摘要:

We evaluated the pregnancies of 427 women who conceived through artificial insemination by donor (AID) at our clinic over a 12-year period. Initial phone contact was followed by a questionnaire. Outcome was known for 594 of the 606 pregnancies, with a total of 502 live-born children including 15 sets of twins. The spontaneous abortion rate was 16.5%, with no difference between fresh- and frozen-semen pregnancies. Significant correlations were found between spontaneous abortion rate and maternal age (P<.001) and spontaneous abortion rate and cycle of conception (P<.025). Follow-up was completed on 481 children, among whom the following were found: one chromosomal anomaly, 22 major congenital anomalies, four children with possibly syndromic conditions, and 38 with minor congenital anomalies. Of the school-aged children, 5.8% had recognized learning disabilities and 10.5% were considered gifted by their schools. We also investigated the psychological impact of AID on each family. The majority of couples (71.7%) informed their obstetricians of the AID. Half of the couples did not tell any family or friends. Many couples did not (47%) or probably did not (14%) plan to tell their children of their origins. The divorce rate among those with AID children was 7.2%, which was significantly less (P<.01) than that in a matched population. Psychological counseling specifically related to AID was sought by 2.8% of the couples. We conclude that AID children are at similar risk for congenital anomalies as normally conceived children but they experience lower rates of family dissolution.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

During an 8-year period, we managed 42 women with 101 pregnancies with previously diagnosed but uncorrected uterine malformations referred to our institution for highrisk obstetric care. All patients were managed under the same standardized protocol requiring weekly visits and decreased physical activity. The population studied consisted of four groups of pregnancies with the following uterine anomalies: unicornuate (five), bicornuate (61), septate (25), and didelphys (ten). Sixty percent of the pregnancies in the unicornuate and didelphys group reached term, 39% in the bicornuate group, and 48% in the septate group. Preterm labor requiring tocolysis occurred in 21% of the pregnancies in the bicornuate group and 15% of the pregnancies in the septate group. Cerclage was placed in 5% of the pregnancies in the bicornuate group. Before our care, the fetal survival rate for pregnancies in the bicornuate and septate groups was 52 and 53%, respectively; with our management protocol, it was 58 and 65%, differences that were not statistically significant. Our experience suggests that high-risk obstetric intervention does not obviate the potential benefit of metroplasty, especially for patients with a bicornuate or septate uterus. We believe that traditional indications for metroplasty should continue to be used.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

We evaluated the efficacy of long-term cimetidine in treating hirsutism by monitoring four indices: subjective hair removal practice, grading of hair growth by the Lorenzo scale, photography, and hair weight measurement. Of 20 women with moderate to severe facial hirsutism treated with cimetidine, 300 mg four times daily, nine were followed for 48 weeks or longer. Of these nine subjects who completed 48-72 weeks of treatment, only two showed a decrease in hirsutism. None of the 11 subjects treated for less than 48 weeks had any decrease in hirsutism. We conclude that cimetidine, a weak antiandrogen, is not sufficiently effective to use in the treatment of hirsutism.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

No previous study has investigated prospectively the quantitative effect of treatment on antiendometrial antibody levels in endometriosis. We measured antiendometrial antibody levels by an enzyme-linked immunosorbent assay in 35 women with Iaparoscopically proved endometriosis who were treated for 6 months with danazol (N=11) or nafarelin (N=24) in a randomized double-blind study. Levels before treatment were significantly higher than in a control group (P<.001). Levels were lowered by treatment, but to a significant extent only in the nafarelin group (P<.001) (danazol group: P=.091). Our data suggest that in relation to antiendometrial antibodies, nafarelin has a suppressive effect which has previously been ascribed only to danazol.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

