摘要:

OBJECTIVETo study the effect of mifepristone and levonorgestrel on ovarian function and endometrial development in doses effective as emergency contraception.METHODSTwelve fertile women were treated with either 10 mg of mifepristone as a single dose (n= 6) or two doses of 0.75 mg of levonorgestrel, 12 hours apart (n= 6) before and after ovulation. An endometrial biopsy performed during the implantation period was analyzed for endometrial maturation and expression of markers of endometrial receptivity. The markers tested for were integrin α4 and β3, cyclooxygenase-1 and -2, progesterone receptors,Dolichos biflorus agglutininlectin binding, and pinopodes. Urinary excretion of luteinizing hormone, estrone, and pregnanediol were also determinedRESULTSTreatment with mifepristone and levonorgestrel before ovulation inhibited the luteinizing hormone surge showing no significant differences between the means of luteinizing hormone measurements. When mifepristone was administered in the early luteal phase, downregulation of progesterone receptors was inhibited in five of six women. No significant alteration was found in any of the remaining markers of endometrial receptivity.CONCLUSIONThe mode of action of emergency contraception with mifepristone or levonorgestrel is primarily due to inhibition of ovulation rather than inhibition of implantation.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate the effect of a low-intensity behavioral therapy program on urinary incontinence in older women.METHODSA randomized clinical trial for community-dwelling women at least 55 years reporting at least one urinary incontinent episode per week was conducted. Women were randomly assigned to a behavioral therapy group (n= 77) or a control group (n= 75). The treatment group had six weekly instructional sessions on bladder training and followed individualized voiding schedules. The control group received no instruction but kept urinary diaries for 6 weeks. After this period, the control group underwent the behavioral therapy protocol. Using per-protocol analyses,tand χ2tests were used to compare the treatment and control groups, and pairedttests were used to evaluate the efficacy of behavioral therapy for all women (treatment and control groups before and after behavioral therapy).RESULTSWomen in the treatment group experienced a 50% reduction in mean number of incontinent episodes recorded on a 7-day urinary diary compared with a 15% reduction for controls (P= .001). After behavioral therapy, all women had a 40% decrease in mean weekly incontinent episodes (P= .001), which was maintained over 6 months (P< .004). Thirty (31%) women were 100% improved (dry), 40 (41%) were at least 75% improved, and 50 (52%) at least 50% improved. There were no differences in treatment efficacy by type of incontinence (stress, urge, mixed) or group assignment (treatment, control).CONCLUSIONA low-intensity behavioral therapy intervention for urinary incontinence was effective and should be considered as a first-line treatment for urinary incontinence in older women.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo determine if the incidence of invasive cervical cancer relative to carcinoma in situ decreased in Medicare-eligible women.METHODSA retrospective cohort was amassed from the California Cancer Registry database. The hypothesis was prospectively specified. Mean ratio of invasive (International Federation of Gynecology and Obstetrics Stages I–IV) to in situ cervical carcinoma in 1988–1990 versus 1991–1995 was stratified by age (24 or younger, 25–44, 45–64, 65 or older) and race (all races, whites, blacks, Hispanics, Asian/Pacific Islanders).RESULTSThe mean ratio of invasive to in situ cervical cancer incidence for women at least 65 years old was lower in 1991–1995 compared with 1988–1990 (P< .001, 95% confidence interval 0.893, 0.954); and had decreased more than observed for women aged 45–64 and 25–44, for all races combined, and for white women. The decreased ratio of invasive to in situ cancer for blacks, Hispanics, and Asian/Pacific Islanders at least 65 years old was no different than the decreased ratio in younger women.CONCLUSIONIn California, in the 5 years after the 1990 change in Medicare funding statutes for cervical cytology screening, the ratio of invasive cervical cancer to in situ disease decreased more in Medicare-eligible patients than in younger women.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Health care personnel must be prepared for the threat of bioterrorism. Our objective is to educate primary care providers, obstetricians in particular, in the prevention, diagnosis, and treatment of smallpox. Smallpox poses a particularly serious threat because of its high case-fatality rate in unvaccinated populations (no one younger than 25 years has been vaccinated, and older persons have little remaining residual immunity). Routine nonemergency smallpox vaccination is restricted to laboratory staff working with smallpox-related viruses. Under these circumstances, contraindications to vaccination are pregnancy, immunodeficiency, exfoliative skin conditions (eczema), and allergy to vaccine components. In case of an intentional release of the smallpox virus, those directly exposed and their close contacts must be vaccinated and isolated. Under such emergency circumstances, pregnant women exposed to the variola virus should be vaccinated because of the lethality of the disease during pregnancy. Currently, there is a limited supply of vaccine available.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo describe the prevalence of hospitalizations during pregnancy, the reason for hospitalization, the length of stay, and the associated costs.METHODSWe analyzed data from a national managed care organization and determined the occurrence of hospitalizations for 46,179 women who had a live birth or a pregnancy loss in 1997.RESULTSOverall, 8.7% of women were hospitalized during their pregnancy. Of these, 5.7% were hospitalized and discharged while pregnant, 0.8% experienced extended stays before a live birth or pregnancy loss, and 2.1% experienced pregnancy loss. Hospitalizations were more common among younger women, women with multiple gestations, and women in the northeastern United States. Women who had a live birth were primarily hospitalized for preterm labor (24%), hyperemesis (9%), hypertension (9%), kidney disorders (6%), and prolonged premature rupture of membranes (6%). Charges totaled over $36 million.CONCLUSIONAntenatal hospitalizations are common.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo assess the association between prenatal antibiotics, including erythromycin, and infantile hypertrophic pyloric stenosis in a large cohort of infants.METHODSThis was a retrospective cohort study of births to women enrolled in Tennessee Medicaid/TennCare, 1985–1997. Prescriptions for erythromycin, nonerythromycin macrolides, and other antibiotics were identified from pharmacy files linked with birth certificate files. The primary study outcome was development of pyloric stenosis in the infant, identified from linked hospital discharge diagnosis and surgical procedure codes.RESULTSThe cohort included 260,799 mother/infant pairs. Among these women, 13,146 filled prescriptions for erythromycin (50.4 per 1000), and 621 filled prescriptions for nonerythromycin macrolides (2.4 per 1000). There was no association with prenatal erythromycin prescription and infantile hypertrophic pyloric stenosis either after 32 weeks' gestation (adjusted odds ratio 1.17, 95% confidence interval, 0.84, 1.64,P= .33) or at any time during pregnancy (adjusted odds ratio 1.15, 95% confidence interval 0.84, 1.56,P= .36). There was an association between maternal prescriptions for nonerythromycin macrolides and infantile hypertrophic pyloric stenosis (adjusted odds ratio 2.77, 95% confidence interval 1.22, 6.30,P= .01).CONCLUSIONThe hypothesized association between erythromycin and infantile pyloric stenosis was not seen. Causal inference from the association between prenatal nonerythromycin macrolides and infantile hypertrophic pyloric stenosis is limited by the small number of affected children and the evidence of other differences between users of nonerythromycin macrolides and controls.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo assess the association between preconception homocysteine and B vitamin status and risk of clinical spontaneous abortion in women from Anqing, China.METHODSAll women were aged 21–34 years, had never smoked, and were primigravid. Patients (n= 49) were women with a clinically recognized pregnancy who experienced a fetal death before 100 days' gestation. Controls (n= 409) were women who maintained a pregnancy that ended in a live birth. Homocysteine, folate, and vitamins B6and B12concentrations were measured in plasma obtained before conception.RESULTSMean vitamin B6concentration was lower in patients than in controls (34.0 versus 37.9 nmol/L,P= .04). In addition, the risk of spontaneous abortion tended to increase with decreasing plasma vitamin B6and folate concentration (Pfor trend = .06 and .07, respectively), although the significance of these trends was further reduced in logistic models that included age, body mass index, and both vitamins. The risk of spontaneous abortion was four-fold higher among women with suboptimal plasma concentrations of both folate and vitamin B6(folate less than or equal to 8.4 nmol/L and vitamin B6less than or equal to 49 nmol/L) than in those with higher plasma concentrations of both vitamins (odds ratio 4.1, 95% confidence interval 1.2, 14.4). Homocysteine and vitamin B12status were not associated with spontaneous abortion risk.CONCLUSIONSuboptimal preconception folate and vitamin B6status, especially when they occur together, may increase the risk of clinical spontaneous abortion. Additional prospective studies are needed to confirm these findings and to determine whether antenatal B vitamin supplementation reduces spontaneous abortion risk.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo examine the extent of neonatal morbidity and its relation with infant size in newborns diagnosed with clavicular fracture after vaginal birth.METHODSA retrospective case-control study was performed onalltheinfantsdiagnosedwithclavicularfracturesandborn vaginally between July 1997 and June 2000. For each index case, a control matched for gestational age (within l week), birth weight (within 100 g), and delivered within the same 24-hour period (8 AM to 8 AM), was selected at random from the delivery suite registry. If a control could not be identified within the period, the search was extended to the previous or the following 24-hour period, and the birth weight criterion relaxed to within 250 g. The overall neonatal outcome was compared between the two groups and the morbidity was further analyzed according to whether the infants were large for gestational age (LGA) or not.RESULTSClavicular fracture, found in 1.6% (151 of 9540) of vaginal births, was associated with increased incidence of instrumental delivery (P= .001) and shoulder dystocia (P= .013). The associated morbidity were Erb palsy (P= .007), which was more often found in the LGA infants (P= .055), and cephalhematoma (P= .031), which was only found in the non-LGA infants (odds ratio 4.48, 95% confidence interval 1.23, 16.30). On multivariable analysis, clavicular fracture was excluded as a significant factor in these outcomes after adjusting for the effect of instrumental delivery and shoulder dystocia.CONCLUSIONNeonatal clavicular fracture is of little clinical significance, and it does not reflect quality of care.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo investigate the association between intra-uterine growth restriction (IUGR) fetuses with echogenic bowel and high resistance in the umbilical artery and increased risk of developing neonatal necrotizing enterocolitis.METHODSWe analyzed two groups: group 1, singleton IUGR fetuses with echogenic bowel or reversed diastolic flow in the umbilical artery, and group 2, neonates who were diagnosed as having neonatal necrotizing enterocolitis. In group 1, the pulsatility index of the superior mesenteric artery and celiac trunk were determined. In group 2, a retrospective analysis was carried out from the medical records of the neonates.RESULTSFifteen fetuses with echogenic bowel and severe IUGR were evaluated by Doppler studies, and 21 neonates with neonatal necrotizing enterocolitis were reviewed. In group 1, none of the IUGR fetuses developed neonatal necrotizing enterocolitis, whereas in group 2, only one neonate was defined as IUGR. The mean gestational age at delivery did not differ statistically between the two groups (28.8 ± 2.3 weeks versus 30.1 ± 3.3 weeks), whereas the mean birth weight was significantly lower in the first group (700 ± 200 g versus 1431 ± 466 g in the second group,P< .001). The mean pulsatility index ± standard deviation in the superior mesenteric artery and celiac trunk of the IUGR fetuses were 1.5 ± 0.14 and 1.2 ± 0.17, respectively, both being found significantly lower than those of normal, appropriate controls (1.9 ± 0.15 and 1.7 ± 0.1, respectively,P< .005).CONCLUSIONFetal echogenic bowel in IUGR fetuses is not associated with development of neonatal necrotizing enterocolitis. In these fetuses, vasodilatation in the superior mesenteric artery and celiac trunk have been demonstrated.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate the contribution of placental histopathology to the diagnosis of congenital syphilis.METHODSFrom January 1, 1986, through December 31, 1998, all pregnant women presenting to a large, urban Dallas County labor and delivery unit with untreated syphilis at delivery and who had placental evaluation performed were identified. Women were clinically staged, and the infants were evaluated for congenital syphilis using a standard protocol. Each placenta was evaluated by two independent pathologists. Histologic characteristics of the placenta related to congenital syphilis in live-born and stillborn infants were then analyzed.RESULTSSixty-seven women met the study criteria: 33 (49%) stillborn and 18 (27%) live-born infants with congenital syphilis, 15 (22%) uninfected live-born infants, and one uninfected stillborn fetus diagnosed by current criteria. There were no differences between the groups with regard to demographic characteristics, prenatal care, or stage of syphilis. Stillborn infants were more likely to deliver pre-term (P< .001). Controlling for gestational age, histopathology revealed necrotizing funisitis, villous enlargement, and acute villitis associated with congenital syphilis. Erythroblastosis was more common in stillborn infants with congenital syphilis than all live-born infants (odds ratio 16, 95% confidence interval 1, 370). The addition of histologic evaluation to conventional diagnostic evaluations improved the detection rate for congenital syphilis from 67% to 89% in live-born infants, and 91% to 97% in stillborn infants.CONCLUSIONOur results show that histopathologic examination of the placenta is a valuable adjunct to the contemporary diagnostic criteria used to diagnose congenital syphilis.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID