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OBJECTIVE: To compare the impact of 1000 microg of self-administered vaginal misoprostol versus self-administered vaginal placebo on preoperative cervical ripening after 2 weeks of pretreatment with estradiol vaginal tablets in postmenopausal women prior to day-care operative hysteroscopy. DESIGN: Randomised, double-blind, placebo-controlled sequential trial. SETTING: Norwegian university teaching hospital. POPULATION: Sixty-seven postmenopausal women referred for day-care operative hysteroscopy. METHODS: The women were randomised to receive either 1000 microg of self-administered vaginal misoprostol or self-administered vaginal placebo on the evening before day-care operative hysteroscopy. All women had administered a 25-microg vaginal estradiol tablet daily for 14 days prior to the operation. PRIMARY OUTCOME: preoperative cervical dilatation at hysteroscopy. SECONDARY OUTCOMES: difference in dilatation at recruitment and before hysteroscopy, number of women who achieved a preoperative cervical dilatation of 5 mm or more, acceptability, complications and adverse effects. RESULTS: The mean cervical dilatation was 5.7 mm (SD, 1.6 mm) in the misoprostol group and 4.7 mm (SD, 1.5 mm) in the placebo group, the mean difference in cervical dilatation being 1.0 mm (95% CI, 0.2-1.7 mm). Self-administered vaginal misoprostol of 1000 microg at home on the evening before day-care hysteroscopy is safe and highly acceptable, although a small proportion of women experienced lower abdominal pain. CONCLUSIONS: One thousand micrograms of self-administered vaginal misoprostol, 12 hours prior to day-care hysteroscopy, after 14 days of pretreatment with vaginal estradiol, has a significant cervical ripening effect compared with placebo in postmenopausal women.

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OBJECTIVE: To compare the impact of 1000 micrograms of self-administered vaginal misoprostol versus self-administered vaginal placebo on preoperative cervical ripening after pre-treatment with estradiol vaginal tablets at home in postmenopausal women prior to day-care operative hysteroscopy. DESIGN: Randomised double-blind placebo-controlled sequential trial. The boundaries for the sequential trial were calculated on the primary outcomes of a difference of cervical dilatation > or = 1 millimetre, with the assumption of a type 1 error of 0.05 and a power of 0.95. SETTING: Norwegian university teaching hospital. POPULATION: Postmenopausal women referred for day-care operative hysteroscopy. METHODS: The women were randomised to either 1000 micrograms of self-administered vaginal misoprostol or self-administered vaginal placebo the evening before day-care operative hysteroscopy. All women had administered a 25-microgram vaginal estradiol tablet daily for 14 days prior to the operation. MAIN OUTCOME MEASURES: Preoperative cervical dilatation (difference between misoprostol and placebo group, primary outcome), difference in dilatation before and after administration of misoprostol or placebo, number of women who achieve a preoperative cervical dilatation > or = 5 millimetres, acceptability, complications and side effects (secondary outcomes). RESULTS: Intra-operative findings and distribution of cervical dilatation in the two treatment groups: values are given as median (range) or n (%). Difference in dilatation before and after administration of misoprostol and placebo: values are given as median (range) of intraindividual differences. Percentage of women who achieve a cervical dilatation of > or = 5 mm, percentage of women who were difficult to dilate. Acceptability in the two treatment groups: values are given as completely acceptable n (%), fairly acceptable n (%), fairly unacceptable n (%), completely unacceptable n (%). Pain in the two treatment groups: pain was measured with a visual analogue scale ranging from 0 (no pain) to 10 (unbearable pain): values are given as median (range). Occurrence of side effects in the two treatment groups. Values are given as n (%). Complications given as n (%). FUNDING SOURCES: No pharmaceutical company was involved in this study. A research grant from the regional research board of Northern Norway has been awarded to finance Dr K.S.O.'s leave from Hammerfest hospital as well as travel expenses between Hammerfest and Oslo, and research courses. The research grant from Prof B.I.N. (Helse Øst) funded the purchase of estradiol tablets, the manufacturing costs of misoprostol and placebo capsules from the hospital pharmacy, as well as the costs incurred for preparing the randomisation schedule and distribution of containers containing capsules to hospital. Prof B.I.N.'s research grant also funded insurance for the study participants. CONCLUSIONS: Estimated completion date 31 December 2008.

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OBJECTIVE: To compare the impact of 1000 micrograms of self-administered vaginal misoprostol versus self-administered vaginal placebo at home on preoperative cervical ripening in both premenopausal and postmenopausal women before operative hysteroscopy. DESIGN: Two separate but identical parallel, randomised, double-blind, placebo-controlled sequential trials, one in premenopausal women and one in postmenopausal women. The boundaries for the sequential trials were calculated on the primary outcomes of a difference of cervical dilatation > or = 1 mm, with the assumption of a type 1 error of 0.05 and a power of 0.95. SETTING: Norwegian university teaching hospital. SAMPLE: Eighty-six women referred to outpatient operative hysteroscopy. METHODS: The women were randomised to either 1000 micrograms of self-administered vaginal misoprostol or self-administered vaginal placebo the evening before outpatient operative hysteroscopy. MAIN OUTCOME MEASURES: Preoperative cervical dilatation (primary outcome), number of women who achieve a preoperative cervical dilatation > or = 5 mm, acceptability, complications and adverse effects (secondary outcomes). RESULTS: In premenopausal women, the mean cervical dilatation was 6.4 mm (SD 2.4) in the misoprostol group and 4.8 mm (SD 2.0) in the placebo group, the mean difference in cervical dilatation being 1.6 mm (95% CI 0.5-2.7). Among the premenopausal women receiving misoprostol, 88% achieved a cervical dilatation of > or = 5 mm compared with 65% in the placebo group. Twelve percent of the women who received misoprostol were difficult to dilate compared with 32% who received placebo. Dilatation was also quicker in the misoprostol group. Misoprostol had no effect on cervical ripening in postmenopausal women compared with placebo, and 43% of the women were difficult to dilate. The trials were terminated after analysis of 21 postmenopausal women and 65 premenopausal women after reaching a conclusion on the primary outcome with only 28% of the number of women needed in a fixed sample size trial. Three of 45 women who received misoprostol experienced severe lower abdominal pain, and there was an increased occurrence of light preoperative bleeding in the misoprostol group. Most women did not experience misoprostol-related adverse effects. The majority (83% of premenopausal and 76% of postmenopausal women) found self-administered vaginal misoprostol at home to be acceptable. There were two serious complications in the premenopausal misoprostol group: uterine perforation with subsequent peritonitis and heavy postoperative bleeding requiring blood transfusion, but these were not judged to be misoprostol related. Complications were otherwise comparatively minor and distributed equally between the two dosage groups. CONCLUSIONS: One thousand micrograms of self-administered vaginal misoprostol 12 hours prior to operative hysteroscopy has a significant cervical ripening effect compared with placebo in premenopausal but not in postmenopausal women. Self-administered vaginal misoprostol of 1000 micrograms at home the evening before operative hysteroscopy is safe and highly acceptable, although a small proportion of women experienced severe lower abdominal pain. There is a risk of lower abdominal pain and light preoperative bleeding with this regimen, which is very cheap and easy to use.

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OBJECTIVE: To compare the impact of 1000-microgram self-administered vaginal misoprostol versus self-administered vaginal placebo at home on preoperative cervical ripening in both premenopausal and postmenopausal women prior to outpatient resectoscopy. DESIGN: Randomised, double-blind, placebo-controlled sequential trial. SETTING: Norwegian university teaching hospital. SAMPLE: Premenopausal and postmenopausal women referred to outpatient resectoscopy. METHODS: The women were randomised to either 1000 micrograms of self-administered vaginal misoprostol or self-administered vaginal placebo the evening before outpatient resectoscopy. MAIN OUTCOME MEASURES: Preoperative cervical dilatation, acceptability and complications. RESULTS: (a) Intraoperative findings and distribution of cervical dilatation in the two treatment groups. Values are given as median (range) or n (%). (b) Acceptability in the two treatment groups. Values are given as completely acceptable, n (%); fairly acceptable, n (%); fairly unacceptable, n (%) and completely unacceptable, n (%). (c) Pain in the two treatment groups. Pain was measured with a visual analogue scale score, scale ranges from 0 (no pain) to 10 (unbearable pain). Values are given as median (range). (d) Occurrence of adverse effects in the two treatment groups. Values are given as n (%). (e) Complications, given as n (%).

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OBJECTIVE: The need for iron in pregnancy is rarely met by dietary food intake alone. Therefore, guidelines on iron supplementation have been developed to ensure optimal maternal and foetal iron provision. Today, the World Health Organization recommends iron supplementation during the second half of pregnancy. Our aim was to study compliance to these guidelines among 431 parous Scandinavian women. In addition, the association between maternal socio-demographic and lifestyle factors, maternal haemoglobin (Hb) values and non-compliance was assessed. METHODS: The women were interviewed about iron use at gestational weeks 25, 33 and 37 at the three Scandinavian study sites, Trondheim, Bergen and Uppsala. RESULTS: In all, 27% of the women used iron supplements continuously during the second half of pregnancy, hence complying with the guidelines. Further, 41% of the women reported periodical and 32% no use of iron supplementation during the second half of pregnancy. In the multivariable analyses, high Hb-concentration, living in Uppsala [OR: 3.1 (1.6-6.0)] or Bergen [OR: 4.7 (2.4-9.3)] as opposed to Trondheim, and smoking during pregnancy [OR: 2.0 (1.1-3.5)] were associated with non-compliance to guidelines. CONCLUSION: We conclude that maternal Hb values, demographic factors and smoking during pregnancy are among the factors associated with non-compliance to guidelines on iron supplementation during pregnancy.

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Over the period May-June 1999, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) was registered in eight newborns in a neonatal intensive care unit (NICU) at the Department of Pediatrics, Ullevål University Hospital (UUH) in Oslo. Seven were infected or colonized with an indistinguishable strain, detected at the NICU, and one patient with a slightly different PFGE type (i.e. a subtype) was registered at the outpatient clinic. The MRSA strains resembled the sensitive, inbred 'Norwegian type' described four years earlier at UUH, showing a relatively low and heterogenic methicillin resistance (MIC 12-96 mg/L), and susceptibility to most other anti-staphylococcal agents. Before and during the outbreak, there was high activity, understaffing, overcrowding and a mix of patients; 42% of the staff were relatively untrained, and up to 62% (during weekends) were extra nursing staff, partly from other Scandinavian countries. All cases were isolated (air and contact isolation), and all other patients and personnel were treated as being exposed to MRSA (isolated from other departments) until the last patient had been identified, disinfection of all rooms was complete, and all screening samples from staff and other patients were negative. The NICU and the delivery suite were closed for one week for disinfection and screening. The outbreak ended after 34 days. Since then, two years later, no further cases have been detected in the NICU or the delivery suite.

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OBJECTIVE: Socio-demographic factors have been associated with drug use in pregnancy. However, information on maternal illness has rarely been included in previous studies. The aim of this study was therefore to estimate the impact of maternal illness and prior pregnancy outcome on the use of analgesics/antipyretics, anti-infectives and antihistamines in early pregnancy controlling for socio-demographic factors. METHODS: One thousand nine-hundred and forty-five parous pregnant women from Norway and Sweden were included in an interview study. Information on drug use, obstetric history, maternal illness and socio-demographic factors was collected by specially trained midwives at gestational week 17 and form the basis for the present analyses. RESULTS: After control for socio-demographic factors, reported illness was associated with the use of analgesics/antipyretics, anti-infectives and antihistamines during early pregnancy. The use of analgesic/antipyretic and anti-infective drugs differed between study sites. Sociodemographic factors such as age, parity, marital status, education, occupation and smoking habits did not influence drug use in the multivariate analysis. CONCLUSION: Maternal illness during pregnancy was associated with drug use in early pregnancy. When studying factors related to drug use during pregnancy, it is important to include information on maternal illness. Socio-demographic factors may be confounders and lead to erroneous conclusions about the factors related to drug use.

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BACKGROUND: Long time interval between pregnancies has been found to increase the risk of pre-eclampsia in second pregnancy. Our aim was to investigate whether this effect is influenced by a history of pre-eclampsia or a change in paternity. METHODS: We studied 547 238 women with a first and second pregnancy registered in the Medical Birth Registry of Norway, 1967-1998. The relative risk of pre-eclampsia in the second delivery according to time interval between deliveries was estimated as odds ratios (OR) in logistic regression models, controlling for changing paternity, maternal age and calendar time period in women with and without previous pre-eclampsia. RESULTS: A change of paternity for the second pregnancy was associated with a reduced risk of pre-eclampsia after controlling for the time since first delivery (adjusted OR = 0.80, 95% CI : 0.72-0.90), but the interaction between change in paternity and time between deliveries was significant only for women with no previous pre-eclampsia. The interaction between history of pre-eclampsia and time interval between the two deliveries was highly significant, and for women with no previous pre-eclampsia the risk of pre-eclampsia in second pregnancy increased with increasing time interval (for intervals longer than 15 years the adjusted OR was 2.11, 95% CI : 1.75-2.53). For women with previous pre-eclampsia the risk tended to decrease with increasing time interval between deliveries. CONCLUSIONS: The protective impact of a new father for the second pregnancy challenges the hypothesis of primipaternity, and implies that the increase in pre-eclampsia risk ascribed to new father by others is due to insufficient control for interpregnancy interval.

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BACKGROUND: The aims of this study were to assess i) the geographical variation in the prevalence of request for induced abortion after 12th week of pregnancy and ii) the geographical variation in the probability of refusal of abortion request for other reasons than foetal defects. MATERIAL AND METHODS: All medical records regarding request for induced abortion after 12 weeks of pregnancy during the period 1996-97 in Norway were collected in 1998 by the National Board of Health. RESULTS: There were a total of 1,061 requests for induced abortion, of whom 41 were withdrawn. 303 requests were based on foetal defects. Of the remaining 717 requests, which were included in the analysis, 144 (20%) were refused. The counties Vest-Agder, Møre og Romsdal and Finnmark had the lowest prevalence of induced abortions after the 12th week of pregnancy (< 4 per 10,000 women, 15-45 years of age, during 1996-97) and Oslo, Buskerud and Sør-Trøndelag had the highest (> 10 per 10,000 women). Hospitals in the south-western part of Norway (Vest-Agder/Aust-Agder/Rogaland) were 7.8 (95% confidence intervall 3.5-17.2) times more likely to refuse the requests as compared to hospitals in Østfold/Oslo/Akershus. INTERPRETATION: Cultural differences within Norway may explain, though not excuse, the observed geographical differences in the practice of the abortion act.

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BACKGROUND: Sociodemographic studies of hyperemesis gravidarum are conflicting. During the last few years, there has been a clinical impression in Norway that immigrants are more afflicted than ethnic Norwegians. METHODS: Of 175 patients hospitalized with the diagnosis hyperemesis gravidarum 1993-1997, 120 had complete records and were compared to a control group of 115 patients without hyperemesis gravidarum, drawn at random from the labor ward protocol. VARIABLES: Ethnicity, age, height, weight at the beginning and at the end of pregnancy, body mass index, gravidity, parity, smoking, gestational age at labor, birth weight, placental weight. The patient's first name was used as an indication of ethnicity. Having a non-Norwegian name means, in the majority of cases, being a first generation immigrant from a developing country. STATISTICS: SPSS statistical package for regression analyses, the chi-square test with Yates correction and the Mann-Whitney U-test. RESULTS: Risk factors for hyperemesis: non-Norwegian name (OR 3.4, 95% CI 1.5-7.6), female sex of the infant (OR 2.6, 95% CI 1.3-5.3), gravidity number (OR 1.4, 95% CI 1.1-1.9). These two last variables were of significance only in patients with a Norwegian name. The hyperemesis group had a lower weight gain and birth weight. In a stepwise multiple regression birth weight (g) was dependent on weight increase (kg) (B=19.0, p=0.001), weight in early pregnancy (kg) (B=8.0, p =0.02) and parity (B= 107.1, p=0.02). Hyperemesis, when corrected for weight increase, did not influence birth weight. CONCLUSIONS: Risk factors vary between different populations. Hyperemesis patients are at risk of having infants with reduced growth.

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BACKGROUND: The objective of this study was to estimate the national and regional rates of induced abortions after the 12th gestational week attributed to fetal maldevelopment in Norway during 1996 and 1997. MATERIALS AND METHODS: In 1998, the National Board of Health requested from all hospitals copies of relevant documents in the medical records of women who had applied for induced abortion after 12th gestational week. RESULTS: There were 303 women in 1996 and 1997 who applied for induced abortion because of diagnosed fetal maldevelopment. For all of these women the application was accepted. One woman did not have an abortion. The national rate of induced abortion attributed to fetal maldevelopment was 2.5 per 1000 births. There were regional differences in the rate of abortion. In 53% of all applications for induced abortion the fetal diagnosis was not reported. Among the reported diagnoses, 28% were chromosomal abnormalities. INTERPRETATION: There is a need for better knowledge of factors influencing the number of induced abortions attributed to fetal malformations. We also need a better understanding of the impact of such abortions on the observed perinatal mortality and occurrence of birth defects.

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OBJECTIVES: To evaluate the effects of hormone replacement therapy (HRT) on lipids and lipoproteins in postmenopausal women with coronary artery disease. SETTING: In this single-centre, controlled and randomized study taking place in a tertiary referral clinic, patients were examined at baseline, and after 3 and 12 months. All analyses were performed examiner-blind. SUBJECTS: Postmenopausal women (n = 118) with angiographically verified coronary artery disease were recruited consecutively from patients referred for investigational procedures due to coronary artery disease. INTERVENTIONS: The women were randomized to HRT, i.e. transdermal application of continuous 17-beta oestradiol with cyclic medroxyprogesterone actetate tablets every 3rd month for 14 days, or to a control group. MAIN OUTCOMES: Effects on lipids and lipoproteins. RESULTS: After 3 months of unopposed oestradiol, triglycerides decreased significantly compared to the control group (P = 0.006). Sequential administration of medroxyprogesterone caused a decrease in HDL cholesterol (P = 0.01), concomitantly with a decrease in ApoA1 lipoproteins (P = 0.007). No other changes in lipids or lipoproteins were observed. After 12 months of therapy, no significant differences were observed between the two groups in lipid or lipoprotein levels. Concomitant statin treatment did not alter the main findings. CONCLUSIONS: In postmenopausal women with established coronary artery disease in whom the majority is treated with statins, no additional effect of HRT on lipids or lipoproteins could be observed except for a transient decrease in triglycerides in the initial unopposed oestradiol phase. No deleterious effect could be observed during medroxyprogesterone administration except for a small transient decrease in HDL cholesterol and ApoA1 lipoproteins.

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PIP: A Norwegian investigation from 1987-88 indicated that 25% of the women who were interviewed at a maternity ward stated that their pregnancy had not been planned. That means that 15,000 of the annual total of 60,000 births in Norway are not planned. This is roughly the same figure as the number of abortions (14,000 per year). 93% of women who carry out an unplanned pregnancy have not used contraception according to a 1991 study, but even a 1999 study showed that half of women seeking abortion had not used contraception. A 1994 investigation revealed that only 8% of women in the 20-24 age group did not use contraception and 5% used unsafe methods (coitus interruptus, safe periods, spermicides), while the rest used effective contraceptives (60% used OCs). There are 144,000 women in this age group in Norway, of which 12,000 give birth within a year. In theory the remaining 132,000 would have 2600 pregnancies. In 1996 there were 3883 abortions in this same age group; half of them would originate from that 8% of women who did not use contraception and the other half owing to contraceptive failure. Two studies among students in Oslo in 1997 demonstrated that even if a young woman started using OCs it did not mean that she would continue using them. A number of them discontinued because their relationship with their partner ended, they neglected to visit their doctor, forgot to take their pills, or thought that they could not get pregnant right after stopping OC use.^ieng

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OBJECTIVE: The scientific debate on oral contraceptives (OCs) and thrombotic diseases continues unabated. The aim of this survey was to evaluate available scientific data on OCs and thrombotic diseases and to make tentative prescription recommendations of OCs to women with and without various thrombotic risk factors. CONSENSUS: In women 15-29 years old, venous thromboembolism is about twice as common as arterial complications. In women between 30 and 44 years, the number of arterial complications exceeds venous diseases by about 50%. The mortality from arterial diseases is 3.5 times higher than the number of deaths from venous diseases in women below 30 years, and 8.5 times higher in women 30-44 years old. A significant disability is more frequent in women suffering and surviving an arterial complication than in women with venous thromboembolism. Although many important scientific issues still have to be addressed, the available scientific data suggests a differential influence of OCs with second and third generation progestagens on the risk of venous and arterial diseases. OCs with second generation progestagens seem to confer a smaller increase in the risk of venous diseases and a higher increase in risk of arterial complications, compared with OCs containing third generation progestagens. The possible difference on the venous side seems to be smaller than primarily anticipated. RESULTS: Young women without any known risk factor for thrombotic diseases may use any low-dose OC. If OCs are prescribed to women with known risk factors for arterial thrombotic disease; e.g. smoking, diabetes, controlled hypertension, migraine without aura, family disposition of acute myocardial infarction (AMI) or thrombotic stroke, a low-dose pill with a third generation progestagen may have an advantage. If OCs are considered for women with risk factors for venous disease such as severe obesity, varicose veins, family history of VTE or with factor V Leiden mutation, a low-dose combined pill with a second generation progestagen may be preferable. In women above 30 years, OCs with third generation progestagens generally seem to confer less overall thrombotic morbidity, mortality and disability than OCs with second generation progestagens. These women should reconsider, however, the indication of combined OCs in the presence of significant risk factors of thrombotic diseases.

PIP: This article discusses available scientific data on oral contraceptives (OCs) and thrombotic diseases and provides tentative prescription recommendations of OCs to women, with and without various thrombotic risk factors. Several studies concerning OCs and venous thromboembolism (VTE), including the original studies serving as scientific databases, were presented. VTE was twice as common as arterial complications in women 15-29 years old, while arterial complications were 50% higher than VTE in women between 30 and 44 years of age. The mortality of arterial disease was 3.5 times higher than the number of deaths from venous disease in women below 30 years, and 8.5 times higher in women aged 30-44 years. The available scientific data suggests a differential influence of OCs with second and third generation progestagens on the risk of venous and arterial diseases. From this consensus, a low-dose OC was prescribed for young women without any known risk factor for thrombotic diseases. Women with a known risk factor for arterial thrombotic disease, a low-dose pill with a third generation progestogen, may have an advantage while a low-dose pill combined with a second generation progestogen was preferable for women with risk factors for venous disease. In women above 30 years, OCs with third generation progestagens generally seem to confer less overall thrombotic morbidity, mortality, and disability than OCs with second generation progestagens. These women should reconsider, however, the indication of combined OCs in the presence of significant risk factors of thrombotic diseases.

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AIMS: To investigate the smoking prevalence the last three months before pregnancy and at 18 weeks of gestation among women in Norway and to evaluate the impact of pre-pregnancy smoking habits, maternal age, level of education, civil status and parity on smoking cessation. MATERIAL AND METHODS: A prospective, multicenter survey. The study population included 4 766 pregnant women who attended a routine ultrasound examination at 18 weeks of pregnancy in six Norwegian hospitals during the period from September 1994 to March 1995. Smoking habits before and during pregnancy were recorded. RESULTS: The point prevalence of self-reported daily smoking among the women three months before the pregnancy was 34%. At 18 weeks of pregnancy, 21% of the women reported smoking daily (p<0.001). A multiple logistic regression analysis revealed that a low number of cigarettes smoked per day during the last three months before pregnancy was the best predictor for smoking cessation. Educational level, maternal age, parity and civil status were also statistically significant contributors to smoking cessation. Eighty percent of the women who were unable to stop smoking, reported a reduction in cigarette consumption. The mean number of cigarettes per day was reduced from 13.9 before pregnancy to 7.3 at 18 weeks of pregnancy (p<0.001). CONCLUSION: In a national survey, 21% of the pregnant women reported smoking daily in the second trimester. Thirty-eight percent of the women who were daily smokers before the pregnancy stopped smoking in early pregnancy. A low cigarette consumption prior to the pregnancy was the best predictor for smoking cessation.

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We report a family with two cases of severe pre-eclampsia/eclampsia in which very high levels of Lp(a) lipoprotein were found. The serum level of Lp(a) lipoprotein is genetically determined and the Lp(a) apolipoprotein has a close homology to plasminogen. Very high levels of Lp(a) lipoprotein might interfere with the fibrinolytic/thrombolytic process in man. A previous report suggested that a high maternal serum Lp(a) lipoprotein level can cause fetal growth retardation, and it is proposed that very high levels might lead to increased deposition of fibrin in the uterine spiral arteries in pregnancy, which is central in the pathogenesis of pre-eclampsia. If confirmed, a very high Lp(a) lipoprotein level could be one risk factor for pre-eclampsia that is genetically determined.

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OBJECTIVE: The present study is a prospective randomized comparison of laparoscopically assisted vaginal hysterectomy (LH) with total abdominal hysterectomy (TAH). METHODS: 100 patients referred for uterine removal were included in the study, 46 undergoing LH and 54 TAH, at two teaching hospitals in Norway. RESULTS: In the LH group, the duration of surgery was longer while duration of hospitalization and time from operation to return to normal activity were shorter as compared to the TAH group. Postoperative pain, assessed by the need for analgesics, was less in the LH group. All these differences were statistically significant. There were two ureteral lesions in the LH group, and one center withdrew early from the study for this reason. CONCLUSIONS: In expert hands, LH as a primary method for uterine removal is superior to TAH.

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