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1.
JAMA Netw Open ; 2(3): e190858, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901042

RESUMO

Importance: Neonatal hyperbilirubinemia can cause lifelong neurodevelopmental impairment (kernicterus) even in high-resource settings. A better understanding of the incidence and processes leading to kernicterus may help in the design of preventive measures. Objectives: To determine incidence rates of hazardous hyperbilirubinemia and kernicterus among near-term to term newborns and to evaluate health care professional adherence to best practices. Design, Setting, and Participants: This population-based nationwide cohort study used prospectively collected data on the highest serum bilirubin level for all infants born alive at 35 weeks' gestation or longer and admitted to neonatal care at all 46 delivery and 37 neonatal units in Sweden from 2008 to 2016. Medical records for newborns with hazardous hyperbilirubinemia were evaluated for best neonatal practices and for a diagnosis of kernicterus up to 2 years of age. Data analyses were performed between September 2017 and February 2018. Exposures: Extreme (serum bilirubin levels, 25.0-29.9 mg/dL [425-509 µmol/L]) and hazardous (serum bilirubin levels, ≥30.0 mg/dL [≥510 µmol/L]) neonatal hyperbilirubinemia. Main Outcomes and Measures: The primary outcome was kernicterus, defined as hazardous neonatal hyperbilirubinemia followed by cerebral palsy, sensorineural hearing loss, gaze paralysis, or neurodevelopmental retardation. Secondary outcomes were health care professional adherence to national guidelines using a predefined protocol with 10 key performance indicators for diagnosis and treatment as well as assessment of whether bilirubin-associated brain damage might have been avoidable. Results: Among 992 378 live-born infants (958 051 term births and 34 327 near-term births), 494 (320 boys; mean [SD] birth weight, 3505 [527] g) developed extreme hyperbilirubinemia (50 per 100 000 infants), 6.8 per 100 000 infants developed hazardous hyperbilirubinemia, and 1.3 per 100 000 infants developed kernicterus. Among 13 children developing kernicterus, brain injury was assessed as potentially avoidable for 11 children based on the presence of 1 or several of the following possible causes: untimely or lack of predischarge bilirubin screening (n = 6), misinterpretation of bilirubin values (n = 2), untimely or delayed initiation of treatment with intensive phototherapy (n = 1), untimely or no treatment with exchange transfusion (n = 6), or lack of repeated exchange transfusions despite indication (n = 1). Conclusions and Relevance: Hazardous hyperbilirubinemia in near-term or term newborns still occurs in Sweden and was associated with disabling brain damage in 13 per million births. For most of these cases, health care professional noncompliance with best practices was identified, suggesting that a substantial proportion of these cases might have been avoided.


Assuntos
Hiperbilirrubinemia Neonatal , Kernicterus , Feminino , Fidelidade a Diretrizes , Humanos , Hiperbilirrubinemia Neonatal/diagnóstico , Hiperbilirrubinemia Neonatal/epidemiologia , Hiperbilirrubinemia Neonatal/terapia , Recém-Nascido , Kernicterus/diagnóstico , Kernicterus/epidemiologia , Kernicterus/terapia , Masculino , Estudos Prospectivos , Suécia
2.
Acta Obstet Gynecol Scand ; 98(4): 523-532, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30578529

RESUMO

INTRODUCTION: The association between vacuum extraction and intracranial hemorrhage has been debated. We sought to investigate the impact of protracted vacuum extraction on the risk for neonatal intracranial hemorrhage in term infants. MATERIAL AND METHODS: This nationwide case-control study covered Swedish maternity wards from 1999 to 2013. All term, live-born infants diagnosed with neonatal intracranial hemorrhage after vacuum-assisted delivery were included as cases (n = 167). For each case, 3 vacuum-delivered controls, without a diagnosis for intracranial hemorrhage, were selected (n = 546 controls). Conditional logistic regression analysis was used to study the association between protracted extraction (defined as vacuum duration > 15 min, > 6 pulls or > 2 cup detachments), and neonatal intracranial hemorrhage. RESULTS: Extractions exceeded 15 min among 33% of the cases, vs 5% of the controls. More than six pulls were used in 25% of the cases and in 4% of the controls, and more than two cup detachments occurred in 3.6% of the cases and in 0.6% of the controls. Compared with extractions adhering to safety recommendations, the odds for intracranial hemorrhage were nine-fold (OR 8.91, 95%, CI 5.22-15.20) among infants exposed to a protracted extraction. After adjustments for potential confounders, the OR decreased to 8.04 (95% CI 4.49-14.38). CONCLUSIONS: The strong association between protracted extraction and intracranial hemorrhage suggests that adherence to safety recommendations may reduce the risk for intracranial hemorrhage in infants delivered by vacuum extraction. However, safe limits for vacuum duration and number of pulls are still unknown and intracranial hemorrhage may occur even when performed in accordance with safety recommendations.


Assuntos
Hemorragias Intracranianas/etiologia , Nascimento a Termo , Vácuo-Extração/efeitos adversos , Adulto , Índice de Apgar , Traumatismos do Nascimento/etiologia , Peso ao Nascer , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Hemorragias Intracranianas/epidemiologia , Gravidez , Fatores de Risco , Suécia , Vácuo-Extração/estatística & dados numéricos
3.
J Matern Fetal Neonatal Med ; 31(18): 2402-2408, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28629251

RESUMO

OBJECTIVE: To investigate the association between complicated vacuum extraction (VE) deliveries and neonatal complications. METHODS: Observational study including data on the management of 596 consecutive VE-deliveries at 6 different birth clinics in Sweden in 2013. We used logistic regression to examine the association between a complicated VE and: extracranial bleeding, severe neonatal complication (intracranial hemorrhage and/or asphyxia/low Apgar score and/or convulsions, and/or encephalopathy), and brachial plexus injury. VE was considered complicated if duration exceeded 15 min, and/or more than six pulls were used, and/or more than one cup detachment occurred. Uncomplicated VE served as the reference group. RESULTS: Ten percent of the infants were diagnosed with at least one of the investigated complications. Cephalohematoma occurred in 5.2% of the infants and 1.5% had a subgaleal hematoma. Altogether 24 (4.0%) infants were diagnosed with a severe complication; low Apgar score, neonatal convulsions, encephalopathy or intracranial hemorrhages. Brachial plexus injury occurred in eight (1.3%) infants. The crude odds ratio for extracranial hemorrhages was 2.6 (95% CI 1.17-5.77), 4.07 (1.67-9.92) for severe neonatal complications, and 4.63 (1.08-19.76) for brachial plexus injury. CONCLUSIONS: Extraction time >15 min, >6 pulls and >1 cup detachment is associated with increased risk of neonatal complications. These results support compliance with guidelines and recommendations for VE deliveries.


Assuntos
Traumatismos do Nascimento/epidemiologia , Traumatismos do Nascimento/etiologia , Vácuo-Extração/efeitos adversos , Vácuo-Extração/estatística & dados numéricos , Adulto , Índice de Apgar , Encefalopatias/epidemiologia , Encefalopatias/etiologia , Feminino , Humanos , Recém-Nascido , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/etiologia , Masculino , Gravidez , Fatores de Risco , Convulsões/epidemiologia , Convulsões/etiologia , Suécia/epidemiologia , Adulto Jovem
4.
BMC Pregnancy Childbirth ; 17(1): 306, 2017 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-28915858

RESUMO

BACKGROUND: Obstetric anal sphincter injury (OASI) is a rare but serious outcome of vaginal birth. Based on concerns about the increasing number of women who commence childbearing later than previous generation, this study aimed at investigating age-related risk of OASI in women of different parity. METHODS: A population-based register study including 959,559 live singleton vaginal births recorded in the Swedish Medical Birth Register 1999 to 2011. In each parity group risks of OASI at age 25-29 years, 30-34 years, and ≥35 years compared with age < 25 years were investigated by logistic regression analyses, adjusted for year of birth, education, region of birth, smoking, Body Mass Index, infant birthweight and fetal presentation; and in parous women, history of OASI and cesarean section. Additional analyses also adjusted for mediating factors, such as epidural analgesia, episiotomy, and instrumental delivery, and maternal age-related morbidity. RESULTS: Rates of OASI were 6.6%, 2.3% and 0.9% in first, second and third births respectively. Age-related risk increased from 25-29 years in first births (Adjusted OR 1.66; 95% CI 1.59-1.72) and second births (Adjusted OR 1.78; 95% CI 1.58-2.01), and from 30-34 years in third births (Adjusted OR 1.60; 95% CI 1.00-2.56). In all parity groups the risk was doubled at age ≥ 35 years, compared with the respective reference group of women under 25 years. Adding mediating factors and maternal age-related morbidity only marginally reduced these risk estimates. CONCLUSION: Maternal age is an independent risk factor for OASI in first, second and third births. Although age-related risks by parity are relatively similar, more nulliparous than parous women will be exposed to OASI due to the higher baseline rate.


Assuntos
Canal Anal/lesões , Parto Obstétrico/efeitos adversos , Lacerações/epidemiologia , Idade Materna , Complicações do Trabalho de Parto/epidemiologia , Paridade , Sistema de Registros , Adulto , Analgesia Epidural , Analgesia Obstétrica , Peso ao Nascer , Índice de Massa Corporal , Cesárea , Episiotomia , Feminino , Humanos , Apresentação no Trabalho de Parto , Modelos Logísticos , Gravidez , Fatores de Risco , Suécia/epidemiologia , Adulto Jovem
5.
Acta Obstet Gynecol Scand ; 96(9): 1063-1069, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28498626

RESUMO

INTRODUCTION: Advanced maternal age is associated with labor dystocia (LD) in nulliparous women. This study investigates the age-related risk of LD in first, second and third births. MATERIAL AND METHODS: All live singleton cephalic births at term (≥ 37 gestational weeks) recorded in the Swedish Medical Birth Register from 1999 to 2011, except elective cesarean sections and fourth births and more, in total 998 675 pregnancies, were included in the study. LD was defined by International Classification of Diseases, version 10 codes (O620, O621, O622, O629, O630, O631 and O639). In each parity group risks of LD at age 25-29 years, 30-34 years, 35-39 years and ≥ 40 years compared with age < 25 years were investigated by logistic regression analyses. Analyses were adjusted for year of delivery, education, country/region of birth, smoking in early pregnancy, maternal height, body mass index, week of gestation, fetal presentation and infant birthweight. RESULTS: Rates of LD were 22.5%, 6.1% and 4% in first, second and third births, respectively. Adjusted odd ratios (OR) for LD increased progressively from the youngest to the oldest age group, irrespective of parity. At age 35-39 years the adjusted OR (95% CI) was approximately doubled compared with age 25 and younger: 2.13 (2.06-2.20) in first birth; 2.05 (1.91-2.19) in second births; and 1.81 (1.49-2.21) in third births. CONCLUSIONS: Maternal age is an independent risk factor for LD in first, second and third births. Although age-related risks by parity are relatively similar, more nulliparous than parous women will be exposed to LD due to the higher rate.


Assuntos
Distocia/epidemiologia , Idade Materna , Paridade , Adulto , Fatores Etários , Distocia/etiologia , Feminino , Humanos , Gravidez , Sistema de Registros , Fatores de Risco , Suécia/epidemiologia , Adulto Jovem
7.
Acta Obstet Gynecol Scand ; 95(10): 1089-96, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27472147

RESUMO

INTRODUCTION: High birthweight is associated with complicated childbirth. The aim of the present study was to investigate the association between birthweight, mode of delivery, and neonatal complications among infants born at term with a birthweight ≥3000 g. MATERIAL AND METHODS: This population-based cohort study used data from the Swedish Medical Birth Register from 1999 to 2012, including 1 030 775 births at >36 completed weeks. Exposure was mode of delivery, categorized into non-instrumental vaginal delivery (VD), emergency cesarean section (CS), vacuum extraction (VE) or cesarean section following attempted vacuum extraction (VE + CS), and birthweight was divided into five categories (3000-3999 g, 4000-4499 g, 4500-4999 g, and ≥5000 g). The following outcomes were assessed: 5-min Apgar score <7, neonatal convulsions, intracranial hemorrhage, and brachial plexus injury. Infants born after VD with a birthweight of 3000-3999 g were used as reference in the logistic regression analysis. RESULTS: The odds ratios for all complications increased at higher birthweights among infants born after VE/VE + CS and VD. The highest risks were seen after VE/VE + CS with an adjusted odds ratio for neonatal convulsions of 2.6 (95% CI 2.1-3.2) in the reference birthweight group and 6.3 (95% CI 4.3-9.2) among infants with a birthweight of ≥4500 g. The corresponding adjusted odds ratios for intracranial hemorrhage were 2.6 (95% CI 1.7-3.9) and 6.7 (95% CI 3.3-13.6) and for brachial plexus injury 4.0 (95% CI 3.3-4.9) and 88.4 (95% CI 71.9-108.4). CONCLUSION: Vacuum extraction is a risk factor for serious neonatal complications, in particular when used in macrosomic fetuses.


Assuntos
Traumatismos do Nascimento/epidemiologia , Macrossomia Fetal/cirurgia , Complicações do Trabalho de Parto/prevenção & controle , Vácuo-Extração/estatística & dados numéricos , Índice de Apgar , Cesárea/estatística & dados numéricos , Estudos de Coortes , Feminino , Macrossomia Fetal/epidemiologia , Humanos , Recém-Nascido , Gravidez , Sistema de Registros , Fatores de Risco , Suécia/epidemiologia
8.
Sex Reprod Healthc ; 8: 94-9, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27179384

RESUMO

OBJECTIVE: The aim of this observational study was to describe the obstetric management in vacuum extraction (VE) deliveries and to compare these findings to instructions in clinical guidelines on VE. METHODS: In 2013, detailed data on management of 600 VE cases were consecutively collected from six different delivery units in Sweden. Each unit also contributed their own clinical VE guideline. RESULTS: In total, 93% of the VEs ended with a vaginal delivery while 7% failed and were converted to an emergency cesarean section. In 2.3% extraction time exceeded 20 minutes, and in 6% more than six pulls were used to deliver the fetus. Cup detachment occurred in 14.6%, and fundal pressure was used in 11% of the deliveries. In 2.3%, fetal station was assessed as above the level of the maternal ischial spines. The clinical guidelines on VE varied in scope and content between units, and were often incomplete according to best practice. CONCLUSION: The vast majority of the VEs were conducted in accordance with safety recommendations. However, in a few extractions, safety rules were disregarded and more than six pulls or an extraction time of more than 20 minutes were used to complete the delivery.


Assuntos
Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Vácuo-Extração/normas , Cesárea , Parto Obstétrico/métodos , Emergências , Falha de Equipamento , Feminino , Humanos , Segurança do Paciente , Gravidez , Pressão , Suécia , Vácuo , Vagina
9.
Birth ; 43(2): 125-33, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26776817

RESUMO

BACKGROUND: Previous studies show contradictory results about the impact of induced labor on the cesarean delivery rate and few studies have investigated the risk of vacuum extraction subsequent to induced labor. The aims of the present study were to describe the rate of induced labor in Sweden from 1999 to 2012, and to assess the risk of unplanned cesarean delivery and vacuum extraction after induced labor in relation to medical complications and length of gestation. METHODS: A register-based cohort study was conducted, including 1,078,536 women with spontaneous or induced onset of labor who gave birth by noninstrumental vaginal delivery, unplanned cesarean delivery, or vacuum extraction in gestational week 37 + 0 to 41 + 6. Logistic regression was used to study the association between induced labor and instrumental delivery. RESULTS: The rate of induced labor increased from 7.7 to 12.9 percent among primiparous and from 7.5 to 11.8 percent among multiparous women. Induced labor was associated with 2-3 times greater risk of unplanned cesarean delivery among all women, except multiparas in gestational week 37-38, and with a 20-50 percent higher risk of vacuum extraction after the adjustment for confounding factors. Among women without a recognized medical complication, induced labor was associated with a threefold increased risk of cesarean delivery in gestational week 39-41 and a 40 percent increase in gestational week 37-38 compared with women with spontaneous onset of labor. CONCLUSIONS: The proportion of induced labors increased substantially during the 14-year study period and was associated with an increased risk of both cesarean delivery and vacuum extraction, even in women without a documented medical complication. The increased risk of instrumental delivery should be taken into account when counseling about the risks and benefits of induced labor.


Assuntos
Cesárea/estatística & dados numéricos , Trabalho de Parto Induzido/tendências , Complicações na Gravidez/epidemiologia , Vácuo-Extração/efeitos adversos , Adolescente , Adulto , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Início do Trabalho de Parto , Modelos Logísticos , Idade Materna , Pessoa de Meia-Idade , Gravidez , Sistema de Registros , Suécia/epidemiologia , Adulto Jovem
10.
J Matern Fetal Neonatal Med ; 29(10): 1646-51, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26135756

RESUMO

OBJECTIVE: The aims of the present study were to investigate risk factors for failed vacuum extraction (VE), and to compare neonatal complications among infants delivered by failed VE with those delivered by successful VE. METHODS: Population-based study including all women (and their newborn infants) with singleton pregnancy who gave birth at term by failed VE (n = 4747) or successful VE (n = 83 671) in Sweden between 1999 and 2010. Failed VE was defined as VE followed by an emergency cesarean section (ECS), forceps, or both forceps and ECS. We used logistic regression to examine the association between failed VE in relation to intracranial hemorrhage, subgaleal hemorrhage, Apgar scores <7 at 5 min, and neonatal convulsions. RESULTS: Risk factors for failed VE included occipito posterior position, mid-pelvic fetal station, high birth weight, short maternal stature, epidural analgesia, and induction of labor. Compared with infants born after a successful VE, those delivered by failed VE had a higher risk of subgaleal hemorrhage OR 7.3 CI (5.5-9.7), convulsions OR 1.9 CI (1.4-2.7), and low Apgar OR 2.6 CI (2.3-3.0), but not of ICH. CONCLUSION: Failed VE is associated with neonatal complications. Fetal head position and station should be carefully assessed prior to the extraction.


Assuntos
Traumatismos do Nascimento/etiologia , Vácuo-Extração/efeitos adversos , Adulto , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Gravidez , Fatores de Risco , Falha de Tratamento , Vácuo-Extração/estatística & dados numéricos , Adulto Jovem
11.
Pediatrics ; 136(6): 1087-94, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26553185

RESUMO

BACKGROUND: Before hospital discharge, newborn infants should be assessed for the risk of excessive hyperbilirubinemia. We determined maternal and obstetric risk factors for hyperbilirubinemia in infants born at term (gestational age ≥37 weeks) to form an individualized risk assessment tool for clinical use. METHODS: This was a population-based study with data from the Swedish Medical Birth Register from 1999 to 2012, including 1,261,948 singleton infants. Outcome was defined as infants diagnosed with hyperbilirubinemia (N = 23,711), excluding all cases of hemolytic (immune-mediated or other specified hemolytic) diseases of the newborn. RESULTS: Risk factors with an adjusted odds ratio (aOR) for neonatal hyperbilirubinemia of ≥1.5 (medium-sized effect or more) were gestational age 37 to 38 weeks (aOR = 2.83), failed vacuum extraction (aOR = 2.79), vacuum extraction (aOR = 2.22), Asian mother (aOR = 2.09), primipara (aOR = 2.06), large-for-gestational-age infant (aOR = 1.84), obese mother (aOR = 1.83), and small-for-gestational-age infant (aOR = 1.66). Planned cesarean delivery (CD) was associated with a reduced risk (aOR = 0.45). Without any of these risk factors (normal birth weight infant delivered vaginally at 39 to 41 weeks' gestation by a non-Asian, nonobese, multiparous mother) the rate of nonhemolytic neonatal hyperbilirubinemia was 0.7%. In relation to the combined load of different risk factors, rates of neonatal hyperbilirubinemia ranged from 0.2% to 25%. CONCLUSIONS: Collection of a few easily available maternal and obstetric risk factors predicts >100-fold variation in the incidence of neonatal hyperbilirubinemia. The information provided herein enables individualized risk prediction with interactions between different risk factors taken into account.


Assuntos
Hiperbilirrubinemia Neonatal/diagnóstico , Adulto , Feminino , Humanos , Hiperbilirrubinemia Neonatal/etiologia , Incidência , Recém-Nascido , Masculino , Mães , Gravidez , Complicações na Gravidez , Sistema de Registros , Medição de Risco , Fatores de Risco , Suécia
12.
Sex Reprod Healthc ; 6(3): 164-8, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26842640

RESUMO

OBJECTIVE: To explore fathers' experiences of a birth by vacuum extraction (VE). METHOD: A qualitative interview study with 10 fathers analysed with qualitative content analysis. FINDINGS: The theme 'affected but helpless' refers to the father's role changing when childbirth terminates with a VE. From initially being involved in the delivery, his role switches to being merely an observer at the mercy of the professionals' knowledge and guidance. The VE procedure evoked concerns over the mother's and the child's safety and wellbeing, even if the fathers wanted the birth process to be over. The fathers considered the choice of conducting a VE as an adequate alternative, but they expressed concerns about consequences on future decisions. The theme encompasses all the main categories: wish to be involved, anxious observer, turbulent feelings and thoughts about consequences. CONCLUSIONS: VE delivery has a strong emotional impact on fathers and the procedure is often experienced as a dramatic way to end a birth and an ultimate way to terminate a long birth process. The results indicate that a lack of support and of a genuine opportunity to participate, as well as the mother's pain impair their experience, not the VE delivery, per se.


Assuntos
Emoções , Pai/psicologia , Parto/psicologia , Vácuo-Extração/psicologia , Adulto , Idoso , Ansiedade/etiologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Papel (figurativo)
13.
BMC Pregnancy Childbirth ; 14: 42, 2014 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-24450413

RESUMO

BACKGROUND: Very few studies have investigated the neonatal outcomes after vacuum extraction delivery (VE) in the preterm period and the results of these studies are inconclusive. The objective of this study was to describe the use of VE for preterm delivery in Sweden and to compare rates of neonatal complications after preterm delivery by VE to those found after cesarean section during labor (CS) or unassisted vaginal delivery (VD). METHODS: Data was obtained from Swedish national registers. In a population-based cohort from 1999 to 2010, all live-born, singleton preterm infants in a non-breech presentation at birth, born after onset of labor (either spontaneously, by induction, or by rupture of membranes) by VD, CS, or VE were included, leaving a study population of 40,764 infants. Logistic regression analyses were used to calculate adjusted odds ratios (AOR), using unassisted vaginal delivery as reference group. RESULTS: VE was used in 5.7% of the preterm deliveries, with lower rates in earlier gestations. Overall, intracranial hemorrhage (ICH) occurred in 1.51%, extracranial hemorrhage (ECH) in 0.64%, and brachial plexus injury in 0.13% of infants. Infants delivered by VE had higher risks for ICH (AOR = 1.84 (95% CI: 1.09-3.12)), ECH (AOR = 4.48 (95% CI: 2.84-7.07)) and brachial plexus injury (AOR = 6.21 (95% CI: 2.22-17.4)), while infants delivered by CS during labor had no increased risk for these complications, as compared to VD. CONCLUSION: While rates of neonatal complications after VE are generally low, higher odds ratios for intra- and extracranial hemorrhages and brachial plexus injuries after VE, compared with other modes of delivery, support a continued cautious use of VE for preterm delivery.


Assuntos
Traumatismos do Nascimento/epidemiologia , Cesárea/estatística & dados numéricos , Hemorragia Intracraniana Traumática/epidemiologia , Parto , Nascimento Prematuro/epidemiologia , Vácuo-Extração/estatística & dados numéricos , Adulto , Plexo Braquial/lesões , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Trabalho de Parto , Gravidez , Sistema de Registros , Couro Cabeludo/lesões , Convulsões/epidemiologia , Suécia/epidemiologia , Adulto Jovem
14.
BMC Pregnancy Childbirth ; 14: 36, 2014 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-24444326

RESUMO

BACKGROUND: Few studies have focused on cerebral complications among newborn infants delivered by vacuum extraction (VE). The aim of this study was to determine the risk for intracranial haemorrhage and/or cerebral dysfunction in newborn infants delivered by VE and to compare this risk with that after cesarean section in labour (CS) and spontaneous vaginal delivery, respectively. METHODS: Data was obtained from Swedish national registers. In a population-based cohort from 1999 to 2010 including all singleton newborn infants delivered at term after onset of labour by VE (n = 87,150), CS (75,216) or spontaneous vaginal delivery (n = 851,347), we compared the odds for neonatal intracranial haemorrhage, traumatic or non-traumatic, convulsions or encephalopathy. Logistic regressions were used to calculate adjusted (for major risk factors and indication) odds ratios (AOR), using spontaneous vaginal delivery as reference group. RESULTS: The rates of traumatic and non-traumatic intracranial hemorrhages were 0.8/10,000 and 3.8/1,000. VE deliveries provided 58% and 31.5% of the traumatic and non-traumatic cases, giving a ten-fold risk [AOR 10.05 (4.67-21.65)] and double risk [AOR 2.23 (1.57-3.16)], respectively. High birth weight and short mother were associated with the highest risks. Infants delivered by CS had no increased risk for intracranial hemorrhages. The risks for convulsions or encephalopathy were similar among infants delivered by VE and CS, exceeding the OR after non-assisted spontaneous vaginal delivery by two-to-three times. CONCLUSION: Vacuum assisted delivery is associated with increased risk for neonatal intracranial hemorrhages. Although causality could not be established in this observational study, it is important to be aware of the increased risk of intracranial hemorrhages in VE deliveries, particularly in short women and large infants. The results warrant further studies in decision making and conduct of assisted vaginal delivery.


Assuntos
Traumatismos do Nascimento/epidemiologia , Lesões Encefálicas/epidemiologia , Cesárea/estatística & dados numéricos , Hemorragia Intracraniana Traumática/epidemiologia , Parto , Convulsões/epidemiologia , Vácuo-Extração/estatística & dados numéricos , Adulto , Peso ao Nascer , Estatura , Feminino , Humanos , Recém-Nascido , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Suécia/epidemiologia , Adulto Jovem
15.
Am J Obstet Gynecol ; 210(4): 361.e1-361.e8, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24215854

RESUMO

OBJECTIVE: The aim of the present study was to investigate cognitive competence, as indicated by school performance, at 16 years of age, in children delivered by vacuum extraction. STUDY DESIGN: This was a register study of a national cohort of 126,032 16 year olds born as singletons, with a vertex presentation, at a gestational age of 34 weeks or older, with Swedish-born parents, delivered between 1990 and 1993 without major congenital malformations. Linear regression was used to analyze mode of delivery in relation to mean scores from national tests in mathematics (40.2; scale, 10-75; SD, 14.9) and mean average grades (223.8; scale, 10-320; SD, 52.3), with adjustment for perinatal and sociodemographic confounders. RESULTS: Children delivered by vacuum extraction (-0.51; 95% confidence interval [CI], -0.76 to 0.26) as well as by nonplanned cesarean section (-0.51; 95% CI, -0.82 to -0.20) had slightly lower mean mathematics test scores than children born vaginally without instruments, after adjustment for major confounders. Mean average grades in children delivered by vacuum extraction were -1.05 (95% CI, -1.87 to -0.23) and -1.20 (95% CI,-2.24 to -0.16) in children delivered by nonplanned cesarean section compared with children born vaginally. CONCLUSION: Children delivered by vacuum extraction had slightly lower grades at age 16 years compared with those born by noninstrumental vaginal delivery but very similar to those delivered by nonplanned cesarean. This suggests that vacuum extraction and nonplanned cesarean are equivalent alternatives for terminating deliveries with respect to cognitive outcomes.


Assuntos
Escolaridade , Vácuo-Extração/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Parto Obstétrico/estatística & dados numéricos , Avaliação Educacional , Feminino , Humanos , Renda , Recém-Nascido , Modelos Lineares , Masculino , Idade Materna , Gravidez , Sistema de Registros , Suécia/epidemiologia , Adulto Jovem
16.
Sex Reprod Healthc ; 4(3): 93-8, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24041729

RESUMO

AIM: The aim of this study is to explore how women from part of the world where female genital mutilation (FGM) is normative perceive and experience FGM after immigrating to Sweden. METHOD: Interviews were conducted with eight women from Djibouti, Eritrea, Ethiopia and Somalia. The data were analyzed using qualitative content analysis. RESULTS: The women's feelings were ambivalent: though they opposed FGM, on the one hand, because of its negative effects on health, they acknowledged the practice's positive cultural aspects on the other hand. The themes that emerged from the interviews are the role of FGM in ensuring virginity and protecting a family's honor, its role in avoiding shame and enhancing purity, social pressure experienced after immigration, an understanding of FGM as a symbol of the country of origin, and support for changing the tradition. CONCLUSION: These findings indicate that women originating from communities where FGM is normative live in a context in which the practice is viewed as an important aspect of life even after immigration. More research concerning this complex and deeply rooted cultural issue is recommended.


Assuntos
Atitude Frente a Saúde , Circuncisão Feminina , Cultura , Emigração e Imigração , Percepção , Adulto , África , Emigrantes e Imigrantes , Emoções , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Pesquisa Qualitativa , Abstinência Sexual , Meio Social , Suécia , Saúde da Mulher , Adulto Jovem
17.
Acta Obstet Gynecol Scand ; 92(10): 1175-82, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23848268

RESUMO

OBJECTIVE: To explain the increasing rates of vacuum extraction in Sweden. DESIGN: Population-based register study. SETTING: Nationwide study in Sweden. POPULATION: A total of 589 108 primiparous women with singleton, term live births in 1992-2010. METHODS: Odds ratios with 95% confidence intervals were estimated for potential risk factors for vacuum extraction and emergency cesarean. To explain the increase in vacuum extraction over time, we successively adjusted for maternal and infant characteristics in four different models. MAIN OUTCOME MEASURES: Vacuum extraction. RESULTS: Rates of vacuum extraction increased from 11.5% in 1992 to 14.8% in 2010. The risk of vacuum extraction increased with maternal age and gestational length, but decreased with increasing maternal height. The increased use of vacuum extraction over time was partly explained by increasing maternal age and increased use of epidural anesthesia. Among women with and without epidural analgesia, the increase in vacuum extraction over time was confined to vacuum extraction due to signs of fetal distress. CONCLUSIONS: Depending on risk factors, the odds of being delivered by vacuum extraction can vary immensely from one woman to another. Increasing maternal age explains a substantial fraction of the increase in vacuum extraction use since 1992. Whether the increase in vacuum extractions due to fetal distress reflects a true increase in fetal distress during labor remains to be explained.


Assuntos
Vácuo-Extração/tendências , Adulto , Anestesia Epidural/estatística & dados numéricos , Anestesia Epidural/tendências , Cesárea/estatística & dados numéricos , Cesárea/tendências , Estudos de Coortes , Feminino , Sofrimento Fetal/epidemiologia , Sofrimento Fetal/terapia , Humanos , Masculino , Idade Materna , Modelos Estatísticos , Razão de Chances , Gravidez , Sistema de Registros , Fatores de Risco , Suécia/epidemiologia , Vácuo-Extração/estatística & dados numéricos
18.
PLoS One ; 8(6): e67368, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23840681

RESUMO

BACKGROUND: It has been proposed that maternal obesity during pregnancy may increase the risk that the child develops allergic disease and asthma, although the mechanisms underpinning this relationship are currently unclear. We sought to assess if this association may be due to confounding by genetic or environmental risk factors that are common to maternal obesity and childhood asthma, using a sibling pair analysis. METHODS: The study population comprised a Swedish national cohort of term children born between 1992 and 2008 to native Swedish parents. Maternal body mass index (BMI) was measured at 8-10 weeks gestation. Unconditional logistic regression models were used to determine if maternal obesity was associated with increased risk of inhaled corticosteroid (ICS) in 431,718 first-born children, while adjusting for potential confounders. An age-matched discordant sib-pair analysis was performed, taking into account shared genetic and environmental risk factors. RESULTS: Maternal over-weight and obesity were associated with increased risk that the child would require ICS (for BMI≥35 kg/m(2), aOR = 1.30, 95%CI = 1.10-1.52 compared with normal weight mothers) in children aged 6-12 years. Similar effects were seen in younger children, but in children aged 13-16 years, maternal obesity (BMI≥30) was related to increased risk of ICS use in girls (aOR = 1.28, 95%CI = 1.07-1.53) but not boys (OR = 1.05, 95%CI = 0.87-1.26). The sib-pair analysis, which included 2,034 sib-pairs older than six years who were discordant for both ICS use and maternal BMI category, failed to find any evidence that increasing maternal weight was related to increased risk of ICS use. CONCLUSION: Maternal obesity is associated with increased risk of childhood ICS use up to approximately 12 years of age, but only in girls after this age. These effects could not be confirmed in a sib pair analysis, suggesting either limited statistical power, or the effects of maternal BMI may be due to shared genetic or environmental risk factors.


Assuntos
Corticosteroides/administração & dosagem , Antiasmáticos/administração & dosagem , Asma/etiologia , Cortisona/administração & dosagem , Obesidade/complicações , Efeitos Tardios da Exposição Pré-Natal/etiologia , Administração por Inalação , Adolescente , Adulto , Asma/tratamento farmacológico , Asma/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Obesidade/epidemiologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/tratamento farmacológico , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Prevalência , Sistema de Registros , Fatores de Risco , Irmãos , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-23590822

RESUMO

BACKGROUND: Mode of delivery may affect the risk of asthma but the findings have not been consistent and factors shared by siblings may confound the associations in previous studies. METHODS: The association between mode of delivery and dispensed inhaled corticosteroid (ICS) (a marker of asthma) was examined in a register based national cohort (n=199 837). A cohort analysis of all first born children aged 2-5 and 6-9 years was performed. An age-matched sibling-pair analysis was also performed to account for shared genetic and environmental risk factors. RESULTS: Analyses of first-borns demonstrated that elective caesarean section was associated with an increased risk of dispensed ICS in both 2-5 (adjusted odds ratio (aOR)=1.19, 95% confidence interval (CI) 1.09-1.29) and 6-9 (aOR=1.21, 1.09-1.34) age groups. In the sibling-pair analysis, the increased risk associated with elective caesarean section was confirmed in 2-5 year olds (aOR=1.22, 1.05-1.43) but not in 6-9 year olds (aOR=1.06, 0.78-1.44). Emergency caesarean section and vacuum extraction had some association with dispensed ICS in the analyses of first-borns but these associations were not confirmed in the sibling-pair analyses. CONCLUSIONS: Confounding by familial factors affects the association between mode of delivery and dispensed ICS. Despite this confounding, there was some evidence that elective caesarean section contributed to a modestly increased risk of dispensed ICS but only up to five years of age.

20.
Acta Obstet Gynecol Scand ; 92(3): 306-11, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23311477

RESUMO

OBJECTIVE: To investigate the pain relief used in association with vacuum extraction assisted deliveries and to identify risk factors for not receiving pain relief during the procedure. DESIGN: Retrospective birth register study. SETTING: Nationwide study in Sweden. POPULATION: The study population consisted of all women (n = 62 568) with a singleton pregnancy who gave birth in gestational weeks 37(+0) to 41(+6) between 1999 and 2008 and were delivered by vacuum extraction. METHOD: Register study with data from the Swedish Medical Birth Register. MAIN OUTCOME MEASURES: Epidural blockade, spinal blockade, pudendal nerve blockade, infiltration of the perineum, no pain relief. RESULTS: In all, 32.4% primiparas and 51.4% multiparas who had a vacuum-assisted delivery had this without potent pain relief such as epidural blockade, spinal blockade or pudendal nerve block. When infiltration was added as a method for pain relief, 18% were still delivered without pain relief. Multiparas were more likely than primiparas to be delivered without potent pain relief, odds ratio (OR) 2.29 95% confidence interval (CI) (2.20-2.38). Compared with women delivered by vacuum extraction due to prolonged labor, those with signs of fetal distress were more likely to be delivered without potent pain relief (OR) 1.74, 95% (CI) (1.68-1.81). CONCLUSION: A considerable number of women are delivered by vacuum extraction without pain relief. The high proportion might reflect that clinical staff do not always consider pain relief to be of high priority in vacuum extraction deliveries or that they fear impaired pushing forces.


Assuntos
Analgesia Epidural/estatística & dados numéricos , Analgesia Obstétrica/estatística & dados numéricos , Dor do Parto/tratamento farmacológico , Vácuo-Extração , Adulto , Anestesia Local/estatística & dados numéricos , Intervalos de Confiança , Distocia/terapia , Feminino , Sofrimento Fetal/terapia , Humanos , Trabalho de Parto , Bloqueio Nervoso/estatística & dados numéricos , Razão de Chances , Paridade , Gravidez , Nervo Pudendo , Estudos Retrospectivos , Suécia
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