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  • 1.
    Andersson, Liselott
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. Department of Obstetrics and Gynecology, Sunderby Hospital, Luleå, Sweden.
    Sundström-Poromaa, Inger
    Wulff, Marianne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Åström, Monica
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bixo, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Implications of antenatal depression and anxiety for obstetric outcome2004In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 104, no 3, p. 467-476Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the obstetric outcome and health care consumption during pregnancy, delivery, and the early postpartum period in an unselected population-based sample of pregnant women diagnosed with antenatal depressive and/or anxiety disorders, compared with healthy subjects. METHODS: Participants were 1,495 women attending 2 obstetric clinics in Northern Sweden. The Primary Care Evaluation of Mental Disorders was used to evaluate depressive and anxiety disorders in the second trimester of pregnancy. To assess demographic characteristics, obstetric outcome, and complications, the medical records of the included women were reviewed. RESULTS: Significant associations were found between depression and/or anxiety and increased nausea and vomiting, prolonged sick leave during pregnancy and increased number of visits to the obstetrician, specifically, visits related to fear of childbirth and those related to contractions. Planned cesarean delivery and epidural analgesia during labor were also significantly more common in women with antenatal depression and/or anxiety. CONCLUSION: There is an association between antenatal depressive and/or anxiety disorders and increased health care use (including cesarean deliveries) during pregnancy and delivery.

  • 2.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Maternal Obesity and Risk of Postpartum Hemorrhage2011In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 118, no 3, p. 561-568Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate whether maternal obesity was associated with an increased risk for postpartum hemorrhage more than 1,000 mL and whether there was an association between maternal obesity and causes of postpartum hemorrhage and mode of delivery. less thanbrgreater than less thanbrgreater thanMETHODS: A population-based cohort study including 1,114,071 women with singleton pregnancies who gave birth in Sweden from January 1, 1997 through December 31, 2008, who were divided into six body mass index (BMI) classes. Obese women (class I-III) were compared with normal-weight women concerning the risk for postpartum hemorrhage after suitable adjustments. The use of heparin-like drugs over the BMI strata was analyzed in a subgroup. less thanbrgreater than less thanbrgreater thanRESULTS: There was an increased prevalence of postpartum hemorrhage over the study period associated primarily with changes in maternal characteristics. The risk of atonic uterine hemorrhage increased rapidly with increasing BMI. There was a twofold increased risk in obesity class III (1.8%). No association was found between postpartum hemorrhage with retained placenta and maternal obesity. There was an increased risk for postpartum hemorrhage for women with a BMI of 40 or higher (5.2%) after normal delivery (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.04-1.45]) compared with normal-weight women (4.4%) and even more pronounced (13.6%) after instrumental delivery (OR 1.69, 95% CI 1.22-2.34) compared with normal-weight women 8.8%). Maternal obesity was a risk factor for the use of heparin-like drugs (OR 2.86, 95% CI 2.22-3.68). less thanbrgreater than less thanbrgreater thanCONCLUSION: The increased risk for atonic postpartum hemorrhage in the obese group has important clinical implications, such as considering administration of prophylactic postpartum uterotonic drugs to this group.

  • 3.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Maternal Obesity, Mode of Delivery, and Neonatal Outcome2013In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 122, no 1, p. 50-55Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate whether adverse neonatal outcome, defined as birth injuries or severe illnesses in the newborn, was associated with maternal body mass index (BMI) in singleton pregnancies overall and depending on mode of delivery. METHODS: This was a cohort study including 1,024,471 women. Data were collected from the Swedish Medical Birth Registry. Women were categorized into six classes of BMI. Obese women were compared with normal weight women regarding adverse neonatal outcome after suitable adjustments. Four modes of delivery were evaluated: vaginal delivery; instrumental vaginal delivery; elective cesarean delivery; and emergency cesarean delivery. RESULTS: Compared with neonates born to women of normal weight, neonates born to women with BMIs of 40 or more (morbidly obese) were at increased risk of birth injury to the peripheral nervous system (odds ratio [OR] 3.80, 95% confidence interval [CI] 2.83-5.12; 0.2% compared with 0.6%), birth injury to the skeleton (OR 2.59, 95% CI 2.10-3.21; 0.5% compared with 1.1%), respiratory distress syndrome (OR 2.08, 95% CI 1.88-2.30; 2.9 compared with 5.8%), bacterial sepsis (OR 2.90, 95% CI 2.43-3.46; 0.6% compared with 1.7%), convulsions (OR 3.43, 95% CI 2.63-4.47; 0.2% compared with 0.8%), and hypoglycemia (OR 3.48, 95% CI 3.20-3.78; 2.4% compared with 7.9%). For morbidly obese women, elective cesarean delivery and vaginal delivery were associated with twice the increased risk of adverse neonatal outcomes when compared with women of normal weight. CONCLUSION: Neonates born to morbidly obese women are at markedly increased risk of adverse neonatal outcome regardless of mode of delivery. Obstetricians should not disregard the neonatal problems associated with elective cesarean delivery for morbidly obese women.

