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Larsson, Per-Göran
Publications (10 of 20) Show all publications
Lamont, R. F., Keelan, J. A., Larsson, P.-G. & Jörgensen, J. S. (2017). The treatment of bacterial vaginosis in pregnancy with clindamycin to reduce the risk of infection-related preterm birth: a response to the Danish Society of Obstetrics and Gynecology guideline groups clinical recommendations. Acta Obstetricia et Gynecologica Scandinavica, 96(2), 139-143
Open this publication in new window or tab >>The treatment of bacterial vaginosis in pregnancy with clindamycin to reduce the risk of infection-related preterm birth: a response to the Danish Society of Obstetrics and Gynecology guideline groups clinical recommendations
2017 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 2, p. 139-143Article in journal, Editorial material (Other academic) Published
Abstract [en]

Preterm birth is the major cause of perinatal mortality and morbidity worldwide. Infection/inflammation is responsible for a significant percentage of preterm birth, particularly at early gestations. A recent clinical recommendation by a guidelines group of the Danish Society of Obstetrics and Gynecology advised against the use of clindamycin for the treatment of bacterial vaginosis in pregnancy to reduce the risk of spontaneous preterm birth based on lack of evidence of efficacy. We believe that the evidence for the use of clindamycin for this indication is robust and that this recommendation was reached erroneously on the basis of flawed inclusion criteria: the inclusion of an unpublished study with poorly diagnosed bacterial vaginosis and the exclusion of an important pivotal study on the use of clindamycin in early pregnancy for the prevention of preterm birth. Had these errors been corrected, the conclusions would have been different.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2017
Keywords
Antibiotics; bacterial vaginosis; clindamycin; infection; preterm birth; preterm labor; prevention
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-135718 (URN)10.1111/aogs.13065 (DOI)000393615900002 ()27874978 (PubMedID)
Available from: 2017-03-17 Created: 2017-03-17 Last updated: 2018-05-02
Eriksson, K., Larsson, P.-G., Nilsson, M. & Forsum, U. (2011). Vaginal retention of locally administered clindamycin. APMIS, 119(6), 373-376
Open this publication in new window or tab >>Vaginal retention of locally administered clindamycin
2011 (English)In: APMIS, ISSN 0903-4641, Vol. 119, no 6, p. 373-376Article in journal (Refereed) Published
Abstract [en]

Since bacterial vaginosis (BV) is characterized by a lack of, or very few, lactobacilli and high numbers of small, mostly anaerobic bacteria, an obvious treatment modality would be eradication of the BV-associated bacterial flora followed by reintroduction of lactobacilli vaginally. As probiotic treatment with lactobacilli is one tool for improving the cure rate when treating BV, it is necessary to know the length of time after treatment that clindamycin can be found in the vagina and if this could interfere with the growth of the probiotic lactobacilli. We evaluated the vaginal concentration of clindamycin in 12 women for 8 days to obtain data on the concentration of clindamycin in the vagina after intravaginal treatment with the drug. The participants were examined five times between two menstrual periods: before treatment, the day after treatment was finished, and 3, 5 and 8 days post-treatment. The first day post-treatment clindamycin 0.46 x 10-3 to 8.4 x 10-3 g/g vaginal fluid (median 2.87 x 10-3) was found. Thereafter, the concentration of clindamycin decreased rapidly. In 10 patients clindamycin was found after 3 days. A very low concentration was still present 5 days after treatment in four patients. After 8 days no clindamycin was found. Clindamycin is rapidly eliminated from the vagina, within 3-8 days, after local administration. Our results indicate that treatment with probiotic lactobacilli could be problematic if carried out within 5 days after cessation of clindamycin treatment.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd, 2011
Keywords
Treatment, clindamycin, bacterial vaginosis, concentration
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-68694 (URN)10.1111/j.1600-0463.2011.02742.x (DOI)000290626500007 ()
Available from: 2011-05-27 Created: 2011-05-27 Last updated: 2012-03-25Bibliographically approved
Adolfsson, A.-S. & Larsson, P.-G. (2010). Applicability of general grief theory to Swedish women’s experiences after early miscarriage, with factor analysis of Bonanno´s taxonomy, using the Perinatal Grief Scale.. Upsala Journal of Medical Sciences, 115(3), 201-209
Open this publication in new window or tab >>Applicability of general grief theory to Swedish women’s experiences after early miscarriage, with factor analysis of Bonanno´s taxonomy, using the Perinatal Grief Scale.
2010 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, Vol. 115, no 3, p. 201-209Article in journal (Refereed) Published
Abstract [en]

Background. Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief.

Material and methods. Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman's categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks.

Results. Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage.

Conclusion. Women's experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman's age, or her number of earlier miscarriages.

Keywords
Content analysis, factor analysis, general grief theory, miscarriage, perinatal grief scale, women
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13810 (URN)10.3109/03009731003739851 (DOI)000281013000008 ()
Note
On the day of the defence day the status of this article was Submitted.Available from: 2006-04-03 Created: 2006-04-03 Last updated: 2010-09-03
Eriksson, K., Adolfsson, A.-S., Forsum, U. & Larsson, P.-G. (2010). The prevalence of BV in the population on the Åland Islands during a 15-year period. APMIS, 118(11), 903-908
Open this publication in new window or tab >>The prevalence of BV in the population on the Åland Islands during a 15-year period
2010 (English)In: APMIS, ISSN 0903-4641, Vol. 118, no 11, p. 903-908Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to describe the prevalence and age distribution of bacterial vaginosis (BV) during an observation period of 15 years in a population study with cross-sectional samples of adult women living on the Aland Islands. The Aland Islands form an archipelago in the Baltic Sea and are a province of Finland. Every fifth year, specific age groups in the adult female population are invited to participate in a screening program for early diagnosis of cervical cancer using a papanicolaou (PAP)-stained vaginal smear. Women in the age groups of 20, 25, 30, 35, 40, 45, 50, 55, and 60 years are called each year. BV diagnosis of the PAP-stained smears uses the classification according to Nugent. The PAP-stained smears from the screening program of cervical cancer 1993, 1998, 2003, and 2008 were used in this study. A total of 3456 slides were investigated and 271 women could be followed for the 15-year observation period. The prevalence of BV declined from 15.6% in 1993 to 8.6% in 2008. The highest prevalence occurred among the age groups of 35 and 50 years. Among the 271 women who could be followed for the 15-year observation period, two-third showed normal/intermediate flora and one-third were infected with BV at least once. As this is a cross-sectional population study spanning 15 years, the prevalence of BV in the female adult population of the Aland Islands can be estimated. The prevalence has declined between 1993 and 2008 from 15.6% to 8.6%.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd, 2010
Keywords
BV, prevalence, population study, diagnostics, PAP smear
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-61210 (URN)10.1111/j.1600-0463.2010.02678.x (DOI)000283161100012 ()
Available from: 2010-11-05 Created: 2010-11-05 Last updated: 2011-06-08Bibliographically approved
Charonis, G. & Larsson, P.-G. (2009). Prolonged use of intrauterine contraceptive device as a risk factor for tubo-ovarian abscess. ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, 88(6), 680-684
Open this publication in new window or tab >>Prolonged use of intrauterine contraceptive device as a risk factor for tubo-ovarian abscess
2009 (English)In: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, ISSN 0001-6349, Vol. 88, no 6, p. 680-684Article in journal (Refereed) Published
Abstract [en]

Objective. The intrauterine contraceptive device (IUCD) is the most preferred method of reversible contraception in the world today. The Swedish Medical Products Agency currently recommends that women who had a copper IUCD inserted around age 40 do not need to have it extracted until one year after the menopause. Design. Retrospective study. Setting. Skovde Central Hospital, Sweden. Population. All 114 women receiving in-patient treatment for pelvic inflammatory disease (PID) over five years between January 2001 and December 2005. Methods. Comparison between cases of tubo-ovarian abscesses and salpingitis with focus on the effects of IUCDs used continually for andgt; 5 years after insertion. Main outcome measures. Age-adjusted risk of PID within or after five years of use, microbiological findings in blood, intraabdominal pus, cervical secretions or on extracted IUCDs. Results. There were 31 cases of tubo-ovarian abscesses, 63 of salpingitis, four of endometritis, and 16 of mild genital infection. When comparing women with the same IUCD andgt; 5 years to women having the same IUCD andlt;= 5 years, the risk of tubo-ovarian abscess was higher than the risk of salpingitis (OR 19.7; 95% CI 4.5-87.2). The risk remained significant after adjustment for age, both on multiple regression analysis (OR 13.5; 95% CI 2.5-72.9) and in stratified analysis for the age group 35-50 years (OR 12.0; 95% CI 1.8-81.7). Blood or abdominal cultures from patients operated upon were positive in 47.7% of the sampled cases. Intestinal tract microbes and upper respiratory tract microbes were more common than sexually transmitted infection microbes. Conclusions. The current Medical Products Agency recommendation that a woman nearing the end of her reproductive phase can safely use the same IUCD for a period exceeding five years is challenged.

Keywords
Salpingitis, tubo-ovarian abscess, intrauterine contraceptive device, pelvic inflammatory disease
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-19628 (URN)10.1080/00016340902893678 (DOI)
Available from: 2009-07-03 Created: 2009-07-03 Last updated: 2009-07-03
Donders, G. G., Larsson, P.-G., Platz-Christensen, J. J., Hallen, A., van der Meijden, W. & Wolner-Hanssen, P. (2009). Variability in diagnosis of clue cells, lactobacillary grading and white blood cells in vaginal wet smears with conventional bright light and phase contrast microscopy. EUROPEAN JOURNAL OF OBSTETRICS and GYNECOLOGY AND REPRODUCTIVE BIOLOGY, 145(1), 109-112
Open this publication in new window or tab >>Variability in diagnosis of clue cells, lactobacillary grading and white blood cells in vaginal wet smears with conventional bright light and phase contrast microscopy
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2009 (English)In: EUROPEAN JOURNAL OF OBSTETRICS and GYNECOLOGY AND REPRODUCTIVE BIOLOGY, ISSN 0301-2115, Vol. 145, no 1, p. 109-112Article in journal (Refereed) Published
Abstract [en]

Objective: Study the reproducibility of wet smear interpretation of clue cells, lactobacillary grades and leukocyte dominance with conventional bright light and phase contrast microscopy. Study design: Sets of vaginal specimens were taken from unselected consecutive women attending an outpatient gynaecology clinic. Air-dried vaginal fluid on a microscope slide was rehydrated with isotonic saline before examination by six independent international investigators. Some investigators initially used a conventional bright light microscope, followed by phase contrast technique. Results: Using phase contrast microscopy, an excellent inter-observer agreement was obtained among all investigators for clue cells detection (Kappa values from 0.69 to 0.94) and lactobacillary grades (Kappa 0.73-0.93). When conventional light microscopes were used, poor agreement was obtained for these criteria (Kappa index 0.37-0.72 and 0.80, respectively), but switching to phase contrast microscopy by the same investigators, improved Kappa to 0.83-0.85 and 0.88, respectively. The inter-observer agreement for estimation of the leukocyte/epithelial cell ratio (Kappa index 0.17-0.67) was poor, irrespective of the type of microscopy applied. Intra-observer agreement of clue cell detection and lactobacillary grading was also found to be excellent if phase contrast microscopy was used (Kappa 0.87-0.93), and poor with conventional bright light microscopy (Kappa 0.45-0.66). Conclusion: Clue cells and the lactobacillary grades are reliably identified by phase contrast microscopy in wet smears, with excellent intra- and inter-observer reproducibility agreement, and better than when simple bright light microscopy was used. Evaluation of leukocyte grading, on the other hand, was inconsistent among the different microscopists, irrespective of the type of microscope used. We propose to grade the leukocytes in a different way than searching for leukocyte dominance over epithelial cells, namely by counting them per high power field and per epithelial cell.

Keywords
Bacterial vaginosis, Clue cells, Lactobacillary grades, Aerobic vaginitis, Abnormal vaginal flora, Leukocytes, Wet smear, Phase contrast microscopy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-19801 (URN)10.1016/j.ejogrb.2009.04.012 (DOI)
Available from: 2009-08-11 Created: 2009-08-10 Last updated: 2009-08-11
Eriksson, K., Forsum, U., Björnerem, A., Platz-Christensen, J. & Larsson, P.-G. (2007). Validation of the use of Pap-stained vaginal smears for diagnosis of bacterial vaginosis. Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), 115(7), 809-813
Open this publication in new window or tab >>Validation of the use of Pap-stained vaginal smears for diagnosis of bacterial vaginosis
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2007 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 115, no 7, p. 809-813Article in journal (Refereed) Published
Abstract [en]

Papanicolaou-stained cervicovaginal smears (Pap smears) are used to screen for cervical cancer. Since there is a lack of consensus in published reports respecting the efficacy of Pap-stained smears in BV diagnostics, there is a need to validate their use for diagnosis of BV. Slides from the international BV00 workshop were Pap stained and independently analyzed by four investigators under a phase-contrast microscope. All workshop slides - whether Pap-stained, Gram-stained or rehydrated air-dried smears - were scored according to the same Nugent classification. The diagnostic accuracy of Pap smears for diagnosis of BV had a sensitivity of 0.85 and a specificity of 0.92, with a positive and negative predictive value of 0.84 and 0.93, respectively. The interobserver weighted kappa index was 0.86 for Pap-stained smears compared to 0.81 for Gram-stained smears, and 0.70 for rehydrated air-dried smears using the mean Nugent score as the criterion standard. Provided that the samples are taken from equivalent locations (the vaginal fornix) and analyzed according to the same scoring criteria, there is no discernable difference in the diagnostic accuracy of the three smear-staining methods. The Pap-stained vaginal smears can be used as a wholly adequate alternative to Gram-stained smears for BV diagnosis. © Apmis 2007.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-38583 (URN)10.1111/j.1600-0463.2007.apm_607.x (DOI)44808 (Local ID)44808 (Archive number)44808 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2018-03-19Bibliographically approved
Adolfsson, A.-S. & Larsson, P.-G. (2006). Cumulative incidence of previous spontaneous abortion in Sweden 1983-2003: A register study. Acta obstetricia et gynecologica Scandinavica, 85(6), 741-747
Open this publication in new window or tab >>Cumulative incidence of previous spontaneous abortion in Sweden 1983-2003: A register study
2006 (English)In: Acta obstetricia et gynecologica Scandinavica, ISSN 0001-6349, Vol. 85, no 6, p. 741-747Article in journal (Refereed) Published
Abstract [en]

Aim. The aim of this study is to find out how common miscarriages are among women who have delivered a child.

Methods. The numbers of deliveries and miscarriages were extracted from the Swedish Medical Birth Register between 1983 and 2003. Linear regression was performed in order to investigate whether the increasing mean age of mothers or differences in pregnancy identification methods could explain the increased frequency of miscarriage.

Results. The reported number of miscarriages increased each year during the 21-year period, with a marked increase between 1991 and 1993 and only a slight increase during the final 10 years. For primiparous women, the frequency of reported miscarriages per delivery increased from 8.6% in 1983 to 13.9% in 2003. The corresponding figures for 2-parous women showed an increase from 14.5% to 21.3% respectively. Women aged 30-34 years had an odds ratio of 1.43 (95% CI 1.40-1.45) to suffer spontaneous abortion compared to the age group 25-29 years. Linear regression showed that an increase in mean age at delivery could only partly explain the increase in the frequency of reported miscarriages. A possible explanation could be differences in methods of identifying early pregnancy.

Conclusion. Of all women who deliver a child, nearly 20% have experienced previous miscarriage. The increased mean age of women could only explain a small portion of the seen increase in miscarriage. The marked increase from 1991 to 1993 is interesting. Possible reasons for the increase are discussed.

Keywords
Miscarriage; register study; retrospective study; spontaneous abortion; Medical Birth Register
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13806 (URN)10.1080/00016340600627022 (DOI)
Available from: 2006-04-03 Created: 2006-04-03
Adolfsson, A., Berterö, C. & Larsson, P.-G. (2006). Effect of a structured follow-up visit to a midwife on women with early miscarriage: A randomized study. Acta obstetricia et gynecologica Scandinavica, 85(3), 330-335
Open this publication in new window or tab >>Effect of a structured follow-up visit to a midwife on women with early miscarriage: A randomized study
2006 (English)In: Acta obstetricia et gynecologica Scandinavica, ISSN 0001-6349, Vol. 85, no 3, p. 330-335Article in journal (Refereed) Published
Abstract [en]

Background. Women's grief after miscarriage is substantial and important. Women who experience early miscarriage do not constitute a homogenous group. The aim of this study is to measure whether a structured follow-up visit to a midwife (group 1) at 21-28 days after early miscarriage could reduce the women's grief, measured using the perinatal grief scale Swedish short version (PGS) after a further 3 months (i.e. 4 months after the miscarriage), compared to a regular follow-up visit to a midwife (group 2). Methods. We performed an open randomized study of women who experienced early miscarriage (n = 88). The midwife's attitude in group 1 came from Swanson science theory of midwifery. In group 2, the women were offered only the ordinary type of consultation at a regular visit. A questionnaire with the PGS was used in both groups. Four months after the miscarriage, a second questionnaire with the same perinatal grief scale was sent by post. Results. There was a 30% greater reduction in grief in group 1 than that in group 2, when comparing the first and second measurements (not significant). The biggest differences were in the subscales active grief and difficulty in coping. Women with the subdiagnosis missed abortions had, as a group, significantly higher PGS scores at both visits, especially in active grief and difficulty in coping, regardless of the type of follow-up visit. Conclusions. A structured follow-up visit did not, in comparison with a regular follow-up visit, imply any significant reduction in grief as measured using the PGS scale. However, the subgroup missed abortion had more extensive grief than the other women with miscarriage. Structured follow-up visits are not imperative for all women with early miscarriage.

Keywords
Early miscarriage; grief; midwife; support; treatment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13809 (URN)10.1080/00016340500539376 (DOI)
Available from: 2006-04-03 Created: 2006-04-03 Last updated: 2013-09-12
Larsson, P.-G., Fåhraeus, L., Carlsson, B., Jakobsson, T. & Forsum, U. (2006). Late miscarriage and preterm birth after treatment with clindamycin: A randomised consent design study according to Zelen. British Journal of Obstetrics and Gynecology, 113(6), 629-637
Open this publication in new window or tab >>Late miscarriage and preterm birth after treatment with clindamycin: A randomised consent design study according to Zelen
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2006 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 113, no 6, p. 629-637Article in journal (Refereed) Published
Abstract [en]

Objective: To screen for bacterial vaginosis (BV) and to investigate the effect of treatment with vaginal clindamycin in order to observe the effect on late miscarriage and delivery prior to 37 completed weeks (primary outcome). Design: Randomised consent design for clinical trials according to Zelen. Setting: Southeast region of Sweden. Population: A total of 9025 women were screened in early pregnancy. Methods: A total of 819 women with a Nugent score of 6 and above were considered to have BV and treated according to Zelen allocation. The incidence of late miscarriage and spontaneous (noniatrogenic) preterm birth was assessed. Main outcome measures: Late miscarriage and spontaneous preterm delivery before 37 weeks. Results: Therapy with vaginal clindamycin had no significant impact on the incidence of spontaneous preterm delivery prior to 37 completed weeks, OR 0.90, 95% CI 0.40-2.02 (primary outcome variable). However, only 1 of 11 women in the treatment group versus 5 of 12 in the control group delivered prior to 33 completed weeks, OR 0.14, 95% CI 0.02-0.95. Treatment was associated with 32 days longer gestation for the 23 participants who had late miscarriage or spontaneous preterm birth (P= 0.024, Mann-Whitney U test) and significantly fewer infants had a birthweight below 2500 g (secondary outcome). A follow up of infants born preterm 4 years postnatally indicated that extending gestational age did not increase the number of sequelae. Conclusions: Clindamycin vaginal cream therapy was associated with significantly prolonged gestation and reduced cost of neonatal care in women with BV. Early screening for BV and treatment with clindamycin saved approximately €27 per woman. © RCOG 2006 BJOG An International Journal of Obstetrics and Gynaecology.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-35129 (URN)10.1111/j.1471-0528.2006.00946.x (DOI)24946 (Local ID)24946 (Archive number)24946 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
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