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ABSTRACT Background: In the late 1980s the possibility was raised that periodontal infections could constitute maternal infections so it could influence adversely birth outcomes. Adversely birth outcomes such as preterm infants (born before 37 weeks of gestation). Low birth weight (LBW) (<2500g) is also usual with preterm infants. Transient bacteraemia commonly occurs in subjects with inflamed gingiva (Kinane et al. 2005) and may reach the tissues of the placenta, which could cause inflammatory impetus for labour induction  Aim: The aim of this study was to review published articles during the last ten years to summarize the current research field to elucidate if there is an association between periodontitis and some adverse birth outcomes, specifically low birth weight, pre-eclampsia and pre-term birth. Methods: A literature search was conducted in the database PubMed with the aim to find published articles in which the association between periodontitis and adverse birth outcomes was examined. Human clinical studies that were published within the last ten years, had an abstract available and a minimum of 200 subjects were included. Studies published before 2012 were excluded. Results: Results of the primary search presented 280 articles. Twentyone of these articles fulfilled the inclusion criteria. Two thirds of the included studies could show an association between periodontitis and adverse birth outcomes.  Conclusions: Within the limitations of this paper there is very likely to be an association between periodontitis and adverse birth outcomes in some populations, and under some conditions such as diagnostic criteria for periodontitis.

Internationally as well as in Sweden, efforts for improvement in gynaecological surgery in recent decades have mainly focused on three new treatment concepts: (1) Use of minimally invasive procedures: since there is an interdependency between the extent of surgical trauma and the risk for adverse outcome, increased use of supposedly atraumatic endoscopic procedures has revolutionized several aspects of surgical care (2) A multimodal approach to eliminate harmful procedures in the peri-operative process based on evidence-based principles (3) Introduction of implants to support damaged tissue with synthetic mesh in incontinence and pelvic organ prolapse patients. Research question 1: Is introduction of a minimally invasive operation enough per se or is the measured improvement mediated by elimination of harmful procedures in the perioperative process? Findings: Our study (Paper I) indicates that by applying a multimodal intervention programme for the pre- and postoperative care of patients undergoing supravaginal hysterectomy, the surgical procedure per se is of less importance than generally considered. Patient-related parameters such as length of postoperative hospital stay, number of days at home with need of painkillers, number of days before return to normal activities, and patient satisfaction did not differ between patients undergoing the laparoscopic procedure and patients undergoing abdominal supravaginal hysterectomy. When evaluating a new and presumably improved operative procedure against an established standard procedure, it is mandatory and of fundamental importance that the two methods are aligned in terms of perioperative care provided. Research question 2: Under which circumstances can it be assumed that a new surgical procedure showing promising efficacy in one setting can be reproduced with similar results in a different clinical setting (Paper I)? Findings: The operating surgeons concluded that, in their hands and under local conditions, laparoscopic technique for supravaginal hysterectomy was not superior to traditional open hysterectomy and stopped using laparoscopic technique. It seems necessary, prior to routine use, to monitor, using scientific tools, whether the advantages described in the literature are achievable under local conditions. Research question 3: Do expected advantages of implants outweigh the unwanted effects and complications caused by implants in operations for recurrent cystocele (Paper II)? Findings: Mesh has better durability but more (minor) complications. It is not possible to determine whether mesh is "generally better" than native tissue operation. Some may focus on the improved durability, others on the increased risks. The surgeon must make a risk assessment for each individual case. The patient must be sufficiently informed to understand the risks and make a personal, informed decision whether she wants an augmentation by implant. Essential for this process is a clear, comprehensible picture of both desired and unwanted effects of the planned surgery. In this context, studies like ours might be of use.

Bakgrund: Forskning har visat att ungdomarna är missnöjda med den sex- och samlevnadsundervisning som idag finns att tillgå. Det sexuella beteendet har förändrats genom tiderna och det har visat sig vara tidskrävande samt svårt att bedriva undervisningen på grund av bristen på barnmorskor. Syfte: Att belysa ungdomsmottagnings-barnmorskornas erfarenheter av sex- och samlevnadsundervisning till ungdomar. Metod: I studien genomfördes intervjuer med sex barnmorskor verksamma på olika ungdomsmottagningar i Västra Götaland. Datamaterialet analyserades med hjälp av kvalitativ innehållsanalys. Resultat: I resultatet framkom fyra teman och åtta subteman; Främja en positiv syn på sexualiteten bland ungdomarna; Ungdomarnas okunskap kan leda till ett riskbeteende; Grundskolans sex- och samlevnadsundervisning möter inte ungdomarnas behov; Betydelsen av utåtriktat arbete. Konklusion: Resultatet visar att den sex- och samlevnadsundervisning som idag erbjuds till ungdomarna är bristande. Barnmorskorna ger tydliga förslag på hur sex och samlevnadsundervisningen kan integreras i grundämnena. Genom att ungdomarna får tillgång till den undervisning de är i behov ökar deras kunskap vilket genererar i en positiv sexualitet.

Background: In Sweden, approximately 440 children die in intrauterine fetal death annually. Losing a child before birth causes great sadness and despair to the parents. Midwives' have a significant role in supporting and nurturing parents in those situations, which is often experienced as a difficult and emotional task. Aim: To describe midwives' experiences associated to intrauterine fetal death. Method: Focus group interviews made with midwives working at a delivery ward in central Sweden, data were analyzed with  qualitative content analysis. Result: The data analysis resulted in ten subcategories,four categories and an overall theme. The categories were Presence, A meaningful task, Being both professional and a human being, and Support at work. The overall theme was To make meaning of the seemingly meaningless. The midwives needed time to be able to be fully present with the parents. According to the midwives it was a meaningful experience to be supportive and make a difference for the parents. To be professional while at the same time dealing with their own feelings appeared as a difficult task. They received the best support from their colleagues. Conclusion: Supporting the parents and creating a memorable moment with their stillborn baby was experienced as the most eager in these situations, and made the task meaningful for the midwives.

Abstract   Objective To study midwives' experiences of working with normal birth in multidisciplinary teams.
 Methods This was a qualitative study based on Semi-structured interviews in focusgroups with 20 midwives at four maternity wards in mid-Sweden. Results The interviews revealed a theme as The midwifery profession is both strong and torned at normal birth in hospital. The results describe that midwives are working independently and are responsible for the normal birth in multidisciplinary team. Hierarchies and relationships influence the independence of the midwives in their work with normal birth. The midwives were also using tools as risk evaluation and medical rounds to identify normal birth. There are no independent guidelines designed by midwives for the normal birth in maternity care. Heavy workload affects the midwives’ ability to work evidence-based and resulted in changes of practices in normal birth. Conclusion The midwives consider they sometimes share involuntary the responsibility in normal birth. A good cooperation and communication is important within a multidisciplinary team for the midwives to support normal birth. Keywords: collaboration, midwives, normal birth, professional responsibility / Sammanfattning                   Bakgrund Att arbeta som barnmorska i Sverige innebär att ansvara för kvinnans vård vid den normala förlossningen. När denna avviker vidtas adekvata åtgärder samt en bedömning av när samverkan krävs med andra professioner. Barnmorskans arbete och ansvar har förändrats över tid och tvärprofessionellt samarbete har växt fram som en rådande arbetsmodell inom förlossningsvården. Syfte: Att studera barnmorskors upplevelser av att handlägga normala förlossningar i tvärprofessionella arbetsgrupper. Metod: Semistrukturerade fokusgruppsintervjuer med 20 barnmorskor vid fyra olika förlossningsavdelningar i Mellansverige. Resultat: Ur fokusgruppsintervjuerna framkommer temat Barnmorskeprofessionen är både stark och söndrad vid normala sjukhusförlossningar. Resultatet visar att barnmorskorna är oftast självständigt ansvariga för den normala förlossningen i en tvärprofessionell arbetsgrupp. Hierarkier och relationer påverkar barnmorskornas självständighet vid handläggningen av den normala förlossningen. Barnmorskorna använder förutom sin professionella kunskap olika verktyg som riskevaluering och rond för att identifiera normala förlossningar. Det saknas självständigt utformade riktlinjer av barnmorskor för normal förlossning inom förlossningsvården. Hög arbetsbelastning påverkar barnmorskans möjligheter att arbeta från ett evidensbaserat perspektiv vilket resulterar i ett förändrat arbetssätt vid normal förlossning. Slutsats: Barnmorskor anser att de ibland har ett ofrivilligt delat ansvar vid normal förlossning. Ett gott samarbete och kommunikation har betydelse inom ett tvärprofessionellt team för att barnmorskan kan stödja kvinnans normala födande.   Nyckelord: barnmorskor normal förlossning, professionellt ansvar, samarbete

Preeclampsia and eclampsia are among the most common causes of maternal and fetal mortality and morbidity worldwide. There are no reliable means to predict eclampsia or cerebral edema in women with preeclampsia and knowledge of the brain involvement in preeclampsia is still limited. S100B and neuron specific enolase (NSE) are two cerebral biomarkers of glial- and neuronal origin respectively. They are used as predictors for neurological outcome after traumatic brain injuries and cardiac arrest but have not yet been investigated in preeclampsia. This thesis is based on one longitudinal cohort study of pregnant women (n=469, Paper I and III), one cross sectional study of women with preeclampsia and women with normal pregnancies (n=53 and 58 respectively, Paper II and IV) and one experimental animal study of eclampsia (Paper V). In Paper I and III, plasma concentrations of S100B and NSE were investigated throughout pregnancy in women developing preeclampsia (n=16) and in women with normal pregnancies (n=36) in a nested case control study. Plasma concentrations were increased in women developing preeclampsia in gestational week 33 and 37 for S100B and in gestational week 37 for NSE compared to women with normal pregnancies. In Paper II and IV, increased plasma concentrations of S100B and NSE were confirmed among women with preeclampsia compared to women with normal pregnancies. Furthermore, increased plasma concentrations of S100B correlated to visual disturbances among women with preeclampsia (Paper II) and plasma concentrations of S100B and NSE remained increased among women with preeclampsia one year after delivery (Paper IV). In Paper V, an experimental rat model of preeclampsia and eclampsia demonstrated increased serum concentrations of S100B after seizures in normal pregnancy (n=5) and a tendency towards increased plasma concentrations of S100B in preeclampsia (n=5) compared to normal pregnancy (n=5) without seizures. Furthermore, after seizures, animals with magnesium sulphate treatment demonstrated increased serum concentrations of S100B and NSE compared to no treatment. In conclusion; plasma concentrations of S100B and NSE are increased in preeclampsia during late pregnancy and postpartum and S100B correlates to visual disturbances in women with preeclampsia. The findings are partly confirmed in an animal model of eclampsia.

BackgroundGender-Based Violence (GBV) is a global problem rooted in gender inequality. South Africa has exceptionally high rates of GBV. Despite the fact that Comprehensive Sexuality Education (CSE) has been taught as part of the school subject Life Orientation to teach topics like gender equality, studies have demonstrated inconsistent implementation of this curriculum.AimTo investigate Life Orientation educators’ experiences of teaching the curriculum in relation to GBV and gender equality and manging the issue of GBV in public schools located in the Gauteng province, South Africa, and gain information about the challenges educators experience and what they think is needed to actively work towards preventing GBV in schools.Research DesignA qualitative research design was utilised.MethodTwelve participants were interviewed online using a semi-structured interview guide. The data was transcribed, coded, and analysed using inductive thematic analysis.ResultsThe results indicate that the participating educators experience various challenges and have diverse views on potential improvements. Limited educational and training resources, deep-rooted views of gender roles and cultural traditions, limited recognition of the subject’s importance by educational authorities, as well as uncertainty regarding existing school GBV policies are crucial findings on how the educators experience teaching GBV.ConclusionThis study identified challenges and the potential benefits of improved educator training to address the topic of GBV, more detailed coverage of GBV in the curriculum, increased awareness surrounding GBV and allocating more time to these concepts.

Bakgrund: Svenska förstföderskor blir allt äldre. Åldern då fertiliteten hos kvinnor är som högst sammanfaller för många med en tid i livet som innefattar olika krav och måsten. Ett stort antal kvinnor i fertil ålder har bristfällig kunskap om hur ålder och olika livsstilsfaktorer påverkar fertiliteten. Genom att undersöka kvinnors önskemål gällande information om fertilitet samt hur kvinnor önskar få denna information kan vården bättre anpassas efter dessa önskemål. Syfte: Att undersöka om svenska kvinnor i 18–45 års ålder önskar information om fertilitet samt på vilket sätt de önskar få denna information. Metod: Kvantitativ tvärsnittsstudie. Datainsamling genom webbenkät, sammanställd med deskriptiv statistik. Resultat: Totalt besvarade 267 kvinnor webbenkäten, en majoritet, 67%, var i åldrarna 24–35 år. Hälften av kvinnorna, 52%, önskade i nuläget information om fertilitet och nästan hälften, 48%, hade önskat information tidigare i livet. En majoritet ansåg att information om fertilitet är lämpligt att ges vid preventivmedelsrådgivning av en barnmorska, samt att skolklasser ska bli kallade till informationsträffar om fertilitet. Sveriges regioner ansågs ha störst ansvar att informera om fertilitet. Slutsatser: Kvinnor i fertil ålder önskar i hög utsträckning information om fertilitet. Genom regionernas ansvar är barnmorskor som yrkesgrupp viktiga informatörer och folkbildare, främst genom preventivmedelsrådgivning.

Bakgrund: En gynekologisk undersökning innebär en undersökning av kvinnans inre ochyttre könsorgan och genomförs vid bland annat cellprovtagning, blödningar, smärta ochgynekologiska sjukdomar. I Sverige genomförs ca 1,5 miljoner gynekologiska undersökningarvarje år. Idag finns lite forskning kring vad som gör upplevelsen positiv för kvinnorna. Syfte:Att beskriva kvinnors upplevelser i samband med gynekologisk undersökning inom hälsoochsjukvården. Metod: En kvalitativ metasyntes med en metaetnografisk analys. Studieninkluderar 11 artiklar som söktes fram i databaserna CINAHL, PubMed samt i GoogleScholar. Resultat: Resultatet presenteras i två teman, Från osäker till empowered beskriverkvinnornas grad av delaktighet som påverkas av information, kunskap och kommunikation.Sexualitetens närvaro beskriver kvinnornas sexuella erfarenheter, sexualitet och könet påundersökaren och hur dessa påverkar den gynekologiska undersökningen. Slutsats:Välinformerade kvinnor som upplever att de har kunskap om den gynekologiskaundersökningen upplever ökad makt och större delaktighet i den gynekologiskaundersökningen. Kvinnornas sexuella erfarenheter, deras (hetero)sexualitet och könet påundersökaren påverkar kvinnornas känsla av trygghet. Klinisk tillämpbarhet: Med resultatetsom bakgrund kan barnmorskor påverka den kliniska verksamheten att ges mer tid tillinformation och utbildning av kvinnor gällande den gynekologiska undersökningen.Framförallt till unga kvinnor vid ungdomsmottagningarna. / Background: A gynecological examination involves an examination of the woman’s internaland external genitalia. It is performed in cases of bleeding, pain, pap-smear testing andgynecological diseases. In Sweden, about 1.5 million gynecological examinations areperformed every year. Today, there is a lack of research on how the experience could bepositive for women. Aim: To describe women’s experiences of the gynecological examinationin health care. Method: A qualitative meta-synthesis analyzed with a meta-ethnographicmethod. The study includes 11 articles which were searched for in CINAHL, PubMed andGoogle Scholar. Results: The result are presented in two themes. From insecure toempowered shows that women’s degree of power and participation is affected by information,knowledge and communication. The presence of sexuality describes the women’s sexualexperiences, their sexuality and the gender of the examiner and how these affect thegynecological examination. Conclusion: Women who are well informed and who feel theyhave knowledge about the gynecological examination experience an increased power and agreater participation. Women’s sexual experiences, (hetero)sexuality and the gender of theexaminer affect women’s sense of security. Clinical applicability: By using the result,midwives can influence the different clinics to give more time for information and educationof women about the gynecological examination. Especially to the young women visiting theyouth clinics.