Abortions that fail Kaunitz, A M; Rovira, E Z; Grimes, D A ...
Obstetrics and gynecology (New York. 1953),
1985-October, Letnik:
66, Številka:
4
Journal Article
Recenzirano
In this study of 33,090 suction curettage abortions performed at less than or equal to 12 weeks' gestation, the rate of unrecognized failed abortions was 2.3 per 1000 abortions. Women with one or ...more prior pregnancies and those having an abortion at less than or equal to six weeks' gestation, particularly when small suction cannulae were used, were at higher risk for this complication (relative risks of 2.2, 2.9, and 11.1, respectively). Failures were also more likely when abortions were performed by resident physicians (relative risk of 2.2) and when they were performed on women with uterine anomalies (relative risk of 90.6). Physicians can minimize the risk of failed abortion by selecting an appropriate suction cannula size and by planning the optimal time to perform the abortion. Likewise, abortions performed either by residents or on women with uterine anomalies merit extra care.
Reversible contraception for the 1980s Grimes, D A
JAMA : the journal of the American Medical Association,
01/1986, Letnik:
255, Številka:
1
Journal Article
From 4%–14% of intrauterine device (IUD) users have their IUD removed due to bleeding or pelvic pain in the first year of use. Past studies have analyzed whether baseline patient information can help ...predict such removals, but no previous analysis has examined whether information provided at the recommended 1-month follow-up visit could improve such predictions. Using data from an international multicenter randomized controlled trial, 89 women with removals for bleeding and pain after the 1-month visit were compared with 2536 continuing users. Logistic regression indicated several significant predictors of removal. Women reporting intermenstrual bleeding since last menses were nearly three times more likely to have removals for bleeding or pain (odds ratio OR 2.9; 95% confidence interval CI 1.4–5.9). Similarly, those complaining of excessive menstrual flow were 3.5 times more likely to have removals within 12 months (95% CI 1.4–9.2). Women reporting these menstrual problems during scheduled revisits may benefit from counseling and treatment with nonsteroidal anti-inflammatory drugs (NSAID).
Compliance and oral contraceptives: A review Rosenberg, Michael J.; Burnhill, Michael S.; Waugh, Michael S. ...
Contraception,
09/1995, Letnik:
52, Številka:
3
Book Review, Journal Article
Recenzirano
Compliance difficulties are more common among oral contraceptive (OC) users than generally appreciated by clinicians, in part because unintended pregnancy is a relatively infrequent consequence and ...in part because more common manifestations such as spotting and bleeding may not be recognized as resulting from poor compliance.
While improving compliance is a shared responsibility of patients, clinicians, and manufacturers, the clinician is the focal point for these efforts. Counseling must be individualized, which requires knowledge of factors that predict compliance and an understanding of the patient's decision-making process as it relates to medications. Most OC compliance research has focused on adolescents, where predictors of poor compliance include multiple sex partners, low evaluation of personal health, degree of concern about pregnancy, and previous abortion. Good compliance has been linked with patient satisfaction with the clinician, the absence of certain side effects, establishing a regular daily routine to take OCs, and reading information distributed with OC packaging.
Conflict in interpreting screening tests Grimes, David A.
International journal of gynecology and obstetrics,
2000, 2000-01-00, Letnik:
70, Številka:
S4
Journal Article
To examine the validity of cervical cytologic diagnosis of sexually transmitted diseases, we reviewed the literature and calculated the efficacy of the Papanicolaou smear as a diagnostic technique. ...The predictive value of a positive test varied widely, but was generally higher for Trichomonas vaginalis (0.81-1.00) than for other organisms. For Chlamydia trachomatis, the predictive value of a positive test ranged from 0.40-1.00. Cytologic diagnosis of sexually transmitted diseases has not been studied adequately, but the available literature suggests that its sensitivity is low. In general, the Papanicolaou smear should not be used to diagnose sexually transmitted diseases, and treatment should not be based on cytologic findings alone. At best, cytologic indications of sexually transmitted diseases should prompt a definitive laboratory test.
Management of Septic Abortion Amy, J J
The New England journal of medicine,
12/1994, Letnik:
331, Številka:
25
Journal Article
Recenzirano
To the Editor:
In their otherwise excellent article (Aug. 4 issue),
1
Stubblefield and Grimes mention the means of emptying the uterus in the case of a retained fetus from a midtrimester abortion. ...Unquestionably, as they state, an “experienced practitioner can usually evacuate the uterus successfully with curettage guided by ultrasonography,” but it should be emphasized that the major part of the retained secundines has to be removed with an ovum forceps. The suction curette will help mainly at the end of the procedure, to remove smaller fragments of tissue.
Prostaglandins are highly effective in terminating second-trimester abortion, but they may . . .
To compare the safety and efficacy of outpatient and inpatient treatment of pyelonephritis in pregnancy.
We performed a randomized controlled trial of pregnant women with pyelonephritis before 24 ...weeks' estimated gestational age, comparing inpatient and outpatient treatment. Sixty inpatients received cefazolin intravenously until afebrile for 48 hours, and 60 outpatients received two injections of ceftriaxone intramuscularly. All patients completed a 10-day course of oral cephalexin. We performed a urine culture 5–14 days after completion of therapy.
The two groups were similar with respect to age, parity, temperature, estimated gestational age, initial white blood cell count, and incidence of bacteremia.
Escherichia coli was the major uropathogen isolated (86% of cultures, 95 of 111). Twelve percent (13 of 111) of bacteria were resistant to cefazolin. Eleven outpatients and 12 inpatients had positive urine cultures after therapy (relative risk 0.9, 95% confidence interval 0.4–1.9). Three patients in each group had recurrent pyelonephritis. We switched six inpatients to gentamicin because of a worsening clinical picture (two) or a prolonged febrile course (four); no outpatients required a change in antibiotic (Fisher exact test,
P = .03). One preterm delivery occurred in an inpatient with recurrent pyelonephritis.
Outpatient antibiotic therapy is effective and safe in selected pregnant women with pyelonephritis.
