摘要:

ObjectiveTo determine the ability of pelvic examination, tumor marker assessment, and transvaginal ultrasonography, with selected use of Doppler ultrasonography, to predict pelvic malignancy.MethodsTwo hundred twenty-six women scheduled for operative removal of a pelvic mass were entered in the study prospectively. Each woman underwent pelvic examination, tumor marker assessment, and transvaginal ultrasonography preoperatively. Women whose gray-scale findings were suspicious for malignancy underwent Doppler ultrasonography. Suspicious findings included masses that were fixed or irregular on pelvic examination; CA 125 level greater than 35 U/mL; elevations in serum lactic dehydrogenase, alphafetoprotein, or hCG; and the presence of a substantial solid component on gray-scale ultrasonography. Suspicious Doppler findings included intratumoral color flow, pulsatility index less than 1.0, or resistance index 0.4 or lower. The findings were correlated with the presence of malignancy.ResultsIf all three indicators (examination, tumor marker assessment, and gray-scale ultrasound findings) were nonsuspicious, 99% of premenopausal women and 100% of postmenopausal women had benign masses. If all three indicators were suspicious, 77% of premenopausal women and 83% of postmenopausal women had malignant tumors. Logistic regression identified ultrasound impression and tumor size to be significant predictors of malignancy in premenopausal women, whereas CA 125 level and ultrasound impression were significant in postmenopausal women. In patients with suspicious gray-scale findings, recategorization based on Doppler findings resulted in inferior diagnostic indices.ConclusionsUltrasonographic tumor size and appearance are the best predictors of pelvic malignancy in premenopausal women, whereas CA 125 level and ultrasonographic appearance are the best predictors in postmenopausal women. Neither color nor spectral Doppler is useful in this setting.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the incidence of surgically managed pelvic organ prolapse and urinary incontinence in a population-based cohort, and to describe their clinical characteristics.MethodsOur retrospective cohort study included all patients undergoing surgical treatment for prolapse and incontinence during 1995; all were members of Kaiser Permanente Northwest, which included 149,554 women age 20 or older. A standardized data-collection form was used to review all inpatient and outpatient charts of the 395 women identified. Variables examined included age, ethnicity, height, weight, vaginal parity, smoking history, medical history, and surgical history, including the preoperative evaluation, procedure performed, and details of all prior procedures. Analysis included calculation of age-specific and cumulative incidences and determination of the number of primary operations compared with repeat operations performed for prolapse or incontinence.ResultsThe age-specific incidence increased with advancing age. The lifetime risk of undergoing a single operation for prolapse or incontinence by age 80 was 11.1%. Most patients were older, postmenopausal, parous, and overweight. Nearly half were current or former smokers and one-fifth had chronic lung disease. Reoperation was common (29.2% of cases), and the time intervals between repeat procedures decreased with each successive repair.ConclusionPelvic floor dysfunction is a major health issue for older women, as shown by the 11.1% lifetime risk of undergoing a single operation for pelvic organ prolapse and urinary incontinence, as well as the large proportion of reoperations. Our results warrant further epidemiologic research in order to determine the etiology, natural history, and long-term treatment outcomes of these conditions.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the force needed to mechanically dilate the cervix of a nonpregnant woman after intracervically injecting dilute (0.05 U/mL) vasopressin solution.MethodsIn a randomized, double-blind study, equal amounts of either a dilute vasopressin solution or placebo (normal saline) were injected into the intracervical stroma at 4- and 8-o'clock positions, just beneath the mucosal surface, in 52 women immediately before cervical dilatation in preparation for operative hysteroscopy. When vasopressin solution was used, 20 mL of a dilute solution (4 U of 0.05 U/mL of vasopressin in 80 mL of normal saline) was injected. An electronic strain gauge and load cell were used to measure the peak linear force needed to dilate the cervix from 3 mm to 11 mm, using half-size metal dilators.ResultsThe mean (± standard error of the mean) total peak linear force needed to dilate the cervix from 3 to 11 mm in the treated (vasopressin) and control (placebo) groups was 20.29 ± 1.22 lb (range 5.54–40.82) and 37.05 ± 2.55 lb (range 6.11–52.2), respectively, a statistically significant difference. The mean total peak linear force needed to dilate the cervix in the treated group and in the control group in 0.5-mm increments from 3 to 11 mm was 1.14 ± 0.07 lb (range 0.81–1.69) and 2.08 ± 0.07 lb (range 1.64–2.43), respectively, also a statistically significant difference. With increasing parity, significantly less force was needed to dilate the cervix from 3 to 11 mm in the treated group than in the control group (P< .001).ConclusionsAdministration of dilute vasopressin solution (0.05 U/mL) to the cervical stroma significantly reduces the force needed to dilate the cervix.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether having had one or more induced abortions increases a woman's risk of having an ectopic pregnancy.MethodsWe conducted a case-control study of all women admitted to a major metropolitan hospital in Georgia with a surgical diagnosis of ectopic pregnancy during the period of October 1988 to August 1990. Controls were randomly selected from women seeking an induced abortion or delivering an infant at the same hospital. After exclusions, this analysis included 182 cases and 1056 controls. Stratified analysis and unconditional logistic regression were used to control for confounding and to estimate the relative risks.ResultsApproximately 90% of cases and controls were non-Hispanic, black women; 34% of the cases and 36% of the controls reported a history of induced abortion. The crude odds ratio for having an ectopic pregnancy associated with a history of induced abortion was 0.9 (95% confidence interval 0.6, 1.3). The odds ratio remained the same after adjusting for selected confounding variables and stratifying by the number of induced abortions, gestational age at the time of abortion, place where the abortion was performed, and the woman's report of medical complications of the abortion.ConclusionWe found no evidence that having one or more induced abortions increases a woman's risk of having an ectopic pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare perinatal outcome in older oocyte recipients with that in women of advanced maternal age who conceived without assisted reproductive technologies.MethodsWe performed a retrospective cohort study of 46 oocyte recipients and 49 women who conceived without assisted reproductive technologies. The obstetric courses in singleton and multiple gestations in the two groups of women were compared.ResultsAmong singleton pregnancies, a comparable obstetric course was noted between the groups. Fifty percent of the oocyte recipients experienced multiple gestations, resulting in an increased risk for placenta previa, premature rupture of membranes, preterm labor and delivery, glucose intolerance of pregnancy, pregnancy-induced hypertension, and cesarean delivery. However, only the risks for pregnancy-induced hypertension and cesarean delivery were significantly increased in the pregnancies of oocyte recipients with multiple gestations.ConclusionsPerinatal complications in women receiving oocyte donation may be related to their higher incidence of multiple gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo study the human teratogenic risk of doxycycline treatment during pregnancy.MethodsPaired analysis of cases with congenital abnormalities and matched healthy controls was performed in the large population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980–1992.ResultsOf 32,804 pregnant women who had infants with no defects in the study period (control group), 63 (0.19%) were treated with doxycycline. Of 18,515 pregnant women who had offspring with congenital abnormalities, 56 (0.30%) were treated with doxycycline, a rate that is higher than that of the control group (P= .01). However, the case-control pair analysis did not show a significantly higher rate of doxycycline treatment in the second and third months of gestation in any group of congenital abnormalities.ConclusionsTreatment with doxycycline during pregnancy presents very little if any teratogenic risk to the fetus. Thus, if doxycycline treatment is necessary during pregnancy, there would appear to be no contraindication.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the accuracy of estimating birth weight among twins with discordancy (intra-pair difference in actual birth weight of more than 25%) and to determine the relative accuracy of an intra-pair difference in abdominal circumference (Δ AC) of 20 mm or more or in estimated fetal weight (Δ EFW) of 25% or more for the identification of discordant growth in twins.MethodsOver a 6-year period, we identified all nonanomalous twin pairs with gestational ages greater than 23 weeks and sonographic examinations within 3 weeks of birth. Ultrasonographic biometry of both twins included AC, head circumference, and femur length; these indices were used to estimate fetal weight by Hadlock's formula. Likelihood ratios, receiver-operating characteristic curves, and prediction limits were applied to assess the accuracy of the two diagnostic methods to predict an abnormal outcome.ResultsA total of 242 twin pairs were studied. The mean gestational age among the 21 twins with abnormal growth (30.6 ± 4.6 weeks) was significantly less than among the 221 twins with normal growth (33.2 ± 4.0 weeks) (P< .005). The biometric measurements of fetal parts, sonographic estimate of fetal weight, and actual birth weight for both fetuses were significantly less for discordant twin pairs (P< .05). The accuracy of predicting birth weight, as determined by mean error and percentage of the estimate within 10% of the actual weight, was similar between the groups. Receiver-operating characteristic curves showed that both diagnostic tests yielded areas under the two curves not significantly different from the area under the nondiagnostic line (P> .05). Most important, prediction limit calculations indicated that a 90% certainty that the actual birth weight discordance was at least 25% was achievable only if Δ AC was 172 mm or greater or Δ EFW was 112% or more.ConclusionThe most popular current methods (difference in AC or EFW) for predicting discordant growth in twin gestations have limited accuracy when held to a standard for discordance that requires a birth weight difference of at least 25%.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether cerebellar hypoplasia in Down syndrome is established and clinically recognizable in the second trimester of pregnancy and to evaluate the screening utility of transverse cerebellar diameter measurements for Down syndrome fetuses.MethodsUltrasonographic biometry data obtained before genetic amniocenteses on 42 fetuses with Down syndrome and 1161 karyotypically normal fetuses were analyzed. Mean transverse cerebellar diameters stratified by gestational age were compared. A regression equation relating transverse cerebellar diameters to gestational age was calculated for 387 normal fetuses and applied to the remaining normal (n= 774) and all Down syndrome fetuses. Ratios of observed to expected cerebellar diameters were calculated. Sensitivity, specificity, and positive predictive values were calculated for various cutoff points and Down syndrome prevalences.ResultsCerebellar diameters in Down syndrome fetuses were smaller than in normal controls at all gestational ages (P< .005) by an average of 0.67–0.87 mm. A ratio of 0.92 for observed/expected cerebellar diameters yielded a sensitivity of 21%, specificity of 95%, and positive predictive values of 1.66% and 0.56% in populations with a risk for Down syndrome of one in 250 and one in 750, respectively.ConclusionsCerebellar hypoplasia is developmentally established and sonographically recognizable in secondtrimester Down syndrome fetuses. However, cerebellar size differences between normal and Down syndrome fetuses are too small to be clinically useful.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess intrauterine growth in a series of nine fetuses diagnosed with Beckwith-Wiedemann syndrome.MethodsInfants confirmed postnatally to have Beckwith Wiedemann syndrome were identified from records maintained in the Division of Clinical Genetics. Antenatal ultrasound and birth records were evaluated. Head circumference (HC), abdominal circumference (AC), and estimated fetal weight (EFW) were assigned percentiles based on gestational age. Newborn HC and birth weight were also assigned percentiles. Polyhydramnios was diagnosed using either amniotic fluid index or documented subjective assessment.ResultsNine infants with Beckwith-Wiedemann syndrome had antenatal ultrasound examinations. Seven of these had more than one examination. Two infants were suspected to have Beckwith-Wiedemann syndrome in utero. Important ultrasound findings included omphalocele (four), enlarged liver and kidneys (one), and enlarged liver (one). Fetal tongue protrusion on ultrasound was not identified in any fetus. Six of nine fetuses (66%) with ultrasound examinations after 25 weeks' gestation had polyhydramnios. Evaluation of the fetal HC, AC, and EFW percentiles demonstrated that fetuses with Beckwith-Wiedemann syndrome may exhibit accelerated growth as early as 25–30 weeks' gestation, but may exceed the 90th percentile only after 36 weeks' gestation.ConclusionsFetuses with omphalocele, polyhydramnios, and an AC less than the 90th percentile may have Beckwith-Wiedemann syndrome. Polyhydramnios and accelerated growth beginning between 25 and 36 weeks' gestation, even without omphalocele, should alert the physician to the possibility of Beckwith-Wiedemann syndrome.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify factors associated with post-term birth and factors associated with adverse outcomes in post-term births.MethodsThe sample was a 10-year cohort (1978–1987) of term (n= 379,445) and post-term (n= 65,796) births from the Medical Birth Registry of Norway. Gestational age was based on mothers' recall of the last menstrual period. Multivariate analyses included proportional hazards regression and binomial logistic regression.ResultsAfter controlling for covariates, there was only a slightly increased risk of perinatal mortality in post-term as compared with term births (adjusted relative risk [RR] 1.11; 95% confidence interval [CI] 0.97, 1.27). For post-term births, risk factors for perinatal mortality were small size for gestational age (SGA) (adjusted RR 5.68; 95% CI 4.37, 7.38) and maternal age 35 years or older (adjusted RR 1.88; 95% CI 1.22, 2.89), whereas large size for gestational age (LGA) was a protective factor (adjusted RR 0.51; 95% CI 0.26, 1.00). Similar risk factor RRs were found for perinatal mortality in term births. Fetal distress was associated with both SGA and post-term birth; labor dysfunction and obstetric trauma were associated with both LGA and post-term birth; shoulder dystocia and maternal hemorrhage were associated with LGA only.ConclusionsAmong post-term births, maternal complications were generally associated with larger fetal size, and fetal complications were associated with smaller fetal size. The evidence for an adverse impact on perinatal mortality of post-term birth is weak once other factors are taken into account.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID