Abstract:
OBJECTIVE:The aim of the study was to determine the most cost-effective delivery management of vertex and nonvertex twin pair gestations. STUDY DESIGN:Two hundred sixty-six consecutive twin gestations were followed up prospectively in a special antepartum Twins Clinic directed by the Maternal-Fetal Medicine Division. Maternal demographic, obstetric, and neonatal data were compiled prospectively. Information regarding 84 vertex and nonvertex twin pair gestations was extracted for review. Comparison groups included 41 twin pairs managed by spontaneous vaginal delivery and breech extraction (group A), 19 twin pairs managed by spontaneous vaginal delivery and external cephalic version (group B), and 24 twin pairs managed by primary cesarean delivery (group C). In-hospital financial data were retrieved and adjusted for inflation to 1996 constant dollars (data from a single institution allow comparison of charges). The Kruskal-Wallis chi2 test, the Fisher exact test, and analysis of variance were used for statistical analysis. RESULTS:The 3 groups did not differ with respect to maternal demographics, medical complications, gestational age, birth weight, fetal sex, or intrauterine growth restriction. Maternal and neonatal hospital charges were both significantly lower (P = .01 and P = .0001, respectively) in the breech extraction group A ($5890 +/- $2304 and $3526 +/- $5017, respectively) than in either group B ($8638 +/- $4175 and $11,754 +/- $15,457, respectively) or group C ($7,608 +/- $3,256 and $36,994 +/- $54,318, respectively). Although maternal morbidity was similar among the 3 groups, length of stay was shorter for mothers in group A. The infants delivered by spontaneous vaginal delivery and breech extraction (group A) had significantly lower rates of pulmonary disease (7% vs 24% vs 31% for groups A, B, and C, respectively; P = .002) and neonatal infectious disease (1% vs 0% vs 16%; P = .0005). These infants required the use of a ventilator less frequently (5% vs 12% vs 24%; P = .01), were more likely to be admitted to the normal newborn nursery (71% vs 51% vs 50%; P = .0001), and had a significantly shorter length of hospitalization (4.8 vs 12.4 vs 17.8 days; P = .0001). CONCLUSIONS:There is no medical consensus regarding delivery management for vertex and nonvertex presenting twin pairs. When hospital charges are examined with clinical data, however, breech extraction of the nonvertex second twin is the most cost-effective delivery management strategy.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Mauldin JG,Newman RB,Mauldin PDdoi
10.1016/s0002-9378(98)70179-6subject
Has Abstractpub_date
1998-10-01 00:00:00pages
864-9issue
4eissn
0002-9378issn
1097-6868pii
S0002937898701796journal_volume
179pub_type
杂志文章abstract::Progeny of women, whose thyroid function was studied gestationally, had psychological and/or neurologic examinations at 8 months, 4 years and 7 years of age. In more than 100 pregnancies (at least 3 per cent of total pregnancies) hypothyroxinemia occurred and was treated adequately or inadequately. Children were deliv...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1976-08-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine the risk of cumulative cervical intraepithelial neoplasia (CIN) grade 2 or 3 according to initial colposcopy and directed biopsy results among women with low-grade squamous intraepithelial lesions (LSIL) or human papillomavirus (HPV) DNA positive atypical squamous ce...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2003.461
更新日期:2003-06-01 00:00:00
abstract:OBJECTIVE:Although a few studies have evaluated the effect of meconium on the lecithin/sphingomyelin ratio for testing of fetal lung maturity, to date these studies have assessed only the lecithin-sphingomyelin ratio of amniotic fluid contaminated with meconium. The purpose of this study was (1) to determine whether me...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(98)70038-9
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:Our purpose was to study the effects of the progestomimetic compound nomegestrol acetate on spontaneous and sulprostone-induced uterine contractility in pregnant cynomolgus monkeys. STUDY DESIGN:Intrauterine pressure was continuously monitored with use of an implanted intraamniotic catheter and a telemetric ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(98)70643-x
更新日期:1998-01-01 00:00:00
abstract::Clonidine is a recommended antihypertensive for use during pregnancy, although little is known of its fetal effects. This study examines the effects of clonidine on breathing and sleep-state cycling in fetal lambs. Clonidine was infused into a fetal lateral ventricle for up to 24 hours at 128 to 135 days' gestation. C...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)91220-7
更新日期:1990-08-01 00:00:00
abstract::The results of therapy of 226 women receiving frozen and fresh donor semen are reported. Overall, 45.6% of patients conceived with a monthly fecundability of 0.102. The effect of a variety of factors on fertility rates was analyzed in life-table analysis of 1000 cycles. Optimal pregnancy rates were obtained in couples...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90258-9
更新日期:1986-09-01 00:00:00
abstract:OBJECTIVE:Our purpose was to evaluate and compare the conversion of 5-aminolevulinic acid into the endogenous photosensitizer protoporphyrin IX in experimentally induced endometriosis and in other normal tissues in a rat model. STUDY DESIGN:Fluorescence of experimental endometriotic lesions, uterus, peritoneum, bowel ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(96)70388-5
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine risk factors for trocar implantation metastasis after diagnostic laparoscopy in patients with primary or recurrent advanced ovarian cancer. STUDY DESIGN:Eighty-three women with primary advanced ovarian cancer and 21 women with recurrent ovarian cancer undergoing a l...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70489-8
更新日期:1999-09-01 00:00:00
abstract:OBJECTIVE:We sought to evaluate changes in bowel symptoms after rectocele repair and identify risk factors for persistent symptoms. STUDY DESIGN:We conducted ancillary analysis of a randomized surgical trial for rectocele repair. Subjects underwent examinations and completed questionnaires for bowel symptoms at baseli...
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.2012.06.054
更新日期:2012-11-01 00:00:00
abstract::Tissue deficiency of folic acid, as measured by a red cell folate level below 150 ng. per milliliter, was present in 16 per cent of 110 sequential pregnant women at the time of their first prenatal visit to a municipal clinic. A further 14 per cent of subjects had red cell folate levels in the range "suggestive but no...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(75)90523-2
更新日期:1975-09-15 00:00:00
abstract:OBJECTIVE:To compare live birth rates following ultrasound-guided embryo transfer (ET) by reproductive endocrinology and infertility fellows versus attending physicians. STUDY DESIGN:Women who underwent their first day-3, fresh, nondonor ET between Oct. 1, 2005, and April 1, 2011, at our academic center were included ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2014.05.042
更新日期:2014-11-01 00:00:00
abstract::Two techniques were used to study the neuromuscular control of rabbit ovarian contractions. First, the ovary was denervated by stripping its artery. Spontaneous contractions were noted, as was a normal response to exogenously administered adrenergic agents. Second, the ovarian nerves were electrically stimulated in an...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(77)90679-2
更新日期:1977-05-15 00:00:00
abstract::Amniotic fluid creatinine, percentage of lipid-positive cells, and L/S ratio were determined on 285 samples from normal pregnancies and 222 samples from abnormal pregnancy states (Rh isoimmunization, diabetes, hypertensive disorders, intrauterine growth retardation, and hydramnios). In normal pregnancy the coefficient...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(76)90777-8
更新日期:1976-07-01 00:00:00
abstract:BACKGROUND:Cesarean scar defect (isthmocele) is a known complication after cesarean delivery. It has become more common due to a rising cesarean delivery rate. Isthmocele has been associated with various gynecological and obstetric problems such as uterine rupture, cesarean scar pregnancy, and bleeding disorders. OBJE...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2018.09.004
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:The incidence and outcomes for community-acquired pneumonia during a pregnancy ending with a live birth in the province of Alberta, Canada, were analyzed. STUDY DESIGN:Hospital abstracts and vital statistics data between April 1, 1994, to March 31, 1999, were used. RESULTS:The incidence of hospitalization f...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2003.175
更新日期:2003-03-01 00:00:00
abstract:OBJECTIVE:To examine whether sexual orientation is associated with disparities in teen pregnancy and hormonal contraception use among adolescent females in 2 intergenerational cohorts. STUDY DESIGN:Data were collected from 91,003 women in the Nurses' Health Study II (NHSII), born between 1947-1964, and 6463 of their c...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2013.06.036
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to determine the relationship between nighttime delivery and neonatal encephalopathy (NE). STUDY DESIGN:The design of the study was a retrospective population-based cohort of 1,864,766 newborns at a gestation of 36 weeks or longer in California, 1999-2002. We determined the ris...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2010.09.022
更新日期:2011-01-01 00:00:00
abstract::To clarify whether there is a variation of dopamine effect throughout the normal menstrual cycle, 24 studies were performed during the follicular, periovulatory, and luteal phase in seven ovulatory women. The subjects were studied for 24 hours after receiving two different dopamine agonists, 2.5 mg of bromocriptine in...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90672-1
更新日期:1986-02-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to compare the performance of first-trimester nuchal translucency (NT) cutoff of ≥3.5 mm with NT percentiles that were calculated for crown-rump length to identify fetuses with critical congenital heart defects (CCHDs). STUDY DESIGN:This was a population-level study of singleton...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2014.10.1102
更新日期:2015-04-01 00:00:00
abstract::The purpose of this study is to clarify fetal cardiovascular effects of four popular analgesics administered to a maternal animal model. Clinical doses of aspirin (14 mg/kg), acetaminophen (14 mg/kg), ibuprofen (6 mg/kg), or indomethacin (0.7 mg/kg) were administered orally to near-term rats. At 1, 4, 8, or 24 hours l...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90042-6
更新日期:1990-05-01 00:00:00
abstract:OBJECTIVE:We sought to establish the lowest dose of 3-keto-desogestrel, when added to a copper-releasing intrauterine contraceptive device, that is needed to reduce menstrual blood loss to a very low level and to treat (essential) menorrhagia successfully. STUDY DESIGN:A double-blind group comparative study was design...
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.2000.104805
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that amniotic fluid volume is increased in aquaporin 1 knockout mice. STUDY DESIGN:Transgenic mice deficient in aquaporin 1 protein were generated by targeted gene disruption, as described previously. After a cesarean section was performed, intact, individual gestational sacs were remo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.02.046
更新日期:2005-06-01 00:00:00
abstract::Vibroacoustic stimulation is widely used in the United States as a test for fetal well-being, yet little information is available on the adequacy of the electronic artificial larynx that is commonly used as the stimulator. To determine whether the intraabdominal sound pressure level was dependent on the static force a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90602-n
更新日期:1991-04-01 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::In this article we report the results of chorionic villus sampling by a biopsy forceps inserted via the cervix under ultrasonic guidance in 300 pregnancies at risk for thalassemia major. A sufficient amount of chorionic villi for deoxyribonucleic acid analysis by oligonucleotide hybridization was obtained in all cases...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(87)90352-8
更新日期:1987-04-01 00:00:00
abstract:OBJECTIVE:This study explores decisional processes regarding termination of pregnancy because of Down syndrome and aims to identify possibilities for improving counseling. STUDY DESIGN:Seventy-one women completed questionnaires 4 months after termination of pregnancy for Down syndrome, including motivations for the de...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2006.09.013
更新日期:2007-02-01 00:00:00
abstract::The effect of fluids from both complete and partial hydatidiform moles on blood coagulation was determined. Coagulation was evaluated with use of the one-stage prothrombin time and the activated partial thromboplastin time. These studies demonstrated that the fluids shortened the activated partial thromboplastin time ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(85)80263-5
更新日期:1985-11-15 00:00:00
abstract:OBJECTIVE:We examined the effect of interferon gamma on proliferation and epidermal growth factor receptor expression in ovarian cancer cell lines and normal ovarian epithelial cells. STUDY DESIGN:The tritiated thymidine incorporation assay was used to assess the effect of interferon gamma on proliferation. Scatchard ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(92)91790-h
更新日期:1992-12-01 00:00:00
abstract::Pure long-term cytotrophoblast cultures were established from human first-trimester placentas by growing chorionic villus explants without enzymatic digestion. Cytoplasmic human chorionic gonadotropin was detectable in all (100%) cells in culture when labeled with a polyclonal anti-human chorionic gonadotropin antibod...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90314-1
更新日期:1989-04-01 00:00:00
abstract::Outpatient endometrial aspiration was offered to patients who suspected that they were pregnant, but were within 5 to 21 days after failure of expected menstruation and had a uterus of normal size on pelvic examination. This is a report of 500 consecutive cases treated between September, 1973, and April, 1975. Histolo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(76)90567-6
更新日期:1976-06-01 00:00:00