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Helle Kieler

Publications and source records attributed to Helle Kieler.

10 recordsLinked to original sources
PubMed2006

Symphysis-fundus measurements for detection of small for gestational age pregnancies.

BACKGROUND: In Sweden measurements of the symphysis-fundus (SF) distance are used to detect small for gestational age (SGA) pregnancies. The aim of this study was to evaluate the efficiency of Swedish ultrasound-based SF reference curves in detecting SGA pregnancies. METHODS: To assess the sensitivity for detection of SGA pregnancies we performed a case-control study. Through the Swedish Medical Birth Register we identified all singleton SGA infants born in Uppsala in 1993-1997 and randomly recruited non-SGA singleton infants as controls. We included 169 term and 73 preterm SGA cases and 296 controls, all born at term. The reference curves constructed by Steingrimsdottir (S curve) and Kieler (K curve) were evaluated. Gestational age at the first alarm in the preterm SGA group was recorded. RESULTS: In term pregnancies the S curve showed a sensitivity of 32% and specificity of 90% at a cut-off of -2 SDs. The corresponding values for the K curve were 51% and 83%, respectively. In preterm SGA pregnancies the sensitivity of the S curve was 49% and of the K curve 58%. The first alarm below 2 SDs was noted before 32 weeks in 37% with the S curve and 43% with the K curve for preterm SGA pregnancies. CONCLUSIONS: Both tested Swedish SF reference curves had low sensitivities for term SGA pregnancies. Sensitivity was higher for the preterm group and SF measurements seem to be better for detecting the most severe cases of SGA.

Adult↗
PubMed2005

Does prenatal sonography affect intellectual performance?

BACKGROUND: Little is known about potential risks of ultrasound during pregnancy. The developing brain is susceptible to environmental influences, and prenatal ultrasound has been reported to affect cognitive abilities in animals. METHODS: To assess a possible association between prenatal ultrasound and intellectual performance, we studied men born in Sweden from 1973 to 1978 who enrolled for military service from 1991 to 1996. Intellectual scores (mean +/- standard deviation = 5 +/- 2) were measured by a test battery at enrollment, and subnormal performance was defined as a score of 3 or less. We estimated differences in mean intellectual score between ultrasound-exposed and ultrasound-unexposed using linear regression, and we calculated relative risks of subnormal performance using logistic regression analysis. RESULTS: There were 7999 eligible men born in a hospital (Malmo) that included ultrasound scanning in standard antenatal care (exposed) and 197,829 men born in hospitals without ultrasound scanning programs (unexposed). We found lower intellectual performance scores (mean difference = -0.16; 95% confidence interval = -0.21 to -0.11) and an increased risk of subnormal performance (odds ratio = 1.28; CI = 1.18 to 1.38) among ultrasound-exposed compared with unexposed. However, men born in Malmo before scanning was introduced also had lower scores, and the decrease in test scores after the introduction of ultrasound was small. Moreover, we found no differences in intellectual performance within pairs of brothers as a result of ultrasound exposure. CONCLUSIONS: This study failed to demonstrate a clear association between ultrasound scanning and intellectual performance.

Adolescent↗
PubMed2005

Emergency cesarean delivery in induction of labor: an evaluation of risk factors.

BACKGROUND: Induction of labor has been associated with an increased risk of emergency cesarean delivery. Knowledge of factors that influence the risk of cesarean delivery in women with induced labor is limited. METHODS: We performed a case-control study, nested within a population-based cohort of women with induced labor at term during 1991-1996 in Uppsala County, Sweden. Cases were women delivered with emergency cesarean delivery, and controls were women vaginally delivered (n = 193, respectively). Using logistic regression, analyses were performed. Odds ratio (OR) with 95% confidence intervals (CI) was used as a measure of relative risk. RESULTS: Women with a previous cesarean delivery had high risks of cesarean delivery (adjusted OR = 10.10, 95% CI = 3.30-30.92). The risk of cesarean delivery was also increased among nulliparous (adjusted OR = 4.92, 95% CI = 2.81-8.61), short (adjusted OR = 2.20, 95% CI = 1.06-4.59), and obese women (adjusted OR = 2.03, 95% CI = 1.07-3.84). A cervix dilatation less than 1.5 cm doubled the risk of cesarean delivery (adjusted OR = 2.26, 95% CI = 1.09-4.66). Mother's age, epidural analgesia, oxytocin augmentation, gestational age, and birthweight were not significantly associated with risks of cesarean delivery. CONCLUSIONS: Women with a previous cesarean delivery, nulliparous, short, and obese women with induced labor are at high risk of a cesarean delivery. When there is a need to deliver a woman with a previous cesarean section or a nulliparous woman with other risk factors for cesarean delivery, it may be prudent to consider an elective cesarean section.

Adult↗
PubMed2004

Surveillance in longitudinal models: detection of intrauterine growth restriction.

