Publications by authors named "Anna Aabakke"

21 Publications

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A prospective cohort study of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy evaluating SARS-CoV-2 antibodies in maternal and umbilical cord blood and SARS-CoV-2 in vaginal swabs.

Acta Obstet Gynecol Scand 2021 12 1;100(12):2268-2277. Epub 2021 Nov 1.

Department of Obstetrics and Gynecology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.

Introduction: Evidence about the consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is rapidly increasing; however, data on antibody response and risk of transmission during pregnancy and delivery are still limited. The aim of this study was to evaluate if SARS-CoV-2 is detectable in vaginal swabs and whether antibodies against SARS-CoV-2 are present in maternal and umbilical cord blood of pregnant women with confirmed SARS-CoV-2.

Material And Methods: A single-unit prospective cohort study in Denmark including pregnant women with SARS-CoV-2 infection confirmed by a pharyngeal swab between August 20, 2020, and March 1, 2021, who gave birth during the same period. All patients admitted to the maternity ward and antepartum clinic were screened for SARS-CoV-2 infection. A maternal blood sample and vaginal swabs were collected at inclusion. If included antepartum, these samples were repeated intrapartum when an umbilical cord blood sample was also collected. Swabs were analyzed for SARS-CoV-2 and blood samples were analyzed for SARS-CoV-2 total antibodies. Placental and neonatal swabs as well as placental histopathological examinations were performed on clinical indications.

Results: We included 28 women, of whom four had serious maternal or fetal outcomes including one case of neonatal death. Within the first 8 days after confirmed SARS-CoV-2 infection, SARS-CoV-2 was detectable in two vaginal swabs (2/28) and SARS-CoV-2 antibodies were detected in 1 of 13 women. From 16 days after confirmed infection, antibodies were observed in 19 of 21 of women. Antibodies in cord blood were not detected during the first 16 days after confirmed infection (n = 7). However, from 26 days, antibodies were present in 16 of 17 cord blood samples of seropositive mothers. Placental examination in two cases of severe fetal outcomes preceded by reduced fetal movements revealed SARS-CoV-2 in swabs and severe histopathological abnormalities.

Conclusions: SARS-CoV-2 was detected in only 2 of 28 vaginal swabs within 8 days after confirmed infection in pregnant women. Our data suggest that maternal seroconversion occurs between days 8 and 16, whereas antibodies in cord blood of seropositive mothers were present in the majority from 26 days after confirmed infection. Additional data are needed regarding timing of seroconversion for the mother and appearance of antibodies in cord blood.
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http://dx.doi.org/10.1111/aogs.14274DOI Listing
December 2021

SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: A nationwide, prospective, population-based cohort study.

Acta Obstet Gynecol Scand 2021 Nov 31;100(11):2097-2110. Epub 2021 Aug 31.

Department of Obstetrics and Gynecology, The North Denmark Regional Hospital Thisted, Thisted, Denmark.

Introduction: Assessing the risk factors for and consequences of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy is essential to guide clinical care. Previous studies on SARS-CoV-2 infection in pregnancy have been among hospitalized patients, which may have exaggerated risk estimates of severe outcomes because all cases of SARS-CoV-2 infection in the pregnant population were not included. The objectives of this study were to identify risk factors for and outcomes after SARS-CoV-2 infection in pregnancy independent of severity of infection in a universally tested population, and to identify risk factors for and outcomes after severe infection requiring hospital admission.

Material And Methods: This was a prospective population-based cohort study in Denmark using data from the Danish National Patient Register and Danish Microbiology Database and prospectively registered data from medical records. We included all pregnancies between March 1 and October 31, 2020 and compared women with a positive SARS-CoV-2 test during pregnancy to non-infected pregnant women. Cases of SARS-CoV-2 infection in pregnancy were both identified prospectively and through register linkage to ensure that all cases were identified and that cases were pregnant during infection. Main outcome measures were pregnancy, delivery, maternal, and neonatal outcomes. Severe infection was defined as hospital admission due to coronavirus disease 2019 (COVID-19) symptoms.

Results: Among 82 682 pregnancies, 418 women had SARS-CoV-2 infection during pregnancy, corresponding to an incidence of 5.1 per 1000 pregnancies, 23 (5.5%) of which required hospital admission due to COVID-19. Risk factors for infection were asthma (odds ratio [OR] 2.19, 95% CI 1.41-3.41) and being foreign born (OR 2.12, 95% CI 1.70-2.64). Risk factors for hospital admission due to COVID-19 included obesity (OR 2.74, 95% CI 1.00-7.51), smoking (OR 4.69, 95% CI 1.58-13.90), infection after gestational age (GA) 22 weeks (GA 22-27 weeks: OR 3.77, 95% CI 1.16-12.29; GA 28-36 weeks: OR 4.76, 95% CI 1.60-14.12), and having asthma (OR 4.53, 95% CI 1.39-14.79). We found no difference in any obstetrical or neonatal outcomes.

Conclusions: Only 1 in 20 women with SARS-CoV-2 infection during pregnancy required admission to hospital due to COVID-19. Risk factors for admission comprised obesity, smoking, asthma, and infection after GA 22 weeks. Severe adverse outcomes of SARS-CoV-2 infection in pregnancy were rare.
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http://dx.doi.org/10.1111/aogs.14252DOI Listing
November 2021

COVID-19 in pregnancy-characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries.

Acta Obstet Gynecol Scand 2021 09 7;100(9):1611-1619. Epub 2021 May 7.

Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Introduction: Population-based studies about the consequences of SARS-CoV-2 infection (COVID-19) in pregnancy are few and have limited generalizability to the Nordic population and healthcare systems.

Material And Methods: This study examines pregnant women with COVID-19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between 1 March and 30 June 2020 and had a positive SARS-CoV-2 PCR test ≤14 days prior to admission. Cause of admission was classified as obstetric or COVID-19-related.

Results: In the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women required hospital care due to COVID-19. The risk of admission due to COVID-19 was 0.4/1000 deliveries in Denmark, Finland and Norway, and 3.8/1000 deliveries in the Swedish regions. Women hospitalized because of COVID-19 were more frequently obese (p < 0.001) and had a migrant background (p < 0.001) compared with the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Among the 56 women admitted due to COVID-19, 48 women delivered 51 infants. Preterm delivery (n = 12, 25%, p < 0.001) and cesarean delivery (n = 21, 43.8%, p < 0.001) were more frequent in women with COVID-19 compared with women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported.

Conclusions: The risk of admission due to COVID-19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the risk of admission due to severe COVID-19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.
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http://dx.doi.org/10.1111/aogs.14160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250817PMC
September 2021

From prescription to guidance: a European framework for generic competencies.

Adv Health Sci Educ Theory Pract 2020 03 26;25(1):173-187. Epub 2019 Aug 26.

Department of Research and Education, OLVG Hospital, Amsterdam, The Netherlands.

In postgraduate medical education, required competencies are described in detail in existing competency frameworks. This study proposes an alternative strategy for competency-based medical education design, which is supported by change management theories. We demonstrate the value of allowing room for re-invention and creative adaptation of innovations. This new strategy was explored for the development of a new generic competency framework for a harmonised European curriculum in Obstetrics and Gynaecology. The generic competency framework was developed through action research. Data were collected by four European stakeholder groups (patients, nurses, midwives and hospital boards), using a variety of methods. Subsequently, the data were analysed further in consensus discussions with European specialists and trainees in Obstetrics and Gynaecology. These discussions ensured that the framework provides guidance, is specialty-specific, and that implementation in all European countries could be feasible. The presented generic competency framework identifies four domains: 'Patient-centred care', 'Teamwork', 'System-based practice' and 'Personal and professional development'. For each of these four domains, guiding competencies were defined. The new generic competency framework is supported by European specialists and trainees in Obstetrics and Gynaecology, as well as by their European stakeholders. According to change management theories, it seems vital to allow room for re-invention and creative adaptation of the competency framework by medical professionals. Therefore, the generic competency framework offers guidance rather than prescription. The presented strategy for competency framework development offers leads for implementation of competency-based medical education as well as for development of innovations in postgraduate medical education in general.
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http://dx.doi.org/10.1007/s10459-019-09910-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018687PMC
March 2020

[Socioeconomic inequality affects pregnancy and birth outcomes in Denmark].

Ugeskr Laeger 2019 Mar;181(13)

The Danish healthcare system offers free and equal access to healthcare, including free preventive maternity care and birth assistance. Nevertheless, in Denmark, women of low socioeconomic status, especially women with a low level of education, have an increased risk of obstetric complications including low birth weight, preterm birth, stillbirth and congenital malformations. Smoking is a significant mediator but cannot alone explain the associations. Inadequate health literacy is probably an influencing factor. Individualised care is offered in Denmark, but the effect has not yet been analysed.
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March 2019

Lessons learnt from anonymized review of cases of peripartum hysterectomy by international experts: A qualitative pilot study.

Acta Obstet Gynecol Scand 2019 08 20;98(8):955-957. Epub 2019 Mar 20.

Department of Obstetrics, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark.

Severe obstetric complications are not extensively studied and individual cases are used too little and inappropriately in quality improvement activities, due to limited numbers and prioritization of quantitative research. Nordic and European experts performed a qualitative pilot study using anonymized cases of peripartum hysterectomy. It was feasible to anonymize narratives and we learned lessons in the form of themes for improved clinical care and future research. Therefore, we plan a Nordic anonymized review of the care of women who have undergone peripartum hysterectomy based on narratives. The qualitative outcomes of clinically relevant themes for quality improvement and research will add value to the quantitative analyses from the Nordic medical birth registries. In the longer term, we believe that qualitative audits should be an essential part of the process of continuing improvement in maternity care.
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http://dx.doi.org/10.1111/aogs.13601DOI Listing
August 2019

Sexual Health During Postgraduate Training-European Survey Across Medical Specialties.

Sex Med 2018 Sep 26;6(3):255-262. Epub 2018 Apr 26.

Department of Urology, University Hospital of Zealand, Roskilde, Denmark.

Background: Sexual health problems are common. Therefore, training in sexual health is relevant for the clinical practice of trainees and early-career specialists in several specialties who deal with patients with sexual health problems. However, little is known about how sexual health training is provided across countries and specialties.

Aim: To assess (i) sexual health training during postgraduate training programs in psychiatry, obstetrics and gynecology, urology, and endocrinology across Europe; (ii) the confidence of trainees and early-career specialists in dealing with patients with sexual health problems; and (iii) their need for further training in sexual health during postgraduate training programs.

Methods: The study was based on a collaboration among European societies of trainees in these 4 specialties. An online survey was developed and conducted from January 2015 through June 2016.

Main Outcome Measures: Self-reported questionnaire.

Results: We collected 366 completed surveys from 40 countries. Sexual health training was considered an important or very important part of specialty training by 78.7% of participants. Overall, 62.3% of participants had not received any training in sexual health. Especially in obstetrics and gynecology, the large majority did not have training in sexual health (82.8%), followed by psychiatry (59.8%), urology (58.4%), and endocrinology (56.1%). There were statistically significant differences among specialties in the confidence of participants in managing patients with sexual health problems. In general, trainees and early-career specialists who had received sexual health training felt more confident in dealing with patients with gender dysphoria (P = .011), need for sexual therapy (P = .0004), paraphilic disorders (P = .0003), and sexual dysfunction (P = .0017).

Conclusions: Trainees and early-career specialists found sexual health training important for their future medical practice; however, less than half received it during their postgraduate training. Participants felt more confident in managing patients with sexual health problems when sexual health training was included in the postgraduate training program. Kristufkova A, Pinto Da Costa M, Mintziori G, et al. Sexual Health During Postgraduate Training-European Survey Across Medical Specialties. Sex Med 2018;6:255-262.
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http://dx.doi.org/10.1016/j.esxm.2018.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085219PMC
September 2018

Workforce planning and training in Obstetrics and Gynaecology across Europe: A survey of national trainee societies.

Eur J Obstet Gynecol Reprod Biol 2017 Jul 10;214:156-161. Epub 2017 May 10.

Dept. Obstetrics and Gynaecology, Frimley Park Hospital, Frimley Health NHS Foundation Trust, Camberley, Surrey, UK.

Objective(s): To describe the infrastructural differences in training in Obstetrics and Gynaecology (ObGyn) across Europe.

Study Design: Descriptive web-based survey of 31 national ObGyn trainee societies representing the 30 member countries of the European Network of Trainees in Obstetrics and Gynaecology. Answers were verified in a telephone interview and only countries which had completed the telephone interview were included in the final analysis.

Results: The final analysis included 28 of 31 societies representing 27 countries (response rate 90%). The median formal duration of training was 5 years (range 4-7). There were mandatory requirements in addition to medical school graduation before specialisation could be started in 20 (71%) countries. The job opportunities after completion of training varied and included academic fellowships (n=21 [75%]), clinical fellowships/junior consultancy (n=21 [75%]), consultancy (n=11 [40%]), and private practice (n=23 [82%)]. Training and working as a specialist abroad was uncommon (≤20% in 21 [78%] and 26 [96%] countries respectively). Exams during ObGyn training were offered in 24 (85%) countries. Unemployment after completion of training was rare (<5% in 26 [93%] countries). Assessment of ObGyn specialists took place in 20 (71%) countries.

Conclusion(s): The study illustrates that there are organisational variations in ObGyn training in Europe; A) The requirements to obtain a training post vary causing differences in the qualifications of trainees starting training. B) The duration of training varies. And C) newly trained specialists carry varying levels of responsibility. The results suggest that the content, organisation, and outcome of training differ across Europe. Differences due to political, social and cultural reasons are expected. However, further harmonisation of training across Europe still seems desirable in order to improve women's healthcare and facilitate the mobility of ObGyn trainees and specialists across Europe. There are currently several European initiatives, however, national and local measures are essential for training to improve.
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http://dx.doi.org/10.1016/j.ejogrb.2017.05.007DOI Listing
July 2017

European trainees support the new European curriculum in Obstetrics and Gynaecology.

Eur J Obstet Gynecol Reprod Biol 2016 Aug 20;203:335-6. Epub 2016 May 20.

Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy.

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http://dx.doi.org/10.1016/j.ejogrb.2016.05.017DOI Listing
August 2016

The effect of maneuvers for shoulder delivery on perineal trauma: a randomized controlled trial.

Acta Obstet Gynecol Scand 2016 Sep 17;95(9):1070-7. Epub 2016 May 17.

Department of Obstetrics and Gynecology, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark.

Introduction: Approximately 85% of vaginal deliveries are accompanied by perineal trauma. The objective of this trial was to compare the incidence of perineal trauma after primary delivery of either the anterior or posterior shoulder during vaginal delivery.

Material And Methods: This was a randomized single-blinded trial comparing primary delivery of either the anterior or posterior shoulder in women having their first vaginal delivery. Primary outcome was any perineal trauma. Results were analyzed according to the intention-to-treat principle and supplemented with a per-protocol and as-treated analysis.

Results: Between June 2013 and March 2015, 650 women were randomized, and 543 (posterior, n = 281; anterior, n = 262) were included in the final intention-to-treat analysis. Most group characteristics were similar. The frequency of any perineal trauma did not differ between the two groups (posterior: 91.5%, anterior: 90.5%; odds ratio 1.130, 95% confidence interval 0.628-2.032, p = 0.684). The results did not change after adjustment for basic characteristics with significant group differences (a1 odds ratio 1.174, 95% confidence interval 0.632-2.179, p = 0.612) or predefined risk factors (a2 odds ratio 1.139, 95% confidence interval 0.599-2.166, p = 0.691). The rate of perineal trauma also did not differ between the groups in a "per-protocol" and "as-treated" analysis.

Conclusions: There was no difference in the degree of perineal trauma after primary delivery of either the anterior or posterior shoulder. Consequently both maneuvers for shoulder delivery can be used at vaginal delivery, but further trials are warranted before certain methods can be recommended.
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http://dx.doi.org/10.1111/aogs.12914DOI Listing
September 2016

[Perimortem caesarean section and timely decision making].

Ugeskr Laeger 2016 Mar;178(12):V12150959

Perimortem caesarean section can be decisive for the outcome of a cardiac arrest in pregnancy for both mother and fetus. We describe a case story of the management of cardiac arrest in early labour where perimortem caesarean section proved to be life-saving for both mother and child. The child was delivered alive seven minutes after recorded cardiac arrest, and the mother had return of spontaneous circulation one minute after delivery. The mother recovered well with no serious sequelae to the resuscitation. We discuss the importance of timely decision and execution of perimortem caesarean.
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March 2016

[Caesarean section may have long-term consequences for both mother and child].

Ugeskr Laeger 2014 Apr;176(17)

Gynækologisk-obstetrisk Afdeling, Holbæk Sygehus, Smedelundsgade 60, 4300 Holbæk.

The rate of caesarean section is increasing worldwide. There is scientific evidence that caesarean sections have long-term consequences in consecutive pregnancies and for mother and child. This article reviews these consequences. When consulting women before decision on mode of delivery it is encouraged that all these issues are taken into account and balanced to the benefits of having a caesarean section.
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April 2014

[Evidence-based surgical techniques for caesarean section].

Ugeskr Laeger 2014 Feb;176(7A):V09130535

Gynækologisk-obstetrisk Afdeling, Holbæk Sygehus, Smedelundsgade 60, 4300 Holbæk.

Caesarean section (CS) is a common surgical procedure, and in Denmark 21% of deliveries is by CS. There is an increasing amount of scientific evidence to support the different surgical techniques used at CS. This article reviews the literature regarding CS techniques. There is still a lack of evidence especially about the long-term consequences of the surgical techniques.
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February 2014

Incidence of incisional hernia after cesarean delivery: a register-based cohort study.

PLoS One 2014 30;9(9):e108829. Epub 2014 Sep 30.

The Research Unit Women's and Children's Health, The Juliane Marie Center, Copenhagen University Hospital, Copenhagen, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.

Objective: To estimate the incidence of incisional hernias requiring surgical repair after cesarean delivery over a 10-year period.

Methods: This population- and register-based cohort study identified all women in Denmark with no history of previous abdominal surgery who had a cesarean delivery between 1991 and 2000. The cohort was followed from their first until 10 years after their last cesarean delivery within the inclusion period or until the first of the following events: hernia repair, death, emigration, abdominal surgery, or cesarean delivery after the inclusion period. For women who had a hernia repair, hospital records regarding the surgery and previous cesarean deliveries were tracked and manually analyzed to validate the relationship between hernia repair and cesarean delivery. Data were analyzed with a competing risk analysis that included each cesarean delivery.

Results: We identified 57,564 women who had had 68,271 cesarean deliveries during the inclusion period. During follow-up, 134 of these women had a hernia requiring repair. Of these 68 (51% [95% CI 42-60%]) were in a midline incision although the transverse incision was the primary approach at cesarean delivery during the inclusion period. The cumulated incidence of a hernia repair within 10 years after a cesarean delivery was 0.197% (95% CI 0.164-0.234%). The risk of a hernia repair was higher during the first 3 years after a cesarean delivery, with an incidence after 3 years of 0.157% (95% CI 0.127-0.187%).

Conclusions: The overall risk of an incisional hernia requiring surgical repair within 10 years after a cesarean delivery was 2 per 1000 deliveries in a population in which the transverse incision was the primary approach at cesarean delivery.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0108829PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4182598PMC
June 2015

The effect of a preoperative single-dose methylprednisolone on postoperative pain after abdominal hysterectomy: a randomized controlled trial.

Eur J Obstet Gynecol Reprod Biol 2014 Sep 7;180:83-8. Epub 2014 Jul 7.

The Research Unit Women's and Children's Health, The Juliane Marie Center, Copenhagen University Hospital, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark.

Objective: Methylprednisolone has been shown to have analgesic effects after orthopedic surgery. The objective of this trial was to compare the effect of 125 mg methylprednisolone with placebo on postoperative pain after abdominal hysterectomy.

Study Design: In this randomized double-blinded placebo-controlled trial women scheduled for elective abdominal hysterectomy (n=59) were randomized to preoperatively receive either 125 mg methylprednisolone or saline intravenously. Primary outcome was postoperative pain measured on a 0.0-10.0 visual analog scale and assessed at rest and during mobilization repeatedly the first 24h and daily on the 2nd to 7th postoperative day. Secondary outcomes were postoperative use of opioids and antiemetics, vomiting, C-reactive protein levels, and time to mobilization and discharge. Repeated measures including the primary outcome were analyzed with linear mixed models.

Results: Forty-nine cases were analyzed (methylprednisolone n=25, placebo n=24). Pain scores were significantly higher in the methylprednisolone group compared to the placebo group during mobilization (0.79 [95% confidence intervals (CI) 0.07-1.50] P=0.03) but not at rest (0.55 [95% CI: -0.06 to 1.16] P=0.08). There was no difference between the methylprednisolone and placebo group regarding use of opioids (P=0.24) and antiemetics (P=0.14), number of vomits (P=0.26), and time to mobilization (P=0.24) and discharge (P=0.28). C-reactive protein levels were significantly higher in the placebo group (P=0.01).

Conclusions: This trial showed no beneficial effect of methylprednisolone on postoperative pain after abdominal hysterectomy. Methylprednisolone significantly lowered postoperative CRP levels.

Clinical Trial Registration: ClinicalTrial.gov: www.clinicaltrials.gov: NCT01106547.
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http://dx.doi.org/10.1016/j.ejogrb.2014.06.026DOI Listing
September 2014

The effect of primary delivery of the anterior compared with the posterior shoulder on perineal trauma: a study protocol for a randomized controlled trial.

Trials 2014 Jul 21;15:291. Epub 2014 Jul 21.

Department of Obstetrics and Gynaecology, University of Copenhagen, Holbæk Hospital, Holbæk, Denmark.

Background: Approximately 85% of vaginal deliveries are accompanied by perineal trauma. The objective of this trial is to compare the incidence and degree of perineal trauma after primary delivery of the anterior compared with the posterior shoulder during vaginal birth. The hypothesis is that primary delivery of the posterior shoulder reduces the rate and degree of perineal trauma.

Methods/design: This is a single-centre, randomized controlled trial, with computer-generated randomization in a 1:1 allocation ratio. Women planning their first vaginal delivery (n = 650) are randomized to primary delivery of either the anterior or posterior shoulder. The primary outcome is any perineal trauma. Additional outcomes are the perineal injury subtypes, postpartum bleeding, umbilical artery pH, Apgar score at 5 minutes and any neonatal birth trauma. Perineal trauma is assessed by a midwife or doctor blinded to the method of shoulder delivery. All midwives are trained in the two methods of shoulder delivery and in the grading of perineal tears. The trial is being undertaken at a Danish community hospital with 1,600 yearly deliveries. Data will be analyzed according to the intention-to-treat principle. Recruitment started in January 2013 and the trial is planned to proceed for 24 months.

Discussion: Most delivery assistance techniques are based on tradition and heritage and lack objective evidence. This trial provides an example of how vaginal delivery techniques can be evaluated in a randomized controlled trial. The results of this trial will clarify the role that delivery of the shoulders has on perineal trauma and thereby provide knowledge to recommendations on birthing technique.

Trial Registration: ClinicalTrials.gov: NCT01937546.
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http://dx.doi.org/10.1186/1745-6215-15-291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223378PMC
July 2014

Water immersion and changes in the foetoplacental and uteroplacental circulation: an observational study with the case as its own control.

J Matern Fetal Neonatal Med 2015 Apr 25;28(6):661-5. Epub 2014 Jun 25.

Department of Gynaecology & Obstetrics, University of Copenhagen, Hvidovre Hospital , Hvidovre , Denmark .

Objective: To evaluate the effect of immersion into water on maternal blood pressure, amount of amniotic fluid and on the foetoplacental- and uteroplacental circulation in healthy women with an uncomplicated singleton pregnancy.

Methods: Twenty-five healthy women were included. Recordings of blood pressure, deepest vertical pocket of amniotic fluid and pulsatility index (PI) measured by Doppler in the umbilical and uterine arteries were obtained. The participants were immersed into water and the measurements were repeated after 5 and 25 min in water and again 15 and 30 min post immersion.

Results: The amount of amniotic fluid increased significantly (p < 0.001), and the maternal blood pressure decreased significantly during immersion (p < 0.001). There was no significant effect of immersion on either umbilical- or uterine artery PI. All changes returned toward baseline-level within 30 min after immersion.

Conclusions: Immersion into water increases the amount of amniotic fluid and decreases the maternal blood pressure. Immersion into water has no significant effect on either the foetoplacental or uteroplacental circulation. Further studies are needed in order to explore the effect of immersion in pregnancies complicated by a dysfunctional placenta.
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http://dx.doi.org/10.3109/14767058.2014.928690DOI Listing
April 2015

Midline versus transverse incision for cesarean delivery in low-income countries.

Int J Gynaecol Obstet 2014 Apr 2;125(1):1-2. Epub 2014 Jan 2.

Research Unit Women's and Children's Health, Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.

While transverse incision is the recommended entry technique for cesarean delivery in high-income countries, it is our experience that midline incision is still used routinely in many low-income settings. Accordingly, international guidelines lack uniformity on this matter. Although evidence is limited, the literature suggests important advantages of the transverse incision, with lower risk of long-term disabilities such as wound disruption and hernia. Also, potential extra time spent on this incision appears not to impact neonatal outcome. Therefore, we suggest that it is time for a change in guidelines for low-income settings in which resources are limited for treating complications that may be life threatening.
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http://dx.doi.org/10.1016/j.ijgo.2013.09.030DOI Listing
April 2014

Sharp compared with blunt fascial incision at cesarean delivery: a randomized controlled trial with each case as her own control.

Eur J Obstet Gynecol Reprod Biol 2014 Jan 5;172:40-5. Epub 2013 Nov 5.

The Research Unit Women's and Children's Health, The Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark.

Objective: To compare patient preference for either sharp incision with scissors or blunt manual cleavage of the fascia at cesarean delivery in a randomized controlled trial in which each woman was her own control.

Study Design: Women undergoing primary cesarean delivery (n=34) were randomized to side distribution of sharp or blunt incision of the fascia (sharp right and blunt left or blunt right and sharp left) and followed three months postoperatively. The primary outcome was patient preference for the right or left side of the scar 3 months postoperatively and modeled by polytomous logistic regression. The secondary outcome was difference in pain between the two sides measured on a 0.0-10.0 numerical rating scale at 1, 3, and 7 days and 1 and 3 months postoperatively. Pain scores were analyzed with a Wilcoxon signed rank test.

Results: 28 cases were analyzed and no significant difference was found in preference after three months. Nine women preferred the sharp (32%, 95% CI 16-52%) and 7 the blunt side (25%, 95% CI 11-45%) (P=0.804). Pain scores did not differ significantly between the two sides at any time postoperatively either at rest or during mobilization.

Conclusion: No significant difference was found in patient preference with regard to sharp or blunt incision of the fascia, nor was there a significant difference in postoperative pain scores.

Clinical Trial Registration: ClinicalTrials.gov: www.clinicaltrials.org;NCT01297725.
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http://dx.doi.org/10.1016/j.ejogrb.2013.10.029DOI Listing
January 2014

Subcuticular suture compared with staples for skin closure after cesarean delivery: a randomized controlled trial.

Obstet Gynecol 2013 Oct;122(4):878-884

Department of Obstetrics and Gynecology, University of Copenhagen, Holbæk Hospital, Holbæk, Demark; the Department of Biostatistics, University of Copenhagen, and the Research Unit, Women's and Children's Health, the Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark;and the Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.

Objective: To compare subcuticular sutures with staples for skin closure after cesarean delivery in a randomized trial in which each woman was her own control.

Methods: Women undergoing cesarean delivery (primary, n=32; repeat, n=31) were randomized to side distribution of skin closure methods with one side of the skin incision closed with staples and the other side closed with subcuticular suture. The primary outcome was the overall preferred side of the scar 6 months postoperatively. Additional outcomes were women's preferred method of closure and cosmetically preferred side of the scar, difference in objective cosmetic scores (assessed by two plastic surgeons), and pain between the two sides of the scar and infection rate.

Results: Significantly more women preferred the stapled side, both overall (odds ratio [OR] 2.55; 95% confidence interval [CI] 1.18-5.52) and cosmetically (OR 2.67; 95% CI 1.24-5.74), and reported staples as their preferred technique (OR 2.00; 95% CI 1.10-3.64). There were no significant differences in pain scores at any time. One plastic surgeon preferred the stapled side (OR 2.8; 95% CI 1.01-7.78) and scored it significantly higher on a cosmetic visual analog scale (P=.031); the other found no significant difference. There were four (6.8%) cases of infection-three on the sutured side and one bilateral.

Conclusion: Staples were preferred to subcuticular suture for skin closure by women after cesarean delivery.

Clinical Trial Registration: ClinicalTrials.gov; www.clinicaltrials.gov; NCT01217567.

Level Of Evidence: : I.
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http://dx.doi.org/10.1097/AOG.0b013e3182a5f0c3DOI Listing
October 2013

Interferon-γ inhibits ghrelin expression and secretion via a somatostatin-mediated mechanism.

World J Gastroenterol 2011 Jul;17(26):3117-25

Genomic Medicine, Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Aim: To investigate if and how the proinflammatory cytokine interferon γ (IFNγ) affects ghrelin expression in mice.

Methods: The plasma concentration of ghrelin, and gastric ghrelin and somatostatin expression, were examined in wild-type mice and mice infected with Helicobacter pylori (H. pylori). Furthermore, ghrelin expression was examined in two achlorhydric mouse models with varying degrees of gastritis due to bacterial overgrowth. To study the effect of IFNγ alone, mice were given a subcutaneous infusion of IFNγ for 7 d. Finally, the influence of IFNγ and somatostatin on the ghrelin promoter was characterized.

Results: H. pylori infection was associated with a 50% reduction in ghrelin expression and plasma concentration. Suppression of ghrelin expression was inversely correlated with gastric inflammation in achlorhdyric mouse models. Subcutaneous infusion of IFNγ suppressed fundic ghrelin mRNA expression and plasma ghrelin concentrations. Finally, we showed that the ghrelin promoter operates under the control of somatostatin but not under that of IFNγ.

Conclusion: Gastric infection and inflammation is associated with increased IFNγ expression and reduced ghrelin expression. IFNγ does not directly control ghrelin expression but inhibits it indirectly via somatostatin.
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http://dx.doi.org/10.3748/wjg.v17.i26.3117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158411PMC
July 2011
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