摘要:

ObjectiveTo identify predictive factors for success or failure of perineoplasty for severe vulvar vestibulitis.MethodsSeventy-nine women with severe vulvar vestibulitis underwent perineoplasty by a single surgeon during 1992–1994. Sixty (76%) who experienced a complete response were compared with 19 (24%) who had an incomplete response. Using univariate and then multivariate (logistic regression) analysis, the two groups were compared with regard to preoperative demographic, social, and medical variables, as well as physical findings in the vestibule.ResultsThe complete- and incomplete-response groups were similar in all comparisons except for constant vulvar pain of vestibular origin (in addition to dyspareunia) and the presence of symptoms since first coitus. On multiple logistic regression, these characteristics had odds ratios (and 95% confidence intervals) of 4.97 (1.49, 16.63) and 5.83 (1.74, 19.55), respectively.ConclusionAn incomplete response to perineoplasty may be anticipated in women with vulvar vestibulitis associated with dyspareunia since their first episode of inter-course and in those with associated persistent vulvar pain. Treatment approaches other than surgery should be considered for such patients.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify the minimum effective single oral dose of metronidazole for trichomoniasis.MethodsWomen attending an inner-city sexually transmitted disease clinic who hadTrichomonas vaginalisvaginitis diagnosed by microscopy were recruited for this randomized, double-blind study. Subjects were given a 0.5-, 1-, 1.5-, or 2-g single oral dose of metronidazole, taken under direct observation. Demographic information, symptoms, and clinical findings were collected from patient interviews, and physical examinations were conducted at the time of enrollment and at the follow-up visit. The primary outcome measure was treatment success at the follow-up visit, established by negative culture and microscopy.ResultsThree (1.8%) of the 167 women enrolled were excluded because of vomiting after taking metronidazole, and 66 (40%) of the 164 remaining subjects did not return for the follow-up visit. No associations were found between the proportion of subjects lost to follow-up and the characteristics of these subjects across assignment groups. The treatment success ratio was highest in subjects who received the 1.5-g dose (23, 85%), followed by the 2-g (16, 84%), 1-g (18, 62%), and the 0.5-g dose (8, 35%).ConclusionA single 1.5-g dose of metronidazole has efficacy equivalent to a single 2-g dose for the treatment ofT vaginalis vaginitis.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the ectopic pregnancy rate among symptom-free women at increased risk undergoing a screening program involving transvaginal sonography and serum hCG testing.MethodsConsecutive symptom-free women at increased risk for ectopic pregnancy were studied prospectively by transvaginal sonography and serum hCG measurement to detect ectopic pregnancy before the onset of symptoms.ResultsBetween September 1993 and May 1996, 143 symptom-free pregnant women with pregnancies of a gestational age of less than 7 weeks were screened. Eight had ectopic pregnancies, 129 had intrauterine pregnancies, and six had trophoblast in regression. Among the eight women with ectopic pregnancies, one was initially diagnosed as having an intrauterine pregnancy. This woman returned 1 week later with abdominal pain, and an ectopic pregnancy with intra-abdominal bleeding was found. Ectopic pregnancies were present in 5.6% (95% confidence interval 2.5%, 10.7%) of the women screened. This was significantly lower than reported in a previous study.ConclusionThe ectopic pregnancy rate in the population that was offered screening was low. Thus, it is questionable whether the possible benefits (prevention of complications and reassurance of the woman) outweigh possible detriments (false-positive diagnosis, financial costs, and emotional stress that could be induced by screening).

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine if a cystometrogram performed using the intrauterine pressure channel of a fetal monitor can be used to screen for detrusor instability in women undergoing evaluation for urinary incontinence.MethodsSixty-six women with primary complaints of urinary incontinence were randomized to have a cystometrogram performed at their initial visit with a multichannel electronic cystometer or with the intrauterine pressure channel of a fetal monitor. Subjects underwent a second cystometrogram 1-4 weeks later with the alternative technique. The results were analyzed with X2analysis and correlation coefficients.ResultsTwenty-two subjects had detrusor instability diagnosed by the multichannel electronic cystometer. The fetal monitor cystometrogram was 91% sensitive and 86% specific in detecting detrusor instability, and had a 77% positive predictive value and a 95% negative predictive value. The correlation coefficients between the two examinations for bladder volume at first sensation, maximum capacity, volume at first contraction, and intensity of uninhibited detrusor contraction werer= 0.51,r= 0.69,r= 0.87, andr= 0.79, respectively; all of these were statistically significant.ConclusionThe intrauterine pressure channel of a fetal monitor can be used reliably to perform a cystometrogram to screen for detrusor instability in patients presenting with complaints of urinary incontinence.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether first-trimester exposure to fluoxetine, a selective serotonin reuptake inhibitor commonly used to treat depression and obsessive-compulsive disorders, is associated with increased frequency of fetal malformations.MethodsWe evaluated outcomes of all pregnancies identified prospectively with confirmed first-trimester fluoxetine exposure contained in the Eli Lilly and Company worldwide fluoxetine pregnancy registry. These outcomes were compared with historic reports of newborn surveys.ResultsOutcomes were available for 796 pregnancies, 37 from fluoxetine clinical trials and 759 from spontaneous reports. Spontaneous abortions were reported in 110 of the 796 (13.8%) pregnancies. Of the remaining 686, malformations, deformations, and disruptions, including those identified after the perinatal period, were reported in 34 (5.0%). No consistent or recurring pattern of abnormalities was observed.ConclusionBased on comparison with historic reports of newborn surveys, it is unlikely that maternal fluoxetine use during the first trimester of pregnancy results in increased risk of fetal malformations.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the reliability of the dipalmitoyl phosphatidylcholine test in predicting respiratory distress syndrome (RDS) in the presence of common contaminants of amniotic fluid.MethodsForty specimens of amniotic fluid collected within 72 hours of delivery were divided in five 25 μL aliquots and diluted with either phosphate-buffered saline (control), meconium, blood, vaginal fluid, or semen. The concentration of dipalmitoyl phosphatidylcholine in all five groups of samples, as measured by the dipalmitoyl phosphatidylcholine test, was compared by pairedttest, Dunnett test, and analysis of variance, and correlated with the neonatal respiratory status of the newborns.ResultsNo significant differences in the concentration of dipalmitoyl phosphatidylcholine were found between control and the corresponding contaminated samples (P= .33). Of the 200 samples evaluated, 80 had dipalmitoyl phosphatidylcholine concentrations below 12 μg/mL and 120 had at least 12 μg/mL. Using a cutoff dipalmitoyl phosphatidylcholine concentration of 12 μg/mL, the presence of RDS was predicted accurately in all 15 control and in 61 of 65 contaminated samples. The absence of RDS, as predicted by a dipalmitoyl phosphatidylcholine value at least 12 μg/mL, was predicted accurately in 24 of 25 control samples and 96 of 100 contaminated samples. The overall accuracy of the dipalmitoyl phosphatidylcholine test in predicting RDS in contaminated samples was 98%.ConclusionThe dipalmitoyl phosphatidylcholine test is a reliable predictor of RDS in contaminated samples.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine if amniotic fluid distribution predicts perinatal outcome in women with spontaneously ruptured membranes.MethodsPatients presenting for labor and delivery with spontaneously ruptured membranes had amniotic fluid indices determined upon admission. Those with greater than 50% of their amniotic fluid in the upper quadrants were placed in the upper-greater group and those with greater than 50% in the lower quadrants were placed in the lower-greater group. The groups were compared with respect to meconium staining, 1- or 5-minute Apgar scores below 7, persistent variable or late decelerations, umbilical arterial or venous pH below 7.20, cesarean for non-reassuring fetal heart rate monitoring, and neonatal intensive care unit admissions.ResultsOne hundred women were studied, 60 in the upper-greater group and 40 in the lower-greater group. Significant differences between upper-greater and lower-greater distributions were noted in meconium staining (28.3% compared with 0%,P< .001), 1-minute Apgar score below 7 (16.7% compared with 2.5%,P< .027), variable decelerations (63.3% compared with 25.0%,P< .001), late decelerations (23.3% compared with 0%,P< .001), and cesarean for non-reassuring fetal heart tracing (11.6% compared with 0%,P< .025). The negative predictive values for all of the variables studied were in the range 92.5-100%, with the exception of variable decelerations (75%).ConclusionAmniotic fluid distribution predicts perinatal outcome in patients with ruptured membranes. This test's high negative predictive value indicates its potential as a valuable screening tool. These results may provide additional guidance in defining the intrapartum management of patients presenting with ruptured membranes.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo find out if hepatocyte growth factor (HGF) in amniotic fluid (HGF-AF) has a direct effect on fetal lung development, we investigated the effects of AF as well as recombinant human HGF (rhHGF) on proliferation, migration, and morphogenesis of fetal alveolar type II cells in vitro.MethodsAmniotic fluid samples were obtained from 37 women at various gestational ages. Mitogenic, motogenic, and morphogenic activity was investigated by 5-bromo-2′deoxyuridine incorporation, Boyden chamber assay, and culture in collagen-gels, respectively.ResultsThe motility of AK-D cells was stimulated by AF from 14 to 31 weeks' gestation in proportion to the concentration of HGF-AF, and this effect was comparable to that observed with rhHGF. Furthermore, this activity was neutralized by anti-human HGF antibody. However, AF samples subsequent to 32 weeks had no motogenic influence despite the continued presence of immunoreactive HGF-AF. Neither increased DNA synthesis nor morphogenesis in response to AF was identified under the conditions used.ConclusionThe present study suggests that AF stimulates alveolar type II cell migration by way of HGF-AF in vitro.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the fetal iliac wing angle in detecting trisomy 21 in the second trimester of pregnancy.MethodsUsing an axial view of the fetal pelvis, the angle between the right and left iliac wings (iliac wing angle) was measured ultrasonographically at the time of the secondtrimester ultrasound or genetic amniocentesis in 377 singleton fetuses. Trisomy 21 was diagnosed by karyotype results from the amniocentesis or newborn examination with karyotype if trisomy 21 was suspected based on phenotypic features. Sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) were calculated using multiple cutoff points. A receiver operating characteristic (ROC) curve was used to identify the optimum iliac wing angle. Descriptive statistics and Student t test were utilized for analyses with aPof less than .05 considered significant.ResultsThe average gestational age was 18.8 weeks (range 13–32). Karyotypes were available in 128 fetuses. The overall prevalence of trisomy 21 was 11 of 377 (2.9%). The mean (± standard deviation) iliac wing angle in the normal fetuses was 68.2 degrees (±15.4 degrees) and 98.5 degrees (±11.3 degrees) in fetuses with trisomy 21 (P< .001). Using an ROC-derived absolute cutoff of 90 degrees, an abnormal iliac wing angle had sensitivity of 90.9% (ten of 11), specificity of 94.5% (346 of 366), NPV of 99.7% (346 of 347), and PPV of 33.3% (ten of 30) to detect trisomy 21.ConclusionFetuses with trisomy 21 have greater iliac wing angles than do normal fetuses. Using an ROC-derived absolute cutoff of 90 degrees, we could detect 90.9% of fetuses with trisomy 21 with a PPV of 33% in our high-risk population. These findings suggest that iliac wing angle is a useful marker in antenatal screening for trisomy 21.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveThe purpose of this study was to investigate the placental passage of erythropoietin in a placental perfusion model ex vivo.MethodsIn an open system 18 placentas were perfused on both the maternal and the fetal side. Erythropoietin and a reference substance were added to either the maternal or fetal perfusion medium. In the first series of experiments, radiolabeled erythropoietin was added to the perfusion medium in four different concentrations to help determine the transfer rate of erythropoietin. Based on the results of these experiments unlabeled erythropoietin was added to the perfusate in three different concentrations. Radiolabeled erythropoietin was used in addition to erythropoietin because measuring radioactivity in a gamma counter is less expensive than measuring by immunoassay.ResultsAccumulation of radioactivity in the venous portion of the fetal circuit was only 3.21% of the activity added to the maternal circuit. No evidence of transfer of erythropoietin to the contralateral compartment was noted, regardless of whether the test substance was added maternally or fetally. These results were independent of the concentration used. The reference compound antipyrine showed a mean transfer rate of 27.9%, which is in keeping with previous results.ConclusionThere is no transport of erythropoietin across fetal membranes. This finding is particularly remarkable in view of results published recently indicating the placenta as a site of erythropoietin production. The lack of its transport across the human placenta is most likely due to its high molecular weight.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID