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ABSTRACT: Abstract Objective To evaluate if acidemia in vigorous infants is useful in the assessment of intrapartum care with regard to cardiotocographic (CTG) patterns during the second stage. Methods Cases (n=241) were infants with an umbilical artery pH < 7.05, controls (n= 482) were infants with pH ≥ 7.05. Apgar score was ≥ 7 at five minutes in both groups. CTGs during the last two hours of labour were assessed and neonatal outcomes compared. A sub analysis of cases with metabolic acidemia: pH < 7.00 and base deficit ≥ 12mmol/L and, acidemia: 7.00 < pH < 7.05 was performed. Results 63% of cases had a pathological CTG versus 26% of controls (p <0.001). Patterns with severe variable decelerations had a significantly longer duration in cases. Metabolic acidemia was significantly associated with severe variable decelerations and, decreased variability. Infants to cases were admitted to neonatal care in 19 % versus 2 % of controls (p <0.001). With metabolic acidemia, 32 % were admitted. Conclusion An umbilical artery pH < 7.05 at birth of vigorous infants may be a useful variable for quality control of intrapartum management with regard to assessment of second stage CTGs. Differences in duration of pathological patterns indicate passiveness in acidemic cases.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 01/2013; · 1.36 Impact Factor
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ABSTRACT: Background. Computerized ST analysis of fetal electrocardiography (ECG) combined with cardiotochography (CTG) has been introduced for intrapartum monitoring and is the prevailing method when ST analysis (STAN®) is used. Objective. To assess the evidence that computerized ST analysis during labor reduces the incidence of fetal metabolic acidosis, hypoxic ischemic encephalopathy, cesarean section, instrumental vaginal delivery or the number of instances where fetal scalp blood sampling is used as compared with CTG only. Methods. Search of PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL and CRD databases. Selection criteria. CTG only compared with CTG + computerized ST analysis. Data collection and analysis. Studies were assessed using pre-designed templates. Meta-analyses of included randomized controlled trials were performed using a random effects model. Results. Risk ratio for cord metabolic acidosis with STAN® was 0.96 [95% confidence interval (CI) 0.49-1.88]. Risk ratio for cesarean sections or instrumental vaginal deliveries for fetal distress was 0.93 (95%CI 0.80-1.08) and for fetal scalp blood sampling 0.55 (95%CI 0.40-0.76). Encephalopathy cases were not assessed due to their low incidence. Conclusions. There is not enough scientific evidence to conclude that computerized ST analysis reduces the incidence of metabolic acidosis. Cesarean sections and instrumental vaginal deliveries due to fetal distress or other indications are the same, regardless of method, but STAN® reduces the number of instances which require scalp blood sampling.
Acta Obstetricia Et Gynecologica Scandinavica 12/2012; · 1.77 Impact Factor
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ABSTRACT: Background: Computerised ST analysis of fetal electrocardiography (ECG) combined with cardiotochography (CTG) has been introduced for intrapartum monitoring and is the prevailing method when ST analysis (STAN®) is used. Objectives: To assess the evidence that computerised ST analysis during labor reduces the incidence of fetal metabolic acidosis, hypoxic ischemic encephalopathy, cesarean section, instrumental vaginal delivery or the number of instances where fetal scalp blood sampling is used as compared with CTG only. Search Strategy: Search of PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL and CRD databases. Selection criteria: CTG only compared with CTG + computerised ST analysis. Data collection and analysis: Studies were assessed using pre-designed templates. Meta-analyses of included randomized controlled trials were performed using a random effects model. Main results: Risk ratio for cord metabolic acidosis with STAN® was 0.96 (95% confidence interval (CI) 0.49-1.88). Risk ratio for cesarean sections or instrumental vaginal deliveries for fetal distress was 0.93 (95%CI 0.80-1.08) and for fetal scalp blood sampling 0.55 (95%CI 0.40-0.76). Encephalopathy cases were not assessed due to their low incidence. Conclusions: There is not enough scientific evidence to conclude that computerised ST analysis reduces the incidence of metabolic acidosis. Cesarean sections and instrumental vaginal deliveries due to fetal distress or other indications are the same regardless of method, but STAN® reduces the number of instances where scalp blood sampling is required.
Acta Obstetricia Et Gynecologica Scandinavica 09/2012; · 1.77 Impact Factor
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ABSTRACT: Obesity is a risk factor for gestational diabetes, whereas the role of the mother's birth weight is more uncertain. We aimed to investigate the combined effect of mothers' birth-weight-for-gestational-age and early pregnancy Body Mass Index (BMI) in relation to risk of gestational diabetes. Between 1973 and 2006, we identified a cohort of 323,083 women included in the Swedish Medical Birth Register both as infants and as mothers. Main exposures were mothers' birth-weight-for-gestational-age (categorized into five groups according to deviation from national mean birth weight) and early pregnancy BMI (classified according to WHO). Rates of gestational diabetes increased with adult BMI, independently of birth-weight-for-gestational-age. However, compared to women with appropriate birth-weight-for-gestational-age [appropriate-for-gestational age (AGA); -1 to +1 SD] and BMI (<25.0), women with obesity class II-III (BMI ≥ 35.0) had an adjusted odds ratio (OR) of 28.7 (95 % confidence interval, CI 17.0-48.6) for gestational diabetes if they were born small-for-gestational-age [small for gestational age (SGA); <-2SD], OR = 20.3 (95 % CI 11.8-34.7) if born large-for-gestational-age [large-for-gestational-age (LGA); >2SD], and OR = 10.4 (95 % CI 8.4-13.0) if born AGA. Risk of gestational diabetes is not only increased among obese women, but also among women born SGA and LGA. Severely obese women born with a low or a high birth-weight-for-gestational-age seem more vulnerable to the development of gestational diabetes compared to normal weight women. Normal pre-pregnancy BMI diminishes the increased risk birth size may confer in terms of gestational diabetes. Therefore, the importance of keeping a healthy weight cannot be overemphasized.
European Journal of Epidemiology 08/2012; · 4.71 Impact Factor
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ABSTRACT: To assess the risk of perinatal complications in overweight and obese women with and without type 1 diabetes (T1DM).
Prospective population-based cohort study.
This study was based on data from the Swedish Medical Birth Registry from 1998 to 2007.
3457 T1DM and 764 498 non-diabetic pregnancies were included. T1DM was identified based on ICD code O24.0. Mothers were categorised according to pre-pregnancy body mass index (BMI: weight in kilograms per height in square metres) as normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9) or obese (BMI ≥30). Only women with singleton pregnancies and with data on BMI were included. PRIMARY/SECONDARY OUTCOMES: The primary outcome was large for gestational age (LGA: birth weight >90th percentile) infants. Secondary outcomes were major malformations, pre-eclampsia (PE), preterm delivery, perinatal mortality, delivery by Caesarean section and neonatal overweight. Logistic regression analysis was performed with normal weight non-diabetic women as the reference category and also within the diabetic cohort with normal weight type 1 diabetic women as the reference. The ORs were adjusted for ethnicity, maternal age, height, parity, smoking and chronic hypertension.
35% of women with T1DM were overweight and 18% were obese, as compared with 26% and 11%, respectively, in non-diabetic pregnancies. The incidences of adverse outcome increased with greater BMI category. As compared with non-diabetic normal weight women, the adjusted OR for obese T1DM for LGA was 13.26 (95% CI 11.27 to 15.59), major malformations 4.11 (95% CI 2.99 to 5.65) and PE 14.19 (95% CI 11.50 to 17.50). T1DM was a significant effect modifier of the association between BMI and LGA, major malformations and PE (p<0.001).
High pre-pregnancy BMI is an important risk factor for adverse outcome in type 1 diabetic pregnancies. The combined effect of both T1DM and overweight or obesity constitutes the greatest risk. It seems prudent to strive towards normal pre-pregnancy BMI in women with T1DM.
BMJ open. 01/2012; 2(1):e000601.
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Ulf Hanson
The Lancet 09/2011; 378(9797):1137-8; author reply 1138. · 38.28 Impact Factor
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ABSTRACT: To evaluate the rate of discrepancy between pH and lactate values in fetal blood sampling (FBS). To evaluate differences in obstetric management in response to combined tests (pH and lactate) and single tests (pH or lactate).
Descriptive study.
Uppsala University Hospital, Sweden.
Labors monitored by FBS during one year (n=241).
Discrepancy in the combined tests was defined as a test having one abnormal and one normal value. Abnormal pH was defined as 7.24 or lower and abnormal lactate as 4.2 or higher. The results were categorized according to whether the test was normal or abnormal and according to whether it was a combined or single analysis.
Discrepancy between pH and lactate values in combined tests. Frequency of operative delivery for fetal distress (ODFD). Time interval from the last FBS to ODFD.
In the combined tests with abnormality, a discrepancy between pH and lactate values occurred in 55%. The mean time interval from the last FBS to ODFD was longer in combined tests with one abnormal compared with two abnormal test results, 75 vs. 37 minutes (p<0.05). Operative delivery for fetal distress was performed less often after combined tests than after single tests: 41/62 (66%) vs. 19/20 (95%) (p<0.05).
In the combined test, discrepancies were common and occurred in half of the samples with an abnormality. Obstetric management was influenced by the discrepancy between test results with respect to ODFD rates and the time interval from the last FBS to delivery.
Acta Obstetricia Et Gynecologica Scandinavica 06/2011; 90(10):1088-93. · 1.77 Impact Factor
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ABSTRACT: To characterize birth size distribution in infants born to mothers with type 1 diabetes. In particular, the relationship between birth weight (BW) and length (BL) was studied because it may provide information on different causal pathways of fetal macrosomia commonly seen in diabetic pregnancies.
This was a population-based cohort study of 3,705 infants of type 1 diabetic mothers (1,876 boys), with a gestational age of 28-43 weeks, born in Sweden between 1998 and 2007. BW and BL were retrieved from the Medical Birth Registry and expressed as SD scores (SDS). Ponderal index (PI) was calculated as BW in g/length in cm³. A BW >90th and a PI ≤ 90th percentile was defined as proportionate large-for-gestational age (LGA), whereas if both BW and PI > 90th percentile, the infant was categorized as disproportionately large. Values are mean (SD).
The BW distribution for offspring of type 1 diabetic mothers was bell-shaped, significantly broader, and markedly shifted to the right (BWSDS: 1.27 [1.48]) of the reference. Of the infants born to diabetic mothers, 47% were LGA, and among them, 46% were disproportionately large compared with 35% in nondiabetic LGA infants (P < 0.001). Female offspring of type 1 diabetic mothers had significantly higher BWSDS than males (1.34 vs. 1.20, P < 0.01), and preterm infants had higher BWSDS than term infants (1.41 vs. 1.23, P < 0.01)
Fetal macrosomia in type 1 diabetic pregnancies is due to a right-shift and broadening of the entire BW distribution. The large number of disproportionate LGA infants born to type 1 diabetic mothers suggests an underlying metabolic problem. Fetal macrosomia was more pronounced in preterm and female offspring of type 1 diabetic mothers.
Diabetes care 03/2011; 34(5):1145-9. · 8.09 Impact Factor
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ABSTRACT: To perform comparative analyses of obstetric and perinatal outcomes between type 1 diabetic pregnancies and the general obstetric population in Sweden between 1991 and 2003.
This was a population-based study. Data were obtained from the Medical Birth Registry, covering >98% of all pregnancies in Sweden. A total of 5,089 type 1 diabetic pregnancies and 1,260,207 control pregnancies were included. Odds ratios (ORs) were adjusted for group differences in maternal age, parity, BMI, chronic hypertensive disease, smoking habits, and ethnicity.
In type 1 diabetes, preeclampsia was significantly more frequent (OR 4.47 [3.77-5.31]) as was delivery by cesarean section (5.31 [4.97-5.69]) compared with results for the general population. Stillbirth (3.34 [2.46-4.55]), perinatal mortality (3.29 [2.50-4.33]), and major malformations (2.50 [2.13-2.94]) were more common in type 1 diabetic than in control pregnancies. The risk of very preterm birth (<32 gestational weeks) was also higher among type 1 diabetic women (3.08 [2.45-3.87]). The incidence of fetal macrosomia (birth weight >or=2 SD above the mean) was increased in the diabetic group (11.45 [10.61-12.36]).
Type 1 diabetes in pregnancy is still associated with considerably increased rates of adverse obstetric and perinatal outcomes. The eightfold increased risk for fetal macrosomia in type 1 diabetic pregnancies is unexpected and warrants further investigation.
Diabetes care 09/2009; 32(11):2005-9. · 8.09 Impact Factor
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ABSTRACT: To investigate consumption of and attitudes toward pornography in relation to demographic factors and relationships to parents among third-year high school students.
A random sample of 718 students with a mean age 18 years (range 17-21) completed a classroom questionnaire consisting of 89 questions.
More students in practical than in theoretical study programmes had parents with a practical profession (p < 0.001). More parents to students attending theoretical programmes owned their housing (p < 0.001). More men than women had ever consumed pornography (98% vs. 72%; p < 0.001). More practical than theoretical students were influenced by watching pornographic films, fantasizing about (p < 0.05) or having performed acts inspired by pornography (p < 0.05). Both theoretical and practical male students had more favourable attitudes toward pornography than either group of female students (p < 0.001; p = 0.037). More female, than male students, were of the opinion that pornography could create uncertainty and demands.
Students' high school programme choices partly reflect their social background. Pornography was consumed mainly by male students, who also had the most favourable attitudes, while females mainly had negative attitudes. To promote sexual health these differences between genders and study programmes should be taken into consideration in counselling, and in sex- and relationships education.
The European Journal of Contraception and Reproductive Health Care 07/2009; 14(4):277-84. · 1.46 Impact Factor
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ABSTRACT: To investigate self-reported sexual experiences, abortions, sexually transmitted infections (STIs), use of contraception and possible influencing factors on contraceptive use among Swedish high school students.
An anonymous classroom survey was distributed to a random sample (n = 924) of 18-year-old high school students in a medium-sized Swedish city. The response rate was 78% (n = 718).
Three out of four students had experienced intercourse and the majority of them stated that they were satisfied with their sexual life. Few students reported having had an abortion (5%) or a STI (4%). Alcohol use appeared the most important contributing risk factor for non-use of contraception in relation to both first and latest intercourse, and the young men reported more unprotected latest intercourse than the young women did.
The fact that young men appear less inclined to use contraception is disturbing, and must be addressed in sexual education and individual counseling to promote a better sexual health for adolescents.
The European Journal of Contraception and Reproductive Health Care 07/2007; 12(2):119-24. · 1.46 Impact Factor
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ABSTRACT: The objective of this study was to analyse the motives behind disciplinary action in obstetric malpractice cases concerning delivery, and to evaluate the frequency of inappropriate oxytocin use in these cases.
An analysis of all malpractice claims resulting in disciplinary action against physicians and midwives during the period 1996-2003. Investigations and decisions made by the Board of Medical Responsibility were reviewed with special focus on the use of oxytocin.
Of 77 cases, 60 regarded patients in labour. In the majority, there had been a normal pregnancy and spontaneous start of labour (78%). At the beginning of labour, 87% showed a normal fetal heart rate (FHR) pattern, indicating fetal well-being. In 70%, there was adverse fetal outcome with brain damage or death. The most common reason for disciplinary action was improper interpretation of fetal monitor tracings and corresponding failure to recognise fetal distress (76%). Injudicious use of oxytocin was common (68.5%), and was the primary reason for disciplinary action in 33% of the cases.
In a Swedish setting, a few common clinical problems pervade; interpretation of FHR patterns and the use of oxytocin account for the majority of rulings of negligence in malpractice cases regarding delivery. Analysis of the cases suggests that the adverse fetal outcomes could possibly have been prevented.
Acta Obstetricia Et Gynecologica Scandinavica 02/2007; 86(3):315-9. · 1.77 Impact Factor
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Elisabet Häggström-Nordin RN, RM, PhD (Senior Lecturer,
PhD (Assistant Professor and Senior Lecturer) Jonas Sandberg RN,
PhD (Associate Professor) Ulf Hanson MD,
Tanja Tydén RN, RM, PhD (Professor and Senior Lecturer,
Elisabet Häggström‐Nordin,
Jonas Sandberg, Ulf Hanson,
Tanja Tydén
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ABSTRACT: Pornography is one of the most sought-after topics on the Internet, and is easily available for anyone, including children and adolescents. At youth centres, nurse-midwives have noticed that young people have different kinds of questions about sexual practices compared with a few years ago. The aim of this study was to gain an understanding of thoughts and reflections about pornography consumption, and its possible influence on sexual practices, among young women and men. The staff at a youth centre in a city in central Sweden asked the visitors if they had seen pornography and if they wanted to be interviewed about their experiences. Ten young women and eight men, aged 16–23 years, participated. In-depth interviews were performed and open-ended questions about pornography and sexuality were posed. The interviews were tape-recorded and transcribed verbatim. Data were analysed according to grounded theory. The core category ‘Living with the current sexual norm’ depicted how pornography created sexual expectations and demands, for instance, to perform certain sexual acts. The informants expressed contradictory feelings towards pornography and felt that sexuality was separated from intimacy. A moral attitude was described and examples of stereotypic gender roles were given. To deal with the current sexual norm, informants had different individual handling strategies and attitudes to pornography, namely liberal, normalization, distance, feminist or conservative. Limitations of this study were the small sample size and that results from a qualitative research study cannot be generalized. The results contribute to an understanding of how pornographic material can influence young peoples’ thoughts, reflections and sexual behaviour. This indicates the importance, for personnel at youth centres and schools, to discuss sexual behaviour and how sexuality is portrayed in pornographic material with young people.
Scandinavian Journal of Caring Sciences 11/2006; 20(4):386 - 393. · 0.89 Impact Factor
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ABSTRACT: Chronic hypertension during pregnancy is associated with an increased risk for birth of small for gestational age offspring. The aim of this study was to determine whether the risk remains after consideration of maternal characteristics and superimposed pre-eclampsia.
A population-based cohort study based on the Swedish Medical Birth Register 1992-98 and comprising 560 188 women aged 15-44 years with singleton pregnancies including 2,754 women with chronic hypertension. The register contains data of maternal characteristics besides maternal and fetal complications. Multiple logistic regression analysis was used. Small for gestational age was defined as birth weight less than -2SD adjusted for gestational age and sex.
Chronic hypertensive women have an independent risk for small for gestational age (OR 3.1; 95% CI 2.7-3.7) when controlling for confounding of maternal characteristics such as age, parity, BMI, smoking, and ethnic origin. After introducing superimposed pre-eclampsia in the model the risk remains but decreases (OR 2.4; 95% CI 2.1-2.9).
Chronic hypertension is an independent risk factor for birth of small for gestational age offspring. Pre-eclampsia is a strong mediating factor.
Acta Obstetricia Et Gynecologica Scandinavica 02/2006; 85(9):1046-50. · 1.77 Impact Factor
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ABSTRACT: The aim of the study was to determine if pregnant women with chronic hypertensive disease have an independent risk for preeclampsia, gestational diabetes or placental abruption. To examine if superimposed preeclampsia in this group of women is related to an increased risk of placental abruption.
This study is a population-based cohort study using the Swedish Medical Birth Register 1992-98. A population of 681 515 women aged between 15-44 years with singleton pregnancies, excluding women with systemic lupus erythematosus (SLE), diabetes mellitus and chronic renal disease were studied. Among these, 3374 women were diagnosed with chronic hypertensive disease. Multiple logistic regression analysis was performed and the outcome measures of crude and adjusted odds ratios (OR) were presented with 95% confidence intervals (CI).
Chronic hypertensive disease is associated with multiparity, age, high body mass index and Nordic ethnicity. After controlling for confounders, chronic hypertensive disease is an independent risk factor for preeclampsia (OR 3.8; 95% CI 3.4-4.3), gestational diabetes (OR 1.8; 95% CI 1.4-2.4) and placental abruption (OR 2.3; 95% CI 1.6-3.4).
Chronic hypertensive disease is independently associated with an increased incidence of preeclampsia, gestational diabetes and placental abruption.
Acta Obstetricia Et Gynecologica Scandinavica 06/2005; 84(5):419-24. · 1.77 Impact Factor
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ABSTRACT: To determine whether gestational diabetes mellitus (GDM) increases the risk for preeclampsia independent of other risk factors.
The association between GDM and preeclampsia was analyzed in a population of women who had given birth to singletons registered in Swedish Medical Birth Register from 1992 through 1996 (n=430,852).
GDM occurred in 0.8% and preeclampsia in 2.9% of all pregnancies. The rate of preeclampsia was higher in the GDM than in the non-GDM group (6.1% versus 2.8%). High age, nullipara, chronic hypertension, kidney disease, and high body mass index (BMI) were all independently associated with increased risk for preeclampsia. Smoking was associated with decreased risk. Adjusted odds ratio for GDM as a risk factor for preeclampsia was 1.61 (95% confidence interval (CI) 1.39-1.86) when prepregnancy BMI, which was a true confounder, was included in the last step of the multiple logistic regression analysis.
There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor but could not explain the total excess risk.
European Journal of Obstetrics & Gynecology and Reproductive Biology 04/2004; 113(1):12-6. · 1.97 Impact Factor
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ABSTRACT: To determine the value of repeated random blood glucose (R-B-glucose) measurements alone or in combination with traditional risk factors [family history of diabetes, obesity, prior large-for-gestational-age (LGA) infant or prior gestational diabetes mellitus (GDM)] to predict the outcome of the oral glucose tolerance test (OGTT).
A prospective population-based study was undertaken in a Swedish county. All pregnant nondiabetic women (n = 4918) visiting the maternal health care clinics over a 2-year period were offered a 75-g OGTT in gestational weeks 28-32. Traditional risk factors and values of repeated R-B-glucose measurements were registered, as well as the results of the OGTT, in terms of fasting B-glucose and 2-h B-glucose.
A total of 3616 women (73.5%) had an OGTT. Of these, 1.7% had GDM, 1.3% impaired glucose tolerance (IGT) and 0.4% diabetes mellitus (DM). An R-B-glucose cut-off level > or =8.0 mmol/L as the only indicator for an OGTT was optimal for detecting GDM with regard to sensitivity (47.5%) and specificity (97.0%). It has the same sensitivity for detecting GDM as using traditional risk factors, but reduces the need to carry out the OGTT from 15.8% to 3.8% of the population. Combined with prior LGA infant or prior GDM as indications for the OGTT in the present study, all women with DM and 44.7% of those with IGT will be identified. Only 7.3% of the population will have to take the OGTT.
A random B-glucose level > or = 8.0 mmol/L prior LGA infant or prior GDM as an indicator for taking the OGTT is a simple and effective first step in a two-step screening model for GDM.
Acta Obstetricia Et Gynecologica Scandinavica 01/2004; 83(1):46-51. · 1.77 Impact Factor
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ABSTRACT: To evaluate whether there is increased maternal or neonatal morbidity in connection with impaired glucose tolerance (IGT) during pregnancy when the condition is not treated.
During the study period of 1997-2001, in a defined geographical area in Sweden, the diagnostic criteria for gestational diabetes mellitus (GDM) were limited to the criteria for diabetes. Prospectively, 213 women who were identified with IGT during pregnancy were undiagnosed and untreated. Data on maternal and fetal outcome was collected from records. For each case subject, four control subjects were taken from the same delivery department.
The proportion of women who underwent cesarean section was significantly higher in the case subjects than in the control subjects and was independently associated with IGT. The adjusted odds ratio (OR) was 1.9 (95% CI 1.2-2.9). The proportion of infants who were large for gestational age (LGA), defined as birth weight >2 SDs greater than the mean for gestation and sex, was independently significantly associated with untreated IGT during pregnancy (OR 7.3, 95% CI 4.1-12.7). Admission to a neonatal intensive care unit (NICU) for 2 days or longer was more common (adjusted OR 2.0, 95% CI 1.1-3.8). However, 71.3% of the children in the IGT group and 87.3% of the control subjects had no neonatal complications.
There is increased independent association between cesarean section rate, prematurity, LGA, and macrosomic infants born to mothers with untreated IGT. Most of the children were healthy, but there is still increased morbidity. Therefore, to evaluate the effects of treatment, there is a need for a randomized study.
Diabetes Care 07/2003; 26(7):2107-11. · 8.09 Impact Factor
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ABSTRACT: The objective of the present study was to determine prevalence of gestational diabetes mellitus (GDM) in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), and the value of traditional anamnestic risk factors for predicting outcome of the oral glucose tolerance test (OGTT).
A prospective population-based study in a defined geographic area in Sweden. All pregnant nondiabetic women (n = 4918) attending maternal health care from July 1994 to June 1996 were offered a 75g OGTT in gestational weeks 28-32. Traditional anamnestic risk factors, as well as results of the OGTT in terms of fasting-B-glucose and 2h-B-glucose, were registered.
3616 (73.5%) women agreed to perform the OGTT. Sixty-one (1.7%) of those had GDM [47 (1.3%) had impaired glucose tolerance and 14 (0.4%) had diabetes mellitus]. 15.8% fulfilled traditional risk factor criteria. Traditional anamnestic risk factors as an indicator to perform an OGTT identified 29/61 GDM women and 9/14 women with DM. Among primiparas, 4/21 with gestational diabetes mellitus were detected.
Using traditional risk factors as an indicator to perform an OGTT gives a low sensitivity to detect GDM and even DM especially among primiparas.
Acta Obstetricia Et Gynecologica Scandinavica 03/2003; 82(2):103-8. · 1.77 Impact Factor
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ABSTRACT: To investigate acupuncture treatment during labour with regard to pain intensity, degree of relaxation and outcome of the delivery.
Randomised controlled trial.
Delivery ward at a tertiary care centre hospital in Sweden.
Ninety parturients who delivered during the period April 12, 1999 and June 4, 2000.
Forty-six parturients were randomised to receive acupuncture treatment during labour as a compliment, or an alternative, to conventional analgesia.
Assessments of pain intensity and degree of relaxation during labour, together with evaluation of delivery outcome.
Acupuncture treatment during labour significantly reduced the need of epidural analgesia (12% vs 22%, relative risk [RR] 0.52, 95% confidence interval [CI] 0.30 to 0.92). Parturients who received acupuncture assessed a significantly better degree of relaxation compared with the control group (mean difference -0.93, 95% CI -1.66 to -0.20). No negative effects of acupuncture given during labour were found in relation to delivery outcome.
The results suggest that acupuncture could be a good alternative or complement to those parturients who seek an alternative to pharmacological analgesia in childbirth. Further trials with a larger number of patients are required to clarify if the main effect of acupuncture during labour is analgesic or relaxing.
BJOG An International Journal of Obstetrics & Gynaecology 07/2002; 109(6):637-44. · 3.41 Impact Factor
