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Featured researches published by Hanna Jangö.


British Journal of Obstetrics and Gynaecology | 2012

Risk factors of recurrent anal sphincter ruptures: a population-based cohort study

Hanna Jangö; Jens Langhoff-Roos; Susanne Rosthøj; Abelone Sakse

Please cite this paper as: Jangö H, Langhoff‐Roos J, Rosthøj S, Sakse A. Risk factors of recurrent anal sphincter ruptures: a population‐based cohort study. BJOG 2012;119:1640–1647.


American Journal of Obstetrics and Gynecology | 2017

Long-term anal incontinence after obstetric anal sphincter injury—does grade of tear matter?

Hanna Jangö; Jens Langhoff-Roos; Susanne Rosthøj; Abelone Saske

Background Anal incontinence is a major concern following delivery with obstetric anal sphincter injury (OASIS), and has been related to the degree of sphincter tear. Objective The aims of this study were (1) to evaluate whether women with a fourth‐degree OASIS in the first delivery have an increased risk of long‐term anal and fecal incontinence after a second delivery, and (2) to assess the impact of mode of second delivery on anal incontinence and related symptoms in these patients. Materials and Methods We performed secondary analyses of a national questionnaire study in all Danish women with an OASIS in their first delivery and 1 subsequent delivery, both deliveries in 1997 to 2005. The questionnaires were sent a minimum of 5 years since the second delivery. In Denmark, women with anal incontinence after a delivery with OASIS are recommended elective cesarean deliveries in subsequent pregnancies. We performed uni‐ and multivariable logistic regression analyses to evaluate the outcomes. Results In total, 2008 patients had an OASIS, of whom 12.2% (n = 245) had a fourth‐degree tear in the first delivery. The median follow‐up time since the first delivery with OASIS was 11.6 years (IQR, 10.2−13.2 years) and since the second delivery 8.5 years (IQR, 7.1−10.1 years). Women with a fourth‐degree sphincter injury in the first delivery were at higher risk for anal incontinence (58.8%, n = 144) as well as fecal incontinence (30.6%, n = 75) than patients with a third‐degree injury in the first delivery (41.0%, n = 723, and 14.6%, n = 258, respectively). The differences between groups persisted after adjustment for important maternal, fetal, and obstetric characteristics (adjusted odds ratio [aOR], 2.14; 95% confidence interval [CI], 1.52−3.02; P < 0.001 for anal incontinence; and aOR, 2.49; 95% CI, 1.73−3.56; P < 0.001 for fecal incontinence). In subgroup analyses of patients with fourth‐degree anal sphincter injury in the first delivery, the mode of second delivery was not associated with the risk of anal incontinence (aOR, 0.97; 95% CI, 0.41−1.84; P = 0.71) or fecal incontinence (aOR, 1.28; 95% CI, 0.65−2.52; P = 0.48). The effect of the mode of the second delivery did not differ between women with a fourth‐degree OASIS and those with a third‐degree injury with regard to both anal (P = 0.09) and fecal (P = 0.96) incontinence. Conclusion After a second delivery, women with a fourth‐degree OASIS in the first delivery have a higher risk of long‐term anal and fecal incontinence than women with a third‐degree sphincter injury. Adjusted odds of long‐term anal and fecal incontinence did not differ significantly by mode of second delivery. Women with a fourth‐degree OASIS should be informed about the increased risk of long‐term anal incontinence and advised that subsequent elective cesarean delivery is not protective.


American Journal of Obstetrics and Gynecology | 2017

Recurrent obstetric anal sphincter injury and the risk of long-term anal incontinence

Hanna Jangö; Jens Langhoff-Roos; Susanne Rosthøj; Abelone Sakse

BACKGROUND: Women with an obstetric anal sphincter injury are concerned about the risk of recurrent obstetric anal sphincter injury in their second pregnancy. Existing studies have failed to clarify whether the recurrence of obstetric anal sphincter injury affects the risk of anal and fecal incontinence at long‐term follow‐up. OBJECTIVE: The objective of the study was to evaluate whether recurrent obstetric anal sphincter injury influenced the risk of anal and fecal incontinence more than 5 years after the second vaginal delivery. STUDY DESIGN: We performed a secondary analysis of data from a postal questionnaire study in women with obstetric anal sphincter injury in the first delivery and 1 subsequent vaginal delivery. The questionnaire was sent to all Danish women who fulfilled inclusion criteria and had 2 vaginal deliveries 1997–2005. We performed uni‐ and multivariable analyses to assess how recurrent obstetric anal sphincter injury affects the risk of anal incontinence. RESULTS: In 1490 women with a second vaginal delivery after a first delivery with obstetric anal sphincter injury, 106 had a recurrent obstetric anal sphincter injury. Of these, 50.0% (n = 53) reported anal incontinence compared with 37.9% (n = 525) of women without recurrent obstetric anal sphincter injury. Fecal incontinence was present in 23.6% (n = 25) of women with recurrent obstetric anal sphincter injury and in 13.2% (n = 182) of women without recurrent obstetric anal sphincter injury. After adjustment for third‐ or fourth‐degree obstetric anal sphincter injury in the first delivery, maternal age at answering the questionnaire, birthweight of the first and second child, years since first and second delivery, and whether anal incontinence was present before the second pregnancy, the risk of flatal and fecal incontinence was still increased in patients with recurrent obstetric anal sphincter injury (adjusted odds ratio, 1.68 [95% confidence interval, 1.05–2.70), P = .03, and adjusted odds ratio, 1.98 [95% confidence interval, 1.13–3.47], P = .02, respectively). More women with recurrent obstetric anal sphincter injury reported affected the quality of life because of anal incontinence (34.9%, n = 37) compared with women without recurrent obstetric anal sphincter injury (24.2%, n = 335), although this difference did not reach statistical significance after adjustment (adjusted odds ratio, 1.53 [95% confidence interval, 0.92–2.56] P = .10). CONCLUSION: Women opting for vaginal delivery after obstetric anal sphincter injury should be informed about the risk of recurrence, which is associated with an increased risk of long‐term flatal and fecal incontinence.


Journal of Biomaterials Applications | 2017

Examinations of a new long-term degradable electrospun polycaprolactone scaffold in three rat abdominal wall models:

Hanna Jangö; Søren Gräs; Lise Christensen; Gunnar Lose

Alternative approaches to reinforce native tissue in reconstructive surgery for pelvic organ prolapse are warranted. Tissue engineering combines the use of a scaffold with the regenerative potential of stem cells and is a promising new concept in urogynecology. Our objective was to evaluate whether a newly developed long-term degradable polycaprolactone scaffold could provide biomechanical reinforcement and function as a scaffold for autologous muscle fiber fragments. We performed a study with three different rat abdominal wall models where the scaffold with or without muscle fiber fragments was placed (1) subcutaneously (minimal load), (2) in a partial defect (partial load), and (3) in a full-thickness defect (heavy load). After 8 weeks, no animals had developed hernia, and the scaffold provided biomechanical reinforcement, even in the models where it was subjected to heavy load. The scaffold was not yet degraded but showed increased thickness in all groups. Histologically, we found a massive foreign body response with numerous large giant cells intermingled with the fibers of the scaffold. Cells from added muscle fiber fragments could not be traced by PKH26 fluorescence or desmin staining. Taken together, the long-term degradable polycaprolactone scaffold provided biomechanical reinforcement by inducing a marked foreign-body response and attracting numerous inflammatory cells to form a strong neo-tissue construct. However, cells from the muscle fiber fragments did not survive in this milieu. Properties of the new neo-tissue construct must be evaluated at the time of full degradation of the scaffold before its possible clinical value in pelvic organ prolapse surgery can be evaluated.


American Journal of Obstetrics and Gynecology | 2014

Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population–based cohort study

Hanna Jangö; Jens Langhoff-Roos; Susanne Rosthøj; Abelone Sakse


American Journal of Obstetrics and Gynecology | 2016

Mode of delivery after obstetric anal sphincter injury and the risk of long-term anal incontinence.

Hanna Jangö; Jens Langhoff-Roos; Susanne Rosthøj; Abelone Sakse


International Urogynecology Journal | 2015

Muscle fragments on a scaffold in rats: a potential regenerative strategy in urogynecology

Hanna Jangö; Søren Gräs; Lise Christensen; Gunnar Lose


International Urogynecology Journal | 2017

Tissue-engineering with muscle fiber fragments improves the strength of a weak abdominal wall in rats

Hanna Jangö; Søren Gräs; Lise Christensen; Gunnar Lose


Archives of Gynecology and Obstetrics | 2017

Anal incontinence after two vaginal deliveries without obstetric anal sphincter rupture

Lisa K.G. Persson; Abelone Sakse; Jens Langhoff-Roos; Hanna Jangö


Neurourology and Urodynamics | 2016

Anal incontinence at long-term follow-up and mode of second delivery after a fourth degree obstetric anal sphincter injury

Hanna Jangö; Jens Langhoff-Roos; Susanne Rosthøj; Abelone Sakse

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Abelone Sakse

University of Copenhagen

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Gunnar Lose

University of Copenhagen

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Søren Gräs

Copenhagen University Hospital

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