摘要:

AbstractIn recent decades, the operative approach for several gynecologic diseases has changed from laparotomy to laparoscopy. New techniques and indications are continuously being developed. Laparoscopy offers a lot of advantages for the patient, but still a lot of additional data are required to determine the exact indications. Operative laparoscopy requires not only skill and experience, but also specialized equipment and paramedical staff. The most important topics for the gynecologist will be reviewed in this article.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02329-B

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To assess the efficacy and safety of labetalol compared with methyldopa in the management of mild and moderate cases of pregnancy‐induced hypertension (PIH). Methods: One hundred four primigravidas with PIH were randomly allocated to receive either labetalol (group A) or methyldopa (group B). The dose of the drugs was doubled every 48 h to maintain a mean arterial blood pressure ≤103.6 mmHg. Clinico‐biochemical effects and frequency of side effects were studied. The statistical level of significance was taken at P30 mg/dl) whereas none developed proteinuria in group A. Labetalol was quicker and more efficient at controlling blood pressure, having a beneficial effect on renal functions and causing fewer side effects compared with methyldopa. The rate of induction of labor and rate of cesarean section for uncontrolled PIH was less in group A (48% and 1%, respectively) compared with group B (63.0% and 5.6%, respectively). Moreover a higher Bishop score at induction of labor was noticed in group A. Conclusions: Labetalol is better tolerated than methyldopa, gives more efficient control of blood pressure and may have a ripening effect on the uterine cervix.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02351-C

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: The purpose of the study was to determine the best regimen for metabolic control of gestational diabetes. Methods: A prospective study was conducted over a period of 5 years in 355 diabetic women delivered at the King Fahd Hospital of the University, Al‐Khobar, Saudi Arabia, between January 1987 and December 1991. The patients were divided into three groups according to their mean plasma glucose levels during pregnancy: good control was defined as a mean plasma glucose level of less than 120 mg/dl (group A); moderate control as a mean plasma glucose level between 120 and 140 mg/dl (group B); and poor control as a mean plasma glucose level in excess of 140 mg/dl (group C). The t‐test was used for statistical analysis. Results: Antenatal and neonatal complications were much higher in groups B and C than in group A, the overall complication rate being five times higher in group C than in group A. Conclusion: The data indicate that good glycemic control is one determinant of maternal and fetal complications in pregnancies complicated by gestational diabetes.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02352-D

出版商:Wiley    

年代:2017

数据来源: WILEY

摘要:

AbstractObjectives: To study the impact of HIV‐1 infection on pregnancy and maternal and early fetal outcome. Method: From January 1992 to January 1993, 160 HIV‐1 seropositive women and 164 HIV‐1 seronegative age‐and parity‐matched pregnant tribal women from Manipur, India, were recruited into a prospective study. Mother and infant were followed until 6 weeks postpartum. Results: Nine percent (15/160) of subjects had AIDS (CDC IV), 38% (60/160) were symptomatic (CDC III) and 53% (85/160) were asymptomatic (CDC I/II). Symptomatic (CDC III/IV) HIV‐1 infection is associated with a significantly increased rate of miscarriage, low birth weight, intrauterine fetal death and preterm delivery. Perinatal, infant and maternal deaths were limited to symptomatic women. HIV‐1 infected women were significantly younger than their HIV‐1 negative counterparts both in age and age at sexual debut. Placental membrane inflammation was significantly higher in the seropositive group and this correlated well with a higher risk of preterm delivery and postpartum endometritis. Asymptomatic HIV‐1 infection was not associated with adverse pregnancy outcome. Conclusion: Symptomatic (CDC III/IV) HIV‐1 infection in Indian tribal women is associated with adverse maternal and fetal outcome.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02356-H

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To test the effect on pregnancy outcome of a policy of very early commencement of postdate surveillance testing, and induction of labor at 42 weeks. Methods: Retrospective analysis of 2776 consecutive cephalic deliveries at 38–42 weeks of gestation. Management of the postdate pregnancies included twice‐weekly antenatal testing beginning at 40 completed weeks and elective induction of labor at 42 completed weeks. Pregnancy outcome parameters were compared between the groups delivered at 38–40 weeks and at 41–42 weeks. Results: There were 2138 pregnancies delivered at 38–40 weeks and 638 at 41–42 weeks. The latter group had a statistically significant increase in the rate of cesarean section, mainly accounted for by an increased rate of fetal distress and failure to progress in labor. Similarly the rate of instrumental vaginal delivery, meconium in labor and macrosomia had a statistically significantly higher incidence in the postdate group. These differences in outcome were already apparent at 41 weeks of gestation. Conclusion: Despite early initiation of fetal surveillance, starting at 40 completed weeks, postdate pregnancies are associated with an increased rate of emergency cesarean section, macrosomia and meconium in labor.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02357-I

出版商:Wiley    

年代:2017

数据来源: WILEY

摘要:

AbstractObjective: To test the effectiveness and safety of low‐dose vaginal misoprostol for induction of labor with a live fetus. Methods: Labor was induced in 666 pregnant women with a live fetus in the cephalic position, who had no medical complications and no history of uterine surgery. One‐fourth of a 200‐μg tablet of misoprostol (50 μg) was placed in the posterior vaginal fornix every 12 h for a maximum of four doses or until active labor commenced. Time from induction to delivery, side effects and neonatal outcome were evaluated. Results: Labor was successfully induced in all cases. The mean time from induction to delivery was 10.4 h. The cesarean section rate was 7.8%. There were eight perinatal deaths, six of which occurred in low birth weight fetuses. There was one case of abruptio placenta, which was less than that expected in the study population. Conclusion: Vaginal misoprostol, in very low doses, was a remarkably efficient and safe method for induction of labor with a live fetus.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02368-M

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To evaluate pregnancy outcome following uterine unification procedures in patients with uterine anomalies. Methods: A retrospective survey included all abdominal metroplasty procedures performed on 43 patients at the American University of Beirut Medical Center between January 1, 1974 and December 31, 1991. Age at metroplasty, type of anomaly and surgical procedures, as well as preoperative and postoperative reproductive performance were all recorded. Results: Forty (93%) out of 43 patients who underwent metroplasty had postoperative live births compared with five (12%) prior to surgery. The fetal wastage rate dropped from 93% pre‐ to 16% postoperatively. All seven patients with a history of primary infertility conceived and had live births. Conclusion: Our data suggest a remarkable improvement following abdominal metroplasty in patients with both typical and uncharacteristic preoperative reproductive performance.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02370-R

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To develop a surgical classification for obstetric fistulas in order to compare surgical techniques and results. Methods: Based on a retrospective analysis of 775 consecutive fistula patients, the following classification is presented: (type I) fistulas not involving the urethral closing mechanism; (type II) fistulas involving the urethral closing mechanism; and (type III) ureter and other exceptional fistulas. Type II fistulas can be further divided into: (A) without (sub)total urethra involvement, and (B) with (sub)total urethra involvement; and (a) without a circumferential defect, and (b) with a circumferential defect. This classification was applied prospectively in over 2700 consecutive fistula patients. Results: The surgical technique becomes progressively more complicated from type I through type IIBb. The results of closure and continence worsen progressively from type I through type IIBb. Personal experience in the case of type III fistulas is very limited. Conclusion: This classification enables a systematic comparison of different surgical techniques and an objective evaluation of results from different centers.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02350-L

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: The aim of the study was to investigate clinically and urodynamically the effects of hormonal replacement in the treatment of genuine stress urinary incontinence in postmenopausal females. Methods: Clinical and urodynamic variables of 30 postmenopausal women with genuine stress urinary incontinence were evaluated after 3 months' treatment with conjugated estrogens plus progestogens. Urodynamic evaluations were performed in all patients before and after treatment. Results: Forty‐six percent of the patients treated medically were judged to be cured and 43% were judged to be markedly improved. Maximum urethral closure pressure, maximum cystometric capacity and mean flow were significantly increased. Residual urine and diurnal and nocturnal voluntary micturition were markedly decreased (P<0.05). Conclusion: We conclude that hormone replacement in the form of conjugated estrogens plus progestogens results in the clinical and urodynamic improvement of genuine stress urinary incontinence in postmenopausal women.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02358-J

出版商:Wiley    

年代:2000

数据来源: WILEY

摘要:

AbstractObjective: To evaluate the effect of alpha‐interferon as an adjuvant to laser or fluorouracil treatment in patients with recurrent genital human papillomavirus (HPV) infection. Methods: Sixty‐two females and 21 males were treated for recurrent HPV infection, with either fluorouracil (Efudex 5%) cream or laser ablation of the lesions. Half of the patients were then randomly treated with adjuvant alpha‐interferon, to the lesions for patients treated with fluorouracil, or beneath areas previously treated by laser, once a week, for 8 weeks. The other half of the patients did not receive interferon adjuvant. Evaluation of both groups was done using colposcopy and acetic acid, to assess recurrence rates up to 1 year after treatment. Results: Of the 83 patients followed for 1 year, colposcopy revealed recurrent anogenital lesions in 3 of 45 receiving interferon, compared with 9 of 38 patients treated without adjuvant interferon. Conclusion: Interferon is effective as adjuvant treatment in controlling the recurrence of genital HPV.

ISSN:0020-6695    

DOI:10.1016/0020-7292(95)02339-E

出版商:Wiley    

年代:2000

数据来源: WILEY