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- Pirhonen, J P, et al.
(författare)
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Frequency of anal sphincter rupture at delivery in Sweden and Finland--result of difference in manual help to the baby's head
- 1998
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 77:10, s. 974-977
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Anal sphincter rupture is a serious complication of vaginal delivery and almost half the affected women have persistent defecatory symptoms despite adequate primary repair. During the past decade, the incidence of anal sphincter ruptures has been increasing in Sweden and is currently estimated to occur in 2.5% of vaginal deliveries. The aim of the study was to report the frequency of anal sphincter ruptures in two university hospitals in two Scandinavian countries, Malmo in Sweden and Turku in Finland, and analyze the potential determinants. METHODS: Retrospective analysis of a population of 30,933 deliveries (26,541 vaginal) during the years 1990 to 1994. RESULTS: The incidence of anal sphincter ruptures in Malmo, Sweden was 2.69%, and in Turku, Finland 0.36%. There were no significant population differences for the known risk factors (fetal weight, nulliparity or fetal head circumference). However, there is a difference in manual support given to the perineum and to the baby's head when crowning through the vaginal introitus between Malmo and Turku. The proportion of operative vaginal deliveries and abnormal presentations was significantly higher in Turku reflected in the lower Apgar score at 5 minutes and longer duration of second phase of labor. When high risk deliveries (operative vaginal delivery, abnormal presentation and newborns over 4,000 g) were excluded, the risk for anal sphincter ruptures was estimated to be 13 times higher in Malmo than in Turku. CONCLUSIONS: The difference in the incidence of anal sphincter rupture between Malmo, Sweden and Turku, Finland may be due to the difference in manual control of the baby's head when crowning.
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- Darj, Elisabeth, et al.
(författare)
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Insulin-like growth factor binding protein-1, a quick way to detect amniotic fluid
- 1998
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 77:3, s. 295-297
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The detection of premature rupture of membranes (PROM) is essential to the management of pregnancy. Various tests, all with different limitations, have been used to diagnose PROM. Insulin-like growth factor binding protein-1 (IGFBP-1) is present in an essentially higher concentration in amniotic fluid, than in serum, cervical mucous, urine and seminal plasma. A commercial kit, with monoclonal antibodies to IGFBP-1 attached to a stick, is available. The aim of this study was to investigate whether a rapid dipstick test could confirm or exclude the presence of amniotic fluid. METHODS: A multicenter study, involving six departments of obstetrics and gynecology in Sweden, was designed to evaluate the new dipstick technique of diagnosing the presence of amniotic fluid in the vagina. One hundred and seventy-four women were examined. Forty-six women with obvious PROM, 29 women without PROM and 99 women with suspected PROM. RESULTS: Forty-four out of forty-six women with obvious PROM had a positive PROM-TEST. Twenty-seven out of twenty-nine women without PROM had a negative PROM-TEST, giving a sensitivity of 95.7% and a specificity of 93.1%. Among the women with suspected rupture of membranes, the sensitivity was 70.8%, the specificity 88.2% and the positive predictive value (PPV) 92%. CONCLUSION: IGFBP is present in high concentration in amniotic fluid. The dipstick test with monoclonal antibodies to IGFBP-1 is rapid and has a high PPV, sensitivity and specificity. It is a useful complement to the existing arsenal of tests to detect PROM.
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- Wijma, Barbro, et al.
(författare)
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Attitudes towards pelvic examination in a random sample of Swedish women
- 1998
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 77:4, s. 422-428
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A pelvic examination is the most common procedure in gynecological practice. A majority of women have negative experiences of such examinations. The aim of the present study was to explore attitudes to and experiences of pelvic examinations, as well as possible background factors to such attitudes and experiences. METHODS: A postal inquiry was sent to 788 randomly selected Swedish women, of fertile age. Sixty-seven per cent answered the questionnaire, which had 56 items and covered, inter alia, attitudes to and experiences of pelvic examinations, as well as possible background factors. RESULTS: The women had positive, uniform attitudes to pelvic examinations in general, but negative experiences of the specific parts of the procedure. Women's attitudes to and experiences of pelvic examinations correlated. The experience of the first pelvic examination was more negative than the experience of the last. A negative experience in general and the experience of pain during the first pelvic examination correlated. The first pelvic examination emerged as a statistically powerful background factor for subsequent attitudes to pelvic examinations. CONCLUSIONS: Swedish women have positive attitudes to pelvic examination in spite of negative previous experiences. A powerful background factor for subsequent attitudes to pelvic examination was the experience of the first one. A woman's first pelvic examination should therefore be used as an opportunity to condition positive emotions and behaviors to the examination situation, as a basis for future positive experiences.
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