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| 2. |
- 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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| 3. |
- 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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| 6. |
- 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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| 12. |
- Brynhildsen, Jan, 1962-, et al.
(författare)
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Oral contraceptive use among female elite athletes and age-matched controls and its relation to low back pain
- 1997
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 76:9, s. 873-878
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Tidskriftsartikel (refereegranskat)abstract
- Background: Exogenous and endogenous female sex steroids may influence the risk of low back pain. The fact that back pain is a very common symptom during pregnancy supports this theory. Back pain is also more common among female than male athletes. Oral contraceptives have been suggested to increase the risk of low back pain.Objective: To evaluate whether the prevalence of low back pain is higher among oral contraceptive users than non-users and if it differs between women taking part in different sports.Methods: A questionnaire was sent to female elite athletes in volleyball (n=205), basketball (n=150), and soccer (n=361) as well as to age-matched controls (n=113). The questionnaire comprised questions about age, constitution, occupation, parity and use of contraceptive method as well as previous and current back pain and possible consequences of the back problems.Results: The response rate was 85%. Between 42% and 52% of the women in the different groups used oral contraceptives. The groups were similar in most background variables, except that the volleyball and basketball players were taller. The prevalence of current low back pain was between 21% and 34% in the different athlete groups with an average of 30%, whereas only 18% of the controls suffered from low back pain (p<0.01). The prevalence of low back pain within each group, athletes as well as controls, was similar in women who used, and did not use oral contraceptives.Conclusions: This study does not support the theory that low back pain is affected by the use of oral contraceptives. Instead, constitutional factors and mechanical stress during intense physical activity is probably more important.
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| 13. |
- Brynhildsen, Jan, 1962-, et al.
(författare)
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Oral contraceptives and low back pain: Attitudes among physicians, midwives and physiotherapists
- 1995
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 74:9, s. 714-717
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Tidskriftsartikel (refereegranskat)abstract
- Background: Only few indications have appeared in the literature concerning a possible relationship between the use of oral contraceptives and low back pain. In our,daily work we often meet women who have been recommended to abandon their use of oral contraceptives depending on coexisting low back pain. In order to assess the opinions of a possible relationship between oral contraceptives and low back pain this study was undertaken.Methods: A validated questionnaire was sent out to physicians, physiotherapists and midwives dealing with either contraceptive counselling or low back pain. A modified questionnaire was sent to medical- and physiotherapist students to assess whether the opinions were a result of the education or the working experience.Results: A total of 225 questionnaires were sent out and 206 (91%) were returned. Sixteen percent thought there was a relationship between the use of oral contraceptives and risk of low back pain. Thirty percent had seen patients with low back pain that was interpreted as being affected by use of oral contraceptives. Twenty-five percent recommended at least some patients with low back pain to change their contraceptive method. Among the students there was a difference in opinion between the first and the last year students indicating that their opinions had been influenced by their education.Conclusions: Evidently many professionals dealing with oral contraceptives and low back pain believe that there is a relationship between oral contraceptives and low back pain, despite the lack of scientific evidence. These recommendations might influence the contraceptive safety for the individual woman and the possible relationship between use of oral contraceptives and low back pain should therefore be more thoroughly investigated before general recommendations are given.
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| 16. |
- Falconer, C, et al.
(författare)
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Different organization of collagen fibrils in stress-incontinent women of fertile age
- 1998
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 77, s. 87-
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective was to test the hypothesis that stress urinary incontinence in women is correlated to changes in the paraurethral connective tissue ultrastructure and metabolism.METHODS: Transvaginal biopsies were obtained from the paraurethral connective tissue in women of fertile age with stress urinary incontinence and in matched continent controls. All the stress-incontinent women were characterized with urodynamic investigation. In the biopsies, collagen concentration, measured as hydroxyproline, and the degree of extraction by pepsin digestion were quantified. Proteoglycan composition and concentration were analyzed using Alcian blue precipitation, followed by electrophoretic separation and quantification. Using Northern blots mRNA levels for the collagens I and III, the small proteoglycans decorin and biglycan, and the large proteoglycan versican, were quantified. Collagen organization was examined with transmission electron microscopy and the diameters of collagen fibrils were analyzed with an interactive image analysis system (IBAS, Zeiss/Kontron).RESULTS: The biochemical and morphological analyses exposed a significant difference in the paraurethral connective tissue between stress urinary incontinent women before menopause and comparable controls. The collagen concentration was almost 30% higher and the diameters of the collagen fibrils were 30% larger in the incontinent group of women. Also the organization of the collagen fibrils differed, with considerably higher cross-linking. A higher level of mRNA for collagen I and III in the incontinent group indicates that the differences can be related to an altered collagen metabolism. No change of proteoglycan amount or composition was observed, resulting in a significantly lower proteoglycan/collagen ratio in the incontinent group of women.CONCLUSION: Stress urinary incontinence in fertile women is associated with a change in collagen metabolism resulting in an increased concentration of collagen and larger collagen fibrils. These alterations should result in a more rigid form of extracellular matrix, suggesting a connective tissue with impaired mechanical function.
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| 24. |
- Herbst, Andreas, et al.
(författare)
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Different types of acid-base changes at birth, fetal heart rate patterns, and infant outcome at 4 years of age
- 1997
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 76:10, s. 953-958
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To study the relationship between different types of acidemia in umbilical artery blood at birth, fetal heart rate (FHR) patterns during labor, and infant long-term outcome. METHODS: Case-control study of 48 infants with pure high base deficit (base deficit (BD) > or = 12 mmol/L and pCO2 < 8.0 kPa), 51 with mixed acidemia (BD > or = 12 mmol/L and pCO2 > or = 8.0 kPa), born at or after term, and controls matched for maternal age, parity, and gestational age at birth. FHR patterns during labor and the results of developmental screening at age 4 were compared between the groups. RESULTS: Late decelerations were associated with pure high base deficit and complicated variable decelerations with mixed acidemia. Both types of acidemia were correlated with Apgar scores below 7 at 1 minute, and mixed acidemia with more admissions to the neonatal intensive care unit. Developmental screening at age 4 years showed no significant differences between infants with mixed acidemia or pure high base deficit and controls. Twelve infants with mixed acidemia and six controls had deficits in language/speech development. CONCLUSIONS: Late decelerations may be an indicator of a metabolic component of acidemia and complicated variable decelerations an indicator of mixed acidemia. The higher rate of admissions to the neonatal intensive care unit in cases with mixed acidemia may suggest that a concomitant hypercapnia (resulting in lower pH) in metabolic acidemia at birth may be of importance for the outcome. A possible relation between acidemia at birth and deficits in speech/language development should be further evaluated.
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| 29. |
- Kurova, T, et al.
(författare)
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Prostitution in Riga, Latvia--a socio-medical matter of concern
- 1998
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 77:1, s. 83-86
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study the background and the working and socio-economic conditions, and the prevalence of some sexually transmitted diseases (STDs), among street and sex club female Latvian prostitutes. STUDY DESIGN: Structured in-depth interviews, as well as clinical examination and laboratory tests for gonorrhea, syphilis, bacterial vaginosis, trichomoniasis, ectoparasites and HIV-infections. RESULTS: Approximately half of the 107 women stemmed from rural Latvian villages, the rest from the capital city of Riga. Of the women, 15-43 years, 36% were ethnic Latvians and 56% ethnic Russians, as compared to 58% vs. 32% of the population of Latvia. Poor economy with unemployment and miserly living conditions were the main reasons for recruitment to prostitution. The income per client was in the range of 25-30 USD (10-15 Ls), but the pimp and brothel/sex club owner often requires half of the women's fees. Unprotected intercourse was common. Twenty of the women were found to be pregnant. One tenth used narcotic drugs, e.g. ecstasy. The prevalences of gonorrhea, active syphilis, bacterial vaginosis, trichomoniasis and ectoparasites were 10.2%, 15.7%, 68.2%, 35.5% and 15.9% respectively. None was HIV-infected. CONCLUSIONS: There is an urgent need for regulation of the Latvian 'sex industry', means for providing prostitutes with adequate contraceptives, and to allocate resources to clinics for investigation, therapy and counseling.
