Study Objective. To evaluate the efficacy of early second-look laparoscopy (ESLL) and the usefulness of the American Fertility Society (AFS) adhesion score at ESLL in terms of reproductive prognosis. Design. Retrospec...
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Study Objective. To evaluate the efficacy of early second-look laparoscopy (ESLL) and the usefulness of the American Fertility Society (AFS) adhesion score at ESLL in terms of reproductive prognosis. Design. Retrospective study (Canadian Task Force classification II-2). Setting, University hospital. Patients. Ninety-two consecutive women undergoing infertility surgery between January 1983 and December 1996. Intervention, We performed ESLL in all but 32 patients, 27 of whom underwent surgery before institution of the protocol. Measurements and Main Results, The pregnancy rate in 1 year was significantly higher in women having ESLL than in those not having the surgery. The AFS score was not significantly different in pregnant and nonpregnant patients. Conclusion. Early second-look laparoscopy may improve fecundity in women requiring fertility surgery.
Study Objective. To analyze fertility outcomes after resection of submucous myomas by operative hysteroscopy in infertile women. Design. Retrospective analysis (Canadian Task Force classification II-2). Setting;Academ...
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Study Objective. To analyze fertility outcomes after resection of submucous myomas by operative hysteroscopy in infertile women. Design. Retrospective analysis (Canadian Task Force classification II-2). Setting;Academic tertiary referral center. Patients. Forty-one women (age 28-42 yrs) old with primary and secondary infertility, and histologically proved submucous myomas. Intervention. Hysteroscopic myomectomy performed with a rigid resectoscope. Measurements and Main Results. Of the 41 patients, 25 (60.9%) became pregnant overall and 20 (48.7%) delivered at term. Seventeen patients delivered a single fetus. Five delivered twins, three at term and two at 33 and 35 weeks. One woman delivered triplets at 31 weeks. The total delivery rate was 56.0%. Two women miscarried, at 6 and 8 weeks. One patient developed postoperative Asherman's syndrome. Conclusion. Our results indicate that hysteroscopic myomectomy improves fertility in previously infertile women. Resection is a viable alternative to abdominal myomectomy for submucous myomas.
Background: Microchimerism from fetal or maternal cells transferred during pregnancy has been implicated in the pathogenesis of systemic sclerosis (SSc). Objective: To determine whether a prior pregnancy influenced di...
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Background: Microchimerism from fetal or maternal cells transferred during pregnancy has been implicated in the pathogenesis of systemic sclerosis (SSc). Objective: To determine whether a prior pregnancy influenced disease progression and cause of death in patients with SSc. Patients and methods: The patients comprised a retrospective study cohort of 111 women with SSc: 78 patients with prior pregnancies (PP) and 33 who were never pregnant (NP), followed up at Thomas Jefferson University. Differences in age at onset, disease subset, organ involvement, cause of death, and type of antinuclear autoantibodies were evaluated statistically, including regression analysis. Results: The age at onset of SSc in NP patients was 32.0 years compared with 45.7 years in patients with one or two prior pregnancies (p<0.0001), 46.6 years in patients with three or four pregnancies (p<0.0001), and 51.3 years in patients with five to seven pregnancies (p<0.0005). In the 16 patients who had an elective pregnancy termination, 14/16 (87.5%) had diffuse SSc v 2/16 (12.5%) with limited SSc (p<0.0001;odds ratio (OR)=49.0). Of the NP women, 7/30 (23%) died from SSc related causes v 3/78 (4%) women who had pregnancies (p=0.0058;OR=7.6). A carbon monoxide transfer factor (TLCO) of <60% and disease duration >10 years was found in 10/13 (77%) NP patients v 10/23 (43%) patients who had pregnancies (p=0.05;OR=4.7), and a TLCO <50% and disease duration > 10 years was identified in 7/13 (54%) NP patients v 6/23 (26%) of the patients who had pregnancies (p=0.09;OR=3.2). Conclusions: There are differences in the age at onset, clinical course, severity of lung involvement, and cause of death in women who develop SSc before pregnancy compared with those who develop it after pregnancies. The NP patients with SSc had onset of disease at an earlier age, more severe lung involvement, and higher rate of death due to SSc.
Objective: To describe timing and severity of abuse before and during pregnancy for African American, Hispanic, and white Angle American women. Findings: Among 199 abused women, 18.1% of the women were abused during p...
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Objective: To describe timing and severity of abuse before and during pregnancy for African American, Hispanic, and white Angle American women. Findings: Among 199 abused women, 18.1% of the women were abused during pregnancy but not the year before, 30.2% were abused the year before but not during pregnancy, and 51.8% were abused both the year before and during pregnancy. The timing of abuse did not vary by ethnicity. The three (ethnicity) by three (timing) factorial analysis of variance showed severity of abuse to vary by timing of abuse. Women reporting abuse both before and during pregnancy reported greater severity of abuse on each of the five measures than did women abused only before pregnancy or only during pregnancy. Conclusions: Over half (51.8%) of the women reported abuse before and during pregnancy with these women reporting greater severity of abuse on all five severity scores. Timing and severity of abuse did not vary by ethnic group. The majority of women abused during pregnancy were also abused prior to pregnancy, indicating the need for universal screening of all women during each health encounter. (C) 1999 by the American College of Nurse-Midwives.
Data from the National Longitudinal Study of the High School Class of 1972 are used to estimate a series of models of entry into marriage, entry into cohabitation, and nonmarital pregnancy. Our models account explicit...
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Data from the National Longitudinal Study of the High School Class of 1972 are used to estimate a series of models of entry into marriage, entry into cohabitation, and nonmarital pregnancy. Our models account explicitly for the endogeneity of one outcome as a predictor of another by taking into account both heterogeneity across individuals due to unmeasured factors that may affect all these outcomes and the correlation in the unmeasured factors across processes. We find that these heterogeneity components ave strongly and positively related across the outcomes. Women who are move likely to cohabit, marry, or become pregnant while unmarried are also more likely to do each of the others. Although black and white women differ in the likelihood of these behaviors, the interrelations of the behaviors are quite similar across groups.
Objective: To study reproductive function and disease outcome in women with borderline ovarian tumors who were treated with conservative surgery. Methods: Patients with borderline ovarian tumors were identified from i...
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Objective: To study reproductive function and disease outcome in women with borderline ovarian tumors who were treated with conservative surgery. Methods: Patients with borderline ovarian tumors were identified from institutional databases. Patients were eligible if they had pathologically confirmed borderline ovarian tumors, no prior sterilization, no history of radiation therapy, retained their uterus and ovarian tissue, and were younger than age 45. Information was acquired by retrospective medical record review and patient interview. Results: Forty-three patients met the eligibility criteria. The median age was 25 years, with a range of 15-39 years. Twenty-six patients had serous tumors, and 17 had mucinous tumors. Fifteen had stage I disease, three had stage III, and 25 were unstaged. Follow-up was available for all patients (median, 5.7 years). Twenty-nine remained disease-free, and 14 developed a new primary lesion/recurrence, with a median time to recurrence of 39.3 months. Recurrence was more frequent in patients treated with ovarian cystectomy than in those treated with oophorectomy alone (58% compared with 23%) (P < .04). After treatment, 29 of 36 patients (81%) retained normal menstrual cycles, and 12 of 24 patients attempting pregnancy conceived 25 pregnancies. Most patients were highly satisfied with conservative surgery. Conclusion: Conservative surgery remains a therapeutic option in selected patients with borderline ovarian tumors. Although the rate of new lesion/recurrence is relatively high, especially in those treated with ovarian cystectomy, mortality from cancer remains low. Many patients who desire pregnancy are able to conceive and deliver healthy offspring after conservative surgery. (C) 2000 by The American College of Obstetricians and Gynecologists.
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