摘要:

OBJECTIVETo evaluate the anatomy and function of the levator ani in normal women by dynamic magnetic resonance imaging.METHODSTwelve asymptomatic, nulliparous, premenopausal women with no previous pelvic surgery underwent a dynamic magnetic resonance imaging scan of their pelvis. The origin, orientation, thickness, and function of the two components of the levator ani were studied.RESULTSThe ileococcygeus is a thin muscle with an upward convexity. It slopes forward and medially. It is of variable thickness (mean thickness 2.9 mm, standard deviation 0.8 mm). There are apparent gaps in the muscle diaphragm and at its site of origin from the obturator fascia. The puborectalis is a thicker muscle. It is shaped like a belt encasing the pelvic organs. It is taller posteriorly than anteriorly. It is not attached to the bladder neck, but the midurethra and lower urethra lie in close proximity to it. The puborectalis moves dorsoventrally, whereas the ileococcygeus moves craniocaudally.CONCLUSIONThe levator ani is not a single muscle but has two functional components that vary in thickness, origin, and function. The ileococcygeus has a mainly supportive function, whereas the puborectalis has a sphincteric function. Gaps in the diaphragmatic portion of the ileococcygeus are a normal finding. Individual components of the levator ani may be prone to different types of childbirth trauma and should therefore be assessed separately when planning rehabilitation.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate oral misoprostol use before office endometrial biopsy.METHODSForty-two nonpregnant women aged 35–77 years were randomized to a prospective, double-blind study to receive either 400 μg oral misoprostol or placebo 3 hours before office endometrial biopsy. Misoprostol effects were assessed by 1) cervical resistance, 2) ease of performing the endometrial biopsy, 3) success rate of obtaining an endometrial biopsy, 4) pain intensity associated with the endometrial biopsy, and 5) adverse clinical side effects.RESULTSPatients in the misoprostol group experienced significantly (P< .01) more pain associated with the endometrial biopsy. The observed power to detect this difference in misoprostol-placebo comparison using the Wilcoxon rank sum test at 0.05 level of significance is 89%. In addition, significantly (P< .05) more patients had the adverse side effect of uterine cramping at 1.5 hours after medication ingestion in the misoprostol group. The observed power to detect this difference is 98%. There were no differences between the misoprostol and placebo groups in cervical resistance, ease of performing the biopsy, success rate for obtaining an endometrial biopsy, or adverse side effects at 3 hours post medication ingestion.CONCLUSIONOral misoprostol 400 μg caused more uterine cramping and pain in nonpregnant women undergoing office endometrial biopsy when given 3 hours before biopsy attempt. No other cervical effects were noted.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate the relationship of assisted reproductive technologies and ovulation-inducing drugs with preeclampsia in multiple gestations.METHODSThis historical cohort study was conducted on 528 multiple gestations from a Colorado health maintenance organization. Using univariate and logistic regression analysis, we determined if women who conceived a multiple gestation as a result of assisted conception were at a greater risk of preeclampsia than those who conceived spontaneously.RESULTSBetween January 1994 and November 2000, there were 330 unassisted and 198 assisted multiple gestations. Sixty-nine multiple gestations followed assisted reproductive technologies (in vitro fertilization and gamete intrafallopian transfer). Human menopausal gonadotropins and clomiphene citrate were associated with 38 and 91 of the multiple gestations, respectively. Compared with unassisted multiple gestations, the relative risk of mild or severe preeclampsia among mothers who received assisted reproductive technologies was 2.7 (95% confidence interval [CI] 1.7, 4.7) and 4.8 (CI 1.9, 11.6), respectively. Adjusted for maternal age and parity, women who received assisted reproductive technologies were two times more likely to develop preeclampsia (odds ratio 2.1, CI 1.1, 4.1) compared with those who conceived spontaneously. The adjusted odds ratios of nulliparity and maternal age for preeclampsia were 2.1 (CI 1.3, 3.4) and 1.1 (CI 1, 1.1), respectively. Although the incidence of preeclampsia was greater in mothers who received clomiphene citrate and human menopausal gonadotropins, this association did not reach statistical significance at theP< .05 level.CONCLUSIONWomen who conceive multiple gestations through assisted reproductive technologies have a 2.1-fold higher risk of preeclampsia than those who conceive spontaneously.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate whether the cesarean delivery rate differs between women with severe preeclampsia who receive intrapartum epidural analgesia versus patient-controlled intravenous opioid analgesia.METHODSWomen with severe preeclampsia at at least 24 weeks' gestation were randomly assigned to receive either intrapartum epidural (n= 56) versus patient-controlled intravenous opioid analgesia (n= 60), and each was administered by a standardized protocol. The sample size was selected to have 80% power to detect at least a 50% difference in the predicted intergroup cesarean delivery rates. Data were analyzed by intent to treat.RESULTSSelected maternal characteristics and neonatal outcomes were similar in the two groups. The cesarean delivery rates in the epidural group (18%) and the patient-controlled analgesia group (12%) were similar (P= .35). Women who received epidural analgesia were more likely to require ephedrine for the treatment of hypotension (9% versus 0%,P= .02), but their infants were less likely to require naloxone at delivery (9% versus 54%,P< .001). Epidural analgesia provided significantly better pain relief as determined by a visual analogue intrapartum pain score (P< .001) and a postpartum pain management survey (P= .002).CONCLUSIONCompared with patient-controlled intravenous opioid analgesia, intrapartum epidural analgesia did not significantly increase the cesarean delivery rate in women with severe preeclampsia at our level III center, and it provided superior pain relief.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo identify predictors of cocaine exposure during pregnancy, using hair and urine assays and self-report, and the association with preterm birth.METHODSA nested case-control study was conducted in a cohort of 2611 black and white women enrolled in prenatal care in central North Carolina. Cocaine exposure was ascertained by self-report (263 cases, 612 controls), urine assays at 24–29 weeks' gestation (226 cases, 564 controls) and postpartum (160 cases, 408 controls), and postpartum hair assays (169 cases, 435 controls). The major metabolite of cocaine, benzoylecgonine, was measured in urine. Cocaine and benzoylecgonine were measured in hair.RESULTSCocaine exposure was identified in 2% based on self-report, 5–6% based on urine assays, and 13–15% based on hair assays. Black ethnicity, lower education, and poverty were strongly predictive of positive hair assays. Hair cocaine and benzoylecgonine were not associated with preterm birth, with the possible exception of higher levels of cocaine and benzoylecgonine and birth before 34 weeks' completed gestation. The urine screen at 24–29 weeks' gestation also gave some indication of a possible association (odds ratio 1.7, 95% confidence interval 0.9, 3.5).CONCLUSIONThe study corroborates the incompleteness of cocaine exposure assessment by self-report and urine screens relative to hair assays. The strong demographic predictors of exposure suggest where intervention efforts should be targeted. The most sensitive markers of exposure, hair cocaine and benzoylecgonine, are not associated with preterm birth, perhaps because they reflect different patterns of cocaine exposure than the other measures.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate the influence of exercise on maternal and perinatal outcome in a low-risk healthy obstetric population.METHODSWe conducted a prospective observational study of low-risk healthy women exercising during their pregnancy. An extensive questionnaire collected antepartum, intrapartum, and postpartum patient information on 750 women. The women were divided into four groups based on exercise level during pregnancy.RESULTSThere were no differences among groups for maternal demographic characteristics, antenatal illnesses, stress, social support, or smoking. Heavily exercising women were older (P= .042), had higher incomes (P= .001), and were exercising more at conception (P= .001). Women who did more exercise were more likely to need an induction of labor (P= .033, relative risk 1.84, 95% confidence interval 1.05, 3.20), induction or augmentation with oxytocin (P= .015, relative risk 1.53, 95% confidence interval 1.19, 1.97), and had longer first-stage labors (P= .032) resulting in longer total labors (P= .011). The difference in the length of first-stage labor was even greater if the no-exercise group was compared with the strongly exercising group (P= .009, relative risk 1.38, 95% confidence interval 0.16, 2.60). Fewer umbilical cord abnormalities (P= .034) were observed with exercise, but exercising women had more colds and flu (P= .008). Heavily exercising women had smaller infants (mean difference 86.5 g) compared with sedentary women.CONCLUSIONExercise in working women is associated with smaller babies, increased number of inductions and augmentations of labor, and longer labors. Colds and flu are more frequent in exercising women.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate the relationship between Q-tip measurement of urethral hypermobility and visual assessment of the urethrovesical junction as assessed by points Aa and Ba of the pelvic organ prolapse quantification (POP-Q) system.METHODSA total of 274 patients with pelvic organ pro-lapse or urinary incontinence had preoperative Q-tip test straining angles and POP-Q staging measurements. By the Q-tip test, urethral hypermobility was defined as a straining angle of 30 degrees or greater relative to the horizontal. As defined in the POP-Q system, point Aa is located in the midline of the anterior vaginal wall 3 cm from the external urethral meatus and represents the urethrovesical junction. Point Ba represents the most dependent position of the anterior vaginal wall. The correlation between point Aa of the POP-Q system and the Q-tip test was assessed using the Spearman correlation coefficient. Similar assessments were made for point Ba.RESULTSMean age of the 274 subjects was 58.5 ± 11.8 years; mean parity was 3.1 ± 1.6. A total of 104 patients reported prior surgery for prolapse or incontinence. Mean Q-tip straining angle was 61 ± 20 degrees; 258 (94%) had urethral hypermobility. Values of point Aa ranged from −3 cm to +3 cm, with median 0 cm. The correlation coefficient between the Q-tip straining angle and point Aa wasr= 0.47 (P< .001). Urethral hypermobility was observed in 95% of patients with stage II prolapse at point Aa and in 100% of patients with stages III and IV prolapse at point Aa. The correlation coefficient between the Q-tip straining angle and point Ba wasr= 0.32 (P< .001).CONCLUSIONAlthough the correlation between the Q-tip straining angle and point Aa of the POP-Q was moderately strong, one value cannot be predicted from the other. The Q-tip test may be unnecessary in patients with stages II, III, and IV prolapse at point Aa as virtually all such patients demonstrate urethral hypermobility.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate whether abnormal umbilical cord insertion (UCI) into the placenta is a risk factor for birth weight discordancy in twin gestations.METHODSPathology records of all liveborn twins delivered between January 1993 and June 1996 were reviewed. The information collected included gestational age at delivery, birth weight, gross placental pathology, and placental UCI—velamentous, marginal, or disc. Discordancy in birth weight was defined as an intrapair difference of at least 20%. Analyses were stratified on placental chorionicity. Odds ratios and 95% confidence intervals for birth weight discordancy were calculated based on the presence of an abnormal (velamentous or marginal) placental UCI relative to normal (disc) UCI on both placentae, after adjusting for potential confounders.RESULTSThere were 447 twin pairs identified. Dichorionic diamniotic placentation was present in 358 pairs (80.1%), monochorionic diamniotic in 84 (18.8%), and monochorionic monoamniotic in five (1.1%). There was a 13-fold increase in the risk of birth weight discordancy in monochorionic diamniotic twins in the presence of a velamentous UCI (odds ratio 13.5, 95% confidence interval 1.4, 138.4), with a rate of birth weight discordancy of 46%. This relationship was not demonstrated in dichorionic diamniotic twins (odds ratio 1.0, 95% confidence interval 0.3, 3.5).CONCLUSIONBirth weight discordancy in twins is a different entity depending on chorionicity. The substantial increase in birth weight discordancy in monochorionic diamniotic twins that accompanies velamentous UCI underscores the need for prenatal detection and increased surveillance in these twins.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo determine the impact of prenatal care in the United States on the fetal death rate in the presence and absence of obstetric and medical high-risk conditions, and to explore the role of these high risk conditions in contributing to the black–white disparity.METHODSThis is a population-based, retrospective cohort study using the national perinatal mortality data for 1995–1997 assembled by the National Center for Health Statistics. Fetal death rate (per 1000 births) and adjusted relative risks were derived from multivariable logistic regression models.RESULTSOf 10,560,077 singleton births, 29,469 (2.8 per 1000) resulted in fetal death. Fetal death rates were higher for blacks than whites in the presence (4.2 versus 2.4 per 1000) and absence (17.2 versus 2.5 per 1000) of prenatal care. Lack of prenatal care increased the (adjusted) relative risk for fetal death 2.9-fold in blacks and 3.4-fold in whites. Blacks were 3.3 times more likely to have no prenatal care compared with whites. Over 20% of all fetal deaths were associated with growth restriction and placental abruption, both in the presence and absence of prenatal care. Lack of prenatal care was associated with increased fetal death rates for both blacks and whites in the presence and absence of high-risk conditions.CONCLUSIONIn the Unites States, strategies to increase prenatal care participation, especially among blacks, are expected to decrease fetal death rates.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Fetal intrauterine growth restriction presents a complex management problem for the clinician. The failure of a fetus to achieve its growth potential imparts a significantly increased risk of perinatal morbidity and mortality. Consequently, the obstetrician must recognize and accurately diagnose inadequate fetal growth and attempt to determine its cause. Growth aberrations, which are the result of intrinsic fetal factors such as aneuploidy and multifactorial congenital malformations, and fetal infection, carry a guarded prognosis. However, when intrauterine growth restriction is caused by placental abnormalities or maternal disease, the growth aberration is usually the consequence of inadequate substrates for fetal metabolism and, to a greater or lesser degree, decreased oxygen availability. Careful monitoring of fetal growth and well-being, combined with appropriate timing and mode of delivery, can best ensure a favorable outcome. Ultrasound evaluation of fetal growth, behavior, and measurement of impedance to blood flow in fetal arterial and venous vessels form the cornerstone of evaluation of fetal condition and decision making.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID