| 1. |
- Blohm, Febe, 1951, et al.
(författare)
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A randomised double blind trial comparing misoprostol or placebo in the management of early miscarriage
- 2005
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Ingår i: Bjog. - : Wiley. - 1470-0328. ; 112:8, s. 1090-5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study if misoprostol 400 microg, administered vaginally, increased the successful resolution of early miscarriage compared with placebo. DESIGN: Randomised, double blind placebo controlled study. SETTING: Sahlgrenska University Hospital, Goteborg, Sweden. SAMPLE: One hundred and twenty-six women seeking medical attention for early miscarriage. METHOD: Women with a non-viable, first trimester miscarriage were randomised to vaginal administration of misoprostol 400 microg or placebo. MAIN OUTCOME MEASURES: Main outcome measure was the proportion of successful complete resolution of miscarriage. Secondary outcomes were incidence of infection, bleeding, gastrointestinal side effects, pain, use of analgesics and length of sick leave between groups. RESULTS: Sixty-four patients were randomised to misoprostol and 62 to placebo. Eighty-one percent in the misoprostol and 52% in the placebo group had a complete miscarriage within one week of the primary visit (RR 1.57; 95% CI 1.20-2.06). Patients in the misoprostol group reported more pain as assessed on a visual analogue scale (60.4 [31.0] vs 43.8 [37.1] mm; P < 0.007) and required analgesics more often (83%vs 61%, RR 1.35; 95% CI 1.08-1.70). There were no significant differences in the occurrence of gastrointestinal side effects, infection, reduction in haemoglobin or sick leave between the groups. CONCLUSIONS: Treatment with 400 mug misoprostol administered vaginally increased the success rate of resolvement of uncomplicated early miscarriages compared with placebo. However, women who received misoprostol experienced more pain and required more analgesics than those who did not.
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| 2. |
- Blohm, Febe, 1951, et al.
(författare)
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Expectant management of first-trimester miscarriage in clinical practice.
- 2003
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 0001-6349. ; 82:7, s. 654-8
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate treatment efficacy and patient compliance in women with an early miscarriage managed expectantly in routine clinical practice.
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| 3. |
- Eriksson, K., et al.
(författare)
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Validation of the use of Pap-stained vaginal smears for diagnosis of bacterial vaginosis
- 2007
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Ingår i: APMIS : acta pathologica, microbiologica, et immunologica Scandinavica. - : Wiley. - 1600-0463 .- 0903-4641. ; 115:7, s. 809-813
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Tidskriftsartikel (refereegranskat)abstract
- Papanicolaou-stained cervicovaginal smears (Pap smears) are used to screen for cervical cancer. Since there is a lack of consensus in published reports respecting the efficacy of Pap-stained smears in BV diagnostics, there is a need to validate their use for diagnosis of BV. Slides from the international BV00 workshop were Pap stained and independently analyzed by four investigators under a phase-contrast microscope. All workshop slides-whether Pap-stained, Gram-stained or rehydrated air-dried smears-were scored according to the same Nugent classification. The diagnostic accuracy of Pap smears for diagnosis of BV had a sensitivity of 0.85 and a specificity of 0.92, with a positive and negative predictive value of 0.84 and 0.93, respectively. The interobserver weighted kappa index was 0.86 for Pap-stained smears compared to 0.81 for Gram-stained smears, and 0.70 for rehydrated air-dried smears using the mean Nugent score as the criterion standard. Provided that the samples are taken from equivalent locations (the vaginal fornix) and analyzed according to the same scoring criteria, there is no discernable difference in the diagnostic accuracy of the three smear-staining methods. The Pap-stained vaginal smears can be used as a wholly adequate alternative to Gram-stained smears for BV diagnosis.
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| 4. |
- Larsson, P G, et al.
(författare)
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Advantage or disadvantage of episiotomy compared with spontaneous perineal laceration.
- 1991
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Ingår i: Gynecologic and obstetric investigation. - : S. Karger AG. - 0378-7346 .- 1423-002X. ; 31:4, s. 213-6
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Tidskriftsartikel (refereegranskat)abstract
- In a prospective clinical investigation of 2,144 deliveries, we elucidate the indications for episiotomy and how different methods of anesthesia affect the frequency of episiotomy and the perineal problems after episiotomy compared with those after spontaneous perineal laceration. We found a significantly higher infection rate (p less than 0.001) and a longer healing period in the episiotomy group. These differences remain even if only primigravida or the indication, imminent perineal laceration, is studied. The results indicate that many women will unnecessarily suffer after an episiotomy. The patient's subjective problems are significantly increased, both immediately and at the 3-month postoperative follow-up.
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| 5. |
- Larsson, P G, et al.
(författare)
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Bacterial vaginosis and the vaginal leucocyte/epithelial cell ratio in women attending an outpatient gynaecology clinic.
- 1991
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Ingår i: European journal of obstetrics, gynecology, and reproductive biology. - : Elsevier BV. - 0301-2115. ; 42:3, s. 217-20
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Tidskriftsartikel (refereegranskat)abstract
- In order to investigate the usefulness of vaginal leucocytosis as a sign of genital infection, vaginal wet smears were obtained from 230 consecutive non-pregnant women attending an outpatient gynaecology clinic. Although 52 (22.6%) of the women were diagnosed as having bacterial vaginosis, none had symptoms of cervicitis or genital infection. Of the patients with bacterial vaginosis 19 (36.5%) had vaginal leucocytosis compared to 37.1% of the women without bacterial vaginosis. In a further study, bacterial vaginosis was also diagnosed in 104 of 384 women (33.3%) attending for first trimester legal abortions. Of the women with bacterial vaginosis 37.5% had vaginal leucocytosis compared to 31.8% for those without bacterial vaginosis (P greater than 0.05). There was no correlation between vaginal leucocytosis and the presence of cervical Chlamydia trachomatis; however, the presence of C. trachomatis did correlate with bacterial vaginosis. Vaginal leucocytes varies with factors unrelated to genital infection. This fact must be taken into consideration when wet smears from patients with suspected genital tract infection are evaluated.
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| 6. |
- Larsson, P. G., et al.
(författare)
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Clue cells in predicting infections after abdominal hysterectomy
- 1991
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Ingår i: Obstetrics and gynecology. - 0029-7844. ; 77:3, s. 450-452
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Tidskriftsartikel (refereegranskat)abstract
- Seventy women scheduled for abdominal hysterectomy were examined for the presence of clue cells in the vaginal discharge in an attempt to identify a possible risk group for development of postoperative infection. Seven of 20 women (35%) with clue cells developed vaginal cuff infections or wound infections, compared with four of 50 women (8%) without clue cells (P less than .01). Women with bacterial vaginosis, diagnosed by air-dried vaginal smears, are therefore at risk for postoperative infection.
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| 7. |
- Larsson, P G, et al.
(författare)
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Is bacterial vaginosis a sexually transmitted disease?
- 1991
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Ingår i: International journal of STD & AIDS. - : SAGE Publications. - 0956-4624 .- 1758-1052. ; 2:5, s. 362-4
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Tidskriftsartikel (refereegranskat)abstract
- The sexual behaviour of 400 women with and 400 women without bacterial vaginosis from a health screening programme was investigated by a questionnaire to see if women with bacterial vaginosis had similar behaviours to women considered at risk for STDs. These patients were randomly selected from computer records. Eight hundred questionnaires were distributed and 641 women answered. The age of first sexual intercourse was lower among women with bacterial vaginosis (17.8 years) than those without (18.6 years; P less than 0.001). Number of lifetime sexual partners was higher among women with bacterial vaginosis (P less than 0.001). Women with bacterial vaginosis smoked or had smoked more often. These results indicate that women with bacterial vaginosis have similar sexual behaviour to those at risk for STDs.
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| 8. |
- Larsson, P G, et al.
(författare)
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The vaginal pH and leucocyte/epithelial cell ratio vary during normal menstrual cycles.
- 1991
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Ingår i: European journal of obstetrics, gynecology, and reproductive biology. - : Elsevier BV. - 0301-2115. ; 38:1, s. 39-41
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Tidskriftsartikel (refereegranskat)abstract
- A higher proportion white blood cells (WBC) than vaginal epithelial cells in wet smears has been accepted as a sign which, together with clinical signs, can be useful in the diagnosis of infections in the genital tract such as cervicitis or salpingitis. However, little is known about the normal variation among healthy women without any symptoms or signs of genital-tract infection. By taking frequent wet smears from three healthy asymptomatic women during four menstrual cycles we found that vaginal leucocytosis usually occurred once each cycle. Normal vaginal leucocytosis must thus be taken into consideration when evaluating wet smear of patients for genital tract infections.
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| 9. |
- Mattsby-Baltzer, Inger, 1949, et al.
(författare)
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IL-1beta, IL-6, TNFalpha, fetal fibronectin, and endotoxin in the lower genital tract of pregnant women with bacterial vaginosis.
- 1998
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 0001-6349. ; 77:7, s. 701-6
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Tidskriftsartikel (refereegranskat)abstract
- In our studies on women with bacterial vaginosis (BV) in early pregnancy a strong association has been found between BV and the levels of endotoxin or interleukin-1alpha (IL-1alpha) in the lower genital tract. In the present study we investigated if an association could be found between BV and other cytokines (IL-1beta, IL-6, tumor necrosis factor alpha, TNF) or fetal fibronectin (FFN). The cytokine-inducing capacity of endotoxins present in the cervical mucus was explored in a monocytic cell assay.Cervical mucus or cervicovaginal fluid was collected from women with (BV) and without BV (nonBV) attending a family planning unit for first trimester abortion. The concentrations of IL-1beta, IL-6, TNF and FFN were determined by quantitative enzyme immunoassays. TNF was determined in 63 women (BV, n=25) out of whom 37 (BV, n=11) were analyzed for IL-1beta and the remaining 26 for IL-6 (BV, n=14). FFN was determined in another 36 women (BV, n= 19). The cytokine-inducing capacity of endotoxin-containing cervical mucus and purified endotoxin of Prevotella bivia were studied by an in vitro cell assay using a human monocytic cell line (THP-1).IL-lbeta and IL-6 were found in almost all women. The levels of IL-1beta, but not IL-6, TNF or FFN, were significantly increased in women with BV compared with the nonBV women (p<0.05). Purified endotoxin from P. bivia, and cervical mucus from BV women containing high levels of endotoxin were able to induce a cytokine response (IL-6) in monocytic cells in vitro.BV is associated with increased levels of IL-1beta in the lower genital tract of pregnant women in the first trimester. The ability of BV-associated endotoxins to induce cytokine production in monocytic cells may partly explain the increased IL-1beta levels.
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| 10. |
- Nielsen, Sven, et al.
(författare)
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Randomised trial comparing expectant with medical management for first trimester miscarriages
- 1999
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Ingår i: British journal of obstetrics and gynaecology. - : Wiley. - 0306-5456 .- 1470-0328 .- 1471-0528. ; 106:8, s. 804-807
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the efficacy of antiprogesterone (mifepristone) in combination with a synthetic prostaglandin E1 analogue (misoprostol) for outpatient treatment of miscarriages. PARTICIPANTS: One hundred and twenty-two women with first trimester miscarriages. METHODS: The women were randomised to treatment with mifepristone 400 mg orally followed by a single oral dose of 400 microg misoprostol 48 hours later (n = 60) or expectant management (n = 62). Women were re-evaluated five days later. If retained intrauterine products of conception were found with an antero-posterior diameter above 15 mm on transvaginal ultrasound, surgical evacuation was performed. RESULTS: Eighty-two percent of the women randomised to pharmacological treatment and 76% of those randomised to expectant management had an empty uterine cavity after five days. Convalescence time was 1.8 days longer for women randomised to pharmacological treatment. Pain, bleeding, complications, and satisfaction with the treatment did not differ between the groups. CONCLUSIONS: Most cases of spontaneous incomplete miscarriage will become a complete miscarriage without intervention. This study shows that outpatient treatment with a combination of antiprogesterone and a prostaglandin E1 analogue did not increase the rate of complete miscarriage, compared with expectancy alone, by a clinical important degree.
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