摘要:

&NA;In 32 human immunodeficiency virus (HIV)‐infected women, routine gynecologic examination was performed with colposcopy and Papanicolaou smear; cervical swabs were collected for human papillomavirus (HPV) DNA screening and typing; and immune status was assessed by CD4 T‐cell count. Dot blot analysis was specifically chosen for HPV DNA screening to detect only relatively substantial HPV DNA infections. Polymerase chain reaction analysis was used for precise DNA typing of dot blot‐positive samples. The HPV data were assessed for immune status; a subject with a CD4 T‐cell count below 200/μL was considered functionally immunosuppressed. The frequency of dot blot positivity was fivefold higher among immunocompromised (nine of ten) than relatively immunocompetent (four of 22) HIV‐infected women. Moreover, four immunosuppressed women, compared with no immunocompetent subjects, had evidence of HPV DNA without signs of HPV‐associated lesions by cytology or histology (ie, latent HPV infection). Furthermore, four of nine of the immunocompromised, compared with four of 21 immunocompetent, subjects had cervical intraepithelial neoplasia. These frequencies are high compared with those reported in the general population. Finally, HPV 18 was detected in five of the ten women with CD4 T‐cell counts below 200/μL and in only one of the 22 with CD4 T‐cell counts above that level. These results suggest that the normal immune system suppresses latent and clinical HPV cervical infections and that the efficiency of suppression may be HPV type‐specific. Furthermore, impaired immune status, as reflected by CD4 T‐cell count, is an important factor increasing the severity of HPV‐induced cervical infections in this population.(Obstet Gynecol 1992;79:321‐7)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;During the years 1982‐1989, 2627 women were recruited into eight studies analyzing the relationship between human papillomavirus (HPV) infection and cervical neoplasia. Subsequently, each individual was assigned as either a case or control, and each cervical sample was rescreened for HPV DNA by low‐stringency Southern blot hybridization. Positive samples were retested at high stringency with specific probes for HPVs 6/11, 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, 56, and (in most instances) 58. Most cases (153 cancers, 261 high‐grade and 377 low‐grade squamous intraepithelial lesions) had target or cone biopsies; all 270 borderline atypia subjects and more than 85% of the 1566 normal controls had cytology plus colposcopy/cytology. Scientists performing HPV testing were masked to the clinical diagnoses. Human papillomavirus DNA was detected in 79.3% of specimens from women with definite cervical disease (627 of 791), in 23.7% of borderline atypia subjects (64 of 270), and in 6.4% of normal subjects (101 of 1566). Graphic analysis of odds ratios at each point in the diagnostic spectrum defined four categories: 1) “low risk” (HPVs 6/11, 42, 43, and 44), present in 20.2% (76 of 377) of low‐grade lesions but absent in all 153 cancers; 2) “intermediate risk” (HPVs 31, 33, 35, 51, 52, and 58), detected in 23.8% (62 of 261) of high‐grade squamous intraepithelial lesions but only 10.5% (16 of 153) of cancers; 3) “high risk/HPV 16,” associated with 47.1% of both highgrade intraepithelial lesions (123 of 261) and cancers (72 of 153); and 4) “high risk/HPV 18” (HPVs 18, 45, and 56), found in 26.8% (41 of 153) of invasive carcinomas but only 6.5% (17 of 261) of high‐grade intraepithelial lesions. The presence of an oncogenic HPV type conferred relative risks ranging at 65.1‐235.7 for the occurrence of a high‐grade lesion and 31.1‐296.1 for an invasive cancer.(Obstet Gynecol 1992;79: 328‐37)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;In applying the Bethesda System of classification to cervical squamous lesions, we evaluated the Papanicolaou smears, cervical biopsies, and human papillomavirus (HPV) DNA status of 76 clinic patients. The biopsy specimens and concurrent Papanicolaou smears were analyzed using criteria for low‐grade and high‐grade squamous intraepithelial lesions, and the biopsies were analyzed for HPV DNA by in situ hybridization. Two independent observers produced good agreement in both cytologic (kappa = 0.62) and histologic (kappa = 0.71) diagnoses. Predictive values of highgrade cytology (for high‐grade histology) were high (0.95 for reviewer 1; 0.97 for reviewer 2), and both high‐grade cytology and histology correlated strongly with certain “highrisk” HPV types. In contrast, the predictive value of lowgrade cytology for either low‐grade histology or HPV types other than “high risk” was poor. This study supports the use of certain histologic criteria for distinguishing squamous intraepithelial lesions into two grades. Limitations in cytologic‐histologic correlation appear to reflect the absence of cytologic criteria for distinguishing well‐differentiated precursor lesions associated with high‐risk HPV types.(Obstet Gynecol 1992;79:338‐46)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Fifty‐nine patients with adenocarcinoma of the cervix were treated with radiation alone (eight stage I, 15 stage II, 25 stage III, and 11 stage IV patients). The disease‐free 5‐year survival rates for each stage were 63, 58, 30, and 9%, respectively. The incidence of vimentin‐positive cancer cells in 20 women with adenosquamous carcinoma was significantly higher than that in 34 with endocervical adenocarcinoma (25 versus 6%;P< .05). The outcome of stage III patients with S‐100 protein‐positive dendritic cells (Langerhans cells) or without vimentin‐positive cancer cells was significantly better than that of women negative for S‐100 protein or positive for vimentin (P< .025 andP< .05, respectively). These findings indicate that, along with clinical stage, Langerhans cell infiltration and the vimentin negativity of cancer cells are favorable prognostic factors in stage III adenocarcinoma of the cervix treated with radiation alone.(Obstet Gynecol 1992;79:347‐50)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;To evaluate the relationships between gestational age, neonatal outcome, and amniotic fluid (AF) bacteria, we obtained AF from women with intact membranes in idiopathic preterm labor. Positive cultures were obtained from 20 (19%) of 105 women. The frequency of positive cultures was inversely related to gestational age: 23‐26 weeks, nine of 20; 27‐30 weeks, four of 24; and 31‐34 weeks, seven of 61 (&KHgr;2for trend, P < .001).Fusobacterium nucleatum, Bacteroides ureolyticus,andUreaplasma urealyticumwere the most common isolates. Facultative and anaerobic bacteria were more commonly isolated from women at less than 30 weeks' gestation, andUreaplasma urealyticumwas commonly isolated at greater than 30 weeks' gestation. Forty percent of the patients identified as having positive AF facultative and anaerobic cultures by the research laboratory had negative cultures in the clinical laboratory. Clinical characteristics and maternal white blood cell count and differential did not differ between women with and without positive cultures. Elevated C‐reactive protein levels and a positive AF Gram stain were the two most sensitive and specific methods to predict positive AF cultures. Women with positive cultures delivered a median of 1.0 day after enrollment, compared with 28.5 days for women with negative cultures. The median gestational age at delivery for women with positive cultures was 27.5 weeks, and the median birth weight was 866 g. Positive AF cultures were associated with respiratory distress syndrome, bronchopulmonary dysplasia, and neonatal death. If occult AF infection among women in preterm labor is a treatable cause of preterm birth, then treatment could markedly reduce both perinatal morbidity and mortality.(Obstet Gynecol 1992;79:351‐7)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Objective:The purpose of this study was to determine the reliability of a rapid enzyme extraction‐latex agglutination test in detecting intrapartum colonization of the maternal genital tract by group B streptococci.Methods:Swabs of vaginal secretions were obtained from 314 patients in labor with either ruptured or intact membranes. Four tests were performed on each specimen: 1) qualitative culture on blood agar, 2) semiquantitative culture on blood agar, 3) culture in selective Todd‐Hewitt broth, and 4) latex agglutination preceded by enzyme extraction.Results:The prevalence of positive cultures was 29%. When compared with culture in Todd‐Hewitt broth, the latex agglutination test had a sensitivity of 30%, specificity 93%, positive predictive value 64%, and negative predictive value 76%. In patients with heavy colonization the test had a sensitivity of 76%, compared with 17% in patients with light growth (P < .001). The lower limit of sensitivity of the test was 4 × 105cfu/mL. The performance of the test was not affected by rupture of the membranes.Conclusion:Although the latex agglutination test is reasonably sensitive in detecting heavy colonization, low overall performance combined with technical difficulties in assessment of particle agglutination make the test unsuitable for general screening.(Obstet Gynecol 1992;79:358‐63)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;The federal government supports a nationwide network of medical centers to evaluate promising therapies against the human immunodeficiency virus (HIV) and the opportunistic infections and cancers that characterize AIDS. Forty‐five obstetricians from the 49 medical centers receiving federal research support for the conduct of AIDS‐related clinical trials, in preparation for a meeting, provided summary information about the number and clinical status of the known HIV‐infected pregnant women under their care and the prenatal screening policies for HIV infection at their institutions. In the 12‐month period before December 1989, an estimated 1000‐1801 HIV‐infected women delivered at these centers. The majority (82%) were asymptomatic, 12% were symptomatic, and 6% had AIDS. Routine T‐cell testing of infected women was done as part of prenatal care in only 30 of 45 centers.Pneumocystis cariniipneumonia was reported in 35 women. Zidovudine was administered during pregnancy in 29 women. Formal prenatal screening policies have been implemented at the majority (43 of 45) of the medical centers. Most of the infected women identified at these centers chose to continue the pregnancy. With the increasing incidence of HIV infection in women, information concerning the clinical and immunologic state of pregnant infected women and the present use of antiretroviral and other related therapeutics during pregnancy can guide the approach to women's health care and is crucial to the design and implementation of AIDS clinical trials.(Obstet Gynecol 1992;79:364‐8)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Lactobacilli provide an important microbial defense against genital colonization by pathogens. The role of hydrogen peroxide (H2O2) in the control of genital microflora was explored in a cross‐sectional study of 275 women in the second trimester of pregnancy. Vaginal cultures were obtained for detection of H2O2‐positive and H2O2‐negative lactobacilli and other members of the genital microflora. Compared with women with H2O2‐negative lactobacilli, women colonized by H2O2‐positive lactobacilli were less likely to have bacterial vaginosis, symptomatic candidiasis, and vaginal colonization byGardnerella vaginalis, Bacteroides, Peptostreptococcus, Mycoplasma hominis, Ureaplasma urealyticum,and viridans streptococci (P ≤ .05 for each comparison). In addition to the above organisms, women without vaginal lactobacilli were more likely than those women with H2O2‐positive lactobacilli to haveChlamydia trachomatis,and less likely to be colonized byEnterococcusor coagulase‐negative staphylococci (P < .05 for each comparison). Vaginal colonization by group B streptococci orEscherichia coliwas not related to the presence of H2O2‐positive lactobacilli. These data suggest that the presence of H2O2‐positive lactobacilli in the vagina is inversely correlated with infection by some genital pathogens in pregnant women.(Obstet Gynecol 1992;79:369‐73)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;The purpose of this randomized, double‐blind study was to evaluate the efficacy and safety of a new controlled‐release hydrogel pessary for ripening the cervix and initiating labor. Subjects had an entry Bishop score of 4 or less and gestational age of 37 or more weeks. One hundred fourteen women received a placebo pessary and 101 received the hydrogel pessary, containing 10 mg of prostaglandin (PG) E2. Compared with the placebo group, those given the PGE2pessary were more likely to have an increase in Bishop score of 3 or more (60 or 59% versus 21 or 18%; P < .0001), change to a Bishop score of 6 or higher (59 or 58% versus 18 or 16%; P < .0001), and active labor (68 or 67% versus 15 or 13%; P < .0001). Including the crossover study, uterine hyperstimulation (28 of 182, 15%) and fetal heart rate abnormalities (18 of 182, 10%) in PGE2‐treated subjects were reversed on removal of the pessary with no apparent harm to the mother or fetus. These temporary adverse effects appeared while the pessary was in place and after the onset of active labor. Oxytocin was unnecessary in 89 of 182 (49%) of the PGE2‐treated cases and was used more often to augment than to induce labor. We conclude that the described controlledrelease PGE2vaginal pessary induces appreciable cervical ripening and frequently initiates active labor with little or no need for oxytocin. The pessary may cause uterine hyperstimulation or fetal heart rate abnormalities, but these would be expected to reverse on removal of the pessary.(Obstet Gynecol 1992;79:374‐9)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

&NA;Emergency maternal transport of women in advanced preterm labor often involves difficult decisions about whether to transport or not. A retrospective review of maternal transports performed in northern Arizona by Samaritan Air Evac covered a 21‐month period. Of the 1080 patients transported for preterm labor, 54 calls for transport (5%) were received when the patient was 7 cm or more dilated. Five women were delivered at the referring hospital and 49 were transported, none of whom delivered en route. Only 21 (39%) of them delivered in the first hour after arrival at the tertiary center. The decision to transport patients in advanced preterm labor should be based on such factors as distance between hospitals, time required to cover that distance, personnel on the transport, facilities available at the transporting hospital, gestational age, and speed with which labor has progressed.(Obstet Gynecol 1992;79: 380‐2)

ISSN:0029-7844    

出版商:OVID    

年代:1992

数据来源: OVID