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Boie S, Glavind J, Bor P, Steer P, Riis AH, Thiesson B, Uldbjerg N. Continued versus discontinued oxytocin stimulation in the active phase of labour (CONDISOX): individual management based on artificial intelligence - a secondary analysis. BMC Pregnancy Childbirth 2024; 24:291. [PMID: 38641779 PMCID: PMC11027395 DOI: 10.1186/s12884-024-06461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/28/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Current guidelines regarding oxytocin stimulation are not tailored to individuals as they are based on randomised controlled trials. The objective of the study was to develop an artificial intelligence (AI) model for individual prediction of the risk of caesarean delivery (CD) in women with a cervical dilatation of 6 cm after oxytocin stimulation for induced labour. The model included not only variables known when labour induction was initiated but also variables describing the course of the labour induction. METHODS Secondary analysis of data from the CONDISOX randomised controlled trial of discontinued vs. continued oxytocin infusion in the active phase of induced labour. Extreme gradient boosting (XGBoost) software was used to build the prediction model. To explain the impact of the predictors, we calculated Shapley additive explanation (SHAP) values and present a summary SHAP plot. A force plot was used to explain specifics about an individual's predictors that result in a change of the individual's risk output value from the population-based risk. RESULTS Among 1060 included women, 160 (15.1%) were delivered by CD. The XGBoost model found women who delivered vaginally were more likely to be parous, taller, to have a lower estimated birth weight, and to be stimulated with a lower amount of oxytocin. In 108 women (10% of 1060) the model favoured either continuation or discontinuation of oxytocin. For the remaining 90% of the women, the model found that continuation or discontinuation of oxytocin stimulation affected the risk difference of CD by less than 5% points. CONCLUSION In women undergoing labour induction, this AI model based on a secondary analysis of data from the CONDISOX trial may help predict the risk of CD and assist the mother and clinician in individual tailored management of oxytocin stimulation after reaching 6 cm of cervical dilation.
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Affiliation(s)
- Sidsel Boie
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark.
| | - Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Pinar Bor
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Philip Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | | | | | - Niels Uldbjerg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Eidhammer A, Glavind J, Skrubbeltrang C, Melgaard D. Healing Architecture in Birthing Rooms: A Scoping Review. HERD 2024:19375867241238439. [PMID: 38591577 DOI: 10.1177/19375867241238439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
AIM The purpose of this scoping review is to map the knowledge about the multisensory birthing room regarding the birth experience and birth outcomes. BACKGROUND The concept of multisensory birthing rooms is relatively novel, making it relevant to explore its impact. METHODS Five databases were searched. The search was limited to articles in English, Danish, Norwegian, and Swedish. There were no time limitations. Fourteen relevant articles were identified providing knowledge about multisensory birthing rooms. RESULTS Eight articles focused on birth experience, six articles focused on birth outcome, and one on the organization of the maternity care. Seven of the studies identified that sensory birthing rooms have a positive impact on the birth experience and one qualitative study could not demonstrate a better overall birth experience. Five articles described an improvement for selected birth outcomes. On the other hand, a randomized controlled trial study could not demonstrate an effect on either the use of oxytocin or birth outcomes such as pain and cesarean section. The definition and description of the concept weaken the existing studies scientifically. CONCLUSIONS This scoping review revealed that multisensory birthing rooms have many definitions and variations in the content of the sensory exposure; therefore, it is difficult to standardize and evaluate the effect of its use. There is limited knowledge concerning the multisensory birthing room and its impact on the birth experience and the birth outcome. Multisensory birthing rooms may have a positive impact on the birth experience. Whereas there are conflicting results regarding birth outcomes.
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Affiliation(s)
- Anya Eidhammer
- Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Hjoerring, Denmark
- Department of Clinical Medicine, Aalborg University, Denmark
| | - Julie Glavind
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Denmark
| | | | - Dorte Melgaard
- Department of Clinical Medicine, Aalborg University, Denmark
- Department of Acute Medicine and Trauma Care, Aalborg University Hospital, Denmark
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Glavind J, Boie S. Continued versus discontinued oxytocin stimulation in active labour and neonatal morbidity. Lancet 2023; 402:2048-2049. [PMID: 37952546 DOI: 10.1016/s0140-6736(23)02017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Julie Glavind
- Department of Clinical Medicine, Obstetrics and Gynecology, Aarhus University Hospital, 8200 Aarhus N, Denmark.
| | - Sidsel Boie
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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Bagger NT, Milidou I, Boie S, Glavind J. Perinatal outcomes after therapeutic rest in the latent phase of labor: A cohort study. Acta Obstet Gynecol Scand 2023; 102:1210-1218. [PMID: 37452448 PMCID: PMC10407018 DOI: 10.1111/aogs.14635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Therapeutic rest refers to the usage of medication to relieve pain in women in the latent phase of labor. Very few data are available to evaluate the safety and effect of its use. The objectives of this study were to compare perinatal and labor outcomes in women who were seeking hospital care during the latent phase of labor and who were treated either with or without therapeutic rest. MATERIAL AND METHODS Retrospective cohort study with inclusion of nulliparous singleton pregnant women in the latent phase of labor presenting at the labor ward at Aarhus University Hospital, Denmark from May 13, 2018 to June 1, 2021. We identified two groups: women who were treated with therapeutic rest and women who were not. The primary outcomes were neonatal admission and neonatal resuscitation. Secondary outcomes included use of cardiotocography during labor, nonreactive fetal heart rate, meconium-stained amniotic fluid, pediatric delivery room assistance, umbilical cord arterial pH and standard base excess, Apgar score at 5 minutes, interventions during labor and mode of delivery. RESULTS In our sample of 800 women in the latent phase of labor, 414 women (52%) were treated with therapeutic rest and 386 women (48%) were not. The most frequently used (n = 206) medication for therapeutic rest was a combination of paracetamol, triazolam and codeine. We found no significant difference in neonatal admission (9.2% vs 6.5%, adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 0.4-3.1) or neonatal resuscitation (2.4% vs 3.1%, aOR 0.7, 95% CI 0.1-4.0) between women treated with or without therapeutic rest. There were no differences between the two groups in other perinatal adverse outcomes, interventions during labor or mode of delivery. CONCLUSIONS This study found no significant association between therapeutic rest and neonatal admission or resuscitation. Our findings indicate that therapeutic rest is a safe method for managing the latent phase of labor concerning neonatal health and does not increase the risk of labor complications.
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Affiliation(s)
- Nanna T. Bagger
- Department of Obstetrics and GynecologyAarhus University HospitalAarhusDenmark
| | - Ioanna Milidou
- Department of Pediatrics and Adolescent MedicineGødstrup HospitalHerningDenmark
| | - Sidsel Boie
- Department of Obstetrics and GynecologyAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAarhus University HospitalAarhusDenmark
| | - Julie Glavind
- Department of Obstetrics and GynecologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus University HospitalAarhusDenmark
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Krogh LQ, Glavind J, Fuglsang J, Henriksen TB, Boie S. Is induction of labor from 37 to 41 weeks per se associated with lower offspring school performance? Acta Obstet Gynecol Scand 2023. [PMID: 37148498 PMCID: PMC10377985 DOI: 10.1111/aogs.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Lise Qvirin Krogh
- Department of Clinical Medicine, Aarhus University & Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Julie Glavind
- Department of Clinical Medicine, Aarhus University & Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Fuglsang
- Department of Clinical Medicine, Aarhus University, Steno Diabetes Centre, Aarhus University Hospital & Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Tine Brink Henriksen
- Department of Clinical Medicine, Aarhus University & Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Sidsel Boie
- Department of Obstetrics and Gynecology, Aalborg University Hospital & Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Krogh LQ, Glavind J, Henriksen TB, Thornton J, Fuglsang J, Boie S. Full-term induction of labor vs expectant management and cesarean delivery in women with obesity; systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100909. [PMID: 36842468 DOI: 10.1016/j.ajogmf.2023.100909] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE This study aimed to review the literature comparing full-term induction of labor with expectant management in women with obesity on the risk of cesarean delivery and other adverse outcomes. DATA SOURCES A literature search was performed on PubMed, EMBASE, Scopus, ClinicalTrials.gov, and the Cochrane Library. This study had no time, language, or geographic restriction. STUDY ELIGIBILITY CRITERIA Studies were eligible if (1) they were cohort or randomized controlled trials, (2) they compared induction of labor at early or late term with expectant management, and (3) they included women with a body mass index of ≥30 kg/m2. Studies restricted to women with multiple pregnancy, premature rupture of membranes, or noncephalic presentation were excluded. The primary outcome was cesarean delivery. The secondary outcomes included maternal and neonatal mortality and morbidities and were evaluated. METHODS The risk of bias was assessed by 2 authors using the Risk of Bias In Non-Randomized Studies of Interventions tool. Only studies assessed with low or moderate risk of bias contributed to the meta-analysis. Data were combined to pooled relative risks and 95% confidence intervals using random effects models. The quality of evidence was assessed for selected outcomes. RESULTS Of the 232 studies identified, 13 were aligned with the inclusion criteria, and 4 cohort studies, including 216,318 women with induction of labor and 1,122,769 women managed expectantly, were included in the meta-analysis for the primary outcome. In women with obesity, full-term induction of labor was associated with a lower risk of cesarean delivery than expectant management (19.7% vs 24.5%; relative risk, 0.71; 95% confidence interval, 0.63-0.81). Moreover, this study found the same direction of the association for other selected outcomes: severe perineal lacerations (relative risk, 0.65; 95% confidence interval, 0.48-0.89), maternal infection (relative risk, 0.42; 95% confidence interval, 0.21-0.84), perinatal mortality (relative risk, 0.41; 95% confidence interval, 0.18-0.90), low Apgar score (relative risk, 0.48; 95% confidence interval, 0.26-0.91), meconium aspiration syndrome (relative risk, 0.40; 95% confidence interval, 0.28-0.56), and macrosomia (relative risk, 0.57; 95% confidence interval, 0.43-0.75). Conversely, induction of labor was associated with an increased risk of instrumental vaginal delivery (relative risk, 1.12; 95% confidence interval, 1.02-1.22). The quality of evidence ranged from low to very low. CONCLUSION Full-term induction of labor in women with obesity may reduce the risk of cesarean delivery compared with expectant management, but the quality of the evidence is low.
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Affiliation(s)
- Lise Qvirin Krogh
- Departments of Obstetrics and Gynecology (Drs Krogh, Glavind, Fuglsang, and Boie), Aarhus University Hospital, Aarhus, Denmark.
| | - Julie Glavind
- Departments of Obstetrics and Gynecology (Drs Krogh, Glavind, Fuglsang, and Boie), Aarhus University Hospital, Aarhus, Denmark; Departments of Clinical Medicine (Drs Glavind, Henriksen, and Fuglsang), Aarhus University Hospital, Aarhus, Denmark
| | - Tine Brink Henriksen
- Departments of Clinical Medicine (Drs Glavind, Henriksen, and Fuglsang), Aarhus University Hospital, Aarhus, Denmark; Departments of Pediatrics (Dr Henriksen), Aarhus University Hospital, Aarhus, Denmark
| | - Jim Thornton
- Department of Obstetrics and Gynecology, Nottingham University, Nottingham, United Kingdom (Dr Thornton)
| | - Jens Fuglsang
- Departments of Obstetrics and Gynecology (Drs Krogh, Glavind, Fuglsang, and Boie), Aarhus University Hospital, Aarhus, Denmark; Departments of Clinical Medicine (Drs Glavind, Henriksen, and Fuglsang), Aarhus University Hospital, Aarhus, Denmark; Steno Diabetes Centre, Aarhus University Hospital, Aarhus, Denmark (Dr Fuglsang)
| | - Sidsel Boie
- Departments of Obstetrics and Gynecology (Drs Krogh, Glavind, Fuglsang, and Boie), Aarhus University Hospital, Aarhus, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aarhus, Denmark (Dr Boie)
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Steer PJ, Glavind J, Uldbjerg N, Bor P, Boie S. Continued versus discontinued oxytocin stimulation in the active phase of induced labour: Factors associated with unexpectedly high rates of conversion to open label oxytocin in the CONDISOX trial. BJOG 2023; 130:636-642. [PMID: 36651106 DOI: 10.1111/1471-0528.17376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the factors associated with unexpectedly high rates of conversion to open label oxytocin in the CONDISOX trial of continuation versus discontinuation of oxytocin infusion during induced labour. DESIGN Secondary retrospective analysis of data from a prospective randomised controlled trial. SETTING Nine hospitals in Denmark and one in the Netherlands between 8 April 2016 and 30 June 2020. POPULATION OR SAMPLE 1200 women having labour induced. METHODS Analysis of outcomes by actual management. MAIN OUTCOME MEASURES Mode of delivery and associated variables. RESULTS Switching to open label oxytocin (42.4% overall) was associated with nulliparity, an unripe cervix, larger babies and higher rates of delivery by caesarean section. CONCLUSIONS In the CONDISOX trial, slow labour was associated with features suggesting a higher 'resistance to progress', often prompting the use of open-label oxytocin infusion rather than study medication.
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Affiliation(s)
- Philip J Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pinar Bor
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
| | - Sidsel Boie
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
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Meier K, Glavind J, Milidou I, Sørensen JCH, Sandager P. Burst Spinal Cord Stimulation in Pregnancy: First Clinical Experiences. Neuromodulation 2023; 26:224-232. [PMID: 35697598 DOI: 10.1016/j.neurom.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Spinal cord stimulation (SCS) is a treatment for chronic neuropathic pain. It is based on the delivery of electric impulses to the spinal cord, traditionally in a regular square-wave pattern ("tonic" stimulation) and, more recently, in a rhythmic train-of-five "BurstDR" pattern. The safety of active SCS therapy in pregnancy is not established, and recommendations are based on limited casuistic evidence. We present in this study clinical data on a case series of six women treated with burst SCS during pregnancy. In addition, we present the ultrasonographic flow measurements of fetal and uteroplacental blood flow in a pregnant patient. MATERIALS AND METHODS Patients were included if they had been implanted with a full SCS system at Aarhus University Hospital, Denmark, between 2006 and 2020 and received active burst SCS stimulation during a pregnancy. Telephone interviews were conducted, including details on SCS therapy, medication, pregnancy course and outcome, and health status of the offspring. In one patient, the uteroplacental and fetal blood flow was assessed in gestational week 29 by Doppler flow measurements performed during both ON and OFF phases of the SCS system. RESULTS Six patients were included with a total of 11 pregnancies. Three pregnancies ended in miscarriages, all in the same patient who had preexisting significant risk factors for miscarriage. Eight resulted in a live-born child with normal birth weight for gestational age; seven were born at term, and one was born late preterm, in gestational week 36. Ultrasonographic Doppler flow, measured in one patient, was normal and did not reveal any immediate changes between burst SCS ON and OFF. Seven children were reported healthy with normal neurodevelopment and one physically healthy but with developmental delays. CONCLUSIONS The data presented in this study add to the accumulating evidence of the safety of SCS in pregnancy.
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Affiliation(s)
- Kaare Meier
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark; Center for Experimental Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Julie Glavind
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ioanna Milidou
- Department of Pediatrics and Adolescent Medicine, Regional Hospital West Jutland, Herning, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Christian Hedemann Sørensen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Center for Experimental Neuroscience, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Puk Sandager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
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Adamina M, Andreou A, Arezzo A, Christogiannis C, Di Lorenzo N, Gioumidou M, Glavind J, Iavazzo C, Mavridis D, Muysoms FE, Preda D, Smart NJ, Syropoulou A, Tzanis AΑ, Van de Velde M, Vermeulen J, Antoniou SA. EAES rapid guideline: systematic review, meta-analysis, GRADE assessment, and evidence-informed European recommendations on appendicitis in pregnancy. Surg Endosc 2022; 36:8699-8712. [PMID: 36307599 DOI: 10.1007/s00464-022-09625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Clinical practice recommendations for the management of acute appendicitis in pregnancy are lacking. OBJECTIVE To develop an evidence-informed, trustworthy guideline on the management of appendicitis in pregnancy. We aimed to address the questions of conservative or surgical management, and laparoscopic or open surgery for acute appendicitis. METHODS We performed a systematic review, meta-analysis, and evidence appraisal using the GRADE methodology. A European, multidisciplinary panel of surgeons, obstetricians/gynecologists, a midwife, and 3 patient representatives reached consensus through an evidence-to-decision framework and a Delphi process to formulate the recommendations. The project was developed in an online authoring and publication platform (MAGICapp). RESULTS Research evidence was of very low certainty. We recommend operative treatment over conservative management in pregnant patients with complicated appendicitis or appendicolith on imaging studies (strong recommendation). We suggest operative treatment over conservative management in pregnant patients with uncomplicated appendicitis and no appendicolith on imaging studies (weak recommendation). We suggest laparoscopic appendectomy in patients with acute appendicitis until the 20th week of gestation, or when the fundus of the uterus is below the level of the umbilicus; and laparoscopic or open appendectomy in patients with acute appendicitis beyond the 20th week of gestation, or when the fundus of the uterus is above the level of the umbilicus, depending on the preference and expertise of the surgeon. CONCLUSION Through a structured, evidence-informed approach, an interdisciplinary panel provides a strong recommendation to perform appendectomy for complicated appendicitis or appendicolith, and laparoscopic or open appendectomy beyond the 20th week, based on the surgeon's preference and expertise. GUIDELINE REGISTRATION NUMBER IPGRP-2022CN210.
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Affiliation(s)
- Michel Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
| | - Anthoula Andreou
- Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Christos Christogiannis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Nicola Di Lorenzo
- Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy
| | - Meropi Gioumidou
- Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
| | - Julie Glavind
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Christos Iavazzo
- Gynaecological Oncology Department, Metaxa Cancer Hospital, Piraeus, Greece
| | - Dimitrios Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
- Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Filip E Muysoms
- Department of Surgery, Maria Middelares Hospital, Gent, Belgium
| | - Daniel Preda
- 1St Clinic of Surgery, Craiova Emergency Clinical County Hospital, Craiova, Romania
| | - Neil J Smart
- Department of General Surgery, Royal Devon and Exeter Hospital, Exeter, UK
| | | | | | - Marc Van de Velde
- Department of Cardiovascular Sciences, KU Leuven and Department of Anaesthesiology, UZ Leuven, Louvain, Belgium
| | - Joeri Vermeulen
- Department Health Care, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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Krogh LQ, Boie S, Henriksen TB, Thornton J, Fuglsang J, Glavind J. Induction of labour at 39 weeks versus expectant management in low-risk obese women: study protocol for a randomised controlled study. BMJ Open 2022; 12:e057688. [PMID: 35470194 PMCID: PMC9039382 DOI: 10.1136/bmjopen-2021-057688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Obesity is associated with many pregnancy complications, including both fetal macrosomia and prolonged labour. As a result, there is often also an increased risk of caesarean section. In other settings, labour induction near to term reduces adverse outcomes such as stillbirth and birth injury, without causing more caesarean deliveries. It has been suggested that induction will reduce adverse events in this setting too, but there have been no trials and the effect on caesarean section is unknown. The objective of this study is to compare induction of labour in gestational week 39 with expectant management on the risk of caesarean section in women with body mass index ≥30 kg/m2. METHODS AND ANALYSIS An open label randomised controlled multicentre trial are conducted at Danish delivery departments with an in-house neonatal intensive care unit. Recruitment started October 2020. A total of 1900 women with a prepregnancy body mass index ≥30 kg/m2 are randomised in a 1:1 ratio to either labour induction at 39 weeks and 0 to 3 days of gestation or to expectant management; that is, waiting for spontaneous labour onset or induction if medically indicated. The primary outcome is caesarean section. Data will be analysed according to intention-to-treat. ETHICS AND DISSEMINATION The Central Denmark Region Committee on Biomedical Research Ethics approved the study. The study is conducted in accordance with the ethical principles outlined in the latest version of the 'Declaration of Helsinki' and the 'Guideline for Good Clinical Practice' related to experiments on humans. The trial findings will be disseminated to participants, clinicians, commissioning groups and via peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04603859.
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Affiliation(s)
- Lise Qvirin Krogh
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sidsel Boie
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
| | - Tine Brink Henriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pediatrics, Aarhus University Hospital, Aarhus N, Denmark
| | - Jim Thornton
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jens Fuglsang
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Glavind J. Therapeutic rest in early labor may adversely affect the risk of neonatal admission. Am J Obstet Gynecol MFM 2021; 3:100432. [PMID: 34214718 DOI: 10.1016/j.ajogmf.2021.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Julie Glavind
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark.
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Boie S, Glavind J, Uldbjerg N, Steer PJ, Bor P. Continued versus discontinued oxytocin stimulation in the active phase of labour (CONDISOX): double blind randomised controlled trial. BMJ 2021; 373:n716. [PMID: 33853878 PMCID: PMC8044921 DOI: 10.1136/bmj.n716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether discontinuing oxytocin stimulation in the active phase of induced labour is associated with lower caesarean section rates. DESIGN International multicentre, double blind, randomised controlled trial. SETTING Nine hospitals in Denmark and one in the Netherlands between 8 April 2016 and 30 June 2020. PARTICIPANTS 1200 women stimulated with intravenous oxytocin infusion during the latent phase of induced labour. INTERVENTION Women were randomly assigned to have their oxytocin stimulation discontinued or continued in the active phase of labour. MAIN OUTCOME MEASURE Delivery by caesarean section. RESULTS A total of 607 women were assigned to discontinuation and 593 to continuation of the oxytocin infusion. The rates of caesarean section were 16.6% (n=101) in the discontinued group and 14.2% (n=84) in the continued group (relative risk 1.17, 95% confidence interval 0.90 to 1.53). In 94 parous women with no previous caesarean section, the caesarean section rate was 7.5% (11/147) in the discontinued group and 0.6% (1/155)in the continued group (relative risk 11.6, 1.15 to 88.7). Discontinuation was associated with longer duration of labour (median from randomisation to delivery 282 v 201 min; P<0.001), a reduced risk of hyperstimulation (20/546 (3.7%) v 70/541 (12.9%); P<0.001), and a reduced risk of fetal heart rate abnormalities (153/548 (27.9%) v 219/537 (40.8%); P<0.001) but rates of other adverse maternal and neonatal outcomes were similar between groups. CONCLUSIONS In a setting where monitoring of the fetal condition and the uterine contractions can be guaranteed, routine discontinuation of oxytocin stimulation may lead to a small increase in caesarean section rate but a significantly reduced risk of uterine hyperstimulation and abnormal fetal heart rate patterns. TRIAL REGISTRATION ClinicalTrials.gov NCT02553226.
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Affiliation(s)
- Sidsel Boie
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
| | - Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Philip J Steer
- Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Pinar Bor
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
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Nielsen TM, Glavind J, Milidou I, Henriksen TB. Early-term elective Caesarean sections did not increase the risk of behavioural problems at six to eight years of age. Acta Paediatr 2021; 110:857-868. [PMID: 32649011 DOI: 10.1111/apa.15468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
AIM Our aim was to explore the under-researched associations between an elective Caesarean section (C-section) at early-term or full-term gestation and behaviour at 6-8 years of age. METHODS We identified 1220 eligible children born by elective C-sections at Danish hospital from 2009 to 2011. Their mothers were randomised to elective C-sections at either 38+3 (early-term) or 39+3 (full-term) weeks of gestation. From December 2017 to August 2018, the parents completed the Strengths and Difficulties Questionnaire. The results were adjusted for maternal education, parity and the child's sex. RESULTS Of the 574 (45%) children followed up, 288 were delivered early-term and 286 were delivered full-term. The groups had similar baseline characteristics. There were no differences in the total difficulties score, subscale scores or the risk of being classified as having a possible or probable psychiatric disorder. Early-term boys had a lower risk of being classified as having a possible or probable psychiatric disorder and early-term girls had higher risk, but the results were not statistically significant. CONCLUSION We found no difference in behaviour at 6-8 years of age between children born by elective C-section at early- versus full-term gestation.
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Affiliation(s)
| | - Julie Glavind
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Obstetrics and Gynaecology Aarhus University Hospital Aarhus Denmark
| | - Ioanna Milidou
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Paediatrics and Adolescent Medicine Herning Regional Hospital Herning Denmark
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Paediatrics and Adolescent Medicine Aarhus University Hospital Aarhus Denmark
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Brogaard L, Barbosa M, Boie S, Glavind J. [Christmas article: Please put your pants on - an RCT]. Ugeskr Laeger 2020; 182:V71111. [PMID: 33280660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION It is common practice after a pelvic exam to ask a woman to put her pants on, before she is given verbal information. We aimed to compare short-term memory in undressed versus dressed women. METHODS Thirty-six female Ob/Gyn doctors were randomised to receive verbal information while undressed and still in a lithotomy position, or once dressed again. The primary outcome was the proportion of items recalled from a 20-item list. RESULTS We found no significant difference in recall; 58% in dressed women versus 62% in undressed women (p = 0.26). CONCLUSION The memory of women is not affected by, whether or not they are dressed. FUNDING none. TRIAL REGISTRATION none.
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Boie S, Lauridsen HH, Glavind J, Smed MK, Uldbjerg N, Bor P. The Childbirth Experience Questionnaire (CEQ)-Validation of its use in a Danish-speaking population of new mothers stimulated with oxytocin during labour. PLoS One 2020; 15:e0233122. [PMID: 32407376 PMCID: PMC7224492 DOI: 10.1371/journal.pone.0233122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/28/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND When determining optimal treatment regimens, patient reported outcomes including satisfaction are increasingly appreciated. It is well established that the birth experience may affect the postnatal attachment to the newborn and the management of subsequent pregnancies and deliveries. As we have no robust validated Danish tool to evaluate the childbirth experience exists, we aimed to perform a transcultural adaptation of the Childbirth Experience Questionnaire (CEQ) to a Danish context. METHODS In accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), we translated the Swedish-CEQ to Danish. The Danish-CEQ was tested for content validity among 10 new mothers. In a population of women who have had their labour induced, we then assessed the electronic questionnaire for validity and reliability using factor analytical design, hypothesis testing, and internal consistency. Based on these data, we determined criterion and construct responsiveness in addition to floor and ceiling effects. RESULTS The content validation resulted in minor adjustments in two items. This improved the comprehensibility. The electronic questionnaire was completed by 377 of 495 women (76.2%). The original Swedish-CEQ was four-dimensional, however an exploratory factor analysis revealed a three-dimensional structure in our Danish population (Own capacity, Participation, and Professional support). Parous women, women who delivered vaginally, and women with a labour duration <12 hours had a higher score in each domain. The internal consistency (Cronbach's alpha) ranged between 0.75 and 0.89 and the ICC between 0.68-0.93. We found ceiling effects of 57.6% in the domain Professional support and of 25.5% in the domain Participation. CONCLUSION This study offers transcultural adaptation of the Swedish-CEQ to a Danish context. The 3-dimensional Danish-CEQ demonstrates construct validity and reliability. Our results revealed significant ceiling effect especially in the domain Professional support, which needs to be acknowledged when considering implementing the Danish-CEQ into trials and clinical practice.
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Affiliation(s)
- Sidsel Boie
- Department of Obstetrics and Gynaecology, Regional Hospital of Randers, Randers NØ, Denmark
| | - Henrik Hein Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Kiel Smed
- Department of Obstetrics and Gynaecology, Rigshospitalet, Copenhagen, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Pinar Bor
- Department of Obstetrics and Gynaecology, Regional Hospital of Randers, Randers NØ, Denmark
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Glavind J, Greve T, de Wolff MG, Hansen MK, Henriksen TB. Medication used in Denmark in the latent phase of labor - Do we know what we are doing? Sex Reprod Healthc 2020; 25:100515. [PMID: 32361536 DOI: 10.1016/j.srhc.2020.100515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe the various combinations of medication used in Denmark in the latent phase of labor (i.e. for therapeutic rest) and to estimate the frequency of use. METHODS An informal e-mail survey based on personal information from Danish midwives or staff obstetricians. The main outcome measures were type and dosage of medications used individually or in combination ("cocktail") for therapeutic rest in Danish delivery wards during the latent phase of labor and also the frequency of their use. RESULTS All twenty-one delivery wards in Denmark participated in the survey. The types and dosages of medication varied substantially. Two delivery wards used prescriptions on morphine with no other medication for therapeutic rest. The remaining 19/21 delivery wards (90%) used a standard "cocktail" with two to four different types of medications; 19/21 wards (90%) used a mild analgesic (paracetamol), 17/21 (81%) used anxiolytics/hypnotics, and 14/21 (64%) wards used a strong analgesic (opioid) in their basic cocktail. Ten delivery wards (48%) combined an opioid, a sedative, and paracetamol in their basic cocktail. Between 7% and 21% of all pregnant women were given a cocktail. CONCLUSION In a small country, we found considerable national variation in the medication or combinations of medication used in the latent phase of labor, and polypharmacy was standard in the majority of the delivery wards.
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Affiliation(s)
- Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark.
| | - Tine Greve
- Department of Obstetrics and Gynecology, Amager and Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Mie Gaarskjaer de Wolff
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Mette Kabell Hansen
- Department of Obstetrics and Gynecology, Amager and Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Tine Brink Henriksen
- Department of Paediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark
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Abstract
Introduction: Whether there is an association between residual myometrial thickness (RMT) after cesarean section (CS) and the risk of uterine rupture (UR) or uterine scar dehiscence at the subsequent delivery has been sparsely investigated.Materials and methods: Our cohort included 149 women with a first CS in whom we measured RMT by transvaginal ultrasonography 6-15 months after their delivery. We did a follow-up study on delivery outcomes in the women's subsequent births. The exposure was scar measurements in the non-pregnant uterus, and the primary outcome was a diagnosis of UR or dehiscence. We calculated likelihood ratios (LRs) with 95% confidence intervals of having UR or dehiscence with a thin RMT (<3 mm).Results: Among the 149 women, 39 had a repeat CS (14 scheduled and 25 unscheduled procedures), and within these, we found one woman with UR and five women with uterine dehiscence. The proportion of women with a thin RMT was significantly higher among cases (4/6) than in controls (4/33); the LR was 5.5 (95% CI 1.9-16.2).Conclusions: The results suggest a significant association between a thin RMT as measured by transvaginal ultrasonography in the non-pregnant uterus after a first scheduled CS and the risk of UR or dehiscence at a subsequent delivery.
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Affiliation(s)
- Johanne Koba Risager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Julie Glavind
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Glavind J, Boie S, Glavind E, Fuglsang J. Risk of recurrent acute fatty liver of pregnancy: survey from a social media group. Am J Obstet Gynecol MFM 2020; 2:100085. [PMID: 33345956 DOI: 10.1016/j.ajogmf.2020.100085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acute fatty liver of pregnancy is a rare but serious complication in the last trimester of pregnancy or postpartum period. Data on the recurrence risk are largely unavailable, as only case reports or very small case series exist in which only 1 woman had recurrent acute fatty liver of pregnancy. OBJECTIVE We aimed to estimate the risk of acute fatty liver of pregnancy recurrence and to compare disease severity and gestational age between primary and recurrent disease using patient-provided data from an acute fatty liver of pregnancy social media patient group. MATERIALS AND METHODS We developed and distributed an electronic questionnaire through an international Facebook group called "Acute Fatty Liver of Pregnancy." The data collection took place from June 11, 2018, to August 17, 2018, using REDCap. Our main outcome measures were recurrence of acute fatty liver of pregnancy, severity with recurrence, and gestational age at delivery. RESULTS A total of 69 women with previous acute fatty liver of pregnancy completed the questionnaire; 24 women had a subsequent delivery, of whom 5 women were diagnosed with acute fatty liver of pregnancy again. In 4 of 5 of these women (80%), acute fatty liver of pregnancy took a milder course, whereas in 1 woman it worsened in the next pregnancy. Women with acute fatty liver of pregnancy recurrence delivered at a median gestational age at 265 days (interquartile range, 242-287 days) in their first pregnancy with acute fatty liver of pregnancy as compared to delivery by a prelabor cesarean delivery at 245 days (interquartile range, 235-261 days) in their second pregnancy with acute fatty liver of pregnancy. Male fetal sex was not associated with an increased risk of recurrent acute fatty liver of pregnancy. CONCLUSION One in 5 women reported having had recurrent acute fatty liver of pregnancy, with most cases being milder, possibly because of an earlier gestational age at delivery.
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Affiliation(s)
- Julie Glavind
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
| | - Sidsel Boie
- Department of Obstetrics and Gynecology, Regional Hospital of Randers, Randers, Denmark
| | - Emilie Glavind
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Fuglsang
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Boie S, Glavind J, Uldbjerg N, Bakker JJH, van der Post JAM, Steer PJ, Bor P. CONDISOX- continued versus discontinued oxytocin stimulation of induced labour in a double-blind randomised controlled trial. BMC Pregnancy Childbirth 2019; 19:320. [PMID: 31477047 PMCID: PMC6720847 DOI: 10.1186/s12884-019-2461-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/15/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Oxytocin is an effective drug for induction of labour, but is associated with serious adverse effects of which uterine tachysystole, fetal distress and the need of immediate delivery are the most common. Discontinuation of oxytocin once the active phase of labour is established could reduce the adverse effects. The objective is to investigate how the caesarean section rate is affected when oxytocin stimulation is discontinued in the active phase of labour compared to labours where oxytocin is continued. METHODS CONDISOX is a double-blind multicentre randomised controlled trial conducted at Danish and Dutch Departments of Obstetrics and Gynaecology. The first participant was recruited on April 8 2016. Based on a clinically relevant relative reduction in caesarean section rate of 7%, an alpha of 0.05, a beta of 80%, we aim for 1200 participating women (600 in each arm). The CONDISOX trial includes women at a gestational age of 37-42 complete weeks of pregnancy, who have uterine activity stimulated with oxytocin infusion for the induction of labour. Women are randomised when the active phase of labour becomes established, to study medication containing either oxytocin (continuous group) or placebo (discontinued group) infusion. Women are stratified by birth site, indication for oxytocin stimulation (induction of labour, prelabour rupture of membranes) and parity (nulliparous, parous +/- previous caesarean section). We will compare the primary outcome, caesarean section rate, in the two groups using a chi-square test with a p-value of 0.05. If superiority is not demonstrated, we have a pre-defined post hoc non-inferiority boundary (margin, delta) at 1.09. Secondary outcomes include duration of the active phase of labour, incidence of uterine tachysystole, postpartum haemorrhage, admission to the neonatal intensive care unit, Apgar score, umbilical arterial blood pH, and birth experience. DISCUSSION The high frequency of oxytocin use and the potential risks of both maternal and fetal adverse effects of oxytocin emphasise the need to determine the optimal oxytocin regime for induction of labour. TRIAL REGISTRATION NCT02553226 (registered September 17, 2015). Eudra-CT number: 2015-002942-30.
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Affiliation(s)
- Sidsel Boie
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
| | - Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jannet J. H. Bakker
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Joris A. M. van der Post
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Philip J. Steer
- Academic Department of Obstetrics and Gynaecology, Division of cancer Imperial College London, London, UK
| | - Pinar Bor
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
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Nielsen TM, Pedersen MV, Milidou I, Glavind J, Henriksen TB. Long‐term cognition and behavior in children born at early term gestation: A systematic review. Acta Obstet Gynecol Scand 2019; 98:1227-1234. [DOI: 10.1111/aogs.13644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/09/2019] [Accepted: 05/11/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Trine M. Nielsen
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
| | - Mette V. Pedersen
- Department of Pediatrics and Adolescent Medicine Aarhus University Aarhus Denmark
| | - Ioanna Milidou
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Pediatrics and Adolescent Medicine Herning Regional Hospital Herning Denmark
| | - Julie Glavind
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Obstetrics and Gynecology Aarhus University Hospital Aarhus Denmark
| | - Tine B. Henriksen
- Perinatal Epidemiology Research Unit Aarhus University Aarhus Denmark
- Department of Pediatrics and Adolescent Medicine Aarhus University Aarhus Denmark
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Boie S, Glavind J, Velu AV, Mol BWJ, Uldbjerg N, de Graaf I, Thornton JG, Bor P, Bakker JJH. Discontinuation of intravenous oxytocin in the active phase of induced labour. Cochrane Database Syst Rev 2018; 8:CD012274. [PMID: 30125998 PMCID: PMC6513418 DOI: 10.1002/14651858.cd012274.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND In most Western countries, obstetricians and midwives induce labour in about 25% of pregnant women. Oxytocin is an effective drug for this purpose, but associated with serious adverse effects of which uterine tachysystole, fetal distress and the need for immediate delivery are the most common. Various administration regimens such as reduced or pulsatile dosing have been suggested to minimise these. Discontinuation in the active phase of labour, i.e. when contractions are well-established and the cervix is dilated at least 5 cm is another method which may reduce adverse effects. OBJECTIVES To assess whether birth outcomes can be improved by discontinuation of intravenous (IV) oxytocin, initiated in the latent phase of induced labour, once active phase of labour is established. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (31 January 2018), Scopus, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (23 January 2018) together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing discontinued IV with continuous IV oxytocin in the active phase of induced labour.No exclusion criteria were applied in terms of parity, maternal age, ethnicity, co-morbidity status, labour setting, gestational age, and prior caesarean delivery.Studies comparing different dosage regimens are outside the scope of this review. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. MAIN RESULTS We found 10 completed RCTs involving 1888 women. One additional trial is ongoing. The included trials were conducted in hospital settings between February 1998 and January 2016, two in Europe (Denmark, and Greece), two in Turkey, and one each in Israel, Iran, USA, Bangladesh, India, and Thailand. Most trials included full-term singleton pregnancies with a fetus in vertex presentation. Some excluded women with cervical priming prior to induction and some excluded women with a history of prior caesarean delivery. When reported, the average age of the women ranged from 22 to 31 years, nulliparity from 45% to 68%, and pre-pregnancy body mass index from 22 to 32.Many of the included trials had design limitations and were judged to be at either high or unclear risk of bias across a number of 'Risk of bias' domains.Four trials included a Consort flow diagram. In three, this gave details of participants delivered before the active phase of labour, and treatment compliance for those who reached that stage. One Consort diagram only provided the latter information. The data in many of the trials without such a flow diagram were implausibly compliant with treatment allocation, suggesting that there had been silent post randomisation exclusions of women delivered before the active phase of labour. We therefore conducted a secondary analysis (not in our protocol) of caesarean section among women who reached the active phase of labour and were therefore eligible for the intervention.Our analysis by 'intention-to-treat' found that, compared with continuation of IV oxytocin stimulation, discontinuation of IV oxytocin may reduce the caesarean delivery rate, risk ratio (RR) 0.69, 95% confidence interval (CI) 0.56 to 0.86, 9 trials, 1784 women, low-level certainty. However, restricting our analysis to women who reached the active phase of labour (using 'reached active phase' as our denominator) suggests there is probably little or no difference between groups (RR 0.92, 95% CI 0.65 to 1.29, 4 trials, 787 women, moderate-certainty evidence).Discontinuation of IV oxytocin probably reduces the risk ofuterine tachysystole combined with abnormal fetal heart rate (FHR) compared with continued IV oxytocin (RR 0.15, 95% CI 0.05 to 0.46, 3 trials, 486 women, moderate-level certainty). We are uncertain about whether or not discontinuation increases the risk of chorioamnionitis (average RR 2.32, 95% CI 0.99 to 5.45, 1 trial, 252 women, very low-level certainty). Discontinuation of IV oxytocin may have little or no impact on the use of analgesia and epidural during labour compared to the use of continued IV oxytocin (RR 1.04 95% CI 0.95 to 1.14, 3 trials, 556 women, low-level certainty). Intrapartum cardiotocography (CTG) abnormalities (suspicious/pathological CTGs) are probably reduced by discontinuing IV oxytocin (RR 0.65, 95% CI 0.51 to 0.83, 7 trials, 1390 women, moderate-level certainty). Compared to continuing IV oxytocin, discontinuing IV oxytocin probably has little or no impact on the incidence of Apgar < 7 at five minutes (RR 0.78, 95% CI 0.27 to 2.21, 4 trials, 893 women, low-level certainty), or and acidotic cord gasses at birth (arterial umbilical pH < 7.10), (RR 1.03, 95% CI 0.50 to 2.13, 4 trials, 873 women, low-level certainty).Many of this review's maternal and infant secondary outcomes (including maternal and neonatal mortality) were not reported in the included trials. AUTHORS' CONCLUSIONS Discontinuing IV oxytocin stimulation after the active phase of labour has been established may reduce caesarean delivery but the evidence for this was low certainty. When restricting our analysis to those trials that separately reported participants who reached the active phase of labour, our results showed there is probably little or no difference between groups. Discontinuing IV oxytocin may reduce uterine tachysystole combined with abnormal FHR.Most of the trials had 'Risk of bias' concerns which means that these results should be interpreted with caution. Our GRADE assessments ranged from very low certainty to moderate certainty. Downgrading decisions were based on study limitations, imprecision and indirectness.Future research could account for all women randomised and, in particular, note those who delivered before the point at which they would be eligible for the intervention (i.e. those who had caesareans in the latent phase), or because labour was so rapid that the infusion could not be stopped in time.Future trials could adopt the outcomes listed in this review including maternal and neonatal mortality, maternal satisfaction, and breastfeeding.
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Affiliation(s)
- Sidsel Boie
- Regional Hospital of RandersDepartment of Obstetrics and GynecologySkovlyvej 1RandersDenmark8930
| | - Julie Glavind
- Aarhus University HospitalDepartment of Obstetrics and GynecologyBrendstrupgaardsvej 100Aarhus NDenmark8200
| | - Adeline V Velu
- Academic Medical CenterDepartment of Obstetrics and GynaecologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Ben Willem J Mol
- Monash UniversityDepartment of Obstetrics and Gynaecology246 Clayton RoadClaytonVictoriaAustralia3168
| | - Niels Uldbjerg
- Aarhus University HospitalDepartment of Obstetrics and GynecologyBrendstrupgaardsvej 100Aarhus NDenmark8200
| | - Irene de Graaf
- Academic Medical CenterDepartment of Obstetrics and GynaecologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Jim G Thornton
- University of NottinghamDivision of Child Health, Obstetrics and Gynaecology, School of MedicineNottingham City Hospital NHS TrustHucknall RoadNottinghamNottinghamshireUKNG5 1PB
| | - Pinar Bor
- Regional Hospital of RandersDepartment of Obstetrics and GynecologySkovlyvej 1RandersDenmark8930
| | - Jannet JH Bakker
- Academic Medical CenterDepartment of Obstetrics and GynaecologyMeibergdreef 9AmsterdamNetherlands1105 AZ
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Abstract
OBJECTIVES To examine the association between postpartum urinary tract infection and intended mode of delivery as well as actual mode of delivery. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS All live births in Denmark between 2004 and 2010 (n=450 856). Births were classified by intended caesarean delivery (n=45 053) or intended vaginal delivery (n=405 803), and by actual mode of delivery: spontaneous vaginal delivery, operative vaginal delivery, emergency or planned caesarean delivery in labour or prelabour. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was postpartum urinary tract infection (n=16 295) within 30 days post partum, defined as either a diagnosis of urinary tract infection in the National Patient Registry or redemption of urinary tract infection-specific antibiotics recorded in the Register of Medicinal Product Statistics. RESULTS We found that 4.6% of women with intended caesarean delivery and 3.5% of women with intended vaginal delivery were treated for postpartum urinary tract infection.Women with intended caesarean delivery had a significantly increased risk of postpartum urinary tract infection compared with women with intended vaginal delivery (OR 1.33, 95% CI 1.27 to 1.40), after adjustment for age at delivery, smoking, body mass index, educational level, gestational diabetes mellitus, infection during pregnancy, birth weight, preterm delivery, preterm prelabour rupture of membranes, pre-eclampsia, parity and previous caesarean delivery (adjusted OR 1.24, 95% CI 1.17 to 1.46).Using actual mode of delivery as exposure, all types of operative delivery had an equally increased risk of postpartum urinary tract infection compared with spontaneous vaginal delivery. CONCLUSIONS Compared with intended vaginal delivery, intended caesarean delivery was significantly associated with a higher risk of postpartum urinary tract infection. Future studies should focus on reducing routine catheterisation prior to operative vaginal delivery as well as improving procedures related to catheterisation.
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Affiliation(s)
| | - Lone Krebs
- Department of Gynecology and Obstetrics, Holbaek Sygehus, Holbaek, Denmark
| | | | | | - Julie Glavind
- Institute for Clinical Medicine, Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
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Haahr T, Glavind J, Axelsson P, Bistrup Fischer M, Bjurström J, Andrésdóttir G, Teilmann-Jørgensen D, Bonde U, Olsén Sørensen N, Møller M, Fuglsang J, Ovesen PG, Petersen JP, Stokholm J, Clausen TD. Vaginal seeding or vaginal microbial transfer from the mother to the caesarean-born neonate: a commentary regarding clinical management. BJOG 2017. [PMID: 28626982 DOI: 10.1111/1471-0528.14792] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- T Haahr
- Department of Obstetrics and Gynaecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus University, Skejby, Aarhus, Denmark
| | - J Glavind
- Department of Obstetrics and Gynaecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus University, Skejby, Aarhus, Denmark
| | - P Axelsson
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, University of Copenhagen, Hillerød, Denmark
| | - M Bistrup Fischer
- Department of Gynaecology and Obstetrics, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - J Bjurström
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - G Andrésdóttir
- Department of Gynaecology and Obstetrics, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - D Teilmann-Jørgensen
- Department of Gynaecology and Obstetrics, University Hospital of Odense, Odense, Denmark
| | - U Bonde
- Department of Gynaecology and Obstetrics, University Hospital of Odense, Odense, Denmark
| | - N Olsén Sørensen
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M Møller
- Department of Gynaecology and Obstetrics, Aalborg University Hospital, Aalborg, Denmark
| | - J Fuglsang
- Department of Obstetrics and Gynaecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus University, Skejby, Aarhus, Denmark
| | - P G Ovesen
- Department of Obstetrics and Gynaecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus University, Skejby, Aarhus, Denmark
| | - J P Petersen
- Department of Paediatrics, Aarhus University Hospital, Skejby, Denmark
| | - J Stokholm
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev, Denmark.,Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T D Clausen
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, University of Copenhagen, Hillerød, Denmark
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Glavind J, Milidou I, Uldbjerg N, Maimburg R, Henriksen TB. Neonatal morbidity after spontaneous labor onset prior to intended cesarean delivery at term: a cohort study. Acta Obstet Gynecol Scand 2017; 96:479-486. [DOI: 10.1111/aogs.13097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Julie Glavind
- Perinatal Epidemiology Research Unit; Department of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Ioanna Milidou
- Perinatal Epidemiology Research Unit; Department of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
- Department of Pediatrics; Aarhus University Hospital; Aarhus Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
| | - Rikke Maimburg
- Perinatal Epidemiology Research Unit; Department of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
- Center of Research in Rehabilitation (CORIR); Aarhus University Hospital; Aarhus Denmark
| | - Tine B. Henriksen
- Perinatal Epidemiology Research Unit; Department of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
- Department of Pediatrics; Aarhus University Hospital; Aarhus Denmark
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Boie S, Velu AV, Glavind J, Mol BWJ, Uldbjerg N, de Graaf I, Bor P, Bakker JJH. Discontinuation of intravenous oxytocin in the active phase of induced labour. Hippokratia 2016. [DOI: 10.1002/14651858.cd012274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sidsel Boie
- Regional Hospital of Randers/Aarhus University; Department of Gynaecology and Obstetrics; Skovlyvej 1 Randers Denmark 8900
| | - Adeline V Velu
- Academic Medical Center; Department of Obstetrics and Gynaecology; Meibergdreef 9 Amsterdam Netherlands 1105 AZ
| | - Julie Glavind
- Regional Hospital of Randers/Aarhus University; Department of Gynaecology and Obstetrics; Skovlyvej 1 Randers Denmark 8900
- Aarhus University Hospital; Department of Obstetrics and Gynecology; Brendstrupgaardsvej 100 Aarhus N Denmark 8200
| | - Ben Willem J Mol
- The University of Adelaide; Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute; Level 3, Medical School South Building Frome Road Adelaide South Australia Australia SA 5005
| | - Niels Uldbjerg
- Aarhus University Hospital; Department of Obstetrics and Gynecology; Brendstrupgaardsvej 100 Aarhus N Denmark 8200
| | - Irene de Graaf
- Academic Medical Center; Department of Obstetrics and Gynaecology; Meibergdreef 9 Amsterdam Netherlands 1105 AZ
| | - Pinar Bor
- Regional Hospital of Randers/Aarhus University; Department of Gynaecology and Obstetrics; Skovlyvej 1 Randers Denmark 8900
| | - Jannet JH Bakker
- Academic Medical Center; Department of Obstetrics and Gynaecology; Meibergdreef 9 Amsterdam Netherlands 1105 AZ
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Rasmussen CK, Glavind J, Madsen LD, Uldbjerg N, Dueholm M. Repeatability of Junctional Zone Measurements Using 3-Dimensional Transvaginal Sonography in Healthy Fertile Women. J Ultrasound Med 2016; 35:1497-1508. [PMID: 27269003 DOI: 10.7863/ultra.15.06086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/22/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To describe the junctional zone and determine the intraobserver and interobserver repeatability of junctional zone measurements using 3-dimensional (3D) transvaginal sonography in healthy fertile women. METHODS We examined 82 consecutive women with 3D transvaginal sonography. The maximum and minimum junctional zone thickness was measured in all uterine walls. The difference between maximum and minimum thickness and average measurements (maximum thickness + minimum thickness/2) of the anterior, posterior, fundal, and lateral walls were calculated. Among the first 40 consecutive women, intraobserver and interobserver repeatability was evaluated according to the Bland-Altman method and expressed as a coefficient of repeatability. RESULTS Using 3D transvaginal sonography, we visualized a thin and regular junctional zone in most women. The posterior uterine wall had the largest median maximum junctional zone thickness value of 5.2 (interquartile range, 3.8-6.5) mm. Ten women (12%) had maximum thickness values of 8.0 to 12.0 mm. The maximum thickness in each uterine wall had intraobserver and interobserver coefficients of repeatability of ±2.1 to ±3.4 and ±2.6 to ±3.9 mm, respectively, which were reduced by average measurements: ±1.9 and ±2.0 mm (anterior and posterior walls) and ±1.5 mm (fundal and lateral walls) for intraobserver and interobserver values. Correlations between measurements were poor in the narrow range of junctional zone thickness. CONCLUSIONS The junctional zone has an indistinct outline on 3D transvaginal sonography, resulting in measurement errors within a broad range of ±2 to ±4 mm, which were only reduced to some extent by average measurements. The thickness of the junctional zone varied within a narrow range in this healthy fertile population, and reliability measurements of junctional zone thickness have to be evaluated in women with a wider range of thickness. The observer repeatability and reliability of junctional zone measurements need to be further evaluated and refined before applying this method in clinical practice.
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Affiliation(s)
| | - Julie Glavind
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Lene Duch Madsen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Margit Dueholm
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
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Glavind J, Madsen LD, Uldbjerg N, Dueholm M. Cesarean section scar measurements in non-pregnant women using three-dimensional ultrasound: a repeatability study. Eur J Obstet Gynecol Reprod Biol 2016; 201:65-9. [PMID: 27064944 DOI: 10.1016/j.ejogrb.2016.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate intra- and inter-observer agreement in measurements of the cesarean scar niche and the residual myometrial thickness (RMT) using 3-dimensional (3D) transvaginal ultrasonography. STUDY DESIGN Fifty-eight uterine 3D volumes from women with deep cesarean scar niches were evaluated. 3D volumes were obtained six to fifteen months after a primary cesarean section. Evaluation of the 3D volume was performed in a standardized multiplanar view. Two observers independently obtained RMT, cesarean scar niche depth (D), length (L), width (W), and myometrium adjacent to the scar (M). Differences within and between observers were expressed in mm and were evaluated according to the Bland-Altman method including the calculation of limits of agreement (LOAs). RESULTS The intra-observer LOAs in mm were as follows: RMT: -3.7 to 4.0; D: -2.2 to 2.6; L: -3.6 to 4.2; W: -4.0 to 3.7; and M: -3.4 to 4.5. The inter-observer LOAs in mm were as follows: RMT: -3.2 to 4.1; D: -3.3 to 2.2; L: -3.4 to 4.2; W: -3.2 to 4.1; and M: -4.1 to 3.2. CONCLUSIONS In non-pregnant women, we found rather wide limits of agreement measuring the cesarean section scar niche and myometrium using 3D volumes. Whether 3D transvaginal ultrasonography provides clinical advantages compared to 2D TVU needs clarification.
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Affiliation(s)
- J Glavind
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
| | - L D Madsen
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - N Uldbjerg
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - M Dueholm
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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28
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Uldbjerg N, Glavind J. [Caesarean section on maternal request]. Ugeskr Laeger 2015; 177:V67465. [PMID: 26324288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Niels Uldbjerg
- Afdeling for Kvindesygdomme og Fødsler, Aarhus Universitetshospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N.
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Glavind J, Henriksen TB, Kindberg SF, Uldbjerg N. Authors' reply: Elective ceasarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial. BJOG 2014; 121:1748-9. [PMID: 25413763 DOI: 10.1111/1471-0528.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 11/29/2022]
Affiliation(s)
- J Glavind
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Glavind J, Uldbjerg N, Kindberg SF, Henriksen TB. Authors' reply: Elective caesarean section at 38 versus 39 weeks of gestation: balance between the perceived benefits and potential drawbacks. BJOG 2014; 121:907-8. [PMID: 24842089 DOI: 10.1111/1471-0528.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J Glavind
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Glavind J, Uldbjerg N, Kindberg SF, Henriksen TB. Authors' reply: elective caesarean section at 38 versus 39 weeks of gestation: neonatal and maternal outcomes in a randomised controlled trial Are we trivialising neonatal intensive care unit admissions? BJOG 2014; 120:1702-3. [PMID: 24589006 DOI: 10.1111/1471-0528.12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
- J Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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Glavind J. Author's reply: elective caesarean section at 38 versus 39 weeks of gestation: neonatal and maternal outcomes in a randomised controlled trial. BJOG 2014; 120:1703-4. [PMID: 24589007 DOI: 10.1111/1471-0528.12471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- J Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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Glavind J, Henriksen TB, Kindberg SF, Uldbjerg N. Do pregnant women prefer timing of elective cesarean section prior to versus after 39 weeks of gestation? Secondary analyses from a randomized controlled trial. J Matern Fetal Neonatal Med 2014; 27:1782-6. [DOI: 10.3109/14767058.2013.879707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Glavind J, Henriksen TB, Kindberg SF, Uldbjerg N. Randomised trial of planned caesarean section prior to versus after 39 weeks: unscheduled deliveries and facility logistics--a secondary analysis. PLoS One 2013; 8:e84744. [PMID: 24376842 PMCID: PMC3869904 DOI: 10.1371/journal.pone.0084744] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 11/26/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives To compare the impact of scheduling caesarean section prior to versus after 39 completed weeks of gestation on the occurrence of unscheduled caesarean section and rescheduling of the procedure. Methods Secondary analysis from a multicentre randomised open-label trial including singleton pregnant women with a healthy foetus and a reliable due date. Women were allocated by computerized telephone randomisation to planned caesarean section at 38 weeks and three days or 39 weeks and three days. The outcomes were unscheduled deliveries with provided reasons, such as spontaneous labour onset or supervening complications, and any changes in the scheduled delivery date. Statistical analyses were according to intention-to-treat using Fisher’s exact test. Results From March 2009 to June 2011 1,274 women were included. Median difference in gestational age at delivery was six days. Compared to the 38 weeks group, the women in the 39 weeks group were more likely to have an unscheduled caesarean section (15.2% vs. 9.3%; RR 1.64, 95% CI 1.21; 2.22), to deliver between 6 pm and 8 am (10 % vs. 6%; RR 1.68, 95% CI 1.14; 2.47), or to have the procedure rescheduled (36.7% vs. 23%; RR 1.6, 95% CI 1.34;1.90). Conclusions Scheduling caesarean section after 39 weeks leads to a 60% increase in unscheduled caesarean sections and a 70% increase in delivery outside regular work hours as compared to scheduling of the procedure prior to 39 weeks. Trial Registration www.clinicaltrials.gov NCT00835003 http://www.clinicaltrials.gov/ct2/show/NCT00835003?term=NCT00835003&rank=1
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Affiliation(s)
- Julie Glavind
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Perinatal Epidemiology Research Unit, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Pediatrics, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sara Fevre Kindberg
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Hansen LK, Becher N, Bastholm S, Glavind J, Ramsing M, Kim CJ, Romero R, Jensen JS, Uldbjerg N. The cervical mucus plug inhibits, but does not block, the passage of ascending bacteria from the vagina during pregnancy. Acta Obstet Gynecol Scand 2013; 93:102-8. [PMID: 24266587 DOI: 10.1111/aogs.12296] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 10/15/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the microbial load and the inflammatory response in the distal and proximal parts of the cervical mucus plug. DESIGN Experimental research. POPULATION Twenty women with a normal, singleton pregnancy. SAMPLE Vaginal swabs and specimens from the distal and proximal parts of the cervical mucus plug. METHODS Immunohistochemistry, enzyme-linked immunosorbent assay, quantitative polymerase chain reaction and histology. RESULTS The total bacterial load (16S rDNA) was significantly lower in the cervical mucus plug compared with the vagina (p = 0.001). Among women harboring Ureaplasma parvum, the median genome equivalents/g were 1574 (interquartile range 2526) in the proximal part, 657 (interquartile range 1620) in the distal part and 60,240 (interquartile range 96,386) in the vagina. Histological examinations and quantitative polymerase chain reaction revealed considerable amounts of lactobacilli and inflammatory cells in both parts of the cervical mucus plug. The matrix metalloproteinase-8 concentration was decreased in the proximal part of the plug compared with the distal part (p = 0.08). CONCLUSION The cervical mucus plug inhibits, but does not block, the passage of Ureaplasma parvum during its ascending route from the vagina through the cervical canal.
