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  • 151.
    Volgsten, Helena
    et al.
    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, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Schmidt, Lone
    Live birth outcome, spontaneous pregnancy and adoption up to five years after undergoing assisted reproductive technology treatment2017In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 8, p. 954-959Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: This study is part of a longitudinal cohort undertaken in both women and men to describe live birth outcome after undergoing assisted reproductive technology (ART) treatment in a clinical setting. Another objective was to follow women and men living with children from other alternatives after ART, such as adoption.

    MATERIAL AND METHODS: A total of 439 (80.5%) women and 423 (77.6%) men were included in the baseline cohort (2005-2007). Live birth rate after ART was 24.8% at baseline. Up to 5 years later (2010-2011) the same participants were sent individual postal questionnaires (n = 439).

    RESULTS: Overall, 278 (63.3%) women and 183 (41.7%) men filled in and returned the questionnaire at follow up. The majority of women (91.7%) and men (93.4%) were living with children. A total of 225 (80.9%) women had a live birth at follow up. Of these, almost three of four (71.6%) had a live birth after ART and more than one of four (28.0%) after spontaneous pregnancies or both. Of these, 52 (26.1%) women had a subsequent live birth after successful ART and 26 (32.9%) women after unsuccessful ART. Nineteen (6.8%) women and 13 (7.1%) men had a child after adoption. Almost one of five (19.1%) women had no live birth at follow up.

    CONCLUSION: The majority of women and men were living with children, resulting from a live birth after ART, spontaneous pregnancy and/or adoption up to 5 years later. However, almost one of five had no live birth at follow up.

  • 152.
    Volgsten, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Olsson, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Unresolved grief in women and men in Sweden three years after undergoing unsuccessful in vitro fertilization treatment2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 10, p. 1290-1297Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Grief is a common reaction in women after a diagnosis of infertility. The study explored the experience of childlessness in both women and men three years after undergoing unsuccessful in vitro fertilization (IVF).

    METHODS: Participants (10 women and 9 men) who had attended a fertility clinic in Sweden were interviewed individually. The methodological approach was qualitative with semi-structured interviews and qualitative content analysis.

    RESULTS: Unsuccessful IVF was experienced by women in terms of grief, whereas men took upon themselves a supportive role and did not express grief. A need for professional support and counselling in how to handle grief was described. An unstructured end after IVF treatment left unanswered questions. Partner relations were affected in both positive and negative ways and an experience of being excluded with no understanding and lack of support from their social network was revealed. Three years after the end of IVF treatment, both men and women were still processing childlessness and had not adapted to being childless, indicating the grieving process was unresolved.

    CONCLUSIONS: The grieving process after unsuccessful IVF treatment was hampered among both men and women. The provision of additional individual support during IVF is recommended as men and women in this study experienced childlessness differently. Support and counselling concerning grief reactions following IVF failure, and a structured end after IVF may facilitate the grieving process after unsuccessful IVF treatment.

  • 153. Wennerholm, Ulla-Britt
    et al.
    Hagberg, Henrik
    Brorsson, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Bergh, Christina
    Induction of labor versus expectant management for post-date pregnancy: Is there sufficient evidence for a change in clinical practice?2009In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, no 1, p. 6-17Article, review/survey (Refereed)
    Abstract [en]

    Objectives. To compare perinatal and maternal outcomes between elective induction of labor versus expectant management of pregnancies at 41 weeks and beyond. Design. Systematic review and meta-analysis. Methods. We searched PubMed, CINAHL, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE) and PsycINFO (1980 to November, 2007). Inclusion criteria were systematic reviews and randomized controlled trials comparing elective induction of labor versus expectant management of pregnancies at 41 weeks and beyond. Three or more reviewers independently read and evaluated all selected studies. Data were extracted and analyzed using Review Manager Software. Main outcome measures. Perinatal mortality. Results. Thirteen trials fulfilled the inclusion criteria for the meta-analysis. Elective induction of labor was not associated with lower risk of perinatal mortality compared to expectant management (relative risks (RR): 0.33; 95% confidence intervals (CI): 0.10-1.09). Elective induction was associated with a significantly lower rate of meconium aspiration syndrome (RR: 0.43; 95% CI: 0.23-0.79). More women randomized to expectant management were delivered by cesarean section (RR: 0.87; 95% CI: 0.80-0.96). Conclusions. The meta-analysis illustrated a problem with rare outcomes such as perinatal mortality. No individual study with adequate sample size has been published, nor would a meta-analysis based on the current literature be sufficient. The optimal management of pregnancies at 41 weeks and beyond is thus unknown.

  • 154.
    Wesström, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Ulfberg, Jan
    Nilsson, Staffan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Sleep apnea and hormone replacement therapy: a pilot study and a literature review2005In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 84, no 1, p. 54-57Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Sleep apnea syndrome (SAS) is a common condition and a risk factor of cardiovascular and cerebrovascular diseases. The purpose of this pilot study was to investigate the effect of a gestagen (trimegeston) and estradiol hormone combination on perimenopausal and postmenopausal women with SAS.

    METHODS:

    Four postmenopausal and one perimenopausal women were studied by polysomnography before and after treatment with hormone replacement therapy (HRT).

    RESULTS:

    The subjects had a mean reduction of the severity of their sleep apnea by 75% measured by apnea/hypopnea index.

    CONCLUSIONS:

    HRT might be an alternative in the treatment of SAS.

  • 155.
    Wiberg-Itzel, Eva
    et al.
    Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Söder Hospital, Stockholm, Sweden.
    Pembe, Andrea
    Department of Obstetrics and Gynecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Wray, Susan
    Department of Molecular and Cellular Physiology, Institute of Translational Medicine, University of Liverpool, UK.
    Wihlbäck, Anna-Carin
    Department of Clinical Science, Obstetrics and Gynecology, University Hospital of Umeå, Sweden.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hoesli, Irene
    Women's Clinic, University Hospital, Basel, Switzerland.
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Level of lactate in amniotic fluid and its relation to the use of oxytocin and adverse neonatal outcome2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 1, p. 80-85Article in journal (Refereed)
    Abstract [en]

    Objective: To assess whether the frequency of adverse neonatal outcome at delivery is related to thelevel of lactate in amniotic fluid and to the use of oxytocin. 

    Design: Prospective observational study. 

    Setting: Soder Hospital, Stockholm, Sweden. 

    Population: Seventy-four women in active labor with a gestational age 36weeks and mixed parity. 

    Methods: Levels of lactate in amniotic fluid were analyzed bedside from an intrauterine catheter every 30min during labor. Deliveries were divided into groups with and without oxytocin. 

    Main outcome measures: The frequency of adverse neonatal outcome at delivery. 

    Result: Of the deliveries 13.5% (10/74) concluded with an adverse neonatal outcome. The levels oflactate in amniotic fluid increased during labor, more so in deliveries where oxytocin was used. In thegroup with an adverse neonatal outcome, the level of lactate in amniotic fluid was significantly higher inthe final sample before delivery (p=0.04). In 18 deliveries, stimulation with oxytocin was temporarily halted for at least 30min due to overly stimulated labor contractions. A decreasing level of lactate inamniotic fluid was shown within a median 5%/30min. In the group where the administration of oxytocinwas halted, there was no adverse neonatal outcome. 

    Conclusion: The frequency of adverse neonatal outcome was associated with the level of lactate inamniotic fluid and with the use of oxytocin. The level of lactate in amniotic fluid may be an additional valuable tool when oxytocin is administered during labor.

  • 156. Wickstrom, Karin
    et al.
    Bruse, Christine
    Sjosten, Anette
    Spira, Jack
    Edelstam, Greta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Quality of life in patients with endometriosis and the effect of pertubation with lidocaine - a randomized controlled trial2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 12, p. 1375-1382Article in journal (Refereed)
    Abstract [en]

    ObjectivePertubation with lidocaine has been shown to reduce pain (on a VAS-scale) in women with endometriosis. A clinical study was performed to evaluate the effect of lidocaine pertubations on quality of life. DesignDouble-blind, randomized and controlled trial. SettingThree outpatient units in Stockholm, Sweden. PopulationEligible patients had endometriosis with dysmenorrhoic pain >VAS 50mm. MethodsThe patients were randomized to pre-ovulatory pertubations with lidocaine (n=24) or placebo (n=18) during three consecutive menstrual cycles. The procedure comprised passing the solution through the uterus and the Fallopian tubes via an intracervical balloon catheter. The effect was evaluated with the validated Endometriosis Health Profile-30 questionnaire before and after treatments. Main outcome measuresChanges in scores at six and 12 months from baseline were compared between the groups with the Mann-Whitney U-test. ResultsAfter 6months there was a significant difference between the lidocaine (n=19) and the placebo (n=16) groups for the dimension social support (median -18.8 vs. -6.3, p=0.034), whereas there were no significant differences for the other dimensions after 6 or 12months. The mean changes in the lidocaine group were above the minimal important difference levels in eight of 12 measurements of quality of life dimensions compared with two of 12 in the placebo group. ConclusionsThis clinical trial indicates that pertubations with lidocaine might improve the social support dimension of quality of life in patients with endometriosis.

  • 157.
    Wikström, Anna-Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Eriksson, Ulf J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Nash, Peppi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Olovsson, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Early postpartum changes in circulating pro- and anti-angiogenic factors in early-onset and late-onset pre-eclampsia2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 2, p. 146-153Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pre-eclampsia is associated with altered plasma concentrations of the pro- and anti-angiogenic factors placental growth factor (PlGF), vascular endothelial growth factor-A (VEGF-A) and soluble fms-like tyrosine kinase 1 (sFlt1). However, there is insufficient knowledge about how these concentrations change after delivery, and whether the changes differ between early-onset and late-onset pre-eclampsia. METHODS: Plasma concentrations of sFlt1, PlGF and VEGF-A were measured before delivery and on days 1, 3 and 7 postpartum in women with early-onset (24-32 weeks' gestation) (n=18) and late-onset pre-eclampsia (35-42 weeks' gestation) (n=20) and in control groups delivered in corresponding weeks of gestation. RESULTS: All groups showed a rapid decrease in median sFlt1 concentration postpartum. Women with late-onset pre-eclampsia did not differ in sFlt1 concentration from controls on day 1 postpartum, whereas women with early-onset pre-eclampsia displayed a persistently elevated sFlt1 concentration on day 7 postpartum compared with controls. PlGF concentrations did not change from before delivery to any time point postpartum in the pre-eclampsia groups. VEGF-A concentrations were slightly increased on day 7 postpartum in both pre-eclampsia and control groups compared to concentrations prior to delivery. CONCLUSION: Median sFlt1 concentrations decreased rapidly postpartum in all groups, but remained higher in early-onset pre-eclampsia than controls on day 7. Postpartum, the median PlGF concentrations were similar to the concentrations measured before delivery in women with pre-eclampsia.

  • 158.
    Wikström, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Stenvall, Harriet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wilander, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Genetics and Pathology.
    Attitudes to self-sampling of vaginal smear for human papilloma virus analysis among women not attending organized cytological screening2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 6, p. 720-725Article in journal (Refereed)
    Abstract [en]

    Background. The major problem with the cytological screening is the non-optimal participation rate among women invited for cervical smear collection. The aim of the present investigation was to examine the attitudes of the non-responding women to perform self-sampling of vaginal smear at home as a method to increase the coverage of the screening and to examine the prevalence of high-risk human papilloma virus (HPV) among the responding women. Methods. From the database of the Department of Cytology, University Hospital of Uppsala 198 women, aged 35-55 years, who had not attended the organized gynaecological screening for over 6 years were identified. They were sent a letter of information about the study and one week later a self-sampling device aimed to collect vaginal smear. The vaginal smear of the women responding to the offer of self-sampling was analysed for high-risk HPV using Hybrid Capture 2 method or polymerase chain reaction amplification of HPV DNA. All women in the study also received a questionnaire in order to investigate their attitudes towards self-sampling as an alternative in the organized screening. Results. Of the 198 women 15 women had to be excluded. Fifty-eight per cent of the women responded and collected vaginal smear at home and among them 7% were positive for high-risk HPV. The questionnaire revealed no significant difference of age, country of birth and occupation or marital status, on using self-sampling of vaginal smear at home. The attitudes among responding and non-responding women differed. The responding women who contributed by sampling vaginal smear were more positive to self-sampling of vaginal smear (p<0.01). Conclusions. Offering self-sampling of vaginal smear in women not attending the organized cytological screening increases the coverage and identifies an additional group of women with an increased risk to develop cervical cancer. The attitude towards self-sampling was mainly positive.

  • 159.
    Wu, Xuxia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Blanck, A
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Möller, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Favini, Roberta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Lindblom, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Apoptosis, cellular proliferation and expression of p53 in human uterine leiomyomas and myometrium during the menstrual cycle and after menopause2000In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 79, no 5, p. 397-404Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Cell proliferation, apoptosis and expression of p53 proteins were studied in human uterine leiomyomas and myometrium during the menstrual cycle and after menopause.

    METHODS:

    Expression of ki-67 and p53 was analyzed by immunohistochemistry and by immunoblotting. Apoptosis was detected by in situ 3' end labelling of cells with DNA fragmentation.

    RESULTS:

    In both the proliferative and the secretory phases, ki-67 expression was higher in leiomyomas than in myometrium and both tissues showed higher expression in the secretory than in the proliferative phase. No difference in apoptotic index was observed between leiomyomas and myometrium or between the proliferative and secretory phases. After menopause, the expression of ki-67 as well as the apoptotic index was lower than in the proliferative and secretory phases and no significant difference between tissues was seen. Both leiomyomas and myometrium showed negative staining for p53. Immunohistochemical results regarding p53 were confirmed by Western blot.

    CONCLUSIONS:

    Our findings indicate that sex steroids influence the growth of leiomyomas by stimulating cell proliferation rather than by affecting apoptosis. The rate of cell proliferation is higher in fertile age than after menopause and appears to be enhanced under the influence of progesterone.

  • 160.
    Wånggren, Kjell
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Baban, Mario
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Attitudes toward embryo donation among staff at in vitro fertilization clinics2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 8, p. 765-770Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine attitudes towards embryo donation among staff at in vitro fertilization clinics in Sweden.

    DESIGN: Descriptive questionnaire study.

    SETTING: University-based in vitro fertilization clinic.

    SAMPLE: Study participants were the staff at all in vitro fertilization clinics in Sweden.

    METHODS: A questionnaire with questions regarding different aspects of embryo donation was sent to the 338 healthcare professionals working at Swedish in vitro fertilization clinics.

    MAIN OUTCOME MEASURES: Attitudes towards embryo donation.

    RESULTS: A total of 207 persons (61%) responded to the questionnaire. A majority of the respondents (77%) considered that embryo donation to infertile couples should be permitted in Sweden. Most respondents (76%), and especially the men (96%), stated that it should be possible to donate surplus embryos for research. Forty-two percent of the respondents agreed with embryo donation to single women. A majority of respondents stated that special requirements with regard to the recipient's age, medical condition and criminal background should potentially be considered. The women stated that there should be special demands made concerning recipients' tobacco (48%) and alcohol abuse (92%). A majority considered that donors should be anonymous to the recipients (66%), but not to the child (9%).

    CONCLUSIONS: Swedish in vitro fertilization staff have positive attitudes concerning embryo donation to infertile couples and also the use of surplus embryos for research.

  • 161.
    Wånggren, Kjell
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Jonassen, Aino Fianu
    Andersson, Sonja
    Pettersson, Gunilla
    Gemzell-Danielsson, Kristina
    Dept of Women and Child Health, Karolinska Institute, Stockholm, Sweden.
    Teaching pelvic examination technique using professional patients: a controlled study evaluating students' skills2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 10, p. 1298-1303Article in journal (Refereed)
    Abstract [en]

    Objective. To compare the skills in pelvic examination technique between students who have had training with professional patients and a control group of students trained using clinical patients. Design. Prospective controlled study. Setting. University hospital. Population. Students attending three consecutive courses in obstetrics and gynecology at Karolinska University Hospital. Methods. A study group of 53 students received training in pelvic examination with professional patients and was compared with a control group of 34 students who were trained using clinical patients. Main outcome measures. The students' skills in pelvic examination technique were examined by teachers in a practical test. Students' skills were also evaluated by the students themselves and by the patients who participated in the examination. Results. Students who had training with professional patients were more skilled in performing a pelvic examination and better prepared to examine their own patients than students trained using clinical patients. Conclusions. Training with professional patients is more effective in teaching pelvic examination technique than training with clinical patients. We recommend that the use of professional patients is considered in the training of medical students.

  • 162.
    Wånggren, Kjell
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Pettersson, Gunilla
    Gemzell-Danielsson, Kristina
    Dept of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden.
    Medical students learning the pelvic examination: evaluation of a clinical patient model2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 10, p. 1304-1309Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate a clinical patient (CP) model for training in pelvic examination. Design. Prospective clinical study. Population. Students attending the course in obstetrics and gynecology and patients at Karolinska University Hospital, Stockholm, Sweden. Main outcome measures. Feelings, attitudes and skills of medical students and ratings from CPs in connection to training in the pelvic examination. Methods. Each student participated in two training sessions at an outpatient clinic. The student participants answered questionnaires after each clinical session to measure different aspects of experiencing distress and to themselves rate the technical performance of the examination as well as the interaction with the CP. The CP answered questions about the examination, communication, information provided by the student and how they felt about participating in a teaching session. Results. The students rated their own performance high including both interpersonal communication and the technical examination. It was felt that the teacher as well as the CP gave good support and guidance. The CPs rated interpersonal communication skills by the students high. The teaching session was regarded as important and useful by both students and CPs. Conclusions. We recommend the use of this type of training sessions where students are allowed to work more independently and train in the role as a doctor under supervision of the teacher.

  • 163.
    Zetterström, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Nordén Lindeberg, Solveig
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Haglund, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hanson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Chronic hypertension as a risk factor for offspring to be born small for gestational age2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 9, p. 1046-1050Article in journal (Refereed)
    Abstract [en]

    Background. Chronic hypertension during pregnancy is associated with an increased risk for birth of small for gestational age offspring. The aim of this study was to determine whether the risk remains after consideration of maternal characteristics and superimposed pre-eclampsia. Method. A population-based cohort study based on the Swedish Medical Birth Register 1992-98 and comprising 560,188 women aged 15-44 years with singleton pregnancies including 2,754 women with chronic hypertension. The register contains data of maternal characteristics besides maternal and fetal complications. Multiple logistic regression analysis was used. Small for gestational age was defined as birth weight less than -2SD adjusted for gestational age and sex. Results. Chronic hypertensive women have an independent risk for small for gestational age (OR 3.1; 95% CI 2.7-3.7) when controlling for confounding of maternal characteristics such as age, parity, BMI, smoking, and ethnical origin. After introducing superimposed pre-eclampsia in the model the risk remains but decreases (OR 2.4; 95% CI 2.1-2.9). Conclusion. Chronic hypertension is an independent risk factor for birth of small for gestational age offspring. Pre-eclampsia is a strong mediating factor.

  • 164.
    Åhman, Annika
    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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Maras, Gordan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sarkadi, Anna
    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.
    Ultrasonographic fetal soft markers in a low-risk population: prevalence, association with trisomies and invasive tests2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 4, p. 367-373Article in journal (Refereed)
    Abstract [en]

    Objective

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

    Design

    Prospective observational study.

    Setting

    Swedish University Hospital.

    Population

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

    Methods

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

    Main outcome measures

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

    Results

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

    Conclusion

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

  • 165.
    Åhman, Annika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Lindgren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sarkadi, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Facts first, then reaction: expectant fathers' experiences of an ultrasound screening identifying soft markers2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, p. 60-61Article in journal (Other academic)
  • 166.
    Åhman, Annika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Maras, Gordan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Lindgren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Prevalence of ultrasonographic fetal soft markers during the second trimester ultrasound screening and its correlation to Down Syndrome2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, p. 60-60Article in journal (Other academic)
  • 167.
    Ångerud, Katja
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Annerbäck, Eva-Maria
    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 Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Tydén, Tanja
    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.
    Boddeti, Santosh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Adverse childhood experiences and depressive symptomatology among pregnant women2018In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 6, p. 701-708Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Adverse childhood experiences (ACE) result in somatic and mental health disturbances. Its influence on antenatal depression is scarcely studied. This study examined the association between experience of ACE and antenatal depressive symptomatology.

    MATERIAL AND METHODS: 1257 women from 172 antenatal clinics in Sweden were surveyed during pregnancy and one year after delivery. Demographics, previous medical history and Edinburgh Postpartum Depression Scale (EPDS) were collected in pregnancy and postpartum and ACE one year postpartum. ACEs were partitioned into 10 categories. Statistical analyses used linear and logistic regression with EPDS score as main outcome measure.

    RESULTS: 736 (58.6%) women reported at least one ACE category and 88 women (7%) reported five or more ACE categories. An EPDS score of ≥13, which qualifies for a probable depression diagnosis, was reported by 277 (23%) women. In simple regression analyses the EPDS score was positively associated with the number of ACEs, cigarette smoking before pregnancy, body mass index and psychiatric disorders while education level was inversely associated. In a multiple regression analysis ACEs, education level and psychiatric disorder remained associated to the EPDS score. Among women with an ACE score ≥5 the odds ratio of having an EPDS score indicating probable depression was 4.2 (CI; 2.5-7.0).

    CONCLUSIONS: ACE was commonly reported. ACE and depressive symptomatology in late pregnancy were strongly associated in a dose-response manner. Women with several ACEs had high odds of depressive symptomatology in late pregnancy and were more likely to report depressive symptoms both in late pregnancy and postpartum.

  • 168.
    Öberg, Mariella
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Stenson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Heimer, Gun
    Uppsala University, National Centre for Knowledge on Men.
    Prevalence of intimate partner violence among women seeking termination of pregnancy compared to women seeking contraceptive counseling2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 1, p. 45-51Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To estimate the prevalence of intimate partner violence among women seeking termination of pregnancy (TOP) in comparison to women seeking contraceptive counseling.

    DESIGN:

    Case-control study.

    SETTING:

    Family planning unit, Uppsala University Hospital.

    POPULATION:

    Women seeking TOP (n=635) and women seeking contraceptive counseling (n=591) answered a self-administered questionnaire regarding experience of intimate partner violence. In addition, the women were interviewed by specially trained staff.

    METHOD:

    Comparisons were made between the two groups and between those who had previously undergone TOP and those who had never done so with experience of intimate partner violence as the main outcome measure. Multivariate logistic regression was used to adjust for age, education, and occupation.

    RESULTS:

    In total 29% of women seeking TOP and 22% of women seeking contraceptive counseling reported experience of violence. Women seeking TOP were more likely to report physical violence (adjusted odds ratio (aOR)=1.6, 95% confidence interval (Cl) 1.2-2.1) and experience of violence during the past year (aOR=2.3, 95%Cl 1.1-4.8). Women who had ever undergone TOP were also more likely to report intimate partner violence compared to women with no history of TOP (aOR=1.7, 95%CI 1.3-2.3). Among women with repeated TOP, 51% reported experience of intimate partner violence.

    CONCLUSION:

    Women seeking TOP reported to a greater extent experience of intimate partner violence. However, women seeking contraceptive counseling had also a high prevalence of violence experiences. These results stress the importance of caregivers approaching both groups of women with questions about intimate partner violence in order to identify exposed women and offer them help. 

  • 169.
    Östlund, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hanson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Occurrence of gestational diabetes mellitus and the value of different screening indicators for the oral glucose tolerance test2003In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 82, no 2, p. 103-108Article in journal (Refereed)
    Abstract [en]

    Background. The objective of the present study was to determine prevalence of gestational diabetes mellitus (GDM) in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), and the value of traditional anamnestic risk factors for predicting outcome of the oral glucose tolerance test (OGTT).

    Methods. A prospective population-based study in a defined geographic area in Sweden. All pregnant nondiabetic women (n = 4918) attending maternal health care from July 1994 to June 1996 were offered a 75g OGTT in gestational weeks 28–32. Traditional anamnestic risk factors, as well as results of the OGTT in terms of fasting-B-glucose and 2h-B-glucose, were registered.

    Results. 3616 (73.5%) women agreed to perform the OGTT. Sixty-one (1.7%) of those had GDM [47 (1.3%) had impaired glucose tolerance and 14 (0.4%) had diabetes mellitus]. 15.8% fulfilled traditional risk factor criteria. Traditional anamnestic risk factors as an indicator to perform an OGTT identified 29/61 GDM women and 9/14 women with DM. Among primiparas, 4/21 with gestational diabetes mellitus were detected.

    Conclusion. Using traditional risk factors as an indicator to perform an OGTT gives a low sensitivity to detect GDM and even DM especially among primiparas.

  • 170.
    Östlund, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hanson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Repeated random blood glucose measurements as universal screening test for Gestational Diabetes Mellitus2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 1, p. 46-51Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    To determine the value of repeated random blood glucose (R-B-glucose) measurements alone or in combination with traditional risk factors [family history of diabetes, obesity, prior large-for-gestational-age (LGA) infant or prior gestational diabetes mellitus (GDM)] to predict the outcome of the oral glucose tolerance test (OGTT).

    METHODS:

    A prospective population-based study was undertaken in a Swedish county. All pregnant nondiabetic women (n = 4918) visiting the maternal health care clinics over a 2-year period were offered a 75-g OGTT in gestational weeks 28-32. Traditional risk factors and values of repeated R-B-glucose measurements were registered, as well as the results of the OGTT, in terms of fasting B-glucose and 2-h B-glucose.

    RESULTS:

    A total of 3616 women (73.5%) had an OGTT. Of these, 1.7% had GDM, 1.3% impaired glucose tolerance (IGT) and 0.4% diabetes mellitus (DM). An R-B-glucose cut-off level > or =8.0 mmol/L as the only indicator for an OGTT was optimal for detecting GDM with regard to sensitivity (47.5%) and specificity (97.0%). It has the same sensitivity for detecting GDM as using traditional risk factors, but reduces the need to carry out the OGTT from 15.8% to 3.8% of the population. Combined with prior LGA infant or prior GDM as indications for the OGTT in the present study, all women with DM and 44.7% of those with IGT will be identified. Only 7.3% of the population will have to take the OGTT.

    CONCLUSION:

    A random B-glucose level > or = 8.0 mmol/L prior LGA infant or prior GDM as an indicator for taking the OGTT is a simple and effective first step in a two-step screening model for GDM.

1234 151 - 170 of 170
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