摘要:

ObjectiveTo test for a significant difference between functional and neoplastic ovarian cysts with respect to epidermal growth factor (EGF) receptor and c-erbB-2 proto-oncogene amplification rates.MethodsWe detemined amplification of EGF-receptor andc-erbB-2 genes by differential polymerase chain reaction (PCR) on 138 ovarian-cyst aspirates. The semiquantitative differential PCR is based on simultaneous co-amplification of a target gene and a reference gene. Amplification rates were detected by densitometry of silver-stained polyacryl-amide gels and were scored as single-, low-, or high-copy numbers. Wilcoxon ranked sum test, Pearson correlation coefficient, and multiple logistic regression were used to evaluate the differences in oncogene amplification and to predict histology.ResultsThere were 71 (51.5%) women with functional cysts, whereas 67 (48.5%) had benign (n= 59) or malignant (n= 8) tumors. Low-copy (two- to fourfold copy numbers) EGF-receptor gene amplification was found in 22 of 67 (33%) women with neoplastic cysts, but in only eight (11%) of those with functional cysts. Neoplastic histology differed significantly from functional histology in correlation to EGF-receptor low-copy gene amplification (r= .279,P< .001). There was no significant difference inc-erbB-2 gene amplification with respect to functional and neoplastic histology (r= .083,P= .32).ConclusionsLow-copy EGF-receptor gene amplification seems to be a marker for neoplastic histology. Epidermal growth factor receptor gene amplification may be involved in proliferation and growth in an early stage of tumorigenesis. However, further studies are required to investigate this gene structure abnormality on a gene function level. Amplification ofc-erbB-2 proto-oncogene does not appear to be a common factor in the development of ovarian tumors.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo investigate the relation between maternal administration of theophylline and breathing movements during late gestation in human fetuses.MethodsAfter a 1-hour control period, 17 women with normally grown fetuses at 33–38 weeks' gestation were given 400 mg of sustained-release theophylline orally. Maternal plasma theophylline and glucose concentrations were measured every hour, and the incidence of fetal breathing movements and breathing rates were measured continuously during the next 8 hours. Results were compared with those of a similar control group that did not receive theoph-ylline.ResultsThe maternal plasma theophylline concentration increased to detectable levels after 1 hour, reached therapeutic levels of 6.9 ± 0.4 μg/mL (standard error of the mean) after 6 hours, and thereafter averaged 8.3 ± 0.3 μg/mL, significantly higher than initial control values (P< .05). The mean glucose concentration was unchanged during the first 6 hours (79.2 ± 1.1 mg/dL) and then decreased somewhat, averaging 75.8 ± 1.1 mg/dL in the 7–8-hour period. The incidence of fetal breathing increased 26.4 ± 1.9% after 5 hours and remained elevated during the next 3 hours at levels significantly higher than in the initial control period (P< .05) and higher than in the control group that did not receive theophylline. The mean hourly breathing rate averaged 40.9 ± 1.3 breaths per minute during the control period and 40.2 ± 1.2 breaths per minute after ingestion of theophylline, a nonsignificant change.ConclusionsIngestion of theophylline by pregnant women in late gestation is associated with an increase in fetal breathing movements. Theophylline has been used widely in the management of asthma in pregnancy, and the assessment of fetal breathing movements is used routinely for evaluation of fetal status. Therefore, account must be taken of changes in breathing movements caused by maternal theophylline administration.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo compare karyotypic, ultrasonographic, and prognostic features of septated cystic hygromas and nonseptated cystic hygromas in second-trimester fetuses.MethodsA computerized ultrasound data base was used to identify fetuses diagnosed with cystic hygromas at 14–22 weeks' gestation. Photographs from the initial ultrasound were reviewed retrospectively for hygroma type (septated or nonseptated) and any abnormal structural findings. Fetal karyotypes were obtained from amniotic fluid, aspiration of hygroma pouches, or fetal tissue culture. Pregnancy outcome information was obtained from hospital charts and physician office records. Ultrasound findings were then compared with fetal karyotype results and pregnancy outcome data.ResultsFrom 1990 to 1995, 61 fetuses with cystic hygromas were identified. Karyotypes were obtained in 55 fetuses, and pregnancy outcome was available for 59. Abnormal karyo-type was present in 42 of 55 fetuses (76%). The most common chromosomal abnormality in septated hygromas was the 45,Xkaryotype. Trisomy 21 was the most common chromosomal abnormality in nonseptated hygromas. Compared with fetuses with nonseptated cystic hygromas, those with septated cystic hygromas were more likely to be aneuploid (33 of 39 [85%] versus nine of 16 [56%];P= .03), more likely to develop hydrops (27 of 45 [60%] versus three of 16 [19%];P= .005), and less likely to be live-born (one of 44 [2%] versus four of 15 [27%];P= .01).ConclusionsFetuses with septated cystic hygromas are more likely to be aneuploid and to develop hydrops, and thus are less likely to survive than fetuses with nonseptated hygromas.