Objective: Previous studies did not establish a clear correlation between the presence of endometriosis and the values of body mass index (BMI). Study design: The BMI of 366 women with endometriosis was compared to th...Objective: Previous studies did not establish a clear correlation between the presence of endometriosis and the values of body mass index (BMI). Study design: The BMI of 366 women with endometriosis was compared to that of 248 controls undergoing laparoscopy because of benign gynaecological conditions. Significant differences at univariate analyses were confirmed by using Analysis of covariance (ANCOVA) to control for potential confounding variables. Results: BMI was significantly lower in women with endometriosis than in controls (p < 0.001); this difference was confirmed when the analysis was restricted to subjects with normal BMI (18.50-24.99 kg/m2) (p = 0.002). 4.8% of control subjects and no woman with endometriosis were obese. No significant difference was observed in the BMI of women with mild (revised classification of the American Fertility Society, rAFS Ⅰ -Ⅱ ) and severe endometriosis (rAFS Ⅲ -Ⅳ ). Conclusion: Women with endometriosis have lower BMI and are less frequently obese than control subjects. Further studies should investigate the physiopathological basis of decreased BMI in women with endometriosis.展开更多
Objective: To examine the HPV type infection of cervical cone specimens with coexistent CIN1 and CIN3 lesions, in order to define if coexistence of low-and high-grade lesions in the same cervix represent different sta...Objective: To examine the HPV type infection of cervical cone specimens with coexistent CIN1 and CIN3 lesions, in order to define if coexistence of low-and high-grade lesions in the same cervix represent different stages of evolution in a continuing process that is caused by a single viral type or independent lesions induced by different HPV types. Study design: The examined material included 43 cases with coexistent CIN1 and CIN3 in the cone biopsy specimen. Detection and typing of HPV was made by RFLP-PCR. Results: All CIN1 lesions were HPV positive, while three CIN3 lesions were HPV-negative. The proportion of agreement of the HPV type in the two lesions, excluding negative cases (n = 40), was 60% (95% confidence interval: 43.3-75.1). HPV 16 was the most common type in both CIN3 (56.8% ) and CIN1 (46.5% ). Conclusions: The so-called morphologic progression of CIN is not always synonymous with biologic progression, since many coexistent CIN lesions are caused by different HPV types, and so represent different cell clones. Clonality of coexistent CIN lesions may be implicated in the evolution of CIN as other recent studies have shown.展开更多
Objective: To analyze the effect of nuchal cords on perinatal features at delivery of term and postterm pregnancies. Methods: A total of 11,748 women with planned vaginal deliveries, including 9,574 term and 2,174 pos...Objective: To analyze the effect of nuchal cords on perinatal features at delivery of term and postterm pregnancies. Methods: A total of 11,748 women with planned vaginal deliveries, including 9,574 term and 2,174 postterm deliveries, were analyzed for intrapartum events, clinical peripartum management, mode of delivery, and neonatal outcome. The presence of nuchal cords was diagnosed clinically at the time of delivery. Data were obtained from our perinatal database between 1995 and 2004 for retrospective analysis. Results: The incidence of nuchal cords in term and postterm deliveries was 33.7% and 35.1% , respectively. Multiple nuchal cords were present in 5.8% of term and 5.5% of postterm deliveries. Intrapartum signs of fetal compromise were increased in all groups, albeit not all reaching statistical significance in postterm deliveries. Meconium staining was significantly increased only in multiple nuchal cords of postterm deliveries (42.1% compared with 30.1% , P < .05). Mode of delivery was unchanged in all nuchal cord groups. Unfavorable neonatal blood gas values were significantly more frequent in all nuchal cord groups. Nevertheless, 5-minute Apgar scores less than 7 were not more common, and admission to neonatal unit was not required more frequently. Neonatal mean birth weight was significantly lower in all nuchal cord groups. Conclusion: Nuchal cords do not influence clinical management at delivery, and neonatal primary adaption is not imapired. Our data show that ultrasonographic nuchal cord assessment is not necessary at the time of admission for delivery.展开更多
Objective: To determine whether supplementation with vitamins C and E after preterm premature rupture of membranes (PPROM) is associated with an increased latency period. Methods: In this double-blind, randomized, con...Objective: To determine whether supplementation with vitamins C and E after preterm premature rupture of membranes (PPROM) is associated with an increased latency period. Methods: In this double-blind, randomized, controlled trial, 60 women with singleton pregnancies of 26 to 34 weeks’ duration and PPROM were randomly assigned to vitamin C (500 mg/day) and vitamin E (400 IU/day) or placebo until delivery. All women received 2 doses of betamethasone in the first 24 h after admission as well as broad-spectrum antibiotic prophylaxis. Results: Important demographic, as well as clinical characteristics such as number of cases of chorioamnionitis, early neonatal sepsis, and respiratory distress syndrome, were similar in the 2 groups. A statically significant difference in the mean ± S.D. number of days of latency was found between the groups (10.5 ± .5.2 days vs. 3.5 ± .4.0 days (P = 0.03). Conclusion: Vitamins C and E supplementation of after PPROM is associated with a longer latency before delivery.展开更多
Objectives: The inlay skin grafting technique proposed by McIndoe is by far the most popular and the safest technique for treatment of vaginal agenesis. The purpose of the current study is to present clinical experien...Objectives: The inlay skin grafting technique proposed by McIndoe is by far the most popular and the safest technique for treatment of vaginal agenesis. The purpose of the current study is to present clinical experiences and long-term results of modified Abbé -McIndoe technique. Study Design: We present the long-term results of 22 patients with a follow-up period ranging between 7 and 14 years. Results: Mean vaginal depth was recorded to be 8 cm and narrowing of the vagina was not noted. Only in two cases was deficient vaginal depth observed which was due to inadequate use of the mould in the postoperative period. Histologic study of the specimens obtained from the neovagina revealed normal vaginal mucosa in all patients. Conclusion: Although numerous methods have been described since the first surgical intervention for the correction of vaginal agenesis, a modified Abbé -McIndoe technique is still the effective and preferred one.展开更多
Objective: To compare the objective anatomic outcomes after sacral colpopexy performed with cadaveric fascia lata and polypropylene mesh. Methods: Patients undergoing a sacral colpopexy were randomized to receive eith...Objective: To compare the objective anatomic outcomes after sacral colpopexy performed with cadaveric fascia lata and polypropylene mesh. Methods: Patients undergoing a sacral colpopexy were randomized to receive either fascia lata or polypropylene mesh in a double-blinded fashion. Data were collected at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The main outcome measures were pelvic organ prolapse quantification (POP-Q) system stage and individual POP-Q points over time. Objective anatomic failure was defined as POP-Q stage 2 or more at any point during the follow-up period. Proportions of patients with objective anatomic failure at 1 year in each group were compared using the χ 2 test. Mean POP-Q points and stage at 1 year were compared by using the independent samples t test. Results: One hundred patients were randomized to receive either fascia (n = 46) or mesh (n = 54). Of the 89 patients returning for 1-year follow-up, 91% (41/45) of the mesh group and 68% (30/44) of the fascia group were classified as objectively cured (P = .007). We found significant differences between the mesh and fascia groups with respect to the 1-year postoperative comparisons of points Aa, C, and POP-Q stage. There were no differences between the 2 groups with respect to points TVL (total vaginal length), GH (genital hiatus), PB (perineal body), Ap or Bp (2 points along the posterior vaginal wall). Conclusions: Polypropylene mesh was superior to fascia lata in terms of POP-Q points, POP-Q stage, and objective anatomic failure rates.展开更多
Objective: To identify risk factors for early wound infection (diagnosed prior to discharge) following cesarean delivery. Methods: A population-based study comparing women who have and have not developed a wound infec...Objective: To identify risk factors for early wound infection (diagnosed prior to discharge) following cesarean delivery. Methods: A population-based study comparing women who have and have not developed a wound infection prior to discharge from Soroka University Medical Center, Ben Gurion University of the Negev, between 1988 and 2002. Results: Of the 19,416 cesarean deliveries performed during the study period, 726 (3.7% ) were followed by wound infection. Using a multivariable logistic regression model, the following risk factors were identified: obesity (odds ratio [OR] = 2.2; 95% confidence interval [CI], 1.6- 3.1); hypertensive disorders (OR = 1.7; 95% CI, 1.4- 2.1); premature rupture of membranes (OR = 1.5; 95% CI, 1.2- 1.9); diabetes mellitus (OR = 1.4; 95% CI, 1.1- 1.7); emergency cesarean delivery (OR = 1.3; 95% CI, 1.1- 1.5); and twin delivery (OR = 1.6; 95% CI, 1.3- 2.0). Combined obesity and diabetes (gestational and pregestational) increased the risk for wound infection 9.3- fold (95% CI, 4.5- 19.2; P < .001). Conclusion: Independent risk factors for an early wound infection are obesity, diabetes, hypertension, premature rupture of membranes, emergency cesarean delivery, and twin delivery. Information regarding higher rates of wound infection should be provided to obese women undergoing cesarean delivery, especially when diabetes coexists.展开更多
文摘Objective: Previous studies did not establish a clear correlation between the presence of endometriosis and the values of body mass index (BMI). Study design: The BMI of 366 women with endometriosis was compared to that of 248 controls undergoing laparoscopy because of benign gynaecological conditions. Significant differences at univariate analyses were confirmed by using Analysis of covariance (ANCOVA) to control for potential confounding variables. Results: BMI was significantly lower in women with endometriosis than in controls (p < 0.001); this difference was confirmed when the analysis was restricted to subjects with normal BMI (18.50-24.99 kg/m2) (p = 0.002). 4.8% of control subjects and no woman with endometriosis were obese. No significant difference was observed in the BMI of women with mild (revised classification of the American Fertility Society, rAFS Ⅰ -Ⅱ ) and severe endometriosis (rAFS Ⅲ -Ⅳ ). Conclusion: Women with endometriosis have lower BMI and are less frequently obese than control subjects. Further studies should investigate the physiopathological basis of decreased BMI in women with endometriosis.
文摘Objective: To examine the HPV type infection of cervical cone specimens with coexistent CIN1 and CIN3 lesions, in order to define if coexistence of low-and high-grade lesions in the same cervix represent different stages of evolution in a continuing process that is caused by a single viral type or independent lesions induced by different HPV types. Study design: The examined material included 43 cases with coexistent CIN1 and CIN3 in the cone biopsy specimen. Detection and typing of HPV was made by RFLP-PCR. Results: All CIN1 lesions were HPV positive, while three CIN3 lesions were HPV-negative. The proportion of agreement of the HPV type in the two lesions, excluding negative cases (n = 40), was 60% (95% confidence interval: 43.3-75.1). HPV 16 was the most common type in both CIN3 (56.8% ) and CIN1 (46.5% ). Conclusions: The so-called morphologic progression of CIN is not always synonymous with biologic progression, since many coexistent CIN lesions are caused by different HPV types, and so represent different cell clones. Clonality of coexistent CIN lesions may be implicated in the evolution of CIN as other recent studies have shown.
文摘Objective: To analyze the effect of nuchal cords on perinatal features at delivery of term and postterm pregnancies. Methods: A total of 11,748 women with planned vaginal deliveries, including 9,574 term and 2,174 postterm deliveries, were analyzed for intrapartum events, clinical peripartum management, mode of delivery, and neonatal outcome. The presence of nuchal cords was diagnosed clinically at the time of delivery. Data were obtained from our perinatal database between 1995 and 2004 for retrospective analysis. Results: The incidence of nuchal cords in term and postterm deliveries was 33.7% and 35.1% , respectively. Multiple nuchal cords were present in 5.8% of term and 5.5% of postterm deliveries. Intrapartum signs of fetal compromise were increased in all groups, albeit not all reaching statistical significance in postterm deliveries. Meconium staining was significantly increased only in multiple nuchal cords of postterm deliveries (42.1% compared with 30.1% , P < .05). Mode of delivery was unchanged in all nuchal cord groups. Unfavorable neonatal blood gas values were significantly more frequent in all nuchal cord groups. Nevertheless, 5-minute Apgar scores less than 7 were not more common, and admission to neonatal unit was not required more frequently. Neonatal mean birth weight was significantly lower in all nuchal cord groups. Conclusion: Nuchal cords do not influence clinical management at delivery, and neonatal primary adaption is not imapired. Our data show that ultrasonographic nuchal cord assessment is not necessary at the time of admission for delivery.
文摘Objective: To determine whether supplementation with vitamins C and E after preterm premature rupture of membranes (PPROM) is associated with an increased latency period. Methods: In this double-blind, randomized, controlled trial, 60 women with singleton pregnancies of 26 to 34 weeks’ duration and PPROM were randomly assigned to vitamin C (500 mg/day) and vitamin E (400 IU/day) or placebo until delivery. All women received 2 doses of betamethasone in the first 24 h after admission as well as broad-spectrum antibiotic prophylaxis. Results: Important demographic, as well as clinical characteristics such as number of cases of chorioamnionitis, early neonatal sepsis, and respiratory distress syndrome, were similar in the 2 groups. A statically significant difference in the mean ± S.D. number of days of latency was found between the groups (10.5 ± .5.2 days vs. 3.5 ± .4.0 days (P = 0.03). Conclusion: Vitamins C and E supplementation of after PPROM is associated with a longer latency before delivery.
文摘Objectives: The inlay skin grafting technique proposed by McIndoe is by far the most popular and the safest technique for treatment of vaginal agenesis. The purpose of the current study is to present clinical experiences and long-term results of modified Abbé -McIndoe technique. Study Design: We present the long-term results of 22 patients with a follow-up period ranging between 7 and 14 years. Results: Mean vaginal depth was recorded to be 8 cm and narrowing of the vagina was not noted. Only in two cases was deficient vaginal depth observed which was due to inadequate use of the mould in the postoperative period. Histologic study of the specimens obtained from the neovagina revealed normal vaginal mucosa in all patients. Conclusion: Although numerous methods have been described since the first surgical intervention for the correction of vaginal agenesis, a modified Abbé -McIndoe technique is still the effective and preferred one.
文摘Objective: To compare the objective anatomic outcomes after sacral colpopexy performed with cadaveric fascia lata and polypropylene mesh. Methods: Patients undergoing a sacral colpopexy were randomized to receive either fascia lata or polypropylene mesh in a double-blinded fashion. Data were collected at 6 weeks, 3 months, 6 months, and 1 year postoperatively. The main outcome measures were pelvic organ prolapse quantification (POP-Q) system stage and individual POP-Q points over time. Objective anatomic failure was defined as POP-Q stage 2 or more at any point during the follow-up period. Proportions of patients with objective anatomic failure at 1 year in each group were compared using the χ 2 test. Mean POP-Q points and stage at 1 year were compared by using the independent samples t test. Results: One hundred patients were randomized to receive either fascia (n = 46) or mesh (n = 54). Of the 89 patients returning for 1-year follow-up, 91% (41/45) of the mesh group and 68% (30/44) of the fascia group were classified as objectively cured (P = .007). We found significant differences between the mesh and fascia groups with respect to the 1-year postoperative comparisons of points Aa, C, and POP-Q stage. There were no differences between the 2 groups with respect to points TVL (total vaginal length), GH (genital hiatus), PB (perineal body), Ap or Bp (2 points along the posterior vaginal wall). Conclusions: Polypropylene mesh was superior to fascia lata in terms of POP-Q points, POP-Q stage, and objective anatomic failure rates.
文摘Objective: To identify risk factors for early wound infection (diagnosed prior to discharge) following cesarean delivery. Methods: A population-based study comparing women who have and have not developed a wound infection prior to discharge from Soroka University Medical Center, Ben Gurion University of the Negev, between 1988 and 2002. Results: Of the 19,416 cesarean deliveries performed during the study period, 726 (3.7% ) were followed by wound infection. Using a multivariable logistic regression model, the following risk factors were identified: obesity (odds ratio [OR] = 2.2; 95% confidence interval [CI], 1.6- 3.1); hypertensive disorders (OR = 1.7; 95% CI, 1.4- 2.1); premature rupture of membranes (OR = 1.5; 95% CI, 1.2- 1.9); diabetes mellitus (OR = 1.4; 95% CI, 1.1- 1.7); emergency cesarean delivery (OR = 1.3; 95% CI, 1.1- 1.5); and twin delivery (OR = 1.6; 95% CI, 1.3- 2.0). Combined obesity and diabetes (gestational and pregestational) increased the risk for wound infection 9.3- fold (95% CI, 4.5- 19.2; P < .001). Conclusion: Independent risk factors for an early wound infection are obesity, diabetes, hypertension, premature rupture of membranes, emergency cesarean delivery, and twin delivery. Information regarding higher rates of wound infection should be provided to obese women undergoing cesarean delivery, especially when diabetes coexists.
