Biomedical subjects

H Rydhstroem

Publications and source records attributed to H Rydhstroem.

At least 19 recordsLinked to original sources

PubMed2005

Implementation of new medical techniques: experience from the Swedish randomized controlled trial on fetal ECG during labor.

BACKGROUND: In a large Swedish multicenter randomized controlled trial (RCT) on intra partum fetal monitoring with automatic analysis of fetal ECG waveform (STAN) in combination with cardiotocography (CTG) (4966 parturients, 300 obstetricians and midwives managing the patients), interim analysis revealed protocol violations. By a post hoc analysis of the results over time, factors affecting the acceptance of the new technique were analyzed. METHODS: The rates of primary and secondary outcome measures (fetal outcome, operative deliveries) were compared in the two study groups (CTG + ST and CTG only). Changes over time were statistically evaluated using a test for homogeneity between the two periods. RESULTS: After retraining, the CTG + ST group showed the lowest rates of operative delivery for fetal distress, fetal blood sampling and admissions to neonatal intensive care unit. Operative deliveries (p = 0.02) and the number of fetal blood sampling decreased significantly over time (p = 0.001). CONCLUSIONS: Training and education probably predisposed the clinicians to a change and reinforced it when it occurred as a result of increased personal experience. The audit and feedback together with the influence of opinion leaders and inter-collegial interactions seem to have been of importance for the successively increasing acceptance of the new method during the RCT.

Cardiotocography↗

PubMed2004

Effects of acupuncture and care interventions on the outcome of inflammatory symptoms of the breast in lactating women.

OBJECTIVES: To compare modes of care and treatment for lactating women with inflammatory symptoms of the breast, with special focus on the use of acupuncture. METHOD: Eighty-eight mothers were randomized into three treatment groups. All three groups were given advice regarding emptying of the breasts and care in the form of comfort interventions. Acupuncture was included in the treatment regime for two of the groups. A severity index was created by adding together scores for signs and symptoms: breast tension, erythema and pain. FINDINGS: Mothers in all groups expressed relative satisfaction with the breastfeeding situation despite considerable discomfort. There was no significant difference between the groups for the number of mothers requiring more than three contact days for recovery nor for their severity index scores on day 3. These findings must be interpreted with care but may suggest that care interventions play as great a part in the recovery of these women as acupuncture treatment or the use of oxytocin spray. Antibiotic therapy was used in 9% of the study population, which is in contrast to other studies. PROPOSED FUTURE ACTION: Based on these results, a new study has been designed to test the hypothesis that acupuncture hastens recovery from inflammatory processes in the lactating breast and approximately 200 mothers will be randomized in a new expanded study.

Acupuncture Therapy↗

PubMed2001

Impaired glucose tolerance associated with adverse pregnancy outcome: a population-based study in southern Sweden.

OBJECTIVE: We conducted a population-based study of maternal and neonatal characteristics and delivery complications in relation to the outcome of a 75-g, 2-hour oral glucose tolerance test at 25 to 30 weeks' gestation. STUDY DESIGN: An oral glucose tolerance test was offered to pregnant women in a geographically defined population. Pregnancy outcome was analyzed according to the test result. RESULTS: Among women delivered at Lund Hospital, we identified 4526 women with an oral glucose tolerance value of <7.8 mmol/L (<140 mg/dL), 131 women with a value of 7.8 to 8.9 mmol/L (140-162 mg/dL), and 116 women with gestational diabetes (> or =9.0 mmol/L [> or =162 mg/dL]). A further 28 cases of gestational diabetes were identified, giving a prevalence of 1.2%. An increased rate of cesarean delivery and infant macrosomia was observed in the group with a glucose tolerance value of 7.8 to 8.9 mmol/L (140-162 mg/dL) and in the gestational diabetes group. Advanced maternal age and high body mass index were risk factors for increased oral glucose tolerance values in 12,657 screened women in the area. CONCLUSION: The study stresses the significance of moderately increased oral glucose tolerance values.

Adolescent↗

PubMed2001

Should all twins be delivered by caesarean section? A preliminary report.

The aim was to analyse the neonatal mortality related to mode of delivery for twins using a population-based registry. In all, 18,125 twins delivered in Sweden between 1991 and 1997, after excluding those with unknown gestational duration, were used to analyse the differences between groups of twins. Results showed the OR for neonatal death, breech vaginal delivery versus caesarean section (all indications) was 1.47 (95% CI 0.99-2.17). The OR at vaginal delivery for neonatal death, twin I in breech versus cephalic presentation was 5.60 (2.62-11.94) and for twin II the corresponding figures were 1.85 (1.03-3.32). Analyses using population-based registries from other countries are needed to confirm or reject the present findings of an increased neonatal mortality for twins in breech presentation delivered vaginally.

Breech Presentation↗

PubMed2001

Gestational duration, and fetal and infant mortality for twins vs singletons.

The aim of this research was to study fetal and infant mortality in Sweden between 1973 and 1996 in twins vs singletons in relation to gestational duration. Analysis was of fetal and infant mortality based on the number of pregnancies at risk as the denominator rather than the number of deliveries each week. The analysis was based on information stored at the Medical Birth Registry (MBR), the National Board of Health and Welfare, Stockholm. The MBR keeps records on virtually all pregnancies (> 99%) regarding delivery and neonatal information, and for infant mortality up to 1 year of age. During the study period, 2,206,738 singleton and 52,658 twin births were registered. Risk evaluation was made as odds ratio (OR) with a 95% confidence interval. The material was stratified according to parity, maternal age, year of delivery, and delivery unit. Results showed the OR for twin births before 34 weeks gestation was 6 to 8-fold increased compared with singletons. The OR for fetal mortality was increased in all gestational weeks, and like-sexed twins had a consistently poorer prognosis compared to unlike-sexed. Between 1989-96, unlike-sexed twins had a fetal mortality approaching that of singletons. In conclusion, real progress in reduction of infant mortality in twins may be impossible until the high incidence of preterm births can be decreased. Hypothetically, about 100 twin labors would have to be induced to avoid one fetal death in like-sexed twin pregnancies.

Female↗

PubMed2000

Obstetric risk factors for stress urinary incontinence: a population-based study.

OBJECTIVE: To evaluate obstetric and maternal risk factors for stress urinary incontinence. METHODS: We linked three national, Swedish, population-based registries with the use of unique personal identification numbers. All women born between 1932 and 1977 and operated on for stress urinary incontinence between 1987 and 1996 were identified from the Hospital Discharge Registry. This information was linked with the Medical Birth Registry (for the years 1973-1995), containing information on antenatal care, delivery, and the newborn, and the Fertility Registry (for the years 1932-1997), containing information on the number of children delivered by each Swedish woman. For determination of odds ratios (ORs) and approximate 95% confidence intervals (CIs), we used the Mantel-Haenszel method and a test-based method after suitable stratifications and exclusions. RESULTS: Diabetes mellitus, body mass index (BMI), age at first delivery, parity, birth weight, and epidural analgesia were positively associated with incontinence surgery. In contrast, cesarean delivery, forceps/vacuum extraction, and episiotomy were negatively associated with incontinence surgery. No association was found between surgery for stress incontinence and age at last delivery, smoking during pregnancy, level of education, multiple birth, large perineal tear, or breech presentation at any vaginal delivery. The OR for incontinence surgery was similarly decreased for nulliparous women and for uniparous women delivered by elective cesarean. CONCLUSION: Vaginal delivery, notably the first, is strongly associated with later surgery for stress incontinence, but the association is modified by maternal conditions and interventions during delivery. No association was found between surgery for stress incontinence and pregnancy per se.

Adult↗

PubMed2000

Asthma during pregnancy--a population based study.

To study delivery outcome in women with asthma, using Swedish health registers. Women with asthma were identified in two ways: by information in interviews performed by midwives at the pregnant woman's first visit to antenatal care, and by linkage between a medical birth register and a hospital discharge register, identifying women who had been hospitalized for asthma and also had a delivery. Births between 1984 and 1995 were studied. An increased risk for preterm birth and low birth weight was seen, possibly co-varying with disease severity. Also a significant increase in pregnancies of more than 41 weeks duration was noticed. An increase in infant death but not in congenital malformations rate was observed. An association with preeclampsia, gestational diabetes, and infant hypoglycemia was verified. Maternal asthma appears to be a risk factor for preterm and postterm births and increases the risk for some pregnancy complications.

Adult↗

PubMed2000

Epidural analgesia with sufentanil during labor and operative delivery.

BACKGROUND: It has been argued that by adding an opioid to the local anesthetic drug used for epidural analgesia during childbirth, one can reduce the risk of operative delivery. Objective. In a population-based observational study, to evaluate the effect of adding an opioid to a local anesthetic drug on the risk of instrumental delivery or cesarean section. DESIGN: Comparison of delivery units adding/not adding opioid to the local anesthetic for epidural analgesia in labor. SETTING: All deliveries using epidural analgesia in Sweden during 1992-96 were evaluated on the basis of information stored at the Medical Birth Registry, the National Board of Health and Welfare, Stockholm. METHOD: A questionnaire was sent to all delivery units (n=61), as well as to the Head of corresponding Anesthesiology Department in each hospital, requesting information regarding the period when opioids (sufentanil) were first added to the local epidural analgesic. Parturients given epidural analgesia were divided into three time-related groups: those delivered before the introduction of opioids (n=34,071), when opioids were first added (n=7,236), and since the introduction of opioids (n=44,384). Odds ratio (OR) with 95% confidence interval (CI) was used to assess the effect of sufentanil versus no sufentanil, on the risk of operative delivery. The parturients were stratified for year of delivery, age, and parity. Main outcome measures. Instrumental delivery, cesarean section, length of stay in hospital post partum. RESULTS: A significant reduction was observed in the incidence of instrumental delivery (OR 0.72; 95% CI 0.68-0.76). A similar though less pronounced effect was evident concerning the risk of cesarean section for nulliparae (OR 0.79; 95% CI 0.72-0.88) but not for multiparae (OR 0.93; 95% CI 0.80-1.07). Fewer women with an opioid added to the local anesthetic spent more than 4 (or more than 7) days in hospital post partum, compared with those given epidural analgesia without an opioid. CONCLUSION: When added to the local anesthetic used for epidural analgesia, as in Sweden during the last 5 years, opioids appear to reduce the incidence of instrumental delivery and cesarean section and also the post partum hospital stay.

Adult↗

PubMed1999

The relation between inter-twin birth weight discordance and total twin birth weight.

OBJECTIVE: We tested the hypothesis that the frequency of growth discordance among twins is not related to the uterine capacity for carrying twins. METHOD: We counted and compared the frequencies of birth weight discordance of more than 25% in an unlike-sexed twin cohort (n = 1244) and in a population-based twin cohort (n = 7570) across the deciles of the total twin birth weight (twin A + twin B) distribution. The birth order of the heavier twin was noted. RESULTS: Similar frequencies of discordant pairs were found in both cohorts (11% and 12%, respectively; Mantel-Haenszel chi2 test: P = .131, odds ratio (OR) 0.9, 99% confidence interval (CI) 0.67, 1.11; Woolf test for heterogeneity: two-tailed P = .472). In the discordant pairs, twin A was considerably more often the heavier twin in all birth weight deciles (unlike-sexed cohort: P < 10(-8), OR 5.9, 99% CI 3.0, 11.7; population-based cohort: P < 10(-8), OR 3.1, 99% CI 2.3, 4.0), and in both cohorts (inter-cohort difference: P = .109, OR 1.4, 99% CI 0.83, 2.32). Both cohorts showed a similar nonlinear trend: given that X = decile order, discordance decreased as a function of 22.0 - 6.54 ln[X] for the unlike-sexed twins cohort and 23.0 - 8.18 ln[X] for the population-based cohort, with r values of 0.967. CONCLUSION: The more favorable the uterine milieu for carrying twins, the smaller the likelihood of discordant twin growth. Birth order of the heavier twin appears to be an integral part of the discordance phenomenon. The similarity of the cohorts suggests that these conclusions are valid for both like and unlike-sexed twins.

Birth Weight↗

PubMed1999

Risk factors for rupture of the anal sphincter.

OBJECTIVE: To evaluate risk factors for rupture of the anal sphincter during vaginal delivery. MATERIAL AND METHODS: All 292 parturients with rupture of the anal sphincter in four neighbouring central hospitals in southern Sweden between 1988 and 1990 were identified retrospectively. For each case a control was selected, the sole matching criterion being that the control woman was the next to give birth vaginally in the same unit as the case. Only singleton deliveries were included. For comparison of risk factors among cases and controls, McNemar's test was used for bivariate testing; multiple regression analysis was restricted to those variables found to be significant in the bivariate analysis. Odds ratios (OR) were calculated with 95% confidence limits (CL). RESULTS: In all, 292 of 22,653 deliveries (1.3%) had a rupture of the anal sphincter. Of a total of 14 independent variables explored, 8 were found to be significantly associated with rupture of the anal sphincter in the bivariate testing. In the following multivariate analysis, three variables remained significantly associated with rupture of the anal sphincter: birthweight > or = 4000 g (OR 2.6; CL 1.7, 3.9), primiparity (OR 2.2; CL 1.5, 3.3) and episiotomy (OR 1.7; CL 1.1, 2.6). CONCLUSION: Episiotomy appears to be significantly associated with rupture of the anal sphincter. In contrast to primiparity and birthweight, the incidence of episiotomy during vaginal delivery may easily be reduced. However, only a prospective, controlled study will disclose the true negative or positive effects of episiotomy.

Anal Canal↗

PubMed1999

Congenital malformations after the use of inhaled budesonide in early pregnancy.

OBJECTIVE: To study possible teratogenic risks with the use of an inhaled glucocorticoid, budesonide, in early pregnancy. METHODS: Using the Swedish Medical Birth Registry, congenital malformations were studied in 2014 infants whose mothers had used inhaled budesonide for asthma in early pregnancy. The presence of congenital malformations was checked further with auxiliary registries. RESULTS: No increase in the general rate of congenital malformations was observed: 3.8% (95% confidence interval [CI] 2.9, 4.6) of the infants had a congenital malformation diagnosed, which is similar to the population rate (3.5%). After exposure to budesonide, four infants were born with orofacial clefts; this also is similar to the expected number (3.3). CONCLUSION: Even though a specific teratogenic effect of use of budesonide in early pregnancy cannot be ruled out, it is unlikely that a clinically significant teratogenic risk exists.

Abnormalities, Drug-Induced↗

PubMed1998

Twinning in Sweden between 1973 and 1990. The recurrence rate.

AIM: To ascertain the recurrence rate of twinning, by determining the repeat frequency in a population-based material of women who have already had one set of twins. MATERIAL AND METHODS: All singleton and twin births in Sweden between 1973 and 1990 were identified from the Medical Birth Registry (MBR), at the National Board of Health and Welfare, Stockholm. In the MBR fewer than 1% of all women with a singleton birth and fewer than 3% of all women with a twin birth are missing. When appropriate, 95% confidence limits (95% CL) were calculated. RESULTS: Altogether, 84 women with at least two twin births were identified. When the proband twins were like-sexed, the observed/expected ratio was 1.7 (95% CL 1.3, 2.2). For unlike-sexed proband twin pairs, the corresponding figures were 3.3 (95% CL 2.3, 4.7). CONCLUSION: For women with one twin birth, the likelihood of having twins in a subsequent birth increases two to three-fold.

Adult↗

PubMed1998

No obvious spatial clustering of twin births in Sweden between 1973 and 1990.

The aim of this work was to ascertain whether spatial clustering of twin deliveries occurred in Sweden between 1973 and 1990. Since 1973, the Medical Birth Registry (MBR) has gathered information on all births in Sweden. Between 1973 and 1990, there were 17,067 twin deliveries. The MBR records data on pregnancies, deliveries, and the neonatal period, including parturients' domicile. To test the hypothesis that atmospheric pollution from refuse incinerators increases the incidence of twin deliveries, the periods before and after the commissioning of 14 such plants were compared. There was no apparent increase in the number of parishes or municipalities having a relative excess of twin deliveries. In the vicinity of one plant, there was a significantly increased number of twin deliveries, whereas in another, there was a significant decrease. There was no spatial clustering when the incidences of twin delivery were compared among parishes, municipalities, and areas near incinerators.

Birth Rate↗

PubMed1998

Gestational duration in the pregnancy after a preterm twin delivery.

OBJECTIVE: This was a population-based medical birth registry investigation designed to study whether a preterm twin delivery portends a shorter gestation in a subsequent pregnancy. STUDY DESIGN: Data on all pregnancies and deliveries from 1973 to 1993 inclusive, stored at the Medical Birth Registry, the National Board of Health and Welfare, Stockholm, were analyzed. Information on gestational duration, estimated during pregnancy with or without ultrasonography in the second trimester, was analyzed for 2979 twin births followed by a singleton delivery. RESULTS: Gestation for women with a singleton pregnancy after a preterm twin birth in the twenty-eighth to thirty-sixth gestational week lasted about 39 +/- 0.5 weeks (mean +/- SEM). When the twin birth had taken place at term (37 to 42 weeks) the corresponding singleton gestation lasted about a week longer. When the twin birth occurred in gestational weeks 28 to 30, 31 to 33, or 34 to 36, the corresponding proportions of women who gave birth earlier than 37 weeks (20 to 27 weeks, only live births) in the subsequent singleton pregnancy were 9.8%, 7.0%, and 5.8%, respectively (chi 2 = 3.4, p > 0.05). CONCLUSION: It would appear that a preterm twin birth does not to any significant extent affect the gestational duration of a subsequent singleton pregnancy.

Female↗

PubMed1998

Cost-effectiveness analysis of in-vitro fertilization: estimated costs per successful pregnancy after transfer of one or two embryos.

Standard protocols for in-vitro fertilization (IVF) include transfer of two or three embryos. Not surprisingly, the rate of twin pregnancy after IVF is high (about 24% of all pregnancies). Routine transfer of one, rather than two, embryos would be expected to result in a much lower rate of twin pregnancies at the cost of a lower take-home baby rate. The aim of this study was to compare hypothetical costs to society incurred by pregnancies achieved with IVF protocols based on the transfer of one or two embryos. We compared actual (for two-embryo transfers) and hypothetical (for one-embryo transfers) take-home baby rates; risks of twin pregnancies; and costs of sick leave and hospitalization during pregnancy, deliveries, neonatal intensive care, and handicap care after transfer of one or two embryos. The study showed that even when more treatments might be needed to achieve similar baby take-home rates after transfer of one compared with two embryos, the lower twin pregnancy rate of the former approach caused it to be more cost-efficient than the latter. In conclusion, IVF costs are the sum of fertilization treatment costs and the costs for health care of the pregnant women and their offspring. Considering the association of the latter costs with numbers of embryos transferred, studies of one-embryo transfer protocols are urgently needed.

Adult↗

PubMed1997

Ultrasound examination in twin pregnancy and late fetal death.

OBJECTIVE: To test the hypothesis that the (case) twin later to succumb in utero has biparietal diameter measurements (by ultrasound) different from those (control) twins surviving the perinatal period. MATERIAL AND METHODS: Information from the Medical Birth Registry, National Board of Health and Welfare, Stockholm, was used to identify all births in a defined population in southern Sweden with about 20,000 deliveries each year. In 3,019 twin pregnancies between 1973 and 1989, one or both twins were stillborn in 47 cases (gestational duration > or = 28 weeks, birthweight > or = 500 g). For each case pregnancy, two control pregnancies were selected, the matching criteria being: same delivery unit, same parity (0, I, II, III+), similar year of delivery (+/- 1 year) and maternal age (+/- 5 years). Data on ultrasound examinations were extracted from the original medical records. Screening in early second trimester started at one of the units as early as 1973 and at the latest of 12 units in 1982. RESULTS: There was no obvious difference between cases and controls in intra-pair discordant biparietal diameter (BPD) measured in early second trimester. Nor was there any evident difference in the rate of deviant BPD between cases and controls. In all, 8% of dead male and 24% of dead female fetuses were by definition small-for-gestational age (< -2 standard deviations). CONCLUSIONS: No significant difference was seen between cases and controls regarding deviating biparietal diameters. Abdominal diameter may be a better predictor of subsequent fetal death (not analysed in this study), though only about 15% of all dead twins were deemed small-for-gestational age.

Birth Weight↗

PubMed1997

Perinatal outcome after leave of absence from work for twin-pregnant women.

AIM: To evaluate the association between the incidence of leave of absence from work and perinatal outcome for the twin-pregnant woman. MATERIAL AND METHODS: A 20.2% sample of all twin-pregnant women between 1982 and 1988 (1,331/6,602) was taken at random from the entire material of twin deliveries in Sweden, archived at the Medical Birth Registry (MBR), National Board of Health and Welfare. For each woman in the sample, information on period(s) and reasons for leave of absence from work during pregnancy was obtained by inquiry to all Regional Health Insurance Offices throughout Sweden. A comparison of perinatal outcome was also made with information from the Danish Fertility Database and the Norwegian Medical Birth Registry. RESULTS: Duration of leave from work increased from 58 days in 1982 to 97 days in 1988 (trend analysis; t = 7.9, p < 0.001). No association was seen between perinatal mortality for twins weighing < 1,500 g and changes in the incidence of leave of absence. The incidence of twins with a birthweight < 1,500 g varied among the three countries, increasing significantly only in Sweden (trend analysis chi 2 = 20.3, p < 0.0001). CONCLUSION: Although the number of days of leave of absence increased by 60%, there was no obvious association with perinatal mortality for twins weighing < 1,500 g. The incidence of Swedish twins with a birthweight < 1,500 g increased significantly, indicating that the effect of leave of absence from work on perinatal outcome may be less effective than previously thought.

Female↗

PubMed1997

Routine oxytocin in the third stage of labour: a placebo controlled randomised trial.

OBJECTIVE: To compare intravenous oxytocin administration (Partocon 10 IU) with saline solution in the management of postpartum haemorrhage in the third stage of labour. DESIGN: A double-blind, randomised controlled trial involving 1000 parturients with singleton fetuses in cephalic presentation and undergoing vaginal delivery, randomly allocated to treatment with oxytocin (n = 513) or 0.9% saline solution (n = 487). SETTING: Labour ward at a central county hospital. MAIN OUTCOME MEASURES: Mean blood loss (total, and before and after placenta delivery); frequencies of blood loss > 800 mL, need of additional oxytocic treatment, postpartum haemoglobin < 10 g/dL; and duration of postpartum hospitalisation. RESULTS: As compared with saline solution, oxytocin administration was associated with significant reduction in mean total blood loss (407 versus 527 mL), and in frequencies of postpartum haemorrhage > 800 mL (8.8% versus 5.2%), additional treatment with metylergometrine (7.8% versus 13.8%), and postpartum Hb < 10 g/dL (9.7% versus 15.2%), and a nonsignificant increase in the frequency of manual placenta removal (3.5% versus 2.3%). There was no group difference in the mean duration of postpartum hospitalisation (4.6 versus 4.5 days, respectively). CONCLUSIONS: Administration of intravenous oxytocin in the third stage of labour is associated with an approximately 22% reduction in mean blood loss, and approximately 40% reductions in frequencies of postpartum haemorrhage (> 500 mL or > 800 mL) and of postpartum haemoglobin < 10 g/dL. Identification of risk groups for oxytocin treatment does not seem worthwhile. Oxytocin is a cheap atoxic drug and should be given routinely after vaginal delivery.

Adult↗