摘要:

ObjectiveTo determine the prevalence of chronic pelvic pain in U.S. women aged 18–50 years, and to examine its association with health-related quality of life, work productivity, and health care utilization.MethodsIn April and May 1994, the Gallup Organization telephoned 17,927 U.S. households to identify women aged 18–50 years who experienced chronic pelvic pain, ie, of at least 6 months' duration. Those who reported chronic pelvic pain were surveyed on severity, frequency, and diagnosis; quality of life; work loss and productivity; and health care utilization.ResultsAmong 5263 eligible women who agreed to participate, 773 (14.7%) reported chronic pelvic pain within the past 3 months. Those who reported chronic pelvic pain had significantly lower mean scores for general health than those who did not (70.5 versus 78.8,P< .05), and 61% of those with chronic pelvic pain reported that the etiology was unknown. Women diagnosed with endometriosis reported the most health distress, pain during or after intercourse, and interference with activities because of pain. Estimated direct medical costs for outpatient visits for chronic pelvic pain for the U.S. population of women aged 18–50 years are $881.5 million per year. Among 548 employed respondents, 15% reported time lost from paid work and 45% reported reduced work productivity.ConclusionFrequently, the cause of chronic pelvic pain is undiagnosed, although it affects approximately one in seven U.S. women. Increased awareness of its cost and impact on quality of life should promote increased medical attention to this problem.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo compare the relative value of work and reimbursement by the resource-based relative value scale (RBRVS) and the charge-based McGraw-Hill relative value scale for invasive services performed for women only (obstetric-gynecologic), for men only (urology), and in a gender-neutral specialty (general surgery).MethodsTwo hundred nineteen obstetric-gynecologic, 125 urology, and 105 general surgery invasive procedures were compared by the mean for each specialty of 1) the ratio of the procedure-specific work component of the RBRVS unit to the total relative value unit, and 2) the ratio of the procedure-specific total RBRVS unit to the McGraw-Hill relative value unit. All procedures were weighted equally. Ratios are reported as percentages. Statistics were compared by analysis of variance with Newman-Keuls test for multiple pairwise comparisons when significant differences were identified. Statistically significant differences were defined asP< .05.ResultsThe mean percentage of the procedure-specific work component of the RBRVS unit to the total relative value unit and the total RBRVS unit to the McGraw-Hill unit were significantly lower (P< .01 for all comparisons) for obstetric-gynecologic (49.7 and 139.5) than for urology (55.1 and 207.1) or general surgery services (53.2 and 181.0). There were no significant differences between urology and general surgery services among the procedures studied.ConclusionThe data support a lower relative value of work and reimbursement for services performed for women only. This may be the result of 1) high initial estimates of work for urology and general surgery services, 2) low initial estimates of work for obstetric-gynecologic services, or 3) a carry-over of reimbursement bias from the charge-based environment to the RBRVS by the methods used in its development.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo evaluate the advantages and pitfalls of the loop electrosurgical excision procedure as applied to the diagnosis and treatment of cervical cancer precursors.MethodsLoop electrosurgical excision procedure using local anesthesia and colposcopic guidance was performed in an outpatient clinical setting in 1189 consecutive patients referred for colposcopy for an abnormal Papanicolaou smear during a period of 4 years.ResultsOf the 1189 patients, 915 (77%) were managed in one sitting with the “see and treat” approach, and in 274 patients endocervical curettage and cervical biopsies preceded loop electrosurgical excision procedure. One hundred nineteen (10%) patients were lost to follow-up. Twenty-one patients had either adenocarcinoma in situ (15) or microinvasive squamous cell carcinoma (six) in the loop electrosurgical excision procedure specimen, whereas the electroexcised specimens contained no lesional tissue in 166 (14%) patients. Cure (ie, disease-free at 6 months or longer) was observed in 92% of the 883 evaluable patients after a single treatment and 95% after a repeat loop electrosurgical excision procedure. High-grade squamous intraepithelial lesion was successfully treated with loop electrosurgical excision procedure in 287 (93%) of 309 patients. Complications, mainly intra-and postoperative bleeding, occurred in 7% of the patients. In most loop electrosurgical excision procedure-negative cases, the referral cytologic diagnosis or colposcopy and/or histology were false-positive on review, or the biopsies performed before loop electrosurgical excision procedure removed smaller areas of abnormal tissue.ConclusionsLoop electrosurgical excision procedure using the see and treat approach should be limited to cytologically and colposcopically unequivocal intraepithelial lesions, and depth of excision should be controlled by colposcopy using loop electrodes of appropriate size. In doubtful cases, particularly in the young patient, disease should be ascertained by expert histology and colposcopy before definite therapy. Loop electroexcision represents an attractive means of diagnosing and treating cervical cancer precursors.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo evaluate the long-term outcomes after treatment of cervical intraepithelial neoplasia (CIN) in women infected with the human immunodeficiency virus (HIV).MethodsHuman immunodeficiency virus-infected and HIV-negative women treated for CIN by ablation or excision were followed-up prospectively by cytology and colposcopy for periods of up to 73 months.ResultsAmong 127 HIV-infected CIN patients, 62% developed recurrent CIN by 36 months after treatment, compared with 18% of 193 HIV-negative CIN patients. Recurrence rates reached 87% in 41 HIV-infected women with CD4 counts less than 200 cells/mm3. Progression to higher-grade neoplasia, including one invasive cancer, occurred by 36 months in 25% of HIV-infected and 2% of HIV-negative women. After adjusting for age, CIN severity, and treatment type, predictors of recurrence included HIV infection (rate ratio 4.4), and, in HIV-positive women, low CD4 count (rate ratio 2.2). In patients treated by excision, predictors of recurrence included HIV infection (rate ratio 2.0) and residual CIN after treatment (rate ratio 2.7). After a second treatment, a second CIN recurrence developed in 14 of 33 HIV-infected and in one of 17 HIV-negative women. After a third treatment, three of six HIV-infected women developed a third recurrence. With long-term follow-up, 45% of treated HIV-infected CIN patients had chronic condylomatous changes in the cervix compared with 5% of HIV-negative women.ConclusionIn HIV-infected women, CIN may recur despite multiple treatments, and chronic condylomatous changes are common. Innovative therapies for controlling CIN in HIV-infected women are needed.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo evaluate the diagnostic accuracy of transvaginal ultrasonography for endometrial abnormalities in women with abnormal uterine bleeding.MethodsIn a prospective study, 136 consecutive patients underwent transvaginal ultrasonography, hysteroscopy, and endometrial sampling through suction curettage or directed biopsy. The ultrasonographic findings were evaluated on the basis of the final diagnosis established by hysteroscopy and histologic examination. Receiver operating characteristic curve analysis and likelihood ratios were used. Likelihood ratios algebraically combine sensitivity and specificity to describe more than the independent values themselves, specifically the change in odds favoring disease given a particular test result.ResultsIn 21 of the 136 patients, hysteroscopy detected polyps or submucous myomas, which curettage failed to detect. In 67 premenopausal women, ultrasonography demonstrated a sensitivity in diagnosing endometrial abnormalities of 88% and a specificity of 68%, using a cutoff point of 5 mm of the single-layer endometrial thickness. The positive likelihood ratio was 2.8 (95% confidence interval [CI] 1.66–4.55) and the negative likelihood ratio 0.18 (95% CI 0.07–0.46). In 69 postmenopausal women, using a cutoff point of 3 mm, the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 97%, 74%, 3.7 (95% CI 2.18–6.38), and 0.04 (95% CI 0.01–0.28), respectively.ConclusionTransvaginal ultrasonography is an excellent first-step diagnostic method of excluding endometrial abnormalities in women with postmenopausal bleeding but is of limited use in premenopausal women with irregular bleeding. Ultrasonography may reduce the number of invasive endometrial investigations by approximately 40%.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo assess the utility of urinary cross-linked N-telopeptides in monitoring bone resorption and predicting bone loss during GnRH agonist administration.MethodsNinety patients who were prescribed GnRH agonist therapy for 3-6 months for treatment of endometriosis, leiomyomas, or other gynecologic disorders participated in this prospective multicenter study. N-telopeptides, serum estradiol (E2), and bone mineral density were monitored before, during, and up to 3 months after the course of GnRH agonist therapy.ResultsN-telopeptide levels increased significantly throughout GnRH agonist therapy and returned to baseline levels by 3 months after treatment was completed. A significant negative correlation was seen between N-telopeptide and E2 measurements after 3 months (r= −0.23, P < .05), 4 months (r= −0.32, P < .05), and 5 months (r= −0.41,P< .005) of GnRH agonist therapy. The percent change in bone mineral density at L1-L4 at 6 months of GnRH agonist treatment correlated inversely with the percent change in N-telopeptides from baseline to 2, 3, 4, and 5 months of treatment; the percent change in bone mineral density at the femoral neck at 6 months correlated inversely with the percent change of N-telopeptides from baseline to month 4.ConclusionUrinary N-telopeptide determinations provide a quantitative measure of bone resorption, due to GnRH agonist-induced hypoestrogenism. Increases in resorption as measured by N-telopeptides parallel decreases in E2 levels. Increases in N-telopeptides on GnRH agonist therapy may provide a tool to predict decreases in bone mineral density.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo measure the length of active labor (first and second stages) in a low-risk population of non-Hispanic white, Hispanic, and American Indian women, and to identify any differences among these ethnic groups.MethodsDescriptive statistics are presented for 1473 low-risk women at term who delivered at the University of New Mexico Hospital. Data examined by ethnicity included demographics, intrapartum care and complications, and duration of the active-phase, first stage (4 cm to complete cervical dilatation) and second stage (complete cervical dilatation to delivery) of labor.ResultsCompared with Friedman's criteria, 20% of these low-risk women had a prolonged active phase of the first stage, and 4% had a prolonged second stage, without excess maternal or infant morbidity. The mean length of active-phase, first-stage labor was 7.7 hours for nulliparas and 5.7 hours for multiparas (statistical limits 19.4 and 13.7 hours, respectively), with no differences according to ethnic group. The mean length of second stage was 53 minutes for nulliparas and 17 minutes for multiparas (statistical limits 147 and 57 minutes, respectively). American Indian nulliparas had significantly shorter second stages than non-Hispanic white women (P< .05).ConclusionActive labor in healthy women lasted longer than is widely appreciated. Upward revision of clinical expectations for the length of active labor is warranted.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo identify biochemical indices for iron and protein nutriture as well as acute-phase reactants as predictors of preterm delivery.MethodsIn this nested case-control study, serum samples were obtained at about 24 weeks' gestation from 94 indigent multiparas. These cases were defined based on having a spontaneous delivery of 32 weeks or less (n = 31) with two control groups, one delivering spontaneously at 33–36 weeks (n= 32) and the other delivering spontaneously at 37 weeks or more (n= 31). The concentrations of iron, ferritin, transferrin, transferrin saturation, and transferrin receptor were measured as indices of iron status. The concentrations of acute-phase reactants, including C-reactive protein, α-2-macroglobulin, β-2-microglobulin and ceruloplasmin, were also measured, along with albumin, prealbumin, retinol-binding protein, copper, and zinc.ResultsSerum ferritin concentrations were negatively correlated with gestational age at birth (P= .034). For subjects having serum ferritin levels above the median compared with those below, the odds ratio of having an early spontaneous preterm delivery was 2.99 (95% confidence interval 1.13–7.89). The other indices, including iron status and the acute-phase reactants, were not significantly associated with gestational age at birth.ConclusionElevated serum ferritin levels during the second trimester are predictive of early spontaneous preterm delivery, possibly because these reflect an acute-phase reaction to subclinical infections that are closely associated with premature delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo determine the effect of selective termination of an abnormal twin on the rate of preterm delivery.MethodsThe study group consisted of 69 patients with twin pregnancies who underwent selective termination between 1987-1994. The comparison groups consisted of singleton (n= 42,362) and twin pregnancies (n= 825) delivered at our institution during the same period. The data were analyzed by χ2and Fisher exact test, as appropriate. P < .05 was considered significant. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated by multiple logistic regression.ResultsTerminating the presenting twin was associated with a significantly higher risk of delivery before 37 weeks (adjusted OR 4.1, 95% CI 1.4–12.3) and low birth weight (adjusted OR 3.8, 95% CI 1.3–11.4) compared with terminating the nonpresenting twin. When the termination was performed at or after 20 weeks' gestation, only the risk of preterm premature rupture of the membranes or preterm labor was significantly increased (adjusted OR 3.7, 95% CI 1.2–11.5). Selective termination patients had a lower rate of preterm delivery than twin pregnancies (40 versus 58%,P< .005) but higher than singleton pregnancies (40 versus 10%,P< .001).ConclusionSelective termination of the presenting twin at 20 weeks or later was associated with a worse perinatal outcome than terminating the nonpresenting twin or performing the procedure before 20 weeks.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo describe our experience with preeclampsia in high-order multifetal gestations.MethodsRecords for all triplet and quadruplet pregnancies delivered after 24 weeks' gestation from January 1988 through June 1994 were reviewed. All patients were treated with bed rest from 20 weeks' gestation onward and received corticosteroids weekly beginning at 24 weeks. Tocolytics were used as needed.ResultsTwenty-one triplet and eight quadruplet pregnancies were studied. The mean gestational age at delivery was 32.3 and 27.9 weeks, and mean birth weights were 1547 and 1028 g, respectively. Seventeen of 29 patients developed preeclampsia, 14 of the 21 triplet mothers and three of the eight quadruplet mothers. Among 16 patients who were delivered for preeclampsia, only eight had blood pressure (BP) elevation before delivery, whereas ten had epigastric pain, visual disturbances and/or headache; nine had elevated liver enzyme levels; and seven had low platelet counts. Only three patients had proteinuria, and only six had edema. Five women developed the syndrome of hemolysis, elevated liver enzymes, and low platelets postpartum, all of whom had normal BP before delivery. Two patients developed preeclampsia after delivery. A total of 95 infants were delivered, all by cesarean, of whom 93 (98%) survived.ConclusionPreeclampsia is common in high-order multifetal gestations and often presents in an atypical manner. Hypertension is not always the presenting sign, and symptoms consistent with severe preeclampsia and abnormal laboratory values predominate.

ISSN:0029-7844    

出版商:OVID    

年代:1996

数据来源: OVID