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  • 1.
    Adolfsson, Ann-Sofie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Genus och medicin. Linköpings universitet, Hälsouniversitetet.
    Miscarriage: Women’s Experience and its Cumulative Incidence2006Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Many women experience miscarriage every year. Every fourth woman who has given birth reports that she has previous experience of miscarriage. In a study of all women in the Swedish Medical Birth Register 1983-2003, we found that the number of cases of self reported miscarriage had increased in Sweden during this 21 year period. This increase can be explained by the introduction of sensitive pregnancy tests around 1990, as well as an increase in the mean age of the mothers, by approximately 3 years, during the observation period. The risk of miscarriage is 13% with the first child. With subsequent pregnancies, the risk of miscarriage is 8%, 6% and 4% with the second, third and fourth child, respectively.

    Thirteen of these women who had suffered a recent miscarriage were interviewed four months later, and their feelings of guilt and emptiness were explored. Their experience was that they wanted their questions to be answered, and that they wanted others to treat them as the mothers to be that they felt themselves to be. They also experienced the need for time to grieve their loss.

    Measurement of grief by means of the Perinatal Grief Scale (PGS) is used in research but has also been proposed for clinical use. We have translated this psychological instrument to Swedish, back-translated and tested it in a small pilot study. In a randomized controlled study, women with early miscarriage were allocated, either to a structured visit (study group) or a regular visit (control group) to a midwife. The structured visit was conducted according to the Swanson caring theory. We could conclude that the structured visit had no significant effect on grief compared to the regular visit, as measured using the PGS. However, women with the sub-diagnosis missed abortion have significantly more grief four months after early miscarriage, regardless of visit type.

    We also performed a content analysis of the tape-recorded structured follow-up visit. The code-key used was Bonanno and Kaltman’s general grief categorization. Women’s expression of grief after miscarriage was found to be very similar to the grief experienced following the death of a relative. Furthermore, the grief was found to be independent of number of children, women’s age, or earlier experience of miscarriage.

    Conclusions: Every fourth woman who gives birth reports that she has also experienced early miscarriage. The experience of these women is that they have suffered a substantial loss and their reaction is grief similar to that experienced following the death of a relative.

    Delarbeten
    1. Cumulative incidence of previous spontaneous abortion in Sweden 1983-2003: A register study
    Öppna denna publikation i ny flik eller fönster >>Cumulative incidence of previous spontaneous abortion in Sweden 1983-2003: A register study
    2006 (Engelska)Ingår i: Acta obstetricia et gynecologica Scandinavica, ISSN 0001-6349, Vol. 85, nr 6, s. 741-747Artikel i tidskrift (Refereegranskat) 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.

    Nyckelord
    Miscarriage; register study; retrospective study; spontaneous abortion; Medical Birth Register
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13806 (URN)10.1080/00016340600627022 (DOI)
    Tillgänglig från: 2006-04-03 Skapad: 2006-04-03
    2. Guilt and emptiness: Women’s experiences of miscarriage
    Öppna denna publikation i ny flik eller fönster >>Guilt and emptiness: Women’s experiences of miscarriage
    2004 (Engelska)Ingår i: Health Care for Women International, ISSN 0739-9332, Vol. 25, nr 6, s. 543-560Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Women who lose an early pregnancy are shocked when they are first given the information that they have miscarried. Later they feel guilt and emptiness. Heideggerian interpretive phenomenology has been used with 13 women from southwest Sweden to uncover their lived experience of miscarriage. Women plan their future with a child during early pregnancy. When miscarriage occurs it is not a gore, an embryo, or a fetus they lose, it is their child. They feel that they are the cause of the miscarriage through something they have done, eaten, or thought. They feel abandonment and they grieve for their profound loss; they are actually in bereavement.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13807 (URN)10.1080/07399330490444821 (DOI)
    Tillgänglig från: 2006-04-03 Skapad: 2006-04-03 Senast uppdaterad: 2018-11-15
    3. Translation of the short version of the Perinatal Grief Scale into Swedish
    Öppna denna publikation i ny flik eller fönster >>Translation of the short version of the Perinatal Grief Scale into Swedish
    2006 (Engelska)Ingår i: Scandinavian journal of caring sciences, ISSN 1471-6712, Vol. 20, nr 3, s. 269-273Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Introduction: Women's emotions and grief after miscarriage are influenced not only by the context in which the miscarriage occurred but also by their past experience, the circumstances around the miscarriage and their future prospects. Their emotions therefore express a specific form of grief. Normally the time needed to work through the loss varies. A number of different scales, measuring women's emotions and grief after miscarriage have been published. One instrument that measures the specific grief, such as the grief after miscarriage is the Perinatal Grief Scale (PGS) that was designed to measure grief after perinatal loss and has good reliability and validity.

    Aims: The purpose of this study was to translate the PGS into Swedish and to use the translation in a small pilot study.

    Material and method: The original short version of the PGS was first translated from English into Swedish and then back-translated into English, using different translators. During translation and back-translation, not only the linguistic and grammatical aspects were considered but also cultural differences. The Likert 5-point and a 10-point scale were tested in a pilot study where 12 volunteers anonymously answered the PGS twice. The intra-personal correlations were compared and analysed with weighted κ-coefficient.

    Findings: In all, five different versions were tested before the final Swedish version was established. The weighted κ-coefficient for the volunteers was 0.58, which is regarded as representing good reproducibility.

    Conclusion: The PGS was translated successfully into Swedish and could be used in a Swedish population. As this work is rather time-consuming we therefore wish to publish the Swedish version so that it may be used by other researchers.

    Nyckelord
    translation, Perinatal Grief Scale, miscarriage, grief, spontaneous abortion
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13808 (URN)10.1111/j.1471-6712.2006.00404.x (DOI)
    Tillgänglig från: 2006-04-03 Skapad: 2006-04-03 Senast uppdaterad: 2010-05-17
    4. Effect of a structured follow-up visit to a midwife on women with early miscarriage: A randomized study
    Öppna denna publikation i ny flik eller fönster >>Effect of a structured follow-up visit to a midwife on women with early miscarriage: A randomized study
    2006 (Engelska)Ingår i: Acta obstetricia et gynecologica Scandinavica, ISSN 0001-6349, Vol. 85, nr 3, s. 330-335Artikel i tidskrift (Refereegranskat) 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.

    Nyckelord
    Early miscarriage; grief; midwife; support; treatment
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13809 (URN)10.1080/00016340500539376 (DOI)
    Tillgänglig från: 2006-04-03 Skapad: 2006-04-03 Senast uppdaterad: 2013-09-12
    5. 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.
    Öppna denna publikation i ny flik eller fönster >>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 (Engelska)Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, Vol. 115, nr 3, s. 201-209Artikel i tidskrift (Refereegranskat) 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.

    Nyckelord
    Content analysis, factor analysis, general grief theory, miscarriage, perinatal grief scale, women
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-13810 (URN)10.3109/03009731003739851 (DOI)000281013000008 ()
    Anmärkning
    On the day of the defence day the status of this article was Submitted.Tillgänglig från: 2006-04-03 Skapad: 2006-04-03 Senast uppdaterad: 2010-09-03
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    FULLTEXT01
  • 2.
    Alvarez-Rodriguez, Manuel
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Ljunggren, Stefan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Arbets- och miljömedicin.
    Karlsson, Helen
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Arbets- och miljömedicin.
    Rodriguez-Martinez, Heriberto
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Exosomes in specific fractions of the boar ejaculate contain CD44: A marker for epididymosomes?2019Ingår i: Theriogenology, ISSN 0093-691X, E-ISSN 1879-3231, Vol. 140, s. 143-152Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Seminal plasma (SP) is a complex fluid containing proteins, peptides, enzymes, hormones as well as extracellular vesicles (EVs). The SP interacts with spermatozoa and the inner cell lining of the female genital tract, adsorbing proteins and exosomes that modulate sperm functions and female immune responsiveness. In the present study, boar sperm-free SP was studied using flow cytometry (FC) after membrane tetraspanins (CD9, CD63 and CD81) and membrane receptor CD44 marking of non-enriched (whole SP) or gradient fractions enriched through two-step discontinuous KBr-density-gradient ultracentrifugation, in whole ejaculate or in selected ejaculate fractions. The results, evaluated by transmission electron microscopy, confirmed the presence of exosomes in all fractions of the pig SP. Noteworthy, these pig SP-exosomes were CD44-bearing when analysed by FC, with bands detected by western blotting (WB) at the expected 85 kD size. The two-step discontinuous KBr-density-gradient ultracentrifugation enriched the population of exosomes in two specific gradient fractions, indicating exosomes (either prostasomes or epididymosomes) could be separated from low-density lipoprotein (LDL) but they co-sediment with the high-density lipoprotein (HDL)-bearing fraction. The findings pave for the selective isolation of exosomes in functional studies of their function when interacting with spermatozoa, the oocyte and/or the female genitalia, including hyaluronan-CD44 interplay. (C) 2019 Elsevier Inc. All rights reserved.

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  • 3.
    Andolf, E.
    et al.
    Karolinska Inst, Sweden.
    Bladh, Marie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Möller, Louise
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Prior placental bed disorders and later dementia: a retrospective Swedish register-based cohort study2020Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 127, nr 9, s. 1090-1099Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To investigate the association between a history of placental bed disorders and later dementia. Design Retrospective population-based cohort study. Setting Sweden. Sample All women giving birth in Sweden between 1973 and 1993 (1 128 709). Methods Women with and without placental bed disorders (hypertensive disorders of pregnancy including pre-eclampsia, fetal growth restriction, spontaneous preterm labour and birth, preterm premature rupture of membranes, abruptio placenta, late miscarriages) and other pregnancy complications were identified by means of the Swedish Medical Birth Register. International classification of disease was used. Data were linked to other National Registers. Participants were followed up until 2013. The Cox proportional hazards model was used to calculate hazard ratios for women with and without pregnancy complications and were adjusted for possible confounders. Main outcome measures Diagnosis of vascular dementia and non-vascular dementia. Results Adjusted for cardiovascular disease and socio-demographic factors, an increased risk of vascular dementia was shown in women with previous pregnancy-induced hypertension (Hazard ratio [HR] 1.88, 95% CI 1.32-2.69), pre-eclampsia (HR 1.63, 95% CI 1.23-2.16), spontaneous preterm labour and birth (HR 1.65, 95% CI 1.12-2.42) or preterm premature rupture of membranes (HR 1.60, 95% CI 1.08-2.37). No statistically significant increased risk was seen for other pregnancy complications or non-vascular dementia even though many of the point estimates indicated increased risks. Conclusions Women with placental bed disorders have a higher risk for vascular disease. Mechanisms behind the abnormal placentation remain elusive, although maternal constitutional factors, abnormal implantation as well as impaired angiogenesis have been suggested. Tweetable abstract Placental bed syndromes associated with vascular dementia even after adjusting for cardiovascular disease.

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  • 4.
    Andolf, Ellika G.
    et al.
    Danderyd Hospital, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Bladh, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Berg, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Sharma, Surendra
    Brown University, RI 02908 USA.
    Hypertensive disorders in pregnancy and later dementia: a Swedish National Register Study2017Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, nr 4, s. 464-471Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction. Our aim was to investigate the rate of vascular dementia and dementia in women with previous hypertensive disorders in pregnancy, since white matter lesions of the brain and cardiovascular disease are linked both to dementia and hypertensive disorders in pregnancy. Material and methods. Prospective population-based registry study on all women giving birth in Sweden between 1973 and 1975 (284 598). Women with and without hypertensive disorders in pregnancy were identified by means of the Swedish Medical Birth Register and linked to the National Patient Register, where data on somatic disease later in life were obtained. International classification of disease was used. The Cox proportional hazard model was used to calculate hazard ratios for both groups and adjusted for possible confounders. Main outcome measures were in-hospital diagnosis of cardiovascular disease, vascular dementia and dementia. Results. No increased risks were seen for vascular dementia or dementia after any hypertensive disorders in pregnancy. If broken down in specific diagnoses for hypertensive disease in pregnancy, adjusted risks for vascular dementia after hypertension and proteinuria during pregnancy the hazard ratio was 6.27 (95% CI 1.65-27.44). Higher risks for cardiovascular disease were confirmed. Conclusions. Because of the very low absolute risk, the wide confidence interval and risk of misclassification, our results on vascular dementia could be questioned. Considering the pathophysiology of preeclampsia, the findings of brain lesions and the increased risk for cardiovascular disease, the possibly increased risk for all kinds of dementia must be investigated in larger and more well-defined cohorts.

  • 5.
    Armuand, Gabriela
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Skoog Svanberg, Agneta
    Uppsala Univ, Sweden.
    Bladh, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Adverse obstetric outcomes among female childhood and adolescent cancer survivors in Sweden: A population-based matched cohort study2019Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, nr 12, s. 1603-1611Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Cancer treatment during childhood may lead to late adverse effects, such as reduced musculoskeletal development or vascular, endocrine and pulmonary dysfunction, which in turn may have an adverse effect on later pregnancy and childbirth. The aim of the present study was to investigate pregnancy and obstetric outcomes as well as the offsprings health among childhood and adolescent female cancer survivors. Material and methods This register-based study included all women born between 1973 and 1977 diagnosed with cancer in childhood or adolescence (age amp;lt;21), as well as an age-matched comparison group. A total of 278 female cancer survivors with their first childbirth were included in the study, together with 829 age-matched individuals from the general population. Logistic regression and analysis of variance were used to investigate associations between having been treated for cancer and the outcome variables, adjusting for maternal age, nicotine use and comorbidity. Results Survivors were more likely to have preeclampsia (adjusted odds ratio [aOR] 3.46, 95% confidence interval [CI] 1.58 to 7.56), undergo induction of labor (aOR 1.66, 95% CI 1.05 to 2.62), suffer labor dystocia (primary labor dystocia aOR 3.54, 95% CI 1.51 to 8.34 and secondary labor dystocia aOR 2.43, 95% CI 1.37 to 4.31), malpresentation of fetus (aOR 2.02, 95% CI 1.12 to 3.65) and imminent fetal asphyxia (aOR 2.55, 95% CI 1.49 to 4.39). In addition, deliveries among survivors were more likely to end with vacuum extraction (aOR 2.53, 95% CI 1.44 to 4.47), with higher risk of clitoral lacerations (aOR 2.18, 95% CI 1.47 to 3.23) and anal sphincter injury (aOR 2.76, 95% CI 1.14 to 6.70) and emergency cesarean section (aOR 2.34 95% CI 1.39 to 3.95). Survivors used pain-reliving methods to a higher extent compared with the comparison group. There was no increased risk of neonate diagnoses and malformations. The results showed that survivors who had been diagnosed with cancer when they were younger than 14 had an increased risk of adverse obstetric outcomes. Conclusions The study demonstrates increased risk of pregnancy and childbirth complications among childhood and adolescent cancer survivors. There is a need to optimize perinatal care, especially among survivors who were younger than 14 at time of diagnosis.

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  • 6.
    Armuand, Gabriela
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Skoog-Svanberg, Agneta
    Uppsala University, Uppsala, Sweden.
    Bladh, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Reproductive Patterns Among Childhood and Adolescent Cancer Survivors in Sweden: A Population-Based Matched-Cohort Study.2017Ingår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 35, nr 14, s. 1577-1583Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose To compare the probability of a first live birth, age at time of birth, and time between diagnosis/referent date and birth between childhood and adolescent cancer survivors and an age-matched comparison group. Materials and Methods A total of 1,206 survivors was included in the study, together with 2,412 age-matched individuals from the general population. A Cox proportional hazards model was used to investigate first live birth after diagnosis/referent date. Data were stratified by sex, age at diagnosis, and diagnostic era (ie, diagnosis before 1988 v in 1988 or later). Results Overall, the probability of having a first live birth (hazard ratio [HR]) was significantly lower; men had lower HRs than women (HR, 0.65 v 0.79). There were no significant differences in the probability of having a first live birth among women diagnosed during adolescence (HR, 0.89), but the HR was lower among women with childhood cancers (HR, 0.47). Among male survivors, the situation was the opposite; men diagnosed during adolescence had lower HRs than survivors of childhood cancer (HR, 0.56 v 0.70). Examination of the data from the two diagnostic eras (before 1988 and 1988 or later) shows that the HR increased among female survivors after 1988 (HR, 0.71 v 0.90) and decreased among male survivors (HR, 0.72 v 0.59). A shorter time had elapsed between diagnosis/referent date and the birth of a first child among both male and female survivors compared with controls. In addition, female survivors were younger at time of birth. Conclusion The study demonstrates reduced probability of having a first live birth among cancer survivors diagnosed during childhood or adolescence; men were particularly vulnerable.

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  • 7.
    Arnison, Tor
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Menon, JA
    Department of Psychology, University of Zambia, Lusaka, Zambia.
    Malambo, C
    Department of Psychology, University of Zambia, Lusaka, Zambia.
    Nilsson, Doris
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Posttraumatic Stress among women with HIV in Zambia2017Ingår i: The Medical Journal of Zambia, ISSN 0047-651X, Vol. 44, nr 2, s. 100-105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To examine whether HIV-positive women in Lusaka District, Zambia, displays a higher degree of PTSD-symptoms than a HIV-negative control group.

    Method: The study targeted 50 HIV-positive women from four ART-clinics and 42 HIV-negative women from corresponding VCT-units. All sites were located in Lusaka District, Zambia. The HIV-positive women were compared with the control group in regard for PTSD, PTSD-symptoms, dissociative symptoms and history of traumatic experiences. The instruments used were PCL-C, DES-T and LYLES-A. Prior to the main study, the validity of the instruments were assessed with a pilot-sample.

    Results: Three participants in the HIV-positive group fulfilled the criteria for clinical PTSD (10.7 %), as compared to none in the control group. The HIV-positive group also displayed a significantly higher degree of PTSD-symptoms and previous traumatic experiences, with strong effect sizes, but not for dissociative symptoms. The significant difference in PTSD-symptoms remained while trauma-history was controlled for.

    Conclusions: The results of this study clearly indicates that women with HIV are vulnerable to PTSD and that contracting HIV in itself can constitute a psychological trauma in itself. Since PTSD among persons with HIV has been associated with transmission risk behaviours, reduced treatment adherence and a faster disease progression, these findings are important to consider in actions against HIV and AIDS. 

  • 8. Beställ onlineKöp publikationen >>
    Axelsson, Daniel
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Department of Obstetrics and Gynecology, Ryhov County Hospital, Jönköping.
    Postpartum infections; prevalence, associated obstetric factors and the role of vitamin D2019Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Postpartum infections are a major cause of maternal mortality and morbidity worldwide. Breast infection, endometritis, urinary tract infection and wound infections are the most common postpartum infections and together they affect almost 20% of women after childbirth. Some risk factors for postpartum infections, for example cesarean section, have been relatively well studied, but other presumable risk factors are yet to be confirmed.

    The proportion of pregnant women who are overweight or obese is increasing in most parts of the world. Increased maternal body mass index (BMI) is associated with maternal and infant morbidity. The association between overweight / obesity and postpartum infections is incompletely understood. Vitamin D deficiency has in epidemiological studies been shown to increase the risk of various infections. Furthermore, vitamin D is an important factor in the human immune system. Concomitantly, vitamin D supplementation seems protective against some types of infections. Whether vitamin D deficiency is a risk factor for postpartum infections has not been studied.

    Material and Methods: In a population-based observational study using questionnaires, the prevalences of postpartum wound infections, endometritis, urinary tract infections and mastitis in the southeast region of Sweden were estimated (Paper I). All women giving birth in the region during one year (n=11 124) were asked to participate. Papers II and III were cohort studies based on all deliveries in Sweden during eight years (2005-2012). Data sources were the Swedish Medical Birth Register, the Swedish National Patient Register and the Swedish Prescribed Drugs Register. In paper II all term deliveries were included (n=795 072). Risk factors for postpartum wound infections, endometritis and urinary tract infection were evaluated. Paper III included all deliveries (n=841 780) and examined the impact of BMI on the risk of postpartum wound infections, endometritis and breast abscess after different modes of delivery. Infections were defined as the presence of applicable ICD-10 codes. The Mantel-Haenszel technique was used to calculate adjusted odds ratios. In paper IV the association between vitamin D deficiency and overall postpartum infectious morbidity was analyzed. Serum samples from the Pregnancy Biobank in Linköping, drawn at the time of delivery, were used to determine concentrations of 25-hydroxyvitamin D in 1397 women. ICD-10 codes were extracted from the women’s medical records. The prevalence of vitamin D deficiency was calculated and adjusted odds ratios for postpartum infections were estimated with multivariable logistic regression analysis.

    Results: More than one out of ten women in southeast Sweden reported wound infections; endometritis, urinary tract infection or mastitis postpartum and 7.5% reported antibiotic treatment for infection. Cesarean section was the strongest risk factor for wound infection, followed by obstetric anal sphincter injuries and episiotomy. For endometritis, the strongest risk factors were anemia, manual placental removal and emergency cesarean section. Urinary tract infection was associated with anemia, instrumental vaginal delivery and emergency cesarean section. There was a dose-dependent increased risk of postpartum infection with higher BMI. For morbidly obese women the risk of infection was over 50% higher than for normal weight women. The risk of endometritis after normal vaginal delivery increased the higher the BMI, as did the risk of wound infection after cesarean section, regardless of the type of cesarean section. For breast abscess, there was an inverse association with BMI.

    Vitamin D deficiency was present among almost 60% of pregnant women at the time of delivery. No association between vitamin D deficiency and postpartum infections was found.

    Conclusions: Every tenth Swedish woman acquired an infection postpartum and three quarters of them received antibiotics for infection. Anemia was an important risk factor for postpartum infection, and the strongest risk factor for endometritis and urinary tract infection. Strong efforts should be made to reduce blood loss during and after childbirth. This thesis confirmed cesarean section as a major risk factor for postpartum infection, especially wound infection. The risk increased if the woman was overweight or obese, regardless of whether it was a planned or an emergency cesarean section.

    Vitamin D deficiency was common among Swedish pregnant women, but it was not found to be associated with postpartum infections.

    Delarbeten
    1. Prevalence of postpartum infections: a population-based observational study
    Öppna denna publikation i ny flik eller fönster >>Prevalence of postpartum infections: a population-based observational study
    2014 (Engelska)Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, nr 10, s. 1065-1068Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    We investigated the prevalence of postpartum infections among women giving birth during 1year in a population-based observational/questionnaire study at seven hospitals in the southeast region of Sweden. Of the women greater than99% (n=11124) received a questionnaire to inquire if they had endometritis, mastitis, or wound, urinary tract or any other infection within 2months postpartum and whether they received antibiotics for this. Prevalence rates for infections and antibiotic treatment were estimated. The response rate was 60.1%. At least one infectious episode was reported by 10.3% of the women and 7.5% had received antibiotics. The prevalence for infections with and without antibiotics were, respectively, mastitis 4.7% and 2.9%, urinary tract infection 3.0% and 2.4%, endometritis 2.0% and 1.7%, wound infection 1.8% and 1.2%. There was no inter-county difference in infection prevalence. Clinical postpartum infections in a high-resource setting are relatively common.

    Ort, förlag, år, upplaga, sidor
    Informa Healthcare / Wiley: 12 months, 2014
    Nyckelord
    Infections; postpartum; mastitis; urinary tract infection; endometritis; wound infection
    Nationell ämneskategori
    Reproduktionsmedicin och gynekologi
    Identifikatorer
    urn:nbn:se:liu:diva-111744 (URN)10.1111/aogs.12455 (DOI)000342582800016 ()25132521 (PubMedID)
    Anmärkning

    Funding Agencies|Medical Research Council of Southeast Sweden

    Tillgänglig från: 2014-10-31 Skapad: 2014-10-31 Senast uppdaterad: 2019-05-15
    2. Postpartum infection in relation to maternal characteristics, obstetric interventions and complications
    Öppna denna publikation i ny flik eller fönster >>Postpartum infection in relation to maternal characteristics, obstetric interventions and complications
    2018 (Engelska)Ingår i: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 46, nr 3, s. 271-278Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The purpose was to evaluate the association between maternal characteristics, obstetrical interventions/complications and postpartum wound infections (WI), urinary tract infection (UTI) and endometritis. Furthermore, this study aimed to determine the time from delivery to onset of infections after discharge from the hospital. Three large Swedish Medical Health Registers were scrutinized for the period 2005-2012. A total of 582,576 women had 795,072 deliveries. Women with diagnosis codes for WIs, UTIs or endometritis, from delivery to 8 weeks postpartum, were compared to non-infected women. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated. Increasing age and body mass index (BMI) were both associated with increasing prevalence of postpartum infections. WIs were most strongly associated with cesarean section (CS) (OR 17.2; 95% CI 16.1-18.3), 3rd and 4th degree tears (OR 10.7%; 95% CI 9.80-11.9) and episiotomy (OR 10.2; 95% CI 8.94-11.5). Endometritis was associated with anemia (OR 3.16; 95% CI 3.01-3.31) and manual placental removal (OR 2.72; 95% CI 2.51-2.95). UTI was associated with emergency CS (OR 3.46; 95% CI 3.07-3.89) and instrumental delivery (OR 3.70; 95% CI 3.29-4.16). For women discharged from the delivery hospital the peak occurrence of UTI was 6 days postpartum, while for WIs and endometritis it was 7 days postpartum.

    Ort, förlag, år, upplaga, sidor
    WALTER DE GRUYTER GMBH, 2018
    Nyckelord
    Anemia; cesarean; endometritis; postpartum infection; urinary tract infection; wound infection
    Nationell ämneskategori
    Reproduktionsmedicin och gynekologi
    Identifikatorer
    urn:nbn:se:liu:diva-147575 (URN)10.1515/jpm-2016-0389 (DOI)000429429900006 ()28672754 (PubMedID)
    Anmärkning

    Funding Agencies|Futurum - the academy for healthcare, Region Jonkoping County, Sweden

    Tillgänglig från: 2018-04-26 Skapad: 2018-04-26 Senast uppdaterad: 2019-05-15
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  • 9.
    Axelsson, Daniel
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet. Ryhov County Hospital, Sweden.
    Blomberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Prevalence of postpartum infections: a population-based observational study2014Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, nr 10, s. 1065-1068Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We investigated the prevalence of postpartum infections among women giving birth during 1year in a population-based observational/questionnaire study at seven hospitals in the southeast region of Sweden. Of the women greater than99% (n=11124) received a questionnaire to inquire if they had endometritis, mastitis, or wound, urinary tract or any other infection within 2months postpartum and whether they received antibiotics for this. Prevalence rates for infections and antibiotic treatment were estimated. The response rate was 60.1%. At least one infectious episode was reported by 10.3% of the women and 7.5% had received antibiotics. The prevalence for infections with and without antibiotics were, respectively, mastitis 4.7% and 2.9%, urinary tract infection 3.0% and 2.4%, endometritis 2.0% and 1.7%, wound infection 1.8% and 1.2%. There was no inter-county difference in infection prevalence. Clinical postpartum infections in a high-resource setting are relatively common.

  • 10.
    Axelsson, Daniel
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Ryhov Cty Hosp, Sweden.
    Brynhildsen, Jan
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Blomberg, Marie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Maternal obesity and the risk of postpartum infections according to mode of delivery2023Ingår i: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, Vol. 36, nr 2, artikel-id 2245102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective The aim of the present study was to assess the impact of different maternal Body Mass Index (BMI) classes on the risk of postpartum endometritis, wound infection, and breast abscess after different modes of delivery. Secondly to estimate how the risk of postpartum infection varies with different maternal BMI groups after induction of labor and after obstetric anal sphincter injuries. Methods A population-based observational study including women who gave birth during eight years (N = 841,780). Data were collected from three Swedish Medical Health Registers, the Swedish Medical Birth Register, the Swedish National Patient Register, and the Swedish Prescribed Drug Register. Outcomes were defined by ICD-10 codes given within eight weeks postpartum. The reference population was uninfected women. Odds ratios were determined using Mantel-Haenszel technique. Year of delivery, maternal age, parity and smoking in early pregnancy were considered as confounders. Results There was a dose-dependent relationship between an increasing maternal BMI and a higher risk for postpartum infections. Women in obesity class II and III had an increased risk for endometritis after normal vaginal delivery aOR 1.45 (95% CI: 1.29-1.63) and for wound infections after cesarean section aOR 3.83 (95% CI: 3.39-4.32). There was no difference in how maternal BMI affected the association between cesarean section and wound infection, regardless of whether it was planned or emergent. Women in obesity class II and III had a lower risk of breast abscess compared with normal-weight women, aOR 0.47 (95% CI: 0.38-0.58). The risk of endometritis after labor induction decreased with increasing maternal BMI. The risk of wound infection among women with an obstetrical sphincter injury decreased with increasing BMI. Conclusion This study provides new knowledge about the impact of maternal BMI on the risk of postpartum infections after different modes of delivery. There was no difference in how BMI affected the association between cesarean section and wound infections, regardless of whether it was a planned cesarean section or an emergency cesarean section.

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  • 11.
    Axelsson, Daniel
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Ryhov Cty Hosp, Sweden.
    Brynhildsen, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Blomberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Postpartum infection in relation to maternal characteristics, obstetric interventions and complications2018Ingår i: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 46, nr 3, s. 271-278Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose was to evaluate the association between maternal characteristics, obstetrical interventions/complications and postpartum wound infections (WI), urinary tract infection (UTI) and endometritis. Furthermore, this study aimed to determine the time from delivery to onset of infections after discharge from the hospital. Three large Swedish Medical Health Registers were scrutinized for the period 2005-2012. A total of 582,576 women had 795,072 deliveries. Women with diagnosis codes for WIs, UTIs or endometritis, from delivery to 8 weeks postpartum, were compared to non-infected women. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated. Increasing age and body mass index (BMI) were both associated with increasing prevalence of postpartum infections. WIs were most strongly associated with cesarean section (CS) (OR 17.2; 95% CI 16.1-18.3), 3rd and 4th degree tears (OR 10.7%; 95% CI 9.80-11.9) and episiotomy (OR 10.2; 95% CI 8.94-11.5). Endometritis was associated with anemia (OR 3.16; 95% CI 3.01-3.31) and manual placental removal (OR 2.72; 95% CI 2.51-2.95). UTI was associated with emergency CS (OR 3.46; 95% CI 3.07-3.89) and instrumental delivery (OR 3.70; 95% CI 3.29-4.16). For women discharged from the delivery hospital the peak occurrence of UTI was 6 days postpartum, while for WIs and endometritis it was 7 days postpartum.

  • 12.
    Baldvinsdottir, Tinna
    et al.
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Sahlgrens Univ Hosp, Sweden.
    Blomberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Lilliecreutz, Caroline
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Improved clinical management but not patient outcome in women with postpartum haemorrhage-An observational study of practical obstetric team training2018Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 13, nr 9, artikel-id e0203806Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Postpartum haemorrhage (PPH) is the most common obstetric emergency. A well-established postpartum haemorrhage protocol in the labour ward is crucial for effective treatment. The aim of the study was to investigate if practical obstetric team training improves the patient outcome and clinical management of PPH. Setting The practical obstetric team training (PROBE) at Linkoping University Hospital, Sweden, with approximate 3000 deliveries annually, was studied between the years of 2004-2011. Each team consisted of one or two midwives, one obstetrician or one junior doctor and one nurse assistant. Emergency obstetrics cases were trained in a simulation setting. PROBE was scheduled during work hours at an interval of 1.5 years. Population Pre-PROBE women (N = 419 were defined as all women with vaginal birth between the years of 2004-2007 with an estimated blood loss of amp;gt;= 1000 ml within the first 24 hours of delivery. Post-PROBE women (N = 483) were defined as all women with vaginal birth between the years of 2008-2011 with an estimated blood loss of amp;gt;= 1000 ml within the first 24 hours of delivery. The two groups were compared regarding blood loss parameters and management variables using retrospective data from medical records. Results No difference was observed in estimated blood loss, haemoglobin level, blood transfusions or the incidence of postpartum haemorrhage between the two groups. Post-PROBE women had more often secured venous access (pamp;lt;0.001), monitoring of vital signs (pamp;lt;0.001) and received fluid resuscitation (pamp;lt;0.001) compared to pre-PROBE women. The use of uterine massage was also more common among the post-PROBE women compared with the pre-PROBE women (pamp;lt;0.001). Conclusion PROBE improved clinical management but not patient outcome in women with postpartum haemorrhage in the labour ward. These new findings may have clinical implications since they confirm that training was effective concerning the management of postpartum haemorrhage. However, there is still no clear evidence that simulation training improve patient outcome in women with PPH.

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  • 13.
    Barranco, Isabel
    et al.
    Univ Murcia, Spain; Univ Girona, Spain.
    Padilla, Lorena
    Univ Murcia, Spain.
    Tvarijonaviciute, Asta
    Univ Murcia, Spain.
    Parrilla, Inmaculada
    Univ Murcia, Spain.
    Martinez, Emilio A.
    Univ Murcia, Spain.
    Rodriguez-Martinez, Heriberto
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Yeste, Marc
    Univ Girona, Spain.
    Roca, Jordi
    Univ Murcia, Spain.
    Levels of activity of superoxide dismutase in seminal plasma do not predict fertility of pig AI-semen doses2019Ingår i: Theriogenology, ISSN 0093-691X, E-ISSN 1879-3231, Vol. 140, s. 18-24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Superoxide dismutase (SOD) is a major antioxidant enzyme in boar seminal plasma (SP). This study evaluated how SP-SOD affected sperm attributes when semen of boars of various breeds, included in commercial artificial insemination (Al)-programs, was extended and liquid-stored at 17 degrees C for AI; as well as their in vivo fertility (farrowing rate and litter size of 10,952 AI-sows). SP-SOD-activity was assessed in 311 ejaculates (100 boars) while sperm motility (by CASA), viability and intracellular H2O2 generation in viable spermatozoa (by flow cytometry) were measured at 0 and 72 h of liquid storage. SP-SOD activity was not affected by breed but differed (P amp;lt; 0.001) between boars (n = 50), ranging from 1.16 +/- 0.11 to 7.02 +/- 0.75 IU/mL. Semen Al-doses (n =44) hierarchically grouped (P amp;lt; 0.001) with low SP-SOD activity showed lower (P amp;lt; 0.05) sperm motility and intracellular H2O2 at 72 h of liquid storage. Fertility did not differ between AI-boars (n = 39) hierarchically grouped (P amp;lt; 0.001) with high or low SP-SOD activity. In conclusion, SP-SOD activity is boar dependent and positively related with sperm functionality of liquid stored semen AI-doses. However, this positive effect is not reflected on in vivo fertility post-AI. (C) 2019 Elsevier Inc. All rights reserved.

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  • 14.
    Bendas, Johanna
    et al.
    Technical University of Dresden, Germany.
    Georgiadis, Janniko R.
    University of Medical Centre Groningen, Netherlands.
    Ritschel, Gerhard
    Technical University of Dresden, Germany.
    Olausson, Håkan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten.
    Weidner, Kerstin
    Technical University of Dresden, Germany.
    Croy, Ilona
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Technical University of Dresden, Germany.
    C-Tactile Mediated Erotic Touch Perception Relates to Sexual Desire and Performance in a Gender-Specific Way2017Ingår i: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 14, nr 5, s. 645-653Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Unmyelinated low-threshold mechanoreceptors-the so-called C-tactile (CT) afferents-play a crucial role in the perception and conduction of caressing and pleasant touch sensations and significantly contribute to the concept of erotic touch perception. Aim: To investigate the relations between sexual desire and sexual performance and the perception of touch mediated by CT afferents. Methods: Seventy healthy participants (28 men, 42 women; mean age+/-SD = 24.84+/-4.08 years, range = 18-36 years) underwent standardized and highly controlled stroking stimulation that varied in the amount of CT fiber stimulation by changing stroking velocity (CT optimal = 1, 3 and 10 cm/s; CT suboptimal = 0.1, 0.3, and 30 cm/s). Participants rated the perceived pleasantness, eroticism, and intensity of the applied tactile stimulation on a visual analog scale, completed the Sexual Desire Inventory, and answered questions about sexual performance. Outcomes: Ratings of perceived eroticism of touch were related to self-report levels of sexual desire and sexual performance. Results: Pleasantness and eroticism ratings showed similar dependence on stroking velocity that aligned with the activity of CT afferents. Erotic touch perception was related to sexual desire and sexual performance in a gender-specific way. In women, differences in eroticism ratings between CT optimal and suboptimal velocities correlated positively with desire for sexual interaction. In contrast, in men, this difference correlated to a decreased frequency and longer duration of partnered sexual activities. Clinical Implications: The present results lay the foundation for future research assessing these relations in patients with specific impairments of sexual functioning (eg, hypoactive sexual desire disorder). Strengths and Limitations: The strength of the study is the combination of standardized neurophysiologic methods and behavioral data. A clear limitation of the study design is the exclusion of exact data on the female menstrual cycle and the recruitment of an inhomogeneous sample concerning sexual orientation. Conclusion: The present results provide further evidence that unmyelinated CT afferents play a role in the complex mechanism of erotic touch perception. The ability to differentiate between CT optimal and suboptimal stimuli relates to sexual desire and performance in a gender-specific way. Copyright (C) 2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

  • 15.
    Bengtsdotter, Hanna
    et al.
    Örebro Univ, Sweden.
    Lundin, Cecilia
    Uppsala Univ, Sweden.
    Gemzell Danielsson, Kristina
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Bixo, Marie
    Umeå Univ, Sweden.
    Baumgart, Juliane
    Örebro Univ, Sweden.
    Marions, Lena
    Karolinska Inst Södersjukhuset, Sweden.
    Brynhildsen, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Malmborg, Agota
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Lindh, Ingela
    Gothenburg Univ, Sweden.
    Poromaa, Inger Sundstrom
    Uppsala Univ, Sweden.
    Ongoing or previous mental disorders predispose to adverse mood reporting during combined oral contraceptive use2018Ingår i: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 23, nr 1, s. 45-51Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Previous studies have emphasised that women with pre-existing mood disorders are more inclined to discontinue hormonal contraceptive use. However, few studies have examined the effects of combined oral contraceptives (COC) on mood in women with previous or ongoing mental disorders. Materials and methods: This is a supplementary analysis of an investigator-initiated, double-blinded, randomised clinical trial during which 202 women were treated with either a COC (1.5mg estradiol and 2.5mg nomegestrolacetate) or placebo during three treatment cycles. The Mini International Neuropsychiatric Interview was used to collect information on previous or ongoing mental disorders. The primary outcome measure was the total change score in five mood symptoms on the Daily Record of Severity of Problems (DRSP) scale in the intermenstrual phase of the treatment cycle. Results: Women with ongoing or previous mood, anxiety or eating disorders allocated to COC had higher total DRSP -scores during the intermenstrual phase of the treatment cycle in comparison with corresponding women randomised to placebo, mean difference 1.3 (95% CI 0.3-2.3). In contrast, among women without mental health problems, no difference in total DRSP -scores between COC- and placebo users was noted. Women with a risk use of alcohol who were randomised to the COC had higher total DRSP -scores than women randomised to placebo, mean difference 2.1 (CI 95% 1.0-3.2). Conclusions: Women with ongoing or previous mental disorders or risk use of alcohol have greater risk of COC-induced mood symptoms. This may be worth noting during family planning and contraceptive counselling.

  • 16.
    Berezin, Linor
    et al.
    Univ Hlth Network, Canada.
    Waseem, Rida
    Univ Hlth Network, Canada.
    Merikanto, Ilona
    Univ Helsinki, Finland.
    Benedict, Christian
    Uppsala Univ, Sweden.
    Holzinger, Brigitte
    Inst Consciousness & Dream Res, Austria; Med Univ Vienna, Austria.
    De Gennaro, Luigi
    Sapienza Univ Rome, Italy; IRCCS Fdn Santa Lucia, Italy.
    Wing, Yun Kwok
    Chinese Univ Hong Kong, Peoples R China.
    Bjorvatn, Bjorn
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Korman, Maria
    Ariel Univ, Israel.
    Morin, Charles M.
    Univ Laval, Canada.
    Espie, Colin
    Univ Oxford, England.
    Landtblom, Anne-Marie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för neurobiologi. Linköpings universitet, Medicinska fakulteten. Uppsala Univ, Sweden.
    Penzel, Thomas
    Charite, Germany.
    Matsui, Kentaro
    Natl Ctr Hosp, Japan.
    Hrubos-Strom, Harald
    Akershus Univ Hosp, Norway; Univ Oslo, Norway.
    Mota-Rolim, Sergio
    Brain Inst, Brazil; Univ Fed Rio Grande do Norte, Brazil.
    Nadorff, Michael R.
    Mississippi State Univ, MS USA.
    Plazzi, Giuseppe
    IRCCS Ist Sci Neurol Bologna, Italy; Univ Modena & Reggio Emilia, Italy.
    Reis, Catia
    Univ Catolica Portuguesa, Portugal; Univ Lisbon, Portugal; Univ Lisbon, Portugal.
    Chan, Rachel Ngan Yin
    Chinese Univ Hong Kong, Peoples R China.
    Cunha, Ana Suely
    Univ Potiguar, Brazil.
    Yordanova, Juliana
    Bulgarian Acad Sci, Bulgaria.
    Bjelajac, Adrijana Koscec
    Inst Med Res & Occupat Hlth, Croatia.
    Inoue, Yuichi
    Tokyo Med Univ, Japan; Inst Neuropsychiat, Japan.
    Dauvilliers, Yves
    Univ Montpellier, France.
    Partinen, Markku
    Univ Helsinki, Finland; Terveystalo Healthcare Serv, Finland.
    Chung, Frances
    Univ Hlth Network, Canada; Univ Toronto, Canada.
    Habitual short sleepers with pre-existing medical conditions are at higher risk of Long COVID2024Ingår i: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 20, nr 1, s. 111-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Study Objectives: Preliminary evidence suggests that the risk of Long COVID is higher among people with pre-existing medical conditions. Based on its proven adjuvant role in immunity, habitual sleep duration may alter the risk of developing Long COVID. The objective of this study was to determine whether the odds of Long COVID are higher among those with pre-existing medical conditions, and whether the strength of this association varies by habitual sleep duration. Methods: Using data from 13,461 respondents from 16 countries who participated in the 2021 survey -based International COVID Sleep Study II (ICOSS II), we studied the associations between habitual sleep duration, pre-existing medical conditions, and Long COVID. Results: Of 2,508 individuals who had COVID-19, 61% reported at least 1 Long COVID symptom. Multivariable logistic regression analysis showed that the risk of having Long COVID was 1.8 -fold higher for average -length sleepers (6-9 h/night) with pre-existing medical conditions compared with those without pre-existing medical conditions (adjusted odds ratio [aOR] 1.84 [1.18-2.90]; P = .008). The risk of Long COVID was 3 -fold higher for short sleepers with pre-existing medical conditions (aOR 2.95 [1.04-8.4]; P = .043) and not significantly higher for long sleepers with pre-existing conditions (aOR 2.11 [0.93-4.77]; P = .073) compared with average -length sleepers without pre-existing conditions. Conclusions: Habitual short nighttime sleep duration exacerbated the risk of Long COVID in individuals with pre-existing conditions. Restoring nighttime sleep to average duration represents a potentially modifiable behavioral factor to lower the odds of Long COVID for at -risk patients.

  • 17. Beställ onlineKöp publikationen >>
    Berin, Emilia
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Resistance Training and Physical Activity in Postmenopausal Women: Effects on Vasomotor Symptoms, Quality of Life and Microcirculation2023Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background  

    Menopause is a physiological event, but is associated with bothersome symptoms as well as physical changes that affect women’s health. About 75 % of women experience vasomotor symptoms (hot flushes and night sweats) related to menopause that often reduce quality of life. The vasomotor symptoms may be attributed to dysfunctional temperature regulation centrally in the hypothalamus and peripherally in the skin’s circulation. The most effective treatment for vasomotor symptoms is menopausal hormone therapy, but not all women are able to, or want to, use it.  

    In addition to the impact on quality of life, studies have associated vasomotor symptoms and menopause with macrovascular endothelial dysfunction. Previous studies on the association of these factors with the skin’s microcirculatory function are small and few. Observational studies have associated physical activity and exercise with less vasomotor symptoms, but the evidence from intervention trials is of low quality and the results are ambiguous. Physical activity has established general health effects, and could potentially decrease vasomotor symptoms by effects on endogenous opioids centrally, and by more efficient thermoregulation peripherally.  

    The aim of this thesis was to investigate the effect of resistance training on vasomotor symptoms and health-related quality of life in postmenopausal women, and to explore the women’s experiences of the training to find barriers and facilitators. We also aimed to investigate whether the skin’s microcirculatory function differed between women regarding menopausal status, vasomotor symptoms, menopausal hormone therapy, and physical activity.  

    Material and methods  

    The first study was an open randomized controlled trial including 65 postmenopausal women with moderate to severe vasomotor symptoms and low physical activity levels. We randomized the women to 15 weeks of resistance training (intervention) or unchanged physical activity (control). The participants registered vasomotor symptoms daily in a diary, and answered health-related quality of life questionnaires at baseline and at 15 weeks. The first 15 women to finish the intervention were recruited to a qualitative study. The women’s experiences of the resistance training intervention were explored in individual interviews after the intervention period, and all were followed-up with telephone interviews after one year. The third study was cross-sectional, including 1148 women from Linköping, 50-64 years old, who participated in the Swedish CArdioPulmonary bioImage Study (SCAPIS). These women answered a questionnaire about menopausal status, vasomotor symptoms and menopausal hormone therapy use, and wore accelerometers for seven days to assess physical activity. The skin’s microcirculation was assessed at rest and during post-occlusive reactive hyperemia.  

    Results  

    Moderate to severe vasomotor symptoms per 24 hours decreased significantly more in the group of women randomized to resistance training compared with the control group (mean difference -2.7, 95% CI -4.2 to -1.3). The resistance training group improved in domains of menopause-specific health-related quality of life compared with the control group but there was little impact on generic health-related quality of life. In the qualitative study we found that the vasomotor symptoms acted as a “trigger” for the women to become motivated to exercise. Their motivation then evolved from being driven by hopes of symptom relief into being driven by a wish for general well-being, which was still a driving force after one year. Microvascular function did not differ between postmenopausal and premenopausal women, or between women with or without vasomotor symptoms or menopausal hormone therapy. Women with higher levels of objectively measured and self-reported physical activity had a better reactivity of the skin’s microcirculation. The differences remained significant after adjusting for BMI, smoking, hypertension, diabetes, and education.   

    Conclusions  

    Resistance training could be effective for decreasing vasomotor symptoms and improving some aspects of health-related quality of life in motivated postmenopausal women. The vasomotor symptoms themselves spurred motivation to exercise, indicating they present an opportunity to increase physical activity. When a woman seeks medical advice for vasomotor symptoms, this could be a chance for health care professionals to help her initiate or increase exercise. Women who performed more physical activity and exercise had better skin microvascular function, but no association with VMS was found. Future studies are needed to investigate what type and dose of exercise is the most effective to reduce vasomotor symptoms and whether there is a way to predict for whom exercise will or will not be an effective intervention.   

    Delarbeten
    1. Resistance training for hot flushes in postmenopausal women: A randomised controlled trial
    Öppna denna publikation i ny flik eller fönster >>Resistance training for hot flushes in postmenopausal women: A randomised controlled trial
    Visa övriga...
    2019 (Engelska)Ingår i: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 126, s. 55-60Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objectives: To investigate the effect of 15 weeks of resistance training on the frequency of moderate to severe hot flushes in postmenopausal women. Study design: Postmenopausal women with at least 4 moderate or severe hot flushes or night sweats per day day were randomized to a 15-week resistance training intervention or unchanged physical activity. Participants did not exercise regularly at baseline and had not used any therapy for hot flushes two months prior to study entry. The resistance training was performed three times per week and the program contained 8 exercises performed with 8-12 repetitions in 2 sets. Loads were set individually from eight-repetition maximum-strength tests and increased progressively. Main outcome measures: The primary outcome was change in mean moderate or severe hot flushes per day from baseline to week 15, assessed with symptom diaries. Secondary outcomes included change in hot flush score and time spent on physical activity. Results: Between November 19, 2013, and October 26, 2016, 65 women were enrolled; 58 completed the trial and were included in the analyses. The mean age was 55 and the mean number of moderate or severe hot flushes per day at baseline was 7.1; there were no baseline differences between groups. The frequency of hot flushes decreased more in the intervention group than in the control group (mean difference -2.7, 95% CI -4.2 to -1.3). The mean percentage change was -43.6% (-56.0 to -31.3) in the intervention group and -2.0% (16.4-12.4) in the control group. Conclusion: A 15-week resistance-training program decreased the frequency of moderate and severe hot flushes among postmenopausal women and could be an effective and safe treatment option to alleviate vasomotor symptoms.

    Ort, förlag, år, upplaga, sidor
    ELSEVIER IRELAND LTD, 2019
    Nyckelord
    Hot flashes; Menopause; Resistance training; Women; Exercise; Randomised controlled trial
    Nationell ämneskategori
    Reproduktionsmedicin och gynekologi
    Identifikatorer
    urn:nbn:se:liu:diva-159240 (URN)10.1016/j.maturitas.2019.05.005 (DOI)000475721400010 ()31239119 (PubMedID)
    Anmärkning

    Funding Agencies|Swedish Research Council [2014-2781]; Ministry of Education and Research

    Tillgänglig från: 2019-08-08 Skapad: 2019-08-08 Senast uppdaterad: 2024-03-22
    2. Effects of resistance training on quality of life in postmenopausal women with vasomotor symptoms
    Öppna denna publikation i ny flik eller fönster >>Effects of resistance training on quality of life in postmenopausal women with vasomotor symptoms
    Visa övriga...
    2022 (Engelska)Ingår i: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 25, nr 3, s. 264-270Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective Most women experience vasomotor symptoms (VMS) around menopause that may affect quality of life negatively. Effective pharmacological treatment exists but is not recommended for all women, and there is a demand for alternatives to reduce symptoms and improve quality of life. The objective of this study was to investigate the effect of a resistance training intervention on health-related quality of life (HRQoL) in postmenopausal women with VMS. Methods This open randomized controlled trial included 65 postmenopausal women >45 years old with daily VMS. The participants were randomized to 15 weeks of resistance training three times per week or an untreated control group. The Womens Health Questionnaire (WHQ) and Short Form Health Survey (SF-36) were used to assess HRQoL at baseline and after 15 weeks. Results The resistance training group improved compared to the control group in the WHQ domains of VMS (p = 0.002), sleep problems (p = 0.003) and menstrual symptoms (p = 0.01) from baseline to post intervention. No significant between-group differences were found in SF-36 summary scores, or in any of the domains. Conclusion In postmenopausal women with moderate to severe VMS, resistance training three times per week for 15 weeks improved menopause-specific HRQoL.

    Ort, förlag, år, upplaga, sidor
    Taylor & Francis Ltd, 2022
    Nyckelord
    Menopause; vasomotor symptoms; hot flushes; quality of life; strength training; exercise; resistance training; patient reported outcome measures
    Nationell ämneskategori
    Reproduktionsmedicin och gynekologi
    Identifikatorer
    urn:nbn:se:liu:diva-179979 (URN)10.1080/13697137.2021.1941849 (DOI)000671474800001 ()34240669 (PubMedID)
    Anmärkning

    Funding Agencies|Swedish Research CouncilSwedish Research CouncilEuropean Commission [2014-2781]; Ministry of Education and Research; County Council of Ostergotland

    Tillgänglig från: 2021-10-08 Skapad: 2021-10-08 Senast uppdaterad: 2024-03-22
    3. Postmenopausal womens experiences of a resistance training intervention against vasomotor symptoms: a qualitative study
    Öppna denna publikation i ny flik eller fönster >>Postmenopausal womens experiences of a resistance training intervention against vasomotor symptoms: a qualitative study
    Visa övriga...
    2022 (Engelska)Ingår i: BMC Women's Health, E-ISSN 1472-6874, Vol. 22, nr 1, artikel-id 320Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Introduction: Resistance training may be an effective intervention to improve menopausal symptoms and increase womens quality of life. However, most postmenopausal women do not perform regular resistance training. The purpose of this study was to explore postmenopausal womens experiences of participation in a resistance-training intervention to find barriers and motivators for the training. Methods: Fifteen postmenopausal women with low physical activity, who participated in a randomized controlled trial evaluating the effect of a resistance-training program on vasomotor symptoms and health-related outcomes, were consecutively recruited to this qualitative study. After completion of the 15-week resistance-training program, they took part in individual semi-structured interviews, followed by a telephone interview 1 year later. All interviews were transcribed verbatim and thematic analysis was used to analyse the data. Results: The analysis generated three themes that were involved at different time points. These were: "Trigger-Hopes of symptom relief", "An evolving motivation as a driving force for change" and "Finding new triggers". Accountability, and continuous professional and emotional support, were factors that fueled the womens motivation to perform regular resistance training during the study. Resistance training improved general well-being and most women experienced improvement in vasomotor symptoms. The womens motivation changed from being driven by a wish to improve bothersome symptoms, into a wish to achieve feelings of well-being and enjoyment. The change was seen regardless of effects of the intervention on vasomotor symptoms. Conclusion: This first qualitative evaluation of physical exercise as an intervention to treat vasomotor symptoms in postmenopausal women, found that the symptoms acted as a motivational trigger to initiate resistance training in low-active women. The motivation to exercise changed during the intervention from a wish to ameliorate symptoms into something the women did for enjoyment and well-being in general. This change in motivating factors may have contributed to a behavior change since all participants had increased their physical activity after 1 year regardless of effects on VMS.

    Ort, förlag, år, upplaga, sidor
    BMC, 2022
    Nyckelord
    Menopause; Resistance training; Strength training; Qualitative research; Vasomotor symptoms; Hot flushes; Exercise motivation
    Nationell ämneskategori
    Reproduktionsmedicin och gynekologi
    Identifikatorer
    urn:nbn:se:liu:diva-187329 (URN)10.1186/s12905-022-01900-0 (DOI)000833494800001 ()35907840 (PubMedID)
    Anmärkning

    Funding Agencies|Linkoping University; Swedish Research Council [2014-2781]; Ministry of Education and Research; County Council of Ostergotland

    Tillgänglig från: 2022-08-19 Skapad: 2022-08-19 Senast uppdaterad: 2024-03-22
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  • 18.
    Berin, Emilia
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Nygatan, Linköping.
    Hammar, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Lindblom, Hanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Lindh Åstrand, Lotta
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Rubér, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Spetz Holm, Anna-Clara
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Resistance training for hot flushes in postmenopausal women: A randomised controlled trial2019Ingår i: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 126, s. 55-60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate the effect of 15 weeks of resistance training on the frequency of moderate to severe hot flushes in postmenopausal women. Study design: Postmenopausal women with at least 4 moderate or severe hot flushes or night sweats per day day were randomized to a 15-week resistance training intervention or unchanged physical activity. Participants did not exercise regularly at baseline and had not used any therapy for hot flushes two months prior to study entry. The resistance training was performed three times per week and the program contained 8 exercises performed with 8-12 repetitions in 2 sets. Loads were set individually from eight-repetition maximum-strength tests and increased progressively. Main outcome measures: The primary outcome was change in mean moderate or severe hot flushes per day from baseline to week 15, assessed with symptom diaries. Secondary outcomes included change in hot flush score and time spent on physical activity. Results: Between November 19, 2013, and October 26, 2016, 65 women were enrolled; 58 completed the trial and were included in the analyses. The mean age was 55 and the mean number of moderate or severe hot flushes per day at baseline was 7.1; there were no baseline differences between groups. The frequency of hot flushes decreased more in the intervention group than in the control group (mean difference -2.7, 95% CI -4.2 to -1.3). The mean percentage change was -43.6% (-56.0 to -31.3) in the intervention group and -2.0% (16.4-12.4) in the control group. Conclusion: A 15-week resistance-training program decreased the frequency of moderate and severe hot flushes among postmenopausal women and could be an effective and safe treatment option to alleviate vasomotor symptoms.

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  • 19.
    Berin, Emilia
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Hammar, Mats
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Lindblom, Hanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Lindh Åstrand, Lotta
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Spetz Holm, Anna-Clara
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Effects of resistance training on quality of life in postmenopausal women with vasomotor symptoms2022Ingår i: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 25, nr 3, s. 264-270Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Most women experience vasomotor symptoms (VMS) around menopause that may affect quality of life negatively. Effective pharmacological treatment exists but is not recommended for all women, and there is a demand for alternatives to reduce symptoms and improve quality of life. The objective of this study was to investigate the effect of a resistance training intervention on health-related quality of life (HRQoL) in postmenopausal women with VMS. Methods This open randomized controlled trial included 65 postmenopausal women >45 years old with daily VMS. The participants were randomized to 15 weeks of resistance training three times per week or an untreated control group. The Womens Health Questionnaire (WHQ) and Short Form Health Survey (SF-36) were used to assess HRQoL at baseline and after 15 weeks. Results The resistance training group improved compared to the control group in the WHQ domains of VMS (p = 0.002), sleep problems (p = 0.003) and menstrual symptoms (p = 0.01) from baseline to post intervention. No significant between-group differences were found in SF-36 summary scores, or in any of the domains. Conclusion In postmenopausal women with moderate to severe VMS, resistance training three times per week for 15 weeks improved menopause-specific HRQoL.

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  • 20.
    Berin, Emilia
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Spetz Holm, Anna-Clara
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Hammar, Mats
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Lindh Åstrand, Lotta
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Berterö, Carina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Postmenopausal womens experiences of a resistance training intervention against vasomotor symptoms: a qualitative study2022Ingår i: BMC Women's Health, E-ISSN 1472-6874, Vol. 22, nr 1, artikel-id 320Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Resistance training may be an effective intervention to improve menopausal symptoms and increase womens quality of life. However, most postmenopausal women do not perform regular resistance training. The purpose of this study was to explore postmenopausal womens experiences of participation in a resistance-training intervention to find barriers and motivators for the training. Methods: Fifteen postmenopausal women with low physical activity, who participated in a randomized controlled trial evaluating the effect of a resistance-training program on vasomotor symptoms and health-related outcomes, were consecutively recruited to this qualitative study. After completion of the 15-week resistance-training program, they took part in individual semi-structured interviews, followed by a telephone interview 1 year later. All interviews were transcribed verbatim and thematic analysis was used to analyse the data. Results: The analysis generated three themes that were involved at different time points. These were: "Trigger-Hopes of symptom relief", "An evolving motivation as a driving force for change" and "Finding new triggers". Accountability, and continuous professional and emotional support, were factors that fueled the womens motivation to perform regular resistance training during the study. Resistance training improved general well-being and most women experienced improvement in vasomotor symptoms. The womens motivation changed from being driven by a wish to improve bothersome symptoms, into a wish to achieve feelings of well-being and enjoyment. The change was seen regardless of effects of the intervention on vasomotor symptoms. Conclusion: This first qualitative evaluation of physical exercise as an intervention to treat vasomotor symptoms in postmenopausal women, found that the symptoms acted as a motivational trigger to initiate resistance training in low-active women. The motivation to exercise changed during the intervention from a wish to ameliorate symptoms into something the women did for enjoyment and well-being in general. This change in motivating factors may have contributed to a behavior change since all participants had increased their physical activity after 1 year regardless of effects on VMS.

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  • 21. Berin, Emilia
    et al.
    Sundell, micaela
    Karki, Chanda
    Department of Obstetrics and Gynecology, Kathmandu Medical College, Kathmandu, Nepal.
    Brynhildsen, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Hammar, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Contraceptive knowledge and attitudes among women seeking induced abortion in Kathmandu, Nepal2014Ingår i: International Journal of Women's Health, E-ISSN 1179-1411, Vol. 6, nr 1, s. 335-341Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To map the knowledge about and attitudes toward birth control methods among women in Kathmandu, Nepal, and to compare the results between women seeking an induced abortion and a control group. Method: This was a cross-sectional cohort study with matched controls. Women aged 15-49 years seeking medical care at the Department of Gynecology and Obstetrics at Kathmandu Medical College were included and interviewed. A case was defined as a woman who sought an elective medical or surgical abortion. A control was defined as a woman who sought medical care at the outpatient department or had already been admitted to the ward for reasons other than elective abortion. A questionnaire developed for the study - dealing with different demographic characteristics as well as knowledge about and attitudes toward contraceptives - was filled out based on the interview. Results: A total of 153 women were included: 64 women seeking an abortion and 89 controls. Women seeking an abortion had been pregnant more times than the control group and were more likely to have been informed about contraceptives. Women with higher education were less likely to seek an abortion than women with lower education. There was no significant difference in knowledge about and attitudes toward contraceptives between cases and controls. The women considered highest possible effectiveness to be the most important feature when deciding on a birth control method. Conclusion: Women seeking abortion in Kathmandu had shorter education and a history of more pregnancies and deliveries than women in the control group. Education and counseling on sex and reproduction as well as on contraceptive methods probably need to be improved in Nepal to avoid unwanted pregnancies. Attitudes about contraceptives need to be further investigated to develop better and more effective methods to educate women about family planning in order to increase reproductive health. © 2014 Berin et al.

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  • 22.
    Berlin, Gösta
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin.
    Hammar, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Tapper, Linus
    Region Östergötland, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Tynngård, Nahreen
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Ledningsstab Region Östergötland, Enheten för forskningsstöd.
    Effects of age, gender and menstrual cycle on platelet function assessed by impedance aggregometry2019Ingår i: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 30, nr 4, s. 473-479Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Platelets are needed to prevent or arrest bleeding and aggregate at the site of injury upon vascular damage. Platelets express receptors for estrogens which might affect the function of the platelets and their hemostatic ability. The aim was to identify possible differences in platelet function related to age, gender, and phases of the menstrual cycle by use of impedance aggregometry with Multiplate. In the first part of the study, platelet function was assessed in 60 healthy individuals (30 men and 30 women) in each of three age groups (20-25, 40-45, and 60-65 years). In the second part of the study, the platelet function was analyzed on four occasions during the menstrual cycle in women without oral contraceptives (OCs) (n = 17) and compared to 19 women on OCs and 18 men of similar age (20-40 years). For the women on OCs, aggregation was analyzed once during the tablet-free week and once late during the period with OCs. The men were sampled once. Women of younger age (amp;lt;45 years) had significantly higher agonist-induced aggregation response than both men and post-menopausal women (60-65 years). The agonist-induced aggregation response did not differ between phases of the menstrual cycle or OC use. The results suggest that estradiol and/or progesterone affect spontaneous aggregation since it was found to be lowest in the mid-luteal phase. Spontaneous aggregation was significantly lower in women on OCs than in both men and women without OCs. Our findings indicate that fertile age is associated with higher aggregation response capacity of the platelets, possibly to prevent excessive bleeding during menstruation, but this response capacity is not altered during the menstrual cycle or by use of OCs.

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  • 23.
    Bernfort, Lars
    et al.
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa.
    Levin, Lars-Åke
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa.
    Obstecares AFL-metod för mätning av laktatkoncentration vid avstannat värkarbete: en kostnadsanalys2020Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Ett vanligt problem i samband med förlossningar, inte minst bland förstagångsföderskor, är att värkarbetet avstannar och förlossningen riskerar att dra ut på tiden. Värksvaghet ökar risken för födsel genom instrumentell förlossning eller med akut kejsarsnitt vilket i sin tur ökar risken för komplikationer (t.ex. blödningar).

    Den vedertagna behandlingen av en värksvaghet är ett användande av Oxytocin, som dock riskerar att överstimulera livmodermuskeln och istället förlänga förlossningstiden. Obstecare har tagit framen smidig, pålitlig och icke-invasiv metod för mätning av laktatnivåer i fostervatten. Med ledning av dessa mätningar kan välgrundade beslut fattas om huruvida oxytocin ska sättas in eller inte vid värksvaghet. Att undvika insättning av oxytocin vid redan höga laktatnivåer skulle leda till färre onödigt långa förlossningar och färre akuta kejsarsnitt och instrumentella förlossningar.

    För att undersöka huruvida kostnaden för användning av Obstecares AFL-metod uppvägs av inbesparade kostnader till följd av förändringar i förlossningsutfall genomfördes en hälsoekonomisk (kostnads)analys av att använda denna metod på förstföderskor jämfört med att inte göra det. Analysen är begränsad till den vårdepisod då förlossningen sker och till kostnader.

    De mest framträdande resultaten av analysen var att antalet akuta kejsarsnitt beräknades minska med cirka 30% och instrumentella förlossningar med cirka 12%. Hälso- och sjukvårdens kostnader beräknades minska med 1 662 kronor (-4%) per förlossning med avstannat värkarbete (inräknat kostnad för laktatmätning).

    Resultatet av denna analys tyder på att mätning av laktatnivåer vid värksvaghet hos förstföderskor är kostnadsbesparande. Tillgänglig evidens tyder på att strategin borde införas i svensk hälso- och sjukvård.

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  • 24.
    Berterö, Carina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Alehagen, Siw
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Grundström, Hanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Norrköping.
    Striving for a biopsychosocial approach: A secondary analysis of mutual components during healthcare encounters between women with endometriosis and physicians2019Ingår i: JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS, ISSN 2284-0265, Vol. 11, nr 3, s. 146-151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective:

    The objective of this study was to identify and describe mutual components during healthcare encounters between women with endometriosis and physicians.

    Methods:

    Secondary analysis of data was obtained from two original face-to-face interview studies, one with nine women with endometriosis and one including 16 physicians. Data in this secondary analysis were analysed using thematic analysis.

    Results:

    Three themes were identified. (1) Continuity as a foundation for a biopsychosocial approach. The women and the physicians described the importance of continuity and both parties strived for a biopsychosocial approach whereby the female body was not treated as biomedical defect object, but as a part of the unity that constitutes a human being. (2) Listening sensitively. Women and physicians believed that listening sensitively involved more than just hearing the actual words – it required thoughtfulness, reflection and responsiveness. (3) Timing of diagnosis. The physicians tried to protect the women from worrying by treating the painful menstruations without mentioning endometriosis. However, the women regarded not mentioning endometriosis as a lack of competence on the part of the physicians.

    Conclusion:

    This study provides new insights into the need for further support in the provision of psychosocial care for women with endometriosis, in the striving towards a biopsychosocial approach.

  • 25.
    Björkman, Stina
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Lilliecreutz, Caroline
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Bladh, Marie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Strömberg, Tomas
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ekholmen. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Mahmoud, Arina
    Linköpings universitet.
    Kafashian, Arian
    Linköpings universitet.
    Bergstrand, Sara
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Sederholm Lawesson, Sofia
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Microvascular dysfunction in women with a history of hypertensive disorders of pregnancy: A population-based retrospective cohort study2024Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 131, nr 4, s. 433-443Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ObjectiveTo evaluate microvascular function in women with previous hypertensive disorders of pregnancy (HDP).DesignRetrospective population-based cohort study.SettingLinkoping, Sweden.PopulationWomen aged 50-65 years, participating in the Swedish CArdioPulmonary bioImage Study (SCAPIS) at one site (Linkoping) 2016-18, who underwent microcirculatory assessment (N = 1222).MethodsForearm skin comprehensive microcirculatory assessment was performed with a PeriFlux PF6000 EPOS (Enhanced Perfusion and Oxygen Saturation) system measuring oxygen saturation and total speed resolved perfusion. Obstetric records were reviewed to identify women with previous HDP. Data on cardiovascular risk factors, comorbidities, medication, lifestyle, anthropometric data, and biochemical analyses were obtained from SCAPIS. The microcirculatory data were compared between women with and without previous HDP.Main outcome measuresSkin microcirculatory oxygen saturation and total speed resolved perfusion at baseline and post-ischaemic peak.ResultsWomen with previous pre-eclampsia displayed impaired post-ischaemic peak oxygen saturation compared with women with normotensive pregnancies (88%, interquartile range [IQR] 84-89% vs 91%, IQR 87-94%, p = 0.001) 6-30 years after pregnancy. The difference remained after multivariable adjustment (& beta; -2.69, 95% CI -4.93 to -0.45).ConclusionsThe findings reveal microvascular dysfunction at long-term follow up in women with previous pre-eclampsia and strengthen the possible role of endothelial dysfunction as a link to the increased risk of cardiovascular disease in women with HDP.

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  • 26.
    Blanken, M. A. J. T.
    et al.
    Vrije Univ, Netherlands; Vrije Univ Amsterdam Med Ctr, Netherlands.
    Oudega, M. L.
    GGZ InGeest Specialized Mental Hlth Care, Netherlands; Vrije Univ, Netherlands; Vrije Univ, Netherlands; Vrije Univ Amsterdam Med Ctr, Netherlands.
    Hoogendoorn, A. W.
    GGZ InGeest Specialized Mental Hlth Care, Netherlands; Vrije Univ, Netherlands; Vrije Univ Amsterdam Med Ctr, Netherlands.
    Sonnenberg, C. S.
    Vrije Univ, Netherlands; GGZ Parnassia NH, Netherlands.
    Rhebergen, D.
    Vrije Univ, Netherlands; Vrije Univ Amsterdam Med Ctr, Netherlands; GGZ Cent, Netherlands.
    Klumpers, U. M. H.
    Vrije Univ, Netherlands; Vrije Univ, Netherlands; Vrije Univ Amsterdam Med Ctr, Netherlands.
    Van Diermen, L.
    Psychiat Ctr Bethanie, Belgium; Univ Antwerp, Belgium; Univ Psychiat Ctr UPC Duffel, Belgium.
    Birkenhager, T.
    Univ Antwerp, Belgium; Erasmus MC, Netherlands.
    Schrijvers, D.
    Univ Antwerp, Belgium; Univ Psychiat Ctr UPC Duffel, Belgium.
    Redlich, R.
    Univ Halle, Germany; Univ Munster, Germany.
    Dannlowski, U.
    Univ Munster, Germany.
    Heindel, W.
    Univ Munster, Germany.
    Coenjaerts, M.
    Univ Hosp Bonn, Germany.
    Nordanskog, Pia
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping.
    Oltedal, L.
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Kessler, U.
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Frid, L. M.
    Univ Bergen, Norway.
    Takamiya, A.
    Keio Univ, Japan; Katholieke Univ Leuven, Belgium.
    Kishimoto, T.
    Keio Univ, Japan.
    Jorgensen, M. B.
    Univ Copenhagen, Denmark; Univ Copenhagen, Denmark.
    Jorgensen, A.
    Univ Copenhagen, Denmark; Univ Copenhagen, Denmark.
    Bolwig, T.
    Univ Copenhagen, Denmark.
    Emsell, L.
    Katholieke Univ Leuven, Belgium.
    Sienaert, P.
    Katholieke Univ Leuven, Belgium.
    Bouckaert, F.
    Katholieke Univ Leuven, Belgium.
    Abbott, C. C.
    Univ New Mexico, NM 87131 USA.
    Peran, P.
    Univ Toulouse, France.
    Arbus, C.
    Univ Toulouse, France.
    Yrondi, A.
    Univ Toulouse, France.
    Kiebs, M.
    Univ Bonn, Germany; Univ Hosp Oldenburg, Germany.
    Philipsen, A.
    Univ Bonn, Germany.
    van Waarde, J. A.
    Rijnstate Arnhem, Netherlands.
    Prinsen, E.
    Rijnstate Arnhem, Netherlands.
    van Verseveld, M.
    Rijnstate Arnhem, Netherlands.
    Van Wingen, G.
    Univ Amsterdam, Netherlands; Amsterdam Neurosci, Netherlands.
    ten Doesschate, F.
    Rijnstate Arnhem, Netherlands; Univ Amsterdam, Netherlands.
    Camprodon, J. A.
    Harvard Med Sch, MA USA.
    Kritzer, M.
    Harvard Med Sch, MA USA.
    Barbour, T.
    Massachusetts Gen Hosp, MA 02114 USA.
    Argyelan, M.
    Feinstein Inst Med Res, NY USA.
    Cardoner, N.
    Hosp Santa Creu & Sant Pau, Spain; Univ Autonoma Barcelona, Spain; Carlos III Hlth Inst, Spain.
    Urretavizcaya, M.
    Carlos III Hlth Inst, Spain; Bellvitge Univ Hosp, Spain; Univ Barcelona, Spain.
    Soriano-Mas, C.
    Carlos III Hlth Inst, Spain; Bellvitge Univ Hosp, Spain; Univ Barcelona, Spain.
    Narr, K. L.
    Univ Calif Los Angeles, CA USA.
    Espinoza, R. T.
    Univ Calif Los Angeles, CA USA.
    Prudic, J.
    Columbia Univ, NY 10027 USA.
    Rowny, S.
    Columbia Univ, NY 10027 USA.
    van Eijndhoven, Ph.
    Radboud Univ Nijmegen, Netherlands.
    Tendolkar, I.
    Radboud Univ Nijmegen, Netherlands.
    Dols, A.
    Vrije Univ, Netherlands; Vrije Univ Amsterdam Med Ctr, Netherlands; Univ Med Ctr Utrecht, Netherlands.
    Sex-specifics of ECT outcome2023Ingår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 326, s. 243-248Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Electroconvulsive therapy (ECT) is the most effective treatment for patients with severe major depressive disorder (MDD). Given the known sex differences in MDD, improved knowledge may provide more sex-specific recommendations in clinical guidelines and improve outcome. In the present study we examine sex differences in ECT outcome and its predictors. Methods: Clinical data from 20 independent sites participating in the Global ECT-MRI Research Collaboration (GEMRIC) were obtained for analysis, totaling 500 patients with MDD (58.6 % women) with a mean age of 54.8 years. Severity of depression before and after ECT was assessed with validated depression scales. Remission was defined as a HAM-D score of 7 points or below after ECT. Variables associated with remission were selected based on literature (i.e. depression severity at baseline, age, duration of index episode, and presence of psychotic symptoms). Results: Remission rates of ECT were independent of sex, 48.0 % in women and 45.7 % in men (X2(1) = 0.2, p = 0.70). In the logistic regression analyses, a shorter index duration was identified as a sex-specific predictor for ECT outcome in women (X2(1) = 7.05, p = 0.01). The corresponding predictive margins did show overlapping confidence intervals for men and women. Conclusion: The evidence provided by our study suggests that ECT as a biological treatment for MDD is equally effective in women and men. A shorter duration of index episode was an additional sex-specific predictor for remission in women. Future research should establish whether the confidence intervals for the corresponding predictive margins are overlapping, as we find, or not.

  • 27.
    Blomberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Fetma under graviditet ökar risken för både kvinna och barn: Kompetent omhändertagande kan minska riskökningen2015Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, nr 48, s. 2156-Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Fetma hos en gravid kvinna innebär ökad risk för missbildning hos fostret. Vid screeningultraljud upptäcks färre missbildningar än hos barn till normalviktiga kvinnor, men KUB-metoden för att upptäcka Downs syndrom är lika effektiv i alla BMI-grupper. Fetma hos kvinnan innebär ökad risk för gestationsdiabetes, preeklampsi, prematur förlossning och intrauterin fosterdöd. Öppningsskedet under förlossningen är förlängt hos kvinnor med BMI >30, men krystskedet är snabbt. Det finns ökad risk för atonisk postpartumblödning, vilket kan indicera profylaktisk behandling med uterotonika. Fetma hos kvinnan medför fler allvarliga komplikationer hos barnet under första levnadsveckan oavsett förlossningssätt.

  • 28.
    Blomberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Maternal Body Mass Index and Risk of Obstetric Anal Sphincter Injury2014Ingår i: BIOMED RESEARCH INTERNATIONAL, ISSN 2314-6133, Vol. 2014, nr 395803Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective. To estimate the association between maternal obesity and risk of three different degrees of severity of obstetric anal sphincter injury. Methods. The study population consisted of 436,482 primiparous women with singleton term vaginal cephalic births between 1998 and 2011 identified in the Swedish Medical Birth Registry. Women were grouped into six categories of BMI. BMI 18.5-24.9 was set as reference. Primary outcome was third-degree perineal laceration, partial or total, and fourth-degree perineal laceration. Adjustments were made for year of delivery, maternal age, fetal head position at delivery, infant birth weight and instrumental delivery. Results. The overall prevalence of third-or four-degree anal sphincter injury was 6.6% (partial anal sphincter injury 4.6%, total anal sphincter injury 1.2%, unclassified as either partial and total 0.2%, or fourth degree lacerations 0.6%). The risk for a partial, total, or a fourth-degree anal sphincter injury decreased with increasing maternal BMI most pronounced for total anal sphincter injury where the risk among morbidly obese women was half that of normal weight women, OR 0.47 95% CI 0.28-0.78. Conclusion. Obese women had a favourable outcome compared to normal weight women concerning serious pelvic floor damages at birth.

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  • 29.
    Blomberg, Marie
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Birch Tyrberg, Rasmus
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Kjölhede, Preben
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Impact of maternal age on obstetric and neonatal outcome with emphasis on primiparous adolescents and older women: a Swedish Medical Birth Register Study2014Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 4, nr 11, s. e005840-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To evaluate the associations between maternal age and obstetric and neonatal outcomes in primiparous women with emphasis on teenagers and older women. Design: A population-based cohort study. Setting: The Swedish Medical Birth Register. Participants: Primiparous women with singleton births from 1992 through 2010 (N=798 674) were divided into seven age groups: less than17 years, 17-19 years and an additional five 5-year classes. The reference group consisted of the women aged 25-29 years. Primary outcome: Obstetric and neonatal outcome. Results: The teenager groups had significantly more vaginal births (adjusted OR (aOR) 2.04 (1.79 to 2.32) and 1.95 (1.88 to 2.02) for age less than17 years and 1719 years, respectively); fewer caesarean sections (aOR 0.57 (0.48 to 0.67) and 0.55 (0.53 to 0.58)), and instrumental vaginal births (aOR 0.43 (0.36 to 0.52) and 0.50 (0.48 to 0.53)) compared with the reference group. The opposite was found among older women reaching a fourfold increased OR for caesarean section. The teenagers showed no increased risk of adverse neonatal outcome but presented an increased risk of prematurity less than32 weeks (aOR 1.66 (1.10 to 2.51) and 1.20 (1.04 to 1.38)). Women with advancing age (greater than= 30 years) revealed significantly increased risk of prematurity, perineal lacerations, preeclampsia, abruption, placenta previa, postpartum haemorrhage and unfavourable neonatal outcomes compared with the reference group. Conclusions: For clinicians counselling young women it is of importance to highlight the obstetrically positive consequences that fewer maternal complications and favourable neonatal outcomes are expected. The results imply that there is a need for individualising antenatal surveillance programmes and obstetric care based on age grouping in order to attempt to improve the outcomes in the age groups with less favourable obstetric and neonatal outcomes. Such changes in surveillance programmes and obstetric interventions need to be evaluated in further studies.

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  • 30. Beställ onlineKöp publikationen >>
    Boij, Roland
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Aspects of inflammation, angiogenesis and coagulation in preeclampsia2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Preeclampsia is a major challenge to obstetricians, due to its impact on maternal and fetal morbidity and mortality and the lack of preventive and treatment strategies. The overall aim of this thesis is to increase the knowledge of the pathogenesis of preeclampsia including the role of inflammation, angiogenesis and coagulation, both locally at the fetomaternal interface and in the maternal circulation. Uncompensated maternal endothelial inflammatory responses to factors from stressed trophoblasts seem to be a major contributor to the syndrome, together with an imbalance in angiogenesis and an activated coagulation system. An increasing amount of data indicates an involvement of the immune system with defect tolerance to the conceptus as an integral part of the pathogenesis, at least in early-onset preeclampsia (EOP).

    We showed that a single administration of human preeclampsia serum in pregnant IL-10−/− mice induced the full spectrum of preeclampsia-like symptoms including hypoxic injury in uteroplacental tissues and endotheliosis in maternal kidneys. Importantly, preeclampsia serum, as early as 12 to 14 weeks of gestation, disrupted cross talk between trophoblasts and endothelial cells in an in vitro model of endovascular activity (Tube formation test). These results indicate that preeclamptic sera can be used to better understand the pathophysiology and to predict the disorder. Preeclampsia has been associated with increased inflammation, aberrant angiogenesis and activated coagulation, but their correlation and relative contribution are unknown. We found that markers for all these mechanisms were independently associated with preeclampsia. Cytokines, chemokines, and complement factors seem all to be part of a Th1-associated inflammatory reaction in preeclampsia, more pronounced in EOP than in late-onset preeclampsia (LOP), in line with a more homogeneous pathogenesis in EOP as based on placental pathology. In women with intrauterine growth restriction (IUGR), with an anticipated pathologic placentation, only differences in levels for sFlt-1 and PlGF were found in comparison with mothers without IUGR. Thus, sFlt-1 and PlGF seem to be indicators of placental pathology, while other biomarkers might also reflect maternal endothelial pathology. Chemokines, in contrast to cytokines, may prove to be useful markers in preeclampsia.

    A deficiency in regulatory T (Treg) cells causing reduced immune regulatory capacity has been proposed in preeclampsia. Utilizing recent advances in flow cytometry phenotyping, we found no major alterations in circulating Treg numbers in preeclamptic women compared with normal pregnant and non-pregnant women. However, preeclampsia was associated with increased fractions of CTLA-4+ and CCR4+ cells within Treg subpopulations, which is in line with a migratory defect of Treg cells, and potentially associated with a reduced number of suppressive Treg cells at the fetomaternal interface. As we found that corticosteroid treatment affected the results, it should be accounted for in studies of EOP. Chemokines are supposed to be part of the immune adaptation in pregnancy. We found a decreased expression of CCL18  (Th2/Tregassociated), in trophoblasts from preeclamptic compared to normal pregnant women, indicating a local regulatory defect in preeclampsia, in line with our finding of a possible migratory defect of circulating Treg cells. Due to increased expression of CCL20 (Th17) and CCL22 (Th2) in first trimester placenta and increased circulating levels of CXCL10 (Th1) and CCL20 (Th17) in third trimester preeclamptic women, we suggest that CCL20 and CCL22 may be important for implantation and early placentation while in third trimester of a preeclamptic pregnancy CXCL10 and CCL20 mainly mirror maternal increased endothelial inflammation and aberrant angiogenesis. In summary, we found that preeclampsia is associated with increased inflammation, aberrant angiogenesis and activated coagulation, caused by placental factors in maternal peripheral circulation, more pronounced in the early-onset form of preeclampsia. It also appears that there is a defective modulation of the immune system in preeclamptic pregnancies. The results provide a better understanding of the pathogenesis of preeclampsia and have given suggestions to predictive markers for preeclampsia in the future.

    Delarbeten
    1. Sera from Preeclampsia Patients Elicit Symptoms of Human Disease in Mice and Provide a Basis for an in Vitro Predictive Assay
    Öppna denna publikation i ny flik eller fönster >>Sera from Preeclampsia Patients Elicit Symptoms of Human Disease in Mice and Provide a Basis for an in Vitro Predictive Assay
    Visa övriga...
    2010 (Engelska)Ingår i: AMERICAN JOURNAL OF PATHOLOGY, ISSN 0002-9440, Vol. 177, nr 5, s. 2387-2398Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Early diagnosis and treatment of preeclampsia would significantly reduce maternal and fetal morbidity and mortality. However, its etiology and prediction have remained elusive. Based on the hypothesis that sera from patients with preeclampsia could function as a "blueprint" of causative factors, we describe a serum-based pregnancy-specific mouse model that closely mirrors the human condition as well as an in vitro predictive assay. We show that a single administration of human preeclampsia serum in pregnant IL-10(-/-) mice induced the full spectrum of preeclampsia-like symptoms, caused hypoxic injury in uteroplacental tissues, and elevated soluble fins-like tyrosine kinase 1 and soluble endoglin, markers thought to be related to the disease. The same serum sample(s) induced a partial preeclampsia phenotype in wild-type mice. Importantly, preeclampsia serum disrupted cross talk between trophoblasts and endothelial cells in an in vitro model of endovascular activity. Disruption of endovascular activity could be documented in serum samples as early as 12 to 14 weeks of gestation from patients who subsequently developed preeclampsia. These results indicate that preeclampsia patient sera can be used to understand the pregnancy-specific disease pathology in mice and can predict the disorder.

    Ort, förlag, år, upplaga, sidor
    American Society for Investigative Pathology (ASIP), 2010
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-62755 (URN)10.2353/ajpath.2010.100475 (DOI)000284182900026 ()
    Tillgänglig från: 2010-12-03 Skapad: 2010-12-03 Senast uppdaterad: 2016-11-11
    2. Biomarkers of Coagulation, Inflammation, and Angiogenesis are Independently Associated with Preeclampsia
    Öppna denna publikation i ny flik eller fönster >>Biomarkers of Coagulation, Inflammation, and Angiogenesis are Independently Associated with Preeclampsia
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    2012 (Engelska)Ingår i: AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, ISSN 1046-7408, Vol. 68, nr 3, s. 258-270Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Problem Although preeclampsia has been associated with inflammation, coagulation, and angiogenesis, their correlation and relative contribution are unknown. Method of Study About 114 women with preeclampsia, 31 with early onset (EOP) and 83 with late onset preeclampsia (LOP), and 100 normal pregnant controls were included. A broad panel of 32 biomarkers reflecting coagulation, inflammation, and angiogenesis was analyzed. Results Preeclampsia was associated with decreased antithrombin, IL-4 and placental growth factor levels and with increased C3a, pentraxin-3, and sFlt-1 levels, with more marked differences in the EOP group. The Th1-associated chemokines CXCL10 and CXCL11 were significantly higher in the preeclampsia and EOP group than in controls, respectively. No correlations between the biomarkers were found in preeclampsia. Multivariate logistic regression tests confirmed the results. Conclusions Cytokines, chemokines and complement activation seem to be part of a Th1-like inflammatory reaction in preeclampsia, most pronounced in EOP, where chemokines may be more useful than cytokines as biomarkers. Biomarkers were not correlated suggesting partly independent or in time separated mechanisms.

    Ort, förlag, år, upplaga, sidor
    John Wiley and Sons, 2012
    Nyckelord
    preeclampsia, coagulation, inflammation, angiogenesis, chemokines, cytokines and early onset preeclampsia
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-81815 (URN)10.1111/j.1600-0897.2012.01158.x (DOI)000307440300012 ()
    Anmärkning

    Funding Agencies|FORSS (Medical Research Council of Southeast Sweden)||Futurum (the Research department of County of Jonkoping)||Swedish Research Council|2007-15809-48800-58|Linneaus University (Sweden)||

    Tillgänglig från: 2012-09-26 Skapad: 2012-09-24 Senast uppdaterad: 2023-12-22
    3. Regulatory T-cell Subpopulations in Severe or Early-onset Preeclampsia
    Öppna denna publikation i ny flik eller fönster >>Regulatory T-cell Subpopulations in Severe or Early-onset Preeclampsia
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    2015 (Engelska)Ingår i: American Journal of Reproductive Immunology, ISSN 1046-7408, E-ISSN 1600-0897, Vol. 74, nr 4, s. 368-378Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Problem A deficiency in regulatory T (Treg) cells causing reduced immune regulatory capacity has been proposed in preeclampsia. Objective Utilizing recent advances in flow cytometry phenotyping, we aimed to assess whether a deficiency of Treg subpopulations occurs in preeclampsia. Method of study Six-color flow cytometry was used for Treg phenotyping in 18 preeclamptic women (one early-onset, one severe and 16 both), 20 women with normal pregnancy, and 20 non-pregnant controls. Results No differences were found in major Treg populations including CD127(low)CD25(+)/CD127(ow)FOXP3(+), resting (FOXP3(dim)CD45RA(+)), and activated (FOXP3(bright)CD45RA(-)) Treg cells, whereas preeclamptic women showed increased CTLA-4(+) and CCR4(+) proportions within resting/activated Treg populations. Corticosteroid treatment prior to blood sampling (n = 10) affected the distribution of Treg populations. Conclusions Although we found no major alterations in circulating Treg frequencies, differences in CTLA-4(+) and CCR4(+) frequencies suggest a migratory defect of Treg cells in preeclampsia. Corticosteroid treatment should be taken into account when evaluating Treg cells.

