Abstract:
OBJECTIVE:To assess the cost-effectiveness of diagnostic laparoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) after indeterminate ultrasonography in pregnant women with suspected appendicitis. METHODS:A decision-analytic model was developed to simulate appendicitis during pregnancy taking into consideration the health outcomes for both the pregnant women and developing fetuses. Strategies included diagnostic laparoscopy, CT, and MRI. Outcomes included positive appendectomy, negative appendectomy, maternal perioperative complications, preterm delivery, fetal loss, childhood cancer, lifetime costs, discounted life expectancy, and incremental cost-effectiveness ratios. RESULTS:Magnetic resonance imaging is the most cost-effective strategy, costing $6,767 per quality-adjusted life-year gained relative to CT, well below the generally accepted $50,000 per quality-adjusted life-year threshold. In a setting where MRI is unavailable, CT is cost-effective even when considering the increased risk of radiation-associated childhood cancer ($560 per quality-adjusted life-year gained relative to diagnostic laparoscopy). Unless the negative appendectomy rate is less than 1%, imaging of any type is more cost-effective than proceeding directly to diagnostic laparoscopy. CONCLUSIONS:Depending on imaging costs and resource availability, both CT and MRI are potentially cost-effective. The risk of radiation-associated childhood cancer from CT has little effect on population-level outcomes or cost-effectiveness but is a concern for individual patients. For pregnant women with suspected appendicitis, an extremely high level of clinical diagnostic certainty must be reached before proceeding to operation without preoperative imaging.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Kastenberg ZJ,Hurley MP,Luan A,Vasu-Devan V,Spain DA,Owens DK,Goldhaber-Fiebert JDdoi
10.1097/AOG.0b013e3182a4a085subject
Has Abstractpub_date
2013-10-01 00:00:00pages
821-829issue
4eissn
0029-7844issn
1873-233Xpii
00006250-201310000-00014journal_volume
122pub_type
杂志文章abstract::The early detection of preterm labor and the prevention of preterm birth require special attention to early subtle signs and symptoms of preterm labor. The concept of "Braxton Hicks contractions" may negate these early signs and symptoms by falsely reassuring patients, thus encouraging them not to seek medical care pr...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1990-04-01 00:00:00
abstract::When any fetal blood group factor inherited from the father is not possessed by the mother, antepartum or intrapartum fetal-maternal bleeding may stimulate an immune reaction in the mother Maternal immune reactions also can occur from blood product transfusion. The formation of maternal antibodies, or"alloimmunization...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,实务指引
doi:10.1097/00006250-200608000-00044
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:To evaluate whether prophylactic dronabinol, a synthetic tetrahydrocannabinol, reduces pain during medical abortion. METHODS:We conducted a randomized, double-blind, placebo-controlled trial of women undergoing medical abortion with mifepristone and misoprostol up through 70 days of gestation. All participan...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1097/AOG.0000000000003850
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVE:To examine the relationships between clinical or histological chorioamnionitis and cerebral palsy using a meta-analysis approach. DATA SOURCES:A systematic review of the literature appeared in PubMed between 2000 and 2009 was conducted using the search terms "cerebral palsy" and "infection," with broad-scope...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章,meta分析,评审
doi:10.1097/AOG.0b013e3181e90046
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:Our objective was to estimate whether a transvaginal endometrial stripe of less than 5 mm in premenopausal women would exclude endometrial polyps and intracavitary leiomyomata, thereby eliminating the need for sonohysterography. METHODS:Data from 206 consecutive sonohysterograms performed in premenopausal wo...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000130065.49187.c8
更新日期:2004-07-01 00:00:00
abstract::A new analog of luteinizing-hormone-releasing factor, (Des-Gly-NH-2-10, Pro-ethylamide-9)-LHRF, was tested in healthy women with regular menstrual cycles. This synthetic nonapeptide amide was injected intravenously in a dose of 200 mug into 15 normal female volunteers in the follicular, preovulatory, and luteal phases...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1975-03-01 00:00:00
abstract:OBJECTIVE:To review facility-based maternal deaths at a tertiary-level center in Johannesburg, South Africa, during a 5-year period (2003 to 2007) and to investigate the proportion of deaths attributable to human immunodeficiency virus (HIV), the etiology of deaths, and the effects of antiretroviral treatment introduce...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3181af33e6
更新日期:2009-08-01 00:00:00
abstract::A program of trial labor by patients who had previously undergone one low cervical transverse cesarean section is described. Experience with 526 such patients shows that 49% delivered vaginally, doing so with slightly less morbidity and a shorter hospital stay than 108 similar patients not given a trial labor. Perinat...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1978-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the sexual and reproductive health characteristics of women in treatment for opioid use disorder in Michigan and explore services provided and desired. METHODS:We conducted a cross-sectional study of female patients aged 18-50 years who accessed opioid use disorder treatment at 22 randomly select...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000003666
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVE:To report our institutional experience with the accuracy and usefulness of cervical conization with frozen section before planned hysterectomy. METHODS:One hundred fifty-nine patients who planned to have hysterectomies for or with a concomitant diagnosis of cervical intraepithelial neoplasia (CIN) underwent ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1993-09-01 00:00:00
abstract:BACKGROUND:Opportunistic salpingectomy at the time of hysterectomy is currently recommended to reduce the lifetime risk of ovarian cancer. The vaginal route is least invasive, but surgeons sometimes may choose to perform this procedure laparoscopically or robotically when anticipating adnexal surgery as a result of lim...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000002746
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVE:To determine the cure rate of urge incontinence after Burch colposuspension in patients with mixed incontinence diagnosed urodynamically, to determine if cure rates were different when the onset of urge symptoms antedated or postdated the symptoms of stress incontinence, and to propose appropriate preoperativ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0029-7844(97)00550-4
更新日期:1998-01-01 00:00:00
abstract:OBJECTIVE:To compare the diagnostic and prognostic performance of maternal blood C-reactive protein, white blood cell count (WBC), and temperature with that of amniotic fluid (AF) WBC in preterm labor. METHODS:One hundred two women with preterm labor and intact membranes were studied. Maternal blood was collected to m...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(95)00380-0
更新日期:1996-02-01 00:00:00
abstract:BACKGROUND:Chylous ascites is a rare phenomenon caused by extravasation of chyle from the lymphatic system. In Western countries, the majority of adult cases are due to occlusion of the lymphatics secondary to a lymphoma or other malignancy. CASE:A middle-aged woman with reports of fecal urgency, incomplete bowel evac...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/01.AOG.0000285479.79030.94
更新日期:2008-02-01 00:00:00
abstract::Two hundred ten rats were randomized into one of five study groups to compare standard absorbable sutures with a new synthetic absorbable suture. We evaluated Maxon (polyglyconate), Vicryl (polyglactin), chromic catgut (catgut), and PDS (polydioxanone) with respect to tissue inflammatory reaction, knot security, sutur...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1988-03-01 00:00:00
abstract::The adult respiratory distress syndrome is a common cause of acute hypoxemic respiratory failure in the adult that is associated with a high mortality. There is a limited experience with managing this entity in the gravid patient. A case of successful management of mother and fetus through spontaneous delivery is pres...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1986-09-01 00:00:00
abstract::Fifty-two women undergoing labor induction and vaginal delivery at term were randomized between two oxytocin infusion protocols, involving hourly versus quarter-hourly increases in dose. Potential differences were sought of duration of labor, amount of uterine activity generated, and amount of oxytocin required. Start...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1990-05-01 00:00:00
abstract:OBJECTIVE:To evaluate whether preoperative dilation and curettage (D&C) lowers the risk of unexpected cancer at hysterectomy. METHODS:Women with complex atypical endometrial hyperplasia on sampling from January 2000 to May 2008 who underwent hysterectomy within 6 months were identified using a pathology database. Pati...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3181b190d5
更新日期:2009-09-01 00:00:00
abstract:OBJECTIVE:To evaluate whether treatment with neuroprotective peptides to young adult mice prenatally exposed to alcohol reverses alcohol-induced learning deficits in a mouse model of fetal alcohol syndrome, whether the mechanism involves the N-methyl-d-aspartate (NMDA) and gamma-aminobutyric acid type A (GABAA) recepto...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0b013e3181cb59da
更新日期:2010-02-01 00:00:00
abstract::A case of twin pregnancy with a fetus in each horn of a uterus didelphys is reported. During labor that resulted in the term birth of 1 fetus, contractions occurred temporarily in the other horn and subsided 2 hours after delivery. ...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1983-01-01 00:00:00
abstract::Cyclic progestin therapy has been widely advocated as an adjunct to postmenopausal estrogen replacement therapy to reduce the risk of endometrial carcinoma. Acceptance of this approach, however, appears to have preceded detailed evaluation of possible adverse side effects of progestins that could result in patient non...
journal_title:Obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1991-07-01 00:00:00
abstract:OBJECTIVE:To compare 12-hour and 72-hour expectant management of premature rupture of membranes (PROM) in singleton term pregnancies. METHODS:In a prospective, nonrandomized study, 566 low-risk women with singleton term pregnancies presenting with PROM were assigned to either 12-hour or 72-hour expectant management. P...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(95)00031-l
更新日期:1995-05-01 00:00:00
abstract::Injury to the sciatic nerve is an infrequent but important complication of gynecologic procedures in which the lithotomy position is used. This lesion may occur after vaginal hysterectomy or after short procedures such as dilatation and curettage or laparoscopy. Few reports are found in the gynecologic literature. The...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1983-09-01 00:00:00
abstract::Eight gravidas with symptomatic polyhydramnios were managed with maternal indomethacin therapy. The mean gestational age at presentation was 28.6 +/- 3.5 weeks. Only patients requiring serial amniotic fluid decompressions for rapid amniotic fluid reaccumulation were enrolled in the study. An initial amniotic fluid dec...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVE:To determine the factors that influence the survival of patients with endometrial carcinoma histologically confined to the uterus. METHODS:Retrospective analysis was conducted of 262 surgically staged cases using multiple regression (Cox proportional hazards model). RESULTS:After excluding patients with cle...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1992-10-01 00:00:00
abstract::Advances in the immunopathology of blistering diseases now provide increased accuracy in the diagnosis of herpes gestationis in pregnancy. Guidelines are presented in this review to determine the presence of the disease. Exogenous corticosteroids will effectively alleviate symptoms and prevent formation of new lesions...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1977-06-01 00:00:00
abstract:OBJECTIVE:To determine if nucleated red blood cell counts(RBC) are different in infants who develop intraventricular hemorrhage and periventricular leukomalacia in the first week of life and in those who do not. METHODS:Nucleated RBCs were obtained from 441 infants weighing more than 499 g and less than 1751 g. Neonat...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0029-7844(95)00436-x
更新日期:1996-03-01 00:00:00
abstract:BACKGROUND:Microangiopathic disorders during pregnancy remain a diagnostic challenge because these conditions often imitate more common obstetric diseases. CASE:A 31-year-old multigravid woman delivered at term with a postpartum course complicated by laboratory indices consistent with hemolysis, elevated liver enzymes...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/AOG.0000000000001675
更新日期:2016-12-01 00:00:00
abstract::The effects of the suboptimal temperature caused by delayed incubation or prolonged transport on the recovery of Neisseria gonorrhoeae were studied in 2 separate patient populations. The individual components of the John E. Martin Biological Environmental Chamber were used to define more precisely other variables that...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1982-05-01 00:00:00
abstract::Caffeine citrate in doses of 6.96 mg/kg (equivalent to 3.50 mg/kg of caffeine) of combined maternal and fetal weight and 69.6 mg/kg (35.0 mg/kg of caffeine) was administered in 1-dl solutions intravenously over ten minutes to chronically prepared pregnant sheep. The ewes and their fetuses were monitored for cardiovasc...
journal_title:Obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1983-04-01 00:00:00