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P Jouppila

Publications and source records attributed to P Jouppila.

At least 37 records · Page 2Linked to original sources
PubMed1999

Transvaginal salpingosonography for assessing tubal patency in women previously treated for pelvic inflammatory disease and benign ovarian tumors.

OBJECTIVE: The aim of this study was to evaluate the role of transvaginal salpingosonography in the assessment of tubal patency among women previously treated conservatively for pelvic inflammatory disease and surgically for a benign ovarian tumor. DESIGN: Twenty-two women were recruited for this study at the University Hospital of Oulu. Transvaginal salpingosonography was scheduled to be performed twice within a 3-month interval. X-ray hysterosalpingography was chosen as a reference method and was performed within 2 days of the second salpingosonography examination during the same menstrual cycle. Altogether, 31 Fallopian tubes were assessed with the second salpingosonography examination and X-ray hysterosalpingography. RESULTS: Twenty-nine Fallopian tubes were observed by both methods to be patent (i.e. 29 tubes by each method, but not necessarily the same tubes). An occlusion was diagnosed by each method in two tubes only, of which one appeared occluded by both methods, while one tube from each method appearing to be occluded was demonstrated to be patent using the other method. The agreement of transvaginal salpingosonography compared with X-ray hysterosalpingography was 94%, the sensitivity 50%, the specificity 97%, the positive predictive value 50% and the negative predictive value 97%. Two successive transvaginal salpingosonography examinations were performed in 18 patients with 27 Fallopian tubes. Disagreement was observed for only one tube. The agreement between these two examinations was 96%, the sensitivity 100%, the specificity 96%, the positive predictive value 67% and the negative predictive value 100%. The kappa coefficient was 0.78 (95% confidence interval 0.75-0.81). CONCLUSIONS: In conclusion, transvaginal salpingosonography can be used in patients with previous pelvic inflammatory disease and adnexal surgery due to its ease of use, reliability and low costs on an out-patient basis. Among these patients, tubal patency was a common finding.

Adult↗
PubMed1998

Perinatal and neonatal outcome and late pulmonary sequelae in infants born after preterm premature rupture of membranes.

OBJECTIVE: To evaluate fetal outcome and long-term impact of very early preterm premature rupture of membranes (PROM). METHODS: In a retrospective cohort study, 78 women with singleton pregnancies who delivered at the Oulu University Central Hospital between 1990 and 1996 and who had early PROM, between the 17th and 30th gestational weeks, were matched with 78 women with spontaneous preterm delivery during the same time (control group). The main outcome measures were maternal morbidity, interval from early PROM to delivery, perinatal and neonatal mortality rates and neonatal morbidity, need for primary and recurrent hospitalization and later pulmonary complications of the infants, and growth and neurologic findings at 1 year of corrected age. RESULTS: The perinatal mortality was 282 per 1000 births in the early PROM group and 256 per 1000 births in the control group. Histopathologically defined chorioamnionitis and puerperal infections were significantly more common in the early PROM group than in controls (51 versus 29%, odds ratio [OR] 2.5, 95% confidence interval [CI] 1.3, 4.9 and 38 versus 22%, OR 2.3, 95% CI 1.1, 5.1, respectively). There were no differences in neonatal infections between groups. Pulmonary hypoplasia was detected more often in the early PROM group (in nine infants) compared with the control group (no infants). The duration of rehospitalization up to 1 year of age due to respiratory problems was a mean of 5 days in the early PROM group and a mean of 1 day in the control group (P = .01; 95% CI 0.9, 6.9). Symptomatic chronic lung disease at 1 year of age was detected more often in the early PROM group than in controls (22 versus 9%; OR 2.4, 95% CI 0.9, 6.5). CONCLUSION: Early PROM seems to be a major obstetric and neonatal problem with pulmonary ramifications extending beyond the neonatal period. However, most of these infants can be saved.

Adolescent↗
PubMed1998

Assessing tubal patency with transvaginal salpingosonography after the reversal of tubal ligation for female sterilization.

The objective of this study was to assess tubal patency using transvaginal salpingosonography (TSSG) among women treated by tubal ligation after sterilization and to compare these results with those obtained using X-ray hysterosalpingography (HSG). Twenty-one healthy women were recruited. Air was used as a contrast medium in TSSG and Omnipaque as a water-soluble contrast medium in the HSG examination. All women underwent at least one TSSG. If the woman did not become pregnant during the follow-up or had a miscarriage or tubal pregnancy, she was re-examined with a second TSSG and the results were compared with those of HSG undertaken during the same menstrual cycle. Because of the high pregnancy rate the final number of patients was reduced to 10. The observed agreement between the two TSSGs was 70%, which was low compared with our earlier results. The kappa coefficient was only 0.41. The sensitivity of TSSG for the detection of tubal occlusion was 54%. This can be explained by the fact that the mean time interval between the two TSSGs was long (5.5 months) and results were not therefore comparable or repeatable. We can conclude that the women with patent tubes became pregnant after the first TSSG while the women taking part in the second TSSG had impaired tubal function. There were more occluded tubes observed in the second TSSG than in the first. An analysis comparing the second TSSG with HSG produced better results. The observed agreement was 84%, kappa coefficient 0.67, demonstrating a good reproducibility of TSSG; the sensitivity of TSSG for the detection of tubal occlusion was 83%, specificity 85%, positive predictive value 91% and negative predictive value 75%. Thus, TSSG should be regarded as a reliable, rapid, safe and inexpensive method for testing tubal patency after reversal of tubal ligation for sterilization. It also allows simultaneous scanning of the uterine corpus, endometrium and ovaries and may have a clearing action on occluded tubes. TSSG can thus replace X-ray HSG in the primary evaluation of tubal status, even in this special group of patients.

Adult↗
PubMed1998

The effect of a levonorgestrel-releasing intrauterine system on uterine artery blood flow, hormone concentrations and ovarian cyst formation in fertile women.

To determine the effect of long-acting intrauterine progestin on the impedance to blood flow in the uterine arteries, we applied a levonorgestrel-releasing (20 microg/day) intrauterine contraceptive system (LNG-IUS) to the uterine cavity of 27 fertile, regularly menstruating women. Measurements were performed using transvaginal colour Doppler ultrasonography in the mid-luteal phase and on day 1 of menstruation in the absence of the LNG-IUS and 3 months later in its presence. The mean (SD) mid-luteal uterine artery pulsatility index (PI) had risen from a pretreatment level of 2.28 (0.48) to 2.70 (0.67) after 3 months use of the LNG-IUS (P < 0.01), but as regards day 1 of menstruation, no change was observed. The increase in the mean PI (SD) at the mid-luteal phase was present only in subjects with serum levonorgestrel concentrations >200 pg/ml (n = 16) [pretreatment, 2.25 (0.47); with LNG-IUS, 2.83 (0.59), P < 0.001], and absent in those with serum levonorgestrel concentrations <200 pg/ml (n = 10) [pretreatment, 2.31 (0.53); with LNG-IUS, 2.51 (0.79), ns]. Mean progesterone concentrations were lower with the LNG-IUS in place in both groups. We conclude that a levonorgestrel-releasing intrauterine device appears to increase the impedance to blood flow in the uterine arteries during the mid-luteal phase in correlation with serum concentrations of LNG and a concomitant decrease in serum progesterone concentrations.

Adult↗
PubMed1998

The effects of a copper-intrauterine device on the uterine artery blood flow in regularly menstruating women.

The aim of the study was to evaluate the effect of a copper-intrauterine device (IUD) on uterine artery blood flow during the midluteal phase and on the first day of the menstrual cycle using pulsed colour Doppler ultrasonography. Twenty-one regularly menstruating women (18-45 years) who were willing to use copper-IUD contraception participated in the study. The patients were first examined without the IUD in the midluteal phase 6-9 days before the expected onset of menstruation and on the first day of menstruation, after which the IUD was inserted. Three months later the patients were examined again on the corresponding cycle days. The patients estimated the level of dysmenorrhoeic pain with a scoring system. Transvaginal ultrasonography with colour flow imaging was used to measure the pulsatility index (PI) in the uterine arteries. There were no significant changes in the uterine artery blood flow after the insertion of the IUD during menstruation or in the midluteal phase. In patients with increased IUD-related pain during menstruation (n = 5), however, there was a decrease in PI (2.87 +/- 0.52 versus 2.41 +/- 0.23, P = 0.05) after IUD insertion. The decrease in the mean PI was present in all five patients. In conclusion, copper-IUD does not induce any major changes in the resistance of the uterine artery blood flow, although during menstruation in patients with increased menstrual pain after IUD insertion there seems to be a decrease in the uterine artery PI.

Adolescent↗
PubMed1998

The effect of diclofenac on uterine artery blood flow resistance during menstruation in patients with and without a copper intrauterine device.

The aim was to evaluate the effect of diclofenac on uterine artery blood flow resistance during the first day of menstruation. A total of 28 regularly menstruating women were examined longitudinally with and without a copper intrauterine contraceptive device (IUD) by transvaginal colour Doppler ultrasonography. The uterine artery pulsatility index (PI) was first measured, after which 50 mg of diclofenac was infused i.v. After 15 min the PI was measured again. The patients evaluated their menstrual pain with a scoring system before and after the diclofenac infusion. The mean PI (SD) during menstruation was significantly lower with the IUD [2.13 (0.43)] than without [2.39 (0.62)], P = 0.05. The mean PI in nine patients who experienced advanced menstrual pain was also lower in the presence of the IUD [2.16 (0.42)] than without it [2.83 (0.78); P < 0.05]. Diclofenac was effective in revealing menstrual pain both with and without the IUD, and reduced the PI in the absence of an IUD [pre-treatment 2.39 (0.62) versus post-treatment 2.12 (0.45); P < 0.001], but had no effect when the IUD was present [pre-treatment 2.13 (0.43) versus post-treatment 2.10 (0.41)]. The results indicate that by inhibiting prostaglandin synthesis one can reduce the resistance to blood flow in the uterine arteries during menstruation. This does not hold true when an IUD is present, however, suggesting that the device might induce the production of vasoactive agents other than prostaglandins in the surrounding tissue.

Adult↗
PubMed1997

Feto-maternal distribution of ropivacaine and bupivacaine after epidural administration for cesarean section.

Ropivacaine is a new amino amide local anesthetic less lipophilic and with a lower affinity for plasma proteins than bupivacaine. The purpose of this study was to examine the feto-maternal distribution of ropivacaine and bupivacaine after epidural administration for cesarean section. Healthy parturients were randomly allocated in a double-blinded manner to receive either 0.5% ropivacaine or 0.5% bupivacaine through a lumbar epidural catheter. The total and free concentrations of ropivacaine and bupivacaine were determined in the maternal and umbilical plasma. The total dose (mg/kg) required for adequate surgical anesthesia and the resulting maximum total concentrations did not differ significantly between ropivacaine and bupivacaine. The free plasma clearance of bupivacaine was higher than that of ropivacaine (7382 vs 3344 ml/min, P = 0.0001). The apparent terminal elimination half-life of ropivacaine was shorter than that of bupivacaine (6.0 vs 8.8 h, P = 0.007). At delivery, the maternal free plasma concentration of ropivacaine was more than twice that of the free concentration of bupivacaine (0.072 vs 0.032 microg/ml, P = 0.002). The free concentration of ropivacaine was about twice that of bupivacaine in the umbilical venous (0.06 vs 0.03 microg/ml, P = 0.001) and umbilical arterial (0.05 vs 0.02 microg/ml, P = 0.007) plasma. The more rapid plasma clearance of bupivacaine compared to ropivacaine, leading to lower maternal plasma concentrations and hence to lower umbilical concentrations at delivery, could be explained by the higher lipid solubility, hence greater distribution volume, of bupivacaine.

Clinical Trial↗
PubMed1997

Intraobserver variation in transvaginal Doppler blood flow measurements in benign ovarian tumors.

Intraobserver variation in transvaginal color Doppler ultrasound measurements in ovarian tumors was evaluated in 20 women selected from a group of patients undergoing surgical exploration for an ovarian lesion. Only those cases who were suspected of having a benign ovarian tumor other than a unilocular simple cyst were recruited. Pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV) and time-averaged maximum velocity (TAMXV) were measured from intratumoral arteries in two repeat ultrasound sessions by the same observer. In each session, only two vessels with optimum Doppler signals were investigated. The repeatability of the measurements was studied by calculation of the within-subjects standard deviation (SD), the value below which the difference between the repeat measurements will lie with a probability of 0.95, the coefficient of variation (CV) and the intraclass correlation coefficient (intra-CC). The CV was 15% for the PI, 13% for the RI, 17% for the PSV and 23% for the TAMXV when the average value from two vessels was used. The corresponding intra-CC values were 0.86, 0.83, 0.96 and 0.90, respectively. In contrast, when a lowest (PI or RI) or a highest (PSV or TAMXV) value was preferred, the CV increased to 25% for the PI, to 18% for the RI, to 28% for the PSV and to 33% for the TAMXV. Similarly, the intra-CC values decreased. All in all, the averaged PI and RI measurements in intratumoral arteries were considered to be reliable. Averaged PSV and TAMXV measurements had high CV figures, raising some doubt as to the consistency of these variables. Averaged index values were more consistent than the extreme (lowest or highest) values.

Adult↗
PubMed1997

Reproducibility of transvaginal Doppler velocimetry measurements in the uterine arteries of postmenopausal women.

Intraobserver and interobserver reproducibility of transvaginal Doppler velocimetry measurements in uterine arteries were assessed by two observers in 20 postmenopausal women. In addition, the agreement between the observers regarding the detection of an ovary as well as the presence or absence of intraovarian arterial blood flow was documented. Pulsatility index (PI), peak systolic velocity (PSV) and time-averaged maximum velocity (TAMV) measurements in uterine arteries were made twice by the same investigator (IJ). Thereafter, the same measurements were made by the second investigator (AT). The agreement in categorical data was studied by using 2 x 2 tables and Cohen's kappa-coefficient. Reproducibility of the Doppler measurements was analyzed by using coefficient of variation, repeatability coefficient, intraclass correlation coefficient, mean differences and limits of agreement. In addition, the 95% confidence interval was calculated as appropriate. There was agreement of 95-100% between the observers with respect to the detection of an ovary in transvaginal scanning. Agreement regarding the presence or absence of intraovarian arterial blood flow, however, was only 75-81%. Intraobserver repeatability was very good, the intraclass correlation coefficient being 0.98-0.99 and the coefficient of variation 6% in PI measurements. The PSV measurements showed an intraclass correlation coefficient of 0.94-0.96 and a coefficient of variation of 10-12%. The intraclass correlation coefficient for TAMV measurements was 0.94 and the coefficient of variation varied from 12 to 16%. Interobserver agreement was good. There was no bias between the observers' measurements. The intraclass correlation coefficient for PI measurements was between 0.93 and 0.95, and the coefficient of variation was 11%. For PSV measurements, the intraclass correlation coefficient was 0.79-0.80 and the coefficient of variation was 18-29%. TAMV measurements showed an intraclass correlation coefficient of 0.83-0.84 and a coefficient of variation of 19-29%. When the limits of agreement for Doppler velocimetry measurements are considered, we expect the two observers to give PI measurements that differ by less than 0.7, with any discrepancy being equally likely in either direction. In conclusion, based on the high intraclass correlation coefficients, the intraobserver repeatability of all Doppler parameters was very good, the most reliable measurement being the PI. Variation in PSV and TAMV measurements increased considerably, however, when Doppler velocimetry was carried out by two investigators instead of one.

Analysis of Variance↗
PubMed1997

Effect of the levonorgestrel-releasing intrauterine system on the uterine artery pulsatility index in postmenopausal hormone replacement therapy.

The aim of this study was to determine the effect of continuous intrauterine release of progestin on the uterine artery pulsatility index (PI) in women on postmenopausal hormone replacement therapy (HRT). The voluntary participants, 13 symptomatic postmenopausal women received transdermal estradiol (50 micrograms/day) for 1 month before combining the levonorgestrel-releasing (20 micrograms/day) intrauterine system (LNG-IUS) with estrogen replacement therapy. The PI of uterine artery blood flow was measured by transvaginal color Doppler ultrasonography before the onset of HRT, 1 month after the treatment with estradiol (estradiol-only phase) and 1, 3 and 6 months after insertion of the LNG-IUS. The mean uterine artery PI decreased significantly from its pretreatment level after 1 month of transdermal estradiol treatment (p < 0.05), but the LNG-IUS induced an increase in PI, and 6 months after its insertion the PI did not differ significantly from the pretreatment level (p > 0.05). Compared with the estradiol-only phase, the last measurement of the PI was significantly increased (p < 0.05). The results suggest that continuous intrauterine release of levonorgestrel abolishes the vasodilatory effect on the uterine arteries accomplished by postmenopausal estradiol treatment.

Drug Delivery Systems↗
PubMed1997

A randomized study comparing air to Echovist as a contrast medium in the assessment of tubal patency in infertile women using transvaginal salpingosonography.

This study was undertaken to compare two different contrast media (air and Echovist) in the assessment of tubal patency using transvaginal salpingosonography (TSSG) in 32 infertile women referred to an infertility outpatient clinic. Altogether, 59 Fallopian tubes were examined with TSSG. Laparoscopic chromopertubation was used as a reference method. In group A (air), concordance was 90%, Cohen's kappa coefficient 0.71 [95% confidence interval (CI): 0.64-0.77], sensitivity 63%, specificity 100%, negative predictive value 88% and positive predictive value 100%. In group B (Echovist), the corresponding parameters were as follows: 93%, 0.71 (CI: 0.67-0.76), 60, 100, 93 and 100% respectively. No statistically significant differences were found between these two contrast media. Either one can reliably be used for assessing tubal patency with TSSG in infertile women as a primary phase examination modality.

Adult↗
PubMed1997

Assessment of tubal patency with transvaginal salpingosonography after treatment for tubal pregnancy.

Tubal patency was studied in 32 patients who had previously undergone a laparoscopic or laparotomy procedure (salpingostomy, salpingectomy or tubal resection), or who had received a local injection of hypertonic glucose because of tubal pregnancy. Transvaginal salpingosonography (TSSG) was subsequently performed in the follicular phase of the menstrual cycle, and laparoscopic chromopertubation was carried out as a comparative method after TSSG. Of 32 patients (47 Fallopian tubes examined), the affected tube was observed to be patent by TSSG in 68%. The contralateral tube was patent in 93%. Nine patients became pregnant and were thus not subsequently assessed with laparoscopy. Two of these pregnancies ended in a miscarriage and one in a recurrent tubal pregnancy. A concordance of 86% for Fallopian tubes was achieved between the TSSG and laparoscopic chromopertubation methods. When checking the Fallopian tubes separately, the concordance for the results in the affected tubes was 67%, and 100% for the contralateral tube. Therefore TSSG appears to be a practical method for the primary examination of tubal patency in patients treated previously for tubal pregnancy. Guidelines for the treatment of infertility after tubal pregnancy can also be set out according to TSSG findings.

Fallopian Tubes↗
PubMed1997

Agreement between two successive transvaginal salpingosonography assessments of tubal patency.

OBJECTIVE: To evaluate the agreement between repeat transvaginal sonographic assessments of tubal patency using a combination of air and saline. MATERIAL AND METHODS: Twenty-nine patients were examined twice by the same investigator (H.S.). There was a three-month interval between the observations, and the investigator was blinded to the results of the first examination. Each patient was evaluated using three categories classified as: 1) bilateral patency, 2) unilateral patency and 3) bilateral occlusion. In addition, the pooled data from individual tubes was examined with respect to the detection of patency or occlusion. Data from the right and left tubes were analyzed separately as well. Agreement between the two examinations was subsequently determined using Cohen's kappa coefficient (kappa). When there were more than two categories, a weighted kappa coefficient was used. RESULTS: There was good (kappa = 0.61) agreement between the two examinations when each patient was evaluated individually. For the pooled data of all tubes (n = 46), the kappa coefficient was 0.53, but increased to 0.66 after correction for prevalence. There was no systematic bias between the successive examinations of tubes. There was more consistency between repeated observations in the right (kappa = 0.70) than in the left (kappa = 0.37) tubes. The prevalence of occlusion was higher in the left tubes. CONCLUSION: Transvaginal salpingosonography was shown to be a reliable method for the assessment of tubal patency.

Fallopian Tube Patency Tests↗
PubMed1997

The clinical significance of an absent end-diastolic velocity in the umbilical artery detected before the 34th week of pregnancy.

BACKGROUND: The aim of this study was to evaluate the clinical significance of absent or reversed (ARED) flow detected in the late second or early third trimester in the umbilical artery in high-risk pregnancies. METHODS: Eighty-three women with hypertensive disorders of pregnancy, gestational diabetes or a suspected disorder of the fetus (e.g. small-for-gestational age) were included in this retrospective study. A constant finding of ARED flow in the umbilical artery was registered with the pulsed Doppler method between the 23+/-0 and 33+/-6 gestational weeks. Perinatal mortality (PNM) rates, Apgar scores and arterial umbilical pH values, birth weights, the frequency of SGA, gestational ages at birth, NICU (=neonatal intensive care unit) days, anomalic fetuses and the mode of delivery were registered. Mann-Whitney U-test and chi-squared test were used for statistical analysis. RESULTS: The PNM in the entire group under study was 19.3% (16 infants/fetuses). The rate of structurally or chromosomally abnormal fetuses was 15.7% (13 infants/fetuses). When anomalic fetuses were excluded the PNM was 18.6%. No non-anomalic fetuses/newborns were lost in cases in which ARED was detected after the 30th week. No statistically significant difference was observed in PNM and SGA frequencies when comparing AEDV (absent end-diastolic velocity) fetuses with those who had REDV (reversed end-diastolic velocity). When anomalic fetuses were excluded the PNM rate in the AEDV group was 8.9% compared with the PNM rate of 35.7% in the REDV group; (p=0.03). CONCLUSIONS: An early ARED finding (before the 34th week) in the umbilical artery signifies a marked warning signal of fetal distress. In these cases the rates of perinatal morbidity and mortality are very high, which is a reflection of the severity of the condition. The majority of fetuses can, however, be saved.

Blood Flow Velocity↗