Abstract:
OBJECTIVE:Before the availability of modern imaging studies the diagnosis of septic pelvic thrombophlebitis causing prolonged puerperal fever was difficult to confirm without surgical exploration. With the use of computed tomography infection-related pelvic phlebitis can now be confirmed, and this study was designed to determine its incidence after delivery. We also designed a randomized clinical trial to evaluate the efficacy of heparin added to antimicrobial therapy for treatment of women with septic phlebitis. STUDY DESIGN:We studied women who had pelvic infection and fever that persisted after 5 days despite adequate antimicrobial therapy with clindamycin, gentamicin, and ampicillin. After giving consent study participants underwent abdominopelvic computed tomographic imaging. Women with pelvic thrombophlebitis were randomly assigned to 1 of 2 management schemes that included continuation of antimicrobial therapy, either alone or with the addition of heparin, until the temperature was =37.5 degrees C for 48 hours. RESULTS:During the 3-year study period 44,922 women were delivered at Parkland Hospital; among these 8535 (19%) were delivered by the cesarean route. There were 69 women who met criteria for prolonged infection, and 15 (22%) of these were found to have septic pelvic thrombophlebitis. Four had infection after vaginal delivery and 11 had been delivered by the cesarean route. Of 14 women randomly assigned to therapy, 8 were assigned to receive continued antimicrobial therapy without the addition of heparin and the other 6 were assigned to receive heparin therapy in addition to the antimicrobial agents. According to an intent-to-treat analysis there was no significant difference between the responses of women with pelvic infection who were and were not given heparin therapy. Specifically, women not given heparin were febrile for 140 +/- 39 hours compared with 134 +/- 65 hours for women who received heparin (P =.83). Duration of hospitalization was also similar between the 2 groups at 10.6 +/- 1.9 days for those with thrombosis who were given antimicrobial agents alone and 11.3 +/- 1.2 days for women who also received heparin (P >.5). The 54 women with persistent fever but without computed tomographic evidence of septic pelvic thrombophlebitis were hospitalized for a mean of 12.0 +/- 4.1 days, compared with 10.9 +/- 2.9 days for women in whom thrombosis was diagnosed (P =.14). These women were followed up for >/=3 months post partum and none showed evidence of reinfection, embolic episodes, or postphlebitic syndrome. CONCLUSIONS:The overall incidence of septic pelvic thrombophlebitis was 1:3000 deliveries. The incidence was about 1:9000 after vaginal delivery and 1:800 after cesarean section. Women given heparin in addition to antimicrobial therapy for septic thrombophlebitis did not have better outcomes than did those for whom antimicrobial therapy alone was continued. These results also do not support the common empiric practice of heparin treatment for women with persistent postpartum infection.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Brown CE,Stettler RW,Twickler D,Cunningham FGdoi
10.1016/s0002-9378(99)70450-3subject
Has Abstractpub_date
1999-07-01 00:00:00pages
143-8issue
1eissn
0002-9378issn
1097-6868pii
S0002-9378(99)70450-3journal_volume
181pub_type
临床试验,杂志文章,随机对照试验abstract::Three hundred forty-three cases of early invasive carcinoma of the uterine cervix were analyzed. Depth of infiltration and lateral extension of the tumors varied between 0.2 and 9.0 mm and 0.4 and 17.2 mm and were found to be of no prognostic importance. A multivariate statistical analysis revealed several risk factor...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(83)91043-8
更新日期:1983-05-15 00:00:00
abstract::The purpose of this study was to determine the effect of labor and chorioamnionitis in interleukin-1 production by human placenta. We studied the activity of the placenta to produce interleukin-1 with an enzyme immunoassay by culturing tissue blocks. The placental tissue obtained after labor produced a larger amount o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90241-i
更新日期:1991-07-01 00:00:00
abstract::Normal fetal growth is a critical component of a healthy pregnancy and influences the long-term health of the offspring. However, defining normal and abnormal fetal growth has been a long-standing challenge in clinical practice and research. We review various references and standards that are used widely to evaluate f...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2009.10.889
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:Conventional diagnosis of bacterial vaginosis contains some controversial points. To understand accurately the relationship between clinical stages and the microbiotas, the intravaginal microbial flora was analyzed by the clone library method. STUDY DESIGN:Vaginal fluid samples from 31 patients were examined...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2011.04.018
更新日期:2011-09-01 00:00:00
abstract::Pregnancy-specific beta 1-glycoprotein (SP-1) was measured by radioimmunoassay in patients admitted to the hospital with a clinical diagnosis of hemorrhage in early pregnancy. The results were compared with a normal range and were analyzed for their predictive value in determining prognosis. Six of the total study gou...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)90243-4
更新日期:1980-10-01 00:00:00
abstract::The effect of actinomycin D on estrogen-induced uterine blood flow was studied in four nonpregnant, oophorectomized sheep, utilizing electromagnetic flow probes chronically implanted around the uterine arteris. Two hours after the intravenous injection of 1 mug of estradiol-17beta per kilogram of body weight, incorpor...
