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  • 51.
    Amini, Hashem
    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 Women's and Children's Health, Obstetrics and Gynaecology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    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, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    The Clinical Impact of Fetal Magnetic Resonance Imaging on Management of Non-CNS Anomalies in the Second Trimester of PregnancyManuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: To evaluate the additional information of second trimester 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.

    Methods: Sixty-three women were included, where the second trimester ultrasound identified or raised suspicion of fetal anomalies. Ultrasound was compared to MRI in relation to the final diagnosis, fetal autopsy if performed or postnatal diagnosis. The additional information of MRI and effect on pregnancy management was estimated in consensus.

    Results: The mean gestational age at the last ultrasound before MRI was 18+1 weeks (range 13+0-21+5). 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. These three cases had all oligohydramnios. In all six cases of diaphragmatic hernia MRI provided additional information.

    Conclusions: Fetal MRI of non-CNS anomalies is feasible in the second trimester and gives additional information in nearly a third of cases. It may provide a clinically valuable adjunct to ultrasound especially in cases of diaphragmatic hernia or oligohydramnios.

  • 52.
    Anders, Larsson
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Lena, Carlsson
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Rasha, Khierallah
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Jan, Holte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Theodora Kunovac, Kallak
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Higher levels of Hepatocyte Growth Factor (HGF) in human seminal plasma in comparison with blood plasma and negative association with several motile sperm cells2023In: Global Journal of Fertility and Research, E-ISSN 2640-7884, Vol. 8, no 1, p. 008-013Article in journal (Refereed)
    Abstract [en]

    Context: Semen is a complex fluid with many functions, some of them well-known, others more obscure.

    Aims: The aim of this study was to investigate the levels of Hepatocyte Growth Factor (HGF) in human seminal plasma in comparison with blood plasma levels.

    Methods: HGF concentrations were measured in seminal plasma from 40 men utilizing commercial ELISA kits. Blood plasma from 40 healthy blood donors served as a comparison group.

    Results: Median seminal plasma HGF was approximately five times higher than the levels found in blood plasma (5717.5 pg/mL vs. 1124.6 pg/mL). There was a negative correlation between HGF values in seminal plasma and the number of sperm cells.

    Conclusion: The study shows that seminal plasma contains high levels of HGF and that HGF binds to prostasomes. Male HGF can thus reach the female reproductive tract during unprotected sexual intercourse. Further studies are warranted to evaluate the effect of this on fertility.

  • 53.
    Andersson, Anneli
    et al.
    Örebro Univ, Sch Behav Social & Legal Sci, Örebro, Sweden..
    Garcia-Argibay, Miguel
    Örebro Univ, Sch Med Sci, Örebro, Sweden..
    Viktorin, Alexander
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden..
    Ghirardi, Laura
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden..
    Butwicka, Agnieszka
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden.;Stockholm Hlth Care Serv, Child & Adolescent Psychiat Stockholm, Stockholm, Region Stockhol, Sweden.;Med Univ Lodz, Dept Biostat & Translat Med, Lodz, Poland..
    Skoglund, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Madsen, Kathrine Bang
    Aarhus Univ, Natl Ctr Register based Res Business & Social Sci, Aarhus, Denmark..
    D'onofrio, Brian M.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden.;Indiana Univ, Dept Psychol & Brain Sci, Bloomington, IN USA.;Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Lichtenstein, Paul
    Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden..
    Tuvblad, Catherine
    Örebro Univ, Sch Behav Social & Legal Sci, Örebro, Sweden.;Univ Southern Calif, Dept Psychol, Los Angeles, CA USA..
    Larsson, Henrik
    Örebro Univ, Sch Med Sci, Örebro, Sweden.;Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden..
    Depression and anxiety disorders during the postpartum period in women diagnosed with attention deficit hyperactivity disorder2023In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 325, p. 817-823Article in journal (Refereed)
    Abstract [en]

    Background: Attention deficit hyperactivity disorder (ADHD) is associated with an increased risk of poor mental health. However, the understanding of ADHD-related burden and impairments in women during the postpartum period is limited. The aim with the present study was to examine the risk of depression and anxiety disorders during the postpartum period among women with and without an ADHD diagnosis.

    Methods: We used register-based data to identify women who gave birth to their first and/or second child between 2005 and 2013 in Sweden (n = 773,047), of which 0.5 % (n = 3515) had a diagnosis of ADHD prior to pregnancy. Diagnoses of depression and anxiety disorders up to one year after delivery were collected from the national patient register.

    Results: A total of 16.76 % of the women with an ADHD diagnosis were also diagnosed with depression disorders in the postpartum period, prevalence ratio (PR) 5.09 (95 % confidence interval (CI), 4.68-5.54). A total of 24.92 % of the women with an ADHD diagnosis were also diagnosed with anxiety disorders in the postpartum period, PR 5.41 (5.06-5.78). Stratified results revealed that having a diagnosis of ADHD increased the risk for both depression and anxiety disorders postpartum, beyond other well-known risk factors.Limitations: There is a potential risk of surveillance bias as women diagnosed with ADHD are more likely to have repeated visits to psychiatric care and might have an enhanced likelihood of also being diagnosed with depression and anxiety disorders postpartum, compared to women without ADHD.

    Conclusions: ADHD is an important risk factor for both depression and anxiety disorders postpartum. Therefore, ADHD needs to be considered in the maternal care, regardless of sociodemographic factors and the presence of other psychiatric disorders.

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  • 54.
    Andersson, Ola
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Department of Research and Development, Region Halland, Sweden.
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Domellöf, Magnus
    Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
    Elective caesarean: does delay in cord clamping for 30 s ensure sufficient iron stores at 4 months of age? A historical cohort control study2016In: BMJ Open, E-ISSN 2044-6055, Vol. 6, no 11, article id e012995Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare iron stores in infants born after elective caesarean section (CS) and a 30 s delay of umbilical cord clamping with those born vaginally after early (≤10 s) or delayed (≥180 s) cord clamping.

    DESIGN: Prospective observational study with historical control.

    SETTING: Swedish county hospital.

    POPULATION: 64 infants born after elective CS were compared with a historical control of 166 early clamped and 168 delayed clamped after vaginal birth.

    METHODS: Blood and iron status were measured in blood samples collected at birth, 48-96 hours after birth, 4 and 12 months of age.

    PRIMARY AND SECONDARY OUTCOME MEASURES: Ferritin at 4 months of age was the primary outcome, second outcome measures were other indicators of iron status, and haemoglobin, at 4 and 12 months of age, as well as respiratory distress at 1 and 6 hours after birth.

    RESULTS: At 4 months infants born by elective CS had better iron status than those born vaginally subjected to early cord clamping, shown by higher adjusted mean difference of ferritin concentration (39 µg/L (95% CI 10 to 60)) and mean cell volume (1.8 fL (95% CI 0.6 to 3.0)); and lower levels of transferrin receptors (-0.39 mg/L (95% CI -0.69 to -0.08)). No differences were seen between infants born after elective CS and delayed clamped vaginally born infants at 4 months. No differences were found between groups at 12 months of age.

    CONCLUSIONS: Waiting to clamp the umbilical cord for 30 s after elective CS results in higher iron stores at 4 months of age compared with early cord clamping after vaginal birth, and seems to ensure iron status comparable with those achieved after 180 s delayed cord clamping after vaginal birth.

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  • 55.
    Andersson, Sam
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Bathula, Deepti. R.
    Department of Computer Science and Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, 140001, India.
    Iliadis, Stavros I.
    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.
    Walter, Martin
    Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany; Department of Psychiatry and Psychotherapy, Eberhardt Karls University, Tübingen, Germany; Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.
    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.
    Predicting women with depressive symptoms postpartum with machine learning methods2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 7877Article in journal (Refereed)
    Abstract [en]

    Postpartum depression (PPD) is a detrimental health condition that affects 12% of new mothers. Despite negative effects on mothers' and children's health, many women do not receive adequate care. Preventive interventions are cost-efficient among high-risk women, but our ability to identify these is poor. We leveraged the power of clinical, demographic, and psychometric data to assess if machine learning methods can make accurate predictions of postpartum depression. Data were obtained from a population-based prospective cohort study in Uppsala, Sweden, collected between 2009 and 2018 (BASIC study, n = 4313). Sub-analyses among women without previous depression were performed. The extremely randomized trees method provided robust performance with highest accuracy and well-balanced sensitivity and specificity (accuracy 73%, sensitivity 72%, specificity 75%, positive predictive value 33%, negative predictive value 94%, area under the curve 81%). Among women without earlier mental health issues, the accuracy was 64%. The variables setting women at most risk for PPD were depression and anxiety during pregnancy, as well as variables related to resilience and personality. Future clinical models that could be implemented directly after delivery might consider including these variables in order to identify women at high risk for postpartum depression to facilitate individualized follow-up and cost-effectiveness.

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  • 56.
    Angeby, Karin
    et al.
    Cent Hosp Karlstad, Womens Dept, Karlstad, Sweden.;Karlstad Univ, Dept Hlth Sci, Fac Hlth Sci & Technol, SE-61588 Karlstad, Sweden..
    Wilde-Larsson, Bodil
    Karlstad Univ, Dept Hlth Sci, Fac Hlth Sci & Technol, SE-61588 Karlstad, Sweden.;Hedmark Univ Coll, Fac Publ Hlth, Dept Nursing & Mental Hlth, Elverum, Norway..
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Mid Sweden Univ, Sundsvall, Sweden. Karoliniska Inst, Stockholm, Sweden..
    Sandin-Bojo, Ann-Kristin
    Karlstad Univ, Dept Hlth Sci, Fac Hlth Sci & Technol, SE-61588 Karlstad, Sweden.;Univ Boras, Sch Hlth Sci, Boras, Sweden..
    Primiparous women's preferences for care during a prolonged latent phase of labour2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 3, p. 145-150Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate primiparous women's preferences for care during a prolonged latent phase of labour. Methods: A qualitative study based on focus groups and individual interviews and analysed with inductive content analysis. Results: Sixteen primiparous women with a prolonged latent phase of labour >18 hours were interviewed in five focus groups (n = 11) or individually (n = 5). One main category emerged "Beyond normality - a need of individual adapted guidance in order to understand and manage an extended latent phase of labour" which covers the women's preferences during the prolonged latent phase. Five categories were generated from the data: "A welcoming manner and not being rejected", "Individually adapted care", "Important information which prepares for reality and coping", "Participation and need for feedback" and "Staying nearby the labour ward or being admitted for midwifery support". Women with a prolonged latent phase of labour sought to use their own resources, but their needs for professional support increased as time passed. A welcoming attitude from an available midwife during the latent phase created a feeling of security, and personally adapted care was perceived positively. Conclusions: Women with a prolonged latent phase of labour preferred woman-centred care. Midwives play an important role in supporting these women. Women's need for midwifery-support increases as the time spent in latent phase increases.

  • 57. Angeles Martinez-Maestre, Maria
    et al.
    Gambadauro, Pietro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Gonzalez-Cejudo, Carmen
    Torrejon, Rafael
    Total Laparoscopic Hysterectomy With and Without Robotic Assistance: A Prospective Controlled Study2014In: Surgical Innovation, ISSN 1553-3506, E-ISSN 1553-3514, Vol. 21, no 3, p. 250-255Article in journal (Refereed)
    Abstract [en]

    Background. Hysterectomies are very common, and most of them are still performed abdominally. The minimally invasive alternatives are perceived as difficult by gynecologists. Robotic assistance is thought to facilitate laparoscopic surgery. The aim of this study was to compare the surgical outcomes of robotic-assisted and conventional total laparoscopic hysterectomy. Methods. Patients, candidate to hysterectomy for benign indications, were allocated to either robotic or conventional laparoscopy in a quasi-randomized fashion. Patients were operated following a standardized surgical protocol. Main outcome measures were total surgical time, conversions to laparotomy, blood loss, hospital stay, and complications. Results. Fifty-one patients underwent robotic hysterectomy (mean age = 46.59 years) and 54 conventional laparoscopy (mean age = 50.02 years). The groups were homogeneous in body mass index and uterine weight. Robotic-assisted hysterectomies were significantly shorter (154.63 +/- 36.57 vs 185.65 +/- 42.98 minutes in the control group; P =.0001). Patients in the robotic group also had a significantly smaller reduction in hemoglobin (9.69% +/- 8.88% vs 15.29% +/- 8.39% in controls; P =.0012) and hematocrit (10.56% +/- 8.3% vs 14.89% +/- 8.11%; P =.008). No intraoperative conversions to laparotomy were required. Complication rate was low and similar in both groups. All patients were fully recovered at 1-month follow-up outpatient visit. Conclusions. Significantly lower operative times and blood loss indicate that robotic assistance can facilitate surgery already during the learning curve period. Nevertheless, proficiency can be reached in conventional laparoscopy through training, and the cost-effectiveness of robotic hysterectomy for benign conditions is yet to be confirmed.

  • 58.
    Ankarcrona, Victoria
    et al.
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.
    Altman, Daniel
    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.
    Jacobsson, Bo
    Univ Gothenburg, Inst Clin Sci, Dept Obstet & Gynecol, Sahlgrenska Acad, Gothenburg, Sweden;Inst Publ Hlth, Dept Genet & Bioinformat, Domain Hlth Data & Digitalizat, Oslo, Norway.
    Wendel, Sophia Brismar
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden;Karolinska Inst, Dept Med, Clin Epidemiol Div, Stockholm, Sweden.
    Delivery outcome after trial of labor in nulliparous women 40 years or older-A nationwide population-based study2019In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 9, p. 1195-1203Article in journal (Refereed)
    Abstract [en]

    Introduction The number of women postponing childbirth until an advanced age is increasing. Our aim was to study the outcome of labor in nulliparous women >= 40 years, compared with women 25-29 years, after both spontaneous onset and induction of labor. Material and methods The nationwide population-based Swedish Medical Birth Register was used to study the perinatal outcome in nulliparous women with a singleton, term (gestational weeks 37-44), live fetus in cephalic presentation and a planned vaginal delivery from 1992 to 2011. We included 7796 nulliparous women >= 40 years and 264 262 nulliparous women 25-29 years. Prevalence and risk of intrapartum cesarean section, operative vaginal delivery, obstetric anal sphincter injury and a 5-minute Apgar score <7 were calculated for women >= 40 years stratified for spontaneous onset and induction of labor, using women 25-29 years as the reference in both strata. Crude and adjusted odds ratios (aOR) were calculated by unconditional logistic regression and presented with 95% confidence intervals (CI). Results Overall, 79% of women >= 40 years with a trial of labor reached a vaginal delivery. After spontaneous onset, intrapartum cesarean section was performed in 15.4% of women >= 40 years compared with 5.4% of women 25-29 years (aOR 3.07, 95% CI 2.81-3.35). Operative vaginal delivery was performed in 22.3% of women >= 40 years compared with 14.2% of women 25-29 years (aOR 1.71, 95% CI 1.59-1.85). After induction of labor, an intrapartum cesarean section was performed in 37.2% women >= 40 years compared with 20.2% women 25-29 years (aOR 2.51, 95% CI 2.24-2.81). Operative vaginal delivery was performed in 22.6% of women >= 40 years compared with 18.4% women 25-29 years (aOR 1.45, 95% CI 1.28-1.65). The risk of obstetric anal sphincter injury or a 5-minute Apgar score <7 was not increased in women >= 40 years, regardless of onset of labor. Conclusions Trial of labor ended in vaginal delivery in 79% of nulliparous women >= 40 years. The risks of intrapartum cesarean section and operative vaginal delivery were higher in women >= 40 years compared with women 25-29 years, after both spontaneous onset and induction of labor. The risk of obstetric anal sphincter injury or a 5-minute Apgar score <7 was not increased.

  • 59.
    Ankarcrona, Victoria
    et al.
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.;Danderyd Hosp, Dept Obstet & Gynecol, S-18288 Stockholm, Sweden..
    Hesselman, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna.
    Kallner, Helena Kopp
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.;Danderyd Hosp, Dept Obstet & Gynecol, S-18288 Stockholm, Sweden..
    Wendel, Sophia Brismar
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.;Danderyd Hosp, Dept Obstet & Gynecol, S-18288 Stockholm, Sweden..
    Attitudes and knowledge regarding episiotomy use and technique in vacuum extraction: A web-based survey among doctors in Sweden2022In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 269, p. 62-70Article in journal (Refereed)
    Abstract [en]

    Objectives: Correct episiotomy use and technique may prevent obstetric anal sphincter injuries. We aimed to explore the attitudes, use, and technique regarding episiotomy among doctors in Sweden, and their willingness to contribute to a randomized controlled trial of lateral episiotomy or no episiotomy in vacuum extraction in nulliparous women.

    Study design: A web-based survey was sent to members of the Swedish Society of Obstetrics and Gynecology (n = 2140). The survey included 31 questions addressing personal characteristics, use of episiotomy, a two-dimensional picture on which the respondents drew an episiotomy, and questions regarding attitudes towards episiotomy and participation in a randomized controlled trial. We calculated the proportion of supposedly protective episiotomies (fulfilling criteria of a lateral or mediolateral episiotomy and a length >= 30 mm). We compared the results between obstetricians, gynecologists, and residents using Chi-square and Kruskal-Wallis tests for differences between groups, and logistic regression to estimate the odds ratio (OR) of drawing a protective episiotomy.

    Results: We received 432 responses. Doctors without a vacuum delivery in the past year were excluded, leaving 384 respondents for further analyses. In all, 222 (57.8%) doctors reported use of episiotomy in<50% of vacuum extractions. We obtained 308 illustrated episiotomies with a median angle of 53 degrees, incision point distance from the midline of 21 mm, and length of 36 mm, corresponding to a lateral episiotomy. Few doctors combined these parameters correctly resulting in 167 (54.2%) incorrectly drawn episiotomies. Residents drew shorter episiotomies than obstetricians and gynecologists. Doctors ranked episiotomy the least important intervention to prevent obstetric anal sphincter injuries in vacuum extraction. Doctors contributing to an ongoing randomized controlled trial of lateral episiotomy or no episiotomy in vacuum extraction were more able to draw a protective episiotomy (OR 3.69, 95% confidence interval 1.94-7.02).

    Conclusions: Doctors in Sweden reported restrictive use of episiotomy in vacuum extraction and depicted lateral type episiotomies, although the majority were incorrectly drawn. Preventive episiotomy was ranked of low importance. Our results imply a need for education, training, and guidelines to increase uptake of correct episiotomy technique, which could result in improved prevention of obstetric anal sphincter injuries.

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  • 60.
    Ankarcrona, Victoria
    et al.
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.;Danderyd Hosp, Dept Obstet & Gynecol, S-18288 Stockholm, Sweden..
    Karlstrom, Sofie
    Karolinska Univ Hosp, Dept Obstet & Gynecol, Huddinge, Sweden..
    Sylvan, Sissela
    Danderyd Hosp, Dept Obstet & Gynecol, S-18288 Stockholm, Sweden..
    Starck, Marianne
    Skane Univ Hosp, Dept Surg, Pelv Floor Ctr, Malmö, Sweden..
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Wendel, Sophia Brismar
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.;Danderyd Hosp, Dept Obstet & Gynecol, S-18288 Stockholm, Sweden..
    Episiotomy in vacuum extraction, do we cut the levator ani muscle?: A prospective cohort study2022In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 33, no 12, p. 3391-3399Article in journal (Refereed)
    Abstract [en]

    Introduction and hypothesis Vaginal delivery may lead to levator ani muscle (LAM) injury or avulsion. Episiotomy may reduce obstetric anal sphincter injury in operative vaginal delivery, but may increase the risk of LAM injury. Our aim was to assess whether lateral episiotomy in vacuum extraction (VE) in primiparous women causes LAM injury. Methods A prospective cohort study of 58 primiparous women with episiotomy nested within an ongoing multicenter randomized controlled trial of lateral episiotomy versus no episiotomy in VE (EVA trial) was carried out in Sweden. LAM injury was evaluated using 3D endovaginal ultrasound 6-12 months after delivery and Levator Ani Deficiency (LAD) score. Episiotomy scar properties were measured. Characteristics were described and compared using Chi-squared tests. We stipulated that if a lateral episiotomy cuts the LAM, >= 50% would have a LAM injury. Among those, >= 50% would be side specific. We compared the observed prevalence with a test of one proportion. Results Twelve (20.7%, 95% CI 10.9-32.9) of 58 women had a LAD (p < 0.001, compared with the stipulated 50%). Six (50.0%, 95% CI 21.1% to 78.9%) of 12 women had a LAD on the episiotomy side, including those with bilateral LAD (p = 1.00). Two (16.7%, 95% CI 2.1% to 48.4%) of 12 women had a LAD exclusively on the episiotomy side (p = 0.02). Conclusions There was no excessive risk of cutting the LAM while performing a lateral episiotomy. LAD was not seen in women with episiotomies shorter than 18 mm.

  • 61.
    Aravidis, Christos
    et al.
    Univ Athens, Sch Med, Evangelismos Hosp, Crit Care Dept,Cytogenet Unit, GR-11527 Athens, Greece..
    Konialis, Christopher P.
    Intergenet Hellas, Diagnost Genet Ctr, Dept Mol Genet & Preimplantat Genet Diag, Athens, Greece..
    Pangalos, Constantinos G.
    Intergenet Hellas, Diagnost Genet Ctr, Dept Mol Genet & Preimplantat Genet Diag, Athens, Greece..
    Kosmaidou, Zoi
    Alexandra Hosp, Dept Genet, Athens, Greece..
    A familial case of Muenke syndrome. Diverse expressivity of the FGFR3 Pro252Arg mutation - case report and review of the literature2014In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 27, no 14, p. 1502-1506Article, review/survey (Refereed)
    Abstract [en]

    Muenke is a fibroblast growth factor receptor 3 (FGFR-3)-associated syndrome, which was first described in late 1990s. Muenke syndrome is an autosomal dominant disorder characterized mainly by coronal suture craniosynostosis, hearing impairment and intellectual disability. The syndrome is defined molecularly by a unique point mutation c.749C>G in exon 7 of the FGFR3 gene which results to an amino acid substitution p. Pro250Arg of the protein product. Despite the fact that the mutation rate at this nucleotide is one of the most frequently described in human genome, few Muenke familial case reports are published in current literature. We describe individuals among three generations of a Greek family who are carriers of the same mutation. Medical record and physical examination of family members present a wide spectrum of clinical manifestations. In particular, a 38-year-old woman and her father appear milder clinical findings regarding craniofacial characteristics compared to her uncle and newborn female child. This familial case illustrates the variable expressivity of Muenke syndrome in association with an identical gene mutation.

  • 62.
    Arffman, R. K.
    et al.
    Univ Oulu, Oulu Univ Hosp, Med Res Ctr, Dept Obstet & Gynecol,PEDEGO Res Unit, Oulu, Finland.
    Saraswat, M.
    Univ Helsinki, Haartman Inst, Transplantat Lab, Helsinki, Finland;Helsinki Univ Hosp, HUSLAB, Helsinki, Finland.
    Joenväärä, S.
    Univ Helsinki, Haartman Inst, Transplantat Lab, Helsinki, Finland;Helsinki Univ Hosp, HUSLAB, Helsinki, Finland.
    Khatun, M.
    Univ Oulu, Oulu Univ Hosp, Med Res Ctr, Dept Obstet & Gynecol,PEDEGO Res Unit, Oulu, Finland.
    Agarwal, R.
    All India Inst Med Sci, Dept Reprod Biol, New Delhi 110029, India.
    Tohmola, T.
    Univ Helsinki, Haartman Inst, Transplantat Lab, Helsinki, Finland;Helsinki Univ Hosp, HUSLAB, Helsinki, Finland.
    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.
    Renkonen, R.
    Univ Helsinki, Haartman Inst, Transplantat Lab, Helsinki, Finland;Helsinki Univ Hosp, HUSLAB, Helsinki, Finland.
    Piltonen, T. T.
    Univ Oulu, Oulu Univ Hosp, Med Res Ctr, Dept Obstet & Gynecol,PEDEGO Res Unit, Oulu, Finland.
    Thromboinflammatory changes in plasma proteome of pregnant women with PCOS detected by quantitative label-free proteomics2019In: Scientific Reports, E-ISSN 2045-2322, Vol. 9, article id 17578Article in journal (Refereed)
    Abstract [en]

    Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder of fertile-aged women. Several adverse pregnancy outcomes and abnormalities of the placenta have been associated with PCOS. By using quantitative label-free proteomics we investigated whether changes in the plasma proteome of pregnant women with PCOS could elucidate the mechanisms behind the pathologies observed in PCOS pregnancies. A total of 169 proteins with >= 2 unique peptides were detected to be differentially expressed between women with PCOS (n = 7) and matched controls (n = 20) at term of pregnancy, out of which 35 were significant (p-value < 0.05). A pathway analysis revealed that networks related to humoral immune responses, inflammatory responses, cardiovascular disease and cellular growth and proliferation were affected by PCOS. Classification of cases and controls was carried out using principal component analysis, orthogonal projections on latent structure-discriminant analysis (OPLS-DA), hierarchical clustering, self-organising maps and ROC-curve analysis. The most significantly enriched proteins in PCOS were properdin and insulin-like growth factor II. In the dataset, properdin had the best predictive accuracy for PCOS (AUC=1). Additionally, properdin abundances correlated with AMH levels in pregnant women.

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  • 63.
    Armuand, G. M.
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Nilsson, J.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Rodriguez-Wallberg, K. A.
    Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden.;Karolinska Univ Hosp, Reprod Med, Stockholm, Sweden..
    Malmros, J.
    Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Paediat Oncol Unit, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Arvidson, Johan
    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), Neuropediatrics/Paediatric oncology.
    Lampic, C.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Wettergren, L.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Physicians' self-reported practice behaviour regarding fertility-related discussions in paediatric oncology in Sweden2017In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 26, no 10, p. 1684-1690Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to investigate practice behaviours of Swedish physicians with regard to discussing the impact of cancer treatment on fertility with paediatric oncology patients and their parents, and to identify factors associated with such discussions.

    Methods: A cross-sectional survey study was conducted targeting all physicians in Sweden working in paediatric oncology care settings. Participants responded to a questionnaire measuring practice behaviour, attitudes, barriers, and confidence in knowledge. Multivariable logistic regression was used to determine factors associated with seldom discussing fertility.

    Results: More than half of the physicians routinely talked with their patients/parents about the treatment's potential impact on fertility (male patients: 62%; female patients: 57%; P = 0.570). Factors associated with less frequently discussing fertility with patients/parents were working at a non-university hospital (male patients: OR 11.49, CI 1.98-66.67; female patients: OR 33.18, CI 4.06-271.07), concerns that the topic would cause worry (male patients: OR 8.23, CI 1.48-45.89; female patients: OR 12.38, CI 1.90-80.70), and perceiving the parents as anxious (male patients: OR 7.18, CI 1.20-42.85; female patients: OR 11.65, CI 1.32-103.17).

    Conclusions: Based on our findings, we recommend structured training in how to communicate about fertility issues in stressful situations, which in turn might increase fertility-related discussions in paediatric oncology.

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  • 64. Armuand, Gabriela
    et al.
    Grandahl, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Volgsten, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Stern, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Department of Health Promotion, Sophiahemmet University, Stockholm, Sweden.
    Characteristics of good contraceptive counselling: An interview study2024In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 39, article id 100948Article in journal (Refereed)
    Abstract [en]

    Objective

    One key component in preventing unplanned pregnancies is to provide effective contraceptive counselling. This study aimed to investigate what characterises good contraceptive counselling from the woman's perspective.

    Methods

    A qualitative study with a phenomenological approach. Twenty-four women aged 15–45 participated in semi-structured, individual, face-to-face interviews that lasted, on average, one hour. Data were analysed by latent content analysis.

    Results

    One overall theme emerged, person-centred contraceptive counselling – an interactive process, with three main categories: (i) a trustworthy healthcare provider, (ii) creating a liaison and (iii) the right time and place.

    Conclusions

    The healthcare provider’s attributes as well as what happened between the healthcare provider and the woman, and the surrounding context, had a bearing on the women’s descriptions of good contraceptive counselling. The process of the counselling was described as more important than the actual outcome; thus, healthcare providers need to be aware that this seemingly straightforward consultation is rather multi-layered and has great health promoting potential.

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  • 65.
    Armuand, Gabriela
    et al.
    Linkoping Univ, Fac Hlth Sci, Dept Clin & Expt Med, Linkoping, Sweden.
    Skoog Svanberg, Agneta
    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.
    Bladh, Marie
    Linkoping Univ, Fac Hlth Sci, Dept Clin & Expt Med, Linkoping, Sweden.
    Sydsjö, Gunilla
    Linkoping Univ, Fac Hlth Sci, Dept Clin & Expt Med, Linkoping, Sweden.
    Adverse obstetric outcomes among female childhood and adolescent cancer survivors in Sweden: A population-based matched cohort study2019In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 12, p. 1603-1611Article in journal (Refereed)
    Abstract [en]

    Introduction: Cancer treatment during childhood may lead to late adverse effects, such as reduced musculoskeletal development or vascular, endocrine and pulmonary dysfunction, which in turn may have an adverse effect on later pregnancy and childbirth. The aim of the present study was to investigate pregnancy and obstetric outcomes as well as the offspring's health among childhood and adolescent female cancer survivors.

    Material and methods: This register-based study included all women born between 1973 and 1977 diagnosed with cancer in childhood or adolescence (age <21), as well as an age-matched comparison group. A total of 278 female cancer survivors with their first childbirth were included in the study, together with 829 age-matched individuals from the general population. Logistic regression and analysis of variance were used to investigate associations between having been treated for cancer and the outcome variables, adjusting for maternal age, nicotine use and comorbidity.

    Results: Survivors were more likely to have preeclampsia (adjusted odds ratio [aOR] 3.46, 95% confidence interval [CI] 1.58 to 7.56), undergo induction of labor (aOR 1.66, 95% CI 1.05 to 2.62), suffer labor dystocia (primary labor dystocia aOR 3.54, 95% CI 1.51 to 8.34 and secondary labor dystocia aOR 2.43, 95% CI 1.37 to 4.31), malpresentation of fetus (aOR 2.02, 95% CI 1.12 to 3.65) and imminent fetal asphyxia (aOR 2.55, 95% CI 1.49 to 4.39). In addition, deliveries among survivors were more likely to end with vacuum extraction (aOR 2.53, 95% CI 1.44 to 4.47), with higher risk of clitoral lacerations (aOR 2.18, 95% CI 1.47 to 3.23) and anal sphincter injury (aOR 2.76, 95% CI 1.14 to 6.70) and emergency cesarean section (aOR 2.34 95% CI 1.39 to 3.95). Survivors used pain-reliving methods to a higher extent compared with the comparison group. There was no increased risk of neonate diagnoses and malformations. The results showed that survivors who had been diagnosed with cancer when they were younger than 14 had an increased risk of adverse obstetric outcomes.

    Conclusions: The study demonstrates increased risk of pregnancy and childbirth complications among childhood and adolescent cancer survivors. There is a need to optimize perinatal care, especially among survivors who were younger than 14 at time of diagnosis.

  • 66. Armuand, Gabriela
    et al.
    Skoog Svanberg, Agneta
    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.
    Lampic, Claudia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Department of Women’s and Children’s Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
    Elenis, Evangelia
    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.
    Sydsjö, Gunilla
    Attitudes among paediatric healthcare professionals in Sweden towards sperm donation to single women: a survey study2020In: Fertility Research and Practice, ISSN 2054-7099, Vol. 6, article id 9Article in journal (Refereed)
    Abstract [en]

    Background: The number of families conceived through sperm donation to single women is increasing. However, there is limited knowledge about health care professionals' attitudes towards solo-mothers by choice, and there is some indication that professionals' personal opinions influence their care of individuals who use alternate ways to build a family. The primary aim of the study was to investigate attitudes towards, and experiences of, families following sperm donation to single women among healthcare professionals working in primary child healthcare.

    Methods: Between April and November 2016 a total of 712 physicians, registered nurses and psychologists working within primary healthcare in Sweden were invited to participate in a cross-sectional online survey study. The study-specific questionnaire contained the following four domains: Attitudes towards legalization and financing, Attitudes towards the family and the child's health, Clinical experience and Knowledge about sperm donation to single women.

    Results: The majority of the participants were positive or neutral towards sperm donation being allowed to single women in Sweden. However, one third believed that children risk worse mental health and social stigma. Half of healthcare professionals had own clinical experience of caring for solo-mothers by choice and their children, and of these one third perceived that these families had more need of support than other parents. One out of four indicated that they did not have sufficient knowledge to be able to provide adequate care to these families.

    Conclusions: The present results indicate that while there was a relatively large support for sperm donation being allowed to single women in Sweden among health care professionals, many expressed concerns about the child's health, as well as low confidence in their knowledge about the specific needs in this patient group. There is a need for educational interventions targeted to healthcare professionals in primary child healthcare in order to provide adequate care to solo-mothers by choice and their children.

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  • 67.
    Armuand, Gabriela
    et al.
    Linkoping Univ, Dept Clin & Expt Med, Fac Hlth Sci, SE-58183 Linkoping, Sweden.
    Sydsjo, Gunilla
    Linkoping Univ, Dept Clin & Expt Med, Fac Hlth Sci, SE-58183 Linkoping, Sweden;Cty Council Ostergotland, Dept Gynaecol & Obstet Linkoping, Linkoping, Sweden.
    Skoog Svanberg, Agneta
    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.
    Lampic, Claudia
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden.
    Attitudes towards embryo donation among healthcare professionals working in child healthcare: a survey study2019In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 19, article id 209Article in journal (Refereed)
    Abstract [en]

    BackgroundThe aim of this study was to investigate attitudes towards embryo donation and embryo donation families among professionals working in primary child healthcare, and their experiences of these families.MethodsA cross-sectional online survey was conducted in Sweden between April and November 2016. A total of 712 primary healthcare physicians, registered nurses and psychologists were approached to participate in this study. The study-specific questionnaire measured attitudes and experiences in the following four domains: legalisation and financing, the family and the child's health, clinical experience of meeting families following embryo donation, and knowledge of embryo donation.ResultsOf the 189 women and 18 men who completed the questionnaire (response rate 29%), relatively few (13%) had clinical experience of caring for families following embryo donation. Overall, 69% supported legalisation of embryo donation for infertile couples, and 54% agreed it should be publicly funded. The majority (88%) agreed the child should have the right to know the donors' identity. Respondents did not believe that children conceived through embryo donation are as healthy as other children (50%), citing the risks of poor mental health (17%) and social stigmatization (18%). Approximately half reported low confidence in their own knowledge of embryo donation (47%) and wanted to know more (58%).ConclusionsThese results indicate relatively large support among healthcare professionals in Sweden for the legalisation of embryo donation. In order to provide adequate healthcare to families following embryo donation, there is a need to develop educational resources to increase knowledge about the medical and psychosocial consequences of embryo donation among healthcare professionals working in primary healthcare.

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  • 68.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Carlbom, Aje
    Faculty of Health and Society, Malmö University, Sweden.
    Culture and religious beliefs in relation to reproductive health2016In: Baillière's Best Practice & Research: Clinical Obstetrics & Gynaecology, ISSN 1521-6934, E-ISSN 1532-1932, Vol. 32, p. 77-87Article in journal (Refereed)
    Abstract [en]

    An increasing number of contemporary research publications acknowledge the influence of religion and culture on sexual and reproductive behavior and health-care utilization. It is currently hypothesized that religious influences can partly explain disparities in sexual and reproductive health outcomes. In this paper, we will pay particular attention to Muslims in sexual and reproductive health care. This review reveals that knowledge about devout Muslims' own experience of sexual and reproductive health-care matters is limited, thus providing weak evidence for modeling of efficient practical guidelines for sexual and reproductive health care directed at Muslim patients. Successful outcomes in sexual and reproductive health of Muslims require both researchers and practitioners to acknowledge religious heterogeneity and variability, and individuals' possibilities to negotiate Islamic edicts. Failure to do so could lead to inadequate health-care provision and, in the worst case, to suboptimal encounters between migrants with Muslim background and the health-care providers in the receiving country.

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  • 69.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, Aje
    Malmo Univ, Fac Hlth & Soc, S-20506 Malmo, Sweden.
    Johnsdotter, Sara
    Malmo Univ, Fac Hlth & Soc, S-20506 Malmo, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Are 'low socioeconomic status' and 'religiousness' barriers to minority women's use of contraception? A qualitative exploration and critique of a common argument in reproductive health research2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 75, p. 59-65Article in journal (Refereed)
    Abstract [en]

    Objective: 'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions.

    Design: Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016.

    Findings: We found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established.

    Conclusion: We have shown that the dominant theory that 'low socioeconomic status' and 'religiousness' are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception.

    Implications for practice: This study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals' health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling.

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  • 70.
    Arvidson, Johan
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Autologous bone marrow transplantation in childhood: A follow-up study1998Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Autologous bone marrow transplantation (ABMT) was introduced to the Uppsala UniversityHospital in 1985. Since then, 50 children (<18 years of age) with haematological malignantdisease have been treated with ABMT. Most of these children had experienced a relapse oftheir disease, and ABMT was superimposed on preceding heavy treatment. The aim of thepresent study was to evaluate late adverse effects in five areas:

    Pulmonary and cardiac function were studied longitudinally. Six months after ABMT, adecrease in lung volumes and flow rates was observed in patients who received total bodyirradiation in their preparative regimen . There were signs of recovery during the following sixmonths, although incomplete. No further deterioration of pulmonary functioning wasobserved from the follow-up visit at 1 year after ABMT and thereafter. Cardiac function, asmeasured by echocardiography and radionuclide ventriculography, did not change frombefore ABMT until the last follow-up measurement (median 7 years post-transplant).

    Neuropsychological and psychosocial functioning were assessed in two cross-sectionalstudies. In addition, tests for general intelligence had been performed longitudinally.Intelligence test results did not change over time. Selective neuropsychological deficits andlearning difficulties were found despite normal results in general intelligence tests. Parentsand teachers reported more behavioural problems, mostly of the internalising type, andparents reported lower school competence relative to normative samples. According to theself-reports, most children were well adapted to the altered life conditions. It was concludedthat the psychosocial functioning seen in children treated with ABMT was dependent on thetype of informant used.

    Prepubertal growth was normal and relative height did not change from initial diagnosisexcept in those children treated with cranial irradiation before ABMT. Measurements ofgrowth hormone were made longitudinally, where all children showed signs of impairedspontaneous growth hormone secretion, irrespective of previous cranial irradiation orpreparative regimen.

  • 71.
    Arvidsson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Challenges of transnational parenthood: Exploring different perspectives of surrogacy in Sweden and India2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Transnational surrogacy challenges traditional norms of parenthood, especially motherhood; additionally, it is viewed as the exploitation of poor women. The overall aim of this thesis was to shed light on the consequences of an unregulated situation on surrogacy in the Swedish and Indian contexts, and to give different perspectives on surrogacy and the surrogate. The experiences of using transnational surrogacy and the consequences of using this reproductive method in a context of a largely unregulated situation had rarely been explored at the start of the study. Between 2012 and 2015, qualitative interviews were conducted with commissioning parents in Sweden who used transnational surrogacy mainly in India, as well as with social workers in Sweden, who have handled cases regarding the legal recognition of parenthood. To capture a non-western perspective on surrogacy, the views of women and men in different social strata in Assam, India were explored through individual interviews and focus group discussions. At the start of the project, India was the most common country to turn to for surrogacy. The results reveal that both commissioning parents and social workers needed to navigate inadequate parental legislation, with the result that commissioning parents felt questioned as parents. Social workers tried to balance the protection of the surrogate’s rights with the child’s best interest. The ethical aspects made the users of surrogacy ambivalent, and, for social workers, it resulted in further reluctance to handle legal parenthood cases. However, from an Assamese point of view, no ethical considerations were expressed; instead, the surrogate would either be stigmatized for her act and seen as though she was “selling her child,” or seen as a woman doing a noble act, helping a childless couple. All the informants demonstrated a pragmatic view of legal parenthood, but the current legal situation in Sweden limits the scope to act as parents in relation to society, because of the length of time it takes to be recognized as legal parents. This comes with a risk for children. From the perspective of reproductive justice, a clearer regulation on surrogacy, and kinship rules that are more adjusted to the current family practice, are needed. Additionally, to limit the risks for all parties involved in the surrogacy process, a more transparent surrogacy process is needed.

    List of papers
    1. Views of Swedish commissioning parents relating to the exploitation discourse in using transnational surrogacy
    Open this publication in new window or tab >>Views of Swedish commissioning parents relating to the exploitation discourse in using transnational surrogacy
    2015 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 5, article id e0126518Article in journal (Refereed) Published
    Abstract [en]

    Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.

    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:uu:diva-253219 (URN)10.1371/journal.pone.0126518 (DOI)000356768100126 ()25955178 (PubMedID)
    Available from: 2015-05-25 Created: 2015-05-25 Last updated: 2021-06-14Bibliographically approved
    2. Gauging the interests of birth mother and child: a qualitative study of Swedish social workers' experiences of transnational gestational surrogacy
    Open this publication in new window or tab >>Gauging the interests of birth mother and child: a qualitative study of Swedish social workers' experiences of transnational gestational surrogacy
    2018 (English)In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 21, no 1, p. 86-99Article in journal (Refereed) Published
    Abstract [en]

    There are few studies on how social workers deal with cases regarding transnational surrogacy. Our study intends to contribute to filling this gap. In Sweden, surrogacy as an assisted reproductive technology method is not permitted. As a result, many prospective parents have turned abroad, mainly to India, for surrogacy. There are no laws regulating surrogacy in Sweden, and difficulties have arisen in establishing legal parenthood when the parents return with the child. This qualitative interview study with social workers found that legal uncertainty and ethical issues surrounded their handling. With no guidelines, the constructions of parenthood will continue to depend on individual social workers' conflicting views on how to best meet the surrogate mother’s interest and the best interest of the child. Regulationis thus needed to better protect those involved and minimize the contingent aspects of legal handling by individual officials.

    Abstract [sv]

    Det finns få studier om hur socialarbetare handlägger ärenden som berör transnationellt surrogatmoderskap. Vår studie har för avsikt att bidra till att fylla detta tomrum. I Sverige är det inte tillåtet för sjukvården att utföra assisterad befruktning vid surrogatmoderskap. Detta har gjort att människor vänt sig utomlands för denna reproduktionsmetod, främst till Indien. Det finns inga lagar som reglerar surrogatmoderskap i Sverige, vilket har lett till svårigheter vid fastställande av rättsligt föräldraskap när föräldrarna återvänt med barnet. Denna kvalitativa intervjustudie med familjerättssekreterare har funnit att det finns rättslig osäkerhet och etiska frågeställningar som påverkar deras hantering av ärendet. Hur föräldraskap konstrueras i nuläget beror till stor del på enskilda familjerättssekreterares uppfattning om hur man bäst väger surrogatmammans intressen mot vad som är bäst för barnet. Avsaknad av riktlinjer och de etiska frågeställningarna har lett till osäker och olika hantering av ärendena, och en reglering behövs för att bättre skydda de inblandade och öka rättsäkerheten i handläggningen.

    Place, publisher, year, edition, pages
    Informa UK Limited, 2018
    Keywords
    Legal parenthood, Sweden, social workers, transnational commercial surrogacy, construction
    National Category
    Social Work Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:uu:diva-307959 (URN)10.1080/13691457.2016.1256869 (DOI)000417767400008 ()
    Note

    Svensk titel: Avvägningar mellan den biologiska moderns och barnets intressen: En kvalitativ studie av svenska familjerättsekreterares erfarenheter av transnationellt surrogatmoderskap

    Available from: 2016-11-23 Created: 2016-11-23 Last updated: 2023-01-05Bibliographically approved
    3. Surrogate mother – praiseworthy or stigmatized: a qualitative study on perceptions of surrogacy in Assam, India
    Open this publication in new window or tab >>Surrogate mother – praiseworthy or stigmatized: a qualitative study on perceptions of surrogacy in Assam, India
    2017 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1328890Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Surrogacy is a reproductive practice that has been strongly marketed in India as a solution for childless couples. As a result, the number of surrogacy clinics is increasing. Meanwhile, a global discourse on surrogacy, originating from a Western perspective, has characterized surrogacy as being exploitative of women in low-income settings, where poverty drives them to become surrogate mothers.

    OBJECTIVE: This study explored perspectives on surrogacy from men and women in Assam, an Indian state known to be a low-income setting. Surrogacy arrangements in Assam are still uncommon. It can be expected that the dominant global discourses on surrogacy will be unfamiliar to the general population, and the objective was also to position the results within the divergent global discourses of surrogacy.

    METHODS:  In order to explore local views on surrogacy, we conducted individual interviews and focus group discussions with people from various socioeconomic groups in Assam.

    RESULTS: Our findings reveal that people in Assam perceive surrogacy as a good option for a childless couple, as it would result in a child who is a 'blood' relation - something highly desirable for sociocultural reasons. However, the part played by the surrogate mother complicates local views on surrogacy. Most people consider payment to the surrogate mother contrary to societal norms. A surrogate mother is also often judged in a moral light, either as a 'bad mother' for selling her child, or as a 'noble woman' who has helped a childless couple and deserves payment for her services.

    CONCLUSIONS: In order to decrease the stigmatization of women, a regulatory policy is needed that will take into account the complex understandings of surrogacy and perceptions of surrogate mothers in Indian society. In policy, the possible effect of the dominant exploitation discourse needs to be modulated by local understandings of this reproduction method.

    Keywords
    Childlessness, in-vitro fertilization (IVF) surrogacy, low-income setting, motherhood, stigmatization, surrogate mother
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-327390 (URN)10.1080/16549716.2017.1328890 (DOI)000403498600001 ()28604252 (PubMedID)
    Available from: 2017-08-10 Created: 2017-08-10 Last updated: 2020-07-13Bibliographically approved
    4. Being questioned as parents:: An interview studywith Swedish commissioning parents usingtransnational surrogacy
    Open this publication in new window or tab >>Being questioned as parents:: An interview studywith Swedish commissioning parents usingtransnational surrogacy
    2019 (English)In: Reproductive Biomedicine and Society Online, E-ISSN 2405-6618, Vol. 8, p. 23-31Article in journal (Refereed) Published
    Abstract [en]

    This study sought to explore how Swedish parents who had commissioned surrogacy abroad experienced the process ofparenthood recognition. The study consisted of in-depth interviews with five couples and 10 individuals representing 10 additionalcouples who had used surrogacy abroad, mainly in India. The construction of motherhood and fatherhood in the Swedish systemcontradicts how parenthood is defined in the surrogacy process. This study found that the formal recognition of parenthood involved acomplex and frustrating process where the presumption of fatherhood and step-child adoption as grounds for parenthood makepeople feel questioned as parents, negatively affecting parental welfare. Policy makers need to take into account the consequencesof an unregulated situation regarding surrogacy, and focus more on the child–parent relationship when regulating surrogacy.

    Keywords
    assisted reproduction, commissioning parents, transnational surrogacy, parenthood, Sweden, India
    National Category
    Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
    Research subject
    Obstetrics and Gynaecology
    Identifiers
    urn:nbn:se:uu:diva-382882 (URN)10.1016/j.rbms.2018.08.001 (DOI)
    Available from: 2019-05-05 Created: 2019-05-05 Last updated: 2020-07-13Bibliographically approved
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  • 72.
    Arvidsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Reproductive Health and Migration.
    Johnsdotter, Sara
    Department of Social Work, Malmö University, Malmö, Sweden.
    Emmelin, Maria
    Department of Clinical Sciences, Division of Social Medicine and Global Health, Lund University, Lund, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Reproductive Health and Migration.
    Gauging the interests of birth mother and child: a qualitative study of Swedish social workers' experiences of transnational gestational surrogacy2018In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 21, no 1, p. 86-99Article in journal (Refereed)
    Abstract [en]

    There are few studies on how social workers deal with cases regarding transnational surrogacy. Our study intends to contribute to filling this gap. In Sweden, surrogacy as an assisted reproductive technology method is not permitted. As a result, many prospective parents have turned abroad, mainly to India, for surrogacy. There are no laws regulating surrogacy in Sweden, and difficulties have arisen in establishing legal parenthood when the parents return with the child. This qualitative interview study with social workers found that legal uncertainty and ethical issues surrounded their handling. With no guidelines, the constructions of parenthood will continue to depend on individual social workers' conflicting views on how to best meet the surrogate mother’s interest and the best interest of the child. Regulationis thus needed to better protect those involved and minimize the contingent aspects of legal handling by individual officials.

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  • 73.
    Arvidsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Johnsdotter, Sara
    Department of Health and Welfare Studies, Malmö University, Malmö, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Views of Swedish commissioning parents relating to the exploitation discourse in using transnational surrogacy2015In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 5, article id e0126518Article in journal (Refereed)
    Abstract [en]

    Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.

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  • 74.
    Arvidsson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Johnsdotter, Sarah
    Faculty of Health and Society, Malmö University.
    Emmelin, Maria
    Department of Clinical Sciences, Division of Social Medicine and Global Health, Lund University.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Being questioned as parents:: An interview studywith Swedish commissioning parents usingtransnational surrogacy2019In: Reproductive Biomedicine and Society Online, E-ISSN 2405-6618, Vol. 8, p. 23-31Article in journal (Refereed)
    Abstract [en]

    This study sought to explore how Swedish parents who had commissioned surrogacy abroad experienced the process ofparenthood recognition. The study consisted of in-depth interviews with five couples and 10 individuals representing 10 additionalcouples who had used surrogacy abroad, mainly in India. The construction of motherhood and fatherhood in the Swedish systemcontradicts how parenthood is defined in the surrogacy process. This study found that the formal recognition of parenthood involved acomplex and frustrating process where the presumption of fatherhood and step-child adoption as grounds for parenthood makepeople feel questioned as parents, negatively affecting parental welfare. Policy makers need to take into account the consequencesof an unregulated situation regarding surrogacy, and focus more on the child–parent relationship when regulating surrogacy.

  • 75.
    Ashish, K. C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Nepal Country Off, United Nations Childrens Fund, Lalitpur, Nepal..
    Wrammert, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nelin, Viktoria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Ewald, Uwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Clark, Robert
    Latter Day St Char, Salt Lake City, UT USA..
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala Univ, Dept Womens & Childrens Hlth, Int Maternal & Child Hlth, Uppsala, Sweden..
    Level of mortality risk for babies born preterm or with a small weight for gestation in a tertiary hospital of Nepal2015In: BMC Public Health, E-ISSN 1471-2458, Vol. 15, article id 877Article in journal (Refereed)
    Abstract [en]

    Background: Globally, 15 million babies were born prematurely in 2012, with 37.6 % of them in South Asia. About 32.4 million infants were born small for gestational age (SGA) in 2010, with more than half of these births occurring in South Asia. In Nepal, 14 % of babies were born preterm and 39.3 % were born SGA in 2010. We conducted a study in a tertiary hospital of Nepal to assess the level of risk for neonatal mortality among babies who were born prematurely and/or SGA. Methods: This case-control study was completed over a 15-month period between July 2012 and September 2013. All neonatal deaths that occurred during the study period were included as cases and 20 % of women with live births were randomly selected as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analyses were conducted to determine the level of risk for neonatal mortality among babies born preterm and/or SGA. Results: During this period, the hospital had an incidence of preterm birth and SGA of 8.1 and 37.5 %, respectively. In the multivariate model, there was a 12-fold increased risk of neonatal death among preterm infants compared to term. Babies who were SGA had a 40 % higher risk of neonatal death compared to those who were not. Additionally, babies who were both preterm and SGA were 16 times more likely to die during the neonatal period. Conclusions: Our study showed that the risk of neonatal mortality was highest when the baby was born both preterm and SGA, followed by babies who were born preterm, and then by babies who were SGA in a tertiary hospital in Nepal. In tertiary care settings, the risk of mortality for babies who are born preterm and/or SGA can be reduced with low-cost interventions such as Kangaroo Mother Care or improved management of complications through special newborn care or neonatal intensive care units. The risk of death for babies who are born prematurely and/or SGA can thus be used as an indicator to monitor the quality of care for these babies in health facility settings.

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  • 76.
    Asif, Sana
    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.
    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.
    Axfors, Cathrine
    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.
    Eckerdal, Patricia
    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.
    Iliadis, Stavros I
    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.
    Fransson, Emma
    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. Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    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.
    Severe obstetric lacerations associated with postpartum depression among women with low resilience: a Swedish birth cohort study2020In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 127, no 11, p. 1382-1390Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Women's levels of resilience and attitudes towards perineal lacerations vary greatly. Some women see them as part of the birthing process, while others react with anger, depressed mood or even self-harm thoughts. A previous study has reported increased risk of postpartum depressive (PPD) symptoms in women with severe perineal lacerations. The aim of this study was to assess the association between severe obstetric perineal lacerations and PPD. A secondary objective was to assess this association among women with low resilience.

    DESIGN: Nested cohort study.

    SETTING: Uppsala, Sweden.

    SAMPLE: Vaginally delivered women with singleton pregnancies (n = 2,990).

    METHODS: The main exposure was obstetric perineal lacerations. Resilience was assessed in gestational week 32 using the Swedish version of the Sense of Coherence Scale (SOC-29). A digital acyclic graph (DAG) was used to identify possible confounders and mediators. Logistic regression was used to estimate odds ratios and 95% confidence intervals. A sub-analysis was run after excluding women with normal or high resilience.

    MAIN OUTCOME MEASURES: Postpartum depression, assessed with the Depression Self-Reporting Scale (DSRS), completed at six weeks postpartum.

    RESULTS: There was no significant association between severe obstetric perineal lacerations and PPD at six weeks postpartum. However, a significant association was found between severe lacerations and PPD in women with low resilience (OR =4.8 95% CI = 1.2-20), persisting even after adjusting for confounding factors.

    CONCLUSION: Health care professionals might need to identify women with low resilience, as they are at increased risk for PPD after a severe perineal laceration.

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  • 77.
    Asp, Joline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Bergman, Lina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Lager, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Hesselman, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna.
    Alcohol exposure prior to pregnancy-does hazardous consumption affect placenta- and inflammatory-mediated pregnancy outcomes? A Swedish population-based cohort study2022In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 101, no 12, p. 1386-1394Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Alcohol consumption during pregnancy is related to severe birth complications such as low birthweight, preterm birth and birth defects. During the last decade, the Alcohol Use Disorders Identification Test (AUDIT) has been used as a screening tool in Swedish maternal healthcare units to identify hazardous, pre-pregnancy alcohol use. However, evaluation of the screening with AUDIT, as well as adverse maternal or neonatal outcomes, has not been assessed at a national level.

    MATERIAL AND METHODS: This was a population-based cohort study of 530 458 births from 2013 to 2018 using demographic, reproductive and maternal health data from the Swedish Pregnancy Register. Self-reported alcohol consumption in the year before pregnancy, measured as AUDIT scores, was categorized into moderate (6-13 points) and high-risk (14-40 points) consumption, with low-risk (0-5 points) consumption as the reference group. Associations with pregnancy- and birth outcomes were explored with logistic regressions using generalized estimating equation models, adjusting for maternal and socioeconomic characteristics. Estimates are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

    RESULTS: High-risk and moderate pre-pregnancy alcohol consumption was associated with preeclampsia, preterm birth and birth of an infant small for gestational age (SGA), but these associations were nonsignificant after adjustments. Prior moderate-risk (aOR 1.29, 95% CI 1.17-1.42) and high-risk consumption (aOR 1.62, 95% CI 1.17-2.25) increased the likelihood of intrapartum and neonatal infections.

    CONCLUSIONS: Apart from identifying hazardous alcohol consumption prior to pregnancy and the offer of counseling, screening with the AUDIT in early pregnancy indicates a high risk of inflammatory-/placenta-mediated pregnancy and birth outcomes. For most outcomes, AUDIT was not an independent contributor when adjusting for confounding factors. Hazardous alcohol use prior to pregnancy was independently linked to intrapartum and neonatal infections; conditions associated with morbidity and long-term sequalae. These associations may be explained by alcohol-induced changes in the maternal or fetal immune system in early pregnancy or persistent alcohol intake during pregnancy, or may depend on unidentified confounding factors.

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  • 78.
    Assaysh-Oberg, Shereen
    et al.
    Dalarna Univ, Sch Hlth & Welf, S-79188 Falun, Sweden..
    Borneskog, Catrin
    Dalarna Univ, Sch Hlth & Welf, S-79188 Falun, Sweden..
    Ternström, Elin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Dalarna Univ, Sch Hlth & Welf, S-79188 Falun, Sweden..
    Women's experience of infertility & treatment: A silent grief and failed care and support2023In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, article id 100879Article in journal (Refereed)
    Abstract [en]

    Infertility is one of the components of sexual and reproductive health and rights, but is not as widely addressed as pregnancy, birth, and contraception. Infertility is a global problem, and it is estimated that around 186 million individuals are affected worldwide. Infertility and infertility treatment impact on women's overall wellbeing including their mental, emotional, sexual and spiritual health. Anxiety and depression is prevalent in these women. This study sought to explore the experiences of women going through infertility and IVF in a global context. This study is a metasynthesis with a meta-ethnographic analysis design based on 19 qualitative research studies, including 503 women, focusing on women's experiences of infertility and IVF treatments. Three main themes were identified; the personal reproductive trauma, the impact of and on relationships, and being failed by the healthcare system and society. The personal trauma and experiences included stress, grief, inability to focus, chock, insomnia, anxiety, withdrawing from others, sense of hopelessness and guilt and shame. The infertility and IVF journey also either caused conflicts in relationships or helped the couples to grow stronger. At the same time, relationships with friends and family were strained due to isolation and feeling stigmatized, and not understood. Finally, the healthcare system and providers lacked adequate support, holistic and caring care, and the women felt dehumanized and failed by the healthcare system. It is therefore critical that the healthcare system provide the time, information and support needed to deal with infertility and IVF to maintain quality of life and wellbeing.

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  • 79.
    Astor, Kim
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Lindskog, Marcus
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Juvrud, Joshua
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Arts, Department of Game Design.
    Wangchuk,
    Namgyel, Sangay Choden
    Wangmo, Tshering
    Tshering, Kinzang
    Gredebäck, Gustaf
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Maternal postpartum depression impacts infants' joint attention differentially across cultures2022In: Developmental Psychology, ISSN 0012-1649, E-ISSN 1939-0599, Vol. 58, no 12, p. 2230-2238Article in journal (Refereed)
    Abstract [en]

    We assessed whether the negative association between maternal postpartum depression (PPD) and infants’ development of joint attention (gaze following) generalizes from WEIRD (Western, Educated, Industrialized, Rich, and Democratic) to Majority World contexts. The study was conducted in Bhutan (N = 105, M = 278 days, 52% males) but also draws from publicly available Swedish data (N = 113, M = 302 days, 49% males). We demonstrate that Bhutanese and Swedish infants’ development follows the same trajectory. However, Bhutanese infants’ gaze following were not related to maternal PPD, which the Swedish infants’ were. The results support the notion that there are protecting factors built into the interdependent family model. Despite all the benefits of being raised in a modern welfare state, it seems like Swedish infants, to an extent, are more vulnerable to maternal mental health than Bhutanese infants.

  • 80.
    August, Furaha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili Univ Hlth & Allied Sci, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania..
    Pembe, Andrea B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Muhimbili Univ Hlth & Allied Sci, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania..
    Mpembeni, Rose
    Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Norwegian Univ Sci & Technol, Dept Publ Hlth & Gen Practice, N-7034 Trondheim, Norway..
    Effectiveness of the Home Based Life Saving Skills training by community health workers on knowledge of danger signs, birth preparedness, complication readiness and facility delivery, among women in Rural Tanzania2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 129Article in journal (Refereed)
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  • 81.
    August, Furaha
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Pembe, Andrea B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mpembeni, Rose
    Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Men's Knowledge of Obstetric Danger Signs, Birth Preparedness and Complication Readiness in Rural Tanzania2015In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 5, p. e0125978-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Men's involvement in reproductive health is recommended. Their involvement in antenatal care service is identified as important in maternal health. Awareness of obstetric danger signs facilitates men in making a joint decision with their partners regarding accessing antenatal and delivery care. This study aims to assess the level of knowledge of obstetric complications among men in a rural community in Tanzania, and to determine their involvement in birth preparedness and complication readiness.

    METHODS: A cross-sectional survey was conducted where 756 recent fathers were invited through a two-stage cluster sampling procedure. A structured questionnaire was used to collect socio-demographic characteristics, knowledge of danger signs and steps taken on birth preparedness and complication readiness. Data were analyzed using bivariate and multivariable logistic regression to determine factors associated with being prepared, with statistically significant level at p<0.05.

    RESULTS: Among the invited men, 95.9% agreed to participate in the community survey. Fifty-three percent could mention at least one danger sign during pregnancy, 43.9% during delivery and 34.6% during the postpartum period. Regarding birth preparedness and complication readiness, 54.3% had bought birth kit, 47.2% saved money, 10.2% identified transport, 0.8% identified skilled attendant. In general, only 12% of men were prepared. Birth preparedness was associated with knowledge of danger signs during pregnancy (AOR = 1.4, 95% CI: 1.8-2.6). It was less likely for men living in the rural area to be prepared (AOR=0.6, 95% CI; 0.5-0.8).

    CONCLUSION: There was a low level of knowledge of obstetric danger signs among men in a rural district in Tanzania. A very small proportion of men had prepared for childbirth and complication readiness. There was no effect of knowledge of danger signs during childbirth and postpartum period on being prepared. Innovative strategies that increase awareness of danger signs as well as birth preparedness and complication readiness among men are required. Strengthening counseling during antenatal care services that involve men together with partners is recommended.

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  • 82.
    Avdic, Daniel
    et al.
    Deakin Univ, Dept Econ, Geelong, Australia..
    Lundborg, Petter
    Lund Univ, Dept Econ, SE-22363 Lund, Sweden..
    Vikström, Johan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Economics, Uppsala Center for Labor Studies (UCLS). Uppsala University, Units outside the University, The Institute for Evaluation of Labour Market and Education Policy (IFAU).
    Does Health-Care Consolidation Harm Patients?: Evidence from Maternity Ward Closures2024In: American Economic Journal: Economic Policy, ISSN 1945-7731, E-ISSN 1945-774X, Vol. 16, no 1, p. 160-189Article in journal (Refereed)
    Abstract [en]

    We study how closures of maternity wards affect maternal and neonatal health. Using data on all hospital births in Sweden between 1990 and 2004, we compare changes in birth -related outcomes across hospital catchment areas that were differently exposed to ward closures. Our findings show that the closures increased maternal obstetric trauma but also decreased fetal stress and infant trauma among newborns. Adverse maternal outcomes are mainly driven by ward overcrowding, whereas increases in travel distance have no distinguishable effects. Positive effects on infant health reflect a shift of births from smaller to larger wards of higher quality.

  • 83.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Eckerdal, Patricia
    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.
    Volgsten, Helena
    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.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    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.
    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.
    Investigating the association between neuroticism and adverse obstetric and neonatal outcomes2019In: Scientific Reports, E-ISSN 2045-2322, Vol. 9, article id 15470Article in journal (Refereed)
    Abstract [en]

    Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Uppsala, Sweden. To assess neuroticism-related personality, the Swedish universities Scales of Personality was used. Swedish national health registers were used to extract outcomes and confounders. In logistic regression models, odds ratios (ORs) with 95% confidence intervals (Cis) were calculated for the outcomes by an increase of 63 units of neuroticism (equalling the interquartile range). Analyses were adjusted for maternal age, educational level, height, body mass index, year of delivery, smoking during pregnancy, involuntary childlessness, and psychiatric morbidity. Main outcomes were mode of delivery, gestational diabetes mellitus, gestational hypertension, preeclampsia, induction of delivery, prolonged delivery, severe lacerations, placental retention, postpartum haemorrhage, premature birth, infant born small or large for gestational age, and Apgar score. Neuroticism was not independently associated with adverse obstetric or neonatal outcomes besides gestational diabetes. For future studies, models examining sub-components of neuroticism or pregnancy-specific anxiety are encouraged.

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  • 84.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Eckerdal, Patricia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Volgsten, Helena
    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.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    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.
    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.
    Neuroticism is not independently associated with adverse obstetric or neonatal outcomes: An observational studyIn: Article in journal (Refereed)
  • 85.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    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.
    Volgsten, Helena
    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.
    Skoog Svanberg, Agneta
    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.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    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.
    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.
    Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women2019In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 4, p. 470-478Article in journal (Refereed)
    Abstract [en]

    Introduction

    Elevated neuroticism is associated with higher health care utilization in the general population. This study aimed to investigate the association between neuroticism and the use of publicly financed antenatal care in obstetric low‐risk women, taking predisposing and need factors for health care utilization into consideration.

    Material and methods

    Participants comprised 1052 obstetric low‐risk women (no chronic diseases or adverse pregnancy conditions) included in several obstetrics/gynecology studies in Uppsala, Sweden. Neuroticism was self‐rated on the Swedish universities Scales of Personality. Medical records of their first subsequent pregnancy were scanned for antenatal care use. Associations between antenatal care use and neuroticism were analyzed with logistic regression (binary outcomes) or negative binomial regression (count outcomes) comparing the 75th and 25th neuroticism percentiles. Depending on the Akaike information criterion the exposure was modeled as either linear or with restricted cubic splines. Analyses were adjusted for predisposing (sociodemographic and parity) and need factors (body mass index and psychiatric morbidity).

    Results

    After adjustment, women with higher neuroticism had more fetal ultrasounds (incidence rate ratio = 1.09, 95% confidence interval (CI) 1.02‐1.16), more emergency visits to an obstetrician/gynecologist (incidence rate ratio = 1.22, 95% CI 1.03‐1.45) and were more likely to visit a fear‐of‐childbirth clinic (odds ratio = 2.71, 95% CI 1.71‐4.29). Moreover, they more often consulted midwives in specialized antenatal care facilities (significant J‐shaped association).

    Conclusions

    Neuroticism was associated with higher utilization of publicly financed antenatal care in obstetric low‐risk women, even after adjusting for predisposing and need factors. Future studies should address the benefits of interventions as a complement to routine antenatal care programs to reduce subclinical anxiety.

  • 86.
    Aydin, Banu K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Istanbul Univ, Dept Pediat, Pediat Endocrinol Unit, Istanbul Fac Med, Istanbul, Turkey..
    Kadioglu, Alev
    ALKA Radiol Diag Ctr, Istanbul, Turkey..
    Kaya, Gamze A.
    Istanbul Univ, Dept Pediat, Pediat Endocrinol Unit, Istanbul Fac Med, Istanbul, Turkey..
    Devecioglu, Esra
    Istanbul Univ, Dept Pediat, Inst Child Hlth, Istanbul, Turkey..
    Bas, Firdevs
    Istanbul Univ, Dept Pediat, Pediat Endocrinol Unit, Istanbul Fac Med, Istanbul, Turkey..
    Poyrazoglu, Sukran
    Istanbul Univ, Dept Pediat, Pediat Endocrinol Unit, Istanbul Fac Med, Istanbul, Turkey..
    Gokcay, Gulbin
    Istanbul Univ, Dept Pediat, Inst Child Hlth, Istanbul, Turkey..
    Darendeliler, Feyza
    Istanbul Univ, Dept Pediat, Pediat Endocrinol Unit, Istanbul Fac Med, Istanbul, Turkey..
    Pelvic and breast ultrasound abnormalities and associated metabolic disturbances in girls with premature pubarche due to adrenarche2022In: Clinical Endocrinology, ISSN 0300-0664, E-ISSN 1365-2265, Vol. 96, no 3, p. 339-345Article in journal (Refereed)
    Abstract [en]

    Objective Premature adrenarche (PA) has been suggested as a risk factor for future health problems, such as metabolic syndrome and early menarche. However, not all girls with PA have these features and it is not certain who will develop them. We propose that these abnormalities might be identified earlier, even before they are visible. Design Case-control study. Setting Tertiary care hospital. Participants Forty-eight girls with premature pubarche due to PA and age (mean age 7.6 +/- 1.0 years), weight, body mass index (BMI), birth weight and gestational age-matched 49 girls with no palpable breast tissue. Measurements Early pubertal pelvic and breast ultrasonographic changes and their associations with obesity and metabolic parameters were evaluated. Blood samples were collected, breast and pelvic ultrasound examinations were performed and bone ages were assessed. Results Girls with PA were taller and their bone ages were higher (p = .049 and p = .005). Fasting blood glucose, insulin, triglycerides, high-density lipoprotein and low-density lipoprotein cholesterol were not different between the groups. Luteinizing hormone (LH), follicle-stimulating hormone (FSH) and estradiol were not different either. Ultrasonography revealed breast gland tissue in 30% of girls with PA and 5% of controls (p = .006). Uterine volume and endometrial thickness were higher in girls with PA (p = .03 and p = .04). Endometrial thickness was positively associated with serum insulin levels in the whole study group and after adjusting for age, diagnosis, BMI, mean ovarian volume and LH, FSH, estradiol levels, this association remained with a borderline p-value (R-2 = 0.486, p = .050). Conclusions We found early changes in uterus and breast glands of girls with PA and endometrial thickness was positively associated with insulin levels.

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  • 87.
    Ayres-de-Campos, Diogo
    et al.
    Univ Lisbon, Santa Maria Univ Hosp, Med Sch, Lisbon, Portugal..
    Louwen, Frank
    Goethe Univ Frankfurt Main, Dept Obstet & Gynecol, Frankfurt, Germany.;Univ Hosp, Frankfurt, Germany..
    Vivilaki, Victoria
    Univ West Attica, Dept Nursing, Athens, Greece..
    Benedetto, Chiara
    Univ Div St Anna Hosp, Dept Gynecol & Obstet, Div Pathol, Turin, Italy..
    Modi, Neena
    Imperial Coll London, Sch Publ Hlth, Sect Neonatal Med, London, England..
    Wielgos, Miroslaw
    Lazarski Univ, Natl Med Inst Minist Interior, Med Fac, Dept Obstet & Perinatol, Warsaw, Poland..
    Tudose, Melania-Elena Pop
    Carol Davila Univ Med, Emergency Hosp, Fac Midwifery & Nursing, Obstet Dept, Bucharest, Buzau, Romania..
    Timonen, Susanna
    Turku Univ Hosp, Turku, Finland..
    Reyns, Marlene
    Turku Univ Hosp, Turku, Finland..
    Yli, Branka
    Oslo Univ Hosp, Delivery Dept, Dept Delivery, Oslo, Norway..
    Stenback, Pernilla
    Arcada Univ Appl Sci, Helsinki, Finland..
    Nunes, Ines
    Univ Porto, Fac Med, Dept Obstet & Gynecol, Unidade Local Saude Gaia Espinho, Porto, Portugal..
    Yurtsal, Burcu
    Sivas Cumhuriyet Univ, Dept Midwifery, Sivas, Turkiye..
    Vayssiere, Christophe
    Toulouse III Univ, Paule Viguier Hosp, Dept Obstet Gynecol Reprod, CHU Toulouse, Toulouse, France..
    Roth, Georges -Emmanuel
    Hop Univ Strasbourg, Dept Obstet & Gynecol, Strasbourg, France..
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Bakker, Petra
    Amsterdam UMC, Dept Obstet & Gynecol, Locat VU Med Ctr, Amsterdam, Netherlands..
    Lopriore, Enrico
    Leiden Univ, Med Ctr, Dept Neonatol, Leiden, Netherlands..
    Verlohren, Stefan
    Charite Univ Med Berlin, Dept Obstet, Berlin, Germany..
    Jacobsson, Bo
    Gothenburg Univ, Sahlgrenska Acad, Sahlgrenska Univ Hosp, Dept Obstet & Gynecol, Gothenburg, Sweden..
    European Association of Perinatal Medicine (EAPM), European Board and College of Obstetricians and Gynaecologists (EBCOG), European Midwives Association (EMA). Joint position statement: Substandard and disrespectful care in labour - because words matter2024In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 296, p. 205-207Article in journal (Refereed)
    Abstract [en]

    Substandard or disrespectful care during labour should be of serious concern for healthcare professionals, as it can affect one of the most important events in a woman's life. Substandard care refers to the use of interventions that are not considered best -practice, to the inadequate execution of interventions, to situations where bestpractice interventions are withheld from patients, or there is lack of adequate informed consent. Disrespectful care refers to forms of verbal and non-verbal communication that affect patients' dignity, individuality, privacy, intimacy, or personal beliefs. There are many possible underlying causes for substandard and disrespectful care in labour, including difficulties in modifying behaviours, judgmental or paternalistic attitudes, personal interests and individualism, and a human tendency to make less arduous, less difficult, or less stressful clinical decisions. The term "obstetric violence" is used in some parts of the world to describe various forms of substandard and disrespectful care in labour, but suggests that it is mainly carried out by obstetricians and is a serious form of aggression, carried out with the intent to cause harm. We believe that this term should not be used, as it does not help to identify the underlying problem, its causes, or its correction. In addition, it is generally seen by obstetricians and other healthcare professionals as an unjust and offensive term, generating a defensive and less collaborative mindset. We reach out to all individuals and institutions sharing the common goal of improving women's experience during labour, to work together to address the underlying causes of substandard and disrespectful care, and to develop common strategies to deal with this problem, based on mutual comprehension, trust and respect

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  • 88.
    Backes, Carl H.
    et al.
    Nationwide Childrens Hosp, Abigail Wexner Res Inst, Ctr Perinatal Res, Columbus, OH 43205 USA.;Ohio State Univ, Dept Pediat, Wexner Med Ctr, Columbus, OH 43210 USA.;Nationwide Childrens Hosp, Ctr Heart, Columbus, OH 43205 USA.;Ohio State Univ, Dept Obstet & Gynecol, Wexner Med Ctr, Columbus, OH 43210 USA..
    Sindelar, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Janvier, Annie
    CHU Ste Justine, Div Neonatol, Clin Eth Unit, Dept Pediat,Palliat Care Unit,Unite Rech Eth Clin, Montreal, PQ, Canada.;Univ Montreal, Dept Pediat & Clin Eth, Montreal, PQ, Canada..
    Opportunities and recommendations in the care of mother-infant dyads at less than 25 weeks of gestation2022In: Seminars in Perinatology, ISSN 0146-0005, E-ISSN 1558-075X, Vol. 46, no 2, article id 151552Article in journal (Other academic)
  • 89.
    Baker, Ulrika
    et al.
    Karolinska Inst, Widerstromska Huset, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Tomtebodavagen 18 A, S-17177 Stockholm, Sweden.;Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Nobels Alle 12, S-14183 Huddinge, Sweden..
    Hassan, Farida
    Ifakara Hlth Inst, Plot 463 Kiko Ave,POB 78 373, Dar Es Salaam, Tanzania..
    Hanson, Claudia
    Karolinska Inst, Widerstromska Huset, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Tomtebodavagen 18 A, S-17177 Stockholm, Sweden.;London Sch Hyg & Trop Med, Dept Dis Control, London WC1E 7HT, England..
    Manzi, Fatuma
    Ifakara Hlth Inst, Plot 463 Kiko Ave,POB 78 373, Dar Es Salaam, Tanzania..
    Marchant, Tanya
    London Sch Hyg & Trop Med, Dept Dis Control, London WC1E 7HT, England..
    Peterson, Stefan Swartling
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Karolinska Inst, Widerstromska Huset, Dept Publ Hlth Sci Global Hlth Hlth Syst & Policy, Tomtebodavagen 18 A, S-17177 Stockholm, Sweden. ;Makerere Sch Publ Hlth, Kampala, Uganda..
    Hylander, Ingrid
    Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Nobels Alle 12, S-14183 Huddinge, Sweden..
    Unpredictability dictates quality of maternal and newborn care provision in rural Tanzania: A qualitative study of health workers' perspectives2017In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 17, article id 55Article in journal (Refereed)
    Abstract [en]

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

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  • 90.
    Bannbers, Elin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    The Effect of Steroid Hormones in the Female Brain During Different Reproductive States2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Women are twice as likely as men to suffer from depression and anxiety disorders and have an increased risk of onset during periods associated with hormonal changes, such as the postpartum period and the menopausal transition. Furthermore, some women seem more sensitive to normal hormone fluctuations across the menstrual cycle, since approximately 3-5% suffers from premenstrual dysphoric disorder (PMDD). Why these disorders are so common in women has not been established but there is a probable involvement of the ovarian hormones.

    The aim of this thesis was to investigate the effect of the ovarian hormones on the female brain during different reproductive states using psychological tests known to affect brain activity in different ways.

    Paper one examined the effect of the ovarian hormones on prepulse inhibition (PPI) on the acoustic startle response (ASR) and comprised cycling women and postmenopausal women. The cycling women had lower levels of PPI compared to postmenopausal women and postmenopausal women with moderate estradiol levels had lower PPI compared to postmenopausal women with low estradiol levels.

    Paper two examined the effect of anticipation and affective modulation on the ASR in women with PMDD and healthy controls. Women with PMDD have an increased modulation during anticipation of affective pictures compared to healthy controls during the luteal phase of the menstrual cycle.

    Paper three examined brain activity during response inhibition among women with PMDD and healthy controls by the use of a Go/NoGo task and fMRI. Women with PMDD displayed a decreased activity in the left insula during follicular phase and an increased activity during the luteal phase compared to controls.

    Paper four comprised women in the postpartum period and non-pregnant controls to examine brain activity during response inhibition. While this study revealed decreased activity at 4 weeks postpartum compared to 48 hours postpartum we cannot ascertain the role of the ovarian steroids, since none of the significant brain areas correlated with ovarian steroid or neurosteroid serum concentrations.

    The results of this thesis demonstrate that the ovarian hormones, or at least various hormonal states, have a probable impact on how the female brain works.

    List of papers
    1. Lower levels of prepulse inhibition in luteal phase cycling women in comparison with postmenopausal women
    Open this publication in new window or tab >>Lower levels of prepulse inhibition in luteal phase cycling women in comparison with postmenopausal women
    2010 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 35, no 3, p. 422-429Article in journal (Refereed) Published
    Abstract [en]

    Menopause denotes the end of the reproductive period in a woman's life and is characterized by gradually declining plasma levels of ovarian hormones. Mounting evidence suggests that prepulse inhibition (PPI) is sensitive to fluctuations in estradiol and progesterone. Deficits in PPI are associated with conditions characterized by increased levels of ovarian steroids, such as the mid-luteal phase of the menstrual cycle and the third trimester of pregnancy. The aim of the current study was to further elucidate ovarian steroid-related effects on PPI by examining 43 women with regular menstrual cycles, 20 healthy postmenopausal women without hormone replacement treatment (HRT) and 21 healthy postmenopausal women with ongoing estradiol-only or estradiol and progesterone therapy (EPT). Cycling women were tested during the late luteal phase of the menstrual cycle while postmenopausal women were tested on any arbitrary day. The PPI was measured by electromyography. Cycling women exhibited lower levels of PPI than postmenopausal women (p<0.05). There were no differences in PPI between postmenopausal HRT users and non-users. However, postmenopausal women with estradiol serum concentrations in the cycling range had lower PPI than postmenopausal women with low estradiol concentrations (groupxPPI interaction, p<0.05). In conclusion, the results further suggest a role for the ovarian steroids in PPI regulation as PPI is increased in postmenopausal women in comparison to regularly menstruating women examined during the late luteal phase. Furthermore, postmenopausal women with estradiol levels in the cycling range had lower PPI than postmenopausal women with low estradiol levels.

    Keywords
    Estradiol, Hormone replacement therapy, Menopause, Prepulse inhibition, Progesterone, Startle response
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-124853 (URN)10.1016/j.psyneuen.2009.08.004 (DOI)000275700000010 ()19735984 (PubMedID)
    Available from: 2010-05-06 Created: 2010-05-06 Last updated: 2022-01-28Bibliographically approved
    2. Patients with premenstrual dysphoric disorder have increased startle modulation during anticipation in the late luteal phase period in comparison to control subjects
    Open this publication in new window or tab >>Patients with premenstrual dysphoric disorder have increased startle modulation during anticipation in the late luteal phase period in comparison to control subjects
    Show others...
    2011 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 36, no 8, p. 1184-1192Article in journal (Refereed) Published
    Abstract [en]

    The acoustic startle response (ASR) is a withdrawal reflex to sudden or noxious auditory stimuli and, most importantly, an unbiased measure of emotional processing of appetitive and aversive stimuli. By exposing subjects to fearful situations, such as aversive pictures, the ASR may be enhanced, suggesting that amygdala modulates the startle circuit during threat situations. As one previous study, investigating affective modulation of the ASR in women with premenstrual dysphoric disorder (PMDD), discovered no difference during picture viewing it is possible that the mood changes observed in PMDD relate to anxious anticipation rather than to direct stimulus responding. Hence we sought to examine the effects of PMDD on picture anticipation and picture response.

    Sixteen PMDD patients and 16 controls watched slide shows containing pleasant and unpleasant pictures and positive and negative anticipation stimuli during the follicular and luteal phase of the menstrual cycle. Simultaneously, semi-randomized startle probes (105dB) were delivered and the ASR was assessed with electromyography.

    Compared with control subjects, PMDD patients displayed an enhanced startle modulation by positive and negative anticipation stimuli in the luteal phase of the menstrual cycle. This finding was mainly driven by increased modulation in the luteal phase in comparison to the follicular phase among PMDD patients but also by an increased modulation in patients compared to controls during luteal phase. This suggests that the neural circuits underlying response to emotional anticipation are more sensitive during this period and emphasize the need of examining the neural correlates of anticipatory processes in women with PMDD.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-152022 (URN)10.1016/j.psyneuen.2011.02.011 (DOI)000295072300009 ()21435793 (PubMedID)
    Available from: 2011-04-20 Created: 2011-04-20 Last updated: 2017-12-11Bibliographically approved
    3.
    The record could not be found. The reason may be that the record is no longer available or you may have typed in a wrong id in the address field.
    4. Prefrontal activity during response inhibition decreases over time in postpartum women
    Open this publication in new window or tab >>Prefrontal activity during response inhibition decreases over time in postpartum women
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:uu:diva-175276 (URN)
    Available from: 2012-06-04 Created: 2012-06-04 Last updated: 2015-06-11
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  • 91.
    Bannbers, Elin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Gingnell, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Engman, Jonas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Morell, Arvid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Sylvén, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Kask, Kristiina
    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.
    Sundström-Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Prefrontal activity during response inhibition decreases over time in postpartum womenManuscript (preprint) (Other academic)
  • 92.
    Bartho, Lucy A.
    et al.
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia.;Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, 163 Studley Rd, Heidelberg, Vic 3084, Australia..
    Kandel, Manju
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia..
    Walker, Susan P.
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia..
    Cluver, Catherine A.
    Stellenbosch Univ, Dept Obstet & Gynecol, ZA-7505 Cape Town, South Africa..
    Hastie, Roxanne
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia.;Stellenbosch Univ, Dept Obstet & Gynecol, ZA-7505 Cape Town, South Africa..
    Bergman, Lina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics. Stellenbosch Univ, Dept Obstet & Gynecol, ZA-7505 Cape Town, South Africa; Univ Gothenburg, Inst Clin Sci, Sahlgrenska Acad, Dept Obstet & Gynecol, S-40530 Gothenburg, Sweden.
    Pritchard, Natasha
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia..
    Cannon, Ping
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia..
    Nguyen, Tuong-Vi
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia..
    Wong, Georgia P.
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia..
    MacDonald, Teresa M.
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia..
    Keenan, Emerson
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia..
    Hannan, Natalie J.
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia..
    Tong, Stephen
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia..
    Kaitu'u-Lino, Tu'uhevaha J.
    Univ Melbourne, Mercy Hosp Women, Dept Obstet & Gynaecol, Translat Obstet Grp, Heidelberg, Vic 3084, Australia.;Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic 3084, Australia..
    Circulating Chemerin Is Elevated in Women With Preeclampsia2023In: Endocrinology, ISSN 0013-7227, E-ISSN 1945-7170, Vol. 164, no 5, article id bqad041Article in journal (Refereed)
    Abstract [en]

    Background: Preeclampsia is a severe complication of pregnancy. Chemerin is an adipokine secreted from adipose tissue and highly expressed in placenta. This study evaluated the biomarker potential of circulating chemerin to predict preeclampsia.

    Methods: Maternal plasma and placenta were collected from women with early-onset preeclampsia (<34 weeks), with preeclampsia and eclampsia, or before preeclampsia diagnosis (36 weeks). Human trophoblast stem cells were differentiated into syncytiotrophoblast or extravillous trophoblasts across 96 hours. Cells were cultured in 1% O2 (hypoxia) or 5% O2 (normoxia). Chemerin was measured by enzyme-linked immunosorbent assay (ELISA) and RARRES2 (gene coding chemerin) by reverse transcription-quantitative polymerase chain reaction.

    Results: Circulating chemerin was increased in 46 women with early-onset preeclampsia (<34 weeks) compared to 17 controls (P < .0006). Chemerin was increased in placenta from 43 women with early-onset preeclampsia compared to 24 controls (P < .0001). RARRES2 was reduced in placenta from 43 women with early-onset preeclampsia vs 24 controls (P < .0001).

    Chemerin was increased in plasma from 26 women with established preeclampsia (P = .006), vs 15 controls. Circulating chemerin was increased in 23 women who later developed preeclampsia vs 182 who did not (P = 3.23 × 10−6).

    RARRES2 was reduced in syncytiotrophoblast (P = .005) or extravillous trophoblasts (P < .0001). Hypoxia increased RARRES2 expression in syncytiotrophoblast (P = .01) but not cytotrophoblast cells.

    Conclusions: Circulating chemerin was elevated in women with early-onset preeclampsia, established preeclampsia, and preceding preeclampsia diagnosis of preeclampsia. RARRES2 was dysregulated in placenta complicated by preeclampsia and may be regulated through hypoxia. Chemerin may have potential as a biomarker for preeclampsia but would need to be combined with other biomarkers.

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  • 93.
    Bauer, Ilena
    et al.
    Univ Tubingen, German Ctr Diabet Res DZD eV, FMEG Ctr, Inst Diabet Res & Metab Dis,Helmholtz Ctr Munich, Otfried Muller Str 47, D-72076 Tubingen, Germany..
    Hartkopf, Julia
    Univ Tubingen, German Ctr Diabet Res DZD eV, FMEG Ctr, Inst Diabet Res & Metab Dis,Helmholtz Ctr Munich, Otfried Muller Str 47, D-72076 Tubingen, Germany..
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Schaal, Nora K.
    Heinrich Heine Univ, Dept Expt Psychol, Dusseldorf, Germany..
    Preissl, Hubert
    Univ Tubingen, German Ctr Diabet Res DZD eV, FMEG Ctr, Inst Diabet Res & Metab Dis,Helmholtz Ctr Munich, Otfried Muller Str 47, D-72076 Tubingen, Germany.;Univ Hosp Tuebingen, Div Endocrinol Diabetol & Nephrol, Dept Internal Med 4, Tubingen, Germany..
    Derntl, Birgit
    Univ Tubingen, Tuebingen Ctr Mental Hlth TuCMH, Dept Psychiat & Psychotherapy, Tubingen, Germany.;Univ Tubingen, LEAD Grad Sch & Res Network, Tubingen, Germany..
    Schleger, Franziska
    Univ Tubingen, German Ctr Diabet Res DZD eV, FMEG Ctr, Inst Diabet Res & Metab Dis,Helmholtz Ctr Munich, Otfried Muller Str 47, D-72076 Tubingen, Germany..
    Acute relaxation during pregnancy leads to a reduction in maternal electrodermal activity and self-reported stress levels2021In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 21, no 1, article id 628Article in journal (Refereed)
    Abstract [en]

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

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  • 94.
    Bay, Annika
    et al.
    Umeå Univ, Dept Nursing, Umeå, Sweden..
    Berghammer, Malin
    Univ West, Inst Hlth Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Queen Silvia Children Hosp, Gothenburg, Sweden..
    Burstrom, Asa
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Holstad, Ylva
    Umeå Univ, Dept Nursing, Umeå, Sweden..
    Christersson, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Dellborg, Mikael
    Sahlgrens Univ Hosp, Dept Mol & Clin Med, Gothenburg, Sweden..
    Trzebiatowska-Krzynska, Aleksandra
    Linköping Univ, Dept Cardiol, Linköping, Sweden.;Linköping Univ, Dept Med & Hlth Sci, Linköping, Sweden..
    Sorensson, Peder
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Thilen, Ulf
    Lund Univ, Dept Clin Sci, Cardiol, Lund, Sweden..
    Johansson, Bengt
    Umeå Univ, Dept Surg & Perioperat Sci, Umeå, Sweden..
    Symptoms during pregnancy in primiparous women with congenital heart disease2024In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 58, no 1, article id 2302135Article in journal (Refereed)
    Abstract [en]

    Background: As more women with congenital heart disease (CHD) are reaching childbearing age, it becomes more common for their symptoms to be evaluated during pregnancy. However, pregnancy-related symptoms are similar to those caused by heart disease. This study investigated the prevalence of factors associated with symptoms during pregnancy in women with CHD. Methods: The national birth register was searched for primiparous women with CHD who were registered in the national quality register for patients with CHD. Results: Symptoms during the third trimester were reported in 104 of 465 evaluated women. The most common symptom was palpitations followed by dyspnea. Factors associated with symptoms were tested in a univariable model; higher NYHA classification (>1) (OR 11.3, 95%CI 5.5-23.2), low physical activity (<= 3 h/week) (OR 2.1 95%CI 1.3-3.6) and educational level <= 12 years (OR 1.9 95%CI 1.2-3.0) were associated with having symptoms. In multivariable analysis, low physical activity level (OR 2.4 95%CI 1.2-5.0) and higher NYHA class (OR 11.3 95%CI 5.0-25.6) remained associated with symptoms during pregnancy. There were no cases with new onset of impaired systemic ventricular function during pregnancy. Conclusion: Symptoms during pregnancy are common in women with CHD but are often already present before pregnancy. Because ordinary symptoms during pregnancy often overlap with symptoms of heart disease, it is important to know if symptoms were present before pregnancy and if they became worse during pregnancy. These results should be included in pre-pregnancy counselling and considered in the monitoring during pregnancy.

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  • 95.
    Bazargani, Farnaz
    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. Reproduction Centre, Women's Clinic, Uppsala University Hospital.
    Iliadis, Stavros I.
    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. Reproduction Centre, Women's Clinic, Uppsala University Hospital.
    Elenis, Evangelia
    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. Reproduction Centre, Women's Clinic, Uppsala University Hospital.
    Mode of conception in relation to nausea and vomiting of pregnancy: a nested matched cohort study in Sweden2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 9039Article in journal (Refereed)
    Abstract [en]

    Nausea and vomiting of pregnancy (NVP) is a common condition reported however inconclusively among pregnancies after assisted conception. The study objective was thus to explore whether NVP is associated to mode of conception or other in vitro fertilization (IVF)-related variables. This nested matched cohort study, originating from the BASIC-project, was conducted at the Uppsala University Hospital in Sweden between 2010 and 2016. IVF pregnancies (n=210) and age and parity-matched women with spontaneous pregnancies (n=420) comprised the study sample. The study outcome was self-reported NVP at gestational week 17. IVF treatment and pregnancy data were obtained after scrutinization of the medical records. NVP with or without medications was not associated with mode of conception (chi-square test, p=0.889), even after adjusting for potential confounders. In a subgroup analysis among IVF pregnancies, NVP without medication was more frequently seen in the group who received cleavage stage embryos vs blastocysts (chi-square test, p=0.019), exhibiting a marginally significant but strongly increased effect even after adjustment [crude RRR 3.82 (95% CI 1.23-11.92) and adjusted RRR 3.42 (95% CI 0.96-12.11)]. No difference in the rate of NVP with or without medication between women that underwent fresh and frozen/thawed embryo transfers as well as IVF or ICSI was observed. Conception through IVF is not associated with NVP. Transfer of a blastocyst may decrease the risk of developing NVP and further, large-scale prospective studies are required to validate this finding.

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  • 96.
    Bazargani, Farnaz
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Elenis, Evangelia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Conception by means of in vitro fertilization (IVF) is not associated with nausea and vomiting of pregnancy2020Conference paper (Refereed)
    Abstract [en]

    Study question:

    Is there any association between mode of conception or IVF-related variables and nausea and vomiting of pregnancy (NVP)?

    Summary answer:

    Conception by means of IVF is not associated with NVP but the stage of the transferred embryo may affect NVP development.

    What is known already:

    The exact cause of NVP is unknown but risk factors including increased hormonal levels, maternal distress and anxiety disorders, also described in IVF populations, have been reported. There are only a few studies exploring NVP in IVF samples. A population-based study examining the characteristics of women who suffered from a severe form of NVP, it was reported that women with severe NVP had more often conceived through assisted reproduction techniques. So far, the relationship between NVP and IVF or different treatment related parameters in the IVF population in relation to NVP remains unclear.

    Study design, size, duration:

    The study is a longitudinal, matched - cohort, pilot study including 630 pregnant women with singletons without malformations, recruited during the pregnancy ultrasound in gestational week 17 (GW 17). The study was conducted between 2010-2016 at the University Hospital of Uppsala, Sweden.

    Participants/materials, setting, methods:

    The study population comprised 210 women with IVF conceived pregnancies and 420 age and parity matched women with spontaneous pregnancies. All participants self-reported sociodemographic and pregnancy-related information. IVF treatment data were obtained after scrutinization of the medical records. The outcome, NVP at GW 17, was divided into: 1) absence of NVP, 2) NVP not requiring medications and 3) NVP requiring medications. NVP was then studied in relation to exposure and to different IVF treatment-associated variables.

    Main results and the role of chance:

    The mean age of the participants was 33.7 years with 2/3 of the participants being primipara. IVF pregnant women reported more frequently comorbidities (such as hypertension, diabetes, migraine etc) (59.1% vs 49.9%), but less frequently alcohol consumption (38.4% vs 48.7%) compared to women with spontaneous pregnancies. Clinical and sociodemographic characteristics such as education, employment, smoking habits, maternal BMI, depression history, delivery fear and newborn gender, were otherwise similar between the groups. NVP with or without medications was not associated with mode of conception (p=0.889); 11.4% of women who conceived through IVF suffered from NVP requiring medications and 62.4% from unmedicated NVP vs 10.8% and 64.3% respectively of women with spontaneous pregnancies. Absence of NVP was reported by 26.2% of IVF and 24.9% of spontaneously pregnant women. However, in a subgroup analysis in the group of women who conceived through IVF, NVP was more frequently seen in the group who received cleavage stage embryos vs blastocysts (p=0.019). We could not however find any significant difference in the rate of NVP with or without medications between fresh (69.4%) or frozen/thawed embryo transfers (78.5%), nor between IVF(72.3%) and intracytoplasmic sperm injection(ICSI)(77.4%) treatments. Lastly, there was no significant difference between infertility diagnosis and NVP.

    Limitations, reasons for caution:

    The study had limited power to detect differences in NVP in relation to mode of conception. In addition, there was a missing rate of 30.5% in the reported embryo stage variable. Finally, the rate of blastocyst-transfers during that period was lower than otherwise expected with current statistics.

    Wider implications of the findings:

    It is still unclear whether IVF has an impact on the risk of NVP. However, transfer of a blastocyst may decrease the risk of developing NVP.

  • 97.
    Belachew, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Placental location, postpartum haemorrhage and retained placenta in women previously delivered by caesarean section: a prospective cohort studyManuscript (preprint) (Other academic)
    Abstract [en]

    Objective The objective was to determine if anterior placental location increased the risk of postpartum haemorrhage (PPH) and retained placenta in women previously delivered by caesarean section.

     

    Design Prospective cohort study.

     

    Setting Fetal medicine unit, Uppsala University hospital, Sweden.

    Population. Four hundred women previously delivered by caesarean section.

    Methods Ultrasound scans were performed at gestational week 28-30. Placental location, myometrial thickness and three-dimensional vascularisation 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 was obtained.

    Main Outcome Measures PPH (≥ 1000 ml) and retained placenta.

    Results Twenty-four women (11.6%) of 213 with anterior placentas had PPH compared to 13 (7.3%) with placentas in other locations. This difference was not significant. No significant risk increase was found for retained placenta in women with anterior placentae. Of the 23 women with low anterior placentae six (26.1%) had PPH compared to 38 (10.3%) with other placental locations (p = 0.032). Three women (13.0%) with low anterior placentae had retained placenta compared to 11 (2.9%) with other locations (p = 0.04). All women but one with low-lying anterior placentae and PPH and all with retained placentae had placenta praevia.

    Conclusion Low anterior placentae in women previously delivered by caesarean section increased the risk of PPH and retained placenta, mostly due to placenta praevia. Other anterior locations of the placenta may add to the increased risk of PPH. 

  • 98.
    Belachew, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Retained Placenta and Postpartum Haemorrhage2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim was to explore the possibility to diagnose retained placental tissue and other placental complications with 3D ultrasound and to investigate the impact of previous caesarean section on placentation in forthcoming pregnancies.

    3D ultrasound was used to measure the volumes of the uterine body and cavity in 50 women with uncomplicated deliveries throughout the postpartum period. These volumes were then used as reference, to diagnose retained placental tissue in 25 women with secondary postpartum haemorrhage. All but three of the 25 women had retained placental tissue confirmed at histopathology. The volume of the uterine cavity in women with retained placental tissue was larger than the reference in most cases, but even cavities with no retained placental tissue were enlarged (Studies I and II).

    Women with their first and second birth, recorded in the Swedish medical birth register, were studied in order to find an association between previous caesarean section and retained placenta. The risk of retained placenta with heavy bleeding (>1,000 mL) and normal bleeding (≤1,000 mL) was estimated for 19,459 women with first caesarean section delivery, using 239,150 women with first vaginal delivery as controls. There was an increased risk of retained placenta with heavy bleeding in women with previous caesarean section (adjusted OR 1.61; 95% CI 1.44-1.79). There was no increased risk of retained placenta with normal bleeding (Study III).

    Placental location, myometrial thickness and Vascularisation Index were recorded on 400 women previously delivered by caesarean section. The outcome was retained placenta and postpartum haemorrhage (≥1,000 mL). There was a trend towards increased risk of postpartum haemorrhage for women with anterior placentae. Women with placenta praevia had an increased risk of retained placenta and postpartum haemorrhage. Vascularisation Index and myometrial thickness did not associate (Study IV).

    In conclusion: 3D ultrasound can be used to measure the volume of the uterine body and cavity postpartum, but does not increase the diagnostic accuracy of retained placental tissue. Previous caesarean section increases the risk of retained placenta in subsequent pregnancy, and placenta praevia in women with previous caesarean section increases the risk for retained placenta and postpartum haemorrhage.

    List of papers
    1. Longitudinal study of the uterine body and cavity with three-dimensional ultrasonography in the puerperium
    Open this publication in new window or tab >>Longitudinal study of the uterine body and cavity with three-dimensional ultrasonography in the puerperium
    2012 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 10, p. 1184-1190Article in journal (Refereed) Published
    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.

    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:uu:diva-182446 (URN)10.1111/j.1600-0412.2012.01418.x (DOI)000308887300009 ()22497320 (PubMedID)
    Available from: 2012-10-10 Created: 2012-10-10 Last updated: 2017-12-07Bibliographically approved
    2. Three-dimensional ultrasound does not improve diagnosis of retained placental tissue compared to two-dimensional ultrasound
    Open this publication in new window or tab >>Three-dimensional ultrasound does not improve diagnosis of retained placental tissue compared to two-dimensional ultrasound
    2015 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 1, p. 112-116Article in journal (Refereed) Published
    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.

    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Identifiers
    urn:nbn:se:uu:diva-240535 (URN)10.1111/aogs.12502 (DOI)000346704100019 ()25303033 (PubMedID)
    Available from: 2015-01-07 Created: 2015-01-07 Last updated: 2017-12-05Bibliographically approved
    3. Risk of retained placenta in women previously delivered by caesarean section: a population-based cohort study.
    Open this publication in new window or tab >>Risk of retained placenta in women previously delivered by caesarean section: a population-based cohort study.
    Show others...
    2014 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 121, no 2, p. 224-229Article in journal (Refereed) Published
    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.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-214810 (URN)10.1111/1471-0528.12444 (DOI)000328863800017 ()24044730 (PubMedID)
    Available from: 2014-01-09 Created: 2014-01-09 Last updated: 2017-12-06Bibliographically approved
    4. Placental location, postpartum haemorrhage and retained placenta in women previously delivered by caesarean section: a prospective cohort study
    Open this publication in new window or tab >>Placental location, postpartum haemorrhage and retained placenta in women previously delivered by caesarean section: a prospective cohort study
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective The objective was to determine if anterior placental location increased the risk of postpartum haemorrhage (PPH) and retained placenta in women previously delivered by caesarean section.

     

    Design Prospective cohort study.

     

    Setting Fetal medicine unit, Uppsala University hospital, Sweden.

    Population. Four hundred women previously delivered by caesarean section.

    Methods Ultrasound scans were performed at gestational week 28-30. Placental location, myometrial thickness and three-dimensional vascularisation 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 was obtained.

    Main Outcome Measures PPH (≥ 1000 ml) and retained placenta.

    Results Twenty-four women (11.6%) of 213 with anterior placentas had PPH compared to 13 (7.3%) with placentas in other locations. This difference was not significant. No significant risk increase was found for retained placenta in women with anterior placentae. Of the 23 women with low anterior placentae six (26.1%) had PPH compared to 38 (10.3%) with other placental locations (p = 0.032). Three women (13.0%) with low anterior placentae had retained placenta compared to 11 (2.9%) with other locations (p = 0.04). All women but one with low-lying anterior placentae and PPH and all with retained placentae had placenta praevia.

    Conclusion Low anterior placentae in women previously delivered by caesarean section increased the risk of PPH and retained placenta, mostly due to placenta praevia. Other anterior locations of the placenta may add to the increased risk of PPH. 

    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Research subject
    Obstetrics and Gynaecology
    Identifiers
    urn:nbn:se:uu:diva-246178 (URN)
    Available from: 2015-03-03 Created: 2015-03-03 Last updated: 2015-04-17
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  • 99.
    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.

  • 100.
    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.

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