Chronic pelvic pain (CPP) and bladder pain syndrome (BPS) can have a negative impact on quality of life. Neuromodulation has been suggested as a possible treatment for refractory pain.
To assess the effectiveness of tibial and sacral nerve stimulation in the treatment of BPS and CPP.
We searched until July 2012: The Cochrane Library, EMBASE (1980-2012), Medline (1950-2012), Web of knowledge (1900-2012), LILACS (1982-2012) and SIGLE (1990-2012) with no language restrictions. We manually searched through bibliographies and conference proceedings of the International Continence Society.
Randomized and prospective quasi-randomized controlled studies versus sham nerve stimulation treatment or usual care of patients with CPP and BPS who underwent sacral or tibial nerve stimulation were included. Any studies involving transcutaneous stimulation were excluded. The outcome was a cure or improvement in symptoms.
Three studies with 169 patients treated with tibial nerve stimulation were included; two for CPP and one for BPS. There were improvements in pain, urinary and quality of life scores. There was no reported data for sacral nerve stimulation.
There is scanty literature reporting variable success of posterior tibial nerve stimulation in improving pain, urinary symptoms and quality of life in CPP and BPS. In view of the dearth of quality literature, a large multi-centered clinical trial investigating the effectiveness of electrical nerve stimulation to treat BPS and CPP along with the cost-analysis of this treatment is recommended.
This article is protected by copyright. All rights reserved.
To investigate factors influencing the mother's choice of delivery mode when vaginal breech delivery is considered possible and safe.
Retrospective study.
University Hospital.
Singleton, term pregnancies with breech presentation were included, n=390.
Information was collected from patient records from January 2006 to December 2010. A questionnaire was sent to those 293 women in whom vaginal breech delivery was considered possible and safe.
Patient characteristics by choice of delivery mode.
Women who were selected for vaginal breech delivery (n = 187) were younger, more often nulliparous and gave birth to smaller babies. Women who requested a cesarean section (n = 112) became more worried when the breech presentation was diagnosed. They had a more negative initial view on breech presentation, took more often additional advice from non-professionals and trusted them more. Women who requested cesarean section reported a positive birth experience more frequently than women who were selected for vaginal delivery, whether ending as vaginal or emergency cesarean delivery. Women in both groups searched web-based information about breech delivery. We found no differences between the sources of information used.
Younger, nulliparous women with smaller babies trusted and listened more to professional advice and were more prone to choose vaginal delivery. Women who requested a cesarean section were more worried and had a more negative initial view on breech presentation. Both groups sought web-based information equally.
This article is protected by copyright. All rights reserved.
Postpartum hemorrhage presents a difficult situation for obstetricians, and several methods have been developed to reduce mortality and morbidity. We recently read the review of uterine compression sutures for postpartum hemorrhage in this journal, which suggested that compression sutures offer improved hemostasis and preserve future fertility (1). Placenta previa can cause postpartum hemorrhage, and we here report successful management of aortic dissection in a patient with Marfan syndrome with total placenta previa.
This article is protected by copyright. All rights reserved.
I thank Drs. Kessler and Yli for their comments where they ask if there is sufficient evidence to conclude anything about the admission CTG. There is sufficient evidence to state that the reliability and predictive values are poor, and that the test causes an increase in minor interventions, - at least in the settings the test has been evaluated (1-3). The test was introduced as a screening test and was evaluated as such
This article is protected by copyright. All rights reserved.
We thank Dr. Fuchs and his colleagues for their comments about our study (1). They ask how frequently the FHR tracing from the abdominal fetal ECG technique (afECG) was of sufficient quality to be used clinically. Our study was not designed to answer that specific question, but we can draw some helpful inferences from our data. The study cases were not selected, i.e., they included all of the 75 fetuses monitored simultaneously with a scalp electrode, Doppler ultrasound, and afECG regardless of the tracing's quality.
This article is protected by copyright. All rights reserved.
Eating disorders is a prevalent, serious condition that affects, mainly young women. An early and enduring sign of anorexia is amenorrhea. There is no evidence for benefits of hormone therapy in patients with anorexia, however, hormone medication and oral contraceptives are frequently prescribed for young women with anorexia as a prevention against and treatment for low bone mineral density. The use of estrogens may create a false picture indicating that the skeleton is being protected against osteoporosis. Thus the motivation to regain weight, and adhere to treatment of the eating disorder in itself, may be reduced. The most important intervention is to restore the menstrual periods through increased nutrition. Hormone and oral contraceptive therapy should not be prescribed to young women with amenorrhea and concurrent eating disorders.
This article is protected by copyright. All rights reserved.
In 1997 Ladfors et al. (1) published a study in which they assessed the diagnostic accuracy of sterile speculum examination for the diagnosis of rupture of the membranes (ROM) in pregnancy. The authors reported a 12% false negative rate which has been quoted in several recent articles (2-4). As part of our work for National Institute for Health and Care Excellence (NICE)'s Medical Technology Evaluation Programme (www.nice.org.uk/mt) we have reviewed the data in the original publication and concluded that this rate has been interpreted inappropriately.
This article is protected by copyright. All rights reserved.
Women who suffered from pregnancy complications are at increased risk for anxiety and depression.
To evaluate whether having suffered from preeclampsia or HELLP syndrome is associated with anxiety and depression, and whether preeclampsia/HELLP is an independent risk factor for developing anxiety and depression.
Systematic search on PubMed and PsycInfo with no time limit.
Studies presenting original data, including women with a history of preeclampsia/HELLP and at least one comparison group of women without preeclampsia/HELLP, reporting the results for each group separately or in a multivariate regression analysis with preeclampsia/HELLP as an independent variable.
Study characteristics and outcomes were extracted using a prespecified form. If necessary, additional calculations were performed.
The search yielded 267 articles, with only six being suitable for inclusion in this review. Studies on depression (6) showed generally positive associations between preeclampsia/HELLP and the prevalence of depression or severity of depressive symptoms. However, the results of three studies were not statistically significant. Studies addressing anxiety (2) did not show significant associations between preeclampsia/HELLP and anxiety scores. Associations between posttraumatic stress and preeclampsia/HELLP, investigated in four studies, were often non-significant. Due to heterogeneity of study methods, a meta-analysis of the results was not possible. In most studies, confounder control was poor.
Evidence is mixed but generally points to positive associations between various forms of psychopathology and previous preeclampsia/HELLP. Causality of the associations can, however, not be judged adequately.
This article is protected by copyright. All rights reserved.
We describe characteristics and risk factors regarding pregnancy outcome in women with a preconception body mass index (BMI) >50 kg/m2 compared to women with BMI≤50 kg/m2 in a retrospective population cohort study in singleton pregnancies from the Danish Medical Birth Registry. Results were analyzed as relative risks by a two-proportion z-test. Women with preconception BMI>50 kg/m2 smoked, developed gestational diabetes and preeclampsia, and needed induction of labor more frequently than mothers with BMI≤50kg/m2. Examination of the case records showed that many attempted vaginal delivery without epidural analgesia, 21% needed an emergency cesarean section (compared to 12% among women with BMI≤50kg/m2), and 25% underwent general anesthesia in this context. Many neonates were macrosomic and 34% needed neonatal intensive care and early feeding compared to 6% of neonates from women with BMI≤50kg/m2. Women with an extremely high preconception BMI develop more pregnancy complications and their neonates appear affected by this as well.
This article is protected by copyright. All rights reserved.
To assess the effect of pelvic floor muscle training on pelvic floor muscle strength and urinary incontinence (UI) in primiparous women who underwent a home training program between three and nine months after delivery.
Randomized controlled trial
One hundred primiparous women were consecutively recruited from four different antenatal clinics in the urban area of Stockholm, Sweden. Women with UI who had undergone normal term singleton vaginal delivery, 10-16 weeks post partum were randomly allocated to either intervention or control group.
Maximally voluntary contraction (MVC) and endurance were measured with a perionometer. The Oxford grading scale was used to manually estimate the strength of the pelvic floor muscle and self-reported symptoms of UI was registered through the Bristol Female Lower Urinary Tract Symptoms Module (ICIQ FLUTS) questionnaire.
MVC of the pelvic floor muscle measured with a perionometer.
MVC increased significantly in both groups between baseline and follow up (p<0.05). The median MVC in cmHg for the intervention and control group was 16.2 and 12.1 at baseline and 26.0 and 18.2 at follow up, respectively. The median endurance, in seconds, for the intervention and control group was 9.6 and 12.0 at baseline and 26.7 and 23.4 at follow up, respectively. Pelvic floor muscle strength measured with the Oxford Scale increased significantly in both groups between baseline and follow up (p<0.05).
The results indicate that home based pelvic floor muscle training is effective. However, written training instructions were as efficient as home based training with follow up visits every sixth week.
This article is protected by copyright. All rights reserved.
We read with great interest your series on the use of Bakri balloon tamponade for postpartum hemorrhage (PPH) and commend you for encouraging the use of this simple technique. We would like to share our data on 43 cases of massive PPH (>2000 mls) in which balloon tamponade was attempted between 2007-2012 at an inner city London hospital. In our own series of 43 women, Bakri balloon tamponade succeeded in abating hemorrhage in 93% of cases, obviating the need for hysterectomy.
This article is protected by copyright. All rights reserved.
We reviewed your article on the conservative management of abnormally invasive placenta (1). Placenta previa with invasion is a serious burden to obstetricians in terms of preserving the uterus. We would like to comment on a rare complication of the remnant placenta. A 36-year-old patient at 20 gestational weeks had total placenta previa with placenta accreta.
This article is protected by copyright. All rights reserved.
Women's understanding of pregnancy and antenatal care is influenced by their cultural context. In low income settings women may have limited influence over their reproductive health including when to seek health care. Awareness of signs of pregnancy complications is essential for timely care. The use of antenatal care services in Vietnam has been studied with quantitative methods but there are few qualitative studies on the perceptions of pregnancy and maternal health care among Vietnamese women.
Four focus group discussions with pregnant women were performed.
The study was conducted in a rural district in northern Vietnam.
Pregnant women in the last trimester.
Manifest and latent content analysis.
The latent theme that emerged was a need for ‘securing pregnancy during it′s normal course and at deviation’, consisting of the main categories ‘ensuring a healthy pregnancy’ and ‘separating the normal from the abnormal’.
This qualitative study of pregnant women in rural Vietnam indicates how women create a strategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insight into pregnancy-related conditions was sought from various sources and influenced both by local traditions and modern medical knowledge. Public knowledge about deviating symptoms during pregnancy and a high confidence in maternal health care are the most likely contributing factors to the relative good maternal health status in Vietnam.
This article is protected by copyright. All rights reserved.
To explore frequencies and experiences with problems in sickness certification consultations among gynecologists and obstetricians in two different years.
Cross-sectional surveys on two occasions; in 2004 and 2008.
Gynecological, obstetric and maternal health care.
Physicians working in gynecology, obstetrics or maternal health care in two Swedish counties from two samples: in 2004 (n=315), and in 2008 (n=327).
Data regarding sickness certification consultations were obtained from comprehensive questionnaires that had been mailed to the physicians in two Swedish counties in 2004 and in 2008, respectively.
Frequencies and types of problems in sickness certification consultations, organizational support, and need to acquire more competence.
The majority experienced that patients requested to be on sick leave for some other reason than work incapacity due to disease or injury, at least a few times per year (85% in 2004 and 88% in 2008). The most problematic situation to handle was when the physician and the patient had different opinions about the need for sick leave (2004: 66% and 2008: 58%). The physicians expressed a need for more competence about the options and responsibilities of employers, social insurance officers and physicians in sickness certification cases.
Most gynecologists/obstetricians find sickness certification consultations problematic and especially when encountering patients requesting to be on sick leave due to other reasons than disease. The physicians expressed a need for more competence in insurance medicine, especially about their own and other stakeholder's options and responsibilities.
This article is protected by copyright. All rights reserved.
Intrahepatic cholestasis of pregnancy has been shown to have a genetic predisposition. We studied whether Finnish women who had suffered from the disorder reported their first degree relatives to have had liver dysfunction during their pregnancies. Questionnaires were sent in autumn 2010 to a total of 544 former intrahepatic cholestasis of pregnancy patients and 1235 controls, all having delivered during 1969-1988. The response rate was 66.2%. The incidence of intrahepatic cholestasis is 0.5-1.5% of pregnancies in Finland. In our survey, altogether 12.8% of mothers (odds ratio 9.2), 15.9% of sisters (odds ratio 5.3) and 10.3% of daughters (odds ratio 4.8) of women who had suffered from intrahepatic cholestasis of pregnancy had had liver dysfunction during pregnancy. Our findings strengthen the earlier knowledge of the genetic component in intrahepatic cholestasis of pregnancy. We suggest that all pregnant women are inquired about their family history regarding liver dysfunction during pregnancy.
This article is protected by copyright. All rights reserved.
In spite of the importance of correct interpretation of umbilical artery Doppler velocimetry, we have noticed that practice with regard to this is not homogeneous. Indeed, it is well known that Doppler parameters vary along the length of the umbilical cord and that these variations follow a gradient: resistances are higher when measured closer to the fetus (1). In order to investigate sonographers′ practice, we carried out a survey in France in which we asked practitioners where and why they measured umbilical artery Doppler parameters. In January 2013, we sent an anonymous online questionnaire to French fetal sonographers.
This article is protected by copyright. All rights reserved.
To identify which cadres of healthcare providers are considered to be skilled birth attendants in South Asia, which of the signal functions of Emergency Obstetric Care each cadre is reported to provide and whether this is included in their training and legislation.
Cross-sectional, descriptive study.
Bangladesh, India, Nepal and Pakistan.
33 key informants involved in training, regulation, recruitment and deployment of healthcare providers.
Between November 2011 and March 2012, structured questionnaires were sent out to key informants by email followed up by face-to-face or telephone interviews.
Mapping of definitions and roles of healthcare providers in four South Asian countries to assess which cadres are skilled birth attendants.
Cadres of healthcare providers expected to provide skilled birth attendance differ across countries. Although most identified cadres administer parenteral antibiotics, oxytocics and perform newborn resuscitation; administration of anticonvulsants varies by country. Manual removal of the placenta, removal of retained products of conception and assisted vaginal delivery are not provided by all cadres expected to provide skilled birth attendance. Conclusion
Key signal functions of Emergency Obstetric Care are often provided by medical doctors only. Provision of such potentially life-saving interventions by more healthcare provider cadres expected to function as skilled birth attendants can save lives. Ensuring better training and legislation are in place for this is crucial.
This article is protected by copyright. All rights reserved.
We investigated the efficacy of 5% lidocaine 25mg-prilocaine 25mg/g cream (EMLA®) applied to the uterine cervix for reducing pain during diagnostic or operative hysteroscopy, using a visual-analogue scale (VAS) for pain in a prospective randomized, non-blinded, controlled study in ninety-two successive patients. Patients were randomized to either 3 ml of EMLA cream or 3 ml of ultrasound gel (placebo), placed endocervically and exocervically, 10 minutes before hysteroscopy. Intensity of pain was evaluated immediately after the procedure using a 10-cm VAS. No differences were found between the two groups (p=0.07). The number of patients who wished to stop the procedure was significantly lower in the EMLA group compared to the control group (p=0.013). We concluded that topical instillation of EMLA does not decrease pain during hysteroscopy, but does reduce a desire to abandon the procedure.
This article is protected by copyright. All rights reserved.
To compare in controlled cardiovascular autonomic function tests the effects of hormone therapy (HT) on heart rate variability (HRV) responses in postmenopausal women with and without pre-treatment hot flushes.
A randomized placebo-controlled trial.
Finland, Helsinki University Central Hospital.
A total of 150 recently postmenopausal and healthy women with prospectively evaluated hot flushes.
Women (72 with and 78 without hot flushes) were randomized to receive estradiol alone or in combination with medroxyprogesterone acetate or placebo for six months. Time and frequency domain measures of HRV were assessed at baseline and after HT with short-term recordings during paced quiet and deep breathing and with active orthostatic tests, both under carefully controlled laboratory conditions to avoid confounding factors present in long-term ambulatory HRV measurements.
Responses of time- and frequency domain measures of HRV to HT.
At baseline HRV was similar in women with and without hot flushes. Pre-treatment hot flushes did not associate with changes in time domain parameters of HRV during controlled quiet or deep breathing or active orthostatic tests after different types of HT. However, HT reduced HRV in very low frequency power in women with pre-treatment hot flushes (from 371±40 to 258±28 ms2, p=0.018). HT did not have an effect on other frequency domain measures during quiet breathing or active orthostatic tests.
HT did not significantly modify the HRV responses in women with or without hot flushes under controlled short-term measurements of the cardiovascular autonomic nervous system.
This article is protected by copyright. All rights reserved.
We congratulate Baroutis and co-authors on their brilliant article (1) which highlights the increase in preterm births as a major public health issue in Greece. We would like to contribute to their excellent analysis.
According to the latest data from the Hellenic Statistical Authority (ELSTAT), preterm births in Greece rose further, reaching 12 831 preterm births (11.18%) in 2010. During 1991-2010, the number of preterm births increased 4.5-fold following an exponential model (R2=0.978, average annual rate of change AARC=+8,3%).
This article is protected by copyright. All rights reserved.
A study was undertaken to assess the distribution of high-risk HPV-genotypes in high-grade cervical intraepithelial neoplastic lesions in Danish women.
Observational, cross-sectional.
Danish data from a multi-centre study undertaken in 13 European countries.
290 archived fixed biopsies with high-grade cervical lesions from the Departments of Pathology at the University Hospitals in Hvidovre and Odense, Denmark.
Relevant histological samples were anonymized and shipped to a central laboratory for histopathology review and PCR-testing for human papillomavirus (HPV)-DNA. A standardised HPV-test methodology was utilised to enable comparison of HPV-genotype distribution.
Of 290 Danish cervical samples 276 were evaluated as histologically adequate and all of these were HPV-positive (HPV+). Of the HPV+ samples 77.9% were diagnosed with a single HPV-type, with cervical intraepithelial neoplasia (CIN)3 diagnosed in 82.3% and CIN2, CIN2/3, adenocarcinoma in situ (AIS) and AIS+ other high-grade lesion diagnosed in the remaining 17.7%. The most prevalent HPV-types were: HPV16: 54.0%; HPV33: 13.5%; HPV31: 10.7%; HPV18: 7.9% and HPV52: 4.7%. Of HPV+ samples 21.4% were diagnosed with multiple HPV-types, with CIN3 diagnosed in 79.6% and CIN2, CIN2/3, AIS and AIS+ other high-grade lesion diagnosed in the remaining 20.4%. The most prevalent HPV-types were: HPV16: 49.2%; HPV31: 30.5%; HPV52: 27.1%; HPV51: 20.3%; HPV18: 16.9%; HPV33: 13.6%; HPV45: 11.9% and 0.7% unknown types.
HPV16 and HPV18 are detected in approximately 75% of high-grade intraepithelial cervical lesions in a Danish population (single or multiple infections) and these two genotypes are considered causative in at least 61.9% of the high-grade intraepithelial lesions (single infection).
This article is protected by copyright. All rights reserved.
During feto-placental development, chorion-amnion fusion occurs in early second trimester and persistent separation of the membranes beyond 17 weeks’ gestation is considered abnormal (1). Several reports have shown that complete chorion-amnion separation, defined as the amnion being separated from the chorion on at least three sides of the gestational sac, is associated with prenatal invasive procedures including amniocentesis (2-4). We would like to call attention to a case of complete chorion-amnion separation that occurred without any invasive procedures.
This article is protected by copyright. All rights reserved.
A commentary by Blix (1) concluded that there is no evidence of benefit in offering admission cardiotocography to low-risk women. It is argued that randomized studies have not shown any advantages in neonatal outcome (2). Furthermore, the admission test has a poor ability to predict adverse events during labor and the neonatal period (3).
This article is protected by copyright. All rights reserved.
Evaluating the validity of pre-eclampsia registration in the Medical Birth Registry of Norway (MBRN) according to both broader and restricted disease definitions.
Retrospective nested cohort study.
Multicenter study.
In this study two cohorts of women with pre-eclamptic pregnancies registered in the MBRN were selected. Study group 1 contained 966 pregnancies from 1967-2002. Concomitant participation in the Nord-Trøndelag Health Study 2 was required. Study group 2 comprised 1138 pregnancies recorded in 1967-2005, examined as a pre-eclampsia biobank was established.
Diagnostic criteria vary. The broader criteria for pre-eclampsia, used by the MBRN, are one measurement of hypertension and proteinuria (Criterion A). Criteria used internationally today require two measurements of hypertension and proteinuria (Criterion B). The diagnostic validities in Study group 1 and 2 were judged against medical records according to Criterion A and Criterion B, respectively.
Positive predictive value (PPV) and trend analyses.
The diagnosis was confirmed in 88.3% of pregnancies in Study group 1, and in 63.6% in Study group 2. PPV was high for Study group 1 throughout the period while for Study group 2 results improved significantly after 1986.
This study ascertains high PPV of pre-eclampsia in the MBRN using broader traditional criteria, although the PPV decreases through assessment by restricted modern criteria. This illustrates how inclusion of direct measurements may improve registration of complex disorders defined by changing diagnostic criteria.
This article is protected by copyright. All rights reserved.
To compare pregnancy outcomes in cutaneous lupus erythematosus (CLE) with systemic lupus erythematosus (SLE) and healthy pregnant women.
Cohort comparative study. Settin. Two university maternity centers in Saudi Arabia and Egypt.
Pregnant patients with CLE and SLE and healthy pregnant women.
Over a three-year period, 201 participants were allocated to three groups; group 1 (n=67) had patients with CLE, group 2 (n=67) SLE patients, and group 3 healthy controls (n=67). Diagnosis of lupus erythematosus was based on American College of Rheumatology criteria. All participants were followed until delivery. Lupus exacerbation was evaluated by lupus Activity Index score. ANOVA and chi-squared tests were used to compare obstetrical and neonatal outcomes and regression analysis to define independent factors of adverse pregnancy outcomes.
Pregnancy losses, preterm labor, intrauterine growth restriction, preeclampsia, neonatal intensive care unit admissions, cesarean sections and lupus exacerbations.
There was no significant difference between groups 1 and 3 in rates of pregnancy loss, preterm labor, preeclampsia, intrauterine growth restriction and neonatal intensive care admission. Group 1 had lower pregnancy loss (p=0.005), growth restriction (p=0.001), preeclampsia (p=0.05), neonatal intensive care admissions (p=0.001), cesarean section (p=0.03,) lupus exacerbations (p=0.05) and anti-phospholipid antibodies (p=0.02) compared to group 2. In groups1 and 2, lupus exacerbation and anti-phospholipid antibodies were significant independent factors for adverse outcomes.
CLE means comparable pregnancy outcomes to the healthy population. Lower rates of disease exacerbation and anti-phospholipid antibodies are potential factors for better pregnancy outcome in CLE compared to SLE.
This article is protected by copyright. All rights reserved.
To explore oocyte and sperm donors’ emotional stress, experiences of care and satisfaction after donation. Design. Prospective multicenter study.
All fertility clinics performing gamete donation in Sweden during the period 2005 to 2008. Population
Of 220 eligible oocyte donors who were approached, 181 agreed to complete the first questionnaire and 165 completed the second questionnaire two months after oocyte donation. Of 156 eligible sperm donors 119 accepted to complete the first questionnaire prior to donation. Eighty-nine participants completed the second questionnaire two months after sperm donation.
Standardized and study-specific questionnaires.
Satisfaction with the donation, respondents′ mental health and overall care.
A larger percentage of sperm donors (97.8%) were satisfied with their overall experience of being a donor than oocyte donors (85.9%, p=0.003). Some oocyte and sperm donors did not get sufficient information about practical issues (9.1% and 13.5%, respectively) and future consequences (12.8% and 3.4%, respectively, p= 0.014). The donors’ symptoms of anxiety and depressive did not show any differences in relation to negative or positive perceptions of satisfaction. The donors who did not indicated ambivalence prior to treatment were on average almost five times more satisfied compared to those who did indicate ambivalence (odss ratio 4.71; 95% confidence interval 1.34-16.51).
Most donors were satisfied with their contribution after the donation. Oocyte and sperm donors who expressed ambivalence before donation were less satisfied after donation. In-vitro fertilization staff fulfilled most of the donors’ needs for information and care.
This article is protected by copyright. All rights reserved.
We have found the article by Cohen and co-workers in the November issue of AOGS, regarding fetal heart function monitoring with electrodes placed on the abdomen of a pregnant woman during labor (fECG), very interesting (1). We are particularly interested in the ratio of cases in which achievement of an electric signal from the fetal heart was successful enough for it to be read, recorded and evaluated; and therefore satisfactory for application of the method for ante- and intralabor monitoring of the fetal condition. In a study at our center we applied transabdominal monitoring to 612 patients between the 28th and 42nd week in an uncomplicated pregnancy, and in 91 cases of a pregnancy complicated by fetal intrauterine growth restriction or pregnancy-induced hypertension, as well as 84 cases complicated by imminent preterm delivery.
This article is protected by copyright. All rights reserved.
To validate uterine rupture registration in the Medical Birth Registry of Norway (MBRN) between 1999 and 2008, and to identify rupture type and causes of incorrect or missed registration during 1967–2008.
Population-based study.
The validation sample was 392 958 maternities from 21 maternity units registered in MBRN and local Patient Administration Systems in 1999–2008. In addition we identified type of rupture and causes of incorrect registration among 2 422 934 maternities from 48 units, and 1 449 201 maternities from 21 units during 1967–2008.
Information about uterine rupture in MBRN was compared with information in medical records.
Sensitivity, specificity, positive and negative predictive value of uterine rupture registration in MBRN.
In 1999–2008, there were 10 false positive cases among 151 uterine ruptures registered in MBRN. In addition, 82 ruptures not registered in MBRN, were identified through Patient Administration Systems. The sensitivity, specificity, positive and negative predictive value of the MBRN to detect uterine rupture was 63.2, 99.99, 93.4 and 99.98%, respectively. The incidence of uterine rupture changed after correction from 0.38 to 0.56/1000. During 1967–2008, false positive cases (125) were mainly due to wrong coding by MBRN. Around 60% of 141 false negative cases were due to lack of reporting by maternity units. Complete rupture accounted for 63.9% of ruptures registered in MBRN.
The validity of MBRN data on uterine rupture is not optimal, diagnosis being under-reported by around 37%. Ticked boxes may improve the quality of registration.
To present a new gestational-age-specific percentile curve for symphysis–fundus (SF) height and to determine the effects of maternal and fetal covariates.
A population-based register study.
Antenatal clinics in Västra Götaland County, Sweden, between 2005 and 2010.
A total of 42 018 women with ultrasound-dated singleton pregnancies who delivered at Sahlgrenska University Hospital.
Measurement of SF height.
A non-linear regression of SF height on day of pregnancy was used to construct a reference chart for the median and other percentiles of SF height.
The new reference curve for SF height showed almost linear growth until term. The median value was considerably larger at each gestational age compared with the curves for SF height used in Norway and Denmark. Compared with the curve currently used in Sweden, higher median values were observed only at gestational ages >34 weeks, accompanied by an upward shift in all percentiles. The only notably influential covariates were maternal pre-pregnancy weight and height.
The new reference curve for SF height shows a pattern that is different from the Scandinavian reference curves of older origin, reflecting changes in the pregnant population, as well as methodological differences. The new curve can be adjusted for maternal and fetal covariates to suit individual pregnancies.
The establishment of universal diagnostic guidelines for gestational diabetes mellitus has been a long time coming. The lack of consensus and uniformity in procedures for diagnosing this disease has been a problem ever since its existence was recognized. The USA, European countries, and Australia have each developed their own guidelines through the years, all based either on the maternal risk of subsequent diabetes, on arbitrary statistics, or on studies conducted on non-pregnant women. None of these guidelines have been based on risk for perinatal complications. Recently, the Hyperglycemia and Adverse Pregnancy Outcomes study demonstrated that maternal hyperglycemia is associated with perinatal risk in a linear way with no obvious threshold. The International Association of Diabetes and Pregnancy Study Group has translated these results into clinical practice by proposing new diagnostic criteria for gestational diabetes mellitus, based for the first time on perinatal outcome.
Association between the histidine-rich glycoprotein (HRG) C633T single nucleotide polymorphism (SNP) and recurrent miscarriage was investigated in a case–control study. The cases constituted 187 women with recurrent miscarriage that were compared with 395 controls who had delivered a child and had no history of miscarriage. Blood samples were collected from each woman, genomic DNA was extracted and genotyped for the HRG C633T SNP. In the whole study population, the percentage of miscarriage was the same, regardless of genotype (C/C 31.2%, C/T 32.9% and T/T 32.5%). However, an association between homozygous T/T carriers and recurrent miscarriage was detected in a subgroup of women with primary recurrent miscarriage (odds ratio 2.44, 95% CI 1.01–5.92). Our results indicate an important role for the HRG C633T SNP in the occurrence of recurrent miscarriage.
To explore if antenatal fear of childbirth in men affects their experience of the birth event and if this experience is associated with type of childbirth preparation.
Data from a randomized controlled multicenter trial on antenatal education.
15 antenatal clinics in Sweden between January 2006 and May 2007.
762 men, of whom 83 (10.9%) suffered from fear of childbirth. Of these 83 men, 39 were randomized to psychoprophylaxis childbirth preparation where men were trained to coach their partners during labor and 44 to standard care antenatal preparation for childbirth and parenthood without such training.
Experience of childbirth was compared between men with and without fear of childbirth regardless of randomization, and between fearful men in the randomized groups. Analyses by logistic regression adjusted for sociodemographic variables.
Self-reported data on experience of childbirth including an adapted version of the Wijma Delivery Experience Questionnaire (W-DEQ B).
Men with antenatal fear of childbirth more often experienced childbirth as frightening than men without fear: adjusted odds ratio 4.68, 95% confidence interval 2.67–8.20. Men with antenatal fear in the psychoprophylaxis group rated childbirth as frightening less often than those in standard care: adjusted odds ratio 0.30, 95% confidence interval 0.10–0.95.
Men who suffer from antenatal fear of childbirth are at higher risk of experiencing childbirth as frightening. Childbirth preparation including training as a coach may help fearful men to a more positive childbirth experience. Additional studies are needed to support this conclusion.
FIGO classification is commonly used for staging of locally advanced cervical cancer. Laparoscopic para-aortic lymphadenectomy is currently used as a diagnostic tool, since we know that presence of para-aortic lymph node metastases identifies patients with poor prognosis. The application of robotics during this procedure needs to be investigated.
Retrospective multi-center study.
Three centers participated in building one database.
Thirty-seven patients with locally advanced cervical cancer underwent a robot-assisted laparoscopic para-aortic lymphadenectomy.
Patients were prospectively enrolled in one register. Retrospective analysis of the whole database was performed.
Surgical outcomes of the robot-assisted procedure and follow-up data.
Median number of lymph nodes collected was 27.5 (1–54) per patient. Five of 37 patients had para-aortic node metastases. The false negative rate for PET-CT diagnosing para-aortic node metastases was 11.4% (4/35). Two major intra-operative complications occurred (5.4%). Postoperative morbidity was low (13.5%). Median follow-up was 27 months [95% confidence interval (95% CI) was 24–30]. Median disease-free survival was 16 months (95% CI 2.4–29.6). Patients with negative nodes had a median disease-free survival of 24 months (not assessable), although patients with positive nodes had a median disease-free survival of 9 months (95% CI 6.9–11.9).
In this series we report that robot-assisted laparoscopic para-aortic lymphadencetomy provided the surgeon with useful information, diagnosing 11.4% of occult para-aortic lymph node metastases in women with locally advanced cervical cancer. Intra-operative and postoperative morbidity were low. The presence of para-aortic lymph node metastases correlated with shorter disease-free survival.
Hypertensive disorders during pregnancy remain a major health burden. Normal pregnancy is associated with systemic cardiovascular adaptation. The augmentation index and pulse wave velocity measures may serve as surrogate markers of cardiovascular pathology, including pre-eclampsia. We evaluated these parameters during and after normotensive and pre-eclamptic pregnancies.
Longitudinal cohort trial involving a case–control analysis of healthy women and women with pre-eclampsia.
University hospital.
Fifty-three healthy pregnant women between 11+6 and 13+6 gestational weeks, as well as 21 patients with pre-eclampsia.
The augmentation index and pulse wave velocity were measured seven times during pregnancy and postpartum.
Changes in augmentation index and pulse wave velocity during and after healthy pregnancies were measured. The influence of early-onset and late-onset pre-eclampsia on these measurements both during and after pregnancy was evaluated.
The normotensive pregnancies exhibited a significant decrease in the augmentation index from the first trimester to the end of the second trimester; however, the normotensive pregnancies showed an increase in the augmentation index during the third trimester as term approached. The patients with early-onset and late-onset pre-eclampsia displayed a significantly elevated augmentation index during pregnancy. The postpartum augmentation index and pulse wave velocity were significantly elevated in the early-onset pre-eclampsia group.
After pregnancy, early-onset and late-onset pre-eclamptic patients exhibit differences in vascular function. This result indicates the presence of a higher cardiovascular risk in patients after early-onset pre-eclampsia.
Clinical practice guidelines for elective cesarean section at early-term gestation (37–38 weeks) recommend antenatal corticosteroids to reduce neonatal respiratory morbidity. However, the long-term health implications for offspring exposed to corticosteroids at term are unknown and may differ from the effects of preterm corticosteroid exposure. We therefore randomized singleton-bearing ewes (n = 64) to receive a clinically relevant dose of corticosteroids at term or no treatment. Body composition was assessed in adult offspring using dual-energy X-ray absorptiometry. Relative to skeletal size female, but not male, offspring of steroid-treated ewes had increased weight and a greater fat mass than controls (relative weight: 49.1 ± 1.1 vs. 52.9 ± 1.2 kg/m2, p = 0.02; relative fat mass: 5.4 ± 0.7 vs. 3.4 ± 0.7 kg/m2, p = 0.04). Whether corticosteroid exposure at early-term gestation increases adult adiposity in humans is unknown and needs further investigation.
The increase in immigration from countries with a high prevalence of female genital mutilation (FGM) has highlighted the need for knowledge and sensitivity in this area of healthcare in high-resource countries. We have surveyed with an online questionnaire 607 members, fellows and trainees of the Royal College of Obstetricians and Gynaecologists (RCOG) on knowledge about the RCOG guidelines for FGM. Completed training and more practical experience with women affected by FGM significantly increased knowledge. Many respondents were not aware of specialist services locally (22.9%) or how to access them (52.3%). Some areas of insufficient knowledge were identified, in particular in relation to psychiatric morbidity, HIV, hepatitis B and pelvic infection. More specialized training efforts might improve this aspect.
To investigate the association between cervical neoplasia and socioeconomic factors, housing conditions and criminal offences.
Longitudinal observational study.
Falun county hospital, Sweden.
A total of 1331 women diagnosed with cervical intraepithelial neoplasia I-III or cervical cancer between 1967 and 1978 were compared with 2604 age-matched controls from the same geographical area in Sweden.
The Population and Housing Censuses were used for information about civil status, education, housing conditions, employment and socioeconomic status. The Swedish Register of Conviction Decisions was used to access information on criminal offences.
Socioeconomic status, housing conditions, criminal offences.
Women with cervical neoplasia had a lower socioeconomic status and a lower educational level than their age-matched controls. They were more often divorced and did not own their home as often as controls. A significant association with criminal offences was observed, and it persisted after adjustment for socioeconomic status. Differences in socioeconomic factors between women with cervical neoplasia and their controls had not diminished in the younger, compared with the older, part of the study population.
The results indicate that women with cervical neoplasia belong to a socioeconomically disadvantaged group. Furthermore, the study provides information about an association with criminal offences.
To evaluate the clinical value of a high-resolution whole-genome array method for examination of genomic imbalances in prenatal samples (46 amniotic fluid, 17 chorionic villus, and 26 products of conception) from fetuses with abnormal ultrasound, in a clinical setting where more than 90% of pregnant women receive first-trimester combined screening and a second-trimester anomaly scan.
Cross-sectional study.
Fetal medicine units (national healthcare system) in Central and North Denmark Regions from March 2009 to April 2012.
Eighty-nine samples obtained at 11.5–35.0 (mean 19.3) gestational weeks, either during ongoing pregnancy or after termination.
DNA was extracted directly from amniotic fluid cells and chorionic villus samples, or from cultured cells, and examined with 80-kb resolution oligonucleotide array-based comparative genomic hybridization (aCGH).
Clinically significant copy number variations identified by aCGH.
We detected clinically significant copy number variations in 11 fetuses (12%, confidence interval 6.0–19%) with structural malformations. Three fetuses (3.4%) had uncertain clinical significant variations and incidental findings.
aCGH is a valuable diagnostic tool when fetal malformations are detected. More affected fetuses may be diagnosed at an earlier gestational age providing better possibilities for postnatal treatment and allowing for women to decide earlier on termination of pregnancy. When a normal result has reduced the risk of significant chromosomal aberration, aCGH may facilitate parental decision-making on whether to continue the pregnancy.
Human papillomavirus (HPV) testing is not currently used in primary cervical cancer screening in Sweden, and corresponding cost-effectiveness is unclear.
From a societal perspective, to evaluate the cost-effectiveness of high-risk (HR)-HPV testing using self-collected vaginal samples.
A cost-effectiveness analysis.
The Swedish organized cervical cancer screening program.
We constructed a model to simulate the natural history of cervical cancer using Swedish data on cervical cancer risk. For the base-case analysis we evaluated two screening strategies with different screening intervals: (i) cytology screening throughout the woman's lifetime (i.e. “conventional cytology strategy”) and (ii) conventional cytology screening until age 35 years, followed by HR-HPV testing using self-collected vaginal samples in women aged ≥35 years (i.e. “combination strategy”). Sensitivity analyses were performed, varying model parameters over a significant range of values to identify cost-effective screening strategies.
Average lifetime cost, discounted and undiscounted life-years gained, reduction in cervical cancer risk, incremental cost-effectiveness ratios with and without the cost of added life-years.
Depending on screening interval, the incremental cost-effectiveness ratios for the combination strategy ranged from €43 000 to €180 000 per life-years gained without the cost of added life-years, and from €74 000 to €206 000 with costs of added life-years included.
The combination strategy with a 5-year screening interval is potentially cost-effective compared with no screening, and with current screening practice when using a threshold value of €80 000 per life-years gained.
To examine the effect of a brief course in self-hypnosis for childbirth on duration of the labor and other birth outcomes.
A randomized, controlled, single-blind trial.
Aarhus University Hospital Skejby, Denmark.
A total of 1222 healthy nulliparous women.
A hypnosis group receiving three 1-h lessons in self-hypnosis with additional audio-recordings to ease childbirth, a relaxation group receiving three 1-h lessons in various relaxation methods and mindfulness with audio-recordings for additional training, and a usual-care group receiving only the usual antenatal care were compared.
Duration of labor, birth complications, lactation success, caring for the child, and preferred future mode of delivery.
No differences were found across the three groups on duration from arriving at the birth department until the expulsive phase of second stage of labor, the duration of the expulsive phase, or other birth outcomes. Fewer emergency and more elective cesarean sections occurred in the hypnosis group. No difference was seen across the groups for lactation success or caring for the child but fewer women in the hypnosis group preferred a cesarean section in future pregnancies because of fear of childbirth and negative birth experiences.
Learning self-hypnosis to ease childbirth taught as a brief course failed to show any effects on duration of childbirth and other birth outcomes.
To study the effect of subcutaneous tissue closing and the effect of two different skin closure methods at cesarean section on long-term cosmetic results.
Randomized controlled trial.
A large teaching hospital in the Netherlands.
Women undergoing a cesarean section.
Women undergoing a cesarean section were assigned to subcutaneous tissue closure or not, and skin closure with staples or intracutaneous sutures. Operating time, postoperative pain and incidence of complications were recorded. Long-term cosmetic result was assessed 1 year postoperatively through the Patient and Observer Scar Assessment Scale (POSAS) and Numeric Rating Scale (NRS).
The POSAS for subjective and objective scar rating and the NRS to provide an overall opinion on appearance of the scar 1 year after surgery.
Of the 218 women randomized, data from 145 women could be analysed after 1 year of follow-up. No significant differences were detected in long-term cosmetic outcome between the different closure methods. Except for operating time, no differences in other secondary outcome measures were found.
At cesarean section, closing the subcutaneous tissue or not and using staples or intracutaneous sutures results in an equivalent long-term cosmetic appearance of the scar.
To evaluate the effects of postgraduate education in obstetrical ultrasound on the prenatal detection rate of congenital heart disease.
Tertiary care center.
Experienced and less experienced midwives performing ultrasound scans.
Number of fetuses and live-born children with severe congenital heart malformations were extracted from patient records. The detection rates of experienced and less experienced midwives were compared following a postgraduate training program in obstetrical ultrasound.
The prenatal detection rate of complex congenital heart malformations.
The prenatal detection rate for the entire unit increased significantly during the study period (32 vs. 69%, p < 0.05). Following education, we observed a significant increase in detection rates (21 vs. 67%, p < 0.01) among experienced midwives. In the group of less experienced midwives, we found a positive effect of training with considerably higher detection rates compared with results achieved by their more experienced colleagues before the program (40 vs. 21%).
There is a clear improvement in the prenatal detection rates of complex heart malformations following a postgraduate education in obstetrical ultrasound. Similar training should be offered to both midwives and doctors performing routine scans to increase the standards of antenatal screening for congenital heart disease.
To assess the concentration of adiponectin, soluble E-selectin, soluble thrombomodulin and tissue activator plasminogen antigen in postmenopausal women who received oral or transdermal hormone therapy.
Case–control study.
Polish university hospitals.
Seventy-six healthy postmenopausal women.
Forty-six women who received oral (n = 26) or transdermal (n = 20) hormone therapy and a control group without such medication (n = 30), all aged 44–58 years.
Plasma concentrations of adiponectin, soluble E-selectin, soluble thrombomodulin and tissue activator plasminogen antigen by enzyme-linked immunosorbent assay.
We found a significantly higher concentration of adiponectin in women on oral and transdermal therapy in comparison to the control group and a significantly lower concentration of soluble E-selectin in women who received oral hormone therapy vs. the control group. A significantly higher concentration of tissue activator plasminogen antigen was obtained in the group of women using transdermal menopausal hormone therapy compared with those receiving oral therapy and with the control group.
Reduced levels of soluble E-selectin in women using menopausal hormone therapy could lead to reduction in the intensity of expression of the adhesion factors on the surface of the vascular endothelium. Menopausal hormone therapy might have advantageous effects on vascular endothelial function through adiponectin. Transdermal therapy may have adverse effects associated with elevated tissue activator plasminogen antigen levels and thereby the higher risk of ischemic heart disease.
To compare the efficacy of fetal nuchal translucency screening, maternal serum screening and combined screening for Down syndrome.
A prospective study.
University hospital and its public health care district in Northern Finland.
A total of 35 314 women participated in the first-trimester screening for Down syndrome within the public healthcare system in 2002–08. There were 95 pregnancies involving Down syndrome. Serum samples were obtained from 35 314 women, nuchal translucency was measured in 27 144 pregnancies and full combined screening was performed in those pregnancies, including 76 involving Down syndrome.
The adjusted estimated risk for Down syndrome was calculated using the Perkin Elmer AutoDELFIA® time-resolved fluoroimmunoassay kit for the measurement of pregnancy-associated plasma protein-A and free β-human chorionic gonadotropin. Nuchal translucency was measured by trained personnel in a university or district hospital. Risk cut-off figures 1:250 and 1:300 at term were used.
Differences in detection rate, false-positive rate, positive and negative predictive values between nuchal translucency screening, serum screening and combined screening.
Using the risk cut-off figure 1:250, the detection rates for serum screening, nuchal translucency screening and combined screening were 64.2, 64.5 and 72.4%, respectively and the false-positive rates were 7.8, 4.4 and 4.0%, respectively.
Combined screening is the method of choice for Down syndrome screening in Finland.
To determine the association between mode of delivery, parity, and pelvic organ prolapse, as assessed by the pelvic organ prolapse quantification system.
Cross-sectional study.
Tertiary referral center, Turkey.
A total of 1964 women with benign gynecological disorders who presented between October 2009 and July 2011.
Evaluation using the pelvic organ prolapse quantification system and questionnaire assessing previous obstetrics and medical history.
Difference in pelvic organ prolapse stages between nulliparous and multiparous women, impact of parity and mode of delivery.
In the study population, 86.4, 7.2 and 6.4% had pelvic organ prolapse of stages 0–I, II, and III–IV, respectively, and 7.9% had significant prolapse beyond the hymen. The mean age, parity, and number of vaginal deliveries were significantly higher in the prolapse than in the non-prolapse group. Vaginal delivery was associated with an odds ratio of 2.92 (95% confidence interval 1.19–7.17) for prolapse when compared with nulliparity. Each vaginal delivery increased the risk of prolapse (odds ratio 1.23; 95% confidence interval 1.12–1.35) after controlling for all confounding factors. Cesarean delivery had no impact on the odds for prolapse.
Vaginal delivery was an independent risk factor for prolapse, and additional vaginal deliveries significantly increased the risk. However, cesarean delivery had no effect on the development of prolapse in this material.
To evaluate the distribution of circulating adiponectin isoforms in pregnant women with gestational diabetes mellitus (GDM) and compare isoform distribution changes 12 months after delivery.
University Hospital.
Sixty-four consecutive pregnant women who underwent routine prenatal tests for GDM between 24 and 28 weeks of gestation. The study group included 36 women diagnosed with GDM, 30 of whom underwent re-testing for diabetes 12 months after delivery. The control group included 28 healthy pregnant women.
Quantitative determination of total adiponectin and its isoforms in serum was performed with the multimeric adiponectin enzyme-linked immunosorbent assay.
Total adiponectin concentration in women with GDM was significantly lower than in women without GDM. Among adiponectin isoforms, significantly lower concentrations of multimers and trimers in women with GDM were found in comparison to controls, while the concentration of hexamers did not differ between the groups. After delivery, a significant increase in total adiponectin and in the concentration of multimers and trimers was found in women with history of GDM. Additionally, we found that multimers and hexamers were negatively correlated with body mass index before and during gestation, as well as after delivery, and middle molecular weight isoforms in gestation were negatively correlated with birthweight.
Hypoadiponectinemia during GDM was characterized by a significant, reversible decrease in multimeric levels; thus this isoform seems to function in a cohesive way with total adiponectin. Negative correlations of adiponectin isomers with body mass index indicate that there is a possibility to normalize total adiponectin and prevent GDM.
To study whether pregnancy-related lumbopelvic pain outcomes at 36 weeks of gestation can be predicted by psychological determinants earlier in pregnancy.
Prospective cohort study.
Nine midwifery practices in different regions of the Netherlands.
A cohort of 223 low-risk pregnant women in the Netherlands was followed from week 12 of gestation until 36 weeks of gestation.
Both psychological determinants and lumbopelvic pain symptoms were investigated with a set of questionnaires at 12, 24 and 36 weeks of gestation. Psychological determinants were measured with the Perceived Stress Scale (PSS), the Symptom Checklist-90-Revised (SCL-90), the Pregnancy-related Anxiety Questionnaire (PRAQ), and the Utrecht Coping List (UCL). Lumbopelvic pain outcomes were measured with the Pregnancy Mobility Index (PMI) and the Overall Complaints Index (OCI).
Lumbopelvic pain symptoms and their impact at 36 weeks of gestation.
There was a significant increase in scores on both the PMI and OCI across the three sampling occasions in pregnancy. Lumbopelvic pain outcomes showed significant associations with the psychological determinants perceived stress and recently perceived psychological and physical distress at all three times during pregnancy. Pregnancy-related anxiety was not a significant predictor of lumbopelvic pain outcomes, neither was coping.
Lumbopelvic pain symptoms and their impact on daily activities at 36 weeks of gestation can be predicted by psychological determinants earlier in pregnancy; the combination of perceived stress and physical disability at 24 weeks of pregnancy seems to be the best predictor of disability in later pregnancy.
To test the hypothesis that clinically relevant vessels can be visualized and interrogated with Doppler recording during the second half of pregnancy at an output energy below the currently advocated limits without loss of information.
Observational cross-sectional study.
Tertiary fetal medicine center.
Based on a power calculation for equivalence studies, we recruited 65 pregnant women.
Ultrasound examination was performed at 18, 24 or 36 weeks of gestation. The umbilical artery, middle cerebral artery, ductus venosus, and both uterine arteries were identified using color Doppler, and the blood velocities were measured using pulsed wave Doppler at a thermal index for bone (TIB) of 1.0. This procedure was repeated at TIB values of 0.5 and 0.1. The depth of Doppler recording was noted.
Visualization of the vessels by color Doppler at all power levels and any systematic changes or increased variance of the recorded parameters with decreasing power level.
All vessels could be visualized by color Doppler and their flow velocities measured using pulsed wave Doppler in all participants and at all power levels. There were no systematic changes or increased parameter variance when reducing the power level, despite the insonation depth being significantly greater than in early pregnancy.
Reducing the ultrasound power from TIB 1.0 to 0.1 does not alter color Doppler visualization or pulsed wave Doppler measurements in the second half of pregnancy. The lower power level can be recommended as a starting point for clinical examinations throughout pregnancy.
To estimate the risk of operative delivery according to maternal pre-pregnant body mass index (BMI) and gestational weight gain.
Population-based pregnancy cohort study.
The Norwegian Mother and Child Cohort Study.
Term singleton deliveries in cephalic presentation, excluding preeclampsia, chronic hypertension, diabetes, gestational diabetes and placenta previa (n = 50 416).
Relative risks (RR) were obtained using general linear models.
RR of operative vaginal delivery and cesarean section.
Overweight and obese women had an increased risk of cesarean section, strongest for women with a pre-pregnancy BMI >40 (RR: 3.4, 95% confidence interval (CI): 2.8–4.1). There was also an increased risk of vacuum extraction delivery for women with a pre-pregnancy BMI >40 (RR: 1.5, 95% CI: 1.04–2.2). Women with a gestational weight gain of ≥16 kg had a significantly increased risk of forceps, vacuum extraction and cesarean section (RR: 1.2, 95% CI: 1.03–1.4, RR: 1.2, 95% CI: 1.1–1.23 and RR: 1.3, 95% CI: 1.26–1.4, respectively). Weight gain during pregnancy was significantly lower in obese women, but the children tended to be larger.
Obese women have an increased risk of operative delivery with vacuum extraction and cesarean section. Independently of pre-pregnancy BMI, we found an increased risk of operative intervention during delivery for women with gestational weight gain above 16 kg.
To measure adherence to annual follow-up among women treated for cervical intraepithelial neoplasia.
Prospective, population-based, register study.
Denmark, 1996–2007.
All women treated for cervical intraepithelial neoplasia with conization.
Treated women were routinely recommended to have follow-up with annual smears for at least 5 years.
Using individually linked nationwide register data on conizations and follow-up tests (smears and biopsies), we calculated the cumulative proportion of treated women undergoing the recommended follow-up. We measured this cumulative proportion conservatively in 15-month intervals for 5 years.
Adherence to annual follow-up among 45 984 treated women decreased gradually. In total, 90% of these women obtained at least one smear in the first post-treatment year, but only 40% obtained the recommended tests for 5 years. Five-year adherence was substantially better outside the capital area, for example, the odds ratio for women from Jutland compared with women from the capital area was 1.70 (95% confidence interval 1.60–1.82).
Adherence to follow-up after conization was poor in Denmark. Our findings suggest that because of this poor adherence, recommendations for long-term annual follow-up after treatment of cervical intraepithelial neoplasia may not be highly effective. Shorter follow-up schedules using highly sensitive tests appear attractive.
To study the association of maternal diabetes mellitus with placental weight, birthweight and placental weight-to-birthweight ratio.
Population-based study.
Medical Birth Registry of Norway.
All singleton births in Norway during 1999–2008 (n = 536 997).
We compared the distribution of placental weight z-scores and placental weight-to-birthweight ratio between pregnancies with and without diabetes. The associations of diabetes with placental weight z-scores were also estimated as odds ratios with and without adjustment for birthweight, maternal age, parity, preeclampsia, smoking and cesarean delivery.
Placental weight, birthweight and placental weight-to-birthweight ratio.
Mean placental weight was 736.6 g in diabetic pregnancies and 672.1 g in non-diabetic pregnancies. The corresponding birthweights were 3682.1 g and 3557.0 g. In diabetic pregnancies, 26.2% of the placentas were in the highest decile of placental weight z-score, as compared with 9.7% in non-diabetic pregnancies (p < 0.001). The corresponding figures for being in the highest decile of placental weight-to-birthweight ratio were 18.2 and 9.9% (p < 0.001). The crude odds ratio for having a placenta in the highest decile of placental weight z-score was 3.29 (95% confidence interval 3.14–3.45) in diabetic pregnancies with non-diabetic pregnancies as the reference. After adjustment for birthweight and other variables, the odds ratio was 2.42 (95% confidence interval 2.29–2.56).
In diabetic pregnancies, placental weight as well as placental weight relative to birthweight were higher than in non-diabetic pregnancies.
Pelvic girdle pain (PGP) is a disabling condition affecting 30% of pregnant women. The aim of this study was to investigate the efficacy of craniosacral therapy as an adjunct to standard treatment compared with standard treatment alone for PGP during pregnancy.
Randomized, multicenter, single blind, controlled trial.
University hospital, a private clinic and 26 maternity care centers in Gothenburg, Sweden.
A total of 123 pregnant women with PGP.
Participants were randomly assigned to standard treatment (control group, n = 60) or standard treatment plus craniosacral therapy (intervention group, n = 63).
Primary outcome measures: pain intensity (visual analog scale 0–100 mm) and sick leave. Secondary outcomes: function (Oswestry Disability Index), health-related quality of life (European Quality of Life measure), unpleasantness of pain (visual analog scale), and assessment of the severity of PGP by an independent examiner.
Between-group differences for morning pain, symptom-free women and function in the last treatment week were in favor of the intervention group. Visual analog scale median was 27 mm (95% confidence interval 24.6–35.9) vs. 35 mm (95% confidence interval 33.5–45.7) (p = 0.017) and the function disability index was 40 (range 34–46) vs. 48 (range 40–56) (p = 0.016).
Lower morning pain intensity and less deteriorated function was seen after craniosacral therapy in conjunction with standard treatment compared with standard treatment alone, but no effects regarding evening pain and sick-leave. Treatment effects were small and clinically questionable and conclusions should be drawn carefully. Further studies are warranted before recommending craniosacral therapy for PGP.
In general, epidemiological studies have evaluated cases with congenital cardiovascular abnormalities together. The aim of this study is to describe the birth outcomes of cases with isolated/single atrial septal defect type II (ASD-II, i.e. only a fossa ovalis defect) after surgical correction or lethal outcome in the light of maternal sociodemographic data.
Comparison of birth outcomes and maternal characteristics of cases with ASD-II and controls without defect.
The population-based Hungarian Case-Control Surveillance of Congenital Abnormalities.
Hungarian newborn infants with or without ASD-II.
Medically recorded birth outcomes, maternal age and birth order were evaluated. Marital and employment status was based on maternal information. The lifestyle factors were analyzed in a subsample of mothers visited at home based on a personal interview with mothers and their close relatives, and the family consensus was accepted.
Mean gestational age at delivery and birthweight, rate of preterm birth and low birthweight, maternal age, birth order, marital and employment status.
The evaluation of 471 cases with ASD-II and 38 151 controls without any defects showed a female excess in cases with ASD-II, having shorter gestational age and lower mean birthweight, and thus a higher rate of preterm births and low birthweight.
Intrauterine growth restriction and shorter gestational age were found in cases with ASD-II, particularly in female children. These factors may have a general developmental process in which there was not closure of the foramen ovale, thus echocardiographic screening of these babies might be of value.
Admission cardiotocography (CTG) was introduced as a screening test for fetal distress in labor in the late 1980s. No systematic assessments of the test were performed before it was taken into widespread use. A screening test is meant to identify individuals with an increased risk for a disease or condition before symptoms occur, to prevent and reduce morbidity or mortality. A screening test should be evaluated according to its effectiveness, prognostic values and reliability. A careful review of the research literature states that routine use of the admission CTG in low-risk women increases the incidence of minor obstetric interventions, may increase the incidence of cesarean sections, but has no impact on other important outcomes. The prognostic values are poor, and the reliability varies from good to poor. There is no evidence showing that the admission CTG is beneficial, and the test should not be offered to low-risk women.
The last 25 years have seen the development of a plethora of new, effective agents for the treatment of osteoporosis. These agents reduce the risk of spine fractures by up to 70%, hip fractures by 40–50% and non-vertebral fractures by up to 50–80%. Amino-bisphosphonates, taken orally or intravenously, remain the dominant treatment modalities for osteoporosis. These so-called anti-resorptive or anti-catabolic agents stabilize the skeleton and reduce fracture risk in osteoporotic as well as osteopenic individuals. A monoclonal antibody against receptor activator of nuclear factor κB ligand, Denosumab, constitutes a new anti-resorptive agent recently approved worldwide. In younger postmenopausal women, low-dose estrogen or estrogen/progestin still has a place for short-term (up to 5 years) preservation of bone mass, especially in women with menopausal symptoms. Likewise, selective estrogen receptor modulators should be considered in younger postmenopausal women, especially those at increased risk of breast cancer. Anabolic (bone forming) regimens, of which parathyroid hormone is the only agent currently available, aid in the build up of new bone, increase bone mass and improve bone architecture. In cancellous bone, 30–60% increases of bone mass have been documented, but cortical bone thickness also increases. These improvements lead to profound reduction in fracture rates in both the axial and appendicular skeleton. Owing to cost and the need for parenteral administration, in most countries these agents are reserved for severe osteoporosis with multiple fractures.
To determine whether transabdominal cervical length screening could identify women at high risk for having a short cervix on transvaginal ultrasound.
Retrospective cohort study.
Tertiary referral center.
A total of 703 patients with a singleton pregnancy at 18 to 23+6 weeks of gestation who underwent transabdominal and transvaginal cervical length assessment during anatomy ultrasound at a single institution between January 2007 and October 2011.
Electronic medical records were reviewed to identify women who met the study criteria.
The primary outcome was the number of women with a short transabdominal cervical length (defined as ≤30 mm) who needed to undergo transvaginal ultrasound to detect one woman with a short transvaginal cervical length of ≤20 mm.
In all, 703 patients were included in the primary analysis; 3.42 women with transabdominal cervical length ≤30 mm needed to undergo transvaginal ultrasound to detect one woman with transvaginal ultrasound cervical length ≤20 mm. Of women with short transvaginal cervical length ≤20 mm, 89.8% had a transabdominal measurement ≤30 mm and 96.7% had a transabdominal measurement ≤33 mm.
Screening of transabdominal cervical length may represent a useful strategy for detecting women with short cervix on transvaginal ultrasound.
To determine pregnancy, pregnancy loss and fertility rates in a rural community of Ethiopia.
A prospective population-based pregnancy surveillance.
Kersa Demographic Surveillance and Health Research Center, a demographic surveillance site in Eastern Ethiopia.
For pregnancy rates, the study included 7738 women of reproductive age permanently residing in the field research site. For pregnancy loss, 2072 pregnant women were included.
Pregnancy screening was done every third month from 1 December 2009 to 30 November 2010 using a questionnaire and a urine pregnancy test. Descriptive analysis was done to calculate the pregnancy rate and pregnancy loss.
Pregnancy rate and pregnancy loss.
The pregnancy rate was 227/year/1000 women of reproductive age. During the study period, 1438 pregnancies ended, with 1295 live births and 143 pregnancies that did not yield a live birth (116 due to bleeding and 27 stillbirths). The incidence of pregnancy loss was 220/year/1000 pregnancies. Based on the one-year data, the total fertility rate was found to be 5.52. The overall pregnancy loss and stillbirth ratio were 11 and 2.1/100 live births, respectively.
The study identified a high fertility rate that is probably accentuated by a high proportion of pregnancy loss in the study population. Improving access to family planning service to limit the number of pregnancies and access to antenatal care (to identify higher risk women) is essential.
To examine the potential effects of prenatal smokeless tobacco use on selected birth outcomes.
A population-based, case–control study using a retrospective medical record review.
Singleton deliveries 1997–2005 to Alaska Native women residing in western Alaska.
Hospital discharge codes were used to identify potential case deliveries and a random control sample. Data on tobacco use and confirmation of pregnancy outcomes were abstracted from medical records for 1123 deliveries. Logistic regression was used to examine associations between tobacco use and pregnancy outcomes. Adjusted odds ratios (OR), 95% confidence intervals (95% CI), and p-values were calculated.
Preterm delivery, pregnancy-associated hypertension, and placental abruption.
In unadjusted analysis, smokeless tobacco use was not significantly associated with preterm delivery (OR 1.44, 95% CI 0.97–2.15). After adjustment for parity, pre-pregnancy body mass index, and maternal age, the point estimate was attenuated and remained non-significant. No significant associations were observed between smokeless tobacco use and pregnancy-associated hypertension (adjusted OR 0.92, 95% CI 0.56–1.51) or placental abruption (adjusted OR 1.11, 95% CI 0.53–2.33).
Prenatal smokeless tobacco use does not appear to reduce risk of pregnancy-associated hypertension or to substantially increase risk of abruption. An association between smokeless tobacco and preterm delivery could not be ruled out. Components in tobacco other than nicotine likely play a major role in decreased pre-eclampsia risk in smokers. Nicotine adversely affects fetal neurodevelopment and our results should not be construed to mean that smokeless tobacco use is safe during pregnancy.
To identify the role of longitudinal measurements of fetal aortic isthmus blood flow using Doppler ultrasonography in the prediction of perinatal morbidity and mortality.
Obstetrics department of a university hospital.
This prospective study includes women with fetal growth restriction and abnormal umbilical artery Doppler results, seen between November 2009 and January 2011.
31 women were divided into two groups according to the aortic isthmus blood flow pattern just before birth: anterograde (n = 12) or retrograde (n = 19).
Longitudinal measurements of fetal aortic isthmus in relation to perinatal outcome.
Total morbidity and mortality rates were significantly higher in the retrograde flow group. There was no statistically significant difference for respiratory distress syndrome, intraventricular hemorrhage, bronchopulmonary dysplasia or necrotizing enterocolitis, but the neonatal sepsis rate was significantly higher in the retrograde flow group. An abnormal aortic isthmus flow pattern was detected approximately 15–20 days after umbilical artery and middle cerebral artery Doppler flow abnormalities and 3–7 days before deterioration in ductus venosus blood flow.
We suggest that aortic isthmus Doppler measurements are useful for identifying fetal growth restriction before deterioration in ductus venosus blood flow and fetal acidosis.
To determine the association between 5-min Apgar score and umbilical cord artery carbon dioxide tension (pCO2).
Observational study.
European hospital labor wards.
Data from 36 432 newborns ≥36 gestational weeks were obtained from three sources: two trials of monitoring with fetal electrocardiogram (the Swedish randomized controlled trial and the European Union Fetal ECG trial) and Mölndal Hospital data. After validation of the acid–base values, 25 806 5-min Apgar scores were available for analysis.
Validation of the umbilical cord acid–base values was performed to obtain reliable data. 5-min Apgar score was regressed against cord artery pCO2 in a polynomial multilevel model.
Five-min Apgar score, umbilical cord pCO2, pH, and base deficit.
Overall, a higher cord artery pCO2 was found to be associated with lower 5-min Apgar scores. However, among newborns with moderate acidemia, lower umbilical cord artery pCO2 (≤median pCO2 for the specific cord artery pH) was associated with lower 5-min Apgar scores, with a relative risk of 2.0 (95% confidence interval: 1.4–2.8) for 5-min Apgar scores 0–6.
Metabolic acidosis affects the newborn's vitality more than respiratory acidosis. In addition, elevated levels of pCO2 may be beneficial for fetuses with moderate acidemia, and thus cord artery pCO2 is a factor that should be considered when assessing the compromised newborn.
This study aimed to observe risk status on admission to hospital and change in risk status during labor.
A prospective observational study allocating all women into low-risk and high-risk groups on admittance to hospital and during labor based on prespecified risk criteria.
Department of Obstetrics and Gynecology in a district hospital.
All 6406 deliveries from 2 May 2004 to 30 September 2006.
A special form was filled out for all women admitted to the department in labor classifying them as either low or high risk. A change in risk status during labor was also recorded.
Risk status (low and high risk) on admittance to hospital and change in risk status during first stage of labor.
On admittance, 67% of women with an intended vaginal delivery were low risk. During the first stage of labor, 41% of the low-risk women changed risk status. Use of epidural anesthesia gave rise to 73% of the risk changes during the first stage of labor and use of oxytocin caused 12%.
Two-thirds of the women were low risk before labor, and 39% of these remained low-risk at the end of the first stage of labor. The main reason for a change of risk status in the obstetric department was the use of epidural anesthesia.
Various reasons may guide the decision of men to become a sperm donor. Our aim was to identify a comprehensive set of possible reasons for and against sperm donation.
Concept mapping.
Assisted reproduction clinics.
Nine sperm donors and seven non-sperm donors.
Interviews to obtain statements for and against sperm donation, card-sorting tasks to categorize these statements according to similarity, and hierarchical cluster analysis to structure these categorizations.
Hierarchical structure with reasons for and against sperm donation.
The hierarchical structure with 91 reasons comprised selfishness (including narcissism and procreation), psychosocial drives (including altruism, detached procreation, and sexual/financial satisfaction), and psychosocial barriers (including normative and moral barriers related to oneself, one's spouse, the donor child, and society).
The identified hierarchical overview of reasons for and against sperm donation may help potential sperm donors when considering becoming a sperm donor, enable more systematic counseling of potential sperm donors, and guide further research on reasons for and against sperm donation.
To present the results of a large series of patients with ovarian hyperstimulation syndrome treated with a conservative medical approach and to compare the cost of this treatment with outpatient management with paracentesis according to published data.
Retrospective case series and cost analysis study using a decision-tree model.
University hospital.
496 consecutive patients with ovarian hyperstimulation syndrome treated in our center from 1991 to 2010.
All patients were treated with a conservative medical approach: (a) conservative outpatient approach: bed rest and a low-sodium diet or (b) hospitalized patients: bed rest, low-sodium diet, 20% albumin (60 g/day) and furosemide (20 mg/8 h).
Percentage of admissions, length of hospital stay and readmissions. Total cost of each therapeutic approach.
(a) Conservative outpatient approach (n = 377): all cases solved without admission. (b) Hospitalized patients with conservative medical treatment (n = 119): 2.8 days of mean hospital stay, no patient required paracentesis or admission to intensive care unit. Readmissions: Five patients (4.2%) resolved on restarting medical treatment. (c) Cost-analysis comparison: Cost of the outpatient approach with paracentesis: US$980 (range US$519–3557). Cost of conservative medical treatment: US$570 (range US$232–1640).
Ovarian hyperstimulation syndrome can be safely managed with a conservative medical approach, which was not found to be more expensive than outpatient management with paracentesis.
To evaluate whether colposcopically directed cervical biopsies during pregnancy are associated with surgical/obstetric complications and to examine the natural course (regression, persistence, progression) of dysplasia during pregnancy.
Prospective clinical study.
University Hospital and 251 pregnant women with atypical cervical cytology in early pregnancy.
The patients were investigated by colposcopically directed punch biopsies, colposcopically directed loop-biopsies or LEEP-cones. The histology results during pregnancy were compared with those after delivery to evaluate the natural course of dysplastic lesions during pregnancies. Postoperative complications were recorded. Obstetric outcome was recorded and compared with the 54 919 other births in the same geographical area during the study period.
Persistence, regression and progression of cervical dysplasia, surgical complications after diagnostic procedure, incidence of preterm birth, mode of delivery.
Only a minor part (12.3%) of the dysplastic lesions showed progression during pregnancy, with 54.6 and 33.1% showing persistence and regression, respectively. No surgically related postoperative bleeding that needed surgical (diathermy/suture) treatment occurred and the miscarriage rate was low (0.8%). There were no differences in mode of delivery, preterm birth or other obstetrical variables between the study group and the large control cohort.
Investigation of atypical cytology during pregnancy with biopsy including large loop excisions is a safe procedure with regard to surgical complications and obstetrical outcome. There is a high rate of persistence and regression of dysplasia during pregnancy.
We investigated whether induced abortion is associated with breast cancer when lifestyle confounders, including smoking and alcohol consumption, are adjusted for. Design. Prospective cohort study.
Danish women from the Diet, Cancer and Health study.
A total of 25 576 women.
We obtained exposure data from baseline questionnaires filled in by the women between 1993 and 1997. Information on breast cancer and emigration was retrieved from Danish national registries. The study power was approximately 85% when applying a minimum detection hazard ratio of 1.2.
Long-term effects of induced abortion on the risk of breast cancer among women above 50 years of age.
During a follow up of approximately 12 years, 1215 women were diagnosed with breast cancer. When comparing parous women who had an abortion with parous women who never had an abortion, there was no association between breast cancer risk and induced abortion (ever vs. never), with a hazard ratio 0.95 (95% confidence interval 0.83–1.09), regardless of whether the abortion occurred before the first birth (hazard ratio 0.86; 95% confidence interval 0.65–1.14), or after the first birth (hazard ratio 0.97; 95% confidence interval 0.84–1.13).
Our study did not show evidence of an association between induced abortion and breast cancer risk.
To investigate asymptomatic shedding from the uterine cervix of five human herpes viruses: cytomegalovirus (CMV), Epstein–Barr virus (EBV), herpes simplex virus (HSV) type 1 and type 2 and varicella zoster virus (VZV), in young women.
A descriptive study.
Sahlgrenska University Hospital.
Three hundred and five young, healthy Swedish women.
Cervical specimens were analyzed for the presence of viral DNA with a quantitative real-time PCR assay.
Detection of viral DNA.
Viral DNA was detected in 66 (21.6%) of the cervical samples. The most common findings were CMV DNA, detected in 35 (11.5%), and EBV DNA, found in 32 (10.5%) of the women. HSV-1 DNA was detected in 5 (1.7%) and HSV-2 DNA in 4 (1.4%), but VZV DNA was not found. The estimated DNA level for the detected viruses was similar with a mean DNA quantity of 2.6 log genome equivalents (Geq)/mL for CMV (range 1.7–4.3), 2.5 log Geq/mL for EBV (range 1.7–4.7), 2.4 log Geq/mL for HSV-1 (range 1.7–3.5) and 2.6 log Geq/mL for HSV-2 (range 1.7–4.1). The simultaneous presence of DNA from two or more herpes viruses was detected in eight specimens.
Asymptomatic shedding of CMV and EBV from the uterine cervix was found in one-fifth of young women. In four of the cervical samples; two with EBV, one with CMV, one with HSV-2, high amounts of viral DNA (>4 log Geq/mL) were detected suggesting a greater risk of transmitting the virus perinatally or sexually.
Both smoking and the release of nitric oxide (NO) in the uterine cervix are determinants for high-risk human papillomavirus (hrHPV) infection. We compared the cervical NO release between smoking and non-smoking women with and without hrHPV infection.
Open clinical cohort study.
University Hospital in Finland.
One hundred and twenty-five smoking and 301 non-smoking women, with (n = 244) and without (n = 182) hrHPV infection. In total, 264 women showed cytological and/or histological cervical epithelial changes.
The presence of hrHPV was tested by an HPV DNA test and the release of NO was assessed from NO metabolites in the cervical fluid by the Griess reaction.
The difference in cervical NO release between smoking and non-smoking women with and without hrHPV.
Infection with hrHPV in smokers (70%) was more frequent (p = 0.001) than in non-smokers (52%). As a whole, smoking was accompanied by a 35% decrease (p = 0.04) in NO release in hrHPV-infected women (35.9 μmol/L, 95% confidence interval 27.0–44.2) compared with non-smoking hrHPV- infected women (48.3 μmol/L, 95% confidence interval 38.0–56.2). No difference in NO release between smokers and non-smokers was seen in women with healthy cervical epithelium, but smoking was accompanied by a suppressed (26%) NO release (p = 0.03) in women with either cytological or histological changes.
Smoking may suppress NO release in the uterine cervix in women with hrHPV infection.
To investigate the effectiveness of an intervention aimed at improving the case management of eclampsia.
A multi-center intervention study.
Six teaching hospitals in Nigeria.
Clinical records of cases of eclampsia treated before and 1 year after the intervention.
Doctors and midwives in selected hospitals were re-trained to manage eclampsia using magnesium sulfate according to the Pritchard protocol.
Eclampsia case fatality rates, maternal and perinatal mortality rates before and after the intervention.
A total of 219 cases of eclampsia were managed over a 12-month period. There were seven maternal deaths. The post intervention case fatality rate of 3.2% was significantly less than the pre-intervention rate of 15.1% (p < 0.001). The overall maternal and perinatal mortality ratios and rates respectively in the hospitals declined from 1199.2 to 954 per 100 000 deliveries and 141.5 to 129.8 per 1000 births, respectively (p > 0.05).
An intervention to build the capacity of care-providers to use an evidence-based protocol for the treatment of eclampsia in Nigeria was successful in reducing associated case fatality rate. The increased and widespread use of such an intervention in maternity units might contribute to the reduction of maternal mortality in low-income countries.
Ovarian cancer patients in whom complete tumor removal is impossible with primary debulking surgery (PDS) may benefit from neoadjuvant chemotherapy and interval debulking surgery. However, the task of performing a pre-operative evaluation of the feasibility of PDS is difficult. We aimed to investigate whether the risk of malignancy index (RMI) was a useful marker for this evaluation. RMI and surgical outcome were investigated in 164 patients, 49 of whom had no residual tumor after PDS. The receiver operating characteristic curve showed an area under the curve of 0.72 (confidence interval: 0.64–0.80). The possibility of complete tumor removal decreased with increasing RMI and there was a tendency towards higher RMI in patients with residual tumor after PDS, but no single cut-off value of RMI produced useful clinical predictive values. In conclusion, RMI alone is not an optimal method to determine whether complete tumor removal is possible with PDS.
The goal of the study was to estimate the prevalence of restless legs syndrome (RLS) among women of childbearing age taking combined hormonal or combined oral contraception (CHC). A survey that included demographic information, contraceptive use history, the four criteria necessary for RLS diagnosis and an International RLS study group severity scale was distributed to 145 women taking CHC and 169 matched control women not on CHC. A high prevalence of moderate to severe RLS of 20.7% was found. A significant correlation between CHC use and RLS was not found (p = 0.53). RLS severity was not significantly associated with CHC use either (p = 0.2127). Women with RLS were significantly heavier compared with those without RLS (p = 0.0015). RLS severity weakly correlated with body mass index (R = 0.26, p = 0.044). Hormonal contraceptive therapy does not increase the risk of developing RLS symptoms.
Women with Müllerian anomalies are at increased risk of preterm labor. The analysis of parameters derived by the electrohysterogram such as its conduction velocity are promising for preterm delivery prediction. However, an electrohysterogram has never been measured in Müllerian anomalies. A multiparous woman with a unicornuate uterus presented at 28 weeks of gestation with preterm contractions. Three electrohysterogram recordings were performed between 28 and 30 weeks of gestation, 4 weeks before delivery. The conduction velocity values were in line with previous literature and differed significantly (p < 0.001) showing an increase between the first and last two recordings. The parameters derived from the electrohysterogram such as conduction velocity and power density spectrum peak frequency are promising ones to follow the evolution of pregnancy towards labor, and to distinguish between productive and unproductive uterine contractions, in the case of a unicornuate uterus as well as one that is normally developed.