Medical compared with surgical management in induced abortions and miscarriages

Abstract Each year approximately 11,000 induced abortions are performed in Finland, the majority of these women being younger than 25 years of age. Medical abortion with the antiprogestin mifepristone and the prostaglandin analogue misoprostol is increasingly being used instead of surgical method (dilatation of cervix and uterine evacuation with instruments). Similarly, miscarriages can be treated with medical or surgical management. Still, clinical outcomes of the medical treatment of miscarriage are not well established, and various different regimens exist. The aim of this study was to investigate the frequency and risk factors of repeat abortions and immediate post-abortal complications, focusing especially on the impact of the method of abortion. National health registries were used as a data source. Another part of the study was aimed at comparing the efficacy, acceptability and cost-effectiveness of the medical and surgical treatment of miscarriage. In national cohort, the risk of repeat abortion was associated with sociodemographic characteristics (parity, previous abortion, low socioeconomic status, being unmarried but cohabiting or single), but not with the method of abortion. The risk of repeat termination of pregnancy decreased with age, among women living in rural area, and when intrauterine devices or sterilization were planned for future contraception. The overall incidence of adverse events was 4-fold greater in the medical compared to the surgical abortion cohort. Hemorrhage and incomplete abortion were more common following medical abortion, but the incidence of infections did not differ. Medical and surgical treatment of miscarriage were compared in a randomized setting; the efficacy of the treatment did not differ. Medically treated patients were less satisfied with the treatment and had experienced more pain. In the cost analysis, the primary costs of the surgical treatment were higher, but more unexpected events and complications increased the secondary costs in the medical group. In summary, medical abortion offered a good alternative to surgical method without increasing the risk of repeat abortions, but with an increased risk of short-term adverse events. The medical method was efficient in treating miscarriages, and the majority of women were satisfied with the treatment. Neither of the methods was economically superior in treating miscarriage

Association of complicated appendicitis on the risk of later in vitro fertilization treatment requirement and ectopic pregnancy:a nationwide cohort study

Abstract Introduction: A population-based register study utilizing three Finnish National Registers was carried out to determine whether uncomplicated appendicitis, complicated appendicitis and appendectomy without appendicitis are associated with a subsequent risk of requiring in vitro fertilization (IVF) treatment or a risk of ectopic pregnancy among reproductive-age women. Material and methods: A total of 23 997 women who underwent appendectomy for uncomplicated or complicated appendicitis or for nonspecific abdominal pain or who had nonspecific abdominal pain without surgical procedures between 2000 and 2012 were included in the study. The later risks of IVF treatment requirement and ectopic pregnancy were assessed after uncomplicated appendicitis, complicated appendicitis and appendectomy without appendicitis. Women with nonspecific abdominal pain without surgical procedures served as the reference group. Results: The rates of later IVF treatment after uncomplicated appendicitis, complicated appendicitis and appendectomy without appendicitis were low (2.1%, 2.5% and 2.3%, respectively; p = 0.681). Neither appendicitis nor appendectomy was associated with the risk of requiring IVF treatment. The rate of ectopic pregnancy after uncomplicated and complicated appendicitis was very low (0.8%). Women with uncomplicated appendicitis had a significantly lower risk of ectopic pregnancy compared with patients with nonspecific abdominal pain. Conclusions: Appendicitis, whether complicated or uncomplicated, and appendectomy without appendicitis does not increase the risk of requiring later IVF treatment or the risk of ectopic pregnancy

Alkuraskauden verenvuoto säikäyttää:milloin on kiire?

Tiivistelmä Alkuraskauden verenvuoto on tavallisin gynekologisen päivystyskäynnin syy. Vuodon etiologia voi olla esimerkiksi uhkaava keskenmeno, keskenmeno tai ektooppinen (kohdunulkoinen) raskaus. Jatkohoidon tarpeen ja kiireellisyyden suunnittelussa keskeisiä ovat vuotomäärän, kivun ja hemodynamiikan arviointi sekä kaikukuvaus, jonka käyttö ja tulkinta vaativat kuitenkin harjoittelua. Ektooppisen raskauden mahdollisuus tulee pitää mielessä, jos alkuraskauteen liittyy poikkeavaa vuotoa tai kipua. Tällöin lähete erikoissairaanhoitoon on tarpeellinen. Kivulias tai runsaasti vuotava potilas lähetetään päivystyksenä. Tilanteen ollessa rauhallinen arvio voidaan tehdä seuraavana arkipäivänä. Kaikukuvauksen ohella seerumin istukkagonadotropiinin määritys on hyödyllinen ektooppisen raskauden diagnostiikassa. Anti-D-immunoglobuliinia suositellaan kahdeksannen raskausviikon jälkeen Rh-negatiivisille naisille.Abstract Bleeding in early pregnancy can frighten : when should on hurry? Vaginal bleeding in early pregnancy is the most common reason for gynecological on-call visits. The etiology can be for instance impending miscarriage, miscarriage or an ectopic pregnancy. Treatment strategy and urgency are based on the amount of bleeding, pain, hemodynamics, and transvaginal ultrasound scan (if available), which however requires some training and experience. In cases with abnormal bleeding and/or pain in early pregnancy and no visible intrauterine pregnancy, the possibility of ectopic pregnancy should be kept in mind. Patients with suspected ectopic pregnancy should be referred to a gynecological unit. Immediate evaluation by gynecologist is needed in cases with extensive pain, heavy bleeding and/or unstable hemodynamic status. Stable cases can be evaluated the next working day. Serum human chorionic gonadotropin measurement is useful in the diagnostics of ectopic pregnancy. Anti-D immunoglobulin is recommended for Rh-negative patients with vaginal bleeding after 8 weeks of pregnancy

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

Gravidity, parity and knee breadth at midlife:a population-based cohort study

Abstract Gestation increases the biomechanical loading of lower extremities. Gestational loading may influence anthropometrics of articular surfaces in similar means as bone diaphyseal properties. This study aimed to investigate whether gravidity (i.e. number of pregnancies) and parity (i.e. number of deliveries) is associated with knee breadth among middle-aged women. The study sample comprised 815 women from the Northern Finland Birth Cohort 1966. The median parity count of our sample was 2 and the median gravidity count 3. At the age of 46, questionnaires were used to enquire gravidity and parity, and posteroanterior knee radiographs were used to obtain two knee breadth parameters (tibial plateau mediolateral breadth (TPML) and femoral condylar mediolateral breadth (FCML)) as representatives of articular size. The associations of gravidity and parity with knee breadth were analyzed using general linear models with adjustments for height, weight, leisure-time physical activity, smoking, and education years. Individuals with osteoarthritic changes were excluded from our sample. The mean TPML in our sample was 70.3 mm and the mean FCML 71.6 mm respectively. In the fully adjusted models, gravidity and parity showed positive associations with knee breadth. Each pregnancy was associated with 0.11–0.14% larger knee breath (p < 0.05), and each delivery accounted for an increase of 0.20% in knee breadth (p < 0.01). Between-group comparisons showed that multiparous women had 0.68–1.01% larger knee breath than nulli- and primiparous women (p < 0.05). Pregnancies and deliveries seem to increase the mediolateral breadth of the knee. This increase is potentially associated with increased biomechanical loadings during gestation

Fear of childbirth after medical vs surgical abortion:population‐based register study from Finland

Abstract Introduction: To evaluate the effect of method of induced abortion and other abortion‐associated variables on the incidence of fear of childbirth in subsequent pregnancy. Material and methods: This population‐based register study cohort includes all nulliparous women with their first pregnancy ending in an induced abortion in 2000‐2015 and subsequent pregnancy with live singleton delivery between 2000 and 2017 (n = 21 479). Data were derived from three national registers maintained by the Finnish Institute for Health and Welfare. We divided the study population in three cohorts: (a) medical and (b) surgical abortion during first trimester (≤84 days of gestation), and (c) medical abortion during second trimester (85‐168 days of gestation). Primary outcome measures were the incidence of registry‐identified fear of childbirth and cesarean delivery related to it. Results: The overall incidence of fear of childbirth was 5.6% (n = 1209). Altogether, 19.2% (n = 4121) of women underwent cesarean delivery. The odds were elevated especially for elective cesarean delivery (odds ratio [OR] 9.30, 95% CI 7.95‐10.88, P < .001) in women with fear of childbirth. In multivariable analysis, the odds for fear of childbirth (adjusted OR [aOR] 0.80, 95% CI 0.68‐0.94) and cesarean delivery (aOR 0.66, 95% CI 0.84‐0.90) were decreased in women with a history of first‐trimester medical abortion compared with those with first‐trimester surgical abortion. Second‐trimester medical abortion had no effect on the odds for fear of childbirth (aOR 1.04, 95% CI 0.71‐1.50). Maternal age of 30‐39 years and interpregnancy interval over 2 years were additional risk factors for both fear of childbirth and cesarean delivery, but surgical evacuation of uterus after the abortion was not. Conclusions: One first‐ or second‐trimester medical abortion does not increase the odds for fear of childbirth, and cesarean delivery related to it in subsequent pregnancy when compared with first‐trimester surgical abortion. Older maternal age and longer interpregnancy interval emerged as risk factors for fear of childbirth

Does climacteric status impact regulation of the autonomic nervous system at the age of 46 years?

Abstract Objectives: To investigate whether an earlier-onset climacteric phase is associated with autonomic imbalance at the age of 46 years. Methods: This cross-sectional birth cohort study included 2661 women aged 46 years. Participants were divided into climacteric (n  = 359) and preclimacteric (n = 2302) groups based on menstrual history and follicle stimulating hormone values. The mean heart rate (HR), low-frequency (LF) power, high-frequency (HF) power and LF/HF ratio were analyzed from heart rate variability recordings. The variables were compared between the groups using multivariable linear regression models, including body mass index, smoking and physical activity. The effects of hormone therapy and hot flashes on autonomic function were evaluated in sub-analyses. Results: Climacteric women had a lower mean HR in seated (71.9 ± 10.5 vs. 72.6 ± 10.4 bpm, p = 0.015) and standing (81.2 ± 12.8 vs. 83.6 ± 12.1 bpm, p = 0.002) positions compared to preclimacteric women, and the differences remained significant after the adjustments. In the sub-analyses, more frequent hot flashes were associated with a lower LF power and LF/HF ratio in the sitting position. Conclusions: The present study suggested an association between greater parasympathetic activation in women with more advanced climacteric status at the age of 46 years