与细菌性阴道病治疗相关的抗微生物药物的耐药性

This study was undertaken to evaluate antimicrobial susceptibility of vaginal anaerobic bacteria before and after treatment of bacterial vaginosis. A randomized clinical trial of 119 nonpregnant women with bacterial vaginosis receiving either intravaginal metronidazole for 5 days or clindamycin for 3 days was performed. Women had 1 baseline and 3 followup visits at which quantitative vaginal cultures were performed. Anaerobic isolates underwent antimicrobial susceptibility testing. Complete susceptibility data was available on 95 women (47 metronidazole and 48 clindamycin). Of 1059 anaerobic bacterial isolates, less than 1% demonstrated resistance to metronidazole. In contrast, 17% demonstrated baseline clindamycin resistance, and 53% demonstrated resistance to clindamycin after therapy. Women exposed to clindamycin (but not metronidazole) had high frequencies (80% ) of clindamy cin resistant anaerobic bacteria that persisted for 90 days after treatment. Treatment of bacterial vaginosis with clindamycin is associated with marked evidence of antimicrobial resistance among vaginal anaerobic bacteria. This may increase the vaginal reservoir of macrolide resistant bacteria.

住院医师、教授与个体开业医生外阴侧切术应用状况的比较

OBJECTIVE: To describe trends in episiotomy use among residents, faculty, and private practitioners at an academic institution. METHODS: We reviewed data from the Magee ObstetricMedical and Infant database, containing details of every delivery atMagee- Womens Hospital since 1995. The study populationwas women who had spontaneous or operative vaginal delivery of a singleton, liveborn, vertex- presenting infant, at 37 weeks or more, from 1995 to 2000 (completed data set years). The first delivery recorded for a patient in the database was analyzed. Residents and faculty were described as "academic" practitioners. Data were analyzed with the Fisher exact test, χ 2 test for linear trend, and logistic regression models. RESULTS: There were 27,702 women with 15,190 episiotomies, for an episiotomy rate of 54.8% . The rate of episiotomies decreased from 59.7% to 45.0% during the study period (P < .001). Independent risk factors for episiotomy included age 30 years or more, white race, higher educational status, married, nulliparity, and history of cesarean delivery. The strongest predictor of episiotomy use was practitioner type, with women attending private physicians having an adjusted 7- fold increased risk of episiotomy (odds ratio 7.1; 95% confidence interval 6.5, 7.7). Patient characteristics related to practitioner type included age, race, educational status, marital status, nulliparity, and mode of delivery (P < .001). CONCLUSION: High rates of episiotomy use were found among private practitioners, despite current evidence- based literature that supports restricted use of episiotomy.

经阴道分娩与剖宫产产妇的发病率

OBJECTIVE: To describe postpartum maternal morbidity associated with mode of delivery in term, singleton pregnancies. METHODS: The Magee Obstetric Medical and Infant database was examined for the years 1995 to 2000. Patients were grouped into 6 types of delivery mode: spontaneous vaginal delivery, operative vaginal delivery, primary cesarean delivery without trial of labor, primary cesarean delivery with trial of labor, repeat cesarean delivery without trial of labor, and repeat cesarean delivery with trial of labor. Multivariable logistic regression provided odds ratios and 95%confidence intervals (CI) for morbidity by delivery mode adjusted for demographic characteristics and comorbidities. Spontaneous vaginal delivery was used as the referent group (odds ratio = 1). RESULTS: Of 32,834 subjects, 27,178 had vaginal delivery (operative = 4,908; spontaneous = 22,270) and 5,656 had cesarean delivery. Third-or fourth-degree lacerations occurred in 1,733 (7.8%)-women who had spontaneous vaginal delivery compared with 1,098 (22.3%) who had operative vaginal delivery. Overall, 523 women (1.6%) had endometritis. Compared with spontaneous vaginal delivery, primary cesarean delivery with trial of labor conferred a 21.2-fold increased risk of endometritis (95%CI 15.4, 29.1). Even without trial of labor, women after primary cesarean delivery were 10.3 times more likely to develop endometritis (95%CI 5.9, 17.9) than after spontaneous vaginal delivery. The risk of transfusion was highest in women delivered by primary cesarean after labor, 4.2 times higher (95%CI 1.8, 10.1) than spontaneous vaginal delivery. The risk of pneumonia was 9.3 times higher (95%CI 3.4, 25.6) after repeat cesarean delivery with labor. Deep venous thromboses occurred in 15 (0.1%) after spontaneous vaginal delivery, 2 (0.04%) after operative vaginal delivery, and 12 (0.2%) after cesarean delivery. CONCLUSION: Compared with spontaneous vaginal delivery, cesarean delivery is associated with increased risks of endometritis, the need for transfusion, and pneumonia; however, these rates are lower than reported previously.

阴道修补术后脱垂复发的危险因素

The purpose of this study was to determine factors that are associated with recurrent prolapse. Of 389 women who underwent vaginal prolapse and incontinence between June 1996 and May 1999, 176 women had 1-year followup evaluations. Recurrent prolapse was analyzed by both pelvic organ prolapse quantification stage and centimeter measurements that were relative to the hymen. Logistic regression was used to determine odds ratios and 95%CI for factors that were associated with recurrent prolapse. One year after surgery, 102 women (58%) had recurrent prolapse (≥stage II). Seventeen women (10%) had prolapse ≥1 cm beyond the hymen. Age <60 years (odds ratio, 3.2; 95%CI, 1.6-6.4; P =. 001) and preoperative pelvic organ prolapse quantification stage III or IV (odds ratio, 2.7; 95%CI, 1.3-5.3; P =. 005) were associated with a greater likelihood of recurrent prolapse (≥stage II) at 1 year. Younger women and women with more advanced prolapse are more likely to experience recurrent prolapse after vaginal repair.