In vitro fertilization in Northern Finland 1990-1995:prenatal and early childhood outcome until three years of age

Abstract The aim of this population-based cohort study was to evaluate prenatal and child outcome and costs resulting from prenatal and neonatal care after in vitro fertilization (IVF) in comparison to those after natural conception using a cohort of 304 IVF exposed children born between 1990–1995 in Northern Finland, and two cohorts of unexposed control children (I: n = 569, representing general population in proportion of multiple births; II: n = 103, matched for plurality). The control children were randomly chosen from the Finnish Medical Birth Register (FMBR) and matched for sex, year of birth, area of residence, parity, maternal age and socioeconomic status. Analyses were performed by comparing the whole IVF population with controls representing general population as well as stratifying by singleton or twin status. IVF mothers carried a higher risk for vaginal bleeding, threatened preterm birth and intrahepatic cholestasis of pregnancy than control mothers, and they used specialized antenatal care more than others. Neonatal outcome was also poorer after IVF in terms of gestational age, birthweight, morbidity and intensive care treatment. The prevalence of congenital heart malformations (septal defects) was 4-fold for IVF children in comparison to controls. The three year follow-up showed delayed growth and increased morbidity for IVF children, but their psychomotor development was similar to that of the control children. Health care costs were 1.3-fold for IVF singletons in comparison to control singletons, but for twins the costs were equal. Multiple births increased the costs ∼3-fold when compared to singleton births. IVF increased the health risks for the pregnancies and the offspring, seen mostly in the comparison between the whole IVF population and controls representing natural proportion of multiple births, indicating that multiple birth is the strongest determinant of medical outcome after IVF. The effects of fertility therapy and maternal characteristics related to infertility cannot be ruled out at this point. The increased health care costs after IVF were mostly due to the high proportion of multiple births. In order to improve the outcomes and to reduce the health care costs after IVF, the amount of multiple births should be limited to a minimum by using single embryo transfer when possible

Endometrioosin lääkkeellinen hoito

Tiivistelmä Endometrioosia tulee muistaa epäillä tyyppioireiden perusteella. Myös teini-ikäisten kuukautiskipuihin tulee suhtautua vakavasti. Hormonaalinen hoito eli yhdistelmäehkäisyvalmiste, progestiinitabletti, -kapseli tai hormonikierukka ja tarvittavat kipulääkkeet voidaan aloittaa jo perusterveydenhuollossa. Lääkehoidon tavoitteena on endogeenisen estrogeenierityksen vähentäminen sekä vuodottomuus ja sitä kautta kipujen helpottuminen sekä elämänlaadun paraneminen. Endometrioosipotilaat hyötyvät pitkäaikaisesta hoitosuhteesta hoitavaan yksikköön.Abstract Endometriosis is a chronic inflammatory condition characterised by the presence of fibrosis and endometrium-like epithelial and stromal cells outside the uterus. It affects women during their fertile years, causing significant morbidity: chronic pain in the form of dysmenorrhoea, non-cyclic pelvic pain and infertility. Hormonal medication is the keystone of medical management of endometriosis, which aims at reducing endogenous estrogen secretion and ensuring amenorrhoea, thereby reducing endometriosis related pain. The first-line therapies are combined contraceptives (pill, patch, vaginal ring) and progesterone only products (pill, subdermal implant, intrauterine device). Every endometriosis patient requires an individual pain management plan including long-term analgesics and prescription for possible acute pain. Fertility counselling is also offered to all endometriosis patients. Endometriosis requires long-standing medical management from the time of diagnosis until menopause. Investing in patient counselling with a tailored treatment plan benefits the patient. A long-term relationship with a treatment unit also supports the management of this chronic pain condition

Increased overall morbidity in women with endometriosis:a population-based follow-up study until age 50

Abstract Objective: To investigate whether there is an association between endometriosis and nongynecological diseases in the general female population by age 50? Design: A prospective cohort study. Setting: Study participants with and without endometriosis were identified from a general population-based birth cohort. The analyzed data, linking to the national hospital discharge registers, spanned up to the age of 50 years. Patient(s): Endometriosis case identification was based on national register data and self-reported diagnoses, producing a study population of 349 women with endometriosis and 3,499 women without endometriosis. Main outcome measure(s): International Classification of Diseases diagnosis codes from 1968 to 2016 were accumulated from the Finnish national Care Register for Health Care, whereas self-reported symptoms and continuous medication usage data were collected from the questionnaires distributed at age 46. The associations between endometriosis and comorbidities were assessed using logistic regression models that included several covariates. The odds ratios and 95% confidence intervals (CIs) were modeled. Endometriosis subtype and temporal analyses were also performed. Result(s): Women with endometriosis were on average twice as likely to have hospital-based nongynecological diagnoses as women without endometriosis (adjusted odds ratio [aOR] 2.32; 95% CI, 1.07–5.02). In more detail, endometriosis was associated with allergies, infectious diseases, pain-causing diseases, and respiratory diseases. Moreover, the affected women presented with nonspecific symptoms and signs (aOR 3.56; 95% CI, 2.73–4.64), especially abdominal and pelvic pain (aOR 4.33; 95% CI, 3.13–4.76) more often compared with nonendometriosis controls. The temporal analysis revealed that diagnoses accumulated at a significantly younger age among women with endometriosis than in nonendometriosis counterparts. Conclusion(s): Women with endometriosis have a high risk for several chronic diseases compared with women without endometriosis, underlying the need for awareness and targeted resources for these women in the health care system. Moreover, endometriosis should be considered in the presence of nonspecific symptoms and abdominal pain, as they may conceal the disease and cause considerable delay in diagnosis and treatment

Laparoscopically guided transversus abdominis plane block versus local wound analgesia in laparoscopic surgery for peritoneal endometriosis:study protocol for a prospective randomized controlled double-blinded LTAP-trial

Abstract Background: Ultrasound-guided transversus abdominis plane block (TAP) performed by anesthesiologist has been shown to be an effective and safe analgesia method in abdominal surgery, reducing postoperative opioid consumption. Recently, there has been growing interest to insert TAP under laparoscopic vision (LTAP) by surgeon. LTAP has been used in laparoscopic gastrointestinal surgery, but studies on LTAP in gynecologic laparoscopic surgery are sparse and inconsistent. The purpose of this study is to compare the efficacy of LTAP and local wound analgesia in laparoscopic surgery due to suspected or diagnosed superficial peritoneal endometriosis. Methods: The LTAP-trial is a prospective randomized controlled double-blinded study comparing the efficacy and safety of LTAP with local wound analgesia in laparoscopic endometriosis surgery. Patients are randomized to receive LTAP with levobupivacaine and wound infiltration with placebo or wound infiltration with levobupivacaine and LTAP with placebo. The primary outcome is postoperative opioid consumption measured by patient-controlled analgesia (PCA) pump. Secondly, subjective postoperative pain up to 24 h postoperatively will be measured by Numeric Rating Scale (NRS). Additional outcome measures are factors related to recovery and length of stay in the hospital as well as a 6-month follow-up survey regarding pain (NRS) and endometriosis-related wellbeing (endometriosis-related health profile, EHP-30) after surgery. A total of 46 patients will be randomized in a proportion of 1:1. Discussion: Patients with peritoneal endometriosis are often prone to severe postoperative pain that may prohibit their enhanced recovery after laparoscopy. Thus, there is a need for effective postoperative pain management with minimal side-effects. This study focusing on laparoscopically inserted transversus abdominis plane block may provide new insight in dealing with postoperative pain after laparoscopic endometriosis surgery as well as after other gynecologic surgery

Robotic versus laparoscopic surgery for severe deep endometriosis:protocol for a randomised controlled trial (ROBEndo trial)

Abstract Introduction: Endometriosis is a common gynaecological disease affecting around 10% of fertile-aged women, causing severe pain symptoms. Deep endometriosis is defined as endometriotic implants that infiltrate the underlying organs more than 5 mm in depth. Surgery for deep endometriosis requires advanced multidisciplinary surgical technique, often in very difficult surgical conditions, with increased risks of complications. Robotic surgery offers a high-definition three-dimensional view and articulating instruments that may allow more precise dissection than conventional laparoscopy in the pelvic area. The superiority of robotic surgery has not, however, been provedin randomised controlled studies, and there is a lack of long-term outcome data. Advanced endometriosis surgery offers an excellent platform to study the feasibility and long-term outcomes of robotic surgery compared with conventional laparoscopy. Methods and analysis: ROBEndo is a prospective, randomised, controlled clinical trial in a single-centre setting. Patients with deep endometriosis verified by MRI needing surgery at Oulu University Hospital (Oulu, Finland) will be considered eligible. 70 patients will be allocated 1:1 to receive either robotic-assisted or conventional laparoscopic surgery in two strata: radical surgery (with the removal of the uterus and adnexae) and gynaecological organ-sparing surgery. The primary outcome will be the surgical outcome as regards to pain symptoms measured on numeric rating scale (NRS) questionnaires at 24 hours and 6, 12 and 24 months postoperatively. As secondary outcomes, intraoperative measures, enhanced recovery after surgery factors, complications, cost and long-term quality of life measured with Endometriosis Health Profile-30 (EHP-30), Female Sexual Function Index (FSFI) and 15-dimensional (15D) questionnaires will be compared. Ethics and dissemination: This study has been approved by the Northern Ostrobothnian Hospital District Ethical Committee at Oulu University Hospital (212/2021). Informed consent will be obtained during the preoperative check-up by the operating gynaecologist. The results will be published in peer-reviewed international journals. Trial registration number: NCT05179109

Cost-analysis and quality of life after laparoscopic and robotic ventral mesh rectopexy for posterior compartment prolapse:a randomized trial

Abstract Background: The aim of this study was to assess, whether robotic-assistance in ventral mesh rectopexy adds benefit to laparoscopy in terms of health-related quality of life (HRQoL), cost-effectiveness and anatomical and functional outcome. Methods: A prospective randomized study was conducted on patients who underwent robot-assisted ventral mesh rectopexy (RVMR) or laparoscopic ventral mesh rectopexy (LVMR) for internal or external rectal prolapse at Oulu University Hospital, Finland, recruited in February–May 2012. The primary outcomes were health care costs from the hospital perspective and HRQoL measured by the 15D-instrument. Secondary outcomes included anatomical outcome assessed by pelvic organ prolapse quantification method and functional outcome by symptom questionnaires at 24 months follow-up. Results: There were 30 females (mean age 62.5 years, SD 11.2), 16 in the RVMR group and 14 in the LVMR group. The surgery-related costs of the RVMR were 1.5 times higher than the cost of the LVMR. At 3 months the changes in HRQoL were ‘much better’ (RVMR) and ‘slightly better’ (LVMR) but declined in both groups at 2 years (RVMR vs. LVMR, p > 0.05). The cost-effectiveness was poor at 2 years for both techniques, but if the outcomes were assumed to last for 5 years, it improved significantly. The incremental cost-effectiveness ratio for the RVMR compared to LVMR was €39,982/quality-adjusted life years (QALYs) at 2 years and improved to €16,707/QALYs at 5 years. Posterior wall anatomy was restored similarly in both groups. The subjective satisfaction rate was 87% in the RVMR group and 69% in the LVMR group (p = 0.83). Conclusions: Although more expensive than LVMR in the short term, RVMR is cost-effective in long-term. The minimally invasive VMR improves pelvic floor function, sexual function and restores posterior compartment anatomy. The effect on HRQoL is minor, with no differences between techniques

Long-term results of a prospective randomized trial comparing tension-free vaginal tape versus transobturator tape in stress urinary incontinence

Abstract Introduction and hypothesis: This study was aimed at investigating the long-term effectiveness of minimally invasive mid-urethral sling (MUS) surgery and at comparing the outcomes between retropubic (tension-free vaginal tape, TVT) and transobturator tape (TOT) methods in the treatment of stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) with a predominant stress component in a long-term follow-up of a randomized controlled trial. Methods: This work is a long-term follow-up study of a previous prospective randomized trial conducted in the Department of Obstetrics and Gynecology at Oulu University Hospital between January 2004 and November 2006. The original 100 patients were randomized into the TVT (n=50) or TOT (n=50) group. The median follow-up time was 16 years, and the subjective outcomes were evaluated using internationally standardized and validated questionnaires. Results: Long-term follow-up data were obtained from 34 TVT patients and 38 TOT patients. At 16 years after MUS surgery, the UISS significantly decreased from a preoperative score in the TVT (11.88 vs 5.00, p<0.001) and TOT (11.05 vs 4.95, p<0.001) groups, showing a good long-term success of the MUS surgery in both groups. In comparing the TVT and TOT procedures, the subjective cure rates did not differ significantly between the study groups in long-term follow-up according to validated questionnaires. Conclusion: Midurethral sling surgery had good long-term outcomes in the treatment of SUI and MUI with a predominant stress component. The subjective outcomes of the TVT and TOT procedures were similar after a 16-year follow-up