摘要:

ObjectiveTo evaluate the cumulative probability of regret after tubal sterilization, and to identify risk factors for regret that are identifiable before sterilization.MethodsWe used a prospective, multicenter cohort study to evaluate the cumulative probability of regret within 14 years after tubal sterilization. Participants included 11,232 women aged 18–44 years who had tubal sterilizations between 1978 and 1987. Actuarial life tables and Cox proportional hazards models were used to identify those groups at greatest risk of experiencing regret.ResultsThe cumulative probability of expressing regret during a follow-up interview within 14 years after tubal sterilization was 20.3% for women aged 30 or younger at the time of sterilization and 5.9% for women over age 30 at sterilization (adjusted relative risk [RR] 1.9; 95% confidence interval [CI] 1.6, 2.3). For the former group, the cumulative probability of regret was similar for women sterilized during the postpartum period (after cesarean, 20.3%, 95% CI 14.5, 26.0; after vaginal delivery, 23.7%, 95% CI 17.6, 29.8) and for women sterilized within 1 year after the birth of their youngest child (22.3%, 95% CI 16.4, 28.2). For women aged 30 or younger at sterilization, the cumulative probability of regret decreased as time since the birth of the youngest child increased (2–3 years, 16.2%, 95% CI 11.4, 21.0; 4–7 years, 11.3%, 95% CI 7.8, 14.8; 8 or more years, 8.3%, 95% CI 5.1, 11.4) and was lowest among women who had no previous births (6.3%, 95% CI 3.1, 9.4).ConclusionAlthough most women expressed no regret after tubal sterilization, women 30 years of age and younger at the time of sterilization had an increased probability of expressing regret during follow-up interviews within 14 years after the procedure.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveWe conducted a multinational randomized trial to determine whether a spermicidal film containing 72 mg of nonoxynol-9 per film was at least as effective in preventing pregnancy as a foaming tablet containing 100 mg of nonoxynol-9 per tablet.MethodsBetween September 1995 and July 1997, 765 women aged 18–35 years who had no evidence of subfecundity were randomly assigned to use one of the two spermicides as their only contraceptive method at every coital act for 28 weeks. Participants were asked to keep coital diaries throughout the study period. Pregnancy tests were performed on a scheduled basis. Each participant was followed for 28 weeks or until she stopped considering the spermicide as her primary method of contraception.ResultsThe Kaplan-Meier estimate of the 6-month probability of pregnancy during typical use of the spermicide was 28.0% in the tablet group and 24.9% in the film group (P= .78, one-tailed test). The study had nearly 75% power to have detected a difference of seven percentage points between groups. Results were almost identical when the analysis included only months when the participants reported use of the spermicide during every coital act. Reported levels of sexual activity and compliance with use of the spermicide were high in both groups.ConclusionThe contraceptive effectiveness of these two spermicidal products appeared similar. Both products were associated with a fairly high risk of pregnancy in this young, highly sexually active population.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo compare the antimetabolites methotrexate and 6-mercaptopurine as single-agent medical abortifacients using clinical and immunohistochemical analyses.MethodsTwenty-seven women with gestations less than 7 weeks from the last menstrual period (LMP) were randomized to receive intramuscular methotrexate, 50 mg/m2, or oral 6-mercaptopurine, 200 mg. Forty-six additional women received methotrexate after randomization was discontinued. Women returned at 2-week intervals. Those without fetal cardiac activity were followed until complete abortion. Those with fetal cardiac activity were considered failures and underwent suction abortions. Tissue collected at the time of suction abortion was analyzed with the cell-proliferation immunohistochemical assay Ki-67.ResultsAll 12 women in the 6-mercaptopurine group had fetal cardiac activity at follow-up and underwent suction abortion; therefore, this arm of the study was discontinued. Six of the 61 women who received methotrexate had fetal cardiac activity at follow-up and also underwent suction abortion. Fetal cardiac activity was present after methotrexate in three of 55 women at less than 6 weeks from the LMP and in three of six between 6 and 7 weeks from the LMP (P< .01). Women who aborted after methotrexate started bleeding on day 19 (standard deviation [SD] 7.8), bled for 9 days (SD 4.0), and used minimal pain medications. Tissues exposed to methotrexate showed decreased Ki-67 activity compared with tissues exposed to 6-mercaptopurine (P= .003).ConclusionIn oral doses of 200 mg, 6-mercaptopurine did not induce early abortion. A single intramuscular dose of methotrexate used without prostaglandins induced abortion in most women at gestational ages of less than 6 weeks. Ki-67 activity was lower in a small sample of fetal tissues exposed to methotrexate than in tissues exposed to 6-mercaptopurine.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo assess patients' ability to compare magnitudes of Down syndrome risk at maternal ages of 35 and 40 years, expressed as rates or as proportions.MethodsWe used a self-administered, anonymous questionnaire that posed the same comparison in two different formats: 2.6 versus 8.9 per 1000 women (rates) and one in 384 versus one in 112 women (proportions). The study setting included several university-affiliated obstetrics and gynecology outpatient clinics in San Francisco, California. A total of 633 women, whose primary languages were English, Spanish, or Chinese, participated. The main outcome measure was correct identification of the larger of two risks.ResultsWomen were more successful with rates (463 of 633 respondents, 73%) than with proportions (353 of 633 respondents, 56%). A paired analysis, in which each woman served as her own control, found risk assessment to be significantly better with rates than with proportions (P< .001). Women with little formal education had difficulty understanding risks framed either way.ConclusionThe traditional use of proportions to express risk in genetic counseling lacks scientific basis. Rates were easier to understand than proportions, regardless of respondents' age, language, and education.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo measure the association between gynecologic conditions and quality of life in women before hysterectomy.MethodsWe retrospectively identified 482 women who had hysterectomies for nononcologic and nonemergency indications in one of nine capitated medical groups in Southern California between 1993 and 1995. Their symptoms and quality of life before hysterectomy were assessed by medical record review and telephone interview. Women were placed into four symptom-based groups (pain, bleeding, pelvic discomfort, and asymptomatic groups) and compared across six quality-of-life scales.ResultsWomen with primary pain conditions reported the highest average role impairment compared with women with primary bleeding, pelvic discomfort, or asymptomatic conditions (8.6 days/month versus 5.0, 2.5, and 1.9 days/month, respectively;P< .05). On the five 0 to 100–point quality-of-life scales, women with primary pain conditions, compared with women with bleeding, pelvic discomfort, or asymptomatic conditions, had the highest mean levels of sexual impairment (71.5 versus 54.1, 29.6, and 17.9, respectively;P< .05) and mood impairment (55.2 versus 45.2, 34.6, and 38.1, respectively;P< .05), the poorest perception of general health (74.4 versus 60.7, 44.1, and 49.4, respectively;P< .05), and the greatest increase in severity of symptoms before hysterectomy (77.2 versus 68.7, 61.5, and 57.1, respectively;P< .05).ConclusionWomen's primary symptoms before hysterectomy are associated differentially with varying levels of impairment. Standardized measurement of quality of life among women with gynecologic complaints that lead to hysterectomy might help in the development of treatment guidelines and in the assessment of appropriateness and outcomes of care for those women.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine whether membership in a managed care organization is associated with a delay in receiving definitive surgical treatment for benign gynecologic or gynecologic oncologic diseases.MethodsFour hundred patients who had definitive surgery between 1994 and 1997 were divided into those with benign gynecologic (n= 207) and gynecologic oncologic diagnoses (n= 193). Each group was subdivided into managed care patients and fee-for-service patients. Subgroups were analyzed for delay in surgical treatment, emergency room visits, length of stay, age, clinic visits, prior evaluation, prior treatment, second opinions, operating room time, estimated blood loss, and surgical complications.ResultsThere were 122 managed care and 85 fee-for-service patients with benign gynecologic diagnoses. The time from initial presentation to the date of definitive surgery was significantly longer for the managed care patients (133.7 ± 21 days compared with 84.9 ± 12.8 days,P= .03). Of the 193 patients with gynecologic cancer 96 were in the managed care group and 97 were under fee-for-service arrangements. There was no significant difference in the time from initial presentation to the date of definitive surgery between these two groups (35.7 ± 7.4 days compared with 20.5 ± 2.5 days,P= .29). There were no significant differences between groups in emergency room or clinic visits, prior evaluations or treatments, or surgical complications when stratified by diagnosis. The mean age of managed care patients was significantly lower than that of fee-for-service patients for gynecologic diagnoses (46.4 ± 9.7 years compared with 56.5 ± 14.9 years,P< .001), and gynecologic oncologic diagnoses (47.5 ± 13.2 years compared with 60.9 ± 15.8 years,P< .001).ConclusionMembership in a managed care organization is associated with a delay in receiving definitive surgical care for benign gynecologic, but not gynecologic oncologic, diseases.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine the screening value of febrile morbidity for detecting infections after vaginal surgery.MethodsA cohort of 431 consecutive women had vaginal surgery at the M. S. Hershey Medical Center from September 1988 through June 1995. Outcomes of febrile morbidity and infection were analyzed.ResultsFifty-four of 431 patients (12.5%) had febrile morbidity. Thirty-five infections (8.1%) were identified, of which only 13 were accompanied by febrile morbidity. Forty-one patients (9.5%) had unexplained fevers. The sensitivity of febrile morbidity for postoperative infection was 40%, specificity was 98%, positive predictive value was 26%, and negative predictive value was 94%. Stepwise logistic regression found blood loss (odds ratio 1.001/mL; confidence interval 1.0001–1.0035), uterine weight (0.987/g; 0.976–0.999), and parity (1.570; 1.146–2.050) as significant independent variables for developing fever. Patient weight (0.984/lb; 0.971–0.998) and type of procedure (2.16; 2.12–6.38) were confirmed as significant independent variables for postsurgical infections.ConclusionFebrile morbidity had limited value as a screening test for postoperative infection, with poor sensitivity and positive predictive value after vaginal surgery.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo assess the efficacy and safety of an external urethral barrier for the management of mild to moderate stress urinary incontinence in adult women.MethodsFour hundred eleven women with the symptom of stress urinary incontinence in 12 United States centers participated. Additional inclusion and exclusion criteria were applied before protocol device use, and ultimately 390 subjects began device use. Outcome measures for efficacy and safety were assessed. Efficacy was evaluated by the number of leakage episodes using a voiding diary, subjective urinary leakage severity, incontinence impact scores, and pad testing. Safety was evaluated by symptom assessment, urinalysis, urine culture, measurement of postvoid residual urine volume, vulvar cytology, vaginal culture, and (n= 81) cystometric testing.ResultsEfficacy was indicated by statistically significant reductions in the number of leakage episodes, subjective leakage severity scores, incontinence impact scores, and pad-test loss during device use. The data also indicated that the device was safe, as evidenced by the lack of statistically significant changes in the percentage of subjects with urinary tract infections during device use or in postvoid residual urine volume and cystometric indices. Symptoms of vulvar irritation or lower urinary tract discomfort occurred in a small percentage of subjects but were generally transient, and only three women discontinued using the device.ConclusionThe external urethral barrier appears to be a safe nonsurgical alternative to absorbent products for the management of mild to moderate stress urinary incontinence in adult women.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo evaluate the safety and efficacy of a bladder-neck support prosthesis, a vaginal device designed to support the bladder neck, in women with genuine stress and mixed incontinence.MethodsFor enrollment, incontinent women underwent a history, physical examination including cotton-swab test, urinalysis, postvoid residual urine, and multichannel urodynamic testing. Those with genuine stress incontinence or mixed incontinence and urethral hypermobility completed 7-day bladder diaries, the Incontinence Impact Questionnaire, and underwent standardized pad tests. They were fitted with a prosthesis and seen weekly to optimize fit and efficacy. At week 5, they underwent repeat evaluations with the best-fitting prosthesis in place.ResultsSeventy women were enrolled and 53 completed the 1-month study (29 genuine stress incontinence, 24 mixed incontinence). The mean ages were 50.4 years for genuine stress incontinence (range 24–76) and 55.7 years for mixed incontinence (range 30–88). A statistically significant reduction in incontinence was noted on pad testing (genuine stress incontinence, mean 46.6–16.6 g; mixed incontinence, mean 31.9–6.8 g) and in the bladder diary (genuine stress incontinence, mean 28.6–7.8 losses per week; mixed incontinence, mean 30.2–15 losses per week). Quality-of-life scores improved in both groups. With the device in place, urodynamic testing indicated normalization of urethral function without evidence of outflow obstruction. Subjects found the device comfortable, easy to use, and convenient. Side effects included five urinary tract infections and 23 cases of vaginal mucosal soreness or mild irritation.ConclusionThe bladder-neck support prosthesis significantly reduced involuntary urine loss in women with stress and mixed incontinence.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo develop a reference for birth weight for gestational age to identify Mexican American infants born in the United States who are small or large for gestational age.MethodsReference percentiles were developed for Mexican American and non-Hispanic white births, using national vital statistics from 1992–1994 for Mexican Americans (n= 1,197,916) and 1994 for non-Hispanic whites (n= 2,238,457). Birth weights and gestation from the last menstrual period were taken from birth certificates. Smoothed curves were fit, using unweighted fourth-degree polynomial equations, for the tenth, 50th, and 90th percentiles by gender and parity.ResultsMexican American infants were heavier than non-Hispanic white infants between 30 and 37 weeks' gestation for all parities and both genders. However, at term there was consistent crossover. Non-Hispanic white infants were heavier at or after 37 through 42 weeks' gestation, whereas the growth of Mexican American infants appeared to slow. Beginning at 37 weeks, the differences in weights of infants of primiparas increased to more than 100 g by 40 weeks; the differences were only slightly less for infants of multiparas.ConclusionGiven differences in distribution of birth weights for gestational age between Mexican Americans and non-Hispanic whites, the ability to recognize fetal growth restriction (FGR) or excessive growth is questionable. These data provide a reference for Mexican Americans for clinical use and for future studies in identifying infants at risk for FGR or overgrowth.

ISSN:0029-7844    

出版商:OVID    

年代:1999

数据来源: OVID