摘要:

ObjectiveTo evaluate the efficacy of adjuvant hysterectomy with chemotherapy for women with low-risk gestational trophoblastic disease.MethodsOne hundred fifteen consecutive Japanese women (16–52 years old) with low-risk gestational trophoblastic disease (46 with metastatic disease and 69 without) were treated initially with single-agent chemotherapy (etoposide in 85, methotrexate in 27, and actinomycin D in three) with or without adjuvant hysterectomy, and 97 patients (84.3%) achieved primary remission with those treatments. Eight women (9.4%) treated with etoposide required other regimens because of drug resistance or toxicities. The total dose of etoposide given to achieve primary remission was analyzed in 77 women who received etoposide alone or with adjuvant hysterectomy.ResultsIn 34 women with metastatic disease, the mean (± standard deviation [SD]) total dose of etoposide was not significantly different with and without adjuvant hysterectomy (2857 ± 842 mg versus 2815 ± 815 mg;P= .957; Mann-WhitneyUtest). However, in 43 women without metastases, the total dose of etoposide was significantly less in those who had adjuvant hysterectomies than in those who did not (1750 ± 635 mg versus 2545 ± 938 mg;P< .05; Mann-WhitneyUtest).ConclusionAdjuvant hysterectomy decreased the total dose of etoposide given to achieve primary remission in women with nonmetastatic, low-risk gestational trophoblastic disease. If the lesions of gestational trophoblastic disease are confined to the uterus and the woman has no desire to preserve fertility, she should be informed of adjuvant hysterectomy as a treatment option.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo compare postoperative wound pain associated with the radially expanding access device and the conventional disposable cutting-tip trocar.MethodsOur randomized, double-masked, self-controlled study involved 34 women scheduled for laparoscopic adnexal surgery. In each, a 10-mm radially expanding access device was inserted laterally on one side of the lower abdomen and a size-matched disposable cutting-tip trocar was placed on the other side, using random assignment. Postoperative pain for each studied wound and patient satisfaction toward the wounds were assessed using a visual analog scale. Any bleeding complication associated with insertion of the trocar was also recorded.ResultsThe radially expanding access device was associated with significant reduction in severity (median 1.4 versus 5.0,P< .001) and duration (median 11 versus 21 days,P< .001) of postoperative wound pain, shorter wound scars (14 versus 17 mm,P< .001), a lower incidence of wound induration (0 versus 9,P< .01), and a higher patient satisfaction (median 9.7 versus 6.2,P< .001). There were four inferior epigastric artery injuries, all at the conventional trocar wound.ConclusionThe radially expanding access device was associated with less postoperative wound pain and more patient satisfaction than the conventional cutting-tip trocar.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo determine whether there is an increased incidence of persistent pulmonary hypertension in neonates delivered by cesarean, with or without labor, compared with those delivered vaginally.MethodsWe did a computerized retrospective review of 29,669 consecutive deliveries over 7 years (1992–1999). The incidences of persistent pulmonary hypertension of the newborn, transient tachypnea of the newborn, and respiratory distress syndrome (RDS) were tabulated for each delivery mode. Cases of persistent pulmonary hypertension were reviewed individually to determine delivery method and whether labor had occurred. The three groups defined were all cesarean deliveries, all elective cesareans, and all vaginal deliveries.ResultsAmong 4301 cesareans done, 17 neonates had persistent pulmonary hypertension (four per 1000 live births). Among 1889 elective cesarean deliveries, seven neonates had persistent pulmonary hypertension (3.7 per 1000 live births). Among 21,017 vaginal deliveries, 17 neonates had persistent pulmonary hypertension (0.8 per 1000 live births). χ2analysis showed an odds ratio 4.6 andP< .001 for comparison of elective cesarean and vaginal delivery for that outcome.ConclusionThe incidence of persistent pulmonary hypertension of the newborn was approximately 0.37% among neonates delivered by elective cesarean, almost fivefold higher than those delivered vaginally. The findings have implications for informed consent before cesarean and increased surveillance of neonates after cesarean.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo assess prospectively the diagnostic reliability and prognostic significance of prenatal diagnosis of cytomegalovirus (CMV) infection.MethodsOne hundred ten pregnant women (four with twin pregnancies) with a risk of congenital CMV infection were investigated. Prenatal diagnosis was carried out by amniocentesis and fetal blood sampling (n= 75) or amniocentesis alone (n= 35). Serial ultrasonographic examinations were performed from time of referral until pregnancy end. All infected neonates were given long-term follow-up. Autopsy was performed in all cases of termination of pregnancy.ResultsNearly 23% (26 of 114) of fetuses were infected and prenatal diagnosis was positive in 20 cases. Sensitivity of prenatal diagnosis was 77% and specificity 100%. In eight cases, parents requested termination of pregnancy on the basis of abnormal ultrasonographic findings and/or biologic abnormalities in fetal blood. In 12 cases, parents decided to proceed with the pregnancy. In this group, one intrauterine and one neonatal death were observed. In one case, prenatal diagnosis revealed an abnormal cerebral sonography and the infant had bilateral hearing loss at birth. In 15 cases (nine positive and six false-negative prenatal diagnoses), no apparent lesion was present at birth, nor did it develop during the follow-up period (mean 31 months). In 88 (77.2%) of 114 infants, no evidence of vertical transmission was found during the pre- or postnatal period.ConclusionPrenatal diagnosis provides the optimal means for both diagnosing fetal infection (amniocentesis) and identifying fetuses at risk of severe sequelae (ultrasound examination, fetal blood sampling), thus allowing proper counseling.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo study the long-term effects of severely abnormal (absent or reversed diastolic) blood flow in the umbilical artery associated with fetal growth restriction on postnatal intellectual, neurologic, and social development.MethodsAbsence or reversal of diastolic blood flow in the umbilical artery was found in 38 consecutive growth-restricted fetuses as determined by biometry and Doppler ultrasound between 1988 and 1992. The 23 infants surviving the prenatal and perinatal period who could be tested were compared at school age with a group of children born at the same gestational age after normal intrauterine growth. They were tested for intellectual, neurologic, and social development by a test battery including the Kaufmann Assessment Battery for Children, Man-Drawing Test, Child Behavior Checklist, Zürich Neuromotor Test, and neuropediatric testing.ResultsIntellectual development was significantly better in the control group compared with the study group. In addition, Zürich Neuromotor testing and neuropediatric testing showed significantly better development of control children compared with the study group in 20% of the items tested. There was no detectable difference in social development as measured by the Child Behavior Checklist.ConclusionSeverely reduced blood flow to the fetus associated with growth restriction was followed by long-term impairment of intellectual development and partial neurodevelopmental delay.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo assess the clinical utility of overshoot fetal heart rate (FHR) decelerations by examining their occurrence after umbilical cord occlusions of varying frequency and length in near-term fetal sheep.MethodsFetuses were allocated to the following three groups: 1-minute umbilical cord occlusion repeated every 5 minutes (1:5 group,n= 8) or every 2.5 minutes (1:2.5 group,n= 8) or 2-minute occlusions repeated every 5 minutes (2:5 group,n= 4). Occlusions were continued for 4 hours or until fetal mean arterial pressure decreased below 20 mmHg during two successive occlusions.ResultsIn the 1:5 group, fetuses tolerated 4 hours of occlusion without hypotension or clinically significant acidosis and overshoot never occurred. In the 2:5 group, fetuses rapidly became hypotensive and acidotic, and occlusions were terminated at 116.3 ± 22.9 min (mean ± standard deviation). Overshoot was seen after every occlusion, starting with the first occlusion. In the 1:2.5 group, fetuses became progressively acidotic and hypotensive and occlusions were stopped at 183.1 ± 42.8 min. Overshoot occurred after 91.6 ± 42.5 minutes, at a pH of 7.17 ± 0.06, base deficit 9.3 ± 4.5 mmol/L. After the appearance of overshoot there was a more rapid decrease in fetal mean arterial pressure (0.25 [0.21, 0.35, 25–75th percentile] mmHg/minute versus 0.11 [0.03, 0.15] mmHg/minute before overshoot appeared,P< .01).ConclusionThese data suggest that overshoot is related to longer (2-minute) occlusions or to developing fetal acidosis and hypotension during 1-minute occlusions. This pattern could have clinical utility, as 1-minute contractions are typical of active labor.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo establish whether fetal DNA can be identified in the maternal circulation in first-trimester spontaneous abortions.MethodsWomen with confirmed spontaneous abortions and no histories of previous pregnancy were recruited. Peripheral venous blood samples were obtained and DNA extracted. Real-time quantitative polymerase chain reaction was done using SRY and β-actin systems for calculating fetal and total DNA, respectively.ResultsOf 25 women, SRY-specific signals were detected in 11 indicating that the abortions were male. The remaining 14 were negative for the SRY gene. Women with positive results were of similar gestational age to those who were negative (mean 68.4 and 69.0 days). Fetal:total DNA ratio was calculated for positive samples and ranged from 15.8 to 360.1 × 10+3. Mean ratio was 99.4 × 10+3and median was 67.5 × 10+3.ConclusionFetal DNA is present in the maternal circulation of first-trimester spontaneous abortions.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo compare six published methods of diagnosing ectopic pregnancy.MethodsDecision analysis compared six diagnostic algorithms involving combinations of clinical examination, transvaginal ultrasound, serum progesterone, serum hCG, and D&C. The population was composed of hemodynamically stable women who presented to a tertiary care university emergency department with abdominal pain or bleeding in their first trimesters. Outcome measures included number of missed ectopic pregnancies, potentially interrupted intra-uterine pregnancies, surgical and diagnostic procedures, time until diagnosis, and cost.ResultsUltrasound followed by serum hCG in women with nondiagnostic scans yielded the most favorable outcomes; no ectopic pregnancy was missed, only 1% of all potential intrauterine pregnancies were interrupted, and time to diagnosis averaged 1.46 days. Quantitative hCG measurement followed by ultrasound only in women with hCG levels above the discriminatory zone was optimal if sensitivity of ultrasound to diagnose intrauterine pregnancy was less than 93%. Serum progesterone measurement was not favored because it was associated with missed ectopic pregnancies (2.6%).ConclusionGiven the current accuracy of tests for diagnosing ectopic pregnancy, algorithms using a combination of ultrasound and hCG resulted in the best outcomes. Ultrasound as the first step was the most efficient and accurate method of diagnosing ectopic pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo examine the efficacy of digoxin for decreasing operative time, difficulty, and pain of late second-trimester surgical abortions.MethodsWe performed a randomized, double-masked, placebo-controlled trial of intra-amniotic digoxin for second-trimester dilation and evacuation (D&E) involving 126 consecutive women at an inner-city public hospital. Eligible women had gestational ages of 20–23.1 weeks, spoke English or Spanish, and were at least 16 years old. Digoxin (1 mg) or saline was injected intra-amniotically 24 hours before the procedure, at cervical laminaria insertion. The primary outcome was procedure duration. Sample size was based on 80% power to detect a difference of 3.5 minutes between groups.ResultsThe two groups were similar in demographic factors, obstetric histories, and gestational duration. The average gestational length was 22.5 weeks. There was no difference in procedure duration (mean ± standard deviation) between groups (placebo 14.7 ± 7.0, digoxin 15.4 ± 8.0). There were no differences in blood loss estimated by surgeons, pain scores, procedure difficulty scores, or complications between groups. Vomiting was significantly more common in those who received digoxin (placebo 3.1%, digoxin 16.1%). Most subjects (91%) reported that they preferred their fetuses were dead before the abortions.ConclusionAlthough digoxin did not increase efficacy of late second-trimester abortion, patient preference might justify its use.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundWe describe two techniques for the laser treatment of twin–twin transfusion syndrome in women with anterior placentas.TechniqueIn the first technique, anastomoses were photocoagulated using a flexible endoscope through a single port. The second technique used a side-firing laser fiber with a rigid angled-view endoscope (two ports).ExperienceSeventy-two women had surgery between July 1997 and December 1999, 35 (48.6%) of whom had anterior placentas. Survival was similar for fetuses with anterior (80%) and posterior (75.6%) placentas, but operating time was significantly longer for those with anterior placentas (81.1 compared with 64.4 minutes for the anterior and posterior placentas, respectively;P= .02, Studentttest). At least one fetus survived in 76% (16 of 21) of women treated with flexible endoscopes and 86% (12 of 14) of those treated with the side-firing lasers. Six of 72 women (8.3%) had patent vascular anastomoses on placental examination, and five of them had anterior placentas (P= .08, Fisher exact test).ConclusionAlthough anterior placentas are surgically more challenging than posterior placentas, both techniques allow an effective percutaneous approach to the laser treatment of twin–twin transfusion syndrome.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID