Marie-Louise Nordström

Symphyseal distention in relation to serum relaxin levels and pelvic pain in pregnancy

Objective. To elucidate whether there is an association between symphyseal distention, circulating relaxin levels and pelvic pain in pregnancy.

The Misgav Ladach method for cesarean section compared to the Pfannenstiel method

OBJECTIVE The aim of the study was to evaluate the outcome of two different methods of cesarean section (CS). DESIGN The study was designed as a prospective, randomized, controlled trial. SETTING All CS were performed at the University Hospital in Uppsala, Sweden. POPULATION Fifty women admitted to hospital for a first elective CS were consecutively included in the study. They were randomly allocated to two groups. METHODS One group was operated on by the Misgav Ladach method for CS and the other group by the Pfannenstiel method. All operations were performed by the same surgeon. MAIN OUTCOME MEASURES Duration of operation, amount of bleeding, analgesics required, scar appearance and length of hospitalization. RESULTS Operating time was significantly different between the two methods, with an average of 12.5 minutes with the Misgav Ladach method and 26 minutes with the Pfannenstiel method (p<0.001). The amount of blood loss differed significantly, with 448 ml and 608 ml respectively (p=0.017). Significantly less analgesic injections and tablets (p=0.004) were needed after the Misgav Ladach method. CONCLUSION The Misgav Ladach method of CS has advantages over the Pfannenstiel method by being significantly quicker to perform, with a reduced amount of bleeding and diminished postoperative pain. The women were satisfied with the appearance of their scars. In this study no negative effects of the new operation technique were discovered.

Sonographic assessment of symphyseal joint distention during pregnancy and post partum with special reference to pelvic pain

OBJECTIVE To elucidate whether there is a relationship between pregnancy-related pelvic pain and degree of symphyseal laxity. METHODS Forty-nine women were interviewed and examined and ultrasonographic measurement of symphyseal width and vertical shift was conducted at 12 and 35 weeks of pregnancy and at 5 months post partum. The patients were retrospectively classified into four groups on the basis of presence and degree of pain in late pregnancy and presence or absence of pain at follow up. RESULTS The prevalence of pelvic pain of any degree during pregnancy was 49%, of pronounced pain 16.3% and of severe pain 6.1%. Nineteen percent had any remaining pain at 5 months post partum. The median symphyseal width at 12 and 35 weeks of pregnancy and at 5 months post partum was 3.5 mm, 4.6 mm and 2.8 mm, the median vertical shift 0.0 mm, 0.8 and 0.9 mm respectively. Those with disabling pain during pregnancy and no pain at follow up had greater symphyseal width (6.3 mm) and vertical shift (1.8 mm) at 35 weeks of pregnancy than controls; 4.5 mm (p<0.01) and 0.5 mm (p<0.01) respectively. Those with disabling pain during pregnancy and persistent pain at follow up did not differ significantly from controls in symphyseal width or shift. The most severe cases were in this group. CONCLUSION There is a minor pregnancy-induced physiological increase in laxity of the symphyseal soft tissue. There is no evidence that the degree of symphyseal distention determines the severity of pelvic pain in pregnancy or after childbirth.

Adolescent Depression: Social Network and Family Climate—A Case-control Study

In a study of a total high-school population, 2300 students aged 16-17 years were screened for depression (BDI, CES-DC). Those with a self-evaluation indicating depression, together with controls matched for sex, age, and class were interviewed (DICA-R-A). The 177 pairs, where both individuals were interviewed and the control had no lifetime diagnosis of depression, were analysed in the form of paired differences for psychosocial factors and compared within diagnostic groups. The psychosocial factors were measured with the ISSI subscales and six attitude questions about family climate (KSP). Adolescents with an episode of major depression during part of the last year did not differ from their controls. Those with long-lasting depressive symptoms, i.e. dysthymia with or without episodes of major depression, had a more limited social interaction and were not satisfied with it. They also evaluated their family climate and attachment network as being more inadequate than did their controls. Depressed adolescents with comorbid conduct disorder had a more negative evaluation of availability and adequacy of both social interaction and attachment network than their controls. This group had a very negative view of their family climate. Since this is a case-control study conclusions cannot be drawn about cause and effect.

Adherence to treatment in Swedish HIV-infected patients

Objectives:  The objectives were to assess the prevalence of adherence to antiretroviral treatment in Swedish human immunodeficiency virus (HIV)‐infected patients and to evaluate factors associated with adherence.

The prevalence of violence investigated in a pregnant population in Sweden

All women registered for antenatal care within a Swedish municipality during a 6-month period were assessed regarding acts of violence. The Abuse Assessment Screen was used on two occasions during pregnancy, and once between 4 and 20 weeks after delivery. The efficacy of repeated interviews was investigated, and characteristics of abused and non-abused women were compared. The participation rate was 93% (1038 women). Physical abuse by a close acquaintance or relative during or shortly after pregnancy was reported by 1.3%, and by 2.8% when the year preceding pregnancy was included. The lifetime prevalence of emotional, physical or sexual abuse was 19.4%. Repeated questioning increased the detection of abuse. Women abused during pregnancy reported more preceding ill-health and more elective abortions than non-abused women. Intervention against sexual violence has been on the political agenda in Sweden for several decades. Even so, physical abuse is a risk factor comparable in frequency to obstetric complications such as gestational diabetes and pre-eclampsia. Routines need to be established to make questioning about violence an integral part of the standardized screening for risk factors during pregnancy.

Lifetime prevalence of sexual abuse in a Swedish pregnant population

Background.  Our primary purpose was to determine the prevalence of sexual abuse in a non‐selected pregnant population. We also endeavored to establish the age at which the abuse had occurred and the identity of the perpetrator and to analyze in sexually abused vis‐à‐vis non‐abused women, various socio‐economic and clinical variables.

Combined oral contraceptives do not increase the risk of back and pelvic pain during pregnancy or after delivery

Objectives. To elucidate whether the duration of previous use of combined oral contraceptives (COC) is associated with disabling back or pelvic pain during pregnancy and pain persisting eight months after delivery.

Adolescent depression and stressful life events: A case-control study within diagnostic subgroups

Life events in depressed adolescents were studied in a case-control design. A total population of 16- to 17-year-old students in the 1st year of high school were screened for depression (n=2300). Every student with indication of depression and one control matched for sex, age, and grade in school was interviewed diagnostically (DICA-R-A). All participating matched pairs in whom the control had no lifetime depressive disorder were used for analysis of life events (177 pairs). They were divided into six subgroups on the basis of depressive and conduct disorders. Depressed and control adolescents were compared with regard to 21 events and conditions of stressful character. Events for total life were studied. Adolescents with depressive disorder had experienced more stressful events and conditions in life than healthy controls. The most characteristic events concerned the important relations to family and friends. The subgroup with comorbid conduct disorder was the most burdened and had much more illness, con...

Factors associated with pregnancy termination in Ukrainian women

Objectives. To study differences in social and demographic characteristics between women undergoing an induced abortion and antenatal care attendants in the Ukraine.