International journal of fertility and menopausal studies最新文献

{"title":"First and second trimester sonography: an American perspective.","authors":"W E Scorza,&nbsp;A Vintzileos","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the United States, first-and second-trimester ultrasonography is most commonly used for gestational dating, detection of fetal aneuploidy, identification of early fetal intrauterine growth restriction (IUGR), and assessment for cervical incompetence. Crown-rump length (CRL) between 7 and 12 weeks is the most accurate parameter for first-trimester dating. In the second trimester, the biparietal diameter, head circumference, transverse cerebellar diameter (TCD), abdominal circumference, femur length, and other long bones, such as tibia and humerus, are useful. The TCD appears to be particularly useful because of its relative sparing in IUGR. Ultrasound can aid in the detection of fetal aneuploidy by identifying structural anomalies or abnormal fetal biometry in the first and second trimester. Numerous structural abnormalities are suggestive of aneuploidy. Cystic hygroma and nuchal translucency appear to be most significant first-trimester markers for fetal aneuploidy. Second-trimester estimated fetal weight (FFW) curves have been developed and are useful in the early detection of IUGR. Second-trimester FFW curves are useful for the detection of trisomy 18 (sensitivity 60%) but not for trisomy 21 (sensitivity 8-12%). Fetal biometry of long bones is also useful in identifying fetuses at risk for aneuploidy. Identification of a second-trimester fetus with either humerus or femur shorter than expected places the fetus at risk for aneuploidy. The sensitivity of short long bone in detection of fetal aneuploidy is approximately 30%, with false positive rates < 5%. Nuchal fold thickness > 6 mm in the second trimester is also used for identifying aneuploid fetuses. The overall sensitivity for the detection of Down's syndrome in fetuses with increased nuchal fold thickness is approximately 34% and the false positive rate is 1.5%. We have developed a model by using an ultrasound examination to adjust the mid-trimester risk for trisomy 21 by combining maternal age or triple screen risk assessment (unconjugated estriol, alpha fetoprotein, and human chorionic gonadotropin) and ultrasound. Using this model, the risk for Down's syndrome is found to be increased with identification of abnormal biometry or anomalies, or decreased with a normal genetic ultrasound examination. Another important application is the use of abdominal and transvaginal ultrasound in the second trimester in pregnancies at risk for premature cervical dilatation, premature delivery, and cervical incompetence. We have found transfundal pressure to be useful in the diagnosis of otherwise clinically inapparent premature cervical dilatation and cervical incompetence.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 3","pages":"288-92"},"PeriodicalIF":0.0,"publicationDate":"1996-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19771293","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":"Hysteroscopic treatment of partial and complete uterine septum.","authors":"R F Valle","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To review the experience with hysteroscopic treatment of uterine septa, particularly those involving the cervix.</p><p><strong>Methods: </strong>One hundred twenty-four patients with septate uterus were treated hysteroscopically. Seven of these women had a uterine septum involving the uterus and cervix. All patients but nine who were infertile had demonstrated repetitive pregnancy losses with nothing to explain the reproductive failure but the uterine septation. The preoperative reproductive performance included 299 pregnancies, of which 258 were spontaneous abortions (86.6%) and 28 preterm pregnancies (9.6%) that resulted in viable infants.</p><p><strong>Results: </strong>Following treatment, 101 patients achieved pregnancy (81.4%). There were 84 term pregnancies (83.1%) and 7 preterm viable pregnancies (6.9%). There were 12 spontaneous abortions, all in the first trimester (11.8%); 23 patients had not become pregnant as yet (18.5%). Of the seven patients with complete uterine septum, including the cervix, six had delivered an infant at term, one by cesarean section at 41 weeks because of breech presentation, and the other five by vaginal delivery at 38, 37 1/2, 39, 40 and 39 weeks.</p><p><strong>Conclusion: </strong>Hysteroscopic treatment of the septate uterus can be extended to practically all types of uterine septa, including those involving the cervix.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 3","pages":"310-5"},"PeriodicalIF":0.0,"publicationDate":"1996-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19771201","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":"Alcohol dependence a growing problem for women. Treating depression in alcoholic patients helps to prevent relapse.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 3","pages":"273-4"},"PeriodicalIF":0.0,"publicationDate":"1996-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19771291","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":"The perimenopause: a critical time in a woman's life.","authors":"P J Sulak","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The interval from the initiation of declining estrogen levels to final ovarian failure usually encompasses many years. The age of onset and duration of this perimenopausal time can vary greatly. While many patients may have minimal to no symptoms as estrogen levels first begin to decrease, most patients will eventually develop symptoms and sequelae as they approach ovarian failure. The consequences of this decline in ovarian function are numerous, and include vasomotor symptoms, declining bone mass, urogenital changes, infertility, irregular uterine bleeding, and psychosexual dysfunction. The women of today entering the perimenopausal period are unique because of their vast numbers, a consequence of the aging of the \"baby boomers.\" Their reproductive history is also different from that of their ancestors in that many have chosen to delay childbearing into their thirties and even forties, and many have elected not to have children. Because of the unique characteristics of this extremely large population of women that are approaching or currently in the perimenopausal period, it is vital that healthcare providers fully understand the variability, consequences, and treatment modalities of this time of declining ovarian function. Risk factors for such common health problems as osteoporosis, heart disease, and cancers must be assessed and managed appropriately. Screening tests including mammography and cholesterol profiles should be offered along with dietary and exercise recommendations. Low-dose oral contraceptive pills and hormone replacement therapy are often effective in preventing and treating many of the common problems encountered during the perimenopausal period.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 2","pages":"85-9"},"PeriodicalIF":0.0,"publicationDate":"1996-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19798568","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":"Medical ethics under managed care.","authors":"P Schwartz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>\"Managed Care\" is having a profound effect on medical ethics and the patient/physician relationship. Historically, the patient (the first party) contracted with a physician (the second party) to provide medical care. The physician had ethical and legal obligations to the patient. In the \"new health care,\" an employer or the government (the fourth party) or infrequently, the patient (the first party) purchases health care from the HMO, PPO, or similar organization (the third party). The third party then contracts with the physician (the second party) to provide that care. The physician has agreed to two, at times competing and possibly immutably conflicting obligations--one to the patient and one to the third party. The ethical and legal problems that arise from conflict between \"the bottom line\" and \"desired\" (appropriate) health care will be difficult to solve. The incompatible duality of physician roles both as patient advocate and manager of limited resources will be further explored, with attention to the enormous pressure being applied to this conflict by society, the law, and the third party. Potential resolutions will be offered. Other ethical problems created by the health care system's conversion to managed care include: CONFIDENTIALITY--Information management is a fundamental underpinning of managed care. With patients switching health care programs frequently, and their enormous size and complexity, careful attention to confidentiality is necessary. INFORMED CONSENT--In addition to informed consent relative to the health care being offered, the patient has a right to know what alternatives might be offered independent of her insurance and payment plan. The patient also has a right to know the economic pressures and arrangements between the second and third parties that could influence the quantity and quality of her health care. QUALITY OF CARE--Managed care contends to be religiously attentive to quality of care. If this is so, the very definition of quality of care may be changing.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 2","pages":"124-8"},"PeriodicalIF":0.0,"publicationDate":"1996-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19796932","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":"Vaginitis: diagnosis and management.","authors":"S Faro","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The various conditions that give rise to vaginitis include specific and nonspecific entities, such as candidiasis, trichomoniasis, bacterial vaginosis, group B streptococcal vaginitis, purulent vaginitis, volvodynia, and vestibulitis. The patient with chronic vaginitis usually develops this condition because of a misdiagnosis. It is critical that patients who have chronic vaginitis be thoroughly evaluated to determine if there is a specific etiology and whether their condition is recurrent or persistent, or is a reinfection. This also must include obtaining a detailed history, beginning with the patient's best recollection of when she felt perfectly normal. The physician must have an understanding of a healthy vaginal ecosystem and what mechanisms are in place to maintain the equilibrium. The vaginal ecosystem is a complex system of micro-organisms interacting with host factors to maintain its equilibrium. The endogenous microflora consists of a variety of bacteria, which include aerobic, facultative and obligate anaerobic bacteria. These organisms exist in a commensal, synergistic or antagonistic relationship. Therefore, it is important to understand what factors control the delicate equilibrium of the vaginal ecosystem, and which factors, both endogenous and exogenous, can disrupt this system. It is also important for the physician to understand that when a patient has symptoms of vaginitis it is not always due to an infectious etiology. There are situations in which an inflammatory reaction occurs but the specific etiology may not be determined. Thus, it is important that the physician not rush through the history or the examination.