Showing papers in "Acta Obstetricia et Gynecologica Scandinavica in 1997"

Scientific basis for the content of routine antenatal care I. Philosophy, recent studies, and power to eliminate or alleviate adverse maternal outcomes

Abstract: Background. Scope and content of antenatal care programs are ritualistic rather than evidence-based. We wanted to identify elements of antenatal care which are of proven benefit in preventing or ameliorating specific adverse outcomes in the mother: bleeding, anemia, preeclampsia, sepsis and genito-urinary infection and obstructed labor. Methods. Review of recent literature, especially randomized controlled trials. Results and conclusions. Recent trials indicate that fewer routine visits for low-risk women do not put pregnancies at increased risk but may lessen patient satisfaction. Bleeding in pregnancy has many causes, none of which can be eliminated through antenatal care. Risk factors can be identified by history-taking. Counselling and advice on what to do is the best option. Anemia in pregnancy is common, especially in developing countries. Routine iron supplementation is not necessary in well-nourished populations, but iron and folate should be provided for every pregnant woman in areas of high anem...

A population study of urinary incontinence and nocturia among women aged 20-59 years : prevalence, well-being and wish for treatment

Abstract: BACKGROUND: The aim was to study urinary incontinence (UI) and nocturia in a female population; prevalence, effect on well-being, wish for treatment and result of treatment in primary health care.M ...

Maternal mortality after cesarean section in The Netherlands.

Abstract: Background. To assess cesarean section-related maternal mortality in The Netherlands during 1983–1992. Methods. A nationwide confidential enquiry into the causes of maternal death. Results. The risk of dying after vaginal birth was 0.04 per 1000 vaginal births (65/1.763.999) compared to 0.53 per 1000 cesarean births (57/108.587). The direct risk of dying from cesarean section was 0.13 per 1000 operations (14/108.587). In some women cesarean section did not initiate, but contributed to, the train of events leading to death. Adding this associated risk to the direct risk gives a fatality rate of 0.28 per 1000 cesarean births (30/108.587). Conclusions. Although cesarean section is a relatively safe procedure nowadays, birth by cesarean section in The Netherlands is seven times more hazardous than vaginal birth. Keeping the cesarean birth rate as low as possible is therefore in the interest of women of reproductive age.

Posttraumatic stress reactions after emergency cesarean section

Abstract: Background. The study aimed at answering the following questions: Do women experience emergency cesarean section as traumatic?Do women experience any posttraumatic stress reactions or even posttrau...

Obstetric outcome in 100 women with severe anxiety over childbirth

Abstract: Background. Extreme fear of delivery with request of cesarean section is a problem. The obstetric outcome in women given psychological and obstetric support is described.Methods. Women, consecutively referred to the Psychosomatic outpatient clinic because of fear of delivery (n= 100), were compared to a matched reference group (n=100).Results. The women in the study group had higher frequency of psychic problems than the references. The majority, 68 of the women (68%) initially requested cesarean section (CS). After individualized psychological and obstetrical support, 38 of these women agreed to vaginal delivery (38%) and 30 had an elective CS (30%). In the end another 13 (13%) women had a CS for obstetric or mixed reasons. Complication rate was low and similar in the groups. The 57 women who eventually had a vaginal delivery (57%) showed an obstetric outcome similar to the reference group. They had a higher frequency of induction of labor (p=0.02), and of epidural and pudendal blocks for pain relief (p=...

Scientific basis for the content of routine antenatal care

Abstract: Background. There is uncertainty concerning antenatal care as a tool to eliminate or alleviate adverse outcomes in the newborn. We identified congenital conditions, intrauterine infections, intrauterine growth retardation, preterm birth and some specific infectious diseases in the mother with a view to prophylactic and other interventions. The value of some special diagnostic tools is also under discussion.Methods.Review of recent literature, especially randomized controlled trials and systematic reviews.Results and conclusions.Genetic abnormalities cannot be prevented after conception, but many of them, and a number of acquired conditions, can be discovered by ultrasonographic and biochemical diagnostics. The advisability of screening must be determined locally for each condition, based on prevalence, treatment options and the legal requirements for abortion. Smoking. excessive alcohol intake, and severe undernutrition cause fetal growth retardation. Interventions to reduce maternal smoking have had limi...

Early dating by ultrasound and perinatal outcome

Abstract: Background. This study aims to evaluate the impact of routine ultrasound in early pregnancy on pregnancy outcome and perinatal mortality.Methods. Using the Swedish Medical Birth Registry, a two-stage study was designed. First, an ecological study that included data from 45 hospitals, with 1,280,746 children born during the years 1974-1991, was designed by differentiating hospitals on the basis of ultrasound usage. Second, a historical cohort study (n=60,864) was designed for the years 1982-84, including a treatment group (having had routine ultrasound in early pregnancy) and a reference group (having had no routine ultrasound).Results. In hospitals practicing early dating by ultrasound, post-term births were reduced from 13.3% to 7.4%, while pre-term births were increased from 5.7% to 6.8%. For the treatment group, the cohort study showed: 1) fewer post-term births, RR 0.7 (95% CL 0.7-0.8), 2) lower post-term perinatal mortality, RR 0.3 (95% CL 0.1-1.0), 3) fewer twin births post-term, RR 0.1 (95%CL 0.1-0...

Epidemiology of endometriosis in a Norwegian county.

Abstract: Objective To estimate the prevalence and incidence of endometriosis in Norwegian women aged 40 to 42, and to evaluate reproductive events and life-style as risk factors for endometriosis as well as to evaluate related health-problemsMaterial and methods The study was performed partly as a cross-sectional study to estimate occurrence of endometriosis, partly as a case-control study to look for factors associated with endometriosis The study group consisted of all female inhabitants-born 1950 to 1952-living in the county of Sor-Trondelag In connection with a cardiovascular screening program information about reproductive events and gynecological problems including endometriosis and infertility was obtainedResults Totally 5 139 women were asked to participate, and a questionnaire was completed by 4 034 (785%) Endometriosis was reported by 20% of the women Life-time risk for endometriosis was estimated to 22% The annual incidence of new cases of endometriosis in this age group is less than 03%

Urinary retention in the post-partum period: The relationship between obstetric factors and the post-partum post-void residual bladder volume

Abstract: Objective. The three objectives of this study are: to investigate the incidence of post-partum urinary retention after vaginal delivery, to investigate the relationship between various obstetric parameters and the post-partum post-void residual bladder volume and to study the natural progression of the post-void residual bladder volume in patients with covert post-partum urinary retention.Methods. Women who had a vaginal delivery (n = 691) in a teaching hospital during a 2-month period were studied. They were classified into three groups: normal patients, those with overt urinary retention, and covert urinary retention. Their day 1 post-partum post-void residual bladder volume were recorded and analyzed with respect to the obstetric parameters. Patients with covert retention were followed up daily with ultrasound to monitor their post-void residual volume.Results. The incidences of overt and covert retention in our unit were 4.9% and 9.7%, respectively. The overall incidence of post-partum urinary retenti...

Prospective comparison of laparoscopic and traditional colposuspensions in the treatment of genuine stress incontinence.

Abstract: Objective. To compare prospectively the results of laparoscopic and traditional colposuspensions in the treatment of genuine stress incontinence and to evaluate the efficacy, technique, and functional and anatomical changes after these two procedures.Materials and methods. Ninety-two patients with urodynamically proven genuine stress incontinence participated in this study, with 46 patients randomly allocated to laparoscopic colposuspension, and the other 46 patients to the traditional procedures. All patients had repeat studies at least 3 months after operation.Results. The bladder neck position was significantly elevated after operation either at rest or during straining in both groups (all p<0.001), but it was higher in the traditional group than the laparoscopy group during straining (p<0.05). Comparison of urodynamics before and after operation in both groups showed significantly increased minimal urethral resistance and improved pressure transmission ratios at the proximal urethra (Q2). The blood lo...

Stillbirths and rate of neonatal deaths in 76,761 postterm pregnancies in Sweden, 1982-1991: a register study

Abstract: Objective. To study stillbirths and neonatal mortality in the postterm period.Design. Register study of information obtained from the Swedish Medical Birth Registry (MBR), National Board of Health and Welfare, Stockholm.Methods. Singleton pregnancies with deliveries occurring between 1982 and 1991 were selected involving 914,702 women (of whom 76,761 had a postterm pregnancy continuing beyond the 42nd week of amenorrhea). All 2,043 records of dead infants were scrutinized before analysis of neonatal deaths. Stratification was made for year of birth, maternal age, and parity.Results. Generally, the rates of stillbirths and neonatal deaths were low. The stillbirth rate was highest for primiparas at 38 completed weeks (2.72‰), lowest at 40 weeks (1.23‰), then increasing to 2.26% in the postterm period. The difference v. multiparas was significant from 41 weeks onwards. Neonatal mortality was increased at 41 completed weeks for primiparas, but for multiparas it changed significantly first in the postterm peri...

Hernias in trocar ports following abdominal laparoscopy. A review.

Abstract: Background. With increasing numbers of laparoscopics in gynecologic surgery as well as the use of larger trocars more post-operative hernias can be expected. Most hernias occur as Richter’s hernias without peritoneal lining and contain small or large intestines or omentum. The incidence is around 1%, but rising with increasing size of trocars. About one fourth of hernias are umbilical, the rest located extraumbilical.Results. The diagnosis is typically based on the presence of vomiting or nausea with an extended and painful abdomen within two weeks of surgery and can be established by a small bowel series. However, the course can be prolonged and ileus can occur up to one year following laparoscopy. In the majority of cases the hernial content was small intestines or omentum.Conclusions. In order to reduce the frequency of trocar hernias it is recommended to apply small trocars. Fascial closure must be done when trocars of 10 mm or larger have been employed and the surgeon must ensure that peritoneal tiss...

Delivery and pudendal nerve function.

Abstract: Objective. To assess the impact of mode of delivery and the occurrence of pelvic instability upon the pudendal nerve function and relate the pudendal nerve function to the occurrence of anal and urinary incontinence. Methods. One hundred and forty-six pregnant women were examined during pregnancy and 12 weeks post partum with measurement of pudendal nerve terminal motor latency (PNTML), the difference between the two measurements was defined as ΔPNTML. Anal and urinary continence status, details of delivery and the occurrence of pelvic instability were recorded prospectively. Results. Pudendal nerve terminal motor latency increased from 1.7 msec in primiparae and 1.8 msec in multiparae during pregnancy to 2.0 msec (p<0.001) and 2.1 (p<0.001) respectively after delivery. The increase was significantly higher after the use of vacuum extraction (p<0.04). Multivariate analysis showed that ΔPNTML was associated with age, the presence of pelvic instability and the use of vacuum extraction. Whereas ΔPNTML was not associated with factors such as infant's head circumference and weight, parity, cesarean section, pudendal block, epidural analgesia and second stage of labor. Only four women had anal incontinence after delivery. Twenty-five women with urinary incontinence had a significantly higher mean PNTML (2.20 msec) than 121 continent women (2.01 msec). Conclusion. Pudendal nerve terminal motor latency increases in both primiparous and multiparous women after delivery. In 10% of the women the increase resulted in a pathologic PNTML value >2.4 msec. The ΔPNTML was significantly associated with age, the occurrence of pelvic instability and the use of vacuum extraction. The group of women with urinary incontinence had a significant increased PNTML.

Pregnancy-associated deaths in Finland 1987-1994 - definition problems and benefits of record linkage

Abstract: Background Our aim was to study the impact of record linkage and different classification principles on maternal mortality rate. Methods The death certificates of all fertile-aged women who died in 1987-94 in Finland (n = 9,192) were linked to the Birth, Abortion, and Hospital Discharge Registers (n = 513,472 births, 93,807 induced abortions, and 71,701 other ended pregnancies) to identify the women who had been pregnant during their last year of life. All deaths that occurred up to 1 year after the end of pregnancy were classified according to their connection to pregnancy. Results In total, 281 qualifying deaths were found. Only in 22% of the death certificates was the pregnancy or its end mentioned. The mortality rate was 41 per 100,000 registered ended pregnancies (27 for births, 48 for miscarriages or ectopic pregnancies, and 101 for abortions). The maternal mortality rate depended greatly on which of these 281 cases were defined as maternal deaths. The early maternal mortality rate varied between 5.6 and 6.8 per 100,000 live births, and the late maternal mortality rate between 0.6 and 2.5 depending on the definition used. The classification of other than direct maternal deaths was ambiguous, especially in case of late cancers, cardio- and cerebrovascular diseases, and early suicides. The official Finnish figure for early maternal mortality (6.0/100,000 live births) seems to be a good estimate, although only 65% of individual deaths were unambiguously classified. Conclusions Register linkage is necessary to identify late maternal deaths and pregnancy-associated deaths. The current official classification of maternal deaths as indirect, direct and fortuitous is arbitrary and allows much variation in defining a maternal death.

Iron supplementation in pregnancy: is less enough? A randomized, placebo controlled trial of low dose iron supplementation with and without heme iron.

Abstract: Background. The purpose of the present study was to evaluate the efficacy of low dose iron supplementation with and without a heme component, prescribed for women in the second half of pregnancy.Method. A randomized, double-blind, placebo controlled trial. Thirty-one women received a daily dose of 27 mg elemental iron in a product containing both heme iron and non-heme iron (Hemofer(r))30 women received the same dose as pure non-heme iron with vitamin C (Collets jern med vitamin C(r))and 29 women received placebo. A double dummy technique was used to mask tablets. The women were tested for red cell indices and iron status markers (s-ferritin, s-iron, Total Iron Binding Capacity and erythrocyte protoporphyrin) throughout pregnancy and 8 and 24 weeks postpartum. The results were analyzed according to the 'intention to treat' principle.Results. The hematological effects were equal in the two treatment groups. 25% of the supplemented women fell below 110 g/1 in Hb vs 52% in the placebo group (p<0.05); none fe...

Small-for-gestational-age (SGA) infants born at term: growth and development during the first year of life

Abstract: BACKGROUND The purpose was to compare growth patterns and psychomotor development of healthy small-for-gestational-age (SGA) and non-SGA infants, and identify factors predictive of outcome at 13 months of age. METHOD A total of 265 SGA infants and 329 non-SGA controls were identified from a multicenter cohort of 5722 para 1 and 2 women who had been followed during pregnancy. The infants were examined at 2 days and at 13 months of age. Psychomotor development at 13 months was assessed with The Bayley Scale of Infant Development. RESULTS The SGA infants showed partial catch-up growth, but had still lower (mean +/- SEM, p < 0.0001) weight (9750 +/- 65 vs 10505 +/- 67 g), crown-heel length (75.9 +/- 0.2 vs 77.5 +/- 0.2 cm) and head circumference (46.9 +/- 0.1 vs 47.7 +/- 0.1 cm) than the non-SGA infants at 13 months. The SGA children scored equally well on the motor (PDI 106.8 +/- 1.0 vs 107.2 +/- 0.8) but lower on the mental scale (MDI 112.1 +/- 0.8 vs 116.5 +/- 0.7, p < 0.0001) of the Bayley Scale, and the asymmetric SGA scored lower than the symmetric SGA infants (MDI 110.2 +/- 1.3 vs 113.3 +/- 0.9, p = 0.05). In a multivariate regression analysis the parents' growth parameters had the greatest effect on growth measures at 13 months while education and maternal smoking had no significant effect. SGA vs non-SGA status had the greatest effect on growth velocities during infancy. For mental development only SGA vs non-SGA status and the mothers' education made significant contributions, but only accounted for 6% of the variance. CONCLUSION The negative impact of intrauterine factors on growth are partly abolished by catch-up growth during infancy, and growth parameters at one year of age are mostly determined by genetic factors even in SGA infants. Decreased intrauterine growth may possibly have a negative effect on brain growth and mental developmental potential.

Markers of intravascular coagulation and fibrinolysis in preeclampsia: association with intrauterine growth retardation

Abstract: Background. Alterations in blood coagulation and fibrinolysis are believed to play an important role in the pathogenesis of preeclampsia. Hypercoagulability may be associated with features seen in preeclampsia, such as fibrin deposition in various organs, consumptive thrombocytopenia, and placental hypoperfusion, insufficiency and infarction.Methods. In this cohort study, we compared the plasma levels of markers of blood coagulation and fibrinolysis in preeclamptic women to normotensive, pregnant controls. We also studied the association between these markers and intrauterine growth retardation (IUGR).Results. In both mild and severe preeclampsia, the mean plasma concentrations of thrombin-antithrombin III complex (TAT) and plasminogen activator inhibitor type 1 (PAI-1) activity were significantly increased, while fibrinogen, antithrombin III (ATIII) and plasminogen activator inhibitor type-2 (PAI-2) antigen levels were significantly reduced compared to controls. Plasma D-dimer concentration was significa...

Body proportions and early neonatal morbidity in small-for-gestational-age infants of successive births

Abstract: Body proportions and early neonatal morbidity in small-for-gestational-age infants of successive births

The prevalence and severity of climacteric symptoms and the use of different treatment regimens in a Swedish population

Abstract: Objectives. To determine (i) the prevalence and severity of climacteric symptoms, and (ii) the prevalence of treatment for climacteric complaints, in a population based, random sample of Swedish women aged 46–62 years.Material and methods. A random sample of 5990 women from the birth cohorts 1946 1942 1938 1934 and 1930. resident in the city of Goteborg, was obtained from the population register. The women were invited by letter to complete a questionnaire concerning general health, reproductive history, climacteric symptoms (severity graded on a scale 0,1,2,3) and the treatment of climacteric complaints. The overall response rate was 76%.Results. The prevalence of climacteric symptoms was as follows : vasomotor symptoms 53%, depression irritability 57%. sleeping disturbance 52%, muscle/joint pain 57%, loss of libido 37”, and vaginal dryness 21%. Hormone replacement therapy (HRT) with medium potency estrogens was currently being used by 13.4% and 7.7% were using low potency estrogens. Medium potency estro...

Symptom-giving pelvic girdle relaxation of pregnancy, postnatal pelvic joint syndrome and developmental dysplasia of the hip

Abstract: Objectives. To describe the clinical characteristics and outcomes of a large group of women with symptom-giving pelvic girdle relaxation of pregnancy and postnatal pelvic joint syndrome. To determine if there is an increased incidence of developmental dysplasia of the hip in the children of women with such pelvic problems.Methods. A postal survey of 1,609 Norwegian women registered as having pregnancy-initiated pelvic joint pain. The response rate was 79% and from the answers 1,115 women were defined as having had symptom-giving pelvic joint syndrome of pregnancy and/or postnatal pelvic joint syndrome.Results. Pelvic pains began in the first pregnancy in 74% of the respondents usually beginning in the first trimester. Pelvic pain worsened with subsequent pregnancies and persisted for a mean of 6.25 years, often causing major incapacity and lifestyle changes. Rest and physical supports brought temporary relief only. Sacroiliac joints and the symphysis pubis were the commonest sites of pain but peripheral j...

Transplacental needle passage and other risk-factors associated with second trimester amniocentesis

Abstract: Objective. To assess the obstetric outcome of all pregnancies undergoing midtrimester amniocentesis over a 10 year period at one center and the risk-factors for pregnancy loss associated to the procedure.Material arid method. All 2083 pregnancies with known pregnancy outcome and second trimester amniocentesis were included. Risk-factors for pregnancy loss were analysed by using patients' charts and a special record from the amniocentesis.Results. The over-all risk of pregnancy loss after second trimester amniocentesis was 1.3% (28/2083). There was a slight but nonsignificant relationship between the degree of experience of the gynecologist and risk for pregnancy loss. A more experienced operator used significantly fewer needle insertions (p<0.001). Multiple needle insertions were also associated with a slight, albeit nonsignificant, increase in incidence in fetal loss (3.8% after three or more insertions vs. 1.2% after one insertion, NS). No difference in spontaneous abortion incidence was found in patien...

The female pelvic floor: A dome-not a basin

Abstract: Background. Classically and based on necropsy observations, the muscles of the pelvic floor (the levator ani and coccygeus muscles) have been described as having the shape of a basin. In a previous study by Hugosson et al. (1991), magnetic resonance imaging revealed the dome shape of the pelvic floor in live subjects when muscular tonus is present.Methods. The normal anatomy and the dynamic movements of the female pelvis were examined with magnetic resonance imaging including conventional and fast sequences. Six nulliparous and six parous healthy women without signs or symptoms of pelvic relaxation were studied in the supine position at rest, during voluntary pelvic contractions and during bearing down.Results. The levator ani muscle was dome-shaped at rest. During voluntary pelvic contractions the muscle straightened, becoming more horizontal and during bearing down it descended, becoming basin-shaped. The width of the genital hiatus was the same in both groups at rest and it widened during bearing down ...

The incidence of ectopic pregnancy in Hordaland county, Norway 1976–1993

Abstract: Objective. To gain longterm knowledge of incidence rates of ectopic pregnancy, as a basis for analysing risk factors. Material. The incidence of ectopic pregnancy was studied in the county of Hordaland, Western Norway, through 18 years, 1976–1993. The protocols of 1821 cases of ectopic pregnancy were registered. Population data of the county, the number of births and legal abortions were available. Results. There was considerable increase in crude numbers of ectopic pregnancies throughout the period. Grouping the cases in three six-year periods showed an increased crude incidence rate per 100000 women from 95 during 1976–81 to 154 during 1988–93. The corresponding rates per 1000 births increased from 13.6 to 22.2 and the rates per 1000 reported pregnancies from 11.2 to 18.0. All rates increased also in women aged 40–44 years. During the years 1979–1993 the rates per 1000 reported pregnancies increased by 25%, from 9.4 to 11.8 in age groups below 30 years, while the rates for women over 35 years increased by 98%, from 20.7 to 40.9. Compared to the age group 15–19, women over 35 years had an eightfold risk during the last period. In addition they also contributed to higher numbers of reported pregnancies by 58%. Conclusion. The rates of ectopic pregnancy increased in age groups older than 20 years during 1976–93, moderately in younger age groups, but considerably in older age groups, who also contributed with higher total rates of pregnancy. More older women, with presumably accumulated risk factors getting pregnant, thus explain part of the increased rates of this disease.

Tick-borne relapsing fever and pregnancy outcome in rural Tanzania

Abstract: Objective. To assess the impact of tick-borne relapsing fever (TBRF) on the outcome of pregnancy.Design. Case control study of 137 pregnant women (cases) and 120 non-pregnant women (controls) with TBRF between 1985 and 1995.Setting. A rural hospital in Tabora Region, Tanzania.Results. Risk of birth during the attack of TBRF was 58.0%, with an extremely high perinatal mortality of 436 per 1000 births. The total loss of pregnancies including abortions was 475 per 1000. Case-fatality rate in pregnant women was 1.5%, compared to 1.7% in the nonpregnant women. A Jarisch-Herxheimer reaction was seen in 1.5% of the cases and in 1.7% of controls. Relapse rate was 3.6%, compared to 1.7% in non-pregnant women. Pregnant women with TBRF show higher densities of spirochetes than non-pregnant women (p<0.001). The risk of delivery during the attack was positively correlated to increasing density of the spirochetemia (p<0.001) and to gestational age (p<0.001). Perinatal death was related to low birthweight (p<0.001) and ...

Ovarian volume in gynecologically healthy women using no contraception, or using IUD or oral contraception

Abstract: Objective. The aim of this study was to determine the ovarian volume by transvaginal ultrasonography in a gynecologically healthy population of women using no contraception, using intrauterine contraceptive device, or using oral contraceptive.Materials and method. The study had a cross-sectional design. The ovaries of 428 women aged 14 45 who contacted the family planning clinic in the county of Funen were examined. Most of the statistical analyses were carried out using standard techniques. However polynomial regression analysis was used to model ovarian volumes as a function of the day of cycle.Results. No differences between the volumes of the right and the left ovary were found in any of the groups. Significant differences were found between the ovarian volumes of the three groups. The ovarian volumes were found to be largest in women using intrauterine contraceptive device, lesser in women using no contraception and smallest in women using oral contraception. A significant difference was found of the...

Laparoscopic management of adnexal mass during pregnancy.

Abstract: Background. To assess the use of laparoscopy in the management of persistent adnexal mass during the second trimester of pregnancy.Subjects. Six consecutive pregnant women undergoing laparoscopic surgery for persistent adnexal masses in the second trimester.Results. Laparoscopic removal of an adnexal mass was successfully performed in all patients. The median operating time was 37.5 minutes. There were no intra- and post-operative complications. Tocolytic therapy was not required and no patients developed uterine contractions. All patients delivered normal infants vaginally at term without complications. Conclusion. With attention to the surgical technique, laparoscopic removal of persistent adnexal mass during the second trimester of pregnancy is safe and carries the same benefits over laparotomy as in non-pregnant women.

Psychological adjustment of infertile women entering IVF treatment: differentiating aspects and influencing factors.

Abstract: Objective. To evaluate the psychological adjustment of infertile women compared with a control group of mothers and to determine which personal or marital factors influence the amount of emotional disorders in the infertile group.Design. Cross-sectional questionnaire study with a group of infertile women and a group of mothers attending a routine gynecological examination.Setting. Infertile women and mothers received the questionnaires after a psychological or medical examination respectively, at a Sterility Center in a Department of Obstetrics and Gynaecology.Participants. One hundred and twenty-two infertile women, entering an IVF program, and 57 mothers attending a routine care visit.Main outcome measures. Stressful events, self-esteem, job and marital satisfaction, care and control measures of intimate bond, state-trait anxiety, depression, psychophysiological symptoms and global emotional factor scores.Results. The organic infertile group was higher than mothers on satisfaction with their relationshi...

Enhanced expression of cytokines may play a fundamental role in the mechanisms of immunologically mediated recurrent spontaneous abortion

Abstract: Objectives. To determine circulatory levels of 1L-1 β, TNFα, IFN-γ and Neopterin in immunologically mediated recurrent abortion. Design. Blood samples were withdrawn from both groups of first trimester recurrent abortion and controls for the determination of serum IL-lβ, TNFα, IFN-γ by the corresponding IRMA and serum neopterin by a double antibody RIA. Setting. Department of Obstetrics & Gynecology, Cairo University Hospitals. Patients. Thirty pregnant women in their first trimester who presented with inevitable abortion with history of at least 3 prior spontaneous consecutive abortions, in addition to twenty-three pregnant women in their first trimester presented with their first miscarriage due to chromosomal anomalies (controls). Every attempt was made to eliminate the possible known contributing factors of recurrent abortion except for the presence of cervical mucus sperm antibodies which were present in 24 out of 30 cases. Interventions. None. Results. Serum ILiβ, TNFα and IFN-γ levels of the aborti...

Some reflections and hypotheses on the pathophysiology of female urinary incontinence

Abstract: It is proposed that opening and closure of the proximal urethra and bladder neck are regulated by a battery of surrounding structures, the most important being the pubourethral-vesical ligaments, the suburethral vaginal wall, 'the hammock', the pubococcygeus muscles, the levator plate and the connective tissue which like glue connects these structures to each other. Inappropriate function in one of these structures can, to some extent, be compensated for by an improved function in another hereby maintaining continence. However, a significantly deteriorated function in the support of urethra--normally maintained by the pubourethral/pubovesical ligaments, the pubococcygeus muscles and suburethral vaginal wall--will result in pronounced stress incontinence. Severe defects in these structures can generally not be compensated for by exercises of the pelvic muscles. This is true, in particular, if there is also a defect function in the connective tissue which 'glues' the urogenital structures to each other. Under such circumstances surgical procedures have to be considered to alleviate the patients symptoms. What is said so far must not exclude the importance of recognizing the role of the internal urethral structures to maintain continence, in particular the quality of urethral muscles, connective tissue and vascularization. In some specific cases of mixed incontinence it can be speculated whether the urge symptom can be caused by an anatomical dysfunction causing the proximal urethra and the bladder neck to remain involuntarily open or to open promptly at even minor pressure provocations. If so distension of the bladder neck and proximal urethra may activate stretch receptors located here which will induce uninhibited detrusor contractions. The presence of estrogen receptors in many of the structures involved in preserving continence may explain the increased prevalence of dysfunctions in the urogenital tract in postmenopausal patients, in particular in those not on hormone replacement therapy.

Comparative study of three vaginal markers of the premature rupture of membranes. Insulin like growth factor binding protein 1 diamine-oxidase pH.

Abstract: Objective. To assess the diagnostic value of three vaginal markers - insulin-like growth factor binding protein 1 (=1GFBP1), diamine-oxidase (=DAO) and pH - for diagnosis of the premature rupture of membranes.Study. One hundred pregnant women participated in the study. They were divided into three groups: group A (34 cases with intact membranes), group B (35 cases with total rupture of the membranes), group C (31 cases of suspected rupture of the membranes). Each patient underwent three successive tests for each of the three markers. The test order was allocated at random. For pH the reaction is colorimetric, for DAO the reaction is radio-enzymatic and for IGFBP1 the reaction is immuno-chromatographic. All three reactions are qualitative in nature. The parameters studied were conventional statistical parameters (sensitivity=SN, specificity=SP, positive predictive value=PPV and negative predictive value=NPV). Results. The analysis of the statistics gave the following results in percentages for SN, SP, PPV ...