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:

OBJECTIVETo estimate the maternal and perinatal morbidity associated with cesarean delivery involving the upper uterine segment compared with that of low transverse cesarean delivery.METHODSA 19-year review of a perinatal database and the relevant charts was used to determine the maternal and perinatal morbidity associated with low transverse cesarean, classic cesarean, and inverted “T” cesarean deliveries.RESULTSOver the 19 years, 1980–1998, there were 19,726 cesarean deliveries: low transverse cesarean, 19,422 (98.5%); classic cesarean, 221 (1.1%); and inverted T cesarean, 83 (0.4%). As a proportion of all cesarean deliveries, the rates of low transverse cesarean and classic cesarean have remained stable, whereas the rate of inverted T cesarean has risen from 0.2% to 0.9%. Maternal morbidity (puerperal infection, blood transfusion, hysterectomy, intensive care unit admission, death) and perinatal morbidity (stillborn fetus, neonatal death, 5 minute Apgar less than 7, intensive care) were significantly higher in classic cesarean compared to low transverse cesarean. Some maternal morbidity (puerperal infection, blood transfusion) and perinatal morbidity (5 minute Apgar less than 7, intensive care) were also significantly higher for inverted T cesarean compared to low transverse cesarean.CONCLUSIONClassic cesarean section has a higher maternal and perinatal morbidity than inverted T cesarean and much higher than low transverse cesarean. There is no increased maternal or perinatal morbidity if an attempted low transverse incision has to be converted to an inverted “T” incision compared to performing a classic cesarean section.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate the prospective risk of stillbirth in multiple gestations.METHODSWe conducted a retrospective analysis of birth notifications and infant mortality records relating to all multiple gestations to residents in a predefined health district. The incidence of live births and stillbirths was used to calculate the prospective risk of stillbirth at each week of gestation.RESULTSThe risk of stillbirth in multiple gestations increased from 1:3333 at 28 weeks' gestation to 1:69 at 39 or more weeks' gestation. The stillbirth risk in multiple gestations at 39 weeks surpassed that of postterm singleton pregnancies (1:526).CONCLUSIONMultiple gestations at 37–38 weeks have a risk of stillbirth equivalent to that of postterm singleton pregnancy. Because multiple gestations rarely proceed beyond 39 weeks, and because stillbirth risk increases severalfold beyond this stage, elective delivery might be justified at this gestational age.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo characterize temperatures for normal full-term parturients.METHODSA retrospective chart review of 189 consecutive singleton deliveries during 1996 was conducted. All available maternal sublingual temperatures were collected from the time of admission to the time of discharge from the delivery area. To evaluate the effect of prophylactic antibiotics in labor, maximum labor temperatures of patients who did not receive (group 1) and who received (group 2) antibiotics were compared. Using simple linear regression, temperature slopes were calculated for patients who had at least two temperature observations during labor.RESULTSA total of 147 (77.7%) patients met inclusion criteria. No statistical difference was found between the maximum temperatures of patients who received and did not receive prophylactic antibiotics for labor or recovery. The mean maximum temperature in labor was 37.0 ± 0.42C. The average of each patient's mean temperature was 36.8 ± 0.33C, and 95% of the observations were between 36.2C and 37.5C. The mean temperature slope of the 100 patients who had more than one labor temperature observation was 0.01 ± 0.12C per hour.CONCLUSIONIn the normal full-term parturient, labor alone does not significantly increase normal body temperature.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate the role of nuchal translucency thickness as a single marker in screening for trisomy 21 at 10–16 weeks' gestation.METHODSFrom December 1996 to October 2001, nuchal translucency was measured in 11,281 consecutive early second trimester fetuses referred to our unit for prenatal care and delivery. Scans were performed by eight experienced ultrasonographers, under strict methodological criteria.RESULTSChromosomal abnormalities were found in 118 cases (52 trisomy 21). Using nuchal translucency greater than the 95th centile as a cut-off, the overall detection rate was 71.2% with a specificity of 95.4%, and a positive predictive value of 14%. In the trisomy 21 selected group, detection rate, specificity, and positive predictive value for nuchal translucency were 92.3%, 95.4%, and 8.5%, respectively. The detection rate of trisomy 21 reached 100% when nuchal translucency was measured between 10 and 14 weeks' gestation, maintaining the same specificity.CONCLUSIONEarly second trimester nuchal translucency measurement can achieve prenatal detection rates of trisomy 21 greater than 95% with a 5% false-positive rate. With a detection rate so high, the benefits of using additional markers may be less than previously considered. Although maternal age, other sonographic or Doppler markers, and maternal serum biochemistry might play a role in prenatal strategies to detect fetal chromosomal abnormalities, the high detection rate of trisomy 21 fetuses using nuchal translucency as a single parameter suggests that early nuchal translucency measurement between 10 and 14 weeks' gestation can be a simple screening strategy for this condition.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo investigate the relationship between fetoplacental leptin secretion and blood gases.METHODSWe measured the levels of umbilical arterial and venous leptin, umbilical cord gas, umbilical venous blood glucose, and estradiol-17β (E2) in 89 pregnant women. Correlation between the leptin levels and other variables (gestational age, birth weight, maternal body weight, height, body mass index, maternal body weight gain, placental weight, umbilical cord gas data, and levels of umbilical venous blood glucose and E2) were examined statistically.RESULTSUmbilical arterial and venous leptin levels were 7.64 ± 12.76 and 7.76 ± 13.17 (ng/mL), respectively, correlating positively with carbon dioxide pressure levels (r= 0.446,P< .001;r= 0.406,P< .001, respectively) and correlating inversely with pH (r= −0.337,P= .001;r= −0.247,P= .019, respectively). Umbilical venous glucose, E2, and other factors did not correlate with leptin levels.CONCLUSIONLeptin secretion into the fetoplacental circulation may be associated with fetal hypercapnia, suggesting two important roles for leptin: one for basal control of fetal fat tissue and one as an acute stress-related hormone.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo determine risk factors for hysterectomy, pelvic pain, and continued menorrhagia after rollerball endometrial ablation.METHODSAll women having rollerball endometrial ablations between 1990 and 2000 were sent standardized questionnaires on pre- and postablation symptoms, satisfaction with the ablation, and subsequent gynecologic surgery. Pathology reports from surgery after the ablation were reviewed when available.RESULTSTwo hundred forty women had a rollerball ablation during this period and 174 (72.5%) responded to the questionnaire. The average age of women at the time of the ablation was 43.1 years and the mean follow-up time since the ablation was 49 months. Seventy-four percent of women were satisfied with the ablation and 92% reported decreased or absent menstrual bleeding since the ablation. However, 13% of women reported new or worsening pelvic pain symptoms since the ablation and 21 women (12%) had a hysterectomy after the ablation for continued symptoms. A previous tubal ligation was a risk factor for having a hysterectomy (hazard ratio of 3.3,P= .03) and for having worsened pelvic pain (hazard ratio of 3.2,P= .05) after an ablation. Women who had a previous tubal ligation were more likely to use pain medications for pelvic pain after an ablation. Age over 35 at the time of the ablation was predictive of less bleeding after the ablation. Pathologic findings consistent with the postablation tubal sterilization syndrome were observed in five surgical specimens for an incidence of 6%.CONCLUSIONHaving a tubal ligation is a risk factor for the development of pelvic pain and for having a hysterectomy after rollerball endometrial ablation. The incidence of pathologically confirmed postablation tubal sterilization syndrome is 6%, but clinical manifestations of this syndrome may be higher. Relatively older age at the time of the ablation is associated with a higher rate of improved bleeding symptoms after ablation.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo establish the relative success of treatment by unstimulated in vitro maturation (IVM) of oocytes or stimulated in vitro fertilization (IVF) in women with polycystic ovaries undergoing assisted conception treatment.METHODSThe case-control study included 107 IVM and 107 IVF cycles matched for age and cause of infertility. In vitro maturation patients underwent transvaginal recovery of immature oocytes during an unstimulated cycle, in vitro oocyte maturation, and fertilization. Those in the IVF group underwent ovarian stimulation after pituitary suppression. Embryos were transferred in the same cycle in both groups. Main outcome measures included numbers of mature oocytes and embryos produced, and rates of implantation, pregnancy, live birth, and complications.RESULTSIn the IVM group after in vitro culture, 7.8 mature oocytes and 6.1 embryos were obtained per retrieval. With IVF, 12.0 mature oocytes (P< .01) and 9.3 embryos (P< .01) were obtained. The IVM pregnancy and live birth rates per retrieval were 26.2% and 15.9% compared with 38.3% and 26.2% for IVF (nonsignificant). The implantation rate of IVF-derived embryos was higher (17.1% versus 9.5%) than that for IVM (P< .01). There were 12 cases (11.2%) of moderate or severe ovarian hyperstimulation syndrome in IVF patients, compared with none in the IVM group (P< .01).CONCLUSIONOur results suggest that for women with polycystic ovaries who require assisted conception, IVM is a promising alternative to conventional IVF treatment.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo compare the outcomes of patients with ovarian tumors of low malignant potential who had complete surgical staging with those who were unstaged to determine whether the rate of recurrence or survival was affected by surgical staging.METHODSA retrospective chart review was performed on 93 consecutive patients who had surgery for histologically confirmed tumors of low malignant potential between 1979 and 1997. Two cohorts of patients were identified: patients who had classic surgical staging (n= 48) versus those who were not staged (n= 45). Outcome data were recorded for patients and compared between the two groups.RESULTSEarly stage (I or II) disease was diagnosed in 31 of 48 patients who had surgical staging and 42 of 45 patients who were not staged (P= .001). In 17% of patients their stage was upgraded on the basis of surgical staging, as a result of retroperitoneal involvement in only 6% of those cases (three of 48 staged patients). During the study interval, the frozen section diagnosis of low malignant potential tumor of the ovary was changed to a final diagnosis of invasive cancer in eight other patients. There were three recurrences and two deaths in both the staged and unstaged low malignant potential groups. The average duration of follow-up was 6.5 ± 4.2 years and was similar in the two groups. Overall 5-year survival was approximately 93% for all stages.CONCLUSIONSurvival and recurrence rates were not significantly different between staged and unstaged patients who had surgery for low malignant potential tumors of the ovary.

ISSN:0029-7844    

出版商:OVID    

年代:2002

数据来源: OVID