journal_title:American journal of obstetrics and gynecology
pub_type: 历史文章,杂志文章
doi:10.1016/0002-9378(75)90166-0
更新日期:1975-06-01 00:00:00
abstract:OBJECTIVE:Our objective was to investigate the possible restoring action of magnesium on vascular sensitivity to angiotensin II in pregnancy. STUDY DESIGN:We studied intraplatelet free calcium and the pressor response to angiotensin II in 10 primigravid women (28 to 32 weeks' gestation) at risk for pregnancy induced h...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(12)80006-8
更新日期:1992-10-01 00:00:00
abstract::Acute vaginitis is one of the most common diseases seen in the practice of office gynecology. Large survey studies of women with lower genital tract symptoms suggestive of vaginitis have demonstrated the presence of three major etiologic categories in acute vaginitis: (1) nonspecific vaginosis (Gardnerella vaginalis),...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(85)80002-8
更新日期:1985-08-01 00:00:00
abstract:BACKGROUND:Randomized controlled trials that have assessed the efficacy of cervical pessary to prevent preterm birth in asymptomatic high-risk women have reported conflicting results. OBJECTIVE:To evaluate the efficacy and safety of cervical pessary to prevent preterm birth and adverse perinatal outcomes in asymptomat...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,meta分析
doi:10.1016/j.ajog.2019.12.266
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVE:Gonadotropin-releasing hormone agonist-induced partial pituitary suppression with low-grade estrogen production may be useful in long-term treatment of uterine leiomyomas. STUDY DESIGN:Twenty-seven women with uterine leiomyomas were treated with a standard dose of triptorelin for 8 weeks. Patients were then ...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-9378(96)70030-3
更新日期:1996-11-01 00:00:00
abstract::Late in 1995 and early 1996, 4 epidemiologic studies were published that resulted in a crude mean weighted relative risk of approximately 2 when third-generation oral contraceptives were compared with second-generation oral contraceptives as risk factors for venous thromboembolism. This article reviews empirical evide...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1053/ob.1998.v179.a93059
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:Readmission rates are used as a quality metric in medical and surgical specialties; however, little is known about obstetrics readmissions. OBJECTIVE:Our goals for this study were to describe the trends in postpartum readmissions over time; to characterize the common indications and associated diagnoses for...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2016.01.174
更新日期:2016-07-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to describe the evaluation and management of synthetic mesh-related complications after surgery for stress urinary incontinence (SUI) and/or pelvic organ prolapse (POP). STUDY DESIGN:We conducted a multicenter, retrospective analysis of women who attended 4 US tertiary referral ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2013.10.012
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:Our purpose was to compare three techniques in their ability to decrease anxiety induced by the pelvic examination among children of different races. STUDY DESIGN:Eighty-nine subjects between 3 and 8 years old of white, African-American, and Hispanic race or ethnicity were randomly assigned to one of three d...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-9378(98)70341-2
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine factors responsible for the increasing number of deaths from corpus cancer over three time periods. STUDY DESIGN:Data were collected from the Surveillance, Epidemiology and End Results database from 1988-2001. Kaplan-Meier and Cox proportional hazards regression ana...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.08.075
更新日期:2008-02-01 00:00:00
abstract::Forty-six infants exposed to indomethacin in utero for treatment for preterm labor were compared with infants from two control groups. In one control group the next consecutive patient treated with a tocolytic agent was used, and the other control group was formed by picking the next consecutive patient matched by ges...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(86)80012-6
更新日期:1986-10-01 00:00:00
abstract::Clear cell carcinoma originating in the abdominal wall is rare and usually develops within endometriotic implants in the scar. We describe 2 patients: a 42 year old with a 15 cm mass on the abdominal wall treated with neoadjuvant chemotherapy and excision and a 51 year old with a 6 cm abdominal mass treated with excis...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2012.05.029
更新日期:2012-08-01 00:00:00
abstract:OBJECTIVES:Our purpose was to evaluate factors that may influence perinatal outcomes in the very-low-birth-weight infant with breech presentation. STUDY DESIGN:An observational study that included all consecutive singletons and twins with the first fetus with breech presentation weighing between 500 and 1500 gm delive...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(94)70074-5
更新日期:1994-07-01 00:00:00
abstract::In this study, we examined whether the doubling time of human chorionic gonadotropin is different at different stages of early pregnancy and whether the use of multiple nomograms for doubling time of human chorionic gonadotropin rather than a single critical value can improve the diagnosis of ectopic pregnancy. Forty-...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80349-6
更新日期:1987-07-01 00:00:00
abstract::Percutaneous umbilical blood sampling (cordocentesis) provides direct access to the fetal circulation in the second and third trimesters of pregnancy. Seventeen patients underwent this procedure between December 1985 and December 1986 for evaluation of a variety of clinical situations, including nonlethal fetal abnorm...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90795-8
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to report the clinical experience collated from the 1995 and 1997 case list summary sheets of United States and Canadian active candidates who were completing the American Board of Obstetrics and Gynecology oral examination for the first time. STUDY DESIGN:Data from the case lis...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.119181
更新日期:2001-12-01 00:00:00
abstract::The purpose of this study is to clarify fetal cardiovascular effects of four popular analgesics administered to a maternal animal model. Clinical doses of aspirin (14 mg/kg), acetaminophen (14 mg/kg), ibuprofen (6 mg/kg), or indomethacin (0.7 mg/kg) were administered orally to near-term rats. At 1, 4, 8, or 24 hours l...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90042-6
更新日期:1990-05-01 00:00:00
abstract:OBJECTIVE:This study was undertaken to determine whether adrenomedullin, a hypotensive peptide, decreases vasomotor tone in fetoplacental vasculature that has been constricted with the thromboxane sympathomimetic U46619. STUDY DESIGN:The fetoplacental vascular beds of 20 perfused human placental cotyledons were vasoco...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.108071
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVE:The aim of this preliminary study was to investigate whether ultrasound-guided high-intensity focused ultrasound (HIFU) can play a role in treating cesarean scar pregnancy (CSP). STUDY DESIGN:Between November 2011 and December 2012, 16 patients with CSP were treated with ultrasound-guided HIFU ablation. Succ...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/j.ajog.2014.04.024
更新日期:2014-10-01 00:00:00
abstract::Colposacropexy procedures restore anatomically correct apical vaginal support on the levator plate at the ischial spine level. Venous hemorrhage resulting from laceration of presacral veins during suture fixation is the major hazard of this procedure. Titanium orthopedic bone anchor fixation minimizes this risk throug...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(97)70361-2
更新日期:1997-06-01 00:00:00
abstract::A placental lesion associated with elevated maternal serum alpha-fetoprotein level and a positive Kleihauer-Betke test is reported. Serial ultrasonograms showed a progressive increase in the echogenicity of the lesion that corresponded to a large intervillous thrombosis after delivery. This case illustrates the import...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90626-i
更新日期:1990-11-01 00:00:00
abstract::Available information suggests that some instances of preterm birth or premature rupture of membranes are associated with clinically unrecognized infection and inflammation of the lower uterine segment, decidua, and fetal membranes. Various cervicovaginal microorganisms have been recovered from these sites. Many of th...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/0002-9378(90)90632-h
更新日期:1990-11-01 00:00:00
abstract::A total of 258 patients with candidal vulvovaginitis, all of whom also exhibited Candida organisms in the rectum, were treated for 1 week with vaginal tablets only (nystatin or clotrimazole) or with both vaginal and oral tablets (nystatin). Mycologic and symptomatic responses were superior for the group receiving comb...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/0002-9378(86)90297-8
更新日期:1986-09-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine the maternal blood glucose response to food throughout pregnancy. STUDY DESIGN:Forty-five normal, healthy primiparous women with singleton pregnancies were studied longitudinally throughout pregnancy. Blood glucose levels were determined at each stage of pregnancy after a standar...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(94)90460-x
更新日期:1994-07-01 00:00:00
abstract:OBJECTIVE:Increasing numbers of mature women are achieving pregnancy largely through assisted reproductive technology (ART). Our objective was to investigate women over 45 years of age to determine the impact of pregnancy complications on newborn outcome. STUDY DESIGN:A study of women older than 45 years at their esti...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2004.07.035
更新日期:2005-01-01 00:00:00