Br J Obstet Gynaecol

The prevalence of chronic pelvic pain in women in the United Kingdom: a systematic review.

Zondervan KT. Yudkin PL. Vessey MP. Dawes MG. Barlow DH. Kennedy SH.
Department of Public Health, University of Oxford, UK.
OBJECTIVE: To obtain a prevalence estimate for chronic pelvic pain in women in the United Kingdom by analysing published data. DESIGN: Systematic review of published papers. SETTING: The general population or hospitals in the United Kingdom. POPULATION: Women participating in relevant community surveys or control women participating in hospital-based studies. METHODS: Papers were retrieved by systematically searching the databases MEDLINE, EMBASE and PsycLit, and by hand searching. Studies were included if they 1. were community-based and reported prevalence rates of chronic pelvic pain, dyspareunia, dysmenorrhoea, or abdominal pain, or 2. referred to a clinical population but reported prevalence rates in a disease-free control group. MAIN OUTCOME MEASURES: Prevalence rates for chronic pelvic pain including any overlap with dyspareunia, dysmenorrhoea and abdominal pain. RESULTS: No community-based study has been performed that provides an estimate of the prevalence of chronic pelvic pain in the general UK population. A rate of 39% was reported in women undergoing laparoscopy for sterilisation or investigation of infertility in the single study from the United Kingdom investigating chronic pelvic pain unrelated to menstruation or intercourse. Prevalence rates for dyspareunia, dysmenorrhoea, and abdominal pain found in UK community-based studies were 8%, 45% to 97%, and 23% to 29%, respectively, but definitions used varied greatly. CONCLUSIONS: Because chronic pelvic pain can reduce the quality of life and general wellbeing, there is a need for a community-based study into the prevalence of chronic pelvic pain and its effect upon the lives of women in the UK.

Increase in incidence of gastroschisis in the south west of England in 1995.

Year 1998
Penman DG. Fisher RM. Noblett HR. Soothill PW.
Fetal Medicine Research Unit, University of Bristol, St. Michael's Hospital, UK.
OBJECTIVE: To describe the incidence of gastroschisis and to identify possible aetiological factors. DESIGN: A retrospective case review study. SETTING: The South West Region of England. POPULATION: All known cases of gastroschisis were identified from the regional fetal medicine, ultrasound, pathology and neonatal surgery, databases. Datasets to be collected were agreed prospectively and included demographic, past medical, family and obstetric information for all pregnancies conceived between January 1987 and December 1995. RESULTS: In the first eight years the incidence was 1.6/10,000 but in 1995 a highly statistically significant rise to 4.4/10,000 was found (P = 0.0009). The increased incidence was not associated with changes in maternal age, proportion of primigravidae, use of tobacco or illicit drugs, conception while taking the oral contraceptive pill, or an increase in the number of teenage pregnancies. The median maternal age at last menstrual period for pregnancies with gastroschisis was 20.4 years which was much younger than the national average of 28 years. Thirty-seven percent of these conceptions occurred during the first quarter of the year compared with the expected 25%. CONCLUSIONS: The incidence of gastroschisis has risen to a higher level than previously reported which, despite a marked association with young maternal age at conception, is not due to an increase in the teenage pregnancy rate. As the average length of inpatient stay in the neonatal intensive care unit for cases with this malformation is approximately four weeks, the rise has considerable cost implications. The increasing incidence may also offer opportunities to determine the cause of gastroschisis.

Incidence of urinary incontinence and constipation during pregnancy and postpartum: survey of current findings at the Rotunda Lying-In Hospital.

Year 1998
Marshall K. Thompson KA. Walsh DM. Baxter GD.
Rotunda Lying In Hospital, Dublin, Republic of Ireland.
OBJECTIVE: To assess the impact of pregnancy upon continence and constipation. DESIGN: A questionnaire survey. SETTING: Maternity wards in the Rotunda Lying In Hospital, Dublin, Republic of Ireland. POPULATION: 7771 women who were delivered of liveborn infants. METHODS: Questionnaires were delivered and collected by physiotherapy staff as part of routine postnatal care. RESULTS: Analysis of data using chi2 tests showed significant differences between three parity groups [primigravidae, multigravidae (2-4) and multigravidae (5+)] for symptoms of both urinary incontinence (chi2 = 119.54, df = 2, P = 0.000) and constipation (chi2 = 12.53, df = 3, P = 0.002); the incidence of both constipation and urinary incontinence increased with parity. CONCLUSION: The results of this survey have emphasised the relation between parity and postpartum incontinence which stresses the importance of early diagnosis and intervention.

A comparative study using two dose regimens (200 microg or 400 microg) of vaginal misoprostol for pre-operative cervical dilatation in first trimester nulliparae.

Year 1998
Fong YF. Singh K. Prasad RN.
Department of Obstetrics and Gynaecology, National University Hospital, Singapore.
OBJECTIVE: To determine the optimal dosage and dosing interval for the use of misoprostol administered vaginally for pre-operative cervical dilatation. DESIGN: Prospective double-blind randomised study. SETTING: Fertility Control Centre, National University Hospital, Singapore. METHODS: Women were randomly allocated to either the 200 microg or the 400 microg misoprostol group. Vacuum aspiration was performed at either three or four hours after the insertion of misoprostol tablets. Using Hegar's dilatator, degree of cervical dilatation before operation was measured. Other parameters assessed included the amount of additional dilatation required (if it was < Hegar 8), pre-operative and intra-operative blood loss, and associated side effects. RESULTS: For the 200 microg misoprostol group, only seven (23.3%) achieved a dilatation of > or = 8 mm compared with 29 women (96.7%) in the 400 microg misoprostol group. The odds ratio was 95.3 (95% CI 10.9-830.9) for 400 microg misoprostol for successful pre-operative cervical dilatation of > or = 8 mm. The mean cervical dilatation for 400 microg and 200 microg misoprostol was 8.2 mm and 6.4 mm, respectively (P < 0.001). The use of 400 microg misoprostol with an evacuation interval of three hours appears to be the optimal dosage and evacuation time interval. Increasing the time interval beyond three hours did not confer any additional advantage on the rate of successful cervical dilatation but was instead associated with an increase in side effects such as vaginal bleeding, lower abdominal pain and the appearance of products of conception at the cervical os. However, besides vaginal bleeding, no significant differences in the frequency of these side effects were demonstrated. CONCLUSION: This first report on the comparison of differing dosages and time intervals to determine the optimal dosage treatment schedule shows that the vaginal application of 400 microg misoprostol for at least three hours is optimal for pre-operative cervical dilatation before vacuum aspiration in first trimester nulliparae.