摘要:

ObjectiveTo examine the postpartum bleeding experience of a cohort of breast-feeding women and to compare it with the conventional definition of lochia.MethodsFour hundred seventy-seven experienced breast-feeding women in Manila, the Philippines, were followed prospectively from delivery and recorded vaginal bleeding in a menstrual diary. The median duration of lochia was calculated using survival analysis. In addition, all bleeding separate from lochia within the first 8 weeks postpartum was noted.ResultsThe median duration of lochia was 27 days and did not vary by age, parity, sex or weight of the infant, breast-feeding frequency, or level of supplementation. More than one-fourth of the women experienced a bleeding episode separated from the original lochial flow by at least 4 bleeding-free days and beginning no later than postpartum day 56. Ten breast-feeding women may have had their first menstrual bleed before day 56.ConclusionsLochia lasted substantially longer than the conventional assumption of 2 weeks. It was common for postpartum bleeding to stop and again or to be characterized by intermittent spotting or bleeding. Return of menses is rare among fully breast-feeding. Return of menses is rare among fully breast-feeding women in the first 8 weeks postpartum.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine bleeding between 6 and 8 weeks postpartum in fully breast-feeding women and its association with fertility as assessed by hormone analysis.MethodsSeventy-two fully breast-feeding women were followed prospectively from 42 days postpartum. Vaginal bleeding was recorded daily. Women who experienced bleeding were compared with women who did not with respect to time ovulation and time of first menses.ResultsNearly half of the women experienced some vaginal bleeding or spotting between 6 and 8 weeks post-partum. These women eventually menstruated and ovulated earlier than the women who did not bleed, but the differences were not significant. The study had 34% and 45% power to detect a 20% difference in the proportion menstruating and ovulating, respectively, at 6 months postpartum, and 10% and 16% power to detect the same differences at 1 year. Seven women experienced ovarian follicular development before day 56, but neither bleeding nor follicular development was associated with ovulation in any woman in the first 8 weeks post partum.ConclusionsIt is unlikely that vaginal bleeding in fully breast-feeding women in the first 8 weeks postpartum represents a return to fertility.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the “U” technique versus the manufacturer-recommended technique for Norplant removal.MethodsWe conducted a randomized comparison of the manufacturer-recommended method of removal and the “U” technique. The latter involves an incision between and parallel to the third and fourth implants and uses a modified vasectomy clamp to remove the implants by pulling perpendicular to the implant's axis.ResultsTwenty-one physicians (three experienced, 18 inexperienced) performed 200 Norplant removals. Inexperienced physicians took significantly less time for removal using the “U” technique than the standard technique (7.9 versus 10.5 minutes), even after controlling for other factors. Experienced physicians also required less time for removal using the “U” technique (3.1 versus 3.7 minutes), but the difference was not statistically significant after controlling for other factors. Both experienced and inexperienced physicians broke implants more frequently using the standard technique, although the difference was significant only for experienced physicians (relative risk 3.6, 95% confidence interval 1.2, 10.8). No differences were noted between the techniques with respect to tissue damage or patient reports of pain during or after removal.ConclusionsThese results suggest that the “U” technique is an improvement over the standard technique, particularly for personnel who are not highly experienced in Norplant removal.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the learning curves and rapidity with which clinicians become competent in implant removal using two Norplant removal techniques.MethodsTwenty-four physicians, none of whom were experienced in the use of Norplant implants, were randomly assigned to learn either the “U” removal technique or the standard technique. The physicians in the two groups received identical training in all other respects. Removal times, procedure problem rates, and the number of procedures performed by the clinicians before they were judged “competent” were assessed for both groups.ResultsData from 240 removals were analyzed. Mean removal times were 38% faster in the “U” group than in the standard group. None of the “U” group procedures took longer than 20 minutes, compared with 11% of removals in the standard group (P< .001). The mean number of cases required before the provider consistently performed all steps adequately was significantly (P< .02) higher in the standard group (5.8 cases) than in the “U” group (3.9 cases).ConclusionsUsing competency-based training methods, the “U” removal technique was learned easily by inexperienced clinicians. It appears to offer significant improvements in speed and achievement of proficiency over the standard technique recommended by the manyfacturer. Large-scale programs should consider using competency-based training and the “U” technique as the removal method of choice when providing training in implant removal.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo test the hypothesis that extending the number of consecutive active oral contraceptives (OC)s given will decrease the frequency of menstrual-related problems including dysmenorrheal, menorrhagia, premenstrual-type symptoms, and menstrual migraines.MethodsA prospective analysis was designed to track the experiences of 50 women taking OCs and experiencing menstrual-related problems. Fifty consecutive patients, who were taking OCs and had symptoms during the pill-free interval, were followed in a multispecialty clinic by an individual physician and nurse practitioner team. The patients were permitted to extend the number of consecutive active OCs to delay menstrual-related symptoms.ResultsImmediate outcome of the 50 patients revealed 74% (37 patients) stabilized on an extended regimen of 6 to 12 weeks of consecutive days with active OCs. Twenty-six percent (13 patients) either discontinued OCs or returned to the standard regimen with 3 weeks of active pills. Of the 37 patients who were stabilized on an extended regimen, 27 have completed thus far between five and 13 extended cycles with 6–23 months of follow-up (mean 16 months).ConclusionExperience in a series of 50°C users with menstrual-related symptoms demonstrated that delaying menses by extending the number of consecutive days of active pills is well tolerated and efficacious. We believe that a large prospective study is warranted to further our knowledge in this are.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo assess the relation of clinical variables and laboratory data to pelvic laproscopic observations of tubal occlusion, adnexal adhensions, and peritoneal exudates in women with acute salpingitis.MethodsClinical and Laboratory evaluations were performed systematically before laproscopy in 155 women with suspected acute pelvic inflammatory disease (PID), 82% of whom proved to have acute salpingitis conformed with laparoscopy. Laparoscopic findings were scored in three categories (tubal patency, adhension, and exudates.)ResultsTwo general categories of laparoscopic findings were present: 1) tubal occlusion and moderate to severe adhensions in 30 women, and 2) pelvic-abdominal exudates in 27 women. In the remaining 16 women, these laparoscopic findings occurred alone or in other combinations. Among women with acute salpingitis, tubal occlusion was associated positively with older age, palpable adnexal mass, and moderate to severe pelvic adhesions; negative associations were found with abdominal rebound tenderness, mean abdominal-pelvic tenderness score, pelvic-abdominal exudates, and isolation of eitherNeisseria gonorrhoeaeorChlamydia trachomatis. Moderate or severe pelvic adhesions were associated positively with increased duration of abdominal pain (5 versus 3 days) compared with limited or no pelvic adhesions, but they were associated negatively with mean abdominal-pelvic tenderness score and with pelvic-abdominal exudates (47% versus 73%). Free exudates in the pelvis or abdomen as compared with limited or no exudates was associated positively with abdominal rebound tenderness (86% versus 65%), abdominal-pelvic tenderness score, elevated white blood cell count (83% versus 52%), and recovery ofN gonorrhoeae(79% versus 57%). Free exudates was associated negatively with the median duration of pain (3 versus 6 days), oral contraceptive use (4% versus 26%), and palpable adnexal mass (7% versus 25%). Analysis limited to women without a history of PID gave similar results.ConclusionsAlthough clinical and laboratory criteria traditionally used to judge the clinical severity of acute PID partially predict the degree of tubal or other pelvic abnormalities among women with acute salpingitis and tend to distinguish those with tubal occlusion or moderate to severe adhesions from those with peritonitis, these criteria have low predictive value and are not reliable in the individual patient.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify (1) those elements in the infrastructure of a regionalized perinatal network that have independent effects on the variation in perinatal mortality among nontertiary units (member level I and II hospitals) and (2) shortcomings, if any, in a traditional perinatal data base that impede quality assessment of contemporary regionalized care.MethodsWe analyzed perinatal surveillance data for 3 years, from 1991 to 1993, in the state of Illinios, representing more than 190, 000 annual births. Fatal death and neonatal mortality reates for the 97 nontertiary hospitals studied were the dependent variables of interest. Two sets of independent variables were studied, those assessing the maternal sociobehavioral risk of populations served and those assessing the network infrastructure (defined as the facilities of member hospitals and their function within the regionalized network). We used multivariate analysis to partition the variation in hospital rates of perinatal mortality into two components, one attributable to maternal sociobehavioral risk and the other to the network infrastructure.ResultsMaterial sociobehavioral risk alone explained 73% of the variation in hospital fetal death rates and 38% of that in hospital neonatal mortality rates. When controlling for maternal sociobehavioral risk, rates of inborn very low birth weight (VLBW) deliveries (P< .001) and neonatal transport (P= .01) had independent effects on the variation in hospital fetal death rate; rates of inborn VLBW deliveries (P< .001) and neonatal transport (P< .001), and proportion of VLBW infants transported out (P= .029) had independent effects on the variation in hospital neonatal mortality rate.ConculsionsIn this mature statewide network, the rate of inborn VLBW deliveries exerted the strongest independent effect on variation in level I and II hospital rates of both fetal death and neonatal mortality. However, that there was such a large effect from maternal sociobehavioral risk alone has important public health implications. Additions and modifications to traditional perinatal surveillance are suggested better to assess the quality of regionalization in a contemporary health care environment.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine the risk factors for adult (aged 20 years and older) paternity in births to teenagers (14-17 years of age).MethodsThis was a population-based, retrospective cohort analysis of 27,215 adolescent mothers residing in California who had a live singleton birth during 1993. Adjusted risks for adult paternity by paternal and maternal characteristics were derived from comparisons of adult-teen and teen-teen couples.ResultsAdult fathers, who were responsible for 49.2% of births to teenage mothers, were a mean of 6.4 years older than the mother. The most important risk factors for adult paternity were as follows: father's (odds ratio [OR] 5.19;95% confidence interval [CI] 4.43, 6.08) or mother's (OR 1.33; 95% CI 1.14,1.55) educational attainment of at least 3 years lower then expected for their age, two or more previous live births (OR 3.34; 95% CI 2.48, 4.53), mother's birthplace outside the United States (OR 2.33; 95% CI 2.11, 2.58), father's (OR 2.16; 95% CI 1.98, 2.36) or mother's (OR 1.28; 95% CI 1.15, 1.42) educational attainment 1–2 years lower than expected for their age, one previous live birth (OR 1.92; 95% CI 1.75, 2.12), and Asian (OR 1.29; 95% CI 1.04, 1.62) or African American race (OR 1.25; 95% CI 1.06, 1.46) of the father.ConclusionsTeenage pregnancy prevention programs must address adult paternity, which contributed to almost half of the births in out study. These programs should consider education adequacy, cultural beliefs and practices, previous live births, and race and ethnicity when designing programs to decrease the number of adults involved in teenage births.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo examine the association between pregravid body mass index (BMI) and praterm delivery among black, white, and Hispanic women.MethodsPreterm deliveries among 12,459 women (43.2% black, 39.3% white, and 17.5% Hispanic) enrolled in a large multicenter trial of preterm birth prevention were examined by pregravid BMI category (very low, less than 16.5; low, 16.5–19.7; normal, 19.8–26.0; high, greater than 26) and by pathway (all, early, late, spontaneous preterm labor, and premature rupture of membranes [PROM])ResultsMore than one-fifth of both black (20.1%) and (28.6%) women had low pregravid BMIs (less than 19.8), whereas only 11.7% of Hispanic women were under weight. The overall prevalence of preterm delivery (gestational age less then 37 completed weeks) was 8.1% (10.3% in black, 7.3% in white, and 4.8% in Hispanic women). Among black and white women, bivariate analysis revealed an inverse linear association between pregravid BMI and the prevalence of all preterm deliveries (P≤ .001) and between pregravid BMI and the prevalence of late (33–36 weeks' gestation) preterm deliveries (P< .001). No such associations were observed for early (20–32 week's gestation) preterm delivery or among Hispanic women. Pregravid BMI was also associated inversely with spontaneous preterm labor among both black (P≤ .01) and white (P< .001) women, but not among Hispanic women. Logistic regression analysis (adjusting for the effects of maternal age, education, smoking, parity, previous preterm delivery, birth interval, and height) revealed that among black and white women, very low and low pregravid BMIs were associated with increased adjusted odds ratios for late (but not early) preterm delivery and for spontaneous preterm labor (but not PROM).ConclusionsThese observations suggest that low pregravid BMI is associated with an increase in the prevalence of late preterm delivery and of spontaneous preterm labor among black and white, but not Hispanic, women.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo explore the relationship between prepregnancy obesity and the risk for cesarean delivery.MethodsThe population studied included 20,130 women with live births after 20 weeks gestation in central New York state between June 1, 1994, and May 31, 1995. Women who were obese before pregnancy were compare with nonobese women with regard to mode of delivery. Obesity was defined as body mass index (BMI) greater than 29. Separate analyses were conducted on the entire sample and on a subset of women with singleton pregnancies and no prior cesarean deliveries, as an estimate of the risk of primary cesarean delivery in obese women. Statistical analyses included χ2test, crude odds ratio (OR) with 95% confidence interval (CI), and adjusted OR with 95% CI, using logistic regression to control for confounding variables.ResultsThe adjusted OR was 1.64 (95% CI 1.46, 1.83) for obese women with singleton pregnancies and no prior cesarean deliveries to undergo cesarean delivery. The adjusted OR was 1.66 (95% CI 1.51, 1.82) for obese women in the entire sample to undergo cesarean delivery. In addition, increasing BMI was associated with increased risk for cesarean delivery.conclusionCompared with nonobese women, women who are obese before pregnancy are at increased risk for cesarean delivery. Preconceptional counseling regarding dietary and life-style nmodifications may alter this pattern.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID