The Journal of reproductive medicine最新文献_第7页

Atypical glandular cells of undetermined significance. Histologic findings and proposed management. 意义不明的非典型腺细胞。组织学表现及建议的处理方法。

The Journal of reproductive medicine Pub Date : 2002-04-01 DOI: 10.1097/00006254-200211000-00015

M. Hammoud, H. Haefner, C. Michael, R. Ansbacher

{"title":"Atypical glandular cells of undetermined significance. Histologic findings and proposed management.","authors":"M. Hammoud, H. Haefner, C. Michael, R. Ansbacher","doi":"10.1097/00006254-200211000-00015","DOIUrl":"https://doi.org/10.1097/00006254-200211000-00015","url":null,"abstract":"OBJECTIVE\u0000To increase understanding of the clinical significance of atypical glandular cells of undetermined significance (AGUS) on cervical cytology and to suggest a management plan.\u0000\u0000\u0000STUDY DESIGN\u0000All Pap smears classified as AGUS over a period of five years at the University of Michigan Medical Center were reviewed and the diagnosis confirmed. The charts of these patients were reviewed for demographics, significant previous medical history, symptoms, diagnostic studies performed and final histologic diagnoses.\u0000\u0000\u0000RESULTS\u0000In 1993-1998, a total of 208,041 Pap smears were read. Two hundred seven smears from 189 patients were classified as AGUS, for an incidence of 0.1%. There were 136 patients with follow-up information and 114 patients with histologic diagnoses. In 55 of the 114 patients (48%), significant histologic abnormalities were observed, including 11 endometrial cancers, 1 invasive adenocarcinoma of the cervix, 3 adenocarcinomas in situ of the cervix, 18 CIN 3 lesions and 5 CIN 2 lesions. Among 20 patients with Pap smears subclassified as \"atypical glandular cells of undetermined significance, favor benign process,\" there were two CIN 2, five CIN 3 and one adenocarcinoma in situ of the cervix.\u0000\u0000\u0000CONCLUSION\u0000A diagnosis of AGUS requires an aggressive workup because of the high rate of cancer and precancerous lesions. The evaluation, at the very least, should include colposcopy with directed biopsies and endocervical curettage. Postmenopausal patients, those with irregular bleeding and those with high risk characteristics should also undergo endometrial biopsy.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124976561","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}

引用次数: 23

Clinical and patient estimation of fetal weight vs. ultrasound estimation. 胎儿体重的临床和患者估计与超声估计。

The Journal of reproductive medicine Pub Date : 2002-03-01 DOI: 10.1097/00006254-200209000-00007

J. D. Baum, D. Gussman, J. Wirth

{"title":"Clinical and patient estimation of fetal weight vs. ultrasound estimation.","authors":"J. D. Baum, D. Gussman, J. Wirth","doi":"10.1097/00006254-200209000-00007","DOIUrl":"https://doi.org/10.1097/00006254-200209000-00007","url":null,"abstract":"OBJECTIVE\u0000To compare clinical and patient estimation of fetal weight to ultrasound estimation.\u0000\u0000\u0000STUDY DESIGN\u0000Prospective study of clinical, patient and ultrasound estimation of fetal weight at term.\u0000\u0000\u0000RESULTS\u0000A total of 200 pregnant women participated. There was no statistically significant difference between clinical and sonographic estimates of fetal weight: of the estimates, 64.0% were within 10% of the actual birth weight vs. 62.5% (P > .2). There was no statistically significant difference between patient and sonographic estimates of fetal weight: of the estimates, 53.5% were within 10% of the actual birth weight vs. 62.5%, respectively (P < .1). Senior resident clinical and sonographic estimates of fetal weight were superior to junior resident estimates: 75.2% of clinical estimates were within 10% of the actual birth weight vs. 59.2% (P < .03), and 73.1% of sonographic estimates were within 10% of the actual birth weight vs. 58.3% (P < .05). Nulliparous and multiparous patients were equally accurate in estimating fetal weight: 48.1% of estimates were within 10% of birth weight vs. 57.4% (P > .2).\u0000\u0000\u0000CONCLUSION\u0000Sonographic estimation of fetal weight offers no advantage over clinical or patient estimation of fetal weight at term. Senior resident clinical and sonographic estimates are superior to junior resident estimates. Parity has no effect on patient accuracy in estimating fetal weight.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116961269","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}

引用次数: 87

U.S. national trends in labor induction, 1989-1998. 美国全国引产趋势，1989-1998年。

The Journal of reproductive medicine Pub Date : 2002-02-01 DOI: 10.1097/00006254-200208000-00011

Jun Zhang, M. Yancey, C. Henderson

引用次数: 110

Preterm delivery and the severity of violence during pregnancy. 早产和怀孕期间暴力的严重程度。

The Journal of reproductive medicine Pub Date : 2001-12-01 DOI: 10.1097/00006254-200206000-00002

D. Covington, M. Hage, Tana Hall, Michele Mathis

{"title":"Preterm delivery and the severity of violence during pregnancy.","authors":"D. Covington, M. Hage, Tana Hall, Michele Mathis","doi":"10.1097/00006254-200206000-00002","DOIUrl":"https://doi.org/10.1097/00006254-200206000-00002","url":null,"abstract":"OBJECTIVE\u0000To determine the severity and consequences of physical violence during pregnancy among participants in a health department prenatal care coordination program.\u0000\u0000\u0000STUDY DESIGN\u0000The prospective cohort study included all program participants from 1994 to 1996. Care coordinators screened participants for physical violence during pregnancy using a validated, systematic assessment protocol three times during prenatal care. The protocol was linked with prenatal records, delivery records and infant records to document complications and infant outcomes. Multiple logistic regression was used to assess the relationship between severe physical violence during pregnancy and pregnancy outcome while controlling for confounding factors.\u0000\u0000\u0000RESULTS\u0000Among the 550 participants, 13.5% reported violence during pregnancy; it included 6.7% severe violence (hitting, kicking, injury with a weapon and abdominal injury) and 6.7% moderate violence (threats, slapping, shoving and sexual abuse). Severe physical prenatal violence was significantly associated with spontaneous preterm labor, preterm delivery, very preterm delivery, very low birth weight, preterm/low birth weight, mean birth weight, mean newborn hospital charges, five-minute Apgar < 7, neonatal intensive care unit admission, and fetal or neonatal death. Body site injured, timing of violence and number of violent incidents were significant factors associated with violence during pregnancy and preterm delivery.\u0000\u0000\u0000CONCLUSION\u0000Because severe physical violence during pregnancy was a significant problem in this population, intervention programs are needed to reduce prenatal violence and its consequences.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127399158","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}

引用次数: 65

Obstetrician-gynecologists' views on the health risks of obesity. 妇产科医生对肥胖健康风险的看法。

The Journal of reproductive medicine Pub Date : 2001-11-01 DOI: 10.1097/00006254-200204000-00015

M. Power, G. Holzman, J. Schulkin

{"title":"Obstetrician-gynecologists' views on the health risks of obesity.","authors":"M. Power, G. Holzman, J. Schulkin","doi":"10.1097/00006254-200204000-00015","DOIUrl":"https://doi.org/10.1097/00006254-200204000-00015","url":null,"abstract":"OBJECTIVE\u0000To assess the knowledge and opinions of obstetrician-gynecologists concerning the health risks of obesity and the importance of weight management of patients to clinical practice.\u0000\u0000\u0000STUDY DESIGN\u0000A questionnaire survey covering physician and patient demography, disease risk related to obesity, relevance of weight management to patient's health, and self-assessments of medical education and training was sent to the 418 American College of Obstetricians and Gynecologists (ACOG) fellows who constitute the Collaborative Ambulatory Research Network and to 700 ACOG fellows selected at random.\u0000\u0000\u0000RESULTS\u0000Five hundred twenty-five surveys were returned (47.0% response rate). Membership in the network was not a significant factor regarding responses; therefore, the data were pooled. Respondents estimated that 20.6 +/- 0.5% of their patients were obese and that a further 35.9 +/- 0.8% were overweight. The respondents were knowledgeable concerning health risks associated with obesity, and a majority considered obesity to be a major health concern that should be treated. Weight management was considered an important or very important part of practice by 81.5% of respondents. Almost half the respondents (45.5%) thought that the importance of weight management would increase. More than one of three responding physicians (36.4%) had prescribed weight loss medications in the previous year. Most responding physicians did not consider medical school or residency to be sources of information on these issues.\u0000\u0000\u0000CONCLUSION\u0000Obstetrician-gynecologists think that managing the weight of their patients is part of their clinical responsibilities but do not consider their training in medical school and residency on these topics to be adequate.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117218115","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}

引用次数: 27

Accidental vaginal incision during cesarean section. A report of four cases. 剖宫产术中意外阴道切口。四例报告。

The Journal of reproductive medicine Pub Date : 2001-11-01 DOI: 10.1097/00006254-200204000-00003

L. Gortzak-Uzan, A. Walfisch, Y. Gortzak, M. Katz, M. Mazor, M. Hallak

{"title":"Accidental vaginal incision during cesarean section. A report of four cases.","authors":"L. Gortzak-Uzan, A. Walfisch, Y. Gortzak, M. Katz, M. Mazor, M. Hallak","doi":"10.1097/00006254-200204000-00003","DOIUrl":"https://doi.org/10.1097/00006254-200204000-00003","url":null,"abstract":"BACKGROUND\u0000Transverse vaginal incision during cesarean section, also known as anterior vaginotomy, is a recognized entity, mostly made unintentionally.\u0000\u0000\u0000CASES\u0000At our institution, four patients underwent a transverse vaginal incision during cesarean section over an eight-year period. In three of them, excessive bleeding required blood transfusion. In one case, only hypogastric artery ligation resulted in bleeding control. None of the patients had subsequent vaginal deliveries.\u0000\u0000\u0000CONCLUSION\u0000The exact incidence of anterior vaginotomy is difficult to evaluate. Accidental vaginal incision occurs mostly following a prolonged second stage of labor but is possible during the first stage. Risk factors include prolonged second stage of labor and an emergency setup. Reported complications resulting from anterior vaginotomy include excessive hemorrhage, with a possible need for hysterectomy, difficult approximation, and bladder or ureter injury. Massive bleeding and multiple blood transfusions occurred in our series as well. Fetal outcome and future obstetric behavior do not seem to be compromised. A high index of suspicion is essential when trying to avoid accidental anterior vaginotomy. Meticulous hemostasis, a search for bladder injury and anatomic closure are mandatory when managing this complication.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"46 11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131375467","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}

引用次数: 6

Pyometra. What is its clinical significance? 子宫积脓。其临床意义是什么?

The Journal of reproductive medicine Pub Date : 2001-11-01 DOI: 10.1097/00006254-200203000-00013

L. Chan, T. Lau, S. Wong, P. Yuen

{"title":"Pyometra. What is its clinical significance?","authors":"L. Chan, T. Lau, S. Wong, P. Yuen","doi":"10.1097/00006254-200203000-00013","DOIUrl":"https://doi.org/10.1097/00006254-200203000-00013","url":null,"abstract":"OBJECTIVE\u0000To evaluate the clinical outcomes of pyometra.\u0000\u0000\u0000STUDY DESIGN\u0000Retrospective study conducted between 1993 and 1999 in two regional hospitals.\u0000\u0000\u0000RESULTS\u0000Pyometra represented 0.038% of gynecologic admissions. Of the 27 women with pyometra, 6 (22.2%) cases were associated with malignancy, 1 (3.7%) was associated with genital tract abnormality, and 20 (74.1%) were idiopathic. Patients with idiopathic pyometra tended to be older and had a higher incidence of concurrent medical conditions. Five (18.5%) women experienced spontaneous perforation of pyometra. A preoperative diagnosis was correctly made in 17 of 22 (77.3%) patients without spontaneous perforation. Most women were treated with dilatation of the cervix and drainage. Nine women (33.3%) had persistent or recurrent pyometra; three of them were asymptomatic.\u0000\u0000\u0000CONCLUSION\u0000Pyometra is an uncommon condition, but the incidence of associated malignancy is considerable, and the risk of spontaneous perforation is higher than previously thought. Dilatation and drainage is the treatment of choice, and regular monitoring after initial treatment is warranted to detect persistent and recurrent disease.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115257598","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}

引用次数: 78

Clinical pathway for evaluating women with abnormal uterine bleeding. 评价女性子宫异常出血的临床途径。

The Journal of reproductive medicine Pub Date : 2001-09-01 DOI: 10.1097/00006254-200201000-00012

T. Dunn, C. Stamm, M. Delorit, G. Goldberg

{"title":"Clinical pathway for evaluating women with abnormal uterine bleeding.","authors":"T. Dunn, C. Stamm, M. Delorit, G. Goldberg","doi":"10.1097/00006254-200201000-00012","DOIUrl":"https://doi.org/10.1097/00006254-200201000-00012","url":null,"abstract":"OBJECTIVE\u0000To devise a clinical pathway for evaluating women with abnormal uterine bleeding.\u0000\u0000\u0000STUDY DESIGN\u0000One thousand women with the complaint of abnormal uterine bleeding were enrolled. All would have undergone endometrial biopsy based on older recommendations. The patients followed a clinical pathway to determine if an endometrial biopsy was necessary. The pathway divided women into the categories of premenopausal, postmenopausal, low risk and high risk. If one risk factor was present, the patient underwent endometrial biopsy. If there were no risk factors, the patient continued down the pathway with medical therapy.\u0000\u0000\u0000RESULTS\u0000Five hundred seventy endometrial biopsies were performed. Five cases of endometrial cancer and three of complex atypical hyperplasia, both in the postmenopausal, high-risk group, were discovered. Subsequent reviews revealed that no cases of endometrial cancer were missed or developed in the two years following the initial complaint.\u0000\u0000\u0000CONCLUSION\u0000Utilization of a clinical pathway reduced the number of endometrial biopsies by 50%. The introduction of clinical pathways at our institution was done successfully in the evaluation of abnormal uterine bleeding.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124487309","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}

引用次数: 13

Failed vacuum extraction. Maternal risk factors and pregnancy outcome. 真空抽吸失败。产妇危险因素与妊娠结局。

The Journal of reproductive medicine Pub Date : 2001-09-01 DOI: 10.1097/00006254-200203000-00009

E. Sheiner, I. Shoham-Vardi, T. Silberstein, M. Hallak, M. Katz, M. Mazor

{"title":"Failed vacuum extraction. Maternal risk factors and pregnancy outcome.","authors":"E. Sheiner, I. Shoham-Vardi, T. Silberstein, M. Hallak, M. Katz, M. Mazor","doi":"10.1097/00006254-200203000-00009","DOIUrl":"https://doi.org/10.1097/00006254-200203000-00009","url":null,"abstract":"OBJECTIVE\u0000To evaluate obstetric risk factors associated with a failed trial of vacuum extraction and to assess its pregnancy outcome.\u0000\u0000\u0000STUDY DESIGN\u0000All attempted vacuum extractions between the years 1990 and 1998 were identified, and a comparison of successful and failed trials of vacuum extraction in singleton, vertex deliveries was performed.\u0000\u0000\u0000RESULTS\u0000Of 2,111 trials of vacuum extraction, 113 (5.4%) cases were complicated by failed extraction and underwent cesarean section. Those neonates were significantly more likely to be large for gestational age, specifically to weigh > 4,000 g as compared to the controls. Patients lacking prenatal care had significantly higher rates of failed vacuum extraction trials. While cervical and uterine tears were rather rare, parturients who had failed trials of vacuum extraction had significantly higher rates of cervical and uterine tears as compared to those with successful vacuum extractions. This association remained significant after controlling for a previous cesarean section using the Mantel-Hanszel technique. Women from the failed vacuum extraction group had significantly higher rates of postpartum anemia. Pregnancies complicated by failed vacuum extraction had significantly higher rates of intrapartum and postpartum fetal death. Those neonates had significantly higher rates of Apgar scores < 7 at one and five minutes.\u0000\u0000\u0000CONCLUSION\u0000Failed trial of vacuum extraction is associated with adverse maternal and fetal outcomes. Risk factors associated with such failures are fetal weight and lack of prenatal care. Thus, careful estimation of fetal weight should be performed before the procedure, and estimated fetal weight > 4,000 g might be considered a relative contraindication to vacuum extraction, especially among patients who did not have prenatal care.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116560748","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}

引用次数: 46

Prevalence of metronidazole-resistant Trichomonas vaginalis in a gynecology clinic. 妇科门诊耐甲硝唑阴道毛滴虫的流行情况。

The Journal of reproductive medicine Pub Date : 2001-06-01 DOI: 10.1097/00006254-200111000-00015

G. Schmid, E. Narcisi, D. Mosure, W. Secor, Joel C. Higgins, H. Moreno

{"title":"Prevalence of metronidazole-resistant Trichomonas vaginalis in a gynecology clinic.","authors":"G. Schmid, E. Narcisi, D. Mosure, W. Secor, Joel C. Higgins, H. Moreno","doi":"10.1097/00006254-200111000-00015","DOIUrl":"https://doi.org/10.1097/00006254-200111000-00015","url":null,"abstract":"OBJECTIVE\u0000To determine the prevalence of in vitro resistance to metronidazole among unselected isolates of Trichomonas vaginalis and correlate in vitro findings with response to metronidazole therapy.\u0000\u0000\u0000STUDY DESIGN\u0000Vaginal fluid from women attending a gynecology clinic at an urban hospital was cultured, isolates were tested for in vitro resistance to metronidazole, and these results were correlated with therapeutic outcome.\u0000\u0000\u0000RESULTS\u0000Among 911 women, T vaginalis was detected by culture in 82 (9.0%). Of the 82 isolates, 2 (2.4%; 95% CI, 0.3-8.5%) had low-level in vitro resistance (minimum lethal concentration, 50 micrograms/mL). Women with positive wet mount examinations were treated with metronidazole, 2 g, once and asked to return in one week. Of the 42 infected women agreeing to return for a repeat examination and culture, 26 (61.9%) did, and all (including one woman with a resistant isolate) were cured.\u0000\u0000\u0000CONCLUSION\u0000Isolates of T vaginalis resistant to metronidazole occur widely throughout the United States. Although the in vitro susceptibility of T vaginalis to metronidazole has been very poorly studied, our study is consistent with a decade-old prevalence estimate of in vitro resistance (5%), and suggests that high-level resistance is uncommon. This study confirmed, in the absence of reinfection, the continuing clinical effectiveness of single-dose metronidazole for the large majority of trichomoniasis cases.","PeriodicalId":192418,"journal":{"name":"The Journal of reproductive medicine","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123643125","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}

引用次数: 107