Journal Article•
Maternal deaths related to cesarean section in Sweden 1951-1980
TL;DR: In this paper, the authors chart the distribution and decline in maternal mortality in Sweden between 1751 and 1980, and furthermore characterize positive (predisposing) factors and negative (protective) factors of maternal mortality, concluding that the major part of the maternal deaths can be prevented by medical technology, including family planning, antenatal and obstetric care.
About: This article is published in Obstetrics & Gynecology.The article was published on 1985-01-01 and is currently open access. It has received 7 citations till now. The article focuses on the topics: Obstetric transition & Case fatality rate.
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TL;DR: Sixty‐eight deaths during pregnancy, parturition and puerperium were recorded in Sweden during the years 1971–80, giving a maternal mortality of 6.6 per 100 000 live births.
Abstract: Sixty-eight deaths during pregnancy, parturition and puerperium were recorded in Sweden during the years 1971–80, giving a maternal mortality of 6.6 per 100 000 live births. the figurese for abdominal delivery and vaginal were 45.0 and 2.5 per 100000 live births respectively. Am-niotic fluid embolism, pulmonary embolism and hemorrhage were the main causes of death within 24 hours after delivery, while pre-eclampsia/eclampsia and sepsis were predominant during the rest of the puerperium. Age and parity are highly important risk factors. Presumed avoidable factors were identified in 19% of the cases. 9% of the deaths were related to unwanted pregnancy.
41 citations
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29 citations
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01 Feb 2018
TL;DR: Prioridades for the control of enfermedades, tercera edicion (DCP3), construye sobre la base and los analisis de la primera and segunda edi- ciones (DCC1 and DCP2) for consolidar su posicion de referencia for el diseno de programas and programacion de recursos in los niveles global and nacional, al proveer una revision actualizada de la eficacia of las intervenciones in salud priorit
Abstract: Acerca de esta serie: Desde su concepcion, la serie Prioridades para el control de enfermedades se ha enfocado en la prestacion de inter- venciones de salud eficaces que puedan resultar en reducciones notables en la mortalidad y discapacidad a un costo relativamente bajo. El enfoque ha sido multidisciplinario y las recomendaciones basadas en evidencia, escalables y adaptables a multiples escenarios. Una atencion en salud mejor y mas equitativa es la responsabilidad compartida de gobiernos y agencias internacionales, sectores publicos y privados, y sociedades e individuos. Todos estos actores se han involucrado en el desarrollo de la serie. Prioridades para el control de enfermedades, tercera edicion (DCP3), construye sobre la base y los analisis de la primera y segunda edi- ciones (DCP1 y DCP2) para consolidar su posicion de referencia para el diseno de programas y programacion de recursos en los niveles global y nacional, al proveer una revision actualizada de la eficacia de las intervenciones en salud prioritarias. Ademas, DCP3 presenta evaluaciones economicas sistematicas y comparables de intervenciones, paquetes, plataformas de prestacion de servicios y politicas seleccionadas que se basan en metodos econometricos de reciente desarrollo. DCP3 presenta sus hallazgos en nueve volumenes individuales que se dirigen a audiencias especificas. Los volumenes estan estructurados alrededor de paquetes de intervenciones relacionadas conceptualmente, entre ellas las referentes a salud materna e infantil, enfermedades cardiovasculares, enfermedades infecciosas, cancer y cirugia. Los volumenes de DCP3 constituiran un recurso esencial para los paises al momento de considerar cual es la forma idonea de mejorar la atencion en salud; igualmente lo seran para la comunidad global de politicas en salud, especialistas tecnicos y estudiantes.
13 citations
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07 May 2018TL;DR: Investigation of the influence of mode of delivery on the global epigenetic state of the neonatal WBC and hematopoietic stem/ progenitor cells found that delivery by elective CS was associated with lower T-lymphocyte formation in newborn infants.
Abstract: Background Birth by Cesarean section (CS) has been associated with a greater risk for immune disorders like allergy, asthma, type 1 diabetes, celiac disease, inflammatory bowel diseases, and cancer later in life. Although elective CS continues to increase rapidly, it is unclear if and how it may contribute to future health and disease. Our aim was to investigate the influence of mode of delivery on the global epigenetic state in white blood cells (WBC) as well as global and genome-wide, locus-specific epigenetic state in hematopoietic stem/progenitor cells. Further, we tested whether surge of immune cell formation at birth is related to mode of delivery, taking other maternal and infant characteristics in account. Objective and methods Study I and II are observational cohort studies including 37 (16 elective CS) and 64 (27 elective CS) healthy infants born at term. Cord blood was sampled and in study I, blood sampling was repeated 3-5 days after birth. Global DNA-methylation was analyzed in leukocytes by luminometric methylation assay (LUMA). In study II and in addition to LUMA, genome-wide, locus-specific DNA-methylation analysis of hematopoietic CD34+ cells was performed after cell separation using the Illumina Infinium 450K platform. In study III, we used a prospectively collected database, including information on maternal and infant characteristics of 6,014 healthy, singleton infants delivered in Stockholm, Sweden, with gestational age ≥ 35 weeks. The data was linked to blood levels of T-cell receptor excision circles (TREC) and κ-deleting recombination excision circles (KREC), determined 3-5 days after birth as part of a neonatal screening program for immune-deficiencies, and representing quantities of newly formed naïve Tand B-lymphocytes. Results Global DNA-methylation of leucocytes and hematopoietic stem cells (CD 34+) was higher in infants delivered by elective CS compared to those born vaginally. The genome-wide, locusspecific analysis identified 343 loci with a > 10 % (maximal 40 %) difference of DNA-methylation between the two groups. In vaginally delivered infants, the degree of DNA-methylation in three loci gradually diminished in relation to duration of labor. Infants born by CS before labor had a 32 % increased risk of having TRECs within the lowest quintile. Low TREC was also independently associated with male gender, preterm birth at 35-36 weeks of gestation and infant being small for gestational age. Low KREC was associated with male gender, postterm birth at > 42 weeks and small for gestational age. Maternal characteristics exhibited no associations with levels of TREC or KREC in newborn infants. Conclusions Mode of delivery affected the epigenetic state of the neonatal WBC and hematopoietic stem/ progenitor cells. In addition, delivery by elective CS was associated with lower T-lymphocyte formation in newborn infants. The significance and functional relevance of epigenetic differences and reduced birth-related surge in lymphocyte formation for future health in children and adults delivered by CS remains to be explored. List of publications I. Schlinzig T, Johansson S, Gunnar A, Ekström TJ, Norman M. Epigenetic modulation at birth – altered DNA-methylation in white blood cells after Caesarean section. Acta Pædiatrica, 2009: 1096–1099. doi:10.1111/j.1651-2227.2009.01371.x II. Almgren M, Schlinzig T, Gomez-Cabrero D, Gunnar A, Sundin M, Johansson S, Norman M, Ekström TJ. Cesarean delivery and hematopoietic stem cell epigenetics in the newborn infant: implications for future health? American Journal of Obstetrics and Gynecology 2014, Volume 211, Issue 5, Pages 502.e1-502.e8, ISSN 0002-9378. III. Schlinzig T, Johansson S, Stephansson O, Hammarström L, Zetterström RH, von Döbeln U, Cnattingius S, Norman M. Surge of immune cell formation at birth differs by mode of delivery and infant characteristics—A population-based cohort study. PLOS ONE, 2017: 12(9), e0184748. 21
4 citations
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22 Jan 2014TL;DR: The overall aim of this thesis was to explore and describe the impact of mode of delivery and other aspects related to the birth of the baby in Sweden.
Abstract: Background: major changes have occurred in Swedish maternity care since the early 20 th century and is now characterized by an increased medicalisation. The incidence of caesarean section and instrumental vaginal births has risen substantially in Sweden the last decades, which means that fewer women give birth spontaneously. Both caesarean section and instrumental vaginal births are associated with adverse physical as well as physiological consequences for both mother and child. The overall aim of this thesis was to explore and describe the impact of mode of delivery and other aspects related to the birth of the
4 citations