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  • 1.
    Georgsson Öhman, Susanne
    et al.
    Karolinska Institutet.
    Saltvedt, Sissel
    South General Hospital, Stockholm.
    Grunewald, Charlotta
    South General Hospital, Stockholm.
    Waldenström, Ulla
    Karolinska Institutet.
    Does fetal screening affect women's worries about the health of their baby?: a randomized controlled trial of ultrasound screening for Down's syndrome versus routine ultrasound screening2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 7, p. 634-640Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Screening for fetal abnormality may increase women's anxiety as attention is directed at the possibility of something being wrong with the baby. The aim of this study was to evaluate the effect of ultrasound screening for Down's syndrome on women's anxiety in mid-pregnancy and 2 months after delivery. METHOD: Two thousand and twenty-six women were randomly allocated to an ultrasound examination at 12-14 gestational weeks (gws) including risk assessment for Down's syndrome or to a routine scan at 15-20 gws. Questionnaires including the State-Trait Anxiety Inventory (STAI), the Cambridge Worry Scale (CWS), and the Edinburgh Postnatal Depression Scale (EPDS) were filled in at baseline in early pregnancy, at 24 gws and 2 months after delivery. RESULTS: No statistically significant differences were found between the trial groups regarding women's worries about the health of the baby, general anxiety and depressive symptoms during pregnancy or 2 months after delivery. Women's worries about something being wrong with the baby in the early ultrasound group and routine group, respectively, decreased from baseline (39.1% versus 36.0%) to mid-pregnancy (29.2% versus 27.8%), and finally to 2 months after delivery (5.2% versus 6.6%). CONCLUSION: Fetal screening for Down's syndrome by an early ultrasound scan did not cause more anxiety or concerns about the health of the baby in mid-pregnancy or 2 months after birth than in women who had a routine scan.

  • 2.
    Ingvoldstad, Charlotta
    et al.
    Uppsala University.
    Georgsson Öhman, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Lindgren, Peter
    Uppsala Univeristy / Karolinska Institutet.
    Implementation of combined ultrasound and biochemistry for risk evaluation of chromosomal abnormalities during the first trimester in Sweden2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 9, p. 868-73Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate how the first trimester risk evaluation for Down syndrome is offered and performed.

    SETTING: Sweden.

    SAMPLE: All 52 known units working with obstetric ultrasound.

    METHODS: Study-specific questionnaire and descriptive statistical analyses.

    MAIN OUTCOME MEASURES: Routines for offering combined ultrasound and biochemistry (CUB), questions about information, questions about tests and analysis used for diagnosis.

    RESULTS: CUB was performed in 28 600 (26%) of the expected 110 000 pregnancies in Sweden during 2011. Of all pregnant women, 15% were living in a county not offering CUB (only invasive prenatal diagnosis); 44% regardless of age; 15% to women ≥33 years; 24% to women ≥35 years; and 2% to women ≥38 years old. Amniocentesis was the most common method offered when the risk was estimated as high. Of the 47 units that replied, 29 (61.7%) offered only amniocentesis. On the questions about information, 40 (95.2%) stated that they gave verbal information. In addition to verbal information, 17 (40.5%) gave written information. Forty-one of the units (71.9%) stated that the CUB is offered to non-Swedish-speaking women.

    CONCLUSION: Without consistent national guidelines, the prenatal diagnostic CUB method is offered in an inequitable manner to pregnant women in Sweden. More than half of all pregnant women live in a county where CUB is not offered or is only offered based on age. The results demonstrate the importance of national consistency before the introduction of new prenatal tests, to enhance equal care for all pregnant women.

  • 3.
    Niklasson, Boel
    et al.
    Karolinska Institutet.
    Börjesson, Astrid
    Karolinska University Hospital.
    Carmnes, Ulla-Britt
    Karolinska University Hospital.
    Segerdahl, Märta
    Karolinska Institutet.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Blanck, Agneta
    Karolinska Institutet.
    Intraoperative injection of bupivacaine-adrenaline close to the fascia reduces morphine requirements after cesarean section: a randomized controlled trial2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 12, p. 1433-1439Article in journal (Refereed)
    Abstract [en]

    Objective. The purpose of this study was to investigate whether a single injection of bupivacaine with adrenaline close to the fascia could decrease opiate consumption and pain in patients undergoing cesarean section in spinal anesthesia. Design. Randomized double-blind controlled study. Settings. Karolinska University Hospital, Huddinge, Sweden. Population. 260 women scheduled for elective cesarean section were enrolled in the study. Methods. The treatment group (n= 130) received 40 mL bupivacaine (2.5 mg/mL) with adrenaline (5 μg/mL) (Marcain® adrenalin) and the control group (n= 130) received 40 mL saline solution (0.9%), which was, in both groups, injected close to the fascia before closure of the wound. Main outcome measures. Morphine consumption and mean resting pain intensity numerical rating scale at 12 and 24 hours were the primary outcome variables. Other assessments for pain as well as mobilization parameters were considered secondary. Results. Morphine requirements were significantly less in the bupivacaine group, 19.0 mg/woman, compared with 24.0 mg/woman in the placebo group, during the first 12 postoperative hours. During this time period there was also a trend towards a difference between groups in mean pain intensity, but significant only during the first six hours. Over the whole first postoperative 24 hours, there were no differences in either morphine requirement or pain intensity between groups. Conclusions. A single injection of bupivacaine with adrenaline in the surgical wound decreases the need for morphine requirements for the first 12 postoperative hours and contributes to safe and effective pain management in women undergoing cesarean section.

  • 4.
    Niklasson, Boel
    et al.
    Karolinska Institutet / Sophiahemmet Högskola.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Segerdahl, Märta
    Karolinska Institutet.
    Blanck, Agneta
    Karolinska Institutet.
    Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 6, p. 622-628Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the overall incidence and risk factors for persistent pain and its interference with daily life after cesarean section.

    DESIGN: Prospective long-term follow-up study.

    SETTING: Karolinska University Hospital, Stockholm, Sweden.

    POPULATION: 260 healthy women who underwent elective cesarean section.

    METHODS: Information on demographics, medical history, postoperative pain and analgesic requirements was collected. A questionnaire consisting of the Brief Pain Inventory was posted at 3, 6 and 12 months after surgery. Women rated pain intensity as well as interference with factors related to general function and quality of life.

    MAIN OUTCOME MEASURES: The overall incidence and risk factors for persistent postoperative pain at three time points. Persistent pain was considered a secondary outcome.

    RESULTS: At 3, 6 and 12 months 40%, 27% and 22% of patients, respectively, reported pain in one or more locations, in the surgical site as well as in other areas. A psychological indication, as well as a first cesarean section, increased the risk for pain at 3 months. Severe postoperative pain in the immediate postoperative period or undergoing a first cesarean section were significant independent risk factors for the development of persistent pain up to 6 months after cesarean section. Parameters related to quality of life were significantly impaired in women with persistent pain.

    CONCLUSION: Several factors, including severe postoperative pain, were shown to influence the risk for persistent pain after cesarean section. Long-term pain markedly affected women's wellbeing. This article is protected by copyright. All rights reserved.

  • 5.
    Ulfsdottir, Hanna
    et al.
    Karolinska Institutet / Sophiahemmet Högskola.
    Saltvedt, Sissel
    Karolinska Institutet.
    Georgsson, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Waterbirth in Sweden - a comparative study2018In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 341-348Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The literature describes advantages for mothers giving birth in water, but waterbirth is controversial in Sweden and has not been offered at hospitals until recently. This study aimed to describe and compare the characteristics and outcome of waterbirths with spontaneous vaginal births at the same clinics.

    MATERIAL AND METHODS: A retrospective cohort study was conducted on all waterbirths at two maternity units in Sweden from March 2014 to November 2015 (n=306), and a consecutively selected comparison group of 306 women having conventional spontaneous vaginal births. Logistic regression was used to analyze the primary outcome; second-degree perineal tears.

    RESULTS: Women giving birth in water had a lower risk of second-degree perineal tears (adj. OR 0.6 [95% CI 0.4-0.9]). Their labor was shorter (6:03 hrs. vs 7:52 hrs.) and there were significantly less interventions than in the comparison group; amniotomy (13.7% vs. 35.3%), internal cardiotocography (11.1% vs.56.8%), and augmentation with oxytocin (5.2% vs.31.3%). There were no differences in Apgar scores or admissions to neonatal intensive care unit. The experience of childbirth, measured with a numeric rating scale, was higher in the waterbirth group indicating a more positive birth experience. Three newborns born in water had an umbilical cord avulsion.

    CONCLUSIONS: In this low-risk population, waterbirth is associated with positive effects on perineal tears, the frequency of interventions, the duration of labor and women's birth experience. Midwives handling waterbirth should be aware of the risk of umbilical cord avulsion. This article is protected by copyright. All rights reserved.

  • 6.
    Volgsten, Helena
    et al.
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Ekselius, Lisa
    Uppsala universitet, Psykiatri, Akademiska sjukhuset.
    Sundström Poromaa, Inger
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Skoog Svanberg, Agneta
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Personality traits associated with depressive and anxiety disorders in infertile women and men undergoing in vitro fertilization treatment2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 1, p. 27-34Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess which personality traits are associated with depressive and/or anxiety disorders in infertile women and men undergoing in vitro fertilization (IVF). DESIGN: Prospective study. SETTING: A university hospital in Sweden. POPULATION: A total of 856 eligible women and men, 428 couples, were approached to participate. Overall 643 (75.1%) subjects filled out the Swedish Universities Scales of Personality (SSP) questionnaire. The response rates were 323 women (75.5%) and 320 men (74.8%). METHODS: The SSP, a self-rating personality trait questionnaire, was used for evaluation. Main outcome measures. Personality traits associated with depression and/or anxiety disorders. RESULTS: Higher mean scores on all neuroticism-related personality traits were found in women and men with depressive and/or anxiety disorders compared to women and men with no diagnosis. High scores of neuroticism and a negative pregnancy test after IVF were associated with depressive and/or anxiety disorders among women. Among men, high scores of neuroticism and unexplained or male infertility factor were associated with depressive and/or anxiety disorders. High neuroticism scores were negatively associated with live birth (p < 0.05). CONCLUSION: High scores on neuroticism-related personality traits were associated with depressive and/or anxiety disorders in women and men undergoing IVF.

  • 7.
    Volgsten, Helena
    et al.
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Skoog Svanberg, Agneta
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Olsson, Pia
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Unresolved grief in women and men in Sweden three years after undergoing unsuccessful in vitro fertilization treatment2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 10, p. 1290-1297Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Grief is a common reaction in women after a diagnosis of infertility. The study explored the experience of childlessness in both women and men three years after undergoing unsuccessful in vitro fertilization (IVF).

    METHODS: Participants (10 women and 9 men) who had attended a fertility clinic in Sweden were interviewed individually. The methodological approach was qualitative with semi-structured interviews and qualitative content analysis.

    RESULTS: Unsuccessful IVF was experienced by women in terms of grief, whereas men took upon themselves a supportive role and did not express grief. A need for professional support and counselling in how to handle grief was described. An unstructured end after IVF treatment left unanswered questions. Partner relations were affected in both positive and negative ways and an experience of being excluded with no understanding and lack of support from their social network was revealed. Three years after the end of IVF treatment, both men and women were still processing childlessness and had not adapted to being childless, indicating the grieving process was unresolved.

    CONCLUSIONS: The grieving process after unsuccessful IVF treatment was hampered among both men and women. The provision of additional individual support during IVF is recommended as men and women in this study experienced childlessness differently. Support and counselling concerning grief reactions following IVF failure, and a structured end after IVF may facilitate the grieving process after unsuccessful IVF treatment.

1 - 7 of 7
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