[Eclampsia in Finland 1990-94].
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Eclampsia↗
Biomedical subjects
R Erkkola
Publications and source records attributed to R Erkkola.
When does estrogen replacement therapy improve sleep quality?
OBJECTIVE: Our purpose was to evaluate the effect of estrogen replacement therapy on sleep complaints by postmenopausal women and to assess the predictive factors involved. STUDY DESIGN: Sixty-three postmenopausal women entered a 7-month prospective, randomized, double-blind, crossover study consisting of two 3-month treatments with estrogen and placebo with a 1-month washout period between. Eight Visual Analogic Scale statements about different sleep complaints, the Basic Nordic Sleep Questionnaire, scoring of climacteric symptoms, The Beck Depression Inventory, and serum estradiol and follicle-stimulating hormone level controls were the main outcome measures. RESULTS: Estrogen replacement therapy improved sleep quality, facilitated falling asleep, and decreased nocturnal restlessness and awakenings (p < 0.001). The subjects were less tired in the mornings and in the daytime (p < 0.001) when taking estrogen replacement therapy. Estrogen-induced sleep improvement was associated with alleviation of vasomotor symptoms (r range 0.27 to 0.55), alleviation of somatic symptoms (palpitations and muscular pain, r range 0.26 to 0.36), and alleviation of mood symptoms (r range 0.28 to 0.37) on estrogen replacement therapy. The severity of initial insomnia predicted only one estrogen-induced sleep improvement effect: the more the subjects experienced insomnia, the better the estrogen replacement therapy facilitated falling asleep (r = 0.26, p = 0.040). Estrogen-induced sleep improvement was also reported by the 15 climacterically asymptomatic subjects. In these subjects initial insomnia scores strongly predicted estrogen-induced sleep improvement (r range 0.50 to 0.75). CONCLUSIONS: Estrogen replacement therapy significantly diminished sleep complaints among postmenopausal women. Alleviation of climacteric symptoms was the most important predictive factor for the beneficial effect of estrogen replacement therapy on sleep complaints. The use of estrogen replacement therapy in women without self-reported climacteric symptoms could also be considered because women do not always recognize their climacteric symptoms or they ignore them.
Climacteric↗
The effect of short-term estrogen replacement therapy on cognition: a randomized, double-blind, cross-over trial in postmenopausal women.
OBJECTIVE: To evaluate the effect of estrogen replacement therapy on cognitive functioning. METHODS: The study consisted of two 3-month treatment periods, one with estrogen and one with the placebo, in random order, separated by a 1-month wash-out period. The study group comprised 70 healthy postmenopausal women, aged 47-65 years, with previous hysterectomy. Sixty-two women completed the study. Cognitive speed and accuracy, attention, and memory were evaluated. Serum estradiol (E2) and FSH levels were controlled at the end of the estrogen, placebo, and wash-out periods. RESULTS: Most of the cognitive tests correlated with age: older women were slower and made more errors than younger women. Estrogen replacement therapy was not superior to the placebo in any test of cognitive performance. In two out of ten visual detection tasks, recognition thresholds were longer with estrogen than with the placebo (P < .001 and P = .004). On the most demanding test of working memory, the reaction times (P = .045) and error rates (P = .043) differed between treatments, yet this finding proved to be an effect of learning rather than treatment. There was no correlation between cognitive performance and serum E2 levels. CONCLUSION: Cognitive performance decreased with age. Short-term estrogen replacement therapy did not provide any advantage over the placebo in terms of improving the performance.
Aged↗
[IPre-eclampsia is a disease of placenta].
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Cell Adhesion Molecules↗
Climacteric symptoms do not impair cognitive performances in postmenopause.
OBJECTIVE: To investigate whether information processing and attention performances are affected by climacteric vasomotor symptoms. METHODS: The study group comprised 66 healthy hysterectomized postmenopausal women. The subjects were divided into two subgroups (high symptomatic and low symptomatic) according to the quantity of climacteric vasomotor symptoms. Information processing was examined using CogniSpeed, a reaction time software that separates, for example, pure controlled processing and working memory from perceptual and motor components. Attention was examined by using visual and auditory tasks. The role of climacteric depression as a determinant of cognitive performance was evaluated by the Beck Depression Inventory and dividing subjects according to self-reported climacteric mood symptoms. The effects of serum oestrogen level and ageing on cognitive performances were also studied. RESULTS: Cognitive performances were similar in high symptomatic and low symptomatic women. On the Verification test younger women had shorter reaction times (P = 0.002) and on the Subtraction test they had fewer errors (P = 0.015) than older women. These tests required working memory and decision making. Accuracy in the tests of sustained and auditory attention worsened slightly with age. Cognitive performances neither correlated with scores on the Beck Depression scale nor with serum oestrogen level. Climacteric mood symptoms did not impair cognitive performance. CONCLUSIONS: Despite subjective complaints of memory impairment in association with climacteric vasomotor symptoms, our results did not support a direct cause-and-effect relationship. Thus, the minor deficits found in cognitive processing efficiency seem to be related rather to age than climacteric symptoms.
Aging↗
Pregnancy in endurance athletes.
The purpose of the present study was to examine pregnancy and delivery among Finnish endurance athletes at the national top level. A questionnaire concerning first pregnancy was sent to 30 Finnish endurance athletes who had been at national top level in cross-country skiing, running, speed-skating or orienteering. Data on labour were collected retrospectively through a questionnaire and from the diaries in the hospital concerned. The next primipara in the diaries formed a member of the control group. Twenty-three athletes (77%) had regular menstrual cycles, seven (23%) had irregularities, and four of them had received hormonal treatment for this. Seven athletes (23%) had experienced spontaneous abortion during the first trimester in previous pregnancy. Sixteen (53%) did not notice any change in their exercise performance, three (10%) subjectively felt themselves to be in a better physical condition, and seven (23%) felt themselves to be in a worse condition than before the pregnancy. Four did not respond on the question. After delivery, 18 athletes continued to compete, the median interval being 8.2 months (range 2-24 months). Two of them (11%) achieved a better condition than before the pregnancy, 11 (61%) reached the same level and five (28%) did not achieve the same performance level. There were no significant differences in labour parameters between the athletes and controls. Endurance training had no harmful side-effects on the pregnancies or deliveries of the athletes. The effect of pregnancy on exercise performance is individual.
Adult↗
European Community Multicentre Trial "Fetal ECG Analysis During Labour": the P-R interval.
The aim of the European Community Multicentre Trial on Fetal ECG Analysis During Labour was to collect a clinical database of electrocardiograms on which the different patterns of ST waveform and time interval changes, so far identified, could be studied. The aim of this paper was to study the PR-RR relationship and the P wave patterns during normal labour. One thousand three hundred fifty accelerations and 350 decelerations were analysed in 618 labours, all with normal fetal outcome. All ECGs were recorded with the STAN recorder and linked to a PC system for data acquisition and analysis. A positive relationship between P-R and R-R intervals was identified in all reactive fetal heart rate traces. A P-R shortening was identified also with all decelerations of more than 40 bpm from the baseline, resulting in a negative PR-RR relationship. Experimental works have described a P-R shortening concurrent with the maximal R-R lengthening during acutely induced hypoxemia in fetal lambs. In our study normal cord acid-base status indicated that the majority of bradycardia episodes recorded were not related to acute hypoxemia: PR-RR relationship changes seem therefore to indicate an intact physiological fetal heart adaptive response to rapid change in the environment of either hypoxemic or haemodynamic origin. A negative PR-RR relationship by itself seems to be nothing more than an indicator of decelerations during labour and seems unable to discriminate between decelerations of different origin. Finally the P wave was no longer detectable during decelerations of more than 800 msec: in this situation the P-R interval can not be reliably measured.
Electrocardiography↗
[Magnesium sulphate in the treatment of severe preeclampsia].
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Adult↗
[Why women still die when giving birth?].
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Cause of Death↗
[Indication for sterilization].
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Family Planning Services↗
Can pre-eclampsia be predicted and prevented?
Pre-eclampsia is still a condition which worldwide kills many mothers and is the cause of a great number of perinatal deaths and one of the leading causes of perinatal morbidity even in developed countries. The definition of pre-eclampsia still varies in the literature, thus making the comparison of results difficult and the issue obscure. Nevertheless, recent advances in research into the pathophysiology of pre-eclampsia has greatly enhanced our understanding of his condition. Therefore, new strategies to predict and prevent this disorder are sought for and emerging.
Female↗
Female menopause, hormone replacement therapy, and cognitive processes.
OBJECTIVES: To give definitions of and to describe the research techniques for cognitive functions. Further, to describe the effect of female aging and hormone replacement therapy on cognitive functions. METHODS: Literature search of pertinent publications and description of initial steps of own research projects. CONCLUSIONS: Effect of aging and hormone replacement therapy on cognitive functions has been researched very insufficiently, and with conflicting conclusions. The best available information suggests that hormone replacement therapy might bring about considerable benefit in this regard, and be of advantage even in trying to prevent senile dementia.
Adult↗
Serum free testosterone in polycystic ovary syndrome measured with a new reference method.
OBJECTIVE: To quantify the actual serum free T with a specific new reference method in women with polycystic ovary syndrome (PCOS) and to analyze the effects of serum free T, total T, and the T:sex hormone-binding globulin (SHBG) ratio on the diagnosis of PCOS. SETTING: Outpatient clinic of reproductive endocrinology at Turku University Central Hospital, Turku, Finland. PATIENTS: Forty-four oligomenorrheic women with PCOS and 26 weight-matched control women with regular menstrual cycles. MAIN OUTCOME MEASURES: The concentrations of free T, total T, androstenedione (A), LH, FSH, SHBG, and insulin in serum. RESULTS: The mean concentrations of free T, total T, A, and LH as well as the LH:FSH and T:SHBG ratios were higher, whereas the mean concentrations of FSH was lower in the women with PCOS than in healthy women. No differences were found in the free T, total T, or T:SHBG levels or in the body mass indexes (BMIs) between the hirsute (n=26) and nonhirsute (n = 18) women with PCOS. Both elevated free T concentrations and high T:SHBG ratios were associated with obesity, but serum total T was independent of BMI. The serum free T measurement discriminated PCOS women from controls to a similar extent as total T and T:SHBG ratio as judged by a receiver operating characteristics analysis. CONCLUSIONS: The present data indicate that determination of free T provides little additional information in the diagnosis of hirsutism or PCOS and does not have to be included to the basic evaluation of these patients. Only half of women with PCOS exhibited elevated serum free T concentrations.
Adolescent↗
Optimal use of hormone determinations in the biochemical diagnosis of the polycystic ovary syndrome.
OBJECTIVE: To investigate, using logistic regression analysis and receiver operator characteristic analysis, the biochemical diagnosis of polycystic ovary syndrome (PCOS) and if it could be improved by using an array of hormone measurements chosen to yield optimal and cost-effective discrimination between women with PCOS and healthy women. DESIGN: Retrospective clinical study. SETTING: Outpatient clinic of reproductive endocrinology at Turku University Central Hospital, Turku, Finland. PATIENTS: Fifty-four oligomenorrheic women with PCOS diagnosed by ovarian ultrasonography, and 29 healthy regularly menstruating women with normal ovarian morphology. MAIN OUTCOME MEASURES: Concentrations of LH, FSH, androstenedione (A), T, and sex hormone-binding globulin in serum. RESULTS: Luteinizing hormone, FSH and A, when used in combination, were the hormonal analytes of highest clinical utility. Diagnostic sensitivity, specificity, and overall concordance of 98%, 93%, and 96%, respectively, were attained. Each of the analytes used alone yielded lower degree of discrimination. CONCLUSIONS: Simultaneous use of the levels of LH, FSH, and A in serum can be used effectively for classification between women with PCOS and healthy women.
Adolescent↗
Controversies: selective vaginal delivery for breech presentation.
Within two last decades many centers have adopted a policy of abdominal delivery, in particular of nulliparous women with breech presentations. In this review of the literature the justification for this policy is questioned. Instead, a recommendation for judicious attempts of vaginal delivery for some breech presentations is emphasized. The maternal complication rates associated with Cesarean deliveries are remarkable higher than those of vaginal deliveries. The list of contraindications to vaginal breech delivery include: feto-pelvic disproportion, hyperextension of the fetal head, umbilical cord presentation, objection on the part of the mother. Relative contraindications include a fetal weight of less than 1500 g, footling presentation, and premature rupture of membranes with a unripe cervix. Overall meta-analysis of the literature gives as neonatal mortality and morbidity rate which is 4 times higher after vaginal breech delivery than after Cesarean delivery. The majority of the studies are non-randomized, comparative and descriptive. In two randomized studies of term breeches, no differences in neonatal outcome was found when Cesarean deliveries were compared to vaginal deliveries. A universal policy of Cesarean delivery of breech presentations may lead to unnecessary maternal complications without any benefit to the fetus or newborn. It is reasonable to assume that about 40% of breech presentations could be delivered vaginally without endangering the neonatal outcome.
Breech Presentation↗
Influence of oral contraceptive use on lipoprotein (a) and other coronary heart disease risk factors.
We have studied the influence of oral contraceptive use on lipoprotein (a) levels in a cohort of women aged 18, 21 and 24 years (n = 559). Data was available on oral contraceptive formulation and dosage, anthropometric variables, exercise, serum lipoprotein (a), insulin, lipid and apolipoprotein levels. Lipoprotein (a) was determined by radioimmunoassay. Differences were assessed with non-parametric statistical methods. Forty per cent of the study women used oral contraceptives. The use of desogestrel-containing monophasic preparations was associated with lower levels of lipoprotein (a) compared to triphasic/levonorgestrel formulations or to non-users (P = 0.005). This effect was seen only in non-smoking women. Oral contraceptive users had higher levels of serum apolipoprotein B, HDL3-cholesterol, apolipoprotein A-I, triglycerides and systolic blood pressure, and lower serum lecithin:cholesterol acyltransferase activity. Lifestyle factors (smoking, exercise) showed no significant influence on lipoprotein levels. In conclusion, the use of desogestrel-containing oral contraceptives has a marked lowering effect on lipoprotein levels. Prospective studies will be needed to assess the net influence of oral contraceptive use on cardiovascular health.
Adolescent↗
Serum total renin is elevated in women with polycystic ovarian syndrome.
OBJECTIVE: To examine the serum total renin in women with polycystic ovarian syndrome (PCOS) and in controls. SETTING: Outpatient clinic of reproductive endocrinology at Turku University Central Hospital, Turku, Finland. PATIENTS: Forty-four oligomenorrheic women with PCOS (body mass index [BMI] 18.0 to 49.0 kg/m2) and 25 control women with regular menstrual cycles (BMI 18.0 to 53.5 kg/m2). MAIN OUTCOME MEASURES: The concentrations of total renin, LH, FSH, T, androstenedione (A), sex hormone-binding globulin (SHBG), and insulin in serum. RESULTS: The concentration of total renin in serum was higher in PCOS women than in healthy women independently of BMI, age, or serum insulin. The serum total renin measurement discriminated PCOS patients and control women to a similar extent as the previously used hormonal parameters (LH:FSH, T, A, and T:SHBG) as judged by receiver-operating characteristic analysis. Positive correlations were found between the serum total renin level and LH concentration, LH:FSH ratio, T and A levels, and T:SHBG ratio. Analysis of serum total renin in PCOS patients during oligomenorrhea and after menstruation did not reveal any significant changes. CONCLUSIONS: The elevated concentration of serum total renin suggests an enhanced activity of ovarian renin-angiotensin system in PCOS. The determination of serum total renin may provide a novel tool in the diagnostics of PCOS, because its serum level is elevated in PCOS women independently of BMI and serum insulin.
Adult↗
Comparison of cardiovascular reflex tests and blood pressure measurement in prediction of pregnancy-induced hypertension.
A changed pressor response to some cardiovascular reflex tests and an increase in midtrimester blood pressure has been reported to precede the appearance of hypertension in pregnancy-induced hypertensive disorders (PIH). In order to compare the value of midtrimester blood pressure with the cardiovascular reflex tests, in predicting the risk of PIH, the Valsalva manoeuvre, the orthostatic test, the deep breathing test and the isometric handgrip test were performed prospectively in 94 women studied once at 21-29 weeks of pregnancy. Eight subjects developed PIH 3-12 weeks after the testing. The resting blood pressure in midpregnancy was related to PIH later in pregnancy. The most powerful measures were the supine diastolic resting blood pressure (odds ratio, 1.24; 95% confidence limits, 1.08-1.43) and the mean arterial pressure (odds ratio, 1.25; 95% confidence limits, 1.09-1.44). Signs of autonomic dysfunction were found in 37% of the patients developing PIH and in 8% of the healthy remaining subjects (P = 0.04). The results show that the preclinical stage of PIH is associated with some changes in the neural hemodynamic control. However, cardiovascular reflex tests do not add much information on the risk of PIH compared with measuring of the resting blood pressure during mid-pregnancy.
Adult↗