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Biomedical subjects

H Rydhström

Publications and source records attributed to H Rydhström.

At least 19 recordsLinked to original sources
PubMed2001

[Patient based care registries as a tool to follow up services].

The Federation of Swedish County Councils and six medical specialties are working together in a project aiming to support and stimulate the development of patient based case registers as a tool to follow up, evaluate, develop and manage medical units. The project is based on participation on the part of the medical professions in a process-oriented way. Each case register shall be based on the individual patient, and will integrate inpatient and outpatient care, all medical professions and important procedures. In hematology the project also seeks to merge case costing data with the patient based case registers in order to facilitate more comprehensive cost analysis and comparison. This episodic perspective is useful for providers per se as well as in discussions between purchasers and providers as a method for understanding and analyzing medical services. The six specialties are hematology, obstetrics and gynecology, ophthalmology, otorhinolaryngology, dermatology and sexually transmitted diseases, and lastly psychiatry.

Databases, Factual↗
PubMed2001

Warm tub bathing during labor: maternal and neonatal effects.

AIM: To study possible detrimental maternal and neonatal effects of immersion in warm water during labor. DESIGN: Prospective randomized controlled bathing during first stage of labor vs no bathing. SETTING: Obstetrical departments at a university hospital and two central hospitals. PRIMARY END-POINT: Referral of newborns to NICU. MATERIAL AND METHODS: Randomization took place by means of sealed opaque envelopes at each delivery unit. Preconditions for participation in the study were: singleton parturient wishing to bathe, a gestational duration of at least 35 weeks+0 days, a planned vaginal delivery, normal admission test, regular contractions and cervix dilated to at least 3-4 cm. Parturients randomized to the 'no bath' control group were allowed to use a shower. Rupture of the membranes was not a contra-indication to participation. Those excluded from randomization were women with intra-uterine growth retardation, meconium-stained amniotic fluid, or in the event that the tub was occupied by another randomized parturient. MAIN RESULTS: On average, parturients stayed in the tub for 50-60 min. No significant difference was seen regarding the referral rate to NICU among 612 cases vs 625 controls, OR 0.8; 95% CL 0.2, 3.1. The OR for epidural analgesia was 1.0; 95% CL 0.8, 1.3. Nor was any significant difference seen in the rate of perineal tear grade III-IV (OR 1.3), instrumental delivery (OR 1.1), cesarean section (OR 1.8), or maternal post partum stay on the ward. During the neonatal period, no significant difference was seen in the number of newborns with Apgar <7 at 5 min (4 vs 5), neonatal distress (OR 2.2) or tachypnéa (OR 1.0). CONCLUSION: In the present study no negative effects of bathing during labor could be discerned. The results indicate that expectant mothers wishing to bathe during labor may do so without jeopardizing their own, or their newborns' wellbeing after birth.

Adult↗
PubMed1998

Fear of childbirth during pregnancy may increase the risk of emergency cesarean section.

BACKGROUND: The purpose of our study was to elucidate the association between fear of childbirth, general anxiety, and stress coping during the third trimester of pregnancy, and a subsequent delivery by emergency cesarean section. METHODS: In a case-control study, 1,981 Swedish-speaking women completed three self-assessment questionnaires at 32 weeks' gestation. Ninety-seven of these women were delivered by emergency cesarean section. Fear of childbirth, general anxiety and the stress coping ability of these 97 cases were compared with the same features in 194 controls, matched for age and parity. RESULTS: Women, subsequently delivered by emergency cesarean section, reported a greater anxiety and a poorer stress coping ability, and, most obviously, a greater fear of childbirth at 32 weeks' gestation. After elimination of possible confounders, the odds ratio for emergency cesarean section was examined for women whose scores were above various cut-off points according to the fear of childbirth measuring instrument. For women with a serious fear of childbirth the odds ratio was 3.0 (95% confidence interval 1.4 to 6.6), and the population attributable risk 0.167. CONCLUSION: Fear of childbirth during the third trimester of pregnancy may increase the risk of subsequent emergency cesarean section.

Adaptation, Psychological↗
PubMed1997

Impaired glucose tolerance during pregnancy is associated with increased fetal mortality in preceding sibs.

OBJECTIVES: To analyze whether women with a diagnosis of gestational diabetes in the current pregnancy had an increased rate of stillbirths or of large for gestational age infants in previous pregnancies without an overtly present/diagnosed gestational diabetes. DESIGN: A case-control analysis with two controls for each case, matched for year of delivery, maternal age (5 year class), and parity. MATERIAL AND METHODS: All women with a diagnosis of gestational diabetes and delivered between 1987 and 1992 were identified from the Swedish Medical Birth Registry. For each woman, the first delivery with that diagnosis was used as proband case (n = 3,958). To each case and control, all previous sibs since 1973 were identified. Comparisons were made between cases and controls but also between sibs of cases and sibs of controls. RESULTS: No significant difference was found in stillbirth rate between cases and controls (OR 1.33, CL 0.64;2.77). The rate of intrauterine deaths was significantly increased among previous sibs of the cases compared with the sibs of the controls: after stratification for year of birth, maternal age and parity an odds ratio of 1.56 (95% CL 1.12;2.19) was found. Infants born of women with gestational diabetes were heavier (mean 145 g, 95% CL 123;168 g). Similar differences were seen between immediately previous sibs of cases and controls (mean 155 g, 95% CL 127;183 g). CONCLUSIONS: The figures indicate that in pregnancies before a delivery with gestational diabetes the perinatal prognosis was significantly poorer than expected which could be due to the presence of undiagnosed and untreated gestational diabetes. The results argue for an improved screening for gestational diabetes during pregnancy.

Abortion, Spontaneous↗
PubMed1994

Insidious urinary retention after vaginal delivery: prevalence and symptoms at follow-up in a population-based study.

The purpose of this study was to investigate the prevalence of postpartum urinary retention in women after vaginal delivery and to determine whether parturients with retention develop voiding problems later. During a 3-month period, all parturients in the catchment area of the University Hospital, Lund, were investigated 3 days after delivery, residual volume being measured by ultrasonography. All those with postpartal retention were contacted 4 years after delivery, when they were reexamined by ultrasonography and asked to fill in a questionnaire regarding urinary problems. In all, 539 women were scanned post partum, and 8 (1.5%) had a residual volume exceeding 150 ml (range 156-320 ml). Retention was more common among primiparae after instrumental delivery or epidural analgesia. The symptoms were normalized spontaneously within a few days in all cases. At follow-up 4 years later, the prevalence of urinary symptoms was not higher than that in the general population. Ultrasonography to detect urinary retention does not seem to have any place in the normal postpartal care. However, extended supervision may be appropriate in parturients receiving epidural analgesia or in those submitted to instrumental deliveries.

Analgesia, Epidural↗
PubMed1994

No relation between maternal weight gain and stillbirth.

BACKGROUND: To evaluate the relationship between stillbirth in singleton pregnancy (> or = 28 weeks gestation) and maternal weight (weight gain) from 24 completed weeks. METHODS: All fetal deaths (n = 210) at five delivery units during seven years in southern Sweden were analysed. To each case a control mother was selected, the only matching criteria being parity and place of delivery. Regression analysis was used for comparison of body weight gain in cases and controls. RESULTS: Mothers experiencing stillbirth had a significantly lower mean body weight at 24 weeks gestation than control mothers (63.5 kg vs 67.3 kg; t = 2.4, p < 0.05). No significant difference between cases and controls was found in mean weight gain during pregnancy from 24 completed gestational weeks to delivery, even when the last three measurements before delivery for cases and controls were compared separately. CONCLUSION: There is no difference in body weight gain between mothers with stillbirth and mothers giving birth to a live infant.

Adult↗
PubMed1994

Discordant birthweight and late fetal death in like-sexed and unlike-sexed twin pairs: a population-based study.

OBJECTIVE: To study the relation between pregnancy loss (one or two fetal deaths in a pair) in twin pregnancy and gender (like-sexed and unlike-sexed pairs), discordant birthweight, and placentation. DESIGN: The type of placentation for gestations with pregnancy loss was studied, based on material retrieved from the original medical records, for a defined region comprising 20.0% of the total twin population. SUBJECTS AND SETTING: Four thousand one hundred and ninety-one unlike-sexed and 10,875 like-sexed twin pairs born in Sweden between 1973 and 1989, in most cases with a gestational duration 28 or more completed weeks. RESULTS: The relative risk (RR) for pregnancy loss in like-sexed pairs, compared with unlike-sexed ones, was 2.3 and the 95% confidence limits (CL) 1.7-3.1. Not until discordance exceeded 999 g did the pregnancy loss rate for unlike-sexed pairs increase significantly, compared with the (first) stratum with discordance less than 250 g (RR = 6.3; CL 3.5-11.3). For like-sexed twin pairs a higher pregnancy loss rate, compared with the first stratum, was seen already in the stratum with discordance 250-499 g (RR = 1.3; CL 1.0-1.8); a significant increase in pregnancy loss rate was found in all the three strata 500-749 g (RR = 2.1; CL 1.5-3.0), 750-999 g (RR = 3.5; CL 2.3-3.0), and 1000 g or more (RR = 10.9; CL 8.4-14.2), respectively. When calculating the discordance as a percentage of the weight of the larger twin, unlike-sexed pairs experienced a significant increase in pregnancy loss when discordance exceeded 40 to 50%. For like-sexed ones, the corresponding figures were 20 to 30%. In the 47 unlike-sexed pregnancies complicated by pregnancy loss, both twins died in two pregnancies (4.3%), whereas for like-sexed pairs the corresponding figures were 65/279 (23.3%). Of 47 gestations with pregnancy loss in a defined region, 32 were monochorionic (monozygous), nine were like-sexed dichorionic (monozygous or dizygous), and six were unlike-sexed (dizygous). CONCLUSIONS: Pregnancy loss was twice as high in like-sexed compared with unlike-sexed pairs, and only in like-sexed pairs was pregnancy loss strongly correlated to birthweight discordance. In twin pregnancies with one fetal death the risk for the surviving twin to succumb is five to six times higher in like-sexed compared with unlike-sexed pairs and is most probably related to monochorionicity.

Birth Weight↗
PubMed1993

Prognosis and long-term follow-up of a twin after antenatal death of the co-twin.

It is generally believed that among twin pregnancies with one fetal loss prior to delivery, the surviving twin has an increased rate of perinatal mortality and childhood morbidity (cerebral palsy and mental retardation). By using data from the National Medical Birth Registry of Sweden between 1973 and 1983, we identified 206 gestations with the death of at least one twin (in 36 pregnancies both twins died) prior to delivery. The original medical records were retrieved for study. The presence of childhood morbidity for 65 of 129 surviving (8 years of age or older) twins born between 1973 and 1980 was evaluated by a questionnaire sent to rehabilitation centers for disabled children, as well as to offices for the Provision of Care for the Mentally Retarded. Perinatal mortality for a twin after the antenatal death of the co-twin was considerable. Fifty percent of survivors died before 34 weeks' gestation, and 18.7% thereafter. At follow-up, 8 years or more after birth, three twins (4.6%) were handicapped. Our results indicate the need for careful monitoring of the surviving twin fetus after one twin has succumbed prenatally.

Cerebral Palsy↗
PubMed1992

Gestational duration and birth weight for twins related to fetal sex.

It has been postulated that male twin pregnancies, in contrast to male singleton pregnancies, differ in some distinctive biologic sense, leading to a shorter gestational duration and a lower individual birth weight than is the case in female twin pregnancies. To test this hypothesis in a relatively large dataset, information on gestational duration and birth weight for nearly all twins born in Sweden during a 4-year period (n = 3,472 twin pairs) was collected from the Medical Birth Registry, National Board of Health and Welfare. Included in the Medical Birth Registry are all pregnancies with a duration of at least 28 completed gestational weeks, or less if the newborns are alive at birth. Male-male pregnancies had a gestational duration similar to female-female pregnancies (median difference less than 2 days). The proportions of twins with a gestational age less than 36 weeks did not differ between male-male and female-female twin pregnancies (27.3 vs. 25.3%; chi 2 = 2.2, p greater than 0.05). Male-male pairs were heavier than female-female pairs (median difference 0.1 kg), and a significantly higher proportion of female-female twin pairs weighted less than 2,500 g (45.0 vs. 39.2%; chi 2 = 17.7, p less than 0.001). The results of this study in an unselected relatively large twin population seem to indicate that fetal sex does not influence gestational duration to any significant extent. Males are heavier than females indicating that the sex has a similar effect on birth weight in twin and in singleton pregnancy.

Birth Weight↗
PubMed1992

A birthweight-for-gestation standard based on 4737 twins born in Sweden between 1983 and 1985.

OBJECTIVE: To construct a birthweight-for-gestation chart based on a population-based material of twins born during a restricted period of time. MATERIAL AND METHODS: Nearly all live-born twins born in Sweden between 1983 and 1985, 4737 all told, were included. Excluded from the analysis were 4.7% of the twins that were not on record at the Medical Birth Registry, 1.8% that died before or during birth, and 8.8% that were without a recorded date of birth or only had information on gestational duration estimated from the first day of the last menstrual period. RESULTS: The standard deviation in birthweight was considerable in most gestational weeks; the range (+/- 2 SD) was 1000-3400 g even if exclusively twins (pregnancies) with estimated date of birth from ultrasound examination early in the second trimester were included. Intra-pair discordance increased with gestational duration, especially for unlike-sexed twins, to reach over 400 g at term. On average, boys weighed 92 g more than girls and twins to multiparae weighed 250 g more than twins to primiparae. Maternal age affected birthweight for twins to primiparae, but not to multiparae. CONCLUSION: Although the problems with secular trends in birthweight were avoided by using a population-based material during a restricted time period, and only twin pregnancies dated with ultrasound were included, the standard deviation in most gestational weeks was still considerable, reflecting the multiplicity of factors involved in determining the birthweight of twins.

Birth Weight↗
PubMed1991

A case-control study of the effects of birth by caesarean section on intrapartum and neonatal mortality among twins weighing 1500-2499 g.

The aim of this nationally-based, matched case-control study was to assess the impact of birth by caesarean section on intrapartum, and neonatal mortality among twins weighing 1500-2499 g, born in Sweden between 1973 and 1983. By using data held at the National Medical Birth Registry, Stockholm, 91 such pregnancies (study cases) where one or both twins died were identified. For each case, two controls (in all 182 pregnancies) were allotted at random from the rest of the twin pregnancies, with similar birthweight (+/- 100 g) and year of delivery (+/- 1 year). The number of twins that died was reduced from 73 during the first four years to 22 between 1977 and 1980, and to 6 during the last 3 years of the study period. Almost a quarter (23.1%) had a lethal malformation. The caesarean section rate increased during the study period, but did not differ between cases and controls (chi 2 = 1.0; P greater than 0.05). The analysis could not confirm a significant difference between cases and controls regarding the number of infants born vaginally in non-vertex presentation (chi 2 = 0.1; P greater than 0.05). The results of this study appear to indicate that birth by caesarean section was not a major factor related to the improved fetal outcome.

Birth Weight↗
PubMed1991

No benefit from conservative management in nulliparous women with premature rupture of the membranes (PROM) at term. A randomized study.

OBJECTIVE: To compare maternal and fetal outcome in pregnancies with premature rupture of the membranes (PROM) at term with either early induction of labor or conservative management awaiting spontaneous labor. DESIGN: A prospective randomized trial. SETTING: The University Hospital of Lund, Sweden. SUBJECTS: Altogether 369 women with singleton pregnancy, cephalic presentation, gestational duration 36-41 weeks, were randomized either to induction of labor (n = 139) or conservative management up to 3 days (n = 138). Those eligible but not participating in the study totalled 92. MAIN OBSTETRIC MEASURES: Obstetric intervention rate (cesarean section or instrumental delivery) and short-term neonatal morbidity. RESULTS: No difference was found in the rate of obstetric intervention between the induction of labor group and the group with conservative management (12.2 vs. 18.8%; chi 2 = 2.3, p greater than 0.05). A slightly increased rate of neonatal infections was seen in the latter group (0.7 vs. 4.3%; chi 2 = 3.2, p less than 0.05). CONCLUSIONS: We found no benefit from conservative management for up to 3 days in women with PROM at term, compared with immediate induction of labor. There was no difference in the number of obstetric interventions during labor. The neonatal infectious morbidity was slightly higher in conservatively managed cases.

Adult↗
PubMed1990

Prognosis for twins with birth weight less than 1500 gm: the impact of cesarean section in relation to fetal presentation.

The purpose of this study of twins weighing less than 1500 gm was to evaluate the impact of cesarean section on intrapartum and neonatal mortality, as well as on cerebral palsy and mental retardation. National data held at the Medical Birth Registry was used for identification of cases. The original medical records were retrieved for 862 such twins born between 1973 and 1983. Twins with cerebral palsy and/or mental retardation born between 1973 and 1980 were identified by questionnaires to all rehabilitation centers for disabled children, offices for the Provision of Care for the Mentally Retarded, and to all local Boards of Education throughout Sweden. The analyses, including calculation of relative risk and 95% confidence interval, were performed after stratification for birth weight (250 gm classes) and period of delivery (1973 to 1976, 1977 to 1980, 1981 to 1983). The cesarean section rate increased from 7.7% (1973 to 1976), and 40.5% (1977 to 1980) to 68.9% (1981 to 1983). Concomitantly, intrapartum and neonatal mortality decreased markedly (51.7% to 29.1%) particularly for twin II but to a much lesser extent for twin I. The relative risk for intrapartum and neonatal mortality (vaginal/abdominal birth) did not increase significantly for twin I in vertex presentation (relative risk 2.0, 95% confidence limits 0.9 to 4.3), for twin I in breech presentation (relative risk 1.8, 95% confidence limits 0.7 to 4.3), for twin II in vertex presentation (relative risk 0.6, 95% confidence limits 0.2 to 1.6), or for twin II in breech presentation (relative risk 1.5, 95% confidence limits 0.7 to 3.0). The rate of cerebral palsy and/or mental retardation was 8.8% during 1973 to 1976 and 8.0 during 1977 to 1980 (chi 2 = 0.1, p greater than 0.05). For twins born in breech presentation the handicap rate in the first period (cesarean section rate 6.0%) was the same as in the second period (cesarean section rate 59.6%). The analysis failed to reveal any significant impact of abdominal birth on the fetal outcome for low-birth-weight twins, even when fetal presentation was taken into consideration.

Cerebral Palsy↗
PubMed1990

The effects of maternal age, parity, and sex of the twins on twin perinatal mortality. A population based study.

The aim of this study on all twin births in Sweden between 1973 and 1985 was to evaluate the effect of maternal age, parity, and sex on twin perinatal mortality (PNM), by using national data held at the Medical Birth Registry, National Board of Health and Welfare, Stockholm. Zygosity in this study was estimated by the Hardy-Weinberg formula. In all, 22,374 twins were born; 972 (4.3%) of these died perinatally. The relative risk for perinatal death (after standardization for maternal age, parity, and like sex) decreased significantly during the study period, and reached its lowest value (0.3) in 1983. Maternal age was not associated with PNM, while women having their first delivery had a significantly higher PNM than the rest of the parturients. The MZ twinning rate increased from 0.36% during 1973-76, to 0.40% during 1977-81 and 0.44% during 1982-85 (trend analysis: chi 2 = 40.1, p less than 0.001). After stratification for year of delivery and birthweight, like-sexed twins had a significantly higher PNM than unlike-sexed twins (odds ratio, OR = 1.25, 95% confidence interval, CI = 1.02-1.54). Males had a significantly higher PNM than females in like-sexed pairs (OR = 1.39, 95% CI = 1.16-1.66), and in unlike-sexed pairs (OR = 1.46, 95% CI = 1.01-2.10). MZ twins had a significantly higher estimated PNM than DZ ones (OR = 1.31, 95% CI = 1.02-1.67).

Adolescent↗
PubMed1990

Lack of correlation between a high caesarean section rate and improved prognosis for low-birthweight twins (less than 2500 g).

The impact of birth by caesarean section on perinatal mortality was estimated for 9368 low-birthweight twins (less than 2500 g) born in Sweden between 1973 and 1985, by using national data from the Medical Birth Registry, National Board of Health and Welfare, Stockholm. During this period the caesarean section rate increased from 7-10% to 45-50% while concomitantly a sharp decrease in the perinatal mortality rate occurred. A causal relation between the increased rate of abdominal delivery and the improved prognosis for low birthweight twins might be expected. However, analysis of the results failed to show any correlation between these two variables. Factors other than route of delivery seem to have a greater impact on fetal outcome.

Cesarean Section↗