Levator Ani Deficiency and Pelvic Floor Dysfunction 1 Year Postpartum: A Prospective Nested Case-Control Study.

Objective: First, to assess whether levator ani deficiency (LAD) is associated with pelvic floor dysfunction 1 year postpartum, including urinary, vaginal and bowel symptoms; and second, to explore at what cut-off of LAD score such pelvic floor dysfunction arises.

Design: Nested case-control study.

Setting: Örebro University Hospital, Örebro, Sweden.

Misoprostol as Oral Solution or Oral Tablet for Induction of Labour (MISOBEST): A Randomised Controlled Non-Inferiority Trial.

Objective: To assess if off-label oral solution of misoprostol compared with licensed oral tablet of misoprostol approved for induction of labour (IOL) is as efficient in resulting in vaginal delivery within 24 h, using a non-inferiority design.

Design: Prospective, randomised, non-inferiority, open-label, blinded endpoint trial.

Setting: Two tertiary level hospitals, Stockholm, Sweden, January 2022 to May 2023.

A longitudinal study of facial function, quality of life, and depression in Bell's palsy during pregnancy and puerperium.

Bell's palsy can reduce facial function and quality of life. Pregnancy may also be physically and psychologically challenging. This study investigates depression among pregnant and puerperal women with and without Bell's palsy and if degree of facial palsy and depression was correlated.

If the first child is breech, overall outcomes for families with two children are similar regardless of the mode of the first birth.

Cesarean section for breech presentation is often recommended. However, cesarean section affects future reproduction. The aim of this study was to assess the effect of mode of the first birth in breech on outcomes of the second birth and the two births together.

Lateral episiotomy or no episiotomy in vacuum assisted delivery in nulliparous women (EVA): multicentre, open label, randomised controlled trial.

Objective: To assess the effect of lateral episiotomy, compared with no episiotomy, on obstetric anal sphincter injury in nulliparous women requiring vacuum extraction.

Design: A multicentre, open label, randomised controlled trial.

Setting: Eight hospitals in Sweden, 2017-23.

Obstetric anal sphincter injury in the second birth after perineal wound complication in the first birth: A nationwide register cohort study.

Objective: To investigate whether perineal wound complications in the first birth, alone or in conjunction with obstetric anal sphincter injury (OASI), is associated with an increased risk of OASI in the second birth.

Design: Nationwide population-based cohort study.

Setting: Sweden.

Pelvic floor dysfunction after intervention, compared with expectant management, in prolonged second stage of labour: A population-based questionnaire and cohort study.

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.

Key outcomes in childbirth: Development of a perinatal core outcome set for management of labor and delivery at or near term.

Introduction: Consistency and relevance of perinatal outcome measures are necessary basics for obstetric research, audit, and clinical counseling. Still, there is an unwarranted variation in reported perinatal outcomes, which impairs research synthesis, validity, and implementation, as well as clinical benchmarking and longitudinal comparisons. The aim of this study was to develop a short-term perinatal (fetal and neonatal) Core Outcome Set to be used in research and quality assurance of management of labor and delivery at or near term.

The association between episiotomy or OASIS at vacuum extraction in nulliparous women and subsequent prelabor cesarean delivery: A nationwide observational study.

Introduction: Severe perineal injuries at childbirth affect women's postnatal health, including future childbirths. First births with vacuum extraction carry an increased risk of obstetric anal sphincter injuries (OASIS). Lateral or mediolateral episiotomy at vacuum extraction may decrease the risk of OASIS.

Interpregnancy interval and maternal and neonatal morbidity: a nationwide cohort study.

This study aimed to assess the association between interpregnancy interval (IPI)-the time from childbirth to conception of the next pregnancy-and maternal and neonatal morbidity. The World Health Organization (WHO) currently recommends an IPI of at least 24 months after a live birth to reduce adverse birth outcomes. However, assessing the relationship between IPI and perinatal outcome is complicated by confounding factors.

Comparing apples and oranges? Variation in choice and reporting of short-term perinatal outcomes of term labor: A systematic review of Cochrane reviews.

Obstetric research is often criticized for using surrogate or combined outcomes with a disproportionately heavy weight of less relevant components. The objective of this methodological systematic review was to assess the choice and reporting of short-term perinatal outcomes for management of labor at or near term and evaluate if there is any need and possibility to harmonize them. A systematic methodological review of Cochrane reviews was performed.

Anal incontinence after a prolonged second stage of labor in primiparous women.

The objective was to investigate the effect of delivery mode on anal incontinence 1-2 years after delivery in primiparous women with prolonged second stage of labor. This population-based cohort and questionnaire study performed in Stockholm Region, Sweden, included 1302 primiparous women with a second stage ≥ 3 h from December 1st, 2017 through November 30th, 2018. Background characteristics and outcome data were retrieved from computerized records.

Delivery mode and severe maternal and neonatal morbidity among singleton term breech births: A population-based cohort study.

Objective: The aim of this study was to examine the association between delivery mode and severe maternal and neonatal morbidity in singleton term breech births.

Study Design: This nationwide population-based cohort study includes 41 319 singleton term and post-term breech births (37 + 0-42 + 6 gestational weeks) in Sweden from 1998 to 2016. Data was retrieved from the Swedish Medical Birth Register.

A step towards better audit: The Robson Ten Group classification system for outcomes other than cesarean section.

Introduction: The Robson Ten Group Classification System is widely used for the audit of cesarean section (CS) rates. However, CS rate alone is a poor quality indicator and should be balanced with other obstetric endpoints. The aim of this study was to evaluate whether Swedish national data on obstetric outcomes other than CS, stratified by the Robson classification, could be analyzed in a useful way.

Attitudes and knowledge regarding episiotomy use and technique in vacuum extraction: A web-based survey among doctors in Sweden.

Objectives: Correct episiotomy use and technique may prevent obstetric anal sphincter injuries. We aimed to explore the attitudes, use, and technique regarding episiotomy among doctors in Sweden, and their willingness to contribute to a randomized controlled trial of lateral episiotomy or no episiotomy in vacuum extraction in nulliparous women.

Study Design: A web-based survey was sent to members of the Swedish Society of Obstetrics and Gynecology (n = 2140).

Episiotomy or not? Midwives' experiences of recruiting to a randomized controlled trial during pregnancy and labor - A qualitative study.

Objective: The performance of randomized controlled trials (RCTs) is dependent on recruitment. Recruiting women to RCTs regarding interventions during childbirth may be difficult due to time constraints and their vulnerable situation. Midwives play a major role in such recruitment.

COVID-19 in Pregnancy and Early Childhood (COPE): study protocol for a prospective, multicentre biobank, survey and database cohort study.

Introduction: There is limited knowledge on how the SARS-CoV-2 affects pregnancy outcomes. Studies investigating the impact of COVID-19 in early pregnancy are scarce and information on long-term follow-up is lacking.The purpose of this project is to study the impact of COVID-19 on pregnancy outcomes and long-term maternal and child health by: (1) establishing a database and biobank from pregnant women with COVID-19 and presumably non-infected women and their infants and (2) examining how women and their partners experience pregnancy, childbirth and early parenthood in the COVID-19 pandemic.

Obstetric anal sphincter injury after episiotomy in vacuum extraction: an epidemiological study using an emulated randomised trial approach.

Objective: To emulate a randomised controlled trial investigating whether lateral or mediolateral episiotomy compared with no episiotomy reduces the prevalence of obstetric anal sphincter injury (OASIS) in nulliparous women delivered with vacuum extraction.

Design: A population-based observational study.

Setting: Sweden.

Characteristics and short-term obstetric outcomes in a case series of 67 women test-positive for SARS-CoV-2 in Stockholm, Sweden.

Introduction: The Stockholm region was the first area in Sweden to be hit by the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The national guidelines on the care of women with a positive test for SARS-CoV-2 (detection with polymerase chain reaction [PCR]) recommend individualized antenatal care, mode of delivery based on obstetric considerations, and no routine separation of the mother and the newborn. Breastfeeding is encouraged, and although there is no specific recommendation regarding wearing a face mask to prevent viral transmission to the newborn while nursing, instructions are given to keep high hygiene standards.

Changing diagnostic criteria for gestational diabetes in Sweden - a stepped wedge national cluster randomised controlled trial - the CDC4G study protocol.

Background: The optimal criteria to diagnose gestational diabetes mellitus (GDM) remain contested. The Swedish National Board of Health introduced the 2013 WHO criteria in 2015 as a recommendation for initiation of treatment for hyperglycaemia during pregnancy. With variation in GDM screening and diagnostic practice across the country, it was agreed that the shift to new guidelines should be in a scientific and structured way.