摘要:

ObjectiveTo determine the vaginal pH level that correlates with elevated parabasal cells in vaginal smearsMethodsPostmenopausal women presenting to a gynecology office for routine annual and incontinence examinations were studied prospectively. Women were excluded if they had vaginal infections or pelvic organ prolapses past the hymen. pH was measured and cytology smears made from the midvagina. A pathologist who was not aware of pH results evaluated the smears. Spearman rho was used to correlate pH and percentage of parabasal cells. Logistic regression was used to analyze the relationship between pH and increased parabasal cells in vaginal smears. Predictive values were used to select a pH level as a cutoff point to predict increased parabasal cells.ResultsSeventy-four women were enrolled and 70 completed the study. The correlation coefficient between pH and percentage of parabasal cells was 0.6 (P< .001). Logistic regression showed association of pH with 20% or more parabasal cells (P< .001). Positive and negative predictive values for pH level above 6.0 as a predictor of 20% or more parabasal cells were 96.3% and 87.5%, respectively. The prevalence of elevated parabasal cells was 22.9%.ConclusionVaginal pH above 6.0 correlates with high levels of parabasal cells (20% or more) from the midvagina.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo assess the feasibility and complications of operative laparoscopy in women with high body mass indices (BMIs).MethodsForty-seven consecutive patients with BMIs exceeding 30 who underwent operative laparoscopy were compared with 160 consecutive patients with BMIs of 30 or less who underwent the same procedure. Patient characteristics, ultrasound features of adnexal masses, and details of operative procedures were compared. Operative and postoperative complications, the percentage of failed laparoscopies, and length of hospital stay were compared between groups.ResultsThere were no significant differences between groups in terms of age, parity, menopausal status, history of laparotomy, ultrasound features of adnexal masses, complexity of laparoscopic procedures, and the presence and degree of adhesions at the time of laparoscopy. Estimated blood loss, operative times, operative and major postoperative complications, and lengths of hospital stay also did not differ significantly between women with high BMIs and those with low BMIs (180.3 versus 151.4 mL,P= .41; 150.5 versus 146.5 minutes,P= .78; 2.1 versus 1.9%,P= .90; 2.1 versus 1.9%,P= .91; and 2.3 versus 1.9 days,P= .51, respectively). However, women with BMIs exceeding 30 had a significantly higher incidence of procedure conversion to laparotomy (14.9 versus 5.6%,P= .04).ConclusionOperative laparoscopy is safe and feasible in women with high BMIs. Although there is an increased chance of procedure conversion to laparotomy in these women, the morbidity and length of hospitalization associated with the procedure are similar to those among women with low BMIs.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveColposcopy is performed by different providers, including nurse practitioners, family physicians, and gynecologists. The training and experience of these providers vary. The fiscal impact of provider type is unknown. This study evaluates pathology resource use by gynecologists and nongynecologists at the time of colposcopy.MethodsA retrospective cohort study was performed. Data were collected by review of pathology reports and records of all patients with cervical dysplasia treated with cervical excision by loop electrosurgical excision procedure or cold knife conization at our institution between January 1, 1996, and December 31, 1997. Data were analyzed according to type of provider performing the colposcopy before the cervical excision.ResultsGynecologists obtained a total of 190 biopsy specimens in 127 patients, with a mean number of 1.5 ± 0.75 per patient and a median of 1. Nongynecologists took a total of 148 biopsy specimens in 44 patients, with a mean of 3.4 ± 1.14 per patient and a median of 3 (P< .001). These differences persisted irrespective of presenting cytology. Nongynecologists were more likely to do endocervical curettage than gynecologists (95% compared with 82%, respectively,P< .001). Cervical dysplasia was diagnosed equally well, even though fewer biopsies were taken by gynecologists.ConclusionBoth groups of providers were equally capable of identifying dysplastic lesions. Despite equivalent diagnostic accuracy, nongynecologists used two to three times more pathology resources. If this pattern of use of resources exists at other clinical sites, patients with cervical dysplasia and payers would be better served by gynecologic rather than nongynecologic care.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo compare the outcomes of black and white women who have surgically staged endometrial carcinoma.MethodsWe retrospectively compared the clinicopathologic factors, socioeconomic status, treatments, and outcomes of 70 black and 302 white women who were treated for surgically staged endometrial carcinoma at our institution.ResultsBlack women had higher-grade tumors, less favorable histologic findings, more comorbid illnesses, and lower socioeconomic indices. A nonsignificant trend was also seen toward more advanced-stage disease. The extent of surgical staging and types of adjuvant therapies were similar. On univariate analysis, black women had worse 5-year disease-free survival than white women (52.8% versus 75.2%;P= .001). Other significant factors included stage, grade, lymph node status, extension to the uterine serosa, cervical involvement, histology, adnexal involvement, lymphovascular invasion, myometrial invasion, positive peritoneal cytology, level of education, and household income. After controlling for pathologic and socioeconomic differences in multivariate analysis, race remained a significant prognostic factor (P= .008; hazard rate 2.0; 95% confidence interval 1.2, 3.5).ConclusionIn a large cohort of surgically staged and uniformly treated patients with endometrial carcinoma, black race was associated with significantly worse outcomes, even after controlling for clinicopathologic and socioeconomic factors.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo study trends and examine risk factors for pregnancy-related mortality due to hemorrhage.MethodsWe analyzed pregnancy-related deaths from 1979–1992 from the National Pregnancy Mortality Surveillance System of the Centers for Disease Control and Prevention. Live-birth data used to calculate mortality ratios were obtained from published vital statistics. Deaths due to ectopic pregnancies were excluded.ResultsThere were 763 pregnancy-related deaths from hemorrhage associated with intrauterine pregnancies, a ratio of 1.4 deaths per 100,000 live births. The pregnancy-related mortality ratio was higher for black women and those of other races than white women. The risk of pregnancy-related mortality increased with age. Abruptio placentae was the overall leading cause of pregnancy-related death due to hemorrhage. Leading causes of death differed by race, age group, and pregnancy outcome.ConclusionHemorrhage is the leading cause of pregnancy-related death in the United States. Black women have three times the risk of death of white women. In-depth investigations are needed to ascertain the risk factors associated with those deaths.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo compare the edema-relieving effects of static immersion with water aerobics.MethodsEighteen healthy women between 20 and 33 weeks' gestation were studied standing on land, immersed to the axilla, and participating in a water aerobics class, each for 30 minutes.ResultsWater aerobics and the static immersion led to a similar diuresis, 187 and 180 mL, respectively. Both were significantly greater than standing 30 minutes on land, 65 mL (P< .01). The dilutional effect as measured by a decline in urine specific gravity was also similar between static immersion and water aerobics and greater than standing on land (P< .01). Standing on land led to a small increase in leg volume compared with water aerobics or static immersion (P< .01).ConclusionWater aerobics had diuretic and edema-relieving effects similar to static immersion. When women develop edema of pregnancy, water aerobics classes may be used as a potential treatment.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo estimate the incidence, timing, and associated clinical characteristics of objectively diagnosed pregnancy-associated venous thromboembolism.MethodsWe retrospectively reviewed venous thromboembolism cases (deep venous thrombosis and pulmonary embolism) that occurred between 1978 and 1996. Study inclusion criteria required the objective diagnosis with either Doppler ultrasound, venography, impedance plethysmography, pulmonary angiography, ventilation-perfusion scanning, or computed tomography or magnetic resonance imaging.ResultsAmong 268,525 deliveries there were 165 (0.06%) episodes of venous thromboembolism (one per 1627 births). There were 127 cases of deep venous thrombosis and 38 cases of pulmonary embolism. Only 14% (23 of 165 patients) had a history of venous thromboembolism. Most cases of deep venous thrombosis were in the left leg (104 of 127, 81.9%), with nearly three quarters of them (94 of 127, 74.8%) occurring during the antepartum period. Among cases of antepartum deep venous thrombosis, half were detected before 15 weeks' gestation (47 of 95, 49.5%), and only 28 cases occurred after 20 weeks (P< .001). Most of the pulmonary embolisms occurred in the postpartum period (23 of 38, 60.5%) and were strongly associated with cesarean delivery (19 of 36,470 compared with four of 232,032,P< .001).ConclusionThe incidence of venous thromboembolism during pregnancy is lower than has been previously described. Most cases occurred in the antepartum period, with the risk of deep venous thrombosis appearing to begin even before the second trimester.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine whether gravidas with prior low vertical uterine incision(s) are at a higher risk for uterine rupture during a trial of labor after cesarean delivery than women with prior low transverse uterine incision(s).MethodsThe medical records of women undergoing a trial of labor after prior cesarean delivery over a 12-year period (July 1984–June 1996) at a tertiary-care hospital were reviewed. Maternal and perinatal outcomes for women with prior low transverse and low vertical incision were compared. Women whose low vertical incision was noted to extend into the corpus of the uterus were excluded. All uterine scar disruptions, which included both symptomatic ruptures and detected asymptomatic dehiscences, were analyzed together, and ruptures were examined separately.ResultsThe outcomes of 2912 patients undergoing trial of labor for the low transverse group and 377 patients undergoing trial of labor for the low vertical group were compared. Overall, there were 38 (1.3%) scar disruptions in the low transverse group and six (1.6%) in the low vertical group,P= .6. There were 28 (1.0%) symptomatic ruptures in the low transverse group and 3 (0.8%) in the low vertical group,P> .999. The study had a power of 80% to detect an increase in the low vertical rupture rate from 1% (as noted for low transverse incisions) to 3%.ConclusionGravidas with a prior low vertical uterine incision are not at increased risk for uterine rupture during a trial of labor compared with women with a prior low transverse uterine incision.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo assess the effect of screening glucose values and gestational diabetes mellitus (GDM) on birth weight in a community-based population of pregnant Hispanic women and infants in Detroit, Michigan.MethodsIn a prospective cohort study of 372 mother-infant pairs, analysis of variance and multiple linear and logistic regression were used to examine the effects of maternal screening glucose and GDM status on mean birth weight and the risk of large for gestational age (LGA) and small for gestational age (SGA) births.ResultsScreening glucose values of at least 135 mg/dL were found in 26.6% of the mothers and GDM in 5.1%. There was a significant relation between increasing maternal screening glucose level and adjusted mean birth weight (P< .005). As glucose level increased, there was a significant trend toward an increasing percentage of LGA infants and a decreasing percentage of SGA infants (Cochran-Armitage test for trend,P= .001 andP= .009, respectively). Among nondiabetic women, a 10-mg/dL increase in glucose value was associated with an adjusted 30.5-g increase in birth weight (standard error 9.0;P< .001), increased adjusted odds of LGA (adjusted odds ratio [OR] 1.17; 95% confidence interval [CI] 1.02, 1.34), and decreased adjusted odds of SGA (adjusted OR 0.69; 95% CI 0.52, 0.93).ConclusionOur findings showed a high prevalence of glucose abnormality and an independent effect of maternal glucose level on birth weight in our Hispanic population. Maternal glucose level should be included in studies of factors that affect birth weight, and appropriate prenatal care provided to Hispanic women with abnormal and borderline metabolic status.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo examine pregnancy-related mortality among Hispanic women in the United States.MethodsWe used data from the Centers for Disease Control and Prevention's ongoing Pregnancy Mortality Surveillance System to examine all reported pregnancy-related deaths (deaths during or within 1 year of pregnancy that were caused by pregnancy, its complications, or treatment) in states that reported Hispanic origin for 1979–1992. The pregnancy-related mortality ratio was defined as the number of pregnancy-related deaths per 100,000 live births.ResultsFor the 14-year period, the overall pregnancy-related mortality ratio was 10.3 deaths per 100,000 live births for Hispanic women, 6.0 for non-Hispanic white women, and 25.1 for black women. In Hispanic subgroups, the pregnancy-related mortality ratio was 9.7 for Mexican women and ranged from 7.8 for Cuban women to 13.4 for Puerto Rican women. Pregnancy-induced hypertension was the leading cause of pregnancy-related death for Hispanic women overall.ConclusionPregnancy-related mortality ratios for Hispanic women were higher than those for non-Hispanic white women, but markedly lower than those for black women. The similarity in socioeconomic status between Hispanic and black women was not an indicator of similar health outcomes. Prevention of pregnancy-related deaths in Hispanic women should include investigation of medical and nonmedical factors and consider the heterogeneity of the Hispanic population.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID