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  • 51. Leeb-Lundberg, Sara
    et al.
    Kjellberg, Svante
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Helping parents to tell their children about the use of donor insemination (DI) and determining their opinions about open-identity sperm donors2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 1, p. 78-81Article in journal (Refereed)
    Abstract [en]

    Objective. To look at the level of compliance with Swedish law whether or not parents intend to tell their child about donor insemination. We also wanted to look at the parents' attitudes towards open-identity sperm donors and at relationships within the family. Method. All parents who were treated and gave birth to a child through donor insemination from 1997 to 2003 were included in the study. Sixteen of 20 couples (80%) were willing to take part in an interview, where the men and women were interviewed separately. The children of these couples had an average age of 2.9 years. Results. Three of the 16 couples had told their child about donor insemination and 9 couples intended to tell the child when he/she was older. Thus 12 couples (75%) had disclosed or planned to inform their child in the future. Fourteen of 16 couples had told others about the donor insemination. The majority (20 of 31 individuals) had a positive attitude towards open-identity for sperm donors and 21 of 31 would have chosen an open-identity sperm donor if they had had the choice between that and an anonymous donor. All the parents felt they had an equal relationship with their child. Conclusion. Couples who conceived a child through donor insemination are open about the donor insemination, both to other people in their surroundings and in their intention to tell the child. These families seem to be functioning well with relaxed attitudes towards the donor insemination process. © 2006 Taylor & Francis.

  • 52.
    Liest, Lisbeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Omran, Ahmed Shaker
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Mikiver, Rasmus
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Regional Cancer Center.
    Rosenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Uppugunduri, Srinivas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    RMI and ROMA are equally effective in discriminating between benign and malignant gynecological tumors: A prospective population-based study2019In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 1, p. 24-33Article in journal (Refereed)
    Abstract [en]

    Introduction Our primary objective was to test the hypothesis that human epididymal protein 4 (HE4) and risk of ovarian malignancy index outperform the CA 125 and risk of malignancy index tests in categorizing a pelvic mass into high or low risk of malignancy in a Swedish population. Furthermore, cut-off values needed to be defined for HE4 and ROMA in premenopausal and postmenopausal women prior to their introduction to clinical practice. A third objective was to investigate the correlation between HE4 levels in serum and urine. Material and methods Women with a pelvic mass scheduled for surgery were recruited from nine hospitals in south-east Sweden. Preoperative blood samples were taken for analyzing CA125 and HE4 as well as urine samples for analyzing HE4. Results We enrolled a total of 901 women, of whom 784 were evaluable. In the premenopausal and postmenopausal groups, no significant differences were found for sensitivity, positive and negative predictive value, either for RMI vs ROMA or for CA125 vs HE4 using a fixed specificity of 75%. Cut-off values indicating malignancy were established for HE4 and ROMA in premenopausal and postmenopausal women. We found no correlation between HE4 concentration in serum and urine. Conclusions We could not confirm that ROMA had diagnostic superiority over RMI in categorizing women with a pelvic mass into low-risk or high-risk groups for malignancy in a Swedish population. We have defined cut-off values for HE4 and ROMA. The lack of correlation between serum and urine HE4 obviates the introduction of urine HE4 analysis in clinical diagnostics.

  • 53.
    Lilliecreutz, Caroline
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Prevalence of blood and injection phobia among pregnant women2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 12, p. 1276-1279Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the study was to investigate the prevalence of blood and injection phobia in an unselected pregnant population, in order to estimate the need for curative intervention programmes.

    Design: A cross-sectional study. Setting. Antenatal care clinics in the southeast region of Sweden.

    Sample: In total, 1,606 consecutively registered pregnant women attending their first visit with a midwife.

    Methods: The women were asked to complete the Injection Phobia-Anxiety scale, measuring phobic symptoms. Women who scored 20 on the questionnaire were telephone-interviewed and then diagnosed or dismissed according to the DSM-IV criteria for blood and injection phobia. Main outcome measures. Prevalence of blood and injection phobia according to the DSM-IV.

    Results: Of 1,529 women who chose to participate (92.5%), 110 women or 7.2% fulfilled the DSM-IV criteria for blood and injection phobia. The mean age of the women was 29.1 years.

    Conclusions: Blood and injection phobia is hitherto unreported in the literature, but seems to be relatively common and needs to be recognized during pregnancy as it causes a great deal of discomfort and fear among pregnant women. The Injection Phobia-Anxiety scale is suitable as a screening tool in an antenatal care clinic setting.

  • 54.
    Lindgren, Richard
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, BKC - Barn och kvinnocentrum, KK - Kvinnokliniken.
    Berg, G.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, BKC - Barn och kvinnocentrum, KK - Kvinnokliniken.
    Hammar, Mats
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, BKC - Barn och kvinnocentrum, KK - Kvinnokliniken.
    Zuccon (Nedstrand), Elizabeth
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, BKC - Barn och kvinnocentrum, KK - Kvinnokliniken.
    Hormonal replacement therapy and sexuality in a population of Swedish postmenopausal women1993In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 72, no 4, p. 292-297Article in journal (Refereed)
    Abstract [en]

    All women (n = 2465) living in the community of Linköping, Sweden, aged 55, 57, 59 and 65 years were studied in a cross-sectional trial concerning the prevalence of vasomotor symptoms, hormonal replacement therapy (HRT) and sexual activities. After one reminder, answers were received from 1867 (76%) women. In all, 51% of the women reported vasomotor symptoms. Ten percent of the women used HRT at the time of the survey. Another 10% of the women had previously used oral HRT but had abandoned treatment. One third of these women reported no vasomotor symptoms when they abandoned treatment. One fifth ceased treatment after recommendation from their physician and another fifth because of ‘fear’ of hormonal treatment.

    Sixty-two percent of the women reported sexual activity. The most common reasons for not having a regular sex-life were lack of partner or lack of desire.

  • 55.
    Lundin, Evelyn S.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Johansson, Torsten
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Zachrisson, Helene
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Leandersson, Ulf
    Kalmar County Hospital, Sweden .
    Backman, Fatma
    University Hospital, Sweden .
    Falknas, Laila
    Ryhov County Hospital, Sweden .
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Single-dose tranexamic acid in advanced ovarian cancer surgery reduces blood loss and transfusions: double-blind placebo-controlled randomized multicenter study2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 4, p. 335-344Article in journal (Refereed)
    Abstract [en]

    ObjectiveTo determine whether single-dose tranexamic acid given intravenously immediately before surgery for presumed advanced ovarian cancer reduces perioperative blood loss and blood transfusions. DesignA randomized double-blind, placebo-controlled multicenter study. SettingTwo university hospitals and two central hospitals in the southeast health region of Sweden. PopulationOne hundred women with presumed advanced ovarian cancer scheduled for radical debulking surgery between March 2008 and May 2012 who complied with inclusion/exclusion criteria were randomized; 50 were allocated to receive tranexamic acid and 50 to receive placebo. Analysis was performed according to intention-to-treat principles. MethodsThe volume of tranexamic acid (15mg/kg body weight, 100mg/mL tranexamic acid) or the same volume of placebo (0.9% NaCl) was added to a 100-mL saline solution plastic bag. The study medication was given immediately before the start of surgery. Data were analyzed by means of non-parametric statistics and multivariate models adjusted for confounding factors. Main outcome measuresBlood loss and red blood cell transfusions. ResultsThe total blood loss volume and transfusion rate were significantly lower in the tranexamic acid group compared with the placebo group. Median total blood loss was 520 and 730mL, respectively (p=0.03). Fifteen (30%) and 22 (44%), respectively received transfusions (odds ratio 0.44; upper 95% CI 0.97; p=0.02). ConclusionA single dose of tranexamic acid given immediately before surgery reduces blood loss and transfusion rates significantly in advanced ovarian cancer surgery. Tranexamic acid may be recommended as standard prophylactic treatment in advanced ovarian cancer surgery.

  • 56.
    Möller, Louise
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Lilliecreutz, Caroline
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Gunnervik, Christina
    Värnamo Cty Hosp, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Reproduction, fear of childbirth and obstetric outcomes in women treated for fear of childbirth in their first pregnancy: A historical cohort2019In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 3, p. 374-381Article in journal (Refereed)
    Abstract [en]

    Introduction About 8% of the pregnant women in Sweden receive counseling for fear of childbirth (FOC) during pregnancy. Little is known about the long-term reproductive and obstetric outcomes after counseling for FOC: Therefore, the objective of this historical cohort study was to compare the long-term reproductive and obstetric outcomes in women treated for FOC in their first pregnancy to women without FOC. Material and methods All nulliparas consecutively referred for treatment of severe FOC between 2001 and 2007 (n = 608) were compared with all other nulliparas giving birth on the same day (n = 431). Women who were not fluent in Swedish, missing a postal address, had moved out of the area, given birth at another hospital or had a late spontaneous abortion were excluded (n = 555). A total of 235 women agreed to participate in the study, 63 (39%) women in the index group and 172 (53%) in the reference group. The women were contacted by letter in 2015, ie 7-14 years after first childbirth, and asked to permit access to their medical charts from pregnancies and childbirths and to fill out a study specific questionnaire. Based on data from the medical charts and questionnaire, the mode of delivery, birth experience, obstetric complications, FOC, counseling for FOC and number of childbirths were compared in the two groups. Results Women in the index group less often gave birth more than twice compared with the reference group (8.2% vs 22.0%, P = 0.012). We found no significant differences in complications during subsequent pregnancies and deliveries. Women in the index group more often gave birth by CS in their first (P = 0.002) and second childbirth (P = 0.001), more often had a less positive birth experience (index group NRS: median 6.0, interquartile range 6 vs reference group NRS: 7.0, interquartile range 5, P = 0.004) in their first delivery and more often received counseling for FOC (58.7% vs 12.5%, P amp;lt; 0.001) in subsequent pregnancies. Women in the index group more often experienced FOC (18% vs 5.3%, P = 0.001) 7-14 years after first childbirth. Conclusions FOC is not easily treated. Despite treatment and exposure to childbirth many women received treatment in their next pregnancy and still suffered from FOC 7-14 years after the first childbirth.

  • 57.
    Möller, Louise
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Lilliecreutz, Caroline
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Gunnervik, Christina
    Värnamo Cty Hosp, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Reproduction, fear of childbirth and obstetric outcomes in women treated for fear of childbirth in their first pregnancy: A historical cohort2019In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 3, p. 374-381Article in journal (Refereed)
    Abstract [en]

    Introduction About 8% of the pregnant women in Sweden receive counseling for fear of childbirth (FOC) during pregnancy. Little is known about the long-term reproductive and obstetric outcomes after counseling for FOC: Therefore, the objective of this historical cohort study was to compare the long-term reproductive and obstetric outcomes in women treated for FOC in their first pregnancy to women without FOC. Material and methods All nulliparas consecutively referred for treatment of severe FOC between 2001 and 2007 (n = 608) were compared with all other nulliparas giving birth on the same day (n = 431). Women who were not fluent in Swedish, missing a postal address, had moved out of the area, given birth at another hospital or had a late spontaneous abortion were excluded (n = 555). A total of 235 women agreed to participate in the study, 63 (39%) women in the index group and 172 (53%) in the reference group. The women were contacted by letter in 2015, ie 7-14 years after first childbirth, and asked to permit access to their medical charts from pregnancies and childbirths and to fill out a study specific questionnaire. Based on data from the medical charts and questionnaire, the mode of delivery, birth experience, obstetric complications, FOC, counseling for FOC and number of childbirths were compared in the two groups. Results Women in the index group less often gave birth more than twice compared with the reference group (8.2% vs 22.0%, P = 0.012). We found no significant differences in complications during subsequent pregnancies and deliveries. Women in the index group more often gave birth by CS in their first (P = 0.002) and second childbirth (P = 0.001), more often had a less positive birth experience (index group NRS: median 6.0, interquartile range 6 vs reference group NRS: 7.0, interquartile range 5, P = 0.004) in their first delivery and more often received counseling for FOC (58.7% vs 12.5%, P amp;lt; 0.001) in subsequent pregnancies. Women in the index group more often experienced FOC (18% vs 5.3%, P = 0.001) 7-14 years after first childbirth. Conclusions FOC is not easily treated. Despite treatment and exposure to childbirth many women received treatment in their next pregnancy and still suffered from FOC 7-14 years after the first childbirth.

  • 58.
    Nieminen, Katri
    et al.
    Department of Obstetrics and Gynaecology, Motala Hospital, Motala, Sweden.
    Stephansson, Olof
    Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden.
    Rryding, Elsa Lena
    Department of Woman and Child Health, Division of Obstetrics and Gynaecology, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden.
    Women’s fear of childbirth and preference for cesarean section – a cross-sectional study at various stages of pregnancy in Sweden2009In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, no 7, p. 807-813Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate Swedish women’s level of antenatal fear of childbirth at various gestational ages, and factors associated with intense fear and with preference for cesarean section.

    Design. A cross-sectional study. Setting. All antenatal clinics in four geographical areas. Sample. Thousand six hundred and thirty-five pregnant women at various gestational ages recruited during September–October 2006.

    Method. A questionnaire completed at the antenatal clinic. The women reported their appraisal of the approaching delivery according to the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ).

    Main outcome measures. The level of fear of childbirth and preferred mode of delivery. Results. Mean W-DEQ score was 62.8. The prevalence of intense fear of childbirth (W-DEQ score ≥85) was 15.8% and very intense fear (tocophobia) (W-DEQ score ≥100) 5.7%. Nulliparous women had a higher mean score than parous women, but more parous women reported an intense fear. Preference for cesarean section was associated with fear of childbirth (OR 11.79, 6.1–22.59 for nulliparous and OR 8.32, 4.36–15.85 for parous women) and for parous women also with a previous cesarean section (OR 18.54, 9.55–35.97), or an instrumental vaginal delivery (OR 2.34, 1.02–5.34). The level of fear of childbirth was not associated with the gestational age.

    Conclusions. When a woman requests a cesarean section, both primary fear of birth and traumatic childbirth experiences need to be considered and dealt with. The W-DEQ can be used at any time during pregnancy in order to identify pregnant women who suffer from intense fear of childbirth.

  • 59.
    Nieminen, Katri
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Norrköping.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Sanna
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health.
    Kinberger, Emelie K
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health.
    Ryding, Elsa-Lena
    Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Severe fear of childbirth indicates high perinatal costs for Swedish women giving birth to their first child.2017In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 4, p. 438-446Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The objective of this study was to calculate costs associated with severe fear of childbirth (FOC) during pregnancy and peripartum by comparing two groups of women expecting their first child and attending an ordinary antenatal program; one with low FOC and one with severe FOC.

    MATERIAL AND METHODS: In a prospective case-control cohort study one group with low FOC [Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) sum score ≤60, n = 107] and one with severe FOC (W-DEQ ≥85, n = 43) were followed up till 3 months postpartum and included in the analysis. Medical records were assessed and medical parameters were mapped. Mean costs for healthcare consumption and sick leave during pregnancy were calculated and compared.

    RESULTS: When means were compared between the groups, the group with severe FOC had more visits for psychosocial reasons (p = 0.001) and more hours on sick leave (p = 0.03) during pregnancy, and stayed longer at the maternity ward (p = 0.04). They also more seldom had normal spontaneous deliveries (p = 0.03), and more often had an elective cesarean section on maternal request (p = 0.02). Postpartum, they more often than the group with low FOC paid visits to the maternity clinic because of complications (p = 0.001) and to the antenatal unit because of adverse childbirth experiences (p = 0.001). The costs for handling women with severe FOC was 38% higher than those for women with low FOC.

    CONCLUSION: Women with severe FOC generate considerably higher perinatal costs than women with low FOC when handled in care as usual.

  • 60.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Holmqvist, Marika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Hultgren, Eva
    Department of Clinical and Experimental Medicine Linlöping University.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Cedergren, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Alcohol use before and during pregnancy and factors influencing change among Swedish women2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 7, p. 768-774Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate alcohol intake during pregnancy among women, to assess health cares providers' advice to the women and the relative importance of different factors on changes in the women's drinking. Design. Questionnaire study. Setting. Linkoping, Sweden. Population. A total number of 1,533 women registered at a maternity health care center in Linkoping during a one-year period, from 1 April 2005 to 31 March 2006. Methods. Mailed anonymous questionnaire with a response rate of 61%. Main outcome measures. Drinking behavior and information sources. Results. During pregnancy, 94% (n=869) of the responding women abstained from alcohol, including 13% (n=117) who were already abstainers. Six percent (n=55) continued drinking during the pregnancy. Those who continued drinking during pregnancy were older, had more often given birth and drank more frequently before pregnancy than the women who abstained. Half of the respondents (n=428) believed that decreases in alcohol intake during pregnancy reported in previous studies could be due to inaccurate self-reporting. The main message from maternity health care providers was perceived to be complete abstinence from alcohol during pregnancy (85%, n=777), although 8% (n=76) claimed that they had not received any advice regarding this. Media attention concerning risks associated with drinking during pregnancy was seen as slightly more important to achieve reduced alcohol intake during pregnancy than advice from maternity health care providers. Conclusions. A majority of women in this study reported abstaining from alcohol during pregnancy. © 2008 Informa UK Ltd. (Informa Healthcare, Taylor & Francis AS).

  • 61.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Skagerström, Janna
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Hultgren, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Alcohol prevention in Swedish antenatal care: effectiveness and perceptions of the Risk Drinking project counseling model2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 6, p. 736-743Article in journal (Refereed)
    Abstract [en]

    Objective. To compare an earlier Swedish antenatal care counseling routine concerning alcohol consumption with an expanded model in terms of effectiveness in achieving abstinence in pregnancy. A further objective was to assess the womens perceptions of the alcohol counseling. Design. Cohort study. Setting. Antenatal care center in a provincial Swedish university town. Population. Women who received alcohol counseling; 1533 in cohort 1 (routine counseling) and 1476 in cohort 2 (expanded model). Approximately 93% of all pregnant women in Linkoping are registered at this center. Methods. Data were collected by means of an anonymous questionnaire. Thirteen questions in the questionnaire were analysed for this study. Main outcome measures. Replies from three questions concerning pre-pregnancy drinking and three questions on drinking during pregnancy. Results. The response rate was 60% for cohort 1 and 64% for cohort 2. Perceptions of the advice from the antenatal care center were generally favorable. Similar proportions of women, approximately 6%, in both cohorts drank at least once during the pregnancy (after pregnancy recognition). There were four predictors for drinking during pregnancy: older age; having previously given birth to a child; frequency of pre-pregnancy drinking; and perceiving the message from antenatal care as small amounts of alcohol during pregnancy dont matter.Conclusions. An expanded counseling model implemented in Swedish antenatal care did not reduce the proportion of women who continued drinking during pregnancy in comparison with a previous counseling model, although the advice provided in the new model was perceived more favorably.

  • 62. Nygren, KG
    et al.
    Finnström, Orvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Källen, B
    Olausson, PO
    Population-based Swedish studies of outcomes after in vitro fertilisation2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 7, p. 774-782Article in journal (Refereed)
    Abstract [en]

    Background. Various outcomes have been described during pregnancy and among infants born to women after in vitro fertilisation (IVF) treatments. This mini-review summarises recent population-based Swedish studies about the short- and long-term effects of IVF on the infant and child, and also comments on disturbances of pregnancies and deliveries occurring after IVF. Methods. Data on women who had IVF treatments and gave birth in Sweden during the period 1982-2001 were collected from all clinics performing IVF. By linkage with the Swedish Medical Birth Register, the Swedish Register of Congenital Malformations, the Swedish Hospital Discharge Register, the Swedish Cancer Register, and the Swedish Cause of Death Register, data on short- and long-term complications were retrieved. Results. From 1982 to 2001, a total of 13,261 women gave birth to 16,280 infants after IVF treatment. During the final years of the study, nearly half of the pregnancies occurred after intracytoplasmic sperm injection intracytoplasmic sperm injection (ICSI). Characteristics of women who delivered after IVF were analysed. Various anomalies in pregnancy and delivery outcome were found, but few long-term effects. Conclusions. Most deviations, except for multiple pregnancies, could be explained by parents characteristics, notably their subfertility status. Little difference was found between pregnancies after standard IVF and pregnancies after ICSI. © 2007 Taylor & Francis.

  • 63.
    Rodriguez-Wallberg, Kenny A.
    et al.
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
    Tanbo, Tom
    Department of Gynecology, Oslo University Hospital, Oslo, Norway.
    Tinkanen, Helena
    Oslo University Hospital, Norway; Tampere University Hospital, Finland.
    Thurin-Kjellberg, Ann
    Sahlgrens University Hospital, Sweden.
    Nedstrand, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Laczna Kitlinski, Margareta
    Skåne University Hospital, Sweden.
    Macklon, Kirsten T.
    Rigshosp University Hospital, Denmark.
    Ernst, Erik
    Aarhus University Hospital, Denmark.
    Fedder, Jens
    Odense University Hospital, Denmark.
    Tiitinen, Aila
    Helsinki University Hospital, Finland.
    Morin-Papunen, Laure
    Oulu University Hospital, Finland; University of Oulu, Finland.
    Einarsson, Snorri
    ART Medica, Iceland.
    Jokimaa, Varpu
    Turku University Hospital, Finland.
    Hippelainen, Maritta
    Kuopio University Hospital, Finland.
    Lood, Mikael
    Örebro University Hospital, Sweden.
    Gudmundsson, Johannes
    University of Uppsala Hospital, Sweden.
    Olofsson, Jan I.
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
    Yding Andersen, Claus
    Rigshosp University Hospital, Denmark; University of Copenhagen, Denmark.
    Ovarian tissue cryopreservation and transplantation among alternatives for fertility preservation in the Nordic countries - compilation of 20 years of multicenter experience2016In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 9, p. 1015-1026Article in journal (Refereed)
    Abstract [en]

    Introduction. The aim of this study is to report the current status of ovarian tissue cryopreservation among alternatives for fertility preservation in the Nordic countries. Material and methods. A questionnaire was sent to 14 Nordic academic reproductive centers with established fertility preservation programs. It covered fertility preservation cases performed up to December 2014, standard procedures for ovarian tissue cryopreservation and oocyte cryopreservation and reproductive outcomes following ovarian tissue transplantation. Results. Among the Nordic countries, Denmark and Norway practice ovarian tissue cryopreservation as a clinical treatment (822 and 164 cases, respectively) and their programs are centralized. In Sweden (457 cases), ovarian tissue cryopreservation is practiced at five of six centers and in Finland at all five centers (145 cases). Nearly all considered ovarian tissue cryopreservation to be experimental. In Iceland, embryo cryopreservation is the only option for fertility preservation. Most centers use slow-freezing methods for ovarian tissue cryopreservation. Most patients selected for ovarian tissue cryopreservation were newly diagnosed with cancer and the tissue was predominantly retrieved laparoscopically by unilateral oophorectomy. Only minor complications were reported. In total, 46 women have undergone ovarian tissue transplantation aiming at recovering fertility, 17 healthy children have been born and several additional pregnancies are currently ongoing. Whenever patients clinical condition is permissive, oocyte cryopreservation after hormonal stimulation is preferred for fertility preservation. Between 2012 and 2014, a smaller proportion of females have undergone fertility preservation in the Nordic centers, in comparison to males (1: 3). Conclusions. Overall, ovarian tissue cryopreservation was reported to be safe. Slow freezing methods are still preferred. Promising results of recovery of fertility have been reported in Nordic countries that have initiated ovarian tissue transplantation procedures.

  • 64. Rugarn, Olof
    et al.
    Carling Moen, Susanne
    Berg, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Eclampsia at a tertiary hospital 1973-992004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 3, p. 240-245Article in journal (Refereed)
    Abstract [en]

    Background. To investigate changes in incidence, patient characteristics, comorbidity and in the care provided in cases of eclampsia at a tertiary hospital during the period 1973-99. Methods. Thirty-nine cases were identified through the Swedish National Birth Registry. Incidences and rates regarding patient characteristics and outcomes (duration of intensive care unit surveillance, assisted ventilation, multiple seizures, predefined major complications, perinatal mortality, small for gestational age, and neonatal intensive care surveillance) were compared between the time periods 1973-79, 1980-89 and 1990-99 with trend analysis. Results. The incidences in the three time periods were 3.0/10 000 births [95% confidence interval (CI) 0.1-5.9], 6.2/10 000 births (95% CI 2.7-9.7) and 10.9/10 000 births (95% CI 6.4-15.4), respectively, which constitutes a significant difference according to trend analysis (p = 0.006). There were no differences in patient characteristics or comorbidity. Onset occurred in hospital in 85% of the cases. Conclusions. The increase in the incidence of eclampsia reported here is contrary to international trends up until the early 1990s. The incidence in 1990-99 is also higher than the reported national incidence in Sweden 1976-80, which was 2.9/10 000 births. Despite successful identification of women at risk for eclampsia and hospital surveillance, several cases were not prevented. Better prognostic tests that identify impending eclampsia are needed to bring the incidence down further.

  • 65.
    Räsänen, T.
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine.
    Messner, Karola
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine.
    Articular cartilage compressive stiffness following oophorectomy or treatment with 17-beta estradiol.1999In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 78, p. 357-362Article in journal (Refereed)
  • 66. Samuelsson, E
    et al.
    Hägg, Staffan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Pharmacology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pharmacology.
    Incidence of venous thromboembolism in young Swedish women and possibly preventable cases among combined oral contraceptive users2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 7, p. 674-681Article in journal (Refereed)
    Abstract [en]

    Background. We wanted to study the incidence of venous thromboembolism (VTE), acquired risk factors of VTE and preventable cases among users of combined oral contraceptives (COCs). Methods. All women aged 15-44 years, (n = 24 373) living in the county of Jämtland, Sweden, between 1991 and 2000, constituted the study base in a retrospective case-reference study. Women with VTE were identified through hospital registers and interviewed by telephone. The utilization of COCs according to age was obtained from a prospective prescription database, and data from national health databases were used. Results. Of 88 women with first-time VTE, 43 (49%) were COC users and 13 (15%) were pregnant. All women had at least one known risk factor, and 51 (58%) women had combinations of risk factors. The total incidence rate of VTE per 100000 women-years for all women were 36 (29-44), for nonusers 19 (12-25) for women using third generation COCs 115 (67-184), for women using other COCs 60 (37-83), and for women during pregnancy and postpartum 103 (55-177). Of the total 244000 women-years represented, COC users constituted 24%, pregnant women 5%, and women with other acquired risk factors 5%. The corresponding incidence rates after excluding VTE cases with other acquired risk factors were 10 (6-14), 1.2 (0.14-44), 64 (29-121), 27 (13-48), and 59 (24-121), per 100000 women-years. In 11 (26%) of the COC-related VTE cases, there were relative contraindications for use of COCs or lack of thromboprophylaxis in relation to surgery. Conclusion. We found a very low incidence of idiopathic VTE among young non-OC users. The incidence of VTE during pregnancy was only slightly higher than during COC use. It was considered that a significant part of COC-related VTE might have been avoided.

  • 67.
    Sarberg, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Restless legs syndrome during and after pregnancy and its relation to snoring2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 7, p. 850-855Article in journal (Refereed)
    Abstract [en]

    Objective. To study development of restless legs syndrome (RLS) during and after pregnancy, and whether RLS is related to snoring or other pregnancy-related symptoms. Design. Prospective study. Setting. Antenatal care clinics in the catchment area of Linkoping university hospital, Sweden. Population. Five hundred consecutively recruited pregnant women. Methods. Sleep disturbances, including symptoms of RLS and snoring, were assessed with questionnaires in each trimester. A complementary questionnaire was sent three years after delivery to women experiencing symptoms of RLS during pregnancy. Main outcome measures. Symptoms of RLS in relation to snoring in each trimester. Results. Symptoms of RLS were reported by 17.0% of the women in the first trimester, by 27.1% in the second trimester and by 29.6% in the third trimester. Snoring in the first trimester was correlated to increased prevalence of RLS in all three trimesters (p= 0.003, 0.017 and 0.044 in the first, second and third trimester, respectively). No correlation was found between RLS and anemia, parity or body mass index. Among the women who experienced RLS, 31% still had symptoms three years after delivery. Fifty-eight per cent of those whose symptoms had disappeared stated that this happened within one month after delivery. Conclusions. Symptoms of RLS progressed most between the first and second trimester. Women who snored in the first or second trimester of pregnancy had a higher prevalence of RLS in the third trimester, which indicates that snoring in early pregnancy might predict RLS later. Symptoms of RLS disappear quite soon after delivery, but about one-third of women with RLS during pregnancy may still have symptoms three years after childbirth.

  • 68.
    Schmidt, H
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Hansen, JG
    Bacterial vaginosis in a family practice population.2000In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 79, p. 999-1005Article in journal (Refereed)
  • 69.
    Skoog Svanberg, Agneta
    et al.
    Uppsala University, Sweden .
    Lampic, Claudia
    Karolinska Institute, Sweden .
    Geijerwall, Ann-Louise
    Sahlgrens Acad, Sweden .
    Gudmundsson, Johannes
    Uppsala University, Sweden .
    Karlstrom, Per-Olof
    Karolinska Institute, Sweden .
    Solensten, Nils-Gunnar
    University of Umeå Hospital, Sweden .
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Gamete donors motivation in a Swedish national sample: is there any ambivalence? A descriptive study2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 8, p. 944-951Article in journal (Refereed)
    Abstract [en]

    Objective. To study donors motivation and ambivalence before donation of gametes. Design. Cross-sectional study. Setting. Seven Swedish university hospital clinics. Sample. Of the 220 eligible oocyte donors and 156 eligible sperm donors who were approached, 181 (82%) oocyte donors and 119 (76%) sperm donors agreed to participate. Methods. Gamete donors completed a questionnaire in the clinic prior to the donation. Main outcome measures. Motives and ambivalence towards donation. Results. In general, gamete donors donated for altruistic reasons (95%). A greater percentage of oocyte than sperm donors had a personal experience of biological children, which motivated them to donate (65 vs. 32%). A greater percentage of sperm donors compared with oocyte donors were curious about their own fertility (24 vs. 9%), and they also believed that they were contributing what they regarded as their own good genes to other couples (45 vs. 20%). Prior to donation, potential sperm donors were more ambivalent towards donating than were oocyte donors (39 and 21%, p similar toandlt;similar to 0.001). Conclusions. The motives to donate gametes are mainly altruistic. We conclude that men and women differ in their view towards donating gametes. Sperm donors had a higher degree of ambivalent feelings towards donation than oocyte donors.

  • 70.
    Skoog Svanberg, Agneta
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Lampic, Claudia
    Department of Neurobiology, Care sciences and Society, Karolinska Institute Stockholm, Stockholm, Sweden.
    Gejerwall, Ann-Louise
    Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
    Gudmundsson, Johannes
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Karlstrom, Per-Olof
    Clintec, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden and Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
    Solensten, Nils-Gunnar
    IVF Clinic, University Hospital of Umeå, Umeå, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Gamete donors' satisfaction: gender differences and similarities among oocyte and sperm donors in a national sample2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 9, p. 1049-1056Article in journal (Refereed)
    Abstract [en]

    Objective

    To explore oocyte and sperm donors' emotional stress, experiences of care and satisfaction after donation.

    Design

    Prospective multicenter study.

    Settings

    All fertility clinics performing gamete donation in Sweden during the period 2005 to 2008.

    Population

    Of 220 eligible oocyte donors who were approached, 181 agreed to complete the first questionnaire and 165 completed the second questionnaire 2 months after oocyte donation. Of 156 eligible sperm donors 119 accepted to complete the first questionnaire before donation. Eighty-nine participants completed the second questionnaire 2 months after sperm donation.

    Methods

    Standardized and study-specific questionnaires.

    Main outcome measures

    Satisfaction with the donation, respondents' mental health and overall care.

    Results

    A larger percentage of sperm donors (97.8%) were satisfied with their overall experience of being a donor than oocyte donors (85.9%, = 0.003). Some oocyte and sperm donors did not receive sufficient information about practical issues (9.1% and 13.5%, respectively) and future consequences (12.8% and 3.4%, respectively, p = 0.014). The donors' symptoms of anxiety and depression did not show any differences in relation to negative or positive perceptions of satisfaction. The donors who did not indicate ambivalence before treatment were on average almost five times more satisfied compared with those who did indicate ambivalence (odds ratio 4.71; 95% CI 1.34–16.51).

    Conclusions

    Most donors were satisfied with their contribution after the donation. Oocyte and sperm donors who expressed ambivalence before donation were less satisfied after donation. In vitro fertilization staff fulfilled most of the donors' needs for information and care.

  • 71.
    Stenfelt, Camilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Fertilitetsctr Stockholm, Sweden.
    Armuand, Gabriela
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Wanggren, Kjell
    Karolinska Inst, Sweden.
    Skoog Svanberg, Agneta
    Uppsala Univ, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Attitudes toward surrogacy among doctors working in reproductive medicine and obstetric care in Sweden2018In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 9, p. 1114-1121Article, review/survey (Refereed)
    Abstract [en]

    IntroductionThe aim of this study was to investigate attitudes and opinions towards surrogacy among physicians working within obstetrics and reproductive medicine in Sweden. Material and methodsPhysicians working within medically assisted reproduction (MAR), antenatal care and obstetrics were invited to participate in a cross-sectional nationwide survey study. The study-specific questionnaire measured attitudes and experiences in three domains: attitudes towards surrogacy, assessment of prospective surrogate mothers, and antenatal and obstetric care for surrogate mothers. ResultsOf the 103 physicians who participated (response rate 74%), 63% were positive or neutral towards altruistic surrogacy being introduced in Sweden. However, only 28% thought that it should be publicly financed. Physicians working at fertility clinics were more positive towards legalization as well as public financing of surrogacy compared than were those working within antenatal and delivery care. The majority of the physicians agreed that surrogacy involves the risk of exploitation of womens bodies (60%) and that there is a risk that the commissioning couple might pay the surrogate mother under the table (82%). They also expressed concerns about potential surrogate mothers not being able to understand fully the risks of entering pregnancy on behalf of someone else. ConclusionThere is a relatively strong support among physicians working within obstetrics and reproductive medicine for the introduction of surrogacy in Sweden. However, the physicians expressed concerns about the surrogate mothers health as well as the risk of coercion. Further discussions about legalization of surrogacy should include views from individuals within a wide field of different medical professions and laymen.

  • 72.
    Sundelin, Helene E. K.
    et al.
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Stephansson, Olof
    Karolinska University Hospital and Institute, Sweden; University of Calif Berkeley, CA 94720 USA.
    Johansson, Kari
    Karolinska University Hospital and Institute, Sweden.
    Ludvigsson, Jonas F.
    Karolinska Institute, Sweden; University Hospital, Sweden; University of Nottingham, England.
    Pregnancy outcome in joint hypermobility syndrome and Ehlers-Danlos syndrome2017In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, no 1, p. 114-119Article in journal (Refereed)
    Abstract [en]

    IntroductionAn increased risk of preterm birth in women with joint hypermobility syndrome or Ehlers-Danlos syndrome is suspected. Material and methodsIn this nationwide cohort study from 1997 through 2011, women with either joint hypermobility syndrome or Ehlers-Danlos syndrome or both disorders were identified through the Swedish Patient Register, and linked to the Medical Birth Register. Thereby, 314 singleton births to women with joint hypermobility syndrome/Ehlers-Danlos syndrome before delivery were identified. These births were compared with 1247864 singleton births to women without a diagnosis of joint hypermobility syndrome/Ehlers-Danlos syndrome. We used logistic regression, adjusted for maternal age, smoking, parity, and year of birth, to calculate adjusted odds ratios for adverse pregnancy outcomes. ResultsMaternal joint hypermobility syndrome/Ehlers-Danlos syndrome was not associated with any of our outcomes: preterm birth (adjusted odds ratio=0.6, 95% confidence interval 0.3-1.2), preterm premature rupture of membranes (adjusted odds ratio=0.8; 95% confidence interval 0.3-2.2), cesarean section (adjusted odds ratio=0.9, 95% confidence interval 0.7-1.2), stillbirth (adjusted odds ratio=1.1, 95% confidence interval 0.2-7.9), low Apgar score (adjusted odds ratio=1.6, 95% confidence interval 0.7-3.6), small for gestational age (adjusted odds ratio=0.9, 95% confidence interval 0.4-1.8) or large for gestational age (adjusted odds ratio=1.2, 95% confidence interval 0.6-2.1). Examining only women with Ehlers-Danlos syndrome (n=62), we found a higher risk of induction of labor (adjusted odds ratio=2.6; 95% confidence interval 1.4-4.6) and amniotomy (adjusted odds ratio=3.8; 95% confidence interval 2.0-7.1). No excess risks for adverse pregnancy outcome were seen in joint hypermobility syndrome. ConclusionWomen with joint hypermobility syndrome/Ehlers-Danlos syndrome do not seem to be at increased risk of adverse pregnancy outcome.

  • 73.
    Swahnberg, Katarina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine.
    Schei, Berit
    Hilden, Malene
    Halmesmäki, Erja
    Sidenius, Katrine
    Steingrimsdottir, Thora
    Wijma, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Patients' experiences of abuse in health care: A Nordic study on prevalence and associated factors in gynecological patients2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 3, p. 349-356Article in journal (Refereed)
    Abstract [en]

    Background. In an earlier Swedish study conducted with The NorVold Abuse Questionnaire, we found that one-third of female patients who had experienced adult abuse in health care (AAHC) had a background of childhood emotional, physical and/or sexual abuse (EPSA) ('revictimised'). But since the majority of women with AAHC were 'new victims' without such a background, there might be other factors associated with AAHC. The present study aimed to map prevalence of abuse in health care (AHC), and associated variables among new victims and revictimised patients. Methods. We carried out a cross-sectional questionnaire study at 5 Nordic gynecological clinics. Associations between AAHC and other variables were tested in a multivariate model in 4 groups of women with adult EPSA, childhood EPSA, childhood and adult EPSA, and no EPSA. Results. The response rate was 77% (n=3,641). The overall prevalence of any lifetime experience of AHC was 13-28%. High educational level, physical complaints, post-traumatic stress symptoms, and sleeping problems were associated with AAHC in women without EPSA (new victims). Poor self-rated health was strongly associated with AAHC in the 3 groups of women with EPSA. Conclusion. AHC is commonly reported by gynecological patients in the Nordic countries, but not yet properly explored or understood. The most important factors associated with AAHC were high educational level and poor self-rated health. © 2007 Taylor & Francis.

  • 74.
    Swahnberg, Katarina
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine.
    Wijma, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Liss, Per-Erik
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Female patients report on health care staff's disobedience of ethical principles2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 7, p. 830-836Article in journal (Refereed)
    Abstract [en]

    Background. Earlier studies have shown a high prevalence of abuse in health care (AHC). We hypothesized that patients might easily feel abused when staff do not follow prevailing ethical principles. Therefore we developed the Violations of Ethical Principles Questionnaire (ViolEP), with 30 examples of situations in health care where four ethical principles are disobeyed (autonomy, nonmaleficence, justice, and integrity). Respondents reported whether or not they had ever experienced each of the situations, and whether or not they had perceived that event as a violation. Research questions: 1. What proportion of female patients have ever experienced staff disobeying ethical principles in health care? 2. To what extent are such events perceived as violations? and 3. How well do perceived violations of ethical principles correspond to experiences of AHC? Method. Our sample was 661 consecutive female patients at the Department of Obstetrics and Gynecology in Linköping, Sweden. They completed ViolEP and NorVold Abuse Questionnaire (NorAQ) at home and returned them by post. Results. 20/661 (64%) women answered the ViolEP and 426/661 (64%) returned the NorAQ. The majority (73%) (306/420) had experienced staff disobeying ethical principles. More than every second woman had perceived those events as violations (68%) (209/306). The prevalence of AHC was 23%. ViolEP had good sensitivity but low specificity when we used AHC according to NorAQ as the "gold standard". Conclusion. The majority of the patients had experienced health care staff disobeying prevailing ethical principles. These events were not always perceived as violations. The reason for this discrepancy needs to be explored. © 2006 Taylor & Francis.

  • 75.
    Swahnberg, Katarina
    et al.
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Schei, Berit
    Department of Gynecology, St Olav Hospital, Trondheim, Norway.
    Hilden, Malene
    The Center for Victims of Sexual Assault, Rigshospitalet, Copenhagen University Hospital, Denmark.
    Irminger, Kirstine
    Department of Obstetrics and Gynecology, Ryhov Hospital, Jönköping, Sweden.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Are sociodemographic and regional and sample factors associated with prevalence of abuse?2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 3, p. 276-288Article in journal (Refereed)
    Abstract [en]

    Background.  The aims of the present study were: 1) to estimate the prevalence of emotional, physical and sexual abuse and abuse in the health care system, and 2) to study the associations between prevalence of abuse and sociodemographic and sample variables.

    Methods.  This cross-sectional study used a validated postal questionnaire in four Swedish samples; patients at three gynecologic clinics with different character and in different regions (n = 2439) and women in one randomized population sample (n = 1168).

    Results.  Any lifetime emotional abuse was reported by 16.8–21.4% of the women; physical abuse by 32.1–37.5%; sexual abuse by 15.9–17.0%; and abuse in the health care system by 14.0–19.7%. For 7–8% abuse had included life threats and 9–20% of all women in the study currently suffered from their experiences of abuse. Most women had not disclosed their background of abuse to the gynecologist.

    There were differences in sociodemographic variables between the four samples. Generally, in the multivariate analyses we found associations between prevalence of abuse and age, educational level, civil status and occupation, but no consistent association between prevalence of abuse and sample variables.

    Conclusion.  Lifetime prevalence rates of the four kinds of abuse were high in all samples as measured by the NorVold Abuse Questionnaire (NorAQ), and 1/10–1/5 women in the study suffered currently from abusive experiences. In multivariate analyses prevalence of abuse was consistently associated with sociodemographic but not to sample variables.

  • 76.
    Sydsjö, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Angerbjörn, Louise
    Palmquist, Sofie
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Secondary fear of childbirth prolongs the time to subsequent delivery2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 2, p. 210-214Article in journal (Refereed)
    Abstract [en]

    Objective. Most pregnant women are anxious about the delivery and up to 30% develop varying degrees of fear of childbirth (FOC). Secondary FOC occurs in parous women who have experienced a traumatic delivery. The aim of this study was to investigate the time to subsequent delivery and delivery outcome in women with secondary FOC, compared with a reference group.

    Setting. Southeast Sweden.

    Sample. 356 parous pregnant women with secondary FOC and a reference group of 634 parous women without FOC.

    Design. Descriptive, retrospective case–control study.

    Main outcome measures. Time to next pregnancy and delivery outcome.

    Results. More women with secondary FOC had a longer interval to subsequent delivery compared with parous women without FOC (p = 0.005). Women with secondary FOC had 5.2 times higher probability of having a cesarean section than the reference group. Women with secondary FOC also had on average a 40-minute longer duration of active labor than women without FOC (p < 0.001).

    Conclusions. Secondary fear of childbirth prolongs the time to subsequent delivery and the active phase of labor itself, and increases the risk for cesarean section.

  • 77.
    Sydsjö, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Östergötlands Läns Landsting.
    Letter: Weight gain restriction for obese pregnant women2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 12, p. 1613-1613Article in journal (Other academic)
    Abstract [en]

    n/a

  • 78.
    Sydsjö, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Kvist, Ulrik
    Karolinska University Hospital, Sweden; Huddinge University Hospital, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Nordgaard, Anders
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences. Swedish Police Authority, National Forensic Centre, Linkoping, Sweden.
    The optimal number of offspring per gamete donor2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 9, p. 1022-1026Article in journal (Refereed)
    Abstract [en]

    Our aim was to create a mathematical basis to calculate the risks for unintended matings of consanguineous half-siblings from a donor in a society with approximately 10 million inhabitants. The Curie-Cohen model for calculation of the risk for consanguineous mating was used. When the number of offspring per donor is limited to 10, then the model gives a yearly risk for consanguineous matings below 1%. Thus 10 offspring gives a risk for consanguineous matings of 0.9% per year, or approximately once in every 100years. The risk increases exponentially: with 15 offspring it exceeds 2% and with 25 it reaches up above 5%.

  • 79.
    Sydsjö, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Lampic, Claudia
    Karolinska Institute, Stockholm, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynecology and Obstetrics UHL.
    Skoog Svanberg, Agneta
    Uppsala University, Sweden .
    Oocyte and sperm donors opinions on the acceptable number of offspring2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 7, p. 634-639Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To investigate opinions on the acceptable number of donation offspring in a national cohort of oocyte and sperm donors.

    DESIGN:

    A prospective follow-up study on a national cohort of gamete donors.

    SETTING:

    Sweden.

    METHODS:

    Study-specific questionnaire.

    MAIN OUTCOME MEASURES:

    Opinion on the acceptable number of offspring from one donor.

    RESULTS:

    About half of both oocyte and sperm donors expressed an opinion that the number of offspring from one donor should be limited to between one and 10, and many donors reported having no firm opinion. When controlling for age, educational level, marital status and biological children, oocyte donors were four times more likely than sperm donors to support an upper limit of five offspring. For many sperm and oocyte donors the number of offspring resulting from their donations was unknown (43.2% oocyte, 47.1% sperm).

    CONCLUSION:

    Oocyte donors have more restrictive opinions compared with sperm donors on the acceptable number of offspring from one donor. Donors perform a very humanitarian and societal act when donating their gametes. In the ambition to have safe and trustworthy clinics we need to have well known regulations to be able to recruit donors in the future.

  • 80.
    Sydsjö, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Skoog Svanberg, Agneta
    Uppsala Univ, Sweden.
    Lampic, Claudia
    Karolinska Inst, Sweden.
    Cross-border surrogacy: Experiences of heterosexual and gay parents in Sweden2019In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 1, p. 68-76Article in journal (Refereed)
    Abstract [en]

    Introduction Surrogacy is a controversial method of assisted reproduction that is not permitted in many countries. While there is some evidence that families following surrogacy seem to fare well, there is limited knowledge about the experiences of parents who turn to cross-border surrogacy. The aim of the present study was therefore to investigate the experiences of heterosexual parents and gay fathers who chose cross-border surrogacy to have a child. Material and methods This cross-sectional survey describes the experiences of 30 families (18 heterosexual parent and 12 gay father families). Participants were recruited through a website for a Swedish surrogacy interest group. The participants were requested individually to complete a postal questionnaire including study-specific questions on their experiences of disclosure and the Swedish Parenting Stress Questionnaire. Results All couples but one were still living together and had a child (3 months to 5 years). Parenting stress levels were generally low and were not related to sexual orientation. While almost all parents were open about the childs mode of conception in contacts with health care, gay fathers were significantly more open about using surrogacy in contacts with preschool (P = 0.004) and child recreational activities (P = 0.005) compared with heterosexual parents. A majority described being treated positively or "as any other parent" in these contexts. Conclusions Heterosexual and gay parents reported low levels of parenting stress and generally experienced positive or neutral reactions to their parenthood in contacts with healthcare providers, in preschool, and in the childs recreational activities.

  • 81.
    Sydsjö, Gunilla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sydsjö, Adam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Newly delivered women's evaluation of personal health status and attitudes towards sickness absence and social benefits2002In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 81, no 2, p. 104-111Article in journal (Refereed)
    Abstract [en]

    Background. Unexpectedly high rates of sickness absence have been observed among pregnant women. No clear medical causes for illnesses reported as the basis for sick leave have yet been identified with certainty. An explanation proposed is the pregnant women's own attitudes towards their own states of well being during pregnancy. The aim of this study was to investigate the validity of this hypothesis. Methods. All of the 384 women who were delivered at the University Hospital during a 2-month period were asked to answer a questionnaire anonymously. Information was sought concerning sickness absence and the use of parental benefits. In addition, questions were asked about working conditions and about each mother's own estimate of her level of 'well being'. The women's attitudes towards work absence due to illness and towards social benefit programs were registered. Results. Forty-three per cent of the women stated that they had been on sick leave during pregnancy. The main reason for sick leave was reported back pain. Seventy-four per cent of the women who were on sick leave stated, nevertheless, that they had been in 'good' or 'excellent' health during pregnancy. Of the 149 women who did not take sick leave, 10 reported being in 'bad' or 'very bad' health during pregnancy. 4.3% of the women stated that they had considered themselves to be ill due to an obstetric condition. Conclusion. In addition to actual disease and severe discomfort, certain social conditions and attitudes as well, are likely to explain the increase of pregnant women on sick leave.

  • 82.
    Sydsjö, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Adam
    Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Gunnervik, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Obstetric outcome for women who received individualized treatment for fear of childbirth during pregnancy2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 1, p. 44-49Article in journal (Refereed)
    Abstract [en]

    Objective. To compare obstetric outcomes for women with fear of childbirth who received counseling during pregnancy with women without fear of childbirth. Design. Descriptive, retrospective case-control study. Setting. University Hospital, Linkoping, Sweden. Sample. 353 women who were referred to a unit for psychosocial obstetrics and gynecology because of fear of childbirth constituted the index group and 579 women without fear of childbirth formed a reference group. Methods. Data were collected from standardized antenatal and delivery records. Main outcome measures. Delivery data. Results. Elective cesarean sections (CS) were more frequent in the index group (pandlt;0.001). Induction of delivery was also more common among the women with fear of childbirth (16.5 compared with 9.6%, pandlt;0.001). Women with fear of childbirth who were scheduled for vaginal delivery were more often delivered by emergency CS (p=0.007). Elective CS was more common among the parous women with fear of childbirth and instrumental delivery was more common among nulliparous women with fear of childbirth. There were no differences in complications during pregnancy, delivery or postpartum between the two groups. Conclusion. Fear of childbirth is a predisposing factor for emergency and elective CS even after psychological counseling. Maximal effort is necessary to avoid traumatizing deliveries and negative experiences, especially for nulliparous women.

  • 83.
    Sydsjö, Gunilla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Sydsjö, Adam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Wijma, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Variations in sickness absence and use of social benefits among pregnant women in a Swedish community 1978-1997.1999In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 78, p. 383-387Article in journal (Refereed)
  • 84.
    Tsimikas, Sotirios
    et al.
    Department of Medicine, University of California, San Diego, Calif. USA.
    Witztum, Joseph L
    Department of Medicine, University of California, San Diego, Calif. USA.
    Miller, Elisabeth R
    Department of Medicine, University of California, San Diego, Calif. USA.
    Sasiela, William J
    Pfizer Pharmaceuticals Group, New York, NY, USA.
    Szarek, Michael
    Pfizer Pharmaceuticals Group, New York, NY, USA.
    Olsson, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Internal Medicine. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Schwartz, Gregory G
    Letter regarding article by Tsimikas et al, - "High-dose atorvastatin reduces total plasma levels of oxidized phospholipids and immune complexes present on apolipoprotein B-100 in patients with acute coronary syndromes in the MIRACL trial" - Response2005In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 111, no 18, p. E284-E285p. e284-e285Article in journal (Other academic)
    Abstract [en]

    [abstract not available]

  • 85.
    Uustal Fornell, Eva
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Kjölhede, Preben
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Prevalence of urinary and fecal incontinence and symptoms of genital prolapse in women2003In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 82, no 3, p. 280-286Article in journal (Refereed)
    Abstract [en]

    Background. Urinary incontinence is common in women. How often incontinence occurs has been only briefly investigated. Studies on the prevalence of fecal incontinence are few. The epidemiology of genital prolapse symptoms is unknown. This epidemiological study describes a general population of women aged 40 and 60 years with regard to the prevalence and frequency of urinary and fecal incontinence and the prevalence of genital prolapse symptoms.

    Methods. A questionnaire on medical background, urinary and fecal incontinence, and genital prolapse symptoms was sent to 1000 40-year-old and 1000 60-year-old randomly selected women.

    Results. Sixty-seven per cent answered: 53% were continent for urine; 9% of the 40-year-olds and 19% of the 60-year-olds had urinary incontinence weekly or more often. Detrusor instability score was significantly higher in the 60-year-olds. Incontinence of flatus, weekly or more often, was reported by 9% and 19%, loose feces by 5% and 8%, and solid feces by 0.3% and 1.7% according to the 40- and 60-year-olds, respectively. Fifty-three per cent reported no flatus incontinence. Of the prolapse symptoms investigated, 15% of the females reported pelvic heaviness, 4% genital bulge, and 12% use of fingers in the vagina or perineum by defecation.

    Conclusions. Incontinence of urine is common in this population. Flatus incontinence is as common, but the concept must be operationalized if used as an endpoint in research. The International Continence Society's (ICS) definition of urinary incontinence is unpractical for use in epidemiological research. We suggest leakage weekly or more often as a criterion for significant incontinence in epidemiological research.

  • 86.
    Uustal Fornell, Eva
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Molecular and Clinical Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 4, p. 383-389Article in journal (Refereed)
    Abstract [en]

    Objective.  To describe a general population of women with regard to factors associated with urinary and fecal incontinence and genital prolapse symptoms.

    Methods.  A questionnaire about medical background, urinary and fecal incontinence and genital prolapse symptoms was mailed to 1000 40-year-old and 1000 60-year-old Swedish women. Associations were described by odds ratios (ORs) with 95% confidence intervals (CIs).

    Results.  Sixty-seven percent answered the questionnaire. Multivariate analysis showed urinary incontinence to be associated with anal sphincter rupture [OR 4.4 (95%  CI 1.0–18.8)], pelvic heaviness [3.8 (2.1–7.0)], body mass index (BMI) ≥30 kg/m2[3.7 (2.0–6.7)], multiparity [1.8 (1.0–3.4)], varicose veins surgery [1.9 (1.2–3.2)] and age [1.9 (1.2–3.2)]. Univariate analyses revealed statistically significant associations between urinary incontinence and incontinence for flatus [4.8 (3.0–7.8)], for liquid stool [5.0 (2.9–8.6)] and for solid stool [5.9 (2.4–14.2)]. Chronic bronchitis [5.7 (1.7–18.9)] was strongly associated with urinary incontinence but was only reported by the older age group. Prolapse symptoms were strongly associated with both urinary and fecal incontinence. Prolapse symptoms as opposed to urinary and fecal incontinence seemed to be associated more with injuries at delivery than with chronic pelvic floor strain.

    Conclusions.  Women with urinary incontinence are also likely to suffer from fecal incontinence and prolapse and vice versa. Other associated factors for pelvic floor dysfunction were overweight, and especially obesity, chronic bronchitis, vaginal delivery and multiparity, age, heredity and diseases suggestive of collagen disorders. A multidisciplinary management of women with pelvic floor symptoms is suggested and possible prevention is discussed.

  • 87.
    Welin, Stellan
    Linköping University, Faculty of Arts and Sciences. Linköping University, The Tema Institute, Department of Water and Environmental Studies.
    Ethical issues in human embryonic stem cell research2002In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 81, no 5, p. 377-382Article in journal (Refereed)
  • 88.
    Westgren, N
    et al.
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Hultling, C
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Levi, Richard
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Seiger, A
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Westgren, M
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Sexuality in women with traumatic spinal cord injury.1997In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 76, no 10, p. 977-983Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sexuality in spinal cord injured women has largely been neglected. One reason may be the male dominance amongst traumatically spinal cord injured individuals. The purpose of this study is to elucidate sexual issues in women with spinal cord injuries.

    METHODS: Survey of near-total prevalence population in the greater Stockholm area. Structured interview, based on a standardized questionnaire. Self-rating scales for evaluation of the importance of sexual activity before and after injury and for defining and rating the medical problem most significantly interfering with sexual activity. Marital status and/or partnership pre- and post-injury and information on sexual matters provided after injury were evaluated in detail. Out of a total 65 women, 62 participated in the study.

    RESULT: Women with complete and incomplete cervical lesions rated the importance of sexual activity significantly lower after, as compared to before, spinal cord injury. No significant differences were found in women with lower-level lesions. Urinary leakage, spasticity and positioning problems were the medical problems most significantly interfering with partner-related sexual activity. Only six women had received information on sexual matters before discharge from hospital. None of the partners had received such information.

    CONCLUSION: The women's neurological status affect their ability to adapt sexually after injury. Medical problems commonly interfere with sexuality and should be identified and treated. No adverse impact of spinal cord injury on marital status could be confirmed. Sexual counseling has yet to become an integral part of rehabilitation.

  • 89.
    Wijma, Barbro
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Gullberg, Mats
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kjessler, Berndt
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Attitudes towards pelvic examination in a random sample of Swedish women1998In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 77, no 4, p. 422-428Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A pelvic examination is the most common procedure in gynecological practice. A majority of women have negative experiences of such examinations. The aim of the present study was to explore attitudes to and experiences of pelvic examinations, as well as possible background factors to such attitudes and experiences. METHODS: A postal inquiry was sent to 788 randomly selected Swedish women, of fertile age. Sixty-seven per cent answered the questionnaire, which had 56 items and covered, inter alia, attitudes to and experiences of pelvic examinations, as well as possible background factors. RESULTS: The women had positive, uniform attitudes to pelvic examinations in general, but negative experiences of the specific parts of the procedure. Women's attitudes to and experiences of pelvic examinations correlated. The experience of the first pelvic examination was more negative than the experience of the last. A negative experience in general and the experience of pain during the first pelvic examination correlated. The first pelvic examination emerged as a statistically powerful background factor for subsequent attitudes to pelvic examinations. CONCLUSIONS: Swedish women have positive attitudes to pelvic examination in spite of negative previous experiences. A powerful background factor for subsequent attitudes to pelvic examination was the experience of the first one. A woman's first pelvic examination should therefore be used as an opportunity to condition positive emotions and behaviors to the examination situation, as a basis for future positive experiences.

  • 90.
    Wijma, Barbro
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Siwe, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Examiner's unique possibilities to catalyze women's empowerment during a pelvic examination2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 12, p. 1102-1103Article in journal (Refereed)
  • 91.
    Wolgast, Emelie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Lindh Åstrand, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Lilliecreutz, Caroline
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Womens perceptions of medication use during pregnancy and breastfeeding-A Swedish cross-sectional questionnaire study2019In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 7, p. 856-864Article in journal (Refereed)
    Abstract [en]

    Introduction Use of medication for different kinds of symptoms and diseases during pregnancy is common. When counseling the pregnant woman, an understanding of her perceptions concerning the use of medication as well as possible associated anxiety and obstacles is important to ensure high adherence to the treatment regimen. Material and methods A questionnaire was developed regarding the use of medication, perceptions on use of medication, as well as perceptions about pregnancy outcomes in association with medication use during pregnancy. In total, 850 pregnant women in gestational weeks 25-29 participated in the study. Results The response rate was 92.7% (n = 832/898). About 19.4% of the respondents (n = 160/824) were frequent users (medication use daily to several times a week) and 28.4% (n = 234/824) were non-frequent users (medication use once a week to once a month). The majority perceived medication use during early pregnancy (61.4%, n = 501/816), late pregnancy (55.6%, n = 455/819) and breastfeeding (57.7%, n = 474/821) as probably harmful or harmful. These findings were more common in non-users (medication used rarely or never) than frequent users (P-value amp;lt;0.001, amp;lt;0.001 and 0.007). The pregnant women had great confidence in advice from a physician (83.8%, n = 666/795) or a midwife (77.0%, n = 620/805) concerning medication during pregnancy. Conclusions The majority of pregnant women in Sweden consider the use of medication during pregnancy either probably harmful or harmful and this perception is associated with non-use of medication. The pregnant women in our study had high confidence in healthcare professionals when seeking advice; thus, actively asking about perceptions could lead to better counseling.

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