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  • 1. Aanesen, Arthur
    et al.
    Westerbotn, Margareta
    Sophiahemmet University.
    Prospective study of a Swedish infertile cohort 2005-08: population characteristics, treatments and pregnancy rates2014In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 31, no 3, 290-7 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We here report on results from a prospective study comprising 380 infertile couples undergoing infertility work-up and various treatments for infertility in our clinic. The aim was to investigate the overall birth rate as a result of different treatments, as well as spontaneous pregnancies.

    METHODS: Three hundred and eighty couples were consecutively included between December 2005 and May 2008. All couples underwent a fertility work-up, including hysterosalpingogram, hormonal characterization, clinical examination, screening for infectious diseases and semen analysis. The mean age of the women at the time of inclusion was 33.2 years. The mean duration of infertility prior to inclusion was 1.8 years. And 46.6% (n = 177) of the women had been pregnant prior to their first visit to the clinic and 30.0% (n = 114) had been pregnant earlier in their present relationship.

    RESULTS: As of November 2010, 57.3% (n = 218) of the women had given birth to a child when they were lost to follow up by the study. Spontaneous conception was observed in 11.3% (n = 43) of the women, 14.5% (n = 64) conceived after intrauterine insemination (IUI), 4.2% (n = 16) conceived after ovarian hyperstimulation and ovulation induction (OH/OI) and 28.4% (n = 113) after in vitro fertilization. There were 280 pregnancies and 58 spontaneous abortions (22.3%) in the group. Mean anti-mullerian hormone significantly correlated with antral follicle count and age and was significantly higher in the subgroup that became pregnant after IUI.

    CONCLUSIONS: Spontaneous pregnancies and IUI + OH/OI contributed significantly to the pregnancies observed in the total population. Predictive factors for pregnancy were anti-mullerian hormone in the group undergoing IUI treatment and in the age group ≥38-duration of infertility. Previous pregnancies, body mass index, estradiol, follicle stimulating hormone or having given birth prior to the infertility period were not predictive of pregnancy for the infertile couples in this study.

  • 2.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Lindgren, H
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet University.
    Women's attitudes, experiences and compliance concerning the use of Mindfetalness: A method for systematic observation of fetal movements in late pregnancy2017Conference paper (Other academic)
  • 3.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Lindgren, Helena
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Women's attitudes, experiences and compliance concerning the use of Mindfetalness- a method for systematic observation of fetal movements in late pregnancy2017In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 17, no 1, 359Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Maternal perception of decreased fetal movements and low awareness of fetal movements are associated with a negative birth outcome. Mindfetalness is a method developed for women to facilitate systematic observations of the intensity, character and frequency of fetal movements in late pregnancy. We sought to explore women's attitudes, experiences and compliance in using Mindfetalness.

    METHODS: We enrolled 104 pregnant women treated at three maternity clinics in Stockholm, Sweden, from February to July of 2016. We educated 104 women in gestational week 28-32 by providing information about fetal movements and how to practice Mindfetalness. Each was instructed to perform the assessment daily for 15 min. At each subsequent follow-up, the midwife collected information regarding their perceptions of Mindfetalness, and their compliance. Content analyses, descriptive and analytic statistics were used in the analysis of data.

    RESULTS: Of the women, 93 (89%) were positive towards Mindfetalness and compliance was high 78 (75%). Subjective responses could be binned into one of five categories: Decreased worry, relaxing, creating a relationship, more knowledge about the unborn baby and awareness of the unborn baby. Eleven (11%) women had negative perceptions of Mindfetalness, citing time, and the lack of need for a method to observe fetal movements as the most common reasons.

    CONCLUSION: Women in late pregnancy are generally positive about Mindfetalness and their compliance with daily use is high. The technique helped them to be more aware of, and create a relationship with, their unborn baby. Mindfetalness can be a useful tool in antenatal care. However, further study is necessary in order to determine whether the technique is able to reduce the incidence of negative birth outcome.

  • 4.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Linde, Anders
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Lindgren, H
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet University.
    Structured daily observation of fetal movements and transfer to neonatal clinic2017Conference paper (Other academic)
  • 5.
    Asplin, Nina
    Sophiahemmet University.
    Women's experiences and reactions when a fetal malformation is detected by ultrasound examination2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Second trimester ultrasound examination among pregnant women in Sweden is almost universal. The detection of a fetal malformation on ultrasound puts health care providers and pregnant women in a difficult and precarious situation. What information and how it is communicated is crucial to women’s decision-making about continuing or terminating at pregnancy. The main aim of this thesis was to describe and analyze women’s experiences and reactions following the detection of a fetal malformation on an ultrasound scan. Methods: Two semi-structured in-depth interviews were performed, with women informed of a fetal malformation following an ultrasound scan. A total of 27 women took part in the first round of interviews: women continuing their pregnancy were interviewed, either in gestational week 30 or three weeks after the diagnosis; those terminating their pregnancy were interviewed two to four weeks after termination (Paper I). A second interview with 11 women who terminated their pregnancy was conducted six months after termination (Paper III). Two questionnaires were also administered. The first, answered by 99 women (Paper II) and comprising 22 study- specific questions along with emotional well-being and socio-demographics variables and medical and obstetric history, was conducted at the same time as the first stage of interviews. The other questionnaire, answered by 56 women incorporated common self- report instruments and was performed three times: first in gestational week 30, and then two respectively six months postpartum (Paper IV). Qualitative data were analyzed through content analysis, and quantitative data were analyzed through descriptive statistics. Results: The timing, duration, and manner of women’s initial counseling and ongoing support were shown to be important in the interaction between women and caregivers. Positive interactions improved the women’s ability to understand the information and fostered feelings of trust and safety, which in turn reduced their anxiety. Most of the women who expected a baby with an abnormality expressed their need for information on several occasions to help them make this difficult decision. They also wished for information from different specialists and continuity of care. These needs were even stronger in women who chose to terminate their pregnancy. We found women continuing their pregnancy to be at high risk of depressive symptoms, major worries, and high anxiety levels, both in mid-pregnancy, and at two months and one year postpartum. Despite these findings, the results of the maternal-fetal attachment scale for women who continued their pregnancy with a fetus diagnosed with a malformation indicated a high level of attachment. Conclusions and Clinical Implications: Effective communication, empathy and compassion, and consistent follow-up routines are important to ensure good treatment and care of this group of women. Taking these results into account may improve caregivers’ ability to counsel these vulnerable patients and to ensure that their needs are properly met.

  • 6.
    Asplin, Nina
    et al.
    Sophiahemmet University.
    Dellgren, Annika
    Conner, Peter
    Education in obstetrical ultrasound - an important factor for increasing the prenatal detection of congenital heart disease2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 7, 804-808 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of postgraduate education in obstetrical ultrasound on the prenatal detection rate of congenital heart disease. SETTING: Tertiary care center. POPULATION: Experienced and less experienced midwives performing ultrasound scans. METHODS: Number of fetuses and live born children with severe congenital heart malformations were extracted from patient records. The detection rates of experienced and less experienced midwives were compared following a postgraduate training program in obstetrical ultrasound. MAIN OUTCOME MEASURES: The prenatal detection rate of complex congenital heart malformations. RESULTS: The prenatal detection rate for the entire unit increased significantly during the study period (32 vs. 69%, p<0.05). Following education, we observed a significant increase in detection rates (21 vs. 67%, p<0.01) among experienced midwives. In the group of less experienced midwives, we found a positive effect of training with considerably higher detection rates compared to results achieved by their more experienced colleagues prior to the program (40 vs. 21%). CONCLUSION: There is a clear improvement in the prenatal detection rates of complex heart malformations following a postgraduate education in obstetrical ultrasound. Similar training should be offered to both midwives and doctors performing routine scans to increase the standards of antenatal screening for congenital heart disease. © 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  • 7. Asplin, Nina
    et al.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Maternal emotional wellbeing over time and attachment to the fetus when a malformation is detected2015In: Sexual & Reproductive Healthcare, ISSN 1877-5756, Vol. 6, no 3, 191-195 p.Article in journal (Refereed)
  • 8.
    Asplin, Nina
    et al.
    Sophiahemmet University.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Pregnancy termination due to fetal anomaly: women's reactions, satisfaction and experiences of care2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 6, 620-627 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to explore what women who have had a pregnancy terminated due to a detected fetal malformation perceived as having been important in their encounters with caregivers for promoting their healthy adjustment and well-being.

    METHOD:

    an exploratory descriptive design was used. Semi-structured interviews were audiotaped, and the information pathway described. The text was processed through qualitative content analysis in six steps.

    SETTING:

    four fetal care referral centres in Stockholm, Sweden.

    PARTICIPANTS:

    11 women opting for pregnancy termination due to fetal malformation.

    FINDINGS:

    in-depth understanding and compassion are important factors in providing the feeling of support people need so they are able to adapt to crisis. The women emphasised that the caregivers have to communicate a sense of responsibility, hope and respect and provide on-going care for them to feel assured of receiving good medical care and treatment. Aside from existing psychological conditions, the women identified as having emotional distress directly after termination and for at least the following three months. Most women experienced a range of negative emotions after pregnancy termination, including sadness, meaninglessness, loneliness, tiredness, grief, anger and frustration. Still some of this group had positive reactions because they experienced empathy and well-organised care.

    CONCLUSION AND IMPLICATIONS FOR PRACTICE:

    The most important factors associated with satisfaction regarding pregnancy termination due to a fetal malformation are the human aspects of care, namely state-dependent communication and in-depth understanding and compassion. The changes in care most often asked for were improvements in the level of standards and provision of adequate support through state-dependent communication, in-depth understanding and compassion, and complete follow-up routines and increased resources. Targeted education for the caregivers may be suited to ensuring that they properly meet needs of their patients.

  • 9.
    Asplin, Nina
    et al.
    Sophiahemmet University.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Pregnant women's experiences, needs, and preferences regarding information about malformations detected by ultrasound scan2012In: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, ISSN 1877-5764, Vol. 3, no 2, 73-8 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of the study was to explore pregnant women's experiences of received information in relation to fetal malformation detected on ultrasound.

    METHOD: An exploratory descriptive design was used. Semi-structured interviews with women who continued their pregnancy and women who chose to terminate were audiotaped, the information pathway described, and the text subjected to qualitative content analysis.

    RESULTS: Most of the women who expected a baby with an abnormality experienced the information given as insufficient, often misleading, conflicting, or incoherent, and sometimes negative. Important factors for interaction between women and caregivers were timing, duration, and manner of the initial dialog and ongoing support. Positive interactions improved the women's ability to understand the information, fostered feelings of trust and safety which reduced their anxiety.

    CONCLUSION: Women expressed dissatisfaction both regarding the care-givers' methods of giving information and apply for information from different specialists and continuity. The study highlights important factors which may be helpful to the professionals for improving the information to this vulnerable group of women.

  • 10.
    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, 79-84 p.Article 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.

  • 11. Avelin, Pernilla
    et al.
    Erlandsson, Kerstin
    Hildingsson, Ingegerd
    Rådestad, Ingela
    Sophiahemmet University.
    Swedish parents' experiences of parenthood and the need for support to siblings when a baby is stillborn2011In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 38, no 2, 150-8 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It has been argued that having a stillborn baby in the family affects older siblings more than parents realize. The aim of this study was to describe parenthood and the needs of siblings after stillbirth from the parents' perspective.

    METHODS: Six focus groups were held with 27 parents who had experienced a stillbirth and who had had children before the loss. The discussion concerned parents' support to the siblings, and the sibling's meeting, farewell, and memories of their little sister or brother. Data were analyzed using qualitative content analysis.

    RESULTS: The overall theme of the findings was parenthood in a balance between grief and everyday life. In the analysis, three categories emerged that described the construction of the theme: support in an acute situation, sharing the experiences within the family, and adjusting to the situation.

    CONCLUSIONS: The siblings' situation is characterized by having a parent who tries to maintain a balance between grief and everyday life. Parents are present and engaged in joint activities around the stillbirth together with the siblings of the stillborn baby. Although parents are aware of the sibling's situation, they feel that they are left somewhat alone in their parenthood after stillbirth and therefore need support and guidance from others.

  • 12. Avelin, Pernilla
    et al.
    Hildingsson, Ingegerd
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Sophiahemmet University.
    Make the stillborn baby and the loss real for the siblings: parents' advice on how the siblings of a stillborn baby can be supported2012In: Journal of Perinatal Education, ISSN 1058-1243, EISSN 1548-8519, Vol. 21, no 2, 90-98 p.Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate parents' advice to other parents on the basis of their own experiences of siblings' taking leave of a stillborn sister or brother. The study was a Web questionnaire study of 411 parents. The thematic content analysis resulted in two categories: "Make the stillborn baby and the loss real for the siblings" and "Take the siblings' resources and prerequisites into account." Parents' advised that siblings should see and hold the stillborn baby and, thus, be invited and included into the leave-taking process with respect to the siblings' feelings, resources, and prerequisites. Based on these findings, professional caregivers can usefully be proactive in their approach to facilitate and encourage the involvement of siblings.

  • 13. Avelin, Pernilla
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Säflund, Karin
    Wredling, Regina
    Erlandsson, Kerstin
    Parental grief and relationships after the loss of a stillborn baby2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 6, 668-673 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to describe the grief of mothers and fathers and its influence on their relationships after the loss of a stillborn baby. DESIGN: a postal questionnaire at three months, one year and two years after stillbirth. SETTING: a study of mothers and fathers of babies stillborn during a one-year period in the Stockholm region of Sweden. PARTICIPANTS: 55 parents, 33 mothers and 22 fathers. FINDINGS: mothers and fathers stated that they became closer after the loss, and that the feeling deepened over the course of the following year. The parents said that they began grieving immediately as a gradual process, both as individuals, and together as a couple. During this grieving process their expectations, expressions and personal and joint needs might have threatened their relationship as a couple, in that they individually felt alone at this time of withdrawal. While some mothers and fathers had similar grieving styles, the intensity and expression of grief varied, and the effects were profound and unique for each individual. KEY CONCLUSIONS: experiences following a loss are complex, with each partner attempting to come to terms with the loss and the resultant effect on the relationship with their partner. IMPLICATIONS FOR PRACTICE: anticipating and being able to acknowledge the different aspects of grief will enable professionals to implement more effective intervention in helping couples grieve both individually and together.

  • 14. Björklund, Ulla
    et al.
    Marsk, Anna
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Does an information film about prenatal testing in early pregnancy affect women's anxiety and worries?2013In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 34, no 1, 9-14 p.Article in journal (Refereed)
    Abstract [en]

    Abstract Objective: To explore if an information film about prenatal examinations affects pregnant women's worry and anxiety. Methods: Randomized controlled study. The intervention was an information film about prenatal examinations. Data was collected in gestational week 26 by a questionnaire including the STAI (State-Trait Anxiety Inventory) instrument and further questions about worry. A total of 184 women in the intervention group and 206 in the control group filled in the questionnaire. Results: There were no statistically significant differences between the groups neither in state nor trait anxiety. Regarding worry about the possibility of something being wrong with the baby and worry about giving birth, there were no statistically significant differences between the groups. The women stated that to see the film increased their worry rather than decreased it. Conclusion: An informational film as additional information to complement written and verbal information about prenatal testing does not appear to increase women's anxiety and worries. However, the informational film may cause worry at the time of viewing which should be taken into consideration.

  • 15. Björklund, Ulla
    et al.
    Marsk, Anna
    Levin, Charlotta
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Audiovisual information affects informed choice and experience of information in antenatal Down syndrome screening: a randomized controlled trial2012In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 86, no 3, 390-395 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of an information film on making an informed choice regarding Down syndrome screening, and women's knowledge and experiences of information. METHODS: Randomized controlled trial including 184 women in the intervention group and 206 controls recruited from maternity units in Stockholm, Sweden. The intervention was an information film presented as a complement to written and verbal information. Data were collected via a questionnaire in gestational week 27. Three different measures were combined to measure informed choice: attitudes towards Down syndrome screening, knowledge about Down syndrome and Down syndrome screening, and uptake of CUB (combined ultrasound and biochemical screening). RESULTS: In the intervention group 71.5% made an informed choice versus 62.4% in the control group. Women in the intervention group had significantly increased knowledge, and to a greater extent than the control group, experienced the information as being sufficient, comprehensible, and correct. CONCLUSIONS: An information film tended to increase the number of women who made an informed choice about Down syndrome screening. Participants were more satisfied with the information received. PRACTICE IMPLICATIONS: Access to correct, nondirective, and sufficient information is essential when making a choice about prenatal diagnostics. It is essential with equivalent information to all women.

  • 16. Bodin, Maja
    et al.
    Käll, Lisa
    Tydén, Tanja
    Stern, Jenny
    Sophiahemmet University.
    Drevin, Jennifer
    Larsson, Margareta
    Exploring men's pregnancy-planning behaviour and fertility knowledge: a survey among fathers in Sweden2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 2, 127-135 p.Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Research about pregnancy-planning behaviour mostly focuses on women, even though pregnancy planning usually also concerns men. The purpose of this study was to investigate how men plan for family, and to measure their fertility knowledge after having become fathers.

    MATERIAL AND METHODS: Data were collected in 2014 as part of a Swedish longitudinal pregnancy-planning study. Men were recruited through their female partner one year after childbirth. Participants were asked to fill out a questionnaire about pregnancy planning, lifestyles, and fertility.

    RESULTS: Of the 796 participants, 646 (81%) stated that the pregnancy had been very or fairly planned, and 17% (n = 128) had made a lifestyle adjustment before pregnancy to improve health and fertility. The most common adjustments were to reduce/quit the consumption of alcohol, cigarettes, or snuff, and to exercise more. First-time fathers and those who had used assisted reproductive technology to become pregnant were more likely to have made an adjustment. Fertility knowledge varied greatly. Men with university education had better fertility knowledge than men without university education.

    CONCLUSION: Our findings indicate that there is variation in how men plan and prepare for pregnancy. Most men did not adjust their lifestyle to improve health and fertility, while some made several changes. Both pregnancy-planning behaviour and fertility knowledge seem to be related to level of education and mode of conception. To gain deeper understanding of behaviour and underlying factors, more research is needed.

  • 17. Davidsson-Bremborg, Anna
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Memory triggers and anniversaries of stillborn children2013In: Nordic Journal of Religion and Society, ISSN 0809-7291, E-ISSN 1890-7008, Vol. 26, no 2, 157-174 p.Article in journal (Refereed)
    Abstract [en]

    Care after stillbirths has changed radically within the last twenty years, not least because of research. However, less attention has been given to memorialization in the longer perspective. This is a qualitative study based on a web questionnaire with the aim to uncover memorialization practices on anniversary days. 596 bereaved mothers of stillborn children provided an answer to an open question on how they observed the anniversary. The inductive analysis resulted in six categories of memorialization: (1) internal memorialization; (2) home-based memorialization; (3) traditional grave visits; (4) extended memorialization rituals; (5) alternative activities; and (6) coincidental activities. Different memory triggers – gifts, objects, food, and places – were used to evoke memories, honour the child, and strengthen the bonds with the child and within the family.

  • 18. Drevin, Jennifer
    et al.
    Kristiansson, Per
    Stern, Jenny
    Sophiahemmet University.
    Rosenblad, Andreas
    Measuring pregnancy planning: A psychometric evaluation and comparison of two scales2017In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 11, 2765-2775 p.Article in journal (Refereed)
    Abstract [en]

    AIMS: To psychometrically test the London Measure of Unplanned Pregnancy and compare it with the Swedish Pregnancy Planning Scale.

    BACKGROUND: The incidence of unplanned pregnancies is an important indicator of reproductive health. The London Measure of Unplanned Pregnancy measures pregnancy planning by taking contraceptive use, timing, intention to become pregnant, desire for pregnancy, partner agreement, and pre-conceptual preparations into account. It has, however, previously not been psychometrically evaluated using confirmatory factor analysis. The Likert-scored single-item Swedish Pregnancy Planning Scale has been developed to measure the woman's own view of pregnancy planning level.

    DESIGN: Cross-sectional design.

    METHODS: In 2012-2013, 5493 pregnant women living in Sweden were invited to participate in the Swedish Pregnancy Planning study, of whom 3327 (61%) agreed to participate and answered a questionnaire. A test-retest pilot study was conducted in 2011-2012. Thirty-two participants responded to the questionnaire on two occasions 14 days apart. Data were analysed using confirmatory factor analysis, Cohen's weighted kappa and Spearman's correlation.

    RESULTS: All items of the London Measure of Unplanned Pregnancy contributed to measuring pregnancy planning, but four items had low item-reliability. The London Measure of Unplanned Pregnancy and Swedish Pregnancy Planning Scale corresponded reasonably well with each other and both showed good test-retest reliability.

    CONCLUSION: The London Measure of Unplanned Pregnancy may benefit from item reduction and its usefulness may be questioned. The Swedish Pregnancy Planning Scale is time-efficient and shows acceptable reliability and construct validity, which makes it more useful for measuring pregnancy planning.

  • 19. Erlandsson, Kerstin
    et al.
    Lindgren, Helena
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Sophiahemmet University.
    Women's premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 1, 28-33 p.Article in journal (Refereed)
    Abstract [en]

    Objective. To identify whether mothers of stillborn babies had had a premonition that their unborn child might not be well and how they dealt with that premonition. Design. A mixed method approach. Setting. One thousand and thirty-four women answered a web questionnaire. Sample. Six hundred and fourteen women fulfilled the inclusion criteria of having a stillbirth after the 22nd gestational week and answered questions about premonition. Methods. Qualitative content analysis was used for the open questions and descriptive statistics for questions with fixed alternatives. Main Outcome Measure. The premonition of an unwell unborn baby. Results. In all, 392 of 614 (64%) of the women had had a premonition that their unborn baby might be unwell; 274 of 614 (70%) contacted their clinic and were invited to come in for a check-up, but by then it was too late because the baby was already dead. A further 88 of 614 (22%) decided to wait until their next routine check-up, believing that the symptoms were part of the normal cycle of pregnancy, and that the fetus would move less towards the end of pregnancy. Thirty women (8%) contacted their clinic, but were told that everything appeared normal without an examination of the baby. Conclusions. Women need to know that a decrease in fetal movements is an important indicator of their unborn baby's health. Healthcare professionals should not delay an examination if a mother-to-be is worried about her unborn baby's wellbeing.

  • 20. Erlandsson, Kerstin
    et al.
    Lindgren, Helena
    Malm, Mari-Cristine
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Sophiahemmet University.
    Mothers' experiences of the time after the diagnosis of an intrauterine death until the induction of the delivery: a qualitative Internet-based study2011In: Journal of obstetrics and gynaecology research, ISSN 1341-8076, E-ISSN 1447-0756, Vol. 37, no 11, 1677-84 p.Article in journal (Refereed)
    Abstract [en]

    AIM: This study aims to describe how mothers spend the period of time between being diagnosed with a dead baby in utero and the induction of the delivery.

    MATERIAL AND METHODS: Data were collected using a web questionnaire. Five hundred and fifteen women who had experienced a stillbirth after the 22nd week of gestation answered the open question: 'What did you do between the diagnosis of the child's death and the beginning of the delivery?' A qualitative content analysis method was used.

    RESULTS: The results show that some mothers received help to adapt to the situation, while for others, waiting for the induction meant further stress and additional psychological trauma in an already strained situation.

    CONCLUSION: There is no reason to wait with the induction unless the parents themselves express a wish to the contrary. Health care professionals, together with the parents, should try to determine the best time for the induction of the birth after the baby's death in utero. That time may vary, depending on the parents' preferences.

  • 21. Erlandsson, Kerstin
    et al.
    Säflund, Karin
    Wredling, Regina
    Rådestad, Ingela
    Sophiahemmet University.
    Support after stillbirth and its effect on parental grief over time2011In: Journal of social work in end-of-life & palliative care, ISSN 1552-4264, Vol. 7, no 2-3, 139-52 p.Article in journal (Refereed)
    Abstract [en]

    In this study the authors describe parents' experiences of support over a 2-year period after a stillbirth and its effect on parental grief. Data was collected by questionnaire from 33 mothers and 22 fathers at 3 months, 1 year, and 2 years after a stillbirth. Midwives, physicians, counselors, and priests--at the hospital where the stillbirth occurred--are those on the front line providing professional support. The support from family and friends was seen to be important 2 years after the stillbirth. The need for professional support after stillbirth can differ, depending on the support provided by family, friends, and social networks. They may not fully realize the value of their support and how to be supportive. Printed educational materials given to individuals in the social network or family might therefore be helpful.

  • 22. Erlandsson, Kerstin
    et al.
    Warland, Jane
    Cacciatore, Joanne
    Rådestad, Ingela
    Sophiahemmet University.
    Seeing and holding a stillborn baby: mothers' feelings in relation to how their babies were presented to them after birth-findings from an online questionnaire2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 3, 246-250 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to determine if the way caregivers offer opportunities to see and hold a stillborn baby impacts a mother's feelings about the experience of seeing and holding her newborn. DESIGN AND SETTING: a web questionnaire hosted by the Swedish National Infant Foundation from March 2008 to April 2010. PARTICIPANTS: 840 eligible participants who had experienced a stillbirth after the 22nd gestational week from 1955 to 2010 and completed an online questionnaire about their experiences. METHODS: descriptive and inferential statistics. FINDINGS: when mothers were presented the baby as a normal part of birth without being asked if they wanted to see, they more often reported that the experience was comfortable compared to mothers who were asked if they wanted to see the baby 86% vs. 76% (p=<0.01). The incitation of fear in mothers was 70% vs. 80% (p=0.02) in favour of mothers who were not asked. Furthermore the mothers who were not asked more often stated that it felt natural and good when compared to those who said staff asked if the mother wanted to see, 73% vs. 61% (p=0.07) and (78%) vs. (69%) p=0.19, respectively. A trend was seen toward more mothers feeling natural, good, comfortable, and less frightened if the provider engaged in 'assumptive bonding', that is the baby is simply and naturally presented to the mother without asking her to choose. KEY CONCLUSIONS: mothers of stillborn babies felt more natural, good, comfortable and less frightened if the staff supported assumptive bonding by simply offering the baby to the mother. IMPLICATIONS FOR PRACTICE: care providers should approach caring for grieving mothers with tenderness and humility, assuming that they will wish to see and hold their stillborn baby.

  • 23.
    Georgsson, Susanne
    Sophiahemmet University.
    Fosterundersökningar: En självklarhet? En möjlighet? En rättighet?2017Conference paper (Other academic)
  • 24.
    Georgsson, Susanne
    Sophiahemmet University.
    Information och psykologiska aspekter kring fosterdiagnostik2016In: Reproduktiv hälsa: barnmorskans kompetensområde / [ed] Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes, Lund: Studentlitteratur AB, 2016, 1, 289-298 p.Chapter in book (Other academic)
  • 25.
    Georgsson, Susanne
    Sophiahemmet University.
    Är det "mission impossible"?: information om fosterdiagnostik2016Conference paper (Other academic)
  • 26.
    Georgsson, Susanne
    et al.
    Sophiahemmet University.
    Sahlin, Ellika
    Iwarsson, Moa
    Nordenskjöld, Magnus
    Gustavsson, Peter
    Iwarsson, Erik
    Knowledge and attitudes regarding non-invasive prenatal testing (NIPT) and preferences for risk information among high school students in Sweden2017In: Journal of Genetic Counseling, ISSN 1059-7700, E-ISSN 1573-3599, Vol. 26, no 3, 447-454 p.Article in journal (Refereed)
    Abstract [en]

    Non-invasive prenatal testing (NIPT) was recently introduced for prenatal testing of genetic disorders. Cell-free fetal DNA is present in maternal blood during pregnancy and enables detection of fetal chromosome aberrations in a maternal blood sample. The public perspective to this new, simple method has not been illuminated. The views of young people (i.e. future parents) are important to develop suitable counseling strategies regarding prenatal testing. The aim was to explore Swedish high school students' attitudes, knowledge and preferences regarding NIPT. A questionnaire was completed by 305 students recruited from one high school in Stockholm, November and December 2014. Most students (80 %) considered prenatal testing as good. The majority (65 %) was positive or very positive towards NIPT and 62 % stated that they potentially would like to undergo the test if they or their partner was pregnant. The vast majority (94 %) requested further information about NIPT. Most students (61 %) preferred verbal information, whereas 20 % preferred information via the Internet. The majority of the high school students was positive towards prenatal testing and most was positive towards NIPT. Further, information was requested by the vast majority before making a decision about NIPT. Most of the students preferred verbal information and to a lesser extent information via the Internet. The attitudes, knowledge and preferences for risk information concerning NIPT in young adults are important, in order to increase knowledge on how to educate and inform future parents.

  • 27.
    Georgsson, Susanne
    et al.
    Sophiahemmet University.
    Stenström Bohlin, Katja
    Den gravida patienten2016In: Omvårdnad & kirurgi / [ed] Christine Kumlien & Jenny Rystedt, Lund: Studentlitteratur AB, 2016, 1, 507-520 p.Chapter in book (Other academic)
  • 28.
    Georgsson, Susanne
    et al.
    Sophiahemmet University.
    Stenström Bohlin, Katja
    Gynekologi2016In: Omvårdnad & kirurgi / [ed] Christine Kumlien & Jenny Rystedt, Lund: Studentlitteratur AB, 2016, 1, 477-491 p.Chapter in book (Other academic)
  • 29.
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Fosterdiagnostik2009 (ed. 1)Book (Other academic)
  • 30.
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Övriga fosterdiagnostiska undersökningar samt psykologiska aspekter2009In: Lärobok för barnmorskor / [ed] Annette Kaplan et al., Lund: Studentlitteratur , 2009, 3, 214-15 p.Chapter in book (Other academic)
  • 31.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet University.
    Björklund, Ulla
    Marsk, Anna
    Does an informational film increase women's possibility to make an informed choice about second trimester ultrasound?2012In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 32, no 9, 833-9 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate effects of an informational film on making an informed choice regarding second trimester ultrasound.

    METHOD: Randomized controlled study. The intervention was an informational film about prenatal examinations. Data were collected at gestational week 26.

    RESULTS: A total of 184 women in the intervention group and 206 women in the control group participated in the study. Of those in the intervention group, 81.3% made an informed choice regarding second trimester ultrasound examination compared with 76.1% in the control group (p = 0.21). Women making an informed choice scored higher in knowledge about the examination (p < 0.001), had higher degree of education (p < 0.001), and spoke more frequently Swedish as mother tongue (89.5% vs 74.7%, p = 0.01).

    CONCLUSIONS: An informational film does not increase women's knowledge or the number of women making an informed choice about the second trimester ultrasound. Women who did not make an informed choice about the second trimester ultrasound had a lower level of education and less knowledge about second trimester ultrasound screening.

  • 32.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet University.
    Grunewald, Charlotta
    Waldenström, Ulla
    Perception of risk in relation to ultrasound screening for Down's syndrome during pregnancy2009In: Midwifery, ISSN 1532-3099, Vol. 25, no 3, 264-76 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to explore how information about being at risk of carrying a fetus with Down's syndrome was understood, and whether the actual risk and the woman's perception of risk was associated with worry or depressive symptoms during and after pregnancy. DESIGN AND SETTING: observational study. The sample was drawn from the intervention group of a Swedish randomised controlled trial of ultrasound screening for Down's syndrome by nuchal translucency measurement. MEASUREMENTS: data were collected by three questionnaires. Questions were asked about recall of the risk score and perception of risk. The Cambridge Worry Scale and the Edinburgh Postnatal Depression Scale measured worry and depressive symptoms, respectively, on all three occasions. FINDINGS: of the 796 women who provided data for this study, one in five was unaware that the risk score was noted in her case record. In total, 620 women stated that they had received a risk score, but only 64% of them recalled the figure exactly or approximately. The actual risk was associated with the perceived risk, but of the 31 women who perceived the risk to be high, only 14 were actually at high risk. A high-risk score was not associated with worry or depressive symptoms in mid-pregnancy, in contrast to a woman's own perception of being at high risk. Two months postpartum, no associations were found between maternal emotional well-being and actual or perceived risk. CONCLUSIONS: information about fetal risk is complicated and women's perception of risk does not always reflect the actual risk, at least not when presented as a numerical risk score. The possibility that the information may cause unnecessary emotional problems cannot be excluded. IMPLICATIONS FOR PRACTICE: caregivers should ascertain that information about fetal risk is interpreted correctly by pregnant women.

  • 33.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet University.
    Grunewald, Charlotta
    Waldenström, Ulla
    Women's worries during pregnancy: testing the Cambridge Worry Scale on 200 Swedish women2003In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 2, 148-52 p.Article in journal (Refereed)
    Abstract [en]

    The Cambridge Worry Scale (CWS) is an instrument including 16 items measuring women's major worries during pregnancy. The aim of the study was to test the scale, translated into Swedish, on pregnant women in Stockholm. We also wanted to explore whether these women were worried about any item not included in the scale. An additional aim was to study possible variation in women's worries related to gestational week. Two hundred women were recruited. The average age was 31 years and 56% were primiparas. Gestational age ranged from 8 to 42 weeks, with a median of 28 weeks. The reliability of the scale was satisfactory (Cronbach's alpha coefficient 0.81). The major worries were about the baby's health, giving birth and miscarriage. These items, all related to pregnancy outcomes, were followed by worries about financial matters. An additional concern not included in the scale was about the maternity services in Stockholm, i.e. that the hospital would be overbooked, the staff being too busy or the medical safety not being guaranteed. Few women worried about their relationship with their partner or if he would be present at birth. Some of the items showed a pattern with a period of less worry in midpregnancy.

  • 34.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet University.
    Saltvedt, Sissel
    Grunewald, Charlotta
    Waldenström, Ulla
    Does fetal screening affect women's worries about the health of their baby?: a randomized controlled trial of ultrasound screening for Down's syndrome versus routine ultrasound screening2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 7, 634-40 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Screening for fetal abnormality may increase women's anxiety as attention is directed at the possibility of something being wrong with the baby. The aim of this study was to evaluate the effect of ultrasound screening for Down's syndrome on women's anxiety in mid-pregnancy and 2 months after delivery. METHOD: Two thousand and twenty-six women were randomly allocated to an ultrasound examination at 12-14 gestational weeks (gws) including risk assessment for Down's syndrome or to a routine scan at 15-20 gws. Questionnaires including the State-Trait Anxiety Inventory (STAI), the Cambridge Worry Scale (CWS), and the Edinburgh Postnatal Depression Scale (EPDS) were filled in at baseline in early pregnancy, at 24 gws and 2 months after delivery. RESULTS: No statistically significant differences were found between the trial groups regarding women's worries about the health of the baby, general anxiety and depressive symptoms during pregnancy or 2 months after delivery. Women's worries about something being wrong with the baby in the early ultrasound group and routine group, respectively, decreased from baseline (39.1% versus 36.0%) to mid-pregnancy (29.2% versus 27.8%), and finally to 2 months after delivery (5.2% versus 6.6%). CONCLUSION: Fetal screening for Down's syndrome by an early ultrasound scan did not cause more anxiety or concerns about the health of the baby in mid-pregnancy or 2 months after birth than in women who had a routine scan.

  • 35.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet University.
    Saltvedt, Sissel
    Waldenström, Ulla
    Grunewald, Charlotta
    Olin-Lauritzen, Sonja
    Pregnant women's responses to information about an increased risk of carrying a baby with Down syndrome2006In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 33, no 1, 64-73 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fetal screening for Down syndrome by an ultrasound examination, including measurement of fetal nuchal translucency, at 12 to14 weeks' gestation is presently being evaluated in a Swedish randomized controlled trial. Women at high risk were offered an amniocentesis to obtain a definite diagnosis. The aim of this study was to explore women's reactions and responses to information about being at high risk after the scan, with a special focus on reactions to a false positive test. METHOD: Interviews were conducted with 24 women within 1 week after the scan, in midpregnancy, and 2 months after the birth. The interviews were analyzed qualitatively. Down syndrome was confirmed in 4 women, who chose to terminate the pregnancy. The remaining 20 women had a false positive test. RESULTS: For the majority, the risk information caused strong reactions of anxiety and worries about the future. A typical way for women to cope was to "withhold" the pregnancy, to take a "timeout," and try to live as if they were not pregnant any longer. Some weeks later, when the women received normal results from the chromosome analysis, they resumed being pregnant. Six women ages more than 35 years who had a risk score lower than their age-related risk did not express similarly strong reactions. Two months after the birth of a healthy baby, most stated they would undergo the same procedure in a subsequent pregnancy. One woman still suffered from the experience when interviewed at 2 months after the birth, and another said she regretted participating in the fetal screening program. CONCLUSIONS: A false positive test of fetal screening for Down syndrome by ultrasound examination may cause strong reactions of anxiety and even rejection of the pregnancy. The prevalence of such reactions and possible long-term effects need further investigation.

  • 36.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet University.
    Waldenström, Ulla
    Effect of first-trimester ultrasound screening for Down syndrome on maternal-fetal attachment: a randomized controlled trial2010In: Sexual & Reproductive Healthcare, ISSN 1877-5756, Vol. 1, no 3, 85-90 p.Article in journal (Refereed)
    Abstract [en]

    Objective: The objective was to investigate how ultrasound screening for Down syndrome (DS) in the first trimester, compared with a routine ultrasound examination in the second trimester, affected Maternal–Fetal Attachment (MFA) in mid-pregnancy. Method: This study of 2026 pregnant women was a sub-study of a larger RCT aiming at evaluating the effect of fetal screening for Down syndrome (DS) by means of an ultrasound scan, including measuring fetal nuchal translucency in gestational weeks 12–14. Women were randomly allocated either to the intervention or to a control group where routine care with an ultrasound scan in gestational week 17–20 was offered. Data were collected by questionnaires before randomization and in gestational week 24. MFA was measured by a modified version of the Cranley Maternal–Fetal Attachment Scale (CMFAS). Results: The mean score of MFA was 3.50 in the intervention group and 3.44 in the control group (p = 0.04). The mean scores on all subscales were slightly higher in the intervention group, but only statistically significant regarding “Differentiation of self from fetus” (p = 0.01). Conclusion: Ultrasound screening for DS in the first trimester may have a modest positive effect on MFA in mid-pregnancy, compared with a ultrasound scan in the second trimester.

  • 37.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet University.
    Waldenström, Ulla
    Second-trimester routine ultrasound screening: expectations and experiences in a nationwide Swedish sample2008In: Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, ISSN 1469-0705, Vol. 32, no 1, 15-22 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate, in a large nationwide Swedish sample, pregnant women's expectations of the routine second-trimester ultrasound examination, with participants expressing themselves in their own words, and to determine whether they had been given sufficient information about why and how the examination was performed, and about possible risks. We focused specifically on reasons for women not having a positive experience. METHOD: Of 4600 eligible Swedish-speaking women, 3061 were recruited to the study in early pregnancy, during three 1-week periods spread evenly over 1 year (1999-2000), and these women completed a questionnaire at a mean of 16 weeks' gestation. A follow-up questionnaire at 2 months after delivery was completed by 2730 women. The representativeness of the sample was assessed by comparison with the total Swedish birth cohort of 1999. RESULTS: The most prominent expectation about the up-coming scan was confirmation that the baby was well, followed by confirmation that the pregnancy was real. Detailed information, such as date of delivery and sex of the baby, was mentioned less often, and very few wrote about the examination as an exciting and joyful experience. After the birth, a large majority was satisfied with information about why (88%) and how (87%) the examination was performed, but only 58% said they had received sufficient information about possible risks. 94% had a positive experience of the scan, and those who had not had more ambivalent feelings about their pregnancy. Women with negative feelings about the scan were more often single and of non-Swedish background, and emotional problems were more common in this group. CONCLUSION: Women's expectations of the routine second-trimester scan differ from those of caregivers, focusing on general reassurance rather than specific information. Level of satisfaction with the scan was high, but information given about risks could be improved. Women with ambivalent or negative feelings about pregnancy may have difficulties enjoying the examination.

  • 38. Gravensteen, Ida Kathrine
    et al.
    Helgadóttir, Linda Björk
    Jacobsen, Eva-Marie
    Rådestad, Ingela
    Sophiahemmet University.
    Sandset, Per Morten
    Ekeberg, Oivind
    Women's experiences in relation to stillbirth and risk factors for long-term post-traumatic stress symptoms: a retrospective study2013In: BMJ open, ISSN 2044-6055, Vol. 3, no 10, e003323- p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: (1) To investigate the experiences of women with a previous stillbirth and their appraisal of the care they received at the hospital. (2) To assess the long-term level of post-traumatic stress symptoms (PTSS) in this group and identify risk factors for this outcome.

    DESIGN: A retrospective study.

    SETTING: Two university hospitals.

    PARTICIPANTS: The study population comprised 379 women with a verified diagnosis of stillbirth (≥23 gestational weeks or birth weight ≥500 g) in a singleton or twin pregnancy 5-18 years previously. 101 women completed a comprehensive questionnaire in two parts.

    PRIMARY AND SECONDARY OUTCOME MEASURES: The women's experiences and appraisal of the care provided by healthcare professionals before, during and after stillbirth. PTSS at follow-up was assessed using the Impact of Event Scale (IES).

    RESULTS: The great majority saw (98%) and held (82%) their baby. Most women felt that healthcare professionals were supportive during the delivery (85.6%) and showed respect towards their baby (94.9%). The majority (91.1%) had received some form of short-term follow-up. One-third showed clinically significant long-term PTSS (IES ≥ 20). Independent risk factors were younger age (OR 6.60, 95% CI 1.99 to 21.83), induced abortion prior to stillbirth (OR 5.78, 95% CI 1.56 to 21.38) and higher parity (OR 3.46, 95% CI 1.19 to 10.07) at the time of stillbirth. Having held the baby (OR 0.17, 95% CI 0.05 to 0.56) was associated with less PTSS.

    CONCLUSIONS: The great majority saw and held their baby and were satisfied with the support from healthcare professionals. One in three women presented with a clinically significant level of PTSS 5-18 years after stillbirth. Having held the baby was protective, whereas prior induced abortion was a risk factor for a high level of PTSS.

    TRIAL REGISTRATION: The study was registered at http://www.clinicaltrials.gov, with registration number NCT 00856076.

  • 39. Gravensteen, Ida Kathrine
    et al.
    Jacobsen, Eva-Marie
    Sandset, Per Morten
    Helgadottir, Linda Björk
    Rådestad, Ingela
    Sophiahemmet University.
    Sandvik, Leiv
    Ekeberg, Øivind
    Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth: a prospective study2017In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate healthcare utilisation, induced labour and caesarean section (CS) in the pregnancy after stillbirth and assess anxiety and dread of childbirth as mediators for these outcomes.

    DESIGN: Population-based pregnancy cohort study.

    SETTING: The Norwegian Mother and Child Cohort Study.

    SAMPLE: 901 pregnant women; 174 pregnant after stillbirth, 362 pregnant after live birth and 365 previously nulliparous.

    METHODS: Data from questionnaires answered in the second and third trimesters of pregnancy and information from the Medical Birth Registry of Norway.

    MAIN OUTCOME MEASURES: Self-reported assessment of antenatal care, register-based assessment of onset and mode of delivery.

    RESULTS: Women with a previous stillbirth had more frequent antenatal visits (mean 10.0; 95% confidence interval [CI] 9.4 - 10.7) compared with women with a previous live birth (6.0; 5.8 - 6.2) and previously nulliparous women (6.3; 6.1 - 6.6). Induced labour and CS, elective and emergency, were also more prevalent in the stillbirth group. The adjusted odds ratio for elective CS was 2.5 (95% CI 1.3 - 5.0) compared with women with previous live birth and 3.7 (1.8 - 7.6) compared with previously nulliparous women. Anxiety was a minor mediator for the association between stillbirth and frequency of antenatal visits, while dread of childbirth was not a significant mediator for elective CS.

    CONCLUSIONS: Women pregnant after stillbirth were more ample users of healthcare services and had more often induced labour and CS. The higher frequency of antenatal visits and elective CS could not be accounted for by anxiety or dread of childbirth. This article is protected by copyright. All rights reserved.

  • 40. Holste, Carola
    et al.
    Pilo, Christina
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Papadogiannakis, Nikos
    Mothers' attitudes towards perinatal autopsy after stillbirth2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 11, 1287-90 p.Article in journal (Refereed)
    Abstract [en]

    We investigated mothers' attitudes to autopsy of their stillborn baby and their experiences concerning information and treatment in relation to their loss in an observational study. Data were collected by postal questionnaires and telephone calls. Fifty-four of 72 mothers (76%) replied. Fifty-one (94%) received information from a physician about the possibility of having an autopsy; three (6%) did not get any information. The autopsy rate was 83% (n= 45). Thirty-six of 45 (80%) received adequate information about results. Twenty-five (56%) were pleased with how results were presented. Eleven (24%) were positive about individual contact with the pathologist who performed the autopsy. Fifty-one (94%) stated that their decision concerning autopsy was right. Mothers do not regret their decision concerning perinatal autopsy but they do not always receive thorough and timely information concerning autopsy and its results. Personal contact with the perinatal pathologist might help with specific questions both before and after autopsy.

  • 41. Ingvoldstad, Charlotta
    et al.
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Lindgren, Peter
    Implementation of combined ultrasound and biochemistry for risk evaluation of chromosomal abnormalities during the first trimester in Sweden2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 9, 868-73 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate how the first trimester risk evaluation for Down syndrome is offered and performed.

    SETTING: Sweden.

    SAMPLE: All 52 known units working with obstetric ultrasound.

    METHODS: Study-specific questionnaire and descriptive statistical analyses.

    MAIN OUTCOME MEASURES: Routines for offering combined ultrasound and biochemistry (CUB), questions about information, questions about tests and analysis used for diagnosis.

    RESULTS: CUB was performed in 28 600 (26%) of the expected 110 000 pregnancies in Sweden during 2011. Of all pregnant women, 15% were living in a county not offering CUB (only invasive prenatal diagnosis); 44% regardless of age; 15% to women ≥33 years; 24% to women ≥35 years; and 2% to women ≥38 years old. Amniocentesis was the most common method offered when the risk was estimated as high. Of the 47 units that replied, 29 (61.7%) offered only amniocentesis. On the questions about information, 40 (95.2%) stated that they gave verbal information. In addition to verbal information, 17 (40.5%) gave written information. Forty-one of the units (71.9%) stated that the CUB is offered to non-Swedish-speaking women.

    CONCLUSION: Without consistent national guidelines, the prenatal diagnostic CUB method is offered in an inequitable manner to pregnant women in Sweden. More than half of all pregnant women live in a county where CUB is not offered or is only offered based on age. The results demonstrate the importance of national consistency before the introduction of new prenatal tests, to enhance equal care for all pregnant women.

  • 42. Johansson, Margareta
    et al.
    Rubertsson, Christine
    Rådestad, Ingela
    Sophiahemmet University.
    Hildingsson, Ingegerd
    Childbirth: an emotionally demanding experience for fathers2012In: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, ISSN 1877-5764, Vol. 3, no 1, 11-20 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While attending birth mostly has a positive impact on becoming a father, it has also been described as including feelings of discomfort and is more demanding than expected.

    OBJECTIVE: The objective was to explore Swedish fathers' birth experiences, and factors associated with a less-positive birth experience.

    METHODS: Mixed methods including quantitative and qualitative data were used. Two months after birth 827 fathers answered a questionnaire and 111 (13%) of these commented on the birth experience. Data were analysed with descriptive statistics, chi-square test for independence, risk ratios with a 95% confidence interval, logistic regression and content analysis.

    RESULTS: In total, 604 (74%) of the fathers had a positive or very positive birth experience. Used method identified a less-positive birth experience associated with emergency caesarean section (RR 7.5; 4.1-13.6), instrumental vaginal birth (RR 4.2; 2.3-8.0), and dissatisfaction with the partner's medical care (RR 4.6; 2.7-7.8). Healthcare professionals' competence and approach to the fathers were also related to the birth experience.

    CONCLUSIONS: As the fathers' birth experiences were associated with mode of birth and experiences of the intrapartum medical care fathers should be respectfully and empathically treated during labour and birth. It is essential to better engage fathers during the intrapartum period through involvement and support to improve the likelihood of a positive birth experience.

  • 43. Johansson, Margareta
    et al.
    Rubertsson, Christine
    Rådestad, Ingela
    Sophiahemmet University.
    Hildingsson, Ingegerd
    Improvements of postnatal care are required by Swedish fathers2013In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 26, no 5, 465-480 p.Article in journal (Refereed)
    Abstract [en]

    Purpose – This paper has two main aims: to explore fathers' postnatal care experiences with a specific focus on deficiencies and to investigate which service deficiencies remained important for fathers one year after childbirth.

    Design/methodology/approach – This is a prospective longitudinal study. Two months and one year after birth, the overall satisfaction with care were sought. A care quality index was created, based on perceived reality and subjective importance of the care given. The study excluded fathers not mastering Swedish. Total eligible fathers was consequently not known therefore pregnancies served as an estimate.

    Findings – In total, 827 fathers answered the questionnaire two months after birth and 655 returned the follow-up questionnaire after one year; 21 per cent were dissatisfied with overall postnatal-care. The most important dissatisfying factors were the way fathers were treated by staff and the women's check-up/medical care. Two months after the birth, information given about the baby's care and needs were most deficient when parents had been cared for in a hotel ward. Furthermore, information about the baby's needs and woman's check-up/medical care was most deficient when fathers had participated in emergency Caesarean section.

    Practical implications – Most fathers were satisfied with the overall postnatal care, but how fathers are treated by caregivers; the woman's check-up/medical care and information given about the baby's care and needs can be improved. Professionals should view early parenthood as a joint project and support both parents' needs.

    Originality/value – The paper provides knowledge about postnatal service quality including fathers' needs.

  • 44.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Pettersson, K
    Holmström, S
    Norberg, E
    Rådestad, Ingela
    Sophiahemmet University.
    Fetal movement in late pregnancy: a content analysis of women´s experiences of how their unborn baby moved less or differently2016Conference paper (Other academic)
    Abstract [en]

    Background: Pregnant women sometimes worry about their unborn baby’s health, often due to decreased fetal movements. Objectives: To examine how women, who consulted health care due to decreased fetal movements, describe how the baby had moved less or differently. Methods: Women were recruited from all seven delivery wards in Stockholm, Sweden, during 1/1 – 31/12 2014.The women completed a questionnaire after it was verified that the pregnancy was viable. A modified content analysis was used to analyse 876 questionnaires with the women’s responses to, “Try to describe how your baby has moved less or had changes in movement”. Results: Four categories and six subcategories were identified: “Frequency” (decreased frequency, absence of kicks and movement), “Intensity” (weaker fetal movements, indistinct fetal movements), “Character” (changed pattern of movements, slower movements) and “Duration”. In addition to the responses categorised in accordance with the question, the women also mentioned how they had tried to stimulate the fetus to move and that they had difficulty in distinguishing fetal movements from contractions. Further, they described worry due to incidents related to changed pattern of fetal movements. Conclusion: Women reported changes in fetal movement concerning frequency, intensity, character and duration. The challenge from a clinical perspective is to inform pregnant women about fetal movements with the goal of minimizing unnecessary consultations whilst at the same time diminishing the length of pre-hospital delay if the fetus is at risk of fetal compromise.

    Funding: The Little Child´s Foundation, Sophiahemmet Foundation, The Swedish National Infant Foundation and Capo’s Research Foundation funded this study.

     

  • 45.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Pettersson, Karin
    Holmström, Sofia
    Norberg, Emma
    Rådestad, Ingela
    Sophiahemmet University.
    Fetal movement in late pregnancy - a content analysis of women's experiences of how their unborn baby moved less or differently2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, no 1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pregnant women sometimes worry about their unborn baby's health, often due to decreased fetal movements. The aim of this study was to examine how women, who consulted health care due to decreased fetal movements, describe how the baby had moved less or differently.

    METHODS: Women were recruited from all seven delivery wards in Stockholm, Sweden, during 1/1 - 31/12 2014. The women completed a questionnaire after it was verified that the pregnancy was viable. A modified content analysis was used to analyse 876 questionnaires with the women's responses to, "Try to describe how your baby has moved less or had changes in movement".

    RESULTS: Four categories and six subcategories were identified: "Frequency" (decreased frequency, absence of kicks and movement), "Intensity" (weaker fetal movements, indistinct fetal movements), "Character" (changed pattern of movements, slower movements) and "Duration". In addition to the responses categorised in accordance with the question, the women also mentioned how they had tried to stimulate the fetus to move and that they had difficulty in distinguishing fetal movements from contractions. Further, they described worry due to incidents related to changed pattern of fetal movements.

    CONCLUSION: Women reported changes in fetal movement concerning frequency, intensity, character and duration. The challenge from a clinical perspective is to inform pregnant women about fetal movements with the goal of minimizing unnecessary consultations whilst at the same time diminishing the length of pre-hospital delay if the fetus is at risk of fetal compromise.

    TRIAL REGISTRATION: Not applicable.

  • 46.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Pettersson, Karin
    Holmström, Sofia
    Norberg, Emma
    Rådestad, Ingela
    Sophiahemmet University.
    Fetal movement in late pregnancy: A content analysis of women's experiences of how their unborn baby moved less or differently2016Conference paper (Other academic)
  • 47.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet University.
    Decreased fetal movements and perinatal outcome2016Conference paper (Other academic)
    Abstract [en]

    Background: Decreased fetal movement is associated with adverse perinatal outcome, including stillbirth. Objectives: To investigate perinatal outcome for women who seek consultation due to reduced fetal movements in late pregnancy. Methods: All women (gestational week 28+), who came to one of the seven obstetric clinics in the Stockholm region, Sweden, in 2014 due to concerns for decreased fetal movements, were asked to fill in a questionnaire and to give informed consent to follow-up of their child in the medical birth register. Preliminary results: In total 2584 women completed the questionnaire, 75 % of the women were born in Sweden and 72% were primiparas. The women were aged <19-24 (10%), 25-34 (66%) 35->40 (24%) and two-thirds had a university education. Almost one third (28%) of the women sought health care more than once due to decreased fetal movement during their pregnancy. Sixty eight percent of the women experienced decreased fetal movement for 24 hours or more before the came to the hospital for an examination of the fetus.  Data from the medical birth registry says that 90% of the women gave birth to a child after a full-term pregnancy and 72 per cent had a vaginal birth. Conclusion: The analysis is in progress, we will have more data to present in September. Funding: The Little Child´s Foundation, Sophiahemmet Foundation, The Swedish National Infant Foundation and Capo’s Research Foundation funded this study.

  • 48.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet University.
    Women´s experiences of fetal movements before the confirmation of fetal death: contractions misinterpreted as fetal movement2016Conference paper (Other academic)
    Abstract [en]

    Background: Decreased fetal movement often precedes a stillbirth. Objectives: The objective of this study was to describe women´s experiences of fetal movement before the confirmation of fetal death. Methods: Data were collected through a Web-based questionnaire in 2009 to 2013 and women who had answered the questionnaire before September 1, 2013. Women with stillbirths after 28 gestational weeks were self-recruited. Content analysis was used to analyze the answers to one open question: “How do you remember the fetal movement during the 48 hours that preceded the diagnosis of intrauterine death?” The statements from mothers of a stillborn, born during gestational weeks 28 to 36 were compared with those of a stillborn at term. Results: The women’s 215 answers were divided into three categories: Decreased, weak, and no fetal movement at all 154 (72%); Fetal movement as normal 39 (18%) and Extremely vigorous fetal activity followed by no movement at all 22 (10%). Eight (15%) of the women with stillbirths in gestational weeks 28 to 36 interpreted contractions as fetal movement as compared to five (5%) of the women with stillbirths at term. Conclusion: Uterine contractions can be interpreted as fetal movement. A single episode of extremely vigorous fetal activity can precede fetal death. The majority of the women experienced decreased, weaker, or no fetal movement at all two days before fetal death was diagnosed. Mothers should be educated to promptly report changes in fetal movement to their health care providers. Using fetal movement information to evaluate possible fetal distress may lead to reductions in stillbirths. Funding:The Little Child´s Foundation, Sophiahemmet Foundation, The Swedish National Infant Foundation and Capo’s Research Foundation.

  • 49.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Women's experiences of fetal movements before the confirmation of fetal death: Contractions misinterpreted as fetal movement2016Conference paper (Other academic)
  • 50.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Women's Experiences of Fetal Movements before the Confirmation of Fetal Death-Contractions Misinterpreted as Fetal Movement2015In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 42, no 2, 189-194 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Decreased fetal movement often precedes a stillbirth. The objective of this study was to describe women's experiences of fetal movement before the confirmation of fetal death.

    METHODS: Data were collected through a Web-based questionnaire. Women with stillbirths after 28 gestational weeks were self-recruited. Content analysis was used to analyze the answers to one open question. The statements from mothers of a stillborn, born during gestational weeks 28 to 36 were compared with those of a stillborn at term.

    RESULTS: The women's 215 answers were divided into three categories: decreased, weak, and no fetal movement at all; 154 (72%) of the descriptions were divided into three subcategories: decreased and weak movement (106; 49%), no movement at all (35; 16%), and contraction interpreted as movement (13; 6%). The category fetal movement as normal includes 39 (18%) of the descriptions. The third category, extremely vigorous fetal activity followed by no movement at all, includes 22 (10%) of the descriptions. Eight (15%) of the women with stillbirths in gestational weeks 28 to 36 interpreted contractions as fetal movement as compared to 5 (5%) of the women with stillbirths at term.

    DISCUSSION: Uterine contractions can be interpreted as fetal movement. A single episode of extremely vigorous fetal activity can precede fetal death. The majority of the women experienced decreased, weaker, or no fetal movement at all 2 days before fetal death was diagnosed. Mothers should be educated to promptly report changes in fetal movement to their health care providers. Using fetal movement information to evaluate possible fetal distress may lead to reductions in stillbirths.

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