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Extremely preterm cesarean delivery: a clinical study.

https://arctichealth.org/en/permalink/ahliterature165432
Source
Acta Obstet Gynecol Scand. 2006;85(12):1442-7
Publication Type
Article
Date
2006
Author
U. Högberg
S. Håkansson
F. Serenius
P A Holmgren
Author Affiliation
Obstetrics and Gynecology, Umeå University, Umeå, Sweden. ulf.hogberg@obgyn.umu.se
Source
Acta Obstet Gynecol Scand. 2006;85(12):1442-7
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Asphyxia Neonatorum - epidemiology
Cesarean Section - methods - statistics & numerical data
Female
Gestational Age
Humans
Infant mortality
Infant, Newborn
Infant, newborn, diseases - epidemiology
Infant, Premature - growth & development
Perinatal care
Perioperative Care
Postoperative Complications - epidemiology
Pregnancy
Pregnancy Complications - surgery
Pregnancy outcome
Abstract
To describe indications for cesarean section for extremely preterm delivery, peri- and postoperative complications and perinatal outcome.
A case-referent study with clinical follow-up.
A tertiary perinatal center.
All deliveries at gestational age
PubMed ID
17260219 View in PubMed
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Infant mortality of very preterm infants by mode of delivery, institutional policies and maternal diagnosis.

https://arctichealth.org/en/permalink/ahliterature163409
Source
Acta Obstet Gynecol Scand. 2007;86(6):693-700
Publication Type
Article
Date
2007
Author
U. Högberg
P A Holmgren
Author Affiliation
Obstetrics and Gynecology, Department of Clinical Science, Umeå University, Umeå, Sweden. ulf.hogberg@obgyn.umu.se
Source
Acta Obstet Gynecol Scand. 2007;86(6):693-700
Date
2007
Language
English
Publication Type
Article
Keywords
Breech Presentation
Cohort Studies
Delivery, Obstetric - methods
Eclampsia
Female
Fetal Membranes, Premature Rupture
Gestational Age
Hemorrhage
Humans
Infant mortality
Infant, Newborn
Infant, Premature
Pregnancy
Pregnancy Complications - epidemiology
Retrospective Studies
Sweden - epidemiology
Abstract
The aim of this study was to analyse infant mortality among infants born extremely preterm in relation to mode of delivery, maternal diagnosis, and different institutional policies.
We conducted a national tertiary health care center study using Swedish Medical Birth Register (MBR) data from 1990 to 2002, to examine the 2,094 live births of infants at 23+0 to 27+6 weeks gestation. We assessed the association between mode of delivery, gestational age (GA), calendar year, maternal condition, and institutional policies on infant mortality outcome.
At 23-25 weeks, 38% of infants (range: 34-69%) were delivered by cesarean section (CS), while at 26-27 weeks, 66% (59-80%) were delivered by CS. The CS rate for fetal or maternal indications was 98% in cases of pre-eclampsia/eclampsia, 42% for premature rupture of membranes (PROM), 68% for hemorrhage, 76% for PROM+hemorrhage, 56% for breech presentation, and 30% for preterm vertex with no other complications. After cases of pre-eclampsia/eclampsia were excluded, vaginal delivery was associated with a small increase of risk for infant death. Vaginal delivery was associated with a significantly increased risk for infant death in breech presentations and multiple births, while vaginal delivery posed a non-significant risk increase for PROM and hemorrhage. For preterm vertex without any other complications, 4 out of 5 infants were delivered vaginally without any risk increase.
This study reports high CS rates for very preterm births at Swedish hospitals. In performing CS for very preterm infants, this study suggests a survival advantage for certain maternal conditions, but not for preterm labor with a vertex presentation without other obstetrical complications.
PubMed ID
17520401 View in PubMed
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Placental and germ cell alkaline phosphatase RFLPs and haplotypes associated with spontaneous abortion.

https://arctichealth.org/en/permalink/ahliterature64566
Source
Hum Hered. 1995 Sep-Oct;45(5):272-7
Publication Type
Article
Author
C. Wennberg
A. Kivelä
P A Holmgren
Author Affiliation
Department of Medical Genetics, Umeå University, Sweden, Finland.
Source
Hum Hered. 1995 Sep-Oct;45(5):272-7
Language
English
Publication Type
Article
Keywords
Abortion, Spontaneous - enzymology - genetics
Alkaline Phosphatase - genetics
Alleles
Chromosomes, Human, Pair 2
Comparative Study
Deoxyribonucleases, Type II Site-Specific
Female
Finland
Genotype
Haplotypes - genetics
Humans
Isoenzymes - genetics
Linkage (Genetics)
Placenta - enzymology
Polymorphism, Restriction Fragment Length
Pregnancy
Research Support, Non-U.S. Gov't
Sweden
Abstract
Placental alkaline phosphatase (PLAP) and germ cell alkaline phosphatase (GCAP) are controlled by closely linked genes on chromosome 2q34-q37. In previous investigations, associations have been found between PLAP types and spontaneous abortion. In this study, PLAP and GCAP RFLPs and haplotypes were found to show highly significant associations with spontaneous abortions in the Finnish and Swedish populations. However, different associations were found in the Finnish and Swedish populations. The Finnish abortions were associated with the GCAP allele PstI(b) 2 and the Swedish abortions with the PLAP allele PstI(a) 2. A possible mechanism behind the associations may therefore be linkage disequilibria with deleterious alleles within or close to the alkaline phosphatase gene complex.
PubMed ID
7590759 View in PubMed
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Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish perinatal centres. Part 3: neonatal morbidity.

https://arctichealth.org/en/permalink/ahliterature58235
Source
Acta Paediatr. 2004 Aug;93(8):1090-7
Publication Type
Article
Date
Aug-2004
Author
F. Serenius
U. Ewald
A. Farooqi
P A Holmgren
S. Håkansson
G. Sedin
Author Affiliation
Department of Paediatrics, Umeå University, Umeå, Sweden. fredrik.serenius.us@vll.se
Source
Acta Paediatr. 2004 Aug;93(8):1090-7
Date
Aug-2004
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Female
Humans
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight
Intensive Care, Neonatal
Logistic Models
Male
Morbidity
Perinatal care
Pregnancy
Research Support, Non-U.S. Gov't
Retrospective Studies
Sweden - epidemiology
Abstract
AIM: To determine major neonatal morbidity in surviving infants born at 23-25 weeks, and to identify maternal and infant factors associated with major morbidity. METHODS: The medical records of 224 infants who were delivered at two tertiary care centres in 1992-1998 were reviewed retrospectively. At these centres, policies of active perinatal and neonatal management were universally applied. Of the 213 liveborn infants, 140 (66%) survived to discharge. Data were analysed by gestational age and considered in three time periods. Logistic regression models were used to identify factors associated with morbidity. RESULTS: Of the survivors, 6% had intraventricular haemorrhage grade > or = 3 (severe IVH) or periventricular leukomalacia (PVL), 15% retinopathy of prematurity > or = stage 3 (severe ROP) and 36% bronchopulmonary dysplasia (BPD). On logistic regression analysis, severe IVH or PVL was associated with duration of mechanical ventilation (odds ratio, OR: 1.53 per 1-wk increment in duration; 95% confidence interval, CI: 1.01-2.33). Severe ROP was associated with the presence of a patent ductus arteriosus (PDA) (OR: 3.31; 95% CI: 1.11-9.90) and birth in time period 3 versus time periods 1 and 2 combined (OR: 6.28; 95% CI: 2.10-18.74). BPD was associated with duration of mechanical ventilation (OR: 2.71 per 1-wk increment in duration; 95% CI: 1.76-4.18) and with the presence of any obstetric complication (OR: 2.67; 95% CI: 1.07-6.65). Gestational age and birthweight were not associated with major morbidity. Of all survivors, 81% were discharged home without severe IVH, PVL or severe ROP. CONCLUSIONS: Increased survival as a result of active perinatal and neonatal management was associated with favourable morbidity rates compared with those in recent studies. Among survivors born at 23-25 weeks, neither gestational age nor birthweight was a significant determinant of major morbidity.
Notes
Comment In: Acta Paediatr. 2004 Aug;93(8):1027-815456188
PubMed ID
15456201 View in PubMed
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Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish tertiary care centres. Part 1: maternal and obstetric factors.

https://arctichealth.org/en/permalink/ahliterature58251
Source
Acta Paediatr. 2004 Jul;93(7):945-53
Publication Type
Article
Date
Jul-2004
Author
F. Serenius
U. Ewald
A. Farooqi
P A Holmgren
S. Hakansson
G. Sedin
Author Affiliation
Department of Paediatrics, Urmea University, Umeå, Sweden.
Source
Acta Paediatr. 2004 Jul;93(7):945-53
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Adult
Delivery, obstetric - statistics & numerical data
Female
Gestational Age
Humans
Infant, Newborn
Infant, Premature
Logistic Models
Maternal Age
Multivariate Analysis
Parity
Pregnancy
Pregnancy outcome
Pregnancy Trimester, Second
Research Support, Non-U.S. Gov't
Retrospective Studies
Sweden
Time Factors
Abstract
AIMS: To provide descriptive data on women who delivered at 23-25 wk of gestation, and to relate foetal and neonatal outcomes to maternal factors, obstetric management and the principal reasons for preterm birth. METHODS: Medical records of all women who had delivered in two tertiary care centres in 1992-1998 were reviewed. At the two centres, policies of active perinatal and neonatal management were universally applied. Logistic regression models were used to identify prenatal factors associated with survival. RESULTS: Of 197 women who delivered at 23-25 wk, 65% had experienced a previous miscarriage, 15% a previous stillbirth and 12% a neonatal death. The current pregnancy was the result of artificial reproduction in 13% of the women. In 71%, the pregnancy was complicated either by pre-eclampsia, chorioamnionitis, placental abruption or premature rupture of membranes. Antenatal steroids were given in 63%. Delivery was by caesarean section in 47%. The reasons for preterm birth were idiopathic preterm labour in 36%, premature rupture of membranes in 41% and physician-indicated deliveries in 23% of the mothers. Demographic details, use of antenatal steroids, caesarean section delivery and birthweight differed between mothers depending on the reason for preterm delivery. Of 224 infants, 5% were stillbirths and 63% survived to discharge. On multivariate logistic regression analysis comprising prenatally known variables, reasons for preterm birth were not associated with survival. Advanced gestational duration (OR: 2.43 per wk; 95% CI: 1.59-3.74), administration of any antenatal steroids (OR: 2.21; 95% Cl: 1.14-4.28) and intrauterine referral from a peripheral hospital (OR: 2.93; 95% CI: 1.5-5.73) were associated with survival. CONCLUSIONS: Women who deliver at 23-25 wk comprise a risk group characterized by a high risk of reproductive failure and pregnancy complications. Survival rates were similar regardless of the reason for preterm birth. Policies of active perinatal management virtually eliminated intrapartum stillbirths.
Notes
Comment In: Acta Paediatr. 2004 Aug;93(8):1027-815456188
PubMed ID
15303811 View in PubMed
Less detail

Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish tertiary care centres. Part 2: infant survival.

https://arctichealth.org/en/permalink/ahliterature51952
Source
Acta Paediatr. 2004 Aug;93(8):1081-9
Publication Type
Article
Date
Aug-2004
Author
F. Serenius
U. Ewald
A. Farooqi
P A Holmgren
S. Håkansson
G. Sedin
Author Affiliation
Department of Paediatrics, Umeå University, Umeå, Sweden.
Source
Acta Paediatr. 2004 Aug;93(8):1081-9
Date
Aug-2004
Language
English
Publication Type
Article
Keywords
Apgar score
Birth weight
Female
Humans
Infant mortality
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight
Intensive Care, Neonatal
Logistic Models
Multivariate Analysis
Perinatal care
Pregnancy
Pregnancy outcome
Research Support, Non-U.S. Gov't
Retrospective Studies
Survival Rate
Sweden - epidemiology
Abstract
AIM: To determine neonatal survival rates based on both foetal (stillborn) and neonatal deaths among infants delivered at 23-25 wk, and to identify maternal and neonatal factors associated with survival. METHODS: The medical records of 224 infants who were delivered in two tertiary care centres in 1992-1998 were reviewed retrospectively. At these centres, policies of active perinatal and neonatal management were universally applied. Data were analysed by gestational age groups and considered in three time periods. Logistic regression models were used to identify factors associated with survival. RESULTS: The rate of foetal death was 5%. Of infants born alive, 63% survived to discharge. Survival rates including foetal deaths in the denominator at 23, 24 and 25 wk were 37%, 61% and 74%, respectively, and survival rates excluding foetal deaths were 43%, 63% and 77%, respectively. Of infants born with 1-min Apgar scores of 0-1, 43% survived. In the total cohort, survival rates including foetal deaths in the denominator increased from 52% in time period 1 to 61% in time period 2 and 74% in time period 3 (p
Notes
Comment In: Acta Paediatr. 2004 Aug;93(8):1027-815456188
PubMed ID
15456200 View in PubMed
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Snoring, pregnancy-induced hypertension, and growth retardation of the fetus.

https://arctichealth.org/en/permalink/ahliterature58809
Source
Chest. 2000 Jan;117(1):137-41
Publication Type
Article
Date
Jan-2000
Author
K A Franklin
P A Holmgren
F. Jönsson
N. Poromaa
H. Stenlund
E. Svanborg
Author Affiliation
Department of Respiratory Medicine, University Hospital, Umeå, Sweden. Karl.Franklin@lung.umu.se
Source
Chest. 2000 Jan;117(1):137-41
Date
Jan-2000
Language
English
Publication Type
Article
Keywords
Adult
Body Weight
Comparative Study
Female
Fetal Growth Retardation - complications
Humans
Hypertension - complications
Infant, Newborn
Infant, Small for Gestational Age
Odds Ratio
Pre-Eclampsia - complications
Pregnancy
Pregnancy outcome
Pregnancy Trimester, Third
Questionnaires
Research Support, Non-U.S. Gov't
Snoring - etiology
Abstract
STUDY OBJECTIVE: Our purpose was to study the relationship between snoring and pregnancy-induced hypertension and growth retardation of the fetus. DESIGN: Retrospective, cross-sectional, consecutive case series. SETTING: The Department of Gynecology and Obstetrics, University Hospital, Umeâ, Sweden. Participants and measurements: On the day of delivery, 502 women with singleton pregnancies completed a questionnaire about snoring, witnessed sleep apneas, and daytime fatigue. Data concerning medical complications were taken from the women's casebooks. RESULTS: During the last week of pregnancy, 23% of the women reported snoring every night. Only 4% reported snoring before becoming pregnant. Hypertension developed in 14% of snoring women, compared with 6% of nonsnorers (p
PubMed ID
10631211 View in PubMed
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The very preterm infant - a population-based study.

https://arctichealth.org/en/permalink/ahliterature32156
Source
Acta Obstet Gynecol Scand. 2001 Jun;80(6):525-31
Publication Type
Article
Date
Jun-2001
Author
P A Holmgren
U. Högberg
Author Affiliation
Obstetrics and Gynecology, Department of Clinical Science, Umeå University, Umeå, Sweden.
Source
Acta Obstet Gynecol Scand. 2001 Jun;80(6):525-31
Date
Jun-2001
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Confidence Intervals
Female
Fetal Death - epidemiology
Fetal Growth Retardation - epidemiology
Fetal Membranes, Premature Rupture - epidemiology
Gestational Age
Humans
Incidence
Infant Mortality - trends
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight
Population Surveillance
Pregnancy
Research Support, Non-U.S. Gov't
Risk assessment
Risk factors
Sweden - epidemiology
Abstract
OBJECTIVES: The aim of this study was to assess perinatal risk factors and the survival of the very preterm infant in comparison with birth beyond 32nd birthweek, as well as health care utilization by mothers and infants in the Northern Health Region of Sweden. DESIGN: A population-based study was designed of all children (66,646) born in the Northern Health Region of Sweden during 1991-1996 and registered in the Swedish Medical Birth Registry. METHODS: Maternal and perinatal factors of infants born very preterm, that is, at
PubMed ID
11380288 View in PubMed
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8 records – page 1 of 1.