Lena Marions

Pregnant women's experiences, needs, and preferences regarding information about malformations detected by ultrasound scan

OBJECTIVESnThe aim of the study was to explore pregnant womens experiences of received information in relation to fetal malformation detected on ultrasound.nnnMETHODnAn exploratory descriptive design was used. Semi-structured interviews with women who continued their pregnancy and women who chose to terminate were audiotaped, the information pathway described, and the text subjected to qualitative content analysis.nnnRESULTSnMost of the women who expected a baby with an abnormality experienced the information given as insufficient, often misleading, conflicting, or incoherent, and sometimes negative. Important factors for interaction between women and caregivers were timing, duration, and manner of the initial dialog and ongoing support. Positive interactions improved the womens ability to understand the information, fostered feelings of trust and safety which reduced their anxiety.nnnCONCLUSIONnWomen expressed dissatisfaction both regarding the care-givers methods of giving information and apply for information from different specialists and continuity. The study highlights important factors which may be helpful to the professionals for improving the information to this vulnerable group of women.

Pregnant women’s perspectives on decision-making when a fetal malformation is detected by ultrasound examination

OBJECTIVESnThe aims of the study were to explore factors influencing the decision to continue or terminate pregnancy due to detection of fetal malformation following ultrasound examination, to elucidate the need for more information or other routines to facilitate the decision-making process and to assess satisfaction with the decision made.nnnDESIGNnDescriptive study.nnnSETTINGnFour fetal care referral centres in Stockholm, Sweden.nnnPOPULATIONnPregnant women with a detected fetal malformation.nnnMETHODSnData was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed.nnnRESULTSnBoth women who continued and those who terminated pregnancy based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were aspects including socioeconomic considerations. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (p < or = 0.004) of previous abortions than those in the continuing group (23.2%).nnnCONCLUSIONnThe decision to continue or terminate the pregnancy was to a great extent based on the severity of the malformation. Religious aspects did not seem to influence the decision. Many women expressed a need for additional occasion of information. The vast majority of women were satisfied with their decision.

Pregnancy termination due to fetal anomaly: Women's reactions, satisfaction and experiences of care

OBJECTIVEnto explore what women who have had a pregnancy terminated due to a detected fetal malformation perceived as having been important in their encounters with caregivers for promoting their healthy adjustment and well-being.nnnMETHODnan exploratory descriptive design was used. Semi-structured interviews were audiotaped, and the information pathway described. The text was processed through qualitative content analysis in six steps.nnnSETTINGnfour fetal care referral centres in Stockholm, Sweden.nnnPARTICIPANTSn11 women opting for pregnancy termination due to fetal malformation.nnnFINDINGSnin-depth understanding and compassion are important factors in providing the feeling of support people need so they are able to adapt to crisis. The women emphasised that the caregivers have to communicate a sense of responsibility, hope and respect and provide on-going care for them to feel assured of receiving good medical care and treatment. Aside from existing psychological conditions, the women identified as having emotional distress directly after termination and for at least the following three months. Most women experienced a range of negative emotions after pregnancy termination, including sadness, meaninglessness, loneliness, tiredness, grief, anger and frustration. Still some of this group had positive reactions because they experienced empathy and well-organised care.nnnCONCLUSION AND IMPLICATIONS FOR PRACTICEnThe most important factors associated with satisfaction regarding pregnancy termination due to a fetal malformation are the human aspects of care, namely state-dependent communication and in-depth understanding and compassion. The changes in care most often asked for were improvements in the level of standards and provision of adequate support through state-dependent communication, in-depth understanding and compassion, and complete follow-up routines and increased resources. Targeted education for the caregivers may be suited to ensuring that they properly meet needs of their patients.

Oral human papillomavirus (HPV) prevalence in youth and cervical HPV prevalence in women attending a youth clinic in Sweden, a follow up-study 2013-2014 after gradual introduction of public HPV vaccination.

Abstract During 2009–2011, we reported that the oral and cervical prevalence of human papillomavirus (HPV) was high by international standards at 9.3% and 74%, respectively, in youth aged 15–23 years attending a youth clinic in Stockholm. After gradual introduction of public HPV vaccination during 2007–2012, between 2013 and 2014, when 73% of the women were HPV-vaccinated, but not necessarily before their sexual debut, oral HPV prevalence had dropped to 1.4% as compared with 9.3% in 2009–2011 (p < 0.00001). Cervical HPV prevalence was high and common cervical high-risk types were HPV51, 56, 59, 73, 16, 39, 52, and 53. However, it was shown that HPV16, 31, and 70 were significantly less common among HPV-vaccinated women than among those who had not received the vaccine.

Health providers' competence in the management of reproductive tract infections in Vientiane, Lao People's Democratic Republic

This cross-sectional study aimed to assess health providers reported knowledge and practice competence regarding management of reproductive tract infections (RTIs) including sexually transmitted infections (STIs) in Vientiane, Laos. All 272 health providers (medical doctors/assistants, midwives/nurses and drug sellers) working with RTI/STI patients in one urban and one rural district were invited to fill in a self-completed questionnaire including four written simulated case scenarios, and 93% participated in the study. Of 252 respondents, 34% scored below 50% regarding both the case scenarios and reported knowledge, and 87% gave inadequate advice regarding health education. Only 34% gave correct advice on contact tracing, 38% on counselling, 52% regarding compliance and 59% on condom promotion. Drug sellers scored lowest in all aspects of RTI/STI management. Urban respondents were more likely to report adequate knowledge. Continuous training in syndromic approach and supervision are recommended to improve the quality of RTI/STI management, particularly at private pharmacies and in rural areas.

Genital human papillomavirus infection among women in Bangladesh: findings from a population-based survey.

Background There has been no population-based study on human papillomavirus (HPV) prevalence or its genotypes in Bangladesh; a country eligible for GAVI funding for HPV vaccine. Methods We used baseline survey data of a prospective cohort study that was conducted in one urban and one rural area of Bangladesh. A total of 997 urban and 905 rural married women, aged 13 to 64 years, were enrolled in the baseline during July-December, 2011. Information was collected on socio-demographic characteristics and potential risk factors for HPV infection followed by gynecological examination and collection of endocervical samples using the cervical cytobrush (Digene cervical sampler). HPV DNA testing was done by Polymerase Chain Reaction (PCR) using a consensus primer set. Results Prevalence of any HPV infection was 7.7% with no significant difference between urban and rural women. Most common high-risk genotypes were HPV16, HPV66, HPV18, HPV45, HPV31 and HPV53. Urban women working as housemaids or garment workers were at higher risk of any HPV infection (ORu200a=u200a2.15, 95% CI: 1.13–4.11) compared to housewives. Rural women whose husband lived overseas were almost two times more likely to have any HPV infection (ORu200a=u200a1.93; 95% CI 1.05–3.55) compared to women whose husbands lived with them. Conclusion The prevalence of HPV infection among Bangladeshi women is similar to other regions of Asia. However, type-specific patterns are different. The study findings will inform the formulation of HPV vaccination policies in Bangladesh, monitoring the impact of vaccination programmes, and the identification of target populations for screening.

Adverse pregnancy outcomes in rural Uganda (1996-2013): trends and associated factors from serial cross sectional surveys.

ObjectiveCommunity based evidence on pregnancy outcomes in rural Africa is lacking yet it is needed to guide maternal and child health interventions. We estimated and compared adverse pregnancy outcomes and associated factors in rural south-western Uganda using two survey methods.MethodsWithin a general population cohort, between 1996 and 2013, women aged 15–49 years were interviewed on their pregnancy outcome in the past 12 months (method 1). During 2012–13, women in the same cohort were interviewed on their lifetime experience of pregnancy outcomes (method 2). Adverse pregnancy outcome was defined as abortions or stillbirths. We used random effects logistic regression for method 1 and negative binomial regression with robust clustered standard errors for method 2 to explore factors associated with adverse outcome.ResultsOne third of women reported an adverse pregnancy outcome; 10.8 % (abortion = 8.4 %, stillbirth = 2.4 %) by method 1 and 8.5 % (abortion = 7.2 %, stillbirth = 1.3 %) by method 2. Abortion rates were similar (10.8 vs 10.5) per 1000 women and stillbirth rates differed (26.2 vs 13.8) per 1000 births by methods 1 and 2 respectively. Abortion risk increased with age of mother, non-attendance of antenatal care and proximity to the road. Lifetime stillbirth risk increased with age. Abortion and stillbirth risk reduced with increasing parity.DiscussionBoth methods had a high level of agreement in estimating abortion rate but were markedly below national estimates. Stillbirth rate estimated by method 1 was double that estimated by method 2 but method 1 estimate was more consistent with the national estimates.ConclusionStrategies to improve prospective community level data collection to reduce reporting biases are needed to guide maternal health interventions.

Effect of post-menstrual regulation family-planning service quality on subsequent contraceptive use in Bangladesh.

To determine whether the quality of post‐menstrual regulation family‐planning services (post‐MRFP) affected contraceptive use at 3‐month follow‐up.

Follow-up on oral and cervical human papillomavirus prevalence 2013–2015 in youth at a youth clinic in Stockholm, Sweden

In 2009–2011, among young people aged 15–23 years who were not vaccinated against human papillomavirus (HPV), the prevalence of cervical HPV was 70%, with 34.7% being HPV 16-positive at a Stockholm youth clinic, while the prevalence of oral HPV was 9.3% [1,2]. In addition, high frequencies of highrisk (HR-HPV) 51 (10.7%), 18 (10.1%) and 52 (9.9%) were observed in cervical samples [1]. In a follow-up study performed from October 2013 to April 2014 at the same youth clinic, we recently reported that 73% of the women had been vaccinated against HPV (the majority with Gardasil), but not necessarily before sexual debut [3]. At this time, overall oral HPV prevalence and cervical HPV 16 prevalence had decreased significantly [3]. Oral HPV prevalence was now 1.4% and cervical HPV 16 prevalence was significantly lower, with 5% in vaccinated as compared with 24% in non-vaccinated individuals [3]. Moreover, there was also a significant decrease in cervical prevalence of HPV 31 and 70 between vaccinated and non-vaccinated individuals [3]. The previous follow-up study has now been extended from May 2014 to May 2015 and here we present an updated report from October 2013 to May 2015, including 457 mouthwash samples (335 from women and 122 from men) and 338 cervical samples. The study was performed according to ethical permissions from the Stockholm Regional Ethical Committee. Vaccination against HPV was self-reported. No behavioural data were acquired. Oral samples, collected in 50% Listerine as described previously or Scope mouthwash, were spun down and stored at –20 C [1,2]. Cervical samples were collected in SurePath solution and stored at +4 C [1,2]. Following DNA extraction and multiplex PCR, the presence of 27 HPV types was evaluated by a bead-based Luminex assay as reported; however, since then the evaluation of the HPV 33 E6 region has also been included [3,4]. During the whole follow-up period from October 2013 to May 2015, 71% of the women reported being catch-up vaccinated. Oral HPV prevalence was 1.5%, with 7/457 samples being positive for HPV DNA, of which 3 were from men and 4 from women, with only one being positive for HPV 16. Cervical HPV prevalence was 64.6% in vaccinated and 74.5% in nonvaccinated women (p1⁄4 0.096), with a lower HR-HPV type frequency in vaccinated as compared with non-vaccinated women (50.8% and 62.2%, respectively, p1⁄4 0.031). Moreover, HPV 16, HPV 31 and HPV 6, were significantly lower in frequency in cervical samples from vaccinated as compared with non-vaccinated women (p1⁄4 0.0006, p1⁄4 0.038 and p1⁄4 0.009, respectively) (Figure 1). In addition, there was a significant decrease in cervical HPV 16 prevalence in nonvaccinated women in 2013–2015 (18%), as compared with nonvaccinated women in 2008–2011 (34.7%) [1], p1⁄4 0.00038. Currently, the five most common HR-HPV types are HPV 59, 56, 51, 52 and 39. For details of cervical HPV prevalence in vaccinated and non-vaccinated women during 2013–2015 in comparison with non-vaccinated women during 2008–2011 see Figure 1. To conclude, in this extended follow-up study, catch-up vaccination frequency was 71%, and both oral HPV prevalence at 1.5% for the whole cohort, and cervical HPV 16 prevalence at 5% in vaccinated women remained low. There was a significant decrease in cervical HPV prevalence of both the vaccine types 16 and 6, as well as the non-vaccine type 31 (but not for HPV 70 in this study as compared with that reported before) in vaccinated as compared with non-vaccinated women.

Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination

Objectives: Exploring factors influencing the decision to continue or terminate a pregnancy after detection of a fetal malformation following an ultrasound examination, to elucidate the need for more information or other routines to facilitate the decisionmaking process and to assess satisfaction with the decision made; Design: Descriptive study; Setting: Four fetal care referral centres in Stockholm, Sweden; Population: Pregnant women with a detected fetal malformation. Methods: Data was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed. Results: Women who continued as well as those who terminated their pregnancies based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were other aspects. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (P = <0.004) of previous abortions than those in the continuing group (23.2%). Conclusions: All women whose fetuses had a severe malformation terminated the pregnancy. Nobody stated religious factors as a reason to terminate. Most of the women declared that they made the right decision about continuing or terminating the pregnancy. Many women expressed a need for further information on several occasions to facilitate the difficult decision-making process.