The Journal of reproductive medicine最新文献

{"title":"Diagnosing and managing thyroid disorders during pregnancy: a survey of obstetrician-gynecologists.","authors":"M. Power, S. Kilpatrick, J. Schulkin","doi":"10.1097/01.OGX.0000134240.62681.10","DOIUrl":"https://doi.org/10.1097/01.OGX.0000134240.62681.10","url":null,"abstract":"OBJECTIVE\u0000To document the knowledge and clinical practice of obstetrician-gynecologists regarding their diagnosis and management of thyroid disorders during pregnancy.\u0000\u0000\u0000STUDY DESIGN\u0000We surveyed 1,392 practicing obstetrician-gynecologists about their knowledge and clinical practice of treating thyroid disorders during pregnancy; 569 of the surveys were returned. Of those, 441 respondents treated pregnant women and completed the entire survey.\u0000\u0000\u0000RESULTS\u0000A majority of respondents had treated patients for hypothyroidism (88.7%) and hyperthyroidism (60.5%) within the previous year. In general, respondents appeared to be well versed in the symptoms of hypothyroidism and hyperthyroidism. Most respondents correctly predicted the likely results for thyroid-stimulating hormone, free thyroxine and total thyroxine for pregnant euthyroid, hyperthyroid and hypothyroid women, but about 50% appeared uncertain of the meaning of free thyroxine index. A majority (53.1%) of respondents considered their training during residency concerning thyroid disorders during pregnancy to be adequate, but few (7.5%) considered it to be comprehensive, and the remainder considered it barely adequate at best. Self-assessment of training and confidence regarding diagnosing and managing thyroid disorders during pregnancy were in concordance (r = .462 and r = .464, respectively; P < .001 in both cases).\u0000\u0000\u0000CONCLUSION\u0000Thyroid disorders are commonly treated by obstetrician-gynecologists, and in general their practices for diagnosis and management conform to accepted practices. A sizable minority of responding obstetrician-gynecologists indicated that they considered their training to be inadequate and their confidence in diagnosing and managing thyroid disorders to be low.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"306 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2004-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133757642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency cesarean delivery for nonreassuring fetal heart rate tracings. Compliance with ACOG guidelines.","authors":"S. Chauhan, E. Magann, John R. Scott, J. Scardo, N. Hendrix, J. Martin","doi":"10.1097/00006254-200406000-00010","DOIUrl":"https://doi.org/10.1097/00006254-200406000-00010","url":null,"abstract":"OBJECTIVE\u0000To review the English-language literature from 1990 to 2000 on cesarean delivery for \"fetal distress\" and assess compliance with American College of Obstetricians and Gynecologists (ACOG) guidelines.\u0000\u0000\u0000STUDY DESIGN\u0000A PubMed search with the search items cesarean, fetal distress, cesarean, nonreassuring fetal heart rate, cesarean, neonatal acidosis and cesarean, umbilical arterial pH was undertaken. Excluded from the search were case reports, letters to the editor, focus on fetal anomaly, combinations with other reasons for operative delivery (either abdominally or vaginally) or absence of pertinent information.\u0000\u0000\u0000RESULTS\u0000Among 392 articles from the search, 169 met the inclusion criteria. Three reports provided detailed information on use of scalp pH; use occurred in 5% (60/1,128) of emergency cesareans. Three reports provided data on the use of tocolytics for intrauterine resuscitation; the combined result was 16% (201/1,261). Five reports assessed the decision-to-incision interval within 30 minutes; in 59% (262/446) of cases it was achieved. Five reports contained cord pH information on 340 emergency cesarean deliveries; umbilical arterial pH was < 7.00 in 10%.\u0000\u0000\u0000CONCLUSION\u0000Physician use of, and compliance with, ACOG guidelines for emergency cesarean deliveries is difficult to assess, and incomplete compliance appears commonplace.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121057818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of vasa previa at delivery with a history of second-trimester placenta previa.","authors":"K. Francois, Staci Mayer, Cathleen Harris, J. Perlow","doi":"10.1097/01.OGX.0000119175.75185.25","DOIUrl":"https://doi.org/10.1097/01.OGX.0000119175.75185.25","url":null,"abstract":"OBJECTIVE\u0000To evaluate whether vasa previa at delivery is associated with a history of second-trimester placenta previa.\u0000\u0000\u0000STUDY DESIGN\u0000Retrospective, case-control study of all vasa previa cases at Good Samaritan Regional Medical Center from January 1, 1991, to May 1, 2001. Cases were identified by ICD-9 codes and confirmed by chart review. Each case was matched in a 1:4 ratio with controls based upon normal placentation at delivery, ultrasound documentation of midtrimester placental location, maternal parity and gestational age at delivery.\u0000\u0000\u0000RESULTS\u0000During the study period, 13 cases of vasa previa were identified. Nine cases (9/13, 69.2%) of vasa previa at delivery had a second-trimester placenta previa as documented by midtrimester ultrasonography, whereas 2 controls (2/52, 3.8%) had a second-trimester placenta previa (P < .000001, OR = 56.3, 95% CI = 8.9-354.1).\u0000\u0000\u0000CONCLUSION\u0000There is a highly significant association between vasa previa at delivery and a history of second-trimester placenta previa.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127464381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Borderline ovarian tumors in reproductive-age women. Fertility-sparing surgery and outcome.","authors":"J. Chan, Yvonne G Lin, V. Loizzi, Mariam Ghobriel, P. Disaia, M. Berman","doi":"10.1097/01.OGX.0000116044.18693.00","DOIUrl":"https://doi.org/10.1097/01.OGX.0000116044.18693.00","url":null,"abstract":"OBJECTIVE\u0000To evaluate the fertility and survival outcomes in young women with borderline ovarian tumors treated with fertility-sparing surgery.\u0000\u0000\u0000STUDY DESIGN\u0000From 1985 to 2002, 25 women with borderline ovarian cancers surgically managed with preservation of the uterus and at least a portion of 1 ovary were identified from tumor registry databases at 2 southern California hospitals. Data for analysis were collected from hospital charts, office records and tumor registry files.\u0000\u0000\u0000RESULTS\u0000Twenty-five patients (median age, 29 years) with borderline ovarian tumors, including 10 with stage IA, 3 with stage IC, 1 with stage IIIA and 11 with unstaged disease, underwent fertility-sparing surgery, consisting of unilateral adnexectomy in 19, unilateral adnexectomy with contralateral cystectomy in 5 and unilateral cystectomy in 1. No disease recurred, providing an overall survival of 100%. Fertility status was available on 15 patients 4-157 months after surgery; 6 of them attempted to become pregnant. Five women had successful pregnancies, with a total of 5 live births. One woman underwent assisted reproductive techniques, became pregnant but aborted. The median follow-up was 80 months (range, 4-157).\u0000\u0000\u0000CONCLUSION\u0000Conservative surgery for borderline ovarian tumors should be considered for women in the reproductive age group who desire preservation of fertility.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124447064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New contraceptive methods.","authors":"David M Plourd, W. Rayburn","doi":"10.5580/13e6","DOIUrl":"https://doi.org/10.5580/13e6","url":null,"abstract":"OBJECTIVE\u0000To provide an update on the current trend toward increasing use of emergency postcoital contraception, continuous (or \"extended-use\") oral contraceptives (OCs) and longer-acting contraceptive delivery systems.\u0000\u0000\u0000DATA SOURCES\u0000This review is based largely upon patient care-oriented clinical experience data, including some original work submitted to the U.S. Food and Drug Administration by the primary investigators of these novel methods, supplemented, when appropriate, with basic pharmacologic and pharmacokinetic information.\u0000\u0000\u0000METHODS OF STUDY SELECTION\u0000This review is a distillation based on an exhaustive literature search of each of the following topics: emergency postcoital contraception, continuous (extended-use) oral contraception, the weekly patch, the monthly vaginal ring and the monthly injectable. The issue of OC formulations recently begun to be marketed in this country was excluded since they have been extensively reviewed elsewhere.\u0000\u0000\u0000RESULTS\u0000Emergency postcoital contraception is highly effective, though not as effective as available proactive methods of hormonal contraception. Of the popular regimens available, all have similar efficacy; those without estrogen are associated with less nausea and vomiting. The prophylactic administration of an antiemetic 1 hour prior to the first contraceptive dose can mitigate this adverse side effect. Continuous (or \"extended\" use) of OCs has become increasingly popular. This can decrease or eliminate menstruation as well as several menstruation-related complaints (e.g., dysmenorrhea, menstrual migraines and premenstrual symptoms). Despite the fact that combination OC regimens offer highly reliable contraception as well as several noncontraceptive health benefits, they are limited by the issue of daily compliance. To address this limitation, several longer-acting delivery systems were recently developed. The weekly patch, monthly vaginal ring and monthly injectable have efficacy and side effect profiles similar to those of comparable OC formulations. They offer the advantages of longer action and lower and more steady steroid levels and are free of the challenges associated with daily compliance.\u0000\u0000\u0000CONCLUSION\u0000We need to continue to develop new and highly effective means of contraception that offer women ease of use and minimal side effects, hence leading to successful and effective use.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127149478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vestibulectomy for vulvar vestibulitis.","authors":"Glenn A. Gaunt, A. Good, C. Stanhope","doi":"10.1097/01.ogx.0000110276.92930.d0","DOIUrl":"https://doi.org/10.1097/01.ogx.0000110276.92930.d0","url":null,"abstract":"OBJECTIVE\u0000To determine if surgery is an effective therapy for vulvar vestibulitis.\u0000\u0000\u0000STUDY DESIGN\u0000A retrospective chart review of all patients having vestibulectomy at the Mayo Clinic, Rochester, Minnesota, from 1992 to 2001 was performed. A scoring system measuring objective and subjective findings was used both preoperatively and postoperatively to assess the effects of surgery. A paired t test was used to analyze the difference between preoperative and postoperative symptom scores. The Wilcoxon signed-rank test evaluated changes in symptom scores.\u0000\u0000\u0000RESULTS\u0000Thirty-eight of 42 patients (90%) with \"pure\" vulvar vestibulitis, as determined by physical findings and pathologic confirmation, had a significant improvement (P < .01) in their symptoms. The remaining 4 patients had confounding factors that may explain their lack of improvement.\u0000\u0000\u0000CONCLUSION\u0000Vestibulectomy is a simple and very effective treatment for vulvar vestibulitis.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134529929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urolithiasis in pregnancy. Diagnosis, management and pregnancy outcome.","authors":"D. Lewis, A. Robichaux, R. Jaekle, Nita G Marcum, C. Stedman","doi":"10.1097/01.OGX.0000074323.48257.83","DOIUrl":"https://doi.org/10.1097/01.OGX.0000074323.48257.83","url":null,"abstract":"OBJECTIVE\u0000To review our experiences with ureterolithiasis and nephrolithiasis in pregnancy and compare their outcomes with those in the rest of the obstetric population.\u0000\u0000\u0000STUDY DESIGN\u0000A database of obstetric deliveries was used to identify patients with (cases) and without (controls) urolithiasis and to compare demographics and pregnancy complications between the groups. Furthermore, retrospective chart review of the cases group was utilized to obtain additional pertinent information.\u0000\u0000\u0000RESULTS\u0000Over a 3-year period, there were 21,010 deliveries, 86 of which had symptomatic urolithiasis, for an incidence of 1 in 244 pregnancies. Renal calculi occurred more commonly in Caucasians than African Americans. Patients were more likely to become symptomatic in the second or third trimester, and most stones passed spontaneously. Pregnancy complications were similar between the groups; however, there was a higher percentage of preterm premature rupture of membranes in the nephrolithiasis cases (7.0% vs. 2.9%, P < .05).\u0000\u0000\u0000CONCLUSION\u0000Nephrolithiasis and ureterolithiasis occurred more commonly in Caucasians during pregnancy. The majority of patients became symptomatic in the last two-thirds of pregnancy and usually passed the calculus spontaneously. A higher incidence of preterm premature rupture of membranes was noted in pregnancies complicated by urolithiasis.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128211697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vulvar dysesthesia (vulvodynia). A follow-up study.","authors":"B. Reed, H. Haefner, Lauren E. Cantor","doi":"10.1097/01.OGX.0000090196.75538.9E","DOIUrl":"https://doi.org/10.1097/01.OGX.0000090196.75538.9E","url":null,"abstract":"OBJECTIVE\u0000To assess long-term outcome in women treated for vulvar dysesthesia (vulvodynia).\u0000\u0000\u0000STUDY DESIGN\u0000Cross-sectional survey via mailed questionnaires of women with vulvar dysesthesia treated at the University of Michigan. Questionnaires addressed symptom characteristics and their predictors, pregnancy response and treatments used. Analysis included t tests, nonparametric tests and multivariate analyses to assess associations between the degree of improvement (in the amount of pain experienced) since diagnosis and potential predictors of that outcome.\u0000\u0000\u0000RESULTS\u0000Of 234 questionnaires mailed, 104 were completed. Based on a 7-point pain scale (0-6, with 6 indicating excruciating pain), the level of pain at the time of the survey (1.6 +/- 1.3) was significantly lower than that at the time of diagnosis (4.5 +/- 1.5) (P < .0001). Of the 104 women, 56.8% reported > 50% improvement in their pain since diagnosis, and the pain had worsened in 1.9%. Greater improvement was noted with higher pain levels at baseline and with a shorter time since onset. The majority of women who had been pregnant since developing vulvar pain reported improvement (30%) or no change (40%) in symptoms during and after pregnancy. Treatments (nonrandom) rated as most effective included antidepressants (used for pain control) and anticonvulsant medications, biofeedback and counseling.\u0000\u0000\u0000CONCLUSION\u0000Most women with vulvar dysesthesia reported markedly less pain at follow-up, although few reported a \"cure.\" Pregnancy was not associated with worsening of vulvar symptoms for most women. Controlled clinical trials will be needed to elucidate treatments that are most effective.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"167 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132198714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using history and colposcopy to select women for endocervical curettage. Results from 2,287 cases.","authors":"L. Massad, Y. Collins","doi":"10.1097/00006254-200305000-00013","DOIUrl":"https://doi.org/10.1097/00006254-200305000-00013","url":null,"abstract":"OBJECTIVE\u0000To enhance the yield of endocervical curettage (ECC) by defining risks for abnormality.\u0000\u0000\u0000STUDY DESIGN\u0000Demographic and medical information collected at colposcopy and subsequent histology were reviewed retrospectively. Statistical analysis was by t and chi 2 tests.\u0000\u0000\u0000RESULTS\u0000Among 2,287 women undergoing ECC at colposcopy, in only 105 (5%) did positive ECC require excisional therapy that would not otherwise have been recommended. Women with positive ECC were older (mean, 39.0 vs. 33.2 years; P < .001) and of higher parity (mean, 3.0 vs. 2.0 births; P < .001), with earlier first intercourse (at 16.6 vs. 17.2 years, P = .006), more unsatisfactory colposcopy (148 [27%] of 545 women with unsatisfactory colposcopy vs. 183 [12%] of 1,523 women with satisfactory colposcopy; P < .001) and more colposcopic impressions of cervical intraepithelial neoplasia (CIN) 2-3 (163 [51%] of 323 vs. 443 [25.6%] of 1,730 women with low grade or a negative impression; P < .001). The likelihood of missed CIN 2-3 was 0.4%, with no missed cancers among women with satisfactory colposcopy and either a normal colposcopic impression (1/254) or nulliparity (2/474).\u0000\u0000\u0000CONCLUSION\u0000ECC identifies otherwise-undetected preinvasive and invasive lesions but may be avoided in women with satisfactory colposcopy who are nulliparous or have no colposcopic lesions.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116926569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dichorionic twins discordant for thanatophoric dysplasia managed with selective reduction at 20 weeks' gestation: a case report.","authors":"A. Vidaeff, M. Lucas, Melissa Strassberg, Keith I Spooner, S. Ramin","doi":"10.1016/S0301-5629(03)00615-X","DOIUrl":"https://doi.org/10.1016/S0301-5629(03)00615-X","url":null,"abstract":"","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128498971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}