ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138338.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138339.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo evaluate endometrial ablation as an alternative to hysterectomy for intellectually disabled women with inadequate menstrual hygiene.Design and settingA retrospective review of all intellectually impaired women referred to a menstrual management clinic at a university teaching hospital for management of inadequate menstrual hygiene between October 1989 and September 1992.ResultsEndometrial resection was considered an appropriate alternative to hysterectomy for eight intellectually disabled women. To date, seven women have undergone the procedure and one is receiving medical treatment. Endometrial ablation was performed with roller‐ball electrocautery. Three patients underwent sterilisation at the time of surgery. The mean operating theatre time was 75 minutes. Postoperative hospital stay was less than 48 hours for all but one patient, who underwent mini‐laparotomy for sterilisation — postoperative analgesia was required only by this patient. There were no complications during or after surgery. Six weeks after surgery, all patients were amenorrhoeic and they and/or their carers expressed satisfaction with the procedure. Four women, followed up for between 16 and 38 months, remain amenorrhoeic and two, followed up for six months, have each experienced one episode of spotting but are otherwise amenorrhoeic. The seventh patient has had irregular bleeding but this is deemed due to erroneous continuation of progesterone therapy and is being monitored.ConclusionEndometrial ablation provides a valuable alternative to hysterectomy. It should be the surgical treatment of choice for intellectually disabled women with inadequate menstrual hygiene unresponsive to medical therapy. (Med J Aust 1994; 160: 533‐536)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138340.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

Optimal gynaecological care for women with intellectual disability is complex. Many of these women suffer unique problems with regard to menstrual hygiene, sexuality, contraception and susceptibility to sexual abuse. Complex medical, ethical, social and legal issues must be carefully considered to address these problems. We discuss the “gynaecological” management of intellectually disabled women, with particular reference to contraception and menstrual suppression. We advocate endometrial ablation as an alternative to hysterectomy for women with intractable menstrual problems. Some ethical issues are reviewed which must be addressed to determine which approach is in the patient's “best interest” and adopts the “least restrictive option”. Finally, we present Federal and State laws governing informed consent for medical procedures for women and children with intellectual disabilities.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138341.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo determine whether women delivering their first child at age 35 years or older are at increased risk of adverse (non‐genetic) pregnancy outcomes.Design and settingA cross‐sectional analytic study of singleton deliveries in Northern Sydney Area Health Service (NSAHS) hospitals.ParticipantsAll women aged>20 years delivering their first child between 1 January 1990 and 31 December 1991.Main outcome measuresObstetric complications and procedures, type of delivery and neonatal outcomes.ResultsCompared with women aged 20‐29 years, women delivering their first child at>35 years were at increased risk of pre‐existing maternal hypertension (adjusted odds ratio [OR], 3.5; 95% confidence interval [CI], 1.7‐7.0), antepartum haemorrhage (adjusted OR, 2.4; 95% CI, 1.6‐3.7), preterm delivery (33‐36 weeks) (adjusted OR, 2.0; 95% CI, 1.5‐2.8) and breech presentation (adjusted OR, 1.8; 95% CI, 1.3‐2.4). Women aged>35 years were also substantially more likely to have an operative delivery, induced labour and/or epidural anaesthesia. Neither these women nor their infants were at increased risk of pregnancy‐induced hypertension, gestational diabetes, threatened premature labour, postpartum haemorrhage, very preterm delivery (<32 weeks), perinatal death, low Apgar scores or the need for neonatal resuscitation.ConclusionsWomen who delay the birth of their first child face some increased risks, but these risks, for the most part, are manageable in the context of modern obstetric care.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138342.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo characterise the structurally abnormal Y chromosomes present in two infertile men by means of the molecular technique of fluorescence in‐situ hybridisation (FISH).MethodsBoth men were pheno‐typically normal and had azoospermia. In Case 1 the karyotype with routine cytogenetics was 46, XX; in Case 2 it was complex, with 3 cell lines — 45, X/46, X,i(Yp)/46, X,+?del(Y)(q11 ). We used probes from the Y chromosome and FISH to clarify these karyotypes.ResultsIn Case 1 a translocation of Y chromosome to the X chromosome was identified with FISH — t(X;Y). In Case 2, an isochromosome of the short arm of the Y chromosome was confirmed in one cell line, and another cell line was shown to contain a small Y chromosome with heterochromatic deletion. These findings explained the underlying pathogenesis in both cases.ConclusionsMolecular investigation with FISH should become part of the routine investigation of infertile men with an abnormal Y chromosome.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138343.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo review the characteristics and experience of Australian women treated with depot medroxyprogesterone acetate (DMPA) in one gynaecological practice in Melbourne since 1973.DesignA detailed retrospective review of clinical data on 363 women treated with a total of 2298 injections of DMPA over the past 20 years.ResultsThe main indication was contraception, although a substantial minority (20%) were treated with DMPA predominantly for medical indications such as endometriosis. No pregnancy occurred within three months of an injection. There was also high acceptability, with a mean of 6.3 injections per subject, and a mean overall follow‐up of 43.3 months. The median delay in the return of fertility in those wishing to conceive immediately was 9.2 months. Only one patient complained of difficulty in conceiving. Menstrual bleeding disturbances only led to 7.3% of the discontinuations, although fairly frequent use of short courses of oral oestrogen (in 40% of women) was employed in the early months of DMPA treatment. Other side effects were relatively infrequent, the most common being superficial dyspareunia or reduced libido (in 8%).ConclusionsThis much maligned drug merits a legitimate place among the contraceptive choices available for Australian women. Accurate, unbiased information about the extensive worldwide experience needs to be made available to all Australian medical practitioners.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138344.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo describe the management and follow‐up of women with initial minor Papanicolaou (Pap) smear abnormalities by general practitioners (GPs) in metropolitan Sydney in 1990.Subjects and settingOne hundred women with cervical intraepithelial neoplasia grade 1 (CIN 1) and 121 women with mild squamous atypia (MSA) on Pap smears taken by GPs in 1990, who had not had Pap smear abnormalities in the previous two years, were sampled from the records of four Sydney pathology laboratories.DesignA descriptive study. Information about the management of women after their Pap smear was obtained from GPs by telephone questionnaire.ResultsOf women with MSA, 19% were initially investigated by colposcopy, and 8% went on to have treatment. Of 82 women with MSA who were not initially investigated, 80% had follow‐up Pap smears within 12 months. Of women with CIN 1, 84 underwent colposcopy with or without biopsy; 27% of these women had CIN 2/3 and 31% had CIN 1 confirmed by investigation. Overall, 51% of women with CIN 1 on their initial Pap smears were treated by excisional or ablative means, including 78% of women with confirmed CIN 2/3, and 69% of women with confirmed CIN 1. Two and a half years after the original Pap smear, only 46% of women with initial MSA and 51% of women with initial CIN 1 were known by their GP to be having follow‐up.ConclusionsMost women with MSA were managed by initial observation, and those with CIN 1 were managed by initial investigation. However, the range of management practices described suggests a lack of consensus among practitioners about the most appropriate management for women with minor cervical abnormalities. A large randomised controlled trial would help elucidate preferred management guidelines. The difficulty individual GPs experience in following up women after abnormal Pap smears supports the establishment of centralised State cytology registers.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138345.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138346.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138347.x

出版商:Wiley    

年代:1994

数据来源: WILEY