Abstract:
BACKGROUND:Mortality associated with cervical cancer is a public health concern for women, particularly in HIV-seropositive women in resource-limited countries. HIV-seropositive women are at a higher risk of high-grade cervical precancer, which can eventually progress to invasive carcinoma as compared to HIV-seronegative women. It is imperative to identify effective treatment methods for high-grade cervical precursors among HIV-seropositive women. OBJECTIVE:Randomized controlled trial data are needed comparing cryotherapy vs loop electrosurgical excision procedure treatment efficacy in HIV-seropositive women. Our primary aim was to compare the difference in the efficacy of loop electrosurgical excision procedure vs cryotherapy for the treatment of high-grade cervical intraepithelial neoplasia (grade ≥2) among HIV-seropositive women by conducting a randomized clinical trial. STUDY DESIGN:HIV-seropositive women (n = 166) aged 18-65 years with histology-proven cervical intraepithelial neoplasia grade ≥2 were randomized (1:1) to cryotherapy or loop electrosurgical excision procedure treatment at a government hospital in Johannesburg. Treatment efficacy was compared using 6- and 12-month cumulative incidence posttreatment of: (1) cervical intraepithelial neoplasia grade ≥2; (2) secondary endpoints of histologic cervical intraepithelial neoplasia grade ≥3 and grade ≥1; and (3) high-grade and low-grade cervical cytology. The study was registered (ClinicalTrials.govNCT01723956). RESULTS:From January 2010 through August 2014, 166 participants were randomized (86 loop electrosurgical excision procedure; 80 cryotherapy). Cumulative cervical intraepithelial neoplasia grade ≥2 incidence was higher for cryotherapy (24.3%; 95% confidence interval, 16.1-35.8) than loop electrosurgical excision procedure at 6 months (10.8%; 95% confidence interval, 5.7-19.8) (P = .02), although by 12 months, the difference was not significant (27.2%; 95% confidence interval, 18.5-38.9 vs 18.5%; 95% confidence interval, 11.6-28.8, P = .21). Cumulative cervical intraepithelial neoplasia grade ≥1 incidence for cryotherapy (89.2%; 95% confidence interval, 80.9-94.9) did not differ from loop electrosurgical excision procedure (78.3%; 95% confidence interval, 68.9-86.4) at 6 months (P = .06); cumulative cervical intraepithelial neoplasia grade ≥1 incidence by 12 months was higher for cryotherapy (98.5%; 95% confidence interval, 92.7-99.8) than loop electrosurgical excision procedure (89.8%; 95% confidence interval, 82.1-95.2) (P = .02). Cumulative high-grade cytology incidence was higher for cryotherapy (41.9%) than loop electrosurgical excision procedure at 6 months (18.1%, P < .01) and 12 months (44.8% vs 19.4%, P < .001). Cumulative incidence of low-grade cytology or greater in cryotherapy (90.5%) did not differ from loop electrosurgical excision procedure at 6 months (80.7%, P = .08); by 12 months, cumulative incidence of low-grade cytology or greater was higher in cryotherapy (100%) than loop electrosurgical excision procedure (94.8%, P = .03). No serious adverse effects were recorded. CONCLUSION:Although rates of cumulative cervical intraepithelial neoplasia grade ≥2 were lower after loop electrosurgical excision procedure than cryotherapy treatment at 6 months, both treatments appeared effective in reducing cervical intraepithelial neoplasia grade ≥2 by >70% by 12 months. The difference in cumulative cervical intraepithelial neoplasia grade ≥2 incidence between the 2 treatment methods by 12 months was not statistically significant. Relatively high cervical intraepithelial neoplasia grade ≥2 recurrence rates, indicating treatment failure, were observed in both treatment arms by 12 months. A different treatment protocol should be considered to optimally treat cervical intraepithelial neoplasia grade ≥2 in HIV-seropositive women.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Smith JS,Sanusi B,Swarts A,Faesen M,Levin S,Goeieman B,Ramotshela S,Rakhombe N,Williamson AL,Michelow P,Omar T,Hudgens MG,Firnhaber Cdoi
10.1016/j.ajog.2017.03.022subject
Has Abstractpub_date
2017-08-01 00:00:00pages
183.e1-183.e11issue
2eissn
0002-9378issn
1097-6868pii
S0002-9378(17)30460-Xjournal_volume
217pub_type
杂志文章,随机对照试验abstract::In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Maayan-Metzger A, Schushan-Eisen I, Todris L, et al. Maternal hypotension during elective cesarean section and s...
