[Too many women are being sterilized in Denmark].
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Denmark↗
Biomedical subjects
P Helm
Publications and source records attributed to P Helm.
Transvaginal sonohysterography and hysteroscopy in the evaluation of female infertility, habitual abortion or metrorrhagia. A comparative study.
BACKGROUND: To assess the diagnostic value of sonohysterography in the evaluation of metrorrhagia and infertility with hysteroscopy as the standard. METHODS: Sixty-six women, 41 with metrorrhagia, 20 with infertility and five with habitual abortion, were examined by sonohysterography and hysteroscopy. Sterile saline instilled through a baby-feeding tube was used to distend the uterine cavity during sonohysterography. Hysteroscopy was performed with a 4 mm hysteroscope under general anesthesia. The endometrial polyps and submucous myomas were recorded and the findings subsequently compared. RESULTS: Of the 66 women, 60 were successfully examined by both sonohysterography and hysteroscopy. The overall sensitivity and specificity for sonohysterography was 90.9% and 100%, respectively. The positive and negative predictive values were 100% and 90%, respectively. When examining the metrorrhagia and infertility groups separately the sensitivity and specificity and predictive values were found to be 88.5%, 100%, 100% and 76.9% (metrorrhagia) and 100% for all parameters in cases of infertility. No complications were recorded during the procedures. CONCLUSION: Sonohysterography is a simple, fast, well tolerated and accurate method to evaluate the uterine cavity in patients with metrorrhagia or infertility.
Abortion, Habitual↗
[Determination of menarche and primary amenorrhea].
It was the aim to determine recalled ages at menarche and prevalence of primary amenorrhea in a random sample of 3743 women, aged 15-44 years, in a Danish county. It was a further object to examine agreement between results obtained by the recall and the status quo method. Response rate was 78%. The prevalence of primary amenorrhea (menarche after the 18th birthday) was 0.48%. In the calculations the reported menarcheal ages were treated as age-at-nearest-birthday, i.e. the usual 0.5 year mid-point correction was omitted. The resulting mean ages showed close agreement with Danish menarcheal ages, obtained by the status quo method, covering the same period of time. On the other hand, previously published recall data for this period, including the 0.5 year correction, were almost consistently 0.5 year higher. It is argued that the 0.5 year midpoint correction should be omitted in recalled whole-year data.
Adolescent↗
A halt in the secular trend towards earlier menarche in Denmark.
BACKGROUND: A halt in the decrease of menarcheal age has been reported in some countries but has not been documented in Denmark. METHODS: The entire population of schoolgirls, attending grades 5 through 10 (n=979), in a particular region of Denmark was investigated by the status quo method in 1996. Similar investigations had been made in the same region and by the same method in 1966 and 1983. Mean age and standard deviation were estimated by probit analysis. RESULT: Mean age was 13.00 years (s.e.=0.080; s.d. = 1.15) and almost identical with the mean age in 1983 (13.03 years), but significantly different from the mean age in 1966 (13.40 years). CONCLUSION: The results indicate a halt in the secular trend towards earlier menarche in the region at some time between 1966 and 1983.
Adolescent↗
[Infertility and treatment in a representative population].
The objective was to investigate lifetime prevalence of infertility, the seeking of infertility treatment and outcomes of treatment. A random sample of 3,743 women, 15 to 44 years old, were asked about infertility, their seeking of infertility treatment, diagnosis provided by their doctors and subsequent parenthood in a postal questionnaire. Response rate was 78%. Of the women who had attempted to have a child, 26.2% had experienced infertility; 4.1% af the women aged 25 to 44 years were currently primary infertile and 8.6% had involuntarily never delivered a child; 47.4% of the infertile women had sought infertility treatment. Significant predictors for seeking treatment were over nine years of school education and not having delivered a child. Of the treated infertile women 54.9% subsequently had a child. Only 30% of these reported that the successful delivery was treatment-related. The health care system should ensure that infertile couples from lower social classes are offered information on the possibility of infertility treatment.
Adolescent↗
Ca++ sensitizers impair cardiac relaxation in failing human myocardium.
The present study was aimed at investigating the effect of two Ca++ sensitizers, EMD 57033 (without significant phosphodiesterase inhibition) and ORG 30029 (with phosphodiesterase inhibition), in myocardium from nonfailing and failing human hearts. In nonfailing myocardium both EMD 57033 and ORG 30029 increased force of contraction by 280 +/- 27% and 94 +/- 13%, respectively (n = 6); the time to 80% relaxation (t80%) by 278 +/- 45% and 155 +/- 21%; and diastolic force by 28 +/- 8% and 12 +/- 3%, respectively. In trabeculae from failing myocardium, the increase in active force was similar to that in nonfailing trabeculae (EMD, 305 +/- 30%; ORG, 88 +/- 12% (n = 6)). However, the increase in t80% (EMD, 378 +/- 56%; ORG, 230 +/- 26%) and diastolic force (65 +/- 12%; 24 +/- 5%) was more pronounced in failing myocardium. EMD had no effect on the peak of the [Ca++]i transient; however, it prolonged the time course of the [Ca++]i transient in both nonfailing and failing myocardial fibers. ORG increased the peak of the Ca++ transient and prolonged the time course in preparations from both nonfailing and failing hearts. Both EMD and ORG shifted the [Ca++]-force relationship toward lower [Ca++] (EMD > ORG). The Ca++ sensitizers EMD 57033 and ORG 30029 increased active force development in nonfailing and failing human myocardium, but both impaired relaxation in failing myocardium to a greater extent than in nonfailing human myocardium in a concentration-dependent fashion.
Adult↗
[Menarche in relation to infertility and adult height and weight].
In order to clarify relationships between menarcheal age and fertility and fecundity later in life, a questionnaire was mailed to 3743 women, aged 15-44 years, selected at random in the county of Copenhagen; 78% responded. Associations were observed between early menarche and increased risk of pelvic inflammatory disease and spontaneous abortion. On the other hand, no association was found between age at menarche and irregular bleedings, amenorrhoea, fertility, or fecundity. Early menarche was associated with excess weight, late menarche with underweight. A positive correlation was found between menarcheal age and final body height. It is concluded that menarche was not associated with fertility or fecundity, whereas early menarche was associated with pelvic inflammatory disease and spontaneous abortion. Age at menarche showed associations with height and weight.
Adolescent↗
Infertility and the seeking of infertility treatment in a representative population.
OBJECTIVE: To investigate lifetime prevalence of infertility, the seeking of infertility treatment and outcomes of treatment. DESIGN: Cross-sectional postal questionnaire study. SETTING: County of Copenhagen, Denmark. SUBJECTS: Three thousand, seven hundred and forty-three women, 15 to 44 years old, selected at random were asked about infertility, their seeking of infertility treatment, diagnoses provided by their doctors and subsequent parenthood. Response rate was 78%, n = 2865. A random sample of non-responders was interviewed by telephone. MAIN OUTCOME MEASURES: Fertility status, seeking of infertility treatment, subsequent deliveries and adoptions. RESULTS: Of the women who had attempted to have a child, 26.2% had experienced infertility; 4.1% of the women aged 25 to 44 years were currently primarily infertile and 8.6% had involuntarily not delivered a first child; 47.4% of the infertile women had sought infertility treatment. Significant predictors for seeking infertility treatment were school education > 9 years and not having delivered a child. Of the infertile women 54.9% subsequently had a child. Only 30% of these reported that the successful delivery was treatment-related. CONCLUSIONS: The health care system should see to it that infertile couples from lower social classes are offered information on the possibility of infertility treatment. High quality infertility treatment has to include both the "supply" of taking care of the infertile couple's psychosocial strain and the goal of ensuring successful pregnancies.
Adolescent↗
Recalled menarche in relation to infertility and adult weight and height.
BACKGROUND: Possible relationships between menarche and fertility and fecundity later in life have not been fully clarified. METHODS: A cross-sectional study was made in a random sample of 3743 women, aged 15-44 years, in the country of Copenhagen; 78% responded. Telephone interviews were made with a sample of the non-respondents. RESULTS: Associations were observed between early menarche and increased risk of pelvic inflammatory disease (odds ratio 2.4 (1.4-4.1)) and spontaneous abortion (OR 3.1 (1.6-5.7)) later in life. On the other hand, no association was found with irregular bleedings or amenorrhoea; nor was a significant relationship established with fertility or fecundity. Late menarche was associated with underweight (OR 3.1 (1.4-6.9)), and early menarche with excess weight (OR 5.0 (2.4-10.6)). A significant positive correlation (R = 0.17) was found between menarcheal age and final body height. CONCLUSIONS: Menarche was not associated with fertility or fecundity. Early menarche was associated with pelvic inflammatory disease and spontaneous abortion. Menarche showed relationships with weight and height.
Adolescent↗
[Heterotopic pregnancy after in vitro fertilization].
Until December 1991, 1171 pregnancies had been established in Denmark after in vitro fertilization and embryo transfer (IVF-ET). Thirteen of these pregnancies were heterotopic (1.1%). Three patients were asymptomatic, four patients presented with an acute abdomen, five had abdominal pain and only two patients had vaginal bleeding. In five cases the diagnosis of heterotopic pregnancy was made by ultrasound, while eight cases were diagnosed at the time of surgery. Eleven patients were treated in the first trimester, while two patients were treated at 23 and 38 weeks of gestation, respectively. In nine of the thirteen cases the intrauterine pregnancy resulted in term delivery. Heterotopic pregnancy occurred in 1% of pregnancies following IVF-ET. Abdominal pain was the predominant symptom, while vaginal bleeding was absent in the majority of women. In most cases removal of the ectopic gestation allowed the intrauterine pregnancy to proceed until term.
Adult↗
Heterotopic pregnancies after in-vitro fertilization and embryo transfer--a Danish survey.
Thirteen cases of heterotopic pregnancy were diagnosed among 1171 pregnancies established in Denmark after in-vitro fertilization and embryo transfer (IVF-ET). Thus the frequency of heterotopic pregnancy was 13/1171 or 1.1%. In five cases the diagnosis of heterotopic pregnancy was made by ultrasound at 6-9 weeks of gestation; three of these patients were asymptomatic, while two patients presented with abdominal pain and vaginal bleeding. All these patients had an unruptured ectopic pregnancy. Eight cases were diagnosed at the time of surgery; all these patients presented with abdominal pain. Only two of the 13 patients had vaginal bleeding. In nine of the 13 cases the intra-uterine pregnancy resulted in term delivery, while one pregnancy is ongoing. In pregnancies following IVF-ET, this diagnosis should particularly be considered in cases with abdominal pain; vaginal bleeding may be absent. Ultrasound examination may lead to early diagnosis even in asymptomatic cases. In most cases, removal of the ectopic gestation will allow the intrauterine pregnancy to proceed to term.
Adult↗
Length and variation in the menstrual cycle--a cross-sectional study from a Danish county.
OBJECTIVE: To investigate the current epidemiology of menstrual patterns among women of fertile age. DESIGN: Cross-sectional postal questionnaire study. SETTING: County of Copenhagen, Denmark. SUBJECTS: 3743 women, aged 15-44, selected at random from a Danish county, who were asked to provide information on menstrual pattern during the preceding year, 1981. The response rate was 78%. Information from non-responders was obtained via telephone interviews. RESULTS: In women with regular menstrual cycles, the 5th-95th centile range of usual cycle length decreased from 23-35 days in the 15-19 years age group to 23-30 days in the 40-44 years age group. Only 0.5% of regular menstruating women had a usual cycle length of less than 21 days and 0.9% had a usual cycle length of greater than 35 days. At least one cycle length of less than 21 days was experienced by 18.6%, whereas 29.5% had at least one cycle of greater than 35 days. Menstrual cycle variation of greater than 14 days was present in 29.3% of all women. Cycle length variation of greater than 14 days was 2.7 times more frequent in women from lower social groups (controlled by age). CONCLUSION: The study confirmed the normally used definitions of polymenorrhoea (cycle length less than 21 days) and oligomenorrhoea (cycle length between 36 and 90 days), as these very short or long menstrual cycle lengths were very seldom recorded for a longer period. However, the high frequency in a normal population of large menstrual cycle length variation challenges the view that an intra-individual variation of greater than 5 days should be regarded as a sign of disease in the woman.
Adolescent↗
Secondary amenorrhoea: prevalence and medical contact--a cross-sectional study from a Danish county.
OBJECTIVE: To examine the prevalence of secondary amenorrhoea and the patterns of seeking medical advice for secondary amenorrhoea in an unselected population. DESIGN: Cross-sectional postal questionnaire study. SETTING: County of Copenhagen, Denmark. SUBJECTS: 3743 women, aged 15-44, selected at random from a Danish county who were asked to provide information on menstrual patterns for the preceding year, 1988. The response rate was 78%. Information from non-responders was obtained via telephone interviews. RESULTS: One-year period prevalence of secondary amenorrhoea of more than 3 months duration was 4.6% and was 7.6%, 3.0%, and 3.7% in women aged 15-24, 25-34, and 35-44 respectively. The duration of secondary amenorrhoea was 6 months or less in 75% aged 15-34 years, but longer than 6 months in 55% of those aged 35-44 years. A social gradient was found of the prevalence of secondary amenorrhoea (odds ratio 3.3, 95% CI 1.5-8.3) in the lowest social group compared with the highest social group; controlled by age. Only 39% of women with secondary amenorrhoea had contacted a doctor. Educational level or social status did not seem to influence the frequency of medical contact in women with amenorrhoea. CONCLUSION: Spontaneous return of the menstrual cycle occurs within 6 months in many amenorrheic women below the age of 35. The detailed investigation of secondary amenorrhoea in this age group can be postponed until it is of 6 months duration, unless there is clinical suspicion of disease. The relative infrequency with which women with secondary amenorrhoea seek medical advice constitutes an important source of selection bias in hospital-based clinical research on this topic.
Adolescent↗
[Cervix factors as a cause of infertility].
The uterine cervix plays an important role in the natural fertilization process and, consequently, it is also a significant factor in infertility. In about 6% of infertile couples, the infertility is caused by the cervical factor. The post coital test (PCT) is the most essential diagnostic procedure. A good PCT result excludes the cervical factor as the cause of infertility. A poor or negative PCT result, on the other hand, only indicates that the cervical tract is the cause in the case of women with verified ovulation and in whom other causes have been excluded. Treatment of the cervical factor has always been difficult. Intrauterine insemination is the best documented treatment method with a pregnancy rate of about 30%. In future, gamete intrafallopian transfer (GIFT) and in vitro fertilization (IVF) may be alternatives in the treatment of infertility owing to the cervical factor.
Cervix Mucus↗
Pelvic inflammatory disease: the influence of contraceptive, sexual, and social life events.
In order to determine associations between pelvic inflammatory disease (PID) and contraceptive, sexual, and social life events, 620 Danish women aged 15-54 were invited to participate in an in-depth interview. Of 585 participating women, 459 were consecutive gynecological in- or outpatients, and 126 were randomly selected from visitors in general practice. Data were analyzed by multivariate test statistics. The mean number of PIDs thereby retrospectively assessed was 1.0. Two-thirds had never had PID, one third had had on average 3 PIDs. The sexual parameter which had the highest predictive value for later PID was the coital debut. Women with coital debut before the 16th year had double the number of PIDs, as women with sexual debut at age 18 or later. Likewise, the mean coital frequency was positively correlated to the number of PIDs. The number of sexual partners, on the other hand, was merely a risk-indicator without a direct influence on PID. Women who used barrier methods (condom and/or diaphragm) for 2 years or more had 23% fewer PIDs than women who had used barrier methods for less than two years. The small number of PIDs among women at high socioeconomic levels could be explained alone by a later coital debut and longer use of barrier methods than that among women at low socioeconomic levels.
Adolescent↗
The relationship between menarche and sexual, contraceptive, and reproductive life events.
Relationships between menarche and sexual, contraceptive, and reproductive life events were investigated by structured interviews of 585 Danish women, aged 15-54 years. Data were analyzed by multivariate test statistics. The trend toward an earlier menarche was confirmed. No association was found between menarche and social class. Women with early menarche had an earlier coital debut. After correction for coital debut, no association was observed between menarche and coital frequency, number of sexual partners, or use of oral contraceptives. Menarche was not associated with number of births, spontaneous or induced abortions, or frequency of ectopic pregnancies. The results suggest that the predictive value of the menarche for sexual and contraceptive life events is conditioned primarily by the association between menarche and coital debut.
Abortion, Induced↗
Premature rupture of the fetal membranes, the phases of the moon and barometer readings.
Over a 2-year period, 1,516 births were investigated to determine whether the onset of parturition could be correlated with the phases of the moon or to barometric height. 1,269 births started spontaneously, and of these, 254 (20%) started with premature rupture of the fetal membranes (PROM). No association was observed between the phases of the moon and deliveries beginning with PROM or with deliveries beginning without PROM. 1,302 of the women had regular menstrual cycles before pregnancy, and among these no specific relationship was found between the phases of the moon and the first day of the last menstruation before pregnancy. No relationship was found between the frequency of PROM and the barometric height. Variations in barometric height up to 9 h before the fetal membranes ruptured did not influence the frequency of PROM. Deliveries with PROM occurred significantly more often among primipara than among multipara. PROM occurred more frequently during night-time in the 8-hour period between 10 p.m. and 6 a.m. These results suggest that the causes of PROM are not correlated to the phases of the moon or to meteorological variations.
Atmospheric Pressure↗
[Tumors of the upper urinary tract. Long-term survival and local resection].
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Adult↗