Faecal incontinence 20 years after one birth: a comparison between vaginal delivery and caesarean section.

INTRODUCTION AND HYPOTHESIS: The aetiology of bowel incontinence in middle-aged women is multifactorial and the contribution of birth-related factors later in life is still poorly defined. The aim was to assess prevalence, risk factors and severity of faecal (FI, defined as the involuntary loss of faeces-solid or liquid) and anal incontinence (AI, includes FI as well as the involuntary loss of flatus) 20 years after one vaginal (VD) or one caesarean section (CS). METHODS: This was a registry-based national cohort study of primiparae giving birth in 1985-1988 and having no further births (n = 5,236). Data from the Swedish Medical Birth Register were linked to information from a pelvic floor disorder questionnaire in 2008 (response rate 65.2%). Analysis of variance and multivariate analysis were used to obtain adjusted prevalence and odds ratios (adj-OR). RESULTS: Overall prevalences of FI and AI were 13.6 and 47.0%. FI prevalence was higher after VD compared with CS [14.5 versus 10.6%, adj-OR 1.43, 95% confidence interval (CI) 1.16-1.77] but was not increased after acute versus elective CS. Perineal tear (≥second degree) increased the prevalence and risk of FI compared with no tear (22.8 versus 13.9%, adj-OR 1.95, 95% CI 1.33-2.85). The prevalence of FI was lower after VD with an episiotomy (11.1%) and similar to that after CS (10.6%). With each unit increase of current body mass index the odds of FI increased by 6% (OR 1.06, 95% CI 1.04-1.08). CONCLUSIONS: Late FI and AI prevalences were higher after VD compared with CS. Perineal tear (≥second degree) versus no tear doubled the prevalence of FI. FI prevalence was similar after a CS and a VD combined with episiotomy.

Magnesium supplementation to prevent high blood pressure in pregnancy: a randomised placebo control trial.

PURPOSE: To assess if hypertension during the last part of pregnancy could be prevented by magnesium supplementation. METHODS: Pregnant primagravida women from a local antenatal care unit were given an oral supply of 300 mg magnesium as citrate or placebo from pregnancy week 25 in a randomised double-blind setup. Blood pressure was recorded during pregnancy as well as pregnancy outcome. RESULTS: In the magnesium-supplemented group, the average diastolic blood pressure at week 37 was significantly lower than in the placebo group (72/1.4 mean/SEM vs 77/1.4, p = 0.031). The number of women with an increase in diastolic blood pressure of ≥15 mmHg was significantly lower in the magnesium group compared with the women who received placebo (p = 0.011). There was an inverse relation between the urinary excretion of magnesium during pregnancy and the diastolic blood pressure (p = 0.005). CONCLUSIONS: Magnesium supplementation prevented an increase in diastolic blood pressure during the last weeks of pregnancy. The relation between diastolic blood pressure and urinary excretion of magnesium suggests that magnesium is involved in the regulation of blood pressure and that the increase in diastolic blood pressure in pregnancy could be due to a lack of magnesium.

Urinary calcium and magnesium excretion relates to increase in blood pressure during pregnancy.

OBJECTIVE: Pregnancy-induced hypertension and preeclampsia are serious clinical manifestations during late pregnancy and the cause for increased maternal and foetal morbidity and mortality. The pathogenesis is unknown but experience from treatment schemes suggests that minerals may be of importance. Mineral homeostasis is influenced by acid-base conditions. The aim of the study was to elucidate the relation between acid-base balance, urinary mineral excretion and blood pressure during pregnancy. DESIGN: A prospective observational study of a general population. MATERIALS AND METHODS: The study was performed at the Midwife Health Center in Borås, Sweden, where practically all pregnant subjects in the catchment area are registered. First time pregnant subjects (n = 123) were voluntarily recruited without exclusion criteria. A 24 h urine sample was collected at pregnancy week 12 and analyzed for creatinine, calcium, magnesium, and urea as a proxy for acid conditions. Blood pressure was recorded every 2-3 weeks until delivery. RESULTS: There was a relation between the excretion of urea and calcium and magnesium at week 12. A blood pressure increase was found after pregnancy week 30 but only among subjects who had a high excretion of calcium and magnesium at week 12. CONCLUSIONS: If an increase in blood pressure during the later part of pregnancy a risk indicator for preeclampsia, the results suggest that an excessive secretion of calcium leading to a functional deficit might be a risk indicator for gestational hypertension and preeclampsia. Intervention experiments are required to assess this hypothesis.

Magnesium Supplementation and Blood Pressure in Pregnancy: A Double-Blind Randomized Multicenter Study.

OBJECTIVE: To investigate the effect of magnesium (Mg) supplementation in healthy pregnant women for prevention of blood pressure increase. Secondary outcomes were comparison of biomarkers for hypertensive disorders and labour and fetal outcomes between the groups. METHODS: Two hundred nulliparous healthy pregnant women were double-blind randomized to receive Mg daily or placebo. RESULTS: There were no differences in blood pressure increase. However, among the Mg-treated women, there was a significant negative correlation between increase in blood levels of magnesium and increase in systolic blood pressure (p = 0.042). Magnesium supplementation seems to be safe for both mother and infant. CONCLUSION: Magnesium supplementation in healthy first-time pregnant women is not to be recommended for prevention of blood pressure increase. Supplementation in risk pregnancies needs to be further investigated. The study is listed on the ISRCTN registry with study ID 13890849.

[Vagina cytological screening--follow up of unsatisfactory specimens]. / Gynekologisk cellprovskontroll--uppföljning av obedömbara cellprov.

During the screening of vaginal cytological samples to determine the pre-stages of cervical cancer, some samples cannot be evaluated, usually as a result of the presence of inflammatory cells. In this study, we compare the clinical handling of these samples at two cytology laboratories at the Norra Alvsborgs Hospital, NAL, in Trollhättan, Sweden and the Södra Alvsborgs Hospital, SAS, in Borås, Sweden. We also present a follow-up of the women involved. At the NAL, the women were treated with anti-inflammatory drugs and new samples were then taken after three months. At the SAS, on the other hand, new samples were simply taken after the next menstruation. The results indicate that no differences can be seen when it comes to the ease of evaluation.

Blood pressure in pregnancy and magnesium sensitive genes.

OBJECTIVES: High blood pressure during the last part of pregnancy is a risk indicator of pre-eclampsia and eclampsia which augment infant and maternal morbidity and mortality. Magnesium deficiency has been related to the risk of hypertension. A study was performed to assess the relation between pregnancy induced hypertension, excretion of urinary magnesium and expression of magnesium sensitive genes (MgSG). METHODS: A cohort of healthy, nulliparous women with singleton pregnancies was recruited. Blood pressure was recorded throughout pregnancy. Urinary magnesium excretion and expression of MgSGs in leukocytes were determined. RESULTS: The expression of the gene TRPM6 was higher among pregnant women compared to non-pregnant controls at week 12. All other genes had lower expressions in pregnant women. At week 37 the expressions of all genes were lower than at week 12. The expressions of SLC41A1, SLC41A3, and TRPM7 were related to the systolic and diastolic blood pressures. Furthermore, the expression of TRPM6 was related to the urinary excretion of magnesium and the change in diastolic blood pressure weeks 12-37 was inversely related to the change in magnesium excretion. CONCLUSIONS: Systolic and diastolic blood pressure and the excretion of magnesium during pregnancy were related to the expression of different MgSGs. The results suggest that magnesium is involved in the regulation of blood pressure during pregnancy.