摘要:

The American College of Obstetricians and Gynecologists (ACOG) has a two-pronged Quality Assurance program for use by practitioners. The Voluntary Review of Quality Care Program allows hospital departments of obstetrics and gynecology to be reviewed, at their own request, by a team of trained reviewers. TheQuality Assurance in Obstetrics and Gynecology Manual, published in May 1989, provides clinical indicators and clinical criteria to be used within a department to establish its own quality assurance program. It allows evaluation of a departmental practice; development of physician profiles, department profiles, and practice trends; and identification of educational needs. The planning of these programs is difficult. Setting standards and establishing quality assurance programs carries some risk, but certainly not the risk incurred by hearing, seeing, and doing nothing. We must provide a quality assurance program that changes appropriately and continuously with proven advances in science and technology.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Laparoscopic tubal sterilization has been performed under local anesthesia in the United States since 1971. Pilot studies suggested that local anesthesia was as adequate and as safe as general anesthesia. Since 1980, the senior author has performed more than 3000 outpatient laparoscopic tubal sterilizations with the silastic ring under local anesthesia. A retrospective descriptive study was conducted on 2827 cases. The technical failure rate was 0.14%. There were no unintended laparotomies due to complications. The mean operative time was 10.0 ± 5.1 minutes. The mean anesthesia time was 23.3 ± 6.9 minutes. The hospital cost for the patient was reduced by 68-85%. This study demonstrates that laparoscopic tubal sterilization can be performed adequately, safely, and quickly under local anesthesia.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Fifteen fallopian tubes in which a previous ipsilateral eccyesis was managed by conservative surgical techniques were examined. The condition of the tube relative to the previous surgical management and the resolution of the previous implantation sites were correlated with the recurrent tubal pregnancy. All previous incisions were identified and all were well-healed, except for one fistula. Residual histologic evidence was present in only five of 16 previous implantation sites. The recurrent eccyeses were related to previous surgical management in only three women, two after anastomosis and one because of inadvertent obstruction of the tube. The cases of tubal obstruction and tuboperitoneal fistula formation were thought to reflect a lack of understanding of the pathologic changes associated with tubal pregnancy during conservative surgery. The previous tubal incision sites were all remarkably well-healed regardless of whether they were primarily closed or left open, and independent of location. Infundibular or fimbrial “milk-outs” were without histologic evidence of damage. The underlying tubal disease (chronic salpingitis, follicular salpingitis, or salpingitis isthmica nodosa) seems to be the major factor identified that is associated with, and probably the cause for, the recurrent tubal gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Fimbrioscopy and salpingoscopy were performed with a rigid salpingoscope during operative laparoscopy in 100 patients with minimal to moderate endometriosis and in 20 normal controls. Five women with endometriosis had perifimbrial adhesions, compared with none of the controls. No subject in either group had adhesion formation of the endosalpinx. These observations indicate that there is no association between endometriosis and intratubal disease.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The excretion of phenoxymethylpenicillin in vaginal fluid was determined in five women after intake of a single dose of 1 g phenoxymethylpenicillin and in five women on a 10-day medication scheme with 1 g twice daily. After the single dose, there was a steady increase of penicillin in vaginal secretion during the following 3 hours. During the same period, the concentrations in serum and saliva peaked and started to decline. Fifteen hours after intake, vaginal fluid contained more than 1 mg/L, whereas no activity was found in serum or saliva. During the 10-day course of treatment, vaginal concentrations ranged between 2-3 mg/L. The drug was not eliminated from the vagina until the second day after ceasing medication. The accumulation and slow pharmacokinetics of phenoxymethylpenicillin in the vagina may be explained by the countercurrent vascular system supplying the internal genitalia and upper vagina. The effect of the high concentrations of penicillin on the vaginal microflora is discussed.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Clinical impression suggests that many cases of detrusor instability are psychosomatic. We evaluated 63 women with urinary incontinence and 27 continent controls using the Minnesota Multiphasic Personality Inventory, Uplift and Hassle Scales, and a structured questionnaire screening sexual dysfunction. All incontinent women underwent diagnostic urodynamic studies including uroflowmetry, subtracted water cystometry with provocation, and urethral closure pressure profilometry. Thirty-five women had genuine stress incontinence and 28 had detrusor instability, including nine with mixed incontinence. No differences in psychological test results were noted between the detrusor-instability and genuine-stress-incontinence groups. On the Minnesota Multiphasic Personality Inventory, subjects with detrusor instability scored significantly higher than controls on the hypochondriasis (P=.006), depression (P=.01), and hysteria (P=.0009) scales. Compared with continent controls, the detrusor-instability group reported a lower frequency of uplifts (P< .05) and a greater intensity of hassles (P<.05). Both incontinent groups reported more sexual dysfunction than did controls. We conclude that many women with urinary incontinence have abnormal psychological and sexual test results reflecting moodiness, feelings of helplessness and sadness, pessimism, general hypochondriasis/ somatization, and sexual dysfunction. These abnormalities appear to be associated with urinary incontinence in general rather than with specific diseases of the urinary tract

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A 10-year review of maternal mortality was conducted at the Municipal Hospital Miguel Couto in Rio de Janeiro. Thirty two deaths occurred between January 1978 and December 1987. In the same period there were 18,071 live births, giving an overall maternal mortality ratio of 177 per 100,000 live births. Maternal mortality increased from 128 per 100,000 live births in 1978 to 462 per 100,000 in 1987. Abortionrelated deaths accounted for 47% of the total mortality, followed by toxemia (19%) and hemorrhage (13%). The contribution of abortion-related mortality to maternal mortality increased 172% over the 10-year period studied. These results indicate that maternal mortality has been increasing in a population of urban poor and that the leading cause of death is induced abortion. In a setting where access to abortion is highly restricted and desire to regulate fertility is high, death due to illegal abortion is a major contributor to maternal mortality. The rise in abortion-related mortality over the past 10 years is attributed to a lack of family planning services in conjunction with urban socioeconomic conditions conducive to smaller families.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

With the active life-style of today's pregnant women, the effects of trauma have become an important obstetric concern. A protocol was developed to monitor pregnancies complicated by major blunt abdominal trauma in the third trimester, looking specifically for delayed placental and/or fetal problems. Of the 84 pregnancies studied, the most serious complication was placental abruption. Although abruption occurred in only two cases, one case was associated with a ruptured uterus and fetal death. There were no cases of delayed abruption or delayed fetal compromise. The most common complication was preterm labor, occurring in 28% of cases when the traumatic insult happened before 37 weeks' gestation. Of these 17 patients, 15 were successfully treated with tocolysis. There were no cases of direct fetal injury or Rh-isoimmunization. A revised protocol is recommended for limited outpatient observation with nonstress testing and screening ultrasonography to rule out preterm labor and placental abruption and to document fetal well-being.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Two hundred twenty-eight adnexal masses during pregnancy were discovered among 37,159 deliveries occurring between January 1, 1983 and October 31, 1988 at Kapiolani Medical Center for Women and Children in Honolulu. Hydatid cysts of morgagni (45.6%) occurred most frequently, followed by benign cystic teratomas (15.8%), epithelial cystadenomas (15.4%), and paraovarian cysts (13.6%). There were no malignant or borderline tumors. The patients were categorized as 22.1% part Hawaiian, 18.5% white, 17% Filipino, and 16% Japanese. We demonstrated an increased incidence of benign cystic teratomas in Filipinas (P< .01). There was no significant predisposition for the occurrence of non-neoplastic or other neoplastic lesions among any of the other ethnic groups studied.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Uterine leiomyomas are associated with various complications during pregnancy. During a 2-year period, pregnant women with a history of leiomyomas were referred to our antenatal testing unit for ultrasound evaluation. Eighty-five patients were found to have single or multiple leiomyomas by ultrasound examination. The size (total leiomyoma volume), number, and location of the leiomyoma(s) were ascertained. Each woman with leiomyoma(s) was matched by age, race, and parity with one without leiomyomas. Both groups were followed throughout pregnancy, and outcomes were compared. Size, number, or location of the leiomyoma had no influence on outcome. Studentttest indicated a significantly (P< .01) lower mean gestational age at the time of delivery in women with leiomyomas.

ISSN:0029-7844    

出版商:OVID    

年代:1990

数据来源: OVID