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Hypertensive disorders of pregnancy (HDP), especially preeclampsia, and diabetes during pregnancy pose significant risks for both maternal and infant health, extending to long‐term outcomes such as early‐onset cardiovascular disease and metabolic disorders. Current strategies for managing HDP focus on screening, prevention, surveillance, and timely intervention. No disease‐modifying therapies exist so far for established preeclampsia; delivery remains the definitive resolution. Preventive measures—including early pregnancy screening, exercise, and low‐dose aspirin—show promise. Antihypertensive treatments reduce severe hypertension risks, whereas magnesium sulfate remains the standard for preventing eclampsia. Planned delivery from gestational week 37 can balance maternal benefits and neonatal risks in women with established preeclampsia. Delivery between 34 and 37 weeks gestation in women with preeclampsia has to balance risks for mother and infant. Lifestyle interventions—particularly diet and physical activity—are pivotal in managing gestational diabetes mellitus and type 2 diabetes. The oral antidiabetic metformin has shown benefits in glycaemic control and reducing maternal weight gain, although its long‐term effects on offspring remain uncertain. The safety of other peroral antidiabetics in pregnancy is less studied. Advancements in glucose monitoring and insulin administration present encouraging prospects for enhancing outcomes in women with diabetes types 1 and 2. Both HDP and diabetes during pregnancy necessitate vigilant management through a combination of lifestyle modifications, pharmacological interventions, and timely obstetric care. Although certain treatments such as low‐dose aspirin and metformin show efficacy in risk reduction, further research is ongoing to ensure safety for both mothers and their offspring to reduce short‐ and long‐term adverse effects. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of vacuum extraction (VE) or caesarean section (CS), compared with expectant management, on pelvic floor dysfunction (PFD) 1–2 years postpartum in primiparous women with a prolonged second stage of labour. Design: A population‐based questionnaire and cohort study. Setting: Stockholm, Sweden. Population: A cohort of 1302 primiparous women with a second stage duration of ≥3 h, delivering from December 2017 to November 2018. Methods: The 1‐year follow‐up questionnaire from the Swedish National Perineal Laceration Register was distributed 12–24 months postpartum. Exposure was VE or CS at 3–4 h or 4–5 h, compared with expectant management. Main outcome measures: Pelvic floor dysfunction was defined as at least weekly symptoms of urinary incontinence, pelvic organ prolapse or a Wexner score of ≥4. The risk of PFD was calculated using Poisson regression with robust variance estimation, presented as crude and adjusted relative risks (RRs and aRRs) with 95% confidence intervals (95% CIs). The implication of obstetric anal sphincter injury (OASI) on pelvic floor disorders was investigated through mediation analysis. Results: In total, 35.1% of women reported PFD. Compared with expectant management, the risk of PFD was increased after VE at 3–4 h (aRR 1.33, 95% CI 1.06–1.65) and 4–5 h (aRR 1.34, 95% CI 1.05–1.70), but remained unchanged after CS. The increased risk after VE was not mediated by OASI. Conclusions: Pelvic floor dysfunction was common in primiparous women after a prolonged second stage, and the risk of PFD increased after VE but was unaffected by CS, compared with expectant management. If a spontaneous vaginal delivery eventually occurred, allowing an extended duration of labour did not increase the risk of PFD. [ABSTRACT FROM AUTHOR]

Objective: To quantify temporal trends and regional variation in severe maternal morbidity (SMM) in Sweden. Design: Cohort study. Population: Live birth and stillbirth deliveries in Sweden, 1999–2019. Methods: Types and subtypes of SMM were identified, based on a standard list (modified for Swedish clinical setting after considering the frequency and validity of each indicator) using diagnoses and procedure codes, among all deliveries at ≥22 weeks of gestation (including complications within 42 days of delivery). Contrasts between regions were quantified using rate ratios (RRs) and 95% confidence intervals (95% CIs). Temporal changes in SMM types and subtypes were described. Main outcome measures: Types and subtypes of SMM. Results: There were 59 789 SMM cases among 2 212 576 deliveries, corresponding to 270.2 (95% CI 268.1–272.4) per 10 000 deliveries. Composite SMM rates increased from 236.6 per 10 000 deliveries in 1999 to 307.3 per 10 000 deliveries in 2006, before declining to 253.8 per 10 000 deliveries in 2019. Changes in composite SMM corresponded with temporal changes in severe haemorrhage rates, which increased from 94.9 per 10 000 deliveries in 1999 to 169.3 per 10 000 deliveries in 2006, before declining to 111.2 per 10 000 deliveries in 2019. Severe pre‐eclampsia, eclampsia and HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome (103.8 per 10 000 deliveries), severe haemorrhage (133.7 per 10 000 deliveries), sepsis, embolism, disseminated intravascular coagulation, shock and severe mental health disorders were the most common SMM types. Rates of embolism, disseminated intravascular coagulation and shock, acute renal failure, cardiac complications, sepsis and assisted ventilation increased, whereas rates of surgical complications, severe uterine rupture and anaesthesia complications declined. Conclusions: The observed spatiotemporal variations in composite SMM and SMM types provide substantive insights and highlight regional priorities for improving maternal health. [ABSTRACT FROM AUTHOR]

Objective: The impact of first stage labour duration on maternal outcomes is sparsely investigated. We aimed to study the association between a longer active first stage and maternal complications in the early postpartum period. Design: A population‐based cohort study. Setting: Regions of Stockholm and Gotland, Sweden, 2008–2020. Population: A cohort of 159 459 term, singleton, vertex pregnancies, stratified by parity groups. Methods: The exposure was active first stage duration, categorised in percentiles. Poisson regression analysis was performed to estimate the adjusted relative risk (aRR) and the 95% confidence interval (95% CI). To investigate the effect of second stage duration on the outcome, mediation analysis was performed. Main outcome measures: Severe perineal lacerations (third or fourth degree), postpartum infection, urinary retention and haematoma in the birth canal or ruptured sutures. Results: The risks of severe perineal laceration, postpartum infection and urinary retention increased with a longer active first stage, both overall and stratified by parity group. The aRR increased with a longer active first stage, using duration of <50th percentile as the reference. In the ≥90th percentile category, the aRR for postpartum infection was 1.64 (95% CI 1.46–1.84) in primiparous women, 2.43 (95% CI 1.98–2.98) in parous women with no previous caesarean delivery (CD) and 2.33 (95% CI 1.65–3.28) in parous women with a previous CD. The proportion mediated by second stage duration was 33.4% to 36.9% for the different outcomes in primiparous women. The risk of haematoma or ruptured sutures did not increased with a longer active first stage. Conclusions: Increasing active first stage duration is associated with maternal complications in the early postpartum period. [ABSTRACT FROM AUTHOR]

Objective: To investigate the risk of recurrent maternal red‐cell transfusion in delivery. Design: Nationwide long‐standing retrospective cohort study. Setting: Swedish medical birth register. Population: All registered births from 2000 to 2017 in Sweden. Methods: We included all women with between one and three consecutive registered births from 22 weeks of gestation onwards and all maternal red‐cell transfusions in the peripartum period within the defined period of study. Information on gestational and non‐gestational comorbidity was collected and we identified any female siblings. In our analyses we compared the risk of red‐cell transfusion in delivery in relation to transfusion history and gestational and non‐gestational comorbidity. Main outcome measures: Maternal peripartum red‐cell transfusion, defined as a recorded transfusion in the period from 1 day before and 7 days after delivery. Results: We included 825 451 women with a total 1 419 909 deliveries, including 786 097 (55.4%) first, 511 398 (36.0%) second and 122 414 (8.6%) third deliveries. Of women with previous obestric transfusion, 8.7% were transfused in a second delivery, compared with 1.7% of women without transfusion or diagnosis of haemorrhage. A previous diagnosis of haemorrhage did not affect the odds ratio of transfusion recurrence. Among women who were transfused in their first two deliveries, 15.5% were transfused in third delivery, corresponding to an 11‐fold increase, compared with non‐transfused women (adjusted odds ratio aOR 11.5, 95% CI 7.9–16.6). Women with a sister transfused in delivery were at increased risk of transfusion in a second delivery (aOR 1.8, 95% CI 1.6–2.1). Conclusions: Women with previous red‐cell transfusion are at an increased risk of red‐cell transfusion in a subsequent delivery, compared with women without a history of red‐cell transfusion. [ABSTRACT FROM AUTHOR]

Introduction: Risk evaluation for preeclampsia in early pregnancy allows identification of women at high risk. Prediction models for preeclampsia often include circulating concentrations of placental growth factor (PlGF); however, the models are usually limited to a specific PlGF method of analysis. The aim of this study was to compare three different PlGF methods of analysis in a Swedish cohort to assess their convergent validity and appropriateness for use in preeclampsia risk prediction models in the first trimester of pregnancy. Material and methods: First‐trimester blood samples were collected in gestational week 11+0 to 13+6 from 150 pregnant women at Uppsala University Hospital during November 2018 until November 2020. These samples were analyzed using the different PlGF methods from Perkin Elmer, Roche Diagnostics, and Thermo Fisher Scientific. Results: There were strong correlations between the PlGF results obtained with the three methods, but the slopes of the correlations clearly differed from 1.0: PlGFPerkinElmer = 0.553 (95% confidence interval [CI] 0.518–0.588) * PlGFRoche –1.112 (95% CI −2.773 to 0.550); r = 0.966, mean difference −24.6 (95% CI −26.4 to −22.8). PlGFPerkinElmer = 0.673 (95% CI 0.618–0.729) * PlGFThermoFisher –0.199 (95% CI −2.292 to 1.894); r = 0.945, mean difference −13.8 (95% CI −15.1 to −12.6). PlGFRoche = 1.809 (95% CI 1.694–1.923) * PlGFPerkinElmer +2.010 (95% CI −0.877 to 4.897); r = 0.966, mean difference 24.6 (95% CI 22.8–26.4). PlGFRoche = 1.237 (95% CI 1.113–1.361) * PlGFThermoFisher +0.840 (95% CI −3.684 to 5.363); r = 0.937, mean difference 10.8 (95% CI 9.4–12.1). PlGFThermoFisher = 1.485 (95% CI 1.363–1.607) * PlGFPerkinElmer +0.296 (95% CI −2.784 to 3.375); r = 0.945, mean difference 13.8 (95% CI 12.6–15.1). PlGFThermoFisher = 0.808 (95% CI 0.726–0.891) * PlGFRoche –0.679 (95% CI −4.456 to 3.099); r = 0.937, mean difference −10.8 (95% CI −12.1 to −9.4). Conclusion: The three PlGF methods have different calibrations. This is most likely due to the lack of an internationally accepted reference material for PlGF. Despite different calibrations, the Deming regression analysis indicated good agreement between the three methods, which suggests that results from one method may be converted to the others and hence used in first‐trimester prediction models for preeclampsia. [ABSTRACT FROM AUTHOR]

Background: Register‐based reproductive and perinatal databases rarely contain detailed information from medical records or repeated measurements throughout pregnancy and delivery. This lack of enriched pregnancy and birth data led to the initiation of the Swedish Stockholm–Gotland Perinatal Cohort (SGPC). Objectives: To describe the strengths of the SGPC, as well as the unique research questions that can be addressed using this cohort. Population: The SGPC is a prospectively collected, population‐based cohort that includes all births (from 22 completed gestational weeks onwards) between 1 January 2008 and 15 June 2020 in the Stockholm and Gotland regions of Sweden (335,153 singleton and 11,025 multiple pregnancies). Design: Descriptive study. Methods: The SGPC is based on the electronic medical records of women and their infants. The medical record system is used for all antenatal clinic visits and admissions, delivery and neonatal admissions, as well as postpartum clinical visits. SGPC has been further enriched with data linkages to 10 Swedish National Health Care and Quality Registers. Preliminary Results: In contrast to other reproductive and perinatal databases available in Sweden, including the Medical Birth Register and the Pregnancy Register, SGPC contains highly detailed medical record data, including time‐varying serial measurements for physiological parameters throughout pregnancy, delivery, and postpartum, for both mother and infant. These strengths have enabled studies that were previously inconceivable; the effects of serial measurements of pregnancy weight gain, changes in haemoglobin counts and blood pressure during pregnancy, fetal weight estimations by ultrasound, duration of stages and phases of labour, cervical dilatation and oxytocin use during delivery, and constructing reference curves for umbilical cord pH. Conclusions: The SGPC—with its rich content, repeated measurements and linkages to numerous health care and quality registers—is a unique cohort that enables high‐quality perinatal studies that would otherwise not be possible. [ABSTRACT FROM AUTHOR]

Background: Active first stage of labour duration can widely vary between women. However, the nature of the relationship between the active first stage and second stage of labour duration is sparsely studied. Objectives: To determine whether active first stage of labour duration (i) influences second stage of labour duration; and (ii) is associated with mode of delivery. Methods: A population‐based cohort study of 13,379 women primiparous women, with spontaneous start in Stockholm‐Gotland Region, Sweden, between 2008 and 2014. Duration of the active first stage of labour was examined in relation to second‐stage duration using univariate and multivariable quantile regressions, with the first quartile (first stage duration) as the reference. Nonlinearity of associations was tested by restricted cubic splines. Association between active first‐stage duration with mode of delivery was estimated using a multinomial logistic regression based on adjusted odds ratios. Results: Longer active first stage of labour duration was linearly associated with longer second stage of labour duration until approximately 12 h of active first stage of labour duration. After 12 h, a non‐linear trend is seen, demonstrated by a plateau in the second‐stage duration. In addition, longer active first stage of labour duration was associated with increased occurrence of operative vaginal delivery (adjusted odds ratio 3.36, 95% confidence interval [CI] 2.89, 3.89) and caesarean delivery (adjusted odds ratio 4.75, 95% CI 3.85, 5.80). Conclusions: Among primiparous women with spontaneous onset of labour, longer active first stage of labour duration was associated with both longer second stage of labour duration and higher odds of operative delivery. This study contributes with findings, which may inform future discussions regarding how to properly account for second‐stage duration, with applications in obstetric and perinatal epidemiology. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of data on patterns of red‐cell transfusions in obstetrical care, but some studies have suggested an increase in transfusion rates during the last decade. The purpose of this study was to investigate maternal characteristics, temporal trends and hospital variations in red‐cell use in a large contemporary obstetric cohort in Sweden. Study design and methods: Nationwide observational cohort study of maternal red‐cell transfusions for all deliveries in Sweden between 2003 and 2017. Results: The proportion of deliveries that received red‐cell transfusions was stable during the study period, although the number of red‐cell units administered per delivery declined. Among transfused women, most received a low‐volume transfusion of 1 or 2 units. Red‐cell transfusion was more common among the nulliparous, for instrumental and caesarean deliveries, and with increased maternal age. We saw large variations in transfusion rates between hospitals in Sweden, despite adjusting for age and parity. Conclusions: In comparison to other high‐resource countries we see a high proportion of deliveries with maternal red‐cell transfusions. However, we do not see an increase in red‐cell use over time. [ABSTRACT FROM AUTHOR]

Introduction: Some studies have shown that women with a previous cesarean section, compared with women with a previous vaginal delivery, have an increased risk of retained placenta during a subsequent vaginal delivery. It is unknown whether this is mediated by anterior placental location, when the placenta might cover the uterine scar. The aim of this study was to evaluate whether the increased risk of retained placenta in women with a previous cesarean section is mediated by anterior placental location. Material and methods: This is a population‐based cohort study, with data from the regional population‐based Stockholm‐Gotland Obstetric Cohort, Sweden, from 2008 to 2014. The overall study population included 49 598 women with a vaginal second delivery, where adequate information about placental location from the second‐trimester ultrasound scan was available. For the main analysis, including the 3921 women with a previous cesarean section, we calculated the relative risk of retained placenta in women with an anterior placental location, using women with non‐anterior placental locations as reference. Relative risks were calculated as odds ratios (OR) with 95% CI. In a second model, adjustments were made for maternal age, height, country of birth, smoking in early pregnancy, infant sex, and in vitro fertilization. Results: In the overall study population, the rate of retained placenta at the second delivery was 2.0%. The proportion of women with a retained placenta was higher among women with a previous cesarean compared with those with a previous vaginal delivery (3.4% vs 1.9%; P <.0001). In the main analysis, including women with a previous cesarean section, the risk for retained placenta was not increased with anterior compared with non‐anterior placental location (OR 0.84, 95% CI 0.60‐1.20). Adjustments did not affect the estimates in a significant way. Conclusions: The increased risk of retained placenta in women with a previous cesarean section is not mediated by anterior placental location. [ABSTRACT FROM AUTHOR]

Introduction: The impact of placenta previa on pregnancy, delivery and infant outcomes has been extensively studied. However, less is known about the possible association of placental location other than previa with pregnancy outcomes. The aim of this study was to investigate if placental location other than previa is associated with adverse pregnancy, delivery and infant outcomes.Material and Methods: This is a population-based cohort study, with data from the regional population-based Stockholm-Gotland Obstetric Cohort, Sweden, from 2008 to 2014. The study population included 74 087 nulliparous women with singleton pregnancies resulting in live-born infants, with information about placental location from the second-trimester ultrasound screening. The association between placental location (fundal, lateral, anterior or posterior) and pregnancy outcomes was estimated using logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated, and adjustments were made for maternal age, height, country of birth, smoking in early pregnancy, sex of the infant and in vitro fertilization. Main outcome measures were pregnancy, delivery and infant outcomes.Results: Compared with posterior placental location, fundal and lateral placental locations were associated with a number of adverse pregnancy outcomes, the most important being: very preterm birth (<32 weeks of gestation) (adjusted OR [aOR] 1.78, 95% CI 1.18-2.63 and aOR 2.12, 95% CI 1.39-2.25, respectively), moderate preterm birth (32-36 weeks of gestation) (aOR 1.23, 95% CI 1.001-1.51 and aOR 1.62, 95% CI 1.32-2.00, respectively), small-for-gestational-age birth (aOR 1.67, 95% CI 1.34-2.07 and aOR 1.77, 95% CI 1.39-2.25, respectively) and manual removal of the placenta in vaginal births (aOR 3.27, 95% CI 2.68-3.99 and aOR 3.27, 95% CI 2.60-4.10, respectively). Additionally, lateral placental location was associated with preeclampsia (aOR 1.30, 95% CI 1.03-1.65) and severe postpartum hemorrhage (aOR 1.42, 95% CI 1.27-1.82).Conclusions: Compared with posterior placental location, fundal and lateral placental locations are associated with a number of adverse pregnancy, delivery and infant outcomes. [ABSTRACT FROM AUTHOR]

International Journal of Paediatric Dentistry 2011; 21: 43-49 A common clinical finding is that many schoolchildren display a nonacceptable oral hygiene. To evaluate the tooth-brushing behaviour in children aged 6-12 years. The study used a cross-sectional descriptive design. Children aged 6, 8, 10, and 12 years in an elementary school in a middle class area in Umeå, a city in northern Sweden, were invited and 82 (82%) consented. Visible plaque on buccal surfaces of incisors and canines was recorded from photographs of the participant's teeth before and after brushing using the scores of the Green and Vermillion Oral Hygiene Index. Brushing technique was recorded with a video camera. A questionnaire was used to collect data about oral hygiene habits at home. The ratio between the sum of plaque scores after and before brushing was statistically significantly higher in the 6-year-old group compared with the 10-year olds, ( P < 0.05). There was a negative correlation between time spent for brushing and the ratio between the sum of plaque scores after and before brushing ( r = −0.31, P < 0.01). The lowest correlation was displayed in the youngest age group ( r = 0.07, P > 0.05). Six-year olds spent statistically significantly less time for brushing than older children ( P < 0.05). Plaque removal from buccal surfaces from brushing was poor and averaged 19% for 6-year olds and 30% for older children. The results of brushing for children aged 8-12 years could benefit from increasing tooth-brushing time. Children could be given an increasing responsibility from 7 to 8 year of age but parental help is motivated up to 10 years of age. [ABSTRACT FROM AUTHOR]