Hakan Rydhstroem

Congenital malformations after the use of inhaled budesonide in early pregnancy

OBJECTIVE To study possible teratogenic risks with the use of an inhaled glucocorticoid, budesonide, in early pregnancy. METHODS Using the Swedish Medical Birth Registry, congenital malformations were studied in 2014 infants whose mothers had used inhaled budesonide for asthma in early pregnancy. The presence of congenital malformations was checked further with auxiliary registries. RESULTS No increase in the general rate of congenital malformations was observed: 3.8% (95% confidence interval [CI] 2.9, 4.6) of the infants had a congenital malformation diagnosed, which is similar to the population rate (3.5%). After exposure to budesonide, four infants were born with orofacial clefts; this also is similar to the expected number (3.3). CONCLUSION Even though a specific teratogenic effect of use of budesonide in early pregnancy cannot be ruled out, it is unlikely that a clinically significant teratogenic risk exists.

Obstetric risk factors for stress urinary incontinence: a population-based study.

Objective To evaluate obstetric and maternal risk factors for stress urinary incontinence. Methods We linked three national, Swedish, population-based registries with the use of unique personal identification numbers. All women born between 1932 and 1977 and operated on for stress urinary incontinence between 1987 and 1996 were identified from the Hospital Discharge Registry. This information was linked with the Medical Birth Registry (for the years 1973–1995), containing information on antenatal care, delivery, and the newborn, and the Fertility Registry (for the years 1932–1997), containing information on the number of children delivered by each Swedish woman. For determination of odds ratios (ORs) and approximate 95% confidence intervals (CIs), we used the Mantel-Haenszel method and a test-based method after suitable stratifications and exclusions. Results Diabetes mellitus, body mass index (BMI), age at first delivery, parity, birth weight, and epidural analgesia were positively associated with incontinence surgery. In contrast, cesarean delivery, forceps/vacuum extraction, and episiotomy were negatively associated with incontinence surgery. No association was found between surgery for stress incontinence and age at last delivery, smoking during pregnancy, level of education, multiple birth, large perineal tear, or breech presentation at any vaginal delivery. The OR for incontinence surgery was similarly decreased for nulliparous women and for uniparous women delivered by elective cesarean. Conclusion Vaginal delivery, notably the first, is strongly associated with later surgery for stress incontinence, but the association is modified by maternal conditions and interventions during delivery. No association was found between surgery for stress incontinence and pregnancy per se.

Asthma during pregnancy--a population based study.

To study delivery outcome in women with asthma, using Swedish health registers. Women with asthma were identified in two ways: by information in interviews performed by midwives at the pregnant womans first visit to antenatal care, and by linkage between a medical birth register and a hospital discharge register, identifying women who had been hospitalized for asthma and also had a delivery. Births between 1984 and 1995 were studied. An increased risk for preterm birth and low birth weight was seen, possibly co-varying with disease severity. Also a significant increase in pregnancies of more than 41 weeks duration was noticed. An increase in infant death but not in congenital malformations rate was observed. An association with preeclampsia, gestational diabetes, and infant hypoglycemia was verified. Maternal asthma appears to be a risk factor for preterm and postterm births and increases the risk for some pregnancy complications.

Routine oxytocin in the third stage of labour: a placebo controlled randomised trial

Objective To compare intravenous oxytocin administration (Partocon® 10 IU) with saline solution in the management of postpartum haemorrhage in the third stage of labour.

The relation between inter-twin birth weight discordance and total twin birth weight

OBJECTIVE We tested the hypothesis that the frequency of growth discordance among twins is not related to the uterine capacity for carrying twins. METHOD We counted and compared the frequencies of birth weight discordance of more than 25% in an unlike-sexed twin cohort (n = 1244) and in a population-based twin cohort (n = 7570) across the deciles of the total twin birth weight (twin A + twin B) distribution. The birth order of the heavier twin was noted. RESULTS Similar frequencies of discordant pairs were found in both cohorts (11% and 12%, respectively; Mantel-Haenszel chi2 test: P = .131, odds ratio (OR) 0.9, 99% confidence interval (CI) 0.67, 1.11; Woolf test for heterogeneity: two-tailed P = .472). In the discordant pairs, twin A was considerably more often the heavier twin in all birth weight deciles (unlike-sexed cohort: P < 10(-8), OR 5.9, 99% CI 3.0, 11.7; population-based cohort: P < 10(-8), OR 3.1, 99% CI 2.3, 4.0), and in both cohorts (inter-cohort difference: P = .109, OR 1.4, 99% CI 0.83, 2.32). Both cohorts showed a similar nonlinear trend: given that X = decile order, discordance decreased as a function of 22.0 - 6.54 ln[X] for the unlike-sexed twins cohort and 23.0 - 8.18 ln[X] for the population-based cohort, with r values of 0.967. CONCLUSION The more favorable the uterine milieu for carrying twins, the smaller the likelihood of discordant twin growth. Birth order of the heavier twin appears to be an integral part of the discordance phenomenon. The similarity of the cohorts suggests that these conclusions are valid for both like and unlike-sexed twins.

Rupture of the sphincter ani: the recurrence rate in second delivery

Background  Injury to the genital tract sustained during childbirth can lead to transient or protracted morbidity. Attention should be paid to avoidable risk factors that can cause this complication.

Ultrasound screening for fetal anomalies in Southern Sweden: a population-based study

Background. The accuracy of ultrasound in the diagnosis of congenital malformations has been the subject of many studies. Most of these are hospital‐based studies over a limited period of years presenting high detection rates and also relatively high incidence of major malformations. We present here a large population‐based study over a long period of years. Methods. The prenatal diagnoses are compared with the diagnoses of the newborns and aborted fetuses, including autopsy results. The detection rate of some common structural malformations is studied. Results. The overall detection rate of malformations in our study was 28.4%. We noticed an improved detection rate of heart defects and cleft lip during the study period. The prevalence of malformations in the population was 2.6%. The false positive diagnoses were few, 54 cases, and mainly of a mild nature. Conclusions. Ultrasound screening of fetal malformations in our population has a low false positive rate and even though the overall sensitivity is low, 28.4%, the detection rate for many common structural malformations is relatively good.

Factors related to breast abscess after delivery: a population‐based study

Objective  To investigate whether there are underlying factors, other than breastfeeding behaviours, which may contribute to the development of breast abscess during the year following delivery.

Pregnancy with stillbirth of both twins

Objective To identify and evaluate clinical characteristics in pregnancy leading to stillbirth of both twins.

The relationship of birth weight and birth weight discordance to cerebral palsy or mental retardation later in life for twins weighing less than 2500 grams

OBJECTIVE This study tested the hypothesis that twins with a birth weight < 2500 gm who subsequently had cerebral palsy or mental retardation had a birth weight distribution or birth weight discordance distribution differing from that of the total live-born twin population also weighing < 2500 gm at birth. STUDY DESIGN All twins born in Sweden between 1973 and 1980 (n = 5382) and having a birth weight < 2500 gm were identified by using information stored at the Medical Birth Registry, the National Board of Health and Welfare, Stockholm, or at Statistics Sweden. To identify twins with cerebral palsy or mental retardation, a questionnaire bearing the personal identification number (given to all newborns in Sweden shortly after birth) was distributed to all rehabilitation centers, all county school boards, all local boards of education, and to all County Councils for the Provisions and Services for the Mentally Retarded. The questionnaire was distributed in 1988 and 1989 when the twins were > or = 8 years old. RESULTS Altogether 115 disabled twins resulting from 99 pregnancies were identified. The incidence of disabled twins per 1000 was 21.4 (95% confidence interval 17.5 to 25.2). No obvious difference was evident in the distribution of birth weight discordance when the twins with disability were compared with the population of all live-born twins having a birth weight < 2500 gm. Disabled twins had a significantly lower birth weight for gestational age (t = -3.5, p < 0.001), but in fact only 10 (8.7%) twins had a birth weight < -2 SD. No difference in the incidence of disability was found for twin A versus twin B (relative risk 1.3, 95% confidence interval 0.8 to 1.9) or for like-sex versus unlike-sex twins (relative risk 1.0, 95% confidence interval 0.6 to 1.6). However, the larger twin in the pair had a significantly higher incidence of cerebral palsy than the smaller one did (relative risk 2.6, 95% confidence interval 1.4 to 4.8). CONCLUSIONS Birth weight discordance for twins seems not to be related to disability later in life. The great majority of twins with a birth weight < 2500 gm who later became disabled were appropriate for gestational age at birth.