摘要:

ObjectiveTo review the management strategies and outcome in gravidas with anti-M isoimmunization over the past 26 years at The Ohio State University.MethodsData collected from 115 pregnancies found to have anti-M antibody at The Ohio State University from September 1969 through February 1996 were reviewed retrospectively. We analyzed indirect antiglobulin tests, amniotic fluid with spectrophotometric examination, direct antiglobulin tests, M antigen status, antepartum course, and perinatal outcome.ResultsAnti-M antibody was found in 90 women who had 115 pregnancies over 26 years. Among those with positive indirect antiglobulin tests, 104 pregnancies had titers at or below 1:4 Only one patient with an initial low titters experienced more than a three-fold increase to 1:64. Two women underwent a total of eight amniocenteses when titers were at or above 1:128 Forty-two (60%) of the 70 infants tested were positive for M antigen. Nine infants required phototherapy. Eight of these infants wee delivered preterm. Thee was an increase in the number of women seen with anti-M antibody in pregnancy at out institution, with nearly 10% of all gravidas with a positive antibody screen having anti-M alloantibodies. There were no cases of hemolytic disease of the newborn, mild or severe.ConclusionThe prevalence of anti-M isoimmunization may be increasing. The incidence of severe hemolytic disease of the newborn due to anti-Mis extremely low. We found no cases in our review of 115 pregnanacies, although there have been several cases of severe hemolytic disease of the newborn reported. If anti-M is detected in pregnancy, the titer is low (no more than 1:4), and there is no history of prior pregnancy complications suggesting a hemolytic disease process, we recommend no further testing other than an indirect antiglobulin test at 28 weeks to look for the emergence of other alloantibodies. However, if the initial titer is elevated or there is a concerning obstetric history, serial titers should be performed and amniocenteses reserved for rising titers.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo quantify the incidence of uterine leiomyoma confirmed by hysterectomy, ultrasound, or pelvic examination according to age and race among premenopausal women.MethodsFrom September 1989 through May 1993, 95, 061 premenopausal nurses age 25–44 with intact uteri and no history of uterine leiomyoma were followed to determine incidence rates of uterine leiomyoma. The self-reported diagnosis was confirmed in 93% of the medical records obtained for a sample of cases. Using pooled logistic regression, we estimated relative risks (RRs) of uterine leiomyoma according to race and examined whether adjustment for other potential risk factors could explain the variation in the race-specific rates.ResultsDuring 327,065 women-years, 4181 new cases of uterine leiomyoma were reported. The incidence rates increased with age, and the age-standardized rates of ultrasound-or hysterectomy-confirmed diagnoses per 1000 woman-years were 8.9 among white women and 30.6 among black women. After further adjustment for marital status, body mass index, age at first birth, years since last birth, history of infertility, age at first oral contraceptive use, and current alcohol consumption, the rates among black women were significantly greater for diagnoses confirmed by ultrasound or hysterectomy (RR 3.25; 95% confidence interval [CI] 2.71, compared with rates among white women. Women. We observed similar RRs when the cohort was restricted to participants who reported undergoing a screening physical examination within the 2 years before baseline.ConclusionA higher prevalence of known risk factors did not explain the excess rate of uterine leiomyoma among premenopausal black women.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the efficacy and complications of laparoscopic presacral neurectomy in pelvic pain.MethodsWe reviewed records of 655 patients receiving laparoscopic surgery and laparoscopic presacral neurectomy for diagnoses including adenomysis with dysmenorrhea (n= 55), moderate and severe endometriosis with dysmenorrhea (n= 127), minimal and mild endometriosis with dysmenorrhea (n= 208), primary dysmenorrhea (n= 99), and chronic pelvic pain with or without pathologic disease (n= 166). Pain relier was evaluated at least 12 months postoperatively.ResultsPain relief was evaluated in 157 patients. Significant pain relief (no pain or mild pain requiring no medication) was found in 22 (52%) of 42 women with adenomysis, in 75 (73%) or 103 with moderate to severe endometriosis with dysmenorrhea, in 123 (75%) of 164 with minimal to mild endometriosis with dysmenorrhea, in 64 (77%) of 83 with primary dysmenorrhea, and in 84 (62%) of 135 with chronic pelvic pain. There were four major complications (0.6%) that required further surgery, including injury of the right internal iliac artery (n= 1) and chylous ascites (n= 3). Three cases (0.5%) had laceration of the middle sacral vein controlled during laparoscopy. In addition, 485 (74%) of the 655 patients complained of constipation after laparoscopic presacral neurectomy, which was relieved easily by medication.ConclusionPresacral neurectomy can be performed safely and efficiently by laparoscopy and is a valuable alternative treatment for pelvic pain.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectivdTo determine if carbon dioxide laser conization fo the cervix is a risk factor for preterm delivery in subsequent gestations and to evaluate whether there is any relationship between cone height and duration of pregnancy.MethodsPatients of fertile are who had carhon dioxide laser conization were followed for reproductive events. Cases were matched one-to-one with controls for known risk factors for preterm delivery. Pregnancy duration, rate of treterm birth, and mode of delivery were studied. Parametric and nonparametric tests were used for statistical analysis. Logistic regression analysis and Cox proportional hazard modeling were used to investigate the relationship between cone height and subsequent preterm delivery.ResultsSixty-four women with sigleton pregnancies after carbon dioxide laser conization and 64 controls were included in the study. Overall, no difference was found in the rate of preterm delivery and duration of pregnancy. However, women with cone height of at least 10 mm had a higher rater of preterm delivery than either those with cone height less than 10 mm remained significant in predicting the occurrence of preterm delivery and the duration of pregnancy after adjusting for known risk factors (odds ratio 11.1,P< .05).ConclusionCone height of at least 10 mm is an independent risk factor for the duration of pregnancy and for the occuraence of preterm delivery in the subsequent gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess specific parturition and reproductive variables as potential risk factors for urinary incontinence in later life.Methodsa mail survey was conducted with a random sample of 1922 women members of a large health maintenance organization. Multivariate analysis was used to estimate the independent association between parturition factors, husterectomy, hormone use, and incontinence.ResultsCompleted surveys were returned by 939 women (49%), 682 of whom reported at least one episode of incontinence in the past 12 months or ever having been treated for incontinence. On univariate analysis, women with incontinence were more likely to be white and heavier and to have had a hysterectomy before age 45, at least one live birth, a postdate (at least 42 weeks' gestation) birth, alabor lasting longer than 24 hours, and exposure to oxytocin. The risk of incontinence increased significantly with the number of exposures to oxytocin. In a multivariate model including age, there was a significant association between incontinence and white race (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.2, 2.8), body mass (OR for fourth quartile 3.0, 95% CI 1.8, 5.0), estrogen replacement (OR 1.9, 95% CI 1.3, 2.8) and oxytocin (OR 1.9, 95% CI 1.0, 3.6). Parity was also associated with incontinence (P< .05).ConclusionThis study supports previous findings of a positive association between urinary incontinence and body mass, parity, and use of estrogen. In addition, we found a significant independent association between exposure to oxytocin during labor and incontinence in later life.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate a simplified protocol for pessary management.MethodsWomen with symptomatic pelvic organ prolapse who opted for pessaries were enrolled in a prospective simplified protocol for pessary management. After the initial pessary fitting, they were seen at 2 weeks for reexamination and thereafter at 3- to 6-month intervals.ResultsOne hundred ten women (mean age 65 years) were enrolled, and 81 (74%) of them were fitted successfully with a pessary. Life-table analysis showed that 66% of those who used a pessary for more than 1 month were still users after 12 months and 53% were still users after 36 months. The severity of pelvic prolapse did not predict the likelihood of pessary failure except in cases of complete vaginal eversion. Patients complaining of stress incontinence were less likely to have a successful pessary fitting and more likely to opt for surgery. Current hormone use and substantial perineal support do not predict greater likelihood of pessary fitting success. No serious complications from using the pessary were observed n the study sample.ConclusionStringent guidelines calling for frequent Pelvic examinations during pessary use can be relaxed safely. Pessaries can be offered as a safe long-term option for the mangement of pelvic prolapse.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the effect of estrogen replacement therapy (ERT) on serum androgen levels in postmenopausal women.MethodsWe measured serum dehydroepiandrosterone (DHEA), DHEA-sulfate, testosterone, estradiol (E2), LH, FSH, and sex hormone binding globulin in 8:00 AM fasting serum samples from a previous randomized, blinded, place-bo-controlled crossover study in which 28 postmenopausal women (27 naturally menopausal) were given 2 mg/day of oral micronized estradiol. The treatment arms were 12 weeks woth a 6-week washout.ResultsEstrogen replacement therapy raised mean (± stnadard error of the mean [SEM] serum E2 from 8.7 ± 1.0 to 117 ± 18.7 pg/mL (P< .001 from baseline). Concurrently, mean (±SEM) DHEA-sulfate fell from 67.3 ± 9.6 to 52.1 ± 6.4 μg/dL (P< .001), and mean (±SEM) testosterone fell from 16.1 ± 2.4 to 9.4 ± 1.4 ng/dL (P= .006). Both FSH and LH declined significantly. Sex hormone binding globulin increased by 160% with ERT (P< .001).ConclusionMenopausal ERT decreases serum androgen levels, decreasing DHEA-dulfate and testosterone by 23% and 42%, respectively. Whereas the decline in testosterone is likely due to decreased LH-driven ovarian stromal steroidogenesis, the declining levels of DHEA-sulfate also may imply a direct adrenal effect of estrogen. Bioavailable testosterone likely is reduced even more profoundly because sex hormone binding globulin is increased 160% by estrogen. Thus, menopausal ERT may induce relative ovarian and adrenal androgen deficiency, creating a rationale for concurrent physiologic androgen replacement.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the prognostic significance of the Bethesda system's cytologic categories in patients with endometrial malignancy.MethodsPatients with biopsy or hysterectomy-proven endometrial malignancy and a Papanicolaou smear result reported using the Bethesda system within 1 year of diagnosis were identified through retrospective review of our computerized database.ResultsAfter introduction of the Bethesda system in our laboratory on November 1, 1992, until January 1, 1997, 112 eligible patients were identified (108 with crcinomas and four with carcinosarcomas). Patients with cytologic dianoses of malignancy (n= 17) were significantly more likely to hacve International Federation of Gynecology and Obstetrics (FIGO) grade 3 tumors and high-risk histology (serous, clear cell, and adenosquamous carcinoma and carcinosarcoma) than those with atypical glandular cells of uncertain significance (n= 33) or those with cytology not suspicious for malignancy (n= 63). Patients with malignant smears were also significantly more likely to have cervical extension, malignant peritoneal cytology, and FIGO stage II, III, or IV than those with atypical glandular cells of uncertain significance or those with cytology not suspicious for malignancy.ConclusionPapanicolaou smears obtained within 1 year of histologic diagnosis of endometrial malignancy and interpreted using the Bethesda system were suspicious for (atypical glandular cells of uncertain significance) or diagnostic of malignancy in nearly half of all cases (29 and 15%, respectively). Patients having malignant glandular cells were more likely to have poor prognostic pathologic finings.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BackgroundThe 4-S modification of the Roeder knot may be tied laparoscopically as a single-throw knot.TechniqueIt is tied by adding a fourth wrap around the suture loop and securing the loop in place with a square knot rather than a single half-hitch.ExperienceWe have used this knot in laparoscopic surgeries for more than 2 years and have not observed knot slippage.ConclusionThis modification results in a knot comparable in strength to the strongest laparoscopic multiple-throw square knots.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BackgroundAlthough current ultrasound techniques provide a linear (amniotice fluid index; AFI) or two-dimensional area index of amniotic fluid (AF), these indices have limited correlation with actual AF volume. We sought to quantify the three-dimensional volume of ultrasound-identified AF pockets, as assessed by the AFI and two-dimensional area methods. The BVI 2500 (Bladder Volume Instrument 2500; Diagnostic Ultrasound Corp., Redmond, WA) has been used to quantify the volume of residual urine in the bladder.Instrument and MethodThe BVI 2500 (Diagnostic Ultrasound Corp.) ultrasound uses a rotating 2-MHz transducer, computer-defined fluid interface, and computer integration of 12 cross-sectional images to calculate three-dimensional fluid volume. After providing written informed consent, 14 term pregnant patients (36–42 weeks) were evaluated using the BVI 2500 and an Ultramark 8 sector scan (Advanced Technology Laboratory, Bothell, WA). The largest vertical fluid pocket in each guadrant of the abdomen was identified with the sector scan, and vertical and horizontal measurements for AFI and two-dimensional area were recorded. Simultaneous AF volume measurements of each pocket were performed three times with the bladder volume instrument, and maximum values were used. Three-dimensional volume, two-dimensional area, and AFI values were compared by correlation anlysis, withP≤ .05 considered statistically significant.ExperienceAmong all patients, the average (± standard deviation) AFI was 7.6 ± 4.1 (range 1.5–1.64) cm, and the average two-dimensional area was 30.9 ± 21.1 (range 4.3–81.3) cm2. This corresponded to an average three-dimensional volume of 215 ± 134 (range 23–497) cm3. Three dimensional volume correlated highly with both AFI(r= 0.9;P< .001) and two-dimensional area (r= 0.86;P< .001). One AFI centimeter was equivalent to a volume of 30 cm3.ConclusionThere are highly significant linear correlations of three-dimensional amniotic fluid volumes with AFI and two-dimensional area. The four pockets used in AFI determination account for only 50% of total AF volume. Three-dimensional determinations may aid in clinical assessments of AF volume.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID