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1.
Br J Cancer ; 131(1): 126-137, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38740969

RESUMO

BACKGROUND: It is important to monitor the association between menopausal hormone therapy (HT) use and breast cancer (BC) risk with contemporary estimates, and specifically focus on HT types and new drugs. METHODS: We estimated hazard ratios (HR) of BC risk according to HT type, administration route and individual drugs, overall and stratified by body mass index (BMI), molecular subtype and detection mode, with non-HT use as reference. RESULTS: We included 1,275,783 women, 45+ years, followed from 2004, for a median of 12.7 years. Oral oestrogen combined with daily progestin was associated with the highest risk of BC (HR 2.42, 95% confidence interval (CI) 2.31-2.54), with drug-specific HRs ranging from Cliovelle®: 1.63 (95% CI 1.35-1.96) to Kliogest®: 2.67 (2.37-3.00). Vaginal oestradiol was not associated with BC risk. HT use was more strongly associated with luminal A cancer (HR 1.97, 95% CI 1.86-2.09) than other molecular subtypes, and more strongly with interval (HR 2.00, 95% CI: 1.83-2.30) than screen-detected (HR 1.33, 95% CI 1.26-1.41) BC in women 50-71 years. HRs for HT use decreased with increasing BMI. CONCLUSIONS: The use of oral and transdermal HT was associated with an increased risk of BC. The associations varied according to HT type, individual drugs, molecular subtype, detection mode and BMI.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/induzido quimicamente , Pessoa de Meia-Idade , Noruega/epidemiologia , Idoso , Estudos de Coortes , Terapia de Reposição de Estrogênios/efeitos adversos , Terapia de Reposição de Estrogênios/estatística & dados numéricos , Fatores de Risco , Menopausa , Índice de Massa Corporal , Terapia de Reposição Hormonal/efeitos adversos , Progestinas/efeitos adversos , Progestinas/administração & dosagem , Estrogênios/efeitos adversos , Estrogênios/administração & dosagem
2.
Acta Obstet Gynecol Scand ; 103(6): 1063-1072, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38382894

RESUMO

INTRODUCTION: The Coronavirus 2019 Disease (COVID-19) pandemic reached the Nordic countries in March 2020. Public health interventions to limit viral transmission varied across different countries both in timing and in magnitude. Interventions indicated by an Oxford Stringency Index ≥50 were implemented early (March 13-17, 2020) in Denmark, Finland, Norway and Iceland, and on March 26, 2020 in Sweden. The aim of the current study was to assess the incidence of COVID-19-related admissions of pregnant women in the Nordic countries in relation to the different national public health strategies during the first year of the pandemic. MATERIAL AND METHODS: This is a meta-analysis of population-based cohort studies in the five Nordic countries with national or regional surveillance in the Nordic Obstetric Surveillance System (NOSS) collaboration: national data from Denmark, Finland, Iceland and Norway, and regional data covering 31% of births in Sweden. The source population consisted of women giving birth in the included areas March 1-December 31, 2020. Pregnant women with a positive SARS-CoV-2 PCR test ≤14 days before hospital admission were included, and admissions were stratified as either COVID-19-related or non-COVID (other obstetric healthcare). Information about public health policies was retrieved retrospectively. RESULTS: In total, 392 382 maternities were considered. Of these, 600 women were diagnosed with SARS-CoV-2 infection and 137 (22.8%) were admitted for COVID-19 symptoms. The pooled incidence of COVID-19 admissions per 1000 maternities was 0.5 (95% confidence interval [CI] 0.2 to 1.2, I2 = 77.6, tau2 = 0.68, P = 0.0), ranging from no admissions in Iceland to 1.9 admissions in the Swedish regions. Interventions to restrict viral transmission were less stringent in Sweden than in the other Nordic countries. CONCLUSIONS: There was a clear variation in pregnant women's risk of COVID-19 admission across countries with similar healthcare systems but different public health interventions to limit viral transmission. The meta-analysis indicates that early suppression policies protected pregnant women from severe COVID-19 disease prior to the availability of individual protection with vaccines.


Assuntos
COVID-19 , Complicações Infecciosas na Gravidez , SARS-CoV-2 , Humanos , Feminino , COVID-19/epidemiologia , COVID-19/prevenção & controle , Gravidez , Países Escandinavos e Nórdicos/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Incidência , Adulto , Pandemias/prevenção & controle , Vigilância da População/métodos
3.
BMC Pregnancy Childbirth ; 23(1): 363, 2023 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-37208647

RESUMO

BACKGROUND: Over the past two decades several high-income countries have reported increased rates of postpartum haemorrhage (PPH). Many of the studies are registry studies with limited access to detailed information. We aimed to explore trends of severe PPH in the largest labour ward in Norway during a 10-year period with a hospital based study. Our population constituted all women who gave birth after week 22 at Oslo University Hospital between 2008 and 2017. The main outcome measure was severe PPH, defined as registered blood loss greater than 1500 ml, or transfusion of blood products due to PPH. METHODS: We estimated the incidence of severe PPH and blood transfusions, and performed temporal trend analysis. We performed Poisson regression analysis to investigate associations between pregnancy characteristics and severe PPH, presented using crude incidence rate ratios (IRR) with 95% confidence intervals (CI)s. We also estimated annual percentage change of the linear trends. RESULTS: Among 96 313 deliveries during the 10-year study period, 2621 (2.7%) were diagnosed with severe PPH. The incidence rate doubled from 17.1/1000 to 2008 to 34.2/1000 in 2017. We also observed an increased rate of women receiving blood transfusion due to PPH, from 12.2/1000 to 2008 to 27.5/1000 in 2017. The rates of invasive procedures to manage severe PPH did not increase, and we did not observe a significant increase in the number of women defined with maternal near miss or massive transfusions. No women died due to PPH during the study period. CONCLUSION: We found a significant increasing trend of severe PPH and related blood transfusions during the 10-year study period. We did not find an increase in massive PPH, or in invasive management, and we suspect that the rise can be at least partly explained by increased awareness and early intervention contributing to improved registration of severe PPH.


Assuntos
Hemorragia Pós-Parto , Gravidez , Feminino , Humanos , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/terapia , Hemorragia Pós-Parto/etiologia , Incidência , Transfusão de Sangue , Hospitais , Noruega/epidemiologia
4.
Acta Obstet Gynecol Scand ; 101(7): 819-826, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35388907

RESUMO

INTRODUCTION: A peripartum hysterectomy is typically performed as a lifesaving procedure in obstetrics to manage severe postpartum hemorrhage. Severe hemorrhages that lead to peripartum hysterectomies are mainly caused by uterine atony and placenta accreta spectrum disorders. In this study, we aimed to estimate the incidence, risk factors, causes and management of severe postpartum hemorrhage resulting in peripartum hysterectomies, and to describe the complications of the hysterectomies. MATERIAL AND METHODS: Eligible women had given birth at gestational week 23+0 or later and had a postpartum hemorrhage ≥1500 mL or a blood transfusion, due to postpartum hemorrhage, at Oslo University Hospital, Norway, between 2008 and 2017. Among the eligible women, this study included those who underwent a hysterectomy within the first 42 days after delivery. The Norwegian Medical Birth Registry provided the reference group. We used Poisson regression to estimate adjusted incidence rate ratios with 95% confidence intervals to identify clinical factors associated with peripartum hysterectomy. RESULTS: The incidence of hysterectomies with severe postpartum hemorrhage was 0.44/1000 deliveries (42/96313). Among the women with severe postpartum hemorrhage, 1.6% ended up with a hysterectomy (42/2621). Maternal age ≥40, previous cesarean section, multiple pregnancy and placenta previa were associated with a significantly higher risk of hysterectomy. Placenta accreta spectrum disorders were the most frequent cause of hemorrhage that resulted in a hysterectomy (52%, 22/42) and contributed to most of the complications following the hysterectomy (11/15 women with complications). CONCLUSIONS: The rate of peripartum hysterectomies at Oslo University Hospital was low, but was higher than previously reported from Norway. Risk factors included high maternal age, previous cesarean section, multiple pregnancy and placenta previa, well known risk factors for placenta accreta spectrum disorders and severe postpartum hemorrhage. Placenta accreta spectrum disorders were the largest contributor to hysterectomies and complications.


Assuntos
Placenta Acreta , Placenta Prévia , Hemorragia Pós-Parto , Cesárea/efeitos adversos , Feminino , Hospitais Universitários , Humanos , Histerectomia/efeitos adversos , Período Periparto , Placenta Acreta/epidemiologia , Placenta Acreta/etiologia , Placenta Acreta/cirurgia , Placenta Prévia/epidemiologia , Placenta Prévia/etiologia , Placenta Prévia/cirurgia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/cirurgia , Gravidez , Estudos Retrospectivos , Fatores de Risco
5.
Acta Obstet Gynecol Scand ; 101(10): 1163-1173, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35946127

RESUMO

INTRODUCTION: A greater risk of obstetric anal sphincter injury has been reported among African migrants in several host countries compared with the general population. To what degree female genital mutilation/cutting affects this risk is not clear. In infibulated women, deinfibulation prevents anal sphincter injury. Whether the timing of deinfibulation affects the risk, is unknown. This study aimed to investigate the risks of anal sphincter injury associated with female genital mutilation/cutting and timing of deinfibulation in Norway, and to compare the rates of anal sphincter injury in Somali-born women and the general population. MATERIAL AND METHODS: In a historical cohort study, nulliparous Somali-born women who had a vaginal birth in the period 1990-2014 were identified by the Medical Birth Registry of Norway and data collected from medical records. Exposures were female genital mutilation/cutting status and deinfibulation before labor, during labor or no deinfibulation. The main outcome was obstetric anal sphincter injuries. RESULTS: Rates of obstetric anal sphincter injury did not differ significantly by female genital mutilation/cutting status (type 1-2: 10.2%, type 3: 11.3%, none: 15.2% P = 0.17). The total rate of anal sphincter injury was 10.3% compared to 5.0% among nulliparous women in the general Norwegian population. Women who underwent deinfibulation during labor had a lower risk than women who underwent deinfibulation before labor (odds ratio 0.48, 95% confidence interval 0.27-0.86, P = 0.01). CONCLUSIONS: The high rate of anal sphincter injury in Somali nulliparous women was not related to type of female genital mutilation/cutting. Deinfibulation during labor protected against anal sphincter injury, whereas deinfibulation before labor was associated with a doubled risk. Deinfibulation before labor should not be routinely recommended during pregnancy.


Assuntos
Circuncisão Feminina , Complicações do Trabalho de Parto , Canal Anal/lesões , Circuncisão Feminina/efeitos adversos , Estudos de Coortes , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Masculino , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Períneo , Gravidez , Fatores de Risco
6.
Tidsskr Nor Laegeforen ; 142(3)2022 02 15.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-35170925

RESUMO

BACKGROUND: It is unclear how the COVID-19 pandemic has affected postnatal women in Norway. We therefore wanted to investigate their depressive symptoms and birthing experiences during the pandemic. MATERIAL AND METHOD: In April 2021, a total of 3 642 postnatal women participated in an online survey. Depressive symptoms were measured using a short matrix version of the Edinburgh Postnatal Depression Scale (EPDS-4), and standardised questions about the ante-, peri- and post-natal periods were used to record birthing experiences. The questions were the same as those used ten years ago in the Ahus Birth Cohort study, which is the reference population here. The women were also asked questions related to the pandemic and mental health care. RESULTS: Twenty-nine per cent of the mothers indicated that the pandemic had had a 'large' or 'very large' impact on their mental health. Thirty-two per cent reported high scores for depressive symptoms (EPDS-4 scores ≥ 6), while the corresponding figure in the reference population was 10 %. The proportion of mothers who were dissatisfied with their pregnancy experience was almost the same in both cohorts, while the proportion that reported poor care in the maternity ward during the pandemic was higher than for the reference population (34 % vs. 13 %). Of those who had mental health problems during the pandemic, 54 % stated that they had not received appropriate help. INTERPRETATION: One in three postnatal women reported high scores for depressive symptoms during the pandemic. The study revealed significant dissatisfaction with the care provided in maternity wards and inadequate follow-up of the mothers' mental health.


Assuntos
COVID-19 , Depressão Pós-Parto , Estudos de Coortes , Depressão/diagnóstico , Depressão/epidemiologia , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/psicologia , Feminino , Humanos , Mães/psicologia , Pandemias , Gravidez , SARS-CoV-2
7.
Tidsskr Nor Laegeforen ; 142(17)2022 11 22.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-36416648

RESUMO

BACKGROUND: Studies have shown a high incidence of emergency caesarean sections among immigrant women, especially those born in Sub-Saharan Africa, but the risk of planned and emergency caesarean section varies with the mother's level of education. The proportion of women with little or no education is higher among those born in Sub-Saharan Africa and other low- and middle-income countries than those born in Norway. We therefore wanted to investigate the relationship between maternal birthplace, level of education and risk of caesarean section. MATERIAL AND METHOD: The study was based on all births recorded in the Medical Birth Registry of Norway between 2008 and 2017 linked to data from Statistics Norway. Maternal birthplace, divided into four categories, was the exposure variable. The outcome was planned or emergency caesarean section. We used multinomial logistic regression and stratified the analyses by level of education. Norwegian-born women constituted the reference group. RESULTS: Of 572 349 births, immigrant women accounted for 26.6 %. Caesarean sections and emergency caesareans made up 15.1 % and 9.6 % of all births respectively. Norwegian-born women had the highest proportion of planned caesarean sections (5.7 %), while women born in Sub-Saharan Africa had the highest proportion of emergency caesareans (16.3 %). Among women with a higher education, the proportion of emergency caesareans was 8.3 % among Norwegian-born women and 18.1 % among women born in Sub-Saharan Africa (adjusted relative risk 2.41, 95 % confidence interval 2.18 to 2.66). INTERPRETATION: The impact of education level on risk of caesarean section differed between immigrant women and Norwegian-born women.


Assuntos
Cesárea , Emigrantes e Imigrantes , Feminino , Gravidez , Humanos , Escolaridade , Modelos Logísticos , Sistema de Registros
8.
Acta Obstet Gynecol Scand ; 100(4): 587-595, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33719034

RESUMO

INTRODUCTION: The impact of female genital mutilation/cutting on obstetric outcomes in high-income countries is not clear. In general, women with female genital mutilation/cutting type 3 (infibulation) seem to be most at risk of adverse outcomes such as cesarean section. Deinfibulation is recommended to prevent obstetric complications. Whether the timing of this procedure affects the complication risk is not known. The aims of this study were, first, to examine the association between female genital mutilation/cutting and the risk of cesarean section in Norway, and, second, whether the timing of deinfibulation affected the cesarean section risk. MATERIAL AND METHODS: This was a historical cohort study of nulliparous Somali-born women who gave birth in Norway between 1990 and 2014. The Medical Birth Registry of Norway identified the women. Data were collected from medical records at 11 participating birth units. The exposures were female genital mutilation/cutting status and deinfibulation before pregnancy, during pregnancy, or no deinfibulation before labor onset. The main outcome was odds ratio (OR) of cesarean section. Type of cesarean section, primary indications, and neonatal outcomes were secondary outcomes. RESULTS: Women with female genital mutilation/cutting type 3 had lower risk of cesarean section compared with women with no female genital mutilation/cutting (OR 0.54, 95% CI 0.33-0.89 P = .02). Among the 1504 included women, the cesarean section rate was 28.0% and the proportion of emergency operations was 92.9%. Fetal distress was the primary indication in approximately 50% of cases, across the groups with different female genital mutilation/cutting status. Women who had no deinfibulation before labor onset had lower risk of cesarean section compared with those who underwent deinfibulation before or during pregnancy (OR 0.64, 95% CI 0.46-0.88 P = .01). CONCLUSIONS: High risk of cesarean section in Somali nulliparous women was not related to the type of female genital mutilation/cutting in the present study. Deinfibulation before labor did not protect against cesarean section. Our findings indicate that nulliparous Somali women are at high risk of intrapartum complications. Future research should focus on measures to reduce maternal morbidity and on how timing of deinfibulation affects the outcomes of vaginal births.


Assuntos
Cesárea , Circuncisão Feminina/efeitos adversos , Adulto , Feminino , Humanos , Noruega , Gravidez , Risco , Somália/etnologia
9.
BMC Pregnancy Childbirth ; 21(1): 686, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620114

RESUMO

BACKGROUND: Migrant women are at increased risk for complications related to pregnancy and childbirth, possibly due to inadequate access and utilisation of healthcare. Recently migrated women are considered a vulnerable group who may experience challenges in adapting to a new country. We aimed to identify challenges and barriers recently migrated women face in accessing and utilising maternity healthcare services. METHODS: In the mixed-method MiPreg-study, we included recently migrated (≤ five years) pregnant women born in low- or middle-income countries and healthcare personnel. First, we conducted 20 in-depth interviews with migrant women at Maternal and Child Health Centres (MCHC) and seven in-depth interviews with midwives working at either the hospital or the MCHCs in Oslo. Afterwards, we triangulated our findings with 401 face-to-face questionnaires post-partum at hospitals among migrant women. The data were thematically analysed by grouping codes after careful consideration and consensus between the researchers. RESULTS: Four main themes of challenges and barriers faced by the migrant women were identified: (1) Navigating the healthcare system, (2) Language, (3) Psychosocial and structural factors, and (4) Expectations of care. Within the four themes we identified a range of individual and structural challenges, such as limited knowledge about available healthcare services, unmet needs for interpreter use, limited social support and conflicting recommendations for pregnancy-related care. The majority of migrant women (83.6%) initiated antenatal care in the first trimester. Several of the challenges were associated with vulnerabilities not directly related to maternal health. CONCLUSION: A combination of individual, structural and institutional barriers hinder recently migrated women in achieving optimal maternal healthcare. Suggested strategies to address the challenges include improved provision of information about healthcare structure to migrant women, increased use of interpreter services, appropriate psychosocial support and strengthening diversity- and intercultural competence training among healthcare personnel.


Assuntos
Pessoal de Saúde/psicologia , Serviços de Saúde Materna/normas , Gestantes/etnologia , Gestantes/psicologia , Cuidado Pré-Natal/normas , Migrantes/psicologia , Adulto , Barreiras de Comunicação , Assistência à Saúde Culturalmente Competente , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Motivação , Noruega/etnologia , Gravidez , Sistemas de Apoio Psicossocial
10.
Acta Obstet Gynecol Scand ; 100(7): 1273-1279, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33524162

RESUMO

INTRODUCTION: Cardiovascular diseases have become increasingly important as a cause of maternal death in the Nordic countries. This is likely to be associated with a rising incidence of pregnant women with congenital and acquired cardiac diseases. Through audits, we aim to prevent future maternal deaths by identifying causes of death and suboptimal factors in the clinical management. MATERIAL AND METHODS: Maternal deaths in the Nordic countries from 2005 to 2017 were identified through linked registers. The national audit groups performed case assessments based on hospital records, classified the cause of death, and evaluated the standards of clinical care provided. Key messages were prepared to improve treatment. RESULTS: We identified 227 maternal deaths, giving a maternal mortality rate of 5.98 deaths per 100 000 live births. The most common cause of death was cardiovascular disease (n = 36 deaths). Aortic dissection/rupture, myocardial disease, and ischemic heart disease were the most common diagnoses. In nearly 60% of the cases, the disease was not recognized before death. In more than half of the deaths, substandard care was identified (59%). In 11 deaths (31%), improvements to care that may have made a difference to the outcome were identified. CONCLUSIONS: Between 2005 and 2017, cardiovascular diseases were the most common causes of maternal deaths in the Nordic countries. There appears to be a clear potential for a further reduction in these maternal deaths. Increased awareness of cardiac symptoms in pregnant women seems warranted.


Assuntos
Doenças Cardiovasculares/mortalidade , Morte Materna/estatística & dados numéricos , Complicações Cardiovasculares na Gravidez/mortalidade , Sistema de Registros , Adulto , Causas de Morte , Feminino , Humanos , Mortalidade Materna , Vigilância da População , Gravidez , Complicações na Gravidez/mortalidade , Países Escandinavos e Nórdicos
11.
Acta Obstet Gynecol Scand ; 100(9): 1611-1619, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33885150

RESUMO

INTRODUCTION: Population-based studies about the consequences of SARS-CoV-2 infection (COVID-19) in pregnancy are few and have limited generalizability to the Nordic population and healthcare systems. MATERIAL AND METHODS: This study examines pregnant women with COVID-19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between 1 March and 30 June 2020 and had a positive SARS-CoV-2 PCR test ≤14 days prior to admission. Cause of admission was classified as obstetric or COVID-19-related. RESULTS: In the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women required hospital care due to COVID-19. The risk of admission due to COVID-19 was 0.4/1000 deliveries in Denmark, Finland and Norway, and 3.8/1000 deliveries in the Swedish regions. Women hospitalized because of COVID-19 were more frequently obese (p < 0.001) and had a migrant background (p < 0.001) compared with the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Among the 56 women admitted due to COVID-19, 48 women delivered 51 infants. Preterm delivery (n = 12, 25%, p < 0.001) and cesarean delivery (n = 21, 43.8%, p < 0.001) were more frequent in women with COVID-19 compared with women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported. CONCLUSIONS: The risk of admission due to COVID-19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the risk of admission due to severe COVID-19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.


Assuntos
COVID-19 , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez , SARS-CoV-2/isolamento & purificação , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/terapia , Causalidade , Cesárea/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Medição de Risco , Países Escandinavos e Nórdicos/epidemiologia
12.
Tidsskr Nor Laegeforen ; 141(2021-15)2021 10 26.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-34726038

RESUMO

BACKGROUND: Seven Norwegian hospitals offer an outpatient service for women who have undergone female genital cutting (FGC). This study presents symptoms, findings and treatment in women who were examined at the outpatient clinics in the period 2004-2015. MATERIAL AND METHOD: Each hospital identified patients by searching for relevant diagnostic and procedure codes. All those who had been examined at the outpatient clinics were included. Data were retrieved from patient records. RESULTS: A total of 913 women were included. The median age at the time of undergoing FGC was seven years, and at the time of consultation, 26 years. Almost half of the women were pregnant. The majority (81 %) had FGC type III (infibulation). Of these, 87 % had gynaecological problems. Of women with types I and II FGC, 55 % and 70 %, respectively, reported gynaecological problems. Altogether 64 % received surgical treatment, primarily deinfibulation (98 %). Few complications were recorded. INTERPRETATION: In many young, non-pregnant infibulated women, FGC-related problems that can be treated with deinfibulation may have been present since childhood and adolescence. There is probably an unmet need for treatment, irrespective of the type of FGM.


Assuntos
Circuncisão Feminina , Adolescente , Criança , Circuncisão Feminina/efeitos adversos , Feminino , Humanos , Noruega/epidemiologia , Gravidez
13.
BMC Pregnancy Childbirth ; 20(1): 321, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32456615

RESUMO

BACKGROUND: The provision of epidural analgesia during labor is ideally a shared decision between the woman and her health care provider. However, immigrant characteristics such as maternal birthplace could affect decision-making and thus access to pain relief. We aimed to assess disparities in the provision of epidural analgesia in planned vaginal birth according to maternal region of birth. METHODS: We performed a nation-wide register study of 842,496 live-born singleton deliveries in Norway between 2000 and 2015. Maternal birthplace was categorized according to the Global Burden of Disease framework. The provision of epidural analgesia was compared in regression models stratified by parity and mode of delivery. RESULTS: Compared to native-born women, primiparous women from Latin America/Caribbean countries with an instrumental vaginal delivery were most likely to be provided epidural analgesia (OR 2.12, 95%CI 1.69-2.66), whilst multiparous women from Sub-Saharan Africa with a spontaneous vaginal delivery were least likely to be provided epidural analgesia (OR 0.42, 95% C 0.39-0.44). Longer residence time was associated with a higher likelihood of being provided analgesia, whereas effects of maternal education varied by Global Burden of Disease group. CONCLUSIONS: Disparities in the likelihood of being provided epidural analgesia were observed by maternal birthplace. Further studies are needed to consider whether the identified disparities represent women's own preferences or if they are the result of heterogeneous access to analgesia during labor.


Assuntos
Analgesia Epidural/estatística & dados numéricos , Analgesia Obstétrica/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Dor do Parto/tratamento farmacológico , Adulto , Parto Obstétrico , Escolaridade , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Trabalho de Parto , Noruega , Paridade , Parto , Gravidez , Adulto Jovem
14.
Am J Obstet Gynecol ; 220(6): 511-526, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30849356

RESUMO

The worldwide incidence of abnormally invasive placenta is rapidly rising, following the trend of increasing cesarean delivery. It is a heterogeneous condition and has a high maternal morbidity and mortality rate, presenting specific intrapartum challenges. Its rarity makes developing individual expertise difficult for the majority of clinicians. The International Society for Abnormally Invasive Placenta aims to improve clinicians' understanding and skills in managing this difficult condition. By pooling knowledge, experience, and expertise gained within a variety of different healthcare systems, the Society seeks to improve the outcomes for women with abnormally invasive placenta globally. The recommendations presented herewith were reached using a modified Delphi technique and are based on the best available evidence. The evidence base for each is presented using a formal grading system. The topics chosen address the most pertinent questions regarding intrapartum management of abnormally invasive placenta with respect to clinically relevant outcomes, including the following: definition of a center of excellence; requirement for antenatal hospitalization; antenatal optimization of hemoglobin; gestational age for delivery; antenatal corticosteroid administration; use of preoperative cystoscopy, ureteric stents, and prophylactic pelvic arterial balloon catheters; maternal position for surgery; type of skin incision; position of the uterine incision; use of interoperative ultrasound; prophylactic administration of oxytocin; optimal method for intraoperative diagnosis; use of expectant management; adjuvant therapies for expectant management; use of local surgical resection; type of hysterectomy; use of delayed hysterectomy; intraoperative measures to treat life-threatening hemorrhage; and fertility after conservative management.


Assuntos
Cesárea , Histerectomia , Placenta Acreta/terapia , Hemorragia Pós-Parto/prevenção & controle , Corticosteroides/uso terapêutico , Tratamento Conservador , Técnica Delphi , Gerenciamento Clínico , Feminino , Idade Gestacional , Hospitalização , Humanos , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Posicionamento do Paciente , Hemorragia Pós-Parto/terapia , Gravidez , Stents , Ureter , Conduta Expectante
15.
Acta Obstet Gynecol Scand ; 98(8): 1024-1031, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30762871

RESUMO

INTRODUCTION: Complete uterine rupture, a rare peripartum complication, is often associated with a catastrophic outcome for both mother and child. However, few studies have investigated large datasets to evaluate maternal outcomes after complete ruptures, particularly in unscarred uteri. This paucity of studies is partly due to the rarity of both the event and the serious outcomes, such as peripartum hysterectomy and maternal death. The incidence of uterine rupture is expected to increase, due to increasing cesarean section rates worldwide. Thus, it is important to have more complete knowledge about the immediate maternal outcome following a complete uterine rupture. The objective was to identify maternal outcomes and their risk factors following complete uterine ruptures. MATERIAL AND METHODS: This was a population-based study using data from the Medical Birth Registry of Norway, the Patient Administration System and medical records. Maternities with complete uterine rupture after start of labor in Norway during 1967-2008 (n = 247 births), identified among 2 209 506 women. Uterine ruptures were identified from both registries and were further studied through a review of medical records. Only complete ruptures were included in analysis. The associations between maternal outcomes and demographic and labor risk factors were estimated. Odds ratios (ORs) were determined with crude logistic regressions for each risk factor. Separate multivariable logistic regressions were performed to calculate adjusted odds ratios and 95% confidence intervals (CIs). RESULTS: We identified 88 (35.6%) healthy mothers, 107 (43.3%) severe postpartum hemorrhages without hysterectomy, 51 (20.6%) peripartum hysterectomies, and three (1.2%) maternal deaths. Peripartum hysterectomy decreased significantly in the last years of study. Unscarred uterine ruptures significantly increased the risk of peripartum hysterectomy compared with scarred uterine ruptures (AOR 2.6, 95% CI 1.3-5.3). Other factors that increased the risk of peripartum hysterectomy following rupture were: maternal age ≥35 years (AOR 2.3, 95% CI 1.1-5.0), parity ≥3 vs parity 1-2 (AOR 2.8, 95% CI 1.2-6.7), and rupture detection after vaginal delivery (AOR 2.2, 95% CI 1.1-4.8). CONCLUSIONS: Unscarred uteri, older maternal age, parity ≥3, and rupture detection after vaginal delivery showed the highest associations with the risk of peripartum hysterectomy after complete uterine rupture.


Assuntos
Histerectomia , Ruptura Uterina/cirurgia , Adulto , Feminino , Humanos , Idade Materna , Noruega , Paridade , Gravidez , Resultado da Gravidez , Sistema de Registros , Fatores de Risco
16.
Am J Obstet Gynecol ; 219(1): 109.e1-109.e8, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29655964

RESUMO

BACKGROUND: Complete uterine rupture is a rare peripartum complication often associated with a catastrophic outcome for both mother and child. However, little has been written based on large data sets about maternal and infant outcome after complete ruptures. This is partly due to the rarity of the event and the serious maternal and infant outcome; it is also partly due to the use of international diagnostic codes that do not differentiate between the less catastrophic partial rupture and more catastrophic complete uterine rupture. As uterine rupture is expected to increase due to increased cesarean delivery rates worldwide, it is important to know more completely about the outcome following complete uterine rupture. OBJECTIVE: We sought to explore risk factors associated with poor infant outcome in cases of complete uterine rupture. STUDY DESIGN: This population-based study used data from the Medical Birth Registry of Norway, the Patient Administration System, and medical records. We included births with complete uterine rupture after start of labor in all maternity units in Norway during the period 1967 through 2008 (n = 244 births), identified among 2,455,797 births. Uterine ruptures were identified and further studied through a review of medical records. We estimated the associations between infant outcomes and demographic and labor risk factors using logistic regression analyses. Odds ratios with 95% confidence intervals for each risk factor were determined after adjustment for demographic factors and period of birth. The main outcome measure was infant outcome: healthy infant, intrapartum/infant deaths, hypoxic ischemic encephalopathy, and admission to the neonatal intensive care unit. RESULTS: We identified 109 (44.7%) healthy infants, 56 (23.0%) infants needing neonatal intensive care unit admission, 64 (26.2%) intrapartum/infant deaths, and 15 (6.1%) infants with hypoxic ischemic encephalopathy. The highest number of intrapartum/infant deaths occurred in 1967 through 1977 (51.6%) and the fewest in 2000 through 2008 (15.0%). Unscarred uterine ruptures did not significantly increase intrapartum/infant deaths compared to scarred uterine ruptures. Placental separation and/or fetal extrusion had the highest odds ratio for intrapartum/infant deaths (odds ratio, 17.9; 95% confidence interval, 7.5-42.4). Time-to-delivery interval <20 minutes resulted in fewest intrapartum/infant deaths (9.9%), although there were 2 deaths at 10-minute interval. Time to delivery >30 minutes vs <20 minutes increased risk of death (odds ratio, 16.7; 95% confidence interval, 6.4-43.5). CONCLUSION: Intrapartum/infant death after complete uterine rupture decreased significantly over the decades. Time to delivery >30 minutes and placental separation and/or fetal extrusion had the highest association with intrapartum/infant deaths after complete uterine rupture. Time to delivery <20 minutes limited the incidence of intrapartum/infant deaths.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Hipóxia-Isquemia Encefálica/epidemiologia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Morte Perinatal , Ruptura Uterina/epidemiologia , Dor Abdominal , Adulto , Bradicardia , Cardiotocografia , Cesárea/estatística & dados numéricos , Pré-Escolar , Cicatriz , Disfunção Cognitiva/epidemiologia , Deficiências do Desenvolvimento/epidemiologia , Epilepsia/epidemiologia , Feminino , Frequência Cardíaca Fetal , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Transtornos do Neurodesenvolvimento/epidemiologia , Noruega , Razão de Chances , Índice de Gravidade de Doença , Taquicardia , Fatores de Tempo , Miomectomia Uterina , Ruptura Uterina/diagnóstico
17.
Acta Obstet Gynecol Scand ; 97(2): 168-179, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29192969

RESUMO

INTRODUCTION: The question of whether universal growth charts can be used in multi-ethnic settings is of general interest. The Intergrowth-21st fetal growth and newborn size standards are suggested to represent optimal fetal growth regardless of country origin. Our aim was to examine whether women fulfilling the strict Intergrowth-21st inclusion criteria were healthier, showed less ethnic differences in fetal growth and newborn size, and less adverse perinatal outcomes. MATERIAL AND METHODS: Data were drawn from a population-based multi-ethnic cohort of 823 presumably healthy pregnant women in Oslo, Norway. We assessed differences in fetal and neonatal gestational age specific z-scores and compared maternal health parameters, pregnancy and birth complications between pregnancies fulfilling and not fulfilling the Intergrowth-21st criteria. RESULTS: Only 21% of pregnancies enrolled in our cohort fulfilled the Intergrowth-21st criteria. Fetal growth deviated substantially from the new standards, in particular for ethnic Europeans. Ethnic differences persisted in pregnancies fulfilling the criteria. In South Asian fetuses, estimated fetal weight was -0.60 SD (95% confidence interval -1.00, -0.20) lower at 24 gestational weeks, and birthweight was -0.62 SD (-0.95, -0.29) lower, compared with ethnic Europeans. Corresponding numbers for Middle-East/North Africans were -0.13 (-0.62, 0.36) and -0.60 (-1.00, -0.20). Maternal health indicators and birth complications were similar in women fulfilling and not fulfilling the criteria, but the relation depended on ethnic origin. CONCLUSIONS: In an urban multi-ethnic Norwegian population, applying an extensive list of criteria to define "healthy" pregnancies excludes the majority of women but does not cancel ethnic differences in fetal growth.


Assuntos
Etnicidade/estatística & dados numéricos , Desenvolvimento Fetal/fisiologia , Gráficos de Crescimento , Ultrassonografia Pré-Natal/normas , Feminino , Idade Gestacional , Humanos , Masculino , Noruega , Gravidez , Padrões de Referência
18.
Acta Obstet Gynecol Scand ; 97(8): 976-987, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29663318

RESUMO

INTRODUCTION: Hypertensive disorders of pregnancy have been the most frequent cause of maternal death in Norway since 1996 and are strongly associated with substandard care. In the UK, the number of maternal deaths due to hypertensive disorders has decreased drastically due to the implementation of updated guidelines, indicating a potential for reducing the number of deaths in other countries as well. Through audits of maternal deaths, we aim to prevent future deaths from hypertensive disorders in pregnancy by identifying suboptimal factors in treatment. MATERIAL AND METHODS: Maternal deaths in Norway from 1996 to 2014 were identified through linked registries. The Norwegian Maternal Mortality Audit Group performed all case assessments included in this study, classified the cause of death, evaluated the treatment, and identified suboptimal factors to care in each case. Emphasis was placed on antihypertensive treatment, timing of delivery, stabilization before delivery, and quality of care. Learning points were prepared to improve the treatment of hypertensive disorders of pregnancy. RESULTS: We identified 74 maternal deaths. The maternal mortality rate was 6.5 deaths per 100 000 live births. The most common cause of death was hypertensive disorders (n = 16 deaths). In 14 of these deaths (87%), the audit group concluded that improvements to care could have made a difference to the outcome. CONCLUSIONS: In 1996-2014, hypertensive disorders were the most common cause of maternal death in Norway. Our study indicates that such deaths can be prevented by improvements in antihypertensive treatment and the timing of delivery.

19.
BMC Pregnancy Childbirth ; 18(1): 323, 2018 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-30089449

RESUMO

BACKGROUND: World Health Organization (WHO) recommends exclusive breastfeeding (EBF) as the optimal way to feed infants below 6 months of age. The benefits of EBF are well documented. However, in Tanzania, EBF is still rarely practised. This study explored the knowledge, attitudes and practises of EBF among mothers in Kilimanjaro region of northern Tanzania. METHODS: This is a qualitative research study. The three districts in Kilimanjaro region namely Same, Moshi Municipal Council and Rombo districts were selected. In each district, three focus group discussions (FGDs) with mothers of infants aged 0-12 months were conducted. A total of 78 mothers participated in the focus group discussion. RESULTS: The main result is that most of the mothers had a theoretical knowledge of the benefits of EBF but were not able to practise this knowledge for a range of reasons. The reasons for not practising EBF in real life included poor maternal nutrition, the pressure for women to return to work, inadequate knowledge about expressing breast milk, and perceived insufficiency of milk supply. Additionally, mothers received conflicting advice from a range of sources including close relatives, community members and health care providers, and they often choose the advice of their elders. Mothers also offered suggestions on ways to improve EBF including educating the community on the benefits of EBF. CONCLUSION: The results show that the women need support from close relatives and employers to successfully practise EBF. This presents a need for involving close relatives in EBF interventions, as they are important sources of breastfeeding information in the community. Additionally, behavioural interventions that promote optimal breastfeeding practises might help to improve exclusive breastfeeding.


Assuntos
Aleitamento Materno , Extração de Leite , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Feminino , Grupos Focais , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Estado Nutricional , Pesquisa Qualitativa , Retorno ao Trabalho , Tanzânia , Adulto Jovem
20.
Int J Cancer ; 141(9): 1763-1770, 2017 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-28685818

RESUMO

The association between use of menopausal hormone therapy (HT) and occurrence of skin malignant melanoma (SMM) is controversial. We investigated the issue in a nationwide cohort of 684,696 Norwegian women, aged 45-79 years, followed from 2004 to 2008. The study was based on linkage between Norwegian population registries. Multivariable Poisson regression models were used to estimate the effect of HT use, different HT types, routes of administration and doses of estrogen and progestin on the risk of SMM. During the median follow-up of 4.8 years, 178,307 (26%) women used HT, and 1,476 incident SMM cases were identified. Current use of HT was associated with increased risk of SMM (rate ratios (RR) = 1.19; 95% confidence interval (CI) 1.03-1.37). Plain estrogen therapy was associated with an increased risk of SMM (RR 1.45; 95% CI 1.21-1.73), both for oral (RR 1.45; 95% CI 1.09-1.93) and vaginal (RR 1.44; 95% CI 1.14-1.84) formulations, while combined estrogen and progestin therapy (EPT) was not (RR 0.91; 95% CI 0.70-1.19). We performed a dose-response analysis of estrogen and progestin in women using tablets, and found that use of estrogens was associated with increased risk (RR 1.24; 95% CI 1.00-1.53 per 1 mg/day) and use of progestins with decreased risk (RR 0.71; 95% CI 0.57-0.89 per 10 mg/month) of SMM. In conclusion, estrogens were associated with increased risk of SMM, while combinations of estrogens and progestins were not. Our results suggest that estrogens and progestins might affect the risk of SMM in opposite ways.


Assuntos
Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Melanoma/epidemiologia , Progestinas/efeitos adversos , Idoso , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Melanoma/induzido quimicamente , Melanoma/patologia , Menopausa/efeitos dos fármacos , Pessoa de Meia-Idade , Fatores de Risco
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