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Biomedical subjects

U Ulmsten

Publications and source records attributed to U Ulmsten.

At least 19 recordsLinked to original sources
PubMed1992

Comparison of umbilical-artery velocimetry and cardiotocography for surveillance of small-for-gestational-age fetuses.

Intrauterine growth retardation is associated with an increased risk of fetal asphyxia as well as greater perinatal morbidity and mortality. Ultrasound fetometry enables detection of fetuses that are small for gestational age. Doppler velocimetry of the umbilical artery has good predictive ability for fetal distress, but it is not yet clear whether it could replace cardiotocography in antenatal surveillance of small-for-gestational-age fetuses. We have done a randomised comparison of the two methods. At four obstetric departments in Sweden, women with fetuses found to be small on ultrasound examination at 31 completed weeks of pregnancy or later were randomly assigned to antenatal surveillance with either doppler velocimetry (doppler; 214) or cardiotocography (CTG; 212). Pregnancies in the doppler group were managed according to a protocol based on blood-flow classes deriving from the semiquantitative evaluation of umbilical-artery velocity waveforms; unless the pregnancy was complicated by any other disorder, no antenatal cardiotocography was done. By comparison with the CTG group, the doppler group had fewer monitoring occasions (mean 4.1 [SD 3.1] vs 8.2 [6.2], p < 0.01), antenatal hospital admissions (68 [31.3%] vs 97 [45.8%], p < 0.01), inductions of labour (22 [10.3%] vs 46 [21.7%], p < 0.01), emergency caesarean sections for fetal distress (11 [5.1] vs 30 [14.2%], p < 0.01), and admissions to neonatal intensive care (76 [35.5%] vs 92 [43.4%], p = 0.10). The groups did not differ in gestational age at birth, birthweight, Apgar scores, or total number of caesarean deliveries. Umbilical-artery doppler velocimetry of small-for-gestational-age fetuses allows antenatal monitoring and obstetric interventions to be aimed more precisely than does cardiotocography.

Adolescent↗
PubMed1992

Serum collagenase levels in relation to the state of the human cervix during pregnancy and labor.

OBJECTIVE: The purpose of our study was to investigate the role of collagenase in the cervical ripening and dilatation process in term pregnancy. STUDY DESIGN: Serum samples were obtained from nonpregnant women (n = 5) and term-pregnant women. The term-pregnant women were either admitted for elective cesarean section or labor induction (unfavorable cervix, n = 19; favorable cervix, n = 12) or in spontaneous, active labor (stiff and inelastic cervix, n = 7; soft compliant cervix, n = 8). Statistical analysis was performed with the Student t test. RESULTS: The nonpregnant women had low serum collagenase levels (5.2 +/- 0.7 micrograms collagen digested per minute per 100 ml serum, mean +/- SEM). At term but before labor, women with unripe cervices had higher collagenase levels (10.3 +/- 0.9). The women with ripe cervices had even higher serum collagenase levels (22.9 +/- 4.2; p < 0.001). During labor, women with stiff and inelastic cervices had lower serum collagenase levels compared with women with soft and compliant cervices (12.9 +/- 1.7 vs 28.0 +/- 4.2; p < 0.01). CONCLUSION: Serum collagenase during ripening at term and in active labor increases, supporting its active role in the ripening process.

Adult↗
PubMed1992

An analysis of rapid pad testing and the history for the diagnosis of stress incontinence.

Two rapid exercise pad tests, the vitamin B test, and the methylene blue test, are introduced for the diagnosis of urinary stress incontinence. The vitamin B test is entirely non-invasive, takes only a few minutes to perform, and is especially useful as an office test. The methylene blue test has fewer variables, and fits easily into a urodynamic routine. With the methylene blue test, a direct correlation was noted between amount of urine lost and pressure generated by the tests. This conforms to the definition of stress incontinence as a passive process. The sensitivity of the test in a group with mainly mixed symptoms was 89.5%, and the specificity 100%. The test is useful where objective diagnosis of stress incontinence is important. A group of 38 patients with a history (questionnaire) of stress incontinence exhibited a total of 105 positive individual symptoms out of a possible 228 symptoms (6 x 38), comprising a history of leaking at sneezing, coughing, exercise, laughing, walking, or bending. The individual symptoms were analyzed for accuracy and predictability by comparing them with six graded provocative exercises comprising a trampoline test, star jumps, coughing, stepping, bending and hand washing. The symptoms were graded into a hierarchy from the results. A history of stress incontinence was found to be an accurate determinant of stress incontinence, even in patients with mixed symptoms. This allows the questionnaire as presented to be used as a semiquantitative index for assessment purposes.

Adult↗
PubMed1992

Urge incontinence history is an accurate predictor of urge incontinence.

The reliability of urge symptoms associated with actual observed urine loss was tested using subtracted cystometry, and a hand-washing pad test in a total of 169 patients with urinary incontinence, 70 of whom had a prior history of urge incontinence. Our results showed: 1. that urodynamic or pad tests performed at a single point in time cannot retrospectively confirm a patient's past history of urge incontinence with any reliability; 2. a patient's history of urge incontinence is likely to be accurate.

Adult↗
PubMed1992

Surgery for female urinary incontinence.

There has been very little advance in the surgery of female urinary incontinence over the past 20 years. In our opinion this is due to 1) uncritical acceptance of the intraabdominal pressure transmission theory, 2) uncritical acceptance of the concept of "detrusor instability," and 3) limited and uncritical evaluation of results of surgery. A new theory for female urinary incontinence is presented. This theory explains existing phenomena in terms of anatomic defects in the vagina and its supporting ligaments. Based on this theory, a new classification of female urinary incontinence and several new minimally invasive surgical procedures are briefly introduced.

Female↗
PubMed1991

Placental morphology in relation to umbilical artery blood velocity waveforms.

The association between umbilical artery flow velocity waveforms, placental morphology and arterial vascular pattern was investigated in 30 pregnant women at risk for intra-uterine growth retardation. The blood velocity waveform was assessed in the umbilical arteries with pulsed Doppler ultrasound. Placentas from fetuses with an end-diastolic zero flow were small and thick with an extrachorial configuration, marginal cord insertion, magistral or mixed allantochorial vessel pattern and few cotyledons. The incidence and the extension of gross lesions were slightly increased in these placentas compared to placentas from fetuses with a normal S/D ratio (peak systolic velocity/minimum diastolic velocity). Placentas from fetuses with an increased S/D ratio (greater than +2SD) were large and thin with a high maximum diameter/maximum thickness ratio. Heavily smoking mothers were overrepresented in the group, with an increased S/D ratio and corresponding SGA infants. End-diastolic zero flow in the umbilical artery was strongly correlated with placental developmental abnormalities.

Angiography↗
PubMed1991

Regional differences in energy charge of the pregnant human uterus regardless of functional status in comparison with the non-pregnant uterus.

The energy status of the cell is mainly dependent on adenine nucleotides and can be expressed as energy charge (EC). EC is known to be kept at narrow limits near 0.90 under normal conditions in most cells. We recently reported remarkably low EC values in the human uterus under apparent steady-state conditions. The present paper is an extension of previous work. It shows that EC varies in different regions of the uterus in that the isthmic part in pregnant women displays a higher EC than the fundus of the uterus. There were no intergroup differences between non-pregnant and term pregnant women, nor between those who were in active normal labour, dysfunctional labour or those who were not in labour at all. On the other hand, EC in uterine muscle of post-menopausal women showed a significantly lower EC value. Human uterus seems to manage its metabolic requirements under different functional conditions in spite of low ATP and EC values. This suggests that ATP occurs in sufficient amounts to pertinent enzyme reactions, especially ATPases, which means Km values adapted for this unusually low ATP concentration.

Adenosine Triphosphatases↗
PubMed1991

Proteoglycan metabolism in the connective tissue of pregnant and non-pregnant human cervix. An in vitro study.

Profound changes occur in the cervix during pregnancy. In particular, the connective tissue is remodelled. To elucidate the mechanisms behind this process, the metabolism of cervical connective tissue was studied using tissue cultures. Cervical biopsies from non-pregnant and pregnant women were incubated with [35S]sulphate. The proteoglycans of the tissue specimens were purified by ion-exchange and gel chromatography and characterized by SDS/PAGE and by enzymic degradation. In the non-pregnant cervix, the incorporation of [35S]sulphate into the proteoglycans was linear for 48 h. During the first 6 h of incubation the accumulation of chiefly one small labelled proteoglycan (apparent Mr 110,000) substituted with dermatan sulphate was recorded. This is in accordance with the known proteoglycan composition of non-pregnant cervical tissue. In addition, small amounts of two larger radioactive dermatan/chondroitin sulphate proteoglycans (apparent Mr values 220,000 and greater than 500,000) were recorded. After longer periods of incubation the proportion of heparan sulphate proteoglycans increased considerably. The pregnant tissue showed a clearly different composition of labelled proteoglycans. An increased accumulation of the two larger dermatan/chondroitin sulphate proteoglycans was seen in addition to the dominant small dermatan sulphate proteoglycan of the non-pregnant cervix. The rate of accumulation of these two proteoglycans was about 3 times higher in the pregnant tissue, whereas that of the small dermatan sulphate proteoglycan was only increased 2-fold. The fact that the concentration of proteoglycans in the pregnant cervix is approximately one-half of that in the non-pregnant cervix indicates that the turnover of proteoglycans in pregnant cervical tissue is significantly increased. The major effect of this profound change of metabolism was a 50% decrease in proteoglycan content and a 2-fold increased proportion of a dermatan sulphate proteoglycan with an apparent Mr of 220,000.

Adult↗
PubMed1991

Transvaginal ultrasound for identifying endometrial abnormality.

Transvaginal ultrasound was used preoperatively to evaluate the endometrium in 96 patients referred for dilatation and curettage. The sonographic display was correlated to the histopathologic diagnosis. In 45 patients with postmenopausal bleeding, 4 patients had adenocarcinoma of the endometrium. All were identified by ultrasound. None of the 22 patients with a normal sonographic appearance had an abnormal histopathologic diagnosis. An endometrial thickness (single layer) cut-off point of greater than or equal to 4 mm precluded any missed malignancies but halves the number of dilatations and curettages in this postmenopausal group. The sensitivity of ultrasound in diagnosing endometrial pathology was 100% and the specificity was 61%. The positive and negative predictive values were 39% and 100% respectively. In 51 premenopausal women there was good agreement between histology and ultrasound. In this group a cut-off point of greater than or equal to 8 mm was used. The sensitivity in diagnosing endometrial pathology was 67% and the specificity 75%. The positive and negative predictive values were 14% and 97%. With further experience, transvaginal ultrasound might be used in clinical routine for diagnosing endometrial pathology.

Adenocarcinoma↗
PubMed1990

Low energy charge in human uterine muscle.

Six pregnant and 10 non-pregnant patients undergoing Caesarean section and laparatomy, respectively participated in this study which was aimed at determining the energy status of human uterine muscle and comparing it to that of striated muscle from the same individual. Biopsies were taken from the fundus uteri between the ligamenta rotunda and from the rectus abdominis muscle. A low energy charge of 0.55 in pregnant patients and 0.64 in non-pregnant patients was observed in uterine biopsies, compared to the expected value of 0.90 found in rectus biopsies. The main determinant of this finding was a 4-8 times lower level of ATP in uterine biopsies compared to that in rectus biopsies. The same pattern was apparent for total nucleotide content and creatine phosphate. The ADP and AMP contents were of the same order of magnitude in both tissues. The lactate content in uterine biopsies from pregnant patients was significantly higher than that found in biopsies from rectus muscle and from uterine tissue of non-pregnant patients, indicating an increased glycogenolysis in pregnant uterus. The low energy charge and low level of phospho-compounds observed in uterine muscle, regardless of the functional state, are new and unexpected findings.

Abdominal Muscles↗
PubMed1990

Myometrial activity after local application of prostaglandin E2 for cervical ripening and term labor induction.

Twelve pregnant women at term with unfavorable cervices (less than or equal to 5 points according to Bishop score) were given prostaglandin E2 for cervical priming and labor induction. Prostaglandin E2 was given in the following manner: 0.5 mg in gel strictly intracervically (n = 4), extraamniotically (n = 4), or prostaglandin E2 (4 mg) in gel vaginally (n = 4). The myometrial activity was registered over a period of 30 minutes before and at least 3 hours after gel application by means of an extraamniotic microtransducer catheter. After both extraamniotic and vaginal gel application, myometrial activity was significantly increased compared with intracervical application. All the women had favorable cervical states 6 hours after treatment and were delivered vaginally within 24 hours. All infants were delivered in good condition with 1-minute Apgar scores greater than 7. From these results we conclude that proper intracervical prostaglandin E2 gel application, in contrast to extraamniotic or vaginal application, induces cervical ripening without significant myometrial activity. Because careful intracervical application appears to avoid or minimize the risks of myometrial hyperstimulation, this technique should be considered particularly in women with unfavorable cervices and delicate fetuses.

Administration, Intravaginal↗
PubMed1990

The physiology of cervical ripening and cervical dilatation and the effect of abortifacient drugs.

The mechanical properties of the human uterine cervix are determined mainly by the connective tissue component, whereas it is doubtful whether the scanty smooth muscle component is of any physiological importance. Histological and biochemical analyses reveal a fibrous connective tissue similar to that found in skin and tendon. Degradation of the collagen and an increase in some special dermatan sulphate proteoglycans can at least partly explain the pregnancy-associated softening of this connective tissue. Relatively high oestrogen levels seem to be an absolute condition for the process, even when it is induced pharmacologically. Treatment with progesterone-receptor blockers, PGE2, PGF2 alpha or relaxin in pregnancy induce cervical softening as well as histological and biochemical changes which cannot be distinguished from the physiological cervical softening which takes place in late pregnancy. Prostaglandins and relaxin might interact and could include cytokines such as interleukin-1 during the process. The effect of cervical tents cannot be explained only by the radial pressures they exert. Most probably stimulation of local prostaglandin synthesis is also involved.

Abortifacient Agents↗
PubMed1990

Steroid hormone receptors in pelvic muscles and ligaments in women.

Using monoclonal antibody assay techniques estrogen receptors (ER) and progesterone receptors (PgR) were quantitated in female pelvic floor muscles, urogenital ligaments and uterus (myometrium). Receptors were detected in all these structures. In addition qualitative assessment showed distinct nuclear staining in the same structures. ER and PgR were not found in the musculus rectus abdominis with either method. The findings provide a rationale for estrogen treatment in women with urogenital disorders.

Adult↗
PubMed1990

Effect of combined treatment with phenylpropanolamine and estriol, compared with estriol treatment alone, in postmenopausal women with stress urinary incontinence.

Twenty-nine postmenopausal women with slight to severe stress urinary incontinence and estrogen deficiency symptoms in the urogenital tract were treated with estriol, p.o. 4 mg once daily, and either phenylpropanolamine (PPA), p.o. 50 mg twice daily, or placebo for periods of 6 weeks according to a randomized double-blind crossover schedule. At urodynamic recordings the maximum urethral closure pressure increased by 22% with combined treatment (p less than 0.001) and an additional effect of PPA to estriol was shown (p = 0.022). The pressure transmission ratio increased, by about 15%, with both treatments (p less than 0.07). The number of leakage episodes was reduced by 28% with combined treatment (p = 0.007), but not with estriol alone (p = 0.08). Both combined treatment and estriol alone reduced significantly (p less than 0.01) the urinary incontinence complaints. Twelve women (43%) preferred combined treatment, while 7 (25%) preferred estriol alone. In women with initially slight to very severe urine loss, combined treatment reduced also (p = 0.02) the amount of urine loss, measured at a standardized physical stress test. Signs of estrogen deficiency in vulva, vagina and urethra were reduced, 75% (p less than 0.001) or 65% (p = 0.001) with estriol given in combination with PPA or alone. Maturation index of both urethral and vaginal epithelium displayed significant changes. It is concluded that the combined treatment, PPA + estriol, by affecting both the muscular and mucosal factor of the urethra, is more effective than estriol alone for treatment of female stress urinary incontinence in the postmenopausal ages.

Double-Blind Method↗