Pål Wølner-Hanssen

Obstetric risk factors for stress urinary incontinence: a population-based study.

Objective To evaluate obstetric and maternal risk factors for stress urinary incontinence. Methods We linked three national, Swedish, population-based registries with the use of unique personal identification numbers. All women born between 1932 and 1977 and operated on for stress urinary incontinence between 1987 and 1996 were identified from the Hospital Discharge Registry. This information was linked with the Medical Birth Registry (for the years 1973–1995), containing information on antenatal care, delivery, and the newborn, and the Fertility Registry (for the years 1932–1997), containing information on the number of children delivered by each Swedish woman. For determination of odds ratios (ORs) and approximate 95% confidence intervals (CIs), we used the Mantel-Haenszel method and a test-based method after suitable stratifications and exclusions. Results Diabetes mellitus, body mass index (BMI), age at first delivery, parity, birth weight, and epidural analgesia were positively associated with incontinence surgery. In contrast, cesarean delivery, forceps/vacuum extraction, and episiotomy were negatively associated with incontinence surgery. No association was found between surgery for stress incontinence and age at last delivery, smoking during pregnancy, level of education, multiple birth, large perineal tear, or breech presentation at any vaginal delivery. The OR for incontinence surgery was similarly decreased for nulliparous women and for uniparous women delivered by elective cesarean. Conclusion Vaginal delivery, notably the first, is strongly associated with later surgery for stress incontinence, but the association is modified by maternal conditions and interventions during delivery. No association was found between surgery for stress incontinence and pregnancy per se.

Microbial Causes of Proven Pelvic Inflammatory Disease and Efficacy of Clindamycin and Tobramycin

Thirty-six women with suspected pelvic inflammatory disease were examined by laparoscopy and endometrial biopsy. Acute salpingitis was diagnosed by laparoscopy in 22. Among women with evaluable biopsy samples, plasma cell endometritis was present in 14 of 20 with acute salpingitis and in 1 of 13 without acute salpingitis (p less than 0.001). Chlamydia trachomatis, Neisseria gonorrhoeae, or both were identified in the endometrium or fallopian tubes in 11 of 14 women with both salpingitis and endometritis, in 2 of 9 with salpingitis or endometritis alone, and in 0 of 13 without salpingitis or endometritis (p less than 0.0001). Anaerobic or facultative bacteria or mycoplasmas were isolated from tubes or peritoneum from 9 of 14 women with both salpingitis and endometritis, 2 of 9 with salpingitis or endometritis alone, and 3 of 13 without salpingitis or endometritis. Therapy with clindamycin plus tobramycin produced an adequate short-term clinical response in 16 of 19 patients, although patients with severe salpingitis at laparoscopy responded slowly.

Bacterial vaginosis - Transmission, role in genital tract infection and pregnancy outcome: An enigma

Whether bacterial vaginosis (BV) is acquired from an endogenous or an exogenous source is subject to controversy. Despite findings of an association between sexual behaviour and BV, some data indicate that BV is not a sexually transmitted infection in the traditional sense, while other data indicate that BV is an exogenous infection. A third aspect of BV is its tendency to go unnoticed by affected women. All of this will have a strong impact on how physicians view the risks of asymptomatic BV. This review focuses on whether or not BV should be regarded as a sexually transmitted infection (STI), its role in postoperative infections and pelvic inflammatory disease (PID), and on whether or not treatment of BV during pregnancy to reduce preterm delivery should be recommended. The reviewed studies do not lend unequivocal support to an endogenous or exogenous transmission of the bacteria present in BV. For women undergoing gynaecological surgery such as therapeutic abortion, the relative risk of postoperative infection is clearly elevated (approx. 2.3–2.8). A weaker association exists between BV and pelvic inflammatory disease. Data on treatment of BV as a way of reducing preterm delivery are inconclusive and do not support recommendations for general treatment of BV during pregnancy. The discrepant associations between BV and preterm birth found in recent studies may be explained by variations in immunological response to BV. Genetic polymorphism in the cytokine response – both regarding the TNF alleles and in interleukin production – could make women more or less susceptible to BV, causing different risks of preterm birth. Thus, studies on the vaginal inflammatory response to microbial colonization should be given priority.

Risk factors for fever in labor

Objective To identify risk factors for fever in labor. Methods A retrospective case-control study was conducted. Maternal sublingual temperature was measured every 2–4 hours during labor in 3109 of 3860 consecutive term parturients presenting from September 1992 through December 1993. Women who had fever (at least one recorded temperature of 38C or more, n = 72) during labor were compared with those who remained afebrile (n = 3037). Furthermore, a matched-pair case-control study was conducted, involving 250 women at term who developed fever in labor and 250 controls matched for parity and duration of labor; all delivered between January 1989 and December 1993. A conditional multiple logistic regression analysis was used to identify independent risk factors for fever during labor. Results In the case-control study, fever was associated with epidural analgesia, nulliparity, and a long duration of labor. These three variables were also related among themselves. However, multiple regression analysis showed that all three variables were independently associated with maternal temperature. In the matched-pair study, epidural analgesia, rupture of membranes longer than 24 hours, latency phase exceeding 8 hours, and a temperature in the upper normal range (37.5–37.9C) at admission were independent risk factors for developing fever in labor. Conclusion Epidural analgesia, duration of labor, and a long interval from rupture of membranes to delivery were independent risk factors for maternal fever in labor.

Laparoscopic Burch colposuspension for stress urinary incontinence: a randomized comparison of one or two sutures on each side of the urethra.

Objective To compare 1-year cure rates after laparoscopic Burch colposuspension using one double-bite or two single-bite sutures on each side of the urethra. Methods Consecutive women with primary stress urinary incontinence at one university hospital were included. Pre-operative clinical and urodynamic evaluation included cystoscopy, cystouretrometry at rest and stress, and a standardized pad test. Immediately before surgery, the patients were randomized to have one or two polytetrafluoroethylene (GoreTex CV 2; W. L. Gore Inc., Flagstaff, AZ) sutures placed on each side of the urethra. During surgery, access to the space of Retzius was achieved by transperitoneal videolaparoscopic technique. Women were scheduled for postoperative interview and pad test 1 year after surgery. Results We included 161 women in the study; 78 were randomized to one suture (group A) and 83 to two sutures (group B). Median time for surgery was significantly shorter for group A than for group B (60 compared with 77 minutes; P < .001). We examined 158 women 1 year after surgery, at which time 148 performed a pad test. Objective cure rate was significantly higher in group B than in group A (83% compared with 58%; P = .001). Conclusion Two single-bite sutures resulted in a significantly higher objective short-term cure rate than one double-bite suture on each side of the urethra.

Infections after hysterectomy : A prospective nation-wide Swedish study

Background. An increased use of prophylactic antibiotics to avoid postoperative infections in women undergoing hysterectomy has been observed in Sweden. This investigation was performed a) to study the infection rate to enable future evaluation of the effect of prophylactic antibiotic regimens and b) to identify subgroups suitable for intervention.

Autotransplantation of cryopreserved ovarian tissue to the right forearm 4(1/2) years after autologous stem cell transplantation.

Premature ovarian failure (POF) may occur as a consequence of chemotherapy and of irradiation to the ovaries (1). Alkylating agents such as cyclophosphamide and chlorambucil are particularly prone to cause ovarian damage (2). The human oocytes are extremely sensitive to radiation. Recently, it was estimated that the radiation required to destroy 50% of the oocytes in human ovaries is less than 2 Grey (3). Besides cryopreservation of embryos and of unfertilized oocytes, cryopreservation of ovarian tissue harvested prior to gonadotoxic treatment is one approach to try to preserve a patient’s fertility. Thus, investigators have reported autotransplantation of fresh ovarian tissue to the forearm (4) and of cryopreserved ovarian tissue heterotopically to the retroperitoneum (5), the rectus abdominis muscle (6) or orthotopically to the remaining ovary (7,8). Recently, Byskov et al. transplanted cryopreserved ovarian tissue to the remaining ovary and could later obtain mature oocytes from the transplant (8). Oktay et al. transplanted cryopreserved ovarian tissue beneath the skin of a woman’s abdomen and succeeded in fertilizing a mature oocyte obtained from the transplant (9). Similarly, Lee et al. obtained mature oocytes from cryopreserved ovarian tissue transplanted to subcutaneous pockets of macaque monkeys. One monkey delivered a healthy female infant at the end of 2003 following in vitro fertilization (IVF) of an oocyte obtained from an abdominal pocket (10). The present report describes the first autotransplantation of cryopreserved ovarian tissue to the forearm of a woman.

Cost-analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension-free vaginal tape procedure

Background.  The aim of this study was to compare laparoscopic colposuspension with tension‐free vaginal tape (TVT) in terms of costs to the county.

Treatment with 2% clindamycin vaginal cream prior to first trimester surgical abortion to reduce signs of postoperative infection : A prospective, double-blinded, placebo-controlled, multicenter study

Background. Bacterial vaginosis (BV) and intermediate flora is known risk‐factor for postoperative infection after surgical termination of pregnancy. Vaginal application of 2% clindamycin cream is an efficacious treatment for BV, but it is not known whether preoperative administration of clindamycin cream might reduce the signs of post‐abortion infection after surgical termination of pregnancy.

Antibodies to the chlamydial 60 kd heat-shock protein are associated with laparoscopically confirmed perihepatitis

OBJECTIVE Our purpose was to examine clinical, microbiologic, serologic, and laparoscopic findings associated with perihepatitis. STUDY DESIGN In a prospective study of 157 women with a clinical diagnosis of pelvic inflammatory disease, 27 women with laparoscopically confirmed perihepatitis and salpingitis were compared with 46 patients with salpingitis alone. RESULTS Both current use or a history of ever using oral contraceptives was negatively associated with perihepatitis (p = 0.05 and p = 0.008, respectively). Moderate-to-severe pelvic adhesions were present at laparoscopy significantly more often in the perihepatitis-salpingitis group (70%) than in the salpingitis alone group (35%, p = 0.003). Antibody to the chlamydial 60 kd heat-shock protein at > or =0.5 optical density was detected in 67% of the perihepatitis-salpingitis group and in 28% of the salpingitis alone group (p = 0.005), and the median titer was significantly higher in the former group (p = 0.02). CONCLUSION Compared with women with salpingitis alone, patients with perihepatitis-salpingitis do not have distinctive clinical or microbiologic findings but do manifest a higher prevalence of moderate-to-severe pelvic adhesions and both a higher prevalence and higher titers of antibody to the chlamydial heat-shock protein-60.