Abstract:
:Urinary tract infections are the most common outpatient infections, but predicting the probability of urinary tract infections through symptoms and test results can be complex. The most diagnostic symptoms of urinary tract infections include change in frequency, dysuria, urgency, and presence or absence of vaginal discharge, but urinary tract infections may present differently in older women. Dipstick urinalysis is popular for its availability and usefulness, but results must be interpreted in context of the patient's pretest probability based on symptoms and characteristics. In patients with a high probability of urinary tract infection based on symptoms, negative dipstick urinalysis does not rule out urinary tract infection. Nitrites are likely more sensitive and specific than other dipstick components for urinary tract infection, particularly in the elderly. Positive dipstick testing is likely specific for asymptomatic bacteriuria in pregnancy, but urine culture is still the test of choice. Microscopic urinalysis is likely comparable to dipstick urinalysis as a screening test. Bacteriuria is more specific and sensitive than pyuria for detecting urinary tract infection, even in older women and during pregnancy. Pyuria is commonly found in the absence of infection, particularly in older adults with lower urinary tract symptoms such as incontinence. Positive testing may increase the probability of urinary tract infection, but initiation of treatment should take into account risk of urinary tract infection based on symptoms as well. In cases in which the probability of urinary tract infection is moderate or unclear, urine culture should be performed. Urine culture is the gold standard for detection of urinary tract infection. However, asymptomatic bacteriuria is common, particularly in older women, and should not be treated with antibiotics. Conversely, in symptomatic women, even growth as low as 102 colony-forming unit/mL could reflect infection. Resistance is increasing to fluoroquinolones, beta-lactams, and trimethoprim-sulfamethoxazole. Most uropathogens still display good sensitivity to nitrofurantoin. First-line treatments for urinary tract infection include nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole (when resistance levels are <20%). These antibiotics have minimal collateral damage and resistance. In pregnancy, beta-lactams, nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole can be appropriate treatments. Interpreting the probability of urinary tract infection based on symptoms and testing allows for greater accuracy in diagnosis of urinary tract infection, decreasing overtreatment and encouraging antimicrobial stewardship.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Chu CM,Lowder JLdoi
10.1016/j.ajog.2017.12.231subject
Has Abstractpub_date
2018-07-01 00:00:00pages
40-51issue
1eissn
0002-9378issn
1097-6868pii
S0002-9378(17)32805-3journal_volume
219pub_type
杂志文章,评审abstract:OBJECTIVE:The purpose of this study was to examine the relationship between gestational age and outcomes of outborn versus inborn preterm infants. STUDY DESIGN:Multivariable logistic regression analysis was used to examine gestational age-specific, risk-adjusted outcomes of 2962 singleton infants who were born at <32 ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2003.139
更新日期:2003-03-01 00:00:00
abstract::Postpartum hemorrhage with concurrent massive inferior epigastric artery bleeding after cesarean delivery is unusual. In the current case, besides embolization of the bilateral hypogastric arteries, recognition and successful embolization of a clinically overlooked active bleeding source in the abdominal wall was cruc...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.122417
更新日期:2002-07-01 00:00:00
abstract::The object of this randomized study was to compare the safety and efficacy of oral ofloxacin, 400 mg twice daily for 10 days, versus intramuscular cefoxitin, 2 gm, plus oral probenecid, 1 gm, followed by oral doxycycline, 100 mg twice daily for 10 days, in the outpatient treatment of uncomplicated acute salpingitis. T...
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(91)91479-g
更新日期:1991-05-01 00:00:00
abstract::Glycosylated hemoglobin and glycosylated serum protein have been suggested as tools for evaluation of long- and short-term glycemic control, respectively. Twenty-six patients with gestational diabetes were prospectively studied to determine the relationship of glycosylated hemoglobin and glycosylated serum protein to ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80032-7
更新日期:1987-09-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to compare cardiac dynamics of high-risk and low-risk fetuses using beat to beat variability. STUDY DESIGN:This study obtained 214 fetal magnetocardiography recordings from a group of high-risk fetuses with maternal conditions associated with placental insufficiency with the ris...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.02.017
更新日期:2007-06-01 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:To assess the effectiveness of inner thigh "Taping" compared with "Traction" using a weighted bag when an intracervical Foley catheter is used for cervical ripening. STUDY DESIGN:We performed a randomized controlled trial at a tertiary hospital on women with a singleton pregnancy in cephalic presentation adm...
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.2013.05.028
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to evaluate the following: (1) pregnancy outcome after blunt abdominal trauma and (2) factors that may predict preterm birth and adverse peripartum outcomes. STUDY DESIGN:All women who had noncatastrophic abdominal trauma and came to the labor and delivery suite July 1994-August 1997...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(98)70121-8
更新日期:1998-11-01 00:00:00
abstract::Behavioral states in the near-term human fetus have been described during pregnancy. The aim of this study was to observe whether these same states are present during labor. Nine patients with uncomplicated singleton pregnancies participated. Fetal heart rate and uterine contractions were recorded. Fetal eye, mouth, r...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(85)80071-5
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVE:Women with a history of preeclampsia (PE) have an increased prevalence of cardiometabolic, cardiovascular, and prothrombotic risk factors. Remotely, these women are at increased risk of developing cardiovascular and thrombotic disease. Decidual vasculopathy (DV) describes vascular lesions in the maternal spir...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2013.12.029
更新日期:2014-06-01 00:00:00
abstract::To determine the effects of suppressing fetal and maternal adrenal activity on parturition, we treated pregnant rhesus macaques with dexamethasone (0.25 to 4.0 mg, twice a day) from gestation day 130 until delivery (term = 167 days). Long-term dexamethasone treatment increased gestation length: 71% of fetuses were bor...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(83)90841-4
更新日期:1983-04-15 00:00:00
abstract::The activity of polyamine oxidase in human pregnancy serum was measured by our new specific method with radioisotopic N1-acetylspermine as substrate. The activity in pregnancy serum was very low and did not increase during gestation; it was not higher than that in nonpregnancy serum. The high polyamine oxidase activit...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90390-d
更新日期:1991-11-01 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
abstract::To investigate the merits of using psychometric testing as a predictive adjunct to counseling patients in the choice of a contraceptive method, 134 family-planning patients using an oral contraceptive for one year or longer completed the Neuroticism Scale Questionnaire. Clinic records of these patients were examined t...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(76)90016-8
更新日期:1976-01-01 00:00:00
abstract::Sixty percent of neonates with Down syndrome have hypoplasia of the middle phalanx of the fifth digit. We demonstrate this finding sonographically between 17 and 20 weeks' gestation in four of five fetuses with Down syndrome. The appearance of this abnormal phalanx as well as the abnormal curvature of the fifth digit ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90517-0
更新日期:1988-07-01 00:00:00
abstract:OBJECTIVE:We sought to determine the pregnancy and infant outcomes of women with gestational diabetes who attempted vaginal birth after previous cesarean delivery. STUDY DESIGN:We conducted a retrospective cohort study to compare women with gestational diabetes with matched control subjects without diabetes who attemp...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.115176
更新日期:2001-05-01 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:OBJECTIVE:The purposes of this study were to assess the risk of malignant cell dissemination into the peritoneal cavity through the fallopian tubes in patients with endometrial carcinoma undergoing sonohysterography and to evaluate the accuracy of sonohysterography in the estimation of myometrial invasion by the tumor ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.08.036
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVE:Many obstetric interventions are performed to improve long-term neonatal outcome. However, long-term neonatal outcome is usually not a primary outcome because it is time-consuming and expensive. The aim of this project was to identify different perinatal risk indicators and to develop prediction models for ne...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2011.02.055
更新日期:2011-05-01 00:00:00
abstract::Twelve normal parturients were studied with a continuous wave Doppler unit to assess changes in uterine and umbilical velocity waveforms during labor. The analysis of these waveforms included the peak systolic/end-diastolic ratio and the evaluation of a diastolic notch. Each woman served as her own control, and all fe...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80342-3
更新日期:1987-07-01 00:00:00
abstract::To assess the effect of endogenous human atrial natriuretic peptide on the vascular system in preeclampsia, the circadian variations of plasma human atrial natriuretic peptide, cyclic guanosine 3'5'-monophosphate, cyclic adenosine 3'5'-monophosphate, and blood pressure were measured. In severe preeclamptic women, the ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90110-5
更新日期:1989-01-01 00:00:00
abstract::The cancer antigen CA 125 is manifest by serous cystadenocarcinoma of the ovary and to a lesser extent by other gynecologic and nongynecologic tumors. Its presence was screened for in normal human fetal tissues and fluids. Appreciable quantities of CA 125 were discovered in amniotic fluid by both a dot blot assay and ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90076-1
更新日期:1986-07-01 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::Different perspectives toward symptoms of urogenital aging exist among postmenopausal women, influenced by social and cultural factors, but one constant is that women rarely feel able to discuss urogenital problems freely--with their physicians, husbands, or friends. European women >55 years old were brought up to pri...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/s0002-9378(98)70556-3
更新日期:1998-05-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to characterize the anatomy of the internal iliac artery (IIA) and its posterior division branches and to correlate these findings to IIA ligation. STUDY DESIGN:Dissections were performed in 54 female cadavers. RESULTS:Average length of IIA was 27.0 (range, 0-52) mm. Posterior...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.08.063
更新日期:2007-12-01 00:00:00
abstract::To test the hypothesis that prostaglandins mediate the high incidence of postoperative pain in patients undergoing mechanical tubal occlusion, we studied the effect of premedication with a prostaglandin synthetase inhibitor in patients having Falope ring sterilization. Fifty-two women were randomly divided into two gr...
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(85)90006-7
更新日期:1985-01-15 00:00:00
abstract::A total of 1,755 fetal heart rate (FHR) tracings of the second stage of labor was analyzed. The FHR patterns were classified according to the behavior of the baseline FHR and are listed in decreasing order of benignity: normocardia, transitory bradycardia, tachycardia, persistent bradycardia, and progressive bradycard...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(81)90041-7
更新日期:1981-06-15 00:00:00
abstract:OBJECTIVE:Our purpose was to examine the hypothesis that corticosteroids, when administered extraamniotically, can enhance the labor process and reduce the induction-to-delivery interval. STUDY DESIGN:A double-blind, randomized study was conducted on 98 women with a gestational age of 36 to 42 weeks, an unfavorable ce...
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(97)70031-0
更新日期:1997-11-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine whether ultrasonography is more accurate than vaginal examination in the determination of fetal occiput position in the second stage of labor. STUDY DESIGN:Eighty-eight patients in the second stage of labor were evaluated by vaginal examination and by combined trans...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.01.029
更新日期:2004-08-01 00:00:00
abstract::The recent birth of octuplets unleashed a firestorm of publicity, casting a harsh light on the mother and her presumed inadequacies as a parent. It also raised questions about the role of reproductive endocrinologists. Herein we consider 3 aspects of this question: should reproductive endocrinologists consider the eco...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2009.04.053
更新日期:2009-07-01 00:00:00