Thora Steingrimsdottir - Academia.edu (original) (raw)

Papers by Thora Steingrimsdottir

Danish Journal of Obstetrics and Gynaecology

The purpose of this publication is to describe the success, which you find at Obstetrics and Gyne... more The purpose of this publication is to describe the success, which you find at Obstetrics and Gynecology - online textbook for medical students - sundhed.dk, an easily accessible, up to date Obstetrics and Gynecology teaching for medical students including international students in the Nordic countries. In 2018, NFOG (the Nordic Federation of Societies of Obstetrics and Gynecology) decided to finance the production of an electronic textbook for medical students by 1,000,000 Danish kr.: Text, illustrations, learning principles to be aligned with the curricula for obstetrics and gynecology in Nordic medical schools (and the needs of GPs and junior doctors outside our specialty, but not trainees in obstetrics and gynecology or midwives). Author fee: none. Availability On the internet, for computer, tablet and smartphone. No paper version published. Based on modern pedagogic principles not addressed in traditional printed books. Free access to the platform (open source). Each chapter wri...

paper has been peer-reviewed but does not include the final publisher proof-corrections or journa... more paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination. Citation for the published paper:

Læknablaðið, 2019

ntroduction: To collect nationwide data in Iceland on pregnancy and its outcomes among female pat... more ntroduction: To collect nationwide data in Iceland on pregnancy and its outcomes among female patients with active inflammatory arthritides we linked two registers, the ICEBIO register and the Icelandic Medical Birth Register. METHODS We used multivariate analysis to evaluate the risk of preterm birth, Caesarean section, low Apgar score at 5-minutes and low birth weight among females with inflammatory arthritis (rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) in comparison with healthy controls matched on age and parity. We also investigated pregnancies before and after the diagnosis of respective rheumatic disease and especially in respect to treatment with TNFα inhibitors (TNFi). RESULTS In the end of 2016, 723 female patients were registered in ICEBIO as they had received treatment with TNFi due to inflammatory arthritis. Of those, 412 women had given birth to 801 children, whereof 597 were delivered before confirmed diagnosis of the mother a...

Hypothesis / aims of study A variety of devices have been developed and made commercially availab... more Hypothesis / aims of study A variety of devices have been developed and made commercially available to measure pelvic floor muscle (PFM) strength (1). Manometers measuring squeeze pressure and dynamometers measuring force directly are the most commonly used measurement tools. However, the dynamometers are still not commercially available and vaginal squeeze pressure measurement is therefore still the most commonly used method in clinical practice. Ideally, before taken into use, all measurement tools should be tested for reliability and validity. The purpose of the present study was to investigate intra-rater reliability of vaginal squeeze pressure measurement component of a widely used PFM strength measurement tool: Myomed 932 (Enraf-Nonius, Delft, Netherland).

International Journal of Gynecology & Obstetrics, 2000

Objectives: Physical and sexual abuse of women is associated to a broad range of psychological an... more Objectives: Physical and sexual abuse of women is associated to a broad range of psychological and somatic disorders as well as to gynaecological complaints. The aim of the study is to estimate the prevalence of abuse among gynaecological patients in the five Nordic countries, related abuse story to reason for encounter, explore the differences and similarities between the countries and assess the impact of abuse on the women's experience of the index visit. Study Methods: All in-and outpatients attending the Department of Gynaecology in the five study sites, one in each country, Denmark, Finland, Iceland, Norway and Sweden were consecutively recruited. All women 1-2 weeks after their visit received a questionnaire addressing emotional, sexual, physical abuse as well as medical history and details of recent visit. Traditionally it has been considered difficult to address sensitive issues as these. Our experience, however, is that the study was very well received by the women in all the countries. Results: The study period started fall 1999 and is ongoing. Till date 2500 questionnaires have been mailed. The response rate varied from 6.5 to 82 % between countries. Preliminary analysis of 700 questionnaires demonstrated differences between countries as to the proportion of women reporting abuse. Life time physical abuse, ranging from mild as slapping to severe as attempted strangulation/ threats of or use of weapons, by any perpetrator, was altogether reported by 340 women (49%), ranging between 34% to 6.5 % between countries. Conclusion: To our knowledge this is the first multicountry study addressing abuse history among gynaecological patients. The standardisation of instruments makes crosscountry comparisons possible. Abuse history was common, and differences were found between countries.

Objectives To study effects of physiotherapist-guided pelvic floor muscle training on pelvic orga... more Objectives To study effects of physiotherapist-guided pelvic floor muscle training on pelvic organ prolapse (POP) early postpartum period. Design Assessor-blinded, randomized controlled trial. Setting Physiotherapy Clinic, Reykjavik. Sample Eighty-four primiparous women with a singleton delivery. Methods Participants were screened for eligibility 6-13 weeks postpartum. Women randomized to the training group conducted 12 weekly individual sessions with a physiotherapist, starting on average 9 weeks after childbirth. Outcomes were assessed after the last session (short-term) and at 12 months postpartum (long-term). The control group received no instructions after the initial assessment. Main outcome measures Self-evaluated POP symptoms by the Australian Pelvic Floor Questionnaire. Results Forty-one and 43 women were randomized to the training and control groups, respectively. At recruitment, 17 (42.5%) of the training and 15 (37%) of the control group reported prolapse symptoms (p=0.6...

Nature Genetics, 2021

Birth weight is a common measure of fetal growth that is associated with a range of health outcom... more Birth weight is a common measure of fetal growth that is associated with a range of health outcomes. It is directly affected by the fetal genome and indirectly by the maternal genome. We performed genome-wide association studies on birth weight in the genomes of the child and parents and further analyzed birth length and ponderal index, yielding a total of 243 fetal growth variants. We clustered those variants based on the effects of transmitted and nontransmitted alleles on birth weight. Out of 141 clustered variants, 22 were consistent with parent-of-origin-specific effects. We further used haplotype-specific polygenic risk scores to directly test the relationship between adult traits and birth weight. Our results indicate that the maternal genome contributes to increased birth weight through blood-glucose-raising alleles while blood-pressure-raising alleles reduce birth weight largely through the fetal genome.

SSRN Electronic Journal, 2019

Midwives play a vital role in promoting early antenatal bookings and adherence to antenatal care ... more Midwives play a vital role in promoting early antenatal bookings and adherence to antenatal care supervision. In the Nelson Mandela Bay Municipality, an increasing number of pregnant teenagers do not use antenatal care services. The study aimed to explore and describe the nature and extent of communication in antenatal care clinics and its impact on pregnant teenagers. Audio-taped semi-structured interviews were used to collect data and field notes were taken by the researchers. Data collected were transcribed verbatim and analysed according to Tesch's eight steps. Trustworthiness was maintained throughout the study by applying the four key aspects of Guba's model, namely truth value, applicability, consistency and neutrality. The ethical considerations of confidentiality, anonymity, and protection of the participants from harm were maintained. Results revealed that the pregnant teenagers experienced a communication breakdown with the midwives and did not experience their an...

International Urogynecology Journal, 2021

To study the prevalence of pelvic floor dysfunction and related bother in primiparous women 6–10 ... more To study the prevalence of pelvic floor dysfunction and related bother in primiparous women 6–10 weeks postpartum, comparing vaginal and cesarean delivery. Cross-sectional study of 721 mothers with singleton births in Reykjavik, Iceland, 2015 to 2017, using an electronic questionnaire. Information on urinary and anal incontinence, pelvic organ prolapse and sexual dysfunction with related bother (trouble, nuisance, worry, annoyance) was collected. Main outcome measures were prevalence of pelvic floor dysfunction and related bother. The overall prevalence of urinary and anal incontinence was 48% and 60%, respectively. Bother regarding urinary symptoms was experienced by 27% and for anal symptoms by 56%. Pelvic organ prolapse was noted by 29%, with less than half finding this bothersome. Fifty-five percent were sexually active, of whom 66% reported coital pain. Of all the women, 48% considered sexual issues bothersome. Urinary incontinence and pelvic organ prolapse were more prevalent in women who delivered vaginally compared to cesarean section, but no differences were observed for anal incontinence and coital pain. Compared to women with BMI < 25, obesity was a predictor for urinary incontinence after vaginal delivery (OR 1.94; 95% CI 1.20–3.14). Birthweight > 50th percentile was predictive for urgency incontinence after vaginal delivery (OR 1.53; 95% CI 1.05–2.21). Episiotomy predicted more anal incontinence (OR 2.19; 95% CI 1.30–3.67). No associations between maternal and delivery characteristics were found for pelvic floor dysfunction after cesarean section. Bothersome pelvic floor dysfunction symptoms are prevalent among first-time mothers in the immediate postpartum period.

Læknablaðið, 2020

MS (multiple sclerosis) er langvinnur bólgusjúkdómur í miðtaugakerfi sem einkennist af köstum, ei... more MS (multiple sclerosis) er langvinnur bólgusjúkdómur í miðtaugakerfi sem einkennist af köstum, einkum hjá ungu fólki, konum frekar en körlum. Meðgöngu-og faeðingarsaga íslenskra kvenna með MS hefur ekki verið rannsökuð áður. Markmið rannsóknarinnar var tvíþaett, annars vegar að skoða sjúkdómsmynd MS á meðgöngu og fyrstu mánuðum eftir faeðingu og hins vegar að kanna útkomu meðgöngu og faeðingar kvenna með MS og bera saman við hóp kvenna sem ekki hafa greinst með MS eða annan langvinnan sjúkdóm. EFNIVIÐUR OG AÐFERÐIR Afturskyggn rannsókn á gögnum úr sjúkraskrá Landspítala og Faeðingaskráningu Embaettis landlaeknis sem náði til kvenna með greininguna MS (ICD-10: G35) á árunum 2009-2018 og faeðinga þeirra á tímabilinu 1999-2018, alls 91 konu og 137 faeðinga. NIÐURSTÖÐUR Köstum faekkaði á fyrsta og öðrum þriðjungi meðgöngu miðað við árið fyrir þungun. Rúmlega helmingur kvennanna var á fyrirbyggjandi lyfjameðferð fyrir meðgöngu og haettu þaer allar meðferðinni um eða fyrir getnað. Konur með MS faeddu oftar með keisaraskurði án faeðingarsóttar. Meðgöngulengd kvenna með MS var sambaerileg við samanburðarhóp þegar sótt hófst sjálfkrafa. Ekki var munur á fjölda léttbura eða þungbura milli hópa. Apgar-stigun var sambaerileg milli hópa. ÁLYKTUN Við teljum að rannsókn okkar endurspegli vel meðgöngu-og faeðingarsögu kvenna með MS á Íslandi og að niðurstöður sýni að þaer skeri sig lítt úr almennu þýði. Niðurstöður okkar samrýmast erlendum rannsóknum um laegri kastatíðni á meðgöngu en munurinn er þó sá að í okkar rannsókn eru þau áhrif bundin við fyrsta og annan þriðjung meðgöngu.

Birth, 2019

BACKGROUND Rising cesarean rates call for studies on which subgroups of women contribute to the r... more BACKGROUND Rising cesarean rates call for studies on which subgroups of women contribute to the rising rates, both in countries with high and low rates. This study investigated the cesarean rates and contributing groups in Iceland using the Robson 10-group classification system. METHODS This study included all births in Iceland from 1997 to 2015, identified from the Icelandic Medical Birth Registry (81 839). The Robson distribution, cesarean rate, and contribution of each Robson group were analyzed for each year, and the distribution of other outcomes was calculated for each Robson group. RESULTS The overall cesarean rate in the population was 16.4%. Robson groups 1 (28.7%) and 3 (38.0%) (spontaneous term births) were the largest groups, and groups 2b (0.4%) and 4b (0.7%) (prelabor cesareans) were small. The cesarean rate in group 5 (prior cesarean) was 55.5%. Group 5 was the largest contributing group to the overall cesarean rate (31.2%), followed by groups 1 (17.1%) and 2a (11.0%). The size of groups 2a (RR 1.04 [95% CI 1.01-1.08]) and 4a (RR 1.04 [95% CI 1.01-1.07]) (induced labors) increased over time, whereas their cesarean rates were stable (group 2a: P = 0.08) or decreased (group 4a: RR 0.95 [95% CI 0.91-0.98]). CONCLUSIONS In comparison with countries with high cesarean rates, the prelabor cesarean groups (singleton term pregnancies) in Iceland were small, and in women with a previous cesarean, the cesarean rate was low. The size of the labor induction group increased, yet the cesarean rate in this group did not increase.

Journal of Midwifery & Women's Health, 2018

INTRODUCTION Obstetric interventions appear to increase with advancing maternal age, but limited ... more INTRODUCTION Obstetric interventions appear to increase with advancing maternal age, but limited supporting evidence exists, particularly for young women and specifically for prelabor and intrapartum cesarean birth. The aim of this study was to explore the association between obstetric interventions and maternal age in a low-risk population. METHODS The study was restricted to all low-risk, nulliparous women with singleton, vertex, term births who gave birth in Iceland from 1997 to 2015, identified in the Icelandic Medical Birth Registry. Logistic regression models were used to calculate adjusted odds ratios (aORs) and 95% CIs for the risks of labor induction, instrumental birth, and cesarean birth (prelabor and intrapartum), according to maternal age group. All models were adjusted for gestational age, year of birth, and demographic factors, and the models for intrapartum cesarean birth were also adjusted for dystocia and fetal distress. RESULTS For women aged more than 40 years, the aOR for induction of labor was 4.69 (95% CI, 3.2-6.8) compared with women aged between 25 and 29 years. In women aged more than 40 years, the increased risks for prelabor cesarean birth and intrapartum cesarean birth were 7.4 (95% CI, 3.0-18.0) and 3.6 (95% CI, 2.1-6.0), respectively. The risk of instrumental birth was slightly increased for women aged between 35 and 39 years (aOR, 1.6; 95% CI, 1.3-2.0), compared with women aged between 25 and 29 years, but not for women aged at least 40 years (aOR, 1.1; 95% CI, 0.7-1.9). For women aged less than 20 years, the risk of induction of labor (aOR, 0.8; 95% CI, 0.7-0.9) and instrumental births (aOR, 0.6; 95% CI, 0.5-0.7) was reduced compared with women aged between 25 and 29 years. DISCUSSION The risk of interventions generally increased with increasing maternal age, but the risk of instrumental births was not increased for women aged over 40 years. Also, young women were at a decreased risk of induction of labor and instrumental births.

Journal of psychosomatic obstetrics and gynaecology, 2016

The rate of cesarean section (CS) for non-medical reasons has risen and it is a concern for healt... more The rate of cesarean section (CS) for non-medical reasons has risen and it is a concern for health care. Women's preferences may vary across countries for psychosocial or obstetric reasons. A prospective cohort study of 6549 women in routine antenatal care giving birth in Belgium, Iceland, Denmark, Estonia, Norway or Sweden. Preference for mode of birth was self-reported in mid-pregnancy. Birth outcome data were collected from hospital records. A CS was preferred by 3.5% of primiparous women and 8.7% of the multiparous women. Preference for CS was associated with severe fear of childbirth (FOC), with a negative birth experience in multiparous women and with depressive symptoms in the primiparous. Women were somewhat more prone to prefer a cesarean in Iceland, odd ratio (OR) 1.70 (1.02-2.83), adjusted for age, education, depression, FOC, history of abuse, previous cesarean and negative birth experience. Out of the 404 women who preferred CS during pregnancy, 286 (70.8%) delivered...

Midwifery, 2016

clinical guidelines for antenatal care recommend informing women about birth. The aim of this stu... more clinical guidelines for antenatal care recommend informing women about birth. The aim of this study was to explore the content of antenatal care from women&amp;amp;amp;amp;amp;amp;#39;s perspective and to establish whether they consider information on birth to be sufficient. the data was gathered in a longitudinal, cross-sectional cohort study known as The Childbirth and Health Study in Iceland. The study group consisted of 765 women attending antenatal care at 26 urban and rural health care centres in Iceland, during the year 2009-2010. They participated by replying to two questionnaires, at 16 gestational weeks and six months after birth. The questions covered objective and subjective aspects of antenatal care, pregnancy, birth, and the postpartum period. the majority (87%) of the women want to be informed about birth in the antenatal phase of care, and 41% reported 5-6 months post partum that too little time had been spent on this issue, by health care professionals. Post partum, mode of delivery affected women&amp;amp;amp;amp;amp;amp;#39;s estimated time spent on information in pregnancy, with women who had planned caesarean section being most satisfied with the time spent on antenatal information about birth. Women who experienced their birth as difficult or very difficult were more likely to report that insufficient time had been spent on information than women who had experienced their birth as easy or very easy. antenatal care can play an important role in preparing women for birth. This study shows that information about birth provided during pregnancy is insufficient from women&amp;amp;amp;amp;amp;amp;#39;s perspective, although some groups of women do report being more satisfied with this information. The way that this segment of antenatal care is provided leaves room for improvement.

Acta Obstetricia et Gynecologica Scandinavica, 2015