Abstract:
OBJECTIVE:This study was undertaken to determine (1) the methadone serum trough level adequate to prevent withdrawal symptoms in heroin-addicted pregnant women and (2) whether the methadone serum trough level in symptomatic women with withdrawal symptoms differs from that of asymptomatic women. STUDY DESIGN:Pregnant women addicted to heroin were followed up prospectively between March 1, 1999, and March 1, 2000, in a specialized multidisciplinary methadone program after in-hospital stabilization. After counseling, women signing Institutional Review Board-approved informed consent had their methadone serum trough (20-24 hours after last dose) level checked at regular intervals throughout pregnancy. Methadone levels were kept blinded from clinicians. Methadone doses were increased only according to withdrawal symptoms. Methadone levels of asymptomatic (without withdrawal symptoms) women were compared with methadone serum trough levels of symptomatic (with withdrawal symptoms) women. RESULTS:Mean methadone serum trough level was 0.295 +/- 0.16 mg/L in asymptomatic women (n = 44) and 0.175 +/- 0.11 mg/L in symptomatic (n = 58) women (P <.001). The mean methadone dose in asymptomatic patients was 101 +/- 42 mg versus 114 +/- 43 mg in symptomatic patients (P =.1). No patient had a toxic-range methadone trough level (all <0.7 mg/L). By receiver operating characteristic curve, the best differentiating methadone trough level between asymptomatic and symptomatic women was 0.24 mg/L. These differences in methadone serum trough levels between asymptomatic and symptomatic women were not influenced by continuing drug abuse, maternal weight, or gestational age when methadone serum trough level was drawn. CONCLUSION:Mean methadone serum trough level in asymptomatic pregnant women is approximately 0.3 mg/L, and levels of 0.24 mg/L or greater should be considered adequate to prevent withdrawal symptoms in pregnancy. Knowledge of these levels will help management of the frequently noncompliant heroin-addicted pregnant woman. Appropriate daily dosing to achieve these levels is usually between 50 and 150 mg methadone, with the occasional need for even higher doses in the third trimester.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Drozdick J 3rd,Berghella V,Hill M,Kaltenbach Kdoi
10.1067/mob.2002.127132subject
Has Abstractpub_date
2002-11-01 00:00:00pages
1184-8issue
5eissn
0002-9378issn
1097-6868pii
S0002937802003897journal_volume
187pub_type
杂志文章abstract::Report of a study of Rh antibody titers in the amniotic fluids from 42 Rh-negative sensitized pregnancies is presented. Amniocentesis was performed in the pregnant Rh-negative women having serum Rh antibody titers (indirect Coombs) ranging from 1/64 to 1/4,096. Spectrophotometric analysis was done on the antiRh-D ti...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1969-12-15 00:00:00
abstract:BACKGROUND:Previous studies have shown a decrease in cervical cancer associated with intrauterine device use. It has been hypothesized that intrauterine device use may alter the natural history of human papillomavirus infections, preempting development of precancerous lesions of the cervix and cervical cancer, but the ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2016.11.1053
更新日期:2017-04-01 00:00:00
abstract::Rates of short-interval pregnancies that result in unintended pregnancies remain high in the United States and contribute to adverse reproductive health outcomes. Long-acting reversible contraception methods have annual failure rates of <1%, compared with 9% for oral contraceptive pills, and are an effective strategy ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2018.03.007
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to compare the efficacy of misoprostol that is administered in the buccal pouch with the intravaginal route of administration. STUDY DESIGN:One hundred fifty-seven pregnant women with a singleton live gestation, Bishop score of <7, estimated fetal weight of <4500 g, and gestatio...
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:10.1067/mob.2002.119630
更新日期:2002-02-01 00:00:00
abstract:OBJECTIVE:Our purpose was to evaluate the efficacy and consequences of sacrospinous ligament suspension and pelvic reconstruction. STUDY DESIGN:Patients who underwent sacrospinous ligament suspension between 1978 and 1991 were evaluated from follow-up visits, telephone interviews, questionnaires, and chart reviews. Be...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(96)70085-6
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVE:The effect of maternal tryptophan loading on fetal plasma and brain, kynurenic acid, and quinolinic acid concentrations was compared in late gestation fetal sheep with either chronically embolized or nonembolized placentas. STUDY DESIGN:The placentas of 4 ewes were embolized by daily injection of mucopolysac...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.117969
更新日期:2001-10-01 00:00:00
abstract:BACKGROUND:The diagnostic criteria for preeclampsia have evolved from the traditional definition of de novo hypertension and proteinuria to a broader definition of hypertension with evidence of end-organ dysfunction. Although this change is endorsed by various societies such as the International Society for the Study o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2020.08.019
更新日期:2020-08-12 00:00:00
abstract::Bicycle ergometry (non-weight-bearing exercise) and treadmill (weight-bearing exercise) were compared to assess physiologic responses to similar work loads. A total of 22 subjects at 29.3 +/- 1.6 (+/- SEM) weeks' gestation who performed non-weight-bearing exercise were compared with 15 similarly fit subjects at 26.1 +...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90905-8
更新日期:1989-12-01 00:00:00
abstract::The premenstrual syndrome (PMS) is a major clinical entity afflicting a large segment of the female population. Available information are descriptive in nature and the etiology of this syndrome remains unclear. In this review, both biochemical and psychosocial elements of the syndrome have been explored in an effort t...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/0002-9378(81)90417-8
更新日期:1981-01-01 00:00:00
abstract:OBJECTIVE:We sought to determine whether sacrospinous uterosacral ligament fixation restores the uterus to its normal anatomic position, preserving uterine function and allowing future childbearing. STUDY DESIGN:This study was undertaken at two separate medical centers. Women with symptomatic uterovaginal prolapse who...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(93)90689-g
更新日期:1993-06-01 00:00:00
abstract::We first performed a vaginosonic scan and then determined the serum human chorionic gonadotropin (beta-hCG) concentration (Second International Standard) in 52 women at an early gestational age to establish criteria for the earliest possible identification of an intrauterine pregnancy by this new ultrasound technique....
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90039-7
更新日期:1988-03-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine the status of screening for fetal Down syndrome in the United States in 1992. STUDY DESIGN:Information was sought from laboratories participating in two proficiency testing programs. RESULTS:The 301 responding laboratories (98%) annually provided services to 2,113,000 pregnant w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(93)90436-m
更新日期:1993-12-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to quantify the risk for anal incontinence and difficult defecation among women with prolapse by comparing them with women without prolapse of similar age, body mass index, race, and hysterectomy status, and to determine whether there are characteristics or findings in women with...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.03.074
更新日期:2007-11-01 00:00:00
abstract::Abnormal uterine bleeding is often the presenting complaint in women with underlying coagulopathies. A clear understanding of the pathophysiology of common bleeding disorders will help the practicing obstetrician/gynecologist in the diagnosis and treatment of these conditions. The normal hemostatic process can be divi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/s0002-9378(96)80083-4
更新日期:1996-09-01 00:00:00
abstract::The management of 430 diabetic pregnancies is presented. Our protocol emphasized "tight" metabolic control and assessment of fetal well-being by antepartum fetal heart rate testings and estriol levels. Spontaneous labor was allowed in uncomplicated Class A diabetic patients. Labor in complicated cases and insulin-depe...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(85)90341-2
更新日期:1985-12-01 00:00:00
abstract::Supernatants from isolated trophoblast cell cultures (trophoblastic fluid) derived from first-trimester human placentas were assessed for immunoregulatory activity. Trophoblastic fluid at different days of culture consistently inhibited the blast transformation of allogenic lymphocytes. This suppressor effect had no a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90540-1
更新日期:1989-08-01 00:00:00
abstract:OBJECTIVE:To investigate if a synthetic, biodegradable scaffold with either autologous in vitro cultured muscle-derived cells or autologous fresh muscle fiber fragments could be used for tissue repair. STUDY DESIGN:Twenty scaffolds with muscle-derived cells and 20 scaffolds with muscle fiber fragments were implanted s...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2011.04.020
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:Age-related decline in reproductive potential is mainly due to the increased incidence of aneuploidy. Furthermore, 2 recent studies have shown that euploid embryos of older women may have a lower implantation potential compared to those of younger women, suggesting that aging might compromise embryos beyond ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2018.11.1103
更新日期:2019-04-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to describe the assessment of lower segment uterine scar (LSCS) by transvaginal ultrasound (TVUS) during a first-trimester scan. STUDY DESIGN:Patients with a history of LSCS were prospectively enrolled over a 6 month period. Four groups were defined: type 1A, thin scar within c...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/j.ajog.2011.06.104
更新日期:2011-12-01 00:00:00
abstract::We have extended our evaluation of the effects of three beta-adrenergic agents in near-term pregnant sheep to include a period of infusion three times longer than previously studied. This extension has provided the following information: (1) Initial depression of uterine blood flow and mean arterial pressure associate...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(77)90708-6
更新日期:1977-08-01 00:00:00
abstract::Production of a biologically active prolactin by human decidual tissue and its influence on the permeability of amniochorion to water suggests a functional relationship between the polypeptide and fetal membrane metabolism. Under in vitro circumstances, we used ovine prolactin and the Ussing chamber technique to deter...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(85)90375-8
更新日期:1985-04-15 00:00:00
abstract:BACKGROUND:In contemporary practice many nulliparous women require intervention during childbirth such as operative vaginal delivery or cesarean delivery (CD). Despite the knowledge that the increasing rate of CD is associated with increasing maternal age, obesity and larger infant birthweight, we lack a reliable metho...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2017.02.017
更新日期:2017-06-01 00:00:00
abstract::A randomized controlled study was carried out at three medical centers to compare the efficacy and side effects of ethanol and ritodrine in the treatment of threatened premature labor. One hundred and thirty-five patients judged to be between the twentieth and thirty-sixth week of gestation and presenting with clinic...
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:10.1016/0002-9378(77)90115-6
更新日期:1977-04-15 00:00:00
abstract::The responsiveness of the pituitary to luteinizing hormone releasing hormone (LRH) during pregnancy and the puerperium was studied in 15 women 18-32 years of age (3 puerperal, 6 pregnant, and 6 eumenorrheic). 25 mcg LRH dissolved in 1 ml sterile water was administered iv to all the subjects. Blood samples were obtai...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(74)90145-8
更新日期:1974-12-15 00:00:00
abstract:OBJECTIVE:The objective of the study was to determine the amniotic fluid soluble intercellular adhesion molecule-1 concentrations in women with preterm labor in relation to intra-amniotic infection. STUDY DESIGN:Amniotic fluids from 125 women with preterm labor (78 with preterm delivery and 47 with term deliveries) we...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.05.020
更新日期:2006-12-01 00:00:00
abstract::The therapeutic effectiveness of the carbon dioxide laser was evaluated in 43 pregnant women with extensive urogenital and anal condylomas. All patients received one treatment and were followed up for an average of 9 months after delivery. Laser failures (persistent disease) and recurrences (new disease) were stratifi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(84)80024-1
更新日期:1984-01-01 00:00:00
abstract::In a previous study, it was suggested that the presence of a grade III placenta correlates 100% with a mature lecithin/sphingomyelin (L/S) ratio and may replace amniocentesis in confirming fetal lung maturity. In this study that hypothesis was tested in 563 pregnancies. All patients underwent amniocentesis and simulta...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(82)90478-1
更新日期:1982-08-15 00:00:00
abstract:OBJECTIVE:Our purpose was to determine whether RU 486 (mifepristone) has direct estrogenic activity in uterine myocytes. STUDY DESIGN:Ovariectomized adult rats were treated with RU 486, and its effect on uterine oxytocin receptor concentration, as a marker of estrogenic activity, was measured. Results were compared wi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)90181-7
更新日期:1995-07-01 00:00:00
abstract:OBJECTIVE:There is an imbalance of increased thromboxane and decreased prostacyclin in placentas of women with preeclampsia, but this may not be the only imbalance. There is also an abnormal increase in serum lipid peroxides in preeclamptic women. Lipid peroxides are toxic compounds that damage cells and inhibit prosta...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(12)80017-2
更新日期:1992-10-01 00:00:00
abstract:BACKGROUND:Only 64% of obstetrics and gynecology program directors report routine, scheduled training in abortion, despite the Accreditation Council for Graduate Medical Education's requirements for routine training. Most report that exposure to training is limited to specific clinical circumstances. OBJECTIVE:We soug...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2019.04.026
更新日期:2019-08-01 00:00:00