妊娠期及产后静脉血栓栓塞的发生率、危险因素及死亡率

Objective: The purpose of this study was to estimate the incidence,risk factors, and mortality from pregnancy-related venous thromboembolism. Study design: The Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for the years 2000 to 2001 was queried for all pregnancy-related discharges with a diagnosis of venous thromboembolism. Results: The rate of venous thromboembolism was 1.72 per 1000 deliveries with 1.1 deaths per 100,000. The risk of venous thromboembolism was 38% higher for women ages 35 and older and 64% higher for black women. Other significant risk factors included thrombophilia, lupus, heart disease, sickle cell disease,obesity, fluid and electrolyte imbalance, postpartum infection,and transfusion. The risk factor with the highest odds ratio, 51.8(38.7- 69.2) was thrombophilia. Conclusion: The incidence of pregnancy-related venous thromboembolism was higher than generally quoted. Women ages 35 and older, black women, and women with certain medical conditions and obstetric complications appear to be at increased risk.

妊娠期和产褥期卒中发病率及危险因素

To estimate the incidence, mortality, and risk factors for pregnancy-related stroke in the United States. Methods: The Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, for the years 2000- 2001 was queried for International Classification of Diseases, 9th Revision, codes for stroke among all pregnancy-related discharges. Results: A total of 2,850 pregnancy-related discharges included a diagnosis of stroke for a rate of 34.2 per 100,000 deliveries. There were 117 deaths or 1.4 per 100,000 deliveries. Twenty-two percent of survivors were discharged to another facility. The risk of stroke increased with age, particularly ages 35 years and older. African-American women were at a higher risk, odds ratio (OR) 1.5 (95% confidence interval [CI] 1.2- 1.9). Medical conditions that were strongly associated with stroke included migraine headache, OR 16.9 (CI 9.7- 29.5), thrombophilia, OR 16.0 (CI 9.4- 27.2), systemic lupus erythematosus, OR 15.2 (CI 7.4- 31.2), heart disease, OR 13.2 (CI 10.2- 17.0), sickle cell disease, OR 9.1 (CI 3.7- 22.2), hypertension, OR 6.1 (CI 4.5- 8.1) and thrombocytopenia, OR 6.0 (CI 1.5- 24.1). Complications of pregnancy that were significant risk factors were postpartum hemorrhage, OR 1.8 (CI 1.2- 2.8), preeclampsia and gestational hypertension, OR 4.4 (CI 3.6- 5.4), transfusion OR 10.3 (CI 7.1- 1 5.1) and postpartum infection, OR 25.0 (CI 18.3- 34.0). Conclusion: The incidence, mortality and disability from pregnancy related-stroke are higher than previously reported. African-American women are at an increased risk, as are women aged 35 years and older. Risk factors, not previously reported, include lupus, blood transfusion, and migraine headaches. Specific strategies, not currently employed, may be required to reduce the devastation caused by stroke during pregnancy and the puerperium.

家中尿液检测促黄体生成激素假阳性但活检提示为非分泌期子宫内膜

To examine the proportion of cases with proliferative endometrium on biopsies performed after positive home urine LH testing. Multicenter clinical trial of the usefulness of endometrial biopsy in the evaluation of infertility, with women from fertile and infertile couples randomly assigned to midluteal vs. late luteal phase endometrial sampling. Twelve clinical sites of the National Institutes of Health/National Institute of Child Health and Human Developmentsponsored Reproductive Medicine Network. All women in the study had regular menstrual cycles. Fertile volunteers who had delivered a live born infant within the past 2 years without medical intervention were recruited through advertisements at participating sites. Infertile women with regular cycles were recruited from the clinical practices of the sitesphysicians. Interview, informed consent, subjectinterpreted home urine LH testing, and endometrial biopsy in either the midluteal or late luteal phase. Proportion of cases with proliferative endometrium on biopsy. In both fertile and infertile women, more than 7%of endometrial biopsies performed 7-13 days after a positive home urine LH test revealed proliferative endometrium. Patient interpretation of home urine LH test kits not uncommonly results in falsepositive tests. Women planning menstrual cycle testing or procedures related to ovulation may benefit from additional confirmatory testing.

确定可生育和不孕症患者子宫内膜组织学分期的阅片者差异性

To assess effects of biopsy timing and fertility status on interand intraobserver variability in dating of the endometrium. Endometrial biopsy slides randomly selected from a multicenter study testing the utility of biopsy in the diagnosis of infertility were distributed to three gynecologic pathologists, who estimated cycle day using standard criteria. Readers were blinded to the purpose of the study, patient age, fertility status, or timing of biopsy relative to LH surge or next menses. Multicenter academic research programs in reproductive medicine. Eightytwo women with proven fertility, 83 infertile patients. Endometrial biopsy during midluteal (days 21-22) or late (days 26-27) luteal phase. Intraclass correlation coefficient (ICC), kappa. Overall agreement was excellent (ICC 0.88); addition of readings by local pathologists decreased ICC only slightly. In subgroup analyses, ICCs were lowest for infertile women during the midluteal phase (0.65 vs. 0.71 for fertile women in the midluteal phase, and 0.88-0.90 for both groups in the late luteal phase). Intraobserver reliability was excellent (0.9-0.99). Agreement for diagnoses of outofphase was only moderate, with kappa values between 0.4 and 0.6. Observer variability in dating the endometrium was greatest in infertile women during the window of implantation.

对血管性血友病妇女月经过多症状的系统性回顾

OBJECTIVE: To review the evidence supporting screening of adult women with menorrhagia for von Willebrand disease. DATA SOURCES: MEDLINE search from January 1, 1990, to December 31, 2003, for articles in English, using “menorrhagia,”“von Willebrand disease,”“diagnosis,”and “screening,”with a hand-search of bibliographies of identified articles, review of published abstracts, and discussion with experts. METHODS OF STUDY SELECTION: One hundred seven articles meeting search criteria were reviewed. Articles included in the study were those that provided primary data on the prevalence of von Willebrand disease in adult women with menorrhagia, quality of life, surgical complications, and the effectiveness of medical therapy in women with menorrhagia and von Willebrand disease and test characteristics of screening tests for von Willebrand disease. TABULATION, INTEGRATION, AND RESULTS: The reported prevalence of von Willebrand disease in women with menorrhagia ranged from 5-20%in 5 published studies. Comparison of results was limited by small sample sizes and large confidence intervals, as well as differences in the definitions of menorrhagia and von Willebrand disease used in the studies. Although menorrhagia in women with known von Willebrand disease has a substantial impact on quality of life, there are no data suggesting that this impact is substantially greater than that of menorrhagia in women without von Willebrand disease. Data on the risk of surgical bleeding in women with von Willebrand disease are limited, with only 3 studies with a total of 29 patients identified. Data on the effectiveness of specific therapies are also limited; only one controlled trial was identified. Of single tests for screening, one study of the ristocetin cofactor assay had a sensitivity of 79%and specificity of 90%. Studies of a test of platelet adhesion and aggregation resulted in pooled sensitivities of 83-94%and specificities of 80-88%; however, significant heterogeneity was present. CONCLUSION: There are inadequate data to justify routine testing for von Willebrand disease in adult women with menorrhagia outside of the research setting.