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Tunón, Katarina
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Larsson, C., Hedberg, C. L., Lundgren, E., Söderström, L., Tunón, K. & Nordin, P. (2019). Anal incontinence after caesarean and vaginal delivery in Sweden: a national population-based study. The Lancet, 393(10177), 1233-1239
Åpne denne publikasjonen i ny fane eller vindu >>Anal incontinence after caesarean and vaginal delivery in Sweden: a national population-based study
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2019 (engelsk)Inngår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, nr 10177, s. 1233-1239Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Elective caesarean delivery is increasing rapidly in many countries, and one of the reasons might be that caesarean delivery is widely believed to protect against pelvic floor disorders, including anal incontinence. Previous studies on this issue have been small and with conflicting results. The aim of present study was to compare the risk of developing anal incontinence in women who had a caesarean delivery, in those who had a vaginal delivery, and in two age-matched control groups (nulliparous women and men).

Methods: In this observational population-based study, we included all women in the Swedish Medical Birth Register who gave birth by caesarean delivery or vaginal delivery during 1973-2015 in Sweden and were diagnosed with anal incontinence according to ICD 8-10 in the Swedish National Patient Register during 2001-15. Exclusion criteria were multiple birth delivery, mixed vaginal and caesarean delivery, and four or more deliveries. We compared the diagnosis of anal incontinence between women previously delivered solely by caesarean delivery and those who solely had delivered vaginally. We also compared it with two age-matched control groups of nulliparous women and men from the Swedish Total Population Register. Finally, we analysed risk factors for anal incontinence in the caesarean delivery and vaginal delivery groups.

Findings: 3 755 110 individuals were included in the study. Between 1973 and 2015, 185 219 women had a caesarean delivery only and 1 400 935 delivered vaginally only. 416 (0.22 %) of the 185 219 women in the caesarean delivery group were diagnosed with anal incontinence compared with 5171 (0.37%) of 1 400 935 women in the vaginal delivery group. The odds ratio (OR) for being diagnosed with anal incontinence after vaginal delivery compared with caesarean delivery was 1 center dot 65 (95% CI 1 center dot 49-1 center dot 82; p<0.0001). When the combination vaginal delivery and caesarean delivery was compared with the nulliparous control group, the OR of being diagnosed with anal incontinence was 2 center dot 05 (1 center dot 92-2 center dot 19; p<0.0001). For the nulliparous women compared with men, the OR for anal incontinence was 1 center dot 89 (1 center dot 75-2 center dot 05; p<0.0001). The strongest risk factors for anal incontinence after vaginal delivery were high maternal age, high birthweight of the child, and instrumental delivery. The only risk factor for anal incontinence after caesarean delivery was maternal age.

Interpretation: The risk of developing anal incontinence increases after pregnancy and delivery. Women with known risk factors for anal incontinence should perhaps be offered a more qualified post-partum examination to enable early intervention in case of injury. Further knowledge for optimal management are needed. Copyright (c) 2019 Elsevier Ltd. All rights reserved.

sted, utgiver, år, opplag, sider
Elsevier, 2019
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-157949 (URN)10.1016/S0140-6736(18)32002-6 (DOI)000462038400030 ()30799061 (PubMedID)
Tilgjengelig fra: 2019-04-17 Laget: 2019-04-17 Sist oppdatert: 2019-04-17bibliografisk kontrollert
Edblad-Svensson, A., Silfverdal, L., Collberg, P. & Tunón, K. (2018). High-Risk Types of Human Papilloma Virus DNA Testing in Women with False Negative Cytology. Acta Cytologica, 62(5-6), 411-417
Åpne denne publikasjonen i ny fane eller vindu >>High-Risk Types of Human Papilloma Virus DNA Testing in Women with False Negative Cytology
2018 (engelsk)Inngår i: Acta Cytologica, ISSN 0001-5547, E-ISSN 1938-2650, Vol. 62, nr 5-6, s. 411-417Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: To determine whether high-risk types of human papilloma virus (hrHPV) DNA testing is reliable for selection patients in need of further investigation with colposcopy in women with increased risk of high-grade cervical lesions as a result of false negative cytology. The secondary objective was to compare the sensitivity of hrHPV testing on self-collected versus physician-collected samples for the detection of histological high-grade cervical intraepithelial neoplasia (CIN2+). Methods: Sixty-three patients identified with a missed abnormality following the re-evaluation of benign cervical cytology were included. A patient-collected and a physician-collected sample for HPV, colposcopy and cervical specimen collection for histology and cytology were performed. Results: The sensitivity of hrHPV testing of physician-collected samples for CIN2+ was 100% (95% CI 82.7-100), and the negative predictive value (NPV) was 100% (95% CI 93.3-100). The sensitivity of the self-sampling device to identify CIN2+ was 84.6% (95% CI 59.1-96.7), and the NPV was 94.4% (95% CI 83.4-98.8). The differences in the sensitivity and NPV between the 2 methods were non-significant. The agreement between the 2 methods regarding the HPV results was good, with a kappa value of 0.74 (95% CI 0.57-0.91). Conclusion: The current findings indicate that physician-collected samples for hrHPV DNA testing may be used as triage for the colposcopy of women with false negative cytology.

sted, utgiver, år, opplag, sider
S. Karger, 2018
Emneord
Cervical screening, Cervical intraepithelial neoplasia, False negative cytology, Triage for colposcopy, man papilloma virus, High-risk types of human papilloma virus DNA testing, Physician-collected mple, Self-collected sample
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-155257 (URN)10.1159/000490487 (DOI)000454161600014 ()30007979 (PubMedID)
Tilgjengelig fra: 2019-01-11 Laget: 2019-01-11 Sist oppdatert: 2019-01-11bibliografisk kontrollert
Rydberg, C. & Tunón, K. (2017). Detection of fetal abnormalities by second-trimester ultrasound screening in a non-selected population. Acta Obstetricia et Gynecologica Scandinavica, 96(2), 176-182
Åpne denne publikasjonen i ny fane eller vindu >>Detection of fetal abnormalities by second-trimester ultrasound screening in a non-selected population
2017 (engelsk)Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, nr 2, s. 176-182Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

IntroductionThis study assessed the sensitivity of routine ultrasound examination for the detection of abnormal chromosomes and structural malformations in fetuses in the second trimester in a non-selected population. Material and methodsPrenatal diagnoses of fetal abnormalities in 10 414 fetuses and newborns were reviewed and compared with all postnatal diagnoses of congenital abnormalities between 2006 and 2013. ResultsOverall, 243 fetuses and newborns had confirmed congenital abnormalities, with a prevalence of 2.3%. Of these fetuses and newborns, 23% (56/243) had chromosomal abnormalities (overall prevalence 0.5%), and 77% (187/243) had normal chromosomes with either major (44%; 82/187) or minor (56%; 105/187) structural malformations (overall prevalence 1.8%). One hundred and seven abnormalities were detected prenatally, yielding a total sensitivity for prenatal detection of fetal abnormalities of 44.0% (107/243; 95% CI 37.8-50.2), with specificity of 99.9%, a positive predictive value of 94.7%, and a negative predictive value of 98.7%. The sensitivity for prenatal detection before 22 weeks of gestation was 40.3% (98/243; 95% CI 34.1-46.5). The prenatal detection rate of chromosomal abnormalities was 60.7% (34/56) and, for structural malformations, was 39.0% (73/187). ConclusionsIn a routine clinical setting at a county hospital with a non-selected population, half of the major structural malformations in chromosomally normal fetuses are detected by routine ultrasound examination in the second trimester. Chromosomal abnormalities have the highest probability for prenatal detection; the majority are diagnosed by amniocentesis before the routine ultrasound examination in high-risk women.

Emneord
Congenital abnormalities, detection rate, screening, ultrasonography
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-132631 (URN)10.1111/aogs.13037 (DOI)000393615900007 ()27714775 (PubMedID)
Tilgjengelig fra: 2017-03-20 Laget: 2017-03-20 Sist oppdatert: 2018-06-09bibliografisk kontrollert
Bäck, L., Sharma, B., Karlström, A., Tunón, K. & Hildingsson, I. (2017). Professional confidence among Swedish final year midwifery students: a cross-sectional study. Sexual & Reproductive HealthCare, 14, 69-78
Åpne denne publikasjonen i ny fane eller vindu >>Professional confidence among Swedish final year midwifery students: a cross-sectional study
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2017 (engelsk)Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 14, s. 69-78Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: Previous international studies have shown that midwifery students do not feel confident in many areas where they are supposed to practice independently. Objective: The knowledge about Swedish midwifery students' confidence is fairly under investigated. The purpose of the present study was to explore final years' midwifery students' professional confidence in basic midwifery skills according to ICM competencies and associated factors. Methods: A cross-sectional survey where all midwifery programs in Sweden were invited to participate. Data was collected by a questionnaire that measured midwifery students self-reported assessment of confidence against four selected domains of ICM competencies; antenatal, intrapartum, postpartum and new-born care. Result: The main findings of this study showed that Swedish midwifery students were confident in managing normal pregnancy, labour and birth. Midwifery students at a school with a medical faculty were more confident in handling obstetric emergency situations. Some background variables were also associated with confidence. Conclusion: This study highlighted some midwifery skills that needs further training and reflection. More training and developing confidence in complicated and emergency situations are needed. There seem to be a need of midwifery education reforms if we believe that high levels of confidence at the time of graduation is equal to competent and skilled midwives in the future.

sted, utgiver, år, opplag, sider
Elsevier, 2017
Emneord
Clinical practice, Confidence, Midwifery education, Midwifery students
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-143943 (URN)10.1016/j.srhc.2017.10.003 (DOI)000418966300011 ()29195637 (PubMedID)
Tilgjengelig fra: 2018-01-15 Laget: 2018-01-15 Sist oppdatert: 2018-06-09bibliografisk kontrollert
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