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  • 1.
    Asplin, Nina
    et al.
    Sophiahemmet Högskola.
    Dellgren, Annika
    Conner, Peter
    Education in obstetrical ultrasound - an important factor for increasing the prenatal detection of congenital heart disease2013Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, nr 7, s. 804-808Artikel i tidskrift (Refereegranskat)
    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.

  • 2. Erlandsson, Kerstin
    et al.
    Lindgren, Helena
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Women's premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell2012Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, nr 1, s. 28-33Artikel i tidskrift (Refereegranskat)
    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.

  • 3.
    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, s. 634-40Artikel 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.

  • 4. Holste, Carola
    et al.
    Pilo, Christina
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Papadogiannakis, Nikos
    Mothers' attitudes towards perinatal autopsy after stillbirth2011Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, nr 11, s. 1287-90Artikel i tidskrift (Refereegranskat)
    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.

  • 5. 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, s. 868-73Artikel 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.

  • 6. 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, s. 1433-1439Artikel 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.

  • 7.
    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, s. 622-628Artikel 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.

  • 8.
    Ulfsdottir, Hanna
    et al.
    Sophiahemmet Högskola.
    Saltvedt, Sissel
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Waterbirth in Sweden - a comparative study2018Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, nr 3, s. 341-348Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: The literature describes advantages for mothers giving birth in water, but waterbirth is controversial in Sweden and has not been offered at hospitals until recently. This study aimed to describe and compare the characteristics and outcome of waterbirths with spontaneous vaginal births at the same clinics.

    MATERIAL AND METHODS: A retrospective cohort study was conducted on all waterbirths at two maternity units in Sweden from March 2014 to November 2015 (n=306), and a consecutively selected comparison group of 306 women having conventional spontaneous vaginal births. Logistic regression was used to analyze the primary outcome; second-degree perineal tears.

    RESULTS: Women giving birth in water had a lower risk of second-degree perineal tears (adj. OR 0.6 [95% CI 0.4-0.9]). Their labor was shorter (6:03 hrs. vs 7:52 hrs.) and there were significantly less interventions than in the comparison group; amniotomy (13.7% vs. 35.3%), internal cardiotocography (11.1% vs.56.8%), and augmentation with oxytocin (5.2% vs.31.3%). There were no differences in Apgar scores or admissions to neonatal intensive care unit. The experience of childbirth, measured with a numeric rating scale, was higher in the waterbirth group indicating a more positive birth experience. Three newborns born in water had an umbilical cord avulsion.

    CONCLUSIONS: In this low-risk population, waterbirth is associated with positive effects on perineal tears, the frequency of interventions, the duration of labor and women's birth experience. Midwives handling waterbirth should be aware of the risk of umbilical cord avulsion. This article is protected by copyright. All rights reserved.

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