ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVESTo estimate the incidence, indications, risk factors, and complications associated with emergency peripartum hysterectomy at a community-based academic medical center.METHODSWe analyzed retrospectively 47 of 48 cases of emergency peripartum hysterectomy performed at Winthrop-University Hospital from 1991 to 1997. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment less than 24 hours after delivery. Fisher exact test, Wilcoxon rank sum test, and Cochran-Armitage exact trend test were used for analysis.RESULTSThere were 48 emergency peripartum hysterectomies among 34,241 deliveries for a rate of 1.4 per 1000. Most frequent indications were placenta accreta (48.9%, 12 with previa, 11 without previa), uterine atony (29.8%), previa without accreta (8.5%), and uterine laceration (4.3%). Placenta accreta was the most common indication in multiparous women (58.8%, 20 of 34), uterine atony the most common in primiparas (69.2%, nine of 13). Twenty-two of 23 (95.6%) women with placenta accreta had a previous cesarean delivery or curettage. The number of cesarean deliveries or curettages increased the risk of placenta accreta proportionally. Thirty-eight (80.9%) of the hysterectomies were subtotal. Postoperative febrile morbidity was 34%; other morbidity was 26.3%.CONCLUSIONPlacenta accreta has become the most common indication for emergency peripartum hysterectomy.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo examine the relationship between prior cesarean delivery and placenta previa.METHODSA hospital-based, case-control study was conducted in which 316 multiparous women with placenta previa were identified. Controls consisted of 2051 multiparous women with spontaneous vaginal deliveries. Information on prior cesarean delivery was examined in three forms: as a dichotomous variable, as an ordinal variable, and as a set of three indicator variables for one, two, and three or more cesarean deliveries. Multivariable logistic regression modeling was used to obtain an adjusted estimate of this association.RESULTSWomen with a prior cesarean delivery were more likely to have a placenta previa than those without (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.21, 2.08). The likelihood of placenta previa increased as both parity and number of cesarean deliveries increased. Thus, the adjusted OR for a primiparous woman with one cesarean delivery was 1.28 (95% CI 0.82, 1.99). For a woman who has four or more deliveries with only a single cesarean delivery, the OR increases to 1.72 (95% CI 1.12, 2.64). This trend continues with greater parity and a greater number of cesarean deliveries such that the likelihood of placenta previa for a woman with parity greater than four and greater than four cesarean deliveries was OR 8.76 (95% CI 1.58, 48.53).CONCLUSIONThis study supports the association between prior cesarean delivery and placenta previa and demonstrates that the joint effect of parity and prior cesarean delivery is greater than that of either variable alone.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BACKGROUNDPlacenta percreta is a rare but potentially lethal condition. Previously described conservative measures to avoid life-threatening hemorrhage and preserve fertility include use of methotrexate and uterine artery embolization.CASEA woman with suspected placenta percreta diagnosed on ultrasound in the second trimester was delivered by classic, fundal cesarean at 30 weeks' gestation for bleeding and premature rupture of membranes. The placenta was left in situ, and she was treated with methotrexate. Postpartum bleeding 1 week later was managed by internal iliac balloon catheterization and manual transcervical removal of the placenta, which resulted in hysterectomy and required massive blood transfusion.CONCLUSIONPlacenta percreta managed conservatively with methotrexate and internal iliac balloon catheterization resulted in serious morbidity.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo compare menstrual status, satisfaction, and acceptability of microwave endometrial ablation with transcervical endometrial resection for the treatment of heavy menstrual bleeding.METHODSWomen were randomized to either endometrial ablative method. Menstrual status, satisfaction, acceptability, and changes in health-related quality of life were obtained by a self-completed questionnaire. Case note review and personal communication identified further surgery rates at 2 years after each procedure.RESULTSAmong the original 263 women who underwent endometrial ablation, 249 (95%) returned questionnaires at 2 years. Menstrual status in both groups was similar, although the amenorrhea rate was higher after microwave endometrial ablation. Seventy-nine percent of women were either completely or generally satisfied after microwave ablation compared with 67% after transcervical endometrial resection. Health-related quality-of-life scores remained higher than at recruitment for both treatments. Hysterectomy rates were similar at 2 years (11.6% after microwave endometrial ablation and 12.7% after transcervical endometrial resection), and no repeat endometrial ablative procedures were required.CONCLUSIONMicrowave endometrial ablation is an effective alternative to transcervical endometrial resection for dysfunctional uterine bleeding.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVEA randomized, controlled trial was performed to compare the patient complication rate, effectiveness, and satisfaction rate of transcervical hysteroscopic endometrial coagulation versus endometrial resection in the treatment for heavy dysfunctional bleeding.METHODSOne hundred and twenty women requiring endometrial ablation for the treatment of heavy bleeding disorders entered the study. All patients were offered a clinical examination 24 months postoperatively and had a questionnaire by mail 5 years after the initial treatment. The number of complications during and after the operation, re-ablations, and hysterectomies were registered. A bleeding index and the patient satisfaction rate were stated.RESULTSSixty-one patients were treated by endometrial coagulation, and 59 were treated by endometrial resection. No differences between the two groups were observed concerning fluid absorption, bleeding, perforation, and infection. At the 5-year follow-up, 64% of the patients had only one ablation, 15% were treated twice, 15% had a hysterectomy, and 6% were lost to follow-up. After 5 years, the bleeding index was halved in patients with menses. Seventy-nine percent of the women would recommend the treatment to their best female friend.CONCLUSIONWe found no significant differences in the frequency of complications. Only 15% of the women had a hysterectomy after 5 years. No significant difference was observed with respect to bleeding reduction and patient satisfaction in the two groups.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate the value of second-trimester genetic sonography in detecting fetal Down syndrome in patients with advanced maternal age (at least 35 years) and normal triple screen.METHODSSince July 1999, a prospective collection and recording of all individual triple screen risks for fetal Down syndrome was initiated for all patients with advanced maternal age presenting in our ultrasound unit for second-trimester genetic sonography. Genetic sonography evaluated the presence or absence of multiple aneuploidy markers. Outcome information included the results of genetic amniocentesis, if performed, and the results of pediatric assessment and follow-up after birth.RESULTSBy June 2001, 959 patients with advanced maternal age and normal triple screen were identified. Outcome information was obtained in 768 patients. The median risk for fetal Down syndrome based on maternal age was 1:213 (range 1:37–1:274). The median risk for fetal Down syndrome based on triple screen results was 1:1069 (range 1:275–1:40,000). A total of 673 patients had normal genetic sonography, and none (0%) had Down syndrome; 95 had one or more aneuploidy markers present, and four (4.2%) had fetuses with Down syndrome. The triple screen risks for these four fetuses ranged from 1:319 to 1:833.CONCLUSIONThis study suggests that patients with advanced maternal age and normal genetic sonography carried very little risk for Down syndrome. The use of genetic sonography may increase the detection rate of fetal Down syndrome in this group of pregnant women.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo estimate the perioperative or postoperative bleeding rates after treatment of cervical intraepithelial neoplasia by loop electrosurgical excision procedure in either the follicular or luteal phase of the menstrual cycle.METHODSA randomized controlled trial was carried out to compare the outcomes in terms of primary and secondary hemorrhage between patients treated by loop electro-surgical excision procedure during either the follicular (30 women) or luteal phase (30 women) of the menstrual cycle. The two groups did not differ in terms of mean age, grade of cervical intraepithelial neoplasia, depth of excision, parity, and duration of menses. Primary outcome measures included the objective and subjective assessment of intra-operative and postoperative bleeding.RESULTSWomen treated during the luteal phase of the menstrual cycle experienced significantly more postoperative bleeding than women treated during the follicular phase, as assessed by the fall in hematocrit levels (P< .001) and subjective reports. Intraoperative bleeding was judged to be more severe in women treated during the luteal phase of the cycle by a single, blinded colposcopist (P= .02). These women also experienced higher levels of anxiety postoperatively, which resulted in more consultations with medical staff (P= .007).CONCLUSIONThe use of loop electrosurgical excision procedure to treat cervical intraepithelial neoplasia results in less bleeding if performed during the follicular phase of the menstrual cycle.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo develop a multivariable approach to determine the added value of tests in routine practice where some diagnostic information is already available from clinical history.METHODSMultivariable logistic regression models were built in a stepwise fashion, considering the clinical sequence used in the rapid access ambulatory diagnosis clinic (clinical history followed by transvaginal ultrasonography and hysteroscopy). The reference standard for confirmation of diagnosis was endometrial biopsy. The diagnostic accuracy of the models was determined by the area under the receiver operating characteristic curve.RESULTSThe area under the receiver operating characteristic curve for the model including historical features alone was 0.78. When hysteroscopy and ultrasonography were each added to the model, it increased to 0.81 (P= .008 for improvement) and 0.82 (P= .02 for improvement), respectively.CONCLUSIONThe type of stepwise analysis we have developed is crucial in facilitating meaningful clinical interpretation about the value of diagnostic technology. Our finding that hysteroscopy or ultrasonography marginally but significantly increased the prediction of serious endometrial pathology above that predicted from patient history alone needs validation in an independent data set. The use of this approach is recommended when evaluating strategies for diagnosis.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID