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Biomedical subjects

A M Kaunitz

Publications and source records attributed to A M Kaunitz.

15 recordsLinked to original sources
PubMed1992

Detection of cervical Chlamydia trachomatis and Neisseria gonorrhoeae with deoxyribonucleic acid probe assays in obstetric patients.

OBJECTIVE: The Gen-Probe PACE 2 deoxyribonucleic acid probe assays for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae are targeted against the ribosomal ribonucleic acid of each pathogen. Our study compared the performance of the probe assays with culture for Chlamydia trachomatis (246 patients) and Neisseria gonorrhoeae (310 patients) while screening obstetric patients. STUDY DESIGN: Using culture as a gold standard, we assessed the sensitivity, specificity, positive predictive value, and negative predictive value of the chlamydia and gonorrhea probes. RESULTS: The prevalence of chlamydia by culture was 13.4% and gonorrhea 4.8%. Against culture, the chlamydia probe assay performed as follows: sensitivity 93.9%, specificity 99.1%, positive predictive value 93.9%, and negative predictive value 99.1%. Values for the gonorrhea probe assay were 93.3%, 99.0%, 82.4%, and 99.7%, respectively. Additional molecular analysis of probe-positive-culture-negative specimens suggests that the gonorrhea probe-positive predictive value may be even higher. CONCLUSION: The Gen-Probe PACE 2 deoxyribonucleic acid probe assays for chlamydia and gonorrhea appear to be promising as convenient, reliable, and cost-effective alternatives to conventional cultures in screening obstetric patients.

Adult↗
PubMed1992

Oral contraceptives and gynecologic cancer: an update for the 1990s.

The most recent statistical evidence confirms a protective effect of oral contraceptive use against ovarian and endometrial cancers. Studies of the association between oral contraceptive use and cervical cancer continue to be hampered by confounding factors; however, results suggest that the overall risk of invasive cervical neoplasia is not increased. Although the association between oral contraceptive use and breast cancer remains controversial, existing data strongly suggest that overall risk of breast cancer is not increased by the use of oral contraceptives. In most candidates for oral contraceptive use, the benefits greatly outweigh the risks.

Breast Neoplasms↗
PubMed1992

Hygroscopic cervical dilators and prostaglandin E2 gel for preinduction cervical ripening. A randomized, prospective comparison.

A randomized, prospective study compared the safety and efficacy of hygroscopic cervical dilators (36 patients) with intracervical prostaglandin E2 (PGE2) gel (38 patients) in preinduction cervical ripening. Maternal age, gestational age and parity were similar in both groups. Both groups had similar cervical Bishop scores upon admission. The change in the cervical score was 3.0 +/- 0.3 (mean +/- SEM) in the dilator group and 2.8 +/- 0.4 in the PGE2 group (P = .7). The mean length of time from amniotomy to delivery was similar in both groups (10.1 +/- 1.0 and 10.3 +/- 1.3 hours, respectively) (P = .9). The proportions of patients in each arm of the study undergoing cesarean section were similar. Eight cesarean sections (21.0%) were performed in the PGE2 group; seven (19.4%) were performed in the dilator group (P = .9). Maternal morbidity, five-minute Apgar scores and admissions to the neonatal intensive care unit were similar in the two groups. Because patients were required to stay in the labor-and-delivery unit for four to six hours of fetal monitoring after PGE2 application, the costs were higher in that group. The dilators and PGE2 gel appear comparable in efficacy as preinduction cervical ripening agents. The need to monitor patients receiving PGE2 gel, however, appears to favor the choice of the dilators from a cost and convenience perspective.

Acrylic Resins↗
PubMed1991

Calcium excretion in preeclampsia.

Recent studies have suggested that preeclampsia is associated with hypocalciuria. We compared 24-hour urine data from 143 obstetric patients: 33 with preeclampsia, 58 normotensives, and 52 patients with gestational hypertension. The mean maternal age, race, and parity of these three groups did not differ significantly. The patients with preeclampsia had significantly less excretion of total calcium (129.7 +/- 18.7 mg/24 hours) (mean +/- SEM) than normotensives (283.9 +/- 12.3) or those with gestational hypertension (233.2 +/- 22.3) (P = .0001). The mean arterial pressure and excretion of total protein were significantly increased in the preeclampsia group (P = .0001). Using the receiver operator curve, a urine calcium threshold of 12 mg/dL was chosen as predictive for the development of preeclampsia, with a sensitivity of 85%, specificity of 91%, and positive and negative predictive values of 85 and 91%, respectively. Urinary calcium levels below 12 mg/dL may help distinguish preeclampsia from other hypertensive disorders of pregnancy.

Adult↗
PubMed1990

Reducing cesarean sections at a teaching hospital.

A department-wide effort to reduce the cesarean section rate at the University Medical Center of Jacksonville (Florida) began in 1987. University Medical Center, a teaching hospital with approximately 4500 annual deliveries, serves an almost exclusively indigent obstetric population. Overall, the cesarean section rate declined from 28 per 100 deliveries in 1986 to 11 per 100 in 1989. Decreasing the number of repeat cesarean sections played an important role in reducing total cesarean deliveries. In 1986 32% of women with prior cesarean sections underwent a trial of labor. By 1989 this proportion had increased to 84%. In 1986 65% of women undergoing a trial of labor were delivered vaginally. By 1989 this proportion had increased to 83%. For these reasons the proportion of patients who had repeat cesarean sections dropped from 8% in 1986 to 3% in 1989. Changing approaches to the evaluation and management of dystocia and fetal distress also helped to lower the overall cesarean section rate. In 1986 cesarean sections for at least one of these two indications accounted for 14% of all deliveries. By 1989 this percentage had dropped to 4%. Because selective criteria for vaginal delivery of fetuses in breech presentation were maintained, incremental increased rates of vaginal breech delivery had only a minimal impact on lower overall cesarean section rates. The reduction in the number of cesarean sections was accomplished without compromising neonatal outcomes. In fact, during this 4-year period neonatal mortality rates actually decreased; neonatal morbidity rates remained stable. Our experience suggests that cesarean section rates can be substantially reduced without compromising the newborn.

Birth Weight↗
PubMed1990

Pseudotumor cerebri following eclampsia.

Pseudotumor cerebri, or increased intracranial pressure without a mass lesion, has been associated with hormonal activity but the exact causative relation is still obscure. We report a case of a 15-year-old girl who developed pseudotumor cerebri manifested by headache, visual symptoms and extraocular muscle palsies 3 weeks after recovering from eclampsia. Possible associations with eclampsia and postpartum changes in estrogen, progesterone and prolactin are discussed.

Adolescent↗
PubMed1988

Successful pregnancy after previous conservative treatment of an advanced cervical pregnancy.

Cervical pregnancy was diagnosed at 12 weeks' gestation in a young nulliparous woman presenting with vaginal bleeding. Initial treatment with methotrexate was unsuccessful. The patient was ultimately treated by internal iliac artery ligation, hysterotomy, and intracervical balloon tamponade. Nineteen months after surgery, the patient delivered a healthy infant at 36 weeks' gestation by cesarean section.

Abortion, Induced↗
PubMed1988

Comparison of endometrial biopsy with the endometrial Pipelle and Vabra aspirator.

Endometrial biopsy can be used to evaluate women at high risk for endometrial cancer and to follow women on hormone replacement therapy. Biopsy methods may produce enough pain, however, to lower patient acceptance. The Endometrial Pipelle is a new plastic endometrial suction curette that provides a histologic biopsy. This study compared the performance of the Pipelle to that of the Vabra aspirator, a widely accepted biopsy device. Endometrial sampling using both techniques was performed on 56 patients. Both instruments provided the correct diagnosis in 50 patients (89%). The Pipelle obtained more tissue than the Vabra in 28 patients (50%) and was noted by the clinician to cause less pain in 50 patients (89%). Forty-seven patients (84%) stated that biopsy with the Pipelle was less painful than with the Vabra. These results suggest that the Pipelle is as efficacious as the Vabra aspirator and has greater patient acceptability.

Adult↗
PubMed1987

A physician's guide to adoption.

The growing number of couples seeking to adopt may have outstripped the number of babies in the United States available for adoption. Although increased availability and use of abortion have resulted in fewer single women continuing their pregnancies, the increased tendency of unmarried mothers to raise rather than relinquish their children has, in particular, limited the number of babies available for adoption. Despite the unpopularity of adoption among women with unintended pregnancies, addressing this option remains an important part of pregnancy counseling. Appropriate obstetric care of women placing their babies for adoption includes acknowledgment of the loss these women experience. Knowledge of adoption resources and willingness to discuss adoption can help physicians provide better care of unintentionally pregnant as well as infertile patients.

Adoption↗
PubMed1986

Maternal mortality in women aged 35 years or older: United States.

To examine maternal mortality among women aged 35 years or older, we used death certificates from the United States for 1974 through 1978. There were 425 maternal deaths, corresponding to a mortality rate of 58.3 deaths per 100,000 live births. This rate was higher than the rate for women 20 through 34 years of age (race-adjusted relative risk [RR] = 4.0; 95% confidence interval [CI], 3.6 to 4.4). The leading causes of death were obstetric hemorrhage and embolism. Black women had higher mortality rates than white women for deaths without abortive outcomes (RR = 3.3; CI, 2.7 to 4.1) and with abortive outcomes (RR = 9.4; 95% CI, 5.8 to 15.3), and the latter difference was largely due to a higher rate of deaths associated with ectopic pregnancy among black women. From 1974 through 1978, compared with 1982, maternal mortality rates for women aged 35 years or older reported by the National Center for Health Statistics declined approximately 50%. Among white women, changes in age and parity accounted for less than half of this decrease, suggesting that improvements have occurred in age- and parity-specific mortality for women aged 35 years or older.

Abortion, Spontaneous↗
PubMed1986

Mental retardation: a controversial indication for hysterectomy.

Some mentally retarded women, particularly those severely affected, may benefit from hysterectomy. Although the contraceptive effect of hysterectomy frequently may be useful, this procedure should be performed only in those women for whom menstrual hygeine is (or is anticipated to be) a major problem. A recommendation from a pediatrician or other physician who has an established relationship with the patient is a prerequisite to surgery. Likewise, informed written consent from the women's legal guardian must include a review of the risks and benefits of and alternatives to the proposed surgery. Our experience suggests that, for selected women with severe mental retardation, hysterectomy, albeit controversial, may improve the quality of life.

Adolescent↗
PubMed1985

Causes of maternal mortality in the United States.

Among 2475 maternal deaths that occurred in the United States from 1974 to 1978, 408 were related to pregnancies with abortive outcomes, and 2067 were related to other causes. Ectopic pregnancy was the most frequent cause of death in the former group. Embolism, hypertensive disease of pregnancy, obstetric hemorrhage, and obstetric infection were the most common causes of death in the latter group. Women who were 30 years of age or older or of minority race were at increased risk of death. Nationwide surveillance of maternal mortality is feasible and should help to increase the safety of childbearing.

Abortion, Spontaneous↗
PubMed1985

Abortions that fail.

In this study of 33,090 suction curettage abortions performed at less than or equal to 12 weeks' gestation, the rate of unrecognized failed abortions was 2.3 per 1000 abortions. Women with one or more prior pregnancies and those having an abortion at less than or equal to six weeks' gestation, particularly when small suction cannulae were used, were at higher risk for this complication (relative risks of 2.2, 2.9, and 11.1, respectively). Failures were also more likely when abortions were performed by resident physicians (relative risk of 2.2) and when they were performed on women with uterine anomalies (relative risk of 90.6). Physicians can minimize the risk of failed abortion by selecting an appropriate suction cannula size and by planning the optimal time to perform the abortion. Likewise, abortions performed either by residents or on women with uterine anomalies merit extra care.

Abortion, Legal↗