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  • 1.
    Amini, Hashem
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Antonsson, Per
    Papadogiannakis, Nikos
    Ericson, Katharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Genetics and Pathology.
    Pilo, Christina
    Eriksson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Genetics and Pathology.
    Westgren, Magnus
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Comparison of ultrasound and autopsy findings in pregnancies terminated due to fetal anomalies2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 10, p. 1208-1216Article in journal (Refereed)
    Abstract [en]

    Objective. To compare antenatal diagnoses with autopsy findings in pregnancies terminated after ultrasound detection of fetal anomalies. A second aim was to study the quality of antenatal fetal diagnosis over time. Design. Retrospective, multicenter study over two consecutive six-year periods in Uppsala and Stockholm. Setting. Cases were identified through fetal autopsy reports. Subjects. Three hundred and twenty-eight fetuses from pregnancies terminated between 1992 and 2003 because of ultrasonographically diagnosed anomalies. Main outcome measures. The findings at the last ultrasound examination were compared with the autopsy reports. Results. In 299 cases (91.2%) ultrasound findings either exactly matched or were essentially similar to the autopsy findings. In 23 cases (7%) ultrasound findings were not confirmed at autopsy, but the postnatal findings were at least as severe as the antenatal ones. In six cases (1.8%) termination was performed for an anomaly which proved to be less severe than was predicted by ultrasound. The number of such cases was the same in both six-year periods, while the total number of cases increased from 113 in the first to 215 in the second period. Fetal examination provided further diagnostic information in 47% of the cases. In 10% a syndrome was disclosed. Conclusion. Termination of pregnancy was not always based on a correct antenatal diagnosis. All fetuses but one from terminated pregnancies had evident anomalies. In six cases (1.8%) the decision to terminate was based on suboptimal prognostic and diagnostic information. Fetal autopsy by an experienced perinatal pathologist is essential to provide a definitive diagnosis.

  • 2.
    Amini, Hashem
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Raiend, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    The Clinical Impact of Fetal Magnetic Resonance Imaging on Management of CNS Anomalies in the Second Trimester of Pregnancy2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 12, p. 20p. 1571-1581Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the additional information of second trimester magnetic resonance imaging (MRI) compared to ultrasound in fetuses with identified or suspected CNS anomalies and to study the clinical impact of the information on pregnancy management.

    Design: Prospective study during 2004-2007. The fetal MRI examination was planned to be performed within three days after the ultrasound.

    Setting: Uppsala University hospital.    

    Subjects: Twenty-nine pregnant women where second trimester ultrasound identified or suspected fetal CNS anomalies.

    Main outcome measures: Evaluation of the additional information gained from MRI and the consequence it had on pregnancy management.

    Results: The mean interval between ultrasound and MRI was 1.6 days (range 0 –7). In 18 fetuses (62 %)  MRI verified the ultrasound diagnosis but provided no additional information, while in 8 (28 %) MRI gave additional information without changing the management. In 3 (10 %), MRI provided additional information that changed the management of the pregnancy. Two of these women were obese.

    Conclusions: Fetal MRI in the second trimester might be a clinically valuable adjunct to ultrasound for the evaluation of CNS anomalies, especially when ultrasound is inconclusive due to maternal obesity.

     

  • 3.
    Amini, Hashem
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Second trimester fetal magnetic resonance imaging improves diagnosis of non-central nervous system anomalies2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 4, p. 380-389Article in journal (Refereed)
    Abstract [en]

    Objectives. To evaluate the additional information of second trimester magnetic resonance imaging (MRI) compared to ultrasound in fetuses with identified or suspected non-CNS anomalies and to study the clinical impact of the MRI information on pregnancy management. Design. Prospective study during 2003-2007. The fetal MRI examination was planned to be performed within three days after the ultrasound. Setting. Uppsala University hospital. Material and methods. Sixty-three women, where the second trimester ultrasound identified or raised suspicion of fetal anomalies were included. Ultrasound was compared to MRI in relation to the final diagnosis, which was based on the assessment of all available data including post-partum clinical follow-up and autopsy results. Main outcome measures. Evaluation of the additional information gained from MRI and the consequences it had on pregnancy management. Results. The mean interval between ultrasound and MRI was 2.6 days (range 0-15). In 42 (67%) cases MRI was performed within three days. All MRI examinations were assessable. In 43 (68%) fetuses MRI provided no additional information, in 17 (27%) MRI added information without changing the management and in three (5%) MRI provided additional information which changed the management. All these three cases had oligohydramnios. In all six cases of diaphragmatic hernia MRI provided additional information. Conclusions. Fetal MRI of non-CNS anomalies in the second trimester seems to be a valuable adjunct to ultrasound diagnosis of non-CNS anomalies, especially in cases of oligohydramnios and diaphragmatic hernia.

  • 4.
    Axelsson, Ove
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Placentafysiologi2001In: Lärobok för barnmorskor, Studentlitteratur , 2001, p. 71-74Chapter in book (Other scientific)
  • 5.
    Axelsson, Ove
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Backe, Björn
    Franklin, Jonas
    Stornes, Inger
    Tapanainen, Juha
    CME/CPD in obstetrics and Gynecology in the nordic countries2000Other (Other (popular scientific, debate etc.))
  • 6.
    Axelsson, Ove
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Marsal, karel
    Valentin, Lil
    Ultraljudsundersökning av foster kräver medicinsk indikation: Riskerna till stor del outforskade, vissa fynd kan oroa2007In: Läkartidningen, ISSN 0023-7205, Vol. 104, no 16, p. 1216-Article in journal (Other academic)
    Abstract [en]

    Fosterundersökningar med diagnostiskt ultraljud är ett ovärderligt instrument vid övervakning av graviditeter och för upptäckt av fosteravvikelser.

    Höga nivåer ultraljudsenergi kan medföra biologiska effekter i vävnader.

    Hittills har inga skadliga effekter påvisats hos foster undersökta med diagnostiskt ultraljud under graviditet. De kunskapsbrister som finns vad gäller säkerhetsaspekterna liksom det faktum att moderna utrustningar kan ge betydligt högre energier än tidigare manar dock till försiktighet.

    Ultraljud för fosterundersökningar skall undvikas om medicinsk vinst inte kan förväntas.

  • 7.
    Belachew, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Eurenius, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Three-dimensional ultrasound does not improve diagnosis of retained placental tissue compared to two-dimensional ultrasound2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 1, p. 112-116Article in journal (Refereed)
    Abstract [en]

    The study objective was to improve ultrasonic diagnosis of retained placental tissue by measuring the volume of the uterine body and cavity using three-dimensional (3D) ultrasound. Twenty-five women who were to undergo surgical curettage due to suspected retained placental tissue were included. The volume of the uterine body and cavity was measured using the VOCAL imaging program. Twenty-one women had retained placental tissue histologically verified. Three of these had uterine volumes exceeding the largest volume observed in the normal puerperium. Seventeen of the 21 women had a uterine cavity volume exceeding the largest volume observed in the normal puerperium. In all 14 cases examined 28 days or more after delivery the cavity volume exceeded the largest volume observed in the normal puerperium. A large cavity volume estimated with 3D ultrasound is indicative of retained placental tissue. However, 3D ultrasound adds little or no diagnostic power compared to 2D ultrasound.

  • 8.
    Belachew, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Eurenius, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Longitudinal study of the uterine body and cavity with three-dimensional ultrasonography in the puerperium2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 10, p. 1184-1190Article in journal (Refereed)
    Abstract [en]

    Objective.

    To describe uterine involution in the puerperium with three-dimensional ultrasound.

    Design.

    Prospective, longitudinal study.

    Setting.

    Fetal medicine unit, department of obstetrics and gynecology, university referral hospital, Uppsala, Sweden.

    Population.

    Fifty women with uncomplicated deliveries and puerperium between February 2009 and February 2010.

    Methods.

    Three-dimensional ultrasound was used to measure the uterine body and cavity volumes. The volume data set was analysed using virtual organ computer-aided analysis (VOCAL) with a 30 degree rotation step. Measurements were performed transabdominally on days 1, 7 and 14 and transvaginally on days 28 and 56 postpartum. Parity, gestational age, birthweight, smoking, breastfeeding and blood loss were recorded.

    Main outcome measures.

    Uterine body and cavity volumes. Results. Median uterine body volume was 756 cm3 on day 1, 440 cm3 on day 7, 253 cm3 on day 14, 125 cm3 on day 28 and 68 cm3 on day 56. Median cavity volume was 22 cm3 on day 1, 18 cm3 on day 7, 6 cm3 on day 14, 1 cm3 on day 28 and not measurable on day 56. The interindividual variation of uterine body and cavity volumes was most pronounced on day 1 and decreased throughout the observation period. Intrauterine content was found in 36% of the women on day 1, 95% on day 7, 87% on day 14 and 28% on day 28.

    Conclusions.

    Three-dimensional ultrasound is a non-invasive tool suitable for measurement of the uterine body and cavity volumes during the puerperium. The volumes decreased in a similar pattern in the study population.

  • 9.
    Belachew, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Cnattingius, S
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden.
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Eurenius, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Risk of retained placenta in women previously delivered by caesarean section: a population-based cohort study.2014In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 121, no 2, p. 224-229Article in journal (Refereed)
    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.

  • 10.
    Belachew, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Eurenius, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Placental location, postpartum hemorrhage and retained placenta in women with a previous cesarean section delivery: a prospective cohort study2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 3, p. 185-189Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Women previously giving birth with cesarean section have an increased risk of postpartum hemorrhage (PPH) and retained placenta. The objective of this study was to determine if anterior placental location increased the risk of PPH and retained placenta in such women.

    MATERIALS AND METHODS: We performed a prospective cohort study on 400 women with cesarean section delivery in a previous pregnancy. Ultrasound examinations were performed at gestational week 28-30, and placental location, myometrial thickness, and three-dimensional vascularization index (VI) were recorded. Data on maternal age, parity, BMI, smoking, gestational week at delivery, induction, delivery mode, oxytocin, preeclampsia, PPH, retained placenta, and birth weight were obtained for all women. Outcome measures were PPH (≥1,000 mL) and retained placenta.

    RESULTS: The overall incidence of PPH was 11.0% and of retained placenta 3.5%. Twenty-three women (11.8%) with anterior placenta had PPH compared to 12 (6.9%) with posterior or fundal locations. The odds ratio was 1.94, but it did not reach statistical significance. There was no significant risk increase for retained placenta in women with anterior placentae. Seven of eight women with placenta previa had PPH, and four had retained placenta.

    CONCLUSIONS: The overall risk of PPH and retained placenta was high for women with previous cesarean section. Anterior location of the placenta in such women tended to impose an increased risk for PPH but no risk increase of retained placenta. Placenta previa in women with previous cesarean section is associated with a high risk for PPH and retained placenta.

  • 11.
    Bergman, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Kieler, Helle
    Centre for Pharmacoepidemiology (CPE), KArolinska Institutet, Solna, Sweden.
    Sonesson, Christian
    E Street Statistics Mölndal, Sweden.
    Petzold, Max
    Nordic School of Public Health, Göteborg, Sweden.
    Relative growth estimated from self-administered symphysis fundal measurements2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 2, p. 179-185Article in journal (Refereed)
    Abstract [en]

    Objective. To establish absolute-and relative-growth reference curves for the detection of intrauterine growth restriction from weekly self-administered symphysis-fundus (SF) measurements and to assess the influence of fetal sex, maternal obesity and parity. Design. Prospective longitudinal study. Setting. Pregnant women from six primary antenatal care centres. Population. Three hundred women with singleton ultrasound dated pregnancies. Methods. Weekly self-administered SF measurements from gestational week 25 until delivery were obtained. A linear mixed longitudinal model was used to estimate the absolute SF growth using the natural logarithm (lnSF). Relative lnSF growth was calculated as the lnSF measurement in one gestational week subtracted by the lnSF measurement in the previous gestational week. The influence of fetal sex, maternal obesity and parity was assessed in regression models and by a graphical display. Main Outcome Measures. Absolute lnSF and relative lnSF growth curves and influence of fetal sex, maternal obesity and parity on these. Results. SF measurements from 191 women were used to establish an SF-growth reference. The absolute lnSF growth was influenced by maternal obesity, and for fetal sex and parity, borderline significance was recorded; while there was no evidence that the relative lnSF growth could depend on these variables. Conclusions. Weekly self-administered SF measurements can be obtained and used to estimate SF growth. Relative growth of the lnSF height seems to be independent of fetal sex, maternal obesity and parity.

  • 12.
    Bergman, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Petzold, Max
    Nordic School of Public Health, Gothenburg.
    Sonesson, Christian
    E Street Statistics, Mölndal.
    Kieler, Helle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Self-administered symphysis-fundus measurements analyzed with a novel statistical method for detection of intrauterine growth restriction: a clinical evaluation2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 8, p. 890-896Article in journal (Refereed)
    Abstract [en]

    Objective. To assess the ability of self-administered symphysis fundus measurements used with the Shiryaev-Roberts statistical method (SR method) to identify growth-restricted (IUGR) fetuses and compare it with the traditional SF method (symphysis fundus measurements used with a population-based reference curve). Design. Longitudinal study. Setting. Pregnant women attending primary antenatal care centres. Population. From a population of 1 888 women with singleton ultrasound-dated pregnancies, we analyzed data from 1 122 women. Methods. Weekly self-administered SF measurements from gestational week 25 until delivery were analyzed according to the SR method. Neonatal morbidity and small for gestational age (SGA) were used as proxies for IUGR. Small for gestational age was defined as a birthweight less than two standard deviations (SD) and <10th percentile. We assessed the sensitivity of the SR and the SF methods to detect neonatal morbidity and SGA. Main Outcome Measures. Birth-related mortality, respiratory distress, hypoglycemia, Apgar score <= 6 at five minutes, pH <= 7.00 in the umbilical artery, neonatal care, preterm delivery, operative delivery for fetal distress and SGA. Results. For the SR method, the sensitivity for neonatal morbidity was between 6.0 and 36.4%, for SGA <2SD 36.8%, and for SGA <10th percentile 20.9%. The SF method had a sensitivity between 6.0 and 13.8% for neonatal morbidity, 52.3% for SGA <2SD and 28.6% for SGA <10th percentile. Conclusions. The SR and the SF methods had low sensitivities for neonatal morbidity.

  • 13.
    Bergman, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Kieler, Helle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Petzold, Max G.
    Nordic School of Public Health, Göteborg.
    Sonesson, Christian
    Statistical Research Unit, Göteborg University.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Symphysis-fundus measurements for detection of small for gestational age pregnancies2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 4, p. 407-12Article in journal (Refereed)
    Abstract [en]

    Background. In Sweden measurements of the symphysis-fundus (SF) distance are used to detect small for gestational age (SGA) pregnancies. The aim of this study was to evaluate the efficiency of Swedish ultrasound-based SF reference curves in detecting SGA pregnancies. Methods. To assess the sensitivity for detection of SGA pregnancies we performed a case-control study. Through the Swedish Medical Birth Register we identified all singelton SGA infants born in Uppsala 1993-1997 and randomly recruited non-SGA singelton as controls. We included 169 term and 73 preterm SGA cases and 296 controls, all born at term. The reference curves constructed from Steingrimsdottir (S curve) and Kieler (K curve) were evaluated. Gestational age at first alarm in the preterm SGA group was recorded. Results. In term pregnancies the S curve showed a sensitivity of 32 % and a specificity of 90 % at a cut-off at -2 SDs. The corresponding values for the K curve were 51 % and 83 %, respectively. In preterm pregnancies the sensitivity of the S curve was 49 % and for the K curve 58 %. The first alarm below -2 SD was noted before 32 weeks in 37 % with the S curve and 43 % with the K curve for preterm pregnancies. Conclusions. Both tested Swedish reference curves had low sensitivity for term SGA pregnancies. Sensitivity was higher for the preterm group and SF measurements seem to be better for detecting the most severe cases of SGA.

  • 14.
    Bergman, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Kieler, Helle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Petzold, Max
    Sonesson, Christian
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Self-administered measurement of symphysis-fundus heights2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 6, p. 671-677Article in journal (Refereed)
    Abstract [en]

    Background. Antenatal identification of infants small for gestational age (SGA) improves their perinatal outcome. Repeated measurements of the symphysis-fundus (SF) heights performed by midwives is the most widespread screening method for detection of SGA. However the insufficiency of this method necessitates improved practices. Earlier start and more frequent SF measurements, which could be acomplished by self-administered measurements, might improve the ability to detect deviant growth. The present study was set up to evaluate wether pregnant wome can reliable perform SF measurements by themself. Method. Forty healthy women with singelton and ultrasound-dated pregancies from 2 antenatal clinics in Uppsala, Sweden, were asked to perform 4 consecutive SF measureemnts once a week, from 20 to 25 weeks of gestation until delivery. The self-administered SF measurements were recorded and systematically compared with midwives' SF measurements. Results. Thirty-three pregnant women performed self-administered SF measurements over a 14-week period (range 1-21). The SF curves constructed from self-admiinistered SF measurements had the same shape as previously constructed population-based reference curves. The variance for self-admiinistered SF measurements was higher than that of the midwives. Conclusions. Pregnant women are capable of measuring SF heights by themselves, but with a higher individual variance than midwives. Repeated measurements at each occasion can compensate for the higher variance. The main advantage of self-administered SF measurements is the opportunity to follow fetal growth earlier and more frequently.

  • 15.
    Bolin, Marie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Wiberg-Itzel, Eva
    Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.
    Olsson, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Ringvall, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Sundström-Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i D län (CKFD).
    Thilaganathan, Basky
    Division of Clinical Development Sciences, Department of Obstetrics and Gynecology, St George’s University of London, England.
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Prediction of Preeclampsia by Combining Serum Histidine-Rich Glycoprotein and Uterine Artery Doppler2012In: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 25, no 12, p. 1305-1310Article in journal (Refereed)
    Abstract [en]

    Background

    Preeclampsia is associated with both maternal and perinatal morbidity and mortality. Histidine-rich glycoprotein (HRG) is a protein interacting with angiogenesis, coagulation, and inflammatory responses, processes known to be altered in preeclamptic pregnancies. Significantly lower levels of HRG have been demonstrated as early as in the first trimester in women later developing preeclampsia compared with normal pregnancies. The aim of this study was to investigate whether the combination of HRG and uterine artery Doppler ultrasonography can be used as a predictor of preeclampsia.

    Methods

    A total of 175 women were randomly selected from a case-control study; 86 women had an uncomplicated pregnancy and 89 women later developed preeclampsia. Blood samples and pulsatility index (PI) were obtained from both cases and controls in gestational week 14.

    Results

    HRG levels were significantly lower in women who developed preterm preeclampsia compared with controls, but not for women developing preeclampsia in general. PI was significantly higher in the preeclampsia group compared with controls, especially in preterm preeclampsia. The combination of HRG and PI revealed a sensitivity of 91% and a specificity of 62% for preterm preeclampsia.

    Conclusions

    The combination of HRG and uterine artery Doppler may predict preterm preeclampsia in early pregnancy.

  • 16.
    Canto Moreira, Nuno
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Teixeira, João
    Department of Neuroradiology, H. G. S. Antonio, Porto, Portugal.
    Themudo, Raquel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Amini, Hashem
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Measurements of the normal fetal brain at gestation weeks 17 to 23: a MRI study2011In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 53, no 1, p. 43-48Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: To obtain measurements of the normal fetal brain before 24 weeks of gestation (GW), a deadline for medical decisions on fetal viability in a large number of countries. METHODS: We retrospectively reviewed 70 normal MR examinations of fetuses aged GW 17 to 23. The fronto-occipital diameter, the cerebral bi-parietal diameter, the transverse cerebellar diameter, the vermian height, and antero-posterior diameter were measured. RESULTS: The median, maximum, and minimum values for each parameter were displayed for each individual GW. CONCLUSION: The recorded data might contribute to a better assessment of fetal health by providing normal boundaries for the brain growth.

  • 17.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Patient Information Websites About Medically Induced Second-Trimester Abortions: A Descriptive Study of Quality, Suitability, and Issues2017In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 19, no 1, article id e8Article in journal (Refereed)
    Abstract [en]

    Background: Patients undergoing medically induced second-trimester abortions feel insufficiently informed and use the Web for supplemental information. However, it is still unclear how people who have experience with pregnancy termination appraise the quality of patient information websites about medically induced second-trimester abortions, whether they consider the websites suitable for patients, and what issues they experience with the websites.

    Objective: Our objective was to investigate the quality of, suitability of, and issues with patient information websites about medically induced second-trimester abortions and potential differences between websites affiliated with the health care system and private organizations.

    Methods: We set out to answer the objective by using 4 laypeople who had experience with pregnancy termination as quality assessors. The first 50 hits of 26 systematic searches were screened (N=1300 hits) using search terms reported by the assessors. Of these hits, 48% (628/1300) were irrelevant and 51% (667/1300) led to websites about medically induced second-trimester abortions. After correcting for duplicate hits, 42 patient information websites were included, 18 of which were affiliated with the health care system and 24 with private organizations. The 4 assessors systematically assessed the websites with the DISCERN instrument (total score range 16-80), the Ensuring Quality Information for Patients (EQIP) tool (total score range 0-100), as well as questions concerning website suitability and perceived issues.

    Results: The interrater reliability was 0.8 for DISCERN and EQIP, indicating substantial agreement between the assessors. The total mean score was 36 for DISCERN and 40 for EQIP, indicating poor overall quality. Websites from the health care system had greater total EQIP (45 vs 37, P>.05) and reliability scores (22 vs 20, P>.05). Only 1 website was recommended by all assessors and 57% (24/42) were rated as very unsuitable by at least one assessor. The most reported issues with the websites involved lack of information (76%, 32/42), and poor design (36%, 15/42).

    Conclusions: The high number of irrelevant hits and poor quality of patient information websites are considerable issues that must be addressed and considered when consulting patients awaiting medically induced second-trimester abortions. In clinical encounters, health professionals should initiate discussions concerning websites about medically induced second-trimester abortions and inform patients about the issues and quality deficits associated with these websites.

  • 18.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Melander, Marttala Ulla
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Languages, Department of Scandinavian Languages.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Bergman, Gunnar
    Institutionen för Kvinnors och Barns Hälsa, Karolinska Institutet.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetric research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Institutionen för Vårdvetenskap, Ersta Sköndal Bräcke Högskola.
    Quality of Patient Information Websites About Congenital Heart Defects: Mixed-Methods Study of Perspectives Among Individuals With Experience of a Prenatal Diagnosis2017In: Interactive Journal of Medical Research, E-ISSN 1929-073X, Vol. 6, no 2, article id e15Article in journal (Refereed)
    Abstract [en]

    Background: When a heart defect is prenatally diagnosed in the fetus, expectant parents experience a great need for information about various topics. After the diagnosis, the Web is used for supplemental information, and the scarcity of research calls attention to the need to explore patient information websites from the perspectives of the intended consumers.

    Objective: The overarching aim of this study was to explore the quality of Swedish patient information websites about congenital heart defects, from the perspectives of individuals with experience of a prenatal diagnosis of congenital heart defect in the fetus.

    Methods: This was a mixed-methods study of websites identified through systematic searches in the two most used Web-based search engines. Of the total 80 screened hits, 10 hits led to patient information websites about congenital heart defects. A quality assessment tool inspired by a previous study was used to evaluate each website’s appearance, details, relevance, suitability, information about treatment choices, and overall quality. Answers were given on a 5-point Likert scale, ranging from 1, representing the lowest score, to 5, representing the highest score. Each website was assessed individually by persons with experience of continued (n=4) and terminated (n=5) pregnancy following a prenatal diagnosis. Assessments were analyzed with Kendall’s coefficient of concordance W, Mann-Whitney U test, Friedman’s test, and a Wilcoxon-Nemenyi-McDonald-Thompson test. In addition, each assessor submitted written responses to open-ended questions in the quality assessment tool, and two joint focus group discussions were conducted with each group of assessors. The qualitative data were analyzed with inductive manifest content analysis.

    Results: Assessments represented a low score (median=2.0) for treatment choices and moderate scores (median=3.0) for appearance, details, relevance, suitability, and overall quality. No website had a median of the highest achievable score for any of the questions in the quality assessment tool. Medians of the lowest achievable score were found in questions about treatment choices (n=4 websites), details (n=2 websites), suitability (n=1 website), and overall quality (n=1 website). Websites had significantly different scores for appearance (P=.01), details (P<.001), relevance (P<.001), suitability (P<.001), treatment choices (P=.04), and overall quality (P<.001). The content analysis of the qualitative data generated six categories: (1) advertisements, (2) comprehensiveness, (3) design, (4) illustrations and pictures, (5) language, and (6) trustworthiness. Various issues with the included websites were highlighted, including the use of inappropriate advertisements, biased information, poor illustrations, complex language, and poor trustworthiness.

    Conclusions: From the perspectives of the intended consumers, patient information websites about congenital heart defects are, to a large extent, inadequate tools for supplemental information following a prenatal diagnosis. Health professionals should initiate discussions with patients about their intentions to use the Web, inform them about the varied quality in the Web-based landscape, and offer recommendations for appropriate Web-based sources.

  • 19.
    Cederholm, M
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Haglund, B
    Axelsson, O
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Infant morbidity following amniocentesis and chorionic villus sampling for prenatal karyotyping2005In: BJOG: an International Journal of Obstetrics and Gynaecology, Vol. 112, no 4, p. 394-402Article in journal (Refereed)
  • 20. Dumitrescu, Bogdan
    et al.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Strand, Roland
    Bed rest when the water breaks early: in accordance with the evidence or old habit?2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Refereed)
    Abstract [en]

    Bed rest is often prescribed as part of the treatment plan for women with preterm premature rupture of membranes in the hope of avoiding premature birth. The purpose of this study was to determine the routine care of these patients in Swedish hospitals.A survey was sent to all hospitals in Sweden with an obstetrics department (n=45). Out of these, 31 answered our survey (69 %). The women were separated into three groups depending on gestation length (22+0-26+6, 27+0-32+6 and 33+0-36+6).Most hospitals chose to admit the women and to recommend total or partial bed rest. The earlier in the pregnancy the rupture occurred, the more likely the patient was to be confined to total bed rest.The study shows that this topic is controversial. Most hospitals use bed rest even though there is no evidence to support that it is of benefit for the patient. More studies in this area are required in order to find an optimal treatment for this patient group.

  • 21.
    Dumitrescu, Bogdan
    et al.
    Obstetrik och gynekologi, Mälarsjukhuset, Eskilstuna.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Strand, Roland T
    Obstetrik och gynekologi, Mälarsjukhuset, Eskilstuna.
    Sängläge vid tidig vattenavgång - enligt evidens eller gammal vana?2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 112Article in journal (Other academic)
  • 22.
    Eurenius, K
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, O
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Sjoden, P.O.
    Department of Public Health and Caring Sciences.
    Pregnancy, ultrasound screening and smoking attitudes.1996In: Gynecologic and Obstetric Investigation., Vol. 42, no 2, p. 73-6Article in journal (Refereed)
  • 23.
    Gustavson, KH
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Genetics and Pathology.
    Anneren, G
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Genetics and Pathology.
    Axelsson, O
    Department of Women's and Children's Health.
    Eriksson, L
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Genetics and Pathology.
    Gustafsson, J
    Department of Women's and Children's Health.
    Lonnerholm, T
    Rehnberg, L
    Skeletal dysplasia. Medical interdisciplinary care is necessary for optimal treatment.1995In: Läkartidningen, Vol. 92, p. 3425-Article in journal (Refereed)
  • 24.
    Kallak, Theodora Kunovac
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Hellgren, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Sandelin-Francke, Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Ubhayasekera, Kumari
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Analytical Chemistry.
    Bergquist, Jonas
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Analytical Chemistry.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Comasco, Erika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neuro-psycho-pharmacology.
    Campbell, Rebecca E
    Centre for Neuroendocrinology, Department of Physiology, University of Otago School of Medical Sciences, Dunedin, New Zealand.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Maternal and female fetal testosterone levels are associated with maternal age and gestational weight gain2017In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 177, no 4, p. 379-388Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Prenatal androgen exposure has been suggested to play a role in polycystic ovary syndrome. Given the limited information on what maternal characteristics influence maternal testosterone levels, and the even less explored routes by which female fetus androgen exposure would occur, the aim of this study was to investigate the impact of maternal age, BMI, weight gain, depressed mood and aromatase SNPs on testosterone levels in maternal serum and amniotic fluid of female fetuses.

    METHODS: Blood samples from pregnant women (n = 216) obtained in gestational weeks 35-39, and pre-labor amniotic fluid samples from female fetuses (n = 56), taken at planned Caesarean section or in conjunction with amniotomy for induction of labor, were analyzed. Maternal serum testosterone and amniotic fluid testosterone and cortisol were measured by tandem mass spectrometry.

    RESULTS: Multiparity (β = -0.28, P < 0.001), self-rated depression (β = 0.26, P < 0.001) and weight gain (β = 0.18, P < 0.05) were independent explanatory factors for the maternal total testosterone levels. Maternal age (β = -0.34, P < 0.001), weight gain (β = 0.19, P < 0.05) and amniotic fluid cortisol levels (β = 0.44, P < 0.001) were independent explanatory factors of amniotic fluid testosterone in female fetuses, explaining 64.3% of the variability in amniotic fluid testosterone.

    WIDER IMPLICATIONS OF THE FINDINGS: Young maternal age and excessive maternal weight gain may increase the prenatal androgen exposure of female fetuses. Further studies are needed to explore this finding.

  • 25.
    Karlsson, F.A.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Severe embryopathy and exposure to methimazole in early pregnancy2002In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 87, no 2, p. 947-949Article in journal (Refereed)
  • 26. Kenan, Naama
    et al.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Helander, Anders
    Changes in transferrin glycosylation during pregnancy may lead to false-positive carbohydrate-deficient transferrin (CDT) results in testing for riskful alcohol consumption2011In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 412, no 1-2, p. 129-133Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An alcohol-induced change in serum transferrin glycosylation, termed carbohydrate-deficient transferrin (CDT), is widely used as a biomarker of heavy long-term drinking. This study examined the transferrin glycosylation profile and the risk for false-positive CDT results during pregnancy. METHODS: Serum samples were collected from 24 healthy pregnant women starting in gestation week 9-21, throughout pregnancy, and 8 or more weeks after delivery. Altogether 171 sera (5-9 samples/person) were analysed. Transferrin glycoforms were quantified as a percentage of total transferrin, using an HPLC candidate reference method for CDT. RESULTS: During pregnancy, the relative disialo-, pentasialo- and hexasialotransferrin levels increased gradually, whereas trisialo- and tetrasialotransferrin were reduced. This effect was most pronounced in the third trimester. For disialotransferrin, the main target in CDT testing, initial values of 1.07±0.17% (mean±SD) increased to 1.61±0.23% before delivery (~50% increase). Nine (38%) pregnant women reached %disialotransferrin values ≥1.7% (97.5th percentile for controls) but all results were <2.0%. In the postpartum samples, all glycoform levels had returned towards the starting values. CONCLUSIONS: These results suggest that the cutoff for %disialotransferrin and %CDT employed to indicate heavy long-term drinking need to be raised slightly in pregnant women, to minimize the risk for false-positive results on CDT testing.

  • 27. Kieler, H
    et al.
    Haglund, B
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Cnattingius, S
    Palmgren, J
    Axelsson, O
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Does prenatal sonography affect intellectual performance?2005In: Epidemiology, ISSN 1044-3983/05/1603-0304, Vol. 16, p. 304-310Article in journal (Refereed)
  • 28.
    Larsson, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Palm, M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hansson, L-O
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Axelsson, O
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Reference values for clinical chemistry tests during normal pregnancy2008In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 115, no 7, p. 874-881Article in journal (Refereed)
    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.

  • 29.
    Larsson, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Palm, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Basu, Samar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Insulin-like growth factor binding protein-1 (IGFBP-1) during normal pregnancy2013In: Gynecological Endocrinology, ISSN 0951-3590, E-ISSN 1473-0766, Vol. 29, no 2, p. 129-132Article in journal (Refereed)
    Abstract [en]

    Background:

    Insulin-like growth factor (IGF) binding protein-1 (IGFBP-1) is the main binder of IGFs in secretory endometrium and decidualized stromal endometrial cells and IGFBP-1 has been shown to modulate IGF bioactivities and influence fetal growth. To be able to evaluate IGFBP-1 values during pregnancy it is important to establish normal values in pregnant women.

    Materials & Methods:

    We have studied IGFBP-1 concentrations in maternal plasma from 52 healthy women with normal singleton pregnancies. Several plasma samples were collected from each woman and the samples were grouped according to gestational age into the following periods: week 7-17; week 17-24; week 24-28; week 28-31; week 31-34; week 34-38; -2 to 0 weeks prior to delivery and postpartum (>6 weeks after delivery).

    Results:

    The 2.5 and 97.5 percentiles for IGFBP-1 were calculated according to the recommendations of the International Federation of Clinical Chemistry on the statistical treatment of reference values.

    Conclusions:

    IGFBP-1 is increased during pregnancy compared to postpartum. Two peaks, at week 17-24 and just before delivery, were observed.

  • 30.
    Larsson, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Palm, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hansson, Lars-Olof
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Cystatin C and modification of diet in renal disease (MDRD) estimated glomerular filtration rate differ during normal pregnancy2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 7, p. 939-944Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To calculate normal values for estimation of the glomerular filtration rate (eGFR) for pregnant females. eGFR is used to monitor patients with suspected kidney disease and to optimize the dosage of drugs that are eliminated by the kidneys. Plasma creatinine and cystatin C are the two most widely used GFR markers. Both markers are recommended to be automatically reported as estimated GFR.

    DESIGN: Retrospective study.

    SETTING: Tertiary university hospital.

    POPULATION: We have studied creatinine (eGFR(MDRD)) (MDRD, modified diet in renal disease) and cystatin C (eGFR(cystc)) estimated GFR during 52 normal pregnancies from pregnancy week 10 to delivery and postpartum.

    METHODS: Each woman was sampled repeatedly and the samples were grouped according to gestational age into the following periods: week 7-16; week 18-24; week 24-28; week 28-31; week 31-34; week 34-38; -2-0 weeks prior to delivery and postpartum (> 6 weeks after delivery).

    MAIN OUTCOME MEASURES: 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: In healthy pregnant females eGFR(cystc) was higher in the first two trimesters and lower prior to delivery in comparison with eGFR(MDRD). eGFR(cystc) and eGFR(MDRD) give different results. No significant correlations between the two estimates were found in any of the time groups.

    CONCLUSIONS: It is important to distinguish between the two GFR estimates and use separate reference intervals for pregnant females.

  • 31.
    Larsson, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Palm, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Helmersson, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Pentraxin 3 Values During Normal Pregnancy2011In: Inflammation, ISSN 0360-3997, E-ISSN 1573-2576, Vol. 34, no 5, p. 448-451Article in journal (Refereed)
    Abstract [en]

    Pentraxin 3 (PTX3) is an inflammatory molecule that has been reported to be a promising early biomarker for subsequent preeclampsia. The levels of PTX3 vary during pregnancy and it is thus a need to establish reference intervals during normal pregnancy. Repeated blood samples were collected from 52 healthy pregnant females. The samples were divided according to collection time into the following groups: week 7-17, week 17-24, week 24-28, week 28-31, week 31-34, week 34-38, before delivery and after delivery. The samples were analyzed for PTX3 with a sandwich ELISA and the 2.5 and 97.5 percentiles for each sample period was calculated. There was a continuous increase of serum PTX3 as pregnancy progressed. The increase was most evident after week 31 with the highest levels just before delivery.

  • 32. Le Blanc, Katarina
    et al.
    Götherström, Cecilia
    Ringdeén, Olle
    Hassan, Moustapha
    Horwitz, Edwin
    Annerén, Göran
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Genetics and Pathology. Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Genetics and Pathology.
    Axelsson, Ove
    Department of Women's and Children's Health.
    Nunn, Janice
    Ewald, Uwe
    Department of Women's and Children's Health.
    Nordén-Lindeberg, Solveig
    Department of Women's and Children's Health.
    Jansson, Monika
    Dalton, Ann
    Åström, Eva
    Westergren, Magnus
    Fetal Mesenchymal Stem-Cell Engraftment in Bone after In Utero Transplantation in a Patient with Severe Osteogenesis Imperfecta2005In: Transplantation, Vol. 79, no 11, p. 1607-14Article in journal (Refereed)
  • 33.
    Lindgren, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Cederholm, Maria
    Haglund, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Invasive procedures for fetal karyotyping: no cause of subsequent gestational hypertension or pre-eclampsia2010In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, no 11, p. 1422-1425Article in journal (Refereed)
    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.

  • 34.
    Lutvica, Ajlana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Belachew, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Eurenius, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Longitudinal study of the uterine body and cavity with 3D-ultrasonography in the puerperium2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, p. 109-109Article in journal (Other academic)
  • 35.
    Marusik, C
    et al.
    Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
    Frykholm, C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Ericson, K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Diagnosis of Placental Mesenchymal Dysplasia with a focus on magnetic resonance imaging (MRI)2017In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 49, no 3, p. 410-412Article in journal (Refereed)
  • 36.
    Mulic Lutvica, A
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Eurenius, K
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    P13.24 Longitudinal study of uterine artery Doppler after normal vaginal delivery2006Other (Other (popular scientific, debate etc.))
  • 37.
    Mulic-Lutvica, A
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Bekuretsion, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Bakos, O
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, O
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Ultrasonic evaluation of the uterus and uterine cavity after normal,vaginal delivery.2001In: Ultrasound Obstet Gynecol, Vol. 18, p. 491-Article in journal (Refereed)
  • 38.
    Mulic-Lutvica, Ajlana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Labor and puerperium1998In: Textbook of Perinatal Medicine: a comprehensive guide to modern clinical perinatology / [ed] Asim Kurjak et al, London: Parthenon Pub. Group , 1998, 1, Vol. 1, p. 386p. 386-400Chapter in book (Other academic)
  • 39.
    Mulic-Lutvica, Ajlana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Postpartum ultrasound in women with postpartum endometritis, after cesarean section and after manual evacuation of the placenta2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 2, p. 210-217Article in journal (Refereed)
    Abstract [en]

    Objectives. To measure anteroposterior (AP) diameters, and to describe qualitative findings of the uterus and the uterine cavity in women with postpartum endometritis, after caesarean section (CS) and after manual evacuation of the placenta, and to compare these women with those in a normal puerperium. Methods. A prospective, descriptive, observational study of 103 postpartum women was conducted. Fifty-five women had clinical symptoms of postpartum endometritis, 28 had undergone CS, and 20 had manual placental evacuation. Ultrasound examinations were scheduled for days 1, 3, 7, 14, 28 and 56 postpartum. Women with endometritis underwent their first examination on the day they presented with clinical symptoms. Results. The AP diameters of the uterus and uterine cavity in all three groups overlapped considerably with the reference values. On day 56 postpartum, the uterus had achieved the same dimensions as found in our reference population. Compared with the reference group, during early puerperium, an empty cavity was less common among women with the three study conditions, and gas was present more often after CS and after manual evacuation of the placenta. An anteverted position of the uterus was less common among women with endometritis on day 14 and 28 postpartum, and among women delivered by CS on days 7, 14 and 28 postpartum. The incision site in the lower uterine segment was visible after CS. Conclusion. The ultrasonic findings in women with postpartum endometritis, after CS and after manual evacuation of the placenta, do not differ substantially from those during an uncomplicated puerperium. A delayed uterine involution process might explain the slight morphological differences observed.

  • 40.
    Mulic-Lutvica, Ajlana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ultrasound finding of an echogenic mass in women with secondary postpartum hemorrhage is associated with retained placental tissue2006In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 28, no 3, p. 312-319Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe sonographic findings associated with retained placental tissue in patients with secondary postpartum hemorrhage, and to compare these findings with those of women with a normal puerperium. Methods: This was a prospective observational study of 79 women with secondary postpartum hemorrhage. Ultrasound examinations were performed on the day the patients presented with clinical symptoms and were scheduled for postpartum days 1, 3, 7, 14, 28 and 56, continuing until uterine surgical evacuation was performed or until the bleeding stopped. The maximum anteroposterior (AP) diameters of the uterus and uterine cavity were measured and morphological findings in the cavity were recorded. The findings were compared with previously published results from a normal population. Results: The patients were divided into two groups. Group 1 (n = 18) underwent surgery and Group 2 (n = 61) was treated conservatively. Sonography revealed an echogenic mass in the uterine cavity in 17 patients from Group 1, and in 14 of these patients histology confirmed placental tissue. The AP diameter of the uterine cavity was above the 90 th percentile in all but two of the 18 Group 1 patients. In 18 patients from Group 2 the cavity was empty and in 43 a mixed-echo pattern was found. The uterine cavity was wider compared with the controls, but the values largely overlapped. Conclusion: This report supports the opinion that the sonographic finding of an echogenic mass in the uterine cavity in women with secondary postpartum hemorrhage is associated with retained placental tissue.

  • 41.
    Mulic-Lutvica, Ajlana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Eurenius, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Longitudinal study of Doppler flow resistance indices of the uterine arteries after normal vaginal delivery2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 10, p. 1207-1214Article in journal (Refereed)
    Abstract [en]

    Objectives. To measure Doppler flow resistance indices in the uterine arteries, and to observe when the early diastolic notches appear during the normal puerperium. Methods. Some 45 women took part in this prospective longitudinal study after normal, vaginal delivery. Ultrasound examinations were scheduled for days 1, 3, 7, 14, 28 and 56 postpartum. A transabdominal probe was used during the first two postpartum weeks, and a transvaginal probe for the later examinations. The pulsatility (PI) and resistance (RI) indices in the uterine arteries were measured, and the presence or absence of early diastolic notches was recorded. Results. Compared to day one, the resistance indices did not change markedly until day 28 postpartum. The mean PI was 1.23 at day 1, 1.22 at day 3, 1.22 at day 7, 1.33 at day 14, 1.81 at day 28, and 2.25 at day 56. The mean RI was 0.65 at day 1, 0.65 at day 3, 0.66 at day 7, 0.65 at day 14, 0.77 at day 28, and 0.84 at day 56. The presence of at least 1 uterine artery notch was found in 13.3% of the women at day 1, and in 90.6% at day 56 postpartum. Bilateral notches were recorded in 6.7% of the women at day 1, and in 84.4% at day 56 postpartum. Conclusion. Reference values of the resistance indices from uncomplicated puerperium are needed when the diagnostic efficacy of Doppler ultrasound for pathological conditions is to be tested. This study confirms that the time needed for the vascular physiology to revert from a pregnant to a non-pregnant state appears to be longer than previously assumed.

  • 42.
    Nilsson, Stefan
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Physical and Analytical Chemistry, Analytical Chemistry.
    Ramström, Margareta
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Physical and Analytical Chemistry, Analytical Chemistry.
    Palmblad, Magnus
    The Ångström Laboratory, Division of Ion Physics, Uppsala University.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Bergquist, Jonas
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Physical and Analytical Chemistry, Analytical Chemistry.
    Explorative study of the protein composition of amniotic fluid by liquid chromatography electrospray ionization Fourier transform ion cyclotron resonance mass spectrometry2004In: Journal of Proteome Research, ISSN 1535-3893, E-ISSN 1535-3907, Vol. 3, no 4, p. 884-889Article in journal (Other academic)
    Abstract [en]

    To explore the suitability of FTICR mass spectrometry for the analysis of the protein composition of amniotic fluid (AF), an AF sample from 15 weeks gestation from a healthy 36-year-old woman was tryptically digested, with or without prior serum albumin removal. The tryptic peptides were separated by gradient capillary liquid chromatography (LC) followed by electrospray ionization (ESI) and mass spectrometric detection with a 9.4 T Fourier transform ion cyclotron resonance mass spectrometer (FT-ICR). The obtained data underwent computer-aided mathematical and statistical evaluation to extract significant tryptic peptide patterns from human proteins. Forty-three proteins were putatively identified; among them were known protein constituents of amniotic fluid, but also many that not have been detected before. The removal of serum albumin prior to tryptic digestion reduced ion suppression from abundant HSA fragments. The protein analysis of amniotic fluid by albumin removal, tryptic digestion and LC/FT-ICR-MS analysis was found to be a straightforward technique.

  • 43.
    Palm, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Wernroth, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Basu, Samar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Involvement of inflammation in normal pregnancy2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 5, p. 601-605Article in journal (Refereed)
    Abstract [en]

    Objective.

    To study the role of inflammatory biomarkers of cytokine and cyclooxygenase origin throughout normal pregnancy and postpartum.

    Design.

    Longitudinal prospective study.

    Setting.

    One outpatient antenatal clinic in Uppsala, Sweden.

    Population.

    Thirty-seven healthy women with normal pregnancies and normal neonatal outcome were included. 

    Methods.

    Blood and urine samples were collected from each woman at least 6 times during pregnancy and postpartum. Plasma levels of IL-6 and TNF-α were measured by using ELISA kits and urine levels of PGF2α metabolite were measured by using RIA.

    Main outcome measures.

    Median plasma and urine levels, the 25:th to the 75:th percentile and the average change per gestational week of IL-6, TNF-α and PGF2α metabolite .

    Results.

    IL-6 levels increased significantly throughout pregnancy and postpartum levels remained high. No change in TNF-α could be seen with advancing gestational age or postpartum period. The PGF2α metabolite levels increased significantly throughout pregnancy and decreased in postpartum period.

    Conclusion.

    These results suggest that mild but significant inflammatory activity is involved in development of normal pregnancy and might have important physiological effects.

  • 44.
    Palm, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Basu, Samar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Wernroth, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research Center.
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    A longitudinal study of plasma levels of soluble fms-like tyrosine kinase 1 (sFlt1), placental growth factor (PlGF), sFlt1: PlGF ratio and vascular endothelial growth factor (VEGF-A) in normal pregnancy2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 11, p. 1244-1251Article in journal (Refereed)
    Abstract [en]

    Objective: To describe plasma levels of angiogenic (PlGF, VEGF-A) and anti-angiogenic (sFlt1) factors as well as the sFlt1:PlGF ratio throughout normal pregnancy and postpartum.

    Design: Longitudinal prospective study.

    Setting: One outpatient antenatal clinic in Uppsala, Sweden.

    Population: Thirty-seven healthy women with normal pregnancies and normal neonatal outcome were included.

    Methods: Blood samples were collected from each woman at least six times. Plasma levels of sFlt1, PlGF and VEGF-A were measured using commercially available ELISA kits. Main outcome measures. Median plasma levels, the 25th to the 75th percentile and the average change per gestational week of sFlt1, PlGF and the sFlt1:PlGF ratio.

    Results: sFlt1 levels were relatively constant until weeks 29-30, when they increased, reaching a peak at week 40. An increase of 643pg/ml per week was observed from weeks 30 to 40. Postpartum levels were low. PlGF increased by 16pg/ml per week from early pregnancy until weeks 29-30 and thereafter decreased by 14pg/ml per week until week 40. The sFlt1:PlGF ratio decreased from weeks 9-12, was constantly low from weeks 19-20 to 37-38 and then increased to weeks 39-40. VEGF-A was detectable in only 8% of the samples during pregnancy and in 64% postpartum.

    Conclusion: This longitudinal study demonstrates how sFlt1, PlGF and the sFlt1:PlGF ratio fluctuate throughout normal pregnancy and postpartum and may serve as a reference against which these factors can be studied in complicated pregnancies. VEGF-A levels were more often detectable postpartum.

  • 45. Roos, Mårten
    et al.
    Sjöberg, Olof
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Karlsson, F. Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Graves' sjukdom vid graviditet ger risk för barnet: TSH-receptorantikroppar hos kvinnan kan ge fetal och neonatal tyreotoxikos2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 3, p. 120-124p. 120-124Article in journal (Other academic)
    Abstract [en]

    Graves' sjukdom hos en gravid kvinna medför risk för fetal och neonatal tyreotoxikos hos barnet, vilket orsakas av stimulerande TSH-receptorantikroppar (TRAK) som passerar placenta under slutet av graviditeten.

    I enstaka fall kan TRAK även finnas hos en kvinna som tidigare opererats eller radiojodbehandlats för Graves' sjukdom.

    Antikroppstitern hos modern är ett bra mått på risken att barnet utvecklar fetal och neonatal tyreotoxikos.

    På senare år har nya metoder för att mäta TRAK introducerats. Vi har jämfört dessa med en tidigare metod och anger vilka TRAK-nivåer under graviditet som innebär stor risk för påverkan på barnet.

    Beskrivning av två fall illustrerar hur förloppet av Graves´ sjukdom under graviditet kan yttra sig.

  • 46. Sandin-Bojö, Ann-Kristin
    et al.
    Larsson, Bodil Wilde
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hall-Lord, Marie Louise
    Intrapartal care documented in a Swedish maternity unit and considered in relation to World Health Organization recommendations for care in normal birth2006In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 22, no 3, p. 207-217Article in journal (Refereed)
    Abstract [en]

    Objectives: to describe documented intrapartal care in relation to the World Health Organization (WHO) recommendations for care in normal birth, and to compare intrapartal care for pregnant women at low and high risk in a conventional maternity unit.

    Design: retrospective examination of 212 consecutive childbirth records using an audit instrument developed from WHO's recommendations.

    Setting: a conventional maternity unit in Western Sweden.

    Findings: practices that are demonstrably useful and should be encouraged were mostly documented, except for physical assessments, such as pulse and temperature and emotional aspects. Vaginal examinations were carried out more often than recommended, and fetal heart rates were seldom monitored intermittently. Practices classified as harmful, practices with insufficient evidence and practices frequently used inappropriately, were used to a large extent. There were high rates of interventions regardless of the women's risk level. The interventions were carried out without a rational documented indication. According to the documentation, only two-thirds of the women were in active labour on admission to the labour ward.

    Conclusion and implications for practice: the recommendations from WHO were only partly adhered to. The instrument is considered useful for systematic audit of documented intrapartal care, and may help to identify areas in need of improvement. Improvements suggested by this study were as follows: inclusion of emotional aspects in the documentation, differentiation in cardiotocographic (CTG) surveillance for women at low and high risk, documentation of explicit indications for interventions and guidelines for admission to the maternity unit.

  • 47. Sandin-Bojö, Ann-Kristin
    et al.
    Louise Hall-Lord, Marie
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Bodil Wilde
    Intrapartal care in a Swedish maternity unit after a quality-improvement programme2007In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 23, no 2, p. 113-122Article in journal (Refereed)
    Abstract [en]

    Objectives

    to study the effects of a quality-improvement programme (QIP) on documented intrapartal midwifery care in the context of a conventional maternity unit. The aim of the QIP was to improve intrapartal midwifery care in accordance with the World Health Organization (WHO)'s recommendations for care in normal birth, without decreasing the number of spontaneous vaginal births.

    Design

    an audit instrument, developed from WHO recommendations for care in normal birth, was used to compare birth records from before and after the implementation of a QIP. Two hundred and twelve consecutive birth records were examined in the pre-test and 240 in the post-test period.

    Setting

    a conventional maternity unit in Western Sweden.

    Findings

    an overall documented improvement towards the recommendations by WHO was observed, especially in items for which guidelines were developed; more women were in active labour, intermittent auscultation increased in first and second stage, and oxytocin augmentation decreased in the first stage. The improved care did not influence the number of spontaneous vaginal deliveries or the duration of active labour and second stage.

    Conclusion and implications for practice

    a QIP facilitated implementation of WHO's recommendations for care in normal birth. Most of the documented care changed in favour of the WHO recommendations. The findings highlight the importance of professional discussions and use of guidelines to implement changes and to show how midwifery care can change in a conventional ward. However, the findings must be interpreted with some caution because of the sample size and because the findings are based on documented, not observed, care.

  • 48.
    Sohlberg, Sara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Weis, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    MRI estimated placental perfusion in fetal growth assessment2015In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 46, no 6, p. 700-705Article in journal (Refereed)
    Abstract [en]

    Objective

    This study aimed to evaluate placental perfusion fraction estimated by magnetic resonance imaging (MRI) in vivo as a marker of placental function.

    Methods

    The study population included 35 pregnant women, of whom 13 had preeclampsia, examined at gestational weeks 22 to 40. Each woman underwent, within a 24 hour period: a MRI diffusion-weighted sequence (from which we calculated the placental perfusion fraction); venous blood sampling; and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. We compared the perfusion fraction in pregnancies with and without fetal growth restriction and estimated correlations between the perfusion fraction and ultrasound estimates and plasma markers with linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of preeclampsia (p < 0.05) and therefore we included an interaction term between preeclampsia and the covariates in the models.

    Results

    The median placental perfusion fraction in pregnancies with and without fetal growth restriction was 21% and 32%, respectively (p = 0.005). The correlations between the placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (p-values 0.002 to 0.0001). The highest coefficient of determination (R2= 0.56) for placental perfusion fraction was found for a model including pulsatility index in ductus venosus, plasma level of sFlt1, estimated fetal weight and presence of preeclampsia.

    Conclusion

    The placental perfusion fraction has potential to contribute to the clinical assessment in cases of placental insufficiency.

  • 49.
    Sohlberg, Sara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lindgren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Weis, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    In vivo(31)P-MR spectroscopy in normal pregnancy, early and late preeclampsia: A study of placental metabolism2014In: Placenta, ISSN 0143-4004, E-ISSN 1532-3102, Vol. 35, no 5, p. 318-323Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 50.
    Stålberg, Karin
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Bodestedt, Ake
    Department of Oncology, Radiology and Clinical Immunology.
    Lyrenäs, Sven
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Axelsson, Ove
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    A narrow pelvic outlet increases the risk for emergency cesarean section.2006In: Acta Obstet Gynecol Scand, ISSN 0001-6349, Vol. 85, no 7, p. 821-4Article in journal (Refereed)
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