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1. |
Reflection |
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Obstetrics & Gynecology,
Volume 100,
Issue 6,
2002,
Page 1145-1145
James Scott,
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ISSN:0029-7844
出版商:OVID
年代:2002
数据来源: OVID
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2. |
“What's in a Name? That Which We Call a Rose, by Any Other Name …”* |
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Obstetrics & Gynecology,
Volume 100,
Issue 6,
2002,
Page 1146-1147
Frederick Stehman,
Jeanne Schilder,
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ISSN:0029-7844
出版商:OVID
年代:2002
数据来源: OVID
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3. |
Hormone Replacement Therapy Regimens and Breast Cancer Risk |
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Obstetrics & Gynecology,
Volume 100,
Issue 6,
2002,
Page 1148-1158
Linda Weiss,
Ronald Burkman,
Kara Cushing-Haugen,
Lynda Voigt,
Michael Simon,
Janet Daling,
Sandra Norman,
Leslie Bernstein,
Giske Ursin,
Polly Marchbanks,
Brian Strom,
Jesse Berlin,
Anita Weber,
David Doody,
Phyllis Wingo,
Jill McDonald,
Kathleen Malone,
Suzanne Folger,
Robert Spirtas,
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摘要:
OBJECTIVEHormone replacement therapy (HRT) has increased in the United States over the past 2 decades in response to reports of long-term health benefits. A relationship between HRT and breast cancer risk has been observed in a number of epidemiological studies. In 2002, the Women's Health Initiative Randomized Controlled Trial reported an association between continuous combined HRT and breast cancer risk. The objective of this study was to examine the association between breast cancer risk and HRT according to regimen and duration and recency of use.METHODSA multicenter, population-based, case-control study was conducted in five United States metropolitan areas from 1994 to 1998. Analyzed were data from 3823 postmenopausal white and black women (1870 cases and 1953 controls) aged 35–64 years. Odds ratios (ORs) were calculated as estimates of breast cancer risk using standard, unconditional, multivariable logistic regression analysis. Potential confounders were included in the final model if they altered ORs by 10% or more. Two-sidedPvalues for trend were computed from the likelihood ratio statistic.RESULTSContinuous combined HRT was associated with increased breast cancer risk among current users of 5 or more years (1.54; 95% confidence interval 1.10, 2.17). Additionally, a statistically significant trend indicating increasing breast cancer risk with longer duration of continuous combined HRT was observed among current users (P= .01). There were no positive associations between breast cancer risk and other HRT regimens.CONCLUSIONOur data suggest a positive association between continuous combined HRT and breast cancer risk among current, longer term users. Progestin administered in an uninterrupted regimen may be a contributing factor. Risk dissipates once use is discontinued.
ISSN:0029-7844
出版商:OVID
年代:2002
数据来源: OVID
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4. |
Local Relapse in Patients Treated for Squamous Cell Vulvar CarcinomaIncidence and Prognostic Value |
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Obstetrics & Gynecology,
Volume 100,
Issue 6,
2002,
Page 1159-1167
Roman Rouzier,
Bassam Haddad,
Francoise Plantier,
Philippe Dubois,
Monique Pelisse,
Bernard-Jean Paniel,
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摘要:
OBJECTIVETo evaluate the risk factors for local relapse in vulvar cancer patients and its impact on survival as a function of its different patterns, which include local recurrences at the primary tumor site, recurrences remote from the primary tumor, and skin bridge recurrences.METHODSBetween January 1978 and June 1999, 215 patients were treated for vulvar squamous cell carcinoma. The median follow-up was 38 months. To evaluate the role of local relapse in survival, a Cox regression multivariable analysis was performed using local relapse as a time-dependent covariate.RESULTSThe local relapse-free survival rate was 78.6% (± 7.1%) at 5 years. Multivariable analyses showed that the local relapse was increased by the factors margin status and depth of invasion. Pathologic nodal status, tumor size, margin status, and depth of invasion were predictors of cancer-related death in the Cox multivariable model with fixed covariates. The contribution of local relapse for disease-specific survival at the site of the primary tumor (relative risk [RR] 6.35; 95% confidence interval [CI] 2.07, 15.76) or skin bridge recurrence (RR 6.48; 95% CI 2.54, 16.49) was highly significant, whereas the contribution of local relapse at the other sites was not (RR 2.29; 95% CI 0.53, 9.91). In this model, margin status was not significant. The risk of cancer-related death after local relapse was 58.4% (± 18.3%) at 1 year and 70.9% (± 17.6%) at 3 years.CONCLUSIONLocal relapses at the site of the primary tumor or skin bridge recurrences are strong predictors for cancer-related death, but not local relapse at a distant site.
ISSN:0029-7844
出版商:OVID
年代:2002
数据来源: OVID
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5. |
Combined Second‐Trimester Biochemical and Ultrasound Screening for Down Syndrome |
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Obstetrics & Gynecology,
Volume 100,
Issue 6,
2002,
Page 1168-1176
Peter Benn,
Lillian Kaminsky,
Jun Ying,
Adam Borgida,
James Egan,
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摘要:
OBJECTIVETo evaluate the efficacy of a Down syndrome screening protocol that combines second-trimester maternal serum analytes and the continuous ultrasound measures of nuchal fold thickness and proximal long bone length.METHODSUltrasound measurements of nuchal fold, femur length, and humerus length were reviewed for 72 second-trimester Down syndrome and 7063 unaffected fetuses. Derived statistical variables for these parameters were entered into a multivariable Gaussian model together with the statistical variables used in the “quad” test (maternal serum alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin, and inhibin A). Maternal age-specific sensitivities, false-positive rates, and positive predictive values were generated together with receiver operating characteristic curves. Overall efficacy of ultrasound screening alone, the quad test, and the combination of the ultrasound and quad test were compared using a 1:270 second-trimester risk cutoff applied to 1999 US births.RESULTSUsing ultrasound, a sensitivity of 79.9% and false-positive rate of 6.7% may be achieved (positive predictive value: 1 in 42). The quad test has a sensitivity of 81.5% and false-positive rate of 6.9% (positive predictive value: 1 in 42). The combination of the quad test with nuchal fold and long bone measurements may achieve 90% sensitivity and a 3.1% false-positive rate (positive predictive value: 1 in 18).CONCLUSIONCombining second-trimester serum testing and fetal biometry is a feasible approach to Down syndrome screening, compatible with current obstetric practice. This modality is substantially more effective than either serum screening or ultrasound alone. Efficacy may be comparable to that reported for combined first- and second-trimester (integrated) screening.
ISSN:0029-7844
出版商:OVID
年代:2002
数据来源: OVID
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6. |
Episiotomy Use in the United States, 1979–1997 |
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Obstetrics & Gynecology,
Volume 100,
Issue 6,
2002,
Page 1177-1182
Anne Weber,
Leslie Meyn,
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摘要:
OBJECTIVETo describe episiotomy usage at vaginal delivery in the United States from 1979–1997.METHODSWe used the National Hospital Discharge Survey, a federal database of a national sample of inpatient hospitals. Data from 1979 to 1997 were analyzed using International Classification of Diseases, Ninth Revision, Clinical Modification codes for diagnoses and procedures. Rates per 1000 women were calculated using the 1990 census population for women aged 15–44 years. We calculated the number of episiotomies per 100 vaginal deliveries. Rates and percentages were compared using the score test for linear trend.RESULTSThe number of episiotomies ranged from a high of 2,015,000 in 1981 to a low of 1,128,000 in 1997. The age-adjusted annual rate for episiotomy with vaginal deliveries varied from 32.7 in 1979 to 18.7 in 1997 per 1000 women aged 15–44 years. The percentage of episiotomy with vaginal deliveries ranged from 65.3% in 1979 to 38.6% in 1997 (P< .001). Episiotomy with operative deliveries decreased over time (87.0% to 70.8%,P< .001), as did episiotomy with spontaneous deliveries (60.1% to 32.8%,P< .001). Women undergoing episiotomy were slightly younger (mean ± standard deviation, 25.7 ± 5.5 years) than women without episiotomy (26.2 ± 5.7 years,P< .001). Black women (39%) were less likely to receive episiotomy than white women (60%,P< .001). More women with private insurance (62%) had episiotomy performed than women with government insurance (43%,P< .001).CONCLUSIONAlthough episiotomy use has decreased over time, the most recent rate of 39 per 100 vaginal deliveries remains higher than evidence-based recommendations for optimal patient care.
ISSN:0029-7844
出版商:OVID
年代:2002
数据来源: OVID
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7. |
Fetal Deaths in the United StatesInfluence of High‐Risk Conditions and Implications for Management |
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Obstetrics & Gynecology,
Volume 100,
Issue 6,
2002,
Page 1183-1189
John Smulian,
Cande Ananth,
Anthony Vintzileos,
William Scorza,
Robert Knuppel,
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摘要:
OBJECTIVETo estimate the effect of specific maternal–fetal high-risk conditions on the risk and timing of fetal death.METHODSThis study examined 10,614,679 non-anomalous singleton pregnancies delivering at or beyond 24 weeks' gestation, derived from the U.S. linked birth/infant death data sets, 1995–1997. Fetal death rates for pregnancies at low risk were compared with pregnancies complicated by chronic hypertension, gestational hypertensive disorders, diabetes, small for gestational age infants, and abruption. Adjusted relative risks as well as population-attributable risks for fetal death were derived by gestational age for each high-risk condition compared with low-risk pregnancies.RESULTSThe fetal death rate for low-risk pregnancies was 1.6 per 1000 births. Adjusted relative risk for fetal death was 9.2 (95% confidence interval [CI] 8.8, 9.7) for abruption, 7.0 (95% CI 6.8, 7.2) for small for gestational age infants, 1.4 (95% CI 1.3, 1.5) for gestational hypertensive disorders, 2.7 (95% CI 2.4, 3.0) for chronic hypertension, and 2.5 (95% CI 2.3, 2.7) for diabetes. Fetal death rates were lowest between 38 and 41 weeks. The fetal death rate (per 1000 births) for these high-risk conditions was 61.4, 9.6, 3.5, 7.6, and 3.9, respectively. Almost two thirds of fetal deaths were attributable to the pregnancy complications examined.CONCLUSIONHigh-risk conditions in pregnancy are associated with an increased risk for fetal death, particularly in the third trimester. Delivery should be considered at 38 weeks, but no later than 41 weeks, for these pregnancies.
ISSN:0029-7844
出版商:OVID
年代:2002
数据来源: OVID
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8. |
Clinical Evaluation of a “Hand Pump” Vacuum Delivery Device |
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Obstetrics & Gynecology,
Volume 100,
Issue 6,
2002,
Page 1190-1195
Richard Hayman,
Jeanette Gilby,
Sabaratnam Arulkumaran,
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摘要:
OBJECTIVETo evaluate the clinical performance of a hand-held vacuum delivery system.METHODSBetween December 1999 and September 2000, a prospective audit was undertaken of all vacuum deliveries performed at Derby City General Hospital.RESULTSIn this period, 3296 deliveries occurred, of which 317 (9.6%) were by vacuum. Of these, data were collected on 300 (94.6%), 78 deliveries with the hand-held vacuum and 222 with standard vacuum. There were no differences in the demographic profiles, indication, gestational age at delivery, or birth weights between the two groups (P> .05 in all instances). In all types of delivery, nonrotational and rotational, the hand-held vacuum performed comparably to its contemporaries with no increase in delivery “failures” being noted. There were no differences in the extent or frequency of maternal injuries between the instruments, and other than transient scalp abrasions, there were no significant fetal injuries.CONCLUSIONThe hand-held vacuum delivery system is a functionally effective addition to the practitioners' “armory,” providing an alternative to the standard metal and silastic cups.
ISSN:0029-7844
出版商:OVID
年代:2002
数据来源: OVID
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9. |
The Recurrence Risk of Adverse Outcome in the Second Pregnancy in Women With Rheumatic Disease |
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Obstetrics & Gynecology,
Volume 100,
Issue 6,
2002,
Page 1196-1202
Johan Skomsvoll,
Valborg Baste,
Lorentz Irgens,
Monika Østensen,
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摘要:
OBJECTIVETo study recurrence risks of adverse pregnancy outcome in the second pregnancy in women with rheumatic disease.METHODSIn a national population-based cohort study, women with rheumatic disease recorded from 1967 to 1995 in the Medical Birth Registry of Norway were compared with mothers without such diagnoses with regard to recurrence risks of adverse pregnancy outcomes in the second pregnancy. The odds ratios (ORs) of all outcomes were adjusted for maternal age, those of cesarean delivery for time period, and those of preeclampsia for interpregnancy interval.RESULTSWomen with rheumatic disease and adverse pregnancy outcome in the first pregnancy had a statistically significant higher recurrence risk of the same event in the second pregnancy than women without rheumatic disease (preeclampsia: OR 2.22; 95% confidence interval [CI] 1.18, 4.19) (cesarean delivery: OR 1.52; 95% CI 1.05, 2.21) (preterm birth: OR 1.86; 95% CI 1.12, 3.11). In women with rheumatic disease diagnosed between the first and second births, a significantly increased recurrence risk of low birth weight occurred. Women with rheumatic disease also had a higher occurrence of markers for placental dysfunction (preeclampsia, preterm birth, or small for gestational age) in the second birth after any of these outcomes in the first birth (OR 1.35; 95% CI 1.02, 1.78) (35.1% versus 29.2%).CONCLUSIONThe recurrence risk of an adverse outcome in the second pregnancy is increased in any woman, but was even higher in women with a rheumatic disease. These patients should be counseled accordingly, be closely monitored during pregnancy, and have access to appropriate subspecialists.
ISSN:0029-7844
出版商:OVID
年代:2002
数据来源: OVID
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10. |
The Resistance Index in the Fetal Middle Cerebral Artery by Gestational Age and Ventricle Size in a Normal Population |
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Obstetrics & Gynecology,
Volume 100,
Issue 6,
2002,
Page 1203-1207
Yaron Zalel,
Benny Almog,
Daniel Seidman,
Reuven Achiron,
Arie Lidor,
Ronni Gamzu,
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摘要:
OBJECTIVETo study the association between fetal middle cerebral artery flow and the lateral cerebral ventricular width throughout gestation.METHODSThe study is a prospective cohort evaluation of 430 singleton male and female fetuses between 20 and 40 weeks' normal gestation. Abdominal ultrasonography and Doppler measurements were performed to measure the fetal atrial ventricular size and resistance index (RI) of the middle cerebral artery.RESULTSThe mean (± standard deviation) ventricular width was 6.2 ± 1.2 mm. The modification in the RI of the middle cerebral artery throughout gestation showed a biphasic mode, increasing gradually to a peak at 30 weeks' gestation and decreasing progressively thereafter. No significant correlation was found between the middle cerebral artery flow and the lateral cerebral ventricular width (r= .11). In addition to the 430 cases studied, three cases of mild ventriculomegaly and three cases of hydrocephalus were evaluated. The RI of the middle cerebral artery was within the normal range in all six of these cases.CONCLUSIONFetal middle cerebral artery blood flow is not affected by the width of the lateral ventricles, even in enlarged ventricles.
ISSN:0029-7844
出版商:OVID
年代:2002
数据来源: OVID
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