A randomized comparison of post-operative pain, quality of life, and physical performance during the first 6 weeks after abdominal or vaginal surgical correction of descensus uteri.

AIMS: With respect to urogenital function, vaginal hysterectomy combined with anterior and/or posterior colporraphy has been shown to be superior to abdominal sacrocolpopexy with preservation of the uterus. We performed a randomized trial to compare the effects of both procedures on pain, quality of life and physical performance during the first six weeks after surgery. METHODS: Eighty-two patients were randomized to have surgery either by vaginal or abdominal approach. All patients were asked to complete the RAND-36 before surgery and 6 weeks after surgery and to keep a diary for the first 6 weeks after surgery. This diary assessed the pain perception and use of pain medication, bother of limitations due to the surgery and performance of daily activities after surgery. These outcomes were compared. RESULTS: All patients completed the RAND-36 and 68 patients completed the diary. Patients who had undergone abdominal surgery had a statistically lower score on the health change domain (56 vs 68), bodily pain domain (63 vs 80) and mental health domain (74 vs 81) of the RAND-36, as compared to patients who had undergone vaginal prolapse surgery. During hospital stay, the abdominal group experienced on average more days of pain (4.5 vs 3.0) and impaired mobility (3.7 vs 2.9) as compared to the vaginal group. Patients received more pain medication following abdominal surgery as compared to vaginal surgery. CONCLUSIONS: The vaginal operation to correct a descensus uteri is associated with less pain, better quality of life and better mobility during the first 6 weeks of the recovery period as compared to the abdominal approach.

A randomised trial comparing low dose vaginal misoprostol and dinoprostone for labour induction.

OBJECTIVE: To compare vaginal misoprostol with dinoprostone for induction of labour. DESIGN: Randomised multicentre trial. SETTING: Labour wards of one university hospital and two teaching hospitals. POPULATION: Six hundred and eighty-one women with indication for labour induction at >or=36 weeks of gestation, singleton pregnancy and no previous ceasarean section. METHODS: Misoprostol (25 mcg, hospital-prepared capsule) in the posterior vaginal fornix, every four hours, maximum three times daily or dinoprostone gel (1 mg) every four hours. Oxytocin was administered if necessary. MAIN OUTCOME MEASURES: Primary: 'adverse neonatal outcome' (5-minute Apgar score <7 and/or umbilical cord pH <7.15). Secondary: labour duration, mode of delivery and patient satisfaction. RESULTS: Three hundred and forty-one women received misoprostol and 340 dinoprostone. The median induction-delivery interval was longer in the misoprostol group compared with the dinoprostone group (25 versus 19 hours, P= 0.008). The caesarean section rate was lower in the misoprostol group: 16.1%versus 21%, but this difference was not statistically significant RR = 0.8 (95% CI 0.6-1.04). 'Adverse neonatal outcome' was found to be similar in both groups: 21% in the misoprostol and 23% in the dinoprostone groups. Significantly fewer neonates were admitted to NICU in the misoprostol group compared with dinoprostone 19%versus 26% (RR = 0.7, 95% CI 0.5-0.98). CONCLUSIONS: Misoprostol in this dosing regimen is a safe method of labour induction. NICU admission rates were lower in the misoprostol group. No difference could be detected in patient satisfaction between groups.

S100 protein content of umbilical cord blood in healthy newborns in relation to mode of delivery.

BACKGROUND: Early detection and quantification of brain damage in neonatal asphyxia is important. In adults, S100 protein in blood is associated with damage to the central nervous system. OBJECTIVE: To determine whether S100 protein can be detected in arterial and venous cord blood of healthy newborns and to relate S100 protein concentrations in cord blood to mode of delivery. METHOD: S100 protein levels in umbilical cord blood of 81 healthy infants were determined. RESULTS: S100 protein was present in arterial (median concentration 1.62 micro g/l) and venous (median concentration 1.36 micro g/l) cord blood. Levels were significantly higher in vaginal births (median arterial concentration 1.72 micro g/l; median venous concentration 1.48 micro g/l) than births by caesarean section (1.51 micro g/l and 1.26 micro g/l respectively). CONCLUSION: More research is necessary to determine whether S100 protein is a useful marker in neonatal asphyxia.

Contraception and induced abortion in rural Ghana.

This article describes the results of a community-based survey on birth control in a rural district in western Ghana. Structured interviews with 2179 women and men aged 15-49 years were used to study the prevalence of contraceptive methods and induced abortion. In addition, the influence of induced abortion on reported fertility in relation to residence and education was analysed. The results show that 59.8% had used a contraceptive method at some time in life, while use of induced abortion was reported by 22.6% of respondents. Prevalence of ever-use of any method to avoid childbirth, contraception and/or induced abortion was 67.1%. Urban residence and higher education were associated with more induced abortions and higher use of contraceptive methods. Differences in use of induced abortion were partly responsible for the education and residence-related changes in fertility. Induced abortion needs to be considered when discussing methods in use to avoid childbirth in developing countries.

Gender and unwanted pregnancy: a community-based study in rural Ghana.

This study investigates attitudes concerning unwanted pregnancies in a rural district of western Ghana. Structured questionnaires were used to interview men and women between 15 and 49 years of age (n = 2179) to measure the prevalence of unwanted pregnancy, how often it led to induced abortion and to establish the reasons why a pregnancy was considered unwanted. At some time in their life at least one unwanted pregnancy was experienced by 41% of men and 43.6% of women. Men and women reported a similar proportion of pregnancies (17.3% and 16.1%, respectively) as unwanted. The proportion of unwanted pregnancies terminated by induced abortion varied with the reason why the pregnancy was undesirable. Among both men and women socio-economic problems were most commonly cited with unwanted pregnancies. Pregnancies perceived by women as unwanted ended more often in an induced abortion than those unwanted by men. Reproductive health programs need to make contraceptives available, accessible and acceptable for both women and men. More research is needed to facilitate a clear understanding of the impact of gender on unwanted pregnancy and its prevention.