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D A Grimes

Publications and source records attributed to D A Grimes.

At least 19 recordsLinked to original sources
PubMed1992

Luteal phase deficiency: effect of treatment on pregnancy rates.

Luteal phase deficiency is thought to be a cause of female infertility. Nevertheless, little agreement exists concerning either its diagnosis or its treatment. To address the latter question, we reviewed the English literature and examined the effect of treatment on pregnancy rates. One randomized controlled trial found a statistically insignificant benefit of treatment with progesterone suppositories or oral dehydroprogesterone versus no treatment (relative risk 1.9; 95% confidence interval 0.4 to 8.1). Three other comparative studies also showed no statistically significant benefit. Case-series reports (before-after studies) claiming benefit failed to account for the effect of regression to the mean. The benefit of treatment for luteal phase deficiency has not been established. Uniform case definitions and randomized controlled trials of adequate power are needed to resolve this problem.

Clomiphene↗
PubMed1979

Local versus general anesthesia: which is safer for performing suction curettage abortions?

The relative safety of suction curettage abortions performed with either local or general anesthesia has not been clearly established. To compare the safety of these two anesthetic techniques, we studied 36,430 women who received local anesthetics and 17,725 who received general anesthetics for this operation in the United States from 1971 through 1975. The aggregated major complication rates for the two groups were similar, but there were significant differences between local and general anesthesia for specific complications and treatments. Local anesthesia was associated with higher rates of febrile and convulsive morbidity; however, general anesthesia was associated with higher rates of hemorrhage, cervical injury, and uterine perforation. Both anesthetic techniques appear to be safe, with similar degrees of overall safety, although each is associated with a different spectrum of complications.

Abdomen↗
PubMed1979

Estimating vaginal blood loss.

In order to estimate amounts of vaginal bleeding, obstetrician-gynecologists have traditionally asked women the number of napkins, pads or tampons they use. This method of estimation rests on the assumptions that the volume of blood absorbed by various sanitary products is (1) known and (2) equivalent. To test these underlying assumptions the blood absorption capacity of 15 commercially available sanitary products was measured. Mean absorptions ranged from 1.32 to 94.86 ml for different products; a one-way analysis of variance showed that these mean absorptions were not equal (p less than .001). Moreover, products within a single package revealed substantial variations in absorbency. Thus, asking women the number of sanitary products they use is unlikely to yield clinically useful information; such questions should probably be deleted from the gynecologic history.

Absorption↗
PubMed1979

The comparative efficacy and safety of intraamniotic prostaglandin F2 alpha and hypertonic saline for second-trimester abortion. A review and critique.

Intraamniotic instillation of prostaglandin F2 alpha (PGF2 alpha) is considered by many to be safer than instillation of hypertonic saline for second-trimester abortion. To evaluate the validity of this hypothesis, we reviewed 15 comparisons of these two abortifacients published in the English literature since 1973. These reports suggest that while PGF2 alpha induces abortion faster than saline, PGF2 alpha is associated with higher rates of unpleasant gastrointestinal side effects, incomplete abortion, hemorrhage and surgical reevacuation. In addition, the rate of live-born fetuses after PGF2 alpha-induced abortion may be 5 to 40 times that of saline. The existing literature does not substantiate the claim that PGF2 alpha is superior to saline as an abortifacient.

Abortifacient Agents↗
PubMed1978

Legalized abortion: effect on national trends of maternal and abortion-related mortality (1940 through 1976).

Both non-abortion-related maternal and abortion-related mortality declined prior to the Supreme Court decisions of 1973. In order to determine the effect of legalized abortion on maternal mortality, we have analyzed the secular trends in national abortion mortality ratios for 1940 through 1976, compared the trends to those maternal mortality ratios, and hypothesized reasons for differences between these trends. Between 1940 and 1950 and after 1965, deaths from abortion declined more rapidly than deaths from other causes associated with childbirth. However, between 1951 and 1965, maternal mortality related to pregnancy of childbirth declined more rapidly than abortion-related mortality. Five possible explanations exist for the more rapid decline in abortion deaths since 1965--selected underreporting, changes in coding practices, improved safety of illegal abortion, introduction of more effective contraception, and increased availability of legal abortion. We consider the last two explanations as the most likely reasons for the accelerated decline in abortion-related deaths.

Abortion, Legal↗
PubMed1978

Routine circumcision of the newborn infant: a reappraisal.

Prompted by the continuing controversy over routine circumcision of the newborn infant, this review of the limited available literature suggests that the operation may facilitate hygiene of the penis and perhaps decrease the risk of carcinoma of the penis. On the the other hand, the operation frequently features illogical bases for patient selection, neglect of the requirement to obtain informed consent, an inappropriate operator, a needlessly radical technique, disregard for pain, dubious objectives, and unknown cost-effectiveness. Long-term prospective studies are needed to evaluate routine circumcision of the newborn infant. However, until the benefits of the procedure can be proved worth the risk and cost, medical resources should probably be allocated to health measures of demonstrated value.

Anesthesia↗
PubMed1978

Comparative risk of death from legally induced abortion in hospitals and nonhospital facilities.

The rapid emergence of nonhospital abortion facilities as alternatives to traditional hospital-based surgical care has raised important questions concerning their safety. Using 1974--1975 data from the Center for Disease Control's nationwide surveillance of abortion mortality and the Alan Guttmacher Institute's nationwide surveys of abortion providers, we have calculated the risk of death from legally induced abortion in the United States at less than or equal to 12 menstrual weeks' gestation in hospitals and nonhospital facilities (clinics and physicians' ofices). The adjusted death-to-case rate for hospitals was 1.1 deaths/100,000 abortions, compared with a crude rate of 1.0 for nonhospital facilities. The risk of death from legal abortion in nonhospital facilities is apparently similar to the risk in hospitals.

Abortion, Legal↗
PubMed1978

World Health Organization studies of prostaglandins versus saline as abortifacients. A reappraisal.

The World Health Organization (WHO) Task Force on the Use of Prostaglandins for the Regulation of Fertility has sponsored a series of randomized clinical trials and case-series investigations to assess the effectiveness and safety of prostaglandins as abortifacients. Our reanalysis of the WHO studies found the prostaglandins to be faster and more hazardour than hypertonic saline as intraamniotic abortifacients. Moreover, studies by the Center for Disease Control imply that dilatation and evacuation (D&E) may be more effective, safe, convenient, and inexpensive than prostaglandins for abortions after 12 weeks' gestation, especially in the 13- to 16-week interval. For gestations of greater than or equal to 17 weeks, the occurrence of live births in prostaglandin-induced abortions has produced serious legal and ethical problems in the United States. Until the effectiveness and safety of other prostaglandins regimen approach that of D&E, we feel that D&E should be the index of comparison against which newer methods of inducing abortion are tested.

Abortion, Induced↗
PubMed1978

Abortion failure.

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Abortion, Induced↗
PubMed1977

Mid-trimester abortion by dilatation and evacuation: a safe and practical alternative.

Abortions by dilatation and evacuation after the 12th menstrual week of pregnancy are said to be both hazardous and impractical. To evaluate this hypothesis, we compared the safety and feasibility of 6213 abortions by this means and 8662 induced by intra-amniotic instillation of saline during the 13th to the 20th week of pregnancy. Abortions by dilatation and evacuation had a lower rate for major complica-tions (0.69 vs. 1.78 per cent; P is less than 0.001) and lower rates for treatment of complications, including antibiotic administration (2.22 vs. 5.65 per cent; P is less than 0.001), blood transfusion (0.19 vs. 0.91 per cent; P is less than 0.001), and curettage or manual evacuation of the uterus (0.98 vs. 34.10 per cent; P is less than 0.001). Such abortions also had a lower rate for failure of the method to produced abortion (0.11 vs. 2.52 per cent; P is less than 0.001). Although large, randomized trials are required to determine the appropriate role of mid-trimester abortion by this means, this method appears safe and practical through the 20th week of pregnancy.

Abortion, Induced↗