B. Calhoun, P. Napolitano, M. Terry, C. Bussey, N. Hoeldtke
{"title":"Perinatal hospice. Comprehensive care for the family of the fetus with a lethal condition.","authors":"B. Calhoun, P. Napolitano, M. Terry, C. Bussey, N. Hoeldtke","doi":"10.1097/01.OGX.0000093270.97479.A4","DOIUrl":"https://doi.org/10.1097/01.OGX.0000093270.97479.A4","url":null,"abstract":"OBJECTIVE\u0000To describe our experience in providing a program of structured interdisciplinary care for the families of fetuses prenatally diagnosed with a lethal congenital anomaly.\u0000\u0000\u0000STUDY DESIGN\u0000We developed a comprehensive \"perinatal hospice\" program for the supportive care of families with fetuses known to have a lethal condition. Upon prenatal diagnosis of a lethal fetal condition, parents were presented with the option of elective pregnancy termination versus a multi-disciplinary program of ongoing supportive care until the time of spontaneous labor or until delivery was required for obstetric indications. We evaluated patient use of this new service and the natural history of pregnancies managed in this fashion.\u0000\u0000\u0000RESULTS\u0000The population consisted of 33 patients carrying a fetus with a clearly delineated lethal anomaly. Twenty-eight (85%) chose to participate in the perinatal hospice program. Of these, 11/28 (39%) had an intrauterine fetal death and 17/28 (61%) delivered a live-born infant. Among the live-born infants were 12 vaginal deliveries, 4 preterm and 8 at term. Obstetric indications or maternal request resulted in cesarean delivery for 5/28 (18%), 4 preterm and 1 at term, all live born. All live-born infants died within 20 minutes to 2 months. There were no maternal complications.\u0000\u0000\u0000CONCLUSION\u0000The availability of a structured program providing ongoing, comprehensive, multidisciplinary, supportive perinatal care offers a tangible and safe alternative to early elective pregnancy termination for patients carrying a fetus with a lethal congenital condition.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"13 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132285747","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":"A clinical pathway for laparoscopically assisted vaginal hysterectomy. Impact on costs and clinical outcome.","authors":"Wei-Chun Chang, Cheng-Chieh Lin","doi":"10.1097/01.OGX.0000079650.86551.10","DOIUrl":"https://doi.org/10.1097/01.OGX.0000079650.86551.10","url":null,"abstract":"OBJECTIVE\u0000To evaluate the cost of and clinical outcome of implementing a clinical pathway for laparoscopically assisted vaginal hysterectomy.\u0000\u0000\u0000STUDY DESIGN\u0000A retrospective study of the case records of patients who underwent laparoscopically assisted vaginal hysterectomy before (May-December 1997) and after (January 1998-March 1999) implementation of a clinical pathway. Data regarding resource consumption and clinical outcome represented by 10 clinical indicators were collected. Student's t test and the chi 2 test were used, as appropriate. Statistical significance was set at P = .05.\u0000\u0000\u0000RESULTS\u0000After implementation of the laparoscopically assisted vaginal hysterectomy clinical pathway, the average total fee decreased significantly, by 8.1% (P = .03), the average inpatient drug fee decreased by 50.6% (P < .01), and the laboratory fee dropped by 56.2% (P < .01). Furthermore, the length of hospital stay significantly decreased, from 6.90 to 4.08 days (P < .01); the average operation time decreased by 24.8% (P < .01); and the average anesthesia time decreased by 21.6% (P < .01). The pre-clinical pathway and post-clinical pathway complication rate did not differ statistically, but the rate of initiating intravenous antibiotic injections > 48 hours following surgery decreased by 76.2% in the clinical pathway group (P = .02).\u0000\u0000\u0000CONCLUSION\u0000Implementation of a clinical pathway for laparoscopically assisted vaginal hysterectomy can improve health care outcomes by decreasing length of hospital stay and admission fees and by maintaining quality of care. The clinical pathway is a good policy for maintaining cost containment and high-quality patient care.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"49 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125095299","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}
S. Bai, H. J. Lee, Jae-Sung Cho, Y. Park, Sei‐Kwang Kim, K. Park
{"title":"Peripartum hysterectomy and associated factors.","authors":"S. Bai, H. J. Lee, Jae-Sung Cho, Y. Park, Sei‐Kwang Kim, K. Park","doi":"10.1097/01.OGX.0000074390.93515.13","DOIUrl":"https://doi.org/10.1097/01.OGX.0000074390.93515.13","url":null,"abstract":"OBJECTIVE\u0000To identify the risk factors associated with peripartum hysterectomy.\u0000\u0000\u0000STUDY DESIGN\u0000The charts of 101 cesarean hysterectomies performed at Severance Hospital from January 1986 to April 2001 were reviewed. The patients were categorized into 2 groups. One was patients who underwent vaginal delivery followed by peripaRtum hysterectomy. The other was those who had cesarean section followed by peripartum hysterectomy. Paired t test and one-way ANOVA were used for statistical analysis.\u0000\u0000\u0000RESULTS\u0000During the study period there were 31,044 deliveries. Peripartum hysterectomy was performed in 54 of 11,924 cesarean sections (0.45%) and 18 of 19,120 vaginal deliveries (0.09%). The most common indication for peripartum hysterectomy was uterine atony (41.58%), followed by placenta previa accreta (23.76%), placenta accreta (16.83%) and placenta previa (11.88%). Placenta previa accreta patients received the highest volume of transfusions, 1,734 +/- 688 mL (P < .05). More cesarean hysterectomies (55.93%) occurred in emergency cesarean section cases than in elective ones (44.06%).\u0000\u0000\u0000CONCLUSION\u0000The risk factors associated with peripartum hysterectomy were placental abnormalities and previous cesarean deliveries. Hemorrhage remained the main cause of maternal mortality. Therefore, peripartum hysterectomy must be performed to save the life of the mother and must be free of dangerous sequelae.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127714900","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":"Use of packing in obstetric hemorrhage of uterine origin.","authors":"S. Hsu, B. Rodgers, A. Lele, J. Yeh","doi":"10.1097/01.ogx.0000079644.05271.30","DOIUrl":"https://doi.org/10.1097/01.ogx.0000079644.05271.30","url":null,"abstract":"OBJECTIVE\u0000To determine the safety and effectiveness of uterine packing to stop hemorrhage in obstetric patients following delivery and pregnancy termination.\u0000\u0000\u0000STUDY DESIGN\u0000A review of obstetric records at Children's Hospital of Buffalo in a 9-year period was undertaken. Patients with uterine packing were identified. Indications, additional medical and surgical procedures, estimated blood loss, postoperative complications and packing material used were reviewed.\u0000\u0000\u0000RESULTS\u0000A total of 9 patients were identified among 34,071. Five patients had hemorrhage during cesarean section. Two patients had hemorrhage after vaginal delivery; 1 case of which had failure with packing and resulted in postpartum hysterectomy. The remaining 2 patients had hemorrhage after dilation and evacuation. Uterine atony unresponsive to oxytocics was the most common indication for uterine packing (44%). The average hematocrit decrease was 10.4% (average total blood loss, 2,200 mL), and all patients received transfusion except 1. The only immediate postoperative complications occurred in a patient with postpartum hysterectomy after failed packing; she developed a pelvic abscess but did well after drainage.\u0000\u0000\u0000CONCLUSION\u0000Uterine packing may be a reasonable alternative to further surgical intervention in patients with intractable obstetric hemorrhage who wish to preserve fertility.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2003-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113942957","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":"Episiotomy and perineal repair. An evaluation of resident education and experience.","authors":"M. McLennan, C. Melick, Stacey L Clancy, R. Artal","doi":"10.1097/01.OGX.0000070125.67809.89","DOIUrl":"https://doi.org/10.1097/01.OGX.0000070125.67809.89","url":null,"abstract":"OBJECTIVE\u0000To describe current training practices and experience with episiotomy and perineal repair in obstetrics and gynecology residency programs in the United States.\u0000\u0000\u0000STUDY DESIGN\u0000A questionnaire mailed to all directors of accredited programs in the United States for distribution to fourth-year residents in their last four months of training included 30 questions regarding formal teaching, supervision, experience and repair techniques.\u0000\u0000\u0000RESULTS\u0000A total of 297 of 1,177 (25.2%) residents, representing 47% of programs, responded. The response rates for the various program sizes were: 32.0% for < or = 12 residents, 29.5% for 13-19 residents, 24.6% for 20-24 residents and 18% for > or = 25 residents. Of the residents, 59.9% received no didactics on episiotomy repair techniques; 59.3% had no formal teaching on pelvic floor anatomy; and 27.7% of third-degree repairs were supervised by attending physicians. Of the respondents, 6.8% had repaired > 20 fourth-degree lacerations and 40.3%, > 20 third-degree lacerations. Ten percent of the graduates felt inadequately trained in perineal repair.\u0000\u0000\u0000CONCLUSION\u0000This survey of fourth-year residents from 47% of obstetric programs indicated that the majority of residents received no formal training in pelvic floor anatomy, episiotomy or perineal repair and, when engaged in such activities, had limited supervision.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114759672","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}
V. Dalton, H. Haefner, B. Reed, S. Senapati, A. Cook
{"title":"Victimization in patients with vulvar dysesthesia/vestibulodynia. Is there an increased prevalence?","authors":"V. Dalton, H. Haefner, B. Reed, S. Senapati, A. Cook","doi":"10.1097/00006254-200302000-00014","DOIUrl":"https://doi.org/10.1097/00006254-200302000-00014","url":null,"abstract":"OBJECTIVE\u0000To examine the prevalence of physical or sexual violence victimization among women referred to a specialty clinic for management of vulvar dysesthesia/vestibulodynia as compared to a healthy gynecology clinic population.\u0000\u0000\u0000STUDY DESIGN\u0000The subjects in this case-control study were women who had completed routine questionnaires prior to presentation to the University of Michigan Center for Vulvar Diseases. Study subjects were all given a diagnosis of vulvar dysesthesia/vestibulodynia. Women without complaints of vulvar pain presenting to a gynecology clinic were enrolled as controls. Information was obtained from the control subjects using a questionnaire similar to the history forms completed by the study group.\u0000\u0000\u0000RESULTS\u0000Comparisons were made between 242 patients with vulvar dysesthesia/vestibulodynia presenting to a specialty clinic and 113 controls. Cases were more likely to be Caucasian, to be married and to have a higher household income than controls but reported less drug or alcohol abuse and a lower frequency of sexual intercourse. After controlling for possible confounders, no relationship between sexual assault and the presence of vulvar dysesthesia/vestibulitis was found.\u0000\u0000\u0000CONCLUSION\u0000The prevalence of victimization was not higher in patients with vulvar dysesthesia/vestibulodynia as compared to the control population after controlling for potential confounding variables.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130756533","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":"Childhood vulvar lichen sclerosus. The course after puberty.","authors":"J. Powell, F. Wojnarowska","doi":"10.1097/00006254-200301000-00013","DOIUrl":"https://doi.org/10.1097/00006254-200301000-00013","url":null,"abstract":"OBJECTIVE\u0000To identify girls with vulvar lichen sclerosus (LS) and to follow them through puberty, documenting the course of the disease.\u0000\u0000\u0000STUDY DESIGN\u0000Twenty-one postpubertal girls were identified from a cohort of 75 girls with LS presenting prepubertally and attending a pediatric vulvar clinic. Details of current symptoms, findings on examination and treatment needs were recorded. A database of 263 women with LS was reviewed for onset of LS premenarche.\u0000\u0000\u0000RESULTS\u0000Of the 21 postpubertal girls, 16 reported an improvement in symptoms, but 11 stated that they still experienced occasional pruritus, requiring intermittent topical steroid application. Although the disorder appeared less active in most cases, definite physical signs persisted in 16 patients (75%); in 5 patients no physical signs of the disease remained. Of 251 postmenopausal women with LS, < 5 could recall symptoms in childhood. Of 12 young adult premenopausal patients with vulvar LS, 4 could recall symptoms in childhood. One of these, a 32-year-old with well-documented LS in childhood resolving at puberty, presented with and died of vulvar squamous cell carcinoma (SCC).\u0000\u0000\u0000CONCLUSION\u0000Patients should be aware that LS may improve symptomatically but usually does not entirely resolve at puberty and that the disease in women may be associated with development of vulvar SCC. Ideally, long-term follow-up should be the standard of care.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"124 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123368626","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":"Correlation between plasma neurotransmitters and memory loss in pregnancy.","authors":"Dhanashri N. Shetty, S. Pathak","doi":"10.1097/00006254-200301000-00002","DOIUrl":"https://doi.org/10.1097/00006254-200301000-00002","url":null,"abstract":"OBJECTIVE\u0000To correlate the levels of plasma neurotransmitters epinephrine, norepinephrine, serotonin and dopamine with memory in healthy, pregnant women.\u0000\u0000\u0000STUDY DESIGN\u0000Fifty healthy, pregnant women were selected in the first trimester and followed in the second and third trimesters of pregnancy. Nonpregnant women served as controls. Epinephrine, norepinephrine, serotonin and dopamine levels were analyzed with high-performance liquid chromatography. The plasma neurotransmitter levels were correlated with memory in each trimester of pregnancy.\u0000\u0000\u0000RESULTS\u0000Significant decreases (P < .001) in plasma epinephrine, serotonin and dopamine were observed in healthy, pregnant women in each trimester of pregnancy when compared to nonpregnant women. A significant increase in plasma norepinephrine was observed in healthy, pregnant women in each trimester of pregnancy. A significant decrease (P < .001) in functional memory was observed in healthy, pregnant women when compared to nonpregnant women.\u0000\u0000\u0000CONCLUSION\u0000Decreases in functional memory and of plasma epinephrine, norepinephrine and serotonin levels in the second trimester of healthy pregnancy suggests that decreased plasma neurotransmitter levels are responsible for loss of functional memory in healthy, pregnant women.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129561312","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}
S. Bai, Jae Sung Lee, Joo Hyun Park, Jeong Yeon Kim, K. Jung, Sei‐Kwang Kim, K. Park
{"title":"Failed methotrexate treatment of cervical pregnancy. Predictive factors.","authors":"S. Bai, Jae Sung Lee, Joo Hyun Park, Jeong Yeon Kim, K. Jung, Sei‐Kwang Kim, K. Park","doi":"10.1097/00006254-200210000-00015","DOIUrl":"https://doi.org/10.1097/00006254-200210000-00015","url":null,"abstract":"OBJECTIVE\u0000To determine the risk factors when primary methotrexate treatment of cervical pregnancy fails.\u0000\u0000\u0000STUDY DESIGN\u0000From January 1985 to December 1999, 32 women with cervical pregnancy were treated with methotrexate intramuscularly according to a repeated intramuscular injection protocol. For evaluation of the efficacy of therapy, pretreatment serum concentrations of human chorionic gonadotropin, size of the gestational mass, fetal cardiac activity and presence of fluid in the peritoneal cavity were measured. These findings were analyzed and compared in terms of success and failure by means of the chi 2 test, Fisher's exact test, receiver operating characteristic curve and Student's t test.\u0000\u0000\u0000RESULTS\u0000There was no relation between the women's age, parity, size of the conceptus or presence of fluid in the peritoneal cavity to the efficacy of treatment. In a cervical pregnancy that presented with a serum human chorionic gonadotropin concentration of > or = 10,000 mIU/mL, fetal cardiac activity was associated with a higher failure rate of primary methotrexate treatment.\u0000\u0000\u0000CONCLUSION\u0000In cervical pregnancies, a high serum human chorionic gonadotropin concentration and fetal cardiac activity were the most important factors associated with failure of treatment using methotrexate.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"01 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130931029","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}
Elizabeth I. O. Garner, E. Lipson, M. Bernstein, D. Goldstein, R. Berkowitz
{"title":"Subsequent pregnancy experience in patients with molar pregnancy and gestational trophoblastic tumor.","authors":"Elizabeth I. O. Garner, E. Lipson, M. Bernstein, D. Goldstein, R. Berkowitz","doi":"10.1097/00006254-200209000-00014","DOIUrl":"https://doi.org/10.1097/00006254-200209000-00014","url":null,"abstract":"Modern therapy for molar pregnancy and gestational trophoblastic tumors has resulted in high cure rates and preservation of fertility, even in the setting of metastatic disease requiring chemotherapy. Patients and their partners facing future pregnancy after treatment for gestational trophoblastic disease express fear related to risk of disease recurrence and outcome of subsequent pregnancies. Data from the New England Trophoblastic Disease Center on later pregnancies following complete and partial mole as well as persistent gestational trophoblastic tumor show that patients, in general, can anticipate normal subsequent pregnancy outcomes.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"143 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124549490","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}