分娩时有妊娠期高尿酸血症的先兆子痫患者早孕期的尿酸浓度

Objective: We investigated changes in serum uric acid across pregnancy in women with gestational hyperuricemia at delivery, with and without preeclampsia, compared with normal pregnant and women with preeclampsia without gestational hyperuricemia. Study design: This was a nested case-control study of 116 controls, 27 women with preeclampsia with predelivery hyperuricemia, 37 women with preeclampsia without predelivery hyperuricemia, and 35 women with gestational hypertension with hyperuricemia at delivery but without proteinuria. Serum uric acid and creatinine was measured across pregnancy. Results: Women with predelivery hyperuricemia,with andwithout preeclampsia, had increased uric acid concentrations across pregnancy compared with controls, after 25 weeks’gestation compared with women with preeclampsia without predelivery hyperuricemia. Adjusting for differences in glomerular filtration by serum creatinine accounted for part but not all of the increase in serum uric acid among women with preeclampsia and predelivery hyperuricemia. Conclusions: Among women with hyperuricemia at delivery, elevations in uric acid occur early. Multiple mechanisms may contribute to increased uric acid including changes in renal function.

伴或不伴子宫内膜异位症妇女:应用口服避孕药、生育史和卵巢上皮癌患病风险

Objective Women with endometriosis may be at an in-creased risk of ovarian cancer.It is not known whether reproductive factors that reduce th e risk of ovarian cancer in general also reduce risk in women w ith endometriosis.We investigated whether the odds ratios for ovarian cancer that were associated with oral contr aceptive use,child-bearing,hysterectomy,and tubal ligation differ among women with and without endometriosis.Study design We pooled information on the self -reported history of en-dometriosis from 4population -base d case -controlled studies of incident epithelial ovarian cancer,comprising2098cases and 2953control subjects.We obtained data on oral contraceptive use,childbearing,breastfeeding,gyne-cologic surgical procedures,and other reproductive factors on each woman.Multivariable uncond itional logistic re-gression was used to calculate odds r atios and 95%CI for ovarian cancer amongwomen with endometriosis compared with women without endometriosis.S imilar methods were used to assess the frequencies of ris k factors among women with and without endometriosis.Adj ustments were made for age,parity,oral contraceptive use,tubal ligation,family history of ovarian cancer,and study site.Results Women with endometriosis were at an increa sed risk of ovarian cancer(odds ratio,1.32;95%CI,1.06-1.65).Using oral contraceptives,bearing child ren,and having a tubal ligation or hysterectomy were associated with a similar re-duction in the odds ratios for ovaria n cancer among women with and without endometriosis.In p articular,the use of oral contraceptives for>10years was associated with a substantial reduction in risk among women with en-dometriosis(odds ratio,0.21;95%CI,0.08-0.58).Conclusion Women with endometriosis are at an increased risk of epithelial ovarian cancer.L ong -term oral contra-ceptive use may provide substantial protection against the disease in this high -risk population.

一项比较不同方案治疗女性盆腔炎效果的随机试验

Objective: Among all women with pelvic inflammatory disease (PID), prevention of adverse reproductive consequences appears to be similarly achieved by outpatient treatment and inpatient treatment. We assessed whether outpatient is as effective as inpatient treatment in relevant age, race, and clinical subgroups of women with PID. Methods: Women with clinical signs and symptoms of mildtomoderate pelvic inflammatory disease (n = 831) were randomized into a multicenter trial of inpatient treatment, initially employing intravenous cefoxitin and doxycycline compared with outpatient treatment consisting of a single intramuscular injection of cefoxitin and oral doxycycline. Comparisons between treatment groups during a mean of 84 months of followup were made for pregnancies, live births, time to pregnancy, infertility, PID recurrence, chronic pelvic pain, and ectopic pregnancy. Results: Outpatient treatment assignment did not adversely impact the proportion of women having one or more pregnancies, live births, or ectopic pregnancies during followup; time to pregnancy; infertility; PID recurrence; or chronic pelvic pain among women of various races; with or without previous PID; with or without baseline Neisseria gonorrhoeae and/or Chlamydia trachomatis infection; and with or without high temperature/white blood cell count/pelvic tenderness score. This was true even in teenagers and women without a previous live birth. Ectopic pregnancies were more common in the outpatient than the inpatient treatment group, but because these were so rare, the difference did not reach statistical significance (5 versus 1, odds ratio 4.91, 95%confidence interval 0.57-42.25). Conclusion: Among all women and subgroups of women with mildtomoderate PID, there were no differences in reproductive outcomes after randomization to inpatient or outpatient treatment.