摘要:

In the period 1965 through 1977 the number of ectopic pregnancies in the United States tripled. A collaborative multicenter case-control study was set up to examine ectopic pregnancy as well as several other suspected complications related to use of an intrauterine contraceptive device (IUD). To determine to what extent IUD use might be related to this increase, the authors analyzed 615 women who had had an ectopic pregnancy and 3453 controls. Most important, women who had never used an IUD were equally likely to have an ectopic pregnancy as women who had used an IUD. Looking at the comparative risks for current contraceptive users, all current users, including IUD users, were less likely to have had an ectopic pregnancy than women not currently using contraceptives. Likelihood of ectopic pregnancy was the same regardless of whether a copper-containing or an inert plastic IUD was used. Among current IUD users, those who had used an IUD for a long time (25 months or more) were 2.6 times as likely to have had an ectopic pregnancy as short-term (less than 25 months) users. This difference between long- and short-term IUD users persisted for some time (not longer than 1 year) after removal of the IUD. Use of the IUD probably did not play a role in the recent tripling of ectopic pregnancies in the United States.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Factors relating to the inappropriate therapy of 66 cases of cervical cancer are reviewed. The patients are divided into 3 major categories: 1) 33 who underwent cryosurgery or hot cautery without colposcopy; 2) 9 who underwent colposcopy without outpatient therapy; and 3) 24 who underwent colposcopy followed by outpatient therapy. Of the patients who had outpatient therapy without colposcopy, the major indication for treatment was “cervicitis,” and all had a normal Papanicolaou smear. Of the 33 patients who underwent colposcopy because of an abnormal Papanicolaou smear, the proper treatment evaluation was carried out in only 5. The endocervical curettage (ECC) was omitted in 17 patients; no biopsies were taken in 8 patients; and conization of the cervix was omitted in 3 patients who had a positive ECC. Recommendations are made to minimize the inappropriate use of the outpatient approach in patients with cervical disease.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The safety and efficacy of the Silastic ring were examined for interval, postabortion, and postpartum sterilizations. The study includes an in-depth analysis of 10,086 cases generated by 51 collaborating institutions in 23 countries. Failure of the tubal ring is studied via the life-table method, although follow-up is limited to a relatively short period. Difficulties encountered when applying the ring, particularly those resulting in technical failure, are explored in detail. Surgical complications, infection, menstrual irregularity and abnormal bleeding, and pelvic surgery following sterilization are discussed. Comparisons are made among various approaches to the fallopian tubes. Such data are found to be similar to those for other occlusion techniques, demonstrating the comparable safety and efficacy of tubal ring sterilization.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The authors evaluated 86 hyperandrogenized women with measurements of serum cortisol, dehydroepiandrosterone sulfate, testosterone, and dihydrotestosterone in pooled sera before and after a dexamethasone suppression test. According to strict criteria, 70 (81%) of 86 women demonstrated a major glucocorticoid-suppressible component to their hyperandrogenism. Endocrine therapy was dictated by the results of the dexamethasone suppression test. To assess the predictive value of this test, we evaluated the clinical responses of a subgroup of 55 women who received appropriate endocrine suppression therapy for 6 to 15 months. Of this subgroup, 38 were identified as having adrenal hyperandrogenism; 3 had ovarian hyperandrogenism; and 14 had mixed hyperandrogenism. Of the 55 patients, 49 received dexamethasone alone; 3 received dexamethasone plus Ovral (an oral contraceptive containing the synthetic progestogen norgestrel 0.5 mg and ethinyl estradiol 0.05 mg); and 3, all with ovarian hyperandrogenism, received depomedroxyprogesterone acetate (Depo-Provera). Clinical response was assessed in terms of improvement or no improvement in menstrual status, acne, and hirsutism. Of 29 patients with adrenal or mixed hyperandrogenism associated with abnormal menses, the menstrual status of 17 (59%) improved after dexamethasone therapy. Acne improved in 39 (100%) of 39 subjects. Hirsutism showed moderate to marked improvement in 40 (73%) of 55 women after 6 to 15 months of endocrine suppression therapy. These results indicate that endocrine suppression therapy, particularly with repeated low-dose dexamethasone, prescribed on the basis of a dexamethasone suppression test, is an effective means of managing hyperandrogenism.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Twelve pregnant women with previously undiagnosed cervical incompetence each presented with membranes bulging through a widely dilated cervix and were treated by a cerclage procedure. This emergency closure of the open cervix resulted in a high rate of fetal salvage; 10 of the 12 women were delivered of surviving infants.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Four hundred sixty-five primary cesarean sections (10.4% of total deliveries) performed during 1977 and 1978 were reviewed and compared with 465 vaginal deliveries to ascertain factors that may be related to postpartum infection. The overall morbidity (19.7%) related to postpartum infection in the primary cesarean section group was statistically different from the 2.4% morbidity in the vaginal group. Cross comparisons of the effect of membrane status, use of internal electronic monitoring, development of postpartum anemia, duration of active labor, and difference in patient populations showed that internal monitoring had little or no effect on the development of postpartum endometritis. However, the development of postpartum anemia, increased time between membrane rupture and delivery, and, most important, a significant difference in patient populations were believed to be related to the development of postpartum endometritis in both groups.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

One hundred patients were treated for postpartum endometritis with ampicillin and clindamycin. Fifty patients were analyzed retrospectively and 50 prospectively for therapeutic response and development of late infectious sequelae. Seventy-eight patients exhibited an acceptable clinical response. One patient developed a wound infection from Staphylococcus aureus, which responded to drainage. The remaining 21 patients responded to the addition of an aminoglycoside. No patient developed a pelvic abscess or septic thrombophlebitis. The therapeutic response of the 2 groups treated with ampicillin and clindamycin is contrasted with the results derived from the traditional antibiotic regimen of a penicillin and an aminoglycoside.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Despite a massive national rubella immunization program, rubella infection remains a public health problem. When a nurse employed in a hospital-based obstetric clinic became ill with rubella, a crisis was precipitated. The hospital staff implemented a plan to inform the exposed 151 patients and 44 employees of the potential danger to themselves and their fetuses. To identify persons at risk, a program of rubella antibody testing of contacts was instituted. In 3 distinct attempts to obtain blood specimens, patient compliance rates fell progressively from 79 to 14%. One additional infected employee was detected. A list of recommendations designed to prevent or lessen the impact of future rubella exposures in hospitals is presented.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The maternal and neonatal data on 225 infants of diabetic mothers (IDM) are presented. The incidence of maternal and neonatal complications confirms previous reports, indicating improved survival rates and decreasing neonatal morbidity for the IDM. The observed incidence of hyaline membrane disease was 2.8%, perhaps reflecting attempts to prolong pregnancy when possible to 39 weeks' gestation with judicious use of primary cesarean section. Further, from analysis of neonatal growth, the head circumference of the large-for-gestational-age infant was found to be significantly increased after 37 weeks' gestation. Whether or not this observation represents increased brain growth in these infants is not known.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Prematurity is a large contributing factor to neonatal morbidity. An obstetric alternative to premature labor is administration of isoxsuprine, an effective inhibitor of uterine contractions. Six crossbred unanesthetized pregnant ewes were used to determine the effects on fetal and maternal cardiovascular and acid-base status of 10 maternal intravenous infusions of 30 mg isoxsuprine over 30 minutes (1 mg/min). Isoxsuprine caused slight maternal hypotension and a transient acidosis, both of which returned to baseline values within 60 minutes. Maternal tachycardia persisted throughout the experiment. A slight decrease in the oxygen percent saturation of the hemoglobin and the calculated O2content was observed after the infusion. There was no significant change in uterine blood flow. Maternal lactate concentration transiently increased at 60 minutes only. In the fetus, isoxsuprine caused transient hypotension and tachycardia. Fetal arterial PCo2calculated bicarbonate concentration, and O2content all decreased slightly at 45 minutes only. Fetal hyperglycemia was observed after the infusion throughout the experiment. All other fetal values returned to baseline levels within 60 minutes. It is suggested that 30 mg isoxsuprine can cause tolerable maternal and fetal metabolic and physiologic effects when administered intravenously to the unanesthetized pregnant ewe.

ISSN:0029-7844    

出版商:OVID    

年代:1981

数据来源: OVID