Objective: The purpose of this study was to determine whether selective use of fetal fibronectin detection after ultrasound measurement of cervical length predicts preterm delivery in symptomatic patients better than ...Objective: The purpose of this study was to determine whether selective use of fetal fibronectin detection after ultrasound measurement of cervical length predicts preterm delivery in symptomatic patients better than either indicator alone. Study design: This prospective blinded study performed both tests on 359 women hospitalized for preterm labor between 18 and 34 completed weeks’gestation. The primary outcome was preterm delivery before 35 weeks’gestation. Results: Among the 359 women included, 48 (13.4%) delivered before 35 weeks’gestation. The sensitivity, specificity, and positive and negative predictive values of cervical length ≤25 mm were 75%, 63%, 24%, and 94%, respectively, and of fetal fibronectin ≥50 ng/mL, 63%, 81%, 33%, and 93%. Fetal fibronectin detection was significantly (P < .001) more specific than cervical length measurement. For selective use of fetal fibronectin detection after cervical length measurement, the test was considered positive if cervical length was ≤15 mm or if cervical length was between 16 and 30 mm with fetal fibronectin ≥50 ng/mL. The predictive values of this test were not significantly different from those of fetal fibronectin detection (67%, 81%, 36%, and 94%). This strategy could have avoided 200 fibronectin tests. Conclusion: Selective use of fetal fibronectin detection after cervical length measurement is more specific than cervical length and as effective as fetal fibronectin assays in the entire population of women in preterm labor for predicting preterm birth.展开更多
PURPOSE: Management of civilian penetrating colon injuries in the adult has ev olved from the universal use of fecal diversion to the highly selective use of c olostomy. We hypothesized that a similar management appro...PURPOSE: Management of civilian penetrating colon injuries in the adult has ev olved from the universal use of fecal diversion to the highly selective use of c olostomy. We hypothesized that a similar management approach was appropriate for the pediatric population. METHODS: A retrospective review of pediatric patients (age <17 years) with a penetrating colorectal injury was performed at six Level I trauma centers for the period January 1990 through June 2001. RESULTS: For th e period of review, 53 children with a penetrating colorectal injury were identi fied. Firearms caused 89 percent of the injuries. The colon was injured in 83 pe rcent (n = 44) of patients and the rectum in 17 percent (n = 9) of patients. The colorectal injury was managed without colostomy in 62 percent (n = 33) and with colostomy in 38 percent (colon = 11, rectum = 9). All rectal injuries were trea ted with colostomy. The hospital length of stay was longer in the colostomy grou p (17.6 days vs. 11.4 days). The complication rate was higher in the colostomy g roup (55 percent vs. 27 percent), which included two patients with stoma-relate d complications. There was no mortality in this series. CONCLUSIONS: Primary rep air was used safely in most cases of civilian penetrating colon injuries in the pediatric population. All rectal injuries were treated with colostomy in this se ries. Fecal diversion was used selectively. Colostomy was performed for selected cases of colon wounds associated with shock,multiple blood transfusions,multipl e other injuries, extensive contamination, and high-velocity weapons. In the ab sence of these associated factors, primary repair appears justified.展开更多
Objective. To evaluate our clinical practice for Group B streptococcus (GBS) screening during pregnancy and antibiotic therapy during delivery, Material and methods. We performed a retrospective evaluation of our SBS ...Objective. To evaluate our clinical practice for Group B streptococcus (GBS) screening during pregnancy and antibiotic therapy during delivery, Material and methods. We performed a retrospective evaluation of our SBS screening protocol, by vaginal swab, for a period of two years, including 1,674 asymptotic patients. Intrapartum antibiotic prophylaxis was administrated for GBS-positive women. Results. The rate of GBS carriage was 6.9% . Antibiotics were administrated for 79,3% patients with GBS-positive culture. Of these women only 39% had an interval greater than four hours between antibiotic injection and delivery. In the group of patients with positive GBS culture, no newborn was infected and only 5% were colonised. In the GBS-negative group with 1.3% of the newborns were GBS positive. Conclusion. We were surprised by our low rate of GBS carriage and the non optimal application of antibiotics during labor. We reviewed our results with all our team and a prospective evaluation has been initiated.展开更多
文摘Objective: The purpose of this study was to determine whether selective use of fetal fibronectin detection after ultrasound measurement of cervical length predicts preterm delivery in symptomatic patients better than either indicator alone. Study design: This prospective blinded study performed both tests on 359 women hospitalized for preterm labor between 18 and 34 completed weeks’gestation. The primary outcome was preterm delivery before 35 weeks’gestation. Results: Among the 359 women included, 48 (13.4%) delivered before 35 weeks’gestation. The sensitivity, specificity, and positive and negative predictive values of cervical length ≤25 mm were 75%, 63%, 24%, and 94%, respectively, and of fetal fibronectin ≥50 ng/mL, 63%, 81%, 33%, and 93%. Fetal fibronectin detection was significantly (P < .001) more specific than cervical length measurement. For selective use of fetal fibronectin detection after cervical length measurement, the test was considered positive if cervical length was ≤15 mm or if cervical length was between 16 and 30 mm with fetal fibronectin ≥50 ng/mL. The predictive values of this test were not significantly different from those of fetal fibronectin detection (67%, 81%, 36%, and 94%). This strategy could have avoided 200 fibronectin tests. Conclusion: Selective use of fetal fibronectin detection after cervical length measurement is more specific than cervical length and as effective as fetal fibronectin assays in the entire population of women in preterm labor for predicting preterm birth.
文摘PURPOSE: Management of civilian penetrating colon injuries in the adult has ev olved from the universal use of fecal diversion to the highly selective use of c olostomy. We hypothesized that a similar management approach was appropriate for the pediatric population. METHODS: A retrospective review of pediatric patients (age <17 years) with a penetrating colorectal injury was performed at six Level I trauma centers for the period January 1990 through June 2001. RESULTS: For th e period of review, 53 children with a penetrating colorectal injury were identi fied. Firearms caused 89 percent of the injuries. The colon was injured in 83 pe rcent (n = 44) of patients and the rectum in 17 percent (n = 9) of patients. The colorectal injury was managed without colostomy in 62 percent (n = 33) and with colostomy in 38 percent (colon = 11, rectum = 9). All rectal injuries were trea ted with colostomy. The hospital length of stay was longer in the colostomy grou p (17.6 days vs. 11.4 days). The complication rate was higher in the colostomy g roup (55 percent vs. 27 percent), which included two patients with stoma-relate d complications. There was no mortality in this series. CONCLUSIONS: Primary rep air was used safely in most cases of civilian penetrating colon injuries in the pediatric population. All rectal injuries were treated with colostomy in this se ries. Fecal diversion was used selectively. Colostomy was performed for selected cases of colon wounds associated with shock,multiple blood transfusions,multipl e other injuries, extensive contamination, and high-velocity weapons. In the ab sence of these associated factors, primary repair appears justified.
文摘Objective. To evaluate our clinical practice for Group B streptococcus (GBS) screening during pregnancy and antibiotic therapy during delivery, Material and methods. We performed a retrospective evaluation of our SBS screening protocol, by vaginal swab, for a period of two years, including 1,674 asymptotic patients. Intrapartum antibiotic prophylaxis was administrated for GBS-positive women. Results. The rate of GBS carriage was 6.9% . Antibiotics were administrated for 79,3% patients with GBS-positive culture. Of these women only 39% had an interval greater than four hours between antibiotic injection and delivery. In the group of patients with positive GBS culture, no newborn was infected and only 5% were colonised. In the GBS-negative group with 1.3% of the newborns were GBS positive. Conclusion. We were surprised by our low rate of GBS carriage and the non optimal application of antibiotics during labor. We reviewed our results with all our team and a prospective evaluation has been initiated.
