Showing papers in "Acta Obstetricia et Gynecologica Scandinavica in 1999"
TL;DR: Although urinary incontinence was a prevalent condition, particularly among the elderly and had a negative influence on the quality of life, only a small number of women had sought medical care.
Abstract: Objectives. To assess the prevalence of urinary incontinence and its influence on the quality of life. Material and methods. A random sample of every fourth woman aged ≥20 years resident in a primary health care district of the city of Goteborg was obtained from the population register (n=2911). The women were invited by letter to complete a questionnaire concerning urinary incontinence. The women were also requested to assess their quality of life using a visual analogue scale. Results. The overall response rate was 77%. The prevalence of urinary incontinence increased (p<0.001) in a linear fashion from 3% in the cohort 20-29 years to 32 % in the cohort of women aged ≥80 years. The proportion of women suffering from stress incontinence decreased (p<0.001) with increasing age, while the proportion of women suffering from urge and mixed incontinence increased (p<0.01) with increasing age. Women with stress incontinence had a greater body weight and had given birth to a greater number of children compared to continent women. There was, however, in this respect no difference between women with urge incontinence and continent women. Women with urinary incontinence reported a poorer quality of life compared to continent women (p<0.01). Women with urge incontinence and women with mixed incontinence reported a poorer quality of life compared to women with stress incontinence (p<0.05). Only 6% of the women from this population had sought medical attention for urinary incontinence. Conclusions. Although urinary incontinence was a prevalent condition, particularly among the elderly and had a negative influence on the quality of life, only a small number of women had sought medical care.
246 citations
TL;DR: Appendicitis in pregnancy should be suspected when a pregnant woman complains of new abdominal pain and prophylactic antibiotic treatment in all laparotomies during pregnancy when appendicitis is suspected is recommended.
Abstract: Background Acute appendicitis is the most common surgical emergency in pregnancy. The purpose of this study is to investigate the clinical presentation, management and outcome in patients who underwent appendectomy during pregnancy. Material and methods The case records of 56 women who underwent appendectomy during pregnancy between January 1985 and December 1997 were reviewed and analyzed. Results The incidence of appendicitis in pregnancy was one in 766 births. The preoperative diagnosis was correct in 75% of the cases. Uterine contractions and a history of diffuse or periumbilical pain migrating to the right lower abdominal quadrant were significantly more frequent among women with appendicitis compared to those patients where the appendectomy revealed a normal appendices. Abdominal pain, nausea, vomiting, leukocyte count, CRP and body temperature were not helpful in establishing the correct diagnosis. There was no maternal morbidity related to the appendectomy. Pregnancy complications were found to be considerable: 4/12 (33%) who underwent appendectomy for appendicitis during the first trimester aborted spontaneously. Second trimester appendectomy for appendicitis was followed by premature delivery in 4/28 (14%). However, no pregnancy complications were observed following third trimester appendectomy for appendicitis. We found no increase in pregnancy complications in cases with perforated appendicitis. Conclusion Appendicitis in pregnancy should be suspected when a pregnant woman complains of new abdominal pain. No laboratory finding was found to be diagnostic for acute appendicitis during pregnancy. Considerable fetal loss was found after appendectomy during pregnancy in the first and second trimester. No increase in pregnancy complications in cases with perforated appendicitis was observed. The combination of symptoms and clinical judgement is still vital in deciding which patient needs surgical treatment. Based on the results in the present study we recommend prophylactic antibiotic treatment in all laparotomies during pregnancy when appendicitis is suspected.
216 citations
TL;DR: Water-gymnastics during the second half of pregnancy significantly reduced the intensity of back/ low back pain and the number of days on sick-leave and no excess risk for urinary or vaginal infections was observed.
Abstract: Objective To investigate if water-gymnastics during pregnancy may reduce the intensity of back/low back pain and the number of days on sick-leave. Methods A prospective, randomized study. One hundred and twenty-nine women were randomized to participate in water-gymnastics once a week during the second half of pregnancy and 129 were randomized to a control group. The women in both groups filled in questionnaires in gestational weeks 18, 34 and within the first postpartum week. Every day from week 18 to labor they assessed the intensity of back/low back pain. Results Back pain intensity increased during pregnancy. No excess risk for the pregnancy associated with water-gymnastics was observed. The women participating in water-gymnastics recorded a lower intensity of back/low back pain. The total number of days on sick-leave because of back/low back pain was 982 in the water-gymnastics group (124 women) compared with 1484 in the control group (120 women). After weeks 32 33, seven women in the water-gymnastics group compared with 17 in the control group were on sickleave because of back/ low back pain (p=0.031). Conclusions Intensity of back/low back pain increased with advancing pregnancy. There was no excess risk for urinary or vaginal infections associated with water-gymnastics. Water-gymnastics during the second half of pregnancy significantly reduced the intensity of back/ low back pain. Water-gymnastics decreased the number of women on sick-leave because of back/low back pain. Water-gymnastics during pregnancy can be recommended as a method to relieve back pain and may reduce the need for sick-leave.
158 citations
TL;DR: Symptom-giving pelvic girdle relaxation is a considerable problem both in pregnancy and post partum, and the occupational risk can possibly be prevented.
Abstract: Background Previous studies concerning symptom-giving pelvic girdle relaxation in pregnancy have to our knowledge been retrospective. We wanted to 1) determine the incidence during pregnancy and the prevalence two, six, and twelve months post partum, 2) identify possible predisposing factors, and 3) determine the frequency and duration of sicklisting, prospectively. Material and methods. A cohort of 1600 consecutive pregnant women filled in a questionnaire. At the routine prenatal examinations they were asked about pelvic pain. Those who fulfilled the inclusion criteria were examined by a rheumatologist to confirm the diagnosis. The affected women were seen again two, six, and twelve months post partum. All participants were asked about sicklisting in pregnancy. Results. The incidence during pregnancy was 14%, the prevalence two, six, and twelve months post partum were 5%, 4%, and 2% respectively. Multivariate analysis indicates that the most important predisposing factor is pelvic pain in a previous pregnancy. Other factors were uncomfortable working conditions, lack of exercise, and previous low back pain and low abdominal pain. At least 37% of the women with symptom-giving pelvic girdle relaxation had been sicklisted in pregnancy due to pelvic pain, on average for twelve weeks. Conclusion, Symptom-giving pelvic girdle relaxation is a considerable problem both in pregnancy and post partum. The occupational risk can possibly be prevented. The syndrome has a great social impact because of the frequent sicklisting.
157 citations
TL;DR: The Misgav Ladach method for cesarean section gives quicker recovery, less use of post-operative antibiotics, antifebrile medicines and analgesics, and a shorter anesthetic and shorter working time for the operative team.
Abstract: Subject. A method description is given for the Misgav Ladach method for cesarean section. This is based on the Joel-Cohen incision originally introduced for hysterectomy. Method The incision is a straight transverse incision somewhat higher than the Pfannenstiel incision. The subcutaneous tissue is left undisturbed apart from the midline. The rectus sheath is separated along its fibres. The rectus muscles are separated by pulling. The peritoneum is opened by stretching with index fingers. The uterus is opened with an index finger and the hole enlarged between the index finger of one hand and the thumb on the other. The uterus is closed with a one-layer continuous locking stitch. The visceral and parietal peritoneal layers are left open. The rectus muscle is not stitched. The rectus sheath is stitched with a continuous non-locking stitch. The skin is closed with two or three mattress sutures. The space in between is apposed with non-traumatic forceps for 5 minutes. Results. The basic philosophy is to work in harmony with the body's anatomy and physiology and not against them. The method is restrictive in the use of sharp instruments, preferring manual manipulation. Conclusion. The method gives quicker recovery, less use of post-operative antibiotics, anti-febrile medicines and analgesics. There is a shorter anesthetic and shorter working time for the operative team. It is suitable for both emergency and planned operations.
148 citations
TL;DR: This follow-up study suggests that the Lng-IUS remains a safe and effective method of contraception, allowing women prolonged relief of menstrual problems, and for women in their late reproductive years, offering a convenient and bleeding-free transition into the menopause.
Abstract: Background This report comprises women from one center, who all participated in a larger European multi-center study, which included 2758 healthy women, of whom 1821 were randomly allocated to the levonorgestrel-releasing intrauterine system (Lng-IUS) and 937 to a copper-IUD (Nova-T). At the end of the 5 year study period, 109 of the 300 women, who originally were allocated to the Lng-IUS at this center, were still using the Lng-IUS. The women were offered the opportunity to continue the Lng-IUS and 100 women chose to do so. After a total period of almost 7 years of continuous use, a second Lng-IUS was offered and 82 of the women chose to start a second segment of Lng-IUS use. After another 5 years, 69 of the women were fitted with their third Lng-IUS. Methods These 82 women were examined yearly throughout the study period and bleeding pattern, hemoglobin, weight, blood-pressure, general well-being and intercurrent disease were analyzed to assess long-term effects. Results No pregnancy occurred during the follow-up. One case of partial expulsion occurred and one case of pelvic inflammatory disease. Seventy-seven percent of the women did not report any health problems at all during the entire follow-up period of 13 years. At the end of the second period with the Lng-IUS, 60% reported amenorrhea, 12% infrequent, scanty bleeds and 28% regular, scanty bleeds. As a consequence, the hemoglobin values increased, with a mean increase, after 12-13 years, being 1.35 g/dl. Blood pressure increased slightly and body weight increased with a mean increase of 0.49 kg/year. Seven women became postmenopausal during the follow-up and started estrogen replacement therapy with the Lng-IUS in situ. Conclusions This follow-up study suggests that the Lng-IUS remains a safe and effective method of contraception, allowing women prolonged relief of menstrual problems, and for women in their late reproductive years, offering a convenient and bleeding-free transition into the menopause.
144 citations
TL;DR: The women reacted more strongly to their infertility than the men and they felt an intense desire to have a child, while the information-seeking coping style was significantly correlated with infertility distress only among men.
Abstract: Background. Gender differences and similarities in psychological reactions related to infertility, perception of social support, the effect of infertility on the marital relationship and coping-style were investigated among Swedish couples seeking in vitro fertilization - or intracytoplasmic sperm injection - treatment. Methods. Ninety-one couples entering treatment completed the Infertility Reaction Scale, a self-report questionnaire with structured and open-ended questions and the Miller Behavioral Style Scale. Results. The women reacted more strongly to their infertility than the men as measured by the Infertility Reaction Scale (p<0.05). Factor analysis of the Infertility Reaction Scale produced three factors for men and women respectively. The first factor that emerged for the men was 'The male role and social pressure' and the second factor was 'The major focus of life'. For the women the two first factors were reversed compared to those of the men. The third factor 'Effect on sexual life' was similar for men and women. Significantly more men than women had not confided in anyone about their infertility problem (p<0.001). The information-seeking coping style was significantly correlated with infertility distress only among men (p<0.05). Conclusion. The women reacted more strongly to their infertility than the men and they felt an intense desire to have a child. They received more social support than their partners, who experienced the fulfilment of the male role as well as the social role to become a parent as the most central aspects of infertility. The information-seeking coping style was significantly correlated with infertility distress only among men.
139 citations
TL;DR: In order to avoid iron deficiency in pregnancy, prophylactic iron supplement should be considered.
Abstract: Background Iron supplementation in pregnancy is a controversial issue. The aim of this review was to summarize the results of relevant papers on this subject. Methods Placebo-controlled studies on iron treatment in pregnancy were identified from the Cochrane database. Results Among fertile women, 20% have iron reserves of >500 mg, which is the required minimum during pregnancy; 40% have iron stores of 100-500 mg, and 40% have virtually no iron stores. The demand for absorbed iron increases from 0.8 mg/day in early pregnancy to 7.5 mg/day in late pregnancy. Dietary iron intake in fertile women is median 9 mg/day, i.e. the majority of women have an intake below the estimated allowance of 12 18 mg/day. Iron absorption increases in pregnancy, but not enough to prevent iron deficiency anemia in 20%, of women not taking supplementary iron. Iron-treated pregnant women have greater iron reserves, higher hemoglobin levels, and a lower prevalence of iron deficiency anemia than placebo-treated women both in pregnancy as well as postpartum. Furthermore, children born to iron-treated mothers have higher serum ferritin levels than those born to placebo-treated mothers. An iron supplement of 65 mg/day from 20 weeks of gestation is adequate to prevent iron deficiency anemia. Conclusions In order to avoid iron deficiency in pregnancy, prophylactic iron supplement should be considered. Iron supplements may be administered on a general or selective basis. The selective approach implies screening with serum ferritin in early pregnancy, in order to identify women who can manage without prophylactic iron.
138 citations
TL;DR: This longitudinal prospective study of hormonal changes during the transition from pre- to postmenopause indicates that not only estrogen hormonal changes, but androgen hormonal changes as well, precedes the menopause by several years.
Abstract: Objective. The purpose of this study was to investigate the hormonal changes during the menopausal transition in a non-clinical population. Methods. Fifty-nine healthy Norwegian women participated in a five year prospective longitudinal study during the transition from pre- to post-menopause, starting one to four years before menopause, and ending one to four years postmenopausal. None of these women were given hormone replacement therapy (HRT). Blood samples were collected every 12 months and luteinizing hormone (LH), follicle stimulating hormone (FSH), steroid hormone binding globuline (SHBG), prolactin (PRL), estradiol (E 2 ), estrone (E 1 testosterone, androstendione, dehydroepiandrostendione-sulphate (DHEA-S), and thyroid stimulating hormone (TSH) were analyzed. Results. The serum levels of FSH and LH, E 2 and E 1 profile essentially confirmed previous data obtained in cross-sectional studies. A continuous increase in serum FSH and LH and a concomitant fall in E 2 and E 1 were observed in all women before menopause and in the two postmenopausal years. Both androstendione and testosterone showed a decline three years before menopause. After the menopause, however, there were fluctuations in the testosterone levels. Androstendione correlated positively with both E 2 and E 1 and testosterone postmenopausally. Body mass index (BMI) did correlate with testosterone, but not with androstendione. BMI correlated negatively with SHBG. No correlation was found between BMI and E 2 , E 1 , FSH and LH. Conclusion. This longitudinal prospective study of hormonal changes during the transition from pre- to postmenopause indicates that not only estrogen hormonal changes, but androgen hormonal changes as well, precedes the menopause by several years.
125 citations
TL;DR: Symptom-giving pelvic girdle relaxation in pregnancy causes considerable disabilities concerning daily activities and seriously interferes with many activities of daily living such as housekeeping, walking, working, and sexual life.
Abstract: Background Pelvic pain in pregnancy appears to be a problem that is increasing. This study was undertaken to describe and analyze the relationship between subjective symptoms, daily disability, and clinical findings in women with symptom-giving pelvic girdle relaxation in pregnancy Materials and methods Out of 1600 pregnant women 238 had pelvic pain. After a clinical examination 11 women were excluded due to low back pain. The rest, 227 women, was considered having symptom-giving pelvic girdle relaxation during pregnancy. Results Symptom-giving pelvic girdle relaxation in pregnancy seriously interferes with many activities of daily living such as housekeeping, walking, working, and sexual life. The women's statements of pelvic pain are well correlated to the number of positive clinical tests. Conclusion Symptom-giving pelvic girdle relaxation in pregnancy causes considerable disabilities concerning daily activities.
112 citations
TL;DR: Organized screening is more effective than spontaneous screening in reducing the risk of cervical cancer, and screening should preferably start soon after age 20 with a screening interval of 2-3 years.
Abstract: Background The objective of cervical cancer screening is to lower the incidence and mortality rates of the disease. This study evaluates the effectiveness of cervical screening and the UICC and EC screening recommendations based on the Nordic screening experience. Methods The study analyzes the features of the Icelandic and the Nordic screening programs and the observed trends in the incidence and mortality rates in these countries through 1995. Results Organized screening started in all the Nordic countries soon after 1960 and had nation-wide coverage in all these countries, except in Denmark (45% coverage in 1991), by around 1973 but in Norway screening was only spontaneous up to late in 1994. Up to 1985 the target age group and screening interval were most intensive in Iceland, followed by Finland, Sweden and Denmark. All countries except Finland lowered the lower age limit and intensified the screening intervals after 1985. Through the period 1986-1995 the reduction in both the mortality and the incidence rates was greatest in Iceland (mortality: 76% and incidence: 67%) and Finland (73% and 75%, respectively), intermediate in Sweden (60% and 55%, respectively) and Denmark (55% and 54%, respectively), and lowest in Norway (43% and 34%, respectively). The age-specific incidence in the 20-29 age group has been increasing since 1971 in all the Nordic countries, except in Finland, where the yearly registered age-specific incidence has been increasing in the targeted 30-54 age group since 1991. In Iceland screening has greatly affected the rate of all stages of squamous cell carcinoma, but not the rate of adeno- and adenosquamous carcinomas. In fact the rate of adenocarcinoma has been increasing. Conclusions Organized screening is more effective than spontaneous screening in reducing the risk of cervical cancer. Although differences in environmental, biological and ethnic factors may call for different screening strategies, screening should preferably start soon after age 20 with a screening interval of 2-3 years.
TL;DR: It is demonstrated that the prevalence of PCO in healthy women varies with age, being more common among women aged < or =35 years than in those aged > or =36 years, and it remains unclear if these women will later develop full-blown syndrome.
Abstract: (1999). The prevalence of polycystic ovaries in healthy women. Acta Obstetricia et Gynecologica Scandinavica: Vol. 78, No. 2, pp. 137-141.
TL;DR: Selective emergency arterial embolization is an effective means of controlling severe post-partum hemorrhage and avoids high risk surgery and maintains reproductive ability.
Abstract: Background To evaluate the efficacy and safety of selective arterial embolization in the management of intractable post-partum hemorrhage. Methods Thirty-five consecutive women with severe post-partum hemorrhage (primary, n=25; secondary, n=10) were treated by selective embolization of the uterine arteries. The main cause of immediate post-partum hemorrhage was atonic uterus. Retained placental fragments with endometritis was the main cause of delayed hemorrhage. In all cases, hemostatic embolization was performed because of intractable hemorrhage. Hysterectomy had been performed in two cases before embolization but it had also failed to stop the bleeding. Results Angiography revealed extravasation in ten cases, spasm of the internal iliac artery in four cases, false aneurysm in two cases and arteriovenous fistula in one case. After embolization, immediate cessation or dramatic diminution of bleeding was observed in all cases. Two patients required repeated embolization the following day. No major complication related to embolization was found. In one patient with placenta accreta, delayed hysterectomy was necessary. Normal menstruation resumed in all women but two who had hysterectomy. One woman became pregnant after embolization. Conclusion Selective emergency arterial embolization is an effective means of controlling severe post-partum hemorrhage. This procedure avoids high risk surgery and maintains reproductive ability.
TL;DR: Premenstrual irritability and depression were significantly relieved by low dose GnRH agonist, and GnRH treatment significantly reduced premenstrual depression and irritability, however, low doses GnRH therapy is prone to induce anovulation, particularly with increasing age.
Abstract: Treatment of premenstrual syndrome with gonadotropin-releasing hormone agonist in a low dose regimen
TL;DR: In this paper, selective arterial embolization of the uterine arteries in themanagement of intractable post-partum hemorrhage was proposed to improve the postpartum bleeding.
Abstract: (1999). Selective arterial embolization of the uterine arteries in themanagement of intractable post-partum hemorrhage. Acta Obstetricia et Gynecologica Scandinavica: Vol. 78, No. 8, pp. 698-703.
TL;DR: The heavy use of labor augmentation indicates that obese women should not be recommended to give birth in an ABC-clinic or at home, and overweight and obesity are only weak predictors of labor complications, given a normal pregnancy.
Abstract: Background. To investigate the influence of Body Mass Index on the incidence of labor complications in a population of women with a normal pregnancy. Material and methods. From a local database, information on maternal weight and height was extracted concerning 4258 women who had an uncomplicated pregnancy. After calculation and stratification with respect to Body Mass Index, this was retrospectively related to labor interventions and complications. Results. High Body Mass Index was related to more oxytocin infusion and early amniotomy, but not to vacuum extraction or cesarean section. Primary inertia and, to a minor degree, cephalopelvic disproportion and secondary inertia were seen more often in women with high Body Mass Index. Conclusions. Overweight (25.0 =30.0) are only weak predictors of labor complications, given a normal pregnancy. However, the heavy use of labor augmentation indicates that obese women should not be recommended to give birth in an ABC-clinic or at home.
TL;DR: Maternal blood-lead level as an environmental factor is an apparent predictor of low birth weight and BMIC and reduced substantially the contribution of a country factor in explaining the observed differences in birth weight.
Abstract: BACKGROUND Delivering women and their newborns in the Kola Peninsula of Russia and the neighboring arctic area of Norway were studied to explore relationships between maternal cadmium and lead status and birth weight as a pregnancy outcome. METHODS Life-style information, maternal blood and cord blood specimens were collected from 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities. Pregnancy outcomes were verified by consulting medical records. Lead and cadmium were determined in the blood samples by electrothermal atomic absorption spectrometry. RESULTS The median blood-cadmium concentration for the Russian mothers was 2.2 nmol/L (n = 148) versus 1.8 nmol/L in the Norwegian group (n = 114, p = 0.55). A weak association was observed between maternal cadmium and amount smoked (r = 0.30, p<0.001); no correlation was found between maternal blood cadmium and birth weight. The corresponding maternal lead values were 0.14 (Russia) and 0.06 micromol/L (Norway), p<0.001. The latter lead concentration constitutes one of the lowest adult population values reported to date. Maternal and cord blood lead levels were strongly correlated (r = 0.88, p<0.001). In a multivariate linear regression model, maternal blood lead was recognized as a negative explanatory variable (p<0.05) for birth weight and child's body mass index (BMIC), with or without adjustment for gestational age. A similar association was suggested by ANOVA-analysis of maternal blood lead by quartiles. CONCLUSION Maternal blood-lead level as an environmental factor is an apparent predictor of low birth weight and BMIC. It reduced substantially the contribution of a country factor in explaining the observed differences in birth weight.
TL;DR: A low concentration of PAI-2 antigen in plasma emerged as the most consistent risk factor for preeclampsia and FGR and is consistent with activated coagulation in the placental vessels in preeClampsia.
Abstract: Background. Preeclampsia is a major contributor to perinatal disease and fetal growth retardation (FGR). It has been suggested that increased intravascular coagulation, fibrin deposition in spiral arteries and hypoperfusion of the placenta are involved in these pregnancy complications. Methods. Multiple variables of the hemostatic system and lipid metabolism, as well as clinical features, were entered into univariate and multivariate models in order to examine the association with preeclampsia and FGR. Results. Two hundred women with preeclampsia and 97 normotensive pregnant women were examined. Plasma levels of the thrombin-antithrombin complex (TAT), tissue factor pathway inhibitor free antigen (TFPI-Fag), protein S free antigen, plasminogen activator inhibitor type-1 (PAI-1) activity and serum levels of triglycerides were significantly increased, whereas plasma levels of antithrombin (AT), fibrinogen, C4b-binding protein (C4b-BP), PAI-2 antigen and serum HDL-cholesterol levels were decreased in the presence of preeclampsia. In the multivariate regression analysis, high TFPI-Fag plasma levels were associated with the presence of preeclampsia. The presence of FGR was in the univariate analysis associated with decreased PAI-I activity and lower concentrations of fibrin, fibrinogen, factor VII antigen and PAI-2 antigen, as well as with evidence of macroscopic placental infarction. In a multivariate regression model, low maternal weight, placental infarction and low PAI-2 levels were predictors for low birth weight. In a logistic regression model, with the presence or absence of FGR as the dependent variable, male sex of the infant, placental infarction, low PAI-I activity and factor VII antigen or PAI-2 antigen levels were independent predictors. Conclusions. Our results are consistent with activated coagulation in the placental vessels in preeclampsia. A low concentration of PAI-2 antigen in plasma emerged as the most consistent risk factor for preeclampsia and FGR.
TL;DR: This study demonstrates that a considerable number of women had experienced threats, physical and sexual abuse during pregnancy, and there is an obvious need for screening of experience of domestic violence among pregnant women to enhance the safety of women and their unborn babies.
Abstract: BACKGROUND: To estimate the prevalence of threats and actual acts of physical and sexual abuse during pregnancy. METHODS: Two hundred and seven pregnant Swedish women married to or cohabiting with Swedish men were randomly selected from three antenatal clinics in the city of Goteborg, Sweden. A standardized questionnaire was used for personal interviews about the women's experience of physical and sexual abuse by a husband or a boyfriend at some point in the past, during the last year and during current pregnancy. RESULTS: Twenty-seven point five percent of the women reported that they had been exposed to physical violence at some point in the past by their husband/boyfriend. Twenty-four and a half percent of the women had experienced some form of threat, physical or sexual violence during the last year. At some time (once or more) during their current pregnancy, the proportions of women who had been exposed to the following categories of violence, were as follows: 14.5%-symbolic violence, 14.5%-threats of mild violence, 2.9%-threats of moderate violence, 2.9%-threats of serious violence, 11%-mild violence, 4.3%-minor violence, 2.4%-moderate violence, 4.3%-serious violence and 3.3%-sexual violence. CONCLUSIONS: This study demonstrates that a considerable number of women had experienced threats, physical and sexual abuse during pregnancy. There is an obvious need for screening of experience of domestic violence among pregnant women to enhance the safety of women and their unborn babies. Language: en
TL;DR: The Misgav Ladach method of CS has advantages over the Pfannenstiel method by being significantly quicker to perform, with a reduced amount of bleeding and diminished postoperative pain.
Abstract: Objective. The aim of the study was to evaluate the outcome of two different methods of cesarean section (CS). Design. The study was designed as a prospective, randomized, controlled trial. Setting. All CS were performed at the University Hospital in Uppsala, Sweden. Population. Fifty women admitted to hospital for a first elective CS were consecutively included in the study. They were randomly allocated to two groups. Methods. One group was operated on by the Misgav Ladach method for CS and the other group by the Pfannenstiel method. All operations were performed by the same surgeon. Main outcome measures. Duration of operation, amount of bleeding, analgesics required, scar appearance and length of hospitalization. Results. Operating time was significantly different between the two methods, with an average of 12.5 minutes with the Misgav Ladach method and 26 minutes with the Pfannenstiel method (p<0.001). The amount of blood loss differed significantly, with 448 ml and 608 ml respectively (p=0.017). Significantly less analgesic injections and tablets (p=0.004) were needed after the Misgav Ladach method. Conclusion. The Misgav Ladach method of CS has advantages over the Pfannenstiel method by being significantly quicker to perform, with a reduced amount of bleeding and diminished postoperative pain. The women were satisfied with the appearance of their scars. In this study no negative effects of the new operation technique were discovered.
TL;DR: There is a minor pregnancy-induced physiological increase in laxity of the symphyseal soft tissue but there is no evidence that the degree of symphySEal distention determines the severity of pelvic pain in pregnancy or after childbirth.
Abstract: Sonographic assessment of symphyseal joint distention during pregnancy and post partum with special reference to pelvic pain
TL;DR: The relatively high rate of concomitant endometrial hyperplasia, especially in patients receiving hormone replacement therapy, dictates a thorough histological evaluation in all cases.
Abstract: Background. To characterize postmenopausal women with endometrial polyps and to evaluate their significance. Methods. The study population included all consecutive postmenopausal patients with a diagnosis of endometrial polyp, treated at our center over a two-year period. Demographic, medical and gynecological data were assessed with regard to the endometrial histologic findings. Results. Of the 146 eligible patients, 15 had endometrial hyperplasia (four with atypia); there were no cases of endometrial carcinoma. The 20 patients (13.7%) using hormone replacement therapy had a significantly higher rate of endometrial hyperplasia than non-hormone users (p<0.006). No differences were observed among the endometrial histological categories for any of the presenting symptoms and signs, ultrasonographic findings, or medical histories. Conclusions. Postmenopausal endometrial polyp is a common, mostly benign entity. However, the relatively high rate of concomitant endometrial hyperplasia, especially in patients receiving hormone replacement therapy, dictates a thorough histological evaluation in all cases.
TL;DR: Provided the surgeons are skilled and the lesions require no ureteral reimplantation, operative laparoscopy is a valid alternative to laparotomy for partial cystectomy.
Abstract: (1999). Laparoscopic management of bladder endometriosis. Acta Obstetricia et Gynecologica Scandinavica: Vol. 78, No. 10, pp. 887-890.
TL;DR: Control studies by at least 11 different research groups in nine countries have established significant positive associations between both proteinuric and nonproteinuric PIH and various measures of insulin resistance, and suggest that relative hyperinsulinemia, glucose intolerance, and insulin insensitivity predict the subsequent development of PIH.
Abstract: PIH, the most common complication of pregnancy, remains a major source of maternal-child morbidity and mortality. Yet the etiology of this disorder is still little understood. There is now a growing body of evidence linking PIH and insulin resistance. Both proteinuric and non-proteinuric PIH predict future essential hypertension, and to a lesser extent, diabetes, disorders strongly related to glucose intolerance and insulin resistance. PIH is associated with diabetes, occurring in up to 50% of diabetic pregnancies. PIH is characterized by the same features that define IRS, including hypertension, dyslipidemia, disruption of endothelial and platelet function and related disturbances of prostanoid synthesis, coagulation and fibrinolytic abnormalities, hyperuricemia, atherosclerotic changes, and obesity. During the last decade, controlled studies by at least 11 different research groups in nine countries have established significant positive associations between both proteinuric and nonproteinuric PIH and various measures of insulin resistance. In particular, prospective investigations by at least five groups of investigators have indicated that relative hyperinsulinemia, glucose intolerance, and insulin insensitivity predict the subsequent development of PIH. These and other studies suggest that insulin resistance may play a causal role in the pathogenesis of PIH, and that some aspects of PIH may represent an early manifestation of IRS, precipitated by the profound metabolic and hemostatic challenges of gestation.
TL;DR: The DNA strand breaks might play an important role for the maturation process of the spermatozoa in the same way as apoptosis is controlling the number of early meiotic germ cells in the testis, and hereby play a important role in advanced fertility treatments (ICSI).
Abstract: Background The aim of this report was to compare the degree of DNA strand breaks in known normal fertile men to those with oligozoospermia, and evaluate the presence of DNA strand breaks in normal raw sperm, after Percoll and swim-up and following conventional cryopreservation, as all these preparation methods might differ in selection of healthy sperm cells. Methods Sperm samples from proven fertile sperm donors (n=20) and infertile men with oligozoospermia (n=33) were tested for the presence of DNA strand breaks in the spermatozoa, by direct immunoperoxidase detection of digoxigenin-labeled genomic DNA. A correlation to other sperm parameters, sperm counts, motility and Kruger's strict criteria was performed. Results DNA strand breaks were found significantly more often in sperm samples from men with oligozoospermia compared to sperm samples of normal fertile men. The degree of spermatozoa with DNA strand breaks was correlated proportional with the degree of morphological pathological sperm cells judged by Kruger's strict criteria. The percentage of spermatozoa with DNA strand breaks in the samples was not influenced by procedures such as the swim-up technique, Percoll gradients or cryopreservation and thawing. Conclusion DNA strand breaks were found significantly more often in men with oligozoospermia compared to normospermic men. The DNA strand breaks might play an important role for the maturation process of the spermatozoa in the same way as apoptosis is controlling the number of early meiotic germ cells in the testis, and hereby play an important role in advanced fertility treatments (ICSI).
TL;DR: Good family planning programs to reduce grandmultiparity and unnecessary curettage for undesired pregnancies, preventing harmful home deliveries by inexperienced people, and fearless usage of episiotomy in difficult deliveries are necessary to prevent pelvic relaxation.
Abstract: Background To determine the possible risk factors in our population. Methods From 250 patients attending our clinic 28 patients with pelvic relaxation were the study group and the rest, 222 in all, were the control group. Results Age, marriage period, parity and number of abortus in pelvic relaxation group are found to be significantly higher with univariate analysis. With logistic regression analysis menopause, grandmultiparity, abortus (two or more), home deliveries, history of macrosomic infant (4500 gr. or more), deliveries without episiotomy and laceration of uterine cervix are found to be risk factors for pelvic relaxation. Conclusions Good family planning programs to reduce grandmultiparity and unnecessary curettage for undesired pregnancies, preventing harmful home deliveries by inexperienced people, and fearless usage of episiotomy in difficult deliveries are necessary to prevent pelvic relaxation.
TL;DR: Both betameth asone and dexamethasone induce a profound, albeit transient, suppression of fetal heart rate characteristics and biophysical activities in the preterm fetus.
Abstract: UNLABELLED BACKGROUND; Contradictory findings on the effect of betamethasone versus dexamethasone on antenatal tests of fetal well-being have been reported. The purpose of this study was to compare the effects of these steroid compounds on fetal heart rate patterns and biophysical activities in a prospective. randomized trial. STUDY DESIGN Forty-six pregnant women (gestational age range 27-34 weeks) at risk for preterm delivery were randomized to receive betamethasone or dexamethasone for enhancement of fetal lung maturity. Fetal heart rate was recorded for 60 minutes and analyzed with the Sonicaid System 8000 before (0 hours), and 48 hours and 96 hours after steroid administration. Subsequently, fetal limb, body and breathing movements were sonographically observed and quantified for 30 minutes. To account for fetal circadian rhythms, all examinations were performed between 1 p.m. and 5 p.m., at least one hour after maternal meals. RESULTS Fetal heart rate accelerations (p<0.001; p<0.01), short-term variation (p<0.0001; p<0.05), long-term variation (p<0.01; p=NS), duration of high episodes (p<0.001; p<0.05), total movement count (p<0.001; p<0.05), and duration of breathing time (p<0.0001; p<0.0001) were substantially reduced 48 h after betamethasone and dexamethasone administration, respectively, with percent reduction being larger for the betamethasone group, except for breathing movements (p<0.05; p<0.001; p<0.001; p<0.005; p<0.05; p=NS; respectively). In 68.2%( and 45.5% of fetuses, less than 30 seconds of continuous breathing movements were found in the betamethasone and dexamethasone groups, respectively. In 71.8% and 12.5%, of fetuses, respectively, less than 2 body/limb movements were observed. Therefore five and two fetuses in the betamethasone and dexamethasone study group, respectively, had both nonreactive fetal heart rate monitors for 60 minutes and biophysical profiles of < or =4/10. All parameters returned to baseline values at 96 h. Baseline fetal heart rate and numbers of decelerations remained unchanged (p=NS). CONCLUSIONS Both betamethasone and dexamethasone induce a profound, albeit transient, suppression of fetal heart rate characteristics and biophysical activities in the preterm fetus. However, the effect of betamethasone is more pronounced. Awareness of these phenomena might prevent unwarranted iatrogenic delivery of preterm fetuses.
TL;DR: The results of the present study show that mifepristone is a simple and effective treatment for inducing labor in post-term women with an unripe cervix.
Abstract: Objective, To evaluate the efficacy of mifepristone in inducing labor in women with an unripe cervix, its effect on the cervix and on the status of the newborn. Methods. In a prospective double-blind study, 36 post-term pregnant women with a Bishop score of 5 or less received either 400 mg mifepristone (n=24) or placebo (n=12). If, 48 hours after the treatment was started, labor had not begun or the Bishop score was 5 or less, the women were given 0.5 mg prostaglandin E 2 intracervically, a treatment which was repeated 12 hours later, if necessary. Results. During the first 48 hours following treatment, 19 (79.2%) of the women treated with mifepristone and two of the women (16.7%) treated with placebo went into labor. In addition, one and three women, respectively, had a ripe cervix at the end of the 48h period. The overall success rate was thus 83.3% for mifepristone and 41.7% for placebo (p=0.008; OR 14.8; 95% Cl 2.1-107.6). The median time from the start of treatment to delivery was also shorter (mifepristone 36h23' and placebo 53h17'). Treatment with intracervical PGE 2 was needed more often after the placebo. The duration of labor, however, tended to be shorter after placebo than after mifepristone in the women who delivered vaginally. The frequencies of instrumental delivery were similar in both treatment groups. The median Apgar score was slightly lower at 1 minute (p<0.05) following mifepristone treatment, but did not differ at 5 and 10 minutes. There was no difference between the two treatment groups in the umbilical pH at delivery. Conclusion. The results of the present study show that mifepristone is a simple and effective treatment for inducing labor in post-term women with an unripe cervix.
TL;DR: Since studies reporting on long-term outcome are lacking, the choice between nifedipine and ritodrine can only be based on obstetrical and short-term neonatal outcomes, and nifingipine should be the drug of first choice for the suppression of preterm labor.
Abstract: Background Since large randomized clinical trials comparing the effectiveness of nifedipine and ritodrine in the suppression of preterm labor are lacking, we performed a meta-analysis on the subject. Methods We searched the databases Medline and EMBASE using the keywords 'nifedipine', 'ritodrine' and 'randomized' or 'randomised'. The studies were scored for blinding, method of randomization and type of analysis ('intention-to-treat' versus 'par protocol'). Subsequently, two by two tables were constructed using 'delay of labor by 48 hours or more', 'delay of labor beyond 36 weeks gestation', perinatal mortality, respiratory distress syndrome and admission to a neonatal intensive care unit as end points. Homogeneity between the studies was tested with a Breslow-Day test. Pooled odds ratios were calculated in case homogeneity could not be rejected. Results We could detect ten studies that were published between 1986 and 1998, incorporating data of 681 patients. Nifedipine reduced the risk of delivery within 48 hours compared to ritodrine, but this difference was not statistically significant (odds ratio 0.85, 95% confidence interval 0.54 to 1.1). Nifedipine also reduced the risk of delivery before 36 weeks compared to ritodrine, and this difference was statistically significant (odds ratio 0.59, 95% confidence interval 0.39 to 0.90). We are not aware of studies reporting on long-term outcome. Conclusion Since studies reporting on long-term outcome are lacking, the choice between nifedipine and ritodrine can only be based on obstetrical and short-term neonatal outcomes. From that perspective, nifedipine should be the drug of first choice for the suppression of preterm labor.
TL;DR: It was found that during pregnancy and lactation a high proportion of Danish women were exposed to one or more drugs in high risk groups; furthermore, knowledge regarding their safety for the fetus and neonate was limited for a large proportion of the prescriptions.
Abstract: Aim. To assess the current prescribing pattern for 15,756 primiparae before, during, and after their pregnancies with reference to fetal and neonatal risk. Method. A prescription database study with linkage to The Danish Medical Birth Registry from 1991 to 1996. The drug subsidy system in Danish retail pharmacies, made it possible to identify prescriptions by individual use. All 34,334 prescriptions were set against the Swedish classification of risk of drug use in pregnancy and lactation. Results. During pregnancy, safe (group A), potentially harmful (group B3, C, and D), and non-classifiable drugs accounted for 40.9%, 26.6% and 28.7% respectively. The proportion of women who redeemed drugs was 29.2%, 8.6%, 18.7% and 0.9% from drug groups A, B, C and D respectively. The proportion of prescriptions from high risk groups declined during the course of pregnancy. Postpartum safe drugs (group I and II), drugs with possible harmful neonatal effects (group III), and non-classifiable drugs accounted for 43.5%, 4.8%, and 35.8% of the prescriptions, respectively. Conclusion. According to the Swedish classification system, we found that during pregnancy and lactation a high proportion of Danish women were exposed to one or more drugs in high risk groups; furthermore, knowledge regarding their safety for the fetus and neonate was limited for a large proportion of the prescriptions. Current evidence about long-term effects of prenatal exposure stresses the need for long-term follow-up of health and development among exposed children.