摘要:

Vulvodynia is a syndrome of unexplained vulvar pain, sexual dysfunction, and psychological disability. The incidence or prevalence of this condition is not known. Several subtypes of vulvodynia have been recognized. Recognition of the distinct subsets of vulvodynia is a prerequisite for successful management. Vulvar vestibulitis syndrome, cyclic vulvovaginitis, and dysesthetic vulvodynia are the most common subtypes. Other frequently misdiagnosed vulvar or vaginal conditions which can also cause culvodynia are vulvar papillomatosis, cytolytic vaginosis, lactobacillosis, and desquamative inflammatory vaginitis. In addition, many vulvar dermatoses can cause acute or chronic vulvar itching or pain, and are a frequent cause of differential diagnostic problems. In conclusion, vulvodynia is a complex multifactorial underdiagnosed clinical syndrome. Systematic epidemiologic, etiologic, and therapeutic studies of vulvodynia should be undertaken.

ISSN:0001-6349    

DOI:10.3109/00016349509024442

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Detection of fetal Y‐specific DNA by polymerase chain reaction was performed on cervical samplings obtained from 24 patients who underwent first trimester suction termination of pregnancy. The results were compared with the fetal gender determined by Y‐sequence polymerase chain reaction on the fetal parts. Fourteen male pregnancies were identified. Correct predictions were made in two (14.3%) from the cervical swabs and three (21.4%) from the trans‐cervical samplings. The failure of isolation of fetal cells from the cervix was not related to the gestation of sam

ISSN:0001-6349    

DOI:10.3109/00016349509024443

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Study objective.To study variations in serum relaxin concentrations during normal and abnormal human pregnancy and parturition and in umbilical cord blood.Design and patients.Diurnal variations were determined in samples collected every 2 hours for 24 hours (n=4). Variations during pregnancy were studied in samples taken every 4th week from normal pregnant women (n=26). Additionally samples were collected once a week from the 37th week of pregnancy and until spontaneous delivery (n= 5). Changes in relaxin during early pregnancy (gestational age: 30 to 97 days) were studied in serum from 12 normal pregnant women, 13 with spontaneous abortion and 38 with an ectopic pregnancy. Fetal serum was obtained at delivery from the umbilical vein (n=20). All samples were analysed for relaxin by an ELISA based on human relaxin antibodies.Main results.No diurnal variation in relaxin concentrations were found. In normal pregnant women relaxin concentrations increased during the first 14 weeks of pregnancy. From week 14 to 24 a gradual decrease was found and the concentrations remained constant during the last part of pregnancy. No changes in concentrations were found immediately before or during spontaneous delivery. Women with abnormal pregnancies had lower serum relaxin values than normal early pregnant women. The relaxin concentration was significantly correlated to the serum HCG concentration in early pregnancy but not to the serum HPL levels after week 28. In the umbilical vein relaxin concentrations were low.Conclusion.The variation in circulating levels of relaxin during human pregnancy differs markedly from those found in other species. This suggests a different role for relaxin in human pregnancy.

ISSN:0001-6349    

DOI:10.3109/00016349509024444

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Purpose.To evaluate the endothelial cell state and the possible relation to placental function in the third trimester of normal pregnancy by an indirect assessment of endothelial cell function.Study‐design.Twenty‐six pregnant women entered the study in the 30th week of pregnancy. Von Willebrand Factor, urate and key hemostatic variables were quantified at entry, and during the 33rd and 37th weeks of pregnancy.Results.Levels of von Willebrand Factor, PAI‐1 antigen, t‐PA antigen; variables produced by the endothelial cell, increased during the third trimester of pregnancy. Serum urate, which is correlated with clinical outcome of pregnancy, increased during the study period and correlated directly with von Willebrand Factor and PAI‐1 antigen, respectively. There was an inverse correlation between the concentrations of placenta‐derived PAI‐2 antigen and urate.Conclusions.In healthy human pregnancy the markers of endothelial related processes of coagulation and fibrinolysis pointed towards a procoagulatory state of the endothelial cell. However, the balance between fibrin formation and resolution seemed to be maintained in uncomplicated pregnancy. Our study indicated an association between this change of endothelial cell function and place

ISSN:0001-6349    

DOI:10.3109/00016349509024445

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Background.To determine whether the effect of live attenuated oral polio virus vaccine given to pregnant women increases pregnancy complications.Methods.A study of women who had been vaccinated against poliovirus during a national vaccination campaign and who had delivered by cesarean section in three obstetrical hospitals in southern Finland. One thousand seven hundred and forty‐seven vaccinated women (in three study cohorts), and their 2293 nonvaccinated controls (in two reference cohorts) were analyzed. Subjects are out of 22 000 deliveries evaluated earlier.Results.Vaccinated sectioned women did not show an excess of pregnancy complications. The mean rate of cesarean sections was 18.4% in the study cohorts and 18.9% in the reference cohorts counted from the 22 000 deliveries.Conclusions.Oral live attenuated polio virus vaccine does not increase pregnancy complications and is considered a safe alternative for vaccinating pregnant wome

ISSN:0001-6349    

DOI:10.3109/00016349509024446

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Maternal serum alphafetoprotein (MSAFP) screening has been set up in Asturias, in the north of Spain, in 1987 in order to make possible the prenatal diagnosis of neural tube defects (NTD) to overall pregnancy population.This large study shows the high sensitivity and specificity of MSAFP screening when it is done with absolute control of all variables such as gestational age, pregnant woman's weight, diabetes, etc. On the other hand, this study also shows a poor sensitivity second level ultrasound for the early diagnosis of NTD in the presence of spina bifidas with no bulge. We have also observed that the incidence of NTD in Asturias remained constant in the last six years, around 1.5‐1.6 per 1000 pregnancies. However, due to MSAFP screening, there has been a decline in the prevalence of children born with these defects. We conclude that MSAFP screening is the best tool to identify and reduce NTD in our Region (Spain

ISSN:0001-6349    

DOI:10.3109/00016349509024447

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Background.We conducted a double‐blind randomized controlled trial to compare a conventional regimen of oxytocin and ergometrine with administration of the prostaglandin E2analogue, sulprostone, for prophylaxis of postpartum hemorrhage in high‐risk women.Methods.Women with a history of postpartum hemorrhage ≥1000 were assigned to two coded prophylactic regimens. Drugs, given respectively at delivery of the anterior shoulder and after delivery of the placenta, were oxytocin and ergometrine in the control group, and sulprostone and placebo in the experimental group. Eighty‐one women, 69 of whom actually participated in the trial, were investigated. Both the women and the caregivers were unaware of treatment allocation.Results.Although the trial was terminated prematurely there was a slight, but not statistically significant, preference for the sulprostone regimen in terms of blood loss and use of blood transfusion. No serious adverse effects were noted with either of the two regimens.Conclusion.Prostaglandins may be more effective for preventing recurrence of severe postpartum hemorrhage than the oxytocin and ergometrine combination, but they do not eliminate the risk e

ISSN:0001-6349    

DOI:10.3109/00016349509024448

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The purpose of this study was to determine the value of Gram stain examination and Limulus amebocyte lysate (LAL) test in the detection of intraamniotic infection. Ninety women with preterm labor and intact membranes (n=55) or preterm premature rupture of membranes (PROM) (n=35) who delivered prematurely were included in the study. Amniotic fluid was cultured for aerobic and anaerobic bacteria as well as for mycoplasmas. Amniotic fluid analysis included Gram stain examination and limulus amebocyte lysate tests. The prevalence of positive amniotic culture was 32.2% (29/90) and the most common isolate wasUreaplasma urealyticum.Patients with preterm PROM group had a higher rate of infection than those with preterm labor and intact membranes 57.1% (20/35) vs. 16.4% (9/55), respectively (p=0.0001). We found a lower gestational age at delivery and lower mean birth weight in neonates born to mothers with a positive amniotic fluid culture than those with negative amniotic fluid culture. The combined use of Gram stain examination and LAL test had a sensitivity and specificity of 51.7%. (15/29) and 95.1% (58/61) respectively for the detection of positive amniotic fluid culture. We conclude that Gram stain examination and LAL test are rapid, simple and specific tests that can be used to detect microbial invasion of the amniotic cavity except in patients with mycoplasmas infections.

ISSN:0001-6349    

DOI:10.3109/00016349509024449

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Background.A study was initiated to identify background factors, clinical features and pre‐operative scoring systems of importance for future selection of patients suitable for fertility surgery.Methods.Surgical procedures, background factors and scoring systems for tubal lesions and adnexal adhesions and risk factors for ectopic pregnancy were analyzed with respect to possible correlation to subsequent fertility in a retrospective study of 246 patients undergoing fertility surgery (adhesiolysis, salpingostomy, tubal anastomoses, implantation and myomectomy) between 1986 and 1990. Follow‐up periods varied between one to six years.Results.In 94% of cases a second look laparoscopy was performed. Adhesiolysis was done in 62%. The conception rate was 41.1%, the ectopic pregnancy rate was 14.6% and the delivery rate was 22.0%. Myomectomy procedures were most successful, with a delivery rate of 44.0% and no ectopic pregnancy. Previous ectopic pregnancy indicated a higher risk for recurrence, as did a high risk score for ectopic pregnancy. The extent of tubal damage was most relevant to subsequent fertility. Salpingostomies in women with mild or moderate tubal damage resulted in a delivery rate of 25.4% compared with those with severe damage (5.6%). No deliveries were seen after lysis of extensive adnexal adhesions.Conclusion.Adhesion formation is not negligible and a second look laparoscopy is recommended. Women with fibroids should always be considered for fertility surgery, not only because of high success rates, but also as an adjuvant to subsequent in vitro fertilization. Patients with previous ectopic pregnancy, extensive adhesions and unfavorable tubal scores should not be considered for surgery but referred for in vitro fertilizat

ISSN:0001-6349    

DOI:10.3109/00016349509024450

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Background.In ovum donation programs oocytes can be requested from infertile women going through anin vitrofertilization cycle. Currently, when embryos can be cryopreserved, these donors have virtually disappeared. Instead, most donors have been healthy fertile volunteers willing to go through an IVF attempt solely for the purpose of donating all oocytes.Methods.Sixty‐four patients had 93 started cycles of oocyte donation from 59 donors. Twenty recipients had primary ovarian failure, 24 had secondary ovarian failure, 15 had had repeated failures in earlier IVF attempts and five were carriers of genetic diseases. The donors were 51 healthy volunteers recruited through the press. Eight patients from an IVF program donated excess oocytes. Donors were not paid and their mean age was 30 years. To minimize discomfort of the treatment, a long‐acting GnRH‐agonist, goserelin, was used for down‐regulation.Results.The pregnancy rate per transfer with fresh embryos was 28.4% (23/81) and with frozen‐thawed embryos, 17% (3/18). Twenty‐one healthy infants have been born including one set of triplets and three sets of twins. Nine pregnancies ended in abortion and one in intrauterine fetal death. The most common complications of pregnancy were pre‐eclampsia and pregnancy‐induced hypertension (41.2%, 7/17). Ten of 17 patients delivered by cesarean section (58.8%).Conclusion.It was possible, through the press, to obtain highly motivated oocyte donors, who go through IVF treatment solely for altruistic reasons. Oocyte recipients appear to have many complications in their pregnancies. Until more data are available, these patients need a high standard of

ISSN:0001-6349    

DOI:10.3109/00016349509024451

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY