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  • 1.
    Adolfsson, Annsofie
    et al.
    University of Skövde, School of Life Sciences.
    Larsson, Per - Göran
    University of Skövde, School of Life Sciences.
    Applicability of general grief theory to Swedish women's experience after early miscarriage, with factor analysis of Bonanno's taxonomy, using the Perinatal Grief Scale2010In: Upsala Journal of Medical Sciences, ISSN 0300-9734, Vol. 115, no 3, p. 201-209Article in journal (Refereed)
    Abstract [en]

    Background. Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief. Material and methods. Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman’s categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks. Results. Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage. Conclusion. Women’s experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman’s age, or her number of earlier miscarriages.

  • 2.
    Adolfsson, Annsofie
    et al.
    University of Skövde, School of Life Sciences. Department of Obstetrics and Gynecology, Central Hospital Skövde.
    Tullander-Tjörnstrand, Karin
    Department of Obstetrics and Gynecology, Central Hospital Skövde.
    Larsson, Per-Göran
    University of Skövde, School of Life Sciences. Department of Obstetrics and Gynecology, Central Hospital Skövde.
    Decreased need for emergency services after changing management for suspected miscarriage2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 8, p. 921-923Article in journal (Refereed)
    Abstract [en]

    We investigated the effect of a changed routine to identify women with a nonviable pregnancy, in order to utilize health care resources more efficiently during office hours rather than relying on emergency care services. From hospital register data about where and when women with miscarriages were treated, there was a significant trend during a nine-year period for miscarriages to be more rarely diagnosed (p-value<0.001) in the emergency ward after office hours. The proportion of miscarriages that were diagnosed and handled at the emergency ward decreased from 31% in 2001 to 17% in 2009. Furthermore, the number of women showing up with bleeding at the emergency ward, but who also had a normal viable pregnancy, declined during the same period (p-value<0.01). Women with suspected miscarriage benefit from structured information and standardized management and can effectively be scheduled for day-time assessment including ultrasound with a concomitant reduced need for emergency services.

  • 3.
    Andrada Hamar, Maria
    et al.
    Skane Univ Hosp, Dept Obstet & Gynecol, Lund, Sweden / Lund University.
    Larsson, Per-Göran
    University of Skövde, School of Life Sciences. Kärnsjukhuset, Skaraborgs Hospital, Skövde, Sweden.
    Teleman, Pia
    Skane Univ Hosp, Dept Obstet & Gynecol, Lund, Sweden / Lund University.
    Etén-Bergqvist, Christina
    Skane Univ Hosp, Dept Obstet & Gynecol, Lund, Sweden / Lund University.
    Persson, Jan
    Skane Univ Hosp, Dept Obstet & Gynecol, Lund, Sweden / Lund University.
    Short-term results of a prospective randomized evaluator blinded multicenter study comparing TVT and TVT-Secur2011In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 22, no 7, p. 781-787Article in journal (Refereed)
    Abstract [en]

    Introduction and hypothesis: The aim of this prospective randomized multicenter study was to compare TVT (tension-free vaginal tape) with TVT-Secur in terms of efficacy and safety.

    Methods:  We set out to enrol 280 stress incontinent women with a half time interim analysis of short-term cure and a continuous registration of adverse events. Of 133 randomized women, 126 were operated and 123 (TVT n = 62, TVT-Secur n = 61) available for 2 months follow-up.

    Results: No significant differences were found between groups regarding demographics or grade of incontinence. At 2 months follow-up, subjective cure rate following TVT-Secur was significantly lower than for TVT (72% and 92%, respectively, p = 0.01). Three major complications occurred in the TVT-Secur group: tape erosion into the urethra, a tape inadvertently placed inside the bladder, and an immediate postoperative bleeding from the corona mortis. No major complications occurred in the TVT group. No significant differences were found between groups regarding perioperative bleeding, hospital stay, urge symptoms, or postoperative urinary tract infections. Median time for surgery was 13 and 22 min for TVT-Secur and TVT, respectively (p < 0.0001).

    Conclusions:  In a prospective randomized controlled study, the TVT-Secur procedure had a significantly lower subjective cure rate than the retropubic TVT procedure. Due to this, in addition to three serious complications in the TVT-Secur group, we decided to stop further enrolment after the interim analysis. We discourage from further use of the TVT-Secur.

  • 4.
    Charonis, Georgios
    et al.
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden / School of Life Sciences, University of Skövde, Skövde, Sweden / Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden / Department of Obstetrics and Gynecology, Kärnsjukhuset, 541 85 Skövde, Sweden.
    Larsson, Per-Göran
    University of Skövde, School of Life Sciences.
    Prolonged use of intrauterine contraceptive device as a risk factor for tubo-ovarian abscess2009In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, no 6, p. 680-684Article in journal (Refereed)
    Abstract [en]

    Objective. The intrauterine contraceptive device (IUCD) is the most preferred method of reversible contraception in the world today. The Swedish Medical Products Agency currently recommends that women who had a copper IUCD inserted around age 40 do not need to have it extracted until one year after the menopause. Design. Retrospective study. Setting. Skövde Central Hospital, Sweden. Population. All 114 women receiving in-patient treatment for pelvic inflammatory disease (PID) over five years between January 2001 and December 2005. Methods. Comparison between cases of tubo-ovarian abscesses and salpingitis with focus on the effects of IUCDs used continually for >5 years after insertion. Main outcome measures. Age-adjusted risk of PID within or after five years of use, microbiological findings in blood, intraabdominal pus, cervical secretions or on extracted IUCDs. Results. There were 31 cases of tubo-ovarian abscesses, 63 of salpingitis, four of endometritis, and 16 of mild genital infection. When comparing women with the same IUCD > 5 years to women having the same IUCD ≤ 5 years, the risk of tubo-ovarian abscess was higher than the risk of salpingitis (OR 19.7; 95% CI 4.5-87.2). The risk remained significant after adjustment for age, both on multiple regression analysis (OR 13.5; 95% CI 2.5-72.9) and in stratified analysis for the age group 35-50 years (OR 12.0; 95% CI 1.8-81.7). Blood or abdominal cultures from patients operated upon were positive in 47.7% of the sampled cases. Intestinal tract microbes and upper respiratory tract microbes were more common than sexually transmitted infection microbes. Conclusions. The current Medical Products Agency recommendation that a woman nearing the end of her reproductive phase can safely use the same IUCD for a period exceeding five years is challenged.

  • 5.
    Ekström, Linnéa
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Adolfsson, Annsofie
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden / School of Health and Medical Sciences, University of Örebro, Örebro, Sweden.
    Ericson, Henrik
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre.
    Poutakidis, Georgios
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden.
    Charonis, Georgios
    Department of Obstetrics and Gynaecology, University of Linköping, Linköping, Sweden / Mitera General and Maternity Hospital, Athens, Greece.
    Larsson, Per-Göran
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, Skövde, Sweden.
    Vaginal flora and urinary and vaginal group B streptococci in early pregnancy2013In: Gynecology, ISSN 2052-6210, Vol. 1, article id 6Article in journal (Refereed)
    Abstract [en]

    Background: Bacterial vaginosis (BV) is a risk factor for premature birth and group B streptococci (GBS) colonizing the vagina are etiological agents of neonatal infections. Significant growth of GBS in the vagina has been assumed to be detectable through urinary culture. The aim was to investigate the correlation between BV and the presence of GBS in qualitative vaginal or quantitative urinary culture, since this could predict a higher risk for perinatal morbidity. Design and setting: A consecutive prospective study of women in early pregnancy included 3101 women between 2007 and 2010, in a region of south-western Sweden. Methods: Vaginal and urine samples were obtained from women in early pregnancy at maternity health care clinics. BV was diagnosed according to the Ison/Hay classification. GBS in urine were detected in amounts as low as 100 CFU/ml. Vaginal culturing for GBS was obtained from a selected group of 481 women. Results: There was no difference in the prevalence of GBS in the urine among women with BV compared with women with lactobacilli flora (OR 0.7; 95% CI 0.4-1.1). Vaginal presence of GBS was found among 17.3% of women with BV and among 23.5% of women with lactobacilli flora (OR 0.7; 95% CI 0.3-1.4). Among the 105 women who had vaginal GBS, the urine culture of GBS was positive in only 21.9% of cases. Conclusions: Even though women with BV. have much higher concentration of bacteria in the vagina, they do not necessarily have more GBS in the vagina or urine. The modest correlation between positive vaginal culture and positive urine culture of GBS question the value of urinary culture for detection of vaginal GBS.

  • 6.
    Eriksson, Katarina
    et al.
    Department of Obstetrics and Gynecology, Ålands Centralsjukhus, Finland.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences. Department of Clinical and Experimental Medicine, Faculty of Health Science, Linköpings University.
    Forsum, Urban
    Department of Obstetrics and Gynecology, Kärnsjukhuset, Skövde.
    Larsson, Per Göran
    University of Skövde, School of Life Sciences.
    Prevalence of BV on the Åland Islands. Reply to Professor Donders2011In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 119, no 3, p. 226-226Article in journal (Refereed)
  • 7.
    Eriksson, Katarina
    et al.
    Linköping University.
    Adolfsson, Annsofie
    University of Skövde, School of Life Sciences.
    Forsum, Urban
    Linköping University.
    Larsson, Per-Göran
    University of Skövde, School of Life Sciences.
    The prevalence of BV in the population on the Åland Islands during a 15-year period2010In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 118, no 11, p. 903-908Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe the prevalence and age distribution of bacterial vaginosis (BV) during an observation period of 15 years in a population study with cross-sectional samples of adult women living on the Åland Islands. The Åland Islands form an archipelago in the Baltic Sea and are a province of Finland. Every fifth year, specific age groups in the adult female population are invited to participate in a screening program for early diagnosis of cervical cancer using a papanicolaou (PAP)-stained vaginal smear. Women in the age groups of 20, 25, 30, 35, 40, 45, 50, 55, and 60 years are called each year. BV diagnosis of the PAP-stained smears uses the classification according to Nugent. The PAP-stained smears from the screening program of cervical cancer 1993, 1998, 2003, and 2008 were used in this study. A total of 3456 slides were investigated and 271 women could be followed for the 15-year observation period. The prevalence of BV declined from 15.6% in 1993 to 8.6% in 2008. The highest prevalence occurred among the age groups of 35 and 50 years. Among the 271 women who could be followed for the 15-year observation period, two-third showed normal ⁄ intermediate flora and one-third were infected with BV at least once. As this is a cross-sectional population study spanning 15 years, the prevalence of BV in the female adult population of the Åland Islands can be estimated. The prevalence has declined between 1993 and 2008 from 15.6% to 8.6%.

  • 8.
    Eriksson, Katarina
    et al.
    Alands Cent Sjukhus, Dept Obstet & Gynecol, Mariehamn, Finland / Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden .
    Larsson, Per-Göran
    University of Skövde, School of Life Sciences.
    Nilsson, Maud
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden .
    Forsum, Urban
    Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden .
    Vaginal retention of locally administered clindamycin2011In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 119, no 6, p. 373-376Article in journal (Refereed)
    Abstract [en]

    Since bacterial vaginosis (BV) is characterized by a lack of, or very few, lactobacilli and high numbers of small, mostly anaerobic bacteria, an obvious treatment modality would be eradication of the BV-associated bacterial flora followed by reintroduction of lactobacilli vaginally. As probiotic treatment with lactobacilli is one tool for improving the cure rate when treating BV, it is necessary to know the length of time after treatment that clindamycin can be found in the vagina and if this could interfere with the growth of the probiotic lactobacilli. We evaluated the vaginal concentration of clindamycin in 12 women for 8 days to obtain data on the concentration of clindamycin in the vagina after intravaginal treatment with the drug. The participants were examined five times between two menstrual periods: before treatment, the day after treatment was finished, and 3, 5 and 8 days post-treatment. The first day post-treatment clindamycin 0.46 x 10-3 to 8.4 x 10-3 g/g vaginal fluid (median 2.87 x 10-3) was found. Thereafter, the concentration of clindamycin decreased rapidly. In 10 patients clindamycin was found after 3 days. A very low concentration was still present 5 days after treatment in four patients. After 8 days no clindamycin was found. Clindamycin is rapidly eliminated from the vagina, within 3-8 days, after local administration. Our results indicate that treatment with probiotic lactobacilli could be problematic if carried out within 5 days after cessation of clindamycin treatment.

  • 9.
    Larsson, Per-Göran
    et al.
    University of Skövde, School of Life Sciences.
    Brandsborg, Erik
    Bifodan AS, Bogbinderivej 6, DK-3390 Hundested, Denmark.
    Forsum, Urban
    Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden.
    Pendharkar, Sonal
    Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
    Krogh Andersen, Kasper
    Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
    Nasic, Salmir
    FoU Skas, Skaraborg hospital, SE-541 85 Skövde, Sweden.
    Hammarström, Lennart
    Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
    Marcotte, Harold
    Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
    Extended antimicrobial treatment of bacterial vaginosis combined with human lactobacilli to find the best treatment and minimize the risk of relapses2011In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 11, p. 223-Article in journal (Refereed)
    Abstract [en]

    Background: The primary objective of this study was to investigate if extended antibiotic treatment against bacterial vaginosis (BV) together with adjuvant lactobacilli treatment could cure BV and, furthermore, to investigate factors that could cause relapse.

    Methods: In all, 63 consecutive women with bacterial vaginosis diagnosed by Amsel criteria were offered a much more aggressive treatment of BV than used in normal clinical practice with repeated antibiotic treatment with clindamycin and metronidazole together with vaginal gelatine capsules containing different strains of lactobacilli both newly characterised and a commercial one (109 freeze-dried bacteria per capsule). Oral clindamycin treatment was also given to the patient’s sexual partner.

    Results: The cure rate was 74.6% after 6 months. The patients were then followed as long as possible or until a relapse. The cure rate was 65.1% at 12 months and 55.6% after 24 months. There was no significant difference in cure rate depending on which Lactobacillus strains were given to the women or if the women were colonised by lactobacilli. The most striking factor was a new sex partner during the follow up period where the Odds Ratio of having a relapse was 9.3 (2.8-31.2) if the patients had a new sex partner during the observation period.

    Conclusions: The study shows that aggressive treatment of the patient with antibiotics combined with specific Lactobacillus strain administration and partner treatment can provide long lasting cure. A striking result of our study is that change of partner is strongly associated with relapse of BV.

  • 10.
    Pendharkar, Sonal
    et al.
    Karolinska institutet, Stockholm, Sweden.
    Brandsborg, Erik
    Bifodan AS, Hundested, Denmark.
    Hammarström, Lennart
    Karolinska Institutet, Stockholm, Sweden.
    Marcotte, Harold
    Karolinska Institutet, Stockholm, Sweden.
    Larsson, Per-Göran
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre. Department of Obstetrics and Gynaecology Kärnsjukhuset, Skaraborg hospital, Skövde, Sweden.
    Vaginal colonisation by probiotic lactobacilli and clinical outcome in women conventionally treated for bacterial vaginosis and yeast infection2015In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 15, p. 1-12, article id 255Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to investigate the colonisation by lactobacilli and clinical outcome in women with bacterial vaginosis (BV) and recurrent vulvovaginal candidiasis (R-VVC) receiving antibiotic or anti-fungal treatment in combination with the probiotic EcoVag(R) capsules. Methods: A total of 40 Scandinavian women diagnosed with BV or VVC on the basis of Amsel's criteria or clinical symptoms were consecutively recruited in two pilot open label clinical trials. In trial I, women with BV were treated with clindamycin and metronidazole followed by vaginal EcoVag(R) capsules, containing Lactobacillus rhamnosus DSM 14870 and Lactobacillus gasseri DSM 14869, for 5 consecutive days after each antibiotic treatment. In trial II, women were recruited in three groups as follows: women with BV receiving clindamycin and metronidazole treatment together with a prolonged administration of EcoVag(R) (10 consecutive days after each antibiotic treatment followed by weekly administration of capsules for next four months), women with R-VVC receiving extended fluconazole and EcoVag(R) treatment, and women receiving extended fluconazole treatments only. The difference in frequency of isolation of EcoVag(R) strains or other lactobacilli between groups was compared by Fisher's exact test. Results: The 6-month cure rate for BV was 50 % in trial I while both the 6- and 12-month cure rates were 67 % in trial II. The 6- and 12-month cure rates for VVC were 100 % and 89 % in women receiving fluconazole and EcoVag(R), and 100 % and 70 % in women receiving fluconazole only. The frequency of isolation of any Lactobacillus species during the course of the study was associated with cure of BV in trial I and II, whereas the frequency of isolation of EcoVag(R) strains was significantly associated with the cure of BV in trial II only. As previously observed, a change in sexual partner was associated with relapse of BV with an Odds ratio of 77 (95 % CI: 2.665 to 2225). Conclusions: The study suggests that the treatment with antibiotics or anti-fungal medication in combination with EcoVag(R) capsules provide long-term cure against BV and R-VVC as compared to previous reports.

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  • 11.
    Pendharkar, Sonal
    et al.
    Karolinska University Hospital, Sweden.
    Magopane, Tebogo
    Chris Hani Baragwanath Hospital, South Africa.
    Larsson, Per-Göran
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre. Department of Obstetrics and Gynaecology, Skaraborg Hosptial, Skövde.
    de Bruyn, Guy
    Chris Hani Baragwanath Hospital, South Africa.
    Gray, Glenda E.
    Chris Hani Baragwanath Hospital, South Africa.
    Hammarstrom, Lennart
    Karolinska University Hospital, Sweden.
    Marcotte, Harold
    Karolinska University Hospital, Sweden / Karolinska Institute, Sweden.
    Identification and characterisation of vaginal lactobacilli from South African women2013In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 13, article id 43Article in journal (Refereed)
    Abstract [en]

    Background: Bacterial vaginosis (BV), which is highly prevalent in the African population, is one of the most common vaginal syndromes affecting women in their reproductive age placing them at increased risk for sexually transmitted diseases including infection by human immunodeficiency virus-1. The vaginal microbiota of a healthy woman is often dominated by the species belonging to the genus Lactobacillus namely L. crispatus, L. gasseri, L. jensenii and L. iners, which have been extensively studied in European populations, albeit less so in South African women. In this study, we have therefore identified the vaginal Lactobacillus species in a group of 40 African women from Soweto, a township on the outskirts of Johannesburg, South Africa. Methods: Identification was done by cultivating the lactobacilli on Rogosa agar, de Man-Rogosa-Sharpe (MRS) and Blood agar plates with 5% horse blood followed by sequencing of the 16S ribosomal DNA. BV was diagnosed on the basis of Nugent scores. Since some of the previous studies have shown that the lack of vaginal hydrogen peroxide (H2O2) producing lactobacilli is associated with bacterial vaginosis, the Lactobacillus isolates were also characterised for their production of H2O2. Results: Cultivable Lactobacillus species were identified in 19 out of 21 women without BV, in three out of five women with intermediate microbiota and in eight out of 14 women with BV. We observed that L. crispatus, L. iners, L. jensenii, L. gasseri and L. vaginalis were the predominant species. The presence of L. crispatus was associated with normal vaginal microbiota (P = 0.024). High level of H2O2 producing lactobacilli were more often isolated from women with normal microbiota than from the women with BV, although not to a statistically significant degree (P = 0.064). Conclusion: The vaginal Lactobacillus species isolated from the cohort of South African women are similar to those identified in European populations. In accordance with the other published studies, L. crispatus is related to a normal vaginal microbiota. Hydrogen peroxide production was not significantly associated to the BV status which could be attributed to the limited number of samples or to other antimicrobial factors that might be involved.

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