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Biomedical subjects

O Axelsson

Publications and source records attributed to O Axelsson.

At least 55 records · Page 3Linked to original sources
PubMed1992

Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses.

Intrauterine growth retardation is associated with an increased risk of fetal asphyxia as well as greater perinatal morbidity and mortality. Ultrasound fetometry enables detection of fetuses that are small for gestational age. Doppler velocimetry of the umbilical artery has good predictive ability for fetal distress, but it is not yet clear whether it could replace cardiotocography in antenatal surveillance of small-for-gestational-age fetuses. We have done a randomised comparison of the two methods. At four obstetric departments in Sweden, women with fetuses found to be small on ultrasound examination at 31 completed weeks of pregnancy or later were randomly assigned to antenatal surveillance with either doppler velocimetry (doppler; 214) or cardiotocography (CTG; 212). Pregnancies in the doppler group were managed according to a protocol based on blood-flow classes deriving from the semiquantitative evaluation of umbilical-artery velocity waveforms; unless the pregnancy was complicated by any other disorder, no antenatal cardiotocography was done. By comparison with the CTG group, the doppler group had fewer monitoring occasions (mean 4.1 [SD 3.1] vs 8.2 [6.2], p < 0.01), antenatal hospital admissions (68 [31.3%] vs 97 [45.8%], p < 0.01), inductions of labour (22 [10.3%] vs 46 [21.7%], p < 0.01), emergency caesarean sections for fetal distress (11 [5.1] vs 30 [14.2%], p < 0.01), and admissions to neonatal intensive care (76 [35.5%] vs 92 [43.4%], p = 0.10). The groups did not differ in gestational age at birth, birthweight, Apgar scores, or total number of caesarean deliveries. Umbilical-artery doppler velocimetry of small-for-gestational-age fetuses allows antenatal monitoring and obstetric interventions to be aimed more precisely than does cardiotocography.

Adolescent↗
PubMed1992

Ultrasonic dating of pregnancies: effect on incidence of SGA diagnoses. A randomised controlled trial.

In order to study the incidence of antenatal identification and postnatal diagnosis of small for gestational age (SGA) infants, 4997 women with optimal menstrual history were randomised. One group had the gestational age estimated from last menstrual period (LMP), the other from ultrasonographically measured biparietal diameter (BPD) in the second trimester. Both the incidence of antenatally suspected and postnatally diagnosed SGA infants were reduced by approximately 30% in the BPD-dated group. It is concluded that this was due to the shift in gestational age estimation.

Female↗
PubMed1991

Clinical and endometrial effects of oestradiol and progesterone in post-menopausal women.

This study reports the clinical effects in a group of post-menopausal women after 4 months of treatment with 2 mg micronized 17 beta-oestradiol (E2) in combination with different doses of micronized progesterone (50, 100 or 200 mg) for 25 days each month. The 30 participants were divided into three groups. All of the subjects tolerated the preparation well and obtained relief from their climacteric complaints. None dropped out because of side effects and no changes were observed in blood pressure, weight or Papanicolaou cytology. Breakthrough bleeding was noted in the first cycle, mainly in the group receiving the lowest dose of progesterone. Endometrial biopsies performed before and after 4 months of treatment showed an atrophic endometrium in most of the women who received 100 mg progesterone and in all of the women on 200 mg progesterone. The results showed that this new combination of 2 mg E2 and micronized progesterone in different doses was both effective and well accepted.

Adult↗
PubMed1991

Uterine myoma causing uremia in a 15-year-old girl.

Uterine myoma leading to uremia in young women below 16 years of age is an extremely rare condition. On reviewing the literature we have not been able to find any case similar to the one described below.

Adolescent↗
PubMed1991

Sonographic dating of pregnancies among women with menstrual irregularities.

In order to study the benefit of sonographic dating, 277 women with irregular periods and 264 women with a scanty last bleeding had gestational age and estimated day of delivery (EDD) estimated from both last menstrual period (LMP) and measurement of fetal Biparietal Diameter (BPD) in the second trimester. For the women with irregular periods, the two estimates differed by more than 7 days for 51.6%, and more than 14 days for 25.6%. Corresponding figures for women with a scanty last bleeding were 44.3% and 21.6%, respectively. In general, the BPD estimates were better than the LMP estimates (P = less than 0.001) in predicting day of delivery, especially when the differences between the estimates exceeded 7 days. For women with irregular periods, post-term pregnancies decreased, from 20.2% according to the LMP estimate to 2.5% according to the BPD estimate. Corresponding figures for women with a scanty last bleeding were 16.7% and 4.5%, respectively. According to the LMP estimate, 64.8% of the women with irregular periods and 69.3% of the women with a scanty last bleeding gave birth within +/- 14 days of EDD. Corresponding figures for the BPD estimate were 83.6% and 88.3%, respectively. The conclusion is that sonographic dating of pregnancies among women with irregular periods and women with a scanty last bleeding substantially improve the accuracy of term prediction.

Embryonic and Fetal Development↗
PubMed1991

Maternal factors associated with high birth weight.

Maternal characteristics associated with high birth weight were studied in 473 mothers delivered of singleton infants at term with a birth weight of 4500 g or more. The controls were mothers who gave birth to singleton infants at term, with a normal birth weight +/- 1 SD for Swedish newborns. In the multivariate analysis the maximum symphysis-fundus height measurement and gestational duration were strongly significant (p less than 0.001), after correction for other variables, for the probability of being delivered of an infant of high birth weight. Maternal height, weight at beginning of pregnancy, total gestational weight increase and previous live birth of an infant weighing greater than or equal to 4500 g were also important (p less than 0.05) for high birth weight. The maternal characteristics included were evaluated in a prognostic model. With symphysis-fundus height measurement included, the sensitivity increased from 80.3 to 83.3% and specificity from 78.8 to 85.6%, compared with a model where symphysis-fundus measurement was not available.

Adult↗
PubMed1990

A comparison of the ability of a sonographically measured biparietal diameter and the last menstrual period to predict the spontaneous onset of labor.

To study whether the estimated date of confinement (EDC) for women with optimal menstrual histories is predicted best from the last menstrual period (LMP) or biparietal diameter (BPD), 2320 women had the EDC estimated by both LMP and BPD measured sonographically in the second trimester. Those who delivered after the spontaneous onset of labor are reported here. Compared with the EDC calculated from the LMP, the EDC calculated from the BPD was postponed more than 1 week for 406 women (17.5%) and advanced more than 1 week for 56 (2.4%). For these women, the BPD estimate of EDC turned out to be closer to the day of delivery in 264 cases, whereas the LMP estimate was closer in 125 (P less than .001). For 73 women, the estimates were equally good. For 80.1% of the women, the two estimates of EDC differed by 1 week or less; in these cases, the estimates were equally good in predicting the day of delivery. We conclude that the BPD is a better predictor of the spontaneous onset of labor than is the LMP.

Clinical Trials as Topic↗
PubMed1989

Breech extraction versus cesarean section for the remaining second twin.

All second twins delivered by cesarean section (CS) after vaginal birth of the first twin (n = 38) and all breech-extracted second twins (n = 282) in Sweden during 1973-81 were identified. Data from the medical records of all CS second twins were extracted and compared with breech-extracted second twins from the same departments born within 2 years of the CS twin (n = 25). Second twins delivered after maternal general anesthesia had lower 5-min Apgar scores, irrespective of mode of delivery. Maternal morbidity was substantial in the CS group. The results encourage the use of breech extraction under local anesthesia rather than CS when there is a need for a quick delivery of the second twin and when both alternatives are available.

Anesthesia, Obstetrical↗
PubMed1988

Effects of routine one-stage ultrasound screening in pregnancy: a randomised controlled trial.

4997 of 7354 pregnant women had no clinical indication for an elective ultrasound examination at 12 weeks' gestation. 2482 of these women were randomly selected for ultrasound screening at 15 weeks and the remainder received the same standard antenatal care without the scan. Labour was less often induced among screened women both for all reasons (5.9% vs 9.1%, p less than 0.0001) and for suspected post-term pregnancy (1.7% vs 3.7%, p less than 0.0001). Earlier detection of twins had no effect on neonatal outcome. Among babies born to screened women, fewer were of birthweight less than 2500 g (59 vs 95, p = 0.005) and mean birthweight was 42 g higher (p 0.008). For babies born to screened women who smoked it was 75 g higher (p 0.012) and for those of non-smokers 26 g (not significant). The reason for the differences in mean birthweight could be that screened women reduced smoking in response to watching their fetus on the scan.

Adult↗
PubMed1988

Traumatic injury in large-for-date infants.

The risk of traumatic injury and low Apgar score was studied in 473 infants with a birth weight of 4500 g or more at term (LFD) and 473 infants with normal weight (NFD, birth weight +/- 1 SD of mean for the respective gestational age). The LFD group comprised 3.2% of all infants delivered during a 5-year period. Traumatic injuries were observed in 8.0% of the LFD versus 0.6% of the NFD group. The injuries in the LFD group were 28 fractured clavicles, four fractured humerus and 12 brachial plexus injuries. Six of the LFD infants had multiple injuries. The injuries in the NFD group were three fractured clavicles. All infants with traumatic injuries were delivered vaginally. Contributory obstetrical factors for traumatic injury were forceps, post-term pregnancy and vacuum extraction. High birth weight was correlated to a low Apgar score at one minute, as also was post-term pregnancy.

Birth Injuries↗
PubMed1988

A prospective controlled five-year follow-up study of primiparas with gestational hypertension.

Primiparas with hypertension first recognized in pregnancy and an age- and parity-matched control group, normotensive throughout pregnancy, were monitored during 5-6 years with blood pressure recordings performed in a standardized way. At the end of the study period, 21 out of 49 women with hypertension in pregnancy had developed hypertension requiring therapy or borderline hypertension, compared with 2 women in the control group who had developed borderline hypertension. Therapy was required in 7 of the women. Factors associated with increased risk of developing hypertension were gestational week at diagnosis of gestational hypertension, 1st diastolic blood pressure during follow-up, family history, smoking, and age.

Adult↗
PubMed1987

Perinatal outcome for small-for-gestational-age infants from an unselected, area-based population.

From an unselected area-based population, where a screening programme for detection of small-for-gestational-age (SGA) infants was in use, the obstetrical and neonatal management of all SGA infants (birth wt. less than or equal to -2 S.D. of the normal mean) was studied. During 1980, there were 3038 singletons born at the University Hospital in Uppsala. The perinatal mortality was 0.6% (17 infants). Three stillborn infants were assessed as SGA, even when gestational age was estimated from the last occasion when fetal heart sounds were registered. Out of a total of 27 live-born SGA infants (0.9%), 19 were suspected and supervised antenatally. All SGA infants were admitted to the neonatal ward. One infant suffered from the fetal alcohol syndrome and one preterm infant died after 11 days due to septicaemia after abdominal surgery. The remaining 25 SGA infants escaped severe neonatal problems and were discharged from the hospital around the time of expected delivery. It is concluded that once an SGA pregnancy is identified and supervised, the risk of intrauterine death is minimized and that the neonatal period generally is uncomplicated for the normally shaped and adequately cared-for SGA infant.

Female↗
PubMed1987

Conservative management of the abnormal smear during pregnancy. A long-term follow-up.

One hundred and thirty-two pregnant women who had a smear suggestive of cervical intra-epithelial neoplasia (CIN) II or more during the 10th to 12th gestational week, were followed with repeated smears and colposcopy every month and, when indicated, a colposcopically guided biopsy. Post-partum follow-up included cytology, colposcopy, portio biopsies and endocervical curettage. Seventy-nine women with normal findings post partum were checked once a year in a long-term study. A close correlation (71% of CINIII) was found between cytological and histological diagnoses in cases of persistent (three or more) abnormal smears. However, in women with regression of the cytological diagnosis, high frequencies of histologically verified CIN were found. Thus, 37.5% (18/48) of normal or CINI smears were histologically still CINIII. Histologically verified CIN during pregnancy, on the other hand, showed a post partum progression of two degrees or more of CIN in only two cases. Cytology seemed to be inappropriate post partum, with 23.3% smears which were normal or suggestive of CINI, when histology showed CINIII. In a long-term follow-up, 24% of women with a normal post partum follow-up for at least one year had a subsequent recurrence of CIN. It is concluded that follow-up of abnormal smears during pregnancy with repeated smears is not a reliable method. Post-partum follow-up should include at least colposcopy and a biopsy when indicated by the colposcopical examination. Women with a normal post partum follow-up constitute a high risk group for future recurrence of CIN and should be carefully followed for at least 5 years.

Adult↗
PubMed1987

Pathologic torsion of the pregnant uterus.

Torsion of the human pregnant uterus is a very rare complication. This presentation describes repeated episodes of pathological CTG patterns in a woman whose uterus showed a levotorsion of 150 degrees at cesarean delivery. To our knowledge, such a pattern has never previously been ascribed to uterine torsion.

Adult↗