The aim of our study was to introduce outpatient induction of labor by Foley catheter, and to compare outcomes and preferences between in-patients and outpatients.
This clinical cohort study was ...conducted in Helsinki University Hospital between January 2011 and January 2012. A total of 485 women scheduled for induction of labor by Foley catheter were included. The main outcome measures were cesarean delivery rate, and maternal and neonatal infectious morbidity. Maternal satisfaction of outpatients was measured after delivery.
Two hundred and four (42.1%) women were managed as outpatients and 281 (57.9%) women as in-patients. The rates of cesarean delivery, and maternal or neonatal infections did not differ between outpatients and in-patients. Of the outpatients, 85.3% were satisfied.
Induction of labor by Foley catheter appears suitable for outpatients, and resulted in no differences in cesarean delivery or infection rates compared with in-patients. Most women were satisfied with the outpatient induction.
I157 The use of IUD in HIV infected women Heikinheimo, O.
International journal of gynecology and obstetrics,
October 2009, Letnik:
107, Številka:
S2
Journal Article
STUDY QUESTION
What are the current trends in teenage termination of pregnancy (TOP) and its risk factors?
SUMMARY ANSWER
The incidence of teenage TOP fluctuated substantially during the study period ...and the incidence of repeat TOP among adolescents increased markedly in the 2000s.
WHAT IS KNOWN ALREADY
Teenage pregnancy is associated with difficulties in psychological, sexual and overall health. The proportion of teenage pregnancies resulting in termination varies by country and time, but only few countries have reliable statistics on TOPs.
STUDY DESIGN, SIZE, DURATION
This nationwide retrospective register study included all the TOPs (n= 52 968) and deliveries (n= 58 882) in Finland between 1987 and 2009 among girls <20 years of age at the beginning of pregnancy.
PARTICIPANTS/MATERIALS, SETTING, METHODS
The cohorts were divided into three subgroups; 13–15- (n= 6087), 16–17- (n= 18 826) and 18–19- (n= 28 055) year-olds.
MAIN RESULTS AND THE ROLE OF CHANCE
After an initial steady decline, the incidence of teenage TOP increased by 44% between 1993 (8.0/1000) and 2003 (11.5/1000), and thereafter declined by 16% until 2009 (9.7/1000). The incidence was higher in older adolescents, but the trends were alike in all age groups. Early TOPs (performed at <56 days of gestation) more than tripled from 11 to 36% during the study period. However, the proportion of second-trimester TOPs remained steady at ∼7%. Young age 13–15 years: odds ratio (OR) 1.75 (95% confidence interval (CI) 1.57–1.94), 16–17 years: OR 1.13 (1.05–1.23), 18–19 years: OR 1 (reference category) and non-use of contraception (OR 11.16 (10.15–12.27) were related to a higher risk of second-trimester TOP. The incidence of repeat TOP increased by 95% from 1.9/1000 to 3.7/1000 in 18–19-year-olds and by 120% from 0.5/1000 to 1.1/1000 in 16–17-year-olds between 1993 and 2009. Increasing age 13–15 years: OR 0.16 (95% CI 0.14–0.19), 16–17 years: OR 0.49 (0.45–0.52), 18–19 years 1 (Ref), living in an urban area rural: OR 0.62 (0.56–0.67), urban: OR 1 (Ref) and having undergone a second-trimester TOP OR 1.46 (1.31–1.63) were risk factors for repeat TOP. The planned use of intrauterine contraception for post-abortal contraception increased from 2.6 to 6.2% and among girls with repeat TOP from 10 to 19%.
LIMITATIONS
The retrospective nature of the study remains a limitation and the quality of the data is reliant on the accuracy of reporting. We were not able to link repeat TOPs of the same woman in our data set. However, the share of repeat abortions was moderate.
WIDER IMPLICATIONS OF THE FINDINGS
The rate of teenage TOP seems to rapidly reflect changes in national sexual and reproductive health services and policy. The rising rate of repeat TOP is alarming and may represent a sign of marginalization among these girls. All efforts to maintain a low rate of teenage pregnancy are welcomed.
STUDY FUNDING
Helsinki University Central Hospital Research Funds, the Academy of Finland and the National Institute for Health and Welfare, Finland.
COMPETING INTERESTS
The authors of the study have no competing interests to report.
ObjectivesCompare hormonal contraceptive use, birth and abortion rates among teenagers in the Nordic countries. A secondary aim was to explore plausible explanations for possible differences between ...countries.DesignEcological study using national registry data concerning births and abortions among all women aged 15–19 years residing in Denmark, Finland, Iceland, Norway and Sweden 2008–2015. Age-specific data on prescriptions for hormonal contraceptives for the period 2008–2015 were obtained from national databases in Denmark, Norway and Sweden.SettingDenmark, Finland, Iceland, Norway and Sweden.ParticipantsWomen 15–19 years old in all Nordic countries (749 709) and 13–19 years old in Denmark, Norway and Sweden (815 044).ResultsBoth annual birth rates and abortion rates fell in all the Nordic countries during the study period. The highest user rate of hormonal contraceptives among 15–19-year-olds was observed in Denmark (from 51% to 47%) followed by Sweden (from 39% to 42%) and Norway (from 37% to 41%). Combined oral contraceptives were the most commonly used methods in all countries. The use of long-acting reversible contraceptives (LARC), implants and the levonorgestrel-releasing intrauterine systems, were increasing, especially in Sweden and Norway. In the subgroup of 18–19-year-old teenagers, the user rates of hormonal contraceptives varied between 63% and 61% in Denmark, 56% and 61% in Norway and 54% and 56% in Sweden. In the same subgroup, the steepest increase of LARC was seen, from 2% to 6% in Denmark, 2% to 9% in Norway and 7% to 17% in Sweden.ConclusionsBirth and abortion rates continuously declined in the Nordic countries among teenagers. There was a high user rate of hormonal contraceptives, with an increase in the use of LARC especially among the oldest teenagers.
In women, a single dose of the antiprogestin mifepristone (RU486) in the secretory phase rapidly renders the endometrium unreceptive and is followed by endometrial breakdown and menstruation within ...72 h. This model provides a system to identify progesterone-regulated genes, which may be involved in endometrial receptivity and the induction of menstruation. We used cDNA microarrays to monitor the response of the endometriuim over 24 h following administration of mifepristone in the mid-secretory phase. We identified 571 transcripts whose expression was significantly altered, representing 131 biochemical pathways. These include new progesterone regulated members of the Wnt, matrix metalloproteinase (MMP), prostaglandin (PG) and chemokine regulatory pathways. Transcripts involved in thyroid hormone metabolism and signalling such as type II iodothyronine deiodinase and thyroid receptors were also found to be highly regulated by progesterone antagonism in the endometrium. Transcripts required for thyroid hormone synthesis such as thyroid peroxidase (TPO) and thyroglobulin (TG) were also expressed, indicating that the endometrium may be a site of thyroxin production. These results add to the existing knowledge of the role of the Wnt, chemokine, MMP and PG pathways in receptivity and early menstrual events. They provide in vivo evidence supporting direct or indirect regulation of many new transcripts by progesterone. We have also identified for the first time the very early transcriptional changes in vivo in response to progesterone withdrawal. This greatly increases our understanding of the pathways leading to menstruation and may provide new approaches to diagnose and treat menstrual disorders.
Introduction Reproductive events have a complex impact on women's lives. The possible effects of endogenous and exogenous gonadal hormones on women's psychological status are matters of debate. Aims ...This research aims at examining mood and sleep symptoms of women in different reproductive stages and in association to contraceptive use. Methods Data were collected at the Centralized Family Planning of the City of Helsinki (March 2012-February 2013) through a questionnaire regarding participants' reproductive features, psychiatric history and current psychological status at baseline and after 3 months. Results A total of 208 women (18-50 years) accepted to participate: 52 (25.0%) starting contraception, 68 (32.7%) stopping or changing to a different method, 62 (29.8%) continuing with their current method, and 26 (12.5%) breastfeeding women. The response rate at follow-up was 73%. Psychiatric symptoms during the previous month were commonly reported both at baseline and follow-up (sleep symptoms: 86.1% and 80.3%, respectively; anxiety and depressive symptoms: 61.8% and 55.6%; death and suicide thoughts: 10.1% and 5.3%), with no differences between the contraceptive groups. At follow-up, women who continued with their contraception had higher risks of early awakening and tiredness (OR=3.312 and OR=2.942; p <0.05), and breastfeeding women of tiredness (OR=5.716, p <0.05), in comparison with women who stopped/changed their contraception. The type of contraceptive method did not influence the results. The contraceptive group was not significantly associated with the other, more severe psychiatric symptoms. Conclusions Sleep, anxiety and depressive symptoms are common among women; the use of contraception seems to only marginally associate with these symptoms.
Objective
To compare the effect of medical versus surgical termination of pregnancy (TOP), performed in primigravid women, on subsequent delivery.
Design
Population‐based register study.
Setting
...Finland 2000–2009.
Population
All primigravid women (n = 8294) who underwent TOP during first trimester of pregnancy by medical (n = 3441) or surgical (n = 4853) method, and whose subsequent pregnancy resulted in singleton delivery.
Methods
The women were identified in the Finnish Register of Induced Abortions, and the data were linked to the Medical Birth and the Hospital Discharge Registries.
Main outcome measures
Risk of preterm birth, low birthweight, small‐for‐gestational‐age (SGA) infant and placental complications (placenta praevia, placental abruption, retained placenta, placenta accreta).
Results
No statistically significant differences in the incidences of preterm birth (4.0% in the medical group versus 4.9% in the surgical group), low birthweight (3.4% versus 4.0%), SGA infants (2.6% versus 2.9%) or placental complications (2.6% versus 2.8%) emerged between the two groups. After adjusting for various background factors, medical TOP was not associated with significantly altered risks of preterm birth (odds ratio OR 0.87, 95% confidence interval 95% CI 0.68–1.13), low birthweight (OR 0.90, 95% CI 0.68–1.19), SGA infant (OR 0.87, 95% CI 0.64–1.20) or placental complications (OR 0.98, 95% CI 0.72–1.34) versus surgical TOP. In a sub‐analysis excluding women who underwent surgical evacuation following the index TOP, medical TOP was associated with a reduced risk of preterm birth (P < 0.01), but the difference became insignificant after adjusting for gestational age at the time of TOP, inter‐pregnancy interval, maternal age, cohabitation status, socio‐economic status, residence and smoking during pregnancy.
Conclusions
A history of one medical versus surgical TOP, performed in primigravid women, is associated with similar obstetric risks in the subsequent delivery.
BACKGROUND The LNG-IUS has increasingly been used for contraception, treatment of menorrhagia and endometrial protection during hormone replacement therapy since mid-1990s. Thus, many women use the ...LNG-IUS consecutively. However, published data on the bleeding pattern regarding consecutive use of the LNG-IUS is scarce. METHODS We performed a prospective 15-month multicentre study on the bleeding profile, removal and insertion procedures and safety of the second LNG-IUS in fertile-aged women who had used their first LNG-IUS between 4 years 3 months and 4 years 9 months and who opted for the insertion of a second IUS immediately after removal of the first IUS. Bleeding data were reported descriptively starting from the last 90 days of the first IUS use and continuing for up to 1 year. RESULTS Of the 234 subjects screened, 204 (87%) entered the trial. The median number of bleeding/spotting days during the last 90 days of the first LNG-IUS was 7 (25 and 75% percentiles 0 and 15). Due to bleeding associated with the insertion procedure, this increased to 8 days (4 and 18) during the first 90-day reference period, thereafter decreasing to 4 (0 and 10) days during the second to fourth reference periods. Only one expulsion and no pregnancies, pelvic inflammatory diseases or perforations occurred. A total of 12 subjects (5.9%) prematurely discontinued the study: five due to an adverse event and seven due to other reasons (inclusive of loss to follow-up). CONCLUSIONS This study confirms the favourable bleeding profile and safety of consecutive use of the LNG-IUS.
BACKGROUND Consecutive use of the levonorgestrel-releasing intrauterine system (LNG-IUS) is increasing. However, little is known about factors that predict the bleeding during consecutive use. The ...objective of this study was to analyse the possible factors which may predict the bleeding pattern during the first year of use of a second LNG-IUS. METHODS Fertile-aged women (n = 204) who had used their first LNG-IUS for over 4 years and who opted for a second LNG-IUS were recruited. Bleeding data were reported using 90-day reference periods (RPs) starting from the last 90 days of the first LNG-IUS use (baseline), until the end of the first year of the second LNG-IUS (RPs 1–4). RESULTS Demographic factors such as age, parity, body mass index, indication of LNG-IUS use or smoking could not be identified as predictors for bleeding and spotting (B/S). Mean (±SD) number of B/S days was 8.9 (±9.1) at baseline. This increased slightly during RP1 and fell to 6.4 (±8.1) during RP4. Compared with the mean, women with uterine fibroids or a bleeding pattern of >9 days of spotting or any bleeding at RP1 had more B/S days during RP1–4. Although the number of B/S days decreased progressively from RP1 to RP4 in the group with a bleeding pattern of >9 days of spotting or any bleeding at baseline, such a phenomenon was not observed for women with fibroids. The difference for the change in B/S days between women with and without fibroids was statistically significant at RP3 and RP4. A high degree (91.7%) of satisfaction with the bleeding pattern was observed, with amenorrhoeic women being most satisfied. CONCLUSIONS Uterine B/S is reduced during consecutive use of the LNG-IUS. Women with uterine fibroids or any bleeding at baseline continued to have more B/S than other women.
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