Post-partum duration of satisfaction with childbirth.

AIM: Satisfaction with childbirth has become increasingly important among healthcare providers. We evaluated whether satisfaction levels change with time (up to 3 months after delivery). METHODS: A prospective study of nulliparous women was designed to evaluate their levels of satisfaction with childbirth and care during birth in the maternity unit of a county hospital in Sundsvall, Sweden. Patient satisfaction with birth and health care was measured twice, during the first week after birth and 3 months later, with the Childbirth Experience Questionnaire (CEQ). Maternal and labor information were collected with a form filled in by the patients and completed with information from the patients' records. RESULTS: A total of 78 primiparous women participated in the study and answered the questionnaire in the first week after labor, and 63 of them completed the study by answering the same questionnaire 3 months after delivery. The total CEQ score did not change after 3 months, but the scores for the subscales 'professional support' and 'participation' decreased 3 months after labor (P = 0.008 and P = 0.001, respectively). A visual analogue scale predicted the total CEQ scores at both 1 week (P < 0.001) and 3 months (P = 0.003). CONCLUSION: Our results indicate that satisfaction with labor and birth among primiparous women was unchanged 3 months after labor.

Symptoms after obstetric sphincter injuries have little effect on quality of life.

OBJECTIVE: To compare the prevalence of anal incontinence and dyspareunia in women with or without obstetric sphincter injury after standardizing the suture technique. DESIGN: Retrospective case-control study. SETTING: Regional hospital, Sweden. POPULATION: 305 women with an obstetric sphincter injury and 297 women with spontaneous vaginal delivery. METHODS: In order to standardize and improve the repairing skills of sphincter injuries, collaboration between obstetricians and colorectal surgeons was begun in 2000. Inner and external sphincters were repaired in two layers with continuous monofilament polidioxane sutures. The participating women received a questionnaire with validated questions on anal incontinence, dyspareunia and quality of life. The follow-up time was 15 months to 8 years. MAIN OUTCOME MEASURES: Anal incontinence, dyspareunia and quality of life. RESULTS: Of the sphincter group, 72% returned the questionnaire, as did 67% in the control group. Significantly more women in the sphincter group suffered from incontinence of flatus and loose stool compared to controls (p < 0.05). There was no significant difference of incontinence of solid stool, soiling, or fecal urgency between the groups. The quality of life questions showed no significant difference between the groups. In the sphincter group, there was significantly more superficial coital pain compared to controls (p= 0.02). Significantly more women with complete sphincter injury reported anal incontinence than women with a partial sphincter injury. CONCLUSION: In spite of increased rate of anal incontinence and dyspareunia after anal sphincter rupture, there was no statistically significant reduction in the women's quality of life.

Women's satisfaction with the birthing experience in relation to duration of labour, obstetric interventions and mode of birth.

OBJECTIVE: To study the influence of the duration of labour on women's satisfaction with their birthing experience. STUDY DESIGN: All labours and births during a four-year period at a secondary level Hospital were included in a continuous audit of events and outcomes based on the Ten Group Classification System (TGCS). The women scored their overall satisfaction with their birth experience on an ordinal Visual Analog Scale. RESULTS: 1780 nulliparous women with a cephalic fetus at term and spontaneous onset of labour in TGCS Group 1 gave birth during the study period. 1716 had complete data on duration of labour and, of these, 1380 (80,4 %) rated their satisfaction with their birthing experience. Satisfaction with the birthing experience was significantly related to mode of birth, oxytocin augmentation, epidural anaesthesia and to duration of labour. Duration of labour and mode of birth had independent significant statistical effect on the satisfaction with the birthing experience. CONCLUSION: Although various aspects of labour management are associated with a negative birth experience, the effect of prolonged labour is independently significant and measures taken to avoid prolonged labour could result in a net benefit to the woman's satisfaction.

The continuous audit of events and outcomes of labour and birth using the Ten Group Classification System and its role in quality improvement.

OBJECTIVE: The knowledge of a labour and birth unit's rates of events and outcomes is essential to design any quality improvement initiative. It is in the same way important to have a system to analyse results of the ongoing changes within the unit. The Ten Group Classification System is the framework for doing this in a systematic and clinically relevant way. We aimed to use this classification system as a quality improvement tool. STUDY DESIGN: All labours and births during four years at a secondary level Hospital were included in a continuous analysis and of events and outcomes based on the Ten Group Classification System. From the results of the audit, policies and guidelines were designed and updated to improve outcomes. RESULTS: The normal vaginal birth rate in Group 1 increased during the four-year-period and the Caesarean Section rate in Group 2 A dropped after the introduction of a new induction method. The overall Caesarean Section rate decreased. The experience of giving birth improved in Groups 1, 2 A and 3. CONCLUSION: The use of a continuous audit of events and outcomes based on a clinically significant classification for all women makes it possible to improve quality. Other labour and birth units are encouraged to collect and present data in a way that allows comparisons between units and over time.

Prediction of preeclampsia by combining serum histidine-rich glycoprotein and uterine artery Doppler.

BACKGROUND: Preeclampsia is associated with both maternal and perinatal morbidity and mortality. Histidine-rich glycoprotein (HRG) is a protein interacting with angiogenesis, coagulation, and inflammatory responses, processes known to be altered in preeclamptic pregnancies. Significantly lower levels of HRG have been demonstrated as early as in the first trimester in women later developing preeclampsia compared with normal pregnancies. The aim of this study was to investigate whether the combination of HRG and uterine artery Doppler ultrasonography can be used as a predictor of preeclampsia. METHODS: A total of 175 women were randomly selected from a case-control study; 86 women had an uncomplicated pregnancy and 89 women later developed preeclampsia. Blood samples and pulsatility index (PI) were obtained from both cases and controls in gestational week 14. RESULTS: HRG levels were significantly lower in women who developed preterm preeclampsia compared with controls, but not for women developing preeclampsia in general. PI was significantly higher in the preeclampsia group compared with controls, especially in preterm preeclampsia. The combination of HRG and PI revealed a sensitivity of 91% and a specificity of 62% for preterm preeclampsia. CONCLUSIONS: The combination of HRG and uterine artery Doppler may predict preterm preeclampsia in early pregnancy.

Histidine-rich glycoprotein as an early biomarker of preeclampsia.

BACKGROUND: Prediction of preeclampsia is of great interest and the coagulation system as well as the angiogenic pathway is known to be dysfunctional in preeclampsia. Histidine-rich glycoprotein (HRG) is a protein interacting with both these biological systems and the purpose of this prospective, longitudinal cohort study was to analyze whether there is a difference in circulating levels of HRG during pregnancy in women developing preeclampsia compared to normal healthy pregnancies. We furthermore wanted to evaluate whether HRG has the potential of being an early biomarker of preeclampsia. METHODS: A cohort of healthy pregnant women (n = 469) was enrolled at gestational weeks 8-12. Plasma samples were collected at gestational weeks 10, 25, 28, 33, and 37 and analyzed with an enzyme-linked immunosorbent assay. RESULTS: The levels of HRG decreased during pregnancy in all women, but the levels were significantly lower at gestational weeks 10, 25, and 28 in women who later developed preeclampsia than in normal pregnant women (P < 0.05, P < 0.05, and P < 0.05). CONCLUSION: Our data indicates that HRG levels in plasma might be a possible biomarker already in gestational week 10 for prediction of later onset of preeclampsia in a low risk population.

Angiopoietin-1/angiopoietin-2 ratio for prediction of preeclampsia.

BACKGROUND: A number of different biophysical and biochemical markers have been proposed as predictors of preeclampsia. Factors involved in the angiogenic balance are suggested as candidate markers. The purpose of this prospective, longitudinal cohort study was to determine whether a ratio between Angiopoietin-1 (Ang-1) and Angiopoietin-2 (Ang-2) can be used to predict preeclampsia in a low-risk population. METHODS: A cohort of healthy pregnant women (n = 469) were enrolled at gestational weeks 8-12. Plasma samples were collected at gestational weeks 10, 25, 28, 33, and 37. By using commercially available enzyme-linked immunosorbent assay kits Ang-1 and Ang-2 were analyzed. RESULTS: The median Ang-1/Ang-2 ratio increased during pregnancy in all women, but the ratios were significantly lower at gestational weeks 25 and 28 in women who later developed preeclampsia than in normal pregnant women (1.49 compared to 2.19 and 2.12 compared to 3.54, P < 0.05 and P < 0.05). CONCLUSION: Our data indicate that in a low-risk population of women the Ang-1/Ang-2 ratio in plasma constitutes a possible biomarker for prediction of later onset of preeclampsia.