A new methodology for online detection of intrauterine growth restriction (IUGR) is proposed where traditional methods for statistical surveillance are applied. Here, deficient growth rate is used to detect IUGR instead of the common surrogate measure "small for gestational age" (SGA). Fetal growth is estimated by repeated measurements of symphysis-fundus (SF) height. At each time point the new method, based on the Shiryaev-Roberts method, is used to evaluate the growth in SF height. We use Swedish data to model a normal growth pattern, which is used to evaluate the capability of the new method to detect IUGR in comparison with a method used in practice today. Results from simulations indicate that the new method performs considerably better than the method used today. We also illustrate the effect of some important factors which influence the detection ability and illuminate the tendency of the method used today to misclassify SGA cases as IUGR.

Biometry↗
PubMed2003

[Venous thromboembolism and combined oral contraceptives. Reported adverse reactions indicate at least similar risk with the most recent contraceptive pills].

Rare adverse drug reactions (ADRs) to combined oral contraceptives (COCs), such as venous thromboembolism (VTE), are seldom disclosed until a COC has been on the market for some time. Two new COCs, Yasmin and Cilest have recently been launched in several European countries with expectations of being safer than older COCs. Utilising data from spontaneous reporting of ADRs to the Medical Products Agency in Sweden and sales data, VTE incidence for Yasmin and Cilest was estimated and compared with VTE incidence for a second (Follimin) and a third generation (Desolett) COC. The reported VTE incidence for Yasmin and Cilest was higher 4.6, and 3.7 per 10,000 users per year, respectively than the corresponding VTE incidences for Follimin and Desolett of 1.9 and 2.9 per 10,000 users per year, respectively. The differences were, however, not statistically significant. We conclude that the risk of VTE associated with the most recent COCs is at least similar to that of older COCs.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

Time of birth and risk of intrapartum and early neonatal death.

BACKGROUND: Previous studies have found that infants born at night and during weekends and holidays have an increased risk of perinatal mortality. However, these associations may be confounded by the distribution of high-risk deliveries according to time of birth. METHODS: We undertook a population-based cohort study of 694,888 singleton births without elective cesarean section in Sweden between 1991 and 1997. We estimated relative risks of intrapartum and early neonatal death according to the hour, day and month of delivery. Estimated risk ratios were adjusted for gestational age, birth weight for gestational age, malformations, induction of labor, breech presentations and year of birth. RESULTS: Infants of high-risk deliveries were more often delivered during daytime (8:00 am to 7:59 pm). Compared with infants born during daytime, infants born at night were at increased risk of early neonatal death (adjusted risk ratio = 1.28; 95% confidence interval = 1.13-1.46), but not intrapartum death (1.05; 0.71-1.54). If this association is causal, 12% of early neonatal deaths can be attributed to the increased risk among nighttime births. There was no association of weekend or holiday births with risks of intrapartum or early neonatal death. CONCLUSIONS: Infants born at night may be at increased risk of early neonatal death.

Cohort Studies↗
PubMed2003

Assessing urinary albumin excretion in pre-eclamptic women: which sample to use?

OBJECTIVE: To evaluate whether the gold standard of 24-hour urine collection for measuring albumin excretion in pre-eclamptic women could be substituted by shorter collection periods. DESIGN: Prospective study. SETTING: Fetal maternity ward, university hospital. PARTICIPANTS: Thirty women with pre-eclampsia and a positive urinary test strip for protein of at least 2+. METHODS: From each woman, within a 25-hour period, three spot, two 12-hour (day and night) and one 24-hour urine sample were collected. Urine albumin concentrations in milligrammes per litre were analysed by rate nephelometry on a Beckman Array protein system. The urinary albumin concentrations in the spot and the 12-hour samples were compared with the concentration in the 24-hour urine collection. MAIN OUTCOME MEASURES: Urinary albumin concentrations in spot and 12-hour samples measured against the standard 24-hour albumin excretion. RESULTS: Albumin concentrations in the day and night collection fitted closely with the concentrations of the 24-hour collection. The median difference between the 24-hour and the day collection was -3 mg/L (interquartile range -264 to 116 mg/L). The median difference between the 24-hour and the night collection was 17 mg/L (interquartile range -186 to 210 mg/L). The association of urinary albumin concentration in the 24-hour collection and the spot samples was much weaker. Of the spot urine samples, the albumin concentration in the sample taken on the morning after admission to hospital was closest to the 24-hour urinary albumin excretion, with a median difference of -62 mg/L (interquartile range -1131 to 285 mg/L). CONCLUSION: The gold standard of 24-hour urinary excretion for assessment of albuminuria in pre-eclamptic women can be substituted with a 12-hour collection. Spot urine samples were inaccurate and are therefore not recommended for quantification of albumin excretion.

Adult↗
PubMed2002

[A nation-wide survey: striking differences in the diagnostic procedures relating to thrombosis].

A questionnaire revealed that nearly 40 000 examinations of clinically suspected deep venous thrombosis (DVT) were performed in Sweden in 2001, with a slight predominance of phlebographies. In about two thirds of all cases the deep muscle veins of the calf were included in the interpretation when phlebography was performed, but in less than one fifth when Doppler sonography (CDU) was used. In more than half of the cases a negative CDU was not followed by phlebograghy. On the other hand, the combination of CDU and phlebography was routinely used in nearly two thirds of all ambiguous cases. The interpretation of nonfiling of contrast medium in vein segments on phlebography varied from DVT to no DVT. Most of the phlebographies were performed with digital X-ray technique.

Humans↗