Abstract:
BACKGROUND:In contrast to conventional laparoscopic sterilization, newer hysteroscopic approaches avoid the need for hospital admission, general anesthesia, and prolonged recovery. However, there are concerns that the feasibility, safety, and efficacy of hysteroscopic sterilization may be lower than established laparoscopic sterilization. OBJECTIVE:We sought to evaluate the outcomes of hysteroscopic sterilization compared with laparoscopic sterilization in routine clinical practice in a comparative observational cohort study. STUDY DESIGN:This study was carried out at University of Birmingham, United Kingdom, National Health Service teaching hospital, office hysteroscopy clinics, and day-case hospital unit. In all, 1085 women underwent hysteroscopic sterilization and 2412 had laparoscopic sterilization. Hysteroscopic sterilization was carried out using the tubal implant permanent birth control system in the office setting and laparoscopic sterilization using the tubal ligation system as a day-case under general anesthesia. Outcome data were collected regarding feasibility (technical completion of the sterilization procedure, satisfactory radiological confirmation at 3 months-hysterosalpingogram or transvaginal pelvic ultrasound scan), safety events within 30 days of procedures, reoperations, and unintended pregnancies within 1 year of procedures. RESULTS:Hysteroscopic sterilization was successful in 992/1085 (91.4%; 95% confidence interval, 89.6-93.0%) at the first attempt. In comparison, bilateral tubal ligation was successfully performed in 2400/2412 (99.5%; 95% confidence interval, 99.2-99.8%) of patients who underwent laparoscopic sterilizations (odds ratio, 18.8; 95% confidence interval, 10.2-34.4). In all, 902/1085 (83.1%; 95% confidence interval, 80.8-85.2%) of successfully performed hysteroscopic procedures attended for radiological confirmation testing were considered satisfactory. The rate of adverse events within 30 days were similar: 2/1085 (0.2%) vs 3 (0.12%; 95% confidence interval, 0.04-0.36%). There were 3/1085 (0.3%; 95% confidence interval, 0.1-0.8%) unintended pregnancies after hysteroscopic sterilization compared with 5/2412 (0.2%; 95% confidence interval, 0.1-0.5%) laparoscopic sterilization (odds ratio, 1.3; 95% confidence interval, 0.3-5.6). Median length of follow-up for pregnancy outcome was 5 years. Hysteroscopic sterilization was associated with a higher risk of reoperation at 1 year compared to laparoscopic sterilization (odds ratio, 6.2; 95% confidence interval, 2.8-14.0) and the commonest reintervention was unilateral salpingectomy (12/22, 54.5%). CONCLUSION:Hysteroscopic sterilization has been introduced as a more convenient, office-based method of permanent fertility control. However, while the small risk of unintended pregnancy is comparable to conventional laparoscopic sterilization, women should also be counselled regarding its lower success rate in successfully completing the procedure and its higher rate of failed reoperation.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Antoun L,Smith P,Gupta JK,Clark TJdoi
10.1016/j.ajog.2017.07.011subject
Has Abstractpub_date
2017-11-01 00:00:00pages
570.e1-570.e6issue
5eissn
0002-9378issn
1097-6868pii
S0002-9378(17)30853-0journal_volume
217pub_type
杂志文章abstract:BACKGROUND:While research has demonstrated increasing risk for severe maternal morbidity in the United States, risk at lower volume hospitals remains poorly characterized. More than half of all obstetric units in the United States perform <1000 deliveries per year and improving care at these hospitals may be critical t...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2016.10.029
更新日期:2017-02-01 00:00:00
abstract::Clostridium sordellii is a common soil and enteric bacterium that is infrequently recovered from the vagina. We describe three women in which C. sordellii caused puerperal infection and a distinctive and lethal toxic shock-like syndrome. Patients were less than 1 week post partum and each had a single, limited focus o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90768-0
更新日期:1989-10-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to explore the association between glycosylated hemoglobin concentrations during pregnancy and macrosomia. STUDY DESIGN:One hundred thirty-six pregnancies in 120 women with type 1 or type 2 diabetes were studied longitudinally between January 1, 1991, and December 31, 1996. Glycosyl...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70460-6
更新日期:1999-07-01 00:00:00
abstract::Fecundity has been extended to the menopause by advances in assisted reproductive techniques. The incidence of ovarian cancer increases with age, and an increased risk of ovarian cancer has been associated with incessant ovulation and infertility. The increased risk of ovarian cancer in older infertility patients must...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(94)90164-3
更新日期:1994-11-01 00:00:00
abstract::Impairment of umbilical cord blood flow has been associated with periodic fetal heart rate changes termed "variable decelerations." These patterns may be observed after amniotomy. A chronic fetal rhesus monkey preparation has been used to investigate this clinical observation. Loss of amniotic fluid produced variable ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(76)90549-4
更新日期:1976-10-01 00:00:00
abstract::Patients with prolonged decelerations after bupivacaine epidural anesthesia were matched with control patients. It was found that there were no differences in the decrease in mean arterial blood pressure after epidural anesthesia between those with prolonged decelerations (5 +/- 9 mm Hg) and those without (5 +/- 9 mm ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)91073-l
更新日期:1990-09-01 00:00:00
abstract::The Reproductive Sciences Branch of the National Institutes of Child Health and Human Development has created pioneering new research and research training programs that address the impending shortage of physician-scientists in obstetrics, gynecology, and women's health and the need to bolster translational and clinic...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.125896
更新日期:2002-10-01 00:00:00
abstract::Seventeen pregnant rabbits were studied under conscious, unstressed conditions after catheterization of the right ventricle (RV), a femoral artery (A), and a uterine vein (UV). Respiratory gas tensions, pH, and oxygen saturations and contents were determined serially throughout the latter half of gestation. The uterin...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(85)80054-5
更新日期:1985-07-15 00:00:00
abstract:OBJECTIVE:We sought to estimate the risk of large for gestational age (LGA) across categories of glucose tolerance. STUDY DESIGN:In a cohort of 89,141 participants, women without gestational diabetes mellitus (GDM) were categorized by their screening and diagnostic test results; those with GDM were categorized as meet...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2010.10.907
更新日期:2011-03-01 00:00:00
abstract:OBJECTIVE:To compare postoperative pain after laparoscopic and vaginal hysterectomy for benign disease.
STUDY DESIGN:A prospective randomized trial was designed to compare laparoscopic hysterectomy and vaginal hysterectomy in patients with uterine volume journal_title:American journal of obstetrics and gynecology pub_type: 杂志文章,随机对照试验 doi:10.1016/j.ajog.2010.04.026 更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:To define the incidence of hypoglycemia and identify risk factors in neonates from term, singleton, nondiabetic pregnancies. STUDY DESIGN:We conducted a matched case-control study of term, singleton infants weighing more than 2500 g in nondiabetic pregnancies. Cases with hypoglycemia (glucose < 50 mg/dL) wer...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.10.015
更新日期:2009-05-01 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::The influence of caffeine and cigarette consumption on fetal growth during pregnancy was studied retrospectively in 913 newborn infants. Analysis of variance was adjusted for length of gestation and sex. A significant caffeine-cigarette interaction was found on birth weight (F = 85.4, p less than 0.01). Among women sm...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80301-0
更新日期:1987-11-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to investigate the effect of plasma volume expansion on the pulsatility indices of the fetal umbilical and middle cerebral arteries. STUDY DESIGN:Two hundred sixteen patients with severe preeclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, ec...
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/j.ajog.2004.06.061
更新日期:2005-01-01 00:00:00
abstract::From late 1970 through December 1987, 580 women began 733 treatment programs (a total of 3405 insemination cycles) with fresh semen for artificial insemination by donor. The unadjusted pregnancy rate was 48.5% and the cumulative pregnancy rate after seven cycles by life-table analysis was 59.6% with a monthly fecundab...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90910-y
更新日期:1990-06-01 00:00:00
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 w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.127132
更新日期:2002-11-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the effect of preterm premature rupture of the membranes on the frequency of respiratory distress syndrome among singleton pregnancies that are complicated with preterm delivery. STUDY DESIGN:We performed a retrospective analysis of singleton pregnancies that were de...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.126203
更新日期:2002-08-01 00:00:00
abstract:OBJECTIVE:A depressed skull fracture is an inward buckling of the calvarial bones and is referred to as a "ping-pong" fracture. This study aimed to look at differences between "spontaneous" and "instrument-associated" depressed skull fractures. STUDY DESIGN:This retrospective, case-control analysis included every neon...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2004.06.035
更新日期:2005-01-01 00:00:00
abstract:OBJECTIVE:The basic mechanisms responsible for human parturition remain to be elucidated. The influx of fetal leukocytes into the myometrium has been recently proposed to be a crucial event in the onset of murine parturition. Surfactant protein-A has been implicated in the initiation of labor. In mice, it is thought th...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.06.052
更新日期:2006-09-01 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::The addition of ovine prolactin (oPRL) to the fetal side of human term amnion in vitro is associated with a decrease in membrane permeability to tritiated water (THO). As the concentration of oPRL is increased from 2.5 to 20.0 micrograms per milliliter, permeability is progressively impaired. The addition of a specifi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1979-02-15 00:00:00
abstract:OBJECTIVE:This study was undertaken to assess the utility of the Advanced Life Support in Obstetrics Course for obstetrics/gynecology first-year residents by triangulating pretest and posttest scores on written test of knowledge by interns, with qualitative surveys by residents, and faculty. STUDY DESIGN:Obstetrics/gy...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.10.912
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to identify correlates of perceived risk of carrying a Down syndrome-affected fetus or experiencing a procedure-related miscarriage among a diverse group of pregnant women. STUDY DESIGN:We conducted a cross-sectional survey of 1081 English-, Spanish-, or Chinese-speaking women ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.09.045
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVE:The molecular mechanisms underlying ectopic implantation have not been well characterized. Here we investigate HOXA10 gene expression at the site of ectopic implantation as compared with the endometrium and with the normal fallopian tube. STUDY DESIGN:Northern blot analysis was used to evaluate HOXA10 gene m...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.01.066
更新日期:2004-05-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to assess the effectiveness of presacral neurectomy in women with severe dysmenorrhea caused by endometriosis that was treated with conservative surgical intervention. STUDY DESIGN:One hundred forty-one sexually active women of fertile age with chronic severe dysmenorrhea caused...
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.2003.358
更新日期:2003-07-01 00:00:00
abstract:OBJECTIVE:Our purpose was to investigate the levels of very-low-density lipoprotein and low-density lipoprotein receptor messenger ribonucleic acid expression in placentas obtained from normal pregnant women at various gestational stages and from patients with preeclampsia. STUDY DESIGN:The relative level of expressio...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(96)70105-9
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to estimate the outcomes of uterine embolization and hysterectomy for uterine leiomyomas. Study design This was a multicenter prospective study of patients who were treated with embolization (n=102 patients) and hysterectomy (n=50 patients) for leiomyomas. Changes in symptoms, co...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/j.ajog.2004.03.037
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:Our purpose was to describe subsequent pregnancy outcome and long-term maternal prognosis in women with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) during the index pregnancy. STUDY DESIGN:This is a descriptive and analytic study of women with HELLP syndrome admitted to E.H. Crump W...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)90099-3
更新日期:1995-01-01 00:00:00
abstract:OBJECTIVE:We wished to determine third-year medical students' opinions and knowledge related to complementary and alternative medicine (CAM) in a school with no formal or elective course on the subject. STUDY DESIGN:A questionnaire was offered to third-year medical students during their 8-week rotation on obstetrics a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.117484
更新日期:2001-09-01 00:00:00
abstract::Substance P is a neuropeptide that has been identified in the ovary, fallopian tube, uterus, and vagina and in the hypothalamic-pituitary axis in both an animal model and human ovaries. We sought to determine if substance P is present in peritoneal fluid and, if so, whether it correlated with the cause of infertility....
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(92)91852-2
更新日期:1992-01-01 00:00:00