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  • 1. Asplin, Nina
    et al.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Maternal emotional wellbeing over time and attachment to the fetus when a malformation is detected2015Ingår i: Sexual & Reproductive Healthcare, ISSN 1877-5756, Vol. 6, nr 3, 191-195 s.Artikel i tidskrift (Refereegranskat)
  • 2.
    Asplin, Nina
    et al.
    Sophiahemmet Högskola.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Pregnancy termination due to fetal anomaly: women's reactions, satisfaction and experiences of care2014Ingår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, nr 6, 620-627 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 3.
    Asplin, Nina
    et al.
    Sophiahemmet Högskola.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Pregnant women's experiences, needs, and preferences regarding information about malformations detected by ultrasound scan2012Ingår i: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, ISSN 1877-5764, Vol. 3, nr 2, 73-8 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Asplin, Nina
    et al.
    Sophiahemmet Högskola.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination2013Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, nr 2, 79-84 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 5. Björklund, Ulla
    et al.
    Marsk, Anna
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Does an information film about prenatal testing in early pregnancy affect women's anxiety and worries?2013Ingår i: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 34, nr 1, 9-14 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 6. Björklund, Ulla
    et al.
    Marsk, Anna
    Levin, Charlotta
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Audiovisual information affects informed choice and experience of information in antenatal Down syndrome screening: a randomized controlled trial2012Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 86, nr 3, 390-395 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Fosterdiagnostik2009 (uppl. 1)Bok (Övrigt vetenskapligt)
  • 8.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Screening för Downs syndrom med tidigt ultraljud tycks inte oroa kvinnor - men bättre riskinformation behövs2005Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, nr 34, 2286- s.Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 9.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Women's Experiences of Fetal Screening for Down's Syndrome by Means of an Early Ultrasound Examination2005Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The general aim of this thesis was to explore women's reactions to and experiences of fetal screening for Down's syndrome PS) by means of an ultrasound examination, including measurement of fetal nuchal translucency (NT). The effect of this screening on maternal worry about the baby's health was investigated, as well as reactions to a false positive test and interpretation of information about riskAlso, an instrument measuring worry during pregnancy, the Cambridge Worry Scale, was translated into Swedish and tested on a sample of pregnant women.A sub-sample of 2026 women was drawn from a larger randomised controlled trial including 39,572 women, which investigated medical outcomes of the new fetal screening policy. Of these women, 1030 were randomly allocated to the intervention group, and 996 to routine care. No statistically significant differences were found between the two groups regarding major worry about something being wrong with the baby, general anxiety and depressive symptoms m midpregnancy and two months postpartum.Twenty-four women who had received information about an increased risk according to NT were interviewed during pregnancy and after birth. Twenty of these women had false positive tests, and for 16 the risk was higher than expected considering their age. These women expressed major worry, and many said they chose to reject their pregnancy, to take "time out", while waiting for the results of fetal karyotyping. Two months after the birth, most of these women seemed to have overcome the stressful situation.In the intervention group of the above trial 796 women had a risk score for DS recorded in a clinical database. Of these women 620 said they had received information about the risk score, and 64 percent stated the figure almost correctly. The actual risk was associated with women's perception of the risk. Worry about the baby's health and depressive symptoms did not differ statistically between women who were at high risk (1:250 or higher) and at low risk. However, women who perceived that the risk was high were more worried about the baby's health and also seemed to have more depressive symptoms in mid-pregnancy compared with those who perceived the risk to be low. No differences were observed at two months after birth.The translated version of the Cambridge Worry Scale was tested on 200 Swedish pregnant women in Stockholm. The three main sources of worry were about the baby's health, giving birth and miscarriage. The internal- consistency reliability was 0.81 (Cronbach's alpha). Three items were added to the original scale to capture women's worry about the maternity services.In conclusion, the intervention with an early ultrasound examination including risk assessment for DS by measuring the NT did not affect maternal worry about the baby's health, general anxiety or depressive symptoms 'm mid-pregnancy or two months after birth. However, a false positive test could cause strong reactions of anxiety and rejection of the pregnancy for some weeks. Many had problems to recall and interpret a given risk score. An actual high risk score was not associated with major worry about the baby's health or depressive symptoms, whereas a woman's perception of being at high risk had such an association. The Swedish version of the Cambridge Worry Scale was considered to be useful and well suited for its purpose.

  • 10.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Övriga fosterdiagnostiska undersökningar samt psykologiska aspekter2009Ingår i: Lärobok för barnmorskor / [ed] Annette Kaplan et al., Lund: Studentlitteratur , 2009, 3, 214-15 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 11.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet Högskola.
    Björklund, Ulla
    Marsk, Anna
    Does an informational film increase women's possibility to make an informed choice about second trimester ultrasound?2012Ingår i: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 32, nr 9, 833-9 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 12.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet Högskola.
    Grunewald, Charlotta
    Waldenström, Ulla
    Perception of risk in relation to ultrasound screening for Down's syndrome during pregnancy2009Ingår i: Midwifery, ISSN 1532-3099, Vol. 25, nr 3, 264-76 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet Högskola.
    Grunewald, Charlotta
    Waldenström, Ulla
    Women's worries during pregnancy: testing the Cambridge Worry Scale on 200 Swedish women2003Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, nr 2, 148-52 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 14.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet Högskola.
    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 screening2004Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, nr 7, 634-40 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 15.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet Högskola.
    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 syndrome2006Ingår i: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 33, nr 1, 64-73 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 16.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet Högskola.
    Waldenström, Ulla
    Effect of first-trimester ultrasound screening for Down syndrome on maternal-fetal attachment: a randomized controlled trial2010Ingår i: Sexual & Reproductive Healthcare, ISSN 1877-5756, Vol. 1, nr 3, 85-90 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 17.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet Högskola.
    Waldenström, Ulla
    Second-trimester routine ultrasound screening: expectations and experiences in a nationwide Swedish sample2008Ingår i: Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, ISSN 1469-0705, Vol. 32, nr 1, 15-22 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 18. Ingvoldstad, Charlotta
    et al.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Lindgren, Peter
    Implementation of combined ultrasound and biochemistry for risk evaluation of chromosomal abnormalities during the first trimester in Sweden2014Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, nr 9, 868-73 s.Artikel i tidskrift (Refereegranskat)
    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.

  • 19. Melas, Philippe A
    et al.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Juth, Niklas
    Bui, The-Hung
    Information related to prenatal genetic counseling: interpretation by adolescents, effects on risk perception and ethical implications2012Ingår i: Journal of Genetic Counseling, ISSN 1059-7700, E-ISSN 1573-3599, Vol. 21, nr 4, 536-46 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Being raised in the genomic era may not only increase knowledge of available genetic testing but may also have an impact on how genetic information is perceived. However, little is known about how current adolescents react to the language commonly used by health care professionals providing prenatal counseling. In addition, as risk communication is related to numbers and figures, having different educational backgrounds may be associated with variability in risk perceptions. In order to investigate these issues, a previously developed questionnaire studying different ways of being told about hypothetical anomalies in a baby and corresponding risks (Abramsky and Fletcher Prenatal Diagnosis 22(13):1188-1194, 2002) was administered to high-school students in Sweden. A total of 344 questionnaires were completed by students belonging to a natural science or a social science program. The data show that teenage participants found technical jargon and words such as rare and abnormal more worrying than the presented comparison terms. Negative framing effects and perception differences related to numeric risk formats were also present. Additionally, participants' gender and educational program did not seem to have an effect on risk assessment. In addition to reporting the questionnaire results, we discuss the ethical implications of the data based on the norm of non-directiveness and make some recommendations for practice. In general, genetic counselors should be aware that the language used within clinical services can be influential on this group of upcoming counselees.

  • 20.
    Niklasson, Boel
    et al.
    Sophiahemmet Högskola.
    Arnelo, Catarina
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Segerdahl, Märta
    Blanck, Agneta
    Oral oxycodone for pain after caesarean section: A randomized comparison with nurse-administered IV morphine in a pragmatic study2015Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 7, 17-24 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims

    The present randomized open label parallel group study was conducted to evaluate if an oral oxycodone (OXY) regimen can be at least equally effective and as safe for postoperative analgesia after caesarean section (CS) as a standard of care program using nurse-administered intravenous morphine (IVM), followed by oral codeine.

    Methods

    Eighty women (40 + 40) were scheduled for elective CS under spinal anaesthesia. All patients received postoperative multimodal analgesic therapy, including ibuprofen and paracetamol. The OXY group got standardized extended release and short acting oral treatment (and in a few cases intravenous OXY) as needed and the other group received current standard of care, IVM as needed for 24 h, followed by codeine. Opioid treatment lasted maximum five days. Outcome measures were pain intensity (numerical rating scale, NRS), opioid requirements, duration of administering opioids and safety for mother and newborn. All opioids in the study were expressed in OXY equivalents, using a conversion table. As the bioavailability of each opioid has a certain extent of interindividual bioavailability this conversion represents an approximation. The possible influence of opioids on the newborns was evaluated by the Neurological Adaptive Capacity Score at birth and at 24 and 48 h.

    Results

    During the first 24 h, there were no differences between treatments in opioid requirements or mean pain intensity at rest but pain intensity when asking for rescue medication was lower in the OXY than in the IVM group (mean ± SD; 5.41 ± 6.42 vs. 6.42 ± 1.61; p = 0.027). Provoked pain (uterus palpation) during the first 6 h was also less in the OXY group (3.26 ± 2.13 vs. 4.60 ± 2.10; p = 0.007). During the 25–48 h period postoperatively, patients on OXY reported significantly lower pain intensity at rest (2.9 ± 1.9 vs. 3.8 ± 1.8; p = 0.039) and consumed less opioids (OXY equivalents; mg) (31.5 ± 9.6 vs. 38.2 ± 38.2; p = 0.001) than those on IVM/codeine. The total amount of opioids 0–5 days postoperatively was significantly lower in the OXY than in the IVM/codeine group (108.7 ± 37.6 vs. 138.2 ± 45.1; p = 0.002). Duration of administering opioids was significantly shorter in the OXY group. Time to first spontaneous bowel movement was shorter in the OXY group compared with the IVM/codeine group. No serious adverse events were recorded in the mothers but the total number of common opioid adverse effects was higher among women on IVM/codeine than among those receiving OXY (15 vs. 3; p = 0.007). No adverse outcomes in the newborns related to treatment were observed in either group.

    Conclusions

    In a multimodal protocol for postoperative analgesia after CS better pain control and lower opioid intake was observed in patients receiving oral OXY as compared to those on IVM/codeine. No safety risks for mother and child were identified with either protocol.

    Implications

    Our findings support the view that use of oral OXY is a simple, effective and time saving treatment for postoperative pain after CS.

  • 21. Niklasson, Boel
    et al.
    Börjesson, Astrid
    Carmnes, Ulla-Britt
    Segerdahl, Märta
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Blanck, Agneta
    Intraoperative injection of bupivacaine-adrenaline close to the fascia reduces morphine requirements after cesarean section: a randomized controlled trial2012Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, nr 12, 1433-1439 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. The purpose of this study was to investigate whether a single injection of bupivacaine with adrenaline close to the fascia could decrease opiate consumption and pain in patients undergoing cesarean section in spinal anesthesia. Design. Randomized double-blind controlled study. Settings. Karolinska University Hospital, Huddinge, Sweden. Population. 260 women scheduled for elective cesarean section were enrolled in the study. Methods. The treatment group (n= 130) received 40 mL bupivacaine (2.5 mg/mL) with adrenaline (5 μg/mL) (Marcain® adrenalin) and the control group (n= 130) received 40 mL saline solution (0.9%), which was, in both groups, injected close to the fascia before closure of the wound. Main outcome measures. Morphine consumption and mean resting pain intensity numerical rating scale at 12 and 24 hours were the primary outcome variables. Other assessments for pain as well as mobilization parameters were considered secondary. Results. Morphine requirements were significantly less in the bupivacaine group, 19.0 mg/woman, compared with 24.0 mg/woman in the placebo group, during the first 12 postoperative hours. During this time period there was also a trend towards a difference between groups in mean pain intensity, but significant only during the first six hours. Over the whole first postoperative 24 hours, there were no differences in either morphine requirement or pain intensity between groups. Conclusions. A single injection of bupivacaine with adrenaline in the surgical wound decreases the need for morphine requirements for the first 12 postoperative hours and contributes to safe and effective pain management in women undergoing cesarean section.

  • 22.
    Niklasson, Boel
    et al.
    Sophiahemmet Högskola.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Segerdahl, Märta
    Blanck, Agneta
    Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section2015Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, nr 6, 622-628 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To investigate the overall incidence and risk factors for persistent pain and its interference with daily life after cesarean section.

    DESIGN: Prospective long-term follow-up study.

    SETTING: Karolinska University Hospital, Stockholm, Sweden.

    POPULATION: 260 healthy women who underwent elective cesarean section.

    METHODS: Information on demographics, medical history, postoperative pain and analgesic requirements was collected. A questionnaire consisting of the Brief Pain Inventory was posted at 3, 6 and 12 months after surgery. Women rated pain intensity as well as interference with factors related to general function and quality of life.

    MAIN OUTCOME MEASURES: The overall incidence and risk factors for persistent postoperative pain at three time points. Persistent pain was considered a secondary outcome.

    RESULTS: At 3, 6 and 12 months 40%, 27% and 22% of patients, respectively, reported pain in one or more locations, in the surgical site as well as in other areas. A psychological indication, as well as a first cesarean section, increased the risk for pain at 3 months. Severe postoperative pain in the immediate postoperative period or undergoing a first cesarean section were significant independent risk factors for the development of persistent pain up to 6 months after cesarean section. Parameters related to quality of life were significantly impaired in women with persistent pain.

    CONCLUSION: Several factors, including severe postoperative pain, were shown to influence the risk for persistent pain after cesarean section. Long-term pain markedly affected women's wellbeing. This article is protected by copyright. All rights reserved.

  • 23. Olin Lauritzen, Sonja
    et al.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Saltvedt, Sissel
    A normal pregnancy?: women's experiences of being at high risk after ultrasound screening for Down's syndrome2007Ingår i: Medical technologies and the life world: the social construction of normality / [ed] Sonja Olin Lauritzen & Lars-Christer Hydén, Abingdon: Routledge , 2007, 115-40 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 24. Sandberg, Christina
    et al.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Development of an observational instrument to assess gastro-esophageal reflux disease in premature infants2014Ingår i: International Journal of Child Health and Nutrition, ISSN 1929-4247, Vol. 3, nr 2, 84-92 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract: Background: Premature infants are at increased risk of developing Gastroesophageal Reflux Disease (GERD), which for these children is associated with a number of severe symptoms. There is great need for effective instruments and clear symptom criteria to assess the presence and degree of severity of GERD.

    Aim: To develop and pilot test an observation instrument for early detection of symptoms of GERD in premature infants.

    Method: A combination of three research methods was used – systematic literature review, observation instrument development and a pilot test.

    Results: The systematic review identified specific symptoms of GERD. The development of the observational instrument started with the establishment of concordance between the criteria of symptoms according to the literature review and to NIDCAP, “Newborn Individualized Developmental Care and Assessment Program”. In the pilot test the criteria of symptoms were revised by comparing the result and the criteria between infants that clinically were estimated to have had a reflux problem and the ones who did not.

    Conclusion: An observation instrument was developed. The clinical evaluation by a pilot test showed that the instrument could be useful to record significant symptoms and combinations of symptoms that may occur in premature infants assessed as having reflux problems.

  • 25. Segerdahl, Märta
    et al.
    Niklasson, Boel
    Sophiahemmet Högskola.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Blanck, Agneta
    Boström, E
    Oxycodone for postoperative pain control after Cesarean section: oxycodone and metabolites' distribution into breast milk and effect on neonate NACS scoreManuskript (preprint) (Övrigt vetenskapligt)
  • 26. Svantesson, Lena
    et al.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Psykologiska aspekter på fosterdiagnostik2009Ingår i: Lärobok för barnmorskor / [ed] Annette Kaplan et al., Lund: Studentlitteratur , 2009, 3, 216-17 s.Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 27. Wallin Lundell, Inger
    et al.
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Moby, L
    Nyberg, S
    Sundström Poromaa, Inger
    Sydsjö, Gunilla
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Östlund, I
    Skoog Svanberg, Agneta
    Post-traumatic stress disorder among women requesting induced termination of pregnancy: a Swedish multi-centre study2012Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 119, nr S2, 2-2 s.Artikel i tidskrift (Övrigt vetenskapligt)
  • 28.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet Högskola.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Nyberg, Sigrid
    Sundström Poromaa, Inger
    Sydsjö, Gunilla
    Östlund, Ingrid
    Skoog Svanberg, Agneta
    Posttraumatic stress among women after induced abortion: a Swedish multi-centre cohort study2013Ingår i: BMC women's health, ISSN 1472-6874, Vol. 13, 52- s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion.

    METHODS: This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student's t-test were used to compare data between groups.

    RESULTS: The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion.

    CONCLUSION: Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support.

  • 29.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet Högskola.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Sundström Poromaa, Inger
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress2015Ingår i: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 20, nr 3, 211-222 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To identify perceived deficiencies in the quality of abortion care among healthy women and those with mental stress. Methods This multi-centre cohort study included six obstetrics and gynaecology departments in Sweden. Posttraumatic stress (PTSD/PTSS) was assessed using the Screen Questionnaire-Posttraumatic Stress Disorder; anxiety and depressive symptoms, using the Hospital Anxiety Depression Scale; and abortion quality perceptions, using a modified version of the Quality from the Patient's Perspective questionnaire. Pain during medical abortion was assessed in a subsample using a visual analogue scale. Results Overall, 16% of the participants assessed the abortion care as being deficient, and 22% experienced intense pain during medical abortion. Women with PTSD/PTSS more often perceived the abortion care as deficient overall and differed from healthy women in reports of deficiencies in support, respectful treatment, opportunities for privacy and rest, and availability of support from a significant person during the procedure. There was a marginally significant difference between PTSD/PTSS and the comparison group for insufficient pain alleviation. Conclusions Women with PTSD/PTSS perceived abortion care to be deficient more often than did healthy women. These women do require extra support, relatively simple efforts to provide adequate pain alleviation, support and privacy during abortion may improve abortion care.

  • 30.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet Högskola.
    Sundström Poromaa, Inger
    Ekselius, Lisa
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Sydsjö, Gunilla
    Skoog Svanberg, Agneta
    Neuroticism-related personality traits are associated with post-abortion posttraumatic stress2014Ingår i: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102Artikel i tidskrift (Refereegranskat)
  • 31.
    Wallin Lundell, Inger
    et al.
    Sophiahemmet Högskola.
    Sundström Poromaa, Inger
    Frans, Örjan
    Helström, Lotti
    Högberg, Ulf
    Moby, Lena
    Nyberg, Sigrid
    Sydsjö, Gunilla
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Östlund, Ingrid
    Skoog Svanberg, Agneta
    The prevalence of posttraumatic stress among women requesting induced abortion2013Ingår i: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 18, nr 6, 480-8 s.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To describe the prevalence and pattern of traumatic experiences, to assess the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS), to identify risk factors for PTSD and PTSS, and to analyse the association of PTSD and PTSS with concomitant anxiety and depressive symptoms in women requesting induced abortion. Methods A Swedish multi-centre study of women requesting an induced abortion. The Screen Questionnaire - Posttraumatic Stress Disorder was used for research diagnoses of PTSD and PTSS. Anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Results Of the 1514 respondents, almost half reported traumatic experiences. Lifetime- and point prevalence of PTSD were 7% (95% confidence interval [CI]: 5.8-8.5) and 4% (95% CI: 3.1-5.2), respectively. The prevalence of PTSS was 23% (95% CI: 21.1-25.4). Women who reported symptoms of anxiety or depression when requesting abortion were more likely to have ongoing PTSD or PTSS. Also single-living women and smokers displayed higher rates of ongoing PTSD. Conclusions Although PTSD is rare among women who request an induced abortion, a relatively high proportion suffers from PTSS. Abortion seeking women with trauma experiences and existing or preexisting mental disorders need more consideration and alertness when counselled for termination.

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