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  • 1.
    Andersson, Liselott
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Sundström-Poromaa, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bixo, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Wulff, Marianne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bondestam, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Åström, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study.2003Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 189, nr 1, s. 148-154Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: This study was undertaken to determine the point prevalence of psychiatric disorders during the second trimester of pregnancy in a population-based sample of pregnant women. STUDY DESIGN: Participants were 1795 consecutive pregnant women attending routine ultrasound screening at two obstetric clinics in Northern Sweden during 1 year. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used for evaluating. RESULTS: Overall, 1734 (96.6%) of the women filled in the PRIME-MD patient questionnaire. Psychiatric disorders were present in 14.1% of the women. Major depression was prevalent in 3.3% of patients and minor depression in 6.9% of patients. Anxiety disorders were encountered in 6.6% of patients. Women with psychiatric disorders displayed significantly more somatic symptoms and more pronounced fear of childbirth. Among diagnosed patients, only 5.5% had some form of treatment. CONCLUSION: The prevalence of mood and anxiety disorders in this unselected population of pregnant women was high and the majority of the women were found to be undiagnosed and untreated.

  • 2. Babula, Oksana
    et al.
    Danielsson, Ingela
    Sjöberg, Inga
    Ledger, William J
    Witkin, Steven S
    Altered distribution of mannose-binding lectin alleles at exon I codon 54 in women with vulvar vestibulitis syndrome2004Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 191, nr 3, s. 762-766Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Mannose-binding lectin (MBL) is active in the innate immune defense against microorganisms. In this study, we determined whether vulvar vestibulitis syndrome, a disorder of unknown etiology, was associated with an altered distribution of MBL alleles.

    Study design: Buccal swabs were obtained from women with vulvar vestibulitis syndrome in New York (62) and from 2 cities in Sweden (60), as well as control women in New York (48) and Sweden (51). DNA was tested for a single nucleotide polymorphism at codon 54 in exon I by polymerase chain reaction, endonuclease digestion, and gel electrophoresis. Blood samples were also obtained from the New York women and tested by ELISA for plasma MBL concentrations. The relationships between genotype, allele frequencies, blood MBL levels, and diagnosis were analyzed by Fisher exact test and one-way analysis of variance.

    Results: The variant MBL allele, MBL*B, was detected in 35.5% and 26.7% of vulvar vestibulitis patients from New York and Sweden, respectively. Only 12.5% of New York controls (P = .007) and 9.8% of Swedish controls (P = .01) were MBL*2-positive. All women, with one exception, who were positive for MBL*B were MBL*A/MBL*B heterozygotes. Women who carried MBL*B had almost a 10-fold reduction in median plasma MBL concentrations (278 ng/mL), as opposed to women who were MBL*A homozygotes (1980 ng/mL) (P < .0001).

    Conclusion: MBL*B carriage and reduced plasma MBL levels are more common in women with vulvar vestibulitis syndrome than in control patients, and may contribute to symptomatology in a subset of patients.

  • 3.
    Bjerre, Pontus
    et al.
    Department of Obstetrics and Gynecology, Central Hospital, Karlstad, Sweden.
    Silfverdal, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Dillner, Lena
    Department of Medical Microbiology, Lund University, University Hospital at Malmö, Malmö, Sweden.
    Hagmar, Björn
    Department of Pathology, Norwegian National Hospital, University of Oslo, Oslo, Norway.
    Edvardsson, Henrik
    Department of Pathology, Central Hospital, Karlstad, Sweden.
    Dillner, Joakim
    Department of Medical Microbiology, Lund University, University Hospital at Malmö, Malmö, Sweden.
    Andersson-Ellström, Agneta
    Department of Obstetrics and Gynecology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    A randomized trial of basing treatment on human papillomavirus and/or cytology results in low-grade cervical lesion triage2008Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 199, nr 1, s. 24.e1-24.e7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: This study was undertaken to compare management algorithms that base treatment with loop electrosurgical excision procedure on human papillomavirus and/or repeat Papanicolaou test smear results.

    STUDY DESIGN: A randomized trial that referred 674 women with either atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions cytology results, detected in organized screening to treatment either (1) if they were positive in a repeat Papanicolaou test smear and/or a human papillomavirus test or (2) if they were positive in the repeat Papanicolaou test smear test only. Women who tested positive were treated, regardless of colposcopic findings.

    RESULTS: There were 208 of 337 (62%) women who were treated in the human papillomavirus /Papanicolaou test smear group (187/337 because of HPV positivity) and 138 of 337 (41%) in the Papanicolaou test smear only group. Histopathologically diagnosed cervical intraepithelial neoplasia grade 2 or worse was found among 112 of 337 (33.2%) women in the human papillomavirus/Papanicolaou test smear group compared with 85 of 337 (25.2%) women in the Papanicolaou test smear only group (P < .05). Twenty-one women with cervical intraepithelial neoplasia 2+ had normal colposcopy.

    CONCLUSION: For adequate cervical intraepithelial neoplasia 2+ sensitivity, the decision to use loop electrosurgical excision procedure needs to be based on human papillomavirus testing results and should not exclude women with normal colposcopy.

  • 4.
    Björn, Inger
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bixo, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Strandberg Nöjd, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Nyberg, Sigrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Negative mood changes during hormone replacement therapy: a comparison between two progestogens2000Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 183, nr 6, s. 1419-1426Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to compare side effects of medroxyprogesterone acetate and norethindrone acetate during postmenopausal hormone replacement therapy in women with and without a history of premenstrual syndrome. Study Design: Fifty-one postmenopausal women were randomly selected in a double-blind crossover study. The women received 2 mg of estradiol continuously during five 28-day cycles and 10 mg of medroxyprogesterone or 1 mg of norethindrone sequentially for 12 days of each cycle. Daily symptom rating scales were kept. Results: The women showed cyclic changes, with negative mood and physical symptoms culminating during the late progestogen phase and positive mood during the estrogen-only phase. Symptoms declined with time but remained after 5 months. Women with a history of premenstrual syndrome responded strongly to both progestogens. Medroxyprogesterone acetate induced less negative and more positive mood symptoms than norethindrone in women with no history of premenstrual syndrome. In both groups medroxyprogesterone caused more physical symptoms than norethindrone. Conclusion: The addition of medroxyprogesterone to estrogen is preferable to norethindrone with respect to mood symptoms in women without a history of premenstrual syndrome.

  • 5.
    Bråbäck, Lennart
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lowe, Adrian
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hjern, Anders
    Elective cesarean section and childhood asthma2013Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 209, nr 5, s. 496-496Artikkel i tidsskrift (Fagfellevurdert)
  • 6.
    Collins, Elin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Strandell, Annika
    Granåsen, Gabriel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Idahl, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Menopausal symptoms and surgical complications after opportunistic bilateral salpingectomy, a register-based cohort study2019Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 220, nr 1, artikkel-id 85.e1-e10Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In recent years, the fallopian tubes have been found to play a critical role in the pathogenesis of ovarian cancer. Therefore, bilateral salpingectomy at the time of hysterectomy has been proposed as a preventive procedure, but with scarce scientific evidence to support the efficiency and safety. OBJECTIVE: Our primary objective was to evaluate the risk of surgical complications and menopausal symptoms when performing bilateral salpingectomy in addition to benign hysterectomy. Furthermore, we sought to compare time in surgery, perioperative blood loss/blood transfusion, duration of hospital stay, days to normal activities of daily living, and days out of work for hysterectomy with bilateral salpingectomy compared with hysterectomy only. A secondary objective was to study the uptake of opportunistic salpingectomy in Sweden. STUDY DESIGN: This was a retrospective observational cohort study based on data from the National Quality Register of Gynecological Surgery in Sweden. Women <55 years of age who had a hysterectomy for benign indications with or without bilateral salpingectomy in 1998 through 2016 were included. Possible confounding was adjusted for in multivariable regression models. RESULTS: During the study period, 23,369 women had a hysterectomy for benign indications. The frequency of bilateral salpingectomy at the time of hysterectomy increased mainly from 2013, which is why the period 2013 through mid-2016 was selected for further analysis (n = 6892). There was a low frequency of vaginal hysterectomy with bilateral salpingectomy performed in this period, which is why only abdominal and laparoscopic surgeries were selected for comparative analysis (n = 4906). This study indicates an increased risk of menopausal symptoms (adjusted relative risk, 1.33; 95% confidence interval, 1.04-1.69) 1 year after hysterectomy with bilateral salpingectomy compared with hysterectomy only. Hospital stay was 0.1 days longer in women having salpingectomy (P = .01), and bleeding was slightly reduced in the salpingectomy group (-20 mL, P = .04). Other outcome measures were not significantly associated with salpingectomy, albeit a tendency toward higher risk of minor complications was seen (adjusted relative risk, 1.30; 95% confidence interval, 0.93-1.83). CONCLUSION: Bilateral salpingectomy at the time of hysterectomy was associated with an increased risk of menopausal symptoms 1 year after surgery. Randomized clinical trials reducing the risk of residual and unmeasured confounding and longer follow-up are needed to correctly inform women on the risks and benefits of opportunistic salpingectomy.

  • 7. Cuneo, Bettina
    et al.
    Clur, Sally Ann
    Swan, Heikki
    Ackerman, Michael
    Herberg, Ulrike
    Etheridge, Susan
    Winbo, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Benson, D. Woodrow
    Schwartz, Peter
    Fetal heart rate and arrhythmia profile predicts long QT syndrome (LQTS) genotype: Results of an 8-center international study2018Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 218, nr 1, s. S93-S93Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Objective: 1. Determine if fetal heart rate (FHR) predicts LQTS across gestational ages (GA). 2. Ascertain genotype specific effects on FHR and rhythm.

    Study Design: FHR and rhythm data were ascertained from fetuses with maternal or paternal LQTS1, LQTS2 or LQTS3 genotype at 8 international centers. We reviewed obstetrical history including maternal beta blocker (BB) use. At each obstetrical visit, FHRs were calculated from an average of 3 heart beats (ultrasound) or 3 10-second periods of FHR auscultation (Doppler monitor) measured during fetal quiescence. Postnatal genetic testing was performed by commercial laboratories. We compared FHR in the 1st, 2nd and 3rd trimesters between fetuses with (LQTS+) and without (LQTS-) the family mutation by t-test. Differences in FHR between LQTS genotypes were compared by ANOVA. Log FHR was analyzed by a linear mixed effect model with GA as the continuous variable and adjusting for maternal BB use. The predictive ability of FHR to discriminate LQTS+ from LQTS- was addressed by ROC analysis, evaluating the magnitude of FHR (intercept) and change in FHR (slope) across GA.

    Results: Data were available on 51 LQTS+ and 27 LQTS-. Mean FHR differed between LQTS+ and LQTS- fetuses in 2nd and 3rd but not in the 1st trimesters (Table). The magnitude of FHR change in 2nd and 3rd trimesters discriminated LQTS + from LQTS- (both, p<0.05); with AUC of 0.81. FHR effect was most pronounced for LQTS1 and differed significantly between genotypes. LQTS3 did not exhibit a FHR effect at any GA. Only LQTS2 had signature LQTS arrhythmias (2◦ AV block and/or torsade de pointes). Maternal BB had no significant effect on FHR.

    Conclusion: In this study with a preponderance of LQTS1, FHR discriminated LQTS+ from LQTS- fetuses in the 2nd and 3rd trimesters. LQTS genotype appears to affect the fetal presentation of LQTS. These findings provide insight into the natural history of LQTS before birth and may facilitate early detection of LQTS1 and LQTS2 fetuses.

  • 8. Haya, Nir
    et al.
    Baessler, Kaven
    Christmann-Schmid, Corina
    de Tayrac, Renaud
    Dietz, Viviane
    Guldberg, Rikke
    Mascarenhas, Teresa
    Nüssler, Emil
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Ballard, Emma
    Ankardal, Maud
    Boudemaghe, Thierry
    Wu, Jennifer M
    Maher, Christopher F
    Prolapse and continence surgery in countries of the Organization for Economic Cooperation and Development in 20122015Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 212, nr 6, artikkel-id 755.e1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to report the rates and types of pelvic organ prolapse (POP) and female continence surgery performed in member countries of the Organization for Economic Co-operation and Development (OECD) in 2012. STUDY DESIGN: The published health outcome data sources of the 34 OECD countries were contacted for data on POP and female continence interventions from 2010-2012. In nonresponding countries, data were sought from national or insurer databases. Extracted data were entered into an age-specific International Classification of Disease, edition 10 (ICD-10)-compliant Excel spreadsheet by 2 authors independently in English-speaking countries and a single author in non-English-speaking countries. Data were collated centrally and discrepancies were resolved by mutual agreement. RESULTS: We report on 684,250 POP and 410,352 continence procedures that were performed in 15 OECD countries in 2012. POP procedures (median rate, 1.38/1000 women; range, 0.51-2.55 prolapse procedures/1000 women) were performed 1.8 times more frequently than continence procedures (median rate, 0.75/1000 women; range, 0.46-1.65 continence procedures/1000 women). Repairs of the anterior vaginal compartment represented 54% of POP procedures; posterior repairs represented 43% of the procedures, and apical compartment repairs represented 20% of POP procedures. Median rate of graft usage was 15.7% of anterior vaginal repairs (range, 3.3-25.6%) and 8.5% (range, 3.2-17%) of posterior vaginal repairs. Apical compartment repairs were repaired vaginally at a median rate of 70% (range, 35-95%). Sacral colpopexy represented a median rate of 17% (range, 5-65%) of apical repairs; 61% of sacral colpopexies were performed minimally invasively. Between 2010 and 2012, there was a 3.7% median reduction in transvaginal grafts, a 4.0% reduction in midurethral slings, and a 25% increase in sacral colpopexies that were performed per 1000 women. Midurethral slings represented 82% of female continence surgeries. CONCLUSION: The 5-fold variation in the rate of prolapse interventions within OECD countries needs further evaluation. The significant heterogeneity (> 10 times) in the rates at which individual POP procedures are performed indicates a lack of uniformity in the delivery of care to women with POP and demands the development of uniform guidelines for the surgical management of prolapse. In contrast, the midurethral slings were the standard female continence surgery performed throughout OECD countries in 2012.

  • 9.
    Idahl, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Lundin, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Elgh, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Jurstrand, Margaretha
    Kliniskt forskingscentrum, Örebro universitetssjukhus.
    Møller, Jens K
    Klinisk mikrobiologi, Århus universitetssjukhus, Skejby, Danmark.
    Marklund, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Lindgren, Peter
    Inst för kvinnors och barns hälsa, obstetrik och gynekologi, Uppsala universitet.
    Ottander, Ulrika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae, human papillomavirus, and polyomavirus are not detectable in human tissue with epithelial ovarian cancer, borderline tumor, or benign conditions2010Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 202, nr 1, s. 71.e1-71.e6Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    OBJECTIVE: We sought to analyze the presence of the microorganisms Chlamydia trachomatis, Mycoplasma genitalium, Neisseria gonorrhoeae, human papillomavirus (HPV), and the polyomaviruses BK virus (BKV) and JC virus (JCV) in ovarian tissues of women with ovarian carcinomas, borderline tumors, and benign conditions. STUDY DESIGN: Ovarian tissue, snap-frozen and stored at -80 degrees C, from 186 women with benign conditions, borderline tumors, and epithelial ovarian cancer, as well as tissue from the contralateral ovary of 126 of these women, were analyzed regarding presence of C trachomatis and N gonorrhoeae (transcription mediated amplification), M genitalium (real-time polymerase chain reaction [PCR]), HPV (PCR), and BKV and JCV (PCR). RESULTS: All the tissue samples studied were found negative for the microorganisms analyzed. CONCLUSION: C trachomatis, M genitalium, N gonorrhoeae, HPV, and the polyomaviruses BKV and JCV are not detectable in ovarian tissues either from women with benign conditions and borderline tumors or from women with ovarian cancer.

  • 10. Kjellberg, L
    et al.
    Wadell, G
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Bergman, F
    Isaksson, M
    Angström, T
    Dillner, J
    Regular disappearance of the human papillomavirus genome after conization of cervical dysplasia by carbon dioxide laser.2000Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 183, nr 5, s. 1238-42Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The human papillomavirus genome present before treatment was regularly cleared, and there was also no recurrence of dysplasia. The results suggest that human papillomavirus testing is useful for monitoring the efficacy of treatment and that treatment modalities resulting in clearance of human papillomavirus should be favored.

  • 11.
    Lose, Gunnar
    et al.
    Department of Gynecology, Glostrup Hospital, Glostrup, Denmark.
    Lalos, Othon
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Freeman, Robert M
    Department of Obstetrics and Gynaecology, Derriford Hospital, Plymouth, United Kingdom.
    van Kerrebroeck, Philip
    Department of Urology, University Hospital Maastricht, Maastricht, The Netherlands.
    Efficacy of desmopressin (Minirin) in the treatment of nocturia: a double-blind placebo-controlled study in women2003Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 189, nr 4, s. 1106-1113Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in women.

    STUDY DESIGN: Women aged 18 years or older with nocturia (>or=2 voids per night with a nocturia index score >1) received desmopressin (0.1 mg, 0.2 mg, or 0.4 mg) during a 3-week dose-titration period. After a 1-week washout period, patients who responded in this period received desmopressin or placebo in a double-blind fashion for 3 weeks.

    RESULTS: In double-blind phase, 144 patients were randomly assigned to groups (desmopressin, n=72; placebo, n=72). For desmopressin, 33 (46%) patients had a 50% or greater reduction in nocturnal voids against baseline levels compared with 5 (7%) patients receiving placebo (P<.0001). The mean number of nocturnal voids, duration of sleep until the first nocturnal void, nocturnal diuresis, and ratios of nocturnal per 24 hours and nocturnal per daytime urine volumes changed significantly in favor of desmopressin versus placebo (P<.0001). In the dose-titration phase headache (22%), nausea (8%), and hyponatremia (6%) were reported. Two deaths occurred, although neither could be directly associated with the study drug.

    CONCLUSION: Oral desmopressin is an effective and well-tolerated treatment for nocturia in women.

  • 12.
    Samuelsson, E C
    et al.
    Uppsala universitet.
    Victor, F T
    Tibblin, G
    Svärdsudd, K F
    Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors.1999Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 180, nr 2 Pt 1, s. 299-305Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Our objective was to study the prevalence of genital prolapse and possible related factors in a general population of women 20 to 59 years of age.

    STUDY DESIGN: Of 641 eligible women in a primary health care district, 487 (76%) answered a questionnaire and accepted an invitation to a gynecologic health examination.

    RESULTS: The prevalence of any degree of prolapse was 30.8%. Only 2% of all women had a prolapse that reached the introitus. In a set of multivariate analyses, age (P <.0001), parity (P <.0001), and pelvic floor muscle strength (P <.01)-and among parous women, the maximum birth weight (P <.01)-were significantly and independently associated with presence of prolapse, whereas the woman's weight and sustained hysterectomy were not.

    CONCLUSIONS: Signs of genital prolapse are frequently found in the female general population but are seldom symptomatic. Of factors associated with genital prolapse found in this study, pelvic floor muscle strength appears to be the only one that could be affected.

  • 13.
    Samuelsson, Eva C
    et al.
    Uppsala universitet.
    Victor, F T Arne
    Svärdsudd, Kurt F
    Five-year incidence and remission rates of female urinary incontinence in a Swedish population less than 65 years old2000Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 183, nr 3, s. 568-574Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: We sought to determine the incidence and remission rates of urinary incontinence in a population-based sample of women.

    STUDY DESIGN: A total of 382 (87.6%) of 436 eligible women aged 20 to 59 years answered a questionnaire and underwent a gynecologic examination at baseline and were followed up approximately 5 years later.

    RESULTS: Urinary incontinence was present in 23.6% of women at baseline and in 27.5% at follow-up. The mean annual incidence rate of incontinence was 2.9%, and the mean annual incidence rate of incontinence weekly or more often was 0.5%. Women that were receiving estrogen at baseline were more likely than other women to have incontinence during follow-up. The mean annual remission rate among the 90 women who were incontinent at baseline was 5.9%. The annual net increase of incontinence in the study population was 0. 82%.

    CONCLUSION: Female urinary incontinence seems to be a dynamic condition with a relatively high rate of spontaneous remission, a fact of which physicians should be aware when assessing and planning prevention and treatment strategies.

  • 14.
    Segebladh, Birgitta
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Borgström, Anna
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Nyberg, Sigrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bixo, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Sundström-Poromaa, Inger
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Evaluation of different add-back estradiol and progesterone treatments to gonadotropin-releasing hormone agonist treatment in patients with premenstrual dysphoric disorder2009Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 201, nr 2, s. 139.e1-139.e8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: The aim of this study was to investigate which add-back hormone replacement therapy would be most beneficial in terms of mood effects for patients with premenstrual dysphoric disorder who are receiving gonadotropin-releasing hormone agonist therapy.

    STUDY DESIGN: Three different add-back hormone replacement treatments were evaluated in a randomized, double-blinded, cross-over clinical trial in 27 patients premenstrual dysphoric disorder. The add-back treatments consisted of 1.5 mg estradiol and 400 mg progesterone, 1.5 mg estradiol and placebo, and 0.5 mg estradiol and 400 mg progesterone. The primary outcome measure was daily symptom ratings for mood and physical symptoms.

    RESULTS: The highest dose of estradiol in combination with progesterone was associated with the most pronounced symptom recurrence, both in comparison with a lower dose of estradiol together with progesterone and estradiol-only treatment.

    CONCLUSION: Based on the findings of the present study, long-cycle add-back treatment to avoid frequent progestagen use appears to be most beneficial for patients with premenstrual dysphoric disorder.

  • 15.
    Silfverdal, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Kemetli, Levent
    Cancer Screening Unit, Oncologic Center, Karolinska University Hospital, Stockholm, Sweden.
    Andrae, Bengt
    Department of Obstetrics and Gynecology, Gävle Hospital, Gävle, Sweden.
    Sparén, Pär
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Ryd, Walter
    Department of Pathology and Clinical Cytology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Dillner, Joakim
    Department of Medical Microbiology, Lund University, Malmö University Hospital, Malmö, Sweden.
    Strander, Björn
    Oncologic Center, Sahlgrenska University Hospital, Göteborg, Sweden.
    Törnberg, Sven
    Cancer Screening Unit, Oncologic Center, Karolinska University Hospital, Stockholm, Sweden.
    Risk of invasive cervical cancer in relation to management of abnormal Pap smear results2009Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 201, nr 2, s. 188.e1-188.e7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: We sought to evaluate the management of women with abnormal cytology in terms of subsequent risk of invasive cervical cancer.

    STUDY DESIGN: The screening histories of all invasive cervical cancer cases diagnosed in Sweden 1999-2001 and of 5 population-based controls per case were reviewed. In all, 159 patients and 258 control subjects aged < 67 years had an abnormal smear result 0.5-6.5 years prior to cancer diagnosis. The cervical cancer risk was estimated in relation to management by calculating odds ratios.

    RESULTS: Histologic assessment of low-grade squamous abnormalities strongly reduced the risk compared to repeated cytology (odds ratio, 0.46; 95% confidence interval, 0.24-0.89). Delaying histologic assessment was also associated with a higher risk (odds ratio, 5.65; 95% confidence interval, 1.39-23.05). After high-grade squamous atypia, absence of any cytologic or histologic specimen was a major determinant of cancer risk (odds ratio, 12.52; 95% confidence interval, 1.42-infinitive).

    CONCLUSION: For adequate protection against invasive cervical cancer, further assessment with histology must be recommended also for women with low-grade squamous abnormalities.

  • 16. Stenström Bohlin, Katja
    et al.
    Ankardal, Maud
    Lindkvist, Håkan
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för matematik och matematisk statistik.
    Milsom, Ian
    Factors influencing the incidence and remission of urinary incontinence after hysterectomy2017Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 216, nr 1, s. 53.e1-53.e9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Studies on the influence of body mass index, smoking, and mode of delivery on the occurrence of urinary incontinence after hysterectomy are required to provide women with information about how these factors influence continence after a hysterectomy.

    OBJECTIVE: The aim was to assess the impact of lifestyle factors such as body mass index, smoking, and delivery mode (vaginal/cesarean) on the incidence and remission of urinary incontinence after hysterectomy.

    STUDY DESIGN: This was a cohort study based on pre-, per-, and postoperative (1 year) data retrieved from the Swedish National Register for Gynecological Surgery on 16,182 hysterectomies performed because of a benign indication between 2006 and 2013. Multivariable logistic regression analyses were used to identify independent risk factors for de novo urinary incontinence and postoperative remission of urinary incontinence, presented as adjusted odds ratios with 95% confidence intervals.

    RESULTS: De novo urinary incontinence was reported by 8.5%, remission of urinary incontinence by 13.3%, and residual urinary incontinence by 16.1% after the hysterectomy. A body mass index ≥30 kg/m(2) (odds ratio, 1.63, 95% confidence interval, 1.37-1.94), having undergone a vaginal delivery (odds ratio, 1.40, 95% confidence interval, 1.14-1.86), the presence of daily urge without incontinence prior to surgery (odds ratio, 1.77, 95% confidence interval, 1.47-2.13), and a uterine weight <500 g (odds ratio, 2.46, 95% confidence interval, 1.96-3.09) were associated with an increased risk of de novo urinary incontinence. A uterine weight >300 g (odds ratio, 1.98, 95% confidence interval, 1.69-2.33), body mass index <25 kg/m(2) (odds ratio, 1.22, 95% confidence interval, 1.01-1.47), prolapse (odds ratio, 2.25, 95% confidence interval, 1.60-3.18), or fibroids (odds ratio, 1.33, 95% confidence interval, 1.09-1.62) as indication for surgery and the absence of daily urge without incontinence preoperatively (odds ratio, 1.51, 95% confidence interval, 1.29-1.76) were associated with an increased remission of urinary incontinence. Vaginal compared with abdominal hysterectomy was associated with a decreased remission of urinary incontinence (odds ratio, 0.70, 95% confidence interval, 0.57-0.87). There was no effect of of age or smoking or a difference between total and subtotal hysterectomy with regard to de novo urinary incontinence or remission of urinary incontinence after the hysterectomy. Residual urinary incontinence and de novo urinary incontinence significantly reduced satisfaction with surgery 1 year postoperatively compared with women without urinary incontinence.

    CONCLUSION: Vaginal delivery, obesity, and daily urge symptoms without incontinence prior to surgery increased de novo urinary incontinence and had a negative influence on the rate of remission of urinary incontinence after hysterectomy, which in turn influenced patients' satisfaction with surgery.

  • 17. Wiberg-Itzel, Eva
    et al.
    Pembe, Andrea
    Norman, Margaretha
    Wihlbäck, Anna-Carin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Hoesli, Irene
    Azria, Elie
    Akerud, Helena
    The dysfunctional labor study2014Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 210, nr 1, s. S328-S329Artikkel i tidsskrift (Annet vitenskapelig)
  • 18. Wiberg-Itzel, Eva
    et al.
    Pembe, Andrea
    Wihlbäck, Anna-carin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Darj, Elisabet
    Åkerud, Helena
    The association between dystocic labors and circadian signals2013Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 208, nr 1, s. S139-S140Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Objective: Human deliveries commonly occur during the dark period of the day. Melatonin hormone is released as a circadian signal from the human brain, and has been shown to have a synergistic effect together with oxytocin in facilitating the uterine contractions during labor. Melatonin is inhibited by light and energized by dark. During winter the numbers of light hours per day in Sweden are few, but during the summer they are numerous. In Tanzania there is no season difference.

    Study Design: In 2011,452 Tanzanian and 919 Swedish healthy primiparas with a normal pregnancy and a spontaneous onset of labor were included in the study. Time and date together with the length and outcome of delivery were studied, and a statistical comparison was made.

    Results: 47% of the Swedish deliveries started in early morning, and 48% ended at midnight. The median time of active labor was significantly longer during the summer season (May to August vs. November to February, p=0.05). The frequency of labor dystocia was increased during summer season, and significantly more in the region on Sweden with midnight sun (29 vs. 40%, p=0.03).

    48% of Tanzania labors started at midnight, and 41% ended at lunch time. Among Tanzanian women, no difference in median time of active delivery (p=0.5) or the frequency of dystocic labors was shown, according to season of the year (13.7 vs. 14.1 %, p=0.8).

    Oxytocin was used in 68% of the Swedish deliveries, and the use was higher during the summer season. Oxytocin was used in 31% of the Tanzanian deliveries. No difference in use of oxytocin was shown according to season.

    Conclusion: In this project a variation of labor dystocia according to season of the year has been studied. A significant overrepresentation of prolonged and dystocic deliveries were shown during the summer season in Sweden. This new knowledge may be of a great importance, when handling a dysfunctional labor.

  • 19. Wikman, M
    et al.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    von Schoultz, B
    Attitudes toward reproduction in a nonpatient population1992Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 166, nr 1 Pt 1, s. 121-126Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: A basic question to be answered in an attempt to understand human reproductive behavior as it manifests itself in clinical practice is, why do people want to have children? STUDY DESIGN: A psychometric instrument for the assessment of reproductive attitudes was developed. A total of 746 men and women at 20, 30, and 40 years of age, who were randomly selected from a nonpatient population, answered. Data were analyzed by factor analysis. Reproductive profiles were constructed. RESULTS: The two most important factors in both sexes were "children as existential satisfaction" and "children as lack of freedom," indicating a basic conflict. The third most important factor in both sexes was "the importance of one's own parents as examples in parenthood," supporting earlier findings that reproductive conflicts are transmitted from one generation to another. Reproductive profiles were uniform in the different age groups. CONCLUSION: The element of ambivalence may be a clue to a deeper understanding of human reproductive behavior.

  • 20. Ödmark, Inga-Stina
    et al.
    Jonsson, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bleeding patterns in postmenopausal women using continuous combination hormone replacement therapy with conjugated estrogen and medroxyprogesterone acetate or with 17β-estradiol and norethindrone acetate2001Inngår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 184, nr 6, s. 1131-1138Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: We studied bleeding patterns in postmenopausal women who were using 2 types of continuous combination regimens.

    STUDY DESIGN: A prospective, double-blind, randomized study of 208 postmenopausal women treated with conjugated estrogen, 0.625 mg, and medroxyprogesterone acetate, 5 mg, or with 17beta-estradiol, 2 mg, and norethindrone acetate, 1 mg.

    RESULTS: The mean number of bleeding days decreased during the first 4 months of treatment (P <.002) but not thereafter. The number of bleeding days was fewer (P <.002) and the time until amenorrhea was shorter (P <.02) in patients receiving conjugated estrogen and medroxyprogesterone acetate than in patients receiving 17beta-estradiol and norethindrone acetate. The odds ratio for progression to amenorrhea with the use of conjugated estrogen and medroxyprogesterone acetate was 1.58, in comparison with the use of 17beta-estradiol and norethindrone acetate. A thick endometrium at the start of treatment resulted in more bleeding days than were found for a thin endometrium (P <.03). Body mass index, age, and blood pressure had no predictive value for bleeding problems.

    CONCLUSIONS: Treatment with continuous combined conjugated estrogen and medroxyprogesterone acetate resulted in fewer bleeding problems than did treatment with 17beta-estradiol and norethindrone acetate. Endometrial thickness may help to predict the chance of achieving amenorrhea during early hormone replacement therapy.

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