Maternal height and risk of caesarean section in singleton births in Sweden-A population-based study using data from the Swedish Pregnancy Register 2011 to 2016.

Caesarean section (CS) has short and long term adverse health consequences, and should therefore only be undertaken when necessary. Risk factors such as maternal age, maternal body mass index (BMI) and fetal weight have been extensively investigated in relation to CS, but the significance of maternal height has been less explored in Sweden. The aim was to investigate the significance of maternal height on risk of CS in a representative, population-based sample from Sweden, also taking into account confounders. Data on singleton births in the Swedish Pregnancy Register 2011 to 2016 were collected, including women with heights of 140 cm and above, constituting a sample of 581,844 women. Data were analysed with epidemiological and biostatistical methods. Mean height was 166.1 cm. Women born outside Sweden were significantly shorter than women born in Sweden (162.8 cm vs. 167.1 cm, p<0.001). There was a decreasing risk of CS with increasing maternal height. This effect remained after adjustment for other risk factors for CS such as maternal age, BMI, gestational age, parity, high birth weight and country of birth. Frequency of CS was higher among women born outside Sweden compared with Swedish-born women (17.3% vs. 16.0%), however, in a multiple regression model country of birth outside Sweden diminished as a risk factor for CS. Maternal height of 178-179 cm was associated with the lowest risk of CS (OR = 0.76, CI95% 0.71-0.81), whereas height below 160 cm explained 7% of CS cases. BMI and maternal age are established factors involved in clinical assessments related to birth, and maternal height should increasingly enjoy a similar status in these considerations. Moreover, when healthcare professionals are counselling pregnant women, taller stature should be more emphasized as a positive indicator for successful vaginal birth to increase pregnant women's confidence in giving birth vaginally, with possible positive impacts for lowering CS rates.

High weight gain during pregnancy increases the risk for emergency caesarean section - Population-based data from the Swedish Maternal Health Care Register 2011-2012.

OBJECTIVE: The aim was to investigate maternal background factors' significance in relation to risk of elective and emergency caesarean sections (CS) in Sweden. STUDY DESIGN: Population-based, retrospective, cross-sectional study. The Swedish Maternal Health Care Register (MHCR) is a national quality register that collects data on pregnancy, delivery and postpartum period. All women registered in MHCR 2011 to 2012 were included in the study sample (N = 178,716). MAIN OUTCOMES: The risk of elective and emergency caesarean section in relation to age, parity, education, country of origin, weight in early pregnancy and weight gain during pregnancy was calculated in logistic regression models. RESULTS: Multiparous women demonstrated a doubled risk of elective CS compared to primiparous women, but their risk for emergency CS was halved. Overweight and obesity at enrolment in antenatal care increased the risk for emergency CS, irrespective of parity. Weight gain above recommended international levels (Institute of Medicine, IOM) during pregnancy increased the risk for emergency CS for women with normal weight, overweight or obesity. CONCLUSION: There is a need of national guidelines on recommended weight gain during pregnancy in Sweden. We suggest that the usefulness of the IOM guidelines for weight gain during pregnancy should be evaluated in the Swedish context.

User perspectives on the Swedish Maternal Health Care Register.

BACKGROUND: Established in 1999, the Swedish Maternal Health Care Register (MHCR) collects data on pregnancy, birth, and the postpartum period for most pregnant women in Sweden. Antenatal care (ANC) midwives manually enter data into the Web-application that is designed for MHCR. The aim of this study was to investigate midwives' experiences, opinions and use of the MHCR. METHOD: A national, cross-sectional, questionnaire survey, addressing all Swedish midwives working in ANC, was conducted January to March 2012. The questionnaire included demographic data, preformed statements with six response options ranging from zero to five (0 = totally disagree and 5 = totally agree), and opportunities to add information or further clarification in the form of free text comments. Parametric and non-parametric methods and logistic regression analyses were applied, and content analysis was used for free text comments. RESULTS: The estimated response rate was 53.1%. Most participants were positive towards the Web-application and the included variables in the MHCR. Midwives exclusively engaged in patient-related work tasks perceived the register as burdensome (70.3%) and 44.2% questioned the benefit of the register. The corresponding figures for midwives also engaged in administrative supervision were 37.8% and 18.5%, respectively. Direct electronic transfer of data from the medical records to the MHCR was emphasised as significant future improvement. In addition, the midwives suggested that new variables of interest should be included in the MHCR - e.g., infertility, outcomes of previous pregnancy and birth, and complications of the index pregnancy. CONCLUSIONS: In general, the MHCR was valued positively, although perceived as burdensome. Direct electronic transfer of data from the medical records to the MHCR is a prioritized issue to facilitate the working situation for midwives. Finally, the data suggest that the MHCR is an underused source for operational planning and quality assessment in local ANC centres.

Internal validity of the Swedish Maternal Health Care Register.

BACKGROUND: The Swedish Maternal Health Care Register (MHCR) is a national quality register that has been collecting pregnancy, delivery, and postpartum data since 1999. A substantial revision of the MHCR resulted in a Web-based version of the register in 2010. Although MHCR provides data for health care services and research, the validity of the MHCR data has not been evaluated. This study investigated degree of coverage and internal validity of specific variables in the MHCR and identified possible systematic errors. METHODS: This cross-sectional observational study compared pregnancy and delivery data in medical records with corresponding data in the MHCR. The medical record was considered the gold standard. The medical records from nine Swedish hospitals were selected for data extraction. This study compared data from 878 women registered in both medical records and in the MHCR. To evaluate the quality of the initial data extraction, a second data extraction of 150 medical records was performed. Statistical analyses were performed for degree of coverage, agreement and correlation of data, and sensitivity and specificity. RESULTS: Degree of coverage of specified variables in the MHCR varied from 90.0% to 100%. Identical information in both medical records and the MHCR ranged from 71.4% to 99.7%. For more than half of the investigated variables, 95% or more of the information was identical. Sensitivity and specificity were analysed for binary variables. Probable systematic errors were identified for two variables. CONCLUSIONS: When comparing data from medical records and data registered in the MHCR, most variables in the MHCR demonstrated good to very good degree of coverage, agreement, and internal validity. Hence, data from the MHCR may be regarded as reliable for research as well as for evaluating, planning, and decision-making with respect to Swedish maternal health care services.

Gendered patterns of high violence exposure among Swedish youth.

OBJECTIVE: The WHO describes violence as a global public health problem. In contrast to domestic violence, violence against youth has been little explored. Our aims were to investigate the prevalence and gender differences in relation to emotional, physical and sexual abuse among young men and women attending youth health centers in Sweden, the current adverse effects of the abuse and the perpetrators of the abuse. DESIGN: Cross-sectional study. SETTING: Nationally representative youth health centers in Sweden. POPULATION AND METHODS: In total, 2,250 women and 920 men aged 15-23 years answered a validated questionnaire about emotional, physical and sexual abuse. RESULTS: A total of 33% (CI: 31-35) of the young women and 18% (CI: 16-21) of the young men had been exposed to emotional abuse during the past year. For physical abuse, 18% (CI: 17-20) of the women and 27% (CI: 24-30) of the men stated that they had been abused during the past year. The gender differences for sexual abuse were pronounced, with 14% (CI: 12-15) of the young women and 4.7% (CI: 3.3-6.0) of the men stating that they had been abused during the past 12 months. The young women reported more severe adverse effects from all types of abuse and were more often abused by a person close to them. CONCLUSIONS: The exposure to violence among young people is alarming and presents prominent gender differences, and should be taken into serious consideration as it is a matter of health, democracy and human rights.

Self-reported reproductive outcome and implications in relation to use of care in women in rural Zimbabwe.

BACKGROUND: In order to assess morbidity and health care utilization in developing countries, health interview surveys are often used. The aim of this paper is to explore morbidity, health care utilization during pregnancy and pregnancy outcome as reported by women in rural Gutu district, Zimbabwe. METHODS: The study was cross-sectional, performed 1992-93 in 12 villages selected at random. Women aged 15-44 years (n = 1213) were interviewed concerning their reproductive history, use of maternity care and complications during pregnancy/labor during their latest pregnancy. RESULTS: The perinatal mortality rate (PMR) for all the completed pregnancies (889 women had completed 3601 pregnancies) was 23/1000 total births. The attendance rate for antenatal care was high (94%). Elevated blood pressure was the most commonly reported late pregnancy complication, and a prolonged labor, i.e. 24 h or more, the most common complication during delivery. Out of women whose latest pregnancy did not end in an early or late abortion (n = 831) the cesarean section rate was 6.3%. The PMR was 8.4/1000 for their latest pregnancy. Institutional deliveries were preferred by the majority of women, with hospital and clinic deliveries constituting 58% and 27% of deliveries, respectively, while 15% delivered at home. Long-term complications were few, and only 14 (1.6%) women reported a current health problem, which they related to previous pregnancies. CONCLUSIONS: Antenatal attendance rate was high. The majority of women preferred institutional deliveries. Few women reported complications, which were not taken care of in the health service. Long-term complications related to previous pregnancies were few.