Where does the money go to? Cost analysis of gynecological patients with a benign condition.

Objectives: The impact of benign gynecological conditions on life of women and on costs for the society is high. The purpose of this study is to gain knowledge and understanding of costs of the treatment of these disorders in order to be able to improve the clinical care processes, gain insight into feasible savings opportunities and to allocate funds wisely.

Methods: The healthcare processes of 311 women attending university or community hospitals in the Helsinki and Uusimaa Hospital District between June 2012 and August 2013 due to a benign gynecological condition were followed up for two years and treatment costs analysed.

Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus.

Aims: In previous reports, cardiotocographic (CTG) fetal heart rate (FHR) monitoring has shown only limited benefits in decreasing adverse perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). The aim of the present study was to evaluate whether an association exists between the recently reported ZigZag pattern (FHR baseline amplitude changes of > 25 bpm with a duration of 2-30 min) and asphyxia-related neonatal outcomes in GDM pregnancies.

Methods: Intrapartal CTGs were recorded in a one-year cohort of 5150 singleton childbirths.

The health-related quality of life of patients with a benign gynecological condition: a 2-year follow-up.

To assess health-related quality of life (HRQoL) of patients with benign gynecological disorders. Prospective 2-year follow-up with the 15D HRQoL-instrument of 311 women treated in Helsinki-area hospitals in 2012-2013. The initially impaired HRQoL regarding excretion, discomfort and symptoms, and vitality and sexual activity improved after treatment.

Factors associated with intrapartum ZigZag pattern of fetal heart rate: A retrospective one-year cohort study of 5150 singleton childbirths.

Objectives: Recent studies suggest that intrapartum ZigZag pattern of fetal heart rate (FHR) is significantly associated with cord blood acidaemia and neonatal complications. For the clinical significance of this pattern, it is mandatory that ZigZag episodes in cardiotocographic (CTG) recording are correctly identified. The aim of the present study was to examine maternal, fetal and delivery-related factors that could explain the occurrence of ZigZag pattern of FHR during the last 2 h of labour in a large obstetric cohort.

Intrapartum zigzag pattern of fetal heart rate is an early sign of fetal hypoxia: A large obstetric retrospective cohort study.

Introduction: The aim of the present study was to identify possible associations of fetal heart rate (FHR) patterns during the last 2 hours of labor with fetal asphyxia expressed by umbilical artery acidemia at birth and with neonatal complications in a large obstetric cohort.

Material And Methods: Cardiotocographic recordings from 4988 singleton term childbirths over 1 year were evaluated retrospectively and blinded to the pregnancy and neonatal outcomes in a university teaching hospital in Helsinki, Finland. Umbilical artery pH, base excess and pO , low Apgar scores at 5 minutes, need for intubation and resuscitation, early neonatal hypoglycemia, and neonatal encephalopathy were used as outcome variables.

Treatment of gynecological malignancies: long-term follow-up of health-related quality of life and healthcare costs.

To assess long-term health-related quality of life (HRQoL) and treatment-related costs in gynecological cancer patients, and to compare HRQoL between cancer types and to age-standardized general female population. A prospective 8-10-year follow-up of 218 patients treated in Helsinki University Hospital in 2002-2004. The most common malignancies were uterine, ovarian and cervical cancers.

Prediction of pre-eclampsia and its subtypes in high-risk cohort: hyperglycosylated human chorionic gonadotropin in multivariate models.

Background: The proportion of hyperglycosylated human chorionic gonadotropin (hCG-h) to total human chorionic gonadotropin (%hCG-h) during the first trimester is a promising biomarker for prediction of early-onset pre-eclampsia. We wanted to evaluate the performance of clinical risk factors, mean arterial pressure (MAP), %hCG-h, hCGβ, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF) and mean pulsatility index of the uterine artery (Uta-PI) in the first trimester in predicting pre-eclampsia (PE) and its subtypes early-onset, late-onset, severe and non-severe PE in a high-risk cohort.

Methods: We studied a subcohort of 257 high-risk women in the prospectively collected Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) cohort.

First trimester serum placental growth factor and hyperglycosylated human chorionic gonadotropin are associated with pre-eclampsia: a case control study.

Background: To study whether maternal serum hyperglycosylated human chorionic gonadotropin (hCG-h) improves first trimester prediction of pre-eclampsia when combined with placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A) and maternal risk factors.

Methods: Gestational-age-adjusted concentrations of hCG, hCG-h, PlGF and PAPP-A were analysed in serum samples by time-resolved immunofluorometric assays at 8-13 weeks of gestation. The case-control study included 98 women who developed pre-eclampsia, 25 who developed gestational hypertension, 41 normotensive women with small-for-gestational-age (SGA) infants and 177 controls.

[Pregnancy contraception (Current Care Guideline)].

There are no age limits for the start or use of contraception. Prior gynecological examination or cervical smear is not needed. Condom is the only method that protects from sexually transmitted diseases.

The Salivary Scavenger and Agglutinin (SALSA) in Healthy and Complicated Pregnancy.

Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. The etiology is not clear, but an immune attack towards components of placenta or fetus has been indicated. This involves activation of the complement system in the placenta.

[Update on Current Care Guidelines: Ectopic pregnancy].

Ectopic pregnancy should be suspected it a woman of fertile age has lower abdominal pain and irregular vaginal bleeding. Symptoms range from almost none to shock. The diagnosis is based on a quantitative serum pregnancy test (hCG) and transvaginal ultrasound.

[Current Care Guideline: Eating disorders].

Early diagnosis with intervention is linked to better outcome. In primary care patients in risk for eating disorder should be screened and actively asked about eating disorder symptoms. Treatment is mainly out-patient care and should first be focused on gaining a normal nutritional status.

[How do I evaluate and utilize information provided by observational study].

The strength of observational study is the utilization of large materials in order to evaluate the risk factors and prognosis of disease, rare adverse effects of treatments and their everyday effectiveness. Observational studies are, however, associated with a higher risk of bias as compared with randomized controlled studies. Whereas the effectiveness of individual interventions under ideal conditions must be resolved in randomized studies, the effectiveness of treatment chains under routine healthcare conditions can be assessed only through observational studies.

[Principles and pitfalls of randomized controlled study].

Randomized controlled study is a central tool in the study of the prevention and treatment of diseases and effect of rehabilitation. Whereas prevention of bias resulting from potential differencies in study groups is a great advantage of the randomized study design, pitfalls are also involved in these studies. The task of the reader of the study is to evaluate the validity of the results, their clinical significance and possible applicability to one's own treatment decisions.

Serum hyperglycosylated human chorionic gonadotrophin at 14-17 weeks of gestation does not predict preeclampsia.

Introduction: Low first-trimester serum concentrations of hyperglycosylated human chorionic gonadotrophin (hCG-h) predict later preeclampsia. We studied whether serum hCG-h at 14-17 weeks of pregnancy also predicts preeclampsia alone or combined with placental growth factor (PlGF) and soluble vascular endothelial growth factor 1 (sVEGFR-1).

Methods: We conducted a nested case-control study comprising 55 women with subsequent preeclampsia, 21 with gestational hypertension, 30 with a small-for-gestational-age infant, and 83 controls.

Cost-effectiveness of hysterectomy for benign gynecological conditions: a systematic review.

The objective of this study was to assess the cost-effectiveness of hysterectomy performed for benign indications. Hysterectomy remains the most common major gynecological operation in the Western world. Rates of hysterectomy have not declined as expected with the introduction of new treatment options.

[Update on current care guidelines: ovarian cancer].

Ovarian cancer is the most lethal gynaecological cancer. It appears that seemingly ovarian or primary peritoneal carcinomas, in fact, originate from fimbriae. BRCA1/2 mutation carriers are recommended for the removal of ovaries and fimbriae, to reduce the risk of cancer.

Significant decrease in maternal serum concentrations of angiopoietin-1 and -2 after delivery.

Objective: To characterize the physiological distribution of angiopoietins (Ang)-1 and Ang-2 and soluble endothelial cell-specific tyrosine kinase receptor-2 (Tie-2) at term and following delivery.

Design: A prospective, descriptive study.

Setting: Helsinki University Central Hospital.

Maternal serum angiopoietin-1 and -2 and tie-2 in early pregnancy ending in preeclampsia or intrauterine growth retardation.

Context: The antiangiogenic growth factor angiopoietin-2 (Ang-2) antagonizes, whereas angiopoietin-1 (Ang-1) activates the endothelial cell-specific tyrosine kinase receptor-2 (Tie-2). In preeclampsia, circulating concentrations of Ang-1 are increased and those of Ang-2 and Tie-2 are decreased.

Objective: We wanted to study whether maternal serum concentrations of Ang-1, Ang-2, and Tie-2 are altered at gestational wk 12-15 or 16-20 in women with subsequent preeclampsia or intrauterine growth retardation (IUGR).

Concentrations of vascular endothelial growth factor C and D in amniotic fluid and maternal plasma.

Objective: Vascular endothelial growth factor-C (VEGF-C) and VEGF-D promote both endothelial and lymphatic vascularization during embryonic development. We studied their presence in amniotic fluid (AF) and maternal plasma during pregnancy.

Design: Descriptive study.

Maternal serum endostatin at gestational weeks 16-20 is elevated in subsequent pre-eclampsia but not in intrauterine growth retardation.

Objective: Endostatin, an important anti-angiogenic factor produced by endothelial cells, is elevated in established pre-eclampsia. We measured maternal serum endostatin concentrations in early pregnancy associated with later pre-eclampsia and intrauterine growth retardation (IUGR).

Design: Retrospective case-control study.

Smoking and sVEGFR-1: circulating maternal concentrations and placental expression.

Smoking reduces the expression of VEGFR-1 in non-pregnant women. In pregnant women it reduces the risk of pre-eclampsia, which in turn is associated with increased placental expression of VEGFR-1 and increased maternal circulating soluble VEGFR-1 (sVEGFR-1). We therefore hypothesized that smoking might affect VEGFR-1 expression in pregnant women.

Is serum-soluble vascular endothelial growth factor receptor-1 of importance in unexplained infertility?

Objective: To analyze the role of vascular endothelial growth factor (VEGF) and its naturally occurring circulating antagonist, soluble VEGF receptor-1 (sVEGFR-1), in infertility. VEGF is a key angiogenic factor in the endometrial and ovarian cyclic processes that are crucial for fertility and sVEGFR-1 impairs its function and fertility in animals - less is known as regards human fertility.

Design: Case-control study.

Vascular endothelial growth factor, its receptors, and the tie receptors in the placental bed of women with preeclampsia, diabetes, and intrauterine growth retardation.

Placental bed vascular function is compromised in pregnancies complicated by preeclampsia (PE), intrauterine growth retardation (IUGR), and maternal diabetes mellitus (DM). We performed an immunohistochemical analysis of vascular endothelial growth factor (VEGF), its receptors (VEGFR) -1 and -2, and the Tie-1 and -2 receptors in cryostat tissue sections of the placental bed from healthy women (n = 5) and women with PE (n = 5), IUGR (n = 5), and DM (n = 5). VEGF immunoreactivity was stable between the study groups.