ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo generate contemporary uterine activity and labor progress data for oxytocin-augmented labor, and assess whether 2 hours of active phase labor arrest with at least 200 Montevideo units justifies cesarean delivery.METHODSFive hundred and one consecutive spontaneously laboring term women with abnormally progressive labor were managed by a standardized protocol: oxytocin and intrauterine pressure catheter with an intent to sustain at least 200 Montevideo units for 4 hours or more before cesarean for labor arrest. Uterine activity was measured, and maternal and neonatal outcomes were evaluated. With a sample of this size, the upper 95% confidence interval limit for an event with an observed rate of 1% is below 3%.RESULTSDuring oxytocin augmentation, nulliparas who were delivered vaginally dilated at a median rate of 1.4 cm/hour versus 1.8 cm/hour for parous women. In both groups, the 5th percentile of cervical dilation rate was 0.5 cm/hour. Thirty-eight women experienced labor arrest for over 2 hours despite at least 200 sustained Montevideo units; 23 (61%) achieved a vaginal delivery. Rates of chorioamnionitis and endometritis for the 38 women were 26%. None of their infants sustained a serious complication, including brachial plexus injury, even though three of the 23 vaginal deliveries (13%) were complicated by shoulder dystocia.CONCLUSIONThese data demonstrate that oxytocin-augmented labor proceeds at substantially slower rates than spontaneous labor, and support our previous contention that the criteria of labor arrest for 2 hours, despite at least 200 sustained Montevideo units, are insufficiently rigorous for the performance of cesarean.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo assess the efficacy of oral sulindac in low doses for prolonged duration to decrease the risk of recurrent preterm labor and extend gestation.METHODSThis was a randomized, double-blind, placebo-controlled study of patients between 24 and 34 weeks' gestation with preterm labor treated with intravenous magnesium sulfate. After successful tocolysis, patients were randomized by the pharmacy to receive either oral sulindac (100 mg) or placebo orally every 12 hours until 34 weeks' gestation. A power analysis required 43 patients in each group.RESULTSNinety-five patients were enrolled (46 in the sulindac group, 49 controls). No significant differences were found with respect to time gained in utero (39 ± 25 versus 45 ± 26 days,P= .29), delivery at more than 35 weeks' gestation (61% versus 74%,P= .29), recurrent preterm labor (20% versus 18%,P= .86), birth weight (2562 ± 623 versus 2624 ± 543 g,P= .62), or time spent in the neonatal intensive care unit (2.8 ± 9.2 versus 2.4 ± 8.6 days,P= .83) for the sulindac and control groups, respectively.CONCLUSIONThe use of oral sulindac until 34 weeks' gestation after successful parenteral tocolysis failed to reduce the incidence of readmission for preterm labor.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo compare the effects of three cyclooxygenase-2 (COX-2) inhibitors: nimesulide, meloxicam, and celecoxib, which exhibit varying COX-2 selectivity, on contractile activity in pregnant (before and after labor) and nonpregnant human myometrial tissue in vitro.METHODSIsometric tension recording was performed under physiologic conditions in isolated myometrial strips obtained from 33 women undergoing hysterectomy or either elective or emergency cesarean section. The effects of cumulative additions of nimesulide, meloxicam, and celecoxib (between 1 nmol/L and 100 μmol/L) on myometrial contractility were measured, and values for −log10EC50and mean maximal inhibition were compared.RESULTSNimesulide, meloxicam, and celecoxib exerted significant relaxant effects on contractility in nonpregnant, pregnant nonlabor, and pregnant labor myometrial strips. Values for −log10EC50values (± standard error of the mean) were as follows: nimesulide (nonpregnant) 5.14 ± 0.93 (n= 6), (pregnant nonlabor) 4.91 ± 0.75 (n= 6), and (pregnant labor) 5.84 ± 0.35 (n= 6); meloxicam (nonpregnant) 6.53 ± 0.57 (n= 6), (pregnant nonlabor) 4.80 ± 0.71 (n= 6), and (pregnant labor) 5.62 ± 0.21 (n= 6); celecoxib (nonpregnant) 6.15 ± 0.99 (n= 6), (pregnant nonlabor) 7.08 ± 0.98 (n= 6), and (pregnant labor) 7.25 ± 0.99 (n= 3). Celecoxib exhibited greater potency than nimesulide or meloxicam (P< .01). The range of maximal relaxation values achieved in the three tissue types were as follows: nimesulide 68–70% (n= 18;P< .01), meloxicam 69–84% (n= 18;P< .01), and celecoxib 69–77% (n= 15;P< .01).CONCLUSIONCOX-2 inhibitors exert significant relaxation in human myometrium with a similar potency in nonpregnant and pregnant (before and after labor onset) tissues. Celecoxib, a COX-2 specific inhibitor, was more potent than nimesulide or meloxicam, COX-2 preferential inhibitors.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo determine whether multiple courses of emergency contraceptive therapy supplied in advance of need would tempt women using barrier methods to take risks with their more effective ongoing contraceptive methods.METHODSWe randomly assigned 411 condom users attending an urban family planning clinic in Pune, India, to receive either information about emergency contraception along with three courses of therapy to keep in case of need, or to receive only information, including that about the locations where they could obtain emergency contraception if needed. For up to 1 year, women returned quarterly for follow-up, answering questions about unprotected intercourse, emergency contraceptive use, pregnancies, sexually transmitted infections, and acceptability.RESULTSWomen given advance supplies reported unprotected intercourse at rates nearly identical to those among women given only information (0.012 versus 0.016 acts per month). Among those who did have unprotected intercourse, however, supply recipients were nearly twice as likely (79% versus 44%) to have taken emergency contraception, although numbers were too small to permit statistically significant inferences. No women used emergency contraception more than once during the study, even though everyone in the advance-supplies group had extra doses available. All women found knowing about emergency contraception useful, and all those receiving only information wished they had received supplies as well.CONCLUSIONMultiple emergency contraception doses supplied in advance did not tempt condom users to risk unprotected intercourse. After unprotected intercourse, however, those with pills on hand used them more often. Women found advance provision useful.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo compare the effect of depot medroxypro-gesterone acetate (DMPA) and two types of oral contraceptives (OC) on bone mineral density (BMD) among women 18–33 years of age with those not using hormonal contraception.METHODSData from 155 women were analyzed. Depot medroxyprogesterone acetate was administered to 33 women; 63 women who chose oral contraception were randomly assigned to receive either a norethindrone-containing pill (n= 28) or a desogestrel-containing pill (n= 35). Fifty-nine women who did not use hormonal contraception served as controls. Lumbar spine BMD was determined using dual-energy x-ray absorptiometry at baseline and after 12 months of contraceptive use. We analyzed method-related percent change in BMD while controlling for body mass index, calcium intake, exercise, and smoking. We had approximately 90% power to detect a 2.5% difference between any two groups.RESULTSUsers of DMPA experienced a mean BMD loss of 2.74% over 12 months compared with controls who sustained a 0.37% loss (P= .01). Users of OCs generally demonstrated a gain (2.33% for norethindrone-containing pills, 0.33% for desogestrel-containing pills), which was different from controls among users of norethindrone-containing pills (P= .01), but not among users of desogestrel-containing pills (P= .99). Observed changes in BMD among DMPA users differed from women who used either type of pill (P< .002).CONCLUSIONDepot medroxyprogesterone acetate has an adverse effect on BMD, in comparison with OCs or non-hormonal methods, when used for 12 months. Results must be interpreted cautiously until it is determined whether these effects endure or are reversible.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

OBJECTIVETo evaluate the outcomes and cost of myomectomy through retrospective claims data analysis.METHODSThe study was performed using a retrospective database of private insurance claims from 1995 to 1997. Records were selected for analysis based on the presence of ICD-9-CM procedure and/or CPT-4 codes associated with myomectomy. In addition, diagnosis of uterine leiomyoma and related symptoms for these patients were confirmed through ICD-9-CM diagnosis codes. Inpatient, outpatient, and physician costs were estimated. All cost data were converted into 1997 dollars.RESULTSA total of 4394 women, between the ages of 14 and 70, were available for analysis. Of these, 3305 were classified by type of myomectomy procedure, and complete data were available on 820 at 1 year and 236 at 2 years. Abdominal myomectomies were the most common procedures, followed by hysteroscopic and laparoscopic myomectomies. Conversion to a more invasive procedure occurred in 5.4% of the patients. The rate of additional surgeries was 8.3% in 6 months, 10.6% in 1 year, and 16.5% in 2 years. Overall cost increased from an initial $6,737 per patient to $7,575 in 1 year and to $8,001 in 2 years.CONCLUSIONThe repeat procedures required after the initial myomectomy add significantly to total cost and highlight the importance of assessing post-procedure health care use. This comprehensive analysis facilitates the systematic evaluation of myomectomy with current and emerging alternative treatments for uterine leiomyomas.

ISSN:0029-7844    

出版商:OVID    

年代:2001

数据来源: OVID