PubMed Health⌕ Search

Biomedical subjects

Jeffrey F Peipert

Publications and source records attributed to Jeffrey F Peipert.

At least 19 recordsLinked to original sources
PubMed2007

Prevalence of bacterial vaginosis: 2001-2004 National Health and Nutrition Examination Survey data.

OBJECTIVE: To estimate the prevalence and correlates of bacterial vaginosis among women between the ages of 14 and 49 years in the United States. METHODS: Data from the 2001-2001 and 2003-2004 National Health and Nutrition Examination Surveys were combined. Correlates of bacterial vaginosis evaluated included sociodemographic characteristics (age, race or ethnicity, education, poverty income ratio) and sexual history (age of first intercourse, number of sexual partners). Crude and adjusted odds ratios and 95% confidence intervals were estimated from logistic regression analyses. RESULTS: Almost one third of women (29%) were positive for bacterial vaginosis. Bacterial vaginosis prevalence varied with age, race or ethnicity, education, and poverty. Black, non-Hispanic (odds ratio [OR] 3.13, 95% confidence interval [CI] 2.58-3.80) and Mexican-American (OR 1.29, 95% CI 0.99-1.69) women had higher odds of bacterial vaginosis than white, non-Hispanic women after adjustment for other sociodemographic characteristics. Douching in the past 6 months was also an important predictor of bacterial vaginosis prevalence (OR 1.93, 95% CI 1.54-2.40). CONCLUSION: Bacterial vaginosis is a common condition among U.S. women, and the prevalence is similar to that in many treatment-seeking populations. Further studies are needed to disentangle the interactions between race or ethnicity and other sociodemographic characteristics. LEVEL OF EVIDENCE: III.

Adolescent↗
PubMed2006

Is vaginal birth after cesarean (VBAC) or elective repeat cesarean safer in women with a prior vaginal delivery?

OBJECTIVE: This study was undertaken to determine whether vaginal birth after cesarean (VBAC) or elective repeat cesarean delivery is safer overall for a woman with a prior vaginal delivery. STUDY DESIGN: This retrospective cohort study of pregnant women from 1996 to 2000 who had a prior cesarean delivery, was conducted in 17 centers. Trained nurses extracted historical and maternal outcome data on subjects by using standardized tools. This planned secondary analysis examined the subcohort that had also previously undergone a vaginal delivery, comparing those who underwent a VBAC trial with those who elected to have a repeat cesarean delivery. Outcomes included uterine rupture, bladder injury, fever, transfusion and a composite (uterine rupture, bladder injury, and artery laceration). We performed bivariate and multivariable analyses. RESULTS: Of 6619 patients with a prior cesarean delivery who had also had a prior vaginal delivery, 5041 patients attempted a VBAC delivery and 1578 had an elective cesarean delivery. Although there was no significant difference in uterine rupture or bladder injury between the two groups, women who underwent a VBAC attempt were less likely to experience the composite adverse maternal outcome, have a fever, or require a transfusion. CONCLUSION: Among VBAC candidates who have had a prior vaginal delivery, those who attempt a VBAC trial have decreased risk for overall major maternal morbidities, as well as maternal fever and transfusion requirement compared with women who elect repeat cesarean delivery. Physicians should make this more favorable benefit-risk ratio explicit when counseling this patient subpopulation on a trial of labor.

Adult↗
PubMed2006

Safety and success of vaginal birth after cesarean delivery in patients with preeclampsia.

The objective of this study was to determine if preeclampsia (PRE) or gestational hypertension (GH) affects the rate of success of vaginal birth after cesarean delivery (VBAC), VBAC-related complications, or patient election to attempt VBAC. We performed a retrospective cohort study of all women who were offered VBAC from 1996 to 2000 in 17 community and university hospitals. Demographic, medical, and obstetric history, complications, treatment, and index pregnancy outcome information was collected on all patients in the database. Bivariate analysis and multivariable logistic regression were used to assess the independent association between GH and PRE and the rate of success of VBAC, VBAC-related complications, or patient election to attempt VBAC. A total of 25,005 patients were registered in the database. 13,706 (54.81%) attempted VBAC and 11,299 (45.19%) elected repeat cesarean delivery. After adjusting for confounding variables using multivariable logistic regression, patients with PRE were more likely to fail VBAC (relative risk [RR], 1.56; 95% CI, 1.22 to 2.00). Patients with GH were less likely to attempt VBAC (RR, 0.39; 95% CI, 0.34 to 0.46). A total of 304 (1.46%) patients had a uterine rupture. The VBAC group had a rupture rate of 0.93% and the elective cesarean group had a rupture rate of 0.04%. There was no difference in uterine rupture rates between the cohorts. Patients with gestational hypertension were less likely to attempt a VBAC. Patients with PRE, if they attempted a VBAC trial, had a higher VBAC failure rate. Patients with PRE or GH do not have increased uterine rupture rates. These findings can be used to improve mode of delivery counseling for VBAC candidate patients with preeclampsia.

Adult↗
PubMed2006

Unplanned pregnancy: does past experience influence the use of a contraceptive method?

OBJECTIVE: To investigate whether women between the ages of 14 and 25 years with a past unplanned pregnancy were more likely to use a contraceptive method compared with women without a history of unplanned pregnancy. METHODS: We analyzed baseline data of 424 nonpregnant women between the ages of 14 and 25 years enrolled in a randomized trial to prevent sexually transmitted diseases and unplanned pregnancy (Project PROTECT). Women at high risk for sexually transmitted diseases or unplanned pregnancy were included. Participants completed a demographic, substance use, and reproductive health questionnaire. We compared women with and without a history of unplanned pregnancy using bivariate analysis and log binomial regression. RESULTS: The prevalence of past unplanned pregnancy in this sample was 43%. Women reporting an unplanned pregnancy were older, and had less education, and were more likely to be nonwhite race or ethnicity. History of an unplanned pregnancy was not associated with usage of a contraceptive method (relative risk 1.01, 95% confidence interval 0.87-1.16) in bivariate analysis or when potential confounders were accounted for in the analysis (adjusted relative risk 1.10, 95% confidence interval 0.95-1.28). CONCLUSION: Several factors were associated with both unplanned pregnancy and overall contraceptive method use in this population. However, a past unplanned pregnancy was not associated with overall contraceptive method usage. Future studies are necessary to investigate the complex relationship between unplanned pregnancy and contraceptive method use. LEVEL OF EVIDENCE: II-2.

Adolescent↗
PubMed2006

Factors associated with increased charges for hysterectomy.

OBJECTIVE: To evaluate factors associated with increased hospital charges for hysterectomy with specific attention to differences based on surgical approach. METHODS: We performed a retrospective cohort study of 686 patients who underwent hysterectomy between January 1997 and September 1997 using medical chart review and hospital financial information. Demographic information, surgical approach (abdominal, vaginal, or laparoscopic), and surgical and postoperative factors were extracted from the medical record. Hospital charges were obtained from the hospital billing database. Relationships between charges and various clinical and demographic variables were examined using chi(2), Fisher exact test, t tests, or analysis of variance, where appropriate. Logistic regression was used to estimate odds ratios while controlling for important confounding variables. RESULTS: In our logistic regression model, blood loss greater than 1,000 mL (odds ratio [OR] 11.8, 95% confidence interval [CI] 4.2-33.2) and operative time 105 minutes or more (OR 14.2, CI 5.8-34.5) were strongly associated with higher charges for hysterectomy. Other factors associated with higher charges included: postoperative fever (OR 2.2, CI 1.1-4.5), increasing length of hospitalization (OR 5.3, CI 3.7-7.7), the use of prophylactic antibiotics (OR 3.0, CI 1.3-6.6), and the laparoscopic surgical approach compared with vaginal hysterectomy (OR 2.7, CI 1.0-7.0). CONCLUSION: Surgical factors such as operative time and blood loss were strongly associated with increased hospital charges for hysterectomy.

Adult↗
PubMed2006

Pelvic inflammatory disease in adolescents.

PURPOSE OF REVIEW: We discuss the epidemiology, risk factors, microbiology, diagnosis, treatment and prevention of pelvic inflammatory disease in adolescents. RECENT FINDINGS: Young age is one of the most important risk factors for sexually transmitted diseases and pelvic inflammatory disease. Sexually active adolescents have the highest incidence of Chlamydia trachomatis, Neisseria gonorrhoeae, and pelvic inflammatory disease of any sexually active age group. Long-term sequelae of pelvic inflammatory disease include ectopic pregnancy, tubal factor infertility, tubo-ovarian abscesses and chronic pelvic pain. Subclinical pelvic inflammatory disease is responsible for a significant portion of these long-term sequelae. New (2006) Centers for Disease Control and Prevention treatment guidelines for pelvic inflammatory disease are available. One of the best methods of prevention of pelvic inflammatory disease is to screen and treat sexually active adolescents for chlamydial infection. Implementation of nucleic acid amplification assays allows screening of adolescents via self-collected urine or vaginal swab samples. SUMMARY: Pelvic inflammatory disease is a highly preventable source of reproductive morbidity for adolescents. It is prudent that clinicians provide counseling regarding healthy sexual behaviors, STD prevention, and contraception whenever an adolescent presents in need of STD screening or evaluation for pelvic inflammatory disease.

Adolescent↗
PubMed2005

First trimester Down syndrome screening: public health implications.

Down syndrome (DS) screening has been an integral part of routine prenatal screening for the last three decades. Recent efforts have been directed at developing additional non-invasive prenatal screening techniques that could not only improve sensitivity of prenatal screening, but also be employed in the first trimester to offer earlier diagnostic and interventional opportunities. Nuchal translucency has proven to be an effective and cost-effective screening test that, when combined with serum markers (hCG and pregnancy-associated plasma protein [PAPP-A]) in the first and/or second trimester, broadens the diagnostic possibilities and improves the diagnostic capabilities of current prenatal DS screening methods. Despite the potential benefits, significant operational issues regarding access to and availability of such testing may limit its widespread application and necessitates the maintenance of both non-sonographic and second trimester screening methods. The implementation of first trimester DS testing requires the development and maintenance of nationally standardized quality control systems to ensure the reliability of serum and ultrasound measurements and the accurate assessment of risk. Future efforts to improve prenatal screening should continue to emphasize the need for improved access to all aspects of prenatal care, stress the importance of provider education and the necessity for extensive patient counseling, and reinforce the role of patient education and choice.

Chorionic Gonadotropin↗
PubMed2005

Evaluation of clinical methods for diagnosing bacterial vaginosis.

OBJECTIVE: To determine whether the current clinical criteria for diagnosing bacterial vaginosis can be simplified by using 2 clinical criteria rather than the standard 3 of 4 criteria (Amsel's criteria). METHODS: This was a prospective observational study of 269 women undergoing a vaginal examination in the Women's Primary Care Center, Division of Research, or Colposcopy Clinic at Women & Infants Hospital. All 4 clinical criteria for diagnosing bacterial vaginosis were collected, and Gram stain was used as the gold standard. Sensitivity and specificity were calculated for each individual criterion, combinations of criteria, and a colorimetric pH and amine card. Receiver operating characteristic curve was generated to estimate the preferred pH and percentage of clue cells for diagnosing bacterial vaginosis. RESULTS: The prevalence of bacterial vaginosis in our study population was 38.7%. Vaginal pH was the most sensitive of all the criteria, at 89%, and a positive amine odor was the individual criteria with the highest specificity, at 93%. Similar specificity was seen with combinations of 2 criteria and Amsel's criteria. Receiver operating characteristic curve analysis yielded a preferred pH and percentage of clue cells of 5.0 and 20%, respectively. However, a pH of 4.5 or greater improves sensitivity with minimal loss of specificity. CONCLUSION: The clinical criteria for diagnosing bacterial vaginosis can be simplified to 2 clinical criteria without loss of sensitivity and specificity.

Adult↗
PubMed2005

The effect of prematurity on vaginal birth after cesarean delivery: success and maternal morbidity.

OBJECTIVE: We sought to compare vaginal birth after cesarean (VBAC) success and uterine rupture rates between preterm and term gestations in women with a history of one prior cesarean delivery. Our hypothesis was that preterm women undergoing VBAC were more likely to be successful and have a lower rate of complications than term women undergoing VBAC. METHODS: We reviewed medical records of women with a history of a cesarean delivery who either attempted a VBAC or underwent a repeat cesarean delivery from 1995 through 2000 in 17 community and university hospitals. We collected information on demographics, medical and obstetric history, complications, and outcome of the index pregnancy. The primary analysis was limited to women with singleton gestations and one prior cesarean delivery. Statistical analysis consisted of bivariate and multivariable techniques. RESULTS: Among the 20,156 patients with one prior cesarean delivery, 12,463 (61%) attempted a VBAC. Mean gestational ages for the term and preterm women were 39.2 weeks and 33.9 weeks of gestation, respectively. The VBAC success rates for the term and preterm groups were 74% and 82%, respectively (P < .001). Multivariable analysis showed that the VBAC success was higher (adjusted odds ratio 1.54, 95% confidence interval 1.27-1.86) in preterm gestations. A decreased risk of rupture among preterm gestations was suggested in these results (adjusted odds ratio 0.28, 95% confidence interval 0.07-1.17; P = .08). CONCLUSION: Preterm patients undergoing a VBAC have higher success rates when compared with term patients undergoing a VBAC. Preterm patients undergoing VBAC may have lower uterine rupture rates.

Cesarean Section, Repeat↗
PubMed2005

Adnexal masses in pregnancy: surgery compared with observation.

OBJECTIVE: To estimate whether the delay of surgery impacts the risk of adverse maternal and fetal outcomes in patients diagnosed with an adnexal mass during pregnancy. METHODS: A review was performed of pregnant patients diagnosed with an adnexal mass 5 cm or greater in diameter. Data collected included age, gravity/parity, gestational age at diagnosis, and presenting symptoms. Ultrasound examinations were evaluated for mass size and complexity. Pregnancy outcome, complications, and surgical pathology were reviewed. RESULTS: Between 1990 and 2003, 127,177 deliveries were performed at our institution. An adnexal mass 5 cm in diameter or greater was diagnosed in 63 (0.05%) patients. Pathologic diagnosis was available for 59 (94%) patients. The remaining 4 patients were lost to follow-up and excluded from the analysis. Antepartum surgery was performed in 17 patients (29%): 13 because of ultrasound findings that suggested malignancy and 4 secondary to ovarian torsion. The remaining patients were observed, with surgery performed in the postpartum period or at time of cesarean delivery. The majority of masses were dermoid cysts (42%). Four patients were diagnosed with ovarian cancer (6.8% of masses, 0.0032% of deliveries), and one patient (1.7%) had a tumor of low malignant potential. Antepartum surgery due to ultrasound findings that caused concern was performed on all 5 women diagnosed with a malignancy or borderline tumor, compared with 12 (22%) of the patients with benign tumors (P < .01). CONCLUSION: In select cases, close observation is a reasonable alternative to antepartum surgery in patients with an adnexal mass during pregnancy.

Adnexal Diseases↗
PubMed2005

Effectiveness of treatment strategies of some women with pelvic inflammatory disease: a randomized trial.

OBJECTIVE: Among all women with pelvic inflammatory disease (PID), prevention of adverse reproductive consequences appears to be similarly achieved by outpatient treatment and inpatient treatment. We assessed whether outpatient is as effective as inpatient treatment in relevant age, race, and clinical subgroups of women with PID. METHODS: Women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease (n = 831) were randomized into a multicenter trial of inpatient treatment, initially employing intravenous cefoxitin and doxycycline compared with outpatient treatment consisting of a single intramuscular injection of cefoxitin and oral doxycycline. Comparisons between treatment groups during a mean of 84 months of follow-up were made for pregnancies, live births, time to pregnancy, infertility, PID recurrence, chronic pelvic pain, and ectopic pregnancy. RESULTS: Outpatient treatment assignment did not adversely impact the proportion of women having one or more pregnancies, live births, or ectopic pregnancies during follow-up; time to pregnancy; infertility; PID recurrence; or chronic pelvic pain among women of various races; with or without previous PID; with or without baseline Neisseria gonorrhoeae and/or Chlamydia trachomatis infection; and with or without high temperature/white blood cell count/pelvic tenderness score. This was true even in teenagers and women without a previous live birth. Ectopic pregnancies were more common in the outpatient than the inpatient treatment group, but because these were so rare, the difference did not reach statistical significance (5 versus 1, odds ratio 4.91, 95% confidence interval 0.57-42.25). CONCLUSION: Among all women and subgroups of women with mild-to-moderate PID, there were no differences in reproductive outcomes after randomization to inpatient or outpatient treatment. LEVEL OF EVIDENCE: I.

Adult↗
PubMed2005

Research methodology and analytic techniques used in the Journal Obstetrics & Gynecology.

OBJECTIVE: To quantify trends over time in the research methodology and statistical reporting of published articles in the journal Obstetrics & Gynecology between the years 1991 and 2001. METHODS: We reviewed 226 articles reporting original clinical research in Obstetrics & Gynecology, including 75 consecutive articles from 1991 and 1996 and 76 consecutive studies from 2001. Articles were classified by research methodology and level of evidence: I for randomized trials; II for controlled trials and observational, analytic studies; and III for case reports or case series. We also noted whether the investigators reported a research hypothesis, P values, effect sizes, 95% confidence intervals, and sample size/power calculations. We calculated chi2 for linear trend to evaluate changes over this 10-year period. RESULTS: Seventy-four percent of the 226 studies evaluated were level II. The percentage of randomized trials did not increase from 1991 to 2001. However, level II studies increased from 71% in 1991 to 88% in 2001 (P = .01). During the same period, level III studies (case reports and case series) declined from 19% in 1991 to 1% in 2001 (P < .001). We also noted that a clearly stated research hypothesis, effect measures (and respective confidence intervals), and sample size calculations were more common in more recent years. CONCLUSION: In the journal Obstetrics & Gynecology, we noted that observational, analytic studies increased in frequency, anecdotal reports decreased, and statistical reporting has improved. However, there still exists considerable opportunities for improvement.

Clinical Trials as Topic↗
PubMed2005

Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation.

OBJECTIVE: To compare rates of vaginal birth after cesarean (VBAC) failure and major complications in women attempting VBAC before and after the estimated date of delivery (EDD) METHODS: This was a 5-year retrospective cohort study in 17 university and community hospitals of women with at least 1 prior cesarean delivery. Women who attempted VBAC before the EDD were compared with those at or beyond 40 weeks of gestation. Logistic regression analyses were performed to assess the relationship between delivery beyond the EDD and VBAC failure or complication rate. RESULTS: A total of 11,587 women in the cohort attempted VBAC. Women past 40 weeks of gestation were more likely to have a failed VBAC. After controlling for confounders, the increased risk of a failed VBAC beyond 40 weeks remained significant (31.3% compared with 22.2%, odds ratio 1.36, 95% confidence interval 1.24-1.50). The risk of uterine rupture (1.1% compared with 1.0%) or overall morbidity (2.7% compared with 2.1%) was not significantly increased in the women attempting VBAC beyond the EDD. When the cohort was defined as 41 weeks or more of gestation, the risk of a failed VBAC was again significantly increased (35.4% compared with 24.3%, odds ratio 1.35, 95% confidence interval 1.20-1.53), but the risk of uterine rupture or overall morbidity was not increased. CONCLUSION: Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.

Adult↗
PubMed2005

Predictors of chronic pelvic pain in an urban population of women with symptoms and signs of pelvic inflammatory disease.

OBJECTIVE: The objective of this study was to assess the risk profile for chronic pelvic pain (CPP) after pelvic inflammatory disease (PID). STUDY: Multivariate logistic regression was used to assess risk factors for CPP in a longitudinal study of 780 predominately black, urban women with clinically suspected PID: complaints of acute pain (<30 days); a clinical finding of pelvic tenderness; and leukorrhea, mucopurulent cervicitis, or untreated gonococcal or chlamydial cervicitis. CPP was defined as pain reported at >or=2 consecutive interviews conducted every 3 to 4 months for 2 to 5 years. RESULTS: Nonblack race (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.31-3.58), being married (OR, 2.06; 95% CI, 1.02-4.18), a low SF-36 mental health composite score (OR, 2.71; 95% CI, 1.69-4.34), >or=2 prior PID episodes (OR, 2.84; 95% CI, 1.07-7.54), and smoking (OR, 1.65; 95% CI, 1.01-2.71) independently predicted CPP. Histologic endometritis or evidence of endometrial Neisseria gonorrhoeae or Chlamydia trachomatis infection was negatively associated with CPP (OR, 0.69; 95% CI, 0.44-1.10). CONCLUSIONS: A range of demographic, clinical, historical, and behavioral factors predict CPP after PID.

Adolescent↗
PubMed2004

Randomization in controlled clinical trials: why the flip of a coin is so important.

The randomized controlled trial (RCT) is considered the highest level of medical evidence. In this brief overview, we discuss several key principles of the RCT. First, balance is paramount. Comparison groups must have similar proportions of participants with "important" prognostic and confounding factors. Randomization may or may not achieve this balance; if it does not, statistical adjustments should be used. Second, a statistical analysis should emphasize comparability and not mask dissimilarity. If the trial was indeed randomized, certain analysis techniques, such as an intention to treat analysis, should always be presented. Third, additional bias-reducing techniques, such as concealing treatment assignments from treating physicians and participants (i.e., masking) and using clearly defined exclusion and inclusion criteria, should be used wherever possible.

Humans↗
PubMed2004

Risk factors for febrile morbidity after hysterectomy.

OBJECTIVE: To identify risk factors for febrile morbidity after hysterectomy for nonmalignant indications. METHODS: We performed a retrospective cohort study of 686 women who had a hysterectomy between January and September 1997 by abdominal (n = 408), laparoscopic-assisted vaginal (n = 90), or vaginal (n = 188) approaches. Potential risk factors for febrile morbidity were extracted from the medical records. By means of multivariable logistic regression, we evaluated demographic, reproductive, clinical, and operative risk factors for febrile morbidity. RESULTS: The risk of postoperative febrile morbidity in this population was 14%. Only 50% of women received prophylactic antibiotics, whereas almost 20% received no antibiotics at all, and 30% were administered antibiotics after surgical incision. Risk factors for febrile morbidity after hysterectomy, after controlling for age, body mass index, operative time, and prophylactic antibiotic administration, were abdominal approach (odds ratio 2.7; 95% confidence interval 1.6, 4.3) and blood loss at surgery of more than 750 mL (odds ratio 3.5; 95% confidence interval 1.8, 6.8). CONCLUSION: Hysterectomy by abdominal approach and increased blood loss at the time of surgery significantly increase the risk of febrile morbidity. Preventive efforts should focus on methods to reduce postoperative febrile morbidity, including meticulous surgical technique and routine use and appropriate timing of prophylactic antibiotic therapy.

Adult↗
PubMed2004

Condom use and the risk of recurrent pelvic inflammatory disease, chronic pelvic pain, or infertility following an episode of pelvic inflammatory disease.

Among 684 sexually active women with pelvic inflammatory disease (PID) followed up for a mean of 35 months, we related contraceptive use to self-reported PID recurrence, chronic pelvic pain, and infertility. Persistent use of condoms during the study reduced the risk of recurrent PID, chronic pelvic pain, and infertility. Consistent condom use (about 60% of encounters) at baseline also reduced these risks, after adjustment for confounders, by 30% to 60%. Self-reported persistent and consistent condom use was associated with lower rates of PID sequelae.

Adolescent↗