Prevalence of Pain Symptoms Suggestive of Endometriosis Among Finnish Adolescent Girls (TEENMAPS Study)

STUDY OBJECTIVE

To evaluate the prevalence of pain symptoms suggestive of endometriosis among adolescent girls aged 15-19 years.

DESIGN

Cross-sectional study.

SETTING

University hospital.

PARTICIPANTS

Adolescent girls aged 15-19 years attending elementary school, high school, or vocational institute at 3 cities in Southwest Finland in 2010-2011.

INTERVENTIONS

The school nurses distributed a detailed questionnaire to 2582 girls who were attending school at the time of the study. Completion of the questionnaire was voluntary and anonymous.

MAIN OUTCOME MEASURES

Prevalence and severity of dysmenorrhea, acyclic abdominal pain, dyspareunia, dyschezia, and dysuria. Severity was evaluated with an 11-point numerical rating scale (NRS).

RESULTS

A total of 1103 eligible answers were analyzed. The prevalence of dysmenorrhea was 68% (738/1092) with mean NRS of 7.0 (SD = 2.0). Acyclic abdominal pain, dyspareunia, dyschezia, and dysuria were less frequent (19% [207/1085], 12% [53/458], 8% [87/1088] and 5% [50/1084], respectively). The prevalence of severe dysmenorrhea (NRS 8-10) was 33% (355/1089). Severe dysmenorrhea was associated with increased risk of concurrent acyclic abdominal pain (odds ratio [OR] = 2.7; 95% confidence interval [CI], 2.0-3.6), dyschezia (OR = 2.5; 95% CI, 1.6-3.9), and regular absenteeism from school or hobbies (OR = 10.0; 95% CI, 4.2-23.6). Using different criteria, 2%-10% (21-106/1103) of all girls could be identified as having symptoms suggestive of endometriosis. Five percent of girls (n = 53/1103) had severe dysmenorrhea, used oral contraceptive pills, and reported inadequate relief from pain medication.

CONCLUSION

One-third (355/1089) of 15- to 19-year-old girls had severe menstrual pain and 14% (49/355) of them were regularly absent from school or hobbies. Five percent of all teenage girls (53/1103) were poor responders to conventional therapy for primary dysmenorrhea.

Outcome of Burch retropubic urethropexy and the effect of concomitant abdominal hysterectomy: a prospective long-term follow-up study

A prospective follow-up study was performed to evaluate the effect of a concomitant abdominal hysterectomy with Burch colposuspension. Sixty-five women underwent Burch colposuspension (the Burch group) and 78 women colposuspension with concomitant abdominal hysterectomy (the hysterectomy group) during a 1-year period in Turku University Hospital. Subjective outcome was assessed with three questionnaires: at 6 weeks, 1 year, and a mean of 4.9 years after the operation. Complications related to the operation occurred in 19 patients (29.2%) in the Burch group and in 36 (46.2%) in the hysterectomy group (P = 0.038). No statistically significant difference in the frequency of any subgroup of complications was found. Instead, complications cumulated to fewer patients in the Burch group. During postoperative care in the hospital intermittent catheterization to treat transient urinary retention was needed more frequently in the Burch group than in the hysterectomy group (10.8% vs. 1.3%, P = 0.046). No significant difference was found in subjective short- and long-term outcome. In the long-term follow-up 79% were subjectively cured or improved, 77% in the Burch group and 81% in the hysterectomy group.

Vaginal axis after abdominal, vaginal and laparoscopic hysterectomy: a preliminary study with perineal ultrasonography using contrast medium

Fifteen consecutive women (mean age 44.5 years) without pelvic relaxation underwent total abdominal (5), vaginal (5) and laparoscopic (5) hysterectomy for benign disease. The vaginal axes of the patients were examined prior to and on average 7 weeks (range 3-10) after the operation with perineal ultrasonography enhanced with an ultrasound contrast medium (SHU454/Echovist-300). Transabdominal and vaginal hysterectomies were performed in the classic manner, i.e. the round as well as cardinal and sacrouterine ligaments were attached to the vaginal vault, followed by peritonealization. In laparoscopic hysterectomy the round, broad and outer parts of the uterosacral and the upper parts of the cardinal ligaments were desiccated by bipolar electrocoagulation and cut with laparoscopic scissors. The vagina was closed by interrupted sutures with no specific fixation of the round, cardinal or uterosacral ligaments. Preoperative ultrasound findings showed that in all women the vagina was an angulated organ. The mean preoperative angle between the upper and lower vaginal portions was 108 degrees, in both the supine and the standing positions. Postoperatively this angulated shape remained almost unchanged after vaginal (mean angle 117 degrees ) and laparoscopic hysterectomy (mean angle 130 degrees ), whereas after transabdominal hysterectomy the vaginal axis rotated anteriorly and became an almost straight tube (mean angle 158 degrees). We conclude that the vaginal axis, at least at an early stage after vaginal and laparoscopic hysterectomy remained in almost the same position as preoperatively, in contrast to that after abdominal hysterectomy. A tight attachment of the round ligaments to the vaginal vault in the abdominal approach could explain the outcome of transabdominal hysterectomy, and should be called into question.

Incidence, risk factors and outcome of infection in a 1-year hysterectomy cohort: a prospective follow-up study

A prospective study was performed following 687 patients who underwent abdominal, vaginal and laparoscopic hysterectomy for benign conditions in Turku University Hospital. This study evaluates and compares infection after hysterectomy and determines risk factors associated with postoperative infection. Infective episodes were recorded during hospital stay, convalescence for 4 to 6 weeks at home and for 1 year of follow-up. Factors found to be statistically significant for hospital-acquired infection on univariate analysis were subsequently assessed by means of multivariate analysis. During the hospital stay 23.7% of the study population became infected, 38.1% after vaginal hysterectomy, 23.4% after abdominal hysterectomy and 3.0% after laparoscopic hysterectomy. Over half of all hospital-acquired infections were lower urinary tract infections. Infection during convalescence occurred in 19.2% of patients: 29.5% in the vaginal hysterectomy group, 17.4% in the abdominal hysterectomy group and 16.7% in the laparoscopic hysterectomy group. One year of follow-up did not find any infection directly attributable to surgery. Five factors were found to be related to in-hospital infection on multivariate analysis. These were lack of antibiotic prophylaxis, blood loss during operation, intermittent catheterization, anaemia and medication for urinary or bowel dysfunction after operation.

Complications and long-term outcomes after adnexal surgery by laparotomy and laparoscopy

STUDY OBJECTIVE

To assess complications and subjective outcomes after adnexal surgery by laparotomy and laparoscopy.

DESIGN

Observational study (Canadian Task Force classification II-2).

SETTING

University-affiliated hospital.

PATIENTS

Two-hundred twenty-eight women requiring adnexal surgery for benign indications.

INTERVENTIONS

The 114 patients who underwent laparotomy and 114 having laparoscopy were followed prospectively for 1 year. Two questionnaire-based evaluations were undertaken to determine subjective outcomes. To evaluate possible later surgical procedures, hospital records were reviewed 4 years after operation.

MEASUREMENTS AND MAIN RESULTS

No major complications occurred in the laparotomy group. The two (1.8%) in the laparoscopy group were intestinal injury and aortal injury, both in women who had previously undergone laparotomy. Rates of minor complications were 11.4% for laparotomy and 7.0% for laparoscopy. Two patients in both groups were readmitted. No difference was found between groups in need for additional adnexal procedures up to 4 years after operation. After 1 year, frequencies of subjective complaints and satisfaction with surgical procedure did not differ significantly. Mean hospital cost per patient was less for laparoscopy than for laparotomy.

CONCLUSION

No statistically significant differences were seen after adnexal surgery by laparoscopy and laparotomy with regard to frequency of complications and subjective outcomes. Laparoscopy in women who have previously undergone laparotomy may be associated with a slightly greater risk of major complications than another laparotomy.

One-year cohort of abdominal, vaginal, and laparoscopic hysterectomies: complications and subjective outcomes

BACKGROUND

In the past decade, changes in operative approaches to hysterectomy have resulted in needs to renew study of postoperative morbidity.

STUDY DESIGN

This prospective observational study, performed in a university teaching hospital in Finland, was conducted to determine the overall number of complications and subjective outcomes after hysterectomy for benign conditions. The population studied during a 1-year period consisted of 687 women, who underwent 516 abdominal hysterectomies, 105 vaginal hysterectomies, and 66 laparoscopic hysterectomies. Complications arising within 1 year of operations were recorded, and subjective complaints and outcomes were assessed using two questionnaire-based evaluations, the first following a convalescence period of 4 to 6 weeks, the second after 1 year.

RESULTS

Intraoperative complications occurred in 16 patients (2.3%), in 9 patients in the abdominal hysterectomy group (1.7%), and in 4 (3.9%) and 3 patients (4.5%) in the vaginal and laparoscopic hysterectomy groups, respectively. During the hospital stay postoperative complications were found in 28.5% of patients, in the vaginal hysterectomy group (41.9%) more often than in the abdominal and laparoscopic hysterectomy groups (28.3% and 9.1%, respectively). Postoperative infection, including urinary infection, was the main problem, during both the stay in the hospital and the convalescence period at home. It was also the principal reason for readmission to the hospital. Despite an increase in incidence of subjective complaints, from 14.9% during the first evaluation to 37.0% during the second (p < 0.001), 95% of respondents remained satisfied with their operation after 1 year.

CONCLUSIONS

Vaginal hysterectomy was more often associated with some adverse event, mainly postoperative infection, than abdominal and laparoscopic hysterectomy. Subjective outcomes were not influenced by the type of hysterectomy. Most patients were satisfied with the operation on both short- and longterm followup.

Screening for endometrial cancer in asymptomatic postmenopausal women with conventional and colour Doppler sonography

OBJECTIVE

To evaluate endometrial thickness and uterine arterial flow measurement as predictors of endometrial cancer.

DESIGN

Prospective study among a cohort of women invited to age-adjusted, population-based breast cancer screening by mammography.

SETTING

City of Turku, Finland.

POPULATION

1074 postmenopausal women aged 57-61 years (mean 59 years).

METHODS

Conventional and colour Doppler sonography. Endometrial biopsy was taken when the endometrial thickness (double layer) was > or = 4.0 mm, if the uterine artery pulsatility index was < or = 1.0 or if there was a fluid accumulation in the endometrial cavity.

MAIN OUTCOME MEASURES

Detection of endometrial cancer in endometrial biopsy. Record linkage with the files of the Finnish Cancer Registry three and a half years after the first ultrasound examination. Major statistical results are based on the analysis of variance and logistic regression models.

RESULTS

An endometrial biopsy was taken from 291 women (27%). One woman had endometrial tuberculosis, three an endometrial polyp, 16 endometrial hyperplasia, three endometrial carcinoma (Stage Ib), and one had cervical carcinoma (Stage Ib). One woman was diagnosed as having endometrial cancer Stage Ib two and a half years after screening; she had refused further examination after a positive screen. A second endometrial cancer (Stage Ib) was diagnosed three years after a negative screening result.

CONCLUSION

Transvaginal sonography is confirmed to have a very high sensitivity for the detection of early endometrial carcinoma, but the specificity remains low. If endometrial cancer is to be detected at an early stage, further examinations should be carried out when the endometrial thickness is > or = 4.0 mm, especially when the woman has risk factors such as obesity, late menopause or current use of hormonal replacement therapy. Doppler sonography does not improve the detection of premalignant and malignant endometrial lesions compared with normal ultrasound.

Laparoscopic instillation of hyperosmolar glucose vs. expectant management of tubal pregnancies with serum hCG < or = 2500 mIU/mL

OBJECTIVE

To compare expectant management with local instillation of 50% glucose solution for tubal pregnancies with a serum hCG level < or = 2500 mIU/mL.

DESIGN

Prospective, non-randomized, comparative clinical study.

SETTING

Two university departments.

PATIENTS

One hundred and twenty-eight patients with laparoscopically-confirmed tubal pregnancy and serum hCG < or = 2500 mIU/mL.

INTERVENTIONS

Eighty patients in Graz were treated with laparoscopic instillation of 50% glucose solution and 48 patients in Turku were followed expectantly.

MAIN OUTCOME MEASURES

Resolution of hCG excretion, need for further interventions.

RESULTS

Seventy-four of the 80 patients (92%) in the glucose group (32 of 33 with an initial hCG < or = 250 mIU/mL and 42 of 47 with hCG 251-2500 mIU/mL) and 36 of 48 (75%) patients in the expectant group (19 of 23 with an initial hCG < or = 250 mIU/mL and 17 of 25 with hCG 251-2500 mIU/mL) had resolution of the pregnancy with no further intervention (p=0.008, chi-square test, odds ratio 0.24).

CONCLUSIONS

Glucose instillation is superior to expectant management for patients with early tubal pregnancy.

Significance of a single CA 125 assay combined with ultrasound in the early detection of ovarian and endometrial cancer

We evaluated the utility of a single CA 125 measurement in combination with transvaginal sonography for early detection of ovarian and endometrial cancer in asymptomatic postmenopausal women. A sample of peripheral blood was taken from 1291 apparently healthy postmenopausal women, who were examined by conventional and color Doppler ultrasound for early detection of ovarian and endometrial cancer. Serum CA 125 was determined in all samples 3 years later by the IMx CA 125 assay (Abbott Laboratories, Abbott Park, IL). The cutoff level based on the 99th percentile was 30 U/ml. Elevated values were controlled by repeat sonography and an additional determination of CA 125. Record linkage with the files of the Finnish Cancer Registry was performed 3 1/2 years after the primary sonographic screening. The mean CA 125 concentration was 8.1 U/ml (range 0-1410 U/ml). Fourteen of the 1291 women had a CA 125 level greater than 30 U/ml. None of these had signs of either endometrial or ovarian malignancy in the primary sonography screening. Among the other women three cases of endometrial carcinoma (all stage Ib) and one ovarian carcinoma (stage Ia with borderline malignancy) were detected by sonography. All these patients had a CA 125 value <30 U/ml, the mean value being 11.4 U/ml (range 7.5-16.7 U/ml). During follow-up of 3.5 years, one stage Ia ovarian carcinoma, one abdominal carcinomatosis, and two endometrial carcinomas (both stage Ib) were diagnosed. In these patients the mean value for CA 125 was 12.7 U/ml (range 2.5-30.9 U/ml) at the primary sonography screening. A single CA 125 measurement provides no advantage in the early detection of ovarian and endometrial cancer in asymptomatic postmenopausal women compared with transvaginal sonography. The vast majority of women with an elevated CA 125 value have some reason other than an ovarian or endometrial malignancy for this finding.

Endometrial fluid accumulation in asymptomatic postmenopausal women

Postmenopausal endometrial fluid accumulation was considered in the past to be related to cancer of the genital organs. Our purpose was to evaluate its prevalence, and its association with cervical stricture, use of hormone replacement therapy and endometrial pathology. A group of 1074 asymptomatic postmenopausal women aged 57-61 (mean 59) years was examined by transvaginal sonography with color Doppler imaging. Women who had an endometrial fluid accumulation underwent endometrial biopsy. Statistical analysis was mainly based on analysis of variance. Endometrial fluid accumulation was found in 134 women (12%). Women using only estrogen as hormone replacement therapy had a relative risk of 3.5 of endometrial fluid accumulation. In 12 women (9%), a cervical stricture precluded endometrial sampling. Six abnormal histopathological samples were found (5%): two endometrial polyps, one cystic hyperplasia, two adenomatous hyperplasias but only one adenocarcinoma. One further patient with endometrial cancer was registered by the Finnish Cancer Registry 2.5 years later in a woman who had refused endometrial sampling. Endometrial fluid accumulation is quite a common finding on transvaginal sonography among asymptomatic postmenopausal women and the process may be multifactorial. Cervical stricture is not the most important etiological factor. The use of estrogen replacement therapy increases the risk of endometrial fluid accumulation; however, it is rarely a sign of malignancy.

Outcome of short stay surgery in conventional gynecological operations

BACKGROUND

To find out the suitability of increasingly common short stay surgery in major conventional gynecological operations.

METHODS

A retrospective study of sixty-six patients who underwent major conventional gynecological operations on a short stay basis between January 1990 and December 1992, in a private hospital, at Turku, Finland, were enrolled to the study. The length of the operation, the time of hospitalization, the duration of the sick leave and possible complications were retrospectively studied. The postoperative long-term outcome and the satisfaction of the patients with short stay surgery was evaluated with a questionnaire.

RESULTS

The patients were hospitalized for mean 2.6 days. There were no peroperative complications but four patients (6%) needed rehospitalization because of postoperative problems. Five minor complications (two wound infections and three urinary tract infections) were treated in outpatients after discharge. All patients were satisfied with the short stay surgery. The day of discharge was considered suitable by 80% of the patients and most of the patients (97%) would also recommend similar treatment to their acquaintances.

CONCLUSION

These results suggest that short stay surgery in major gynecological operations can be considered as an alternative to conventional hospitalization.

Transdermal estrogen for female stress urinary incontinence in postmenopause

OBJECTIVE

To evaluate the effect of transdermal estrogen for stress urinary incontinence in postmenopause.

STUDY DESIGN

An open within patient, dose-finding study with transdermal 17-beta-estradiol combined with cyclic medroxyprogesterone acetate was conducted over 9 months in 21 patients (mean age 57.3 years) suffering from urodynamically verified mild to moderate stress incontinence without detrusor instability.

RESULTS

Subjective improvement was noted in 16 out of 21 patients (76%). The dose level of 50 micrograms was better tolerated than 100 micrograms and sufficient enough to achieve continence.

CONCLUSION

Transdermal estrogen therapy plays an adjuvant role in conservative therapy for mild to moderate stress urinary incontinence in postmenopausal women.

Evaluation of ovarian findings in asymptomatic postmenopausal women with color Doppler ultrasound

BACKGROUND

To evaluate the prevalence and significance of abnormal ovarian findings in asymptomatic postmenopausal women, screening for ovarian cancer with color Doppler ultrasound was performed.

METHODS

One thousand three hundred sixty-four asymptomatic women aged 56-61 years (mean, 59 years) were examined by color Doppler sonography. Ninety-six percent of the examinations were transvaginal and 4% transabdominal. The criteria for abnormality were an ovarian volume 8 cm3 or greater, nonuniform echogenicity, and/or pulsatility index (PI) of the ovarian artery or tumor vessel, if present, 1.0 or less. Repeat sonograms were performed 1-3 months later on all patients with abnormal findings, and exploratory laparotomy was performed if a malignant tumor was suspected.

RESULTS

Abnormal ovarian findings were detected in 160 women (12%). At the time of repeat sonogram there were 28 persisting abnormalities (2%). At that time, the ovary was regarded as normal if it still contained a small clear cyst with an unchanged greatest dimension of less than 20 mm. Three women had a low PI value but all had also abnormal ovarian sonographic morphology. Two ultrasound-guided cyst punctures were performed and three patients had surgery; one benign serous cyst, one benign serous cystadenoma, and one serous cystadenoma of borderline malignancy were detected. The remaining abnormal findings disappeared or remained unchanged during a minimum follow-up of 2 years. One case of Stage IA ovarian cancer has been reported 2 years after a negative screening and one abdominal carcinomatosis 2 1/2 years after a negative screening result.

CONCLUSIONS

There is a high frequency of small ovarian cysts in asymptomatic postmenopausal women. A large percentage of these cysts regress spontaneously or remain unchanged. Transvaginal color Doppler ultrasound is an effective method for detecting these lesions. Color Doppler does not increase substantially the number of operations for benign reasons. However, as a primary screening modality, the conventional sonography seems to be quite sufficient.

Mortality after gynaecologic operations in Finland, 1986-1991

OBJECTIVE

To study the current in-hospital, 30-day and 42-day mortality after conventional gynaecologic procedures in Finland, with special reference to hysterectomy.

DESIGN

Nationwide six-year annual study.

SETTING

Data were from the Finnish Population Register Centre, the Finnish Cause-of-Death and Hospital Discharge Register, and the Register for Legal Abortions and Sterilisations.

SUBJECTS

Gynaecologic operations (n = 299,257) performed between January 1986 and December 1991.

MAIN OUTCOME MEASURES

The overall and age-adjusted mortality rates during the initial hospitalisation, as well as 30 and 42 days after the operations. Age-adjusted probability of dying within 42 days after hysterectomy compared with the overall probability of age-matched Finnish female control population.

RESULTS

Overall mortality rates per 10,000 hysterectomies increased gradually from 6.0 during initial hospitalisation to 9.1 and 12.9 when calculated 30 and 42 days post-operatively. The overall 42-day mortality rates of radical hysterectomy, curettage and laparoscopy (other than sterilisation) exceeded the post-hysterectomy mortality rate, while the rates after caesarean section, legal abortion and laparoscopic sterilisation did not. No deaths occurred after laparoscopic sterilisation (n = 40,346). The patients who died after radical hysterectomy, curettage and for other laparoscopy than sterilisation were old, and the great majority of them died of cancer.

CONCLUSIONS

The mortality rates after gynaecologic procedures in Finland are currently very low and have clearly decreased in recent decades. Patients may be reassured that conventional gynaecologic operations are safe.

Vesicocervical fistula--a rare cause of urinary incontinence

A vesicocervical fistula is reported. This extremely rare and late sequela of caesarean section, secondary to a lesion in the bladder and unrecognized intraoperatively, was followed with a distressing, long-lasting urinary incontinence unreactive to conservative treatment. Not until 7 years after the primary operation was this lesion diagnosed and treated successfully by vaginal approach. Etiological factors, clinical features and treatment possibilities are discussed.

Urinary tract fistulas following abdominal hysterectomy

Sixteen patients with urinary tract fistulas (14 vesicovaginal and two ureterovaginal) following simple abdominal hysterectomy were treated over a period of 17 years. Most vesicovaginal fistulas were treated by a transvesical technique, which proved to be a comfortable and successful method in our hands. Closure of the fistula followed usually more than four weeks after diagnosis. Earlier repair, which has been forwarded as an alternative therapy, might give equally good results and would save the patient from the severe hygienic problem of continuous urinary leakage. Conservative treatment with an indwelling urinary catheter led to spontaneous closure of the fistula in one patient. Two ureterovaginal fistulas were corrected by an anti-reflux ureteroneocystostomy.

Retrospective analysis of 711 patients operated on for pelvic relaxation in 1983-1989

OBJECTIVE

To analyze which factors, including gynecological surgery in particular, contribute to the occurrence of pelvic relaxation.

METHOD

A retrospective analysis of 711 consecutive patients treated surgically for pelvic relaxation from 1983 to 1989 at the Department of Obstetrics and Gynecology of Turku University Central Hospital was undertaken.

RESULT

The patients who underwent surgery for recurrent pelvic relaxation were significantly older (66.8 vs. 62.1 years) and suffered significantly less (20% vs. 41%) from urinary stress incontinence than patients undergoing primary surgery for pelvic relaxation. Anterior vaginal segment relaxation (i.e. cysto- and urethrocele) was common in patients undergoing the initial operation (n = 684), and posterior vaginal segment relaxation (i.e. rectocele and perineal laceration) in recurrent operations (n = 58). Of the patients studied, 87 had pelvic relaxation, which had developed after partial (n = 46), total abdominal (n = 16) or vaginal (n = 25) hysterectomy.

CONCLUSION

Care must be taken in the treatment of the posterior vaginal segment during the initial operation for pelvic relaxation in order to avoid late sequelae. Moreover, when the removal of the uterus is planned, the matter of a stable vaginal vault must be taken into account especially when partial hysterectomy should be performed.

Long-term effects of hormone replacement therapy on the uterus and on uterine circulation

OBJECTIVE

Our purpose was to study the effects of postmenopausal hormone replacement therapy on the uterus and uterine circulation.

STUDY DESIGN

The study population consisted of 432 women, 58 to 59 years of age. Color Doppler ultrasonography with a transvaginal probe was used to measure the size of the uterus and the uterine artery pulsatility index.

RESULTS

The mean endometrial thickness in group 1 (controls without hormone replacement therapy) was significantly thinner compared with group 2 hormone replacement therapy and with group 3 after discontinuance of hormone replacement therapy. The mean uterine artery pulsatility index was lower both in group 2 and 3 compared with group 1. When hormone replacement therapy was initiated 2 to 10 years after menopause, the endometrial thickness did not differ from that among those who had started hormone replacement therapy earlier, but the pulsatility index was significantly higher. There was positive correlation between the size of the uterus and the pulsatility index in group 1, but the correlation was negative in group 2. In general, the duration of hormone replacement therapy had no effect on the pulsatility index. Estrogen users had a significantly thicker endometrium compared with estrogen-progestogen users. The pulsatility index was highest in the estrogen users with progestogen added every month.

CONCLUSION

The duration, onset of treatment in relation to menopause, discontinuance of hormone replacement therapy, and mode of treatment modify both the normal postmenopausal endometrial thickness and the uterine vascular resistance.

Single dose of labetalol in normotensive pregnancy: effects on maternal hemodynamics and uterine and fetal flow velocity waveforms

The short-term effect of 0.8 mg/kg of intravenous bolus of labetalol upon maternal and fetal hemodynamics was investigated in 10 healthy women at 38 weeks of gestation admitted to the hospital for elective cesarean section. The maximum effect occurred within 35 min after labetalol. At that point, the mean arterial pressure had decreased by 16%, and a slight decrease was observed in maternal heart rate. As to the flow velocity waveforms, no significant change was found in mean systolic/diastolic (S/D) ratio of uterine artery, umbilical artery or fetal middle cerebral artery. However, in 2 subjects with a large decrease in blood pressure also the uterine artery S/D ratio decreased.

Single dose of labetalol in hypertensive pregnancy: effects on maternal hemodynamics and uterine and fetal flow velocity waveforms

The short-term effect of 0.8 mg/kg of an intravenous bolus of labetalol on maternal and fetal hemodynamics was investigated in ten women with pregnancy-induced hypertension. The maximum effect occurred within 35 minutes after labetalol administration. At that point, the mean arterial pressure had decreased by 18% and there was a slight decrease in maternal heart rate. As to flow velocity waveforms, no significant change was found in mean systolic/diastolic (S/D) ratio of the uterine artery, umbilical artery or fetal middle cerebral artery. However, in two subjects with a marked reduction in blood pressure also the uterine artery S/D ratio decreased.

The regional versus national incidence of ectopic pregnancy in Finland from 1966 to 1986

The annual incidence of ectopic pregnancy (EP) per deliveries, per all diagnosed pregnancies and per female population at fertile age (15-44 years) were measured from 1966 to 1986 in a well-defined urban area of Southwestern Finland, the Turku Region. The incidence rates increased markedly, and were, in the mid-80s, among the highest in the world: 2.6 per 100 deliveries, 1.8 per 100 diagnosed pregnancies and 153 per 100,000 fertile-aged women. The regional incidence rate exceeded the national one in the 1970s, whereas in the 1980s the regional rate which has levelled-off during recent years has been equal to, and currently even lower than the national one. This suggests that changes in the incidence of EP in urban area(s) preceed those in the whole country.

Causes of the increase in the incidence of ectopic pregnancy. A study on 1017 patients from 1966 to 1985 in Turku, Finland

The relationship between the increased incidence of ectopic pregnancy and the known risk factors of this disorder was examined by 5-year age groups and equivalent calendar periods to determine the causes of the recent "epidemic" of ectopic pregnancy. None of the known risk factors would alone explain the observed increase. Consequently, multivariate analysis by log-linear models was applied: age, past pelvic operation, previous pelvic inflammatory disease, antecedent legal abortion, and current use of an intrauterine contraceptive device were responsible for the increase in the occurrence of the disease. The strongest association with the observed temporal trend in the increase of ectopic pregnancy was found for pelvic operation (including previous ectopic pregnancy), pelvic inflammatory disease, and current use of an intrauterine contraceptive device. Improved diagnosis and changing demographic patterns also contributed to the increase in the annual number of ectopic pregnancies.

Increase of ectopic pregnancy in Finland--combination of time and cohort effects

The marked increase of ectopic pregnancy in Finland was studied in 5-year age groups from 1968-1984. In the early 1970s, the overall increase was attributable to women under 30 years of age, and in the early 1980s to women aged 30 years or more. The increase in the incidence rate of ectopic pregnancy per 100,000 women has taken place somewhat successively since the late 1960s in women aged 20-24, 25-29, 30-34, and 35-39 years. The incidence of ectopic pregnancy per 100,000 women increased by every successive 5-year cohort born since the late 1930s up to the cohort born in 1954-1958; thereafter, the birth cohorts have experienced an equal or even lower risk of ectopic pregnancy. The findings suggest that the large "baby boom" cohort (born in 1945-1954), with its high risk of ectopic pregnancy, is mainly responsible for the overall increase in the number of ectopic pregnancies seen in the past decade. When these cohorts end their reproductive years, the marked increase in the number of ectopic pregnancies in Finland may decrease, but the incidence rates will probably stay stable.

Encouraging rates of fertility after ectopic pregnancy

A follow-up study (4 to 8 years) on fertility of 110 patients seeking pregnancy after ectopic pregnancy (EP) showed normal delivery in 65%, recurrent EP in 20%, and infertility in 15%. Delivery rates were better in patients who were under age 30 years, used an IUD at the time of operation for EP, and underwent conservative operative treatment for acute EP. The subsequent intrauterine pregnancy rates of EP patients who had used an IUD at the time of ectopic nidation were the same (92%) as after removal of IUD in the healthy population. It appears that IUD plays a predisposing role in EP only when in use. The study also shows that modern diagnostic and therapeutic procedures are beneficial for improving subsequent fertility rates after EP. These fertility rates are highly encouraging with respect to the massive increase of EP in the Finnish population.

Ectopic pregnancy in Finland 1967-83: a massive increase

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