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:

OBJECTIVEEmergency contraceptives can prevent unintended pregnancy after unprotected intercourse. The best-studied regimen (“Yuzpe”) consists of ordinary combined oral contraceptives containing levonorgestrel and ethinyl estradiol. Women traditionally take one dose within 72 hours after unprotected intercourse, and a second dose 12 hours later. Historically, half experience nausea and a fifth vomit. The purpose of this study was to determine whether 1) women could use combined oral contraceptives other than those containing levonorgestrel and 2) eliminating the second dose improves comfort and convenience.METHODSWomen presenting within 72 hours after unprotected intercourse were randomized to receive 1) standard two-dose Yuzpe, 2) a variant of Yuzpe substituting norethindrone for levonorgestrel, or 3) only the first dose of Yuzpe, followed 12 hours later by a placebo.RESULTSPerfect-use failure rates were low in all groups and did not differ in a statistically significant way (standard Yuzpe 2.0% [n= 589], norethindrone–ethinyl estradiol 2.7% [n= 547], single dose of Yuzpe 2.9% [n= 546]). Typical-use failure rates were slightly higher but similarly did not differ significantly. Side effects were similar across groups, except that women taking the single dose reported half the vomiting. Taking the pills with food did not seem to reduce nausea or vomiting, and the pills were not more effective when started sooner after unprotected intercourse.CONCLUSIONOral contraceptives containing norethindrone–ethinyl estradiol work approximately as well for emergency contraception as levonorgestrel–ethinyl estradiol formulations and should be offered when first-line therapies are not available.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVECurrent protocols state that the Yuzpe regimen of emergency contraception can be initiated up to 72 hours after unprotected intercourse. The purpose of this study was to determine whether the window for emergency hormonal contraception can be extended to 120 hours.METHODSIn an observational study, we tracked 111 women who requested emergency contraception between 72 and 120 hours after unprotected sex but refused postcoital copper intrauterine devices (IUDs), preferring instead the Yuzpe regimen. We compared failure rates for this group with rates among 675 otherwise similar women who started the same therapy within 72 hours.RESULTSBoth perfect use (1.9%) and typical use (3.6%) failure rates were low among women presenting between 72 and 120 hours after unprotected intercourse. These rates did not statistically differ from failure rates for the standard Yuzpe regimen (2.0% during perfect use and 2.5% during typical use). Our small sample size of 111, however, gave us just 25% power to detect a doubling in the failure rates (2% to 4%) and 59% power to detect a tripling in the failure rates (2% to 6%).CONCLUSIONThe 72-hour cutoff for the Yuzpe regimen of emergency contraception appears needlessly restrictive. Women who request this therapy more than 72 hours after unprotected sex should be allowed to receive it, particularly if they decline postcoital insertion of a copper IUD and would otherwise have no options for reducing pregnancy risk.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUNDPostoperative bleeding may be complicated by failure to identify the site of bleeding, multiple bleeding points, and persistent hemorrhage despite surgical intervention.CASEActivated recombinant factor VII was used successfully in a patient with life-threatening postsurgical bleeding after resection of two large extraperitoneal pelvic sarcomas.CONCLUSIONIn severe hemorrhage, hemostasis can be achieved with activated recombinant factor VII.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BACKGROUNDPostpartum hemorrhage is one of the most common causes of maternal mortality and morbidity worldwide. The aims of treatment are to maintain the circulation and to stop the bleeding. The latter is achieved by either medical or surgical management. In intractable bleeding, emergency hysterectomy is usually required.CASEA 30-year-old nullipara presented with major postpartum hemorrhage due to uterine atony and vaginal lacerations. The patient developed hemorrhagic shock, resulting in prolonged prothrombin time, prolonged activated partial thromboplastin time, and low levels of factor VIII and fibrinogen. Treatments with uterotonic drugs, suturing, ligation of internal iliac arteries, subtotal hysterectomy, packing of the pelvis, and blood transfusion failed to control diffuse pelvic and vaginal bleeding. Recombinant activated factor VIIa (60-μg/kg intravenous bolus injection) was given as a final attempt to control the bleeding. The bleeding was successfully controlled within 10 minutes after administration. No side effects were noted.CONCLUSIONRecombinant factor VIIa may be an alternative hemostatic agent in a patient with life-threatening postpartum hemorrhage unresponsive to conventional therapy.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo investigate the serum and intrafollicular tumor necrosis factor–α and interleukin-6 concentrations in infertile women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF).METHODSThirty-one patients with PCOS undergoing IVF were studied. Thirty-nine normally ovulating women matched for age and body mass index and undergoing IVF for male infertility were the control group. Serum tumor necrosis factor–α, interleukin-6, and estradiol levels were assayed before recombinant follicle-stimulating hormone stimulation under gonadotropin-releasing hormone analogue suppression and 34–36 hours after human chorionic gonadotropin (hCG) administration at the time of the oocyte retrieval. Cytokine and estradiol concentrations were also evaluated in the follicular fluids obtained at the time of oocyte retrieval.RESULTSThe patients with PCOS had higher serum and follicular fluid tumor necrosis factor–α and interleukin-6 concentrations (P< .001) and lower follicular fluid estradiol levels (P< .05) than control women. In both groups, the serum tumor necrosis factor–α, interleukin-6, and estradiol values increased significantly after hCG stimulation. In both groups, the follicular fluid cytokine concentrations were higher than those found in the serum. In the PCOS women the follicular fluid tumor necrosis factor–α values were significantly and inversely correlated to the follicular fluid estradiol values (ρ = −0.79;P< .001); this correlation was not found in the control subjects.CONCLUSIONIn infertile women with PCOS, 1) serum and follicular fluid interleukin-6 and tumor necrosis factor–α values were higher than those found in control women, 2) the cytokine concentrations were higher in the follicular fluid than in the serum, and 3) the intrafollicular tumor necrosis factor–α concentrations were significantly and inversely correlated to the estradiol levels. These results suggest an involvement of the immune system in PCOS.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo determine if extended spectrum prophylactic antibiotic treatment (with efficacy againstUreaplasma urealyticum) reduces post–cesarean delivery clinical endometritis.METHODSAfter cord clamping at cesarean delivery, subjects received prophylaxis with cefotetan. Subjects were then simultaneously randomized (double blind) to receive doxycyline plus azithromycin versus placebo. Post–cesarean delivery endometritis was defined clinically as fever of 100.4F or higher with one or more supporting clinical signs or a physician diagnosis of endometritis plus the absence of a nonpelvic source of fever.RESULTSA total of 597 women were enrolled, 301 in the doxycycline/azithromycin group and 296 in the placebo group. The study population was 56% black, 25.5 ± 6.2 years of age, and 43% nulliparous. The groups were similar (P> .05) for black race, parity, maternal age, and most risk factors for post–cesarean delivery endometritis. The frequency of post–cesarean delivery endometritis (16.9% versus 24.7%,P= .020), wound infections (0.8% versus 3.6%,P= .030), and a combination of these two outcomes (19.0% versus 27.8%,P= .019) were significantly lower in the doxycycline/azithromycin group compared with the placebo-treated group. The doxycycline/azithromycin versus placebo groups were dissimilar for maternal leukocytosis (24.9% versus 12.5%,P= .042) and frequency of classic uterine incision (7.6% versus 12.5%,P= .048). Adjusting for these factors did not alter the risk ratio for post–cesarean delivery endometritis in the active versus placebo-treated group (relative risk 0.65, 95% confidence interval 0.43, 0.98). Length of stay was longer in the placebo group overall (104 ± 56 versus 95 ± 32 hours,P= .016) and among women with endometritis (146 ± 52 versus 127 ± 46 hours,P= .047).CONCLUSIONExtended spectrum prophylactic antibiotic treatment (with presumed efficacy againstU urealyticum) given to women undergoing cesarean delivery at term shortens hospital stay and reduces the frequency of post–cesarean delivery endometritis and wound infections.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID