Emotional, physical, and sexual abuse in patients visiting gynaecology clinics: a Nordic cross-sectional study.

BACKGROUND: Abuse against women causes much suffering for individuals and is a major concern for society. We aimed to estimate the prevalence of three types of abuse in patients visiting gynaecology clinics in five Nordic countries, and to assess the frequency with which gynaecologists identify abuse victims. METHODS: We did a cross-sectional, multicentre study of women attending five departments of gynaecology in Denmark, Finland, Iceland, Norway, and Sweden. We recruited 4729 patients; 3641 (77%) responded and were included in the study. Participants completed a postal questionnaire (norvold abuse questionnaire) confidentially. Primary outcome measures were prevalences of emotional, physical, and sexual abuse, and whether abused patients had told their gynaecologist about these experiences. We assessed differences between countries with Pearson's chi(2) test. FINDINGS: The ranges across the five countries of lifetime prevalence were 38-66% for physical abuse, 19-37% for emotional abuse, and 17-33% for sexual abuse. Not all abused women reported current ill-effects from the abusive experience. Most women (92-98%) had not talked to their gynaecologist about their experiences of abuse at their latest clinic visit. INTERPRETATION: Despite prevalences of emotional, physical, and sexual abuse being high in patients visiting gynaecology clinics in the Nordic countries, most victims of abuse are not identified by their gynaecologists. This lack of discussion might increase the risk of abused patients not being treated according to their needs. Gynaecologists should always consider asking their patients about abuse.

Low myometrial glycogen content compared with rectus muscle in term pregnant women before labor.

Glycogen, glucose, some nucleosides and purine base derivatives were determined in biopsies from 10 term pregnant women undergoing elective cesarean sections before labor. The concentrations were compared in the biopsies which were cut from isthmus and fundus of the uterus and m. rectus abdominis. M. rectus biopsies had 1.5 and 2 times higher concentration of glycogen than the isthmic and fundal uterine biopsies, respectively. The glucose concentration in the striated muscle was on the other hand only half that in the myometrium. The uterus displayed regional differences in concentrations of glycogen (higher in isthmus). A relatively low glycogen content in term pregnant uterine smooth muscle compared with striated muscle signifies the restricted energy demands of pregnant myometrium.

Human uterine smooth muscle exhibits a very low phosphocreatine/ATP ratio as assessed by in vitro and in vivo measurements.

The purpose of the study was to investigate by in vitro and in vivo methods the phosphocreatine (PCr)/ ATP ratio as an expression of the energy metabolic state of human myometrium in comparison with striated skeletal muscle. The contents of PCr and adenylates in biopsies of uterine smooth muscle and m. rectus abdominis from seven term pregnant women were determined in vitro and compared with results obtained in vivo by phosphorus magnetic resonance spectroscopy (31P-MRS) in the uterus and m. gastrocnemius of eight non-pregnant women. The PCr/ATP ratio in the striated skeletal muscle was about three times higher than that of the myometrium. The results of the in vitro biopsy part of the study and the in vivo 31P-MRS part conformed with each other. In the biopsies both PCr and ATP concentrations were significantly lower in the myometrium than in the rectus muscle, but the difference for PCr was more pronounced, accounting for the significantly lower PCr/ATP ratio in the uterine smooth muscle. The energy metabolic pattern of uterine smooth muscle differs from that of striated skeletal muscle regarding the contents of high-energy phosphocompounds and the PCr/ATP ratio. This in vivo finding is the first report on human smooth muscle using 31P-MRS.

Neutral and cationic amino acids in striated rectus muscle are generally in excess of those in smooth uterine muscle of term pregnant women.

The concentrations of 24 amino acids and four other related compounds were determined in extracts of biopsy specimens from myometrium and musculus rectus abdominis of 10 healthy term pregnant women during elective cesarean sections. The total free amino acid pool did not differ significantly between the two muscle types. There was a myometrial abundance of the two anionic amino acids glutamate and aspartate and the two aromatic amino acids tyrosine and phenylalanine, but most neutral and cationic amino acids in striated skeletal muscle tissue were found in excess of those in uterine muscle tissue.

Different energy metabolite pattern between uterine smooth muscle and striated rectus muscle in term pregnant women.

OBJECTIVE: To study the energy metabolite pattern in term pregnant myometrium and to compare it with that of a striated skeletal muscle. STUDY DESIGN: Metabolites of carbohydrates, triglycerides and nucleotides were determined in biopsies from myometrium and rectus abdominis muscle from ten healthy term pregnant women before onset of labour. The metabolite concentrations in the two types of muscle were compared by two tailed Student's t-test for paired values and correlations were calculated by Pearsson's correlation test. RESULTS: Comparison of the two muscle types revealed a higher concentration of glucose and a higher lactate/pyruvate ratio in the myometrium but a lower concentration of triglyceride metabolites. Adenosine was found in 36-fold higher concentration in the uterine compared with the rectus muscle and an inverse relationship between adenosine and glucose concentrations was observed in the myometrium. CONCLUSION: The results indicated that the pregnant uterine smooth muscle utilized glucose as the principal nutritive metabolite rather than lipids and that the anaerobic pathway of the glucose metabolism was more active in the myometrium compared with the striated rectus muscle. Also, it is suggested that glucose has a critical role as the principal fuel for ATP formation and the involvement of the adenylate kinase and 5'-nucleotidase reactions in any event of glucose shortage.

Symphysis-fundus height: construction of a new Swedish reference curve, based on ultrasonically dated pregnancies.

Repeated measurements of the symphysis-fundus (SF) distance is generally regarded as an acceptable screening instrument for antenatal detection of intrauterine growth retardation (IUGR). In the present investigation an SF curve is constructed, based on measurements from 1650 Swedish women with ultrasound dated pregnancies. The SF measurements were included in a cross-sectional stratified manner; only one measurement from each woman was used and the same number of measurements (n = 75) was used for each gestational week from 20 through 41. A regression analysis by a polynomial equation of third degree was applied on the means and standard deviations of the SF measurements in each week respectively to construct a graph of fundal height. This SF curve was compared with the SF curve in common use in Sweden (constructed by Westin); in the new curve the mean measurement was about one cm higher up to 37 gestational weeks, after which time the curves almost coincided. Neither did the mean SF height differ between smokers and non-smokers nor between nulliparous and parous women. The mean SF difference between the heaviest women (> or = 79 kg) and the lightest (> or = 53 kg) was about two cm throughout pregnancy. The validity of the constructed SF curve as a screening instrument for IUGR needs to be investigated in a different study.

Energy economy in the pregnant human uterus at term: studies on arteriovenous differences in metabolites of carbohydrate, fat and nucleotides.

Metabolic regulation was studied in the pregnant human uterus by determining its uptake and release of various substrates, some of which are commonly used as a fuel and some are markers of disturbed energy status in cells. Ten healthy women with normal pregnancy were examined when undergoing elective Caesarean section at term, before onset of labour. Carbohydrate metabolites (glucose, lactate and pyruvate), fat metabolites (free fatty acids (FFA) and glycerol) and nucleotide metabolites (hypoxanthine, xanthine and urate) were determined in arterial (radial artery) and venous (plexus of the uterine and ovarian veins) blood. In addition the arteriovenous difference in each substance across the uterus was calculated. A distinct uptake of glucose was a typical finding in the pregnant uterus as reflected by a positive difference. On the other hand, glycerol and FFA were released from the pregnant uterus. Similarly, a degradation of adenine-containing nucleotides seemed to be continuously ongoing in the pregnant uterus, since oxypurines displayed a negative difference as well.

Balance of amino acids in the pregnant human uterus at term.

The nutritive and metabolic state of the human uterus at term is evaluated by measuring the uptake and release of amino acids. The subjects are ten healthy women with normal pregnancy undergoing elective caesarean section at term, before onset of labour. Free amino acids in arterial (radial artery) and venous (plexus of the uterine and ovarian veins) blood are determined and arteriovenous (AV) differences in each amino acid across the uterus are calculated. Generally the AV differences are negative, i.e. uterus at term releases amino acids in most cases. The human pregnant uterus at term is characterized by a release of amino acids rather than uptake. This indicates that they are in excess and are not needed in anabolic processes or as a fuel, even when the uterine tissue at term is supposed to be preparing for its grand performance, i.e. the delivery.

[Symphysis-fundus measurements in Scandinavia]. / Symfys-fundus mått i Norden.

Since the late 1970s symphysis-fundus measurements have been used in the Nordic countries to predict fetal growth deviation. Via a questionnaire, sent to Nordic university hospitals representative of health care areas, existing practices have been investigated. Symphysis-fundus measurements are almost invariably obtained and plotted onto nomograms as part of routine antenatal care. Five normal curves are in use showing some variation, but there are considerable differences in the selection of material and in the statistical treatment of the data. Revision of some of these curves may be required.