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 2","pages":"115-23"},"PeriodicalIF":0.0,"publicationDate":"1996-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19796935","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":"Proceedings of the 1st meeting of the World Foundation for Medical Studies in Female Health (WFFH). Carlsbad, California, October 26-29, 1995.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 2","pages":"59-192"},"PeriodicalIF":0.0,"publicationDate":"1996-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19797417","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":"Androgen excess in women.","authors":"R J Derman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>There exists a growing body of evidence in women that links androgen excess to increases in cardiovascular disease and reproductive site neoplasia. Ten to fifteen percent of women exhibit clinical signs and symptoms of hyperandrogenism wherein more extensive evaluation is warranted. Women with adult acne, android-type obesity, and alopecia often have been treated for cosmetic reasons without regard to the underlying pathophysiology. Adverse changes in insulin resistance, lipids, and apoproteins favor earlier progression of diabetes for some patients and an unfavorable cardiovascular risk profile for most. Patients with polycystic ovarian syndrome (PCOS) often present to different health providers with different complaints that include excessive facial hair, obesity, hypertension, impaired glucose tolerance, dysfunctional uterine bleeding, or infertility. First-line treatment options, after excluding ovarian or adrenal tumors, include use of non-androgenic OCs until pregnancy is desired. Early identification of patients allows for use of risk-reduction strategies, which may affect clinical outcomes.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 2","pages":"172-6"},"PeriodicalIF":0.0,"publicationDate":"1996-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19797415","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":"Diabetes mellitus: its impact on women.","authors":"K L Wishner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Diabetes mellitus is a serious chronic illness. It affects approximately 16 million people in the United States, half of whom are undiagnosed. The prevalence of non-insulin-dependent diabetes is higher in women than in men, and more women die each year from diabetes than from breast cancer. Its complications, retinopathy, nephropathy, neuropathy and cardiovascular disease, exact a heavy toll on the individual with diabetes, as well as society. Because of its significant morbidity and mortality in women, diabetes deserves a place in the concerns designated \"women's health issues.\" It deserves more research attention and especially more public awareness, since many of its devastating complications can be prevented by improved detection and control. This review examines the available data concerning the impact of diabetes on women, as well as gender differences in the incidence of diabetes and its complications. It will also discuss life cycle issues which are specific to women.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 2","pages":"177-86"},"PeriodicalIF":0.0,"publicationDate":"1996-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19797416","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":"Long-acting contraceptive options.","authors":"A M Kaunitz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Long-acting contraceptive methods are appropriate choices for women who prefer the convenience and high contraceptive efficacy of methods not requiring frequent compliance, and women for whom contraceptive doses of estrogen are either medically contraindicated or associated with persistent intolerable side effects. Annual pregnancy rates for the three methods described below are less than 1 per 100 woman-years. As currently formulated, levonorgestrel implants (Norplant) consist of six 34 x 2.4 mm soft plastic implants, each filled with 36 mg of crystalline levonorgestrel. Irregular and often persistent menstrual bleeding and spotting constitute the most important side effects experienced by and leading to method discontinuation in implant users. Implant removal is technically more difficult and time-consuming than insertion. Depot-medroxyprogesterone acetate (DMPA or Depo-Provera) is injected as an aqueous suspension of microcrystals. Intramuscular injection of 150 mg of DMPA results in more than 3 months of contraception. Irregular bleeding and spotting followed by amenorrhea, constitute the most importance side effects experienced by DMPA users. Because DMPA use can result in prolonged (but not permanent) infertility, DMPA is not an optimum contraceptive choice for women who may want to conceive in the next one or two years. The Copper T380A intrauterine device (IUD) provides reversible contraception for up to 10 years. IUDs act as contraceptives, not early abortafacients. Recent epidemiologic data indicate that long-term IUD use does not increase the occurrence of pelvic inflammatory disease. Heavier menstrual flow and cramps constitute the main side effects experienced by women using the copper IUD. Intrauterine device insertion and removal are accomplished during brief office-based procedures.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 2","pages":"69-76"},"PeriodicalIF":0.0,"publicationDate":"1996-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19797354","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}