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  • 1.
    Allbrand, Marianne
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Åman, Jan
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Lodefalk, Maria
    Örebro University, School of Medical Sciences. Örebro University Hospital. Health Care Research Center, Region Örebro County, Örebro, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Placental ghrelin and leptin expression and cord blood ghrelin, adiponectin, leptin, and C-peptide levels in severe maternal obesity2017In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 31, no 21, p. 2839-2846Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study is to investigate placental ghrelin and leptin expression as well as cord blood ghrelin and adiponectin levels in maternal obesity and associations between placental ghrelin expression, cord blood ghrelin levels and maternal and infant variables.

    MATERIALS AND METHODS: Placental ghrelin and leptin expression were analyzed by RT-PCR in 32 severely obese and 32 matched normal-weight women. Cord blood ghrelin, adiponectin, leptin, and C-peptide concentrations were analyzed by ELISA.

    RESULTS: Neither ghrelin nor leptin expression and neither cord blood ghrelin nor adiponectin levels differed between the groups. Placental ghrelin expression was associated with BMI at delivery in the obese women (r = 0.424, p = .016) and in the infants born to normal-weight women with their weight z-scores at six (r = -0.642, p = .010), nine (r = -0.441, p = .015), and 12 months of age (r = -0.402, p = .028).

    CONCLUSIONS: Placental ghrelin and leptin expression as well as cord blood ghrelin and adiponectin levels do not seem to be altered in severe maternal obesity. Placenta-derived ghrelin may influence the infants' postnatal weight gain, but possibly only when the mother has normal weight.

  • 2.
    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.

  • 3. Di Renzo, G C
    et al.
    Melin, P
    Berardi, A
    Blennow, M
    Carbonell-Estrany, X
    Donzelli, G P
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hod, M
    Hughes, R
    Kurtzer, M
    Poyart, C
    Shinwell, E
    Stray-Pedersen, B
    Wielgos, M
    El Helali, N
    Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference2015In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 7-8, p. 766-782Article in journal (Refereed)
    Abstract [en]

    Abstract Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecology-obstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing.

  • 4.
    Finnström, Orvar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Gäddlin, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Leijon, Ingemar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Samuelsson, S
    Wadsby, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry.
    Very-low-birth-weight children at school age: Academic achievement, behavior and self-esteem and relation to risk factors2003In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 14, no 2, p. 75-84Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate school performance, behavior and self-esteem of children with very low birth weight (VLBW). Methods: All children with birth weight below 1501 g (VLBW) and normal birth weight controls, born in the south-east region of Sweden during a 15-month period in 1987-88, were enrolled in a prospective follow-up study. At the age of 9 years, 81% and 82%, respectively, were re-examined regarding growth, neurofunctional classification, academic achievement tests, need for special education and behavioral problems. At 12 years, 89% and 76%, respectively, were re-examined regarding growth, neurofunctional classification, visual acuity and self-esteem. Results: VLBW children were shorter and lighter, and differed from the controls with regard to neurological functional classification. They produced poorer results in most academic achievement tests. When the comparison was restricted to children with normal intelligence, almost all the differences in other academic achievements disappeared. VLBW children had more reading difficulties but were less often than expected defined as dyslexics compared to control children. We did not find any major disparity in visual acuity and self-esteem between the groups. Low Apgar scores, intracranial hemorrhage and the need for mechanical ventilation neonatally were associated with poorer results in most outcome measures. Neurofunctional assessments in early childhood were associated with most outcome measures. The mother's education was related to delayed reading skills and need for special education. Conclusions: Although VLBW children performed less well in most academic achievement tests and on some behavioral subscales, those who had a normal intellectual capacity did not differ in any important aspects from the controls.

  • 5.
    Hoppe, Michael
    et al.
    Sahlgrens Univ Hosp, Clin Nutr Unit, Dept Gastroenterol & Hepatol, Gothenburg, Sweden;Univ Gothenburg, Sahlgrenska Acad, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Hulthen, Lena
    Univ Gothenburg, Sahlgrenska Acad, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Samuelson, Gösta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology. Univ West, Dept Hlth Sci, Trollhattan, Sweden.
    Is cord blood hepcidin influenced by the low-grade acute-phase response occurring during delivery?: A small-scale longitudinal study2019In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 32, no 13, p. 2166-2172Article in journal (Refereed)
    Abstract [en]

    Aim:

    To measure serum hepcidin in late pregnancy and in cord blood, and to analyze relationship between hepcidin, interleukin-6, and biomarkers of fetal iron status.

    Materials and methods:

    Data from 15 uncomplicated singleton pregnancies were analyzed longitudinally in trimester 3 (T3) and at birth.

    Results:

    In T3, S-ferritin (median 14 mu g/L) and transferrin (median 4.0 g/L) indicated low iron status, whereas the median soluble transferrin receptor (sTfR) was 4.0 mg/L, i.e. within the reference interval. Median T3 S-hepcidin was 7.8 ng/mL. Later on in cord blood, ferritin concentration (180 mu g/L) were significantly higher, transferrin concentration (1.8 g/L) were significantly lower, and both sTfR (4.7 mg/L) and S-hepcidin concentrations (30.5 ng/mL) were significantly higher than maternal T3 concentrations. At the same time, cord blood interleukin-6 indicated an activated acute-phase reaction. In T3, after logarithmic transformation, there was a significant correlation between S-hepcidin and both S-ferritin (r = 0.691) and sTfR (r = -0.825). There was also a significant correlation between S-ferritin and both sTfR (r = -0.729) and transferrin (r = 0.549) in T3.

    Conclusions:

    Although S-ferritin, S-hepcidin, and sTfR were correlated during pregnancy, these relationships were not apparent in umbilical cord blood. Further, cord blood interleukin-6 indicated an activated acute-phase response, and sTfR, which is known to be unaffected by inflammation, indicated a low iron status in cord blood. Thus, instead of representing an enhanced iron status, the data appear to suggest that hepcidin and ferritin in cord blood may be influenced by the low-grade acute-phase response that occurs during delivery.

  • 6.
    Hoppe, Michael
    et al.
    Department of Gastroenterology and Hepatology , Clinical Nutrition Unit , Sahlgrenska University Hospital , Gothenburg , Sweden.
    Hulthén, Lena
    University of Gothenburg , Department of Internal Medicine and Clinical Nutrition , Sahlgrenska Academy , Gothenburg , Sweden.
    Samuelson, Gösta
    University West, Department of Health Sciences, Section for nursing - graduate level. Uppsala University , Department of Clinical Sciences/Clinical Physiology , Uppsala , Sweden..
    Is cord blood hepcidin influenced by the low-grade acute-phase response occurring during delivery?: A small-scale longitudinal study2019In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 32, no 13, p. 2166-2172Article in journal (Refereed)
    Abstract [en]

    AIM: To measure serum hepcidin in late pregnancy and in cord blood, and to analyze relationship between hepcidin, interleukin-6 and biomarkers of fetal iron status.

    MATERIALS AND METHODS: Data from 15 uncomplicated singleton pregnancies were analyzed longitudinally in trimester 3 (T3) and at birth.

    RESULTS: In T3, S-ferritin (median 14 µg/L) and transferrin (median 4.0 g/L) indicated low iron status, whereas the median soluble transferrin receptor (sTfR) was 4.0 mg/L, ie within the reference interval. Median T3 S-hepcidin was 7.8 ng/mL. Later on in cord blood, ferritin concentration (180 µg/L) were significantly higher, transferrin concentration (1.8 g/L) were significantly lower, and both sTfR (4.7 mg/L) and S-hepcidin concentrations (30.5 ng/mL) were significantly higher than maternal T3 concentrations. At the same time, cord blood interleukin-6 indicated an activated acute-phase reaction. In T3, after logarithmic transformation, there was a significant correlation between S-hepcidin and both S-ferritin (r = 0.691) and sTfR (r = -0.825). There was also a significant correlation between S-ferritin and both sTfR (r = -0.729) and transferrin (r = 0.549) in T3.

    CONCLUSIONS: Although S-ferritin, S-hepcidin, and sTfR were correlated during pregnancy, these relationships were not apparent in umbilical cord blood. Further, cord blood interleukin-6 indicated an activated acute-phase response, and sTfR, which is known to be unaffected by inflammation, indicated a low iron status in cord blood. Thus, instead of representing an enhanced iron status, the data appear to suggest that hepcidin and ferritin in cord blood may be influenced by the low-grade acute-phase response that occurs during delivery.

  • 7.
    Håkansson, Stellan
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Kaellen, Karin
    Bullarbo, Maria
    Holmgren, Per-Åke
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Bremme, Katarina
    Larsson, Åsa
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Norman, Margareta
    Noren, Hakan
    Ortmark-Wrede, Catharina
    Pettersson, Karin
    Saltvedt, Sissel
    Sondell, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Tokarska, Magdalena
    von Vultee, Anna
    Jacobsson, Bo
    Real-time PCR-assay in the delivery suite for determination of group B streptococcal colonization in a setting with risk-based antibiotic prophylaxis2014In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 27, no 4, p. 328-332Article in journal (Refereed)
    Abstract [en]

    Objective: Intrapartum antibiotic prophylaxis (IAP) reduces the incidence of neonatal early onset group B streptococcal infections. The present study investigated if an automated PCR-assay, used bedside by the labor ward personnel was manageable and could decrease the use of IAP in a setting with a risk-based IAP strategy. Methods: The study comprises two phases. Phase 1 was a multicenter, randomized, controlled trial. Women with selected risk-factors were allocated either to PCR-IAP (prophylaxis given if positive or indeterminate) or IAP. A vaginal/rectal swab and superficial swabs from the neonate for conventional culture were also obtained. Phase 2 was non-randomized, assessing an improved version of the assay. Results: Phase 1 included 112 women in the PCR-IAP group and 117 in the IAP group. Excluding indeterminate results, the assay showed a sensitivity of 89% and a specificity of 90%. In 44 % of the PCR assays the result was indeterminate. The use of IAP was lower in the PCR group (53 versus 92%). Phase 2 included 94 women. The proportion of indeterminate results was reduced (15%). The GBS colonization rate was 31%. Conclusion: The PCR assay, in the hands of labor ward personnel, can be useful for selection of women to which IAP should be offered.

  • 8.
    Jonsson, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Lindeberg, Solveig Norden
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ostlund, Ingrid
    Hanson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Acidemia at birth in the vigorous infant as a trigger incident to assess intrapartum care with regard to CTG patterns2013In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 26, no 11, p. 1094-1098Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate if acidemia in vigorous infants is a useful variable in the assessement of intrapartm care with regard to cardiotocographic (CTG) patterns during the second stage. Methods: Cases (n = 241) were infants with an umbilical artery pH<7.05, controls (n 482) were infants with pH >= 7.05. Apgar score was >= 7 at 5 min in both groups. CTGs during the last two hours of labor were assessed and neonatal outcomes compared. A sub-analysis of cases with metabolic acidemia: pH<7.00 and base deficit >= 12 mmol/L and acidemia: 7.00<pH<7.05 was performed. Results: 63% of cases had a pathological CTG versus 26% of controls (p<0.001). Patterns with severe variable decelerations had a significantly longer duration in cases. Metabolic acidemia was significantly associated with severe variable decelerations and decreased variability. Infants to cases were admitted to neonatal care in 19% versus 2% of controls (p<0.001). With metabolic acidemia, 32% were admitted. Conclusion: An umbilical artery pH<7.05 at birth of vigorous infants may be a useful variable for quality control of intrapartum management with regard to the assessment of second-stage CTGs. Differences in duration of pathological patterns indicate passiveness in acidemic cases.

  • 9. Jonsson, Maria
    et al.
    Nordén Lindeberg, Solveig
    Östlund, Ingrid
    Örebro University Hospital.
    Hanson, Ulf
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Acidemia at birth in the vigorous infant as a trigger incident to assess intrapartum care with regard to CTG patterns2013In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 26, no 11, p. 1094-1098Article in journal (Refereed)
    Abstract [en]

    Abstract Objective To evaluate if acidemia in vigorous infants is useful in the assessment of intrapartum care with regard to cardiotocographic (CTG) patterns during the second stage. Methods Cases (n=241) were infants with an umbilical artery pH < 7.05, controls (n= 482) were infants with pH ≥ 7.05. Apgar score was ≥ 7 at five minutes in both groups. CTGs during the last two hours of labour were assessed and neonatal outcomes compared. A sub analysis of cases with metabolic acidemia: pH < 7.00 and base deficit ≥ 12mmol/L and, acidemia: 7.00 < pH < 7.05 was performed. Results 63% of cases had a pathological CTG versus 26% of controls (p <0.001). Patterns with severe variable decelerations had a significantly longer duration in cases. Metabolic acidemia was significantly associated with severe variable decelerations and, decreased variability. Infants to cases were admitted to neonatal care in 19 % versus 2 % of controls (p <0.001). With metabolic acidemia, 32 % were admitted. Conclusion An umbilical artery pH < 7.05 at birth of vigorous infants may be a useful variable for quality control of intrapartum management with regard to assessment of second stage CTGs. Differences in duration of pathological patterns indicate passiveness in acidemic cases.

  • 10.
    Junus, Katja
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Olovsson, Matts
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Early second-trimester plasma levels of NT-proBNP in women who subsequently develop early-onset preeclampsia2017In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 30, no 18, p. 2163-2165Article in journal (Refereed)
    Abstract [en]

    Plasma levels of NT-proBNP are elevated in women with preeclampsia at the time of diagnosis. The objective of this case-control study was to evaluate N-terminal proBNP (NT-proBNP) in maternal plasma as an early second-trimester biomarker for prediction of early-onset preeclampsia. In early second-trimester samples, women who later developed preeclampsia at gestational age 34 wk + 0 or earlier (n = 16) had similar plasma levels of NT-proBNP (median 51.8, range 26.1-131.9 pg/ml) as women with uncomplicated pregnancy outcomes (n = 43) (53.0, 14.9-184.2 pg/ml). The early second-trimester level of NT-proBNP cannot therefore be used as a predictive biomarker of early-onset preeclampsia.

  • 11.
    Lundgren, Cecilia
    et al.
    Department of Obstetrics and Gynecology, Kalmar County Hospital, Kalmar, Sweden.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Clinical Physiology , Kalmar County Hospital, Kalmar, Sweden.
    Wanby, Anna-Stina
    Department of Obstetrics and Gynecology , Kalmar County Hospital , Kalmar , Sweden.
    Cedergren, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Ante- and intrapartum risk factors for neonatal hypoxic ischemic encephalopathy2018In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 31, no 12, p. 1595-1601Article in journal (Refereed)
    Abstract [en]

    To identify obstetrical risk factors for the diagnosis of neonatal hypoxic ischemic encephalopathy (HIE). A secondary aim was to determine the incidence of HIE.

  • 12.
    Malmqvist, Olle
    et al.
    Department of Pediatrics, Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Pediatrics.
    Ågren, Johan
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Jonsson, Maria
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Seizures in newborn infants without hypoxic ischemic encephalopathy - antenatal and labor-related risk factors: a case-control study2018In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, p. 1-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To identify antepartum and intrapartum risk factors for neonatal seizures in the absence of hypoxic ischemic encephalopathy (HIE).

    METHODS: Population-based case-control study. Of 98 484 births, 40 newborns at 34 gestational weeks or later had seizures within the first 7 days of life. Cases (n = 40) and controls (n = 160) were retrieved from the University hospitals of Örebro for 1994-2013 and Uppsala for 2003-2013. Demographics and characteristics of pregnancy, labor, delivery, and neonatal data were analyzed. Crude odds ratio (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CIs) for antenatal and intrapartum factors were calculated using logistic regression analysis. Main outcome measure was neonatal seizures within the first 7 days of life.

    RESULTS: The incidence of neonatal seizures without HIE was 0.41/1000 live births. Antenatal risk factors for neonatal seizures were as follows: short maternal stature (AOR: 5.4; 1.8-16.5); previous caesarean section (AOR: 4.8; 1.5-15.0); and assisted fertilization (AOR: 6.8; 1.3-35.2). Intrapartum risk factors were as follows: induction of labor (AOR: 5.7; 1.8-17.7); preterm birth (AOR: 13.5; 3.7-48.9); and head circumference >37 cm (AOR: 6.9; 1.4-34.8).

    CONCLUSIONS: Preterm birth was the strongest risk factor for neonatal seizures in the absence of HIE. The results also indicate that feto-pelvic disproportion is associated with the occurrence of seizures.

    RATIONALE: Antepartum and intrapartum risk factors for newborn seizures in the absence of HIE were investigated in a case-control study. Out of 98 484 births at 34 gestational weeks or more, 40 newborns had seizures without HIE. All had a normal Apgar score although they later presented with seizures. Preterm birth was the strongest risk factor (OR: 13.5; 95% CI: 3.7-48.9). Our results also indicate that feto-pelvic disproportion is of importance. Furthermore, a history of prior caesarean was associated with seizures. This is the first study to assess obstetric risk factors for newborn seizures separate from those with seizures and concomitant HIE. The distinction is of importance due to different etiologies, treatments, and preventive strategies.

  • 13.
    Stenson, David
    et al.
    Karolinska Inst, Soder Hosp, Sect Obstet & Gynecol, Dept Clin Sci & Educ, S-11883 Stockholm, Sweden..
    Wallstrom, Tove
    Karolinska Inst, Soder Hosp, Sect Obstet & Gynecol, Dept Clin Sci & Educ, S-11883 Stockholm, Sweden..
    Sjostrand, Maria
    Karolinska Inst, Soder Hosp, Sect Obstet & Gynecol, Dept Clin Sci & Educ, S-11883 Stockholm, Sweden..
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Gemzell-Danielsson, Kristina
    Karolinska Inst, Karolinska Univ Hosp, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Wiberg-Itzel, Eva
    Karolinska Inst, Soder Hosp, Sect Obstet & Gynecol, Dept Clin Sci & Educ, S-11883 Stockholm, Sweden..
    Induction of labor in women with a uterine scar2016In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 29, no 20, p. 3286-3291Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the frequency of uterine rupture following induction of labor in women with a previous cesarean section. Misoprostol was compared to other methods of induction.

    Methods: A retrospective cohort study of 208 women attempting induction of labor after one previous cesarean section. Delivery data were collected retrospectively and compared. Group 1(2009-2010) was compared with Group 2 (2012-2013). In Group 1, the main method of induction was vaginal PGE(2) (prostaglandin-E-2), amniotomy, oxytocin or a balloon catheter. In Group 2, the dominant method of induction was an oral solution of misoprostol. Main outcome measures: frequency of uterine rupture in the two groups.

    Results: Nine cases (4.3%) of uterine rupture occurred. There was no significant difference in the frequency of uterine rupture following the change of method of induction from PGE(2), amniotomy, oxytocin or mechanical dilatation with a balloon catheter to orally administered misoprostol (4.1 versus 4.6%, p=0.9). All ruptures occurred in women with no prior vaginal delivery.

    Conclusion: The shift to oral misoprostol as the primary method of induction in women with a previous cesarean section did not increase the frequency of uterine rupture in the cohort studied.

  • 14.
    Sterpu, Irene
    et al.
    Karolinska Inst, Womens Clin, Dept Clin Sci & Educ, Sodersjukhuset, Sweden.
    Anfelter, Peter
    Karolinska Inst, Womens Clin, Dept Clin Sci & Educ, Sodersjukhuset, Sweden.
    Wray, Susan
    Univ Liverpool, Inst Translat Med, Dept Mol & Cellular Physiol, Liverpool, Merseyside, England.
    Kaihola, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Wiberg-Itzel, Eva
    Karolinska Inst, Womens Clin, Dept Clin Sci & Educ, Sodersjukhuset, Sweden.
    The association of second trimester biomarkers in amniotic fluid and fetal outcome2019In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 32, no 21, p. 3627-3632Article in journal (Refereed)
    Abstract [en]

    Objective: To identify the level of amniotic fluid lactate (AFL), placental growth factor (PLGF), and vascular endothelial growth factor (VEGF) at second trimester amniocentesis, and to compare levels in normal pregnancies with pregnancies ending in a miscarriage, an intrauterine growth restricted fetus (IUGR) or decreased fetal movements.

    Study design: A prospective cohort study. Amniotic fluid was consecutively collected at amniocentesis in 106 pregnancies. Fetal wellbeing at delivery was evaluated from medical files and compared with the levels of AFL, VEGF, and PLGF at the time of amniocentesis.

    Results: The median level of AFL was 6.9 mmol/l, VEGF 0.088 pg/ml, and PLGF 0.208 pg/ml. The median levels of AFL in pregnancies ended in miscarriage were significantly higher (10.7 mmol/l) compared to those with a live new-born (6.9 mmol/L, p = .02). The levels of VEGF (p = .2) and PLGF (p = .7) were not affected. In pregnancies with an IUGR, the median level of AFL was higher compared to those with normal fetal growth (p = .003). No differences VEGF (p = .5), but significant lower PLGF were found in IUGR pregnancies (p = .03).

    Conclusions: Pregnancies ending in a miscarriage or with IUGR had significantly higher median values of AFL but lower values of PLGF in the amniotic fluid at the time of second trimester amniocentesis compared to normal pregnancies.

  • 15.
    van den Berg, Johannes
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Olsson, Linn
    Umeå University, Faculty of Medicine, Department of Nursing.
    Svensson, Amelie
    Umeå University, Faculty of Medicine, Department of Nursing.
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Adverse events during air and ground neonatal transport: 13 years' experience from a neonatal transport team in Northern Sweden2015In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 28, no 10, p. 1231-1237Article in journal (Refereed)
    Abstract [en]

    Objective: To study the prevalence of adverse events (AEs) associated with neonatal transport, and to categorize, classify and assess the risk estimation of these events.

    Methods: Written comments in 1082 transport records during the period 1999-2011 were reviewed. Comments related to events that infringed on patient and staff safety were included as AEs, and categorized and further classified as complaint, imminent risk of incident/negative event, actual incident or actual negative event. AEs were also grouped into emergency or planned transports, and risk estimation was calculated according to a risk assessment tool and defined as low, intermediate, high or extreme risk.

    Results: AEs (N = 883) were divided into five categories: logistics (n = 337), organization (n = 177), equipment (n = 165), vehicle (n = 129) and medical/nursing care (n = 75). Eighty-five percent of AEs were classified as incidents or negative events. The majority of AEs were estimated to be of low or intermediate risk in both planned and emergency transports. AEs estimated to be of high or extreme risk were significantly more frequent in emergency transports (OR = 10.1; 95% CI: 5.0-20.9; p < 0.001).

    Conclusion: AEs are common in both planned and emergency neonatal transport, often related to imperfect transport logistics or equipment failure. AEs of high or extreme risk were more frequent in emergency transports.

  • 16.
    Wallström, Tove
    et al.
    Sodersjukhuset Hosp, Karolinska Inst, Sect Obstet & Gynaecol, Dept Clin Sci & Educ, S-11883 Stockholm, Sweden..
    Hellgren, Charlotte
    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.
    Wiberg-Itzel, Eva
    Sodersjukhuset Hosp, Karolinska Inst, Sect Obstet & Gynaecol, Dept Clin Sci & Educ, S-11883 Stockholm, Sweden..
    Skin conductance activity in post-term pregnancies2015In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 28, no 16, p. 1912-1916Article in journal (Refereed)
    Abstract [en]

    Objective: The pain threshold in humans rises during late pregnancy, and the woman becomes less sensitive to stress. The aim of this study was to investigate whether monitoring the sympathetic nervous system response to stimuli by skin conductance activity might be a useful predictor of spontaneous onset of labour in post-term pregnancies. Study design: A prospective observational study. Fifty-two healthy pregnant women were consecutively asked for inclusion in the study at their post-term pregnancy examination. Initially, a Ctg (cardiotocography) registration was performed, followed by 5 min of skin conductance measurement including a ''cold pressor test''. Finally, a vaginal examination with a cervical assessment were performed according to clinical guidelines. Results: A statistically significant lower pain reaction during the period of provocation was seen in deliveries close to spontaneous onset of labour compared with induced deliveries with an non-spontaneous onset of labour before 294 days (p = 0.02). Sixty-three per cent (19/30) of the women with spontaneous onset had a negative value at provocation compared with 30% (6/20) in the induced group. Conclusions: Decreased response to pain stimuli, as an indication of decreased activity in the sympathetic nervous system, has a correlation to spontaneous onset of labour in post-term pregnancies.

  • 17.
    Wiberg-Itzel, Eva
    et al.
    Södersjukhuset, Dept Obstet & Gynecol, Stockholm, Sweden;Karolinska Inst, Sodersjukhuset, Sect Obstet & Gynaecol, Dept Clin Sci & Educ, Stockholm, Sweden.
    Wray, Susan
    Univ Liverpool, Inst Translat Med, Dept Mol & Cellular Physiol, Liverpool, Merseyside, England.
    Åkerud, 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), Reproductive Health.
    A randomized controlled trial of a new treatment for labor dystocia2018In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 31, no 17, p. 2237-2244Article in journal (Refereed)
    Abstract [en]

    Objective: Labor dystocia is an intransigent, high-profile issue in obstetric care. Amniotic fluid lactate (AFL) reflects the uterine metabolic status. High levels associate with subsequent need for operative intervention due to dystocia. In sports medicine, it is known that lactic acid can affect muscular performance and can be decreased by bicarbonate given orally before physical activity.

    Material and methods: Two hundred dystocic deliveries were included. At the confirmation of dystocia, the AFL-level was analyzed. Deliveries were randomized to an intake of bicarbonate or not. In the non-bicarbonate-group, stimulation with oxytocin was started immediately. In the bicarbonate-group, bicarbonate was given; and oxytocin was started 1hour after the intake. New sampling of AF was performed after 1hour in both groups. Outcome measured: if an oral intake of bicarbonate changes the AFL levels and enhances delivery outcome in dystocic deliveries.

    Results: Bicarbonate decreases the AFL levels (p<.001). The spontaneous vaginal delivery rate after treatment with bicarbonate was increased (p=.007), without affecting the fetal outcome.

    Conclusions: An increase of spontaneous vaginal deliveries resulted from bicarbonate ingestion by dystocic women. A decreased level of AFL-level was shown. This simple, low cost treatment has the potential to improve maternal morbidity and satisfaction worldwide.

  • 18.
    Zaigham, Mehreen
    et al.
    Department of Obstetrics and Gynecology Skåne University Hospital, Institution of Clinical Sciences, Lund University, Malmö, Sweden.
    Lundberg, Fredrik
    Department of Neonatology, Skåne University Hospital, Institution of Clinical Sciences, Lund University, Malmö, Sweden.
    Hayes, Ronald
    Banyan Biomarkers Inc., Alachua, FL, USA.
    Undén, Johan
    Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Institution of Clinical Sciences, Lund University, Malmö, Sweden.
    Olofsson, Per
    Department of Obstetrics and Gynecology Skåne University Hospital, Institution of Clinical Sciences, Lund University, Malmö, Sweden.
    Umbilical cord blood concentrations of ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) in neonates developing hypoxic-ischemic encephalopathy.2015In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 29, no 11, p. 1822-1828Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) concentrations in umbilical cord blood of neonates who develop Sarnat stage II-III hypoxic-ischemic encephalopathy (HIE) to healthy controls, and to relate the concentrations to the severity of neurology and long-time outcomes.

    MATERIAL AND METHODS: Cord sera of 15 neonates with HIE II-III and 31 matched controls were analyzed for UCH-L1 and GFAP. Comparisons were performed for cord artery pH, amplitude-integrated electroencephalography (aEEG), stage of HIE, and death or sequelae up to an age of 6 years. Parametric and non-parametric statistics were used with a two-sided p < 0.05 considered significant.

    RESULTS: Among controls no associations between biomarker concentrations and gestational age, birthweight, length of storage of cord sera and degree of hemolysis were found. No significant differences in biomarker concentrations were found between HIE neonates and controls, and no differences were found with regard to HIE stage, cord acidemia, severity of aEEG changes, or persistent sequelae or death.

    CONCLUSIONS: No differences in cord blood UCH-L1 and GFAP concentrations were found between HIE neonates and controls, and no associations were found between the biomarker concentrations and the severity of disease, or whether the condition developed into a permanent or fatal injury.

  • 19.
    Örtendahl, Monica
    et al.
    KTH, School of Architecture and the Built Environment (ABE), Transport and Economics, Safety Research.
    Näsman, Per
    KTH, School of Architecture and the Built Environment (ABE), Transport and Economics, Safety Research.
    Quitting smoking is perceived to have an effect on somatic health among pregnant and non-pregnant women2008In: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 21, no 4, p. 239-246Article in journal (Refereed)
    Abstract [en]

    Objective. To examine the association of pregnancy and intent to quit smoking with perception of the somatic health risk of smoking and the effect on risk of quitting smoking. Methods. Pregnant and non-pregnant women, intending and not intending to quit smoking, (n = 80) over a two-week period rated the probability for smoking-related health consequences to occur, given both conditions of not quitting smoking and of quitting smoking. Results. Groups were the determining variable accounting for differences in risk perception. For pregnant women who did not intend to quit smoking, the estimated probability for the consequences to occur was generally low given the condition of continuing to smoke. There was no effect for time. The estimated effect of quitting smoking was statistically significant. Conclusions. Future campaigns need to integrate risk information so that it can be grounded cognitively in order to increase the personal responsibility that women take for their own health and the health of the fetus.

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