Trends in caesarean section and instrumental deliveries in relation to Body Mass Index: a clinical survey during 1978 - 2001

<p>Abstract</p> <p>Background</p> <p>During the last 20 years the rate of CS has increased in Sweden as it has in many other countries. The proportion of pregnant women suffering from a high BMI has also increased rapidly during the same time period. It would therefore be of interest to study both how and if these two observations are related to each other. The aim was therefore to study trends in mode of caesarean section (CS) and instrumental deliveries among women in three BMI groups over a time span of almost 25 years with special focus on the observed body weight of pregnant women.</p> <p>Method</p> <p>The design is a retrospective cohort study using medical records of consecutively delivered women at two delivery wards in South East Sweden during the years 1978, 1986, 1992, 1997 and 2001.</p> <p>Results</p> <p>No significant time-trends were found for CS and instrumental delivery within each BMI-group for the time period studied. The proportion of women with BMI ≥ 25 delivered by means of CS or instrumental delivery increased quite dramatically from 1978 to 2001 (χ²test for trend; p < 0.001 for both CS and instrumental deliveries). The mean birth weight in relation to BMI and year of study among women delivered by means of CS decreased, a trend that was most evident between 1997 and 2001 (F-test; p = 0.005, p = 0.004, and p = 0.003 for BMI < 20, 20-24.9, and ≥ 25, respectively).</p> <p>Conclusion</p> <p>Overweight and obese pregnant women constitute a rapidly growing proportion of the total number of CS and instrumental deliveries. Planning and allocation of health resources must be adjusted to this fact and its implications.</p

Short‐term recovery after subtotal and total abdominal hysterectomy ‐ a randomised clinical trial

Objective: To determine whether the day‐byday postoperative recovery differs between women undergoing subtotal and total abdominal hysterectomy and to analyse factors associated with postoperative recovery and sick‐leave. Design: A prospective, open, randomised multicenter trial. Setting: Seven hospitals and one private clinic in the south‐east of Sweden. Population: 200 women scheduled for hysterectomy for benign conditions were enrolled in the study and 178 women completed the study. 94 women were randomised to subtotal abdominal hysterectomy and 84 to total abdominal hysterectomy. Methods: Day‐by day recovery of general well‐being measured by a visual analogue scale in a diary seven days preoperatively and 35 days postoperatively. Psychometric measurements included depression, anxiety and general psychological well‐being. Main outcome measures: Effects of operating method and preoperative well‐being on the day‐by‐day recovery and sick‐leave duration. Results: No significant difference was found in the day‐by‐day recovery between operating methods. Day‐by‐day recovery of general well‐being and duration of sick‐leave was strongly associated with the occurrence of minor complications but not with major complications. The level of psychological wellbeing preoperatively was strongly associated with the day‐by‐day recovery of general wellbeing and duration of sick‐leave. Conclusions: Day‐by‐day recovery of general well‐being is not faster in subtotal versus total abdominal hysterectomy. Independent of operation method there is an interaction between preoperative psychological wellbeing, postoperative recovery of general wellbeing and duration of sick‐leave. Postoperative complications and preoperative psychological well‐being are strong determinants for duration of sick‐leave. There is a need for intervention studies with focus on complications and preoperative well‐being.This is the author's version of the work. It is posted here for personal use, not for redistribution. The definitive version was published:Persson Pär, Jan Brynhildsen and Preben Kjølhede, Short‐term recovery after subtotal and total abdominal hysterectomy ‐ a randomised clinical trial, 2010, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, (117), 4, 469-478.http://dx.doi.org/10.1111/j.1471-0528.2009.02468.xCopyright: Blackwell Publishing Ltd

Maternal obesity and the risk of postpartum infections according to mode of delivery

Objective The aim of the present study was to assess the impact of different maternal Body Mass Index (BMI) classes on the risk of postpartum endometritis, wound infection, and breast abscess after different modes of delivery. Secondly to estimate how the risk of postpartum infection varies with different maternal BMI groups after induction of labor and after obstetric anal sphincter injuries. Methods A population-based observational study including women who gave birth during eight years (N = 841,780). Data were collected from three Swedish Medical Health Registers, the Swedish Medical Birth Register, the Swedish National Patient Register, and the Swedish Prescribed Drug Register. Outcomes were defined by ICD-10 codes given within eight weeks postpartum. The reference population was uninfected women. Odds ratios were determined using Mantel-Haenszel technique. Year of delivery, maternal age, parity and smoking in early pregnancy were considered as confounders. Results There was a dose-dependent relationship between an increasing maternal BMI and a higher risk for postpartum infections. Women in obesity class II and III had an increased risk for endometritis after normal vaginal delivery aOR 1.45 (95% CI: 1.29-1.63) and for wound infections after cesarean section aOR 3.83 (95% CI: 3.39-4.32). There was no difference in how maternal BMI affected the association between cesarean section and wound infection, regardless of whether it was planned or emergent. Women in obesity class II and III had a lower risk of breast abscess compared with normal-weight women, aOR 0.47 (95% CI: 0.38-0.58). The risk of endometritis after labor induction decreased with increasing maternal BMI. The risk of wound infection among women with an obstetrical sphincter injury decreased with increasing BMI. Conclusion This study provides new knowledge about the impact of maternal BMI on the risk of postpartum infections after different modes of delivery. There was no difference in how BMI affected the association between cesarean section and wound infections, regardless of whether it was a planned cesarean section or an emergency cesarean section

Vitamin D deficiency at the time of delivery - Prevalence and risk of postpartum infections.

BACKGROUND: Postpartum infections are a common cause of morbidity after childbirth. Vitamin D deficiency has been shown to increase the risk for several infections in a non-pregnant population. Vitamin D deficiency has been described as common in pregnant women. OBJECTIVE: To investigate whether vitamin D deficiency in pregnant women in labor was associated with an increased risk of overall postpartum infectious morbidity within eight weeks of delivery. A secondary aim was to estimate the prevalence of vitamin D deficiency among pregnant women in Linköping, Sweden at the time of delivery. MATERIAL AND METHODS: Serum vitamin D levels in labor were analyzed for 1397 women. Vitamin D deficiency was defined as serum levels &lt;50 nmol/L. All ICD-10 codes given to the women eight weeks postpartum were reviewed and postpartum infections were defined as the presence of an ICD-10 code suggestive of infection. The prevalence of postpartum infections among women with sufficient vitamin D levels was compared with women with vitamin D deficiency. Adjusted Odds Ratios and 95% confidence intervals for postpartum infections were calculated using multivariate logistic regression analysis. RESULTS: Fifty eight per cent of the women had serum vitamin D levels &lt;50 nmol/L. The proportion of women with vitamin D deficiency varied, as expected, with season. No association between vitamin D deficiency and postpartum infections was found. For vitamin D 25-50 nmol/L the adjusted Odds Ratio was 0.85 (95% confidence interval 0.56-1.29) and for vitamin D &lt;25 nmol/L the adjusted Odds Ratio was 1.15 (95% confidence interval 0.66-2.03). Women who smoked or who had a cesarean section had an increased risk of postpartum infections. CONCLUSIONS: Vitamin D deficiency was more common than previously reported in Swedish pregnant women. No association between vitamin D deficiency and postpartum infections was found. Other well-known risk factors for postpartum infection were identified.Funding agencies: Futurum - the academy for healthcare, Region Jonko ping County, Sweden [879861, 711011, 712481]; ALF grants, Region Ostergotland, Sweden [LIO-794921, LIO-792621]</p

A survey of young womens perceptions of the influence of the Levonorgestrel-Intrauterine System or copper-intrauterine device on sexual desire

Objectives: Few studies, with contradictory results, evaluate intrauterine contraceptives (IUC) and sexual function specifically. This study compares perception of sexual desire related to IUC use and aspects of sexual function in women who use the Lng-IUS with those using the Cu-IUD. Study design: A secondary analysis regarding IUC use based on a larger cross-sectional survey of contraceptive use in Sweden, conducted in 2013. In total, 153 IUC users (103 Cu-IUD and 50 Lng-IUS users) answered the questionnaire. The only inclusion criterion was intrauterine contraceptive use. Main outcome measures: Were self-reported sexual desire changes related to contraceptive method. We also analysed aspects of sexual functioning; sexual desire level, sexual activity, orgasm frequency, satisfaction with sex life and satisfaction of desire level. Results: A negative effect on sexual desire due to contraceptive method was reported by 28% of the Lng-IUS users and by 10.1% of the Cu-IUD users (p amp;lt; 0.05). Results were more marked after adjusting for age, body mass index, depression, parity, switching behaviour, and partnership (OR 5.0; CI: 1.8-13.8). The adjusted odds of reporting low sexual desire level (never or almost never feeling sexual desire) (OR 3.5; CI: 1.1-11.2) as well as low satisfaction with sex life (OR 2.7; CI: 1.2-6.3) was higher in the Lng-IUS group (adjusted for same confounders as above). Conclusions: The women in this study using the Lng-IUS more often report negative sexual desire effects of their contraception as well as lower sexual desire level compared with women using the Cu-IUD.Funding Agencies|Region of Ostergotland</p

Examining the pace of change in contraceptive practices in abortion services - a follow-up case study of a quality improvement collaborative

Background Among all women who experienced an abortion in Sweden 2017, 45% had previously underwent at least one abortion. This phenomenon of increasing rates of repeat abortions stimulated efforts to improve contraceptive services through a Quality Improvement Collaborative (QIC) with user involvement. The participating teams had difficulty in coordinating access post-abortion to the most effective contraception, Long-acting reversible contraception (LARC), during the eight-month QIC. This prompted questions about the pace of change in contraceptive services post-abortion. The aim of the study is to evaluate the evolution and impact of QIC changes regarding patient outcomes, system performance and professional development over 12 months after a QIC designed to enhance contraceptive services in the context of abortion. Methods This follow-up case study involves three multi-professional teams from abortion services at three hospitals in Sweden, which participated in a QIC during 2017. We integrated qualitative data on the evolution of changes and quantitative data regarding the monthly proportion of women initiating LARC, analysed in statistical control charts from before the QIC up until 12 months after its conclusion. Results Teams A and B increased the average proportion of women who initiated LARC within 30 days post abortion in the 12 months after the QIC; Team A 16-25%; Team B 20-34%. Team C achieved more than 50% in individual months but not consistently in the Post-QIC period. Elusive during the QIC, they now could offer timely appointments for women to initiate LARC more frequently. Team members reported continued focus on how to create trustful relationships when counseling women. They described improved teamwork, leadership support and impact on organizing appointments for initiating LARC following the QIC. Conclusions QIC teams further improved womens timely access to LARC post abortion through continued changes in services 12 months after the QIC, demonstrating that the 8-month QIC was too short for all changes to materialize. Teams simultaneously improved womens reproductive health, health services, and professional development.Funding Agencies|Futurum - the Academy for Healthcare; Jonkoping County Region; Medical Research Council of Southeast Sweden (FORSS); Linkoping University Library</p

Hormonal contraception and sexual desire : A questionnaire-based study of young Swedish women

Objectives The aim of the study was to determine whether a decrease in sexual desire is more prevalent among women using hormonal contraception than among women using hormone-free contraception, and whether a decrease increases the risk of changing to another contraceptive method. Methods A validated questionnaire was posted to 3740 women (aged 22, 25 or 28 years) living in Sweden. Descriptive statistics were used to present the results; differences between groups were tested using χ(2) analyses. A multiple logistic regression model was used for analysis of possible confounders. Results The response rate was 50%. The majority (81%) of respondents used some kind of contraception, and 88% were generally satisfied with the method used. Regardless of the type of method, 27% of hormonal contraceptive users reported a decrease in sexual desire that they attributed to their use of hormonal contraception, whereas only 12% of women using hormone-free contraception reported a decrease in sexual desire (p&lt;0.01). This twofold risk of a decrease in sexual desire was shown in the multiple regression analysis to be independent of age group, depression, BMI, educational level and parity. However, having a partner was found to be a factor of equal importance: women with partners experienced reduced desire twice as often as women without partners. The observed odds ratio for planning to stop hormonal contraception or to change to a different type due to reduced desire was 8.16 (95% confidence interval 6.65-10.1) among women who had had the same experience during a previous period of hormonal contraceptive use. Conclusions Women using hormonal contraception were more likely to experience reduced sexual desire compared with women using hormone-free contraception. Experiencing reduced desire was a strong predictive factor for women to change contraceptive method

Risk of abortion within 1-2 years after childbirth in relation to contraceptive choice: a retrospective cohort study

Objectives: The primary objective of the study was to investigate whether the choice of long-acting reversible contraception (LARC) was associated with the risk of abortion over a period of 24 months postpartum. The secondary objective was to analyse whether other significant factors were affecting the risk of abortion during this period. Methods: In this retrospective cohort study, we analysed 11,066 women who had delivered in three Swedish cities during 2013 and 2014. Demographic and medical variables were obtained from medical records. Attendance at the postpartum visit, choice of postpartum contraception and history of abortion was noted. Logistic regression analysis was performed to assess factors associated with the risk of abortion. The main outcome measure was the proportion of women with abortion up to 24 months postpartum. Results: Data from 11,066 women were included in the final analysis. Within 12-24 months after delivery 2.5% of women had an abortion. The choice of LARC after childbirth reduced the risk of subsequent abortion (odds ratio 0.74; 95% confidence interval [CI] 0.60, 0.91; p = .005). Smoking, age amp;lt;25 years and have had a previous abortion significantly increased the risk of abortion during follow-up, whereas exclusive breastfeeding decreased the risk. Conclusions: Increasing the proportion of women who choose LARC postpartum could decrease the risk of abortion for up to 2 years after childbirth.Funding Agencies|county council of Ostergotland and county council of Stockholm</p

Effectiveness, safety and overall satisfaction of early postpartum placement of hormonal IUD compared with standard procedure : An open-label, randomized, multicenter study

Introduction In this open-label, randomized controlled, non-inferiority, multicenter study we aimed to study the risk of termination of pregnancy within 1 year postpartum, the safety profile and patient acceptability after early postpartum insertion of a hormonal intrauterine device (LNG-IUS, Mirena (R)) compared with standard placement 6-8 weeks postpartum. Material and methods April 2018 to January 2020 women with uncomplicated vaginal delivery at four urban birth centers in Sweden, were randomized to either early placement within 48 h after delivery (early group) or standard placement 6-8 weeks postpartum (standard group) of a hormonal intrauterine device. The main outcome measure was the proportion of terminations of pregnancies in each group during the first year after placement of the intrauterine device. Registration EudraCT database no. 2017-001945-29. Results The study was prematurely stopped according to the protocol due to an expulsion rate &amp;gt;20% in the early group. No pregnancies occurred. Fifty-two women were randomized to early and 49 women to standard insertion. In the early group, 23/52 (44.2%) of the intrauterine devices were expelled. After expulsion, 10 women chose to have another hormonal intrauterine device placed but still significantly fewer women (39/52, 75%, p = 0.22) in the early group used the hormonal intrauterine device method at study completion. No expulsions occurred in the standard group, but 5/49 (10.2%) requested removal and 41/49 (83.7%, p = 0.22) had used the hormonal intrauterine device method continuously for 1 year. Conclusions Early hormonal intrauterine device insertion after vaginal delivery is associated with high expulsion rates. Despite this, a high continuation rate of the hormonal intrauterine device method is seen among women once choosing the method. In the light of high continuation rates, the advantages of early insertion could balance the risk of expulsion for well-informed women.Funding Agencies|County Council of Ostergotland (ALF) [LIO-931995, LIO-794921]</p