Pelle G. Lindqvist

Thrombotic risk during pregnancy: a population study.

OBJECTIVE To determine the incidence of pregnancy-related venous thromboembolic events and the relationship to selected risk factors such as maternal age, parity, smoking, preeclampsia, or cesarean delivery. METHODS All Swedish women reported as having pregnancy-related venous thromboembolic events during 1990-1993 (608 of 479,422 deliveries) were compared with all thrombosis-free Swedish pregnant women during 1993 (114,940). RESULTS The incidence of pregnancy-related venous thromboembolic events was 13 per 10,000 deliveries. Cesarean delivery was associated with a fivefold increased risk of venous thromboembolic events. Advanced age was not a significant risk factor itself, but was associated with an age-related increase in frequency of cesareans. Women with preeclampsia were at a threefold higher risk postpartum, but at no increased risk before delivery. There was a tobacco consumption-dependent increase in the risk of thrombosis among smokers. CONCLUSION The incidence of pregnancy-related thrombosis was 13 per 10,000 and provided new insights to important risk factors such as age, cesarean delivery, smoking, and preeclampsia.

Does antenatal identification of small‐for‐gestational age fetuses significantly improve their outcome?

Most obstetric clinics have a program for the identification of small‐for‐gestational age (SGA) fetuses because of the increased risk of fetal complications that they present. We have a structured model for the identification and follow‐up of SGA pregnancies. We aimed to determine whether the recognition of SGA antepartum improves fetal outcome.

The Association of Factor V Leiden and Prothrombin Gene Mutation and Placenta-Mediated Pregnancy Complications: A Systematic Review and Meta-analysis of Prospective Cohort Studies

Marc Rodger and colleagues report the results of their systematic review and meta-analysis of prospective cohort studies that estimated the association of maternal factor V Leiden and prothrombin gene mutation carrier status and placenta-mediated pregnancy complications.

General Acquisition of Human Papillomavirus Infections of Skin Occurs in Early Infancy

ABSTRACT The human skin papillomaviruses (HPVs) represent a group of ubiquitous viruses detected at a high prevalence in the normal skin of healthy adults. In the present study, we analyzed skin swab samples from babies during their first days of life and from infants at various ages up to age 4 years. Specimens from their parents and, for the newborn babies, environmental samples were also investigated. HPV DNA was already detected on the day of birth in samples from 2 of the 16 babies, and 45% of the samples from the babies were positive for HPV in the days following birth. Seventy-seven percent of the skin samples collected from the mothers were HPV DNA positive. The prevalence of HPV DNA among children from the ages of 1 month to 4 years varied between 50 and 70%. The HPV DNA sequences detected revealed a great diversity of genotypes and putative genotypes. Among 115 samples from 38 infants and 31 parents and 7 environmental samples, a total of 73 HPV types or putative types were isolated. Of these, 26 putative HPV types have not been described before. Our data suggest that asymptomatic HPV infections of normal skin are acquired very early in infancy and are caused by a great multiplicity of HPV types.

Frequency of anal sphincter rupture at delivery in Sweden and Finland ‐ result of difference in manual help to the baby's head

BACKGROUND Anal sphincter rupture is a serious complication of vaginal delivery and almost half the affected women have persistent defecatory symptoms despite adequate primary repair. During the past decade, the incidence of anal sphincter ruptures has been increasing in Sweden and is currently estimated to occur in 2.5% of vaginal deliveries. The aim of the study was to report the frequency of anal sphincter ruptures in two university hospitals in two Scandinavian countries, Malmö in Sweden and Turku in Finland, and analyze the potential determinants. METHODS Retrospective analysis of a population of 30,933 deliveries (26,541 vaginal) during the years 1990 to 1994. RESULTS The incidence of anal sphincter ruptures in Malmö, Sweden was 2.69%, and in Turku, Finland 0.36%. There were no significant population differences for the known risk factors (fetal weight, nulliparity or fetal head circumference). However, there is a difference in manual support given to the perineum and to the babys head when crowning through the vaginal introitus between Malmö and Turku. The proportion of operative vaginal deliveries and abnormal presentations was significantly higher in Turku reflected in the lower Apgar score at 5 minutes and longer duration of second phase of labor. When high risk deliveries (operative vaginal delivery, abnormal presentation and newborns over 4,000 g) were excluded, the risk for anal sphincter ruptures was estimated to be 13 times higher in Malmö than in Turku. CONCLUSIONS The difference in the incidence of anal sphincter rupture between Malmö, Sweden and Turku, Finland may be due to the difference in manual control of the babys head when crowning.

The relationship between lifestyle factors and venous thromboembolism among women: a report from the MISS study

There has been a great advance in our knowledge of the role that thrombophilic factors play in the risk of venous thromboembolic events (VTE). However, the effect of lifestyle factors on VTE has been inadequately explored in large scale studies of women. This cohort study comprised one thousand native Swedish women for each age year between 25 and 64 inclusive (total = 40 000) drawn from the South Swedish population registry for 1990 (n = 40 000), who were followed for a mean of eleven years. Seventy‐four percent completed a questionnaire at the inception of the study (n = 29 518) and 24 098 women responded to a follow‐up inquiry between the years 2000–2002. The main outcome was the relationship between VTE and physical exercise, smoking habits, and alcohol consumption. Moderate drinkers of alcohol (10–15 g/d) and women engaged in strenuous exercise were at half the risk of VTE compared to those who consumed little or no alcohol or lived a sedentary life. Heavy smoking was associated with a 30% increased risk of VTE. Lifestyle factors have a major impact on the risk of VTE. Women non‐smokers who were physically active and who consumed alcohol in moderation were at a lower risk of VTE.

Does an active sun exposure habit lower the risk of venous thrombotic events? A D‐lightful hypothesis

Summary.  Background: Venous and arterial thrombotic complications exhibit a seasonal variation, with risk peaking in winter and dropping to a nadir in summer. We sought a possible correlation between sun exposure habits and venous thromboembolism (VTE) events. Methods: This was a cohort study comprising 40 000 women (1000 per year of age from 25 to 64 years) who were drawn from the southern Swedish population registry for 1990 and followed for a mean of 11 years. Seventy‐four per cent answered an inquiry at the inception of the study (n = 29 518), and provided detailed information on their sun exposure habits. Cox regression analysis was used with the presence of VTE as a dependent variable and selected demographics as independent variables. The main outcome was the relationship between VTE and sun exposure habits. Results: Swedish women who sunbathed during the summer, on winter vacations, or when abroad, or used a tanning bed, were at 30% lower risk of VTE than those who did not. Risk estimates did not change substantially after adjustment for demographic variables. The risk of VTE increased by 50% in winter as compared to the other seasons; the lowest risk was found in the summer. Conclusions: Women with more active sun exposure habits were at a significantly lower risk of VTE. We speculate that greater ultraviolet B light exposure improves a person’s vitamin D status, which in turn enhances anticoagulant properties and enhances the cytokine profile.

Factor V Leiden in pregnancies complicated by placental abruption.

OBJECTIVE Recent studies suggest an increased prevalence of obstetric complications in female carriers of hereditary or acquired thrombophilias. The aim of the study was to determine if carriership of the factor V (FV) Leiden mutation (activated protein C [APC] resistance) is higher in women who have had of placental abruption during pregnancy. DESIGN A retrospective case-control study. SETTING University Hospital MAS, Malmö, Sweden. METHODS A comparison of 102 women with placental abruption with 2371 prospectively collected controls. Carriership of FV Leiden was determined and the women were interviewed. MAIN OUTCOME MEASURES Proportion of FV Leiden carriership, first degree heritage of thrombosis and previous placental abruption in cases and controls. RESULTS Carriage of FV Leiden was found in 15.7% of women who have had placental abruption as compared with 10.8% of controls (P = 0.12, odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.9-2.7). Around 20% of women with placental abruption reported first degree heritage for venous thrombosis, as compared with 6.7% of controls (P < or = 0.001). CONCLUSIONS FV Leiden carriership was not significantly different in women with placental abruption. However, there was an increased prevalence of first degree heritage for venous thrombosis in women with placental abruption, indicating a higher prevalence of thrombophilia among women with placental abruption.

Venous thromboembolism in relation to in vitro fertilization: an approach to determining the incidence and increase in risk in successful cycles

OBJECTIVE To determine the incidence and the increase in risk of venous thromboembolism (VTE) in relation to IVF and ovarian hyperstimulation syndrome (OHSS) in successful cycles. DESIGN Cohort study. SETTING Population based. PATIENT(S) All deliveries (n = 964,532) in Sweden during a 10-year period (1999-2008). INTERVENTION(S) Comparison of VTEs among those with and without IVF. The National Birth Registry was cross-matched with both the National Discharge Registry and the National IVF Registry. Logistic regression analysis was used to determine odds ratios and 95% confidence intervals. MAIN OUTCOME MEASURE(S) Risk of first trimester VTE. RESULT(S) The incidence of first-trimester VTE in relation to IVF was 0.2%, representing a 10-fold increase as compared with the background population. The 6% to 7% of IVF pregnancies that were complicated by OHSS showed a 100-fold increased risk of VTE, as opposed to the fivefold increased risk seen in the absence of OHSS. The VTEs in conjunction with IVF were diagnosed at a mean gestational age of 62 days; there was no increased risk of VTE related to frozen embryo replacement cycles or IVF after the first trimester. CONCLUSION(S) Treating women with OHSS with low-molecular-weight heparin thromboprophylaxis during the first trimester and treating cases at high-risk for OHSS with frozen embryo replacement is likely to lower the risk of VTE.

Correlation of birth injury with maternal height and birthweight

Background  Infant or maternal injury during vaginal delivery is a constant threat to all involved, but difficult to predict.