Abstract:
BACKGROUND:Patients with ovarian cancer tend to receive the highest quality of care at high-volume cancer centers with gynecological oncologists. However, the care that they receive prior to gynecological oncology consult has not been examined. We investigated the quantity and quality of care given to patients with ovarian cancer before being seen by a gynecological oncologist. OBJECTIVE:We evaluated the variability, quantity, and quality of diagnostic testing and physician-referral patterns prior to consultation with a gynecological oncologist, in women with suspicious pelvic masses seen on imaging. STUDY DESIGN:A chart review was performed on patients treated for ovarian cancer at a single institution from 2001 to 2014. We evaluated their workup in 4 categories, drawn from National Comprehensive Care Network guidelines: provider visits, abdominal/pelvic imaging, chest imaging, and tumor markers. Workup was classified as guideline adherent or guideline nonadherent. RESULTS:We identified 335 cases that met our criteria. In the provider visit category, 83.9% of patients received guideline-adherent workup: 77% in the abdominal/pelvic imaging, 98.2% in the chest imaging, and 95.2% in the tumor marker categories. Each patient's workup was assessed as a compilation of the 4 categories, yielding 65.7% patients as having received an adherent workup and 34.3% of workup as nonadherent to guidelines. The timeframe to see a gynecological oncologist for patients with guideline-adherent workup was significantly shorter than for those whose workup was nonadherant (20 vs 86 days, P < .001). A suspicious pelvic mass was identified by obstetrics-gynecology in only 23.9% of patients; 42.7% of patients did not have tumor marker testing before a gynecological oncologist consult. When an obstetrics-gynecology specialist discovered the suspicious pelvic mass, the remaining workup was more likely to be guideline adherent prior to gynecological oncologist referral than when initial imaging was not ordered by an obstetrics-gynecology specialist (P = .18). Survival was not significantly different (P = .103). CONCLUSION:With a guideline-adherent workup, including tumor marker testing, gynecological oncologist referral times can be shortened, minimizing cost inefficiencies and delays that can compromise the effectiveness of downstream care for patients with ovarian cancer. Guidelines should be disseminated beyond the obstetrics-gynecology field.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Boac BM,Xiong Y,Apte SM,Wenham RM,Shahzad MM,Munroe DG,Lancaster JM,Chon HSdoi
10.1016/j.ajog.2018.01.015subject
Has Abstractpub_date
2018-04-01 00:00:00pages
436.e1-436.e7issue
4eissn
0002-9378issn
1097-6868pii
S0002-9378(18)30018-8journal_volume
218pub_type
杂志文章abstract:OBJECTIVE:Our purpose was to compare the accuracy of ultrasonographic and manual cervical examinations for the prediction of preterm delivery. STUDY DESIGN:One hundred two singleton pregnancies at high risk for preterm delivery were followed up prospectively from 14 to 30 weeks with both serial cervical ultrasonograph...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(97)70259-x
更新日期:1997-10-01 00:00:00
abstract::The effect of type I and II diabetes in pregnancy on the circadian rhythm and diurnal excursion of plasma cortisol was studied in the second and third trimesters and post partum. Cosignor analysis demonstrated persistence during gestation of the significant circadian rhythm of the nonpregnant state. As previously repo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90140-7
更新日期:1986-12-01 00:00:00
abstract:BACKGROUND:Accurate gestational dating is a critical component of obstetric and newborn care. In the absence of early ultrasound, many clinicians rely on less accurate measures, such as last menstrual period or symphysis-fundal height during pregnancy, or Dubowitz scoring or the Ballard (or New Ballard) method at birth...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2015.11.029
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to examine whether women with gestational diabetes mellitus (GDM) and their offspring have reduced endothelial progenitor cell subsets and vascular reactivity. STUDY DESIGN:Women with GDM, healthy control subjects, and their infants participated. Maternal blood and cord blood we...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2010.10.913
更新日期:2011-03-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine whether microbial DNA hybridization is a useful method to study bacterial vaginosis in asymptomatic pregnant women. STUDY DESIGN:Vaginal specimens were collected at <26 weeks' gestation from 230 women, and analyzed for bacterial vaginosis by both Gram stain using Nu...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.01.068
更新日期:2005-09-01 00:00:00
abstract::Correlation between Goodwin's high-risk score and Apgar score was studied in 266 pregnancies managed with the use of the information from clinical monitoring. The correlation coefficients between Goodwin's score and Apgar scores were -0.3178 for one-minute Apgar scores and -0.2668 for five-minute Apgar scores. Both ar...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(77)90313-1
更新日期:1977-01-01 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::The gonadotropin-releasing hormone antagonist offers several advantages over the use of the agonist and allows several physiologic questions to be addressed. In this study, we evaluated the ability of Nal-Glu to acutely inhibit the luteinizing hormone surge and prevent ovulation. We also assessed whether recovery of 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)90037-r
更新日期:1991-12-01 00:00:00
abstract::Evidence from autoradiographic studies with 1,25(OH)2-vitamin D3 (vitamin D, soltriol) labeled with tritium and from the literature indicates that the steroid hormone soltriol regulates and modulates reproductive processes in the female, as it does in the male. Nuclear receptors for soltriol have been discovered in th...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/0002-9378(89)90699-6
更新日期:1989-11-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine whether elevated second-trimester human chorionic gonadotropin levels identify women likely to benefit from low-dose aspirin therapy. STUDY DESIGN:We evaluated second-trimester human chorionic gonadotropin levels obtained from healthy nulliparous women before screening for partic...
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(95)91373-4
更新日期:1995-10-01 00:00:00
abstract::Eighteen women aged 12 to 20 years with congenital cervicovaginal atresia were treated with a new technique of surgical canalization. All are now having regular menses. Two pregnancies have been achieved, with delivery of viable neonates. Surgical correction of this anomaly during adolescence may aid in restoration of...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.105740
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to review the validity of published studies that consider modifying physical activity during pregnancy to decrease preterm births and low birth weight. STUDY DESIGN:Presented is a critical review of extant literature, both case-control studies and studies of pregnant women follo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/0002-9378(93)90374-r
更新日期:1993-04-01 00:00:00
abstract::It is hypothesized that ampicillin may treat subclinical deciduitis and prolong the "effective" latent period in patients with preterm premature rupture of the membranes. We studied 82 patients with preterm rupture of membranes who were managed expectantly and were randomly assigned either to receive ampicillin prophy...
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(88)80002-4
更新日期:1988-09-01 00:00:00
abstract::Estradiol and progesterone receptors in the myometrium, decidua, placenta, chorion, and amnion of eight women who underwent elective cesarean section at term were determined by means of an exchange assay. The hormone levels in the peripheral plasma and cytosol of these tissues were measured by radioimmunoassays. Mater...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(84)90428-9
更新日期:1984-11-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to establish the risk of fetal death in early-onset growth-restricted fetuses with absent or reversed end-diastolic velocities in the umbilical artery or ductus venosus. DATA SOURCES:A systematic search was performed to identify relevant studies published in English, Spanish, F...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,meta分析
doi:10.1016/j.ajog.2017.11.566
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:The purpose of our study was to determine whether a relationship exists between diabetic glucose control and the immaturity rate of fetal pulmonary maturity test results. STUDY DESIGN:One thousand consecutive women who had fetal pulmonary maturity testing before delivery were studied. Diabetic patients were ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(12)90819-4
更新日期:1993-03-01 00:00:00
abstract::To determine whether anesthesia lowers fetal oxygen consumption, sodium pentobarbital (10 mg/kg) was given intravenously to seven chronically instrumented pregnant ewes (123 to 144 days' gestation). Oxygen consumption fell by 23% in association with a rise in fetal vascular PO2. Fetal breathing movements were abolishe...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90628-9
更新日期:1986-03-01 00:00:00
abstract:OBJECTIVES:Our goals were (1) to determine whether hypertension, proteinuria, and glomerular endotheliosis can be produced by chronic reduction of lower aortic pressure in pregnant rhesus monkeys and (2) to study the time course of the development of hypertension by means of longitudinal arterial blood pressure measure...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(93)90171-e
更新日期:1993-07-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to investigate temporal correlations between maternal serum placenta growth factor levels and placental perfusion in early human pregnancies. STUDY DESIGN:Systolic umbilical artery Doppler blood flow velocity indices at fetal and placental insertion sites were measured between 7...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.01.012
更新日期:2006-06-01 00:00:00
abstract::We studied whether plasma membranes from normal human placentas contain receptors for atrial natriuretic peptide. We identified specific, high-affinity, low-capacity atrial natriuretic peptide binding sites in the nonbrush border, microsomal fraction presumed to originate from cellular membranes near the fetal circula...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(88)80014-0
更新日期:1988-09-01 00:00:00
abstract:OBJECTIVE:Excess soluble vascular endothelial growth factor receptor, fms-like tyrosine kinase-1 (sFlt-1), and reduced placental growth factor (PlGF) mediate the genesis of preeclampsia. Cigarette smoking reduces the risk of preeclampsia. We hypothesized that placental secretion of sFlt-1 and PlGF was affected by expos...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.06.025
更新日期:2007-10-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to assess whether endometrial polyps (EMPs) represent cancer precursors. STUDY DESIGN:Age standardized incidence ratios (SIRs) of histologically verified endometrial cancers (EmCas) were estimated in women with EMPs and in women with uterine leiomyomata, which is a condition tha...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2010.03.036
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVE:Intrapartum fetal heart rate (FHR) recordings in twins were compared for fetal signal loss during both stages of labor to assess the quality of these recordings by the method that had been used: external ultrasound or directly via a scalp electrode. STUDY DESIGN:Analysis of recordings collected between Janua...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.04.037
更新日期:2004-12-01 00:00:00
abstract::Prolactin (PRL) release in response to surgical stress has been demonstrated in a variety of species. Previous studies in rats indicate this response is blunted or blocked by pretreatment with either glucocorticoids or antihistamines. The present study was designed to investigate this phenomenon in man. Serum PRL leve...
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(78)90769-x
更新日期:1978-10-15 00:00:00
abstract:OBJECTIVES:To precisely evaluate fetal renal function in cases of bilateral fetal urinary tract obstruction, we analyzed fetal urine metabolites by nuclear magnetic resonance spectroscopy. STUDY DESIGN:Fifty-six specimens of fetal urine samples in utero were retrospectively analyzed by proton nuclear magnetic resonanc...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(94)70235-7
更新日期:1994-02-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine the rates of late preterm inductions without a medical indication from birth certificate data and to compare them with rates that were obtained from medical charts. STUDY DESIGN:The Ohio Perinatal Quality Collaborative, which comprises 20 hospitals in Ohio that came...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2010.07.004
更新日期:2010-09-01 00:00:00
abstract::A case discussing the medical management of a 30-year-old gravid patient with recurrent pericarditis and pericardial constriction secondary to juvenile rheumatoid arthritis is presented. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90418-7
更新日期:1986-01-01 00:00:00
abstract::The effect upon fetal breathing movements (FBM) in 49 women with uncomplicated pregnancies who inhaled 5% carbon dioxide in air for 15 minutes was observed with an ADR real-time ultrasound scanner. A threefold increase in FBM occurred during the inhalation of CO2. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)90867-4
更新日期:1980-02-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to describe trends and outcomes of planned births. STUDY DESIGN:Data from linked birth and hospital records for 779,521 singleton births at ≥33 weeks' gestation from 2001-2009 were used to determine trends in planned births (prelabor cesarean section and labor inductions). Adver...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2012.06.082
更新日期:2012-09-01 00:00:00
abstract:OBJECTIVE:Fetal plasma angiotensin II levels are 10 times the levels found in adults. Despite these high levels, central injection of angiotensin II may stimulate fetal swallowing and increase fetal arterial blood pressure. We postulated that the high rate of spontaneous fetal swallowing and normal fetal pressor regula...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.117310
更新日期:2001-10-01 00:00:00