ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo estimate whether antibiotic treatment of asymptomatic women with a positive cervical or vaginal fetal fibronectin test in the second trimester would reduce the risk of spontaneous preterm delivery.METHODSWomen were screened between 21 weeks 0 days and 25 weeks 6 days of gestation with cervical or vaginal swabs for fetal fibronectin. Women with a positive test (50 ng/mL or more) were randomized to receive metronidazole (250 mg orally three times per day) and erythromycin (250 mg orally four times per day) or identical placebo pills for 10 days. The primary outcome was spontaneous delivery before 37 weeks' gestation after preterm labor or premature membrane rupture.RESULTSA total of 16,317 women were screened for fetal fibronectin, and 6.6% had a positive test; 715 fetal fibronectin test–positive women consented to randomization. Outcome data were available for 703 women: 347 in the antibiotic group and 356 in the placebo group. The antibiotic and placebo groups were not significantly different for maternal age (P= .051), ethnicity (P= .849), marital status (P= .127), education (P= .244), and bacterial vaginosis (P= .236). No difference was observed in spontaneous preterm birth before 37 weeks' (odds ratio [OR] 1.17, 95% confidence interval [CI] 0.80, 1.70), less than 35 weeks' (OR 0.92, 95% CI 0.54, 1.56), or less than 32 weeks' (OR 1.94, 95% CI 0.83, 4.52) gestation in antibiotic-compared with placebo-treated women. Among women with a prior spontaneous preterm delivery, the rate of repeat spontaneous preterm delivery at less than 37 weeks' gestation was significantly higher in the active drug compared with the placebo group (46.7% versus 23.9%,P= .039).CONCLUSIONTreatment with metronidazole plus erythromycin of asymptomatic women with a positive cervical or vaginal fetal fibronectin test in the late second trimester does not decrease the incidence of spontaneous preterm delivery.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo determine whether amnio–polymerase chain reaction (amnio-PCR) can replace conventional cytogenetic study for confirming the karyotype of fetuses in women with positive biochemical screening for fetal Down syndrome.METHODTo check the accuracy of this technique in our laboratory, we first compared the amnio-PCR results with those of conventional cytogenetic study in 235 patients referred from June 1999 to December 2001 for prenatal diagnosis in a referral center in Hong Kong. We then reviewed the results of 1526 amniotic fluid cultures performed for positive fetal Down syndrome screening between January 1997 and December 2001 and classified them as detectable or not detectable by amnio-PCR, using the assumption that we had replaced conventional cytogenetic study with amnio-PCR.RESULTSThe 235 amnio-PCR results were all informative, without a false-positive or false-negative result. Of the 1526 cases with positive fetal Down syndrome screening and no ultrasound abnormalities, only two cases of sex chromosome abnormalities and two cases of marker chromosomes would have been missed if conventional cytogenetic study had been replaced by amnio-PCR.CONCLUSIONAmnio-PCR can be an alternative to conventional cytogenetic study for women with positive biochemical screening for fetal Down syndrome and no demonstrable fetal structural abnormality.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo examine the association between bacterial vaginosis, vaginal fluid neutrophil defensins, and preterm birth.METHODSVaginal fluid specimens were obtained at 24–29 weeks' gestation from 242 cases with preterm birth and 507 noncases sampled using a case–cohort study design. We tested for bacterial vaginosis by Gram staining and Nugent scores and assayed for neutrophil defensins by enzyme-linked immunosorbent assay. Bacterial vaginosis was studied as a categoric variable (negative, intermediate, and positive), whereas defensins were studied as a continuous, categoric (based on percentiles), and dichotomous measure (presence versus absence). Three gestational age cut points were used to define preterm birth. Modified Cox proportional hazard models were used to evaluate the associations between bacterial vaginosis, defensins, and degree (less than 32, less than 34, and less than 37 weeks) and type (premature rupture of membranes, preterm labor) of pre-term birth.RESULTSElevated vaginal fluid neutrophil defensins were not associated with birth before 37 weeks. Compared with women who did not have measurable vaginal fluid defensins, women with higher defensin levels (0–2.8 μg/mL, 2.8–8.2 μg/mL, and greater than 8.2 μg/mL) had a greater risk of delivering before 32 weeks. Hazard ratios adjusted for maternal race and vaginal bleeding during pregnancy and 95% confidence intervals for these defensin levels were 1.7 (0.4, 6.9), 2.4 (0.7, 7.9), and 3.1 (1.0, 9.8), respectively. Bacterial vaginosis status did not influence the association between defensins and preterm birth.CONCLUSIONElevated concentrations of vaginal fluid neutrophil defensins at 24–29 weeks' gestation might predict preterm birth before 32 weeks.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo identify demographic, obstetric, and gynecologic risk factors associated with the development of pelvic floor disorders in women who undergo surgical correction.METHODSWe conducted a case–control study, with cases selected from all women who had surgery by our urogynecology service from July 1, 1999 to July 1, 2000 and who had a first obstetric delivery at Magee Womens Hospital (n= 80). Controls were patients seen in the general gynecology office over the same time period who had no complaints associated with pelvic floor disorders in the previous 3 years, less than stage I prolapse on pelvic examination, and first obstetric delivery at Magee Womens Hospital (n= 176). Demographic, obstetric, and gynecologic variables were compared between cases and controls.RESULTSThere were no significant differences in race, current age, gravidity, or parity. Cases were more likely than controls to have a higher body mass index (BMI) (28.6 ± 6.3 versus 26.4 ± 6.1 kg/m2,P= .01), to be younger at first delivery (25.8 ± 5.3 versus 28.4 ± 4.9 years,P< .001), to have undergone a forceps delivery (64% versus 44%,P≤ .001), and to have had previous gynecologic surgery (34% versus 16%,P= .003). Using logistic regression modeling, all of these factors were found to be independently associated with pelvic floor disorders. After menopause, use of hormone replacement therapy 5 or more years was protective (P= .001).CONCLUSIONIn our surgical patients, younger age at first delivery, higher BMI, forceps delivery, and history of gynecologic surgery were significantly associated with subsequent development of pelvic floor disorders.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo test the intraobserver (are observers likely to agree between themselves?) and interobserver (are observers likely to agree with other observers?) reproducibility and the overall diagnostic accuracy of laparoscopic diagnosis of pelvic inflammatory disease (PID).METHODSThree senior consultants and three residents in training in obstetrics and gynecology scored the four laparoscopic images (adnexa, cul-de-sac, and pelvic panoramic view) from each of 40 patients and repeated the process 2 days later after the order of presentation had been randomized. A standardized predesigned scoring form was used. Histopathologically proven PID was used as the gold standard.RESULTSThe overall accuracy of the laparoscopic diagnosis of PID was 78%, the sensitivity was 27%, and the specificity was 92%. The overall intraobserver reproducibility of the diagnosis of PID was only fair (κ = 0.58), and it was clearly better among the consultants than among the residents (κ = 0.76 and 0.39, respectively). The overall interobserver reproducibility was poor to fair (κ = 0.43), and it was again better among the consultants than among the residents (κ = 0.48 and 0.38, respectively). When specific diagnostic features (including tubal erythema, edema, adhesions, cul-de-sac fluid) were separately analyzed, the results were no different suggesting only poor-to-fair reproducibility.CONCLUSIONBased on photographic images, the observer reproducibility and the overall diagnostic accuracy of the laparoscopic diagnosis of PID are unsatisfactory when histopathologically proven PID is used as the gold standard.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

OBJECTIVETo estimate the effects of race and preoperative uterine anatomy on complication rates after myomectomy.METHODSA total of 239 abdominal myomectomies were performed at Duke University Medical Center from July 1992 through June 1998. Charts were abstracted using standardized forms. We assessed patient characteristics, surgical indications, preoperative hematocrit, and operative findings. Outcomes were defined as any complication, including transfusion.RESULTSThe population (n= 225) was 53% black and 47% white. The mean body mass index was 26. Fourteen percent had comorbidities. Twenty percent required transfusion. Black women were found to be more likely to have uteri with more than four leiomyomata and less likely to have only one leiomyoma (P= .001). Black women were 2.48 times more likely to have a complication (P< .006). Race was no longer a significant predictor for complications (odds ratio [OR] 1.36, 95% confidence interval [CI] 0.56, 3.15) after adjustment for uterine size (OR 1.86, 95% CI 1.3, 2.67), number of leiomyomata (OR 1.83, 95% CI 1.1, 3.14), and comorbidities (OR 2.77, 95% CI 1.1, 7.69). A similar pattern was seen for blood transfusion.CONCLUSIONBlack women undergoing myomectomy are more than twice as likely to have in-hospital complication or blood transfusion than white women. This is largely attributable to differences in uterine size and leiomyoma number. Research is needed to explore why black women are more likely to have larger and more numerous leiomyomata at the time of presentation for surgery.

ISSN:0029-7844    

出版商:OVID    

年代:2003

数据来源: OVID