| 1. |
- Altman, Daniel, et al.
(författare)
-
Anal sphincter lacerations and upright delivery postures - a risk analysis from a randomized controlled trial
- 2007
-
Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 18:2, s. 141-146
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate obstetric sphincter lacerations after a kneeling or sitting position at second stage of labor in a multivariate risk analysis model. MATERIALS AND METHODS: Two hundred and seventy-one primiparous women with normal pregnancies and spontaneous labor were randomized, 138 to a kneeling position and 133 to a sitting position. Medical data were retrieved from delivery charts and partograms. Risk factors were tested in a multivariate logistic regression model in a stepwise manner. RESULTS: The trial was completed by 106 subjects in the kneeling group and 112 subjects in the sitting group. There were no significant differences with regard to duration of second stage of labor or pre-trial maternal characteristics between the two groups. Obstetrical sphincter tears did not differ significantly between the two groups but an intact perineum was more common in the kneeling group (p<0.03) and episiotomy (mediolateral) was more common in the sitting group (p<0.05). Three grade IV sphincter lacerations occurred in the sitting group compared to none in the kneeling group (NS). Multivariate risk analysis indicated that prolonged duration of second stage of labor and episiotomy were associated with an increased risk of third- or fourth-degree sphincter tears (p<0.01 and p<0.05, respectively). Delivery posture, maternal age, fetal weight, use of oxytocin, and use of epidural analgesia did not increase the risk of obstetrical anal sphincter lacerations in the two upright postures. CONCLUSION: Obstetrical anal sphincter lacerations did not differ significantly between a kneeling or sitting upright delivery posture. Episiotomy was more common after a sitting delivery posture, which may be associated with an increased risk of anal sphincter lacerations. Upright delivery postures may be encouraged in healthy women with normal, full-term pregnancy.
|
|
| 2. |
|
|
| 3. |
- Altman, Daniel, et al.
(författare)
-
Anticholinergic drug use for overactive bladder in Sweden: a nationwide pharmacoepidemiological study
- 2009
-
Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 20:11, s. 1285-1291
-
Tidskriftsartikel (refereegranskat)abstract
- Nationwide use and costs of anticholinergic drug for overactive bladder are unknown. We performed a nationwide study based on the Swedish Register on Prescribed Pharmaceuticals. From 2000 to 2007, there was a 68.8% increase in dispensed anticholinergic drugs in a population of 9 million. More than 93 million DDDs (calculated average maintenance dose per day) of anticholinergic drugs were dispensed corresponding to an overall DDD/TID (DDD per 1,000 inhabitants per day) of 3.5 per 1,000 persons per year. Approximately two thirds of anticholinergic drugs were prescribed to women, regardless of drug type. In 2007, the cost for anticholinergic drugs was 22 million a,not sign of which tolterodine comprised 70.8%. Solifenacin and darifenacin steadily increased their DDD/TIDs after market introduction. In this nationwide study, there was a 70% increased rate of expedited prescriptions of anticholinergic drugs for the treatment of overactive bladder in a relatively stable population.
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
- Altman, D, et al.
(författare)
-
The risk of anal incontinence in obese women
- 2007
-
Ingår i: International urogynecology journal and pelvic floor dysfunction. - : Springer Science and Business Media LLC. - 0937-3462. ; 18:11, s. 1283-1289
-
Tidskriftsartikel (refereegranskat)
|
|
| 7. |
- Ekström, Å., et al.
(författare)
-
Planned cesarean section versus planned vaginal delivery : Comparison of lower urinary tract symptoms
- 2008
-
Ingår i: International Urogynecology Journal. - : Springer London. - 0937-3462 .- 1433-3023. ; 19:4, s. 459-465
-
Tidskriftsartikel (refereegranskat)abstract
- We compared the prevalence and risk of lower urinary tract symptoms in healthy primiparous women in relation to vaginal birth or elective cesarean section 9 months after delivery. We performed a prospective controlled cohort study including 220 women delivered by elective cesarean section and 215 by vaginal birth. All subjects received an identical questionnaire on lower urinary tract symptoms in late pregnancy, at 3 and 9 months postpartum. Two hundred twenty subjects underwent elective cesarean section, and 215 subjects underwent vaginal delivery. After childbirth, the 3-month questionnaire was completed by 389/435 subjects (89%) and the 9-month questionnaire by 376/435 subjects (86%). In the vaginal delivery cohort, all lower urinary tract symptoms increased significantly at 9 months follow-up. When compared to cesarean section, the prevalence of stress urinary incontinence (SUI) after vaginal delivery was significantly increased both at 3 (p < 0.001) and 9 months (p = 0.001) follow-up. In a multivariable risk model, vaginal delivery was the only obstetrical predictor for SUI [relative risk (RR) 8.9, 95% confidence interval (CI) 1.9 - 42] and for urinary urgency (RR 7.3 95% CI 1.7 - 32) at 9 months follow-up. A history of SUI before pregnancy (OR 5.2, 95% CI 1.5 - 19) and at 3 months follow-up (OR 3.9, 95% CI 1.7 - 8.5) were independent predictors for SUI at 9 months follow-up. Vaginal delivery is associated with an increased risk for lower urinary tract symptoms 9 months after childbirth when compared to elective cesarean section. © International Urogynecology Journal 2007.
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Hellberg, Dan, et al.
