摘要:

ObjectiveTo determine risk factors for pregnancy after tubal sterilization with bipolar electrocoagulation.MethodsA total of 2267 women who had bipolar electrocoagulation were followed for up to 8 to 14 years as part of a multicenter, prospective, cohort study conducted in medical centers in nine United States cities. We used proportional hazards analysis and cumulative life-table probabilities to assess pregnancy risk in these women.ResultsThe 5-year cumulative probability of pregnancy for women sterilized in 1978–1982 was 19.5 per 1000 procedures (95% confidence interval [CI], 12.2, 26.9); the comparable probability for women sterilized in 1985–1987 was significantly lower, 6.3 per 1000 procedures (95% CI, 0.0, 13.5) (one-tailedP= .01). Women enrolled in 1985–1987 who had fewer than three sites of coagulation had a probability of failure of 12.9 per 1000 procedures (95% CI, 0.0, 38.0); by contrast, women who had three or more sites coagulated had a probability of failure of 3.2 per 1000 procedures (95% CI, 0.0, 9.6) (one-tailedP= .01).ConclusionThe long-term probability of pregnancy after tubal sterilization with bipolar coagulation was very low when three or more sites of the fallopian tube were coagulated. Bipolar coagulating systems can be highly effective for sterilization when the fallopian tube is coagulated adequately.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo compare reproductive benefits of hysteroscopic myomectomy and polypectomy for infertility to outcomes in infertile couples with normal hysteroscopic findings.MethodsWomen with diagnoses of infertility who had hysteroscopic evaluations by a single surgeon between 1975 and 1996 were sent a routine follow-up questionnaire regarding their reproductive histories. All 92 subjects who were located responded to the questionnaire, and 78 met inclusion criteria: age under 45 years, at least 12 months of infertility, and at least 18 months of follow-up with attempts to conceive, including in vitro fertilization in women with bilateral tubal occlusion.ResultsOf the 78 subjects, 36 had myomectomies, 23 had polypectomies, and 19 had normal cavities. Among the three groups, there were no significant differences in age, type of infertility, length of infertility, or follow-up after the procedure. Polypectomy subjects had significantly higher pregnancy and live birth rates than women with normal cavities. Women who had myomectomies larger than 2 cm had significantly higher pregnancy and live birth rates, achieving statistical significance at a myoma size of 3 cm or greater for live births. Spontaneous abortion rates among first pregnancies after myomectomy, polypectomy, or normal study were similar: 31.5%, 27.7%, and 37.5%, respectively.ConclusionBoth hysteroscopic polypectomy and hysteroscopic myomectomy appeared to enhance fertility compared with infertile women with normal cavities. Despite concern that hysteroscopic resection of a large myoma might ablate a large surface area of the endometrial cavity, the reproductive benefit appears greater than the risk.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo examine trends in spontaneous abortion–related mortality and risk factors for these deaths from 1981 through 1991.MethodsWe used national data from the Centers for Disease Control and Prevention's Pregnancy Mortality Surveillance System to identify deaths due to spontaneous abortion (less than 20 weeks' gestation). Case-fatality rates were defined as the number of spontaneous abortion–related deaths per 100,000 spontaneous abortions. We calculated annual case-fatality rates as well as risk ratios by maternal age, race, and gestational age.ResultsDuring 1981–1991, a total of 62 spontaneous abortion-related deaths were reported to the Pregnancy Mortality Surveillance System. The overall case fatality rate was 0.7 per 100,000 spontaneous abortions. Maternal age 35 years and older (risk ratio [RR] 1.7, 95% confidence interval [CI] 0.9–3.0), maternal race other than white (RR 3.8, 95% CI 2.2–5.9), and gestational age over 12 weeks (RR 8.0, 95% CI 4.2–11.9) were risk factors for death due to spontaneous abortion. Of the 62 deaths, 59% were caused by infection, 18% by hemorrhage, 13% by embolism, 5% from complications of anesthesia, and 5% by other causes. Disseminated intravascular coagulation (DIC) was an associated condition among half of those deaths for which it was not the primary cause of death.ConclusionWomen 35 years of age and older, of races other than white, and in the second trimester of pregnancy age are at increased risk of death from spontaneous abortion. In addition, DIC complicates many spontaneous abortion cases that end in death. Because spontaneous abortion is a common outcome of pregnancy, continued monitoring of spontaneous abortion–related deaths is recommended.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine barriers to prenatal care among managed-care enrollees who receive Medicaid.MethodsIn-person interviews were conducted with women 13–45 years old who were members of the Prudential HealthCare Community Plan in Memphis, Tennessee. Interview data were linked to medical chart reviews for 200 women who were currently pregnant or had delivered a baby since enrollment in Prudential. Factors related to untimely entry to prenatal care and inadequate prenatal visits were examined.ResultsMore than half of the respondents had either untimely entry to or inadequate prenatal care. Overall, 89% of respondents had favorable attitudes about prenatal care. Several system and personal factors were associated with receipt of early or adequate prenatal care. Multivariate analysis showed that one system and two personal factors remained significantly related to entry to prenatal care. Women who entered Prudential during pregnancy were 2.4 times more likely (95% CI 1.1, 5.0) to receive late care than women who enrolled before pregnancy. Women who felt too tired to go for care were 2.2 times more likely (95% CI 1.0, 4.9) to receive late care. Women who experienced physical violence during pregnancy were 3.5 times more likely (95% CI 1.0, 12.0) to receive late care. Multivariate analysis with adequacy of prenatal care as the outcome showed several personal factors that increased odds of receiving inadequate prenatal care; however, only help from the infant's father was significantly related to adequacy of prenatal care. Women who did not have much help from the infant's father were 1.9 times more likely not to have adequate care (95% CI 1.0, 3.6).ConclusionEven when affordable care was available, many low-income women did not avail themselves of it. Although women knew the importance of prenatal care, there was a gap between attitudes and actually seeking appropriate care. System and personal factors need to be addressed to overcome barriers to prenatal care.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine whether severe intrapartum complications resulting in poor neonatal outcome increased obstetricians' cesarean delivery rates.MethodsFrom July 1996 through June 1998 we prospectively studied 3008 deliveries by 12 obstetricians. We chose adverse neonatal outcomes that would be viewed by obstetricians as anxiety-provoking experiences that are rare in obstetric practice. Index events included head entrapment of breech infants, Apgar score less than 3 at 10 minutes, shoulder dystocia resulting in persistent brachial plexus injury, and intrapartum fetal death. After an index event was identified, the obstetrician's cesarean delivery rate for the 50 deliveries before the index event was compared with the 50 deliveries after the index event. Obstetricians who had no intrapartum complication during the observational period were matched as controls.ResultsSix index events were identified, three cases of shoulder dystocia and three intrapartum fetal deaths. In three of these six cases, the Apgar score at 10 minutes was less than 3. Obstetricians who attended a delivery with severe intrapartum complications had an average increase in their cesarean delivery rate of 37% in the 50 deliveries after the index event (21.0% to 28.7%,P< .05). This rate was greater (P< .05) than that of matched control obstetricians observed during the same observation period (19.0% to 18.7%).ConclusionIntrapartum complications such as persistent neonatal brachial plexus injury or fetal death increased the cesarean delivery rate of the obstetrician experiencing these events. Obstetricians should be aware of the effect of these adverse events on their practice of obstetrics.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine the risk of adverse pregnancy outcomes resulting from intrahepatic cholestasis.MethodsWe analyzed 91 women with singleton pregnancies complicated by cholestasis who gave birth at Kuopio University Hospital from January 1990 to December 1996. Logistic regression analysis was used to compare pregnancy outcomes of this group with those of the general obstetric population (n= 16,818).ResultsWomen of relatively advanced age (over 35 years) were at increased risk of developing intrahepatic cholestasis. Affected pregnant women delivered by cesarean significantly more often (25.3%) than the general obstetric population (15.8%). Intrahepatic cholestasis increased the low basic risk of preterm delivery and the need for neonatal care in the general population (odds ratio [OR] 2.73; 95% confidence interval [CI] 1.50, 4.95 and OR 2.15; 95% CI 1.21, 3.83, respectively). Otherwise, the courses of pregnancy were comparable in both groups.ConclusionIntrahepatic cholestasis has an adverse effect on fetal development, and affected pregnancies merit closer surveillance. Delivery of infants when maturity is reached may minimize the risk of adverse outcomes.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine whether women with polycystic ovary syndrome (PCOS) are more likely to develop gestational diabetes mellitus compared with age- and weight-matched controls.MethodsThis retrospective cohort study compared reproductive-age women with and without PCOS who received prenatal care at the University of North Carolina Hospitals between April 1989 and June 1998. We reviewed the medical charts of 22 women with PCOS diagnosis before pregnancy based on menstrual histories, elevated androgen levels, and LH-FSH ratios greater than 2. These women were compared with 66 women without PCOS matched for age and weight. Gestational diabetes mellitus (GDM) was diagnosed in women if they had abnormal results on a 50-g glucose screening test and at least two abnormal plasma glucose values during a 100-g glucose tolerance test. Medical complications of pregnancy, pregnancy complications, and birth outcomes were compared between women with and without PCOS.ResultsNine of 22 women with PCOS also had GDM diagnosis, compared with two of 66 controls (odds ratio [OR] 22.2; 95% confidence interval [CI] 3.8, 170.0), and these women exhibited increased plasma glucose values for all measurements except fasting. Five of 22 women with PCOS developed preeclampsia compared with one of 66 controls (OR 15.0; 95% CI 1.9, 121.5).ConclusionWomen with PCOS are at increased risk of glucose intolerance and preeclampsia during pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo evaluate colposcopically directed brush cytology as a substitute for directed biopsy of acetowhite lesions identified during pregnancy.MethodsPregnant patients eligible for the study were referred for colposcopic evaluation for either newly diagnosed abnormal cervical cytology or follow-up of a previously diagnosed squamous intraepithelial lesion (SIL). All patients with acetowhite lesions underwent colposcopically directed brush cytology followed by directed biopsy.ResultsOf 81 pregnant patients referred, 50 paired samples of colposcopically directed brush cytology and directed biopsies were evaluated from 49 patients. One patient was sampled in the first and third trimesters and one patient's brush cytology was unsatisfactory for interpretation because of clumping artifact, leaving 49 brush-biopsy pairs that were satisfactory for examination. One patient in the study group had an intrauterine fetal death of uncertain cause, remote from the time of biopsy. Compared with the corresponding biopsy, the directed brush caused significantly less blood loss (P< .001). For all diagnostic categories, directed cytology demonstrated a good degree of correlation with biopsy (kappa = 0.73). The brush technique correctly identified 12 of 14 cases (86%) of biopsy-proved cervical intraepithelial neoplasia II–III as high-grade SIL. If one considers “atypical squamous cells, favor human papillomavirus effect” as a true positive, brush sensitivity was 88 ± 9% and specificity was 74 ± 12%, with an accuracy of 80%.ConclusionIn the absence of lesions suspicious for carcinoma, colposcopically directed brush cytology is a safe substitute for directed biopsy in pregnant patients.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo examine the relationship between history of interpersonal assault victimization and severity of depressive symptoms during pregnancy.MethodsTwo hundred forty-eight pregnant, married women, aged 15–46 years presenting to obstetric clinics in Kuwait were assessed for lifetime history of assault victimization and other stressful events, marital conflict, family stress, and depressive symptoms using various self-report measures. An analysis of covariance was used to examine the effect of assault victim history on depression scores, using assault victim history and marital conflict as independent variables, and family stress and other stressful event scores as covariates.ResultsAssault victim history, but not marital conflict, was significant in self-reported severity of depressive symptoms, even after controlling for effects of family stress and other stressful events (F= 11.58;P< .001). Specifically, regardless of marital conflict, women with assault victim histories (mean ± standard deviation, 1.27 ± 0.15) had significantly higher depression scores than those with no assault histories (0.78 ± 0.14). Lack of statistical power might have limited detection of independent effects of marital conflict, and possible interactions between marital conflict and assault victim history.ConclusionAssault victim history has a significant influence on depressive symptoms in pregnant women. Routine assessment of detailed assault victim history and marital problems in obstetric patients is strongly recommended.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine if measuring fetal abdominal fat antenatally using ultrasound can predict fetal growth restriction (FGR).MethodsOne hundred thirty-seven unselected women with singleton pregnancies had serial ultrasound scans at 20, 26, 31, and 38 weeks' gestation. Subcutaneous fat in the fetal abdomen was measured using the same section as the abdominal circumference (AC). Outcome measures were birth weight, neonatal morbidity, and ponderal index.ResultsInfants with subcutaneous fat less than 5 mm at 38 weeks (n= 51) were almost five times more likely to have a birth weight below the 10th centile than those with subcutaneous fat of 5 mm or more (n= 75). The incidence of neonatal morbidity was significantly higher in infants with subcutaneous fat less than 5 mm, compared with those with subcutaneous fat of 5 mm or more (20% versus 8%,P< .05). Decreased subcutaneous fat was also associated with a high prevalence of low ponderal index, regardless of birth weight category.ConclusionMeasurement of fat in the abdominal wall is a simple technique with a sensitivity for predicting low birth weight similar to that of conventional sonography and might potentially predict FGR irrespective of fetal weight.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID