Histocompatibility antigen studies in women with recurrent miscarriages and Müllerian uterine anomalies.

OBJECTIVE: To determine whether the HLA alleles DR1, DR3, DR4 and DR10 which have been suggested to be risk markers for unexplained recurrent miscarriages also play a part in women with recurrent miscarriages with Müllerian uterine fusion anomalies. STUDY DESIGN: HLA-DR typing was undertaken in 28 women with recurrent miscarriage who had been surgically treated for Müllerian anomalies and in 360 controls. In the study group, outcome of pregnancies after surgery was correlated to the results of the HLA typing. RESULTS: In the study group, 61% were positive for HLA-DR1, -DR3, -DR4 or -DR10 compared with 65% of the controls (not significantly different). Among patients positive for these HLA risk markers, 64% of the pregnancies after surgery miscarried compared with 13% in those negative (P<0.005, RR for miscarriage=4.8, 95% CI= 1.3-18.0). CONCLUSION: The proposed risk HLA markers for unexplained recurrent miscarriage also seem to display a negative impact on pregnancy outcome in patients with recurrent miscarriages with Müllerian uterine anomalies.

[Effect of uterine fibromas on pregnancy]. / Uterusfibromers betydning for graviditetsforløbet.

The recent published journal reports concerning the influence of uterine myomas on pregnancy are reviewed. The prevalence of uterine myomas in pregnancy is 0.1-5%, and less than half of the cases can be diagnosed by clinical investigation alone. The previous belief that continuous growth of myomas occurs during pregnancy seems incorrect. Most myomas grow during the first trimester, whereafter only few continue to enlarge. The most often recognized complication during pregnancies with uterine myomas is abdominal pain. About ten percent will suffer from this. Treatment is with non-steroidal anti-inflammatory drugs, which are extremely effective. In resistant cases epidural blockade may be used. Placental abruption is possibly more common among women with myomas that have direct contact to the placenta, and there is a trend towards shorter pregnancies in women with myomas. Further investigation on these subjects is required. No other complications are consistently reported more frequently among women with myomas than among those without. Myomectomy during pregnancy should only be performed in extreme cases. The value of myomectomy before conception to avoid pregnancy complications is doubtful, if no other pathology is present.

[School children's knowledge of, need for and use of contraception before and after the AIDS campaigns. Knowledge and sources of information]. / Skoleelevers viden om, behov for og brug af praevention før og efter AIDS-kampagnerne. Viden og informationskilder.

The purpose of the present paper was to investigate the influence of the AIDS-campaigns on adolescents' knowledge of contraception and pregnancy and their sources of information. All pupils in their ninth school year in the municipality of Viborg answered an identical questionnaire in 1986 and 1993, dealing with the mentioned subjects. In 1986, 539 questionnaires were included, in 1993, 391. In 1986, sexually inexperienced boys had lesser knowledge than the rest. This could not be shown in 1993. Although their knowledge was not optimal, the pupils in 1993 answered better than the 1986-pupils. They had the same informational sources, but in 1993, the school was mentioned as an important source by nearly all. The mother, on the contrary, had decreasing importance as a source of information. Two thirds were generally satisfied by the sexual information given by the school. Experienced boys were significantly more often unsatisfied. It is concluded that the condom-orientated AIDS-campaigns have not in general decreased the knowledge of contraception and pregnancy among adolescents. Their knowledge is, however, not optimal. The school is extremely important as an informational source, especially if the importance of the parents decreases. This implies that fewer of those adolescents, who have left school, have adult support in dealing with sexual problems.

[School children's knowledge of, need for and use of contraception before and after the AIDS campaigns. Sexual activity and contraception habits]. / Skoleelevers viden om, behov for og brug af praevention før og efter AIDS-debatten. Seksuel aktivitet og proeventionsvaner.

The purpose of the present investigation was to evaluate changes in contraceptional habits or sexual activity among adolescents as a consequence of the AIDS-campaigns. In 1986 and 1993 all pupils in their ninth school year in the municipality of Viborg answered an identical questionnaire concerning the mentioned subjects. Both in 1986 and 1993 one third had had sexual intercourse, and one seventh had had their sexual debut before the age of 15. There were significantly more condom users at the first coitus in 1993 and fewer pill users. The proportion of unprotected intercourse did not differ. More pupils had had experience using condoms in 1993, but, as in 1986, nearly half of the girls had used coitus interruptus or safe periods. The proportion of girls who had had intercourse within a week of answering the questionnaire increased from 26% to 42%, indicating a more sexually active population of girls. It is concluded that the increased sexual activity, the fewer pill users and the persisting large proportion of un- or low-protected intercourse may result in more unintended pregnancies. The coincident use of pill and condom should be encouraged.

[Violence towards pregnant women]. / Vold mod gravide.

The current literature concerning violence against pregnant women is reviewed. The prevalence of battering during pregnancy is estimated to be between one and ten percent, and the problem is most often hidden from the medical staff. In one fourth of the cases, violence increases during pregnancy, and usually the violent episodes are a continuation of the couple's habitual way of life. An episode of battering per se is only in extreme situations dangerous for the pregnancy, but serves as a marker of negative social events, e.g. unemployment, smoking, emotional instability etc., which increases the risk of an adverse pregnancy outcome. Furthermore, the violent husband may extend the battering to the child after delivery. It is concluded, that all medical personnel dealing with pregnant women should be aware of the high prevalence of battering during pregnancy. If battering is detected, the pregnancy may be at risk, but the main problem is the social issue and the later consequences for the child. The general practitioner is central in the long-term approach to these cases.

[Vaginal hysterectomy in non-prolapsed uterus]. / Vaginal hysterektomi ved ikke-prolaberet uterus.

AIM OF STUDY: To describe the results of vaginal removal of the non-prolapsed uterus in women conventionally operated on abdominally or with the assistance of laparoscopy. MATERIAL AND METHODS: At the departments of gynaecology, Herning Central Hospital and Holstebro Central Hospital, approximately one third of all hysterectomies are performed vaginally. All records of women, who had had a vaginal hysterectomy on a non-prolapsed uterus over a nineteen-month period, were reviewed retrospectively. Women, who had additional surgery, were excluded. RESULTS: One-hundred and thirteen patients entered. In one patient (1%) the vaginal hysterectomy was converted to an abdominal one. One fourth of the women had a uterus weighing more than 200 grams. The median operation time was 58 minutes; 73% bled less than 200 ml. Half of the women were discharged from hospital on the third postoperative day or earlier; 90% on the fifth postoperative day or earlier. During operation three accidental bladder lesions occurred, and four women needed an additional haemostatic operation. Postoperatively, 10 women (9%) suffered from a haematoma or an abscess in the vaginal vault. CONCLUSIONS: Vaginal hysterectomy on the non-prolapsed uterus is an operation that should be offered to a large group of women, who today are operated on abdominally or with laparoscopic assistance. The operation is quick and the patients are discharged after a few days. No advanced equipment is needed. Some women will, however, suffer from a haematoma in the vaginal vault.

[Habitual abortion. A review of etiology, diagnosis and treatment with emphasis on immunonological factors]. / Abortus habitualis. En gennemgang af aetiologi, diagnostik og behandling med hovedvaegten lagt p¿ immunologiske faktorer]

Almost 1% of women who attempt pregnancy will experience recurrent miscarriage. The majority of traditionally accepted causes of recurrent miscarriage lack proper documentation and the evidence for the majority of treatments is sparse. An increased level of midfollicular phase luteinizing hormone seems to be associated with some cases of recurrent miscarriage. Many autoantibodies are found with increased frequency in women with recurrent miscarriage, and they seem to be associated with an increased risk of adverse pregnancy outcome. This may indicate that the autoantibodies per se or associated immunological phenomena are risk factors for the condition. Polygenically determined immunological phenomena seem to play an important role. Treatment of recurrent miscarriage by anticoagulation, allogeneic lymphocyte immunization or intravenous immunoglobulin is under evaluation in controlled trials.

The "forgotten" intrauterine device: a cause of infertility.

We present a case of infertility due to a "forgotten" IUD. Users of intrauterine devices are reported to have an increased risk of frank or subclinical genital infections which later may be the cause of infertility. Other mechanisms of causing infertility are possible. During the last two years we have seen three infertile patients with an IUD in situ. Two had ovulation, and one got pregnant immediately after the IUD was removed.

PIP: A case of infertility due to a forgotten IUD is presented. During 1991-92, three infertile patients with an IUD in situ were examined. 2 had ovulation, and 1 got pregnant immediately after the IUD was removed. A 33-year-old woman was referred to the Department of Surgery, Skive Hospital, Denmark, because of 2 years of secondary infertility. She had has a child in 1984 with a previous partner without problems with that conception. There was no past history of salpingitis. In the mean time she had been using an IUD for contraception, and had it changed twice. 2 years before being referred, the IUD was removed because of vaginal discharge. Shortly after that the patient started trying to get pregnant. Physical examination, semen analysis, basal body temperature charts, and hormone profiles were all normal. Before hysterosalpingography, a plain abdominal X-ray showed an IUD. At the subsequent vaginal examination, the threads were found a few millimeters within the cervical canal, and the IUD was easily removed. The patient conceived in that same cycle. It is estimated that more than 60 million woman wear IUDs, and the problem of forgotten IUDs is underestimated. There are several reasons for this phenomenon: the IUD may fragment at removal, the absence of threads may be misinterpreted, or the patient may simply have forgotten that she had an IUD inserted. In this case, a new IUD was probably inserted and later removed, but without removal of the old IUD. This underlines the importance of asking all infertile woman about previous IUDs before embarking on complex investigations of infertility. All infertile woman who are previous IUD-user should have ultrasonography or a plain abdominal x-ray. Users of intrauterine devices are reported to have an increased risk of frank or subclinical genital infections which later may be the cause of infertility.

An extra-uterine pregnancy in an ectopic fallopian tube.

A case report of an ectopic pregnancy in a non-communicating, undescended fallopian tube. A rare embryological development-failure is described, consisting of a right hemiuterus, a remotely located noncommunicating left fallopian tube and undescended left ovary associated with agenesis of the left kidney. A noncommunicating fallopian tube should be removed when recognized to prevent ectopic pregnancy.

Obesity as a predictor of postpartum urinary symptoms.

BACKGROUND: To investigate the relationship between pre-pregnancy obesity, and urinary symptoms, especially urinary incontinence, before, during, and 6-18 months after delivery. METHODS: Body Mass Index extracted from obstetric records. Postal questionnaire. MATERIAL AND SETTING: One hundred and eight women with Body Mass Index of at least 30 kg/m2 delivered at the Obstetric Department, Herning Central Hospital, October 1994 to September 1995. As control served 108 matched, normal weight women delivering during the same period. RESULT: Response rate was 83%. Stress incontinence, urgency and the feeling of having a hygienic problem was significantly more common after delivery in both groups, but at any time significantly more common among obese women. Urge incontinence was a numerically small problem after delivery. CONCLUSION: Obesity is a potent risk factor for several urinary symptoms after pregnancy and delivery, and a substantial number of women still have problems 6-18 months postpartum.

The possible role of ultrasound in early cervical cancer.

The value of preoperative ultrasonography to detect lymph node metastases in patients with early cervical carcinoma (stage IB-IIA) was investigated in 111 patients. Comparison was made between ultrasound and the operative histopathologic findings in 109 patients and with fine-needle biopsy in 2 patients. The positive predictive value was 71%, and the negative predictive value was 84%. Sensitivity was 23%, specificity was 98%. Lymph node metastases were found in 19% (21 patients) by operative histopathologic examination; these patients received subsequent radiotherapy. The rest, 92 patients with no lymph node metastases at Meigs' operation, were followed by abdominal and transvaginal ultrasonography as well as clinical examination at 6, 9, 12, 18, 24, 36, and 48 months postoperatively to detect recurrences. The recurrence rate was 9.8%. Ultrasound alone detected only one recurrence in an asymptomatic patient. We conclude that ultrasonography is not reliable in the preoperative detection of lymph node metastases. Moreover, ultrasound examination presents no advantage over clinical examination in early detection of asymptomatic recurrent cervical cancer after radical hysterectomy.

A comparison of survival and side effects in two periods with a different approach to radical hysterectomy as treatment of cervical cancer stages Ib and IIa.

The study compares survival and complications during two periods with a different approach to radical hysterectomy as treatment of cervical cancer stages Ib and IIa. Group A included 128 patients operated during the years 1983-87. In that period 5 of the patients who were offered radical hysterectomy had cervical cancer stage IIa. Group B included 135 patients operated during the years 1988-91. In that period 7 of the patients who were offered radical hysterectomy had cervical cancer stage IIa. Considering stage 1b separately, the frequency of operation was raised from 52 (123/237) to 87% (128/148). A 5-years crude survival rate of 85% and 88% was observed in the two groups. The mortality rate was zero in both periods and no fistulae occurred. There were no significant increase in morbidity or length of hospitalization. In the elderly patients over sixty years a significant increase in minor postoperative complications and hospitalization more than 2 weeks were seen. The conclusion is that the frequency of radical hysterectomy as treatment of cervical cancer stage Ib can be raised from 52% to 87% without any noticeable influence on survival or complication rate.

High interferon alpha levels in placenta, maternal, and cord blood suggest a protective effect against intrauterine herpes simplex virus infection.

Interferons (IFN) are produced by the placenta during pregnancy, and they can be detected in the maternal and fetal blood. Although the antiviral potential of IFNs is well established, it remains unclear whether the IFNs associated with pregnancy can prevent transplacental spread of viral infection. The present study was undertaken in order to determine the possible protective effect of placentally produced IFN-alpha on fetal acquisition of herpes simplex virus (HSV). Nine mothers with a known history of genital HSV infection were studied. In five cases IFN-alpha was detected in the placenta, maternal, and fetal blood, whereas in three cases IFN-alpha could not be detected. in the remaining case, IFN-alpha was found only in the maternal blood. As corroborated by the serological evidence of early HSV infection in the cord blood, the single case of vertical HSV transmission was observed in the group of IFN nonproducers. Furthermore, virus transmission did not occur in cases where IFN-alpha was present in the placenta and simultaneously in the maternal and fetal circulations. Thus, the present data indicate that high levels of IFN during pregnancy may protect the fetus from acquiring a possibly fatal intrauterine HSV infection.