Manifest diabetes after gestational diabetes: a double-cohort, long-term follow-up in a Danish population.

PURPOSE: The aim was to follow-up two cohorts of women with GDM to investigate the incidence and time of diagnosis of manifest diabetes mellitus (DM) postpartum and identify the risk factors for diabetes in our population. METHODS: A follow-up study on two independent cohorts having oral glucose tolerance test (OGTT) in 1991/1992 and 2011-2016: Cohort 1 consisted of 406 women including 54 with GDM and 352 with a non-GDM OGTT-test and cohort 2 had 433 women diagnosed with GDM. The first cohort had nearly 25 years of follow-up and gave information on magnitude, conversion rate and type of diabetes manifestation. The second cohort was started recently to evaluate whether newer diagnostic criteria and baseline information on the old cohort are still valid for prediction of diabetes risk. RESULTS: The risk of manifest diabetes in cohort 1 at the end of follow-up was six times higher in women with previous GDM compared with non-GDM (RR = 6; 95% CI 4-11). We observed a 70% diabetes rate 25 years after pregnancy. Only family history of diabetes in cohort 2 was associated with conversion to manifest diabetes (p = 0.002), also after adjustment for age, BMI, non-Danish origin and smoking during pregnancy (p < 0.001) CONCLUSION: The incidence of diabetes after GDM is higher than that previously reported in Scandinavian populations and the rate of manifest diabetes rises steeply 15 years after pregnancy and after 40 years of age. The women of cohort 2 with recent GDM are at risk of DM at a higher rate. On this background our results are useful in identifying the time where GDM women may benefit from the effective implementation of evidence-based treatment to postpone and advert manifest DM.

[Long-term follow-up after endometrial ablation. A questionnaire study on bleedings, hormone treatment and surgery]. / Langtidsopfølgning efter endometrieresektion. En spørgeskemaundersøgelse om blødninger, hormonbehandling og operationer.

INTRODUCTION: Long-term follow-up 11 years after endometrial ablation. MATERIAL AND METHODS: A questionnaire on menstruation, hormone treatment, and surgery was conducted among women who had 420 endometrial ablations during the 1990-96 period; the results were analysed in conjunction with register data on cancer, surgery and obstetric history. RESULTS: A total of 82% of the questionnaires were answered. In all, 26% of the women who received hormone treatment after ablation subsequently had a hysterectomy compared with 34% of the women who received no hormone treatment after ablation (p = 0,28; chi(2)-test). Hysterectomy was associated with occurrence of meno-/metrorrhagia. However, the number of women who were hysterectomised was distributed evenly throughout the duration of hormone treatment. The time of hormone treatment according to the ablation was not associated with the distribution of meno/metrorrhagia or whether the women subsequently had a hysterectomy. We observed three women with incidental endometrial cancer at follow-up, here of one in a polyp, and the expected number was 6,8 cases. CONCLUSION: Endometrial ablation is a good treatment for menorrhagia, but in 40% of cases it is followed by further gynaecological surgery. Hormone treatment was not found to have any effect on the course of events. No additional cases of incidental cancer were noted at follow-up.

Surgery and cancer after endometrial resection. Long-term follow-up on menstrual bleeding and hormone treatment by questionnaire and registry.

PURPOSE: Long-term follow-up 11 years after endometrial ablation. METHODS: A questionnaire on menstruation, hormone treatment, and operations on women, which had 421 endometrial ablations during 1990-1996, was added to registered data on cancer, operational and obstetrical history. RESULTS: Eighty-two percent of the questionnaires were returned and answered. Of those women on hormone treatment after ablation 26% had a hysterectomy later on compared to 34% of women with no hormone treatment after ablation (P = 0.28; chi (2) test). Hysterectomy was directly proportional to the amount of meno/metrorrhagia; however, the number of women with a hysterectomy was evenly distributed in relation to the duration of hormone treatment. The time of hormone treatment in relation to the ablation was not associated with the distribution of meno/metrorrhagia or whether the women had a hysterectomy later on. We observed three women with incidental endometrial cancer at follow-up and the expected numbers were 6.8 cases. CONCLUSION: Endometrial ablation is an effective form of treatment for menorrhagia with no increase in the incidence of endometrial cancer. Hormonal treatment does not seem to have any influence on the course of events.

Hysterectomy is associated with stress incontinence in women who previously had a transcervical endometrial resection.

OBJECTIVES: To compare the prevalence of urological symptoms in a population of women, who had a transcervical endometrial resection (TCER) only, and a population of women, who had a TCER and a subsequent hysterectomy. The superior goal was to evaluate the possible association between hysterectomy and urinary incontinence. DESIGN: All women, who had a TCER at our department during the period of 1990-1996 received a questionnaire with focus on urological symptoms. The answers from women, who later had a hysterectomy were compared to the answers from women, who were sufficiently treated with TCER only. RESULTS: Of 356 women, who were alive, 16 were lost to follow-up, leaving 340 women to receive the questionnaire, which was returned by 310 women (85%). Ninety-three (31%) had a subsequent hysterectomy mainly indicated by metrorrhagia or dysmenorrhea. Of the hysterectomized women 24% reported bothersome stress incontinence against 14% in the group of women, who had TCER only (p = 0.03). No significant difference was seen with respect to urge incontinence, urgency, pollakisuria or nocturia. Significantly more women with a normal sized uterus reported bothersome stress incontinence after the hysterectomy compared to women with a slightly enlarged uterus. CONCLUSION: Hysterectomy is significantly associated with stress urinary incontinence in women, who previously had a TCER.

[Vaginal vault fluid collection after hysterectomy. Frequency and clinical significance]. / Vaginaltopansamling efter hysterektomi. Hyppighed og klinisk betydning.

INTRODUCTION: Our aim was to investigate the prevalence of sonographically detectable vault fluid collection after hysterectomy and its relation to post-operative morbidity. MATERIALS AND METHODS: We studied a group of 103 women below 60 years of age who had undergone abdominal or vaginal hysterectomy for benign causes apart from uterovaginal prolapse. A transvaginal ultrasound examination was carried out 24 to 72 hours after surgery. A telephone follow-up and a record review were done six to eight weeks later to determine the morbidity rate. RESULTS: Of the 103 women scanned, 39 (38%) had sonographically detected vaginal vault fluid collection. A haemoglobin concentration drop was observed in a significant number of patients (33% vs. 13%) who had fluid collection in the immediate post-operative period. At follow-up, a significant increase in the complaints of post-operative pain (15% vs. 42%) and re-presentation (32% vs. 55%) was seen in the fluid collection group. The increased risk of re-presentation was not accompanied by an increased risk of needing additional treatment. CONCLUSION: Sonographic detection of vaginal vault fluid collection is common after hysterectomy, but such a finding rarely indicates additional treatment. Vaginal ultrasound examination should not be performed routinely after hysterectomy.