  • 4.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Maternal morbid obesity and the risk of adverse pregnancy outcome2004In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 103, no 2, p. 219-224Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate whether morbidly obese women have an increased risk of pregnancy complications and adverse perinatal outcomes. METHODS: In a prospective population-based cohort study, 3,480 women with morbid obesity, defined as a body mass index (BMI) more than 40, and 12,698 women with a BMI between 35.1 and 40 were compared with normal-weight women (BMI 19.8-26). The perinatal outcome of singletons born to women without insulin-dependent diabetes mellitus was evaluated after suitable adjustments. RESULTS: In the group of morbidly obese mothers (BMI greater than. 40) as compared with the normal-weight mothers, there was an increased risk of the following outcomes (adjusted odds ratio, 95% confidence interval): preeclampsia (4.82, 4.04, 5.74), antepartum stillbirth (2.79, 1.94,4.02), cesarean delivery (2.69, 2.49,2.90), instrumental delivery (1.34, 1.16, 1.56), shoulder dystocia (3.14, 1.86, 5.31), meconium aspiration (2.85, 1.60, 5.07), fetal distress (2.52, 2.12,2.99), early neonatal death (3.41, 2.07,5.63), and large-for-gestational age (3.82, 3.50, 4.16). The associations were similar for women with BMIs between 35.1 and 40 but to a lesser degree. CONCLUSION: Maternal morbid obesity in early pregnancy is strongly associated with a number of pregnancy complications and perinatal conditions. tricians and Gynecologists.

  • 5.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Optimal gestational weight gain for body mass index categories2007In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 110, no 4, p. 759-764Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To establish optimal gestational weight gain for each maternal body mass index (BMI) category based on significant risk estimates of adverse maternal and fetal outcome. METHODS: The study population consisted of 298,648 singleton pregnancies delivered in Sweden between January 1, 1994, and December 31, 2004. The number of individuals in each weight gain class was compared with the number of individuals in all other weight gain classes in the same BMI group with regard to adverse maternal and fetal outcome. Odds ratios were calculated after suitable adjustments. RESULTS: The optimal gestational weight gain in women by prepregnancy BMI was 9-22 lb (4-10 kg) for BMI less than 20, 5-22 lb (2-10 kg) for BMI 20-24.9, less than 20 lb (less than 9 kg) for BMI 25-29.9, and less than 13 lb (less than 6 kg) for BMI of 30 or more. CONCLUSION: The gestational weight gain limits for BMI categories determined in this large population-based cohort study from Swedish Medical Registers showed that a decreased risk of adverse obstetric and neonatal outcomes was associated with lower gestational weight gain limits than was earlier recommended, especially among obese women. © 2007 The American College of Obstetricians and Gynecologists.

  • 6. Darj, Elisabeth
    et al.
    Stralin, Eva-Britta
    Nilsson, Staffan
    The prophylactic effect of doxycycline on postoperative infection rate after first-trimester abortion1987In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 70, no 5, p. 755-758Article in journal (Refereed)
    Abstract [en]

    A prospective double-blind study was performed to evaluate the effect of prophylactic antibiotic treatment before induced abortion. Eight hundred consecutive women admitted for first-trimester abortion, without signs of genital infection or antibiotic use in the last three weeks, were included in the study. Doxycycline 400 mg or placebo was given as a single oral dose ten to 12 hours before vacuum aspiration. Ninety-one women (11.8%) returned to the hospital with suspected complications. Thirty-two of these women were diagnosed as having pelvic inflammatory disease, eight of whom (2.1%) had received doxycycline before the abortion and 24 of whom (6.2%) had received placebo, a statistically significant difference (P less than .01). A history of pelvic inflammatory disease increased the risk of developing it again after an abortion.

  • 7.
    Ekblad, Sara
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Lönnberg, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Berg, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Ödkvist, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, RC - Rekonstruktionscentrum, ÖNH - Öron- Näsa- Halskliniken.
    Ledin, Torbjörn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, RC - Rekonstruktionscentrum, ÖNH - Öron- Näsa- Halskliniken.
    Hammar, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Estrogen effects on postural balance in postmenopausal women without vasomotor symptoms: A randomized masked trial2000In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 95, no 2, p. 278-283Article in journal (Refereed)
    Abstract [en]

    Objective: To assess whether estrogen treatment given to postmenopausal women without vasomotor symptoms improves balance more than placebo. Methods: Forty healthy postmenopausal women without vasomotor symptoms were randomized to transdermal 17▀-estradiol (E2) 50 ╡g/day for 14 weeks or identical transdermal placebo patches. Postural balance was measured with dynamic posturography before and after 4, 12, and 14 weeks of therapy. In this test, the visual, vestibular, and somatosensory systems were provoked with increasing difficulty and body sway was measured with a dual forceplate. A low score showed large sway and a score of 100 showed no sway at all. Results: Thirty-eight women completed the study. Both groups had normal balance for their ages and near maximum scores in the three easier balance tests at baseline. In the most difficult test, both groups improved their postural balance significantly (from 13 to 32 and from 22 to 39, respectively) after 4 weeks. Thereafter, no change was seen. One problem was low statistical power, but the relative change in balance did not differ between groups. The comparison did not show even a minute advantage of E2 over placebo, so a study with higher power would probably not have shown a more pronounced effect of estrogen than placebo. The change over time did not differ between groups, which indicates a significant learning effect.Conclusion: In women without vasomotor symptoms, estrogen therapy did not seem to increase postural balance significantly more than placebo. However, we could not rule out that estrogens affect postural balance in women with vasomotor symptoms. Copyright (C) 2000 The American College of Obstetricians and Gynecologists.

  • 8.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Holmgren, P A
    Engberg, Staffan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Survival and 2-year outcome with expectant management of second-trimester rupture of membranes.1998In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 92, no 6, p. 895-901Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the perinatal and 2-year outcomes in pregnancies complicated by preterm premature rupture of membranes (PROM) during the second trimester.

    METHODS: Fifty-three consecutive singleton pregnancies with PROM at 14 to 28 weeks of gestation were studied retrospectively. Management goals were to prolong the pregnancies to 32 weeks through expectant management and to avoid fetal compromise through closer monitoring and active intervention, when necessary, after 23 weeks. Outcome of the surviving infants was based on neurologic, audiometric, and ophthalmologic examinations at 2 years of corrected age.

    RESULTS: Rupture of membranes occurred at 14-19 weeks (mean 17.4 weeks) in 10 women, at 20-25 weeks (mean 24.0 weeks) in 24, and at 26-28 weeks (mean 27.6 weeks) in 19. The median latency periods to delivery were 72 days, 12 days, and 10 days when rupture of membranes occurred at 14-19 weeks, 20-25 weeks, and 26-28 weeks, respectively. The overall incidence of chorioamnionitis was 28%. There were no fetal deaths and nine neonatal deaths. When rupture of membranes occurred at 14-19 weeks, 20-25 weeks, and 26-28 weeks, the perinatal survival rates were 40%, 92%, and, 100%, respectively. Pulmonary hypoplasia accounted for seven deaths. Of the live-born infants, 81% were alive at 2 years of corrected age. Survival without major impairment was observed in 75%, 80%, and 100% of the survivors when rupture of membranes occurred at 14-19 weeks, 20-25 weeks, and 26-28 weeks, respectively.

    CONCLUSION: Expectant management of second-trimester PROM offers better perinatal and long-term survival than previously thought.

  • 9.
    Granfors, Michaela
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Skogö, Johan
    Stridsberg, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemical endocrinology.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sundström-Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Targeted Thyroid Testing During Pregnancy in Clinical Practice2014In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 124, no 1, p. 10-15Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:To evaluate the efficacy of a targeted thyroid testing approach during pregnancy in clinical practice.

    METHODS:This is a retrospective cohort study performed within Uppsala County, Sweden. Data were derived from the population-based Uppsala Biobank of Pregnant Women, in which blood samples are collected in conjunction with the routine ultrasound screening in gestational week 17-19. For this study, 5,254 pregnant women with an estimated date of delivery between January 1, 2009, and December 31, 2011, were included. On review of their medical records, women who were tested for thyroid dysfunction during pregnancy in clinical practice were identified (n=891). From the remaining untested women, 1,006 women were randomly selected for analyses of thyrotropin (TSH), free thyroxine levels, and thyroid peroxidase antibodies. Thyroid-stimulating hormone levels in both groups were analyzed with regard to trimester-specific upper reference levels as recommended by the International Endocrine Society Guidelines.

    RESULTS:The proportion of trimester-specific TSH elevation was 12.6% in the targeted thyroid testing group and 12.1% in the untested group (P=.8; odds ratio [OR] 1.04, 95% confidence interval [CI] 0.79-1.37). The proportion of overt hypothyroidism was 1.1% and 0.7% in the groups, respectively (P=.4; OR 1.57, 95% CI 0.55-4.45).

    CONCLUSIONS:The prevalence of trimester-specific elevated TSH and overt hypothyroidism was equal in targeted thyroid tested and untested women. When implemented in clinical practice, targeted thyroid testing is unsatisfactory. If ongoing studies provide support for treatment of pregnant women with elevated TSH, universal thyroid testing appears the most reasonable approach.

  • 10. Hammar, M. L.
    et al.
    Lindgren, R.
    Berg, G. E.
    Möller, Claes
    Örebro University, School of Health and Medical Sciences.
    Niklasson, M. K.
    Effects of hormonal replacement therapy on the postural balance among postmenopausal women1996In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 88, no 6, p. 955-960Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To establish whether hormone replacement therapy affects postural balance in postmenopausal women.

    METHODS:

    Nineteen healthy postmenopausal women with vasomotor symptoms were included. Median age was 54 years, median time since menopause was 3 years. They underwent dynamic posturography before and after 4 and 12 weeks of transdermal estrogen treatment (17 beta-estradiol 50 micrograms/day) as well as after 2 additional weeks of combined estrogen-progestagen treatment. The dynamic posturography method quantifies the amplitude, frequency, and pattern of body sway and tests the visual, vestibular, and somatosensory systems, which together maintain balance. The two most difficult tests either cancel visual and distort somatosensory inputs or give distorted information from both the visual and somatosensory systems.

    RESULTS:

    Hormone replacement therapy increased static balance performance assessed by dynamic posturography. A highly significant improvement was seen in the two most difficult tests between the pretreatment test and the test performed after 4 weeks of estrogen therapy (P < .01, P < .001, respectively). This improvement was sustained after 12 weeks and also during the 14th week, with the women on combined estrogen-progestagen treatment.

    CONCLUSION:

    Estrogen treatment increased balance performance measured by dynamic posturography, indicating that the beneficial effects from estrogens on postmenopausal fracture risk may include central nervous system effects on balance. Two weeks' addition of gestagen to the treatment regimen did not counteract the estrogen effects.

  • 11.
    Hastie, Roxanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics. Univ Melbourne, Mercy Hosp Women, Translat Obstet Grp, Dept Obstet & Gynecol, Heidelberg, Vic, Australia;Univ Melbourne, Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia;Stellenbosch Univ, Dept Obstet & Gynecol, Cape Town, South Africa.
    Brownfoot, Fiona C.
    Univ Melbourne, Mercy Hosp Women, Translat Obstet Grp, Dept Obstet & Gynecol, Heidelberg, Vic, Australia;Univ Melbourne, Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia;Stellenbosch Univ, Dept Obstet & Gynecol, Cape Town, South Africa.
    Cluver, Catherine A.
    Univ Melbourne, Mercy Hosp Women, Translat Obstet Grp, Dept Obstet & Gynecol, Heidelberg, Vic, Australia;Univ Melbourne, Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia;Stellenbosch Univ, Dept Obstet & Gynecol, Cape Town, South Africa.
    Walker, Susan P.
    Univ Melbourne, Mercy Hosp Women, Translat Obstet Grp, Dept Obstet & Gynecol, Heidelberg, Vic, Australia;Univ Melbourne, Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia;Stellenbosch Univ, Dept Obstet & Gynecol, Cape Town, South Africa.
    Hesselman, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Univ Melbourne, Mercy Hosp Women, Translat Obstet Grp, Dept Obstet & Gynecol, Heidelberg, Vic, Australia;Univ Melbourne, Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia;Stellenbosch Univ, Dept Obstet & Gynecol, Cape Town, South Africa;Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden;Uppsala Univ, Ctr Clin Res, Uppsala, Sweden.
    Tong, Stephen
    Univ Melbourne, Mercy Hosp Women, Translat Obstet Grp, Dept Obstet & Gynecol, Heidelberg, Vic, Australia;Univ Melbourne, Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia;Stellenbosch Univ, Dept Obstet & Gynecol, Cape Town, South Africa.
    Bergman, Lina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics. Univ Melbourne, Mercy Hosp Women, Translat Obstet Grp, Dept Obstet & Gynecol, Heidelberg, Vic, Australia;Univ Melbourne, Mercy Hosp Women, Mercy Perinatal, Heidelberg, Vic, Australia;Stellenbosch Univ, Dept Obstet & Gynecol, Cape Town, South Africa.
    Predictive Value of the Signs and Symptoms Preceding Eclampsia: A Systematic Review2019In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 134, no 4, p. 677-684Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate the predictive value of signs and symptoms that occur before onset of eclampsia among pregnant women.

