摘要:

Objective:To study the long‐term ovarian neoplastic consequences of resection of a dermoid cyst.Methods:The study population comprised 99 patients who were operated on for an ovarian dermoid cyst. Follow‐up information was obtained for 91 women for a mean period of 5.06 ± 2.46 years.Results:Of the 99 women, 18 had bilateral dermoid cysts. Multiple dermoid cysts in a single ovary were found in nine of the women with bilateral cysts and in one of the remaining patients. Two patients developed malignant germ cell tumors, and three developed a recurrent dermoid cyst in an ovary from which a dermoid cyst had previously been extracted. Bilateral or multiple ovarian dermoid cysts were present at the initial operation in four (80%) of these patients.Conclusions:Women with bilateral or multiple dermoid cysts may include a subgroup of patients with a greater tendency to develop future ovarian germ cell neoplasms.(Obstet Gynecol 1994;83:605‐8)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine the clinical utility of longitudinal Doppler umbilical artery systolic‐diastolic ratios (S/D) to predict the occurrence of either preeclampsia or fetal growth retardation (FGR) in a low‐risk population.Methods:Healthy nulliparas with singleton gestations were enrolled in a double‐blind trial of low‐dose (60 mg) aspirin for preeclampsia prevention. Treatment was initiated at 24 weeks and continued until delivery. Continuouswave Doppler studies were scheduled before assignment to treatment and at 27‐31, 32‐36, and 37‐42 weeks. Preeclampsia was defined as a persistent diastolic blood pressure of at least 90 mmHg with proteinuria, and FGR was defined as birth weight below the tenth percentile. Doppler values were considered abnormal if they exceeded the 90th percentile for the gestational age range in the study population. Summary predictive values were computed for the abnormal S/D at each gestational age interval. To assess the potential effect of the administration of low‐dose aspirin, logistic regression was used to model the relation between the Doppler indices, aspirin use, and these abnormal pregnancy outcomes.Results:A total of 1665 Doppler examinations were performed on 565 women. Forty‐four fetuses developed FGR and 21 women were diagnosed with preeclampsia. The positive predictive values of an abnormal S/D for the subsequent development of FGR were 13‐17% across the gestational age ranges studied, and the positive predictive values for preeclampsia were 0‐5%. Aspirin treatment did not affect the relation between the Doppler indices and these outcomes in the logistic regression model.Conclusion:Elevated umbilical artery S/D is not a clinically useful predictor of either FGR or preeclampsia in a low‐risk population.(Obstet Gynecol 1994;83:609‐12)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine whether pregnancy enhances cocaine toxicity in the isolated perfused whole rat heart model and whether this enhanced toxicity can be simulated by pre‐treatment with either estrogen or progesterone.Methods:Hearts excised from 65 female Sprague‐Dawley rats were attached to a Langendorff apparatus for measurement of left ventricular systolic pressure, heart rate, and contractility. Before excision, the animals were assigned to one of five groups: 1) nonpregnant, 2) pregnant, 3) nonpregnant pretreated with progesterone, 4) nonpregnant pretreated with estrogen, and 5) nonpregnant pretreated with estrogen and progesterone. Each group was exposed serially to the following cocaine concentrations: 5 × 10‐6, 1 × 10‐5, and 6 × 10‐5mol/L.Results:Heart rate declined at all doses of cocaine (9.2, 6.9, and 31.0%, respectively). The lowest dose of cocaine had positive inotropic effects, with a 23.2% increase in left ventricular pressure and a 15.3% increase in contractility. Exposure to the two higher doses resulted in negative inotropic effects (a 24.8% decrease in left ventricular pressure and a 39.7% decrease in contractility for the highest dose). Although pre‐treatment with estrogen, alone or with progesterone, resulted in responses similar to those seen in pregnant animals, progesterone pre‐treatment alone failed to do so.Conclusions:Cocaine displayed cardiotoxicity in isolated rat hearts similar to that in other animal models. This toxicity was enhanced by pregnancy. We were able to simulate changes by pretreating the animals with estrogen. Perhaps the enhanced cardiotoxicity of cocaine in pregnancy is partially mediated by estrogen.(Obstet Gynecol 1994;83:613‐5)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To review studies and investigations regarding the safety and efficacy of nifedipine.Data sources and methods:We reviewed the published literature on calcium channel blockers and their pharmacology and therapeutic applications in obstetrics and gynecology. We paid particular attention to methods of animal research and recent clinical evaluations.Conclusions:The dihydropyridine group of calcium channel blockers (type II calcium blockers) and, specifically, nifedipine are safe for use in pregnancy. They have little teratogenic or fetotoxic potential. Nifedipine's mechanism of action is through smooth‐muscle relaxation secondary to blockage of the slow calcium channels into the cells. In vivo, there is minimal effect on the cardiac conducting system. Multiple studies in women have demonstrated the effectiveness and safety of nifedipine as an antihypertensive. Therapeutic doses range from 10‐30 mg orally every 6‐8 hours. For acute control of hypertension, 10 mg of sublingual nifedipine may be used. Nifedipine is as effective as betamimetics in decreasing uterine activity. As a tocolytic agent, it is more effective as there are fewer patients who have to discontinue nifedipine because of side effects. The side effects of nifedipine include flushing, headache, or, rarely, hypotension in the hypovolemic patient. Nifedipine has potential and theoretical indications for dysmenorrhea and bladder irritability.(Obstet Gynecol 1994;83:616‐24)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To determine whether cesarean delivery can lead to fewer childhood neurologic problems.Data sources:We reviewed English language articles published between 1969 and 1993, obtained via MEDLINE search of the heading “delivery, abdominal.” Bibliographies of book chapters and articles about cerebral palsy and other childhood neurologic disorders were also searched.Methods of study selection:We sought articles that dealt with vaginal versus cesarean delivery and the following outcomes: cerebral palsy, abnormal neurologic development, neonatal seizures, and neonatal intraventricular hemorrhage. Ten relevant studies were identified, only four of which were prospective, and only one of which (involving breech births) was a randomized trial.Data extraction and synthesis:No study found a significant difference in the rates of cerebral palsy, abnormal neurologic development, and neonatal seizures between those children born vaginally or by cesarean. The severity of handicap of infants born with myelomeningocele was less in those delivered via cesarean. Infants born by cesarean had a decreased risk for developing neonatal brachial plexus palsy. Cesarean delivery of mothers with human immunodeficiency virus (HIV) or with genital lesions and no history of herpes may benefit the infant.Conclusions:Cesarean delivery can reduce the risk of adverse childhood neurologic outcome for those born with myelomeningocele, and may reduce the rate of brachial plexus palsies and neonatal herpes and HIV infections. However, children born by cesarean have no documented reduced risk of other childhood neurologic problems or cerebral palsy.(Obstet Gynecol 1994;83:624‐30)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Objective:To survey current practices among obstetricians and gynecologists concerning a wide range of infectious diseases to guide future efforts in continuing medical education.Methods:A survey questionnaire of multiple‐choice questions was mailed to 2500 physicians, under age 65, randomly selected from the American Medical Association specialty list of obstetrician‐gynecologists. The first 500 returns constituted the data set and were analyzed by computer.Results:We found many clinical areas in which practice patterns were deemed appropriate, including antibiotic selection, universal screening for hepatitis B, and follow‐up of urinary tract infection in pregnancy. In other areas, marked by controversy among “experts,” practice patterns varied widely. These areas included management of premature rupture of the membranes and premature labor, and universal screening for group B streptococci. Areas in need of further continuing medical education efforts include management of perinatal viral infections and diagnosis and treatment of sexually transmitted diseases.Conclusions:Although this survey indicated that practice patterns of American obstetricians and gynecologists are appropriate in many clinical areas relevant to infectious diseases, there are other clinical conditions requiring future efforts in continuing medical education.(Obstet Gynecol 1994;83:631‐6)

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1994

数据来源: OVID