PubMed Health⌕ Search

Biomedical subjects

J F Peipert

Publications and source records attributed to J F Peipert.

At least 55 records · Page 3Linked to original sources
PubMed1995

Battering in pregnancy: an assessment of two screening methods.

OBJECTIVE: To compare two different screening techniques for identifying women with a history of domestic violence or battering in the current pregnancy. METHODS: The five-question Abuse Assessment Screen was incorporated into routine social service interviews and applied prospectively to all registrants for routine prenatal care at Women & Infants' Hospital during an initial social service evaluation from September 7 through October 29, 1993. This group (N = 143) was compared to a historical control group of all new registrants from July 12 through September 3, 1993 (N = 191) who had routine interviews by social services. Demographic and medical data were compared, as well as the specific information addressed by the screen, including history of domestic violence, physical or sexual violence within the last year, violence during the current pregnancy, recent sexual abuse, and fear of partner. RESULTS: The median age of the study population was 23 years old, 50% were white, 63% were single, and 42% had no insurance. There was a higher detection of violence in all categories using the Abuse Assessment Screen compared with the standard interview--any history: 41 versus 14% (relative risk [RR] 3.0, 95% confidence interval [CI] 2.0-4.5); recent history: 15 versus 3% (RR 5.6, CI 2.2-14.5); during pregnancy: 10 versus 1% (RR 9.3, CI 2.2-40.5); recent sexual abuse: 4 versus 0% (P = .006); and fear of abuser: 6 versus 3% (RR 1.8, CI 0.6-5.0). CONCLUSION: Use of a structured screen improves detection rates of battering both before and during pregnancy, enabling clinicians to have a greater opportunity to intervene.

Adult↗
PubMed1995

Sample size and statistical power in reproductive research.

The calculation of sample size should be an integral part of the planning stages of all research projects to avoid wasting time, money, and valuable resources. The necessary information for sample size calculations includes the alpha (type I) error level, the beta (type II) error, delta (or the difference you would like to be able to detect), and, for continuous variables, the variance. We review these terms and outline their importance in the calculation of sample size and statistical power. When necessary, the investigator should seek expertise and advice to perform these calculations.

Female↗
PubMed1994

Prognostic value of clinical variables in invasive cervical cancer.

OBJECTIVE: To test the hypothesis that clinical variables, such as patients' symptoms, symptom severity, and co-morbidity, affect the survival rate of patients with invasive cervical cancer. METHODS: From the medical records of 251 cases of invasive cervical cancer treated at Yale-New Haven Hospital between 1984 and 1988, information was extracted for patients' demographic characteristics, symptoms, symptom severity, comorbidity, physical findings, laboratory data, treatment, and subsequent course. RESULTS: Three-year survival data were available for 250 (99%) of the 251 cases. For a composite clinical predictive system based on symptom status and co-morbidity, the 3-year survival rates were as follows: 85% (64 of 75) for the patients who were asymptomatic without co-morbidity; 63% (58 of 92) for the group that was either symptomatic or co-morbid, but not both; and 40% (33 of 83) for symptomatic patients with co-morbidity or patients with systemic, metastatic, or severe symptoms (P < .0001, chi 2 for linear trend). When entered into a Cox proportional hazards model along with other variables that might affect prognosis, including International Federation of Gynecology and Obstetrics stage, the composite symptom-co-morbidity stage remained statistically significant. CONCLUSIONS: Our findings demonstrate the importance of clinical variables, such as symptoms and co-morbidity, in estimating prognosis in cervical cancer, even after stage and other factors are controlled. Unless the clinical variables are suitably analyzed, prognostic estimates based on morphology alone will be imprecise and therapeutic evaluations may be misleading.

Cohort Studies↗
PubMed1994

Epidemiology of adolescent sexual assault.

OBJECTIVE: To describe the epidemiology of sexual assault in adolescents and to compare this group with sexual assault victims over 20 years of age. METHODS: Charts were reviewed of 405 women presenting for sexual assault evaluation between January 1, 1990 and December 31, 1993, and demographic, historical, and laboratory data were extracted. RESULTS: The median age of the study population was 21 years. Adolescent victims (less than 20 years old, N = 178) were more likely to be assaulted by an acquaintance or relative (77 versus 56%; P < .0001) and to delay medical evaluation (11 versus 7 hours; P < .02) than were women 20 years of age and older (N = 227). CONCLUSIONS: The epidemiology of sexual assault in adolescents is unique and poses special challenges to the health care provider and the sexual assault evaluation team. Clinicians evaluating adolescents should be familiar with the epidemiology of sexual assault in this age group and the widespread problem of acquaintance rape. Adolescents should be offered preventive strategies to help them avoid future violence in dating relationships and the sequelae of sexual assault, such as unwanted pregnancy and sexually transmitted diseases.

Adolescent↗
PubMed1994

Cytologic-histologic discrepancy in human immunodeficiency virus-positive women referred to a colposcopy clinic.

OBJECTIVE: To evaluate the rate of discrepancy between cytology and histology in a referral-based population of human immunodeficiency virus (HIV)-positive women compared to HIV-negative women and women whose HIV status was unknown. METHODS: From January 1, 1990 to December 31, 1993, approximately 830 women underwent evaluation at Women and Infants' Hospital colposcopy clinic. Women who had histologic diagnosis and recent cytologic evaluation during this interval (N = 678) were selected for study. Forty-one HIV-positive women were compared to 228 HIV-negative women and 409 women whose HIV status was unknown. RESULTS: Of the 41 HIV-positive women, seven (17%) were noted to have a discrepancy between cytologic and histologic findings. In HIV-negative and HIV-unknown women, 15% (34 of 228) and 22% (91 of 409) were discrepant, respectively. Using HIV-negative women as the reference group, the relative risk of cytologic-histologic discrepancy was 1.1 (95% confidence interval [CI] 0.51-2.41) for HIV-positive women and 1.5 (95% CI 1.04-2.14) for women whose HIV status was unknown. CONCLUSION: Human immunodeficiency virus-positive women referred for colposcopic evaluation have no more cytologic-histologic discrepancy than HIV-negative women or women whose HIV status is unknown.

Cervix Uteri↗
PubMed1994

The case-control study: a primer for the obstetrician-gynecologist.

Case-control studies begin at the end. Two groups of patients, those with disease (cases) and those without (controls), are compared to determine the degree of exposure to a presumed risk factor. This research method is commonly used to study rare diseases or diseases that take years to develop. If a higher proportion of cases than controls has the exposure of interest, the exposure may be associated with illness. The strength of this association is measured by an "odds ratio," which is a good proxy for a relative risk when the illness in question is infrequent. Although some case-control studies are easy to do, all are easy to do poorly, especially because of selection bias in the choice of controls. A greater familiarity with the case-control study should enable obstetrician-gynecologists to evaluate critically published studies using this research method.

Case-Control Studies↗
PubMed1993

The impact of symptoms and comorbidity on prognosis in stage IB cervical cancer.

OBJECTIVE: Like other gynecologic malignancies, cervical cancer is classified by the anatomic location and extent of the tumor. Because clinical variables such as patients' symptoms, symptom severity, and comorbidity may indicate a cancer's biologic virulence and the host-tumor interaction, this study was performed to test the hypothesis that clinical variables will also affect survival of patients with stage IB cervical cancer. STUDY DESIGN: From medical records of 251 cases of invasive cervical cancer treated at Yale-New Haven Hospital between 1984 and 1988, information was extracted for patients' demographic characteristics, symptoms, symptom severity, comorbidity, physical findings, laboratory data, treatment, and subsequent course. RESULTS: In the 122 available cases of stage IB cervical cancer the overall 3-year survival rate was 79%. For a composite clinical predictive system on the basis of symptom status and comorbidity, the 3-year survival rates were as follows: symptomatic patients with comorbidity 58% (seven of 12), either symptomatic or comorbid but not both 77% (46/60), and asymptomatic patients without comorbidity 86% (43/50) (p = 0.02 for linear trend chi 2). When entered into a Cox proportional-hazard model along with other variables that might have an impact on prognosis, the composite symptom-comorbidity stage was the only variable that remained statistically significant. CONCLUSION: These findings demonstrate the importance of clinical variables in estimating prognosis in stage IB cervical cancer. Unless these variables are suitably analyzed, prognostic estimates based only on morphologic studies will be imprecise and therapeutic evaluations may be misleading.

Adenocarcinoma↗
PubMed1993

Diagnostic testing in obstetrics and gynecology: a clinician's guide.

As we enter a new era of health care in the United States with limited economic resources, there will be an increasing demand for thoughtful and critical evaluation of the diagnostic tests used in clinical medicine. To interpret the clinical utility of diagnostic tests, the physician must understand the fundamental concepts of sensitivity, specificity, and predictive values. The purpose of this paper is to define these terms, demonstrate the use of receiver operating characteristic curves and Bayes' theorem, and provide clinical examples in obstetrics and gynecology to illustrate their use. Practitioners must be able to interpret the results of diagnostic tests to provide accurate information to their patients.

Bayes Theorem↗
PubMed1993

Maternal age: an independent risk factor for cesarean delivery.

OBJECTIVE: To evaluate whether there is an increased risk of cesarean delivery in women who delay childbearing into their later reproductive years, using a well-defined cohort and controlling for difference in baseline susceptibility such as complications of pregnancy and labor. METHODS: The current study included all women at least 20 years of age delivering their first child and evaluated between 1988-1991 as part of the prospective Yale Health in Pregnancy Study (N = 735). All women planned to deliver at Yale-New Haven Hospital. The study group was divided into three maternal age groups: 20-29 (N = 422), 30-34 (N = 239), and 35 and over (N = 74). Information collected included demographic characteristics, medical history, pregnancy complications, labor complications, mode of delivery, and pregnancy outcome. RESULTS: The cesarean delivery rates for the three age groups were 16.8% (71 of 422), 26.8% (64 of 239), and 32.4% (24 of 74), respectively. This trend was highly significant when evaluated with chi 2 for linear trend (P = .0002). Within groups of women with and without complications of pregnancy or labor, cesarean rates increased with maternal age. Using stepwise logistic regression to adjust simultaneously for confounding variables, adjusted odds ratios were 1.6 (95% confidence interval [CI] 0.9-2.7) for the women aged 30-34 and 2.3 (95% CI 1.1-4.8) for the 35 and older age group. CONCLUSIONS: Maternal age appears to be an independent risk factor for cesarean delivery. The reasons for this clinically important and statistically significant increased risk are unclear, but may be due to physician and patient concern over pregnancy outcome in older women.

Adult↗
PubMed1993

Oral contraceptive risk assessment: a survey of 247 educated women.

OBJECTIVE: To determine womens' beliefs regarding the risks and health benefits of oral contraceptives (OCs). METHODS: Between April 26 and June 7, 1991, 247 women completed a self-administered questionnaire at the Yale University Health Services evaluating their perceptions of the risks and benefits of OC agents. RESULTS: The mean age of the study population was 30.2 years (range 16-68), and more than 90% of the study group had at least 1 year of college education. Forty-nine percent of the study group believed there are substantial risks to OC use. Between 80-95% of women were unaware of the following health benefits of OCs: decreased risks of endometrial cancer, ovarian cancer, pelvic inflammatory disease, ectopic pregnancy, anemia, and benign breast disease. CONCLUSIONS: Perceptions of the risks of OCs are exaggerated and there is a clear knowledge deficit with regard to their health benefits. Increased educational efforts by health care providers should emphasize the health benefits of OCs and attempt to dispel the common misconceptions.

Adolescent↗
PubMed1992

Mullerian adenosarcoma of the uterus with sarcomatous overgrowth.

A case of mullerian adenosarcoma of the uterus with sarcomatous overgrowth is described. The patient was also found to have bilateral polycystic ovaries. This 25 year-old white female presented with irregular vaginal bleeding and was diagnosed as having mullerian adenosarcoma with sarcomatous overgrowth by dilatation, curettage, and biopsy. Total abdominal hysterectomy, bilateral salpingo-oophorectomy with lymph node sampling were performed.

Adult↗
PubMed1992

Nonimmune hydrops fetalis and fetal congenital syphilis. A case report.

Nonimmune hydrops fetalis occurred secondary to a syphilitic infection. Ultrasonographic evaluation and cordocentesis were used to confirm the antenatal infection. An IgM antibody specific for Treponema pallidum wall antigen (anti-47-kDa) was used to document the fetal infection. High-dose intravenous penicillin was administered in an attempt to achieve adequate fetal levels.

Adolescent↗
PubMed1991

Oligohydramnios: a review.

Oligohydramnios is a relatively common complication of pregnancy. Etiologies include congenital anomalies, intrauterine growth retardation, premature rupture of the membranes, drugs, postterm gestation and postmaturity. Sequelae from prolonged oligohydramnios including pulmonary hypoplasia and fetal compression syndrome can be devastating. Perinatal morbidity and mortality are both significantly increased in pregnancies complicated by oligohydramnios. Successful management requires a thorough search for the cause of the decreased amniotic fluid volume, and close antenatal surveillance.

Female↗
PubMedDate not supplied

Ambulatory gynecology.

Explore the source record for details and available documents.

Ambulatory Care↗
PubMedDate not supplied

Fatal spontaneous rupture of a gravid uterus: case report and literature review of uterine rupture.

Spontaneous uterine rupture is a life-threatening obstetrical emergency encountered infrequently in the emergency department. The diagnosis of spontaneous uterine rupture is often missed or delayed, leading to maternal and fetal mortality. Emergency physicians must consider this diagnosis when presented with a pregnant patient in shock with abdominal pain. We present the case of a 38-year-old gravid female who presented to the emergency department in cardiac arrest 24 hours after an initial complaint of abdominal pain. We review the uterine rupture literature with specific focus on risk factors, signs and symptoms, diagnosis, treatment, and outcome.

Adult↗