ABSTRACT
OBJECTIVE: To examine the incidence of deeply infiltrating endometriotic lesions among surgically treated endometriosis patients, and determine clinical parameters associated with the presence of deep disease. DESIGN: Prospective observational study. SETTING: Regional central hospital. POPULATION: Patients undergoing surgical treatment of endometriosis. METHODS: Complete excision of all visible endometriotic lesions and adhesions. MAIN OUTCOME MEASURES: The number and location of deep lesions, association between the presence of deep lesions, relevant preoperative and intraoperative factors. RESULTS: Of 201 surgically treated endometriosis patients, 103 (51.2%) had deep lesions, 43.3% had uterosacral ligament deep lesions, 18.4% intestinal, 15.4% rectovaginal, and 3.5% urinary bladder deep lesions. Patients with deep lesions had more often undergone previous operations for endometriosis (p<0.01), had been operated on for pelvic pain (p<0.01) and had a totally obliterated rectovaginal pouch (p<0.01), compared to patients without deep lesions. In multivariate analysis, pelvic pain as an indication for surgery (OR 3.9, 95%CI 1.8-8.9, p<0.01) and totally obliterated rectovaginal pouch (OR 4.0, 95%CI 1.7-9.4, p<0.01) were independent prognostic factors for the presence of deep disease. CONCLUSIONS: Deeply infiltrating endometriosis is common in surgically treated endometriosis patients and should be searched for in those with persistent pelvic pain and where obliteration of the rectovaginal pouch is detected at surgery.
Subject(s)
Endometriosis/pathology , Endometriosis/surgery , Adult , Analysis of Variance , Appendectomy , Endometriosis/complications , Female , Humans , Hysterectomy , Infertility/etiology , Intestinal Diseases/pathology , Intestinal Diseases/surgery , Middle Aged , Ovarian Diseases/pathology , Ovarian Diseases/surgery , Ovariectomy , Pelvic Pain/etiology , Peritoneal Diseases/pathology , Peritoneal Diseases/surgery , Prospective Studies , Recurrence , Reoperation , Urologic Diseases/pathology , Urologic Diseases/surgery , Uterine Diseases/pathology , Uterine Diseases/surgery , Vaginal Diseases/pathology , Vaginal Diseases/surgeryABSTRACT
We analyzed surveillance data on group B streptococcus (GBS) infection in Finland from 1995 to 2000 and reviewed neonatal cases of early-onset GBS infection in selected hospitals in 1999 to 2000. From 1995 to 2000, 853 cases were reported (annual incidence 2.2-3.0/100,000 population). We found 32-38 neonatal cases of early-onset GBS disease per year (annual incidence 0.6-0.7/1,000 live births). In five hospitals, 35% of 26 neonatal cases of early-onset GBS infection had at least one risk factor: prolonged rupture of membranes, preterm delivery, or intrapartum fever. Five of eight mothers screened for GBS were colonized. In one case, disease developed despite intrapartum chemoprophylaxis. Although the incidence of early-onset GBS disease in Finland is relatively low, some geographic variation exists, and current prevention practices are suboptimal. Establishing national guidelines to prevent perinatal GBS is likely to reduce the incidence of the disease.
