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1.
BMJ ; 367: l6131, 2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31748223

RESUMO

OBJECTIVE: To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with a low risk pregnancy compared with expectant management and induction of labour at 42 weeks. DESIGN: Multicentre, open label, randomised controlled superiority trial. SETTING: 14 hospitals in Sweden, 2016-18. PARTICIPANTS: 2760 women with a low risk uncomplicated singleton pregnancy randomised (1:1) by the Swedish Pregnancy Register. 1381 women were assigned to the induction group and 1379 were assigned to the expectant management group. INTERVENTIONS: Induction of labour at 41 weeks and expectant management and induction of labour at 42 weeks. MAIN OUTCOME MEASURES: The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score less than 7 at five minutes, pH less than 7.00 or metabolic acidosis (pH <7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, or obstetric brachial plexus injury. Primary analysis was by intention to treat. RESULTS: The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group. The composite primary perinatal outcome did not differ between the groups: 2.4% (33/1381) in the induction group and 2.2% (31/1379) in the expectant management group (relative risk 1.06, 95% confidence interval 0.65 to 1.73; P=0.90). No perinatal deaths occurred in the induction group but six (five stillbirths and one early neonatal death) occurred in the expectant management group (P=0.03). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups. CONCLUSIONS: This study comparing induction of labour at 41 weeks with expectant management and induction at 42 weeks does not show any significant difference in the primary composite adverse perinatal outcome. However, a reduction of the secondary outcome perinatal mortality is observed without increasing adverse maternal outcomes. Although these results should be interpreted cautiously, induction of labour ought to be offered to women no later than at 41 weeks and could be one (of few) interventions that reduces the rate of stillbirths. TRIAL REGISTRATION: Current Controlled Trials ISRCTN26113652.


Assuntos
Idade Gestacional , Doenças do Recém-Nascido , Trabalho de Parto Induzido , Conduta Expectante/estatística & dados numéricos , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Análise de Intenção de Tratamento , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Natimorto/epidemiologia , Suécia/epidemiologia , Nascimento a Termo
2.
Acta Obstet Gynecol Scand ; 96(1): 86-95, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27696340

RESUMO

INTRODUCTION: Gestational age is estimated by ultrasound using fetal size as a proxy for age, although variance in early growth affects reliability. The aim of this study was to identify characteristics associated with discrepancies between last menstrual period-based (EDD-LMP) and ultrasound-based (EDD-US) estimated delivery dates. MATERIAL AND METHODS: We identified all singleton births (n = 1 201 679) recorded in the Swedish Medical Birth Register in 1995-2010, to assess the association between maternal/fetal characteristics and large negative and large positive discrepancies (EDD-LMP earlier than EDD-US and 10th percentile in the discrepancy distribution vs. EDD-LMP later than EDD-US and 90th percentile). Analyses were adjusted for age, parity, height, body mass index, smoking, and employment status. RESULTS: Women with a body mass index >40 kg/m2 had the highest odds for large negative discrepancies (-9 to -20 days) [odds ratio (OR) 2.16, 95% CI 2.01-2.33]. Other factors associated with large negative discrepancies were: diabetes, young maternal age, multiparity, body mass index between 30 and 39.9 kg/m2 or <18.5 kg/m2 , a history of gestational diabetes, female fetus, shorter stature (<-1 SD), a history of preeclampsia, smoking or snuff use, and unemployment. Large positive discrepancies (+4 to +20 days) were associated with male fetus (OR 1.80, 95% CI 1.77-1.83), age ≥30 years, multiparity, not living with a partner, taller stature (>+1 SD), and unemployment. CONCLUSIONS: Several maternal and fetal characteristics were associated with discrepancies between dating methods. Systematic associations of discrepancies with maternal height, fetal sex, and partly obesity, may reflect an influence on the precision of the ultrasound estimate due to variance in early growth.


Assuntos
Idade Gestacional , Ciclo Menstrual , Ultrassonografia Pré-Natal , Adulto , Estatura , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Idade Materna , Obesidade/epidemiologia , Paridade , Pré-Eclâmpsia/epidemiologia , Gravidez , Sistema de Registros , Fatores Sexuais , Fumar/epidemiologia , Suécia/epidemiologia , Desemprego , Adulto Jovem
3.
Acta Obstet Gynecol Scand ; 94(12): 1373-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26381500

RESUMO

INTRODUCTION: Post-term pregnancies are associated with greater risks for mother and child. Accurate determination of gestational age is necessary for safe care. Female fetuses have been shown to be smaller than males at the time of second-trimester ultrasound (US) examination, leading to underestimation of their age and, potentially, greater impacts of perinatal complications in post-term girls than in post-term boys. The purpose of this study was to investigate the sex ratio of post-term births and differences in perinatal complications (stillbirth, low Apgar score, low birthweight, meconium aspiration and low umbilical artery pH) between post-term boys and girls according to dating method [second-trimester US and last menstrual period (LMP)]. MATERIAL AND METHODS: Data from gestational week ≥39 to delivery of 13 338 singleton pregnancies between 13 February 2006 and 15 January 2014, were collected from the Obstetrix(®) (Siemens Healthcare) medical records system in Dalarna County, Sweden. RESULTS: The neonatal male:female ratio increased with gestational age after week 40, as dated by US, reaching 1.69 in gestational week 42. This ratio remained 1 throughout gestation according to dating by the LMP. Post-term pregnancy increased the risks of meconium aspiration and low Apgar score, with no sex difference observed. CONCLUSIONS: US gestational dating indicated that more boys than girls were born post-term, whereas dating according to LMP revealed no sex difference. These results support the hypothesis that female fetuses are smaller than males, leading to underestimation of their gestational age, at the time of second-trimester US examination.


Assuntos
Idade Gestacional , Gravidez Prolongada/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adolescente , Índice de Apgar , Peso ao Nascer , Feminino , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Masculino , Síndrome de Aspiração de Mecônio , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Risco , Natimorto , Suécia , Artérias Umbilicais
4.
J Clin Sleep Med ; 10(5): 527-33, 2014 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-24812538

RESUMO

OBJECTIVES: Both restless legs syndrome ([RLS], also known as Willis-Ekbom Disease [WED]) and depression are common during pregnancy. However, no prior studies have assessed if pregnant women with RLS have an elevated risk of depression during and/or after pregnancy. METHODS: 1,428 women who were pregnant in gestational week 16-17 were asked to participate in a longitudinal survey. They were followed by web-based questionnaires in gestational week 17 and 32, and 6 weeks after delivery. Data were also retrieved from prenatal and birth records. Two different sets of criteria were used to examine the prevalence of RLS in the cohort (International Restless Legs Syndrome Society Group standard criteria and the later developed CH-RLSQ11 questionnaire). The latter questionnaire attempts to exclude those with common "mimics" of RLS. RESULTS: Adjusted odds ratio for depression in gestational week 17, 32, and postpartum week 6 in relation to pre-pregnancy RLS onset and moderate to severe symptom severity were 4.74 (2.30 - 9.76), 3.67 (1.85 - 7.28), and 2.58 (1.28 - 5.21), respectively. No significant associations were seen in pregnant women with de novo RLS during pregnancy. When using the standard diagnostic RLS criteria and frequency of symptoms more than 2-3 days per week, the prevalence of RLS was 12.3%. With the CH-RLSQ11 questionnaire and the same threshold for frequency of symptoms the prevalence was 6.5%. CONCLUSION: Women with RLS onset before pregnancy with moderate or severe symptoms had an increased risk of both antenatal and postnatal depression. The self-reported prevalence of RLS during pregnancy is lower when a questionnaire dealing with "mimics" is used.


Assuntos
Depressão Pós-Parto/etiologia , Síndrome das Pernas Inquietas/complicações , Adulto , Feminino , Humanos , Estudos Longitudinais , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/psicologia , Prevalência , Escalas de Graduação Psiquiátrica , Síndrome das Pernas Inquietas/epidemiologia , Síndrome das Pernas Inquietas/psicologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Suécia/epidemiologia
5.
J Clin Sleep Med ; 10(1): 15-20, 2014 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-24426815

RESUMO

STUDY OBJECTIVES: Periodic limb movements (PLMs) are characterized by involuntary movements of the lower extremity during sleep. The etiology of PLM has been suggested to involve the dopaminergic system which, in turn, can be modulated by estrogen. It is currently unknown whether PLMs are associated with the menopausal transition and/or concomitant vasomotor symptoms. The aim of the present study was to examine if objectively diagnosed PLMs (with and without arousals) are more common in postmenopausal women or in women with vasomotor symptoms. A secondary aim was to analyze the influence of PLMs on self-reported HRQoL. METHODS: A community-based sample of 348 women underwent full-night polysomnography. PLMs (index > 15) and associated arousals (PLM arousal index > 5) were evaluated according to AASM scoring rules. Health-related quality of life was measured using the SF-36 questionnaire. The occurrence of peri- and postmenopausal symptoms were evaluated by a questionnaire and plasma levels of follicle stimulating hormone (FSH) were measured. RESULTS: After adjusting for confounding factors, vasomotor symptoms remained a significant explanatory factor for the occurrence of PLMs (adj. OR 1.86, 95% CI 1.03-3.37). In women with PLM arousals, adjusted OR for vasomotor symptoms was 1.61, 95% CI 0.76-3.42. PLMs did not seem to affect HRQoL. CONCLUSION: We found that clinically significant PLMs, but not PLM with arousals, were more common among women with vasomotor symptoms, even after controlling for confounding factors. Menopausal status per se, as evidenced by FSH in the postmenopausal range, was not associated with PLMs.


Assuntos
Fogachos/complicações , Síndrome da Mioclonia Noturna/complicações , Sistema Vasomotor/fisiopatologia , Adulto , Idoso , Nível de Alerta , Feminino , Fogachos/fisiopatologia , Humanos , Pessoa de Meia-Idade , Síndrome da Mioclonia Noturna/fisiopatologia , Razão de Chances , Pós-Menopausa , Pré-Menopausa , Inquéritos e Questionários , Sudorese , Suécia , Adulto Jovem
6.
Sleep Med Rev ; 16(4): 297-307, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22075215

RESUMO

Sleep is an essential human behavior that shows prominent gender differences. Disturbed sleep, in particular, is much more prevalent in females than males. Restless legs syndrome (RLS) as one cause of disturbed sleep was observed to be somewhat more common among women than men in Ekbom's 1945 seminal series of clinical cases with the disease. He, however, reported this gender difference mainly for those with more severe symptoms. Since then numerous studies have reported that women are affected by RLS about twice as often as males for mild as well as moderate to severe RLS. The present review focuses on RLS in females from the perspectives of both epidemiology and pathophysiology. RLS will generally become worse or might appear for the first time during pregnancy. Parity increases the risk of RLS later in life suggesting that pregnancy is a specific behavioral risk factor for developing RLS. Some evidence suggests that dysfunction in iron metabolism and high estrogen levels might contribute to RLS during pregnancy. But, menopause does not lower the incidence of RLS nor does hormone replacement therapy lead to an increase, suggesting a quite complex uncertain role of hormones in the pathophysiology of RLS. Therefore, further, preferably longitudinal studies are needed to unravel the factors causing RLS in women. These studies should include genetic, clinical and polysomnographic variables, as well as hormonal measures and variables assessing iron metabolism.


Assuntos
Síndrome das Pernas Inquietas/epidemiologia , Adulto , Estrogênios/fisiologia , Feminino , Humanos , Ferro/metabolismo , Ferro/fisiologia , Masculino , Menopausa , Paridade , Gravidez , Complicações na Gravidez/epidemiologia , Prevalência , Qualidade de Vida , Síndrome das Pernas Inquietas/etiologia , Síndrome das Pernas Inquietas/fisiopatologia , Fatores de Risco , Fatores Sexuais
7.
Psychiatry Clin Neurosci ; 64(5): 574-9, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20727108

RESUMO

AIM: Restless legs syndrome (RLS) is a common neurological movement disorder with a female preponderance, an increasing prevalence with age and comorbidity. Previous studies on the relationship between health-related quality of life (HRQOL) and RLS are still sparse but knowledge is increasing. The aim of this study was to evaluate the unique impact of RLS on HRQOL in a population-based sample. METHODS: A random sample of 5000 women aged 25-64 years was selected from the general Swedish population. The women were sent diagnostic questions on RLS together with the Short Form 12 (SF-12) questionnaire for assessment of physical and mental HRQOL. The unique burden of RLS on HRQOL was analyzed by excluding RLS-positive women from four self-reported diagnostic groups (diabetes, depression, heart problems, muscle and joint pain) and by excluding subjects with these diagnoses from the group of RLS-positive women. RESULTS: Compared with mental SF-12 scores for the RLS-negative women in our population, mental HRQOL of the RLS sample in our study was lower in every age group but not significantly lower in the age group 35-44 years. Physical SF-12 scores for RLS-positive women were also below scores for RLS-negative women in every age group but significance was only found in women between 45 and 54 years. A unique burden of RLS on HRQOL remained after statistical adjustment for comorbidities. CONCLUSION: RLS-positive women had an impaired mental HRQOL compared to RLS-negative women in the studied population. The physical aspects of HRQOL were less affected among RLS-positive women. The impaired well-being among women with RLS further strengthens the importance of identifying women with this condition and evaluating their need for medication or other actions in order to improve their quality of life.


Assuntos
Qualidade de Vida , Síndrome das Pernas Inquietas/psicologia , Adulto , Fatores Etários , Comorbidade , Efeitos Psicossociais da Doença , Feminino , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Síndrome das Pernas Inquietas/complicações , Síndrome das Pernas Inquietas/epidemiologia , Inquéritos e Questionários , Suécia/epidemiologia
8.
Acta Obstet Gynecol Scand ; 84(1): 54-7, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15603568

RESUMO

BACKGROUND: Sleep apnea syndrome (SAS) is a common condition and a risk factor of cardiovascular and cerebrovascular diseases. The purpose of this pilot study was to investigate the effect of a gestagen (trimegeston) and estradiol hormone combination on perimenopausal and postmenopausal women with SAS. METHODS: Four postmenopausal and one perimenopausal women were studied by polysomnography before and after treatment with hormone replacement therapy (HRT). RESULTS: The subjects had a mean reduction of the severity of their sleep apnea by 75% measured by apnea/hypopnea index. CONCLUSIONS: HRT might be an alternative in the treatment of SAS.


Assuntos
Terapia de Reposição Hormonal , Promegestona/análogos & derivados , Síndromes da Apneia do Sono/tratamento farmacológico , Estradiol/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Polissonografia , Pós-Menopausa , Promegestona/administração & dosagem
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