摘要:

From an analysis of 11 abdominal pregnancy-related deaths and an estimated 5221 abdominal pregnancies in the United States, we estimated that there were 10.9 abdominal pregnancies per 100,000 live births and 9.2 per 1000 ectopic pregnancies; the mortality rate was 5.1 per 1000 cases. Although the risk of having an ectopic pregnancy is rising, the risk of abdominal pregnancy, which is probably always a sequel of a missed ruptured ectopic pregnancy, is apparently declining; this may be due to improved prenatal care. However, only one of nine women who reached the hospital alive had an accurate preoperative diagnosis of abdominal pregnancy, which suggests that preventing abdominal pregnancy-related death may depend, at least in part, upon increasing physicians' awareness of its clinical features.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Two hundred fifty-six vacuum extractions and 300 randomly chosen forceps deliveries were analyzed retrospectively. Vacuum extraction use increased from 0.3 to 3.1%, while forceps use declined from 10.1 to 4.9% over a five-year period. No differences were found in indications for vacuum extraction and forceps, but the preapplication position differed (occiput posterior or transverse in 81.2% in the vacuum group and 27% in forceps patients). Preapplication station also differed, with 59.8% of vacuum extraction at +1 or higher stations, compared with 9% of forceps. Under these conditions we found less maternal trauma, similar failure rates (3.9 versus 2%), and no difference in maternal morbidity. There was a higher incidence of shoulder dystocia and neonatal jaundice in the vacuum group, but cephalohematoma frequency did not differ significantly (3.9% vacuum extraction, 4.3% forceps). Cosmetic injuries (ecchymoses, abrasions) were more likely with vacuum extraction than with forceps (44.1 versus 29.5%). One death occurred in each group. Vacuum extraction replaced midforceps in our institution in the study period. We consider vacuum extraction a useful technique to teach house staff in view of today's decreasing instrumental delivery rate.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We used second laparoscopy with dye insufflation to evaluate tubal findings in 20 women 15–45 weeks after treatment for acute pelvic inflammatory disease. Eight women had pelvic adhesions, including all six women with adhesions seen at first laparoscopy. However, in five of the six women, adhesions were milder or had disappeared unilaterally. Dye insufflation revealed tubal occlusion in five of eight women with adhesions and one of 12 women without adhesions. Thus, nine women (45%) had pelvic adhesions or tubal occlusion at second laparoscopy. Second laparoscopy is useful to objectively assess posttreatment tubal and peritubal morphology. Larger studies are needed to evaluate the cost-effectiveness of the procedure and the correlation of second laparoscopy findings to future infertility.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A monoclonal antibody specific forChlamydia trachomatis(Syva Microtrak) was used to stain directly 249, 127, and 67 specimens obtained from the cervix, and the female and the male urethra, respectively. The Microtrak system identified 100% or 23 culture-positive cases from the cervix (prevalence 9.2), 100% or seven culture-positive cases from the female urethra (prevalence 5.5%), and 93% or 14 culture-positive cases from the male urethra (prevalence 22.4%). Because the Microtrak system is readily available, relatively inexpensive, and easy to read with a fluorescent microscope, it should become a valuable tool to assess objectively both men and women suspect for this common sexually transmitted disease.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A solid-phase enzyme immunoassay (Gonozyme) was used to detectNeisseria gonorrhoeae; the results were compared with the results of cultures taken simultaneously from 201 patients from sexually transmitted disease clinics or family planning clinics. Cultures were positive in 32 of 201 consecutive patients seen in the clinics, while the Gonozyme was positive in 28 of these patients. Overall, five positive cultures were not detected by the Gonozyme, and one positive Gonozyme was not confirmed by culture in the 201 patients tested. The overall sensitivity of the enzyme immunoassay was 84.4% and the specificity 99.4%. The predictive values of a positive and negative Gonozyme result were 96.4 and 97.1%, respectively.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The group B β-hemolytic streptococcus has been implicated in significant maternal and neonatal infections. The usual criteria for identifying the organism has been culture. A preliminary prospective study of the applicability of a simple, rapid, and readily available inexpensive screening tool, the Gram stain, was evaluated in 98 high-risk patients (premature rupture of the membranes and/or premature labor). In this selected population, cervical Gram stain was found to have a 98% negative predictive value for subsequent culture-proven group B β-hemolytic streptococcus colonization. The sensitivity, specificity, and positive predictive values were, respectively, 93, 69, and 33%. Gram stain may be an appropriate test to assist in evaluation of group B β-hemolytic streptococcus colonization in an at-risk population.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Interpreting ultrasound measurements in preterm pregnancies complicated by premature rupture of the membranes is problematic; the effects of physical compression and diminished fetal growth are unclear. To delineate these factors, we analyzed ultrasound scans from 397 preterm pregnancies, including 26 with premature rupture of the membranes. Mean biparietal diameter (BPD), abdominal circumference, femur length, and estimated fetal weight were all significantly smaller with premature rupture of the membranes than without. However, this reflected younger gestational age and diminished fetal growth, rather than physical compression. The reduction in abdominal circumference was greater than that in other indices, which further suggests compromised intrauterine growth. Clinical interpretation of ultrasound measurements should consider the increased likelihood of growth retardation with preterm premature rupture of the membranes to avoid underestimating gestational age and/or missing the diagnosis of intrauterine growth retardation.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Forty-three consecutive twin pregnancies were evaluated by ultrasound to establish criteria for antenatal detection of discordant fetal growth. For each fetus an attempt was made to measure the biparietal diameter (BPD), abdominal circumference, and femur length; the estimated fetal weight was also calculated based on published formulas. The intrapair differences in BPD, abdominal circumference, femur length, and estimated fetal weight were evaluated as predictors of discordant fetal growth. Although the intrapair difference in BPD measurement was not a statistically significant predictor, an intrapair difference in abdominal circumference of 20 mm or more was found to have sensitivity 80%, specificity 85%, positive predictive value 62%, and negative predictive value 93%. Intrapair difference in the estimated fetal weight was found to be the best predictor of discordant fetal growth (sensitivity 80%, specificity 93%, positive predictive value 80%, and negative predictive value 93%). These data suggest that the intrapair difference in abdominal circumference measurement could be effectively used as a screening test for the diagnosis of discordant fetal growth. If the intrapair difference in abdominal circumference is 20 mm or greater, further evaluation, by determining the intrapair difference in estimated fetal weight, is indicated.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We evaluated prospectively the extent of trophoblastic embolization and its central hemodynamic effects during and after evacuation of large molar pregnancies in six women. A pulmonary artery catheter was inserted to obtain hemodynamic measurements as well as to obtain blood samples to identify trophoblasts before, during, and six hours after evacuation. Small numbers of both multinucleated giant cells and of large mononuclear cells with abundant cytoplasm were identified in the buffy coat of blood, aspirated in two cases before evacuation and for all six cases, during evacuation. There were no significant changes in heart rate or mean systemic arterial, pulmonary arterial, central venous, and pulmonary capillary wedge pressures; or cardiac output, stroke volume, and pulmonary or systemic vascular resistance when preevacuation preanesthetic values were compared with those six hours after evacuation. However, significant decreases in heart rate, mean arterial pressure, and pulmonary vascular resistance were observed during evacuation, which returned to preevacuation levels by completion of anesthesia.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Aneuploidy is commonly associated with malignancy and certain premalignant conditions. Recent studies have demonstrated an association between prognosis and the presence of aneuploidy. In this study, flow cytometry was used to determine the deoxyribonucleic acid (DNA) content of tissues with cervical intraepithelial neoplasia or invasive cervical carcinoma. Of 41 evaluable patients with cervical intraepithelial neoplasia, aneuploidy was demonstrated in the specimens of three of ten patients with cervical intraepithelial neoplasia II and six of 13 with cervical intraepithelial neoplasia III. No specimens with cervical intraepithelial neoplasia I, with condylomata, or without pathologic diagnosis contained aneuploid populations. Of the 22 evaluable specimens with invasive cervical carcinoma, 13 contained aneuploid populations. In stage I cervical lesions, aneuploidy appeared to be a poor prognostic factor with an overall survival of two of five patients with aneuploid tumors versus five of five patients with diploid tumors.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID