Ylva Vladic Stjernholm

Karolinska Institutet | KI · Department of Women's and Children's Health Obstetric Unit

According to data from 150 countries, the worldwide caesarean section rate increased from 7% in 1990 to 19% in 2014. Latin America and the Caribbean region reported the highest CS rate 42%, followed by North America 32%, Oceania 31%, Europe 25%, Asia 19%, and Africa 7%. This trend is accompanied by increasing reports of severe adverse outcomes, suc...

Introduction: The aim was to determine risk factors among mothers and outcomes for their children born at the limit of viability in 2009-2019, before and after the introduction of extended interventionist guidelines. Methods: A retrospective cohort study of births at 22 + 0-23 + 6 gestational weeks in a Swedish Region in 2009-2015 (n = 119), as...

Induced labor has increased in Sweden since the 1990s. The reasons for labor induction were changed between the years 2013 and 2020, and prolonged pregnancy 41+0 - 6 weeks was the primary reason for labor induction at our hospital in 2020. We conclude, that the evidence for labor induction due to prolonged pregnancy is limited, especially in parou...

The aim of this trial was to evaluate the effect of progesterone gel compared to placebo in prolonging pregnancy among women with preterm labor. Methods: A randomized controlled trial in Sweden in 2009–18. Women with early preterm labor were randomized to daily doses of progesterone gel 90 mg (n = 28) or placebo (n = 30) after standard intravenous...

Blue rubber bleb nevus syndrome (BRBNS) is a rare systemic syndrome characterized by venous malformations usually found in the skin and visceral organs. To date, 11 case reports describing BRBNS during pregnancy have been published. To our knowledge, this is the first report describing intracranial, airway, epidural, and birth canal involvement of...

Background: Obstetric labor and childbirth are mostly regarded as a physiological process, whereas social, cultural, psychological and transcendental aspects have received less attention. Labor support has been suggested to promote labor progress. The aim of this study was to investigate whether continuous labor support by a midwife promotes labor...

Key Clinical Message A neonatal parietal bone fracture was complicated by subgaleal and subdural hematomas after a vacuum extraction delivery. Low‐dose computer tomography visualized a comminuted skull fracture. Close observation of infants delivered by vacuum extraction, conservative management after a skull fracture, and further studies on vacuum...

Introduction: The increasing Cesarean Section (CS) rate worldwide is followed by increased maternal morbidity due to Placenta Accreta Spectrum (PAS) disorders. The objective was to evaluate the rate of CS with Peripartum Hysterectomy (PPHE) due to advanced PAS disorders during the years 2008-18. Furthermore, we compared the rates of antenatal detec...

Objective The objective of this study was to compare duration of active labor, delivery mode, maternal and neonatal morbidity and women’s satisfaction with delivery after intravenous remifentanil patient-controlled analgesia (PCA) or standard epidural analgesia (EDA). Based on clinical observations, we hypothesized that women with PCA would have sh...

Background: The increasing caesarean delivery rate worldwide is followed by increased maternal morbidity due to pathological placentation, peripartum hysterectomy and obstetric bleeding. The aim of this study was to investigate the indications for caesarean delivery. Study design: A retrospective observational study. Data were retrieved from the...

Objective To compare labor induction with transcervical catheter compared with oral misoprostol in primiparous women and women with an unripe cervix, who are at high risk for unsuccessful labor induction. Study Design A retrospective study in a university hospital in Sweden. Primary outcomes were vaginal birth within 24 hours and the cesarean secti...

Ethical approval: Regional Board of Ethics Stockholm, 9 April 2015. Conflict of interests: None. Background: Indications for planned, urgent and immediate caesarean sections were analysed in order to suggest adequate actions to prevent unnecessary caesareans. Study design: Data were collected from the Swedish Medical Birth Register, the Swedish P...

Extrem prematurbörd (PTB) orsakar en övervägande del av all neonatal dödlighet och sjuklighet. Antenatala kortikosteroider minskar mortalitet och morbiditet vid extrem PTB, men effekten vid 22 – 24 v är oklar. Syfte: Att studera om ändrade regionala riktlinjer i Stockholmsregionen 2014 gällande administrering av antenatala steroider från 22+5 v jäm...

Prematurbörd (PTB) är den ledande orsaken till perinatal mortalitet och morbiditet. Tidig (28+0 – 33+6 v) och sen (34+0 – 36+6 v) PTB utgör majoriteten av all PTB. Fler studier över orsaker och utfall efter tidig och sen PTB har efterlysts. Syftet med dessa examensarbeten var att studera riskfaktorer för och utfall efter tidig och sen PTB. Tidigt...

p> Background: Universal health coverage is a human right according to the United Nations Universal Declaration of Human Rights. Healthcare across the world has undergone frequent management reforms during the 20^th century. The aim of this review was to investigate the impact of management reforms on patient safety and universal health c...

Introduction: Maternal S-cortisol levels increase throughout pregnancy and peak in the third trimester. Even higher levels are seen during the physical stress of delivery. Since analgesia for women in labor has improved, it is possible that maternal stress during labor is reduced. The aim of this study was to compare maternal S-cortisol during vag...

OBJECTIVE: To compare the efficacy and safety of oral prostaglandin (PG) in solution versus vaginal PG gel for labor induction. DESIGN: A retrospective study. METHODS: Data from original obstetric records at a university hospital in Sweden 2012-2013. RESULTS: In all women, oral PG resulted in vaginal birth (VB) < 24 h in 66% compared to...

Objective: To compare the efficacy and safety of oral prostaglandin in solution, vaginal prostaglandin gel and trans cervical catheter for labor induction in primiparous women and women with an unripe cervix. Design: A retrospective study. Methods: Data from original obstetric records at a university hospital in Sweden in 2012-2013. Results: In pri...

Abstract Objective. To compare the efficacy and safety of oral prostaglandin in solution versus vaginal prostaglandin gel for labor induction. Design. A retrospective study. Methods. Data from original obstetric records at a university hospital in Sweden 2012-2013. Results. In all women, oral prostaglandin resulted in vaginal birth < 24 hours in...

FALLBESKRIVNING Reumatisk hjärtsjukdom bakom livshotande hjärtsvikt hos gravid Michelle Ek, ST-lä-kare, kvinnokliniken, Södersjukhuset b michelle.ek@sodersjuk-huset.se Ylva Vladic Stjern-holm, docent, överlä-kare, kvinnokliniken Anders Günther, specialistläkare, Tho-raxanestesin Caroline Hällsjö-Sander, med dr, biträdande överläka-re, ANOPIVA-klini...

Objective: To compare the efficacy and safety of oral prostaglandin (PG) in solution versus vaginal PG gel for labor induction. Design: A retrospective study. Methods: Data from original obstetric records at a university hospital in Sweden 2012-2013. Results: In all women, oral PG resulted in vaginal birth (VB) < 24 h in 66% compared to 80%...

Valvular heart disease constitutes the majority of all causes of heart disease in pregnancy. In the presence of valvular heart disease, the necessary haemodynamic changes of pregnancy might cause heart failure, leading to severe maternal and fetal morbidity and even mortality. In lower-income countries, rheumatic heart disease remains one of the ma...

Objective: The aim was to compare the efficacy and safety with oral prostaglandin in solution, vaginal prostaglandin gel and transcervical catheter for labor induction in primiparous women and women with an unripe cervix. Design: A retrospective study. Methods: Data from obstetric records at a university hospital in Sweden 2012-2013. Results: In pr...

Objective: To compare the efficacy and safety of oral prostaglandin in solution, vaginal prostaglandin gel and trans cervical catheter for labor induction in primiparous women and women with an unripe cervix. Design: A retrospective study. Methods: Data from original obstetric records at a university hospital in Sweden in 2012-2013. Results: In pri...

Hur många inom läkarprofessionen, sjukvårdsorganisationen eller sjukvårdspolitiken känner till den internationella läkareden? Hur många känner till historien bakom dess tillkomst? Sjuttio år efter andra världskrigets slut finns anledning att se tillbaka på utformningen av det internationella samfundets värdegrund och läkareden. I dokumentärfilmen »...

Objective: To compare labor induction with transcervical catheter to oral misoprostol treatment in primiparous women and women with an unripe cervix, who are at high risk for unsuccessful labor induction. Study Design: A retrospective study was carried out in a university hospital in Sweden. Primary outcomes were vaginal birth within 24 hours and t...

Efter andra världskriget sågs Sverige som ett mönsterland vad gäller välfärd. Ett riksdagsbeslut från 1938 hade givit alla medborgare tillgång till kostnadsfri mödrahälsovård, vilket var världsunikt. När affärsvärldens nya offentliga styrning (New public management, NPM) fläktade in över den svenska sjukvården under 1990-talet kom fokus att riktas...

På initiativ av Neonatalsektionen (SNS) inom Svensk Barnläkarförening beslutades att tillsammans med Svenska Barnmorskeförbundet (SBF) och Svensk Förening för Obstetrik och Gynekologi (SFOG) att bilda en arbetsgrupp med syfte att utarbeta rekommendationer för vård efter förlossningen för modern och barnet. Arbetsgruppen tillsattes under 2010 med Lo...

Prostaglandins (PGs) mediate cervical ripening leading to parturition. PGs are used successfully to induce cervical ripening. However, the cell type specific expression of PG receptor subtypes and various stromal factors important for cervical ripening in human cervix is not known. Our objective was to investigate the expression and localization of...

To investigate expression and localization of prostaglandin receptors EP1-4 and FP and localization of stromal factors CTGF (connective tissue growth factor), furin, calgranulin B and ALOX15 (arachidonate 15-lipooxygenase) in human cervical tissue from post-term women with failed and successful labor induction after prostaglandin priming. Experimen...

Prostaglandins (PGs) mediate cervical ripening lead-ing to parturition. PGs are used successfully to induce cervical ripening. However, the cell type specific ex-pression of PG receptor subtypes and various stromal factors important for cervical ripening in human cer-vix is not known. Our objective was to investigate the expression and localization...

Rekommendation om sängläge är vanligen den första åtgärden vid hotande prematurbörd (förlossning 22+0 – 36+6 graviditetsveckor), för tidig livmoderhalsutmognad, preeklampsi eller komplicerad mulipel graviditet. Litteraturstödet för att sängläge verkligen förhindrar förtidsbörd och förbättrar graviditetsutfallet förefaller dock begränsat (1,2). De r...

1. Introduction 8 1.1 Progesterone synthesis 9 Progesterone was independently discovered by different research groups (Butenandt & 10 Westphal 1934, Allen 1935). Allen and collaborators discovered progesterone in 1933, and 11 were the first to determine the molecular weight and partial molecular structure. The name 12 progesterone derives from pro...

”I vår samtid kan nästan allting värderas, köpas och säljas. Här finns också en utförsäljning av familjen och relationerna mellan människor” säger Dramatens teaterchef och VD Marie-Louise Ekman (1). Under hösten 2011 kommer Dramaten att ge ”Den girige” av Jean-Baptiste Molière och ”Två herrar” av Carlo Goldoni. Sjukvården styrs av en närmast religi...

The aim of this study was to investigate the indications for cesarean sections in the early 1990s as compared to the middle 2000s. Retrospective cohort study. Data were collected from original obstetrical records in a tertiary hospital in 1992 and 2005. The total cesarean delivery rate rose from 11% to 20%. The main indications for an elective cesa...

Treatment with prostaglandin(PG)-E2 is clinically efficient for cervical priming. The aim of this study was to evaluate the impact of PG-E2 on the expression of the progesterone (PR), androgen (AR) and glucocorticoid (GR) receptors in human uterine cervix in prolonged pregnancy. The study groups were postterm nulliparous women with unripe cervices...

Prolonged pregnancies are associated with increased rate of maternal and fetal complications. Post term women could be divided into at least two subgroups, one where parturition is possible to induce by prostaglandins and one where it is not. Our aim was to study parameters in cervical biopsies in women with spontaneous delivery at term (controls)...

Syntetiskt, esterifierat progesteron-caproat är associerat till minskad risk för prematurbörd < 37 veckor och födelsevikt < 2500 g. Bristande information angående övriga maternella och neonatala effekter, eftersom den mesta informationen härrör från en studie, Meis et al 2003.

Blivande föräldrars möjligheter att få samtal, information och stöd angående graviditeten har minskat på grund av reducerade resurser. Läkar- och barnmorskebesöken har blivit färre och psykoprofylaxen tagits bort. Samtidigt har kejsarsnitt kommit att framställas som en rättighet. Men överkonsumtion av kejsarsnitt är skadlig både för individen, sjuk...

Kejsarsnittsförlossningar har ökat i flertalet utvecklade länder under de senaste decennierna. I Sverige förlöstes 5 procent av kvinnorna med kejsarsnitt vid mitten av 1970-talet [1]. Under åren 2004–2005 var kejsarsnittsfrekvensen i Sverige 17 procent, i Europa 20 procent och i USA 29 procent [2, 3]. Andelen kejsarsnitt varierar inte bara mellan u...

Cervical ripening resembles an inflammatory reaction. Estrogens induce leukocyte migration into tissue and factors promoting cervical remodeling and labor, although the mechanisms are only partially known. The aim of this study was to investigate whether plasma membrane receptor mediated pathways, known to be activated by estrogens and proinflammat...

Preterm birth is still the leading cause of neonatal morbidity and mortality. The level of corticotropin-releasing hormone (CRH) is known to be significantly elevated in the maternal plasma at preterm birth. Although, CRH, CRH-binding protein (CRH-BP), CRH-receptor 1 (CRH-R1) and CRH-R2 have been identified both at mRNA and protein level in human p...

Cervical ripening is an inflammatory reaction. The glucocorticoid receptor (GR) mediates glucocorticoid anti-inflammatory reactions, whereas nuclear factor (NF)kappaB is a key pro-inflammatory transcription factor. Prostaglandins as well as platelet activating factor (PAF) are inflammatory mediators. Inducible nitric oxide synthase (iNOS) regulates...

The concept of a blockade of progesterone during human pregnancy and withdrawal of this blockade at parturition remains controversial There is no sharp fall in serum progesterone before parturition, but treatment with an antiprogestin is successful for labor induction at term pregnancy. The human progesterone receptor (PR) exists in two isoforms (P...

Cervical softening is crucial for a normal parturition and corresponds to remodeling of the dominating cervical extra cellular matrix (ECM). The onset of labor as well as cervical ripening is under hormonal control. To get further information about the endocrine regulation of term cervical ripening the following study was undertaken: cervical biops...

Thioredoxin (Trx) and glutaredoxin (Grx) are dithiol redox enzymes, catalyzing general thiol-disulfide oxidoreductions apart from being hydrogen donors for ribonucleotide reductase, an enzyme essential for DNA synthesis. In mammals, isoenzymes of Trx and Grx are found in the cytoplasm (Trx1 and Grx1) or in mitochondria (Trx2 and Grx2). Trx and Grx...

The human uterine cervix is a fibrous organ with a high connective tissue content. An extensive remodeling of the connective tissue prior to parturition, i.e., cervical ripening, requires the presence of proteolytic enzymes. The exact mechanism of cervical ripening has not been clarified. We evaluated in vivo distribution and expression of matrix m...

Cervical ripening during parturition is associated with rapid production of catabolic enzymes by invading leukocytes and increased collagen metabolism. The recruitment of leukocytes is regulated by various factors including inflammatory mediators, prostaglandins and matrix metalloproteinases. Sex steroids may be indirectly or directly involved in t...

During pregnancy, a cervical connective tissue remodelling takes place, clinically recognized as softening, effacement and dilatation. The role of oestrogens and their receptors (ER) in this process is not clear. ERalpha is a ligand-activated transcription factor involved in many physiological processes. The identification of a second oestrogen rec...

Glutaredoxins are glutathione disulphide oxidoreductases catalysing disulphide reductions via a redox active disulphide. We have examined the presence of glutaredoxin in the human cervix, and its differential expression during cervical remodelling in term pregnancy and immediately post-partum as compared to the non-pregnant state. Cervical biopsies...

The aim was to evaluate the peptidergic innervation and the dendritic cell content in the cervix uteri. Cervical biopsies were obtained from late pregnant (n=5), postpartal (n=5) and non-pregnant (n=5) women. The samples were prepared for immunohistochemistry using antibodies to protein S-100 (S-100), calcitonin gene-related peptide (CGRP), vasoact...

To compare the mechanisms for cervical ripening after treatment with prostaglandin E2 or antiprogestin (RU486) to spontaneous cervical ripening, with focus on gonadal steroid receptors. Cervical biopsies were obtained from postpartal women after treatment with prostaglandin E2 (n=10), or antiprogestin (n=5). Postpartal women after spontaneous cervi...

The aim of this study was to examine the occurrence and distribution of the general neuronal marker protein gene product (PGP) 9.5 in the cervix uteri. Cervical biopsies were obtained from late pregnant (n=5), postpartal (n=5) and non-pregnant (n=5) women. The samples were prepared for immunohistochemistry using antibodies to PGP 9.5. Nerve fibers...

Studies of the cervix are important for the understanding of structural and physiological changes occurring during the estrous cycle and the second half of pregnancy. The aim of the present study was to illustrate the structural differences seen in the porcine cervix, in relation to the estrogen/progesterone status of the animal. Tissue samples fro...

During pregnancy and involution, an extensive remodelling of the human cervical connective tissue occurs. This cervical ripening is one of the most pronounced physiological remodelling processes known in human connective tissue. To investigate how the remodelling is accomplished, the levels of mRNA for collagen I and III, versican and three small p...

The classic function for thioredoxin is to act as a hydrogen donor for the enzyme ribonucleotide reductase, which is essential for DNA synthesis. In addition, thioredoxin participates in the regulation of different metabolic processes via thiol redox control. These kind of processes involve changes in the activity of different enzymes, receptors or...

To determine whether gonadal steroids and insulin-like growth factor I influence the final cervical remodeling during parturition. Cervical biopsies were obtained transvaginally before labor (n = 10) and after spontaneous cervical ripening and vaginal delivery (n = 20). Levels of estrogen and progesterone receptors, their messenger RNAs, insulin-li...

During pregnancy in humans a gradual connective tissue remodeling takes place in the cervix. The aim of this study was to examine a possible relationship between the action of gonadal steroids and growth factors and the biochemically identifiable changes in connective tissues during cervical ripening. Cervical biopsy specimens and serum samples wer...