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo analyze the results of prenatal findings and the outcome of triploidy and to organize an efficient approach to prenatal diagnosis during the second trimester.MethodsWe reviewed 70 cases of triploidy presenting between 13 and 29 weeks' gestation over a 10-year period.ResultsEach fetus had at least one measurement below the normal range, and 50 cases (71.4%) presented with asymmetrical growth restriction and normal placental appearance. All cases of triploidy associated with partial mole were diagnosed before 25 weeks. Structural fetal defects were observed antenatally in 65 (92.9%) cases. The most common defects were abnormalities of the hands (52.3%), bilateral cerebral ventriculomegaly (36.9%), heart anomalies (33.8%), and micrognathia (26.2%). The most frequent combination of abnormalities was malformation of the hands and ventriculomegaly. Decreased red blood cell counts and high mean cell volume were found in the 50 cases tested. Vaginal bleeding in the first or second trimester was the most common maternal symptom reported.ConclusionsThe major features that should alert the sonographer to the possible diagnosis of triploidy are partial molar changes or severe asymmetrical fetal growth restriction in the presence of an apparently normal placenta.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo evaluate maternal parity, the sonographic measurement of cervical length, and the five components of the Bishop score to determine which factors best predict the length of latent-phase labor in women undergoing labor induction.MethodsCervical position, cervical consistency, cervical effacement, cervical dilation, station of fetal presenting part, maternal parity, and sonographic measurement of cervical length were studied prospectively in 109 women undergoing labor induction. A multiple regression model was used to determine which factors best predict the length of latent-phase labor.ResultsA model using these seven factors was predictive in determining the number of hours of latent-phase labor (F= 32.1,P< .001). Backward stepwise multiple linear regression indicated that only cervical dilation independently predicted the length of latent-phase labor. There was a significant correlation between the clinical assessment of cervical effacement and the sonographic estimation of cervical length, (r= −0.523,P< .001).ConclusionOnly cervical dilation appears to predict the length of latent-phase labor. The sonographic evaluation of cervical length and maternal parity do not add significant independent information.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo evaluate whether epidural analgesia during the first stage of labor is associated with an increased risk of cesarean delivery.MethodsThe association of epidural analgesia and cesarean delivery was examined in a retrospective study of 1733 low-risk, term nulliparas with singleton infants in vertex presentations, in which labor began spontaneously. To evaluate the effect of epidural analgesia on cesarean deliveries, independent of other factors influencing the use of epidural analgesia, we used propensity scores to create five subgroups (quintiles) of women who, based on characteristics discernible at admission, appeared equally likely to receive epidural analgesia. Multivariate logistic regression analysis was used to control for confounding.ResultsOverall, the cesarean rate among women receiving epidural analgesia was 17% (168 of 991), compared with 4% (30 of 742) among those who did not receive epidural analgesia. An increased cesarean rate among women receiving epidural analgesia was present in all propensity quintiles. In an adjusted logistic regression analysis, women receiving epidural analgesia were 3.7 times more likely to undergo a cesarean (95% confidence interval 2.4, 5.7). The greatest increase in cesarean risk was noted when epidural analgesia was administered earlier in labor, but there was a more than twofold increase regardless of the dilation and station at administration of epidural analgesia.ConclusionsEpidural analgesia may increase substantially the risk of cesarean delivery. Although the causal nature of this association remains open to debate, prenatal care providers should routinely discuss the risks and benefits of epidural analgesia with women during their pregnancies so that they can make informed decisions about the use of pain relief during labor.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo assess changes in urethral movement during the Valsalva maneuver and pelvic floor muscle contraction following vaginal delivery.MethodsIn a prospective repeated-measures study, 25 primigravidas, 20 multiparas, and ten women who were to have elective cesarean delivery were examined sonographi-cally at 36–42 weeks of pregnancy and 6–10 weeks after delivery. Vesical neck position at rest and excursion during Valsalva maneuver and maximum pelvic muscle contraction were measured with perineal ultrasound. Data about resting bladder neck position and bladder neck elevation at contraction were compared with findings in age-matched nulli-gravid volunteers.ResultsThe bladder neck was significantly lower at rest in women after vaginal delivery than in those who had an elective cesarean delivery and in nulligravid controls. Bladder neck mobility had increased during the Valsalva maneuver in 16 of 25 primigravidas and 15 of 20 multiparas 6–10 weeks after vaginal delivery. The ability to elevate the vesical neck during pelvic muscle contraction was decreased in six of 25 primigravidas and in two of 20 multiparas 6–10 weeks after birth. Two women, one primigravid and one para 2 (with a previous elective cesarean delivery), both of whom had forceps delivery, completely lost the ability to contract voluntarily the pelvic floor muscles.ConclusionVaginal delivery alters vesical neck descent during the Valsalva maneuver, and the ability of the pelvic muscles to elevate the urethra in some women.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo document operative vaginal delivery rates of ACOG Fellows and to stratify practice patterns with regard to mid-pelvic delivery and deep transverse arrest by the time elapsed since residency.MethodsA survey was mailed to a random sample of 1600 ACOG Fellows. Of the 597 respondents (37%), 558 who still practice obstetrics formed the study group. Selection bias regarding recipients of the survey was reduced by random-ization by an uninvolved third party. The length of time since residency was categorized as 10 years or fewer (“recent,” 31%), 11–20 years (“intermediate,” 43%), and more than 20 years (“remote,” 26%).ResultsThe majority of respondents (338 of 558, 61%) reported an operative vaginal delivery rate of 15% or less. One hundred forty-two (25%) use only forceps, whereas 78 (14%) use vacuum extraction exclusively. More than half have abandoned mid-pelvic operative vaginal deliveries, and of the 41% who still perform these operations, about half use forceps. In cases of deep transverse arrest, about 25% perform cesarean delivery, whereas 26% and 42% use forceps or vacuum, respectively. Resident training and practice in vacuum delivery were more common in the recently trained groups (recent > intermediate > remote;P< .001). There were no differences among the groups with respect to attempting mid-pelvic operative vaginal delivery (P= .29), but the remote group was more likely to use forceps, whereas the recent group was more likely to use vacuum (P= .039). A large disparity existed among the groups regarding the management of deep transverse arrest, with vacuum use associated with group assignment (P< .001).ConclusionsThe majority of respondents have an operative vaginal delivery rate of no more than 15%. Most respondents have abandoned mid-pelvic operative vaginal delivery. Practice patterns reflect differences in residency training; the more recently trained Fellows more often were taught and use vacuum for delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo gather information on women's perceptions of the services delivered in collaborative obstetrics and gynecology practices and to determine whether patients perceive a difference in the delivery of services in a variety of practice settings.MethodsA cross-sectional patient satisfaction survey was developed by the Collaborative Practice Advisory Group of ACOG. Ten collaborative practices were selected to participate: five in private offices, two in clinics, two in health maintenance organizations, and one in the military. Between April 15 and May 15, 1994, 3257 completed surveys were obtained for analysis.ResultsBetween 71% and 92% of women, depending upon the practice setting, agreed with statements regarding the possible benefits from being cared for in a collaborative practice. The majority (75–92%) expected services provided in a collaborative practice to differ from those provided in a noncollaborative practice. Women making their first visit to a collaborative practice expected quicker appointments, more time with the provider, more health information, and more specific diet information than did women who had previously been seen in such a practice. There were minimal differences in comfort levels when discussing issues of sexuality and physical and sexual abuse in either public or private settings with physicians or non-physicians.ConclusionsPatients in this survey were accepting of the concept of collaborative practice and felt that it offered quicker appointments, more time with the provider, more health information, and more specific diet information than did physician-only practices.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo describe the perceived quality of life and functional status of women with human immunodeficiency virus (HIV) during the antenatal, perinatal, and postpartum periods.MethodsMedical Outcome Survey—Short Form questionnaires were completed during antenatal visits, 24 hours after delivery, and 6 months postpartum by 21 HIV-positive women and 21 HIV-negative controls matched for age, race, parity, and education. The Medical Outcome Survey—Short Form measures subject perceptions of overall health, pain, physical role, social and cognitive function, mental health, energy/fatigue, health distress, quality of life, and health transition. Median scores between 0 and 100 (with 0 indicating poorest health) were compared using the Wilcoxon signed-rank and Kruskal Wallis/Dunn tests.ResultsAll HIV-positive patients were asymptomatic; the median CD4 count was 386 on entry into the study. Seropositive patients reported increased health distress (50.0 versus 87.5;P< .001) and worse health transition (60.0 versus 80.0;P= .01) during antenatal visits. During the perinatal period, HIV-negative patients had a decreased sense of overall health (40 versus 80;P< .001) and worse health transition (40.0 versus 60.0;P= .04). Six months postpartum, the HIV-positive women reported decreased cognitive function (41.7 versus 62.5;P< .005) and worse social function (33.3 versus 66.7;P= .02). In general, HIV-negative women reported better quality of life in the antepartum as compared with the perinatal or postpartum period. This overall trend was also seen in the HIV-positive population.ConclusionsThis is the first longitudinal evaluation of perceived quality of life in HIV-positive pregnant subjects. We conclude that perceived quality of life differs between HIV-positive and HIV-negative pregnant women. These differences may not be manifest during initial antenatal visits but may develop as pregnancy, the disease process, and other life events specific to delivery and the postpartum period interact and affect overall perceived quality of life. Longitudinal evaluation of quality-of-life issues may be important in the comprehensive care of HIV-positive women during pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID