Abstract：
OBJECTIVE:To evaluate the appropriateness of recommendations for hysterectomies done for nonemergency and non-oncologic indications. METHODS:We assessed the appropriateness of recommendations for hysterectomy for 497 women who had the operation between August 1993 and July 1995 in one of nine capitated medical groups in Southern California. Appropriateness was assessed using two sets of criteria, the first developed by a multispecialty expert physician panel using the RAND/University of California-Los Angeles appropriateness method, and the second consisting of the ACOG criteria sets for hysterectomies. The main outcome measure was the appropriateness of recommendation for hysterectomy, based on expert panel ratings and ACOG criteria sets. RESULTS:The most common indications for hysterectomy were leiomyomata (60% of hysterectomies), pelvic relaxation (11%), pain (9%), and bleeding (8%). Three hundred sixty-seven (70%) of the hysterectomies did not meet the level of care recommended by the expert panel and were judged to be recommended inappropriately. ACOG criteria sets were applicable to 71 women, and 54 (76%) did not meet ACOG criteria for hysterectomy. The most common reasons recommendations for hysterectomies considered inappropriate were lack of adequate diagnostic evaluation and failure to try alternative treatments before hysterectomy. CONCLUSION:Hysterectomy is often recommended for indications judged inappropriate. Patients and physicians should work together to ensure that proper diagnostic evaluation has been done and appropriate treatments considered before hysterectomy is recommended.
journal_name
Obstet Gynecoljournal_title
Obstetrics and gynecologyauthors
Broder MS,Kanouse DE,Mittman BS,Bernstein SJdoi
10.1016/s0029-7844(99)00519-0subject
Has Abstractpub_date
2000-02-01 00:00:00pages
199-205issue
2eissn
0029-7844issn
1873-233Xpii
S0029-7844(99)00519-0journal_volume
95pub_type
杂志文章abstract：:Postcesarean section febrile morbidity remains a common problem on obstetric services. Although a few preliminary studies have reported on the use of ultrasound to assess the postcesarean section patient, they have not compared sonographic findings with either intraoperative or postoperative events. These reports have...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1985-08-01 00:00:00
abstract：:This study investigated unconjugated E3 and cortisol in normal and abnormal (diabetes and chronic stress) pregnancies and the compartmental (maternal, fetoplacental, amniotic fluid) concentrations and relationships in simultaneous samples. It was demonstrated that in labor both steriods are higher in all compartments ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1978-09-01 00:00:00
abstract：:Fifty-five patients at less than 36 weeks' gestation with severe toxemia were treated conservatively. The pregnancies were continued for a mean duration of 19.2 days and the mean gestation at delivery was 35.2 weeks. Fifty-three percent of the deliveries were by cesarean section. Of the neonates, 56.5% showed severe i...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1979-11-01 00:00:00
abstract：:This study was carried out to determine whether some of the lowest doses of natural estrogens currently prescribed for postmenopausal women result in significant changes in plasma lipids, urinary calcium, urinary free cortisol, or level of androgens. Twenty-four postmenopausal women were studied and the estrogens inge...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1983-07-01 00:00:00
abstract：:An unusual case is presented of advanced dysgerminoma in a patient with Swyer syndrome, 46,XY pure gonadal dysgenesis. Unexpected regional invasion necessitated bowel resection, total abdominal hysterectomy, and bilateral salpingogonadectomy for a complete en bloc excision of the primary tumor mass and the dysgenetic ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1992-09-01 00:00:00
abstract：OBJECTIVE:To estimate the prevalence of filled opioid prescriptions after vaginal delivery. METHODS:We conducted a retrospective cohort study of 164,720 Medicaid-enrolled women in Pennsylvania who delivered a liveborn neonate vaginally from 2008 to 2013, excluding women who used opioids during pregnancy or who had an ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0000000000001868
更新日期：2017-03-01 00:00:00
abstract：OBJECTIVE:To estimate the effect of prolonged vaginal distention and anal sphincter transection on contractile properties of the external anal sphincter. METHODS:Young female virgin rats were randomly assigned to four treatment groups (sham, vaginal distention, transection of anal sphincter plus repair, or combined di...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/AOG.0b013e318162f6a7
更新日期：2008-02-01 00:00:00
abstract：:Women who develop preeclampsia during pregnancy excrete less calcium than healthy pregnant women. Whether this reduction in calcium excretion precedes or follows hypertension is unknown. We prospectively measured urinary calcium excretion in 103 consecutive nulliparous women at risk for preeclampsia and presenting for...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1991-05-01 00:00:00
abstract：OBJECTIVE:To identify potential predictors for treatment success in medical management with misoprostol for early pregnancy failure. METHODS:We conducted a planned secondary analysis of data from a multicenter trial that compared medical and surgical management of early pregnancy failure. Medical management consisted ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.1097/01.AOG.0000206737.68709.3e
更新日期：2006-04-01 00:00:00
abstract：OBJECTIVE:Preeclampsia is associated with abnormal lipid metabolism, including fatty acid metabolism. Carnitine plays an indispensable role in the oxidation of fatty acids. The aim of the study was to evaluate the possible role of abnormal fatty acid oxidation in preeclampsia by comparing plasma carnitine levels betwee...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1097/01.AOG.0000125699.60416.03
更新日期：2004-05-01 00:00:00
abstract：OBJECTIVE:To evaluate a quality improvement protocol for venous thromboembolism prevention in postoperative gynecologic cancer patients. METHODS:On January 1, 2006, we initiated a universal protocol of dual prophylaxis with sequential compression devices and three times daily heparin (or daily low molecular weight hep...
journal_title：Obstetrics and gynecology
pub_type： 临床试验,杂志文章
doi：10.1097/AOG.0b013e31818b1486
更新日期：2008-11-01 00:00:00
abstract：OBJECTIVE:To evaluate whether myo-inositol supplementation, an insulin sensitizer, reduces the rate of gestational diabetes mellitus (GDM) and lowers insulin resistance in obese pregnant women. METHODS:In an open-label, randomized trial, myo-inositol (2 g plus 200 micrograms folic acid twice a day) or placebo (200 mic...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,随机对照试验
doi：10.1097/AOG.0000000000000958
更新日期：2015-08-01 00:00:00
abstract：BACKGROUND:There has been one reported case of porencephaly diagnosed postnatally as a result of amniocentesis. We report the first antenatal diagnosis of porencephaly, which apparently resulted from penetration of the fetal skull during amniocentesis. CASE:A 37-year-old woman had genetic amniocentesis at 16 weeks' ge...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：10.1016/0029-7844(94)00315-5
更新日期：1995-05-01 00:00:00
abstract：:Ectopic pregnancy is suspected when a pregnancy test is positive and an Arias-Stella phenomenon with decidua is seen on endometrial curettings in the absence of chorionic villi and trophoblast. We performed immunoperoxidase stains for beta-hCG, hPL, placental alkaline phosphatase, and keratin (AE1/AE3) on endometrial ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1991-09-01 00:00:00
abstract：:Real-time ultrasonography utilizing a hand-held linear array transducer provides a highly accurate method of identifying and evaluating the twin gestation. The rapidity of real-time scanning eliminates interpretational problems caused by fetal movements. Additionally, the versatility of transducer positioning facilita...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1978-02-01 00:00:00
abstract：:This study was designed to compare single-point prevalence estimates with a cumulative prevalence estimate of human papillomavirus (HPV) type 16 in cervical smears. The influence of the menstrual cycle and the long-term effect of HPV 16 positivity on the development of cervical intraepithelial neoplasia (CIN) were mon...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1992-05-01 00:00:00
abstract：:We have reviewed the family histories of children with neural tube defects to determine which relatives are at sufficient risk to be offered amniocentesis for prenatal diagnosis. The recurrence risks for sibs was 6%; therefore, women with one affected child should be made aware of the availability of this test for mon...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1978-01-01 00:00:00
abstract：BACKGROUND:Erythrasma is an uncommon vulvar infection, best diagnosed by its fluorescence under the Wood lamp. This report shows that despite a negative Wood lamp examination, the diagnosis can be made histologically. CASE:A 42-year-old woman was referred to our clinic with a persistent candidal infection. Evaluation ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1993-05-01 00:00:00
abstract：OBJECTIVE:To ascertain whether the TDx-FLM assay is a better predictor of neonatal respiratory distress syndrome (RDS) than the lecithin-sphingomyelin ratio (L/S) and phosphatidylglycerol (PG). METHODS:Amniotic fluid samples of 140 women requiring assessment of fetal lung maturity and delivering within 72 hours of amn...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1993-12-01 00:00:00
abstract：OBJECTIVE:Adverse fetal heart rate (FHR) changes occur frequently during the first 30 minutes after epidural analgesia. The aim of this study was to estimate whether intravenous administration of ephedrine during induction of epidural analgesia can reduce the frequency of adverse FHR changes. METHODS:We prospectively ...
journal_title：Obstetrics and gynecology
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1097/01.AOG.0000146281.05275.73
更新日期：2004-12-01 00:00:00
abstract：:This study compared peritoneal fluid volume, macrophage count, and macrophage concentration by diagnosis and cycle week of 426 patients undergoing laparoscopy. Patient diagnosis and cycle week had no significant interaction. Peritoneal fluid volume was dependent upon cycle week and diagnostic group, but macrophage cou...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1987-03-01 00:00:00
abstract：:On an infertility service, 170 patients were evaluated for possible ectopic pregnancy using tests for beta-human chorionic gonadotropin levels, ultrasound, and clinical examination. Thirty-four (20%) of those evaluated underwent laparoscopy, of whom 31 (91%) were found to have ectopic pregnancies. Only three of the ec...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1986-12-01 00:00:00
abstract：:Endometrial cancer is by no means a benign disease. While many adequate treatment plans now exist for early endometrial cancer, the best method of treadtment of this disease has yet to be defined. The prognostic factors need further study and definition. Pelvic and aortic nodes are of more than passing significance in...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,评审
doi：
更新日期：1976-05-01 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：BACKGROUND:Laparoscopic cholecystectomy is becoming a popular surgical option in the management of gallstone disease. Reports on complications of this procedure have usually focused on prolonged operative time, bleeding, and infections. We describe a case of cholelithiasis of the ovary following laparoscopic cholecyste...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1993-10-01 00:00:00
abstract：:The aortic diameters of 89 normotensive pregnant women were compared with those of nine rigorously defined preeclamptic women and 59 women who required antihypertensive therapy. Over the course of normal pregnancy, the diameter increased significantly; it was larger in preeclamptic than in normotensive women throughou...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1991-12-01 00:00:00
abstract：OBJECTIVE:To evaluate whether hysteroscopic morcellation or bipolar electrosurgical resection is more favorable for removing endometrial polyps in an office setting in terms of feasibility, speed, pain, and acceptability. METHODS:A multicenter, single-blind, randomized, controlled trial of office hysteroscopic morcell...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.1097/AOG.0000000000000187
更新日期：2014-04-01 00:00:00
abstract：OBJECTIVE:To describe the outcomes of intended home birth in the practices of certified nurse-midwives. METHODS:Twenty-nine US nurse-midwifery practices were recruited for the study in 1994. Women presenting for intended home birth in these practices were enrolled in the study from late 1994 to late 1995. Outcomes for...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章,评审
doi：10.1016/s0029-7844(98)00182-3
更新日期：1998-09-01 00:00:00
abstract：OBJECTIVE:To compare the safety and efficacy of outpatient and inpatient treatment of pyelonephritis in pregnancy. METHODS:We performed a randomized controlled trial of pregnant women with pyelonephritis before 24 weeks' estimated gestational age, comparing inpatient and outpatient treatment. Sixty inpatients received...
journal_title：Obstetrics and gynecology
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/0029-7844(95)00244-l
更新日期：1995-10-01 00:00:00
abstract：:Recent studies suggest that fetal biometry may allow recognition of pregnancies at risk for Down syndrome. Second-trimester biparietal diameter (BPD)/femur length and observed-to-expected femur length ratios were examined in 48 chromosomally abnormal fetuses and compared with those of a control population composed of ...
journal_title：Obstetrics and gynecology
pub_type： 杂志文章
doi：
更新日期：1989-11-01 00:00:00
