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  • 1.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Lindgren, Helena
    Karolinska Institutet.
    Georgsson, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Warland, Jane
    University of South Australia, Adelaide, Australia.
    Pettersson, Karin
    Karolinska Institutet.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 32-37Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We investigated how women, seeking care due to decreased movements, had paid attention to fetal movements and if the method of monitoring was associated with pregnancy outcome.

    METHODS: A questionnaire was distributed to women from gestational week 28, who had sought care due to decreased fetal movements in Stockholm between January 1st and December 31st, 2014. Women were included in the study if the examination did not reveal any signs of a compromised fetus requiring immediate intervention. Birth outcome and sociodemographic data were collected from the obstetric record register.

    RESULTS: There were 29166 births in Stockholm in 2014, we have information from 2683 women who sought care for decreased fetal movements. The majority (96.6%) of the women stated that they paid attention to fetal movements. Some women observed fetal movements weekly (17.2%) and 69.5% concentrated on fetal movements daily (non-structured group). One in ten (9.9%) used counting methods daily for observing fetal movements (structured group). Women in the structured group more often had caesarean section before onset of labor (RR 1.6, 95% CI 1.2-2.2) and a lower risk of their baby being transferred to neonatal nursery (RR 0.25, 95% CI 0.03-0.94) compared to women in the non-structured group.

    CONCLUSIONS: Women, who had a daily and structured approach to awareness of fetal movements, were more likely to have a caesarean section but their babies were less likely to be transferred to a neonatal nursery as compared with women who used a non-structured method daily.

  • 2.
    Asplin, Nina
    et al.
    Karolinska Institutet / Ultragyn i Sverige AB.
    Wessel, Hans
    Karolinska Institutet / Ultragyn i Sverige AB.
    Marions, Lena
    Karolinska Institutet / Karolinska University Hospital.
    Georgsson Öhman, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Maternal emotional wellbeing over time and attachment to the fetus when a malformation is detected2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 3, p. 191-195Article in journal (Refereed)
  • 3.
    Asplin, Nina
    et al.
    Karolinska Institutet / Karolinska University Hospital / Sophiahemmet Högskola.
    Wessel, Hans
    Karolinska Institutet / Wessel MediConsult AB / Ultragyn.
    Marions, Lena
    Karolinska Institutet / Karolinska University Hospital.
    Georgsson Öhman, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Pregnant women's experiences, needs, and preferences regarding information about malformations detected by ultrasound scan2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 2, p. 73-78Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of the study was to explore pregnant women's experiences of received information in relation to fetal malformation detected on ultrasound.

    METHOD: An exploratory descriptive design was used. Semi-structured interviews with women who continued their pregnancy and women who chose to terminate were audiotaped, the information pathway described, and the text subjected to qualitative content analysis.

    RESULTS: Most of the women who expected a baby with an abnormality experienced the information given as insufficient, often misleading, conflicting, or incoherent, and sometimes negative. Important factors for interaction between women and caregivers were timing, duration, and manner of the initial dialog and ongoing support. Positive interactions improved the women's ability to understand the information, fostered feelings of trust and safety which reduced their anxiety.

    CONCLUSION: Women expressed dissatisfaction both regarding the care-givers' methods of giving information and apply for information from different specialists and continuity. The study highlights important factors which may be helpful to the professionals for improving the information to this vulnerable group of women.

  • 4.
    Asplin, Nina
    et al.
    Sophiahemmet Högskola / Karolinska Institutet / Karolinska University Hospital.
    Wessel, Hans
    Karolinska Institutet / Wessel MediConsult AB, Ultragyn i Sverige AB.
    Marions, Lena
    Karolinska Institutet / Karolinska University Hospital.
    Georgsson Öhman, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 2, p. 79-84Article in journal (Refereed)
    Abstract [en]

    Objectives

    The aims of the study were to explore factors influencing the decision to continue or terminate pregnancy due to detection of fetal malformation following ultrasound examination, to elucidate the need for more information or other routines to facilitate the decision-making process and to assess satisfaction with the decision made.

    Design

    Descriptive study.

    Setting

    Four fetal care referral centres in Stockholm, Sweden.

    Population

    Pregnant women with a detected fetal malformation.

    Methods

    Data was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed.

    Results

    Both women who continued and those who terminated pregnancy based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were aspects including socioeconomic considerations. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (p⩽ 0.004) of previous abortions than those in the continuing group (23.2%).

    Conclusion

    The decision to continue or terminate the pregnancy was to a great extent based on the severity of the malformation. Religious aspects did not seem to influence the decision. Many women expressed a need for additional occasion of information. The vast majority of women were satisfied with their decision.

  • 5.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet Högskola / Karolinska Institutet.
    Waldenström, Ulla
    Karolinska Institutet.
    Effect of first-trimester ultrasound screening for Down syndrome on maternal-fetal attachment: a randomized controlled trial2010In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, no 3, p. 85-90Article in journal (Refereed)
    Abstract [en]

    Objective: The objective was to investigate how ultrasound screening for Down syndrome (DS) in the first trimester, compared with a routine ultrasound examination in the second trimester, affected Maternal–Fetal Attachment (MFA) in mid-pregnancy. Method: This study of 2026 pregnant women was a sub-study of a larger RCT aiming at evaluating the effect of fetal screening for Down syndrome (DS) by means of an ultrasound scan, including measuring fetal nuchal translucency in gestational weeks 12–14. Women were randomly allocated either to the intervention or to a control group where routine care with an ultrasound scan in gestational week 17–20 was offered. Data were collected by questionnaires before randomization and in gestational week 24. MFA was measured by a modified version of the Cranley Maternal–Fetal Attachment Scale (CMFAS). Results: The mean score of MFA was 3.50 in the intervention group and 3.44 in the control group (p = 0.04). The mean scores on all subscales were slightly higher in the intervention group, but only statistically significant regarding “Differentiation of self from fetus” (p = 0.01). Conclusion: Ultrasound screening for DS in the first trimester may have a modest positive effect on MFA in mid-pregnancy, compared with a ultrasound scan in the second trimester.

  • 6.
    Rådestad, Ingela
    et al.
    Sophiahemmet Högskola.
    Akselsson, Anna
    Sophiahemmet Högskola / Karolinska Institutet.
    Georgsson, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Lindgren, H
    Karolinska Institutet.
    Pettersson, K
    Karolinska Institutet.
    Steineck, G
    University of Gothenburg / Karolinska Institutet.
    Rationale, study protocol and the cluster randomization process in a controlled trial including 40,000 women investigating the effects of mindfetalness2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 10, p. 56-61Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Shortening pre-hospital delay may decrease stillbirth rates and rates of babies born with a compromised health. Stillbirth may be preceded by a decrease in fetal movements. Mindfetalness has been developed as a response to the shortcomings of kick-counting for the monitoring of fetal movements by the pregnant woman. We do not know if practicing Mindfetalness may diminish pre-hospital delay. Nor do we know if practicing Mindfetalness may increase or decrease the percentage of women seeking health care for unfounded, from a medical perspective, worry for her fetus' well-being.

    METHODS:

    This article describes the rationale, study protocol and the randomization process for a planned study randomly allocating 40,000 pregnant women to receive, or not receive, proactive information about practicing Mindfetalness. The unit of randomization is 63 antenatal clinics in the Stockholm area. Midwives in the antenatal clinics randomized to Mindfetalness will verbally inform about practicing Mindfetalness, hand out brochures (printed in seven languages) and inform about a website giving information about Mindfetalness. Routine care will continue in the control clinics. All information for the analyses, including the main endpoint of an Apgar score below 7 (e.g., 0-6 with stillbirth giving a score of 0), measured five minutes after birth, will be retrieved from population-based registers.

    RESULTS:

    We have randomized 33 antenatal clinics to Mindfetalness and 30 to routine care. In two clinics a pilot study has been performed. One of the clinics randomly allocated to inform about Mindfetalness will not do so (but will be included in the intention-to-treat analysis). In October 2016 we started to recruit women for the main study.

    CONCLUSION:

    The work up to now follows the outlined time schedule. We expect to present the first results concerning the effects of Mindfetalness during 2018.

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