journal_title:American journal of obstetrics and gynecology
pub_type: 评论,杂志文章
doi:10.1016/j.ajog.2009.11.012
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine if the success and safety of vaginal birth after cesarean delivery in a small, isolated, rural hospital compare with those seen in larger centers. STUDY DESIGN:As part of a continuing study, the prenatal and hospital records of all patients with previous cesarean de...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(12)90885-6
更新日期:1993-01-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to identify clinical signs and symptoms associated with detection of human papillomavirus (HPV) DNA in the female genital tract. STUDY DESIGN:A total of 516 university students (18 to 24 years old) enrolled in a cohort study that included the collection of genital specimens for ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2003.164
更新日期:2003-03-01 00:00:00
abstract::Large ovarian cysts are conventionally treated by laparotomy. We describe a technique of transabdominal drainage under ultrasonographic control followed by laparoscopic excision of an ovarian cyst that was 24 x 10 x 20 cm. This approach has the benefits of minimal-access surgery and is suitable for unilocular benign c...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(96)70060-1
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to calculate the prospective risk of fetal death in monochorionic-diamniotic twins. STUDY DESIGN:We evaluated 193 monochorionic diamniotic twin pregnancies that were followed and delivered after 24 weeks. Surveillance included cardiotocography and sonography performed at least o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.01.099
更新日期:2006-07-01 00:00:00
abstract::Multifetal gestation is associated with increased frequency of maternal complications and higher perinatal morbidity and mortality. The need for contemporary data on the outcome of multifetal gestations is further underscored when selective reduction is considered. The present study details the obstetric management, n...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90407-x
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVE:We sought to study midpregnancy placental volume in rural Indian women, its maternal determinants, and its relationship to neonatal size. STUDY DESIGN:We performed a prospective community-based study of maternal nutrition and fetal growth in 6 villages near the city of Pune. Measurements included midpregnanc...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(00)70237-7
更新日期:2000-02-01 00:00:00
abstract::The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Marc I, Rainville P, Masse B, et al. Hypnotic analgesia intervention during first-trimester pregnancy termi...
journal_title:American journal of obstetrics and gynecology
pub_type: 评论,杂志文章
doi:10.1016/j.ajog.2008.09.013
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVE:We sought to compare the perinatal outcomes in twin pregnancies with short cervical length (CL) with ultrasound-indicated cerclage (UIC) vs no cerclage (control). STUDY DESIGN:This was a retrospective cohort study of asymptomatic twin pregnancies with transvaginal ultrasound (TVU) CL ≤25 mm at 16-24 weeks fr...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2015.01.031
更新日期:2015-06-01 00:00:00
abstract::A rapid bedside test has been devised that enables an untrained observer to predict (p less than 0.001) when amniotic fluid will be greater than or equal to 0.15 at an optical density of 650 nm, lecithin/sphingomyelin ratio will be greater than or equal to 2.0, or when phosphatidylglycerol will be present. By a visual...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90366-y
更新日期:1991-11-01 00:00:00
abstract:OBJECTIVE:Our objective was to determine any associations among midtrimester cervical fluid sialidase activity, bacterial vaginosis, and subsequent spontaneous preterm birth. STUDY DESIGN:In this nested case-control study all patients (n = 126) with spontaneous preterm birth at <35 weeks' gestation and selected contro...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70609-5
更新日期:1999-05-01 00:00:00
abstract:OBJECTIVES:This study was designed to evaluate the clinical significance of the Doppler flow velocity waveform analysis of the two uterine arteries on an individual basis and in combination expressed as the mean uterine artery. STUDY DESIGN:We evaluated uterine artery resistance by means of continuous wave Doppler ult...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(92)91683-2
更新日期:1992-02-01 00:00:00
abstract::Immunoreactive gonadotropin-releasing hormone was quantitated in maternal blood. Circulating levels of gonadotropin-releasing hormone were found to be significantly higher during pregnancy than in nonpregnant cycling women. The highest concentrations of gonadotropin-releasing hormone immunoreactivity were observed in ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(84)80142-8
更新日期:1984-10-15 00:00:00
abstract:OBJECTIVE:Ureaplasma colonization in the setting of polymicrobial flora is common in women with chorioamnionitis, and is a risk factor for preterm delivery and neonatal morbidity. We hypothesized that Ureaplasma colonization of amniotic fluid would modulate chorioamnionitis induced by Escherichia coli lipopolysaccharid...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2013.02.018
更新日期:2013-05-01 00:00:00
abstract::Despite advances in diagnostic techniques, endometriosis remains an enigmatic condition. Clinical symptoms and signs often do not correlate with the anatomic stage of the disease, and morphologic characteristics very widely. A definitive diagnosis can be established only by direct visualization, usually by laparoscopy...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90431-6