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Affiliation(s)
- Lea K Hansen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Studsgaard A, Skorstengaard M, Glavind J, Hvidman L, Uldbjerg N. Trial of labor compared to repeat cesarean section in women with no other risk factors than a prior cesarean delivery. Acta Obstet Gynecol Scand 2013; 92:1256-63. [DOI: 10.1111/aogs.12240] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 08/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Anne Studsgaard
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus; Denmark
| | - Malene Skorstengaard
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus; Denmark
| | - Julie Glavind
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus; Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus; Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus; Denmark
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Glavind J, Madsen LD, Uldbjerg N, Dueholm M. Ultrasound evaluation of Cesarean scar after single- and double-layer uterotomy closure: a cohort study. Ultrasound Obstet Gynecol 2013; 42:207-212. [PMID: 23288683 DOI: 10.1002/uog.12376] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To compare residual myometrial thickness (RMT) and size of the Cesarean scar defect after single- and double-layer uterotomy closure following first elective Cesarean section. METHODS A retrospective cohort study was conducted in 149 women at least 6 months after an uncomplicated, elective Cesarean delivery. Two-dimensional transvaginal ultrasonographic measures of RMT, scar defect depth, width and length and myometrial thickness adjacent to the scar were compared in 68 women with single-layer and 81 women with double-layer closure delivered before and after, respectively, a change in the surgical procedure. Outcomes between the two groups were compared. RESULTS Median RMT was 5.8 (interquartile range (IQR), 4.1-7.8) mm in women with double-layer closure vs 4.6 (IQR, 3.4-6.5) mm in those with single-layer closure (P = 0.04). Scar defect length was greater in women with single-layer closure (median, 6.8 (IQR, 4.4-8.5) mm) than in those with double-layer closure (median, 5.6 (IQR, 3.9-6.8) mm) (P = 0.01). Measurements of defect depth and width, and the proportion of scars with RMT < 2.3 mm were similar in the two groups. CONCLUSIONS RMT was greater and defect length, but not defect depth and width, was smaller following double-layer compared with single-layer closure, which may indicate some limited benefit of double-layer closure following first elective Cesarean section.
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Affiliation(s)
- J Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark.
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38
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Affiliation(s)
- Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, DK-8200 Aarhus, Denmark.
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Glavind J, Kindberg SF, Uldbjerg N, Khalil M, Møller AM, Mortensen BB, Rasmussen OB, Christensen JT, Jørgensen JS, Henriksen TB. Elective caesarean section at 38 weeks versus 39 weeks: neonatal and maternal outcomes in a randomised controlled trial. BJOG 2013; 120:1123-32. [DOI: 10.1111/1471-0528.12278] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J Glavind
- Department of Obstetrics and Gynaecology; Aarhus University Hospital; Aarhus N; Denmark
| | - SF Kindberg
- Department of Obstetrics and Gynaecology; Aarhus University Hospital; Aarhus N; Denmark
| | - N Uldbjerg
- Department of Obstetrics and Gynaecology; Aarhus University Hospital; Aarhus N; Denmark
| | - M Khalil
- Department of Obstetrics and Gynaecology; Kolding Hospital; Kolding; Denmark
| | - AM Møller
- Department of Obstetrics and Gynaecology; Aalborg University Hospital; Aalborg; Denmark
| | - BB Mortensen
- Department of Obstetrics and Gynaecology; Regional Hospital of Viborg; Viborg; Denmark
| | - OB Rasmussen
- Department of Obstetrics and Gynaecology; Regional Hospital of Randers; Randers; Denmark
| | - JT Christensen
- Department of Obstetrics and Gynaecology; Regional Hospital of Herning; Herning; Denmark
| | - JS Jørgensen
- Department of Obstetrics and Gynaecology; Odense University Hospital; Odense; Denmark
| | - TB Henriksen
- Department of Paediatrics; Aarhus University Hospital; Aarhus N; Denmark
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Glavind J, Kindberg S, Uldbjerg N, Henriksen T. O277 TIMING OF ELECTIVE CESAREAN SECTION AND NEONATAL MORBIDITY: A RANDOMIZED CONTROLLED TRIAL. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60707-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sharif H, Glavind J, Uldbjerg N. [Reconvalescence following Caesarean section]. Ugeskr Laeger 2009; 171:2902-2905. [PMID: 19814937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Recommendations for reconvalescence and restriction of physical activity after elective caesarean section are not consistent and there is a lack of evidence on the subject. Although physiological changes are rapidly normalized after the operation, the women experience an extended period characterized by fatigue caused by lack of sleep due to nursing and breastfeeding of the baby. This paper accounts for the effects of post-operative pain, breastfeeding, fatigue, sexuality and physical recovery in the period of reconvalecence following elective caesarean section.
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Affiliation(s)
- Heidi Sharif
- Gynaekologisk Obstetrisk Afdeling, Juliane Marie Centret, Rigshospitalet, DK-2100 København Ø, Denmark.
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Glavind J, Arffmann E. The possible carcinogenic properties of altered lipids. A study of purified compounds by the newt test. Acta Pathol Microbiol Scand A 2009; 78:345-50. [PMID: 5507259 DOI: 10.1111/j.1699-0463.1970.tb03310.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Glavind K, Mørup L, Madsen H, Glavind J. A prospective, randomised, controlled trial comparing 3 hour and 24 hour postoperative removal of bladder catheter and vaginal pack following vaginal prolapse surgery. Acta Obstet Gynecol Scand 2007; 86:1122-5. [PMID: 17712655 DOI: 10.1080/00016340701505317] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of this prospective, randomised, study was to determine whether or not there was a higher incidence of bleeding, reoperation, urinary retention or bacterial count in the urine, depending on whether urinary catheter and vaginal pack was removed 3 h or 24 h after vaginal prolapse surgery. METHODS Some 136 women were randomised into Group 1 (removal of catheter and vaginal pack after 3 h), and Group 2 (removal of catheter and vaginal pack after 24 h). Data on postoperative bleeding, reoperation, and urinary retention were collected. Preoperatively, day after operation, and 14 days after operation, a urine culture was performed. RESULTS There was no tendency towards more bleeding with early removal of vaginal pack and urinary catheter. No patients in either group were reoperated during the first 48 postoperative hours. Three patients in Group 1 required sterile intermittent catheterisation postoperatively, however, only once in 2 patients. There was a trend towards a higher postoperative bacterial count in patients in Group 2 (p=0.306). CONCLUSION We recommend removing the vaginal pack and urinary catheter after 3 h with careful monitoring of the patient's voiding.
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Affiliation(s)
- Karin Glavind
- Department of Gynecology and Obstetrics, Aalborg Sygehus, Aalborg, Denmark.
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Affiliation(s)
- H Dam
- The Biochemical Institute of the University, Cophenhagen 1
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Affiliation(s)
- H Dam
- The Biochemical Institute, University of Copenhagen
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Klaer HW, Glavind J, Arffmann E. Carcinogenicity in mice of some fatty acid methyl esters. 2. Peroral and subcutaneous application. Acta Pathol Microbiol Scand A 1975; 83:550-8. [PMID: 809992 DOI: 10.1111/j.1699-0463.1975.tb00167.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Two fatty acid methyl esters, methyl oleate and methyl 12-oxo-trans-10-octadecenoate, have been tested for carcinogenicty by oral and subcutaneous administration in ST/a mice of both sexes. A positive effect of methyl oleate could not be assessed, while the results pointed to a promoter effect of methyl oxo-octadecenoate. Given in the diet, this compound increased the incidence and number of forestomach papillomas within 83 weeks after initiation by 4-nitroguinoline 1-oxide. Repeated injections of methyl oxo-octadecenoate in the inguinal area resulted in 2 local sarcomas in a group of 20 females which had previously received skin initiation by 7, 12-dimethylbenz [alpha] anthracene in the neck. In no other animal group did sarcomas appear at this location within the observation period of 2 years. An influence by the injected methyl esters on the initiated skin carcinogenesis was possibly, but weakly, present. The need for more extensive experiments is stressed, especially with a view to the possible carcinogenic hazards involved in dietary intake of oxygen-containing derivatives of oleic acid.
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Arffmann E, Glavind J. Carcinogenicity in mice of some fatty acid methyl esters. 1. Skin application. Acta Pathol Microbiol Scand A 1974; 82:127-36. [PMID: 4827342 DOI: 10.1111/j.1699-0463.1974.tb03834.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
1. The colorimetric micro-adaption of the iodometric method and the colorimetric thiocyanate method for the determination of lipoperoxides were compared. Similar results were obtained when methyl linoleate hydroperoxide was tested, but when lipid from rat liver, muscle, kindney and testes was examined, substantial amounts were found by the iodometric, but almost nothing by the thiocyanate method.2. The main reason for the discrepancy between the methods seems to be that the iodometric micromethod also estimates substances other than true lipoperoxides. The presence of ubiquinone and vitamin A in the organ extracts was shown to interfere in this way in the method.3. The yellow colour which develops when retinol and its esters are tested by the iodometric micromethod is due not to liberated iodine but to conversion products of retinol.4. It is concluded that the occurrence of substantial amounts of lipoperoxides in vivo has so far been demonstarted only in the adipose tissue, and not in the parenchymatous organs of the rat.
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