Emergency contraception, efficacy and public health impact.

Purpose Of Review: Emergency contraception in the past two decades had been proven to be effective and well tolerated. Counseling and advance provision and prescription of emergency contraception have been embraced by professional organizations in practice guidelines for its potential to reduce the number of unintended pregnancies and abortions. Has emergency contraception lived up to that promise?

Recent Findings: Mifepristone (not available in the USA) is the agent of choice.

Experience using cryotherapy for treatment of cervical precancerous lesions in low-resource settings.

Cervical cancer can be successfully prevented if timely identification of precancerous lesions is followed by effective treatment. In many developing countries, treatment of precancer is neglected because therapeutic services are unavailable, inaccessible, inappropriate, or inadequately linked to screening services. One of the main focuses of the Alliance for Cervical Cancer Prevention (ACCP) has been to ensure that safe and effective methods of treatment for precancer are both available and accessible to women who need them.

Two-hour urine collection for evaluating renal function correlates with 24-hour urine collection in pregnant patients.

Objective: We sought to determine if 2-h urine collection for the assessment of urine protein excretion and creatinine clearance correlates with 24-h urine collection in pregnant patients with renal disease.

Methods: We enrolled patients of gestational ages ranging from 8-41 weeks, admitted as inpatients and having undergone evaluation for renal function (n = 59). We obtained the following samples: 1) 2-h urine, and 2) 24-h urine.

A randomized trial comparing prostaglandin E(2) vaginal insert (Cervidil) to vaginal gel for cervical ripening before induction of labor.

Objective: To compare the efficacy and safety of a controlled release vaginal insert (Cervidil) with hospital compounded prostaglandin E(2) vaginal gel for cervical ripening before labor induction.Methods: A prospective randomized study was performed between July 1996 and August 1997 on 200 patients undergoing cervical ripening before induction of labor. The efficacy and safety of a 12-hour controlled release 10-mg vaginal insert (Cervidil, Forest Pharmaceuticals) was compared with two 4-mg doses of prostaglandin E(2) gel.

Interpreting fetal heart rate tracings. Is there a difference between labor and delivery nurses and obstetricians?

Objective: To analyze the influence of increasing education and clinical experience on fetal heart rate interpretation by health care providers in labor and delivery areas.

Study Design: Eleven tracings representing a variety of fetal heart rate patterns and neonatal outcomes were selected. Respondents were asked to interpret the tracing strips on a 1-5 scale and predict Apgar scores and cord blood gases.

Nucleated red blood cells in cord blood of singleton term neonates.

Objective: This study aims to establish normal values for nucleated red blood cells in term singletons and factors associated with their elevation.

Study Design: Cord blood was prospectively collected from term singleton gestations from Feb. 1 to July 31, 1995.

Randomized, double-blind trial of prostaglandin E2 intravaginal gel versus low-dose oxytocin for cervical ripening before induction of labor.

Objective: Our purpose was to compare two methods of preinduction cervical ripening in a randomized, double-blind clinical trial.

Study Design: Two intravaginal, 4 mg prostaglandin E2 gel applications administered 4 hours apart were compared with 10 hours of low-dose oxytocin (2 mU/min) in 200 patients undergoing preinduction cervical ripening.

Results: There were no differences in parity, initial Bishop scores, estimated gestational ages, indications for induction, or birth weights.

Correlates of multigravida women's binge drinking during pregnancy. A longitudinal study.

Objective: To refine our understanding of prenatal psychosocial factors associated with binge drinking during pregnancy and the contribution of binge drinking during pregnancy to the duration of newborn hospitalization.

Design: Prospective cohort.

Setting: A large urban medical center in Wisconsin.

Value of wet mount and cervical cultures at the time of cervical cytology in asymptomatic women.

Objective: To correlate Papanicolaou smear findings with the wet mount and cervical culture results in asymptomatic patients, and to review the value of doing wet mount and/or cervical cultures in these patients at the time of Papanicolaou smear.

Methods: Asymptomatic women presenting for routine Papanicolaou smears at Sinai Samaritan Medical Center, Milwaukee, Wisconsin, between January 1991 and January 1994 were studied by preparing wet mount (saline and potassium hydroxide preparations) and cervical cultures for Chlamydia trachomatis and Neisseria gonorrhoeae at the same visit. Fisher exact test and Pearson chi 2 statistics were applied.

Primary syphilis and nonimmune fetal hydrops in a penicillin-allergic woman. A case report.

The incidence of congenital syphilis is on the rise. Penicillin continues to be the drug of choice for it during pregnancy. A penicillin-allergic woman with primary stage syphilis who was treated initially with erythromycin presented with fever and nonimmune fetal hydrops secondary to an intrauterine syphilitic infection.

Spontaneous quadruplet pregnancy in a woman with a personal and family history of spontaneous twin and triplet pregnancy. A case report.

Spontaneous quadruplet pregnancies are exceptional. As compared with singleton pregnancies, quadruplets are associated with a higher incidence of preterm labor, first-trimester bleeding, toxemia, anemia, stillbirths and perinatal deaths. We report a 25-year-old, black woman with a spontaneous quadruplet pregnancy.

The effect of urban socioeconomic problems on perinatal statistics in Milwaukee, 1983-1991.

Perinatal statistics in an urban environment are analyzed over a 9-year period. Perinatal outcome parameters in 27,986 deliveries are analyzed. The number of prenatal visits, low birth weight, illicit drug use, perinatal mortality, race, and age are studied.

Acetic acid visualization of the cervix to detect cervical dysplasia.

Objective: To determine whether acetic acid visualization of the cervix can identify cervical dysplasia and improve detection of lesions missed by Papanicolaou test screening.

Methods: During a 2-year period, patients attending family planning clinics for regular gynecologic examinations had acetic acid applied to the cervix, followed by gross visualization without magnification. Patients with suspicious acetowhite lesions and normal Papanicolaou tests were referred for colposcopic evaluation.

Drug use or inadequate prenatal care? Adverse pregnancy outcome in an urban setting.

Objective: This study analyzed the relationships between illicit drug use, low birth weight, adequacy of prenatal care, and perinatal mortality.

Study Design: Perinatal outcome parameters in 23,926 deliveries between 1983 and 1990 were analyzed. Statistical analysis (chi 2 analysis) was applied for each year of study to separate the effects of inadequate prenatal care from illicit drug use.

Terconazole for the treatment of vulvovaginal candidiasis.

A double-blind, randomized trial was conducted to evaluate the efficacy and safety of terconazole for vulvovaginal candidiasis. Treatment consisted of daily intravaginal application of one of the following regimens: 80-mg terconazole suppositories for 3 days, miconazole nitrate suppositories for 7 days or placebo suppositories for 7 days. The terconazole and miconazole nitrate groups had significantly higher therapeutic cure rates than did the placebo group.

Growth of Trichomonas vaginalis in commercial culture media.

There are only two commercially available, ready-to-use culture media which are approved by the Food and Drug Administration for clinical diagnosis of vaginal trichomoniasis: Kupferberg's STS and Diamond's medium (modified). Diamond's medium (Klaas modification), recommended by the Centers for Disease Control for the isolation of Trichomonas vaginalis, was compared in vitro to Kupferberg's (STS) medium. Growth studies using six fresh clinical isolates, all from different patients, showed that while generation time was about 6 h in both STS and Diamond's, the period of exponential growth was longer in Diamond's.

Is pH test paper as accurate as the electronic measurement of the pH of vaginal secretions?

A comparison was made of two brands of pH test paper and electronic instrumentation for measuring the pH of vaginal secretions. When the pH of vaginal secretions was greater than 4.5 (abnormal), there was no significant difference between the methods, showing that pH test paper is reliable for pH determination of vaginal secretions.

Statistical evaluation of diagnostic criteria for bacterial vaginosis.

Bacterial vaginosis is the most common cause of vaginitis in women of reproductive age. In an attempt to clarify diagnosis of this condition, various parameters of signs and symptoms and groups of parameters were compared with classical diagnostic criteria in 310 patients. There was no significant difference in positive diagnosis rates between the Amsel et al.

Advances in the understanding of bacterial vaginosis.

Bacterial vaginosis is a disease that results from massive overgrowth of vaginal bacterial flora. The exact etiology is unknown. The major components of the normal bacterial flora, peroxide-producing lactobacilli, are replaced by non-peroxide-producing lactobacilli, allowing overgrowth of anaerobic and gram-negative aerobic flora.

Using amnioinfusion for the relief of repetitive variable decelerations during labor.

Amnioinfusion is a method of replacing intrauterine amniotic fluid volume through intrauterine infusion of a saline solution using a pressure catheter. This method simply and effectively relieves variable decelerations not alleviated by the conventional measures of maternal position change and oxygen administration. The mechanisms underlying variable decelerations, the technique for amnioinfusion administration, and two case studies are reported.

Obstetric vacuum extraction.

A brief historical review of vacuum extraction, indications for use, safety considerations, mode of action, delivery technique, and discussion of nursing implications is presented. Safety and effectiveness of vacuum extraction are supported by the results of a comparative study done at Mount Sinai Medical Center in which 256 vacuum extractions and 300 randomly selected forceps deliveries were performed. Indications for use, clinical status before application, maternal complications, and immediate neonatal complications are analyzed and discussed.

Vacuum extraction versus forceps delivery: indications and complications, 1979 to 1984.

Two hundred fifty-six vacuum extractions and 300 randomly chosen forceps deliveries were analyzed retrospectively. Vacuum extraction use increased from 0.3 to 3.