A 40-year-old woman considering contraception.
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Adult↗
Biomedical subjects
H B Peterson
Publications and source records attributed to H B Peterson.
Treatment for lactation suppression: little progress in one hundred years.
Our goal was to characterize the postpartum symptoms experienced by women who do not breast-feed and to review data on the efficacy of nonpharmacologic methods of lactation suppression. The placebo arms of randomized clinical trials of pharmacologic methods for lactation suppression were used to characterize postpartum symptoms. A subset of the placebo arms was reviewed to assess current strategies for treatment of symptoms associated with lactation suppression. Studies of nonpharmacologic methods of lactation suppression were also reviewed to assess efficacy. Engorgement and breast pain may encompass most of the first postpartum week. Up to one third of women who do not breast-feed and who use a brassiere or binder, ice packs, or analgesics may experience severe breast pain. Specific studies of nonpharmacologic methods of lactation suppression were limited and inconclusive. Available data suggest that many women using currently recommended strategies for treatment of symptoms may nevertheless experience engorgement or pain for most of the first postpartum week.
Adolescent↗
Severity of pelvic inflammatory disease as a predictor of the probability of live birth.
OBJECTIVE: Our aim was to study the association between severity of pelvic inflammatory disease at laparoscopy and the probability of achieving a live birth, while accounting for subsequent episodes of pelvic inflammatory disease. STUDY DESIGN: Beginning in 1960 a cohort of 1288 women in Lund, Sweden, who had clinical symptoms of acute pelvic inflammatory disease and who desired pregnancy was followed for up to 24 years. All participants underwent laparoscopy and were categorized by degree of salpingitis: mild (n = 371), moderate (n = 580), or severe (n = 337) pelvic inflammatory disease. Cumulative live birth rates, obtained by life-table analysis, and proportional hazards ratios were compared among women by severity of pelvic inflammatory disease, while accounting for subsequent episodes. RESULTS: The cumulative proportion of women achieving a live birth after 12 years was 90% for women with mild, 82% for women with moderate, and 57% for women with severe pelvic inflammatory disease. The occurrence of subsequent episodes in women with mild pelvic inflammatory disease did not diminish their long-term probability of live birth, whereas it significantly lowered the probability of live birth in women with severe pelvic inflammatory disease. Women with severe disease and subsequent episodes were eight times more likely to fail to achieve live birth compared with women with a single pelvic inflammatory disease episode with mild disease (relative risk 8.1; 95% confidence interval 3.0 to 22.2). CONCLUSIONS: Increasing severity of pelvic inflammatory disease correlates with a lower long-term probability of live birth. Subsequent episodes have a greater impact on women with severe pelvic inflammatory disease at the index episode compared with those with milder disease.
Adult↗
Vasectomy and prostate cancer: the evidence to date.
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Humans↗
Higher hysterectomy risk for sterilized than nonsterilized women: findings from the U.S. Collaborative Review of Sterilization. The U.S. Collaborative Review of Sterilization Working Group.
OBJECTIVE: To compare the risk of hysterectomy among previously sterilized women and women whose husbands had undergone vasectomy, and to evaluate whether this risk differed by age at surgical procedure or by method of tubal occlusion. METHODS: Our study population comprised 7718 women enrolled in a prospective, multicenter cohort study between 1978 and 1986. After stratifying by the woman's age at surgical procedure, we used the life-table approach and adjusted hazards ratios to examine whether the relative risk of hysterectomy during the 5 years after enrollment differed between the 7174 women who had been sterilized and the 544 women whose husbands had undergone vasectomy. RESULTS: The 5-year cumulative probability of hysterectomy was 8% among the previously sterilized women and 2% among the women whose husbands had undergone vasectomy. Among women 34 years of age and younger at enrollment, sterilized women were 4.4 times as likely to have a hysterectomy as women whose husbands had undergone vasectomy (95% confidence interval [CI] 1.9, 10.0). Findings were similar for women 35 years of age and older (rate ratio = 4.6; 95% CI 1.4, 14.5). Each of the six most commonly used methods of tubal occlusion was associated with an increased risk of hysterectomy. CONCLUSION: Women undergoing tubal sterilization were more likely than women whose husbands underwent vasectomy to undergo hysterectomy within 5 years after sterilization, regardless of age at sterilization. An increased risk of hysterectomy was observed for each method of tubal occlusion.
Adult↗
Visits to emergency departments for gynecologic disorders in the United States, 1992-1994.
OBJECTIVE: To assess rates of visits to emergency departments for gynecologic disorders among women of reproductive age in the United States. METHODS: Data from the National Hospital Ambulatory Medical Care Survey for 1992-1994 were analyzed to determine rates of visits to emergency departments among women, ages 15-44 years. Average annual rates per 1000 women were calculated using age, race, and region-specific population estimates. Rate ratios were used to compare rates among subgroups. RESULTS: Approximately 1.4 million gynecologic visits were made to emergency departments annually, for an average annual rate of 24.3 visits per 1000 women, ages 15-44 years (95% confidence interval [CI] 22.0, 26.6). The most frequent diagnoses were pelvic inflammatory disease (average annual rate 5.8, 95% CI 5.0, 6.6), lower genital tract infections including sexually transmitted diseases (average annual rate 5.7, 95% CI 4.8, 6.6), and menstrual disorders (average annual rate 2.9, 95% CI 2.3, 3.5). Nearly half of all gynecologic visits resulted in diagnoses of genital tract infections. Younger women (ages 15-24 years) were 2.3 (95% CI 2.0, 2.6) times as likely as older women (ages 25-44 years), and black women were 3.6 (95% CI 2.9, 4.3) times as likely as white women, to visit emergency departments for gynecologic disorders. Rate ratios for genital tract infections were 10-20 times higher for younger black women than for older, white women. CONCLUSION: Almost half of gynecologic visits to emergency departments were related to genital tract infections, which largely are preventable.
Adolescent↗
Meta-analysis for the practicing obstetrician-gynecologist.
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Female↗
Intrapartum electronic fetal monitoring: data for clinical decisions.
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Data Interpretation, Statistical↗
The risk of ectopic pregnancy after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group.
BACKGROUND: Tubal sterilization is an increasingly common method of contraception in the United States. Although pregnancy after sterilization is uncommon, it can occur and may be ectopic. We used data from the U.S. Collaborative Review of Sterilization to estimate the risk of ectopic pregnancy in women who had undergone the common types of tubal sterilization. METHODS: A total of 10,685 women undergoing tubal sterilization were followed in a multicenter, prospective cohort study. We intended to follow all the women for 5 years by means of annual telephone interviews; for women enrolled early in the study, we attempted an additional follow-up telephone interview 8 to 14 years after sterilization. To assess the risk of ectopic pregnancy in these women, we used cumulative life-table probabilities and proportional-hazards analysis. RESULTS: There were 47 ectopic pregnancies in the 10,685 women; the 10-year cumulative probability of ectopic pregnancy for all methods of tubal sterilization combined was 7.3 per 1000 procedures. The cumulative probability varied substantially according to the method of sterilization and the woman's age at the time of sterilization. Women sterilized by bipolar tubal coagulation before the age of 30 years had a probability of ectopic pregnancy that was 27 times as high as that among women of similar age who underwent postpartum partial salpingectomy (31.9 vs. 1.2 ectopic pregnancies per 1000 procedures). The annual rate of ectopic pregnancy for all methods combined in the 4th through 10th years after sterilization was no lower than that in the first 3 years. CONCLUSIONS: A history of tubal sterilization does not rule out the possibility of ectopic pregnancy, even many years after the procedure.
Adolescent↗
Tubal sterilization and long-term risk of hysterectomy: findings from the United States collaborative review of sterilization. The U.S. Collaborative Review of Sterilization Working Group.
OBJECTIVE: To estimate the long-term probability of hysterectomy after sterilization according to demographic and clinical characteristics before the procedure. METHODS: We used a prospective, multi-center cohort study of 10,698 women undergoing tubal sterilization to examine the cumulative probability of hysterectomy up to 14 years after sterilization. Independent risk factors for subsequent hysterectomy were examined using the life-table approach and the Cox proportional hazards model. RESULTS: The cumulative probability of undergoing hysterectomy 14 years after sterilization was 17%. The highest long-term cumulative probabilities of hysterectomy occurred among women who, at the time of sterilization, reported a history of endometriosis (35%) or were older than 30 years and reported prolonged bleeding during menses (46%). Multivariate modeling demonstrated an independently increased risk of hysterectomy among women who, at the time of tubal sterilization, reported a history of heavy menstrual flow (relative risk [RR] 1.4; 95% confidence interval [CI] 1.1, 1.7), severe menstrual pain (RR 1.3; 95% CI 1.1, 1.6), bleeding of more than 7 days during menstrual cycles (RR 1.8; 95% CI 1.1, 2.8), pelvic inflammatory disease (RR 1.3; 95% CI 1.04, 1.7), ovarian cysts (RR 1.6; 95% CI 1.2, 2.0), endometriosis (RR 2.5; 95% CI 1.7, 3.9), or uterine leiomyomata (RR 2.7; 95% CI 2.0, 3.7). CONCLUSIONS: Although women with gynecologic disorders before tubal sterilization were at greater risk of hysterectomy during the 14 years after sterilization than were women without these disorders, the majority of sterilized women in both categories did not undergo subsequent hysterectomy.
Adolescent↗
Uterine size and risk of complications among women undergoing abdominal hysterectomy for leiomyomas.
OBJECTIVE: To measure the influence of uterine size on the risk of operative complications among women undergoing abdominal hysterectomy for uterine leiomyomas. METHODS: Four hundred forty-six women undergoing abdominal hysterectomy for pathologically confirmed leiomyomas were analyzed using data from a previously reported prospective cohort study. We compared the risk of operative complications among women with uterine weights less than 250 g, 251-500 g, and greater than 500 g. Logistic regression was used to estimate the independent effect of uterine size on the probability of operative complications. RESULTS: The risk of blood transfusion increased with increasing uterine weight; 13.7, 14.2, and 26.7% of women with uterine weight less than 250 g, 251-500 g, and greater than 500 g, respectively, required transfusion (P for trend < .05). After adjustment for race, previous surgery, preoperative weight, concurrent endometriosis, and type of insurance coverage, women with uterine weight greater than 500 g had increased odds of having a transfusion (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.3). These women also had increased odds of having an estimated blood loss greater than 500 mL (OR 2.5, 95% CI 1.5-4.2), vaginal cuff cellulitis (OR 2.8, 95% CI 1.3-6.2), and at least one of a number of operative complications (OR 1.6, 95% CI 1.0-4.0). CONCLUSION: Women with leiomyomas whose uterine weight exceeds 500 g have an increased risk of complications from abdominal hysterectomy.
Adult↗
Clinical and pathologic characteristics of women undergoing hysterectomy after tubal sterilization.
OBJECTIVE: To examine differences in clinical and pathologic characteristics between women undergoing hysterectomy who had had prior tubal sterilization and those who had not. METHODS: One thousand eight hundred fifty-one women undergoing hysterectomy were enrolled as part of a multicenter, prospective cohort study. We used logistic regression to describe the association between prior tubal sterilization and patient characteristics at hysterectomy. RESULTS: Although sterilized women were not more likely than nonsterilized women to have a menstrual disorder as a presenting complaint, they were more likely to have a primary discharge diagnosis of menstrual disorder (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-2.0). After adjustment for menstrual indices, sterilized women had an increased probability of having normal findings on pathologic examination, which differed by age (women less than 30 years: OR 3.4, 95% CI 2.0-5.8; women 30 years of age and older: OR 1.7, 95% CI 1.3-2.3). CONCLUSION: Differences in clinical and pathologic characteristics between sterilized and nonsterilized women suggest that nonbiologic factors may influence decision making regarding hysterectomy among sterlized women.
Adult↗
Metaanalysis for the obstetrician-gynecologist.
To provide guidance to obstetricians and gynecologists for using findings from metaanalyses in clinical practice, we describe the principles and methods of metaanalysis, including its strengths and weaknesses. Then we illustrate these principles by reviewing four metaanalyses published recently in the American Journal of Obstetrics and Gynecology by using a systematic approach to evaluation based on 15 questions. In these published metaanalyses most of the questions are addressed, but we noted an absence of attention to coding aspects in all studies. The usefulness of metaanalysis largely depends on the quality of the studies that are synthesized, the conduct of the metaanalysis, and the reporting of the methods and results. Proper use of metaanalyses requires an understanding of the strengths and weaknesses of the method and attention to the manner of reporting. The principles of metaanalysis are not complex, and the potential benefits can be enormous for patient care.
Evaluation Studies as Topic↗
The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization.
OBJECTIVE: Our purpose was to determine the risk of pregnancy after tubal sterilization for common methods of tubal occlusion. STUDY DESIGN: A multicenter, prospective cohort study was conducted in U.S. medical centers. A total of 10,685 women who underwent tubal sterilization was followed up for 8 to 14 years. The risk of pregnancy was assessed by cumulative life-table probabilities and proportional hazards models. RESULTS: A total of 143 sterilization failures was identified. Cumulative 10-year probabilities of pregnancy were highest after clip sterilization (36.5/1000 procedures) and lowest after unipolar coagulation (7.5/1000) and postpartum partial salpingectomy (7.5/1000). The cumulative risk of pregnancy was highest among women sterilized at a young age with bipolar coagulation (54.3/1000) and clip application (52.1/1000). CONCLUSIONS: Although tubal sterilization is highly effective, the risk of sterilization failure is higher than generally reported. The risk persists for years after the procedure and varies by method of tubal occlusion and age.
Age Factors↗
The impact of knowledge of human immunodeficiency virus serostatus on contraceptive choice and repeat pregnancy.
OBJECTIVE: To examine relationships among human immunodeficiency virus (HIV) serostatus, postpartum contraceptive choice, and the rate of repeat pregnancy within a short interval. METHODS: This retrospective cohort study was performed in 83 seropositive and 218 seronegative women identified from an inner-city prenatal population undergoing routine voluntary HIV antibody screening from July 1987 through June 1989. Postpartum contraceptive choices and rate of repeat pregnancies were compared based on HIV serostatus. RESULTS: Seropositive women were significantly more likely than seronegative women to undergo tubal sterilization (27 versus 15%; odds ratio [OR] 2.9, 95% confidence interval [CI] 1.5-5.9). This relationship persisted after controlling for age, race, marital status, and parity by logistic regression modeling (adjusted OR 2.9, 95% CI 1.4-5.9). Seropositive women were significantly less likely than seronegative women to select oral contraceptives (34 versus 68%; OR 0.2, 95% CI 0.1-0.4), a relationship that persisted after controlling for age, race, marital status, parity, and foam and condom use (adjusted OR 0.2, 95% CI 0.1-0.5). Seropositive women were significantly more likely than seronegative women to select foam and condoms as their primary method of contraception (30 versus 15%; OR 2.4, 95% CI 1.2-4.5), a relationship that did not persist after controlling for age, race, marital status, and parity (adjusted OR 0.7, 95% CI 0.4-1.3). The risk of repeat pregnancy was slightly lower in seropositive versus seronegative women (34 versus 44%; OR 0.7, 95% CI 0.4-1.3). Most repeat pregnancies among seropositive and seronegative women were unplanned (90 and 82%, respectively). CONCLUSION: There was a relationship between the method of postpartum contraception and HIV serostatus, but no significant difference in repeat pregnancy rates associated with choice of method.
Adolescent↗
Rate of hospitalization for gynecologic disorders among reproductive-age women in the United States.
OBJECTIVE: To analyze reproductive-tract disorders that resulted in hospitalization of reproductive-age women in the United States. METHODS: Data from the National Hospital Discharge Survey for 1988, 1989, and 1990 were used to study women 15-44 years old who had any gynecologic diagnoses noted in their discharge summaries. RESULTS: Based on average annual discharge rates per 10,000 women, the five most frequent diagnostic groups were pelvic inflammatory disease (PID) (average annual rate 49.3, 95% confidence interval [CI] 43.6-55.0), benign cysts of the ovary (average annual rate 32.7, 95% CI 28.8-36.6), endometriosis (average annual rate 32.4, 95% CI 28.5-36.3), menstrual disorders (average annual rate 31.4, 95% CI 27.6-35.2), and uterine leiomyomas (average annual rate 30.4, 95% CI 26.7-34.1). The highest rates for PID were among women 25-39 years old and for women of races other than white. Highest rates for uterine leiomyomas were among women 40-44 years old and for women of races other than white. Highest rates for endometriosis were among women 40-44 years old and white women. Racial difference existed among all ages in the uterine leiomyoma and endometriosis groups. Average annual rates of benign cysts and menstrual disorders increased with age, but there were no statistically significant differences according to race in these two diagnostic groups. CONCLUSIONS: Our findings confirmed the importance of PID as a common cause of hospitalization among reproductive-age women and identified additional gynecologic conditions as causes for hospitalization as well. We found significant age and racial differences not only among women with discharge diagnoses of PID but also among those with discharge diagnoses of uterine leiomyomas and endometriosis.
Adolescent↗
The effectiveness of hysterectomy for chronic pelvic pain.
OBJECTIVE: To evaluate the effectiveness of hysterectomy in treating chronic pelvic pain, and to identify risk factors for persistent pelvic pain. METHODS: A group of 308 women who had hysterectomy for chronic pelvic pain of at least 6 months' duration was followed-up for 1 year after surgery, as part of a large, prospective, multicenter cohort study. Persistent pain was defined as a trichotomous variable, and ordinal logistic regression was used to identify independent predictors of the trichotomous outcome. RESULTS: Overall, 74% of women experienced complete resolution of pelvic pain, 21% reported continued but decreased pain, and 5% reported either unchanged or increased pain after hysterectomy. In unadjusted analyses, women at increased risk for persistent pain (eg, continued but decreased, and unchanged or increased) included those who were under age 30 (36 versus 22%, P < .05), had a history of pelvic inflammatory disease (41 versus 25%, P < .05), were uninsured or covered under Medicaid (41 versus 22%, P < .001), had no identified pelvic pathology (38 versus 23%, P < .05), or had a history of at least two pregnancies (31, 27, and 15% for those with at least four, two or three, and one or none, respectively; P < .05). After adjustment, an increased probability of persistent pain was observed among women who had no identified pelvic pathology (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.0-3.6), were uninsured or covered under Medicaid (OR 2.3, 95% CI 1.2-4.3), or had experienced at least two pregnancies (OR 2.3, 95% CI 1.0-5.3). CONCLUSION: Most women with chronic pelvic pain have long-term improvement after hysterectomy. However, up to 40% of women in specific subgroups may continue to experience long-term pain.
Adolescent↗
Operative laparoscopy: American Association of Gynecologic Laparoscopists' 1993 membership survey.
The American Association of Gynecologic Laparoscopists' 1993 membership survey on operative laparoscopy had 825 respondents reporting 45,042 procedures. The most frequent indication was pelvic pain (56% of procedures), followed by infertility (38%). There were 7382 laparoscopically assisted hysterectomies reported. Compared with 1988 and 1991 survey data, the rates of unintended laparotomy, hemorrhage, and bowel or urinary tract injury increased, but the overall complication and death rates remained essentially unchanged.
Female↗