants born to mothers with type 1 diabetes. Design Population-based cohort study. Setting Data from the Swedish Medical Birth Registry from 1998 to 2007. Population National cohort of 3517 infants born to mothers with type 1 diabetes. Only singletons with gestational age 32-43 weeks were included. Methods Large for gestational age (LGA) was defined as birthweight > 90th centile and appropriate for gestational age (AGA) as birthweight between 10th and 90th centiles. Disproportionate (D) infants were defined as having a ponderal index [PI: calculated as birthweight in grams/(length in cm) 3 > 90th centile] and proportionate (P) as PI <= 90th centile. LGA infants were classified as P-LGA or D-LGA. Odds ratios were calculated for D-LGA and P-LGA infants, with AGA infants as the reference category. Odds ratios were adjusted for mode of delivery, fetal distress and stratified by gestational age. Main outcome measures The primary outcome was a composite of neonatal morbidities, i. e. any of the following diagnoses: Apgar score < 7 at 5 minutes, birth trauma (Erb's palsy or clavicle fracture), respiratory disorder, hyperbilirubinaemia or hypoglycaemia requiring treatment. Results Composite morbidity was significantly more frequent in LGA as opposed to AGA infants, but there was no difference in risk between P-LGA and D-LGA infants. Conclusions High birthweight, irrespective of body proportionality, is a risk factor for neonatal complications in offspring of women with type 1 diabetes.

  • 42.
    Persson, P.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Brynhildsen, J.
    Kjolhede, P.
    A 1-year follow up of psychological wellbeing after subtotal and total hysterectomy-a randomised study2010Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, nr 4, s. 479-487Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To compare subtotal abdominal hysterectomy (SH) and total abdominal hysterectomy (TH) regarding influence on postoperative psychological wellbeing and surgical outcome measurements. Design A prospective, open, randomised multicentre trial. Setting Seven hospitals and one private clinic in the south-east of Sweden. Population Two-hundred women scheduled for abdominal hysterectomy for benign conditions were enrolled in the study; 179 women completed the study (94 SH and 85 TH). Methods Four different psychometric tests were used to measure general wellbeing, depression and anxiety preoperatively, and at 6 and 12 months postoperatively. Statistical analysis of variance and covariance were used. Main outcome measures Effects of operating method on psychological wellbeing postoperatively. Analysis of demographic, clinical and surgical data, including peri-and postoperative complications and complaints at follow up. Results No significant differences were observed between the two groups in any of the psychometric tests. Both surgical methods were associated with a significantly higher degree of psychological wellbeing at 6 and 12 months postoperatively, compared with preoperatively. No significant differences were found in the clinical measures including complications. A substantial number of women experienced persistent cyclic vaginal bleedings after SH. Neither minor or major postoperative complications, nor serum concentration of sex hormones, were associated with general psychological wellbeing 12 months after the operation. Conclusions General psychological wellbeing is equally improved after both SH and TH within 12 months of the operation, and does not seem to be associated with the occurrence of peroperative complications or serum concentration of sex hormones.

  • 43.
    Persson, P.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Brynhildsen, J.
    Kjolhede, P.
    Short-term recovery after subtotal and total abdominal hysterectomy-a randomised clinical trial2010Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, nr 4, s. 469-478Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To determine whether the day-by-day postoperative recovery differs between women undergoing subtotal and total abdominal hysterectomy, and to analyse factors associated with postoperative recovery and sick leave. Design A prospective, open, randomised multicentre trial. Setting Seven hospitals and one private clinic in the south-east of Sweden. Population Two-hundred women scheduled for hysterectomy for benign conditions were enrolled in the study, and 178 women completed the study. Ninety-four women were randomised to subtotal abdominal hysterectomy; 84 women were randomised to total abdominal hysterectomy. Methods The day-by-day recovery of general wellbeing was measured on a visual analogue scale in a diary 7 days preoperatively and 35 days postoperatively. Psychometric measurements included depression, anxiety and general psychological wellbeing. Main outcome measures Effects of operating method and preoperative wellbeing on the day-by-day recovery and duration of sick leave. Results No significant difference was found in the day-by-day recovery between operating methods. The day-by-day recovery of general wellbeing and duration of sick leave was strongly associated with the occurrence of minor complications, but not with major complications. The level of psychological wellbeing preoperatively was strongly associated with the day-by-day recovery of general wellbeing and duration of sick leave. Conclusions Day-by-day recovery of general wellbeing is no faster in subtotal versus total abdominal hysterectomy. Independent of operation method there is an interaction between preoperative psychological wellbeing, postoperative recovery of general wellbeing and the duration of sick leave. Postoperative complications and preoperative psychological wellbeing are strong determinants for the duration of sick leave. There is a need for intervention studies with a focus on complications and preoperative wellbeing.

  • 44.
    Persson, Pär
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Brynhildsen, J.
    Kjolhede, P.
    Pelvic organ prolapse after subtotal and total hysterectomy: a long-term follow-up of an open randomised controlled multicentre study2013Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, nr 12, s. 1556-1565Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ObjectiveTo analyse the development of pelvic organ prolapse (POP) after subtotal (SH) and total hysterectomy (TH) in the long-term, and to assess patient-reported symptoms regarding pelvic floor dysfunction (PFD). DesignLong-term follow-up study of a randomised controlled multicentre study. SettingSeven hospitals and one private clinic in the south-east of Sweden. PopulationOf the 184 women who were eligible from the original trial, 151 (82%) responded to a postal questionnaire and 128 (70%) were clinically examined. MethodsPostal questionnaire using the short-form version of the Pelvic Floor Distress Inventory (PFDI-20) and clinical examination using the POP-Q system. Multivariate analyses were used. Main outcome measuresPOP-Q measurements and symptoms of PFD. ResultsFollow-up time was a median of 11.3years. Less than 3% had stage-3 prolapse. No significant difference was found in the presence of stage-2 or higher stage prolapse between the two hysterectomy groups (39% in SH versus 37% in TH; OR 1.28, 95%CI 0.59-2.80). Nor was there any significant difference in the quality-of-life measurement between the SH and TH groups [summary score PFDI-20: median 93 (range 60-201) versus 87 (range 60-186); Fisher's protected least significant difference post hoc test, P=0.78 ). None of the symptoms of PFD revealed statistically significant differences between the hysterectomy groups. ConclusionsThis long-term follow-up study of PFD showed basically no significant differences in subjective or objective measurements of POP, or in specific pelvic floor quality-of-life aspects after SH and TH. However, because of the low statistical power the results are inconclusive. Larger trials, and probably also a longer follow-up period, are necessary.

  • 45.
    Persson, Pär
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Wijma, K.
    Hammar, M.
    Kjolhede, P.
    Psychological wellbeing after laparoscopic and abdominal hysterectomy - a randomised controlled multicentre study2006Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 113, nr 9, s. 1023-1030Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To compare laparoscopic hysterectomy and abdominal total hysterectomy regarding influence on postoperative psychological wellbeing and surgical measures. Design A prospective, open, randomised multicentre trial. Setting Five hospitals in the South East of Sweden. Population Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study, and 119 women completed the study. Fifty-six women were randomised to abdominal hysterectomy and 63 to laparoscopic hysterectomy. Methods Psychometric tests measuring general wellbeing, depression and anxiety preoperatively and 5 weeks and 6 months postoperatively. Main outcome measure Effects of operating method on the psychological wellbeing postoperatively. Analysis of data regarding operating time, peroperative and postoperative complications, blood loss, hospital stay and recovery time. Results No significant differences in the scores were observed between the two groups in any of the four psychometric tests. Both the surgical methods were associated with a significantly higher degree of psychological wellbeing 5 weeks postoperatively compared with preoperatively. The operating time was significantly longer for the laparoscopic hysterectomy group, but the duration of the stay in hospital and sick-leave were significantly shorter for laparoscopic hysterectomy group compared with the abdominal hysterectomy group. Conclusions General psychological wellbeing is equal after laparoscopic and abdominal hysterectomy within 6 months after the operation. The advantages of the laparoscopic hysterectomy are the shorter stay in hospital and shorter sick-leave, but these issues must be balanced by a longer duration of the operation.

  • 46. Petridou, E
    et al.
    Salvanos, H
    Skalkidou, A
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Dessypris, N
    Moustaki, M
    Trichopoulos, D
    Are there common triggers of preterm deliveries?2001Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 108, nr 6, s. 598-604Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To assess the effect(s) of transient events which are perceived as stressful on the inseption of preterm delivery.

    DESIGN: A case-control study, with immature infants as cases and borderline term babies as controls.

    SETTING: A teaching maternity hospital in Athens.

    POPULATION: All infants born at less than 37 weeks of gestation, during a twelve-month period.

    METHODS: Information was collected about maternal socio-demographic and lifestyle characteristics, clinical variables and stressful events occurring within two weeks prior to delivery.

    MAIN OUTCOME MEASURES: Factors affecting the risk of preterm delivery.

    RESULTS: Extreme prematurity (<33 weeks) is more common among younger (<25 years of age) and older (>29 years of age) women and is positively associated with parity, body mass index and smoking, whereas it is inversely associated with educational level, regular physical exercise and serious nausea/vomiting. After controlling for these factors, however, only coitus during the last weeks of pregnancy had a significant triggering effect on prematurity (P = 0.004, odds ratio 3.21, 95% CI 1.45 to 7.09 for very immature babies, and P = 0.04, OR = 2.20, 95% CI 1.03 to 4.70 for immature babies). On the contrary, several events perceived as stressful, such as illness of relatives or friends, husband's departure, loss of employment, were unrelated to the onset of premature labour.

    CONCLUSIONS: Coitus during the last few weeks of pregnancy appears to increase the risk of preterm delivery, while a possible detrimental effect of physical exertion seems more limited. Stressful events should not receive undue attention as possible causes of preterm delivery.

  • 47. Prathapan, R.
    et al.
    Prathapan, S.
    Lindmark, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Fonseka, P.
    Lokubalasooriya, A.
    Quality of detection of pregnancy induced hypertension to reduce maternal mortality to one digit in Sri Lanka2012Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, s. 4-5Artikel i tidskrift (Övrigt vetenskapligt)
  • 48.
    Rapp, H
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Ledin Eriksson, S
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Smith, P
    Superior hypogastric plexus block as a new method of pain relief after abdominal hysterectomy: double-blind, randomised clinical trial of efficacy.2017Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, nr 2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To determine whether superior hypogastric plexus block performed during abdominal hysterectomy decreases postoperative opioid consumption and pain.

    DESIGN: A randomised, double-blind, placebo-controlled, clinical trial.

    SETTING: A county hospital in Sweden.

    POPULATION: Sixty-eight women scheduled for total abdominal hysterectomy for a benign indication.

    METHODS: Twenty ml of ropivacaine 7.5 mg/ml or saline was injected retroperitoneally in the area of the superior hypogastric plexus during the hysterectomy. The participants were individually randomised to either intervention. The participants, caregivers, and those assessing the outcomes were blinded to group assignment.

    MAIN OUTCOME MEASURES: The primary outcomes were postoperative opiate consumption and patients' self-assessment of pain (VAS scores). Secondary outcomes were mobilisation and side effects related to opiate consumption.

    RESULTS: The trial was completed with 38 women randomised to ropivacaine and 37 women randomised to saline. Analysis was performed on 35 women in the ropivaciane group and 33 women in the saline group. The postoperative opioid consumption was significantly lower in the ropivacaine group than in the placebo group (median 55.8 and 72.4 mg, respectively, P = 0.032). The proportion of women scoring VAS <4 at 2 hours after block was significantly higher in the ropivacaine group (63%) than in the placebo group (25%) (P = 0.015). No side effects or important adverse events occurred during the trial.

    CONCLUSIONS: The superior hypogastric plexus block is a new method in this context and a promising contribution to postoperative pain treatment after abdominal hysterectomy.

    TWEETABLE ABSTRACT: Superior hypogastric plexus block during abdominal hysterectomy lowers opioid consumption.

  • 49.
    Sandström, A
    et al.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, and Institutet, Stockholm, Sweden.
    Cnattingius, S
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, and Institutet, Stockholm, Sweden.
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Stephansson, O
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, and Institutet, Stockholm, Sweden.
    Labour dystocia - risk of recurrence and instrumental delivery in following labour: a population-based cohort study2012Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, nr 13, s. 1648-1656Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective

    To investigate risk of recurrence of labour dystocia and mode of delivery in second labour after taking first labour and fetal and maternal characteristics into account.

    Design 

    A population-based cohort study.

    Setting 

    The Swedish Medical Birth Register from 1992 to 2006.

    Population 

    A total of 239 953 women who gave birth to their first and second singleton infants in cephalic presentation at ≥37 weeks of gestation with spontaneous onset of labour.

    Methods

    We used logistic regression analysis to estimate crude and adjusted odds ratios.

    Main outcome measures 

    Labour dystocia and mode of delivery in second labour.

    Results 

    Overall labour dystocia affected only 12% of women with previous dystocia. Regardless of mode of first delivery, rates of dystocia in the second labour were higher in women with than without previous dystocia, but were more pronounced in women with previous caesarean section (34%). Analyses with risk score groups for dystocia (risk factors were long interpregnancy interval, maternal age ≥35 years, obesity, short maternal stature, not cohabiting and post-term pregnancy) showed that risk of instrumental delivery in second labour increased with previous dystocia and increasing risk score. Among women with trial of labour after caesarean section with previous dystocia and a risk score of 3 or more, 66% had a vaginal instrumental or caesarean delivery (17 and 49%, respectively). In women with trial of labour after caesarean section without previous dystocia and a risk score of 0, corresponding risk was 32% (14 and 18%, respectively).

    Conclusion

    Previous labour dystocia increases the risk of dystocia in subsequent delivery. Taking first labour and fetal and maternal characteristics into account is important in the risk assessments for dystocia and instrumental delivery in second labour.

  • 50.
    Stephansson, O.
    et al.
    Karolinska Univ Hosp & Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden.;Karolinska Univ Hosp & Inst, Dept Womens & Childrens Hlth, Div Obstet & Gynaecol, Stockholm, Sweden..
    Sandstrom, A.
    Karolinska Univ Hosp & Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden.;Karolinska Univ Hosp & Inst, Dept Womens & Childrens Hlth, Div Obstet & Gynaecol, Stockholm, Sweden..
    Petersson, G.
    Karolinska Univ Hosp & Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden..
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Karolinska Univ Hosp & Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden..
    Cnattingius, S.
    Karolinska Univ Hosp & Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden..
    Prolonged second stage of labour, maternal infectious disease, urinary retention and other complications in the early postpartum period2016Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 123, nr 4, s. 608-616Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ObjectiveTo study the association between duration of second stage of labour and risks of maternal complications (infection, urinary retention, haematoma or ruptured sutures) in the early postpartum period. DesignPopulation-based cohort study. Setting and sampleWe included 72593 mothers with singleton vaginal deliveries at 37weeks of gestation in cephalic presentation, using the obstetric database from the Stockholm-Gotland region in Sweden, 2008-12. MethodsLogistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated and adjustments were made for maternal age, body mass index, height, smoking, cohabitation, gestational age, labour induction, epidural analgesia and oxytocin augmentation. ResultsRates of any complication varied by parity from 7.3% in parous women with previous caesarean section, 4.8% in primiparas and 1.7% in parous women with no previous caesarean section. Compared with a second stage <1hour, the adjusted ORs for any complication (95% CI) in primiparas were for 1 to <2hours 1.28 (1.11-1.47); 2 to <3hours 1.54 (1.32-1.79), 3 to <4hours 1.63 (1.38-1.93) and 4hours 2.08 (1.74-2.49). The corresponding adjusted ORs for parous women without previous caesarean were 2.27 (1.78-2.90), 2.97 (2.09-4.22), 3.65 (2.25-5.94) and 3.16 (1.44-6.94), respectively. The adjusted ORs for women with previous caesarean were for 1 to <2hours 1.62 (1.13-2.32); 2 to <3hours 1.56 (1.00-2.43), 3 to <4hours 2.42 (1.52-3.87), and 4hours 2.31 (1.25-4.24). ConclusionsRisks of maternal complications in the postpartum period increase with duration of second stage of labour also after accounting for maternal, pregnancy and delivery characteristics. Special attention has to be given to parous women with previous caesarean deliveries.

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