Abstract:
OBJECTIVE:We examined trends in overall and preoperative urodynamics utilization among women with stress urinary incontinence (SUI) to determine if practice patterns changed following publication of a 2012 randomized trial questioning the value of preoperative urodynamics in patients with uncomplicated SUI. STUDY DESIGN:We collected electronic medical record data on the number of female patient visits to Kaiser Permanente Southern California urology and urogynecology clinics with stress or mixed incontinence, urodynamic studies (UDS) performed, surgeries performed for stress incontinence, and the demographic and clinical characteristics of these patients during 2 discrete time periods before and after a potentially practice-changing publication. We used χ(2) tests and t tests as appropriate. A multivariate logistic regression model was used to estimate the odds of urodynamics performed during January 2013 through June 2014 (study period 2) compared to urodynamics performed during July 2010 through December 2011 (study period 1) after adjustment for demographic and clinical characteristics. RESULTS:In all, 33,775 women were diagnosed as having SUI or mixed urinary incontinence during study period 1 and 37,238 women were diagnosed with these conditions during study period 2. Among these women 12.8% underwent UDS in study period 1 compared to 8.4% in study period 2 (P < .01). The rate of UDS per patient visit decreased 27.0% between the 2 time periods (P < .01). In women undergoing surgery for stress incontinence, urodynamics were performed 56.5% of the time in study period 1 and 46.5% of the time in study period 2. After controlling for demographic, pelvic organ prolapse, and other bladder diagnoses, the odds of urodynamics performed in study period 2 was 0.54 times the odds of urodynamics performed in study period 1 (95% confidence interval, 0.52-0.57). Among women with only the diagnosis of stress incontinence, 1.78% underwent urodynamics in study period 1 compared with 0.84% in study period 2 (P < .01). Preoperative urodynamics decreased from 39% in study period 1 to 20% in study period 2 (P < .01). CONCLUSION:Significantly fewer UDS are being performed overall and prior to stress incontinence surgery in this population. This change may be due to recent studies suggesting low utility of urodynamics in patients with uncomplicated, stress-dominant incontinence.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Lippmann QK,Diwadkar GB,Zhou H,Menefee SAdoi
10.1016/j.ajog.2015.06.062subject
Has Abstractpub_date
2015-11-01 00:00:00pages
724.e1-6issue
5eissn
0002-9378issn
1097-6868pii
S0002-9378(15)00711-5journal_volume
213pub_type
杂志文章abstract::The National Institutes of Health funding for reproductive sciences research, specifically in academic departments of obstetrics and gynecology, is disproportionately low. Research is one of the most important pillars in advancing healthcare. Despite US Congress' vision in providing increased funding to the National I...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2020.03.022
更新日期:2020-07-01 00:00:00
abstract::During a 20 month period, 110 women with gonococcal pelvic inflammatory disease an 165 women with uncomplicated gonorrhea were provided intensive case-finding services (interviewing of patients and tracing of contacts). Approximately three contacts per case were investigated, and 24.3% of the 859 male contacts were in...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)91116-3
更新日期:1980-12-01 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:OBJECTIVE:The purpose of this study was to compare clinical outcome and health related quality of life (HRQOL) 5 years after uterine artery embolization (UAE) or hysterectomy in the treatment of menorrhagia caused by uterine fibroids. STUDY DESIGN:Patients with symptomatic uterine fibroids who were eligible for hyster...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ajog.2010.01.049
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:The bleeding time is one of the most commonly used diagnostic tests to evaluate platelet-related hemorrhagic disorders. Magnesium has been shown in vitro to be a platelet antiaggregant. This study was conducted to evaluate the hypothesis that magnesium sulfate has no effect on the template bleeding time. STU...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)91363-7
更新日期:1995-10-01 00:00:00
abstract:OBJECTIVE:We assessed the screening and remediation of home lead hazards prenatally in a high-risk population, hypothesizing that average blood-lead level and the number of poisonings would drop by 25%. STUDY DESIGN:One hundred fifty-two women underwent prenatal home inspections by certified lead inspectors. The hazar...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2012.01.001
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVE:Absent end-diastolic blood flow in the umbilical artery identifies growth-restricted fetuses at high risk of perinatal mortality and severe morbidity. We explored antenatal variables predictive of perinatal mortality or severe neonatal morbidity in such fetuses. STUDY DESIGN:We accessed a cohort of 39 single...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.07.032
更新日期:2005-09-01 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:OBJECTIVE:The purpose of this study was to examine whether women with one elevated value of the 3-hour glucose tolerance test are at increased risk for adverse perinatal outcomes. STUDY DESIGN:This was a retrospective cohort study of singleton pregnancies that were screened for gestational diabetes mellitus with the u...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.01.028
更新日期:2006-05-01 00:00:00
abstract:OBJECTIVE:We hypothesized that diagnostic approaches to lower genital tract infections are inaccurate and proposed this study to evaluate typical approaches. STUDY DESIGN:Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with genital complaints. Laboratory t...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2004.02.015
更新日期:2004-04-01 00:00:00
abstract::The daily symptom records of 150 untreated women with a convincing history of the premenstrual syndrome were investigated qualitatively and quantitatively by means of time series analysis in the form of Trigg's technique for trends. Symptoms were monitored with use of a modified menstrual distress questionnaire. Analy...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90808-2
更新日期:1986-08-01 00:00:00
abstract::A severely Rh-isoimmunized pregnancy is described in which an intrauterine transfusion of blood was given by the intravascular route directly into an umbilical vessel. Fetoscopy was not used, and the procedure was performed percutaneously under direct ultrasound visualization. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90613-7
更新日期:1986-03-01 00:00:00
abstract::Lidocaine was recently found to rapidly cross the placenta and result in considerable fetal exposure after local infiltration of the perineum for episiotomy. For this reason, a more appropriate agent for local perineal infiltration might be a drug with rapid metabolism and inactive metabolites. 2-Chloroprocaine, an es...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80313-7
更新日期:1987-11-01 00:00:00
abstract:OBJECTIVE:The objectives of this study were to determine whether insulin autoantibodies are present in umbilical cord blood from normal pregnancies, determine whether cord blood insulin autoantibody levels correlate with respective maternal levels at delivery, determine whether cord blood insulin autoantibody levels ar...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)90445-x
更新日期:1995-12-01 00:00:00
abstract::The risk of infection from puerperal tubal ligation is studied 1, 2, 3, and 5 days postpartum. Aliquots of 52 oviduct homogenates and 26 endometrial saline aspirates were cultured in serum. PPLO, tryptic soy, and thioglycolate broth, and blood, PPLO, and chocolate agar. A Brown and Brenn Gram stain was run on ovidu...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(16)33944-8
更新日期:1970-06-15 00:00:00
abstract:OBJECTIVE:The purpose of this study was to identify differences in antepartum uterine contraction frequency (UCF) in twin pregnancies with and without preterm labor (PTL). STUDY DESIGN:Twin gestations enrolled for outpatient surveillance with twice daily electronic uterine activity monitoring and telephonic nursing as...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.10.781
更新日期:2008-05-01 00:00:00
abstract::The present investigation was designed to reassess the fractional postcoital test (PCT). Specifically, the study addressed the question of whether the internal cervical mucus sperm count is significantly different from the sperm counts at other cervical levels. By means of standardized methodology, 25 normal postcoita...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(79)90056-5
更新日期:1979-02-15 00:00:00
abstract:BACKGROUND:Pelvic organ prolapse is common, but the underlying etiologies are poorly understood, which limits our current prevention and treatment options. OBJECTIVE:Our primary objective was to compare the uterosacral ligament histologic features in women with and without prolapse using the novel pelvic organ prolaps...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2020.10.040
更新日期:2021-01-01 00:00:00
abstract::After treatment with human gonadotropins, 289 anovulatory women with apparently normal fallopian tubes became pregnant 379 times. Ten ectopic pregnancies in nine women were diagnosed, for an incidence of 2.7% of all conceptions. All the ectopic pregnancies were found in the fallopian tubes. Four patients had also an i...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(82)90006-0
更新日期:1982-08-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine whether women with polycystic ovary syndrome have greater subclinical atherosclerosis as measured by carotid artery ultrasonography. STUDY DESIGN:Sixteen premenopausal women > or = 40 years old with a history of clinical polycystic ovary syndrome and a current total testosterone ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(96)70665-8
更新日期:1996-04-01 00:00:00
abstract:BACKGROUND:Planned home births have leveled off in the United States in recent years after a significant rise starting in the mid-2000s. Planned home births in the United States are associated with increased patient-risk profiles. Multiple studies concluded that, compared with hospital births, absolute and relative ris...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2020.01.045
更新日期:2020-08-01 00:00:00
abstract::The placentas of five mothers with severe preeclampsia who gave birth to moderately growth-retarded term infants were compared to a group of placentas collected from mothers who had uncomplicated pregnancies and normal term infants who were appropriate for gestational age. This study demonstrated that, on a quantitati...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(85)80170-8
更新日期:1985-05-01 00:00:00
abstract::We have investigated the effect of 17beta-estradiol on lung surfactant production in the fetal rabbit. Pregnant rabbits were administered intramuscularly 75microgram of 17beta-estradiol per day at 25 and 26 days' gestation. Control rabbits were similarly injected with the solvent only. At 27 days' gestation the fetuse...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(79)90479-4
更新日期:1979-01-15 00:00:00
abstract::Although previous studies have suggested that the breech infant weighing less than 1,500 gm benefits from cesarean section, the published results have not demonstrated statistically significant differences. We have evaluated pediatric outcome data for 240 breech infants and 525 vertex infants who weighed less than 1,5...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(83)90807-4
更新日期:1983-07-01 00:00:00
abstract::Cervical cultures of 2013 consecutive obstetric patients with no history of genital herpes simplex virus infection were used to determine the frequency of asymptomatic herpes simplex virus shedding in labor. Four (0.20%) of these patients had positive cultures. None of the exposed neonates developed clinical evidence ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90034-8
更新日期:1988-03-01 00:00:00
abstract::Intrapartum fetal scalp blood pH studies remain controversial in obstetrics. Electronic fetal monitoring, by contrast, has achieved nearly uniform acceptance. Controlled comparative studies from one institution are unlikely to provide adequate numbers. Intrapartum fetal monitoring is used consistently at our instituti...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(84)90233-3
更新日期:1984-06-01 00:00:00
abstract::In pregnancy a decrease in fibrinolytic activity, which is due to an increase in plasminogen activator inhibitor activity and plasminogen activator inhibitor type 1 and type 2, has been described. Because the placenta is a source of both type 1 and type 2 plasminogen activator inhibitor, we have studied them and other...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90242-j
更新日期:1991-07-01 00:00:00
abstract:OBJECTIVE:We sought to assess blood flow in relation to jugular lymphatic distension in fetuses with increased and normal nuchal translucency (NT). STUDY DESIGN:In all, 72 fetuses with normal NT and 71 fetuses with NT >95th percentile were evaluated. NT size, jugular lymphatic sacs (JLS), jugular vein and ductus venos...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2010.01.054
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:We sought to develop a valid, reliable assessment of intraoperative judgment by residents during gynecologic surgery based on Script Concordance Theory. STUDY DESIGN:This was a multicenter prospective study involving 5 obstetrics and gynecology residency programs. Surgeons from each site generated case scena...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2010.04.010
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVE:The mechanism underlying myometrial quiescence during pregnancy is unknown. Our group has previously shown that during pregnancy myometrial cyclic guanosine monophosphate content rises to several hundred times the nonpregnant levels, only to abruptly decline days before the onset of labor. Cyclic guanosine mo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.107462
更新日期:2000-12-01 00:00:00