    DATA SOURCES: Electronic databases, including MEDLINE, EMBASE, Cochrane, and ClinicalTrials.gov were searched from inception to 2018. Search terms included eclampsia, predict, likelihood ratio, predictive value, and risk.

    METHODS OF STUDY SELECTION: Abstracts and later full texts were selected for review if a diagnosis of eclampsia was made, a comparator arm included (women without a diagnosis of eclampsia), and predictors of imminent eclampsia reported. Of 2,791 retrieved records, 11 were selected. Significant heterogeneity existed between studies, with differing designs, settings, participants, and signs or symptoms. In total, 28 signs or symptoms were reported, with visual disturbances and epigastric pain most common (six studies), followed by headache (five studies), and any edema (four studies).

    TABULATION, INTEGRATION, AND RESULTS: Data on study characteristics and predictive value of signs or symptoms were extracted, and, where appropriate, bivariate mixed-effect meta-analysis was applied to raw data. None of the pooled estimates were able to accurately predict eclampsia nor rule out eclampsia in their absence, with moderate specificity (83-94%) and poor sensitivity (29-56%).

    CONCLUSION: There is a dearth of high-quality studies investigating the predictive value of imminent signs and symptoms of eclampsia. Owing to the small number of studies, heterogeneity, and inconsistent reporting, it is difficult to provide accurate estimates of the predictive value of prodromal symptoms of eclampsia. Of the most commonly reported symptoms-visual disturbances, epigastric pain, and headache-none were able to accurately predict, nor rule out, imminent eclampsia.

  • 12.
    Högberg, U
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Innala, E
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Sandström, A
    Maternal mortality in Sweden, 1980-1988.1994In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 84, no 2, p. 240-4Article in journal (Refereed)
    Abstract [en]

    Regular reviews of maternal mortality are still important in a country with a low rate of maternal deaths. The new classification of maternal deaths allows a better international comparison of mortality risks. Continuous surveillance of maternal deaths and pregnancy-related deaths requires record linkage of birth and death registrations.

  • 13.
    Ildgruben, A.
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Sjöberg, I.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Hammarström, Marie-Louise
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Influence of Hormonal Contraceptives on the Immune Cells and Thickness of Human Vaginal Epithelium2003In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 102, no 3, p. 571-582Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine whether use of steroid hormone contraceptives modifies immune defense parameters of the vaginal epithelium in humans. METHODS: Vaginal biopsies were collected during the follicular and luteal phases in regularly menstruating women (controls) and in women using combined oral contraceptives, depot-medroxyprogesterone acetate injections, or levonorgestrel implants. Fifteen healthy women (aged 20-34 years) were enrolled in each group. Biopsies were analyzed in a blinded manner. Epithelial thickness was estimated by morphometry. Immune cells were analyzed by immunomorphometry with cell-type-specific monoclonal antibodies. RESULTS: The epithelium of controls harbored 241+/-35 leukocytes (CD45+ cells) per mm2 (mean+/-1 standard error of the mean), and the thickness was 261+/-16 microm. T lymphocytes (CD3+) dominated, and cytotoxic or suppressor T cells (CD8+) were more frequent than T helper cells (CD4:CD8 ratio: 0.7+/- 0.1). Macrophages (CD68+) constituted the second-largest population, followed by Langerhans cells (CD1a+). B cells, natural killer cells, monocytes, and granulocytes were generally absent. There were no significant differences between the follicular and luteal phases. The epithelium was significantly thicker in all three groups that used hormonal contraceptive (333+/-9 microm) compared with controls, and it exhibited superficial hyperplasia. The frequency of intraepithelial leukocytes (CD45+) was increased in depot-medroxyprogesterone acetate (P<.001) and levonorgestrel implant users (P<.04). In depot-medroxyprogesterone acetate users, this was explained by an increased frequency of the CD8+ T lymphocyte subset. CONCLUSION: Hormonal contraceptives induce hyperplasia of the vaginal epithelium. The significant changes in the intraepithelial leukocyte population in depot-medroxyprogesterone acetate and levonorgestrel implant users most probably reflect altered local immune capacity.

  • 14. Larsson, Caroline
    et al.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms2004In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 104, no 3, p. 459-466Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study whether women with antepartum depression have an increased risk for adverse perinatal outcome. METHODS: From a sample of 1,489 women, an index group (n = 259) of all women with depressive symptoms on the Edinburgh Postnatal Depression Scale in gestational week 35-36 was selected. Two hundred fifty-nine women with no depressive symptoms on the Edinburgh Postnatal Depression Scale antepartum or postpartum were randomly chosen as the reference group. Medical, gynecologic, and obstetric history, sodoeconomic status, pregnancy, and perinatal data were collected from standardized medical records for all women. RESULTS: Women with antepartum depressive symptoms were more often multiparas with a history of earlier obstetric complications. Complications during the present pregnancy were more frequent in the antepartum-depressed group of women. There were no differences concerning outcome of delivery, puerperium, and neonatal health between the index and reference groups. Forty-six percent of the women with antepartum depressive symptoms had depressive symptoms at 6-8 weeks or 6 months postpartum or both. CONCLUSION: Women depressed during pregnancy constitute a group without an increased risk for adverse obstetric or neonatal outcome but with a high risk for postpartum depressive symptoms.

  • 15.
    Löfgren, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Bäckström, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Progesterone concentrations in maternal and fetal serum are lower during functional dystocia than in normal labor1992In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 79, no 5, p. 752-759Article in journal (Refereed)
    Abstract [en]

    Concentrations of progesterone and estradiol (E2) were measured in parturient serum and in fetal cord serum during normal labor and in women with functional dystocia. In the study group, there were no cases of cephalopelvic disproportion. In oxytocin-resistant dystocia, the course of labor could not be corrected with oxytocin. To ascertain the effect of oxytocin, we included a number of women whose labor had been induced with oxytocin, followed by normal cervical dilatation and descent of the fetus. All the parturients were grouped retrospectively into those with normal labor and those with dystocia, based on previous definitions. The serum concentrations of progesterone in both the fetal cord and maternal vein were found to be significantly lower in the oxytocin-resistant dystocia group than in women in spontaneous normal labor and those with oxytocin-induced labor and normal progression (P < .05-.005). Oxytocin had no evident effect on the serum concentration of either progesterone or E2, nor did concentrations vary following epidural blockade. Serum E2 concentrations in the maternal vein were similar in all delivery groups. Fetal cord E2 serum concentrations were similar in all vaginal deliveries. Women with the most severe oxytocin-resistant dystocia, delivered by cesarean, had significantly lower serum concentrations of E2 in fetal cord serum compared with the vaginally delivered women (P < .001).

  • 16.
    Nelson, Gregg
    et al.
    ERAS Alberta, ERAS Society, Division of Gynecologic Oncology, Tom Baker Cancer Center, Calgary AB, Canada.
    Ramirez, Pedro T.
    Minimally Invasive Surgical Research and Education, Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston TX, United States.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. ERAS Society, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Dowdy, Sean C.
    Division of Gynecologic Oncology, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester MN, United States.
    Enhanced Recovery Program and Length of Stay After Laparotomy on a Gynecologic Oncology Service: A Randomized Controlled Trial2017In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 129, no 6, p. 1139-1139Article in journal (Refereed)
  • 17. Pikarinen, Ulla
    et al.
    Saisto, Terhi
    Schei, Berit
    Swahnberg, Katarina
    Linköpings universitet.
    Halmesmäki, Erja
    Experiences of physical and sexual abuse and their implications for current health2007In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 109, no 5, p. 1116-1122Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate the prevalence of a history of physical and sexual abuse in adulthood among gynecological patients and the association with general and reproductive health.

    METHODS: A cross-sectional questionnaire study on abusive experiences of gynecologic outpatients in a tertiary hospital. The total sample size was 691.

    RESULTS: Of all women, 42.4% had experienced moderate or severe physical or sexual abuse as an adult. One hundred forty-seven (21.6%) women reported physical abuse, 84 (12.3%) sexual abuse, and 58 (8.5%) both. The abused and nonabused women did not differ in mean age, education, or parity. Sexually abused women and those who were both sexually and physically abused reported poor general health significantly more often (P=.005 andP=.001, respectively) than the nonabused. They also rated their sex life as significantly worse than the nonabused women (P=.002 and P=.012, respectively). Over half of abused women had experienced common physical complaints during the previous 12 months compared with one third of the nonabused (P<.001). Two thirds of both the abused and the nonabused women preferred that their gynecologist not ask directly about abuse.

    CONCLUSION: Abusive experiences were common in gynecologic outpatients. Women with abusive experiences had ill health and poor sexual life more often than the controls. In contrast to the results of previous studies, most of the women did not want to be asked about abuse by their gynecologist.

    LEVEL OF EVIDENCE: II

  • 18. Pikarinen, Ulla
    et al.
    Saisto, Terhi
    Schei, Berit
    Swahnberg, Katarina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine.
    Halmesmäki, Erja
    Experiences of physical and sexual abuse and their implications for current health.2007In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 109, no 5, p. 1116-1122Article in journal (Refereed)
    Abstract [en]

       

  • 19. Steel, Jennifer L.
    et al.
    Herlitz, Claes A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Risk of sexual dysfunction in a radoml selected nonclinical sample of the Swedish population2007In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 109, no 3, p. 663-668Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the risk of sexual dysfunction as a result of childhood sexual abuse or sexual assault in a randomly selected nonclinical sample of men and women. METHODS: In 1996, a randomly selected sample of 2,810 Swedish males and females completed a 322-item interview and questionnaire. Age-adjusted odds ratios (ORs) were calculated to assess risk of sexual dysfunction and analysis of variance was employed to test differences by gender and abuse or assault history in regard to seeking assistance for sexual dysfunction. RESULTS: For females with a history of childhood sexual abuse, an increased risk of anorgasmia for more than 12 months was found for women aged between 31 and 45 years (OR 1.21, P=.009). For females with a history of sexual assault; an increased risk for hypoactive sexual desire disorder was found for women who between the ages of 16 and 30 years (OR 1.51, P=.03), 31 and 45 years (OR 1.28; P=.02), 46 and 60 years (OR 1.21, P=.03), and 61 and 84 years (OR 1.62, P=.04); lubrication problems in the past year for women between 46 and 60 years (OR 1.28, P=.02) and for more than 12 months (OR 1.38, P=.02). No statistically significant increased risk of sexual dysfunction was found for males with a history of childhood sexual abuse. Males who reported a history of sexual assault as an adult had a significant increased risk of retarded ejaculation in the last 12 months if they were between the ages of 31 and 45 years (OR 2.00, P=.008) or 46 and 60 years (OR 2.11, P=.02). Women most often reported sexual dysfunction to their gynecologists (18%) or midwives (8.4%), whereas men reported their sexual dysfunction to their physicians (5.6%) or urologists (4.3%). CONCLUSION: Future research should focus on predictors of sexual dysfunction and resilience subsequent to childhood sexual abuse and sexual assault as an adult.

  • 20.
    Sydsjö, Adam
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Ekholm, Katarina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology.
    Josefsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Influence of rest during pregnancy on birth weight in working women2006In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 107, no 5, p. 991-996Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Birth weight in Sweden has increased during the past decades. We investigated whether rest provided by the combination of time off from work and social benefits among working pregnant women contributed to the observed changes. METHOD: A total of 7,459 consecutively delivered women in 1978, 1986, 1992, and 1997 at 2 delivery wards in southeastern Sweden were studied. RESULTS: Between 1978 and 1997, the average birth weight among the children of the women studied increased from 3,484 to 3,566 grams (P < .001). The increase in weight was most evident among infants born to women who were employed during pregnancy. The use of social benefits and increased rest during pregnancy did not significantly influence birth weight (P = .107), even after adjustment for gestational length, parity, smoking, age, and occupation. CONCLUSION: The continuous increase in infants' birth weight among pregnant women in this study did not correlate with rest periods in the form of leave supported by social benefit programs. The effects of social benefit programs on pregnancy outcome may thus be overrated and merits further research. © 2006 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.

  • 21. Toriola, Adetunji T
    et al.
    Vääräsmäki, Marja
    Lehtinen, Matti
    Zeleniuch-Jacquotte, Anne
    Lundin, Eva
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Rodgers, Kenneth-Gary
    Lakso, Hans-Ake
    Chen, Tianhui
    Schock, Helena
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Hallmans, Goran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Pukkala, Eero
    Toniolo, Paolo
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Surcel, Helja-Marja
    Lukanova, Annekatrin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Determinants of maternal sex steroids during the first half of pregnancy2011In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 118, no 5, p. 1029-1036Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:: To examine the associations of maternal and child characteristics with early pregnancy maternal concentrations of testosterone, androstenedione, progesterone, 17-hydroxyprogesterone, and estradiol (E2).

    METHODS:: We analyzed these hormones among 1,343 women with singleton pregnancies who donated serum samples to the Finnish Maternity Cohort from 1986 to 2006 during the first half of pregnancy (median 11 weeks). The associations of maternal and child characteristics with hormone concentrations were investigated by correlation and multivariable regression.

    RESULTS:: Women older than age 30 years had lower androgen and E2 but higher progesterone concentrations than women younger than that age. Multiparous women had 14% lower testosterone, 11% lower androstenedione and 17-hydroxyprogesterone, 9% lower progesterone, and 16% lower E2 concentrations compared with nulliparous women (all P<.05). Smoking mothers had 11%, 18%, and 8% higher testosterone, androstenedione, and 17-hydroxyprogesterone levels, respectively, but 10% lower progesterone compared with nonsmoking women (all P<.05). E2 concentrations were 9% higher (P<.05) among women with a female fetus compared with those with a male fetus.

    CONCLUSION:: Parity, smoking, and, to a lesser extent, maternal age and child sex are associated with sex steroid levels during the first half of a singleton pregnancy. The effects of smoking on the maternal hormonal environment and the possible long-term deleterious consequences on the fetus deserve further evaluation.

    LEVEL OF EVIDENCE:: II.

  • 22. Urquia, ML
    et al.
    Glazier, RH
    Gagnon, AJ
    Mortensen, LH
    Nybo Andersen, A-M
    Janevic, T
    Guendelman, S
    Thornton, D
    Bolumar, F
    Sanchez, I
    Small, J
    Davey, M-A
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Disparities in pre-eclampsia and eclampsia among immigrant women giving birth in six industrialised countries2014In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 121, no 12, p. 1492-1500Article in journal (Refereed)
  • 23.
    Valaldares, Eliette
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Ellsberg, Mary
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Peña, Rudolfo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Persson, Lars Åke
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Physical partner abuse during pregnancy: a risk factor for low birth weight in Nicaragua2002In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 100, no 4, p. 700-705Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess whether being physically abused during pregnancy increases the risk of a low birth weight (LBW) infant. METHODS: We conducted a hospital-based case-control study in León, Nicaragua. Cases consisted of 101 newborns with a birth weight under 2500 g, and for each case two controls with a birth weight over 2500 g were selected randomly from infants born the same day. Anthropometry of newborns was done immediately after birth, and background information and data on experiences of violence and potential confounders were obtained through private interviews with mothers. Crude and adjusted odds ratios (ORs) and population-attributable proportion were calculated for exposure to partner abuse in relation to LBW. Multivariate logistic regression analysis was used to control for potential confounding. RESULTS: Seventy-five percent of LBW newborns (cases) were small for gestational age and 40% were preterm. Twenty-two percent of the mothers of LBW infants had experienced physical abuse during pregnancy by their intimate partners compared with 5% of controls. Low birth weight was associated with physical partner abuse even after adjustment for age, parity, smoking, and socioeconomic status (OR 3.9; 95% confidence interval 1.7, 9.3). Given a causal interpretation of the association, about 16% of the LBW in the infant population could be attributed to physical abuse by a partner in pregnancy. CONCLUSION: Physical abuse by a partner during pregnancy is an independent risk factor for LBW.

  • 24. Waldenstrom, Ulla
    et al.
    Aasheim, Vigdis
    Britt, Anne
    Nilsen, Vika
    Rasmussen, Svein
    Pettersson, Hans Jarnbert
    Shytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Adverse Pregnancy Outcomes Related to Advanced Maternal Age Compared With Smoking and Being Overweight2014In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 123, no 1, p. 104-112Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the association between advanced maternal age and adverse pregnancy outcomes and to compare the risks related to advanced maternal age with those related to smoking and being overweight or obese. METHODS: A population-based register study including all nulliparous women aged 25 years and older with singleton pregnancies at 22 weeks of gestation or greater who gave birth in Sweden and Norway from 1990 to 2010; 955,804 women were analyzed. In each national sample, adjusted odds ratios (ORs) of very preterm birth, moderately preterm birth, small for gestational age, low Apgar score, fetal death, and neonatal death in women aged 30-34 years (n=319,057), 35-39 years (n=94,789), and 40 years or older (n=15,413) were compared with those of women aged 25-29 years (n=526,545). In the Swedish sample, the number of additional cases of each outcome associated with maternal age 30 years or older, smoking, and overweight or obesity, respectively, was estimated in relation to a low-risk group of nonsmokers of normal weight and aged 25-29 years. RESULTS: The adjusted OR of all outcomes increased by maternal age in a similar way in Sweden and Norway; and the risk of fetal death was increased even in the 30-to 34-year-old age group (Sweden n=826, adjusted OR 1.24, 95% confidence interval [CI] 1.13-1.37; Norway n=472, adjusted OR 1.26, 95% CI 1.12-1.41). Maternal age 30 years or older was associated with the same number of additional cases of fetal deaths (n=251) as overweight or obesity (n=251). CONCLUSION: For the individual woman, the absolute risk for each of the outcomes was small, but for society, it may be significant as a result of the large number of women who give birth after the age of 30 years.

  • 25. Westgren, N
    et al.
    Hultling, C
    Richard, Levi
    Westgren, M
    Pregnancy and delivery in women with a traumatic spinal cord injury in Sweden, 1980-1991.1993In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 81, no 6, p. 926-30Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the incidence of delivery in women after a traumatic spinal cord injury and to describe pregnancy outcome in this group of patients.

    METHODS: Between 1980-1991, 29 women with a traumatic spinal cord injury experienced 49 pregnancies and gave birth to 52 children in Sweden. A retrospective chart review of the antepartum, intrapartum, and perinatal records of these patients was performed. In addition, all patients participated in a telephone interview held by one of the authors. Of the 29 women, 12 had lesions above T5 and 17 had lesions at T5 or below.

    RESULTS: Antenatal complications occurred frequently in this group. Nine of 12 patients with lesions above T5 had symptoms of autonomic hyperreflexia during pregnancy and/or delivery. Only in a minority of the women was the problem recognized by the medical professionals. Nine of the infants (19%) were born preterm and two were small for gestational age. The perinatal mortality rate was two of 52 (3.8%) and occurred in two cases of abruptio placentae. Few of the patients were allowed to deliver vaginally. The cesarean delivery rate for women with lesions above T5 was 47% and for women with lesions below that level, 26%.

    CONCLUSION: The overall prognosis for these women was favorable. However, women with higher spinal cord lesions would probably benefit from referral to centers with a particular interest and expertise in the management of their problems.

  • 26.
    Wiberg-Itzel, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Andolf, Ellika
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Winbladh, Birger
    Wennerholm, Ulla-Britt
    Association Between Adverse Neonatal Outcome and Lactate Concentration in Amniotic Fluid2011In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 118, no 1, p. 135-142Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate whether a high lactate concentration in amniotic fluid, together with cardiotocography, can be used as an indicator for an increased risk of adverse neonatal outcome at delivery. METHOD: A prospective cohort study was performed at two tertiary center labor wards in Sweden. Healthy women with full-term, singleton pregnancies and cephalic presentation in spontaneous active labor were included in the study (N=825). Lactate concentration in samples of amniotic fluid collected in the course of vaginal examinations during labor were correlated with cardiotocography 30 minutes before delivery and a composite score for adverse neonatal outcome. RESULTS: High lactate concentration in amniotic fluid (greater than 10.1 mmol/L) was associated with an adverse neonatal outcome (odds ratio [OR] 4.4, 95% confidence interval [CI] 2.3-8.2). Fetal bradycardia within 30 minutes before delivery was also associated with an increased risk of adverse neonatal outcome (OR 7.4, 95% CI 3.04-18.11). If lactate in amniotic fluid was greater than 10.1 mmol/L and bradycardia was seen together, the risk of delivering a neonate with an adverse neonatal outcome was increased 11-fold (OR 10.7, 95% CI 3.7-31.7). CONCLUSION: High lactate concentration in amniotic fluid and fetal bradycardia during the last 30 minutes before delivery indicate an increased risk of adverse neonatal outcome at delivery.

  • 27.
    Wihlbäck, A C
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Sundström-Poromaa, I
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Allard, Per
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Mjörndal, T
    Spigset, O
    Bäckström, T
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Influence of postmenopausal hormone replacement therapy on platelet serotonin uptake site and serotonin 2A receptor binding.2001In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 98, no 3, p. 450-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine whether binding of [3H]paroxetine to the platelet serotonin transporter or binding of [3H]lysergic acid diethylamide (LSD) to the platelet 5-HT(2A) receptor are influenced by postmenopausal estrogen/progestogen treatment. METHODS: Twenty-three postmenopausal women with climacteric symptoms completed this double-blind, randomized, crossover study. The women received 2 mg of estradiol continuously during four 28-day cycles. In the last 14 days of each cycle, 10 mg of medroxyprogesterone acetate, 1 mg of norethindrone acetate, or placebo was given. Before treatment, as well as once during the last week of each treatment, blood samples were collected for analysis of [3H]LSD and [3H]paroxetine binding. The power of the study setup was 81%. The study had an effect size of 0.36, corresponding to the ability to detect a 15% difference in [3H]paroxetine and [3H]LSD binding between treatments with alpha =.05 and beta =.20, based on a previously reported standard deviation within cells of 20% of the mean binding values. RESULTS: The number of platelet receptors (B(max)), or the affinity of the radioligand to the receptor (K(d)), for [3H]paroxetine binding did not change during estrogen or estrogen-progestogen treatment, nor did B(max) or K(d) for [3H]LSD binding change during the different treatments. However, in a subgroup of depressed patients, the decrease in B(max) for [3H]LSD binding during treatment was significantly more pronounced than in the nondepressed subgroup (P <.05). CONCLUSION: Estrogen treatment with or without the addition of progestogen does not affect binding to the serotonin transporter or to the serotonergic 5-HT(2A) receptor in healthy postmenopausal women.

  • 28.
    Wihlbäck, Anna-Carin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Sundström-Poromaa, I
    Allard, Per
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Mjörndal, T
    Spigset, O
    Bäckström, T
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Influence of postmenopausal hormone replacement therapy on platelet serotonin uptake site and 5-HT2A receptor binding2001In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 98, no 3, p. 450-457Article in journal (Refereed)
  • 29.
    Wikström, Anna-Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Eriksson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Nash, Peppi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Nordén-Lindeberg, Solveig
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Placental growth factor and soluble fms-like tyrosine kinase-1 in early-onset and late-onset preeclampsia2007In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 109, no 6, p. 1368-1374Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate whether alterations in plasma levels of the proangiogenic proteins placental growth factor (PlGF) and vascular endothelial growth factor-A (VEGF-A), and the antiangiogenic protein soluble fms-like tyrosine kinase-1 (sFlt1) were more pronounced in early-onset than in late-onset preeclampsia. METHODS: A cross-sectional study was conducted to estimate the levels of sFlt1, PlGF, and VEGF-A in plasma in a control group of nonpregnant women, in an early control group of women at 24-32 weeks of gestation, in a late control group of women at 36-42 weeks of gestation, and in cases of women with early-onset (before 32 weeks of gestation) and late-onset (after 35 weeks of gestation) preeclampsia. RESULTS: Women with early-onset preeclampsia had a 43 times higher median plasma sFlt1 level than early controls (P<.001). Women with late-onset preeclampsia had a three times higher median plasma sFlt1 level than late controls (P<.001). Women with early-onset preeclampsia had a 21 times lower median plasma PlGF level than early controls (P<.001). Women with late-onset preeclampsia had a five times lower median plasma PlGF level than late controls (P=.01). The median level of VEGF-A in plasma was less than 15 pg/mL in all groups of pregnant women. CONCLUSION: Both early- and late-onset preeclampsia are associated with altered plasma levels of sFlt1 and PlGF. The alterations are more pronounced in early-onset rather than in late-onset disease.

  • 30. Zeisler, Harald
    et al.
    Llurba, Elisa
    Chantraine, Frederic
    Vatish, Manu
    Staff, Anne Cathrine
    Sennstrom, Maria
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Brennecke, Shaun P.
    Stepan, Holger
    Allegranza, Deirdre
    Dinkel, Carina
    Schoedl, Maria
    Dilba, Peter
    Hund, Martin
    Verlohren, Stefan
    Soluble fms-Like Tyrosine Kinase-1-to-Placental Growth Factor Ratio and Time to Delivery in Women With Suspected Preeclampsia2016In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 128, no 2, p. 261-269Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the association of a serum soluble fms-like tyrosine kinase 1-to-placental growth factor (sFlt-1-to-PlGF) ratio of greater than 38 with time to delivery and preterm birth.

    METHODS: Secondary analysis of an observational cohort study that included women 18 years of age or older from 24 to 36 6/7 weeks of gestation at their first study visit with suspected (not confirmed) preeclampsia. Participants were recruited from December 2010 to January 2014 at 30 sites in 14 countries. A total of 1,041 women were included in time-to-delivery analysis and 848 in preterm birth analysis.

    RESULTS: Women with an sFlt-1-to-PlGF ratio greater than 38 (n=250) had a 2.9-fold greater likelihood of imminent delivery (ie, delivery on the day of the test) (Cox regression hazard ratio 2.9; P <.001) and shorter remaining time to delivery (median 17 [interquartile range 10-26] compared with 51 [interquartile range 3075] days, respectively; Weibull regression factor 0.62; P <.001) than women with an sFlt-1-to-PlGF ratio of 38 or less, whether or not they developed preeclampsia. For women who did not (n=842) and did develop preeclampsia (n=199), significant correlations were seen between an sFlt-1-to-PlGF ratio greater than 38 and preterm birth (r=0.44 and r=0.46; both P <.001). Among women who did not develop preeclampsia, those who underwent iatrogenic preterm delivery had higher median sFlt-1-to-PlGF ratios at their first visit (35.3, interquartile range 6.8-104.0) than those who did not (8.4, interquartile range 3.4-30.6) or who delivered at term (4.3, interquartile range 2.4-10.9).

    CONCLUSIONS: In women undergoing evaluation for suspected preeclampsia, a serum sFlt-1-to-PlGF ratio greater than 38 is associated with a shorter remaining pregnancy duration and a higher risk of preterm delivery.

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