摘要:

OBJECTIVETo describe changes in neonatal and obstetric practices that may have contributed to the decreasing incidence of meconium aspiration syndrome in our population during this time.METHODSWe compared neonatal and obstetric characteristics of 61 infants diagnosed with meconium aspiration syndrome with 1365 infants born through moderate or thick meconium-stained amniotic fluid at more than 37 weeks' completed gestation. Data were prospectively collected, and all respiratory diagnoses were concurrently made. Three distinct birth year groups were analyzed based on changing obstetric practice paradigms.RESULTSMeconium aspiration syndrome decreased nearly four-fold from 1990–1992 to 1997–1998 (5.8% to 1.5% of meconium-stained infants more than 37 weeks;P< .003). The only change in neonatal characteristics was a 33% decrease in births more than 41 weeks with a reciprocal 33% increase in births 38–39 weeks during 1997–1998. Significant changes in obstetric practice included more frequent diagnosis of nonreassuring fetal heart rate patterns, greater use of amnioinfusion, and increased cesarean delivery rate in 1997–1998. By logistic regression analysis, the only consistent risk factor for meconium aspiration syndrome across all three epochs was the presence of tracheal meconium.CONCLUSIONReduction in post-term delivery was the most important factor in reducing meconium aspiration syndrome.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo compare diabetic and nondiabetic pregnant women near term regarding the accuracy of predicted birth weight by the gestation-adjusted projection method using ultrasonographic measurements.METHODSPatients with singleton pregnancies who had diabetes and who underwent sonograms between 34.0 weeks and 36.9 weeks formed the study group. The control group was comprised of nondiabetic women who had sonograms in the same gestational age range. The absolute birth weight errors and absolute percent errors in the study group and the controls were compared withttests.RESULTSA total of 133 diabetic women and 1690 controls were included in the study. The mean (± standard deviation) absolute error of the predicted birth weight was 265 ± 210 g in the diabetic women and 261 ± 204 g in the control group (P= .87). The mean (± standard deviation) absolute percent error was 7.4% ± 6.3% for diabetic women compared with 8.3% ± 6.6% for the controls (P= .14).CONCLUSIONPrediction of birth weight using the gestation-adjusted projection method is as accurate in diabetic women as in controls.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo compare the Pfannenstiel incision with transverse muscle-cutting Maylard incision in women who had cesarean delivery.METHODSPatients were assigned randomly to a Pfannenstiel or Maylard incision. Postoperative ttreatment was similar for each group. Surgical characteristics, complications, postoperative pain (visual analog scale, analgesic use), and related quality of life (1- and 3-month self-administered questionnaires) were analyzed. Abdominal wall muscle recovery was compared objectively by dynamometer.RESULTSFifty-four women had a Pfannenstiel incision and 43 had the Maylard incision. There were no differences in intraoperative characteristics, postoperative morbidity, or pain. Women's responses to the Nottingham Health Profile questionnaire at 1 and 3 months postoperatively and clinical and isokinetic testing for abdominal wall strength were similar between the two groups.CONCLUSIONTransecting the rectus muscle was no more deleterious than the Pfannenstiel incision. There was no difference in objectively measured abdominal wall strength.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate the effect of repeated cigarette smoking on fetal heart rate (FHR) characteristics.METHODSFifteen chronic smokers who were between 28 and 36 weeks' gestation were evaluated during an 8-hour smoking session. Baseline FHR and reactivity were evaluated before an initial cigarette and 4 hours later (after the fourth cigarette), when the effects of smoking on FHR were expected to be maximal. Plasma nicotine was measured at baseline and repeated at times of fetal monitoring.RESULTSSubjects smoked a mean ± standard deviation of 22 ± 6 cigarettes per day. They abstained from smoking for 9.2 ± 3.2 hours before evaluation. The initial baseline FHR was 134 ± 9 beats per minute versus 135 ± 11 beats per minute after the fourth cigarette (P= .17). Plasma nicotine increased from 2.6 ± 5.6 ng/mL to 24 ± 9.9 ng/mL after the fourth cigarette (P< .001). The initial nonstress test was reactive in 12 of 15 (80%) of the fetuses. After the fourth cigarette, only four of 15 (27%) of the nonstress tests were reactive. A majority of tracings (eight of 15) were initially reactive before smoking and became nonreactive after smoking. Some tracings remained nonreactive (three of 15), and some tracings remained reactive (four of 15) at both assessments. None of the tracings that were initially nonreactive became reactive. The change in reactivity was significant (P= 013).CONCLUSIONAcute, repeated smoking decreases FHR reactivity.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo investigate whether preoperative treatment with erythropoietin facilitates the collection of a sufficient amount of autologous blood in a short period of time.METHODSForty-one women scheduled for radical hysterectomy were randomized to preoperative autologous blood donation with or without preoperative recombinant human erythropoietin therapy. All patients were scheduled to deposit three units of blood within 2 weeks before surgery. Hemoglobin, erythrocyte volume fraction, blood cells, iron status, and hemolysis were analyzed before and after surgery.RESULTSHemoglobin levels decreased continuously in both groups after the first autologous donation until day 1 postoperatively. With erythropoietin therapy, the erythrocyte volume fraction and hemoglobin levels were significantly higher during precollection and day 1 after surgery. Preoperatively, the drop was 12 g/L less in the erythropoietin-treated group. The additional use of erythropoietin therapy reduced the inability of patients to predeposit blood from 17.8% to 3.4%.CONCLUSIONMost women can predeposit three units of whole blood in only 2 weeks without obtaining severe anemia. By treating women with erythropoietin, one out of seven can be prevented from a hemoglobin level below the 100 g/L limit for donation.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo assess current practice management, attitudes, and strategies of reproductive endocrinologists in the United States regarding high-order (at least three) multiple gestations.METHODSQuestionnaires were mailed to 768 board-certified reproductive endocrinologists of whom 722 were eligible for the study. The questionnaires addressed topics such as practitioner demographics, management strategies, and attitudes regarding high-order multiple gestations.RESULTSThe survey response rate was 52%. Most physicians performed 100–300 cycles of each ovulation induction with intrauterine insemination and in vitro fertilization in 1998 and 1999. The most commonly reported incidence of high-order multiple gestations resulting from each ovulation induction with intrauterine insemination and in vitro fertilization was 2–5% in 1998 and 1999. Strategies used to decrease the rate of high-order multiple gestations varied among practitioners. Informed consent regarding high-order multiple gestations was provided by 99.5% of practitioners. Information regarding selective reduction was provided by 98.3% of respondents. Over 90% of practitioners believed it is worthwhile to attempt to decrease the risk of high-order pregnancies at the risk of decreasing their group's overall pregnancy rates.CONCLUSIONMost reproductive endocrinologists reported concern over the rising risk of high-order multiple gestations resulting from therapies such as superovulation with intrauterine insemination or in vitro fertilization. However, the ways in which patients are counseled regarding such events, their sequelae, and methods to avoid them greatly differ among respondents. Given the inconsistent practice patterns, a multifaceted educational approach may provide an opportunity to reduce the incidence of high-order multiple gestations and their sequelae.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate utility and cost-effectiveness of preoperative autologous blood donation in gynecologic and gynecologic oncology patients.METHODSPheresis unit records were retrospectively reviewed to identify all women who performed autologous blood donation. Clinical charts were abstracted. Use rate (number of units used/number of units donated) and quality-adjusted life years were calculated. Statistical analysis consisted of χ2, Studentt, and Fisher exact tests.RESULTSA total of 106 women with benign (n= 63) and malignant disease (n= 43) donated 143 units (1.4 units per patient) of which 126 (88%) were discarded. Fifteen patients (14%) were transfused a total of 24 units, 17 autologous (71%) and seven allogeneic (29%). Those transfused had a significantly higher estimated blood loss (700 mL versus 275 mL,P< .001), lower nadir hemoglobin (7.9 versus 9.6,P< .001), and longer hospital stay (4.9 days versus 4.0 days,P= .05). Despite similar estimated blood loss (370 mL versus 310 mL), the use rate for malignant versus benign disease was significantly greater (0.31 versus 0.07,P= .005). Radical versus nonradical surgery had a significantly higher estimated blood loss (620 mL versus 250 mL,P= .001) and use rate (0.26 versus 0.11,P= .001) as well. Estimated cost per quality-adjusted life years for autologous blood donation for each category exceeded $1,000,000.CONCLUSIONAutologous blood donation is an expensive medical practice and does not guarantee that exposure to allogeneic blood will not occur. If pursued, it should be directed towards those who have a known malignancy or those for whom radical surgery is anticipated. Other methods of blood conservation may be safer and more cost-effective.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate the efficacy of isotretinoin for prevention of progression of low-grade squamous intraepithelial lesions (SIL) of the cervix to high-grade lesions or invasive cervical cancer; to estimate the regression rate of low-grade SIL with isotretinoin and the toxicity of isotretinoin in this setting; and to correlate serum CD4 levels with progression of low-grade SIL.METHODSA randomized, phase III, observation-controlled, multicenter trial was performed in which 117 human immunodeficiency virus (HIV)-positive women with low-grade SIL of the cervix received either oral isotretinoin at 0.5 mg/kg per day for 6 months or observation. Papanicolaou smears and colposcopy/biopsy were done at regular intervals during follow-up. The primary endpoint was progression to high-grade SIL or cervical cancer.RESULTSTwenty-one of 102 women (20.6%) completing follow-up experienced progression to high-grade SIL, 13 in the observation group and eight in the isotretinoin group. This difference was not significant (P= .29). No cases of invasive cancer were seen. Baseline CD4 levels were lower than anticipated (median 329 cells/mm3), but not associated with time to progression (P= .36). Most subjects (63 of 102, 61.7%) used highly active antiretroviral therapy. Subjects under age 30 were more likely to progress than those older than 30 (P= .046).CONCLUSIONIsotretinoin was not associated with longer time to progression of low-grade SIL. This appears to be a chronic condition in HIV-positive women, with a low risk of progression and significant rate of resolution. As in the general population, observation without excisional therapy may be appropriate for HIV-positive women with low-grade SIL.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo examine the effects of cesarean and forceps or vacuum delivery and parental smoking habits on the initiation and duration of breast-feeding.METHODSWe conducted a prospective, population-based birth cohort study in 1997. Data were collected on breast-feeding history, household smoking habits, method of delivery, and other demographic, obstetric, behavioral, and potential confounding variables via a standardized self-administered questionnaire. Multivariable logistic regression was used to examine the association between method of birth (cesarean versus forceps or vacuum delivery versus normal vaginal birth) and either not initiating breast-feeding or doing so for less than 1 month. Among women who breast-fed for 1 month or more, multivariable survival analysis was employed to study the relationship between method of delivery and breast-feeding duration. We repeated these analyses to examine the link between parental smoking habits and breast-feeding initiation and duration.RESULTSA total of 7825 mother-infant pairs were followed up for 9 months. Cesarean delivery was a risk factor for not initiating breast-feeding, for breast-feeding less than 1 month, and remained a significant hazard against breast-feeding duration. Assisted delivery with forceps or vacuum, although not associated with breast-feeding initiation, was a significant risk against breast-feeding duration. Conversely, current parental smoking habits only affected breast-feeding initiation but were unrelated to breast-feeding duration.CONCLUSIONThis study indicates a possible effect of forceps or vacuum delivery on breast-feeding and of cesarean on long-term breast-feeding duration. The findings provide additional evidence in support of the avoidance of unnecessary obstetric interventions.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo investigate the frequency of parvovirus B19 infection in first-trimester fetal loss, as measured by B19 DNA polymerase chain reaction in placental tissue in a prospective descriptive study from a nonendemic area.METHODSPlacental tissues from first-trimester fetal losses were examined for presence of B19 DNA by polymerase chain reaction in a prospective study during 30 months. For comparison, placental tissues from second-trimester fetal losses, as well as from full-term normal pregnancies, were also studied.RESULTSB19 DNA was detected by polymerase chain reaction in one of 36 (3%) placental tissues from first-trimester fetal losses. In second-trimester fetal losses, eight of 64 (12%) samples were B19 DNA positive. None of the 53 placental tissues from full-term normal pregnancies were B19 DNA positive. In first-trimester fetal losses, maternal serum from the B19 DNA-positive sample was B19 immunoglobulin (Ig)G positive but B19 IgM negative. In second-trimester fetal losses, six of six tested B19 DNA-positive samples were both B19 IgG and IgM positive.CONCLUSIONThe frequency of first-trimester fetal loss associated with parvovirus B19 infection was low, 3%, during a nonepidemic period in Sweden, as measured by B19 DNA-specific polymerase chain reaction in placental tissue.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID