Abdominal fat assessment in postmenopausal women receiving hormone replacement therapy.
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Abdomen↗
Biomedical subjects
J W Gay
Publications and source records attributed to J W Gay.
How to increase referrals.
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Appointments and Schedules↗
Substance abuse during pregnancy in a rural population.
Drug abuse during pregnancy in rural populations has received less attention than that in urban populations. Urban studies have reported alarming rates, but it is unknown whether the situation is the same in rural areas. To investigate this, urine samples were collected anonymously from 181 pregnant women who presented to the University of Missouri clinics for care and who resided in communities of less than 25,000. Each urine specimen was tested for cocaine, marijuana, amphetamines, barbiturates, opiates, phencyclidine, benzodiazepines, ethanol, and nicotine. Of the 181 specimens, 83 (46%) contained nicotine, 17 (9.4%) contained marijuana, and one each (0.6%) tested positive for cocaine, barbiturates, ethanol, and benzodiazepines. No other tested substances were detected. Excluding nicotine and ethanol, 20 (11%) of the urine samples tested positive for the screened substances. Review of the prenatal records revealed that 46% of the women reported using tobacco, 15% reported using alcohol, and 8.3% reported illicit drug use during pregnancy. This study indicates that there is a substantial drug abuse problem in rural populations, and that the profile of abuse differs from that of urban populations. Tobacco, ethanol, and marijuana were the most prevalent substances abused during pregnancy, but cocaine was a minor problem. This information may help in directing resources to reduce drug abuse during pregnancy.
Female↗
Physician peer review: have we gone far enough or too far?
The authors discuss the long history of physician peer review and offer insight on the process, while presenting factors that have lead to increased physician non-peer review. The question at hand--have we gone far enough ... or too far?
Clinical Competence↗
Current techniques of prenatal screening for Down syndrome.
Prenatal testing for Down Syndrome, the most common human malformation, is possible through three techniques: analysis of historical risk factors, ultrasonography, and evaluation of maternal serum alpha-fetoprotein levels. The authors describe these current screening techniques.
Adult↗
Improving perinatal outcome for rural Missouri.
Improving perinatal outcome in rural Missouri as reflected by a lowering of the perinatal mortality rate is a realistic and achievable goal for the state. The authors present information and data with suggestions for reaching this goal.
Female↗
Oral contraceptives and breast cancer.
The possible relationship of oral contraception use to breast cancer is a concern to physicians and their patients. In this article, the authors present a review of the major studies conducted during the last 10 years, from an epidemiologic viewpoint.
Adult↗
Silicone rubber band for laparoscopic tubal sterilization.
In 1974, Yoon and associates (Am J Obstet Gynecol 120:132, 1974) described a new approach in which laparoscopic tubal occlusion was accomplished by utilizing the silicone rubber band technique. Recognizing the great advantages of the new technique in eliminating potential thermal injury associated with electrocoagulation, the authors have utilized the Yoon silicone rubber band technique in these institutions over the past 20 months. Thus far the procedure has been performed in 304 patients without any major complications. In the hope of eliminating and/or reducing possible pregnancy-failure rates, in 110 cases. In addition to application of the silicone band, the tube within the band was transected with non-electrical Seigler biopsy forceps. This, we believe, should provide an interesting long-term comparative study.
Female↗
Does evidence of inflammation on Papanicolaou smears of pregnant women predict preterm labor and delivery?
BACKGROUND: Preterm delivery is the most common cause of neonatal morbidity and mortality in the United States. There is evidence that cervicovaginal infection could predispose to preterm labor. This study explored a possible association of evidence of inflammation on an otherwise normal Papanicolaou smear obtained during pregnancy with subsequent preterm labor and preterm delivery. METHODS: Using a retrospective matched cohort design, we studied women who gave birth to live singleton infants at the University of Missouri Hospital and Clinics during a 21-month period. Papanicolaou smears were obtained from 1 to 8 months before delivery and were interpreted in the same cytopathology laboratory. Data pertaining to outcome variables and potential confounding variables were collected from hospital charts. RESULTS: Incidence rates were 14.4 percent for labor < 37 weeks' gestation (preterm labor), 12.3 percent for hospitalization for preterm labor, 9.9 percent for delivery < 37 weeks (preterm delivery), 2.6 percent for delivery < 34 weeks, and 7.5 percent for birth weight < 2500 g. On univariate and multivariate analyses, there were no significant differences in any outcome between the 293 women with inflammation and the 284 women without inflammation on Papanicolaou smear. Results were unchanged when the analysis was limited to the 412 women who received no antibiotics during pregnancy. Among the 38 women with a history of preterm labor or preterm delivery, those with cervical inflammation had a higher rate of preterm labor than those without inflammation. CONCLUSIONS: In the sample as a whole, there was little evidence that findings of inflammation on Papanicolaou smear constituted a risk factor for preterm labor or preterm delivery. The data suggest that inflammation could be associated with an increased risk in a subgroup of women at higher risk by virtue of their obstetric history.
Adult↗
Cervical inflammation and preterm delivery in pregnant women with a history of preterm delivery.
BACKGROUND: A previous preterm delivery is a risk factor for preterm delivery in a subsequent pregnancy. We tested the hypothesis that evidence of inflammation on a Papanicolaou smear obtained during pregnancy is a risk factor for preterm delivery for women with a history of preterm delivery. METHODS: We studied women who had two singleton deliveries at a university hospital during an 8-year period. Women eligible for our study were those whose first delivery was preterm (< 37 weeks of gestation) and for whom a Papanicolaou smear was obtained during the second pregnancy. These smears were examined for evidence of inflammation by a cytopathologist. Information about the second pregnancy was obtained by chart review. RESULTS: The cytopathologist reviewed Papanicolaou smears from 92 study pregnancies and found evidence of cervical inflammation on 34 smears (37 percent). Preterm delivery ended 24 (26.1 percent) of the second pregnancies. The incidence of preterm delivery in women with inflammation on Papanicolaou smear was 41.2 percent compared with an incidence of 17.2 percent in women without inflammation (relative risk of 2.40 with a 95 percent confidence interval of 1.19 to 4.83). This association remained significant after controlling for potential confounding variables. A stratified analysis found that the association of cervical inflammation with preterm delivery was limited to women who had systemic exposure to an antibiotic during pregnancy. CONCLUSION: Among pregnant women with a history of preterm delivery, evidence of inflammation on Papanicolaou smear was associated with an increased risk of preterm delivery. If replicated in other studies, this finding might have implications for the management of pregnancies in women with a history of preterm delivery.
Adult↗