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Consecutive Women (consecutive + woman)
Selected AbstractsDepression and Altered Quality of Life in Women with Epilepsy of Childbearing AgeEPILEPSIA, Issue 1 2004Ettore Beghi Summary: Purpose: To calculate the prevalence of depression in a referral population of women of childbearing age, to define the factors associated with depression, and to assess health-related quality of life (HRQOL) in the same population. Methods: The 642 consecutive women with epilepsy aged 18,55 years were enrolled by 40 neurologists over an 8-month period and asked to give details on selected demographic and clinical features regarding the disease, any associated clinical condition, and any drug treatment. Depression was diagnosed by using the Hamilton depression scale and HRQOL was measured through the SF-36 form. Demographic, clinical, and therapeutic risk factors for depression were searched for within the study population. Results: Depression (any severity) was present at interview in 242 women, giving a prevalence rate of 37.7%[95% confidence interval (CI), 33.9,41.6]. Mild depression was reported by 18.5% of women, moderate depression by 8.6%, major depression by 10.3%, and severe depression by 0.3%. Factors found to be independently associated with depression (any severity) included treatment of associated conditions [relative risk (RR), 1.5; 95% CI, 1.2,1.8), concurrent disability (RR, 1.3; 95% CI, 1.0,1.6), seizures in the preceding 6 months (RR, 1.4; 95% CI, 1.1,1.7), and being unemployed or a housewife (RR, 1.3; 95% CI, 1.0,1.5). Factors associated with moderate to severe depression included treatment for associated conditions (RR, 2.0; 95% CI, 1.4,2.7), seizures in the preceding 6 months (RR, 1.7; 95% CI, 1.2,2.5), and being unemployed or a housewife (RR, 1.6; 95% CI, 1.1,2.2). Compared with normal women of similar age, patients with epilepsy tended to present lower scores for each HRQOL domain (mostly Role Physical, General Health, Social Functioning, and Role Emotional). However, when the analysis was limited to nondepressed women with epilepsy, any difference disappeared. Conclusions: Women with epilepsy of childbearing age are at high risk of depression. Factors associated with depression include lack of occupation, the presence of an underlying disabling condition (with treatment), and the severity of epilepsy. Compared with the general population, depressed women have greater impairment of HRQOL with epilepsy, which reflects the physical, social, and emotional implications of the disease. [source] Antithrombin plasma levels decrease is associated with preeclampsia worseningINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 2 2009M. MARIETTA Summary Antithrombin plasma levels (AT) have been found decreased in women with preeclampsia (PE), but little is known about the trend of AT during the course of this disease. We prospectively investigated AT in consecutive women admitted to our hospital with a diagnosis of PE, to assess if AT fluctuations could be associated with the evolution of the disease. AT, platelet count and d -dimer levels were determined every other day. In the 73 patients studied, AT, platelet count and fibrinogen progressively reduced during the observational period, reaching a nadir on the day of delivery, whereas d -dimer progressively increased over time. Statistical analysis was restricted to the 39 women that had an AT measurement performed on each of days ,1, 0 and +1, with respect to the day of delivery. These subjects showed a significant decrease in AT on the day of delivery compared to the day just before (77.8 ± 15.1%vs. 85.4 ± 14.2%, P = 0.027), followed by a recovery on the first day after delivery (87.6 ± 21.3% from 77.8 ± 15.1%, P = 0.005). Our study demonstrates that a significant drop in AT levels is associated with the clinical worsening of PE, regardless of its severity. [source] Clinical pathway for tension-free vaginal mesh procedure: Evaluation in 300 patients with pelvic organ prolapseINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2009Kumiko Kato Objectives: To evaluate a clinical pathway of discharge on postoperative day 3 for the tension-free vaginal mesh (TVM) procedure in patients with pelvic organ prolapse (POP). Methods: Between May 2006 and December 2007, 305 consecutive women with POP quantification stage 3 or 4 were planned to undergo the TVM procedure in a single general hospital. Excluding five patients with concomitant hysterectomy, a pathway (removal of the indwelling urethral catheter on the next morning, discharge on postoperative day 3) was applied to the remaining 300 patients. The perioperative complications and postoperative hospitalization were prospectively evaluated in this case series. Results: Perioperative complications were: bladder injury (11 cases, 3.7%), vaginal wall hematoma (two cases, 0.7%), rectal injury (one case, 0.3%) and temporary hydronephrosis (one case, 0.3%). None needed blood transfusion. The indwelling urethral catheters were removed on the next morning as in the pathway in 287 cases (95.6%), and none required clean intermittent catheterization at home. Postoperative hospitalization was within 3 days in 280 cases (93.3%). The six cases (2.0%) with longer hospitalization were due to complications (two cases of bladder injury, one of rectal injury, one of blood loss over 200 mL, one of temporary urinary retention, and one of hydronephrosis). Two patients were re-hospitalized within one month due to vaginal bleeding or gluteal pain. Conclusions: Patients generally accepted the pathway of discharge on postoperative day 3 in spite of the Japanese culture preferring a longer hospital stay. [source] Color doppler imaging in the sonohysterographic diagnosis of residual trophoblastic tissueJOURNAL OF CLINICAL ULTRASOUND, Issue 4 2002Yaron Zalel MD Abstract Purpose The purpose of this study was to evaluate the role of color Doppler imaging during sonohysterography in the diagnosis of residual trophoblastic tissue. Methods This prospective cohort study involved 25 consecutive women with clinical and sonographic signs of an echogenic intrauterine mass who were referred to the sonography unit of our institution for evaluation. All women underwent saline infusion sonohysterography with color Doppler sonographic evaluation. An operative hysteroscopy with histologic examination was performed in 17 cases. Results Thirteen women (group A) had sonohysterographic features suggestive of residual tropho- blastic tissue (ie, an echogenic intrauterine lesion not detached from the uterine wall after introduction of saline). The initial diagnosis was confirmed by histologic analysis in all cases. Blood flow was detected within the intrauterine mass in 6 (46%) of these 13 women; the resistance indices were low in all 6 cases (mean ± standard error, 0.38 ± 0.01). Twelve women (group B) had sonohysterographic findings negative for retained tissue, and no blood flow was detected within any of the intrauterine masses in this group (p < 0.05). Conclusions Our results confirm the potential role of color Doppler sonography in the initial diagnosis of residual trophoblastic tissue. The detection of color Doppler signals, especially with low-resistance flow, within an intrauterine lesion should increase the confidence of the sonologist in the diagnosis of residual trophoblastic tissue. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30: 222,225, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.10059 [source] Menopausal asthma: a new biological phenotype?ALLERGY, Issue 10 2010M. P. Foschino Barbaro To cite this article: Foschino Barbaro MP, Costa VR, Resta O, Prato R, Spanevello A, Palladino GP, Martinelli D, Carpagnano GE. Menopausal asthma: a new biological phenotype? Allergy 2010; 65: 1306,1312. Abstract Background:, Female hormones play an important role in women's lung health, especially in asthma pathophysiology. Although a growing interest has recently been aroused in asthma related to short-term reproductive states, menopausal asthma has been little studied in the past. The aim of the present study was to explore airway inflammation in menopausal asthmatic women in a noninvasive manner. Methods:, Forty consecutive women with menopausal asthma, 35 consecutive women with premenopausal asthma and 30 age-matched healthy controls were enrolled in the study. Urinary LTE-4, induced sputum inflammatory cells, and exhaled LTE-4, IL-6, pH, and NO levels were measured in all the subjects enrolled. Results:, Women with menopausal asthma showed decreased estradiol concentrations, high sputum neutrophils, and exhaled IL-6. Women with premenopausal asthma presented instead an essentially eosinophilic inflammatory pattern. Higher urine and breath condensate LTE-4 concentrations were found in premenopausal and menopausal asthma compared to controls. Conclusion:, Our results substantiate the existence of a new biological phenotype of menopausal asthma that is mainly characterized by neutrophilic airways inflammation and shares several characteristics of the severe asthma phenotype. [source] Midurethral sling procedures for stress urinary incontinence in women over 80 years,,NEUROUROLOGY AND URODYNAMICS, Issue 7 2010Kobi Stav Abstract Aims To compare the safety and efficacy of midurethral sling surgery for management of urinary stress incontinence in women over 80 years versus younger women. Methods 1225 consecutive women with urodynamic stress incontinence had a synthetic midurethral sling (955 retropubic, 270 transobturator) at our institution between 1999 and 2007. Ninety one percent (n,=,1112) of the patients were interviewed via phone call with a structured questionnaire and were included in the analysis. The mean follow-up was 50,±,24 months (range 12,114). Comparison between elderly (,80 years, n,=,96) and younger patients (<80 years, n,=,1016) was performed. Results The overall subjective cure rate was 85% (elderly 81%, younger 85%, ,=,0.32). There was no significant difference in cure rate between retropubic and transobturator sling in the elderly group (82% vs. 79.3%, P,=,0.75). The bladder perforation rate was similar between the two groups (3%). The hospitalization time was significantly longer in the elderly (1.6,±,1.7 days vs. 0.7,±,1.1 days, P<0.001). However, major perioperative complications were uncommon (1%). Of the patients who had an isolated sling procedure, 37% of the elderly and 9% of the young patients failed their 1st trial of void (P,<,0.001). However, the long-term rate of voiding difficulty was similar between the two groups (elderly 8% vs. young 6%, P,=,0.21). The rate of de novo urge incontinence was similar between the two groups (7%). Conclusion Retropubic and transobturator slings in women older than 80 years are effective and safe but are associated with an increased risk of transient postoperative voiding difficulty. Neurourol. Urodynam. 29:1262,1266, 2010. © 2010 Wiley-Liss, Inc. [source] Post void dribbling: Incidence and risk factors,NEUROUROLOGY AND URODYNAMICS, Issue 3 2010Tova Ablove Abstract Aims The primary aim of this study was to determine the incidence of post void dribbling (PVD) in women being evaluated for pelvic floor dysfunction. The secondary aim was to identify other conditions present in women with symptoms of PVD. Materials and Methods 163 consecutive women with complaints of PVD who underwent urodynamic testing were studied. Testing was performed to evaluate women scheduled for surgery for incontinence, irritative bladder, urinary retention and pelvic organ prolapse. Subjects completed a medical history and voiding diary. A complete pelvic exam was performed. Patients were questioned regarding symptoms of PVD, stress incontinence, urge incontinence and insensible urine loss. Menopausal status, hormone replacement therapy status, age, body mass index, residual urine volume, genital hiatus length, and evidence of pelvic organ prolapse were recorded. Maximal urethral closure pressure, urethral length, pressure transmission ratio, and documentation of detrusor overactivity or urodynamic stress incontinence were determined by urodynamic testing. Results 42% of patients had symptoms of PVD. The incidence of PVD decreased with age. In pre- and peri-menopausal women, there was an association between PVD and urge incontinence. In post-menopausal women, there was an association between age, body mass index, and genital hiatus length. Conclusions There was a significant correlation between PVD and urge incontinence in pre-menopausal patients. The overall incidence and causes of PVD relative to age require further study. Body mass index and genital hiatus length may play an important role in PVD, especially in post-menopausal women. Neurourol. Urodynam. 29:432,436, 2010. © 2009 Wiley-Liss, Inc. [source] Patient reported and anatomical outcomes after surgery for pelvic organ prolapse,,NEUROUROLOGY AND URODYNAMICS, Issue 3 2009Ahmed S. El-Azab Abstract Aim Primary aim was to modify Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) to assess pelvic organ prolapse (POP) in Arabic Muslim women. Secondary aim was to compare functional and anatomical outcomes of POP repair. Methods Questionnaire. A characteristic (prayer) was added to PFIQ. Linguistic validation of questionnaires was then done. Twenty cases were enrolled in a pilot study to test internal consistency and reliability. Subsequent study. Prospective study included women with symptomatic POP,,,stage II. History, examination by POP-Q, and administration of PFDI and PFIQ, were done before and 6 months after surgery. Results Questionnaire. Internal consistency of added question was good (Cronbach ,,=,0.78). Test,retest reliability of individual PFIQ items was variable. Subsequent Study. Between September 2004 and February 2007, 78 consecutive women were included. Cystocele, rectocele, and no site predominated in 74.4%, 17.9% and 7.7% of cases, respectively. Preoperatively 19.2%, 15.4% and 47.4% reported stress, urge, and mixed incontinence, respectively. Overall and individual urinary symptoms scores improved significantly after surgery. There were significant improvements in individual symptoms of constipation, splint to defecate and losing not well formed stools. Low self-esteem was most negative impact of prolapse on quality of life (QoL) followed by prayer. After surgery 90% of subjects had anatomical cure. After surgery, QoL issues are significantly related to anatomic location of prolapse as determined by POP-Q. Conclusions Modified PFIQ and PFDI are suitable to assess POP among Muslim women. Postoperatively, many prolapse-related symptoms and QoL significantly improve after surgery on the short term with an anatomic cure rate of 90%. Neurourol. Urodynam. 28:219,224, 2009. © 2008 Wiley-Liss, Inc. [source] Are psychotropics drugs used in pregnancy?,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 9 2007Carlos De las Cuevas Abstract Purpose To assess the prevalence and characteristics of psychiatric drug use in pregnancy. Methods A prospective observational study was performed on a total of 1332 consecutive women admitted for delivery, during a 3 months period, in the public obstetric services of Tenerife Island (covering a population of 1,000,000 inhabitants). Results Less than 4% (3.6%) of the women recognised having a psychiatric disorder, and only 2.5% were receiving psychiatric drug treatment at the moment they knew they were pregnant; of those, 68.7% introduced substantial modifications in their treatment at that moment, 47.9% did not report any change with respect to the period before pregnancy and 35.4% recognised that their mood was worse than previously. Although patients affected by a psychiatric disorder registered a higher rate of abdominal delivery, no differences in delivery or obstetric complications were found between women with and without psychiatric illness or in relation to psychiatric drug treatment. Conclusions Compared to the literature, the studied population shows a lower rate of psychiatric problems and pharmacological treatment. This might reflect underrecognition or undertreatment. Copyright © 2007 John Wiley & Sons, Ltd. [source] Beginning IVF Treatments After Age 30 Increases the Risk of Breast Cancer: Results of a Case,Control StudyTHE BREAST JOURNAL, Issue 6 2008Daniela Katz MD Abstract:, The long-term risks of in vitro fertilization (IVF) treatment remain unclear. This study was designed to determine breast cancer risk factors in women who underwent IVF, and to establish characteristics of these tumors. Records of 7,162 consecutive women who underwent IVF at a single center between 1984 and 2002 were linked with the Israel Cancer Registry to identify women who developed breast cancer. IVF-related parameters were compared between 28 breast cancer patients who had undergone IVF (IVF BC) and for whom complete IVF data were available with 140 women who underwent IVF and did not develop breast cancer (IVF non-BC). Tumor parameters were compared between 38 patients who developed breast cancer after IVF and 114 age-matched breast cancer patients who did not undergo IVF (non-IVF BC). Age over 30 at the time of first IVF treatment, even after controlling for age at first birth, was the only parameter significantly associated with increased breast cancer risk (RR = 1.24, p = 0.02, 95% CI = 1.03,1.48). There were no differences between IVF-BC and IVF non-BC patients in all other IVF-related parameters. The only statistically significant difference in tumors developing in IVF-BC patients compared with non-IVF BC patients was in grade distribution, particularly for grade II tumors. However, the significance of such a difference is unclear. Women who start IVF after the age of 30 appear to be at increased risk of developing breast cancer. The characteristics of breast tumors in women who underwent IVF are no different than in patients without previous exposure to IVF. [source] A randomised controlled trial of two instruments for vacuum-assisted delivery (Vacca Re-Usable OmniCup and the Bird anterior and posterior cups) to compare failure rates, safety and use effectivenessAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010Glen D.L. MOLA Background:, Most previous trials of vacuum-assisted delivery have been in settings with high rates of instrumental vaginal delivery (8,12%) and high rates of failure to deliver with the intended instrument (20,30%). Over the past 20 years, vacuum-assisted delivery rates at the Port Moresby General Hospital have been 3,4% with failure rates of <3%. Objective:, The objective is to compare the failure rates of two vacuum extractor instruments, the Vacca Re-Usable Omnicup and the Bird Vacuum delivery system (anterior and posterior cups). Setting:, Port Moresby General national referral and teaching Hospital (PMGH), Papua New Guinea. Population:, Two hundred consecutive women requiring assisted delivery, June,December, 2007. Methods:, When a woman required an assisted delivery, she was randomised into either the Vacca Re-Usable Omnicup (Clinical Innovations Inc.) or Bird anterior or posterior metal cup (depending upon the position of the vertex). One hundred women were randomised to each vacuum device. Statistical analysis was on ,an intention-to-treat' basis. Main outcome measures:, The main outcome measure was the successful completion of the delivery with the allocated instrument. Secondary outcomes were maternal trauma (episiotomy and trauma to the maternal genital tract), significant scalp trauma (sub-galeal haemorrhage or serious abrasion) and fetal and neonatal outcomes (Apgar score less than seven at 5 minutes, days spent in the Special Care Nursery and neonatal death). Results:, Failure rates for both Omnicup (2/100) and Bird metal cups (6/100) were not statistically different (RR 1.05, 95% CI 0.99,1.12; P = 0.17). Rates of maternal trauma and fetal scalp trauma were similar in both groups. Conclusion:, Both the Vacca re-useable Omnicup and the Bird metal cups are very effective instruments to achieve successful assisted delivery and equally so. Failures and problems were associated with not applying the vacuum cup to the flexion point on the fetal scalp and the mechanical faults with vacuum equipment devices. [source] Long-term outcomes of patients who failed to attend following midurethral sling surgery , A comparative study and analysis of risk factors for non-attendanceAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010Kobi STAV Background and aims:, To assess long-term subjective cure and subjective complication rates of women who underwent midurethral sling (MUS) for stress urinary incontinence (SUI) in those who failed to attend (FTA) versus those who attended for postoperative follow-up. Predictive factors for non-attendance were identified. Methods:, A total of 1225 consecutive women with urodynamic SUI had a synthetic MUS at our institution between 1999 and 2007. Patients were interviewed via phone call with a structured questionnaire. Comparison between FTA and non-FTA patients was performed and multivariate analysis was utilised to identify risk factors for non-attendance. Results:, Univariate analysis revealed that the FTA rate was lower in patients who underwent concomitant prolapse surgery (29% vs. 84%, P < 0.001), FTA patients were younger (mean age 56 vs. 67 years, P < 0.001) and more depressed (14% vs. 4%, P < 0.05). At a mean follow-up of 50 ± 24 months, the subjective cure rate was similar between the two groups (84% vs. 86%, NS). The incidence of overactive bladder symptoms was significantly higher in the non-FTA patients (34% vs. 6%P < 0.001). Isolated sling procedure (OR = 2.71, P < 0.01) and age <50 years (OR = 3.15, P < 0.05) were significant predictors for failed attendance. Conclusions:, Our results indicate that the subjective cure rate is similar between non-FTA and FTA patients subsequent to a MUS procedure. However, the rate of overactive bladder symptoms is higher in the non-FTA patients. Isolated MUS procedure and younger age are significant risk factors of failure to attend in the longer term. [source] Women who miscarry: The effectiveness and clinical utility of the Kessler 10 questionnaire in screening for ongoing psychological distressAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Helen M. STALLMAN Background:, Early pregnancy loss has been linked to enduring psychological morbidity. Aims:, This study aimed to investigate the utility of the Kessler 10 (K10) questionnaire as a brief screening instrument to identify women at risk for the development of psychiatric diagnoses three months post-miscarriage. Method:, Participants were 117 consecutive women presenting at a public hospital emergency department and receiving a diagnosis of miscarriage. Main outcome measures:, K10 screen for psychological distress and the Structured Clinical Interview for DSM Disorders to determine psychiatric diagnoses. Results:, A majority of women (81.2%) experienced elevated levels of distress initially, 24.8% in the very high range. They were not at increased risk of psychiatric diagnoses at three months compared with the general population; however, they were significantly more likely to report subsyndromal symptoms at this time compared with the general population. The baseline K10 score was the only significant predictor of distress at follow-up (r = 0.45, P < 0.001). The receiver operating characteristic curve shows that a cut-off of 14 on the K10 has suitable sensitivity (97%) and specificity (82%) for predicting ongoing psychological distress in women who miscarry. Conclusions:, The K10 is effective in identifying women at risk for ensuring psychological symptoms following miscarriage. [source] The prevalence and significance of high-risk human papillomavirus DNA test in southern Malaysia and SingaporeAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2009Sun-Kuie TAY Aim of Study: To investigate the prevalence of high-risk human papillomavirus (HPV) and its associated cytological abnormalities among women attending cervical screening clinics in southern Malaysia and Singapore. Method: Laboratory results of Hybrid Capture-II (Digene) HPV DNA and liquid-based cytology tests of consecutive women who had screening performed between January 2004 and December 2006 were studied retrospectively. Results: Of 2364 women studied, the overall prevalence of high-risk HPV DNA detection rate was 25.6%. The prevalence peaked at 49.1% for women between 20 and 24 years old and declined to 23% among women between the age of 30 and 49 years. A small second peak of prevalence rate of 30% was observed among women above the age of 50 years old. 76.1% of the high-risk HPV infection regressed within the study period. An incidence infection rate of 16% was noted among a small group of women who had a second HPV DNA test. A total of 1153 women had both the HPV DNA and the cytology tests. Cytological abnormality (ASCUS or more) was detected in 8.9% in HPV DNA-positive group and in 3.1% in HPV DNA-negative group (P < 0.001). The risk ratio for HSIL was 9.8 for HPV-positive women compared to HPV-negative women. The prevalence of cytological abnormalities increased with increasing age of the women. Conclusion: The epidemiology and clinical impact of high-risk HPV infection for women in Southern Malaysia and Singapore were indistinguishable from experience elsewhere. The apparent moderately high incidence of cervical cancer was explainable by suboptimal screening program. [source] Routine investigations might be useful in pre-eclampsia, but not in gestational hypertensionAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2005David J. BAILEY Abstract Background:, Women referred to secondary care with suspected pregnancy-induced hypertension (PIH) are commonly investigated with blood tests and cardiotocography (CTG), regardless of the clinical severity of their condition. Over-investigation might lead to inappropriate intervention. Aims:, To investigate how often abnormal blood test and CTG results occur in women with pre-eclampsia and gestational hypertension and in women who do not have pregnancy-induced hypertension. Methods:, Retrospective case note review of 526 consecutive women referred with suspected pregnancy-induced hypertension to a district hospital. The frequency of abnormal test results and the pregnancy outcomes were analysed according to clinical classification. Results:, 36% of women referred did not meet the clinical criteria for a diagnosis of pregnancy-induced hypertension. Abnormalities of platelet count and/or liver function were seen in 11% of women with pre-eclampsia and in less than 2% of women with gestational hypertension and in a similar proportion of women who did not have pregnancy-induced hypertension. Gestational hypertension was associated with increased induction and caesarean birth rates, but not with low birthweight or preterm delivery. Progression from gestational hypertension to pre-eclampsia was not predicted by blood test abnormalities. Support for the routine use of antenatal CTG was not found. Conclusions:, A clinical diagnosis of pregnancy-induced hypertension should be confirmed before blood tests are ordered. The incidence of test abnormalities was only increased in pre-eclampsia and in gestational hypertension before term. CTG might only be of use in selected cases. [source] Appropriate antenatal corticosteroid use in women at risk for preterm birth before 34 weeks of gestationBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2010R Mahony Please cite this paper as: Mahony R, McKeating A, Murphy T, McAuliffe F, O'Herlihy C, Foley M. Appropriate antenatal corticosteroid use in women at risk for preterm birth before 34 weeks of gestation. BJOG 2010;117:963,967. Objective, To determine the utilisation of antenatal corticosteroid administration in women presenting at risk of preterm birth (PTB) in a centre where tocolytics are not prescribed. Design, A prospective cohort study. Setting, Tertiary referral centre, Dublin, Ireland. Population, Four hundred and fourteen consecutive women presenting at risk of PTB. Methods, Clinical details were collated prospectively on all booked patients who presented at risk of PTB (i.e. at <34 weeks of gestation) during 2008. Main outcome measure, Rate of administration of antenatal corticosteroids in PTB. Results, Of 8985 deliveries, 414 women (5%) presented at <34 weeks of gestation with a clinical potential for PTB, of whom 277 (67%) received antenatal corticosteroids. Amongst women delivering at <34 weeks of gestation, 93% (80/86) received any corticosteroids and 76% (65/86) received a complete course. The ratio of women given a complete course of corticosteroids to the number who actually delivered before 34 weeks of gestation was 4:1 overall. Analysis by indication for PTB revealed this ratio to be 15:1 in suspected preterm labour (PTL), 8:1 in antepartum haemorrhage (APH), and 2:1 in both preterm prelabour rupture of membranes (PPROM) and medically indicated PTB (MIPTB). Seven of ten multiparae (70%) who delivered prematurely during the study period following PTL had a history of previous PTL before 34 weeks of gestation. Conclusion, The ratio of maternal antenatal corticosteroid administration for potential versus actual PTB at <34 weeks of gestation was high in categories such as PTL and substantial APH, whereas selection in PPROM and MIPTB approached 100%. There should be a low threshold for single course therapy for women with prior PTL before 34 weeks of gestation. [source] Laparoscopic debulking of bulky lymph nodes in women with cervical cancer: indication and surgical outcomesBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2009R Tozzi Objective, To describe the technique and the surgical outcome of laparoscopic resection of bulky lymph nodes before adjuvant treatment. Design, Prospective pilot study. Setting, Gynaecological oncology cancer centre. Population, From January 2006 to February 2008, 22 consecutive women presented with cervical cancer and bulky metastatic lymph nodes (>2 cm). Methods, All women underwent resection of bulky lymph nodes by laparoscopy. A prospective record of the main surgical outcomes was performed. Main outcome measures, Safety and efficacy of laparoscopic resection of bulky lymph nodes, conversion to laparotomy, intra- and perioperative morbidity. Results, All the operations were completed by laparoscopy. Median operative time was 197 minutes (range 180,320). Median blood loss was 60 cc (range 10,100), two women experienced complications: one thermal injury of the sciatic root provoking postoperative leg palsy and one chylous ascites. The woman with the thermal injury has recovered most leg function with physiotherapy and the woman with chylous ascites recovered within 2 weeks, slightly delaying the adjuvant treatment. All women were discharged within 4 days from the operation (range 2,4). Pathology reports confirmed the presence of tumour metastases and the lymph nodes size. The adjuvant treatment started at a median time of 12 days (range 3,22). Conclusion, Debulking of large pelvic and para-aortic lymph nodes was effectively accomplished by laparoscopy in all 22 women with 9% complication rate. The surgical outcome is similar to historical series on women operated on by laparotomy, with the advantage of a faster recovery and an early start of adjuvant treatment. [source] Human papillomavirus infection and primary fallopian tube carcinoma: a seroepidemiological studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2007A Riska Objective, To evaluate the role of human papillomavirus (HPV) types 6, 11, 16, 18, 31 or 33 infection in primary fallopian tube carcinoma (PFTC). Design, A retrospective case,control study. Setting, Department of Obstetrics and Gynaecology, Helsinki University Hospital, Finland. Population, Seventy-eight consecutive women with PFTC diagnosed between 1985 and 2000 were studied. For each case, two healthy controls were selected. Methods, Serum immunoglobulin G antibodies to HPV types 6, 11, 16, 18, 31 and 33 were measured from women with PFTC and their healthy controls. Main outcome measures, Analysis of HPV 6, 11, 18, 31 and 33 seropositivity among women with PFTC and controls. Results, Seropositivity rates of non-oncogenic or oncogenic HPV types did not differ between cases and controls, odds ratios being 1.04,1.30 for oncogenic HPVs and 1.08,1.19 for non-oncogenic HPVs, similarly. We did not find any multiplicative joint effect in PFTC by antibodies to more than one oncogenic HPV type; neither did we find any antagonistic effect among women with antibodies to non-oncogenic and oncogenic HPV types. Conclusions, Our results do not suggest any link between PFTC and serological evidence for HPV infection. [source] General obstetrics: Failing pregnancies of unknown location: a prospective evaluation of the human chorionic gonadotrophin ratioBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2006G Condous Objective, To assess the performance of the human chorionic gonadotrophin (hCG) ratio (hCG 48 hours/hCG 0 hour) to predict spontaneous resolution of pregnancies of unknown location (PUL). Design, Prospective cohort study. Setting, Teaching Hospital Early Pregnancy Unit. Population, Women classified as having a PUL. Methods, The optimal cutoff value for hCG ratio (serum hCG at 48 hours/serum hCG at 0 hours) was calculated from data on 189 consecutive PULs (the ,training set'). This cutoff was tested prospectively on a further 200 consecutive PULs (the ,test set'). The hCG ratio was also compared to absolute levels of serum hCG at 0 and 48 hour for the prediction of failing PULs. Main outcome measures, hCG ratio in spontaneously resolving (,failing') PUL compared with those requiring intervention. Optimum cutoff determined and tested to predict spontaneously resolving PUL. Comparison of hCG ratio with absolute levels of serum hCG. Results, A total of 3996 consecutive women were scanned, of which 438 (11.0%) were classified as PULs. Complete data were available for 389 women: 189 in the training set and 200 in the test set. In the training set, there were 102 (54%) failing PUL, while 109 (55%) in the test set. hCG ratio of <0.87 predicted failing PUL, with a sensitivity of 93.1% (95% CI 85.9,97.0) and a specificity of 90.8% (95% CI 82.2,95.7) in the training set. In the test set, sensitivity was 92.7% (95% CI 85.6,96.5) and specificity was 96.7% (95% CI 90.0,99.1). The hCG ratio outperformed absolute serum hCG levels at 0 and 48 hours. Conclusions, We have defined the optimal hCG ratio for the prediction of failing PUL. Using this cutoff, clinicians can safely adopt a noninterventional approach in women with PUL. [source] The prevalence of domestic violence in pregnant womenBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2003J.K. Johnson Objective To determine the prevalence of domestic violence in a population of pregnant women. Design Questionnaire survey. Setting Antenatal booking clinic in a north of England hospital. Population Five hundred consecutive women were included. Methods Anonymous confidential questionnaire to women who were not accompanied by their partners. Main outcome measures Disclosure of a past history of physical, emotional or sexual abuse. Results Four hundred and seventy-five questionnaires were returned (95% response rate). The prevalence of domestic violence was 17%. Domestic violence was highest in the age group 26,30 years and boyfriends were the main perpetrators. Punching and slapping were the most common pattern of violence, and 10% of women experiencing domestic violence had had forced sexual activity. Conclusion The prevalence of domestic violence in a cohort of pregnant women in the north of England was 17%. Consideration should be given for routine screening for domestic violence in pregnancy to institute effective intervention strategies. [source] Women's attitudes to HIV screening in pregnancy in an area of low prevalenceBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 2 2003Swati Jha Objectives To identify factors that influence acceptance of the human immunodeficiency virus (HIV) screening test by pregnant women. Design Prospective survey using questionnaires. Setting An antenatal clinic at a tertiary referral hospital. Population 200 pregnant women of multiethic origin residing in a low prevalence area. Methods Two hundred consecutive women attending the antenatal booking clinic were interviewed. We collected data on reasons for opting in or out and factors that could influence the rate of acceptance, such as ethnicity, age, parity, level of education, first language and marital or relationship status. Main outcome measure Attitudes of pregnant women to HIV screening. Results The rate of acceptance of HIV screening was 160/200(80%). The most frequent reasons for opting in were the perceived benefits of screening (92/160, 58%) and the fact that the test is now routinely offered (87/160, 54%). The most frequent reason for refusal of screening was perceived low risk of HIV (27/40, 68%). Logistic regression analysis showed that ethnicity, age, parity and level of formal education did not play a role in influencing uptake of the test. However, women whose first language was English were more likely to opt in compared with those whose first language was not English (P= 0.016) and those who were married or in a stable relationship were more likely to opt in than those who were not (P < 0.001). Conclusion We have not reached the national target of 90% in our region. This appears to be due to a combination of factors, the main one being a perception of low risk. Greater knowledge of the ease of transmission of HIV may alter this perception, which may improve acceptance of the test. [source] Adnexectomy for benign pathology at vaginal hysterectomy without laparoscopic assistanceBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2002Shirish S. Sheth Of 166 consecutive women with a benign adnexal mass scheduled for vaginal hysterectomy with adnexectomy, the operation was successful in 158 (95%). Preoperatively, attempts were made to ascertain that adnexal mass was benign and either freely mobile or with only slightly restricted mobility. Laparotomy was required in eight women, in five for adhesions and in three for malignancy detected during the operation. No woman required laparoscopic-assisted surgery. The 158 women who had successful vaginal hysterectomy with adnexectomy were compared with 100 similar women who had a laparotomy performed by same single operator. The vaginal group had a lower morbidity, speedier recovery and shorter hospital stay. [source] Influence of omental biopsy on adjuvant treatment field in clinical Stage I endometrial carcinomaBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2002Jose J. Nieto In this study to assess the role of omental biopsy in the diagnosis of extrapelvic disease, data from 100 consecutive women with clinical Stage I endometrial cancer undergoing primary surgical treatment in our institution were analysed: 80 women had an omental biopsy, 20 did not, and six had adenocarcinoma in the omentum. No obvious morbidity attributable to this rapid and easily performed surgical procedure was recorded. We conclude that visual inspection and palpation of the omentum at the time of abdominal surgery for endometrial carcinoma is worthwhile and advisable. In addition, adopting a protocol of histological assessment upstaged a further two cases of this series. These data suggest that this technique might influence the prescription of adjuvant pelvic radiation in approximately one in 10 women currently considered for such therapy, as disease can be easily documented as having extended beyond the conventional radiotherapy field. [source] Medical management of early fetal demise using sublingual misoprostolBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2002Prabhath T. Wagaarachchi The aim of this study was to determine the efficacy of mifepristone in combination with sublingual misoprostol for the medical management of early fetal demise. Fifty-six consecutive women were studied prospectively. The mean (SD) gestation at diagnosis was 9.6 weeks (1.84). Four women had complete miscarriage with mifepristone alone. The overall success rate was 83.9% and the median induction,miscarriage interval was 8.19 hours (range 0.83 to 37.50 hours). Of those women who had a successful outcome, 91.5% were satisfied with the regimen. Sublingual misoprostol in combination with mifepristone is an effective and safe alternative to vaginal or oral misoprostol in the management of early fetal demise. [source] Pregnancy testing prior to sterilisationBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2000Asha Kasliwal Specialist Registrar Objective To determine the incidence of positive pregnancy test on the day of laparoscopic sterilisation. Design Prospective longitudinal observational study. Setting Gynaecology unit in a UK teaching hospital. Sample Between 1 January 1997 and 31 December 1998, eight hundred and two consecutive women were admitted for laparoscopic sterilisation after assessment in the gynaecology clinic. On the day of planned surgery, all women had a pregnancy test performed on a urine sample taken that morning following overnight fasting, immediately prior to operation. Main outcome measures A positive pregnancy test on the day of planned surgery. Results Of 802 women tested, 21 (2.6%) were pregnant. A careful medical history taken before surgery revealed evidence of amenorrhoea and menstrual irregularity in 17 of the pregnant women. Of the 21 pregnant women, 11 underwent termination of pregnancy, six continued the pregnancy, four had a miscarriage and one had an ectopic pregnancy. Conclusion The routine practice of pregnancy testing on the day of laparoscopic sterilisation introduced in our hospital should continue to be part of a thorough clinical assessment before surgery. This may help to reduce the considerable level of existing litigation in a high risk area of gynaecological practice. [source] Assessment of menstrual blood loss using a pictorial chart: a validation studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2000Gynaecology), Peter C. Reid Consultant (Obstetrics Objective To assess the accuracy of a pictorial blood loss assessment chart (PBAC) as a method for estimating menstrual blood loss in women complaining of heavy periods. Design A prospective analysis of 103 consecutive women complaining of excessive menstrual blood loss. Population Women recruited into an on-going study of menstrual blood loss in a large district general hospital. Main outcome measures Correlation between pictorial assessment of blood loss and actual measured menstrual blood loss. Results There was poor correlation between observed PBAC score and menstrual blood loss. Conclusion We have not been able to validate previously published work. The pictorial assessment chart offers no significant improvement in the quality of objective diagnosis in women complaining of menorrhagia. [source] There is no clear association between low serum ferritin and chronic diffuse telogen hair lossBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2002R. Sinclair SummaryBackground Low iron stores are considered a possible cause of chronic diffuse telogen hair loss in women. Estimation of serum ferritin is recommended as part of the initial assessment when women present with chronic diffuse telogen hair loss, and iron supplementation therapy is commonly recommended for those found to have low iron stores. Objectives To evaluate the relationship between low serum ferritin (,20 µg L,1) and chronic diffuse telogen hair loss in women. Methods Between 1997 and 1999, 194 consecutive women who presented to a specialist hair clinic were assessed for diffuse telogen hair loss of greater than 6 months duration. All underwent biochemical investigations that included serum ferritin and had two 4-mm punch biopsies taken from the vertex of the scalp. One biopsy was sectioned horizontally and the other vertically. Results Twelve women were found to have a serum ferritin of 20 µg L,1 or less (6·2%). Androgenetic alopecia was found on scalp biopsy in seven of these 12 women, while the other five women had normal histology. The five women with low iron stores and normal histology were treated with iron supplementation alone. This was continued until the serum ferritin was > 20 µg L,1. Cessation or reversal of hair loss was not seen in any of these women. Conclusions No direct relationship between low serum ferritin and hair loss can be established. The usefulness of serum ferritin in the routine investigation of women with chronic diffuse telogen hair loss is unclear, as is the role of iron supplementation therapy in the management of hair loss. [source] Case-orientated approach to the management of hepatocellular adenoma,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2006D. J. van der Windt Background: Treatment of suspected hepatocellular adenoma (HA) remains controversial. The aim of this study was to evaluate the management of HA at a time when magnetic resonance imaging (MRI) and computed tomography (CT) are highly sensitive methods for diagnosing HA. Methods: Between January 2000 and January 2005, data from 48 consecutive women with HA (median age 36 years) were prospectively collected. The protocol for diagnostic work-up consisted of multiphasic MRI or CT. Management was observation if the tumour was smaller than 5 cm and surgical intervention if it was 5 cm or larger. Results: The median follow-up was 24 (range 3,73) months. Sixteen (33 per cent) patients had invasive procedures because of tumour size 5 cm or larger, malignant characteristics or haemorrhage. The remaining 32 patients (67 per cent) were observed; haemorrhage and malignant degeneration did not occur and none of the lesions showed enlargement after withdrawal of oral contraceptives. Multiple HAs were found in 32 (67 per cent) patients; liver steatosis was significantly more common in these patients than in those with a solitary lesion (59 versus 19 per cent; P = 0·008). Conclusion: Observation of adenomas smaller than 5 cm is justified because of improved radiological reliability. Resection should be reserved for patients with malignant tumour characteristics or with single lesions 5 cm or larger. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Relationship between hormone receptor status and tumour size, grade and comedo necrosis in ductal carcinoma in situ,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2005N. L. P. Barnes Background: Results of the National Surgical Adjuvant Breast Project B-24 trial indicate that adjuvant tamoxifen therapy is of benefit only in oestrogen receptor (ER)- positive ductal carcinoma in situ (DCIS). In the UK, ER status is not routinely determined in DCIS. The aim of this study was to assess the ER status in women with DCIS to determine whether any clinicopathological factors could predict positivity instead of immunohistochemical assessment. Methods: The ER and progesterone receptor (PR) status of consecutive women diagnosed with DCIS during 2001 and 2002 was determined by immunohistochemistry. Results: One hundred and nineteen tumours diagnosed between 2001 and 2002 were analysed; 73·0 per cent were ER positive and 61·1 per cent were PR positive. PR positivity was associated with ER positivity (P < 0·001). Increasing tumour grade correlated with a decrease in ER and PR positivity (both P = 0·002). Comedo necrosis was associated with ER negativity (P = 0·026), PR negativity (P = 0·033) and a lower percentage of ER expression in ER-positive tumours (mean(s.d.) 82(27) versus 93(10) per cent; P = 0·021). Conclusion: Tumour grade and comedo necrosis were not strong enough predictors to be used as surrogates for immunohistochemical assessment. ER status should be determined before commencing endocrine therapy. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Anal vector volume analysis complements endoanal ultrasonographic assessment of postpartum anal sphincter injuryBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2000M. M. Fynes Background The aim of this study was to determine the role of anal vector manometry in the assessment of postpartum anal sphincter injury and to establish the most suitable method of anal vector volume analysis for identifying significant external anal sphincter (EAS) injury in an at-risk parous population. Methods A total of 101 consecutive women with a history of instrumental or traumatic vaginal delivery was recruited. Anal ultrasonography and anal vector manometry were performed. Receiver,operator characteristic curves were used to determine the usefulness of anal manometry and anal vector volume analysis in the identification of significant EAS disruption (full thickness, more than one quadrant involved) detected by ultrasonography. Results Seventeen women had significant EAS disruption identified by anal ultrasonography. Anal vector manometry provided complementary functional information. Anal vector symmetry index (VSI), determined by analysis of mean maximum squeeze pressure, yielded 100 per cent sensitivity for significant EAS disruption, with a positive predictive value of 61 per cent. Conclusion Anal vector manometry complements endoanal ultrasonography. VSI, determined by means of the squeeze pressure profile, correlates best with significant EAS disruption identified at anal ultrasonography. © 2000 British Journal of Surgery Society Ltd [source] | ||||||||||||||||||||||||||||