(författare)
-
The very obese woman and the very old woman : Tension-free vaginal tape for the treatment of stress urinary incontinence
- 2007
-
Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 18:4, s. 423-429
-
Tidskriftsartikel (refereegranskat)abstract
- A mailed questionnaire was sent to 970 consecutive women who underwent a tension-free vaginal tape (TVT) procedure between 1995 and 2001 at the Department of Obstetrics and Gynecology in Falun Hospital. Seven hundred and sixty (78.4%) women responded. The outcome was compared between women older than 75 years (n=113) and younger women, and between women with a body mass index (BMI) above 35 (n=61) and those who had normal weight. Mean follow-up was 5.7 years. Thirty-six elderly women and one of the obese women were deceased at the long-term follow-up. TVT was easy to perform and was a safe procedure for women in all groups. There was a sharp decrease in cure rate of any urinary incontinence problems among women aged 75 years or more (55.7%), as compared to those who were younger (79.7%). The cure rate moderately decreased from BMI groups 19–24 to 30–34. BMI ≥35 seemed to be the best explanatory cutoff level. The overall cure rate in women of normal weight was 81.2%, as compared to 52.1% in the very obese. The cure rate for urinary incontinence with tension-free vaginal tape in women above 75 years of age and in women with a BMI above 35 was acceptable, but lower as compared to the remaining study population.
|
|
| 11. |
|
|
| 12. |
- Nilsson, C. G., et al.
(författare)
-
Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence
- 2008
-
Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 19:8, s. 1043-1047
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the long-term effectiveness and safety of the tension-free vaginal tape (TVT) procedure. In a Nordic three-center prospective observational cohort study, 90 women with primary stress incontinence had a TVT operation performed in local anesthesia. Assessment included a 24-h pad test, a stress test, physical examination, and a visual analog scale for assessing the degree of bother. Patient's global impression of cure was obtained, and condition specific quality of life questionnaires were used. Seventy-seven percent of the initial cohort of 90 women and 89% of those alive and capable of cooperating were assessed 11.5 years after the TVT operation. Ninety percent of the women had both a negative stress test and a negative pad test being objectively cured. Subjective cure by patients global impression was found in 77%, 20% being improved and only 3% regarded the operation as a failure. No late-onset adverse effects of the operation were found, and no case of tape erosion was seen. The TVT procedure is safe and effective for more than 10 years.
|
|
| 13. |
- Nordenstam, J, et al.
(författare)
-
Natural progression of anal incontinence after childbirth
- 2009
-
Ingår i: International urogynecology journal and pelvic floor dysfunction. - : Springer Science and Business Media LLC. - 0937-3462. ; 20:9, s. 1029-1035
-
Tidskriftsartikel (refereegranskat)
|
|
| 14. |
- Rezapour, Masoumeh, 1954-, et al.
(författare)
-
A 3-month preclinical trial to assess the performance of a new TVT-like mesh (TVTx) in a sheep model
- 2007
-
Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 18:2, s. 183-187
-
Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to evaluate in a sheep model the performance of a new polypropylene mesh (TVTx), which is intended as a less invasive treatment for female stress urinary incontinence. Eight female sheep were used in this study, each one being implanted with eight TVTx samples. At each time-point (weeks 1, 2, 4, and 12) seven TVTx were pulled out, while one TVTx was carefully dissected for histological investigations. One TVTx and one TVT, moreover, were inserted and immediately pulled out for obtaining the initial pullout forces in all sheep. The initial pullout values of TVT and TVTx were overlapping. The pullout forces of TVTx were > 5 N (500 g) and increasing from weeks 1 to 12 (p < 0.001). Histology revealed good tissue integration of TVTx in the tissue within 12 weeks after implantation. No abnormal histological findings were observed. This data could support the realization of a clinical trial with the TVTx mesh.
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
- Teleman, Pia, et al.
(författare)
-
Urethral pressure response patterns induced by squeeze in continent and incontinent women.
- 2007
-
Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 18:9, s. 1027-1031
-
Tidskriftsartikel (refereegranskat)abstract
- Our aim was to compare the urethral pressure response pattern to pelvic floor muscle contractions in 20-27 years old, nulliparous continent women (n=31) to that of continent (n=28) and formerly untreated incontinent (n=59) (53-63 years old) women. These women underwent urethral pressure measurements during rest and repeated pelvic muscle contractions. The response to the contractions was graded 0-4. The young continent women showed a mean urethral pressure response of 2.8, the middle-aged continent women 2.2 (NS vs young continent), and the incontinent women 1.5 (p < 0.05 vs middle-aged continent, p < 0.001 vs young continent). Urethral pressures during rest were significantly higher in the younger women than in both groups of middle-aged women. The decreased ability to increase urethral pressure on demand seen in middle-aged incontinent women compared to continent women of the same age as well as young women seems to be a consequence of a neuromuscular disorder rather than of age.
|
|
| 18. |
- Tibaek, S., et al.
(författare)
-
Is there a long-lasting effect of pelvic floor muscle training in women with urinary incontinence after ischemic stroke? A 6-month follow-up study
- 2007
-
Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 18:3, s. 281-287
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the long-lasting effect of pelvic floor muscle training (PFMT) in women with urinary incontinence after stroke measured by quality of life parameters. Twenty-four (24/24) women with urinary incontinence after stroke, who had completed a prospective, randomised controlled and single-blinded trial evaluating the effect of 12 weeks PFMT, were included in this follow-up study. The follow-up assessments were done by telephone interview 6 months after the intervention. The effect was evaluated by The Short Form 36 (SF-36) Health Survey Questionnaire and Incontinence Impact Questionnaire (IIQ). Twenty-four subjects completed the study. In the treatment group, the SF-36 showed a trend to a long-lasting effect in one of the eight domains and the IIQ showed a tendency to decreased impact of UI in two sub-scales compared to the control group. Our data indicated that PFMT may have a long-lasting effect measured by quality of life parameters.
|
|
