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Objective: The aim of the study was to evaluate the association between abdominal adhesions at the time of gynaecologic surgery and a history of caesarean delivery, and to investigate obstetric factors contributing to adhesion formation after caesarean section (CS).Design: Longitudinal population-based register study.Setting: Sweden.Population: Women undergoing benign hysterectomy and/or adnexal surgery in Sweden, 2000-2014, with a previous delivery during 1973-2013 (n = 15 479).Methods: Information about abdominal adhesions during gynaecological surgery, prior medical history, pregnancies and deliveries were retrieved from Swedish National Health and Quality registers.Main Outcome Measures: Adhesions.Results: In women with previous CS, adhesions were present in 37%, compared with 10% of women with no previous CS [odds ratio (OR): 5.18, 95% confidence interval (CI): 4.70-5.71]. Adhesions increased with the number of caesarean sections: 32% after one CS; 42% after two CS and 59% after three or more CS (P < 0.001). Regardless of the number of CS, factors at CS such as age ≥35 years (aOR: 1.28, 95% CI: 1.05-1.55), body mass index (BMI) ≥30 [adjusted OR (aOR): 1.91, 95% CI: 1.49-2.45] and postpartum infection (aOR: 1.55, 95% CI: 1.05-2.30) increased the risk of adhesions.Conclusions: Presence of adhesions in abdominal gynaecological surgery is associated with women's personal history of caesarean delivery. The number of caesarean sections was the important predictor of adhesions; advanced age, obesity and postpartum infection further increased the incidence.Tweetable Abstract: Repeat caesarean, age, obesity and infection increased the risk of pelvic adhesions after caesarean section. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Aasheim V, Waldenström U, Hjelmstedt A, Rasmussen S, Pettersson H, Schytt E. Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. BJOG 2012;119:1108-1116. Objective To investigate if advanced maternal age at first birth increases the risk of psychological distress during pregnancy at 17 and 30 weeks of gestation and at 6 and 18 months after birth. Design National cohort study. Setting Norway. Sample A total of 19 291 nulliparous women recruited between 1999 and 2008 from hospitals and maternity units. Methods Questionnaire data were obtained from the longitudinal Norwegian Mother and Child Cohort Study, and register data from the national Medical Birth Register. Advanced maternal age was defined as ≥32 years and a reference group of women aged 25-31 years was used for comparisons. The distribution of psychological distress from 20 to ≥40 years was investigated, and the prevalence of psychological distress at the four time-points was estimated. Logistic regression analyses based on generalised estimation equations were used to investigate associations between advanced maternal age and psychological distress. Main outcome measures Psychological distress measured by SCL-5. Results Women of advanced age had slightly higher scores of psychological distress over the period than the reference group, also after controlling for obstetric and infant variables. The youngest women had the highest scores. A history of depression increased the risk of distress in all women. With no history of depression, women of advanced age were not at higher risk. Changes over time were similar between groups and lowest at 6 months. Conclusion Women of 32 years and beyond had slightly increased risk of psychological distress during pregnancy and the first 18 months of motherhood compared with women aged 25-31 years. [ABSTRACT FROM AUTHOR]

Aim: This paper reports an investigation of how the survey question 'How would you summarize your state of health at present' is interpreted and what it captures when asked at 1 year after childbirth.Background: Self-rated health measured by a single item question is a well-established patient outcome as it predicts morbidity and the use of health services. However, there is limited understanding of what the question captures in early motherhood.Method: A qualitative design combining data collection by means of a short form, concurrent and retrospective thinkaloud interviews, and a semi-structured interview, with 26 Swedish women during 2005 was employed. The text was analysed by qualitative content analysis. A theoretical framework describing four cognitive tasks usually performed when a respondent answers a survey question guided the analysis: interpretation of the question, retrieval of information, forming a judgement and giving a response.Findings: The questions of self-rated health left open for the new mothers to evaluate what was most important for her. It captured a woman's total life situation, such as family functioning and well-being, relationship with partner, combining motherhood and professional work, energy, physical symptoms and emotional problems affecting daily life, stressful life events, chronic disease with ongoing symptoms, body image, physical exercise and happiness. Neither childbirth-related events nor childbirth-related symptoms were included in the responses. Less than 'good' self-rated health represented a high burden of health problems.Conclusion: Our results showed that the question on selfrated health was a measure of women's general health and well-being in their present life situation, but it did not seem to measure recovery after childbirth specifically. [ABSTRACT FROM AUTHOR]

Objective To investigate the memory of labour pain at 2 months, 1 year and 5 years after childbirth and its association with the use of epidural analgesia and overall evaluation of childbirth. Design Longitudinal observational. Setting All hospitals in Sweden. Population One thousand three hundred eighty-three women, who were recruited at their first antenatal visit and who provided complete data up to 5 years after the birth. Methods Postal questionnaires in the second trimester and 2 months, 1 year and 5 years after the birth. Main outcome measures Memory of labour pain measured by a seven-point rating scale (1 = no pain at all, 7 = worst imaginable pain). Results Memory of labour pain declined during the observation period but not in women with a negative overall experience of childbirth. Women who had epidural analgesia reported higher pain scores at all time points, suggesting that these women remember ‘peak pain’. Conclusions There was significant individual variation in recollection of labour pain. In the small group of women who are dissatisfied with childbirth overall, memory of pain seems to play an important role many years after the event. These findings challenge the view that labour pain has little influence on subsequent satisfaction with childbirth. In-labour pain and long-term memory of pain are discussed as two separate outcomes involving different memory systems. [ABSTRACT FROM AUTHOR]