Jes G. Westergaard

Prognosis in four syndromes of pregnancy-related pelvic pain.

Background. The aim of the present study was to describe, on the basis of specific classification criteria and for a period of two years after delivery, the prognosis for women suffering from pregnancy‐related pelvic joint pain, and to describe the characteristics influencing the prognosis.

Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain.

Abstract Pain in the pelvic joints and lower back, a major problem for pregnant women, has proved resistant to precise measurement and quantification. To develop a classification system, the clinical tests used must be able to separate pelvic from low back pain; they must also have a high inter-examiner reliability, sensitivity and specificity, and preferably be easy to perform. The aim of this study was to describe a standardised way of performing tests for examining the pelvis, and to evaluate inter-examiner reliability, and establish the sensitivity and specificity of 15 clinical tests. It was designed as a longitudinal, prospective, epidemiological cohort study. First, 34 pregnant women were examined by blinded examiners to establish inter-examiner reliability. Second, a cohort of 2269 consecutive pregnant women, each responded to a questionnaire and underwent a thorough and highly standardised physical examination (15 tests with 48 possible responses) of the pelvic joints and surrounding areas. The 535 women who reported daily pain from the pelvic joints and had objective findings from the joints were divided, according to symptoms, into four classification groups and one miscellaneous group. The results of the study showed inter-examiner agreement of the tests was high, calculated in percentage terms, at between 88 and 100%. Using the Kappa coefficient, most tests kept the high agreement: six tests had an inter-examiner agreement of between 0.81 and 1.00, three between 0.61 and 0.80, and two between 0.60 and 0.41. Five tests showed superior sensitivity. The specificity of the tests was between 0.98 and 1.00, except the value for pelvic topography, which was 0.79. These results show that it is possible to standardise examination and interpretation of clinical tests of the pelvic joints, resulting in a high degree of sensitivity, specificity and inter-examiner reliability.

Peri-Conceptional A1C and Risk of Serious Adverse Pregnancy Outcome in 933 Women With Type 1 Diabetes

OBJECTIVE To study the association between peri-conceptional A1C and serious adverse pregnancy outcome (congenital malformations and perinatal mortality). RESEARCH DESIGN AND METHODS Prospective data were collected in 933 singleton pregnancies complicated by type 1 diabetes. RESULTS The risk of serious adverse outcome at different A1C levels was compared with the background population. The risk was significantly higher when peri-conceptional A1C exceeded 6.9%, and the risk tended to increase gradually with increasing A1C. Women with A1C exceeding 10.4% had a very high risk of 16%. Congenital malformation rate increased significantly at A1C above 10.4%, whereas perinatal mortality was increased even at A1C below 6.9%. CONCLUSIONS These results support recent guidelines of preconceptional A1C levels <7% in women with type 1 diabetes.

Screening for gestational diabetes mellitus by a model based on risk indicators: A prospective study

OBJECTIVE This study was performed to prospectively evaluate a screening model for gestational diabetes mellitus on the basis of clinical risk indicators. STUDY DESIGN In a prospective multicenter study with 5235 consecutive pregnant women, diagnostic testing with a 2-hour 75-g oral glucose tolerance test was routinely performed in women with risk indicators and offered to women without risk indicators as part of the study. RESULTS Forty-four percent of the women underwent testing, 43% declined participation, 6% did not speak Danish, and 7% could not be contacted. By extrapolation of the results from tested women to the whole group in question, a 2.4% prevalence of gestational diabetes mellitus was calculated. Sensitivity and specificity of the model was 80.6 (73.7-87.6) and 64.8 (63.5-66.1), respectively (95% CIs). CONCLUSION Under ideal conditions, sensitivity of the model was comparable with universal screening by fasting glucose or a 1-hour 50-g glucose challenge test. Both screening and diagnostic testing could be avoided in two thirds of all pregnant women.

Maternal and perinatal outcomes in 143 Danish women with gestational diabetes mellitus and 143 controls with a similar risk profile

Aims To assess maternal and fetal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM) compared to non‐diabetic pregnancies with an otherwise similar risk profile and to study the association between different anti‐diabetic treatments and fetal outcomes.

Risk factors in developing pregnancy-related pelvic girdle pain.

Background. In this prospective epidemiologic cohort study the aim was to identify possible risk factors for developing four different syndromes of pelvic girdle pain during pregnancy. Methods. Over a one‐year period a total of 2,269 consecutive pregnant women – at week 33 of gestation – responded to a structured questionnaire and underwent a thorough physical examination. Women who at baseline reported daily pain from pelvic joints and had corresponding objective findings were allocated, according to symptoms, into one of four classification groups, and followed up with questionnaires and physical examinations up to two years after delivery. Results. Multivariate analysis could distinguish the four pelvic pain sub groups from the “Pelvic healthy” group with respect to 13 of 24 variables. The pelvic girdle syndrome group revealed a history of previous low back pain, trauma of the back or pelvis, multiparae, had a relatively higher weight, a higher level of self reported stress and of job At a higher risk of developing symphysiolysis were women who were multiparae, had a relatively higher weight, and were smokers. If a woman had vocational training or a professional education, was stressed, had a poorer experience of previous delivery, had previous low back pain, trauma of back, or previous salpingitis, she had an increased risk of developing one‐sided sacroiliac syndrome. The risk factors for developing double‐sided sacroiliac syndrome were previous low back pain and trauma of the back or pelvis, multiparae, poorer relationship with spouse, and less job satisfaction. Conclusions. This study demonstrates no single dominant risk factor for developing pelvic girdle pain in pregnancy, but reveals a set of physical and psychosocial factors. The risk factors for developing pelvic girdle pain in general are: history of previous low back pain, trauma of the back or pelvis, multivariate, higher level of stress, and low job satisfaction.

Two fetal antigens (FA-1 and FA-2) and endometrial proteins (PP12 and PP14) isolated from amniotic fluid; preliminary observations in fetal and maternal tissues

Rabbit antihuman antibodies were derived by the injection of fractions of second trimester amniotic fluid known to contain proteins of endometrial/decidual origin. Using standard separation and absorption procedures, two antibody preparations were generated which demonstrated specificities against two and three proteins, respectively, in line immunoelectrophoresis and crossed immunoelectrophoresis. Analysis against proteins of fetal, maternal, endometrial and placental origin revealed that the bispecific antiserum reacted only with placental protein 14 (PP14; also known as progestagen-dependent endometrial protein, PEP) and one other hitherto undescribed antigen referred to as Fetal Antigen 1 (FA-1) molecular mass 60 kDa; electrophoretic mobility: slow; alpha 1-alpha 2; fast, albumin. The trispecific antiserum demonstrated specifities against placental protein 12 (PP12), alpha-fetoprotein (AFP) and another previously undescribed antigen referred to as Fetal Antigen 2 (FA-2) molecular mass 35 and 140 kDa; electrophoretic mobility: albumin. Following purification, monospecific antisera against each of these proteins (with the exception of AFP) were derived in new rabbits. Maternal and fetal blood, amniotic fluid and aqueous extracts from endometrial/decidual and placental tissues were analysed in rocket immunoelectrophoresis using these antisera to examine the distribution in these tissues. The analyses demonstrated a pattern of distribution typical for proteins of endometrial/decidual origin in these compartments in the case of PP12 and PP14, but suggested that the primary source of origin of FA-1 and FA-2 may be the fetus.

Circulating levels of relaxin are normal in pregnant women with pelvic pain

OBJECTIVE The hormone relaxin induces loosening of the pelvic ligaments and joints in several species. Previous studies have suggested a similar role for relaxin during human pregnancy. Furthermore, a correlation has been noted between high circulating levels of this hormone and severe pelvic pain in pregnant women. The present study was designed to evaluate whether serum relaxin concentrations were elevated in pregnant women with clear subjective and objective evidence of pain attributable to relaxation of the pelvic ligaments. STUDY DESIGN Serum relaxin was measured at week 33 of gestation in 455 pregnant women with clearly defined pain in their pelvic joints and 455 normal pregnant controls matched for age and parity. All participants underwent an examination consisting of a structured questionnaire and fifteen specific tests for pelvic joint pain. The group with pain was further subdivided into four subgroups with different levels of disability and prognosis. Relaxin concentrations were measured using enzyme-linked immunoassay. RESULTS There was no difference in serum relaxin concentration between the control and study group, nor between the subgroups of women with pelvic pain. CONCLUSION We failed to confirm an earlier claim that circulating relaxin levels are related to pelvic girdle pain in pregnant women.

Ovarian volume in gynecologically healthy women using no contraception, or using IUD or oral contraception

Objective. The aim of this study was to determine the ovarian volume by transvaginal ultrasonography in a gynecologically healthy population of women using no contraception, using intrauterine contraceptive device, or using oral contraceptive.

Functional ovarian cysts in premenopausal and gynecologically healthy women

The present study describes 29 women coincidentally found to have ovarian cysts while participating in a cross-sectional study. The prevalence of functional ovarian cysts is determined. In this study, 428 women, aged 14-45 years, were examined by transvaginal ultrasonography. The women were gynecologically healthy and were using either no contraception, intrauterine contraceptive devices, none of which were hormone releasing, or oral contraception (OC). Cysts were defined as cystic spaces larger than 30 mm. All women were asymptomatic and regularly menstruating.The prevalence of ovarian cysts was lower for women using OC than for women using no contraception or using intrauterine contraceptive devices. The relative risk (measured as the prevalence proportion ratio) of having an ovarian cyst when using OC was 0.22 (CI: 0.13-0.39), compared to women not using OC. No difference was found in the prevalence of ovarian cysts between women using intrauterine contraceptive devices and women using no contraception. The prevalence of ovarian cyst increased throughout the menstrual cycle in women not using OC. This relation was not found in the group of users of OC. The majority of the cysts resolved within the first few days of menstruation. Sixty-five percent of the cysts persisting after menstruation had resolved at the first control examination 3 months later, independently of use of OC. Low-dose monophasic contraceptive pills seem to have a protective effect against development of functional ovarian cysts, independent of the type of gestagen and the dose of ethinylestradiol used. Ovarian cysts resolved independently of treatment with OC. The use of intrauterine contraceptive device had no influence on the occurrence of functional ovarian cysts.