ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo study the effect of child birth on pelvic organ mobility in a prospective observational study.METHODSA total of 200 women were recruited early in their first ongoing pregnancy and examined by translabial ultrasound in the first/early second trimester, the late third trimester, and 2–5 months postpartum. Peripartal changes in the mobility of urethra, bladder, cervix, and rectal ampulla were correlated with labor and delivery data.RESULTSA total of 169 women returned postpartum (84.5%). Highly significant increases in organ mobility on Valsalva were found after vaginal delivery (P< .001), with forceps causing the most marked changes. Length of second stage, especially active second stage, correlated with an increase in pelvic organ descent (P= .03 toP< .001). The influence of gestational age, length of first stage, and birth weight did not reach significance.CONCLUSIONVaginal birth, in particular operative delivery, negatively affects pelvic organ support. This appears to be true for all three vaginal compartments. All forms of cesarean delivery were associated with relatively less pelvic organ descent. These findings may partly explain the protective effect of elective cesarean delivery for future symptoms of pelvic floor disorders.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUNDWest Nile virus is an emerging pathogen in the United States. Although most cases are subclinical, serious infection can occur in the form of fulminant meningoencephalitis.CASEWe present a case of West Nile virus meningoencephalitis complicating pregnancy. The patient presented in the second trimester with fever, nuchal rigidity, and mental status changes. The diagnosis was made by demonstrating the presence of immunoglobulin M antibody to West Nile virus in the cerebrospinal fluid. Gradual clinical improvement was noted after several days of supportive care. No obvious fetal consequences of infection were noted after birth.CONCLUSIONObstetricians and health care providers need to be mindful of West Nile virus infection in pregnant women presenting with fever and neurological signs, particularly in endemic areas.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo investigate the pituitary–thyroid axis function in the early neonatal period of newborns to hypothyroid mothers who have been apparently adequately treated.METHODSAmong the 27,386 full-term newborns delivered over a 6-year period, 259 were born to 250 treated hypothyroid mothers (0.9%); 246 of these newborns constituted the study group. Controls were 139 term healthy neonates from healthy group-matched mothers. The study infants and controls underwent thyroid function tests in a prospective design. A single blood sample was collected from each infant at 25–120 hours of life.RESULTSCompared with the controls, serum thyroid-stimulating hormone (TSH) levels were higher in the study neonates (P< .005), as were those of serum free thyroxine (T4) (P< .03), particularly at 49 hours of life or older (P< .001). At 49–120 hours, 44.7% of the study group newborns had serum free T4 levels greater than the 95th percentile of the controls (P< .001), and 16.8% had significantly higher TSH levels (P< .001). Serum free T4 correlated positively with TSH in the controls (r= .316) but not in the study newborns (r= .062,P= .36). Neonatal TSH at 49 hours or older correlated positively with maternal TSH during pregnancy in the 18 cases where maternal TSH values during pregnancy were available (r= .751,P< .001). Birth weight and head circumference were significantly lesser in the study group (P< .001).CONCLUSIONThe impaired intrauterine growth and the unduly elevated serum values of TSH and serum free T4 found in a substantial fraction of the study newborns might reflect an insufficient level of hormone replacement therapy of their hypothyroid mothers during pregnancy, despite an assumed adequate management. Gestational hypothyroidism requires close monitoring.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVELaparoscopy has become an accepted approach in the management of adnexal masses. We evaluated clinical outcomes of laparoscopic management of adnexal masses thought to be benign preoperatively.METHODSWe performed a retrospective study of patients undergoing laparoscopic evaluation of adnexal masses over a 7-year period. Regression models evaluated predictors of blood loss, length of stay, complications, mass rupture, conversion to laparotomy, and operating time. Preoperative predictors of malignant and borderline disease were evaluated using a separate model.RESULTSComplications occurred in 8% of 396 patients undergoing laparoscopic evaluation of adnexal masses and were associated with concurrent hysterectomy (P= .01) and smaller mass (P= .01). Conversion to laparotomy occurred in 25% and was associated with larger mass (P= .001), prior hysterectomy (P= .002), and younger age (P= .002). Mass rupture occurred in 25% and was associated with prior (P< .001) or concurrent (P= .003) hysterectomy and younger age (P= .001). Blood loss greater than 500 mL was associated with concurrent hysterectomy (P< .001). Length of stay was associated with concurrent (P< .001) and prior (P< .001) hysterectomy, larger mass (P= .01), prior abdominal surgery (P= .009), and medical comorbidities (P= .007). Malignancy occurred in 2%, and laparoscopic management was not associated with adverse outcomes.CONCLUSIONAdnexal masses thought to be benign preoperatively were successfully managed laparoscopically in three fourths of cases and clinical outcomes were acceptable. To a great extent, adverse events were attributable to concurrent hysterectomy rather than removal of the adnexal mass.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo determine whether current contraceptive method affects functional ovarian cyst risk, with emphasis on oral contraceptives (OCs) and tubal sterilization.METHODSWe conducted a case–control study of 18–39-year-old health maintenance organization enrollees with a functional ovarian cyst diagnosed between January 1, and June 30, 1994, and age-matched female controls randomly selected from enrollment files. In-person interviews as well as medical and pharmacy records were obtained for 78% of cases and 82% of controls; these analyses were based on 392 cases and 623 controls. Odds ratios (ORs) calculated with unconditional logistic regression were used to estimate the risk of a functional ovarian cyst diagnosis associated with current contraceptive method.RESULTSIn multivariable analyses adjusting for age, education, number of live births, and reference year, the overall OR was 0.72 (95% confidence interval [CI] 0.53, 0.99) for current OC use, compared with use of nonsurgical nonhormonal contraception or no contraception. The risk associated with use of 35 μg ethinyl estradiol monophasic OCs (OR 0.69; 95% CI 0.44, 1.10) was slightly lower than that associated with less than 35 μg ethinyl estradiol monophasic (OR 0.79; 95% CI 0.43, 1.47) or multiphasic OCs (OR 0.76; 95% CI 0.49, 1.19). Women with tubal sterilization had a substantially increased risk of a functional ovarian cyst diagnosis (OR 1.70; 95% CI 1.05, 2.75) compared with women using nonhormonal or no contraception.CONCLUSIONOur findings suggest that low-dose OC use has little or no effect on functional ovarian cyst likelihood. The increased risks we found associated with tubal sterilization merit further investigation.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo estimate the current cervical cytology screening practices of American College of Obstetricians and Gynecologists (ACOG) Fellows, to establish a baseline for tracking future changes in practice.METHODSQuestionnaires were mailed to a random sample of ACOG Fellows (n= 599) and to a group of Fellows who have regularly participated in past ACOG surveys (n= 409). The questionnaires asked about current cytology screening and evaluation practices and presented clinical practice vignettes with additional questions. Descriptive statistical methods were used to evaluate the responses.RESULTSQuestionnaires were returned by 651 physicians (64.6%); 624 were complete. More than 94% of the respondents start cytology testing at age 18 years. Almost three fourths (74.2%) continue screening indefinitely. More than 80% use a liquid-based method of collection. Almost two thirds (65.1%) order human papillomavirus testing occasionally, usually (81.9%) for reports of atypical squamous cells of undetermined significance (ASCUS). Most Fellows in the sample perform colposcopy for an ASCUS result. Reports of atypical glandular cells resulted in variable approaches to further evaluation. Patient age and history were important variables for all test reports. Legal concerns were mentioned as important determinants of practice patterns.CONCLUSIONIn this sample of ACOG Fellows, most perform cervical cytology and evaluate abnormal results in accord with guidelines in place before the recommended changes in screening and evaluation were published in 2003.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID