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  • 1.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Lindgren, Helena
    Georgsson, Susanne
    Sophiahemmet University.
    Warland, Jane
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 32-37, article id S1877-5756(18)30321-5Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We investigated how women, seeking care due to decreased movements, had paid attention to fetal movements and if the method of monitoring was associated with pregnancy outcome.

    METHODS: A questionnaire was distributed to women from gestational week 28, who had sought care due to decreased fetal movements in Stockholm between January 1st and December 31st, 2014. Women were included in the study if the examination did not reveal any signs of a compromised fetus requiring immediate intervention. Birth outcome and sociodemographic data were collected from the obstetric record register.

    RESULTS: There were 29166 births in Stockholm in 2014, we have information from 2683 women who sought care for decreased fetal movements. The majority (96.6%) of the women stated that they paid attention to fetal movements. Some women observed fetal movements weekly (17.2%) and 69.5% concentrated on fetal movements daily (non-structured group). One in ten (9.9%) used counting methods daily for observing fetal movements (structured group). Women in the structured group more often had caesarean section before onset of labor (RR 1.6, 95% CI 1.2-2.2) and a lower risk of their baby being transferred to neonatal nursery (RR 0.25, 95% CI 0.03-0.94) compared to women in the non-structured group.

    CONCLUSIONS: Women, who had a daily and structured approach to awareness of fetal movements, were more likely to have a caesarean section but their babies were less likely to be transferred to a neonatal nursery as compared with women who used a non-structured method daily.

  • 2.
    Asplin, Nina
    et al.
    Sophiahemmet University.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 2, p. 79-84Article in journal (Refereed)
    Abstract [en]

    Objectives

    The aims of the study were to explore factors influencing the decision to continue or terminate pregnancy due to detection of fetal malformation following ultrasound examination, to elucidate the need for more information or other routines to facilitate the decision-making process and to assess satisfaction with the decision made.

    Design

    Descriptive study.

    Setting

    Four fetal care referral centres in Stockholm, Sweden.

    Population

    Pregnant women with a detected fetal malformation.

    Methods

    Data was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed.

    Results

    Both women who continued and those who terminated pregnancy based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were aspects including socioeconomic considerations. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (p⩽ 0.004) of previous abortions than those in the continuing group (23.2%).

    Conclusion

    The decision to continue or terminate the pregnancy was to a great extent based on the severity of the malformation. Religious aspects did not seem to influence the decision. Many women expressed a need for additional occasion of information. The vast majority of women were satisfied with their decision.

  • 3. Edqvist, Malin
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Lundgren, Ingela
    Mollberg, Margareta
    Lindgren, Helena
    Practices used by midwives during the second stage of labor to facilitate birth - Are they related to perineal trauma?2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, p. 18-22, article id S1877-5756(17)30103-9Article in journal (Refereed)
  • 4. Melin, Amanda
    et al.
    Björklund, Philicia
    Zwedberg, Sofia
    Sophiahemmet University.
    Pediatricians' experiences of working with breastfeeding: An interview study2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 218-223Article in journal (Refereed)
  • 5.
    Rådestad, Ingela
    et al.
    Sophiahemmet University.
    Akselsson, Anna
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Lindgren, H
    Pettersson, K
    Steineck, G
    Rationale, study protocol and the cluster randomization process in a controlled trial including 40,000 women investigating the effects of mindfetalness.2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 10, p. 56-61Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Shortening pre-hospital delay may decrease stillbirth rates and rates of babies born with a compromised health. Stillbirth may be preceded by a decrease in fetal movements. Mindfetalness has been developed as a response to the shortcomings of kick-counting for the monitoring of fetal movements by the pregnant woman. We do not know if practicing Mindfetalness may diminish pre-hospital delay. Nor do we know if practicing Mindfetalness may increase or decrease the percentage of women seeking health care for unfounded, from a medical perspective, worry for her fetus' well-being.

    METHODS:

    This article describes the rationale, study protocol and the randomization process for a planned study randomly allocating 40,000 pregnant women to receive, or not receive, proactive information about practicing Mindfetalness. The unit of randomization is 63 antenatal clinics in the Stockholm area. Midwives in the antenatal clinics randomized to Mindfetalness will verbally inform about practicing Mindfetalness, hand out brochures (printed in seven languages) and inform about a website giving information about Mindfetalness. Routine care will continue in the control clinics. All information for the analyses, including the main endpoint of an Apgar score below 7 (e.g., 0-6 with stillbirth giving a score of 0), measured five minutes after birth, will be retrieved from population-based registers.

    RESULTS:

    We have randomized 33 antenatal clinics to Mindfetalness and 30 to routine care. In two clinics a pilot study has been performed. One of the clinics randomly allocated to inform about Mindfetalness will not do so (but will be included in the intention-to-treat analysis). In October 2016 we started to recruit women for the main study.

    CONCLUSION:

    The work up to now follows the outlined time schedule. We expect to present the first results concerning the effects of Mindfetalness during 2018.

  • 6. Tinglöf, Soile
    et al.
    Högberg, Ulf
    Wallin Lundell, Inger
    Sophiahemmet University.
    Skoog Svanberg, Agneta
    Exposure to violence among women with unwanted pregnancies and the association with post-traumatic stress disorder, symptoms of anxiety and depression2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 2, p. 50-53Article in journal (Refereed)
    Abstract [en]

    Aim

    The objective was to examine lifetime exposure to violence, physical and sexual, among women seeking termination of pregnancy (TOP) and its association with socio-demographic factors, PTSD, symptoms of anxiety and depression.

    Design

    The design of the study was a Swedish multi-centre study targeting women requesting TOP.

    Methods

    All women requesting TOP with a gestational length less than 12 pregnancy weeks were approached for participation in the study. The questionnaire comprised the following research instruments: Screen Questionnaire-Post traumatic Stress Disorder (SQ-PTSD) and Hospital Anxiety and Depression Scale (HADS). The response rate was 57% and the final sample was 1514 women. Descriptive and analytic statistics were applied.

    Results

    Lifetime exposure to violence was common among women seeking abortion. Exposure to violence was associated with low education, single marital status, smoking and high alcohol consumption. Exposure to violence was associated with the occurrence of signs of PTSD and symptoms of anxiety and depression. Among those having PTSD, all had been exposed to sexual violence and almost all had been exposed to physical violence, while for those with symptoms of anxiety and depression almost half had been exposed to either physical or sexual violence.

    Conclusion

    Exposure to physical and sexual abuse was common among women requesting TOP, and was strongly associated with the occurrence of PTSD, symptoms of anxiety and depression. This underscores the importance for health professionals to recognize and offer support to those women exposed to violence.

  • 7. Åhlund, Susanne
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Zwedberg, Sofia
    Sophiahemmet University.
    Edqvist, Malin
    Lindgren, Helena
    Haemorrhoids - A neglected problem faced by women after birth2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 18, p. 30-36, article id S1877-5756(18)30042-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the prevalence and severity of haemorrhoids after birth among first-time mothers in relation to management during the second stage of labour and to describe the women's experiences with haemorrhoids.

    METHOD: A mixed method explanatory sequential design was used. Nulliparous women were allocated to an intervention group for whom the second-stage of labour practice followed the MIMA model (Midwives management during second stage of labour) or to a control group for whom standard-care practice was followed. Data were collected three weeks and 1.5 years after birth.

    RESULT: A total of 496 (82.1%) women responded to the questionnaire three weeks after birth, 120 (70%) responded to the questionnaire 1.5 years after the birth. The women in the intervention group had fewer symptoms from haemorrhoids three weeks after birth compared to the women in the control group (adj. OR 0.6 95% CI 0.4-0.9). Half of the women in the intervention and control group (50.8%) who reported problems with haemorrhoids three weeks after birth still experienced problems after 1.5 years. The majority of all women did not seek medical care due to their symptoms. The women who described that they experienced haemorrhoids as a problem after birth felt neglected by the healthcare system.

    CONCLUSION: A substantial percentage of women had symptoms from haemorrhoids after birth. Many of these women felt that their problems were neglected. Women who experienced a slow birth of the baby's head and spontaneous pushing suffered less from haemorrhoids 3 weeks after birth.

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