Natural history of pelvic organ prolapse in postmenopausal women

OBJECTIVE: To describe the natural history of pelvic organ prolapse and risk factors for changes in vaginal descent in older women. METHODS: This 4-year prospective observational study included 259 postmenopausal women with a uterus enrolled at one Women's Health Initiative clinical site who completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations. We calculated 1-year and 3-year incidence and resolution risks for prolapse (defined as maximal vaginal descent to or beyond the hymen) and estimated progression and regression rates (1 cm or greater and 2 cm or greater changes in maximal vaginal descent) and risk factors. RESULTS: Mean age was 68.1+/-5.5 years, and median vaginal parity was 4. Seventy-three (28%) women had four exams, 128 (49%) had three exams, and 58 (22%) had two exams. Prolapse waxed and waned yearly in individual women. Overall 1-year and 3-year prolapse incidences were 26% (95% confidence interval [CI] 20-33%) and 40% (95% CI 26-56%); 1-year and 3-year prolapse resolution risks were 21% (95% CI 11-33%) and 19% (95% CI 7-39%). Rates of any change in maximal vaginal descent over time varied depending on baseline measurements. Over 3 years, the maximal vaginal descent increased by at least 2 cm in 11.0% (95% CI 4.9-20.5%) of the women and decreased by at least 2 cm in 2.7% (95% CI 0.3-9.5%). Increasing body mass index and grand multiparity increased the risk for vaginal descent progression. CONCLUSION: Prolapse progresses and regresses in older women, although rates of vaginal descent progression are slightly greater than regression overall. Obesity is a risk factor for progression in vaginal descent. LEVEL OF EVIDENCE: III.     

Risk factors in Mozambican women with eclampsia: a case-referent study

In Maputo 133 consecutive eclamptic patients were compared with 393 non-eclamptic referent women. Significant risk factors for eclampsia were age < or = 18 years, household size < or = 3 individuals, unwanted pregnancy, walking to antenatal clinics and, in the thrid trimester, headache, foot oedema, hand or face oedema, epigastric pain, visual disturbance, ear buzzing and dizziness. Significantly more cases than referents reported no blood pressure measurements in antenatal clinics. It is concluded that the quality of antenatal clinics can be improved by enhanced community awareness of danger signs, by early recognition of risk factors and by better management of prodromal symptoms of eclampsia.     

Head computed tomographic scans in women with eclampsia

From 1980 to 1986, head computed tomographic scans were performed in 49 women with eclampsia managed according to the standardized regimen used at Parkland Memorial Hospital. Abnormal radiographic findings were seen in 14 (29%). Although this incidence may have been affected by the temporal relationship of the scan to the seizure, it was greatly impacted by technical resolution obtained with succeeding improved equipment. In the last 3 years of the study more than a third of these scans showed some abnormality, and in 1986, using "fourth-generation" equipment, half were abnormal. These areas of radiographic hypodensity correspond to those with petechial hemorrhages and local edema that have been described at autopsy in women who died after eclamptic episodes. All women recovered fully despite ominous findings in some. We conclude that the clinical utility of tomography in women with otherwise "uncomplicated eclampsia" is limited because these findings seldom alter management.     

Counseling for women with preeclampsia or eclampsia

Preconception counseling may address issues such as nutrition, prevention and prediction of preeclampsia, utility of prenatal visits and fetal surveillance, risk of superimposed preeclampsia, recurrence risks for future gestation, diagnosis of underlying predisposing factors, and potential impact on future maternal and fetal health. Although certainty is lacking in medicine, it appears that minimal risk to either mother or fetus is attributable to mild chronic hypertension complicating pregnancy. Increased maternal and fetal morbidity is associated with superimposed preeclampsia. Unfortunately, we are unable to predict which of these gravidas will have superimposed preeclampsia and thus suffer added morbidity. There appears to be a greater than 50% chance of maternal or fetal morbidity for those women entering pregnancy with severe chronic hypertension in association with other renocardiovascular complications. Unfortunately, for the majority of women whose medical condition falls between these two extremes, the current predictive value remains vague. The best option is to review the existing literature with patients in a nondirective manner, allow them their decisions, and provide them the best available prenatal care.     

Human leucocyte antigen status in African women with eclampsia

Summary. Investigation of the HLA system in 53 African eclamptic or imminently eclamptic women showed that they were significantly more likely to be heterozygous at the B locus than were normal controls. This did not apply to the A or D related loci.     

Human leucocyte antigen status in African women with eclampsia

Investigation of the HLA system in 53 African eclamptic or imminently eclamptic women showed that they were significantly more likely to be heterozygous at the B locus than were normal controls. This did not apply to the A or D related loci.     

Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women

OBJECTIVE: To determine the natural history of simple unilocular adnexal cysts in asymptomatic postmenopausal women. METHODS: Eight thousand seven hundred ninety-four asymptomatic postmenopausal women underwent transvaginal ultrasound as part of routine gynecological check-up at our institution between January 1995 and June 2002. All patients in whom a simple unilocular adnexal cyst was found out were offered surgical treatment or conservative follow-up with serial transvaginal ultrasound at 6-month intervals. In all these cases, serum CA-125 levels was determined. RESULTS: Two hundred twenty-three simple adnexal cysts in 215 women were found out (prevalence: 2.5%). Annual incidence did not change significantly. Sixty-six (30.6%) women were lost after initial diagnosis. One hundred and forty-nine patients with 153 cysts were entered ultimately in the study. Forty-five (30%) underwent surgery (34 after initial diagnosis and 11 during follow-up). A total of 49 cysts were removed. The most frequent histological diagnosis was serous cystadenoma (84%). There was a case of a stage IA ovarian carcinoma (2% of the cysts removed, 0.6% of all the cysts included in the study). One hundred and four patients with 104 cysts underwent conservative follow-up throughout the study period. Forty-six (44%) of these cysts resolved spontaneously (74% of them within 2 years). In 14 (30%) of these women, a new cyst was diagnosed when follow-up went on. In 58 patients, cysts persisted during all study period (median follow-up: 48 months, range: 6-90 months), 69.6% of them remained unchanged, 17.2% increased, and 17.2% decreased. Patients in whom cysts resolved spontaneously had a shorter menopausal time (P=0.001) and tend to be younger (P=0.06). No differences were found regarding cysts' features. CONCLUSION: The risk of malignancy of simple adnexal cysts in asymptomatic postmenopausal women is low. Almost half of them will resolve spontaneously during follow-up. Most of those that persist remain unchanged. Asymptomatic postmenopausal women having simple adnexal cysts can be managed conservatively with a very reasonable degree of reassurance.     

Genital bacteriology: a comparative study of premenopausal women with postmenopausal women.

Premenopausal women are reportedly at a higher risk than postmenopausal women of postoperative infection following vaginal hysterectomy. A study was designed to determine whether a relationship exists between bacterial flora and patient age that may explain the difference in the risk of postoperative infection. No statistically significant difference was found in the number or type of bacterial species isolated from the cervix or vagina of premenopausal and postmenopausal women. Postmenopausal women on a regimen of conjugated estrogens had genital flora similar to that of the other women studied.     

Estrogenization in women with postmenopausal ovarian hyperthecosis

The cases of two women who show postmenopausal bleeding and signs of endogenous estrogen production are presented. At laparotomy, ovarian hyperthecosis was found and confirmed histologically. Determination of 17 beta-estradiol concentrations in ovarian and peripheral veins suggested that these ovaries actively secreted excessive estrogens. Ovarian hyperthecosis is discussed as a cause of renewed endogenous estrogen activity in the postmenopausal women.     

Raloxifene in postmenopausal women

Since the diffusion of the WHI's trial and MWS results, which reported a negative risk/benefit balance of hormone therapy, the management of postmenopausal women has deeply changed over the last 2-3 years. In particular, for the prevention of osteoporosis, the use of other efficient agents tends now to be more widely recommended rather than estrogens. The SERMs with raloxifene are new molecules that have estrogen agonist effects on bone and estrogen antagonist or neutral effects on endometrial and breast tissue. The efficacy of raloxifene to inhibit postmenopausal bone loss as well as to reduce the incidence of vertebral fractures has been demonstrated in women at high risk for osteoporosis through a large randomized placebo-controlled trial involving several thousands of postmenopausal women (MORE trial). Furthermore, the extraskeletal effects of raloxifene might represent an advantage for a global management approach of postmenopausal women, although to date, its exclusive indication is namely the prevention of osteoporosis. However, the estrogen antagonist effects of raloxifene on breast tissue as well as its good safety profile with regard to both the endometrium and the risk of heart diseases are likely to make raloxifene of particular interest for women around the age of 60 years old. Adverse events associated with raloxifene only included an increase in the absolute risk of venous thromboembolism in a comparable manner as with estrogen therapy. Also, its lack of efficacy in reducing hot flushes or preventing vaginal dryness may limit its use in young symptomatic postmenopausal women. Also, its lack of reimbursement in women with no prior fragility fracture must be taken into account.     

Factors associated with quality of life in a cohort of postmenopausal women

Objective.?To evaluate quality of life (QOL) and identify its associated factors in a cohort of postmenopausal women who had not received hormone therapy.

Methods.?A cross-sectional study was conducted among 81 postmenopausal women who had not used hormone therapy in the last six months. Sociodemographic and clinical characteristics, in addition to the prevalence of menopausal symptoms, were evaluated. QOL was assessed by the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire, which may be condensed into two summaries: Physical Component Summary and Mental Component Summary. Generalized linear models were used to analyze the data, allowing the identification of factors affecting QOL, adjusting for confounding variables.

Results.?The mean (±standard deviation) age of the participants was 58.1 ± 4.7 years. The most prevalent symptoms were nervousness (67%) and hot flushes and sweating (51%). Factors associated with poorer QOL were sweating, palpitations, nervousness (physical component), and dizziness, nervousness, depression, insomnia and dyspareunia (mental component).

Conclusion.?We observed that menopausal symptoms negatively affected the physical and mental components of QOL in postmenopausal women.     

Magnesium sulfate compared with lytic cocktail for women with eclampsia.

OBJECTIVE: To compare magnesium sulfate with lytic cocktail for the treatment of eclampsia. METHODS: The register of trials kept by the Cochrane Pregnancy and Childbirth Group and the Cochrane Controlled Trials Register were searched for randomized trials comparing magnesium sulfate with lytic cocktail for the treatment of eclampsia. RESULTS: Two studies were included (a total of 199 women). Magnesium sulfate was more effective than lytic cocktail at preventing further convulsions [relative risk (RR) 0.09, 95% confidence interval (C.I.)=0.03-0.24; risk difference=0.43, 95% C.I.=-0.53 to -0.34; number needed to treat=3, 95% C.I.=2-3) and was associated with less respiratory depression (RR=0.12, 95% C.I.=0.02-0.91) and fewer baby deaths (RR=0.26, 95% C.I.=0.26-0.79). There were non-significantly fewer maternal deaths associated with magnesium sulfate (RR=0.25, 95% C.I.=0.04-1.43). CONCLUSIONS: Magnesium sulfate is the anticonvulsant of choice for eclampsia. Lytic cocktail should be abandoned.