摘要:

ObjectiveTo investigate the use of over-the-counter and alternative medicines in women with chronic vaginal symptoms.MethodsOne hundred five patients, referred by their gynecologists for evaluation of chronic vaginal symptoms, were interviewed about their use of over-the-counter and alternative medicines during the preceding year, the amount of money spent on each, and whether or not their physicians had been informed of these treatments.ResultsThe mean age was 36 years, and one-half had finished college. The median symptom duration was 2 years. Seventy-seven (73.3%) patients had self-treated with over-the-counter medications such as miconazole (74% of over-the-counter users), clotrimazole (38.2%), or povidone-iodine (13.2%). The median expenditure for over-the-counter use was $50 (range $2–1000). Forty-four (41.9%) had used alternative medicines, most frequently acidophilus pills orally (50%) or vaginally (11.4%), yogurt orally (20.5%) or vaginally (18.2%), vinegar douches (13.6%), and boric acid (13.6%). The median expenditure for alternative medicines was $35 (range $0–1200). Fewer physicians were aware of the use of alternative (70.5%) than of over-the-counter medicines (88.3%). Although most patients thought that vulvovaginal candidiasis was the cause of their symptoms, the most common diagnoses at initial presentation were candidiasis in 29 (27.6%), vulvar vestibulitis in 18 (17.1%), irritant dermatitis in 16 (15.2%), and bacterial vaginosis in 11 (10.5%). Women who actually had candidiasis were more likely to have used alternative medicines (odds ratio 2.31, 95% confidence interval 1.00, 5.42) than other patients.ConclusionWomen with chronic vaginal symptoms often use over-the-counter and alternative medicines that add to health care costs and are unlikely to be of benefit.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the clinical utility of transvaginal sonography for the diagnosis of upper genital tract infection.MethodsFifty-five women who either met the Centers for Disease Control and Prevention's minimal criteria for acute pelvic inflammatory disease or were being seen for non-classic signs of upper genital tract infection were evaluated. During abdominal and endovaginal ultrasound testing, fluid in the cul-de-sac, discrete tubes with or without tubal fluid, multicystic ovaries, and adnexal masses were noted. Upper genital tract infection was confirmed by laparoscopic visualization or histologic or microbiologic evidence of salpingitis or endometritis.ResultsThe specificity of identifying fallopian tubes with or without intraluminal fluid on ultrasound was 97% (35 of 36); the sensitivity, however, was only 32% (six of 19). Calculated using Bayes theorem and based on a prevalence rate of 50%, the positive predictive value of visualizing fallopian tubes was 91%. The sensitivities associated with the visualization of a multicystic ovary or tubo-ovarian abscess were 42% (eight of 19) and 32% (six of 19), with specificities of 86% (31 of 36) and 97% (35 of 36), and positive predictive values of 75% and 91%, respectively. Cul-de-sac fluid was associated with low sensitivity (37%; seven of 19), low specificity (58%; 21 of 36), and the lowest positive predictive value (47%).ConclusionEndovaginal sonography has limited clinical utility in the diagnosis of upper genital tract infection due to its low sensitivity.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the range of normal findings at endovaginal sonography after abdominal hysterectomy and to assess the relation between these findings and febrile morbidity.MethodsFifty-eight women had endovaginal ultrasound at a median of 4 days after abdominal hysterectomy. The volume of fluid in the cul-de-sac and its sonographic characteristics were assessed. Ultrasound findings, which were not released to the patients' physicians, were correlated with febrile morbidity and clinical outcomes.ResultsThe median pelvic fluid volume was 3.4 mL (interquartile range 0–16.8 mL). No pelvic fluid was detected in 22 of 58 women (37.9%). In the other 36 women, fluid volumes ranged between 0.2 and 76.3 mL. Febrile morbidity was present in 15 of 58 women (26%) overall: eight of 36 (25%) with and seven of 22 (32%) without pelvic fluid. There was no association between the presence of pelvic fluid collections and febrile morbidity (P= .54) or prolonged fever (P= 1.00). There was no difference in the median or mean fluid volumes between women with and without febrile morbidity. The study had a power of 90% with α = .05 to detect a difference of 20 mL. Even women with fixed, markedly echoic fluid collections larger than 35 mL did not have significantly more febrile morbidity than women with no pelvic fluid (P= .33).ConclusionThe volume of pelvic fluid 3–5 days after hysterectomy does not predict febrile morbidity or the need for drainage. Large or complex fluid collections may be present without adverse clinical consequences, and discovering such a collection in a patient with febrile morbidity after hysterectomy does not necessitate antibiotic therapy or surgical drainage of the fluid collection.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine the risk of preterm birth for mothers who themselves were born before term.MethodsData were taken from a linked data base of birth certificates composed of two cohorts: 1) a parental cohort of women born between 1947 and 1957 and 2) their offspring born between 1970 and 1992. “Preterm mothers” were women in the parental cohort who were born at less than 37 weeks' gestation. “Term mothers” were women in the parental cohort born at or after 38 weeks' gestation. Preterm mothers and term mothers were matched for birth year, county of birth, marital status, parity, and age. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the risk of preterm delivery in preterm mothers. Multiple logistic regression was used to assess the interaction of concomitant variables with the risk of premature delivery.ResultsThe risk of preterm birth was significantly higher in preterm mothers than in term mothers (OR 1.18; 95% CI 1.02, 1.37). This risk increased as the gestational age at the mothers' birth decreased (less than 30 weeks': OR 2.38; 95% CI 1.37, 4.16). The interaction between maternal age and parity increased the risk of preterm delivery at less than 34 weeks in some age and parity strata.ConclusionAn increased risk of preterm delivery exists for women who themselves were born before 37 weeks' gestation. This risk is inversely correlated with the maternal gestational age at birth and is influenced by maternal age and parity.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether a schedule of fewer prenatal visits than traditional for women with low-risk pregnancies leads to additional medical services outside prescribed prenatal care.MethodsIn a randomized, controlled trial conducted within a group-model health maintenance organization, we studied 2328 pregnant women judged to be at low risk of adverse perinatal outcomes. After risk assessment and consent, women were assigned to an experimental (nine visits) or a control (14 visits) schedule, with additional visits if requested either by providers after identifying risks or by women seeking additional services. We recorded whether women underwent maternal serum alpha-fetoprotein screening, obstetric ultrasound examination at 15–24 weeks' gestation, hematocrit testing after 20 weeks, and diabetic screening. We also noted visits to nonobstetric care providers or our emergency care center, telephone calls, and hospitalizations.ResultsWe found no significant differences between the two groups for prenatal blood tests, visits to nonobstetric providers or to the emergency care center, telephone calls from patients, or hospital admissions. A significantly greater percentage of women underwent ultrasound examinations at 15–24 weeks in the control group compared with the experimental group (57.3% and 53.1%, respectively;P= .045).ConclusionThe reduction in prenatal visits achieved using the experimental schedule was not accompanied by an increase in the use of other medical services compared with the routine schedule. The use of the schedule proposed by the Expert Panel on the Content of Prenatal Care improved the efficiency of delivery of prenatal care to low-risk women.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether characteristics in a woman's first pregnancy were associated with the trimester in which she initiated prenatal care in her second pregnancy.MethodsData for white and black women whose first and second pregnancies resulted in singleton live births between 1980 and 1992 were obtained from Georgia birth certificates (n = 177,041). Adjusted relative risks (RRs) for early prenatal care in the second pregnancy were computed by logistic regression models that included trimester of prenatal care initiation, infant outcomes, or maternal conditions in the woman's first pregnancy as the exposure and controlled for maternal age, education, child's year of birth, interval between first and second pregnancy, presence of father's name on the birth certificate, and the interaction between prenatal care and education. Models were stratified by race.ResultsWomen of both races who initiated prenatal care in the first trimester of their first pregnancies were more likely than those with delayed care to initiate prenatal care in the first trimester of their second pregnancies (RR = 1.25 and 1.63 for white and black women educated beyond high school, respectively). Both white and black women who delivered a baby with very low birth weight (RR = 1.06 and 1.15, respectively) or who suffered an infant death (RR = 1.09 and 1.31, respectively) in their first pregnancies were more likely than those who did not experience these events to begin prenatal care in the first trimester of their second pregnancies.ConclusionWomen with some potentially preventable adverse infant outcomes tend to obtain earlier care in their next pregnancy. Unfortunately, women who delayed prenatal care in their first pregnancy frequently delay prenatal care in their next.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo establish the actual number of maternal deaths in The Netherlands by determining the degree of underreporting.MethodsWe conducted a nationwide, retrospective crosscheck of the three available maternal mortality registration systems and issued a questionnaire to senior obstetricians in all hospitals during the years 1983–1992.ResultsThe officially reported maternal mortality rate during the study period was 7.1 per 100,000 live births (133 maternal deaths per 1,862,985 live births). After completion of the study, our data indicate that the rate should be at least 9.7 per 100,000 live births (180 maternal deaths). Early pregnancy and indirect deaths were more likely to be underreported than direct deaths during labor and the puerperium. Failure to register the recent pregnancy on the death certificate was a frequent problem. Misclassification was particularly evident for cerebrovascular disorders, cardiovascular disorders, and eclampsia.ConclusionThe level of underreporting of maternal mortality in The Netherlands was estimated at 26%. The pregnancy status of women should be registered on death certificates. Officially reported maternal mortality rates are unreliable and international comparisons using these data thus are less meaningful.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether ranitidine (Zantac) taken once or twice daily is effective for relieving symptoms of gastroesophageal reflux among pregnant women who had failed conservative measures.MethodsVolunteers with heartburn despite antacids were sought among our obstetric clinic population for this double-blind, placebo-controlled, triple crossover trial. After a baseline week, 20 patients were randomized to receive the three following weekly regimens: ranitidine 150 mg twice daily, placebo in the morning and ranitidine 150 mg in the evening, or placebo twice daily. Daily scores on symptom diaries, global assessments, and number of antacids taken were compared among the 18 patients completing the study.ResultsThe twice-daily dosage of ranitidine was the only regimen found to reduce heartburn symptoms when compared with the baseline (P< .001) or a placebo (P< .01). Compared with ranitidine taken once daily, the twice-daily dosing prompted less need for antacid tablets compared with the placebo (P< .05 versusP> .05) and to the baseline (P< .001 versusP< .05). The average reduction of heartburn severity using twice-daily ranitidine was 55.6% when compared with baseline (95% confidence interval [CI] 34.8%, 76.5%) and was 44.2% when compared with placebo (95% CI 15.4%, 72.9%).ConclusionThis study indicates the efficacy of ranitidine 150 mg taken twice daily, rather than once daily, for relief of gastroesophageal reflux symptoms during pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare the pharmacokinetics of vaginal and oral administration of the prostaglandin E1analogue, misoprostol.MethodsTwenty women received 400-μg doses of misoprostol either orally or as tablets placed in the vagina. Serum levels of the principal metabolite, misoprostol acid, were measured at 7.5, 15, 30, 45, 60, 90, 120, and 240 minutes. The first ten women were pregnant and undergoing firsttrimester abortions, and the last ten were not pregnant and had additional blood sampling at 360 minutes. We compared the pharmacokinetics of misoprostol acid after oral and vaginal administration.ResultsAll 20 subjects completed the study. The maximum mean (± standard deviation [SD]) of misoprostol acid differed significantly between the oral and vaginal groups (277 ± 124 compared with 165 ± 86 pg/mL, respectively;P= .03, analysis of variance), as did the mean ± SD time to peak levels (34 ± 17 compared with 80 ± 27 minutes, respectively;P< .001) and areas under the misoprostol concentration versus time curve (mean ± SD) up to 4 hours (n = 20, 273.3 ± 110.0 compared with 503.3 ± 296.7 pg. hour/mL, respectively;P= .033) and up to 6 hours (n = 10, 300.0 ± 103.3 compared with 956.7 ± 541.7 pg. hour/mL, respectively;P= .029). The extent of absorption was highly variable among subjects in each group.ConclusionThere are significant differences in the pharmacokinetics of misoprostol administered by vaginal and oral routes that may explain the difference observed in clinical efficacy. Assuming that the pharmacologic effect of misoprostol is related to its concentration in the plasma, our observation of the prolonged serum concentrations in the vaginal group suggests that vaginal administration could be dosed at longer intervals than oral.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate standardized developmental test performance of infants and children who as fetuses had mild isolated cerebral ventriculomegaly diagnosed by ultrasound.MethodsUltrasound records from 1990 to 1996 were searched for cases of mild isolated ventriculomegaly, and standardized developmental testing of the children was offered to their parents. Each consented child was matched to a normal antepartum subject with respect to sex, race, indication for ultrasound, and gestational age (±2 weeks) at the time of ultrasound. Tests of cognitive, motor, and adaptive behavior were then administered by examiners blinded to the subjects' case or comparison status.ResultsTwenty-two cases and an equal number of matched comparison subjects completed the testing. The ventriculomegaly and comparison groups were similar with respect to parental age, maternal education, and household income. The ventriculomegaly subjects scored significantly lower than the comparison group on both the Bayley Scales of Infant Development: mental development index (88.95 versus 99.68,P= .017) and psychomotor development index (95.55 versus 103.95,P= .039). Eight of the 22 ventriculo-megaly children were classified as developmentally delayed on the mental development index compared with one of 22 children in the comparison group (P= .021). Adaptive behavior skills, as measured by the Vineland Behavior Scales (99.64 versus 102.68), were not significantly different between the groups (P= .571).ConclusionMild isolated ventriculomegaly detected on antepartum sonographic examination is associated with a significant risk for developmental delay. Insofar as these children were judged to be completely normal at birth, our findings represent an important application of antepartum sonography for identifying infants who could be targeted for early childhood intervention.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID