[Pregnancy, nausea and vomiting].
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Female↗
Biomedical subjects
Britt-Ingjerd Nesheim
Publications and source records attributed to Britt-Ingjerd Nesheim.
Performance of acupuncture as labor analgesia in the clinical setting.
BACKGROUND: Three randomized controlled trials have shown that acupuncture during labor can reduce the use of epidural analgesia and meperidine. To supplement these trials, we have designed an observational study to answer the research question: "Do laboring women in a normal hospital setting who receive acupuncture require less epidural analgesia than those who do not receive acupuncture?" METHODS SETTING: Delivery ward of a tertiary care University hospital in Norway. SUBJECTS: All attempted vaginal labors during the period 01.12.99-31.12.03 (n = 17,741). STATISTICAL ANALYSIS: Multivariate logistic regression analysis. RESULTS: The dependent variable in the regression analysis was use of epidural analgesia. The independent variables were: use of acupuncture, use of nitrous oxide, use of meperidine, parity, ethnicity, age, duration of pregnancy, type of labor (induced or not), and duration of first stage of labor. In the multivariate analysis the odds ratio for having an epidural was 0.6 (95% CI 0.5-0.7) for the patients having acupuncture compared to those not having acupuncture. CONCLUSIONS: Women having acupuncture as labor analgesia in the clinical setting have a reduced use of epidural analgesia.
Acupuncture Analgesia↗
Oral versus self-administered vaginal misoprostol at home before surgical termination of pregnancy: a randomised controlled trial.
OBJECTIVE: To compare the impact of 400 mug oral versus self-administered vaginal misoprostol at home on pre-operative cervical priming in both primigravid and multigravid women prior to first trimester surgical abortion. DESIGN: Randomised controlled trial. SETTING: Norwegian University Teaching Hospital. SAMPLE: Three hundred and thirty-eight women undergoing surgical abortion between 7 and 12 weeks of gestation. METHODS: The women were randomised to either 400 microg of oral misoprostol the evening before or 400-microg of self-administered vaginal misoprostol at home the same day as vacuum aspiration. Main outcome measures Pre-operative cervical dilatation, complications and acceptability. RESULTS: The median cervical dilatation was 6.2 mm (range 0-11 mm) for the women in the 400 mug oral misoprostol and 6.5 mm (range 0-11 mm) in the 400-microg vaginal misoprostol groups. The median pre-operative dilatation was larger in multigravidae (6.4 and 6.7 mm for the oral and vaginal routes, respectively) than in primigravidae (5.8 and 6.0 mm, respectively). In primigravidae, 19% achieved a pre-operative dilatation of > or = 7 mm, with no significant difference between oral and vaginal dosage. In multigravidae, 52% achieved a pre-operative dilatation of > or = 7 mm with vaginal dosage, compared with 36% with oral dosage (P = 0.03). There was no difference between non-immigrant versus immigrant women in pre-operative cervical dilatation. The 400-microg oral dosage group had a higher risk of bleeding, compared with the group receiving 400-microg vaginal misoprostol [odds ratio (OR) = 10.4; confidence interval (CI) 5.2-20.8]. There was no difference between non-immigrant and immigrant women in acceptability of self-administered vaginal misoprostol; almost all women found this administration route acceptable. Complications were minor and were distributed equally between the two dosage groups. CONCLUSIONS: The vaginal route will result in a satisfactory dilatation in about half of multigravidae but is much less effective in primigravidae. The oral route does not lead to satisfactory dilatation in either group and is associated with a higher occurrence of pre-operative bleeding. Self-administered vaginal misoprostol at home is highly acceptable.
Abortifacient Agents, Nonsteroidal↗
Recurrence risk of preeclampsia in twin and singleton pregnancies.
The etiology of preeclampsia is unknown. The relatively high risk of recurrence of preeclampsia in subsequent pregnancies to the same mother suggests a genetic basis for the disease, but the mode of inheritance is uncertain. We compare the risk of preeclampsia in second pregnancies for mothers whose first preeclamptic pregnancy was either a singleton or a twin pregnancy. The crude and adjusted recurrence risks of preeclampsia in twin and singleton pregnancies were estimated in a population-based register including the first and second pregnancies of 550218 women registered in the Medical Birth Registry of Norway, 1967-1998. The recurrence risk of preeclampsia in second pregnancy for women with a singleton pregnancy with preeclampsia the first time was 14.1% (95% CI: 13.6-14.6). For women with a first time twin pregnancy the recurrence risk was lower, 6.8% (CI: 4.3-10.1), P < 0.001. Thus, the crude excess risk for recurrent preeclampsia was 7.3% (95% CI: 4.5-10.0) in women with a first time singleton as compared to women with a first time twin pregnancy. The recurrence risk of preeclampsia is lower when the first pregnancy was a twin as compared to a singleton pregnancy. This observation is consistent with a polygenic liability model.
Adult↗
[Nausea and vomiting during pregnancy].
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Female↗
The use of oral misoprostol for pre-abortion cervical priming: a randomised controlled trial of 400 versus 200 microg in first trimester pregnancies.
OBJECTIVE: To compare the impact of 200 and 400 microg oral misoprostol on pre-operative cervical priming in both primi- and multigravidae prior to first trimester termination of pregnancy. Pre-operative cervical dilatation and bleeding were assessed. DESIGN: Randomised controlled trial. SETTING: Norwegian university teaching hospital. SAMPLE: Five hundred and fifty-one women undergoing surgical termination of pregnancy between 7 and 12 weeks of gestation. METHODS: Patients were randomised to either 200 or 400 microg of oral misoprostol 10-16 hours before vacuum aspiration. The degree of cervical dilatation prior to abortion by vacuum aspiration was measured. Pre-operative bleeding and pain were recorded and vaginal bleeding was measured. MAIN OUTCOME MEASURES: Degree of pre-operative cervical dilatation and pre-operative bleeding. RESULTS: The mean cervical dilatation was 5.8 mm (SD 1.7) for the women who received 400 microg misoprostol and 5.4 mm (SD 1.4) for those who received 200 microg (P= 0.004). The pre-operative dilatation was larger in multigravidae than in primigravidae in both dosage groups. The odds ratio (OR) of pre-operative bleeding was 3.3 (95% confidence interval [CI] 2.1-5.0) in the 400 microg dosage group, as compared with the group receiving 200 microg misoprostol. The occurrence of bleeding was dose-dependent. Frequency of bleeding was similar in multigravidae compared with primigravidae in the 400 microg dosage group, whereas the occurrence of bleeding was less in primigravidae than multigravidae in the 200 microg dosage group. Only 89 out of 551 patients bled one or more grams. The volumes measured were not statistically significantly different. Complications were minor, and were distributed equally between the two dosage groups. CONCLUSIONS: The 200 microg oral misoprostol compared with the 400 microg oral misoprostol given 10-16 hours before first trimester surgical abortions results in less pre-operative vaginal bleeding and in a statistically, although not clinically significant reduction in cervical dilatation.
Abortifacient Agents, Nonsteroidal↗
[Medically induced abortion--a provocative issue?].
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Abortifacient Agents↗
Early evaluation of bowel symptoms after primary repair of obstetric perineal rupture is misleading: an observational cohort study.
PURPOSE: This study was conducted to investigate the long-term development of anal and urinary incontinence and to investigate the clinical value of electromyography and pudendal nerve terminal motor latency after obstetric anal sphincter rupture. METHODS: One hundred females with obstetric anal sphincter rupture were evaluated by an anal incontinence questionnaire at 5 and 18 months postpartum and by a urine incontinence questionnaire at 18 months postpartum. Pudendal nerve terminal motor latency and electromyography examinations were performed on 68 and 67 females, respectively, at 10 months postpartum. RESULTS: Fecal incontinence increased from 7 to 17 percent between 5 and 18 months (P = 0.04). At 18 months, the incidence of anal incontinence in females working outside the home (42/70 (60 percent)) was greater than that for females still at home with their child (12/30 (40 percent); P = 0.05). Anal incontinence at 18 months was significantly higher (P = 0.01) in subjects with pathologic electromyographic findings (76 percent) than in those with normal electromyography (45 percent; observed differences, 31 percent (95 percent confidence interval, 9 to 54 percent)). Thirty percent of the subjects had urinary stress incontinence. The risk of fecal urgency was greater in females with urinary urgency (difference, 44 percent; 95 percent confidence interval, 18 to 69 percent) and urinary stress incontinence (difference, 24 percent; 95 percent confidence interval, 3 to 44 percent) than in those without. CONCLUSION: Fecal incontinence symptoms worsen with increased follow-up time, and the change in working status is the most likely explanation; therefore, early evaluation of bowel symptoms is misleading. Denervation injury of the anal sphincter is an independent risk factor for anal incontinence but has no association with urinary incontinence. Urinary urgency and stress incontinence symptoms are strongly associated with fecal urgency.
Anal Canal↗
Testing for toxoplasmosis in pregnancy: a study of the routines in primary antenatal care.
OBJECTIVES: The question of benefit of screening for antibodies against Toxoplasma gondii in pregnancy to prevent impairment in the infant has not been settled. Despite this, it is believed that such testing is common. The aim of this study was to describe the test routines and to identify factors associated with testing in primary antenatal care. SETTING: Ulleval University Hospital, Oslo, Norway. METHODS: All women who gave birth at Ulleval University Hospital, Oslo, Norway, in May 2000 were included. The number of antibody tests during pregnancy was obtained from the patient registry at the department of microbiology at the same hospital. RESULTS: 81% (361/446) had been tested for antibodies against Toxoplasma gondii during pregnancy. Women attending primary antenatal care at a specialist in obstetrics and gynaecology were most likely to be tested. Among women with no signs of prior toxoplasmosis, 35% (110/317) were tested only once. DISCUSSION: The majority of pregnant women are being tested for toxoplasmosis even though such testing has no documented preventive effect and has not been recommended.
Adult↗
[Acetylsalicylic acid against pre-eclampsia?].
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Aspirin↗
Is there any correlation between objective anal testing, rupture grade, and bowel symptoms after primary repair of obstetric anal sphincter rupture?: an observational cohort study.
PURPOSE: The purpose of this study was to investigate the relationships between the grade of anal sphincter rupture, anal sphincter defect, manometry variables, and anal incontinence. METHODS: A total of 132 females with first-time obstetric sphincter rupture were evaluated by transanal ultrasound, manometry, and scoring of bowel symptoms five months after delivery. RESULTS: Anal sphincter rupture and transanal ultrasound grade correlated with each other ( rs= 0.427, P= 0.001). Both rupture and transanal ultrasound grade correlated with soiling grade ( rs= 0.2, P= 0.03 for both), but in a multiple regression analysis, only transanal ultrasound grade was significant ( P= 0.001) as an independent variable. Anal incontinence score correlated with all the manometry variables, but in a multiple regression analysis, only squeeze pressure was significant ( P= 0.001, beta = -0.4) as an independent variable. Both anal sphincter rupture and transanal ultrasound grade were correlated with manometry variables, but only transanal ultrasound grade was significant as an independent variable after multiple regression analysis. The frequency of transanal ultrasound-verified extensive defect of anal sphincter was higher in rupture Grade 3B (25; 95 percent confidence interval, 12-38 percent) and Grade 4 (45; 95 percent confidence interval, 24-66 percent) than in Grade 3A (2.8; 95 percent confidence interval, -1 to -6.6 percent).(s) (s)CONCLUSION Manometry variables are significantly lower in incontinent females than in continent females, and the Wexner incontinence score was correlated with manometry variables. Both anal sphincter rupture and transanal ultrasound grade correlated with soiling grade and with manometry variables, but in both cases only the transanal ultrasound grade was a significant independent variable.
Adult↗
Do occult anal sphincter injuries, vector volume manometry and delivery variables have any predictive value for bowel symptoms after first time vaginal delivery without third and fourth degree rupture? A prospective study.
BACKGROUND: The aim of this study was to determine whether there exists a correlation between anal incontinence, occult sphincter injuries, anal manometry values, and delivery variables in primiparous women after first time vaginal delivery. METHODS: Eighty-six primigravida women were recruited for this study. Transanal ultrasonography (TAUS) and vector volume manometry (VVM) was performed and bowel symptoms were recorded at 25 weeks of pregnancy and 5 months after labor. Incontinent women at 5 months after vaginal delivery were interviewed again at 12 months. RESULTS: Nineteen women (25%) experienced flatus incontinence postpartum. After 12 months, only one-third of the women were still incontinent. Fourteen women (19%) showed abnormal TAUS of the anal sphincter. Of the delivery variables, only baby head circumference was significantly associated with flatus incontinence (p = 0.01). There was no correlation between flatus incontinence or delivery variables and anal sphincter injuries; VVM values were not associated with either anal sphincter injuries or flatus incontinence at 5 months, but VVM values were negatively associated with flatus incontinence at 12 months after labor. CONCLUSIONS: At 5 months after labor, flatus incontinence is relatively common, and is not associated with reduced VVM values. Two-thirds of women recover from flatus incontinence during the first year. Women who had flatus incontinence persisting for a minimum of 1 year had reduced VVM values. Anal sphincter injuries as seen by TAUS are not associated with either VVM values or any delivery variable. Baby head circumference is the only delivery variable significantly associated with flatus incontinence.
Adult↗
Acupuncture during labor can reduce the use of meperidine: a controlled clinical study.
OBJECTIVE: To evaluate the effectiveness of acupuncture as an analgesic during labor. DESIGN: A randomized, unblinded, controlled study. SETTING: A labor ward in a University Hospital. PATIENTS: Parturients at term. INTERVENTIONS: One group received acupuncture (N = 106); another did not (N = 92). A second control group (N = 92), drawn from the labor ward protocol, consisted of patients who met the eligibility criteria for the study and were matched to the "no acupuncture" group by parity, but who had not been offered the opportunity to take part. Outcome measure "effectiveness of acupuncture" was measured by the requirement for use of meperidine. RESULTS: Meperidine was given to 11% of the acupuncture group, 37% of the no acupuncture group (P < 0.0001), and 29% of the control group. The use of other analgesics was also lower in the acupuncture group. Patient satisfaction was high: 89 of 103 patients asked said they would want acupuncture during another labor. CONCLUSIONS: Acupuncture during labor reduced the requirement for other painkillers and has high patient satisfaction in this randomized, unblinded, controlled study.
Acupuncture Analgesia↗