Kjeld Leisgaard Rasmussen

The influence of prepregnancy body mass index on labor complications.

BACKGROUND To investigate the influence of Body Mass Index on the incidence of labor complications in a population of women with a normal pregnancy. MATERIAL AND METHODS From a local database, information on maternal weight and height was extracted concerning 4258 women who had an uncomplicated pregnancy. After calculation and stratification with respect to Body Mass Index, this was retrospectively related to labor interventions and complications. RESULTS High Body Mass Index was related to more oxytocin infusion and early amniotomy, but not to vacuum extraction or cesarean section. Primary inertia and, to a minor degree, cephalopelvic disproportion and secondary inertia were seen more often in women with high Body Mass Index. CONCLUSIONS Overweight (25.0<=BMI<30.0) and obesity (BMI>=30.0) are only weak predictors of labor complications, given a normal pregnancy. However, the heavy use of labor augmentation indicates that obese women should not be recommended to give birth in an ABC-clinic or at home.

The influence of body mass index on the prevalence of complications after vaginal and abdominal hysterectomy

Aim of study.  To investigate the association between obesity and peri‐ or postoperative complications after hysterectomy for nonmalignant bleeding disorders.

Changes in plasma volume and extracellular fluid volume after addition of prazosin to propranolol treatment in patients with hypertension.

In fifteen patients with hypertension, inadequately controlled during treatment with propranolol alone (mean dosage 333 mg/day), plasma volume (PV) and extracellular fluid volume (ECV) were determined. After addition of prazosin for 3 months (mean dosage 9 mg/day) there was a significant increase in PV and ECV, on average 8 and 5%, respectively. The decrease in supine blood pressure, systolic as well as diastolic, was very modest, on average 11 mmHg (SD +/- 12) and 4 mmHg (SD +/- 7), respectively. The changes in standing blood pressure were more pronounced. It is assumed that the expansion of PV and ECV contributes to the inadequate blood pressure response found in the present study.

External skeletal fixation as treatment for total puerperal rupture of the pubic symphysis

A caw of total puerperal rupture of the pubic symphysis during non‐operative delivery is rcportcd and the literature reviewed. The patient in our case was successfully treated by external skeletal fixation. In agreement with the literature the authors recommend external skeletal fixation when lesions are unstable, when inadequate reduction is achieved. or when the diastasis is more than 40 mm.

Hysterectomy Is Associated with Stress Incontinence in Women Who Previously Had a Transcervical Endometrial Resection

Objectives: To compare the prevalence of urological symptoms in a population of women, who had a transcervical endometrial resection (TCER) only, and a population of women, who had a TCER and a subsequent hysterectomy. The superior goal was to evaluate the possible association between hysterectomy and urinary incontinence. Design: All women, who had a TCER at our department during the period of 1990–1996 received a questionnaire with focus on urological symptoms. The answers from women, who later had a hysterectomy were compared to the answers from women, who were sufficiently treated with TCER only. Results: Of 356 women, who were alive, 16 were lost to follow-up, leaving 340 women to receive the questionnaire, which was returned by 310 women (85%). Ninety-three (31%) had a subsequent hysterectomy mainly indicated by metrorrhagia or dysmenorrhea. Of the hysterectomized women 24% reported bothersome stress incontinence against 14% in the group of women, who had TCER only (p = 0.03). No significant difference was seen with respect to urge incontinence, urgency, pollakisuria or nocturia. Significantly more women with a normal sized uterus reported bothersome stress incontinence after the hysterectomy compared to women with a slightly enlarged uterus. Conclusion:Hysterectomy is significantly associated with stress urinary incontinence in women, who previously had a TCER.

Influence of Body Mass Index on hysterectomy rates after endometrial resection

The influence of age on hysterectomy rates after transcervical endometrial resection (TCER) is well known (1). Other suggested, but inconsistently shown, risk factors are uterine size and the presence of leiomyomas (2). The influence of the Body Mass Index (BMI) on hysterectomy rates after TCER is unknown. The purpose of the present study was to investigate whether BMI was related to the frequency of hysterectomy after endometrial resection.

Salmonella Newport as the infective agent in a pyosalpinx

apoptosis as well. These cells are brain neurons and photoreceptor cells. A metastatic pancreatic carcinoid tumor found as ectopic erythropoietin producer (1). Female reproductive organs can produce erythropoietin, and thus contributes to the cyclic changes in the female reproductive organs. Erythropoietin mRNA is expressed in the normal human endometrium (2). Erythropoietin mRNA expression was determined in isolated endometrial epithelial and stromal cells using reverse transcriptase-polymerase chain reaction (3). There are two case reports that determine erythropoietin messenger RNA found in tumor tissue in patients with uterine myoma and erythrocytosis (4). In conclusion, we report the case of young woman who developed extreme polycythemia, as a result of erythropoietin produced by a benign cystic leiomyoma of uterus. An elevated erythropoietin protein was found in cystic fluid of myoma. Elevated plasma erythropoietin concentration and polycythemia were normalized after tumor resection. Acknowledgements

Asymptomatic primary peritoneal carcinoma presenting as adenocarcinoma on routine cervical cytology

A 39-year-old, otherwise healthy woman was referred to the gynecologic outpatient clinic because of suspected cervical intraepithelial neoplasia 2 /3 in a cervical smear. Colposcopically directed biopsies showed only human papilloma-virus, why she was recommended further cytology taken via her General practitioner. One year later, she was referred again after a routinely taken cervical smear was strongly suspicious for adenocarcinoma (Figure 1). Colposcopy, cervical curettage, and vaginal ultrasound examination were normal. A conization and a high cervical and endometrial curettage were performed. Histological examination of the conus was normal, but in the cervical curettage, abnormal columnar epithelial cells were found. In the endometrium were abnormal cells and tumor embolies in the vessels, but no primary tumor was seen. Metastatic cancer of the breast was excluded by mammography. Ca-125 was 30 kU/l (normal rangeB/35 kU/l). However, a small ovarian carcinoma was suspected, and a laparotomy was performed. Both ovaries and salpinges were normal, but in the parametrium, at the back of the uterus and at the pelvic walls, several tumors measuring a few millimeters were found. These tumors were thought to be metastases from an invisible ovarian cancer, the reason why a hysterectomy, a bilateral salpingoooforectomy, an omentectomy and an appendectomy were performed. Histological examination showed, however, a highly differentiated primary peritoneal serous adenocarcinoma (Figures 2 /4). Malignant cells were found in the peritoneal washing. The patient received intravenous chemotherapy (taxol, carboplatin, and gemcitabine) during six courses. After 6 months, she was well without recurrent disease.

Intermembraneous polyhydramnios in a pregnancy with separated membranes

Early rupture of the amniotic membrane/separation of the amnion from the chorion plate during pregnancy has not been considered associated with polyhydramnios in the past. The major concern regarding this entity has been the formation of amniotic bands resulting in the amniotic band syndrome with intrauterine amputations, malformations, or fetal deaths (3). Few case reports have been published, in which an amniotic rupture has been observed sonographically, not leading to amniotic band syndrome. We present a case of polyhydramnios associated with separation of the amniotic membrane from the chorion plate, with 4-6 liters of amniotic fluid lying between the membranes, but with no associated lesions of the fetus. 7. Fait G, Goyert G, Sundareson A, Pickens A jr. Intramural pregnancy with fetal survival: case history and discussion of etiologic factors. Obtet Gynecol 1987; 70: 472-4. 8. Achmatowicz L. Ectopic pregnancy inside the uterine wall in a fibromatous uterus. Lancet 1952; ii: 6 3 4 . 9. McGowan L. Intramural pregnancy. JAMA 1965; 192: 637-9. 10. Hamilton CJ, Legarth J, Jaroudi KA. Intramural pregnancy after in vitro fertilization and embryo transfer. Fertil Steril 1992; 57(1): 215-7. 11. Mendiondo HA. Embarazo intramural. SOC Obstet Gynecol Buenos Aires, 1948; 27: 133-7. 12. Ahumada JC, Sarti JL, Arrighi LA. Endometriosis genitaly embarazo. Obstet Ginecol Latino-Am 1957; 15: 15. 13. Madersbacher H. Schwangerschaftsveranderungen in uteriner Adenomyose. Wien Klin Wochenschr 1964; 76: 52733. 14. Azziz R. Adenomyosis: current perspectives. Obstet Gynecol Clin North Am 1989; 16: 221-35. 15. Azziz R. Adenomyosis in pregnancy. J Reprod Med 1986; 31: 224-7. 16. Perez JA, Sadek MM, Savale M, Boyer P, Zorn JR. Local medical treatment of interstitial pregnancy after IVF-ET: two case reports. Hum Reprod 1993; 8(4):6314. 17. Sasso RA. Laparoscopic diagnosis and treatment of cornual pregnancy. J Reprod Med 1995; 40(1): 68-70.