To determine the role of previous abdominal surgery in tubal pregnancy risk, we compared 337 women diagnosed with tubal pregnancy during 1981-1986 with 893 populationbased controls concerning their medical, reproductive, and sexual histories. After excluding types of abdominal surgery that involve the fallopian tubes directly and after adjusting for age, gravidity, and reference year, we found no increased risk for tubal pregnancy related to previous cesarean delivery (relative risk 0.6, 95% confidence interval 0.3-1.2), ovarian surgery (relative risk 1.2, 95% confidence interval 0.6- 2.5), or removal of an unruptured appendix (relative risk 1.2, 95% confidence interval 0.7-2.2). An increased risk was noted for tubal pregnancy associated with previous ruptured appendix (relative risk 1.8, 95% confidence interval 0.6-5.5), but the increase was well within the limits of chance. With the possible exception of ruptured appendix, our study indicates that abdominal surgery that does not directly involve the fallopian tubes has little or no influence on the occurrence of tubal pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The current study was designed to evaluate Nd:Yag laser endometrial ablation as an alternative to hysterectomy in women with uncontrolled benign uterine bleeding. The subjects were candidates for hysterectomy, had benign endometrial histology, had failed hormonal therapy and/or D&C, and did not desire future childbearing. Medication was given to render the endometrium atrophic, and treatment was carried out using a “touch” technique. Forty-two treated patients have been followed 3-36 months, with a success rate of 81%. Fourteen (33%) are amenorrheic and 13 31%) estimate that they have less than 25% of their pretreatment flow. Those with uterine size over 10 cm or large submucous fibroids were usually excluded because of technical difficulty in performing the procedure. Treatment outcome was not related to patient weight, uterine size, or small intrauterine abnormalities. Twelve patients had medical conditions that were relative contraindications for hysterectomy, and 11 were treated successfully. Endometrial ablation with the Nd:Yag laser is an effective alternative to hysterectomy in patients with uncontrolled benign uterine bleeding.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Previous studies from our laboratory have demonstrated pentoxifylline to be a potent inhibitor of primary posttraumatic adhesion formation in a rodent model. To evaluate pentoxifylline in a situation more closely mimicking the events encountered in infertility surgery, we developed a model for adhesion reformation after lysis of pelvic adhesions. New Zealand White rabbits received a standardized primary traumatic lesion to the left uterine horn. One week later, a laparotomy was performed for evaluation (prescore) and subsequent lysis of adhesions. After closure, the animals were randomized to treatment with vehicle or subcutaneous pentoxifylline, 2.5 mg/kg, administered at 12-hour intervals for six doses. Seven days later, the rabbits were sacrificed and evaluated in a blinded manner to quantify adhesion reformation (postscore). Using a scoring scale from 0=no adhesions to 4+=most severe, the mean prescore was not different between pentoxifylline-treated and control rabbits (3.8 versus 3.9, respectively). However, the mean postscore (0.7 versus 3.7, respectively) was markedly reduced by pentoxifylline (P<.001). These data demonstrate a marked inhibition of adhesion reformation after lysis of pelvic adhesions under the influence of pentoxifylline in rabbits.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

By retrospective exclusion of gestations with known obstetric complications, maternal diseases, or unreliable menstrual histories, we found that uncomplicated, spontaneous-labor pregnancy in private-care white mothers is longer than Naegele's rule predicts. For primiparas, the median duration of gestation from assumed ovulation to delivery was 274 days, significantly longer than the predicted 266 days (P=.0003). For multiparas, the median duration of pregnancy was 269 days, also significantly longer than the prediction (P = .019). Moreover, the median length of pregnancy in primiparas proved to be significantly longer than that for multiparas (P=.0032). Thus, this study suggests that when estimating a due date for private-care white patients, one should count back 3 months from the first day of the last menses, then add 15 days for primiparas or 10 days for multiparas, instead of using the common algorithm for Naegele's rule.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A preterm birth prevention program consisting of risk scoring, intensive weekly observation including cervical examinations, and detailed education about preterm labor signs and symptoms was tested in a predominantly black, indigent population. One thousand high-risk women were randomized to treatment or control groups. Although more preterm labor was diagnosed and treated in the treatment group, there were no significant differences between the groups with respect to mean birth weight or gestational age, spontaneous preterm delivery rates, or low or very low birth weight rates. The rates of respiratory distress syndrome and fetal and neonatal mortality, although greater in the treatment group, were not statistically different. However, the treatment-group infants had significantly more intracranial hemorrhages and spent more days on ventilators. At this institution, the preterm birth prevention program was not effective.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Blood transfusion during or after delivery is a serious and sometimes predictable event. An analysis of 30,621 consecutive deliveries showed that previous abortion, bleeding during pregnancy, polyhydramnios, oligohydramnios, operative delivery, multiple pregnancy, abnormal placentation, and primary cesarean were each associated with unexpectedly high transfusion rates. Most women who were transfused received 2 U of blood or fewer. Only 0.09% of pregnant women received more than 8 U. There has been a temporal reduction in the rate of blood transfusion in obstetric practice over the past 10 years. Currently, it appears that approximately 2% of women may require blood transfusion during the peripartum period.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID