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 evaluate the effect of introducing two biophysical ultrasound examinations in a low-risk antenatal population.METHODSScans were performed at 30–32 weeks' gestation and 36–37 weeks' gestation. Scans assessed placental maturity, amniotic fluid volume, and estimated fetal weight. One thousand nine hundred ninety-eight low-risk patients were randomized at 30 weeks' gestation to a control group receiving standard antenatal care, or to the study group who also received an ultrasound scan. Outcome measures were frequency of small for dates (less than 10th percentile at birth), intervention rates, and admissions to neonatal intensive care.RESULTSThe proportion of infants assessed as small for dates at birth in the study group was 6.9% (69 of 994) compared with 10.4% (104 of 999) in the control group (P= 008). The rates of intervention in the study and control groups were 31.3% (313 of 999) and 16.9% (169 of 999), respectively (P< .001). Twenty-eight (2.8%) neonates in the study group were admitted to the neonatal unit compared with 34 (3.4%) in the control group (P= .532).CONCLUSIONIntroduction of an ultrasound scan at 30–32 weeks' and 36–37 weeks' gestation may reduce the risk of a growth-restricted infant and increases antenatal interventions. Rates of admission to a neonatal unit are not significantly affected.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo compare the daily glycemic profile reflected by continuous and intermittent blood glucose monitoring in pregnant women with type 1 diabetes and to compare the treatment protocols based on the two monitoring methods.METHODSThe study sample consisted of 34 gravid patients at gestational weeks 16–32, with type 1 diabetes being treated by multiple insulin injections. Data derived from the continuous glucose monitoring system for 72 hours were compared with fingerstick glucose measurements performed 6–8 times per day. During the study period, patients documented the time of food intake, insulin injections, and hypoglycemic events. Data on demographics, gravidity, parity, body mass index, hemoglobin A1c, and fructosamine levels were collected for each patient.RESULTSAn average (± standard deviation) of 780 ± 54 glucose measurements was recorded for each patient with continuous glucose monitoring. The mean total time of hyperglycemia (glucose level greater than 140 mg/dL) undetected by the fingerstick method was 192 ± 28 minutes per day. Nocturnal hypoglycemic events (glucose level less than 50 mg/dL) were recorded in 26 patients; in all cases, there was an interval of 1–4 hours before clinical manifestations appeared or the event was revealed by random blood glucose examination. Based on the additional information obtained by continuous monitoring, the insulin therapeutic regimen was adjusted in 24 patients (70%).CONCLUSIONContinuous glucose monitoring can diagnose high postprandial blood glucose levels and nocturnal hypoglycemic events that are unrecognized by intermittent blood glucose monitoring and may serve as a basis for determining treatment regimens. A large, prospective study on maternal and neonatal outcome is needed to evaluate the clinical implications of this new monitoring technique.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo assess pregnancy hormone levels in relation to nausea with or without vomiting.METHODSIn the context of a prospective cohort study, 262 white pregnant women in Boston were observed through delivery. Maternal blood was collected at 16 and 27 weeks' gestation and serum levels of estradiol, estriol, progesterone, prolactin, and sex hormone–binding globulin were determined. Information on sociodemographic and medical variables was collected through an interviewer-administered questionnaire and review of medical records. At the 27th gestational week, nausea with or without vomiting at any time during the index pregnancy was ascertained.RESULTSBy the 27th gestational week, 209 women (79.8%) had experienced nausea with or without vomiting. There was a substantial and statistically significant (P< .01) inverse association of prolactin with nausea with or without vomiting at both the first and the second samplings, with or without adjustment for the other measured compounds. Estradiol was positively associated with nausea with or without vomiting risk, but the association was evident only after adjustment for the other measured compounds (Pvalues of .06 and .07 at the first and second samplings, respectively). We found no evidence that estriol, progesterone, or sex hormone–binding globulin was related to nausea with or without vomiting at either the 16th or the 27th week of pregnancy.CONCLUSIONOur results point to lower levels of prolactin and, perhaps, higher levels of estradiol as contributing to or correlating with the occurrence of nausea with or without vomiting at any time during the pregnancy until the 27th gestational week. We found no evidence that estriol, progesterone, or sex hormone–binding globulin is associated with this condition.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo assess the risk of juvenile-onset recurrent respiratory papillomatosis conferred by a maternal history of genital warts in pregnancy, and to identify additional cofactors such as the method of delivery (cesarean versus vaginal) and procedures or complications during pregnancy.METHODSA retrospective cohort design was used to evaluate maternal and infant characteristics associated with respiratory papillomatosis among Danish births between 1974 and 1993. Using data from Danish registries, we identified 3033 births with a maternal history of genital warts during pregnancy. Fifty-seven respiratory papillomatosis cases were identified by review of medical records from ear, nose, and throat departments.RESULTSSeven of every 1000 births with a maternal history of genital warts resulted in disease in the offspring, corresponding to a 231.4 (95% confidence interval 135.3, 395.9) times higher risk of disease relative to births without a maternal history of genital warts. In women with genital warts, delivery times of more than 10 hours were associated with a two-fold greater risk of disease. Cesarean delivery was not found to be protective against respiratory papillomatosis, and no other procedures or complications during pregnancy were observed to increase the risk of respiratory papillomatosis.CONCLUSIONA maternal history of genital warts in pregnancy is the strongest risk factor for respiratory papillomatosis in the child. Future studies should examine the efficacy of genital wart treatment for the prevention of disease.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo compare bleeding profiles of a traditional 28-day oral contraceptive pill cycle with continuous administration.METHODSAfter a 28-day run-in cycle, women were randomized to either 28-day cycles (21 active pills and a pill-free week) or continuous use of the same 20-μg ethinyl estradiol/100-μg levonorgestrel formulation for 12 study cycles (336 days). The number of bleeding and spotting days were measured by daily diary. A subset underwent cycle 1 (n= 16), and nine (n= 14) pelvic ultrasound and endometrial histology sampling. Blood pressure, weight, hemoglobin, and adverse events were measured at revisit. The sample size with 80% power to detect a 67% reduction in bleeding days required 27 subjects in each arm.RESULTSOf the 79 subjects randomized, 28 (70%) of the 28-day cycle and 32 (82%) of the continuous-use subjects completed the entire study (P= .6). With continuous use, 49%, 68%, and 88% of women reported no bleeding during cycles 2, 6, and 12, respectively. Amenorrhea or infrequent bleeding was present in 68% of continuous users during cycles 1–3 and increased to 88% during cycles 10–12. Spotting during cycle days 1–21 increased initially with continuous use but reduced over time, and by 9 months was less than the spotting reported by cyclic users. Adverse events, blood pressure, weight, and hemoglobin findings were similar between groups.CONCLUSIONExtension of the 28-day oral contraceptive cycle to continuous use with a low-estrogen dose combination oral birth control pill resulted in significantly fewer bleeding days.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo investigate the effect of vaginal prolapse and bladder fullness on Q-tip test assessment of urethral mobility.METHODSTwenty-six women with genital prolapse to or beyond the hymen and undergoing urodynamics for urogynecologic dysfunction were assessed by the Q-tip test. Measurements were obtained with the bladder empty, with and without the prolapse reduced by the posterior blade of a Graves speculum. Angles were repeated at bladder capacity. Measured Q-tip angles were compared using the Wilcoxon signed rank test.RESULTSQ-tip angles were significantly altered by vaginal prolapse and bladder fullness. With an empty bladder, the median Q-tip angle measured with the prolapse reduced was significantly less than that measured without reduction (53°, interquartile range 25–65, versus 68°, interquartile range 45–75;P< .001). With a full bladder, similar but lesser results were obtained (33°, interquartile range 15–55 [reduced] versus 48°, interquartile range 31–60 [unreduced];P< .001). The median Q-tip angle with an empty bladder was greater than that with a full bladder. With the prolapse reduced, the Q-tip angle was 53° (interquartile range 25–65) with an empty bladder versus 33° (interquartile range 15–55) with a full bladder (P< 001). Without the prolapse reduced, the median Q-tip angle was 68° (interquartile range 45–75) with an empty bladder and 48° (interquartile range 31–60) with a full bladder (P< .001).CONCLUSIONMeasurement of urethral mobility by the Q-tip test is significantly affected by genital prolapse. Q-tip angles are less with the reduction of vaginal prolapse and with the bladder full. Standardization of measurement technique is necessary for the development of clinical management recommendations.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo determine whether the mode of anesthesia used during the tension-free vaginal tape procedure affects postoperative voiding function.METHODSA retrospective cohort study was performed using cases in which tension-free vaginal tape placement was the sole procedure performed. Of the 173 cases reviewed, we were able to use the data from 163. Hierarchal linear regression was used to identify independent predictors of our dependent variable: days to complete voiding. In the first block, established predictors of postoperative voiding dysfunction were entered into the model. In the second block, potential confounders of the relationship between anesthesia type and days to complete voiding identified during univariate analysis (P< .15) were entered into the model. In the third block, anesthesia type was entered into the model to determine whether it added any unique variance after controlling for previously established predictors of postoperative voiding dysfunction.RESULTSThe mean days to complete voiding was similar in our local or regional anesthesia (n= 90) and general anesthesia groups (n= 73) (2.3 [0–21] versus 2.3 [0–14],P= 95). Our final regression model (F= 2.74,P= .011) included age, prior pelvic organ prolapse surgery, and preoperative urge symptoms and explained 22.2% of the variance in days to complete voiding. Anesthesia type did not add any predictive improvement after controlling for these variables.CONCLUSIONGeneral anesthesia, and therefore lack of a cough-stress test, does not increase the chance of postoperative voiding dysfunction associated with tension-free vaginal tape.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID