Caroline Lilliecreutz

Psychiatric illness in women requesting caesarean section.

To compare psychiatric in‐ and outpatient care during the 5 years before first delivery in primiparae delivered by caesarean section on maternal request with all other primiparae women who had given birth during the same time period.

Obstetric and perinatal outcomes among women with blood- and injection phobia during pregnancy

BACKGROUND Little is known about how anxiety disorders affect pregnancy outcomes. Therefore we investigated the impact of one anxiety disorder, blood- and injection phobia, on obstetric and neonatal outcomes. METHODS From a population-based prospectively collected cohort we compared an index group of 110 women with blood- and injection phobia with a control group of 220 women. Standardized medical records were used to collect data. Obstetric and neonatal outcomes e.g. elective cesarean, prematurity, and small for gestational age were used as the main outcome measures. RESULTS Women with blood- and injection phobia stated more often a fear of childbirth (p<0.001) and were more frequently delivered by elective cesarean section (p=0.032). The incidence of premature delivery (p=0.028), neonatal morbidity (p=0.001) and the risk of having a baby born small for gestational age (p=0.009) was higher among women with blood- and injection phobia. LIMITATIONS The medical records, from which all information is drawn, despite standardization, sometimes may lack some information. However, this dilemma exists in both groups. CONCLUSIONS Women with an anxiety disorder such as blood- and injection phobia are at increased risk for adverse obstetric outcomes, premature delivery and for having a baby born with higher neonatal morbidity. It therefore seems important to identify and treat women with anxiety disorders without delay early during pregnancy in an effort to minimize risks of complications for the woman herself and the child.

Prevalence of blood and injection phobia among pregnant women.

Objective. The aim of the study was to investigate the prevalence of blood and injection phobia in an unselected pregnant population, in order to estimate the need for curative intervention programmes. Design. A cross‐sectional study. Setting. Antenatal care clinics in the southeast region of Sweden. Sample. In total, 1,606 consecutively registered pregnant women attending their first visit with a midwife. Methods. The women were asked to complete the Injection Phobia‐Anxiety scale, measuring phobic symptoms. Women who scored >20 on the questionnaire were telephone‐interviewed and then diagnosed or dismissed according to the DSM‐IV criteria for blood and injection phobia. Main outcome measures. Prevalence of blood and injection phobia according to the DSM‐IV. Results. Of 1,529 women who chose to participate (92.5%), 110 women or 7.2% fulfilled the DSM‐IV criteria for blood and injection phobia. The mean age of the women was 29.1 years. Conclusions. Blood and injection phobia is hitherto unreported in the literature, but seems to be relatively common and needs to be recognized during pregnancy as it causes a great deal of discomfort and fear among pregnant women. The Injection Phobia‐Anxiety scale is suitable as a screening tool in an antenatal care clinic setting.

Obstetric outcomes for nulliparous women who received routine individualized treatment for severe fear of childbirth - a retrospective case control study

BackgroundTo study pregnancy and delivery outcomes in nulliparous women with severe FOC (fear of childbirth), all of whom had received routine treatment for their FOC and to make comparisons with a healthy reference group of nulliparous women.To study the possible relationship between the number of FOC-treatment sessions and the delivery method.MethodsAll nulliparous women with a diagnose FOC who received routine treatment for FOC (n = 181) and a reference group of nulliparous women without FOC (n = 431) at a university and a county hospital in the south east region of Sweden were analysed. Data from antenatal and delivery medical records were used to study outcome.ResultsThe majority of women with severe FOC had a vaginal delivery. The incidence of elective CS was greater in the index group than in the reference group (p < 0.001). The total number of women with a planned CS in the index group was 35 (19.4%) and in the control group 14 (3.2%). Thus, on average five women per year received an elective CS during the study years due to severe FOC. The women in the index group who wished to have a CS were similar to the other women in the index group with reference to age, BMI, chronic disease but had been in in-patient care more often during their pregnancy than those who did not ask for CS (p = 0.009).ConclusionIn this study of women treated for severe FOC, the majority gave birth vaginally and no relationship was found between number of treatment sessions and mode of childbirth.

Reproduction and mode of delivery in women with vaginismus or localised provoked vestibulodynia: a Swedish register‐based study

To compare sociodemographics, parity and mode of delivery between women diagnosed with vaginismus or localised provoked vestibulodynia (LPV) to women without a diagnosis before first pregnancy.

Drug use in pregnant women—a pilot study of the coherence between reported use of drugs and presence of drugs in plasma

PurposeIn Sweden, information on drug use during pregnancy is obtained through an interview and recorded in a standardized medical record at every visit to the antenatal care clinic throughout the pregnancy. Antenatal, delivery, and neonatal records constitute the basis for the Swedish Medical Birth Register (MBR). The purpose of this exploratory study was to investigate the reliability of reported drug use by simultaneous screening for drug substances in the blood stream of the pregnant woman and thereby validate self-reported data in the MBR.MethodsPlasma samples from 200 women were obtained at gestational weeks 10–12 and 25 and screened for drugs by using ultra-high performance liquid chromatography with time of flight mass spectrometry (UHPLC-TOF-MS). The results from the analysis were then compared to medical records.ResultsAt the first sampling occasion, the drugs found by screening had been reported by 86% of the women and on the second sampling, 85.5%. Missed reported information was clearly associated with drugs for occasional use. The most common drugs in plasma taken in early and mid-pregnancy were meclizine and paracetamol. Two types of continuously used drugs, selective serotonin reuptake inhibitors and propranolol, were used. All women using them reported it and the drug screening revealed a 100% coherence.ConclusionsThis study shows good coherence between reported drug intake and the drugs found in plasma samples, which in turn positively validates the MBR.