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVE:We sought to identify modifiable risk factors for excessive gestational weight gain (GWG). STUDY DESIGN:We assessed associations of diet and physical activity with excessive GWG among 1388 women from the Project Viva cohort study. RESULTS:Three hundred seventy-nine women (27%) were overweight (body mass ind...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2009.02.025
更新日期:2009-07-01 00:00:00
abstract::The ability of the calcium antagonist nifedipine to inhibit uterine contractions during labor and in the postpartum period was measured in the ewe. The hemodynamic effects of tocolytic doses of this drug were measured and compared with the hemodynamic effects of equivalent doses of ritodrine. Intravenous nifedipine wa...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(85)90397-7
更新日期:1985-04-15 00:00:00
abstract:OBJECTIVE:Our purpose was to compare operative vaginal and abdominal delivery rates in a large population before and after on-demand labor epidural analgesia became available. STUDY DESIGN:We retrospectively compared patients who gave birth during a 20-month period immediately before the introduction of an on-demand l...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70213-9
更新日期:1999-02-01 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:In 1994, the National Institutes of Health recommended a full course of antenatal corticosteroids (ACS) to women who were at risk of delivery at 24-32 weeks of gestation. In 2010, the Joint Commission on Accreditation of Healthcare Organization incorporated ACS administration rates as a perinatal core quality...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2013.09.024
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:Retinoic acid plays an essential role in epithelial differentiation, and retinoid homeostasis is disrupted in cancers of epithelial origin. The goal of this study was to determine whether hRoDH-4, an enzyme that can catalyze the first and rate-limiting step in retinoic acid biosynthesis, is expressed in norma...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.122127
更新日期:2002-04-01 00:00:00
abstract::Sacral neuromodulation with an implanted device is used in patients who experience urinary retention and malfunctioning overactive bladder where conservative treatment is not sufficient. The knowledge of its effect on pregnancy is not known. This article presents the case of a 34-year-old pregnant woman with an implan...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2014.04.015
更新日期:2014-07-01 00:00:00
abstract::One hundred and fifty-three patients with pelvic endometriosis met the study criteria of inferility, tissue diagnosis, treatment with conservative surgery, and adequate follow-up. The extent of disease was classified according to Acosta and and associates. Pregnancy rates were 10 to 100% in various subclassifications ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(78)90417-9
更新日期:1978-06-15 00:00:00
abstract::Hemorrhagic endovasculitis of the placenta is a distinct vasodestructive process of unknown cause that has been associated with perinatal morbidity and mortality. A relationship between nonimmune hydrops fetalis and hemorrhagic endovasculitis has not been previously described. At a large teaching hospital, six cases o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90445-w
更新日期:1991-10-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine the ability of pregnant women to incorporate sophisticated screening information about risk assessment into their decisions about invasive testing in an appropriate way. STUDY DESIGN:Assessment of risk for trisomy 21 was carried out by a combination of maternal age,...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.02.134
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVE:This study was undertaken to determine whether the frequency of fetal surveillance could be safely reduced from twice weekly to fortnightly in the case of small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry studies. STUDY DESIGN:Pregnant women between 24 and 36 weeks...
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(00)70494-7
更新日期:2000-01-01 00:00:00
abstract::The luteolytic activity of oxymetholone, and anabolic steroid, has been evaluated in 10 women. Administration early in the follicular phase of the cycle inhibited ovulation and prolonged the duration of the cycles in 2 of 3 subjects, but treatment beginning on Day 10 (3 subjects) did not prevent ovulation, although su...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(75)90987-4
更新日期:1975-01-01 00:00:00
abstract::Myometrium was obtained from pregnant volunteers by biopsy of the upper margin of the uterine incision at the time of cesarean section. A multistep enzymatic digestion with collagenase, trypsin, protease, and deoxyribonuclease yielded viable cells capable of contraction. Primary monolayer culture was carried out in th...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90463-2
更新日期:1988-11-01 00:00:00
abstract::Scientific evidence indicates that improving a woman's health before pregnancy will improve pregnancy outcomes. However, for many years, our efforts have focused primarily on prenatal care and on caring for infants after birth. The concept of preconception care has been identified repeatedly as a priority for improvin...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.08.059
更新日期:2008-12-01 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