摘要:

ObjectiveTo determine the test characteristics of a self-report questionnaire, the Beck Depression Inventory, when used as a screening test for depression in a population of ambulatory pregnant women.MethodsOne hundred five pregnant women completed the Beck Depression Inventory and underwent a structured interview using the National Institute of Mental Health Diagnostic Interview Schedule—version III. Current depression was diagnosed according to the criteria of theDiagnostic and Statistical Manual of Mental Disorders—III-R. A receiver operating characteristic curve was constructed for the Beck Depression Inventory score as a predictor of current depression. A table of sensitivities, specificities, predictive values, and likelihood ratios was created for various cutoff values.ResultsFor the 105 women enrolled, the median Beck Depression Inventory score was 8.0. Twelve women (11%) were diagnosed with current depression and had a median Beck Depression Inventory score of 25.5, compared with those without current depression, who had a median score of 8.0 (P= .001). The area under the receiver operating characteristic curve was 0.9940. Using a cutoff range of greater than 16, the sensitivity of the Beck Depression Inventory to detect current depression was 0.83, the specificity was 0.89, the positive predictive value was 0.50, and the negative predictive value was 0.98.ConclusionsThe Beck Depression Inventory can serve as a rapid screening test for depression during pregnancy. A higher cutoff value is required for pregnant women than is customarily used outside of pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo evaluate the importance of prenatal education on the proper use of seat belts during pregnancy.MethodsThree hundred fifty pregnant women were provided surveys at their first prenatal visit and then again at 28–32 weeks' gestation. The surveys assessed the actual use and placement of seat belts before and during pregnancy and knowledge about the use of restraint systems during pregnancy. In addition, the women were surveyed with respect to the information provided to them regarding seat belt use.ResultsTwo hundred ninety-eight women returned both surveys, 68% of whom reported using seat belts in a manner currently recommended. Nearly 20% stated that they rarely or never used seat belts during their pregnancy. Women who reported receiving information regarding seat belt use from their prenatal provider were significantly more likely both to use their belts (83% versus 65%;P< .001) and to identify proper belt placement (77% versus 57%;P< .001) compared with those who did not receive information, respectively.ConclusionsDespite current recommendations and laws regarding seat belt use during pregnancy, one-third of women report either not using seat belts or using them improperly during pregnancy. Prenatal care providers can substantially influence the proper use of seat belts by discussing their correct use during pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo determine the clinical effectiveness of blood pressure (BP) measurement using conventional sphygmo-manometry in the antenatal clinic and obstetric day unit compared with automated BP monitoring at home.MethodsThe study population consisted of 109 nulliparous white women with BPs of at least 140 or 90 mmHg at the antenatal clinic after 20 weeks' gestation, who underwent obstetric day unit and 24-hour automated BP monitoring on the same day. Automated measurement was obtained every half hour for 24 hours using a commercially available device that had been previously validated in pregnancy.ResultsAt the traditional BP cutoff point (140/90 mmHg), the relative risk for subsequent development of adverse obstetric outcome was greatest for automated BP measurement: The relationships between outcome and automated diastolic BP were all statistically significant: proteinuria (P= .034), preterm delivery (P< .001), birth weight below the tenth percentile (P= .001), admission to the special care neonatal unit (P= .001), and cesarean delivery (P= .007).ConclusionAutomated BP measurement appears to improve the identification of patients who are at high risk of poor obstetric outcome. Automated BP measurement is worthy of further evaluation as an antenatal screening and diagnostic test.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo compare the diagnostic performance of maternal blood C-reactive protein, white blood cell count (WBC), and amniotic fluid (AF) WBC in the identification of positive AF culture, histologic and clinical chorioamnionitis, and neonatal morbidity in women with preterm premature rupture of membranes (PROM).MethodsMaternal blood was collected for the determination of C-reactive protein and WBC at the time of amniocentesis from 90 women with preterm PROM. Amniotic fluid was cultured for aerobic and anaerobic bacteria as well as mycoplasmas. Amniotic fluid WBC was determined for research purposes. Receiver operating characteristic curve and logistic regression were used for statistical analysis.ResultsThe prevalence of positive AF culture was 28% (25 of 90). Women with positive AF culture and clinical chorioamnionitis had significantly higher median C-reactive protein, WBC, and AF WBC than did women without these conditions (P< .05), whereas women with histologic chorioamnionitis and significant neonatal morbidity had higher median C-reactive protein and AF WBC, but not WBC, than those without the conditions (P< .05). An AF WBC of at least 20 cells per mm3had a greater sensitivity than C-reactive protein (cutoff, 0.7 mg/dL) and WBC (cutoff, 13,000 cells per mm3) in the detection of positive AF culture and histologic chorioamnionitis. Logistic regression analysis indicated that among AF WBC, C-reactive protein, and WBC, AF WBC was the best predictor of positive AF culture (odds ratio [OR] 24.2, 95% confidence interval [CI] 6.0, 97.5,P< .001), histologic (OR 74.0, 95% CI 7.4, 736.3,P< .001) and clinical chorioamnionitis (OR 8.9, 95% CI 0.9, 85.6,P= .057), and neonatal morbidity (OR 4.3, 95% CI 1.1, 16.6,P< .05).ConclusionAmniotic fluid WBC performs better than C-reactive protein and maternal blood WBC in the diagnosis of positive AF culture, histologic and clinical chorioamnionitis, and neonatal morbidity in women with preterm PROM.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo determine the prevalence of urinary dysfunction in Hong Kong Chinese women.MethodsA telephone survey was conducted in the territory of Hong Kong. The subjects were a sample of women between the ages of 10 and 90 years. The main outcome determined was the prevalence of urinary dysfunction.ResultsWe made 3248 calls, resulting in 819 evaluable responses. Stress incontinence was reported by 21% (174) of respondents, urgency or urge incontinence in 15% (120), urinary frequency in 19% (154), nocturia in 20% (166), bed-wetting in 4% (31), and voiding difficulties in 13% (109). Stress incontinence occurred as the only symptom in 7% (53), the combination of urgency and frequency in 1% (11), and mixed symptoms in 6% (52). Four percent required protective underwear or pads, with 2% wearing protective underwear continuously; 4% were incapacitated by their incontinence. Symptoms of urgency, urge incontinence, frequency, and nocturia increased with increasing age, but voiding difficulties and nocturnal enuresis were unrelated to age. Stress incontinence, urgency, urge incontinence, frequency, nocturia, and voiding difficulties increased with increasing parity to para 4.ConclusionUrinary dysfunction and its patterns appear to be as common and incapacitating in Hong Kong Chinese as they are in other populations.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo report our initial experience with allogenic (human cadaver donor) fascia lata for the suburethral sling procedure.MethodsAllogenic fascia lata for the suburethral sling procedure has been used in our practice since July 1994. Fascial grafts were obtained from licensed tissue banks. Women who underwent this procedure were followed prospectively to determine the incidence of perioperative complications, the incidence of local wound complications at the sling insertion site, and the subjective and objective cure rates.ResultsSixteen women underwent the suburethral sling procedure with allogenic fascia. Fourteen had genuine stress urinary incontinence and two required replacement of a previously placed synthetic graft because of chronic infection. Follow-up ranged from 6 months to 1 year. No patient developed sinus tract formation or persistent granulation tissue. Two of 16 patients (12%) developed abdominal wound infections, which resolved with local care. The mean duration of postoperative bladder drainage was 29 days. One patient continued to require intermittent catheterization at 187 days. Among the 14 women with preoperative genuine stress incontinence, the subjective cure rate was 86% and the objective cure rate was 79%. The two patients who required replacement of a chronically infected synthetic graft remained subjectively continent.ConclusionsThese preliminary data suggest that allogenic fascia lata is an acceptable material for the suburethral sling procedure. This material may be considered as an alternative to autologous fascia, which must be harvested from the patient intraoperatively, and to synthetic materials, which have been associated with local complications in up to 40% of cases.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo investigate the presence and modulation of growth-regulated α, a member of the chemokine family with neutrophil chemotactic activity, in the peritoneal fluid of women with or without endometriosis.MethodsPeritoneal fluid samples were obtained at laparoscopy from 63 women with endometriosis and 19 fertile women without endometriosis. Endometrial tissue was obtained from uteri after hysterectomy for reasons other than endometrial disease or from endometrial biopsies of reproductive-age women. Cellular RNA was extracted and northern blots were hybridized with an oligonucleotide probe complementary to a specific sequence of growth-regulated α messenger RNA. Growth-regulated α in peritoneal fluid and culture supernatant was quantified using enzyme-linked immunosorbent assay. Statistical analyses were performed using Kruskal-Wallis and Mann-Whitney tests.ResultsThe median (range) concentration of growth-regulated α in peritoneal fluid samples from 19 normal fertile women was 27 pg/mL (0-108), from 24 women with moderate endometriosis 34 pg/mL (8–150), and from seven with severe endometriosis was 73 pg/mL (10–221) (P= .04,P= .01, respectively). In the moderate and severe endometriosis groups, the levels of growth-regulated α were significantly higher in the peritoneal fluid of women with untreated endometriosis (73 pg/mL [10–221]) than in women with medically treated endometriosis (25 pg/mL [8–47]). In mesothelial and endometrial stromal cells in culture, growth-regulated α messenger RNA and protein were detectable constitutively; however, both interleukin-1α and tumor necrosis factor-α induced higher levels of growth-regulated α messenger RNA and protein in a dose- and time-dependent manner.ConclusionsGrowth-regulated α levels are elevated in the peritoneal fluid of women with moderate and severe endometriosis. This chemotactic factor, which acts via the interleukin-8 receptor, may play a role in the pathogenesis of endometriosis.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

In laparoscopy-assisted radical vaginal hysterectomy, laparoscopy is used to develop the paravesical and pararectal spaces. The cardinal ligament is isolated and cut after bipolar coagulation to the level of the deep uterine vein. By the vaginal approach, the ureters are identified before their entry into the bladder pillar. The uterine vessels are pulled down until their laparoscopically coagulated ends become visible. After incision of the vesicocervical reflection, the uterine fundus is grasped and developed (Döderlein maneuver). The lower cardinal and uterosacral ligaments are exposed by pulling the cervix and fundus uteri to the contralateral side. The cardinal and uterosacral ligaments are dissected and ligated, and the specimen is removed. We combined laparoscopic lymphadenectomy with radical vaginal hysterectomy in 33 women with cervical cancer. The mean operating time was 80 minutes for the vaginal phase and 215 minutes for the laparoscopic phase, including paraaortic and pelvic lymphadenectomy and preparation of the cardinal ligaments. Blood transfusions were necessary in four women. Three patients sustained injury to the bladder, one patient to the left ureter, and another patient to the left internal iliac vein. Repair was achieved at primary surgery for all intraoperative complications. No fistula was observed. The patients had fully recuperated after a mean of 28 days. The laparoscopy-assisted Schauta-Stoeckel approach may prove to be a safe alternative to conventional radical abdominal hysterectomy.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo review the specificity and sensitivity of diagnostic techniques using the polymerase chain reaction (PCR) on amniotic fluid (AF) samples for the determination of fetal RhD status.Data SourcesA MEDLINE computerized search was conducted for January 1991 through March 1996 using the key terms “polymerase chain reaction,” “rhesus,” and “RhD typing.”Methods of Study SelectionAll articles describing the use of PCR in AF for RhD typing were reviewed. Only cases in which the results of PCR testing were confirmed by fetal or neonatal serology were included in the final analysis.Tabulation, Integration, and ResultsThe results of PCR typing were compared with serology to determine the sensitivity, specificity, and positive and negative predictive values of DNA-based techniques. A total of 500 cases were reviewed, in which four different sets of oligonucleotide primers were used. The sensitivity and specificity of PCR typing were 98.7% and 100%, respectively, and the positive and negative predictive values were 100% and 96.9%, respectively. In five cases, an RhD-positive fetus was incorrectly diagnosed: Two fetuses died, one neonate needed exchange transfusions, and another neonate needed phototherapy in conjunction with a simple transfusion. The remaining infant was lost to follow-up. A theoretical model indicated that amniocentesis with PCR-based techniques for fetal RhD typing would be associated with a fourfold reduction in perinatal loss compared with funipuncture and serology for fetal typing.ConclusionsThis lower rate of procedure-related loss makes RhD typing using AF the preferred method for assessing the fetal Rh status in cases of a heterozygous paternal genotype.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID