HIV-related stigma among healthcare providers working within infectious diseases and gynecology and obstetrics at a large teaching hospital in Denmark.

HIV-related stigma experienced in healthcare settings may be particularly detrimental to people with HIV (PWH). This study aims to examine the drivers of stigma and enacted HIV-related stigma among healthcare providers working in HIV and non-HIV care at a large teaching hospital in Denmark. In total, 162 providers working in gynecology and obstetrics, and 57 providers working in infectious diseases completed the "Measuring HIV stigma and discrimination among health facility staff" questionnaire. Compared to providers working in infectious diseases, providers working in gynecology and obstetrics had less training in infection control, HIV, and stigma, and although their level of worry and negative attitudes toward PWH was overall low, they were more like to use extra precaution measures (e.g., double gloves) when caring for PWH (20% versus 0%). Addressing HIV-related stigma in healthcare is important, as any amount of HIV-related stigma from providers has the potential to compromise the patients' engagement in care and health outcomes.

SARS-CoV-2 in first trimester pregnancy: a cohort study.

STUDY QUESTION: Does maternal infection with severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) in first trimester pregnancy have an impact on the fetal development as measured by nuchal translucency thickness and pregnancy loss? SUMMARY ANSWER: Nuchal translucency thickness at the first trimester scan was not significantly different in pregnant women with versus without SARS-CoV-2 infection in early pregnancy and there was no significantly increased risk of pregnancy loss in women with SARS-CoV-2 infection in the first trimester. WHAT IS KNOWN ALREADY: Pregnant women are more vulnerable to viral infections. Previous coronavirus epidemics have been associated with increased maternal morbidity, mortality and adverse obstetric outcomes. Currently, no evidence exists regarding possible effects of SARS-CoV-2 in first trimester pregnancies. STUDY DESIGN, SIZE, DURATION: Cohort study of 1019 women with a double test taken between 17 February and 23 April 2020, as a part of the combined first trimester risk assessment, and 36 women with a first trimester pregnancy loss between 14 April and 21 May 2020, prior to the double test. The study period was during the first SARS-CoV-2 epidemic wave in Denmark. PARTICIPANTS/MATERIALS, SETTING, METHODS: Cohort 1 included pregnant women with a double test taken within the study period. The excess serum from each double test was analyzed for SARS-CoV-2 antibodies. Results were correlated to the nuchal translucency thickness and the number of pregnancy losses before or at the time of the first trimester scan. Cohort 2 included women with a pregnancy loss before the gestational age for double test sample. Serum from a blood test taken the day the pregnancy loss was identified was analyzed for SARS-CoV-2 antibodies. The study was conducted at a public university hospital serving ∼12% of pregnant women and births in Denmark. All participants in the study provided written informed consent. MAIN RESULTS AND THE ROLE OF CHANCE: Eighteen (1.8%) women had SARS-CoV-2 antibodies in the serum from the double test suggestive of SARS-CoV-2 infection in early pregnancy. There was no significant difference in nuchal translucency thickness for women testing positive for previous SARS-CoV-2 infection (n = 16) versus negative (n = 966) (P = 0.62). There was no significantly increased risk of pregnancy loss for women with antibodies (n = 1) (OR 3.4, 0.08-24.3 95% CI, P = 0.27). None of the women had been hospitalized due to SARS-CoV-2 infection. None of the women with pregnancy loss prior to the double test (Cohort 2) had SARS-CoV-2 antibodies. LIMITATIONS, REASONS FOR CAUTION: These results may only apply to similar populations and to patients who do not require hospitalization due to SARS-CoV-2 infection. A limitation of the study is that only 1.8% of the study population had SARS-CoV-2 antibodies suggestive of previous infection. WIDER IMPLICATION OF THE FINDINGS: Maternal SARS-CoV-2 infection had no effect on the nuchal translucency thickness and there was no significantly increased risk of pregnancy loss for women with SARS-CoV-2 infection in first trimester pregnancy. Evidence concerning COVID-19 in pregnancy is still limited. These data indicate that infection with SARS-CoV-2 in not hospitalized women does not pose a significant threat in first trimester pregnancies. Follow-up studies are needed to establish any risk to a fetus exposed to maternal SARS-CoV-2 infection. STUDY FUNDING/COMPETING INTEREST(S): Prof. H.S.N. and colleagues received a grant from the Danish Ministry of Research and Education for research of COVID-19 among pregnant women. The Danish government was not involved in the study design, data collection, analysis, interpretation of data, writing of the report or decision to submit the paper for publication. A.I., J.O.-L., J.B.-R., D.M.S., J.E.-F. and E.R.H. received funding from a Novo Nordisk Foundation (NNF) Young Investigator Grant (NNF15OC0016662) and a Danish National Science Foundation Center Grant (6110-00344B). A.I. received a Novo Scholarship. J.O.-L. is funded by an NNF Pregraduate Fellowship (NNF19OC0058982). D.W. is funded by the NNF (NNF18SA0034956, NNF14CC0001, NNF17OC0027594). A.M.K. is funded by a grant from the Rigshospitalet's research fund. H.S.N. has received speaker's fees from Ferring Pharmaceuticals, Merck Denmark A/S and Ibsa Nordic (outside the submitted work). N.l.C.F. has received a grant from Gedeon Richter (outside the submitted work). A.M.K. has received speaker's fee from Merck (outside the submitted work). The other authors did not report any potential conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.

Impact of adding a second layer to a single unlocked closure of a Cesarean uterine incision: randomized controlled trial.

OBJECTIVE: To investigate short- and long-term effects on residual myometrial thickness (RMT) of adding a second layer to a single unlocked closure of a Cesarean uterine incision. METHODS: This was a randomized double-blind controlled trial. Healthy nulliparous women scheduled for first-time elective Cesarean delivery were operated on using a modified version of the Misgav Ladach surgical technique. The women were examined by transabdominal ultrasound before discharge from the maternity ward and by transvaginal saline contrast sonohysterography at a minimum of 5 months postpartum. RESULTS: Seventy-six nulliparae met the criteria and agreed to participate in the study. Thirty-five women were assigned to the single-layer technique and 38 to the double-layer unlocked closure technique. Groups were comparable regarding gestational age at delivery, duration of surgery and perioperative blood loss. There was no difference in RMT between the two groups, both at time of discharge (mean ± SD, 20.2 ± 8.0 mm vs 21.0 ± 9.7 mm) and after 5 months postpartum (mean, 5.7 ± 2.9 mm vs 5.7 ± 2.2 mm). RMT was approximately half that of the normal myometrium at both examinations. CONCLUSION: The results of this study suggest that double-layer closure of a Cesarean uterine incision does not increase RMT compared with single-layer closure when an unlocked technique is used.

The aging woman: the role of medical therapy.

The growth of the postmenopausal population demands a change in the medical profession's approach to health and disease. Especially in the developed world, lifespan is increasing, and at the age of 60 the majority of women will still have at least 20 years to live. There will, therefore, be an increasing need for health programs that lead to more years of disability free life. Hormone replacement therapy (HRT) is but one example of the dilemmas medical therapy of the aging woman poses. In the sixties, estrogen was considered a wonder drug, effective for a multitude of postmenopausal problems and illnesses. Recent research has placed this notion into a more balanced perspective, emphasizing that every medical treatment should be based on evidence. It is therefore worrisome if the decline in the use of HRT is followed by an increased use of alternative medicine with mostly undocumented effects.

[Pregnancy associated pelvic pain. I: Prevalence and risk factors]. / Graviditetsrelaterede baekkensmerter. I: Praevalens og risikofaktorer.

With this study, we wanted to determine the incidence of symptom-giving pelvic girdle relaxation during pregnancy and the prevalence post partum, identify predisposing factors, and determine the frequency of sick leave. A total of 1600 pregnant women entered the study. The incidence during pregnancy was 14%, the prevalence two, six, and twelve months post partum was 5%, 4%, and 2%, respectively. Multivariate analysis indicated that the most important predisposing factor was pelvic pain in a previous pregnancy. Other factors were uncomfortable working conditions, lack of exercise, and previous low back and low abdominal pain. At least 37% of the women with symptom-giving pelvic girdle relaxation were on sick leave during pregnancy, on average for twelve weeks. Symptom-giving pelvic girdle relaxation is a considerable problem both in pregnancy and post partum. The occupational risk can possibly be prevented. The syndrome has a great social impact because of the high frequency of sick live.

[Pregnancy associated pelvic pain. II: Symptoms and clinical findings]. / Graviditetsrelaterede baekkensmerter. II: Symptomer og kliniske fund.

Pelvic pain in pregnancy appears to be a problem on the increase. This study was undertaken to describe and analyse the relationship between subjective symptoms, daily disability, and clinical findings in women with symptom-giving pelvic girdle relaxation in pregnancy. Out of 1600 pregnant women, 238 had pelvic pain. After a clinical examination 11 women were excluded due to low back pain. The rest, 227 women, was considered to have symptom-giving pelvic girdle relaxation during pregnancy. Symptom-giving pelvic girdle relaxation in pregnancy seriously interferes with many activities of daily living such as housekeeping, walking, working, and sexual life. The women's statements of pelvic pain are well correlated to the number of positive clinical tests. Symptom-giving pelvic girdle relaxation in pregnancy causes considerable disabilities concerning daily activities.

Stratified rates of cesarean sections and spontaneous vaginal deliveries. Data from five labor wards in Denmark--1996.

BACKGROUND: A fundamental point when auditing labor management is to ensure present and stratified process data. METHOD: Stratification of deliveries into ten mutually exclusive groups enabled comparisons of rates of cesarean sections and rates of spontaneous vaginal deliveries between labor wards. RESULTS: Data from five labor wards in Denmark in 1996 were included in the study comprising a total of 11,287 women. The overall cesarean section rates were between 13.2 and 15.2% which was not a significant difference, whereas cesarean section rates in several of the ten groups and the rates of spontaneous vaginal delivery in group 1 and 3 were significantly different between the labor wards. DISCUSSION: The method presented here is simple and can be used as an integrated part of the daily work and quality assurance. We advocate that stratification of the delivering women into ten groups should take place in every labor ward with focus on both the cesarean section rate and the rate of spontaneous vaginal delivery. Stratification provides data for periodical evaluation of the outcome within a department and for comparison between departments with different populations and policy.

Symptom-giving pelvic girdle relaxation in pregnancy. I: Prevalence and risk factors.

BACKGROUND: Previous studies concerning symptom-giving pelvic girdle relaxation in pregnancy have to our knowledge been retrospective. We wanted to 1) determine the incidence during pregnancy and the prevalence two, six, and twelve months post partum, 2) identify possible predisposing factors, and 3) determine the frequency and duration of sicklisting, prospectively. MATERIAL AND METHODS: A cohort of 1600 consecutive pregnant women filled in a questionnaire. At the routine prenatal examinations they were asked about pelvic pain. Those who fulfilled the inclusion criteria were examined by a rheumatologist to confirm the diagnosis. The affected women were seen again two, six, and twelve months post partum. All participants were asked about sicklisting in pregnancy. RESULTS: The incidence during pregnancy was 14%, the prevalence two, six, and twelve months post partum were 5%, 4%, and 2% respectively. Multivariate analysis indicates that the most important predisposing factor is pelvic pain in a previous pregnancy. Other factors were uncomfortable working conditions, lack of exercise, and previous low back pain and low abdominal pain. At least 37% of the women with symptom-giving pelvic girdle relaxation had been sicklisted in pregnancy due to pelvic pain, on average for twelve weeks. CONCLUSION: Symptom-giving pelvic girdle relaxation is a considerable problem both in pregnancy and post partum. The occupational risk can possibly be prevented. The syndrome has a great social impact because of the frequent sicklisting.

Symptom-giving pelvic girdle relaxation in pregnancy. II: Symptoms and clinical signs.

BACKGROUND: Pelvic pain in pregnancy appears to be a problem that is increasing. This study was undertaken to describe and analyze the relationship between subjective symptoms, daily disability, and clinical findings in women with symptom-giving pelvic girdle relaxation in pregnancy MATERIALS AND METHODS: Out of 1600 pregnant women 238 had pelvic pain. After a clinical examination 11 women were excluded due to low back pain. The rest, 227 women, was considered having symptom-giving pelvic girdle relaxation during pregnancy. RESULTS: Symptom-giving pelvic girdle relaxation in pregnancy seriously interferes with many activities of daily living such as housekeeping, walking, working, and sexual life. The women's statements of pelvic pain are well correlated to the number of positive clinical tests. CONCLUSION: Symptom-giving pelvic girdle relaxation in pregnancy causes considerable disabilities concerning daily activities.

[Birth statistics for "standard populations". A basis for obstetric quality development]. / Fødselsstatistik for "standardpopulationer". Et grundlag for obstetrisk kvalitetsudvikling.

Using standard populations like "standard-primipara" (normal pregnancy, singleton term delivery and cephalic presentation) and "caesarean secundapara" (previous caesarean section and second birth) as the basis for interunit comparisons of maternity care will control for differences in casemix that may be seen at different units, thereby increasing the validity of comparisons. Focusing on clinically meaningful subsets of the population may have the additional benefit of clarifying the relationship between everyday clinical decision making, and the statistics from medical birth registration. Birth registry data from Rigshospitalet, Hvidovre Hospital and Herning Centralsygehus 1993-1994 have been used to illustrate the association between local quality improvement activities, on the one hand, and rates of interventions and foetal outcome in "standard-primipara" on the other.

Relaxin is not related to symptom-giving pelvic girdle relaxation in pregnant women.

BACKGROUND: The pregnancy associated hormone relaxin induces loosening of the pelvic ligaments in several species. This study was undertaken to evaluate whether pregnant women with symptom-giving girdle relaxation had increased serum relaxin concentrations during pregnancy. METHOD: Serum relaxin concentrations were measured in 38 pregnant women with symptom-giving pelvic girdle relaxation at the time of diagnosis, in the 30th and 38th week of pregnancy as well as 2 and 6 months after delivery. Fourteen pregnant women without symptoms served as a control group. Relaxin concentrations were measured by a homologous enzyme linked immuno-sorbent assay. All participants were clinically examined including tests for symptom-giving pelvic girdle relaxation. RESULTS: No differences in serum relaxin concentrations were found throughout pregnancy and after delivery. CONCLUSION: The present results do not suggest an important role for relaxin in symptom-giving pelvic girdle relaxation during human pregnancy.

A randomised controlled trial of prophylaxis of post-abortal infection: ceftriaxone versus placebo.

OBJECTIVE: To investigate the incidence of post-operative infection after first trimester abortion in women treated with a long-acting cephalosporin (ceftriaxone) compared with low risk patients receiving no treatment and with high risk patients receiving our standard treatment of ampicillin/pivampicillin and metronidazole. DESIGN: A prospective, randomised controlled trial. SETTING: Department of Obstetrics and Gynaecology, Rigshospitalet, University of Copenhagen, Denmark. SUBJECTS: Nine hundred and ninety-six women, admitted on an outpatient basis for legal termination of pregnancy at 12 weeks or less of gestation, were included in the study after giving informed consent. The women were divided into high risk and low risk categories and allocated either to treatment with ceftriaxone or to standard treatment. For high risk patients the standard treatment was initiated by a peroperative injection of ampicillin and metronidazole, followed by oral doses of metronidazole and pivampicillin three times daily for four days. No prophylactic antibiotics were given to the women randomised to standard treatment in the low risk group. INTERVENTIONS: All women were kept under observation, and, between six and 14 days postoperatively, underwent pelvic examination. Clinical endpoints were noted. MAIN OUTCOME MEASURES: Post-operative pelvic inflammatory disease in women applying for legal first trimester abortion. RESULTS: Seven hundred and eighty-six women fulfilled the criteria for evaluation. A tendency toward a prophylactic effect of ceftriaxone was observed in most clinical findings. A significant prophylactic effect of ceftriaxone was found in the low risk group. CONCLUSIONS: This study demonstrated a significant reduction in post-operative pelvic inflammatory disease in low risk patients, who were applying for legal first trimester abortion, treated peroperatively with ceftriaxone. No significant difference was demonstrated between high risk patients treated with ceftriaxone or ampicillin/pivampicillin and metronidazole.

The influence of nitrous oxide on recovery of bowel function after abdominal hysterectomy.

The influence of nitrous oxide on the recovery of bowel function was studied in 36 patients anaesthetised for elective abdominal hysterectomy with or without salpingo-oophorectomy. Patients were randomly assigned to receive either isoflurane in nitrous oxide and 30% oxygen (N2O group) or isoflurane in air and 30% oxygen (Air group). Anaesthetic management included thiopentone, fentanyl, suxamethonium and atracurium. The lungs were not ventilated prior to intubation. Before closing the abdomen, the surgeon assessed the degree of distension of the intestines and the closing conditions. Postoperative nausea and vomiting was assessed 2, 6, 12 and 24 h after recovery from anaesthesia. The lapse of time before mobilisation and passing of flatus and faeces was recorded. The patients in the Air group were significantly older than the patients in the N2O group (48.9 years versus 44.0 years, P = 0.04); otherwise, there were no differences in the demographic data of the patients. We found no significant differences between the groups with respect to nausea and vomiting, distension of the intestines before closure of the abdomen, closing conditions, time elapsing before mobilisation, constipation before recovery of bowel function or time elapsing before passing of flatus. We found a statistically significant delay of 10.3 h in time elapsing before passing of faeces in the N2O group compared to the Air group (P = 0.04), suggesting a potentially adverse effect of nitrous oxide.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant giant cell tumour of the uterus.

Two rare cases of malignant giant cell tumours of the uterus in pure heterologous form are presented. Light microscopy showed numerous osteoclast-like cells in a background of spindle cells. Immunohistochemistry demonstrated Vimentin, Actin, alpha-1-antitrypsin and LCA in the latter, and Vimentin, alpha-1-antitrypsin and LCA in the giant cells while tartrate resistant acid phosphatase reactivity was demonstrated in both mononuclear cells and giant cells. Electron microscopy did not reveal smooth muscle or epithelial differentiation. The findings suggest a common origin of malignant giant cell tumours and malignant fibrous histiocytomas.

Decreased maternal serum alpha-feto protein associated with arthrogryphosis multiplex congenita.

Decreased maternal serum alpha-feto protein is known to be associated with fetal chromosomal abnormalities. A case of low maternal alpha-feto protein associated with congenital malformations in a fetus with a normal karyotype is described.

Endocrine, metabolic and cardiovascular responses to adrenaline after abdominal surgery.

Adrenaline-induced changes in heart rate, blood pressure, plasma adrenaline and noradrenaline, cortisol, glucagon, insulin, cAMP, glucose lactate, glycerol and beta-hydroxybutyrate were studied preoperatively and 4 and 24 h after skin incision in 8 patients undergoing elective cholecystectomy. Late postoperative responses of blood glucose, plasma cAMP, lactate and glycerol to adrenaline infusion were reduced, whereas other responses were unaffected. Blood glucose appearance and disappearance rate as assessed by [3H]3-glucose infusion was unchanged pre- and postoperatively. The increase in glucose appearance rate following adrenaline was similar pre- and postoperatively. These findings suggest that several beta-receptor-mediated responses to adrenaline are reduced after abdominal surgery.