    Ort, förlag, år, upplaga, sidor
    WILEY-BLACKWELL, 2015
    Nyckelord
    Early-onset preeclampsia; preeclampsia; pregnancy; regulatory T cells
    Nationell ämneskategori
    Reproduktionsmedicin och gynekologi
    Identifikatorer
    urn:nbn:se:liu:diva-122528 (URN)10.1111/aji.12410 (DOI)000362664200009 ()26118401 (PubMedID)
    Anmärkning

    Funding Agencies|FORSS (Medical Research Council of Southeast Sweden); Futurum, academy for Health and Care Jonkoping County Council, Sweden

    Tillgänglig från: 2015-11-09 Skapad: 2015-11-06 Senast uppdaterad: 2023-12-22
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    Aspects of inflammation, angiogenesis and coagulation in preeclampsia
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  • 31.
    Boij, Roland
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. County Hospital Ryhov, Sweden.
    Mjosberg, Jenny
    Karolinska Institute, Sweden.
    Svensson-Arvelund, Judit
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Hjorth, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Berg, Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Matthiesen, Leif
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Helsingborg Hospital, Sweden.
    Jenmalm, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Ernerudh, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin.
    Regulatory T-cell Subpopulations in Severe or Early-onset Preeclampsia2015Ingår i: American Journal of Reproductive Immunology, ISSN 1046-7408, E-ISSN 1600-0897, Vol. 74, nr 4, s. 368-378Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Problem A deficiency in regulatory T (Treg) cells causing reduced immune regulatory capacity has been proposed in preeclampsia. Objective Utilizing recent advances in flow cytometry phenotyping, we aimed to assess whether a deficiency of Treg subpopulations occurs in preeclampsia. Method of study Six-color flow cytometry was used for Treg phenotyping in 18 preeclamptic women (one early-onset, one severe and 16 both), 20 women with normal pregnancy, and 20 non-pregnant controls. Results No differences were found in major Treg populations including CD127(low)CD25(+)/CD127(ow)FOXP3(+), resting (FOXP3(dim)CD45RA(+)), and activated (FOXP3(bright)CD45RA(-)) Treg cells, whereas preeclamptic women showed increased CTLA-4(+) and CCR4(+) proportions within resting/activated Treg populations. Corticosteroid treatment prior to blood sampling (n = 10) affected the distribution of Treg populations. Conclusions Although we found no major alterations in circulating Treg frequencies, differences in CTLA-4(+) and CCR4(+) frequencies suggest a migratory defect of Treg cells in preeclampsia. Corticosteroid treatment should be taken into account when evaluating Treg cells.

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  • 32.
    Borendal Wodlin, Ninnie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Intraoperative cervical treatment does not affect the prevalence of vaginal bleeding 1 year postoperatively after subtotal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery2017Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, nr 12, s. 1430-1437Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IntroductionThe objectives were to establish the prevalence of persistent vaginal bleeding following subtotal hysterectomy, to analyze the effect of intraoperative cervical treatment on the occurrence of persistent vaginal bleeding, and to evaluate the impact of persistent vaginal bleeding on the patient-reported opinion concerning result of surgery and medical condition. Material and methodsRetrospective study with data from the Swedish National Register for Gynecological Surgery including 5240 women undergoing subtotal hysterectomy for benign conditions between January 2004 and June 2016. Demographic and clinical data were obtained from the pre- and perioperative forms. Data concerning occurrence of persistent vaginal bleeding, rating of medical condition and contentment with result of surgery were collected from the 1-year inquiry form. Statistical analyses were performed with multivariable logistic regression models. The results are presented as adjusted odd ratios and 95% confidence intervals. ResultsPersistent vaginal bleeding occurred in 18.6%. Intraoperative cervical treatment did not affect the frequency of persistent vaginal bleeding (adjusted odds ratio 1.48; 95% confidence interval 0.93-2.37). More than 90% were satisfied with the result of the hysterectomy, but women with persistent vaginal bleeding were less content compared with those without persistent vaginal bleeding (adjusted odds ratio 0.42; 95% confidence interval 0.26-0.67). The self-perception of the medical condition did not differ between the women with and without persistent vaginal bleeding (adjusted odds ratio 1.16; 95% confidence interval 0.33-4.12). ConclusionsNearly two in ten women may expect persistent vaginal bleeding following subtotal hysterectomy, and cervical treatment intraoperatively did not affect this. More than 90% were satisfied with the result but women with persistent vaginal bleeding were less content. Preoperative information on this risk of persistent vaginal bleeding may be important when choosing hysterectomy technique.

  • 33.
    Borendal Wodlin, Ninnie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Intraoperative Cervical Treatment Does Not Affect the Prevalence of Vaginal Bleeding 1 Year Postoperatively After Subtotal Hysterectomy: A Register Study From the Swedish National Register for Gynecological Surgery2018Ingår i: Obstetrical and Gynecological Survey, ISSN 0029-7828, E-ISSN 1533-9866, Vol. 73, nr 2, s. 88-89Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A subtotal hysterectomy implies retaining the cervix. Women who undergo this procedure are more likely to present with persistent vaginal bleeding (PVB) after surgery. To prevent subsequent vaginal bleeding, intraoperative cervical treatment (electrosurgical cauterization or resection) has been recommended. However, there is insufficient evidence demonstrating the efficacy of this treatment. The aims of this retrospective register study were to (1) establish the prevalence of PVB 1 year after subtotal hysterectomy, (2) analyze the effect of intraoperative cervical treatment during the subtotal hysterectomy on the occurrence of PVB, and (3) assess the impact of PVB on the patients self-reported assessment of her medical condition and satisfaction with the hysterectomy 1 year after surgery. Data were obtained fromthe SwedishNational Register for Gynecological Surgery for a cohort of women who underwent subtotal hysterectomy for benign conditions between January 2004 and June 2016. Preoperative and perioperative forms were collected to obtain demographic and clinical data. The 1-year inquiry form was used to collect data on occurrence of PVB, rating of medical condition, and satisfaction with surgical results. Multivariate logistic regression analyses were used to assess outcome measures. The prevalence of PVB following subtotal hysterectomy was 18.6%. Intraoperative treatment of the cervix at the time of the subtotal hysterectomy did not affect the frequency of PVB; the adjusted odds ratio (aOR) was 1.48, with a 95% confidence interval (CI) of 0.93 to 2.37. Althoughmore than 90% of women were satisfied or very satisfied with the surgical results, those experiencing bleeding episodes 1 year after the subtotal hysterectomy were significantly less content with the result of the surgery (aOR, 0.42; 95% CI, 0.26-0.67). There was no difference in self-perception of the medical condition 1 year after the surgery between women with and without PVB; the aOR was 1.16 with a 95% CI of 0.33 to 4.12. These data show that nearly 2 in 10 women may expect PVB following subtotal hysterectomy and that intraoperative cervical treatment does not affect the prevalence of bleeding. Although more than 90% of patients are satisfied with the results of surgery, women with PVB are less content. When choosing hysterectomy technique, information on the risk of PVB may be important. Subtotal hysterectomy may not be an option for women not willing to accept this risk.

  • 34.
    Borneskog, C.
    et al.
    Uppsala University, Sweden .
    Lampic, C.
    Karolinska Institute, Sweden .
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Bladh, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken US.
    Skoog Svanberg, A.
    Uppsala University, Sweden .
    How do lesbian couples compare with heterosexual in vitro fertilization and spontaneously pregnant couples when it comes to parenting stress?2014Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, nr 5, s. 537-545Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimTo study parenting stress in lesbian parents and to compare that stress with heterosexual parents following in vitro fertilisation (IVF) or spontaneous pregnancies. MethodsThis survey took place during 2005-2008 and was part of the Swedish multicentre study on gamete donation. It comprised 131 lesbian parents, 83 heterosexual IVF parents, who used their own gametes, and 118 spontaneous pregnancy parents. The participants responded to the questionnaire when the child was between 12 and 36-months-old and parenting stress was measured by the Swedish Parenting Stress Questionnaire (SPSQ). ResultsLesbian parents experienced less parenting stress than heterosexual IVF parents when it came to the General Parenting Stress measure (p=0.001) and the subareas of Incompetence (pless than0.001), Social Isolation (p=0.033) and Role Restriction (p=0.004). They also experienced less parenting stress than heterosexual spontaneous pregnancy couples, according to the Social Isolation subarea (p=0.003). Birth mothers experienced higher stress than co-mothers and fathers, according to the Role Restriction measure (p=0.041). ConclusionThese are reassuring findings, considering the known challenges that lesbian families face in establishing their parental roles and, in particular, the challenges related to the lack of recognition of the co-mother.

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  • 35.
    Bothou, Christina
    et al.
    Univ Spital Zurich, Switzerland.
    Anand, Gurpreet
    Univ Spital Zurich, Switzerland.
    Li, Dingfeng
    Mayo Clin, MN 55905 USA.
    Kienitz, Tina
    Endocrinol Charlottenburg, Germany.
    Seejore, Khyatisha
    St James Univ Hosp, England.
    Simeoli, Chiara
    Univ Federico II Napoli, Italy.
    Ebbehoj, Andreas
    Aarhus Univ, Denmark.
    Ward, Emma G.
    St James Univ Hosp, England.
    Paragliola, Rosa Maria
    Univ Cattolica Sacro Cuore Fdn Policlin Univ Agos, Italy.
    Ferrigno, Rosario
    Univ Federico II Napoli, Italy.
    Badenhoop, Klaus
    Univ Hosp, Frankfurt, Germany.
    Bensing, Sophie
    Karolinska Univ Hosp, Sweden.
    Oksnes, Marianne
    Endocrinol Charlottenburg, Germany; Univ Bergen, Norway; Univ Bergen, Norway.
    Esposito, Daniela
    Univ Gothenburg, Sweden; Sahlgrenska Univ Hosp, Sweden.
    Bergthorsdottir, Ragnhildur
    Univ Gothenburg, Sweden; Sahlgrenska Univ Hosp, Sweden.
    Drake, William
    St Bartholomews Hosp, England.
    Wahlberg, Jeanette
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Endokrinmedicinska kliniken.
    Reisch, Nicole
    Klinikum Univ Munchen, Germany.
    Hahner, Stefanie
    Univ Wurzburg, Germany.
    Pearce, Simon
    Newcastle Univ, England.
    Trainer, Peter
    Christie NHS Fdn, England.
    Etzrodt-Walter, Gwendolin
    Praxis Dr Etzrodt Walter Endokrinol Zentrum Ulm, Germany.
    Thalmann, Sebastien P.
    Arztezentrum Sihlcity, Switzerland.
    Saevik, Ase B.
    Univ Bergen, Norway.
    Husebye, Eystein
    Univ Bergen, Norway.
    Isidori, Andrea M.
    Sapienza Univ Rome, Italy.
    Falhammar, Henrik
    Karolinska Univ Hosp, Sweden.
    Meyer, Gesine
    Univ Hosp, Germany.
    Corsello, Salvatore M.
    Univ Cattolica Sacro Cuore Fdn Policlin Univ Agos, Italy.
    Pivonello, Rosario
    Univ Federico II Napoli, Italy.
    Murray, Robert
    St James Univ Hosp, England.
    Bancos, Irina
    Mayo Clin, MN 55905 USA.
    Quinkler, Marcus
    Endocrinol Charlottenburg, Germany.
    Beuschlein, Felix
    Univ Spital Zurich, Switzerland; Klinikum Univ Munchen, Germany.
    Current Management and Outcome of Pregnancies in Women With Adrenal Insufficiency: Experience from a Multicenter Survey2020Ingår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 105, nr 8, s. E2853-E2863Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Context

    Appropriate management of adrenal insufficiency (AI) in pregnancy can be challenging due to the rarity of the disease and lack of evidence-based recommendations to guide glucocorticoid and mineralocorticoid dosage adjustment.

    Objective

    Multicenter survey on current clinical approaches in managing AI during pregnancy.

    Design

    Retrospective anonymized data collection from 19 international centers from 2013 to 2019.

    Setting and Patients

    128 pregnancies in 113 women with different causes of AI: Addison disease (44%), secondary AI (25%), congenital adrenal hyperplasia (25%), and acquired AI due to bilateral adrenalectomy (6%).

    Results

    Hydrocortisone (HC) was the most commonly used glucocorticoid in 83% (97/117) of pregnancies. Glucocorticoid dosage was increased at any time during pregnancy in 73/128 (57%) of cases. In these cases, the difference in the daily dose of HC equivalent between baseline and the third trimester was 8.6 ± 5.4 (range 1-30) mg. Fludrocortisone dosage was increased in fewer cases (7/54 during the first trimester, 9/64 during the second trimester, and 9/62 cases during the third trimester). Overall, an adrenal crisis was reported in 9/128 (7%) pregnancies. Cesarean section was the most frequent mode of delivery at 58% (69/118). Fetal complications were reported in 3/120 (3%) and minor maternal complications in 15/120 (13%) pregnancies without fatal outcomes.

    Conclusions

    This survey confirms good maternal and fetal outcome in women with AI managed in specialized endocrine centers. An emphasis on careful endocrine follow-up and repeated patient education is likely to have reduced the risk of adrenal crisis and resulted in positive outcomes.

  • 36.
    Brann, Emma
    et al.
    Uppsala Univ, Sweden.
    Fransson, Emma
    Uppsala Univ, Sweden; Karolinska Inst, Sweden.
    Wikman, Anna
    Uppsala Univ, Sweden.
    Kollia, Natasa
    Uppsala Univ, Sweden; Harokopio Univ, Greece.
    Nguyen, Diem
    Uppsala Univ, Sweden.
    Lilliecreutz, Caroline
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Skalkidou, Alkistis
    Uppsala Univ, Sweden.
    Who do we miss when screening for postpartum depression?: A population-based study in a Swedish region2021Ingår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 287, s. 165-173Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Universal screening for postpartum depression is crucial for early detection, interventions and support. The aim of this study was to describe the proportion of, and explore risk factors for, women not being offered screening, as well as for declining an offer or not being screened due to any other unknown reason. Methods: Socioeconomic, obstetrical and neonatal data, extracted from the Swedish Pregnancy Registry, for 9,959 pregnancies recorded for the ?Ostergo?tland county between 2016 and 2018 were linked to Edinburgh Postnatal Depression Scale (EPDS) screening results at 6?8 weeks postpartum, extracted from medical records. Risk factors were assessed using logistic regression models and with a nomogram for easy visualization. Results: In total, there were no recorded offers of EPDS screening in the medical records for 30.0% of women at the postpartum follow-up. Women born outside of Sweden and women reporting poor self-rated health were at increased risk of not being offered screening for postpartum depression. Limitations: There is a possibility that women were offered screening or were screened, but this was incorrectly or never recorded in medical records. Conclusions: The majority of women were offered screening for postpartum depression, but there is room for improvement in order to achieve universal screening. Awareness among healthcare providers of the risk factors for not screening might increase adherence to guidelines for universal screening. Overcoming barriers for screening and raising the topic of mental-health issues for postpartum women should be prioritized.

  • 37.
    Brynhildsen, Jan
    et al.
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, BKC - Barn och kvinnocentrum, KK - Kvinnokliniken.
    Nedstrand, Elizabeth
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, BKC - Barn och kvinnocentrum, KK - Kvinnokliniken.
    Wyon, Yvonne
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, BKC - Barn och kvinnocentrum, KK - Kvinnokliniken.
    Hammar, Mats
    Linköpings universitet, Institutionen för molekylär och klinisk medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, BKC - Barn och kvinnocentrum, KK - Kvinnokliniken.
    Motion motverkar menopausens minus. Gynnsamma effekter på både kropp och själ [Exercise counteracts the negative effects of menopause. Positive effects on both body and soul]1994Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 91, nr 23, s. 2323-5Artikel i tidskrift (Refereegranskat)
  • 38.
    Brüggemann, Cecilia
    et al.
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Carlhäll, Sara
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Grundström, Hanna
    Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken ViN. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa.
    Blomberg, Marie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Labor dystocia and oxytocin augmentation before or after six centimeters cervical dilatation, in nulliparous women with spontaneous labor, in relation to mode of birth2022Ingår i: BMC Pregnancy and Childbirth, E-ISSN 1471-2393, Vol. 22, nr 1, artikel-id 408Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The effects of diagnosing and treating labor dystocia with oxytocin infusion at different cervical dilatations have not been fully evaluated. Therefore, we aimed to examine whether cervical dilatation at diagnosis of dystocia and initiation of oxytocin infusion at different stages of cervical dilatation were associated with mode of birth, obstetric complications and womens birthing experience. Methods A retrospective cohort study, including 588 nulliparous term women with spontaneous onset of labor and dystocia requiring oxytocin augmentation. The study population was divided into three groups according to cervical dilatation at diagnosis of dystocia and initiation of oxytocin-infusion (<= 5 cm, 6-10 cm, fully dilated) with mode of birth as the primary outcome. Secondary outcomes were obstetrical and neonatal complications and women s experience of childbirth. Statistical comparison between groups using Chi-square and ANOVA was performed. The risk of operative birth (cesarean section and instrumental birth) was assessed using binary logistic regression with suitable adjustments (maternal age, body mass index and risk assessment on admission to the labor ward). Results The cesarean section rate differed between the groups (p < 0.001); 12% in the <= 5 cm group, 6% in the 6-10 cm group and 0% in the fully dilated group. There was no increased risk for operative birth in the <= 5 cm group compared to the 6-10 cm group, adjusted OR 1.28 95%CI (0.78-2.08). The fully dilated group had a decreased risk of operative birth (adjusted OR 0.48 95%CI (0.27-0.85). The rate of a negative birthing experience was high in all groups (28.5%, 19% and 18%) but was only increased among women in the <= 5 cm group compared with the 6-10 cm group, adjusted OR 1.76 95%CI (1.05-2.95). Conclusions Although no difference in the risk of operative birth was found between the <= 5 cm and 6-10 cm cervical dilatation-groups, the cesarean section rate was highest in women with dystocia requiring oxytocin augmentation at <= 5 cm cervical dilatation. This might indicate that oxytocin augmentation before 6 cm cervical dilatation could be contra-productive in preventing cesarean sections. Further, the increased risk of negative birth experience in the <= 5 cm group should be kept in mind to improve labor care.

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  • 39.
    Byrne, Molly
    et al.
    National University of Ireland, Ireland.
    Murphy, Patrick
    National University of Ireland, Ireland.
    DEath, Maureen
    National University of Ireland, Ireland.
    Doherty, Sally
    Royal Coll Surgeons Ireland, Ireland.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Association Between Sexual Problems and Relationship Satisfaction Among People With Cardiovascular Disease2017Ingår i: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 14, nr 5, s. 666-674Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Relationship satisfaction is generally positively correlated with sexual satisfaction, but this relation has been poorly examined in people with cardiovascular disease who are at increased risk of sexual problems compared with the general population. Aim: To document reported changes to sex after a diagnosis of cardiac disease and determine whether there is an association between sexual function and relationship satisfaction. Methods: Semistructured telephone interviews focused on relationship satisfaction and sexual problems were conducted with 201 people with cardiovascular disease who were currently in a sexual relationship with one main partner and were recruited from six hospital cardiac rehabilitation centers in Ireland. Comparisons between groups were conducted using t-tests and multivariate analysis of variance for continuous variables and chi(2) tests for categorical variables. Predictors of relationship satisfaction were assessed using multiple linear regression analysis. Outcomes: Data were gathered on demographic and clinical variables, sexual problems, and relationship satisfaction, including satisfaction with the physical, emotional, affection, and communication aspects of relationships. Results: Just less than one third of participants (n = 61, 30.3%) reported that sex had changed for the worse since their cardiac event or diagnosis, with approximately half of these stating that this was a serious problem for them. Satisfaction with relationships was high among patients surveyed; more than 70% of the sample reported being very or extremely satisfied with the physical and emotional aspects and showing affection during sex. Satisfaction with communication about sex was lower, with only 58% reporting being very or extremely satisfied. We did not find significant associations between reporting of sexual problems or deterioration of sex as a result of disease and relationship satisfaction. Clinical Implications: Cardiac rehabilitation programs should address these sexual problems, potentially by enhancing communication within couples about sex. Strengths and Limitations: The strength is that data are presented on the sexual experiences and relationship satisfaction of a relatively large sample of people diagnosed with cardiac disease, a relatively underexplored research area. Limitations include the possibility of selection bias of study participants and bias associated with self-report measurement. Conclusions: Sexual problems were significant in this population but were not related to relationship satisfaction in this cross-sectional survey. Copyright (C) 2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

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  • 40.
    Cambra, J. M.
    et al.
    Univ Murcia, Spain; Inst Biomed Res Murcia IMIB Arrixaca, Spain.
    Martinez-Serrano, Cristina
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Univ Murcia, Spain; Inst Biomed Res Murcia IMIB Arrixaca, Spain.
    Maside, C.
    Univ Murcia, Spain; Inst Biomed Res Murcia IMIB Arrixaca, Spain.
    Rodriguez-Martinez, Heriberto
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Martinez, E. A.
    Univ Murcia, Spain; Inst Biomed Res Murcia IMIB Arrixaca, Spain.
    Gil, M. A.
    Univ Murcia, Spain; Inst Biomed Res Murcia IMIB Arrixaca, Spain.
    Cuello, C.
    Univ Murcia, Spain; Inst Biomed Res Murcia IMIB Arrixaca, Spain.
    The cytokine platelet factor 4 successfully replaces bovine serum albumin for the in vitro culture of porcine embryos2020Ingår i: Theriogenology, ISSN 0093-691X, E-ISSN 1879-3231, Vol. 148, s. 201-207Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The cytokine platelet factor 4 (PF4) enhances differentiation and cell viability of different stem cells lines in vitro. This study investigated whether PF4 addition to customary pig embryo semi-defined culture media can improve their developmental outcome (Experiment 1) and ultimately replace the need for bovine serum albumin (BSA, Experiment 2). Experiment 1 added PF4 (100-1000 ng/mL, 0 = control) to NCSU-23 with 0.4 mg/mL BSA culturing 3430 presumptive zygotes. Experiment 2 added PF4 (100 -1000 ng/mL, 0 = Control-PVA) to a BSA-free medium (NCSU-23 with 0.3 mg/mL PVA) culturing 3820 presumptive zygotes. Zygote culture in NCSU-23 with 0.4 mg/mL BSA was used as overall control. All groups of Experiment 1 displayed similar rates of day 2-cleavage (range: 65.0 +/- 10.9 to 70.0 +/- 5.8%); of day 7-blastocyst rates (range: 46.6 +/- 10.0 to 56.4 +/- 8.2%) and of total day 7-blastocyst efficiency (range: 32.3 +/- 8.3 to 37.2 +/- 7.3%). Addition of PF4 did not affect total cell numbers of day 7 blastocysts (range: 44.1 +/- 23.2 to 50.5 +/- 26.4). In Experiment 2, PF4 accelerated embryo development, increasing (P < 0.01) blastocyst yield compared to 0-PF4, and blastocyst formation by day 5 adding PF4 100-500 ng/mL (range: 29.9 +/- 7.8 to 31.8 +/- 5.5%; P < 0.05) compared with BSA-control (17.2 +/- 8.2%) and PF4 1000 ng/mL (15.5 +/- 7.9%); showing similar blastocyst rates (range: 42.0 +/- 11.5 to 49.3 +/- 10.0%), total efficiency (28.0 +/- 8.2 to 32.3 +/- 7.1%) total cell numbers (range: 42.6 +/- 19.3 to 45.7 +/- 23.9) as BSA-controls. In conclusion, although PF4 did not show additive improvement under usual semi-defined, BSA-supplemented embryo media, it successfully replaced BSA sustaining porcine blastocyst production in chemically defined conditions. (C) 2019 Elsevier Inc. All rights reserved.

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  • 41.
    Cambra, Josep M.
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Univ Murcia, Spain; Inst Biomed Res Murcia IMIB Arrixaca, Spain.
    Jauregi-Miguel, Amaia
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Alvarez-Rodriguez, Manuel
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Parrilla, Inmaculada
    Univ Murcia, Spain; Inst Biomed Res Murcia IMIB Arrixaca, Spain.
    Gil, Maria A.
    Univ Murcia, Spain; Inst Biomed Res Murcia IMIB Arrixaca, Spain.
    Martinez, Emilio A.
    Univ Murcia, Spain; Inst Biomed Res Murcia IMIB Arrixaca, Spain.
    Cuello, Cristina
    Univ Murcia, Spain; Inst Biomed Res Murcia IMIB Arrixaca, Spain.
    Rodriguez-Martinez, Heriberto
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Martinez Serrano, Cristina
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Allogeneic Embryos Disregulate Leukemia Inhibitory Factor (LIF) and Its Receptor in the Porcine Endometrium During Implantation2020Ingår i: Frontiers in Veterinary Science, E-ISSN 2297-1769, Vol. 7, artikel-id 611598Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Despite its advantages for pig breeding, embryo transfer (ET) has a major handicap: high embryo mortality during the pre- and implantation period, probably caused by divergent phenomena of tolerance between the immunologically unrelated (i.e., allogeneic) embryos and the recipient sow. Thus, to reach a similar maternal tolerance as in conventional breeding by artificial insemination (AI) would be the key to ET-success. For this reason, we studied the expression of the leukemia inhibitory factor (LIF) cytokine and its receptor in the pig endometrium during the implantation period (days 18 and 24) in sows subjected to ET (AL group) vs. post-cervical-AI controls (Hemi-AL group). Quantification of expression was performed at both mRNA (rt-qPCR) and protein (WB) levels. The expression of endometrial LIF on day 24 was considerably lower in ET than in AI pregnancies. Correlations between endometrial mRNA levels of LIF and LIF-R showed that, contrary to early AI-pregnancies, ET-pregnancies lack an inverse relation between cytokine and receptor levels. In conclusion, ET-pregnancies lack sufficient endometrial levels of LIF to develop adequate immunotolerance mechanisms to prevent the rejection of allogeneic ET-embryos.

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  • 42.
    Campbell, Rachel
    et al.
    Univ Sydney, Australia.
    Costa, Daniel S. J.
    Univ Sydney, Australia.
    Stockler, Martin R.
    Univ Sydney, Australia.
    Lee, Yeh Chen
    Univ Sydney, Australia; Australia New Zealand Gynaecol Oncol Grp ANZGOG, Australia; Prince Wales Hosp, Australia.
    Ledermann, Jonathan A.
    NCRI UK, England.
    Berton, Dominique
    GINECO Grp Invest Nationaux Etud Canc Ovariens, France; Ctr Rene Gauducheau, France.
    Sehouli, Jalid
    Arbeitsgesmeinschaft Gynakol Onkol Studiengrp AGO, Germany; North Eastern German Soc Gynecol Oncol NOGGO, Germany; Charite, Germany.
    Roncolato, Felicia T.
    Univ Sydney, Australia; Australia New Zealand Gynaecol Oncol Grp ANZGOG, Australia; Prince Wales Hosp, Australia; Campbelltown Hosp, Australia.
    Connell, Rachel O.
    Univ Sydney, Australia.
    Okamoto, Aikou
    Japanese Gynecol Oncol Grp JGOG, Japan; Jikei Univ, Japan.
    Bryce, Jane
    Ist Nazl Tumori IRCCS, Italy; Ascens St John Clin Res Inst, OK USA.
    Oza, Amit M.
    Princess Margaret Consortium PMHC, Canada; Univ Toronto, Canada.
    Åvall Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US. Nordic Soc Gynaecol Oncol NSGO, Denmark; Karolinska Inst, Sweden.
    Berek, Jonathan S.
    Cooperat Gynecol Oncol Investigators COGI, CA USA; Stanford Univ, CA USA.
    Lanceley, Anne
    UCL, England.
    Joly, Florence
    GINECO Grp Invest Nationaux Etud Canc Ovariens, France; Ctr Francois Baclesse, France.
    Hilpert, Felix
    Arbeitsgesmeinschaft Gynakol Onkol Studiengrp AGO, Germany; North Eastern German Soc Gynecol Oncol NOGGO, Germany; Krankenhaus Jerusalem, Germany.
    Feeney, Amanda
    NCRI UK, England.
    Kaminsky, Marie C.
    GINECO Grp Invest Nationaux Etud Canc Ovariens, France; Alexis Vautrin, France.
    Diamante, Katrina
    Univ Sydney, Australia.
    Friedlander, Michael L.
    Australia New Zealand Gynaecol Oncol Grp ANZGOG, Australia; Prince Wales Hosp, Australia.
    King, Madeleine T.
    Univ Sydney, Australia.
    Measure of Ovarian Symptoms and Treatment concerns (MOST) indexes and their associations with health-related quality of life in recurrent ovarian cancer2022Ingår i: Gynecologic Oncology, ISSN 0090-8258, E-ISSN 1095-6859, Vol. 166, nr 2, s. 254-262Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose. The Measure of Ovarian Symptoms and Treatment (MOST) concerns is a validated patient-reported symptom assessment tool for assessing symptom benefit and adverse effects of palliative chemotherapy in women with recurrent ovarian cancer (ROC). We aimed to examine (i) how symptoms within MOST symptom indexes track together (i.e. co-occur) and (ii) the association between MOST symptom indexes and key aspects of health-related quality of life (HRQL). Method. A prospective cohort of women with ROC completed the MOST-T35, EORTC QLQ-C30 and EORTC QLQ-OV28 at baseline and before each cycle of chemotherapy. Analyses were conducted on baseline and end -of-treatment data. Exploratory factor analysis and hierarchical cluster analysis identified groups of co-occurring symptoms. Path models examined associations between MOST symptom indexes and HRQL. Results. Data from 762 women at baseline and 681 at treatment-end who completed all 22 symptom-specific MOST items and at least one HRQL measure were analysed. Four symptom clusters emerged at baseline and treatment-end: abdominal symptoms, symptoms associated with peripheral neuropathy, nausea and vomiting, and psychological symptoms. Psychological symptoms (MOST-Psych) and symptoms due to disease (ovarian cancer) or treatment (MOST-DorT) were associated with poorer scores on QLQ-C30 and OV28 functioning do-mains and worse overall health at both time points. Conclusion. Four MOST symptom clusters were consistent across statistical methods and time points. These findings suggest that routine standardized assessment of psychological and physical symptoms in clinical prac-tice with MOST plus appropriate symptom management referral pathways is an intervention for improving HRQL that warrants further research. (c) 2022 Elsevier Inc. All rights reserved.

  • 43.
    Carlander, Anna-Karin Klint
    et al.
    Danderyd Hosp, Sweden.
    Thorsell, Malin
    Danderyd Hosp, Sweden.
    Demetry, Youstina
    Karolinska Inst, Sweden.
    Nikodell, Sky
    Linköpings universitet, Medicinska fakulteten.
    Kallner, Helena Kopp
    Danderyd Hosp, Sweden.
    Skoglund, Charlotte
    Uppsala Univ, Sweden.
    Knowledge, challenges, and standard of care of young women with ADHD at Swedish youth clinics2022Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 32, artikel-id 100727Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Sexual risk-taking and its consequences for young women with ADHD(attention deficit hyperactivity disorder) including sexually transmitted diseases, teenage pregnancies and underage parenthood constitute substantial challenges for individuals and midwives. The aim was to investigate current knowledge and specific challenges in reproductive health and contraceptive counselling for women with ADHD at Swedish youth clinics.

    Method: Inductive qualitative interview study of ten midwives at six youth health clinics in Stockholm and Uppsala County. We used a semi-structured interview guide. The interviews were transcribed verbatim and analyzed with the NVivo 12 qualitative data analysis software.

    Results: Three main categories were identified: (1) challenges in provision of care of young women with ADHD, (2) standard of care and active adaptations towards women with ADHD and (3) organizational readiness for change;. Several challenges and frustrations, such as difficulties with attention with or without concomitant impulsivity and overactivity, in provision of reproductive health and contraceptive counselling for young women with ADHD were identified. Midwives reported high organizational readiness for improvement of standard of care.

    Conclusions: Inadequate contraceptive counseling or lack of knowledge on specific challenges in the sexual and reproductive health of young women with ADHD may contribute to this group failing to access, inadequately respond to, or act upon counseling at youth clinics. Support for midwives with evidence-based interventions specifically developed for these women are imperative. Development of such tools should be a priority for research.

  • 44. Beställ onlineKöp publikationen >>
    Carlhäll, Sara
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Maternal obesity, duration of labor and the role of leptin2018Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: The prevalence of obesity substantially increases in pregnant women. Maternal obesity is associated with adverse maternal and neonatal outcomes. The increased risk for cesarean section present in obese women has been related to potential impaired uterine contractility. The mechanism that underlies this theory is not clear. In vitro studies have shown that leptin, produced by adipose tissue and the placenta, exerts an inhibitory effect on myometrial contractility. The aim of this thesis was to evaluate the labor process in relation to maternal body mass index (BMI) and the clinical role of leptin in this process.

    Material and Methods: Studies I-IV are cohort studies. The first two studies analyze the association between labor duration and maternal BMI based on data from the Perinatal Revision South register and the Swedish Pregnancy Register. Study I included 63,829 nulliparous women with a spontaneous onset of labor between 1995 and 2009. Study II included 15,259 nulliparous women with induced labor between 2014 and 2017. In study III, the maternal leptin levels during and after pregnancy were analyzed in 343 obese women with respect to their obesity class (I-III) and degree of gestational weight gain (GWG). In study IV, the association between the maternal leptin levels measured in active labor and duration of the active phase of labor was analyzed in 914 women.

    Results: The duration of spontaneous labor significantly increased with an increasing maternal BMI; however, the duration of the pushing phase was inversely related to BMI. Time in induced labor increased with maternal BMI; however, the differences between the BMI categories were more pronounced in the latent phase than the active phase. Leptin levels were higher in women with obesity class III than women with class I during and after pregnancy. The degree of GWG in obese women was not associated with maternal leptin. No significant association between maternal leptin and the duration of the active phase of labor was identified in the adjusted analyses.

    Conclusions: Nulliparous obese women have a higher risk for a prolonged duration of spontaneous and induced labor. This is important to consider prior to diagnosing labor arrest that results in a cesarean delivery. As maternal leptin levels are increased with the degree of obesity during pregnancy, future research on the association of high maternal leptin levels and the duration of labor is warranted.

    Delarbeten
    1. Maternal body mass index and duration of labor
    Öppna denna publikation i ny flik eller fönster >>Maternal body mass index and duration of labor
    2013 (Engelska)Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 171, nr 1, s. 49-53Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective: To evaluate whether the duration of the active phase of labor is associated with maternal body mass index (BMI), in nulliparous women with spontaneous onset of labor. less thanbrgreater than less thanbrgreater thanStudy design: Historical prospective cohort study including 63,829 nulliparous women with a singleton pregnancy and a spontaneous onset of labor, who delivered between January 1, 1995 and December 31, 2009. Data were collected from the Perinatal Revision South registry, a regional perinatal database in Southern Sweden. Women were categorized into six classes of BMI. Overweight and obese women were compared to normal weight women regarding duration of active labor. Adjustments were made for year of delivery, maternal age and infant birth weight. less thanbrgreater than less thanbrgreater thanResults: The median duration of labor was significantly longer in obese women (class I obesity (BMI 30-34.9) = 9.1 h, class II obesity (BMI 35-39.9) = 9.2 h and class III obesity (BMI andgt; 40) = 9.8 h) compared to normal-weight women (BMI 18.5-24.9) = 8.8 h (p andlt; 0.001). The risk of labor lasting more than 12 h increased with increasing maternal BMI: OR 1.04(1.01-1.06) (OR per 5-units BMI-increase).The risk of labor lasting more than 12 h or emergency cesarean section within 12 h, compared to vaginal deliveries within 12 h, increased with increasing maternal BMI. Duration of the second stage of labor was significantly shorter in obese women: in class III obesity the median value was 0.45 h compared to normal weight women, 0.55 h (p andlt; 0.001). less thanbrgreater than less thanbrgreater thanConclusion: In nulliparous women with a spontaneous onset of labor, duration of the active phase of labor increased significantly with increasing maternal BMI. Once obese women reach the second stage they deliver more quickly than normal weight women, which implies that the risk of prolonged labor is restricted to the first stage of labor. It is clinically important to consider the prolonged first stage of labor in obese women, for example when diagnosing first stage labor arrest, in order to optimize management of this rapidly growing at-risk group of women. Thus, it might be reasonable to adapt the considered upper limit for duration of labor, according to maternal BMI.

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2013
    Nyckelord
    Maternal body mass index, Obesity, Active phase of labor, Second stage of labor, Nulliparous women
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-102720 (URN)10.1016/j.ejogrb.2013.08.021 (DOI)000327562900011 ()
    Tillgänglig från: 2013-12-19 Skapad: 2013-12-19 Senast uppdaterad: 2024-01-10
    2. Maternal obesity (Class I-III), gestational weight gain and maternal leptin levels during and after pregnancy: a prospective cohort study
    Öppna denna publikation i ny flik eller fönster >>Maternal obesity (Class I-III), gestational weight gain and maternal leptin levels during and after pregnancy: a prospective cohort study
    Visa övriga...
    2016 (Engelska)Ingår i: BMC Obesity, ISSN 2052-9538, Vol. 3, nr 28Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background

    Maternal obesity is accompanied by maternal and fetal complications during and after pregnancy. The risks seem to increase with degree of obesity. Leptin has been suggested to play a role in the development of obesity related complications. Whether maternal leptin levels differ between obese and morbidly obese women, during and after pregnancy, have to our knowledge not been previously described. Neither has the association between maternal leptin levels and gestational weight gain in obese women. The aim was to evaluate if maternal plasma leptin levels were associated with different degrees of maternal obesity and gestational weight gain.

    Methods

    Prospective cohort study including women categorized as obesity class I-III (n = 343) and divided into three gestational weight gain groups (n = 304). Maternal plasma leptin was measured at gestational week 15, 29 and 10 weeks postpartum. Maternal Body Mass Index (BMI) was calculated from early pregnancy weight. Gestational weight gain was calculated using maternal weight in delivery week minus early pregnancy weight. The mean value and confidence interval of plasma-leptin were analysed with a two-way ANOVA model. Interaction effect between BMI and gestational weight gain group was tested with a two-way ANOVA model.

    Results

    The mean maternal leptin concentrations were significantly higher in women with obesity class III compared to women in obesity class I, at all times when plasma leptin were measured. The mean leptin concentrations were also significantly higher in women with obesity class II compared to women in obesity class I, except in gestational week 29. There was no difference in mean levels of plasma leptin between the gestational weight gain groups. No significant interaction between BMI and gestational weight gain group was found.

    Conclusions

    Plasma leptin levels during and after pregnancy were associated with obesity class but not with degree of gestational weight gain. These results are in concordance with epidemiological findings where the risk of obstetric complications increases with increased maternal obesity class. The effect on obstetric outcome by degree of gestational weight gain is less pronounced than the adverse effects associated with maternal obesity.

    Ort, förlag, år, upplaga, sidor
    BioMed Central, 2016
    Nyckelord
    Maternal obesity, Leptin, Gestational weight gain, Pregnancy and body mass index
    Nationell ämneskategori
    Reproduktionsmedicin och gynekologi Näringslära Endokrinologi och diabetes Pediatrik Farmaceutisk synteskemi
    Identifikatorer
    urn:nbn:se:liu:diva-134846 (URN)10.1186/s40608-016-0108-2 (DOI)
    Tillgänglig från: 2017-02-27 Skapad: 2017-02-27 Senast uppdaterad: 2024-01-10Bibliografiskt granskad
    3. Maternal plasma leptin levels in relation to the duration of the active phase of labor
    Öppna denna publikation i ny flik eller fönster >>Maternal plasma leptin levels in relation to the duration of the active phase of labor
    2018 (Engelska)Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, nr 10, s. 1248-1256Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Abstract Introduction Obese women have increased leptin levels and longer duration of labor compared with normal-weight women. Leptin has an inhibitory effect on myometrial contractility in vitro. Our purpose was to examine whether maternal leptin levels in active labor were associated with the duration of the active phase of labor. Material and methods This prospective cohort study included 914 women. Maternal blood samples were collected in active labor. The plasma-leptin concentration was obtained using a direct sandwich-based ELISA. Bivariate and multiple linear regression analyses were used to study the association between leptin levels and the duration of labor. Results A 1 ng/mL increase in maternal plasma leptin was associated with a 0.015 hour increase in duration of labor (P < .007). This association was not statistically significant in the adjusted analyses nor when analyzing nulliparous and multiparous women separately. In women with spontaneous labor (n = 766) leptin levels were not associated with an increase in duration of labor in the adjusted analyses. Conclusions There was no significant association between leptin levels and duration of the active phase of labor. Leptin in vivo might display a similar dose-response effect on myometrial contractility as demonstrated in in vitro studies. Future studies need to explore the association between leptin levels and time in labor in obese women with high leptin levels to evaluate a possible dose-response effect.

    Ort, förlag, år, upplaga, sidor
    Wiley-Blackwell, 2018
    Nyckelord
    active phase of labor, delivery, duration of labor, leptin, obesity
    Nationell ämneskategori
    Reproduktionsmedicin och gynekologi
    Identifikatorer
    urn:nbn:se:liu:diva-151340 (URN)10.1111/aogs.13380 (DOI)000444070900014 ()
    Konferens
    2018/09/18
    Anmärkning

    Funding agencies: Ostergotland County Council

    Tillgänglig från: 2018-09-18 Skapad: 2018-09-18 Senast uppdaterad: 2024-01-10
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    Maternal obesity, duration of labor and the role of leptin
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  • 45.
    Carlhäll, Sara
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US. Univ Auckland, New Zealand.
    Alsweiler, Jane
    Univ Auckland, New Zealand.
    Battin, Malcolm
    Univ Auckland, New Zealand.
    Wilson, Jessica
    Univ Auckland, New Zealand; Univ Auckland, New Zealand.
    Sadler, Lynn
    Te Toka Tumai, New Zealand.
    Thompson, John M. D.
    Univ Auckland, New Zealand; Univ Auckland, New Zealand.
    Wise, Michelle R.
    Univ Auckland, New Zealand.
    Neonatal and maternal outcomes at early vs. full term following induction of labor; A secondary analysis of the OBLIGE randomized trial2024Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Birth at early term (37(+0) -38(+6) completed gestational weeks [GW] and additional days) is associated with adverse neonatal outcomes compared with waiting to >= 39 GW. Most studies report outcomes after elective cesarean section or a mix of all modes of births; it is unclear whether these adverse outcomes apply to early-term babies born after induction of labor (IOL). We aimed to determine, in women with a non-urgent induction indication (elective/planned >48 h in advance), if IOL at early and late term was associated with adverse neonatal and maternal outcomes compared with IOL at full term.

    Material and methods: An observational cohort study as a secondary analysis of a multicenter randomized controlled trial of 1087 New Zealand women with a planned IOL >= 37(+0) GW. Multivariable logistic regression was used to analyze neonatal and maternal outcomes in relation to gestational age; 37(+0) -38(+6) (early term), 39(+0) -40(+6) (full term) and >= 41(+0) (late term) GW. Neonatal outcome analyses were adjusted for sex, birthweight, mode of birth and induction indication, and maternal outcome analyses for parity, age, body mass index and induction method. The primary neonatal outcome was admission to neonatal intensive care unit (NICU) for >4 hours; the primary maternal outcome was cesarean section.

    Results: Among the 1087 participants, 266 had IOL at early term, 480 at full term, and 341 at late term. Babies born following IOL at early term had increased odds for NICU admission for >4 hours (adjusted odds ratio [aOR] 2.16, 95% confidence intervals (CI) 1.16-4.05), compared with full term. Women having IOL at early term had no difference in emergency cesarean rates but had an increased need for a second induction method (aOR 1.70, 95% CI 1.15-2.51) and spent 4 h longer from start of IOL to birth (Hodges-Lehmann estimator 4.10, 95% CI 1.33-6.95) compared with those with IOL at full term.

    Conclusions: IOL for a non-urgent indication at early term was associated with adverse neonatal and maternal outcomes and no benefits compared with IOL at full term. These findings support international guidelines to avoid IOL before 39 GW unless there is an evidence-based indication for earlier planned birth and will help inform women and clinicians in their decision-making about timing of IOL.

  • 46.
    Carlhäll, Sara
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Bladh, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Brynhildsen, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Claesson, Ing-Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Josefsson, Ann
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Thorsell, Annika
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten.
    Blomberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Maternal obesity (Class I-III), gestational weight gain and maternal leptin levels during and after pregnancy: a prospective cohort study2016Ingår i: BMC Obesity, ISSN 2052-9538, Vol. 3, nr 28Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Maternal obesity is accompanied by maternal and fetal complications during and after pregnancy. The risks seem to increase with degree of obesity. Leptin has been suggested to play a role in the development of obesity related complications. Whether maternal leptin levels differ between obese and morbidly obese women, during and after pregnancy, have to our knowledge not been previously described. Neither has the association between maternal leptin levels and gestational weight gain in obese women. The aim was to evaluate if maternal plasma leptin levels were associated with different degrees of maternal obesity and gestational weight gain.

    Methods

    Prospective cohort study including women categorized as obesity class I-III (n = 343) and divided into three gestational weight gain groups (n = 304). Maternal plasma leptin was measured at gestational week 15, 29 and 10 weeks postpartum. Maternal Body Mass Index (BMI) was calculated from early pregnancy weight. Gestational weight gain was calculated using maternal weight in delivery week minus early pregnancy weight. The mean value and confidence interval of plasma-leptin were analysed with a two-way ANOVA model. Interaction effect between BMI and gestational weight gain group was tested with a two-way ANOVA model.

    Results

    The mean maternal leptin concentrations were significantly higher in women with obesity class III compared to women in obesity class I, at all times when plasma leptin were measured. The mean leptin concentrations were also significantly higher in women with obesity class II compared to women in obesity class I, except in gestational week 29. There was no difference in mean levels of plasma leptin between the gestational weight gain groups. No significant interaction between BMI and gestational weight gain group was found.

    Conclusions

    Plasma leptin levels during and after pregnancy were associated with obesity class but not with degree of gestational weight gain. These results are in concordance with epidemiological findings where the risk of obstetric complications increases with increased maternal obesity class. The effect on obstetric outcome by degree of gestational weight gain is less pronounced than the adverse effects associated with maternal obesity.

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    Maternal obesity (Class I-III), gestational weight gain and maternal leptin levels during and after pregnancy: a prospective cohort study
  • 47.
    Carlhäll, Sara
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Kallen, Karin
    Lund Univ, Sweden.
    Blomberg, Marie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    The effect of maternal body mass index on duration of induced labor2020Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 99, nr 5, s. 669-678Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Obese primiparous women with induction of labor are at high risk for a cesarean section. There are contradictory results regarding time in induced labor in relation to maternal body mass index (BMI). It is important to characterize the course of induced labor to prevent unnecessary cesarean section. We aimed to evaluate whether the duration of labor was associated with maternal BMI in primiparous women with induction of labor. Material and methods A national retrospective cohort study, including 15 259 primiparae with a single term pregnancy, admitted for induction of labor from January 2014 to August 2017. Data were obtained from the Swedish Pregnancy Registry. Cox regression analyses were used to illustrate the association between BMI and active labor and between BMI and time from admission until start of active labor. Results Duration of active labor was shorter in underweight women and prolonged in women with BMI amp;gt;= 40 kg/m(2) compared with women in other BMI classes, illustrated by Cox regression graphs (P amp;lt; .001). The median durations of active labor in underweight women were 6.1 and 7.4 hours in women with BMI amp;gt;= 40 kg/m(2). The time from admission until start of active labor increased with maternal BMI, illustrated by Cox regression graphs (P amp;lt; .001) and the median duration increased from 12.9 hours in underweight women to 22.6 hours in women with BMI amp;gt;= 40 kg/m(2). The cesarean section rate in active labor increased significantly with BMI (P amp;lt; .001) from 7.4% in underweight women to 22.0% in women with BMI amp;gt;= 40 kg/m(2). Obese and normal weight women had similar rates of spontaneous vaginal delivery (69.9% in the total study population). Conclusions The duration of active labor was associated with maternal BMI for underweight women and women with BMI amp;gt;= 40 kg/m(2). Although women with BMI amp;gt;= 40 kg/m(2) who reached the active phase of labor had the same chance for a spontaneous vaginal delivery as normal weight women, the duration of active labor and the cesarean section rate were increased. The time from admission until start of active labor increased successively with maternal BMI.

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  • 48.
    Carlhäll, Sara
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Källén, Karin
    Institution of Clinical Sciences Lund, Center for Reproductive Epidemiology, Tornblad Institute, Lund University, Lund, Sweden.
    Thorsell, Annika
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten.
    Blomberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Maternal plasma leptin levels in relation to the duration of the active phase of labor2018Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, nr 10, s. 1248-1256Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract Introduction Obese women have increased leptin levels and longer duration of labor compared with normal-weight women. Leptin has an inhibitory effect on myometrial contractility in vitro. Our purpose was to examine whether maternal leptin levels in active labor were associated with the duration of the active phase of labor. Material and methods This prospective cohort study included 914 women. Maternal blood samples were collected in active labor. The plasma-leptin concentration was obtained using a direct sandwich-based ELISA. Bivariate and multiple linear regression analyses were used to study the association between leptin levels and the duration of labor. Results A 1 ng/mL increase in maternal plasma leptin was associated with a 0.015 hour increase in duration of labor (P < .007). This association was not statistically significant in the adjusted analyses nor when analyzing nulliparous and multiparous women separately. In women with spontaneous labor (n = 766) leptin levels were not associated with an increase in duration of labor in the adjusted analyses. Conclusions There was no significant association between leptin levels and duration of the active phase of labor. Leptin in vivo might display a similar dose-response effect on myometrial contractility as demonstrated in in vitro studies. Future studies need to explore the association between leptin levels and time in labor in obese women with high leptin levels to evaluate a possible dose-response effect.

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  • 49.
    Carlsson, Isabelle
    et al.
    Skaraborg Hosp Skovde, Sweden.
    Breding, Karin
    Skaraborg Hosp Skovde, Sweden.
    Larsson, Per-Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Skaraborg Hosp Skovde, Sweden.
    Complications related to induced abortion: a combined retrospective and longitudinal follow-up study2018Ingår i: BMC Women's Health, E-ISSN 1472-6874, Vol. 18, artikel-id 158Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Induced abortion is one of the most common gynecological procedures in Sweden, but there is still little knowledge about the adverse effects. The aims of this study are to provide an overview of complications of medical and surgical abortions and to evaluate the impact of bacterial screening to prevent postabortal infections. Methods: All women who underwent induced abortion at Skaraborg Hospital between 2008 and 2015 are included in the study. Bacterial screening for chlamydia, gonorrhea, mycoplasma, and bacterial vaginosis was performed prior to the abortions. Abortion complications, categorized as bleeding, infection, or incomplete abortion were assessed in women who came in contact with the gynecological clinic within 30 days after the procedure. Results: A total of 4945 induced abortions were performed during the study period. Nearly all, 4945 (99.7%) were eligible for inclusion in the study. Medical abortions amp;lt; 12 weeks were the most common procedure (74.7%), followed by surgical abortions (17.5%), and medical abortion amp;gt; 12 weeks (7.8%). Complications were registered in 333 (6.7%) of all abortions. Among medical abortions amp;lt; 12 weeks, the complication frequency increased significantly, from 4.2% in 2008 to 8.2% in 2015 (RR 1.49, 95% 1.04-2.15). An incomplete abortion was the most common complication related to medical abortions amp;lt; 12 weeks. Of all women who tested positive for one or several bacteria at the screening and therefore received antibiotics, 1.4% developed a postabortal infection. Among those who tested negative at the screening, 1.7% developed infectious complications. Conclusions: The share of complications related to medical abortions amp;lt; 12 weeks increased significantly during 2008-2015 without any evident cause. Women who tested positive for one or several bacteria upon screening and received antibiotics experienced almost an equal proportion of postabortal infections compared to women who tested negative upon screening. The screening process seems to fulfill its purpose of reducing the risk of infectious complications.

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  • 50.
    Carlsson, Ylva
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Bergman, Lina
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Zaigham, Mehreen
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Linden, Karolina
    Univ Gothenburg, Sweden.
    Andersson, Ola
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Veje, Malin
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Sandström, Anna
    Karolinska Inst, Sweden.
    Wikström, Anna-Karin
    Uppsala Univ, Sweden.
    Östling, Hanna
    Orebro Univ, Sweden.
    Fadl, Helena
    Orebro Univ, Sweden.
    Domellöf, Magnus
    Umea Univ, Sweden.
    Blomberg, Marie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Wendel, Sophia Brismar
    Karolinska Inst, Sweden; Danderyd Hosp, Sweden.
    Åden, Ulrika
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Sengpiel, Verena
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    COVID-19 in Pregnancy and Early Childhood (COPE): study protocol for a prospective, multicentre biobank, survey and database cohort study2021Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 11, nr 9, artikel-id e049376Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction There is limited knowledge on how the SARS-CoV-2 affects pregnancy outcomes. Studies investigating the impact of COVID-19 in early pregnancy are scarce and information on long-term follow-up is lacking. The purpose of this project is to study the impact of COVID-19 on pregnancy outcomes and long-term maternal and child health by: (1) establishing a database and biobank from pregnant women with COVID-19 and presumably non-infected women and their infants and (2) examining how women and their partners experience pregnancy, childbirth and early parenthood in the COVID-19 pandemic. Methods and analysis This is a national, multicentre, prospective cohort study involving 27 Swedish maternity units accounting for over 86 000 deliveries/year. Pregnant women are included when they: (1) test positive for SARS-CoV-2 (COVID-19 group) or (2) are non-infected and seek healthcare at one of their routine antenatal visits (screening group). Blood, as well as other biological samples, are collected at different time points during and after pregnancy. Child health up to 4 years of age and parent experience of pregnancy, delivery, early parenthood, healthcare and society in general will be examined using web-based questionnaires based on validated instruments. Short- and long-term health outcomes will be collected from Swedish health registers and the parents experiences will be studied by performing qualitative interviews. Ethics and dissemination Confidentiality aspects such as data encryption and storage comply with the General Data Protection Regulation and with ethical committee requirements. This study has been granted national ethical approval by the Swedish Ethical Review Authority (dnr 2020-02189 and amendments 2020-02848, 2020-05016, 2020-06696 and 2021-00870) and national biobank approval by the Biobank Vast (dnr B2000526:970). Results from the project will be published in peer-reviewed journals.

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