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| 30. |
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| 31. |
- Löfgren, Mats, et al.
(författare)
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High progesterone is related to effective human labor : study of serum progesterone and 5α-pregnane-3,20-dione in normal and abnormal deliveries
- 1997
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - 0001-6349 .- 1600-0412. ; 76:5, s. 423-430
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Tidskriftsartikel (refereegranskat)abstract
- Background. The role of progesterone levels during human labor is unclear. Objective. To investigate serum concentrations of progesterone and 5α-pregnane-3,20-dione in normal and abnormal deliveries. Methods. Venous and umbilical cord serum samples were collected from 108 parturient women. In a further 49 deliveries, arterial and venous umbilical cord sera were collected separately. The concentrations of progesterone and 5opregnane-3,20-dione were determined by radioimmunoassay. The delivery modes studied were: elective cesarean section; oxytocin-resistant dystocia; normal but induced delivery, and normal spontaneous delivery. Results. Progesterone concentrations in maternal and umbilical serum were higher following normal labor than after dystocia (p<0.005) and elective cesarean section (p<0.005). The maternal and umbilical progesterone concentrations in dystocia and elective cesarean section were between 77–43 % of those in normal labor. The concentrations did not vary between gestational weeks 37 and 42, within the different modes of delivery. The 5α-pregnane-3,20-dione serum concentration in the fetal compartment was twice that in the maternal compartment (p<0.001); its concentration in venous umbilical serum was higher than in corresponding arterial samples (p<0.001). No distinct differences in the 5α-pregnane-3,20-dione serum concentration were found with regard to parity or mode of delivery. Conclusion. High progesterone concentrations during parturition appear to be related to effective labor. The findings support results from in vitro experiments on human term myometrium. Read More: http://informahealthcare.com/doi/abs/10.3109/00016349709047823
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| 32. |
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| 33. |
- Nisell, H, et al.
(författare)
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Definition and treatment of severe preeclampsia
- 1995
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 74:10, s. 852-852
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 34. |
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| 35. |
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| 36. |
- Nyman, M, et al.
(författare)
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Chorea gravidarum
- 1997
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 76:9, s. 885-886
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Tidskriftsartikel (refereegranskat)
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| 37. |
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| 38. |
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| 39. |
- Radestad, I, et al.
(författare)
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Stillbirth and maternal well-being
- 1997
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 76:9, s. 849-855
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Tidskriftsartikel (refereegranskat)
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| 40. |
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| 41. |
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| 42. |
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| 43. |
- Samsioe, Göran
(författare)
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Review Article: Osteoporosis - an update
- 1997
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 76:3, s. 189-199
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Forskningsöversikt (refereegranskat)abstract
- Osteoporosis and subsequent fractures is a rapidly growing major health problem in many parts of the world. Even if prevalence and incidence are high in Europe, rate of increase is even higher in Asia. The majority of fractures occur in women underlining the importance of ovarian deficiency. Genetic factors and lifestyle greatly influence the incidence and prevalence both in men and women and the importance of estrogen deficiency at ages over 85, where a large number of fractures actually occur, may well be questioned. Among several risk factors the amount of bone mass remains crucial. Several techniques adequate in accuracy and precision exist to determine bone mass. The costs for these measurements are not negligible. Several pharmacologic regimens look promising for the prevention of osteoporosis and indeed for treatment of established osteoporosis. However, long-term data and clinical experience are warranted prior to establishing these pharmacological tools in the field of osteoporosis. For HRT and ERT such data are available. ERT and indeed HRT may halve the risk of osteoporotic fractures in women at least in current users. The effect at least on bone mass wears off after discontinuation of treatment but is never totally lost. In the interest of health care costs it is suggested that HRT could be started 15-20 years after the menopause and still provide protection for subsequent fractures.
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| 44. |
- Samuelsson, Eva, et al.
(författare)
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A population study of urinary incontinence and nocturia among women aged 20-59 years : prevalence, well-being and wish for treatment
- 1997
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Munksgaard Forlag. - 0001-6349 .- 1600-0412. ; 76:1, s. 74-80
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Tidskriftsartikel (refereegranskat)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.METHODS: A postal questionnaire was sent to all women aged 20-59 years who were scheduled for gynecological health examination by midwives in a primary health care district during one year. Questions concerning well-being were based on the Gothenburg QOL instrument. All women with incontinence were offered treatment by a midwife and a family doctor.RESULTS: Of the included 641 women, 491 (77%) answered the questionnaire. The prevalence of urinary incontinence was 27.7%, 3.5% having daily leakage. Nocturia occurred in 32 women (6.5%), 12 of whom were also incontinent. Self-assessed health, sleep, fitness and satisfaction with work situation decreased significantly with increased frequency of incontinence. Well-being was not correlated to type of incontinence. Nocturia correlated to poor health and sleep. About a quarter of the incontinent women started treatment when offered and 80% of those who completed the treatment program were subjectively improved. Wish for treatment was directly correlated to frequency of incontinence but not to type.CONCLUSIONS: Urinary incontinence and nocturia affect well-being in a negative way. Well-being and wish for treatment correlate to frequency of incontinence but not to type of incontinence. Most women with UI accept it, only about a quarter of incontinent women, or 6-7% of all women in the studied age group, want treatment. Treatment of female urinary incontinence in primary health care is successful.
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| 45. |
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| 48. |
- Vural, Gürcan, et al.
(författare)
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Inflammatory signs in wet smear and Pap-smear compared with the histopathology from the female lower genital tract.
- 1995
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 74:6, s. 451-4
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Tidskriftsartikel (refereegranskat)abstract
- In order to define the relationship between various criteria of female lower genital tract inflammation, we examined wet smears, cervical smears and biopsies from 131 patients. The presence of clue cells in rehydrated dry smears showed a positive correlation to the presence of clue cells in Papanicolaou stained smears, and to some extent with cytological evidence of inflammation (Kappa 0.48). Cytological inflammatory findings correlated well with the presence of clue cells in rehydrated dry smears, but signs of inflammation diagnosed by histopathology did not correspond to findings in cytological smears, probably because these methods reveal inflammation at different sites.
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| 49. |
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| 50. |
- Westgren, N, et al.
(författare)
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Sexuality in women with traumatic spinal cord injury.
- 1997
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 76:10, s. 977-983
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sexuality in spinal cord injured women has largely been neglected. One reason may be the male dominance amongst traumatically spinal cord injured individuals. The purpose of this study is to elucidate sexual issues in women with spinal cord injuries.METHODS: Survey of near-total prevalence population in the greater Stockholm area. Structured interview, based on a standardized questionnaire. Self-rating scales for evaluation of the importance of sexual activity before and after injury and for defining and rating the medical problem most significantly interfering with sexual activity. Marital status and/or partnership pre- and post-injury and information on sexual matters provided after injury were evaluated in detail. Out of a total 65 women, 62 participated in the study.RESULT: Women with complete and incomplete cervical lesions rated the importance of sexual activity significantly lower after, as compared to before, spinal cord injury. No significant differences were found in women with lower-level lesions. Urinary leakage, spasticity and positioning problems were the medical problems most significantly interfering with partner-related sexual activity. Only six women had received information on sexual matters before discharge from hospital. None of the partners had received such information.CONCLUSION: The women's neurological status affect their ability to adapt sexually after injury. Medical problems commonly interfere with sexuality and should be identified and treated. No adverse impact of spinal cord injury on marital status could be confirmed. Sexual counseling has yet to become an integral part of rehabilitation.
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